Usefulness of pulsed Doppler of lymph nodes in diagnosis of cervical lymphadenitis

Svrha ovog rada bila je istražiti vrijednost Dopplera u razlikovanju uzroka uvećanja limfnih čvorova vrata i vrijednost sniženja vaskularnog otpora kao specifičnog znaka limfadenitisa. Dopplerska analiza spektara s mjerenjem indeksa otpora (RI), indeksa pulzatilnosti (PI), vršne sistoličke brzine (PSV) i krajnje dijastoličke brzine (EDV) učinjena je u 98 bolesnika s metastatskim, limfomskim, upalnim ili normalnim limfnim čvorovima. Rezultati su uspoređeni s nalazom citologije i histologije ili s kliničkom prezentacijom i praćenjem bolesnika. Značajne razlike RI i PI nađene su između svih skupina osim između limfomskih i normalnih limfnih čvorova. Specifičnost od 100% za metastaze je nađena za granične vrijednosti RI > 0,80 i PI > 1,80. Pozitivna prediktivna vrijednost od 100% za akutni limfadenitis je dokazana za granične vrijednosti RI 9 cm/s ima 100% negativnu prediktivnu vrijednost, a EDV 0.80 and PI > 1.80. Positive predictive value of 100% for acute lymphadenitis was shown for cutoff values RI 9 cm/s has 100% negative predictive value and EDV < 1 cm/s has 100% specificity and positive predictive value for metastases. Although differences in RI, PI, PSV and EDV between different nodal diseases were found, only extreme cutoff values are helpful in differential diagnosis. The finding of very low vascular resistance is valuable in prediction of inflammatory etiology of lymphadenopathy

ULTRASOUND GUIDED PERCUTANEOUS SCLEROTHERAPY OF SIMPLE RENAL CYSTS: PRIMARY SUCCESS AND PROCEDURE SAFETY

Svrha: Procijeniti primarni (tehnički) uspjeh i sigurnost procedure perkutane skleroterapije jednostavnih cista bubrega vođene ultrazvučno 96%-tnim etanolom. Bolesnici: 17 bolesnika sa simptomatskim jednostavnim cistama bubrega upućenih od nefrologa ili urologa. Metode: Perkutana punkcija ciste vođena UZ-om s 18 G (gauge) iglom i »pigtail« kateterom debljine 5 F (French), drenaža i inspekcija sadržaja ciste te instilacija etanola. Rezultati: Kod 2 upućena bolesnika punkcija nije učinjena zbog ciste Bosniak II i blizine hilusa bubrega. U 15 bolesnika učinjene su punkcija i drenaža sadržaja ciste. U 4 bolesnika etanol nije instiliran zbog gustog ili krvavog sadržaja ciste, blizine hilusa bubrega i jake boli pri pokušaju instilacije etanola. U 11 bolesnika uspješno je učinjena sklerozacija ciste. Prosječna veličina sklerozirane ciste bila je 8 cm (raspon 6 – 12 cm). Nije bilo znatnijih komplikacija. Zaključak: Perkutana sklerozacija jednostavnih cista bubrega vođena UZ-om lako je izvediva i za bolesnika sigurna metoda, uz prethodnu dobru selekciju cista pogodnih za sklerozaciju.Objective: To evaluate primary (technical) success and procedure safety in ultrasound (US)-guided percu­taneous sclerotherapy of simple renal cysts, using 96% ethanol. Patients: 17 patients with symptomatic simple renal cysts referred by nephrologists or urologists. Methods: US-guided percutaneous puncture of the cyst with an 18G (gauge) needle and a »pigtail« 5F (French) catheter, drainage and inspection of the cyst content, and injection of ethanol. Results: Puncture was rejected in two referred patients because of Bosniak II cyst and renal hilum proximity. 15 patients underwent puncture and drainage of the cyst content. In 4 patients ethanol was not injected because: thick or bloody cyst, proximity of renal hilum and severe pain during injection of ethanol. 11 patients underwent sclerotherapy of the cyst. The average size of sclerosed cyst was 8 cm (range 6–12 cm). There were no significant complications. Conclusion: US-guided percutaneous sclerotherapy of simple renal cysts is easy to perform and safe procedure, with the previous good selection of cysts that are suitable for the sclerotherapy

