Quantitative measurement of renal perfusion following transplant surgery.

We developed an easily implemented clinical procedure for quantitative perfusion measurements in transplanted kidneys using intravenously administered [99mTc]DTPA and the tracer fractionation technique. F = Ak(T)/0 integral of T [Aa(t)/Va] dt, where F = renal blood flow, Ak(T) = DTPA activity in kidney at time = T, Va = ultrasonographically measured femoral artery segment volume, T = time postinjection of F determination, and Aa(t) = time course of DTPA activity in femoral artery segment. The technique was applied to a group of 80 studies in 35 patients in whom an independent clinical determination of transplant function was available. Blood flow (units of ml/min) measured 439 +/- 83 in normally functioning transplants, 248 +/- 63 in transplants with acute tubular necrosis, 128 +/- 62 in transplants with rejection, and 284 +/- 97 in transplants with cyclosporine toxicity. These preliminary results indicate potential usefulness of this method in the evaluation of renal function following transplant surgery.

New criteria for the diagnosis of gestational trophoblastic disease.

The purpose of the study was to test the hypothesis of whether the combined use of ultrasound and human chorionic gonadotropin (hCG) determinations could increase the diagnostic accuracy of sonography in the diagnosis of hydatidiform mole. The criteria used were the absence of fetal heart movement by ultrasound when the hCG level was above 82,350 mIU/mL and the presence of an hCG level in excess of 2 SD above the mean for the biometrically derived gestational age for suspected partial moles. The threshold of 82,350 mIU/mL was derived by probit analysis of the hCG serum levels of a population of normal intrauterine pregnancies prospectively examined to determine the level of hCG at which fetal heart activity would be visible by sonography. The diagnostic accuracy of these criteria was compared with the preoperative sonographic examination in 36 hydatidiform moles. When sonography was used alone, 15 of 36 cases (41.6%) did not have a definitive diagnosis on the first examination. The combination of hCG and ultrasound would have correctly identified 32 of the 36 cases (88.8%). This improvement was statistically significant (P less than .005).

Isodense colloid cysts of the third ventricle: a diagnostic and therapeutic problem resolved by ventriculoscopy.

Eighteen patients with a colloid cyst of the 3rd ventricle presented to the Frenchay Hospital Neurosurgery Unit. The investigations included computed tomography (CT). Of these patients, 9 had radiographically isodense cysts that caused considerable diagnostic difficulties, being described only as an anterior 3rd ventricular space-occupying lesion and lateral ventricular dilatation in all but 2 cases. The clinical findings are described and the CT appearance is discussed. The new use of ventriculoscopy may resolve the problem rapidly; ventriculoscopy made the diagnosis in 5 cases and confirmed a CT diagnosis in 3 others. (It has also confirmed the diagnosis in 2 cases of hyperdense cysts.) Lately, it has been possible to aspirate the cyst contents endoscopically or, if the colloid is too viscous, to remove it with endoscopic rongeurs. After either of these procedures, the cyst wall can be coagulated with diathermy endoscopically. The method is described, and the advantages over other investigations and treatment are discussed.

Portal venous velocity in biliary atresia.

From December 1986 to April 1989, 38 patients with biliary atresia (eight newly diagnosed) were evaluated with doppler ultrasound of the portal venous system. Peak and mean velocities were computer derived from the spectral waveform. Good velocity was greater than 15 cm/s, intermediate velocity was 8 to 14 cm/s, abnormal velocity was less than 7 cm/s or hepatofugal. Patients were grouped according to clinical status: group 1 (n = 14), normal liver function; group 2 (n = 15), recurrent cholangitis; group 3 (n = 2), established bile drainage but complicated cirrhosis; group 4 (n = 7), failed portoenterostomy. All patients with normal liver function (group 1) had good or intermediate velocities. Thirteen of 15 patients with recurrent cholangitis (group 2) had good or intermediate velocities. Both patients in this group with abnormal velocities required transplantation. In group 3 the patient with abnormal velocity is on the transplant waiting list. In group 4, abnormal velocities preceded or coincided with deterioration of liver function in five of seven patients. Doppler ultrasound provides useful anatomic information, determines direction of flow, quantitates velocity of flow, and, when performed serially, provides adjunctive information on liver status in children with biliary atresia. These preliminary results suggest that patients with abnormal or significantly decreasing velocity are destined for transplantation. Patients with good portal venous velocity warrant ongoing, aggressive surgical management.

Sonographic detection of prenatal liver mass.

Ultrasound examination is now performed on about 30% of all pregnancies. Although it is used primarily to estimate gestational age, viability, presentation, and placental site, detailed fetal anatomy is also disclosed. Many abnormalities are now detected prenatally which may not be clinically apparent at birth, and raise new dilemmas of patient management. We describe a large mass documented by ultrasound in the right lobe of liver in a 29-week-old fetus. Subsequent postnatal investigation confirmed the initial ultrasound findings and documented spontaneous regression.

Neonatal periventricular leukomalacia: real-time sonographic diagnosis with CT correlation.

