Normal values for thyroid ultrasonography, goiter prevalence and urinary iodine concentration in schoolchildren of the Veneto Region, Italy.

Goiter prevalence in school-age children and median urinary iodine concentration (UIC) are the main indicators of iodine deficiency in a population. In areas of mild iodine deficiency, where goiters are small, ultrasound is preferable to physical examination to estimate goiter prevalence. The World Health Organization (WHO) has adopted thyroid volume ultrasonography results from a survey of European schoolchildren as an international reference, but these values have recently been questioned. The aims of the study were: a) to determine regional normal echographic reference values of thyroid volume in children aged between 11 and 14 yr in the Veneto Region, in North-East Italy; b) to determine goiter prevalence by physical and ultrasonographic examination; c) to determine UIC in this section of the population. A cross-sectional study was carried out on 1730 schoolchildren, aged between 11 and 14, living in towns in low-lying areas, in the valleys of the pre-Alps and in the mountains between 600 and 1200 m. Thyroid volume was evaluated by inspection and palpation using the WHO criteria. In 560 children thyroid volume was determined by ultrasound. UIC was measured in 1368 children. On physical examination a grade I goiter was found in 7.5% of children. No goiter grade II or grade III was found. The regional thyroid volume reference values by ultrasonography were similar, or slightly lower (5-20%), to the corresponding WHO reference values. Mean UIC was 148 +/- 110 microg/l, with no difference between lowlands and uplands; UIC values less than 100 microg/l were found in about 30-35% of the children. UIC was higher in children using iodized salt than in non-users. No correlation was found between thyroid volume by ultrasonography and UIC. Thyroid volume was found to be bigger in upland children than in those in low-lying areas, probably because of low iodine intake in people living in the mountains in previous generations. This data show that Veneto is not a iodine-deficient area, with no presence of endemic goiter. However, the great number of children with a UIC of less than 100 microg/l also suggests the use of iodized salt in the Veneto Region.

Agenesis of the gallbladder associated with Gilbert's syndrome.

A case of gallbladder agenesis associated with Gilbert's syndrome in a 52-year-old man with a striking family history of cholelithiasis is reported. The diagnosis of Gilbert's syndrome was made 30 years earlier, whereas the anomaly of the gallbladder was manifested when the patient, at the age of 34 years, started complaining of abdominal symptoms suggestive of biliary tract disease. Diagnostic confirmation was accomplished by magnetic resonance cholangiography, thus avoiding laparotomy, whereas conventional hepatobiliary imaging studies and laparoscopy could not achieve a definite diagnosis. No other malformations were detected. To our knowledge, this is the first report of an association between gallbladder agenesis and Gilbert's syndrome. Such association may be incidental or could represent the occurrence of a concomitant metabolic error in adults with isolated agenesis of the gallbladder.

[Power Doppler signals produced by static structures: a frequent cause of interpretation errors in the study of slow flows]. / Segnali con power Doppler prodotti da strutture statiche: causa frequente di errori interpretativi nello studio dei flussi lenti.

INTRODUCTION: The main characteristic of power Doppler US is its high sensitivity in showing blood vessels with small caliber and slow flow. However, artifacts are a common problem with this technique and they lead to impaired and subjective image reading. We analyzed the artifacts from Power Doppler signals from static structures both in vitro and in vivo. MATERIAL AND METHODS: Some samples of different tissues (liver, muscle, fat) positioned into a water bath were studied with Power Doppler in vitro. The static structures were imaged with a 10 MHz transducer (Esaote AU4, Genoa, Italy) both through water and with the transducer resting directly on the tissue. PRF and WF were set differently every time and their individual/combined role in causing artifacts was assessed. Then we examined different organs in vivo to investigate if the same setting as in vitro would cause the same artifacts. RESULTS: All our tissue samples exhibited strong and persistent color signals at low PRF and WF settings, with stronger signals at the solid/liquid interface and no signals from the liquid color box. Comparison of images acquired with same setting, particularly color gain, but different PRF (750 Hz to 3 KHz) or WF (50 to 600 Hz) showed that artifacts are mainly related to the latter. In vivo examinations showed similar findings, especially relative to the liquid/solid and solid hypoechoic/solid hyperechoic interfaces. CONCLUSIONS: Persistent and fairly strong Power Doppler signals can be produced by echogenic structures with no flow; these artifacts are frequent at low PRF, but are mainly caused by incorrect WF setting. They are most frequent along interfaces with specular reflection. To conclude, we would like to stress that, in addition to motion artifacts, which are easier to recognize, other potentially misleading signals may come from static structures.

Doppler ultrasound of the testis in azoospermic subjects as a parameter of testicular function.

