Ultrasound Examination Findings Research Articles

Role of targeted ultrasound for the diagnosis of rib fracture, a comparative study with plain x-ray

Background and objective: Thoracic injuries are a common presentation in emergency hospitals in the Kurdistan region, mainly caused by road traffic accidents. Early and accurate diagnosis of rib fractures is essential in saving lives and preventing complications. The objective was to assess the validity of ultrasound in the diagnosis of rib fractures in comparison to plain x-ray. Methods: Present study was a cross-sectional study carried out in the Emergency department of Rozhalat Hospital in Erbil city-Kurdistan region/Iraq over ten months, from August 2021 to May 2022, on a sample of fifty-five (55) patients with suspected rib fractures. Rib fractures were diagnosed by the researcher based on clinical, ultrasound, and x-ray findings, and the findings of rib fracture were confirmed by CT-scan. All imaging methods were done at the Radiology department of Rozhalat hospital. Results: The validity findings of ultrasound examination taking CT scan as the gold standard was as follow: (97.7% sensitivity, 63.6% specificity, and 90.0% accuracy), while the validity findings of x-ray examination taking CT scan as the gold standard were (56.8% sensitivity, 54.5% specificity and 56.3% accuracy). The validity of ultrasound in detecting cortical disruption or hematoma was (93.8% sensitivity, 43.6% specificity, and 58.1% accuracy), while the validity of CXR in the detection of displacement was (31.3% sensitivity, 84.6% specificity, and 48.7% accuracy). Conclusion: Sonograph is an accurate diagnostic tool for detecting rib fracture with superior validity compared to a chest x-ray.

Dependence of the Thyroid Gland Ultrasound Findings on Somatotypological Parameters in Young Men Living in the Republic of Sakha (Yakutia)

The paper highlights the study results related to the structural features of the thyroid gland (TG) based on ultrasound examination findings and their relationship with somatotypological parameters in young men living in the Republic of Sakha (Yakutia). Since diagnosis of thyroid pathology is associated with ultrasound examination, advanced information about the regional features of the anatomical standad parameters of the thyroid gland remains an acute research and practical issue. The aim of the study was to identify the morphometric parameter features of the thyroid gland during ultrasound scanning and the nature of their relationship with the somatotype in young men living in the Republic of Sakha (Yakutia), indigenous and non-indigenous ethnic groups. Material and methods. The study involved total 195 males, aged 17-21, who were divided into groups depending on indigenous and non-indigenous ethnicity. All subjects underwent anthropometric measurements of 10 parameters, followed by determination of the somatotype according to Heath-Carter. To determine the linear dimensions and volume of the thyroid gland, the ultrasound diagnostic option was used. Results. As stated, representatives of the mesomorphic somatotype predominate among young men of the indigenous ethnic group; representatives of the ectomorphic somatotype predominate among young men of the non-indigenous ethnic group. A comparative analysis of ultrasound morphometry revealed significantly larger values of the total volume of the thyroid gland, due to an increased thickness and volume of the right lobe, as well as the thickness, width and volume of the left lobe in young men of the non-indigenous ethnic group, compared with young men of the indigenous ethnic group. When comparing the thyroid volume with the identified distribution of somatotypes according to Heath-Carter, statistically significant differences were registered in representatives of the mesomorphic somatotype: in young men of the non-indigenous ethnic group, the volume was 2.1 cm3 greater than in young men of the indigenous ethnic group. Conclusion. Thus, the obtained findings related to linear parameters and thyroid volume evidence their relationship with ethnicity and somatotype.

