Ultrasound Assessment Research Articles

Ultrasonographic Assessment of Diaphragm Function to Predict Need for Mechanical Ventilation and its Liberation in Patients with Neuromuscular Disorders: An Observational Cohort Pilot Study.

Management of assisted ventilation and determining the optimal timing for discontinuation presents a significant clinical obstacle in patients affected by neuromuscular (NM) diseases. This study aimed to evaluate the efficacy of ultrasound in appraising diaphragmatic function for predicting the necessity of intubation and determining the opportune moment to discontinue mechanical ventilation (MV) in patients with NM disorders. The study was conducted in adult patients with NM diseases requiring inpatient care in the high-dependency neurology ward and the intensive care unit. Ultrasonographic assessment of diaphragmatic excursion (DE) and diaphragmatic thickness fraction (DTF) was conducted at the patient's bedside every 48h for ventilated patients and every 72h for nonventilated patients until they were weaned from the ventilator or discharged home. Qualitative data are expressed as percentages or numbers, and quantitative data are represented as mean ± standard deviation. Unpaired t-tests were employed to compare continuous variables, and χ2 tests were used for categorical variables. Contingency table analysis was used to compute relative risks in comparing the baseline DE and DTF with the sequential changes in these values. In cases in which the baseline left DE measured less than 1cm, the relative risk for the requirement of ventilation was 2.5 times higher, with a confidence interval of 0.62-0.99 (P = 0.19). Notably, a bilateral reduction in DE within the initial 48h of admission was identified as predictive of need for intubation. When comparing ventilated and nonventilated patients, it was observed that the mean DE values for the left and right sides in ventilated patients (0.74 and 0.79) were significantly lower than those in nonventilated patients (1.3 and 1.66), with corresponding P values of 0.05 and 0.01, respectively. Furthermore, a decline in right DE by more than 50% within 72h of admission presented a relative risk of 3.3 for the necessity of ventilation, with a confidence interval of 1.29-8.59 (P = 0.01). Duration of ventilation ranged from 2 to 45days, with an average of 13.14days, whereas the mean ventilator-free days recorded was 13.57. Notably, a sequential increase in bilateral DE correlated with an extended duration of ventilator-free days. The presence of a baseline left DE of less than 1cm, a consecutive decrease in DE measurements within 48h, and a comparative reduction in right DE of more than 50% within the initial 3days are indicators associated with the requirement for MV in patients with NM disease. Furthermore, the upward trajectory of DE in mechanically ventilated patients is linked to an increased number of days free from ventilator support, suggesting its potential to forecast earlier weaning.

Ultrasonographic assessment of hydronephrosis in adults and children: Experience from a tertiary care hospital

Ultrasonographic assessment of hydronephrosis in adults and children: Experience from a tertiary care hospital

Reliability of Ultrasound Assessment of Hamstring Morphology, Quality, and Stiffness Among Healthy Adults and Athletes: A Systematic Review.

The incidence and recurrence rate of hamstring strain injuries remain persistently high, with recurrent injuries leading to increased time lost during play and extended recovery periods compared with initial injury. Ultrasound imaging assesses important factors such as hamstring fascicle length (FL), pennation angle (PA), cross-sectional area (CSA), muscle thickness (MT), echo intensity (EI), and shear wave elastography (SWE), all impacting athletic performance. However, its reliability must be established before employing any measurement tool in research or clinical settings. To determine the reliability and measurement error of ultrasound for assessing hamstring FL, PA, CSA, MT, EI, and SWE among healthy adults and athletes; to synthesize the information regarding the operationalization of ultrasound. A systematic literature search was done from January 1990 to February 5, 2023, to identify reliability and validity studies of hamstring ultrasound assessment published in peer-reviewed journals with identifiable methodology of outcome measures. Intraclass correlation coefficient measurement of 14 included studies reported moderate to excellent intrarater, interrater, and test-retest reliabilities of FL, PA, and MT regardless of the site of muscle testing, probe size, and setting, state of muscle, and use of different techniques in the extrapolation of FL. Good to excellent test-retest reliability rates for all hamstring anatomic CSA along midmuscle and different percentages of thigh length using panoramic imaging. Good intrarater reliability of EI regardless of gender and orientation of the probe but with excellent intrarater reliability in transverse scan using maximum region of interest. Good intrarater, interrater, and interday repeatability on SWE with the muscle in a stretched position. Evidence from studies with a predominantly low risk of bias shows that ultrasound is a reliable tool to measure hamstring FL, PA, CSA, MT, EI, and SWE in healthy adults and athletes under various experimental conditions.

