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Ruiter NV, Kripfgans OD. Medical ultrasound: Time-honored method or emerging research frontier? Z Med Phys 2023; 33:251-254. [PMID: 37302938 PMCID: PMC10517395 DOI: 10.1016/j.zemedi.2023.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
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Golemati S, Cokkinos DD. Recent advances in vascular ultrasound imaging technology and their clinical implications. Ultrasonics 2022; 119:106599. [PMID: 34624584 DOI: 10.1016/j.ultras.2021.106599] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 08/26/2021] [Accepted: 09/21/2021] [Indexed: 06/13/2023]
Abstract
In this paper recent advances in vascular ultrasound imaging technology are discussed, including three-dimensional ultrasound (3DUS), contrast-enhanced ultrasound (CEUS) and strain- (SE) and shear-wave-elastography (SWE). 3DUS imaging allows visualisation of the actual 3D anatomy and more recently of flow, and assessment of geometrical, morphological and mechanical features in the carotid artery and the aorta. CEUS involves the use of microbubble contrast agents to estimate sensitive blood flow and neovascularisation (formation of new microvessels). Recent developments include the implementation of computerised tools for automated analysis and quantification of CEUS images, and the possibility to measure blood flow velocity in the aorta. SE, which yields anatomical maps of tissue strain, is increasingly being used to investigate the vulnerability of the carotid plaque, but is also promising for the coronary artery and the aorta. SWE relies on the generation of a shear wave by remote acoustic palpation and its acquisition by ultrafast imaging, and is useful for measuring arterial stiffness. Such advances in vascular ultrasound technology, with appropriate validation in clinical trials, could positively change current management of patients with vascular disease, and improve stratification of cardiovascular risk.
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Affiliation(s)
- Spyretta Golemati
- Medical School, National and Kapodistrian University of Athens, Athens, Greece.
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Shin Low S, Nong Lim C, Yew M, Siong Chai W, Low LE, Manickam S, Ti Tey B, Show PL. Recent ultrasound advancements for the manipulation of nanobiomaterials and nanoformulations for drug delivery. Ultrason Sonochem 2021; 80:105805. [PMID: 34706321 PMCID: PMC8555278 DOI: 10.1016/j.ultsonch.2021.105805] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Revised: 10/08/2021] [Accepted: 10/20/2021] [Indexed: 05/04/2023]
Abstract
Recent advances in ultrasound (US) have shown its great potential in biomedical applications as diagnostic and therapeutic tools. The coupling of US-assisted drug delivery systems with nanobiomaterials possessing tailor-made functions has been shown to remove the limitations of conventional drug delivery systems. The low-frequency US has significantly enhanced the targeted drug delivery effect and efficacy, reducing limitations posed by conventional treatments such as a limited therapeutic window. The acoustic cavitation effect induced by the US-mediated microbubbles (MBs) has been reported to replace drugs in certain acute diseases such as ischemic stroke. This review briefly discusses the US principles, with particular attention to the recent advancements in drug delivery applications. Furthermore, US-assisted drug delivery coupled with nanobiomaterials to treat different diseases (cancer, neurodegenerative disease, diabetes, thrombosis, and COVID-19) are discussed in detail. Finally, this review covers the future perspectives and challenges on the applications of US-mediated nanobiomaterials.
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Affiliation(s)
- Sze Shin Low
- Continental-NTU Corporate Lab, Nanyang Technological University, 50 Nanyang Drive, Singapore 637553, Singapore; Department of Chemical and Environmental Engineering, Faculty of Science and Engineering, University of Nottingham Malaysia, Jalan Broga, Semenyih 43500, Selangor Darul Ehsan, Malaysia
| | - Chang Nong Lim
- School of Engineering and Physical Sciences, Heriot-Watt University Malaysia, No. 1, Jalan Venna P5/2, Precinct 5, Putrajaya 62200, Malaysia
| | - Maxine Yew
- Department of Mechanical, Materials and Manufacturing Engineering, University of Nottingham Ningbo China, 199 Taikang East Road, Ningbo 315100, Zhejiang, China
| | - Wai Siong Chai
- School of Mechanical Engineering and Automation, Harbin Institute of Technology, Shenzhen, Shenzhen 518055, Guangdong, China
| | - Liang Ee Low
- Biofunctional Molecule Exploratory (BMEX) Research Group, School of Pharmacy, Monash University Malaysia, Jalan Lagoon Selatan, Bandar Sunway 47500, Selangor Darul Ehsan, Malaysia; Advanced Engineering Platform, Monash University Malaysia, Jalan Lagoon Selatan, Bandar Sunway 47500, Selangor Darul Ehsan, Malaysia; Institute of Pharmaceutics, College of Pharmaceutical Sciences, Zhejiang University, 866 Yuhangtang Road, Hangzhou 310058, Zhejiang, China.
| | - Sivakumar Manickam
- Petroleum and Chemical Engineering, Faculty of Engineering, Universiti Teknologi Brunei, Jalan Tungku Link Gadong, Bandar Seri Begawan, BE1410, Brunei Darussalam.
| | - Beng Ti Tey
- Advanced Engineering Platform, Monash University Malaysia, Jalan Lagoon Selatan, Bandar Sunway 47500, Selangor Darul Ehsan, Malaysia; Chemical Engineering Discipline, School of Engineering, Monash University Malaysia, Jalan Lagoon Selatan, Bandar Sunway 47500, Selangor Darul Ehsan, Malaysia
| | - Pau Loke Show
- Department of Chemical and Environmental Engineering, Faculty of Science and Engineering, University of Nottingham Malaysia, Jalan Broga, Semenyih 43500, Selangor Darul Ehsan, Malaysia.
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Barry HC. Ultrasonography Is Accurate for Diagnosing Upper Extremity Fractures in Children. Am Fam Physician 2021; 104:Online. [PMID: 34913666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
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Affiliation(s)
- José L Díaz-Gómez
- From the Baylor College of Medicine, Houston (J.L.D.-G.); and the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead (P.H.M.), and the Albert Einstein College of Medicine, New York (S.J.K.) - both in New York
| | - Paul H Mayo
- From the Baylor College of Medicine, Houston (J.L.D.-G.); and the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead (P.H.M.), and the Albert Einstein College of Medicine, New York (S.J.K.) - both in New York
| | - Seth J Koenig
- From the Baylor College of Medicine, Houston (J.L.D.-G.); and the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead (P.H.M.), and the Albert Einstein College of Medicine, New York (S.J.K.) - both in New York
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6
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Dal Maso L, Panato C, De Paoli A, Mattioli V, Serraino D, Elisei R, Zoppini G, Gobitti C, Borsatti E, Di Felice E, Falcini F, Ferretti S, Francisci S, Giorgi Rossi P, Guzzinati S, Mazzoleni G, Pierannunzio D, Piffer S, Vaccarella S, Vicentini M, Zorzi M, Franceschi S, Fedeli U. Trends in thyroid function testing, neck ultrasound, thyroid fine needle aspiration, and thyroidectomies in North-eastern Italy. J Endocrinol Invest 2021; 44:1679-1688. [PMID: 33460012 PMCID: PMC8285305 DOI: 10.1007/s40618-020-01475-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 11/24/2020] [Indexed: 11/04/2022]
Abstract
PURPOSE Evidence of an increased diagnostic pressure on thyroid has emerged over the past decades. This study aimed to provide estimates of a wide spectrum of surveillance indicators for thyroid dysfunctions and diseases in Italy. METHODS A population-based study was conducted in North-eastern Italy, including 11.7 million residents (20% of the total Italian population). Prescriptions for TSH testing, neck ultrasound or thyroid fine needle aspiration (FNA), surgical procedures, and drugs for hypo- or hyperthyroidism were extracted from regional health databases. Proportions and rates of selected examinations were calculated from 2010 to 2017, overall and by sex, calendar years, age, and region. RESULTS Between 2010 and 2017 in North-eastern Italy, 24.5% of women and 9.8% of men received at least one TSH test yearly. In 2017, 7.1% of women and 1.5% of men were prescribed drugs for thyroid dysfunction, 94.6% of whom for hypothyroidism. Neck ultrasound examinations were performed yearly in 6.9% of women and 4.6% of men, with a nearly two-fold variation between areas. Thyroid FNA and thyroidectomies were three-fold more frequent in women (394 and 85 per 100,000) than in men (128 and 29 per 100,000) with a marked variation between areas. Both procedures decreased consistently after 2013. CONCLUSIONS The results of this population-based study describe recent variations over time and between surrounding areas of indicators of 'diagnostic pressure' on thyroid in North-eastern Italy. These results emphasize the need to harmonize practices and to reduce some procedures (e.g., neck ultrasound and total thyroidectomies) in certain areas.
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Affiliation(s)
- L Dal Maso
- Cancer Epidemiology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Via Franco Gallini 2, 33081, Aviano, PN, Italy.
| | - C Panato
- Cancer Epidemiology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Via Franco Gallini 2, 33081, Aviano, PN, Italy
| | - A De Paoli
- Epidemiological Department, Azienda Zero, Via J. Avanzo, 35, 35132, Padua, Italy
| | - V Mattioli
- Cancer Epidemiology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Via Franco Gallini 2, 33081, Aviano, PN, Italy
| | - D Serraino
- Cancer Epidemiology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Via Franco Gallini 2, 33081, Aviano, PN, Italy
| | - R Elisei
- Unit of Endocrinology, Department of Clinical and Experimental Medicine, University Hospital of Pisa, Pisa, Italy
| | - G Zoppini
- Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Hospital Trust of Verona, Verona, Italy
| | - C Gobitti
- Radiation Oncology, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, 33081, Aviano, Italy
| | - E Borsatti
- Nuclear Medicine Unit, CRO Aviano National Cancer Institute, Via Franco Gallini, 2, 33081, Aviano, Italy
| | - E Di Felice
- Authority for Healthcare and Welfare, Emilia Romagna Regional Health Service, Bologna, Italy
| | - F Falcini
- Romagna Cancer Registry, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), IRCCS, Meldola, Italy
- Azienda Usl della Romagna, Forlì, Italy
| | - S Ferretti
- Ferrara Cancer Registry, University of Ferrara, Azienda USL Ferrara, Ferrara, Italy
| | - S Francisci
- National Centre for Disease Prevention and Health Promotion, National Institute of Health, Rome, Italy
| | - P Giorgi Rossi
- Reggio Emilia Cancer Registry, Epidemiology Unit, AUSL ASMN-IRCCS, Azienda USL di Reggio Emilia, Reggio Emilia, Italy
| | - S Guzzinati
- Epidemiological Department, Azienda Zero, Via J. Avanzo, 35, 35132, Padua, Italy
| | | | - D Pierannunzio
- National Centre for Disease Prevention and Health Promotion, National Institute of Health, Rome, Italy
| | - S Piffer
- Trento Province Cancer Registry, Unit of Clinical Epidemiology, Trento, Italy
| | - S Vaccarella
- Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France
| | - M Vicentini
- Reggio Emilia Cancer Registry, Epidemiology Unit, AUSL ASMN-IRCCS, Azienda USL di Reggio Emilia, Reggio Emilia, Italy
| | - M Zorzi
- Epidemiological Department, Azienda Zero, Via J. Avanzo, 35, 35132, Padua, Italy
| | - S Franceschi
- Cancer Epidemiology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Via Franco Gallini 2, 33081, Aviano, PN, Italy
| | - U Fedeli
- Epidemiological Department, Azienda Zero, Via J. Avanzo, 35, 35132, Padua, Italy.
