Ultrasound Study Research Articles

Variations in pelvic tilt during day-to-day activities after total hip arthroplasty measured with an ultrasound system

IntroductionThe pelvis plays a major role in the orientation of total hip arthroplasty (THA) implants and consequently, on the postoperative stability of the new hip joint. The relationship between the spine and pelvis affects the functional orientation of the acetabular cup, although this relationship differs between individuals and the positions encountered in everyday life. We believe this should be factored in when planning the THA procedure. This led us to conduct an in vivo ultrasound study to document the values of pelvic tilt in standing, sitting and lying positions in patients who have advanced hip osteoarthritis, before and after they undergo THA. HypothesisThe pelvic tilt when standing, sitting and lying supine does not change significantly after THA. Materials and methodsThe pelvic tilt, defined as the angle between the anterior pelvic plane and a vertical line was measured using an ultrasound device in 30 patients before the THA procedure and again 6 months later in standing, sitting and lying positions. The measurements were done during an office visit with the patient on an examination table for the lying position, on a chair for the sitting position and with the heels and occiput against the wall for the standing position. ResultsThe preoperative and 6-month postoperative pelvic tilt were –5.6̊±10.4̊ [–30.6̊; 11.7̊] and –5.8̊±7.9̊ [–20.6̊; 10.4̊] (p=0.4129) when standing, –44.5̊±6.10 [–53.8̊; –23.9̊] and –43.5̊±6.9̊ [–54.4̊; –17.3̊] (p=0.5760) when sitting, –88.3̊±5.1̊ [–99.3̊; –78.7̊] and –87.9̊±5.9̊ [–97.6̊; –72.4̊] (p=0.6106) when lying supine, respectively. There was no significant difference in the pelvic tilt before and 6 months after THA procedure. Variations of±5̊; ±5–10̊; ±10–15̊ and 15–20̊ were found in 72% (18); 20% (5); 4% (1) and 4% (1) of patients when lying supine, 56% (14); 36% (9); 8% (2); 0% (0) of patients when standing and 76% (19); 24% (6); 0% (0); 0% (0) when sitting. The mean variation for each patient between the preoperative and 6 months postoperative measurement was 4.8±3.4̊ [0.8̊; 10.4̊] (p=0.4129), 3.5±2.3̊ [0.2̊; 9.1̊] (p=0.5760), and 4.6̊±3.2̊ [1.2̊; 15.4̊] (p=0.6106) for the standing, sitting and lying positions respectively. ConclusionThe pelvic tilt does not significantly change 6 months after THA. Taking into account the various positions used in everyday life may help to optimize the implant position. We have described the use of an affordable, accurate and non-irradiating device that provides fast and easy measurements of pelvic tilt in various positions. Level of evidenceIV.

Ultrasonographic study of hand joints erosions in rheumatoid arthritis: Relation to clinical characteristics, disease activity and functional status

BackgroundRheumatoid arthritis (RA) is a commonly diagnosed chronic inflammatory arthritis. Bone erosion can occur early during RA and is considered as an important predictor of a severe clinical course. Aim of the workTo assess ultrasound-detected bone erosions in RA patients and establish their associations with clinical and laboratory variables. Patients and methodsThis study included sixty RA patients. The dorsal and volar joint aspects of the wrist (midcarpal and radiocarpal joints), the first to the fifth metacarpophalangeal (MCP) and proximal interphalangeal joints were scanned in the long and short axes for synovial hypertrophy, tenosynovitis, and erosions. Erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), rheumatoid factor (RF), and anti-cyclic citrullinated peptide (anti-CCP) were performed. The disease activity score (DAS28) and health assessment questionnaire (HAQ) was evaluated ResultsThe mean age of the patients was 43 ± 11.04 years with median disease duration of 5 (0.1–20) years and there were 57 females. Forty-one patients had bone erosions and 19 did not. Erosions were most frequently found in the MCP joints (48.3 % of examined patients). There was no significant difference between the two groups regarding age (p = 0.36), gender (p = 1), RF (p = 0.4), and anti-CCP (p = 0.6). The bone erosion scores significantly correlated with swollen joint count (p = 0.001), tender joint count (p = 0.018), patient global health (p = 0.024), DAS28 (p = 0.003), HAQ (p = 0.032), ESR (p = 0.005), presence of synovitis (p = 0.005), and synovitis score (p < 0.001). ConclusionsThe US-detected bone erosions are predominant in RA, most frequently at the MCP joints, and are associated with disease activity, inflammatory markers, and synovitis.

