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Simple Summary: Insulinomas are the most common tumors of the endocrine pancreas in dogs, often resulting in severe hypoglycemia and neurological symptoms. Surgical resection has been the traditional treatment, but it poses significant risks. This study explores the use of ultrasound-guided radiofrequency ablation (RFA) as a safer and less invasive alternative. RFA was found to effectively control glucose levels and reduce tumor size in most treated dogs while reducing recovery times and complications. These findings suggest that RFA offers a valuable treatment option for managing insulinomas and their metastasis in canine patients. Insulinomas are the most common neoplasms of the endocrine pancreas in dogs, leading to persistent hypoglycemia due to inappropriate insulin secretion. The standard treatment is surgical resection, but it carries significant risks, including pancreatitis and diabetes mellitus. This study investigates the efficacy and safety of percutaneous ultrasound-guided radiofrequency ablation (RFA) as an alternative to surgery. A total of 29 dogs diagnosed with insulinoma were treated with RFA, targeting both primary pancreatic tumors and metastases in regional lymph nodes or the liver. Blood glucose levels and tumor size were monitored before and after the procedure. RFA led to a significant increase in blood glucose levels and a reduction in tumor size in all patients, with minimal postoperative complications. The results suggest that RFA is a feasible and effective treatment option for insulinomas in dogs. [ABSTRACT FROM AUTHOR] more...

Objective: Current laryngeal injection models rely on the transoral route and are suboptimal due to limited view, narrowed working space, and the need to sacrifice animals for investigation of the injectables. In the present study, a novel surgical model for laryngeal intervention therapy utilizing an ultra‐high frequency ultrasound imaging system was proposed. Based on this system, we developed a systemic evaluation approach, from guidance of the injection process, documentation of the injection site of the material, to in vivo longitudinal follow‐up on the augmentation and medialization effect by analyzing the ultrasonography data. Study Design: In vivo animal study. Setting: Academic institution. Methods: Injection laryngoplasty with hyaluronic acid under ultrasonography guidance was performed on Sprague‐Dawley rats one week after induced unilateral vocal paralysis. Ultrasonography was performed at preinjection, immediately postinjection, on Day 2, Day 7 and then weekly for 4 weeks to obtain measurements, including the glottic area, angle between bilateral folds, and vocal fold width ratio. Laryngoscopic and histologic studies were also performed. Results: Unilateral injections to the paralyzed fold were successfully performed as demonstrated by ultrasonographic, laryngoscopic, and histologic studies. The width ratio was significantly increased after injection for 4 weeks, while the glottic airway area was unchanged. Conclusion: Here, a novel surgical model for laryngeal injection utilizing ultrasonography in rats was established. In addition to providing visual guidance for precise localization of the injection, robust documentation of the treatment effect was also demonstrated. This methodology could be beneficial for screening therapeutic agents for treatment of glottic insufficiency. [ABSTRACT FROM AUTHOR] more...

Aim of the study: Arthroscopy ranks among the frequently performed interventions in orthopedics. The aim of this study was to compare the palpation technique with the ultrasound technique for locating the dorsal glenohumeral joint space (JS) in shoulder joint punctures. Material and Methods: Participants inexperienced in ultrasound examinations were included. Palpatory and ultrasound finding of the joint space by the participants was performed according to current recommendations and was initially demonstrated by an instructional video. The ideal point (IP) was marked under ultrasound visualization by an experienced ultrasound examinator and shoulder–elbow surgeon. Furthermore, a corridor for a safe puncture was defined. The palpatorily determined point (pdP) was marked by the participants and evaluated by means of a coordinate system. The evaluation of the sonographically determined point (sdP) was performed similarly to that of the palpatory procedure. Results: Fifty-four participants were included in the study, and the mean length of work experience was 6.3 years. On average, participants had performed 16.5 punctures of the shoulder joint and 6.8 arthroscopies of the shoulder joint. The mean experience in performing sonographic examinations of the shoulder was 27.6 examinations. A total of 100 shoulder joints were examined (54 left, 46 right shoulders). The mean deviation from the ideal point (IP) for the palpatory approach was 17.1 mm with a maximum deviation of 59.5 mm; for the sonographic technique, the mean deviation was 10.3 mm (max. 30.2 mm). Overall, 22% of pdPs were within the defined corridor, while 42% of sdPs were within the target corridor. The average difference between palpatory and sonographic approaches was 9.0 mm in favor of the sonographic technique (max. 46.5 mm). A significantly greater deviation (p < 0.001) from the IP was observed with the palpatory approach than with the sonographic approach. Conclusion: Based on the results, the authors recommend ultrasound imaging of the shoulder joint as well as ultrasound-assisted punctures, especially for inexperienced users. Furthermore, training in ultrasound-assisted interventions should be implemented in future training curricula. [ABSTRACT FROM AUTHOR] more...

