Edmund H.Y. Yuen

Treatment of pyogenic liver abscess: Prospective randomized comparison of catheter drainage and needle aspiration

This study aims to compare the therapeutic effectiveness of continuous catheter drainage versus intermittent needle aspiration in the percutaneous treatment of pyogenic liver abscesses. Over a 5‐year period, 64 consecutive patients with pyogenic liver abscess were treated with intravenous antibiotics (ampicillin, cefuroxime, and metronidazole) and randomized into two percutaneous treatment groups: continuous catheter drainage (with an 8F multi‐sidehole pigtail catheter); and intermittent needle aspiration (18G disposable trocar needle). There was no statistically significant difference between the two groups regarding patient demographics, underlying coexisting disease, abscess size, abscess number, number of loculation of abscess, the presenting clinical symptoms such as fever, abdominal pain, and pretreatment liver function test. Although not statistically significant, the duration of intravenous antibiotics treatment before percutaneous treatment was longer with the catheter group, and the change of antibiotics after the sensitivity test was more frequent with the needle group. The needle group was associated with a higher treatment success rate, a shorter duration of hospital stay, and a lower mortality rate, although this did not reach statistical significance. In conclusion, this study suggests that intermittent needle aspiration is probably as effective as continuous catheter drainage for the treatment of pyogenic liver abscess, although further proof with a large‐scale study is necessary. Due to the additional advantages of procedure simplicity, patient comfort, and reduced price, needle aspiration deserves to be considered as a first‐line drainage approach. (HEPATOLOGY 2004;39:932–938.)

Shear wave elastography of focal salivary gland lesions: preliminary experience in a routine head and neck US clinic

Book synopsis: New Materialisms rethinks the relevance of materialist philosophy in the midst of a world shaped by forces such as digital and biotechnologies, global warming, global capital, and population flows. Moving away from modes of inquiry that have prioritized the study of consciousness and subjectivity over matter, the essays in this collection show that any account of experience, agency, and political action demands renewed attention to the urgent issues of our own material existence and our environment. The editors propose “new materialisms” as a way to take matter seriously without falling into the conceptual dualism that posits an opposition between matter and thought, materialism and idealism, and body and mind. They locate new materialisms within post-humanist discourses, explaining that new materialist philosophies do not privilege human bodies, but rather view human bodies as one of many bodies, or agential materialities, in the world. By revealing how emerging accounts of matter, materiality, and corporeality are combining with developments in science and technology to demand radically new conceptions of nature, agency, and social and political relationships, New Materialisms makes a significant contribution to the recent resurgence of interest in phenomenology and materialist philosophy in the humanities.

Shear wave elasticity imaging of cervical lymph nodes.

A pilot study of real-time shear wave ultrasound elastography (SWE) for cervical lymphadenopathy in routine clinical practice was conducted on 55 nodes undergoing conventional ultrasound (US) with US-guided needle aspiration for cytology. Elastic moduli of stiffest regions in nodes were measured on colour-coded elastograms, which were correlated with cytology. Malignant nodes (n = 31, 56.4%) were stiffer (median 25.0 kPa, range 6.9-278.9 kPa) than benign nodes (median 21.4 kPa, range 8.9-30.2 kPa) (p = 0.008, Mann Whitney U test). A cut-off of 30.2 kPa attained highest accuracy of 61.8%, corresponding to 41.9% sensitivity, 100% specificity and 0.77 area under the receiver operating characteristic curve. Qualitatively, elastograms of benign nodes were homogeneously soft; malignant nodes were homogeneously soft or markedly heterogeneous with some including regions lacking elasticity signal. SWE is feasible for neck nodes. It appears unsuitable for cancer screening but may detect a subset of malignant nodes. The cause of spatial heterogeneity of malignant nodes on SWE is yet to be established.

Early Swallowing Problems in a Cohort of Patients With Nasopharyngeal Carcinoma: Symptomatology and Videofluoroscopic Findings

Objective: To study the incidence and the degree of swallowing dysfunction in patients with nasopharyngeal carcinoma (NPC) who underwent radiation therapy treatment.

Ultrasound elastography in the head and neck. Part II. Accuracy for malignancy

Abstract Ultrasound elastography (USE) describes a variety of ultrasound-based imaging techniques that measure tissue stiffness properties, and is currently under intense investigation for tissue characterization in several anatomic sites. This article summarizes the evidence regarding the accuracy of USE for malignancy in the head and neck. Currently, most published data pertains to small pilot studies with varied methodologies. Encouragingly, most studies have documented promising results for USE in terms of high accuracy for malignancy in thyroid nodules and cervical lymph nodes, which have surpassed conventional sonographic criteria. However, a minority of studies have documented opposite findings. USE seems to be suboptimal for salivary malignancies, and some evidence suggests that USE does not provide useful diagnostic information compared with conventional ultrasonography for miscellaneous neck masses. Further larger studies are required to validate these findings although, in view of the predominance of highly optimistic results for thyroid nodules and cervical lymph nodes, USE may become a useful ancillary technique in the routine diagnostic work-up of lesions in these tissues in the near future.

