Real-time Ultrasonic Scanning Research Articles

Endoscopic ultrasound-guided diagnosis and treatment of gastric varices.

Gastric varices (GV) represent a common and severe complication in patients with portal hypertension, commonly seen in patients with cirrhosis and severe pancreatic disease. Endoscopic ultrasonography is a safe and efficacious approach that can perform real-time ultrasonic scanning and intervention for the gastrointestinal submucosa, portal vein and its tributaries, and collateral circulations during direct endoscopic observation. Recently, various studies have been published about endoscopic ultrasound (EUS)-guided management of GV, mainly including diagnosis, treatment, and prognostic analysis. This article reviews published articles and guidelines to present the development process and current management of EUS-guided GV procedures.

Swine Ultrasonography Numerical Modeling for Pregnancy Diagnosis and Prediction of Litter Size

Early and reliable diagnosis of pregnancy in sows is considered one of the most crucial parameters for the proper management in pig farming. Reproductive activity of the sows is directly correlated with the overall productivity of the enterprise. The best and most precise methodology to diagnose pregnancy in farm animals, including pigs, is ultrasonography. For getting optimal outputs of real-time ultrasonography application in pigs, both gestation status and litter size of sows is of high importance. Hence, a detailed evaluation and careful reading of the retrieved ultrasonic image could serve to the prediction of the sow’s litter size, providing valuable information to the producer. In the present article we studied the ultrasonic typification of sows in an effort to develop a methodology for the precise pregnancy diagnosis and the prediction of the litter size. To achieve this goal, 1214 matings and 1010 pregnancies were recorded and evaluated over a period of 20 months, in a pig unit in Northern Greece. Two thorough scans were performed on each sow, classifying the ultrasonic image in a scale of 0 to 10, 0 being ‘non pregnant’ and 10 given to the most reassuring image of pregnancy. Evaluations took place in a wide range of time since mating, hence between days 16 (the earliest first scan) and 68 (the latest that a second scan was performed) and the mean values obtained were 8,36 and 8,83 for the first and second scan respectively. Furthermore, the litter size of each subsequent parturition was recorded (mean: 12.22) and correlated to the score of each of the two scans performed during pregnancy. The results showed that more reassuring images and higher scores for both examinations of pregnancy were achieved with increasing time interval from mating (P<0.05). It is therefore suggested that a detailed real-time ultrasonic scanning, can provide a very useful tool, not only for pregnancy diagnosis, but also for the prediction of litter size and eventually the precise management of pregnant sows.

Sonographic Assessment of Renal Length of Adults in Lagos, Nigeria

Introduction: Ultrasound is an important imaging modality used in the prognosis and diagnosis of renal conditions and diseases and also in the evaluation of kidney donors. This study aimed at providing a reference for the normal metric variables of the kidney such kidney lengths of healthy Nigerian adults in Lagos State and to compare with previously obtained results.Materials and Methods: This study was conducted in the radiology department of Ikorodu Hospital. This study adopted a descriptive cross-sectional study design with a cluster sampling approach which consisted of 150 adults (with 300 kidneys) participants ages 18-87 years. Real-time gray-scale ultrasonic scanning using Prosound 3500 Aloka device and a 3.5–5 MHz curvilinear explorer was employed for the abdominal imaging. The data acquired were compiled and explored via the Statistical Package for the Social Sciences (SPSS) version 20. The student’s t-test was utilized in probing for statistical significance between age as well as gender in relation to renal length. P-value < 0.05 was adjudged to be significant.Results: The kidney length was of a greater distance in males, and the length of the left kidney was more extensive than that of the right kidney in both sexes. Average kidney length was greater on the left when compared to the right among the various age groups. No significant association was noted between kidney length and age as well as gender.Conclusions: Normal values for kidney length and diversifications in the kidney length of healthy adults in Nigeria have been established.