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Dacrema A, Silva M, Rovero L, Vertemati V, Losi G, Piepoli MF, Sacchi R, Mangiacotti M, Nazerian P, Pagani L, Tinelli V, Poggiali E, Bastoni D, Vercelli A, Magnacavallo A. A simple lung ultrasound protocol for the screening of COVID-19 pneumonia in the emergency department. Intern Emerg Med 2021; 16:1297-1305. [PMID: 33428110 PMCID: PMC7797709 DOI: 10.1007/s11739-020-02596-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 12/02/2020] [Indexed: 01/08/2023]
Abstract
The most relevant manifestation of coronavirus disease 2019 (COVID-19) is interstitial pneumonia. Several lung ultrasound (US) protocols for pneumonia diagnosis are used in clinical practice, but none has been proposed for COVID-19 patients' screening in the emergency department. We adopted a simplified 6-scan lung US protocol for COVID-19 pneumonia diagnosis (LUSCOP) and compared its sensitivity with high resolution computed tomography (HRCT) in patients suspected for COVID-19, presenting to one Emergency Department from February 21st to March 15th, 2020, during the outbreak burst in northern Italy. Patients were retrospectively enrolled if both LUSCOP protocol and HRCT were performed in the Emergency Department. The sensitivity of LUSCOP protocol and HRCT were compared. COVID-19 pneumonia's final diagnosis was based on real-time reverse-transcription polymerase chain reaction from nasal-pharyngeal swab and on clinical data. Out of 150 suspected COVID-19 patients, 131 were included in the study, and 130 had a final diagnosis of COVID-19 pneumonia. The most frequent lung ultrasonographic features were: bilateral B-pattern in 101 patients (77%), B-pattern with subpleural consolidations in 26 (19.8%) and lung consolidations in 2 (1.5%). LUSCOP Protocol was consistent with HRCT in correctly screening 130 out of the 131 COVID-19 pneumonia cases (99.2%). In one case COVID-19 pneumonia was excluded by both HRCT and lung US. LUSCOP protocol showed optimal sensitivity and can be proposed as a simple screening tool for COVID-19 pneumonia diagnosis in the context of outbreak burst areas where prompt isolation of suspected patients is crucial for patients' and operators' safety.
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Affiliation(s)
- Alessandro Dacrema
- Emergency Department, Guglielmo Da Saliceto Hospital, via Cantone del Cristo 40, 29121, Piacenza, Italy
| | - Matteo Silva
- Emergency Department, Guglielmo Da Saliceto Hospital, via Cantone del Cristo 40, 29121, Piacenza, Italy
| | - Luca Rovero
- Emergency Department, Guglielmo Da Saliceto Hospital, via Cantone del Cristo 40, 29121, Piacenza, Italy
| | - Valeria Vertemati
- Emergency Department, Guglielmo Da Saliceto Hospital, via Cantone del Cristo 40, 29121, Piacenza, Italy
| | - Giulia Losi
- Emergency Department, Guglielmo Da Saliceto Hospital, via Cantone del Cristo 40, 29121, Piacenza, Italy
| | | | - Roberto Sacchi
- Earth and Environmental Sciences Department, University of Pavia, Pavia, Italy
| | - Marco Mangiacotti
- Earth and Environmental Sciences Department, University of Pavia, Pavia, Italy
| | - Peiman Nazerian
- Department of Emergency Medicine, Careggi University Hospital, Florence, Italy
| | - Laura Pagani
- Emergency Department, Guglielmo Da Saliceto Hospital, via Cantone del Cristo 40, 29121, Piacenza, Italy
| | - Valentina Tinelli
- Emergency Department, Guglielmo Da Saliceto Hospital, via Cantone del Cristo 40, 29121, Piacenza, Italy
| | - Erika Poggiali
- Emergency Department, Guglielmo Da Saliceto Hospital, via Cantone del Cristo 40, 29121, Piacenza, Italy
| | - Davide Bastoni
- Emergency Department, Guglielmo Da Saliceto Hospital, via Cantone del Cristo 40, 29121, Piacenza, Italy
| | - Andrea Vercelli
- Emergency Department, Guglielmo Da Saliceto Hospital, via Cantone del Cristo 40, 29121, Piacenza, Italy
| | - Andrea Magnacavallo
- Emergency Department, Guglielmo Da Saliceto Hospital, via Cantone del Cristo 40, 29121, Piacenza, Italy.
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Bowles EJA, Miglioretti DL, Kwan ML, Bartels U, Furst A, Cheng SY, Lau C, Greenlee RT, Weinmann S, Marlow EC, Rahm AK, Stout NK, Bolch WE, Theis MK, Smith-Bindman R, Pole JD. Long-term medical imaging use in children with central nervous system tumors. PLoS One 2021; 16:e0248643. [PMID: 33882069 PMCID: PMC8059842 DOI: 10.1371/journal.pone.0248643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 02/15/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Children with central nervous system (CNS) tumors undergo frequent imaging for diagnosis and follow-up, but few studies have characterized longitudinal imaging patterns. We described medical imaging in children before and after malignant CNS tumor diagnosis. PROCEDURE We conducted a retrospective cohort study of children aged 0-20 years diagnosed with CNS tumors between 1996-2016 at six U.S. integrated healthcare systems and Ontario, Canada. We collected computed topography (CT), magnetic resonance imaging (MRI), radiography, ultrasound, nuclear medicine examinations from 12 months before through 10 years after CNS diagnosis censoring six months before death or a subsequent cancer diagnosis, disenrollment from the health system, age 21 years, or December 31, 2016. We calculated imaging rates per child per month stratified by modality, country, diagnosis age, calendar year, time since diagnosis, and tumor grade. RESULTS We observed 1,879 children with median four years follow-up post-diagnosis in the U.S. and seven years in Ontario, Canada. During the diagnosis period (±15 days of diagnosis), children averaged 1.10 CTs (95% confidence interval [CI] 1.09-1.13) and 2.14 MRIs (95%CI 2.12-2.16) in the U.S., and 1.67 CTs (95%CI 1.65-1.68) and 1.86 MRIs (95%CI 1.85-1.88) in Ontario. Within one year after diagnosis, 19% of children had ≥5 CTs and 45% had ≥5 MRIs. By nine years after diagnosis, children averaged one MRI and one radiograph per year with little use of other imaging modalities. CONCLUSIONS MRI and CT are commonly used for CNS tumor diagnosis, whereas MRI is the primary modality used during surveillance of children with CNS tumors.
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Affiliation(s)
- Erin J. A. Bowles
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, Washington, United States of America
- * E-mail:
| | - Diana L. Miglioretti
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, Washington, United States of America
- Department of Public Health Sciences, University of California, Davis, Davis, California, United States of America
- University of California Davis Comprehensive Cancer Center, Davis, California, United States of America
| | - Marilyn L. Kwan
- Division of Research, Kaiser Permanente Northern California, Oakland, California, United States of America
| | - Ute Bartels
- The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Adam Furst
- Department of Public Health Sciences, University of California, Davis, Davis, California, United States of America
| | | | | | - Robert T. Greenlee
- Marshfield Clinic Research Institute, Marshfield Clinic Health System, Marshfield, Wisconsin, United States of America
| | - Sheila Weinmann
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon, United States of America
- Center for Integrated Health Research, Kaiser Permanente Hawaii, Honolulu, Hawaii, United States of America
| | - Emily C. Marlow
- Department of Public Health Sciences, University of California, Davis, Davis, California, United States of America
| | - Alanna K. Rahm
- Center for Health Research, Genomic Medicine Institute, Geisinger, Danville, Pennsylvania, United States of America
| | - Natasha K. Stout
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, United States of America
| | - Wes E. Bolch
- Department of Biomedical Engineering, University of Florida, Gainesville, Florida, United States of America
| | - Mary Kay Theis
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, Washington, United States of America
| | - Rebecca Smith-Bindman
- Department of Radiology and Biomedical Imaging, Epidemiology and Biostatistics and The Philip R. Lee Institute for Health Policy, University of California, San Francisco, San Francisco, California, United States of America
| | - Jason D. Pole
- The Hospital for Sick Children, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
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Sasaki T, Miyauchi A, Ito Y, Kudo T, Kanemura N, Sano T, Kawano S, Yamamoto M, Fujishima M, Masuoka H, Higashiyama T, Kihara M, Miya A. Marked Decrease Over Time in Conversion Surgery After Active Surveillance of Low-Risk Papillary Thyroid Microcarcinoma. Thyroid 2021; 31:217-223. [PMID: 32664805 PMCID: PMC7891222 DOI: 10.1089/thy.2020.0319] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Background: Active surveillance for low-risk papillary microcarcinoma (PMC) of the thyroid is an accepted and safe management strategy. However, some patients undergo conversion surgery after the initiation of active surveillance for various reasons. We investigated the reasons for conversion surgery and whether and how they changed over time. Methods: We enrolled 2288 patients with PMC who underwent active surveillance. Of these, 162 (7.1%) underwent conversion surgery >12 months after initiating active surveillance due to disease progression (57 patients), patient preference (43 patients), physician preference (31 patients), other associated thyroid or parathyroid diseases (24 patients), and other reasons (7 patients). We analyzed cumulative conversion rates not only in the whole cohort but also in the first three major subsets based on the reasons for surgery. We also divided our whole cohort into two groups based on the period of active surveillance commencement: the first-half group (February 2005-November 2011; 561 patients) and the second-half group (December 2011-June 2017; 1727 patients). Results: The criteria for PMC progression did not differ between the first- and second-half groups. The proportion of female patients in the physician preference group was significantly higher than that in the disease progression and the patient preference groups. Tumor size at surgery was larger, and tumor volume-doubling rate was higher in the disease progression group than in the other two groups. Patients in the second-half group were significantly less likely to undergo conversion surgery than those in the first-half group. Furthermore, conversion surgery rates in the second-half group were significantly lower than those in the first-half group in the patient preference, physician preference, and disease progression groups. Conclusions: Patients with PMC in the second-half group were significantly less likely to undergo conversion surgery than those in the first-half group regardless of the reason. This is probably because data accumulation of favorable outcomes with active surveillance significantly contributed to physicians' confidence and patients' trust and understanding of this disease.
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Affiliation(s)
- Takahiro Sasaki
- Department of Head and Neck Surgery, Kuma Hospital, Kobe, Japan
| | - Akira Miyauchi
- Department of Surgery, Kuma Hospital, Kobe, Japan
- Address correspondence to: Akira Miyauchi, MD, PhD, Department of Surgery, Kuma Hospital, 8-2-35 Shimoyamate-dori, Chuo-Ku, Kobe 650-0011, Japan
| | - Yasuhiro Ito
- Department of Surgery, Kuma Hospital, Kobe, Japan
| | - Takumi Kudo
- Department of Internal Medicine, Kuma Hospital, Kobe, Japan
| | | | - Tsutomu Sano
- Department of Head and Neck Surgery, Kuma Hospital, Kobe, Japan
| | | | | | | | | | | | | | - Akihiro Miya
- Department of Surgery, Kuma Hospital, Kobe, Japan
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Schroeder AN, Kruse RC. The Future of Virtual Sports Ultrasound Education and Collaboration. Curr Sports Med Rep 2021; 20:57-61. [PMID: 33395131 DOI: 10.1249/jsr.0000000000000802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
ABSTRACT Sports ultrasound (US) is a rapidly advancing and expanding field, where "hands-on" education and real-time instructor feedback are paramount in developing this skill. In light of a global pandemic and limited access to instructors and educational conferences, sports US education must adapt to continue to teach future ultrasonographers. Virtual US education, conducted using various virtual meeting platforms not only allows for continued didactic education but also can virtually recreate the "hands-on" training sessions with live, immediate instructor feedback that is necessary for acquiring competence. Additionally, using these methods, sports US conferences can continue in a virtual manner, sports US education can expand remote areas, and collaboration among distant experts may increase, all without the cost of travel and extended time away from work. While immediately relevant because of the COVID-19 pandemic, virtual US methods may continue to be beneficial as sports US education and collaboration continue to expand.
