Intravenous pyelography in children with urinary tract infection and vesicoureteral reflux.

In a previous study of the radiologic evaluation of children with urinary tract infection it was recommended that IVP be performed in all patients with either abnormal ultrasonographic or voiding cystourethrographic findings. However, the benefit from IVP was believed to be questionable in children with normal ultrasonography findings and vesicoureteral reflux of only a low grade (I or II of V). To gain a better understanding of the need for IVP in the radiologic evaluation of such children, the database was expanded and the findings concerning ultrasonography and IVP were analyzed in 52 children with urinary tract infection and vesicoureteral reflux seen during the last 3 years. Of a total of 72 instances of reflux, 44 (61.1%) were of low grade (I or II), 14 of medium grade (III), and 14 of high grade (IV or V). Of the 44 urinary systems with low-grade reflux, results were as follows: renal ultrasonography appeared normal in 38 and in 34 of these, the IVP also appeared normal; in the other four, only minor and negligible changes were seen with IVP. Surgical intervention was not necessary in any of these 38 urinary systems. In six systems with low-grade vesicoureteral reflux but with abnormal ultrasonography findings, IVP results were also abnormal, and surgery was necessary in two instances. Of the 14 urinary systems with medium-grade reflux, ultrasonography appeared normal in ten but in six of these the IVP appeared abnormal.(ABSTRACT TRUNCATED AT 250 WORDS)

Ultrasonography in the radiologic evaluation of children with urinary tract infection.

A prospective blind study comparing the findings of ultrasonography, intravenous pyelography, and voiding cystourethrography was conducted on 81 patients to examine the place of ultrasonography in the initial radiologic evaluation of children with urinary tract infection. The patients' mean age was 4.8 years; 15 were male. Forty-eight were inpatients (mean age, 3.2 years) and 33 were outpatients (mean age 7.2 years). In 29 patients (35.8%) abnormality of the urinary system was detected by one or more of the three imaging procedures; 21 were inpatients and eight were outpatients. The most frequent finding was vesicoureteral reflux, occurring in 62.1% of the pathologic cases. The findings at ultrasonography correlated well with those of intravenous pyelography in 73 of the 81 studies (90.1%), but they failed to demonstrate double collecting systems and several of the minor changes. However, ultrasonography in combination with cystourethrography identified all patients who had abnormal urinary systems, except for two children with negligible findings. Moreover, ultrasonography and cystourethrography together identified all 11 patients, nine of them inpatients, in whom surgical treatment was indicated. It is concluded that ultrasonography can successfully replace intravenous pyelography as a screening imaging procedure for the urinary system, but because of the superiority of intravenous pyelography in the detection of some types of lesions, intravenous pyelography will be required whenever ultrasonography or cystourethrography results are abnormal.(ABSTRACT TRUNCATED AT 250 WORDS)

Immotile cilia syndrome including polysplenia, situs inversus, and extrahepatic biliary atresia.

Here we report on 2 sibs with immotile cilia syndrome (ICS), born to consanguineous Arab parents. Both had the Kartagener triad. In addition, one sib had polysplenia and extrahepatic biliary atresia. This observation, together with other literature reports, suggests that the occurrence of ICS with polysplenia and extrahepatic biliary atresia represent the result of a single dysmorphogenetic process. It is concluded that polysplenia and extrahepatic biliary atresia are rare and unusual manifestations of ICS.

The hypothyroidism in an inbred kindred with congenital thyroid hormone and glucocorticoid deficiency is due to a mutation producing a truncated thyrotropin receptor.

Growth and function of the thyroid and adrenal glands are maintained and controlled by thyrotropin (TSH) and adrenocorticotrophic hormone (ACTH), respectively. The action of these trophic hormones requires the presence of functional TSH and ACTH receptors. We describe a large inbred Bedouin kindred in which profound congenital hypothyroidism and hypoadrenocortisolism occurred alone or together in eight family members belonging to four nuclear families. The high serum TSH and ACTH levels in the presence of normal or hypoplastic thyroid glands and low glucocorticoid, but not mineralocorticoid concentrations, are characteristic of resistance to TSH and ACTH. Linkage analysis, using specific polymorphic markers, excluded the involvement of the ACTH receptor but not thyrotropin receptor (TSHR). A novel point mutation was identified in exon 10 of the TSHR that replaces the normal cytosine in nucleotide 2024 with a thymidine. As a result the normal arginine in codon 609 (CGA) is replaced with a stop codon (TGA). This mutation produces a truncated TSHR lacking the third intracellular and extracellular loops, the sixth and seventh transmembrane segments, and the intracytoplasmic tail. The presence of hypothyroidism did not affect the timing, severity, and manner of clinical manifestation of hypoadrenocortisolism.

