Historical overview of spinal deformities in ancient Greece

Little is known about the history of spinal deformities in ancient Greece. The present study summarizes what we know today for diagnosis and management of spinal deformities in ancient Greece, mainly from the medical treatises of Hippocrates and Galen. Hippocrates, through accurate observation and logical reasoning was led to accurate conclusions firstly for the structure of the spine and secondly for its diseases. He introduced the terms kyphosis and scoliosis and wrote in depth about diagnosis and treatment of kyphosis and less about scoliosis. The innovation of the board, the application of axial traction and even the principle of trans-abdominal correction for correction of spinal deformities have their origin in Hippocrates. Galen, who lived nearly five centuries later impressively described scoliosis, lordosis and kyphosis, provided aetiologic implications and used the same principles with Hippocrates for their management, while his studies influenced medical practice on spinal deformities for more than 1500 years

PREDIKSI KESULITAN LAPAROSKOPIK KOLESISTEKTOMI BERDASARKAN PARAMETER ULTRASONOGRAFI KANDUNG EMPEDU

Latar Belakang: Penyakit batu kandung empedu atau kolelitiasis merupakan penyakit yang lazim ditemukan dalam masyarakat. Kolesistektomi merupakan terapi gold standar untuk kolelitiasis, namun dalam 96% kasus, prosedur dapat dilaksanakan secara laparoskopik. Salah satu faktor penting untuk pencegahan timbulnya komplikasi adalah keterampilan operator dalam mengendalikan alat laparoskopinya. Alat diagnostik berupa ultrasonografi bisa memberikan gambaran terhadap anatomi kandung empedu sehingga operator bisa memperkirakan tingkat kesulitan yang akan dihadapinya. Metode: Penelitian ini merupakan uji diagnostik yang dilaksanakan dari Maret 2016 sampai dengan Mei 2016. Pemeriksaan ultrasonografi dilakukan di RS M. Djamil Padang dan Semen Padang Hospital sedangkan operasi kolesistektomi laparoskopik dilakukan di RS M. Djamil Padang, Semen Padang Hospital dan RS Islam Siti Rahmah. Besar sampel adalah 20 pasien. Data diolah dengan batas kemaknaan P ≤ 0,05. Hasil: Pericholecystic fluid memiliki sensitifitas yang kurang baik terhadap kejadian operasi lama, spillage, perdarahan serta kesulitan diseksi kandung empedu. Namun memiliki sensitifitas dan nilai duga positif yang baik (100%) terhadap semua variabel kesulitan kolesistektomi laparoskopik yang diteliti. Batu multipel memiliki sensitifitas dan nilai duga negatif yang baik terhadap lama operasi (100%), namun kurang baik untuk memprediksi terjadinya spillage dan perdarahan. Batu multipel memiliki sensitifitas yang baik yakni 71,43% terhadap kesulitan diseksi kandung empedu. Penebalan dinding kandung empedu memiliki nilai duga negatif yang baik (71,43%) terhadap lama operasi. Sludge memiliki spesifitas dan nilai duga negatif yang baik terhadap perihal tersebut (94,18% dan 88,89%). Terhadap spillage, spesifisitas dan nilai duga negatif juga didapatkan baik (92,86% dan 72,23%). Untuk hubungannya dengan perdarahan dan kesulitan diseksi kandung empedu, sludge memiliki spesifisitas yang baik sedangkan variabel lainnya dinilai kurang baik. Indeks kontraktilitas memiliki nilai duga negatif yang baik terhadap semua variabel penyulit kolesistektomi laparoskopik, namun nilai prediksi lain didapatkan kurang baik. Kesimpulan: Setiap parameter dari ultrasonografi yang dilakukan memiliki nilai prediksi terhadap kesulitan kolesistektomi laparoskopik. Kata kunci: kolesistektomi laparoskopik, ultrasonograf

Percutaneous thrombin injection under contrast-enhanced ultrasound guidance to control active extravasation not associated with pseudoaneurysm