Real-time ultrasonic observation of combined spinal-epidural anaesthesia

Background and objective: The quality of combined spinal-epidural anaesthesia mainly depends on accurate identification of the epidural space. The real-time ultrasound control of the procedure for puncture was therefore evaluated. Methods: Thirty parturients scheduled for Caesarean section were randomized to three equal groups. Ten control patients received conventional combined spinal-epidural anaesthesia. Ten of the remaining patients received ultrasonic scans by an offline scan technique, and 10 received online imaging of the lumbar region during epidural puncture. The epidural space was identified and needle advancement was surveyed through the interspinal and flaval ligaments. The number of attempts to advance the needle to achieve a successful puncture was measured and compared, as well as the number of vertebral interspaces punctured before successful entry into the epidural space. Results: There was no difference between patient characteristics in the three groups. The visualization of the epidural structures and of the needle manipulations was very effective. In the ultrasound group, the reduction in the number of attempts at puncture was significant (P < 0.036). The number of interspaces necessary for puncture was reduced (P < 0.036) in the ultrasound online group compared with controls. The number of spinal needle manipulations was significantly reduced (P < 0.036). Conclusions: Real-time ultrasonic scanning of the lumbar spine is an easy procedure. It provides an accurate reading of the location of the needle tip and facilitates the performance of combined spinal-epidural anaesthesia.

Transurethral microwave coagulation therapy for bladder diverticula and prostate cancer

Sixteen patients with bladder diverticula received transurethral microwave coagulation therapy (TUMCT) under endoscopic monitoring. The diameter of the total of 24 diverticula ranged from 1 to 11 cm (mean 2.8 cm). Fifteen patients with severe dysuria caused by prostate cancer also received TUMCT under intra-operative real-time ultrasonic scanning. Following TUMCT, 15 (63%) of 24 diverticula completely disappeared and seven (29%) of the residual 9 diverticula were reduced to less than half their previous size in diameter. All patients with prostate cancer were able to void satisfactorily without significant complications. Our clinical results indicate that TUMCT is a safe and effective treatment for bladder diverticula and a useful procedure to relieve obstructive symptoms caused by prostate cancer.

Experimental study of microwave coagulation of a VX-2 carcinoma implanted in rabbit kidney.

This paper describes the results of an experimental study of the microwave coagulation of VX-2 renal tumors implanted in rabbits. The rabbits undergoing microwave treatment exhibited a satisfactory survival rate and a complete response to treatment, as verified by histological examination. All the rabbits receiving no treatment died within 6 weeks of implantation of the VX-2 carcinoma. These results indicate that microwave coagulation may be a curative method of treatment for a relatively small renal tumor. Intraoperative real-time ultrasonic scanning permits the percutaneous microwave coagulation of renal cancer in a clinical situation.

The Role of Cut Surface Muscle Area in the Prediction of Carcass Composition of Beef, Lamb and Pork

1. Increased leanness is an economic objective of nearly all breed improvement programmes. Predictions of lean concentration can be used in an index of performance or can be used to select animals for slaughter.2. Predictions of carcass composition from ultrasonic measurements of fat and muscle depths are currently used to aid the selection of animals for breeding and slaughter. Recent developments allow muscle area to be measured using B-Mode pulse echo real-time ultrasonic scanning machines. These machines produce a two-dimensional image of a cross section through the animal, from which measurements may be taken.3. There is a need to estimate for the live animal the benefits of including eye muscle area in the prediction of carcass composition but few data are available to estimate this directly. Therefore the potential benefit of including such measurements in the prediction of carcass composition has been evaluated using measurements taken on the cut surface of carcasses

Homœopathy in treatment of patients with fibromyoma of the uterus

The efficacy of homœopathic treatment of patients with firomyoma of the uterus has been studied. Eighty-four patients with various clinical manifestations of the disease were under our observation. All patients received homœopathic therapy only. Besides pelvic examination, real-time ultrasonic scanning was used for evaluation of tumour volume. The period of observation varied from one to three years. In our opinion homœopathy used alone is an effective method of treatment of patients with fibromyoma of the uterus. It is possible to stop the growth of a tumour and even to reduce its size, as well as to control pain and abnormal endometrial bleeding. In the course of investigation certain patterns of response to treatment were found. These require further investigation.

