Hypoechoic Zone Research Articles

Placenta Previa: Case Report

Placenta previa is a significant obstetric complication that occurs during pregnancy, characterized by abnormal implantation of the placenta in the lower uterine segment. Risk factors for having had a previous caesarean section, multiple pregnancies, advanced maternal age, or having a history of uterine surgery at higher risk, a history of previous uterine curettage, may increase the likelihood of placenta previa. woman aged 29 years G3P2A0 38 weeks pregnant came with complaints of fresh blood coming out of the birth canal since 3 hours before entering the hospital about half of the pads. Previous history to an obstetrician with malpositioned ultrasound results and a history of 2 previous deliveries by cesarean section. Physical examination, blood pressure 110/70, pulse 78 times/minute, respiration 18 times/minute, temperature 360C, there was no clinical anemia, obstetric examination of the height of the uterine fundus (TFU) 33 cm with an estimated fetal weight (TBJ) 3100 gr, FHR 152 times/minute regularly, positive His 1-2 times/10 minutes 10-15 seconds each. From vaginal positive spots, no active bleeding, vaginal touch was not done. Ultrasound of the fetus in cephalic presentation, positive FHB, EFW 3100 gr, placenta corpus posterior closing OUI grade 3 SDP 6 cm PAI score 2 positive hypoechoic zone, negative lacuna, KTG category 1. From investigations, Hb was 10.2 gr/dl. Ht 30%, leukocytes 12,950 uL, platelets 322,000 uL, bleeding time and clotting time within normal limits. management carried out strict vital signs monitoring, planned sectio caesaria cito and given premedication injection of ceftriaxone 2gr and 250cc PRC blood supply. Placenta previa is a complex obstetric condition that requires careful diagnosis, monitoring and management. Prompt recognition of the condition, close monitoring of maternal and fetal safety, and timely intervention, such as cesarean section when indicated, are critical to reducing the risks associated with placenta previa.

Use of High-Frequency Ultrasound for the Correlation of Epithelial Rete Peg Variation

ObjectiveRete pegs are projections of the oral epithelium into connective tissue. Their dimensions change during pathological conditions and may correlate with wound-healing status. Non-invasive, high-frequency ultrasound (US) may be able to capture these changes and aid in early detection of histopathological changes. The aim of this preclinical study is to correlate US images with histology and quantify epithelial layers at different tooth sites. MethodsSagittal B-mode images of mid-facial and interproximal oral soft tissue sites were recorded in a preclinical minipig model using a linear array in second harmonic mode (12/24 MHz). Histology samples from the same locations were stained (hematoxylin and eosin), digitized and registered with US images. Manual annotations were used to measure distances D1 (thickness of epithelium on histology vs. hyperechoic zone on US) and D2 (sum of epithelial thickness and length of rete pegs on histology vs. sum of hyperechoic and hypoechoic zone on US) to statistically analyze them. ResultsUltrasonic-derived dimensions yielded a mean bias of -0.64 (55% coefficient of variance [COV]: -180 to +180 µm) and -12 µm (39% COV: -260 to +240 µm) for D1 and D2, respectively. Individualized analysis of D1 and D2 by tooth type showed similar tends in the ability to differentiate between epithelium at different tooth locations, on both histology and US. ConclusionAssessing soft tissue dimensions on a sub-millimeter scale using clinical imaging hardware is still a developing area. Future research might open doors for diagnosis of oral pathologies and abnormal wound healing, and may limit false-positive indications for biopsies.

Sensitivity of antenatal ultrasound in diagnosing posterior placenta accreta spectrum disorders.

