Testicular adrenal rest tissue in a patient with classical congenital adrenal hyperplasia: color Doppler findings.

Congenital adrenal hyperplasia (also known as congenital adrenogenital syndromes) refers to a group of autosomal recessive diseases characterized by altered cortisol production, which may be associated with aldosterone deficiency. The absence of cortisol synthesis stimulates corticotropin production by the adrenal cells and the accumulation of cortisol precursors, which will be diverted for the production of sex hormones. In affected males, ectopic adrenal tissue frequently develops, usually at the testicular level. This tissue is absolutely identical to that of the adrenal gland itself, and its functionality can be stimulated by ACTH and suppressed with glucocorticoid therapy. The authors report the case of a male patient with classic congenital adrenal hyperplasia, who was referred to our staff for evaluation of bilateral testicular tenderness and enlargement. Color Doppler sonography revealed mild enlargement of both gonads, widespread disruption of the testicular echostructure, and hypervascularization. Two months later, when the underlying disease had been controlled, repeat color Doppler ultrasonography revealed markedly decreased vascularity, although no change was noted on the B-mode examination. The color Doppler findings thus represent an early indicator of response to treatment.

Baker's cyst in pediatric patients: Ultrasonographic characteristics.

OBJECTIVE: Evaluate incidence, etiology, and sonographic features of Baker's cyst in children. MATERIALS AND METHODS: We examined 16 pediatric patients, with the clinical diagnosis of Baker's cyst. The possibility to confirm or to exclude the presence of the lesion, assess the structure, presence of bilateralism and joint effusion were considered. Three subjects had known juvenile arthritis, 2 hemophilia, 11 a popliteal swelling in the absence of concomitant diseases. RESULTS: In all patients it was possible to confirm (11) or to exclude (5) the presence of Baker's cyst. The idiopathic forms (6) exhibited anechoic structure; in patients with arthritis (3) there was hypertrophic synovium; in hemophilic patients at the presentation (2) anechoic structure with layering (serum and red blood cells); in chronic hemophilia synovial hypertrophy was seen. Joint effusion was constantly present in children with hemophilia and arthritis and in 1 case of idiopathic cyst. CONCLUSION: Baker's cysts in children are rare. Ultrasound is able to confirm or to exclude the presence of the lesion and it is able to evaluate characteristics, bilateralism and association with joint effusion.

[Levofloxacin-induced bilateral rupture of the Achilles tendon: clinical and sonographic findings]. / Tendinopatia dell'achilleo da levofloxacina: dalle immagini alla diagnosi.

The fluoroquinolones are antibiotics widely used in the clinical practice. The concomitant use of corticosteroids and fluoroquinolones in elderly patients is recognised as a risk factor for developing clinically relevant tendon lesions. Fluoroquinolone-induced tendinopathy is underreported in the literature. A 67-year-old man, came to our observation complaining of 5 days history of bilateral heel pain. The patient had a medical history of sarcoidosis and was treated with a daily dose of 5 mg of prednisone. He was initially given oral levofloxacin (500 mg/die) for 10 days, because of an acute respiratory infection. Two days before the end of the antibiotic therapy, he developed bilateral heel pain. He denied any history of trauma. Physical examination revealed swelling and marked tenderness with mild palpation of the Achilles tendons at the calcaneal insertion. The ultrasound evaluation of the Achilles tendons revealed the following main abnormalities: diffuse thickening, loss of the "fibrillar" echotexture, blurred margins, and bilateral partial tendon tears. Bilateral Achilles tendon pain and rupture has been described as a rare adverse effect of fluoroquinolone treatment. Most of the fluoroquinolone-induced tendinopathies of the Achilles tendon are due to ciprofloxacin. To the best of our knowledge, this is the first description of bilateral Achilles tendon rupture due to levofloxacin. The risk/benefit ratio of the fluoroquinolones should be carefully considered and these drugs should be prescribed cautiously in elderly patients treated with corticosteroids. This case can be regarded as a representative example of the potential clinical efficacy of sonography in daily rheumatological practise.

Analysis of capture-recapture data with a Rasch-type model allowing for conditional dependence and multidimensionality.

In this article, we show that, if subjects are assumed to be homogeneous within a finite set of latent classes, the basic restrictions of the Rasch model (conditional independence and unidimensionality) can be relaxed in a flexible way by simply adding appropriate columns to a basic design matrix. When discrete covariates are available so that subjects may be classified into strata, we show how a joint modeling approach can achieve greater parsimony. Parameter estimates may be obtained by maximizing the conditional likelihood (given the total number of captures) with a combined use of the EM and Fisher scoring algorithms. We also discuss a technique for obtaining confidence intervals for the size of the population under study based on the profile likelihood.

