N. Evripidou, A. Antoniou, George Lazarou, L. Georgiou, Antreas Chrysanthou, C. Ioannides, C. Damianou
Establishing an efficient workflow is crucial for the success of magnetic resonance-guided focused ultrasound (MRgFUS) procedures. The current study provides a comprehensive description of the workflow of a customized MRgFUS robotic body device for preclinical use and accompanied software through experiments in excised porcine tissue. The employed system comprises a single-element spherically focused transducer of 2.6 MHz that can be moved along four PC-controlled axes. A detailed description of essential software functionalities and its integration with a 3T Siemens magnetic resonance imaging (MRI) scanner through Access-I for interactive remote control of the scanner and real-time access to imaging data is provided. Following treatment planning on preoperative MR images, porcine tissue samples were sonicated in rectangular and irregular grid patterns with varying ultrasonic parameters and spatial step under software-based monitoring. MRgFUS ablations of ex vivo porcine tissue were successfully performed utilizing a multimodal monitoring approach combining MRI-based temperature, thermal dose, and necrotic area mapping, thus demonstrating an efficient procedural workflow. The simulated necrotic regions were in excellent agreement with the actual lesions revealed upon tissue dissection and highly consistent with the planned sonication patterns. The software’s ability to accurately identify regions where necrosis did not occur and indicate to the user the specific points to be re-sonicated was demonstrated. Overall, the study highlights critical aspects in accurately planning and executing preclinical MRgFUS protocols within an efficient workflow. The provided data could serve as the basis for other researchers in the field.
{"title":"Workflow of a Preclinical Robotic Magnetic Resonance Imaging-guided Focused Ultrasound Body System","authors":"N. Evripidou, A. Antoniou, George Lazarou, L. Georgiou, Antreas Chrysanthou, C. Ioannides, C. Damianou","doi":"10.4103/jmu.jmu_135_23","DOIUrl":"https://doi.org/10.4103/jmu.jmu_135_23","url":null,"abstract":"\u0000 \u0000 \u0000 Establishing an efficient workflow is crucial for the success of magnetic resonance-guided focused ultrasound (MRgFUS) procedures. The current study provides a comprehensive description of the workflow of a customized MRgFUS robotic body device for preclinical use and accompanied software through experiments in excised porcine tissue.\u0000 \u0000 \u0000 \u0000 The employed system comprises a single-element spherically focused transducer of 2.6 MHz that can be moved along four PC-controlled axes. A detailed description of essential software functionalities and its integration with a 3T Siemens magnetic resonance imaging (MRI) scanner through Access-I for interactive remote control of the scanner and real-time access to imaging data is provided. Following treatment planning on preoperative MR images, porcine tissue samples were sonicated in rectangular and irregular grid patterns with varying ultrasonic parameters and spatial step under software-based monitoring.\u0000 \u0000 \u0000 \u0000 MRgFUS ablations of ex vivo porcine tissue were successfully performed utilizing a multimodal monitoring approach combining MRI-based temperature, thermal dose, and necrotic area mapping, thus demonstrating an efficient procedural workflow. The simulated necrotic regions were in excellent agreement with the actual lesions revealed upon tissue dissection and highly consistent with the planned sonication patterns. The software’s ability to accurately identify regions where necrosis did not occur and indicate to the user the specific points to be re-sonicated was demonstrated.\u0000 \u0000 \u0000 \u0000 Overall, the study highlights critical aspects in accurately planning and executing preclinical MRgFUS protocols within an efficient workflow. The provided data could serve as the basis for other researchers in the field.