Lens Thickness in Infants and Children with Cataracts.

Purpose: The purpose of this study was to determine the association between lens thickness and cataract in participants aged 0 to 5 years. Design: This was a prospective, multicenter, case-control study. Participants: We enrolled 118 participants (171 eyes) aged 0 to 5 years, mean age 14.6 ± 17.0 months, range 0 to 60 months. Methods: Lens thickness was measured on 342 ultrasound biomicroscopy (UBM) images. Main Outcome Measures: Lens thickness; feasibility of lens thickness measurement from UBM images. Results: The mean lens thickness among noncataracts was 3.60 ± 0.17 mm, compared with 3.16 ± 0.61 mm among cataracts (P < 0.0001). Lens thickness <3.5 mm was significantly associated with increased odds of cataract; adjusted odds ratio = 5.99 (95% confidence interval, 2.41-14.88; P < 0.0003) among participants age 0 to 7 months. Lens thickness was significantly associated with cataract laterality among participants age 0 to 7 months (P < 0.0001). Conclusions: Quantitative UBM can be used to evaluate lens thickness in infants and children with congenital cataracts. The lens in congenital cataract eyes was thinner than that of controls among infants. Abnormal lens thickness was significantly associated with cataract. Future longitudinal studies will examine the association between lens thickness and postcataract surgery outcomes. Financial Disclosures: Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

A case of intra-abdominal gossypiboma diagnosed preoperatively by endoscopic ultrasound fine-needle-aspiration.

Gossypiboma is an extremely rare adverse event occurring post-surgery, where surgical gauze is left within the body. If aseptically retained, it can lead to the formation of granulation tissue through chronic inflammation and adhesion with surrounding tissues, potentially persisting asymptomatically for many years. While diagnosis of this condition has been reported through various imaging modalities such as abdominal ultrasound and computed tomography, cases not presenting with typical findings are difficult for preoperative diagnosis, and instances where it is discovered postoperatively exist. Particularly when in contact with the gastrointestinal tract within the abdominal cavity, differentiation from submucosal tumors of the digestive tract becomes problematic. This report describes the imaging characteristics of endoscopic ultrasound and the usefulness of endoscopic ultrasound-fine-needle-aspiration for tissue diagnosis in the preoperative diagnosis of intra-abdominal gossypiboma.

Sedative effects of propofol and risk factors for excessive sedation in the endoscopic treatment of biliary and pancreatic diseases.

Objectives: The safety and effectiveness of propofol in more complex endoscopic procedures, such as endoscopic retrograde cholangiopancreatography, remain unknown. Thus, we aimed to evaluate propofol sedation during endoscopic cholangiopancreatography, ultrasound-guided intervention, and gastroduodenal stenting and examine risk factors for excessive sedation. Methods: We retrospectively analyzed data from 870 patients who underwent endoscopic treatment with propofol sedation for biliary and pancreatic disease between October 2020 and September 2021. Sedation included propofol and fentanyl, with continuous monitoring of vital signs and the bispectral index. The assessed risk factors included age, complications, body mass index, treatment duration, and specialty. Results: Distal bile duct treatment (n = 367), hilar bile duct treatment (n = 197), post-small-intestinal reconstruction treatment (n = 75), endoscopic ultrasound-guided intervention (n = 140), and gastrointestinal obstruction treatment (n = 91) were performed. The rates of excessive sedation, hypoxemia, and hypotension were 7.8%, 6.0%, and 1.8%, respectively. Post-small-intestinal reconstruction treatment had the highest incidence rate of excessive sedation (16%), whereas endoscopic ultrasound-guided intervention had the lowest incidence rate (4.3%). Multivariate analysis revealed significant associations between excessive sedation and comorbid sleep apnea, obesity, and prolonged procedural time. Conclusions: Obesity, sleep apnea syndrome, and prolonged procedure time are risk factors for excessive sedation related to propofol use. Thus, sedation techniques should be tailored for these patients.

Endoscopic ultrasound-guided tissue acquisition for focal liver lesions in patients with a history of multiple primary malignant neoplasms.

