Ultrasound-guided Localization Research Articles

Ultrasound-guided localization of the radial nerve along the humerus: providing reference points for safer upper arm surgery.

The close proximity of the radial nerve to the humerus poses a risk during upper arm surgery. Although the general course of the radial nerve is well-known, its exact position in relation to anatomical reference points remains poorly investigated. This study aimed to develop a standardized protocol for the sonographic and clinical identification of the radial nerve in the upper arm. The ultimate goal is to assist surgeons in avoiding iatrogenic radial nerve palsy. A total of 76 measurements were performed in 38 volunteers (both sides). Ultrasound measurements were performed using a linear transducer (10MHz) to identify the radial nerve at two key points: RD (where the radial nerve crosses the dorsal surface of the humerus) and RL (where the radial nerve crosses the lateral aspect of the humerus). Distances from specific reference points (acromion, lateral epicondyle, medial epicondyle, olecranon fossa) to RD and RL were measured, and the angle between the course of the nerve and the humeral axis was recorded. Humeral length was defined as the distance between the posterodorsal corner of the acromion and the lateral epicondyle. The distance from the lateral epicondyle to RD was on average 15.5cm ± 1.3, corresponding to 50% of the humeral length. The distance from the lateral epicondyle to RL was on average 6.7cm ± 0.8, corresponding to 21% of the humeral length. The course of the nerve between RD and RL showed an average angulation of 37° to the anatomical axis of the humerus. Gender, BMI, dominant hand, and arm thickness did not correlate with the distances to RD or RL. Measurements were consistent between the left and right side. The radial nerve can typically be identified by employing a 1/2 and 1/5 ratio on the dorsal and lateral aspects of the humerus. Due to slight variations in individual anatomy, the utilization of ultrasound-assisted visualization presents a valuable and straightforward approach to mitigate the risk of iatrogenic radial nerve palsy during upper arm surgery. This study introduces an easy and fast protocol for this purpose.

880 Extraction of a Metal Arrow Entering the Skull Base Using a Three-Surgeon Combined Microscopic and Endoscopic Approach

INTRODUCTION: Low velocity penetrating brain injuries (PBI) present both a diagnostic and therapeutic challenge in management particularly in operative planning for the extraction of the impaled foreign body. METHODS: A 3-surgeon combined microscopic-endoscopic approach with the use of intraoperative ultrasound, angiogram, and C-arm localization was done. This involved a 5-part procedure: internal carotid angiography; parieto-occipital vertex craniotomy with ultrasound-guided localization; right transciliary cranio-orbito-zygomatic osteotomy transciliary approach; endoscopic guided advancement and extraction of foreign body and endoscopic endonasal transsphenoidal repair of skull base defect. RESULTS: The rationale for the procedures borders on obtaining information on the relationship of the arrow to the major vessels at the base of the brain, visualization of the arrow’s entry into the skull, guidance on the point of exit as the arrow was pushed upwards towards cortex and extracted it from the surface, and the integrated use of a basal approach for actual visualization of the shaft of the arrow. The patient remained clinically and neurologically stable post-operatively and was discharged after 10 days. He was back to pre-morbid functional status during follow-up at the outpatient two weeks after surgery. CONCLUSIONS: Presented is a successfully managed case of low-velocity PBI. The knowledge of surgical anatomy combined with the different concepts and principles of neurosurgery led to the development of combined techniques that can be used and may further be improved in the management of these injuries.

