Treat, follow-up, or discharge? An aid in sonographic decisions for the borderline centered neonatal/infantile hips.

Aim: To investigate whether linear measurements or ratios on the Graf's "standard plane" ultrasound images of the neonatal/infantile hip, can support the clinically important differentiation between type I and type II hips. Material and methods: A total of 60 Graf type II hips and 124 randomly selected Graf type I hips, matched to the gestational age at delivery, birth weight, delivery mode, and age at the time of the examination, were identified through our hip screening service, during a period of two years. The images were diagnostically suitable, following anatomical identification and usability check, according to Graf. Anatomical landmarks including the lower limb of the os ilium, the bony rim, the silhouette of the os ilium, the labrum and the femoral head's borders, were used to determine the measurements and ratios which quantified their inter-relationships. Results: The indices which differed significantly between type I and type II hips included: (a) the width of the "bony roof" (cut-off value 5.91 mm, sensitivity: 75%, specificity: 70%), (b) the ratio of the width of the "bony roof" to the femoral head's width (cut-off value 0.40, sensitivity 83%, specificity 71%), and (c) the ratio of the cartilaginous acetabular roof's width (including the labrum), to the width of the femoral head (cut-off value 0.450, sensitivity 82%, specificity 67%). Conclusions: Newly introduced measurements and calculated ratios on "standard plane" ultrasound images can be used as additional indices in the differentiation between Graf's types of "centered hips", thus increasing the diagnostic certainty of the examiner in borderline cases and limiting unnecessary re-examinations or treatment.

The odontoid process: various configuration types in MR examinations.

PURPOSE: Several developmental anomalies have been described with respect to the odontoid process. The purpose of the study was to describe the MR appearance of the odontoid process and to calculate the prevalence of its morphological variants. METHODS AND MATERIALS: We retrospectively reviewed 133 patients (85 males and 48 females, age range of 19-81 years, mean 39.5), examined within a 7-year period. Patients were divided into two age groups: ≤30 and >30-year-old. The morphology of the odontoid process was classified into type I: pyramidal tip and type II: ovoid or convex tip. The incidence of os odontoideum and os terminale and the presence of longitudinal cleft were also recorded. Fischer's exact test was used for statistical analysis (p < 0.05). RESULTS: Type I was identified in 54 cases (40.6 %) and type II in 79 cases (59.4 %). Os odontoideum was recorded in one case (0.7 %), os terminale in 24 cases (18 %) and the presence of a longitudinal cleft (partial or complete) in 86 cases (64.7 %). Type I showed a higher prevalence in the ≤30 age group (p < 0.05). No differences were shown between sexes. CONCLUSION: The configuration types of odontoid process are reported herein. The clinical relevance of this morphological variation needs to be elucidated with further studies.

Thyroid gland metastasis from small cell lung cancer: an unusual site of metastatic spread.

Metastasis to the thyroid gland is uncommon compared with the frequency of primary thyroid tumors. The primary sites of metastatic thyroid tumors usually include the breast, lung, kidney and stomach. Among lung cancer types metastasizing to the thyroid, adenocarcinomas are the commonest followed by squamous and large cell carcinomas. Small cell lung carcinoma has not been frequently reported to cause thyroid metastatic deposits. Herein, we describe a patient with small cell lung cancer who developed metastatic lesions to the thyroid and brain simultaneously. Thyroid ultrasonography-guided fine-needle aspiration cytology (US-FNAC) and particularlyimmunocytochemistry documented metastasis from primary lung cancer. Clinical, cytopathological and therapeutic aspects of this unusual site of extrathoracic metastatic disease are discussed laying special emphasis on the paramount importance of the immunocytochemistry in distinguishing primary thyroid tumors from thyroid metastasis due to lung cancer.