[Jejunum diverticulosis--a rare cause of gastrointestinal hemorrhage]

In this case report the diagnostic difficulties of massive intestinal hemorrhage caused by diverticula of the small intestine are demonstrated. After resuscitation of the patient by transfusion of 8 units of packed red cells the segment of the jejunum bearing the diverticula was resected. There was no complication until discharge nor was any recurrent bleeding or functional disorder of the bowel reported during follow-up. The clinical presentation, the different value of diagnostic tools and the therapy are discussed.

Estimation of antithyroid drug dose in Graves' disease: value of quantification of thyroid blood flow with color duplex sonography

The purpose of this study was to evaluate if there is an association between the antithyroid drug dose that is needed to establish euthyroidism and thyroid blood flow measurements. A total of 23 Graves' disease patients with euthyroidism taking antithyroid drug therapy were enlisted to undergo spectral duplex sonography of the thyroid arteries and color-flow mapping of the thyroid gland. Color pixel density (CPD) was calculated with computer assistance from the color-flow maps. There was a strong correlation between the CPD and methimazole dose (rp = 0.79). Methimazole maintenance dosage could be predicted from CPD values with a coefficient of determination of 0.62. In conclusion, CPD measurements could be a useful tool for the clinical endocrinologist to estimate the antithyroid drug dose that is needed to maintain euthyroidism.

Real-time Compound imaging: Verbesserte Erkennbarkeit von Punktionsnadeln und Markierungsdrähten gegenüber Single-line- Ultraschall?

AIM

To compare the visibility of biopsy needles and localization wires using real-time compound imaging (SonoCT) and single-line ultrasound (SLU).

METHODS

14-18 G biopsy needles and 5 different localization wires with and without puncture needle were placed into cadaverous muscle in 4 different angulations (0, 12, 18 and 25 degrees). Sonography was performed with an ATL HDI 5000 sonography device with a 5-12 MHz linear array using single-line ultrasound and compound imaging with 3 and 9 frames (Comp3 and Comp9) from different viewing angles. Images of the needles were obtained in the longitudinal plane without changing depth, focus position, and gain settings between the measurements. The mean grey values of the needle (gv_n) and of the background (gv_b) were obtained from histograms. Contrast was calculated using the equation (gv_n-gv_b)/gv_b + gv_n). Mean contrast in single-line and compound images was compared for each angulation using a Student t-test.

RESULTS

The mean contrast at 0 degree was 0.686 in single-line ultrasound. This was significantly higher than in Comp3 (0.62) and Comp9 (0.633) (p < 0.05) images. At 12 degrees no significant differences could be observed. At 18 degrees image contrast was significantly higher in compound images with 0.493 (Comp3) and 0.498 (Comp9), compared to SLU (0.433) (p < 0.05). At 25 degrees the difference between compound images (Comp3: 0.394; Comp9: 0.402) and SLU (0.306) was greatest (p < 0.0001).

CONCLUSION

At 0 degree and 12 degrees visibility is very good for all tested materials. For steeper angulations contrast was partly critical in SLU and significantly enhanced with compound imaging. Thus, SonoCT may be useful to increase precision of ultrasound-guided percutaneous interventions.

Erlaubt das Tissue Harmonic Imaging eine frühe postoperative Schilddrüsenvolumetrie?

AIM

Therapy for endemic goitre after surgical resection depends on the residual thyroid volume. Post-operative changes have been known to impair the fundamental sonographic evaluation of residual thyroid tissue. It was our aim to determine whether THI is a feasible method for thyroid volumetry after surgery.

METHODS

48 patients underwent thyroidectomy, hemithyroidectomy, near total resection, or partial resection of the thyroid gland. In all patients THI of the neck was performed 4 (mean; range: 2-7 days) days after surgery using an Elegra sonographic device (Siemens, Erlangen, Germany) with a transmitted frequency of 3.4 MHz and received frequency of 6.8 MHz. The examiner was blinded to the patient's diagnosis and the type of surgery. The residual tissue volume measured by means of THI and intra-operative volumetry were both compared to sonographic volumetry 12 weeks after surgery, the latter serving as the gold standard. Accuracy of THI and intraoperative volumetry were tested for significant differences using a paired t-test.

RESULTS

Volumetry by the surgeon was available in 26 patients (54%). The men error of THI volumetry was 2.4 ml (SD: 3.3 ml; maximum: 17 ml). The mean error of intraoperative volumetry was 1.4 ml (SD: 1.9 ml; maximum: 6 ml). The mean difference between THI and intraoperative volumetry was 1 ml (SD: 2.7 ml; maximum: 7 ml; p = 0.085).

CONCLUSIONS

THI permits early volumetry of the residual tissue after thyroid surgery comparable with the intraoperative volumetry. Thus, THI may be helpful in guiding the substitution of thyroid hormones.

Perforated jejunal diverticulitis as a rare cause of acute abdomen

Jejunal diverticula is rare and in most cases without any symptoms. They become clinically relevant when complications, such as diverticulitis, malabsorption caused by bacterial overgrowth, intestinal hemorrhage, or obstruction, occur. In this case report a case of perforated jejunal diverticulitis is presented and the problems in finding the correct diagnosis are discussed.