Sonography Score Research Articles

Effects of Preoperative Oral Carbohydrate on Cirrhotic Patients under Endoscopic Therapy with Anesthesia: A Randomized Controlled Trial.

Preoperative fasting causes significant perioperative discomfort in patients. Preoperative oral carbohydrate (POC) is an important element of the enhanced recovery after surgery protocol, but its effect on cirrhotic patients who tend to have abnormal gastric emptying remains unclarified. We investigated the influence of POC on gastric emptying and preprocedural well-being in cirrhotic patients. A prospective, randomized, controlled study of cirrhotic patients with gastroesophageal varices scheduled for elective therapeutic endoscopy under intravenous anesthesia was conducted. We enrolled 180 patients and divided them into three groups: those not supplemented with carbohydrates for 8 h before therapeutic endoscopy (control group) and those administered a carbohydrate beverage 2 h (2 h group) and 4 h (4 h group) before endoscopy. The residual gastric volume was quantified before anesthesia, gastric emptying was evaluated using gastric ultrasonography, and preprocedural well-being was assessed using the visual analogue scale (VAS). Preanesthesia gastric sonography scores were similar among the three groups. No patient had residual gastric volume > 1.5 ml/kg in the control and 4 h groups, but six patients (11%) had a residual gastric volume of >1.5 ml/kg in the 2 h group, hence were at a risk of regurgitation and aspiration. Moreover, VAS scores for six parameters (thirst, hunger, mouth dryness, nausea, vomiting, and fatigue) in the 2 h group and three parameters (thirst, hunger, and mouth dryness) in the 4 h group were significantly lower than those in the control group, suggesting a beneficial effect on cirrhotic patients' well-being. Preoperative gastric peristaltic and operation scores, postoperative complications, length of hospital stay, and in-hospital expenses were not significantly different among the three groups. Our study indicated that avoiding preoperative fasting with oral carbohydrates administered 4 h before anesthesia can be achieved in cirrhotic patients. Further studies to assess whether POC can help improve postoperative outcomes in cirrhotic patients are needed.

Evaluation of the Diagnostic Value of Bedside Transthoracic Ultrasonography (TTUS) and Lower Extremity Three-Points Compression Duplex in the Diagnosis of the Pulmonary Embolism

Background: The present study aimed at evaluating the diagnostic value of lung transthoracic ultrasonography (TTUS) and lower extremity sonography versus computed tomography pulmonary angiography (CTPA) in the diagnosis of pulmonary embolus (PE). Materials and Methods: This study was performed on 104 patients with clinically suspected PE. CTPA and D-dimer was performed on all patients. Wells’ deep vein thrombosis criteria (WDVTC) was evaluated and recorded at the patient’s admission. Finally, the results of adding venous and lung sonography scores to the WDVTC with and without the results of D-dimer test were analyzed for predicting the diagnosis of PE. Results: There were 104 patients clinically suspected of having a PE and enrolled in the study. A PE was confirmed in 37.5% of this cohort. WDVTC had a sensitivity and specificity of 94.87% and 80.00%, respectively, to predict PE. When adding D-dimer to the WDVTC for patients unlikely to have a PE (WDVTC≤4), the sensitivity and specificity of positive D-dimer in diagnosis of PE were 94.87% and 56.92%, respectively ( P < .001). Conclusion: According to these study results, the modification of the WDVTC along with the results of lung TTUS and lower extremity venous sonogram significantly increase the diagnostic power for PE.

The Reliability and Accuracy of Palpation, Radiography, and Sonography for the Detection of Keel Bone Damage.

Simple SummaryDue to the recent increase in reports of the prevalence of keel bone damage in laying hens, this has become a topic of welfare concern. Keel bone damage is often in the form of a fracture, and therefore may compromise the hen’s welfare. Detecting keel bone damage in live hens has been problematic, as the bone must either be palpated, which is a measure poor in accuracy, or dissected, in which case the hen must be sacrificed. However, use of imaging technology is increasing in experimental studies. We set out to determine if training with feedback on accuracy could improve palpation accuracy, as well as to determine the accuracy of portable radiography and sonography to detect keel bone damage. Even with feedback, palpation remained an inaccurate method, while both radiography and sonography showed high accuracy for detecting fractures. These two techniques show promise in detecting keel bone fractures in live birds.Palpation is the most popular method of measuring keel bone damage on live birds, although it has been criticized for being subjective and inaccurate. The goals of this study were to examine intra- and inter-rater reliability when trained with feedback of accuracy, as well as determine the accuracy of portable radiography and sonography. Four evaluators palpated 50 103-week old Lohmann LSL-lite hens immediately following euthanasia. Of those birds, 34 were then radiographed, sonographed, and all 50 were re-palpated. Lastly, the keels were dissected and scored. The presence of deviations (DEV), fractures (FR), and tip fractures (TFR) was scored for each method. Reliability of palpation was analyzed using Cronbach’s Alpha (intra) and Fleiss’ Kappa (inter) tests. Radiography and Sonography scores were further compared with dissection scores to determine sensitivity and specificity. Initial inter-observer reliability was 0.39 DEV, 0.53 FR, and 0.12 TFR, with similar scores for the second round of palpation. Scores for intra-observer reliability ranged from 0.58–0.79 DEV, 0.66–0.90 FR, and 0.37–0.87 TFR. A high prevalence of TFR, but low assessor agreement, warrants the development of specialized training for the palpation of this area. Both radiography and sonography showed relatively high sensitivity for FR and TFR, but low for DEV. On the other hand, specificity was generally high across all damage types. Even with feedback, palpation reliability was poor. However, portable radiography and sonography show promise for detecting keel fractures.

