The incidence of thyroid abnormalities in adults irradiated for lymphoma

The aim of the study was to investigate the incidence of thyroid abnormalities in neck irradiated lymphoma patients. Of the 298 patients who had irradiation to the neck for lymphoma between 1966-1988, 174 were found to be alive and free of disease. These patients were invited to participate in the study. From the 174, 93 were able to participate (group 1). Two control groups were recruited; both were sex and aged matched. One group (group 2) consisted of lymphoma patients who were treated with chemotherapy (n=39) or irradiation to areas other than the neck (n=16). The other group (group 3) consisting of healthy volunteers (n=35) recruited from hospital staff and minor surgery attendees, had never had lymphoma or radiotherapy. All participants were required to complete a past medical history and thyroid symptom questionnaire, had blood taken for assays of thyroid stimulating hormone (TSH), thyroglobulin antibodies, thyroid peroxidase antibodies, sodium iodide symporter antibodies and TSH receptor antibodies and underwent ultrasound and clinical examination of the neck. A significant percentage of patients who had been irradiated in the neck had abnormalities on ultrasound, compared to groups 2 and 3 (77% vs 42% vs 24%). Abnormal TSH levels were found to be significantly more common in neck irradiated patients compared to the other groups (50% vs 9% vs 5%). There is a clear difference between neck irradiated patients and control groups. The importance of screening irradiated patients for thyroid abnormalities is re-emphasised.

Lung function tests and risk factors for pneumonia in adults with chickenpox

BACKGROUND

Varicella is 25 times more likely to be complicated by pneumonia in adults than in children. Data on changes in lung function following pneumonia are limited. This study was undertaken to describe the epidemiological factors associated with pneumonia and to investigate lung function up to 1 year following chickenpox.

METHODS

Thirty eight consecutive suitable patients admitted to a university hospital were enrolled in the study; 19 had pneumonia and 19 did not. Epidemiological data and density of rash were recorded, spirometric tests were performed, and carbon monoxide transfer factor was measured.

RESULTS

Varicella pneumonia was associated with the presence of respiratory symptoms (p=0.006), current smoking (p=0.003), and history of close contact (p=0.009). There was a trend towards patients with pneumonia having a more severe rash. No association was observed between pneumonia and age or sex. Current smokers had a higher mean number of spots than non-smokers (p=0.005). Carbon monoxide transfer factor at hospital discharge was reduced in 27 patients (71%), more markedly in the group with pneumonia (p=0.009). Nine patients (seven with pneumonia) still had a reduced carbon monoxide transfer factor (mean reduction 36%) at 12 months.

CONCLUSION

Chickenpox may result in a defect in carbon monoxide transfer factor for at least a year after acute illness.

Renal arteriovenous malformation mimicking hydronephrosis

Color and spectral Doppler sonography revealed that a patient believed to have hydronephrosis actually had a renal arteriovenous malformation. Although rare, such a misdiagnosis could have serious implications. In the case described here, there was a coexisting carcinoma of the colon, which required staging and could have led to complications for percutaneous intervention. This case illustrates that color Doppler sonography can be used to establish a diagnosis of arteriovenous malformation.

Case report: chronic osteomyelitis demonstrated by high resolution ultrasonography

Ultrasound is a well established method of imaging for many systems of the body. The physical properties of bone do not usually lend themselves to ultrasonic investigation, due to the reflection of sound waves at a soft tissue/bone interface. However, the periosteum, early new bone formation and soft tissue changes alongside dense bone may be imaged. The diagnosis of osteomyelitis is usually made using a combination of plain radiography, nuclear medicine and computed tomography, although magnetic resonance imaging is also proving to be of value. The use of sonography has occasionally been recorded in acute osteomyelitis. We present a case of chronic osteomyelitis in which the features were clearly shown ultrasonographically.

