Lillemor Forsberg

Intracapsular pressure in transient synovitis of the hip

Fourteen consecutive children with symptoms of transient synovitis of the hip were examined with sonography regarding intracapsular effusion, with scintimetry regarding blood-flow in the proximal femoral epiphysis (PFE) and with intracapsular pressure recording and aspiration. All patients had an intracapsular effusion. Intracapsular pressure was found to depend on the position of the hip. The mean pressure with hips in extension and inward rotation was 22.6 kPa (170 mm Hg) whereas in 45 degrees of flexion it was 2.3 kPa. In two cases scintimetry demonstrated reduced blood flow to the PFE; after aspiration, isotope uptake returned to normal, indicating that increased intracapsular pressure has a harmful effect on circulation to the PFE. Children with transient synovitis should be treated with the hips in 45 degrees of flexion to reduce intracapsular pressure. Forcing the hip in extension causes a risk of ischaemia of the PFE.

Ultrasonography in Carcinoma of the Gallbladder Diagnostic Difficulties and Pitfalls

Gallbladder carcinoma (GBCA) is difficult to diagnose in its early stage by ultrasound (US) due to the non-specificity of various characteristics. In an investigation of 25 female patients (mean age 68.2 years) all with a histologic diagnosis of primary GBCA (adenocarcinoma) and a US examination prior to that, the correct diagnosis was only established in 11. The sensitivity was thus low (44%). The inability to differentiate GBCA from chronic cholecystitis (contracted gallbladder with stones) makes this US finding hazardous, and implicates a considerable risk of overlooking malignancy. A cholecystectomy without delay in these patients may lead to the discovery of further cases of GBCA in early stages.

Sonography, arthroscopy, and intracapsular pressure in juvenile chronic arthritis of the hip

Sonography was used in the preoperative evaluation of the hip joint in 14 patients with juvenile chronic arthritis (JCA). The joint capsule distension found at sonography and the intracapsular pressure were increased in patients with severe synovitis revealed at arthroscopy. Sonography and intracapsular pressure-recording can be recommended for assessments of synovitis of the hip joint in JCA.

Impotence, Smoking, and β-Blocking Drugs

Four patients complaining of erectile dysfunction and using tobacco or propranolol were examined with penile blood pressure measurements and Doppler recordings, calculating the penile acceleration ratio (PAR). After a change in regimen, erectile capacity was restored, PAR returned to normal, and blood pressure measurements revealed increased systolic penile blood pressure in three patients. The changes, especially in PAR, indicate a marked penile vascular reaction during smoking and beta-blocking treatment in these men.

Computed tomography and ultrasonography for diagnosis of hip joint effusion in children

Nineteen consecutive children with transient synovitis of the hip were examined for intracapsular joint effusion using computed tomography (CT) and ultrasonography (US). The two techniques were highly correlated in measurements of the anterior displacement of the joint capsule, indicating both to be reliable diagnostic tools. Such an effusion is clinically important because of the increase in intracapsular pressure with ensuing disturbance in the vascular supply to the proximal femoral epiphysis, as demonstrated experimentally and clinically in transient synovitis.

Liver biopsy complications monitored by ultrasound.

Ultrasound (US) was performed in 96 patients (on 108 occasions) 2-4 h after diagnostic liver puncture with a modified Menghini needle. Serious complications (major haemorrhages: one intraparenchymal and one into the abdominal cavity) were seen in two patients, while seven presented with minor bleedings though without any registered clinical abnormality (slight pain in one). On 11 occasions (10 patients) slight to moderate pain was observed though in combination with a normal US. Findings on US and clinical observations showed poor correlation and the number of bleeding complications discovered by US examination seems to depend upon when the study is performed. US does not replace the clinical follow-up but may be helpful in the presence of adverse clinical reactions in order to establish the type of lesion: profuse parenchymal haemorrhage versus bleeding into the abdominal cavity. This information may be helpful in the choice between conservative and surgical therapy.

Accuracy of radiological staging procedures in non-seminomatous testis cancer compared with findings from surgical exploration and histopathological studies of extirpated tissue

Preliminary and reviewed statements describing results from abdominal CT and US were compared with surgical findings and with the report from the histopathological investigation of extirpated retroperitoneal tissue. No false positive diagnoses of retroperitoneal metastases were made by CT investigation, while US made one false positive but revealed metastases in one patient overlooked by CT. The overall accuracies (correct answers/all patients) were 81% with CT and 80% with US (31 and 21 patients in Group I respectively). Surgical exploration alone was no more sensitive than either of the two other methods. CT and US are highly reliable when positive but the risks of obtaining false negative results are considerable.

Ultrasound, hepatic lymph nodes and chronic active hepatitis

Thirty-two consecutive patients with a histological diagnosis of chronic active hepatitis were examined with liver biopsy, laboratory tests and ultrasonography of the hepato-duodenal ligament to investigate the possible correlation between enlarged lymph nodes in the hepato-duodenal ligament and biochemical activity, histological activity and/or humoral immunoreactivity. We found a significant correlation between lymph-node size and serum alkaline phosphatase in the total material. In the hepatitis C-virus-associated group of patients a significant correlation between the size of the lymph nodes and gamma-glutamyl transpeptidase was found. In the autoimmune group there was a trend towards a negative correlation between lymph-node size and albumin.

Ultrasound examination of lymph nodes in the hepato duodenal ligament

The significance of finding lymph nodes in the hepato-duodenal ligament on ultrasound, with special emphasis on patients with inflammatory liver disease, has been evaluated. In one study a comparison was made with magnetic resonance imaging (MRI), which is another non-invasive imaging modality without the hazards of ionizing radiation. Lymph nodes in the hepato-duodenal ligament were found in benign as well as in malignant disease. In patients with abnormal biochemical test results regarding liver function, enlarged lymph nodes as the only pathological finding on ultrasound examination indicate the presence of chronic inflammatory liver disease and indicate the need for a liver biopsy. In patients with primary biliary cirrhosis, lymph node size, as well as changes in node size at a follow-up examination after two years, correlated with laboratory values reflecting cholestasis, hepatocellular damage and immunoreactivity. Changes in node size also correlated with changes in intralobular inflammation, as seen in the liver biopsies. In patients with chronic active hepatitis, a tendency towards a positive correlation between the size of the lymph nodes and laboratory values reflecting cholestasis and humoral immunoreactivity was seen, as well as a tendency towards an association with liver inflammation in the liver biopsies. These findings support our hypothesis that size and change in size of the hepatic nodes are valuable diagnostic parameters in patients with chronic liver diseases. Compared with basic low-field MRI (0.2 T), ultrasound seems superior for evaluation of lymph nodes in the liver hilus. (Less)

The Effect of Arthrocentesis in Transient Synovitis of the Hip in the Child: A Longitudinal Sonographic Study

Twenty-one children with transient synovitis of the hip were treated in two consecutive groups. In 12 patients aspiration of the synovial effusion was performed within 24 h of admission. In a second group of nine patients no aspiration was performed. There was no other difference in treatment. Joint effusion was studied sonographically in comparison with the nonsymptomatic contralateral hip. Sonography was performed immediately after admission, within 12 h after aspiration, and repeatedly during a follow-up period of up to 15 days. Following aspiration the capsular distention decreased to 49% but recurred within 24 h to 72% of the preoperative value. However, during the first 4 days of follow-up the capsular distention in the aspirated cases was significantly and permanently lower than in the nonaspirated cases. We conclude that arthrocentesis in the acute stage of transient synovitis of the hip in the child permanently reduces the intracapsular effusion.