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Ultrasonography can provide a clear depiction of Muscle Thickness (MT) and Cross-sectional Area (CSA) while monitoring muscle contraction. Estimating muscle contraction through ultrasonography with physiotherapy interventions has shown to be a beneficial method for training tightened muscles. A 26-year-old male patient presented to physical therapy with a diagnosis of acute hamstring tightness in both lower extremities, based on clinical examination. Muscle tightness was confirmed through the CSA of the hamstring muscles using ultrasonography. A total of six sessions over two weeks, three times per week, including High-Intensity Laser Therapy (HILT) on each hamstring muscle using the contact method, were applied. Circumference and area of each hamstring muscle were measured through ultrasonography, along with flexibility using the sit-toe and touch test and the Active Knee Extension (AKE) test, both pre- and post-intervention. At the end of the sessions, the subject reported clinically meaningful improvement in outcome scores. This case illustrates the improvement in hamstring muscle flexibility as observed in radiological ultrasonography findings following HILT intervention in a subject with hamstring muscle tightness. [ABSTRACT FROM AUTHOR]

Background and Aims: Rising extravascular lung-water index (ELWI) following cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS + HIPEC), if not timely intervened, can progress to pulmonary oedema. Transpulmonary thermodilution (TPTDL) is a standard technique to estimate ELWI (T-ELWI score), and track ongoing changes. Lung ultrasound (LUS) is another technique for ELWI (L-ELWI score) estimation. However, reproducibility and reliability of LUS for tracking serial L-ELWI changes during CRS + HIPEC remains to be validated. Methods: This prospective observational study included 360 L-ELWI and T-ELWI measurements at 12 peri-operative time-points. Cohen's Kappa test was used to assess reproducibility, Inter-rater agreement (between the anaesthetist and radiologist), and agreement between LUS and TPTDL for classifying the severity of pulmonary oedema. Reliability of LUS for 'tracking serial changes' in ELWI over time in individual patients was assessed by determining the repeated measures correlation (z-rrm) between weighted L-ELWI and T-ELWI scores. The ability of both techniques to discriminate pulmonary oedema was compared by analysing the area under ROC curves. Results: Excellent inter-rater agreement for assigned L-ELWI scores was observed (linear weighted κ = 0.95 for both). Both techniques had a good agreement in classifying the severity of pulmonary oedema (linear weighted κ = 0.63, 95% CI 0.51–0.79). T-ELWI and weighted L-ELWI scores correlated strongly (z-rrm = 0.88, 95% CI 0.80–0.92, P < 0.0001). Both techniques had comparable ability to discriminate pulmonary oedema (difference in area under ROC curve = 0.0014, 95%CI –0.0027 to 0.0055, P = 0.5043). Conclusion: We found the utility of LUS as a reliable and reproducible technique for ELWI estimation and tracking its changes over time in CRS + HIPEC. [ABSTRACT FROM AUTHOR]

Biliary sludge is seen on ultrasound as an amorphous echogenic material, which slowly moves to the dependent part. Endoscopic ultrasound has a sensitivity of 96% to detect biliary sludge, and the appearance is similar to that seen on transabdominal ultrasound. Other entities which can have a similar appearance include blood, pus, necrotic debris, and multiple small stones. This case represents a unique finding on endoscopic ultrasound of an echogenic image in CBD, mimicking biliary sludge. [ABSTRACT FROM AUTHOR]

Introduction: Treatment of gingival recession defects should aim at addressing both the biological and aesthetic demands. The chances of relapse are minimised if periodontal therapy fulfils the main goal to attain complete root coverage and an increase in the thickness of the keratinised tissue. Aim: To clinically evaluate and compare the efficacy of amnion and chorion membranes in the treatment of gingival recession as root coverage procedures. Further to assess their effect on the gingival biotype. Materials and Methods: Twenty sites in 10 patients with gingival recession defects were selected. These sites were divided into two groups as Group A sites (coronally advanced flap along with the placement of amnion membrane) and Group B sites (coronally advanced flap along with the placement of chorion membrane) according to the treatment modality received. All the subjected sites were assessed for clinical parameters like plaque index, gingival index, probing pocket depth, relative clinical attachment level, position of the gingival margin and the gingival thickness measured by manual and ultrasonographic methods; pre and postoperatively at different intervals. For the intragroup comparisons, 'paired t test' was used and for intergroup comparisons, 'independent t test' was applied. Pearson's coefficient correlation was used for correlation of gingival thickness measured by manual and ultrasonographic methods. For the intragroup comparisons, 'paired t-test was used and for intergroup comparisons independent t-test was applied. A statistical significance p-value was considerd <0.05. Results: A significant reduction in the plaque index and gingival index scores was seen but statistically no significant difference between the probing pocket depth measured at baseline to six months postoperatively, were observed for both the groups. Amnion group (Group A) showed statistically significant mean gain in relative clinical attachment (p-value=0.01*) and highly significant mean reduction in position of gingival margin (p-value=0.001*) at six months. Chorion group (Group B) showed statistically highly significant mean gain in the relative clinical attachment level (p-value=0.001*) and significant mean reduction in the position of gingival margin (p-value =0.03*) in six months. Both the groups showed statistically high significant mean increase in the gingival thickness measured by both manual and ultrasonographic methods, after six months postoperatively. An improvement in clinical parameters was observed in both the groups but the difference was not statistically significant. Conclusion: The various clinical parameters suggest that both amnion and chorion membranes are biocompatible and safe to use without causing any inadvertent tissue response or antigenic reaction and thus can be used in the treatment of gingival recession defects and to augment the gingival biotype. [ABSTRACT FROM AUTHOR]

