Sonographically guided triamcinolone injection for the treatment of chronic post-operative mammillary fistula.

We describe ultrasound-guided intralesional triamcinolone (ILT) injection for the management of chronic post-operative mammillary fistula (MF). Seven patients with chronic post-operative intraglandular MF were enrolled in this study. The initial response to treatment was assessed as complete in three cases; of the remaining four, three were resolved successfully with an additional ILT injection and the other had no resolution with an additional ILT injection. In five cases there was no recurrence after more than 1 year of follow-up. One patient had recurrence at 7 months, which was treated with a further ILT injection; this patient is without recurrence after a further 9 months' follow-up. This simple, safe procedure is suggested as an option for the treatment of chronic post-operative intraglandular MF and may be an alternative to surgery.

Measurement of atherosclerosis markers in patients with periodontitis: a case-control study.

BACKGROUND: It is suggested that periodontitis enhances the process of vascular inflammation leading to atherosclerosis. The present study explores the effect of periodontitis in relation to the clinical and ultrasound markers of carotid atherosclerosis. METHODS: Sixty systemically healthy patients >45 years of age (30 with chronic periodontitis and 30 without periodontitis) were studied in a university dental school. Traditional cardiovascular risk factors for atherosclerosis were evaluated. Carotid intima-media thickness (IMT) was assessed by ultrasound. RESULTS: The internal carotid IMT was 0.77 and 0.81 mm in the periodontal disease and control groups, respectively, with no statistically significant differences between the two groups (P = 0.538). There were significant differences in the presence of carotid atheroma plaques and the severity of periodontitis (P = 0.003). In the logistic regression analysis, significant differences in terms of age and periodontitis were recorded in relation to the presence of atheroma plaques in the carotid intima. CONCLUSION: The severity of periodontitis was seen to influence the presence of carotid atheroma plaques.

[Optimization of the dose of radiation in shoulder arthrography]. / Optimización de las dosis de radiación en la artrografía de hombro.

OBJECTIVE: The aim of this study was to determine whether using a film with radiopaque coordinates placed over the region of interest to guide shoulder arthrography can reduce the dose of radiation received by patients. MATERIAL AND METHODS: The entrance dose was obtained in 34 patients (mean age, 44 years; range, 15 to 75 years). The dose received by organs at risk and the effective dose were estimated with Monte Carlo techniques using the following input parameters: patient anatomy, examination geometry, and air kerma at the entrance to the patient without backscattering. Arthrography was performed with a remote controlled device and images were acquired digitally without fluoroscopy. RESULTS: The mean thickness of the shoulders studied was 14.6+/-2.1cm (9-20 cm). Images were obtained with 80+/-10 kVp (60-85 kVp) and 6.5+/-3.5 mAs (1.4-17 mAs). The mean time of irradiation for each patient was 20+/-6 ms (6.9-47.9 ms). The calculated air kerma was 0.41+/-0.19 mGy and the effective dose was 0.79+/-0.40 muSv. CONCLUSIONS: The technique described in this study has enabled us to reduce the dose of radiation received by patients undergoing shoulder arthrography in comparison with other techniques described in the literature and to ensure that the radiologist performing the procedure is not irradiated.

Optimización de las dosis de radiación en la artrografía de hombro / Optimization of the dose of radiation in shoulder arthrography

Objetivo: El objetivo de este estudio fue reducir la dosis de radiación recibida por los pacientes sometidos a una artrografía de hombro y en los que se utiliza como sistema de guiado una placa con coordenadas radiopacas situada sobre el área de interés. Material y métodos: La dosis a la entrada se obtuvo en 34 pacientes con edades comprendidas entre 15 y 75 años, media de 44 años. La dosis a órganos de riesgo y la dosis efectiva se estimaron mediante técnicas de Monte Carlo, donde los parámetros de entrada son: anatomía del paciente, geometría de la exploración y kerma en aire a la entrada del paciente sin retrodispersión. Las artrografías se realizaron en un equipo telemando y las imágenes se obtuvieron mediante adquisición digital sin fluoroscopia. Resultados: El espesor medio de los hombros estudiados fue 14,6±2,1 cm (9-20 cm). Las imágenes se obtuvieron con 80±10kVp (60-85kVp) y 6,5±3,5 mAs (1,4-17 mAs). El tiempo medio de irradiación para cada paciente fue 20 ± 6ms (6,9-47,9ms). El kerma en aire calculado fue de 0,41 ± 0,19 mGy y la dosis efectiva de 0,79 ± 0,40 μ Sv. Conclusiones: La técnica descrita en este trabajo ha permitido reducir la dosis de radiación al paciente respecto a otros procedimientos descritos en la bibliografía y que el radiólogo que realiza la artrografía no se irradie durante el procedimiento (AU)