Application of a bedside whole blood D-dimer assay in the diagnosis of deep vein thrombosis.

Cross-linked fibrin degradation products have been used to detect venous thrombosis. While the sensitivity of plasma D-dimer measured by ELISA in the diagnosis of deep vein thrombosis (DVT) is high, the utility of ELISA methods is limited in a clinical setting. This study analysed the diagnostic value of a rapid D-dimer assay performed on whole blood samples (SimpliRed D-dimer) compared with latex and ELISA in 86 patients suspected of having DVT. SimpliRed D-dimer was positive in 47/50 of patients with DVT established by Doppler ultrasound (DU; sensitivity 94%). SimpliRed D-dimer was positive in 35/37 of patients with proximal DVT, nine out of nine with popliteal DVT and three out of four with superficial thrombophlebitis. The specificity of SimpliRed D-dimer in the diagnosis of DVT was 61%. The sensitivity of the SimpliRed D-dimer assay was at least comparable with the ELISA (87%) and superior to the latex assay (80%). The positive predictive value (77%), the negative predictive value (88%) and the overall accuracy (80%) of the SimpliRed assay were better than the ELISA and latex methods. It is concluded that SimpliRed D-dimer is a rapid useful assay for screening of patients suspected of having deep vein thrombosis.

Late changes in veins after deep venous thrombosis: ultrasonographic findings.

In a prospective trial, 43 patients (45 legs) were re-examined by high resolution and continuous-wave Doppler ultrasonography 3-32 months after an acute episode of deep venous thrombosis (DVT). The veins were abnormal in 31 legs (69%). Abnormal veins were either narrowed with a highly echogenic lumen (thought to represent persistent occlusion) or with a relatively sonolucent lumen and thickened walls (thought to represent recanalized veins). Collateral veins were present. Some compression by probe could be achieved in partially occluded veins, but full collapsibility was absent. Continuous-wave Doppler studies were similar to those in acute DVT. In order to be able to diagnose new episodes of DVT in patients who have had DVT in the past, a baseline ultrasound study should be carried out approximately 6-12 months after an acute episode. In the absence of such a baseline study, contrast phlebography should be resorted to.

High-resolution real-time ultrasonography in the diagnosis of deep vein thrombosis.

The contribution of high-resolution real-time ultrasonography to the diagnosis of deep vein thrombosis (DVT) was evaluated in a prospective study performed on 96 patients. 45 patients were also examined with contrast venography and 79 with continuous wave Doppler ultrasound. The femoral and popliteal veins were examined for compressibility by pressure with the transducer probe, response to deep inspiration and Valsalva's manoeuvre and presence of an intraluminal mass. The contralateral veins were routinely screened for comparison. The diagnostic sensitivity versus phlebography was 87%, and the specificity 100% for the femoral vein. When including the popliteal vein the specificity was 91%. Real-time ultrasonography together with Doppler ultrasound examination is an effective non-invasive approach for the diagnosis of DVT. Phlebography can be avoided if these two examinations are unequivocally positive or negative for DVT.

Fibromatosis (desmoid tumor) following radiation therapy for Hodgkin's disease.

Fibromatosis (desmoid tumor) can sometimes develop at sites of previous surgery or previous trauma, but it is very rarely detected at sites of prior irradiation. We report two cases of fibromatosis following radiotherapy for Hodgkin's disease. The fibromatoses, developing in the radiation fields, were detected at the posterior area of the neck 11 years after irradiation in one case and in the peritoneal cavity 3 years after laparotomy and irradiation in the second case. The tumors did not differ clinically or histologically from those seen in patients who did not undergo irradiation. Although rare, fibromatosis should enter the differential diagnosis of masses developing in irradiated fields in patients with treated Hodgkin's disease.

[Ultrasonographic diagnosis of deep vein thrombosis of the leg].

142 patients with the clinical diagnosis of deep vein thrombosis (DVT) of the legs were examined by high resolution ultrasound. The deep and superficial femoral and popliteal veins were examined with 6.5 and 10 MHz transducers. 124 of the patients were also examined with continuous wave Doppler ultrasound and in 46 contrast phlebography was performed. The overall accuracy of ultrasound compared to phlebography was 90%. If only the deep femoral vein was considered, ultrasound and phlebography correlated in 100%. The ultrasonographic characteristics of DVT are increased echogenicity of the involved vein, absence of response to the Valsalva maneuver and non-collapsibility of the thrombosed vein on pressing with the transducer probe. High resolution ultrasonography should be the primary tool for the diagnosis of DVT.

