Diagnostic Value of Ultrasound for Sternal Fractures in Patients with Trauma Experiencing Anterior Chest Wall Pain.

Background: Ultrasound is an attractive modality for the confirmation of sternal fractures in patients with trauma because of its easy, quick, and accurate nature, as well as its increased availability for focused assessment with sonography for trauma at the bedside. We aimed to confirm the diagnostic value of ultrasonography for sternal fractures in patients with trauma, anterior chest wall pain, and tenderness. Methods: This retrospective observational study included patients visiting a single regional trauma center from March 2022 to February 2023, diagnosed with sternal fractures via chest CT and bone scans, who underwent sternal ultrasound. Results: Twenty-six patients were divided into two groups: those with sternal fractures diagnosed with an initial chest CT scan (n = 19) and those without fractures (n = 7). Using ultrasound, 23 patients (88.5%) were diagnosed with sternal fractures. In the initial CT scan (+) group, all 19 patients (100%) were diagnosed using ultrasound. In the initial CT scan (-) group, four (57.1%) of the seven patients were diagnosed using ultrasound. In the initial CT scan (+) group, 14 (73.7%) of the 19 patients underwent bone scans and all 14/14 (100%) were diagnosed with sternal fractures. In the initial CT scan (-) group, seven (100%) patients underwent bone scans, and all were diagnosed with sternal fractures. Conclusions: Ultrasound is useful for the diagnosis of sternal fractures, with sensitivity of 88.5%. Therefore, in patients with blunt trauma experiencing anterior chest wall pain and tenderness, sternal ultrasonography might be helpful in diagnosing sternal fractures as an adjunct to chest CT and bone scans.

Evaluation of internal exposure of nuclear medicine staff working with radioiodine in Poland.

The iodine-131 (I-131) content in the thyroid of staff members working with this radionuclides has been measured with about 500 employees in about 25 hospital's departments of nuclear medicine performing therapy and diagnosis of thyroid disease in Poland. The measurements were performed with portable detection unit for in situ measurements of radioiodine. This is consist with scintillation detector sodium iodine activated by thallium (NaI(Tl)) - battery-powered and portable tube base Multichannel Analyzer Canberra UniSPEC. Based on direct measurements of the iodine content, the effective dose equivalent for workers due to inhalation of I-131 was estimated. All individuals actively working with iodine show measurable amounts of this isotopes in their thyroids. The average measured activity in the thyroid of the nuclear medicine staff was found to be equal at average 550 Bq within the range 70 Bq-2.5 kBq. There is no apparent correlation between the measured I-131 levels and risk categories. Nevertheless the technical and nuclear medicine staff show higher I-131 thyroid level comparing to hospital services staff. Calculated maximum committed effective dose for particular exposed person is <10% of 20 mSv/year. Int J Occup Med Environ Health. 2023;36(5):587-95.

The Spectrum of Parenchymal Changes in Kidneys Affected by Intrarenal Reflux, Diagnosed by Contrast-Enhanced Voiding Urosonography and DMSA Scan.

