Use Of Ultrasound Scanning Research Articles

A prospective study of the association between varicoceles and semen quality in men with infertility

BackgroundMale infertility is a global problem, and varicoceles are a common and treatable cause of male infertility. This study prospectively evaluated the effects of varicoceles on the fertility status and potential among Nigerian men. The consequences of the presence, location, and grades of varicoceles on the fertility status of infertile men with varicoceles were determined using a Doppler scrotal ultrasound scan and their seminal fluid parameters.MethodsOne hundred infertile males with clinical varicoceles (study group) and 100 infertile males without varicocele (control group) were recruited. Varicoceles were confirmed/excluded and graded with an ultrasound scan in each subject. They also all had a seminal fluid analysis to measure their fertility potential. The findings were compared and correlated in the two groups.ResultsMost subjects in the study group (67%) had bilateral varicoceles, 31% had isolated left varicoceles, and only 2% had isolated right varicoceles. The majority of the participants (61%) in the study group had secondary infertility, while the majority (63%) in the control group had primary infertility (p = 0.001). There were significant increases in the prevalence of azoospermia (p = 0.008) and oligospermia (p = 0.030) with the higher grades of left varicoceles.ConclusionBilateral varicoceles were significantly present in males with infertility in the study group. Varicoceles were more common in males with secondary infertility, and higher grades of varicoceles were significantly more associated with azoospermia and severe oligospermia. We recommend the routine use of ultrasound scans to diagnose varicoceles for the optimal management of infertile male patients.

Familial cross-testicular ectopia: a clinical case report

Cross or transverse testicular ectopia is a rare congenital condition of the reproductive system that involves the migration of a testicle into the opposite inguinal canal, along with the presence of an inguinal hernia on the same side as the ectopic testicle. In the modern literature, there are discussions about diagnostic issues, particularly the use of ultrasound scanning and magnetic resonance imaging to diagnose this condition. However, it is the results of laparoscopic examination that determine the most accurate criteria for surgical treatment. Many publications discuss the choice of surgical tactics, including separate transabdominal orchiopexy, with or without laparoscopic assistance; transeptal orchiopexy on both sides of the scrotum; and rare cases of orchiopexy for both testicles on one side of the scrotum. Ultimately, the choice of surgery depends on the individual characteristics and needs of the patient, and the surgeon should make the decision based on these factors. The article describes, for the first time, a case of familial testicular ectopia with bilateral inguinal hernia in siblings who underwent surgery using laparoscopic assistance. The method used was single-trocar laparoscopic access with transscrotal transeptal orchiopexy and simultaneous bilateral puncture of the inguinal ring and suture. During the long-term follow-up period (50 and 20 months after surgery) in both siblings, there were no signs of malformation or atrophy of the gonads.

Is pelvic ultrasound useful in the clinical assessment and management of women with right iliac fossa pain? A single-centre retrospective study.

Acute right iliac fossa (RIF) pain is a common presenting symptom in surgical patients, with a wide range of differentials, particularly in premenopausal females. This study explores ultrasound usage in the management of women aged 16-55 years presenting with RIF pain. A total of 1,082 patients who presented to a tertiary hospital over 12 months were included. Data were collected from patients' electronic records, including initial clinical impression, imaging, management, operative findings, histology and subsequent hospital attendances within 6 weeks and within 6 months. Following clinical assessment, 607 (56%) of patients underwent an ultrasound. Of these, 280 (25.9%) patients received no radiological imaging on initial presentation, and 252 (42%) had pathology identified on ultrasound. The most common finding was an ovarian cyst, closely followed by unexplained free pelvic fluid. Of the 607 patients scanned, 29 (4.8%) had an ultrasound diagnosis of appendicitis; 254 of 1,082 (23.5%) patients underwent operative management. Of the 254 patients who had surgery, 179 (70.5%) had preoperative imaging. Of the 29 (11.4%) cases where the intraoperative finding was gynaecological, 15 (51.7%) cases had not had any preoperative imaging. The negative appendicectomy rate was 21.3% (45/211). Of the 45 patients who had a histologically normal appendix, 22 (48.9%) had not had any previous imaging. Ultrasound had a specificity of 78% for diagnosing appendicitis. In patients who underwent operative management, a negative finding or finding not requiring surgical management was associated with no preoperative imaging. This supports the use of ultrasound scans as an adjunct in a multimodal approach to the assessment of women presenting with RIF pain.