Optimal management of placenta accreta spectrum (PAS) requires antenatal diagnosis. We sought to evaluate the sensitivity of ultrasound findings suggestive of PAS in detecting posterior PAS. Cohort study of patients with posterior placentation and pathology-confirmed PAS from 2011 to 2020 at a tertiary center. Patients were excluded if ultrasound images were unavailable. Ultrasounds were reviewed for presence of lacunae, hypervascularity, myometrial thinning, loss of the hypoechoic zone, bridging vessels, abnormal uterine serosa-bladder interface, placental bulge, placental extension into/beyond the myometrium, and an exophytic mass. Risk factors, postpartum outcomes, and ultrasound findings were compared by antepartum suspicion for PAS. Sensitivity was calculated for each ultrasound finding. Thirty-three patients were included. PAS was not suspected antenatally in 70 % (23/33). Patients with unsuspected PAS were more likely to be non-Hispanic, have invitro fertilization, no prior Cesarean deliveries, no placenta previa, and delivered later in gestation. Depth of invasion and estimated blood loss were less for unsuspected PAS, but there was no difference in hysterectomy between groups. Ultrasound findings were less frequently seen in those who were not suspected antenatally: lacunae 17.4 vs. 100 % (p<0.001), hypervascularity 8.7 vs. 80 % (p<0.001), myometrial thinning 4.4 vs. 70 % (p<0.001), and placental bridging vessels 0 vs. 60 % (p<0.001). There was poor sensitivity (0-42.4 %) for all findings. Posterior PAS is less likely to be detected antenatally due to a lower sensitivity of typical ultrasound findings in the setting of a posterior placenta. Further studies are needed to better identify reliable markers of posterior PAS.

The Evaluation of the Effect of Suburethral Transobturator Sling on the Urethra Using Ultrasound Examination

Abstract Background Despite the use of suburethral tapes for many years, the mechanism of their action and the reasons for their failures have not been thoroughly understood. Objectives The aim of this study was to analyze the impact of the TOT tape on changes in urethral mobility depending on its location. Additionally, the urethral funneling was evaluated. Material and methods 57 patients with SUI symptoms had TOT implanted. Ultrasound examinations were performed before and 3–6 months after surgery, among others, urethral length, suburethral tape location, bladder neck mobility, and urethral funneling were evaluated. Results 77.2% of patients were cured, while 22.8% were not cured. After tape insertion, a reduction in bladder neck mobility parameters was observed in the group of patients with preoperative hypermobile urethras, regardless of the therapeutic outcome. The average distance of the tape from the hypoechoic area of the urethra was smaller in cured patients, while the relative tape position did not differ significantly between cured and not cured women. Before surgery, all patients had a long urethral funneling. Postoperatively, all non‑cured patients had a long funneling, while in cured patients, no long urethral funneling was observed. Conclusions The TOT suburethral tape reduced urethral mobility to a similar extent in cured and not cured women. The effect on UM was noticeable in patients with preoperative hypermobile urethrae. The obtained TOT tape locations did not affect the degree of UM reduction. Patients in whom the TOT tape was located closer to the hypoechoic zone of the urethra had a greater chance of effective elimination of SUI symptoms. It was confirmed that the assessment of the urethral funneling during PFS ‑TV may be useful for confirming SUI and for assessing the effects of SUI treatment after suburethral tape implantation.

Ultrasonographic features of mass lesions in the oral submucosal epithelium using intraoral ultrasonography.

Mass lesions occurring under the oral mucosal epithelium are often small and difficult to diagnose; however, intraoral ultrasonography can delineate these lesions. We aimed to investigate the features of submucosal mass lesions in the oral cavity using intraoral ultrasonography. Fifty patients with hemangioma, irritation fibroma, mucous cyst, lipoma, and pleomorphic adenoma were included. Age, site, largest diameter, thickness, marginal morphology type, border type, internal echo posterior echo, and internal or peripheral Doppler images of the lesions were recorded. The hemangiomas were internally hypoechoic and exhibited a cord-like structure; irritation fibromas, mainly internally isoechoic; mucous cysts, hypoechoic; and the lipomas appeared as homogeneous, isoechoic, or hyperechoic images with unclear borders. Pleomorphic adenomas were surrounded by a single hypoechoic zone, suggesting a thick capsular structure, were predominantly isoechoic internally, and appeared as cyst-like hypoechoic images. The features of the lesions were identified and delineated using intraoral ultrasonography.

