US-guided Group Research Articles

Role of Pocket Ultrasound in Assessing Intravascular Volume to Guide Management in Heart Failure Patients with Renal Impairment.

IntroductionInpatient management of patients with heart failure (HF) and renal impairment is challenging. We sought to evaluate the role of pocket ultrasound (US)-guided management of this patient population.MethodsWe prospectively included patients with acute HF exacerbation and renal impairment admitted to the HF service in our University hospital from January 2017 to August 2018. We compared the outcomes of patients who received US-guided management with those who received standard of care management. The main study outcome was the change in estimated glomerular filtration rate (eGFR). Multivariable logistic analysis was used to adjust for basic demographics and risk factors.ResultsA total of 211 patients with renal impairment presenting with acute HF exacerbation (mean age 66.8 ± 14.6 years, 41% females, 62% white) were enrolled in the study, of whom 69 (32.7%) received US-guided management and 151 (68%) received standard of care management. The change in the eGFR was significantly lower in US-guided group than in the group receiving standard of care (1.1 ± 4.3% vs. − 11.15 ± 2.9%; p = 0.04). No significant difference was observed between the patient groups in the length of stay (6.45 ± 0.38 vs. 6.44 ± 0.56; days; p = 0.98) and in the 30-day HF readmission rate (hazard ratio 1.27, 95% confidence interval 0.28–5.6; p = 0.75).ConclusionUltrasound-guided management of patients admitted with acute HF exacerbation and renal impairment may be beneficial in preserving kidney function. US provides a simple easily accessible tool to guide the management of patients with HF.

Ultrasound guidance versus conventional technique for radial artery puncture in septic shock patients: A pilot study.

Arterial puncture, for obtaining an analysis of blood gas, is an interventional procedure often performed in emergency departments and intensive care units. This study compares the ultrasound (US) guided method with the conventional digital palpation method in radial artery puncture (RAP) for blood gas analysis in septic shock patients. This is a prospective, single-centre study. Septic shock patients over 18 years of age who needed a RAP sample for blood gas analysis were included. Patients with local infection or trauma at the puncture site, arteriovenous fistula, vascular graft, coagulopathy, a positive Allen test, or did not want to participate were excluded. Patients were randomized into two groups and RAP was obtained with either the US-guided method or the conventional method. The main outcomes were success at first entry, the number of attempts before success, and the time to success. The 50 eligible patients were randomized into two groups. First entry success rate for the US-guided group and the conventional group was 80% and 42%, respectively. The number of attempts before success and time to success was significantly higher in the conventional group. The US-guided method has been found to be more successful in terms of first entry success, the number of attempts before success, and the time to success when compared to the conventional method.

Can Ultrasound Replace CT in Peripheral Lung Biopsy Guidance: A Comparative Study

Abstract Background: Selecting the most effective guidance method for peripheral lung biopsy is a priority for interventional radiologists. The clinical trials comparing efficacy and safety of ultrasound (US) and computerized tomography (CT) as biopsy-guiding modalities for peripheral lung biopsy tech-niques are limited in the literature, and most of them are retrospective. Aim of Study: To compare the efficacy and safety of biopsy guided by US versus CT for lung lesions with pleural contact. Patients and Methods: This is a prospective comparative study; included 40 patients underwent image-guided biopsy at Nasser Institute Hospital, Cairo, Egypt. From June 2018 to May 2020. Lesion size, location, length of pleural contact, number of needle passes, and number of tissues cores, proce-dure times, complications, and histopathology reports were documented for each biopsy. Statistical analysis using Fisher's exact test and t-test, (Alfa-point=0.05). Results: US-guided group had significantly fewer com-plications; 15% (3/20) versus 40% (8/20) for CT-guided group; (p=0.036). Fewer number of needles passes were required for US-guided biopsies (mean, 2.7 passes ±0.8 (SD) than for CT-guided biopsies (mean, 3.4 passes ±1.2 (SD); p=0.04). Proce-dural times were significantly shorter in the US-guidance group, with a mean procedure time of 6.3 minutes ±2.2 (SD) compared to 21.8 minutes ±5.7 (SD) for CT-guided biopsies; (p=0.0001). Conclusion: US guidance should be thought of as a primary tool for guidance of peripheral lung lesions' biopsy, because it is superior to CT in safety and time-saving with comparable accuracy.

