Sarcoidosis of The Breasts - When Should It Be Considered? a Case Report.

Sarcoidosis is a systemic inflammatory disease of unknown aetiology. Given its complex clinical presentation, the disorder frequently causes diagnostic challenges. In most cases, the primary manifestation is in the lungs and mediastinum. Breast involvement as the primary manifestation of sarcoidosis is rare, accounting for less than 1% of cases. The authors present the case of a 44-year-old woman whose disease first manifested as multiple non-specific BIRADS 4 lesions in both breasts, accompanied by axillary lymphadenopathy, detected by ultrasound examination. The lesions were not visible on mammography. The course of the disease was clinically silent, with intermittent remissions, until the complete resolution of focal breast lesions on ultrasound after two years of follow-up. The paper presents an algorithm for the management of multifocal breast pathology with associated lymphadenopathy, which led to the prompt verification of sarcoidosis.

High-frequency ultrasound in the 21st century.

The beginnings of skin ultrasound date back to about 50 years ago. However, the dynamic progress of skin ultrasound took place in the last twenty years, when the unprecedented development of computer technologies occurred, which resulted in the popularization of and easier access to modern ultrasound equipment. Skin tests can be performed with both classic scanners equipped with broadband transducers with a minimum frequency of 15 MHz, and specially dedicated skin systems with high-frequency scanners, which are equipped with mechanical transducers with a frequency of 20 MHz to up to 100 MHz. Owing to technologically advanced machines, ultrasonography has proved to be useful in many areas. The aim of this study was to present the current knowledge and possibilities of skin imaging using high-frequency ultrasonography. Te paper discusses technical aspects, types of devices available on the market, as well as methods for the analysis of ultrasound skin images and parameters useful in their interpretation. We also present current applications of skin ultrasound, with particular emphasis on dermatology and aesthetic medicine. In the field of dermatology, we discussed imaging of focal lesions as well as an assessment of pathologically changed skin and treatment monitoring. We also focused on the use of high-frequency ultrasonography in aesthetic medicine and cosmetology. The popularity of this method is constantly growing in these fields, and ultrasound is now used in everyday practice to assess the skin, plan and monitor procedures, as well as to treat potential complications. High-frequency ultrasonography is a highly effective method for skin evaluation, although still underappreciated in may fields. Further research is needed to standardize this modality, as well as to implement training for operators, and to popularize this imaging technique.

The use of high-frequency ultrasonography for the diagnosis of palpable nodules after the administration of dermal fillers.

INTRODUCTION: Esthetic medicine is a buoyant field of medicine. As the number of performed procedures - mainly injections of botulin toxin and dermal fillers - is increasing, the number of complications is rising as well. The most popular dermal filler is hyaluronic acid. Injection of hyaluronic acid dermal fillers is considered a minimally invasive procedure, but complications in the form of skin nodules and lumps are being encountered more and frequently. Esthetic medicine does not currently offer its own diagnostic methods that would allow one to diagnose complications. In these circumstances, the implementation of objective diagnostic methods from other fields of medicine becomes significant. High-frequency ultrasound is one of such methods. AIM OF THE STUDY: The aim of this study was to implement high-frequency ultrasound for the diagnosis of palpable nodules after the administration of dermal fillers. MATERIAL AND METHOD: The study group included 15 women who developed palpable nodules in the region of hyaluronic acid injection. The study includes both early and late complications. An EPIQ 5 (Philips, Bothell, USA) ultrasound machine and a L5-18 transducer were used to examine the nodules. Ultrasound images were evaluated qualitatively by 2 independent investigators. RESULTS: Ultrasound enabled the diagnosis of hyaluronic acid deposition in 9 women, granulomas in 3 women, fibrosis in 2 women and a deposition with inflammation in 1 case. Each of the diagnosed structures presented a typical ultrasound appearance. CONCLUSIONS: High-frequency ultrasound is a useful diagnostic method that has a chance to become a widespread tool to diagnose and treat complications. Because of a low number of study reports in this area, continued research is warranted.

Usefulness of high-frequency ultrasound to assess the healing progress of shin ulcers.

