Urethrography in the male: the clamp method.

BACKGROUND: Retrograde urethrography is considered the gold standard for evaluating stenosis or urethral disease. PURPOSE: To describe the clamp method for optimizing retrograde urethrography (RUG) using a perfected device and a drip infusion system. material and methods: RUG was performed in 42 patients with a mean age of 63.4+/-16.5 years suspected of having urethral stenosis. The modifications to the device are shown, and the steps of the technique described. The intensity of pain from both catheterization and external compression was measured on a visual analog scale (VAS). RESULTS: All the RUG examinations were conducted satisfactorily. The use of the drip infusion system enabled visualization of the posterior urethra in 97.6% of cases, and bladder repletion was achieved in 95.2% of cases. The urethrograms revealed images of stenosis in 31 patients. With catheterization the mean pain intensity registered by VAS was 0.7+/-0.6 (SD), whereas with external compression the mean pain intensity was 0.06+/-0.02 (SD). CONCLUSION: The clamp method and drip infusion system used in this study are efficient and reduce patient discomfort. The procedure makes it possible to assess cases with stenosis close to the meatus that are difficult to manage with the conventional method.

La carpeta de aprendizaje: una innovación docente en la asignatura de Radiología y Medicina Física Especial / The portfolio: an innovate educational project on the subject of Radiology and Special Physical Medicine

Objetivo. Presentar una innovación docente desarrollada en la asignatura de Radiología y Medicina Física Especial durante el curso académico 2006-2007. Sujetos y métodos. Los alumnos realizaron una rotación durante dos semanas en los servicios de Radiodiagnóstico y Medicina Nuclear, en grupos pequeños. La metodología docente utilizada fue la carpeta de aprendizaje o portafolio. Se describen los aspectos fundamentales para la elaboración de la carpeta y de los casos clínicos, así como del sistema de evaluación. Dentro del ciclo de mejora continuada se llevó a cabo una encuesta de satisfacción. Resultados. Los resultados académicos obtenidos fueron excelentes. La mayoría de los alumnos consideraron que la asignatura fue interesante. También señalaron una valoración positiva de la rotación, de los seminarios y del sistema de evaluación. Asimismo, la opinión de los alumnos acerca de la experiencia docente realizada fue muy favorable. Conclusión. La satisfacción global de los alumnos ha sido muy alta con la metodología docente implantada en la asignatura (AU)

Aim. To introduce a learning innovation on the subject of Radiology and Special Physical Medicine along the academic year 2006/2007. Subjects and methods. Working in small groups, students carried out a two-week rotation in the departments of Radiology and Nuclear Medicine. The portfolio was the educational methodology used. The main aspects to elaborate the portfolio, the case reports, aswell as the evaluation system are described. A satisfaction survey within the continuous improvement course was performed. Results. The academic results achieved were excellent. The subject was considered interesting by most of the students. A positive evaluation about the rotation made by the students, the seminaries and the evaluation system was made. Students’ opinion about the educational experience performed was also, very favourable. Conclusion. The educational methodology introduced in the subject has produced a high level of satisfaction among the students (AU)

Reproducibility of sonographic measurements of carotid intima-media thickness.

BACKGROUND: Carotid intima-media thickness (IMT), measured with B-mode ultrasound, is a marker for atherosclerosis and widely used as an outcome in intervention trials. PURPOSE: To evaluate the reproducibility of carotid intima-media thickness measurements using tissue harmonic imaging (THI) sonography between two observers with different levels of experience. MATERIAL AND METHODS: IMT measurement was performed in 40 patients: 26 males and 14 females, with a mean age of 62.6 years. The measurements were taken on the posterior wall of the right common carotid artery using a standardized protocol. Observer measurement of the IMT was independent and blind. Statistical analysis was done with parametric tests and Pearson's correlation coefficient. RESULTS: The measurements of the IMT were taken satisfactorily in all cases. IMT measurement time was 5 min/study. No significant differences were noted between the means obtained by the two observers. The interobserver correlation of the measurements was very high (97.2%). CONCLUSION: The results of this study show that carotid IMT measurement using THI sonography and a standardized protocol is accurate and reproducible.

A multimodality approach to the diagnosis of breast hamartomas with atypical mammographic appearance.