Case: A 65-year-old man with chronic extensor carpi ulnaris (ECU) stenosing tenosynovitis who had failed treatments for 3 years was successfully treated with an ultrasound-guided retinaculum release of the sixth dorsal compartment. Conclusion: There are limited options in the literature for treating chronic, recalcitrant ECU tenosynovitis. We describe a novel technique in which the retinaculum overlying the ECU tendon was successfully incised under ultrasound guidance to release the sixth dorsal compartment stenosis. There was no recurrence of symptoms in the following 2 years of follow-up. [ABSTRACT FROM AUTHOR] more...

Purpose Arthroscopy is one of the most common interventions in orthopedics. Hence it is important to train users early in order to ensure the safest possible identification of access portals (AP). This prospective study aimed to compare a palpatory (PalpMethod) with a sonographic (SonoMethod) method for AP location in the shoulder and knee joints. more...

Introduction: Pregnancy in a scar after caesarean section (CSP) is a rare complication associated with the risk of morbidly adherent placenta (MAP) and adverse outcomes. The management of CSP is evolving, with various surgical and medical approaches employed. Aim of the research: To analyse the outcomes of 35 cases of CSP and their treatment modalities. Material and methods: Medical records of patients hospitalized at a single institution were reviewed. Data on patient characteristics, gestational age, treatment methods, hospitalization length, complications, and rehospitalization rates were collected. Statistical analysis was conducted using nonparametric Spearman correlation. Results: The study included 35 CSP patients with a mean age of 33 years. The median gestational age at diagnosis was 6 weeks. Methotrexate (MTX) administration to the gestational sac, alone or with intragestational MTX injection, was the primary treatment method. The median length of hospitalization was 6 days. No significant correlation was found between hospital stay and patient age, number of previous caesarean sections, or pre-procedure β-human chorionic gonadotropin (β-HCG) levels. Spontaneous evacuation occurred in most cases, with only a minority requiring subsequent uterine evacuation. No significant complications occurred, but 1 patient experienced heavy bleeding requiring a blood transfusion. Conclusions: Intra-amniotic MTX administration, combined with potassium chloride in certain cases, was found to be an effective and safe approach for managing CSP in the first trimester. This study contributes to the understanding of CSP management and supports the use of intra-amniotic MTX as a minimally invasive treatment option. Further research is needed to refine management guidelines and improve outcomes for this rare complication. [ABSTRACT FROM AUTHOR] more...

A parapharyngeal abscess (PPA) was diagnosed and aspirated under local anesthesia using transoral ultrasound by an ENT surgeon. This case demonstrates that transoral ultrasound is a valuable point-of-care tool for both diagnosing PPA and enabling minimally invasive, ultrasound-guided drainage. Laryngoscope, 2025., (© 2025 The Author(s). The Laryngoscope published by Wiley Periodicals LLC on behalf of The American Laryngological, Rhinological and Otological Society, Inc.) more...

BACKGROUND: Management of surgical emergencies in spaceflight will pose a challenge as the era of exploration class missions dawns, requiring increased crew autonomy at a time when training and supplies will be limited. Ultrasound-guided percutaneous intervention would allow for the management of a variety of pathologies with largely shared equipment and training. This proof-of-concept work attempts to determine the feasibility of "just-in-time" remote teaching and guidance of a sample procedure of this type. METHODS: Subjects naïve to ultrasound-guided intervention were instructed via a short video regarding the technique for placement of a percutaneous drain into a simulated abscess within a gel phantom. Subjects were then guided through the performance of the procedure via two-way audiovisual communication with an experienced remote assistant. Technical success was determined by the successful aspiration or expression of fluid from the simulated abscess following drain placement. This was then performed by and compared with staff experienced with such procedures. Time to completion and number of needle redirections required were also measured. RESULTS: All 29 subjects naïve to interventional work and the 4 experienced control subjects achieved technical success. There was a statistically significant difference in the time to completion between the two groups, with the experienced subjects averaging 2 min to completion and the inexperienced 5.8 min. There was no statistically significant difference in the number of redirections. DISCUSSION: This proof-of-concept work demonstrates high rates of technical success of percutaneous ultrasound-guided intervention in previously inexperienced personnel when provided with brief just-in-time training and live two-way audiovisual guidance. [ABSTRACT FROM AUTHOR] more...