Objective: The aim of this study was to determine whether using a film with radiopaque coordinates placed over the region of interest to guide shoulder arthrography can reduce the dose of radiation received by patients. Material and methods: The entrance dose was obtained in 34 patients (mean age, 44 years; range, 15 to 75 years). The dose received by organs at risk and the effective dose were estimated with Monte Carlo techniques using the following input parameters: patient anatomy, examination geometry, and air kerma at the entrance to the patient without backscattering. Arthrography was performed with a remote controlled device and images were acquired digitally without fluoroscopy. Results: The mean thickness of the shoulders studied was 14.6±2.1cm (9–20cm). Images were obtained with 80±10kVp (60–85kVp) and 6.5±3.5mAs (1.4–17mAs). The mean time of irradiation for each patient was 20±6ms (6.9–47.9ms). The calculated air kerma was 0.41±0.19mGy and the effective dose was 0.79±0.40 μSv. Conclusions: The technique described in this study has enabled us to reduce the dose of radiation received by patients undergoing shoulder arthrography in comparison with other techniques described in the literature and to ensure that the radiologist performing the procedure is not irradiated (AU)

Anterior urethral trauma: role of sonourethrography.

We present a case of blunt anterior urethral trauma during sexual activity in a 20-year-old man. The patient had abundant urethrorrhagia, but there were no obvious clinical data to help locate the urethral lesion. Diagnosis was established by sonourethrography (SUG), which showed a coagulum in the urethral lumen from a small haematoma in the corpus spongiosum of the proximal pendulous urethra. No lesion was observed in the sonography performed previously without urethral distension or in the retrograde urethrography performed afterwards. The utility of SUG for early diagnosis of urethral contusion is analysed, and a novel technique for performing SUG is described. We believe that this procedure should be used routinely in the initial management of patients suspected with lesions of the anterior urethra.

Galactography without discomfort using lidocaine/prilocaine anesthetic cream.

BACKGROUND: Galactography (ductography) is the technique of choice for studying pathologic nipple discharge. It is sometimes difficult or even impossible to perform cannulation of the ductal orifice because of the discomfort caused to the patient. PURPOSE: To evaluate the efficacy of a eutectic mixture of local anesthetics (EMLA) containing lidocaine and prilocaine applied as a cream to reduce discomfort during galactography. MATERIAL AND METHODS: 46 patients with abnormal nipple secretion underwent galactography. The patients were distributed in non-randomized form into two groups (A and B). Group A consisted of 19 patients who were treated without application of the anesthetic cream; group B consisted of 27 patients to whom the anesthetic cream was applied prior to galactography. Pain intensity was measured using a verbal description scale. RESULTS: Galactography was successfully performed in all cases in group B (n = 27) and in 15 cases (78.9%) in group A. In four patients from group A, it was initially impossible to cannulate the discharging duct because of patient discomfort and anxiety. The same patients were submitted to galactography 1 week later after application of the anesthetic cream to the areola/nipple area. In total, then, 31 cases (all 27 of group B plus four) registered 0 ( = no pain) on the verbal description scale after application of the cream. In the 19 patients of group A, the degree of pain registered was mild in 11 cases and discomforting in eight cases. CONCLUSION: The application of anesthetic cream over the areola/nipple area enables galactography to be performed without patient discomfort. It also reduces anxiety, allowing the radiologist to perform the procedure with confidence and safety, and without stress on the part of the patient or radiologist.

Evaluation of the triangular fibrocartilage in cadaveric wrists by means of arthrography, magnetic resonance (MR) imaging, and MR arthrography.

PURPOSE: To evaluate the diagnostic accuracy of arthrography, magnetic resonance (MR) imaging, and MR arthrography in the detection and localization of defects of the triangular fibrocartilage (TFC) in cadaveric wrists, using arthroscopy as a reference standard. MATERIAL AND METHODS: Twenty-four specimen wrists were evaluated. The different imaging modalities were blinded to reviewers and were interpreted independently. A classification of TFC defects was used for the evaluation of images in the different imaging modalities, thus permitting a more uniform correlation. Two cases were excluded from the MR imaging study because of poor image quality. Contingency tables with the chi-square test and Fisher's exact test were used for statistical analysis. RESULTS: Defects of the TFC were identified in 17 of the 24 specimen wrists by means of arthroscopy, and 16 defects were observed when arthrography was carried out. With MR imaging 14 defects of the TFC were detected in the 22 specimen wrists evaluated, and with MR arthrography 16 defects were observed. Most defects were central or combined (two or more defects). In comparison to arthroscopy, the accepted diagnostic gold standard, the following results were found for arthrography in the detection of TFC defects: sensitivity 95%, specificity 100%, and accuracy 95% (P<0.0005); for MR imaging: sensitivity 86%, specificity 85%, and accuracy 70% (P<0.002); and for MR arthrography: sensitivity 100%, specificity 85%, and accuracy 95% (P<0.0005). CONCLUSION: The results of the study seem to indicate that both arthrography and MR arthrography have high accuracy, and either would be useful for evaluation of the TFC. The combined approach using both techniques would have a very high accuracy equivalent to that resulting from arthroscopy.

