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Ultrasound-Guided Treatment Effective in Rotator Cuff Tendonitis
An ultrasound-guided needle treatment relieves pain and restores mobility for patients with calcific tendonitis of the rotator cuff...
A nonsurgical, ultrasound-guided needle treatment relieves pain and restores mobility for patients with calcific tendonitis of the rotator cuff, researchers said.
Patients who received the treatment -- which dissolves and extracts the calcium -- had significantly reduced pain scores and improved function at one year compared with those who didn't have the procedure, Luca M. Sconfienza, MD, of the University of Milan, and colleagues reported in the July issue of Radiology.
However, the groups had similar pain and function scores at five and 10 years, the researchers said."One might argue that the procedure seems to accelerate the natural healing process," they said. However, the results show that "two-needle ultrasound-guided percutaneous treatment facilitates prompt pain relief and functional recovery from rotator cuff calcific tendonitis."
In patients with mild symptoms, the disease can be managed conservatively with physical therapy and a short course of oral nonsteroidal anti-inflammatory drugs. Other treatments have also been proposed, such as acetic acid iontophoresis, although it seems to be no more effective than physical therapy or placebo.
Arthroscopic surgery is effective, the researchers said, but it requires a hospital stay and rehabilitation, and major complications such as tendon rupture, although rare, have occurred. Lithotripsy has been demonstrated to be only partially effective but requires at least three separate applications.
The researchers acknowledged that their ultrasound technique is not new, and that its disadvantages are radiation exposure and potential difficulty localizing the calcium deposit. So to determine whether the treatment is effective, the researchers performed ultrasound-guided percutaneous treatment in 219 patients with rotator cuff calcific tendonitis.
They compared the results with those of 68 controls, who were referred for but refused treatment, after following both groups for 10 years. For the procedure, patients were given anesthesia, followed by the insertion of two 16-gauge needles into the calcific deposit.
Saline solution was injected through one needle, and the dissolved calcium was extracted through the other.
The 20-minute procedure cost about $120 in total -- $80 for operators, $15 for the use of the room, and $25 for syringes, needles, and drugs, the researchers said. The volume of calcium extracted from each shoulder ranged from 0.5 to 4.5 mL.
Compared with controls, treated patients reported a significant decrease in symptoms at one month, three months, and one year (P<0.001), as measured by the Constant score -- a functional assessment -- and the visual analog scale (VAS) score -- a pain assessment.
At five and 10 years, however, symptom scores were not significantly different between the groups.There were no tendon tears in the treatment group. Limitations of the study included a control group that was not random although well-matched with the patients receiving the treatment, no follow-up between one and five years, and significant loss to follow-up in both the treatment and control groups even at the one-year mark.
The researchers concluded that ultrasound-guided percutaneous treatment facilitated prompt shoulder function recovery and pain relief. "The treatment proved to be an effective, quick, and low-cost therapy that provided prompt long-standing recovery of shoulder function," they said.
Article written by staff at medpagetoday.com and adapted for the purposes of this newsletter.
Contrast-Enhanced Ultrasound Useful in Crohn's Disease
Contrast-enhanced ultrasound can accurately assess disease activity in patients with Chron's disease...
In patients with Crohn's disease, contrast-enhanced ultrasound can accurately assess disease activity, according to a study published in the July issue of Gastroenterology.
Vincenzo Migaleddu, M.D., of the Sardinian Mediterranean Imaging Research Group in Sassari, Italy, and colleagues performed baseline ultrasound, color Doppler ultrasound, and contrast-enhanced ultrasound on 47 patients before and after injecting them with sulfur hexafluoride-filled microbubbles.
The researchers found that contrast-enhanced ultrasound showed the best performance, with a sensitivity, specificity, and overall accuracy of 93.5, 93.7, and 93.6 percent, respectively. After microbubble injection, it identified three bowel wall perfusion patterns: submucosal enhancement, and inward and outward transparietal enhancement. They also found that contrast-enhanced ultrasound had a stronger correlation with the Crohn's disease activity index than either ultrasound or color Doppler ultrasound.
"Recent technological improvements in sonography, such as contrast-enhanced ultrasound, have increased the usefulness of this imaging modality in the diagnosis and evaluation of inflammatory activity in Crohn's disease," the authors concluded. "The routine use of the contrast-enhanced ultrasound in the clinical assessment of the patient with active Crohn's disease for therapeutic and surgical management could be suggested."
Article written by staff at modernmedicine.com and adapted for the purposes of this newsletter.
Successful Neurosurgery with Transcranial MR-guided High-Intensity Focused Ultrasound (HIFU)
The Magnetic Resonance Centre of the University Children's Hospital Zurich has achieved a world first breakthrough in MR-guided, non-invasive neurosurgery...
The Magnetic Resonance Centre of the University Children's Hospital Zurich has achieved a world first break through in MR-guided, non-invasive neurosurgery. Ten patients have been successfully treated by means of transcranial high-intensity focused ultrasound. This fully non-invasive procedure opens new horizons for neurosurgery and the treatment of different neurological brain disorders.
In the context of a clinical study at the MR Centre of the University Children's Hospital Zurich transcranial MR-guided high-intensity focused ultrasound (HIFU) for brain surgery has been successfully applied for the first time world-wide. A research team under the direction of Professor Daniel Jeanmonod, neurosurgeon at the Department of Functional Neurosurgery of the Neurosurgical Clinic at the University Hospital Zurich and Professor Ernst Martin, director of the Magnetic Resonance Centre at the University Children's Hospital Zurich succeeded in proving the safety and efficacy of this revolutionary surgical method which permits fully non-invasive brain interventions even on an out-patient basis.
