Ultrasound monitoring to detect embolic phenomena in the inferior vena cava during hip arthroplasty

INTRODUCTION AND OBJECTIVES

Embolic phenomena frequently occur during hip joint replacement surgery, and may lead to haemodynamic instability in frail patients. Transoesophageal ultrasound monitoring is rarely available in non-cardiac operating theatres, and cannot be performed in awake patients under spinal anaesthesia. The main objectives of this prospective exploratory study were to determine the feasibility of using an alternative ultrasound approach to monitor the inferior vena cava during hip replacement surgery, and to determine the intra and interobserver reliability of the ultrasound findings.

METHOD

We conducted a prospective exploratory study in 20 patients undergoing cemented hip arthroplasty in the supine position under spinal anaesthesia and sedation. The inferior vena cava was assessed through a subcostal window at 10 intraoperative time points, and the findings were rated on a qualitative embolism severity scale. The ultrasound images were evaluated by 2 independent observers.

RESULTS

An adequate subcostal window was obtained in 90% of cases. Intra- and inter-observer reliability was high (kappa index >0.80, p < 0.001). Nearly all (95%) patients presented some degree of embolism, which was severe in 50% of cases.

CONCLUSIONS

Our study suggests that ultrasound assessment of embolic phenomena in the inferior vena cava through a subcostal window is feasible in 90% of cases. The qualitative embolic severity rating scale is highly reproducible and has high intra- and inter-observer reliability.

Use of ultrasound for hardware removal

INTRODUCTION

Osteosynthesis hardware removal is one of the most frequent practices in Orthopedic electives surgeries and is usually carried out guided under fluoroscopy. There are other tools such as ultrasound that allow us to visualize the hardware with the advantage of being free of ionizing radiation and with better availability. The objective of our study is to analyze the results obtained in patients undergoing hardware removal in the operating room under ultrasound assistance and local anesthesia.

MATERIAL AND METHODS

A descriptive study was carried out collecting variables such as demographic data, reason for the removal, pain during the procedure and in subsequent days, as well as the duration and rate of success of the procedure and the degree of satisfaction.

RESULTS

We obtained a 100% success in ultrasound-guided extraction without the need for conventional radiology, with a mean VAS of 1.91 and need for subsequent analgesia in 36.4% of the cases, with syndesmotic dynamization being the most frequent reason for intervention.

CONCLUSION

Ultrasound is a useful tool in osteosynthesis hardware removal, and that may be sufficient by itself; also saving health personnel and patients from ionizing radiation resulting from the use of conventional fluoroscopy.

[Ultrasound-guided caudal block with ropivacaine in infraumbilical surgeries in pediatric patients]

Background

The use of local anesthetics as part of multimodal analgesia is an attractive concept in pediatric patients, since the evaluation and management of pain is a challenge in children under 7 years of age. Despite having guidelines and multiple studies on volume calculation, no safe and effective recommendation has been issued.

Objective

To demonstrate that ultrasound-guided caudal block with a dose of 0.75 mL/kg of 0.2% ropivacaine has the same analgesic effect as a dose of 1.2 mL/kg.

Material and methods

Randomized, prospective, longitudinal, comparative equivalence clinical trial. One hundred patients 0-7 years of age scheduled for elective or emergency infraumbilical surgery were enrolled between April 2021 and January 2022. Children were randomized 1:1 to be assigned to ultrasound-guided caudal block.

Results

100 patients divided into two groups with 0.2% ropivacaine volumes (0.75 mL vs. 1.2 mL). Both groups demonstrated the trans-anesthetic and post-anesthetic sedoanalgesia variables without significant differences for both groups on the FLACC pain scale after surgery and in recovery (p > 0.5), in the pain reassessment on the FLACC scale in the office called chronic pain (p > 0.5) in both groups. No complications were reported in the follow-up consultations and no arrhythmias were reported in both groups during surgery.

Conclusions

the results of both groups did not show differences between a volume of 0.75 mL and 1.2 mL, the administration of 0.2% ropivacaine is favored with the use of ultrasound, which allows effective administration of lower doses of local anesthetic with reduced risk of complications. It is necessary to carry out studies in other types of surgery to compare the use of less volume of local anesthetic compared to the Melman formula used in this study.

Percutaneous achilles tendon repair with absorbable suture: Outcomes and complications

OBJECTIVE

The purpose of this study is to evaluate the clinical outcomes and complications of percutaneous achilles tendon repair with absorbable sutures.

MATERIAL AND METHODS

A prospective cohort study including patients treated for an achilles tendon rupture from January 2016 to March 2019 was conducted.

INCLUSION CRITERIA

≥18 years of age, non-insertional (2-8cm proximal to insertion) achilles tendon ruptures. Open or partial ruptures were excluded. The diagnosis was based on clinical criteria and confirmed by ultrasonography in all patients. Epidemiological data, rupture and healing risk factors, previous diagnosis of tendinopathy, pre-rupture sport activity, job information, mechanism of rupture and the time in days between lesion and surgery were collected. Patients were assessed using visual analogue scale (VAS) at the 1, 3, 6 and 12-month follow-up. The achilles tendon rupture score (ATRS) were assessed at the 6 and 12 month follow-up. Ultrasound was performed at the 6-month follow-up. The re-rupture rate and postoperative complications were also collected.