Association between situs inversus and maternal SARS-CoV-2 infection at gestational age 4–6 weeks

A dramatic increase in fetal situs inversus diagnoses by ultrasound in the months following the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) surge of December 2022 in China led us to investigate whether maternal SARS-CoV-2 exposure could be associated with elevated risk of fetal situs inversus. In this multi-institutional, hospital-based, matched case-control study, we investigated pregnant women who underwent ultrasonographic fetal biometric assessment at gestational weeks 20-24 at our hospitals. Each pregnant woman carrying a situs inversus fetus was randomly matched with four controls based on the date of confinement. Relevant information, including SARS-CoV-2 infection, and other potential risk factors were collected. Conditional logistic regression was used to test possible associations between fetal situs inversus and SARS-CoV-2 infection at different gestational weeks as well as individual risk factors. A total of 52 pregnant women diagnosed with fetal situs inversus between January 1 and October 31, 2023 and 208 matched controls with normal fetuses were enrolled. We found no association between an increased risk of fetal situs inversus with gestational SARS-CoV-2 infection or with other risk factors. However, fetal situs inversus was significantly associated with SARS-CoV-2 infection specifically in gestational weeks 4-6 (adjusted odds ratio [aOR] 6.54 [95% confidence interval 1.76-24.34]), but not with infection at other gestational ages, after adjusting for covariates. Increased risk of fetal situs inversus is significantly associated with maternal SARS-CoV-2 infection at gestational weeks 4-6, corresponding to the fetal developmental window for visceral lateralization in humans. National Key R&D Program of China, etc.

Diagnostic Accuracy of USG and MRI for the Detection of Rotator Cuff Injury.

Rotator cuff disease frequently causes shoulder pain and is diagnosed using various radiological methods alongside history and physical examination. Arthrography has traditionally been employed for this purpose, but newer non-invasive techniques such as ultrasonography (USG) and magnetic resonance imaging (MRI) are increasingly used. However, no single method is universally agreed upon as the best diagnostic tool, each having its own limitations. To evaluate how effectively ultrasound and MRIcan diagnose rotator cuff tears. Seventy patients suspected of having a rotator cuff tear underwent investigations at the Radiology Department of Krishna Vishwa Vidyapeeth (Deemed to be University), Karad. USG and MRI examinations were done on the same day, along with a detailed history. USG was conducted using a GE LOGIQ P9 machine with a high-frequency 3-12 MHz transducer. MRI was conducted using a 1.5T SiemensMagnetom Avanto scanner. Pain and stiffness are the most common complaints in rotator cuff tears. The predisposing factors include male predominance, increasing age, dominant hand use, and trauma history. The supraspinatus tendon is the most frequently injured, with partial tears, especially articular surface tears, being more common than full-thickness tears. Clinical examinations, USG, and MRI are valuable in diagnosing rotator cuff tears. Our findings indicate that USGmay not be as reliable in detecting rotator cuff tears as once believed. A positive ultrasound result is more trustworthy than a negative one. In contrast, MRIdemonstrates greater sensitivity and overall diagnostic accuracy compared to both ultrasonography and clinical assessment for detecting rotator cuff tears.

Ultrasonographic Assessment of the Thymus Among Neonates Admitted in a Special Newborn Care Unit of a Medical College Hospital in Eastern India.

The thymus is essential for the maturation of T-lymphocytes, crucial for adaptive immunity. In neonates, thymic development is influenced by factors such as gestational age, birth weight, birth length, etc. Ultrasonography offers a non-invasive method to assess thymic size and morphology. However, there is limited research on thymic ultrasonography among neonates in Eastern India. This study aimed to investigate the ultra-sonographic characteristics of the thymus in neonates admitted to a Special Neonatal Care Unit (SNCU) in Eastern India and its correlation with certain clinical and anthropometric variables. Conducted from May to July 2024, this cross-sectional observational study involved 80 neonates admitted to the SNCU at the College of Medicine & Sagore Dutta Hospital. Thymic ultrasonography, using an Esaote MylabX7 ultrasound machine with a 3-11 MHz linear probe (Esaote, Genoa, Italy), measured thymic length, width, anteroposterior (AP) dimension, sagittal area, and thymic index. Clinical data, including gestational age, birth weight, birth length, and antibiotics received, were collected from medical records. Pearson's correlation coefficient and linear regression analysis were used to examine correlations and predictors of thymic dimensions. The cohort consisted of 45 boys (56%) and 35 girls (44%). The average birth weight was 2,626 grams for boys and 2,639 grams for girls. The median gestation period was 38 weeksfor both groups. Thymic measurements did not significantly differ by gender. Correlation analysis revealed significant relationships between thymic dimensions and neonatal anthropometric measurements. Birth weight showed a strong positive correlation with thymic length (r = 0.486) and width (r = 0.233). Linear regression identified birth weight as a significant predictor of the thymic index (p < 0.001), explaining 21.2% of the variance. This study provides insights into the factors associated with thymic size in neonates, highlighting the critical role of birth weight in thymic development. Future research should explore additional variables influencing thymic size and consider larger sample sizes to enhance model explanatory power and its potential role in immunity.