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Affiliation(s)
- Allison N Schroeder
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh Medical Center
| | - Ryan C Kruse
- Department of Orthopedics and Rehabilitation, University of Iowa Sports Medicine, Iowa City, IA
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Vos HJ, Voorneveld JD, Groot Jebbink E, Leow CH, Nie L, van den Bosch AE, Tang MX, Freear S, Bosch JG. Contrast-Enhanced High-Frame-Rate Ultrasound Imaging of Flow Patterns in Cardiac Chambers and Deep Vessels. Ultrasound Med Biol 2020; 46:2875-2890. [PMID: 32843233 DOI: 10.1016/j.ultrasmedbio.2020.07.022] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 07/17/2020] [Accepted: 07/20/2020] [Indexed: 06/11/2023]
Abstract
Cardiac function and vascular function are closely related to the flow of blood within. The flow velocities in these larger cavities easily reach 1 m/s, and generally complex spatiotemporal flow patterns are involved, especially in a non-physiologic state. Visualization of such flow patterns using ultrasound can be greatly enhanced by administration of contrast agents. Tracking the high-velocity complex flows is challenging with current clinical echographic tools, mostly because of limitations in signal-to-noise ratio; estimation of lateral velocities; and/or frame rate of the contrast-enhanced imaging mode. This review addresses the state of the art in 2-D high-frame-rate contrast-enhanced echography of ventricular and deep-vessel flow, from both technological and clinical perspectives. It concludes that current advanced ultrasound equipment is technologically ready for use in human contrast-enhanced studies, thus potentially leading to identification of the most clinically relevant flow parameters for quantifying cardiac and vascular function.
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Affiliation(s)
- Hendrik J Vos
- Biomedical Engineering, Department of Cardiology, Erasmus University Medical Center, Rotterdam, The Netherlands; Medical Imaging, Department of Imaging Physics, Applied Sciences, Delft University of Technology, Delft, The Netherlands.
| | - Jason D Voorneveld
- Biomedical Engineering, Department of Cardiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Erik Groot Jebbink
- M3i: Multi-modality Medical Imaging Group, Technical Medical Centre, University of Twente, Enschede, The Netherlands; Department of Vascular Surgery, Rijnstate Hospital, Arnhem, The Netherlands
| | - Chee Hau Leow
- Department of Bioengineering, Imperial College London, London, United Kingdom
| | - Luzhen Nie
- School of Electronic and Electrical Engineering, University of Leeds, Leeds, United Kingdom
| | | | - Meng-Xing Tang
- Department of Bioengineering, Imperial College London, London, United Kingdom
| | - Steven Freear
- School of Electronic and Electrical Engineering, University of Leeds, Leeds, United Kingdom
| | - Johan G Bosch
- Biomedical Engineering, Department of Cardiology, Erasmus University Medical Center, Rotterdam, The Netherlands
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Drukker L, Noble JA, Papageorghiou AT. Introduction to artificial intelligence in ultrasound imaging in obstetrics and gynecology. Ultrasound Obstet Gynecol 2020; 56:498-505. [PMID: 32530098 PMCID: PMC7702141 DOI: 10.1002/uog.22122] [Citation(s) in RCA: 71] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Revised: 05/10/2020] [Accepted: 06/01/2020] [Indexed: 05/05/2023]
Abstract
Artificial intelligence (AI) uses data and algorithms to aim to draw conclusions that are as good as, or even better than, those drawn by humans. AI is already part of our daily life; it is behind face recognition technology, speech recognition in virtual assistants (such as Amazon Alexa, Apple's Siri, Google Assistant and Microsoft Cortana) and self-driving cars. AI software has been able to beat world champions in chess, Go and recently even Poker. Relevant to our community, it is a prominent source of innovation in healthcare, already helping to develop new drugs, support clinical decisions and provide quality assurance in radiology. The list of medical image-analysis AI applications with USA Food and Drug Administration or European Union (soon to fall under European Union Medical Device Regulation) approval is growing rapidly and covers diverse clinical needs, such as detection of arrhythmia using a smartwatch or automatic triage of critical imaging studies to the top of the radiologist's worklist. Deep learning, a leading tool of AI, performs particularly well in image pattern recognition and, therefore, can be of great benefit to doctors who rely heavily on images, such as sonologists, radiographers and pathologists. Although obstetric and gynecological ultrasound are two of the most commonly performed imaging studies, AI has had little impact on this field so far. Nevertheless, there is huge potential for AI to assist in repetitive ultrasound tasks, such as automatically identifying good-quality acquisitions and providing instant quality assurance. For this potential to thrive, interdisciplinary communication between AI developers and ultrasound professionals is necessary. In this article, we explore the fundamentals of medical imaging AI, from theory to applicability, and introduce some key terms to medical professionals in the field of ultrasound. We believe that wider knowledge of AI will help accelerate its integration into healthcare. © 2020 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of the International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- L. Drukker
- Nuffield Department of Women's & Reproductive HealthUniversity of Oxford, John Radcliffe HospitalOxfordUK
| | - J. A. Noble
- Institute of Biomedical EngineeringUniversity of OxfordOxfordUK
| | - A. T. Papageorghiou
- Nuffield Department of Women's & Reproductive HealthUniversity of Oxford, John Radcliffe HospitalOxfordUK
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Li X, Wang C, Hou X, Tao Y. Diagnostic accuracy of ultrasound superb microvascular imaging for lymph nodes: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2020; 99:e22034. [PMID: 32899060 PMCID: PMC7478526 DOI: 10.1097/md.0000000000022034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 08/04/2020] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND As a novel ultrasound technique, superb microvascular imaging can quickly, simply and noninvasively study the microvascular distribution in the tumor and evaluate the microvascular perfusion. Studies suggested that superb microvascular imaging is helpful for the differentiation between benign and malignant lymph nodes. However, the results of these studies have been contradictory. Therefore, the present meta-analysis aimed at determining the accuracy of superb microvascular imaging in the differential diagnosis between benign and malignant lymph nodes. METHODS We will search PubMed, Web of Science, Cochrane Library, and Chinese biomedical databases from their inceptions to the July 30, 2020, without language restrictions. Two authors will independently carry out searching literature records, scanning titles and abstracts, full texts, collecting data, and assessing risk of bias. Review Manager 5.2 and Stata14.0 software will be used for data analysis. RESULTS This systematic review will determine the accuracy of superb microvascular imaging in the differential diagnosis between benign and malignant lymph nodes. CONCLUSION Its findings will provide helpful evidence for the accuracy of superb microvascular imaging in the differential diagnosis between benign and malignant lymph nodes. SYSTEMATIC REVIEW REGISTRATION INPLASY202070133.
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14
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Granata A, Maccarrone R, Raspanti FG, Puliatti D, Costanza G, Cantavenera P, Di Lullo L, Forcella M, Pesce F, Fiorini F. [Ultrasonography for diagnosis and management of nephrolithiasis: state of the art and new perspectives]. G Ital Nefrol 2020; 37:37-S75-2020-8. [PMID: 32749088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The correct management of patients with kidney stones is a crucial issue for nephrologists. In recent years, the incidence and prevalence rates of nephrolithiasis have maintained a growing trend worldwide, showing a strong correlation with other systemic disease such as diabetes mellitus, hypertension, obesity, metabolic syndrome and chronic kidney disease. International guidelines indicate computed tomography as the first choice for all adult patients with suspected acute symptoms for obstructive nephrolithiasis. Intravenous pyelogram is more useful in the follow-up of patients with relapsing nephrolithiasis and known stone composition, while the high costs and the long image acquisition times limit the routine use of magnetic resonance. Recent innovative tools have improved the accuracy of kidney stone localization and measuring with B-Mode and color Doppler imaging, thereby reducing the gap between ultrasonography and computer tomography. The aim of this review is to report the latest evidence on risk factors and on the pathophysiology of nephrolithiasis, and to compare the utility of the available imaging techniques in the management of patients with kidney stones, focusing on the role of ultrasonography and the present and future strategies to improve its accuracy.
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Affiliation(s)
- Antonio Granata
- U.O.C. di Nefrologia e Dialisi, A.O. per l'Emergenza "Cannizzaro", Catania - Italia
| | - Rosario Maccarrone
- U.O.C. di Nefrologia e Dialisi, P.O. "San Giovanni di Dio", Agrigento - Italia
| | | | - Daniela Puliatti
- U.O.C. di Nefrologia e Dialisi, A.O. per l'Emergenza "Cannizzaro", Catania - Italia
| | - Giuseppa Costanza
- U.O.C. di Nefrologia e Dialisi, P.O. "Vittorio Emanuele", Gela (CL) - Italia
| | - Paolo Cantavenera
- U.O.C. di Nefrologia e Dialisi, A.O. per l'Emergenza "Cannizzaro", Catania - Italia
| | - Luca Di Lullo
- U.O.C. di Nefrologia e Dialisi, P.O. "L. Parodi - Delfino", Colleferro (Roma) - Italia
| | - Mauro Forcella
- S.C. Nefrologia, Dialisi e Trapianto, A.O.U. " OO.R.R.", Università di Foggia, Foggia - Italia
| | - Francesco Pesce
- Dip. di Nefrologia, Dialisi e Trapianto, A.O.U. "A. Moro" Università di Bari, Bari - Italia
| | - Fulvio Fiorini
- U.O.C. di Nefrologia e Dialisi, P.O. "S.M. della Misericordia", Rovigo - Italia
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15
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Nugent EK, Nugent AK, Nugent R, Nugent C, Nugent K. The Management of Women's Health Care by Internists With a Focus on the Utility of Ultrasound. Am J Med Sci 2020; 360:435-446. [PMID: 32586640 DOI: 10.1016/j.amjms.2020.05.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 05/07/2020] [Accepted: 05/08/2020] [Indexed: 11/18/2022]
Abstract
Adult women require routine care for the acute and chronic health problems found in both sexes, and they require specialized care for women's health problems, including disease prevention, disease screening, and disease management. Internists should direct primary care and participate in specialized care and to the extent possible follow guidelines published by various professional organizations. They should understand the use of ultrasound in breast cancer screening, the management of pregnancy, and other gynecologic problems, including vaginal bleeding, pelvic pain, and investigation for pelvic malignancy. Finally, all management decisions need discussions on the potential benefit or harm in each step of a woman's care with an emphasis on personal preferences.
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Affiliation(s)
| | - Anne K Nugent
- University of Kansas Medical Center, Kansas City, Kansas
| | | | - Connie Nugent
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Kenneth Nugent
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas.
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Platt LD, Han CS. Moving Ultrasound First in Women's Health. Obstet Gynecol Clin North Am 2020; 46:xv-xvi. [PMID: 31677760 DOI: 10.1016/j.ogc.2019.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Lawrence D Platt
- Center for Fetal Medicine and Women's Ultrasound, Department of Obstetrics and Gynecology at David Geffen School of Medicine at UCLA, 6310 South San Vicente Boulevard, Suite 520, Los Angeles, CA 90048, USA.
| | - Christina S Han
- Center for Fetal Medicine and Women's Ultrasound, Department of Obstetrics and Gynecology at David Geffen School of Medicine at UCLA, 6310 South San Vicente Boulevard, Suite 520, Los Angeles, CA 90048, USA.
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17
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Zhang LH, Chen G, Tao W. Can high-frequency ultrasound combined computed tomography accurately diagnose thyroid tumor?: A protocol of systematic review and meta-analysis. Medicine (Baltimore) 2020; 99:e20180. [PMID: 32443337 PMCID: PMC7253711 DOI: 10.1097/md.0000000000020180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 04/07/2020] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Previous clinical studies have reported that clinical value of high-frequency ultrasound combined computed tomography (HFUCT) is used for diagnosis of thyroid tumor (TT). However, no study has investigated this topic systematically. Therefore, this study will evaluate the clinical value of HFUCT for the diagnosis of TT. METHODS We will search the databases of Cochrane Library, EMBASE, PUBMED, SCOPUS, Web of Science, OpenGrey, Cumulative Index to Nursing and Allied Health Literature, Allied and Complementary Medicine Database, and China National Knowledge Infrastructure from any time period published to the present. We will consider all case-controlled studies that assessed the clinical value of HFUCT for diagnosis of TT. Two authors will independently scan titles and abstracts to check eligible studies, followed by full-text read. We will extract data and assess study quality using Quality Assessment of Diagnostic Accuracy Studies tool. RevMan 5.3 software will be utilized for data pooling and statistical analysis. RESULTS This study will be performed to assess the clinical value of HFUCT for the diagnosis of TT, and will provide an evidence-based synthesis for clinical application and further study. CONCLUSION Summary of this study will provide the latest evidence to determine whether HFUCT can be used for TT diagnosis accurately. STUDY REGISTRATION INPLASY202040022.