CONCLUSIONS

In our experience, percutaneous achilles tendon repair with absorbable sutures in patients with an acute achilles tendon rupture has shown good functional results but with a high incidence of complications. Although most complications were transitory sural nerve symptoms, this complication would be avoided in patients treated conservatively. For this reason, conservative treatment associated with an early weightbearing rehabilitation protocol should be considered a viable option for patients with achilles tendon ruptures, mainly in cooperative young patients.

Nutritional ultrasound®: Conceptualisation, technical considerations and standardisation

Nutritional ultrasound® is a new concept that uses ultrasound to assess body composition. It is composed of the evaluation of fat-free mass and fat mass. It is an emerging, economical, portable, non-invasive technique that evaluates the musculoskeletal area with linear, broadband, multifrequency probes, with a depth field of 20-100mm. It quantifies muscle modifications in malnutrition and provides information on functional changes (echogenicity). Although there are no validated specific cut-off points, the anterior rectum area of the quadriceps can be used as a criterion for malnutrition. The distribution of adipose tissue provides information on the energy reserve and the inflammatory pattern. It is important to integrate nutritional ultrasound® measures in clinical practice adapted to different settings and pathologies. It is necessary to establish training plans in nutritional ultrasound® for use by Endocrinology and Nutrition Specialists, with the aim of improving the diagnosis and treatment of their patients.

Percutaneous achilles tendon repair with absorbable suture: Outcomes and complications

OBJECTIVE

The purpose of this study is to evaluate the clinical outcomes and complications of percutaneous achilles tendon repair with absorbable sutures.

MATERIAL AND METHODS

A prospective cohort study including patients treated for an achilles tendon rupture from January 2016 to March 2019 was conducted.

INCLUSION CRITERIA

≥18 years of age, non-insertional (2-8cm proximal to insertion) achilles tendon ruptures. Open or partial ruptures were excluded. The diagnosis was based on clinical criteria and confirmed by ultrasonography in all patients. Epidemiological data, rupture and healing risk factors, previous diagnosis of tendinopathy, pre-rupture sport activity, job information, mechanism of rupture and the time in days between lesion and surgery were collected. Patients were assessed using visual analogue scale at the 1, 3, 6 and 12-month follow-up. The achilles tendon rupture score were assessed at the 6 and 12 month follow-up. Ultrasound was performed at the 6-month follow-up. The re-rupture rate and postoperative complications were also collected.

CONCLUSIONS

In our experience, percutaneous achilles tendon repair with absorbable sutures in patients with an acute achilles tendon rupture has shown good functional results but with a high incidence of complications. Although most complications were transitory sural nerve symptoms, this complication would be avoided in patients treated conservatively. For this reason, conservative treatment associated with an early weightbearing rehabilitation protocol should be considered a viable option for patients with achilles tendon ruptures, mainly in cooperative young patients.

Percutaneous Achilles tendon repair with absorbable suture: Outcomes and complications

BACKGROUND AND OBJECTIVE

The purpose of this study is to evaluate the clinical outcomes and complications of percutaneous Achilles tendon repair with absorbable sutures.

MATERIAL AND METHODS

Prospective cohort study including 52 patients treated for Achilles tendon ruptures (January 2016 to March 2019).

INCLUSION CRITERIA

≥18 years of age, non-insertional Achilles tendon ruptures. Diagnosis based on clinical criteria, confirmed by ultrasonography. Assessment using Visual Analogue Scale (VAS), Achilles Tendon Rupture Score (ATRS) and ultrasound. Re-rupture rate and postoperative complications were collected.

RESULTS

VAS scoring (SD) at 1, 3, 6 and 12 months follow-up (FU) were 2.63 (0.83), 1.79 (1.25), 0.69 (1.09) and 0.08 (0.39), respectively. Mean (SD) ATRS score was 92.45 points at 6 months (6.27) and 94.04 points at 12 months FU (4.59). Three re-ruptures (5.77%) occurred with a mean time between surgery and re-rupture of 108.75 days (SD 28.4), all of them within 4-month FU. No ruptures at the time to return to sports activity. Thirteen complications (25%) (3 re-ruptures, 1 superficial wound infection and 9 transitory sural nerve injuries).

CONCLUSIONS

Percutaneous Achilles tendon repair with absorbable sutures in patients with acute Achilles tendon ruptures has shown good functional results but with a high incidence of complications. Although most complications were transitory sural nerve symptoms, these would be avoided with conservative treatment. Conservative treatment associated with an early weight-bearing rehabilitation protocol should be considered a viable option for patients with Achilles tendon ruptures, specially in cooperative young patients.

Percutaneous Achilles tendon repair with absorbable suture: Outcomes and complications

BACKGROUND AND OBJECTIVE

The purpose of this study is to evaluate the clinical outcomes and complications of percutaneous Achilles tendon repair with absorbable sutures.

MATERIAL AND METHODS

Prospective cohort study including 52 patients treated for Achilles tendon ruptures (January 2016 to March 2019).

INCLUSION CRITERIA

≥18 years of age, non-insertional Achilles tendon ruptures. Diagnosis based on clinical criteria, confirmed by ultrasonography. Assessment using Visual Analogue Scale (VAS), Achilles Tendon Rupture Score (ATRS) and ultrasound. Re-rupture rate and postoperative complications were collected.

RESULTS

VAS scoring (SD) at 1, 3, 6 and 12 months follow-up (FU) were 2.63 (0.83), 1.79 (1.25), 0.69 (1.09) and 0.08 (0.39), respectively. Mean (SD) ATRS score was 92.45 points at 6 months (6.27) and 94.04 points at 12 months FU (4.59). Three re-ruptures (5.77%) occurred with a mean time between surgery and re-rupture of 108.75 days (SD 28.4), all of them within 4-month FU. No ruptures at the time to return to sports activity. Thirteen complications (25%) (3 re-ruptures, 1 superficial wound infection and 9 transitory sural nerve injuries).

