---

Background and Objective: Acute appendicitis is one of the most common surgical emergencies. Preoperative diagnosis of acute appendicitis remains challenging, despite improvements in history taking and clinical examination. Methods advocated to assist in the diagnosis of appendicitis include laparoscopy, ultrasonography, computed tomography and magnetic resonance imaging. The purpose of this study was to assess the accuracy of ultrasonography in the diagnosis of acute appendicitis. Materials and Methods: This prospective descriptive study was done to evaluate 265 patients suspected to have acute appendicitis and admitted to the emergency department of 5 Azar hospital of Gorgan from Aug 2005 to Aug 2006. Suspected patients visited by the general surgeon and ultrasonography of the appendix was performed subsequently. The ultrasonography examination was done using high graded-compression ultrasongraphy with 5 MHz variable focus linear array transducer. The sonographic data were compared with clinical, operative and pathological findings. Results: The sensivity and specifity of ultrasonography was 66% and 4%, respectively. Also positive and negative predictive value of ultrasonography was 98% and 40%, respectively. Conclusion: This study showed that ultrasonography is a useful method in the diagnosis of acute appendicitis. It also increase diagnostic accuracy of acute appendicitis and minimize negative laparotomy and prevent unnecessary appendectomy.

---

Background and Objective: Lower ureter is the most common site of stone traped causing renal colic and hydroureteronephrosis. If medical therapy is not effective , the treatment consist of extracorporeal shock wave lithotripsy (ESWL), transurethral lithotripsy (TUL) or on rare cases, open surgery. This study was done to compare the ESWL with TUL in sixty patients with lower ureteral stones which did not responed to thraputic regiment. Materials and Methods: This prospective cohort study was done on sixty patients with obstructive lower ureteral stones for more than 3 weeks, that have not been responded to the thraputic regiment in Imam Reza hospital, Mashhad, Iran during 2004-06. According to treatment indications sixty patients divided in two equal ESWL and TUL groups. Success of procedure were evaluated by ultrasonography and KUB radiography. The success rate of two different technique and the side effects in each patients was recorded. Results: In ESWL group in 14 patients (46.66%) the stone was broken and its particles were removed but in 13 patients (43.33%) the stone was not broken and they became candidates for TUL. In 3 patients (10%) the stone was broken but the particles did not pass. The only complication of ESWL was renal colic which was in 15 patients (50%) and cured by medical treatment. In TUL group, in 93.5% of patients, the stone was broken and particles were removed, but in 6.5% the procedure was not successful and the patients underwented ESWL or open surgery. 10% of patients experienced fever and colic pain, who underwented medical treatment. Conclusion: This study showed that TUL technique has higher successful rate than ESWL technique in lower uretaral stones.

---

Background and Objective: Internal derangement of knee (IDK) is a common problem following knee trauma. Magnetic resonance imaging (MRI) extensively is used to diagnose the ligamentous and meniscal injuries, but the use of ultrasonography remains controversial. Previous studies showed different results about the usefulness of sonography (IDK). This study was done to determine diagnostic accuracy of ultrasonography in comparison with magnetic resonance imaging in patients with knee trauma. Materials and Methods: This descriptive study was done on internal knee disorders of 73 patients with knee trauma who referred to MRI center of Imam Khomeini hospital in Sari, Iran during 2009-10. Three radiologists independently reported the ultrasonography and MRI of the patients. Results: The study population comprised of 61 (83.6%) men and 12 (16.4%) women, 91.9% of patients were less than 40 years old. The joint pain was the most common complaint (89%). The sensitivity, specificity, positive and negative predictive value of ultrasonography for the lateral meniscus was 100%, 97.14%, 60%, 100%, for the medial meniscus were 61.90%, 94.23% ,81.25%, 85.96%, for the anterior cruciate ligament (ACL) was 65%, 100%, 100%, 70.21% and for the medial collateral ligament (MCL) was 100%, 94.28, %42.86 and 100%. Conclusion: This study showed that the high specificity of ultrasonography as a noninvasive and inexpensive method to exclude the ACL and meniscal lesion. Ultrasonography can reasonably be applied for screening of internal derangement of knee in the absence of MRI, especially in urgent conditions. In clinical setting of highly suspicious of ACL and meniscal tear, MRI is preferred due to low sensitivity of sonography.

---

Low back pain (LBP) is a common and complicated disorder which is influenced by a number of factors, among them is the lack of spinal stability provided by muscle contraction. One of the most important muscles which has a role in spinal stability is musculus transversus abdominis. A literature search for the period of 2000-11 was performed in PubMed, ProQuest, Science Direct, Thomson, EMBASE, OVID, CINAHL and MEDLINE databases using musculus Transversus Abdominis, ultrasonography, chronic nonspecific low back pain as keywords. Nineteen articles were selected according to the inclusion criteria of the study. Evidences demonstrated that thickness of transversus abdominis reduces in patients with chronic nonspecific low back pain (LBP) and ultrasonography seemed to be a valid and highly reliable instrument for measuring thickness of transversus abdominis in patients with LBP and healthy subjects on different positions and states. Studies demonstrated that there are adequate evidences to confirm the merit of ultrasonography in the assessment of musculus transversus abdominis in patients with chronic LBP and healthy subjects.

