Ultrasonography role for diagnosis of temporomandibular joint disorders

Aim: The aim of this study is to show the importance and reliability of ultrasonography (US) in the diagnosis of the temporomandibular disorders (TMJ) in patients affected by orofacial pain and dysfunction with dentofacial and skeletal malocclusions. Materials and Methods: 30 patients have been assessed by ultrasonographic exams. Us was performed with a 11-18 MHz linear transducer. US offers specific advantages because it is non-invasive, does not require sedation or general anesthesia (which facilitates examinations for follow-up), is quickly accessible bedside, and is easy to combine with clinical assessment (interactivity). Agitation of the patient is rarely a problem, as MRI and multiple locations can be assessed during a single session. Furthermore, modern high-frequency US transducers used by experienced US examiners can provide unsurpassed resolution of the superficial musculoskeletal structures. Results: Were detected morphological alterations and positions of mandibular condyles in the glenoid fossa, condylar synovitis, disc displacement and joint effusion. Conclusions: Ultrasonography is a noninvasive and inexpensive diagnostic procedure that can be suggested for the evaluation of TMJ disorders, with particular accuracy in the detection of disc displacement and joint effusion. Limitations are especially related to the scarce accessibility of the medial part of the TMJ structures, and the need for trained and calibrated operators

Successful extracorporeal membrane oxygenation after incidental azygos vein cannulation in a neonate with right-sided congenital diaphragmatic hernia interruption of the inferior vena cava and azygos continuation

Incidental azygos vein cannulation has been reported in a few cases of neonatal extracorporeal membrane oxygenation (ECMO). This complication is described in the literature mainly in pathological conditions wherein increased central venous pressure dilates the superior vena cava (SVC), i.e., right congenital diaphragmatic hernia (CDH) or pulmonary hypertension. Azygos vein cannulation should always be suspected in cases of impaired venous return and circuit failure. Although rare, it hinders proper venous aspiration of the ECMO circuit and generally requires repositioning or replacement of the venous cannula or conversion to central cannulation. In this report, we describe a newborn with severe right CDH who required ECMO assistance, wherein incidental cannulation of the azygos vein resulted in successful functioning of the circuit because of the concomitant presence of isolated interruption of the inferior vena cava and azygos continuation. To the best of our knowledge, this is the first report of successful neonatal ECMO despite azygos vein cannulation in a patient with such rare physiology

A maChine and deep Learning Approach to predict pulmoNary hyperteNsIon in newbornS with congenital diaphragmatic Hernia (CLANNISH): Protocol for a retrospective study

Introduction Outcome predictions of patients with congenital diaphragmatic hernia (CDH) still have some limitations in the prenatal estimate of postnatal pulmonary hypertension (PH). We propose applying Machine Learning (ML), and Deep Learning (DL) approaches to fetuses and newborns with CDH to develop forecasting models in prenatal epoch, based on the integrated analysis of clinical data, to provide neonatal PH as the first outcome and, possibly: Favorable response to fetal endoscopic tracheal occlusion (FETO), need for Extracorporeal Membrane Oxygenation (ECMO), survival to ECMO, and death. Moreover, we plan to produce a (semi)automatic fetus lung segmentation system in Magnetic Resonance Imaging (MRI), which will be useful during project implementation but will also be an important tool itself to standardize lung volume measures for CDH fetuses. Methods and analytics Patients with isolated CDH from singleton pregnancies will be enrolled, whose prenatal checks were performed at the Fetal Surgery Unit of the Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico (Milan, Italy) from the 30th week of gestation. A retrospective data collection of clinical and radiological variables from newborns' and mothers' clinical records will be performed for eligible patients born between 01/01/2012 and 31/12/2020. The native sequences from fetal magnetic resonance imaging (MRI) will be collected. Data from different sources will be integrated and analyzed using ML and DL, and forecasting algorithms will be developed for each outcome. Methods of data augmentation and dimensionality reduction (feature selection and extraction) will be employed to increase sample size and avoid overfitting. A software system for automatic fetal lung volume segmentation in MRI based on the DL 3D U-NET approach will also be developed. Ethics and dissemination This retrospective study received approval from the local ethics committee (Milan Area 2, Italy). The development of predictive models in CDH outcomes will provide a key contribution in disease prediction, early targeted interventions, and personalized management, with an overall improvement in care quality, resource allocation, healthcare, and family savings. Our findings will be validated in a future prospective multicenter cohort study