\u0000","PeriodicalId":45466,"journal":{"name":"Journal of Medical Ultrasound","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140674959","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Rheumatoid arthritis (RA) is a form of inflammatory disease whose clinical pattern is largely dependent on the presence of both anti-citrullinated protein antibodies and rheumatoid factor (RF). Although this is still debatable, seronegative RA seems to be a somewhat less serious condition. The present study aimed to evaluate ankle joint ultrasound in relation to RF status and disease activity in RA patients. A cross-sectional study involving RA patients from a single center was conducted. Laboratory test evaluations and clinical activity assessments were carried out. The ankle joint was examined using musculoskeletal ultrasound (US). The study included 100 patients with established RA in total. Eighty-two patients tested positive for RF with a mean age of 42.3, whereas only 18 tested negative with a mean age of 39.6. Patients who tested positive for RF had a longer duration of illness (9.39 ± 5.39 vs. 4.56 ± 3.24). There were no differences in clinical activity scores between the seropositive and seronegative groups. The pathological US findings of any ankle joint showed no differences between the seropositive and seronegative groups. Patients with US findings of tibialis posterior tenosynovitis in the left ankle and synovitis and erosion in the right ankle, particularly in the tibiotalar and talonavicular joints, had significantly high Disease Activity Score 28-Erythrocyte sedimentation rate-scores. The increased disease activity was accompanied by significant erosions on both ankles. In terms of disease activity, there is no clinically significant difference between seropositive and seronegative RA patients. Sonographic ankle joint abnormalities do not appear to be associated with the patients’ RF status. High RA disease activity, on the other hand, is associated with synovitis and erosions, particularly in the talonavicular and tibiotalar joints, as well as tibialis posterior tenosynovitis.
类风湿性关节炎（RA）是一种炎症性疾病，其临床模式主要取决于抗瓜氨酸蛋白抗体和类风湿因子（RF）的存在。尽管这一点仍有争议，但血清阴性的 RA 似乎病情较轻。本研究旨在评估踝关节超声与类风湿关节炎患者的类风湿因子状态和疾病活动性的关系。 这项横断面研究涉及一个中心的 RA 患者。研究人员进行了实验室测试评估和临床活动评估。使用肌肉骨骼超声（US）对踝关节进行了检查。 研究共纳入了 100 名已确诊的 RA 患者。82名患者的RF检测呈阳性，平均年龄为42.3岁，而只有18名患者的RF检测呈阴性，平均年龄为39.6岁。RF检测呈阳性的患者病程较长（9.39 ± 5.39 对 4.56 ± 3.24）。血清反应阳性组和血清反应阴性组的临床活动评分没有差异。血清反应阳性组和血清反应阴性组的踝关节病理检查结果无差异。左脚踝胫骨后腱膜炎和右脚踝滑膜炎及糜烂（尤其是胫距关节和距骨关节）的患者，其疾病活动度评分 28-红细胞沉降率明显偏高。在疾病活动度增加的同时，两个脚踝都出现了明显的侵蚀。 就疾病活动性而言，血清反应阳性和血清反应阴性的 RA 患者之间没有明显的临床差异。踝关节声像图异常似乎与患者的射频状态无关。另一方面，高RA疾病活动度与滑膜炎和侵蚀有关，尤其是在距骨关节和胫距关节，以及胫骨后腱膜炎。
{"title":"Ultrasonographic Evaluation of the Ankle Joint in Relation to Rheumatoid Factor Status and Disease Activity in Patients with Rheumatoid Arthritis","authors":"A. Azzam","doi":"10.4103/jmu.jmu_111_23","DOIUrl":"https://doi.org/10.4103/jmu.jmu_111_23","url":null,"abstract":"\u0000 \u0000 \u0000 Rheumatoid arthritis (RA) is a form of inflammatory disease whose clinical pattern is largely dependent on the presence of both anti-citrullinated protein antibodies and rheumatoid factor (RF). Although this is still debatable, seronegative RA seems to be a somewhat less serious condition. The present study aimed to evaluate ankle joint ultrasound in relation to RF status and disease activity in RA patients.\u0000 \u0000 \u0000 \u0000 A cross-sectional study involving RA patients from a single center was conducted. Laboratory test evaluations and clinical activity assessments were carried out. The ankle joint was examined using musculoskeletal ultrasound (US).\u0000 \u0000 \u0000 \u0000 The study included 100 patients with established RA in total. Eighty-two patients tested positive for RF with a mean age of 42.3, whereas only 18 tested negative with a mean age of 39.6. Patients who tested positive for RF had a longer duration of illness (9.39 ± 5.39 vs. 4.56 ± 3.24). There were no differences in clinical activity scores between the seropositive and seronegative groups. The pathological US findings of any ankle joint showed no differences between the seropositive and seronegative groups. Patients with US findings of tibialis posterior tenosynovitis in the left ankle and synovitis and erosion in the right ankle, particularly in the tibiotalar and talonavicular joints, had significantly high Disease Activity Score 28-Erythrocyte sedimentation rate-scores. The increased disease activity was accompanied by significant erosions on both ankles.