Effect Of Ultrasound Research Articles

Sonography for Complete Evaluation of Neonatal Intensive Care Unit Central Support Devices: A Pilot Study.

Neonates in the neonatal intensive care unit often require considerable support with endotracheal tubes, umbilical arterial and venous catheters, and peripherally inserted central venous catheters. Support device evaluation with radiography exposes neonates to ionizing radiation. This study evaluated the effectiveness of sonographic localization for endotracheal tubes, umbilical arterial and venous catheters, and peripherally inserted central venous catheters. This blinded prospective Institutional Review Board-approved, Health Insurance Portability and Accountability Act-compliant study with informed consent compared sonography to radiography for endotracheal tube, umbilical arterial and venous catheter, and peripherally inserted central venous catheter localization. Participants were consecutively recruited NICU patients of any weight, gestation, and chronologic age who had an endotracheal tube, umbilical arterial catheter, umbilical venous catheter, or peripherally inserted central venous catheter placed or adjusted and had subsequent radiographic confirmation within 24 hours. Sonographic evaluation was obtained as soon as possible, without prior review of the radiograph, and results were compared. Thirty sonographic studies were performed in 25 patients (14 male and 11 female), for a total of 50 lines and tubes: 18 umbilical venous catheters, 12 umbilical arterial catheters, 11 peripherally inserted central venous catheters, and 9 endotracheal tubes. Forty-nine support devices (98%) were visualized with sonography, all concordant with radiography. Forty-four were correctly positioned, and 6 were malpositioned. Sonography identified the location of umbilical venous catheters in all 18 cases (100%), umbilical arterial catheters in all 12 (100%), peripherally inserted central venous catheters in 10 (91%), and endotracheal tubes in 9 (100%). The effectiveness of sonography was excellent for evaluation of umbilical arterial and venous catheters, endotracheal tubes, and peripherally inserted central venous catheters. These results support the goal of further point-of-care training and accreditation to use sonography as a primary modality for complete evaluation of NICU support devices.

The Effectiveness of Sonography in the Detection of Diaphragmatic Paralysis

Unilateral or bilateral paralysis of the diaphragm is an acquired dysfunction caused by injury or trauma to the phrenic nerve. Patients will often experience symptoms of respiratory distress, and severe cases can be life-threatening. Though not widely used, sonography, specifically M-mode imaging, has proven to be convenient and effective in the detection of this condition. A case is presented describing the sonographic techniques used to evaluate this entity.

術後サーベイランスで乳房超音波が有用であった遺伝性乳癌の1例

術後サーベイランスで乳房超音波が有用であった遺伝性乳癌の1例

Effectiveness of ultrasonography in detecting intraosseous vascularization: an in-vitro study

Ultrasonography is useful to diagnose lesions, insofar as it detects the type of injury, and to assess the degree of vascularization of tumors. However, intraosseous lesions may represent a challenge, since the surrounding bone thickness could prevent ultrasound signal capture. The aim of this study was to evaluate the infl uence of surrounding bone thickness on the ability of ultrasonography in capturing the echo signal of blood vessels. Macerated porcine hemimandibles (n = 20) with different buccal bone thicknesses were prepared and adapted to receive CFlex-type rubber tubes connected to a glass capillary through which pump-driven water was conducted to simulate blood vasculature. Doppler ultrasonography was used to assess the blood fl ow in the region of the mandibular canal at the level of the molar teeth. Student’s t-test was used to assess differences between the bone thicknesses of hemimandibles with a negative and with a positive ultrasound signal. The presence of the echo signal in the simulated vasculature was assessed by ultrasonography. Reproducibility and reliability were confi rmed for the analyses. The simulated fl ow signal was captured in cortical bones with a thickness in the 0.2–1.0 mm range (0.59 ± 0.42 mm), but was not captured in those with a thickness greater than 1.0 mm (1.39 ± 0.59 mm). In conclusion, ultrasonography can be used to investigate intraosseous vascularization in mandibular areas with a buccal bone thickness up to 1.0 mm.