Fetal insular measurements in pregnancy with estimated fetal weight

A growing body of evidence suggests that fetal growth restriction is associated with changes in brain structures as a result of chronic hypoxia. However, less is known about the effects of growth restriction on the fetal insula, particularly in less severely affected late-onset growth-restricted fetuses. This study aimed to (1) compare sonographic insular measurements between fetal-growth restricted, small-for-gestational-age, and appropriate-for-gestational-age control fetuses; and (2) evaluate the association of sonographic insular measurements with perinatal and neurodevelopmental outcomes in fetuses categorized as fetal-growth restricted or small-for-gestational-age. This was a cohort study of singleton nonanomalous pregnancies with an estimated fetal weight <10th centile. Using data from the last examination before delivery, fetal insular depth, Sylvian fissure depth, hypoechoic insular zone thickness, circumference, and area were measured. All measurements were adjusted for by head circumference. Neurodevelopmental outcomes were evaluated at 2 to 3 years of age using the Bayley-III scales. Kruskal-Wallis H tests were performed to compare insular measurements between groups. Paired t tests were used to compare insular measurements between appropriate-for-gestational-age fetuses and gestational age-matched growth-restricted fetuses. Insular measurements for patients with and without an adverse perinatal outcome were compared using independent-samples t-tests. Spearman correlations were performed to evaluate the relationship of insular measurements to the percentile scores for each of the 5 Bayley-III subscales and to a summative percentile of these subscales. A total of 89 pregnancies were included in the study; 68 of these pregnancies had an estimated fetal weight <10th percentile (fetal-growth restricted: n=39; small-for-gestational-age: n=29). The appropriate-for-gestational-age cohort consisted of 21 pregnancies. The gestational age at measurement was similar between fetal-growth restricted and small-for-gestational-age groups, but lower in the appropriate-for-gestational-age group. Differences between groups were noted in normalized insular depth, Sylvian fissure depth, and hypoechoic insular zone (P<.01). Normalized insular depth and hypoechoic insular zone circumference were larger in the growth-restricted cohort (P<.01). Normalized Sylvian fissure depth was smaller in the growth-restricted cohort (P<.01). There were no significant differences in insular measurements between pregnancies with and without an adverse perinatal outcome. Bayley-III results were available in 32 of the growth-restricted cases. Of all insular measurements, hypoechoic insular zone circumference was inversely correlated with the adaptive behavior Bayley-III score. In our cohort, fetuses with estimated fetal weight <10th percentile had smaller Sylvian fissure depths and larger insular depths and hypoechoic insular zone circumferences than normally grown controls. A larger hypoechoic insular zone circumference was substantially correlated with worse neurodevelopmental outcomes in early childhood. We speculate that enlargement of this region may be an indication of accelerated neuronal maturation in growth-restricted fetuses with mild hypoxia.

Imaging the Uterus in Placenta Accreta Spectrum Disorder.

Antenatal diagnosis of placenta accreta spectrum (PAS) improves maternal and neonatal outcomes by allowing for multidisciplinary planning and preparedness. Ultrasound is the primary imaging tool. Simplification and standardization of placental evaluation and reporting terminology allows improved communication and understanding between teams. Prior to 10 weeks of gestation, gestational sac position and least myometrial thickness surrounding the gestational sac help PAS diagnosis very early in pregnancy. Late first-, second-, and third-trimester evaluation includes comprehensive evaluation of the placenta, transabdominal and transvaginal with partially full maternal urinary bladder, and by color Doppler. Subsequently, the sonologist should indicate whether the evaluation was optimal or suboptimal; the level of suspicion as low, moderate, or high; and the extent as focal, global, or extending beyond the uterus. Other complementary imaging modalities such as 3D-power Doppler ultrasound, magnetic resonance imaging (MRI), and vascular topography mapping strive to improve antenatal placental evaluation but remain investigational at present. KEY POINTS: · Antenatal imaging, primarily using ultrasound with partially full maternal urinary bladder, is an essential means of evaluation of those at risk for PAS.. · Simplification and standardization of placental evaluation and reporting will allow improved communication between the multidisciplinary teams.. · Gestational sac location prior to 10 weeks of gestation and four markers after that (placental lacunae and echostructure, myometrial thinning, hypoechoic zone with or without bulging between placenta and myometrium, and increased flow on color Doppler)..

