The Prevalence, Clinicodemographics, and Outcomes of Incidental and Symptomatic Renal Cysts in a Pediatric Cohort Undergoing Ultrasonography.

PURPOSE: The growing availability of modern-day imaging has resulted in an increase in the number of renal cysts detected in the pediatric population. Few publications have reported outcomes of these childhood cysts. In this study we assessed the prevalence and evolution of renal cysts in children, and described clinical characteristics, mode of presentation and ultimate outcomes. MATERIALS AND METHODS: Our institutional ultrasound database was searched for all abdominal ultrasound reports from 2006 to 2017. These reports were then cross-referenced with a manual retrospective chart review. Clinical characteristics including mode of presentation, cyst characteristics, and outcomes were analyzed using descriptive and nonparametric statistical methods. RESULTS: Of 70,500 abdominal ultrasound scans during the study period 1,531 (2.2%) met the study inclusion criteria. Overall 26% of cysts were complex and 10.1% of cases were associated with hydronephrosis. Echogenic kidneys were more likely to be associated with simple cysts (p=0.0001). There was no difference between cyst diameter and symptomatology (p=0.82). The conversion of simple to complex renal cysts was less than 1% and 1.8% of complex cysts developed renal cell carcinoma. CONCLUSIONS: In a large cohort of children who underwent abdominal imaging we found a 10-year renal cyst prevalence of 2.2%. Given that nearly all cysts follow a benign course and that simple cysts will invariably grow within 2 years, we believe that these cases could be safely discharged after that point. We continue to recommend surveillance for patients with cysts larger than 15 mm, complex cysts, family history of adult polycystic kidney disease or those with concomitant genitourinary anomalies requiring ongoing followup.

Comparison of image quality and lens dose in helical and sequentially acquired head CT.

AIM: To prospectively compare helical and traditional sequential acquisition of computed tomography (CT) images of the head with respect to lens dose, thyroid dose, and image quality. MATERIALS AND METHODS: Patients undergoing non-emergency unenhanced CT examinations of the head were prospectively randomized to sequential or helical multidetector CT (MDCT) acquisition. Lens dose and thyroid dose were measured directly using a MOSFET (metal oxide field effect transistor) system. The quality of images at the level of the basal ganglia and the posterior fossa were assessed by two neuroradiologists on a scale of 1 (poor) to 5 (very good), with respect to grey-white matter conspicuity and posterior fossa artefact respectively. RESULTS: The lens dose was significantly higher for the sequential technique than the helical technique (61.5±12.9 mGy versus 43.5±4.3 mGy; p<0.0001). The thyroid dose was not significantly different (1.6±0. 6 mGy versus 2.1±0.6 mGy; p=0.8). The sequential technique was ranked higher than the helical technique with respect to the basal ganglia image for overall quality and grey-white matter conspicuity, but the majority of images in both groups were rated good or excellent. Posterior fossa images showed more artefacts on the sequential images than the helical technique images. Signal-to-noise ratios for grey and white matter were better using the sequential technique. CONCLUSIONS: Helically acquired head CT images using 16 and 64 section MDCT are of comparable quality to sequential acquisition, have reduced posterior fossa artefacts and approximately two-thirds of the lens dose.

Radiation therapy of testicular seminoma: a 15-year survey.

A retrospective review of 69 patients with testicular seminoma, stage I and II, treated by orchiectomy and adjuvant irradiation at McGill University Hospitals from 1972 to 1987 was performed. All patients underwent either lymphangiogram or computed axial tomography scan for evaluation of retroperitoneal disease. There were 52 stage I (75%), 13 stage IIA (11%), 2 stage IIB (3%), and 2 stage IIC (Royal Marsden Hospital staging criteria). Median follow-up time was 6.2 years. The 10-year actuarial survivals were 94% and 93% for stages I and II, respectively. Only two stage I patients failed treatment, and both died from metastatic disease. Interestingly, both developed biopsy-proven metastatic brain disease and had no evidence of intra-abdominal recurrence. In stage II disease, only one patient failed the treatment. There was no serious acute toxicity and no late complications have been encountered. Radiation therapy following orchiectomy is the treatment of choice for stage I and for most stage II patients with testicular seminoma. The controversial aspects of radiographic retroperitoneal staging, the use of prophylactic mediastinal irradiation for stage II patients, and the role of surveillance only for stage I patients are discussed.

Screening Mammography: Reasons for non-compliance in a family medicine teaching unit.

In a telephone survey of patients aged 52 to 62 years in a family medicine teaching unit, 61% reported having had mammography within the last 2 years (1988 or later); for 49% of the patients, this was documented in the hospital record. The main reason given for non-compliance was the absence of breast symptoms or signs. Patient willingness to follow physician recommendations is high, emphasizing the importance of physician compliance with screening guidelines.