Purpose: To describe the parenchymal defects in kidneys with intrarenal reflux (IRR) diagnosed using contrast-enhanced voiding urosonography (ceVUS) and 99mTc-DMSA scintigraphy (DMSA scan). Materials and Methods: A group of 186 uretero-renal units (URUs) was analyzed using ceVUS and DMSA scans: 47 without vesicoureteral reflux (VUR) (group A) and 139 with VURs, comprising 73 VURs without (group B), and 66 with IRR (group C). VURs included non-dilating (grades I-II), mildly non-dilating (grade III), and non-dilating (grades IV-V) grades. The parenchymal changes were analyzed using a DMSA scan. Results: The median age for VUR diagnosis was 16.5 months in girls, and 8.5 months in boys (Z = 3.9; p = 0.001). IRR occurred in 51.4% of boys and in 25.9% of girls (χ2 = 12.4; p < 0.001). The non-dilating VUR occurred in 44% of boys and 24.1% of girls (χ2 = 7.7; p = 0.005). IRRs characterized upper and lower renal segments (81.8 and 63.6%) and middle segments (33.3%). Both incidence and increase in IRR correlated with the grade of VUR (p < 0.001). The incidence of reduced DMSA signal was statistically different among groups A + B and C, but not between groups A and B (χ2 = 32.2; p < 0.001). No statistically significant relationship existed between the reduced DMSA signal and the grade of VUR in group C. The reduced DMSA signal appeared in 9.9% positions in kidneys from group A, 14% from group B, and 32% from group C. Out of all 118 IRRs, 38.1% had reduced and 61.9% had normal DMSA signal. Among 11 parenchymal scars found in all three groups, 2 belonged to group B, 9 to group C, while group A had no scars. Conclusion: The parenchymal changes are the most prominent in the group with IRR, but they do not significantly differ among kidneys with different grades of VUR. VURs of higher grades are associated with a higher incidence of IRR and early clinical presentation. Scars can also appear in lower-grade VURs accompanied by IRR. Boys with VUR have earlier clinical presentation than girls, as they have significantly higher grades of VUR with a higher proportion of IRRs. Therefore, we suggest a subdivision of VURs into those with IRR and abundant parenchymal damage, and those without IRR and less parenchymal damage.

Establishing a diagnostic scale of subacute thyroiditis without radioisotope scanning.

BACKGROUND: Radioisotope scanning is important to diagnose subacute thyroiditis (SAT), but it's not always available. So we aim to establish a diagnostic scale for SAT without radioisotope scanning. METHODS: The suspected SAT patients hospitalized in Yuebei people's Hospital from January 2012 to December 2016 were selected and divided into study group and control group according to whether they were diagnosed as SAT. The clinical indexes of two groups were collected and the diagnostic scale of SAT was established by using binary logistic regression analysis. The effectiveness of the scale was evaluated by ROC curve. RESULTS: Of 309 patients, 58.25% of patients were confirmed with SAT and the remaining 41.75% of patients were not diagnosed with SAT. After univariate analysis, variables which were considered statistically different(P < 0. 05) between the two groups were selected as independent variables and the diagnosis of SAT was taken as dependent variable in the binary logistic regression model. The logistic regression model consisted of 4 variables, each was thyroid tenderness, firm on palpation, increased ESR and elevated thyroid hormone level. The P value of Omnibus tests was≤0. 001 and the Nagelkerke R Square was 0. 915. The diagnostic scoring scale was established with these four variables according to their regression coefficient. The area under the ROC curve for this diagnostic scale was 0. 991(95% confidence interval, 0. 982-0.999). The highest Youden index was 0. 912, the corresponding cut-off point was 7. Internally validation shows a sensitivity of 92. 78% and a specificity of 98.45% of our scale. CONCLUSIONS: We established and validated a diagnostic scale for SAT without the need for radioisotope scanning for the first time. It has good application in institutions that do not have radioisotope machines or among pregnant and lactating women.

The application of pyeloureteroplasty in the treatment of children with affected kidney function less than 10％ / 中华泌尿外科杂志

