Ultrasound imaging is a rapid and noninvasive tool ideal for the imaging of soft tissue infections and is associated with a change of clinician management plans in 50% of cases. We developed a realistic skin abscess diagnostic and therapeutic training model using fresh frozen cadavers and common, affordable materials. Details for construction of the model and suggested variations are presented. This cadaver-based abscess model produces high-quality sonographic images with internal echogenicity similar to a true clinical abscess, and is ideal for teaching sonographic diagnostic skills in addition to the technical skills of incision and drainage or needle aspiration.

No description available.

BACKGROUND. The cytologic differentiation between neoplastic and reactive/reparative processes in the endoscopic ultrasound-guided fine-needle aspirations (EUS-FNA) of the pancreas can be difficult. Malignant transformation of the pancreatic ductal epithelium changes the expression of apomucins. The goal of the current study was to determine an optimal immunohistochemical panel of mucin (MUC) antibodies that would allow the cytomorphologic distinction of pancreatic ductal adenocarcinoma and its differentiation from reactive/reparative processes and inadvertently sampled gastric and duodenal mucosa. METHODS. Pancreatic EUS-FNA specimens performed on 351 patients were reviewed. Expression profiles of MUC1, 2, 5AC, and 6 were examined on 56 cell block sections and 26 follow-up pancreatectomy specimens. RESULTS. MUC1 and 6 expression was found in nonneoplastic pancreatic samples, whereas there was an absence of expression of MUC2 and 5AC. MUC2 was detected in mucosal goblets cells of the duodenum, MUC6 in Brunner glands, and MUC5AC in gastric foveolar cells. MUC5AC expression in differentiating ductal adenocarcinomas from benign conditions demonstrated better operating characteristics than either MUC1 or MUC6. The apomucin expression pattern both in cytology and follow-up surgical pathology specimens was similar. In surgical pathology specimens, the panel of 3 antibodies, MUC1+/MUC2-/MUC5AC+, was noted in 15 of 17 ductal carcinomas (88.2%). In nonneoplastic pancreatic tissue, the expression panel MUC1+/MUC2-/MUC5AC- was observed in 14 of 17 (82.4%) cases. In cytology specimens, the combination of MUC1+/MUC2-/MUC5AC+ was noted in 21 of 30 ductal carcinoma cases (70.0%), 3 of 6 atypical cases (50%), and 1 of 1 suspicious for malignancy cases (100%). The combination MUC1+/MUC2-/MUC5AC+ was not observed in any of the negative for malignancy or reactive cases (0 of 6). CONCLUSIONS. The most optimal panel for the diagnosis of ductal adenocarcinoma in both the EUS-FNA specimens is a panel including MUC1/MUC2/MUC5AC, whereas a panel of all 4 antibodies (MUC1, 2, 5AC, and 6) will in addition aid in differentiating inadvertently sampled normal/reactive duodenal and gastric epithelium from neoplastic pancreatic tissue.

Skeletal muscle metastasis from breast carcinoma is a relatively rare clinical entity. We report two cases of breast cancer metastatic to the skeletal muscle, diagnosed by ultrasound guided fine needle aspiration (US-FNA) biopsy done by interventional cytopathologists at an outpatient cytopathology center. Our two patients presented with lower anterior neck firmness and chest wall mass, respectively. Ultrasound evaluation of our first case demonstrated hypo-echoic thickened anterior strap muscles while in the second case there was significant distortion of the anatomy from previous surgeries. It was necessary to proceed with FNA biopsy even when their ultrasound findings were equivocal, to establish a definite rapid diagnosis. The immediate onsite evaluation findings were suggestive of malignancy in both cases with subsequent core biopsy confirming the diagnosis of metastatic breast carcinoma. In cytopathology, point-of-care (POC) ultrasound is used as an adjunct tool that offers visual guidance during FNA of nonpalpable masses and enables sampling of lesional “hot” spots to ensure specimen adequacy. Studies have demonstrated a reduction in FNA nondiagnostic rates with the use of ultrasound-guidance consequently reducing health care costs associated with nondiagnostic FNAs. US-FNA also provides adequate samples for cell block preparations. Metastatic lobular carcinoma of the breast has a wide range of clinical presentations and a high level of suspicion is advised. Cytopathologists-performed US-FNA is a proven, less-invasive, cost-effective tool that provides timely cytologic diagnosis.