Haemorrhoids are associated not with hypertrophy of the internal anal sphincter, but with hypertension of the anal cushions

A combined manometric and ultrasonographic study of the internal anal sphincter was carried out in 20 patients with haemorrhoids and 20 age-matched normal controls. Mean(s.e.m.) basal anal pressure was significantly higher in patients than in controls, 62(4) versus 45(6) cmH2O (P less than 0.05), although there were no significant differences in mean maximum basal and squeeze pressures. During rectal distension 90 per cent of patients showed no reduction in anal pressure in the outermost anal channel, although the internal sphincter electromyogram was suppressed and the external sphincter electromyogram did not necessarily increase above baseline. The mean(s.e.m.) maximum residual pressure was significantly higher in patients, 70(6) versus 45(6) cmH2O (P less than 0.05). Direct pressure measurement in anal cushions exhibited abnormally high median pressure in patients compared with controls, 35 versus 10 cmH2O (P less than 0.001). Pressures recorded during coughing and straining were also significantly higher in patients than in controls (P less than 0.001). Ultrasonographic study of the anal canal revealed a clear image of the internal sphincter, the thickness of which could easily be measured. The mean(s.e.m.) thickness of the sphincter was not significantly different, 2.3(0.2) versus 2.1(0.1) mm, between patients with haemorrhoids and controls (P = 0.18). The absence of any significant differences in the internal sphincter thickness between normal subjects and patients with haemorrhoids suggests that the high anal pressure in patients with haemorrhoids is of vascular origin.

Case report: the ultrasound diagnosis of enterocutaneous fistula

The sonographic diagnosis of post-operative enterocutaneous fistula is presented. This has not previously been reported in the English literature.

Case report: the ultrasound and Doppler appearances of pelvic varices

Dilatation of the veins of the broad ligament and ovarian plexi cause a very specific clinical entity called the pelvic congestion or pelvic pain syndrome. The ultrasound and Doppler appearances of this condition are unique and should be easily recognized. We describe these appearances in one patient and review the literature.

A sonographic appearance of testicular lymphoma

The sonographic findings in two cases of testicular lymphoma are presented. Both show hypoechoic striations radiating out from a hypoechoic mediastinum testis. This appearance has not previously been described and may represent infiltration along the lymphatics within the testis.

Ultrasound in the investigation of the right iliac fossa mass

Patients presenting with a right iliac fossa (RIF) mass are a diagnostic problem. The objective of this study was to assess the role of ultrasound (US) in their investigation. A prospective series of 50 patients presenting with a clinically suspected RIF mass was examined by US and the finding correlated with the final diagnosis. There was a positive finding in 34 patients (68%). Ultrasound correctly identified the organ of origin in 33 (97%) and was able to guide the patients' further management. In 12 cases no abnormality was found in the RIF, of which 11 had no positive findings at follow-up and one was shown to have an unrelated abnormality at laparotomy. In four cases the findings were due to normal variants. Ultrasound is the imaging modality of first choice in patients presenting with a RIF mass.

The complications of high brachial artery puncture

Fifty-two angiograms via a high brachial puncture were performed in Sheffield from 1986 to 1988 in patients in whom femoral artery catheterization was not possible or was contraindicated. Follow-up was obtained in 49 procedures. The procedure was initially successful in 43 cases. Twelve patients developed haematomas, graded large in 5, but no intervention for haematoma was required. The radial pulse was diminished or absent at the end of examination in four patients; three of these patients had no associated ischaemia, the pulse returning spontaneously within 24 hours, although remaining chronically reduced in one patient. One patient developed ischaemia due to acute occlusion of the brachial artery--this was successfully treated with immediate angioplasty. Paraesthesiae in the median nerve distribution were noted in two patients. These resolved spontaneously and no permanent neurological problem was seen. We conclude that high brachial artery puncture is a useful alternative when femoral artery puncture is not possible.

Early myositis ossificans: a new echographic sign

A case of soft tissue swelling of the thigh in which myositis ossificans developed is presented. A series of ultrasound examinations showed previously unreported changes which suggested the diagnosis. The use of ultrasound and other imaging modalities in this condition are discussed and the ultrasound appearances are related to the histology.

Comparison of low-osmolar contrast media in cardiac angiography

Two hundred and twenty-five patients investigated by left ventricular, coronary artery and/or proximal aortic angiography were randomly assigned to one of three contrast medium groups (Hexabrix 320, Niopam 300 or Omnipaque 300). Subjective response to injection of contrast medium was noted at the time of investigation and during the next 24 h. No significant difference was found between the three currently available low-osmolar contrast media.