Objective To determine the efficacy and long-term outcome of pyeloureteroplasty in the ureteropelvic junction obstruction (UPJO) patients with poor kidney function(＜ 10％).Methods The data of UPJO patients with poor kidney function treated from January 2006 to September 2016,was retrospectively analyzed.The renal function ＜ 10％ undergoing pyeloureteroplasty were included.Ipsilateral vesicoureteric reflux,ureterovesical junction obstruction and renal dysplasia were excluded.39 patients was enrolled.There were 31 boys and 8 girls.The mean age at surgery was 3.1 years old (range 7 months-14 years).There were 36 primary UPJO and 3 extrinsic vessel cases.Twenty-seven cases of UPJO in left side,9 cases in right side,and 1 case in bilateral side.The preoperative examination included ultrasound,intravenous pyelography (IVU) and 99 mTc DTPA renography.Mean anteroposterior diameter of pelvis was (5.5 ± 2.4) cm before operation (range 3.4-7.4cm);IVU showed non visualized kidney or rim sign.The ill kidneys' mean renal function was (3.25 ± 2.78) ％ (range 0-9％).Results Open pyeloureteroplasty were performed in the 38 patients,additional nephrectomy was required in 1 because of repeated urinary infection,while the other patients had good prognosis,nephrostomy was kept until 2-3 days' successful clipping.Laparoscope pyeloplasty were performed in one patient with double-J.The patient had urinary infection post operation and was cured.The postoperative examination included ultrasound,intravenous pyelography and 99mTc DTPA renography were performed after 3-6 months.Mean anteroposterior diameter of pelvis was (3.2 ± 1.9) cm (range 2.1-4.5 cm);Intravenous urography showed visualized kidney;Mean renal function was (18.16 ± 13.17)％ (9％-27％).There was significant difference between preoperational and postoperational evaluation of renography and pelvis (P ＜ 0.05).There was no correlation between the changed renal function and age (P ＞ 0.05).The mean follow-up time was 10.2 months (range 6-25 months).Conclusions Pyeloureteroplasty could be safe and feasible for the UPJO patients with renal function less than 10％,and could improve the renal function.

20 años de investigaciones y aplicaciones en Cuba de los radiotrazadores y el perfilaje en la industria y el medioambiente / 20 years of Cuban radiotracer and scanning researches and applications at the industry and the environment

Las tecnologías de radiotrazadores y de escaneo son herramientas bien consolidadas para el estudio, análisis y evaluación de los procesos industriales y medioambientales. En este trabajo se sintetizan los principales resultados alcanzados por el Grupo de Aplicaciones Industriales y Medioambientales de los Radiotrazadores en el Departamento de Radioquímica. La tecnología de radiotrazadores se ha empleado con éxito para la caracterización del mezclado en reactores discontinuos, los estudios sobre el comportamiento del 99mTc en aguas naturales y residuales, la calibración y validación del modelo de calidad de agua del río Almendares, la caracterización de un reactor anaerobio para el tratamiento de los residuales en el CAI “Pablo Noriega”, la verificación y validación del modelo DFC en un cristalizador azucarero, el desarrollo de un generador radisotópico de ? / ?, la modelación de la calidad del agua en el segmento medio del río Luyanó, y para la modelación de la calidad del agua en el río Guaire, Caracas, Venezuela. En los últimos años el grupo ha desarrollado y evaluado a nivel de laboratorio radiotrazadores para fluidos orgánicos, particularmente relacionados con la industria del petróleo y para sólidos, empleando como precursor al ?. Mientras la técnica de escaneo se ha utilizado para el perfilaje gamma en torres de destilación de alcohol de los CAI "Héctor Molina”“Heriberto Duquesne" y "Jesús Rabí".

Predicting Factors of Breakthrough Infection in Children with Primary Vesicoureteral Reflux

