Intraoperative sonography in cranial neurosurgery: new possibilities and integration with neuronavigation. Review

In current review we represented new possibilities of intraoperative sonography introduced into clinical practice for the last 20 years. Contrast‑enhanced ultrasound and blood flow imaging (BFI) method are intended for assessment of cerebral hemodynamics. Elastosonography distinguishes tissues by differences of their density. Fusion of sonography with navigation is forwarded to brainshift reduction. Combination of ultrasound with endoscopy is effective in resection of intraventricular tumors and pituitary adenomas. Embedded three‑dimensional sonography is intended to facilitate interpretation of ultrasound results and tailoring craniotomy.

Influence of Electroacupuncture on Acupoints of Yanglingquan (GB34) on Gallbladder Volume and Gallbladder Arterial Hemodynamics in Patients With Chronic Cholecystitis

Introduction: In China, patients with chronic cholecystitis account for approximately 10% of the total population, in which over 90% of cholecystitis is caused by cholelithiasis. This study aimed to discuss the possible mechanism of electroacupuncture on the Yanglingquan acupoint promoting gallbladder contractibility of patients with chronic cholecystitis. Methods: 60 patients were randomly divided into a trial group and a control group. Doppler ultrasound and color Doppler blood flow imaging was applied. The trial group adopted the BT701-1B electroanesthesia apparatus to perform electroacupuncture on the bilateral acupoints of Yanglingquan, while electroacupuncture was made on sham acupoints in the control group. Results: Before the electroacupuncture, gallbladder volume was 49.6 ± 5.66 ml, after 15 min and 30 min of electroacupuncture, the gallbladder volume was then 32.9 ± 5.66 ml and 23.0 ± 2.83 ml respectively. The comparison before and after electroacupuncture was obviously and statistically different (P < 0.01). The comparison between after 15 min and 30 min is obviously statistically different (P < 0.01). Before the electroacupuncture, the gallbladder artery Vmax, Vmin, and RI were 18.4 ± 2.69 cm/s, 9.7 ± 0.07 cm/s, and 0.47 ± 0.06, respectively; the cystic artery Vmax, Vmin, and RI after 30 min were 8.1 ± 0.92 cm/s, 3.1 ± 0.57 cm/s, and 0.61 ± 0.02. The comparison in gallbladder artery Vmax and Vmin and the drag index (RI) before and after electroacupuncture was obviously and statistically different (P < 0.01). Conclusions: Electroacupuncture on the acupoints of Yanglingquan has the potential to promote the emptying of the gallbladder. The mechanism may be related to that the smooth muscle of the gallbladder contracts after electroacupuncture and the gallbladder empties.

Granulomatous orchitis: case report and review of the literature

We report the disease characteristics, diagnosis, and treatment of granulomatous orchitis. A 38-year-old man presented with a history of intermittent swelling, pain, and discomfort in the right testicle of 3 days’ duration. Unenhanced magnetic resonance imaging (MRI) of the testis and scrotum revealed an oval mass in the right testis measuring approximately 17 mm in diameter, with clear borders and a target ring-like appearance from periphery to center. T1-weighted imaging (T1WI) showed uniform low-intensity signals, and T2WI showed mixed high- and low-intensity signals. Diffusion-weighted imaging (DWI) signals were iso-intense, and the outer ring on enhanced scans showed progressive enhancement. We performed radical resection of the right testis under combined spinal–epidural anesthesia. The pathological diagnosis was granulomatous right orchitis. Two months postoperatively, ultrasonography showed no testis and epididymal echo signals in the right scrotum, and no obvious abnormalities; color Doppler blood flow imaging (CDFI) findings were normal. Granulomatous orchitis is rare in clinical practice, and the cause is unknown. The disease involves non-specific inflammation; however, it is currently believed that antibiotics and steroids are ineffective for conservative treatment, and orchiectomy should be actively performed.