CONCLUSIONS

Percutaneous Achilles tendon repair with absorbable sutures in patients with acute Achilles tendon ruptures has shown good functional results but with a high incidence of complications. Although most complications were transitory sural nerve symptoms, these would be avoided with conservative treatment. Conservative treatment associated with an early weight-bearing rehabilitation protocol should be considered a viable option for patients with Achilles tendon ruptures, specially in cooperative young patients.

How the training of ultrasonographers influences the certainty of prenatal detection of congenital malformations of interest to the pediatric surgeon

BACKGROUND

The training needed for doing obstetric ultrasounds is rarely reported. The aim of this study was to determine whether the training of the ultrasonographer influences the prenatal diagnostic certainty of some congenital malformations.

METHODS

We conducted a retrospective evaluation of antepartum sonographic findings of newborn infants found ultimately to have a congenital anomaly in a tertiary level pediatric reference center. Data were collected on admission for consecutive patients at a tertiary-level pediatric reference center. The mother´s pregnancy and birth demographic variables and those of the prenatal ultrasound (PUS) were analyzed and correlated with the final diagnosis.

RESULTS

Sixty-seven neonates were included. All cases underwent PUS with a mean of 4.6. Prenatal diagnosis was established in 24 cases (35.8%). Thirteen surgical anomalies were detected, particularly anorectal malformation and gastroschisis. The accuracy of PUS was associated with the training of the physician performing the PUS, whereby PUS with the greatest accuracy were performed by gynecologists and maternal-fetal specialists against radiologists and general practitioners (p = 0.005). Patients without an accurate prenatal diagnosis had a greater risk of presenting comorbidities (relative risk [RR]: 1.65, p = < 0.001, 95% confidence interval [CI]: 1.299-2.106).

CONCLUSIONS

In our setting, prenatal diagnosis of these malformations is directly determined by the training of the person performing the ultrasound.

Comparison of ultrasound guidance and palpation technique for femoral artery catheterization in children undergoing cardiac surgery

OBJECTIVE

The aim of this study was compare the palpation technique and ultrasound-guidance for femoral artery catheterization in pediatric patients undergoing surgery for congenital heart disease.

MATERIALS AND METHODS

This prospective and randomized controlled study included American Society of Anesthesiologists III-IV 40 children who underwent congenital heart surgery. The patients were divided into two groups; ultrasound-guided catheterization group and palpation-guided catheterization group. Demographic and clinical characteristics of the patients, access time, success rate, number of attempts, first-attempt success, number of trials, and failed cannulations were recorded.

RESULTS

The diameter of the femoral artery was significantly shorter, access time and numbers of trials were significantly lower, and first-attempt success rate was significantly higher in the US group. The complication rate was significantly higher in the P group. The number of failed catheterization was higher in the P group. Total cost required for the procedure was significantly lower in the US group.

CONCLUSION

We found that ultrasound-guided arterial catheterization increases the success rate and the number of successful catheterizations, while reducing the overall procedure time, incidence of complications, and cost. Therefore, we believe that the use of ultrasound guidance in arterial catheterization in pediatric cardiac surgery would be a better choice.

Usefulness of lung ultrasound in the evaluation of children with lower respiratory tract infection in the emergency room

BACKGROUND

Lung ultrasound is a bedside tool that allows the evaluation of pulmonary parenchymal involvement in pediatric patients through the lung ultrasound score (LUS). We aimed to evaluate a group of patients under 3 years of age with lower respiratory tract infections using LUS at the Hospital Infantil del Estado de Sonora.

METHODS

We included patients younger than 3 years admitted to the emergency department with lower respiratory tract infections. A lung ultrasound was performed within the first 24 h of admission to the emergency department and evaluated using LUS. We analyzed age, sex, etiology of infection, days of stay, use of mechanical ventilation, Downes scale, failure of mechanical ventilation on admission, and mortality. Descriptive analysis was performed with frequencies and percentages for qualitative variables and medians and interquartile intervals for quantitative variables. Differences in the distribution of LUS variables were evaluated with the Fishers' exact test and Student's t-test.

RESULTS

We included a total of 19 patients with lower respiratory tract infections, 73.7% with bronchiolitis. Fifty percent of the cases scored 7 on the LUS, 91.7% were admitted to the pediatric intensive care unit, and 53.8% required invasive mechanical ventilation.

CONCLUSIONS

The use of LUS in lower respiratory tract infections can predict the need for PICU admission, the use of invasive ventilatory support, and prolonged hospital stay.

[Magnetic resonance imaging accuracy and utility for testicular cancer diagnosis]

PURPOSE

The purpose of our study is to analyze the imaging findings described in MRI and the histopathologic type of testicular lesions to determine which findings are the best predictors of malignancy.

MATERIALS AND METHODS

Forty six (46) patients with testicular lesions were initially studied with ultrasound (US) and with testicular MRI (tMRI) on a 1.5-T magnet. MRIs were reviewed by a radiologist with 8 years of experience and imaging findings such as the size of the lesion, the signal intensity in T1, T2 weighted sequences, and the enhancement after endovenous contrast administration, were correlated with the histopathologic diagnosis. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were analyzed.