Ultrasound-guided hydrostatic enema reduction of intussusception and confirmation with single abdominal radiograph in children.

To detect false-positive reduction results after ultrasound (US)-guided hydrostatic intussusception reduction, we have incorporated water-soluble contrast material to the enema fluid and confirmed the reduction with a single abdominal radiograph. We present the results of the combined imaging method for the reduction of intussusception in children. The records of the patients who were treated for intussusception were analyzed retrospectively. Patients were divided into two groups: a US-guided reduction group and a US-guided reduction plus radiographic control group. The patient characteristics, symptoms, treatment methods, outcomes, and complications and follow-up were analyzed. A total of 164 intussusception episodes were treated in 153 patients. Hydrostatic reduction of intussusception was performed in 59 patients in the US-guided group and in 94 patients in the US-guided plus radiographic control group. Recurrence rate in the US-guided group was 15.7%, vs 3.5% in the US-guided plus radiography group (P = .029). In the US-guided plus radiographic control group, 5 (5.3%) false positive reductions under US guidance were determined by abdominal radiography. In order to decrease false positive reduction rate and early recurrence, US-guided intussusception reduction can be performed with saline plus water-soluble contrast material and confirmation of reduction obtained with a single direct abdominal radiograph.

Accuracy of non-guided versus ultrasound-guided injections in cervical muscles: a cadaver study.

The col-cap concept encouraged neurologists to inject a large group of muscles in the treatment of cervical dystonia. This includes deep muscles such as the obliquus capitis inferior or the semispinalis capitis, and muscles close to vascular or neurological structures such as scalene muscles. Our aim was to determine the accuracy of injections in cervical muscles using ultrasonography (US) or palpation of anatomical landmarks. A mix of paint, gelatin and iodized contrast agent was injected in nine pairs of cervical muscles of human cadavers, according to two injection techniques: US-guided and non-guided. The dye was localized on 1cm-thick, frozen slices. A total of 102 muscles was injected in the US-guided group (n = 8). The global accuracy was 88.2%. The lowest accuracy was in the OCI (41.7%); trying to avoid the vertebral artery, injections were too medial. A total of 54 muscles was injected in the non-guided group (n = 3). The global accuracy was 48.0%; moreover, some dye was found in four blood vessels. The embalming process produced texture changes, making difficult the palpation of bony landmarks. Our results indicate that US-guided injections are more accurate than non-guided injections in most cervical muscles.

Ultrasound Guidance and Risk for Central Venous Catheter-Related Infections in the Intensive Care Unit: A Post Hoc Analysis of Individual Data of 3 Multicenter Randomized Trials.

Ultrasound (US) guidance is frequently used in critically ill patients for central venous catheter (CVC) insertion. The effect of US on infectious risk remains controversial, and randomized controlled trials (RCTs) have assessed mainly noninfectious complications. This study assessed infectious risk associated with catheters inserted with US guidance vs use of anatomical landmarks. We used individual data from 3 large RCTs for which a prospective, high-quality data collection was performed. Adult patients were recruited in various intensive care units (ICUs) in France as soon as they required short-term CVC insertion. We applied marginal Cox models with inverse probability weighting to estimate the effect of US-guided insertion on catheter-related bloodstream infections (CRBSIs, primary outcome) and major catheter-related infections (MCRIs, secondary outcome).We also evaluated insertion site colonization at catheter removal. Our post hoc analysis included 4636 patients and 5502 catheters inserted in 2088 jugular, 1733 femoral, and 1681 subclavian veins, in 19 ICUs. US guidance was used for 2147 catheter insertions. Among jugular and femoral CVCs and after weighting, we found an association between US and CRBSI (hazard ratio [HR], 2.21 [95% confidence interval {CI}, 1.17-4.16]; P = .014) and between US and MCRI (HR, 1.55 [95% CI, 1.01-2.38]; P = .045). Catheter insertion site colonization at removal was more common in the US-guided group (P = .0045) among jugular and femoral CVCs in situ for ≤7 days (n = 606). In prospectively collected data in which catheters were not randomized to insertion by US or anatomical landmarks, US guidance was associated with increased risk of infection.

Assessment of patient satisfaction, functionality, and quality of life after ultrasound-guided knee intervention: a prospective study.

