Vitamin D supplementation in patients with alcoholic liver cirrhosis: a prospective study.

BACKGROUND: The liver is involved in the metabolism of vitamin D. The prevalence of osteopenia in alcoholic liver disease (ALD) patients is 34-48%, and the prevalence of osteoporosis is 11-36%. Advanced liver disease is considered a risk factor for the development of osteoporosis. The aim of this study was to establish the relationship between vitamin D level and Child-Pugh score in patients with alcoholic liver cirrhosis (ALC), and to evaluate the effects of oral vitamin D supplementation. METHODS: Seventy male ALC patients in the absence of active alcohol intake were enrolled and their clinical and laboratory data were recorded. A supplementation of cholecalciferol 1000 IU/day was administered. The vitamin D status was analyzed during the study, in patients stratified by Child-Pugh score. RESULTS: The study was completed by fifty patients. At the enrollment, the mean level of vitamin D was 60.73±28.02, 50.53±39.52 and 26.71±12.81 nmol/L, respectively for Child-Pugh score class A, B and C. During vitamin D supplementation it was found in all the patients a significant increase of its levels during the first six months (P<0.05). However, in class C the improvement was consistent also after year (P<0.05). At the end of the study, two of seven patients initially in class C changed in class A, four from class C to B, and one remained in class C (P=0.012). Out of seventeen patients initially in class B, eleven changed to class A, and six remained in class B. CONCLUSIONS: In patients with ALC, higher level of vitamin D level is related with lower Child-Pugh score. The supplementation of 1000 IU/day of vitamin D in these patients was optimal for a period of at least six months. A decrease in the Child-Pugh score was also found, with a redistribution of the patients in different classes.

Dynamic simulation and Doppler Ultrasonography validation of blood flow behavior in Abdominal Aortic Aneurysm.

Criteria for rupture prediction of Abdominal Aortic Aneurysm (AAA) are based only on the diameter of AAA. This method does not consider complex hemodynamic forces exerted on AAA wall. The methodology used in our study combines Computer-Aided Design (CAD) with Computational Fluid Dynamics (CFD). Three-dimensional vascular structures reconstructions were based on Computed Tomography (CT) images and CAD. CFD theory was used for mathematical modeling and simulations. In this way, dynamic behavior of blood flow in bounded three-dimensional space was described. Doppler Ultrasonography (US) was used for model results validation. All simulations were based on medical investigation of 4 patients (male older than 65years) with diagnosed AAA. Good correspondence between computed velocities in AAA and measured values with Doppler US (Patient 1 0.60m·s-1 versus 0.61m·s-1, Patient 2 0.80m·s-1 versus 0.80m·s-1, Patient 3 0.75m·s-1 versus 0.78m·s-1, Patient 4 0.50m·s-1 versus 0.49m·s-1) was noticed. The good agreement between measured and simulated velocities validates our methodology and the other data available from simulations (eg. von Misses stress) could be used to provide useful information about the possibility of AAA rupture.

The role of the color Doppler ultrasonography and computed tomography in estimation of portal hypertension.

Introduction: Liver diseases with disturbances of hepatic and splanchnic circulation lead to the portal hypertension, with or without a portal vein thrombosis. Objective: This study was based on the testing of hypothesis that more data and more precise diagnosis in patients with disorders of portal circulation can be obtained by using color Doppler ultrasonography (CDU) and computed tomography (CT) with contrast. Methods: The study was conducted from February 2011 to May 2014 and it comprised 120 patients who were suspected to have portal hypertension or already had clinical confirmation of the portal hypertension, patients with hepatitis, and some patients with hematological diseases. The first group of 40 patients was examined by conventional ultrasonography and CDU, the second group by contrast CT, and the third group of patients was examined by both methods (CDU and contrast CT). After six months of adequate therapy, the patients had control examinations with the same diagnostic technique used during their first examination. Results: Retrospective analysis showed that CDU is more sensitive than CT in the assessment of presence and age of thrombi (CDU 93.9%; CT 86.1%). CT gives precise data in detection of portosystemic collaterals. Sensitivity of CT is 100% and its specificity is 67%. Cumulative sensitivity and specificity for most parameters were increased in patients with portal hypertension when both methods were applied. Conclusion: This study emphasizes the possibility of early and more accurate diagnosis achieved when combining two radiological techniques (CDU and contrast CT scan), which is not the case when these methods are used separately.

