The grumpy stump - ultrasound and stump appendicitis

BACKGROUND: Stump appendicitis, the inflammation of an incompletely removed appendix, is a rare clinical presentation. Sonography can be useful in the diagnosis of the condition; by either directly visualising the inflamed stump, or by identifying signs of peri-caecal inflammation that can raise suspicion of the condition. SUMMARY OF WORK: A potential case of stump appendicitis was identified. This prompted a review of literature focused on the incidence of stump appendicitis, utility of ultrasound to identify an inflamed appendiceal stump, and surgical techniques used in appendectomy. SUMMARY OF RESULTS: Stump appendicitis is rare, with as few as 61 cases identified in literature during the last 60 years1. Of the two common techniques of appendectomy, which are ligation and invagination, the former can sometimes leave a residual stump that acts as a potential lumen for the pathophysiological process of appendicitis to recur. Established sonographic criteria for appendicitis also apply to the residual stump. Sonographic secondary signs that suggest the presence of acute appendicitis2 have also been demonstrated in cases of stump appendicitis3, even in the absence of an identifiable stump. DISCUSSION AND CONCLUSIONS: Appendicitis is usually dismissed in patients with a history of appendectomy. Though uncommon, sonographers should be aware of stump appendicitis in post-appendectomy patients that present with right iliac fossa pain from months to decades later. REFERENCE(S) 1. Subramanian A, Liang MK. A 60-year literature review of stump appendicitis: The need for a critical view. Am J Surg; 2012;203(4):503–7. 2. Reddan T, Corness J, Mengersen K, Harden F. Ultrasound of paediatric appendicitis and its secondary sonographic signs: providing a more meaningful finding. J Med Radiat Sci. 2015;DOI: 10.1002/jmrs.154 3. Martínez Chamorro E, Merina Castilla A, Muñoz Fraile B, Koren Fernández L, Borruel Nacenta S. Stump appendicitis: Preoperative imaging findings in four cases. Abdom Imaging. 2013;38(6):1214–9.

Evaluation of noise attenuation due to exhaust mufflers

This paper deals with the evaluation of noise attenuation due to exhaust mufflers fitted to the conventional piston engines. A discussion of the existing methods for the purpose, reveals the undesirability of the assumptions and simplifications implied therein. An expression for the attenuation of a general muffler has been derived. The classical theory of "sound transmission in pipes" [1] has been exploited to evaluate this "expression" for mufflers of different geometry. The quantitative effects of atmospheric impedance, and the engine exhaust impedance on the attenuation curves of a specific muffler have been found for an automotive engine. Finally, attenuation curves of a number of mufflers have been drawn and compared to suggest certain design criteria.

