IntroductionAbdominal ultrasonography has replaced barium studies in establishing the diagnosis in difficult cases of infantile hypertrophic pyloric stenosis (IHPS). The aim of this retrospective study was to establish sonographic criteria of qualification for surgical treatment in children with IHPS.Material and methodsHundred and fifteen infants (98 boys and 17 girls) with suspected IHPS were treated between 2000 and 2009. Pyloric muscle thickness, pyloric diameter and pyloric length were measured in US scans in all patients. Results were compared with US results of 19 infants with negative diagnosis and 29 children of the reference group.ResultsDiagnosis of IHPS was confirmed by US examination in 96 children (83.5%). There were 86 boys in the group with male prevalence 8.6 : 1. The remaining 19 infants (16.5%) had a negative ultrasound. The mean PL (20.89 vs. 12.73), PMT (5.41 vs. 2.24), and PD (14.1 vs. 7.42) differed significantly between patients with and without pyloric stenosis (p < 0.0001). The mean PL (12.34), PMT (2.2), and PD (7.48) in the reference group did not differ statistically from values obtained in patients with negative IHPS diagnosis and were significantly lower than in children from the IHPS group (p < 0.0001). US imaging had a sensitivity of 98%, specificity of 100%, with a positive and negative predictive value of 100% and 90% respectively.ConclusionsThis study confirmed that ultrasonography is the first choice of diagnostic method in an infant with suspected hypertrophic pyloric stenosis. In cases with an uncertain clinical diagnosis of IHPS the examination can be easily repeated.
SummaryBackgroundIn the process of diagnosis and treatment of fractures, an X-ray study is typically performed. In modern medicine very important is the development of new diagnostic methods without adverse effects on the body. One of such techniques is ultrasound imaging. It has a high value in imaging most areas of the body, including the musculoskeletal system. Reports on the use of ultrasound in the evaluation of the callus are rare and this could be a method equivalent to or even better than standard radiographs. The aim of the study was to analyze the correlation of ultrasound with radiographs in imaging of callus formation after fractures of long bones in children and to analyze the correlation of vascular resistance index (RI) and the degree of vascularization of the callus with a subjective radiological assessment of the bone union quality.Material/MethodsThe prospective study was planned to qualify 50 children treated for long bones fractures of the arm, forearm, thigh and lower leg. Ultrasound diagnosis was carried out using a Philips iU22 camera equipped with a linear probe with 17-5-MHz resolution and MSK Superficial program. During ultrasound examination measurements of the callus were performed. Using the Power Doppler callus vascularity was visualized and vascular resistance index (RI) was measured. The same measurements were made within the corresponding area of the healthy limb. The results obtained by ultrasound were compared with radiograph measurements and with the subjective assessment of the callus quality.ResultsPreliminary results were developed on a group of 24 patients, where 28 fractured bones and 28 corresponding healthy bones were examined. Fifteen boys and 9 girls participated in the study. The average age at injury was, respectively, 11 and 9 years. In both groups fractures without displacement were the most frequent. A similar frequency was observed in fractures requiring reposition and subperiosteal fractures. In contrast, fractures with a slight displacement of the fragments, were 3 times more common in girls. Statistical analysis of the measurements of length and width of the callus demonstrated that the differences between results obtained in the ultrasound in comparison with X-rays were not statistically significant. Moreover, preliminary results showed a significantly higher degree of vascularization of the callus than of the healthy periosteum.ConclusionsPreliminary results indicate the high efficacy of ultrasound in the evaluation of callus formation after fractures of long bones in children and the possibility of its alternative use to X-ray examinations.
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