Reticulated livedoid skin patterns after soft-tissue filler–related vascular adverse events

BackgroundFor the treatment of vascular adverse events caused by filler injections, duplex ultrasound imaging may be used. The findings of duplex ultrasound examination and the clinical features of reticulated livedoid skin patterns were compared to the hemifaces anatomy. Objectiveto link the reticulated livedoid skin patterns, to the corresponding duplex ultrasound findings and the facial perforasomes. Methodsduplex ultrasound imaging was used for diagnosis and treatment of vascular adverse events. The clinical features and duplex ultrasound findings of 125 patients were investigated. Six cadaver hemifaces were examined to compare the typical livedo skin patterns to the vasculature of the face. ResultsClinically, the affected skin showed a similar reticulated pattern in each facial area corresponding with arterial anatomy and their perforators in the cadaver hemifaces. With duplex ultrasound, a disturbed micro vascularization in the superficial fatty layer was visualized. After hyaluronidase injection, clinical improvement of the skin pattern was seen. Normalization of blood flow was noted accompanied by restoration of flow in the corresponding perforator artery. The skin patterns could be linked to the perforators of the superficial fat compartments. Conclusionthe livedo skin patterns seen in vascular adverse events may reflect the involvement of the perforators

A Study of Valvular Incompetencies in the Lower Limb Veins Using Doppler Ultrasound Findings.

Varicose veins (VV) are one of the most common pathologies associated with the venous system of the lower limb. In the Indian population, its incidence is higher, and it is one of the most commonly encountered cases in the hospital. The study aimed to note the widely affected anatomical structure in male and female varicose patients using Doppler ultrasound (DU) examination findings. A total of 200 Doppler ultrasound reports of varicose patients were retrospectively analyzed and categorized based on the affected structure. The demographic data of all cases, such as age, sex, brief history, signs, symptoms, and affected side of the lower limb, was noted. Anatomical structures causing venous refluxes in the saphenous systems, junctions, and perforating venous systems were noted. Pearson's correlation coefficient was applied to find out its association. Out of 200 Doppler reports studied, 133 (67%) were male and 67 (33%) were female patients. The majority, 180 (90%) cases, belonged to C1-C3 stages according to the Clinical, Etiology, Anatomy, and Pathological (CEAP) classification, while 20 (10%) were in C4-C5 stages. Male patients aged between 31 and 40 years were predominantly affected, with their left side being affected most commonly. In female patients, the older age group of 50-60 years was predominantly affected.Great saphenous reflux in the groin due to incompetent terminal valve was noted in 126 (63%) cases. In the perforator venous (PV)system,defects in the medial leg perforator (189 (95%)), posterior leg (92(46%)), and thigh perforator (20 (10%)) were noted. In the present study, the occurrence of varicose veins is due to the involvement of superficial, deep, and perforator veins with varying percentages. Among the structures, the medial leg perforator was predominantly involved, followed by other perforators. Since most patients were in C1-C3 stages, the involvement of deep veins was noted minimally.

Abdominal ultrasonographic findings of cats with feline infectious peritonitis: an update.

The aim of this study was to describe the abdominal ultrasonographic findings in cats with confirmed or presumed feline infectious peritonitis (FIP). This was a retrospective study performed in an academic veterinary hospital. The diagnosis of FIP was reached on review of history, signalment, clinical presentation, complete blood count, biochemistry panel, peritoneal fluid analysis, cytology and/or histopathology results from abnormal organs, and/or molecular testing (immunohistochemical or FIP coronavirus [FCoV] RT-PCR). Cats with confirmed FIP by molecular testing or with a highly suspicious diagnosis of FIP were included. Abdominal ultrasound examination findings were reviewed. In total, 25 cats were included. Common clinical signs/pathology findings included hyperglobulinemia (96%), anorexia/hyporexia (80%) and lethargy (56%). Abdominal ultrasound findings included effusion in 88% and lymphadenopathy in 80%. Hepatic changes were noted in 80%, the most common being hepatomegaly (58%) and a hypoechoic liver (48%). Intestinal changes were noted in 68% of cats, characterized by asymmetric wall thickening and/or loss of wall layering, with 52% being ileocecocolic junction and/or colonic in location. Splenic changes were present in 36% of cats, including splenomegaly, mottled parenchyma and hypoechoic nodules. Renal changes were present in 32%, encompassing a hypoechoic subcapsular rim and/or cortical nodules. Mesenteric and peritoneal abnormalities were seen in 28% and 16% of cats, respectively. Most cats (92%) had two or more locations of abdominal abnormalities on ultrasound. The present study documents a wider range and distribution of ultrasonographic lesions in cats with FIP than previously reported. The presence of effusion and lymph node, hepatic and/or gastrointestinal tract changes were the most common findings, and most of the cats had a combination of two or more abdominal abnormalities.