INTRODUCTION: As the average lifespan becomes longer, the number of cases of chronic shin ulcers is rising, which is slowly becoming a societal problem. Currently, there no methods for objective evaluation of ulcer healing process. AIM OF THE STUDY: The aim of the study was to assess the use of high-frequency ultrasound to monitor the healing of shin ulcers subjected to laser biostimulation. MATERIAL AND METHODS: The study included 8 patients (4 men and 4 women) aged from 46 to 81 years with 9 shin ulcers in whom the healing process did not progress within 8 weeks despite effective causal treatment. The ulcers were subjected to laser biostimulation. The induced changes were monitored using high-frequency ultrasound and photographic records. Ultrasound examination was used to assess the depth of ulceration and the thickness of granulation tissue, migrating epidermis, subepidermal low-echogenic band (SLEB) and epidermis in the immediate vicinity. The wound severity index and ulcer vascularity were also assessed. RESULTS: As a result of laser therapy, in 7 out of 9 cases the ulcers healed completely and in the remaining 2 cases ulcer size was reduced. During the ulcer healing process induced by laser therapy, ultrasound examination revealed decreasing ulcer depth, wound severity index and SLEB thickness. Granulation tissue increased in thickness and there was an epidermal formation effect (newly formed epidermis was much thicker than the one surrounding the wound and became thicker as a result of laser therapy sessions). During the healing of ulcers induced by laser therapy no significant changes were observed in ulcer vascularity and thickness of the surrounding epidermis. CONCLUSIONS: High-frequency ultrasound is a useful technique for the imaging of leg ulcers. It allows one to monitor their healing process induced by laser biostimulation. Further research on the subject needs to be pursued.

Ultrasound image of healthy skin in newborns in the first 24 hours of life.

INTRODUCTION: Ultrasound imaging is a safe, repeatable and easily available imaging procedure. Based on these qualities, it may become a useful tool for skin assessment in newborns. Aims: The aim of the study was to evaluate the usefulness of high-frequency ultrasound imaging for neonatal skin assessment. Another aim was to identify differences in ultrasound features of the skin in newborns depending on the examination site, sex, age, birth weight, and arterial blood gas results. MATERIAL AND METHOD: A total of 72 newborns in the first 24 hours of life, without any skin lesions, were included in the study. All newborns underwent ultrasound skin examinations in three body sites (forearm, abdomen and thigh) during the first 24 hours of life. DermaMed Ultrasound Scanner with a 48 MHz probe was used for imaging. A total of three structures were identified in the ultrasound images: epidermal echo, dermis, and subcutaneous tissue. The study assessed the thickness of the epidermis and dermis, and the echogenicity of the dermis and subcutaneous tissue. Data were analysed to determine possible links with sex, post-conceptional age, body weight, birth route, and results of umbilical cord blood gas analysis. RESULTS: Depending on the body site examined, the mean epidermal thickness was 0.081 to 0.083 mm, while the mean thickness of the dermis ranged between 0.679 and 0.722 mm. The newborns with higher birth weights were shown to have a thicker epidermis regardless of the examined site [R (correlation coefficient) for the forearm: 0.47 (p <0.001), abdomen: 0.53 (p <0.001), thigh: 0.48 (p <0.001)]. A positive correlation was found between epidermal and dermal thickness (R = 0.34; p = 0.004), but a comparison of the three examined sites revealed no significant differences in the thickness of the two structures. The sex of the newborn had no significant effect on the ultrasound features of the skin. None of the ultrasound parameters under study was found to correlate with the pH level in umbilical cord blood gas analysis. Subcutaneous oedema was detected in the examined sites in all the newborns studied. CONCLUSIONS: High-frequency ultrasound imaging may become a useful method for neonatal skin assessment, complementing existing diagnostic techniques for monitoring pathologically altered skin.

The efficacy of high-frequency ultrasound-guided injection lipolysis in reducing fat deposits located on the inside of the knees.

