Ultrasound Findings Research Articles

Surgical decision-making: key factors influencing the shift from laparoscopic to open cholecystectomy

Background: Recognizing the preoperatively and intraoperatively factors can aid surgeons in making timely decisions to shift from laparoscopic cholecystectomy (LC) to open cholecystectomy (OC). This study aims to identify the main factors leading to LC conversion to OC among Iraqi patients. Methods: One-year prospective research was performed using cross-sectional design between 1st April, 2023, and 3oth March, 2024, at Alkalis General Public Hospital and Al Hayat Private Hospital, Diyala, Iraq. Pre and intraoperative data were collected from the planned LC surgeries including demographics, medical history, laboratory and Ultrasound findings. Descriptive and bivariate analysis was carried out to compare variables between patients undergoing LC and those requiring conversion to OC. Results: Out of 172 LC patients (mean age 48.28±12.62), 52.9% were female, 55.8% obese, 50.6% aged 49+, 23.3% diabetic, and 19.8% had emergency cholecystectomy; 15 (8.7%) required conversion to open surgery. The conversion group was mainly men (66.7% vs. 46.5%, P = 0.001) and older (73.3% vs. 48.4% aged 49+, P = 0.003). Obesity (60.0% vs. 55.4%, P = 0.005) and diabetes (53.3% vs. 20.4%, P < 0.001) were more common. Public hospital referrals were higher (86.7% vs. 52.2%, P < 0.001). Elevated total bilirubin, direct bilirubin, and alkaline phosphatase levels were significant predictors of conversion to OC. Adhesions in Calot's triangle (20.0% vs. 13.4%, P = 0.021) were more common in the conversion group, along with unclear anatomy, thick gallbladder wall, bleeding, stone and bile spillage, and cystic duct injury. Conclusion: In conclusion, out of 172 LC patients, 15 (8.7%) required conversion to open surgery, predominantly older men with higher obesity, diabetes, and elevated bilirubin and alkaline phosphatase levels, and more adhesions in Calot's triangle.

Obstetric and neonatal outcomes in pregnancies complicated by placental abruption with vs. without supporting sonographic findings- A retrospective cohort study

Placental abruption (PA) is a major obstetric complication associated with worse maternal and neonatal outcomes. Though ultrasound findings may support the diagnosis of PA, the association of such findings to the severity of PA and maternal and neonatal outcomes is not yet clear. We aimed to assess the maternal and neonatal outcomes of PA cases with vs. without related sonographic findings. In this retrospective cohort study, all deliveries complicated by PA between 2009 and 2022 were included. Placental histopathology, obstetric, and neonatal outcomes were compared between cases of PA with vs. without supporting sonographic findings. A composite of severe neonatal morbidity was compared between the groups, including ≥1 of the following: seizures, intraventricular hemorrhage, hypoxic-ischemic encephalopathy, periventricular leukomalacia, respiratory-distress syndrome, sepsis, anemia, blood transfusion or death. Of the 420 cases with PA eligible for the study, 50 patients (12%) were in the PA with sonographic features group and 370 (88%) were in the PA without sonographic features group. The PA with sonographic features group was characterized by significantly higher rates of prematurity (p<0.001), severe composite adverse neonatal outcome (p<0.01), and a composite maternal vascular malperfusion lesions in placental histopathology (p=0.001) In multivariable regression analyses, preterm birth was independently associated with the presence of sonographic features (aOR=8.79, 95% CI 2.41-31.93, p<0.001). PA with supporting sonographic features is associated with higher rates of adverse obstetric and neonatal outcomes and placental lesions. These findings emphasize the importance of sonographic evaluation for every case of PA before deciding upon management.

B-mode, Doppler, and Elastography abdominal ultrasound in Tamandua tetradactyla.

