Thomas H. Grant

Does ultrasound training boost Year 1 medical student competence and confidence when learning abdominal examination

Objectives  Learning to perform physical examination of the abdomen is a challenge for medical students. Medical educators need to find engaging, effective tools to help students acquire competence and confidence in abdominal examination techniques. This study evaluates the added value of ultrasound training when Year 1 medical students learn abdominal examination.

Changes in Passive Mechanical Properties of the Gastrocnemius Muscle at the Muscle Fascicle and Joint Levels in Stroke Survivors

OBJECTIVES To investigate the ankle joint-level and muscle fascicle-level changes and their correlations in stroke survivors with spasticity, contracture, and/or muscle weakness at the ankle. DESIGN To investigate the fascicular changes of the medial gastrocnemius muscle using ultrasonography and the biomechanical changes at the ankle joint across 0 degrees, 30 degrees, 60 degrees, and 90 degrees knee flexion in a case-control manner. SETTING Research laboratory in a rehabilitation hospital. PARTICIPANTS Stroke survivors (n=10) with ankle spasticity/contracture and healthy control subjects (n=10). INTERVENTIONS Not applicable. MAIN OUTCOME MEASUREMENTS At the muscle fascicle level, medial gastrocnemius muscle architecture including the fascicular length, pennation angle, and thickness were evaluated in vivo with the knee and ankle flexion changed systematically. At the joint level, the ankle range of motion (ROM) and stiffness were determined across the range of 0 degrees to 90 degrees knee flexion. RESULTS At comparable joint positions, stroke survivors showed reduced muscle fascicle length, especially in ankle dorsiflexion (P< or =.048) and smaller pennation angle, especially for more extended knee positions (P< or =.049) than those of healthy control subjects. At comparable passive gastrocnemius force, stroke survivors showed higher fascicular stiffness (P< or =.044) and shorter fascicle length (P< or =.025) than controls. The fascicle-level changes of decreased muscle fascicle length and pennation angle and increased medial gastrocnemius fascicle stiffness in stroke were correlated with the joint level changes of increased joint stiffness and decreased ROM (P<.05). CONCLUSIONS This study evaluated specific muscle fascicular changes as mechanisms underlying spasticity, contracture, and joint-level impairments, which may help improve stroke rehabilitation and outcome evaluation.

Ultrasound diagnosis of peroneal tendon tears: A surgical correlation

BACKGROUND Musculoskeletal ultrasound is an established diagnostic technique for the assessment of tendon injuries. The purpose of the present study was to determine whether ultrasound is effective for evaluating peroneal tendon injuries, with surgical findings used as the standard of reference. METHODS Fifty-eight patients with a suspected peroneal tendon injury were prospectively evaluated with use of dynamic ultrasound. Twenty-five patients were found to have peroneal tendon tears and were managed operatively. Five patients with normal peroneal tendons on ultrasound examination also were managed operatively for other reasons and are included in the series as the peroneal tendons were inspected at the time of the procedure. Ultrasound and surgical criteria were used to grade the peroneal tendons on a scale from grade 0 (normal tendon) to grade III (tendon rupture). RESULTS Of the sixty tendons that were evaluated operatively, twenty-five were found to be torn. The sensitivity, specificity, and accuracy of ultrasonography were 100%, 85%, and 90%, respectively. CONCLUSIONS The use of dynamic ultrasound is effective for determining the presence or absence of a peroneal tendon tear and should be considered a first-line diagnostic tool.

Role of Intrathyroidal Calcifications Detected on Ultrasound as a Marker of Malignancy

Objectives: Clinically palpable thyroid nodules are present in between 4% and 7% of the population, with only a small percentage of those harboring malignancy. Thus, it is important to find a cost‐effective way to determine which nodules are more likely to be malignant. The purpose of this study was to evaluate the use of intrathyroidal calcifications detected on ultrasound as a risk factor for malignancy.

Ovarian Failure after Uterine Artery Embolization for Treatment of Myomas

Uterine artery embolization (UAE) is an effective, safe, nonsurgical treatment for uterine myomas. Although menstrual irregularities and transient amenorrhea have occurred after UAE, these reports did not provide proper hormonal documentation of ovarian failure. Our patient experienced elevated follicle-stimulating hormone (FSH) levels and vasomotor symptoms (hot flushes) within 4 weeks after the procedure. To our knowledge, this is the first report in the literature of ovarian failure after UAE confirmed by comparing preprocedure FSH levels with postprocedure levels over 12 months.