\u0000 \u0000 \u0000 \u0000 In terms of disease activity, there is no clinically significant difference between seropositive and seronegative RA patients. Sonographic ankle joint abnormalities do not appear to be associated with the patients’ RF status. High RA disease activity, on the other hand, is associated with synovitis and erosions, particularly in the talonavicular and tibiotalar joints, as well as tibialis posterior tenosynovitis.\u0000","PeriodicalId":45466,"journal":{"name":"Journal of Medical Ultrasound","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140676809","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
First-trimester cystic hygroma (CH) was a frequent finding in a general obstetric screening program for fetal aneuploidy. Chromosomal abnormalities can be diagnosed in most cases with CH, especially common trisomies and Turner syndrome. For first-trimester CH with a normal array result, management choices are limited except for waiting for serial ultrasounds to detect structural anomalies. We report two cases with a recurrent diagnosis of fetal first-trimester CH in two subsequent pregnancies. In both cases, detailed anatomic surveys in the second trimester showed structural anomalies. After excluding chromosomal abnormalities, trio-exome sequencing (ES) revealed two pathogenic variants, P3H1:c.1032T >A and c.1927_1930delinsGCTT in Case 1, and two pathogenic variants, KIAA1109:c.5788del and c. 3055C >T in Case 2. These findings were associated with two recessive genetic syndromes, osteogenesis imperfecta type VIII and Alkuraya-Kucinskas syndrome, in the two cases, respectively. Our study showed that the recurrence of fetal CH with a normal karyotype strongly indicates the existence of an autosomal recessive type of genetic disorder. For such cases, health providers should be alerted to this possibility, and early application of ES should be considered before the presentation of fetal structural anomalies which are usually present in second-trimester anatomic scans.
{"title":"Recurrent First-trimester Cystic Hygroma with Normal Chromosomes Identified in Two Cases with a Recessive Genetic Syndrome","authors":"L. Zhen, Dong-Zhi Li","doi":"10.4103/jmu.jmu_128_23","DOIUrl":"https://doi.org/10.4103/jmu.jmu_128_23","url":null,"abstract":"\u0000 First-trimester cystic hygroma (CH) was a frequent finding in a general obstetric screening program for fetal aneuploidy. Chromosomal abnormalities can be diagnosed in most cases with CH, especially common trisomies and Turner syndrome. For first-trimester CH with a normal array result, management choices are limited except for waiting for serial ultrasounds to detect structural anomalies. We report two cases with a recurrent diagnosis of fetal first-trimester CH in two subsequent pregnancies. In both cases, detailed anatomic surveys in the second trimester showed structural anomalies. After excluding chromosomal abnormalities, trio-exome sequencing (ES) revealed two pathogenic variants, P3H1:c.1032T >A and c.1927_1930delinsGCTT in Case 1, and two pathogenic variants, KIAA1109:c.5788del and c. 3055C >T in Case 2. These findings were associated with two recessive genetic syndromes, osteogenesis imperfecta type VIII and Alkuraya-Kucinskas syndrome, in the two cases, respectively. Our study showed that the recurrence of fetal CH with a normal karyotype strongly indicates the existence of an autosomal recessive type of genetic disorder. For such cases, health providers should be alerted to this possibility, and early application of ES should be considered before the presentation of fetal structural anomalies which are usually present in second-trimester anatomic scans.","PeriodicalId":45466,"journal":{"name":"Journal of Medical Ultrasound","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140673886","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