Ultrasonographic Assessment of Optic Nerve Sheath Diameter as a Screening Tool for Intracranial Hypertension in Traumatic Brain Injury

BackgroundSevere traumatic brain injury (TBI) is a condition burdened by high morbidity and mortality. Prevention of secondary insults is one of the main goals of management and intracranial pressure monitoring is a cornerstone in management of TBI. The relationship between intracranial pressure and optic nerve sheath is known from the literature. Optic nerve sheath ultrasonography could represent a method added to our armamentarium for monitoring intracranial pressure. MethodsWe investigated how ultrasound-measured optic nerve sheath diameter varies as a function of intracranial pressure in a cohort of patients with severe blunt head injury in whom an intraparenchymal sensor was placed. We evaluated the accuracy of optic nerve sheet diameter (ONSD) in distinguishing dichotomized ICP cut-offs and analyzed the learning curve and its potential as screening tool to select TBI patients most in need of invasive ICP monitoring in a setting with constraints on resources. ResultsONSD and ICP have a linear relationship. Nevertheless, there are limits of evaluating the one-to-one correspondence between those two variables. We selected a cut-off of sonographic ONSD above which there is a concernable elevation of intracranial pressure (ICP>15 mmHg) worthy of invasive second line invasive monitoring. Thus, it is possible to use ONSD as a first line non-invasive tool to intercept patients at risk of developing frank intracranial hypertension. ConclusionsWe propose the use of ONSD ultrasound as a screening investigation for post-traumatic intracranial hypertension in the context of an emergency department, especially in contexts where there is limited availability of intracranial pressure monitors.

Comparative Study of Diluted Hydrogen Peroxide and Sulfur Hexafluoride in the Contrast-Enhanced Ultrasound Assessment of Anal Fistulas.

Endoanal ultrasound for the diagnosis of anal fistulas requires the injection of hydrogen peroxide, but it is often uncomfortable for the patient and has the potential to cause complications. Novel ultrasound contrast is currently available. To assess the efficacy and safety of sulfur hexafluoride as an ultrasound contrast agent for the diagnosis of a perianal fistula by comparing it with those of 50% diluted hydrogen peroxide. Double-blinded superiority study with 4 consecutive visits to perform an ultrasound without contrast, a hydrogen peroxide-enhanced ultrasound, a sulfur hexafluoride-enhanced ultrasound, and a rectal exploration in the operating room (the criterion standard). The 3 expert surgeon sonographers independently reviewed the ultrasound images. This study was conducted at a single university hospital. Data from 176 patients were evaluated. Demographic and exploratory data and the ultrasound findings related to the location of the internal fistula orifice, description of the primary and secondary tracts, and presence of cavities and sphincter defects were analyzed. Complications occurring before and after the contrast agent administration and pain score measured using a visual analog scale were considered. Eighty-eight patients were included (men: 71.5%; mean age: 48.3 years), with 62.5% having a complex type fistula and 83.7% having a transsphincteric type fistula. Sulfur hexafluoride-enhanced ultrasounds demonstrated a higher interobserver agreement in determining the secondary tracts (κ = 0.604) and anal fistula height (κ = 0.604) compared with other methods. Both hydrogen peroxide-enhanced ultrasound (90.91%) and sulfur hexafluoride-enhanced ultrasound (89.77%) detected the internal orifice more frequently than ultrasounds without contrast (62.5%; p < 0.001), with no differences between contrast agents ( p = 0.810). Sulfur hexafluoride-enhanced ultrasound was less painful than peroxide-enhanced ultrasound ( p < 0.001). Most of the patients had transsphincteric anal fistulas. Sulfur hexafluoride proved comparable to hydrogen peroxide in evaluating fistulous tracts and identifying the internal orifice, and it significantly reduced pain and discomfort. Furthermore, it demonstrated a higher interobserver agreement in determining the secondary tracts and anal fistula height compared with other methods. See Video Abstract . ANTECEDENTES:La ecografía endoanal para el diagnóstico de fístulas anales requiere la inyección de peróxido de hidrógeno, pero generalmente resulta incómoda para el paciente y presenta potenciales complicaciones. Actualmente se encuentran disponibles nuevos contrastes ecográficos.OBJETIVO:Evaluar la eficacia y seguridad del hexafluoruro de azufre como agente de contraste ecográfico para el diagnóstico de fístula perianal comparándolo con el peróxido de hidrógeno diluido al 50%.DISEÑO:Estudio de superioridad doble ciego con cuatro visitas consecutivas realizando una ecografía sin contraste, ecografía potenciada con peróxido de hidrógeno, ecografía potenciada con hexafluoruro de azufre y exploración rectal en el quirófano (el estándar de oro). Las imágenes ecográficas fueron revisadas de forma independiente por tres cirujanos ecografistas expertos.AJUSTE:Estudio llevado a cabo en un único hospital universitario.PACIENTES:Se evaluaron datos de 176 pacientes.PRINCIPALES MEDIDAS DE RESULTADO:Se analizaron los datos demográficos y exploratorios y los hallazgos ecográficos relacionados con la ubicación del orificio interno de la fístula, descripción de los trayectos primario y secundario y la presencia de cavidades y defectos del esfínter. Se consideraron las complicaciones ocurridas antes y después de la administración del agente de contraste y la presencia de dolor medido mediante un puntaje.RESULTADOS:Se incluyeron 88 pacientes (hombres: 71,5%; edad media: 48,3 años). El 62,5% fueron tipo complejo y el 83,7% tipo transesfintérico. Las ecografías mejoradas con hexafluoruro de azufre demostraron mayor concordancia interobservador en la determinación de los trayectos secundarios (κ = 0,604) y la altura de la fístula anal (κ = 0,604) en comparación con otros métodos. Tanto la ecografía con peróxido de hidrógeno (90,91%) como la ecografía con hexafluoruro de azufre (89,77%) detectaron con mayor frecuencia el orificio interno que la ecografía sin contraste (62,5%) (p < 0,001), sin diferencias entre agentes de contraste (p = 0,810). La ecografía potenciada con hexafluoruro de azufre fue menos dolorosa que la ecografía potenciada con peróxido (p < 0,001).LIMITACIONES:La mayoría de los pacientes presentaron fístulas anales transesfintéricas.CONCLUSIONES:El hexafluoruro de azufre demostró ser comparable al peróxido de hidrógeno en la evaluación de los trayectos fistulosos y la identificación del orificio interno y con reducción significativa del dolor y malestar. Además, demostró mayor concordancia interobservador en la determinación de los trayectos secundarios y la altura de la fístula anal en comparación con otros métodos. (Traducción-Dr. Fidel Ruiz Healy ).