The effectiveness of ultrasonography in verifying the placement of a nasogastric feeding tube in patients with low consciousness at an emergency center

Background: This study was designed to compare the effectiveness of using auscultation, pH measurements of gastric aspirates, and ultrasonography as physical examination methods to verify nasogastric tube(NGT) placement in emergency room patients with low consciousness who require NGT insertion. Methods: The study included 47 patients who were all over 18 years of age. In all patients, tube placement was verified by chest X-rays. Auscultation, pH analysis of gastric aspirates, and ultrasonography were conducted on each patient in random order. The mean patient age was 57.62±17.24 years, and 28 males (59.6%) and 19 females (40.4%) were included. The NGT was inserted by an emergency room resident. For pH testing, gastric aspirates were dropped onto litmus paper, and the resulting color of the paper was compared with a reference table. Ultrasonography was performed by an emergency medicine specialist, and the chest X-ray examination was interpreted by a different emergency medicine specialist who did not conduct the ultrasonography test. The results of the auscultation, gastric aspirate pH, and ultrasonography examinations were compared with the results of the chest x-ray examination. Results: The sensitivity and specificity were 100% and 33.3%, respectively, for auscultation and 86.4% and 66.7%, respectively, for ultrasonography. Kappa values were the highest for auscultation at 0.484 compared to chest x-rays, followed by 0.299 for ultrasonography and 0.444 for pH analysis of the gastric aspirate. The ultrasonography has a positive predictive value of 97.4% and a negative predictive value of 25%. Conclusions: Ultrasonography is useful for confirming the results of auscultation after NGT insertion among patients with low consciousness at an emergency center. When ultrasound findings suggest that the NGT placement is not gastric, additional chest X-ray should be performed.

Treatment of the calcific tendinopathy of the rotator cuff by ultrasound-guided percutaneous needle lavage. Two years prospective study

to evaluate the short and long term effectiveness of ultrasonography (US)-guided percutaneous needle lavage in calcific tendinopathy of the rotator cuff. To study the evolution of the size of calcifications and pain in the two years after treatment. a 2 year longitudinal prospective study is carried out after applying the UGPL technique on a number of patients diagnosed with calcific tendinitis of the rotator cuff. Clinical, ultrasound and radiology follow-up controls were performed, 3 months, 6 months, one year and two years after the treatment. The Visual Analog Scale (VAS) was used to assess the pain. The degree and point of pain is selected on a 10cm line, arranged horizontally or vertically. The "0" represents no pain and "10" represents worst pain. The population studied was made up of 121 patients that required our service as a result of suffering from a painful shoulder. the pain (VAS) and the size of the calcification significantly decreased with the application of the technique (p< 0,001 in both cases) and regardless of the sex (p: 0.384 for pain and p: 0.578 for the size of the calcification). This occurred from the first check-up (3 months) and was maintained for two year. we consider this technique to be a valid alternative as a first-choice treatment of calcific tendinitis of the shoulder. The intervention is simple, cost-effective, does not require hospitalization, involves no complications, rehabilitation treatment is not required and it shows very few side effects without sequelae, significantly reducing the size of the calcification and pain in the majority of patients.

The Effectiveness of Ultrasonography in Verifying the Placement of a Nasogastric Tube in Patients with Low Consciousness at an Emergency Center

The Effectiveness of Ultrasonography in Verifying the Placement of a Nasogastric Tube in Patients with Low Consciousness at an Emergency Center

The effectiveness of ultrasonography in verifying the placement of a nasogastric tube in patients with low consciousness at an emergency center

