Appendix-preserving elective herniorrhaphy for de Garengeot hernia: two case reports

Background Emergency appendectomy is often performed for de Garengeot hernia. However, in some cases, there may be a chance to perform an appendix-preserving elective surgery. Case description A 76-year-old woman presented to our hospital with complaints of a right inguinal swelling, which we diagnosed as a de Garengeot hernia using computed tomography (CT). B-mode ultrasonography (US) of the mass showed an appendix 4–6 mm in diameter with a clear wall structure; color Doppler US showed pulsatile blood flow signal in the appendiceal wall. Twenty-eight days later, herniorrhaphy with transabdominal preperitoneal repair (TAPP) was performed without appendectomy. Another 70-year-old woman presented to our hospital with complaints of a painful bulge in the right inguinal region. The diagnosis of de Garengeot hernia was made using CT. B-mode US showed an appendix 5 mm in diameter with a clear wall structure. Color Doppler US showed a pulsatile blood signal in the appendiceal wall. Seven days later, herniorrhaphy with TAPP was performed without appendectomy. Conclusion De Garengeot hernia is often associated with appendicitis; however, an appendix-preserving elective herniorrhaphy can be performed if US and intraoperative findings do not suggest appendicitis or circulatory compromise in the appendix.

Effects of Compound Danshen Injection Combined with Magnesium Sulfate on Pregnancy-Induced Hypertension Syndrome under the Guidance of Empirical Mode Decomposition Algorithm-Based Ultrasound Image

Objective. The study focused on the separation effects of ultrasound blood flow signal detection, based on empirical mode decomposition (EMD) algorithm, and the clinical efficacy of Compound Danshen injection and magnesium sulfate in the treatment of pregnancy-induced hypertension (PIH) syndrome. Methods. The empirical mode decomposition (EMD) algorithm was optimized first and compared with other algorithms for the accuracy and stability in separation of blood flow signals. 80 patients with PIH syndrome undergoing ultrasound examination were selected as the research subjects and randomly divided into control group and observation group according to the actual treatment methods. 40 cases in the observation group were treated with Compound Danshen injection + magnesium sulfate, and 40 cases in the control group were treated with magnesium sulfate. After the treatment, the clinical indicators of the two groups of patients were analyzed. Results. The accuracy and stability in separating blood flow signal of the optimized EMD algorithm were better than those of other algorithms. After treatment, the total effective rate and blood pressure control of the observation group were significantly better than those of the control group, and the incidence of adverse maternal and infant outcomes was significantly lower than that of the control group. After treatment, the endothelin-1 (ET-1), C-reactive protein (CRP), and homocysteine (Hcy) indexes of the two groups of patients decreased significantly, and the decrease level of the observation group was significantly greater than that of the control group ( P < 0.05). The prothrombin time (PT), fibrinogen (FIB), activated partial thromboplastin time (APTT), and plasma thrombin time (TT) levels of the two groups after treatment were better than those before treatment, and the observation group was better than the control group ( P < 0.05). Conclusion. The optimized EMD algorithm is of great value for the separation of ultrasound blood flow signals. For patients with PIH syndrome, Compound Danshen injection combined with magnesium sulfate can be used as a treatment plan, which can improve maternal and infant outcomes; control blood pressure; reduce 24 h urine protein and serum ET-1, Hcy, and CRP levels; and improve coagulation function. It is worthy of promotion.

Isolated unilateral axillary lymphadenopathy diagnosed in a teenager by ultrasonography after BNT162b2 COVID-19 vaccination

Axillary lymphadenopathy is a local reaction to mRNA COVID-19 vaccination. A 19-year-old healthy woman presented with a mass in the axilla diagnosed by ultrasonography as vaccine-induced hyperreactive lymphadenopathy. After two weeks, ultrasonography revealed that the lymph node had shrunk and that the blood flow signal in the hilum had disappeared.

Total flow intensity, active flow intensity and volume related flow intensity as new quantitative metrics in optical coherence tomography angiography

Optical coherence tomography (OCT) angiography (OCTA) is a non-invasive tool for the in-vivo study of the intraretinal vascular network. It is based on the analysis of motion particles within the retina to reconstruct the paths followed by the erythrocytes, i.e. retinal capillaries. To date, qualitative and quantitative information are based on the morphological features disclosed by retinal capillaries. In the present study, we proposed new quantitative functional metrics, named Total Flow Intensity (TFI), Active Flow Intensity (AFI), and Volume-related Flow Intensity (VFI), based on the processing of the blood flow signal detected by OCTA. We studied these metrics in a cohort of healthy subjects, and we assessed their clinical utility by including a cohort of age-matched patients affected by Stargardt disease. Moreover, we compared TFI, AFI, and VFI to the widely used vessel density (VD) parameter. TFI, AFI, and VFI were able to describe in detail the different properties of the retinal vascular compartment. In particular, TFI was intended as the overall amount of volumetric retinal blood flow. AFI represented a selective measure of voxels disclosing blood flow signal. VFI was developed to put in relationship the volumetric blood flow information with the not vascularized retinal volume. In conclusion, TFI, AFI, and VFI were proposed as feasible functional OCTA biomarkers based on the analysis of retinal blood flow signal.