Features of ultrasound diagnosis of pathological placentation

Pathological placentation (placenta previa and placenta accreta) is one of the main problems in modern obstetrics, which negatively affects maternal and perinatal mortality rates. The use of modern technologies for the timely diagnosis of this pregnancy complication and the correct route of the patient allow to reduce blood loss significantly, to save not only the life of the mother and the child, but also to save the uterus in some cases.The objective: to evaluate the diagnostic possibilities of ultrasound examination of pathological placentation.Materials and methods. An ultrasound examination was performed in 86 pregnant women with pathological placentation. Ultrasound signs of pathological placentation are divided into two groups depending on the gray or color image.Results. In 92 % of examined pregnant women with pathological placentation, the clear zone was lost. In patients with placenta previa a loss of the hypoechoic retroplacental zone was found in 70 % of cases, a significant number of placental lacunae of various shapes and sizes – 87 %, segmental thinning of the myometrium &lt;1 mm – 50 %.Protrusion of the uterus into the surrounding tissues is often observed due to placenta accreta, in cases of placenta percreta – the exophytic mass indicates the invasion of the placental tissue through the myometrium into the extrauterine organs. 80 % of pregnant women with placenta previa and 75 % of patients with placenta accreta have hypervascularization within or under the placental bed.Conclusions. Ultrasound examination is an affordable and effective method of visualization of pathological placentation. The following criteria for placenta accreta were established and confirmed: myometrial thinning &lt;1 mm, placental lacunae, bladder wall rupture, loss of the lunate zone, placental protrusion, subplacental vascularization, uterovesicular hypervascularization, and vessels that vascularize the lacunae.

Pregnancy characteristics of patients with placenta acreta spectrum at Prof. Dr. I.G.N.G. Ngoerah Hospital Denpasar, Bali-Indonesia during January 2020 - January 2022

Introduction: Placenta accreta spectrum is a problem during delivery when the placenta is not completely separated from the uterus and is followed by massive obstetric bleeding and can cause postnatal morbidity and mortality. The purpose of this study was to describe the pregnancy characteristics of patients with placenta accreta spectrum at Prof. Dr. I.G.N.G. Ngoerah Hospital Denpasar, Bali-Indonesia during period 1 January 2020 - 1 January 2022. Methods: This study is a descriptive study that describes the basic sociodemographic characteristics, ligation procedures, ultrasonographic findings, and histopathology. Results: A total of 48 patients were sampled in this study, the highest proportion of pregnant women with placenta accreta spectrum with lacuna grade II (39.6%), loss of basal hypoechoic zone (64.6%), myometrial thickness &lt;1 mm (39.6%), anterior placenta location (81.3%), regular vesicouterine border (75%), no exophytic mass (97.9%), bridging vessels (68.8%), no feeding vessels (85.4%), loss of placental basal Doppler image (97.9%), no hypervascularity of the vesicouterine area (66.7%), no lacunae vascular turbulence (83.3%) and the highest PAI score with a value of less than 5.37 (56.3%). Conclusion: The spectrum of placenta accreta was found with grade II lacunae, loss of basal hypoechoic zone, myometrial thickness &lt;1 mm, anterior placenta location, regular vesicouterine border, no exophytic mass, no bridging vessels, no feeding vessels, loss of placental basal Doppler image, there was no hypervascularity in the vesicouterine area, no vascular lacunae turbulence and the highest PAI score with a value of less than 5.37.

Features of the sonographic picture in female veterans of reproductive age who suffered injuries during combat actions

The objective: to study the features of the sonographic picture of the pelvic organs in women of reproductive age who took part in combat operations and suffered a concussion. Materials and methods. Ultrasound examination of the pelvic organs with Doppler study on the 5th and 21st days of the menstrual cycle was performed in 457 women of reproductive age who took part in combat operations and suffered a concussion. 246 patients of theses persons with a history of trauma without post-concussion syndrome were included in the comparison group, 211 women with consequences of concussion in the form of post-concussion syndrome – in the main group. The control group included 30 healthy civilian women of reproductive age. The concentration of progesterone in blood serum was studied in all subjects on the 5th and 21st days of the menstrual cycle. The average age of women was 37.08±4.23 years. The period of stay in the combat zone was 60.26±42.21 months, the time since the traumatic brain injury (concussion) was 18.8±9.2 months. Results. In patients of the main group without hyperplastic processes of the endometrium the M-echo thickness on the 21st day of the menstrual cycle was 1.12 times less (p&lt;0.001) than in the control group, and 1.15 times less in patients in the comparison group (p&lt;0.001). In 20.71 % of women with a contusion during combat operations, there is an inferior secretory transformation of the endometrium with increased echogenicity only in the peripheral parts of the M-echo with a hypoechoic zone in the center, in 13.81 % of patients there are no secretory changes in the endometrium on echograms, which manifested by the preservation on the 21st day of its three-layer construction, typical for the preovulatory period, with a hypoechoic functional layer. Intrauterine synechiae are formed in 10.95 % of women who suffered contusions during combat operationss, hyperplastic endometrial processes – 30.24 % of women, 12.3 8% of which had hyperplasia, 17.86 % –endometrial polyps.In patients who suffered a contusion during combat operations a decrease in the vascularization of the corpus luteum with a significant increase in the resistance index of blood flow in the corpus luteum by 1.27 times and a decrease in the maximum systolic velocity by 1.19 times was, in the subjects of the main group compared to women of the comparison group – 1.07 (p&lt;0.01) and 1.05 (p&lt;0.01) times, respectively. On the 21st day of the menstrual cycle in women who took part in combat operations and had concussion, a correlation between the level of serum progesterone and the index of blood flow resistance in the corpus luteum – r=-0.76, p&lt;0.05, as well as maximum systolic blood flow velocity - r=0.70, p&lt;0.05 was established. Conclusions. According to the ultrasound examination of the pelvic organs for women of reproductive age who took part in combat operations and suffered a concussion, ultrasound changes in the structure of the tissues of the pelvic organs and their vascularization are typical, in particular, the thickening of the M-echo on the 21st day of the menstrual cycle, and in a third of cases – the presence of hyperplastic changes of the endometrium.

