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The aim of the paper is to provide a comprehensive overview on the applications of real time sonoelastography (SE) in the diagnosis of superficial lymphadenopathy. Some technical aspects of performing SE are presented as a preamble. The typical appearance of benign and malignant nodes is illustrated. The paper discusses and depicts the various elastographic scores in use. It also provides a critical appraisal of the relative strain ratio (SR) or stiffness index. Shear wave elastography, as a novel technique, is mentioned. In conclusion, hardness on more than 50% of the node surface or SR > 1.5 is fair to good indicators of malignancy. Work is still needed both to fully understand the various appearance of disease and to standardize the application.Keywords: sonoelastography, lymph nodes, neoplasm Accurate assessment of the superficial lymph node status is of paramount importance in the treatment planning, follow-up and prognosis of malignancies originating in the head and neck, breast, superficial tissues or in lymphoma. Ultrasonography (US) is extensively used as a first line diagnostic means, due to its cost-effectiveness, ease of use and high resolution of provided information. However, grey-scale and Doppler information are limited either in sensitivity or specificity and no single US criterion has sufficient diagnostic accuracy [1][2][3][4][5].Sonoelastography (SE) depicts the relative stiffness of tissues. Beyond breast, prostate and thyroid applications, over the last five years, the method was also used as a complimentary imaging technique to conventional US for the assessment of superficial lymph nodes [6][7][8][9]. Assessment of nodal SE information is done either by grading the appearance on a score system (elasticity score -ES) or by calculating a relative stiffness or strain ration (SR) [10].The aim of this paper is to review the current status of the knowledge on the applications of SE in the diagnosis of the character of superficial lymphadenopathy. Technical aspectsReal-time sonoelastography is, essentially, an elaborate speckle tracking technique with autocorrelation for out-of-plane displacement of the target [11,12]. It provides information about the relative stiffness of the structures within the scan plane, inside a region of interest (ROI). It is, therefore, important to encompass in the scan area not only the target lesion but also surrounding "normal" reference soft tissues. There are no standard recommendations on how to achieve this. In our experience [13,14], the upper limit of the ROI should always be placed as close to the transducer as possible. When aiming to use ES, the ROI should exceed the target boundaries at least 5 mm on each side. When the purpose is to calculate SR, the ROI should be as wide as possible, to encompass both the target lesion and the surrounding, reference tissue, at the same depth with the lesion. Transducer stabilizer, although desirable, is difficult to use of curved surfaces such as neck or axilla. During compression the transducer should be perpen...

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Objective:The treatment of slipped capital femoral epiphysis (SCFE) is evolving, with the development of new surgical techniques. |We wanted to study if modified Dunn procedure restores the normal alignment of the proximal femur and the risk of avascular necrosis is increased.Methods:This is a single centre, retrospective study, comparing the outcomes of in situ pinning and modified Dunn procedure. Between 2001 and 2014, 7 children (7 hips) underwent the modified Dunn procedure and 10 children (10 hips) pinning in situ for stable and unstable SCFE. Mean age of the patients was 12.7 years with a median follow-up of 18 months.Results:The radiological parameters improved in the modified Dunn procedure group, while the length of the femoral neck didn’t change significantly (p=0.09). Postoperative clinical outcomes were slightly better in the modified Dunn procedure group (6 hips out of 7 had good and excellent results) compared to the pinning in situ group (8 good and excellent results out of 10 hips) (p=0.04). No avascular necrosis was found and there were no cases of chondrolysis.Conclusion:Radiographic parameters of the proximal femur assessed in our study improved in all hips that underwent modified Dunn procedure, without the creation of secondary deformities.

In this paper we intend to define a strategy for managing databases with mobile structures, taking into account their redistribution in the nodes of a computer network. The minimal cost of the redistribution is highlighted and some applications for medical and business databases are presented.

Manipulation and casting according to the Ponseti method are the 'gold standard' for clubfoot treatment, and this method is endorsed by the American Association of Orthopaedic Surgeons. We conducted a retrospective study from January 2004 to December 2012 in our institution. All patients with idiopathic clubfoot were included, and a very strict analysis of the treatment outcomes, relapses and their treatment was carried out. A total of 382 children were included and followed up for a mean period of 6 years. The initial correction rate was 100%. At latest follow-up, the relapse rate was 19.03%, the initial correction being recovered by recasting, second or third percutaneous Achilles tenotomy or anterior tibial tendon lateral transfer. The Ponseti method is safe, efficient in the conservative treatment of clubfoot and decreases the number of surgical interventions, and the very good results are maintained through a 9 years follow-up period.

The current study aims at presenting the results of the two methods of conservative treatment in clubfoot: the Romanian traditional method and the Ponseti method. The study population included 103 children (148 clubfeet) treated in our department between 1998 and 2005. Between 1998 and 2003, the conservative treatment protocol was based upon the Romanian method. The Ponseti method has been used since 2004. The main criterion for the assessment of the efficiency of the two conservative methods in clubfoot is the number of feet requiring surgical treatment - posteromedial release at 18 months. This criterion is clearly in favor of the Ponseti method: four feet (5%) needed posteromedial release in Ponseti group patients versus 13 feet (18%) in Romanian group patients (P=0.0193). The Ponseti method is safe, efficient in the conservative treatment of clubfoot and decreases the number of surgical interventions needed for the correction of the deformation compared with our traditional method.

Elastic stable intramedullary nailing (ESIN) is a minimally invasive technique. According to this technique, two elastic nails are introduced through the metaphysis into the medullary canal, advanced through the fracture site and impacted into the opposite metaphysis. These nails are preformed in a C-shaped manner, which allows for their precise orientation and the creation of an elastic system that resists deformation.