Metastatic choriocarcinoma presenting as upper gastrointestinal bleeding: A case report.

Choriocarcinoma is a type of gestational trophoblastic disease that occurs as a complication of pregnancy-related events. The gestational trophoblastic disease includes both benign and malignant conditions including complete and partial mole, invasive mole, choriocarcinoma, and placental site trophoblastic disease. Choriocarcinoma generally presents with pervaginal bleeding, symptoms of anemia, and symptoms of its metastatic lesion. The common sites of metastasis are the lung, vagina, brain, and liver. The gastrointestinal (GI) tract is an uncommon site of metastasis occurring in <5% of patients. Upper GI bleeding as presenting complaints without pervaginal bleeding is also very rare with only a few reported cases. Here we present a case of 29 years young female who presented in our emergency department with complaints of hematemesis and altered sensorium where clinical suspicion was peptic ulcer disease but imaging modality with computed tomography showed hypervascular lesions in the brain with suspicion of choriocarcinoma. With further imaging and laboratory tests, confirmatory diagnosis of choriocarcinoma was made. This case highlights the importance of imaging in the diagnosis of choriocarcinoma where the history of the patient is misleading.

Evaluation of testicular volume in males with congenital hypogonadotropic hypogonadism: a comparative analysis.

INTRODUCTION: Estimating accurate testicular volume (TV) of congenital hypogonadotropic hypogonadism (CHH) individuals is challenging due to the typically small testicular size. Ultrasound (USG) emerges as a vital solution, enabling precise measurements and reproducible results. The purpose of the study was to assess the three-dimensional measurement of the testis using USG and its volume was estimated using Ellipsoid (E) and Lambert (L) formulae and compared these with the TV by Prader orchidometer (OrTV). METHODS: This is an exploratory analysis of data taken from a clinical trial conducted from May 2022 to March 2024 which included 94 testes from 47 CHH participants. The OrTVs and USGTVs were assessed at baseline and every three months till the completion of the study making a total of 348 observations. The three-dimensional measurement of the testes was noted and TVs were calculated using the above formulae. RESULTS: The mean age of the participants was 25.8 ± 6.14 years with a mean height of 169.9 ± 8.42 cm and body mass index (BMI) of 22.4 ± 4.72 kg/m2. The baseline mean OrTV, USGTV(E) and USGTV(L) were 2.15 ± 0.79 ml, 0.69 ± 0.43 ml and 0.93 ± 0.59 ml respectively. The smallest OrTV observed was 1 ml with its respective mean USGTV of 0.41 ± 0.2 ml(E) and 0.56 ± 0.27 ml(L). An OrTV of 4 ml had a mean USGTV of 1.11 ± 0.42 ml(E) and 1.51 ± 9.57 ml(L). At spermatogenesis, the mean OrTV was 8.84 ± 3.13 ml with the USGTV determined to be 4 ± 1.46 ml(E) and 5.46 ± 1.99 ml(L). CONCLUSION: The study revealed that all CHH patients at diagnosis had OrTV < 4 ml. This corresponds to a USG TV cut-off of 1.11 ml using the Ellipsoid formula and 1.51 ml with the Lambert formula, which could serve as a USG diagnostic criterion for CHH.

Diagnostic accuracy of airway ultrasound in confirming the endotracheal tube depth in critically ill children.

BACKGROUND: Chest X-ray, the established standard of confirming endotracheal tube (ETT) position, has important drawbacks including radiation exposure. Point-of-care airway ultrasound, which has been insufficiently studied in children, can overcome these problems. MATERIALS AND METHODS: This was a prospective cross-sectional study done on children aged 2 months to 17 years undergoing intubation with cuffed ETT in the PICU. The ETT cuff was filled with saline and three ultrasonographic techniques were used- 1) Suprasternal (SS) method 2) Cricoid (CC) metho and 3) Tracheal ring (TR) method. Position of the ETT as determined by ultrasound and X-ray were compared. The main outcomes were sensitivity, specificity, and area under curve (AUC) for ultrasound-based methods vs. X-ray. For the TR method, concordance between the X-ray and ultrasound categories were taken. RESULTS: Total 62 patients were enrolled. The sensitivity and specificity of SS method were 71% (95% CI: 57-83%) and 100% (40-100%). The CC distance method had an AUC of 0.94 (95% CI: 0.86, 1.0). In the TR method, 98% of correct position on X-ray were correctly classified by USG. The agreement between X-ray and ultrasound categories with the cuff between the first and third tracheal rings, was very good [kappa (95% CI): 0.87 (0.70, 1.00), p ≤0.001)]. CONCLUSION: Bedside ultrasound is a good method to confirm ETT depth in children. The tracheal ring method had the best diagnostic accuracy and is easy to perform. The new method using cricoid cuff distance needs further validation in different ICU settings.

