Laparoscopic mesh repair for lumbar hernia after iliac crest bone harvest

Lumbar hernia after iliac crest bone harvest is relatively rare. When it does occur, it presents as a flank abdominal protrusion through a lateroposterior abdominal wall defect. A laparoscopic approach for this type of hernia is reported to have advantages over the classic open method. Here, we present a case of a 49‐year‐old Caucasian man who presented with an enlarged left flank mass after iliac bone harvest for pseudarthrosis. He had undergone open onlay mesh repair for inferior lumbar hernia, but the hernia recurred 3 months postoperatively. Laparoscopic intraperitoneal onlay mesh repair using a composite mesh was performed 7 months after recurrence. The patient was discharged 6 days postoperatively without complications. No signs of recurrence were detected during 1‐year follow‐up period. The laparoscopic approach for lumbar hernia conferred excellent visualization of the hernia defect and enabled a safe mesh repair using intra‐abdominal pressure to hold it in position. This approach provided all the benefits of minimally invasive surgery.     

Maternal Obesity Limits the Ultrasound Evaluation of Fetal Anatomy

Objective. The purpose of this study was to evaluate the effect of maternal habitus on adequate visualization of fetal anatomy during a standard second‐trimester ultrasound examination. Methods. This was a retrospective cohort study of singleton pregnancies at 18 to 24 weeks that underwent sonography over a 5‐year period. Pregnancies complicated by an indication for targeted sonography were excluded. Standard ultrasound examinations were performed according to American Institute of Ultrasound in Medicine criteria. Ten anatomic components were evaluated for adequacy of visualization: atria of the cerebral ventricles, posterior fossa, midline face, 4‐chamber view of the heart, spine, ventral wall, umbilical cord vessels, stomach, kidneys, and bladder. The body mass index (BMI) was based on the patient's weight at the first prenatal visit. Results. Of 10,112 women who underwent a standard ultrasound examination, 2% were underweight; 38% were of normal weight; 34% were overweight; and 26% were obese. Visualization of fetal anatomy decreased significantly with increasing maternal BMI for the complete survey as well as for each individual component with the exception of the fetal bladder (all P < .001). Among those with a normal or underweight BMI, an overweight BMI, and class 1, 2, and 3 obesity, all 10 anatomic components were adequately visualized at the initial examination in 72%, 68%, 57%, 41%, and 30% of cases, respectively (P < .001). Conclusions. Increasing maternal BMI limits visualization of fetal anatomy during a standard ultrasound examination at 18 to 24 weeks. In obese women, the fetal anatomy survey could be completed during the initial examination in only 50% of cases. Counseling may need to be modified to reflect the limitations of sonography in obese women.     

Trends in sonographic fetal organ visualization.

In order to assess changes in sonographic visualization over the last 6 years, 7092 second- and third-trimester ultrasound examinations from separate pregnancies in three individual years (1451 in 1985, 3016 in 1988, and 2625 in 1991) were compared. Overall, visualization across all gestational ages improved from 63.9% (1985) to 85.8% (1988) to 87.3% (1991), with the year in which the scan was performed explaining 19.6% of the variance in visualization. Maternal size (as determined by body mass index) remained the major determinant of ultrasound visualization in 1991 (r(2) = 11.2%), with gestational age explaining only 5.2% additional variance. Overall organ visualization was maximal at 21-23 weeks' gestation, with the decline in later gestation primarily accounted for by worsened visualization of fetal extremities and spine. Improved fetal visualization earlier in the second trimester and the advent of embryonic visualization in the first trimester may allow a continuum of prenatal sonographic diagnosis.     

Umbilical Cord Cysts

Objective. The purpose of this series was to determine whether the use of different 3‐dimensional (3D) sonographic modes allows better definition of umbilical cord cysts and pseudocysts in utero. Methods. Two cases of umbilical cord cysts and 1 of a pseudocyst were analyzed and compared with 2‐dimensional (2D), 3D, angiopower Doppler, tomographic ultrasound imaging (TUI), virtual organ computer‐aided analysis (VOCAL), and automatic volume calculation (AVC) sonographic modes. All cases were followed during pregnancy. A karyotype analysis was also obtained. Results. Three‐dimensional sonography, TUI, and VOCAL allowed clear visualization and evaluation of the sizes, locations, and numbers of umbilical cord cysts. A clear differentiation between a pseudocyst and the yolk sac was obtained with AVC and angiopower Doppler sonography. The 3D sonographic surface mode allowed better visualization of other accompanying fetal malformations. Conclusions. Three‐dimensional sonography allows for a more accurate diagnosis and provides a clearer visualization of malformations than 2D imaging. Cysts and pseudocysts can be defined much more accurately by using the different modes described here.     

