Multimodal ultrasound evaluation of asymptomatic ulnar nerve dislocation at the cubital tunnel.

Background: Ultrasonography has received broad acceptance as an effective peripheral nervous imaging examination. Shear wave elastography (SWE) can quantitatively assess the stiffness of nerves; however, little research has been conducted on elastography for ulnar nerve dislocation. The purpose of this study was thus to investigate the characteristics of multimodal ultrasound, including high-resolution ultrasonography and SWE, for asymptomatic ulnar nerve dislocation at cubital tunnel. Methods: In this prospective cross-sectional study, 41 participants were recruited in Shandong Provincial Hospital Affiliated to Shandong First Medical University in July 2022. The inclusion criteria for participants were being in good health and being 18-60 years of age. Meanwhile, the exclusion criterion was a history of upper limb pain or fractures, peripheral neuropathy, or systemic or immunological diseases. Finally, 38 participants were enrolled. Two ultrasound doctors measured the maximum diameter, the maximum cross-sectional area (CSA), and the shear modulus of the ulnar nerve at the cubital tunnel independently. Another two ultrasound doctors determined whether dislocation was present during dynamic elbow flexion and extension and divided the elbows into a dislocation group and a control group. The descriptive statistics and independent sample t-test were used for data analysis, and intragroup correlation coefficient (ICC) was used to determine the consistency of evaluation between observers. Results: Ulnar nerve dislocation was observed in 15.8% (12/76) of the ulnar nerves. There was no significant difference in the maximum diameter between the dislocation group (0.194±0.022 cm) and the control group (0.181±0.023 cm) (t=1.888; P=0.063). The CSA and SWE of the ulnar nerve were 0.064±0.009 cm2 and 43.629±6.737 kPa in the dislocation group, respectively, and were 0.050±0.008 cm2 and 31.293±7.858 kPa in the control group, respectively. There were significant differences between the two groups in terms of CSA (P<0.001) and SWE (P<0.001). The ICCs of the maximum diameter, CSA, and SWE values between observers were 0.970, 0.900, and 0.915, respectively. Conclusions: Multimodal ultrasound consisting of high-resolution ultrasonography combined with elastography can comprehensively and quantitatively evaluate the morphological changes and mechanical properties of the dislocated ulnar nerve and monitor disease progress.

The role of ultrasonography in diagnosing acute closed volar plate injury of proximal interphalangeal joint.

BACKGROUND: Acute closed volar plate injury of the proximal interphalangeal joint (PIP) is a common hand injury. In the past, there were few objective evaluation imaging methods for the degree of volar plate injury. The purpose of this study was to investigate the role of high frequency ultrasonography in diagnosing volar plate injury, and to explore whether ultrasound can provide a beneficial guidance to clinical decision-making and appropriate treatment adopting through accurate US classification of volar plate injury. METHODS: From May 2019 to may 2022, 41 patients diagnosed with volar plate injury were included in this study. All patients underwent ultrasonography and X-ray examinations. The sonographic features were analyzed. A new kind of classification of volar plate injury based on ultrasonography findings was described. RESULTS: Either an injury of volar plate or an avulsion fracture of middle phalangeal base was identified clearly on ultrasonography, according to which volar plate injury could be divided into three types: A, B and C. Type A, avulsion fracture of the middle phalangeal base without volar plate rupture; Type B, full thickness tear of the volar plate without avulsion fracture; Type C, partial thickness tear of the volar plate. The average thickness of the three types of injured volar plate measured by ultrasound was 0.33 ± 0.05 cm, and the average thickness of the volar plate at the same site of the corresponding finger on the contralateral side was 0.22 ± 0.03 cm. There was significant difference between the two group (t = 11.823, p = 1.2476 *10^(-14)). CONCLUSIONS: High frequency ultrasonography could be a reliable, accurate, convenient and non-radioactive diagnostic imaging technique in the evaluation of acute closed volar plate injury of PIP. And ultrasound could provide a beneficial guidance to clinical decision-making and appropriate treatment adopting through accurate US classification.

Comparative analysis of ultrasound diagnosis and pathological characteristics of external jugular venous aneurysm.