The utility of real-time sonography in the diagnosis of neonatal periventricular leukomalacia (PVL) has been described only recently. Six cases are reported of PVL diagnosed by serial real-time scanning. The sonographic findings were correlated with the computed tomographic findings and the clinical history. In five of six infants in whom scanning was performed, characteristic multiseptated periventricular cavitations developed 2-3 weeks after birth or later. A transition from normal to increased periventricular echogenicity was often observed before the development of the periventricular cavitations in nonhemorrhagic PVL. The parenchymal abnormality demonstrated by sonography correlated well with an abnormal neurologic outcome. It is suggested that serial real-time scanning be performed in neonates whose history suggests the possibility of hypoxic-ischemic brain injury. Nonspecific predictors of PVL include seizures, apnea, disturbed mental status, abnormal muscle tone, and leg weakness.

Is renal ultrasound a reliable indicator of a nonobstructed duplication anomaly?

Twelve kidneys which had a non-obstructed duplication anomaly on excretory urography were studied sonographically. Ten of the twelve kidneys had a single central renal sinus echo complex; only two kidneys had a split sinus complex typical of duplication. Sonography is not a reliable technique to identify a nonobstructed duplication anomaly.

Acute respiratory infections during the first three months of life: clinical, radiologic and physiologic predictors of etiology.

The usefulness of clinical, radiologic, and physiologic characteristics to identify pathogens was assessed in 90 infants aged two through 12 weeks, presenting to an outpatient clinic with an acute respiratory infection. Eighty-four cases had cultures or rapid diagnostic tests for RSV, of which 25 were positive. Eighty-two infants had cultures or rapid diagnostic tests for Chlamydia, of which 16 were positive. Additional respiratory pathogens identified included parainfluenza (6 cases), rhinovirus (3 cases), pertussis (2 cases), and CMV (1 case). Multiple pathogens were identified in four cases: Chlamydia and RSV (2 cases), Chlamydia and parainfluenza (1 case), and Chlamydia and CMV (1 case). Clinical characteristics other than the need for hospitalization were not useful predictors of specific pathogens. X-rays were obtained in 20 (80%) of the RSV infections, 13 (81%) of the Chlamydia infections, six of the parainfluenza infections, two pertussis infections, and 25 cases without identification of the pathogen. X-ray findings could not distinguish between patients with or without a pathogen or between the pathogens. Severe findings were present in 28% (11/40) of cases with a pathogen identified, compared to 12% (3/26) of cases without a pathogen identified (NS). Moderate findings were present in 58% (23/40) of cases with a pathogen identified compared to 62% (16/26) of cases without a pathogen identified. Slight/negative findings were present in 15% (6/40) of cases with a pathogen identified, compared to 27% (7/26) of cases without a pathogen identified. Pulse oximetry was done in 30 cases, 22 of which had a pathogen identified (RSV 14, Chlamydia 7, pertussis 1).(ABSTRACT TRUNCATED AT 250 WORDS)

The junctional parenchymal defect: a sonographic variant of renal anatomy.

A triangular echogenic area in the upper pole renal parenchyma can be identified at times during routine sonography of the right kidney. Thirty such cases are presented. Occasionally similar echogenic defects in the parenchyma can be seen posteriorly in the lower pole and in the left kidney. These defects in the parenchyma result from normal extensions of the renal sinus of kidneys that have a distinct division of their upper and lower poles. This is due to partial fusion of two embryonic parenchymatous masses called renunculi. The defects in the parenchyma occur at the junction of the renunculi; hence we have termed them junctional parenchymal defects. In order to differentiate them from pathologic conditions, one must identify their characteristic location and demonstrate continuity with the renal sinus.

Scintigraphy in the diagnosis and management of septic sacro-iliitis.

Septic sacro-iliitis is a rare, life-threatening condition. The diagnosis is difficult, both clinically and radiographically, resulting in increased morbidity and delay in treatment. Skeletal scintigraphy is a sensitive method of establishing the diagnosis and monitoring progress. The blood pool image of the bone scan is the most informative part of the investigation.

CT and sonography in the recognition of mucocele of the appendix.

Mucocele of the appendix is uncommon, and preoperative diagnosis is rare. Diagnosis is important because some of these lesions are malignant, and early identification may reduce the incidence of pseudomyxoma peritonei. In two of three cases reviewed the correct preoperative diagnosis was established with sonography and computed tomography. These findings suggest that, in a patient who has not undergone appendectomy, the presence of a low-attenuating mass at computed tomography and a through-transmitting mass with echogenic content at sonography in the correct location is typical of mucocele.

Absolute intracranial blood-flow velocities evaluated by duplex Doppler sonography in asymptomatic preterm and term neonates.

Thirty-eight asymptomatic preterm and term neonates were studied with pulsed Doppler sonography to assess absolute (true) intracranial blood-flow velocities. The middle and posterior cerebral arteries were evaluated by a transcranial approach, and the anterior cerebral artery was evaluated via the anterior fontanelle. Intracranial velocities were seen to increase with increasing gestational age and with increasing age of the neonate. The rate of increase in velocity was greater with higher gestational age. Middle cerebral artery velocities were greater than anterior cerebral velocities. Likewise, antegrade diastolic flow was always seen in these normal neonates. Intracranial velocities increased with gestational age and with increasing age of the child; the resistive index decreased progressively with age.