Application of ulnar nerve diameter changes examined by HRUS in patients with cubital tunnel syndrome / 中国骨伤

OBJECTIVE@#To evaluate the value of high-resolution ultrasound the diagnosis and prognosis of cubital tunnel syndrome.@*METHODS@#From January 2018 to June 2019, 47 patients with cubital tunnel syndrome were treated with ulnar nerve release and anterior subcutaneous transposition. There were 41 males and 6 females, aged from 27 to 73 years old. There were 31 cases on the right, 15 cases on the left, and 1 case on both sides. The diameter of ulnar nerve was measured by high-resolution ultrasound pre-and post-operatively, and measured directly during the operation. The recovery status of the patients was evaluated by the trial standard of ulnar nerve function assessment, and the satisfaction of the patients was assessed.@*RESULTS@#All the 47 cases were followed up for an average of 12 months and the incisions healed well. The diameter of ulnar nerve at the compression level was (0.16±0.04) cm pre-operatively, and the diameter of ulnar nerve was (0.23±0.04) cm post-operatively. The evaluation of ulnar nerve function:excellent in 16 cases, good in 18 cases and fair in 13 cases. Twelve months post-operatively, 28 patients were satisfied, 10 patients were general and 9 patients were dissatisfied.@*CONCLUSION@#The preoperative examination of ulnar nerve by high-resolution ultrasound is consistent with the intuitive measurement during operation, and the result of postoperative examination of ulnar nerve by high-resolution ultrasound is consistent with follow-up results. High-resolution ultrasound is an effective auxiliary method for the diagnosis and treatment of cubital tunnel syndrome.

Ultrasonography findings of appendicular wall thickness in acute appendicitis and recurrent appendicitis with pathological correlation

Background: Appendicitis is among most common cause for acute abdominal pain requiring operative management. This study is to establish relationship between wall thickness of acute appendicitis and recurrent appendicitis with its pathological outcome.Methods: In this prospective study, 24 patients of acute appendicitis and 8 patients of recurrent appendicitis presenting as acute appendicitis were examined by High resolution Ultrasonography within 48 hrs of acute onset of symptoms following a detailed clinical examination. Alvarado scoring was done in all patients. Acute appendicitis and recurrent appendicitis were differentiated on the basis of clinical details and timeline of illness. Post operatively all specimens underwent gross and histopath examination and were divided into subgroups and tabulated as “early acute appendicitis”, “acute suppurative appendicitis” and “acute gangrenous Appendicitis”.Results: Wall thickness of acute appendicitis and recurrent appendicitis (presenting with acute onset of symptoms) were tabulated. Patients with wall thickness of <3mm had statistically significant higher prevalence of acute gangrenous appendicitis on pathological correlation. Patients with recurrent appendicitis had higher incidence of wall thickness <3mm, consequently increased incidence of acute gangrenous appendicitis. The value of z was 6.0715. The value of p is <0.00001. The result was significant at p <0.01 according to SPSS 16, which correlates well with findings.Conclusions: Wall thickness is an important indicator in the management of acute or recurrent appendicitis, wall thickness of <3mm or >3mm was decisive in patient management. Reduced wall thickness of appendix in patients with acute or recurrent appendicitis correlate with higher incidence of acute gangrenous appendicitis therefore are at higher risk of perforation and should be managed aggressively by surgical intervention to avoid complications.

High-resolution ultrasonography measurement of dimensions of median nerve at wrist in asymptomatic adults

