The seven-layer stratification theory of gastric wall under ultrasonography and its clinical application

ObjectiveHere, we develop a seven-layer gastric wall stratification theory based on the physical basis of ultrasound and histology, and further discuss its potential clinical application. Methods1. Experimental methods: Ex vivo human gastric specimens were immersed in normal saline and examined with a high-frequency probe to study the relationship between the sonograms and the corresponding anatomy of the gastric wall. 2. The study enrolled 136 patients admitted to our hospital with gastric diseases who underwent gastric contrast ultrasonography supplemented with the pathological examination. The seven-layer stratification theory was adopted during the analysis to profile sonogram characteristics with lesions originating from various layers. ResultsAll the sonograms of the in vitro human gastric specimens could be divided into seven intervals of strong and weak echoes. The pathological examinations were performed on 136 patient-derived samples as the golden criteria of diagnosis: 29 cases of gastric polyps, 10 cases of lymphomas, 5 cases of neuroendocrine tumors, 11 cases of ectopic pancreas, 22 cases of gastric stromal tumor, 19 cases of leiomyomas, 29 cases of chronic inflammation, 9 cases of diffuse invasive cancer, and 2 cases of neurilemmoma. The ultrasound and pathological examination results were consistent in 110 cases, showing a coincidence rate of 80.9%. ConclusionBy adopting the seven-layer stratification theory of the gastric wall, the ultrasound can accurately locate the position of mucosal muscularis, which is of great significance for accurate measurement of the thickness of each anatomical layer and the correct judgment of the origin and the classification of the space-occupying lesions. Keywords Gastric wall; ultrasound; seven-layer stratification; clinical application

The Value of Colorectal Filling Contrast Ultrasonography in Diagnosing Paediatric Juvenile Polyps

Objectives: To describe a facilitated procedure of colorectal filling contrast ultrasonography (CFCUS) and investigate its potential role in the assessment of paediatric juvenile polyps. Methods: The general information, clinical symptoms, ultrasound image characteristics, and colonoscopy findings of 101 children with clinical signs of colorectal polyps admitted to our hospital between May 2018 and May 2021 were retrospectively reviewed. All children underwent conventional transabdominal ultrasonography (CTUS), and CFCUS before colonoscopy, and the latter served as the gold standard. Chi-squared tests and Mann-Whitney U tests were used for the statistical analysis. Results: Forty-five children with fifty-two colorectal polyps were diagnosed by colonoscopy. Ten polyps had false-negative results on CTUS, six of which were detected by CFCUS. The sensitivity, specificity, positive predictive value, and negative predictive value of CFCUS vs CTUS was 92.3% vs 80.7%, 100% vs 100%, 100% vs 100%, 93.3% vs 84.8%, respectively. The maximum diameter of polyps (mean ± standard deviation) missed by CTUS was significantly smaller than that detected by CTUS (7.50±2.12 mm [range 4–12 mm] vs. 19.62±7.89 mm [range 6–41 mm], P<0.0001). A significant difference was observed between CTUS and CFCUS. The difference between CTUS and CFCUS regarding the detection rate of polyps with a diameter < 1 cm (P=0.031). A statistical difference was observed in the detection rate of polyps (P=0.031), and pedicles (P<0.001) between CTUS and CFCUS. The Kappa values for the assessment of Yamada’s classification between CTUS and colonoscopy and CFCUS and colonoscopy were 0.51 and 0.84, respectively. Six colonic polyps were accompanied by a punctate hyperechoic area on the surface, which may be suggestive of a correlation with erosion and bleeding findings.Conclusion: CFCUS can increase the detection rate of polyps and pedicles, especially polyps with diameters <1 cm, and accurately evaluate Yamada’s classification, providing useful preoperative information for colonoscopy.

Methotrexate injection for interstitial pregnancy: Hysteroscopic conservative mini-invasive approach.