The ultrasonographic appearance of breast hamartomas (BHs) is described and its diagnostic utility is discussed in this study of 27 women with mammographic findings both typical and atypical of BH. The role of computed tomography (CT) in the diagnosis of BH of atypical mammographic appearance is also analyzed. These 27 cases of BH were detected in women submitted to mammographic screening. Ages ranged from 45 to 65 years (mean age 52.6 years). In all cases physical and ultrasonographic examinations were carried out. CT studies were carried out in seven cases. Core biopsy was performed in 18 cases of lesions with a mammographic appearance atypical of BH. Lesions were palpable in 9 cases and nonpalpable in 18. Mammographic appearance was characteristic in nine cases. In 19 cases a hypoechoic solid mass with hyperechoic lines and/or bands was seen. This ultrasonographic image is suspicious of BH. Finally, both CT and core biopsy findings were of great help in the diagnosis of BH in the cases where mammographic and ultrasonographic studies were inconclusive. We consider that a combination of mammography, ultrasonography, CT, and core biopsy is fundamental for the successful diagnosis of breast hamartomas not seen in typical form in mammograms.

Electrical nerve stimulation in the management of enterocutaneous low-output fistulas: a report of two cases.

Two patients with low-output enterocutaneous fistulas after surgery were treated with electrical nerve stimulation (ENS). Ultrasonography was useful for the application of this treatment method and for the charting of its progress. Fistula output diminished rapidly in both cases, and the closure of the track was achieved after several sessions of ENS. The procedure is simple and safe and is suggested as an option for the treatment of low-output enterocutaneous fistulas.

Conservative treatment of large rectus sheath hematoma in patients undergoing anticoagulant therapy.

BACKGROUND: The purpose of this study was to describe our experience in the conservative management of large rectus sheath hematoma (RSH) in patients undergoing anticoagulation therapy. METHODS: This is a retrospective study of the medical histories of 12 cases of RSH (11 female, one male; mean age = 67.6 years). Seven patients were taking oral anticoagulants, three were taking intravenous unfractionated heparin, and two were taking subcutaneous low-molecular-weight heparin. Six patients had a history of coughing fits. Ultrasound examination and computed tomography (CT) was performed in all cases. RESULTS: Clinically, the majority of patients presented acute abdominal pain, infraumbilical masses, and anemic syndrome. Ultrasonography demonstrated nine of the 12 cases of RSH, and CT showed the hematoma in all 12 cases. Type II (five cases) and type III (seven cases) indicate moderate and severe hematomas, respectively. Excessive anticoagulation was observed in eight cases, and coagulation within correct ranges was seen in the remaining four cases. In five patients the normalization of coagulation was achieved by administering vitamin K1 and fresh frozen plasma. All cases of type III hematoma required blood transfusion. Conservative treatment was effective in all cases. CONCLUSIONS: RSH must be suspected in women of advanced age undergoing treatment with anticoagulants who present the clinical triad of acute abdominal pain, infraumbilical mass, and anemic syndrome. CT is the examination of choice for the diagnosis of RSH. Early diagnosis of RSH permits conservative management, even in the case of large hematomas with hemodynamic repercussions and avoids unnecessary surgical intervention.

Scaphoid fractures and nonunions: a comparison between panoramic radiography and plain X-rays.

This study describes the diagnostic potential of the panoramic X-ray technique in the evaluation of scaphoid fractures and nonunions. Fifty-eight symptomatic wrists were examined using both plain X-rays and the panoramic procedure. The panoramic images showed in detail the line of the scaphoid fracture and nonunion in detail; they revealed four scaphoid fractures and five nonunions that were not shown clearly with plain X-rays. The panoramic technique is a useful complement to plain X-rays for the investigation of scaphoid fractures and nonunions.

[Alkaline encrusted cystitis secondary to Proteus mirabilis infection in a HIV infected patient]. / Cistitis alcalina incrustante secundaria a infección por Proteus mirabilis en un paciente VIH.

We described for the first time an alkaline encrusting cystitis in a patient with the acquired immune deficiency. This is an entity characterized by severe dysuria and long standing urinary frequency, alkaline urine and radiographically visible calcification of the urinary bladder. It has been observed in patients with permanent Foley catheter, persistent infections due to microorganisms with urolytic activity, urinary bilharziosis or tuberculosis, or malignant bladder tumors. None of these entities were described and the patient had all conditions for this syndrome.