Dirofilariasis of the breast: sonographic appearance.

Human dirofilarial infections characteristically manifest as pulmonary "coin" lesions or as subcutaneous nodules. A case of subcutaneous Dirofilaria infection of the breast involving a 25-year-old woman with a painful breast lump is presented. The patient had not traveled anywhere and did not have any animals, but provided a history of being bitten by mosquitoes. The suspicion of a parasitic infection was raised by the presence of rod-like structures within a hypoechoic nodule on sonography; movement within the nodule was detected during the examination. Histopathological examination revealed viable, adult female Dirofilaria repens, a nematode that is commonly found in dogs, cats, and wild mammals throughout parts of Europe, Africa, and Asia. © 2014 Wiley Periodicals, Inc. J Clin Ultrasound 42:433-435, 2014.

[Blunt injuries of the lungs, pleura and chest bone structures: computed tomography contribution].

INTRODUCTION: The most frequent incidences of blunt chest injuries occur due to motorvehicle accidents, falls and work-related traumas. Chest computed tomography is usually associated with examination of the subsequent regions with the aim to enable a more efficient diagnostic procedure. The purpose of this research study is to define the contribution of the chest CT in blunt injury patients. MATERIAL AND METHODS: This retrospective study encompasses the results of CT examination of 36 patients with one or more injuries of the thoracic wall, pleura, lungs and spinal column suspected to suffer chest organs traumas. Chest CT survey was performed in 30 patients, while thoracic spine CT survey was performed in 11 patients. RESULTS AND DISCUSSION: The most frequent incidences of injuries were due to motor vehicle accidents (22 patients--61.11%). Falls were the reason of injuries in 11 patients--17.46%. Chest injuries are usually associated with injuries of the surrounding regions, but occurred in isolated form, too (27.78%). Rib fractures and lungs parenchyma traumas were evidenced by CT examination in more than 60% of the patients. Thoracic spine fractures were most frequently reported at the 10-th, 11-th and 12-th vertebra and made more than 70% of the thoracic spine fractures. CONCLUSION: The findings of this study coincide to a great extent with the findings presented in world literature.

[Stromal tumor of colon--case report].

INTRODUCTION: Gastrointestinal stromal tumor is relatively new term, it can be localized anywhere inside the gastrointestinal system. It has formerly been called leiomyoma, leiomyoblastoma, and/or leiomyosarcoma. CASE REPORT: Case report is about a female patient with indefinite difficulties described as "bother", mild anemia and anamnesis data of her mother who had been operated on for colon tumor. After blood examination, which had shown values within referential limits except for mild anemia, patient underwent radiological examination. Primarily, an abdominal cavity ultrasound had been performed, where a suspicious formation in the right hemiabdomen was found, but without distinctive anatomical localization in the abdominal cavity. Secondly, a checkup by Duplex Doppler ultrasound was made, as well as radiological examination with double contrast of colon and computed tomography, where tumor was visualized on ascendant colon with extraluminal localization. DISCUSSION: Radiological findings were confirmed by surgery. Histopathological findings were positive for gastrointestinal stromal colon tumor. CONCLUSION: Gastrointestinal stromal tumors represent extremely rare tumors of gastrointestinal system, especially when localized at the colon but they should be included in a differential diagnosis for their malignant potential.

Duplex Doppler sonography in portal hypertension.