Long-Term Ultrasound Twinkling Detectability and Safety of a Polymethyl Methacrylate Soft Tissue Marker Compared to Conventional Breast Biopsy Markers—A Preclinical Study in a Porcine Model

ObjectiveWe have studied the use of polymethyl methacrylate (PMMA) as an alternative biopsy marker that is readily detectable with ultrasound Doppler twinkling in cases of in vitro, ex vivo, or limited duration in vivo settings. This study investigates the long-term safety and ultrasound Doppler twinkling detectability of a PMMA breast biopsy marker following local perturbations and different dwell times in a 6-mo animal experiment. MethodsThis study, which was approved by our Institutional Animal Care and Use Committee, involved three pigs and utilized various markers, including PMMA (Zimmer Biomet), 3D-printed, and Tumark Q markers. Markers were implanted at different times for each pig. Mesh material or ethanol was used to induce a local inflammatory reaction near certain markers. A semiquantitative twinkling score assessed twinkling for actionable localization during monthly ultrasounds. At the primary endpoint, ultrasound-guided localization of lymph nodes with detectable markers was performed. Following surgical resection of the localized nodes, histomorphometric analysis was conducted to evaluate for tissue ingrowth and the formation of a tissue rind around the markers. ResultsNo adverse events occurred. Twinkling scores of all markers for all three pigs decreased gradually over time. The Q marker exhibited the highest mean twinkling score followed by the PMMA marker, PMMA with mesh, and Q with ethanol. The 3D-printed marker with mesh and PMMA with ethanol had the lowest scores. All wire-localized lymph nodes were successfully resected. Despite varying percentages of tissue rind around the markers and a significant reduction in overall twinkling (p < 0.001) over time, mean PMMA twinkling scores remained clinically actionable at 6 and 5 mo using a General Electric C1-6 probe and 9L-probe, respectively. ConclusionsIn this porcine model, the PMMA marker demonstrates an acceptable safety profile. Clinically actionable twinkling aids PMMA marker detection even after 6 mo of dwell time in porcine lymph nodes. The Q marker maintained the greatest twinkling over time compared to all the other markers studied.

Preoperative Ultrasound-Guided Localization of the Lateral Femoral Cutaneous Nerve: From Guide Wire to Novel Clip.

Lateral femoral cutaneous nerve (LFCN) decompression and transposition are surgical treatment options for meralgia paresthetica. Identifying the LFCN during surgery may be challenging, and preoperative localization is a valuable adjunct in this case. The objective of this study was to explore a new technique using preoperative ultrasound-guided clip localization (USCL) of the LFCN. After Institutional Review Board approval, data were collected on patients who underwent both preoperative ultrasound-guided wire localization (USWL) and USCL over the past 13 years. Skin-to-nerve time was calculated prospectively. Fifty-six patients were identified, 51 had USWL and 5 had USCL; the skin-to-nerve median time was 7.5 and 6 minutes, respectively. Six wires were misplaced, and this was at the beginning of utilization of the USWL technique. There were no nerve injury, infection, or bleeding complications related to either wire or clip placement. USWL or USCL is safe and time-efficient in LFCN surgeries.

Application of Machine Learning to Ultrasonography in Identifying Anatomical Landmarks for Cricothyroidotomy Among Female Adults: A Multi-center Prospective Observational Study

We aimed to develop machine learning (ML)-based algorithms to assist physicians in ultrasound-guided localization of cricoid cartilage (CC) and thyroid cartilage (TC) in cricothyroidotomy. Adult female volunteers were prospectively recruited from two hospitals between September and December, 2020. Ultrasonographic images were collected via a modified longitudinal technique. You Only Look Once (YOLOv5s), Faster Regions with Convolutional Neural Network features (Faster R-CNN), and Single Shot Detector (SSD) were selected as the model architectures. A total of 488 women (mean age: 36.0 years) participated in the study, contributing to a total of 292,053 frames of ultrasonographic images. The derived ML-based algorithms demonstrated excellent discriminative performance for the presence of CC (area under the receiver operating characteristic curve [AUC]: YOLOv5s, 0.989, 95% confidence interval [CI]: 0.982–0.994; Faster R-CNN, 0.986, 95% CI: 0.980–0.991; SSD, 0.968, 95% CI: 0.956–0.977) and TC (AUC: YOLOv5s, 0.989, 95% CI: 0.977–0.997; Faster R-CNN, 0.981, 95% CI: 0.965–0.991; SSD, 0.982, 95% CI: 0.973–0.990). Furthermore, in the frames where the model could correctly indicate the presence of CC or TC, it also accurately localized CC (intersection-over-union: YOLOv5s, 0.753, 95% CI: 0.739–0.765; Faster R-CNN, 0.720, 95% CI: 0.709–0.732; SSD, 0.739, 95% CI: 0.726–0.751) or TC (intersection-over-union: YOLOv5s, 0.739, 95% CI: 0.722–0.755; Faster R-CNN, 0.709, 95% CI: 0.687–0.730; SSD, 0.713, 95% CI: 0.695–0.730). The ML-based algorithms could identify anatomical landmarks for cricothyroidotomy in adult females with favorable discriminative and localization performance. Further studies are warranted to transfer this algorithm to hand-held portable ultrasound devices for clinical use.