To test the novel ultrasound (US)-guided bilateral anterior quadratus lumborum block (QLBA) at the lateral supra-arcuate ligament (supra-LAL) technique combined with postoperative intravenous analgesia was a viable alternative approach of conventional thoracic epidural analgesia (TEA) for laparoscopic radical gastrectomy (LRG). Three hundred and four patients scheduled for LRG were randomized 1:1 into QLBA group: receiving a novel pathway of US-guided bilateral QLBA at the supra-LAL before general anesthesia (GA) and patient-controlled intravenous analgesia (PCIA) after surgery, and TEA group: receiving TEA before GA and patient-controlled epidural analgesia following surgery. The difference in procedure time between the treatment groups was set as the primary endpoint. Compared to TEA, procedure time was significantly shorter in the QLBA group (13.19 ± 0.78 vs. 15.65 ± 3.49, P = 0.001). At 5–10 min after block, QLBA group achieved more dermatomes coverage of cold sensory block with both P < 0.001 and less influence on mean artery pressure. Intraoperative consumption of propofol and remifentanil were comparable between the two groups (1116.21 ± 199.76 vs. 1166.45 ± 125.31 ug, P = 0.245 and remifentanil 1.83 ± 0.41 vs. 1.81 ± 0.37 ng, P = 0.988). However, the QLBA group was associated with less intraoperative consumption of norepinephrine and atropine, shorter time to urinary catheter removal, and out-of-bed activity. No significant difference in extubation time, pain scores at rest and exercising across all time points postoperation was observed between two groups. Compared with conventional TEA, the novel technique combined with PCIA was an equivalent effective multimodal analgesic protocol for LRG. There were some advantages of technical simplicity with shorter procedure time, wider anesthetized dermatomes, less influence on intraoperative hemodynamic variables, fewer postoperative adverse events, and improved several sensible parameters of postoperative recovery. The study was registered in the Chinese Clinical Trial Registry on November 02, 2022 (ChiCTR2200065325).
{"title":"Comparison of Ultrasound-guided Bilateral Anterior Quadratus Lumborum Block at the Lateral Supra-arcuate Ligament with Conventional Epidural Block in Patients Undergoing Laparoscopic Radical Gastrectomy: A Randomized Controlled Study","authors":"Liangqing Lin, Yao-Wen Yu, Pinhui Ke, Lili Liu, Qinghua Wu, Qingshui Lin","doi":"10.4103/jmu.jmu_67_23","DOIUrl":"https://doi.org/10.4103/jmu.jmu_67_23","url":null,"abstract":"\u0000 \u0000 \u0000 To test the novel ultrasound (US)-guided bilateral anterior quadratus lumborum block (QLBA) at the lateral supra-arcuate ligament (supra-LAL) technique combined with postoperative intravenous analgesia was a viable alternative approach of conventional thoracic epidural analgesia (TEA) for laparoscopic radical gastrectomy (LRG).\u0000 \u0000 \u0000 \u0000 Three hundred and four patients scheduled for LRG were randomized 1:1 into QLBA group: receiving a novel pathway of US-guided bilateral QLBA at the supra-LAL before general anesthesia (GA) and patient-controlled intravenous analgesia (PCIA) after surgery, and TEA group: receiving TEA before GA and patient-controlled epidural analgesia following surgery. The difference in procedure time between the treatment groups was set as the primary endpoint.\u0000 \u0000 \u0000 \u0000 Compared to TEA, procedure time was significantly shorter in the QLBA group (13.19 ± 0.78 vs. 15.65 ± 3.49, P = 0.001). At 5–10 min after block, QLBA group achieved more dermatomes coverage of cold sensory block with both P < 0.001 and less influence on mean artery pressure. Intraoperative consumption of propofol and remifentanil were comparable between the two groups (1116.21 ± 199.76 vs. 1166.45 ± 125.31 ug, P = 0.245 and remifentanil 1.83 ± 0.41 vs. 1.81 ± 0.37 ng, P = 0.988). However, the QLBA group was associated with less intraoperative consumption of norepinephrine and atropine, shorter time to urinary catheter removal, and out-of-bed activity. No significant difference in extubation time, pain scores at rest and exercising across all time points postoperation was observed between two groups.