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Статья освещает сложную проблему абдоминальной гипогастральной боли: приводится клинический случай у пациентки, получившей удовлетворительный результат в результате радиочастотной нейромодуляции после длительных неудачных попыток хирургического и консервативного лечения. Пациентка жаловалась на боль в нижнем отделе живота, иррадиирующую в пах. С целью устранения боли осуществлена эмболизация вен и удалена матка с придатками. Это привело к ухудшению состояния. Нами установлен диагноз: хроническая абдоминальная гипогастральная боль: нейропатия гипогастрального нерва справа, илиоингвинального нерва справа и генитофеморального нерва справа. Представленный в статье клинический случай требовал этапного лечения, которое заключалось в выполнении лечебно-диагностических блокад и применении радиочастотных методик под контролем ультразвуковой диагностики. Успешность лечения гипогастральной боли заключается именно в таком последовательном подходе — от стероидных блокад к деструктивным радиочастотным процедурам — с учетом особенностей течения болезни в каждом отдельном случае., Стаття висвітлює складну проблему абдомінального гіпогастрального болю: наводиться клінічний випадок у пацієнтки, яка отримала задовільний результат від радіочастотної нейромодуляції після тривалих невдалих спроб хірургічного та консервативного лікування. Пацієнтка скаржилась на біль у нижньому відділі живота, що іррадіював у пах. З метою усунення болю здійснена емболізація вен та видалена матка з придатками. Це призвело до погіршення стану. Нами встановлено діагноз: хронічний абдомінальний гіпогастральний біль: нейропатія гіпогастрального нерва справа, іліоінгві­нального нерва справа і генітофеморального нерва справа. Поданий у статті клінічний випадок потребував етапного лікування, що полягало у виконанні діагностично-лікувальних блокад та застосуванні радіочастотних методик під контролем ультразвукової діагностики. Успішність лікування абдомінального гіпогастрального болю полягає саме в такому почерговому підході — від стероїдних блокад до деструктивних радіочастотних процедур — з урахуванням особливостей перебігу хвороби в кожному окремому випадку., The article deals with the complex problem of abdominal hypogastric pain: a clinical case is presented in a female patient who received a positive result of radiofrequency neuromodulation after long unsuccessful attempts of surgical and conservative treatment. The patient complained of pain in the lower abdomen irradiating into the groin. In order to eliminate pain, embolization of veins was carried out and the uterus with appendages was removed. This led to a worsening of the condition. We established the diagnosis: “chronic abdominal hypogastric pain: the neuropathy of the right hypogastric, inguinal and genitofemoral nerve”. The clinical case presented in the article required stage-by-stage treatment, which consisted in performing therapeutic and diagnostic blocks and applying radiofrequency techniques under the ultrasound control. The success of the hypogastric pain treatment lies precisely in such a consistent approach — from steroid blockades to radiofrequency procedures, taking into account the features of the disease course in each case.

The article presents the results of the introduction of puncture drainage and sclerosis of kidney cysts under ultrasound guidance in the clinic. This technique refers to minimally invasive surgery, it is the least traumatic, does not lead to large material costs, is very reliable and effective. It is easy to perform in a hospital setting of any level. According to this method, 38 patients were treated in the hospital for five years.

Objective. To improve the results of treatment of patients with liver echinococcosis and carry out a comparative assessment of techniques of surgical treatment depending on the nature of postoperative complications, hospital stay and antirecurrent efficacy. Materials and methods. The experience of complex examination and treatment of 65 patients with liver echinococcosis for the period of 1999-2019 was analyzed. Open echinococectomy was performed in 21 patients, atypical liver resection in 18 patients, anatomical liver resection in 14 patients, pericystectomy in 10, laparoscopic echinococectomy in 1, percutaneous puncture of an echinococcal cyst under ultrasound control in 1 patient. Results. The time of inpatient treatment of patients after open echinococectomy was 23.5 4.3 days, after pericystectomy 19.8 1.4 days, after liver resection 14.4 2.7 days, after laparoscopic echinococcectomy 6, after percutaneous puncture echinococcal cyst 7 days. Postoperative complications were observed in 52.4 % of patients who underwent open echinococectomy, in 20 % of patients after pericystectomy, and in 15.6 % after liver resection. There were no relapses of liver echinococcosis in all the groups. Mortality was 1.5 % and was recorded after open echinococectomy. Conclusions. The most effective techniques for preventing postoperative complications are pericystectomy and liver resection. The duration of surgery and the average length of hospital stay with minimally invasive methods of treatment are shorter. However, the use of these methods of treatment remains controversial due to the possibility of intra-abdominal spread of the parasite. Patients with parasitic liver cysts after surgical treatment are subjected to dynamic follow-up observation (ultrasound examination of the liver, enzyme-linked immunosorbent assay, computed tomography of the abdominal organs) after 3-6 months for at least 5 years.