Higher choroidal thickness and lower choriocapillaris blood flow signal density based on optical coherence tomography angiography in diabetics

Diabetes mellitus (DM) is one of the fastest growing chronic diseases in the world and one of the main causes of vision loss. Whether or not diabetic choroidopathy (DC) is involved in the initiation and progression of diabetic ocular complications needs to be explored. We included 54 diabetic eyes from 36 diabetic patients, and 54 healthy eyes from 32 control subjects after propensity scores matching. All of the subjects were given pupil light and dark adaptation examination and optical coherence tomography angiography (OCTA). Scotopic pupil diameter (SPD), pupil contraction amplitude, and velocity of pupil contraction of the diabetic group were significantly lower than that of the healthy control group (P < 0.05).Choroidal thickness at temporal quadrant (at 750 μm) and superior quadrant (at 1500 μm and 2250 μm) increased in diabetic group compared to control group(P < 0.05).In the diabetic group, choriocapillaris blood flow signal density (CCBFSD) in the macular area (diameter = 2000 μm) were significantly decreased compared with the healthy control group (P < 0.05). Apparent changes in pupil and choroidal blood flow were observed in the diabetic patients.

Application of Ultrasound in Diagnosis of Prosthesis Loosening and Infection After Total Hip Arthroplasty

Objective: To explore the diagnostic efficiency of ultrasound for the identification of periprosthetic joint infection (PJI) and aspetic loosening.Methods: 50 patients with joint pain after total hip arthroplasty, who were all clinically diagnosed as aseptic prosthesis loosening or PJI, were examined by ultrasonography combined with C-reactive protein, erythrocyte sedimentation rate, bacterial culture and pathology.Results: Thirty-eight of the 50 cases were PJI (group A) , and twelve cases were aseptic loosening (group B) . Fourteen patients with extra-capsular effusion were diagnosed as PJI, while none appeared extra-capsular effusion effusion in group B. 34 cases PJI obtained joint fluid, which was more than group B (7/11) (P < 0.05). The average depth of joint effusion of group B (19.83 ± 8.9mm), was significantly less than group A (25.97±15.25mm) (P < 0.05). In group A , 21 cases (55.26%) had grade 2-3 synovial blood flow signal,which was higher than group B (8.3%) (P < 0.05). Under the circumstance that PJI was diagnosed: (1) There was a sinus tract or extra-capsular effusion; or (2) Joint fluid depth was ≥ 17.0 mm; or (3) Grade 2-3 synovial blood flow signal was detected,the positive predictive value of ultrasound diagnosis of PJI was 92.1% (35/38)，and the accuracy of aseptic loosening was 83.3% (10/12) (P < 0.05).Conclusions: Ultrasound has significant value in the differential diagnosis of PJI and aspetic loosening.

Effectiveness of Deep Hyperthermia Combined with Dynamic Traction in the Treatment of Knee Osteoarthritis

Background: Different treatments with varying clinical efficacies have been applied to treat knee osteoarthritis (KOA). This study observes the effectiveness of deep hyperthermia combined with dynamic traction in KOA treatment. Methods: Deep hyperthermia and dynamic traction was administered to 60 patients with KOA. The pretreatment and 20- and 40-day post-treatment visual analog scale (VAS) and Lysholm score, knee joint cavity effusion, synovium thickness, and synovial blood flow signal (by high-frequency ultrasound) of the patients were recorded. The pretreatment and 20- and 40-day post-treatment Lysholm scores were 47.17 ± 5.07, 63.22 ± 3.44, and 81.98 ± 3.30 (P < 0.001), respectively. Results: The pretreatment and 20- and 40-day post-treatment VAS scores were 5.67 ± 0.91, 2.92 ± 0.81, and 0.60 ± 0.72 (P < 0.001), respectively. The pretreatment and 20- and 40-day post-treatment articular effusion was 5.41 ± 0.46 mm, 4.34 ± 0.34 mm, and 2.32 ± 0.32 mm (P < 0.001), respectively. The pretreatment and 20- and 40-day post-treatment synovial thickness was 3.44 ± 0.31 mm, 2.79 ± 0.15 mm, and 2.32 ± 0.32 mm (P < 0.001), respectively. The pretreatment and 20- and 40-day post-treatment grades of synovial blood flow signal exhibited a significant difference (P < 0.001). Conclusion: Deep hyperthermia combined with dynamic traction can significantly improve the clinical symptoms and pain degree in KOA, reduce joint cavity effusion, synovium thickness, and internal blood flow, and the effect improves with time. The changes in soft tissues observed by high-frequency ultrasound are reliable and consistent with clinical signs.