The use of ultrasound (US) guidance for the injection and aspiration of joints has improved accuracy. The aim of this study was to determine if differences exist in the level of patient satisfaction, functionality, and the quality of life in adult patients receiving US-guided (USG) versus landmark-guided (LMG) knee procedures. This prospective, randomized study enrolled 41 patients undergoing knee procedures to USG or LMG groups. visual analogue scale (VAS) for pain, knee injury and osteoarthritis outcome score (KOOS), and patient satisfaction score on a 5-point Likert scale were measured pre-procedure, immediate (< 30min) and late (4-6weeks) post-procedure. Thirty-seven patients were included in the final analysis after exclusion of 4 dropouts (18 in LMG arm, 19 in USG arm). Compared with LMG group, patients in the USG group had significantly better improvement in pain immediately (VAS 1.63 ± 1.6 (95% CI 0.91, 2.35) vs 4.05 ± 2.5 (95% CI 2.90, 4.62), p = 0.001) and later post-procedure (VAS 2.68 ± 2.0 (95% CI 1.78, 3.58) vs 6.38 ± 3.8 (95% CI 4.62, 8.14) p = 0.004) and satisfaction scores immediately (4.89 ± 0.3 (95% CI 4.76, 5.02) vs 4.11 ± 1.0 (95% CI 3.65, 4.57), p = 0.002) as well as delayed post-procedure (4.52 ± 0.9 (95% CI 4.12, 4.92) vs 3.38 ± 1.6 (95% CI 2.64, 4.12), p = 0.028). USG knee procedures were associated with higher patient satisfaction, both immediately after the procedure and after 4-6weeks compared with LMG knee procedures. Key Points •This prospective study is the first one to look at patient satisfaction as an outcome measure after intra-articular steroids knee injections. •USG (US-guided) knee procedures were associated with higher patient satisfaction compared with LMG (landmark-guided) knee procedures. •USG knee procedures resulted in greater improvement in symptoms, pain, and quality of life scales after 4-6weeks compared with LMG knee procedures.

Comparing the effectiveness of ultrasound guided versus blind genicular nerve block on pain, muscle strength with isokinetic device, physical function and quality of life in chronic knee osteoarthritis: a prospective randomized controlled study.

BackgroundThe genicular nerve block (GNB) is demonstrated from several reports to alleviate pain and improve knee functionality in patients with chronic knee osteoarthritis (OA). Ultrasound (US)-guided GNB has been the most used imaging method. This study aimed to compare the effectiveness of US-guided versus blind GNB in the treatment of knee OA.MethodsThis prospective, randomized clinical trial included patients with knee OA based on American College of Rheumatology diagnostic criteria. The patients were evaluated for clinical and dynamometer parameters at the baseline, 4 weeks after treatment, and 12 weeks after treatment. The patients underwent blind injection or US-guided injection.ResultsWhen compared with the baseline, both groups showed significant improvement in pain, physical function, and quality of life parameters. Significant differences were observed between the groups for clinical parameters (30-second chair stand test, 6-minute walk test) in favor of the US-guided group. On the other hand, blind injection was more significantly effective on some parameters of the Nottingham Health Profile. There wasn’t any significant improvement in isokinetic muscle strength for either group.ConclusionsThis study demonstrated that both US-guided and blind GNB, in the treatment of knee OA, were effective in reducing symptoms and improving physical function. GNB wasn’t an effective treatment for isokinetic muscle function. US-guided injections may yield more effective clinical results than blind injections.

Bedside ultrasound in the emergency department for reduction and radial manipulation of distal radial fractures.

Distal radial fracture reduction is a common procedure in the ED. Previous studies have suggested that ultrasound (US)-guided reduction improves outcomes for patients who undergo manipulation and reduction of distal radial fractures in the ED. We aimed to investigate this with the first randomised controlled trial looking at US-guided distal radial fracture reduction. Our primary objective was to compare rates of operative intervention between the study groups. Rate of re-manipulation was compared as a secondary outcome. ED patients were prospectively randomised to either standard landmark guided or US-guided closed reduction of distal radial fractures. The closed reductions were performed by senior emergency clinicians and the USs were performed by emergency physicians experienced in point-of-care US. Following reduction patients were managed equally and referred to the local orthopaedic service who were blinded to whether US was used to assist manipulation or not. This service decided on the need for re-manipulation or operative intervention. One hundred patients were enrolled and randomised equally into each cohort. We found no statistically significant difference between the control and intervention groups of our study. In the control group, 46% of patients underwent operative fixation, compared to 48% in the US-guided group (P = 0.36). Our secondary intervention of re-manipulation in the ED or theatre following the initial reduction showed no statistically significant difference between the groups (P = 1.0). US-guided reduction of dorsally displaced, distal radius fractures in the ED setting, did not improve measured clinical outcomes.