Background: Due to its availability, high information content and harmlessness, ultrasound is an extremely effective method of differential diagnosis of thyroid pathology. Despite the sufficient arsenal of diagnostic methods, thyroid biopsy with cytological examination is the «gold» standard in diagnostic algorithms. Most often, fine — needle aspiration biopsy is carried out using disposable syringes of different capacities (5, 10, 20 ml3). The procedure is performed in most cases according to the «Free hand» method, this leads to several problems associated with the peculiarity of the study, primarily with the low vacuum created in the syringe and insufficient collection of cytological material, as well as insufficient practical experience for a novice specialist.Aim: Determination of the range of the possibility of using vacuum aspiration fine needle biopsy under the control of ultrasound navigation in patients with focal thyroid pathology.Materials and methods: On the basis of the Problem Research Laboratory «Diagnostic studies and minimally invasive technologies» of the Smolensk State Medical University, a device for vacuum fine — needle aspiration biopsy was developed. In the period 2019–2020, 780 vacuum fine — needle aspiration biopsy was performed under the control of ultrasound navigation in patients with thyroid nodules. The level of vacuum in the syringe during sampling of the material was — 0,5 bar (- 50 kPa).Results: A comparative analysis of the cytological results obtained with the help of vacuum fine — needle aspiration biopsy and the «Free hand» method shows a decrease in obtaining the category of Bethesda 1 by 3.3% and Bethesda 3 by 10.2%.Conclusion: This indicates the effectiveness and in formativeness of the use of vacuum fine — needle aspiration biopsy in patients with focal thyroid pathology in comparison with the standard «Free hand» method, as well as with vacuum fine — needle aspiration biopsy due to constant visual monitoring and the lack of movement of the syringe piston to create a discharge when taking cytological material, the probability of needle deviation from the biopsy zone is reduced, which increases the effectiveness of the study and facilitates the work of a novice specialist.

The article presents a description of the main puncture and drainage interventions, indicating the method of their implementation, techniques, materials used for their implementation. The own experience of application of the specified minimally invasive interventions in the treatment of a syndrome of mechanical jaundice of benign and malignant genesis, acute cholecystitis, acute pancreatitis and its complications, hepatic abscesses, limited liquid accumulations of an abdominal cavity and retroperitoneal space is described. The advantages and disadvantages are noted, a comparative assessment is made and recommendations are given for the use of different puncture and drainage interventions depending on the type of pathology in which they are used.

One of the main diagnostic methods used in diseases of the thyroid gland is ultrasound examination of the thyroid gland. Due to its availability and noninvasiveness, high information content, ultrasound is an extremely effective method of differential diagnosis of thyroid pathology. Despite the sufficient Arsenal of diagnostic methods that allows us to suspect nodal changes in the thyroid gland, a cytological biopsy is the “golden standard” in diagnostic algorithms. The use of ultrasound control methods for performing minimally invasive interventions significantly facilitates manipulation and reduces the risk of possible complications, but does not exclude the possibility of their occurrence. In connection with all the above, there is an idea to create a device that helps to facilitate the performance of a fine-needle aspiration biopsy to a specialist, reduce the risk of possible complications and increase the information content. In the Problem scientific research laboratory «Diagnostic studies and minimally invasive technologies” of the Smolensk state medical University developed a device to increase the efficiency and informational content of fine-needle aspiration biopsy under the control of ultrasound navigation in patients with nodular formations of the thyroid gland. 26 (9.5%) patients were performed fine-needle vacuum aspiration biopsy using the created device, thanks to which 18 (6.6%) patients were found to have adenomatous formation, changes in the type of subacute thyroiditis were found in 5 (1.8%) patients, and 3 (1.09%) cases of follicular neoplasia. In cases where a higher discharge is necessary for the collection of cytological material, and the developed device allows you to create conditions that increase the information content and facilitate the procedure, in addition, it is possible to perform the procedure by one specialist, which reduces the workload of several specialists in the Department dealing with minimally invasive interventions.

Goal. Develop a model of purulent liver abscess (GAP), which corresponds to all the classic signs of a delimited abscess. Material and methods. Simulation of GAP was carried out in an experiment on 60 laboratory animals. Under ultrasound control (UC), a double-lumen Fogerty catheter was inserted into the established portion of the liver, a cystic cavity was formed in 3 days, which was infected and after 3 days GAP was obtained. In the modeling of GAP, clinical, planimetric, microbiological, morphological and instrumental methods of investigation were used. Results. On the third day of the experiment, a round cystic cavity of the liver with a diameter of 1,8 cm3 was formed. Three days after infection, a classic purulent abscess develops, surrounded by a dense wall formed from the liver parenchyma. As a result of the experiment, a clinical, microbiological, morphological and instrumental justification for modeling GAP with all its classic features was obtained. The conclusion. The proposed method for modeling purulent liver abscess is economically and technically profitable, minimally traumatic, provides guaranteed formation of classical GAP in the shortest possible time.