Routine use of ultrasound imaging to diagnose skier’s thumb. Results from a first-aid orthopedic department in an Italian ski resort

Damage to the ulnar collateral ligament (UCL) of the thumb’s metacarpophalangeal joint (TMPJ) can result in severe functional impairment: correct diagnosis is critical to ensure the appropriate treatment to restore full TMPJ function. In an acute phase, clinical findings and X-rays alone are not reliable enough for a precise diagnosis: ultrasound scan (USS) may represent a fast, inexpensive and sensitive technique to improve the diagnosis of thumb trauma in emergency department. The purpose of this study is to assess if the introduction of the routine use of USS in clinical practice to evaluate thumb trauma could aid in diagnosis and treatment of this common injury. During eight winter seasons (2012-19), we dealt with 2553 injuries of the TMCJ at our emergency department. During the first period (2012-2015), the diagnosis of TMCJ injuries relied on clinical examination and X-rays; in the second study period (2016-2019) the diagnosis of all thumb traumas were based on clinical examination, radiographs, and ultrasound. Patients affected by type I and II lesions were conservatively treated by the application of a thumb spica plaster for three weeks, while in type III injuries for a period of one month. Type IV UCL lesions underwent surgery through a phalanx tunneling and anchor fixation technique followed by 5-weeks of immobilization in a thumb spica plaster cast. Both groups were followed up either clinically or as phone consultations for foreign patients. In the period 2012-2015, we classified 27% of TMPJ lesions as type I, 19% as type II, 15% as type III, and 27% as type IV lesions. The remaining 12% represented a fracture variant (type V). USS identified 30% type I, 21% type II, 18% type III, and 19% type IV lesions, the latter with a positive so called tadpole sign (14) (247 pts.); the remaining 12% of patients presented a fracture variant. During the first study period, the diagnosis of TMPJ injuries made exclusively by clinical examination and X-ray studies, lead to a high number of false positive type IV diagnoses that were not confirmed during surgery (13%). The introduction of USS imaging during the second period led to a detection of almost all (> 98%) type IV lesions intra-operatively, thereby avoiding unnecessary surgery, possible complications, rehabilitation, and recovery. Our work demonstrates that the routine use of USS imaging in the study of thumb UCL injuries improves the diagnostic sensitivity of clinical findings in a low cost, quick and feasible manner. USS can lead to a significant decrease in the number of misdiagnoses as previously demonstrated by other studies. USS is likely to improve patient collaboration and could potentially supplant stress-test radiography which can be painful and potentially risky in some patients.

Abscess of the piriformis muscle in a 14-year old boy - a transrectal drainage method under transabdominal ultrasound guidance

IntroductionSciatica is a common reason for a medical consultation throughout the population. Piriformis pyomyositis is a rare cause of these symptoms. Its probable etiology is transient bacteraemia co-existing temporarily with a muscle injury.AimThe aim of the study is to present a method for treating a piriformis muscle abscess with transabdominal ultrasound-guided transrectal drainage.Case studyA 14-year old boy, previously healthy, was admitted with symptoms of sciatica that appeared after intense physical exertion. Laboratory tests revealed elevated inflammatory parameters and positive blood culture results indicating Staphylococcus aureus. Antibiotic therapy was implemented. MRI of the small pelvis revealed a forming abscess of the right piriformis muscle. On day 6 of the antibiotic therapy, in the absence of improvement, it was decided to perform transrectal drainage under ultrasound guidance. Clinical improvement was achieved, and the inflammatory parameters decreased.Results and discussionCo-existence of sciatica symptoms and signs of an inflammatory condition should prompt the consideration of piriformis pyomyositis. The mainstay of treatment for piriformis pyomyositis is antibiotic therapy. The abscess formation reduces its effectiveness, which necessitates surgical intervention. The authors present the application of transrectal drainage under transabdominal ultrasound guidance as the shortest route of abscess evacuation.ConclusionsTransrectal drainage of piriformis pyomyositis is an effective and safe method. Concomitant use of ultrasound scans reduces the patient’s exposure to ionising radiation. However, the widespread use of this method requires more in-depth research and broadened experience.