Neočekivani ishod kod liječene bolesnice s gonadnom disgenezom

Hormone replacement therapy is mandatory to maintain quality of life and bone mineralization status in patients with gonadal dysgenesis. Occasionally, these patients need higher than recommended estrogen dosage to prevent signs and symptoms of hypoestrogenic state. Our 18-year-old female patient with XY sex reversal syndrome was gonadectomized and administered conventional hormone replacement therapy. Gonadoblastoma was found in the excised streak gonad. Five years after continuous replacement therapy, the patient reported unexpectedly hot flushes and amenorrhea in spite of regular hormone intake. Severe osteopenia was also detected. Unconventionally high estrogen dose was given with additional daily vitamin D and calcium supplement. Dual energy x-ray absorptiometry revealed lesser but evident osteopenia and the patient reported repeated bleeding without hot flushes on the new hormone regimen. Individualized dosage of estrogen is essential for these patients according to their bone status and subjective symptoms. Early therapy initiation along with continuous and frequent evaluation of bone status and quality of life is advised.U bolesnica s disgenezom gonada liječenje hormonskom nadomjesnom terapijom potrebno je kako bi se očuvala kvaliteta života te primjerena mineralizacija koštanog tkiva. U liječenju je ponekad potrebno primijeniti višu dozu estrogena od preporučene kako bi se spriječili znaci i simptomi hipoestrogenemije. Prikazuje se osamnaestgodišnja bolesnica s čistom disgenezom gonada, liječena standardnom hormonskom nadomjesnom terapijom u koje je učinjena gonadektomija. Unutar fibrotičnog gonadnog tračka nađen je gonadoblastom. Bolesnica je liječena kontinuiranom hormonskom nadomjesnom terapijom pet godina, nakon čega je naglo razvila amenoreju te valove vrućine. Denzitometrijom se dokazala teška osteopenija. Bolesnica je potom liječena visokim dozama estrogena uz dodatak vitamina D i kalcija svakodnevno. Denzitometrijom se i dalje verificirala postojana osteopenija, ali manje izražena. Uspostavljena su redovita krvarenja bez valova vrućine tek uz tromjesečni režim hormonske terapije (estradiol 3 mg/3 mjeseca i didrogesteron 10 mg/posljednjih 14 dana). U bolesnica s čistom disgenezom gonada uputno je rano započeti s hormonskim liječenjem uza stalne i česte kontrole statusa koštanog tkiva i kvalitete života. Nužan je individualni pristup hormonskom nadomjesnom liječenju ovisno o subjektivnim smetnjama i statusu koštanog tkiva

ULTRASOUND GUIDED PERCUTANEOUS SCLEROTHERAPY OF SIMPLE RENAL CYSTS: PRIMARY SUCCESS AND PROCEDURE SAFETY

Svrha: Procijeniti primarni (tehnički) uspjeh i sigurnost procedure perkutane skleroterapije jednostavnih cista bubrega vođene ultrazvučno 96%-tnim etanolom. Bolesnici: 17 bolesnika sa simptomatskim jednostavnim cistama bubrega upućenih od nefrologa ili urologa. Metode: Perkutana punkcija ciste vođena UZ-om s 18 G (gauge) iglom i »pigtail« kateterom debljine 5 F (French), drenaža i inspekcija sadržaja ciste te instilacija etanola. Rezultati: Kod 2 upućena bolesnika punkcija nije učinjena zbog ciste Bosniak II i blizine hilusa bubrega. U 15 bolesnika učinjene su punkcija i drenaža sadržaja ciste. U 4 bolesnika etanol nije instiliran zbog gustog ili krvavog sadržaja ciste, blizine hilusa bubrega i jake boli pri pokušaju instilacije etanola. U 11 bolesnika uspješno je učinjena sklerozacija ciste. Prosječna veličina sklerozirane ciste bila je 8 cm (raspon 6 – 12 cm). Nije bilo znatnijih komplikacija. Zaključak: Perkutana sklerozacija jednostavnih cista bubrega vođena UZ-om lako je izvediva i za bolesnika sigurna metoda, uz prethodnu dobru selekciju cista pogodnih za sklerozaciju.Objective: To evaluate primary (technical) success and procedure safety in ultrasound (US)-guided percu­taneous sclerotherapy of simple renal cysts, using 96% ethanol. Patients: 17 patients with symptomatic simple renal cysts referred by nephrologists or urologists. Methods: US-guided percutaneous puncture of the cyst with an 18G (gauge) needle and a »pigtail« 5F (French) catheter, drainage and inspection of the cyst content, and injection of ethanol. Results: Puncture was rejected in two referred patients because of Bosniak II cyst and renal hilum proximity. 15 patients underwent puncture and drainage of the cyst content. In 4 patients ethanol was not injected because: thick or bloody cyst, proximity of renal hilum and severe pain during injection of ethanol. 11 patients underwent sclerotherapy of the cyst. The average size of sclerosed cyst was 8 cm (range 6–12 cm). There were no significant complications. Conclusion: US-guided percutaneous sclerotherapy of simple renal cysts is easy to perform and safe procedure, with the previous good selection of cysts that are suitable for the sclerotherapy