Genome-wide association study of exercise-induced skeletal muscle hypertrophy and the construction of predictive model.

The aim of the current study was to investigate interindividual differences in muscle thickness of the rectus femoris (MTRF) following 12 wk of resistance training (RT) or high-intensity interval training (HIIT) to explore the genetic architecture underlying skeletal muscle hypertrophy and to construct predictive models. We conducted musculoskeletal ultrasound assessments of the MTRF response in 440 physically inactive adults after the 12-wk exercise period. A genome-wide association study was used to identify variants associated with the MTRF response, separately for RT and HIIT. Using the polygenic predictor score (PPS), we estimated the genetic contribution to exercise-induced hypertrophy. Predictive models for the MTRF response were constructed using random forest (RF), support vector mac (SVM), and generalized linear model (GLM) in 10 cross-validated approaches. MTRF increased significantly after both RT (8.8%, P < 0.05) and HIIT (5.3%, P < 0.05), but with considerable interindividual differences (RT: -13.5 to 38.4%, HIIT: -14.2 to 30.7%). Eleven lead single-nucleotide polymorphisms in RT and eight lead single-nucleotide polymorphisms in HIIT were identified at a significance level of P < 1 × 10-5. The PPS was associated with the MTRF response, explaining 47.2% of the variation in response to RT and 38.3% of the variation in response to HIIT. Notably, the GLM and SVM predictive models exhibited superior performance compared with RF models (P < 0.05), and the GLM demonstrated optimal performance with an area under curve of 0.809 (95% confidence interval: 0.669-0.949). Factors such as PPS, baseline MTRF, and exercise protocol exerted influence on the MTRF response to exercise, with PPS being the primary contributor. The GLM and SVM predictive model, incorporating both genetic and phenotypic factors, emerged as promising tools for predicting exercise-induced skeletal muscle hypertrophy.NEW & NOTEWORTHY The interindividual variability induced muscle hypertrophy by resistance training (RT) or high-intensity interval training (HIIT) and the associated genetic architecture remain uncertain. We identified genetic variants that underlie RT- or HIIT-induced muscle hypertrophy and established them as pivotal factors influencing the response regardless of the training type. The genetic-phenotype predictive model developed has the potential to identify nonresponders or individuals with low responsiveness before engaging in exercise training.

