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Purpose: The aim of this study was to compare the ultrasonographic optic nerve sheath diameter (ONSD) in different grades of papilledema and in controls and to evaluate ONSD in atrophic papilledema/optic atrophy when raised ICP was suspected. Methods: Prospective cross-sectional case–control study. Following an ocular examination, papilledema was graded clinically using modified Frisén's grading. An ultrasonographic cross section of the retrobulbar optic nerve was obtained with a posterior transverse scan. Independent t-test and analysis of variance were the statistical tools used in the study. Results: The study included 55 cases and 55 age- and gender-matched controls; mean (± standard deviation) age was 37.17 (±11.25) years and male: female ratio was 49:61. There was a statistically significant difference in the mean ultrasonographic ONSD between cases [4.89 (±0.65) mm] and controls [3.12 (±0.22) mm] (P < 0.001). There was a significant difference in the mean ONSD across Frisén's grades of papilledema (P < 0.001). The mean ONSD in atrophic papilledema was 6.2 (±0.75) mm. Conclusion: In the presence of symptoms, ultrasonographic ONSD >4 mm is diagnostic of papilledema. Ultrasonographic ONSD correlates well with the severity of papilledema and can be used to follow-up patients with chronically elevated ICP. It is useful in detecting raised ICP in the presence of optic atrophy and to distinguish true papilledema from pseudopapilledema.
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BACKGROUND: The purpose of this study is to assess the utility of ocular ultrasound B scan in the emergency at the first point of care for detecting posterior segment and orbital pathologies in cases of paediatric ocular emergencies. METHODS: A prospective observational study involving 122 paediatric patients presenting to eye emergency over a period of ninety days were assessed with ultrasonography for the posterior segment as well as orbital pathology whenever indicated. The ocular ultrasound was performed gently over closed eyelids. RESULTS: Posttraumatic globe injuries were the most common indication for posterior segment evaluation, which constituted 80 (65.57％) eyes. Among these 52 patients had an anechoic posterior segment and 28 patients had variable findings such as vitreous haemorrhage (8.19％), retinal detachment (6.55％), choroidal detachment (4.91％), posteriorly dislocated clear lens (0.81％) and retained intraocular foreign body (5.73％). Non-traumatic cases constituted around 42 (34.42％) eyes, which included corneal ulcer (7.37％), retinoblastoma (6.55％), endophthalmitis (4.91％), extraocular muscle cysticercosis (4.91％), orbital cellulitis (4.09％), periocular haemorrhage (2.45％), proptosis(1.63％), paediatric cataract (1.63％) and cryptophthalmos (0.81％). No adverse events of performing the ultrasound was noted. CONCLUSION: First point ultrasonography in paediatric ocular emergencies is a cheap, portable and an effective tool in the assertion of significant posterior segment and orbital diseases.
RESUMEN
La ecografía bidimensional y Doppler es la primera prueba a realizar en los pacientes con deterioro de la función del injerto renal de causa no aclarada. Ofrece información rápida sobre las características morfológicas relacionadas con el tamaño, grosor y ecogenicidad del parénquima, diferenciación corticomedular, obstrucción del flujo urinario, colecciones perirenales, características del flujo sanguíneo en el interior de las arterias y venas renales que son de especial importancia cuando se sospecha una enfermedad de causa vascular. El índice de resistencia tiene valor predictivo en la función del trasplante renal a largo plazo y en el diagnóstico de la nefropatía crónica del injerto. La ecografía constituye la modalidad imagenológica de elección para el diagnóstico precoz y seguimiento de las complicaciones clínicas y quirúrgicas del riñón trasplantado, lo cual contribuye al tratamiento oportuno de las complicaciones, la preservación del injerto y el mejoramiento de la calidad de vida del enfermo.
Doppler scanning and ultrasound B-scan are the first test to perform in patients with impaired renal implant function of unknown cause. It provides rapid information on morphological characteristics related to size, thickness and parenchymal echogenicity, corticomedullary differentiation, urinary outflow obstruction, perirenal collections and blood flow characteristics within the renal arteries and veins that are of particular importance when a disease of vascular cause is suspected. The resistance index has predictive value in long-term renal transplant function and in the diagnosis of the implant chronic kidney disease. Ultrasound constitutes the imaging modality of choice for the early diagnosis and monitoring the clinical and surgical complications of the transplanted kidney, which contributes to the early treatment of complications, implant preservation and improvement of the quality of patient's life.