\u0000 \u0000 \u0000 \u0000 Compared with conventional TEA, the novel technique combined with PCIA was an equivalent effective multimodal analgesic protocol for LRG. There were some advantages of technical simplicity with shorter procedure time, wider anesthetized dermatomes, less influence on intraoperative hemodynamic variables, fewer postoperative adverse events, and improved several sensible parameters of postoperative recovery.\u0000 \u0000 \u0000 \u0000 The study was registered in the Chinese Clinical Trial Registry on November 02, 2022 (ChiCTR2200065325).\u0000","PeriodicalId":45466,"journal":{"name":"Journal of Medical Ultrasound","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140676066","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-21eCollection Date: 2024-01-01DOI: 10.4103/jmu.jmu_123_23
Tze-Yi Yang, Tung-Yao Chang
Orofacial clefts (OFCs), including cleft lip (CL), cleft palate (CP), and CL with palate (CL/P), are relatively common congenital birth defects occurring in approximately 1 in 500 to 1 in 2500 live births. Detecting OFCs during prenatal ultrasound screening is crucial for informed decision-making and multidisciplinary medical care. This review provides a practical guide for routine and advanced screening for OFCs during mid-pregnancy. The Maarse classification system facilitates effective communication among the multidisciplinary team, categorizing OFCs into five types. Basic ultrasound views encompass coronal, sagittal, and axial imaging of the face and hard palate. Additional visualization techniques are employed in case of suspected anomalies during the initial screening. Advanced ultrasound views provided by the expert in prenatal OFC diagnosis include imaging of the posterior edge of the hard palate and the posterior part of the soft palate. Detected OFCs exhibit a range of severity and affect different structures, underscoring the importance of accurate detection and classification for appropriate treatment planning. Implementing a standardized screening protocol for OFCs is essential. By enhancing detection rates and enabling early diagnosis, prenatal ultrasound screening contributes to improved patient outcomes and facilitates timely intervention by the multidisciplinary team. In conclusion, this review emphasizes the significance of standardized protocols and specialized techniques for prenatal ultrasound screening of OFCs. Early detection and classification of these malformations play a vital role in comprehensive management, ensuring that affected individuals and their families receive the appropriate care and support they need.
{"title":"Prenatal Ultrasound Imaging of Orofacial Clefts: A Pictorial Essay.","authors":"Tze-Yi Yang, Tung-Yao Chang","doi":"10.4103/jmu.jmu_123_23","DOIUrl":"https://doi.org/10.4103/jmu.jmu_123_23","url":null,"abstract":"<p><p>Orofacial clefts (OFCs), including cleft lip (CL), cleft palate (CP), and CL with palate (CL/P), are relatively common congenital birth defects occurring in approximately 1 in 500 to 1 in 2500 live births. Detecting OFCs during prenatal ultrasound screening is crucial for informed decision-making and multidisciplinary medical care. This review provides a practical guide for routine and advanced screening for OFCs during mid-pregnancy. The Maarse classification system facilitates effective communication among the multidisciplinary team, categorizing OFCs into five types. Basic ultrasound views encompass coronal, sagittal, and axial imaging of the face and hard palate. Additional visualization techniques are employed in case of suspected anomalies during the initial screening. Advanced ultrasound views provided by the expert in prenatal OFC diagnosis include imaging of the posterior edge of the hard palate and the posterior part of the soft palate. Detected OFCs exhibit a range of severity and affect different structures, underscoring the importance of accurate detection and classification for appropriate treatment planning. Implementing a standardized screening protocol for OFCs is essential. By enhancing detection rates and enabling early diagnosis, prenatal ultrasound screening contributes to improved patient outcomes and facilitates timely intervention by the multidisciplinary team. In conclusion, this review emphasizes the significance of standardized protocols and specialized techniques for prenatal ultrasound screening of OFCs. Early detection and classification of these malformations play a vital role in comprehensive management, ensuring that affected individuals and their families receive the appropriate care and support they need.