Background: Interstitial localisation of ectopic pregnancy is associated with high rates of maternal morbidity and mortality. Considering the rarity of interstitial pregnancy, the optimal treatment regimen remains unclear. We propose the management of interstitial pregnancy with local methotrexate injection using a combined hysteroscopic and ultrasonographic approach. Technique: Hysteroscopy was performed under local anaesthesia in the operating room, using a 2.9-mm Hopkins II Forward-Oblique Telescope 30° endoscope with a 4.3-mm inner sheath and 5 FR instruments. A needle was pushed into the cornual region injecting methotrexate solution directly into the gestational sac and into the myometrial tissue tangentially at the four cardinal points. A contemporary transabdominal ultrasound (US) was performed in order to reduce risks of complications. Experience: Five patients with an US diagnosis of interstitial ectopic pregnancy admitted to our department between January 2016 and September 2019 were managed with a local hysteroscopic injection of methotrexate. The technique was effective in all patients and no surgical complications occurred during or after the procedure. Three patients were evaluated for tubal patency with contrast ultrasonography confirming bilateral tubal patency 9 months from treatment, while one patient had a spontaneous birth 22 months from their initial surgery. Conclusion: The hysteroscopic ultrasound-guided approach combined with the local injection of methotrexate is a minimally invasive conservative approach that seems to be promising in the management of interstitial ectopic pregnancy.

Comparison of Hystero-salpingography and Hysterosalpingo-Contrast Sonography for tubal patency testing: technical success, pain perception, side effects and complications

Aims: The aim of this study was to compare technical success and tolerability between hysterosalpingography (HSG) and hysterosalpingo-contrast ultrasonography (HyCoUs) as a first-line evaluation method in a single fertility center. Material and methods: The study included 56 infertile women: 27 patients underwent HSG and 29 patients underwent HyCoUs. Pain perception was measured by means of an 11-point visual analog scale (VAS) and the Stacy score. Side-effects, technical aspects, complications and variable correlations were documented. Results: The median VAS scale was 5 (4;6) for HSG and 1 (1;2) for HyCoUs. The median Stacy score was 2 (1;3) for HSG and 1 (0;1) for HyCoUs. The difference in pain perception was statistically significant for both pain scores (p<0.001). All patients undergoing HyCoUs reported a visual analog (VAS) pain score of <5 and 59.3% of patients undergoing an HSG reported a score of >5. Increased pain scores showed a statistically significant association with duration and total volume of substance infused. The type of procedure and volume infused were independently associated with the VAS scale. In the HSG group, 14.8% (4) of patients reported a vagal effect (p<0.001), one patient requiring hospitalization. No vagal effects were reported following HyCoUs and the method was technically successful in 100% (29) of cases. HSG was successful in 88.9% (24) of cases. Conclusions: HyCoUs is a well-tolerated procedure with reduced frequency of adverse effects. Low pain perception is strongly correlated with a low volume infused. It is non-invasive and efficient in rendering good quality images.

Use of saline contrast ultrasonography in the diagnosis of complete jugular vein occlusion in a horse

Background: Thrombophlebitis and thrombosis are the most common causes of jugular vein occlusion in horses. Medical and surgical treatments aim to recanalize the occluded vessel and reduce proximal venous congestion and edema.Case Description: The present report describes a clinical case of equine jugular vein thrombosis (JVT) with complete vein occlusion diagnosed by saline contrast ultrasonography (SCU) and confirmed by contrast venography.Conclusion: Our results demonstrated that the SCU test can be easily performed and objectively interpreted using standard ultrasound equipment; it is not expensive and it does not require x-ray exposure. The SCU test is a valid tool to assess vessel patency and presence of collateral circulation in JVT. The test could therefore be used to monitor the progression of the disease and the effectiveness of therapy against JVT in horses. Keywords: Contrast, Equine, Jugular, Thrombus, Ultrasound.

Observational Study to evaluate the role of Ultrasonography and X-Ray in Urinary Disease

Urinary diseases are very common in our society which system constitutes kidneys ureters urinary bladder and urethra various abnormalities occur in these organs due to many reasons like infection inflammation metabolic abnormalities neoplastic changes trauma etc. these abnormalities lead to various physical problems ending into death many times the abnormalities of urinary system can be diagnosed by hematological examination urine analysis radiological examination and histopathological examination especially radiological examination provide wide range of diagnosis of disease of urinary system of almost all origin although various radiological technique like X-ray (plain and contrast) Ultrasonography CT scan MRI and many others are available but in present study X-ray (plain and contrast ) and ultrasonography were used for diagnosis of disease of urinary system because of its easy availability and affordability the diseases of urinary system has been described under the name of Mutrakrichha and Mutraghata in ayurveda these two conditions are in fact group of clinical entities in which urination is difficult and retention is present respectively further they are divided into various subtypes these conditions resembles clinically with various types of urinary diseases early diagnosis has been the always advocated by ayurveda by virtue of this prevention and management becomes easy in the present study written informed consent has been taken from all the patients early detection of these conditions facilitates the management otherwise renal failure may complicate the condition