Intermittent pneumatic compression. A comparison of femoral vein velocity with five different devices.

Aim: Different mechanical devices for thromboprophylaxis have different flow characteristics. A new device (Vadoplex) has been developed to provide a short impulse around the calf, a concept derived from the efficacy of foot impulse technology. New devices should be compared with existing devices to establish whether it has a comparable ability to augment venous velocity.

Assessment of the natural history of forefoot bursae using ultrasonography in patients with rheumatoid arthritis: a twelve-month investigation.

Objective: To determine the natural history and clinical significance of forefoot bursae over a 12-month period in patients with rheumatoid arthritis (RA).

Methods: Patients with RA (n=149) attending rheumatology outpatient clinics were assessed at baseline. A total of 120 participants, mean±SD age 60.

Improvement in symptoms and signs in the forefoot of patients with rheumatoid arthritis treated with anti-TNF therapy.

Background: Inhibition of tumour necrosis factor (TNF) is an effective way of reducing synovitis and preventing joint damage in rheumatoid arthritis (RA), yet very little is known about its specific effect on foot pain and disability. The aim of this study was to evaluate whether anti-TNF therapy alters the presence of forefoot pathology and/or reduces foot pain and disability.

Methods: Consecutive RA patients starting anti-TNF therapy (infliximab, etanercept, adalimumab) were assessed for presence of synovial hypertrophy and synovitis in the 2nd and 5th metatarso-phalangeal (MTP) joints and plantar forefoot bursal hypertrophy before and 12 weeks after therapy.

Musculoskeletal ultrasound imaging of the plantar forefoot in patients with rheumatoid arthritis: inter-observer agreement between a podiatrist and a radiologist.

Background: The use of musculoskeletal ultrasound (MSUS) in the diagnosis and management of foot and ankle musculoskeletal pathology is increasing. Due to the wide use of MSUS and the depth and breadth of training required new proposals advocate tailored learning of the technique to discrete fields of practice. The aims of the study were to evaluate the inter-observer agreement between a MSUS radiologist and a podiatrist, who had completed basic skills training in MSUS, in the MSUS assessment of the forefoot of patients with Rheumatoid Arthritis.

Ultrasound findings of masses of the paratesticular space.

Ultrasound is a routine investigation for the assessment of scrotal masses. Many of the detected lesions involve the paratesticular structures. The most common paratesticular masses in clinical practice are epididymal cysts and spermatoceles, but there are a large number of other pathologies that can be encountered and may result in diagnostic uncertainty.

Transrectal ultrasound-guided biopsy of the prostate: aspirin increases the incidence of minor bleeding complications.

Aim: To assess whether patients taking aspirin were more likely to experience bleeding complications after transrectal ultrasound (TRUS)-guided prostate biopsy.

Materials And Methods: Three hundred and eighty-seven patients taking aspirin who underwent prostate biopsy over a 3.5 year period and 731 patients not taking aspirin over a 2 year period returned a questionnaire assessing the incidence and severity of bleeding complications.

A novel approach to mechanical prophylaxis: calf impulse technology mimics natural ambulation more effectively than sequential calf compression.

Background: The risk of thrombosis can be reduced by mechanical compression, but the optimal device is unknown.

Objectives: To record the effect of natural ambulation on deep venous flow, providing a reference for evaluating the efficacy of mechanical compression systems, assuming that ambulation is the gold standard against which such systems should be compared; and to compare the hemodynamic effect of the A-V Impulse System CalfPad garment (A-VI) (Orthofix Vascular Novamedix, United Kingdom) with the SCD Express calf compression garment (SCD) (Covidien, USA).

Methods: Twelve healthy volunteers were recruited and randomly assigned to either A-VI or SCD in a two-device, two-period crossover design.

Cortisol clearance and associations with insulin sensitivity, body fat and fatty liver in middle-aged men.

Aims/hypothesis: The regulation of cortisol metabolism in vivo is not well understood. We evaluated the relationship between cortisol metabolism and insulin sensitivity, adjusting for total and regional fat content and for non-alcoholic fatty liver disease.

Materials And Methods: Twenty-nine middle-aged healthy men with a wide range of BMI were recruited.

Non-esterified fatty acid concentrations are independently associated with hepatic steatosis in obese subjects.

Aims/hypothesis: We tested the hypothesis that NEFA concentrations are higher in obese subjects with fatty liver than in obese subjects without fatty liver.

