[Use of transrectal ultrasound and magnetic resonance imaging in the staging of early-stage cervical cancer]. / Vyuzití transrektálního ultrazvukového vysetrení a magnetické rezonance ve stagingu casných stadií zhoubného nádoru delozního hrdla.

OBJECTIVE: The goal of this study was to compare the accuracy of magnetic resonance imaging (MRI)--a standard method--and transrectal ultrasound (TRUS) in the staging and determination of significant prognostic parameters in early-stage cervical cancer. The following prognostic parameters were evaluated: identification of residual tumor in the cervix after cone-biopsy, tumor volume, and early parametrial infiltration. DESIGN: Prospective study. SETTING: Oncogynecological Center, Department of Obstetrics and Gynecology, General Faculty Hospital of Charles University, Prague. METHODS: Patients referred to Oncogynecological Center from January 2004 to February 2006, in whom early-stage cervical cancer (T1a1-T2a) was diagnosed by clinical examination, were prospectivelly enrolled in the study. Only those patients who were examined by both MRI and TRUS with following surgical treatment were included. Imaging results were compared with pathology findings. RESULTS: Data from 95 patients were evaluated. The accuracy of tumor detection in 95 patients was 93.7% for TRUS and 83.2% for MRI (P < or = 0.006). In small tumors (< or = 1 cm3), the accuracy of tumor detection by TRUS was 90.5% and 81.1% by MRI (P < or = 0.049). The accuracy of parametrial infiltration detection by TRUS and MRI was 98.9% and 94.7%, respectively (P < or = 0.219). The accuracy was not influenced by body mass index values. CONCLUSION: Our results show TRUS achieving comparable or even higher accuracy than the more commonly used MRI in staging of early-stage cervical cancer.

Transrectal ultrasound and magnetic resonance imaging in staging of early cervical cancer.

The goal of this study was to determine the sensitivity, specificity, and accuracy of transrectal ultrasound (TRUS) in comparison to magnetic resonance imaging (MRI) in the evaluation of tumor volume, early parametrial infiltration, and identification of residual tumor in early-stage cervical cancer. Patients in whom an early-stage cervical cancer was diagnosed by clinical examination were enrolled in the study. Only those patients who were examined by both MRI and TRUS with following surgical treatment were included. Imaging results were compared with pathology findings. Altogether, 120 patients were consecutively enrolled from January 2004 to February 2006. Data from 95 patients were evaluated. Correlation coefficient for TRUS- and MRI-derived volumes versus volumes at pathology reached R = 0.996 and R = 0.980, respectively. The accuracy for detecting tumor in 95 patients was 93.7% for TRUS and 83.2% for MRI (P

[Blood pressure, functional and morphological study of kidneys in children with autosomal dominant polycystic kidney disease]. / Krevní tlak, funkcní a morfologické vysetrení ledvin u detí s autozomálne dominantním polycystickým onemocnením ledvin.

BACKGROUND: Autosomal dominant polycystic kidney disease is one of the most common inherited disorders with a prevalence of 1:1000 and is responsible for cca 10% of end-stage renal disease in adult patients. Renal insufficiency is a rare symptom of ADPKD in children, however, there are some symptoms, which can occur already in childhood. The aim of this study was to detect early signs of renal damage and to reveal the blood pressure profile in children with ADPKD using ABPM (ambulatory blood pressure monitoring). METHODS AND RESULTS: 32 children (aged 3.4-19.4 years, mean age 12.3)-carriers of PKD-gene with normal GFR, diagnosed on the basis of a positive family history and characteristic ultrasound features, and in 21 cases also indirect DNA analysis revealed positive results. 11/32 children (34%) presented arterial hypertension detected by ABPM (values higher than 95th centile of normal individuals). The mean of ABPM values of all patients was significantly higher than normal children (p < 0.01), 76% patients had values above the 50th centile. Signs of renal damage (proteinuria, microalbuminuria, decreased renal concentrating capacity, pathological excretion of tubular markers) were found in 22-64% of investigated children. Significantly higher renal volume and renal length were found in more than 1/3 of the children, renal volume and length higher than the mean of healthy children in about 90% of patients and a significant correlation between ABPM parameters and renal length and volume (p < 0.05). CONCLUSIONS: The results of this study show, that the signs of renal damage and arterial hypertension occur relatively often in children with ADPKD despite still normal GFR. This justifies the early diagnosis of ADPKD especially as it reveals the most important treatable complication of ADPKD-arterial hypertension. These findings emphasise the importance of early diagnosis in children from families with ADPKD. Probably, early treatment of hypertension could even postpone the otherwise common end-stage renal damage in adult patients with ADPKD. Careful follow up of all children with ADPKD is strongly recommended, above all the blood pressure should be controlled.