In vivo comparison of tantalum,tungsten, and bismuth enteric contrast agents to complement intravenous iodine for double‐contrast dual‐energy CT of the bowel

To assess the ability of dual‐energy CT (DECT) to separate intravenous contrast of bowel wall from intraluminal contrast, we scanned 16 rabbits on a clinical DECT scanner: n = 3 using only iodinated intravenous contrast, and n = 13 double‐contrast enhanced scans using iodinated intravenous contrast and experimental enteric non‐iodinated contrast agents in the bowel lumen (five bismuth, four tungsten, and four tantalum based). Representative image pairs from conventional CT images and DECT iodine density maps of small bowel (116 pairs from 232 images) were viewed by four abdominal imaging attending radiologists to independently score each comparison pair on a visual analog scale (?100 to +100%) for (1) preference in small bowel wall visualization and (2) preference in completeness of intraluminal enteric contrast subtraction. Median small bowel wall visualization was scored 39 and 42 percentage points (95% CI 30–44% and 36–45%, both p < 0.001) higher for double‐contrast DECT than for conventional CT with enteric tungsten and tantalum contrast, respectively. Median small bowel wall visualization for double‐contrast DECT was scored 29 and 35 percentage points (95% CI 20–35% and 33–39%, both p < 0.001) higher with enteric tungsten and tantalum, respectively, than with bismuth contrast. Median completeness of intraluminal enteric contrast subtraction in double‐contrast DECT iodine density maps was scored 28 and 29 percentage points (95% CI 15–31% and 28–33%, both p < 0.001) higher with enteric tungsten and tantalum, respectively, than with bismuth contrast. Results suggest that in vivo double‐contrast DECT with iodinated intravenous and either tantalum‐ or tungsten‐based enteric contrast provides better visualization of small bowel than conventional CT. Copyright © 2016 John Wiley & Sons, Ltd.     

Ultrasound-Guided Lumbar Plexus Block for Open Reduction and Internal Fixation of Hip Fracture

Purpose: Ultrasound technology has been applied to increase both efficacy and safety of certain peripheral nerve blocks. This case report describes the first successful ultrasound‐guided lumber plexus block. Clinical Features: We describe a 91‐year‐old woman with aortic stenosis who successfully underwent open reduction and internal fixation of a fractured right hip with a lumbar plexus block. Ultrasound provided direct visualization to help identify the anatomical structures and guide the block needle during performance of the block. Complete block of the lumbar plexus was attained within 15 min, and the surgical procedure was performed uneventfully. Conclusion: The use of ultrasound has gained popularity to perform peripheral nerve blocks. In this case report, a successful lumbar plexus block was performed with ultrasound guidance. By direct visualization, using this technology may potentially reduce complications associated with lumbar plexus blocks.     

A new prenatal sonographic sign of epidermolysis bullosa

We report on the prenatal sonographic appearance of epidermolysis bullosa (EB). The third viable pregnancy of a consanguineous couple was found at 23 weeks to have dysplastic external ears and nose. The neonate was born at 33 weeks and was found to have junctional EB with pyloric atresia. On reviewing the 23‐week ultrasound images, skin denudation was evident. This is a report of visualization of skin denudation in EB. When EB is suspected prenatally, special attention should be given to the visualization of skin surfaces.     

Cryoablation of atrial fibrillation with the fourth‐generation balloon: The first reported case

Cryoballoon ablation was developed as a new treatment for pulmonary vein (PV) isolation and has demonstrated high procedural success and comforting long‐term clinical outcome. However, some improvements are necessary for real‐time visualization of PV signals that appeared important to increase the efficacy and reduce ineffective cryoapplications. We report, for the first time, a cryoablation procedure using the fourth‐generation cryoballoon, describing betterment in vein signal recording and acute procedural success.     

Caseous calcification of the mitral annulus imaged with 64-slice multidetector CT and magnetic resonance imaging

Caseous calcification of the mitral annulus is a rare entity in cardiac imaging. We present CT and magnetic resonance imaging (MRI) in a patient evaluated for severe mitral valve regurgitation with such calcified cardiac mass in the thickened basal wall of the left ventricle. Despite good visualization of the mass both with 64-slice multidetector CT and MRI, the characterization of the lesion was difficult. The most critical finding was the presence of a hyperdense mass with an even denser peripheral rim on pre-contrast CT images. The mass did not enhance after X-ray contrast agent administration. We discuss the preoperative differential for calcified intramyocardial mass.     