PURPOSE: This study aimed to investigate the diagnosis of the external jugular venous aneurysm on color Doppler ultrasound and its relationship with pathological characteristics. METHODS: A retrospective analysis of 17 patients with external jugular venous aneurysm admitted to the Provincial Hospital Affiliated with Shandong First Medical University from May, 2010, to June, 2020, was performed. The color Doppler ultrasound characteristics of 17 patients with external jugular vein aneurysms were analyzed and summarized, which were then compared with postoperative pathological outcomes. RESULTS: All 17 patients with external jugular venous aneurysms were presented with cystic structures adjacent to and communicated with the external jugular vein. Color Doppler flow imaging showed a bidirectional venous flow signal in the communication between the cystic structure and the external jugular vein. Among the 17 patients, ultrasound diagnosis showed true venous aneurysm due to degenerative changes in the venous wall in 8 cases, venous pseudoaneurysm in 4 cases, and external jugular venous aneurysm in 5 cases, and postoperative pathology indicated degenerative changes in the venous wall in all 17 patients. CONCLUSION: Bidirectional blood flow at the communication between the cystic lesion and the external jugular vein on color Doppler ultrasound should not be the criterion for the diagnosis of external jugular venous pseudoaneurysm, which requires pathological support.

Ultrasound diagnosis of renal cell carcinoma associated with Xp11.2 translocation/TFE3 gene fusion in children and adolescents.

BACKGROUND: Many studies have reported Xp 11.2 translocation renal cancer in radioimaging,but there is little literature on the evaluation of Xp11.2 translocation renal cell carcinoma by ultrasound. OBJECTIVE: To investigate the ultrasonographic features and diagnostic value of renal cell carcinoma associated with Xp11.2 translocation/TFE3 gene fusion in children and adolescents. MATERIALS AND METHODS: The clinical and ultrasonographic data of 10 patients with renal cell carcinoma associated with Xp11.2 translocation/TFE3 gene fusion confirmed by pathology in our hospital were analyzed retrospectively. The age ranged from 3 to 18 years old, including 7 males and 3 females. The tumor location, size, boundary, echo, hemorrhage, cystic change, calcification, blood flow, lymph node status and metastasis were mainly observed, and the results were compared with the pathological results. RESULTS: There were 10 masses in 10 cases of renal cell carcinoma associated with Xp11.2 translocation/TFE3 gene fusion, including 4 in the right kidney and 6 in the left kidney; the maximum diameter line is 5-23cm; 9 cases had clear mass boundary (90%); 9 masses (90%) showed mixed cystic and solid masses with high echo of solid components, and 1 mass (10%) showed huge multilocular cystic mass with multiple septations; necrosis and cystic changes were seen in all 10 masses (100%); calcification in 5 masses (50%); blood flow signals were seen in the solid components of the mass (100%). CONCLUSION: Renal cell carcinoma associated with Xp11.2 translocation/TFE3 gene fusion in children and adolescents are mostly large cystic and solid mixed echo masses, with high echo of solid components, and often accompanied by cystic changes and calcification. Its ultrasonic manifestations have certain characteristics. Color Doppler ultrasound has a certain diagnostic value for this disease.

Diagnostic value of high-frequency ultrasound for Poland syndrome.

BACKGROUND: The imaging diagnosis of Poland syndrome is mostly computed tomography (CT) or magnetic resonance imaging (MRI), whereas high-frequency ultrasound for the diagnosis of Poland syndrome is relatively rare. PURPOSE: To investigate the diagnostic value of high-frequency ultrasound for Poland syndrome. MATERIAL AND METHODS: A retrospective analysis of 15 patients diagnosed with Poland syndrome was performed, and the characteristics of ultrasound images were summarized. RESULTS: High-frequency ultrasound clearly depict the anatomical structures of each layer of the chest wall in patients with Poland syndrome. Ultrasonography mainly showed partial or total absence of the pectoralis major muscle on the affected side, and some of which were combined with the absence of the pectoralis minor muscle. The difference was statistically significant in the thickness of the affected chest wall compared with the healthy side (P < 0.01). Out of 15 cases with Poland syndrome, 11 were associated with ipsilateral brachydactyly or syndactyly, and high-frequency ultrasonography showed that the bifurcation position of the common palmar digital artery on the affected finger was lower than that on the healthy side. CONCLUSION: High-frequency ultrasound is an effective imaging method for the diagnosis of Poland syndrome.