Development of Tough Hydrogel Phantoms to Mimic Fibrous Tissue for Focused Ultrasound Therapies.

Tissue-mimicking gels provide a cost-effective medium to optimize histotripsy treatment parameters with immediate feedback. Agarose and polyacrylamide gels are often used to evaluate treatment outcomes as they mimic the acoustic properties and stiffness of a variety of soft tissues, but they do not exhibit high toughness, a characteristic of fibrous connective tissue. To mimic pathologic fibrous tissue found in benign prostate hyperplasia (BPH) and other diseases that are potentially treatable with histotripsy, an optically transparent hydrogel with high toughness was developed that is a hybrid of polyacrylamide and alginate. The stiffness was established using shear wave elastography (SWE) and indentometry techniques and was found to be representative of human BPH ex vivo prostate tissue. Different phantom compositions and excised ex vivo BPH tissue samples were treated with a 700-kHz histotripsy transducer at different pulse repetition frequencies. Post-treatment, the hybrid gels and the tissue samples exhibited differential reduction in stiffness as measured by SWE. On B-mode ultrasound, partially treated areas were present as hyperechoic zones and fully liquified areas as hypoechoic zones. Phase contrast microscopy of the gel samples revealed liquefaction in regions consistent with the target lesion dimensions and correlated to findings identified in tissue samples via histology. The dose required to achieve liquefaction in the hybrid gel was similar to what has been observed in ex vivo tissue and greater than that of agarose of comparable or higher Young's modulus by a factor >10. These results indicate that the developed hydrogels closely mimic elasticities found in BPH prostate ex vivo tissue and have a similar response to histotripsy treatment, thus making them a useful cost-effective alternative for developing and evaluating different treatment protocols.

Predicting Placenta Accreta Spectrum Disorders in a Cohort of Pregnant Patients in the North-East Region of Romania-Diagnostic Accuracy of Ultrasound and Magnetic Resonance Imaging.

Background: Placenta accreta spectrum (PAS) disorders are associated with high mortality and morbidity due to postpartum hemorrhage, hysterectomy, and organ injury, and a multidisciplinary team is required for an individualized case management. In this study, we assessed the diagnostic and prognostic accuracy of the most important ultrasonographic (US) and magnetic resonance imagining (MRI) markers for PAS disorders. Material and Methods: The study included 39 adult pregnant patients with at least one previous cesarean delivery and both US and MRI investigations for placenta previa evaluated at the tertiary maternity hospital ‘Cuza Voda’, Iasi, between 2019 and 2021. The following US signs were evaluated: intra-placental lacunae, loss of the retroplacental hypoechoic zone, myometrial thinning < 1 mm, bladder wall interruption, placental bulging, bridging vessels, and the hypervascularity of the uterovesical or retroplacental space. The MRI signs that were evaluated were intra-placental dark T2 bands, placental bulging, loss of the retroplacental hypointense line on T2 images, myometrial thinning, bladder wall interruption, focal exophytic placental mass, and abnormal vascularization of the placental bed. Results: The US and MRI signs analyzed in our study presented adequate sensitivities and specificities for PAS, but no sign proved to be a useful predictor by itself. The presence of three or more US markers for accretion was associated with a sensitivity of 84.6.6% and a specificity of 92.3% (p < 0.001). The presence of three or more MRI signs supplemented these results and were associated with a sensitivity of 92.3% and a specificity of 61.5% for predicting PAS (p < 0.001). Moreover, US and MRI findings were correlated with FIGO grading and severity of PAS. Conclusions: Even though no US or MRI finding alone can predict PAS with high sensitivity and specificity, our study proves that the presence of three or more imagistic signs could significantly increase the diagnostic accuracy of this condition. Furthermore, US and MRI could be useful tools for evaluating prognostic and perinatal planning.

