Can sonography predict the outcome in patients with achillodynia?

PURPOSE: We evaluated whether the grade assigned to the Achilles tendon's appearance on sonograms can be used to predict the outcome of achillodynia. METHODS: A retrospective evaluation was done of a case series of patients with Achilles tendon pain seen at a sports medicine clinic. The study consisted of chart reviews, telephone follow-up interviews, and grading of ultrasound images of the tendon obtained during the initial visit. The grading scheme was as follows: grade 1, normal tendon; grade 2, enlarged tendon; and grade 3, tendon containing a hypoechoic area, regardless of size. The time needed to recover from symptoms was compared between grades using survival analysis. RESULTS: The group consisted of 33 patients, with a mean age of 35.8 years and a mean follow-up time of 24.3 months. There was a statistically significant difference in the time to full recovery between grades (p = 0.02). Patients with grade 1 tendons had a prompter resolution of symptoms than did patients with grade 2 or 3 tendons. CONCLUSIONS: This retrospective study of the outcome of achillodynia demonstrates the possible use of tendon sonography as a prognostic tool to supplement physical examination.

Iliopsoas bursitis and tendinitis. A review.

This review examines the diagnosis and management of iliopsoas bursitis and/or tendinitis. It is a relatively uncommon and unrecognised cause of anterior hip pain and anterior snapping hip. In view of its pathology, iliopsoas bursitis might be better referred to as iliopsoas syndrome. It can usually be diagnosed by history and physical examination, though real time ultrasound may be useful in confirming the diagnosis. Magnetic resonance and computerised tomography imaging have limited roles in its diagnosis, but may identify other pathology or surgical lesions. Nonoperative management has not been well established. Surgical management does not guarantee treatment success. There is a need for further research into both diagnostic and treatment options for those patients with iliopsoas bursitis/tendinitis.

Serial ultrasonographic imaging evaluation of the patellar tendon after harvesting its central one third for anterior cruciate ligament reconstruction.

The purpose of this study was to assess ultrasonographic image changes in the patellar tendon after removal of its central one third for anterior cruciate ligament reconstruction. Fourteen patellar tendons in 14 patients were assessed preoperatively and at 2 weeks, 4 weeks, 2 months, 6 months, and 12 months postoperatively. With time, the entire donor tendon became enlarged, hypoechoic, and inhomogeneous compared with the presurgical state. Tendons enlarged maximally in anteroposterior thickness by 2 months and then began to diminish, remaining two times their original anteroposterior thickness by 12 months and never returning to their preoperative appearance. The margins of the defect became indistinct over time. In the donor patellar tendon, abnormal echogenicity was profound and persisted up to 1 year after surgery. Ultrasonographic imaging has the ability to evaluate the postoperative patellar tendon over time and to monitor the normal changes seen with healing.

Cryosurgery for malignant tumours of the liver.

OBJECTIVE: To evaluate the safety and efficacy of ultrasound-guided cryosurgery to treat malignant tumours of the liver. DESIGN: A prospective nonrandomized trial. The follow-up was complete and ranged from 8 to 35 months. SETTING: A university-affiliated hospital. PATIENTS: Ten patients with secondary malignant tumours of the liver; 1 with primary hepatoma. INTERVENTIONS: Computed portography for preoperative staging; laparotomy and ultrasonographic examination of the liver; cryosurgical ablation of liver tumours with or without a concomitant resection. Thirteen procedures were performed on 11 patients. MAIN OUTCOME MEASURES: Preoperative morbidity, disease-free and overall survival. RESULTS: Of 24 lesions frozen, the procedure on 4 lesions was considered a technical failure because of persistent disease. There were no perioperative deaths. One patient had a liver abscess that resolved with percutaneous drainage. One patient had a biliary fistula that resolved spontaneously, and one had a transient rise in the serum creatinine level. Of 11 patients treated, 7 had a recurrence in the liver (persistent disease in 2 and new liver metastases in 5); 2 of these patients died. One patient died of distant disease with no local recurrence. At the time of writing, one patient was alive with extrahepatic disease and no local recurrence and two were free of disease. CONCLUSIONS: Cryosurgery of the liver is a relatively safe procedure that allows treatment of otherwise unresectable malignant disease. Proof of long-term benefit requires further experience and follow-up.

Ultrasound catheter placement for deep posterior compartment pressure measurements in chronic compartment syndrome.