The role of ultrasonography in diagnosis of neuralgic amyotrophy.

OBJECTIVE: To investigate the value of high frequency ultrasound in diagnosis of neuralgic amyotrophy. MATERIALS AND METHODS: From January 2010 to December 2020, the ultrasonographic images of 117 patients with neuralgic amyotrophy diagnosed by the Department of Neurology and hand & foot surgery of Shandong Provincial Hospital Affiliated to Shandong First Medical University were retrospectively analyzed. The ultrasonographic features were summarized. RESULTS: High frequency ultrasound could clearly show the degree of the affected nerves: No ultrasonic findings were found in 12 cases (10%). The affected nerves were thickening and hypoechogenicity with loss of normal fascicular definition in 28 cases (24%). The affected nerves showed hourglass-like changes, including constriction and torsion in 77 cases (66%). In addition, ultrasound can determine the extent of the lesion, and microvascular imaging can display small blood flow signal within the nerve. There was a significant statistical difference between the diameter of the thickened nerve fascicle and the diameter of the nerve fascicle at the corresponding site of the contralateral normal limb. CONCLUSIONS: High frequency ultrasound is a valuable imaging method for diagnosis of neuralgic amyotrophy.

Study on the Crush Injury Model of the Sciatic Nerve in Rabbits by Conventional Ultrasound and Elastography.

BACKGROUND: The crush injury model of the sciatic nerve in rabbits is a common nerve injury model, but there is little literature on the evaluation of nerve stiffness by ultrasound elastography. PURPOSE: To explore the value of ultrasound elastography in diagnosing crush injury of the sciatic nerve in rabbits. MATERIALS AND METHODS: Forty cases of crush injury model of the sciatic nerve in rabbits were examined by conventional ultrasound and elastography. The sonographic manifestations and stiffness of the model were analyzed, and the regularity of nerve injury with time was summarized. RESULTS: Ultrasound could clearly show the location, range, and thickness of the injured nerve in this model. The thickness of the injured area reached a peak in the 2nd week and returned to normal thickness in the 8th week. The nerve stiffness of the injured area increased gradually with time. CONCLUSION: Conventional ultrasound combined with elastography can comprehensively and quantitatively evaluate the morphological changes and mechanical properties of the injured sciatic nerve in rabbits, which may be of great significance to the repair and rehabilitation of peripheral nerve crush injuries.

Failure to achieve reduction on developmental dysplasia of hip: an ultrasound evaluation.

BACKGROUND: Ultrasound examination of the medial side of the hip joint has been rarely used to evaluate the status of developmental dysplasia of the hip (DDH) in Pavlik harness treatment according to the literature. PURPOSE: To analyze the effects of cartilaginous acetabulum, hip joint labrum, and acetabular tissue on the reduction of DDH. MATERIAL AND METHODS: A total of 50 cases (100 hips) were detected by the Graf method with a high-frequency linear transducer (L 5-12), and there were 59 dislocated hips and 41 non-dislocated hips. Patients were treated with a Pavlik harness. Ultrasound examination of the medial side of the hip joint was performed for follow-up. The hip joints were divided into three groups: the non-dislocated group; the reducible group; and the non-reducible group. RESULTS: The success rate of reduction was significantly higher when the acetabulum cartilage was located on the cephalic side (chi-square = 28.12, P < 0.001). The success rate was also significantly higher when the hip joint labrum was located on the cephalic side (chi-square = 17.21, P < 0.001). Type III and D had a higher success rate of reduction than type IV (P < 0.001). The pairwise comparison of the measurements of acetabular tissue between the non-dislocated group, the reducible group, and the non-reducible group showed statistical differences (P < 0.001). CONCLUSION: The present study confirmed that the location of acetabulum cartilage and hip joint labrum affected the outcome of treatment. The degree of dislocation and the amount of acetabular tissue were correlated with the success rate of treatment.