Predicting value for incomplete recovery in Bell's palsy of facial nerve ultrasound versus nerve conduction study

ObjectiveThis longitudinal study aims at assessing the predictive value of facial nerve high-resolution ultrasound (HRUS) for incomplete clinical recovery in patients with Bell’s palsy, the most common facial nerve disease. MethodsWe prospectively enrolled 34 consecutive patients with Bell’s palsy. All patients underwent neurophysiological testing (including facial nerve conduction study) and HRUS evaluations 10–15 days (T1), one month (T2), and three months (T3) after the onset of Bell’s palsy. Patients who did not experience complete recovery within three months were also evaluated after six months (T4). We have then compared the accuracy of HRUS with that of the facial nerve conduction study in predicting incomplete clinical recovery at three and six months. ResultsAt T1, the facial nerve diameter, as assessed with HRUS, was larger on the affected side than on the normal side, particularly in patients with incomplete recovery at T2, T3 and T4. ROC curve analysis, however, showed that the facial nerve diameter at T1 had a lower predictive value than the facial nerve conduction study for an incomplete clinical recovery at three (T3) and six (T4) months. Still, the facial nerve diameter asymmetry, as assessed with HRUS, had a relatively high negative predictive value (thus indicating a strong association between normal HRUS examination and a good prognosis). ConclusionsAlthough HRUS shows abnormally increased facial nerve diameter in patients in the acute phase of Bell’s palsy, the predictive value of this technique for incomplete clinical recovery at three and six months is lower than that of the nerve conduction study. SignificanceNerve ultrasound has a low predictive value for incomplete clinical recovery in patients with Bell’s Palsy.

Tocilizumab Vs Methotrexate in a Cohort of Patients Affected by Active GCA: A Comparative Clinical and Ultrasonographic Study.

No head-to-head study has assessed the superiority of tocilizumab versus methotrexate in giant cell arteritis (GCA), and few studies have demonstrated its effectiveness in terms of ultrasonographic findings, but without a control group. The primary endpoint was to assess whether tocilizumab was superior to methotrexate in inducing normalization of US findings, whereas the secondary endpoint was to assess the effectiveness of precocious withdrawal of glucocorticoids. We prospectively enrolled all the patients with active GCA at our clinic. The inclusion criteria were clinical diagnosis of GCA; active disease; and clinical, laboratory, and US data, evaluated using the halo count (HC) and OMERACT GCA Ultrasonography Score (OGUS). Evaluations were repeated at 3, 6, and 12 months. Twenty patients were treated with Tocilizumab and 9 with Methotrexate. All but three tocilizumab-treated patients achieved remission at six months, whereas at 12 months, all patients were in glucocorticoid-free remission. Up to three of the nine methotrexate patients experienced a lack of efficacy or minor relapses. Tocilizumab-treated patients showed a statistically significant difference between baseline and all follow-ups in terms of OGUS and HC, whereas the difference in the Methotrexate group was significant after 1 year. The mean glucocorticoid dosage significantly decreased in both groups. No severe adverse events or major relapses were reported. Our study demonstrates the superiority in terms of rapidity of a tocilizumab-based scheme over a methotrexate-based scheme in inducing clinical and US remission. Precocious withdrawal of glucocorticoids did not increase the risk of relapse.

