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Introduction: Gynecomastia (GM) is a benign proliferation of glandular breast tissue in men. Some cases need surgical intervention. Traditional open surgery by semicircular inferior periareolar incision is the most common surgical approach. In order to obtain better esthetic results, some alternatives to open surgery have been proposed, such as liposuction, endoscopic mastectomy, and vacuum-assisted excision (VAE). Objective: To describe the technical surgical approach of ultrasound-guided VAE of GM and its results from a case series. Method: This is an evaluation of seven GM cases submitted to ultrasound-guided VAE with a 10G needle using the ENCOR® BD whole circumference automated breast biopsy system in Redimasto Redimama, a Brazilian breast center. The result was considered good or satisfactory when it showed minimal remaining gland, good symmetry, no retraction, necrosis, hypertrophic scar, or displacement of the nipple-areola complex. All patients answered a questionnaire to evaluate their satisfaction and perception of the procedure. Results: Seven (7) patients with Simon grade 1 and 2 bilateral GM underwent ultrasound-guided VAE. No case of displacement, necrosis, or retraction of the nipple-areola complex, post-procedure bleeding, infection, skin necrosis, or asymmetry was detected. No patient reported decrease or change in nipple sensation or erection. All patients had bruises and hematomas that spontaneously resolved within 30 days. All results were considered good or excellent by patients and surgeons. Conclusion: Minimally invasive ultrasound-guided VAE is an excellent alternative for the treatment of GM. It is better indicated for Simon grade 1 and 2 GM, with good and excellent esthetic results, small scar, and low rates of nipple and areolar complications. It allows an outpatient procedure with low morbidity (local anesthesia) and fast recovery.
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�In recent years, with the development of novel ultrasonic techniques, ultrasonography has been widely used as a non-invasive examination method in the diagnosis and treatment of pulmonary tuberculosis. Conventional ultrasound combined with contrast-enhanced ultrasound has great significance in the diagnosis and the long-term observation of treatment of tuberculosis, contrast-enhanced ultrasound combined with interventional ultrasound techniques can improve the success rate of percutaneous lung puncture, and endobronchial ultrasound has definite diagnostic value for pulmonary tuberculosis patients with negative results in sputum smear or sputum culture bacteriological examination. In this paper, we reviewed the progress of conventional ultrasound, contrast-enhanced ultrasound, ultrasound-guided percutaneous lung puncture and endobronchial ultrasound in the diagnosis of pulmonary tuberculosis.
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China has the third largest tuberculosis burden in the world, with a heavy anti-tuberculosis task. In recent years, ultrasound imaging technology has been widely used in the diagnosis of pulmonary and extrapulmonary tuberculosis. Because of its simplicity, convenience, and diagnostic function for multiple organs, ultrasound has gradually become an effective auxiliary diagnostic method for tuberculosis. In this paper, we reviewed the application status, problems and prospects of ultrasonic techniques in tuberculosis, hoping to provide new methods for the diagnosis of tuberculosis.
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La colangiopancreatografía retrógrada endoscópica (CPRE) se considera el tratamiento de primera línea para el drenaje biliar en pacientes con cáncer de páncreas. En los casos de fracaso por CPRE, generalmente se realiza un drenaje biliar transparietohepático o una derivación biliar quirúrgica. En la última década, las indicaciones y la utilidad de la ecoendoscopia en pacientes con cáncer de páncreas han ido creciendo, y se han informado numerosos casos de drenajes biliares guiados por ecoendoscopia como una alternativa al drenaje biliar percutáneo o quirúrgico en fracasos en la CPRE. Nuestro objetivo es comunicar un caso con cáncer de páncreas localmente avanzado que se presentó con ictericia indolora y síndrome coledociano con obstrucción biliar y duodenal, en el que se realizó una colédoco-duodenostomía guiada por ecoendoscopia mediante la colocación de una prótesis metálica autoexpandible.