Spontaneous rupture of hepatic hemangioma: case report and literature review

Hepatic lesions represent a potential etiology of spontaneous hemoperitoneum. Among these, hepatic hemangiomas, characterized by congenital vascular malformations, stand out as the most likely benign liver neoplasms, frequently presenting as asymptomatic entities. However, spontaneous rupture constitutes the gravest complication associated with these lesions, underscoring the imperative of prompt diagnosis. Notably, the global mortality rate attributed to spontaneous rupture of hepatic hemangiomas remains elevated. Hence, achieving an accurate diagnosis of this condition is paramount for informing. Hepatic hemangioma stands as the prevailing benign hepatic neoplasm, with autopsy studies indicating a prevalence ranging between 3% and 20%. In a clinical scenario, a 64-year-old patient presented at Sant’Anna and S. Sebastian Hospital with severe abdominal pain, hypotension (blood pressure 70/40 mm Hg), tachycardia (heart rate 120 bpm), and abdominal muscle guarding upon physical examination. Ultrasound assessment revealed the presence of free intraperitoneal fluid. However, the ultrasound examination could not be completed due to the patient’s deteriorating hemodynamic status and manifestation of instability. Consequently, an urgent exploratory laparotomy was deemed necessary and promptly undertaken in the operating theater.

The educational game SonoQz improves diagnostic performance in ultrasound assessment of ovarian tumors.

Our objective was to determine whether the educational game SonoQz can improve diagnostic performance in ultrasound assessment of ovarian tumors. The SonoQz mobile application was developed as an educational tool for medical doctors to practice ultrasound assessment, based on still images of ovarian tumors. The game comprises images from 324 ovarian tumors, examined by an ultrasound expert prior to surgery. A training phase, where the participants assessed at least 200 cases in the SonoQz app, was preceded by a pretraining test, and followed by a posttraining test. Two equal tests (A and B), each consisting of 20 cases, were used as pre- and posttraining tests. Half the users took test A first, B second, and the remaining took the tests in the opposite order. Users were asked to classify the tumors (1) according to International Ovarian Tumor Analysis (IOTA) Simple Rules, (2) as benign or malignant, and (3) suggest a specific histological diagnosis. Logistic mixed models with fixed effects for pre- and posttraining tests, and crossed random effects for participants and cases, were used to determine any improvement in test scores, sensitivity, and specificity. Fifty-eight doctors from 19 medical centers participated. Comparing the pre- and posttraining test, the median of correctly classified cases, in Simple Rules assessment increased from 72% to 83%, p < 0.001; in classifying the lesion as benign or malignant tumors from 86% to 95%, p < 0.001; and in making a specific diagnosis from 43% to 63%, p < 0.001. When classifying tumors as benign or malignant, at an unchanged level of sensitivity (98% vs. 97%, p = 0.157), the specificity increased from 70% to 89%, p < 0.001. Our results indicate that the educational game SonoQz is an effective tool that may improve diagnostic performance in assessing ovarian tumors, specifically by reducing the number of false positives while maintaining high sensitivity.

Value of serum muscular creatinine phosphokinase levels in patients with adenomyosis as a non-invasive diagnostic marker.

In the present study, we aimed to compare serum CK-MM levels in patients with and without adenomyosis and to investigate whether CK-MM level can be a non-invasive marker for myometrial damage due to adenomyosis. Our study was a prospective case-control study in a tertiary center and consisted of 40 patients with a clinical/ultrasonographic diagnosis of adenomyosis and 40 patients without a clinical/ultrasonographic diagnosis of adenomyosis as the control group based on recently published morphological uterus sonographic assessment (MUSA) criteria. Individuals of similar age who signed a voluntary consent form were included in our study. Demographic, clinical, and laboratory findings of the patients in both groups were recorded. Blood serum samples were used for the determination of serum CK-MM levels of the participants in our study. The samples were analyzed by using the human CK-MM enzyme-linked immunosorbent assay (ELISA) kit. In our study, the mean serum CK-MM level was 16.2 ± 21.7 (ng/dL) in patients with adenomyosis and 2.6 ± 2.2 (ng/dL) in patients without adenomyosis. Serum CK-MM level was statistically significantly higher in the patient group with adenomyosis than in the control group (p < 0.001). The CK-MM threshold value of 3.43 ng/mL, with a sensitivity of 82.5% and specificity of 85%, has been found to be a valuable distinguishing level in patients with and without adenomyosis. In this study, we demonstrated that serum CK-MM can be used as a non-invasive diagnostic method in patients with adenomyosis. As the number of studies around this subject in the literature is insufficient, larger studies are needed to use CK-MM as a diagnostic marker in adenomyosis.