PATHOMORPHOLOGICAL CHANGES IN THE ORGANS OF CATS CAUSED BY ALIMENTARY LYMPHOMA. CLINICAL CASES

The article presents the results of clinical, ultrasonographic, pathomorphological and immunohistochemical studies of two random cases of alimentary lymphoma in 9- and 12-year-old domestic cats. Clinical signs of the disease were similar and characterized by anorexia, cachexia, vomiting and diarrhea that appeared in different periods of the disease. The mucous membranes of the oral cavity and eyes were icteric, the abdomen was visually enlarged, palpation revealed nodular thickenings in the abdominal cavity. During the ultrasound diagnostics, diffuse multiple non-encapsulated anechoic formations with uneven edges and growth of tumorous tissue into the intestinal wall were visualized. In another cat, there was an encapsulated formation of a hypoechoic fine-grained structure with well-defined vascularization.&#x0D; From the moment of the preliminary diagnosis until the very death, the cats were kept in the clinic under supervision. After the death, an autopsy was performed with the selection of material for histopathological examination. Organs’ fragments were fixed in 10% aqueous solution of neutral formalin and Carnois fluid. Histological preparations were made according to the generally accepted methods. Immunophenotyping of lymphoma type was performed using CD3 (T-cell) and CD79a (B-cell) markers. During the pathological autopsy, an increase in mesenteric lymph nodes, their compaction, and focal thickening of the small intestine wall were revealed. The histological examination showed that jejunum was the most infiltrated intestinal segment, in which massive, diffusely placed monomorphic lymphoblastic cells were localized in the mucous membrane lamina, submucosa and muscle layers. The submucosal layer vessels were sharply dilated, filled with erythrocytes; the muscles of the inner circular layer were swollen. The outer (longitudinal) muscle layer of the jejunum thickened significantly and was intensively infiltrated by lymphoblastic cells.&#x0D; Typical diffuse lymphoblastic proliferations were also detected in the cortical substance of lymph nodes and lymphoid nodules. Stasis and significant expansion of the marginal sinus vessels were visualized too. In addition, moderate mononuclear lymphoblastic infiltrates were detected in the pancreas parenchyma with their perivascular location. Immunohistochemically, a significant positive expression of CD3 cells was detected both in the jejunum mucous membrane and the marginal sinus area, around the germinal centers of the lymph nodes, which indicated a T-cell type of lymphoma.

The influence of a single 30-pitch session on elbow laxity in adolescent and collegiate baseball pitchers

BackgroundUlnar collateral ligament (UCL) injuries are a source of significant injury among baseball players, and are increasingly evaluated under ultrasound. The purpose of this study is to determine the effect of a single session of pitching upon UCL thickness and laxity via a cross sectional, controlled ultrasonographic study. We hypothesize that a single session of pitching will cause the ulnar collateral ligament to thicken and become more lax. MethodsThis was a cross sectional comparative study of collegiate and high school pitchers. Pitchers underwent an ultrasonographic assessment of the UCL before and after a thirty-pitch bullpen warm-up. Laxity was measured as the change in the distance between the ulna and the trochlea with and without a five-pound weight held in hand with the elbow at 30° of flexion. Pre- and post-throwing UCL thickness and medial laxity were statistically compared with paired tests. ResultsOur study included 15 pitchers, 8 collegiate and 7 high school level athletes. All played baseball at least six days a week, and nearly all played for at least 10 months a year. Pitchers reported a peak velocity of 89±6 (77 to 98) miles per hour. In the prior season, these pitchers pitched 56±33 (10 to 120) games, throwing 62±34 (25 to 140) pitches per game on average. After throwing, there was significantly less UCL laxity (p=0.013). Post-throwing laxity was significantly positively correlated with both peak pitch velocity (p=0.009) and an average number of pitches thrown per game (p=0.10). ConclusionThrowing 30 pitches significantly decreases medial elbow laxity with stress, possibly due to flexor-pronator activation. Post-throwing medial laxity is correlated with both peak pitch velocity and average number of pitches thrown per game. Future studies should be conducted to determine the number of throws at which laxity begins to increase, as this may provide a workload management guideline for injury prevention.

