The validity of voiding cystourethrography (VCUG) for detecting vesicoureteral reflux in children and assessing its extent was compared with that of direct radionuclide cystography (DRNC). Of 131 patients with recurrent urinary tract infection, all underwent DRNC and most also VCUG. Vesicoureteral reflux was found at DRNC in nine renal units (9 patients) in which VCUG was negative. In 17 renal units (15 patients) VCUG showed reflux to the ureter, but not to the renal pelvis, whereas DRNC revealed backflow from the bladder up to the renal pelvis. Reflux visualized at DRNC but not at VCUG was defined as grade Io. In all cases with reflux of grade I according to current classifications, DRNC showed reflux up to the renal pelvis. These observations make the distinction between grades I and II reflux in presently used classification less relevant and indicated the possible pathway of renal infection in patients with grade I vesicoureteral reflux and in so-called "elusive" reflux. We propose the addition of an extra grade (Io) of vesicoureteral reflux.
In patients with PACD, pelvic MRI before and after IFX treatment is an important diagnostic tool to asses fistula tract localisation, reveal abscess, planning adequate treatment approach and assess the effect of treatment. Surgical decision to remove seton was in accordance with MRI criteria for remission in PACD.
Dual ectopic lingual and sublingual thyroid gland is an extraordinarily rare condition. We present 1 patient with subclinical hypothyroidism. The clinical examination revealed that the thyroid gland was not palpable in its usual cervical location, whereas ultrasonography confirmed an empty thyroid bed without any ectopic thyroid tissue in the rest of the neck. The final diagnosis of dual ectopic lingual and sublingual thyroid was established by ultrasound examination through the mouth floor and confirmed by scintigraphy and CT thereafter.
Endorectal ultrasound (ERUS) imaging is a complex process using electronic devices to control ultrasound waves and produce images of anatomic structures. It is a simple, cheep and well-tolerated procedure that provides excellent images of rectal and anal canal wall and pelvic floor muscles together with surrounding organs and tissues. The direct imaging of anal canal and pelvic floor muscles with surrounding tissues allows one to identify sphincter defects, anorectal abscesses and fistulas as well as great variety of benign and malignant pathology of the pelvis. Basically, techniques for ERUS are very similar, but there are some slight modifications regarding equipment, indications, and localization of pathologic process. We describe the technique, indications, results and pitfalls of ERUS with the Bruel and Kjaer type 1850 endosonic probe with 7 and 10 MHz transducers in benign pelvic disorders.
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