Purpose: In patients who had undergone percutaneous endoscopic gastrostomy(PEG), PEG catheter needs to be replaced periodically because of degradation over time, and confirmation of intragastric placement after the replacement is mandatory. Currently, catheter placement is generally confirmed endoscopically under radiographic illumination, but the burden on the patient is heavy. In this study, we examined the usefulness to observe catheter placement in the stomach by performing ultrasonography after PEG catheter replacement, with the aim of reducing the patient burden.
Subjects and Methods: Fifty patients (12 men and 38 women) with a mean age of 82.1±10.9 years who underwent replacement of a bumper-type PEG catheter were included in this study. Semisolid water (water jelly) was injected in the stomach to create good echo domain to make visible, and the catheter was replaced in the routine manner. The clarity of the ultrasonographic images obtained before catheter replacement, after injection of the semisolid water, and after the replacement was evaluated by using a 5-point scale (0 to 4).
Results and Discussion: The scores obtained before replacement, after injection, and after replacement based on the ultrasonographic images were 1.5±0.7, 3.2±0.8, and 2.6±0.9, respectively. Injection of semisolid water in the stomach was effective in confirming the catheter placement because it provided a better image of the PEG catheter.
Conclusion: The use of ultrasonography for confirmation of PEG catheter placement in the stomach was less invasive and reduced patient burden. Moreover, because its application is not limited to the site of the PEG catheter replacement, it may be an effective method.

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Purpose: The purpose of this study was to measure the echo intensity of the infraspinatus muscle, and compare magnetic resonance imaging (MRI) and ultrasound (US) findings.
Methods: Thirty-two patients with rotator cuff tears (RCTs) were enrolled in this study (women: 12; men: 20; mean age: 68.2±11.4 years). Tear size and fatty infiltration were determined by MRI. The subjects were classified into three grades according to Goutallier's classification: mild was stages 0 and 1, moderate was stage 2, and severe was stages 3 and 4. Gray-scale histogram analysis was used for US assessment, which was performed in both subcutaneous fat and muscle in three different regions; the echogenicity ratio (ER) was the ratio between subcutaneous fat and muscle echogenicity. Sonograms of the 32 patient's shoulders revealed 3 shoulders with a partial tear, and 6 with a small tear, 6 with a medium tear, 7 with a large tear and 6 with a massive tear; 4 shoulders had no tear.
Results: When compared by tear size, significant differences were observed according to age [F(5, 26)＝2.75, p＝0.040]. Subsequently, age was significantly higher in the massive tear cases than in the no tear cases. Meanwhile, significant differences were observed in the echo intensities within subcutaneous fat [F(2, 29)＝3.71, p＝0.037], and infraspinatus muscle [F(2, 29)＝6.63, p＝0.004], as well as in ER [F(2, 29)＝13.30, p⟨0.001], when compared by MRI fatty infiltration staging. Subsequently, in subcutaneous fat was significantly higher in the mild grade than in the severe grade subjects. Conversely, ER and muscle echo intensities were significantly lower in the mild grade than in the severe grade.
Conclusion: The study suggests that US can quantitatively and objectively assess fatty infiltration in the infraspinatus muscle.

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[in Japanese]

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