PURPOSE: Many pediatric urologists still favor using prophylactic antibiotics to treat children with vesicoureteral reflux (VUR). However, breakthrough infection sometimes occurs, leading to significant increases in morbidity as a result of renal scarring. Therefore, we tested whether abnormal renal scan and other factors are predictive of breakthrough infection using univariate analyses. MATERIALS AND METHODS: We retrospectively reviewed the medical records of 163 consecutive children who were diagnosed with vesicoureteral reflux between November 1997 and June 2010. Clinical parameters for the statistical analysis included form of presentation, gender, age, VUR grade, laterality, presence of intrarenal reflux, class of antibiotic drug, and presence of abnormal renal scan by Dimercapto-succinic acid. Clinical parameters used for prognostic factors were established by univariate analyses. Fisher's exact test and unpaired t-test were done using SPSS software [SPSS ver. 12.0 (SPSS Inc., Chicago, IL, USA)]. RESULTS: Breakthrough infection developed in 61 children (48.0%). A total of 58 children (45.7%) had abnormal renal scans. Time to development of breakthrough infection was significantly longer in girls (9.0+/-8.2 months) than in boys (5.8+/-4.8 months, p<0.05). On univariate analysis, though statistically not significant, the most predictive factor of breakthrough infection was abnormal renal scan (p=0.062). In patients with abnormal renal scans, breakthrough infection was not associated with mode of presentation, gender, grade or prophylactic antibiotics. However, there was a significant difference between patients younger than 1 year and those 1 year old or older. Mean+/-SD age at diagnosis of VUR in patients with breakthrough infection (1.14+/-3.14) was significantly younger than in those without breakthrough infection (5.05+/-3.31, p=0.009). There was also a significant difference between patients with bilateral or unilateral reflux (p=0.028). CONCLUSION: Our data showed that abnormal renal scan was the most predictive factor of breakthrough infection and demonstrated statistical significance in patients under the age of 1 year. Parents and physicians should remain aware that these patients are at high risk of breakthrough urinary tract infection, which may potentially lead to renal damage.

Primary Vesico-Ureteral Reflux: Comparison of Factors between Infants and Children.

PURPOSE: The association of age, sex and renal parenchymal damage (RPD) in vesicoureteral reflux (VUR) is well known. We compared various factors between infants and children in a cohort of patients with primary VUR. MATERIALS AND METHODS: Medical records of 147 patients diagnosed as VUR between 1997 and 2010 were reviewed. Of these children 91 (61.9%) were boys and 56 (38.1%) were girls. 99 (67.3%) of the 147 patients were younger (Group 1), and 48 (32.7%) were older than 1 year (Group 2). The impact of patient's gender and age as well as VUR grade on RPD were analyzed in each patient. The Fisher's exact test and chi square test was done with SPSS ver. 12.0 (SPSS Inc., Chicago, IL, USA). RESULTS: VUR was unilateral in 88 patients (59.9%) and bilateral in 59 patients (40.1%). Abnormal renal scan was found in 78 (37.7%) renal units. The incidence of VUR was significantly higher in male in group 1 (p<0.01) and in female in group 2 (p<0.01). The incidence of abnormal renal scan was significantly higher in intermediate and high grade VUR comparing low grade VUR in group 1 (p=0.042). In both group, abnormal renal scan didn't show any difference between male and female statistically (p>0.05). CONCLUSIONS: Our data showed that VUR in infant was significantly higher in male than in female, whereas VUR in children was significantly higher in female. This may be due to that characteristic of a population where neonatal circumcision is not a common procedure in infant and urinary tract infections are more common in female children. Further study may be needed to identify gender difference in RPD in infant with high grade reflux.

The role of ultrasonography in primary congenital hypothyroidism.

BACKGROUND: The aim of this study was to compare the usefulness of ultrasonography and scintigraphy in diagnosing the etiology of primary congenital hypothyroidism (CH). METHODS: The newborns that were examined by both thyroid scintigraphy and ultrasonography during CH screening program in Isfahan were included in this study. The ultrasonographic findings were compared with the scintigraphic findings and the sensitivity and specificity of the ultrasonography was determined. RESULTS: During this study, 102 CH newborns were studied. According to the ultrasonographic results, 61.8%, 26.5%, 2.9% and 8.8% of them had normal thyroid gland, agenesia, ectopia and hypoplasia, respectively, and according to scintigraphic results, 55.9%, 35.3% and 8.8% of them had normal thyroid gland, agenesia and ectopia, respectively. Ultrasound detected sensitivity, specificity, positive predictive value, negative predictive value, and positive and negative likelihood ratio were 77%, 92%, 89%, 84%, 9.6 and 0.25, respectively. The sensitivity and specificity of ultrasonography compared with thyroid scintigraphy in diagnosis of thyroid gland ectopia was 33% and 100%, respectively. CONCLUSIONS: Though thyroid ultrasonography failed to diagnose 67% of ectopic cases and nonfunctioning thyroid gland, it had the ability to determine the anatomy of thyroid gland. So, considering some limitations of scintigraphy, we concluded that ultrasonography is a relatively appropriate imaging tool for diagnosing CH etiologies, especially in the initial phase of CH screening.