The aim of this study was to describe the normal B-mode, Doppler, and 2D Shear Wave Elastography ultrasonographic findings of some abdominal structures in a six-month-old male Southern Tamandua (Tamandua tetradactyla). The animal was found and rescued by the environmental police after being discovered in the wild near its mother, who had died in a car accident. For the ultrasonographic exams, the animal's abdominal region was shaved, and only physical restraint was used. In the B-mode exam, the urinary bladder, small intestine, kidneys, left adrenal gland, stomach, liver, and gallbladder were located and evaluated. Doppler examination obtained spectral tracings of the arcuate and renal arteries of both kidneys. Elastography assessed the stiffness of the renal cortex, liver, and spleen. The ultrasound examination provided an adequate evaluation and novel findings of the Southern Tamandua abdominal structures without invasiveness.

Hallazgos bioquímicos y ecográficos en caninos obesos

The aim of this study was to identify comorbidities in obese canines attending Centro de Veterinaria y Zootecnia CES, Medellín, Colombia. Thirty canines with a body condition of 7/9 to 9/9 were evaluated. Those with signs of systemic disease or endocrinopathy were excluded. An evaluation of body condition, abdominal ultrasound (with emphasis on pancreas, liver and adrenal glands), non-invasive blood pressure measurement and blood analysis of cholesterol, triglycerides, glucose and canine-specific pancreatic lipase (cPLI) were performed. The results showed that 19 individuals presented hypertriglyceridemia, and those with higher triglyceride values presented ultrasound findings of vacuolar liver disease (p&lt;0.01). Systolic blood pressure, cholesterol, glucose and cPLI were found within normal ranges and without differences between body condition ranges. The importance of including abdominal ultrasound in the diagnosis of obese patients is highlighted. It is concluded that hypertriglyceridemia associated with obesity leads to the accumulation of hepatic fatty infiltrates and vacuolar liver disease.

Evaluation of Etiological Causes and Demographic Characteristics of Neonatal Seizure in Adiyaman University Training And Research Hospital, Türkiye: A Retrospective Study

Aim: Neonatal seizures are different from seizures seen at other ages in terms of etiology, clinical follow-up, treatment and prognosis. The purpose of this study was to determine the etiological causes and demographic characteristics of neonates admitted due to seizures in the neonatal intensive care unit. Methods: This is an original study involving newborns hospitalized for seizures in the neonatal intensive care unit at Adıyaman University Training and Research Hospital. The files of 40 patients followed up due to seizures between September 2016 and July 2021, were examined retrospectively. 40 out of 45 patients satisfied the inclusion criteria. The files of 40 patients were retrospectively analyzed in terms of age, sex, gestational age, birth weight, mode of delivery, APGAR score, seizure etiology, intervention and treatment, electroencephalography (EEG), trans fontanel ultrasonography (USG) and brain magnetic resonance imaging (MRI) findings, length of hospital stay, and mortality rates. Results: The study group consisted of 40 patients, 21 girls (52.5%) and 19 boys (47.5%). Twenty-seven (67%) of the patient group were born at term and 13 (33%) preterm. The mean birth week was 38, and the mean birth weight was 2900 g. The underlying seizure etiology was unknown in 37.5% (n = 15) of cases, while the most common known etiological cause was hypoxic ischemic encephalopathy, seen in 20% (n = 8). The mortality rate in our patient group was 22.5% (n = 9). Conclusion: Among the known causes of neonatal convulsions, hypoxic-ischemic encephalopathy in term babies and germinal matrix bleeding in preterm babies were found to be the most common causes. However, despite all kinds of examinations and evaluations, the cause of a significant portion of them has not been determined. Long-term follow-up of newborns with convulsions is required to detect early neurodevelopmental problems that may develop during follow-up.

A Comparison of the Alvarado Score and the Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) Score in the Diagnosis of Acute Appendicitis: A Prospective Cohort Study.