Radiološka snimanja u trudnoći

There are many false assumptions, both in the general population and among physicians, regarding the influence of radiation on pregnant patients and the fetus during diagnostic procedures, in spite of scientific facts based on studies. These false assumptions are mostly based on the idea that every diagnostic procedure using ionizing radiation is a cause for serious concern and that artificial abortion as a possible solution might be considered. We analyzed data from counseling of pregnant patients exposed to ionizing radiation during diagnostic procedures in the Merkur University Hospital during a 4-year period. In this period, 26 patients presented for counseling after exposure to diagnostic ionizing radiation during pregnancy. Results showed most of these patients to have been exposed to radiation between the 2nd and 3rd week of gestation (36%), between the 4th and 5th week 32%, before the 2nd week 24%, and after the 6th week of gestation less than 8%. To provide reasonable estimate of fetal doses, Report No. 174 from the National Council on Radiation Protection and Measurements (NCRP) was used. Data from the Report include estimate of the fetal dose from direct and indirect exposures. Th e mean doses were up to 0.01 cGy in 46.2%, 0.01-0.15 cGy in 19.2%, 0.2-1 cGy in 26.9% and 1 cGy or more in 7.7% of patients. None of the counseled patients had medical indication for abortion, even though in a small percentage of patients abortion was a personal subjective decision. Considering that there are no Croatian guidelines for counseling patients exposed to ionizing radiation during pregnancy, it is recommended to use the International Commission on Radiological Protection guidelines in the management of pregnant patients exposed to ionizing radiation.Usprkos znanstvenim spoznajama temeljenim na dugogodišnjim studijama utjecaja zračenja u dijagnostičke svrhe na trudnicu i plod o toj temi vladaju zablude kako u općoj populaciji tako i među liječnicima. Te se zablude odnose uglavnom na razmišljanje o svakoj dijagnostičkoj pretrazi koja rabi ionizirajuće zračenje kao o razlogu za ozbiljnu zabrinutost i razmatranje artificijelog pobačaja kao mogućeg rješenja. Analizirali smo podatke savjetovanja trudnica ozračenih u dijagnostičke svrhe u KB Merkur kroz razdoblje od 4 godine. U tom razdoblju savjetovalo se 26 trudnica ozračenih u dijagnostičke svrhe u našoj ustanovi. Rezultati su pokazali da je najveći broj trudnica, njih 36%, ozračen između 2. i 3. tjedna gestacije, između 4. i 5. tjedna 32%, do 2. tjedna 24%, a iznad 6. tjedna gestacije njih manje od 8%. Za izračun fetalnih doza korišten je Izvještaj 174 Nacionalnog vijeća za zaštitu od zračenja i mjerenja zračenja. Podaci iz izvještaja omogućuju procjenu doze izračun koje uzima u obzir izravnu i neizravnu izloženost za sve postupke. Prosječne doze bile su: do 0,01 cGy kod 46,2%; 0,01-0,15 cGy kod 19,2%; 0,2-1 cGy kod 26,9%; 1 cGy i više kod 7,7% trudnica. Niti jedna savjetovana trudnica nije imala medicinsku indikaciju za pobačaj, makar je u malom postotku slučajeva pobačaj bio osobna subjektivna odluka. S obzirom na to da ne postoje hrvatske smjernice za savjetovanje trudnica ozračenih u dijagnostičke svrhe preporuka je koristiti smjernice ICRP vezane za medicinske indikacije pobačaja kod određenih doza zračenja

