Zastosowanie ultrasonografii w okulistyce dziecięcej : technika badania i możliwości obrazowania gałki ocznej u wcześniaków i niemowląt

Background: Ultrasonography, a safe, repeatable, and easy examination, is used as the first method in the diagnosis of the ophthalmologic diseases in infants. This examination is also important in visualizing the vitreous body, retina, chorioidea, and the orbit as well as opaque structures of the eyeball. Among the methods using ultrasound waves in pediatric ophthalmology, the most common are real-time ultrasonography and the color Doppler technique. Material/Methods: In 2002-2005, ultrasonographic examinations were performed on 1162 children aged 3 weeks to 12 months, of whom 1135 (97.7%) were preterm and 27 (2.3%) term infants. The real-time ultrasonograhic examination was conducted using a 5-7 MHz sector probe and a 7.5-10.5 MHz linear probe. However, in cases of difficult diagnosis, the color Doppler technique was applied. In all, 4549 ultrasound examinations were performed. Results: In the premature group, the normal image of the eyeball was diagnosed in 1057 (91%) children. In 78 cases (6.7%), typical changes for retinopathy as well as changes in the vitreous body were found. In 27 children (2.3%) eyeball changes were observed as results of other ophthalmic disorders. The normal images of the eyeball in newborns in real-time US as well as in color Doppler US were presented. Conclusions: Ultrasonographic examination, particularly color Doppler, being safe and not time-consuming, could be the method of choice in ophthalmologic diagnostics in infants and, especially, premature newborns

Clinical usefulness of color Doppler imaging in the management of the neck region vessels in patients with intraocular tumors : preliminary report

Background: The purpose of the study was to assess the clinical usefulness of color Doppler ultrasonography (CDU) examinations of the neck vessels in patients with intraocular tumors as well as to establish whether the changes in these vessels had an influence on further ophthalmologic procedures. Material/Methods: Clinical ophthalmological examinations such as visual acuity, anterior segment and ocular fundus, as well as color Doppler ultrasonography of the bulbar and neck region vessels were performed on 38 patients, aged 44-70 years with eyeball tumors. Localization, size, vascularization of the intrabulbar tumors and big vessels of the neck region were analyzed. Results: In 28 patients, choroidal melanoma was identified, and the vascularity of tumor mass was monitored in 10 patients after brachytherapy. Compression or infiltration of jugular veins or carotid artery were not observed. Severe internal carotid artery stenosis due to arteriosclerosis was detected in 5 patients, but no one was suggested to be operated on first in Vascular Surgery Department. Conclusions: Color Doppler ultrasonography should be the first choice technique in the neck vessels and intrabulbar tumors imaging. Visualization of the mass lesions vascularity and the evaluation of amplitude of blood flow velocity allows to monitor the effectiveness of their therapy. It was found that this technique is useful in deciding upon the method of treatment in patients with coexisting arteriosclerosis

Zastosowanie ultrasonografii w okulistyce dziecięcej : diagnostyka chorób oczu u wcześniaków i niemowląt

Background: Ultrasonographic (US) examinations in ophthalmology play a major role as one of the additional examination modes in the diagnostics of orbital diseases, and in cases of changes of a vascular origin it is useful in the evaluation of blood flow velocity. The special value of this examination in the assessment of the opaque optical structures on the fundus of the eye is emphasized. The aim of the study was 1) to present the ultrasonographic images and the efficacy of the method in the evaluation of some congenital and acquired bulbar diseases and 2) on the bases of the advantages of the examination, to determine whether ultrasonography could be included as a screening method in the diagnostics of preterm infants as well as a method of choice in term infants with ophthalmologic diseases. Material/Methods: One thousand sixty-two children between the ages of 3 weeks to 12 months, of whom 1135 were preterm and 27 term infants, with ophthalmologic changes were examined. A real-time ultrasonographic apparatus with color Doppler (5-7.5 MHz sectoral and 7.5-10 MHz linear transducers). The US examinations of preterm infants were conducted four times and in term infants twice. Results: In 105 children (8.99%) and in 184 eyes, premature retinopathy, intra-bulbar tumors, retinal ablation, posttraumatic changes, inflammatory processes in the posterior chamber of the eyeball, and congenital anomalies of the bulbar structures were diagnosed. Conclusions: Bulbar ultrasonography, being a safe, quick, and efficient examination, should be included as an additional screening method in preterm infants. Ultrasonography with color Doppler is an efficient method of choice for diagnosing problematic diseases of the eyeballs of infants