An ultrasound-based femoral artery calcification score

ObjectiveDuplex ultrasound (US) of the lower extremities is commonly used to assess patients with lower extremity atherosclerosis. Arterial calcification can often be visualized in these images; however, efforts to quantify its extent have been limited. We, thus, sought to develop a new scoring system to measure calcification on duplex US studies of the femoral artery and correlate it with standard computed tomography (CT)-based methods. We then made preliminary attempts to correlate US-based femoral artery calcification scores with limb-specific outcomes in patients with peripheral arterial disease. MethodsPatients who underwent CT evaluation of the lower extremities and arterial duplex US of either lower extremity within 6 months of each examination were included in the study. CT-based calcium scores of the femoral artery were generated using calcium scoring software. To determine the US score, five standard arterial segments (ie, common femoral artery, proximal superficial femoral artery [SFA], mid-SFA, distal SFA, and above the knee popliteal artery) were scored using a scale of 0 to 2 (0, a completely normal vessel segment; 1, a vessel with hyperechoic irregularities of the vessel wall; and 2, clear anechoic shadowing). The available scores were then averaged to yield a single femoral calcium score for each leg. Predictors of femoral calcification scores were then assessed and compared with the CT-based methods. The correlation between the US- and CT-based femoral calcification was assessed, and then the association between the US-based femoral calcification score and limb outcomes was evaluated. ResultsA total of 113 patients met the inclusion criteria and were included in the final analysis. US-based calcification scores were increased in patients with diabetes, renal failure, and the presence of chronic limb threatening ischemia similar to CT-based femoral calcification. The US- and CT-based calcification scores showed a moderate to strong correlation (r = 0.64). An elevated US-based femoral artery calcification score was associated with decreased amputation-free survival. ConclusionsA novel US-based method shows promise as a simple method for quantifying the extent of femoral artery calcification in patients with peripheral arterial disease. The US-based method correlates with standard CT-based methods. Preliminary studies show that it could be useful for predicating outcomes for patients with peripheral arterial disease.

Recurrent de novo SPTLC2 variant causes childhood-onset amyotrophic lateral sclerosis (ALS) by excess sphingolipid synthesis

BackgroundAmyotrophic lateral sclerosis (ALS) is a neurodegenerative disease of the upper and lower motor neurons with varying ages of onset, progression and pathomechanisms. Monogenic childhood-onset ALS, although rare, forms an...

Characterization of digital annular pulleys and their entheses: an ultrasonographic study with anatomical and histological correlations.

Digital annular pulleys (DAP) are important anatomical structures for finger function. The anatomy, histology, and imaging assessment of DAP, particularly at the level of their entheses is still not clearly defined. The advent of high-frequency ultrasound (US) transducers opened new perspectives in evaluating sub-millimeter scale structures, such as pulleys, paving the way for their global assessment. The study aimed at characterizing DAP from an anatomical, histological, and US perspective, focusing on the detection and complete description of pulley entheses. US assessment and gross anatomy dissection were conducted on 20 cadaveric hands to study DAP thickness and structure including enthesis identification. The results of the US and anatomical measurements were correlated. DAP entheses identified by US were characterized via histological analysis. DAP in 20 healthy controls (HC) were detected and measured by US. The A1, A2, and A4 DAP entheses were assessed using a new dynamic maneuver to better evaluate those structures. 1200 DAP (400 cadaveric, 800 HC) were analyzed. The cadaveric study demonstrated strong correlation between anatomical and US measurement of DAP (r = 0.96). At histological level, DAP entheses at the volar plate, sesamoid bones, or phalangeal ridges contained fibrous and fibrocartilaginous tissue. The US assessment of A1, A2, and A4 DAP in HC allowed the identification of 718/720 (99.73%) entheses. US is an effective tool to detect and study DAP. DAP entheses reveal both fibrous and fibrocartilaginous characteristics. A newly described maneuver to optimize DAP enthesis visualization enhances their detection by US.

Ultrasonographic study in healthy rabbits: B-mode of abdominal organs and Dopplerflowmetry of major vessels

Rabbit farming in Brazil is growing due to the quality of meat, ease of management, high prolificacy, and their use in research and as pets. However, studies on diagnostic imaging in rabbits are scarce. This study investigated the use of ultrasonography to assess abdominal organs and blood flow in 15 male rabbits, separated by weight. The results highlighted the uniform texture of the liver, which showed lower echogenicity than the right renal cortex, a hyperechoic wall of the gallbladder, and a fusiform shape of the spleen. Parameters such as size and location of the kidneys, bladder wall thickness, and adrenal gland measurements were evaluated. Doppler was used to analyze the aorta and renal artery, calculating Doppler velocity indices to assess hemodynamic function. This study contributes to understanding abdominal ultrasonography in rabbits, providing relevant information about the anatomy and hemodynamics of these organs.

I Thought I Saw a Retrocaval Ureter; Don't Bite the Fish-Hook Sign So Easily.