ABSTRACT: Audience: The pork belly paracentesis simulator is designed to instruct Emergency Medicine (EM) residents and Emergency Medicine-bound students. Introduction: Abdominal paracentesis is a common procedure done in the Emergency Department (ED) that must be mastered by EM residents and students. The purpose of a paracentesis is to remove accumulating ascites from the peritoneum. Diagnostic paracentesis is indicated with new cases of ascites or to detect the presence of infection in patients with already known or suspected ascites.1 Therapeutic paracentesis is often conducted in the ED setting to relieve any cardiorespiratory and gastrointestinal manifestations of tense ascites.2 While this procedure has been described in modern medical literature for over a hundred years, the addition of ultrasound can enhance the safety of the procedure and can help detect as little as 100 ml of fluid.3 Objectives: By the end of this instructional session learners should be able to: 1) Discuss the indications, contraindications, and complications associated with abdominal paracentesis; and 2) competently perform an ultrasound-guided abdominal paracentesis on a simulator and remove fluid. Methods: This paracentesis simulator uses a porcine skin with underlying muscle and fascia to replicate the feel of human tissue undergoing this procedure. A gallon water jug is used to simulate the peritoneal cavity filled with ascites. Placing a small hand towel or sterile blue towel in the water jug acts as a wonderful mimic of bowel loops “floating” in the peritoneal fluid when ultrasound is used. A layer of ultrasound gel is placed liberally on one side of the water jug, and then the pork belly is layered on top of that. This tissue is secured to the jug with 3M microfoam surgical tape (or other adhesive-like duct tape). This model has a realistic feel and can be used with ultrasound to replicate intraperitoneal contents. The thickness of the plastic jug will give a realistic “pop” into the peritoneum with the paracentesis needle. Also, this trainer can be used multiple times by different learners before being replaced. This model will allow the learner to conduct a realistic paracentesis procedure while removing actual fluid.Topics: Paracentesis, ascites, ultrasound-guided procedure, simulation. more...

Neonatal pneumothorax (NP) is a potentially life-threatening condition. Lung ultrasound (LUS) has shown higher sensitivity and specificity in diagnosis compared to x-rays, but evidence regarding its usefulness in complex NP is lacking. We report four neonates suffering from cardiac or esophageal malformations who developed lateral and/or posterior pneumothoraces, in which LUS helped, making NP diagnosis and management easier and faster.Conclusion: LUS is an easy-to-use, fast, simple, and accurate tool when evaluating newborns with NP, also in atypical positions such as in surgical patients.What Is Known: • Lung ultrasound (LUS) has higher sensitivity and specificity than x-rays in the diagnosis of pneumothorax in neonatal patients.What Is New: • This is the first report about neonatal pneumothorax in non-conventional areas (lateral/posterior) diagnosed by lung ultrasound and how obtaining this information is critical in order to optimize management. [ABSTRACT FROM AUTHOR] more...

Background: Contraceptive arm implants, such as Implanon NXT ® /Nexplanon ® , are reversible methods of birth control that have gained global popularity, with over 20 million worldwide users. While palpable implants can be easily removed, deep or non-palpable implants pose complications during extraction, often requiring open surgery. This ultrasound-guided removal technique offers a minimally invasive, safe, and effective alternative, providing real-time control over the implant and neurovascular structures. Our study aims to evaluate the effectiveness and challenges of this implant removal method., Methods: In this retrospective observational study, all cases referred to our institution for ultrasound-guided removal of contraceptive implants, from June 2022 to December 2023, were reviewed. Our facility serves as a referral center for handling challenging implants. Twenty-nine women with contraceptive implants were referred for implant removal in this period of time. Thirty implants were sent for removal in total (one patient had a double implant). Data specific to the patients were collected: age and body mass index (BMI). Data specific to the implant were also collected: time since implant insertion (months), history of a previous removal attempt, type of implant (single or double rod), implant palpability, laterality of the implant, supra or subfascial location, success or failure of the ultrasound-guided removal procedure and presence of complications in the post-procedure. Statistical analysis was conducted to determine the relationship between the procedure success rate and these variables, and also between these variables and the supra or subfascial location of the implant., Results: Twenty-six of the 30 implants (86.67%) were successfully removed with this fully ultrasound-guided technique. In cases where the implant could not be removed, there was a higher rate of subfascial implant location (75%), while in cases where the removal was successful, the rate of subfascial implant location was significantly lower at 19.23% (P=0.048). Patients whose implants could be removed had a median BMI of 23.71 kg/m 2 , which was higher than the BMI of patients whose implants could not be removed (20.82 kg/m 2 ), with a P=0.022. No complications were registered., Conclusions: Percutaneous real-time ultrasound-guided implant removal is effective, safe and offers a minimally-invasive alternative to open surgery. The removal of subfascial implants is also feasible but more challenging, leading to a reduction of success rate in this group. These positive outcomes suggest its potential as a standard initial approach for deep contraceptive implant removal., Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://qims.amegroups.com/article/view/10.21037/qims-24-356/coif). The special issue “Advances in Diagnostic Musculoskeletal Imaging and Image-guided Therapy” was commissioned by the editorial office without any funding or sponsorship. X.T. served as the unpaid Guest Editor of the issue. The authors have no other conflicts of interest to declare., (2024 AME Publishing Company. All rights reserved.) more...