INTRODUCTION: Many women consider local fat deposits unacceptable for aesthetic reasons as they have negative impact on appearance and thus, contribute to reduced self-esteem. Injection lipolysis (intralipotherapy) may be an alternative for conventional liposuction in reducing fat deposits. AIM: The aim of this paper was to assess the efficacy of high-frequency ultrasound-guided injection of deoxycholic acid (intralipotherapy) to remove fat deposits on the inner side of knees. MATERIALS AND METHODS: The procedure was performed in 7 women (14 inner sides of knees). The formulation was administered under high-frequency ultrasound guidance. The procedure was performed twice at 4-week intervals in each patient. High-frequency ultrasound guidance was used to monitor such parameters as the thickness of the dermis (DermaMed, Draminski S.A.) or the subcutaneous tissue (Philips Epiq 5, USA). Ultrasound was performed both before and after treatment. Additionally, anthropometric measurements were taken, a questionnaire was performed, and a photographic documentation was recorded. RESULTS: Reduction in knee circumference and subcutaneous tissue occurred in 71.42% of patients. CONCLUSIONS: Intralipolysis with deoxycholic acid formulation is an effective method for reducing fat deposits on the inner part of the knees. Ultrasonography proved to be a useful method to monitor the procedure (correct administration of the preparation) and to assess treatment outcomes. A small sample size was a limitation of our study; therefore further studies are needed.

Usefulness of high-frequency ultrasound in the monitoring of laser treatment of acne scars.

INTRODUCTION: Acne scarring is considered one of the complications of acne vulgaris. Scarring is an important aesthetic problem for patients; therefore, effective methods for scar removal are sought. In recent years, laser methods for the treatment of acne scarring have become popular as a result of technological development. Monitoring and objective assessment of treatment outcomes are important elements of laser treatment. High-frequency ultrasonography is a diagnostic modality likely to become a common tool used for this purpose. AIM: The aim of this study was to assess the usefulness of high-frequency ultrasonography for the monitoring of laser treatment of acne scarring. MATERIALS AND METHODS: The study group included 7 patients (6 women and 1 man) aged 29-43 years with evident facial acne scarring. Each patient underwent laser treatment with Alma Harmony Er:Yag laser. Ultrasound examinations were performed with high-frequency DermaMed scanner. The following parameters were assessed on ultrasound images: the thickness of epidermis and dermis, the depth and width of scars. We additionally collected photographic documentation and assessed patient satisfaction with treatment outcomes. RESULTS: The analysis of our findings showed statistically significant changes in the thickness of the epidermis and the depth of scars. No statistically significant results were obtained for the thickness of the dermis and the extent (width) of scars. The patients rated treatment outcomes as good. CONCLUSIONS: High-frequency ultrasonography is a useful method for the monitoring of laser treatment of acne scarring.

High frequency ultrasound assessment of labial glands simulating small nodules or granulomas after lip augmentation.

AIM OF THE STUDY: The aim of this study is to evaluate the utility of high-frequency ultrasound in the assessment of the nature and differentiation of lumps occurring in the labial mucosa after lip filling procedures. MATERIAL AND METHODS: The study sample included 5 women aged from 28 to 43 years (mean age: 37.4 years) who previously underwent a lip augmentation or rejuvenation procedure. Photographic documentation was taken and high-frequency ultrasound assessment was performed in all the patients. The presence of deposits, foreign body granulomas, fibrosis and labial glands was mainly investigated taking into account the shape of the abnormalities, their margins, surface area, location and echogenicity. In order to confirm the diagnosis, histopathological examination was performed. RESULTS: The examinations performed made it possible to differentiate between granulomas and persistent deposit nodules and to demonstrate the presence of massive fibrosis and of labial glands pushed out by these abnormalities with the glands presenting as hypoechoic oval areas. Histopathological examination confirmed the morphology of labial glands reported by the patients as uncomfortable lumps felt from the side of the mucosa, which clinically simulate persistent deposit nodules or granulomas. CONCLUSIONS: High-frequency ultrasound is a method that is essential for the correct differentiation between complications of tissue filler procedures. This, in turn, makes it possible to apply the right treatment. In this study, it was demonstrated for the first time that the lumps reported by patients who have had a lip filling procedure may be the result of labial glands being pushed out by deposits, granulomas or massive fibrosis, which are complications of such procedures.