RESULTS

The enhancement after administration of contrast was the finding of better performance with a sensitivity, specificity, PPV and NPV of 90 (71-97), 47 (24-71), 74 (56-87) and 73 (40-92), respectively. Meanwhile, the results for hypointense/heterogeneous lesions in T2 weighted sequences and with enhancement with intravenous contrast were 87 (49-84), 47 (44-89), 74 (55-86) y 67 (35-89), respectively.

CONCLUSION

The finding of a testicular lesion of low signal intensity and heterogeneous in T2 weighted sequences, with IV contrast enhancement represents a valuable predictor of malignancy. The latter being the most sensitive as a predictor of malignancy.

Usefulness of the optic nerve sheath ultrasound in patients with cessation of cerebral flow

Optic nerve sheath diameter (ONSD) ultrasound has proven to be a useful tool for the detection of intracranial hypertension (IH). The DVNO values, in patients with cessation of cerebral blood flow (CCBF), has not been clarified yet.

OBJECTIVE

Establish an association between DVNO and CFSC in neurocritical patients admitted to an ICU.

PATIENTS AND METHODS

Cross-sectional study of patients admitted in a third level ICU, between April 2017 and April 2018, with neurological pathology. ONSD ultrasound was performed in the first 24 h and as the patient was diagnosed of CCBF. The ONSD values of patients with and without diagnosis of CCBF were compared.

RESULTS

99 patients were included, 29 of whom showed CCBF in transcranial Doppler. The ONSD measurement did not demonstrate significant differences between both groups, 65.94 ± 7.55 in the group with CCBF and 63.88 ± 5.56 in the group without CCBF, p = 0.14.

CONCLUSION

In our study, ONSD values capable of recognizing CCBF were not identified.

Ultrasound-guided brachiocephalic vein access in neonates and pediatric patients

Central venous accesses in neonates and pediatric patients represent a common and important procedure for both, intraoperative and postoperative care. Point-of-care ultrasound-guided technique has been proposed to increased success rate and efficiency, as well as to decrease the number of complications. Ultrasound-guided internal jugular vein cannulation is considering the "gold standard" in children. Another central venous cannulation option in neonates and children has been supraclavicular ultrasound-guided cannulation of the brachiocephalic vein using the in-plane approach. This article gives a review of the current evidence, the basic knowledge of the technique and the structured approach to follow for supraclavicular ultrasound-guided brachiocephalic vein access in children and neonates.

[Double catheter J: ultrasound guided placement, experience initial.]

INTRODUCTION AND OBJECTIVES

 The ureteral catheter is used to provide adequate drainage of the upper urinary tract. They have been used to prevent or relieve ureteral obstruction due to multiple causes. The literature mentions the standard placement of double J catheter guided by fluoroscopy, reporting the use of ultrasound exclusively in cases of pregnant patients in order to avoid ionizing radiation. Based on the aforementioned, the primary objective was to evaluate the placement of double J catheter guided by ultrasound, as an alter native technique to the use of the fluoroscope in ureteral obstructions, as secondary objectives the intensity of the pain and the complications of the procedure.

MATERIALS AND METHODS

An observational, descriptive and prospective study was carried out with 41patients who attended the lithiasis consultation.

RESULTS

A total of 41 patients who under went double J catheter guided by ultrasound were evaluated, achieving it successfully in 35 of the cases, resulting in bad position in 2 patients and being impossible to insert it in 4. Averageage was 41 years, size of the lithium 10.41mm. The complications presented were 17% with the use of the scale of Clavien modified these complications were represented as follows: 4.9% grade I back pain, 7.2% grade II lower urinary tract symptoms, lower tract infections, and 4.9% grade IIIa malposition.

CONCLUSIONS

The placement of ureteral catheters guided by ultrasound, represent a useful tool, safe, with manageable complications, taking place in times adjusted to the procedure.

Preoperative axillary ultrasonography in patients with breast cancer: a prospective study to evaluate its ability to predict axillary tumor load

OBJECTIVE

This study aimed to determine the ability of axillary ultrasonography to predict the number of lymph nodes with metastases found in sentinel node axillary surgery or axillary lymph node resection in patients recently diagnosed with breast cancer after percutaneous biopsy.

METHODS

This prospective study included patients diagnosed with invasive breast cancer by percutaneous biopsy. Axillary lymph nodes were classified at ultrasound examination as suspicious or not suspicious, and the number of suspicious nodes was compared with the number classified as suspicious in the surgical specimen.

RESULTS

We included 142 patients, 4 of whom had bilateral cancer; 133 of the 146 tumors were clinically classified as T1-T2 N0. The median number of suspicious lymph nodes at ultrasound was 2 (1-6), and the median number of suspicious lymph nodes in the surgical biopsy specimen was 1 (1-16); the difference was not significant (p=0.1). The correlation between the number of positive lymph nodes on axillary ultrasound and the number of metastatic lymph nodes in the surgical specimen was 72.7% p=0.0002 and the concordance was 79% (95%CI 62.4%-95.6%) p=0.0001. For diagnosing high axillary tumor load (≥3 metastatic lymph nodes) versus low axillary tumor load (<3 metastatic lymph nodes), axillary ultrasound had 86.6% sensitivity, 83.3% specificity, 92% PPV, and 71.4% NPV.

CONCLUSION

Our results show that preoperative axillary ultrasound can differentiate between low and high tumor load and can be used as a tool to select the type of treatment. These results need to be confirmed in randomized multicenter studies.