BackgroundThis study was designed to compare the effectiveness of using auscultation, pH measurements of gastric aspirates, and ultrasonography as physical examination methods to verify nasogastric tube(NGT) placement in emergency room patients with low consciousness who require NGT insertion.MethodsThe study included 47 patients who were all over 18 years of age. In all patients, tube placement was verified by chest X-rays. Auscultation, pH analysis of gastric aspirates, and ultrasonography were conducted on each patient in random order. The mean patient age was 57.62 ± 17.24 years, and 28 males (59.6%) and 19 females (40.4%) were included. The NGT was inserted by an emergency room resident. For pH testing, gastric aspirates were dropped onto litmus paper, and the resulting color of the paper was compared with a reference table. Ultrasonography was performed by an emergency medicine specialist, and the chest X-ray examination was interpreted by a different emergency medicine specialist who did not conduct the ultrasonography test. The results of the auscultation, gastric aspirate pH, and ultrasonography examinations were compared with the results of the chest x-ray examination.ResultsThe sensitivity and specificity were 100% and 33.3%, respectively, for auscultation and 86.4% and 66.7%, respectively, for ultrasonography. Kappa values were the highest for auscultation at 0.484 compared to chest x-rays, followed by 0.299 for ultrasonography and 0.444 for pH analysis of the gastric aspirate. The ultrasonography has a positive predictive value of 97.4% and a negative predictive value of 25%.ConclusionsUltrasonography is useful for confirming the results of auscultation after NGT insertion among patients with low consciousness at an emergency center. When ultrasound findings suggest that the NGT placement is not gastric, additional chest X-ray should be performed.

Letter to the Editor regarding the article “Effectiveness of ultrasonography in the postoperative follow-up of pediatric patients undergoing ureteroscopic stone manipulation”

This is an important study demonstrating the radiation safety and effectiveness of the ultrasonography (US), adjacent to plain film, in the postoperative follow-up of children with ureteral calculi treated with ureteroscopy (URS) [1]. US is the most popular, effective and X-ray free imaging modality used for children in the diagnosis of follow-up period. In addition, it provides the threedimensional visualization of the urinary tract. Doppler US is another safety and highly specific method in the diagnosis of residual ureteral stones after extracorporeal shock wave lithotripsy (ESWL) [2]. The usage of doppler US in the follow-up of children after the URS procedure may increase the sensitivity and specificity of the US. In addition of the cumulative or deterministic effects of the radiation which are commonly known, the stochastic effects of ionizing radiation, which are not dose-dependent and do not have a threshold, may lead to genetic mutations and cancer. Mean radiation doses per diagnostic interventions are 0.05 mSv for anteroposterior and lateral abdomen graph (equal to 2.5 chest X-ray radiation dose), 0.33 mSv for fluoroscopic cystogram (equal to 16 chests X-ray dose) and 5 mSv for abdomen CT (equal to 250 chests X-ray dose) for a 5-year-old child [3]. It is underlined that a single abdomen CT in a 1-year-old child would cause in one CT related death per 550 scans [4]. The URS is generally performed under fluoroscopic guidance that may lead to the radiation exposure. Krupp et al. [5] underlined that the delivered radiation from fluoroscopy devices during URS is not in the level to be underestimated. Although the imaging guidance modality used for URS in the study is not described [1], the selection of guidance method during the endoscopic treatment of pediatric patients is very important as well as the imaging methods used for followup. In conclusion, pediatric urologists should consider the deleterious effects of radiation exposure and choose the appropriate imaging method for the diagnosis, treatment and follow-up of urinary stone disease in children, who are more sensitive to the effects of radiation.

Proposal for an Ultrasonic Tool to Monitor the Osseointegration of Dental Implants