Goal. The aim of the study is to determine the possibility of using small volumes of ropivacaine for blockade of the femoral nerve performed with the use of an electrostimulator of peripheral nerves under ultrasound. Materials and methods. 44 blockages of the femoral nerve were performed under ultrasound control with the use of electrical stimulation of the peripheral nerves. In the first group (22 patients), a blockade of the femoral nerve was performed with 10 ml of 0.75% ropivacaine; in the second group (22 patients), 0.75% ropivacaine was used in a volume of 5 ml. Evaluation of the development time of the sensory, motor blocks and the duration of analgesia was carried out from the time the local anesthetic solution was introduced into the fascial sheath of the femoral nerve. Results. The time of development of the complete sensory block in the 1st and 2nd groups of patients was 21 (20; 24) minutes and 30 (24; 35) minutes (p 0.05). The time of development of the full motor block in the 1st group was 22 (16; 24) minutes; in the second group, 21 (17; 30) minutes (p 0.05). There was no difference in the duration of analgesia in the postoperative period between the groups: 7.75 (7; 8) h and 8 (7.5, 8) h. respectively (p 0.05). Conclusion. It has been established that 5 ml of 0.75% solution of ropivacaine is sufficient for effective blockade of the femoral nerve. With a decrease in the effective amount and volume of local anesthetic, there is an increase in the time of development of complete blockade of the femoral nerve without reducing the period of postoperative analgesia.

BACKGROUND & OBJECTIVE: Varicose veins are the commonest vascular problem both in men and women worldwide. Lack of timely management, inadequate treatment, and maltreatment of varicose veins can lead to the development of nonhealing ulcers and affects the quality of life in terms of health. Surgery, heat therapy, chemical therapy, and endoscopic treatment are the options of treatment. Foam sclerotherapy is relatively a new technique being practiced all over the world and has promising results.The objective was to determine the outcomes of foam sclerotherapy in the treatment of non-healing varicose ulcers. METHODOLOGY:In this descriptive study, 240 patients with chronic leg ulcers with varicose veins had been managed with foam sclerotherapy under ultrasound and compression bandage. All patients were reviewed at 7 days, 1month, 3 months, 6 months, 1 year, and 18 months both clinically and radiologically with a doppler ultrasound to assess the ulcer healing rates. RESULTS:The overall healing after 04 weeks of foam sclerotherapy was 83%. Two hundred and twenty-nine patients (95.4%) with ulcers healed within 02 months of the start of ultrasound-guided foam sclerotherapy. Delayed healing occurred after four months in11 cases. All those cases had either previous varicose veins surgery or deep vein thrombosis,or extensive perforator disease. During 18 months of follow-up, seven patients showed recurrence with a mean symptom-free period of 07 months. CONCLUSION:Chronic venous ulcers treated with foam sclerotherapyunder ultrasound guidance are associated with a high healing rate and low recurrence rate.

Objectives: We developed a minimally invasive technique for ALL reconstruction with the gracilis tendon folded in two strands. This is done by palpating the bone contours or under ultrasound control. Our hypothesis is that ultrasound control improves the positioning of the graft. Methods: We conducted a prospective controlled before-after study. All the patients who had an anatomical ALL reconstruction surgery were included. Patients for whom the postoperative control radiographs of a strict cross-section of the knee did not meet the quality criteria were excluded. The first 60 patients included were palpated for lateral epicondyle location, and for the next 60 patients ultrasound was used. The primary endpoint was the distance measured along an antero-posterior and proximo-distal axis between the graft insertion point and the theoretical ALL insertion point. The comparative analysis was carried out by student’s t-test. We determined the number of subjects to be included at 60 per group by assuming a minimum of 90% of grafts ≤5 mm in the "US" group versus 50% in the "palpation" group. Results: 120 patients were included in 2 groups of 60 (US vs. palpation) with no statistical difference. The mean anteroposterior distance between the theoretical point and the point identified in the palpation group was 6.3 mm (+/- 2.4) and 1.2 mm (+/- 1.1) in the ultrasound group (pConclusion: Our hypothesis was confirmed. Ultrasound control improves the positioning of the ALL graft.

Relevance. Punctic-drainage interventions under the control of ultrasound have become an effective help in complex treatment. But some technological aspects in the procedure and post-operative management of patients remain the subject of discussion. Objective: to improve the results of the use of punctional drainages under ultrasound control in abdominal and retroperitoneal pathology. Materials and methods. Echo-controlled puncture-drainage interventions are used in 89 patients: with pancreatogenic fluid concentrations in the stuffing box, parapancreatic cellular spaces (34); with intra-abdominal complications following operations on the abdominal organs (18), inflammatory processes in the gall bladder (15), tumor obstruction of the bile ducts (12), and with liver abscesses (10). Depending on the nature of the contents of the "target", its localization for puncture drainage was used by trokars of various modifications and diameters, as well as stylet-catheters of the type "PIGTAIL". Manipulation was carried out using ultrasonic devices with convection (frequency 3.5 MHz) and linear (frequency 7-12 MHz) sensors. In 68 patients, the display for intervention was infected fluid formation. In 12 – jaundice syndrome and 9 patients – sterile clusters of enzymatically active content. The main task of puncture-drainage procedures was the evacuation of the content of pathological or anatomical fluid formations to reduce intoxication and (or) their decompression. In assessing the effectiveness of minimally invasive techniques, account was taken of the effectiveness of the operation, that is, the target effect for which the intervention was performed, and the number of complications. Results. Puncture-drainage interventions have become independent and end-of-term treatment in 68 out of 85 cases (with the exception of 4 patients who, due to complications during the procedure, used other methods). The reasons for the reduced effectiveness of echo-controlled puncture-drainage interventions in 9 patients were: the predominance of the tissue component (large sequester) in the cavity, the presence of multiple isolated gates, the use of drainage structures with insufficient drainage properties. Fatal consequences in 5 patients are caused both by the above reasons, and by endogenous factors (a significant prevalence of the pathological process, decompensated background pathology, reduction of internal reserves of the organism). Conclusions. Puncture-draining interventions under ultrasound control are an alternative to open surgical interventions, especially in patients with severe concomitant pathology, severe general condition. In this case, they can be as element (stage) of complex treatment and an independent, final method of surgical care. The choice of echo-controlled interventional technologies as a method of operational correction should be carried out with understanding their capabilities. The effectiveness of such mini-invasive methods allows us to recommend their acceptance in surgical hospitals for diseases of the abdominal cavity organs and retroperitoneal space.

