Historical overview of spinal deformities in ancient Greece

Little is known about the history of spinal deformities in ancient Greece. The present study summarizes what we know today for diagnosis and management of spinal deformities in ancient Greece, mainly from the medical treatises of Hippocrates and Galen. Hippocrates, through accurate observation and logical reasoning was led to accurate conclusions firstly for the structure of the spine and secondly for its diseases. He introduced the terms kyphosis and scoliosis and wrote in depth about diagnosis and treatment of kyphosis and less about scoliosis. The innovation of the board, the application of axial traction and even the principle of trans-abdominal correction for correction of spinal deformities have their origin in Hippocrates. Galen, who lived nearly five centuries later impressively described scoliosis, lordosis and kyphosis, provided aetiologic implications and used the same principles with Hippocrates for their management, while his studies influenced medical practice on spinal deformities for more than 1500 years

PREDIKSI KESULITAN LAPAROSKOPIK KOLESISTEKTOMI BERDASARKAN PARAMETER ULTRASONOGRAFI KANDUNG EMPEDU

Latar Belakang: Penyakit batu kandung empedu atau kolelitiasis merupakan penyakit yang lazim ditemukan dalam masyarakat. Kolesistektomi merupakan terapi gold standar untuk kolelitiasis, namun dalam 96% kasus, prosedur dapat dilaksanakan secara laparoskopik. Salah satu faktor penting untuk pencegahan timbulnya komplikasi adalah keterampilan operator dalam mengendalikan alat laparoskopinya. Alat diagnostik berupa ultrasonografi bisa memberikan gambaran terhadap anatomi kandung empedu sehingga operator bisa memperkirakan tingkat kesulitan yang akan dihadapinya. Metode: Penelitian ini merupakan uji diagnostik yang dilaksanakan dari Maret 2016 sampai dengan Mei 2016. Pemeriksaan ultrasonografi dilakukan di RS M. Djamil Padang dan Semen Padang Hospital sedangkan operasi kolesistektomi laparoskopik dilakukan di RS M. Djamil Padang, Semen Padang Hospital dan RS Islam Siti Rahmah. Besar sampel adalah 20 pasien. Data diolah dengan batas kemaknaan P ≤ 0,05. Hasil: Pericholecystic fluid memiliki sensitifitas yang kurang baik terhadap kejadian operasi lama, spillage, perdarahan serta kesulitan diseksi kandung empedu. Namun memiliki sensitifitas dan nilai duga positif yang baik (100%) terhadap semua variabel kesulitan kolesistektomi laparoskopik yang diteliti. Batu multipel memiliki sensitifitas dan nilai duga negatif yang baik terhadap lama operasi (100%), namun kurang baik untuk memprediksi terjadinya spillage dan perdarahan. Batu multipel memiliki sensitifitas yang baik yakni 71,43% terhadap kesulitan diseksi kandung empedu. Penebalan dinding kandung empedu memiliki nilai duga negatif yang baik (71,43%) terhadap lama operasi. Sludge memiliki spesifitas dan nilai duga negatif yang baik terhadap perihal tersebut (94,18% dan 88,89%). Terhadap spillage, spesifisitas dan nilai duga negatif juga didapatkan baik (92,86% dan 72,23%). Untuk hubungannya dengan perdarahan dan kesulitan diseksi kandung empedu, sludge memiliki spesifisitas yang baik sedangkan variabel lainnya dinilai kurang baik. Indeks kontraktilitas memiliki nilai duga negatif yang baik terhadap semua variabel penyulit kolesistektomi laparoskopik, namun nilai prediksi lain didapatkan kurang baik. Kesimpulan: Setiap parameter dari ultrasonografi yang dilakukan memiliki nilai prediksi terhadap kesulitan kolesistektomi laparoskopik. Kata kunci: kolesistektomi laparoskopik, ultrasonograf

Utilization of a steerable microcatheter and adjunctive techniques for prostatic artery embolization in anatomically challenging vesicoprostatic trunks

Prostatic artery (PA) origination from a common trunk with the superior vesical artery (SVA) is a frequent cause of technical difficulties in PA catheterization for PA embolization (PAE). These difficulties, which substantially increase the operative time, radiation dose, cost, and technical failure rate of PAE, can often be overcome by the utilization of a steerable microcatheter (MC) with a tip that can be manually adjusted at an angle that optimally conforms to the shape and origin of the common vesicoprostatic trunk. Adjunctive techniques that can be applied when the steerable MC fails to engage the PA include: 1) the protective temporary embolization of the SVA so that a permanent embolic can be redirected into the PA; 2) PAE via collaterals between superior vesical branches and the PA; and 3) embolization from a proximal position of the MC near the PA orifice to exploit preferential flow to the PA. In the authors’ recent experience, the utilization of a steerable MC with and without adjunctive techniques (in 12 and 23 patients, respectively) resulted in a 35% increase in the technically successful embolization of PAs originating from vesicoprostatic trunks with no significant complications. Familiarization with alternative devices and techniques may substantially improve the technical outcome of PAE in cases with challenging arterial anatomy