Medial shin pain, often referred to as shin splints, is a common but difficult to diagnose entity in many athletes. Chronic deep posterior compartment syndrome as a cause of medial leg pain is still controversial. The problems of deep posterior compartment pressure measurement contribute to this controversy. These problems include safety of catheter insertion and the possibility that the patient has more than one deep posterior compartment. In this paper, we present a new technique for catheter placement in which continuous ultrasound guidance is used. This technique allows for the safe placement of the catheter into the deep posterior compartment and for documentation of catheter tip location.

Oocyte retrieval in an in vitro fertilization-embryo transfer program: comparison of four methods.

The records of 191 patients involved in 316 treatment cycles over 3 years in an in vitro fertilization-embryo transfer program were reviewed. Follicular aspiration, oocyte retrieval, pregnancy rates, technical difficulty, and complications were compared in four oocyte retrieval methods: 117 laparoscopic retrievals, 116 ultrasound (US)-guided percutaneous transvesical retrievals, 43 US-guided transvaginal retrievals, and 40 combined US and laparoscopic retrievals. The mean number of aspirated follicles (9.14) was greatest in the transvaginal retrieval group, but the ratio of oocytes to punctured follicles was not statistically greater in any of the groups. The overall clinical pregnancy rate per cycle was highest in the transvaginal retrieval group: 12 of 43 cycles resulted in pregnancy, or 27.9%. The number of delivered babies (16.3%) was also highest in the transvaginal retrieval group. US-guided transvaginal oocyte retrieval is recommended as the method of choice.

Prospective study of the incidence of ultrasound-detected intrahepatic and subcapsular hematomas in patients randomized to 6 or 24 hours of bed rest after percutaneous liver biopsy.

Percutaneous liver biopsies were performed in 40 adult patients with acute or chronic liver disease. Real-time sector scan ultrasound of the right upper quadrant was obtained just before biopsy, 1 day after biopsy, and in 10 randomly selected cases 7 days after biopsy. Twenty patients were randomized, by sealed envelope, to 6-h and 20 patients to 24-h postbiopsy bed rest. Nine patients (23%) had ultrasound-detected hematomas 1 day after liver biopsy (7 intrahepatic, 2 subcapsular). Five of these patients had been randomized to 6-h and 4 to 24-h bed rest. Follow-up ultrasound at 7 days in the 10 randomly selected patients failed to reveal any hematomas not seen on day 1 (n = 6) and showed complete or partial resolution of those that had been detected previously (n = 4). Significant drops in systolic and diastolic blood pressure and increases in pulse rate were common postbiopsy findings, and were unrelated to hematoma formation. The results of this study indicate that intrahepatic and subcapsular hematomas are common after percutaneous liver biopsy. The length of postbiopsy bed rest (6 vs. 24 h) does not appear to influence the frequency of this complication.

Ovarian hyperstimulation with exogenous pulsatile gonadotropin releasing hormone therapy.

Two cases are reported of women with hypothalamic amenorrhea who had sonographic and biochemical evidence of ovarian hyperstimulation during the first cycle of exogenous pulsatile gonadotropin releasing hormone (GnRH) therapy. In one case, it was demonstrated that, with early detection, decrease in the dosage of GnRH may stabilize the condition and prevent further progression of the hyperstimulation. Therefore, the authors suggest that sonographic monitoring should be performed at least in the initial ovulatory cycle so that adjustment of the dosage of GnRH can be made with early detection of hyperstimulation.

Clinical and laboratory assessment of the pathogenicity of serotyped enteropathogenic Escherichia coli.

Only one of 167 separate isolates of enteropathogenic Escherichia coli (EEC) was shown to produce enterotoxin, and none of the 167 isolates were invasive. Clinical features of 123 hospitalized children with EEC were compared with those of 917 infants with nonbacterial gastroenteritis and 145 infants infected with Shigella. The average duration of diarrhea (five or more stools per day) in hospitalized children with EEC, nonbacterial gastroenteritis, Shigella flexneri, and Shigella sonnei was 4.6, 2.4, 5.1, and 2.5 days, respectively. The average duration of fever in these four groups was 1.4, 1.2, 2.1, and 1.2 days, respectively. The difference in duration of diarrhea between children with EEC and those with nonbacterial gastroenteritis was significant (P less than 0.001), even when age and rural/urban origin were controlled by analysis of variance. Nevertheless, the EEC group tended to be younger and to have a higher proportion of infants of rural origin. Although it appears that EEC serotypes rarely identify invasive or enterotoxin-producing organisms, clinical features of infants with EEC-associated gastroenteritis suggest that these infants may represent a distinctive and clinically important group with gastroenteritis of greater severity than nonbacterial gastroenteritis.