Intraluminal colonic calcifications associated with anorectal atresia: Prenatal sonographic detection

Intra-abdominal meconium calcifications in the fetus can be detected with sonography.t-3 Fetal peritoneal calcifications are usually related to meconium peritonitis secondary to bowel perforation; intraluminal calcifications (enterolithiasis) are relatively rare but are often associated with bowel obstruction. 2.3 Sonographic characteristics clearly reveal the presence of calcified meconium and may distinguish intraluminal from peritoneal foci. The following is a report of two cases of prenatal detection of calcified intraluminal meconium associated with anorectal atresia. Sonographic signs useful in the antenatal diagnosis of enterolithiasis are described. To our knowledge, these have not been previously reported.

ACR Appropriateness Criteria® on Crohn's Disease

In the past decade, new therapeutic agents have been developed that permit gastroenterologists to treat virtually all forms of Crohns disease. The success of these treatments depends on an accurate diagnosis of the nature and extent of disease. Fortunately, radiologists now possess a powerful arsenal of imaging techniques to guide the choice of therapy. This article discusses the usefulness of both traditional and newer imaging techniques in the management of Crohns disease and its various clinical presentations.

ACR Appropriateness Criteria ® on Colorectal Cancer Screening

Colorectal cancer remains one of the most common causes of cancer death in this country. This malignancy is ideally suited for screening because the detection and removal of the precursor adenomatous polyp can prevent most colorectal cancers from ever forming. The choice of a test for screening involves consideration of various individual parameters, including patient age and the presence of risk factors for the development of colorectal cancer. Computed tomographic colonography (CTC) has emerged as the leading imaging technique for colorectal cancer screening in average-risk individuals on the basis of the evidence presented in this paper. The double-contrast barium enema is an alternative imaging test that is appropriate particularly when CTC is not available. In 2008, the American Cancer Society guideline for colorectal cancer screening was revised jointly with the US Multi-Society Task Force on Colorectal Cancer and the ACR to include CTC every 5 years as an option for average-risk individuals. Computed tomographic colonography is also the preferred test for colon evaluation after an incomplete colonoscopy. Imaging tests including CTC and the double-contrast barium enema are usually not indicated for colorectal cancer screening in high-risk patients with polyposis syndromes or inflammatory bowel disease. This paper presents the new colorectal cancer imaging test ratings and is the result of evidence-based consensus by the ACR Appropriateness Criteria Expert Panel on Gastrointestinal Imaging.

Lymphangiographic Visualization of Pleural and Pulmonary Lymphatics in a Patient Without Chylothorax

Pulmonary lymphatic visualization during lymphangiography was demonstrated without evident abnormality of the lymphatic system. Such visualization has not heretofore been reported in the absence of chylothorax. Filling from the thoracic duct via the inferior pulmonary ligaments and from the basal pleural lymphatics to the pulmonary lymphatics is the probable direction of flow.

Use of MRI images to measure tissue thickness over the ischial tuberosity at different hip flexion

The goal of this experiment was to investigate changes in the thickness of the soft tissue overlying the ischial tuberosity (IT) due to changes in hip flexion angle and the addition of a sitting load. Eleven healthy subjects were tested. An apparatus constructed from foam blocks and an air bladder was used to position the subjects in different postures within an MRI tube. MRI images of the buttocks and thigh were obtained for four postures: Supine, 45° Hip Flexion, Non‐Weight‐Bearing 90° Hip‐Flexion, and Weight‐Bearing 90° Hip‐Flexion. The thickness of muscle, adipose tissue, and skin was measured between the IT tip and skin surface, perpendicular to the cushion placed beneath the thighs. The tissue overlying the IT was found to be significantly (P < 0.001) thinner in 90° Hip‐Flexion (73.8 ± 9.0 mm) than in the supine position (135.9 ± 8.1 mm). Muscle thickness decreased significantly from Supine to Non‐Weight‐Bearing 90° Hip‐Flexion (59.1 ± 8.5%, P < 0.001), and further decreased from Non‐Weight‐Bearing to Weight‐Bearing 90° Hip‐Flexion (46.2 ± 7.9%, P < 0.001). Under Weight‐Bearing 90° Hip‐Flexion, the muscle tissue deformed significantly (P < 0.001) more than the adipose tissue and skin. We concluded that the tissue thickness covering the IT significantly decreased with hip flexion, and further decreased by nearly half during loading caused by sitting. In addition, the muscle tissue experienced the largest deformation during sitting. The results of this study may improve our understanding of risk factors for pressure ulcer development due to changes in tissue padding over the IT in different postures. Clin. Anat. 24:638–645, 2011.