Endoscopic retrograde cholangiopancreatography (ERCP) is considered the first-approach for biliary drainage. In cases of ERCP failure, patients are usually referred for percutaneous transhepatic biliary drainage or surgical biliary bypass. In the last decade, the indications of endoscopic ultrasound (EUS) in the management of patients with pancreatic cancer have increased, and numerous cases of EUS-guided biliary drainage have been reported in patients with failures during the ERCP. Our goal is to report a patient with locally advanced pancreatic cancer who presented with painless jaundice and cholestasis with biliary and duodenal obstruction. A EUS-guided choledochoduodenostomy was performed by placement of a self-expanding metal stent.
Subject(s)
Humans , Female , Aged, 80 and over , Pancreatic Neoplasms/surgery , Choledochostomy/methods , Adenocarcinoma/surgery , Duodenoscopy/methods , Duodenal Obstruction/surgery , Pancreatic Neoplasms/diagnostic imaging , Adenocarcinoma/diagnostic imaging , Cholestasis/complications , Ultrasonography , Jaundice, Obstructive/complications , Duodenal Obstruction/diagnostic imaging , Self Expandable Metallic StentsABSTRACT
A ultrassonografia é um método eficaz na avaliação de afecções agudas acometendo o sistema músculo-esquelético, constituindo importante arma propedêutica nos serviços de atendimento de urgência. O ultrassom permite a avaliação de lesões de origem traumática acometendo uma variedadede estruturas de partes moles (por exemplo: músculos, tendões e ligamentos), bem como a caracterização de fraturas ocultas e corpos estranhos. Permite ainda a orientação de procedimentos intervencionistas diagnósticos ou terapêuticos. Será apresentada uma breve revisão dasprincipais indicações do exame ultrassonográfico no contexto das urgências, ilustrada com casos típicos provenientes de arquivo digital, sendo discutidos os achados fundamentais para a caracterização e o diagnóstico das afecções traumáticas mais frequentes, além das principais indicações de procedimentos intervencionistas guiados por ultrassom. Todos os casos apresentados procuraramo serviço de pronto-atendimento do nosso hospital, devido a queixas agudas relacionadas ao sistema músculo-esquelético.
Ultrasonography is accurate in the evaluation of acute musculoskeletalinjuries, and became an important diagnostic method in the urgency department. Sonography allows evaluation of diverse traumatic lesions, as muscle, tendon, ligament and pulley lesions. Ultrasonography also allows evaluation of occult fractures andforeign body. Finally, ultrasonography also can guide diagnostic or therapeutic interventional procedures. This article review the role of ultrasonographic assessment in the acute musculoskeletalsetting, illustrated with cases from soft copy archives, discussing the main aspects of the most common musculoskeletal complains in the urgency department.
Subject(s)
Humans , Emergencies , Musculoskeletal System/injuries , Musculoskeletal System , Foreign Bodies , Ligaments , Rupture , TendonsABSTRACT
Objective To investigate the clinical value of interventional ultrasound treatment for non-ruptured ectopic pregnancy. Methods Seventeen cases of ectopic pregnancy with masses 20~50 mm(mean,35 mm) in diameter and embryo sacs 15~42 mm(mean,26 mm) in diameter were included.Under the guidance of ultrasonography,needle puncture and aspiration of lesions of ectopic pregnancy was conducted through the posterior fornix.Then the methotrexate(MTX) 20~40 mg was injected into.Results All the 17 cases were punctured and MTX-injected on one session.The embryo sac disappeared within 4 weeks after the treatment in 16 cases,while there was no improvement in 1 case and a further surgery was given.Of the 16 successfully treated cases,salpingography showed the oviduct as "patent" in 14 cases and as "unobstructed" in 2.Conclusions Interventional ultrasound treatment of non-ruptured ectopic pregnancy has advantages of simplicity of performance,good safety and efficiency,minimal invasion,and few adverse effects.This procedure is worthy of being recommended.
