Retinopexia neumática para el tratamiento de desprendimientos regmatógenos de retina seleccionados / Pneumatic Retinopexy for Treating Selected Rhegmatogenous Retinal Detachments

Objetivo: Determinar los resultados anatómicos y funcionales en pacientes operados de desprendimiento de retina regmatógeno con técnica de retinopexia neumática. Métodos: Se realizó un estudio descriptivo, longitudinal y prospectivo con pacientes operados con técnica de retinopexia neumática en el Centro Oftalmológico de Villa Clara entre junio del 2019 y abril del 2023. Resultados: La edad media de los pacientes estudiados fue de 62,1años. Los hombres fueron más afectados que las mujeres (60,6 por ciento). El 57,6 por ciento de los ojos tuvo agudeza visual mejor corregida de movimiento de manos al diagnóstico y el 93,9 por ciento mácula desprendida. En el 66,7 por ciento de las operaciones se utilizó el hexafloruro de azufre como tamponador. Se logró el éxito anatómico con una intervención en el 81,8 por ciento (IC 95 por ciento: 80-83,6 por ciento) de los casos. En estos, se alcanzó el éxito funcional en el 85,2 por ciento (IC 95 por ciento: 83,4 -87 por ciento). Los ojos con éxito anatómico alcanzaron como media una agudeza visual mejor corregida de 0,5 décimas (IC 95 por ciento: 0,2-0,7) y se logró una ganancia media de 0,4 décimas (IC 95 por ciento: 0,3-0,5). La complicación más frecuente fue la persistencia de líquido subretinal residual, el cual se presentó con más frecuencia en pacientes mayores de 60 años y desapareció como promedio a los 55,9 días sin necesidad de tratamiento. Conclusiones: La retinopexia neumática es una muy buena opción para tratar desprendimientos de retina seleccionados. En pacientes con ninguna o mínima vitreorretinopatía proliferativa, se logran buenos resultados anatómicos y funcionales(AU)

Objective: To determine the anatomical and functional results in patients operated on for rhegmatogenous retinal detachment using the pneumatic retinopexy technique. Methods: A descriptive, longitudinal and prospective study was conducted with patients operated on using the pneumatic retinopexy technique at Centro Oftalmológico, of Villa Clara Province, Cuba, between June 2019 and April 2023. Results: The mean age of the studied patients was 62.1 years. Men were more affected than women (60.6 percent). 57.6 percent of the eyes had best-corrected visual acuity of hand movement at diagnosis and 93.9 percent had detached macula. Sulfur hexafluoride was used as a buffer solution in 66.7 percent of the operations. Anatomical success was achieved with one operation in 81.8 percent (95 percent CI: 80-83.6 percent) of cases. In these, functional success was achieved in 85.2 percent (95 percent CI: 83.4-87 percent). The anatomically successful eyes achieved a mean best-corrected visual acuity of 0.5 tenths (95 percent CI: 0.2-0.7), apart from a mean gain of 0.4 tenths (95 percent CI: 0.3-0.5). The most frequent complication was the persistence of residual subretinal fluid, which occurred more frequently in patients older than 60 years and disappeared, on average, at 55.9 days without the need for treatment. Conclusions: Pneumatic retinopexy is a very good option to treat selected retinal detachments. In patients with no or minimal proliferative vitreoretinopathy, good anatomical and functional results are achieved(AU)

A Case Of Descemet Membrane Detachment Postcataract Surgery.

Descemet Membrane Detachment is a vision-threatening complication of Cataract Surgery. If not treated promptly it can lead to serious vision impairment with the possible need for corneal transplantation. We present a case report of a 60 years old female who presented with blurry vision post phacoemulsification and lens placement after a cataract in the left eye. She was diagnosed with Descemet membrane detachment on slit-lamp examination that was confirmed on Anterior-segment Optical Coherence Tomography and treated with intracameral 20% SF6 injection. There was a marked improvement in her vision with complete resolution of corneal oedema. Conclusion: Anterior Segment OCT can be used as a diagnostic tool to accurately ascertain the site and extent of detachment and monitor disease progress. 20% Sulfur-hexafluoride intracameral injection can be used as a surgical option for large, central detachments.

