Ultrasound Assessment Research Articles

Levator Ani Deficiency and Pelvic Floor Dysfunction 1 Year Postpartum: A Prospective Nested Case-Control Study.

First, to assess whether levator ani deficiency (LAD) is associated with pelvic floor dysfunction 1 year postpartum, including urinary, vaginal and bowel symptoms; and second, to explore at what cut-off of LAD score such pelvic floor dysfunction arises. Nested case-control study. Örebro University Hospital, Örebro, Sweden. Primiparous women 1 year after vaginal birth. Three-dimensional endovaginal ultrasound assessment of the levator ani muscle; LAD score based on this ultrasound, and validated questions about pelvic floor dysfunction. Logistic regression models were used. Symptoms of pelvic floor dysfunction associated with LAD. Altogether 190 women were included, 103 of whom were symptomatic cases and 87 asymptomatic controls. 53% in the case group, and 58% in the control group had a LAD score of 0. A greater LAD score was significantly associated with urinary incontinence (adjusted odds ratio [aOR] 1.11, 95% confidence interval [CI] 1.00-1.22) and vaginal laxity (aOR 1.14, 95% CI 1.03-1.25). The risk of urinary incontinence was increased when the LAD cut-off score was set between ≥ 1 point and ≥ 4 points. The risk of vaginal laxity was increased when the cut-off was set between ≥ 8 and ≥ 14 points. LAD was associated with both urinary incontinence and vaginal laxity. The risk of urinary incontinence increased already with minor LAD and defects of the most medial levator ani muscle portions normally supporting the midurethra may explain this increase.

Automated ultrasonographic pupillary assessment: a new neuro-ophthalmological assessment tool.

To evaluate correlations between ultrasonographic pupillary assessment (UPA) and automated UPA in neurocritical patients. This was a prospective, observational study of 20 adult patients admitted to the intensive care unit with neurological pathology. Between UPA and automated UPA, 40 pupillary measurements were made. The time required to conduct UPA and automated UPA on a single patient was consistently < 3 minutes. Automated UPA required a markedly shorter operational time than UPA. There were strong positive associations between UPA and automated UPA measurements, with the following correlations: right eye at rest, r = 0.9973; left eye at rest, r = 0.9989; right eye post-pupillary light response, r = 0.9975; left eye post-pupillary light response, r = 0.9955. Bland-Altman analyses confirmed the strong agreement between the two methods under both conditions, with most measurements falling within the limits of agreement. Both the right and left pupillary diameters at rest demonstrated consistency, and the post-pupillary light response measurements for both eyes indicated good agreement, with a few outliers. Automated UPA was strongly correlated with UPA in neurocritical patients. Automated UPA is a rapid, feasible, and noninvasive method that enables the precise evaluation of pupillary size and light response.

Relationship between residual gastric content and peri-operative semaglutide use assessed by gastric ultrasound: a prospective observational study.

Semaglutide is a long-acting glucagon-like peptide-1 receptor agonist known to delay gastric emptying. Despite a growing body of evidence, its peri-operative safety profile remains uncertain, particularly with regard to the risk of increased residual gastric content and aspiration of gastric contents during anaesthesia. We hypothesised that semaglutide interruption of ≤ 10 days before elective surgical procedures is insufficient to reduce or normalise the residual gastric content, despite fasting intervals that comply with current guidelines. In this prospective observational study, we recruited patients who received pre-operative once-weekly subcutaneous semaglutide within 10 days of the procedure (semaglutide group) and control patients who had not been exposed to semaglutide (non-semaglutide group). On the day of surgery, all patients underwent pre-operative point-of-care gastric ultrasound to evaluate their residual gastric content. Increased residual gastric content was defined as any solid content or > 1.5 ml.kg-1 of clear fluids as assessed by gastric ultrasound. We recruited 220 patients, 107 in the semaglutide group and 113 in the non-semaglutide group. Increased residual gastric content was found in 43/107 patients (40%) in the semaglutide group and 3/113 (3%) in the non-semaglutide group (p < 0.001). In propensity-weighted analysis, semaglutide use (OR 36.97, 95%CI 16.54-99.32), age (OR 0.95, 95%CI 0.93-0.98) and male sex (OR 2.28, 95%CI 1.29-4.06) were significantly associated with increased residual gastric content. There were no cases of pulmonary aspiration of gastric contents. Pre-operative semaglutide use within 10 days of elective surgical procedures was independently associated with increased risk of residual gastric content on pre-operative gastric ultrasound assessment.