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Affiliation(s)
| | - Gang Chen
- Department of Radiology, Ningbo Municipal Hospital of TCM, Ningbo, China
| | - Wei Tao
- Department of Radiology, Ningbo Municipal Hospital of TCM, Ningbo, China
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Leidi A, Rouyer F, Marti C, Reny JL, Grosgurin O. Point of care ultrasonography from the emergency department to the internal medicine ward: current trends and perspectives. Intern Emerg Med 2020; 15:395-408. [PMID: 32034674 DOI: 10.1007/s11739-020-02284-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 01/22/2020] [Indexed: 12/20/2022]
Abstract
The advent of portable devices in the early 80s has brought ultrasonography to the patient's bedside. Currently referred to as 'point of care ultrasonography' (POCUS), it has become an essential tool for clinicians. Initially developed in the emergency and critical care settings, POCUS has gained increasing importance in internal medicine wards in the last decade, with both its growing diagnostic accuracy and portability making POCUS an optimal instrument for everyday clinical assessment and procedures. There is large body of evidence to confirm POCUS' superiority when compared to clinical examination and standard X-ray imaging in a variety of clinical situations. On the contrary, only few indications, such as procedural guidance, have a proven additional benefit for patients. Since POCUS is highly user-dependent, pre- and post-graduate curricula are needed and the range of use should be clearly defined. This review focuses on trends and perspectives of POCUS in the management of diseases frequently encountered in emergency and internal medicine. In addition, questions are raised regarding the teaching and supervision of POCUS needing to be addressed in the near future.
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Affiliation(s)
- Antonio Leidi
- General Internal Medicine, Department of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Frédéric Rouyer
- Emergency Medicine, Department of Acute Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Christophe Marti
- General Internal Medicine, Department of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Jean-Luc Reny
- General Internal Medicine, Department of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Olivier Grosgurin
- General Internal Medicine, Department of Medicine, Geneva University Hospitals, Geneva, Switzerland.
- Emergency Medicine, Department of Acute Medicine, Geneva University Hospitals, Geneva, Switzerland.
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Cismaru G, Grosu A, Istratoaie S, Mada L, Ilea M, Gusetu G, Zdrenghea D, Pop D, Rosu R. Transesophageal and intracardiac ultrasound in arrhythmogenic right ventricular dysplasia/cardiomyopathy: Two case reports. Medicine (Baltimore) 2020; 99:e19817. [PMID: 32282747 PMCID: PMC7220632 DOI: 10.1097/md.0000000000019817] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 01/15/2020] [Accepted: 03/04/2020] [Indexed: 11/17/2022] Open
Abstract
RATIONALE Two-dimensional echocardiography (2D echo) is a major tool for the diagnosis of Arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C). However 2D echo can skip regional localized anomalies of the right ventricular wall. We aimed to determine whether transesophageal and intracardiac ultrasound can provide additional information, on the right ventricular abnormalities compared to 2D echo. PATIENT CONCERNS Case 1 is a 30-year-old patient that presented in the Emergency Department with multiple episodes of fast monomorphic ventricular tachycardia (VT) manifested by palpitations and diziness. Case 2 is a 65-year-old patient that also presented with episodes of ventircular tachycardia associated with low blood pressure. DIAGNOSIS Both patients had a clear diagnosis of arrhythmogenic right ventricular dysplasia/cardiomyopathy confirmed by cardiac magnetic resonance imaging. INTERVENTION In both patients transesophageal and intracardiac ultrasound was performed, which brought more information on the diagnosis of ARVD/C compared to transthoracic echocardiograpy. OUTCOMES The first patient was implanted with an internal cardiac defibrillator and treated with Sotalol for VT recurrences. He presented episodes of VT during follow-up, treated with antitachycardia pacing. The second patient was implanted with an internal cardiac defibrillator and treated with Sotalol without any VT recurrence at 18 month-follow-up. LESSONS Transesophageal echocardiography and intracardiac echocardiography can provide additional information on small, focal structural abnormalities in patients with ARVD/C: bulges, saculations, aneurysms with or without associated thrombus, partial or complete loss of trabeculations and hypertrophy of the moderator band. These changes are particularly important in cases with "concealed" form of the disease in which no morphological abnormalities are evident in transthoracic echocardiograpy.
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Affiliation(s)
- Gabriel Cismaru
- 5th Department of Internal Medicine, Cardiology-Rehabilitation
| | - Alin Grosu
- 5th Department of Internal Medicine, Cardiology-Medical Clinic No5, “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca
| | | | - Laura Mada
- Alba County Hospital, Department of Cardiology, Alba-Iulia, Romania
| | - Maria Ilea
- 5th Department of Internal Medicine, Cardiology-Rehabilitation
| | - Gabriel Gusetu
- 5th Department of Internal Medicine, Cardiology-Rehabilitation
| | | | - Dana Pop
- 5th Department of Internal Medicine, Cardiology-Rehabilitation
| | - Radu Rosu
- 5th Department of Internal Medicine, Cardiology-Rehabilitation
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Abstract
BACKGROUND The aim of this study was to present several cases of benign and malignant nipple lesions and contribute to diagnosis and differential diagnosis. METHODS A retrospective study was conducted on 13 patients. All of the patients were evaluated by ultrasonography, and 11 of them had pathological results. We analyzed the clinical and sonographic features. RESULTS There were 3 malignant lesions, 7 benign lesions, and 3 congenital nipple dysplasia, listed as follows:Malignant lesions (n = 3, 23%): Paget's disease (PD, n = 3, 23%). All of the patients with PD showed unilateral nipple erosion, discharge, and pain. The ultrasound showed abundant blood flow (n = 3, 23%); 2 patients (n = 2, 15%) had microcalcifications.Benign lesions (n = 7, 54%): Adenoma of the nipple (n = 2, 15%). One patient (n = 1, 8%) had nipple erosion and discharge. Two patients (n = 2, 15%) had a palpable nodule in the nipple. The ultrasound of both patients (n = 2, 15%) showed regular-shaped, clear border nodule with abundant blood flow (n = 2, 15%).Leiomyoma of the nipple (n = 1, 8%): This male patient was characterized by unilateral nipple enlargement and pain. The ultrasound showed a regular nodule with absent blood flow.Plasma cell mastitis (n = 2, 15%): Two patients showed unilateral nipple inversion and pain. One patient (n = 1, 8%) showed swollen and redness. The 2 patients showed a lesion in the gland around the nipple present as an irregular shape and unclear boundary hypoechoic mass.Nipple wart (n = 2, 15%): Two patients showed a unilateral soft exogenous neoplasm. Both of the patients showed a hypoechoic wart; the echo was similar to the nipple, the border was clear, and had no blood flow in the wart.Nipple Dysplasia (n = 3, 23%): Accessory nipple (n = 3, 23%). Two patients (n = 2, 15%) had accessory nipples in the subcoastal area, 1 patient (n = 1, 8%) in the areolar. All of the patients' sonographic features were the same as the nipple.The positive predict value (PPV) of the clinical symptoms: Erosion and discharge are both 75% (P < 0.05). The PPV of the US manifestations: irregular shape, indictinct margin, abundant blood flow, microcalcification, thicken skin in diagnosing malignant lesions are 60%,60%,60%,100%,100%, respectively (P < 0.05). CONCLUSIONS The characteristic sonographic features together with clinical symptoms contribute to the diagnosis of nipple lesions.
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Affiliation(s)
| | | | | | | | - Qiang Sun
- Department of Breast Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
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Frinking P, Segers T, Luan Y, Tranquart F. Three Decades of Ultrasound Contrast Agents: A Review of the Past, Present and Future Improvements. Ultrasound Med Biol 2020; 46:892-908. [PMID: 31941587 DOI: 10.1016/j.ultrasmedbio.2019.12.008] [Citation(s) in RCA: 123] [Impact Index Per Article: 30.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 12/05/2019] [Accepted: 12/06/2019] [Indexed: 06/10/2023]
Abstract
Initial reports from the 1960s describing the observations of ultrasound contrast enhancement by tiny gaseous bubbles during echocardiographic examinations prompted the development of the first ultrasound contrast agent in the 1980s. Current commercial contrast agents for echography, such as Definity, Optison, Sonazoid and SonoVue, have proven to be successful in a variety of on- and off-label clinical indications. Whereas contrast-specific technology has seen dramatic progress after the introduction of the first approved agents in the 1990s, successful clinical translation of new developments has been limited during the same period, while understanding of microbubble physical, chemical and biologic behavior has improved substantially. It is expected that for a successful development of future opportunities, such as ultrasound molecular imaging and therapeutic applications using microbubbles, new creative developments in microbubble engineering and production dedicated to further optimizing microbubble performance are required, and that they cannot rely on bubble technology developed more than 3 decades ago.
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Affiliation(s)
- Peter Frinking
- Tide Microfluidics, Capitool 41, Enschede, The Netherlands.
| | - Tim Segers
- Physics of Fluids group, University of Twente, Enschede, The Netherlands
| | - Ying Luan
- R&D Pharmaceutical Diagnostics, General Electric Healthcare, Amersham, UK
| | - François Tranquart
- R&D Pharmaceutical Diagnostics, General Electric Healthcare, Amersham, UK
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Puntoni A, Giannese D, Varricchio E, D'Alessandro C, Egidi MF, Cupisti A. [Different methods to manage dry weight in hemodialysis patients]. G Ital Nefrol 2020; 37:37-01-2020-2. [PMID: 32068356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Estimating the euvolemia and dry weight of hemodialysis patients still represents a challenge for the nephrologist, since both dehydration and hyperhydration are associated with intradialytic events and cardiovascular complications in the short and long term. Despite the need for a precise and objective definition of the dry weight for the individual patient on dialysis, this is usually determined on a clinical basis. To obtain greater sensitivity the dosage of natriuretic peptides, Bioelectrical Impedance Analysis (BIA) and, more recently, Lung Ultra-Sound (LUS) can all be used. The BIA allows to estimate the subject's body composition and, in particular, the distribution of body fluids. The presence of hyperhydration, as determined through the BIA, is predictive of an increased mortality in numerous observational studies. In recent years, pulmonary ultrasound has taken on an increasingly important role not only within the cardiology and intensive care units, but also in a nephrology setting, especially in dialysis. The purpose of this article is to analyze the advantages and limitations of the methods that can be used to assess the dry weight of patients undergoing hemodialysis treatment.