Flap invertido de membrana limitante interna en agujero macular grande / Inverted internal limiting membrane flap technique in large macular hole

RESUMEN El agujero macular es un desorden de la interface vitreorretinal definido como un defecto de espesor completo desde la membrana limitante interna hasta los segmentos externos de los fotorreceptores, que normalmente involucra a la fóvea. Con el desarrollo de la tomografía de coherencia óptica se han mejorado el diagnóstico, el tratamiento y el seguimiento de las enfermedades de la interface vitreorretinal, entre ellas el agujero macular. La vitrectomía pars plana es la técnica quirúrgica de elección para el agujero macular. Se presenta una paciente de 75 años, pseudofáquica, con mejor agudeza visual corregida en el ojo derecho de 0,1 Snellen. Se diagnostica agujero macular grande (810 µm) según su mínima apertura, con 8 meses de evolución. Se realizó vitrectomía pars plana, el levantamiento de la hialodes posterior, el flap invertido de membrana limitante interna, el uso de hexafluoruro de azufre en mezcla 20 por ciento y el posicionamiento de la paciente 24-72 horas. Se logró el cierre anatómico del agujero macular y la recuperación visual de 0,6 Snellen a los seis meses del tratamiento quirúrgico(AU)

ABSTRACT Macular hole is a disorder of the vitreous-retina interface defined as a full-thickness defect from the internal limiting membrane to the external segments of photoreceptors which typically involves the fovea. The development of optical coherence tomography has improved the diagnosis, treatment and follow-up of vitreous-retina interface diseases, among them macular hole. Pars plana vitrectomy is the surgical technique of choice for macular hole. A case is presented of a female 75-year-old pseudophakic patient with best corrected right eye visual acuity of 0.1 on the Snellen chart. Large macular hole is diagnosed (810 µm) according to its minimum opening, of 8 month's evolution. The following procedures were performed: pars plana vitrectomy, posterior hyalode lifting, inverted internal limiting membrane flap, use of sulfur hexafluoride in a 20% mixture, and positioning of the patient for 24-72 hours. Anatomical closure of the macular hole and a visual recovery of 0.6 Snellen were achieved six months after surgery(AU)

Uso de ecocontraste en el diagnóstico de rotura de una fístula coronaria / Use of echo-contrast in the diagnosis of coronary fistula rupture

No disponible

Resultado a corto plazo de la trabeculectomía asociada al hexafluoruro de azufre / Short-term outcomes of trabeculectomy associated to sulfur hexafluoride

Objetivo: describir los resultados a corto plazo de la trabeculectomía asociada al hexafluoruro de azufre. Métodos: se realizó un estudio analítico de caso-control en 30 ojos (30 pacientes) donde 15 ojos (15 pacientes) recibieron trabeculectomía con mitomicina C y hexafluoruro de azufre (grupo caso) y 15 ojos (15 pacientes) recibieron trabeculectomía con mitomicina C (grupo control). Se evaluaron la agudeza visual mejor corregida y la presión intraocular preoperatorias y posoperatorias, así como las complicaciones quirúrgicas. Se realizó seguimiento hasta los 3 meses posoperatorios. Resultados: en el preoperatorio la agudeza visual mejor corregida media fue 88 VAR (±16; 79-97) para el grupo caso y 86 VAR (± 16; 77-95) para el grupo control (p= 0,628) y la presión intraocular media 28,8 mmHg (± 6,3; 25,2-32,3) y 30 mmHg (± 9,5; 24,8-35,3) respectivamente (p= 0,868). A los 3 meses la agudeza visual mejor corregida media fue similar en ambos grupos: 88 VAR (± 13; 80-95) y 84 VAR (± 17; 74-93) respectivamente; (p= 0,659); mientras la presión intraocular fue 14,6 mmHg (± 2,8; 13,0-16,3) y 15,7 mmHg (± 5,4; 12,7-18,8) respectivamente (p= 0,707). Las complicaciones más frecuentes para el grupo caso fueron catarata (6,7 por ciento) y uveítis (6,7 por ciento), y para el grupo control fueron atalamia (19,9 por ciento), hipema (13,3 por ciento) y quiste de Tenon (13,3 por ciento). La densidad celular descendió a 2 004 cél/mm2 (± 87) en el grupo caso y 1 886 cél/mm2 (± 66) en el grupo control (p= 0,494). Conclusiones: el resultado visual, el poder hipotensor y las complicaciones quirúrgicas, a corto plazo, son similares en la trabeculectomía con mitomcina C con/sin hexafluoruro de azufre asociado. Se requieren estudios a mediano-largo plazo para evaluar el beneficio hipotensor del hexafluoruro de azufre(AU)

