Ultrasound in the evaluation of interstitial pneumonia.

BACKGROUND: The diagnostic value of thoracic ultrasonography (US) has recently increased. Skilled sonographers with experience in pulmonary medicine have demonstrated the existence of US signs of chest pathology. PURPOSE: To detect US findings associated with infectious interstitial pneumonia that can be used to supplement other diagnostic tools. MATERIALS AND METHODS: Over a period of 5 years (2001-2006), 55 patients were referred to our ultrasonography units for evaluation of probable viral or viral-like infections of the respiratory tract. Each patient was subjected to a work-up that included clinical examination, blood tests, pulmonary function tests, bronchoscopy, chest radiographs, high-resolution computed tomography (HRCT), and thoracic US, which was performed under blinded conditions. RESULTS: Based on the findings that emerged from the work-up described above, all 55 patients were diagnosed with interstitial pneumonia. Evaluation of the US scans for the signs of interstitial lung disease described by Lichtenstein revealed "comet-tail" artifacts in the anterolateral lung fields in 31 (56.36%) patients and mixed patterns consisting in increased density associated with ring-down artifacts in 24 (46.64%). Pleural involvement was also observed in 34 cases (61.82%). CONCLUSIONS: Thoracic US appears to be a useful adjunct to clinical, laboratory and radiological studies in patients suspected of having infectious interstitial pneumonia.

Follow-up study of thyroid function in polytransfused thalassemic patients.

The aim of our investigation was to evaluate thyroid function by a follow-up study in 45 polytransfused thalassemic patients, since endocrine abnormalities are frequent consequences of iron overload in thalassemia major. Significant changes of thyroid function have been revealed in the time elapsing the observation, despite unchanged haematological parameters; at the end of the present study five patients were affected by overt hypothyroidism and 15 patients by subclinical hypothyroidism. Ultrasound thyroid volume in 13 randomly selected patients was greatly reduced, while thyroid Magnetic Resonance Imaging (MRI) was not able to detect tissue alterations. Inversely, liver MRI was markedly reduced in 14 patients and negatively related to ferritine levels (P< 0.01). We conclude that polytransfused thalassemics are frequently affected by thyroid disfunction; haepatic haemosiderosis due to iron overload seems influence hormonal peripheral metabolism, although the patients display a moderate compliance with iron chelation therapy. Therefore, periodic thyroid investigation should be carried out in thalassemic subjects in order to detect patients who need hormone replacement therapy.

Morphologic and functional evaluation of the exocrine pancreas in beta-thalassemia major.

Thirty-nine consecutive patients with beta-thalassemia major and iron overload were studied by ultrasonography and serum pancreatic enzyme determination to assess the frequency and characteristics of pancreatic damage in this condition. The results were compared with those of a matched group of healthy controls. Most of the thalassemic patients had a markedly increased echogenicity of the pancreas and decreased size of the gland (p < 0.001 for both features as compared with controls). Both echogenicity and decreased size of the gland were significantly correlated (p < 0.001) with patient age and duration of transfusional therapy. Serum concentrations of trypsin and lipase were significantly lower (p < 0.02) in patients than in controls. The lowest enzyme values were found in older patients with longer duration of transfusional therapy, who also had the most marked sonographic changes. The results suggest that the exocrine pancreas is structurally and functionally damaged in the majority of thalassemic patients with iron overload.

Inhibition of caerulein-induced gall bladder emptying by cimetropium bromide in humans.

The effect of cimetropium bromide, a new potent antimuscarinic compound, on caerulein-induced gall bladder emptying in 8 male volunteers was studied by real time ultrasonography. During saline infusion, caerulein (10-40 ng.kg-1.h-1) induced dose-dependent emptying of the gall bladder. There was a significant linear correlation between the dose of the peptide and the reduction in gall bladder size. A continuous infusion of cimetropium bromide (5 mg.h-1) significantly inhibited the contracting effect of caerulein on the human gall bladder, by 74% in response to the lowest dose and by 45% and 22%, respectively, to the two higher doses. The data confirm that the contracting effect of CCK-like peptides on the human gall bladder is at least partly cholinergically mediated, and they demonstrate the relaxing activity of cimetropium previously shown in animals. Provided its antispasmodic activity is also evident in disease, cimetropium should be regarded as a potentially useful agent for the treatment of biliary colic and spasm of the biliary tree.

Ultrasonography in the diagnosis of portal hypertension: diminished response of portal vessels to respiration.

This study assesses the usefulness of ultrasound in the diagnosis of portal hypertension due to hepatic cirrhosis. Seventy-nine patients with portal hypertension and 45 control subjects underwent ultrasonography. Two factors were measured: (a) the caliber of the portal vein and (b) the caliber variation of the splenic and superior mesenteric veins during respiration. A lack of normal caliber variation (an increase during inspiration and a decrease during expiration) in these vessels is put forward as an ultrasonographic sign of portal hypertension, and the pathophysiological and clinical significance of this finding are discussed. The sensitivity of ultrasound in detecting portal hypertension, based on the measurement of caliber variation, was 79.7%, and the specificity was 100%. In contrast, the sensitivity of the method, assessed on the basis of portal dilatation, was only 41.8%.