Role of imaging techniques in the diagnosis of selective hypertrophy of the tensor fascia lata

The tensor fascia lata is a muscular structure that forms part of the lateral portion of the pelvis and proximal thigh. Because conditions affecting this muscle have not been widely reported and are relatively unknown, hypertrophy and pseudo-hypertrophy of the tensor fascia lata, although relatively common imaging findings, often go undiagnosed; instead, radiologists perform the differential diagnosis with more complex and more dangerous conditions. This article aims to review the anatomic and functional characteristics of the tensor fascia lata, going into detail about the radiological description of this muscle and pathological conditions that can affect it, as well as reviewing the relevant literature.

Ultrasound-guided brachiocephalic vein access in neonates and pediatric patients

Central venous accesses in neonates and pediatric patients represent a common and important procedure for both, intraoperative and postoperative care. Point-of-care ultrasound-guided technique has been proposed to increased success rate and efficiency, as well as to decrease the number of complications. Ultrasound-guided internal jugular vein cannulation is considering the "gold standard" in children. Another central venous cannulation option in neonates and children has been supraclavicular ultrasound-guided cannulation of the brachiocephalic vein using the in-plane approach. This article gives a review of the current evidence, the basic knowledge of the technique and the structured approach to follow for supraclavicular ultrasound-guided brachiocephalic vein access in children and neonates.

Is breast ultrasound a good alternative to magnetic resonance imaging for evaluating implant integrity?

OBJECTIVE

To compare the diagnostic performance of breast ultrasound and breast magnetic resonance imaging and to correlate the findings on the two techniques that are suggestive of implant rupture.

MATERIAL AND METHODS

We reviewed the images and reports of breast ultrasound and magnetic resonance imaging studies done in our diagnostic and interventional breast imaging unit to evaluate breast implants in 205 patients between January 2015 and December 2017.

RESULTS

Ultrasound findings were compatible with implant rupture in 87 (42.4%) patients: intracapsular rupture in 44 (21.5%) and intracapsular and extracapsular rupture in 43 (21.0%). Ultrasound yielded 85.2% sensitivity, 89.7% specificity, 86.2% positive predictive value, and 89.0% negative predictive value. Magnetic resonance imaging findings were compatible with implant rupture in 88 (42.9%) patients: intracapsular rupture in 50 (24.4%) and intracapsular and extracapsular rupture in 38 (18.5%). The correlation between positive findings for the location of the rupture on the two imaging techniques was excellent (0.77; p<0.0001).

CONCLUSION

We found high concordance between the two techniques for the detection of intracapsular and extracapsular implant rupture. These results consolidate the use of ultrasound as the first-line imaging technique to evaluate implant integrity in our population; magnetic resonance imaging can be reserved for cases in which the ultrasound diagnosis of implant integrity is uncertain.

Usefulness of the optic nerve sheath ultrasound in patients with cessation of cerebral flow

Optic nerve sheath diameter (ONSD) ultrasound has proven to be a useful tool for the detection of intracranial hypertension (IH). The ONSD values, in patients with cessation of cerebral blood flow (CCBF), has not been clarified yet.

OBJECTIVE

Establish an association between ONSD and CCBF in neurocritical patients admitted to an ICU.

PATIENTS AND METHODS

Cross-sectional study of patients admitted in a third level ICU, between April 2017 and April 2018, with neurological pathology. ONSD ultrasound was performed in the first 24 hours and as the patient was diagnosed of CCBF. The ONSD values of patients with and without diagnosis of CCBF were compared.

RESULTS

99 patients were included, 29 of whom showed CCBF in transcranial Doppler. The ONSD measurement did not demonstrate significant differences between both groups, 6,59 ± 0,75 in the group with CCBF and 6,39 ± 0,56 in the group without CCBF p=0.141.

CONCLUSION

In our study, ONSD values capable of recognizing CCBF were not identified.

Ultrasound measurement of femoral cartilage thickness in the knee of healthy young university students

BACKGROUND AND OBJECTIVE

Articular cartilage (AC) is always affected in any joint with osteoarthritis. Ultrasound can be a useful tool in monitoring changes in the AC. The purpose of the present study is to ultrasound measure the thickness of the AC in the distal femur in young students and determine its relationship with body mass index (BMI), muscle mass, body fat and sports practice.

MATERIALS AND METHODS

An observational cross-sectional study was conducted with healthy volunteers, between 15 and 25 years old. Anthropometric data were collected and the thickness of the femoral cartilage of the knee was measured at 5 points. In addition, the percentage of muscle and body fat was measured in a subgroup.

RESULTS

100 subjects were included in the study. The average age was 20 years (± 2.5). The average BMI was 23 kg/m² (± 3.1). AC was thicker in men and sportsmen, versus women and sedentary people, with a statistically significant difference. When comparing BMI with AC thickness no significant relationship was found; however, only 2 participants had BMI > 30.

CONCLUSIONS

Cartilage thickness has a direct relationship with the percentage of muscle, and inversely with the percentage of fat. BMI is not a good parameter when evaluating the dynamic behaviour of cartilage in non-obese youths.

Location and removal of non-palpable subdermal single-rod contraceptive implant

Objective

The objective of the study was to present the experience of the family planning service Hospital General de México, in locating and removing no palpable subdermal single-rod contraceptive implants.

Materials and methods

A descriptive, prospective, and cross-sectional study was performed from January 2011 to April 2018.

Results

Hundred and sixty-four patients in whom the implant was not palpable were reviewed, the time between insertion and removal averaged 3.3 years (maximum 10 years and minimum 3 months). Three implants were inserted in the right arm, the rest on the left one. Forty-seven implants were found in fatty tissue (29%), 18 in fascia (11%), 94 in muscle (57%), 2 in the armpit (1.2%), and 3 were not found (1.8%).