Azoospermia frequently represents the end-point of different pathological conditions that cause important quantitative and qualitative alterations of both spermatogenesis and testicular structure, including intratesticular blood vessels. In this study we performed colour Doppler ultrasound of the testis in 12 azoospermic subjects affected by primary testicular pathology (four bilateral post-orchitis, four postradiotheraphy for cancer, four post-traumatic) aged 28.2+/-3.3 (mean+/-SD) years, in six subjects affected by obstructive azoospermia aged 29.7+/-2.4 years and in 20 age-matched fertile subjects (aged 28.6+/-2.5 years). The analysis of intratesticular vessels per organ was quantified using a semiquantitative score: category 0, no vessels visible; category 1, between one and three intratesticular vessels visible; and category 2, more than three vessels visible. In obstructive azoospermic patients and in fertile subjects there were always more than three intratesticular vessels. No intratesticular vessels were detected in eight testes (33.3%) and fewer than three vessels in 16 testes (66.6%) in subjects affected by primary testicular pathology. In azoospermic subjects the testicular structure of the testis was evaluated by diagnostic fine needle aspiration cytology (FNAC) performed in the middle portion of the testis. In non-obstructive azoospermic patients this procedure showed the presence of only Sertoli cells in all cases. When detectable vessels were present, a new aspiration was performed in these areas. In 12 out of 16 cases, spermatogenetic cells including mature spermatozoa, were found when the FNAC was performed in testicular regions showing the presence of blood vessels. These results indicate that colour Doppler sonography of the testis may be useful in the differential diagnosis of azoospermia and suggest the evaluation of the intratesticular blood vessel distribution before performing any method to retrieve intratesticular spermatozoa for intracytoplasmic sperm injection.

The latest in ultrasound: three-dimensional imaging. Part 1.

OBJECTIVE: The state-of-the-art of three-dimensional ultrasound is reviewed to evaluate technological achievements and future possibilities in diagnosis and in the follow-up of medical or invasive therapy. MATERIAL AND METHODS: The problems related to volumetric acquisitions in the tissues of interest to provide three-dimensional images are considered. Three-dimensional images are easier to achieve with computed tomography because the scanning system of this technique is automatic and thus provides sequential slices. The same is true for magnetic resonance imaging which can aquire volumes directly. The problem with ultrasound lies in the fact that the scans are manual and therefore less precise. To obtain three-dimensional images these devices are commonly used: manual scanning probes connected to spatial magnetic evidencers with remote processing; manual scanning probes connected to spatial magnetic evidencers placed on the patient's examination table with processing internal to the ultrasound unit; mechanical probes that can provide volumetric scans; 'matrix' probes. Recent contributions are discussed relative to three-dimensional applications to cardiology (cardiac valve studies), obstetrics (malformations), gynecology (uterine malformations and extensive ovarian disease studies), gastroenterology (diagnosis of pancreatic and hepatoabiliary tumor extent), uro-nephrology (detection of stones, prostatic tumors) and finally in the study of rectal carcinomas. CONCLUSIONS: Nearly all the papers about three-dimensional ultrasound are works in progress because the technique has not been standardized yet and some of its future diagnostic possiblities are difficult to foresee. Moreover, 'matrix' probes are still in the experimental stage. Nevertheless, this technique seems to be able to yield the best results in: fetal malformations; calculating the volumes of normal and diseased organs; the follow-up of masses treated with irradiation/chemotherapy or with alcohol or chemoembolization; the spatial reconstruction of extensive lesions; the detection of small lesions (metastases); the study of some complex functions such as cardiac valve dynamics. But the real problem with three-dimensional sonography is not its efficiency but rather its efficacy, that is which actual role this technique can play in diagnosis and which information it can add to that obtained with two-dimensional imaging.

Non-occupational recurrent bilateral pneumoparotitis in an adolescent.

This is a case report of recurrent bilateral parotid swelling with intraglandular gaseous bubbles in a 14-year-old boy, together with a review of the literature on this condition, which is usually called pneumoparotitis. The disorder has been reported as an occupational hazard in wind instrument players and glass-blowers and also as a rare non-occupational disease, mainly in adolescents and often associated with psychological problems.

Carotid body tumors: US evaluation.

The ultrasound (US) findings in 20 patients with 23 carotid-body chemodectomas were reviewed. Twenty-two of 23 tumors could be seen at US; the remaining lesion could not be differentiated from surrounding enlarged lymph nodes resulting from thyroid cancer. The lesions were solid, slightly heterogeneous masses that ranged in size from 1.2 to 5.0 cm and were located within the carotid bifurcation. Pulsed Doppler analysis of blood flow within the tumor mass was possible in eight patients with nine chemodectomas, and low-resistance waveforms were obtained from multiple sites within the mass in all cases. The diagnostic possibility of a chemodectoma has to be considered when a solid mass is detected within the carotid bifurcation. On the basis of these findings, as US diagnosis was possible in 18 of 20 patients in the authors' series. Doppler analysis of the mass to evaluate intratumor blood flow is helpful in differentiating chemodectomas from other solid, nonhypervascular masses.

Sonography of abnormal lymph nodes in vitro: correlation of sonographic and histologic findings.

