Sonographic evaluation of normal diaphragmatic thickness and excursion in Malaysia paediatric population: A single-institution cross-sectional study.

INTRODUCTION: Diaphragmatic dysfunction is often underdiagnosed as clinical presentation is non-specific and reference values for normal diaphragmatic excursion are inadequate. The rationale of this study is to provide a normal reference value of diaphragmatic excursion and thickness in Malaysia's paediatric population using M-mode sonography, as no previous local data are available to our knowledge. MATERIALS AND METHODS: A total of 119 healthy infants and children fulfilling our inclusion and exclusion criteria were recruited. They were divided into three groups according to age - 0-2 years old in group 1; 2-6 years old in group 2; 6- 12 years old in group 3. Sonography B-mode was used to assess bilateral diaphragmatic thickness and M-mode to assess diaphragmatic excursion during quiet spontaneous respiration. RESULTS: In our paediatric population, the normal right and left diaphragmatic thickness were 2.0 mm ± 0.5 and 2.0 mm ± 0.5 for group 1; 2.5 mm ± 0.8 and 2.4 mm ± 0.6 for group 2; 2.7 mm ± 0.7 and 2.5 mm ± 0.5 for group 3, respectively. The normal right and left diaphragmatic excursion were 7.7 mm ± 2.5 and 7.3 mm ± 2.6 for group 1; 11.5 mm ± 3.8 and 10.6 mm ± 3.8 for group 2; 13.8 mm ± 3.9 and 12.9 mm ± 3.3 for group 3, respectively (data presented in mean ± standard deviation). There were no significant differences between two genders for each group. Significant positive correlation between age, weight, height, and body surface area with bilateral diaphragmatic thickness and excursion were detected in all studied population. The percentage difference between excursions of both hemidiaphragm was below 40%. CONCLUSIONS: M-mode sonography is the modality of choice for diaphragmatic kinetics especially in paediatric population. This study provides normal sonographic reference value of diaphragmatic excursion and thickness in the Malaysian paediatric population as well as percentile curves for right diaphragmatic excursion plotted against body weight. The availability of this data will aid in the diagnosis of diaphragmatic dysfunction and hence immediate intervention for better recovery.

Sonographic nomogram of paediatric renal size in Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM).

INTRODUCTION: A person's childhood is an important period of growth, and also one's most vulnerable, as one can be exposed to various pathologies, for example those that could affect the growth of one's kidney. Asians are physiologically different from Caucasians, and the nomogram renal size obtained from a Western population (mostly of Caucasians) is not be suitable for representing Asian children. As such a nomogram on paediatric renal size derived from Malaysia is needed. METHODS: A total of 109 (64 males and 45 females) aged 0-12 in Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM) took part in this study. They underwent ultrasonography of both kidneys, and their demographic and anthropometric data were collected. The mean and standard deviations of the renal length and renal volume according to their age groups was calculated, and the final data was compared to the ones reported by Rosenbaum et al. (1984). RESULT: Body weight and Body Surface Area (BSA) of the children reported the strongest correlation with renal size. Significant differences were found between local and the data from Rosenbaum et al (1984). A nomogram on paediatric renal size based on children in PPUKM was then created. DISCUSSION: Ultrasonography is regarded as the standard method for determining renal size. Body weight and BSA were both strongly correlated with renal size. It was shown that the widely used nomograms derived from data obtained from Caucasian was not suitable to represent the population of Malaysian children.

Accuracy of ultrasound versus computed tomography urogram in detecting urinary tract calculi.

AIM: To determine the (i) sensitivity and specificity of ultrasound (USG) in the detection of urinary tract calculi, (ii) size of renal calculi detected on USG, and (iii) size of renal calculi not seen on USG but detected on computed tomography urogram (CTU). METHODS: A total of 201 patients' USG and CTU were compared retrospectively for the presence of calculi. Sensitivity, specificity, accuracy, positive predictive value and negative predictive value of USG were calculated with CTU as the gold standard. RESULTS: From the 201 sets of data collected, 59 calculi were detected on both USG and CTU. The sensitivity and specificity of renal calculi detection on USG were 53% and 85% respectively. The mean size of the renal calculus detected on USG was 7.6 mm ± 4.1 mm and the mean size of the renal calculus not visualised on USG but detected on CTU was 4 mm ± 2.4 mm. The sensitivity and specificity of ureteric calculi detection on USG were 12% and 97% respectively. The sensitivity and specificity of urinary bladder calculi detection on USG were 20% and 100% respectively. CONCLUSION: This study showed that the accuracy of US in detecting renal, ureteric and urinary bladder calculi were 67%, 80% and 98% respectively.

Renal doppler assessment in differentiating obstructive from non-obstructive hydronephrosis in children.

BACKGROUND: to determine the usefulness of Doppler ultrasound measurement of resistive index (RI) in differentiating obstructive from non-obstructive hydronephrosis in children. METHODS: From August 2011 to November 2012, renal Doppler assessments of the intra-renal renal arteries were performed on 16 children (19 kidneys) with congenital hydronephrosis. the independent t-test was used to assess for significant difference in RI values between those with obstructive hydronephrosis (6 kidneys) and those with non-obstructive hydronephrosis (13 kidneys) as determined by dynamic renal scintigraphy. the assessor was blinded to the clinical findings and scintigraphy results. RESULTS: RI was significantly different between obstructive and non-obstructive hydronephrosis. Obstructive hydronephrosis returned higher RI values, with mean RI of 0.78. Mean RI in non-obstructive hydronephrosis was 0.70, and the difference was significant (p <0.05). the sensitivity and specificity of Doppler ultrasound were 100% and 53% respectively. CONCLUSION: Doppler ultrasound measurement of resistive index is useful in differentiating obstructive from nonobstructive hydronephrosis and provides an alternative non-ionizing investigation.