The OBJECTIVE of the study was to improve the results of treatment of patients with fluid collections in acute pancreatitis with a minimally invasive method. MATERIAL AND METHODS. Results of percutaneous-puncture interventions under ultrasound in 62 patients with acute pancreatitis in the presence of fluid clusters were analyzed. In the first day from the moment of the disease, 39 % of patients admitted during the second and the third days – 31 % and more than three days – 20 % of patients. RESULTS. Diagnostic punctures of fluid collections under ultrasound control were performed. In 49 (79 %) of 62 patients, the puncture was effectively transformed into percutaneous drainage. In 13 of 49 patients were further operated. Lethal outcomes after puncture-draining interventions were in 5 cases. Among 44 patients operated with a minimally invasive method of acute pancreatitis, recovery was noted in 24, recurrence of fluid collections – in 7, 13 patients were operated on. CONCLUSION. Thus, early diagnosis and timely implementation of conservative and minimally invasive methods of treatment contributed to improving the immediate results of treatment of patients with fluid collections in acute pancreatitis.

The ultrasonic inspection of aluminum bars is performed according to the method by immersion using longitudinal waves. Immersion of aluminum bars is done in deionized pure water or filtered water. The ultrasonic inspection of extruded rods is manual, using a plastic tube that acts as a transducer mount and is performed on areas indicated by the scan plane at a constant velocity of maximum 10 inches/sec.

Background. The aim of our research was to define the minimal effective volume and amount of lidocaine with added adrenaline (1:200,000) to perform a femoral nerve block under ultrasound control and with neurostimulation.Methods. The chosen starting concentration of lidocaine was 1%, as the most widely applied solution for the peripheral blocks. Subsequently , depending upon the acquired results, we applied 0.75%, 1.5%, 2%, 3%, and 4% solutions in volumes that were defined in accordance with the results of the research. All blocks were performed with added adrenaline (1:200,000). In all, 181 blocks of the femoral nerve, in combination with sciatic nerve blocks, were carried out with the help of the electrostimulation of peripheral nerves, and under ultrasound.Results. While measuring the cross-sectional area of the femoral nerve, no valid intergroup differences were observed (p = 0.98). The cross-sectional area of the femoral nerve within the region of the performed block was 0.27 cm2 (range: 0.24–0.3 cm2). Our research indicated that the minimal efficient volume of lidocaine that was necessary for the development of a complete block of the femoral nerve was 5 ml, and the amount of 75 mg. Conclusion. For a complete motor and sensory block of the femoral nerve: the minimum effective volume of local anesthetics was 5 ml; and the minimum effective amount of lidocaine was 75 mg. А complete block of the femoral nerve was achieved only with the spreading of local anesthetic along the whole circumference of the femoral nerve.

The article deals with the actual problem of modern treatment of infant hemangiomas. The accumulated 10-year experience of using propranolol in 512 patients has shown its effectiveness and safety. The team of authors developed a protocol for managing patients with infantile hemangiomas of various localization at all stages of treatment. Special attention was paid to the cardiological aspect of patient monitoring using modern methods of instrumental diagnostics. Due to the clear application of the created protocol with the use of ultrasound control, in most cases, it was possible to achieve complete cure of this pathology, minimize incidence of undesirable effects and avoid the formation of relapses (rebound effect). The effectiveness of the developed algorithm of diagnosis and treatment is confirmed by both clinical results and the results of instrumental examinations.

In light of the growing availability of ultrasound testing and invasive diagnostic methods of the breast in everyday gyneco- logic practice, lesions of uncertain malignant potential, classified histologically as B3, have become a significant health issue. Intraductal papillomas (IPs) are the most common pathology in that group of lesions. Despite their benign histologic appearance, IPs may accompany malignant growths and the diagnosis made on the basis of biopsy material carries the risk of breast cancer (BC) underestimation. The article presents a review of the available literature on the management of patients diagnosed with intraductal papilloma at a standard core needle biopsy or vacuum-assisted core needle biopsy. The management is not uniform and depends not only on the verification technique or the accompanying pathological growths, but also on the result of clinical-pathological correlations. As it turns out, open surgical biopsy should not necessarily be recommended to every affected woman, and a growing number of sources have recently suggested that a control program would be sufficient in many cases. Thus, it is vital for gynecologists to be able to differentiate between those women who may be included in the annual ultrasound control program and those who require further surgical management.