Sonographic Features in the Placenta Accreta Spectrum

Background: Abnormally invasive placenta is defined as abnormal adhesion to the implantation site, it is a spectrum of abnormal placentation that leads to obstetric hemorrhage, knowledge of risk factors and ultrasound evaluation is what allows antenatal diagnosis allowing transfer to specialized centers, surgical planning, and modifying the maternal outcome, causing a decrease in maternal morbidity and mortality. Objective: To describe the main ultrasound signs found in patients diagnosed with abnormally invasive placenta. Methodology: Cross-sectional, descriptive, retrospective study, carried out through a bibliographic review in the databases of PubMed, Scholar.google.com, SciELO, MEDLINE, of articles published in English and Spanish between 1992 and 2020. The following methods were used. Keywords Mesh (Medical Subject Headings): placenta accreta; previous placenta; prenatal diagnosis; abnormally invasive placenta; placenta percreta; abnormally attached placenta. Inclusion criteria: case report-type articles that include pregnant patients with placenta accreta, associated risk factors and diagnostic evaluation sections, as well as a systematic review and meta-analysis on the prenatal diagnosis of placenta accreta, whose results were analyzed by analysis of frequency. Results: From the reviewed studies, it was observed that 66.7% of the patients had cesarean section as the predominant uterine surgery, ultrasound findings such as the loss of the hypoechoic zone in 35.7% of the cases; the presence of placental lacunae in 28.6%; myometrial thinning in 16.7%; as well as disruption of the uterus-bladder interface in 7.1%, in 54.8% intraoperative diagnosis was made. Conclusions: Placental accreta is an increasingly frequent pathology, the incessant search for alternatives to reduce maternal death, the ultrasound characterization of the most frequent signs help timely prenatal detection

Pathogenetic Mechanisms of Relationship of Metabolic and Morphofunctional Disorders of Thyroid and Adrenal Glands in Diabetes Mellitus and Obesity

Pathogenetic Mechanisms of Relationship of Metabolic and Morphofunctional Disorders of Thyroid and Adrenal Glands in Diabetes Mellitus and Obesity

Effectiveness of Ultrasound Screening for a Placenta Accreta Spectrum Using Standard Ultrasound Criteria in a Secondary Care Setting

Objectives: Ultrasound detection of a placenta accreta spectrum (PAS) among women at risk is a key goal to reduce obstetric morbidity, but there is scarce information on its performance in real clinical settings. We report the effectiveness of a standardized ultrasound protocol to detect PAS in women with placenta previa (PP) in a secondary-level hospital. Methods: A retrospective analysis, including a cohort of 126 women with persistent PP among 27,975 pregnancies between 2008 and 2020, was performed. All 126 women underwent standardized transabdominal and transvaginal ultrasound scan that assessed 5 criteria: (1) loss of hypoechoic retroplacental zone and/or myometrial thinning <1 mm; (2) lacunar images with a flow of >15 cm/s; (3) thick and bulging placenta; (4) thinning or interruption of the uterine-bladder serous interface; and (5) placental or uterovesical hypervascularity. The presence of at least one criterion was considered a high risk for PAS. Diagnosis of PAS was confirmed during the caesarean section and by histopathological analysis. Results: Among 126 women with PP, 11 (8.7%) cases of PAS were diagnosed, of which 10 were detected prenatally by ultrasound scan. This resulted in a sensitivity of 90.9%, a specificity of 98.3%, a positive predictive value of 83.3%, and a negative predictive value of 99.1%. Histopathological assessment showed 6 placenta increta (54.5%), 4 percreta (36.4%), and 1 accreta (9.1%). All 10 cases of invasive placenta presented more than 3 ultrasound criteria. Conclusions: Standardized ultrasound screening protocol in women at risk due to PP in the third trimester was highly effective in detecting PAS in a secondary-level hospital setting.