Hemangioma-like lesions in chronic liver disease: diagnostic evaluation in patients.

PURPOSE: To quantify the risk of misdiagnosis of focal hepatic lesions manifesting at ultrasonography (US) as typical hemangiomas in a population at high risk for hepatocellular carcinoma (HCC) and to identify the most effective approach to their diagnostic evaluation. MATERIALS AND METHODS: A total of 1,982 patients with newly diagnosed cirrhosis underwent US and serum alpha-fetoprotein determinations for early detection of HCC. Focal lesions with typical features of hemangioma were evaluated with confirmatory findings of contrast material-enhanced dynamic or spiral computed tomography (CT) and/or single photon emission CT with technetium 99m-labeled red blood cells and, in the absence of confirmatory imaging findings, US-guided fine-needle biopsy. Patients whose initial US scan depicted no lesions or hemangiomas were enrolled in a US follow-up program. All hemangioma-like lesions detected during follow-up were evaluated, or biopsy was performed. RESULTS: US depicted hemangioma-like lesions in 44 of 1,982 patients: 22 hemangiomas and 22 HCCs. Hemangioma-like lesions detected during follow-up in 1,648 patients were HCCs (n = 22) or dysplastic nodules (n = 4). Only 85 (22%) of 383 patients with HCC had alpha-fetoprotein levels suggestive of the diagnosis. The probability of a diagnosis of HCC (or preneoplastic lesion) is 100% for hemangioma-like lesions depicted on subsequent US scans. CONCLUSION: If initial US examination of a cirrhotic liver depicts a hemangioma, confirmatory findings of imaging studies are necessary since 50% of hemangiomas in this study were hyperechogenic HCCs. US-guided biopsy can be safely performed, and its findings can be used to confirm the diagnosis.

[Late reactions to a radiologic contrast media (Iopamidol-Bracco). Prospective study]. / Reazioni tardive a un mezzo di contrasto radiologico (Iopamidolo-Bracco). Studio prospettico.

PURPOSE: This prospective, non-randomized study was aimed at evaluating the incidence of Delayed Adverse Drug Reactions (DADRs) to iodinated contrast agents and to evaluate possible risk factors to the development of these reactions. DADRs are those reactions occurring one to 48 hours after contrast medium administration. Their symptoms and frequency are not well defined, but the majority of DADRs are mild in intensity and resolve spontaneously without sequelae. In the literature, DADRs are reported to occur in 1 to 15% of patients undergoing contrast-enhanced examinations. MATERIAL AND METHODS: This prospective, non-randomized trial was carried out on 403 patients undergoing either dynamic CT or urography with iopamidol-300 (Iopamiro-300, Bracco SpA). Before the examination, data were collected regarding patients' anagraphical details, presence of risk factors, allergy, previous exposure and previous adverse reactions to iodinated contrast agent. After the examination, any adverse events occurring between 30 minutes and 48 hours post-dose were recorded, specifying time of onset and duration of symptoms. Studied variables were type of DADRs and risk factors to their development (sex, age, underlying disease, allergy, previous exposure to contrast agent, type of diagnostic examination). Two hundred and sixty-two patients were male (65%), and 141 were female (35%). Mean age was 61 years (+/- 11.8); 192 patients (48%) had underlying disease, and 115 (28%) were allergic. About half of the patients had previously undergone another contrast-enhanced examination. Two hundred and seventy-one patients underwent dynamic CT and 132 urography. RESULTS: A total of 50 patients (12.4%) reported DADRs. Factors associated with a significantly higher incidence of DADRs were found to be allergy (p = 0.001), previous exposure to contrast agent (p = 0.001), female sex (p = 0.001), underlying disease (p = 0.030). The most frequently reported DADRs were nausea and vomiting, drowsiness, rash, itching and headache. All reported reactions were mild and resolved spontaneously without sequelae. DISCUSSION AND CONCLUSIONS: In our experience, though limited and not on large numbers, DADRs to nonionic low osmolality contrast agents such as iopamidol have been few, mild, and not clinically significant. Although there are no absolute contraindications to the use of iodinated contrast agent, the risk/benefit ratio should always be evaluated, especially in patients with allergy, in those with severe renal, hepatic or cardiac insufficiency, and in diabetics.