The sonographic evaluation of lymph nodes is based primarily on evaluation of their shape and size. Recently, however, the availability of high-frequency transducers has made consideration of internal structure possible. An important objective is to determine whether node enlargement is due to inflammatory or neoplastic processes. To determine the accuracy of sonography for this purpose, we obtained in vitro sonograms of 53 enlarged lymph nodes excised from 41 patients during surgery for neoplastic or nonneoplastic disease. The sonograms were obtained with 7.5- and 10-MHz transducers. They were interpreted by a radiologist who was unaware of the clinical diagnosis. The nodes were subsequently processed for anatomohistologic study; findings were compared side by side. In 26 of the 53 nodes, sonograms showed an identifiable central echogenic line, which on histologic specimen corresponded to the internal part of the medulla where the lymphatic sinuses converge. All these nodes were benign. Two other nodes had an echogenic internal structure not resembling the normal hilum; in one case this was caused by metastatic disease and in the other by fibrosis. Sonograms of the remaining 25 nodes showed no detectable hilar structure; 21 were involved by a tumor and four had diffuse fatty replacement. Our results suggest that the sonographic finding of a central echogenic line is a valid criterion of benignity. Absence of this finding may be due to factors other than neoplastic disease, such as fatty replacement.

[Multisystemic sarcoidosis. A clinical case report]. / Sarcoidosi multisistemica. A proposito di un caso clinico.

Sarcoidosis is a granulomatous disorder of unknown etiology with a multi-disciplinary interest. However, a multiple organ involvement is not always clearly presented. A case of a 62-year-old woman with cutaneous, pulmonary, ocular, cardiac, bone and articular involvement is described.

Gastric leiomyoblastoma in childhood--a case report and review of the literature.

A rare case of gastric leiomyoblastoma in a boy of 11 years of age is reported. The patient complained of abdominal pain and presented with a palpable mass. Ultrasonography showed a typical aspect with mixed solid and liquid components. At surgery simple excision of the tumour was sufficient for radical exeresis, and there was no recurrence after 2 years. 13 further cases in patients under 20 years of age were collected from the literature and briefly reviewed.

Vascular parenchymal sources of upper gastrointestinal bleeding.

Fourteen cases of upper gastrointestinal bleeding (UGIB) were reviewed: 6 (group A) were caused by pancreatitis, 3 (group B) by hemobilia, and 5 (group C) by rupture of esophageal varices due to arterioportal shunts. Elective endoscopy carried out in 7 patients in groups A and B was negative; in 2 actively bleeding patients in group A emergency endoscopy could not detect the source of hemorrhage. Endoscopy was carried out in 4 patients in group C for diagnosis and sclerosis, but severe hemorrhage recurred in spite of treatment. Ultrasonography (US) and computed tomography (CT) were carried out prior to angiography in 5 and 4 patients, respectively, and always suggested a parenchymal lesion. All patients underwent angiography. Transcatheter control of the hemorrhage was attempted as an emergency in 2 patients (as a presurgical step in one); elective embolization was the treatment of choice for 8 patients, with good results in 6. This study suggests the usefulness of US and CT both in the detection of parenchymal lesions causing UGIB not clarified by endoscopy, and in the selection of patients for angiographic treatment.

Infantile recurrent sialectatic parotitis: the role of sonography and sialography in diagnosis and follow-up.

The results of a clinical, sonographic and sialographic study in 10 children (aged 4-10 years) with recurrent sialectatic parotitis are presented. Alteration in the sonographic pattern of the parotid glands, consisting of multiple hypoechogenic areas in the parenchyma, were found in four cases; milder nonhomogeneity was seen in four cases, and an almost normal pattern in two cases. Sonographic follow-up in two children showed a parallel reduction in non-homogeneity with symptomatic improvement. A probable therapeutic action following sialography using fat-soluble contrast medium was observed in four of the 10 children. The familial nature of the disease, which has not previously been described, is documented.

Branchio-oto-renal dysplasia and branchio-oto dysplasia: report of eight new cases.

Eight new cases of "ear-pits-deafness syndrome" are reported here; in particular, the audiometric and tomographic findings of the ear and renal echography are discussed. Although it is difficult to give a nosologic definition of the syndrome, these cases can be classified as branchio-oto-renal dysplasia and branchio-oto dysplasia.

The thyroid gland with low uptake lesions: evaluation by ultrasound.

An ultrasound examination was performed in 401 patients who had isotopically cold, solitary lesions of the thyroid gland. Of the parameters studied, the level of echoes was the most useful in making the sonographic diagnosis: the rate of malignancy was extremely low both in hyperechoic and echo-free lesions. The presence of a peripheral, complete "halo" appeared to be helpful in differentiating benign lesions from malignant lesions. Approximately 20-25% of the lesions thought to be solitary on the radionuclide study were found to be multinodular on US. When fine-needle aspiration biopsy was used with US the need for surgical exploration of the thyroid gland was obviated in selected cases.

Halometasone cream by day and halometasone ointment at night for the treatment of patients with chronic psoriasis vulgaris.

In an open non-comparative trial forty-three hospitalized patients with chronic psoriasis vulgaris were treated with 0.05% halometasone cream (without dressing) by day and 0.05% halometasone ointment (with occlusive dressing) at night. This combined regimen yielded good to very good results in 93.1% of the patients treated. The trial treatment was fairly well tolerated, did not have any systemic adverse effects and had to be discontinued in only one patient, due to severe pustular eruption at the site of application.