Objective: This study aimed to investigate the usefulness of endoscopic ultrasound-guided tissue acquisition (EUS-TA) for diagnosing focal liver lesions in patients with a history of multiple primary malignant neoplasms. Methods: Among patients who underwent EUS-TA for focal liver lesions between 2016 and 2022, those with a history of multiple malignant neoplasms were included. A histologically confirmed malignant tumor within the past 5 years before EUS-TA was defined as a history of malignant neoplasm. The primary outcomes were diagnostic ability and adverse events of EUS-TA. Results: This study included 16 patients (median age, 73 [33-90] years), the median tumor size was 32 (6-51) mm, 14 had a history of double malignant neoplasms, whereas two had triple malignant neoplasms. Malignant neoplasms were detected histologically or cytologically in all cases. Immunohistochemistry was performed in 75% (12/16), and the final diagnosis of EUS-TA was metastatic liver tumor in 12 patients, and primary malignant liver tumor in four patients. The primary site could be identified in 11 of 12 metastatic tumor cases. The diagnostic yield of EUS-TA was 100% (16/16) for differentiating benign and malignant tumors and 94% (15/16) for confirming the histological type including the primary site of metastatic lesions. No adverse events were associated with the procedure. Conclusion: EUS-TA is a useful diagnostic modality for focal liver lesions in patients with a history of multiple malignant neoplasms, allowing for the differential diagnosis of primary and metastatic tumors and identification of the primary site of metastatic lesions.

Radiomics analysis for prediction and classification of submucosal tumors based on gastrointestinal endoscopic ultrasonography.

Objectives: To identify and classify submucosal tumors by building and validating a radiomics model with gastrointestinal endoscopic ultrasonography (EUS) images. Methods: A total of 144 patients diagnosed with submucosal tumors through gastrointestinal EUS were collected between January 2019 and October 2020. There are 1952 radiomic features extracted from each patient's EUS images. The statistical test and the customized least absolute shrinkage and selection operator regression were used for feature selection. Subsequently, an extremely randomized trees algorithm was utilized to construct a robust radiomics classification model specifically tailored for gastrointestinal EUS images. The performance of the model was measured by evaluating the area under the receiver operating characteristic curve. Results: The radiomics model comprised 30 selected features that showed good discrimination performance in the validation cohorts. During validation, the area under the receiver operating characteristic curve was calculated as 0.9203 and the mean value after 10-fold cross-validation was 0.9260, indicating excellent stability and calibration. These results confirm the clinical utility of the model. Conclusions: Utilizing the dataset provided curated from gastrointestinal EUS examinations at our collaborating hospital, we have developed a well-performing radiomics model. It can be used for personalized and non-invasive prediction of the type of submucosal tumors, providing physicians with aid for early treatment and management of tumor progression.

Clinical outcomes and significance of postoperative ultrasound biomicroscopy in patients with Boston type 1 keratoprosthesis

ABSTRACT Purpose: To determine the clinical outcomes in patients after type 1 Boston keratoprosthesis surgery and the significance of ultrasound biomicroscopy imaging for postoperative follow-up. Methods: This retrospective analysis included 20 eyes of 19 patients who underwent corneal transplantation with type 1 Boston keratoprosthesis between April 2014 and December 2021. Data on patient demographics, preoperative diagnosis, visual acuity, and postoperative clinical findings were analyzed. Results: Type 1 Boston keratoprosthesis implantation resulted in intermediate- and long-term positive outcomes. However, blindness and other serious complications such as glaucoma, retroprosthetic membrane formation, endophthalmitis, or retinal detachment also occurred. The use of ultrasound biomicroscopy imaging allowed for better evaluation of the back of the titanium plate, anterior segment structures, and the relationship of the prosthesis with surrounding tissues, which provided valuable postoperative information. Conclusion: Regular lifetime monitoring and treatment are necessary in patients who undergo Boston type 1 keratoprosthesis implantation for high-risk corneal transplantation. ultrasound biomicroscopy imaging can be a valuable imaging technique for the evaluation of patients with Boston type 1 keratoprosthesis, providing important information on anterior segment anatomy and potential complications. Further studies and consensus on postoperative follow-up protocols are required to optimize the management of patients with Boston type 1 keratoprosthesis.

Interaction of Te(IV) and Te(VI) with the soil matrix - Sorption and fractionation as a function of soil composition.

