Ultrasound for the detection of the pyramidal lobe of the thyroid gland.

PURPOSE: The pyramidal lobe (PL) is an ancillary lobe of the thyroid gland that can be affected by the same pathologies as the rest of the gland. We aimed to assess the diagnostic performance of high-resolution sonography in the detection of the PL with verification by dissection and histological examination. METHODS: In a prospective, cross-sectional mono-center study, 50 fresh, non-embalmed cadavers were included. Blinded ultrasound examination was performed to detect the PL by two investigators of different experience levels. If the PL was detected with ultrasound, dissection was performed to expose the PL and obtain a tissue sample. When no PL was detected with ultrasound, a tissue block of the anterior cervical region was excised. An endocrine pathologist microscopically examined all tissue samples and tissue blocks for the presence of thyroid parenchyma. RESULTS: The prevalence of the PL was 80% [40/50; 95% CI (68.9%; 91.1%)]. Diagnostic performance for both examiners was: sensitivity (85.0%; 42.5%), specificity (50.0%; 60.0%), positive predictive value (87.2%; 81.0%), negative predictive value (45.5%; 21.0%) and accuracy (78.0%; 46.0%). Regression analysis demonstrated that neither thyroid parenchyma echogenicity, thyroid gland volume, age nor body size proved to be covariates in the accurate detection of a PL (p > .05). CONCLUSION: We report that high-resolution ultrasound is an adequate examination modality to detect the PL. Our findings indicate a higher prevalence than previously reported. Therefore, the PL may be regarded as a regular part of the thyroid gland. We also advocate a dedicated assessment of the PL in routine thyroid ultrasound.

Introduction and first validation of EpiTrack Junior, a screening tool for the assessment of cognitive side effects of antiepileptic medication on attention and executive functions in children and adolescents with epilepsy.

OBJECTIVE: Maximum seizure control, preservation of cognition, and prevention of developmental hindrance are major aims of the pharmacological treatment of children and adolescents with epilepsy. Herewith we introduce the junior version of EpiTrack, a 12- to 15-minute screening test for monitoring the cognitive effects of antiepileptic drug treatment in children and adolescents aged 6 to 18. METHODS: The test, which comprises six subtests (Speed, Flexibility, Planning, Response Inhibition, Word Fluency, Working Memory), was administered to 277 children and adolescents aged 6-18 years, 111 of whom were retested after an interval of 3 months. For the first clinical validation, 155 patients (46% idiopathic/benign, 62% seizure free) were evaluated. RESULTS: Standardization and correction for age resulted in a mean score of 33 ± 2 points, which was no longer correlated with age (r=0.005). The retest practice effect was 0.7 ± 2 points, and the reliability r(tt)=0.78. Factor analysis indicated one executive factor in controls and patients. In the epilepsy group, 50% of the patients were impaired (controls 14%). Number of antiepileptic drugs, use/no use of individual drugs, type of epilepsy, earlier age at onset, generalized tonic-clonic seizures, and history of febrile seizures made a difference in test performance. For patients and controls, EpiTrack scores reflected parents' performance ratings and the children's needs for extra education. CONCLUSION: The junior version of EpiTrack appears to be a valid and reliable screening tool for the assessment of executive functions in children and adolescents. Future studies with a repeated measurement design must show how well this tool is suited for the tracking of cognitive effects of antiepileptic drug treatment.