Ultrasound for diagnosis of infection in revision total hip arthroplasty.

Eighty consecutive patients (85 hips; 43 women; median age, 74 years [range, 33-90 years]) underwent a revision total hip arthroplasty. Preoperatively and guided by ultrasound, biopsy specimens of the joint pseudocapsule were taken, and joint fluid was aspirated for culture. Capsule morphology was investigated with light microscopy. When septic loosening was defined as 2 intraoperative cultures yielding the same microorganism, the prevalence was 12%. Sensitivity of the capsule biopsy cultures was 67%; specificity, 68%; positive predictive value, 22%; and negative predictive value, 94%. Joint fluid was often sparse and always falsely sterile. One specimen from a hip with septic loosening showed histologic changes (> or =3 foci, each with > or =3 plasma cells/high-power field) consistent with chronic infection. The remaining 8 septic loosenings eluded histologic detection, yielding 11% sensitivity. All aseptic loosenings were classified correctly (specificity 100%). Positive and negative predictive values were 100% and 89%. Ultrasound-guided aspiration and capsule biopsy with cultures and histology does not seem to be sufficiently accurate in the preoperative diagnosis of infected total hip arthroplasty.

Endoluminal ultrasonography: a new method to evaluate dysphagia.

Dysphagia consists of various diseases, which all lead to an impaired quality of life. Besides a thorough case history and clinical examination, there is a need for objective diagnostic examinations to evaluate the extent of the disease. The present study includes 38 patients suffering from the most common causes of dysphagia such as benign or malignant strictures of the esophagus, esophagitis, achalasia cardiae, cricopharyngeal dysfunction and motility disorders. The patients were examined by endoluminal ultrasonography using a 2.7 mm-wide-probe. The present study clearly indicates the value of the method in evaluating the extent of the disease in patients suffering from the aforementioned diseases.

The normal wall of the esophagus as seen by endoluminal ultrasonography.

Endoluminal ultrasonography of the esophagus offers a possibility to study the esophageal wall, even in pathological disorders with narrow lumina such as benign or malignant strictures, by using 2.7-mm-wide probes. In order to evaluate the normal variations in size of the esophageal wall components, 10 volunteers and 10 deceased humans without upper gastrointestinal disease were studied with a 2.7-mm-wide endoluminal ultrasonic probe. A comparison with a histopathological technique was also performed. The results indicated a good correlation between the volunteers and the deceased in using endoluminal ultrasonography. In contrast a discrepancy was noted between the measurements made by ultrasonography and histopathology.

Intraoral ultrasonography in the diagnosis of peritonsillar abscess.

The diagnosis of quinsy is traditionally established on the basis of clinical observations and sometimes several diagnostic punctures. The present study has focused on the possible usefulness of intraoral ultrasonography (IOU) as a diagnostic tool when a peritonsillar abscess is suspected. The results show that it is possible to demonstrate, with a high degree of accuracy, the presence of an abscess, its volume, location, and its relation to the carotid artery. With this information an exact and safe diagnostic puncture can be performed when necessary and avoided in cases with clinical signs of quinsy with no abscess.

Endoscopic clearance of the pancreatic duct in chronic pancreatitis with severe pain.

In a phase I study endoscopic removal of pancreatic duct stones and protein plugs was attempted in five patients suffering from chronic pancreatitis with severe chronic pain. The pancreatic duct contents could be extracted after successful sphincterotomy in three patients. Clearance of the pancreatic duct was followed by complete or partial relief of pain. The follow-up period was 17-48 months. Endoscopic extraction is, however, not without complications; it is technically difficult, and many attempts may be required. The combination of endoscopic therapy and extracorporeal shock-wave lithotripsy may be a better alternative.

Endoluminal ultrasound of the bile ducts.

Miniaturization of ultrasound probes has made possible endoluminal investigation of small duct systems. We have used a 360 degree transaxial real-time sector-scan imaging system with a field of view of 3-5 cm. It operates at ultra-high frequencies, which allows very high resolution. Ten jaundiced patients, aged 35-73 years, were investigated. Malignant bile-duct obstructive disease was present in eight and benign strictures in the remaining two. In all of them the intrahepatic bile ducts had undergone percutaneous transhepatic cannulation for diagnostic and therapeutic purposes. The resolution capacity has been sufficient to allow studies of the bile duct wall and adjacent tissues, and it has thus been possible to study the papilla of Vater, biliary-enteric anastomoses, and adjoining portions of the pancreatic and cystic ducts. Adjacent vessels have been identified. This preliminary study indicates that the character of strictures and the extent of tumour growth may be evaluated, thereby demonstrating the clinical potential of these miniature transducers. Endoluminal ultrasound evaluation of the bile ducts may also be possible intraoperatively and as a supplement to duodenoscopy.

Low urinary counts of P-fimbriated Escherichia coli in presumed acute pyelonephritis.

We report 6 children who showed clinical symptoms and laboratory signs of acute pyelonephritis but in whom bacteriuria was insignificant, with Escherichia coli 10(4)/ml, or less. None of the children had symptoms of other disease. Three of the children who were at first treated inadequately or were not treated with antibiotics developed significant bacteriuria later on (10(5)/ml, or greater). Ultrasonic scanning to evaluate kidney involvement at the acute phase of disease showed transient changes in four of the 6 children--dilatation of one or both pelves or increased ecogenicity of the renal sinus, or both. The urinary E coli strains isolated from all 6 children were P-fimbriated, as determined by a P-fimbriae specific particle agglutination test (PPA test). P-fimbriate E coli are known to be strongly associated with acute non-obstructive pyelonephritis in children and we suggest that the finding of any number of P-fimbriated E coli in the urine of children with clinical evidence of acute pyelonephritis supports this clinical diagnosis.

Radiologic method to assess urinary bladder capacity and proportions in children.

The bladder capacity has been determined physiologically and radiologically at micturition urethrocystography in 139 otherwise normal children 4 to 8 weeks after a bacteriologically confirmed, successfully treated urinary tract infection. This capacity, at a pressure of 50 cm of contrast medium, has been correlated to the length of the lumbar segment L1 to L3. The assessment of normal and abnormal bladder size can be made from infused volume or three dimensional radiologic measurements and is expressed in standard deviations.