The use of high-frequency skin ultrasound in the diagnosis of lipodermatosclerosis.

INTRODUCTION: Lipodermatosclerosis is a symptom of severe venous insufficiency, the diagnosis of which is based on the clinical picture. Although the histopathology of the skin and the subcutaneous tissue allows for the most reliable diagnosis, it is not recommended due to healing disorders. AIM: The aim of this study was to assess the usefulness of high-frequency ultrasound in the diagnosis of lipodermatosclerosis. MATERIALS AND METHODS: The study included 10 patients with lipodermatosclerosis who underwent Duplex Doppler ultrasound of lower limb veins, high-frequency ultrasound of the tibial skin, and radiography of the lower leg, all of which were analyzed in correlation with clinical symptoms. RESULTS: The study group included 9 women and 1 man aged 39-81 years. Manifestations of lipodermatosclerosis were detected in 14 limbs. High-frequency ultrasound showed that the mean dermis thickness at the affected sites was 2.63 mm, and was significantly thicker compared to healthy skin (1.45 mm) (p = 0.00002). Higher echogenicity was detected in the affected body regions in 85.7% of cases for the skin and 92.9% of cases for the subcutaneous tissue. Subcutaneous and vascular wall calcifications were detected in 92.9% and 78.6% of cases, respectively. Fibrosis was observed in all limbs, and compression sonoelastography showed that the compliance of the subcutaneous tissue was lower than that of muscles. The border between the skin and the subcutaneous tissue was blurred in 57.1% of cases. Radiography revealed thickening of the affected skin regions in all limbs, with calcifications detected in 85.7% of cases. A blurred border between the skin and the subcutaneous tissue was observed in 35.7% of limbs. CONCLUSION: High-frequency ultrasonography of the skin and the subcutaneous tissue in the lower legs supported with radiological findings is highly useful in the diagnosis of lipodermatosclerosis.

Usefulness of Doppler sonography in aesthetic medicine.

INTRODUCTION: In recent years, ultrasonography has been used in an increasing number of fields, such as dermatology, aesthetic medicine and cosmetology. For skin imaging, research has shown the usefulness of both classic scanners equipped with linear transducers, and high-frequency scanners with mechanical transducers. An increasing number of reports indicating high usefulness of Doppler sonography have been published recently. The aim of this study was to assess the usefulness of high-frequency Doppler imaging in the diagnosis of vascular complications after aesthetic procedures using tissue fillers. MATERIALS AND METHODS: A total of 12 women aged 19-48 years (mean age 36.08 years) who had undergone hyaluronic acid treatment were included in the study group. Ultrasound scans were performed using standard ultrasound scanners, i.e. Philips Epiq 5 with a linear transducer and Samsung RS85 with linear transducers and Doppler Microflow Imaging option. Ultrasound scans were performed to assess the presence of blood flow using Color Power Doppler (CPA). Pulsed-Wave Doppler was used only for arteries. If no blood flow was recorded with Color Power Doppler, Microflow Imaging was used. RESULTS: Doppler ultrasound showed normal blood flow despite reported symptoms in 3 cases. Vascular stenosis was found in 2 patients. In the other 7 patients, Doppler ultrasound showed no blood flow at the sites where complications developed. CONCLUSIONS: Skin ultrasound with Doppler options is a useful tool in the diagnosis of aesthetic medicine complications.

Gallbladder-duodenal fistula detected by ultrasound - a case report.

Gallbladder-duodenal (cholecystoduodenal) fistula is an uncommon bilioenteric fistula between the gallbladder and the duodenum. It usually occurs following a chronic case of cholecystitis upon which the gallbladder adheres to the adjacent duodenum, and a stone penetrates through the wall. The case presented herein is that of a gallbladder-duodenal fistula detected primarily with the use of ultrasound imaging, and subsequently confirmed by computed tomography. The patient is a 54-year-old woman who was admitted with upper abdominal pain. The fistula was caused by chronic cholecystitis, however no gallstones were present in the duodenum. Surgical management was undertaken for the patient, and the recovery was uneventful.

S-Detect Software vs. EU-TIRADS Classification: A Dual-Center Validation of Diagnostic Performance in Differentiation of Thyroid Nodules.

