ABSTRACT
A system for defining renal scarring on ultrasound is proposed and compared with DMSA scintigraphy. Renal scarring was assessed with ultrasound in children following urinary tract infection (UTI) using the following criteria: (1) proximity of sinus echoes to cortical surface; (2) loss of pyramids; (3) irregularity of outline; (4) loss of definition of capsular echo; and (5) calyceal dilatation. Three hundred and thirty-nine consecutive ultrasound scans (US) and DMSA scintigrams, comprising 648 kidneys, were performed and reported blindly and the results were compared. Using DMSA scintigraphy as the gold standard, ultrasound had a positive predictive value of 93% and a negative predictive value of 95%. Ultrasound disagreed with DMSA scintigraphy in 5.2% of kidneys. On review of the cases of disagreement where arbitration was possible by comparison with other imaging, ultrasound was incorrect in 10 kidneys and DMSA was incorrect in 13. We conclude that the sensitivity in the ultrasound detection of renal scarring can be greatly improved using this method. If no scars were detected at ultrasound an alternative explanation for an abnormal DMSA scintigram should be sought.
Subject(s)
Cicatrix/diagnostic imaging , Kidney Diseases/diagnostic imaging , Urinary Tract Infections/etiology , Adolescent , Age Factors , Child , Child, Preschool , Cicatrix/complications , False Negative Reactions , False Positive Reactions , Female , Humans , Infant , Infant, Newborn , Kidney Diseases/complications , Male , Predictive Value of Tests , Radionuclide Imaging , Sensitivity and Specificity , Succimer , UltrasonographyABSTRACT
A cross-sectional study of bone density involving 30 patients who had undergone orchidectomy and para-aortic radiotherapy for Stage I seminoma of the testis, has been performed. Bone density measurements were made of the whole body, lumbar spine and hips, including all irradiated areas. Comparison was made with previously obtained standard sex and age matched control data. The 30 patients treated for seminoma had a significantly increased mean bone density compared with age matched normal values. No significant differences were demonstrated between the mean bone densities of the irradiated and non-irradiated hips. There was no significant relationship between bone density measurement and time since orchidectomy or radiotherapy. These results suggest that nodal irradiation for seminoma has little long term effect on bone density.
Subject(s)
Bone Density/radiation effects , Orchiectomy/adverse effects , Seminoma/radiotherapy , Testicular Neoplasms/radiotherapy , Absorptiometry, Photon , Adult , Combined Modality Therapy , Cross-Sectional Studies , Humans , Male , Middle Aged , Seminoma/surgery , Testicular Neoplasms/surgeryABSTRACT
We have studied, in 37 adult patients, the anatomy of the sacral extradural (caudal) space using magnetic resonance imaging. The sacrococcygeal membrane (SCM) could not be detected in 10.8% of patients. The maximum depth of the caudal space adjacent to the SCM was beneath the upper third of the SCM in more than 90% of patients (mean depth 4.6 mm; range 1.0-8.0 mm). The shortest linear distance from the dura to the upper limit of the SCM varied considerably (60.5 mm; 34-80 mm) as did the volume of the caudal space excluding the foraminae and dural sac (14.4 cm3; 9.5-26.6 cm3). The dimensions of the caudal space and their variability have implications for clinical practice and a knowledge of these dimensions may increase both the reliability and safety of caudal techniques in adult patients.
Subject(s)
Epidural Space/anatomy & histology , Magnetic Resonance Imaging , Adolescent , Adult , Aged , Analgesia, Epidural , Anesthesia, Caudal , Anthropometry , Female , Humans , Male , Middle Aged , Prospective Studies , Sacrum/anatomy & histologyABSTRACT
Fourteen 15-kg hand-raised lambs were subjected to a control treatment or to one 3-hr, -5 C cold shock each day for 4 days. The greatest increase in heart rate occurred at the second hour of cold shock, when ambient temperatures were lowest. This increase became successively smaller each day. The greatest rectal temperature decreases occurred after 3 hr of cold shock, 1 hr after the minimum ambient temperature had been reached. This rectal temperature decrease became successively greater each day as the lambs habituated to the cold shocks. Urinary calcium excretion was 67% higher (P less than .05) in the cold-shocked lambs than in the controls during the 18-hr intervals following the shock. Urinary cortisol excretion was different only on day 2, when the control group showed higher (P less than .05) values. A confinement stress was induced by the placing of four lambs in metabolic cages 5 days after they were removed from a range environment. These lambs were compared to four other lambs in metabolic cages which had been reared in the laboratory. Confinement stress increased urinary cortisol excretion (P less than .05) above that of the laboratory-reared lambs for the first 3 days. A mean urinary cortisol excretion of 41 ng.MBS-1.mr-1 or 20 ng.mg.creatine-1 was found in lambs in the range and laboratory groups over the remainder of the study. The range lambs' nitrogen retention, measured after cortisol excretion returned to baseline, was greater (P less than .05) than that of the laboratory lambs.