Tellurium is a technology-critical element (TCE), with relatively limited data on its behavior in the environment, especially the pedosphere. As with other TCEs, its more widespread use, especially in new energy sources, might lead to Te spillage during production or in the eventual waste. Investigation of tellurium's interaction with soil is a necessary step in the research into the physiochemical transformation and determining the mobility of different tellurium species. To broaden the hitherto scarce knowledge of tellurium behavior in the soil environment, selected soluble tellurium compounds were introduced into different types of well-characterized soil (content of fertilizers, organic matrix, clay minerals, Mn, Fe, pH). The study of Te(IV) and Te(VI) sorption indicated that after 7 days the sorption is quantitative and close to 100%. Addition of Fe2O3 to a soil deficient in Mn and Fe increases its sorption potential by about 10 percentage points. Based on fractionation study (0.11 mol L-1 CH3COOH, 0.1 mol L-1 ascorbic acid in oxalate buffer (pH 3), 30% H2O2 at 85 °C followed by 0.5 mol L-1 CH3COONH4), it was shown that the presence of Mn/Fe (oxyhydr)oxides plays an essential role in the mobility of Te, especially Te(VI), regardless of the soil type. In the soil poor in reducible fraction and rich in organic matrix (peat), the organic fraction was responsible for the immobilization of Te, especially Te(IV). Extraction of the mobile fraction after incubation in the presence of DI water (Te extraction: 7-8%), oxalic acid (5-7%) or citric acid (6%) (mimicking rhizosphere activity) indicated that these did not play a significant role in Te retention. Nevertheless, soil modification with biocarbon limited the effect of citrates on Te mobilization. This knowledge is fundamental, i.e. in the context of soil remediation processes and counteracting the migration of Te in the environment from anthropogenic sources (e.g. solar farms).

Low-frequency focused thermosonication for Salmonella typhimurium inactivation: an in vitro study.

Customer requests are addressed to safe products that best express their characteristics of "naturalness" and "freshness" for their entire shelf life; therefore, scientific research has been exploring the use of "non-thermal technologies". Thermosonication using low-frequency focused ultrasound determines bacterial inactivation through the phenomenon of "cavitation", guaranteeing high-quality standards of safety, nutrition, and freshness of the products. The present work aims to evaluate the effectiveness of the inactivation of Salmonella typhimurium in culture broth by low-frequency focused thermosonication with two different operational parameters: sublethal temperature (40°C, 50°C) and treatment time (5, 10, and 15 minutes). Treatment determined a bacterial load reduction compared to the negative control (untreated inoculum), which was statistically significant at the t-test (p<0.05). Average decreases of 1.5 log and 3.5 CFU/mL were observed, respectively, after treatment and after 24 hours of storage at +4°C. Treatment at 50°C for 15 minutes was the most effective (average value: 3.06 log CFU/mL; minimum value: 2.13 log CFU/mL; maximum value: 4.59 log CFU/mL). However, strains have shown markable variability: one of them even showed an increase in the microbial load 24 hours after treatment at 40°C for 5 minutes (-0.20 log CFU/mL); however, the same treatment showed a reduction of bacterial charge in all the other strains (average value: 1.05 log CFU/mL; minimum value: -0.20 log CFU/mL; maximum value: 2.28 log CFU/mL). This study poses numerous perspectives on the use of low-frequency focused thermosonication treatment in the food industry as a sustainable and safe alternative to classic thermal treatments.

Association of Lung Ultrasound Scores With Different Modes of Respiratory Support and Clinical Outcomes: An Observational Study in a Tertiary Care Neonatal Unit.