Contrast-enhanced ultrasound of abdominal organs in cats

The primary aim of this thesis was the evaluation of the perfusion of normal organs in cats using contrast-enhanced ultrasound (CEUS), to serve as a reference for later clinical studies. Little is known of the use of CEUS in cats, especially regarding its safety and the effects of anesthesia on the procedure, thus, secondary aims here were to validate the quantitative analyzing method, to investigate the biological effects of CEUS on feline kidneys, and to assess the effect of anesthesia on splenic perfusion in cats undergoing CEUS. -- The studies were conducted on healthy, young, purpose-bred cats. CEUS of the liver, left kidney, spleen, pancreas, small intestine, and mesenteric lymph nodes was performed to characterize the normal perfusion of these organs on ten anesthetized, male cats. To validate the quantification method, the effects of placement and size of the region of interest (ROI) on perfusion parameters were investigated using CEUS: Three separate sets of ROIs were placed in the kidney cortex, varying in location, size, or depth. The biological effects of CEUS on feline kidneys were estimated by measuring urinary enzymatic activities, analyzing urinary specific gravity, pH, protein, creatinine, albumin, and sediment, and measuring plasma urea and creatinine concentrations before and after CEUS. Finally, the impact of anesthesia on contrast enhancement of the spleen was investigated by imaging cats with CEUS first awake and later under anesthesia on separate days. -- Typical perfusion patterns were found for each of the studied organs. The liver had a gradual and more heterogeneous perfusion pattern due to its dual blood flow and close proximity to the diaphragm. An obvious and statistically significant difference emerged in the perfusion between the kidney cortex and medulla. Enhancement in the spleen was very heterogeneous at the beginning of imaging, indicating focal dissimilarities in perfusion. No significant differences emerged in the perfusion parameters between the pancreas, small intestine, and mesenteric lymph nodes. -- The ROI placement and size were found to have an influence on the quantitative measurements of CEUS. Increasing the depth or the size of the ROI decreased the peak intensity value significantly, suggesting that where and how the ROI is placed does matter in quantitative analyses. --- A significant increase occurred in the urinary N-acetyl-β-D-glucosaminidase (NAG) to creatinine ratio after CEUS. No changes were noted in the serum biochemistry profile after CEUS, with the exception of a small decrease in blood urea concentration. The magnitude of the rise in the NAG/creatinine ratio was, however, less than the circadian variation reported earlier in healthy cats. Thus, the changes observed in the laboratory values after CEUS of the left kidney did not indicate any detrimental effects in kidneys. Heterogeneity of the spleen was observed to be less and time of first contrast appearance earlier in nonanesthetized cats than in anesthetized ones, suggesting that anesthesia increases heterogeneity of the feline spleen in CEUS. ---- In conclusion, the results suggest that CEUS can be used also in feline veterinary patients as an additional diagnostics aid. The perfusion patterns found in the imaged organs were typical and similar to those seen earlier in other species, with the exception of the heterogeneous perfusion pattern in the cat spleen. Differences in the perfusion between organs corresponded with physiology. Based on the results, estimation of focal perfusion defects of the spleen in cats should be performed with caution and after the disappearance of the initial heterogeneity, especially in anesthetized or sedated cats. Finally, these results indicate that CEUS can be used safely to analyze kidney perfusion also in cats. Future clinical studies are needed to evaluate the full potential of CEUS in feline medicine as a tool for diagnosing lesions in various organ systems.

Elastic property estimation using Ultrasound Assisted Optical Elastography through Remote Palpation - A simulation study - art. no. 61640Q

We propose an effective elastography technique in which an acoustic radiation force is used for remote palpation to generate localized tissue displacements, which are directly correlated to localized variations of tissue stiffness and are measured using a light probe in the same direction of ultrasound propagation. The experimental geometry has provision to input light beam along the ultrasound propagation direction, and hence it can be prealigned to ensure proper interception of the focal region by the light beam. Tissue-mimicking phantoms with homogeneous and isotropic mechanical properties of normal and malignant breast tissue are considered for the study. Each phantom is insonified by a focusing ultrasound transducer (1 MHz). The focal volume of the transducer and the ultrasound radiation force in the region are estimated through solving acoustic wave propagation through medium assuming average acoustic properties. The forward elastography problem is solved for the region of insonification assuming the Lame's parameters and Poisson's ratio, under Dirichlet boundary conditions which gives a distribution of displacement vectors. The direction of displacement, though presented spatial variation, is predominantly towards the ultrasound propagation direction. Using Monte Carlo (MC) simulation we have traced the photons through the phantom and collected the photons arriving at the detector on the boundary of the object in the direction of ultrasound. The intensity correlations are then computed from detected photons. The intensity correlation function computed through MC simulation showed a modulation whose strength is found to be proportional to the amplitude of displacement and inversely related to the storage (elastic) modulus. It is observed that when the storage modulus in the focal region is increased the computed displacement magnitude, as indicated by the depth of modulation in the intensity autocorrelation, decreased and the trend is approximately exponential.

Assessment of ultrasound modulation of near infrared light on the quantification of scattering coefficient

Purpose: To assess the effect of ultrasound modulation of near infrared (NIR) light on the quantification of scattering coefficient in tissue-mimicking biological phantoms.Methods: A unique method to estimate the phase of the modulated NIR light making use of only time averaged intensity measurements using a charge coupled device camera is used in this investigation. These experimental measurements from tissue-mimicking biological phantoms are used to estimate the differential pathlength, in turn leading to estimation of optical scattering coefficient. A Monte-Carlo model base numerical estimation of phase in lieu of ultrasound modulation is performed to verify the experimental results. Results: The results indicate that the ultrasound modulation of NIR light enhances the effective scattering coefficient. The observed effective scattering coefficient enhancement in tissue-mimicking viscoelastic phantoms increases with increasing ultrasound drive voltage. The same trend is noticed as the ultrasound modulation frequency approaches the natural vibration frequency of the phantom material. The contrast enhancement is less for the stiffer (larger storage modulus) tissue, mimicking tumor necrotic core, compared to the normal tissue. Conclusions: The ultrasound modulation of the insonified region leads to an increase in the effective number of scattering events experienced by NIR light, increasing the measured phase, causing the enhancement in the effective scattering coefficient. The ultrasound modulation of NIR light could provide better estimation of scattering coefficient. The observed local enhancement of the effective scattering coefficient, in the ultrasound focal region, is validated using both experimental measurements and Monte-Carlo simulations. (C) 2010 American Association of Physicists in Medicine. [DOI: 10.1118/1.3456441]