POINT-OF-CARE ULTRASOUND IN THE EARLY DIAGNOSIS OF NECROTIZING FASCIITIS.

The aim: To detect the ultrasonographic signs of necrotizing fasciitis (NF) suitable for its early diagnosis. Materials and methods: Eigty two patients with soft tissue infection, including 14 with necrotizing faciitis, were examined by ultrasonography at the admission. Ultrasonografic features were compared to intraoperative findings by the same surgeon. Results: The thickening of subcutaneous tissue had high sensitivity (100%), but low specificity (5.8%). The hypoechoic and hyperechoic zones had the shape of "cobblestone" with sensitivity - 78.5%, specificity - 33.8%. Higher specificity (69.1%) had sign of "cobblestone separation" on two layers. The presence of fluid above the fascia (sensitivity - 71.4%; specificity - 69.1%), thickening of the fascia (sensitivity - 85.7%; specificity - 58.8%), indistinctness of the fascia edges (sensitivity - 85.7%; specificity - 66.1%) and loss of fascial homogeneity (sensitivity - 71.4%, specificity - 66.1%) were noted in early stages of NF. Advanced cases of NF were accompanied by the dissection of thick¬ened fascia with a strip of fluid (sensitivity - 57.1%, specificity - 92.6%) and accumulation of a fluid under the fascia (sensitivity - 28.5%, specificity - 95.5%). The muscles thickening (sensitivity - 28.5%; specificity - 67.6%), skin thickening (sensitivity - 57.1%; specificity - 58.8%), and loss of the skin's lower edge clarity (sensitivity - 57.1%; specificity - 63.2%) don't have diagnostic value without other signs of NF. Conclusions: Point-of-care ultrasonography allows visualization of soft tissue changes that may be hidden in the initial stages of necrotizing fasciitis and should be recommended for implementation as mandatory method of examination in patients with suspected surgical soft tissue infection.

Comparative study of Cripto-1 in placenta accreta and normal placenta

Background: Placenta accreta (PA) is a life-threatening condition that endangers both the mother and infant. PA can result in postpartum haemorrhage, coagulation dysfunction, and puerperal infection. Cripto-1 is a glycosylphosphatidylinositol-anchored small molecular signalling protein and a member of epidermal growth factors EGF-CFC family. The purpose of this research was to study Cripto-1expression in placenta accreta and normal placenta, compare intensity of staining in both placenta accrete and normal placenta and throw light on possible role of cripto-1in invasion of the trophoblast through the myometrium. Methods: This study included 50 pregnant females with a singleton pregnancy. By ultrasound patients were classified into 2 equal groups: PA group diagnosed by (Loss of normal hypoechoic retroplacental zone, Retroplacental myometrial thickness of 1 mm, Blood vessels or placental tissue bridging uterine-placental margin, myometrial-bladder interface, or crossing uterine serosa, Multiple vascular lacunae within placenta, giving “Swisscheese” appearance) and normal Placenta (NP) group. All patients were subjected to doppler U/S, specimen collection, immunohistochemistry and Western blot. Results: There was a significant association between accreta and control groups as regard Cripto-1 levels (P= 0.001). There was a significant relationship between degree of invasion and cripto-1 levels in accreta group (P-value = 0.001). The incidence of complications was insignificantly different in comparison to Cripto-1 levels in accreta group. Conclusions: The increase in cripto-1 is related to the increase in the degree of invasion of the placenta, yet our study recorded that the severity of complications was insignificantly different among the different Cripto-1 levels in accreta groups. Therefore, we can correlate the risk of complications to the degree of invasion.

Multiple posttraumatic pseudoaneurisms of the spleen in a 13-year old child

Introduction. Until now, there is an ongoing controversy regarding the curative strategy in spleen pseudoaneurysms which are detected by CT imaging.Purpose. To present a diagnostic and curative algorithm for treating spleen injury complicated by multiple pseudoaneurysms in a 13-year-old child.Observation. A 13-year-old boy was injured in a traffic accident (a cyclist hit by a car) and was admitted to the hospital by an ambulance with brain concussion, abrasions and bruises of soft tissues. On the second day after the injury, the child complained of the pain in the left lumbar region. Multiphase spiral computed tomography (MSCT) revealed damage of the lower pole of the spleen with formation of multiple round hyperdense formations in the arterial phase disappearing in the portal phase. Ultrasound examination revealed multiple hypoechoic zones up to 8 mm in diameter in the lower pole of the spleen, in which blood flow was seen at the color Doppler mapping (CDM). Diagnosis: closed trauma of the spleen, Grade 4 (AAST). Multiple pseudoaneurysms of the lower pole of the spleen. Repeated MSCT on the 6th day after the injury registered disappearance of pseudoaneurysms, like it was at the ultrasound examination. In six months after the injury, there were no complaints; spleen structure at ultrasound examination corresponded to age normal parameters.Conclusion. The presented clinical observation demonstrates the success of conservative treatment of spleen injury complicated by the formation of multiple pseudoaneurysms.