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No. of bitstreams: 1 silveira_cra_me_jabo.pdf: 1335776 bytes, checksum: 2c41b17b49dd121d78806d292d582d58 (MD5) Previous issue date: 2016-06-17 / Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) / Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) / O objetivo do presente estudo foi avaliar o desempenho na produção embrionária in vivo e in vitro de doadoras da raça Holandesa não lactantes, verificar a ocorrência de polimorfismos no gene JY-1 e sua associação com a produção in vivo e in vitro de embriões. Primeiramente, foi verificada a similaridade na produção de embrião da mesma doadora entre as biotécnicas (produção in vivo e in vitro), sendo utilizadas 44 vacas e comparados os desempenhos nas produções de embrião. Na produção in vivo de embriões não foram observados efeitos de ano (P=0,13), estação dentro de ano (P=0,46) e touro dentro de estação e ano (P=0,20). Na produção in vitro, também não foram observados efeitos de ano (P=0,64) e estação dentro de ano (P=0,72), entretanto, o efeito do touro dentro da estação e ano foi significativo (P<0,01). Não há correlação entre as produções in vivo e in vitro dentro de doadora (r=- 0,04; P=0,56). Nenhuma probabilidade de semelhança entre as biotécnicas de produção de embriões, ou seja, se a mesma doadora tem o mesmo desempenho nas duas técnicas (acima ou abaixo da média), foi encontrada (P=0,12). Para verificar a ocorrência de polimorfismos no gene JY-1 e sua associação com a produção embrionária, dados retrospectivos de produções in vivo e in vitro de embriões foram obtidos de 144 vacas não lactantes da raça Holandesa. Para a identificação dos polimorfismos do gene JY-1, as regiões do éxon 2 e íntron 2 foram amplificadas e sequenciadas pelo método de PCR-sequenciamento. Foram detectados quatro SNPs [dois no éxon 2 (rs381676360; rs384600927) e dois no íntron 2 (rs378994837; rs211595914)]. O SNP rs381676360 provocou uma substituição não sinônima de aminoácido (leucina/isoleucina) e o rs384600927, uma substituição sinônima do aminoácido valina. Em relação ao equilíbrio de Hardy-Weinberg, uma das quatro frequências genotípicas não se encontrava em equilíbrio (rs211595914; P<0,01). Considerando o teste de desequilíbrio de ligação (DL), maiores valores de r2 (>0,33) foram observados entre os SNPs rs381676360, rs384600927 e rs378994837 (r2=0,767-0,973) e um SNP (rs211595914) apresentou baixos valores de r2 (r2=0,016-0,025). A associação dos SNPs com as características [número de embriões transferíveis produzidos in vivo (NET); taxa de embriões transferíveis in vivo; (%ET); número de embriões produzidos in vitro (NEV); taxa de clivagem (%CLIV) e taxa de embriões in vitro (%EV)] foi verificada. Nenhum dos SNPs isoladamente foi associado às características estudadas. Porém, quando todos os SNPs foram considerados em conjunto quanto à associação às características, valores significativos foram encontrados para o NET (P<0,01), NEV (P<0,01) e %EV (P<0,01). Desta forma, é possível concluir que o desempenho de produção de doadores de embriões depende da biotécnica utilizada. Ainda, que o gene JY-1 possui polimorfismos do tipo SNP em vacas não lactantes da raça Holandesa e que estes estão associados à produção embrionária. / The aim of this study was to evaluate the performance in in vivo and in vitro embryo production in non-lactating Holstein donors, verify the occurrence of JY-1 gene polymorphisms and their association with the in vivo and in vitro embryo production. First, the similarity in embryo production from the same donor between biotechnologies (in vivo and in vitro production) was verified, being used 44 cows and the embryo production performance was compared. In in vivo embryo production no effects of year (P=0.13), season within year (P=0.46) and sire within the season and year (P=0.20) were found. Regarding in vitro embryo production, no effects of year (P=0.64) and season within year (P=0.72) were found, however, the effect of sire within season and year was significant (P<0.01). There was no correlation concerning embryo production between techniques within donors (r=- 0.04, P=0.56). No probability of similarity between the embryo production techniques, i.e., if the same donor has the same performance in two