Real-time ultrasound was assessed as a means of evaluating osteoarthritis of the knee. The knee was maintained in complete flexion so as to expose the weight-bearing portion of the femoral condylar cartilage. After establishing the validity of the method in an excised bovine knee, 7 asymptomatic individuals, 10 arthritic patients, and several patients with other conditions were examined. The results indicated that sonography can be used to measure the thickness of the articular cartilage in man, as well as to detect changes in its surface and internal characteristics. Early changes of arthritis may be revealed in this manner.

The authors' experience with the intraoperative use of real-time ultrasonography during 21 neurosurgical procedures is reported. These procedures include neoplasm surgery in 18 cases, treatment of an arteriovenous malformation in one case, and ventricular catheter placement for hydrocephalus in two cases. In each of the neoplasm cases, the tumors were imaged just as well through the intact dura as on the brain surface itself. There were no cases in which the pathology could not easily be identified. The use of portable intraoperative ultrasonography in sterile coverings has proven to be extremely useful in localizing small subcortical neoplasms, as well as locating the solid and cystic portions of deep lesions. It has assisted in guiding needles for both biopsy and aspiration. It has also accurately identified and guided Silastic catheters during their placement in the ventricular system in cases of hydrocephalus. The authors have found real-time ultrasonography to be an important new tool in the operating room and will continue to rely on its imaging ability during selected procedures in the future.

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Three cases of ovarian cysts diagnosed antenatally by sonography are analyzed. Two patients also had congenital hypothyroidism, and one of these also had hypertrophic pyloric stenosis. The significance of fetal ovarian cysts is discussed, with emphasis on the implications for clinical management of the baby. In instances where screening thyroid function tests are not routinely performed on all newborns, prenatal identification of ovarian cysts should be considered as an indication to evaluate thyroid status.

The ultrasonographic features of multicystic renal dysplasia in 15 patients (14 children, 1 adult) are described with emphasis on differentiating this condition from hydronephrosis. The most useful ultrasonographic criteria for identifying multicystic kidney include: (a) the presence of interfaces between cysts (accurate in 100% of cases); (b) nonmedial location of the largest cyst (100%); (c) absence of an identifiable renal sinus (100%); (d) multiplicity of oval or round cysts that do not communicate (93%); and (e) absence of parenchymal tissue (73%). The role and usefulness of radionuclide renal scanning are also discussed. Ultrasonography followed by nuclear scintigraphy appears to be a logical diagnostic sequence in the evaluation of neonates with flank masses. Excretory urography is of value in assessing the status of the uninvolved kidney.