Materials And Methods: We recruited 22 obese (BMI>30 kg/m(2)) men aged 42-64 years, in whom liver fat was assessed by ultrasound and classified into categories of no, mild to moderate and severe fatty liver by two independent radiologists. Regional and visceral abdominal fat were assessed by dual-energy X-ray absorptiometry and magnetic resonance imaging, and endogenous glucose production, whole-body glucose disposal during an insulin clamp, and NEFA concentrations were measured, along with NEFA suppression (percent (%) suppression and insulin sensitivity index for NEFA during an OGTT).

Biopsy of the prostate guided by transrectal ultrasound: relation between warfarin use and incidence of bleeding complications.

Aim: To determine the relation between warfarin use and the frequency of bleeding complications after biopsy of the prostate guided by transrectal ultrasound (TRUS).

Methods: Overall, 1022 consecutive patients with suspected prostatic disease were followed after biopsy. Warfarin and aspirin use was determined on the day of the procedure.

Ultrasound appearances of testicular epidermoid cysts.

Benign testicular tumours are uncommon but if recognized can enable a conservative approach to surgery to be recommended. This pictorial review demonstrates the variety of sonographic appearances of testicular epidermoid cysts correlating them with pathological findings in 19 lesions, the largest reported imaged series to date. Atchley, J.

Sonography of palpable breast cancer.

Purpose: Because of the increasing use of sonography to rule out cancer in women with palpable breast abnormalities, this study was performed to determine the rate of sonographically occult malignancy in this clinical setting.

Methods: Women who were recommended for biopsy based on mammographic and/or clinical findings underwent breast sonography. This study retrospectively analyzed the subset of patients with palpable malignant lesions.

The changes seen on high-resolution ultrasound in orchitis.

Orchitis and epididymitis are increasingly common lesions encountered in general practice. The clinical diagnosis of inflammation of the testis can be difficult as 10% of neoplasms present acutely with features of inflammation or torsion. The radiological diagnosis is also difficult as the changes seen on ultrasound, whether diffuse or focal, acute or chronic, have to be differentiated from the changes seen with tumours of the testis.

The ultrasound appearances of intratesticular varicocoele.

Extratesticular varicocoele is a common clinical finding, with well recognized sonographic appearances. We report the ultrasound findings in a patient with intratesticular varicocoele (ITV), an extremely rare entity, which was an incidental finding during scrotal sonography. There are differences in both the imaging findings and clinical presentation from previously reported cases.

Scrotal ultrasound.

Ultrasound is the most sensitive imaging method available for demonstration of the scrotal contents. The main indications for the use of ultrasound are scrotal masses and pain. Solid intratesticular masses are typically malignant, whereas solid epididymal masses are usually benign.

Case report: multiple highly reflective foci in the renal parenchyma are not specific for pseudoxanthoma elasticum.

A characteristic appearance of highly reflective foci in the renal parenchyma has been reported in patients with pseudoxanthoma elasticum. We describe a similar patient but in addition have found two patients with a similar appearance on ultrasound who have no other evidence of the condition. The appearance of highly reflective foci in the renal parenchyma is not therefore specific for pseudoxanthoma elasticum.

Ultrasound imaging of the appendix testis and appendix epididymis.

The appendix testis and epididymis are well visualized on ultrasound examination. It is important to recognize the normal anatomy of the appendages to exclude them as a cause of pathology and confirm their presence as normal structures. We describe the appearances of the appendices testis and epididymis in fifty-one consecutive patients presenting to the Southampton Radiology Department.

Case report: multiple epidermoid cysts of the testes--the ultrasound appearances.

Epidermoid cysts are uncommon tumours of the testes representing approximately 1% of all testicular tumours. Their importance lies in the fact that they are completely benign and can be treated by local excision, thereby saving the patient an orchidectomy. We describe a case in which the patient had multiple epidermoid cysts involving both testes and faced possible bilateral orchidectomy.

Orchiectomy after chemotherapy in patients with metastatic testicular cancer. Is it indicated?

Background: A small proportion of patients with testicular germ cell tumors present with widely metastatic disease and are treated initially with chemotherapy. Little is known about the efficacy of systemic chemotherapy in eradicating the primary testicular germ cell cancer; however, there is concern that the testis may act as a sanctuary site for germ cell cancer in these patients, and orchiectomy, is, therefore, recommended after chemotherapy.

Methods: The results from a clinical and pathologic review of 24 patients who underwent delayed orchiectomy after chemotherapy are presented.