A simple technique for shoulder arthrography.

PURPOSE: To present a systematic approach to teaching a technique for arthrography of the shoulder. Using an adhesive marker-plate with radiopaque coordinates, precise sites for puncture can be identified and the need for fluoroscopic guidance obviated. MATERIAL AND METHODS: Forty-six glenohumeral arthrograms were performed in 45 patients; in 1 case involving examination of both shoulders. The stages of the technique are described in detail, as are the fundamental aspects of achieving an effective glenohumeral injection. Pain intensity was measured in all patients using a verbal description scale. RESULTS: Shoulder arthrography was successful in all cases. Average time taken for the procedure was 7 min, with no difference in the respective times required by an experienced radiologist and a resident. The procedure was well tolerated by most patients, with slight discomfort being observed in a very few cases. CONCLUSION: The arthrographic technique used in this study is simple, safe, rapid, and reproducible, and has the advantage of precise localization of the site for puncture without need for fluoroscopic guidance. The procedure described in this study can be of help in teaching residents and can reduce the learning curve for radiologists with no experience in arthrographic methods. It also reduces the time of exposure to fluoroscopy.

A new system for localization of nonpalpable breast lesions with adhesive marker plate.

The objective of this article is to present a new method of preoperative localization of nonpalpable breast lesions by means of an adhesive marker plate that makes an anteroposterior approach to the thoracic wall possible. Between January 2000 and September 2002, 41 consecutive mammographic localizations were performed with the adhesive marker plate. In most cases (n = 34) the lesions were microcalcifications. The mean age of the patients was 54.7 years. The device used consists of a square plate made of highly flexible plastic with an adhesive film on the back for firm attachment to the area of the breast surface corresponding to the approximate location of the lesion. This plate contains a network of holes and a system of radiopaque coordinates. The technique for its use is described step by step. All 41 lesions were localized: to within 5 mm or by transfixation of the lesion in 95.1% of cases (39/41) and to within 1 cm in the remaining 2 cases. Surgical excision of the breast lesions was carried out successfully in all cases, and in 56% (23/41) it was possible to use a periareolar incision. Histological findings revealed 24 benign and 17 malignant lesions. This new technique permits the localization of nonpalpable breast lesions accurately, simply, and with very little discomfort to the patient. The anteroposterior approach simplifies the surgeon's task in the management of these lesions.

Remission status defined by immunofixation vs. electrophoresis after autologous transplantation has a major impact on the outcome of multiple myeloma patients.

We have retrospectively analysed 344 multiple myeloma (MM) patients (202 de novo patients) treated in a non-uniform way in whom high-dose therapy and autologous stem cell transplantation (ASCT) response was simultaneously measured by both electrophoresis (EP) and immunofixation (IF). Patients in complete remission (CR) by EP were further subclassified as CR1 when IF was negative and CR2 when it remained positive. Partial responders (PR) were also subclassified as PR1 (very good PR, > 90% reduction in M-component) or PR2 (50-90% reduction). CR1 patients showed a significantly better event-free survival (EFS) [35% at 5 years, 95% confidence interval (CI) 17-53, median 46 months] and overall survival (OS) (72% at 5 years, CI 57-86, median not reached) compared with any other response group (univariate comparison P < 0.00000 to P = 0. 004). In contrast, comparison of CR2 with PR1 and with PR2 did not define different prognostic subgroups (median EFS 30, 30 and 26 months respectively, P = 0.6; median survival 56, 44 and 42 months respectively, P = 0.5). The non-responding patients had the worst outcome (5-year OS 8%, median 7 months). Multivariate analysis confirmed both the absence of differences among CR2, PR1 and PR2 and the highly discriminatory prognostic capacity of a three-category classification: (i) CR1 (ii) CR2 + PR1 + PR2, and (iii) non-response (EFS P < 0.00000; OS P < 0.00000; both Cox models P < 0.00000). In the logistic regression analysis, the factors significantly associated with failure to achieve CR1 were the use of two or more up-front chemotherapy lines, status of non-response pre-ASCT and inclusion of total body irradiation (TBI) in the preparative regimen. Tandem transplants or the use of multiple agents (busulphan and melphalan) in the preparative regimen resulted in a higher CR1 level; none of the biological factors explored influenced the possibility of achieving CR1. These results confirm that, in MM patients undergoing ASCT, achieving a negative IF identifies the patient subset with the best prognosis; accordingly, therapeutic strategies should be specifically designed to achieve negative IF.