Use of real-time ultrasonic scanning for the detection of reproductive failure in pig herds

Reproductive failure in a pig farm in which farrowing rate was lower than 70% was investigated ultrasonographically. A total of 190 sows of different breeds and parities were examined. Both pregnancy diagnosis and exploration of the left and right ventral abdominal wall were performed using a portable ultrasonograph with electronic linear transducer of 3.5 MHz. Sows were scanned in the standing position in individual gestation crates 21–22, 23–25, 26–28, 32–37 and 46–49 days after the second insemination. The sensitivity of the test was 95.2% 21–22 days after insemination and reached 100% from 23–25 days onwards. The specificity of the test, however, was lower (about 70–80% 21–49 days after insemination). Of 190 sows inseminated, 145 farrowed, and one had an observed abortion. Forty-four (23.15%) returned to oestrus or failed to farrow and of these, 21 (47.72%) presented no abnormalities in the uterus and returned to oestrus 18–25 (11 sows), 25–35 (two sows), 36–45 (seven sows) or >45 (one sow) days post-insemination. Four sows (9.1%) were diagnosed empty between 21 and 49 days post-insemination and no returns to oestrus were observed. Five sows (11.35%) with delayed returns were previously diagnosed not pregnant but with endometritis. In four sows (9.1%) the false-positive diagnoses might have been caused by total embryonic mortality, as embryonic vesicles were detected between Days 22 and 28. In ten sows (22.73%) unobserved abortion was the probable reason for their failure to farrow because both conceptus and foetal cardiac activity were observed 32 or 46–49 days post-insemination. These results indicate that the low specificity of the real-time ultrasonic method is because of different disorders which may occur during pregnancy and that this technique is of great value in evaluating reproductive failure.

System of therapeutic ultrasound and real-time ultrasonic scanning

A system is described for obtaining in real-time cross-sectional and 3-dimensional images of a body under study using ultrasonic energy. A piezoelectric transducer is positioned to emit ultrasonic energy and receive echo pulses. The transducer is electronically swept or physically rotated to produce a series of sectored scan planes which are separated by a known angular distance. The echo pulses are processed to produce an ultrasonic image in pseudo 3-dimensional display. By using data from one scan plane, processed as a B-scan image, cross-sectional data can be obtained. Such is combined in a display with an overlay to visually portray the object and positioning information or comparative data. The system is combined with a computer for data analysis and a therapeutic transducer for treatment.

Intraoperative real-time ultrasonic scanning for microwave coagulation of the prostate

Nine patients with severe dysuria caused by prostatic cancer received prostatic microwave coagulation under intraoperative real-time ultrasonic scanning. During the procedure, the microwave applicator was clearly observed, and the coagulation region appeared as an hyperechoic area compared to the noncoagulated region. Intraoperative real-time ultrasonic scanning allowed safer and more efficacious application of prostatic microwave coagulation.

Reproductive technology in animal production

Research into physiology and embryology has provided a basis for the development of technologies that increase productivity of farm animals through enhanced control of reproductive function. Progestagens, alone or in combination with luteolysins, are used to control the time of oestrus in cattle, sheep and pigs, thus permitting better use of artificial insemination, providing synchronised recipients for embryos and facilitating management strategies. Treatment with progestagens and pregnant mare serum gonadotrophin (PMSG) or with gonadotrophin releasing hormone induces breeding activity in sheep and goats before the commencement of the breeding season and reduces the duration of postpartum anoestrus in cattle. In pigs, gonadotrophins are used to hasten puberty in gilts, control the time of oestrus in sows and gilts and reduce the interval between farrowing and oestrus. Implants of melatonin hasten the onset of the breeding season in sheep and goats. Success in increasing litter size in sheep and cattle with PMSG has been limited because of the large variation in response between animals. Likewise, immunisation against steroids has not given consistent results. Immunisation against inhibin appears to offer the possibility of increasing farm animal fecundity. Induction of twinning in cattle by embryo transfer is practicable, and recent developments suggest that in vitro fertilisation may provide a source of embryos for this purpose. Real-time ultrasonic scanning has proved to be a reliable method for diagnosing pregnancy in small ruminants and pigs. The identification of pregnancy-specific proteins in cattle and sheep may provide a cheap and practical serological test for pregnancy in these species. Partial segregation of spermatozoa into X- and Y-bearing components has been reported, but the method is not yet practicable for use in conventional artificial insemination of farm animals. The sex of bovine and ovine embryos can be determined reliably by DNA probes specific for the Y chromosome. Monozygous twins can be produced in all farm animal species by microsurgical bisection of embryos and techniques for cloning from embryonic cells are rapidly being developed. There is a need to devise strategies to utilise these clones to best advantage in genetic programmes. Chimeric animals can be produced in the common farm animal species and will play an important role in genetic engineering, particularly when embryonic stem cell lines are produced in these species.