Clinical, laboratory and ultrasonographic criteria for reveaing inflammation of the appendix and its regression in children

Introduction. Because of the numerous studies on a possible regression of inflammation in the cecum appendix, the question of finding reliable criteria for preoperative verification of inflammation and of assessing its dynamics in children is relevant.Material and methods. In January 2017 – December 2021, case-histories of 92 children aged from 3 to 18 years – (Me (age median) = 12; Q1 (lower quartile) = 9; Q2 (upper quartile) = 14.5 – were analyzed in the Yaroslavl Children's Clinical Hospital. The researchers assessed diagnostic and management algorithms. All children had a high risk of appendicitis (PAS (Pediatrics appendicitis score) ≥ 6 points) because of changes in the appendix and findings of ultrasound examination, but due to the symptoms relief, no surgical interventions were performed.Results. 78 (84.8%) children were prescribed antibacterial therapy. The median duration of symptom regression was 2 days (Q1 = 1 day; Q2 =4 days). On days 5–8 (Q1–Q2) (Me = 6 days), relief of all symptoms of the disease was recorded. The average diameter dimensions of the vermiform process, by ultrasound findings at the initial examination, were 8.6 ± 1.47 (95% CI 8.31–8.92), wall thickness – 3.2 ± 0.39 (95% CI 3.12–3.28). After the symptom relief , these indicators were 6.3 ± 1.29 (95% CI 5.95–6.58) and 2.0 ± 0.63 (95% CI 1.18–1.88), respectively. The decrease in size was statistically significant (p 0.001), signs regressed in parallel (r = 0.63; p 0.0001).95% CI lower limit of ultrasonographic parameters at the initial examination exceeded the threshold values indicating inflammatory changes (8 mm and 2.7 mm, respectively). After regression of the disease symptoms, 95% CI upper limit returned to the normal state.Conclusion. The presented clinical observations may be considered as cases of appendix inflammation with regression. The selected clinical and ultrasonographic criteria can be used both for verifying inflammation and for assessing the regression of inflammatory process.

Correlation research between preoperative ultrasonographic features and postoperative recurrence of papillary thyroid carcinoma: a retrospective study.

This study sought to evaluate the risk factors for recurrent papillary thyroid carcinoma by preoperative ultrasonography. A retrospective study enrolled a total of 146 patients with thyroid papillary carcinoma confirmed by postoperative pathology, and divided into a recurrence group (n = 35) and a non-recurrence group (n = 111) to study their preoperative ultrasound report examination, including the presence of thyroiditis, tumor location, the maximum diameter of the primary tumor, tumor number, the presence of focal strong echogenicity within the lesion, the presence of abnormal lymph nodes, the presence of ultrasound imaging manifestations of thyroid invasion, and to explore the risk factors associated with recurrent papillary thyroid cancer. Moreover, the consistency of ultrasound examination and postoperative pathological findings was explored. There were significant differences in the maximum diameter of the primary tumor and thyroid invasion between the recurrent and non-recurrent papillary thyroid carcinoma groups (P < 0.05), and the preoperative tumor diameter diagnostic cutoff value is 13.750mm. At the same time, ultrasound and pathology have good consistency in the number of papillary thyroid carcinoma tumors, moderate consistency in lymph node metastasis, and excellent consistency in the presence or absence of thyroid invasion. The maximum diameter of the primary tumor and thyroid invasion can be used as indicators to evaluate the risk of recurrence of thyroid papillary carcinoma by ultrasonic examination. In addition, the number of tumors and the presence of thyroid invasion in ultrasonic and pathological diagnosis showed good consistency.

