Paediatric triceps avulsion fracture identified with ultrasound

INTRODUCTIONTriceps avulsion fracture rupture is a rare tendon. Radiography remains the initial imaging modality of choice for evaluating a suspected triceps injury. However, in children the osseous insertion may not be visible on standard plain film imaging if it is partially ossified.PRESENTATION OF CASEAn 8-year-old child presented to Accident and Emergency complaining of localised pain over the right olecranon following a fall onto an outstretched hand. The X-rays did not reveal a visible fracture however with subtle radiological signs and objective clinical findings an ultrasound was sought demonstrating a visibly avulsed bony fragment.DISCUSSIONThis report demonstrates the importance of a thorough clinical examination needed to acquire a high index of suspicion as a missed or delayed diagnosis can lead to failure of surgical fixation resulting in prolonged disability.CONCLUSIONThe child underwent exploration under anaesthesia with anatomical reduction and fixation of the bony fragment with k-wires and periosteal sutures. Thereafter, following immobilisation in a cast the child regained full movement and power of extension.     

Radiosynthesis of 11‐[18F]fluoroundecyltriphenylphosphonium (MitoF) as a potential mitochondria‐specific positron emission tomography radiotracer

Changes in the magnitude of the mitochondrial membrane potential occur in a range of important pathologies. To assess changes in membrane potential in patients, we set out to develop an improved mitochondria‐targeted positron emission tomography probe comprising a lipophilic triphenylphosphonium cation attached to a fluorine‐18 radionuclide via an 11‐carbon alkyl chain, which is well‐established to effectively transport to and localise within mitochondria. Here, we describe the radiosynthesis of this probe, 11‐[¹⁸F]fluoroundecyl‐triphenylphosphonium (MitoF), from no‐carrier‐added [¹⁸F]fluoride and a fully automated synthetic protocol to prepare it in good radiochemical yields (2–3 GBq at end‐of‐synthesis) and radiochemical purity (97–99%). Copyright © 2013 John Wiley & Sons, Ltd.     

Multiport staging laparoscopy in esophageal and cardiac carcinoma

Between February 1993 and September 2000, 320 patients with esophageal cancer were referred to our oesophagogastric unit. One hundred and thirty-three consecutive patients with histologically proven carcinoma of the esophagus were assessed with a view to resection using multiport staging laparoscopy. Multiport staging laparoscopy was performed as a short stay/day case procedure in 133 patients with esophageal and oesophagogastric junctional carcinoma. Multiple ports were used to inspect the liver, omentum, peritoneal surfaces, coeliac/left gastric lymph nodes and obtain biopsies and cytology. Satisfactory assessment was possible in 127 cases (95%). Laparoscopy detected incurable disease in 31 patients (24%), some of whom had more than one contraindication to surgery, including hepatic metastases (n = 10), peritoneal metastases (n = 12) and malignant small volume ascites (n = 5). Lymph node metastases were confirmed histologically by biopsy at laparoscopy in 26 patients (fixed nodes, n = 14; mobile nodes, n = 12). Sensitivity for the detection of liver and peritoneal metastases was 100%, and lymph node metastases were 83%. Specificity for detection of hepatic metastases was 99%, 100% for peritoneal metastases and 82% for lymph node metastases. Ninety-nine patients proceeded to definitive surgery and only two were unresectable. Multiport laparoscopic assessment of metastases in patients with esophageal carcinoma avoids unnecessary surgery and allows for more efficient use of theatre and intensive care time.     

Endo-hepatology: An emerging field

Gastroenterologists have long been spearheading the care of patients with various forms of liver disease. The diagnosis and management of liver disease has traditionally been a combination of clinical, laboratory, and imaging findings coupled with percutaneous and intravascular procedures with endoscopy largely limited to screening for and therapy of esophageal and gastric varices. As the applications of diagnostic and therapeutic endoscopic ultrasound (EUS) have evolved, it has found a particular niche within hepatology now coined endo-hepatology. Here we discuss several EUS-guided procedures such as liver biopsy, shear wave elastography, direct portal pressure measurement, paracentesis, as well as EUS-guided therapies for variceal hemorrhage.