Background: During the management of patients with hydronephrosis, a possibility of retrocaval ureter (RCU) may emerge indicated by a fish-hook sign or its mimickers. Owing to infrequent incidence, the proper way to diagnose or exclude an RCU is challenging and has not been discussed previously. Methods: The aim of this study was to retrospectively evaluate the children who were suspected to have an RCU during management for urinary tract dilation. An RCU may be missed or misdiagnosed owing to rare incidence. Results: The children with urinary tract dilation in whom RCU was considered are enrolled in the study (n = 13). The demographics of the patients, findings suggesting RCU, evaluation process, management, and final diagnosis are retrospectively evaluated. The final diagnosis of the patients was RCU (n = 4), ureteropelvic junction obstruction (UPJO) (n = 7), and duplicated collecting system (n = 2). An RCU was confirmed or excluded by ultrasonography (US) while there was a stent in the ureter in 6 patients and by laparoscopic exploration in the other 7 patients. Four underwent correction for RCU, 7 for UPJO, 1 for reflux, and 1 ureterocele puncture. Conclusion: The fish-hook sign is a rare conflicting radiological finding that can be encountered in imaging studies. This uncommon finding needs confirmation or exclusion of a possible RCU as missed cases manifested after failed pyeloplasty or ureteroneocystostomy were reported. Radiological evaluation (by US or cross-sectional studies) while there is a stent in the ureter is the most satisfactory radiological technique to confirm or exclude an RCU. Alternatively, being aware of a possible RCU and performing a more extensive dissection may be necessary during surgery to confirm or exclude it. If available, laparoscopy may provide this goal in a minimally invasive manner with superior visualization.

ClotCatcher: a novel natural language model to accurately adjudicate venous thromboembolism from radiology reports

IntroductionAccurate identification of venous thromboembolism (VTE) is critical to develop replicable epidemiological studies and rigorous predictions models. Traditionally, VTE studies have relied on international classification of diseases (ICD) codes which are inaccurate – leading to misclassification bias. Here, we developed ClotCatcher, a novel deep learning model that uses natural language processing to detect VTE from radiology reports.MethodsRadiology reports to detect VTE were obtained from patients admitted to Emory University Hospital (EUH) and Grady Memorial Hospital (GMH). Data augmentation was performed using the Google PEGASUS paraphraser. This data was then used to fine-tune ClotCatcher, a novel deep learning model. ClotCatcher was validated on both the EUH dataset alone and GMH dataset alone.ResultsThe dataset contained 1358 studies from EUH and 915 studies from GMH (n = 2273). The dataset contained 1506 ultrasound studies with 528 (35.1%) studies positive for VTE, and 767 CT studies with 91 (11.9%) positive for VTE. When validated on the EUH dataset, ClotCatcher performed best (AUC = 0.980) when trained on both EUH and GMH dataset without paraphrasing. When validated on the GMH dataset, ClotCatcher performed best (AUC = 0.995) when trained on both EUH and GMH dataset with paraphrasing.ConclusionClotCatcher, a novel deep learning model with data augmentation rapidly and accurately adjudicated the presence of VTE from radiology reports. Applying ClotCatcher to large databases would allow for rapid and accurate adjudication of incident VTE. This would reduce misclassification bias and form the foundation for future studies to estimate individual risk for patient to develop incident VTE.

Evaluation of ultrasound as diagnostic tool in patients with clinical features suggestive of carpal tunnel syndrome in comparison to nerve conduction studies: Study protocol for a diagnostic testing study.

Carpal Tunnel Syndrome (CTS) is the most common compressive neuropathy, accounting for 90% of all neuropathies. Its prevalence ranges from 3.8%-7.8% in the population. The gold standard for its diagnosis is the neurophysiological study (85% sensitivity and 95% specificity), with the disadvantage of being invasive, complex and expensive, which means an increase in cost and time for the diagnosis of the disease. The main objective of this diagnostic test evaluation study is to investigate the value of ultrasound in the diagnosis of CTS, and among the secondary objectives, to establish the ultrasound parameters that are predictors of CTS in comparison with neurophysiological studies, attempting to standardize a protocol and reference values that determine the presence or absence of CTS. Prospective, cross-sectional study. The reference test with which we compared the ultrasound is the neurophysiological test (NPT). Patients will come consecutively from the Neurophysiology Department of the Virgen Macarena Hospital, with clinical suspicion of CTS and fulfilling the inclusion/exclusion criteria. To calculate the sample size (EPIDAT program) we proposed a sensitivity of 78% and specificity of 87% with a confidence level of 95%, requiring 438 patients (264 NPT positive, 174 NPT negative). We followed an ultrasound study protocol that included the ultrasound variables: cross-sectional area at the entrance and exit of the tunnel, range of nerve thinning, wrist-forearm index, flexor retinaculum bulging, power Doppler uptake and the existence of adjacent wrists or masses. We propose a timeline for the study to be performed between 2020 and 2023. Finally, we propose a cost-effectiveness analysis. Ultrasound not only allows to objectify the alterations of the median nerve but also the underlying pathological mechanisms in CTS. A multitude of ultrasound parameters have been described that should be regarded in syndrome's study, among which we included the cross-sectional area, the range of nerve thinning, the wrist-forearm index, flexor retinaculum bulging, power Doppler uptake and assessment of anatomical alterations. The use of ultrasound as a diagnostic tool in CTS has many advantages for both doctors and the patients, as it is a non-invasive, convenient, and fast tool increasingly accessible to professionals. Trials registry number: NCT05556278.