Background: Simulation for training is becoming a trend topic worldwide, even if its applications are commonly limited to adulthood. Ultrasound-guided procedures require practice and experience-especially in the pediatric field, where the small size of the involved anatomical structures poses major problems. In this context, a realistic 3D printed pediatric phantom for training of the ultrasound-guided placement of peripheral central venous catheters in children was developed., Materials and Methods: Starting from Computed Tomography scans of an 8 years-old girl, her left arm was virtually reconstructed-including bones, arteries, and veins-through a semi-automatic segmentation process. According to preliminary results, the most suitable 3D printing technologies to reproduce the different anatomical structures of interest were selected, considering both direct and indirect 3D printing techniques. Experienced operators were asked to evaluate the efficacy of the final model through a dedicated questionnaire., Results: Vessels produced through indirect 3D printing latex dipping technique exhibited the best echogenicity, thickness, and mechanical properties to mimic real children's venous vessels, while arteries-not treated and/or punctured during the procedure-were directly 3D printed through Material Jetting technology. An external mold-mimicking the arm skin-was 3D printed and a silicone-based mixture was poured to reproduce real patient's soft tissues. Twenty expert specialists were asked to perform the final model's validation. The phantom was rated as highly realistic in terms of morphology and functionality for the overall simulation, especially for what concerns vessels and soft tissues' response to puncturing. On the other hand, the involved structures' US appearance showed the lower score., Conclusions: The present work shows the feasibility of a patient-specific 3D printed phantom for simulation and training in pediatric ultrasound-guided procedures., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. more...

Ultrasound-guided procedures require excellent hand-eye coordination and practice. Trainees should gain this important skill with a phantom prior to performing procedures on patients. Currently available phantoms each have their own unique limitations. We propose an easily made, inexpensive, tissue-like phantom using a previously unreported material. The sonographic appearance of the phantom, with and without a 14-gauge needle, is compared with breast tissue, gelatin phantoms, and commercial phantoms. Target lesions can be produced using readily available materials. The proposed phantom is cheaper than commercial phantoms; performs better than gelatin phantoms, and is ultimately a superior practice tool for residents. [ABSTRACT FROM AUTHOR] more...

Preoperative ultrasound‐guided lateral abdominal wall botulinum toxin injection is a promising method for improving patient outcomes and reducing recurrence rates after ventral hernia repair. A review of the literature demonstrates variability in the procedural technique, without current standardization of protocols. As radiologists may be increasingly asked to perform ultrasound‐guided botulinum toxin injections of the lateral abdominal wall, familiarity with the procedure and current literature is necessary. [ABSTRACT FROM AUTHOR] more...

Background: Although ultrasound guidance has significantly improved the success rate of radial artery catheterization, the failure rate in children is still high. For the further improvement of success rate, we prospectively evaluated the factors that make ultrasound‐guided radial artery catheterization difficult in children under two years old. Methods: From October 2018 to September 2019, patients who required radial artery catheterization for surgery were enrolled. After collecting the anatomical characteristics of the radial artery using ultrasound at the puncture site, ultrasound‐guided radial artery catheterization was performed by one experienced anaesthesiologist. The primary outcome was to identify the factors related to the first attempt failure. The factors associated with the total duration of the procedure until success were also evaluated. Results: A total of 183 children were included in the analysis. A radial artery cross‐sectional area of ≤1 mm2 (odds ratio [OR] = 5.26; 95% confidence interval [CI], 2.48‐11.18; P <.0001) and the presence of an anomalous radial artery branch (OR = 3.37; 95% CI, 1.43‐7.95; P =.005) were independent predictors of first‐attempt failure during ultrasound‐guided radial artery catheterization. The total procedure time was also negatively associated with the small cross‐sectional area (P <.001). Conclusions: A cross‐sectional area of ≤ 1 mm2 and the presence of an anomalous branch of radial artery significantly increased the difficulty of ultrasound‐guided radial artery catheterization in children under two years old. In patients of these ages, pre‐procedural ultrasound scanning to find an optimal site for catheterization may increase the first‐attempt success rate although further studies are needed to verify our results. Trial Registration: Clinical Research Information Service (https://crits.nih.go.kr, October 6, 2018 [KCT0003239]; Principle investigator: Jong‐Hwan Lee). [ABSTRACT FROM AUTHOR] more...

Nasogastric tube (NGT) insertion is commonly performed in pediatric emergency care. Point‐of‐care ultrasound is used for confirming NGT insertion, but reports of its use in the pediatric emergency department (ED) are scarce. We describe our experience of ultrasound‐guided NGT placement in a pediatric ED. The study pool consisted of twelve patients and the NGT tip was successfully visualized in the esophagus and gastric cardia in all cases, demonstrating that ultrasound has the potential to be a useful alternative to conventional methods of NGT insertion in the pediatric ED. [ABSTRACT FROM AUTHOR] more...

Background: Proximal humeral fractures are commonly encountered in the emergency department (ED). These injuries are often associated with significant pain, with patients often receiving multiple doses of opiate medications while awaiting definitive management. The interscalene nerve block has been efficacious as perioperative analgesia for patients undergoing operative shoulder repair. The utilization of the interscalene nerve block in the ED for proximal humeral fractures is largely unexplored.Discussion: We report the use of an ultrasound-guided interscalene nerve block in the ED for a patient presenting with significant pain from a proximal humerus fracture. The procedure provided excellent regional anesthesia with no additional need for intravenous or oral opiates during the rest of her ED course. With the significant risks associated with pain medication, particularly opiates, regional anesthesia may be an excellent option for the appropriate patient in the ED.Conclusions: As documented in this report, the ultrasound-guided interscalene block, in particular, may be utilized as a means to provide adequate pain control for patients with proximal humerus fractures in the ED. [ABSTRACT FROM AUTHOR] more...