Conclusions

The no palpable implant is caused by an incorrect insertion technique. Migration should not be assumed as a cause of difficult location. Amount of non-palpable implants is not possible to determine due to a lack of records, but approximately 3% are considered non-palpable. Ultrasound has proven to be the study of choice to locate an incorrect inserted implant. In this case, the total number of implants was located, except in two patients.

Landmark versus ultrasound-guided insertion of femoral venous catheters in the pediatric intensive care unit: An efficacy and safety comparison study

BACKGROUND

Central venous cannulation (CVC) is common and necessary in pediatric intensive care. However, this procedure is not without risks or complications. Although CVCs have classically been placed following anatomical landmarks, the use of ultrasound guidance has largely replaced the latter, given its better profile of efficacy and safety, demonstrated at least in adult populations.

OBJECTIVES

To compare the effectiveness and safety in the insertion of femoral central venous catheters guided by ultrasound (US) versus the anatomical method (LM) in critical care pediatric patients.

METHODS

100 patients were randomized: 50 were assigned to the US group and 49 to the LM group. In the LM group the traditional method consisted in palpating the femoral artery pulse as a; in the US group the CVC was inserted using a real time technique. Success at the first attempt, overall success in cannulation, number of attempts and arterial puncture were the variables studied in both groups.

RESULTS

Success at the first attempt and overall success in cannulation were significantly higher in the US group versus the LM (US 42% vs. LM 18%, p 0.011, US 84% vs. LM 51% p <0.001, respectively). The incidence of puncture of the femoral artery was lower in the US group (LM 12 vs. US 5, p 0.056) without achieving statistical significance.

CONCLUSIONS

According to our results, the placement of central venous access via the femoral approach should be preferably performed under ultrasound guidance, however, further studies in larger populations are needed to confirm this findings.

Perioperative ultrasound neuromonitoring: transcraneal Doppler and optic nerve

Monitoring of the neurocritical in the perioperatory is in constant evolution. There are essentially two ultrasonographic application of neuromonitoring: the diameter of the sheath of the optic nerve and transcranial Doppler. Ultrasound-guided neuromonitoring can detect stenosis or occlusion of intracranial arteries, monitor the evolution of patients with vasospasm after subarachnoid hemorrhage, detect cerebral embolism, evaluate the cerebral collateral system, determine brain death, calculate indirectly Intracranial pressure and cerebral perfusion and helps in clinical decisions and early therapeutic interventions in neurocritical care. The purpose of this review is to present the applications of ultrasonography to the head of the patient in neuromonitoring.

Pulmonary sequestration associated with congenital pulmonary airway malformation

Introduction

Congenital pulmonary malformations are a rare cause of neonatal morbidity. Some of them have a common origin, which allows the identification of combined lesions. Its diagnosis can be made prenatally by ultrasound, with the limitation that this study is performed in specialized centers and depends on the expertise of the operator. The association of pulmonary sequestration and congenital malformation of the airway has been described in approximately 40-60 cases since its first description in 1949. Many lesions are not perceptible in intrauterine life and in the neonatal period there are recurrent respiratory symptoms that in some cases are associated with a congenital pulmonary malformation.

Case report

We report the case of a young infant, who was diagnosed with pulmonary sequestration at 24 weeks of gestational age, undergoing intrauterine surgical treatment with a report of complete resolution of the malformation in posterior ultrasounds. She was valued by pediatric pneumology at 4 months of age, where angiotomography was performed and the presence of pulmonary sequestration was confirmed by lobectomy. The histopathological study reported extralobar pulmonary sequestration with congenital malformation of the pulmonary airway type 2. These combined lesions were identified by histopathological study. The treatment of choice was surgical.

Conclusions

Upon the confirmation of a malformation, we emphasize the importance of performing a screening in order to search for other that could be associated.

Transcranial Doppler ultrasound measurements of cerebral hemodynamic parameters in healthy volunteers at 2850 meters altitude

BACKGROUND

Transcranial Doppler ultrasound (TDU) is useful in cerebrovascular patients. TDU findings are operator-dependent; they can also be influenced by anatomical and physiological variables as well as by the altitude at which the study is done.

OBJECTIVE

To report the cerebral hemodynamic parameters measured by TDU in subjects who live in Quito, Ecuador (altitude 2850 meters).

MATERIAL AND METHODS

We recruited 47 volunteers with no history or clinical evidence of stroke, hypertension, metabolic disorders, or hematologic disorders; 2 patients were excluded because they did not have a viable cranial window for TDU study. Thus, we recorded mean cerebral blood flow velocity, peak systolic flow velocity, end-diastolic flow velocity, and pulsatility indices in 45 patients (28 (62.2%) women; mean age, 35.9 years). We recorded patients' age, sex, and hematocrit. We analyzed cerebrovascular hemodynamic parameters by sex and age group.

RESULTS

No significant differences between hemispheres were observed in mean flow velocities, except in the anterior cerebral arteries with right predominance. Flow velocities were higher in women and in the youngest age group. No significant differences in the pulsatility indices were found between sexes or between age groups. The flow velocities in this series are lower than those reported for other series.

CONCLUSIONS

The hemodynamic parameters in this series are lower than in other series and are influenced by the altitude, age, and sex.

