Echographic aspects of superficial lipoma

The author analyzes the sonographic patterns of 14 superficial benign lipomas. Echogenicity ranges from hypoechogenicity with distal sound enhancement to isoechogenicity with the possibility of hyperechoic areas. 50% of the lipomas of this series were ill-defined from the surrounding fatty soft-tissues.     

Fine-needle aspiration biopsy with a vacuum test tube

A simple, low-cost, automatic aspiration system that makes use of vacuum test tubes designed for the drawing of venous blood has been used for real-time ultrasound (US)-guided fine-needle aspiration biopsy of 13 cysts (breast), an abscess (liver), and five solid (breast, liver, thyroid) masses. Because it allows the operator to perform aspiration with one hand while holding the real-time US transducer with the other, and because creation of the suction is associated with no significant displacement of the needle, this approach has allowed sampling of lesions less than 1 cm in diameter. No complications have occurred.     

Ultrasound examination of the hand and foot

The use of ultrasound in the examination of the distal extremities is a recent application of sonography of the musculotendinous system. Real-time sonography is unique in providing a dynamic study of complex anatomic structures such as the flexor tendons of the hand. The normal anatomic appearance of the hand and foot are reviewed as well as the sonographic appearance of pathologic conditions of the distal extremities.     

Ultrasound examination of the hand

Twenty-five surgically confirmed soft-tissue lesions of the hand were examined prospectively by real-time ultrasound. Use of sonography enabled a reliable diagnosis of the cystic or solid nature of soft-tissue lesions, an accurate estimation of the volume, and precise three-dimensional localization of the abnormality. Sonography also facilitated the location of foreign bodies. Assessment of anatomic relationships of these lesions to tendons and surrounding structures by real-time sonography during palpation, flexion, and/or extension also aided in the surgical approach.     

Disease-free and overall survival after pathologic complete disease remission of cytologically proven inflammatory breast carcinoma axillary lymph node metastases after primary systemic chemotherapy

BACKGROUND: Breast carcinoma axillary lymph node (ALN) pathologic complete response (pCR) after primary chemotherapy is associated with significantly higher recurrence-free survival (RFS) and overall survival (OS) rates. The purpose of the current study was to determine long-term outcome in patients achieving a pCR of cytologically proven inflammatory breast carcinoma ALN metastases after primary chemotherapy. METHODS: Patients with cytologically documented ALN metastases from inflammatory breast carcinoma were treated in three prospective primary chemotherapy trials. After surgery, patients were subdivided into those patients with and those patients without residual ALN carcinoma. Survival was calculated using the Kaplan-Meier method. RESULTS: Of 175 patients treated, 61 had cytologically confirmed ALN metastases. Fourteen patients (23%) achieved a pCR of the ALNs after primary chemotherapy. The 5-year OS and RFS rates were found to be improved in those patients achieving a pCR of the ALNs (82.5% [95% confidence interval (95% CI), 62.8-100%] and 78.6% [95%CI, 59.8-100%], respectively, vs. 37.1% [95%CI, 25.4-54.2%] and 25.4% [95%CI, 15.5-41.5%], respectively) (P = 0.01 [for OS] and P = 0.001 [for RFS]). Combination anthracycline and taxane-based primary chemotherapy resulted in significantly more patients achieving an ALN pCR (45% vs. 16%; P = 0.01). CONCLUSIONS: pCR of ALN metastases is associated with an excellent prognosis in patients with inflammatory breast carcinoma. The rates of ALN pCR are nearly 50% in patients with inflammatory breast carcinoma who are treated with anthracyclines and weekly paclitaxel before surgery. However, those patients with residual ALN disease at the time of surgery greatly require the introduction of novel therapeutic strategies.     

High-frequency sonography of the skin

This article reviews and illustrates the current applications of high-frequency (20-MHz) ultrasound imaging of the skin. This new imaging technique for the skin has gained popularity with the advent of commercially available dedicated ultrasound equipment. The normal ultrasound appearance is described first. Ultrasound features of benign and malignant skin tumors and inflammatory conditions are then described. The accurate delineation of the deep margins of a lesion and the non invasive measurement of its thickness represent an aid in evaluating skin tumors and monitoring the response to therapy of inflammatory conditions.     

Transoral resection of thyroid cancer metastasis to lateral retropharyngeal nodes

BACKGROUND: Lymph node metastasis from differentiated thyroid carcinoma may occur outside of the basins at greatest risk of spread, such as the lateral retropharyngeal lymph nodes. The extensive surgery of traditional approaches to the retropharyngeal space are rarely justified in the treatment of metastatic differentiated thyroid cancer. Therefore, a less invasive surgical approach is advantageous in resection of metastatic lateral retropharyngeal nodes. METHODS: To assess feasibility and safety, we report transoral excision guided by preoperative ultrasonography in a series of 3 consecutive patients with differentiated thyroid cancer metastatic to the retropharyngeal space. RESULTS: In all cases, the metastatic lateral retropharyngeal lymph node was successfully removed by transoral retropharyngotomy without complications. CONCLUSIONS: We advocate a transoral approach guided by preoperative ultrasonography for resection of differentiated thyroid cancer metastatic to the retropharyngeal lymph nodes. The approach is feasible, minimally invasive, and safe in achieving the goals in management of regionally metastatic disease.     

Ala54Thr polymorphism of the fatty acid binding protein 2 gene and saturated fat intake in relation to lipid levels and insulin resistance: the Coronary Artery Risk Development in Young Adults (CARDIA) study

The Thr54 allele of the intestinal fatty acid–binding protein Ala54Thr functional polymorphism (FABP2) is associated with increased fat oxidation and insulin resistance. We determined the cross-sectional associations of the FABP2 gene with lipid levels and insulin resistance in 2148 participants who completed the year-20 examination of the Coronary Artery Risk Development in Young Adults (CARDIA) study. No significant difference in total cholesterol, low-density or high-density lipoprotein cholesterol, triglycerides, high-density lipoprotein cholesterol to total cholesterol ratio, or homeostasis model assessment of insulin resistance (HOMA-IR) was found between FABP2 genotypes. However, in the presence of a high–saturated fat diet (≥53.2 g/d, the 90th percentile for the population), the AA/AG genotypes (carriers of the Thr54 allele) of FABP2 had statistically significantly higher levels of log(HOMA-IR) (P = .006) and a lower high-density lipoprotein cholesterol to total cholesterol ratio (P = .03), and borderline statistically significantly higher levels of total cholesterol, low-density lipoprotein cholesterol, and log(triglycerides) (P values = .08, .07, and .05, respectively) compared with those with the GG genotype (Ala54 homozygotes). Lipid levels and log(HOMA-IR) did not vary by genotype with saturated fat intake less than 53.2 g/d. Limiting dietary saturated fat intake may be particularly important among carriers of the A allele of FABP2.