Use of ultrasonography to evaluate early outcomes of reduction in developmental dysplasia of the hip.

OBJECTIVE: To compare pubo-femoral distance (PFD) in normal hips and those treated for developmental dysplasia of the hip (DDH) and to investigate the value of ultrasonography from the medial hip in early follow-up of dislocated DDH after reduction. MATERIALS AND METHODS: This study included 58 infants (49 females) with DDH who presented with 65 dislocated hips (51 unilateral and 7 bilateral). Dislocation was treated by closed reduction for 53 and open reduction for 12 hips. Ultrasonography on the medial side of the hip was performed within 1-2 weeks and 4 weeks after reduction. The distance from the pubic bone to the femoral head (PFD) was measured to assess the reduction and stability of the femoral head and compared to that on the contralateral side (control) in cases of unilateral DDH. RESULTS: The PFD value for the normal group (2.9 ± 0.4 mm) was significantly less than that for the closed reduction group (4.9 ± 2.8 mm, P<0.001) and that for the open reduction group (4.4 ± 1.6 mm; P=0.02), but no difference in the PFD was observed between the closed reduction and the open reduction groups (P=0.73). Despite successful reduction, the PFD values in the successful reduction group remained higher than those of the normal hips. CONCLUSION: PFD measurement by ultrasonography of the medial hip can be used to evaluate the effectiveness of reduction procedures in DDH. The clinical implications of post-reduction ultrasound evaluation in the diagnosis and long-term follow-up of outcomes require further research.

Epidemiological investigation and ultrasonic diagnosis of developmental dysplasia of the hip in Chinese infants: A large multi-center cohort study.

ABSTRACT: Developmental dysplasia of the hip (DDH) is common among Chinese infants, but a lack of large-scale, multi-center epidemiological studies has made it difficult to characterize the risk factors associated with this disease.This multi-center cohort study included 19,833 Chinese infants aged 14 days to 6 months. A multi-center ultrasound protocol was used to diagnose hip abnormalities, and epidemiological data of the infants were collected through questionnaires. Categorical variables were expressed as percentages and compared using χ2 test. Multivariate analysis was performed through logistic regression.Of 19,833 infants, 345 had DDH (1.7%). DDH incidence was higher in female infants (n = 279) than in male infants (n = 66) (χ2 = 95.89, P < .05), and there were more left hip cases (n = 149) than right hip cases (n = 79) (χ2 = 12.49, P < .05). DDH incidence was statistically different amongst different age groups in months (χ2 = 451.71, P < .05), and it gradually decreased with age (P < .05). The prevalence of a positive DDH family history, breech presentation, oligohydramnios, swaddling style, and other musculoskeletal deformities was higher in the positive group than in the negative group (all P < .05). No significant differences were found in terms of delivery by cesarean section, multiple births, or premature birth between both groups.Family history, breech presentation, oligohydramnios, musculoskeletal deformities, and female sex are high-risk factors for DDH in Chinese infants. The incidence of DDH gradually decreases with age. The results of this study provide evidence for the epidemiology of infant DDH in China.

The role of ultrasonography in diagnosing hourglass-like fascicular constriction(s) of the anterior interosseous nerve.

BACKGROUND: In the past, the diagnosis of hourglass-like fascicular constriction(s) of the anterior interosseous nerve mostly depended on electrophysiological examination, by which the location could not be diagnosed. There are few studies on the evaluation of hourglass-like fascicular constriction(s) by ultrasonography. PURPOSE: To evaluate the role of ultrasonography in the diagnosis of hourglass-like fascicular constriction(s) of the anterior interosseous nerve. MATERIAL AND METHODS: A retrospective analysis of 12 patients with hourglass-like fascicular constriction(s) of the anterior interosseous nerve was carried out, and the characteristics of the high-frequency ultrasonographic images were summarized and compared with surgical exploration. RESULTS: The 12 cases of hourglass-like fascicular constriction(s) of the anterior interosseous nerve were all located in the median nerve of the distal upper arm, including nine cases of single hourglass-like fascicular constriction and three cases of multiple hourglass-like fascicular constrictions. High-frequency ultrasonography can accurately locate the hourglass-like fascicular constriction(s) of the anterior interosseous nerve and the extent of neuropathy. The ultrasonographic images of hourglass-like fascicular constriction(s) of the anterior interosseous nerve showed single or multiple hourglass-like change(s) in the median nerve of the distal upper arm. The nerve fascicles on both sides of the affected nerve with hourglass-like change thickened. CONCLUSIONS: High-frequency ultrasonography could be a reliable, convenient, and non-invasive diagnostic imaging method for hourglass-like fascicular constriction(s) of the anterior interosseous nerve.