Background Diagnosing acute appendicitis remains a problem, especially in teenagers with right lower quadrant pain.Imaging studies aid in accurate diagnosis but have limitations such as cost and availability. The Modified Alvarado Scoring System (MASS) is simple and cost-effective with fewer parameters. The Raja Isteri Pengiran Anak Saleha Appendicitisscoring system (RIPASA), designed for Asian populations, includes more parameters. This study compares the effectiveness of RIPASA and Alvarado scores in diagnosing acute appendicitis in a specific clinical setting. Objectives To compare the scoring systems of RIPASA and Alvarado in the diagnosis of acute appendicitis at a tertiary care hospital. Methods Data has been collected from all patients who attended the NRI general hospital emergency department and outpatient wing with acute appendicitis, admitted as inpatients based on clinical history and relevant investigations. Patients satisfying inclusion and exclusion criteria were selected and the basic investigations were done. Summary statistics were done using mean, standard deviation and proportions. Inferential statistics were done by using an independent t-test, kappa statistic, sensitivity and specificity with a 95% confidence interval (CI). All the measurements are done using the statistical package for the social sciences (SPSS) software version 21.0 (IBM Corp., Armonk, NY, USA) and open epidemiological (OpenEpi) software 3.01. A probability (p) <0.05 is considered as statistically significant. Results A total of 110 patients were analyzed for this study with a majority (39%) of them in the 21-30 age group. In our study, females (53%) outnumbered males (47%). Ultrasound findings in our cohort were acute appendicitis (93%), chronic appendicitis (2%) and normal appendix (5%). However, histopathology reported acute appendicitis (75%), chronic appendicitis (9%) and negative/non-specific (15%). The probability of appendicitis as predicted by Alvarado and RIPASA were 40% and 51% respectively. Definitive diagnosis of appendicitis was made in 16.4% with RIPASA whereas only 5.5% with Alvarado. When comparing the Alvarado and RIPASA scores, the sensitivity or true positive rate was higher for RIPASA (73.63%) than for Alvarado (50.55%). Conclusion There was a significant difference between the mean scores in Alvarado and RIPASA inpatients with scores suggestive of appendicitis and no appendicitis. Diagnostic accuracy was higher in RIPASA scoring compared to ALVARDO scoring. There was a significant statistical difference between the two scoring systems. When it comes to diagnosing in low-resource countries the study recommends a combination of Alvarado and RIPASA scoring systems.

Ultrasound-guided staging and reversal of female genital mutilation.

FGM/C is common, effecting over 200 million women worldwide and has substantial associated morbidity. We seek improving the reversal procedure using ultrasound imaging. The use of peri- and intraoperative ultrasound imaging for reconstructive surgery following FGM/C for staging and surgical planning, with focus on the clitoral structures and blood flow. This is a case series of patients with FGM/C who were evaluated and underwent reconstructive surgical management at a single institution between 2018 and 2022. Ultrasound examination with Doppler imaging was performed. The electronic medical record was queried for data regarding patient characteristics, examination and ultrasound findings, and surgical and postoperative course. Seven patients are described in this case series who sustained the FGM/C with classifications ranging from Ia to IIIb. The primary complaints were dyspareunia or apareunia. Six of seven (86%) reported anorgasmia. Four of seven (57%) had prior vaginal deliveries, and one of seven (14%) was delivered only by cesarean sections, two of seven (29%) have not been able to have intercourse. Ultrasound examination was utilized to facilitate recognition of the anatomic structures during the reconstruction, and Doppler was used to evaluate the clitoral blood flow. Doppler was useful to delineate clitoral tissues from a closely involved periclitoral inclusion cyst, aiding in surgical excision while minimizing clitoral vascular or nerve injury. Postoperative anatomical restoration, sexual function, and alleviation of dyspareunia were excellent. None of the patients reported decreased sexual pleasure postoperatively. Ultrasound imaging with Doppler can be utilized to facilitate personalized approaches to optimize both anatomical and functional results in cases of genital reconstruction.