The use of sirolimus in the treatment of giant cystic lymphangioma : Four case reports and update of medical therapy

Rationale: Lymphatic malformations (LMs) are rare and benign anomalies resulting from the defective embryological development of the primordial lymphatic structures. Due to their permeative growth throughout all tissue layers, treatment is often challenging. Small asymptomatic lesions can be conservatively managed, while symptomatic lesions require active management. Surgery has been historically considered the treatment of choice, but today less invasive therapeutic options are preferred (sclerotherapy, laser therapy, oral medications). However, there are not uniform therapeutic protocols. Sirolimus is an oral medication that has been reported to be effective in the recent literature. Here we present the case of 4 newborns with giant multicystic lymphangioma treated with oral sirolimus after surgical resection had failed. Patient concerns: At birth the LMs were clinically appreciated as giant masses involving different organs and structures. Diagnoses: All patients had a prenatal diagnosis of giant multicystic lymphangioma confirmed at histological and cytological analysis. Interventions: Patients were treated with oral sirolimus after unsuccessful surgical resection. Outcomes: In all patients, sirolimus determined an overall reduction of the mass and a global involution from the macro-to the microcystic composition. Sirolimus was safe and poor disadvantages had been observed. The main and isolated adverse effect at laboratory analysis was progressive dyslipidemia, with increasing levels of total cholesterol and triglycerides. Lessons: To date, our experience with sirolimus in the management of LMs is favorable. We recommend the use of sirolimus after unsuccessful surgical excision have been tried or when the surgical approach is not feasible. A multidisciplinary follow-up is needed to monitor disease evolution

Liver metastases on serial contrast-enhanced multidetector computed tomography examinations: was the detection possible on previous examinations?

OBJECTIVE: To verify the earliest detectability of liver metastases in patients who underwent serial multidetector computed tomography (MDCT) examinations. METHODS: We selected 12 patients with known primary cancer who underwent 4 or more contrast-enhanced, 4-detector MDCTs. When metastases had been reported, an evaluation of the preceding MDCT was done to define whether the lesion was detectable, detectable only by minimal signs, undetectable, or detected but misdiagnosed as a benign lesion (MBL). RESULTS: Eighty-eight lesions were analyzed. Evaluating the preceding examination, we defined detectable (n= 8), detectable only by minimal signs (n= 5), undetectable (n= 74), and MBL (n= 1). The group with minimal signs was composed of 4 small hypodense foci and 1 calcification. The MBL was a non-Hodgkin lesion first misdiagnosed as a hemangioma. CONCLUSION: Approximately 15% of liver metastases were prospectively missed, 9% of them being retrospectively detectable, 6% being retrospectively visible as minimal signs, whereas only 1% of liver metastases were misdiagnosed as a benign lesion. Copyright (copyright) 2006 by Lippincott Williams & Wilkins

Temporomandibular joint disorders imaging by Ultrasonography in Juvenile Idiopathic Arthritis

Aim: The aim of this study is to show the importance and reliability of ultrasonography (US) in the diagnosis of the temporomandibular disorders in patients affected by Juvenile Idiopathic Arthritis (JIA). Materials and Methods: 30 patients with JIA have been assessed by ultrasonographic exams. Us was performed with a 11-18 MHz linear transducer. For paediatric patients, US offers specific advantages because it is non-invasive, does not require sedation or general anesthesia (which facilitates examinations for follow-up), is quickly accessible bed side, and is easy to combine with clinical assessment (interactivity). Agitation of the patient is rarely a problem, and hence young children can be seated on a patent\u2019s lap or play while being examined, and multiple locations can be assessed during a single session. Furthermore, modern high-frequency US transducers used by experienced US examiners can provide unsurpassed resolution of the superficial musculoskeletal structures in children. Results: Were detected morphological alterations and positions of mandibular condyles in the glenoid fossa, condylar synovitis disc displacement and joint effusion. Conclusion: Ultrasonography is a noninvasive and inexpensive diagnostic procedure that can be suggested for the evaluation of TMJ disorders, with particular accuracy in the detection of disc displacement and joint effusion. Limitations are especially related to the scarce accessibility of the medial part of the TMJ structures, and the need for trained and calibrated operators