Comparative Evaluation of USG-Guided Single Tissue Marker Versus Multiple Tissue Marker Placements in Breast Malignancy Patients Undergoing Neoadjuvant Chemotherapy for Tumor Localization.

Background Breast cancer remains one of the most common malignancies affecting women globally, contributing significantly to the disease burden. The advent of neoadjuvant chemotherapy (NAC) has revolutionized the treatment for locally advanced breast cancer, allowing tumors to be downstaged and making breast-conserving surgery (BCS) feasible. Accurate localization of the tumor bed post-NAC is crucial for successful surgical removal of residual disease. While traditional single tissue marker placement has been effective, recent advances suggest multiple markers might provide superior localization by comprehensively delineating the entire tumor area. This study aims to compare the effectiveness of single versus multiple tissue marker placements in breast malignancy patients undergoing NAC. Materials and methods A prospective study was conducted in the Department of Radio-diagnosis at Saveetha Medical College over 18 months, including 10 patients diagnosed with breast carcinoma, selected through convenience sampling. Inclusion criteria involved patients diagnosed with breast cancer via mammography, sonography, and histological confirmation, referred for clip placement before NAC. Exclusion criteria were patients unwilling to participate. The procedure involved placing one to two surgical clips within the tumor using a 14/16-gauge coaxial guiding needle under USG guidance, with additional clips for larger or multiple tumors. Data collection included pre-procedural USG, post-procedural mammography (MG1), pre-operative mammography (MG2)/USG, and gross specimen histopathological examination/specimen mammography. Statistical analysis Demographic data, clipping distribution, receptor status, localization methods, surgical outcomes, operation diagnoses, and correlation analysis were statistically analyzed. Mean age, standard deviation, and p-values were calculated to determine the significance of differences between single and multiple clip groups. Results The study included 10 patients with a mean age of 52.5 years. Of these, five (50%) had a single clip, and two (20%) had four clips. The average time from clipping to the second mammogram (MG2) was 106.3 days, and from clipping to operation was 111.0 days, with longer follow-up times for multiple clip patients. Six (60%) of the patients were estrogen receptor (ER) positive, and six (60%) were human epidermal growth factor receptor 2 (HER2) negative. Localization methods were similar between single and multiple clip groups. However, multiple clip patients tended to undergo more extensive surgeries like modified radical mastectomy (MRM). Imaging responses showed no preoperative ultrasound lesions in single clip patients, while multiple clip patients had higher inconsistent diagnoses (10 (100%)) suggesting that multiple clips provide better tumor localization but are linked to increased complexity and longer follow-up times. Conclusion Patients with multiple clips experienced significantly longer follow-up times, reflecting more complex clinical scenarios. Despite no significant differences in receptor status distributions, multiple clip patients required more extensive surgeries, emphasizing the need for tailored surgical planning. The study underscores the importance of considering the number of clips in clinical decision-making. Future research should focus on larger, prospective studies to validate these findings and explore underlying mechanisms.

Determination of the Accuracy of Transcerebellar Diameter in Estimating Gestational Age in the Second and Third Trimesters of Pregnancy.