Veins in the Lateral Fascial Compartment of the Calf

Venous insufficiency mostly arises from valvular incompetence in the great saphenous vein (GSV) and small saphenous vein (SSV). However, non-saphenous reflux (NSR) remains relatively unexplored in clinical practice and ultrasound investigations. This study reports an uncommon anatomical finding and the associated venous reflux, which is believed to involve the peripheral nerve. A systematic database search was conducted to identify patients from our clinic previously diagnosed with an interfascial vein in the lateral calf compartment during duplex ultrasound examination. Subsequently, a questionnaire was distributed to those who volunteered to participate, collecting further demographic details and clinical information related to peripheral neuropathy of the calf. Ultrasound findings, including venous competency and diameter measurements, were included for data analysis. In total, 20 legs with an interfascial vein were identified from 19 patients between 2008 and 2022. Of the 6 patients who returned the questionnaire and provided consent for inclusion, 2 reported lateral calf pain in the lower calf. Calf numbness was noted in 2 patients, primarily affecting the upper and mid portions with 2 further patients reporting foot drop. Reflux flow in the interfascial vein was detected in 5 patients. Sonographic findings revealed interfascial vein diameters range from 1.1 to 4.0 mm, with a mean of 2.4 mm. The distance between the interfascial vein and SSV varied, with a mean of 36.3 mm. Based on topographic anatomy and reflux flow originating from sciatic nerve varices, we hypothesize that the interfascial vein identified in our patients likely represents the superficial peroneal nerve vein. This study sheds light on the existence of an interfascial vein in the lateral calf compartment and its role in producing lateral calf neuropathy.

Glomus tumor of gastric antrum: A rare differential

Introduction: Gastric glomus tumor is a rare clinical entity. Surgical excision could be avoided in selected patients if the diagnosis of glomus tumor could be made preoperatively. Cross-sectional imaging and endoscopic ultrasound (EUS) provide vital clues to nudge us in the right direction; however, these are inconclusive. Histopathology remains the gold standard for diagnosis of this condition. Case Report: We report a case of a man in his 60s who presented to the surgical outpatient clinic with long-standing history of abdominal bloating and discomfort. Upper gastrointestinal endoscopy revealed a submucosal lesion, and contrast-enhanced computed tomography (CECT) of the abdomen revealed a homogeneously enhancing lesion in the antrum of the stomach. Following successful surgical excision, histopathological examination established the diagnosis of gastric glomus tumor. This case presentation elaborates on the clinical features of this rare clinical entity and the various options available for diagnosis and management. Conclusion: Glomus tumors are rare mesenchymal tumors that need to be differentiated from other submucosal lesions and should be considered as a differential for submucosal lesions in the distal stomach. Endoscopic ultrasound and CT findings may provide clues to guide us toward the diagnosis; however, diagnosis can be confirmed only with histopathology. Surgical excision with negative margins either by laparoscopic or open operation is the treatment of choice.

Role of targeted ultrasound for the diagnosis of rib fracture, a comparative study with plain x-ray

Background and objective: Thoracic injuries are a common presentation in emergency hospitals in the Kurdistan region, mainly caused by road traffic accidents. Early and accurate diagnosis of rib fractures is essential in saving lives and preventing complications. The objective was to assess the validity of ultrasound in the diagnosis of rib fractures in comparison to plain x-ray. Methods: Present study was a cross-sectional study carried out in the Emergency department of Rozhalat Hospital in Erbil city-Kurdistan region/Iraq over ten months, from August 2021 to May 2022, on a sample of fifty-five (55) patients with suspected rib fractures. Rib fractures were diagnosed by the researcher based on clinical, ultrasound, and x-ray findings, and the findings of rib fracture were confirmed by CT-scan. All imaging methods were done at the Radiology department of Rozhalat hospital. Results: The validity findings of ultrasound examination taking CT scan as the gold standard was as follow: (97.7% sensitivity, 63.6% specificity, and 90.0% accuracy), while the validity findings of x-ray examination taking CT scan as the gold standard were (56.8% sensitivity, 54.5% specificity and 56.3% accuracy). The validity of ultrasound in detecting cortical disruption or hematoma was (93.8% sensitivity, 43.6% specificity, and 58.1% accuracy), while the validity of CXR in the detection of displacement was (31.3% sensitivity, 84.6% specificity, and 48.7% accuracy). Conclusion: Sonograph is an accurate diagnostic tool for detecting rib fracture with superior validity compared to a chest x-ray.

Abdominal ultrasound has inconsistent agreement with subsequent surgery or necropsy findings in dogs and cats with septic peritonitis.