Objective: describe the short-term results of trabeculectomy associated to sulfur hexafluoride. Methods: an analytical case-control study was conducted of 30 eyes (30 patients) of which 15 eyes (15 patients) underwent trabeculectomy with mitomycin C and sulfur hexafluoride (case group) and 15 eyes (15 patients) underwent trabeculectomy with mitomycin C (control group). An evaluation was performed of the best corrected visual acuity, preoperative and postoperative intraocular pressure and surgical complications. Follow-up extended for up to three months after surgery. Results: mean preoperative best corrected visual acuity was 88 VAR (± 16; 79-97) for the case group and 86 VAR (± 16; 77-95) for the control group (p= 0,628). Mean intraocular pressure was 28.8 mmHg (± 6.3; 25.2-32.3) and 30 mmHg (± 9.5; 24.8-35.3) respectively (p= 0.868). At three months, mean best corrected visual acuity was similar in the two groups: 88 VAR (± 13; 80-95) and 84 VAR (± 17; 74-93) respectively; (p= 0.659); whereas intraocular pressure was 14.6 mmHg (± 2.8; 13.0-16.3) and 15.7 mmHg (± 5.4; 12.7-18.8) respectively (p= 0.707). The most common complications were cataract (6.7 percent) and uveitis (6,7 percent) in the case group, and athalamia (19.9 percent), hyphema (13.3 percent) and Tenon's cyst (13.3 percent) in the control group. Cellular density dropped to 2 004 cell/mm2 (± 87) in the case group and 1 886 cell/mm2 (± 66) in the control group (p= 0.494). Conclusions: short-term visual outcomes, hypotensive effects and surgical complications were similar in trabeculectomy with mitomycin C with or without associated sulfur hexafluoride. Medium-term studies are required to evaluate the hypotensive effect of sulfur hexafluoride(AU)

Ciclodiálisis traumática tratada con criopexia / Traumatic cyclodialysis treated with cryopexy

La ciclodiálisis es el resultado de la separación de las fibras longitudinales del músculo ciliar de su inserción escleral, creando estados de hipotonía ocular. Es causada principalmente por traumatismos. La gonioscopia ha sido tradicionalmente la prueba diagnóstica para esta entidad, sin embargo, en la actualidad está siendo sustituida por otras técnicas, como la biomicroscopía ultrasónica (BMU). Presentamos el caso de un varón de 57 años que tras sufrir un traumatismo en el ojo izquierdo con un disco de sierra radial, presentó perforación corneal y hemorragia vítrea con edema panretiniano. La gonioscopia fue normal a pesar de la existencia de hipotonía ocular persistente. La realización de una BMU permitió diagnosticar una pequeña ciclodiálisis, inferior de diez grados. El tratamiento quirúrgico permitió recuperar una presión intraocular normal (AU)

Cyclodialysis is the result of the separation of the longitudinal fibres of the ciliary muscle from their scleral insertion, creating states of ocular hypotony. It is mainly caused by traumatisms. Gonioscopy has traditionally been the diagnostic test for this entity, however, at present it is being replaced by other techniques, such as ultrasound biomicroscopy (UBM). We present the case of a 57-year-old male who, following a traumatism in the left eye caused by the disc of a radial saw, presented corneal perforation and vitreous haemorrhage with pan-retinal edema. The gonioscopy was normal in spite of the existence of persistent ocular hypotony. The realization of a UBM enabled diagnosis of a small cyclodialysis of less than ten degrees. Surgical treatment made it possible to recover normal intraocular pressure (AU)

The impact of microbubble-enhanced therapeutic ultrasound combined with prothrombin on microwave ablation in the rabbit liver.