[Abdominal lymphangiomas in childhood]. / Abdominální lymfangiomy v detském veku.

The authors evaluate their experience with the diagnosis and treatment of abdominal lymphangiomas during the period of 1995-1999. During the above period 6 girls and 4 boys with abdominal lymphangiomas were operated. The mean age at the time of operation was 5 years and 8 months. Ultrasonographic examination was made in all 10 patients, CT examination in 8. The surgical finding was lymphangioma of the mesenterium 4x, of the omentum 2x, of the adrenals 2x of the retroperitoneum 1x and intestinal lymphangiomatosis 1x. Macroscopically complete extirpation of the lymphangioma was possible in 9 patients and called for resection of the gut 3x and for adrenalectomy 2x. In one patient subtotal extirpation was performed. Postoperative follow-up did not reveal a relapse in any of the children. Abdominal cystic lymphangiomas are rare benign malformations of the lymphatic system. For preoperative differential diagnosis in typical cases USG is sufficient. The therapeutic method is complete surgical extirpation which is associated with a low incidence of relapses.

Ambulatory blood pressure monitoring in children with unilateral multicystic dysplastic kidney.

UNLABELLED: Multicystic dysplastic kidney (MCDK) is one of the most common congenital renal anomalies. Arterial hypertension is a potential complication of MCDK. Blood pressure (BP) has so far been measured only casually and the frequency of hypertension has been estimated to be between 0%-8%. Ambulatory blood pressure monitoring (ABPM) provides more precise information on BP than the casual BP measurement. The aim of this study was to investigate the BP profile in children with MCDK using ABPM. A group of 25 children (16 girls), with a mean age of 7.8 years (range 3.8-17.7 years) were investigated. ABPM was performed using the oscillometric SpaceLabs 90207 device. Hypertension was defined as mean systolic and/or diastolic BP during the day and/or in the night exceeding 95th percentile for ABPM. Five (20%) children showed hypertension, two of them had combined daytime and night-time hypertension and three had isolated nocturnal hypertension, although daytime BP was between the 90th-95th percentile in two of them. Children with ultrasonographical and/or laboratory signs of contralateral kidney abnormalities showed a higher incidence of hypertension than those without abnormalities (two of four versus 3 of 21). The mean night-time systolic and diastolic BP of children with MCDK was significantly higher than in healthy children (+ 0.50 and + 0.54 SDS, respectively, P = 0.012 and 0.03, respectively). Three of the hypertensive children were already nephrectomised. All five hypertensive children showed ultrasonographical and/or laboratory signs of contralateral kidney abnormalities. Hypertensive children had significantly higher microalbuminuria than normotensive children (6.9 +/- 3.2 mg/mmol creatinine versus 1.8 +/- 0.7, P = 0.03). The nocturnal BP fall (dip) was attenuated in five children, only one of whom was hypertensive. CONCLUSION: Arterial hypertension in children with multicystic dysplastic kidney is seen more often if based on ambulatory blood pressure monitoring than on casual blood pressure recordings. The main risk factor for developing hypertension is contralateral kidney damage. Ambulatory blood pressure monitoring should be performed in children with multicystic dysplastic kidney, especially in those with contralateral kidney abnormalities.

Blood pressure and renal function in autosomal dominant polycystic kidney disease.

The purpose of this study was to identify hypertension in children and adolescents in an early stage of autosomal dominant polycystic kidney disease (ADPKD) by the application of ambulatory blood pressure monitoring (ABPM) over 24 h; 32 children and adolescents (mean age 12.3 +/- 4.7 years) were examined. The diagnosis was based on family history and ultrasound examination. In 21 children ADPKD was confirmed by molecular genetic analysis. At the time of the study, 45% patients were asymptomatic and all had glomerular filtration rates (GFRs) > or = 65 ml/min per 1.73 m2. By ABPM, 11 patients (34%) were defined as hypertensive (systolic or diastolic blood pressure > 95th percentile), including 4 with an exclusive nocturnal hypertension. Of 7 patients with daytime hypertension, 4 had normal blood pressure by casual measurements. The nocturnal dip in blood pressure was reduced in 2 patients. Blood pressure correlated with renal size, but not with GFR, concentrating capacity, proteinuria, and plasma renin activity. The study reveals an early trend for increased blood pressure in children with ADPKD, requiring close supervision.