Primary Vesico-Ureteral Reflux: Comparison of Factors between Infants and Children

PURPOSE: The association of age, sex and renal parenchymal damage (RPD) in vesicoureteral reflux (VUR) is well known. We compared various factors between infants and children in a cohort of patients with primary VUR. MATERIALS AND METHODS: Medical records of 147 patients diagnosed as VUR between 1997 and 2010 were reviewed. Of these children 91 (61.9%) were boys and 56 (38.1%) were girls. 99 (67.3%) of the 147 patients were younger (Group 1), and 48 (32.7%) were older than 1 year (Group 2). The impact of patient's gender and age as well as VUR grade on RPD were analyzed in each patient. The Fisher's exact test and chi square test was done with SPSS ver. 12.0 (SPSS Inc., Chicago, IL, USA). RESULTS: VUR was unilateral in 88 patients (59.9%) and bilateral in 59 patients (40.1%). Abnormal renal scan was found in 78 (37.7%) renal units. The incidence of VUR was significantly higher in male in group 1 (p0.05). CONCLUSIONS: Our data showed that VUR in infant was significantly higher in male than in female, whereas VUR in children was significantly higher in female. This may be due to that characteristic of a population where neonatal circumcision is not a common procedure in infant and urinary tract infections are more common in female children. Further study may be needed to identify gender difference in RPD in infant with high grade reflux.

The Clinical Significance of Intrarenal Reflux in Voiding Cystourethrography (VCUG).

PURPOSE: Intrarenal reflux (IRR) occurs in 3-10% of cases of total reflux and can lead to renal injury, which may eventually result in renal scarring. In this study, we evaluated the clinical importance of IRR detected by voiding cystourethrography and evaluated the relationship between IRR and renal scarring. MATERIALS AND METHODS: From January 2002 to May 2008, 50 patients who were diagnosed with vesicoureteral reflux (VUR) and showed IRR in voiding cystourethrography were enrolled. IRR was seen in 59 renal units in our enrolled patients. A (99m)Tc 2,3-dimercaptosuccinic acid (DMSA) renal scan was performed after VUR was detected in all cases. Nine patients were conservatively treated with prophylactic antibiotics, whereas 41 patients received an anti-reflux operation. A follow-up renal scan was performed after 3 to 6 months to check for any changes in renal scarring. RESULTS: The average patient age was 9.2 months (range, 1-42 months). Forty-nine patients were male; only one patient was female. The mean duration until surgery was 2.9 months. Generally, the IRR sites corresponded to the sites of photon defects on DMSA renal scans (76.3%). Furthermore, the photon defects on IRR sites tended to progress to renal scarring (65.2%). The rate of change in scarring was lower in the surgery group (47.1%) than in the prophylactic antibiotic group (75%). CONCLUSIONS: IRR sites and the sites of photon defects on DMSA renal scans showed a high correspondence, and these sites tended to progress to renal scarring. We suggest that VUR with IRR should be actively managed to decrease the chances of renal scarring.

