Soft-Tip Stylet and Saline Instillation Technique: Making Difficult Percutaneous CT-Guided Biopsies Possible

Finding a safe needle path during percutaneous computed tomography-guided biopsy is sometimes difficult due to concern for injuring a vital structure. Saline instillation technique has been used to displace the structure out of the way. Another useful tool is a soft-tip stylet. A soft-tip also referred as blunt-tip stylet for the introducer cannula is provided with some coaxial biopsy sets in additional to standard sharp-tip stylet. While the sharp-tip stylet is fitted with introducer cannula for piercing skin, muscle, and fascia, a soft-tip stylet may be used for avoiding injury to structures like vessels and bowel loops especially while advancing introducer cannula through fatty tissue. Additionally, it is also useful for avoiding injury to nerves and giving pleural anesthesia. Although its use has been described in medical literature, many radiologists are still not utilizing this tool to its full potential. In this educational exhibit, various applications of soft-tip stylet and saline instillation technique have been depicted using representative cases.

Restoration of neglected fracture dislocation hip in elderly: a case report

<p class="abstract">Neglected traumatic fracture dislocation of the hip is a challenging problem due to soft tissue contractures, adhesions, fibro fatty tissue filling acetabulum, avascular necrosis, arthritis and myositis ossificans. These types of injury often get missed at initial evaluation in the presence of distracting injuries and in poly trauma patients. Femoral head fractures account for only 7-16% of all hip fracture dislocations, with combined femoral head and acetabular fractures in elderly being even lower. Literature favours primary hip replacement as compared to hip salvage in age above 60 years and in patients with neglected hip fracture dislocations of more than 3 months duration due to high chances of afore mentioned complications. Here, we report a case of 69 years old male with neglected hip fracture dislocation associated with posterior acetabular wall and femoral head fracture for the challenges in management with a total hip replacement.</p>

Anti-Synthetase Syndrome Complicated by Pyogenic Myositis

Background: Anti-synthetase syndrome is a rare autoimmune disorder characterized by autoantibodies against aminoacyl-tRNA-synthetases. Inflammatory myopathy and interstitial lung disease could be present among other manifestations. Anti-Jo-1 is the most common antisynthetase antibody and is the most likely to present with the classic triad (interstitial lung disease, myositis, and arthritis) and have more muscle and joint involvement than patients with other antisynthetase antibodies. Case report: Here, we present a case of a 60-year-old female patient, with a previous diagnosis of myositis, secondary to the anti-synthetase syndrome, with a complication by pyogenic myositis. Conclusion: Diagnosis is made by a multidisciplinary approach, occasionally muscle and/or lung biopsy are needed. Imaging studies, Especially magnetic resonance imaging, based on findings such as muscle and fascial edema, and fatty tissue replacement, allow an optimal approach.

Quantitative Assessment of Iodine Intensity of Different Types of Lesions in the Low-Energy (LE) Images of Contrast-Enhanced Spectral Mammography (CESM)

Purpose: To assess the iodine enhancement intensity of breast lesions in low energy (LE) images obtained in contrast-enhanced spectral mammography (CESM) with different tissue compositions. Materials and Methods: A 50 mm dedicated phantom with different lesion insert and iodine insert were used to assess the enhancement intensity quantitatively. The target slab of the phantom consists of three lesions + iodine inserts together and 100% adipose equivalent,100% glandular equivalent inserts alone to mimic the adipose and glandular lesion without contrast-enhancement. Each iodine inserts having a concentration of 0.5 mgI/cm3, 1.0 mgI/cm3, 2.0 mgI/cm3. The phantom was exposed under semiautomated function at 28 kV, 30 kV, and 32 kV with Mo/Rh target/filter combination. Iodine intensity was estimated for three types of lesions at three breast equivalent compositions. Results: Lesions with fatty tissue had high intensity while lesions with glandular tissues had the minimum intensity. Among fatty lesions, highest mean intensity value (0.972±0.003) observed with minimum iodine concentration (F + 0.5 mgI/cm3). The highest mean intensity value (0.882±0.001) was found related to the glandular lesion with maximum iodine concentration (G + 2.0 mgI/cm3). The one-way ANOVA statistical test confirmed that mean intensity values were significantly varied among different lesions (P < 0.05). Conclusion: LE images obtained in CESM can be used to identify the different types of lesions without performing the full field digital mammography (FFDM) as an additional examination prior to the CESM procedure.

The Influence of Surface Mycobiota on Sensory Properties of “Istarski pršut” and “Dalmatinski pršut”

This study aimed to identify surface mould species overgrowing the Croatian protected meat products “Istarski pršut” and “Dalmatinski pršut” and their effect on sensory properties. Dry-cured hams were produced in 2018/2019 and obtained from annual fairs. The predominant surface species found on “Dalmatinski pršut” were Aspergillus chevalieri, Penicillium citrinum and Aspergillus cibarius, whereas those overgrowing “Istarski pršut” were Aspergillus proliferans, P. citrinum and Penicillium salamii. The results show species diversity, higher presence, and greater variety of Aspergillus species in “Dalmatinski pršut” in comparison to “Istarski pršut”, and significant variations in 9 of 20 sensory attributes. Principal component analysis revealed a clear distinction between the two, and a large contribution of P. salamii and Penicillium bialowienzense to one principal component. The texture traits, smoky odour, muscle and subcutaneous fatty tissue colour, and mould species found are valuable for product characterisation. The results also indicate that mould species may be responsible for some sensory traits, such as tenderness, juiciness, and lesser freshness.

