Clinical follow-up method for frontal sinus obliteration with bioactive glass S53P4.

A clinical follow-up method was developed to investigate the behavior of a massive amount of bioactive glass S53P4 (BG) clinically used in frontal sinus obliteration. Two sizes of granules (0.63-0.8 mm or 0.8-1.0 mm) in 16 separate BG amounts, weight 25 g, were tested both in simulated body fluid (SBF) and in a buffer containing tris-hydroxymethyl aminomethane citric acid (TRIS-c.a) in standard conditions. The dissolution of silicon (Si) and phosphate (P) was detected with direct current plasma atom emission spectroscopy (DCP-AES) monthly up to 6 months. The BG masses were scanned both wet in the solutions and dried by computer tomography (CT), and the scans were analyzed by Region of Interest (ROI) technique. Calcium phosphate (CaP)- and silica (Si)-gel-layers were studied by scanning electron microscopy (SEM) at 1, 3, and 6 months. Cumulative loss of Si and P was stronger in TRIS-c.a than in SBF (p < 0.0001), and it was higher with smaller than with larger granules in both solutions (p < 0.0001). This was shown correspondingly by the decrease of Hounsfield units (HUs) in ROI analysis (p < 0.0001). The level of HUs was lower with dried than with wet BG (p < 0.0001). The results were compared for clinical ROI analysis of patients with obliterated frontal sinuses up to 48 months and they were parallel. The follow-up method seems to indirectly reveal the behavior of BG and the healing process in the obliterated cavity.

Assessment of cervical lymph node status in head and neck cancer patients: palpation, computed tomography and low field magnetic resonance imaging compared with ultrasound-guided fine-needle aspiration cytology.

OBJECTIVE: Since the assessment of lymph node metastases in head and neck cancer patients remains a major problem, the findings of different imaging methods and the role of these methods in the clinical management are compared. MATERIAL AND METHODS: Palpation, computed tomography (CT) and low field magnetic resonance imaging (MRI; 0.1 T) are evaluated and compared with ultrasound-guided fine-needle aspiration cytology (US-guided FNAC) prospectively in 105 consecutive patients with a primary cancer in the head and neck region. RESULTS: In the subgroup of 86 patients with palpable normal necks, CT showed lymph nodes fulfilling the radiologic criteria for malignancy in 27% (23/86), MRI in 17% (10/60) and US in 14% (12/86) of the patients US guided FNAC usually showed malignancy in necks containing lymph nodes with central necrosis on CT, but the enlarged lymph nodes that were also common on the contralateral side were often benign on cytology. In 5 patients, FNAC under US-guidance showed malignancy although none of them had lymph nodes fulfilling the radiologic criteria for malignancy. In the other subgroup of 19 patients with palpable metastatic necks, 2 patients had bilateral metastases detected by all imaging methods but not by palpation. CONCLUSION: CT is superior to low field MRI in depicting small pathologic lymph nodes. Unlike lymph node structure, lymph node size is not a highly reliable criterion for malignancy. The findings must be correlated in relation to the primary disease. Since FNAC under US-guidance offers additional information about enlarged lymph nodes and since it can show malignancy in small lymph nodes not found by other methods, it can be recommended for most head and neck cancer patients irrespective of the use of CT or MRI.

Palpation, ultrasound, and ultrasound-guided fine-needle aspiration cytology in the assessment of cervical lymph node status in head and neck cancer patients.

BACKGROUND: Lymph node status of the neck is the most important prognostic factor in head and neck cancer patients. Assessment of the lymph nodes status is still often based on palpation only, although the low accuracy of palpation is known. METHODS: Altogether 105 consecutive head and neck cancer patients were examined using ultrasound (US) and ultrasound-guided fine-needle aspiration cytology (FNAC) to evaluate the additional information obtained by these methods. RESULTS: Of the 86 patients with palpable normal necks, FNAC taken under US-guidance showed malignancy in 13. The US size criteria for malignancy were fulfilled in 7 of these patients, whereas the lymph nodes were of normal size in 6 of them. In the whole patient material, US-guided FNAC showed bilateral metastasis in 3 patients although only unilateral or no metastasis was found by palpation. CONCLUSION: US combined with US-guided FNAC can be recommended as a method for evaluating for regional metastases in head and neck cancer patients, both for those with and those without palpable metastasis.

Perineal ultrasound: an alternative for radiography for evaluating stress urinary incontinence in females.

Perineal sonography was used to assess the position and descent of the bladder neck at rest and during straining in 38 female patients with stress urinary incontinence. Twenty nine patients had primary and nine patients recurrent stress incontinence. There was a statistically significant positive correlation between the degree of sonographically determined bladder neck descent and the severity of stress incontinence by urodynamic criteria among the patients with primary but not with recurrent stress incontinence.

Staging of uterine endometrial carcinoma with ultra-low field (0.02 T) MRI: a comparative study with CT.

OBJECTIVE: The purpose of this investigation was to evaluate the capability of ultra-low field MRI for staging endometrial carcinoma. MATERIALS AND METHODS: Computed tomography and MRI were performed on 47 patients with uterine endometrial carcinoma. The results were compared with those from clinical examination and with histopathological results after operation in 43 cases. The local extension of the endometrial carcinoma was correctly staged in 77% with clinical examination in 58% with CT, and in 88% with MRI. RESULTS: Tumor growth was overestimated by clinical examination in 21%, by CT in 35%, and by MRI in only 5%. Magnetic resonance imaging was most accurate in detecting cervical extension and was better than CT in detecting tumor invasion to the outer half of the myometrium. The sensitivities of CT and MRI in the assessment of deep myometrial invasion were 67 and 83%, respectively, the corresponding specificities being 67 and 79%. Magnetic resonance imaging at 0.02 T was not able to differentiate tumors with superficial myometrial invasion from those confined entirely to the endometrium. The detection of metastatic lymphadenopathy was difficult with all examination methods. CONCLUSION: Our results indicate that MRI at 0.02 T is a convenient, inexpensive, and accurate imaging method for the preoperative staging of endometrial carcinoma.