AIM: This study aimed to investigate the effect of microbubble-enhanced ultrasound (MEUS) combined with prothrombin on regional hepatic circulation and microwave ablation (MWA) in rabbit livers. MATERIALS AND METHODS: High-pressureamplitude therapeutic ultrasound (TUS) was used to treat 52 surgically exposed livers of healthy New Zealand rabbits: 13 livers were treated with MEUS alone, 13 with MEUS and prothrombin (PMEUS), 13 with ultrasound plus normal saline and 13 with ultrasound plus prothrombin as controls. Contrast-enhanced ultrasound (CEUS) imaging was performed on the exposed livers before and after treatment, and acoustic quantification was done to assess liver perfusion. Then, the liver was divided into two parts, one was used for pathologic examination and the other was ablated with microwave (MWA) and then processedfor pathologic examination. RESULTS: The CEUS images and Peak value after treatment in the PMEUS group were significantly reduced as compared to the remaining 3 groups (p<0.05). Occasional piecemeal hemorrhage was evidenced in the pathological examination in the MEUS group. Obvious cellular degeneration and necrosis with thrombosis were observed in the PMEUS group. Electron microscopy showed endothelial damage in both the MEUS group and PMEUS group. After MWA, coagulated volumes (V) in the PMEUS group were larger than in the remaining 3 groups (p<0.05). The cell ultrastructure disorder wasmore severe in the PMEUS group than in remaining 3 groups. CONCLUSION: PMEUS promotes endothelial injury and produces more obvious thrombotic occlusion, improving the therapeutic effect of MWA on the rabbit liver.

Diagnostic performance of power doppler and ultrasound contrast agents in early imaging-based diagnosis of organ-confined prostate cancer: Is it possible to spare cores with contrast-guided biopsy?

OBJECTIVES: To evaluate the diagnostic performance of gray scale transrectal ultrasound-B-mode US (BMUS), power Doppler (PDUS), and sonographic contrast (CEUS) in early imaging-based diagnosis of localized prostate cancer (PCa) and to compare the diagnostic profitability of randomized biopsy (RB), US-targeted prostate biopsy by means of PDUS and CEUS. MATERIAL AND METHODS: A single-center, prospective, transversal, epidemiological study was conducted from January 2010 to January 2014. We consecutively included patients who an imaging study of the prostate with BMUS, PDUS, and CEUS was performed, followed by prostate biopsy due to clinical suspicion of prostate cancer (PSA 4-20ng/mL and/or rectal exam suggestive of malignancy). The diagnostic performance of BMUS, PDUS, and CEUS was determined by calculating the Sensitivity (S), Specificity (Sp), Predictive values (PV), and diagnostic odds ratio (OR) of the diagnosis tests and, for these variables, in the population general and based on their clinical stage according to rectal exam (cT1 and cT2). PCa detection rates determined by means of a randomized 10-core biopsy scheme were compared with detection rates of CEUS-targeted (SonoVue) 2-core biopsies. RESULTS: Of the initial 984 patients, US contrast SonoVue was administered to 179 (18.2%). The PCa detection rate by organ of BMUS/PDUS in the global population was 38% versus 43% in the subpopulation with CEUS. The mean age of the patients was 64.3±7.01years (95% CI, 63.75-64.70); mean total PSA was 8.9±3.61ng/mL (95% CI, 8.67-9.13) and the mean prostate volume was 56.2±29cc (95% CI, 54.2-58.1). The detection rate by organ of targeted biopsy with BMUS, PDUS, and CEUS were as follows: Global population (10.6, 8.2, 24.5%), stage cT1 (5.6, 4.2, 16.4%), and stage cT2 (32.4, 22.3, 43.5%). Comparing the detection rates of the CEUS-targeted biopsy and randomized biopsy, the following results were obtained: Global population (24.5% vs. 41.8%), stage cT1 (16% vs. 35%), and stage cT2 (43.5% vs. 66.6%), with a p value<0.05. Following the "core-by-core" analysis, the detection rates by core of CEUS-targeted biopsy versus randomized biopsy were: Global population (16% vs. 13%), stage cT1 (30.3% vs. 28%), and stage cT2 (48% vs. 37%), with a p value>0.05. The NNT for CEUS-targeted biopsy was 83.3. CONCLUSIONS: The low sensitivity, specificity, positive predictive and negative predictive values of gray scale-B-mode, PDUS and CEUS represent scant diagnostic performance of these variables in prostate cancer detection. Prostate cancer detection rates yielded by randomized biopsy were superior than the detection rate of targeted biopsy using B-mode, PDUS and CEUS; as a result, randomized biopsy versus CEUS-targeted biopsies cannot be excluded from biopsy strategy plans for the diagnosis of prostate cancer.