Preprocedural ultrasound for neuraxial blockade in nonobstetric patients. Should it be considered as a standard of care?

Preprocedural ultrasound for neuraxial blockade in nonobstetric patients. Should it be considered as a standard of care?

1050 An Audit of the Management of Acute Epididymo-orchitis

Abstract Aim To evaluate the management of patients referred to our Surgical Assessment Unit presenting with acute epididymo-orchitis. Concordance with local antibiotic guidance, the use of ultrasound scanning, and microbiological testing were all assessed over a one-year period. Method All adult patients presenting with acute epididymo-orchitis in 2019 were identified retrospectively using ICD-10 codes and the choice of antibiotic used was compared to our own local guidance. The use of ultrasound scanning was recorded and whether this led to a change in diagnosis or management. Use of microbiological investigations including urine microscopy & culture and sexual health screening were assessed. Results After exclusion criteria were applied 64 cases were identified with an average age of 55 (16-88). Concordance with local antibiotic guidance was low with 3/64 patients receiving antibiotics in-line with local guidance. This was predominantly due to the frequent use of Ciprofloxacin (49/64) which is not advised locally, however is in-keeping with guidance from organisations such as EAU/BASHH. Ultrasound was used acutely in 46/64 patients with 28/46 showing evidence of epididymo-orchitis, 15/46 were normal and 1/46 confirmed an abscess which required surgical drainage. All normal scans were still treated with antibiotics based on clinical findings. 25/64 had a urine sample sent for MC&S and uptake of sexual health screening was low. Conclusions Urologists should be aware of differences between local prescribing policy and broader guidance from relevant organisations. Epididymo-orchitis remains a clinical diagnosis and ultrasound should be reserved acutely for diagnostic uncertainty, unwell patients, or failure to improve.

How to set up a regional specialist referral service for Placenta Accreta Spectrum (PAS) disorders?

There has been an approximately fivefold increase in the incidence of placenta accreta spectrum (PAS) disorders during the last 30 years, believed to be secondary to increasing Caesarean section rates. PAS disorder is associated with significantly increased maternal morbidity and mortality worldwide. Antenatal diagnosis by foetal medicine teams that have a special expertise to diagnose PAS disorder by the use of ultrasound scan, and a dedicated, highly specialised multidisciplinary team (MDT) comprising surgeons who are skilled in complex pelvic surgery and obstetric anaesthetists who have an expertise in high-risk obstetric anaesthesia, supported by haematology, operating theatre, interventional radiology, midwifery, neonatology, high-dependency and intensive care teams have been recommended to improve maternal and perinatal outcomes. Setting up a specialist MDT regional referral service, PAS involves collaboration with all stakeholders, ensuring appropriate funding, developing MDT care pathways, continuously auditing patient outcomes and disseminating knowledge through research, innovation, education and publications.

The Impact of a Simplified Hydrostatic Bypass Flow Technique on Error Detection during Surgical Limb Revascularization.

Technical errors have an impact on the results of surgical lower limb revascularization. Use of ultrasound scanning or angiography on the operating table is inconvenient and, in case of angiography, carries a certain risk of radiation and contrast exposure. A simpler method of screening for errors is required. This study assessed the accuracy of a new simple hydrostatic bypass flow technique during surgical limb revascularization. In all, 885 patients were included in the retrospective study. All were treated for Chronic Limb-Threatening Ischemia (CLTI) with a femoropopliteal bypass. Preoperatively, the radiological Vascular Surgery/International Society of Cardiovascular Surgery (SVS/ISCVS) score was used to assess the complexity of the anatomical changes. The surgeon made a subjective runoff assessment for every surgery. In 267 cases, the hydrostatic bypass flow (HBF) technique was used, and, in 66 cases, a digital subtraction angiography (DSA) was used. In each case, a postoperative Doppler ultrasound (DUS) examination was performed following the HBF. Good early results were achieved in 89.46%, and 154 errors (17.4%) were detected (85 were detected on the operating table, including 57 technical errors). Independent efficacy in error detection was proven with a postoperative Doppler examination (Aera Under Curve (AUC) = 0.89; criterion mid-graft peak systolic velocity (PSV) <24 cm/s, p = 0.00001) and hydrostatic bypass flow (AUC = 0.71, criterion HBF < 53 mL/min, p = 0.00001) during surgery. The hydrostatic bypass flow technique is an effective intraoperative screening method in bypass surgery. Algorithmic use of HBF, DSA if needed, and DUS postoperatively improves the outcome. HBF sufficiently reduced the need for on-table angiography.