To evaluate whether abdominal ultrasound correctly diagnosed septic peritonitis and correctly identified its causative lesion in dogs and cats. 84 client-owned dogs and 10 cats that underwent an abdominal ultrasound and had confirmation of septic peritonitis via exploratory laparotomy or necropsy. This retrospective case series documented abdominal ultrasound findings, surgical or necropsy findings, and method for initial diagnosis of septic peritonitis, if different from surgery or necropsy. The surgical report and necropsy findings were compared to sonography results to confirm a diagnosis of septic peritonitis. The frequency at which sonography diagnosed septic peritonitis and its causative lesion was calculated for each type of lesion pathology and organ system. Secondary aims included evaluating the effect of patient characteristics (body weight and species) on sonographic results and whether lesion type or location affected mortality. Most lesions causing septic peritonitis (70.2%) were gastrointestinal in origin and were nonneoplastic ulcerations or perforations (50%). Abdominal ultrasound diagnosed 56.3% of cases of subsequently confirmed septic peritonitis and correctly identified 67% of the causative lesions. Lesions of the gastrointestinal tract and ulcerations/perforations were the most frequent correct sonographic diagnoses and most likely to lead to a correct sonographic diagnosis of septic peritonitis. Lesions located in the hepatobiliary system and lesion types other than neoplasia or ulcerations/perforations were the most frequently missed by abdominal ultrasound. Abdominal ultrasound often fails to diagnose septic peritonitis or the underlying causative lesion, and its accuracy depends on the affected organ and type of lesion.

Sonographic findings using the SAFE-A protocol in pre- and post-hemodialysis patients

BackgroundAccurate assessment of relative intravascular volume is one of the cornerstones for the proper management of hospitalized patients requiring hemodialysis. Currently, the use of dynamic parameters such as bedside ultrasonography is recommended to support the assessment of the intravascular volume profile. This study aimed to prospectively evaluate findings of sonographic assessment of intravascular volume estimate (SAFE-A) protocol among hemodialysis inpatients with end-stage renal disease, before and after the hemodialysis sessions, and correlate these findings with the net ultrafiltrate (UFNET).ResultsA positive correlation was found between the negative variation of 1 point in the score of the SAFE-A protocol with the withdrawal of 426.73 mL of net ultrafiltrate.ConclusionsThere was a strong correlation between the score of the SAFE-A protocol and the net ultrafiltrate. Therefore, this study concludes that the application of the SAFE-A protocol in dialysis patients demonstrates a correlation between the suggested score and volume status, consistent with findings from the original study conducted in a distinct population.

Pre-Operative Calcitonin and CEA Values May Predict the Extent of Metastases to the Lateral Neck Lymph Nodes in Patients with Medullary Thyroid Cancer.

Background: In medullary thyroid cancer (MTC), lymph node metastases are often present at diagnosis and the extent of surgery is usually based upon pre-operative calcitonin and CEA levels as well as ultrasound findings. The aim of this study was to evaluate the role of pre-operative calcitonin and CEA levels as predictive markers of the burden of lymph node metastases at diagnosis. Methods: we conducted a retrospective study analyzing 87 MTC patients. Results: The median levels of calcitonin and CEA were 88.4 pg/mL and 7.0 ng/mL, respectively, in patients with no lymph nodes metastases; 108.0 pg/mL and 9.6 ng/mL, respectively, in patients with metastases to 1-5 lymph nodes; 520.5 pg/mL and 43.2 ng/mL, respectively, in patients with metastases to >5 lymph nodes. There were no significant differences in pre-operative calcitonin and CEA values between N0 and N1a patients, whereas they were significantly higher in N1b patients. Pre-operative cut-off levels distinguishing N0/N1a from N1b patients were 90 pg/mL for calcitonin (sensitivity 100%, specificity 59.3%, AUC = 0.82) and 17 ng/mL for CEA (sensitivity 100%, specificity 75%, AUC = 0.89). Conclusions: in patients with MTC, pre-operative serum calcitonin and CEA levels may drive the decision-making process to better define the extent of surgery.