The longevity of dental implants depends on osseointegration, which providesload-bearing capacity without putting the prosthesis at risk from micromotions at theimplant-bone interface. This research involved an analysis of the viability of an ultrasonicevaluation tool to quantify osseointegration. Ultrasonic transmission is directly dependenton the difference between the acoustic impedance of materials in intimate contact witheach other. The closer their acoustic impedances the more intense their transmission.Therefore, an analysis of the ultrasonic echoes would presumably allow for a quantitativeevaluation of the bone tissue that has grown into the pores of the implant. In addition, theliterature reports that bone fracture healing can be accelerated by the application of acontrolled low-amplitude mechanical stimulus on the site of the lesion. In fact, acousticpressure waves of low-intensity pulsed ultrasound are reportedly a secure technique forpromoting mechanical stimulus without impairing the healing process. Many experimentaland clinical trials have confirmed that daily transcutaneous ultrasound applications on theinjured site are beneficial to the enhancement of fractured bone. This proposal aims tobring together the characteristics of ultrasound propagation and the positive effect ofultrasound on bone growth into a single tool that quantitatively monitors the evolution ofthe osseointegration process. The viability of a device with these features was investigatedthrough simulations and experimentally. The initial simulations were conducted to explorethe influence of waveguide shapes on the tool’s sensitivity to changes in the implantsupporting media. The waveguides were designed in two parts, one consisting of a screw-shaped part to attach to the implant and the other a conical or step-shaped part to which the ultrasonic source was fixed in the first simulations. The step-shaped waveguide proved to be the more sensitive; intermediate stages of the osseointegration process were simulated and experiments were conducted with the step-shaped aluminum waveguide attached to a cylindrical aluminum nut embedded at different depths, so that the results obtained were only due to lateral attachment of the parts. These devices indicated that the transmission of ultrasound through the lateral surface of the implant by dilatational waves could render this tool suitable for monitoring the osseointegration of dental implants.

CHARACTERISTICS OF SOFT TISSUE MASS IN THE HAND BY ULTRASONOGRAPHIC EXAMINATION

Soft tissue masses are amongst the commonest complaints encountered in orthopedic practice. Of these, masses found in the hand and the wrist are presented at higher frequency. They are often painful and may cause limitation of movement.This work describes the prevalence and the nature of soft tissue masses in the hand and wrist encountered in routine practice. This work was performed to assess the characteristics of soft tissue mass in the hand and the effectiveness of ultrasonography in the diagnosis of soft tissue masses and their differentiation from other lesions in the hand and wrist. Orthopedic surgical conditions that involve soft tissue in the hand and wrist may remain a diagnostic challenge when clinical diagnosis is uncertain and standard X-rays are non-diagnostic. High resolution ultrasound is widely available, non-invasive, without damage of radiation, imaging modality that can help the diagnosis.We reviewed retrospectively 25 patients with soft tissue masses. We compared the ultrasound findings with the histological findings in seven operated patients.A substantial majority of these lesions occurred in the right hand: 79% of the lesions were in the dorsal aspect of the hand, of which 37% were distal to the wrist joint, among them 42% at wrist either radial or ulnar; and 21% of the lesions were found in the volar aspect, among them 17% at wrist aspect, either radial or ulnar side. No predisposing factors could be found.The findings of this study reaffirm the utility of ultrasonography as primary diagnostic tool in routine orthopedic practice.

Effect of Ultrasonography in the Assessment of Carotid Artery Stenosis

Effect of Ultrasonography in the Assessment of Carotid Artery Stenosis

Effect of Ultrasonography in the Assessment of Carotid Artery Stenosis

Although ultrasonography (US) advantageously portrays lumen and wall thickness, velocity criteria have been used primarily to interpret carotid artery stenosis. The relationship of US and velocity measurements was investigated. Peak-systolic and end-diastolic velocities (PSV, EDV) increase exponentially as the lumen of the internal carotid artery narrows and the percent stenosis (%S) increases. We tested the consistency of the, relationship between carotid velocities and US %S in two distinct data sets. One data set was used to obtain regression equations relating velocity parameters and %S based on US. Validation of these equations was conducted using a separate, independent data set. US measurements were classified in 12 %S intervals, PSV, EDV, the ratio of the internal carotid artery to the common carotid artery PSV, and %S were entered consecutively until 10 records for each %S interval were obtained. Regression equations obtained in the first data set were used to predict %S in the second data set. Predicted %S was then compared with actual US %S. The highest correlation in the first data set (r = .89) was between %S and the natural logarithm (In) of PSV. This In PSV -%S equation was then applied to a second data set of an additional 120 carotid duplex images. In the second data set, actual %S and PSV-predicted %S differed by >10% in 38 cases (32%). When all velocity-%S regression equations were used for comparison, differences between actual and at least one velocity-predicted %S were >10% in 19% of the arteries. Conversely, actual %S matched at least one prediction of %S based on velocity data in 81% of the cases. US %S differed significantly from single velocity-based estimates of %S in at least one-third of the cases. On the other hand, four of five US measurements were confirmed by at least one velocity parameter. Emphasis on US, in addition to velocity data, is recommended for the interpretation of duplex US carotid examinations.