techniques (above or below of the average), was found (P=0.12). To check the occurrence of JY-1 gene polymorphisms and their association with embryo production, retrospective data from in vivo and in vitro embryo production were obtained from 144 non-lactating Holstein cows. For the identification off JY-1 gene polymorphisms, the region of exon 2 and intron 2 was amplified and sequenced by PCR-sequencing method. Four SNPs were found [two in exon 2 (rs381676360; rs384600927) and two in intron 2 (rs378994837; rs211595914)]. SNP rs381676360 caused a non-synonymous amino acid substitution (leucine/isoleucine) and rs384600927 a synonymous substitution of the valine amino acid. Regarding the Hardy-Weinberg equilibrium, one of the four genotypic frequencies was not in equilibrium (rs211595914; P<0.01). For linkage disequilibrium test (LD) higher r2 values (>0.33) were observed between the SNPs rs381676360, rs384600927 and rs378994837 (r2=0.767 to 0.973) and one SNP (rs211595914) showed lower r2 values (r2=0.016 to 0.025). The association of SNPs with the characteristics [number of in vivo transferable embryos (NET); in vivo transferable embryo rate; (%ET); number of in vitro embryos (NEV); cleavage rate (% CLIV) and in vitro embryo rate (%EV)] was observed. None of the SNPs alone was associated with traits. However, when all SNPs were considered together for the association, significant values were found for NET (P<0.01), NEV (P<0.01) and %EV (P<0.01). Thus, it is possible to conclude that the donor embryo production performance depends on the implemented technique. Still, the JY-1 gene has SNP polymorphisms and they are associated with embryo production in non-lactating Holstein cows. / CNPq: 447172/2014-0 / FAPESP: 2014/13162-1

La fibrillation atriale (FA) est l’arythmie cardiaque la plus fréquente. Elle touche près de 750 000 personnes en France. La technique de traitement la plus courante est l’ablation intracardiaque par radiofréquence (RF). Son principe consiste à isoler électriquement les veines pulmonaires du reste de l’oreillette. Cependant cette technique est invasive et a une efficacité limitée. Les Ultrasons Focalisés de Haute Intensité (HIFU) permettent de léser à distance de façon précise les tissus biologiques. Un traitement de la FA par HIFU transoesophagiens aurait l’avantage d’être mini-invasif et plus efficace qu’un traitement par RF intracardiaque de par la possibilité de générer des lésions transmurales sans nécessiter de contact entre la sonde et la zone à traiter. Un applicateur HIFU transoesophagien à guidage échographique intégré a donc été développé pour le traitement de la FA. Le transducteur peut focaliser le faisceau ultrasonore de 17 mm à 55 mm de profondeur avec une intensité acoustique maximale à sa surface de 12 W•cm-2. Une procédure de traitement HIFU préservant les tissus adjacents a été simulée numériquement sur un modèle anatomique réaliste. Des lésions HIFU transoesophagiennes ont été obtenues ex vivo dans du myocarde dans des conditions anatomiques et physiologiques proches de l’in vivo. Des essais préliminaires d’élastographie par ondes de cisaillement ont permis d’évaluer la faisabilité d’un contrôle de la formation des lésions à l’aide du transducteur d’imagerie intégré. Une première série d’expérimentations in vivo sur le modèle porcin a finalement permis de valider la procédure de traitement et d’induire des dommages biologiques dans le tissu cardiaque / Atrial fibrillation (AF) is the most frequent cardiac arrhythmia. This pathology affects more than 750,000 persons in France. Radiofrequency (RF) endocardial ablation is performed to treat this disease and involves the generation of transmural thermal lesions, to isolate electrically the pulmonary veins (PV) from the left atrium. The technique is, however, invasive and has a limited efficiency, especially for ensuring transmurality which requires a perfect contact between the RF probe and cardiac tissues. High Intensity Focused Ultrasound (HIFU) allows the creation of precise thermal lesions, deep within biological tissues. A transesophageal HIFU approach could provide a minimally-invasive alternative for AF treatment, since deep transmural lesions could be generated at distance from the HIFU probe. In this work, an ultrasound-guided