Radio-frequency thermal ablation is one of the most promising minimally invasive techniques for the treatment of nonresectable hepatic tumors. Essential technical tips to successful radio-frequency ablation therapy were collected from five international experts. They were organized into five categories: understanding the mechanisms and principles of radio-frequency ablation, modulation of tissue physiologic characteristics to increase tumor destruction, strategies of overlapping ablations, strategies to improve ablation according to tumor location, and imaging strategies after ablation to ensure adequate therapy. Established factors for optimal ablation, as well as emerging technical tips, are addressed with illustrations in each section. These essential tips will be very helpful for physicians performing radio-frequency ablation of hepatic tumors.

In the past 15 years high-frequency B-mode sonography and colour-power Doppler have become the most important and most widely employed imaging modalities for the study of the neck, in particular for thyroid gland, parathyroids and lymph nodes. Sonography allows not only the detection but often also the characterization of the diseases of these organs, distinguishing benign from malignant lesions with high sensitivity and specificity, which could be further improved by the employ of ultrasound contrast agents and harmonic imaging. Although no single sonographic criterion is specific for benign or malignant nature of the lesions, the combination of different signs can be markedly helpful to speed up the diagnostic process. Fine-needle aspiration biopsy (FNAB) remains the most accurate modality for the definitive assessment of thyroid gland nodules and of any doubtful case of nodal disease. In association with clinical findings and serum levels of parathormone, FNAB has specificity close to 100% for the characterization of parathyroid adenomas. A combined approach with sonography and FNAB is generally highly effective.

No abstract

IntroductionOver the last decade, the therapeutic approach for treating focal liver malignancies, including both hepatocellular carcinoma (HCC) and metastatic lesions, has changed dramatically, particularly due to the proliferation of new treatment strategies. These have included percutaneous ablative therapies such as percutaneous ethanol injection (PEI), thermal therapies such as radiofrequency (RF), laser, and microwaves, as well as angiographic therapies such as segmental chemoembolization and hypoxic perfusion, and orthotopic liver transplantation (OLT). Furthermore, at the same time, there has been a general greater acceptance of previously characterized, more standard treatment modalities such as surgical resection and systemic chemotherapy. Given this wide range of potential therapeutic options, a main aim of current medical management of focal liver cancer is to tailor therapy for every patient by selecting the therapeutic modality which will ideally provide the highest success rate, fewest risks and lowest costs for each given situation. However, in order to provide this level of optimized, individualized care, accurate detection of neoplastic lesions by imaging modalities including ultrasound (US), computed tomography (CT), and magnetic resonance imaging (MRI) is mandatory.Worldwide, US is the most widely available imaging modality for the screening of liver pathology, and has furthermore functioned as the mainstay for screening efforts for the detection of small incidental hepatomas in high-risk patients. Nevertheless, the limitations of conventional gray-scale B-mode US for the detection of focal liver lesions have been well documented [1,2]. Color Doppler and power Doppler increased the sensitivity for hepatic lesion detection compared to grayscale US, but they did not allow levels of sensitivity comparable to those of contrast enhanced axial imaging (CT and MRI). Two breakthroughs in US, harmonic imaging and the development of second-generation contrast agents, have recently been described and have demonstrated the potential to dramatically broaden the scope of US diagnosis of hepatic lesions. This paper will review the prior state of the art for the sonographic detection of the two most common forms of focal liver neoplasia (HCC and metastases), and illustrate the potential of the newer techniques for improving the sensitivity of US . Historical review of conventional ultrasonography Hepatocellular carcinomasThe detection rate of HCC using US is related to the size, location, and echotexture of the lesions, as well as to both the US technology employed and operator experience. Nevertheless, due to successive technologic improvements, there has been a trend toward detecting ever smaller lesions. Given a wide range of techniques and technology, the reported detection rate of HCCs measuring less than 2 cm in diameter has been variable, ranging from 46% to 95% [1, 3, 4], with accurate detection of 82-93% of HCCs measuring between 2 and 3 cm. For HCCs smaller than 1 cm, US is reported to have a detecti...

Aspergillus meningitis may occur in both immunocompetent and immunocompromised patients and run an acute or chronic course. The findings of this systematic review extend the information on this life-threatening infection and could assist physicians in achieving an improved outcome.

No abstract

TPUS is a simple and accurate diagnostic method for classifying perianal fistulae in CD and could be used for the preliminary assessment and follow-up of perianal CD.

No abstract