Sonographic visibility of the UltraCorTM TwirlTM tissue marker.

Tissue markers are inserted into the breast after percutaneous biopsy to mark the site of the lesion to facilitate potential re-localisation. Tissue markers are increasingly developed with improved sonographic visibility due to benefits conferred by ultrasound-guided localisation. We aim to study the sonographic visibility of the recently-introduced UltracorTM TwirlTM tissue marker and feasibility of its pre-operative localisation under ultrasound guidance. All patients who underwent insertion of the UltracorTM TwirlTM tissue marker in our institution from July 2017 to December 2018 were reviewed. Retrospective data including sonographic visibility, evidence of migration and rate of successful surgical excision were collected. All tissue markers were visible on subsequent ultrasound with 198 (85.0%) well-visualised with high degree of confidence while 35 (15.0%) were moderately well-visualised with moderate level of confidence. None of the tissue markers were poorly visualised and none demonstrated migration. No statistical difference in sonographic visibility is seen based on interval duration between deployment and subsequent ultrasound assessment or depth of tissue marker. UltracorTM TwirlTM demonstrates consistent sonographic visibility, identifiable with a high or moderate level of confidence with no associated migration. Its use in pre-operative localisation with ultrasound guidance is therefore both reliable and feasible.

The significance of ultrasound-guided localization of nonpalpable breast lesions using carbon suspension

The significance of ultrasound-guided localization of nonpalpable breast lesions using carbon suspension

Feasibility of Ultrasound-Guided Localization for Clipped Metastatic Axillary Lymph Nodes After Neoadjuvant Chemotherapy in Breast Cancer Patients: A Pilot Study.

We present our initial experience of ultrasound (US)-guided localization of clipped metastatic axillary lymph nodes (LNs) following neoadjuvant chemotherapy (NAC). We evaluated US visibility and the successful excision rate of clipped LN after NAC in 29 consecutive patients with breast cancer. US-guided localization of clipped nodes was performed in 22 patients on the day of surgery, while seven patients underwent surgery without localization. The clips were identified in all patients with residual metastatic LNs and 6 of 12 (50%) patients without residual metastatic LNs on US. Six patients without visible clips underwent US-guided localization at the presumed previous clip insertion site. The successful excision rate of 22 LNs with localization was 100% (even though 3 of them were non-sentinel LNs) and 57% (4/7) without localization. Regardless of the presence of visible residual metastatic LNs on US after NAC, successful excision of the clipped LN with US-guided localization is feasible.

Optimal localization strategies for non-palpable breast cancers -A network meta-analysis of randomized controlled trials.