Contrast-enhanced ultrasound-guided percutaneous microwave ablation of renal cell carcinoma that is inconspicuous on conventional ultrasound.

PURPOSE: This study was designed to determine the safety, effectiveness and feasibility of contrast-enhanced ultrasound (CEUS)-guided percutaneous microwave ablation (MWA) of renal cell carcinoma (RCC) that is inconspicuous on conventional ultrasound (US). MATERIALS AND METHODS: A total of 32 RCC nodules in 29 patients (23 men and 6 women) were treated with CEUS-guided percutaneous MWA between January 2010 and September 2014. The median maximum diameter of the nodules was 2.4 cm (interquartile range: 1.8-2.9 cm). The US contrast agent was SonoVue, a second-generation contrast agent. CEUS was applied before the needle was inserted into the tumour, and percutaneous MWA was performed under CEUS-guidance. RESULTS: In total 31 tumours were successfully visualised via CEUS using 1-2 (1.0-2.0 mL) contrast agent injections, and percutaneous MWA was performed under CEUS-guidance. The technical success rate of CEUS-guided percutaneous MWA of RCC was 96.9% (31/32). The mean number of sessions of CEUS-guided percutaneous MWA for each tumour was 1.2 ± 0.4. The mean duration of energy application for each tumour was 7.3 ± 2.7 min. All patients were followed up for 3-71 months (median 17 months) to observe the therapeutic effects and complications. The therapeutic effects were assessed at follow-up with computed tomography (CT) or magnetic resonance imaging (MRI) and CEUS. There was no local tumour progression and the technique effectiveness rate was 100% (31/31). The complications rate was 6.5% and the major complications rate was 3.2%. We observed one case of pleural effusion and one case of renal subcapsular haemorrhage after the percutaneous MWA procedures. CONCLUSION: CEUS-guided percutaneous MWA is a safe, efficient and feasible therapy for patients with RCCs inconspicuous on conventional US.

Contrast echocardiography for analysis of heart anatomy in tortoises.

OBJECTIVE: The cardiac anatomy in tortoises depicted on B-mode and color-Doppler should be better differentiated by additional contrast-echocardiography. MATERIAL AND METHODS: An intravenous contrast agent (INN-sulphur hexafluoride [SonoVue®]) was injected in four tortoises (three Testudo hermanni, one Agrionemys horsfieldii), via the coccygeal vein, with parallel B-mode echocardiographic examination. The results of the contrast-enhanced echocardiography were compared with the contrast-free B-mode recordings and color-Doppler ultrasound. RESULTS: The use of SonoVue® enabled clearer distinction of the cardiac structures, differentiation of the arising major arteries, identification of wash-out-shunts, and visualization of blood flow patterns throughout the tortoise heart. CONCLUSION AND CLINICAL RELEVANCE: This study enables the accurate depiction and differentiation of cardiac anatomy in tortoises through the use of a combination of B-mode, color-Doppler and contrast-echocardiography. Basic knowledge of blood flow in the reptile heart is essential to understand echocardiographic anatomy. Blood-flow-patterns and anatomy of the tortoise heart as found in this study will help to establish a basis for further echocardiographic examinations of these animals.

Contrast-enhanced ultrasound for evaluation of high-intensity focused ultrasound treatment of benign uterine diseases: retrospective analysis of contrast safety.

As a noninvasive treatment technique, ultrasound-guided high-intensity focused ultrasound (HIFU) has been considered as a routine treatment for uterine fibroids and adenomyosis in China. Contrast-enhanced ultrasound (CEUS) has been proposed as another option to assess the treatment efficacy during HIFU treatment. The aim of this investigation is to evaluate the adverse effects of HIFU ablation for benign uterine diseases in a group of patients studied with ultrasound contrast agent (UCA), in comparison with a group of patients not exposed to UCA. From November 2010 to December 2013, 2604 patients with benign uterine diseases were treated with HIFU. Among them, 1300 patients were exposed to an UCA, whereas 1304 patients were not.During HIFU procedure, the incidences of leg pain, sacral/buttock pain, groin pain, treatment area pain, and the discomfort "hot" sensation on skin were higher in the patients who were exposed to SonoVue (Bracco, Milan, Italy) than those who were not (20.5% vs 11.7%, 52.5% vs 42.3%, 6.5% vs 4.5%, 68.9% vs 55.4%, and 48.1% vs 42.9%, respectively). Among the postoperative adverse effects, the incidence of lower abdominal pain was significantly higher in patients who were exposed to an UCA than those who were not (51.2% vs 39.9%, P < 0.05). Two patients who were exposed to an UCA had acute renal function failure.In conclusion, UCA may increase the incidences of some common HIFU-related adverse effects during HIFU treatment for benign uterine diseases, but most of which were acceptable and self-limited. After HIFU treatment, renal function should be monitored in patients with a history of hypertension or taking nonsteroidal anti-inflammatory drugs.

