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Background: Syphilis has been referred to as "the great imitator" due to its ability to imitate other diseases. Untreated syphilis becomes a systemic infection that can involve almost every organ systems. Treponema pallidum has a high affinity for bone tissue, but osteitis has mainly been described in late stages of the disease. Vertebral involvement is rare, and this is to our knowledge the first case describing syphilitic spondylitis in early acquired syphilis., Case Presentation: We here describe destructive osteitis in the vertebral column as the initial manifestation of early acquired syphilis in a 24-year-old caucasian homosexual male with HIV infection. The diagnosis was reached by universal bacterial PCR and DNA sequencing of the DNA product. It was confirmed by PCR specific for Treponema pallidum, immunohistochemistry and detection of increasing antibody titer., Conclusions: As syphilis has re-emerged in Western countries and remains a worldwide common disease it is important to have in mind as a causative agent of skeletal symptoms, especially among HIV-infected individuals or men who have sex with men (MSM).

Objective: The aim of our article is to give an overview of the current and future possibilities of real-time image fusion involving ultrasound. We present a review of the existing English-language peer-reviewed literature assessing this technique, which covers technical solutions (for ultrasound and endoscopic ultrasound), image fusion in several anatomic regions, and electromagnetic needle tracking., Conclusion: The recent progress of real-time ultrasound in image fusion may provide several new possibilities, including diagnosis, treatment, and follow-up of oncologic patients.

Strain elastography (SE), which estimates tissue strain, is an adjunct to the conventional ultrasound B-mode examination. We present a short introduction to SE and its clinical use. Furthermore, we present an overview of the 10 largest studies performed on the diagnostic accuracy of SE in breast cancer diagnostics. Eight of 10 studies presented data for both SE and B-mode imaging. Seven studies showed better specificity and accuracy for SE than for B-mode imaging in breast cancer diagnosis. Four studies showed an increase in specificity and accuracy when combining B-mode imaging with SE. The ways of combining B-mode imaging with SE in the diagnosis of breast cancer differed between the five studies. We believe that further studies are needed to establish an optimal algorithm for the combination of B-mode ultrasound and SE in breast cancer.

Image fusion involving real-time ultrasound (US) is a technique where previously recorded computed tomography (CT) or magnetic resonance images (MRI) are reformatted in a projection to fit the real-time US images after an initial co-registration. The co-registration aligns the images by means of common planes or points. We evaluated the accuracy of the alignment when varying parameters as patient position, respiratory phase and distance from the co-registration points/planes. We performed a total of 80 co-registrations and obtained the highest accuracy when the respiratory phase for the co-registration procedure was the same as when the CT or MRI was obtained. Furthermore, choosing co-registration points/planes close to the area of interest also improved the accuracy. With all settings optimized a mean error of 3.2 mm was obtained. We conclude that image fusion involving real-time US is an accurate method for abdominal examinations and that the accuracy is influenced by various adjustable factors that should be kept in mind.

Objective: To evaluate the intra-/interobserver agreement of the visual interpretation of contrast-enhanced ultrasound (CEUS) of pancreatic head lesions and its concordance with the histological test results., Material and Methods: Two observers (A + B) evaluated by simple visual interpretation 40 consecutive CEUS examinations of pancreatic head lesions and one of the observers evaluated the examinations twice (A1 + A2). The examinations were evaluated according to the criteria outlined in EFSUMB guidelines. The two experienced observers were blinded to histological evidence and clinical information of tumor type and to each other's results., Results: The kappa value for the intraobserver evaluation between observer A1 and A2 was 0.89, equating to almost perfect agreement. The kappa value for the interobserver evaluation between observer A1 and B was 0.76 and between observer A2 and B it was 0.75, both equating to substantial agreement. Evaluation of the visual interpretation compared to the histological test result showed a positive predictive value for A1, A2 and B versus biopsy of 97%, 94% and 90% respectively and an accuracy of 83%, 88% and 73% respectively., Conclusions: Visual interpretation for assessment of contrast enhancement of pancreatic head lesions seemed to be an accurate method with reproducible results and good concordance with the histological test results.

We present the first case of a gastric bezoar caused by barium sulphate acting as an intermittently occluding mass in a patient who had undergone small bowel follow-through on suspicion of small bowel obstruction (SBO) after total pancreatectomy. The patient underwent acute surgery but intermittent symptoms of SBO persisted. A barium bezoar was seen on plain abdominal film and afterwards diluted and fragmented gastroscopically. A barium bezoar giving rise to SBO is a possible complication to barium follow-through in patients with impaired gastric transit time.

Background and Aims: The objective was to determine the sensitivity and specificity of Focused Assessment with Sonography for Trauma (FAST) in patients with confirmed liver lesions and also to compare results from surgeons trained in FAST with results from radiologists trained in general abdominal ultrasound as part of the specialist training. Explorative laparotomy or CT served as gold standard., Materials and Methods: This retrospective study included all patients admitted to our institution from 2003 to 2010 registered with the diagnosis "Injury of the liver or gallbladder". Of 405 patients, 135 patients were eligible for analysis. Seventy-two patients were examined by radiologists and 63 by surgeons., Results: We found FAST to have a sensitivity, specificity, PPV, and NPV of 79.6%, 100%, 100%, and 68.9%. There was no statistically significant difference between FAST performed by radiologists and surgeons trained in FAST., Conclusion: FAST remains an important screening tool in abdominal trauma including liver lesions, and can be performed at a satisfactory level by surgeons trained in the FAST procedure only.

