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- Mammographic and sonographic features of fat necrosis of the breast. [Journal Article]
- Indian J Radiol Imaging 2013 Oct; 23(4):366-72.
Imaging features of fat necrosis vary depending on its stage of evolution and can mimic malignancy in late stages. Imaging may suffice to differentiate fat necrosis in the early stages from malignancy and thus avoid unnecessary biopsy. In this pictorial essay, we present combination of benign features in mammography and/or ultrasonography (USG) that can lead to imaging diagnosis of fat necrosis. The follow-up imaging features of fat necrosis which mirror its pathophysiological evolution have also been demonstrated. To summarize, in the appropriate clinical setting, no mammographic features suspicious for malignancy should be present. When the typical mammographic features are not present, USG can aid with the diagnosis and follow up USG can confirm it.
- Qualitative ultrasound elastography assessment of benign thyroid nodules: Patterns and intra-observer acquisition variability. [Journal Article]
- Indian J Radiol Imaging 2013 Oct; 23(4):337-41.
To report and evaluate qualitative elastography patterns by using gray-scale and Doppler ultrasound (US) in patients presenting with benign thyroid nodules and to evaluate the reproducibility of US elastography examinations.Institutional review board approval was obtained, and all patients provided informed consent. Over a 3-month time period, all consecutive adult patients were referred to our institution to undergo a thyroid nodule fine-needle aspiration biopsy (FNAB) procedure. Patients presenting with benign cytology according to the Bethesda 2008 classification were prospectively enrolled in the study. Each thyroid nodule was assessed by using gray-scale, Doppler US, and elastography acquisitions by a single operator (A. L.). Multiple elastography acquisitions per thyroid nodule were performed and elastography scorings of the nodules were compared with each other.Nineteen patients (16 women and 3 men, mean age 58 years) with 22 thyroid nodules were included in the present study. Elastographic patterns 1, 2, and 3 were reported (23% nodules showed pattern 3). The elastography pattern showed a strong variability in 13 nodules (59%). The elastography acquisition result variability involved the "malignant" pattern 3 in 36% of cases.Almost one-third of benign thyroid nodules displayed pattern 3 on qualitative US elastography. The intra-observer variability of the benign thyroid elastography scoring is wide, thus limiting the thyroid nodule US examination accuracy. In FNAB-proven benign thyroid nodules, elastography pattern 3 is frequent and cannot be used as a strong indicator of thyroid malignancy.
- Safety and Efficacy of Carbon Dioxide and Intravascular Ultrasound-Guided Stenting for Renal Artery Stenosis in Patients With Chronic Renal Insufficiency. [JOURNAL ARTICLE]
- Angiology 2014 Mar 5.
We evaluated the feasibility, safety, and mid-term outcomes of renal artery stenting using carbon dioxide (CO2) digital subtraction angiography and intravascular ultrasound (IVUS) for patients with renal insufficiency and significant atherosclerotic renal artery stenosis (RAS). Eighteen consecutive patients with chronic renal insufficiency underwent renal artery stenting under the guidance of CO2 angiography and IVUS without contrast media. Renal function and blood pressure were assessed pre- and postintervention. A total of 27 de novo RAS in 18 patients (15 males; mean age: 72 ± 9 years) with renal insufficiency were treated by renal artery stenting with the combined use of the CO2 angiography and IVUS without any procedural complications. Although the mean serum creatinine concentration preprocedure and 6 months after treatment did not change (2.7 ± 1.0-2.4 ± 1.1 mg/dL), blood pressure significantly decreased 6 months after stenting (158 ± 10-147 ± 11 mm Hg, P < .01).
- Adenomyomatous hyperplasia of the ampulla of Vater presenting as acute pancreatitis. [Journal Article]
- BMJ Case Rep 2014.
We report an interesting and rare case of a man with adenomyomatous hyperplasia of the ampulla of Vater presenting as acute pancreatitis, which to our knowledge, is only the second reported case in the English literature. The patient presented with an acute onset of abdominal pain, nausea and vomiting, without fever, chills or rigours. CT of the abdomen revealed changes of acute pancreatitis with a peripancreatic adenopathy, and abdominal ultrasound revealed a slightly hyperechoic and oedematous head of the pancreas, consistent with acute pancreatitis. Endoscopic retrograde cholangiopancreaticography revealed an ampullary lesion. Pathology of the ampullary lesion revealed an inflammatory polyp. Endoscopic ultrasound with endoscopic mucosal resection of the lesion revealed an adenomyomatous hyperplasia. The patient recovered well postendoscopic resection without recurrent pancreatitis or cholestasis.
- "Post-LA space index" as a potential novel marker for the prenatal diagnosis of isolated total anomalous pulmonary venous connection. [JOURNAL ARTICLE]
- Ultrasound Obstet Gynecol 2014 Mar 6.