Effectiveness of ultrasonography in determining medial and lateral orbital wall fractures with a curved-array scanner

Purpose The purpose of the study was to evaluate the diagnostic value of ultrasonography to determine medial and lateral orbital wall fractures. Materials and methods Sixty-two patients with the clinical diagnosis of an orbital trauma underwent coronal computed tomography (CCT) and ultrasonographic investigation (US). Inclusion criteria were clinically suspected orbital injuries defined by reduced bulbus motility, diplopia, or additional traumatic injuries of the orbit or the globe. US and CCT were used as imaging diagnostic methods. Results Ultrasonography showed a sensitivity of 56%, a specificity of 95%, and an accuracy of 88% at the medial orbital rim. Regarding the lateral orbital rim, ultrasonography showed a sensitivity of 92%, a specificity of 88%, and an accuracy of 90% using CCT as a reference method. Conclusion Ultrasonography with a curved-array scanner seems to be a valuable method in the detection of lateral orbital wall fractures. Further studies have to be done to improve sensitivity in the interpretation of medial orbital wall fractures.

Ultrasonography and lung mechanics can diagnose diaphragmatic paralysis quickly.

Diaphragmatic paralysis after cardiovascular surgery requires early diagnosis prior to extubation. The effectiveness of ultrasonography and a lung mechanics assessment was evaluated. Paralysis of the diaphragm was diagnosed when the diaphragm failed to move or moved in a cephalad direction during inspiration. It was diagnosed in 3 of 40 patients (7.5%) who underwent cardiovascular surgery from 1998 to 1999. Patients were extubated when all parameters met the extubation criteria, irrespective of the presence or absence of diaphragmatic paralysis. One patient required prolonged assisted ventilation and died from mediastinitis on the 35th postoperative day. The other 2 patients required assisted ventilation for an additional 1-3 days. Ultrasonography and a lung mechanics assessment are effective tools for the early diagnosis of diaphragmatic paralysis and assessment of respiratory function after cardiovascular surgery.

Effect of ultrasonography and optional computed tomography on the outcome of appendectomy.

The aim of this study was to investigate the value of US and complementary CT in patients with suspected appendicitis, and to detect adverse outcomes of preoperative imaging. We retrospectively reviewed the data of 233 consecutive patients who underwent an appendectomy as an emergency procedure in our hospital, within a 2-year period. Our hospital policy is to perform diagnostic imaging in all patients with clinical suspicion of appendicitis. The US was performed in 227 patients, followed by additional unenhanced helical focused appendiceal CT in 30 patients with equivocal US results. We evaluated the negative appendectomy rate, occurrence of perforation, and our in-hospital delay. Acute appendicitis was pathologically proven in 219 patients, corresponding to a negative appendectomy rate of 6%. The US with optional CT diagnosed appendicitis with a sensitivity of 96.7%. Forty-eight appendices (21.9%) were perforated. The median overall in-hospital delay was 5 h (range 0.5-123.5 h). For the perforated appendices this was 4.5 h (range 0.5-64.5 h), for the non-perforated appendices 6.0 h (range 0.5-123.5 h). In patients with suspected acute appendicitis, US examination with the option of additional CT significantly lowers the negative appendectomy rate as compared with the clinical acumen alone, without adverse effects on the perforation rate or the in-hospital delay.