Prevalence of hepatic steatosis and its relation to liver function tests and lipid profile in patients at medical check-up

INTRODUCTION AND AIMS

Nonalcoholic fatty liver disease has now become a worldwide health problem, and its dramatic increase is due to the prevalence of diseases such as obesity, type 2 diabetes mellitus, and metabolic syndrome. The aim of our study was to publish the current prevalence of hepatic steatosis in a Mexican population undergoing routine medical check-up, as well as to analyze its relation to BMI, liver function tests, and lipid profile.

MATERIALS AND METHODS

An observational, retrospective, cross-sectional study was conducted on patients that underwent medical check-up within the time frame of January 2011 and December 2015 at the Hospital San Javier. Patients included in the study were those with somatometry measurements (BMI), lipid profile, liver function tests, and abdominal ultrasound with a multi-frequency convex transducer.

RESULTS

We found that 65% of the patients presented with overweight or obesity and there was a 49.19% prevalence of hepatic steatosis in the study population. That prevalence was more frequent in men and hepatic steatosis was strongly linked to an increase in triglycerides, AST, and GGT and a decrease in HDL.

CONCLUSIONS

Establishing the technical aspects of the study was an important aid to having better correlation with and standardization of the accepted definitions, given that ultrasound is an adequate screening technique for an open population. Our results clearly showed a direct relation between hepatic steatosis and alterations in BMI, triglycerides, HDL, ALT, and GGT.

Self limiting sternal tumors of childhood: two case reports

Sternal tumours are rare in children. The differential diagnoses include a wide spectrum of benign (from bone cyst to osteoblastoma, osteochondroma and fibrous displasia) and malignant tumours (Ewing's sarcoma, chondrosarcoma rhabdomyosarcoma), inflammatory lesions and infectious processes. The SELSTOC (Self Limiting Sternal Tumours of Childhood) are entities of non-specific origin, they are self-limiting and characterised by a rapidly growing tumour that disappears spontaneously with no history of trauma or active infection. The onset of a rapidly growing mass with no preceding trauma is worrying to parents who then consult the health professionals. Soft tissue ultrasound enables us to characterise these lesions and define their nature in relation to the adjacent tissues. Chest x-ray and MRI can also help to characterise these lesions. In this paper we present two case reports of children referred to our department for characterisation of sternal tumours.

Ultrasound, histopathological, and genetic features of uveal melanoma in a Mexican-Mestizo population

OBJECTIVE

To describe the ultrasound, histopathological and genetic characteristics of uveal melanoma in a Mexican-Mestizo population.

MATERIAL AND METHODS

A total of 39 enucleated eyes with a histopathological diagnosis of uveal melanoma were assessed by describing the clinical findings, and ultrasound, histopathological and genetic features.

RESULTS

A high correlation was observed between tumour height measurement using ultrasound and histopathology. In our cases, tumour size and reflectivity were higher compared with those reported in the literature. The preliminary data on the molecular assessment of the tumours show the presence of an unreported polymorphism (T>C IVS5+34) and one sample with GNAQ mutation (A>C CAA>CCA Gln 209 Pro).

CONCLUSION

Ultrasound is a reliable method to identify the size of the tumour. Furthermore, knowledge of the molecular mechanisms promises new perspectives for the development of new targeted therapeutics. Fortunately this leads to progress in the treatment of patients with metastatic disease or prevents it in those at high risk.

Preoperative factors associated with technical difficulties of laparoscopic cholecystectomy in acute cholecystitis

OBJECTIVE

To identify preoperative factors associated with surgical time and conversion of the laparoscopic cholecystectomy (LC) to open surgery in subjects with acute cholecystitis (AC).

METHOD

We developed a cross-sectional study that included 99 subjects older than 17 years with definitive diagnosis of AC who had undergone to LC. Preoperative variables such as clinical data, laboratory markers and ultrasound findings as wall thickness, the size of the major calculus and the presence of: perivesicular fluid, multiple cholelithiasis, biliary mud or microlithiasis were registered. We consider indirect measures of technical difficulties of LC the total surgical time and the need for conversion to open surgery. We used the square chi and Mann-Whitney U test to stablish the correlation between preoperative variables and the technical difficulties of LC. We build ROC curves of the variables with significant statistical association (p ≤0.05 and 95% confidence interval [95%CI]) to determine the cut-off points of better sensitivity and specificity to predict conversion of LC to open surgery.

RESULTS

A gallbladder wall thickness ≥6mm detected by ultrasound has a sensitivity of 87.5% and a specificity of 62.6% with OR 11.71 (95%CI: 1.38-99; p = 0.008) for predict conversion to open surgery. There was no relationship between surgical time and the preoperative evaluated variables.

CONCLUSION

The gallbladder wall thickness detected by the ultrasound is associated with the need of conversion of LC to open surgery in subjects with AC, furthermore this finding could warn the surgeon on the complexity with a particular patient.

[Ultrasound examination of hidradenitis suppurativa]

Hidradenitis suppurativa is a debilitating chronic, recurrent, inflammatory cutaneous disease of the hair follicle that usually presents with painful, deep and inflamed lesions in the areas of the body with apocrine glands, most frequently the axillary, groin and anogenital regions. This entity is difficult to manage since it can be difficult to determine the true nature and extension of the lesions. Cutaneous ultrasound allows real-time visualization of the cutaneous structures under examination, defining the type of lesion, its anatomical extension, and the degree of inflammatory activity, which affects adequate patient management. The present review analyses the importance of ultrasound in the assessment of patients with hidradenitis suppurativa.