HIV and Early Treatment Outcomes Among Women With Cervical Cancer Treated With Concurrent Chemoradiation in Tanzania.

Cervical cancer (CC) is the leading malignancy in Tanzania. Low-income countries are faced with double epidemics of HIV and CC. This study aimed to investigate how HIV and cancer stage at diagnosis affect early treatment outcomes among women with CC treated with concurrent chemoradiation in Tanzania in the highly active antiretroviral therapy era. This was a prospective cohort study of patients newly diagnosed with CC at the Ocean Road Cancer Institute from November 2019 to January 2020. The tumor response was assessed using RECIST 3 months post-treatment. The tumor response was categorized as a complete or partial response according to the ultrasound and pelvic examination findings. The univariate and multivariate logistic regression explained the relationship between several covariates (age, stage, HIV status, equivalent dose in 2 Gy fractions, chemotherapy cycles, and treatment time) and treatment response. A total of 102 patients with CC were included in this study at baseline. After adjusting for other covariates, only completion of treatment within 56 days (odds ratio [OR], 9.23; 95% CI, 1.53 to 55.85; P = .016) and receiving at least three cycles of cisplatin (OR, 5.6; 95% CI, 1.47 to 21.34; P = .012) were significantly associated with complete tumor response. HIV status was not significantly associated with complete tumor response (OR, 1.534; 95% CI, 0.424 to 5.545; P = .5144). Early treatment response was independent of HIV status. With wide coverage of anitretroviral therapy, patients with HIV can receive radical treatment and have the same early outcomes as their HIV-negative counterparts.

Features of diagnostics in acute diseases of the scrotum organs in children

Introduction. The syndrome of “acute scrotum” is an important problem in pediatric surgery – reproductive health of the future male population depends on the choice of therapeutic and diagnostic tactics. Ultrasound examination helps to perform differential diagnostics in the acute state of scrotum organs; however, ultrasound is still a conditionally objective technique.Purpose. To evaluate informative significance of ultrasound examination in acute diseases of the scrotum organs.Material and methods. 637 patients were admitted to the surgical department 2 in the Regional Children’s Clinical Hospital No. 3 in Omsk with acute scrotum syndrome in 2017–2019. Upon admission, clinical and anamnestic findings, findings of ultrasound examination of the scrotum organs were collected in all of them. 93% of patients required an emergency surgery – scrototomy.Results. The article presents echographic signs of hydatid lesion, orchoepididymitis and testicular torsion. The sensitivity and specificity of clinical and ultrasound examination in acute diseases of the scrotum organs has been found out.Conclusion. Ultrasound is a mandatory technique for examining acute scrotum diseases. Due to qualitative ultrasound visualization of the scrotum organs, it is easier to diagnose a nosological form of the “acute scrotum” syndrome. In doubtful cases, when there are discrepancies in clinical and instrumental findings, it is necessary to make revision of the scrotum organs.

Confirmation of Heart Malformations in Fetuses in the First Trimester Using Three-Dimensional Histologic Autopsy.

We aimed to evaluate the usefulness of three-dimensional (3D) reconstruction of histology slides to confirm congenital heart disease (CHD) detected by first-trimester fetal cardiac ultrasonography. Conventional autopsy is hindered by the small size of the first-trimester fetal heart, and current CHD confirmation studies employ the use of highly specialized and expensive methods. An extended first-trimester ultrasound examination protocol was used to diagnose fetal heart anomalies. Medical termination of pregnancies was followed by fetal heart extraction. The specimens were sliced, and the histology slides were stained and scanned. The resulting images were processed, and volume rendering was performed using 3D reconstruction software. The volumes were analyzed by a multidisciplinary team of maternal-fetal medicine subspecialists and pathologists and compared with ultrasound examination findings. Six fetuses with heart malformations were evaluated using histologic 3D imaging: two with hypoplastic left heart syndrome, two with atrioventricular septal defects, one with an isolated ventricular septal defect, and one with transposition of the great arteries. The technique allowed us to confirm ultrasound-detected anomalies and also identified additional malformations. After pregnancy termination or loss, histologic 3D imaging can be used to confirm the presence of fetal cardiac malformations detected during first-trimester ultrasound examination. Additionally, this technique has the potential to refine the diagnosis for counseling regarding recurrence risk and retains the advantages of standard histology.