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Affiliation(s)
| | | | | | | | | | - Adamasco Cupisti
- Dipartimento di Medicina Clinica e Sperimentale, Università di Pisa
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23
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Schwarzenbach HR. [Not Available]. Praxis (Bern 1994) 2020; 109:565. [PMID: 32517590 DOI: 10.1024/1661-8157/a003503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
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Tuma J. [Not Available]. Praxis (Bern 1994) 2020; 109:563-564. [PMID: 32517602 DOI: 10.1024/1661-8157/a003502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
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Shen-Wagner J, Deutchman M. Point-of-Care Ultrasound: A Practical Guide for Primary Care. Fam Pract Manag 2020; 27:33-40. [PMID: 33169960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
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26
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Wibbelsman TD, Pandit RR, Xu D, Jenkins TL, Mellen PL, Soares RR, Obeid A, Levin H, Hsu J, Ho AC. Trends in Retina Specialist Imaging Utilization from 2012 to 2016 in the United States Medicare Fee-for-Service Population. Am J Ophthalmol 2019; 208:12-18. [PMID: 31265802 DOI: 10.1016/j.ajo.2019.06.026] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 06/21/2019] [Accepted: 06/21/2019] [Indexed: 11/19/2022]
Abstract
PURPOSE To characterize temporal trends and regional variance in retinal imaging utilization in the United States Medicare fee-for-service population from 2012-2016. DESIGN Cross-sectional, retrospective database analysis. METHODS This study addresses office or operating-room based retinal imaging. Our study population included retina specialists, defined as ophthalmologists performing either intravitreal anti-vascular endothelial growth factor injections or posterior segment laser photocoagulation and no neodymium-doped yttrium aluminum garnet laser capsulotomy. We recorded fundus photography, optical coherence tomography (OCT), intravenous fluorescein angiography (IVFA), indocyanine-green angiography, and ophthalmic ultrasound (B-scan) billed in the Medicare fee-for-service population from 2012-2016. Imaging obtained on any platform or device was eligible for inclusion (eg, posterior pole imaging vs ultrawidefield imaging). The main outcome measure was the relative utilization of retinal imaging modalities. RESULTS National relative utilization of OCT increased from 61.5% in 2012 to 70.5% in 2016 (P < .001), while IVFA fell from 20.9% to 15.1% over the same interval (P < .001). Fundus photography decreased from 14.6% in 2012 to 11.7% in 2016 (P < .001). By 2016, the Midwest region had the highest relative utilization of OCT (75.2%) and lowest of IVFA (12.0%), while the West region had the lowest OCT (68.4%) and highest IVFA (17.0%). CONCLUSIONS Among retina specialists, OCT usage increased while the utilization of fundus photography and IVFA has declined. The Midwest region had the highest utilization of OCT and lowest of IVFA.
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Affiliation(s)
| | - Ravi R Pandit
- Retina Service, Wills Eye Hospital, Philadelphia, Pennsylvania, USA
| | - David Xu
- Retina Service, Wills Eye Hospital, Philadelphia, Pennsylvania, USA
| | - Thomas L Jenkins
- Retina Service, Wills Eye Hospital, Philadelphia, Pennsylvania, USA
| | - Phoebe L Mellen
- Retina Service, Wills Eye Hospital, Philadelphia, Pennsylvania, USA
| | - Rebecca R Soares
- Retina Service, Wills Eye Hospital, Philadelphia, Pennsylvania, USA
| | - Anthony Obeid
- Retina Service, Wills Eye Hospital, Philadelphia, Pennsylvania, USA
| | - Hannah Levin
- Retina Service, Wills Eye Hospital, Philadelphia, Pennsylvania, USA
| | - Jason Hsu
- Retina Service, Wills Eye Hospital, Philadelphia, Pennsylvania, USA
| | - Allen C Ho
- Retina Service, Wills Eye Hospital, Philadelphia, Pennsylvania, USA.
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Smith-Bindman R, Kwan ML, Marlow EC, Theis MK, Bolch W, Cheng SY, Bowles EJA, Duncan JR, Greenlee RT, Kushi LH, Pole JD, Rahm AK, Stout NK, Weinmann S, Miglioretti DL. Trends in Use of Medical Imaging in US Health Care Systems and in Ontario, Canada, 2000-2016. JAMA 2019; 322:843-856. [PMID: 31479136 PMCID: PMC6724186 DOI: 10.1001/jama.2019.11456] [Citation(s) in RCA: 306] [Impact Index Per Article: 61.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 07/24/2019] [Indexed: 12/17/2022]
Abstract
Importance Medical imaging increased rapidly from 2000 to 2006, but trends in recent years have not been analyzed. Objective To evaluate recent trends in medical imaging. Design, Setting, and Participants Retrospective cohort study of patterns of medical imaging between 2000 and 2016 among 16 million to 21 million patients enrolled annually in 7 US integrated and mixed-model insurance health care systems and for individuals receiving care in Ontario, Canada. Exposures Calendar year and country (United States vs Canada). Main Outcomes and Measures Use of computed tomography (CT), magnetic resonance imaging (MRI), ultrasound, and nuclear medicine imaging. Annual and relative imaging rates by imaging modality, country, and age (children [<18 years], adults [18-64 years], and older adults [≥65 years]). Results Overall, 135 774 532 imaging examinations were included; 5 439 874 (4%) in children, 89 635 312 (66%) in adults, and 40 699 346 (30%) in older adults. Among adults and older adults, imaging rates were significantly higher in 2016 vs 2000 for all imaging modalities other than nuclear medicine. For example, among older adults, CT imaging rates were 428 per 1000 person-years in 2016 vs 204 per 1000 in 2000 in US health care systems and 409 per 1000 vs 161 per 1000 in Ontario; for MRI, 139 per 1000 vs 62 per 1000 in the United States and 89 per 1000 vs 13 per 1000 in Ontario; and for ultrasound, 495 per 1000 vs 324 per 1000 in the United States and 580 per 1000 vs 332 per 1000 in Ontario. Annual growth in imaging rates among US adults and older adults slowed over time for CT (from an 11.6% annual percentage increase among adults and 9.5% among older adults in 2000-2006 to 3.7% among adults in 2013-2016 and 5.2% among older adults in 2014-2016) and for MRI (from 11.4% in 2000-2004 in adults and 11.3% in 2000-2005 in older adults to 1.3% in 2007-2016 in adults and 2.2% in 2005-2016 in older adults). Patterns in Ontario were similar. Among children, annual growth for CT stabilized or declined (United States: from 10.1% in 2000-2005 to 0.8% in 2013-2016; Ontario: from 3.3% in 2000-2006 to -5.3% in 2006-2016), but patterns for MRI were similar to adults. Changes in annual growth in ultrasound were smaller among adults and children in the United States and Ontario compared with CT and MRI. Nuclear medicine imaging declined in adults and children after 2006. Conclusions and Relevance From 2000 to 2016 in 7 US integrated and mixed-model health care systems and in Ontario, rates of CT and MRI use continued to increase among adults, but at a slower pace in more recent years. In children, imaging rates continued to increase except for CT, which stabilized or declined in more recent periods. Whether the observed imaging utilization was appropriate or was associated with improved patient outcomes is unknown.
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Affiliation(s)
- Rebecca Smith-Bindman
- Department of Radiology and Biomedical Imaging, Epidemiology and Biostatistics, and Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco
| | - Marilyn L. Kwan
- Division of Research, Kaiser Permanente Northern California, Oakland
| | - Emily C. Marlow
- Department of Public Health Sciences, University of California, Davis
- Graduate Group in Epidemiology, University of California, Davis
| | - Mary Kay Theis
- Kaiser Permanente Washington Health Research Institute, Seattle
| | - Wesley Bolch
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville
| | | | | | - James R. Duncan
- Interventional Radiology Section, Washington University in St Louis, St Louis, Missouri
| | | | - Lawrence H. Kushi
- Division of Research, Kaiser Permanente Northern California, Oakland
| | - Jason D. Pole
- ICES, Toronto, Ontario, Canada
- Pediatric Oncology Group of Ontario and Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Alanna K. Rahm
- Center for Health Research, Genomic Medical Institute, Geisinger, Danville, Pennsylvania
| | - Natasha K. Stout
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Sheila Weinmann
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon
| | - Diana L. Miglioretti
- Department of Public Health Sciences, University of California, Davis
- Kaiser Permanente Washington Health Research Institute, Seattle
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Ternovoy SK, Alyaev YG, Amosov AV. [Multidisciplinary approach in urology. Current imaging studies in urology]. Urologiia 2019:25-27. [PMID: 31535794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Imaging studies play a crucial role in the diagnosis of urologic diseases. X-ray and ultrasound studies are used as first-line diagnostic methods. Computed tomography and magnetic resonance imaging (MD-CT and MRI), radionuclide and hybrid methods allow to clarify diagnosis. Currently, the trend "from simple to complex" contributes to obtaining maximum information in the shortest possible time with a minimum cost.
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Affiliation(s)
- S K Ternovoy
- FGAOU VO I.M. Sechenov First Moscow State Medical University of Minzdrav of Russia, Moscow, Russia
| | - Yu G Alyaev
- FGAOU VO I.M. Sechenov First Moscow State Medical University of Minzdrav of Russia, Moscow, Russia
| | - A V Amosov
- FGAOU VO I.M. Sechenov First Moscow State Medical University of Minzdrav of Russia, Moscow, Russia
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Yan L, Zhou X, Zheng Y, Luo W, Yang J, Zhou Y, He Y. Research progress in ultrasound use for the diagnosis and treatment of cerebrovascular diseases. Clinics (Sao Paulo) 2019; 74:e715. [PMID: 30864640 PMCID: PMC6438134 DOI: 10.6061/clinics/2019/e715] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 10/15/2018] [Indexed: 11/18/2022] Open
Abstract
Cerebrovascular diseases pose a serious threat to human survival and quality of life and represent a major cause of human death and disability. Recently, the incidence of cerebrovascular diseases has increased yearly. Rapid and accurate diagnosis and evaluation of cerebrovascular diseases are of great importance to reduce the incidence, morbidity and mortality of cerebrovascular diseases. With the rapid development of medical ultrasound, the clinical relationship between ultrasound imaging technology and the diagnosis and treatment of cerebrovascular diseases has become increasingly close. Ultrasound techniques such as transcranial acoustic angiography, doppler energy imaging, three-dimensional craniocerebral imaging and ultrasound thrombolysis are novel and valuable techniques in the study of cerebrovascular diseases. In this review, we introduce some of the new ultrasound techniques from both published studies and ongoing trials that have been confirmed to be convenient and effective methods. However, additional evidence from future studies will be required before some of these techniques can be widely applied or recommended as alternatives.
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Affiliation(s)
- Li Yan
- Department of Ultrasonography, Xijing Hospital, The Fourth Military Medical University, Xi’an , China
- Department of Ultrasonography, Xi’an Central Hospital, The Third Affiliated Hospital of JiaoTong University, Xi’an, China
| | - Xiaodong Zhou
- Department of Ultrasonography, Xijing Hospital, The Fourth Military Medical University, Xi’an , China
- Corresponding author. E-mail:
| | - Yu Zheng
- Department of Ultrasonography, Xi’an Central Hospital, The Third Affiliated Hospital of JiaoTong University, Xi’an, China
| | - Wen Luo
- Department of Ultrasonography, Xijing Hospital, The Fourth Military Medical University, Xi’an , China
| | - Junle Yang
- Department of CT & MRI, Xi’an Central Hospital, The Third Affiliated Hospital of JiaoTong University, Xi’an, China
| | - Yin Zhou
- Department of Ultrasonography, Xi’an Central Hospital, The Third Affiliated Hospital of JiaoTong University, Xi’an, China
| | - Yang He
- Department of General Surgery, Xi'an Medical University, Xi'an, China
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Ferrero S, Scala C, Stabilini C, Vellone VG, Barra F, Leone Roberti Maggiore U. Transvaginal sonography with vs without bowel preparation in diagnosis of rectosigmoid endometriosis: prospective study. Ultrasound Obstet Gynecol 2019; 53:402-409. [PMID: 30079504 DOI: 10.1002/uog.19194] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 07/22/2018] [Accepted: 07/23/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES The primary aim of this study was to compare the diagnostic accuracy of transvaginal sonography (TVS) with vs without bowel preparation (BP) in detecting the presence of rectosigmoid endometriosis. Secondary objectives were to compare the diagnostic accuracy of the two techniques in estimating infiltration of the submucosa, length of the largest rectosigmoid nodules, distance of the nodules from the anal verge and presence of multifocal disease. METHODS This was a prospective study of patients with symptoms of pelvic pain for more than 6 months and/or suspicion of endometriosis referred to our institution between October 2016 and April 2018. Participants underwent a first TVS without BP followed by TVS with BP within a time interval of 1 week to 3 months. The examinations were performed independently and blindly by two sonographers. Only patients who underwent laparoscopy within the 6 months following the second ultrasound examination were included. Ultrasound results using the two techniques were compared with surgical and histological findings. RESULTS Of the 262 patients included in the study, 118 had rectosigmoid endometriosis confirmed at surgery. There was no significant difference in accuracy between TVS with and that without BP in diagnosing the presence of rectosigmoid endometriosis (93.5% vs 92.3%; P = 0.453). No significant difference was observed in accuracy between TVS with and that without BP in diagnosing submucosal infiltration (88.8% vs 84.6%; P = 0.238) and multifocal disease (97.2% vs 95.2%; P = 0.727) in patients diagnosed sonographically with rectosigmoid endometriosis. The accuracy of TVS with BP was similar to that of TVS without BP in estimating the maximum diameter of the largest nodule (P = 0.644) and the distance between the more caudal rectosigmoid nodule and the anal verge (P = 0.162). CONCLUSION BP does not improve the diagnostic performance of TVS in detecting rectosigmoid endometriosis and in assessing characteristics of endometriotic nodules. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- S Ferrero
- Academic Unit of Obstetrics and Gynecology, IRCCS AOU San Martino - IST, Genoa, Italy
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Genoa, Italy
| | - C Scala
- Academic Unit of Obstetrics and Gynecology, IRCCS AOU San Martino - IST, Genoa, Italy
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Genoa, Italy
| | - C Stabilini
- Department of Surgical and Diagnostic Sciences, IRCCS San Martino Hospital and National Institute for Cancer Research, University of Genoa, Genoa, Italy
| | - V G Vellone
- Department of Surgical and Diagnostic Sciences, IRCCS San Martino Hospital and National Institute for Cancer Research, University of Genoa, Genoa, Italy
| | - F Barra
- Academic Unit of Obstetrics and Gynecology, IRCCS AOU San Martino - IST, Genoa, Italy
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Genoa, Italy
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Alves P. Imaging innovation and rheumatology. Acta Reumatol Port 2019; 44:5-6. [PMID: 31249272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
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32
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Braun L. [SGUM/SSUM Course System. A Joint Basic Course with Students and Universities - an Opportunity as a Continuation of an Eventful History]. Praxis (Bern 1994) 2018; 107:1251-1253. [PMID: 30424698 DOI: 10.1024/1661-8157/a003120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
SGUM/SSUM Course System. A Joint Basic Course with Students and Universities - an Opportunity as a Continuation of an Eventful History Abstract. In the ultrasound course, the basic course Sonography Blended Learning is starting an interesting and promising cooperation between universities, students and the SGUM/SSUM. It is hoped that we will seize this opportunity. We are well on the way to it.
