Alexander Loizides

High resolution ultrasound in posterior interosseous nerve syndrome

Introduction: Posterior interosseous nerve (PIN) syndrome is a rare compression neuropathy of the PIN in the region of the supinator muscle, most common by the arcade of Frohse. We aimed to specify ultrasonographic findings in patients with PIN syndrome in comparison to healthy volunteers. Methods: Ultrasound images and clinical data of 13 patients with PIN syndrome confirmed by neurological examination and electrophysiological testing were evaluated retrospectively. Anteroposterior nerve diameters measured at the arcade of Frohse were compared with those of 20 healthy volunteers. The echotexture and the presence of a caliber change of the PIN were additionally assessed. Results: Enlargement of the PIN was seen in all patients with PIN syndrome, but not in volunteers (statistically significant difference in mean diameter P < 0.05). Furthermore, edema and caliber change of the PIN were present in all patients. Conclusions: High‐resolution ultrasound allows for differentiation between patients with PIN syndrome and healthy volunteers. Muscle Nerve 49: 35–39, 2014

What is new

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[18F]choline positron emission tomography in prostate cancer patients with biochemical recurrence after radical prostatectomy: influence of antiandrogen therapy - a preliminary study.

ObjectiveOur purpose was to evaluate whether antiandrogen therapy (AAT) influences [18F]choline PET results in patients with biochemical recurrence after radical prostatectomy (RPE). MethodsThrough a retrospective study we evaluated two groups of patients, both with histologically proven carcinoma of the prostate, who had undergone RPE and a subsequent [18F]choline PET because of biochemical failure (<4 ng/dl). One group consisted of 13 patients under AAT at the time of the PET examination (age range, 55–80 years; median, 68). The other group who had not undergone AAT consisted of 22 patients (age range, 48–72 years; median, 67). Our results were correlated with follow-up information related to histopathology, changes in prostate-specific antigen levels, other imaging modalities and clinical examination. Mean follow-up was 27 months. ResultsIn patients who had undergone AAT, [18F]choline PET was true positive in eight out of 10 patients. The overall sensitivity in this group was 80%. In two cases [18F]choline PET turned out to be false negative, missing local relapse. Of the patients treated only with RPE, 10 out of 20 turned out to be true positive, resulting in a sensitivity of 50%.In all, in four patients biochemical recurrence could not be correlated to pathological findings in any of the available modalities. The difference in sensitivity between patients with and without AAT was statistically not significant (P=0.235). ConclusionIn patients with biochemical recurrence during AAT after RPE, [18F]choline PET can yield true-positive findings, even at prostate-specific antigen values of less than 4 ng/dl, and is an accurate technique for the detection of recurrence.

Doppler-guided haemorrhoidal artery ligation with suture mucopexy compared with suture mucopexy alone for the treatment of Grade III haemorrhoids: a prospective randomized controlled trial

Novel minimally invasive techniques aimed to reposition the haemorrhoidal zone have been established for prolapsing haemorrhoids. We present a prospective randomized controlled trial to evaluate the efficacy of additional Doppler‐guided ligation of submucosal haemorrhoidal arteries (DG‐HAL) in patients with symptomatic Grade III haemorrhoids. The trial was registered as ClinicalTrials.gov identifier NCT02372981.

Focused high-resolution sonography of the suprascapular nerve: A simple surrogate marker for neuralgic amyotrophy?

OBJECTIVES To define the diagnostic value of high-resolution ultrasound (HRUS) of the suprascapular nerve (SSN) in the diagnosis of neuralgic amyotrophy (NA). METHODS The cross-section areas (CSA) of the SSN at the C5 root (CSA1) and the omohyoid muscle in the midclavicular line (CSA2) were assessed bilaterally in 15 healthy volunteers and 14 patients with clinically and electrophysiologically verified NA. Receiver-operator-characteristics (ROC) curves were generated and cut-off values, sensitivity, specificity, positive (PPV) and negative predictive values (NPV), likelihood (LR) and odds ratios (OR) were calculated. RESULTS Patients with NA had significantly higher CSA2-values than controls (6.36±2.75vs. 2.79±0.83mm2, p<0.0001) and significantly higher ratios of SSN CSA2-values of the affected vs. contralateral side (224.6±78.5% vs. 127.7±51.1%, p<0.0001). The ratios of SSN CSA2-values vs. CSA1-values (146.7±74.5% vs. 99.9±28.3%, p=0.008) and CSA1-values were also significantly higher (4.70±2.00vs. 2.90±0.90mm2, p=0.0028) than in controls. Beyond a CSA2 cut-off value of 4.2mm2, the ROC-AUC was 0.939 [0.861-1.00] when compared against healthy volunteers and 0.971 [0.901-1.00] when compared to patients with degenerative shoulder pain. Sensitivity was 85.7% [57.2-98.2%], specificity 96.7% [82.8-99.9%], PPV 92.3% [64.0-99.8%], NPV 93.5% [78.6-99.2%], OR 174.0 [14.4-2106.0] and LR 25.7 (95% confidence intervals in brackets). CONCLUSION SSN swelling in the lateral cervical region could be a supportive finding to identify NA patients. SIGNIFICANCE This method allows for the rapid sonographic identification of NA.