STUDY TO COMPARE FASTING GASTRIC VOLUME USING ULTRASOUND IN DIABETIC AND NON DIABETIC PATIENTS POSTED FOR ELECTIVE SURGERIES

Objective: To study the comparison of fasting gastric volume using ultrasound in diabetic and nondiabetic patients in elective surgeries. To compare the incidence of delayed gastric emptying in diabetic and nondiabetic after standard fasting guidelines Material and Methods: After institutional ethical committee approval, CTRI registration and patient consent, prospective study was conducted in 30 diabetic and 30 non-diabetic patients aged 30-60years of American society of anesthesiologists- physical status I-III having similar fasting intervals. Pre operatively, quantitative assessments of gastric antrum in supine and right lateral decubitus (RLD) positions were performed using curvilinear probe in accordance to standard gastric scanning. USG grade, cross-sectional area (CSA) of the antrum and gastric volume were calculated. The gastric antrum was classified as Grade 0, 1 or 2, signifying empty antrum, fluid in RLD position only and antral fluid in both supine and RLD positions, respectively. Results:The CSA of 2.35 ± 1.07 cm2 and 3.51 ± 1.4 cm2 in diabetic were significantly higher (P = 0.001) than 1.37 ± 0.32 cm2 and 2.19 ± 1.15 cm2 of control, in supine and RLD positions, respectively. GV was 3.85± 20.06 ml in control group and 6.5±23.51 ml in diabetic group. Conclusion: Diabetic patients have higher gastric antral cross-sectional area and gastric volumes as observed by gastric ultrasound than the non-diabetic patients. Reference - 1. Robinson M, Davidson A. Aspiration under anaesthesia: Risk assessment and decision-making. Contin Edu Anaesth Crit Care Pain. 201314:171–5. 2.Perlas A, Chan VW, Lupu CM, Mitsakakis N, Hanbidge A. Ultrasound assessment of gastric content and volume. Anesthesiology. 2009111:82–9. 3. Smith I, Kranke P, Murat I, Smith A, OSullivan G, Soreide E, et al. Perioperative fasting in adults and children: Guidelines from the European Society of Anaesthesiology. Eur J Anaesthesiol. 201128:556–69.

Ultrasonographic assessment of cricothyroid membrane height in a Turkish cohort

Aims: Cricothyrotomy is a life-saving technique utilized in emergency airway management. This study aimed to assess the variability in the height of the cricothyroid membrane (CTM) based on gender, age, and body-mass index (BMI) across different neck positions, neutral and maximally extended. Methods: The study enrolled healthy volunteers aged 18 years and older. Participant baseline characteristics (age, gender, and BMI) were systematically documented. The height of the CTM was measured using, with the participants’ necks positioned in neutral and extended postures. Associations between CTM height and demographic variables, including sex, age, height, and BMI, were evaluated. Results: The study cohort comprised 296 individuals with a mean age of 41.84±15.76 years, ranging from 18 to 75 years. 30.3% of the participants were between 18 and 29 years old. 175 participants (59.1%) were female. The CTM height was significantly greater in the maximum extension position compared to the neutral position (p

Non-alcoholic Fatty Liver Disease in Overweight and Obese Children; Can Ultrasonography Substitute Laboratory Studies? A Case-Control Study

Background: Non-alcoholic fatty liver disease (NAFLD) comprises a large burden on the global healthcare system with a high prevalence and lethal outcomes. Moreover, this disease is showing an incremental trend over time, partly due to the rise in obesity rates among children. Objectives: In this study, we aimed to elucidate the correlation of ultrasonographic and laboratory-assisted diagnosis of NAFLD in obese and normal-weight children. Methods: This study assessed 50 pediatric obese or overweight children with BMIs higher than the 85th percentile for their age and sex, as well as 50 age-and sex-matched control counterparts using ultrasonography and a liver enzyme panel. The prevalence of NAFLD and the differences in lab studies were evaluated. Then, receiver operating characteristics (ROC) curves were used to determine the optimal cut-off value for NAFLD based on liver enzymes. Results: A total of 100 participants were included in this study, 58% of whom were male. The mean age of the participants was 10.41 ± 2.224 years. The prevalence of sonographically diagnosed NAFLD in obese and overweight children was 34.0% (95% CI: 21.2% - 48.8%). The prevalence of NAFLD when assessed by lab values in this population was 58.0% (95% CI: 43.2% - 71.8%), with a low measure of agreement (K = 0.239, P = 0.058). High BMI increased the risk of NAFLD to about 8.5 times its baseline in the normal-BMI population. Non-alcoholic fatty liver disease patients had significantly higher values for aspartate aminotransferase (AST) (P &lt; 0.001), alanine aminotransferase (ALT) (P &lt; 0.001), and gamma-glutamyl transferase (GGT) (P &lt; 0.001), but not alkaline phosphatase (ALP) (P = 0.743). The ROC curves for AST, ALT, GGT, and BMI percentile had areas of 0.800, 0.899, 0.807, and 0.874, respectively, all of which could be used for screening NAFLD. A cut-off value of 43.5 IU/L for AST had a specificity and positive predictive value of 100% for the diagnosis of NAFLD in children. Conclusions: Obese and overweight children are 8.5 times more likely to develop NAFLD compared to their normal-BMI peers. For the evaluation of this disease, liver enzyme panels integrated with ultrasonographic assessment should be utilized.

