Evaluation of 18FDG PET-CT-positive mediastinal-hilar lymph nodes in extrathoracic malignancies by EBUS-TBNA; correlation of SUVmax, and short-axis diameter with the final diagnosis

Introduction: Intrathoracic lymph node metastasis from extrathoracic neoplasms are rare. Primary malignancies that metastasize to mediastinal-hilar lymph nodes are head and neck , carcinoma breast ,and genitourinary. Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA)/endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is currently the preferred modality for mediastinal lymph node sampling. Methods: Fifty seven patients with extrathoracic malignancies with maximum standardized uptake value (SUVmax) of mediastinal-hilar lymph nodes greater than or equal to 2.5 were taken up for EBUS-TBNA. The histo-cytopathological results obtained from EBUS-TBNA were compared with SUVmax value and short-axis diameter of a lymph node as noted on EBUS. Results: Out of 74 sampled nodes, 49 (66.2%) were benign and 25 (33.8%) were malignant. The SUVmax range of benign nodes was 2.8� as compared to 3� of malignant nodes. The size range of malignant and benign nodes were 8� mm and 8� mm, respectively. The mean size of abnormal nodes (metastatic + granulomatous) was 17.5 (8� mm) and the mean SUVmax was 9.1 (3.4�), and it was a statistically significant difference when compared to reactive (normal) nodes. At SUVmax cut-off 7.5, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) were 78.5%, 81.2%, 84.6%, and 74.2%, respectively for detecting abnormal nodes. At 13 mm size cut-off, sensitivity, specificity, PPV, NPV were 75.5%, 65%, 75%, and 72%, respectively, for detecting abnormal nodes. Conclusion: The majority of mediastinal-hilar nodes with increased metabolic activity are benign in nature. Size and SUVmax are poor predictors of metastasis in tuberculosis endemic region. There should be a restrictive attitude toward invasive diagnostic testing for mediastinal-hilar nodes in extrathoracic malignancies.

Sonologic features of vulvar cancer and lymph node status among patients at a tertiary hospital - A 10‑year review / Philippine Journal of Obstetrics and Gynecology

Context@#Vulvar cancers are rare gynecologic tumors. Ultrasound can characterize primary tumors and guide the biopsy of suspicious nodes. Currently, there are no studies on the sonologic features of different vulvar cancer types.@*Aims@#The aim is to determine the sonologic features of different vulvar malignancies. To compare the accuracy of ultrasound in identifying lymph node status.@*Settings and Design@#This is a retrospective descriptive study.@*Subjects and Methods@#Patient records, ultrasound images, and reports of vulvar cancer with long‑ and short‑axis (L/S) ratio of inguinal nodes were reviewed from the year 2010 to 2019. @*Statistical Analysis Used@#The accuracy of ultrasound to detect lymph nodes and the correlation of L/S ratio to histopathology were done. @*Results@#The study included 49 patients. The most common histopathologies were squamous cell carcinoma (SCCA), vulvar melanoma (VM), and adenocarcinoma (ADCA). Most tumors were > 4 cm, unifocal, and lateral in location. SCCA, verrucous carcinoma, VM, ADCA, adenosquamous carcinoma (ASCA), eccrine carcinoma (ECCA), and carcinosarcoma (CS) were irregular heterogeneous masses. Leiomyosarcoma (LMS) and proximal‑type epithelioid sarcoma (PES) were regular, heterogeneous masses. Paget’s disease of the vulva (PDV) was hypoechogenic with regular borders. Vascularities were absent in PDV and LMS, minimal in ECCA, moderate in ASCA and PES, moderate to abundant in CS, and variable in VM. The accuracy of ultrasound in detecting lymph nodes was 78%; the accuracy of the L/S ratio was 75%. Tumor border and FIGO stage showed significant association with histopathologic type.@*Conclusions@#Sonologic features and accuracy of ultrasound in predicting lymph node status help prognostication in vulvar cancer. Nodal morphometric studies are recommended for future researches.

Pulmonary perfusion defect index, pulmonary artery obstruction index and right heart function parameters for evaluating the severity of pulmonary embolism / 中国基层医药