[Rhodococcus equi pneumonia in patients with HIV infection: report of 2 cases and review of the literature]. / Neumonía por Rhodococcus equi en pacientes infectados por el HIV: presentación de 2 casos y revisión de la litertura.

BACKGROUND: Pneumonia by Rhodococcus equi is infrequent and is associated with patients with important immunosuppression. To date 66 cases of pneumonia by Rhodococcus equi in patients with HIV infection have been published. The diagnosis, problems in determining diagnosis and treatment are discussed. MATERIALS AND METHODS: Two new cases of pneumonia by Rhodococus equi in C3 stage patients with HIV infection are reported. Diagnosis was achieved by study of bronchoalveolar lavage samples with the Apy-Coryne method and gas chromatography. RESULTS: The two patients presented pneumonia, one of which was necrotizing pneumonia with localization in the upper left lung and in the lower right lung, respectively. The clinical manifestations were characterized by respiratory involvement of a subacute course with pleural involvement in both cases and hemoptisis in one. Prolonged, combined antibiotic treatment was administered with good response in both cases. One patient died at one year of diagnosis from consumptive syndrome while the other remains asymptomatic. CONCLUSIONS: Infection by Rhodococcus equi should be suspected in HIV patients with slow evolution pneumonia, especially in the pneumonia is necrotizing. Combined i.v. antibiotic treatment is recommended and followed from 3 to 5 months with an association including clarithromycin.

Percutaneous catheter drainage of breast abscesses.

Experiences with ultrasonically guided percutaneous catheter drainage of breast abscesses (BA) are presented. The 12 cases were: 10 non-lactating women, one lactating women, and one HIV-positive man. The percutaneous procedure employed was successful in all cases. The mean duration of drainage was 5 days post-catheter insertion. All percutaneous drainages and subsequent follow-up were performed in the outpatient clinic. No recurrence of BA was observed. Percutaneous drainage of BA is a simple, effective and economical technique. Its use is recommended as an alternative to surgical drainage.

Rectus sheath hematoma: diagnostic classification by CT.

A method of classification for hematomas of the rectus abdominis sheath (RSH) is proposed based on findings observed in CT in the 13 cases of RSH in the present study. Type I hematomas (five cases) are slight and do not require hospitalization. Type II (three cases) and type III (five cases) are moderate and severe hematomas, respectively, and do require hospitalization. The patients with type III hematomas were all undergoing anticoagulant therapy and presented with a picture of acute abdomen, and in all five cases blood transfusion was carried out. Ultrasonography and, in particular, CT permitted a correct diagnosis of RSH. RSH should be considered (anticoagulant therapy induced) in females with sudden abdominal pain to avoid unnecessary surgical intervention.

Orthopantography of the wrist and the knee.

Initial experience with panoramic radiography of the wrist and the knee is presented. The technique offers potential new evaluation of these joints. A standard PA projection demonstrates the carpal bones with almost no superimposition. Additional projections permit more detailed demonstration of the scaphoid and wrist compartments. Similar panoramic studies of the normal knee demonstrated alternative images of the patella, the femoral condyles and tibial plateau. Orthopantography of the joints may provide additional information in the diagnosis of joints abnormalities.

Urethral sonography in the diagnosis of penile and bulbar urethral stenosis.

Ultrasound was used in 25 patients for the study of penile (21) and bulbar (4) strictures and for the follow-up of 8 of these patients on whom dural urethroplasty was carried out. There was a good correlation with urethrography. Ultrasound has the added advantages of enabling study of the periurethral tissues without testicular irradiation, and safety and economy of the exploration.

A new apparatus for the localization of nonpalpable mammary lesions.

A new apparatus has been used for the localization of 46 nonpalpable mammary lesions seen in either of two radiological projections. This device compresses and immobilizes the breast independently of the mammography equipment and permits a three-dimensional localization of the lesion by using the technique of X-ray angulation. The results demonstrate the efficiency of the procedure. Transfixation of the lesions was established in 30 cases (65.2%), the guidewire passed very close to the lesion in 14 cases (30.4%), and in 2 cases (4.4%) the guidewire was seen to be less than 10 mm away from the lesion. Correct preoperative localization of the lesions permitted a correct diagnosis with minimal biopsies.