The HFA PEFF diagnostic algorithm poorly correlates with invasive LV filling pressure in HF PEF

Abstract Background Heart failure with preserved ejection fraction (HFPEF) patients typically have elevated LV filling pressures, whether at rest and/or on exercise. In 2020, the HFA-ESC proposed a process to detect HFPEF called HFA–PEFF diagnostic algorithm, which has not been validated against invasive right heart catheterization (RHC). Purpose The purpose of this work was to compare this algorithm against LV filling pressures invasively calculated. Methods PH-HF registry enrolled 663 patients with HF from which 276 had preserved ejection fraction with and without pulmonary hypertension explored at 11 French centres between 2011 and 2021. Patients meeting the 2021 ESC definition of heart failure underwent both RHC at steady state under optimal medical therapy and a complete ultrasound study within 24 hours. From 4 domains, the HFA–PEFF score was calculated with the use of major and minor criteria. A score ≥5 points is considered to be diagnostic, while between 2-4, further investigations are requested. The score was compared to pulmonary wedge pressure. Results Mean age age was 69,5±12.4 years, 35,1% male, mean left ventricular ejection fraction was 62,5±7,2%. Wedge pressure was 20,5±7,5 mm Hg and HFA-PEFF score averaged 4,9±1,2 with 181 patients (66%) above 5. Sensitivity and specificity were 68% and 46%, respectively. The figure 1 demonstrates the misclassification of patients, particularly those with high HFA-PEFF score but normal left ventricular filling pressure (lower right), that are badly categorized. Conclusions The HFA-PEFF score poorly correlates with invasive measurement of LV filling pressure. Patients with high score may require more careful attention as they are often misclassified.Figure 1

Abstract 13091: Chronic Thromboembolic Pulmonary Hypertension Associated With Prolonged Use of Combined Oral Contraceptives in a 27-Year-Old Woman: A Successful Case of Pulmonary Endarterectomy

Introduction: Chronic thromboembolic pulmonary hypertension (CTEPH) is associated with venous thromboembolism (VTE); however, in half of the cases, no prior deep vein thrombosis is ever found. The use of combined oral contraceptives (COCs) is a known risk factor for VTE. We present the case of a young woman with CTEPH in whom timely diagnosis and intervention prevented irreversible pulmonary hypertension (PH). Case Presentation: A 27-year-old woman with 10-year use of COCs presented with progressive dyspnea for 3 weeks. The ECG showed right ventricular systolic overload and right atrial enlargement. Laboratory tests showed elevated pro-BNP and D-dimer. TTE showed right atrium and right ventricle (RV) enlargement and elevated right ventricular systolic pressure (RVSP) of 83 mmHg. The ventilation/perfusion scintigraphy showed mismatched segmental perfusion defects in both lung fields with greater involvement of the left lung, and oral anticoagulation was started. Lower extremity venous ultrasound and hypercoagulability studies were normal. CTPA revealed filling defects in the left main pulmonary artery and bilateral segmental branches. After 3 months of anticoagulation, she persisted in NYHA class III, and right heart catheterization showed mean PAP of 38 mmHg, PCWP of 8 mmHg, and PVR of 9 WU, confirming CTEPH. Due to unavailability in Peru, she was referred to a US center for pulmonary endarterectomy (PEA). After a successful intervention, she improved clinically with a reduction in RVSP to 34 mmHg. This case highlights the importance of rapid intervention in CTEPH even in situations where optimal treatment is not readily available. Conclusion: CTEPH may be associated with the prolonged use of COCs in young women. Timely intervention can reverse PH and prevent RV remodeling. Unfortunately, Peru does not have a PEA center and not every case will undergo treatment. We call for the training of local surgeons to ensure fair and equitable access for the population.