For quite some years, HIFU has been used for the treatment of uterine fibroids and tumors of the prostate gland. However, its application to the brain through the intact skull for non-invasive neurosurgery was not possible until recently, because of insurmountable technical difficulties.
In a Swiss National research project, the team of the University of Zurich successfully implemented and optimized a prototype system for transcranial Magnetic Resonance-guided High-Intensity Focused Ultrasound (HIFU) for neurosurgical interventions. The HIFU system ExAblate(R) 4000, developed by the cooperation partner InSightec, Tirat Carmel Israel, has been combined with a 3 Tesla high field GE MR-scanner. The two systems together provide a platform for image-guided, non-invasive interventions. Since September 2008 ten patients were treated at the Children's Hospital Zurich with this new neurosurgical procedure in the context of a clinical study. All interventions were completed successfully and without complications. This novel technology now opens up new horizons allowing developing non-invasive intervention procedures for a variety of brain diseases including brain tumors.
The whole surgical procedure is planned and monitored in real time by magnetic resonance imaging (MRI). The HIFU beams produced by 1024 transducers are transferred through the intact skull of the patient into the brain and concentrated onto a focus of 3 to 4 millimeters in diameter. Thus, sharply defined targets deep inside the brain are coagulated by heating them up to a focal temperature of 60 degrees Celsius. The temperature increase during the sequential 'sonications,' each lasting 10 to 20 seconds, is continuously displayed and controlled on precise MR-temperature distribution maps. The whole surgical procedure lasts several hours and is performed without anesthesia. Patients are awake and fully conscious during the intervention.
In the context of the Swiss National Research Program NCCR Co-Me (computer aided and image guided medical interventions), the potential of non-invasive, transcranial MR-guided high-intensity focused ultrasound (tcMRgHIFU) is investigated in clinical studies at the University Children's Hospital Zurich. Scientists working in the Co-Me program pursue the goal of establishing and developing surgical interventions by means of tcMRgHIFU, in order to broaden the spectrum of completely non-invasive interventions for functional neurosurgery and for the treatment of brain tumors, stroke and various neurological brain disorders by targeted drug delivery.
Article written by staff at sciencecentric.com and adapted for the purposes of this newsletter.
Naya Health brings Ultrasound Expertise to Nepal
Naya Health improves the quality of healthcare for residents previously without access to doctors...
In the mountains of the Achham district in rural Nepal, a five-room, four-bed medical clinic bustles on the spot where once only the wind whistled through an old grain shed. In this remote location, high-tech medical imaging technology combined with satellite telecommunications is improving the quality of healthcare to residents previously without access to doctors.
Since August 2008, Nyaya Health, comprising an outpatient department, maternity ward, emergency room, pharmacy, and laboratory, has served 100 patients a day in a population of 250,000. In addition to providing basic medical care, ultrasound images acquired at the facility are beamed via satellite to Yale University in New Haven, CT, where they are reviewed at the institution's Section of Emergency Medicine.
Providing access to quality medical imaging is a key part of the project, according to Duncan Smith-Rohrberg Maru, Ph.D., a member of the Yale School of Medicine Medical Scientist Training Program and co-founder of Nyaya Health.
"Diagnostic radiology is a major growth industry worldwide, but it's not accessible at all to most of world's poor," Maru said. "There are estimates that over 50% of the world lacks access to any form of x-ray, and even fewer have access to ultrasound. In the region surrounding Achham, for example, there is only one functioning x-ray for over 1 million people."
The region has some of the starkest health conditions in South Asia, among them elevated infant and maternal mortality, chronic malnourishment in 60% of children, high economic emigration to India, and rampant rates of HIV infection (greater than 7% in men who return from Mumbai). The average income is $150 a year, and it costs one month's earnings to travel 10 hours by bus to the nearest airport, hospital, or CT scanner. In such conditions, a portable ultrasound scanner with backup battery power offers invaluable diagnostic insight, especially in maternal care.
"If we have a patient presenting with abdominal pain and not aware that she had been pregnant, if you missed a diagnosis of stillbirth the woman would be on the verge of sepsis," Maru said. "You might just pick up a positive pregnancy test, but you don't hear a fetal heart rate. Without ultrasound, you're stuck in a rural setting like that. With ultrasound, you can diagnose that very easily. We're training the midwives to do this. They've never seen a computer before, but now they can pick up that there was a miscarriage."
The Nyaya project revolves around a portable scanner (Logiq e, GE Healthcare, Chalfont St. Giles, U.K.) that's packed with four probes in a rugged carrying case. The system is a good fit for use in a rugged, rural environment such as Achham, according to Maru.
Although maternal care offers the best diagnostic yield for ultrasound, other clinical applications include evaluation of trauma, long-bone fractures, pericardial and pleural effusions, organomegaly, kidney disease, tuberculosis, and gallstones.
"It's somewhat of a non-intuitive point that ultrasound is quite versatile, portable, can be in the hands of a practitioner, and offers immediate point-of-care results," he said.
Article written by staff at auntminnie.com and adapted for the purposes of this newsletter.
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