The technique of percutaneous thrombin injection (PTI) under contrast-enhanced ultrasound (CEUS) guidance for control of acute hemorrhage-active extravasation not associated with pseudoaneurysm is demonstrated in three cases: 1) Massive spontaneous retroperitoneal hematoma in a patient with multiple comorbidities. Contrast-enhanced computed tomography (CT) showed extensive active extravasation, which was only partially controlled by transarterial embolization. CEUS was performed in the angiography suite. Contrary to unenhanced US and colour Doppler US (CDUS), CEUS confirmed persistent extravasation; CEUS-guided PTI was performed immediately thereafter. 2) Large rectus sheath hematoma in a patient on anticoagulant therapy. Contrast-enhanced CT and unenhanced US/CD could not definitely diagnose extravasation. CEUS clearly showed extravasation and was used for guidance of PTI. 3) Chest wall hematoma complicating central venous catheter placement in a patient with coronavirus on anticoagulant therapy. CDUS was inconclusive. CEUS was performed at the bedside, clearly showed active extravasation, and was used for guidance of PTI. In all three cases, post-PTI CEUS confirmed the absence of residual enhancement of the hematomas, and the hemodynamic status of the patients improved. PTI appears to be effective in selected cases of hematomas associated with active extravasation. In this context, CEUS may be the most suitable modality for guidance and for an immediate evaluation of the treatment effect

mRECIST criteria and contrast-enhanced US for the assessment of the response of hepatocellular carcinoma to transarterial chemoembolization

PURPOSEWe aimed to evaluate the combination of the modified Response Evaluation Criteria In Solid Tumors (mRECIST) and contrast-enhanced ultrasonography (CEUS) as a tool for the assessment of hepatocellular carcinoma treated with transarterial chemoembolization. MATERIALS AND METHODSForty-seven hepatocellular carcinoma patients (80 target tumors suitable for mRECIST measurements) were studied. They were treated with scheduled transarterial chemoembolization with doxorubicin-eluting microspheres every 5–7 weeks. Imaging follow-up (performed one month after each transarterial chemoembolization) included a standard, contrast-enhanced modality (computed tomography [CT] in 12 patients or magnetic resonance imaging [MRI] in 35 patients) and CEUS. The study focused on response evaluation after the third transarterial chemoembolization. CEUS required a bolus injection of an echo-enhancer and imaging with a dedicated, low mechanical index technique. The longest diameters of the enhancing target tumors were measured on the CEUS or CT/MRI, and mRECIST criteria were applied. Radiologic responses were correlated with overall survival and time to progression. RESULTSThe measurements of longest diameters of the enhancing target tumors were easily performed in all patients. According to mRECIST-CEUS and mRECIST-CT/MRI, complete response was recorded in five and six patients, partial response in 22 and 21 patients, stable disease in 16 and 14 patients, and progressive disease in four and six patients, respectively. There was a high degree of concordance between CEUS and CT/MRI (kappa coefficient=0.84, P < 0.001). Responders (complete+partial response) according to mRECIST-CEUS had a significantly longer mean overall survival and time to progression compared to nonresponders (37.1 vs. 11.0 months, P < 0.001 and 24.6 vs. 10.9 months, P = 0.007, respectively). CONCLUSIONThe mRECIST-CEUS combination is feasible and has prognostic value in the assessment of hepatocellular carcinoma following transarterial chemoembolization

The value of contrast-enhanced ultrasonography in detection of prostatic infarction after prostatic artery embolization for the treatment of symptomatic benign prostatic hyperplasia

PURPOSEWe aimed to assess the clinical and predictive role of contrast-enhanced ultrasonography (CEUS) as the primary method for imaging evaluation of prostatic artery embolization (PAE) for the treatment of symptomatic benign prostatic hyperplasia (BPH).METHODSThirty-one patients with symptomatic BPH, treated with PAE from October 2016 until February 2018, were enrolled in this prospective, single-center study. Microspheres (100–700 µm) were utilized for PAE. International prostate symptom score (IPSS), quality of life (QoL), maximum urinary flow (Qmax), prostatic volume (PV) and post void residual volume (PVR) were measured at baseline and at 1, 3, and 6 months post PAE. Unenhanced transabdominal US was utilized for PV and PVR measurements; prostatic enhancement was studied with transabdominal CEUS at baseline, during the procedure, 1 day and 1, 3, and 6 months post PAE. Technical success was defined as embolization of the PA of at least one pelvic side. Clinical success was based on the improvement of IPSS and QoL, with no need for any additional treatment. Follow-up time ranged from 6 to 18 months (mean, 9.7±4.3 months). Clinical success rates were calculated and changes in prostatic enhancement were correlated with the outcome parameters.RESULTSTechnical success rate was 90.3%. Clinical success rates at 3, 6, and 12 months post PAE were 85.7%, 85.7%, and 79.1% respectively. Improvement of outcome parameters (baseline vs. 6-month values) was statistically significant, with 12.4 points mean reduction of IPSS (50.4%, P = 0.003), 2.0 points mean reduction of QoL (45.4%, P 10%.CONCLUSIONCEUS appears to be a practical method for the study of the local ischemic effect of PAE, with potential predictive value