Objective:To investigate the value of pulmonary perfusion defect index (PPDI), pulmonary artery obstruction index (PAOI) and right heart function parameters in the evaluation of severity of pulmonary embolism.Methods:The clinical data of 108 patients with pulmonary embolism who received treatment in The Second Hospital of Jiaxing from January 2019 to June 2021 were retrospectively analyzed. These patients were divided into high-risk ( n = 25), moderate-risk ( n = 32), and low-risk ( n = 51) groups according to the severity of pulmonary embolism. PAOI, PPDI, right ventricular short axis maximum diameter (RV), left ventricular short axis maximum diameter (LV), ratio of right/left right ventricular short axis maximum diameter (RV/LV) were determined in each group. PPDI, PAOI and right ventricular function parameters were correlated with the severity of pulmonary embolism. The area under the receiver operating characteristic curve, specificity and severity of PPDI, PAOI, RV, LV, RV/LV used alone and in combination to predict the severity of pulmonary embolism were analyzed. Results:PPDI, PAOI, RV, and RV/LV in the high-risk group were (32.52 ± 10.85)%, (45.01 ± 15.02)%, (50.32 ± 12.32) mm, (1.42 ± 0.45), respectively, which were significantly lower than (5.32 ± 1.85)%, (12.52 ± 3.25)%, (37.25 ± 8.52) mm, (0.96 ± 0.21) in the low-risk group, and LV was significantly lower in the high-risk group than that in the low-risk group [(35.14 ± 10.52) mm vs. (44.02 ± 15.21) mm, t = 13.95, 11.91, 2.62, 6.09, 5.44, all P < 0.05]. PPDI, PAOI, RV, and RV/LV in the moderate-risk group were (18.62 ± 6.02)%, (28.65 ± 8.65)%, (45.85 ± 10.02) mm, and (1.20 ± 0.32), respectively, which were significantly higher than those in the low-risk group ( t = 14.75, 12.06, 4.18, 4.13, all P < 0.05). There was no significant difference in LV between moderate-risk and low-risk groups ( t = 1.51, P > 0.05). Spearman correlation analysis showed that PPDI, PAOI, RV, RV/LV were positively correlated with the severity of pulmonary embolism ( r = 0.87, 0.84, 0.45, 0.41, all P < 0.001). LV was negatively correlated with the severity of pulmonary embolism ( r = -0.27, P < 0.001). The receiver operating characteristic curve (ROC curve) showed that the areas under the receiver operating characteristic curve of PPDI, PAOI, RV, LV, RV/LV used alone or in combination to predict the severity of pulmonary embolism were 0.941, 0.911, 0.721, 0.693, 0.726, and 0.951, respectively (all P < 0.001). Conclusion:PPDI, PAOI and right heart function parameters can be used as effective indexes to dynamically monitor the severity of pulmonary embolism.

Research progress on the measurement of anterior segment parameter and calculation formula of IOL power of abnormal eye axis / 国际眼科杂志(Guoji Yanke Zazhi)

@#The good effect of refractive cataract surgery depends on a variety of factors, mainly including accuratebiometrics before surgery and accurate calculation of intraocular lens(IOL)power. The accuracy of intraocular biometrics with abnormal eyes axis before surgery is lower. Moreover, compared with the normal eyes axis, the error of postoperative refractive state prediction is larger, which brings great challenges to obtaining the best postoperative visual quality. Recently, new optical biometrics have been used clinically, and individualized IOL power calculation formulas have been developed and applied, which makes the choice of intraocular lens power more accurate. This article reviews the latest research progress on the measurement of eye parameters and the selection of IOL power calculation formula in patients with abnormal axial cataract in the past 3a, in order to provide reference for clinical application.

Comparison of transverse short-axis classic and oblique long-axis "Syringe-Free" approaches for internal jugular venous catheterization under ultrasound guidance / Comparação das abordagens clássica transversal no eixo curto e longitudinal oblíqua no eixo longo sem seringa para cateterização de veia jugular interna guiada por ultrassom

Abstract Background and objectives: There are different ultrasound probe positions used for internal jugular venous catheter placement. Also, in-plane or out of plane needle approach may be used for catheterization. Transverse short-axis classic approach is the most popular performed approach in literature. "Syringe-Free" is a new described technique that is performed with oblique long-axis approach. We aimed to compare performance of these two approaches. Methods: This study was conducted as a prospective and randomized study. 80 patients were included the study and allocated into two groups that were named Group C (transverse short-axis classic approach) and Group SF (oblique long-axis syringe-free approach) by a computer-generated randomization. The primary outcome was mean time that guidewire is seen in the Internal jugular vein (performing time). The secondary outcomes were to compare number of needle pass, number of skin puncture and complications between two groups. Results: Demographic and hemodynamic data were not significantly different. The mean performing time was 54.9 ± 19.1 s in Group C and 43.9 ± 15.8 s in Group SF. Significant differences were found between the groups (p = 0.006). Mean number of needle pass was 3.2 (± 2.1) in Group C and 2.1 (± 1.6) in Group SF. There were statistically significant differences between two groups (p = 0.002). The number of skin puncture was 1.6 (± 0.8) and 1.2 (± 0.5) in Group C and SF, respectively (p = 0.027). Conclusion: "Syringe-Free" technique has lower performing time, number of needle pass and skin puncture. Also, it allows to follow progress of guide-wire under continuous ultrasound visualization and the procedure does not need assistance during catheter insertion. Namely, "Syringe-Free" is effective, safe and fast technique that may be used to place internal jugular venous catheter.