Background: Nasogastric tube (NGT) placement is commonly performed in pediatric emergency care and is classically confirmed by any one of several methods, among which auscultation or aspiration and radiography comprise the currently recognized as the reference standard. Point-of-care ultrasound (POCUS) is used to confirm NGT insertion, especially in adults or prehospital patients, but reports of its use in the pediatric emergency department (ED) are still scarce. We report a case of successful POCUS-guided NGT placement in a pediatric ED.Case Report: A 3-year-old male undergoing remission therapy for acute lymphocytic leukemia presented to our ED with fever and decreased appetite. Tumor lysis syndrome was diagnosed, and endotracheal intubation was required because of the need for emergency hemodialysis for hypercalcemia. Because of difficulty in guiding the tube through the nose, ultrasound-guided placement was attempted. In the transverse view over the neck below the level of the cricoid cartilage, the 10-Fr NGT was visualized under ultrasound guidance as it passed through the esophagus. Subsequently, the entry of the NGT tip into the gastric cardia was confirmed on the subxiphoid longitudinal view. A chest radiograph confirmed the presence of the NGT in the stomach. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Although the utility of POCUS for NGT placement was reported in adult patients, reports of its use in pediatric cases are still few. POCUS is a real-time, noninvasive, time-saving procedure that can be a useful alternative to radiography for confirming correct NGT placement. [ABSTRACT FROM AUTHOR] more...

Background: Chest tube drainage is a common procedure performed by physicians in the emergency setting. Complications may arise in up to 25% of the cases. These vary from drain misplacement to lethal iatrogenic injuries. Ultrasound provides adequate visualization and correct identification of the insertion site, allows the exclusion of a vulnerable intercostal artery, and enables timely diagnosis of drain malpositioning. Although feasible, ultrasound-guided techniques are underused and seldom applied during chest drainage. One reason for that is the lack of a comprehensive step-by-step description incorporating these techniques. This article aims to describe a standardized ultrasound-guided chest tube drainage technique, and also review the evidence supporting its potential benefits.Materials and Methods: we conducted a thorough literature search on ultrasound techniques regarding the identification of the diaphragm, the neurovascular intercostal bundle, and the position of the chest drain. Also, we analyzed published articles about complications of chest drainage.Results: we propose a feasible step-by-step ultrasound-guided technique of chest drainage and discuss why this technique should be incorporated in the routine practice.Conclusion: ultrasound guidance should be incorporated in chest drainage in a stepwise fashion. Although intuitively safer, future randomized studies are warranted to support this technique. [ABSTRACT FROM AUTHOR] more...

Objective Ultrasound-guided foam sclerotherapy (UGFS) – one of the most frequently recommended methods for treating great saphenous vein incompetence – is easy and inexpensive. However, it achieves a lower occlusion rate compared to endovenous thermal ablation. The application of UGFS to pre-terminal great saphenous vein interruption, eliminating the saphenous stem wash out effect, enhances the short-term occlusion rate. This study explores the results of this technique at 12 months. Method Thirty great saphenous veins (28 patients) with junction incompetence, with calibres >6 mm and >30 cm reflux stem length were submitted to echo-guided pre-terminal great saphenous vein interruption and foam great saphenous vein occlusion. Participants were subjected to a 12-month post-operative review by ultrasound assessment of great saphenous vein occlusion and terminal stump stability. Comparisons were made between pre-operative and 12-month Validation of Venous Clinical Severity Score (VCSS), photopletismography, Aberdeen questionnaire and complications. Results After 12 months, 28/30 great saphenous veins remained occluded (93%). One complete and one partial recanalization did not require retreatment. Four saphenous stumps showed a reflux during Valsalva (one due to recanalization, one limited to the stump, two with reflux in the anterior accessory saphenous vein). VCSS improved from 3.33 ± 1.64 to 0.67 ± 1.21 (p < 0.05). Aberdeen questionnaire scores decreased from 9.44 ± 6.18 to 2.47 ± 3.77 (p < 0.05). For photopletismographic examination, the mean venous refilling time (normal value: > 25 s) improved from 17.94 ± 11.97 to 31.4 ± 11.99 (p < 0.05). Conclusion Applying pre-terminal great saphenous vein interruption to UGFS of the saphenous stem achieved an occlusion rate at one year similar to that of endovenous thermal ablation. The procedure is simple, effective, office based, and may be used as a 10-min prolongation to a phlebectomy. [ABSTRACT FROM AUTHOR] more...

