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.

[Diagnostic imaging in primary hyperparathyroidism. Radiological techniques: US--CAT--MR]. / Diagnostica per immagini nell'iperparatiroidismo primitivo.

This study aims to clarify the diagnostic value of ultrasonography, computerised tomography and magnetic resonance in adenomatous pathology of primary and persistent hyperparathyroidism. Although the diagnostic efficacy of the various imaging techniques is still the subject of current debate, the latest specific surgical techniques, require their use either individually or in association, in order to achieve faster and safer surgery. After an overview of the various methods, illustrating their indications and diagnostic limitations, the authors emphasise that the role played by ultrasonography, CAT and MR justifies their use in the preoperative localisation of parathyroid adenoma. It is not possible to assert in absolute terms that one methods is better than another, but each offers different potential. The use of US as the method of choice is indicated in primary hyperparathyroidism with hyperplastic glands owing to its innocuous nature and rapidity. In addition to US and scintigraphy, magnetic resonance may be appropriate in primary hyperparathyroidism with adenomatous glands. In persistent forms of primary hyperparathyroidism, magnetic resonance is the most reliable method, whereas CT and, to an even greater degree, ultrasonography play a marginal role.

Clinical approach in patients with metastatic differentiated thyroid carcinoma and negative 131I whole body scintigraphy: importance of 99mTc MIBI scan combined with high resolution neck ultrasonography.

AIMS AND BACKGROUND: The aim of this study was to define the clinical impact of MIBI scan combined with neck ultrasonography on the detection of metastates in differentiated thyroid carcinoma (DTC) patients with elevated serum Tg levels but negative 131I scan (non-functioning DTC). METHODS AND STUDY DESIGN: Eighty-two patients with non-functioning DTC, 19 patients with 131I-positive metastases (functioning DTC), and 24 DTC patients who were disease free after therapy (no cancer patients) were enrolled. 131I scan was performed after administration of low diagnostic and high therapeutic tracer doses. Early and delayed images were obtained after MIBI injection. Neck-chest CT scan and/or MRI were also performed in patients with non-functioning DTC. RESULTS: In the group of non-functioning DTC patients, metastatic foci were detected in 71/82 cases: in the cervical lymph nodes in 51 cases (sensitivity 94.1% with MIBI, 90.2% with US, 35.3% with CT/MRI), mediastinal lymph nodes in 31 cases (sensitivity 100% with MIBI, 58% with CT/MRI), lungs in 8 cases (sensitivity 100% with both MIBI and CT/MRI), and bone in 2 cases (sensitivity 50% with MIBI, 100% with MDP bone scan). Among the 19 patients with functioning DTC a close relationship between MIBI and 131I findings was observed. As regards the 24 tumor-free patients, MIBI was correctly negative in all cases, while US visualized enlarged cervical lymph nodes that were suspected to be neoplastic but proved to be inflammatory lesions at cytology in three patients. CONCLUSIONS: On the basis of these data, MIBI scan combined with neck US could be proposed as a first-line diagnostic imaging modality in the follow-up of DTC patients with elevated serum Tg levels and negative 131I scan.

[Ultrasonography in the study of lesions of the menisci and the collateral ligaments of the knee. Findings in 48 surgically treated patients]. / L'ecografia nello studio delle lesioni meniscali e dei legamenti collaterali del ginocchio. Riscontro su 48 casi operati.

