Damir Miletić

Sonographic measurement of absolute and relative renal length in adults

The aim of this study was to evaluate sonographically measured absolute and relative lengths of normal kidneys according to subject height, sex, and age.

The role of nonenhanced magnetic resonance imaging in the early assessment of acute pancreatitis.

BACKGROUND AND AIMS:Computed tomography (CT), especially contrast-enhanced CT (CECT), provides important information on the severity and prognosis of acute pancreatitis (AP). Magnetic resonance imaging (MRI) has become a useful tool as an alternative to CT in the assessment of AP. The primary aim of our study was to determine the diagnostic value of nonenhanced MRI (NEMRI) to assess severity and predict outcome in patients with AP from the third to fifth day after admission. We also correlated MRI findings with CT and biochemical parameters.PATIENTS AND METHODS:The study included 101 patients (49 men, 52 women, median age 62 yr, range 20–82) with a diagnosis of AP admitted to our hospital between January 1, 2004 and June 31, 2005. The inclusion criteria consisted of a combination of clinical features, a typical case history, elevation of serum pancreatic enzymes, and diagnosis confirmed by imaging studies. Contrast-enhanced spiral CT exams were performed in all patients from the third to fifth day after admission, and Balthazar grade and CT severity index were calculated. All patients underwent NEMRI, and MR severity index (MRSI) was calculated. We also performed magnetic resonance cholangiopancreatography (MRCP) in all patients to detect bile duct lithiasis.RESULTS:Significant correlation between CECT and NEMRI was found for Balthazar grade (P < 0.001) and the assessment of pancreatic necrosis (P < 0.001), as well as between the combined severity indices (ρ = 0.819, P < 0.001). MRSI correlated with Ranson score (ρ = 0.656, P < 0.01), C-reactive protein (CRP) levels 48 h after admission (ρ = 0.502, P < 0.01), appearance of systemic complications (ρ = 0.576, P < 0.01), and length of hospital stay (ρ = 0.484, P < 0.01). Considering the Atlanta criteria as the gold standard and the Ranson score, no difference in sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of the two methods was observed. Comparing the group of patients with presumed acute pancreatic hemorrhage with the group of patients with severe AP, we found a significantly higher APACHE II score on the first day (P < 0.05), that the development of systemic complications was more frequent (P < 0.05), and that the hospital stay and ICU management of patients with MRI signs of pancreatic hemorrhage tended to be longer.CONCLUSION:NEMRI is comparable to CECT in the early assessment of the severity of AP, and both methods are equally efficient in predicting local and systemic complications of AP. MRI has a potential advantage over CT in detecting bile duct lithiasis and pancreatic hemorrhage.

Role of Magnetic Resonance Cholangiography in the Diagnosis of Bile Duct Lithiasis

Aim:The aim of our study was to assess diagnostic value of magnetic resonance cholangiography (MRC) in patients with suspected common bile duct (CBD) stones focusing on the capability of this noninvasive method to replace invasive diagnostic procedures in these patients and to limit the use of endoscopic retrograde cholangiography (ERC) to the patients who need simultaneous therapeutic intervention.Materials and methods:Single-shot fast-spin-echo rapid-acquisition thick-section MRC images were obtained in 310 patients recruited into this prospective study. There were 136 male and 174 female patients aged 21–95 years [mean ± standard deviation (SD) 64.9 ± 13.6 years]. Patients were subsequently classified into different risk groups (high, moderate, low) according to biochemical abnormalities or morphological features on abdominal ultrasonography and computed tomography. Direct cholangiography was the reference method of CBD evaluation.Results:CBD stones were diagnosed in 115 (37%) patients; 86 of 175 patients in the high-risk group, 24 of 83 patients in the moderate-risk group, and 5 of 50 patients in the low-risk group. In dependent risk groups, the mean CBD caliber was 9.7 ± 4.5, 7.1 ± 2.0, and 4.8 ± 1.2 mm, respectively. The difference was significant between all three groups (P < 0.05). The median size of CBD stones was 7 mm (range 3–21 mm). MRC achieved accuracy and positive and negative predictive values of 97%, 94%, and 98%, respectively.Conclusions:MRC has a potential to substitute diagnostic ERC in all patients with suspected choledocholithiasis due to its high accuracy, reducing invasive direct cholangiography to patients who require therapeutic intervention.

