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- Unlocking the Jaw: Advanced Imaging of the Temporomandibular Joint. [JOURNAL ARTICLE]
- AJR Am J Roentgenol 2014 Nov; 203(5):1047-1058.
OBJECTIVE. Temporomandibular joint (TMJ) dysfunction is a common condition, affecting up to 28% of the population. The TMJ can be affected by abnormal dynamics of the disk-condyle complex, degenerative arthritis, inflammatory arthritis, and crystal arthropathy. Less commonly, neoplasms and abnormal morphologic features of the condyle are causes of TMJ symptoms. Cross-sectional imaging is frequently used for diagnosis. CONCLUSION. Knowledge of the normal imaging appearance of the TMJ, its appearance on radiological examination, and interventional techniques are useful for providing a meaningful radiologic contribution. This article will review normal TMJ anatomy; describe the normal ultrasound, CT, and MRI appearances of TMJ; provide imaging examples of abnormal TMJs; and illustrate imaging-guided therapeutic TMJ injection.
- Three-Step Sequential Positioning Algorithm During Sonographic Evaluation for Appendicitis Increases Appendiceal Visualization Rate and Reduces CT Use. [JOURNAL ARTICLE]
- AJR Am J Roentgenol 2014 Nov; 203(5):1006-1012.
OBJECTIVE. The purpose of this article is to examine the rates of appendiceal visualization by sonography, imaging-based diagnoses of appendicitis, and CT use after appendiceal sonography, before and after the introduction of a sonographic algorithm involving sequential changes in patient positioning. MATERIALS AND METHODS. We used a search engine to retrospectively identify patients who underwent graded-compression sonography for suspected appendicitis during 6-month periods before (period 1; 419 patients) and after (period 2; 486 patients) implementation of a new three-step positional sonographic algorithm. The new algorithm included initial conventional supine scanning and, as long as the appendix remained nonvisualized, left posterior oblique scanning and then "second-look" supine scanning. Abdominal CT within 7 days after sonography was recorded. RESULTS. Between periods 1 and 2, appendiceal visualization on sonography increased from 31.0% to 52.5% (p < 0.001), postsonography CT use decreased from 31.3% to 17.7% (p < 0.001), and the proportion of imaging-based diagnoses of appendicitis made by sonography increased from 63.8% to 85.7% (p = 0.002). The incidence of appendicitis diagnosed by imaging (either sonography or CT) remained similar at 16.5% and 17.3%, respectively (p = 0.790). Sensitivity and overall accuracy were 57.8% (95% CI, 44.8-70.1%) and 93.0% (95% CI, 90.1-95.3%), respectively, in period 1 and 76.5% (95% CI, 65.8-85.2%) and 95.4% (95% CI, 93.1-97.1%), respectively, in period 2. Similar findings were observed for adults and children. CONCLUSION. Implementation of an ultrasound algorithm with sequential positioning significantly improved the appendiceal visualization rate and the proportion of imaging-based diagnoses of appendicitis made by ultrasound, enabling a concomitant decrease in abdominal CT use in both children and adults.
- Bacterial Contamination of Ultrasound Probes at a Tertiary Referral University Medical Center. [JOURNAL ARTICLE]
- AJR Am J Roentgenol 2014 Nov; 203(5):928-932.
