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Purpose We evaluated whether the grade assigned to the Achilles tendon's appearance on sonograms can be used to predict the outcome of achillodynia. Methods A retrospective evaluation was done of a case series of patients with Achilles tendon pain seen at a sports medicine clinic. The study consisted of chart reviews, telephone follow-up interviews, and grading of ultrasound images of the tendon obtained during the initial visit. The grading scheme was as follows: grade 1, normal tendon; grade 2, enlarged tendon; and grade 3, tendon containing a hypoechoic area, regardless of size. The time needed to recover from symptoms was compared between grades using survival analysis. Results The group consisted of 33 patients, with a mean age of 35.8 years and a mean follow-up time of 24.3 months. There was a statistically significant difference in the time to full recovery between grades (p = 0.02). Patients with grade 1 tendons had a prompter resolution of symptoms than did patients with grade 2 or 3 tendons. Conclusions This retrospective study of the outcome of achillodynia demonstrates the possible use of tendon sonography as a prognostic tool to supplement physical examination. © 1998 John Wiley & Sons, Inc. J Clin Ultrasound 26:335–339, 1998.

The purpose of this study was to assess ultrasonographic image changes in the patellar tendon after removal of its central one third for anterior cruciate ligament reconstruction. Fourteen patellar tendons in 14 patients were assessed preoperatively and at 2 weeks, 4 weeks, 2 months, 6 months, and 12 months postoperatively. With time, the entire donor tendon became enlarged, hypoechoic, and inhomogeneous compared with the presurgical state. Tendons enlarged maximally in anteroposterior thickness by 2 months and then began to diminish, remaining two times their original anteroposterior thickness by 12 months and never returning to their preoperative appearance. The margins of the defect became indistinct over time. In the donor patellar tendon, abnormal echogenicity was profound and persisted up to 1 year after surgery. Ultrasonographic imaging has the ability to evaluate the postoperative patellar tendon over time and to monitor the normal changes seen with healing.

Umbilical cord cysts diagnosed antenatally present a challenge to the clinician as they may be associated with adverse perinatal outcomes including abnormal karyotypes and stillbirths. We present a case of an umbilical cord cyst diagnosed by routine ultrasound at 30 weeks of gestation. Findings on sonography included unidirectional movement of echogenic particles suggesting a large varix of the umbilical vein. The patient delivered vaginally at 39 weeks and histopathology confirmed the diagnosis.

High premature birth rates have been observed in the rookeries of the California sea lion Zalophus californianus since 1968. The reasons for the premature pupping are complex and, hence, not well understood, although leptospirosis infection and elevated PCB and DDT residues have been implicated. We were interested in determining what role trace and major elements played in these events. Livers and kidneys from 10 normal parturient and 10 premature parturient mothers and their pups were analyzed for Hg, Se, Br, Cd, Ag, Cu, Fe, Zn, Mn, K, Na, Ca, and Mg in order to detect differences that might exist between the two groups. A further objective was to establish how these elements varied in relation to each other in the normal and abnormal sea lions. Our results revealed that Hg, Se, Cd, and Br levels were significantly higher in the livers of the normal mothers and that these elements were all in balance (highly correlated) with each other. This was especially true for Hg, Se, and Br. In mothers with high concentrations of these elements (e.g. Hg greater than 800 μg/g dry weight), atomic ratios of approximately 1Hg:1Se:1Br were observed. Atomic Se:Hg ratios were also near unity in the abnormal mothers; however, Br concentrations were always severely depressed in these individuals. Normal full-term pups had higher hepatic levels of Hg and Se, and near-perfect 1:1 Se:Hg atomic ratios were almost always observed. In contrast, the livers of the premature pups appeared to be deficient in Hg, and, consequently, elevated Se:Hg ratios were always found. In almost all cases, the premature pups had increased concentrations of Na, Ca, and Br. Levels of these elements were correlated with their Se:Hg ratios. Amounts of Mn and Cu were reduced in the premature pups and negatively correlated with Se:Hg ratios. The results suggest that balance between elements is of more importance than absolute concentration when the possible effects of toxic elements are considered. It also appears that bromine may be important in the detoxification process involving Se and Hg and perhaps Cd as well; i.e., every mother that had Br in balance with Hg, Cd, and Se had a normal pup, while every mother that lacked sufficient Br had a premature pup. The question of whether Hg detoxifies Se is also raised. All the normal pups had Se:Hg atomic ratios of less than 2.2, while all the premature pups had reduced Hg amounts and Se:Hg ratios above 3.4.

Cholelithiasis is uncommon in infants. A case of cholelithiasis in a preterm boy who required total parenteral nutrition (TPN) because of prolonged fasting is described. The diagnosis was confirmed by ultrasonography. Despite cholestasis, reintroduction of oral feeding and discontinuation of TPN resulted in the spontaneous disappearance of the gallstones.

The records of 191 patients involved in 316 treatment cycles over 3 years in an in vitro fertilization-embryo transfer program were reviewed. Follicular aspiration, oocyte retrieval, pregnancy rates, technical difficulty, and complications were compared in four oocyte retrieval methods: 117 laparoscopic retrievals, 116 ultrasound (US)-guided percutaneous transvesical retrievals, 43 US-guided transvaginal retrievals, and 40 combined US and laparoscopic retrievals. The mean number of aspirated follicles (9.14) was greatest in the transvaginal retrieval group, but the ratio of oocytes to punctured follicles was not statistically greater in any of the groups. The overall clinical pregnancy rate per cycle was highest in the transvaginal retrieval group: 12 of 43 cycles resulted in pregnancy, or 27.9%. The number of delivered babies (16.3%) was also highest in the transvaginal retrieval group. US-guided transvaginal oocyte retrieval is recommended as the method of choice.