Reproducibility of sonographic measurements of the median nerve.

OBJECTIVE: The purpose of this study was to evaluate the reproducibility of median nerve cross-sectional area (CSA) measurements using the indirect method (ellipsoid formula) and the direct or tracing method. METHODS: The median nerve CSA was measured in 22 wrists of patients with carpal tunnel syndrome by means of high-frequency sonography. Measurements were made at the level of the pisiform bone by a standardized sonographic examination protocol. Two observers with different levels of experience performed the measurements, independently and blinded. An analysis of reliability was carried out, and the concordance between the methods was determined with parametric statistical tests. RESULTS: The results point to good reproducibility of the median nerve CSA measurements obtained by both methods, whether performed by an experienced observer or by an inexperienced observer after a short learning period. CONCLUSIONS: The results suggest sonography for median nerve CSA measurements is reproducible by either the direct or indirect method when a standardized sonographic examination protocol is used.

Panoramic versus conventional radiography of scaphoid fractures.

OBJECTIVE: The objective of this study was to compare the diagnostic value of panoramic and conventional radiography in the detection of fractures of the carpal scaphoid bone. MATERIALS AND METHODS: Panoramic (orthopantomographic) and conventional radiographs of 90 patients with acute or chronic wrist trauma were reviewed retrospectively. Images were analyzed and reviewed independently by four observers: two radiologists and two traumatologists. The kappa statistic was used to calculate intraand interobserver agreement and the correlation between the two imaging techniques. RESULTS: Panoramic radiography of the wrist was superior to conventional radiography in ruling out scaphoid fractures (74%, 20/27) in patients with suspicious findings on conventional radiography; revealed more cases of scaphoid fractures (21.4%, 12/56); and revealed more cases of delayed union (n = 2), nonunion (n = 3), and union (n = 3). Agreement values were higher, with better inter- and intraobserver agreement, for the panoramic examinations than for the conventional radiographic examinations. CONCLUSION: The panoramic examination of the wrist is a useful technique for the diagnosis and follow-up of scaphoid fractures. Its use is recommended as a complement to conventional radiography in cases with inconclusive findings.

A new device for retrograde urethrography in the male.

A new technique is presented for retrograde urethrography (RGU) using a plastic adjustable clamp. The procedure was performed in 36 patients with suspected urethral stenosis. Mean age was 55.3 years. The device and the procedure are described. All the radiologic examinations of the urethra were carried out successfully. The urethrograms showed images of stenosis in 27 patients. The stenoses localized in the distal tip of the anterior urethra were clearly seen with this clamp system. This method enables evaluation of the cases with stenosis close to the meatus that are difficult or even impossible to visualize with the conventional method. When necessary, a finer catheter can be used. This clamp system is recommended for RGU. The technique is simple, effective, and well tolerated by patients.

An alternative approach to the treatment of mammary duct fistulas: a combination of microwave and ultrasound.

Between 1994 and 1999, 11 women with recurrent mammary duct fistula underwent nonsurgical treatment with microwave and ultrasound. An initial ultrasonographic examination was performed during the recurrence of mammary duct fistula, and in ten cases it revealed a small superficial periareolar anechoic, hypoechoic, or heterogenic lesion with poorly defined edges and without posterior reinforcement (marked distal sound enhancement). Findings indicated an extraglandular inflammatory process; duct ectasia was not seen in any of the 11 patients. A combination of microwave and ultrasound was administered on an outpatient basis for 20 days. Clinical improvement was rapid after the first few sessions of treatment. In nine of the 11 patients there has been no recurrence during more than 2 years of follow-up. The two current episodes were resolved by a second application of the same treatment. In one of those patients (with recurrence at 6 months) an infiltration of steroids was also administered, and this patient is without recurrence after 23 months' follow-up.

Percutaneous endoscopy of an intracystic papilloma of the breast.

We present a new endoscopic procedure for the evaluation of intracystic papilloma of the breast. We suggest that the method is a potential alternative to open surgery.