Background Every antenatal woman and her treating doctor aim for a healthy newborn. In obstetrics, accurately determining the gestational age (GA) is a critical aspect of managing pregnancy and evaluating fetal growth and development. The transcerebellar diameter (TCD) is the greatest transverse measurement of the fetal cerebellum. The growth of the cerebellum is minimally affected by fluctuations in growth, making the TCD the most reliable measurement for predicting GA. The purpose of the present research is to determine the accuracy of TCD in estimating GA in the second and third trimesters of pregnancy. Materials and methods The study included 500 antenatal women at 18-40 weeks of gestation. We also measured TCD in addition to routine ultrasound parameters like biparietal diameter (BPD), head circumference (HC), abdominal circumference (AC), and femur length (FL). We used IBM SPSS Statistics for Windows, Version 22 (Released 2013; IBM Corp., Armonk, New York, United States) for statistical analysis. The collected data was subjected to statistical tests, including Pearson's correlation coefficient and coefficient of determination. We conducted a regression analysis and used correlation coefficients to compare each ultrasound-measured parameter with the GA. Results The current research demonstrates a significant linear relationship between the TCD and GA (r = 0.9865; p = 0.0001), a strong association between BPD and GA (r = 0.9541; p = 0.0001), between HC and GA (r = 0.9613; p = 0.0001), between AC and GA (r = 0.9489; p = 0.0001), and between FL and GA (r = 0.9697; p = 0.0001). TCD showed the best correlation with GA among all the biometric parameters. TCD showed a correct assessment of GA by the last menstrual period (LMP) in 479 (95.8%) antenatal women. Conclusion The current research concludes that the TCD can be utilized as an independent measure to determine GA in the second and third trimesters of pregnancy, particularly in cases where the LMP is unknown, no dating scan has been performed in the first trimester, initial assessment taking place in the third trimester and in fetuses with variations in head shape such as dolichocephaly and brachycephaly.

Late-Onset Manifestations of Von Hippel-Lindau Syndrome: A Case Report.

Von Hippel-Lindau (VHL) syndrome is characterized by a range of tumors including phaeochromocytomas, pancreatic adenomas, cerebellar haemangioblastomas, and renal cell carcinomas. A 50-year-old male presented with a three-week history of headache. Additionally, the patient exhibited signs of hypertension. Ultrasonography (USG) abdomen and pelvis showed a solid mass lesion in the left adrenal gland, iso-echoic to the renal cortex. On contrast-enhanced computed tomography (CECT) of the brain, a well-defined solid cystic lesion was seen in the left posterior cerebellar hemisphere. Small nodular enhancing lesions were seen in the right cerebellar hemisphere. On further imaging with MRI brain contrast, the lesions in the cerebellum were diagnosed as multifocal hemangioblastomas. Laboratory investigations revealed elevated urinary metanephrines and normetanephrine, suggesting pheochromocytoma. Based on radiological and biochemical investigations, with the features of cerebellar haemangioblastomas and pheochromocytoma, a diagnosis of VHL syndrome was made.

Pre-chemotherapy clinically-guided skin tattooing + post-chemotherapy USG-guided skin marking: A time-tested, cost-effective technique for breast lesion localization, before Breast Conservation Surgery (BCS), in a high volume tertiary care cancer hospital.

Post neoadjuvant chemotherapy tumor localization is a challenge in LMI economy countries. Various options are available in High economy countries. Pre-chemotherapy clinically guided skin tattooing and post chemotherapy USG guided skin marking is a valid technique. In patients with complete clinic-radiological response larger volume resection may be an issue. Head-to-head comparison between skin marking and parenchymal marking is needed to make a conclusive statement.

Role of ultrasonography (USG) and color Doppler in the evaluation of thyroid nodules and its association with USG-guided FNAC - A cross-sectional study.