Ultrasound as a Useful Tool for a Peripheral Nerve Surgeon: Examples in Clinical Practice.

Peripheral nerve surgeons often require additional imaging for examination, diagnostic testing, and preoperative planning. Point-of-care ultrasound (US) is a cost-effective, accessible, and well-established technique that can assist the surgeon in diagnosing and treating select peripheral nerve pathologies. With this knowledge, the properly trained surgeon may perform US-guided nerve blocks to help accurately diagnose and treat causes of neuropathic pain. We offer this paper, not as an exhaustive review, but as a selection of various peripheral nerve pathologies, which the senior author treats, and their associated US examination findings. Our goal is to encourage other peripheral nerve surgeons to incorporate US into their practices. We provide various cases from our outpatient peripheral nerve clinic demonstrating relevant US anatomy. We also review techniques for US guided nerve blocks with relevant anatomic landmarks. US imaging successfully assisted in identification and injection techniques for various peripheral nerve pathologies in a surgeon's practice. Examples were presented from the neck, trunk, upper extremity, and lower extremity. Our review highlights the use of US by a peripheral nerve surgeon in an outpatient private practice clinic to diagnose and treat select peripheral nerve pathologies. We encourage reconstructive surgeons to add US to their arsenal of diagnostic tools.

Preoperative Examination Is Not Associated with Postoperative Function following Radial Forearm Free Flap Harvest.

There is debate on the utility of a preoperative Allen test or ultrasound before radial forearm free flap (RFFF) harvest. This study sought to evaluate correlations between preoperative testing and donor-site morbidity. A survey of plastic surgery and otolaryngology RFFF patients was conducted at a Midwestern academic center. The modified Cold Intolerance Symptom Severity (modCISS) and Quick Disabilities of the Arm, Shoulder, and Hand (QDASH) instruments were administered. A retrospective chart review was performed to assess perioperative factors. Of 212 RFFFs completed over 7 years, 144 patients were contacted, and 71 patients completed the survey (33% response rate). Preoperative Allen test was negative in 92% of patients (65 of 71). There was no statistical association between Allen test and duplex ultrasound findings ( P = 0.19). Cold intolerance screening was positive on 20% of donor arms (14 of 71), with an average positive modCISS score of 39.0 ± 14.7. Disability was reported on the QDASH by 76% of patients (54 of 71), with an average score of 21.0 ± 22.3. There was no statistical correlation between preoperative Allen test or ultrasound classification and modCISS or QDASH score. There was a borderline positive correlation between modCISS and QDASH scores that did not reach statistical significance ( r = 0.22, P = 0.067). Operative characteristics also did not predict modCISS or QDASH scores. Following RFFF harvest, donor extremity cold intolerance is reported in 20% of patients, and extremity-related disability is reported in the majority of patients. Preoperative ultrasound and physical examination findings are not predictive of morbidity.

Preoperative ultrasound combined with routine blood tests in predicting the malignant risk of pancreatic cystic neoplasms.