Purpose: We present our experience in the diagnosis, follow-up and planning therapy of thoracic, abdominal and retroperitoneal liquid collections in different emergency patients using conventional and interventional ultrasound. Material and Methods: The right and left oblique and poly positionning view was used in 235 patients (159 male and 76 female) for US examination to identify fluids in the thorax and peritoneal or retroperitoneal space. The examination was performed after the clinical survey with patients supine. Positive findings of US were compared with those provided by CT, punctures under US control or surgery. US machine supplied with linear and convex transducers, CT machine, needles and catheters were used. Results: 197 of all 235 US examined patients had fluid collections, confirmed by CT scan, surgery or clinival course. In 156 patients we performed FN diagnostic punctures under US control. There was 155 true-positives, 25 true-negatives, 5 false-positives and 2 false-negative results. Overall this demonstrated that ultrasonography hamaunt of d a sensitivity of 98.72%, specificity of 83.33% and accuracy of 96.25%. The PPV is 96.87% and the NPV – 92.59%. Conclusions: Our experience and literature reports support the opinion that US examination can and should be used as a primary method for diagnosis and follow-up of clinically suspected free and organaised fluids in the thorax, abdomen and retroperitoneum.

Aim The goal of the paper was to evaluate the procedure of percutaneous drainage of symptomatic hepatic cysts under the transabdominal ultrasound control combined with obliteration. Material and method Within the period from 2005 to 2015, 70 patients diagnosed with a simple hepatic cyst of symptomatic nature were subject to hospitalization and treated at the 2(nd) General, Gastroenterological and Cancer Surgery of the Alimentary System Center and Clinics of the Medical University of Lublin. All the patients subject to evaluation were qualified to percutaneous drainage under an ultrasound control. The drainage utilized typical sets of drains with the diameter of at least 9 F, most often of pigtail type. The fluid aspirated form the cyst was dispatched for complex laboratory testing. Further, a 10% sodium chloride solution was administered to the cyst through the drain, in the volume depending on the previous size of the cyst and the patient's reaction. Results Patients reported for a re-visit within the period from 3 to 9 months following the procedure. Complete obliteration of the cyst was confirmed only in 8 patients (11%). Cyst recurrence was reported in cases when during the ultrasound evaluation, the diameter of the cyst following aspiration and obliteration enlarged to over 75% of the initial dimension. In this group, in 10 out of 12 examined (83%) there was a relapse of the previously observed ailments. Among patients, who has a cyst imaged within the period of observation, which had the diameter from 50% to 75% of the previous size, only in 6 cases (37.5%) the initial symptoms relapsed. Conclusions The utilization of a drainage and obliteration enables one to achieve the acceptable result of the therapy as well as significant decrease in the number of previously reported ailments and symptoms described.

The growing rod technique is currently one of the most common procedures used in the management of early onset scoliosis. However, in order to preserve spine growth and control the deformity it requires frequent surgeries to distract the rods. Magnetically driven growing rods have recently been introduced with same treatment goal, but without the inconvenience of repeated surgical distractions. One of the limitations of this technical advance is an increase in radiation exposure due to the increase in distraction frequency compared to conventional growing rods. An improvement of the original technique is presented, proposing a solution to the inconvenience of multiple radiation exposure using ultrasound technology to control the distraction process of magnetically driven growing rods.

THE AIM of the study was to develop a minimally invasive technique that does not have the disadvantages of traditional surgical treatment, does not have any restrictions in patients with external hemorrhoids as in HAL-RAR method. Technique that is more effective than HAL-RAR and isolated laser destruction methods, in the treatment of patients with chronic hemorrhoids stage II-III. MATERIALS AND METHODS. We developed a combined method of treatment of the patients with hemorrhoids, that unites artery ligation under the ultrasound control with Doppler effect and submucous subdermal laser destruction of internal and external hemorrhoids. We studied the safetiy and effectiveness of the developed method. The study included 100 patients with chronic hemorrhoids stage II and III, the patients were treated with the use of combined methodology HAL-laser (study group), the method HAL-RAR (1 control group) and closed hemorrhoidectomy linear stapler (control group 2). RESULTS. The analysis showed that the combined method HAL-laser has higher efficiency than the method HAL-RAR, and thus is as safe and well tolerated in patients. Its not so efficient compare to conventional hemorrhoidectomy because of the risk of a cosmetic defect, but does not increase the risk of recurrence of the disease, reduces the risk of complications and more endurable for the patients, it also allows to reduce the time of disability.

We demonstrated that the feats of the dolphin biosonar system can be achieved through physical implementation. Numerical and experimental results suggested that dolphins have evolved to intelligently manipulate physical laws. Gradient distributions of sound speed and density in the forehead counterpart can enhance the main beam by gathering more sound energy to reinforce the main beam and lowering side lobes. As dolphins prove to accomplish efficient control on their biosonar capabilities in multiple ways, this paper provides an additional aspect to enrich our understanding of how one of the best natural biosonar systems works and build a step to inspire additional advanced sound control systems.