Conventional echotomography and duplex Doppler ultrasonography are noninvasive imaging techniques in measurement of hepatic blood flow. In the period from February 2002 to March 2004, 29,086 patients underwent ultrasound examination at the Institute of Radiology in Novi Sad, and 17,503 presented with symptoms of gastroenterology diseases and/or hepatobiliary tract diseases. 984 patients underwent duplex Doppler sonography. This prospective study included 50 patients with suspected or confirmed diagnosis of portal hypertension. All patients were examined using Siemens Versa Pro (3.5 MHz convex probe: B-mode, color and pulse Doppler). The following parameters were evaluated: Doppler sonoscore, congestion index and portal vein thrombosis. By analyzing gathered data, the diagnosis of portal hypertension was confirmed in 10% of patients at baseline, and in 6% of patients at last follow-up, six months later. Results of this investigation demonstrate the importance of duplex Doppler ultrasonography as an excellent noninvasive diagnostic method used for visualization of the direction and velocity of blood flow, as well as presence of portal vein thrombosis. This imaging modality is used as an initial diagnostic tool in the evaluation of the portohepatic circulation, especially in portal hypertension syndrome and in suspected portal vein thrombosis.

[Duplex Doppler ultrasonography in the diagnosis of deep venous thrombosis of the lower extremities].

INTRODUCTION: The aim of this study was to investigate the role of duplex Doppler ultrasonography in diagnosis of deep venous thrombosis (DVT) of the lower extremities. MATERIAL AND METHODS: During a 2-year period, 860 patients were examined by duplex Doppler sonography. Among these, 619 (72%) were women and 241 (28%) men, with the age-range of 16-91; (mean 56,2) years. Siemens Versa Pro colour doppler was used, with 7MHz transducers. Findings were categorized into four categories: 1. deep venous thrombosis (DVT); 2. pathology predominantly related to superficial veins without DVT; 3. pathology of superficial and deep veins; 4. normal findings. RESULTS: 185 (21%) patients had DVT, 366 (42.5%) patients had predominant pathology of superficial veins: postthrombotic syndrome, superficial thrombophlebitis and varicose veins. 128 (14.9%) patients had pathology of superficial and deep veins. Normal findings were found in 181 (21.1%) patients. COCNCLUSIONS: Various vascular and nonvascular diseases may mimic deep venous thrombosis, and that is why US should be used whenever possible to avoid unnecessary anticoagulant therapy.

[Ultrasound artifacts as differential diagnostic problems in ultrasound of the upper abdomen].

INTRODUCTION: The word artifact stands for any visible result of imaging procedures which is caused by the procedure itself and not the entity being analyzed. Recognition of artifacts in everyday work is of great significance for final diagnosis, since their wrong interpretation not only compromises the value of ultrasound finding, but may also lead to a wrong therapeutic approach. ULTRASOUND ARTIFACTS: Artifacts appear as the result of physical properties of an ultrasound beam, technical aspects of ultrasound apparatus and immobility in creation of ultrasound image. Artifacts in the form of acoustic shadows, acoustic enhancements and reverberation most commonly appear and lead to changed appearance of certain structures. That is why great experience and knowledge of radiologists-ultrasonographists is necessary, since diagnostic accuracy of the method itself is under their immediate control. Incorrect interpretation of artifacts and failure to recognize them reduces the value of ultrasound imaging which has, during the past 25 years, confirmed its exceptional diagnostic value.

[Diagnostic significance of ultrasonography in focal splenic lesions]. / Dijagnosticki znacaj ultrazvuka u fokalnim promenama slezine.

INTRODUCTION: The spleen is situated in the upper left abdominal cavity and spleen parenchyma has a homogenous appearance. For that reason changes in parenchymal echogenicity should be understood as pathological, since many splenic focal lesions appear as different changes in echostructure of spleen parenchyma. FOCAL SPLENICE LESIONS: Focal lesions are not rare and are found in every day work. Great advantages of ultrasound diagnostics in relation to other complementary methods put this method into the leading position in diagnostics, not only in spleen disorders, but the whole abdomen. Advantages include: diagnostic accuracy, possibility of repetition, low price of the examination, and no irradiation. SPLENIC ULTRASONOGRAPHY: Splenic ultrasonography is efficient and provides findings which represent a significant contribution in reaching the final diagnosis and selecting the appropriate therapeutic approach. Due to various ultrasonographic images of numerous splenic focal lesions (metastasis, hemangioma, cysts, infarction, hematoma etc) great knowledge and experience is required in order to come to accurate diagnosis. This will bring application of other diagnostic procedures, such as CT and MR, mostly available in large radiological institutes, to a minimum.