BACKGROUND: Lung ultrasound (LUS) is an evolving point-of-care tool in the neonatal intensive care unit. LUS score has been evaluated in adults as well as in neonates to characterize and diagnose various respiratory conditions. Recently, the LUS score has been evaluated for predicting clinical respiratory outcomes in neonates. OBJECTIVE: To assess the association between LUS score and various modes of respiratory support and clinical outcomes among neonates presenting with respiratory distress. METHODS: In this prospective, cross-sectional, observational study done in a tertiary care neonatal unit, the LUS score was calculated within three hours of receiving respiratory support. Subsequently, the LUS score was assigned with each escalation and de-escalation of respiratory support. Maximum LUS scores for each clinical outcome were also recorded. Inter-rater agreement was determined with the intraclass correlation coefficient. RESULT: A total of 162 LUS scans were performed in 65 babies with a mean gestation of 32.4 ± 3.7 weeks and median (IQR) birth weight of 1480 (1130-2000) grams. The LUS scores (median (IQR)) of babies on continuous positive airway pressure (CPAP), noninvasive positive pressure ventilation (NIPPV), and mechanical ventilation (MV) were 4 (3-6.5), 9 (8-11), and 12 (11-13.5), respectively (p-value < 0.001). The difference in maximum median LUS scores between different clinical outcomes was statistically significant, with a p-value < 0.001. LUS score had an excellent inter-rater agreement (intraclass correlation coefficient = 0.998; p-value < 0.001). CONCLUSION: There is an association between LUS score and different modes of respiratory support with scores increasing as the level of support increased. LUS score was also found to be related with clinical outcomes like death, extubation failure, and recovery, which could help in predicting the prognosis.

Association between apolipoprotein C-III levels and coronary calcification detected by intravascular ultrasound in patients who underwent percutaneous coronary intervention.

There are few reports on the association between apolipoprotein C-III (ApoC-III) and coronary calcification using intravascular modalities. This study aimed to investigate the impacts of ApoC-III levels on coronary calcification using grayscale intravascular ultrasound (IVUS). Consecutive 263 culprit lesions for 202 patients who underwent percutaneous coronary intervention using grayscale IVUS were included in this study and divided into four groups based on quartile ApoC-III values. This study assessed plaque characteristics, including severe calcification (>180° arc) at the minimum lumen area site and presence of calcified nodules within the culprit lesion using grayscale IVUS, and evaluated whether ApoC-III levels were associated with coronary calcified plaques. The highest ApoC-III quartile [Quartile 4 (Q4)] had a higher proportion of complex lesions, calcified plaques, severe calcification, calcified nodules, plaque burden, and total atheroma volume than the lowest ApoC-III quartile [Quartile 1 (Q1)]. Additionally, multivariable logistic regression analysis showed that Q4 was significantly associated with severe calcification and calcified nodules, with Q1 as the reference (odds ratio [OR]: 2.70, 95% confidence intervals [CIs]: 1.04-7.00, p = 0.042; and OR: 3.72, 95% CIs 1.26-11.0, p = 0.017, respectively). Furthermore, ApoC-III level (1-mg/dl increase) was a strong significant predictor of severe calcification (OR: 1.07, 95% CIs: 1.00-1.15, p = 0.040) and calcified nodules (OR: 1.09, 95% CIs: 1.01-1.19, p = 0.034) according to the multivariable logistic regression analysis. This study is the first to verify that elevated ApoC-III levels are associated with the development of severe calcification and progression to calcified nodules as detected by grayscale IVUS.

Successful percutaneous coronary intervention of left main coronary artery dissection following mechanical aortic valve replacement surgery: a case report and literature review.

Background: Iatrogenic left main coronary artery (LMCA) dissection resulting from cardiac surgery is a rare complication. Its early detection is challenging and often poses a significant threat to the patient's life. However, evidence regarding the most effective management strategy for this condition remains limited at present. Case presentation: We present a case of 65-year-old female patient who developed cardiogenic shock after mechanical aortic valve replacement surgery associated acute myocardial infraction. Despite concurrent coronary artery bypass graft (CABG) surgery, the patient's condition remained unimproved. Subsequent coronary angiography revealed extensive LMCA dissection involving the left circumflex (LCx) artery. Percutaneous coronary intervention (PCI) guided by intravascular ultrasound (IVUS) led to an immediate improvement in hemodynamic status. The patient was successfully discharged after 22 days of treatment. Conclusions: Iatrogenic LMCA dissection is an uncommon complication following cardiac surgery. It can manifest in a variety of ways, including as incidental findings, cardiogenic shock or sudden cardiac arrest. The precise prevalence rates of causes linked to cardiac surgery remain largely unknown due to the scarcity of reported cases and the absence of research on this issue. Currently, a definitive management strategy for this condition has not been established. However, previous reported clinical cases provide insight that CABG could be considered if coronary artery dissection is detected during cardiac surgery. Upon postoperative identification, diagnostic coronary angiography and PCI may be feasible alternatives.