Do we more often opt for conservative management of ovarian tumors after changing the Dutch national guideline on enlarged ovaries? A nationwide cohort study.

Increasing evidence shows that conservative management of ovarian tumors classified as benign, based on ultrasound assessment, is safe. Therefore, conservative management has been adopted as the preferred strategy for certain ovarian tumors assessed as benign in the Dutch national guideline on enlarged ovaries in 2013. The aim of this study was to examine whether implementation of this guideline has led to changes in the number of women/100 000 women undergoing surgery for an ovarian tumor in the Netherlands. Histopathology reports were requested for all examinations of ovarian and fallopian tube specimens (including cyst enucleations) registered in Palga, the Dutch nationwide pathology databank, from 2011 (before guideline adaptation) and 2019 (after guideline adaptation). Reports on prophylactically removed adnexa, removal for other primary tumors (eg endometrial carcinoma), and for patients under 18 years of age, were excluded from the analysis. Interobserver agreement for the inclusion and classification of reports was assessed using Cohen's Kappa analysis. A total of 34 932 reports were retrieved, 13 917 of which were included in the analysis. In 2011 and 2019, respectively, 96.3/100 000 vs 68.8/100 000 women aged ≥18 underwent surgery for benign ovarian tumors, and 19.6/100 000 vs 18.3/100 000 for borderline and malignant tumors combined. The number of women/100 000 who had surgery for a benign ovarian tumor per 100 000 women declined by 28.5% (p < 0.001) between 2011 and 2019. The largest difference between 2011 and 2019 was observed in the number of women per 100 000 women who underwent surgery for a serous cystadenoma (-40.7%; 20.8/100 000 vs. 12.3/100 000), followed by endometrioma (-33.2%; 14.7/100 000 vs. 9.8/100 000), simple epithelial cyst (-57.3%; 8.4/100 000 vs. 3.6/100 000), and corpus luteum cyst (-57.0%; 4.0/100 000 vs. 1.7/100 000). Cohen's Kappa for the interobserver agreement was 0.96. The number of women/100 000 undergoing surgery for a benign ovarian tumor has substantially decreased in the Netherlands when comparing data before and after implementation of the national guideline in 2013, while the number of women/100 000 undergoing surgery for a malignant or borderline tumor remained the same. These findings suggest successful implementation of the updated guideline, and a measurable effect on increased adoption of conservative management for benign-looking ovarian tumors.

Ultrasound assessment of the distal resection margin during robotic rectal surgery.

Ensuring an adequate distal resection margin (DRM) is a key factor in achieving the gold standard in surgical treatment for rectal surgery. The aim of this article is to describe our surgical technique and the usefulness of intraoperative ultrasonography (IOUS) for evaluating the DRM during robotic rectal surgery (RRS). Prospective data on five consecutive patients with rectal cancer who underwent RRS between January 2023 and December 2023 were collected. IOUS was utilized to evaluate the DRM in all patients. The mean time for the IOUS examination ranged from 5 to 10 min. There were no intraoperative complications or conversions to open surgery. The median length of hospital stay was 6.4 days (±1.67 days). During hospitalization, one patient experienced a Grade II complication according to the Clavien-Dindo classification, specifically postoperative ileus. Furthermore, one patient experienced a delayed anastomotic fistula, which was conservatively treated without readmission. At definitive pathology, the median distance of the tumour from the DRM was 29 mm (±1.41 mm) and all patients had an R0 resection. IOUS is a reproducible and helpful modality for identifying the distal margin of the cutting line during robotic resection of rectal cancers. It does not affect the operating time compared with other methods and could be an alternative method for assessment of the DRM during RRS.

Ultrasound-guided procedures for plantar fasciitis: a randomized clinical study

BackgroundCorticosteroid injections are commonly used for the treatment of plantar fasciitis. In recent years, ultrasound-guided multipuncture treatment of the fascia has been described in the literature. Our study aimed to compare the effectiveness of these two techniques in the treatment of plantar fasciitis.MethodsThe outcomes achieved over 120 days following the use of these techniques to treat plantar fasciitis were examined. A total of 81 patients were randomly selected for the study; 41 were treated with ultrasound-guided multipuncture and 40 with ultrasound-guided corticosteroid injection. Clinical examinations and ultrasound assessments were performed before treatment and at 30, 60 and 120 days post-treatment. Clinical assessments included the use of a visual analog scale (VAS) to record pain and the Foot Function Index (FFI) to evaluate function. Ultrasound was used to measure the thickness of the plantar fascia.ResultsBoth the ultrasound-guided multipuncture and corticosteroid injection techniques were associated with significant functional and echographic improvements at 4 months post-treatment (P < 0.001). Pain did not improve significantly after 120 days with ultrasound-guided corticosteroid injection, whereas significant pain reduction was observed with ultrasound-guided multipuncture.ConclusionCorticosteroid injection provides better short-term results in terms of VAS pain and FFI scores. However, ultrasound-guided multipuncture shows superior outcomes in VAS pain and FFI scores at 120 days.