</p>","PeriodicalId":45466,"journal":{"name":"Journal of Medical Ultrasound","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11040495/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140857587","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"CME Test.","authors":"","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":45466,"journal":{"name":"Journal of Medical Ultrasound","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11040485/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140856274","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-21eCollection Date: 2024-01-01DOI: 10.4103/jmu.jmu_133_23
Mahmood Dhahir Al-Mendalawi
{"title":"Comment on Shear-wave Elastography of Palatine Tonsils: A Normative Study in Children.","authors":"Mahmood Dhahir Al-Mendalawi","doi":"10.4103/jmu.jmu_133_23","DOIUrl":"https://doi.org/10.4103/jmu.jmu_133_23","url":null,"abstract":"","PeriodicalId":45466,"journal":{"name":"Journal of Medical Ultrasound","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11040481/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140858604","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sandeep Diwan, Anju Gupta, P. Sancheti, Madhuri Dadke
Ultrasound (US)-guided costoclavicular block (CCB) is a promising new approach to brachial plexus (BP) block which is increasingly being utilized. Conventionally, the costoclavicular space (CCS) has been described to contain three cords. However, there may be variations in the neural pattern of the BP which is important to know to prevent inadvertent injury. We intend to describe the variations in neural patterns from retrospective scans of patients receiving costoclavicular BP block. The stored US images of patients who had received BP block using the CCB for surgery at the level of the elbow or below in the last year (from March 2021 to March 2022) were analyzed by two investigators independently. The clinical data were retrieved from the records of the same patients for the study outcomes. We collated the variations of the neural pattern, the number of neural structures seen, and the echogenicity of the structures in the costoclavicular BP space. In the CCS, the median number of neural structures was 4.5 (minimum of 3 to maximum of 8). With the BP lateral to the axillary artery and sandwiched between the subclavius-pectoralis minor superiorly and the serratus anteriorly inferiorly, numerous variations in the neural structures were noted. The most common arrangement was caterpillar-like (28.6%) and pecker-like (20.3%). The neural structures were found to be hypoechoic in the majority (66%). The CCS hosts several mostly hypoechoic neural structures which may be the variations of the cords or the extension of BP divisions. These new findings have been unreported in the recent past.
超声（US）引导下的锁骨肋间阻滞（CCB）是一种很有前途的臂丛神经（BP）阻滞新方法，目前正得到越来越多的应用。根据传统描述，锁骨肋间隙（CCS）包含三条神经索。然而，臂丛神经的神经模式可能存在变化，了解这一点对于防止误伤非常重要。我们打算通过对接受肋锁神经阻滞的患者进行回顾性扫描来描述神经模式的变化。 两位研究人员独立分析了去年（2021 年 3 月至 2022 年 3 月）在肘部或肘部以下手术中使用 CCB 接受 BP 阻滞的患者的存储 US 图像。研究结果的临床数据取自同一患者的病历。我们整理了神经模式的变化、所见神经结构的数量以及肋锁BP间隙中结构的回声性。 在CCS中，神经结构的中位数为4.5个（最少3个，最多8个）。BP位于腋动脉外侧，夹在锁骨下-胸大肌小节（上）和锯肌前（下）之间，因此神经结构的变化非常多。最常见的排列方式是毛虫状（28.6%）和啄木鸟状（20.3%）。大部分（66%）的神经结构呈低回声。 CCS中存在多个低回声神经结构，它们可能是脊索的变异或BP分部的延伸。这些新发现在近期还未见报道。
{"title":"Analysis of the Characteristics and Intricacies of Arrangement of Neural Elements in the Costoclavicular Block Using Ultrasound: A Retrospective Qualitative Study","authors":"Sandeep Diwan, Anju Gupta, P. Sancheti, Madhuri Dadke","doi":"10.4103/jmu.jmu_125_22","DOIUrl":"https://doi.org/10.4103/jmu.jmu_125_22","url":null,"abstract":"\u0000 \u0000 \u0000 Ultrasound (US)-guided costoclavicular block (CCB) is a promising new approach to brachial plexus (BP) block which is increasingly being utilized. Conventionally, the costoclavicular space (CCS) has been described to contain three cords. However, there may be variations in the neural pattern of the BP which is important to know to prevent inadvertent injury. We intend to describe the variations in neural patterns from retrospective scans of patients receiving costoclavicular BP block.