The leading clinical manifestation of trigeminal neuralgia is pain syndrome. Recently, an integrative biopsychosocial approach has been proposed in the study of pain. Trigeminal neuralgia is marked by a significant prevalence, often severe course, lack of sufficiently effective methods of treatment. The aim of the article was to introduce the technique of trigeminal nerve block under the ultrasound control. When the trigeminal nerve block is performed, the terminal sections of its three main branches are to be anesthetized. The maximum full and wide blockade can be achieved with the block of the Gasser's node, but performance of this procedure is complicated, requires a special qualification of a neurosurgeon and fluoroscopic control due to the complexity of the innervation of the head, the presence of mutually overlapping zones and commision. The most frequent indications for trigeminal nerve block are diagnostic, therapeutic and surgical blockades. It is recommened to consider the need for a combination of blocks, when anesthesia is planned. Double navigation with a neurostimulator is used for the accuracy of the needle positioning improvement. In this case, we expect a motor response from the masticatory muscle. Thus, the trigeminal nerve block under the ultrasound control can be used in the management of pain syndrome in trigeminal neuralgia., Ведущим клиническим проявлением при невралгиях тройничного нерва является болевой синдром. В последнее время в изучении боли предложен интегративный биопсихосоциальный подход. Невралгия тройничного нерва отличается значительной распространённостью, нередко тяжелым течением, отсутствием достаточно эффективных методов лечения. Целью статьи было представить технику блокады тройничного нерва под контролем УЗИ. При выполнении блокады тройничного нерва целью являются терминальные участки трех его основных ветвей. Максимально полной и широкой блокады можно добиться при блокаде гассерова узла, но эта процедура сложна технически, требует квалификации нейрохирурга и флюороскопического контроля, учитывая сложность иннервации головы, наличие взаимно перекрывающихся зон и коммуникации нервов. Наиболее частыми показаниями к выполнению блокад ветвей тройничного нерва являются диагностические, терапевтические и хирургические блокады. При планировании анестезиологического пособия целесообразно рассматривать необходимость выполнения комбинации блоков. Для повышения точности позиционирования иглы при наличии нейростимулятора применима двойная навигация. В данном случае ожидаем двигательный ответ от жевательной мышцы. Таким образом, блокады веток тройничного нерва под контролем УЗИ могут быть использованы в менеджменте болевого синдрома при невралгии тройничного нерва., Провідним клінічним проявом при невралгіях трійчастого нерва є больовий синдром. Останнім часом у вивченні болю запропоновано інтегративний біопсихосоціальний підхід. Невралгія трійчастого нерва вирізняється значною поширеністю, нерідко – тяжким перебігом, відсутністю достатньо ефективних методів лікування. Метою статті було представити техніку блокади трійчастого нерва під контролем УЗД. При виконанні блокади трійчастого нерва метою є термінальні ділянки трьох його основних гілок. Максимально повної і широкої блокади можна домогтися при блокаді гассерового вузла, але ця процедура складна технічно, вимагає кваліфікації нейрохірурга і флюороскопічного контролю, з огляду на складність іннервації голови, наявність зон, що взаємно перекриваються, і комунікантних гілок. Найчастішими показаннями до виконання блокад гілок трійчастого нерва є діагностичні, терапевтичні та хірургічні блокади. При плануванні анестезіологічної допомоги доцільно розглядати небхідність виконання комбінації блоків. Для підвищення точності позиціонування голки при наявності нейростимулятора застосовна подвійна навігація. В даному випадку очікуємо рухову відповідь від жувального м’яза. Таким чином, блокади гілок трійчастого нерва під контролем УЗД можуть бути використані в менеджменті больового синдрому при невралгії трійчастого нерва.

Abstract. Background: In obese patients with end stage renal disease, puncturing matured arteriovenous fistulas (AVF) that run deep under the skin surface may prove difficult. To achieve reliable puncturability, there are several surgical solutions. Superficialization with mobilization is common. With some newer options (lipectomy and liposuction) subcutaneous adipose tissue is surgically reduced. There are only a few authors who have published their experience with liposuction and we want to add our own results. Patients and methods: We report our experience with ultrasound-guided liposuction (USGL). We introduce liposuction cannulas via small incisions to reduce the subcutaneous adipose tissue overlying the planned cannulation zones under ultrasound control using tumescent anaesthesia till the prospective needle access segments become easily palpable. So far, we have used this technique for cephalic forearm and upper arm fistulas only. Furthermore, we review the relevant literature. Results: From February 2014 through November 2016, six patients were treated using USGL. Their body mass indices ranged from 30.8 to 53.8 kg/m2 (mean 37.6). The mean depths of the AVFs beneath the skin surface were 13.3 (8–20) mm before and 5.1 (3.5–6) mm after surgery. The mean time of the procedure was 15 minutes. There were no postoperative complications. In five patients, the AVFs could reliably be punctured after three weeks. One patient is not yet on dialysis. During the follow-up period of 24 (11–43) months, all six AVFs remained primarily patent. In the literature, we found nine reports on altogether 81 patients undergoing USGL. Almost all noteworthy complications occurred only after ultrasound-powered liquefaction of adipose tissue, which was only used by a single investigator. Conclusions: USGL is a method that can be learned easily, is minimally invasive, seems to be safe, and requires only short operation times.