Advanced multimodal ultrasound for pre-operative assessment of skin tumours: A case series.

Pre-operative assessment of non-melanoma skin cancers via advanced ultrasound techniques may potentially provide additional information to tumour margins and morphology compared to current assessment via dermoscopy or optical coherence tomography. In this case series, the findings of multimodal ultrasonography of non-melanoma skin cancer are described, with histological correlation. Consecutive patients with clinical suspicion of malignant skin lesions underwent multimodal ultrasonography, comprising B-mode, colour Doppler imaging, superb microvascular imaging, strain elastography, and shear-wave elastography, followed by surgical excision. Images were reviewed by two radiologists. There were 8 female and 3 male patients, whose age ranged from 66 to 98 years. A total of 11 malignant skin tumours (basal cell carcinoma, n = 6; squamous cell carcinoma, n = 5) were reviewed. Tumour depth measured via ultrasound assessment ranged from 1.20 to 7.00 mm (mean ± standard deviation: 4.35 ± 1.99 mm). Tumours were located within dermis (n = 1) and abutting subcutaneous layer (n = 10) sonographically. Where corresponding histological reports for tumour depth were available, ultrasound correlated well with histology. Ultrasound also correctly predicted the deepest layer of involvement for all lesions. The sonographic features observed in all malignant skin tumours (11/11:100%) are solid, hypoechoic, with abundant neovascularity on colour Doppler imaging and superb microvascular imaging, and appeared stiff on strain elastography and shear-wave elastography. In some cases, the microvascular network of intra-tumoural flow were better demonstrated on superb microvascular imaging. Multimodal ultrasound can potentially be a useful and quick adjunctive tool for the pre-operative assessment of skin cancer by delineating the tumour depth and deepest skin layer involvement, ensuring complete excision of tumour.

Ultrasound Imaging of the Superficial and Deep Fasciae Thickness of Upper Limbs in Lymphedema Patients Versus Healthy Subjects

Background/Objectives: Lymphedema, a common source of disability among oncology patients, necessitates continuous targeted rehabilitation. Recent studies have revealed the role of connective tissue in this pathology; however, despite existing research on ultrasound (US) use in lymphedema, no studies have specifically addressed the use of ultrasound to assess fasciae in patients with lymphedema. This study aims to provide a more objective characterization of typical US alterations in these patients by quantifying the thickness of superficial and deep fasciae and comparing them with those of healthy volunteers. Methods: A cross-sectional study was performed using US imaging to measure the thickness of superficial and deep fascia in different regions and levels of the arm and forearm in a sample of 50 subjects: 25 chronic lymphedema patients and 25 healthy participants. Results: No significant difference in fascial thickness was observed between affected and unaffected upper limbs, but patients had notably thinner superficial fascia and deep fascia compared with healthy volunteers. The findings for superficial and deep fascia revealed statistically significant differences (p &lt; 0.0001) in all regions and levels. Conclusions: This study demonstrates the effectiveness of US imaging as a non-invasive tool for detecting subtle fascial changes in chronic lymphedema patients, revealing thinner fasciae compared with those in healthy volunteers. These findings suggest a potential anatomical predisposition to lymphedema, highlighting the importance of incorporating detailed US assessments in diagnosis and management to improve early intervention and patient outcomes. Future studies could, therefore, investigate whether preventive fascia assessment might improve the early identification of individuals at risk.

Within-session repeatability of Doppler ultrasound leg blood flow assessments during exercise in patients with chronic obstructive pulmonary disease.