Transvaginal three-dimensional ultrasound assessment of embryonic genital tubercle at 8-10+6weeks of gestation.

To assess embryonic genital tubercle using transvaginal three-dimensional (3D) ultrasound at 8-10+6weeks of gestation. One-hundred and two transvaginal 3D ultrasound scans were performed for first-trimester dating at 8-10+6weeks of gestation. The genital tubercle angle (GTA) and genital tubercle length (GTL) were measured with a mid-sagittal view of the embryo using the 3D ultrasound multiplanar mode. Intra- and inter-observer agreements regarding GTA and GTL were also assessed with Bland-Altman plots and intra- and inter-correlation coefficients. There were no significant differences in GTA between male and female embryos at 8, 9, 10weeks, or 8-10+6weeks of gestation, respectively. There were also no significant differences in GTL between male and female embryos at 8, 9, 10weeks, or 8-10+6weeks of gestation, respectively. However, GTL increased linearly with advancing gestation (r=0.8276, p<0.00001). Mean GTL (SD) values at 8, 9, and 10weeks were 0.833 mm (0.274), 1.623 mm (0.262), and 2.152 mm (0.420), respectively (p<0.001). Intra- and inter-reproducibilities of GTA and GTL were excellent. The intra- and inter-correlation coefficients of GTA and GTL were 0.964 and 0.995, and 0.996 and 0.9933, respectively. The genital tubercle could be identified using transvaginal 3D ultrasound at 8-10+6weeks of gestation. However, sex differentiation could not be performed at this age. The genital tubercle linearly developed with advancing gestation during the mid-first trimester of pregnancy.

Free-hand ultrasound strain elastography in evaluation of soft tissue tumors.

The purpose of this study is to evaluate elastography in a wide spectrum of soft tissue superficial lesions by correlating the elastographic characteristics of these lesions with the elastographic score (ES) system established by Asteria. Forty patients with different superficial lesions of the soft tissues were studied, including lipomas, schwannomas, neuromas, epidermal inclusion cysts, "in transit" melanoma metastasis, arterio-venous malformation, and giant-cell tumor. An ultrasound examination was performed combined with color-Doppler and elastographic module. The B-mode criteria were echogenicity, margins, and structural homogeneity of the lesion. The color-Doppler criterion was irregular and mainly intra-nodular vascularization. ES 1-4 was attributed, in relation with the increasing tissue stiffness, according to the classification of Asteria adapted for soft tissues. Subsequently, we added to each single B-mode and color-Doppler criterion the ES 3 and 4, thus crossing two parameters of malignancy. All the presumptive diagnoses formulated were confirmed with the clinical data or with the histopathological result. The hypoechoic appearance had the best diagnostic performance. Sensitivity was 87%, specificity 71%, positive predictive value (PPV) 80%, negative predictive value (NPV) 80%, and diagnostic accuracy 80%. There was a good correlation with the clinical and biopsy data, the irregularity of margins the worst performance, the inhomogeneity an intermediate. Color-Doppler had sensitivity 74%, specificity 82%, PPV 85%, NPV 70% and diagnostic accuracy 77.5%. Elastography had sensitivity 87%, specificity 94%, PPV 95%, NPV 84%, and diagnostic accuracy 90%. The combination hypoechoic appearance + ES3/ES4 showed sensitivity 83%, specificity 100%, PPV 100%, NPV 81%,and diagnostic accuracy of 90%. The combination of irregularity of margins + ES3/ES4 showed sensitivity 43%, specificity 100%, PPV 100%, NPV 59%, and diagnostic accuracy of 67.5%. The combination of inhomogeneity of the lesion + ES3/ES4 showed sensitivity 65%, specificity 94%, PPV 94%, NPV 68%, and diagnostic accuracy of 78%. The combination of the color-Doppler with the ES3/ES4 showed sensitivity 69.5%, specificity 100%, PPV 100%, NPV 71%, and diagnostic accuracy of 82.5%.In the combined evaluation, there was a significant increase in specificity, allowing healthy subjects to be categorized as correctly negative, with a reduction in false positives which also translates into an increase in PPV. Elastography alone is not sufficient for a correct diagnostic classification and must be considered as an additional parameter in the study of soft-tissue lesions. Although there was a good agreement between B-mode malignancy criteria and ES3/ES4, there is no significant improvement in sensitivity. Ultrasound assessment, especially of superficial lesions, cannot be separated from an integrated approach that foresees the additional and routine use of the elastographic examination.