A few quotations from the book Breast Cancer: A Lobar Disease by Tibor Tot will be used as an introduction to this chapter, which will be followed by the presentation of several cases of early breast cancers invisible on mammography and detected by ultrasound. It is exactly through the presentation of the cases mentioned above that I will prove the theory stated in the quotations claiming that breast cancer is a lobar disease, even at the earliest stages. Lesions, detected by ultrasound, were cytologically verified under ultrasound control, and then an open biopsy was performed after a preoperative marcation under ultrasound control. All the lesions were impalpable, invisible on mammography, and up to 10 mm long at the ultrasound examination.

Background: For many years, ERCP was avoided in pregnancy given the concerns regarding the adverse effects that, with special focus on radiation, could occur in the developing fetus. However, the postponement or rejection of ERCP in pregnant women, may lead to a higher risk for mother and fetus, especially when the indication is unequivocal, namely cholangitis, biliary pancreatitis and symptomatic choledocholithiasis. Summary and key messages: This review aims to summarize the scarce literature on the subject in order to plan ERCP in pregnancy with the highest safety. The use of techniques that reduce radiation and increase the protection of pregnant women allow radiation levels far below the safety limits. We also discuss the various alternatives of ERCP without radiation. EUS can eliminate the need for ERCP with doubtful choledocholithiasis and plan the best approach in those with previous evidence. The possibility of performing “ERCP” with a linear echoendoscope uniquely under ultrasound control has been described. Conversely, the two-step strategy (initial sphincterotomy with stent placement without fluoroscopy and after delivery, ERCP with lithiasis extraction) proved to be safe obviating fluoroscopy. In conclusion, ERCP can be performed in pregnancy safely and effectively with minimal radiation or even no-radiation at all. info:eu-repo/semantics/publishedVersion

Aim: We hypothesized in this prospective study that the addition of an injection of PRP to a percutaneous epicondylar tenotomy under ultrasound control would optimize the results with an early gain on pain, strength, and with a rapid return to professional activities at three months postoperative. Backround: Surgical treatment of patients with recalcitrant epicondylitis remains difficult with suboptimals results. Recently, minimally invasive treatments such as percutaneous epicondylar tenotomy and PRP injections have been described. Few studies have examined the combination of the two techniques especially under ultrasound. Methods: 261 patients with recalcitrant lateral epicondylitis were treated by percutaneous epicondylar tenotomy under ultrasound control, coupled with an injection of PRP. We analyzed prospectively the evolution of pain on the visual analogue scale (VAS-P), the functional scores: Quick DASH, PRTEE and MEPS, patient satisfaction (Self Evaluation Elbow), the grip strength and return to work. Results: At 3 months follow up significants improvements were observed in all scores. VAS-P decreased by 3.4 points (SD 2.2; p Conclusion: Treatment of recalcitrant epicondylitis by percutaneous tenotomy combined with PRP injection under ultrasound control provides rapid recovery on pain and force with a high satisfaction rate at 3 months postoperative.

Summary Endovascular procedures are commonly used for treatment of vascular pathologies. These interventions are routinely performed under angiographic control. Angioplasty is increasingly more often used for correction of dialysis fistula – especially dilatation of stenosis. We describe the technique of dialysis fistula angioplasty under ultrasound control. Benefits of this procedure include lack of nephrotoxic contrast, what is especially important in chronic kidney disease patients in pre-dialysis period. Advantages of ultrasound guidance during dialysis fistula angioplasty lead to cause more and more frequent employment of this technique.

Background and purpose Drooling is a challenging entity to manage. Botulinum toxin A (BOTOX-A) infiltration of salivary glands is a promising alternative to surgical treatment. This study aims to assess the outcome of BOTOX-A salivary glands infiltration in children with drooling. Methods Patients treated between January 2012 and March 2015 were enrolled. BOTOX-A was injected in the parotid and submandibular glands under ultrasound control and general inhalational anesthesia. The outcome was evaluated through the DSFS: Drooling Severity (1-best to 5-worst) and Frequency (1 to 4) Scale, that was applied before treatment, and 1-, 3-, and 6-month after injection. The inclusion criteria were a DSS ≥4 and/or DFS ≥3. Statistical significance was set at 5%. Results There were 17 patients aged 12.1±5.1 [4–19]years, all of them with neurologic impairment. After the first injection, 13 (76.5%) patients had reduction of the severity (S) and 12 (70.6%) of the frequency (F) scale; in 6 (35.5%) patients drooling resolved completely. Pre-treatment S+F score was 8.59±0.71 [7–9]; it decreased significantly to 4.65±2.32 ( p =0.001) at 1-month post-injection evaluation. At 3-month and 6-month the scores were also significantly lower than the pre-treatment one (4.00±1.96, p =0.002; 5.36±2.20, p =0.005; respectively), but there was a significant increase between the 3-month and 6-month evaluations ( p =0.01). With a follow-up of 20.1±9.2 [4–38] months, 4 out of the 13 successful injections needed a second one after 7.5±3.1 [3–10] months. The patient with the longest time not requiring re-injection had 28months of follow-up. One (6%) patient presented mild dysphagia that regressed spontaneously. All but two (88%) parents/caregivers would repeat the treatment. Conclusions BOTOX-A seems to be an effective minimal invasive treatment for drooling with few complications. After 6months the need for re-injection becomes substantial but it may not be necessary for several months. Further studies are needed to establish the most effective dosage and frequency of injections. Level of evidence IV