Is it worth trying? A cross-sectional study on the implementation of point-of-care ultrasound in Hungarian primary care.

BACKGROUND: Although the number of point-of-care ultrasound devices available in Hungarian primary care practices are increasing due to government funding, their use in day-to-day patient care is limited and unregulated. Our study aimed to evaluate the attitudes and needs of general practitioners (GPs) and patients in Hungary regarding the introduction of bedside ultrasonography in primary care practices. METHODS: As a part of a cross-sectional study, an anonymous, self-administered questionnaire was distributed to GPs and patients on a social media platform. Data collection was carried out from August 2023 to October 2023. Chi-square test was used to determine the associations between categorical variables. RESULTS: The survey was completed by 415 GPs (mean age 53.8 ± 11.1 years, 54.9% female, mean 19.5 ± 11.9 years of practice) and 693 patients (mean age 45.5 ± 12.3 years, 95.2% female). There was a statistically significant increase in interest in PoCUS among young and middle-aged GPs (age 28-59; p = 0.02). In addition, this population of GPs was also more likely to undertake training in PoCUS than their older colleagues (p < 0.0001). An inverse relationship was found between the duration of practice and training willingness (p = 0.0011). Even with the government's financial support, only 8.2% of GPs currently use PoCUS in a daily basis, and 59.5% of GPs are unfamiliar with the indications and the ways of using it. Patients would even pay to have the examination done in a primary care setting, even though only 45.9% of patients would pay a GP who is not certified in PoCUS, but the willingness to pay increased to 99.4% for those with formal training (p = 0.024). CONCLUSION: Our findings indicate a significant interest in adapting PoCUS in primary care from both GPs and patients. Based on the fact that a significant proportion of Hungarian GPs are unaware of PoCUS and its indications, it is particularly important to develop educational frameworks, and practical guidelines for the effective incorporation of PoCUS in Hungary.

Topology-preserving segmentation of abdominal muscle layers from ultrasound images.

BACKGROUND: In clinical anesthesia, precise segmentation of muscle layers from abdominal ultrasound images is crucial for identifying nerve block locations accurately. Despite deep learning advancements, challenges persist in segmenting muscle layers with accurate topology due to pseudo and weak edges caused by acoustic artifacts in ultrasound imagery. PURPOSE: To assist anesthesiologists in locating nerve block areas, we have developed a novel deep learning algorithm that can accurately segment muscle layers in abdominal ultrasound images with interference. METHODS: We propose a comprehensive approach emphasizing the preservation of the segmentation's low-rank property to ensure correct topology. Our methodology integrates a Semantic Feature Extraction (SFE) module for redundant encoding, a Low-rank Reconstruction (LR) module to compress this encoding, and an Edge Reconstruction (ER) module to refine segmentation boundaries. Our evaluation involved rigorous testing on clinical datasets, comparing our algorithm against seven established deep learning-based segmentation methods using metrics such as Mean Intersection-over-Union (MIoU) and Hausdorff distance (HD). Statistical rigor was ensured through effect size quantification with Cliff's Delta, Multivariate Analysis of Variance (MANOVA) for multivariate analysis, and application of the Holm-Bonferroni method for multiple comparisons correction. RESULTS: We demonstrate that our method outperforms other industry-recognized deep learning approaches on both MIoU and HD metrics, achieving the best outcomes with 88.21%/4.98 ( p m a x = 0.1893 $p_{max}=0.1893$ ) on the standard test set and 85.48%/6.98 ( p m a x = 0.0448 $p_{max}=0.0448$ ) on the challenging test set. The best&worst results for the other models on the standard test set were (87.20%/5.72)&(83.69%/8.12), and on the challenging test set were (81.25%/10.00)&(71.74%/16.82). Ablation studies further validate the distinct contributions of the proposed modules, which synergistically achieve a balance between maintaining topological integrity and edge precision. CONCLUSIONS: Our findings validate the effective segmentation of muscle layers with accurate topology in complex ultrasound images, leveraging low-rank constraints. The proposed method not only advances the field of medical imaging segmentation but also offers practical benefits for clinical anesthesia by improving the reliability of nerve block localization.