The Possibilities and Limitations of Direct Digital Radiography, Ultrasound and Computed Tomography in Diagnosing Pleural Mesotelioma

The goal of this study was to compare the possibilities and limitations of direct digital radiography of the chest (DDR), the use of ultrasound of the chest (US) and single slice computed tomography of the chest (CT) in diagnosing pleural mesothelioma. The study was conducted during the course of one year, on 80 patients who were successively referred to a specialized institution, under clinical suspicion of mesothelioma. The method of investigation was the comparison of findings, obtained by the reviewed methods of examination, with the pathohistologic results of a biopsy performed on each patient. The findings that were obtained by the enumerated methods were classified according to the radiologic signs that were found in each individual patient. We evaluated following radiological findings (signs), on each of the investigated methods: plaques, localized and generalized pleural thickenings, calcifications of the pleura, pleural effusions, parapneumonic effusions, pleural empyema, (round) atelectasis, pneumothorax, tumor mass or node, inflammatory infiltrate, elevation of the hemidiaphragm and osteolysis. The results of these were compared with pathohistologic findings and analyzed by means of standard statistical methods. The highest sensitivity was found for CT (94.4 %), followed by US (92.6%), and by DDR (90.7%). The highest specificity was obtained with DDR (46.2 %), followed by CT (35.5%) and US (23.8%). The comparison of these methods showed 90% diagnostic accuracy for DDR in relation to CT. CT as an individual method best satisfied most of the criteria for diagnosing mesothelioma. No pathognomonic radiologic sign for mesothelioma was found

The Possibilities and Limitations of Direct Digital Radiography, Ultrasound and Computed Tomography in Diagnosing Pleural Mesotelioma

The goal of this study was to compare the possibilities and limitations of direct digital radiography of the chest (DDR), the use of ultrasound of the chest (US) and single slice computed tomography of the chest (CT) in diagnosing pleural mesothelioma. The study was conducted during the course of one year, on 80 patients who were successively referred to a specialized institution, under clinical suspicion of mesothelioma. The method of investigation was the comparison of findings, obtained by the reviewed methods of examination, with the pathohistologic results of a biopsy performed on each patient. The findings that were obtained by the enumerated methods were classified according to the radiologic signs that were found in each individual patient. We evaluated following radiological findings (signs), on each of the investigated methods: plaques, localized and generalized pleural thickenings, calcifications of the pleura, pleural effusions, parapneumonic effusions, pleural empyema, (round) atelectasis, pneumothorax, tumor mass or node, inflammatory infiltrate, elevation of the hemidiaphragm and osteolysis. The results of these were compared with pathohistologic findings and analyzed by means of standard statistical methods. The highest sensitivity was found for CT (94.4 %), followed by US (92.6%), and by DDR (90.7%). The highest specificity was obtained with DDR (46.2 %), followed by CT (35.5%) and US (23.8%). The comparison of these methods showed 90% diagnostic accuracy for DDR in relation to CT. CT as an individual method best satisfied most of the criteria for diagnosing mesothelioma. No pathognomonic radiologic sign for mesothelioma was found

Low-dose Computed Tomography in a Pregnant Woman with a Ruptured Pseudoaneurysm of the Abdominal Aorta