Exercise improved semen quality and reproductive hormone levels in sedentary obese adults / Mejora de calidad seminal y perfil hormonal en adultos obesos sedentarios mediante ejercicio

Introduction: From the previously published literature on the relationship between obesity and infertility, it is clear that male obesity negatively impacts semen quality. Accordingly, this study was conducted to determine whether regular exercise may improve semen quality in sedentary obese adults. Material and methods: Ninety obese adults were randomly allocated to the intervention (n = 45) or control group (n = 45). Participants in the intervention group performed a 16-week aerobic training program in a treadmill, three sessions per week, consisting of a warm-up (10-15 minutes), 35-50 minutes treadmill exercise (increasing five minutes per four weeks) at a work intensity of 50-65% of peak heart rate (increasing a 5% per four weeks) and cooling-down (5-10 minutes). Semen quality assessment included semen volume, sperm concentration and the percentages of progressive motility and normal morphology. Serum levels of follicle-stimulating hormone (FSH), luteinizing hormone (LH), testosterone and estradiol were determined by ELISA. Body composition and physical fitness were also assessed. Results: After the completion of the training program, sperm count, motility and normal morphology were significantly increased. A second key finding was that exercise improved reproductive hormone levels by increasing serum testosterone. Lastly, significant correlations were found between seminal outcomes and abdominal obesity. Conclusion: A short-term intervention program based on aerobic training improved semen quality in sedentary obese adults. This finding may be explained, at least in part, by an improvement of the reproductive hormone profile (AU)

Introducción: cada vez existe un mayor nivel de evidencia sobre el impacto negativo de la obesidad en la calidad seminal. Sin embargo, la utilidad del ejercicio en este grupo de pacientes ha recibido escasa atención. El presente estudio pretende determinar la influencia de un programa de entrenamiento aeróbico en la calidad seminal de adultos obesos. Material y métodos: noventa adultos varones se asignaron aleatoriamente al grupo experimental (n = 45) o control (n = 45). El grupo experimental desarrolló un programa de entrenamiento aeróbico en tapiz rodante de 16 semanas con tres sesiones/semana. Cada sesión se estructuró en calentamiento (10-15 minutos), 35-50 minutos en tapiz rodante (incrementando cinco minutos/cuatro semanas) a una intensidad del 50-65% de su frecuencia cardiaca máxima (incrementando 5%/cuatro semanas) y vuelta a la calma (5-10 minutos). La calidad seminal se evaluó mediante determinación de volumen seminal, concentración espermática, así como porcentajes de motilidad y morfología normal según criterios de la Organización Mundial de la Salud (OMS). Los niveles séricos de las hormonas folículo estimulante (FSH), luteinizante (LH) y testosterona se determinaron mediante ELISA. También se evaluó la composición corporal y condición física de los participantes. Resultados: tras finalizar el entrenamiento, la concentración, la motilidad y la normal morfología se incrementaron significativamente. Asimismo, se observó una mejoría de los niveles de testosterona. Finalmente, se observaron correlaciones estadísticamente significativas entre parámetros seminales y marcadores de masa grasa abdominal. Conclusión: el ejercicio aeróbico mejoró la calidad seminal de adultos obesos sedentarios. Estos resultados podrían explicarse, al menos en parte, por la mejora del perfil hormonal de los participantes (AU)

Percutaneous kidney needle biopsy in children is less traumatic than in adults.

Hemorrhagic complications following percutaneous kidney needle biopsy were prospectively assessed in 20 children and adolescents (age 2-17 years) undergoing a total of 22 biopsies. Macroscopic hematuria was observed in 1 case and hematocrit reduction of more than 3% in 2. Gray-scale ultrasonography performed in all patients 48 h after the biopsy detected peri- and intrarenal hematomas in 2 cases. Based on these data and those from another study on children, comparison to three similar studies in adults showed a 9.3% mean incidence of macroscopic hematuria in children versus 36.2% in adults (p less than 0.01), a 9.1 versus 31.3% mean incidence of hematocrit reduction of more than 3% (p less than 0.05), and a mean incidence of only 10.9% in children versus 65.6% in adults of radiologically detected peri- and intrarenal hematomas (p less than 0.001). We conclude that percutaneous kidney needle biopsy in children is less traumatic than in adults. Hence when relating to hemorrhagic complications of the procedure, the two populations have to be addressed separately.

Idiopathic cricopharyngeal achalasia.