• Treatment of refractory granulomatous mastitis can be approached with targeted aspirations, intralesional corticosteroid injections, and clinical and sonographic breast diagrams for longitudinal follow-up. Literature on how to perform intralesional steroid injections, a valuable therapy for idiopathic granulomatous mastitis (IGM), is limited. This technical note offers a detailed technical guide on intralesional steroid injections for IGM and provides a framework for long-term follow-up. Ultrasound characterization of IGM severity considering breadth, depth, and ancillary findings was used to guide steroid dosing and injection frequency. Clinical and sonographic breast diagrams were designed for accurate longitudinal tracking of IGM. A step-by-step guide for ultrasound-guided IGM aspirations and intralesional steroid injections was developed. A detailed approach for ultrasound-guided IGM interventions with clinical and sonographic breast diagrams for longitudinal follow-up is now in practice. The treatment approach described provides a framework for multidisciplinary treatment of IGM and offers insights that may contribute to the ongoing development and improvement of management strategies for this challenging disease. [ABSTRACT FROM AUTHOR] more...

Background: After the thread transecting technique was successfully applied for the thread carpal tunnel release, we researched using the same technique in the thread trigger finger release (TTFR). This study was designed to test the operational feasibility of the TTFR on cadavers and verify the limits of division on the first annular (A1) pulley to ensure a complete trigger finger release with minimal iatrogenic injuries. Methods: The procedure of TTFR was performed on 14 fingers and 4 thumbs of 4 unembalmed cadaveric hands. After the procedures, all fingers and thumbs were dissected and visually assessed. Results: All of the digits and thumbs demonstrated a complete A1 pulley release. There was no injury to the neurovascular bundle (radial digital nerve in case of thumb), flexor tendon, or A2 pulley for each case. Conclusions: The cadaveric study showed that the technique of TTFR was safe and effective, and the future clinical study is necessary to verify the findings of this study. [ABSTRACT FROM AUTHOR] more...

Background: Previous studies have indicated that the thread carpal tunnel release (TCTR) is a safe and effective technique. Through a study on 11 cadaveric wrists, the TCTR procedure was modified and the needle control accuracy was improved to 0.15 to 0.2 mm, which is precise enough to preserve superficial palmar aponeurosis (SupPA), Berrettini branch, and common digital nerves. The aim of the present study was to verify the modified TCTR clinically. Methods: The modified TCTR was performed on 159 hands of 116 patients. The Boston Carpal Tunnel Syndrome Questionnaire was used for assessing the outcomes. Statistical analyses were used to compare the outcomes with the available data from the literature for the open and endoscopic techniques. Results: TCTR led to significant improvement in the short-term results, and the outcomes were better in long-term results compared with the open or endoscopic release. The SupPA, Berrettini branch, and common digital nerves were protected. There was no neurovascular complication for any case. Significant relief of symptoms was observed 3 to 5 hours post procedure. Most patients used their hands on the day of the procedure for simple daily activity. Patients reported their sleep quality was improved on the surgical day. Most patients with office jobs were able to return to work on postoperative day 1, and those with repetitive jobs returned to work in about 2 weeks. The statistical evidence proves that the modified TCTR procedure results in improved clinical outcomes as compared with open carpal tunnel release (CTR) and endoscopic CTR. Conclusions: The TCTR procedure has been shown to be a safe and effective technique for CTR. The modified TCTR procedure minimizes postoperative complications, such as pillar pain, scar tenderness, or functional weakness, by avoiding unnecessary injuries to the surrounding structures around the transverse carpal ligament during the procedure. [ABSTRACT FROM AUTHOR] more...

The aim of this study was to evaluate an agar model that could be used to train physicians to perform ultrasound-guided procedures. Eleven (N = 11) physical medicine and rehabilitation residents volunteered to be subjects. All subjects completed a questionnaire about their experience and comfort with ultrasound-guided procedures. In phase 1, subjects were instructed to identify specific structures and perform specific procedures on the agar models; these tasks were timed. All subjects were then given a short lecture on fundamentals of ultrasound-guided procedures and percutaneous needle tenotomy. In phase 2, subjects then performed the same tasks again on the agar model and completed the questionnaire again. Analysis was performed using paired t tests. The number of structures successfully identified significantly increased from phase 1 (mean = 1.45) to phase 2 (mean = 2.54) (P = 0.003). Time to complete the needle access task in phase 2 (mean = 258 secs) significantly decreased compared with phase 1 (mean = 394 secs) (P = 0.04). Subjectively, our participants reported that they felt more comfortable performing ultrasound-guided procedures (P = 0.005) and felt more familiar with percutaneous needle tenotomy (P = 0.00004) after using the model. In conclusion, residents demonstrated improvement in ultrasound-guided procedural skills and reported increased comfort performing these procedures after training on the agar model. [ABSTRACT FROM AUTHOR] more...