Thanatophoric dysplasia in nonadherent to antenatal care in low middle income country: a rare case reports.

Thanatophoric dysplasia is a rare, fatal, and sporadic form of skeletal dysplasia caused by a mutation in fibroblast growth factor receptor 3 (FGFR3). It is characterized by a conical thorax, platyspondyly (flat vertebral bodies), and macrocephaly. This disorder can be diagnosed antenatally as early as 13 weeks of gestation. The authors reported a case of thanatophoric dysplasia on USG in a 19 year old young consanguineous female in her second trimester of pregnancy. Ultrasound examination showed a clover leaf-shaped skull, a widened anterior fontanel, a coarse and edematous face, a flattened nasal bridge, a short neck, a low set of ears, shortening of both upper and lower limbs with short fingers, bowed thighs and legs, and a relatively narrow thorax. Lung hypoplasia, polyhydramnios, and hydrops in affected individuals lead to a poor prognosis. Hence, timely intervention should be done to avoid a poor prognosis. However, a mix of sonographic, genetic, histological, and autopsy studies are applied to make the most accurate diagnosis. The authors reported this case due to the rarity of this condition and the need for a systematic and multidisciplinary approach.

A Narrative Review of Advancements in Understanding and Treating Varicose Veins.

Chronic venous disease, with varicose veins as its archetypal manifestation, stands as a pervasive and intricate health quandary, encompassing a vast array of contributing factors. Age, genetics, obesity, pregnancy, and prolonged immobility weave a complex tapestry, underscoring the omnipresence of this ailment. Its societal and economic footprint is undeniably formidable, as diverse classifications underscore its multifaceted character. The intricate interplay of chronic venous disease with diabetes mellitus and neuropathy compounds the challenge, fostering soaring healthcare expenditures and a palpable erosion of quality of life, particularly among women harboring cardiometabolic risk factors. Despite research shedding light on heightened susceptibility within certain demographics, the enigmatic determinants orchestrating the transition from mild to severe chronic venous disease continue to elude us. Varicose veins, marked by the presence of dilated and tortuous subcutaneous vessels, precipitate both physical discomfort and cosmetic concerns, frequently necessitating meticulous clinical evaluation coupled with ultrasound studies to secure a precise diagnosis. Treatment strategies are strategically crafted to ameliorate distressing symptoms, enhance aesthetic concerns, and forestall potential complications. Nevertheless, the prognostication of chronic venous disease remains ensconced in a degree of ambiguity, hinting at the vast terrain yet to be charted in this medical domain. The quest to fathom the intricacies of this condition uncovers an ever-evolving panorama where conservative interventions play an indispensable role in managing mild cases, while interventional procedures like endovenous laser ablation and sclerotherapy step onto the stage for patients grappling with severe symptoms, thus treading the fine line between efficacy and invasiveness. Moreover, a meticulous economic analysis underscores the cost-effectiveness of various therapeutic modalities, thereby bolstering the imperative of a patient-centered approach. As we navigate the labyrinthine complexities of chronic venous disease and varicose vein management, we are inexorably drawn to the pivotal role of customized treatment approaches, as well as the dynamic interplay between scientific progress, patient preferences, and therapeutic innovations in the relentless pursuit of optimized outcomes and an enhanced quality of life.

A Multimodal Ultrasound Observation Study on the Effect of Vitamin D on Uterine Fibroids in Non-menopausal Women.