Role of intra-operative contrast-enhanced ultrasound (CEUS) in robotic-assisted nephron-sparing surgery.

This review examines studies of intra-operative contrast-enhanced ultrasound (CEUS) and its emerging role and advantages in robotic-assisted nephron-sparing surgery. Contrast-enhanced ultrasound is a technology that combines the use of second-generation contrast agents consisting of microbubbles with existent ultrasound techniques. Until now, this novel technology has aided surgeons with procedures involving the liver. However, with recent advances in the CEUS technique and the introduction of robotics in nephron-sparing surgery, CEUS has proven to be efficacious in answering several clinical questions with respect to the kidneys. In addition, the introduction of the microbubble-based contrast agents has increased the image quality and signal uptake by the ultrasound probe. This has led to better, enhanced scanning of the macro and microvasculature of the kidneys, making CEUS a powerful diagnostic modality. This imaging method is capable of further lowering the learning curve and warm ischemia time (WIT) during robotic-assisted nephron-sparing surgery, with its increased level of capillary perfusion and imaging. CEUS has the potential to increase the sensitivity and specificity of intra-operative images, and can significantly improve the outcome of robotic-assisted nephron-sparing surgery by increasing the precision and diagnostic insight of the surgeon. The purpose of this article is to review the practical and potential uses of CEUS as an intra-operative imaging technique during robotic-assisted nephron-sparing surgery.

Enhancing ablation effects of a microbubble-enhancing contrast agent ("SonoVue") in the treatment of uterine fibroids with high-intensity focused ultrasound: a randomized controlled trial.

PURPOSE: To evaluate the role of the ultrasound contrast agent SonoVue in enhancing the ablation effects of ultrasound-guided high-intensity focused ultrasound (HIFU) on uterine fibroids. METHODS: Eighty patients with solitary uterine fibroids at a single center were randomly assigned to a control or SonoVue group. Of these, 40 were treated using HIFU alone; 40 who were pretreated with SonoVue received a bolus before the HIFU procedure. All patients underwent magnetic resonance imaging (MRI) scan before and after HIFU treatment. RESULTS: The post-HIFU MRI showed the nonperfused volume (NPV) in all of the treated uterine fibroids; the mean fractional ablation (NPV ratio) was 90.4 ± 8.3 % (range 66.4-100 %) in the SonoVue group and 82.8 ± 13.3 % (range 53.4-100 %) in the control group. The frequency of massive gray-scale changes that occurred during HIFU was greater in the group that received SonoVue than the group that did not. The average sonication time to reach massive gray-scale changes was significantly shorter in the group receiving SonoVue than the group without SonoVue. The acoustic energy for treating 1 mm(3) of uterine fibroid was less in the SonoVue group than the control group. No any major complication occurred in this study. CONCLUSION: Based on the results of this randomized controlled trial, SonoVue could be safely used to enhance the effects of HIFU treatment for uterine fibroids.

Investigation into the impact of diagnostic ultrasound with microbubbles on the capillary permeability of rat hepatomas.

Ultrasound-targeted microbubble destruction (UTMD) takes advantage of transiently increased capillary permeability to enhance the release of tumor-specific drugs from blood vessels into sonicated tumor tissues. However, the application of focused ultrasound is limited because of the lack of an appropriate image-monitoring system. In this study, hepatoma-bearing Sprague-Dawley rats were insonicated with low-frequency diagnostic ultrasound and injected with Evans Blue (EB) dye and microbubbles through their tail veins to test changes in capillary permeability. We studied how the mechanical index, sonication duration and the injected microbubble (MB) concentration affect the hepatoma vascular permeability by quantitatively evaluating the EB delivery efficiency. Confocal laser scanning microscopy was used to observe the deposition of red fluorescence-dyed EB in tumor tissues. In addition, P-selectin, a type of biochemical marker that reflects vascular endothelial cell activation, was identified using an immunoblotting analysis. The experimental results reveal that EB delivery efficiency in tumor tissues was greater in groups with the diagnostic ultrasound-mediated UTMD (8.40 ± 0.71 %ID/g) than in groups without UTMD (1.73 ± 0.19 %ID/g) and EB delivery efficiency could be affected by MI, sonication duration and MB dose. The immunoblotting analysis indicates that diagnostic ultrasound-induced UTMD results in the vascular endothelial cell activation to increase capillary permeability, justifying the high quantity of EB deposited in tumor tissues.