(OBJECTIVES): Total anomalous pulmonary venous connection (TAPVC) is a congenital heart disease that results in deleterious cyanosis and dyspnoea just after birth. It is well known that the prenatal diagnosis of TAPVC without intracardiac malformation is very difficult. We performed a retrospective review of the foetal echocardiograms of patients with TAPVC to determine whether the distance between the left atrium and the descending aorta would be useful in the prenatal diagnosis of foetal TAPVC. (METHODS): We reviewed the foetal echocardiograms of eight TAPVC cases (supracardiac type 4 and infracardiac type 4) with no intracardiac malformations. We compared and examined the left atrium-descending aorta distance and the descending aorta diameter ratio (post-LA space index) in 101 normal and 8 TAPVC foetuses. In addition, we examined the tricuspid valve/mitral valve diameter ratio (TVD/MVD) and the right ventricular end-diastolic diameter/left ventricular end-diastolic diameter ratio (RVDd/LVDd). (RESULTS): The foetal echocardiograms for TAPVC and normal foetuses were performed at mean gestational ages of 27.5 weeks and 29.6 weeks, respectively. There were no significant differences in the TVD/MVD and RVDd/LVDd between the groups. In contrast, the post-LA space index was significantly higher in the TAPVC cases (1.51) than it was in the normal cases (0.71) (SD 0.23; p < 0.0001). In an analysis of the receiver operating characteristic (ROC) curve with a post-LA space index cut-off of 1.27 for distinguishing between TAPVC and normal hearts, the sensitivity was 100% and the specificity was 99%. (CONCLUSIONS): The post-LA space index can be used as a potential novel index for foetal TAPVC diagnosis. A diagnosis of TAPVC is very likely in cases with a post-LA space index > 1.27.
- The relationship between hypotension, cerebral flow and the surgical field during endoscopic sinus surgery. [JOURNAL ARTICLE]
- Laryngoscope 2014 Mar 7.
Objective: Hypotensive anesthesia is often used in endoscopic sinus surgery (ESS) to improve surgical visibility; however its safety and efficacy in this role is yet to be justified. This study aims to evaluate the effect of hypotensive anesthesia on both real-time middle cerebral artery blood flow velocity (Vmca) and the severity of surgical bleeding in patients undergoing ESS. Study Design: Prospective observational cohort study. Methods: Thirty-two patients undergoing hypotensive anesthesia for ESS at a single tertiary institution during February 2011 to July 2012 were recruited for the study. Transcranial Doppler ultrasonography measured periodic Vmca; which were time-matched for hemodynamic and respiratory factors. One-minute video segments corresponding with each Vmca reading were randomized and distributed to two blinded observers for bleeding assessment. Results: 356 data time-points were recorded for systolic, diastolic and mean arterial blood pressure (MAP), pulse rate, respiratory rate, end-tidal carbon dioxide concentration, Vmca, and bleeding assessment score (BAS). A direct relationship exists between MAP and Vmca (r=0.77, p<0.0001) as well as MAP and BAS (r=0.36, p<0.0001). Mean arterial pressure levels above 60mmHg maintained at least 50% of baseline Vmca flow in almost 90% of all time-points. Conclusions: Hypotensive anesthesia is an effective method of controlling intraoperative bleeding during endoscopic sinus surgery, however in low MAP ranges the effect is clinically small. In otherwise healthy patients undergoing endoscopic sinus surgery with general anesthesia, reducing MAP below 60mmHg may increase the risk of cerebral ischemia.
- A comparison of matching fetuses by body volume or gestational age for calculation of the observed to expected total fetal lung volume (o/e TFLV) in fetuses with isolated congenital diaphragmatic hernia (CDH). [JOURNAL ARTICLE]
- Ultrasound Obstet Gynecol 2014 Mar 6.
To determine the bias induced by matching fetuses by gestational age (GA) or by fetal body volume (FBV) when calculating the observed/expected total fetal lung volume (o/e TFLV) in isolated congenital diaphragmatic hernia (CDH).Single-center, retrospective study on archived magnetic resonance (MR) images of isolated CDH fetuses over a 10-year's period. We retrieved the TFLV, GA and o/e TFLVGA , delineated FBV to obtain TFLVFBV . We correlated o/e TFLVFBV and o/e TFLVGA by Bland Altman analysis. All outliers were manually identified to retrieve specific clinical features.377 MR examinations from 225 fetuses were identified. The average time spent on FBV measurement was 16.12 ± 4.95 min. Reproducibility of FBV measurement was 0.998 and the interobserver intraclass correlation coefficient was 0.999. FBV was highly correlated with GA (R = 0.94, p < 0.0001). There was a good agreement between o/e TFLVGA or o/e TFLVFBV , with a mean difference = -1.10% and 95%-limits-of-agreement of -8.58 to 6.39. There were no outliers in fetuses that had an o/e TFLV<25%. Discrepancies induced by different methods were more likely in woman with BMI≥25 kg/m(2) (+16.49%), fetuses with an estimated fetal weight (EFW)≤10(th) percentile (+21.33%) or EFW>90(th) percentile (+14.82%).Discrepancies are more likely in fetuses with an abnormal EFW or in overweighted mothers. The clinical relevance of using FBV rather than GA for calculation of the o/e TFLV might be limited, as there was no discrepancy between both methods in fetuses with small lungs (<25%), the group of interest for lung volume assessment.
