Ultrasonography in the diagnosis and follow-up of idiopathic inflammatory myopathies--a preliminary study.

OBJECTIVE: To study the utility of ultrasonography (US) in diagnosis and follow up of patients with idiopathic inflammatory myopathy (IIM). METHODS: High-resolution US of thigh muscles was recorded at baseline and after six months of treatment in eleven patients of early, active, untreated IIM. Parameters studied were muscle power, timed function tests (TFT), muscle enzymes, electromyography, muscle histopathology and US parameters such as echogenicity of muscle and perimysial septa count per 1 cm muscle width. RESULTS: There was a significant increase in muscle echogenicity and septa count of patients as compared to those of controls (p = 0.002 and 0.00003, respectively). These abnormalities resolved on treatment. Muscle echogenicity and perimysial septa count showed mild positive correlation with walking time, 4-step climbing and myopathic pattern on EMG. Perimysial septa count in addition correlated weakly with creatine phosphokinase, lactate dehydrogenase and muscle fibre necrosis. CONCLUSION: US seems to be a useful, non-invasive, cheap modality to monitor the disease course in IIM. Larger studies to confirm these primary findings are warranted.

Color Doppler and duplex sonography in 5 patients with thoracic outlet syndrome.

PURPOSE: To evaluate the use of color Doppler sonography in the diagnosis of thoracic outlet syndrome. METHODS: We studied color Doppler sonographic findings in 5 clinically suspected cases of thoracic outlet syndrome. The subclavian artery and vein were studied in varying degrees of abduction to assess the severity of the syndrome. RESULTS: Significant changes, i.e., stages of increased velocities, preocclusion, and occlusion in the subclavian artery in varying degrees of abduction, were noted in 4 of 5 cases. Blunted flow in the axillary artery (4 patients) and a rebound increase in velocities on release of abduction were noted in 3 patients. These changes suggested that significant narrowing was causing symptoms. CONCLUSION: Color Doppler sonography is a noninvasive, effective method compared with digital subtraction angiography in the diagnosis of thoracic outlet syndrome.

Color Doppler sonographic diagnosis of dissecting aneurysm of the superior mesenteric artery.

We report a case of dissecting aneurysm of the superior mesenteric artery (SMA) diagnosed on gray-scale and color Doppler sonography and confirmed on angiography. Spontaneous dissection of the SMA is rare, and there are few reported cases of the color Doppler sonographic findings. Gray-scale sonography revealed an aneurysmal dilatation of the SMA 3-4 cm from the SMA's origin, with an echogenic linear membrane (an intimal flap) within the aneurysm. Color Doppler sonography showed color flow within the aneurysm and showed that the intimal flap separated the aneurysm into 2 lumina. Spectral analysis revealed anterograde flow in the anterior (ie, true) lumen and retrograde flow in the posterior (ie, false) lumen.

Evaluation of intraoperative ultrasound in neurosurgery.

The value of real-time ultrasonography as a means of guidance during neurosurgical operations was assessed in a prospective study comprising 89 cases. There were 75 cranial and 14 spinal cases. After every such operation involving the ultrasonographic guidance, the operating surgeon subjectively assessed its usefulness vis-a-vis the information and/or help provided by it, on a scale ranging from 0 (no use) to 3 (invaluable). The intraoperative ultrasonographic guidance has been found to be extremely helpful in quickly and easily locating a small, deep-seated supratentorial lesion as also in certain spinal cases. In the absence of the much costlier CT/MRI-guidance system, intraoperative use of ultrasonography offers the desired help in majority of neurosurgical cases requiring intraoperative guidance. Additionally, it has got certain distinct advantages over the CT/MRI-guidance system.

Balloon techniques for percutaneous gastrostomy in a patient with partial gastrectomy.

Intragastric balloon techniques were used to achieve direct gastric distention and efferent loop obstruction in order to perform percutaneous gastrostomy on two occasions in a patient with a partial gastrectomy and Billroth II anastomosis. Previous attempts at percutaneous endoscopic gastrostomy and conventional radiologic percutaneous gastrostomy had been unsuccessful. Although a history of partial gastrectomy has been considered an impediment to both percutaneous gastrostomy and percutaneous endoscopic gastrostomy, this experience demonstrates that percutaneous gastrostomy can be performed safely in this setting with balloon assistance.

Percutaneous transcatheter steel-coil embolization of a large proximal post-traumatic superior mesenteric arteriovenous fistula.

Arteriovenous fistulae affecting the proximal portions of the superior mesenteric vessels are extremely rare. We are reporting one such fistula which occurred in a young male as a sequel to a stab in the epigastrium. The arteriovenous fistula was successfully treated by percutaneous steel coil embolization.