Intra-biliary contrast-enhanced ultrasound for evaluating biliary obstruction during percutaneous transhepatic biliary drainage: a preliminary study.

OBJECTIVES: The aimed of this study was to investigate the value of intra-biliary contrast-enhanced ultrasound (IB-CEUS) for evaluating biliary obstruction during percutaneous transhepatic biliary drainage (PTBD). MATERIALS AND METHODS: 80 patients with obstructive jaundice who underwent IB-CEUS during PTBD were enrolled. The diluted ultrasound contrast agent was injected via the drainage catheter to perform IB-CEUS. Both conventional ultrasound and IB-CEUS were used to detect the tips of the drainage catheters and to compare the detection rates of the tips. The obstructive level and degree of biliary tract were evaluated by IB-CEUS. Fluoroscopic cholangiography (FC) and computer tomography cholangiography (CTC) were taken as standard reference for comparison. RESULTS: Conventional ultrasound displayed only 43 tips (43/80, 53.8%) of the drainage catheters within the bile ducts while IB-CEUS identified all 80 tips (80/80, 100%) of the drainage catheters including 4 of them out of the bile duct (P<0.001). IB-CEUS made correct diagnosis in 44 patients with intrahepatic and 36 patients with extrahepatic biliary obstructions. IB-CEUS accurately demonstrated complete obstruction in 56 patients and incomplete obstruction in 21 patients. There were 3 patients with incomplete obstruction misdiagnosed to be complete obstruction by IB-CEUS. The diagnostic accuracy of biliary obstruction degree was 96.3% (77/80). CONCLUSION: IB-CEUS could improve the visualization of the drainage catheters and evaluate the biliary obstructive level and degree during PTBD. IB-CEUS may be the potential substitute to FC in the PTBD procedure.

Surgical management of retinal detachment resulting from macular hole in a setting of high myopia.

PURPOSE: To evaluate the anatomical and visual outcomes of pars plana vitrectomy (PPV) with internal limiting membrane (ILM) peeling and use of retinal tamponade for retinal detachments resulting from macular hole (MHRD) in highly myopic eyes. METHODS: Twenty-nine highly myopic patients (29 eyes) underwent PPV with ILM peeling and retinal tamponade for MHRD were enrolled. Demographics and best-corrected visual acuity (BCVA) were measured preoperatively and at final follow-up. Anatomical success and macular hole closure were analyzed. RESULTS: Patients' mean age of patients was 58.7 ± 10.6 years, mean follow-up was 11.7 ± 7.4 months. Twenty three eyes (23/26, 88.5%) undergoing primary PPV combined with ILM peeling had successful initial retinal reattachment, including 19 eyes (19/19, 100%) with silicone oil tamponade and in 4 eyes (4/7, 57.1%) with sulfur hexafluoride (C3F8) tamponade. Overall anatomical success was achieved in 27 eyes (27/29, 93.1%). The macular hole closure was observed in 17 eyes (17/26, 65.4%) with final anatomical success. Compared to preoperative BCVA, the mean postoperative BCVA in the eyes with anatomical success was significantly improved (P = 0.007, Wilcoxon signed rank test). CONCLUSION: As a primary or secondary procedure, PPV combined with ILM peeling and usage of retinal tamponade serves as an effective method for MHRD in highly myopic eyes.

Effect of healthy tissue ablation surrounding VX2 rabbit liver tumors by high-intensity focused ultrasound combined with an ultrasound contrast agent.