CLINICAL EVALUATION OF MEDADUSTI IN PRAMEHA W.S.R. TO ITS THERAPEUTIC MEASURES WITH MUSTAK

Introduction: Agni (digestive and metabolic energy) is the main factor for digestion and metabolism. Meda (a type of body tissue i.e., fats) is formed from the Mamsa (a type of body tissue i.e., muscle) with its own Ushma (heat) in addition to the Snigdhatva (unctuousness) & Dravadtva Guna (liquidity) of Apa Mahabhuta (one of the fundamental components of this universe i.e., water). Due to impairment of Dhatvagni (metabolic energy), Medadusti (impair- ment of fats) takes place and in turn may result in Prameha (diabetes mellitus), Sthaulya (obesity) etc. Prameha is one of the leading diseases in the present era. The aggravated Kapha afflicts Meda, Mamsa and Kleda (moisture elements of the body) and in due course of time, Kaphaja Meha (a type of Prameha) is converted into Pittaja Meha (a type of Prameha), followed by Vataja Meha (another type of Prameha) if not treated properly. Aim: The present study was carried out to evaluate the concept of Meda and the role of Medadusti in the pathogenesis of Prameha along with the efficacy of the selected drug Mustak (Cyperus rotundus Linn.) to combat the situation. Material & Methods: In selected 35 patients of Prameha having the Medadusti Lakshan based on inclusion and exclusion criteria, Mustak (Cyprus rotundus Linn.) was administered in stipulated dose (12 grams in two divided doses with plain warm water) for two months. Result: The subjective parameters for Medadusti is clinically present in a max- imum number of Prameha patients. The result also reveals the significant efficacy of Mustak on relevant subjective and objective parameters with a 'p-value <0.001 in all subjective and objective parameters. Conclusion: The Nidan (aetiology) of Medadusti has a definite role to cause Prameha. In all the patients of Prameha, Medadusti Lakshan (features of impaired fatty tissue) is clinically present. The patients suffering from Prameha can be treated with the drug response to arrest the Medadusti like Mustak. Keywords: Medadusti, Mustak, Prameha

COMORBID CONDITIONS IN OBESITY IN CHILDREN AND ADOLESCENTS AND MODERN TECHNOLOGIES OF THEIR DIAGNOSIS

The review presents modern views of not only the long-known comorbid conditions and obesity in children and adolescents, including arterial hypertension, dyslipidemia, steatohepatosis, impaired carbohydrate tolerance and type 2 diabetes, but also less studied comorbid associations with overweight in childhood: ectopic deposition of fatty tissue, reproductive and psychological disorders, orthopedic problems and disorders of the gastrointestinal tract. It is emphasized that only a comprehensive interdisciplinary approach to the observation and treatment of obesity can help in the development and implementation of a personalized and therefore more effective selection of therapeutic and preventive interventions.

Analysis of the paraspinal muscle morphology of the lumbar spine using a convolutional neural network (CNN)

Purpose This single-center study aimed to develop a convolutional neural network to segment multiple consecutive axial magnetic resonance imaging (MRI) slices of the lumbar spinal muscles of patients with lower back pain and automatically classify fatty muscle degeneration. Methods We developed a fully connected deep convolutional neural network (CNN) with a pre-trained U-Net model trained on a dataset of 3,650 axial T2-weighted MRI images from 100 patients with lower back pain. We included all qualities of MRI; the exclusion criteria were fractures, tumors, infection, or spine implants. The training was performed using k-fold cross-validation (k = 10), and performance was evaluated using the dice similarity coefficient (DSC) and cross-sectional area error (CSA error). For clinical correlation, we used a simplified Goutallier classification (SGC) system with three classes. Results The mean DSC was high for overall muscle (0.91) and muscle tissue segmentation (0.83) but showed deficiencies in fatty tissue segmentation (0.51). The CSA error was small for the overall muscle area of 8.42%, and fatty tissue segmentation showed a high mean CSA error of 40.74%. The SGC classification was correctly predicted in 75% of the patients. Conclusion Our fully connected CNN segmented overall muscle and muscle tissue with high precision and recall, as well as good DSC values. The mean predicted SGC values of all available patient axial slices showed promising results. With an overall Error of 25%, further development is needed for clinical implementation. Larger datasets and training of other model architectures are required to segment fatty tissue more accurately.

Comportamento de tecidos à implantação de partículas esféricas de limalha

Introduction os spherical alloys particles (size range from 15 to 70 micra) in the back at the level of the first thoracic vertebra of 24 male rats, 60 days old, for a period of time of 12, 13, 14 and 15 months, shows no alteration in the connective tissue, striate muscle, fatty tissue, brown fatty tissue, nerve fibres and hair follicle.