Diagnostic accuracy of preoperative palpation- versus ultrasound-guided thyroid fine needle aspiration cytology: an observational study

ABSTRACT Background Thyroid fine needle aspiration (FNA) is the mainstay for diagnosis of malignancy, and is an integral part of current thyroid nodule assessment. The present study analyzes the diagnostic accuracy of palpation-directed versus ultrasound guided fine-needle aspiration in patients who underwent surgery for thyroid nodules. Methods A retrospective chart review of all consecutive patients who had FNA biopsy (palpation or ultrasound guided) of thyroid nodules and underwent thyroid gland surgery between 1998 and 2014 was conducted. The FNA findings of the palpation-guided and ultrasound-guided groups were compared for baseline characteristics. Moreover, the diagnostic accuracy of FNA findings and surgical histopathology results were analyzed. Results A total of 1174 patients were included in the study with a mean age of 46.3 ± 11.7 years and the majority were females (75.5%). Among the study population, 392 (33.4%) patients underwent US-guided FNA; 570 (48.6%) had palpation-guided FNA in clinic and no FNA was done in 212 (18%) cases. Patients underwent US-guided FNA were more likely to have suspicion of malignancy (p = 0.001), and had indeterminate findings (p = 0.001). On the other hand, palpation-guided FNA group had significantly higher frequency of benign cytology (p = 0.001). With respect to the suspicion for malignancy as well as malignancy, the US-guided group had a similar diagnostic accuracy in comparison to the palpation group. The proportion of malignancy finding on US-guided FNA (8.9%) was higher than the palpation-guided FNA (6.4%) that had been confirmed on postoperative histopathological examination (p = 0.95). Conclusion The present study demonstrates higher sensitivity of US-guided thyroid FNA biopsies over palpation-guided FNA for the suspicion of malignancy; however, the accuracy is comparable. Moreover, both groups showed more postoperative malignancy in the benign and unsatisfactory categories than predicted in the Bethesda system. Further prospective studies are needed to underpin a realistic correlation between FNA and final histopathology reports.

Intraoperative ultrasound-guided lumpectomy versus wire-guided excision for nonpalpable breast cancer.

ObjectiveThis study was designed to compare the margin clearance and re-excision rates of ultrasound (US)- and wire-guided excision in a large number of patients with nonpalpable breast cancer.MethodsIn total, 520 women who were histologically diagnosed with nonpalpable breast cancer were recruited in this study. All nonpalpable lesions were visible by US. The patients were randomly divided into two groups: those who underwent wire-guided breast-conserving surgery (BCS) and those who underwent US-guided BCS. Re-excision rates and positive surgical margins were recorded.ResultsA total of 262 patients underwent US-guided excision and 258 patients underwent wire-guided excision. No differences were found in tumor or patient characteristics. The positive margin rate was 4.6% in the US-guided group and 19.4% in the wire-guided group with a significant difference. Age, menopausal status, excision volume, histological grade, and tumor type significantly influenced the positive surgical margin rate. The intraoperative re-excision rate was significantly lower in the US-guided group than wire-guided group (11.1% vs. 24.0%, respectively).ConclusionsUS-guided BCS seems to be more effective than wire-guided BCS for treatment of nonpalpable breast cancers in terms of the margin clearance and re-excision rates. Patients can avoid the discomfort caused by preoperative wire placement.