PurposeMammographic screening programmes have increased detection rates of non-palpable breast cancers. In these cases, wire-guided localization (WGL) is the most common approach used to guide breast conserving surgery (BCS). Several RCTs have compared WGL to a range of novel localization techniques. We aimed to perform a network meta-analysis (NMA) of randomized controlled trials (RCTs) comparing methods of non-palpable breast cancer localization.MethodsA NMA was performed according to PRISMA-NMA guidelines. Analysis was performed using R packages and Shiny.Results24 RCTs assessing 9 tumour localization methods in 4236 breasts were included. Margin positivity and reoperation rates were 16.9% (714/4236) and 14.3% (409/2870) respectively. Cryo-assisted localization had the highest margin positivity (28.2%, 58/206) and reoperation (18.9%, 39/206) rates. Compared to WGL (n = 2045 from 24 RCTs) only ultrasound guided localization (USGL) (n = 316 from 3 RCTs) significantly lowered margin positivity (odds ratio (OR): 0.192, 95% confidence interval (CI): 0.079–0.450) and reoperation rates (OR: 0.182, 95%CI: 0.069–0.434). Anchor-guided localization (n = 52, 1 RCT) significantly lowered margin positivity (OR: 0.229, 95%CI: 0.050–0.938) and magnetic-marker localization improved patient satisfaction (OR: 0.021, 95%CI: 0.001–0.548). There was no difference in operation duration, overall complications, haematoma, seroma, surgical site infection rates, or specimen size/vol/wt between methods.ConclusionUSGL and AGL are non-inferior to WGL for the localization of non-palpable breast cancers. The reported data suggests that these techniques confer reduced margin positivity rates and requirement for re-operation. However, caution when interpreting results relating to RCTs with small sample sizes and further validation is required in larger prospective, randomized studies.

Ultrasound-guided Spinal Needle Localization for Resection of Abdominal Wall Endometrioma

A 47-year-old patient with 2 previous cesarean sections presented with 2 years of right lower quadrant spasm-inducing pain. The pain began with menses and lasted for 15 days each month. Magnetic resonance imaging revealed a 3.3 × 1.9 × 6.0-cm lesion in the medial aspect of the right rectus abdominis muscle, consistent with abdominal wall endometrioma (Fig. 1A). No fascial involvement was identified. At the time of surgery, intraoperative ultrasound was used to map the endometrioma (Fig. 1B). Under ultrasound guidance, the endometrioma borders were marked using 3.5-cm 20 gauge needles through the anterior abdominal wall (Fig. 2). During robotic-assisted excision of the endometrioma, the needles were intermittently advanced and withdrawn from the peritoneal cavity by the bedside assistant to delineate the limits of necessary dissection (Fig. 3). This technique contributed to efficient and complete excision. Postoperatively, the patient reported complete resolution of right lower quadrant pain. Final pathologic evaluation confirmed extensive endometriosis. Abdominal wall endometriosis (AWE) is most often found in previous abdominal surgical incisions. In women undergoing surgical excision of endometriosis, AWE was noted in 1.34% [1Khan Z Zanfagnin V El-Nashar SA Famuyide AO Daftary GS Hopkins MR. Risk factors, clinical presentation, and outcomes for abdominal wall endometriosis.J Minim Invasive Gynecol. 2017; 24: 478-484Abstract Full Text Full Text PDF PubMed Scopus (33) Google Scholar]. The most common procedure before AWE is cesarean section with a higher risk reported with Pfannenstiel incision vs vertical midline incision [1Khan Z Zanfagnin V El-Nashar SA Famuyide AO Daftary GS Hopkins MR. Risk factors, clinical presentation, and outcomes for abdominal wall endometriosis.J Minim Invasive Gynecol. 2017; 24: 478-484Abstract Full Text Full Text PDF PubMed Scopus (33) Google Scholar, 2Horton JD Dezee KJ Ahnfeldt EP Wagner M. Abdominal wall endometriosis: a surgeon's perspective and review of 445 cases.Am J Surg. 2008; 196: 207-212Abstract Full Text Full Text PDF PubMed Scopus (184) Google Scholar, 3Zhang P Sun Y Zhang C et al.Cesarean scar endometriosis: presentation of 198 cases and literature review.BMC Womens Health. 2019; 19: 14Crossref PubMed Scopus (23) Google Scholar]. Cesarean scar endometriosis is likely secondary to direct implantation of endometrial tissue in the incision [2Horton JD Dezee KJ Ahnfeldt EP Wagner M. Abdominal wall endometriosis: a surgeon's perspective and review of 445 cases.Am J Surg. 2008; 196: 207-212Abstract Full Text Full Text PDF PubMed Scopus (184) Google Scholar]. Surgical excision allows pathologic evaluation and therapeutic resection [4Karapolat B Kucuk H. A rare cause of abdominal pain: scar endometriosis.Emerg Med Int. 2019; 20192584652Crossref PubMed Google Scholar,5Behbehani S Magtibay P Chen L Wasson M. Clear cell carcinoma of the anterior abdominal wall secondary to iatrogenic endometriosis.J Minim Invasive Gynecol. 2020; 27: 1230-1231Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar]. Excision is often planned with preoperative ultrasound or magnetic resonance imaging. Previously reported surgical approaches to AWE include ablative techniques such as percutaneous cryoablation or ethanol injection [6Welch BT Ehman EC VanBuren WM et al.Percutaneous cryoablation of abdominal wall endometriosis: the Mayo Clinic approach.Abdom Radiol (NY). 2020; 45: 1813-1817Crossref PubMed Scopus (6) Google Scholar]. If AWE involves the fascia, surgical excision can still be performed by a minimally invasive approach with endoscopic mesh placement and fascial repair by general surgery. Intraoperative techniques to assist with excision include injecting the lesion with methylene blue or ultrasound-guided wire localization [7Lee MMH Robson NK Carpenter TT. Ultrasound-guided wired localisation for resection of impalpable anterior abdominal wall scar endometriomas.Gynecol Surg. 2012; 9: 103-105Crossref Scopus (2) Google Scholar,8Takmaz T Kiran G Ozcan P Sahin N Tanoglu B. Total surgical excision by ultrasound–guided wire localization for spontaneous abdominal-wall endometriosis.J Gynecol Surg. 2020; 36: 76-79Crossref Scopus (1) Google Scholar]. Ultrasound-guided localization with spinal needles is a simple, practical technique that can assist with complete excision of abdominal wall endometriomas.