\u0000 \u0000 \u0000 \u0000 The stored US images of patients who had received BP block using the CCB for surgery at the level of the elbow or below in the last year (from March 2021 to March 2022) were analyzed by two investigators independently. The clinical data were retrieved from the records of the same patients for the study outcomes. We collated the variations of the neural pattern, the number of neural structures seen, and the echogenicity of the structures in the costoclavicular BP space.\u0000 \u0000 \u0000 \u0000 In the CCS, the median number of neural structures was 4.5 (minimum of 3 to maximum of 8). With the BP lateral to the axillary artery and sandwiched between the subclavius-pectoralis minor superiorly and the serratus anteriorly inferiorly, numerous variations in the neural structures were noted. The most common arrangement was caterpillar-like (28.6%) and pecker-like (20.3%). The neural structures were found to be hypoechoic in the majority (66%).\u0000 \u0000 \u0000 \u0000 The CCS hosts several mostly hypoechoic neural structures which may be the variations of the cords or the extension of BP divisions. These new findings have been unreported in the recent past.\u0000","PeriodicalId":45466,"journal":{"name":"Journal of Medical Ultrasound","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140220709","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-21eCollection Date: 2024-01-01DOI: 10.4103/jmu.jmu_18_23
Shu-Chin Chien, Chih-Ping Chen
Fetal microcephaly is a small head with various losses of cerebral cortical volume. The affected cases may suffer from a wide range in severity of impaired cerebral development from slight to severe mental retardation. It can be an isolated finding or with other anomalies depending on the heterogeneous causes including genetic mutations, chromosomal abnormalities, congenital infectious diseases, maternal alcohol consumption, and metabolic disorders during pregnancy. It is often a lifelong and incurable condition. Thus, early detection of fetal microcephaly and identification of the underlying causes are important for clinical staff to provide appropriate genetic counseling to the parents and accurate management.
{"title":"Genetic Counseling of Fetal Microcephaly.","authors":"Shu-Chin Chien, Chih-Ping Chen","doi":"10.4103/jmu.jmu_18_23","DOIUrl":"https://doi.org/10.4103/jmu.jmu_18_23","url":null,"abstract":"<p><p>Fetal microcephaly is a small head with various losses of cerebral cortical volume. The affected cases may suffer from a wide range in severity of impaired cerebral development from slight to severe mental retardation. It can be an isolated finding or with other anomalies depending on the heterogeneous causes including genetic mutations, chromosomal abnormalities, congenital infectious diseases, maternal alcohol consumption, and metabolic disorders during pregnancy. It is often a lifelong and incurable condition. Thus, early detection of fetal microcephaly and identification of the underlying causes are important for clinical staff to provide appropriate genetic counseling to the parents and accurate management.</p>","PeriodicalId":45466,"journal":{"name":"Journal of Medical Ultrasound","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11040482/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140868440","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-21eCollection Date: 2024-01-01DOI: 10.4103/jmu.jmu_155_23
Duzgun Can Senbil, Sonay Aydin
{"title":"Reply to Comment on Shear-wave Elastography of Palatine Tonsils: A Normative Study in Children.","authors":"Duzgun Can Senbil, Sonay Aydin","doi":"10.4103/jmu.jmu_155_23","DOIUrl":"https://doi.org/10.4103/jmu.jmu_155_23","url":null,"abstract":"","PeriodicalId":45466,"journal":{"name":"Journal of Medical Ultrasound","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11040489/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140872526","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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