Aims: The aim of the study was to evaluate the ability of contrast-enhanced ultrasonography (CEUS) compared to grayscale B-mode and color Doppler ultrasound in differentiate benign versus malign superficial cervical lymph nodes. Material and methods: In a prospective study ultrasonography (gray scale, color and spectral Dopller, and CEUS) was performed in 61 patients (33 men, 28 women; mean age of 51.2 years, range: 18-81 years), with cervical lymphadenopathy. The nodes were examined and biopsied or surgically removed. CEUS was performed with 2.4 ml intravenous bolus of contrast agent Sono Vue and the results were registered with a special software. Results: Of all the nodes, 32 were benign and 29 were malignant (metastases). Solbiati index was higher in benign nodes (2.23 ± 0.84 vs 1.50 ± 0.48, p<0.05). Doppler parameters (vessel location, vascular pattern, pedicullum number, resistivity index, and pulsatility index) were significantly lower in benign nodes (p<0.001), and ROC analysis returned excellent results. For CEUS, derived peak intensity (DPI %) was higher in benign nodes (17.72 ± 5.43 vs 11.76 ± 4.88, p<0.05); regional blood volume (RBV) was also higher (849.8 ± 467.1 vs 458.3 ± 283.3, p<0.05). The time to peak (TTP, s) and area under the curve (AUC, cm2) were similar in both benign and malignant nodes. Enhancement pattern was the most accurate to characterize benign versus malignant nodes. Sensitivity and specificity were higher for DPI, RBV and enhancement pattern from CEUS, according to ROC analysis, compared to gray scale ultrasound, but lower than color Doppler. Analyzing the place of CEUS in lymph node evaluation we found that CEUS is most useful for the evaluation of the lymph nodes with uncertain aspect at gray scale and Doppler evaluation. Conclusions: ROC analysis confirmed the higher degree of diagnostic accuracy of CEUS in comparison with conventional techniques for some parameters such as enhancement pattern. Evaluation of nodal perfusion with this method can be helpful in the differentiation of benign from malignant nodes but requires further confirmation.

Cardiovascular autonomic neuropathy is a common form of autonomic dysfunction in diabetes mellitus (DM) and associates abnormalities in heart rate control and in vascular dynamics. This study evaluates the impact of diabetes mellitus on left ventricular diastolic dysfunction (LVDD) and heart rate variability in a group of type 2 diabetes mellitus without signs of cardiovascular disease. The study group consisted of 58 patients, aged 61 ± 8 years, diagnosed with type 2 DM. The subjects were selected from a series of 104 consecutive diabetic patients. All the subjects were on oral therapy or on diet for DM, and ECG was normal for all the subjects. The control group consisted of 45 healthy subjects, matched for age and sex. Heart rate variability was measured using a 24-h ECG monitoring system, and standard 2D and Doppler echocardiography was performed in all the subjects. There are significant differences between groups regarding disease duration, longer in patients with impaired relaxation (11.22 ± 9.17 vs. 8.31 ± 8.95 years), and disease control, worse in impaired relaxation group. Heart rate in impaired relaxation group is significantly higher than in controls, and higher, but not significantly, when compared with normal group (91 ± 10, vs. 88 ± 11 and 71 ± 11, respectively). Cardiac autonomic neuropathy was associated with LVDD in patients with type 2 DM, but without clinically manifest heart disease. Twenty-four-hour ECG monitoring and echocardiography can detect diabetic cardiomyopathy in early stages and should be performed in all subjects.

Reduced femoral neck BMD is negatively associated with the presence of AAC in postmenopausal women. The association between BMD and AAC seems to be age-independent, which suggests a common pathogenesis for bone loss and vascular calcifications.

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