RESUMEN
OBJECTIVE: Conventional two-dimensional ultrasound has been assessed for the non-invasive diagnosis of giant cell arteritis (GCA), but the results are operator dependent, resulting in low sensitivity. Tomographic three-dimensional (3D) ultrasound is a novel technique that enables the objective documentation of vessel geometry. Here, for the first time, its utility is assessed for visualizing temporal arteries. METHOD: The temporal artery of 14 healthy subjects and three subjects with suspected GCA was examined using tomographic 3D ultrasound. RESULTS: This technique enabled 3D mapping of the architecture of the temporal artery. The inner and outer vessel diameters showed considerable interindividual variability. However, calculation of the vessel wall fraction revealed the combination of vessel wall thickening and lumen narrowing, which may be indicative of GCA. CONCLUSIONS: This proof-of-concept study indicates that tomographic 3D ultrasound can be used for objective mapping of the temporal artery. The technique must be evaluated regarding its diagnostic sensitivity in GCA before it can be introduced in clinical practice.
Asunto(s)
Arteritis de Células Gigantes , Imagenología Tridimensional , Arterias Temporales , Ultrasonografía , Humanos , Arterias Temporales/diagnóstico por imagen , Arteritis de Células Gigantes/diagnóstico por imagen , Imagenología Tridimensional/métodos , Femenino , Masculino , Ultrasonografía/métodos , Anciano , Persona de Mediana Edad , Adulto , Prueba de Estudio Conceptual , Anciano de 80 o más AñosRESUMEN
OBJECTIVE: Giant cell arteritis (GCA) is a treatable, but potentially sight- and life-threatening form of systemic vasculitis. Prompt and correct diagnosis is therefore important. Temporal artery biopsy (TAB) is the gold standard for diagnosing GCA, but is associated with risks. There is no reliable non-invasive technique for the diagnosis of GCA. Ultrasound centre frequency shift (CFS) is a novel technique that uses high-frequency ultrasound and the analysis of the centre frequency of the ultrasound pulse, which is dependent on the size of the microstructures in the tissue. This provides an objective measure of the scattering microstructures in the tissue, and thus has the potential to discriminate changes due to disease. The aim of this study was to assess ultrasound CFS as a means of discriminating arteries affected by GCA from healthy arteries. METHOD: TAB specimens from 68 subjects, 53 female and 15 male, with a mean age of 73 (range 52-87) years, with suspected GCA were examined using ultrasound ex vivo and the CFS was analysed. The temporal arteries were then examined histopathologically. RESULTS: Histopathological examination revealed that 25 of the 68 biopsies of the temporal artery showed inflammatory changes in the vessel wall compatible with GCA. The ultrasound CFS decreased less in TAB-positive than in TAB-negative temporal arteries (p < 0.05). CONCLUSIONS: This proof-of-principle study indicates that ultrasound CFS has the potential to detect GCA in temporal arteries. Further technical development will be needed before in vivo examination can be performed and the clinical applicability can be assessed.
Asunto(s)
Arteritis de Células Gigantes , Humanos , Masculino , Femenino , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Arteritis de Células Gigantes/diagnóstico , Sensibilidad y Especificidad , Arterias Temporales/patología , Ultrasonografía , Biopsia/métodos , Estudios RetrospectivosAsunto(s)
Biopsia/métodos , Formaldehído/farmacología , Arteritis de Células Gigantes/diagnóstico , Arterias Temporales/patología , Fijación del Tejido/métodos , Anciano , Anciano de 80 o más Años , Femenino , Fijadores/farmacología , Humanos , Masculino , Persona de Mediana Edad , Arterias Temporales/efectos de los fármacosRESUMEN
In men with non-obstructive azoospermia (NOA), the risk of hypogonadism is often overlooked. Testicular sperm extraction (TESE) may increase this risk. The objective of this study was to elucidate the prevalence of hypogonadism in NOA-patients, the impact of TESE on hormone balance and the association between testosterone deficiency and dyslipidaemia. Men with NOA who had undergone TESE during the period 2004-2009 were eligible. Hypogonadism was defined as total testosterone <10 nmol/L and/or LH >10 IU/L and/or ongoing androgen replacement therapy. Sixty-five consecutive men who had undergone TESE owing to NOA and from whom post-TESE serum testosterone levels measured before 1100 h were available. Furthermore, 141 fertile men served as controls. Serum concentrations of testosterone, LH and lipids were assessed. Odds ratios (OR) for biochemical hypogonadism were calculated. Pre- and post-TESE hormone levels were compared. Lipid profile was related to testosterone levels. Hypogonadism was found in 47% (95% CI, 0.36, 0.59) of the NOA-men. As compared with fertile controls, the OR for hypogonadism post-TESE was 17 (95% CI 6.6-45). Serum LH (p = 0.03), but not testosterone (p = 0.43), differed significantly pre- and post-TESE. Compared with eugonadal NOA-men, the OR for having deviations in lipid profile was 3.3 (95% CI 1.3-8.8) for the hypogonadal NOA-men. NOA-men are at very high risk of androgen deficiency, which even in young subjects is associated with dyslipidaemia. Medical management of these men should therefore include endocrinological evaluation and follow-up after completion of infertility treatment.