Background: Ultrasonography (USG) is a cheap, easily available and painless modality for the diagnosis of carpal tunnel syndrome. However, the main sonographic criteria of cross sectional area (CSA) and flattening ratio (FR) of median nerve show a wide normal variation which warrants establishment of normal range of variability in the dimensions of median nerve in different populations. Objective: The main aim of this study was to calculate the mean cross sectional area (CSA) and flattening ratio (FR) of median nerve at wrist in asymptomatic adults. Materials and methods: This prospective observational study included asymptomatic adults visiting our tertiary care hospital for unrelated heath conditions with no symptoms to suggest carpal tunnel syndrome. Ultrasound examination of both wrists was carried out by high frequency linear array transducer with frequency of 10MHz with the arm in supine neutral position on LOGIQ P5 (GE Healthcare, Chicago, Illinois, USA) ultrasound machine. The cross-sectional area (CSA) and flattening ratio (FR) of the median nerve was measured at the level of carpal tunnel inlet and mean values with standard deviation were calculated. Results: Three hundred seventy six (376) wrists of 188 subjects were examined. 36 wrists were excluded owing to presence of anatomic variations of the median nerve in them. 340 wrists of 170 patients were included in the study. Mean cross sectional area of median nerve was 9.2 mm2 (±1.2). Arshed Hussain Parry, Abdul Haseeb Wani, Naseer Ahmad Choh, Tariq Ahmad Gojwari. High-resolution ultrasonography measurement of dimensions of median nerve at wrist in asymptomatic adults. IAIM, 2019; 6(4): 144-149. Page 145 Mean value of flattening ratio was 2.4 (±0.6). Mean CSA (9.26 ±1.2 mm2 ) and FR (2.41 ±0.6) of males was not significantly different from mean CSA (9.16 ±1.2 mm2 ) and FR (2.4±0.55) of females. However, mean CSA of right wrist (9.4 ±1.2 mm2 ) was significantly different from mean CSA of left wrist (9.10 ±1.1 mm2 ). Conclusion: We found a higher mean cross sectional area (CSA) of 9.2 mm2 of median nerve in our population. There was a significant difference in the cross sectional area of median nerve between right and left wrists. However, we did not find statistically significant difference in the CSA and FR between the males and females. Establishment of normative data for the dimensions of median nerve is essential for different populations given the wide range of variations in the dimensions of median nerve

Bayesian analysis of high-resolution ultrasonography and guided fine needle aspiration cytology in diagnosis of palpable thyroid nodules / Análise bayesiana de ultrassonografia de alta resolução e citologia de aspiração poragulha fina guiada no diagnóstico de nódulos palpáveis da tireoide

Abstract Introduction To evaluate diagnostic accuracy of high-resolution ultrasonography in differentiation of benign and malignant thyroid nodules in comparison to results of guided fine needle aspiration cytology based on the Bayes rule. Objective To assess the validity of ultrasonography results of thyroid nodules in comparison to guided fine needle aspiration cytology findings. Methods This study was done on randomly chosen 80 patients presented with palpable thyroid nodules, undergone real-time sonographic evaluation of thyroid nodules to characterize features, internal consistency, margins, echotexture, calcification, peripheral lucent halo and vascularity. Ultrasonography guided fine needle aspiration cytology studies of thyroid nodules were done. Results Palpable thyroid nodules were highly prevalent in fourth and fifth decades of life with female-male ratio, 4:1. Solid internal consistency was demonstrated by 75% malignant nodules. Hypoechogenicity and intra-nodular micro-calcifications were observed in 92% malignant nodules; 83% malignant nodules had intra-nodular vascularity and absence of peripheral halo. The pre-test prevalence of malignant nodules in the targeted population was 17.5%. As type I error, 2.5% false-positive cases and as type II error, 5.0% false-negative cases were detected. Values of sensitivity and specificity of the ultrasonography test were 71.43 and 96.97%, respectively. Conclusion Malignant thyroid nodules demonstrated ultrasonography characteristics of hypoechoic texture, intra-nodular micro-calcifications, solid consistency, internal vascularity and absence of peripheral halo. The ultrasonography test has 92.5% diagnostic accuracy to differentiate malignant from benign lesions in comparison to the gold standard fine needle aspiration cytology test.

Resumo Introdução Avaliar a precisão diagnóstica da ultrassonografia de alta resolução na diferenciação de nódulos tireoidianos benignos e malignos em comparação com os resultados da citologia de aspiração por agulha fina baseada na regra de Bayes. Objetivo Avaliar a validade dos resultados da USG de nódulos da tireoide em comparação com os resultados obtidos por citologia de aspiração por agulha fina. Método Este estudo foi feito em 80 pacientes selecionados aleatoriamente, que apresentavam nódulos palpáveis da tireoide, submetidos à avaliação ultrassonográfica em tempo real de nódulos da tireoide para estabelecer características, consistência interna, margens, ecotextura, calcificação, halo lucente periférico e vascularização. Foram feitos estudos por citologia de aspiração por agulha fina guiados pela USG dos nódulos de tireoide. Resultados Nódulos palpáveis da tireoide foram altamente prevalentes na quarta e quinta décadas de vida com uma razão sexo feminino-masculino de 4:1. A consistência interna sólida foi demonstrada em 75% de nódulos malignos. Hipoecogenicidade e microcalcificações intranodulares foram observadas em 92% de nódulos malignos; 83% dos nódulos malignos apresentaram vascularidade intranodular e ausência de halo periférico. A prevalência pré-teste de nódulos malignos na população alvo foi de 17,5%. Como erro tipo I, houve 2,5% de casos falso-positivos e como erro tipo II, foram detectados 5,0% de casos falso-negativos. Os valores de sensibilidade e especificidade do exame por USG foram de 71,43 e 96,97%, respectivamente. Conclusão Nódulos malignos da tireoide mostraram características de textura hipoecoica, microcalcificações intranodulares, consistência sólida, vascularidade interna e ausência de halo periférico na USG. O exame por USG tem 92,5% de precisão diagnóstica para diferenciar lesões malignas de benignas em comparação com o padrão ouro da citologia de aspiração por agulha fina.