Sirenomelia apus after trimethoprim exposure: First‐trimester ultrasound diagnosis—a case report

We report the early prenatal ultrasound diagnosis of sirenomelia apus at 12+4 weeks in a patient with trimethoprim exposure in the vulnerable period. First‐trimester scan revealed a malformed fetus with one femur, one small tibia, no feet, intraabdominal unilocular cystic structure, and two‐vessel umbilical cord with allantoic cyst. Ultrasound visualization with two/three/four‐dimensions was helpful in the process of parental counseling. © 2012 Wiley Periodicals, Inc. J Clin Ultrasound, 2012;     

Connexin 43‐targeted T1 contrast agent for MRI diagnosis of glioma

Glioblastoma multiforme is the most aggressive form of brain tumor. Early and accurate diagnosis of glioma and its borders is an important step for its successful treatment. One of the promising targets for selective visualization of glioma and its margins is connexin 43 (Cx43), which is highly expressed in reactive astrocytes and migrating glioma cells. The purpose of this study was to synthesize a Gd‐based contrast agent conjugated with specific antibodies to Cx43 for efficient visualization of glioma C6 in vivo. We have prepared stable nontoxic conjugates of monoclonal antibody to Cx43 and polylysine–DTPA ligands complexed with Gd(III), which are characterized by higher T₁ relaxivity (6.5 mM^?1 s^?1 at 7 T) than the commercial agent Magnevist® (3.4 mM^?1 s^?1). Cellular uptake of Cx43‐specific T₁ contrast agent in glioma C6 cells was more than four times higher than the nonspecific IgG‐contrast agent, as detected by flow cytometry and confocal analysis. MRI experiments showed that the obtained agents could markedly enhance visualization of glioma C6 in vivo after their intravenous administration. Significant accumulation of Cx43‐targeted contrast agents in glioma and the peritumoral zone led not only to enhanced contrast but also to improved detection of the tumor periphery. Fluorescence imaging confirmed notable accumulation of Cx43‐specific conjugates in the peritumoral zone compared with nonspecific IgG conjugates at 24 h after intravenous injection. All these features of Cx43‐targeted contrast agents might be useful for more precise diagnosis of glioma and its borders by MRI. Copyright © 2015 John Wiley & Sons, Ltd.     

Use of perfluorocarbon nanoparticles for non‐invasive multimodal cell tracking of human pancreatic islets

In vivo imaging of engraftment and immunorejection of transplanted islets is critical for further clinical development, with ¹H MR imaging of superparamagnetic iron oxide‐labeled cells being the current premier modality. Using perfluorocarbon nanoparticles, we present here a strategy for non‐invasive imaging of cells using other modalities. To this end, human cadaveric islets were labeled with rhodamine‐perfluorooctylbromide (PFOB) nanoparticles, rhodamine‐perfluoropolyether (PFPE) nanoparticles or Feridex® as control and tested in vitro for cell viability and c‐peptide secretion for 1 week. ¹⁹F MRI, computed tomography (CT) and ultrasound (US) imaging was performed on labeled cell phantoms and on cells following transplantation beneath the kidney capsule of mice and rabbits. PFOB and PFPE‐labeling did not reduce human islet viability or glucose responsiveness as compared with unlabeled cells or SPIO‐labeled cells. PFOB‐ and PFPE‐labeled islets were effectively fluorinated for visualization by ¹⁹F MRI. PFOB‐labeled islets were acoustically reflective for detection by US imaging and became sufficiently brominated to become radiopaque allowing visualization with CT. Thus, perfluorocarbon nanoparticles are multimodal cellular contrast agents that may find applications in real‐time targeted delivery and imaging of transplanted human islets or other cells in a clinically applicable manner using MRI, US or CT imaging. Copyright © 2011 John Wiley & Sons, Ltd.     

Ultrasound‐Guided Injection of the Temporalis Tendon: A Novel Technique

A novel technique, ultrasound‐guided injection of the temporalis tendon in adults, is described. Ultrasound‐guided injection of the temporalis tendon is based on visualization of the temporalis muscle, temporalis tendon, and coronoid process. A practical step‐by‐step guide to doing the procedure is given. This technique is effective and reproducible. Two patients successfully treated with this technique will be briefly discussed. The anatomic location and size of the temporalis tendon make it mandatory to use ultrasound to ensure precision.     

