Contrast-enhanced ultrasonography to guide diagnostic and therapeutic interventional procedures.

Although not necessary for the vast majority of ultrasound-guided procedures, intravenous contrast agents can be useful for procedures aimed at lesions that require contrast enhancement to be seen on ultrasonography. Using contrast-enhanced ultrasonography to guide procedures has two drawbacks: first, because enhancement from ultrasound contrast agents is short lived, it is often necessary to plan several injections; second, because the needle is poorly seen on contrast-enhanced ultrasonography, a dual image display format is necessary. Contrast-enhanced ultrasonography can be used for planning and monitoring diagnostic and therapeutic procedures, for guiding the procedures, and for follow-up. Using contrast-enhanced ultrasonography enables better results in both types of procedures; moreover, it can be used within cavities.

Contrast-enhanced ultrasonography to guide diagnostic and therapeutic interventional procedures. / Ecografía con contraste en procedimientos ecoguiados.

Although not necessary for the vast majority of ultrasound-guided procedures, intravenous contrast agents can be useful for procedures aimed at lesions that require contrast enhancement to be seen on ultrasonography. Using contrast-enhanced ultrasonography to guide procedures has two drawbacks: first, because enhancement from ultrasound contrast agents is short lived, it is often necessary to plan several injections; second, because the needle is poorly seen on contrast-enhanced ultrasonography, a dual image display format is necessary. Contrast-enhanced ultrasonography can be used for planning and monitoring diagnostic and therapeutic procedures, for guiding the procedures, and for follow-up. Using contrast-enhanced ultrasonography enables better results in both types of procedures; moreover, it can be used within cavities.

Detección de cassette cromosómico en cepas de Staphylococcus aureus resistente a meticilina aisladas en un hospital universitario de la ciudad de Maracaibo / Detection of chromosomal cassette in MRSA Staphylococcus aureus strains isolated in a University Hospital in Maracaibo City

Staphylococcus aureus resistente a meticilina, es un importante patógeno nosocomial y comunitario. El determinante genético de resistencia es el gen mecA. Se han descrito 11 tipos de SCCmec, encontrándose con frecuencia los tipos II, III en infecciones hospitalarias, y los tipos IV y V en infecciones comunitarias. La presente investigación se llevó a cabo para estudiar la distribución de los tipos de SCCmec y su relación con la Leucocidina Panton-Valentine, tipificados mediante la reacción en Cadena de la Polimerasa. Para ello se estudiaron un total de 42 cepas resistentes a meticilina portadoras del gen mecA. Veintinueve (29) cepas mostraron la presencia del cassette cromosomal tipo IV (69,05%); 30,95% presentaron el SCCmec tipo I. Un 61,95% (n=13) de las cepas fueron portadoras del SCCmec IV resultando todas positivas para el gen PVL. Cabe destacar la diseminación del cassette tipo IV en cepas intrahospitalarias portadoras de PVL, lo que es preocupante tanto para la terapéutica como para el agravamiento de las infecciones en los pacientes.

Methicillin-resistant Staphylococcus aureus is an important nosocomial and community pathogen. The genetic determinant of resistance is the mecA gene. 11 types of SCCmec have been described, with types II, III frequently found in hospital infections, and types IV and V in community infections. The present investigation was carried out to study the distribution of the SCCmec types and their relation with the Panton-Valentine Leucocidin, typified by the reaction in the Polymerase Chain. To this end, a total of 42 methicillin-resistant strains carrying the mecA gene were studied. Twenty-nine (29) strains showed the presence of type IV chromosomal cassette (69.05%); 30.95% presented SCCmec type I. A 61.95% (n= 13) of the strains were carriers of SCCmec IV, all of which were positive for the PVL gene. It is worth noting the dissemination of the type IV cassette in intrahospital strains carrying PVL, which is worrisome both for the therapeutic and for the aggravation of infections in patients.

[Ultrasound-guided interventional procedures in the musculoskeletal system]. / Intervencionismo guiado por ecografía en el sistema musculoesquelético.

Ultrasonography is the most appropriate tool for interventional procedures in the musculoskeletal system when the lesion is visible on ultrasonography. Procedures performed under ultrasonographic guidance include: taking biopsies; draining abscesses; bursitis; hematomas or muscle tears; treating cystic lesions; diagnostic or therapeutic arthrocentesis; injecting substances into joints or lesions; aspirating calcium deposits and extracting foreign bodies. Although some of these procedures are often carried out without imaging guidance, ultrasonographic guidance improves their efficacy. Drainage can be performed with catheters or needles and makes it possible to avoid more aggressive treatments in most cases. Urokinase is useful for draining hematomas or fibrinous collections. Injecting corticoids is useful in the treatment of synovial cysts, Baker's cyst, tendinitis, and non-infective arthritis. Calcifying tendinitis of the shoulder can be treated effectively with percutaneous calcium lavage.