Two neonates with cricopharyngeal achalasia are presented. In one of them myotomy of the cricopharyngeus relieved the obstruction. In the other baby, the symptoms disappeared without surgical treatment.

Image-directed Doppler ultrasound in the diagnosis of lower-limb venous insufficiency.

Ninety-eight legs in 73 patients were evaluated with image-directed Doppler ultrasound for suspected chronic venous insufficiency. Examinations of the entire venous system were performed to determine lumen patency and valvular competence. Reflux during Valsalva maneuver in the femoral and great saphenous vein, and, after release of distal compression in the popliteal vein, indicated valvular incompetence. Twenty limbs had normal veins; Baker's cysts were found in three. Superficial venous insufficiency was found in 25 cases. Deep reflux, either alone or in combination with superficial reflux, was the predominant pathological feature (53 legs). Photoplethysmographic studies of the veins were performed on 24 limbs. Image-directed Doppler ultrasound was more successful in defining the exact site of venous incompetence and in detecting nonvenous pathology. By the combination of real-time imaging of the vein with gated Doppler sonography of flow, image-directed Doppler sonography is becoming the method of choice for the investigation of chronic venous insufficiency.

Thickness of the gallbladder wall in patients with hypoalbuminemia: a sonographic study of patients on peritoneal dialysis.

Thickening of the gallbladder wall in patients with ascites has been attributed not to the presence of ascites but to the associated hypoalbuminemia. The contribution of hypoalbuminemia was examined by sonographically measuring the thickness of the gallbladder wall in 12 patients with chronic renal failure who were on peritoneal dialysis. All patients had hypoalbuminemia, with serum albumin levels of 2.2-3.3 g/dl (normal range, 3.5-5.0 g/dl). In all patients, the thickness of the gallbladder wall was within the normal range of less than 3 mm. In the patients studied, hypoalbuminemia was not a cause of thickening of the gallbladder wall even when peritoneal fluid was present.

False uroradiologic pathology in children with urinary tract infection and fecal impaction.

Intravenous pyelography (IVP) in 5 children with urinary tract infection detected various uroradiologic abnormalities. Despite the lack of history of constipation, a common denominator to all 5 patients was the finding of fecal impaction in the rectosigmoid. In the first 3 patients, repeated complete IVP series done several weeks later and after preparatory bowel enema were normal. In the last 2 patients, the radiologic investigation was interrupted when the first exposure disclosed uroradiologic abnormalities and fecal impaction. Following immediate bowel enema, the studies were completed on the same settings to be found normal. It is concluded that in the face of fecal impaction, pathologic uroradiologic findings should be interpreted with great caution. Moreover, in such cases, intraprocedure cleansing enema is feasible and recommended.

High-resolution real-time ultrasonography. Diagnosis and follow-up of jugular and subclavian vein thrombosis.

Thrombosis of the internal jugular and subclavian veins was demonstrated by high-resolution real-time ultrasonography in eight patients. The sonographic findings were an intraluminal mass of low or mild amplitude echoes, loss of respiratory rhythmicity and venous pulsation, absence of vein response to respiratory maneuvers (Valsalva and sniff test) and incompressibility of the thrombotic jugular vein. Follow-up examinations after anticoagulant and local streptokinase therapy allowed monitoring of the treatment. High-resolution ultrasonography is a useful noninvasive technique for the diagnosis and follow-up of therapy in thrombosis of the jugular and subclavian veins.

The use of ultrasound scanning in the management of developmental disorders of the hip.

Ultrasound was used, together with clinical examination, to help in the diagnosis and to evaluate the treatment of 48 babies with congenital disorders of the hip. The femoral head, and its relation to the acetabulum, can be demonstrated before it becomes visible on radiographs. Ionising radiation is avoided. Ultrasound scanning can be used to visualise the repositioning of the femoral head. It is also possible to examine babies on an abduction frame.

Ultrasonographic detection of plastic materials in various organs of the human body.

The ultrasonographic appearance of different plastic catheters, tubes, and prostheses used in medical practice were tested in vivo and in vitro. According to the direction of the sound beam, the different plastic catheters and tubes appeared as parallel echogenic lines if scanned longitudinally, or as echogenic dots if scanned transversely. The exact position of the tip of the catheter and its relationship to neighboring organs can be established by ultrasonography. Repositioning of tubes, if necessary, can be done under ultrasonographic guidance. The flexibility and mobility of modern ultrasound scanners allows one to examine the sick patient with minimal disturbance, and to evaluate the location and effect of the various plastic catheters and tubes inserted into the body for medical reasons.