Accurate preoperative identification of benign or malignant pancreatic cystic neoplasms (PCN) may help clinicians make better intervention choices and will be essential for individualized treatment. Preoperative ultrasound and laboratory examination findings, and demographic characteristics were collected from patients. Multiple logistic regression was used to identify independent risk factors associated with malignant PCN, which were then included in the nomogram and validated with an external cohort. The Net Reclassification Index (NRI) and Integrated Discrimination Improvement (IDI) were calculated to evaluate the improvement in the predictive power of the new model with respect to that of a combined imaging and tumor marker prediction model. Malignant PCN were found in 83 (40.7%) and 33 (38.7%) of the model and validation cohorts, respectively. Multivariate analysis identified age, tumor location, imaging of tumor boundary, blood type, mean hemoglobin concentration, neutrophil-to-lymphocyte ratio, carbohydrate antigen 19-9, and carcinoembryonic antigen as independent risk factors for malignant PCN. The calibration curve indicated that the predictions based on the nomogram were in excellent agreement with the actual observations. A nomogram score cutoff of 192.5 classified patients as having low vs. high risk of malignant PCN. The model achieved good C-statistics of 0.929 (95% CI 0.890-0.968, P < 0.05) and 0.951 (95% CI 0.903-0.998, P < 0.05) in predicting malignancy in the development and validation cohorts, respectively. NRI = 0.268; IDI = 0.271 (P < 0.001 for improvement). The DCA curve indicated that our model yielded greater clinical benefits than the comparator model. The nomogram showed excellent performance in predicting malignant PCN and may help surgeons select patients for detailed examination and surgery. The nomogram is freely available at https://wangjunjinnomogram.shinyapps.io/DynNomapp/.

Diagnostic performance of ultrasound in assessing the extension of disease in advanced ovarian cancer

Surgical exploration remains the gold standard for evaluating the extension of disease and predicting resectability. A laparoscopy-based scoring model was developed by Fagotti and colleagues in 2006 and updated in 2015, based on the intraoperative presence or absence of some specific cancer features. The model proved an overall accuracy rate of 77% to 100% and is considered the reference test for assessing resectability in our institution. The primary aim of the study was to analyze the agreement between preoperative ultrasound examination and laparoscopic findings in assessing the extension of intraabdominal disease using 6 parameters described by Fagotti's score. This was a prospective single-center observational study. Between January 2019 and June 2020, consecutive patients with clinical or radiological suspicion of ovarian or peritoneal cancer were assessed with preoperative ultrasound examination and assigned a score based on the 6 Fagotti score parameters (great omentum, liver surface, lesser omentum/stomach/spleen, parietal peritoneum, diaphragms, bowel disease). Presence of mesenteral retraction of the small bowel and miliary carcinomatosis on the serosa were also evaluated. Each parameter was correlated with laparoscopic findings. Concordance was calculated between ultrasound and laparoscopic parameters using Cohen's kappa. Cohen's kappa ranged from 0.70 to 0.90 for carcinomatosis on the small or large bowel, supracolic omentum, liver surface, and diaphragms. Cohen's kappa test was lower for carcinomatosis on the parietal peritoneum (k=0.63) and on the lesser omentum or lesser curvature of the stomach or spleen (k=0.54). The agreement between ultrasound and surgical predictive index value (score) was k=0.74. For the evaluation of mesenteral retraction and miliary carcinomatosis, the agreement was low (k=0.57 and k=0.36, respectively). The results of ultrasound and laparoscopy in the assessment of intraabdominal tumor spread were in substantial agreement for almost all the parameters. Ultrasound examination can play a useful role in the preoperative management of patients with ovarian cancer when used in dedicated referral centers.

Prenatal sonographic findings in confirmed cases of Wolf-Hirschhorn syndrome

BackgroundWolf-Hirschhorn syndrome (WHS) is a common genetic condition and prenatal diagnosis is difficult due to heterogeneous expression of this syndrome and rather non-specific ultrasound findings. Objective of this study was to examine the prenatal ultrasound findings in fetuses with Wolf-Hirschhorn syndrome (WHS).MethodsRetrospective assessment of 18 pregnancies that were seen at three tertiary referral centers (Universities of Bonn, Tuebingen and Nuernberg / Germany). Findings of prenatal ultrasound examinations, genetic results and outcome were compared. Additionally, findings of our study were compared to previous small case series from the literature and then compared to data on postnatal frequencies and abnormalities in affected patients.ResultsMedian gestational age at the time of examination was 23 + 1 weeks’ (range: 13 + 4 to 29 + 1 weeks’) with female-to-male ratio of > 2.5:1. Most frequent ultrasound findings were facial abnormalities, symmetric IUGR and microcephaly that presented in 94.4, 83.3 and 72.2% of cases, respectively. The combination of microcephaly and hypoplastic nasal bone was a particularly characteristic finding. Growth retardation presented in all fetuses > 20 weeks, but not below. Other frequent abnormalities included cardiac anomalies in 50 and single umbilical artery (SUA) in 44.4% of fetuses.ConclusionWHS should be considered in the presence of symmetric IUGR together with microcephaly, hypoplastic nasal bone and facial abnormalities on prenatal ultrasound. Genetic testing by chromosomal microarray analysis (CMA) is strongly recommended in this context.