Use of color Doppler ultrasonography in primary vasospastic syndrome and assessment of ocular blood flow in patients with transient monocular blindness

Background: Transient monocular blindness (TMB) may appear as a consequence of vasospasm called the primary vasospastic syndrome. Because of pathogenesis of this disorder it is an essential diagnostic procedure in evaluation of hemodynamic disturbances in eyeball circulation system in group of TMB patients. The aim of this study was to investigate the changes in eyeball circulation in patients with TMB, using colour Doppler ultrasound imaging method (CDI). Material/Methods: 89 patients (59 women and 30 men) aged 34 to 56 (avg. 49.53, sd 3.15) with symptoms of transient blindness were examined using Acuson 128XP apparatus and sector probe frequency of 7.5 MHz. In ophthalmic artery (OA), central retinal artery (CRA) and short posterior temporal ciliary artery (SPTCA), the following parameters of blood flow were determined: peak systolic velocity (PSV, m/s), peak end - diastolic velocity (EDV, m/s), vascular pulsation index (PI) and resistance index (RI). The determined blood flow parameters were compared with the same blood flow indicators in the group of healthy individuals, matched for sex and age with the study group. T-Student test was applied in the statistical analysis of the differences between studied ocular blood flow parameters. In case of lack of normal variance, non - parametric U-Mann-Whitney test was used. Results: Statistical diminishing of average values of PSV (p =0.0001) in CRA and SPTCA; RI (p = 0.0001 in CRA and p = 0.0003 in SPTCA) and PI (in OA p = 0.0005, in CRA p = 0.0001, in SPTCA p = 0.0004) of examined eyes in comparison to healthy subjects was revealed. Peak-diastolic and mean velocities did not indicate statistically relevant difference in the control group. Conclusions: The statistically significant decrease of peak systolic parameters of blood flow velocity, pulsation and resistance indices in eyeball arteries were observed in patients with transient monocular blindness. Color Doppler ultrasonography was an effective and helpful method in assessing blood flow changes of eyeball microcirculation in transient monocular blindness

Problems in diagnostics of breast diseases

Background: The aim of the study was to determine the diagnostic problems encountered in breast diseases, their causes as well as the methods of the procedure in such cases. Material/Methods: Clinical and mammographic examinations were conducted in 5445 women aged 35-70 years. The patients were divided into 3 groups: group I comprised 4200 patients after screening (aged 50-69 years), group II - 915 (aged 40-49) and group III - 330 high-risk patients. Additional sonomamography was performed in 336 women (8%) in group I, 192 (21%) in group II and on all the patients in group III. Anamnesis, palpation, mammography (MMG) in 2 projections and magnified X-rays were performed. In cases of an unclear image the following procedures were undertaken: sonomammography (USG), fine needle aspiration (FNA), mammotomy and surgical biopsy The MMG and USG images were evaluated in BI-RADS scale. The false positive and false negative results were established. Results: In group I, 228 FNA biopsies (5.4%) were carried out, 55 cancers (1.3%), 32 false positive, 5 false negative radiological results were diagnosed. In II group 21 women underwent FNA, false positive radiological diagnoses occurred in 14 cases. In group III comprising 60 women who had undergone FNA, 18 cancers were observed. These proved false positive diagnosis in 8 cases and false negative in 4 cases. It was found, that the most common reasons for error were due to dense cysts displaying with irregular outlines and microcalcifications accompanying hormonal dysfunction. The displacement of tumors near the pectoral muscle or the nipple also interfered with establishing the correct diagnosis. Conclusions: The diagnostic problems can be due to the inherent limitations of the methods, the physical nature of the breast and localization of the changes. The diagnosis of the benign process should be established on the basis of radiological, cytological and histopathological methods. The radiologically unclear changes should be diagnosed with the use of FNA/ core biopsy, mammotomy or surgical biopsy. In cases of hormonal dysfunctions and during the conservative treatment, follow-up after 6 months is suggested