Introduction: Thyroid diseases affect approximately 42 million people in India. The majority (15%-40%) of these cases remain asymptomatic and benign and warrant special investigations such as ultrasonography (USG) and fine-needle aspiration cytology (FNAC) for diagnosis. Early diagnosis and management of thyroid disorders determine the disease course in many patients. Objective: To determine the role of USG and color Doppler in the evaluation of thyroid nodules and its association with USG-guided FNAC. Methods: We did a cross-sectional analytical study over 2 years, where we recruited 108 patients with thyroid swelling attending the OPD. We used a semi-structured data collection proforma that captured information on sociodemographic details, clinical symptoms, physical examination, and all ne cessary laboratory investigations. All patients underwent USG, color Doppler, and FNAC as a part of the investigation of thyroid nodules. The diagnostic value of ultrasound and Doppler parameters was assessed in terms of sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy for detection of malignancy in comparison to FNAC. Results: Approximately 155 nodules were identified from the selected 108 cases, and the prevalence of malignancy among the selected thyroid nodule patients was found to be 9.1%. We observed that malignant tumors were likely to be solitary with lobulated margins, >2 cm in size with <50% peripheral halo, with markedly hypoechoic, predominantly solid, with nodal involvement and extrathyroidal extension, microcalcifications, and central vascularity. We also observed that tumors that had USG characteristics of being taller than wide (91%), poorly defined margins (92%), marked hypoechoic (95%), and microcalcifications (96%) had the highest diagnostic accuracy in detecting malignancy when compared to FNAC. Conclusion: Thus, through our study findings, we conclude that USG and color Doppler can serve as vital tools for the evaluation of thyroid nodules with high sensitivity and specificity.

Ultrasound-guided procedures for postoperative pain management in pediatric patients undergoing abdominal surgeries: A systematic review.

Many ultrasound-guided procedures are available for administering analgesia via peripheral nerve blockade. This systematic review aims to compare different ultrasound-guided procedures to determine which procedure is better suited for pediatric abdominal surgeries. The objective is to understand the efficacy of ultrasound-guided procedures for postoperative pain management in children undergoing abdominal surgeries and to identify which procedure takes less time and is better suited for a particular surgery. A systematic literature search was performed in PubMed, SCOPUS, Central Cochrane Registry of Controlled Trials (The Cochrane Library), and ScienceDirect databases for pediatric abdominal surgeries conducted with ultrasound-guided procedures for administering analgesia. We included studies involving randomized controlled trials (RCTs). Quasi-randomized controlled studies, prospective, retrospective observational studies, case series, case reports, letters, editorials, comments, animal studies, and studies from non-English literature were excluded. We reviewed 13 articles with 910 patients included. Age groups varied from 6 months to 21 years. The most common block used was the transversus abdominis block (47.76%), and the most common surgery performed was hernia and hydrocele (52.10%). Quadratus lumborum block was used in 26.92%, erector spinae block in 8.97%, modified transversus abdominus block and rectus sheath block in 9.62%, and ilioinguinal block in 6.73% of the patients. No complications were reported in any of the studies. Transversus abdominus block is less effective in two of the studies. Each procedure for pediatric postoperative analgesia has specific advantages and limitations, highlighting the complexity of tailoring interventions. Our review focuses on the advancements in ultrasound-guided analgesia for lower abdominal surgeries in pediatric patients while also emphasizing the need for future randomized controlled trials (RCTs) to compare efficacy, standardize practices, and improve patient outcomes.

A Systematic Review and Meta-Analysis of 29 Studies Predicting Diagnostic Accuracy of CT, MRI, PET, and USG in Detecting Extracapsular Spread in Head and Neck Cancers.

BACKGROUND: Extracapsular spread (ECS) is the extension of cancer cells beyond the lymph node capsule and is a significant prognostic factor in head and neck cancers. This meta-analysis compared the diagnostic accuracy of CT, MRI, PET, and USG in detecting ECS in head and neck cancers. METHODOLOGY: The authors conducted a systematic review and meta-analysis of studies that compared the diagnostic accuracy of CT, MRI, PET, and USG in detecting ECS in head and neck cancers. They included studies that were published between 1990 and December 2023 and that used histopathology as the reference standard for ECS. RESULTS: The pooled sensitivity and specificity of CT scan were 0.63 (95% CI = 0.53-0.73) and 0.85 (95% CI = 0.74-0.91), respectively. The pooled sensitivity and specificity of MRI were 0.83 (95% CI = 0.71-0.90) and 0.85 (95% CI = 0.73-0.92), respectively. The pooled sensitivity and specificity of PET were 0.80 (95% CI = 0.74-0.85) and 0.93 (95% CI = 0.92-0.94), respectively. The pooled sensitivity and specificity of USG were 0.80 (95% CI = 0.68-0.88) and 0.84 (95% CI = 0.74-0.91), respectively. MRI had significantly higher sensitivity than CT scan (p-0.05). The specificity of CT and MRI was not significantly different (p-0.99). PET scan had the highest specificity among all imaging modalities. CONCLUSION: MRI is the most accurate imaging modality for detecting ECS in head and neck cancers. CT scan is a reasonable alternative, but PET scan may be considered when high specificity is required. USG may not add any further benefit in detecting ECS.