Protective laryngeal closure during swallowing

This investigation was part of a general research effort to develop noninvasive methods for examining swallowing, which may serve as a supplement or alternative to conventional radiological techniques. The temporal onset of laryngeal closure during swallowing was monitored simultaneously with real-time ultrasonic scanning and electroglottography. Application of both techniques is complicated by extensive laryngeal excursions during deglutition. Transverse ultrasonic scans, although capable of showing anatomically clear vocal fold abduction and adduction activity, are especially sensitive to transducer position. In young adults, a sagittal placement of a linear array transducer yielded distinctive and consistent echo evidence of laryngeal closure, with temporal correspondence to an electroglottic signal feature indicative of the onset of sustained laryngeal closure in swallowing. The applications and limitations of these techniques for swallowing study are reviewed. [Work supported by NIH, CA 43838.]

Choices in medicine: illustrations from imaging

Progress in medicine is almost always led by advances in science and technology. During the last quarter of a century, startling developments have taken place in medical imaging. X-ray techniques have been extended by improvements in film-screen technology and image intensifiers; digital radiography and computed tomography have been introduced. The gamma camera has been combined with computer processing and new radiopharmaceuticals have been devised. The resolution of real-time two-dimensional ultrasonic scanning has been improved almost to the diffraction limit and Doppler techniques provide detailed information about blood flow. Magnetic resonance imaging yields exquisite anatomical detail, tissue characterization and flow data and biochemistry can be studied through spectroscopy. Research aimed at improving all these methods is actively being pursued and there is interest in the potential of microwave, electrical impedance and light transmission techniques as medical imaging tools. In parallel with these diagnostic advances, techniques for minimally invasive surgery are being developed. Guided by appropriate imaging methods, suitable forms of radiation can be directed through the intact skin, or small instruments can be introduced through natural orifices or tiny incisions. Thus it is possible to undertake many interventional procedures that previously required open surgery. Because resources are limited, choices have to be made taking benefits, risks and costs into account. No diagnostic method is perfect; medical imaging is expensive in terms of equipment and trained personnel and its use has to be justified in competition with demands from other areas of health care. Unproductive work is having to be identified and abandoned.(ABSTRACT TRUNCATED AT 250 WORDS)

Diagnosis of pregnancy and prediction of fetal age in red deer by real-time ultrasonic scanning.

Sixteen pregnant red deer hinds were scanned using real-time ultra sound at regular intervals during the first 150 days of pregnancy. In the early stages of pregnancy, an intra-rectal linear array transducer was used but later in pregnancy the hinds were scanned externally with a sector scanner. Pregnancy was determined from 30 days of gestation by intra-rectal scanning, and from 50 days by external scanning. With advancing age the size of the fetus increased, and linear regressions of size on age gave residual standard deviations of 0.508 days for head diameter and 0.506 days for trunk diameter. It is concluded that this technique can be used to determine pregnancy with a high degree of accuracy from 30 days of gestation and to predict calving date from fetal measurements within the range 1.5 cm to 7 cm for head diameter or 0.5 cm to 8 cm for trunk diameter, corresponding to a fetal age range of 35 to 150 days.

Evaluation of a new technology when applied to sheep production systems: Part II—Real-time ultrasonic scanning of ewes in mid-pregnancy