Effects of preoperative oral carbohydrates on patients undergoing ESD surgery under general anesthesia: A randomized control study.

Background:Preoperative oral carbohydrate (POC) has been recommended as an important element of the enhanced recovery after surgery (ERAS) protocol, but its effect on patients undergoing endoscopic submucosal dissection (ESD) remains unclear. Our study aims to investigate the effects of POC for ESD surgery, with particular focus on perioperative well-being and gastric peristalsis.Methods:A prospective, randomized, and controlled study of patients undergoing ESD was conducted. Seventy-three patients were assigned to 2 groups: experiment (36 patients) and control (37 patients). The experiment group received oral carbohydrate solution 710 mL the night before and 355 mL 2 hours prior to operation. The control group fasted for 10 hours prior to operation. Gastric empty assessment, peristaltic score, and operation score were measured. In addition, visual analogue scale (VAS) scores for 6 parameters (thirst, hunger, mouth dryness, nausea, vomit, and weakness) of wellbeing were compared perioperatively. Preoperative basic conditions of patients, postoperative complications, and their clinical outcomes were also recorded.Results:Before anesthesia induction, gastric sonography score was higher in experiment group, while sucked fluid by gastroscopy was similar between 2 groups. And no patient had regurgitation. Moreover, gastric peristaltic score and operation score before operation were both lower in experiment group. Importantly, VAS scores for 3 parameters (thirst, hunger, and mouth dryness) were significantly lower in experiment patients. In addition, clinical outcomes including first time exhaust, first time for drinking water, the usage of hemostasis, postoperative complication, lengths of hospital stay, and in-hospital expense were not significantly different between 2 groups.Conclusions:Oral administration of carbohydrates preoperatively instead of fasting improves the feelings of thirst, hunger, and mouth dryness in patients following ESD surgery without enhancing risk of regurgitation. And, avoiding preoperative fasting with POC can decrease the degree of gastric peristalsis that may facilitate the successful completion of ESD surgery.

Arthritis of the Knee Joint in Rheumatoid Arthritis - Evaluation of Treatment Response by Ultrasound in Daily Clinical Practice.

Background: Rheumatoid arthritis (RA) commonly involves the knee joint in up to 30% of patients. Musculoskeletal ultrasound enables the skilled clinician to easily assess disease activity.Objective: To evaluate the sensitivity to change of the sonography score of large joints in Rheumatology (SOLAR) for different treatments of knee arthritis in RA.Method: Joints were assessed by ultrasound at 4 visits. Laboratory, immunological and clinical parameters were recorded.Results:225 RA patients were analyzed. The DAS 28 in the subgroup receiving systemic steroids was significantly higher (p < 0.001) than in patients treated with intraarticular glucocorticosteroids (GCs) at T0, comparing the values from T0 to T3 the same appeared (p=0.003). Concerning the acute GC treatment regimens, the gray scale ultrasound (GSUS) sum score was found to be significantly higher in patients receiving intraarticular GCs versus no GCs (p=0,035), as well as in patients receiving systemic versus intraarticular GCs (p=0.001). Regarding the differences from T0 and T3, similar to the baseline analysis, a high GSUS sum score was significantly associated with intraarticular GCs, a low to no GC administration (p=0.035), while a high GSUS sum score was significantly linked to intraarticular GCs, rather than systemic GCs (p=0.008).Conclusion: SOLAR score is sensitive to change in knee arthritis. Intraarticular GC administration is performed in patients with high GSUS scores. Systemic administration of GC is linked to high disease activity (DAS28) rather than GSUS or power Doppler ultrasound (PDUS) results.

