Advancing preconception health in the United States: strategies for change.

In January 2015, the US Preconception Health and Health Care Initiative (PCHHC) established a new national vision that all women and men of reproductive age will achieve optimal health and wellness, fostering a healthy life course for them and any children they may have. Achieving this vision presents both challenges and opportunities. This manuscript describes the reasons why the US needs to prioritize preconception health as well as its efforts historically to advance change. The authors share lessons from past work and current strategies in the US to reach this ambitious goal.

Ensuring excision of intraductal lesions: marker placement at time of ductography.

RATIONALE AND OBJECTIVES: To propose grid coordinate marker placement for patients with suspicious ductogram findings occult on routine workup. To compare the success of marker placement and wire localization (WL) with ductogram-guided WL. MATERIALS AND METHODS: A retrospective search of radiology records identified all patients referred for ductography between January 2001 and May 2008. Results for 16 patients referred for ductogram-guided WL and 5 patients with grid coordinate marker placement at the time of ductography and subsequent WL were reviewed. Surgical pathology results and clinical follow-up were reviewed for concordance. RESULTS: Nine of 16 patients (56.3%) underwent successful ductogram-guided WL. Eight of nine patients had papillomas, one of which also had atypical ductal hyperplasia (ADH). One of nine patients had ectatic ducts with inspisated debris. Seven patients who failed ductogram-guided WL eventually underwent open surgical biopsy. Four of seven patients had papillomas, one of which also had lobular carcinoma in situ. Remaining patients had ADH (1/7) and fibrocystic changes with chronic inflammation (3/7). All five (100%) patients with grid coordinate marker placement underwent successful WL and marker excision. Pathology results included three papillomas, papillary intraductal hyperplasia, and fibrocystic change. CONCLUSION: Grid coordinate marker placement at the time of abnormal ductogram provided an accurate method of localizing ductal abnormalities that are occult on routine workup, thus facilitating future WL. Marker placement obviated the need for repeat ductogram on the day of surgery and ensured surgical removal of the ductogram abnormality.

Imaging of emphysematous pyelonephritis: self-assessment module.

The educational objectives for this self-assessment module are for the participant to exercise, self-assess, and improve his or her understanding of the role of imaging in the diagnosis of emphysematous pyelonephritis and the impact of CT findings on the management of emphysematous pyelonephritis.

Sonographic evaluation of Lisfranc ligament injuries.

OBJECTIVE: This study characterized the sonographic appearances of Lisfranc injuries. METHODS: Sonography reports (2000-2007) were searched for "Lisfranc," resulting in 10 patients. Sonographic images of affected and asymptomatic contralateral feet were reviewed, recording the thickness of the dorsal ligament between the first (medial) cuneiform (C1) and second metatarsal (M2) ligaments, distance between C1 and M2, and change in this distance with weight bearing, hyperemia, and fractures. Correlations were made to clinical, surgical, and other imaging findings. RESULTS: In 5 asymptomatic feet, the dorsal C1-M2 ligament was 0.9 to 1.2 mm thick, and the C1-M2 distance was 0.5 to 1 mm. Of the symptomatic feet, 1 group (n=3) had normal sonographic findings (thickness, 0.9-1.1 mm; distance, 0.6-0.7 mm; all had normal radiographic findings and follow-up, and 1 had normal magnetic resonance imaging [MRI] findings). Another group (n=3) had abnormal hypoechogenicity and thickening of the dorsal C1-M2 ligament (1.4-2.3 mm), a normal C1-M2 distance (0.6-0.7 mm), and no widening with weight bearing (1 of 1), consistent with a ligament sprain (1 had normal computed tomographic [CT] findings, and all had uneventful follow-up). The third group (n=4) had nonvisualization of the dorsal C1-M2 ligament, an increased C1-M2 distance of 2.5 to 3.1 mm, and further widening with weight bearing (3 of 4) from Lisfranc ligament disruption (shown at surgery in 2, MRI in 1, and CT in 1). CONCLUSIONS: Nonvisualization of the dorsal C1-M2 ligament and a C1-M2 distance of 2.5 mm or greater were indirect signs of a Lisfranc ligament tear. Dynamic evaluation with weight bearing showed widening of the space between C1 and M2.