---

Background and Objective: Cholelithiasis have concomitant with biliary tract stones (BTS) in about 10-15% of the affected patients. This study was carried out to compare the specificity and the sensitivity of ultrasonography and computed tomography (CT scan) with the endoscopic retrograde cholangio pancreatography (ERCP) for detecting of the biliary tract stones and to evaluate the efficacy of the ERCP therapy. Methods: In this descriptive study, 135 patients suspected of BTS whom were candidate for the ERCP were gone under investigation. Ultrasonography of the gallbladder, liver, biliary tract, oral and IV contrast of abdominal CT scan and the ERCP were conducted for each patient. ERCP was considered as key critria to define BTS. The specificity and sensitivity of the ultrasonography and CT scan and the success rate of the therapeutic ERCP was estimated. Results: BTS were observed in 112 patients by ERCP method. The specificity and sensitivity of the ultrasonography was 72.3% and 73.9%, respectively. The specificity and sensitivity of the CT scan was 50.8% and 91.3%, respectively. The success rate of the therapeutic ERCP was estimated as 76.9%. Conclusion: Ultrasonography as a non-invasive, non-expensive and well sensitivity method which is recommended in patient screening of biliary tract stones in compare to ERCP and CT scan.

---

Background and Objective: Urinary tract infection is the second common bacterial infection in children. Constipation as a risk factor in urinary tract infection was reported by several studies. This study was carried out to evaluate the relationship between rectal diameter and constipation with urinary tract infections in children. Methods: This case – control study was performed on 40, 2-12 years old hospitalized children with urinary tract infections as cases and 40 healthy children with the same age as controls in Boali Hospital in Sari, Iran. Rectal diameter was measured by ultrasonography. Demographic characteristics, rectal diameter, during of infectious and disease clinical signs were recorded for each subject. Results: Constipation was observed in 62.5% and 17.5% of cases and controls, respectively (P<0.05). Rectal diameter was 47.64 mm and 26.48 mm in case and control groups, respectively (P<0.05). Conclusion: Regarding to increasing of rectal diameter in patients with urinary tract infections in comparison with healthy subjects, ultrasonography can be a reliable method either to confirm or reject the presence of constipation in urinary tract infections.

---

Background and Objective: The causes of non traumatic abdominal pain are varied from mild to severe onset. This study was carried out to assess the outcome of the patients with non-specific abdominal pain discharged from the emergency department. Methods: This cohort study was carried out on 247 patients (68.4% female, 31.6% male) with non-specific abdominal pain which referred to the emergency department of Imam Hossain hospital in Tehran, Iran during 2010-11. The existence or improvement of pain, readmission to hospital and possible subsequent complications diagnose and death was recorded after four-week through telephone follow-up. Results: 247 patients with non-specific abdominal pain were enrolled. Out of 158 patients with recurrence pain, 71 (45%) patients were admitted to the hospital again that finally, cause of pain was diagnosed in 45 (28.5%) patients. The most common cause of abdominal pain was irritable bowel syndrome (3.2%). History of similar pain (OR=4.04, P<0.05), abnormal findings in abdominal ultrasonography (OR=8.2, P<0.05), abnormal urine analysis (OR=7.4, P<0.05) and abdominal pain persisted for more than 2 days (OR=4.04, P<0.05) were independent factors to identifying the causes of abdominal pain. Conclusion: Nonspecific abdominal pain will not lead to appropriate recognition and most of them recover without any complication.

---

Background and Objective: Thyroid nodules are common among the general population and they increase the risk of thyroid malignancies. This study was done to evaluate the correlation of findings of ultrasound based on Thyroid Imaging and Reporting Data System (TIRADS) and cytology of fine needle aspiration (FNA) based on Bethesda system to evaluate of thyroid nodules.
Methods: This descriptive-analytical study, was performed on 165 patients (152 females and 13 males) referred to the sonography center of Sayyad Shirazi Educational Hospital, Gorgan, northern Iran during 2018. Ultralosonographic features of nodules were recorded in the pre-filled checklist. According to TIRADS and endocrinologist clinical suspicion, couple of patients was eligible for FNA under the ultrasound guidance. The cytology of FNAs was reported based on the Bethesda system classification.
Results: The mean age was significantly lower in patients with malignant nodules (35.4 vs 44.8; P<0.05). Frequency of malignancy was 8 times higher among females than males (16 vs. 2). TIRADS 3 and 4 were the most common categories among the others with the prevalence of 44.4% and 32.3%, respectively. Bethesda 2 and 4 were the most prevalent categories with prevalence of 58.8% and 20.6%, respectively. The strongest agreement was observed between TIRADS 2 and Bethesda 2 that showed benign findings. Kappa index was 0.061 between TIRADS and Bethesda (P<0.05). Echogenicity, echogenic foci, shape, and margin of nodules were seen significantly more in malignancy.
Conclusion: The most accurate prediction of TIRADS belongs to benign nodules. The correlation between TIRADS and Bethesda was evaluated to be significant overall and the maximum level of correlation was at benign findings. Therefore, these two systems can efficiently be used in order to rule out malignancies and reduce the rate of invasive interventions.

---

Background and Objective: Puberty is a period of transition from childhood to adulthood which is accompanied by physiological changes. Menarche age is an important puberty indicator for assessing growth status. Growth and maturity of the genitals are essential for a girl's reproductive health. This study aimed to investigate the relationship between uterine sonographic characteristics and dimensions with menarche and puberty in girls.
Methods: This descriptive-analytical study was performed on 76 healthy girls (aged 9-16 years) who were referred to the endocrinology clinic of Taleghani Hospital in Gorgan (Iran) during 2017-2020. Height, weight and age were recorded and uterine and ovarian dimensions were measured by pelvic sonography.
Results: There was a significant positive correlation between menarche age (r=0.79, P=0.001) and ovarian length (r=0.81, P=0.007), ovarian volume and the length of the largest side of the uterus (r=0.77, P=0.001). Height had a significant positive association with menarche age (b=0.082, P=0.002) and ovarian length in the second place (b=0.097, P=0.004). But there was an inverse relationship between menarche age and girls' weight.
Conclusion: An increase in the menarche age increases the size of the uterus and its volume.