Effect of Neck Rotation With Flexion on Ultrasonographic Optic Nerve Sheath Diameter in Patients Undergoing Elective Craniotomy.

Background Extreme neck positioning to facilitate craniotomy can result in impaired venous drainage from the brain and a subsequent rise in increased intracranial pressure (ICP). The effects of varied neck positioning intraoperatively on ultrasonographic optic nerve sheath diameter (USG-ONSD) are still unexplored. This study aims to quantify the angle of neck rotation and flexion that can cause a significant increase in USG-ONSD in patients undergoing elective craniotomy. Methods A total of 100 patients were recruited in this non-randomized study and equally divided into two groups. In one group, patients with neck rotation ≤30 degrees and in another group, patients with neck rotation >30 degrees with varying degrees of neck flexion were included. The average of three USG-ONSD measurements in both eyes was obtained and compared in both groups at baseline, after positioning, and at the end of the surgery after making the neck neutral. Results The results of 100 recruited patients were analyzed. All the patients had neck flexion in the range of 40° to 45°, whereas the neck rotation ranged from 10° to 45°. The USG-ONSD of both eyes changed significantly from baseline to post-positioning time point in patients with neck rotation >30° (right eye p=0.038, left eye p=0.04) when compared to neck rotation ≤30°. There was no significant change in USG-ONSD from baseline to the postoperative time point after making the neck neutral (right eye p=0.245, left eye p=0.850) in both groups. Conclusions This study demonstrates that USG-ONSD, a surrogate measure of ICP, increased significantly after neck flexion with rotation >30° in neurosurgical patients. However, USG-ONSD becomes comparable to baseline after putting the patient's neck in a neutral position after surgery.

Reasons for Requesting Ultrasonography: A Retrospective Study.

OBJECTIVES: The aim of this study is to evaluate (i) the reasons for requesting ultrasonography (USG) in a dentistry faculty and (ii) the scanning regions, the type of probe used, and the use of Doppler USG. METHODS: USG request forms of patients who applied to our radiology clinic for USG were analyzed retrospectively. According to the clinical information of the patients in the request forms, the reasons for requesting USG were divided into four groups: soft tissue swelling, soft tissue calcification, lymph node, and other examinations. Data were statistically compared between sex (female and male) and age groups (≤40-years-old and ˃40-years-old). RESULTS: The USG request forms of 50 patients were obtained. The mean patient age was 45.06±14.50 years. Twenty-six patients were female (52%), while twenty-four patients were male (48%). Soft tissue swelling, soft tissue calcification, lymph node, and other examinations were noted as the reasons for requesting USG in 42%, 26%, 18%, and 14% of the patients, respectively. The most scanned regions were the submandibular (56%), parotid (16%), and cheek (10%) regions. Extraoral probe was used more frequently than intraoral probe (78% vs. 22%). Doppler USG was used in most patients (98%). A statistically significant difference was found between age groups and calcification examination (p<0.05). CONCLUSION: The reasons for requesting USG were mostly soft tissue swelling, soft tissue calcification, and lymph node examinations. The most commonly scanned region and used type of probe were the submandibular region and extraoral probe, respectively. Doppler USG was used in most patients.

A large abdominal cyst as a manifestation of pelviureteric junction obstruction in a neonate.

Intraabdominal cystic lesions diagnosed during antenatal period are uncommon. They are found to have varying origins, with renal tract being the most common site. Rarely, a large unilateral cystic lesion of renal origin is caused by Pelviureteric junction obstruction, crossing the midline, leading to compression of the contralateral kidney. We present a case of a neonate who was diagnosed with a large abdominal cyst in the antenatal period. The cyst persisted and crossed the midline causing hydronephrosis on the contralateral side. This is an unusual presentation of a commonly occurring condition, usually such large cyst at birth origins from alimentary tract rather renal system. It is important to understand unusual presentations of intraabdominal lesions and the associated pathology. It is mandatory to rule out renal obstruction, if there is any decompression of renal function, it is mandatory to save renal function till the time of definitive surgery.