In the era of evidence-based medicine, ultrasonography has emerged as an important and indispensable tool in clinical practice in various specialties including critical care. Lung ultrasound (LUS) has a wide potential in various surgical and clinical situations for timely and easy detection of an impending crisis such as pulmonary edema, endobronchial tube migration, pneumothorax, atelectasis, pleural effusion, and various other causes of desaturation before it clinically ensues to critical level. Although ultrasonography is frequently used in nerve blocks, airway handling, and vascular access, LUS for routine intraoperative monitoring and in crisis management still necessitates recognition. After reviewing the various articles regarding the use of LUS in critical care, we found, that LUS can be used in various intraoperative circumstances similar to Intensive Care Unit with some limitations. Except for few attempts in the intraoperative detection of pneumothorax, LUS is hardly used but has wider perspective for routine and crisis management in real-time. If anesthesiologists add LUS in their routine monitoring armamentarium, it can assist to move a step ahead in the dynamic management of critically ill and high-risk patients. [ABSTRACT FROM AUTHOR]

Background and Aims: The conventional techniques of epidural space (EDS) identification based on loss of resistance (LOR) have a higher chance of complications, patchy analgesia and epidural failure, which can be minimised by objective confirmation of space before catheter placement. Acoustic puncture assist device (APAD) technique objectively confirms EDS, thus enhancing success, with lesser complications. This study was planned with the objective to evaluate the APAD technique and compare it to LOR technique for EDS identification and its correlation with ultrasound guided EDS depth. Methods: In this prospective study, the lumbar vertebral spaces were scanned by the ultrasound for measuring depth of the EDS and later correlated with procedural depth measured by either of the technique (APAD or LOR). The data were subjected to descriptive statistics; the concordance correlation coefficient and Bland-Altman analysis with 95% confidence limits. Results: Acoustic dip in pitch and descent in pressure tracing on EDS localisation was observed among the patients of APAD group. Analysis of concordance correlation between the ultrasonography (USG) depth and APAD or LOR depth was significant (r ≥ 0.97 in both groups). Bland-Altman analysis revealed a mean difference of 0.171cm in group APAD and 0.154 cm in group LOR. The 95% limits of agreement for the difference between the two measurements were - 0.569 and 0.226 cm in APAD and - 0.530 to 0.222 cm in LOR group. Conclusion: We found APAD to be a precise tool for objective localisation of the EDS, co-relating well with the pre-procedural USG depth of EDS. [ABSTRACT FROM AUTHOR]

Spinal tuberculosis is common in endemic regions. Psoas abscess associated with lumbosacral tuberculosis is a common finding in long standing cases. But vague symptoms and signs make the clinical diagnosis of psoas abscess with tuberculous spondylodiscitis a challenge. A 22-year-old married female presented with low backache, anorexia and bilateral swellings in the flank regions. The swellings extended to the upper medial quadrant of the buttocks bilaterally. Abdominal ultrasonography showed bilateral psoas abscesses above inguinal ligaments and extending into buttocks bilaterally after iliac bone erosion. Magnetic resonance images showed diffuse spondylodiscitis from L1 to S1 and bilateral psoas abscesses, erosion of the iliac bones and a large subfascial abscess over the gluteal muscles. The communication of the buttock abscess into the retroperitoneum and and with the psoas abscess was evident. Operative drainage of abscesses was performed and histological examination showed caseaous necrosis confirming the clinical diagnosis of tuberculosis. Antituberculous therapy was started and continued for 12 months with complete recovery. [ABSTRACT FROM AUTHOR]