A Comparison Between MRI, Sonography and FISH Methods in Diagnosis, Evaluation and Classification of Arthropathy in Severe Haemophilia a and B

Background: Haemophilia A and haemophilia B are the most common severe inherited bleeding disorders. Chronic arthropathy is a major long-term disabling complication of haemophilia. Imaging and evaluation of joints in children with haemophilia is important in detecting abnormalities, staging their severity and following the effects of treatment. The aim of this study is to evaluate the correlation of FISH score (Functional Independence Score in Haemophilia) with the scores obtained by MRI and sonography for the diagnosis, evaluation and classification of arthropathy in severe Haemophilia A and B.Methods: This is a cross-sectional study which was conducted in a Hospital affiliated to Shiraz University of Medical Sciences in Shiraz from April 2013 to April 2014. Twenty five male patients with severe hemophilia above 10 years old were participated. FISH, MRI and sonography procedures were performed in the elbow or knee joint of the patients. All patients’ information including age, type of Haemophilia, affected joint, scores of MRI, sonography and FISH, dose of factor consumed, weight and prophylaxis protocol were collected. Correlation between scores of FISH, MRI and sonography was calculated by Spearman Correlation test. P-value of less than 0.05 was considered significant.Results: The patient’s age ranged between 11 to 70 years-old. Twenty-two patients were Haemophilia A(88%) and 3 patients were Haemophilia B (12%). Among the 25 patients 12(48%) affected joints were right knee, 9(36%) left knee and 4(16%) right elbow.The FISH score ranged between 16 and 28, with mean score of 20.8 ± 3.2. Only two of the 25 patients were rated as fully independent in all seven activities (maximum possible score of 28). Although 24 patients could walk, six required aids in the form of a cane or a brace. Seventeen patients could not squat (score 1) and three patients could not climb steps. It was determined that 18 patients (72%) did not have any problem in self-care management (eating, bathing and dressing), and the remaining were able to perform them with slight discomfort.In this study MRI P scale ranged between 9 and 10, MRI A scale ranged between 5 and 20 and the sonography scores (maximum 11 means cartilage loss) ranged between 4 and 11.Correlation between FISH scores, MRI (A and P scales) and sonography was assessed. There was only a statistically significant negative correlation between FISH and MRI Additive (A) scale (rs=-0.537, P value=0.006).Also we categorized the FISH scores of patients in different stages of MRI. Considering cartilage loss domain (related MRI A scale: 13-20), 20 patients (80%) were classified in this group with FISH scores ranged from 17 to 22.Conclusion: FISH appears to be a promising disease-specific instrument for assessing overall musculoskeletal function in haemophilia patients. Based on our results, FISH scores in severe hemophilia patients were negatively correlated with MRI A scale. Also, it seems that FISH score less than 22 could be considered as loss of cartilage; however, due to small number of our patients it needs further assessment in different populations. DisclosuresNo relevant conflicts of interest to declare.

Lipoprotein(a) Serum Concentration and Apolipoprotein(a) Phenotype Correlate With Severity and Presence of Ischemic Cerebrovascular Disease

Serum lipoprotein(a) [Lp(a)] levels are genetically determined and considered to be an independent risk factor for atherosclerosis. The aim of this study was to provide a complete analysis of Lp(a) serum levels, apolipoprotein(a) phenotypes, and other lipid parameters for different forms of severity of symptomatic ischemic cerebrovascular disorders as well as for different stages of carotid atherosclerosis. Lp(a) concentration, apolipoprotein(a) phenotype, triglyceride, low-density lipoprotein, high-density lipoprotein, and total cholesterol levels of blind-coded specimens as well as degree of carotid artery stenosis were assessed in a consecutive series of patients with ischemic cerebrovascular disease. We evaluated 265 male (34%) and female (66%) patients (mean age, 51 +/- 7.4 years) with transient ischemic attack (55.8%), prolonged reversible ischemic neurological deficits (28.3%), and cerebral infarction (15.9%) as well as 288 male (30%) and female (70%) control subjects (mean age, 51 +/- 7.1 years). All subjects were white. Lp(a), total, and low-density lipoprotein cholesterol were statistically significantly elevated in all patients compared with control subjects. Lp(a) correlated with the severity of symptomatic cerebrovascular disease and the degree of carotid stenosis. Logistic regression analysis revealed Lp(a) as the best single marker for the presence of cerebrovascular disease (P < .001) followed by high-density lipoprotein cholesterol (P = .003) and triglycerides (P = .049). With a cutoff of 20 mg/dL of Lp(a), the odds ratio for a subject to have had ischemic stroke with elevated Lp(a) was 20.3 and 23.7 depending on the method of the Lp(a) estimation, whereas the odds ratio when the sonography score was > 0 was 15.4. The investigation of the distribution of the apo(a) phenotypes revealed that 16.73% of the control subjects had major isoforms < or = 580 kD molecular weight (B, F, S1, S2) versus 42.65% of the patients' group (P < .001). These isoforms were also present in 14.71% of all individuals with a sonography score of 0 but in 52.30% of all individuals with a sonography score > 0 (P < .001). This case-control study shows that an elevated Lp(a) level is the primary factor associated with the presence of ischemic cerebrovascular disease and that the increased portion of the smaller-molecular-weight apo(a) isoforms in patients and individuals with a sonography score > 0 points toward an inherited predisposition for this disease.