AB0425 PRELIMINARY EVALUATION OF THE SURAL NERVE USING 24-MHZ ULTRASOUND: A NEW APPROACH TO EVALUATE SURAL NEUROPATHY OF SJOGREN’S SYNDROME PATIENTS

Background:Peripheral neuropathy is one of the most frequent extraglandular manifestations of primary Sjögren’s syndrome (pSS). The diagnosis of peripheral neuropathy complications of pSS is based primarily on careful neurologic examination and electrodiagnostic tests. The value of ultrasound in peripheral nerve has been recognized. However, little clinical researches have focused specifically on cutaneous nerve of pSS.Objectives:To evaluate the morphological changes of sural nerve in patients with pSS by high-frequency ultrasound.Methods:The prospective study subjects consisted of 31 consecutive pSS patients underwent sural nerve biopsy and 30 healthy volunteers as controls. The ultrasonic presentations of the fascicle, perineurium, epineurium of sural nerve were observed, and the cross-sectional areas (CSA) of the sural nerves was measured.Results:Among the 21 sural nerves confirmed by pathology, all showed the thickening of the perineurium and epineurium (Figure 1-2), and abnormal blood flow signal in perineurium or epineurium in 14 cases (Figure 2). The mean CSAs were (1.41±0.44) mm2 for the control group, and (1.58±0.48) mm2 for the case group (P>0.05). In addition, the abnormal blood flow signal in sural nerve correlated with disease activity.Conclusion:This study indicated that high-frequency ultrasound may be a valuable tool for evaluating cutaneous nerve neuropathy of Sjogren’s syndrome patients.References:[1]Vitali C, Bombardieri S, Jonsson R, Moutsopoulos HM, Alexander EL, Carsons SE, et al. Classification criteria for Sjögren’s syndrome: a revised version of the European criteria proposed by the American-European Consensus Group. Ann Rheum Dis. 2002;61(6):554-8.[2]Terrier B, Lacroix C, Guillevin L, Hatron PY, Dhote R, Maillot F, et al. Diagnostic and prognostic relevance of neuromuscular biopsy in primary Sjögren’s syndrome-related neuropathy. Arthritis Rheum.2007;57(8):1520-9.[3]McCoy SS, Baer AN. Neurological Complications of Sjögren’s Syndrome: Diagnosis and Management. Curr Treatm Opt Rheumatol. 2017;3(4):275-88.[4]Carvajal Alegria G, Guellec D, Devauchelle-Pensec V, Saraux A. Is there specific neurological disorders of primary Sjögren’s syndrome? Joint Bone Spine. 2015;82(2):86-9.Figure 1.Transverse sonograms of the sural nerve (arrows) V: indicates lesser saphenous veinFigure 2.Longitudinal sonograms of the sural nerve (arrows) The sonogram of sural nerve showed abnormal blood flow signal. V indicates lesser saphenous vein.Acknowledgments:This work was partly supported by National Natural Science Foundation of China (No. 81701712).Disclosure of Interests: :None declared

Superb microvascular imaging technique in depicting vascularity in focal liver lesions: more hypervascular supply patterns were depicted in hepatocellular carcinoma

Purpose To investigate the capacity of Superb Microvascular Imaging (SMI) to detect microvascular details and to explore the different SMI features in various focal liver lesions (FLLs) and the correlation between SMI and microvessel density (MVD). Method: Eighty-three liver lesions were enrolled in our study, including 35 hepatocellular carcinomas (HCCs) and 48 non-HCCs. All patients underwent color Doppler flow imaging (CDFI) and SMI examination and were categorized into subgroups according to Adler semiquantitative grading (grade 0–3) or the microvascular morphologic patterns (pattern a-f). The correlation between SMI blood flow signal percentage and MVD was assessed. Results Compared with CDFI, SMI detected more high-level blood flow signals (grade 2–3) and more hypervascular supply patterns (pattern e-f) in HCCs (p < 0.05). Furthermore, more hypervascular supply patterns and fewer hypovascular supply patterns were detected in HCC compared with non-HCC (p < 0.05). Based on Adler’s grading or microvascular morphologic patterns, the areas under the receiver operating characteristic curve were 0.696 and 0.760 for SMI, 0.583 and 0.563 for CDFI. The modality of “SMI-microvascular morphologic pattern” showed the best diagnostic performance. There was significant correlation between MVD and the SMI blood flow signal percentage (vascular index, VI) in malignant lesions (r = 0.675, p < 0.05). Conclusion SMI was superior to CDFI in detecting microvascular blood flow signals. More hypervascular supply patterns were depicted in HCC than in non-HCC, suggesting a promising diagnostic value for SMI in the differentiation between HCC and non-HCC. Meanwhile, we were the first to demonstrate that SMI blood flow signal percentage (VI) was correlated with MVD in malignant lesions.