Computer-aided diagnosis (CAD) and other risk stratification systems may improve ultrasound image interpretation. This prospective study aimed to compare the diagnostic performance of CAD and the European Thyroid Imaging Reporting and Data System (EU-TIRADS) classification applied by physicians with S-Detect 2 software CAD based on Korean Thyroid Imaging Reporting and Data System (K-TIRADS) and combinations of both methods (MODELs 1 to 5). In all, 133 nodules from 88 patients referred to thyroidectomy with available histopathology or with unambiguous results of cytology were included. The S-Detect system, EU-TIRADS, and mixed MODELs 1-5 for the diagnosis of thyroid cancer showed a sensitivity of 89.4%, 90.9%, 84.9%, 95.5%, 93.9%, 78.9% and 93.9%; a specificity of 80.6%, 61.2%, 88.1%, 53.7%, 73.1%, 89.6% and 80.6%; a positive predictive value of 81.9%, 69.8%, 87.5%, 67%, 77.5%, 88.1% and 82.7%; a negative predictive value of 88.5%, 87.2%, 85.5%, 92.3%, 92.5%, 81.1% and 93.1%; and an accuracy of 85%, 75.9%, 86.5%, 74.4%, 83.5%, 84.2%, and 87.2%, respectively. Comparison showed superiority of the similar MODELs 1 and 5 over other mixed models as well as EU-TIRADS and S-Detect used alone (p-value < 0.05). S-Detect software is characterized with high sensitivity and good specificity, whereas EU-TIRADS has high sensitivity, but rather low specificity. The best diagnostic performance in malignant thyroid nodule (TN) risk stratification was obtained for the combined model of S-Detect ("possibly malignant" nodule) and simultaneously obtaining 4 or 5 points (MODEL 1) or exactly 5 points (MODEL 5) on the EU-TIRADS scale.

Sex and body mass index implications on gluteofemoral subcutaneous tissue morphology visualized by ultrasonography - preliminary study.

Introduction: Since the protective value of gluteofemoral subcutaneous adipose tissue against cardiovascular risk factors has already been described in scientific reports, it is important to pay more attention to its evaluation. Aim of the study: The purpose of this study was to evaluate sex and body mass index implications on gluteofemoral subcutaneous tissue morphology visualized by ultrasonography. Material and method: A population of 40 participants between 20-50 years of age was examined. All individuals underwent the ultrasound examination of subcutaneous adipose tissue in three locations: anterior, posterior and lateral side of a thigh in the 1/3 distal part. All examinations were collected, and the following parameters were evaluated: thickness of subcutaneous adipose tissue in general, thickness of superficial and deep subcutaneous adipose tissue. Results: The study revealed significant differences in the architecture of subcutaneous adipose tissue between male and female subgroups. In the group of males, a significantly thinner layer of not only subcutaneous adipose tissue in general (0.65 vs. 1.67 cm, p <0.0001), but also in its main compartments was observed. Moreover, we observed strong positive correlation between body mass index and all subcutaneous adipose tissue layers in the female subgroup. Interestingly, there was no relation between the thickness of the subcutaneous adipose tissue layers between subgroups with a decreased and normal body mass index and an increased body mass index. Conclusions: The presented data indicates that sex is an important factor in the determination of subcutaneous adipose tissue architecture of a thigh. The ultrasound examination of this structure can be a useful prognostic tool in the assessment of cardiovascular risk.Introduction: Since the protective value of gluteofemoral subcutaneous adipose tissue against cardiovascular risk factors has already been described in scientific reports, it is important to pay more attention to its evaluation. Aim of the study: The purpose of this study was to evaluate sex and body mass index implications on gluteofemoral subcutaneous tissue morphology visualized by ultrasonography. Material and method: A population of 40 participants between 20­50 years of age was examined. All individuals underwent the ultrasound examination of subcutaneous adipose tissue in three locations: anterior, posterior and lateral side of a thigh in the 1/3 distal part. All examinations were collected, and the following parameters were evaluated: thickness of subcutaneous adipose tissue in general, thickness of superficial and deep subcutaneous adipose tissue. Results: The study revealed significant differences in the architecture of subcutaneous adipose tissue between male and female subgroups. In the group of males, a significantly thinner layer of not only subcutaneous adipose tissue in general (0.65 vs. 1.67 cm, p <0.0001), but also in its main compartments was observed. Moreover, we observed strong positive correlation between body mass index and all subcutaneous adipose tissue layers in the female subgroup. Interestingly, there was no relation between the thickness of the subcutaneous adipose tissue layers between subgroups with a decreased and normal body mass index and an increased body mass index. Conclusions: The presented data indicates that sex is an important factor in the determination of subcutaneous adipose tissue architecture of a thigh. The ultrasound examination of this structure can be a useful prognostic tool in the assessment of cardiovascular risk.