A novel two sources ultrasound modulated optical tomographic system for screening breast cancer through elasticity characterization

The study of non-invasive characterization of elastic properties of soft biological tissues has been a focus of active researches since recent years. Light is highly scattered by biological tissues and hence, sophisticated reconstruction algorithms are required to achieve good imaging depth and a reasonable resolution. Ultrasound (US), on the otherhand, is less scattered by soft tissues and it has been in use for imaging in biomedical ultrasound systems. Combination of the contrast sensitivity of light and good localization of ultrasound provides a challenging technique for characterization of thicker tissues deep inside the body non-invasively. The elasticity of the tissues is characterized by studying the response of tissues to mechanical excitation induced by an acoustic radiation force (remotely) using an optical laser. The US modulated optical signals which traverse the tissue are detected by using a CCD camera as detector array and the pixel map formed on the CCD is used to characterize the embedded inhomogeneities. The use of CCD camera improves the signal-noise-ratio (SNR) by averaging the signals from all of the CCD pixels.

Detection and Evaluation of Impact damage in CFRP Laminates Using Ultrasound C-Scan and IR Thermography

Advanced composite structural components made up of Carbon Fibre Reinforced Polymers (CFRP) used in aerospace structures such as in Fuselage, Leading & Trailing edges of wing and tail, Flaps, Elevator, Rudder and entire wing structures encounter most critical type of damage induced by low velocity impact (<10 m/s) loads. Tool dropped during maintenance & service,and hailstone impacts on runways are common and unavoidable low-velocity impacts. These lowvelocity impacts induce defects such as delaminations, matrix cracking and debonding in the layered material, which are sub-surface in nature and are barely visible on the surface known as Barely Visible Impact Damage (BVID). These damages may grow under service load, leading to catastrophic failure of the structure. Hence detection, evaluation and characterization of these types of damage is of major concern in aerospace industries as the life of the component depends on the size and shape of the damage.In this paper, details of experimental investigations carried out and results obtained from a low-velocity impact of 30 Joules corresponding to the hailstone impact on the wing surface,simulated on the 6 mm CFRP laminates using instrumented drop-weight impact testing machine are presented. The Ultrasound C-scan and Infrared thermography imaging techniques were utilized extensively to detect, evaluate and characterize impact damage across the thickness of the laminates.

Ultrasound-modulated optical tomography: recovery of amplitude of vibration in the insonified region from boundary measurement of light correlation

We address a certain inverse problem in ultrasound-modulated optical tomography: the recovery of the amplitude of vibration of scatterers [p(r)] in the ultrasound focal volume in a diffusive object from boundary measurement of the modulation depth (M) of the amplitude autocorrelation of light [phi(r, tau)] traversing through it. Since M is dependent on the stiffness of the material, this is the precursor to elasticity imaging. The propagation of phi(r, tau) is described by a diffusion equation from which we have derived a nonlinear perturbation equation connecting p(r) and refractive index modulation [Delta n(r)] in the region of interest to M measured on the boundary. The nonlinear perturbation equation and its approximate linear counterpart are solved for the recovery of p(r). The numerical results reveal regions of different stiffness, proving that the present method recovers p(r) with reasonable quantitative accuracy and spatial resolution. (C) 2011 Optical Society of America

Ultrasound modulated optical tomography: Young's modulus of the insonified region from measurement of natural frequency of vibration

