Dermoscopy of necrobiosis lipoidica and granuloma annulare.

BACKGROUND: Dermoscopy is traditionally used for the diagnosis of skin tumors, but it has also gained increasing interest as an adjunct in the clinical diagnosis of inflammatory skin diseases. OBJECTIVE: To evaluate the dermoscopic patterns of necrobiosis lipoidica (NL) and granuloma annulare (GA) and to compare these findings with other granulomatous skin disorders. METHODS: This is a retrospective analysis of patient data and clinical and dermoscopic images of histopathologically diagnosed cases of NL and GA. RESULTS: A total of 24 cases, including 12 cases of NL and 12 cases of GA, were evaluated. In all cases of NL, dermoscopy revealed evident, sharply focused, elongated and serpentine telangiectasias, which were typically located over a whitish, structureless background. In contrast, all cases of GA were dermoscopically typified by peripheral, structureless orange-reddish borders, which were associated in 5 cases with isolated, unfocussed small vessels. CONCLUSION: Our study suggests that NL and GA reveal different dermoscopic patterns, which may aid the correct diagnosis. In addition, the dermoscopic patterns of NL and GA appear to differ from other forms of granulomatous diseases.

Clinical application of transthoracic ultrasonography in inpatients with pneumonia.

PURPOSE: The aim of this study was to investigate the clinical applicability of transthoracic ultrasound (TUS) in the diagnosis and follow-up of community acquired pneumonia (CAP). METHODS: We designed a pilot study in 15 patients and subsequently investigated 342 patients (206 men and 136 women) consecutively admitted to our Department from September 2005 to November 2009 because of radiographically diagnosed CAP. All patients underwent standard chest radiography, and consequently TUS. Follow-up TUS were performed at 4th and 8-10th day, in most patients. RESULTS: Concerning the reproducibility of TUS method, no reader's bias was present (P=0·18), overall variability and between-subject variability (inter-reader agreement) did not show any difference between readers (P = 0·62 and P = 0·32 respectively), and estimated within-subject variabilities (intra-reader agreement) suggested a very high repeatability of the method (P ∼ 1). Of 342 patients with Rx diagnosis of CAP, in 314 patients (92% of cases) a pulmonary consolidation was also detected using TUS, whose ultrasonographic patterns were studied. Pleural effusion was detected in 120/342 (35%) patients using ultrasound and in 111/342 (32%) patients using chest radiography. Overall dimensional changes of the lung consolidated areas assessed with TUS method showed highly significant results. (1st day mean ± SD: 66·34 ± 19·25; 4th day: 39·92 ± 14·61; 8-10th day: 7·41 ± 1·50; P < 0·0001). CONCLUSIONS: TUS is easily reproducible and we proved it to be a useful complementary diagnostic tool for the diagnosis and the follow-up of CAP.

Transthoracic ultrasound in the evaluation of pulmonary fibrosis: our experience.

The purpose of this study was to identify the ultrasonographic features of mild, moderate and severe pulmonary fibrosis. Between December 2005 and November 2007, transthoracic ultrasonography (US) was performed by a single operator with specific training in lung sonography on 84 consecutive patients (51 males and 33 females, aged 46 to 73 y) with pulmonary fibrosis. The obtained data were compared with those from a sample of 162 healthy subjects (78 men and 84 women, aged 18 to 76 y). The disease was idiopathic (biopsy confirmed) in 53/84 cases (63%). In the remaining (all histologically confirmed) cases, it was associated with systemic sclerosis (n = 18), rheumatoid arthritis (n = 4), mixed connective tissue disease (n = 4), Sjogren syndrome (n = 4), polymyositis (n = 2) or primary biliary cirrhosis (n = 1). Disease severity was classified as mild, moderate or severe based on clinical findings and the results of standard chest radiography, high-resolution computed tomography and pulmonary function tests. Pulmonary fibrosis was associated with the following US findings: (1) fragmented, irregular thickening (micro3 mm) of the "pleural line" distributed over the whole surface of the lung, especially in the lower posterior lobe (observed in all 84 patients); (2) subpleural cysts (seen in 57/84 (68%) cases of moderate-severe disease); (3) reduction or absence of the physiological "gliding sign" related to disease severity (observed in 33/84 to 39% cases); and (4) increased number of horizontal (and to a lesser extent vertical) reverberation artifacts (seen in 41 patients with advanced fibrosis, 34% of the total series). All abnormalities were detected in both lungs. Although lung biopsy is still the gold standard for diagnosis of interstitial lung disease, transthoracic ultrasound can document early and late-stage changes associated with this disease.