The authors report the results of the study of 48/112 patients who underwent US examination of the knee for gonalgia. Meniscopathy or capsular-ligamentous lesions were clinically suspected. US results were compared with arthroscopic or athrotomic findings; the latter two methods were considered as the reference gold standard. US exhibited 81.2% overall diagnostic accuracy, thus confirming its limitations, more evident than those of arthroscopy and arthrography, CT and MR imaging. Major limitations of US were its failed recognition of meniscal tears smaller than 5-6 mm, and its failed distinction of degenerative meniscopathies from common meniscal fractures (with the exception of 2 cases). Moreover, US did not allow cruciate ligament lesions to be demonstrated; however, in all these cases, US did demonstrate increased capsular thickness (greater than 3 mm at the lower margin of femoral condyle). This indirect sign, together with roudness of parameniscus and capsular-ligamentous limitans (at the hemirhyme), and the direct sign of inhomogeneous hyperechogenicity of the meniscal triangle (normally hypoechoic) contributed to raising overall diagnostic accuracy of US to 89.9%. In the 5 patients with a suspected lesion of the medial collateral ligament examined within 48 hours from trauma, US gave 2 false-positive results in 2 cases where forced abduction test was also positive. Massive edema and swelling of adjacent structures prevented the correct evaluation of ligament limitans. In these 2 cases, a lesion in the anterior cruciate ligament was found at surgery; one of them was associated with a meniscal lesion already diagnosed at US. Both parameniscal and popliteal cysts were correctly diagnosed with US. Due to the well-known limitations of clinics in the diagnosis of knee pain, US could be suggested as the examination of choice to evaluate suspected meniscopathy or ligamentous lesions, thanks to its low cost and short execution time. The use of US could also spare the patients more invasive examinations--e.g., arthroscopy and arthrography--and more expensive ones--e.g., CT and MR imaging.

[Diagnosis of deep venous thrombosis of the legs: accuracy of ultrasonography using vein compression]. / Diagnosi di trombosi venosa profonda degli arti inferiori: accuratezza dell'ecotomografia con compressione venosa.

We prospectively compared real-time US findings with venographic results in the legs of 171 consecutive outpatients with clinically suspected deep venous thrombosis (DVT). In each leg the common femoral and the popliteal veins were evaluated with venography and US. The two examinations were independently performed and reviewed. Vein compressibility (VC), intraluminal echogenicity and response to Valsalva maneuver were evaluated with US. Venography detected DVT in 54/171 legs. 10/54 legs had isolated distal DVT. With VC, US was 100% specific, 87% sensitive and 96% accurate. 6/7 false negative US studies were due to isolated distal DVT; therefore US sensitivity for proximal DVT was 98%. The other two US diagnostic criteria were much less accurate than VC. VC-US is an accurate, cheap and reproducible test for the detection of DVT in symptomatic outpatients.

[The side effects of phlebography of the lower extremities using iohexol. A prospective study]. / Effetti collaterali della flebografia degli arti inferiori con ioexolo. Studio prospettico.

In this prospective study 463 consecutive outpatients, who had undergone phlebography because of clinically suspected deep venous thrombosis (DVT) were examined with clinical follow-up and impedance plethysmography to evaluate the rate of contrast media complications. Seventy-nine patients had immediate and mild side effects, and one had moderate side effects (bronchospasm); no patient suffered from severe life-threatening conditions. There was only one case of DVT which occurred after an initially negative phlebography. In a subgroup of 40 patients, who underwent iodine-125-fibrinogen scanning after phlebography, the study was positive in 9 cases. None of them presented with any evidence of DVT at follow-up phlebography. Contrast phlebography with iohexol is a safe and comfortable procedure. Low-osmolality nonionic contrast media are well tolerated by the patient.

[Meniscal injuries of the knee: arthrographic and echographic study]. / Le lesioni meniscali del ginocchio: studio artrografico ed ecografico.

In order to evaluate the diagnostic capabilities of sonography (US) in meniscal lesions of the knee, 65 unquestionable cases of meniscopathy at arthrography were studied with high-resolution US. In 92% of the cases, inhomogeneous echo structure was demonstrated in correspondence with pathological meniscus, with irregular hyperechoic areas and, in some cases, with hyperechoic lines corresponding to the tear. 40% of patients presented with tumefaction and external bulging of the parameniscal region, while in 87% of the cases the articular capsule was thickened. These results confirm that, as reported by some authors, US is a promising method for the study of meniscopathies. We therefore believe that US could nowadays be at least employed as a complement to clinical examination, while its diagnostic capabilities are further assessed through other studies.