[Adolescent with paraovarian cyst. Surgycal treatment]

BACKGROUND

Adnexal paraovarian cysts are not frequently seen during teen development, their incidence is around 10% and usually benign.

CLINICAL CASE

Adolescent female 15 years old with no pathological family and personal history relevant to her current condition. Chief complaint: Six months ago she complained with abdominal pain in meso, hypogastrium and right iliac fossa. Later, she observed an increased volume on her lower quadrant of the abdomen, mostly on her right side. During physical examination an abdominal tumor was palpated. By an abdominal-rectal manouvre, the presence of tumor was confirmed and located in front of the rectum and no implants. Imaging studies confirmed a paraovarian cyst. She underwent on surgical laparatomy and a paraovarian cyst was found. The histological diagnosis was a cystadenoma. The postoperative course was satisfactory.

DISCUSSION

Epidemiological data and ultrasonographic findings are examined to confirm the diagnosis of paraovarian cyst. The laparoscopic treatment for adnexal problems is described.

[Ultrasound findings in rhabdomyolysis]

BACKGROUND

Rhabdomyolysis is defined as skeletal muscle necrosis. Ultrasound assessment has recently become a useful tool for the diagnosis and monitoring of muscle diseases, including rhabdomyolysis. A case is presented on the ultrasound findings in a patient with rhabdomyolysis.

OBJECTIVE

To highlight the importance of ultrasound as an essential part in the diagnosis in rhabdomyolysis, to describe the ultrasound findings, and review the literature.

CLINICAL CASE

A 30 year-old with post-traumatic rhabdomyolysis of both thighs. Ultrasound was performed using a Philips Sparq model with a high-frequency linear transducer (5-10MHz), in low-dimensional scanning mode (2D), in longitudinal and transverse sections at the level of both thighs. The images obtained showed disorganisation of the orientation of the muscle fibres, ground glass image, thickening of the muscular fascia, and the presence of anechoic areas.

CONCLUSIONS

Ultrasound is a useful tool in the evaluation of rhabdomyolysis.

The use of portable ultrasound devices in low- and middle-income countries: a systematic review of the literature

OBJECTIVES

To review the scientific literature pertaining to the use of hand-carried and hand-held ultrasound devices in low- and middle-income countries (LMIC), with a focus on clinical applications, geographical areas of use, the impact on patient management and technical features of the devices used.

METHODS

The electronic databases PubMed and Google Scholar were searched. No language or date restrictions were applied. Case reports and original research describing the use of hand-carried ultrasound devices in LMIC were included if agreed upon as relevant by two-reviewer consensus based on our predefined research questions.

RESULTS

A total of 644 articles were found and screened, and 36 manuscripts were included for final review. Twenty-seven studies were original research articles, and nine were case reports. Several reports describe the successful diagnosis and management of difficult, often life-threatening conditions, using hand-carried and hand-held ultrasound. These portable ultrasound devices have also been studied for cardiac screening exams, as well as a rapid triage tool in rural areas and after natural disaster. Most applications focus on obstetrical and abdominal complaints. Portable ultrasound may have an impact on clinical management in up to 70% of all cases. However, no randomised controlled trials have evaluated the impact of ultrasound-guided diagnosis and treatment in resource-constrained settings. The exclusion of articles published in journals not listed in the large databases may have biased our results. Our findings are limited by the lack of higher quality evidence (e.g. controlled trials).

CONCLUSIONS

Hand-carried and hand-held ultrasound is successfully being used to triage, diagnose and treat patients with a variety of complaints in LMIC. However, the quality of the current evidence is low. There is an urgent need to perform larger clinical trials assessing the impact of hand-carried ultrasound in LMIC.

[Variation of muscle mass and weight in critical patient]

OBJECTIVES

Quantify the muscle mass and body weight variation in critically ill patients and to identify associated factors.

METHOD

A descriptive follow-up study. Data for demographic variables, body weight, fluid balance, daily kilocalories, the amount of sedation and muscle relaxants received and motor physiotherapy applied were collected. Three consecutive measurements were performed in the brachial biceps and quadriceps rectus by using ultrasound, upon admission and every 5 days until discharge.

RESULTS

68 patients were included. Average age was of 73.5 [57-78,5] years. The median length of stay was 9.5 [5.5 -15] days. The median 16 (SD=5.7) daily kilocalories per kg/weight, 91.2% received sedation, 44.1% received muscle relaxants and 20% received physiotherapy. The patients presented a muscle wasting of 4.9 (SD=3.9)mm, p <.001 in the brachial biceps and 5.6 (SD=4.8)mm, p <.001 in the quadriceps rectus. Regression analysis selected the length of stay and the muscle relaxants are the most influential variables in the brachial biceps muscle wasting (R2=0.4), and length of stay as the most influential in the quadriceps rectus muscle wasting (R2=0.3). Patient's mean body weight on admission was of 81.1 (SD=15)kg and 81.2 (SD=14.2)kg on discharge, p=.95.

CONCLUSIONS

The critically ill patient presents a significant muscle waste related with the length of stay and the treatment received with muscle relaxants. Patients are being discharged with a similar body weight to which they were admitted but with a significant reduction of muscle mass.

Ultrasound skin imaging

The interaction of high-frequency ultrasound waves with the skin provides the basis for noninvasive, fast, and accessible diagnostic imaging. This tool is increasingly used in skin cancer and inflammatory conditions as well as in cosmetic dermatology. This article reviews the basic principles of skin ultrasound and its applications in the different areas of dermatology.