Splinter or foreign body removal from the hand and foot is a common occurrence. Usually only the deep seated, broken or missed splinters are referred to the surgeon for removal. Unless the object is radio-opaque, plain radiograph will not give any useful information, hence removal can sometimes be very difficult and traumatic. We are reporting a case where a radiolucent splinter was removed with the aid of ultrasonography. This modality can help to localize a splinter at the pre and intra-operative period, minimizing amount of exploration and time of operation.
In the current study, we report a new technique to place a tunnelled peripherally inserted central catheter
(PICC) at the upper arm of patient under real-time ultrasound-guided venipuncture using disposal equipment
provided within a standard PICC set. The tunnelling of the PICC required an extra time of 5 minutes but was
well tolerated by all patients involved in the study. The tunnelled PICC was applied on 50 patients and the
infection rate as well its catheter dwell time were compared to another 50 patients with conventional PICC.
The rate of patients who developed infection decreased from 34% for conventional PICC to 16% in tunnelled
PICC patients. The central line-associated blood stream infections rate was also decreased from 4.4 per 1000
catheter-days for conventional PICC to 1.3 per 1000 catheter-days for tunnelled PICC. The mean time to infection
development for tunnelled PICC (24 days) was longer than those observed with conventional PICC (19 days).
Tunnelled PICC has also increased the mean catheter dwell time from 27 days (for conventional PICC) to 47
days. Tunnelling a PICC has the potential to reduce the infection rate while increase the catheter dwell time.
The impaction of dental prostheses in either the airway or esophagus is an under-recognized problem which may result in severe morbidity or even mortality. The radio-opacity and the size of fixed and removable dental prostheses in an animal carcass was investigated. Prostheses were placed one at a time in the oro-laryngopharynx or in tho trachea and the esophagus. Lateral radiographs were taken for each prosthesis in site. The radio-opacity and size of the prostheses on the radiograph was graded. Most of the prostheses investigated were radio-opaque though the removable prostheses were more likely to be radiolucent and differ in size. In a symptomatic patient with a missing dental prosthesis, a negative chest or abdominal radiograph does not exclude impaction, inhalation or ingestion. Further evaluation with endoscopy or even computed tomography may be essential to reduce the possibility of severe morbidity or even mortality.
The study was taken to assess the feasibility of diffusion-weighted imaging (DWI) and apparent diffusion
coefficient (ADC) mapping using different b-values for magnetic resonance-guided focused ultrasound (MRgFUS)
treatment of uterine fibroid and adenomyoma.
The contrast-enhanced T1-weighted image (cT1WI) as well as DWIs and ADC maps of different b-values (i.e.
200, 600 and 800 s/mm²) were obtained from nine fibroid and five adenomyoma patients, immediately after,
and 12 months after MRgFUS treatment. The image contrast score, non-perfused volume (NPV) and NPV
ratio obtained were compared to determine the feasibility of DWI and ADC mapping for MRgFUS treatment
outcome evaluation.
Our finding showed that immediately after MRgFUS treatment, the DWI acquired using 200 s/mm² b-value
gave the highest image contrast score among all other b-values. The NPV calculated from DWI of 200 s/
mm² showed the best correlation (R² = 0.938) with post-contrast NPV. At 12 months follow-up, there was no
specific b-value considered as significantly superior to others in terms of image contrast. However, the NPVs
and NPV ratios obtained from all DWIs and ADC maps of different b-values were in good agreement with the
post-contrast NPV and NPV ratio.
We observed that the DWI, particularly obtained with a low b-value (i.e. 200 s/mm²), is feasible for delineation
and quantitative volumetric evaluation of the ablated region immediately after the MRgFUS treatment. At 12
months follow-up, both DWIs and ADC maps are feasible for NPV and NPV ratio calculation.