The imaging modalities computed tomography (CT) and the ultrasonography (US) examination focused assessment with sonography for trauma (FAST) in relation to damage control in traumas are discussed. CT has the advantage of high sensitivity and specificity for detection of organ specific lesions. FAST ultrasound is a good screening tool for intraperitoneal bleeding, but the sensitivity and specificity is lower than by CT. We recommend FAST-US prehospitally or early in the trauma room resuscitation. Haemodynamically stable patients with relevant traumas should undergo CT.

The aim of this thesis was to test the clinical application of image fusion involving US. The first study describes the accuracies of different methods of co-registration in a phantom. The accuracy improved if co-registration was made from points or planes close to the area examined. The second study describes the accuracy of image-guided intervention on structures invisible to US but visible to CT or MRI. We measured a rate of success of biopsies in a phantom and found a rate of success, similar to that of conventional US-guided biopsy. In the third study, we found that the number of identifiable lesions by US increased by using the fusion-guided US, and the method was helpful as guidance for contrast-enhanced US (CEUS) as it enabled us to focus on a specific area. In the fourth study we computed a program to fuse a 3D-US dataset with a PET/CT examination. We have presented some of the first results on accuracy of real-time image fusion involving US and of the application of the method to patients with liver lesions.

Unlabelled: Gastric neuroendocrine carcinomas (NECs) are rare tumours that are divided into four subtypes depending on tumour characteristics. Patients with NECs are known to have an increased risk of synchronous and metachronous cancers mainly located in the gastrointestinal tract. A case of synchronous gastric NEC and hepatocellular carcinoma in a patient with several other precancerous lesions is presented. The patient had anaemia, and a gastric tumour and two duodenal polyps were identified on upper endoscopy. A CT scan of the abdomen revealed several lesions in the liver. The lesions were invisible on B-mode sonography and real-time sonography fused with CT was used to identify and biopsy one of the lesions. Histology showed hepatocellular carcinoma. A literature search showed that only one case of a hepatocellular carcinoma synchronous with a gastric NEC has been reported previously., Trial Registration Number: NCT00781924.

Vaginal rupture is a rare complication of hysterectomy. It is, among others, related to age and the incidence is higher in postmenopausal women. The rupture can occur spontaneously or in relation to clinical follow-up. In ovarian cancer the follow-up after surgery includes clinical examination, cancer antigen (CA)-125, and transabdominal and transvaginal ultrasonography. We experienced vaginal rupture in three patients with ovarian cancer. All patients had undergone surgery for ovarian cancer and were receiving chemotherapy. The rupture occurred shortly after transvaginal ultrasonography, performed by separate radiologists specialised in ultrasonography. All patients had acute surgery without any complications. Caution should be taken when performing transvaginal ultrasonography in hysterectomised patients and the complication of vaginal rupture should always be borne in mind.

We present a case of inflammatory cloacogenic polyp in a 28-year-old man who had suffered from intermittent rectal bleeding for four years. A colonoscopy showed anal polyps. The patient had no previous medical history and had no known family history of polyps. Histopathology showed changes in the colonic mucous membrane consistent with the diagnosis inflammatory cloacogenic polyp, no dysplasia. Dysplasia has been described in ICP, but is rare. Nonetheless, histological examination of all perianal lesions, even in young adults, is important.

Objective: The purpose of our study was to test the accuracy of sonographically guided biopsies in a phantom of structures not visible on sonography but shown on MRI by using commercially available sonography systems with image fusion software., Materials and Methods: A previously recorded MRI examination from a custom-made phantom was loaded into the sonography system. The phantom contained spheres that were invisible to sonography and contained red dye. The red dye was visible in the biopsy if it was successful. The images were coregistered using structures visible on both sonography and MRI, and biopsies were taken. The biopsy procedure was continued until a biopsy was successful, and the number of needle passes and time spent were registered., Results: A total of 130 targets were hit. Ten minutes was used for loading the MRI data set and the coregistration; 94 of the 130 biopsies (72.3%) were successful at the first needle pass. The median number of needle passes until a successful biopsy was obtained was one (range, 1-7)., Conclusion: The described method was successful in obtaining an adequate sample in a phantom.

We report a case of fundic gland polyposis (FGP) in a non-familial adenomatous polyposis (FAP) patient. The patient was suffering from persistent heartburn. Esophagogastroduodenoscopy revealed multiple polyps of a few millimetres. Histopathology was consistent with the diagnosis of FGP. Fundic gland polyps are among the most common of all gastric polyps. Dysplasia in FGP is rare but is seen in patients suffering from FAP. In patients with FGP, sigmoideoscopy is recommended to exclude FAP.

Introduction: Reading a wireless capsule endoscopy (WCE) may be time-consuming. In order to reduce the time needed by a physician to view a WCE, we investigated if other medical professions could preview the video and detect bowel pathology in advance., Materials and Methods: A specialist in gastroenterology and two laboratory technicians independently viewed 34 consecutive WCEs and noted all findings. Thereafter, two specialists reviewed the findings made by the technicians independently in order to make a diagnosis. The results were compared with the diagnosis made by the first specialist, who viewed the entire WCE himself., Results: The reviewing specialists were able to make a correct diagnosis based on the technicians' findings in 97% and 85% of the patients, respectively., Conclusion: The study indicates that it is safe and timesaving to use other medical professions than physicians to preview WCEs.