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Berná-Serna JDD, Chico-Sánchez P, Berná-Mestre JDD, Carbonell-López Del Castillo G. A new method for ocular ultrasound examination. Med Ultrason 2018; 20:402-403. [PMID: 30167599 DOI: 10.11152/mu-1640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
| | - Pablo Chico-Sánchez
- Radiology Departament, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain.
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Bobbia X, Abou-Badra M, Hansel N, Pes P, Petrovic T, Claret PG, Lefrant JY, de La Coussaye JE. Changes in the availability of bedside ultrasound practice in emergency rooms and prehospital settings in France. Anaesth Crit Care Pain Med 2018; 37:201-205. [PMID: 28826982 DOI: 10.1016/j.accpm.2017.06.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 05/25/2017] [Accepted: 06/01/2017] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Ensuring the availability of ultrasound devices is the initial step in implementing clinical ultrasound (CUS) in emergency services. In France in 2011, 52% of emergency departments (EDs) and only 9% of mobile intensive care stations (MICS) were equipped with ultrasound devices. The main goal of this study was to determine the movement of these rates since 2011. METHODS We conducted a cross-sectional, descriptive, multicentre study in the form of a questionnaire. To estimate the numbers of EDs and MICS equipped with at least one ultrasound system with a confidence level of 95% and margin of error of 5%, 170 responding EDs and 145 MICS were required. Each service was solicited three times by secure online questionnaire and then by phone. RESULTS Three hundred and twenty-eight (84%) services responded to the questionnaire: 179 (86%) EDs and 149 (82%) MICS. At least one ultrasound machine was available in 127 (71%, 95% CI [64; 78]) EDs vs. 52% in 2011 (P<0.01). 42 (28%, 95% CI [21; 35]) MICS were equipped vs. 9% in 2011 (P<0.01). In 97 (76%) EDs and 24 (55%) MICS, less than a half of physicians were trained. CUS was used at least three times a day in 52 (41%) EDs and in 8 (19%) MICS. CONCLUSION Our study demonstrates improved access to ultrasound devices in French EDs and MICS. Almost three-quarters of EDs and nearly one-third of MICS are now equipped with at least one ultrasound device. However, the rate of physicians trained per service remains insufficient.
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Affiliation(s)
- X Bobbia
- Pôle anesthésie réanimation douleur urgence, CHU de Nîmes, place du Pr-Debré, 30029 Nîmes, France.
| | - M Abou-Badra
- Pôle anesthésie réanimation douleur urgence, CHU de Nîmes, place du Pr-Debré, 30029 Nîmes, France.
| | - N Hansel
- Pôle anesthésie réanimation douleur urgence, CHU de Nîmes, place du Pr-Debré, 30029 Nîmes, France.
| | - P Pes
- Samu-Smur urgence (PHU3), CHU de Nantes, 1, Quai Moncousu, 44093 Nantes cedex 01, France.
| | - T Petrovic
- Samu-Smur, CHU Avicenne, 125, rue de Stalingrad, 93009 Bobigny cedex, France.
| | - P G Claret
- Pôle anesthésie réanimation douleur urgence, CHU de Nîmes, place du Pr-Debré, 30029 Nîmes, France.
| | - J Y Lefrant
- Pôle anesthésie réanimation douleur urgence, CHU de Nîmes, place du Pr-Debré, 30029 Nîmes, France.
| | - J E de La Coussaye
- Pôle anesthésie réanimation douleur urgence, CHU de Nîmes, place du Pr-Debré, 30029 Nîmes, France.
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Carlin E, Urban C, Sidle J, Cirilli A, Larson J, Richman M, Dexeus D. Gonococcal Tenosynovitis Diagnosed with the Aid of Emergency Department Bedside Ultrasound. J Emerg Med 2018; 54:844-848. [PMID: 29685466 DOI: 10.1016/j.jemermed.2018.02.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2017] [Revised: 01/23/2018] [Accepted: 02/22/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND Gonorrhea is the second most common sexually transmitted infection. Disseminated gonococcal infection (DGI) consists of gonococcal infection plus one or more of the triad of arthritis, tenosynovitis, and dermatitis. Diagnosis in the emergency department (ED) must be suspected clinically, as confirmatory tests are often not available. Point-of-care ultrasound (POCUS) can aid in diagnosis and appropriate management by identifying tenosynovitis and excluding arthritis. CASE REPORT A 26-year-old man with multiple recent sex partners presented to the ED with slowly progressing right wrist pain and swelling over 5 days. His dorsal right wrist was swollen, with slightly decreased range of motion owing to mild pain, and no warmth, tenderness, erythema, or drainage. Multiple hemorrhagic, gray-purple blisters were noted over both hands. Serum white blood cell count was 12 × 103/μL; C-reactive protein was 30.3 mg/L. POCUS of the dorsal right wrist found no joint effusion; the extensor tendon sheath contained a large anechoic space with clear separation of the extensor tendons, suggesting a tendon sheath effusion/tenosynovitis. DGI was suspected, without septic arthritis. The patient was admitted and treated with ceftriaxone and azithromycin. Gonococcus grew from blood cultures and pharyngeal swabs. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: DGI must be suspected clinically, as confirmatory tests are often not available in the ED. Not all patients present with arthritis, tenosynovitis, and dermatitis. It is often difficult to differentiate tenosynovitis from arthritis. POCUS can aid in diagnosis by identifying tenosynovitis (vs. arthritis or simple soft-tissue swelling), allowing timely appropriate DGI diagnosis and management, and, importantly, averting unnecessary arthrocentesis.
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Affiliation(s)
- Edward Carlin
- Department of Emergency Medicine, Northwell Health North Shore University Hospital, Manhasset, New York
| | - Colleen Urban
- Department of Emergency Medicine, Lehigh Valley Health Network, Allentown, Pennsylvania
| | - Jessica Sidle
- Department of Emergency Medicine, Northwell Health Long Island Jewish Medical Center, New Hyde Park, New York
| | - Angela Cirilli
- Emergency Ultrasound, Department of Emergency Medicine, St. John's Riverside Hospital, Yonkers, New York
| | - Jennifer Larson
- Northwell Health Department of Emergency Medicine, New Hyde Park, New York; Northwell Health Department of Internal Medicine, New Hyde Park, New York
| | - Mark Richman
- Department of Emergency Medicine, Northwell Health Long Island Jewish Medical Center, New Hyde Park, New York
| | - Daniel Dexeus
- Department of Emergency Medicine, Northwell Health Long Island Jewish Medical Center, New Hyde Park, New York
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Michels G, Hempel D, Pfister R, Janssens U. Emergency ultrasound and echocardiography in patients with infarct-related cardiogenic shock : A survey among members of the German Society of Medical Intensive Care and Emergency Medicine. Med Klin Intensivmed Notfmed 2018; 114:434-438. [PMID: 29632969 DOI: 10.1007/s00063-018-0431-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 02/13/2018] [Accepted: 03/07/2018] [Indexed: 02/07/2023]
Abstract
Current international and national guidelines promote the use of emergency echocardiography in patients with cardiogenic shock. We assessed whether these recommendations are followed in clinical practice of infarct-related cardiogenic shock patients. For this purpose we conducted a web-based survey among all members of the German Society of Medical Intensive Care and Emergency Medicine (DGIIN); 40% of the DGIIN members completed the survey. Participants reported that in their department emergency echocardiography/ultrasound is performed on most patients in infarct-related cardiogenic shock presenting to the emergency department/chest pain unit or intensive care unit (58.6% versus 81.4%). Only 33% stated that on patients admitted directly to the catheterization laboratory emergency ultrasound/echocardiography is applied in their institution. Local availability of a standardized algorithm was lacking in the majority of departments (77.2%). A great proportion (38.3%) of participants stated that they personally had no formal training in emergency ultrasound. In order to meet the demands of the current guidelines, in addition to integration of ultrasound examinations into diagnostic algorithms, a structured training of all emergency and intensive care physicians is necessary.
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Affiliation(s)
- G Michels
- Department III of Internal Medicine, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany.
| | - D Hempel
- Department of Emergency Medicine, University Hospital Jena, Jena, Germany
| | - R Pfister
- Department III of Internal Medicine, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - U Janssens
- Department of Cardiology, St Antonius Hospital, Eschweiler, Germany
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Abstract
Microbubble ultrasound contrast agents (UCAs) were recently approved by the Food and Drug administration for non-cardiac imaging. The physical principles of UCAs, methods of administration, dosage, adverse effects, and imaging techniques both current and future are described. UCAs consist of microbubbles in suspension which strongly interact with the ultrasound beam and are readily detectable by ultrasound imaging systems. They are confined to the blood pool when administered intravenously, unlike iodinated and gadolinium contrast agents. UCAs have a proven safety record based on over two decades of use, during which they have been used in echocardiography in the U.S. and for non-cardiac imaging in the rest of the world. Adverse effects are less common with UCAs than CT/MR contrast agents. Compared to CT and MR, contrast-enhanced ultrasound has the advantages of real-time imaging, portability, and reduced susceptibility to metal and motion artifact. UCAs are not nephrotoxic and can be used in renal failure. High acoustic amplitudes can cause microbubbles to fragment in a manner that can result in short-term increases in capillary permeability or capillary rupture. These bioeffects can be beneficial and have been used to enhance drug delivery under appropriate conditions. Imaging with a mechanical index of < 0.4 preserves the microbubbles and is not typically associated with substantial bioeffects. Molecularly targeted ultrasound contrast agents are created by conjugating the microbubble shell with a peptide, antibody, or other ligand designed to target an endothelial biomarker associated with tumor angiogenesis or inflammation. These microbubbles then accumulate in the microvasculature at target sites where they can be imaged. Ultrasound contrast agents are a valuable addition to the diagnostic imaging toolkit. They will facilitate cross-sectional abdominal imaging in situations where contrast-enhanced CT and MR are contraindicated or impractical.