Update on the Role of Imaging in the Diagnosis, Staging, and Prognostication of Gallbladder Cancer

AbstractGallbladder cancer (GBC) is a highly aggressive malignancy with dismal prognosis. GBC is characterized by marked geographic predilection. GBC has distinct morphological types that pose unique challenges in diagnosis and differentiation from benign lesions. There are no specific clinical or serological markers of GBC. Imaging plays a key role not only in diagnosis and staging but also in prognostication. Ultrasound (US) is the initial test of choice that allows risk stratification in wall thickening and polypoidal type of gallbladder lesions. US findings guide further investigations and management. Computed tomography (CT) is the test of choice for staging GBC as it allows comprehensive evaluation of the gallbladder lesion, liver involvement, lymph nodes, peritoneum, and other distant sites for potential metastases. Magnetic resonance imaging (MRI) and magnetic resonance cholangiopancreatography allow better delineation of the biliary system involvement. Contrast-enhanced US and advanced MRI techniques including diffusion-weighted imaging and dynamic contrast-enhanced MRI are used as problem-solving tools in cases where distinction from benign lesion is challenging at US and CT. Positron emission tomography is also used in selected cases for accurate staging of the disease. In this review, we provide an up-to-date insight into the role of imaging in diagnosis, staging, and prognostication of GBC.

Ultrasonographic measurements of gastro-soleus fascia thickness in midportion Achilles tendinopathy: A case-control study

BackgroundThe Achilles tendon is one of the thickest, largest, and strongest tendons in the human body. Biomechanically, the AT represents the conjoint tendon of the triceps surae muscle, placed in series with the plantar fascia (PF) to ensure force transmission from the triceps surae toward the toes during walking, running, and jumping. Commonly encountered in the diagnostic evaluation of heel pain, Achilles tendinopathy (AT) refers to a combination of pathological changes affecting the tendon itself often resulting from excessive repetitive stress and overuse. Nevertheless, increasing evidence demonstrates that structural alterations due to overuse or abnormal patterns of skeletal muscle activity are not necessarily restricted to the muscles or tendons but can also affect the fascial tissue. At the same time, there has been recent discussion regarding the role of the fascial tissue as a potential contributor to the pathophysiological mechanisms of the development of several musculoskeletal disorders including tendinopathies. To the best of our knowledge, ultrasound (US) imaging studies on the fascial structures related to the triceps surae complex, as well as their possible correlation with Achillodynia have never been presented in the current literature. MethodsIn the present study, a comparative US imaging evaluation of textural features of the suro-Achilleo-plantar complex was performed in 14 healthy controls and 14 symptomatic subjects complaining of midportion AT. The thickness of the Achilles tendon, paratenon, intermuscular fascia, and PF has been assessed with US. In addition, both groups underwent the Victorian Institute of Sport Assessment-Achilles (VISA-A), a disease-specific questionnaire that measures the severity of symptoms of AT. Correlations between quantitative ultrasound measures and VISA-A scores were determined through Pearson or Spearman's rho correlations. ResultsOur ultrasonographic findings revealed statistically significant differences (p<0.05) in Achilles tendon and paratenon thicknesses between AT patients and controls. No significant differences were observed between groups in PF at the calcaneal insertion as all mean measures were within the expected range of a normal PF on US imaging. In contrast, in tendinopathic subjects, the deep intermuscular fascia between medial gastrocnemius (MG) and soleus (SOL) muscles is significantly (p<0.01) and considerably thickened compared to those of healthy subjects. Moderate correlations exist between tendon and paratenon thicknesses (r= 0.54, p= 0.04) and between MG-SOL fascia and tendon thicknesses (r= 0.58, p= 0.03). Regarding symptom severity and US morphological findings, the Spearman ρ test showed no correlation. ConclusionsOur data demonstrate that, in symptomatic subjects, US alterations are not restricted to paratenon and intratendinous areas, but also affect upstream structures along the myofascial chain, resulting in thickening of the fascia interposed between MG and SOL muscles. Moreover, positive correlations were found between MG-SOL fascia thickening and abnormalities in AT, paratenon, and symptom severity. Thus, US alterations in the fascial system should be interpreted within the clinical context of patients with AT as they may in turn represent important predictors of subsequent clinical outcomes and could help healthcare professionals and clinicians to refine non-operative treatment strategies and rehabilitation protocols for this disease.