Establishing reference values for the pubofemoral distance in normal infant medial hips by ultrasound.

BACKGROUND: Measuring the pubofemoral distance (PFD) is important for evaluating the effectiveness of hip reduction in the treatment of developmental dysplasia of the hip (DDH). However, reference PFD values have not been established in normal infants. PURPOSE: To investigate variations in PFD values measured in normal infant medial hips stratified by age, laterality, and gender. MATERIAL AND METHODS: A total of 240 infants diagnosed with Graf type Ia and/or Graf type Ib hips by ultrasonography were stratified into eight age groups: 0-1 month; 1-2 months; 2-3 months; 3-4 months; 4-5 months; 5-6 months; 6-7 months; and 7-12 months. The bilateral medial hips were scanned with transinguinal ultrasound. The PFD was defined as the distance between the lateral edge of the superior ramus of pubic bone and the medial edge of the femoral head. Inter-observer reproducibility was assessed. RESULTS: Among the 240 infants, there were 371 Graf type Ia hips and 109 Graf type Ib hips. Mean ± SD bilateral PFD values of eight groups were measured separately. There were no significant differences in mean PFD values for left or right hips (t = 0.946, P = 0.345) or mean bilateral PFD values in male and female infants (t = 1.445, P = 0.149). Mean PFD values increased linearly with age (left: r = 0.680, P < 0.0001; right: r = 0.682, P < 0.0001). Inter-observer reproducibility was excellent. CONCLUSION: This study established reference PFD values from the medial hip in infants aged 0-12 months. PFD values increased with age, but were not significantly influenced by laterality or gender. These data provide detailed information that can support follow-up of infants treated for DDH.

The role of ultrasonography in the diagnosis of talocalcaneal coalitions.

BACKGROUND: Patients with talocalcaneal coalitions (TCC) often undergo computed tomography (CT). However, ultrasonography diagnosis of TCC has been seldom done according to the literature. PURPOSE: To investigate the accuracy of ultrasonography in diagnosing TCC compared to CT. MATERIAL AND METHODS: Ninety-seven consecutive patients with a clinical suspicion of TCC were included. Ultrasonography was used to assess the classification and complication of TCC. The main sonographic criteria for a positive diagnosis in cases of osseous coalition were the joint space between the medial surface of talar head and the underlying sustentaculum tali of calcaneus disappearing and being replaced by a continuous hyperechoic bony structure. In cases of fibrous coalition, ultrasonography revealed a reduced space of the joint associated with an irregular, angular appearance of its outline and hypoechoic fibrous tissue inside. These data were compared with CT findings. κ statistic was applied to determine the level of agreement. The sensitivity, specificity, positive and negative predictive values, accuracy, and Youden index of ultrasonography as a diagnostic method were assessed. RESULTS: Ultrasonography findings were positive in 20 of 97 patients with a clinical suspicion of TCC. The diagnosis was confirmed by CT in 21 patients. There were one false-positive result and two false-negative results by ultrasonography. The κ value was 0.907. The sensitivity, specificity, positive and negative predictive values, accuracy, and Youden index of ultrasonography were 90.5%, 98.7%, 95.0%, 97.4%, 96.9%, and 0.892, respectively. CONCLUSION: Ultrasonography could be a reliable, accurate, and non-radioactive diagnostic imaging method in diagnosis of patients with suspected TCC.