We are presenting the case of a 26-year-old female patient who presented with a large swelling in the left thigh anteromedially. She was preoperatively diagnosed as a case of intramuscular hydatid cyst radiologically, and then cyst was removed and pathology proved the diagnosis. This case illustrates that echinococcal disease should be considered in the differential diagnosis of every cystic mass in any anatomic location, especially when they occur in areas where the disease is endemic. [ABSTRACT FROM AUTHOR]

Context: Cysticercosis is an infection with the larval (cysticercus) stage of Taenia solium. It is difficult to diagnose cysticercosis on ultrasonography. Ultrasonography was done on Logiq 500 Pro machine with convex probe at 3.5 MHz frequency and diagnosed as cysticercosis with surrounding inflammation in the right vastus medialis muscle of thigh with a linear probe at 9.6 MHz frequency. In this case, we are discussing the role of high resolution sonography which helped in non-invasive diagnosis and treatment. Case Report: A 12 years old male patient presented with a swelling on the medial aspect of the right thigh. There was complaint of pain in the right thigh for the last one week with history of fever since three days. On local examination, a single swelling of size approximately 4x5 cm in the right medial aspect of thigh was present. On ultrasonography there was a well defined isolated cystic lesion of size 3.3 x 2.5 cm intermuscular area. We have successfully managed the patient conservatively with albendazole and steroids only. Conclusion: We conclude that intermuscular cystic swelling in thigh can be diagnosed on high resolution sonography with a great confidence to manage it conservatively. Cost of investigations also reduced. Ultrasonography plays an important role. Child is doing well in follow-up. [ABSTRACT FROM AUTHOR]

This case report concerns a 30-year-old man who presented with a large mass on the left side of the jaw in the submandibular area. Panoramic radiography and computed tomography revealed the swelling to be a peripheral osteoma of the mandible, which was excised surgically. [ABSTRACT FROM AUTHOR]

Objectives: Clinically or sonographically suspected gallbladder carcinoma was evaluated on multidetector computed tomography. Based on the spectrum of multidetector computed tomography findings, staging of gallbladder carcinoma was done. Multidetector computed tomography diagnosis was compared with pathological diagnosis. Material and Methods: This is a prospective study carried out in 100 patients at a rural Indian center between May 2012 and June 2015. Multidetector computed tomography was performed in all the cases and the findings were observed. Based on the radiological spectrum, staging of gallbladder carcinoma was done. The diagnosis was confirmed by ultrasound guided fine needle aspiration cytology/histopathological examination of surgical specimens. Results: The most common multidetector computed tomography findings noted by us were mass replacing gallbladder, followed by diffuse/focal gallbladder wall thickening and polypoidal mass. Other findings noted were cholelithiasis, liver infiltration, intra hepatic biliary dilatation, liver metastases, portal vein invasion, antroduodenal and hepatic flexure involvement. Ultrasonography guided fine needle aspiration cytology done in all cases was positive in 92 cases and inconclusive in eight cases. Surgery was performed in only 22 patients, and histopathological findings were correlated with multidetector computed tomography findings associa Conclusion: Multidetector computed tomography is also reliable in detection of extension of tumor and lymph nodes. multidetector computed tomography plays a major role in evaluating and staging of carcinoma gallbladder. It also guides the surgeons for operatibility and resectability of tumour. [ABSTRACT FROM AUTHOR]

Abstract: Aim: To evaluate the efficacy of Ultrasonography compared to clinical diagnosis, radiography and histopathological findings in the diagnosis of maxillofacial swellings. Material and methods: The study was conducted on forty-five patients with maxillofacial swellings. The clinical diagnosis, radiographic diagnosis and ultrasonographic diagnosis were made which was compared to the histopathological diagnosis. The maxillofacial swellings included cystic lesions, benign swellings, malignant swellings, lymphadenopathies and abscesses and space infections. Results: The diagnostic accuracy and contingency coefficient was evaluated considering histopathology as gold standard. The diagnostic accuracy of ultrasound was found to be 92.30% in the diagnosis of cystic lesions, 87.5% in benign tumors, 81.8% in malignant tumors, 100% in lymphadenopathies and 90% in space infections and abscesses. The contingency coefficient of 0.934 was obtained when ultrasonography was compared to the histopathology, which was highly significant. Similar significant results were obtained comparing ultrasonography with clinical diagnosis (0.895) and radiographic diagnosis (0.889). Conclusion: Ultrasonography provides accurate imaging of the head and neck region and provides information about the nature of the lesion, its extent, and relationship with the surrounding structures. As the conventional and digital radiography enable the diagnosis of the presence of the disease, but do not give any indication of its nature. So, together with clinical and histopathological examinations, real time ultrasound imaging works out as a valuable adjunct in the diagnosis of orofacial swellings. [Copyright &y& Elsevier]