Carpal Tunnel Syndrome Treatment Using Ultrasound-Guided Versus Landmark-Guided Corticosteroid Injection: A Randomized Prospective Trial

Background: Carpal tunnel syndrome (CTS) is the most prevalent entrapment neuropathy occurring due to increased pressure in the carpal tunnel. Objectives: The study aimed to evaluate the degree of symptom improvement, safety, and the change in electrophysiological findings after ultrasound (US)-guided versus Landmark (LM)-guided local steroid injection for the treatment of CTS. Methods: This randomized clinical trial recruited 52 patients with moderate or moderate-to-severe CTS. The subjects were randomly assigned to US-guided or LM-guided corticosteroid injection groups and received 40 mg methylprednisolone. After four weeks and 12 weeks of treatment, the patients were evaluated using the Boston questionnaire and electrophysiological parameters were determined. Results: All variables, including symptom/functional scores and electrophysiological findings, improved significantly in both groups after four weeks (all P 0.05). Conclusions: The symptom severity, functional status, and all electrophysiological parameters improved significantly in both US-guided and LM-guided corticosteroid injection groups and generally, no statistically significant difference was observed between both methods.

The Impact of Hand Carried Ultrasound on the Management of Acute Heart Failure with Chronic Kidney Disease

Purpose Inpatient management of patients with heart failure (HF) and chronic kidney disease (CKD) is challenging. We studied the role of hand carried ultrasound (US) in directing clinical care. Methods We conducted a prospective non-randomized study of patients admitted with acute heart failure with chronic kidney disease between January, 2017 and August of 2018. Patients were divided into two groups; US-guided management group and standard of care group. Multivariate linear regression analyses were used to compare length of stay and percent change in eGFR. Multivariate Cox proportional hazard regression analysis was used to compare HF readmission between the two groups. Models were adjusted for age, sex, race, BMI, hypertension and diabetes. Results We included 221 patients (mean age 67±14, 42% females, 69% HFrEF and 31% HFpEF). 71 (32%) patients underwent US-guided management and 150 (68%) had standard of care management. The US-guided group had less reduction in eGFR (-1%, 95% CI: -9.1, 7.1) compared to standard of care group (-11.2%, 95% CI: -16.7, 5.7, p=0.04). No significant difference in the length of stay was observed (6.4±1.2 days vs 6.6±0.8, p=0.7). Finally, no significant difference in HF readmission between the two groups (HR 0.9, 95% CI: 0.51, 1.6, p=0.73) (Figure). Conclusion US-guided management of patients admitted with acute HF exacerbation and chronic kidney disease may be beneficial in preserving kidney function. Multi-center studies with longer follow up time are needed to evaluate the impact of hand carried US on hospital readmissions.

Efficacy and safety of ultrasound (US) guided percutaneous needle biopsy for peripheral lung or pleural lesion: comparison with computed tomography (CT) guided needle biopsy.

Ultrasound (US)-guided percutaneous needle biopsy is a useful diagnostic technique with short examination time and real-time monitoring at the bedside. However, there are only a few studies that report on thoracic lesions, whereas the computed tomography (CT)-guided biopsy is well established. There is also limited data comparing US- and CT-guided biopsy. We aimed to clarify the efficacy and safety of US-guided biopsy for thoracic lesions adjacent to the chest wall. We retrospectively enrolled consecutive patients who underwent US- or CT-guided percutaneous biopsies for thoracic lesions adjacent to the chest wall between April 2012 and December 2017. Clinical characteristics, lesion size, lesion-pleura contact arc length (LPCAL), diagnostic rate, and complications were compared between the 2 groups. This study enrolled 61 US-guided and 70 CT-guided biopsies. No significant difference was found in age or sex. The lesion size and LPCAL in the US-guided group were significantly larger than those in the CT-guided group (P<0.0001). The diagnostic rate was marginally higher in the US-guided group (93.4%) than in the CT-guided group (84.3%) (P=0.101). When the median cut-off of the LPCAL was defined as 40 mm in all cases, the diagnostic rate for lesion size >40 mm was significantly higher in the US-guided group than in the CT-guided group (P=0.009). Complication rates were significantly lower in the US-guided group (3.3%) than in the CT-guided group (24.3%) (P<0.001). US-guided percutaneous needle biopsy for thoracic lesions adjacent to the chest wall is a feasible technique compared with CT-guided biopsy because of its higher diagnostic rate with a longer LPCAL and reduced complications.

Accuracy and efficacy of ultrasound-guided pes anserinus bursa injection.