OBJECTIVE. The purpose of this study was to assess the adequacy of our institution's ultrasound probe-disinfecting protocols, determine compliance with the guidelines, and then implement changes if needed. MATERIALS AND METHODS. We first assessed the prevalence of bacterial contamination (and thus the potential for bacterial transmission) by swabbing all ultrasound probes (n = 31) in the radiology department and culturing the samples. Next, in conditions simulating the typical work environment, we determined the efficacy of our probe-disinfecting protocols by seeding probes with 10(4)-10(9) CFU/mL of methicillin-resistant Staphylococcus aureus (MRSA), disinfecting the seeded probes with 0.5% accelerated hydrogen peroxide, and then swabbing the disinfected probes to assess for bacterial growth. RESULTS. Seven of 31 (22.6%) probes were positive for bacterial growth-none of which were endocavity probes (0/4). Four of 14 visibly soiled probes (28.6%) showed bacterial growth, and four of seven probes positive for bacteria (57.1%) were visibly soiled. No MRSA grew after seeding probes with MRSA and then disinfecting with 0.5% accelerated hydrogen peroxide. Sonography guidelines and general disinfecting guidelines were reviewed. CONCLUSION. Our protocols for disinfecting nonendocavity and endocavity probes are compliant with sonography guidelines and general disinfecting guidelines. Although limited by a small sample size, our study showed that our protocol for disinfecting endocavity probes seems adequate. With a 25.9% bacterial contamination rate for nonendocavity probes, the adequacy of our protocol for disinfecting nonendocavity probes is more debatable; however, this bacterial contamination rate is at the lower end of the values reported in the literature. With the use of an effective disinfectant, education of sonographers, and implemented changes, we hope to decrease bacterial contamination rates and thus decrease the potential for bacterial transmission.
- Clinical relevance of patency capsule combined with abdominal ultrasonography to detect small bowel strictures. [JOURNAL ARTICLE]
- Eur J Gastroenterol Hepatol 2014 Oct 21.
PillCam patency capsule (PC) is a novel and radiofrequency identification tag-free device that remains intact in the gastrointestinal tract for 30-33 h after ingestion and then disintegrates. The aim of this study was to determine the clinical relevance of PC combined with abdominal ultrasonography as a reliable indicator of functional patency.The study was prospective and PillCam PC was administered to consecutive patients with known or suspected small bowel strictures. PC was verified if it was excreted intact in 33 h after administration. Following excretion failure and radiograph detection in the pelvic cavity, ultrasonography was used to detect the PC in relation to the stricture.The participants were 52 patients with known or suspected small bowel strictures (58% women, mean age 51 years, including 32 with or suspected Crohn's disease). Twenty-two patients (42.3%) retrieved PC in the stool within 33 h after ingestion. Radiograph identified the four PCs in the colon and eight were not observed. Ultrasonography precisely judged all 17 PCs retained including six PCs at the proximal side of small bowel stricture in the patients considered ineligible for capsule endoscopy (CE). In all eligible patients, CE passed through the small intestine without incident.PillCam PC combined with ultrasonography before CE appears to be a reliable indicator of functional patency to predict and minimize the risk of impaction in suspected or even known cases with small bowel stricture.
- The Diagnosis of Neonatal Pulmonary Atelectasis Using Lung Ultrasound. [JOURNAL ARTICLE]
- Chest 2014 Oct 23.
Generally，the diagnosis of neonatal pulmonary atelectasis (NPA) is based on history, clinical and chest x-ray (CXR) findings while ultrasound could not be used in lung disease diagnostics. Recently, ultrasound has been used for the diagnosis of many kinds lung conditions, but few studies have investigated ultrasound for the diagnosis of NPA. In this study, we evaluated the usefulness of lung ultrasound for the diagnosis of NPA.From May 2012 to December 2013, 80 neonates with NPA and 50 neonates without lung disease were enrolled in this study. In a quiet state, infants were placed in the supine, lateral or prone position for the examination. Each lung of every infant was divided into the anterior, lateral and posterior regions by the anterior axillary and posterior axillary lines. Each region of both lungs was scanned carefully with the probe perpendicular or parallel to the ribs. The ultrasound findings were confirmed by CXR or computed tomography findings.Sixty of the 80 patients with signs of NPA on lung ultrasound also had signs of NPA on CXR (termed focal type of atelectasis), and the other 20 patients had signs of NPA on chest computed tomography (termed occult lung atelectasis). In NPA patients，the main ultrasound findings were large areas of lung consolidation with clearly demarcated borders, air bronchograms, pleural line abnormalities, and absence of A-lines, as well as presence of lung pulse and absence of lung sliding on real-time ultrasound. The sensitivity of lung ultrasound for the diagnosis of NPA was 100%, whereas the sensitivity of CXR was 75%. Large areas of lung consolidation with clearly demarcated borders were only observed in patients with NPA (specificity of 100% for NPA).Lung ultrasound is an accurate and reliable method for diagnosing NPA, most importantly, it can find those occult lung atelectasis that could not be detected on CXR. Routine lung ultrasound is a useful method of diagnosing or excluding NPA in neonates.