Doppler ultrasound can be used to evaluate leg blood flow (Q̇leg), especially of interest when investigating peripheral vascular limitations in patients with chronic obstructive pulmonary disease (COPD). However, the within-session repeatability, a subdomain of test-retest reliability, of this method remains unknown. This study aimed to provide within-session repeatability estimates of Doppler ultrasound-based Q̇leg at rest and during single-leg knee-extensor exercise (KEE) in patients with COPD, and to compare these estimates to matched healthy controls. In this case-controlled study, 16 participants with COPD were matched based on sex and age with 16 healthy controls. All participants underwent measurement of Q̇leg using Doppler ultrasound in a KEE setup at various intensities with the same measurement being performed again separated by 10 s. Smallest real difference (SRD) was lowest at rest in both groups and increased during exercise, reaching values ranging from 164 to 231 mL in COPD and 122-180 mL in the control group. The coefficient of variance (CV) was highest at rest and decreased during exercise to values ranging from 4.0% to 5.0% in COPD and 2.6%-3.2% in the control group. The CV was significantly lower in the control group during 0 watt and exercise at 20% of max watt, but apart from that, no reliability estimates were different between groups. To conclude, Doppler ultrasound showed nearly equal within-session repeatability when evaluating Q̇leg in COPD patients and healthy individuals with a CV not exceeding 5% during exercise for both groups.

Digital nerve reconstruction with a new composite silk fibroin nerve conduit.

Peripheral nerve injuries often require bridging when direct repair is not feasible. Nerve autografts are the gold standard, but they can lead to donor site morbidity. Silk fibroin-based nerve conduits, like the novel SILKBridge, offer a promising alternative. This pilot study evaluates the mid-term outcomes of the first in-human digital nerve reconstruction using the SILKBridge, focusing on sensory recovery, complication rates, patient-reported outcomes, and biological integration. This study included four patients with digital nerve defects reconstructed using the SILKBridge. Clinical assessments included two-point discrimination, Semmes-Weinstein monofilament testing, and pain evaluation using the Numeric Rating Scale. Sonographic assessments were also performed to evaluate the conduit's biointegration and potential complications. At a mean follow-up of 32 months, all patients demonstrated satisfactory sensory recovery and reported minimal to no pain. Sonographic assessments confirmed effective biointegration with no signs of inflammation or scarring. The mid-term evaluation of the first in-human digital nerve reconstruction with the SILKBridge revealed safety, efficiency, and favorable biocompatibility properties. Further studies with larger cohorts are needed to validate these findings and compare them with other nerve repair methods.

An observational study of ultrasound semiquantitative scoring for predicting the risk of gout flare.

An observational study was conducted to determine whether semiquantitative scoring of ultrasound signs of gout predicted flare over 12months. Gout patients were enrolled consecutively in this 12-month prospective observational single-center study. Ultrasound evaluation and clinical assessment were performed at baseline. All patients were examined bilaterally evaluating 14joints (knee, ankle, metatarsophalangeal joints 1-5) and 10tendons (posterior tibial, quadriceps, peroneus longus and brevis scored as one, patellar, and Achilles tendons). The following ultrasound features were examined and semiquantitative scoring was performed: DC sign, aggregates, tophi, bone erosion, synovial hypertrophy, PD activity, and tenosynovitis. Patients were divided into two groups, one with flares during the follow-up period and the other without flares. Atotal of 119 participants completed the study; 61(51.3%) participants experienced at least one flare over 12months, with amedian of 2.0flares. The ultrasound findings indicative of DC sign, aggregate, tophi, bone erosion, and PD activity at baseline were significantly correlated with the development of gout flares over 12months. Logistic regression analysis suggested that DC sign score (OR:2.41, 95% CI: 0.92-4.37; P = 0.02), tophi score (OR:1.87, 95% CI: 0.65-2.28; P = 0.04), and PD activity score (OR:1.93, 95% CI: 0.58-3.26; P = 0.03) were independent predictors of flare. ROC curve analysis to assess ultrasound semiquantitative scoring has good sensitivity and specificity for the prediction of gout flares. Ultrasound semiquantitative scoring can predict the risk of flare, and ultrasound findings indicative of DC sign, tophi, and PD activity are independent predictors of gout flares over 12months.