B-mode ultrasound-based CAD by learning using privileged information with dual-level missing modality completion.

Learning using privileged information (LUPI) has shown its effectiveness to improve the B-mode ultrasound (BUS) based computer-aided diagnosis (CAD) by transferring knowledge from the elasticity ultrasound (EUS). However, LUPI only performs transfer learning between the paired data with shared labels, and cannot handle the scenario of modality imbalance. In order to conduct the supervised transfer learning between the paired ultrasound data together with the additional single-modal BUS images, a novel multi-view LUPI algorithm with Dual-Level Modality Completion, named DLMC-LUPI, is proposed to improve the performance of BUS-based CAD. The DLMC-LUPI implements both image-level and feature-level (dual-level) completions of missing EUS modality, and then performs multi-view LUPI for knowledge transfer. Specifically, in the dual-level modality completion stage, a variational autoencoder (VAE) model for feature generation and a novel generative adversarial network (VAE-based GAN) model for image generation are sequentially trained. The proposed VAE-based GAN can improve the synthesis quality of EUS images by adopting the features generated by VAE from the BUS images as the model constrain to make the features generated from the synthesized EUS images more similar to them. In the multi-view LUPI stage, two feature vectors are generated from the real or pseudo images as two source domains, and then fed them to the multi-view support vector machine plus classifier for model training. The experiments on two ultrasound datasets indicate that the DLMC-LUPI outperforms all the compared algorithms, and it can effectively improve the performance of single-modal BUS-based CAD.

Antibacterial effect of ultrasound combined with Litsea cubeba essential oil nanoemulsion on Salmonella Typhimurium in kiwifruit juice.

This study investigated the antibacterial effect of ultrasound (US) combined with Litsea cubeba essential oil nanoemulsion (LEON) on Salmonella Typhimurium in kiwifruit juice and effect on the quality and sensory properties of kiwifruit juice. In this study, LEON prepared by ultrasonic emulsification method had a good particle size distribution and high stability. The US+LEON treatment significantly (P < 0.05) improved antibacterial efficacy, compared to the control, and would not destroy the nutritional components containing ascorbic acid, flavonoids, total phenol and total soluble solids. Meanwhile, US+LEON treatment enhanced 2, 2-diphenyl-1-picrylhydrazyl (DPPH), 2, 2'-azino-bis-(3-ethylbenzothiazoline-6 sulfonic acid) (ABTS) radical scavenging capacity and ferric ion reducing antioxidant power (FRAP). In terms of sensory properties, US and LEON had a significant (P < 0.05) effect on the odor and overall morphology of kiwifruit juice. The enhance of antibacterial efficacy and the retention of nutrients by combined treatments shows that US+LEON is a promising antibacterial method that will provide new ideas for the processing and safety of fruit juices, and the US parameters and LEON concentration should be adjusted to reduce the effect on food sensory properties in future studies.

Sex-specific effects of a Mediterranean diet on lower limb bone strength in Polish children.

Lifestyle factors have the potential to influence bone health in various ways, whether positively or negatively. As osteoporosis is believed to originate in early years, it is therefore essential to indicate factors that may positively affect bone health during childhood. The aim of our study was to investigate the effects of early and current diet, vitamin D supplementation, and BMI z-score on bone properties in a group of children aged 3-7 years. A cross-sectional sample of 205 preschoolers and their parents participated in the study. Dietary assessment was made using a modified version of the Polish-adapted Mediterranean Diet score (MVP-aMED) on the basis of the data from food frequency questionnaire (FFQ), filled out by the parents. Quantitative ultrasound (QUS) was used in the assessment of bone properties. In the sex-stratified analysis, significant associations were observed between MVP-aMED score (ß = 0.193, 95 % CI: 0.005, 0.237; p = 0.04), BMI z-score (ß = -0.318, 95 % CI: -1.455, -0.039; p = 0.04) and QUS z-score, exclusively among girls. After adjustment, only the relationship with diet remained significant (ß = 0.209, 95 % CI: 0.007, 0.255; p = 0.04), suggesting that a higher adherence to the Mediterranean Diet may be associated with better bone properties in girls aged 3-7 years old. Our results emphasize the importance of fostering healthy dietary habits and maintaining proper weight in children in order to promote optimal bone development.