Ultrasonographic findings in the bladder of cattle at different stages of evolution of bovine enzootic hematuria in Brazil

Despite the diagnostic capacity of ultrasonography (US) in cases of bovine enzootic hematuria (BEH), it has been underused in the medical clinic for ruminants. Studies comparing ultrasound findings in healthy animals (HA) with subclinical (SCH) and clinical (CH) BEH are scarce in the literature. As a result, the present work aims to describe the US findings of cattle at different stages of BEH evolution, evaluating the diagnostic capacity and precocity of the technique. The study was carried out on five rural properties in the municipalities of Rio Preto and Bom Jardim de Minas – MG, Brazil, using 46 dairy cattle, females over 18 months of age, evaluated and classified as G1/CH, G2/SCH and G3/HA, according to history, clinical examination and urinalysis, with subsequent ultrasound analysis of the bladder. The mean bladder wall thickness was 36.50 mm in G1/CH, 33.53 mm in G2/SCH and 37.93 mm in G3/HA. Irregular walls were observed in 53.33 % (8/15) of G1/CH, 27 0.78 % (5/18) of G2/SCH and 38.46 % (5/13) of G3/HA. Loss of the architecture of the urothelium layers was observed in 53.33 % (8/15) of G1/CH, 33.33 % (6/18) of G2/SCH and 38.46 % (5/13) of G3/HA. Multifocal and Grade I lesion were the most common. Ultrasonography allowed the identification of lesions in 38.46 % of animals that did not present hematuria and in 33.33 % of animals that presented occult blood and proved to be an efficient technique for detecting pre-clinical cases of BEH, allowing easy identification. and early onset of BEH cases.

Predictive factors for iliac vein compression syndrome in patients with varicose veins.

This study aimed to identify predictors of iliac vein compression syndrome (IVCS) in patients with varicose veins and to evaluate the necessity of routine lower extremity venography for preoperative assessment of these patients. A retrospective analysis was conducted on data from 1165 patients with lower-limb varicose veins who underwent preoperative venography at Wuhan Union Hospital, Tongji Medical College, China, between January 2019 and September 2023. Logistic regression analyses identified factors associated with concurrent IVCS, and a nomogram was constructed based on these findings. Out of 1165 patients, 75 (6.4%) had IVCS according to venography and 769 had iliac vein ultrasound and found 2 (0.17%) positives. Multivariate analysis revealed the independent predictive value of left-sided involvement (odds ratio (OR) = 3.22, 95% confidence interval (CI): 1.24-8.33, p = 0.016), history of deep vein thrombosis (DVT) in the affected limb (OR = 3.11, 95% CI: 1.21-8.00, p = 0.018), pain (OR = 2.24, 95% CI: 1.17-4.26, p = 0.014), and positive results on iliac vein ultrasound (OR = 25.56, 95% CI: 2.10-311.26, p = 0.011) for the presence of IVCS in patients with lower-limb varicose veins. A nomogram incorporating these predictors demonstrated moderate predictive ability (AUV = 0.689, 95% CI: 0.607-0.771), with good calibration upon validation. Patients with left lower extremity varicose veins, pain symptoms, history of DVT in the affected limb, and positive iliac vein ultrasound findings are at a higher risk of concurrent IVCS. Patients with varicose veins who have the aforementioned risk factors may need to undergo preoperative angiography.

Role of oral hypoglycaemic drugs in preventing complication in non-alcoholic fatty liver disease with type 2 diabetes mellitus.