Minimally invasive diagnosis of temporomandibular joint disorders: Ultrasonography Versus Magnetic Resonance Imaging

AIM: The aim of this study is to show the importance and reliability of ultrasonography (US) and Magnetic Resonance Imaging (MRI) in the diagnosis of the Temporomandibular Joint Disorders (TMJ) in patients affected by orofacial pain and dysfunction with dentofacial and skeletal malocclusions. MATERIALS AND METHOD: 30 patients have been assessed by ultrasonographic exams. Us was performed with a 11-18 MHz linear transducer. US offers specific advantages because it is non-invasive, does not require sedation or general anesthesia (which facilitates examinations for follow-up), is quickly accessible bedside, and is easy to combine with clinical assessment (interactivity). Agitation of the patient is rarely a problem, as MRI and multiple locations can be assessed during a single session. Furthermore, modern high-frequency US transducers used by experienced US examiners can provide unsurpassed resolution of the superficial musculoskeletal structures. RESULTS: Were detected morphological alterations and positions of mandibular condyles in the glenoid fossa, condylar synovitis, disc displacement and joint effusion. CONCLUSIONS: Ultrasonography is a noninvasive and inexpensive diagnostic procedure that can be suggested for the evaluation of TMJ disorders, with particular accuracy in the detection of disc displacement and joint effusion. Limitations are especially related to the scarce accessibility of the medial part of the TMJ structures, and the need for trained and calibrated operators

Abdominal mass hiding rib osteomyelitis

Background Rib osteomyelitis is a rare entity, occurring in approximately 1 % or less of all cases of haematogenous osteomyelitis. Given its rarity and clinical heterogeneity, the diagnosis of rib osteomyelitis can be challenging and requires a high index of suspicion. We present a case of acute osteomyelitis of the rib due to community-acquired methicillin-resistant Staphylococcus aureus (MRSA), which occurred in an otherwise healthy 3-month-old infant and mimicked an epigastric hernia at first. Case presentation An otherwise healthy 3-month-old female infant was sent by her primary care paediatrician to the paediatric emergency department for possible incarcerated epigastric hernia because for 2 days, she had suffered from mild to moderate fever, irritability, poor feeding, and tender epigastric swelling. Ultrasonographic imaging excluded epigastric hernia, and transthoracic echocardiography ruled out endocarditis. However, clinical assessment combined with laboratory criteria classified the child into the high-risk group for having severe bacterial infection. Consequently, awaiting the definitive diagnosis, she was immediately treated with a broad-spectrum regimen of intravenous antibiotic therapy based on vancomycin (40 mg/kg/die in 3 doses) and meropenem (100 mg/kg/die in 3 doses). Three days after admission, the blood culture result was positive for methicillin-resistant Staphylococcus aureus, and vancomycin remained as antibiotic therapy. On day 3, a second swelling appeared at the level of the seventh left rib, 2 cm-wide, non-erythematous, mildly painful. Ultrasonography of the left chest wall on this occasion showed an image consistent with an acute osteomyelitis of the anterior osteo-chondral region of the 7th rib and associated adjacent periosteal and soft tissue collection and magnetic resonance imaging confirmed the osteomyelitis of the anterior middle-distal part of the 7th left rib, near the costochondral junction. Vancomycin was continued up to a total of 6 weeks of therapy, and at the end, the child was discharged in good condition with no relapse during the follow-up. Conclusion This is one of the few reported cases of paediatric rib osteomyelitis caused by community-acquired MRSA. Timely identification associated with prompt and targeted antibiotic therapy may allow full recovery