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Affiliation(s)
- Wui K Chong
- Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, Unit 1473 | FCT15.5092, 1400 Pressler Street, Houston, TX, 77030, USA.
| | - Virginie Papadopoulou
- UNC-NC State Joint Department of Biomedical Engineering, Chapel Hill, NC, 27599, USA
| | - Paul A Dayton
- UNC Biomedical Research Imaging Center, Chapel Hill, NC, 27599, USA
- UNC-NC State Joint Department of Biomedical Engineering, Chapel Hill, NC, 27599, USA
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Affiliation(s)
- F Tovoli
- Unit of Internal Medicine, Department of Medical and Surgical Sciences, University of Bologna, Hospital S.Orsola Malpighi, Bologna, Italy
| | - V Cantisani
- Department of Radiological Sciences, Policlinico Umberto I, University La Sapienza, Rome, Italy
| | - C Schiavone
- Unit of Internistic Ultrasound. Department of Medicine and Science of Aging. G. d'Annunzio University, Chieti, Italy
| | - F Piscaglia
- Unit of Internal Medicine, Department of Medical and Surgical Sciences, University of Bologna, Hospital S.Orsola Malpighi, Bologna, Italy
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Mozzini C, Di Dio Perna M, Pesce G, Garbin U, Fratta Pasini AM, Ticinesi A, Nouvenne A, Meschi T, Casadei A, Soresi M, Cominacini L. Lung ultrasound in internal medicine efficiently drives the management of patients with heart failure and speeds up the discharge time. Intern Emerg Med 2018; 13:27-33. [PMID: 28803375 DOI: 10.1007/s11739-017-1738-1] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Accepted: 08/09/2017] [Indexed: 01/10/2023]
Abstract
Lung ultrasound (LUS) is a valid tool for the assessment of heart failure (HF) through the quantification of the B-lines. This study in HF patients aims to evaluate if LUS: (1) can accelerate the discharge time; (2) can efficiently drive diuretic therapy dosage; and (3) may have better performance compared to the amino-terminal portion of B type natriuretic peptide (NT-proBNP) levels in monitoring HF recovery. A consecutive sample of 120 HF patients was admitted from the Emergency Department (ED) to the Internal Medicine Department (Verona University Hospital). The Chest X-ray (CXR) group underwent standard CXR examination on admission and discharge. The LUS group underwent LUS on admission, 24, 48 and 72 h later, and on discharge. The Inferior Cava Vein Collapsibility Index, ICVCI, and the NT-proBNP were assessed. LUS discharge time was significantly shorter if compared to CXR group (p < 0.01). During hospitalization, the LUS group underwent an increased number of diuretic dosage modulations compared to the CXR group (p < 0.001). There was a stronger association between partial pressure of oxygen in arterial blood (PaO2) and B-lines compared to the association between PaO2 and NT-proBNP both on admission and on discharge (p < 0.001). The B-lines numbers were significantly higher on admission in patients with more severe HF, and the ICVCI was inversely associated with B-lines number (p < 0.001). The potential of LUS in tailoring diuretic therapy and accelerating the discharge time in HF patients is confirmed. Until the technique comes into common use in different departments, it is plausible that LUS will evolve with different facets.
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Affiliation(s)
- Chiara Mozzini
- Department of Medicine, Section of Internal Medicine, University of Verona, Piazzale L.A. Scuro, 10, 37134, Verona, Italy.
| | - Marco Di Dio Perna
- Department of Medicine, Section of Internal Medicine, University of Verona, Piazzale L.A. Scuro, 10, 37134, Verona, Italy
| | - Giancarlo Pesce
- Department of Diagnostic and Public Health, Unit of Epidemiology and Medical Statistics, University of Verona, Piazzale L.A. Scuro, 10, 37134, Verona, Italy
| | - Ulisse Garbin
- Department of Medicine, Section of Internal Medicine, University of Verona, Piazzale L.A. Scuro, 10, 37134, Verona, Italy
| | - Anna Maria Fratta Pasini
- Department of Medicine, Section of Internal Medicine, University of Verona, Piazzale L.A. Scuro, 10, 37134, Verona, Italy
| | - Andrea Ticinesi
- Department of Medicine and Surgery, Geriatric/Rehabilitation Department, University of Parma, Via A. Gramsci, 14, 43126, Parma, Italy
| | - Antonio Nouvenne
- Department of Medicine and Surgery, Geriatric/Rehabilitation Department, University of Parma, Via A. Gramsci, 14, 43126, Parma, Italy
| | - Tiziana Meschi
- Department of Medicine and Surgery, Geriatric/Rehabilitation Department, University of Parma, Via A. Gramsci, 14, 43126, Parma, Italy
| | - Alder Casadei
- Ultrasound Association of South-Tyrol, Bolzano Health, District, Piazza W.A.Loew-Cadonna 12, 39100, Bolzano, Italy
| | - Maurizio Soresi
- Biomedical Department of Internal Medicine and Medical Specialities, University of Palermo, Via del Vespro, 141-90127, Palermo, Italy
| | - Luciano Cominacini
- Department of Medicine, Section of Internal Medicine, University of Verona, Piazzale L.A. Scuro, 10, 37134, Verona, Italy
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Aringhieri G, Vitali S, Rossi P, Caramella D. The new frontier of imaging: the micron. Clin Exp Rheumatol 2018; 36:169. [PMID: 29352839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 10/27/2017] [Indexed: 06/07/2023]
Affiliation(s)
- Giacomo Aringhieri
- Radiology, Department of Translational Research on New Technologies in Medicine and Surgery, University of Pisa, Italy.
| | - Saverio Vitali
- Radiology, Department of Translational Research on New Technologies in Medicine and Surgery, University of Pisa, Italy
| | - Piercarlo Rossi
- Radiology, Department of Translational Research on New Technologies in Medicine and Surgery, University of Pisa, Italy
| | - Davide Caramella
- Radiology, Department of Translational Research on New Technologies in Medicine and Surgery, University of Pisa, Italy
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Buerger AM, Clark KR. Point-of-Care Ultrasound: A Trend in Health Care. Radiol Technol 2017; 89:127-138. [PMID: 29298917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 07/12/2017] [Indexed: 06/07/2023]
Abstract
PURPOSE To discuss the current and growing use of point-of-care (POC) ultrasound in the management and care of patients. METHODS Several electronic research databases were searched to find articles that emphasized the use of POC ultrasound by health care providers who manage and treat critically ill or injured patients. Thirty-five relevant peer-reviewed journal articles were selected for this literature review. RESULTS Common themes identified in the literature included the use of POC ultrasound in emergency medicine, military medicine, and remote care; comparison of POC ultrasound to other medical imaging modalities; investigation of the education and training required for nonimaging health care professionals who perform POC ultrasound in their practices; and discussion of the financial implications and limitations of POC ultrasound. DISCUSSION POC ultrasound provides clinicians with real-time information to better manage and treat critically ill or injured patients in emergency medicine, military medicine, and remote care. In addition to providing immediate bedside diagnostic information, use of POC ultrasound has increased because of concerns regarding radiation protection. Finally, the expansion of POC ultrasound to other specialty areas requires nonimaging health care professionals to perform bedside ultrasound examinations and interpret the resulting images. Because POC ultrasound is user-dependent, adequate training is essential for all who perform and interpret the examinations. CONCLUSION Research involving POC ultrasound will continue as innovations and confidence in ultrasound applications advance. Future research should continue to examine the broad use of POC ultrasound in patient care and management.
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Hassanzadeh Rad A, Badeli H. Point-of-Care Ultrasonography: Is It Time Nephrologists Were Equipped With the 21th Century's Stethoscope? Iran J Kidney Dis 2017; 11:259-262. [PMID: 28794287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Accepted: 01/05/2017] [Indexed: 06/07/2023]
Abstract
In the past 3 decades, ultrasonography has gifted internal organs visualization to physicians to have a better detection of various diseases. Previously performed solely by radiologists as a method with high feasibility and accuracy, recently ultrasonography is being recommended and used by many other physicians in practice. Ultrasonography not only can be used to diagnose and manage kidney diseases, but also is an essential tool in nephrology for the guidance of invasive procedures. This method of bedside ultrasonography by physicians in real time is called point-of-care ultrasonography (POCUS). Given the limitations of collecting information by routine physical examination in kidney diseases and the simplicity of performing ultrasonography to examine kidney location, architecture, and restricted pathologies, nephrologists that have been lagging in this area, should join the spectrum of clinicians using the POCUS to provide safe and rapid diagnosis of common renal abnormalities. Although physicians may imagine POCUS as a difficult tool to use and there has been an initial resistance and reluctance to use ultrasonography by nonradiologists, investigations have shown that learning and doing POCUS was possible even for undergraduate medical students during a short course. According to the collected evidence in the field of POCUS in different branches of medicine, it seems that it should be added to nephrology examination room in the near future.
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Affiliation(s)
| | - Hamidreza Badeli
- Division of Pediatric Nephrology, Pediatrics Growth Disorders Research Center, 17 Shahrivar Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran.
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Gardener H, Caunca MR, Dong C, Cheung YK, Elkind MSV, Sacco RL, Rundek T, Wright CB. Ultrasound Markers of Carotid Atherosclerosis and Cognition: The Northern Manhattan Study. Stroke 2017; 48:1855-1861. [PMID: 28630235 PMCID: PMC5482565 DOI: 10.1161/strokeaha.117.016921] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 04/04/2017] [Accepted: 05/01/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Ultrasound markers of carotid atherosclerosis may be related to cognitive status. We hypothesized that individuals with greater carotid intima-media thickness (cIMT) and carotid plaque burden would exhibit worse cognition. METHODS One thousand one hundred sixty-six stroke-free participants from the NOMAS (Northern Manhattan Study) underwent carotid ultrasound and neuropsychological examination. Among them, 826 underwent a second neuropsychological examination an average of 5 years later. cIMT and plaque were assessed by a standardized B-mode ultrasound imaging and reading protocol. We used multivariable linear regression to examine cIMT, carotid plaque presence, and carotid plaque area as correlates of domain-specific neuropsychological Z scores cross-sectionally and over time. We also investigated possible effect modification by APOE ε4 allele, age, and race/ethnicity. RESULTS Participants had a mean (SD) age of 70 (9) years and were 60% women, 66% Hispanic, 15% white, and 18% black. Those with greater cIMT exhibited worse episodic memory after adjustment for demographics and vascular risk factors (β=-0.60; P=0.04). APOE ε4 carriers with greater cIMT exhibited worse episodic memory (β=-1.31; P=0.04), semantic memory (β=-1.45; P=0.01), and processing speed (β=-1.21; P=0.03). Participants with greater cIMT at baseline did not exhibit significantly greater cognitive decline after adjustment. APOE ε4noncarriers with greater cIMT exhibited greater declines in executive function (β=-0.98; P=0.06). Carotid plaque burden was not significantly associated with cognition at baseline or over time. CONCLUSIONS Subclinical carotid atherosclerosis was associated with worse cognition among those at higher risk for Alzheimer disease. Interventions targeting early stages of atherosclerosis may modify cognitive aging.
