Nadia Perrone

Ultrasound-Guided Treatment of Meralgia Paresthetica (Lateral Femoral Cutaneous Neuropathy) Technical Description and Results of Treatment in 20 Consecutive Patients

The purposes of this study were to describe a technique for treatment of meralgia paresthetica (lateral femoral cutaneous neuropathy) using ultrasound guidance and to report the results of treatment.

High-resolution, three-dimensional, and contrast-enhanced ultrasonographic findings in diseases of the eye

OBJECTIVES To review the contrast-enhanced ultrasound (CEUS) and 3D ultrasound findings (3D-US) in various pathologies involving the eye and orbit and to compare them with high-resolution US (HRUS) findings. BACKGROUND CEUS is a valid diagnostic tool for study several districts. There are numerous pathological conditions of the eye in which CEUS can be very helpful or detrimental. IMAGE FINDINGS: We review a wide range of ocular lesions, traumatic (retinal and choroidal detachments) and malignant (choroidal melanoma, tumors inside and outside the muscle cone) evaluated alternatively with CEUS and 3D and compare these findings with those obtained with HRUS. Dysthyroid orbitopathy is not included in this review. CONCLUSION CEUS plays a central role in the differentiation of detached retina (vascular) and vitreous membranes (avascular). It is also helpful in the assessment of tumor of the eye, in planning treatment for choroidal melanoma, and in assessing orbital masses for neovascularization. HRUS is highly effective in the detection of traumatic and non-traumatic lesions of the eye, but it is less effective for the assessment of orbital lesions. The 3D module has increased the diagnostic value of CEUS. CEUS is cost-effective and can be used when CT and MR cannot be performed.

Ultrasound-guided injection of botulinum toxin A in the treatment of iliopsoas spasticity

PURPOSE Intramuscular injection of botulinum toxin A (BTX-A) is a common treatment for iliopsoas muscle spasticity, but it is not easy to position the needle in this muscle without guidance. In this paper we describe an ultrasound-guided technique for the intramuscular injection of BTX-A to treat spasticity of the iliopsoas muscle. Its effectiveness was assessed in 10 patients. METHOD AND MATERIALS The ultrasound-guided technique for BTX-A injection was used on 10 patients. The needle was inserted into the muscle belly at an angle of 45° along the longitudinal axis of the muscle when allowed by patients condition. RESULTS In all cases, the iliopsoas muscle was easily identified and both the iliac and psoas components were assessed. Introduction of the needle and drug injection were entirely carried out under ultrasonographic guidance. The procedure was successful in all patients, even in those with a high-grade spasticity, and general anesthesia was not required. CONCLUSIONS This ultrasound-guided technique allows accurate guidance for the injection of BTX-A, and it can be considered as an alternate supportive therapy in patients with spasticity and dystonia.

Three-dimensional sonohysterography for examination of the uterine cavity in women with abnormal uterine bleeding: Preliminary findings

INTRODUCTION To compare the diagnostic values of three-dimensional sonohysterography (3DSH), transvaginal ultrasound (TVUS), and 2-dimensional sonohysterography (2DSH) in the work-up of abnormal uterine bleeding (AUB), in particular the ability of each method to identify intracavitary lesions arising from the endometrium or uterine wall. MATERIALS AND METHODS 24 patients referred for AUB underwent TVUS followed by 2-D and 3-D HS in the same session. Three-dimensional data were acquired with a free-hand technique during maximal distention of the uterus. Within 10 days of the sonographic session, each patient underwent hysteroscopy, which was considered the reference standard. For each of the 3 imaging methods, we calculated sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy. RESULTS Hysteroscopy demonstrated the presence of an intrauterine lesion in 21/24 patients (87.5%). In 3/24 patients hysteroscopy was negative. For TVUS, 2DSH, and 3DSH, sensitivity was 76% (16/21), 90% (19/21), 100% (21/21), respectively; specificity was 100% (3/3), 100% (19/19), 100% (21/21); PPV was 100%, 100%, 100%; NPV was 37%, 60%, 100%; accuracy was 76%, 90%, 100%. CONCLUSIONS 3DSH is more sensitive that 2DSH or TVUS in the detection of intrauterine lesions. If these preliminary results are confirmed in larger studies, 3DSH could be proposed as a valuable alternative to diagnostic hysteroscopy.

Gastrointestinal stromal tumor metastatic to the scrotum

Solid malignant tumors metastatic to the scrotum are rare. A 0.68% incidence rate of metastates to the testes has been reported in an autopsy series of 738 patients with solid malignancies,1 and in a group of 85 patients with tumors of paratesticular structures, 9.4% were found to have lesions of metastatic origin. 2 A large variety of primary tumors can metastasize to the scrotum, the most common being lung, prostate, and melanoma. 1-4 The suggested patterns of metastatic involvement vary according to the origin of the lesion: hematogenous for lung cancer and melanoma and retrograde venous embolism, lymphatic extension, or retrograde endocanalicular spread for prostatic tumors. To the best of our knowledge, only 2 cases of gastrointestinal stromal tumors (GISTs) involving the scrotum have been reported in the literature, 5,6 and a third case had an extragastrointestinal stromal tumor presenting as a scrotal mass. 7 We describe the imaging findings observed in a patient with an abdominal GIST who had a metastatic nodule on the surface of the tunica vaginalis, possibly due to metastatic spread through a patent peritoneo-vaginalis duct.

Pelvi acuta infiammatoria e non infiammatoria

La valutazione della pelvi acuta femminile deve necessariamente iniziare con l’accurata raccolta dell’anamnesi e con l’esame clinico. Un quadro clinico di pelvi acuta puo infatti essere determinato da patologie sia ginecologiche sia di pertinenza non ginecologica, quali calcolosi ureterale, forme infiammatorie dell’intestino e adenomesenteriti, diverticoliti e occlusione intestinale. Inoltre, l’emergenza pelvica in eta pediatrica o fertile pone problematiche relative non solo alla vita della paziente, ma anche alla conservazione dell’integrita anatomo- funzionale dell’apparato riproduttivo.