Detection of deep-vein thrombosis by real-time B-mode ultrasonography.

In 220 consecutive outpatients with clinically suspected deep-vein thrombosis of the leg, we compared contrast venography with real-time B-mode ultrasonography, using the single criterion of vein compressibility with the ultrasound transducer probe. The common femoral and popliteal veins were evaluated for full compressibility (no thrombosis) and noncompressibility (thrombosis). Both veins were fully compressible in 142 of the 143 patients with normal venograms (specificity, 99 percent; 95 percent confidence interval, 97 to 100). All 66 patients with proximal-vein thrombosis had noncompressible femoral veins, popliteal veins, or both (sensitivity, 100 percent; 95 percent confidence interval, 95 to 100). For all patients (including 11 with calf-vein thrombi), sensitivity and specificity were 91 (95 percent confidence interval, 82 to 96) and 99 percent, respectively. The sensitivity for isolated calf-vein thrombosis was only 36 percent. The compression ultrasound test was repeated in a subset of 45 consecutive patients by a second examiner, unaware of the results of the first test, whose results agreed in all patients with those of the first examiner (kappa = 1). We conclude that ultrasonography with the single criterion of vein compressibility is a highly accurate, simple, objective, and reproducible noninvasive method for detecting proximal-vein thrombosis in outpatients with clinically suspected deep-venous thrombosis.

[High-resolution echography of the neck. Preoperative evaluation of lymph node metastases in patients with thyroid carcinoma]. / Ecografia ad alta risoluzione del collo. Valutazione preoperatoria delle metastasi linfonodali nei pazienti con carcinoma tiroideo.

Twenty-six patients with papillary and 4 with medullary thyroid carcinoma were examined by HRUS before surgery in order to evaluate its accuracy in detecting lymph node metastasis (N) of the neck from thyroid carcinoma. All patients underwent total thyroidectomy and nodal dissection. HRUS was accurate in 73% of cases in N staging, while clinical staging was accurate in 60% of cases only. In 50% of patients HRUS provided with interesting additional information, such as disclosing lymphadenopathy in 8 patients with no clinical evidence, proving nodal involvement in 5 cases, and showing extranodal extension in 5 cases. HRUS allowed the observation of anechoic necrotic areas and microcalcified nodes. On the other hand, according to our results, HRUS cannot either discriminate metastatic from benign nodal involvement, or identify mediastinal adenopathy. False negatives are possible due to micrometastatic areas in normal size nodes. Nevertheless, HRUS proved to be a valuable aid to complete clinical examination of the neck, and a good guide for the surgeon during nodal neck dissection.

[A simple method of studying cruciate ligaments in arthrography]. / Un semplice metodo per lo studio dei legamenti crociati in artrografia.

After a review of the methods employed for arthrographic visualization of cruciate ligaments (CL), the authors present a new technique to separately study the anterior and posterior CL during traction. This technique enables to obtain a good visualization of CL and a good diagnostic accuracy; it can radiographically demonstrate a pathologic sagittal instability of the knee; it is easy to perform and is easily repeatable in different patients.

[Pathology of the residual urachus: a congenital anomality of possibly late clinical onset]. / Patologia dei residui uracali: anomalia congenita a possible espressione clinica tardiva.

The authors report on two rare case urachal residue disease of late onset. They define the pathogenic factors contributing to the disease and describe the semeiological and radiological methods used in diagnosing the condition.

[Echography in the diagnosis of spontaneous hematoma of the rectus muscle]. / L'ecografia nella diagnosi dell'ematoma spontaneo del muscolo retto.

After a brief explanation of the pathogenesis and of the clinical picture of spontaneous rectus muscle hematoma, the Authors describe 9 diagnosed cases by ultrasonography. The various echographic appearances of this disease are described and the importance of ultrasonography for a correct diagnosis and to avoid unnecessary laparotomy is emphasized.