It has been reported in the literature that Vitamin D can inhibit the growth of uterine fibroids, but the evaluation index is only the size of the uterine fibroids. The purpose of this study was to evaluate the effect of vitamin D on the size, hardness, and blood flow of uterine fibroids in premenopausal women by multimodal ultrasound. A total of 64 pre-menopausal women with uterine fibroids complicated vitamin D deficiency were enrolled in this study and randomly divided into two groups: the vitamin D group (n=32) which received oral vitamin D (1600 IU/ day) and the control group (n=32) without vitamin D supplementation. After three months of intervention, the mean diameter of uterine fibroids, elastic strain ratio, and blood flow grade were evaluated by multimodal ultrasound, and the clinical symptoms of the two groups were evaluated by questionnaire. The vitamin D group reported a significant increment in the serum 25-hydroxyvitamin D (P < 0.001). In addition, there were significant reductions in the mean diameter, and elastic strain ratio of uterine fibroids (P =.043 and P =.038, respectively), but no significant difference in the blood flow grade of uterine fibroids was observed (P =.272). Compared with the control group, the vitamin D group achieved significant relief in dysmenorrhea and frequent urination, as well as improvement in heavy menstrual bleeding. The application of multimodal ultrasound provides a more comprehensive theoretical basis for vitamin on uterine fibroids. Vitamin D can effectively reduce the size of uterine fibroids in pre-menopausal women and relieve their symptoms. It is highly likely to be a promising, safe, effective, and inexpensive drug for uterine fibroids, which has good application value and promotion prospects.

Clinical scale for assessing the risks of complications in pediatric cardiac surgery patients

Mortality-based comorbidity indices worldwide have had mixed success in adjusting for risk in children. Despite numerous attempts to predict perioperative mortality and complications after cardiac surgery in adults, an objective model for predicting risks in children has not been developed. The purpose of the study: to analyze the frequency and structure of comorbidities and conditions in children with cardiac surgical pathology in order to assess the perioperative risks of complications and implement their own prognostic risk scale. &#x0D; Materials and methods. A comprehensive analysis of five hundred cardiac surgery patients hospitalized in the Department of Cardiac Surgery for the period of 2017–2023 was carried out, and there was studied the autopsy material of 350 patients with congenital heart defects according to the pathoanatomical bureau. Patients underwent standard research methods: echocardiography, chest X-ray, neurosonography and abdominal ultrasound, clinical and laboratory studies, blood for IUI, for procalcitonin, immunogram, angiocardiography, CT and MRI according to indications, bacteriological studies of smears, plain radiography of the abdominal cavity in the standard positions, trepanobiopsy, and genetic studies according to indications. &#x0D; Results. A classification of common comorbidities in pediatric cardiac surgery patients is presented and a stratification scale of comorbidity is developed. A high incidence of comorbidity in cardiac surgery patients (70%) and its impact on preoperative and postoperative management, timing of surgery and the development of complications, and financial risks are shown. It is shown that, along with the Aristotle cardiac surgical scale, the surgical risk assessment based on comorbidity developed by us improves the awareness of patients’ parents about the prognosis and risks of heart and vascular surgery. &#x0D; Conclusion. Evaluation of the role of the coexistence of extracardiac congenital malformations, genetic anomalies and syndromes, metabolic diseases in cardiac surgical patients can significantly affect surgical and therapeutic strategies and outcomes. Early identification of children at high risk of complications and death through the use of different stratification scales can lead to improved treatment outcomes.

The role of ultrasound in predicting non-invasive ventilation outcomes: a systematic review.

To systematically review and compare ultrasonographic methods and their utility in predicting non-invasive ventilation (NIV) outcomes. A systematic review was performed using the PubMed, Medline, Embase, and Cochrane databases from January 2015 to March 2023. The search terms included the following: ultrasound, diaphragm, lung, prediction, non-invasive, ventilation, and outcomes. The inclusion criteria were prospective cohort studies on adult patients requiring non-invasive ventilation in the emergency department or inpatient setting. Fifteen studies were analyzed, which comprised of 1,307 patients (n = 942 for lung ultrasound score studies; n = 365 patients for diaphragm dysfunction studies). Lung ultrasound scores (LUS) greater than 18 were associated with NIV failure with a sensitivity 62-90.5% and specificity 60-91.9%. Similarly, a diaphragm thickening fraction (DTF) of less than 20% was also associated with NIV failure with a sensitivity 80-84.6% and specificity 76.3-91.5%. Predicting NIV failure can be difficult by routine initial clinical impression and diagnostic work up. This systematic review emphasizes the importance of using lung and diaphragm ultrasound, in particular the lung ultrasound score and diaphragm thickening fraction respectively, to accurately predict NIV failure, including the need for ICU-level of care, requiring invasive mechanical ventilation, and resulting in higher rates of mortality.