Pure neuritic leprosy: Current status and relevance.

Pure neuritic leprosy has always been an enigma due to its clinical and management ambiguities. Although only the Indian Association of Leprologist’s classifi cation recognizes ‘pure neuritic leprosy’ as a distinct sub group of leprosy, cases nonetheless are reported from various countries of Asia, Africa, South America and Europe, indicating its global relevance. It is important to maintain pure neuritic leprosy as a subgroup as it constitutes a good percentage of leprosy cases reported from India, which contributes to more than half of global leprosy numbers. Unfortunately, a high proportion of these patients present with Grade 2 disability at the time of initial reporting itself due to the early nerve involvement. Although skin lesions are absent by defi nition, when skin biopsies were performed from the skin along the distribution of the affected nerve, a proportion of patients demonstrated leprosy pathology, revealing sub-clinical skin involvement. In addition on follow-up, skin lesions are noted to develop in up to 20% of pure neuritic leprosy cases, indicating its progression to manifest cutaneous disease. Over the decades, the confi rmation of diagnosis of pure neuritic leprosy has been subjective, however, with the arrival and use of high-resolution ultrasonography (HRUS) for nerve imaging, we have a tool not only to objectively measure and record the nerve thickening but also to assess the morphological alterations in the nerve including echo texture, fascicular pattern and vascularity. Management of pure neuritic leprosy requires multidrug therapy along with appropriate dose of systemic corticosteroids, for both acute and silent neuritis. Measures for pain relief, self-care of limbs and physiotherapy are important to prevent as well as manage disabilities in this group of patients.

Role of high resolution ultrasound in ulnar nerve neuropathy

SUMMARY Aim: This study was conducted to measure the cross sectional area (CSA) of the ulnar nerve (UN) in the cubital tunnel and to evaluate the role of high-resolution ultrasonography in the diagnosis of ulnar nerve neuropathy (UNN). Materials and Methods This was a cross sectional study with 64 arms from 32 patients (34 neuropathic, 30 nonneuropathic). Diagnosis was confirmed by nerve conduction study and electromyography. The ulnar nerves were evaluated with 15MHz small footprint linear array transducer. The ulnar nerve CSA was measured at three levels with arm extended: at medial epicondyle (ME), 5cm proximal and 5cm distal to ME. Results from the neuropathic and nonneuropathic arms were compared. Independent T-tests and Pearson correlation tests were used. P value of less than 0.05 was considered significant. Results: Mean CSA values for the UN at levels 5cm proximal to ME, ME and 5cm distal to ME were 0.055, 0.109, 0.045 cm2 respectively in the neuropathic group and 0.049, 0.075, 0.042 cm2 respectively in the non-neuropathic group. The CSA of the UN at the ME level was significantly larger in the neuropathic group, with p value of 0.005. However, there was no statistical difference between the groups at 5cm proximal and distal to the ME, with p values of 0.10 and 0.35 respectively. Conclusion: There is significant difference in CSA values of the UN at ME between the neuropathic and non-neuropathic groups with mean CSA value above the predetermined 0.10cm2 cut-off point. High-resolution ultrasonography is therefore useful to diagnose and follow up cases of elbow UNN.

Cysticercosis In Anterior Abdominal Wall : A rare case report.

Cysticercosis, caused by Taenia solium larva is a major public health problem especially in developing world. In this unusual form of infection man becomes the intermediate host. The encysted larval stage commonly infests brain, but muscles and subcutaneous tissues are also often affected. High resolution ultrasonography is diagnostic for subcutaneous or intramuscular cysticercosis.Here we present a rare case of anterior abdominal wall cysticercosis.