Relationship between Standing Trunk Extension Angle and Medial Elbow Injuries in Young Baseball Pitchers.

Purpose: The purpose of this study was to investigate the relationship between the standing trunk extension angle and medial elbow injuries. Subjects and methods: The study participants were 90 male baseball pitchers (10–12 years) belonging to youth baseball teams. Pitching elbow injuries were evaluated by an orthopedic surgeon using ultrasound scans and physical examination findings. A single optical three-dimensional motion analysis system was used for the trunk extension measurements, with three-dimensional coordinates captured. The overall, upper, and lower trunk angles were then analyzed. Results: Trunk extension angle during standing trunk extension was significantly smaller among participants who were positive for medial elbow injuries on ultrasound scans (positive: 71.4° ± 10.3°; negative: 75.7° ± 9.2°; t = 2.05, p < 0.05). The upper trunk extension angle was significantly smaller than the lower trunk extension angle among participants who were positive for medial elbow injuries on physical examination (upper: 33.0° ± 6.9°; lower: 41.2° ± 8.2°; t = −2.42, p < 0.05). Conclusions: Trunk extension angle during standing trunk extension is associated with medial elbow injuries. Evaluating the trunk extension angle as multiple segments rather than a single rigid body is valuable.

Comparison of prenatal central nervous system abnormalities with postmortem findings infetuses following termination of pregnancy andclinical utility of postmortem examination.

In this study, we aimed to compare prenatal ultrasound (USG) and postmortem examination findings of central nervous system (CNS) abnormalities in fetuses following termination of pregnancy (TOP). A total of 190 fetuses with USG-confirmed fetal CNS abnormalities of terminated pregnancies between January 2001 and January 2017 were retrospectively analyzed and USG and postmortem examination findings were compared. The most frequent CNS abnormalities were acrania/anencephaly (n=45, 24%), spina bifida (n=43, 23%), and ventriculomegaly (n=35, 18%). In 144 of the 190 (76%) cases, there was total agreement between USG and postmortem examination diagnosis. Postmortem examination provided minor findings which did not change the major clinical diagnosis in two (1%) cases with spina bifida and ventriculomegaly. In six (3%) cases, the diagnosis changed after postmortem examination. In 25 of the 190 (13%) cases with multiple abnormalities as evidenced by USG, CNS abnormality was unable to be confirmed at postmortem examination. Our study results show an overall high agreement (76%) between USG and postmortem examination findings for CNS malformations. Due to autolysis and fluid structure, USG-confirmed CNS diagnosis cannot be always confirmed by postmortem examination. This potential discrepancy should be explained to patients before considering TOP. Postmortem examination is the gold standard to confirm prenatal diagnosis.

Effect of Hypertonic Dextrose Injection on Pain and Shoulder Disability in Patients with Chronic Supraspinatus Tendinosis: A Randomized Double-Blind Controlled Study