Purpose: Isolated tenotomy of the long head of the biceps (LHB) is known to improve function in patients with massive and non-reparable cuff tears without osteoarthritis. This two step cadaveric study was performed with the purpose to identify the best surgical technique for isolated LHB tenotomy under USG guidance (pilot study) and evaluate its feasibility (subsequent study).Methods: Pre-operative ultrasonographic evaluation of the rotator cuff was performed and any specimens whose long head of the biceps was not found to be intact during the pre-operative ultrasound evaluation were excluded. In the pilot study, nine scar-free cadaveric shoulders underwent ultrasound-guided tenotomy through a single percutaneous portal to determine the best instrument and approach which ensure elective and complete LHB tenotomy. Using it, a second series of 12 cadaveric shoulders were operated following a similar protocol to evaluate the feasibility of this technique.Result: Pilot study: The use of a backward endoscopic cutter through a posterior percutaneous portal was found to be the safest. Control of the tenotomy was possible by manipulating the intra-articular part of the tendon with the instrument ("Groove Alone" test). Subsequent study: The tenotomy of the LHB was complete in all cases. Mean length of the proximal LHB stump was 0.3 cm (range, 0-0.8 cm). No iatrogenic lesion was observed when using the backward endoscopic cutter. On the other hand, the use of straight endoscopic scissors led to severe damage to the rotator cuff and the conjoined tendon. The "Groove Alone" test checked against iatrogenic injury. This was not done in one of the cases and it led to a partial section of the superior half of the tendon of the subscapularis.Conclusion: By the use of both appropriate endoscopic instrumentation and the newly described "Groove Alone" test, ultrasound-guided LHB tenotomy through a single percutaneous portal appears to be a feasible and reliable procedure that could be an alternative to isolated arthroscopic tenotomy. The choice of a posterior portal (soft point) may increase the safety and precision of this procedure and decrease the length of the proximal stump of the LHB. [ABSTRACT FROM AUTHOR] more...

We tested the technical feasibility of ultrasound-guided percutaneous tenotomy of the long head of the biceps tendon (LHBT) in cadavers. Both shoulders of two fresh cadavers were scanned anteriorly to evaluate the extra-articular portion of the LHBT. Under ultrasound monitoring, a scalpel was advanced obliquely up to touch the superficial medial side of the LHBT, cutting it until the tendon was not visible anymore. Ultrasound evaluation was repeated after the procedure, and anatomic dissection was performed. The procedure was 100% feasible: four cuts were made to completely sever the tendon; the duration was less than 1 min. Skin incision measured 5 mm in two cases and 6 mm in two cases. Anatomic dissection confirmed complete tendon cut in all cases with proximal and distal tendon stumps very close to each other. Ultrasound-guided percutaneous LHBT tenotomy was 100% technically feasible in cadavers with a quick procedure and minimal cutaneous incision. [ABSTRACT FROM AUTHOR] more...

Placement of ultrasound-guided central lines is a critical skill for physicians in several specialties. Improving the quality of care delivered surrounding this procedure demands rigorous measurement of competency, and validated tools to assess performance are essential. Using the iterative, modified Delphi technique and experts in multiple disciplines across the United States, the study team created a 30-item checklist designed to assess competency in the placement of ultrasound-guided internal jugular central lines. Cronbach α was .94, indicating an excellent degree of internal consistency. Further validation of this checklist will require its implementation in simulated and clinical environments. [ABSTRACT FROM AUTHOR] more...

Objective. To evaluate the efficacy of a lumbosacral spine phantom to improve novices' proficiency in performing ultrasound-guided facet joint injection and medial branch block. Design and Setting. Prospective study in a university hospital. Subjects. In total, 30 participants with no experience of spinal ultrasonography were included and were allocated to one of two groups (control group, N=10 and training group, N=20). Methods. A lumbosacral spine phantom was prepared using a lumbosacral spine model embedded in a mixture of gelatin and psyllium husk. All participants were tested (test-1) following a basic education introductory program. Participants in the control group were then tested again after 1 week (test-2). Those in the training group received a further 3-h training, individually, and were tested again after 1 week (test-2). Results. The mean performance scores on test-1 were 57.6±6.0 in the control group and 57.3±6.7 in the training group; and at test-2, 61.0±8.6 and 91.764.9 (P < 0.001), respectively. The median time of performance at test-1 was 158.3±41.9 seconds in the control group and 185.3±68.1 seconds in the training group; and at test-2, 146.9±38.9 seconds and 69.9±22.0 seconds (P < 0.001), respectively. In the training group, the mean self-rating level of proficiency scores were 2.2±1.0 at pretraining, and 6.860.8 at post-training, respectively (P < 0.001). Conclusion. Training using a gelatin-based spine phantom helped novices to acquire the skills necessary to perform ultrasound-guided lumbar facet joint injections and medial branch blocks. [ABSTRACT FROM AUTHOR] more...

Purpose: This study aims to develop an alternate technique for improving the surgical procedure of carpal tunnel release. Method: The transverse carpal ligament is transected by utilizing a piece of thread looped percutaneously under the visualization of ultrasound. The procedure, the thread carpal tunnel release (TCTR), was performed on 34 hands of 20 patients. Self-administrated Levine-Katz questionnaire was used for assessing the symptom severity and functional status of the outcomes. Results: TCTR was performed in each case with no unintended consequences. The average duration for a procedure was 7 min, excluding time of preparation. Significant improvements in subjective sensibility were reported within 24 h, and sleep quality improved for all cases. There were no postoperative complications. The scores of questionnaire 3 months postoperatively were comparable to the literature controls. Conclusion: TCTR is a safe and effective minimally invasive surgery performed under local anesthesia in a clinic-based procedure room and results in only one-needle entrance point at the wrist and one-needle exit point in the palm. The feature of the procedure includes the potentials of reduced risk of iatrogenic injury, reduced surgical cost, and reduced patient recovery time. The study has shown encouraging promise for optimizing the technique of carpal tunnel release, and more clinical trials are necessary to confirm the findings. [ABSTRACT FROM AUTHOR] more...