transesophageal applicator has been developed for AF treatment. The HIFU transducer, embedding a transesophageal echocardiography (TEE) probe, can focus the acoustic beam from 17 to 55 mm axially and generate a surface acoustic intensity up to 12 W•cm-2. A complex treatment plan, the HIFU Mini-Maze (HIFUMM), was successfully simulated on a realistic anatomical human model. Transesophageal HIFU lesions were induced experimentally in static myocardium, under ex vivo configurations reflecting an increasing complexity in anatomical and physiological conditions. Investigations conducted on shear wave elastography confirmed the feasibility of using TEE to control the formation of HIFU lesions. Finally, in vivo experiments in a porcine model allowed validating the treatment procedure by inducing biological damages in beating heart

Les structures mécaniques utilisées de nos jours ne cessent d’évoluer en utilisant des matériaux composites ou à gradient fonctionnel afin de répondre aux enjeux de résistance accrue, allégement de la structure et amélioration des performances. Ceux-ci nécessitent un contrôle adéquat de leur état de santé afin de s’assurer de l’intégrité de la structure. L’utilisation des ondes guidées ultrasonores fournit un moyen efficace et rapide d’inspection sur de longues distances. Néanmoins, ces ondes présentent certaines caractéristiques complexes qui rendent la tâche très difficile. L’utilisation d’outils d’analyse tels que les modèles numériques constitue un grand atout pour ce type d’application. Dans ce contexte, l’objectif de cette de thèse est le développement d’un outil de modélisation performant, permettant d’étudier la propagation des ondes guidées ultrasonores avec une grande précision et une faible consommation de ressources et de temps de calculs. De ce fait, l’intérêt est porté sur des méthodes numériques d’ordres élevés dont les propriétés de convergence sont beaucoup améliorées que les méthodes classiques. En particulier, la méthode semi-analytique éléments finis de Galerkin discontinue pour la détermination des courbes de dispersion des ondes guidées est développée. La méthode est applicable aux structures planes et cylindriques fabriquées de matériaux isotropes, anisotropes et hétérogènes (à gradient fonctionnel de propriétés). Une étude comparative sur l’analyse des performances de ces méthodes est effectuée. Celle-ci a démontré la capacité de la méthode à modéliser la propagation des ondes guidées ultrasonores dans des guides d’ondes à section arbitraire avec des performances prometteuses par rapport à la méthode des éléments finis classique. / The mechanical structures used today are constantly evolving using composite or functionally gradient materials to meet the challenges of increased strength, lightening the structure and improving performance. These require adequate control of their state of health to ensure the integrity of the structure. The use of Ultrasound Guided Waves (UGW) provides an efficient and fast way of inspection over long distances. Nevertheless, these waves have some complex features that make the task very difficult. The use of analysis tools such as numerical models is a great asset for this type of application. In this context, the objective of this thesis is the development of a powerful modeling tool, allowing to study the propagation of UGWs with a great precision, less computational time and consumption of resources. Accordingly, we are interested in higher order numerical methods whose convergence properties are much improved than the classical methods. In particular, a semi-analytical discontinuous Galerkin finite element method (SADG-FE) is developped for the determination of the dispersion properties of guided waves in arbitrary cross-section waveguides. The method is applicable to plates and cylindrical structures made of isotropic, anisotropic heterogeneous (functionally graded) materials. The performance analysis of these methods and their comparisons are performed with respect to the models based on the classical finite element method. The results demonstrated the ability of the proposed method to model the propagation of ultrasounic guided waves in arbitrary section waveguides with promising performance over the conventional finite element method.