Aims: To quantify the procedure-related complication rate after using modified technique of amniocentesis with a 29-gauge (29-G) pencil-point needle. Methods: This is a prospective, descriptive study of 316 amniocenteses that were performed by means of atraumatic 29-G pencil-point needle under ultrasound control. Results: A total of 316 amniocenteses were observed through the postprocedural period. The median time needed to retrieve 15 mL of amniotic fluid was 4 min. A total of 19 pregnancies were terminated after genetic testing. No case was regarded as procedure-related fetal loss. No other complications were observed. Seventeen children were born before 37 completed weeks of gestation and five children had a birth weight Conclusions: Amniocentesis with the 29-G atraumatic pencil-point needle seems to be a safe procedure with extremely low risk of complications and is a good alternative to the traditional 22-G Quincke needle.

Purpose: To describe a new geometrical stepper-guided navigation system for positioning ProACT®. Methods: The sizing of the stepper-guided navigation system was calculated using the distance from the ideal position of the device to anatomic referral points previously measured by ultrasound. The trocar and subsequently the device were maneuvered to the ideal position in accordance with the navigation system. Measurements: Treatment efficacy was evaluated with daily pad count, 1-hour pad test, Incontinence Quality of Life questionnaire (IQoL), visual analog scale and overall impression. Complications, balloon volume and number of adjustments were reported at 1, 3, 6 and 12 months follow-up visits. Results: Mean follow-up was 12 (range 3–19) months. Daily pad count showed 30 patients (71%) dry and 9 patients (21%) improved. 1 hour pad test showed 28 patients were dry (66%) and 11 patients improved (26%). IQoL increased from an average of 35.3 to 80. Average visual analog scale score was 8. Complications requiring device removal occurred in 3 patients (7%). Mean balloon volume was 3.1 ml. Conclusions: The stepper-guided navigation system to implant ProACT is feasible and extremely reproducible making this procedure more standardized.

Objective. To analyze the advantages of ultrasound-guided catheterization of the internal jugular vein in patients with scoliotic deformity. Material and Methods. Patients with scoliotic deformity (n = 366), aged 16 months to 18 years were divided into two groups. The study group included patients (n = 128) in whom ultrasound guided approach to the internal jugular vein was used. Out of them 79 patients underwent classical catheterization over the guidewire with aspiration sample, and 49 intravasal insertion of J-guidewire without aspiration sample. The control group included patients (n = 238) who underwent catheterization without ultrasound control with aspiration sample over the guidewire. Results. Ultrasound-guided puncture and catheterization of the internal jugular vein decreases complication rate and shortens the time of preoperative preparation. Conclusion. The study showed that puncture in Trendelenburg's position improves verification of the internal jugular vein. Ultrasound control allows performing catheterization over guidewire without aspiration sample with low rate of complications.

Central venous cannulation is frequently used in patients with serious diseases, although it may be unsuccessful and known to have complications in many cases. It is especially true in more complicated cases e.g. after unsuccessful punctures or cervical operations. With the use of ultrasound control success rate increases, while the chance of the complications decreases. In this prospective study, authors used ultrasound control during jugular vein punction in complicated cases. 56 successful central venous cannulation controlled by ultrasound has been performed since year 2000. This report overviews these cases and the related literature.

Tolerance to and efficacy of a fibrin adhesive injected into thyroid cysts after their evacuation by fine needle puncture was investigated in 60 consecutive patients (52 women, 8 men; mean age 50 [18-82] years) with solitary thyroid cysts. The patients were randomly separated into two groups of 30 each. In group A patients the cysts were completely emptied by fine needle puncture under ultrasound control. In group B patients a fibrin adhesive (0.8-1.4 ml) was subsequently injected. 25 of 30 patients in group A had recurring cysts, twelve of which were larger than the original one. There were 13 recurrences in group B (P < 0.005), but only one was of a larger volume. In each group three patients reported a brief period of pain after the evacuation procedure. The described technique has proven to be reliable and well tolerated. Cysts obliterated by fibrin adhesive recurred less frequently and had a smaller volume than those only evacuated by needle puncture.

In CDH ultrasound control of reduction in the unstable period of the first 3 months has to be performed by an inguinal access, as the splint can not be removed for the reason of high risks of redislocation. Controls are possible whenever required, according to anglo-american techniques. Thus treatment within the first year of life may be controlled by ultrasound imaging alone. Criteria for detection of posterior and cranial redislocation as well as for the anterior positioning of the femoral head are given.

This is a case series of women presenting to a tertiary care centre with a diagnosis of interstitial pregnancy. Dilatation and evacuation was performed under ultrasound control with systemic methotrexate post-operatively. All women had successful termination of their interstitial pregnancy. Although described in the international literature, this is the first time that this technique has been documented in Australia, and it may ultimately prove to be a relatively safe and simple fertility preserving method of treating women with unruptured interstitial pregnancies.