Summary: Transcranial sonography (TCS) of the brain parenchyma meanwhile allows a high-resolution imaging of deep brain structures in the majority of adults. A new application of TCS is the intra- and post-operative visualization with TCS and the TCS-assisted insertion of deep brain stimulation (DBS) electrodes. In pilot studies it has been shown that the TCS-assisted insertion of DBS electrodes into the subthalamic nucleus and the globus pallidus interna is feasible and safe provided the exact knowledge on the extent of electrode TCS imaging artifacts. Even more, TCS can be recommended for the post-operative monitoring of DBS electrode position. Dislocation of a DBS electrode can be easily detected. In a recent longitudinal study we could demonstrate that TCS measures of lead coordinates agreed with MRI measures in anterior–posterior and medial–lateral axis, and that the TCS-based grading of optimal vs suboptimal lead location predicts the clinical 12 months outcome of patients with movement disorders. Currently, an international multi-center study is being planned to further prove the value of TCS in the post-operative monitoring of DBS electrode position. This trial is intended to start in 2012, and is still open for joining. The obvious advantages of TCS will promote its increasing use for the intra- and post-operative monitoring of deep brain implants. [ABSTRACT FROM AUTHOR] more...

Background: Percutaneous cholecystostomy (PC) is an alternative among high-risk surgical patients or those with multiple comorbidities, but its indications have not been clearly established in the literature. The aim of this paper is to provide the reader with an updated review of the literature summarizing what is known on this topic., Data Sources: We reviewed articles from 1979 to 2016 using the PubMed/Medline Database on PC and especially those evaluating this option as a bridge to surgery., Conclusions: There remains a paucity of randomized control trials to ascertain the use of PC as a definitive treatment for acute cholecystitis. In most studies, more than 50% of patients underwent PC as a definite treatment without subsequent cholecystectomy. A newer avenue of endoscopic ultrasound is also discussed, which requires rigorous trials to determine its appropriate applications., (Copyright © 2018 Elsevier Inc. All rights reserved.) more...

Purpose The thread carpal tunnel release (TCTR) technique has been improved and offers more precise control in dissecting thread placement. The purpose of this cadaveric study was to test the procedure operationally and verify the modified TCTR anatomically. Methods Eleven unembalmed cadaver wrists underwent the transverse carpal ligament (TCL) release by using the modified TCTR technique. An experienced observer dissected each specimen and assessed for completeness of release under direct visual assessment. Injury to the superficial palmar aponeurosis (SupPA), the Berrettini and common digital nerve branches were also recorded as a secondary outcome. Results Eleven out of 11 wrists (100%) underwent the modified TCTR with complete release of the TCL. All 11 wrists were released without damage to any vital neurovascular structure including the Berrettini branch and the common digital nerves. The SupPA remained intact in all 5 wrists performed with the preservation steps. Conclusions The modified TCTR technique demonstrated complete division of the TCL while protecting the SupPA as well as the Berrettini and common digital nerve branches. Clinical relevance The modified TCTR has the potential to offer a clinically safe and effective minimally invasive procedure for complete carpal tunnel release. [ABSTRACT FROM AUTHOR] more...

Background: Previous studies have indicated that the thread carpal tunnel release (TCTR) is a safe and effective technique. Through a study on 11 cadaveric wrists, the TCTR procedure was modified and the needle control accuracy was improved to 0.15 to 0.2 mm, which is precise enough to preserve superficial palmar aponeurosis (SupPA), Berrettini branch, and common digital nerves. The aim of the present study was to verify the modified TCTR clinically., Methods: The modified TCTR was performed on 159 hands of 116 patients. The Boston Carpal Tunnel Syndrome Questionnaire was used for assessing the outcomes. Statistical analyses were used to compare the outcomes with the available data from the literature for the open and endoscopic techniques., Results: TCTR led to significant improvement in the short-term results, and the outcomes were better in long-term results compared with the open or endoscopic release. The SupPA, Berrettini branch, and common digital nerves were protected. There was no neurovascular complication for any case. Significant relief of symptoms was observed 3 to 5 hours post procedure. Most patients used their hands on the day of the procedure for simple daily activity. Patients reported their sleep quality was improved on the surgical day. Most patients with office jobs were able to return to work on postoperative day 1, and those with repetitive jobs returned to work in about 2 weeks. The statistical evidence proves that the modified TCTR procedure results in improved clinical outcomes as compared with open carpal tunnel release (CTR) and endoscopic CTR., Conclusions: The TCTR procedure has been shown to be a safe and effective technique for CTR. The modified TCTR procedure minimizes postoperative complications, such as pillar pain, scar tenderness, or functional weakness, by avoiding unnecessary injuries to the surrounding structures around the transverse carpal ligament during the procedure. more...