ObjectivesTo investigate the effect of hypertonic dextrose injection on pain and disability in patients with chronic supraspinatus tendinosis. The secondary aim was to evaluate its effect on the tendon range of motion (ROM) and morphology. DesignRandomized double-blind placebo-controlled trial. SettingOutpatient clinic. ParticipantsIndividuals (N=57) with symptomatic chronic supraspinatus tendinosis. InterventionsParticipants were randomly administered ultrasound-guided injections of 20% hypertonic dextrose (study group, n=29) or 5% normal saline (control group, n=28). Main Outcome MeasuresThe primary outcome measure was visual analog scale (VAS) scores for pain and Shoulder Pain and Disability Index (SPADI) scores. Secondary outcomes included the ROM and ultrasound examination findings of the supraspinatus tendon at baseline and at 2, 6, and 12 weeks postintervention. ResultsThe study group exhibited significant improvements in the VAS (mean difference [MD], −2.1; 95% confidence interval [CI], −2.7 to −1.4; P<.001) and SPADI (MD, −11.6; 95% CI, −16.5 to −6.7; P<.001) scores compared with baseline scores at week 2. However, the effect was not sustained to week 6. Flexion ROM increased at weeks 2 (MD, 14.1; 95% CI, 5.7-22.5; P<.001) and 6 (MD, 8.9; 95% CI, 2.4-15.4; P=.003) compared with baseline. The thickness of the supraspinatus tendon improved at weeks 6 (MD, .50; 95% CI, .26-.74; P<.001) and 12 (MD, .61; 95% CI, .37-.84; P<.001) compared with baseline. The ratio of histograms also improved at weeks 6 (MD, .19; 95% CI, .06-.32; P=.002) and 12 (MD, .26; 95% CI, .10-.41; P<.001) compared with baseline. ConclusionHypertonic dextrose injection could provide short-term pain and disability relief in patients with chronic supraspinatus tendinosis. Ultrasound imaging at week 6 revealed changed tendon morphology.

Handheld ultrasound; point-of-care examinations by intensive care nurses in a cardiac intensive care unit. An interrater agreement study

Abstract Background Adding point-of-care ultrasound to the physical examination of patients to assess early signs of decompensation and fluid overload has been proven to add information and improve quality of care, also when performed by nurses. Few studies have examined intensive care nurses’ point-of-care ultrasound examinations in acute cardiac settings. Purpose To evaluate if the findings of intensive care nurses ultrasound examinations, after brief training, were in agreement with conventional ultrasound examination performed by physicians. Methods This comparative cross sectional interrater agreement study included 50 patients admitted with signs and symptoms of dyspnoea and suspected cardiac disease to a cardiac intensive care unit. After brief training, the study nurses performed standardized examinations of the patients’ inferior vena cava (IVC) and the pleural- and pericardial cavities using a handheld ultrasound device. A physician repeated the same examinations using conventional ultrasound, blinded of the nurses’ findings. Results Analysis using Gwets agreement coefficient (AC2) with quadratic weights showed moderate agreement for the IVC respiration variation 0.60 (95% CI 0.38-0.82), and substantial agreement for the IVC diameter 0.70 (95% CI 0.50- 0.90) and right-sided pleural effusion 0.70 (95% CI 0.52-0.88). For left-sided pleural effusion 0.85 (95% CI 0.75-0.95) and for pericardial effusion 0.95 (95% CI 0.90-1.01) the agreement was almost perfect. Conclusion This study indicates that intensive care nurses, after brief training in point-of- care ultrasound, can perform reliable examinations of the IVC and pleural- and pericardial cavities compared to a physicians conventional ultrasound examination.

Ultrasound evaluation of dialysis access-related distal ischaemia.

Dialysis access-related distal ischaemia is a rare yet potentially rather risky complication of haemodialysis angioaccess. Timely diagnosis is crucial to target both the goals of the access team: first of all to preserve the function of the hand ideally along with angioaccess patency. Unfortunately for some patients, urgent access ligation and central vein catheter insertion would be needed to save the hand. After a first clinical examination to determine the diagnostic suspicion, the ultrasound evaluation would provide nearly all the needed information to confirm the diagnosis and to determine the most appropriate procedure to rescue the patient from distal ischaemia. In some cases, photoplethysmography would help in the differential diagnosis of other non-ischaemic causes of similar signs and symptoms. Angiography would complete the preoperative evaluation for some.Dialysis access-related distal ischaemia would be briefly reviewed, and a deep description of the ultrasound examination tools and findings would be provided for a tailored therapeutic approach.