[US-guided interventional procedures: what a radiologist needs to know]. / Intervencionismo guiado por ecografía: lo que todo radiólogo debe conocer.

US has important advantages in guiding interventional procedures: it is economical and widely available, it does not use ionizing radiation, and it requires less time than other techniques. US guidance can be provided using devices adapted to probes or using the freehand technique (holding the needle in one hand and the probe in the other). US-guided procedures require careful planning, adequate hemostasis or a directly compressible puncture site, the patient's informed consent, and appropriate measures to ensure asepsis and anesthesia. The technique involves introducing the needle or catheter through the plane of the US slice. The advance of the needle is controlled in real time. High resolution linear probes are ideal for interventional procedures in superficial tissues, but 3.5 MHz probes are required for procedures in deep tissues. The most common procedures include biopsies, drainages, and percutaneous injections. Biopsies can be carried out using fine needles to obtain material for cytological study (fine-needle aspiration cytology) or using large needles to obtain specimens for histologic study (core biopsy). Core biopsy is more sensitive and more specific, and it has a low rate of complications. Drainage almost always involves placing a catheter in a fluid collection; it can be done using the Seldinger techniques, trocars, or pleural catheters. US-guided percutaneous injections can be used to inject substances into infectious lesions, tumors, or nerve plexuses, and they are especially useful in musculoskeletal disease.

Teleophthalmology: the use of real-time telementoring to remove an orbital tumor.

OBJECTIVE: To determine whether current telemedicine technology can support real-time surgical telementoring to remove an orbital tumor. DESIGN: Interventional case report METHODS: An orbital specialist guided a general ophthalmologist in the removal of a lateral orbital tumor from a site 210 miles away on another island. A 3-mm endoscope connected to a three-chip digital video camera attached to a Concorde 4500 Picture-Tel videoconferencing system was used to transmit images at a rate of 384 kb per second over integrated service digital network lines. MAIN OUTCOME MEASURES: Successful performance and outcome of the telementored procedure comparable to hands-on orbital surgery. RESULTS: The surgical procedure was successfully telementored with uncomplicated removal of the orbital tumor. CONCLUSIONS: Current telemedicine technology can support real-time telementoring to remove an orbital tumor.

Pseudocyst of the ear. Report of three cases.

Pseudocyst of the ear is a rare entity with controversial pathogenesis. Usually it is presented as a solitary, unilateral, fluctuant and non-inflammatory tumour of the ear with overlying normal skin. It occurs most often in young adult males. Incission reveals a serous liquid, with the consistency of olive oil, contained in the cyst-like lesion. Histopathology shows an intracartilaginous cavity with signs of degeneration and necrosis of the limiting cartilage. We present three new cases of this entity. Continuous minor trauma appears to be the causative factor in one of the patients, who also presented bilateral lesions.

Carcinoma hepato-celular en los Andes Venezolanos / Hepatocellular carcinoma in the Venezuelan Andes

Se estudian 31 casos de carcinoma hepatocelular (CHC), edad promedio de 56.9 años, 21 hombres y 10 mujeres. El grupo control edad promedio 52.7 años, 25 hombres y 6 mujeres. Las formas de presentación clínica fueron: franca 61.29 porciento; febril 12.90 porciento; metastásico 9.67 porciento; cirrótico 6,45 porciento incidental 3.22 porciento; hepatitis aguda 3.22 porciento; colestásico 3.22 porciento. Las pruebas hepáticas no reportaron diferencias estadísticamente significativas. El único test que demostró diferencias estadísticamente significativas fue la FA P<0.01 y las GO Vs TGP en CHC; apreciamos que las TGO tuvieron valores mayores que las TGP y esa diferencia es significativa P<0.001. De los CHC 77.41 porciento están sobre hígado no cirróticoy 22.59 porciento asociados a CH. En la serie los CHC sin cirrrosiis 57.14 porciento son HbsAg negativos y 17.85 porciento son positivos. En los CHC en hígado cirrótico, 21.42 porciento son HsbAg positivos y 3.57 porciento negativos. El total CHC HbsAg positivo es 39.28 porciento y 60.71 porciento son negativos, esta diferencia es 9X2 Yates) estadísticamente significativa P<0.02. La clasificación histológica demostró: trabeculares 21 (67.74 porciento), glandulares 8 (25.80 porciento), celulas claras 1 (3.23 porciento) y fibrolaminar 1 (3.23 porciento). La tasa de sobrevida global a 3meses 0.72 porciento. En nuestra región el CHC predomina en hígado no cirrótico, el HbsAg y cirrosis no son un factor esencial en su etiología