Accuracy of High-resolution Sonography Compared with Magnetic Resonance Imaging in the Diagnosis of Head and Neck Venous Vascular Malformations

AIMS To evaluate whether modern ultrasound examination helps to establish the diagnosis of head and neck venous vascular malformations (VVMs) and whether it can delineate their full extent. MATERIALS AND METHODS Sonographic appearances of 30 head and neck VVMs were assessed for: location, extent, internal architecture, presence of flow and phleboliths. These results were compared with the magnetic resonance imaging (MRI) of the same patients. RESULTS The lesions showed well-defined margins (22 of 30, 73%), heterogeneous (30 of 30, 100%) and hypoechoic echo pattern (27 of 30, 90%), with sinusoidal spaces (28 of 30, 93%) and phleboliths (24 of 30, 80%) on grey-scale imaging, and flow signal on Doppler (28 of 30, 93%). For delineating the extent, ultrasound was comparable with MRI in 53% (16 of 30) and inferior to MRI in 47% (14 of 30). Ultrasound did not detect deeper extent, intra-osseous involvement and other clinically occult VVMs. CONCLUSION Ultrasound with high-resolution transducers can confidently suggest the diagnosis of head and neck VVMs in up to 90% of cases, and delineate the full extent of some superficial lesions. The major disadvantage is its inability to evaluate intra-osseous involvement and the entire extent of large, deep-seated lesions.

Basal Cell Adenocarcinoma of the Salivary Gland

BACKGROUND: Basal cell adenocarcinoma of the parotid is rare and prone to recur. CASE: A 54-year-old woman had a history of a facial mass 12 years earlier that had been excised and was diagnosed as low grade adenocarcinoma of the parotid. Over the years, the patient had multiple local and lymph node recurrences. Histology of the excised local recurrent tumor showed basal cell adenocarcinoma, and FNAC of a separate recurrent nodule was performed. The aspirate showed moderate cellularity of basaloid cells with mildly pleomorphic nuclei, small nucleoli and occasional mitotic figures The cells were mostly single, but some formed clusters with a rosettelike pattern of tumor cells surrounding central eosinophilic globules. A second, less prominent population of smaller cells with darkstaining nuclei was also noted. The differential diagnosis included adenoid cystic carcinoma, polymorphous low grade adenocarcinoma, and basal cell and pleomorphic adenoma. CONCLUSION: The cytologic features of basal cell adenocarcinoma are not distinctive, but the presence of two cell populations with moderate pleomorphism and a rosettelike pattern with central, eosinophilic globules may assist with its differentiation from other salivary gland neoplasms.

Ultrasound elastography in the head and neck. Part I. Basic principles and practical aspects

Abstract Ultrasound elastography (USE) is a rapidly developing field of imaging that measures and displays tissue elasticity or stiffness properties using ultrasound. In recent years, real-time USE modes have appeared on commercially available clinical ultrasound machines, stimulating an explosion of research into potential oncologic and non-oncologic clinical applications of USE. Preliminary evidence suggests that USE can differentiate benign and malignant conditions accurately in several different tissues. This article presents an overview of the basic principles of different USE technologies that are currently under investigation in the head and neck region. In addition, more practical aspects pertaining to the optimal performance of USE at this site are discussed.

Unusual anterior neck mass visible only during Valsalva's maneuver in a child.

2Department of Surgery, Division of Otorhinolaryngology, The Chinese University of Hong Kong, Shatin, Hong Kong, SAR. child with an anterior neck mass is a common clinical presentation. To the best of our knowledge, there are only a few conditions in which the neck mass is apparent or aggravated only during Valsalva’s maneuver. We present an unusual case of a superior herniation of the normal mediastinal thymus into the lower anterior neck in a child during Valsalva’s maneuver. The role of imaging in the diagnosis and common differential diagnoses are discussed.

A pilot study evaluating real-time shear wave ultrasound elastography of miscellaneous non-nodal neck masses in a routine head and neck ultrasound clinic.

A pilot study was performed to evaluate shear wave ultrasound elastography (SWE) for miscellaneous non-nodal/salivary/thyroid neck lesions. Forty-six lesions undergoing conventional sonography also underwent SWE. Elastic moduli from the stiffest areas in lesions were correlated with diagnosis. Forty lesions were benign (9 lipomas, 8 lymphatic/venous vascular malformations, 7 thyroglossal duct cysts, 4 branchial cleft cysts, 4 abscesses/phlegmons, 3 neurogenic tumors and 1 each of paraganglioma, sebaceous cyst, pseudotumor, hypertrophic scar, ranula) and 6 were malignant (1 malignant fibrous histiocytoma, 2 primary squamous cell carcinomas and 3 intramuscular metastases [2 squamous cell carcinomas, 1 malignant melanoma]).Median stiffness of malignant lesions (226.4 kPa, range 55.6 to 300.0) was higher than benign lesions (28.3 kPa, range 4.0 to 300.0) (p < 0.001). SWE cut-off with highest accuracy (174.4 kPa) achieved 83.3% sensitivity and 97.5% specificity, and the cut-off with 100% sensitivity (55.6 kPa) achieved 75% specificity. All malignant lesions were suspected on conventional sonography. The preliminary data indicate that SWE is feasible for miscellaneous neck lesions. SWE would not have altered management in terms of detecting undisclosed malignancies, although as a quantitative technique, it may increase the diagnostic confidence of less experienced operators performing head and neck ultrasound.