Association between Asymptomatic Unilateral Internal Carotid Artery Stenosis and Electrophysiological Function of the Retina and Optic Nerve

Purpose. This study was designed to assess retinal and optic nerve bioelectrical function in patients with unilateral asymptomatic but hemodynamically significant internal carotid artery stenosis (ICAS). Methods. Forty-two subjects with a diagnosis of unilateral ICAS and 34 controls were analyzed. Full-field electroretinogram (ERG), pattern electroretinogram (PERG), and pattern visual-evoked potentials, as well as optical coherence tomography and ophthalmological examination, were performed. Data analysis included eyes ipsilateral to ICAS (EIS) and eyes contralateral to ICAS (ECS). Results. Intraocular pressure was significantly decreased in EIS and ECS compared to that in the controls. In the macula, both the cube average thickness and cube volume values were significantly reduced both in EIS and ECS compared to those in the controls. Similarly, PERG P50 and N95 wave amplitudes were significantly smaller in EIS and ECS compared to those in the controls. The ERG rod b-wave and rod-cone a-wave amplitudes were decreased, and implicit times were significantly prolonged, whereas the OP wave index was reduced in EIS compared to that in the controls. No differences in IOP, OCT, or ERG and PERG parameters were identified between EIS and ECS. Conclusions. Our study demonstrated that retinal bioelectrical function is negatively affected by ICAS despite the absence of objective clinical signs and symptoms of ocular ischemia

Badania ultrasonograficzne tarczycy u pacjentek obciążonych występowaniem nowotworów rodzinnych

Background: Detection of new gene mutations, which increase the risk of neoplasm (e.g. breast and thyroid gland) improves the examinations that can help in early diagnosis and quick treatment. The aim of this study was to assess the frequency of asymptomatic focal lesions in ultrasonographic examinations of women at confirmed risk of family neoplasm aggregation. Material/Methods: A total of 445 women aged 25-60 years were examined in 2004-2005. 278 patients descended from families with higher frequency of confirmed risk of familial neoplasm (I group), 167 belonged to the control group. Ultrasonographic examinations of the breast and thyroid gland were performed in all women. Patients were divided into selected groups depending on the kind of changes. Results: In the analyzed material asymptomatic focal changes in the thyroid gland were found in 46, 5% of the first group and 61,6% of the control group. The solid-cystic lesions in this material were ascertained in 36% of the first group and 51% of the second group. Conclusions: A large frequency (almost 50%) of the asymptomatic focal changes in thyroid glands were found. Detections of lesions were similar in both groups: the confirmed risk of familial neoplasm group and the control group. On the basis of these findings we can conclude, that it is reasonable to perform screening examinations of thyroid glands in connection with breast's diagnostics

Obrazy mammograficzne i sonomammograficzne raka sutka u pacjentek obciążonych genetycznie, w tym z wykrytą mutacją BRCA1

Background: Carriers o f the BRCA1 mutation have 50-80% increased risk o f breast cancer. Therefore it is necessary to perform screening examinations regularly, more frequently than in the normal population. We suggest beginning mammography at 35 years of age, which significantly increases the chance of early detection of the cancer. Material/Methods: A total of 293 women aged 20-60 years were analyzed. All the women were examined at the Hereditary Cancer Center. Mammography and sonomammography were performed on all patients. Mammograms of women who had undergone mastectomy were evaluated retrospectively. Results: Benign-like changes, such as dense cysts or fibroadenomas, in the carrier group of the BRCA1 gene mutation were found in 40.5% of the women. Dynamic growth of the tumor was symptomatic. In the remaining group of women, morphology o f the detected cancers revealed large, stagingdependent variability. Conclusion: On the basis of these findings we can conclude that cancer in women with the BRCA1 gene mutation can have a benign-like morphology, but with rapid tumor growth. Therefore all suspicious or atypical changes should be verified histopathologically