To compare the accuracy and efficacy of ultrasound (US)-guided versus blind pes anserinus bursa (PAB) injection in patients with pes anserinus tendinobursitis (PATB). Forty-seven patients with clinically diagnosed PATB were randomly assigned to a US-guided group or a blind group of steroid injection. In the US-guided group, the injectate was delivered under sonographic visualization. In the blind group, the conventional technique was used without any visual guidance. After the PAB injection, the injectate location was identified using US in both groups. Treatment effects were assessed using the visual analogue scale (VAS) of knee tenderness. Outcomes were measured before, 1 week and 4 weeks after the injection. Both groups showed pain relieving at 1 week and 4 weeks after the injection. The injectate in the US guided group were found to be accurately at the PAB in all subjects, whereas blind group were found to be just in 4 of 22 subjects. The US-guided group showed significant improvement of both of VAS scores compared to the blind group at 1 week and 4 weeks after the injection (P < .05). Our results suggest that US-guided PAB injection is more accurate and effective than blind injection in patients with PATB.

A propensity score matching study between ultrasound-guided percutaneous microwave ablation and conventional thyroidectomy for benign thyroid nodules treatment

Purpose: Our study aims to compare ultrasound (US)-guided percutaneous microwave ablation (PMWA) and conventional thyroidectomy in benign thyroid nodules (BTN) treatment.Materials and methods: From December 2015 to December 2017, a total of 280 patients with at least one benign thyroid nodule were studied retrospectively, including 156 patients treated with US-guided PMWA and 124 patients treated with conventional thyroidectomy. Propensity score matching was performed to decrease the confounding bias due to retrospective assignment and to balance the pre-operation data of the two groups. A total of 106 pairs (1:1) was created. The operation time, intraoperative blood loss, postoperative hospitalization time, serum levels of interleukin (IL-6), C-reactive protein (CRP), tumor necrosis factor-α (TNF-α) 12 h after operation and postoperative complications incidence rate were compared between the two groups. The volume reduction ratio was calculated in the US-guided PMWA group at 1, 3, 6 and 12 months after treatment. Registration number: ChiCTR1800015531.Results: Significant differences were found between the two groups in levels of CRP, IL-6, and TNF-α after the operation； there were significant differences between the two groups in intraoperative blood loss, operation time, postoperative hospitalization time and postoperative complications rate. The volume reduction ratio at 1, 3, 6 and 12 months after treatment was 15.2%, 47.6%, 67.2% and 79.6%, respectively.Conclusions: Our study demonstrated that US-guided PMWA is characterized by a definite therapeutic success rate, good cosmetic effect, slight injury and rapid recovery. US-guided PMWA is an effective technique for benign thyroid nodules treatment．

Comparison of Ultrasound Guidance and Conventional Method for Common Femoral Artery Cannulation: A Prospective Study of 939 Patients.

Many techniques, methods and closure devices have been developed in order to reduce vascular complications that occur after coronary and peripheral interventions. The aim of the present study was to identify which method i.e. ultrasound (US) guidance or traditional access technique, is better for common femoral artery cannulation. The study included 939 patients, who were assigned to either the US-guided cannulation group (n = 449) or manual technique group (n = 490). The procedure time, first pass success rate, inadvertent venous puncture rate and complications developing within the first 7 days of the procedure were compared between the two groups. No differences were found between the two groups regarding basic characteristics and antiplatelet and anticoagulant therapy administered during and up to 24 hours before the procedure. Arterial puncture attempts (p < 0.001), inadvertent venous entry (p = 0.02), and total procedure time (p = 0.012) were significantly lower in the US-guided group compared to the manual technique group. Furthermore, the first pass success rate was significantly higher in the US-guided group compared to the manual technique group (p < 0.001). The US-guided group had significantly lower pain levels (p < 0.001), hematomas (p < 0.001) and arteriovenous fistulas (p = 0.011) than the manual technique group. US-guided common femoral artery cannulation yields both higher access rates at first attempt and a shorter access time, and lower pain and complication rates.