Role of magnetic resonance imaging and scintigraphy in the diagnosis and follow-up of osteomyelitis in cat-scratch disease

Abstract:  Cat‐scratch disease (CSD) is a self‐limiting infectious disease characterised with lymphadenopathy in a patient with a history of cat contact. Cases of bone involvement in patients with CSD are rare. We reported a case of 11‐year‐old boy with prolonged intermittent fever, inguinal lymphadenopathy and osteomyelitis. He had a history of exposure to kittens. The physical examination revealed a febrile boy without an apparent site of infection except an enlarged inguinal lymph node. Its histopathology demonstrated ganulomatous lesion with no presence of acid‐fast bacilli. Serum titers for Bartonella henselae were positive. Multiple bone lesions were detected by skeletal scintigraphy. Magnetic resonance imaging (MRI) confirmed and characterised osteolytic masses. The oral combination of azithromycin and rifampicin were given for 6 weeks with a good clinical response. At follow‐up, the boy was without symptoms or signs of the disease. Successive MRI controls showed gradual regression of the bone lesions together with significant decrease of acute‐phase reactants. In conclusion, CSD should be considered in the differential diagnosis of osteomyelitis. MRI is more reliable for the characterisation, evaluation of soft‐tissue extension and follow‐up of the bone lesions than scintigraphy. However, the later method permits an overview of the multiple osseous lesions. Therefore, standard MRI equipment may not exclude bone scintigraphy. Both methods are required until whole‐body MRI units become routine.

Resistance and pulsatility indices in acute renal obstruction

The aim of this study was to evaluate the reliability of Doppler waveform alterations in diagnosing acute unilateral renal obstruction.

Kidney length in postoperative acute renal failure

The aim of this study was to evaluate kidney length in patients with postoperative acute renal failure (PARF).

Lateral ventricle epidermoid

Lateral ventricle epidermoid Background. Epidermoids occurring within the lateral ventricles are rare. They are slow growing benign tumours, usually presented with non-specific signs of deterioration of mental functions. Case report. Authors present a case of 49-year-old woman with epidermoid located in the frontal part of lateral ventricle. She underwent magnetic resonance imaging before the surgical treatment and the final patohistological diagnosis. Conclusions. Suprasellar and intraventricular epidermoids are rare, but must be included in differential diagnoses as well as meningeomas, ependimomas, subependimomas and papillomas of the choroid plexus.

Rapid idiopathic osteolysis of the humeral head and clavicle

Idiopathic osteolysis is a very rare bone condition of unknown origin. The length of the illness usually lasts for several years. The purpose of this paper is to point out the possibility of severely rapid progression of idiopathic osteolysis and to contribute to a better understanding of the natural history of Gorham-Stout disease. We report the case of a 58-year old man whose right humeral head and lateral clavicle had disappeared as a result of massive osteolysis observed only six months after onset of the symptoms. Such rapid progression has not been reported previously. His physical examination was otherwise normal. Serum interleukin-6 (IL-6) was elevated and the other laboratory tests were normal. Radiography, computed tomography scan, bone scan, and magnetic resonance imaging (MRI) evaluation revealed extensive destruction of the right humeral head and lateral clavicle involving the acromioclavicular joint. Although the histologic features could not be confirmed because the patient refused a biopsy, it was felt that the patient satisfies the other diagnostic features of Gorham-Stout disease. Follow-up examinations revealed no further bone or soft-tissue involvement. Gorham-Stout disease should be considered in the differential diagnosis of such severely rapid progression of lytic bony lesions.

Dacryocystitis provoked by recurrence of extramedullary plasmacytoma of the orbit: a case report

Extramedullary plasmacytoma (EMP) of the orbit is an extremely rare tumor, which frequently manifests with nonspecific symptoms. In the case reported, the symptoms of relapsing dacryocystitis appeared before the diagnosis of orbital EMP in a 60-year-old man. Moreover, EMP of the right submandibular gland that had been excised and treated by radiotherapy preceded the orbital lesion by seven years. The present report emphasizes the importance of an extensive medical workup to rule out multiple myeloma or other malignant lymphoproliferative diseases, because their treatment and prognosis are very different. Additionally, it is necessary to consider all tumors that can provoke relapsing dacryocystits.

Bilateral fibular stress fracture in young female basketball player.

This report is a unique case of three stress fractures in a 14-year-old active female basketball player and we emphasize the importance of triple-phase bone scanning in differential diagnosis of the stress fracture. According to radiographic examination and laboratory tests, which were normal, the stress fracture of the right fibula was strongly suspected while making the diagnosis. Despite the treatment applied, recurrence, and deterioration of the symptoms were presented. Repeated laboratory test results were again normal, but the presence of an abundant periosteal reaction on the plain radiographs was confusing, so osteomyelitis or Ewing sarcoma of the fibula was suspected. We decided to perform a three-phase bone scanning; its findings were critical for the judgment and we diagnosed three stress fractures involving both fibulae. Final confirmation of the diagnosis of the bilateral fibular stress fractures in our case, however, was done by computed tomography examination.