Use of inferior vena cava guided fluid therapy in the treatment of septic shock: A randomised controlled trial.

INTRODUCTION: By administering inferior vena cava (IVC) directed fluid, it is possible to avoid the use of additional fluid and fluid overload in patients with septic shock (SS) and sepsis-induced hypoperfusion (SIH). METHODOLOGY: In patients with SIH and SS, we conducted prospective observational research on fluid therapy. A time-motion trace of the IVC diameter was created using M-mode imaging. The ability to predict fluid responsiveness was based on the IVC collapsibility index (cIVC) > 40%. Participants were randomised into 2 groups using a permuted block-of-four randomization list, with the investigators being blinded prior to patient allocation. They were split equally between the usual-care (UC) group, which received sepsis-guided fluid treatment, and the interventional ultrasound-guided fluid therapy (UGFT) group. RESULTS: The average age of the participants was 63.2 years (62.8 years for the UGFT group and 63.7 years for the UC group). Co-morbid health conditions were practically the same in both arms at baseline. Prior to enrolment, both groups received the same quantity of fluid as part of resuscitation (UGFT arm received 2.4 0.6 L, UC group received 2.2 0.7 L). The UGFT group outperformed the UC group with a P value of 0.02 due to a significantly lower positive fluid balance after 72 hours of ICU discharge (-1.37 L), which rendered the UGFT group superior to the UC group. Even after accounting for the fluids consumed before enrolment, there was still a sizable difference in the fluids infused. When the pre-enrolment fluids were counted at 72 hours, UGFT participants still displayed a decreased positive fluid balance. However, there was no discernible difference in the 30-day mortality rate overall (6.3% difference, UGFT: 15.7%, and UC: 22.0%). CONCLUSIONS: In contrast to the UC group, the UGFT arm of our study demonstrated a statistically significant benefit of Point of Care USG (POCUS) guided fluid therapy during resuscitation in sepsis in reducing the positive fluid balance in 72 hours, preventing fluid overload, and reducing the need for dialysis and invasive ventilation. However, there was no statistically significant variation in the 30-day mortality rate.

Validity of combined hydration self-assessment measurements to estimate a low vs. high urine concentration in a small sample of (tactical) athletes.

PURPOSE: Relationships between body weight, urine color (Uc), and thirst level (WUT) have been proposed as a simple and inexpensive self-assessment method to predict dehydration. This study aimed to determine if this method also allowed us to accurately identify a low vs. high urine concentration in (tactical) athletes. METHODS: A total of n = 19 Army Reserve Officer Training Corps cadets and club sports athletes (22.7 ± 3.8 years old, of which 13 male) were included in the analysis, providing morning body weight, thirst sensation, and Uc for five consecutive days. Each item received a score 0 or 1, resulting in a WUT score ranging from 0 (likely hydrated) to 3 (very likely dehydrated). WUT model and individual item outcomes were then compared with a ≥ 1.020 urine specific gravity (USG) cut-off indicating a high urine concentration, using descriptive comparisons, generalized linear mixed models, and logistic regression (to calculate the area under the curve (AUC)). RESULTS: WUT score was not significantly predictive of urine concentration, z = 1.59, p = 0.11. The AUC ranged from 0.54 to 0.77 for test days, suggesting a fair AUC on most days. Only Uc was significantly related to urine concentration, z = 2.49, p = 0.01. The accuracy of the WUT model for correctly classifying urine samples with a high concentration was 68% vs. 51% of samples with a low concentration, resulting in an average accuracy of 61%. CONCLUSION: This study shows that WUT scores were not predictive of urine concentration, and the method did not substantially outperform the accuracy of Uc scoring alone.

The effect of preinduction cervical length measurement with three different ultrasonographic methods on predicting delivery time.