We demonstrate a method to recover the Young's modulus (E) of a tissue-mimicking phantom from measurements of ultrasound modulated optical tomography (UMOT). The object is insonified by a dualbeam, confocal ultrasound transducer (US) oscillating at frequencies f(0) and f(0) + Delta f and the variation of modulation depth (M) in the autocorrelation of light traversed through the focal region of the US transducer against Delta f is measured. From the dominant peaks observed in the above variation, the natural frequencies of the insonified region associated with the vibration along the US transducer axis are deduced. A consequence of the above resonance is that the speckle fluctuation at the resonance frequency has a higher signal-to-noise to ratio (SNR). From these natural frequencies and the associated eigenspectrum of the oscillating object, Young's modulus (E) of the material in the focal region is recovered. The working of this method is confirmed by recovering E in the case of three tissue-mimicking phantoms of different elastic modulus values. (C) 2011 Optical Society of America

Distinct mechanisms of DNA repair in mycobacteria and their implications in attenuation of the pathogen growth

About a third of the human population is estimated to be infected with Mycobacterium tuberculosis. Emergence of drug resistant strains and the protracted treatment strategies have compelled the scientific community to identify newer drug targets, and to develop newer vaccines. In the host macrophages, the bacterium survives within an environment rich in reactive nitrogen and oxygen species capable of damaging its genome. Therefore, for its successful persistence in the host, the pathogen must need robust DNA repair mechanisms. Analysis of M. tuberculosis genome sequence revealed that it lacks mismatch repair pathway suggesting a greater role for other DNA repair pathways such as the nucleotide excision repair, and base excision repair pathways. In this article, we summarize the outcome of research involving these two repair pathways in mycobacteria focusing primarily on our own efforts. Our findings, using Mycobacterium smegmatis model, suggest that deficiency of various DNA repair functions in single or in combinations severely compromises their DNA repair capacity and attenuates their growth under conditions typically encountered in macrophages. (C) 2011 Elsevier Ireland Ltd. All rights reserved.

Ultrasound Assisted Optical Tomography: Estimation of phase Shift experienced by photon on transit through US insonified region for detection of breast tumor

A Monte Carlo model of ultrasound modulation of multiply scattered coherent light in a highly scattering media has been carried out for estimating the phase shift experienced by a photon beam on its transit through US insonified region. The phase shift is related to the tissue stiffness, thereby opening an avenue for possible breast tumor detection. When the scattering centers in the tissue medium is exposed to a deterministic forcing with the help of a focused ultrasound (US) beam, due to the fact that US-induced oscillation is almost along particular direction, the direction defined by the transducer axis, the scattering events increase, thereby increasing the phase shift experienced by light that traverses through the medium. The phase shift is found to increase with increase in anisotropy g of the medium. However, as the size of the focused region which is the region of interest (ROI) increases, a large number of scattering events take place within the ROI, the ensemble average of the phase shift (Delta phi) becomes very close to zero. The phase of the individual photon is randomly distributed over 2 pi when the scattered photon path crosses a large number of ultrasound wavelengths in the focused region. This is true at high ultrasound frequency (1 MHz) when mean free path length of photon l(s) is comparable to wavelength of US beam. However, at much lower US frequencies (100 Hz), the wavelength of sound is orders of magnitude larger than l(s), and with a high value of g (g 0.9), there is a distinct measurable phase difference for the photon that traverses through the insonified region. Experiments are carried out for validation of simulation results.

Ultrasound modulation of coherent light in a multiple-scattering medium: experimental verification of nonzero average phase carried by light

We demonstrate the phase fluctuation introduced by oscillation of scattering centers in the focal volume of an ultrasound transducer in an optical tomography experiment has a nonzero mean. The conditions to be met for the above are: (i) the frequency of the ultrasound should be in the vicinity of the most dominant natural frequency of vibration of the ultrasound focal volume, (ii) the corresponding acoustic wavelength should be much larger than l(n)*, a modified transport mean-free-path applicable for phase decorrelation and (iii) the focal volume of the ultrasound transducer should not be larger than 4 - 5 times (l(n)*)(3). We demonstrate through simulations that as the ratio of the ultrasound focal volume to (l(n)*)(3) increases, the average of the phase fluctuation decreases and becomes zero when the focal volume becomes greater than around 4(l(n)*)(3); and through simulations and experiments that as the acoustic frequency increases from 100 Hz to 1 MHz, the average phase decreases to zero. Through experiments done in chicken breast we show that the average phase increases from around 110 degrees to 130 degrees when the background medium is changed from water to glycerol, indicating that the average of the phase fluctuation can be used to sense changes in refractive index deep within tissue.