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Affiliation(s)
- Hannah Gardener
- From the Evelyn F. McKnight Brain Institute, Neuroscience Program (H.G., M.R.C., C.D., R.L.S., T.R.), Department of Neurology (H.G., M.R.C., C.D., R.L.S., T.R.), and Department of Public Health Sciences (M.R.C., R.L.S., T.R.), Miller School of Medicine, University of Miami, FL; Department of Neurology, College of Physicians and Surgeons (M.S.V.E.), Department of Biostatistics, Mailman School of Public Health (Y.K.C.), and Department of Epidemiology, Mailman School of Public Health (M.S.V.E.), Columbia University, New York, NY; and National Institute of Neurological Diseases and Stroke, National Institutes of Health, Bethesda, MD (C.B.W.).
| | - Michelle R Caunca
- From the Evelyn F. McKnight Brain Institute, Neuroscience Program (H.G., M.R.C., C.D., R.L.S., T.R.), Department of Neurology (H.G., M.R.C., C.D., R.L.S., T.R.), and Department of Public Health Sciences (M.R.C., R.L.S., T.R.), Miller School of Medicine, University of Miami, FL; Department of Neurology, College of Physicians and Surgeons (M.S.V.E.), Department of Biostatistics, Mailman School of Public Health (Y.K.C.), and Department of Epidemiology, Mailman School of Public Health (M.S.V.E.), Columbia University, New York, NY; and National Institute of Neurological Diseases and Stroke, National Institutes of Health, Bethesda, MD (C.B.W.)
| | - Chuanhui Dong
- From the Evelyn F. McKnight Brain Institute, Neuroscience Program (H.G., M.R.C., C.D., R.L.S., T.R.), Department of Neurology (H.G., M.R.C., C.D., R.L.S., T.R.), and Department of Public Health Sciences (M.R.C., R.L.S., T.R.), Miller School of Medicine, University of Miami, FL; Department of Neurology, College of Physicians and Surgeons (M.S.V.E.), Department of Biostatistics, Mailman School of Public Health (Y.K.C.), and Department of Epidemiology, Mailman School of Public Health (M.S.V.E.), Columbia University, New York, NY; and National Institute of Neurological Diseases and Stroke, National Institutes of Health, Bethesda, MD (C.B.W.)
| | - Ying Kuen Cheung
- From the Evelyn F. McKnight Brain Institute, Neuroscience Program (H.G., M.R.C., C.D., R.L.S., T.R.), Department of Neurology (H.G., M.R.C., C.D., R.L.S., T.R.), and Department of Public Health Sciences (M.R.C., R.L.S., T.R.), Miller School of Medicine, University of Miami, FL; Department of Neurology, College of Physicians and Surgeons (M.S.V.E.), Department of Biostatistics, Mailman School of Public Health (Y.K.C.), and Department of Epidemiology, Mailman School of Public Health (M.S.V.E.), Columbia University, New York, NY; and National Institute of Neurological Diseases and Stroke, National Institutes of Health, Bethesda, MD (C.B.W.)
| | - Mitchell S V Elkind
- From the Evelyn F. McKnight Brain Institute, Neuroscience Program (H.G., M.R.C., C.D., R.L.S., T.R.), Department of Neurology (H.G., M.R.C., C.D., R.L.S., T.R.), and Department of Public Health Sciences (M.R.C., R.L.S., T.R.), Miller School of Medicine, University of Miami, FL; Department of Neurology, College of Physicians and Surgeons (M.S.V.E.), Department of Biostatistics, Mailman School of Public Health (Y.K.C.), and Department of Epidemiology, Mailman School of Public Health (M.S.V.E.), Columbia University, New York, NY; and National Institute of Neurological Diseases and Stroke, National Institutes of Health, Bethesda, MD (C.B.W.)
| | - Ralph L Sacco
- From the Evelyn F. McKnight Brain Institute, Neuroscience Program (H.G., M.R.C., C.D., R.L.S., T.R.), Department of Neurology (H.G., M.R.C., C.D., R.L.S., T.R.), and Department of Public Health Sciences (M.R.C., R.L.S., T.R.), Miller School of Medicine, University of Miami, FL; Department of Neurology, College of Physicians and Surgeons (M.S.V.E.), Department of Biostatistics, Mailman School of Public Health (Y.K.C.), and Department of Epidemiology, Mailman School of Public Health (M.S.V.E.), Columbia University, New York, NY; and National Institute of Neurological Diseases and Stroke, National Institutes of Health, Bethesda, MD (C.B.W.)
| | - Tatjana Rundek
- From the Evelyn F. McKnight Brain Institute, Neuroscience Program (H.G., M.R.C., C.D., R.L.S., T.R.), Department of Neurology (H.G., M.R.C., C.D., R.L.S., T.R.), and Department of Public Health Sciences (M.R.C., R.L.S., T.R.), Miller School of Medicine, University of Miami, FL; Department of Neurology, College of Physicians and Surgeons (M.S.V.E.), Department of Biostatistics, Mailman School of Public Health (Y.K.C.), and Department of Epidemiology, Mailman School of Public Health (M.S.V.E.), Columbia University, New York, NY; and National Institute of Neurological Diseases and Stroke, National Institutes of Health, Bethesda, MD (C.B.W.)
| | - Clinton B Wright
- From the Evelyn F. McKnight Brain Institute, Neuroscience Program (H.G., M.R.C., C.D., R.L.S., T.R.), Department of Neurology (H.G., M.R.C., C.D., R.L.S., T.R.), and Department of Public Health Sciences (M.R.C., R.L.S., T.R.), Miller School of Medicine, University of Miami, FL; Department of Neurology, College of Physicians and Surgeons (M.S.V.E.), Department of Biostatistics, Mailman School of Public Health (Y.K.C.), and Department of Epidemiology, Mailman School of Public Health (M.S.V.E.), Columbia University, New York, NY; and National Institute of Neurological Diseases and Stroke, National Institutes of Health, Bethesda, MD (C.B.W.)
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Otero HJ, Crowder L. Imaging Utilization for the Diagnosis of Appendicitis in Stand-Alone Children's Hospitals in the United States: Trends and Costs. J Am Coll Radiol 2017; 14:603-608. [PMID: 28223114 DOI: 10.1016/j.jacr.2016.12.013] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Revised: 12/14/2016] [Accepted: 12/15/2016] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To describe the imaging utilization patterns for the diagnosis of appendicitis among children's hospitals in the United States over the last 10 years (2005-2014). METHODS All patients with a primary discharge diagnosis of appendicitis included in a large administrative database of 45 pediatric institutions in the United States between 2005 and 2014 were selected. Demographics, imaging utilization, and costs were described. RESULTS In all, 96,786 children with appendicitis (59% boys, 41% girls; mean age: 9.9 years) were studied. The average length of stay decreased from 5.0 days in 2005 to 3.4 days in 2014 (P < .01). The percentage of patients undergoing CT increased between 2005 and 2007 from 59.1% to 62.6%, respectively, followed by a decrease from 62.6% to 32.7% in 2014 (r2 = 0.93). Radiograph utilization decreased from 14.2% in 2005 to 3.6% in 2014 (r2 = 0.93), and ultrasound and MRI increased from 25% and 0.03% in 2005 to 61% and 1.0% in 2014 (r2 = 0.97 and 0.64), respectively. The mean total hospital costs increased from $11,700 in 2005 to $16,500 in 2014; imaging costs increased only slightly from $3,205 to $3,259. The imaging fraction of hospital costs decreased from 27.5% to 19.8%. CONCLUSION There has been a significant decrease in utilization of CT and radiographs for the management of appendicitis in children, and ultrasound has continued to increase. Imaging costs have remained stable in comparison to rising hospital costs, generating a drop in the fraction of costs related to imaging.
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Affiliation(s)
- Hansel J Otero
- Department of Diagnostic Imaging and Radiology, Children's National Health System, Washington, DC.
| | - Lauren Crowder
- Department of Diagnostic Imaging and Radiology, Children's National Health System, Washington, DC
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Affiliation(s)
- Fabian Kiessling
- Department of Experimental Molecular Imaging University Clinics, RWTH-Aachen University Pauwelsstrasse 20 52074 Aachen, Germany
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Avinadav E, Almog A, Kravarusic D, Seguier E, Samuk I, Nika A, Freud E. Point-of-Care Ultrasound in a Department of Pediatric and Adolescent Surgery. Isr Med Assoc J 2016; 18:677-679. [PMID: 28466618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND Point-of-care ultrasound (POCUS) is becoming a common tool for routine use in emergency medicine, anesthesiology and intensive care for diagnostic and interventional purposes. When a portable ultrasound device became available for the department of Pediatric and Adolescent Surgery at the Schneider's Children Medical Center of Israel, we added POCUS assessments to the physician's daily rounds. POCUS is performed by pediatric surgeons trained in basic ultrasonography skills. Starting September 2015 all POCUS examinations were documented. OBJECTIVES To describe the current use, diagnostic and therapeutic impacts of POCUS in a department of pediatric and adolescent surgery. METHODS We conducted an observational study of all the documented POCUS procedures performed during a half-year period. Data regarding patient condition and the POCUS procedures were collected, as well as data on the use of other diagnostic modalities, mainly formal ultrasound exams (by radiologists) and computed tomography scans and their correlation with the POCUS assessment. RESULTS Fifty-one POCUS exams were performed during the study period, most of which served to define the presence and resolution of a collection - intraabdominal (34%) and subcutaneous (31%). Despite a high rate for formal diagnostic studies (65%), probably due to a relative lack of confidence of surgeons performing the POCUS exams during this initial period, most results (92%) were compatible. CONCLUSIONS The ability and availability to perform multiple POCUS exams by the attending physician proved to be a valuable aide to the classical physical and laboratory examinations of surgical patients, and we predict its increasing use in quotidian practice.
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Affiliation(s)
- Efrat Avinadav
- Department of Pediatric and Adolescent Surgery, Schneider's Children Medical Center of Israel, Petah Tikva, affiliated with Sacker Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Anastasia Almog
- Department of Pediatric and Adolescent Surgery, Schneider's Children Medical Center of Israel, Petah Tikva, affiliated with Sacker Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dragan Kravarusic
- Department of Pediatric and Adolescent Surgery, Soroka Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Emanuelle Seguier
- Department of Pediatric and Adolescent Surgery, Schneider's Children Medical Center of Israel, Petah Tikva, affiliated with Sacker Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Inbal Samuk
- Department of Pediatric and Adolescent Surgery, Schneider's Children Medical Center of Israel, Petah Tikva, affiliated with Sacker Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Adrianna Nika
- Department of Pediatric and Adolescent Surgery, Schneider's Children Medical Center of Israel, Petah Tikva, affiliated with Sacker Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Enrique Freud
- Department of Pediatric and Adolescent Surgery, Schneider's Children Medical Center of Israel, Petah Tikva, affiliated with Sacker Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Lanni S, De Lucia O, Possemato N, Malattia C, Ravagnani V, Magni-Manzoni S. Musculoskeletal ultrasound in paediatric rheumatology: the Italian perspective. Clin Exp Rheumatol 2016; 34:957-958. [PMID: 27157383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2015] [Accepted: 02/01/2016] [Indexed: 06/05/2023]
Affiliation(s)
- Stefano Lanni
- Pediatria II Reumatologia, Istituto Giannina Gaslini, Genoa, Italy
| | - Orazio De Lucia
- Department of Rheumatology, Gaetano Pini Institute, Milan, Italy
| | - Niccolò Possemato
- Department of Internal Medicine, Azienda Ospedaliera ASMN, IRCCS, Reggio Emilia, Italy
| | - Clara Malattia
- Pediatria II Reumatologia, Istituto Giannina Gaslini, Genoa, Italy
| | | | - Silvia Magni-Manzoni
- Paediatric Rheumatology Unit, IRCCS Bambino Gesù Children's Hospital, Rome, Italy.
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Hickner J. Practical "pearls" to help improve your care. J Fam Pract 2016; 65:516. [PMID: 27660834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
This month's review of the current uses of ultrasound in family medicine made me wonder whether ultrasound might become the stethoscope of the future.
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Steinmetz P, Oleskevich S. The benefits of doing ultrasound exams in your office. J Fam Pract 2016; 65:517-523. [PMID: 27660835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Family medicine ultrasound is more accurate, more cost-effective, and less time-consuming than you might imagine. Here's how it can improve your care.
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Affiliation(s)
- Peter Steinmetz
- Department of Family Medicine, Steinberg Centre for Simulation and Interactive Learning, McGill University, Montreal, Canada.
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Sporea I. Why isn't Contrast Enhanced Ultrasound for Focal Liver Lesions used more in daily practice? Med Ultrason 2016; 18:5-6. [PMID: 26962546 DOI: 10.11152/mu.2013.2066.181.isp] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- Ioan Sporea
- Department of Gastroenterology and Hepatology, "Victor Babes" University of Medicine and Pharmacy Timisoara, Romania.
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