Ultrasonography is a painless and rapid method, which is attractive for testing in children. The objective of this study was to try to measure a cross-sectional area (CSA) at predetermined sites along the median and ulnar nerves in children by ultrasonography. The CSAs measured by ultrasonography were determined bilaterally at the mid-humerus of median nerve (MedArm) and the arterial split of ulnar nerve (UlnProx) in 20 healthy Japanese children from 1 to 6 years old. Participants were 10 boys and 10 girls, 4.0 ± 1.8 years of age. The maximum value of CSA at the MedArm was 5mm² up to 3 years old and 7mm² from 4 to 6 years old. The maximum value of CSA at the UlnProx was 3mm² up to 3 years old and 4mm² from 4 to 6 years old. We identified the possibility of the ultrasonographic measurement of nerve sizes in children who were younger than those of the previous studies for children.

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Purpose: This study is to assess the clinical utility of jugular venous flow pattern by evaluating ultrasonography.
Methods: Consecutive 438 patients who underwent carotid artery ultrasonography were enrolled. They were evaluated jugular vein flow patterns and divided into three types: orthodromic, to-and-fro and antidromic. All of them were received MRA and compared to the flow patterns of ultrasonography. The relationship of jugular venous flow pattern and dural arteriovenous fistula (dAVF)/transient global amnesia (TGA) was also assessed.
Results: The to-and-fro or antidromic pattern was significantly associated with older age, but not heart failure, in 81 patients, which was more frequently found on the left side. On MRA, venous flow signals were observed in 28 patients. The to-and-fro or antidromic pattern were more frequently observed on ultrasonography and was significantly associated with venous flow signals on MRA. Four patients who were diagnosed as dAVF showed the orthodromic flow pattern. Twelve patients who were diagnosed as TGA, and five of them showed a to-and-fro or antidromic flow pattern, which was a significantly high frequency.
Conclusions: Assessment of jugular flow patterns by ultrasonography and/or MRA can help the diagnosis of diseases which are supposed to jugular venous flow abnormality.

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Introduction: Detection of systemic embolization is important for treating patients with infective endocarditis (IE). Subclinical small emboli, many of which might occur behind the overt embolization, will be detected as a microembolic signal (MES) with transcranial Doppler (TCD).
Case report: A 54-year-old male with fever and impaired consciousness was admitted with suspected encephalopathy. His medical history included bioprosthetic aortic valve replacement performed 3 years before admission. Although IE was considered as differential diagnosis, transthoracic echocardiography and contrast-enhanced CT scan did not reveal the presence of lesions. According to the modified Duke criteria, his case was classified as “rejected IE.” However, TCD revealed four MESs in the left middle cerebral artery, and IE was reconsidered. Transesophageal echocardiography revealed a 14-mm mobile vegetation on the prosthetic valve. Although early surgery was planned, CT revealed small subarachnoid hemorrhages in the left cerebral hemisphere. The risk of systemic embolization was considered high; therefore, valve replacement was performed at day 6 after admission. After 1 month, the patient was discharged without sequelae.
Conclusions: MESs may be useful as a marker for subclinical embolization in patients with IE. Further studies should assess the potential of TCD for the diagnosis and risk stratification of IE.

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A 77-year-old man with chronic kidney disease was presented to our hospital because he developed involuntary movement of bilateral upper limbs and dysarthria during dialysis. On admission, he showed myoclonus on bilateral upper limbs and dysarthria caused by involuntary movement of the tongue. We diagnosed metabolic involuntary movements due to renal failure. Myoclonus on bilateral upper limbs disappeared on the next day, however, involuntary movement of the tongue remained. Transoral motion-mode ultrasonography (TOMU) revealed that the tongue moved with a frequency of 4–5Hz intermittently, and we made diagnosis of lingual myoclonus. TOMU can measure the frequency of involuntary movements of tongue. TOMU is useful for the diagnosis of oral involuntary movement.

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A 71-year-old man was admitted to our hospital with disturbances of consciousness and right hemiparesis. Upon admission, brain magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) revealed an acute infarction in the area of the left middle cerebral artery, and a near-occlusion of the left internal carotid artery (ICA). A stent was placed in the ICA to maintain cerebral blood flow. Contrast-enhanced ultrasonography (CEUS) was performed on day 3, and a thrombus was identified along the inner surface of the stent. Intravenous heparin was continuously administered to decrease the size of the thrombus. A repeat CEUS on day 17 revealed a complete disappearance of the stent thrombus and stenosis. This case suggests that CEUS is a useful modality for the detection of stent thromboses, and for the evaluation of the effects of antithrombotic therapy.

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Purpose: In ultra-acute stroke treatment, our hospital revised the manual by inducing a single call activation system and promoting multidisciplinary cooperation. Clinical laboratory technologists perform emergent carotid ultrasonography. We investigated the effect of the revised manual.
Methods: We compared the therapeutic time before and after induction of the revised manual. In addition, we conducted questionnaires with doctors and clinical laboratory technologists.
Results: We investigated 36 cases before the induction of the revised manual and 24 patients after. Door-to-needle time was significantly shortened after induction of the revised manual (71.02min vs. 33.33min). According to questionnaires, emergent carotid ultrasonography by clinical laboratory technologists reduced the burden on doctors and assisted in policy decisions for therapy because the results of carotid ultrasonography suggested the etiologies. The revised manual revealed that clinical laboratory technologists were not experienced enough with the emergent situation to perform ultrasonography precisely. In addition, the system of holiday/night time should be discussed.
Conclusions: The revised manual and routinized emergent carotid ultrasonography by clinical laboratory technologists improved the quality of ultra-acute stroke treatment. Moreover, for the clinical laboratory technologists, it becomes a valuable multidisciplinary cooperation.

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