Granuloma as a complication of polycaprolactone-based dermal filler injection: ultrasound and histopathology studies.

In aesthetic medicine, there has been an ongoing search for an ideal dermal filler to offer zero complication rate. Polycaprolactone-based dermal filler (PCL) has been available since 2009. The purpose of the paper was to present a case of granuloma as a complication of PCL injection, which has not been reported so far by other researchers. A 68-year-old female was injected with PCL. One year later, nodules accompanied by bluish skin discoloration developed within the injection site. Ultrasound and histopathology studies were performed. The examinations confirmed the presence of foreign body granuloma after PCL, which makes it the first reported case worldwide. The published data analyses showed general lack of studies and case reports to address this issue. The PCL, like an injection of any soft tissue filler, may lead to serious complications, such as granuloma formation. This makes further research legitimate and necessary.

The use of high-frequency ultrasonography in the assessment of selected female reproductive structures: the vulva, vagina and cervix.

INTRODUCTION: High-frequency ultrasonography enables visualization the layered structure of the skin and shows the epidermis, dermis, subcutaneous tissue and skin appendages: hair follicles, sebaceous glands, sweat glands and blood vessels. The aim of this study was to apply high-frequency ultrasonography to evaluate the structure of the vulva, vagina and cervix, and to describe their anatomy in ultrasound. MATERIAL AND METHOD: The examinations were conducted with the use of high-frequency probes: DermaView 48 MHz and Episcan 50 MHz, by three operators experienced in performing classical ultrasound scans (with 30-, 10- and 9-year experience). The study involved 50 women aged 20-80 years who reported for a periodical gynecological check-up and presented no symptoms within the reproductive system. RESULTS: In this study, the individual layers of the skin in the area of the mons pubis, labia majora (together with hair follicles and sweat glands) and labia minora were successfully visualized in all the patients. The subepidermal low-echogenicity band was seen in the area of the mons pubic and labia majora in 40 cases. This concerned 100% of women who underwent cosmetic skin treatments. In all the patients, HFUS demonstrated the layered structure of the anterior and posterior vaginal walls, the walls of the urinary bladder and rectum, layers of the vaginal portion of the cervix and the external opening of the cervix. CONCLUSIONS: High-frequency ultrasonography offers new quality of vulvar, vaginal and cervical imaging. It can be used for evaluation of the vulva and vagina, and confirms their layered structure. It also enables accurate measurements of the thickness of the vulvar epidermis and dermis as well as the thickness of the vaginal walls.

The utility of high-frequency ultrasonography in preoperative assessment of vulvar Paget's disease - a case report.

Paget's disease of the vulva is a rare skin cancer accounting for less than 1% of all vulvar neoplasias. Surgery is the first treatment of choice. Unfortunately, it is insufficient in many cases, which require further treatment, and the risk of recurrence is high. We present a case of an 85-year-old woman who underwent surgery due to Paget's disease of the vulva. A preoperative skin imaging using a high-frequency 48 MHz mechanical probe was used to assess the lesion margins. Typical high-frequency ultrasonographic features of vulvar Paget's disease were identified and analyzed. This is the first report of high-frequency ultrasonography imaging of vulvar Paget's disease.

Lipoma removal using a high-frequency ultrasound-guided injection of a Class III CE-marked device-Empirical findings.

