Contrast-enhanced ultrasound findings in soft-tissue lesions: preliminary results

OBJECTIVES

There is currently no widely available, minimally invasive first-level examination that allows physicians to identify soft-tissue lesions that are likely to be malignant. The aim of this pilot study was to explore the potential suitability of dynamic contrast-enhanced ultrasound (DCE-US) for this purpose.

MATERIALS AND METHODS

23 patients were referred to the Veneto Oncological Institute for work-up of superficial soft-tissue lesions. Fourteen lesions were examined with CEUS and enhancement kinetics was analyzed. Subsequently, all lesions were surgically removed and subjected to histological analysis.

RESULTS

The 14 lesions included in the study were histologically classified as malignant (n = 7) or benign (n = 7, including 3 schwannomas). A statistically significant difference between benign and malignant lesions was found in terms of mean times to peak enhancement intensity (p = 0.03) but not mean filling times (FT). When schwannomas were analyzed as a separate group, their mean FT was found to be significantly different from that of the other benign lesions (p = 0.001) and from that of the group comprising other benign lesions as well as malignant lesions (p < 0.005).

CONCLUSIONS

CEUS with analysis of contrast-enhancement kinetics is a relatively low-cost, minimally invasive imaging technique, which appears to be a potentially effective first-level method for identifying suspicious soft-tissue masses.

Guideline for the management of pediatric idiopathic constipation and soiling. Multidisciplinary team from the University of Michigan Medical Center in Ann Arbor

OBJECTIVE

To develop an evidence-based guideline for the primary pediatric care of children (birth to 18 years old) with idiopathic constipation and soiling.

DATA SOURCES

References were identified through a MEDLINE search from January 1975 through January 1998 to address 3 focus questions: (1) the best path to early, accurate diagnosis; (2) best methods for adequate clean-out; and (3) best approaches to promote patient and family compliance with management.

DATA SELECTION

Twenty-five references were identified.

DATA EXTRACTION

References were reviewed by a multidisciplinary team and graded according to the following criteria: randomized controlled trial; controlled trial, no randomization; observational study; and expert opinion. Evidence tables were developed for each focus question.

DATA SYNTHESIS

An algorithm and clinical care guideline were developed by consultation and consensus among team members. Emphasis was placed on methods to promote early identification of pediatric idiopathic constipation and soiling, to recognize points of referral, and to increase patient and family compliance with treatment through use of education, developmentally based interventions, and variables for tracking success of management.

CONCLUSION

An algorithm and guideline for pediatric idiopathic constipation and soiling are presented for use by primary care physicians.

Efficacy of anterior gastric fundoplication in the treatment of gastroesophageal reflux in infants and children

Anterior gastric fundoplication (AGF) has been performed at the University of Michigan since 1988. To objectively evaluate the long-term efficacy of the AGF, the authors performed a study of children who had undergone AGF between June 1988 and June 1990 (n = 46). Six of them died of unrelated causes. Twenty-two consented to follow-up evaluation that included parental interview, physical examination, upper gastrointestinal series (UGI), 24-hour esophageal pH probe monitoring (EpH), and a liquid-phase gastric emptying study. Twenty patients (74%) remained asymptomatic, and only one child required reoperation. Four asymptomatic patients exhibited gastroesophageal reflux (GER) by UGI, and three others by EpH. Three children were noted to have delayed gastric emptying. These results compare favorably with data previously reported from this institution of a 5-year follow-up of children after Nissen fundoplication. There is a trend toward improved efficacy (87% v 74%; P = .12), decreased reoperation rate (4% v 14%; P = .11), and less severe complications. The present study shows that AGF is effective treatment for GER when evaluated by objective studies and is comparable in therapeutic efficacy and safety to the Nissen fundoplication.

Comparison of oxygen consumption, carbon dioxide production, and resting energy expenditure in premature and full-term infants

A newly developed closed circuit water-sealed infant calorimeter has been used to measure oxygen consumption (VO2), carbon dioxide production (VCO2), respiratory quotient (RQ) and resting energy expenditure (REE) in 31 infants. There were 17 full-term and 14 premature infants. VO2 was measured volumetrically, keeping the inspired oxygen concentration constant. VCO2 was determined by infrared analysis of the mixed expired gases. Values for REE and RQ were calculated from measurements of VO2 and VCO2. All values were normalized for the infants body weight. Our findings demonstrate significant differences in VO2, VCO2, and REE associated with weight, gestational age, postnatal age, activity, feeding, and sex. In addition, VO2, VCO2, and REE were significantly higher for the premature infants. The water-sealed indirect calorimetry system: (a) is safe and noninvasive, (b) does not interfere with infant tube feeding or IV infusion, (c) permits long-term monitoring of metabolic activity, and (d) allows a more exact matching of oral and intravenous feedings to actual energy expenditure. We are finding that indirect calorimetry removes the guess work from writing daily caloric regimens, with potential advantage for the treatment of sick infants.

Airway compression by a right aortic arch in the absence of a vascular ring

This case describes the diagnosis and successful management of an unusual form of respiratory distress in an infant with tetralogy of Fallot. Severe compression of the airway resulted from a large right aortic arch in the absence of a vascular ring.