OBJECTIVES: The purpose of this study was to determine the minimum amount of healthy peripheral tissue that should be ablated when treating VX2 liver tumors with high-intensity focused ultrasound combined with an ultrasound contrast agent. METHODS: Fifty-one rabbits with hepatic tumors were established and randomly divided into the following groups: group A, which only had their tumors ablated; group B, which had their tumors and 2 mm of healthy adjacent tissue ablated; and group C, which had their tumors and 4 mm of healthy adjacent tissue ablated. The pathologic characteristics of the target tissue, serum alanine aminotransferase (ALT) level, presence of intrahepatic and distant metastases, and survival time between different groups were compared after high-intensity focused ultrasound treatment. RESULTS: After ablation, coagulative necrosis was observed in all targeted tissue. The serum ALT level in group C was the highest and the level in group A was the lowest on the third and fifth days after ablation (P < .05), respectively. Fourteen days later, the serum ALT level in groups B and C decreased to normal, whereas the level in group A was abnormal and significantly higher (P < .05). Compared with group A, the prevalence of metastases in groups B and C was significantly lower (P < .05), and the survival time was significantly longer (P < .05); there appeared to be no statistically significant difference between groups B and C (P > .05). CONCLUSIONS: Ablation of a tumor along with 2 mm of healthy surrounding tissue is a more effective strategy for treating hepatic cancer with high-intensity focused ultrasound coupled with an ultrasound contrast agent.

Clinical utility of a microbubble-enhancing contrast ("SonoVue") in treatment of uterine fibroids with high intensity focused ultrasound: a retrospective study.

PURPOSE: To evaluate the clinical value of the contrast agent SonoVue in the treatment of uterine fibroids with ultrasound-guided high intensity focused ultrasound (HIFU) therapeutic ablation. MATERIALS AND METHODS: A total of 291 patients with solitary uterine fibroid from three centers were treated with ultrasound-guided HIFU. Among them, 129 patients from Suining Central Hospital of Sichuan were treated without using SonoVue. 162 patients from the First Hospital of Chongqing Medical University and Chongqing Haifu Hospital were treated with using SonoVue before, during and after HIFU procedure to assess the extent of HIFU. RESULTS: The non-perfused volume (indicative of successful ablation) was observed in all treated uterine fibroids immediately after HIFU ablation; median fractional ablation, defined as non-perfused volume divided by the fibroid volume immediately after HIFU treatment, was 86.0% (range, 28.8-100.0%) in the group with using SonoVue, and 83.0% (8.7-100.0%) without SonoVue. The rate of massive gray scale changes was higher with SonoVue than without the agent. The sonication time to achieve massive gray scale changes was shorter with SonoVue than without. The sonication time for ablating 1cm(3) of fibroid volume was significantly shorter with using SonoVue than without. No major complications were observed in any patients. CONCLUSIONS: Based on our results, SonoVue may enhance the outcome of HIFU ablation and can be used to assess the extent of treatment.

Effect of microbubble contrast agent during high intensity focused ultrasound ablation on rabbit liver in vivo.

OBJECTIVE: To evaluate the effect of a microbubble contrast agent (SonoVue) during HIFU ablation of a rabbit liver. MATERIALS AND METHODS: HIFU ablations (intensity of 400W/cm(2) for 4s, six times, with a 5s interval between exposures) were performed upon 16 in vivo rabbit livers before and after intravenous injection of a microbubble contrast agent (0.8ml). A Wilcoxon signed rank test was used to compare mean ablation volume and time required to tissue ablation on real-time US. Shape of ablation and pattern of coagulative necrosis were analyzed by Fisher's exact test. RESULTS: The volume of coagulative necrosis was significantly larger in the combination microbubble and HIFU group than in the HIFU alone group (P<0.05). Also, time to reach ablation was shorter in the combination microbubble and HIFU group than in the HIFU alone group (P<0.05). When analyzing the shape of tissue ablation, a pyramidal shape was more prevalently in the HIFU alone group compared to the combination microbubble and HIFU group (P<0.05). Following an analysis of the pattern of coagulative necrosis, non-cavitary necrosis was found in ten and cavitary necrosis in six of the samples in the combination microbubble and HIFU group. Conversely, non-cavitary necrosis occurred in all 16 samples in the HIFU alone group (P<0.05). CONCLUSION: HIFU of in vivo rabbit livers with a microbubble contrast agent produced larger zones of ablation and more cavitary tissue necrosis than without the use of a microbubble contrast agent. Microbubble contrast agents may be useful in tissue ablation by enhancing the treatment effect of HIFU.