BACKGROUND: Lipomas are very common benign neoplasms, which constitute 99% of all adipose-derived tumors. Main treatment option includes surgical excision, which is unacceptable for a number of patients seeking ways to improve esthetic appearance of their skin. Therefore, alternative treatment options are being sought. OBJECTIVE: The aim of the present study was to assess the efficacy of lipoma removal using a Class III CE-marked device (Aqualyx™) administered as a high-frequency ultrasound-guided injection (intralipotherapy). METHODS: A total of 17 lipomas were treated. The procedure involved a high-frequency ultrasound-guided injection. A maximum of 3 injections per a lipoma were performed. High-frequency ultrasound was used for assessing the size of lipomas and monitoring treatment-induced changes to the lipomas and adjacent tissue. RESULTS: Response to treatment was achieved in all cases. A complete removal was achieved in 70.59% of lipomas. The remaining 29.41% of lipomas were not completely removed, yet significantly reduced in size. CONCLUSION: An injection of Aqualyx™, a CE-marked drug, is a good noninvasive treatment of lipomas. Ultrasound guided procedure is recommended, as it ensures appropriate technique and enables monitoring treatment-induced changes. Considering a low number of published reports of such treatment, it is crucial to continue this research.

Efficacy of intradermal mesotherapy in cellulite reduction - Conventional and high-frequency ultrasound monitoring results.

BACKGROUND: Cellulite affects the majority of women and is an unacceptable cosmetic defect. Therefore, effective methods for cellulite reduction are being sought. Intradermal mesotherapy is one of such methods. OBJECTIVE: The aim of the study was to assess the efficacy of intradermal mesotherapy in cellulite reduction, using conventional and high-frequency ultrasound. METHODS: Twenty-one women with cellulite underwent a series of intradermal mesotherapy procedures. The following parameters were assessed: thickness of epidermis, dermis and hypodermis, echogenicity of dermis and the surface area of serrated hypodermis-dermis junction. Furthermore, the thigh circumference was measured; body mass index and cellulite severity were assessed based on photographs using Nürnberger-Müller's scale. RESULTS: Intradermal mesotherapy reduced severity of cellulite. The surface area of serrated hypodermis-dermis junction and hypodermis thickness decreased significantly as compared to baseline. Cellulite reduction was also confirmed by palpation, decreased thigh circumference and the Nürnberger-Müller's grade. There were no statistically significant changes in epidermis or dermis thickness, body weight and the BMI. CONCLUSION: Intradermal mesotherapy offers effective cellulite reduction. It is a simple and safe treatment, which makes it popular. Further research in mesotherapy is essential due to a limited number of published studies. Ultrasound is a useful method to monitor intradermal mesotherapy and assess its efficacy.

Assessment of the efficacy and safety of steam vein sclerosis as compared to classic surgery in lower extremity varicose vein management.

INTRODUCTION: For the last 10 years, endovenous thermal ablation methods have gradually predominated over the classic Babcock procedure in varicose vein treatment. Steam vein sclerosis is the newest thermal ablation technique. AIM: To assess the efficacy and safety of steam vein sclerosis as compared to the Babcock procedure in lower extremity varicose vein treatment. MATERIAL AND METHODS: One hundred and two adult subjects with varicose veins of clinical grade C2 to C6 according to the CEAP classification, treated with varicose vein surgery between 2010 and 2012, were enrolled in the study. These were subdivided into two groups: the study group of 52 patients treated with endovenous steam vein sclerosis and the control group of 50 patients treated with the Babcock procedure. A single lower extremity with isolated great or small saphenous vein insufficiency was operated on in each subject. The groups were compared for demography, disease severity, involved veins, potential perioperative and postoperative complications, as well as treatment efficacy based on the VCSS score reduction. RESULTS: There were no statistically significant differences between the groups in terms of demography, disease severity, involved veins, or perioperative and postoperative complications. The treatment efficacy of both methods, assessed based on the recurrence rate and the quantitative VCSS score reduction, was similar. Clinically significant recanalisation was observed in 1 (1.9%) patient in the study group. CONCLUSIONS: The efficacy and safety analysis shows that steam vein sclerosis is a safe, simple method which can be recommended as effective varicose vein treatment.