Ultrasound-Guided Hook-Wire Localization for Surgical Excision of Non-Palpable Superficial Inguinal Lymph Nodes in Dogs: A Pilot Study.

Simple SummaryThe evaluation of regional/sentinel lymph nodes (LN) plays an important prognostic role and assists the clinical decision making in canine cancer patients; thus, surgeons are frequently asked to perform regional/sentinel lymphadenectomies together with management of the primary tumor sites, even when these are non-palpable and/or normal size LN. Several techniques have been described to localized regional/sentinel LN in a pre-surgical setting. The wire-guided localization is commonly used to localize non-palpable breast masses in women, with the aim to reduce surgical dissection and excision of unnecessary tissue and to reduce surgical time. This study describes the use of an ultrasound-guided hook-wire localization method to facilitate intraoperative localization of non-palpable superficial inguinal LN. The results of the present study suggest that this method is safe and effective and may allow a high rate of successful superficial inguinal LN excisions in dogs.The evaluation of loco-regional lymph nodes (LN) plays an important prognostic role and assists the clinical decision making in canine cancer patients. Excision of non-palpable LN can be challenging. The aim of the study was to evaluate surgical time, successful excision rate and surgical complications associated with the use of an ultrasound-guided hook-wire (UGHW) LN localization method for non-palpable superficial inguinal LN (SILN) in dogs. Dogs that presented for excision of non-palpable SILN, performed with the aid of an UGHW placement, were enrolled. Information including signalment, SILN width, UGHW placement and surgical procedure time, hook-wire position, successful excision and intra- and post-operative complications were reviewed. Seventeen dogs were enrolled. Median LN width was 3 mm (range 2–11). Median time of preoperative UGHW placement and surgical LN excision was 8 min and 15 min, respectively. Successful SILN excision was achieved in all cases. Two minor intra-operative (hook migration and wire fragmentation) and one minor post-operative complications (seroma) were observed. No major intraoperative or post-operative complications occurred. The UGHW LN localization method is safe and effective and may allow a high rate of successful SILN excisions in dogs. This method has the potential to facilitate LN excision for other superficial LN locations.