Diagnosis of Occult Thyroid Carcinoma by Ultrasonography

The increased sensitivity of many imaging devices has increased the identification of asymptomatic nodules in the thyroid gland. In this study we investigated the actual incidence of nonpalpable thyroid nodules and occult carcinoma in women. Between January and June 2003, among the women who were scheduled to undergo breast ultrasonography, 697 without palpable thyroid nodules were screened for thyroid nodules. They were classified into four categories according to ultrasonographic findings: negative, benign, indeterminate and malignant. Ultrasound-guided fine-needle aspiration biopsy (FNAB) was carried out for all malignant lesions and for some of the benign and indeterminate ones. The nodule detection and malignancy rates were determined and the effectiveness of ultrasonography as a diagnostic tool was also investigated. Out of the 697 subjects, 246 (35.3%) were found to have thyroid nodules. The malignancy detection rate based on the FNAB results, including both suspicious and malignant groups, was 3.6% (25/697) for all subjects. In addition, 3.0% (21/697) of all the women were confirmed to have thyroid cancer by surgery. The sensitivity of sonographic classification was increased from 80% to 100% when the indeterminate class was added to the malignant one, although this decreased the specificity from 91.7% to 33.3%. In conclusion, high-resolution ultrasonography detected a high percentage of malignant nodules. Ultrasonography can augment its value by guiding FNAB, in addition to providing diagnostic images.

Ultrasonographic Examination of Glomus Tumor of the Finger

Purpose: We evaluated the effectiveness of ultrasonography in glomus tumor of the finger and reviewed the clinical results. Materials and Methods: We retrospectively reviewed cases of glomus tumor in the finger, which were treated from January 2000 to November 2002. In all cases, preoperative ultrasonography was done using a 12 MHz linear transducer to evaluate the location and size of the tumor. These results were compared with operative findings. Curretage and complete excision of the tumor was done in all cases. Results: Tumor location was in the subungal region in 8 cases and on the volar aspect of the finger in 1 case. The precise location of tumor evaluated by ultrasonography correlated well with the surgical findings, and sonographic mass sizes correlated stastically with operative mass sizes. No incidence of tumor recurrence or of nail deformity was found at the last follow up. Conclusion: Ultrasonography with a high frequency transducer was found to be useful for both the diagnosis and preoperative localization of glomus tumors.

Costs and effectiveness of ultrasonography and limited computed tomography for diagnosing appendicitis in children.

A protocol of ultrasonography (US) followed by computed tomography with rectal contrast (CTRC) has been shown to be 94% accurate in the diagnosis of acute appendicitis in children. To evaluate the changes in patient management and costs of a protocol using US and CTRC in the evaluation of appendicitis in children. Prospective cohort study of 139 children between 3 and 21 years of age who had equivocal clinical findings for acute appendicitis seen in the emergency department of a large, urban pediatric teaching hospital between July 1998 and December 1998. Children with equivocal clinical presentations for acute appendicitis were prospectively evaluated with US. Patients with positive findings for acute appendicitis went directly to the operating room. Patients with negative or equivocal findings on US underwent CTRC. Surgical management plans were recorded before imaging, after US, and after CTRC. Surgical management plans before and after the imaging protocol as well as total hospital direct and indirect costs incurred or saved by each change in management were determined. Costs were obtained through the hospital's cost database and by ratios of costs to charges. Of the 139 children, the protocol resulted in a beneficial change in management in 86 children (61.9%), no change in management in 50 children (36.0%) and an incorrect change in management in 3 children (2.1%). US alone resulted in a beneficial change in management decision in 12/31 children (38.7%), while US followed by CTRC resulted in a beneficial change in management in 74/108 children (68.5%). The protocol resulted in a total cost savings of $78 503.99 or $565/patient. A protocol of US followed by CTRC in children with negative or equivocal US examinations results in a high rate of beneficial change in management as well as in total cost savings in children with equivocal clinical presentations for suspected appendicitis.

The effect of ultrasonography on the performance of routine outpatient liver biopsy: [formula omitted]. Digestive Healthcare, Minneapolis, MN

The effect of ultrasonography on the performance of routine outpatient liver biopsy: [formula omitted]. Digestive Healthcare, Minneapolis, MN