Clinical Application of Ultra-High-Frequency Ultrasound

Musculoskeletal ultrasound involves the study of many superficial targets, especially in the hands, wrists, and feet. Many of these areas are within the first 3 cm of the skin surface and are ideal targets for ultra-high-frequency ultrasound. The high spatial resolution and the superb image quality achievable allow foreseeing a wider use of this novel technique, which has the potential to bring innovation to diagnostic imaging

High resolution real time ultrasonography of the sural nerve after percutaneous repair of the Achilles tendon

Background Percutaneous Achilles tendon repair has been developed to minimise soft tissue complications following treatment of tendon ruptures. However, there are concerns because of the risk of sural nerve injury. Few studies have investigated the relationship between the Achilles tendon, the sural nerve and its several anatomical course variants. Methods We studied 7 cadaveric limbs (7 Achilles tendons) in which a percutaneous repair of the Achilles tendon was performed. On each tendon, high resolution real time ultrasonography examination was performed by an experienced musculoskeletal radiologist before and after the procedure, with the surgeons blind to the results of the scan both before and after surgery. Results In two instances, high resolution real time ultrasonography examination revealed nerve entrapment at the level of most proximal lateral suture. Conclusions Since the sural nerve can be easily visualised using high-frequency high resolution real time ultrasonography, intraoperative ultrasound can be of assistance during percutaneous repair of Achilles tendon rupture. Clinical relevance The sural nerve can be readily visualised by high-frequency high resolution real time ultrasonography probes. It could be beneficial to use high resolution real time ultrasonography intraoperatively or perioperatively to minimise the risks of sural nerve injury when undertaking percutaneous repair of Achilles tendon tears

RECTAL IMPACTION DUE TO PRICKLY PEAR SEEDS BEZOAR: A CASE REPORT

: Fecal impaction is the third cause of lower gastrointestinal tract obstruction after strictures for colon cancer and postoperative adhesions. A rapid diagnosis is necessary to avoid complications due to intestinal obstruction. Rectal phytobezoar due to prickly pear fruit seeds are an extremely rare entity, in the literature about twenty similar cases are described. Prickly pears are common in many countries, even in the Mediterranean area. When the ingestion of their fruit is excessive, this can be harmful, leading to the formation of phytobezoar causing fecal impaction. We describe the first case of phytobezoar due to prickly pear fruit seeds in continental Europe: a 76-year-old Italian female who ingested almost 40 prickly pear fruit leading to the composition of a large rectal phytobezoar. The patient presented clinically with fecal impaction, diagnosed by imaging and successfully treated by rectal irrigation and manual disimpaction. Our aim is to remind the physicians of these risks in evaluating patients with intestinal obstruction, when there is positive anamnesis for provenience from some areas in which these fruits are eaten. We also want to underline the role of Imaging Multi Detector Computed Tomography (MDCT) in the diagnosis of these very uncommon entities

Ultra high-frequency ultrasound: New capabilities for nail anatomy exploration

Recent development of ultra high-resolution ultrasound systems, with frequencies as high as 70 MHz and capability resolution as fine as 30 mu m, could permit new diagnostic applications to small parts. A variety of superficial targets within the first 1 cm of the skin surface could be imaged, including dermatological applications such as assessment of skin layers, hair follicles and the nail unit. Nail disorders are frequent but they are diagnosed mainly based on clinical examination; although biopsies and scrapings can provide clinically significant information, most patients do not perceive biopsies positively. To image the skin layer and annexes is often difficult with conventional ultrasound but, because of anatomical details obtained with the newest systems, this method holds great promise for addressing important biomedical applications offering unique advantages over the existing noninvasive imaging modalities. This will enable physicians to assess and manage the conditions involving the nails of a large and growing segment of the population in a better way

Early MRI findings of small bowel obstruction: an experimental study in rats

This study was undertaken to identify the early magnetic resonance imaging (MRI) findings of small bowel obstruction (SBO) and to analyse their evolution over time comparing them with histological findings. SBO was surgically induced in 10 rats divided into two groups monitored at predetermined time points until the 8th hour: group 1, macroscopically observed and group 2, investigated with 7-Tesla micro-MRI (7T mu-MR). At the end of observation, the bowel was excised for histological analysis. 7T mu-MRI T2-w sequences acquired 15 min after SBO, showed early evidence of bowel wall hyperintensity and a small amount of peritoneal free fluid. At 1 h, a hyperintensity of the loop proximal to the obstruction was found and, after 4 h, free fluid between the loops, bowel wall thickening and increased wall hyperintensity were also found. After 6 h hypotonic reflex ileus (only gas-filled dilated loops) was detected, which became paralytic ileus (dilation with air-fluid levels) after 8 h. The MRI findings were all confirmed at histological examination. This study allows definition of the early MRI features of SBO (peritoneal free fluid and hyperintensity of the injured bowel) and their chronological evolution, also confirmed by histological examination. Our data suggest a potential role of MR imaging in the early diagnostic assessment and management of patients with SBO. The chance to achieve an early detection of bowel injury and to correlate the histological pattern with imaging findings could contribute to a finer and earlier diagnosis and a more effective treatment