Wire- and Ultrasound-Guided Localization: A Novel Technique for Excision of Nonpalpable Breast Tumors.

Background:Excision of nonpalpable breast lesions requires intraoperative guidance. Wire-guided localization and intraoperative ultrasounds have been used successfully but suffer from some disadvantages. We describe a new modification of the standard technique using a combination of preoperative ultrasound in conjunction with standard wire-guided localization.Methods:Wire and ultrasound-guided localization (WUGL) technique was used for the excision of nonpalpable breast lesions.Results:Sixty-nine patients with nonpalpable breast lesions were subjected to excision using WUGL, out of whom 63 patients had a preoperative diagnosis of invasive/noninvasive breast cancer. Six patients had a preoperative diagnosis of benign lesions, out of which 3 patients were converted to invasive breast cancer on final pathology. Only 1 patient had positive margin.Conclusions:WUGL is a technique that uses a combination of well-accepted and easily available techniques. It has given good results and has the potential for widespread acceptance in resource-constrained situations.

Feasibility of Magnetic Seeds for Preoperative Localization of Axillary Lymph Nodes in Breast Cancer Treatment.

OBJECTIVE. The objective of this study was to evaluate the feasibility of using a magnetic seed system for preoperative localization of axillary lymph nodes in patients with breast cancer. MATERIALS AND METHODS. We performed a retrospective analysis that included patients with breast cancer who underwent preoperative magnetic seed localization of axillary lymph nodes at our institution between January 1, 2017, and January 1, 2019. Magseed (Endomag) is a nonradioactive inducible magnetic seed that is induced to become a magnet when under the influence of its detector in the operating room. Clinical history, prior axillary sampling and clip placement, and procedure details and surgical outcomes were determined from a search of our PACS and electronic medical records. RESULTS. Thirty-five patients (34 women and one man) composed our study cohort. The mean patient age was 56 years (range, 32-78 years). One patient underwent two separate consecutive localizations for two separate operations, and another patient had bilateral lesions, for a total of 37 axillary lymph node localizations. One case of seed misplacement occurred during the ultrasound-guided localization procedure, resulting in immediate placement of a second seed, for a total of 38 Magseeds placed. All seeds were placed under ultrasound guidance. The mean number of days from seed placement to surgery was 5 days (range, 0-31 days). Thirty-seven of 38 Magseeds (97%) were documented to be successfully retrieved in the operating room. CONCLUSION. Magseed localization appears to be a safe, nonradioactive way to accurately localize axillary lymph nodes preoperatively.

A safe percutaneous technique for the reduction of irreducible femoral neck fractures using ultrasound localization of the femoral vascular and nervous structures at the hip.

We present a safe percutaneous technique for the placement of Kirschner wires into the femoral head to assist in the reduction of irreducible femoral neck fractures using ultrasound to identify the vascular and nervous structures about the hip.From January 2011 to June 2014, a total of 36 patients (25 males and 11 females) were enrolled in this study. Patients were placed on a fracture reduction table for limb traction. After 3 unsuccessful reductions with limb traction, ultrasound-guided localization of the patient's femoral artery, vein, and nerve at the hip was performed. These structures were marked on the overlying skin and then Kirschner wires were inserted into the femoral head avoiding these marked structures. After the surgery, the Kirschner wire insertions were routinely reviewed by ultrasound, the hip fracture reduction and the femoral nerve sensorimotor function were routinely examined as well.All 36 patients with an irreducible variant of a femoral neck fracture showed anatomic reduction under C-arm fluoroscopy using ultrasound to avoid K wire injury to the femoral vascular structures and nerve. No major vascular injury during operation. In post-surgical ultrasound examination, local hematoma formation was not evident. There was normal function of the femoral nerve. On follow-up, there were no infections, wound problems, recurrence of fracture displacement, laxity, or implant breakage.Preoperative ultrasonic localization of the femoral artery, vein, and femoral nerve safely allowed. Kirschner wire placement under C-arm fluoroscopy into the femoral head to assist in fracture reduction. This assisted reduction method for irreducible femoral neck fractures had a number of advantages, including closed anatomic reduction with minimal attempts, used simple equipment, and avoided further destruction of the blood supply to the femoral head.