Role of IVC Indices to Determine the Volume Status in Edematous Nephrotic Syndrome Children

Background: Ultrasonography is a widely used tool for assessment of volume status of nephrotic syndrome in children. Objective: This study aims to assess the efficacy of sonographic assessment of inferior vena cava indices to detect this volume status. Methodology: This cross-sectional study involved around 50 children of steroid-sensitive Nephrotic Syndrome relapse, attending the department of Pediatric Nephrology of Bangladesh Shishu Hospital and Institute. Results: About 64% reported non-hypovolemic status; 36% patients had hypovolemia on the basis of urinary indices. The mean value of Fe Na was 0.24 ± 0.19 Umol/L in non-hypovolemic group and 0.14 ± 0.16 Umol/L in hypovolemic group. On the basis of sonographic assessment of IVC Collapsibility index, 80% were in non-hypovolemic group and 20% were in hypovolemic group. Based on IVC Aortic ratio, 66% belonged to non-hypovolemic patient and 34% in hypovolemic group. Statistically significant relationship was not found between different volume status by urinary indices and IVC collapsibility index (p=0.463) sensitivity and specificity of IVCCI in relation to urinary indices was 27.7%; 84.3% and positive prediction value was 50%. Conclusion: The majority of patients with nephrotic syndrome followed non-hypovolemic status. IVC: Aortic ratio can be better tool for volume assessment in nephrotic syndrome children. However, large scale study should be executed to confirm the efficacy of this tool.

Celostna ultrazvočna ocena kongestije pri bolnikih s srčnim popuščanjem – kaj moramo vedeti?

In clinical practice, the assessment of congestion in patients with heart failure is most often based on history, clinical examination, and chest X-ray. Clinical symptoms and signs of congestion or signs of congestion on the radiograph appear only in moderate or severe congestion, which can lead to a delay in the diagnosis and appropriate treatment of patients with heart failure. Ultrasound assessment of pulmonary and systemic venous congestion enables more accurate and early identification of congestion, enables better adjustment of diuretic therapy, and represents an important risk assessment for predicting the treatment outcome in patients with heart failure. For clinical use, ultrasound evaluates systemic venous congestion in the inferior vena cava, internal jugular, hepatic, portal, and interlobar renal veins. In contrast, pulmonary congestion is evaluated with lung ultrasound. Due to the ease of implementation and interpretation, the ultrasound assessment of congestion is accessible to both beginners and those who are not skilled in ultrasound examination of the heart and opens the possibility of using the method to a wide range of doctors who encounter patients with heart failure. In the article, we present individual ultrasound methods for assessing systemic venous and pulmonary congestion, their advantages and disadvantages, and explain the interpretation of the obtained values.

Study of Severe Preeclampsia: Epidemiological, Diagnostic, Therapeutic, and Prognostic Aspects over One Year at SMGS Hospital, Jammu: A Retrospective Study

ABSTRACT Background: This research was conducted retrospectively, with a focus on description and analysis, spanning from July 2022 to June 2023. Materials and Methods: The research included all pregnant women who were hospitalized to the department and delivered with a gestational age of more than 22 weeks and had severe preeclampsia. Results: The total number of deliveries was 22,180, out of which 63 cases were diagnosed with severe pre-eclampsia. Upon admission, ultrasound assessment of pregnant women revealed intrauterine growth limitation in 17 instances, accounting for 26.98% of the total. Conclusion: Increasing awareness among pregnant women during antenatal care (ANC) about the dangers of pre-eclampsia, providing additional training for healthcare workers, closely and promptly monitoring women at high risk, and managing the condition in a multidisciplinary environment may improve the prognosis for both the mother and the fetus.

Carotid Ultrasound Assessment prior to Coronary Artery Bypass Grafting – an Irish Cardiac Surgery Centre’s Experience