- Extracorporeal shock wave therapy for chronic calcifying tendinitis of the shoulder. [Journal Article]
- J Orthop Traumatol 2002 Jun; 2(3):147-50.
Over the past few years, extracorporeal shock wave therapy (ESWT) has been introduced for the treatment of some orthopedic diseases. The aim of this study was to assess the efficacy of ESWT on chronic calcifying tendinitis of the shoulder through a prospective study. We studied 30 patients (mean age, 56.6 years) with chronic calcifying tendinitis of the shoulder. The patients were treated for a mean of 6 sessions, with 1400 impulses for each session. We used the new device Electro Medical Systems-Swiss Dolorclast (Electro Medical Systems, Nyon, Switzerland), which emits radial expanded shock waves, pneumatically generated. Patients were evaluated before treatment and after a mean of 10 weeks on a patient-oriented questionnaire (Dawson shoulder questionnaire, validated Italian version) and by radiological and ultrasound examinations. Radiographic disintegration and partial resorption of the calcium deposit were respectively recorded in 50% and 30% of cases, and the ultra-sound image showed modification of echogenicity in all cases. Clinically a good response to pain and to joint movement was recorded; the questionnaire also showed a statistically significant improvement. Shock wave therapy for calcifying tendinitis of the shoulder is effective from the patient's perspective and according to imaging outcomes. It could be considered an effective therapy for chronic calcifying tendinitis of the shoulder.
- The cross-sectional association of sitting time with carotid artery stiffness in young adults. [Journal Article]
- BMJ Open 2014; 4(3):e004384.
Physical activity is negatively associated with arterial stiffness. However, the relationship between sedentary behaviour and arterial stiffness is poorly understood. In this study, we aimed to investigate the association of sedentary behaviour with arterial stiffness among young adults.Cross-sectional.34 study clinics across Australia during 2004-2006.2328 participants (49.4% male) aged 26-36 years who were followed up from a nationally representative sample of Australian schoolchildren in 1985.Arterial stiffness was measured by carotid ultrasound. Sitting time per weekday and weekend day, and physical activity were self-reported by questionnaire. Cardiorespiratory fitness was estimated as physical work capacity at a heart rate of 170 bpm. Anthropometry, blood pressure, resting heart rate and blood biochemistry were measured. Potential confounders, including strength training, education, smoking, diet, alcohol consumption and parity, were self-reported. Rank correlation was used for analysis.Sitting time per weekend day, but not per weekday, was correlated with arterial stiffness (males r=0.11 p<0.01, females r=0.08, p<0.05) and cardiorespiratory fitness (males r = -0.14, females r = -0.08, p<0.05), and also with fatness and resting heart rate. One additional hour of sitting per weekend day was associated with 5.6% (males p=0.046) and 8.6% (females p=0.05) higher risk of having metabolic syndrome. These associations were independent of physical activity and other potential confounders. The association of sitting time per weekend day with arterial stiffness was not mediated by resting heart rate, fatness or metabolic syndrome.Our study demonstrates a positive association of sitting time with arterial stiffness. The greater role of sitting time per weekend day in prediction of arterial stiffness and cardiometabolic risk than that of sitting time per weekday may be due to better reflection of discretionary sitting behaviour.
- Quinolines in clothing textiles-a source of human exposure and wastewater pollution? [JOURNAL ARTICLE]
- Anal Bioanal Chem 2014 Mar 7.
A production process in which the use of various types of chemicals seems to be ubiquitous makes the textile industry a growing problem regarding both public health as well as the environment. Among several substances used at each stage, the present study focuses on the quinolines, a class of compounds involved in the manufacture of dyes, some of which are skin irritants and/or classified as probable human carcinogens. A method was developed for the determination of quinoline derivatives in textile materials comprising ultrasound-assisted solvent extraction, solid phase extraction cleanup, and final analysis by gas chromatography/mass spectrometry. Quinoline and ten quinoline derivatives were determined in 31 textile samples. The clothing samples, diverse in color, material, brand, country of manufacture, and price, and intended for a broad market, were purchased from different shops in Stockholm, Sweden. Quinoline, a possible human carcinogen, was found to be the most abundant compound present in almost all of the samples investigated, reaching a level of 1.9 mg in a single garment, and it was found that quinoline and its derivatives were mainly correlated to polyester material. This study points out the importance of screening textiles with nontarget analysis to investigate the presence of chemicals in an unbiased manner. Focus should be primarily on clothing worn close to the body.