Darbų apžvalgoje nagrinėjami sergamumo skydliaukės vėžiu pokyčiai Lietuvoje 1978 – 2003 metais bei sergamumo sąsajos su diagnostika. Sergamumas skydliaukės vėžiu Lietuvoje 1978-2003 metais didėjo ir vidutinis metinis pokytis vyrams siekė 4,2% (p<0,0001), o moterims - 6,1% (p<0,0001). Standartizuotas vyrų sergamumo rodiklis padidėjo nuo 0,7 atvejo 100 000 gyventojų 1978 metais iki 2,5 atvejo 100 000 gyventojų 2003 metais, o moterų – atitinkamai nuo 1,5 iki 11,4 atvejo 100 000 gyventojų. Mirtingumas nuo skydliaukės vėžio nagrinėjamu laikotarpiu nepakito. Nustatytas papilinės skydliaukės karcinomos padidėjimas 1978 – 2003 metų laikotarpiu. Didžiausią įtaką susirgimo skaičiaus pokyčiams turėjo skydliaukės vėžio atvejai diagnozuoti ankstyvosiose stadijose. Žymų sergamumo skydliaukės vėžiu padidėjimą 2002-2003 metais Lietuvoje galima susieti su pokyčiais skydliaukės mazgų diagnostikoje, tobulesnių ultragarsinių technologijų panaudojimu bei aktyviu ultragarsu kontroliuojamų aspiracinių biopsijų plona adata pritaikymu klinikinėje praktikoje. / The aim of this study is to analyse changes in thyroid cancer incidence trends in Lithuania during the period of 1978–2003 and the relationship between incidence and diagnostic strategies. Annual percentage changes in the age-standardized rates over this period were 4.2% (p<0.0001) and 6.1% (p<0.0001) for men and women, respectively, for all carcinomas combined. During study period the age-standardized incidence rates increased in males from 0.7 to 2.5 cases per 100000 and in females from 1.5 to 11.4 per 100000. Mortality due to thyroid cancer did not change during the period of 1978–2003. By histopathology, number of papillary thyroid carcinoma cases increased in 1998-2003. Also, there was increase in the number of early stages of thyroid cancer. The increase in thyroid cancer incidence in Lithuania seems to be mainly due to the changes in the management of thyroid nodules and increased usage of ultrasound guided fine needle aspiration biopsy in clinical practice.

