Ultrasound Detected Subcutaneous Changes in a Pediatric Cohort After Initiation of a New Insulin Pump or Glucose Sensor.

Objective: This study examined subcutaneous tissue changes at sites used by continuous subcutaneous insulin infusion (CSII) and continuous glucose monitoring (CGM), and tested whether these changes, if any, were associated with glycated hemoglobin (HbA1c). Research Design and Methods: This prospective study investigated recently used CSII or CGM sites in 161 children and adolescents during the first year after initiation of a new diabetes device. Subcutaneous changes such as echogenicity, vascularization, and the distance from the skin surface to the muscle at CSII and CGM sites were assessed by ultrasound. Results: The distance from skin surface to muscle fascia at both the upper arm and abdomen was influenced by age, body mass index z-score, and sex. Especially in boys and the youngest, the depth of many devices outreached the mean distance. The mean distance for boys at the abdomen and upper arm ranged from 4.5-6.5 mm and 5-6.9 mm for all ages, respectively. Hyperechogenicity at CGM sites was 4.3% after 12 months. The frequency of subcutaneous hyperechogenicity and vascularization at CSII sites increased significantly over time (41.2% to 69.3% and 2% to 16% respectively, P < 0.001 and P = 0.009). Hyperechogenicity in the subcutis was not a predictor of elevated HbA1c (P = 0.11). Conclusion: There is large variation in the distance from the skin surface to the muscle fascia and many diabetes devices reach even deeper. Hyperechogenicity and vascularization increased significantly over time at CSII sites, but not CGM sites. The importance of hyperechogenicity for insulin absorption is unclear and further investigations are needed. Clinical Trial Registration number: NCT04258904.

Significance of Partial or Complete Thrombosis of the Common and Deep Femoral Vein in Patients With Deep Vein Thrombosis.

OBJECTIVE: The aim was to assess the anatomical distribution of acute deep venous thrombosis (DVT) with a focus on iliofemoral DVT, and, in particular, to characterise thrombus in the common femoral vein (CFV) and the deep femoral vein (DFV). METHODS: A one year prospective study including patients older than 18 years of age with an acute first time DVT according to ultrasound examination at one of three university hospitals in Copenhagen, Denmark. Thrombus location and extent were registered and divided into five segments: calf veins; popliteal vein; femoral and deep femoral vein; common femoral vein; and iliac veins and/or the inferior vena cava. Thrombus appearance of the CFV and the DFV (partial or occlusive) was examined in detail. RESULTS: Acute DVTs were identified in 203 extremities in 200 patients (58% male). The median age of the patients was 68 years (range 19-92 years), and left-sided DVT was observed in 56%. Iliofemoral DVT was present in 54 (27.0%) patients. Thrombus involving the CFV but not the iliac veins (CFV group) was seen in 28 patients; the remaining 26 had involvement of the iliac veins (iliac group). Thrombus in the CFV was more likely to be occlusive in the iliac group than in the CFV group (77% vs. 4%; p < .001). Thrombus in the DFV was more often occlusive in the iliac group than in the CFV group (81% vs. 11%; p < .001). The DFV was free of thrombus in 12% of patients in the iliac group and in 64% of those in the CFV group. CONCLUSION: The presence of occlusive thrombus in the CFV and/or in the DFV pointed to a DVT also involving the ipsilateral iliac veins. Thrombosis of the deep leg veins extending into the CFV below the inguinal ligament was more likely to be partial in the CFV, mainly due to inflow from the DFV.

Ultrasonographic examination in juvenile idiopathic arthritis is better than clinical examination for identification of intraarticular disease.

INTRODUCTION: The diagnosis of juvenile idiopathic arthritis (JIA) is formally based on clinical examination, but ultrasound (US) examination is used increasingly. Our purpose was to compare US and clinical examination in the assessment of synovitis in JIA. MATERIAL AND METHODS: This study was retrospective and included 62 consecutive patients with newly diagnosed JIA admitted to the Department of Paediatrics at Gentofte Hospital, Denmark from 2003 to 2010. The included patients were examined clinically and by US at their first visit. All peripheral joints were examined clinically, 24% of these joints were examined by US. The development of new, clinically arthritic joints was followed during the next six months. RESULTS: The mean sensitivity of clinical examination was 48% with a clear hierarchy among joints, knees having the highest sensitivity, small joints of hands and feet the lowest. On average, 0.4 joints per child, which were arthritic by clinical examination, were negative by US. Inversely, US detected 1.3 more arthritic joints than clinical examination did per child. The latter is a minimum estimate since only 24% of the joints were examined by US. Subclinically arthritic joints had a 29% probability of developing clinical arthritis within the first six months following the initial examination. CONCLUSION: Although there is no formal validation of US examination in children suspected for JIA, we recommend that it is used routinely and performed by a highly experienced US operator. FUNDING: not relevant. TRIAL REGISTRATION: not relevant.

[FDG-PET and CT in gastrointestinal stromal tumor treated with imatinib]. / FDG-PET og CT ved gastrointestinal stromal tumor i behandling med imatinib.

The combined imaging modality PET/CT is a possible superior tool for evaluation of gastro-intestinal stromal tumor treatment illustrated in a case of a 59-year-old woman responding to imatinib.

[Pseudarthrosis of the ulna in a patient with neurofibromatosis]. / Pseudartrose af ulna hos patient med neurofibromatose.

A case of pseudoarthrosis and partial resorption of the ulna in a 12-year-old girl with neurofibromatosis is described. Neurofibromatosis is a common neurocutaneous disease with characteristic osseous lesions. The pseudoarthrosis in this case developed after fracture. The bone most commonly affected is the tibia and involvement of the ulna has been reported in only a few cases. The possible cause of pseudoarthrosis, the radiographic changes, and the treatment are discussed.