Percutaneous thrombin injection under contrast-enhanced ultrasound guidance to control active extravasation not associated with pseudoaneurysm

The technique of percutaneous thrombin injection (PTI) under contrast-enhanced ultrasound (CEUS) guidance for control of acute hemorrhage-active extravasation not associated with pseudoaneurysm is demonstrated in three cases: 1) Massive spontaneous retroperitoneal hematoma in a patient with multiple comorbidities. Contrast-enhanced computed tomography (CT) showed extensive active extravasation, which was only partially controlled by transarterial embolization. CEUS was performed in the angiography suite. Contrary to unenhanced US and colour Doppler US (CDUS), CEUS confirmed persistent extravasation; CEUS-guided PTI was performed immediately thereafter. 2) Large rectus sheath hematoma in a patient on anticoagulant therapy. Contrast-enhanced CT and unenhanced US/CD could not definitely diagnose extravasation. CEUS clearly showed extravasation and was used for guidance of PTI. 3) Chest wall hematoma complicating central venous catheter placement in a patient with coronavirus on anticoagulant therapy. CDUS was inconclusive. CEUS was performed at the bedside, clearly showed active extravasation, and was used for guidance of PTI. In all three cases, post-PTI CEUS confirmed the absence of residual enhancement of the hematomas, and the hemodynamic status of the patients improved. PTI appears to be effective in selected cases of hematomas associated with active extravasation. In this context, CEUS may be the most suitable modality for guidance and for an immediate evaluation of the treatment effect

Nonepiphyseal Giant Cell Tumor of the Rib: A Case Report

A case of a 32-year-old female patient with a giant cell tumor originating in the middle part of the left 10th rib is presented. On X-rays and CT, the tumor caused a well-defined osteolysis with nonsclerotic borders. On MRI, it exhibited intermediate signal intensity on T1 sequences and central high signal and peripheral intermediate signal on T2 sequences. On contrast-enhanced MR images both central and peripheral-periosteal enhancement was noted. Thanks to its small size (2 × 1.3 cm), the lesion was easily resected en bloc with a part of the affected rib. The patient is free of recurrence for 3 years after the operation

mRECIST criteria and contrast-enhanced US for the assessment of the response of hepatocellular carcinoma to transarterial chemoembolization

PURPOSEWe aimed to evaluate the combination of the modified Response Evaluation Criteria In Solid Tumors (mRECIST) and contrast-enhanced ultrasonography (CEUS) as a tool for the assessment of hepatocellular carcinoma treated with transarterial chemoembolization. MATERIALS AND METHODSForty-seven hepatocellular carcinoma patients (80 target tumors suitable for mRECIST measurements) were studied. They were treated with scheduled transarterial chemoembolization with doxorubicin-eluting microspheres every 5–7 weeks. Imaging follow-up (performed one month after each transarterial chemoembolization) included a standard, contrast-enhanced modality (computed tomography [CT] in 12 patients or magnetic resonance imaging [MRI] in 35 patients) and CEUS. The study focused on response evaluation after the third transarterial chemoembolization. CEUS required a bolus injection of an echo-enhancer and imaging with a dedicated, low mechanical index technique. The longest diameters of the enhancing target tumors were measured on the CEUS or CT/MRI, and mRECIST criteria were applied. Radiologic responses were correlated with overall survival and time to progression. RESULTSThe measurements of longest diameters of the enhancing target tumors were easily performed in all patients. According to mRECIST-CEUS and mRECIST-CT/MRI, complete response was recorded in five and six patients, partial response in 22 and 21 patients, stable disease in 16 and 14 patients, and progressive disease in four and six patients, respectively. There was a high degree of concordance between CEUS and CT/MRI (kappa coefficient=0.84, P < 0.001). Responders (complete+partial response) according to mRECIST-CEUS had a significantly longer mean overall survival and time to progression compared to nonresponders (37.1 vs. 11.0 months, P < 0.001 and 24.6 vs. 10.9 months, P = 0.007, respectively). CONCLUSIONThe mRECIST-CEUS combination is feasible and has prognostic value in the assessment of hepatocellular carcinoma following transarterial chemoembolization