IntroductionCarotid stenosis is a risk factor for cerebrovascular accident(CVA) following coronary artery bypass grafting(CABG). Guidelines recommend selective pre-operative screening with Doppler US but non-selective application is commonplace. Recent data has questioned the efficacy of peri-operative carotid intervention, challenging the value of this practice. AimTo analyse the utility of carotid US assessment prior to CABG in our institution. MethodsThis was a retrospective review of all patients over 18 that underwent a non-emergency CABG in a single Irish cardiac surgery centre from January 2019 to December 2022. Results1161 subjects were included. 1084/1161(93.36%) underwent US assessment. 41/1084(3.8%) had ≥70% stenosis and 189/1084(17.5%) had ≥50% stenosis. 32/1084(2.95%) underwent confirmatory imaging and 7/1084(0.64%) underwent carotid intervention. Post-operative CVA occurred in 18/1161(1.55%) and ≥70%(p=0.024) and ≥50%(p<0.001) carotid stenosis were associated with same.Chronic kidney disease (OR=1.66,p=0.01), decreasing haemoglobin (OR=1.13,p=0.019), increasing age (OR=1.03,p=0.011) and being a current (OR=3.21,p<0.001) or ex- smoker (OR=1.82,p=0.004) were risk factors for ≥50% carotid stenosis on logistic regression. Multivessel coronary artery disease was not associated with carotid stenosis (p=0.563).Of those that underwent carotid intervention, 0/7(0%) suffered a CVA, but this protective effect failed to reach statistical significance for those with ≥70%(p=1) or ≥50%(p=1) carotid stenosis. ConclusionCarotid US screening altered the management of only a small proportion of CABG patients despite near universal application, challenging the effectiveness of this practice. Multivessel coronary artery disease was not associated with carotid stenosis despite European guidelines listing it as a screening criteria. Predictive models must be developed using identified risk factors to enable targeted pre-operative screening.

Ultrasound and shear wave elastography assessment of diaphragm thickness and stiffness in malnourished pediatric patients.

Our study indicated that there was a reduction in the thickness of the diaphragm and a decline in its stiffness, which could be an indirect indicator of the quality and strength of the diaphragm muscle. These findings suggest that US and SWE evaluation of the diaphragm muscle may have the potential for use in the diagnosis and follow-up of sarcopenia. However, further comprehensive randomized controlled studies are needed to confirm this. • Magnetic resonance imaging, computed tomography, and dual-energy x-ray absorptiometry are commonly used in the evaluation of sarcopenia. • The psoas and paraspinal muscles are commonly used in the evaluation of sarcopenia. • Ultrasound and shear wave elastography can be used in the evaluation of pediatric sarcopenia. • Diaphragm muscle can be used in the evaluation of pediatric sarcopenia.

Thermographic and ultrasound assessment in patients with rheumatoid arthritis: can thermography detect subclinical synovitis at the wrist?

BackgroundThermography is an emerging imaging modality which allows for a quick and objective measure of joint surface temperature in patients with rheumatoid arthritis (RA). To date, there are no published studies comparing thermography with ultrasonography in the subclinical assessment of joint inflammation at the wrist of patients with RA, and no published data on inter-rater reliability for multiple raters for thermographic assessment at the RA wrist. In our study comparing thermography and ultrasonography at the RA wrist, we aim to determine if thermography can detect subclinical synovitis. Additionally, we performed inter-reliability testing (multiple raters) for both thermography and ultrasonography.MethodsThermographic (average (Tavg), maximum (Tmax) and minimum (Tmin) temperatures) and ultrasound (total grey-scale (TGS) score and total power Doppler (TPD) scores) parameters were compared between two patient groups: Asymptomatic Group (with non-swollen and non-tender wrists) and Symptomatic Group (with swollen and/or tender wrists). Among Asymptomatic Group patients, thermographic parameters were compared between those with and without wrist joint recess(es) having ultrasound synovitis (PD ≥ 1 or GS ≥ 2); Spearman’s correlation and simple linear regression were used to study the relationship between thermographic and ultrasound parameters. Intra-class correlation coefficient (ICC) was used for inter-rater reliability calculation.ResultsEighty-seven RA patients’ right wrists were imaged in this cross-sectional study. Thermographic temperatures, TPD and TGS scores were all significantly (p < 0.05) greater among Symptomatic Group versus Asymptomatic Group patients. Among Asymptomatic Group patients, thermographic temperatures were all significantly higher (P < 0.01) in wrists having joint recess(es) with ultrasound PD ≥ 1 or GS ≥ 2, while all thermographic parameters correlated significantly with TPD (correlation coefficient ranging from 0.43 to 0.48, p < 0.001) and TGS (correlation coefficient ranging from 0.33 to 0.37, p < 0.01). The ICC values based on a subset of images obtained for inter-reliability testing were high for thermography (0.994 to 0.998) and ultrasonography (0.933 to 0.952).ConclusionsSwollen and/or tender RA wrists displayed greater thermographic and ultrasound-detected joint inflammation. At clinically quiescent (non-swollen; non-tender) wrists, thermographic temperatures significantly correlated with ultrasound-detected joint inflammation.Clinical trial numberNot applicable.