Resumo Justificativa e objetivos: Há diferentes posições do probe do ultrasom que são utilizadas para a colocação de cateter em veia jugular interna. Além disso, a aproximação da agulha no plano ou fora do plano pode ser usada para o cateterismo. A abordagem transversal clássica no eixo curto é a abordagem mais popular na literatura. Sem seringa é uma nova técnica descrita, realizada com a abordagem oblíqua no eixo longo. Nosso objetivo foi comparar o desempenho dessas duas abordagens. Métodos: Este foi um estudo prospectivo e randômico. No total, 80 pacientes foram incluídos no estudo e divididos em dois grupos denominados Grupo C (abordagem transversal clássica no eixo curto) e Grupo SF (abordagem sem seringa oblíqua no eixo longo) por meio de randomização gerada por computador. O desfecho primário foi o tempo médio para a visibilização do fio-guia na veia jugular interna (tempo de execução). Os desfechos secundários foram o número de passagens da agulha, o número de punções da pele e as complicações entre os dois grupos. Resultados: Os dados demográficos e hemodinâmicos não foram significativamente diferentes. O tempo médio de execução foi de 54,9 ± 19,1 segundos no Grupo C e 43,9 ± 15,8 segundos no Grupo SF. Diferenças significativas foram observadas entre os grupos (p = 0,006). O número médio de passagens da agulha foi de 3,2 (± 2,1) no Grupo C e 2,1 (± 1,6) no Grupo SF. Houve diferença estatisticamente significativa entre os dois grupos (p = 0,002). O número de punções da pele foi de 1,6 (± 0,8) no Grupo C e 1,2 (± 0,5) C no Grupo SF (p = 0,027). Conclusão: A técnica sem seringa apresentou tempo de execução, número de passagens da agulha e número de punções da pele menores. Além disso, essa técnica permite acompanhar o progresso do fio-guia com visibilização ecográfica contínua e o procedimento não precisa de auxílio durante a inserção do cateter. Ou seja, sem seringa é uma técnica eficaz, segura e rápida que pode ser usada para a colocação de cateter em veia jugular interna.

Clinical research of micro - incision phacoemulsification for short axis cataract / 国际眼科杂志(Guoji Yanke Zazhi)

AlM:To observe the clinical effect of 2. 2mm micro-incision phacoemulsification ( Phaco ) combined intraocular lens( lOL) implantation in the eyes with short axial length and compared with traditional 3. 0mm incision phacoemulsification operation for clinical work and research objective information.METHODS:ln this prospective clinical control study, 60 cases (60 eyes) with cataract performed 2. 2mm micro-incision phacoemulsification combined lOL implantation ( micro-incision group, implanted Akreos Ml60 lOL ) and 3. 0mm incision phacoemulsification operation ( small incision group, implanted Akreos Adapt lOL ) , whose axial length ranged 17. 68 ~ 21. 32mm, average 20. 35 ± 0. 61mm. Average axiall ength respectively of two groups:20.57±0.39mm and 20.21±0.52mm. Effect Phaco time ( EPT ) and average ultrasonic energy ( AVE ) were recorded. The best corrected visual acuity ( BCVA ) , intraocular pressure ( lOP ) , anterior chamber depth ( ACD) , corneal endothelial cell density and the operative complications were observed postoperatively. All cases were followed up at 1, 7, 30 and 90d after operation.RESULTS:EPT and AVE between two groups had no statistical significance(P>0. 05). At the 1, 7 and 30d after surgery, induced astigmatism ( SlA ) of micro-incision group was lower than that of small-incision group. SlA between two groups had statistically significant ( P 0. 05). At the 7d, the BCVA between two groups had statistical significance(P0. 05). At the 7, 30 and 90d, corneal endothelial cell density of micro-incision group was higher than that of small incision group. Corneal endothelial cell density between two groups had no statistical significance. The mean ACD was significant increased postoperatively than preoperatively and had no statistical significance ( P>0. 05 ) . The anterior chamber stabilized during the operation. There was not incision hot harmed during operation and postoperation.CONCLUSlON:Compared with 2. 2mm micro-incision and traditional 3. 0mm incision phacoemulsification, two groups have the same safety and 2. 2mm micro-incision phacoemulsification has small SlA, organization small harm and improved visual acuity in early stage.

A Study of the Usefulness of Apical Rotation Method of the Transducer for the Visualization of the Left Atrial Appendage / 대한내과학회지

OBJECTIVES: Visualization of the left atrial appendage(LAA) by the transesophageal echocardiography(TEE) is excellent, but it is difficult to visualize the LAA by the modified parasternal short-axis view(MPSA) in transthoracic echocardiography(TTE). We studied to determine the usefulness of the apical horizontal view(AHV) abtained by the apical rotation method of the transducer for the detection of the LAA. METHODS: We studied the MPSA and AHV in 602 patients, The LAA was observed during diastole of the LAA. We obtained an apical horizontal view by 45 degree clockwise rotation of the transducer from the apical 2 chamber view and compared with the visualization of the LAA in AHV and MPSA. RESULTS: Among 602 patients, LAA could not be visualized in 88(14.6%) because of a poor echo-window. LAA was more clearly visualized in 222 patients by the AHV than the MPSA and 56 patients by the MPSA than the AHV. LAA was same degree visualization in patients by the AHV and MPSA. In male and female, more than 55 ages and less than 55 ages, visualization of inner margin of the LAA by the AHV was more clear than by the MPSA. CONCLUSION: The AHV was a useful, noninvasive and reproducible method for the visualization of the LAA.