L’anesthésie loco-régionale présente une alternative intéressante à l’anesthésie générale dans de nombreuses interventions chirurgicales. L’atout majeur de cette technique est qu’elle réduit grandement les scores de douleurs et améliore par la même la mobilité post-opératoire. L’anesthésie locorégionale écho-guidée (UGRA) devient aujourd’hui, la méthode de référence dans le domaine de l’anesthésie, offrant de nombreux avantages par rapport aux autres méthodes comme la neurostimulation. Cependant, cette technique nécessite en contrepartie un apprentissage spécifique afin d’éviter des complications sévères liées à une erreur de localisation visuelle du nerf dans les images échographiques. L’objectif de cette thèse est de faciliter et de sécuriser la pratique de l’anesthésie loco-régionale écho-guidée. Dans un premier temps, nous avons proposé une méthode de détection du nerf mettant en oeuvre un algorithme qui suite à un prétraitement à partir de filtres fréquentielles, réalise une analyse de texture par apprentissage. Dans ce cadre, deux nouvelles approches ont été explorées : l’une concerne la caractérisation du nerf qui s’appuie sur la prise en compte du bruit présent dans une image ultrasonore, bruit ayant été au préalable atténué partiellement. L’autre propose une technique de sélection des caractéristiques mettant en avant celles qui sont les moins redondantes et les plus pertinentes. Dans un second temps, après étude fine du comportement variable de la morphologie du nerf tout au long d’une séquence d’images ultrasonores, nous avons développé un modèle dynamique ayant comme paramètres des informations en lien avec la cohérence temporelle de la position, de la forme et la confiance de classification des ROI potentielles afin de générer une segmentation robuste. Il est proposé également dans cette partie, un nouveau modèle de forme prenant en compte un ensemble d’intervalles de points de repères du contour, permettant ainsi de s’adapter aux variations de la forme du nerf dans le temps. / Regional anesthesia presents an interesting alternative or complementary act to general anesthesia in many surgical procedures. It reduces pain scores, improves postoperative mobility and facilitates earlier hospital discharge. Ultrasound-Guided Regional Anesthesia (UGRA) has been gaining importance in the last few years, offering numerous advantages over alternative methods of nerve localization (neurostimulation or paraesthesia). However, nerve detection is one of the most difficult tasks that anesthetists can encounter in the UGRA procedure. The context of the present work is to provide practitioners with a method to facilitate and secure the practice of UGRA. However, automatic detection and segmentation in ultrasound images is still a challenging problem in many medical applications. This work addresses two main issues. The first one, we propose an algorithm for nerve detection and segmentation in ultrasound images, this method is composed of a pre-processing, texture analysis and machine learning steps. In this part of work, we explore two new approaches ; one to characterize the nerve and the second for selecting the minimum redundant and maximum relevant features. The second one, we studied the nerve detection in consecutive ultrasound frames. We have demonstrated that the development of an algorithm based on the temporal coherence of the position, the shape and the confidence measure of the classification, allows to generate a robust segmentation. In this work, we also propose a new model of shape based on a set of intervals landmarks able to adapt to the nerve shape under a morphological variations.

Background Dislocation of catheters within the tissue is a challenge in continuous regional anesthesia. A novel self-coiling catheter design is available and has demonstrated a lower dislocation rate in a cadaver model. The dislocation rate and effect on postoperative pain of these catheters in vivo has yet to be determined and were the subjects of this investigation. Methods After ethics committee approval 140 patients undergoing elective distal lower limb surgery were enrolled in this prospective randomized controlled trial. Preoperatively, patients were randomly assigned and received either the conventional (n = 70) or self-coiling catheter (n = 70) for ultrasound-guided popliteal sciatic nerve block in short axis view and by the in-plane approach from lateral to medial. The primary outcome was pain intensity after surgery and on the following three postoperative days. Secondary outcomes investigated were dislocation rate in situ determined by sonography, catheter movement visible from outside, opioid consumption as well as leakage at the puncture site. Results All catheters were successfully inserted. The study population of self-coiling catheters had significantly lower mean numeric rating scale values than the reference cohort on the first (p = 0.01) and second postoperative days (p < 0.01). Sonographic evaluation demonstrated, 42 standard catheters (60%) and 10 self-coiling catheters (14.3%) were dislocated in situ within the first three postoperative days. The externally visible movement of the catheters at insertion site did not differ significantly between groups through the third postoperative day. The opioid consumption was significantly lower in the self-coiling catheter group on the day of surgery and on the second and third postoperative days (p = 0.04, p = 0.03 and p = 0.04, respectively). Conclusion The self-coiling catheter offers a better postoperative pain control and a lower dislocation rate within the tissue when blocking the popliteal sciatic nerve compared to a conventional catheter. Further trials in large patient cohorts are warranted to investigate the potential beneficial effects of self-coiling catheters for other localisations and other application techniques.