Multiparametric Ultrasound Assessment of Carpal Tunnel Syndrome: Beyond Nerve Cross-sectional Area.

Carpal tunnel syndrome (CTS), the most common mononeuropathy, results from compression of the median nerve within the fibro-osseous carpal tunnel. Diagnosis is typically based on clinical evaluation and confirmed by nerve conduction studies. However, ultrasound (US) has emerged as a valuable noninvasive adjunct for CTS confirmation, offering potential advantages over electrodiagnostic testing in terms of patient comfort and diagnostic accuracy. This review begins with a concise summary of carpal tunnel anatomy and CTS pathophysiology as a foundation for exploring the diverse applications of US in CTS evaluation. B-mode US assessment is presented with a focus on cross-sectional imaging and dynamic evaluations, including the transverse translocation and longitudinal gliding of the median nerve. We also review current methods for assessing vascularization in CTS and explore the usefulness of elastography in CTS evaluation. The advantages and limitations of each US method are elucidated, highlighting their practical utility in clinical practice.

Pre- and Postoperative Ultrasound Assessment of Biceps Brachial Tendon Tears.

Rupture of the distal biceps brachii tendon is a rare but debilitating injury, resulting in significant loss of strength. Diagnosis of complete rupture is based on clinical history and physical tests, with surgical repair often recommended due to functional discomfort. Ultrasound (US) is a powerful tool for diagnosing and classifying ruptures, particularly partial ruptures, which is crucial for therapeutic decisions. A good understanding of the tendon's anatomical arrangement in two twisted bundles enables optimal analysis. If several surgical techniques are available, the minimally invasive approach to reinsert the tendon on the radial tuberosity is often preferred. Postoperative assessment includes radiographs, US, and sometimes magnetic resonance imaging, revealing postoperative changes with constant thickening of the repaired tendon. With accurate diagnosis and appropriate surgical technique, surgical repair has a low complication rate. Single-incision repairs show higher rates of re-tears and nerve injuries, and double-incision repairs are prone to heterotopic ossification.

Cross-Sectional Study of Ultrasonographic Assessment of Renal Volume and Its Correlation with Basal Metabolic Index

Objective: Renal volume measurements are useful for differentiating between upper and lower urinary tract infections and for monitoring unilateral kidney disease by comparison with the other. The goal of the current study is to evaluate the relationship between renal volumes and BMI in the local population. Normal renal volume varies with BMI. Clinicians could use this to distinguish between volume variations caused by healthy processes and variations caused by diseased processes. This study aims to find the relationship between BMI and renal volumes in patients in a private tertiary care hospital who have no prior history of renal disease. Methods: This six-month cross-sectional study, conducted at the Department of Diagnostic Radiology, Shifa International Hospital in Islamabad, involved 310 participants in total. In this study, participants between the ages of 18 and 70 who had no prior history of renal disease were chosen. Using ultrasonography, the volumes of both kidneys were measured and correlated with BMI. Results: The mean value of the right renal volume was 88.7 cm3 with 15.7 SD, while the left renal volume had a mean value of 95.3 cm3 with 16.5 SD. The calculated correlation coefficients between the right renal volume and BMI were 0.947 (P=0.001) and the left renal volume and BMI was 0.911 (P=0.001), suggesting a strong and statistically significant positive correlation between the renal volumes obtained by ultrasonography and BMI. Conclusion: This study found a strong statistically significant positive correlation between BMI and renal volumes as determined by ultrasonography.

Recent progress in hematoporphyrin monomethyl ether-photodynamic therapy for port-wine stains: updates and insights.