The Role of High Frequency Ultrasonography in Diagnosis of Acute Closed Mallet Finger Injury.

To evaluate the role of high frequency ultrasonography in diagnosis of acute closed mallet finger injury. 36 patients diagnosed with mallet finger were included in this study. All patients underwent ultrasonography, magnetic resonance imaging(MRI) and X-ray examinations. A new kind of classification of acute mallet finger injury based on ultrasonography findings was described. The difference in terms of extensor tendon injury and bony fragment identification ability among the three types of examinations were described respectively. Either an injury of extensor digital tendon or an avulsion fracture of distal phalangeal base was identified clearly on ultrasonography. Among the 36 cases, avulsion fracture of the distal phalangeal base was found without extensor tendon rupture in Type A, complete rupture of the extensor tendon was found without avulsion fracture in Type B, and contusion of the extensor tendon was found in Type C. Compared with X-ray, ultrasonography and MRI could show the extensor tendon injury clearly. While compared with MRI, ultrasonography and X-ray was more sensitive in showing bony fragment. High frequency ultrasonography could be an accurate, reliable, and non-invasive diagnostic imaging method in diagnosis of acute close mallet finger injury.

The association between testicular microlithiasis and semen parameters in Chinese adult men with fertility intention: experience of 226 cases.

OBJECTIVE: To investigate the association between testicular microlithiasis (TM) and semen parameters in Chinese adult men with fertility intention. MATERIALS AND METHODS: We retrospectively reviewed the ultrasonography results of the reproductive system of 16,204 consecutive adult male patients in our hospital with fertility intention from November 2012 to October 2013. TM was diagnosed by scrotal ultrasonography. Patients with TM were divided into classic testicular microlithiasis (CTM) or limited testicular microlithiasis (LTM). The clinical data of CTM, LTM, and non-TM groups, especially of patients in whom sperms were found in semen analysis, were collected and analyzed. RESULTS: There were 226 men (1.39%) diagnosed with TM. The mean age was 28.96 ± 5.12 years (range, 21-46 years), whereas mean testicular volume was 15.38 ± 4.90 mL (range, 1.62-31.23 mL). CTM and LTM were detected in 141 (62.39%) and 85 patients (37.61%), respectively. Among 200 patients who underwent semen analysis, sperms were found in 159 men (79.5%; 97 men with CTM and 62 men with LTM). One hundred and twenty cases without TM (ie, non-TM group) were collected in the control group. Sperm concentration, total motility, and percentage of progressively motile of CTM, LTM, and non-TM groups was (38.01 ± 31.58 million/mL vs 52.31 ± 33.26 million/mL vs 67.16 ± 36.94 million/mL; P <.001), (46.03 ± 23.69% vs 55.37 ± 24.16% vs 62.08 ± 20.45%; P <.001), and (35.88 ± 20.17% vs 43.15 ± 21.08% vs 47.10 ± 17.84%; P <.001), respectively. CONCLUSION: TM is associated with worse semen parameters in adult men with fertility intention. The extent of microlithiasis correlates inversely with semen parameters.

Sonographic appearances of desmoid tumors.

The medical records of 16 patients (9 female and 7 male; age range, 5-66 years) with 24 lesions that had a histologic diagnosis of desmoid tumors were reviewed at our institution. Six cases were extra-abdominal, 4 intra-abdominal, and 6 in the abdominal wall. Lesions ranged from 1.5 to 18.0 cm in diameter (mean, 6.8 cm). All lesions were solid masses, which appeared hypoechoic, isoechoic, or hyperechoic with homogeneous or heterogeneous echogenicity. Posterior acoustic enhancement was seen in 18 lesions. No lesions showed central necrosis. Most lesions had substantial flow and high resistive index values (>0.70). Sonography can show a desmoid tumor's site, size, contour, margin, echogenicity, homogeneity, vascularity, and resistive index value in detail.

Ultrasonographic features of renal oncocytoma with histopathologic correlation.