To determine the prevalence of non-alcoholic fatty liver disease, and the effect of oral hypoglycaemic drugs and lifestyle modifications in reducing fatty liver changes and liver enzymes in these patients. The comparative, observational study was conducted at the Department of Pharmacology, Sohail University, Karachi, from October 2022 to October 2023, and comprised patients of either gender having elevated liver enzymes and ultrasound finding of fatty liver changes along with raised glycated haemoglobin, transaminases, total cholesterol and triglycerides. The participants were prescribed oral hypoglycaemic agents by endocrinologists. Those given empaglifazolin + metformin were in group A, empaglifazolin + linglaptin in group B, sitaglaptin + metformin in group C, metformin alone in group D and sitaglaptin alone in group E. Lifestyle modifications were advised in all the treatment groups, while control group F was only advised lifestyle modifications. The intervention lasted 3 months. Investigations included B-mode ultrasound liver, liver enzymes and glycated haemoglobin, which were done at baseline and after the intervention. Data was analysed using SPSS 25. Of 200 patients, 40 were males and 160 were females in ratio of 1:4. The overall mean age was 48±16 years. There were 154(77%) patients who had non-alcoholic fatty liver disease with type 2 diabetes mellitus, while 46(23%) had only fatty liver changes. There were 50(25%) patients in group A, 30(15%) in group B, 30(15%) in group C, 40(20%) in group D, 10(5%) in group E and 40(20%) in group F. Post-intervention improvement was noted in 48(24%) patients, with 20(41.7%) of them being in group A. The prevalence of non-alcoholic fatty liver disease with type 2 diabetes was high. Combination of empagliflozin + metformin along with lifestyle modifications was highly effective in reducing fatty changes and the level of liver enzymes.

Lateral plantar fasciopathy: An frequently overlooked cause of atraumatic pain at the fifth metatarsal base

BackgroundLateral cord plantar fasciitis (LCPF) causes atraumatic pain at the fifth metatarsal base. This study assesses the outcomes of a conservative treatment (PRP + casting) on LCPF. MethodsMedical history, clinical diagnosis, and ultrasound imaging were used to determine LPCF. All patients received a leucocyte-poor PRP injection at the proximal part of the fifth metatarsal base, followed by three weeks in a walking cast. Follow-up questionnaires, encompassing NRS, AOFAS, and Foot Functioning Index (FFI), were administered at 6 weeks, 12 weeks, and 2 years post-treatment. ResultsTen patients were enrolled in the study. Ultrasound findings revealed hyposonant and thickened lateral fascia plantaris at the MT 5 insertion point with normal peronei tendons. There was a notable reduction in pain from pre-treatment (NRSrest 55.1 ± 29.6, NRSactivity 79.20 ± 15.5) to 6 weeks post-treatment (NRSrest: 22.4 ± 23.6, p = 0.03; NRSactivity: 38.6 ± 30.3, p = 0.005). FFI indicated an improvement between 12 weeks (25.7 ± 25.7) and 2 years (9.1 ± 8.5) compared to pre-treatment (42.6 ± 16.7). ConclusionUltrasound stands out as the preferred diagnostic method for identifying LCPF. A PRP injection followed by a walking cast proves effective in relieving LCPF symptoms within six weeks with sustained relief up to two years. Level of evidenceLevel IV

Experiences of attending prenatal ultrasounds during the COVID-19 pandemic in Australia: A cross-sectional survey.

Prenatal ultrasounds form an important part of routine maternity care in Australia and indeed internationally. The COVID-19 pandemic necessitated rapid changes in society and healthcare to curb transmission, with evidence demonstrating detrimental impacts on childbearing women associated with these restrictions. However, experiences with pandemic restrictions for prenatal ultrasounds in relation to distress, patient expectations, and satisfaction are largely unknown. This study aimed to explore the experiences of pregnant women attending prenatal ultrasound during the pandemic in Australia. A cross-sectional online survey of people in Australia who had undergone at least one prenatal ultrasound during the period of maternity care restrictions was performed. The survey included validated tools for assessing post-traumatic stress, satisfaction, and expectations with maternity care. A total of 1280 responses were obtained. Almost 37% of respondents returned a PCL-C score consistent with probable post-traumatic stress disorder. Unexpected ultrasound findings or a high PCL-C score were more likely to have higher expectations and lower levels of satisfaction with their maternity care experience. Having an ultrasound for pregnancy loss, fetal abnormality, and/or a prior post-traumatic stress disorder diagnosis were the strongest factors correlating with a high PCL-C score. The prevalence of post-traumatic stress symptoms in the study population is concerning and elucidates the distress experienced in association with prenatal ultrasounds during pandemic restrictions in Australia. Maternity services should acknowledge the high levels of service consumers with post-trauma symptoms and consider trauma-responsive maternity care adaptations in response to adverse perinatal outcomes for those afflicted with post-trauma and distress-related symptoms.