Preoperative discrimination between uterine myomas and sarcomas.

The narrative review article is focused on the strengths and limitations of modern imaging methods in the preoperative differential diagnosis of uterine mesenchymal tumours. In order to tailor the surgical procedures, imaging methods, namely ultrasound and magnetic resonance imaging (MRI), should be taken into account as well as clinical symptoms, age, and fertility plans. On ultrasound scans, uterine sarcomas have the appearance of large, usually solitary tumours of non-homogenous structure with irregular cysts, ill-defined outline borders (interrupted capsule), absence of calcifications with acoustic shadowing, and moderate to rich internal vascularisation. Rapid growth between follow-ups or atypical growth in peri- or post-menopause is also a sign of malignancy. On MRI, uterine sarcomas are characterized by irregular borders, hyperintense areas on T1-weighted and T2- weighted images, and central non-enhancing necrotic areas. On diffusion-weighted imaging (DWI/MRI), sarcomas exhibit markedly restricted diffusion but there is a significant overlap with some variants of fibroids. Core-needle or hysteroscopic biopsy can be used preoperatively if suspicious features are detected on ultrasound or MRI scans, particularly before myomectomy if fertility preservation is required or when conservative management is considered in asymptomatic women. Other imaging methods, such as positron emission tomography fused with CT (PET-CT) or computed tomography (CT) have limited role to distinguish uterine sarcomas from myomas and are suitable only for staging purposes. The importance of tumour markers including lactate dehydrogenase in preoperative work-up have not been verified yet. Conclusion: Uterine sarcomas can be distinguished from much more common myomas based on a combination of malignant features on ultrasound or MR imaging. In these suspicious cases the type and extent of surgery should be adjusted, avoiding intraperitoneal morcellation, which could lead to iatrogenic tumour spread and worsening of the patient's prognosis.

Effect of Respirophasic Displacement of the Inferior Vena Cava on Size Measurement in 2-D Ultrasound Imaging.

OBJECTIVE: Volume status assessment of a patient by ultrasound (US) imaging of the inferior vena cava (IVC) is important for the diagnosis and prognosis of various clinical conditions. In order to improve the clinical investigation of IVC, which is mainly based on unidirectional US (in M-mode), automated processing of 2-D US scans (in B-mode) has enabled tissue movement tracking on the visualized plane and can average this in various directions. However, IVC geometry outside of the visualized plane is not under control and could result in errors that have not yet been evaluated. METHODS: We used a method that integrates information from long- and short-axis IVC views (simultaneously acquired in the X-plane) to assess challenges in IVC diameter estimations using 2-D US scans in eight healthy subjects. RESULTS: Relative movements between the US probe and IVC induced the following problems when assessing IVC diameter via 2-D view: a median error (i.e., absolute difference with respect to diameter measured in the X-plane) of 17% using 2-D US scans in the long-axis view of the IVC affected by medio-lateral displacements (median: 4 mm); and a median error of 7% and 9% when measuring the IVC diameter from a short-axis view in the presence of pitch angle (median: 0.12 radians) and cranio-caudal movement (median: 15 mm), respectively. CONCLUSION: Relative movements in the IVC that are out of view of B-mode scans cannot be detected, which results in challenges in IVC diameter estimation.

Diagnosis and Management of Molar Pregnancies.

Complete and partial molar pregnancies arise from abnormal fertilization with marked proliferation of syncytiotrophoblasts. Earlier diagnosis has reduced the frequency of severe medical complications at presentation; however, the risk of progression to gestational trophoblastic neoplasia (GTN) has remained unchanged. Initial assessment should include serum hCG measurement after physical examination, laboratory testing for organ dysfunction, and Doppler ultrasound. Following uterine evacuation, pathologic assessment can distinguish complete from partial moles or non-molar gestations. Close surveillance is essential for the timely diagnosis of GTN. Cure rates and subsequent obstetrics outcomes are excellent, but all patients should be referred for psychologic support and expert level care.