Evaluating degree of symptom improvement, safety and the change of electrophysiological findings after ultrasound versus landmark guided steroid injection in treatment of carpal tunnel syndrome

To evaluate the degree of symptom improvement, safety and the change of electrophysiological findings after ultrasound (US)-guided versus landmark (LM)-guided local steroid injection in treatment of carpal tunnel syndrome (CTS). Fifty-two patients with moderate or moderate to severe CTS were recruited in this study. The subjects were randomly assigned into each US-guided or LM-guided steroid injection group and received 40 mg methylprednisolone. After 4 weeks and 12 weeks, the patients were evaluated using Boston questionnaire and electrophysiologic parameters. All variables including symptom/functional scores and electrophysiological findings improved significantly in both groups after 4 weeks (all P < 0.05) except CMAP amplitude in LM-guided group. However, LM-guided group showed a regress with all variables after the 12-week period compared with the 4-week period, these improvements persisted at the week 12 after treatment in the US-guided group ( P < 0.05) except Functional Status Scale (FSS) and Sensory Nerve Action Potential (SNAP). The improvement in the Compound Muscle Action Potential (CMAP) amplitude in the US-guided group at the week 12 was higher than in the LM-guided group ( P < 0.05); however, SNAP amplitude and SNAP Nerve Conduction Velocity (NCV) had improved significantly in the LM-guided group. Significant differences were not observed between groups with respect to Symptom Severity Score (SSS), FSS, SNAP latency, and CMAP latency in 4 or 12 weeks after treatment ( P > 0.05). symptom severity, functional status and all electrophysiologic parameters improved significantly in both groups and generally no statistical significant difference was observed between two groups.

Ultrasound guidance versus anatomical landmark approach for femoral artery access in coronary angiography: A randomized controlled trial and a meta-analysis.

The objective was to assess the effect of ultrasound (US)-guidance compared to the anatomical landmark (AL) approach in patients requiring femoral artery (FA) access for coronary angiography/percutaneous coronary interventions (PCI). US-guidance has been proposed as a strategy to optimize FA access, potentially leading to decreased vascular complications. Patients requiring FA access for coronary angiography/PCI were randomized to the US-guided or AL approaches. The primary endpoint was a composite of immediate procedural vascular outcomes, and access-site outcomes at day one. Results were subsequently pooled in a study-level meta-analysis of randomized trials comparing US-guided FA access to another strategy. A total of 129 patients were randomized (64 US-guided group; 65 AL group). The primary endpoint occurred in 30 patients (47%) with US, and in 39 patients (62%) with AL (P = 0.09). Four additional studies met the inclusion criteria and were included in the meta-analysis (1553 patients). Following data pooling, bleeding events (OR = 0.41; 95%CI 0.20-0.83; P = 0.01), venipunctures (OR = 0.18; 95%CI: 0.11-0.29; P < 0.0001), and multiple puncture attempts (OR = 0.24; 95%CI: 0.19-0.31; P < 0.0001) were significantly improved with US-guidance, but not successful common FA cannulation (OR = 0.84; 95%CI: 0.60-1.17; P = 0.29). Our study did not show significant benefits for the use of US to guide arterial femoral access compared to the anatomical landmark approach, but pooled analysis of five randomized trials showed decreased rates of bleeding events and venipunctures, and improved first-pass success. The clinical impact of these findings is uncertain, and do not warrant a systematic use of US-guidance in this clinical setting.

Acoustic puncture assist device versus ultrasound imaging technique for thoracic epidural space identification in obese patients

Introduction Newer techniques have been used lately such as the ultrasonography (US) and the acoustic puncture assist device (APAD) to identify the epidural space (EDS). The difference between using these techniques in obese patients has not been studied enough yet. The primary aim of this study is to evaluate the ease of placement of thoracic epidural catheter in obese patients using either APAD versus US imaging assisted technique. The secondary aim is to compare the incidence of complications between both techniques. Patients and methods The institutional review board at the University of Alexandria approved the study protocol. One hundred obese patients (BMI >30 kg/m2) were randomly enrolled into one of the two study groups. The placement of thoracic epidural catheter was done using an US-assisted technique in cases of group I, while epidural catheter was inserted into the thoracic EDS using APAD in group II patients. Results First attempt success rate for EDS localization was higher in group II (APAD) as compared with group I (US group) (83 vs. 79%), but there was no significant statistical difference between both groups (P=0.461). Mean time for EDS localization was statistically significantly longer in group I (US-guided group) than in group II (APAD) (78.44±23.6 vs. 58.78±22.2 s; P Conclusion The previous findings of the shorter time of EDS localization and more patient comfort in APAD-guided epidural analgesia than those of US-guided technique has ended in the conclusion that the use of APAD for thoracic epidural anesthesia in obese patients is a better choice than using US.