Port-wine stains (PWS) are congenital vascular malformations characterized by capillary malformations that persist and often darken over time. Traditional treatment methods, including laser therapy, have shown varying degrees of effectiveness and can be associated with significant side effects. Hematoporphyrin Monomethyl Ether-Photodynamic Therapy (HMME-PDT) has emerged as a promising alternative, offering targeted treatment with potentially fewer adverse effects. This paper aims to evaluate the clinical efficacy and potential of HMME-PDT as a treatment strategy for PWS. It provides a comprehensive review of the literature and clinical investigations to assess the application and outcomes of HMME-PDT in treating PWS. Briefly introduce the nature of PWS, innovations and challenges in treatment, the mechanism of HMME-PDT, clinical effectiveness and sonographic appearance, safety and long-term effects, and challenges and suggestions for optimizing treatment. The review highlights the mechanism by which HMME-PDT works, focusing on its ability to target abnormal blood vessels selectively. Clinical evaluations included clinical and sonographic assessments to determine the efficacy of the treatment. The findings revealed significant improvements in the clinical appearance and sonographic features of vascular lesions following HMME-PDT. The paper also discusses the utility of dermoscopy in HMME-PDT applications, factors affecting treatment efficacy, the impact of thermal assistance on the effectiveness of PDT, and the management of adverse reactions through proper nursing care. The review underscores the considerable potential of HMME-PDT as an effective treatment for PWS, noting its promising outcomes in clinical and sonographic assessments. However, it also emphasizes the need for further research to standardize treatment protocols and assess long-term outcomes.

Abnormal AFI and Its Implications on Fetomaternal Outcome

Background: The AFI is directly associated with adverse outcomes for both the mother and the foetus; oligohydramnios (AFI ≤8 cm) and polyhydramnios (AFI ≥25 cm) are considered ‘abnormal’. The aim of this study was to compare the maternal and foetal complications in full-term pregnancies with abnormal AFI, as well as to assess the effectiveness of ultrasound and Doppler in identifying possible threats that may affect delivery plans. Methods: The current observational study was conducted in a hospital context at Paropakar Maternity and Women’s Hospital located in Kathmandu, Nepal between October 2019 and February 2020. This study investigates the maternal and fetal outcomes associated with polyhydramnios and oligohydramnios in 60 cases of pregnancy. Data on maternal and foetal results, including the type of birth, problems, and neonatal APGAR ratings, were collected and evaluated. Continuous variables were described as mean ± SD, while categorical data were expressed in percentage. Results: The prevalence of polyhydramnios was 2% and oligohydramnios was 5.33%. Common maternal complications included preeclampsia, postpartum hemorrhage, and gestational hypertension, while fetal outcomes included low APGAR scores, low birth weight, and NICU admissions. Oligohydramnios was found to be predominantly associated with post-term pregnancies (36.36%) and preterm premature rupture of membranes (13.63%), which led to a higher frequency of caesarean sections (70.46%) when compared to polyhydramnios cases. Conclusion: Our findings suggest that ultrasound and Doppler assessments are crucial in identifying high-risk pregnancies and making appropriate delivery decisions to improve maternal and fetal outcomes."

Focal what focal? — The diverse entities within focal adenomyosis

Adenomyosis is a benign uterine condition defined as the presence of endometrial glands and stroma within the myometrium. Unfortunately, its pathogenesis remains uncertain. The international Morphological Uterus Sonographic Assessment (MUSA) group has published a consensus on the ultrasound features of adenomyosis in 2015. Among different adenomyosis phenotype, focal adenomyosis is a heterogeneous group of different pathogenic, histopathological and clinical entities. By using the sonographic features different types of focal adenomyosis may be identified: 1) focal adenomyosis in the outer myometrium involving the serosa, which might have a strong correlation with deep infiltrating endometriosis; 2) the presence of a focal area of direct signs of adenomyosis in the inner myometrium, most likely through direct invasion from endometrial cells from the uterine cavity; 3) the presence of a focal area of direct signs (i.e., hyperechogenic islands with or without myometrial cysts) in the middle or outer myometrium. Most likely, this lesion is part of more diffuse disease; 4) A macro-cystic lesion in the myometrium without contact with the junctional zone of myometrium; 5) Accessory and cavitated uterine mass (ACUM) in the outer myometrium, which are suggested to be a continuum of congenital uterine anomalies. Some of these entities have also been described in MRI. The scope of the present opinion paper is to describe the different entities of focal adenomyosis leading to new insights of the impact of each of these entities on both clinical symptoms (e.g. pain, bleeding, subfertility) and management options. However, the proposed concept might need amendment and should be the object of future research.