BACKGROUND: To analyze the sonographic (US) features of renal oncocytoma and correlate them with histopathologic findings. METHODS: The medical records of 12 patients with a histologic diagnosis of renal oncocytomas were reviewed. The location, size, shape, margin, echogenicity, homogeneity, and blood flow distribution of the lesions were analyzed, and the US features were compared with histopathologic findings. RESULTS: Oncocytomas appeared as solid, solitary, well-marginated, unencapsulated, fairly homogeneous renal cortical masses (n = 10), with regular shape, relatively isoechoic (n = 5) or slightly hyperechoic (n = 7) to the adjacent renal parenchyma, and an exophytic growth pattern was exhibited in most cases (n = 9). Two larger masses (≥9 cm) demonstrated a central stellate scar and a characteristic of spoke-wheel vascular pattern. The tumors with a low percentage of stroma (<20%) were associated with an echotexture isoechoic to renal parenchyma, whereas oncocytomas with a higher percentage of stroma (>20%) were slightly hyperechoic. CONCLUSIONS: Although the US features are not pathognomonic, their presence should alert to the possible diagnosis of renal oncocytoma.

Sonographic detection of unilateral hip dislocation in a spica cast after closed reduction for developmental dysplasia of the hip.

OBJECTIVES: To determine the value of sonography for evaluating unilateral hip dislocation in a spica cast after closed reduction for developmental dysplasia of the hip. METHODS: Seventy-three cases of unilateral hip dislocation were detected by sonography after closed reduction and monitored through the perineal opening of the cast during follow-up. The transinguinal approach was used first to determine the position of the femoral head. Then a sonogram of the bilateral hips was obtained by transverse scanning on the lower margin of the pubic symphysis. To determine the status of the affected femoral head, a bilateral comparison of the femoral head positions was made by measuring the horizontal distance from the medial rim of each femoral head to a center line through the pubic symphysis. RESULTS: In all 73 cases, the femoral head position after reduction could be identified by sonography. With the transinguinal approach, the reduction was successful in 69 cases and unsuccessful in 4. On the sonograms of the bilateral hips, the dislocated femoral heads were repositioned in the acetabular fossa in the successful cases and redislocated posterolaterally in the unsuccessful cases. Among the successful cases, the position differences were less than 2 mm in 61, 3 to 4 mm in 7, and 5 mm in 1. In the unsuccessful cases, the positions of the bilateral hips were asymmetric; the differences were indecipherable after an unsuccessful first reduction but were 3 to 5 mm after a successful second reduction. During follow-up, the differences were never greater than 2 mm in the cases with initial differences of less than 2 mm and gradually decreased to less than 2 mm in those with initial differences of greater than 2 mm. CONCLUSIONS: Sonography can be considered as the first imaging tool for evaluating the effect of closed reduction for developmental dysplasia of the hip.

[Value of degree diagnosis with color Doppler flow imaging in the treatment of male erectile dysfunction].

OBJECTIVE: To study the value of degree diagnosis with color Doppler flow imaging (CDFI) in the treatment of male erectile dysfunction (ED). METHODS: After CDFI and intracavernosal vasoactive agent injection (ICI) with papaverine 60 mg and prostaglandin E(1) 10 microg, 198 male ED patients were divided into 4 groups by their penile stiffness based on the Schramek criterion. The therapeutic methods such as antibiotics for prostatitis, sexual behavior therapy, sildenafil, vacuum constriction device (VCD), vena fistula repairing operation, prosthetic implantation and enhanced external counterpulsation (EECP) were recommended to the patients according to their different penile stiffness degree and their different preferences. RESULTS: Prior to ICI, there was no significant difference in the cavernosa artery peak systolic velocities (PSV), end diastolic velocities (EDV), resistant indexes (RI), dorsal artery PSV, EDV, RI and deep dorsal vein velocity (V) (P > 0.05). After ICI, the cavernosa artery PSV, EDV and RI were significantly different (P < 0.05) while other indices were not (P > 0.05). The patients were treated differently according to their preferences. The selective goal-oriented therapy increased the satisfactory rate to 91.91% (182/198). CONCLUSION: Based on the penile stiffness degree with CDFI plus ICI, different therapeutic methods yield a better clinical outcome.