AIM: This study aimed to evaluate the effect of preinduction cervical length (CL) measurement by transvaginal (TV), transperineal (TP), and transabdominal (TA) ultrasonography (USG) on the time of delivery and to compare these three sonographic methods in terms of superiority over one another. METHODS: This study included TV, TP, and TA CL measurements in pregnant women who were planned to undergo induction of labor at 37 weeks' gestation or later. The correlations between the said three methods and BISHOP scores were evaluated. These three methods were compared in terms of superiority in predicting the time of delivery. RESULTS: Pregnant women at 37-42 weeks' gestation undergoing labor induction were included, and all three methods were used for CL measurements. Three methods were correlated with each other (p < 0.001) and with BISHOP scores (p < 0.001). CONCLUSION: The correlation between all three methods and BISHOP scores indicates that TP and TA USG can be used instead of TV USG. On the other hand, while TA USG did not give a clear result in the accurate estimation of vaginal delivery time, TP, and TV USG gave both accurate and close results. When all these data are evaluated, it is concluded that TPU can be used safely instead of TVU, especially in patients receiving induction.

Is there a synergistic relationship between diaphragm and pelvic floor muscles in pregnant women?

OBJECTIVE: The aim of this study is to examine whether there is a synergistic relationship between the diaphragm and pelvic floor muscles (PFM) in pregnant women. MATERIAL AND METHODS: Our study was carried out as a cross-sectional study in primigravid pregnants in the second and third trimesters. Superficial electromyography (EMG), 2D/3D ultrasonography (USG), pulmonary function test (PFT), PERFECT, maximum expiratory pressure (MEP) and inspiratory pressure (MIP) measurements were used to evaluate pelvic floor and diaphragm muscle functions during pregnancy. Mann-Whitney U test was used to show the change in the second and third trimesters, and Spearman correlation was used to determine the relationship. RESULTS: No correlation was found between the EMG data of the PFM and diaphragm, or between the USG data of the PFM and diaphragm in all participants, in the second and third trimesters. In the third trimester of the study, diaphragmatic thickness and levator hiatal area (LHA) decreased and both diaphragm and PFM % MVC EMG parameters increased. In the third trimester, FVC, MIP, MEP decreased, and nonsignificant increase in FEV1, FEV1/FVC and peak ekspiratuar flow(PEF) were detected. A significant correlation was found between pelvic floor levator hiatal area USG and FEV1/FVC in both trimesters (r: 0,577p: 0,004). CONCLUSION: There may be a synergistic relationship between the diaphragm and PFM in pregnant women, the relationship may weaken as pregnancy progresses, and there may be no coactivation relationship between the two muscles. In order to prevent the occurrence of pelvic floor dysfunction during pregnancy and to increase the effect of rehabilitation programs, the relationship between the diaphragm and the PFM should be determined and more studies should be conducted.

A Case of Phlebectasia in a Child Presenting With Neck Mass.

Jugular phlebectasia is an enlargement of the jugular vein that manifests as a soft, cystic lump in the neck which can be compressed, becomes prominent on crying or straining and disappears on rest. It needs to be distinguished from laryngocele, neck cysts, and tumours that can also develop with straining. We report a case of a seven-year-old boy presenting with a cervical cystic mass. Comparable computed tomography and ultrasonography findings helped identify the pathology.

Unveiling the power of imaging techniques: comparing high-resolution ultrasound and functional MR neurography in peripheral nervous system pathology: a short communication.

MRI and ultrasonography are used for diagnosing and helping manage peripheral nervous system pathologies. Multiple studies have compared the diagnostic accuracy of these two modalities, but the results can vary depending on the specific conditions being evaluated. In general, high-resolution ultrasound is considered a reliable and accurate tool for evaluating peripheral nerves, with high sensitivity and specificity. High-resolution ultrasound and functional MR neurography are both noninvasive imaging techniques used to evaluate nerve structures in the body. However, they differ in several technical aspects like imaging modality, spatial resolution, field of view, image quality, and accessibility. Establishing consensus on image acquisition techniques, and reporting formats to facilitate effective communication and comparison of results will further enhance the outcomes. The use of advanced ultrasound techniques, such as contrast-enhanced ultrasound, elastography, and ultrasound biomicroscopy, should be promoted for better visualization and characterization of nervous tissues, like transcranial Doppler for cerebrovascular evaluation.