Differentiation between pancreatic metastases from renal cell carcinoma and pancreatic neuroendocrine neoplasm using endoscopic ultrasound

ObjectivesPancreatic metastases from renal cell carcinoma (PRCC) often appear many years after treatment of the primary tumor, and differentiation from pancreatic neuroendocrine neoplasm (PanNEN) can be challenging due to their hypervascularity. Here, we investigated the utility of endoscopic ultrasound (EUS) for differentiation of these conditions. MethodsA retrospective analysis was performed in 17 and 79 consecutive patients with pathologically proven PRCC and non-functional PanNEN who were examined by EUS. In cases examined by EUS elastography or contrast-enhanced harmonic EUS (CH-EUS), the lesions were classified as stiff or soft, or into three vascular patterns as hypoechoic, isoechoic, and hyperechoic. CH-EUS images at 20 s, 40 s, 60 s, 3 min and 5 min were used for evaluation. EUS images were independently reviewed by two readers who were blinded to all clinical information. ResultsThe patients with PRCC were significantly older than those with PanNEN (median, 71 (range, 45–81) vs. 58 (22–76), P = 0.001) and more often had multiple tumors (6/17 (35%) vs. 7/79 (9%), P = 0.010). In EUS findings, PRCC lesions significantly more frequently had a marginal hypoechoic zone (MHZ) (11/17 (65%) vs. 27/79 (34%), P = 0.028), being classified as soft (12/13 (92%) vs. 26/58 (45%), P = 0.002), and showed sustained hyperechoic vascular patterns at 5 min (7/8 (88%) vs. 4/59 (7%), P < 0.001) compared to PanNEN lesions. ConclusionsThe presence of a MHZ, a soft lesion, and a sustained hyperechoic vascular pattern in EUS may be useful for differentiating PRCC from PanNEN.

Suspected Placenta Accreta: Using Imaging to Stratify Risk of Morbidity.

This study was aimed to compare clinical outcomes and use of interventions in women with suspected accreta based on the degree of antenatal suspicion. This was a retrospective cohort study of women with suspected accreta from 2007 to 2019. Included patients had one or more imaging studies suggestive of accreta. Cases were classified as "lower risk" if imaging showed possible signs of accreta including mild or superficial myometrial infiltration, an abnormal uterine contour, an abnormal uteroplacental interface, or loss of the retroplacental hypoechoic zone and "higher risk" if there was clear evidence of more than superficial myometrial infiltration, placental tissue extruding beyond the uterine serosa, bridging vessel(s), or placental lacunae with high velocity and/or turbulent flow. The primary study outcome was a composite maternal morbidity including cesarean hysterectomy, transfusion of blood or blood products, unintentional cystotomy, or intensive care unit (ICU) admission. Chi-square, Fisher's exact test, and Mann-Whitney U-test were used for analysis. A total of 78 women had a suspected accreta on imaging, 36 with "lower risk" features and 42 with "higher risk" features. There were no differences in baseline maternal demographics. Women in the "higher risk" group were more likely to have a placenta previa (p < 0.01) and preoperative consultation with gynecologic oncology (p = 0.04). There was a significant difference in composite maternal morbidity between patients with "lower risk" and "higher risk" features of accreta on imaging (50 vs. 92.9%, p < 0.01). Median gestational age at planned and actual delivery were earlier in the "higher risk" group (36.6 vs. 34.9 weeks, p < 0.01; 36.0 vs. 34.7 weeks, p < 0.01). Stratification of women with suspected accreta based on imaging corresponded to rates of maternal morbidity and operative complications, and appears to have been used clinically in selecting timing of delivery and interventions. · Increased morbidity with high risk accreta imaging.. · Interventions correlate with accreta imaging risk.. · Imaging can be used to stratify accreta cases..