Ultrasound-guided Pulsed Radiofrequency in the Management of Thoracic Postherpetic Neuralgia: A Randomized, Double-blinded, Controlled Trial.

This study was designed to evaluate the efficacy and safety of ultrasound-guided pulsed radiofrequency (PRF) for the intercostal nerves (ICNs) in the management of thoracic postherpetic neuralgia. After 2 weeks of treatment by pregabalin 150 mg/12 hours, patients were randomly allocated into 2 groups. The PRF group, after ultrasound-guided localization of the ICN of the affected thoracic dermatome, sensory stimulation of the ICN was tested. Thereafter, the patient received 2 cycles PRF at 42°C temperature, for 120 seconds. The sham group, after stimulation, the same time was spent to mimic PRF. The same procedures were repeated to the upper and lower adjacent ICNs. Pain intensity using Visual Analogue Scale (VAS), and total analgesics consumption were assessed at the baseline, every 2 weeks for 6 months then after 9 and 12 months. The duration of effective pain relief was recorded. Quality of life was evaluated using self-evaluation questionnaires (SF-36) at baseline then after 1, 3, 6, and 12 months. PRF group expressed a significant decrease on the VAS throughout the study period. VAS<30 was reported in the PRF group until the 22nd week. Pregabalin and acetaminophen consumption was significantly lower in the PRF group. The 8 domains of the SF-36 revealed a significant improvement in the PRF group when compared with the sham group throughout the study period except for the physical role which displayed nonsignificant improvement. Ultrasound-guided PRF for ICNs in combination with pharmacotherapy seems to be a safe and effective treatment modality for postherpetic neuralgia.

Ultrasound-guided restaging and localization of axillary lymph nodes after neoadjuvant chemotherapy for guidance of axillary surgery in breast cancer patients: Experience with activated charcoal.

e12615Background: The aim of this study was to review our experience with ultrasound (US)-guided localization of axillary lymph nodes using activated charcoal for the guidance of axillary surgery a...

Technique of ultrasound-guided localization of lung nodule

Technique of ultrasound-guided localization of lung nodule

Ultrasound guided K-wire reduction of irreducible femoral neck fractures

Objective To evaluate the effect of ultrasound-guided K-wire reduction of irreducible femoral neck fractures. Methods A retrospective analysis was made on 21 patients with irreducible femoral neck fractures hospitalized from January 2011 to January 2014. There were 13 males and 8 females, aged 23-60 years (mean, 41.5 years). The fractures of nine patients were caused by road traffic accidents, seven by slipping, and five by fall from the height. According to the Garden classification, four patients were classified as type Ⅱ, eleven type Ⅲ, and six type Ⅳ. Patients were placed in traction bed for limb traction. After 3-times unsuccessful reduction with limb traction, the patients were performed ultrasound-guided localization of superficial femoral artery, vein and nerve in the hip, marked and stabilized with two K-wires into the surface markers. Position relations of femoral artery, vein and nerve with the femoral head were determined under fluoroscopic guidance. After operation, the part with K-wire insertion was routinely reviewed by ultrasound, the anterior and lateral positions of the hip joint were routinely reviewed, and the sensorimotor function of the area of femoral nerve and sense function of the anterolateral femoral cutaneous nerve were routinely examined. Quality of reduction was assessed with the Garden index. Hip function was assessed with Harris score. Results All patients were followed up for mean 18 months (range, 6-28 months), which showed satisfactory reduction. No major vascular or nerve injury occurred intraoperatively. Postoperative ultrasound examination revealed no local hematoma formation, normal functions of the femoral nerve and normal superficial sensibility of the anterolateral femoral cutaneous nerve. No deep vein thrombosis of the lower limb occurred postoperatively. According to the Garden index, reduction was reached grade Ⅰ in fourteen patients and grade Ⅱ in seven patients. Harris hip score was excellent in 14 patients, good in six and poor in one, with the excellent-good rate of 95%. One patient underwent total hip arthroplasty for the postoperative femoral head necrosis, and none had screw displacement and implant loosening. Conclusion Ultrasound guided K-wire reduction of irreducible femoral neck fractures is associated with simple equipment, high repeatability, safe and effective results, and decreased iatrogenic injury. Key words: Ultrasonography; Femoral neck fractures; Reduction