- Acute Impact of Pacing at Different Cardiac Sites on Left Ventricular Rotation and Twist in Dogs. [JOURNAL ARTICLE]
- PLoS One 2014; 9(10):e111231.
We evaluated the acute impact of different cardiac pacing sites on two-dimensional speckle-tracking echocardiography (STE) derived left ventricular (LV) rotation and twist in healthy dogs.Twelve dogs were used in this study. The steerable pacing electrodes were positioned into right heart through the superior or inferior vena cava, into LV through aorta across the aortic valve. The steerable pacing electrodes were positioned individually in the right atrium (RA), right ventricular apex (RVA), RV outflow tract (RVOT), His bundle (HB), LV apex (LVA) and LV high septum (LVS), individual pacing mode was applied at 10 minutes interval for at least 5 minutes from each position under fluoroscopy and ultrasound guidance and at stabilized hemodynamic conditions. LV short-axis images at the apical and basal levels were obtained during sinus rhythm and pacing. Offline STE analysis was performed. Rotation, twist, time to peak rotation (TPR), time to peak twist (TPT), and apical-basal rotation delay (rotational synchronization index, RSI) values were compared at various conditions. LV pressure was monitored simultaneously.Anesthetic death occurred in 1 dog, and another dog was excluded because of bad imaging quality. Data from 10 dogs were analyzed. RVA, RVOT, HB, LVA, LVS, RARV (RA+RVA) pacing resulted in significantly reduced apical and basal rotation and twist, significantly prolonged apical TPR, TPT and RSI compared to pre-pacing and RA pacing (all P<0.05). The apical and basal rotation and twist values were significantly higher during HB pacing than during pacing at ventricular sites (all P<0.05, except basal rotation at RVA pacing). The apical TPR during HB pacing was significantly shorter than during RVOT and RVA pacing (both P<0.05). The LV end systolic pressure (LVESP) was significantly lower during ventricular pacing than during pre-pacing and RA pacing.Our results show that RA and HB pacing results in less acute reduction on LV twist, rotation and LVESP compared to ventricular pacing.
- Sudden Death Due to Anaphylactic Shock in a Patient With an Intact Hepatic Hydatid Cyst. [JOURNAL ARTICLE]
- Am J Forensic Med Pathol 2014 Oct 21.
Hydatid disease of the liver is a parasitic infection primarily caused by the larvae of Echinococcus granulosus. Hydatid cysts may remain clinically silent for many years and are often an incidental finding on ultrasonography performed for unrelated reasons. Sudden death due to unrecognized hydatid cysts can occur, and rare case reports of this kind are present in the literature. We present a sudden death due to an intact hydatid cyst in a 13-year-old girl, who had a sudden onset of anaphylactic shock after a blunt abdominal trauma. Sudden death in this case was attributed to anaphylactic shock caused by intravascular spread of the cyst contents. We believe that high intracystic pressure coupled with blunt trauma was the cause of leakage of cystic fluid into the bloodstream. In cases of sudden death in endemic areas, the possibility of a hydatid disease should be taken into consideration, especially if no other cause is evident.
- Genetic Testing in the Assessment of Living Related Kidney Donors at Risk of Autosomal Dominant Polycystic Kidney Disease. [JOURNAL ARTICLE]
- Transplantation 2014 Oct 21.