Usefulness of High-Resolution Ultrasonography after Foreign Body Injection on Aesthetic Plastic Surgery

PURPOSE: The purpose of this study is to demonstrate the usefulness of the high resolutional ultrasonographic features in patients with foreign body. METHODS: From September 2007 to August 2009, we retrospectively reviewed high resolutional ultrasonogram using 5~12MHz linear transducer of 13 patients presenting with inflammation after foreign body injection. They were referred for complications after foreign body injection. Injected foreign bodies were 4 silicone, 4 paraffin, 2 artecoll, and 3 unknown. We treated them with foreign body removal(7), foreign body removal and corrective plastic surgery(4), and conservative treatment with antibiotics and steroid injection(2). RESULTS: High resolutional ultrasonography well demonstrated the existence of foreign body and it's overall size, location within the tissue layer, and vascularity. Comparison between preoperative and postoperative ultrasonographic findings was useful not only to evaluate the prognosis but also to plan the treatment. These ultrasonographic findings aided in precise assessment of the contour and location of the foreign body and led to an accurate surgery. We were able to acquire various information in order to set a detailed plan for the operation which in turn, led to a precise, successful surgery. After the treatment, complication did not occur in 12 patients, except 1 patient. But this patient was also treated after reoperation. Postoperative high resolutional ultrasonography shows almost foreign body removed and inflammation disappeared. CONCLUSION: Considering the usefulness of high-resolution ultrasonography in foreign body injection, high-resolution ultrasonography would be necessary for both the patient and the doctor. Preoperative and postoperative high resolutional ultrasonography is highly accurate, safe, inexpensive and easy. It can be a useful modality in foreign body after plastic surgery.

Post-Operative Morphometric Analysis of Carpal Tunnel Syndrome using High Resolution Ultrasonography

We evaluated the morphologic changes that follow division of transverse carpal ligament in patients with carpal tunnel syndrome using high resolution sonography. Twenty hands of 10 patients underwent high- resolution ultrasonographic studies before the operation and 8 months after the operation. They were all diagnosed as bilateral idiopathic CTS. We evaluated the configuration of the median nerve and carpal tunnel at different three levels of the wrist; the distal radiocarpal joint level, the pisiform level, and the hook of hamate level. The median nerve remarkably gained its thickness at distal two levels after the operation. The morphology of carpal tunnel has also changed at distal levels. Increase in the anteroposterior diameter at distal two levels was obvious, but the cross sectional area of the carpal tunnel was increased significantly only at the hook of hamate level. The transverse diameters of the carpal tunnel were not significantly changed. As above, we found that the median nerve gained its volume significantly at distal part of carpal tunnel postoperatively, and the volumetric increase of carpal tunnel would have resulted from an anterior displacement of newly formed transverse carpal ligament and not from a widening of the bony carpal arch.

Detection of Synovial Hypertrophy in Idiopathic Carpal Tunnel Syndrome Using Ultrasongraphy / 대한정형외과학회잡지

OBJECTS: Synovial thickness in carpal tunnel was measured by high-resolution ultrasonography to evaluate the relation of synovial hypertrophy in idiopathic carpal tunnel syndrome. MATERIALS AND METHODS: Thickness of synovium of flexor tendons in 46 hands of idiopathic carpal tunnel syndrome and 50 hands of normal control were measured quantitatively by high-resolution ultrasonography. The patients were classified into three groups according to the clinical severity: Group I had typical clinical symptoms and positive provocation test (17 cases) , Group II had sensory decreation on the dermatome of median nerve (21 cases) , and Group III had sensory decreation and thenar muscle weakness. The thickness of flexor tendons in the three groups and control group were statistically compared. RESULTS: The mean value of thickness of carpal tunnel syndrome was 1.06mm and that of control group was 0.87mm (p=0.012) . Positive correlation was revealed according to the clinically classified three groups. CONCLUSION: Synovial hypertrophy in carpal tunnel has positive relationships with idiopathic carpal tunnel syndrome, and it reveal possibly the progression of the disease.

High Resolution Ultrasonography of Male Reproductive Organ Disease / 中华超声影像学杂志

One hundred and eleven cases of male reproductive diseases including epididymis,testi tis,cyst of epididymis,cryptochidism and varicocele were scanned with 10 MHz bifunctional soft probe.Utilization of high frequency probe may differentiate distinctively testitis from hemorrhage of testis and may easily find the locatipn and structrure of the eryptochidism.The combined use of 2 dimensional ul-trasonography and Doppler technique may be helpful fo detect the extent of varicocele and to evaluatethe postoperative efficacy.High resolution ultrasonography has been an important method for diagnos-ing the scrotal disease and the main indicator to decide whether the surgical or nonsurgical treatment should be undertaken.