Value of radial probe endobronchial ultrasound-guided localization of solitary pulmonary nodules with the combination of ultrathin bronchoscopy and methylene blue prior to video-assisted thoracoscopic surgery.

The aim of this study was to assess the clinical value of radial probe endobronchial ultrasound (RP-EBUS)-guided localization of solitary pulmonary nodules (SPNs) with the combination of ultrathin bronchoscopy and methylene blue prior to video-assisted thoracoscopic surgery (VATS). An ultrathin bronchoscope was used to localize the lesions under RP-EBUS guidance in 48 patients (18 men and 30 women; age range, 41–72 years; mean age, 54 years), who subsequently underwent VATS resection. The lesion size, distance from the parietal pleura, localization time and complications were evaluated. The RP-EBUS-guided localization success rate was 72.9%. The lesion size ± standard deviation was 12.8±4.2 mm and the mean distance from the parietal pleura was 11.2±9.7 mm. The mean localization time was 15.7±8.3 min. The major complication of RP-EBUS-guided localization was asymptomatic hemorrhage in 4 patients (8.3%). The VATS resection success rate was 95.8%. In terms of pathological type, the 48 lesions included atypical adenomatous hyperplasia (n=4), adenocarcinoma in situ (n=5), minimally invasive adenocarcinoma (n=7), adenocarcinoma (n=18), squamous cell carcinoma (n=1), inflammation (n=6), hamartoma (n=4) and tuberculosis (n=3). Therefore, RP-EBUS-guided localization with the combination of an ultrathin bronchoscope and methylene blue prior to VATS resection is a promising technique for SPNs, it plays an important role in the accurate localization of SPNs and it is an effective and safe technique to assist VATS resection of such nodules.

Meta analysis of the application of ultrasound-guided for the vein catheterization in infants

Objective To systematically evaluate the difference between ultrasound-guided and traditional body surface localization for the vein catheterization in infants .Methods Cochrane library , PubMed, Highwire, EMbase, China biomedical literature databases （CBM）, CNKI and so on were searched.The randomized clinical trials of ultrasound-guided and traditional body surface localization for the vein catheterization in infants were collected .The date of retrieval documents is from January 1993 to January 2013 . The evaluation method of Cochrane system was used , and the research objects were chosen according to the inclusion and exclusion criteria .The effective data were analyzed by RevMan 5.0 software through Meta analysis.Results Six randomized controlled clinical studies （319 cases） in which the ultrasound-guided and traditional body surface localization for the vein catheterizations in infants were used were chosen .The results showed that in the ultrasound-guided group the time was shorter [ WMD =-6.10, 95%CI （ -8.10 --4.10）],and the successful rate of puncture was higher [WMD=5.06, 95%CI（2.33-10.97）], and the attempt times of puncture was less [WMD=-1.05, 95%CI （ -1.43--0.68）], and the incidence rate of complication was lower [WMD=0.13, 95%CI （0.55-0.34）].Conclusions On the premise of mastering the use of ultrasonic instrument , the ultrasound-guided for the vein catheterization can shorten the time , and improve the successful rate , and reduce the times of puncture , and decrease the complications compared with the traditional body surface localization .Especially for the cases of difficultly puncturing through the traditional body surface localization , the ultrasound-guided for the vein catheterization has significant advantages , and is worthy of clinical application . Key words: Vein catheterization; Infants; Ultrasound-guided; Traditional body surface localization; Meta analysis