3D可视化技术在腹腔镜下肾错构瘤剜除术中的应用

目的 探究3D可视化技术在腹腔镜下肾错构瘤剜除术中的临床应用价值.方法 回顾性分析2019年3月-2021年3月行腹腔镜下肾错构瘤剜除术的65例肾错构瘤患者的临床资料,术前行3D重建37例,常规CT检查28例.比较两组患者人口学参数、肿瘤位置和围手术期结果.用SPSS 26.0软件进行分析.结果 两组患者年龄、性别、住...     

Sonographic diagnosis of a pseudoaneurysm in an intravenous drug abuser

We report a case of a traumatic pseudoaneurysm and arteriovenous fistula in the groin of a drug abuser. Gray-scale and Doppler sonography were used to establish the diagnosis. Gray-scale sonography revealed an anechoic, ovoid, 7 x 4 cm mass posterior to the right superficial femoral artery, which was displaced anteriorly, with limited visualization of the deep femoral artery. Power Doppler sonography showed complete color filling of the mass, and turbulence was seen on conventional color Doppler sonography. The turbulence was confirmed with pulsed Doppler sonography of the mass. Pulsed Doppler imaging of the right external iliac vein also showed an arterialized spectral flow pattern.     

Evaluation of Vaginal Cysts and Masses by 3‐Dimensional Endovaginal and Endoanal Sonography

The purpose of this pictorial essay is to describe the utility of 3‐dimensional endovaginal and endoanal sonography in the assessment of vulvovaginal cysts and masses. It is accepted that compared with transabdominal pelvic sonography, transvaginal end‐fire sonography provides improved resolution for visualization of female reproductive organs with fewer artifacts. To visualize the structures that are located in or lateral to the vaginal canal, side‐fire 3‐dimensional endovaginal or endoanal sonography can be used. This special technique has the advantage of maintaining the spatial anatomic relationship of any abnormality in the vagina.     

Occipital Neuromodulation: Ultrasound Guidance for Peripheral Nerve Stimulator Implantation

We report a case of chronic left‐sided occipital neuralgia in a 21‐year old female patient. The patient in question suffered from chronic greater occipital neuralgia for a duration of many years, which had been refractory to other conservative medical management strategies. Blockade of the greater occipital nerve with local anesthetic was consistently useful in attenuating the patient's pain, though the effects were always short lived. Consequently, a successful trial of greater occipital nerve stimulation was undertaken. Compared with spinal cord stimulation, peripheral nerve stimulation devices are often more difficult to precisely place given limited ability to visualize soft tissues with traditional fluoroscopic guidance. Additionally, there are anatomic subtleties relevant to the greater occipital nerve that potentially complicate stimulator lead placement, both from the standpoint of optimal neuromodulation efficacy and maximum safety. Ultrasound technology is a maturing imaging modality that allows soft tissue visualization and is consequently useful in addressing each of these aforementioned concerns. The specific use of high‐frequency ultrasound guidance for this procedure simplified the initial device placement and allowed proper visualization of soft tissue structures, which facilitates precise device deployment. Additionally, the ability to identify relevant vascular structures may further increase the safety of stimulator lead placement. The potential advantages of ultrasound‐augmented procedural techniques, specifically as they pertain to occipital stimulator lead placement, are discussed with particular emphasis on potentially decreasing intraoperative and postoperative complications while optimizing stimulation efficacy.     

Early sonographic diagnosis of intrauterine device migration to the adnexa

Uterine perforation is an uncommon complication of intrauterine devices (IUDs). Perforating IUDs can migrate to various locations but paradoxically are rarely found in ovaries or broad ligament. We describe an unusual case of a 23‐year‐old woman 1‐month postpartum with an IUD translocation to the right adnexa. The IUD was inserted only 1 week prior to presentation, and she experienced pain on insertion. After visualization by ultrasound, the IUD was laparoscopically removed. We suggest early use of ultrasound in cases of potential IUD migration, particularly in high‐risk patients and when IUD insertion causes pain. © 2009 Wiley Periodicals, Inc. J Clin Ultrasound, 2009     

Antenatal 3-dimensional sonographic diagnosis of fetal oropharyngeal teratoma

We report a case of a large fetal oropharyngeal teratoma in a 19-week fetus evaluated with 3-dimensional (3D) sonography. The 3D sonographic surface and maximum mode rendering of the tumor allowed detailed visualization of the mass lesion and thus enabled active patient participation in the management of the pregnancy.