Galvanic current dosage and bacterial concentration are determinants of the bactericidal effect of percutaneous needle electrolysis: an in vitro study.

Percutaneous needle electrolysis (PNE) is a physiotherapy technique that has been shown to be effective in different pathologies such as tendinopathies or mammary fistula. For many years, theoretical bactericidal and germicidal effects have been attributed to this type of galvanic currents, partly explained by the changes in pH that it generates. However, these effects have not yet been demonstrated. The aim of this study was to evaluate the bactericidal effect and the changes in pH caused by PNE. S. aureus were prepared in two different solutions (TSB and saline solution) and in different concentrations (from 9 to 6 Log10 CFU/mL). Bacteria were treated with three experimental PNE doses to assess bacterial death levels and the changes caused to the pH of the medium. The viable cell count showed that all experimental PNE doses had a bactericidal effect against a high concentration (9 Log10 CFU/mL) of S. aureus in saline solution (p < 0.001). Furthermore, we found that when the concentration of bacteria decreased, a lower dose of galvanic current generated the same effect as a higher dose. Changes in pH were registered only in experiments performed with saline solution. PNE had a bactericidal effect against S. aureus and the level of this effect was mainly modulated by the solution, the bacterial concentration and the dose. Changes affecting pH were modulated by the type of solution and there was no relationship between this and bacterial death.

Interobserver agreement for thyroid elastography: value of the quality factor.

OBJECTIVES: The purpose of our study was to investigate interobserver agreement for thyroid ultrasound elastography and to analyze the reproducibility of real-time freehand elastography in thyroid nodules. METHODS: A prospective nonrandomized double-blind study was conducted between September 2008 and June 2010. Real-time elastography of 89 thyroid nodules was performed by two radiologists, with the first radiologist evaluating each thyroid nodule 5 minutes before the second. The elastograms were obtained with the patients holding their breath and considered valid when the quality factor was 50 or higher. The region of interest was positioned to include the nodule and 0.5 cm of surrounding normal thyroid parenchyma but to exclude the carotids and esophageal-tracheal structures. The elastograms were classified on a scale of 5 different patterns. RESULTS: Observers 1 and 2 coincided in 79 elastographic patterns and disagreed on 10 nodules (11.2%). The results between the radiologists had a statistically significant agreement (P < .005), with a κ value of 0.838. CONCLUSIONS: The introduction of a quality factor in elastographic software and the selection of elastograms with a quality factor of 50 or higher confer almost perfect interobserver agreement for thyroid nodule elastography and make elastography a reproducible technique that could be used in daily clinical practice.

MR and CT arthrography of the wrist.

The study of the wrist represents a major diagnostic challenge because of its complex anatomy and the small size of individual structures. Recent advances in imaging techniques have increased our diagnostic capabilities. However, 3T magnets, multichannel specific wrist coils, and new MRI sequences have not restricted the indications of arthrographic imaging techniques (CT arthrography and MR arthrography). Distension of the different wrist compartments at CT arthrography and MR arthrography significantly improves the diagnostic accuracy for triangular fibrocartilage (TFC) complex injuries and carpal instability. Dedicated multichannel wrist coils are essential for an adequate study of the wrist, but the placement of these coils and the positioning of the wrist are also important for proper diagnosis. The development of dynamic multislice CT studies allows a diagnostic approach that combines dynamic information and the accurate assessment of ligaments and the TFC complex. New advances in arthroscopy have changed the anatomical description of the TFC with a functional division in the proximal and distal TFC complex, and they have allowed a better characterization of lesions of the TFC complex with subclassification of Palmer 1B and 1D lesions and description of new lesions not included in the Palmer classification, such as capsular injuries.