The physical and financial ramifications of using real-time ultrasonic scanning for the differential management of single- and twin-bearing ewes have been evaluated. A model of a self-replacing flock of Merino ewes located in Western Victoria was used. A number of different management systems involving scanning were tested under a variety of seasonal and market conditions. Local weather, farm survey and research data were used in the analysis. Scanning enables feed to be used more efficiently. Thus, economic advantages to scanning were evident where the feed supply was limiting during pregnancy and lactation with the greatest financial response recorded during drought. Ewes in southern Australia which lamb in the autumn regularly experience extended periods of feed shortage and are therefore particularly sensitive to the management of the available feed. Returns to scanning ewes lambing in May were therefore generally higher than for ewes lambing in August when pasture availability was less likely to be limiting. The identification of twin-bearing ewes became an economically more viable proposition as their proportion in the flock was increased. Increases in farm income were also achieved when scanning was used to improve flock fecundity levels. Setting the fecundity of a flock at a very high level resulted in a marked increase in farm cash operating surplus. The susceptibility of highly fecund flocks to erosion of their reproductive potential, and the financial penalties of not preventing such wastage through technologies such as scanning, are demonstrated. For flocks where external sources of higher fecundity are unavailable, or in some way undesirable, scanning provides a practicable and financially viable means of increasing the size of the breeding flock. However, given the relatively low levels of fecundity in Australian wool-producing flocks, the increase in net farm income resulting from scanning without substantial changes in genotype and management would in general be small. Farm income was more sensitive to a change in wool production than it was to an equivalent change in the number of stock sold in a given class. Even where a dramatic fall in the price of wool was maintained for a prolonged period, the improvement in farm income resulting from scanning a flock with few twins was modest. The sale of non-pregnant ewes after scanning in some or all years was not economic. Such ewes produced up to 20% of the flock's wool. The price received for non-pregnant ewes would have to be much higher than was assumed in our study before this strategy would become viable. A major aim of this study was to evaluate scanning technology and identify those areas where it is economically viable. This aim was achieved, but another important insight emerged. For the benefits of scanning to be maximised, the opportunities it provides to increase selection pressure for improved fecundity, reduced reproductive wastage and increased wool production must be utilized.

Ultrasonographic identification and measurement of the normal ovary in postmenopausal Japanese women.

Real-time ultrasonic scanning examinations were performed on 31 postmenopausal Japanese women with no evidence of pathology. Both ovaries were visualized in 25 patients. Only the left ovary was imaged in 5 and only the right one in 1 patient. Ovarian sectional area (OSA) was 1.45 +/- 0.61 cm2 in the left-sided ovary and 1.36 +/- 0.64 cm2 in the right-sided ovary, with no statistically significant difference. In all 56 ovaries, the OSA was 1.41 +/- 0.63 cm2. These normal values in postmenopausal women provide a useful indicator for detection of postmenopausal palpable ovary syndrome.

Prediction of calving date in beef cows by real-time ultrasonic scanning.

Three hundred pregnant beef cows between 35 and 125 days of gestation were scanned ultrasonically and their calving dates were predicted from measurements of fetal parts. The mean difference between the actual and predicted calving dates was 0.9 day with a standard deviation of 9.0 days. The accuracy and precision of the prediction of calving date were sufficient to be of benefit in the management of cows in late pregnancy and at calving.

Effect on ewe and lamb performance of feeding twin-bearing hill ewes adequately in late pregnancy

Real-time ultrasonic scanning of pregnant ewes has become popular, and offers many potential advantages in flocks lambing at 110-170%. This experiment was set up to quantify the beneficial effect on sheep performance that can be obtained, from correct late pregnancy feeding of outwintered, twin-bearing hill ewes.A hill flock numbering 369 Scottish Blackface ewes in regular ages were pregnancy scanned in mid-February 1985 and 1986 (45-92 days post-conception). From the identified twin-bearing ewes, 102 ewes in 1985 and 166 ewes in 1986 were randomised into two groups in early March, six weeks before lambing was due to commence.

Hormone levels in early morning urine during clomiphene cycles

SummaryFifteen clomiphene induced cycles were monitored with real time ultrasonic scanning and early morning urine samples. Twelve cases had evidence of ovulation with a 41 per cent incidence of double ovulation. The follicles increased in diameter linearly in the last five days before ovulation. The mean maximum follicle diameter was 23.9 ± 2.6 mm. Urinary oestrone-3-glucuronide reached a peak in all ovulatory patients 18 hours before ultrasonically detected ovulation. Pregnanediol-3-glucuronide rose one day before ovulation. Luteinising hormone (LH) increased 12 hours before ovulation. A good correlation (r = 0.715, P > 0.01) was found between follicular diameter and volume and urinary oestrone-3-glucuronide values in monofollicular cases. No correlation was found between the sum of the follicle volumes and urinary oestrone-3-glucuronide in bi-follicular patients. There was considerable individual variation in the two glucuronide levels in urine.