Systemic air embolism causing acute stroke and myocardial infarction after percutaneous transthoracic lung biopsy - a case report.

The air embolism in this case was likely to have been caused by positioning the patient in a prone position, which was associated with the lesion to be biopsied being at a maximum height over the left atrium. Due to the resulting negative pressure, air entered through a fistula that formed between the airspace and the pulmonary vein. The air could have been trapped in the left atrium by positioning the patient in left lateral position. The event itself could have been prevented by positioning the patient in an ipsilateral dependent position during the biopsy. In addition to hyperbaric oxygen therapy, the preferred treatment options are positioning maneuvers, administration of pure oxygen, and heparinization.

Measures to Prevent Air Embolism in Transthoracic Biopsy of the Lung

OBJECTIVE Systemic air embolism (AE) is a rare but feared complication of transthoracic biopsy with potentially fatal consequences. The aim of the study was to assess the effect of patient positioning during transthoracic biopsy on preventing systemic AE. MATERIALS AND METHODS We compared a historical control group of 610 patients (group 1) who underwent transthoracic biopsy before the implementation of measures to prevent systemic AE during transthoracic biopsy and a group of 1268 patients (group 2) who underwent biopsy after the measures were implemented. The patients in group 2 were placed in the ipsilateral-dependent position so that the lesion being biopsied was located below the level of the left atrium. RESULTS The rate of systemic AE was reduced from 3.77% to 0.16% (odds ratio [OR], 0.040; 95% CI, 0.010-0.177; p < 0.001). Logistic regression analyses identified needle penetration depth, prone position of the patient during biopsy, location above the level of the left atrium, needle path through ventilated lung, and intubation anesthesia as independent risk factors for systemic AE (p < 0.05). Propensity score-matched analyses identified the number of biopsy samples obtained as an additional risk factor (p = 0.003). The rate of pneumothorax was reduced from 15.41% in group 1 to 5.99% in group 2 (OR, 0.374; 95% CI, 0.307-0.546; p < 0.001). CONCLUSION Performing transthoracic biopsy with the patient in an ipsilateral-dependent position so that the lesion is located below the level of the left atrium is an effective measure for preventing systemic AE. Needle path through ventilated lung and intubation anesthesia should be avoided whenever possible.

Triple hourglass-like fascicular constriction of the posterior interosseous nerve: a rare cause of PIN syndrome

Abstract Supinator syndrome or posterior interosseous nerve (PIN) syndrome is a compression neuropathy of the deep branch of the radial nerve in the region of the Arcade of Frohse. An extremely rare cause of an acute onset supinator syndrome is the hourglass-like fascicular constriction of the posterior interosseous nerve due to torsion. To our knowledge, only a limited number of cases which describe the sonographic appearance of fascicular torsions are known in the literature. We present a rare case of a supinator syndrome associated with hourglass-like constrictions of the PIN diagnosed by means of sonography.

Reliability of Sonography in the Assessment of Sialolithiasis: Is the Fishnet Mesh Too Small?

AJR 2014; 202:W119 0361–803X/14/2021–W119

Soft-Tissue Tumor Contrast Enhancement Patterns: Diagnostic Value and Comparison Between Ultrasound and MRI

OBJECTIVE The purpose of this study was to assess and compare contrast-enhanced ultrasound and MRI patterns in the diagnosis of soft-tissue masses. MATERIALS AND METHODS Two hundred fifty-five consecutively registered patients with histologically confirmed soft-tissue masses were included in this retrospective study. The diagnostic properties of four predefined contrast enhancement (CE) patterns were assessed, and logistic regression analysis was performed to determine the correlation between diagnosis and CE pattern, lesion size, and patient age and sex. The influence of lesion size on the occurrence of inhomogeneous CE patterns in malignancies was also determined. RESULTS Homogeneous CE patterns were highly specific for benignity, and inhomogeneous CE was moderately specific for malignancy in both ultrasound and MRI. A combination of homogeneous and inhomogeneous CE patterns led to 88.3% and 88.7% sensitivity, 66.7% and 59.7% specificity, 73.4% and 68.2% correct classification, 54.6% and 47.8% positive predictive value, 92.6% and 92.7% negative predictive value, 2.65 and 2.20 positive likelihood ratio, and 0.18 and 0.19 negative likelihood ratio for contrast-enhanced ultrasound and contrast-enhanced MRI. Cases with homogeneous CE in either ultrasound or MRI also were predominantly benign. The occurrence of inhomogeneous CE in malignant lesions increased with size. CONCLUSION CE patterns in ultrasound and MRI offer additional information about the differentiation of an unknown soft-tissue mass. The results of this study showed that homogeneous or absent CE was specific for benign differentiation and that heterogeneous CE was linked to malignancy. The routine analysis of CE patterns should increase diagnostic reliability in unclear soft-tissue masses.