Contrast-enhanced ultrasound (CEUS) for the study of peripheral lung lesions: a preliminary study.

The use of contrast-enhanced ultrasound (CEUS) for the study of peripheral lung lesions has never been systematically investigated. We evaluated the CEUS patterns of 98 peripheral lung lesions before performing US-guided fine-needle biopsies (FNB). The examinations were done with an Esaote Technos MPX scanner in the harmonic mode with a mechanical index of 0.04 or less. Contrast enhancement was achieved with a 4.8 mL bolus of SonoVue (Bracco) administered via an antecubital vein. All FNBs performed under CEUS guidance were adequate for pathologic diagnosis. Seventy-eight lesions were malignant: 33 (41.9%) were adenocarcinomas, 29 (36.5%) were squamous-cell carcinomas, 13 (17.6%) were undifferentiated large-cell carcinomas and the remaining three (4.1%) were small-cell carcinomas. All presented intralesional enhancement consistent with tumor neovascularization. In some cases, there were unenhanced areas consistent with zones of necrosis and these areas were avoided during FNB. The other 20 lesions were benign (four lipomas, two fibrous lung tumor, two noncaseous granulomas, six abscesses, one rheumatoid nodule, one histiocytosis X, one chondroid hamartoma, one sclerosing hemangioma, two sarcoid nodules) and none presented intralesional enhancement. This initial and admittedly limited experience suggests that CEUS may provide diagnostically useful information on peripheral lung lesions and increase the diagnostic yield of transthoracic FNB by reducing the risk of inadequate tissue sampling.

Vitamin D status in inpatients admitted to an internal medicine department.

BACKGROUND/AIMS: A role of hypovitaminosis D has been advocated in several medical conditions. We investigated vitamin D status in medical inpatients, compared to a blood donors' group from the same area. METHODS: Fifty-nine consecutive medical patients were recruited at hospital admission, concomitantly to 207 blood donors of both genders. Serum calcium, albumin, phosphate, creatinine, alkaline phosphatase total activity, 25-hydroxyvitamin D [25(OH)D] and parathyroid hormone (PTH) were assessed from April to May 2005. RESULTS: In patients, 25(OH)D values were lower (13.1 +/- 9.2 vs. 16.3 +/- 8.5 ng/ml; p < 0.02) and PTH values higher (73.9 +/- 77.7 vs. 53.4 +/- 24.3 pg/ml; p < 0.01) than in controls, whose mean age was lower (62.5 +/- 14.5 vs. 45.8 +/- 15.6 years, p < 0.01). Such differences were not confirmed when comparing patients to a subgroup of age and sex-matched controls drawn from the whole sample of blood donors. In both patients and controls there was a trend towards a negative correlation between 25(OH)D and age and a positive correlation between PTH and age. The prevalence of 25(OH)D <12 ng/ml was higher in patients than in controls as a whole (58 vs. 34%; chi(2) = 9.95; p < 0.002), but not in respect to the subgroup of matched controls (58 vs. 44%; chi(2) = 2.09; p = 0.14). The prevalence of severe vitamin D deficiency, 25(OH)D <5 ng/ml, was significantly higher in patients than in matched controls (17 vs. 4%; chi(2) = 6.75; p < 0.01). CONCLUSION: Hypovitaminosis D, defined as 25(OH)D <12 ng/ml, is frequent among inpatients, as in the general population of comparable age. A severe vitamin D deficiency is more common in hospitalized patients.