Imaging the pregnant patient presents a unique challenge to radiologist due to the risk of radiation to the conceptus (embryo/fetus). A rare case of a successfully recognized and treated pseudoaneurysm (PA) of the abdominal aorta is to be presented. The pseudoaneurysm occurred in the third trimester and had a favorable outcome for the mother and the baby. Emergent abdominal ultrasound (US) is the first modality in diagnostic algorithm for the rupture of aortic aneurysm in a pregnant woman. It provides the most rapid diagnostic information, although intestinal gas and abdominal tenderness may limit its accuracy. To confirm the findings, magnetic resonance angiography (MRA) or CT angiography (CTA) can be used. In our case, the diagnosis was established using a color Doppler ultrasonography of the abdomen and was later confirmed by a low dose CT scan of the abdominal aorta. MRA in such cases have some disadvantages. At many health centers, the monitoring of patients with acute ruptures is more difficult in the MR suite than at the CT scanner. MRA angiographic images are also subject to degradation by multiple artifacts, and the visualization of the distal vasculature is suboptimal and inferior to the one done by CTA. Due to fetal movements, a small quantity of fresh blood can be overlooked by MR. MRA is often not available on a 24-hours basis, and the time required for making a diagnosis can preclude the use of MRA in an unstable patient. For this reason, we used a low dose CTA protocol to confirm the diagnosis. Low dose scanning protocols in CT can obtain sufficient diagnostic information while reducing the risk of radiation. A particular focus is put on the outline of new concepts for dose management and optimization. We used new approaches based on tube current modulation. The birth was induced by an urgent Caesarean section followed by a resection of a pseudoaneurysm and a reconstruction of the aorta with an end-to- end vascular prosthesi

The possibilities and limitations of direct digital radiography, ultrasound and computed tomography in diagnosing pleural mesotelioma [Mogućnsoti i ograničenja direktne digitalne radiografije, ultrazvuka i kompljutorizirane tomografije u dijagnostici mezotelioma pleure]

The goal of this study was to compare the possibilities and limitations of direct digital radiography of the chest (DDR), the use of ultrasound of the chest (US) and single slice computed tomography of the chest (CT) in diagnosing pleural mesothelioma. The study was conducted during the course of one year, on 80 patients who were successively referred to a specialized institution, under clinical suspicion of mesothelioma. The method of investigation was the comparison of findings, obtained by the reviewed methods of examination, with the pathohistologic results of a biopsy performed on each patient. The findings that were obtained by the enumerated methods were classified according to the radiologic signs that were found in each individual patient. We evaluated following radiological findings (signs), on each of the investigated methods: plaques, localized and generalized pleural thickenings, calcifications of the pleura, pleural effusions, parapneumonic effusions, pleural empyema, (round) atelectasis, pneumothorax, tumor mass or node, inflammatory infiltrate, elevation of the hemidiaphragm and osteolysis. The results of these were compared with pathohistologic findings and analyzed by means of standard statistical methods. The highest sensitivity was found for CT (94.4 %), followed by US (92.6%), and by DDR (90.7%). The highest specificity was obtained with DDR (46.2 %), followed by CT (35.5%) and US (23.8%). The comparison of these methods showed 90% diagnostic accuracy for DDR in relation to CT. CT as an individual method best satisfied most of the criteria for diagnosing mesothelioma. No pathognomonic radiologic sign for mesothelioma was found

Safety of radiographic imaging in pregnancy

There are many false assumptions, both in the general population and among physicians, regarding the influence of radiation on pregnant patients and the fetus during diagnostic procedures, in spite of scientific facts based on studies. These false assumptions are mostly based on the idea that every diagnostic procedure using ionizing radiation is a cause for serious concern and that artificial abortion as a possible solution might be considered. We analyzed data from counseling of pregnant patients exposed to ionizing radiation during diagnostic procedures in the Merkur University Hospital during a 4-year period. In this period, 26 patients presented for counseling after exposure to diagnostic ionizing radiation during pregnancy. Results showed most of these patients to have been exposed to radiation between the 2nd and 3rd week of gestation (36%), between the 4th and 5th week 32%, before the 2nd week 24%, and after the 6th week of gestation less than 8%. To provide reasonable estimate of fetal doses, Report No. 174 from the National Council on Radiation Protection and Measurements (NCRP) was used. Data from the Report include estimate of the fetal dose from direct and indirect exposures. Th e mean doses were up to 0.01 cGy in 46.2%, 0.01-0.15 cGy in 19.2%, 0.2-1 cGy in 26.9% and 1 cGy or more in 7.7% of patients. None of the counseled patients had medical indication for abortion, even though in a small percentage of patients abortion was a personal subjective decision. Considering that there are no Croatian guidelines for counseling patients exposed to ionizing radiation during pregnancy, it is recommended to use the International Commission on Radiological Protection guidelines in the management of pregnant patients exposed to ionizing radiation