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Objective To develop a computer-assisted multiangular guiding system for interventional ultrasound.Methods A computer-assisted multiangular guiding system was developed which included a high-accuracy electromagnetic tracker and a passive arm with 5 degree-of-freedom.The electromagnetic tracker was used to track ultrasound probe and needle.The position of B-mode ultrasound image plane and needle were displayed in real-time in the reconstructed 3D ultrasound.The passive arm was used to assist needle delivering.A 10mm ball immersed in a transparent water tank and a formal acoustical prototype was punctured with random angle by using this system.The systematic precision was assessed.Results The whole progress was finished successfully,the ball was touched by the tip of the needle for all the occasions,the error of the system was less than 5mm.Conclusion The computer-assisted multiangular guiding system can get rid of the limitation of angle and make the operation flexible and accurate.
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Objective To investigate the practical value of ultrasound-guided percutaneous transhepatic gallbladder drainage (PTGD) and percutaneous transhepatic bile duct drainage (PTBD)in the treatment of hepatobiliary diseases. Methods A total of 68 times of ultrasound-guided PTGD/PTBD were performed in 60 patients from December 2000 to December 2003, including 15 cases of acute pyogenic cholecystitis, 8 cases of acute severe cholangitis and 37 cases of malignant obstructive jaundice. Results Out of the 15 cases of acute pyogenic cholecystitis, PTGD was completed successfully in 14 cases and failed in 1 case which then required a conversion to open operation. The 37 cases of malignant obstructive jaundice had undergone 45 times of PTBD, which consisted of 42 times of successful drainage tube placement and 3 times of failure (2 cases of conversions to open operation and 1 case of quitting treatment). Out of the 37 cases, resection of bile duct carcinoma or palliative cholangiojejunostomy was conducted in 14 cases, stents were inserted into the bile ducts under radioscopy in 8 cases, and the drainage tubes were left in place permanently in 15 cases (the maximum survival time was over 2 years and the mean survival time was 9 months). Of the 8 cases of acute severe cholangitis, successful drainage was achieved in 6 cases, a conversion to open surgery was required in 1 case because of blocked drainage, and 1 patient died of the multiple organ failure (MOF). Complications included 2 cases of bile leakage, 3 cases of hemorrhage, 1 case of portal vein-bile duct fistula, and 7 cases of drainage tube dislocation or blockage. Conclusions Ultrasound-guided PTGD/PTBD is an effective alternative for bile duct drainage, with advantages of minimal invasion, simplicity and accurateness of performance, safety and fewer complications. It presents much clinical value for hepatobiliary diseases, especially acute cholecystitis.
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5cm hepatic cancer, the effective rate (CR+PR) was 60 8% (62/102), no change (NC) rate 39 2% (40/102), and the 1-, 2-, 3-year survival rates 67 6% (69/102), 49 1% (50/102) and 39 2% (40/102), respectively. The effective rates (CR+PR) in patients with bone tumor and lung cancer were 100%(12/12) and 60%(3/5), respectively. There were no other severe complications found. Conclusions Ultrasound-guided microwave intervention is a safe, effective and feasible method for hepatic cancer, lung cancer and bone tumor.
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In order to treat or prevent portal vein metastases of liver cancer, intraportal chemotherapies were carried on in 18 and in 42 patients with and without portal vein thrombosis. The agents used were Pharmorubicin 30 mg, Mitomycin—C 8 mg and 5—Flurouracil 500 mg. The results showed that the incidence of portal thrombosis in preventive group (19.04％) was lower than that in control group (38.9％) (P
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WJ multipurpose guided puncture outfit in interventional ultrasound was developed.Guided puncture with this outfit was performed on 203 cases of various diseases.All 274 punctures were saccessful The study shows hat this guided puncture outfit can be set on various linear probes,fit-ted into puncture,biolpsy or catheter needles.It can actively adjust the puncture angle,precisely forecast,fix and calibrate the puncture angle and depth,perlorm guided puncture in real time etc.It is notnecessary to set line and tabulate the puncture angle.The outfit is easy and rapid to handle and also is reliable with high success rate