Percutaneous radiofrequency ablation of the posterior and anterior interosseous nerves for chronic wrist pain: A novel technique

The treatment of chronic wrist pain, due to posttraumatic, degenerative, or inflammatory arthritis, is challenging to adequately manage. The ideal surgical procedure should preserve wrist mobility and provide long-lasting pain relief. In this regard, denervation aims to decrease wrist pain by interrupting sensory innervation, without impairing motor function, and avoids the need for postoperative immobilization to decrease the risk of stiffness. For these reasons, denervation is particularly attractive as a possible treatment for chronic wrist pain. Our aim was to describe our novel technique for partial percutaneous wrist denervation, performed by radiofrequency ablation of the posterior and anterior interosseous nerves, and to report on the prospective outcomes over a 1-year follow-up for 3 patients (4 wrists) treated as of March 2019. The technique is performed on an outpatient basis and does not require postprocedure wrist immobilization or restriction in activities of daily living or work. Findings at the 1-year follow-up indicate that partial denervation improved grip strength, provided pain relief, maintained wrist motion, and improved subjective report of disabilities of the arm, shoulder, and hand. One patient did not report a benefit of the procedures, with other patients being very satisfied. Our percutaneous procedure is an evolution of the traditional partial denervation technique, providing advantages of being less invasive, not requiring restriction of movement or activities in the postoperative phase, can be performed on an out-patient basis, and does not preclude the subsequent use of invasive surgical procedures, as needed

CT findings in acute, subacute, and chronic ischemic colitis: suggestions for diagnosis.

This paper aims at evaluating CT findings of occlusive and nonocclusive ischemic colitis (IC), in correlation with the etiology and the different phases of the disease. MATERIALS AND METHODS: CT examination and clinical history of 32 patients with proven IC were retrospectively reviewed. The CT findings were analyzed according to the different phases of the disease (acute, subacute, and chronic). RESULTS: Among the 32 CT examinations performed in the acute phase, 62.5% did not present signs of occlusion of the superior mesenteric artery (SMA) or inferior mesenteric artery (IMA), whereas IMA occlusion was detected in 37.5% of CT examinations. In the acute phase, the presence of pericolic fluid was found in 100% of patients undergoing progressive resorption from acute to subacute phase if an effective reperfusion occurred; the bowel wall thickening was observed in 28.1% patients in acute phase and in 86.4% patients evaluated in subacute phase. The unthickened colonic wall was found in all conditions where ischemia was not followed by effective reperfusion (71.9% of cases), and it was never found in chronic phase, when the colon appeared irregularly thickened. CONCLUSION: CT allows determining the morphofunctional alterations associated with the IC discriminating the occlusive forms from the nonocclusive forms. CT, furthermore, allows estimating the timing of ischemic damag

Early MRI findings of small bowel obstruction: an experimental study in rats.

Abstract PURPOSE: This study was undertaken to identify the early magnetic resonance imaging (MRI) findings of small bowel obstruction (SBO) and to analyse their evolution over time comparing them with histological findings. MATERIALS AND METHODS: SBO was surgically induced in 10 rats divided into two groups monitored at predetermined time points until the 8th hour: group 1, macroscopically observed and group 2, investigated with 7-Tesla micro-MRI (7 T μ-MR). At the end of observation, the bowel was excised for histological analysis. RESULTS: 7 T μ-MRI T2-w sequences acquired 15 min after SBO, showed early evidence of bowel wall hyperintensity and a small amount of peritoneal free fluid. At 1 h, a hyperintensity of the loop proximal to the obstruction was found and, after 4 h, free fluid between the loops, bowel wall thickening and increased wall hyperintensity were also found. After 6 h hypotonic reflex ileus (only gas-filled dilated loops) was detected, which became paralytic ileus (dilation with air-fluid levels) after 8 h. The MRI findings were all confirmed at histological examination. CONCLUSIONS: This study allows definition of the early MRI features of SBO (peritoneal free fluid and hyperintensity of the injured bowel) and their chronological evolution, also confirmed by histological examination. Our data suggest a potential role of MR imaging in the early diagnostic assessment and management of patients with SBO. The chance to achieve an early detection of bowel injury and to correlate the histological pattern with imaging findings could contribute to a finer and earlier diagnosis and a more effective treatment