The Clinical Significance of Intrarenal Reflux in Voiding Cystourethrography (VCUG)

PURPOSE: Intrarenal reflux (IRR) occurs in 3-10% of cases of total reflux and can lead to renal injury, which may eventually result in renal scarring. In this study, we evaluated the clinical importance of IRR detected by voiding cystourethrography and evaluated the relationship between IRR and renal scarring. MATERIALS AND METHODS: From January 2002 to May 2008, 50 patients who were diagnosed with vesicoureteral reflux (VUR) and showed IRR in voiding cystourethrography were enrolled. IRR was seen in 59 renal units in our enrolled patients. A 99mTc 2,3-dimercaptosuccinic acid (DMSA) renal scan was performed after VUR was detected in all cases. Nine patients were conservatively treated with prophylactic antibiotics, whereas 41 patients received an anti-reflux operation. A follow-up renal scan was performed after 3 to 6 months to check for any changes in renal scarring. RESULTS: The average patient age was 9.2 months (range, 1-42 months). Forty-nine patients were male; only one patient was female. The mean duration until surgery was 2.9 months. Generally, the IRR sites corresponded to the sites of photon defects on DMSA renal scans (76.3%). Furthermore, the photon defects on IRR sites tended to progress to renal scarring (65.2%). The rate of change in scarring was lower in the surgery group (47.1%) than in the prophylactic antibiotic group (75%). CONCLUSIONS: IRR sites and the sites of photon defects on DMSA renal scans showed a high correspondence, and these sites tended to progress to renal scarring. We suggest that VUR with IRR should be actively managed to decrease the chances of renal scarring.

Analysis on clinical and pathological features of 127 thyroid carcinomas / 中国实用内科杂志

Objective To study the clinical features of thyroid carcinoma and to explore the approach of early diagnosis for the disease.Methods The data of patients with thyroid carcinoma confirmed by pathology during January of 1999 to January of 2005 in the First Hospital affiliated to Shanghai Jiao Tong University were retrospectively reviewed,including clinical appearance,thyroid ultrasonography and radioisotope scanning.Results One hundred and twenty-seven consecutive patients,30 males and 97 females,mean age(48.9?13.6)years,were diagnosed with thyroid carcinoma by surgery and pathology.A total of 127 cases of thyroid carcinoma were included,which were 105 papillary thyroid carcinomas,14 follicular thyroid carcinomas,2 undifferentiated thyroid carcinomas and 6 medullary thyroid carcinomas.Thyroid ultrasonography findings showed the majority(85.1%)thyroid nodules were low echo nodules and the proportions of solid and mixed nodules were 81.8%and 17.4%,respectively.The proportion of cold nodules was 88.9% by radioisotope scanning.Mean values of serum triiodothyronine,thyroxine and thyrotropin were all within the normal range.Conclusion In the present study the thyroid carcinomas are predominant in females and the incidence of papillary thyroid carcinomas is very high.The diagnosis of thyroid carcinoma can not just depend on findings of ultrasonography,radioisotope scanning and serum thyroid hormone.

Singificance of Bone Scan in the Early Diagnosis of Acute Osteomyelitis / 대한정형외과학회잡지

Bone imagings have played important role in early detection of acute osteomyelitis. In acute osteomylitis, bone scan findings precede the appearance of bone change on radiograph. Also, recent studies have reported accuracies of bone scan in diagnosis of osteomyelitis ranging from 84% to 100%. But, in above datas, bone scan reading were only qualitative studies. So we have reviewed Technetium-99m labelled methylen dipho sphonate(99mTc-MDP) scan on 21 patients who had been diagnosed acute osteomyelitis by clinical symptoms, blood culture, pus culture and operative findings from January, 1984 to September, 1985. The purpose of this study is to establish the quantitative study of bone scan using computed pixel counting method. The 21 cases were classified into group I and group II according to initial radiographic findihgs. The group I showed normal radiographic finding or soft tissue swelling without osseous change. The group II showed osseous change. The results obtained were as follows: 1. We obtained positive bone scans in the all cases which were confirmed acute osteomyelitis. 2. We experienced diagnosis of acute osteomyelitis by bone scan which was confirmed as early as 48 hours after onset of clinical symptom. 3, In group I, the average uptake ratio of 99mTc-MDP was 3.22±0.82 ranging from 2.20 to 4.80. 4. In group II, the average uptake ratio of 99mTc-MDT was 6.20±2.27 ranging from 4.00 to 9.40. (p <0.001).