Autosomal dominant polycystic kidney disease (ADPKD) is the most common genetic cause of renal failure. In most patients who develop end-stage renal disease, transplantation is the renal replacement modality of choice. For living related kidney donation (LRKD), the major challenge is to exclude the diagnosis of ADPKD in potential donors. Renal imaging may not exclude ADPKD particularly in younger donors and molecular genetic testing is advised. We report the largest series to date evaluating the role of genetic testing for ADPKD in LRKD assessment.A cohort of patients with ADPKD and potential LRKD were referred for genetic testing for ADPKD between April 2010 and October 2012. DNA sequencing of PKD1 and PKD2 was performed. Imaging investigations and transplant outcomes after genetic testing were collected.Nineteen patients and 25 potential LRKD underwent genetic testing. Of potential LRKD, one tested positive for ADPKD and one with a diagnostic ultrasound tested negative. Despite negative genetic testing, two potential LRKD were considered unsuitable because of the detection of stage I ("simple") renal cysts on computed tomography. Four living related kidney transplants have occurred, and two are planned. Three patients subsequently refused the donation as the potential donor was a child.Predictive genetic testing can facilitate donor evaluation and augment living related kidney transplantation in ADPKD. Psychologic challenges associated with accepting an LRKD require careful consideration during recipient assessment. The acceptability of using a kidney with cysts from a mutation-negative donor should be evaluated by a multidisciplinary team.
- Microfluidic Fabrication of Perfluorohexane-Shelled Double Emulsions for Controlled Loading and Acoustic-Triggered Release of Hydrophilic Agents. [JOURNAL ARTICLE]
- Langmuir 2014 Oct 23.
The ability of low boiling point liquid perfluorocarbons (PFCs) to undergo a phase change from a liquid to a gas upon ultrasound irradiation makes PFC-based emulsions promising vehicles for triggered delivery of payloads. However, loading hydrophilic agents into PFC-based emulsions is difficult due to their insolubility in PFC. Here, we address this challenge by taking advantage of microfluidic technologies to fabricate double emulsions consisting of large aqueous cores and a perfluorohexane (PFH) shell, thus yielding high loading capacities for hydrophilic agents. Using this technology, we efficiently encapsulate a model hydrophilic agent within the emulsions and study its response to ultrasound irradiation. Using a combination of optical and acoustic imaging methods, we observe payload release upon acoustic vaporization of PFH. Our work demonstrates the utility of microfluidic techniques for controllably loading hydrophilic agents into PFH-based emulsions, which have great potential for acoustically triggered release.
- Nilotinib Is More Potent than Imatinib for Treating Plexiform Neurofibroma In Vitro and In Vivo. [JOURNAL ARTICLE]
- PLoS One 2014; 9(10):e107760.
Plexiform neurofibromas (PNFs) are benign nerve sheath tumors mostly associated with neurofibromatosis type 1. They often extend through multiple layers of tissue and therefore cannot be treated satisfactorily by surgery. Nilotinib is a tyrosine kinase inhibitor used to treat leukemia, with advantages over the prototype imatinib in terms of potency and selectivity towards BCR-ABL, and the DDR, PDGFR, and KIT receptor kinases. In this study, we compared efficacies of the two drugs on cultured cells of PNF in vitro and on xenografted tumor fragments on sciatic nerve of athymic nude mice. Xenografts were monitored weekly using a high resolution ultrasound measurement. Treatment with nilotinib at a daily dose of 100 mg/kg for four weeks led to a reduction of the graft sizesstd by 68±7% in the 8 treated mice, significantly more than the 33±8% reduction in the 8 untreated mice (P<0.05) and the 47±15% in the 7 mice treated with imatinib (P<0.05). The peak plasma nilotinib concentration 6.6±1.1 µM is within the pharmacological range of clinical application. Imatinib, but not nilotinib significantly hindered body weight increase of the mice and elevated cytotoxicity of mouse spleen cells (P<0.05). Our results suggest that nilotinib may be more potent than imatinib for treating PNFs and may also be better tolerated. Imatinib seems to have some off-target effect in elevating immunity.