Evaluation of IoT Capability in Detecting Kidney Malformations on Ultrasound Imaging System

Background: Remote radiology is used in the remote areas today to diagnose scanned ultrasound data due to the lack of trained radiologists. The availability of online radiography experts and the availability of portable ultrasound communication facilities are some of the issues in remote radiology for the use of ultrasound scanning in telehealth. Objectives: The purpose of the present study was to investigate the ability of IoT to detect computer abnormalities of kidneys on ultrasound imaging. Methods: The study was conducted systematically by searching the Scopus, Science Direct, PubMed, and Google Scholar search engine databases using the PRISMA flow diagram to select articles. The English language input and the time range of 2013 to 2018 were used for the search. There were about 123 articles, 42 of which were included in the study. Then, the qualitative evaluation of articles was done based on the 12-question CASP diagnostic test study checklist and finally, 15 articles related to the study were selected. Results: The results of studies showed that IoT was more acceptable and satisfactory than other imaging modalities and had a significant role in the diagnosis of kidney disease, in terms of both cost and time. Conclusion: The results of the study showed that in the absence of a radiologist in the therapeutic environment or the patient’s inability to visit the hospital or clinic, using IoT is the best way to solve the mentioned problems.

Aiming for complete safety of first trocar insertion of laparoscopic surgery: usefulness of preoperative ultrasonography of umbilical region.

Vascular or intestinal injuries at the time of the first trocar insertion can cause serious complications during laparoscopic surgeries. In this study, we evaluate the usefulness of ultrasound scans of the umbilical region as well as intraumbilical conditions to help prevent serious complications. The subjects included 430 cases who underwent laparoscopic gynecologic surgeries. The umbilical ultrasound scan was performed after tracheal intubation to observe the intestinal movements associated with respiration. Structures of the umbilical region as well as peristalsis and the movement of the intestinal tract were observed. Then, the thickness of the subcutaneous fat (between the umbilical skin surface and the rectus fascia) and the preperitoneal fat (between the rectus fascia and the peritoneum) were measured. The relationship between body mass index (BMI), insertion time of the first trocar and ultrasound measurements were analyzed. The anatomical structures of the umbilical region (the subcutaneous tissue and the preperitoneal fat) were clearly observed in all cases. The BMI score had a significant relationship with subcutaneous fat thickness (r = 0.547), but remarkably not with preperitoneal fat thickness (r = 0.174). There was no significant relationship between BMI and insertion time. However, insertion time of the first trocar had a significant relationship with preperitoneal fat thickness (r = 0.534). Preoperative ultrasonography of the umbilical region is asimple process, and it is helpful inpreventing serious complications caused by the first trocar insertion. We have found that preperitoneal fat thickness seems to be an important factor in predicting the potential difficulty of the first trocar insertion.

Training and experiences in ultrasound and focused echo among post graduate trainees in anaesthesia, critical care and emergency medicine

Introduction: Use of ultrasound scans (USS) has rapidly expanded and it is being used by many non-radiology specialists in fields such as anaesthesia, critical care and emergency medicine. There are well established guidelines on the use of USS in these specialities. Training in USS should be appropriately supervised and should lead to an accreditation to ensure the quality and to minimize mistakes. Study objectives: We evaluated the training, experience, and confidence in USS/Focused ECHO among anaesthesia, critical care and emergency medicine trainees. Methods: An online survey was sent to the post-graduate trainees in anaesthesia, critical care and emergency medicine who wereundergoing local training in Sri Lanka during August-September 2017. No ethical approval was required, and participation was entirely voluntary with responses kept anonymised. Results: Out of 69 responders, only 25 (36.2%) had a dedicated training programme in USS/F-ECHO. Trainees gained their knowledge mainly from their seniors (52.1%), workshops (46.3%) and local educational supervisor (37.6%). Only 9 (13.1%) maintained a log book. Majority were always or often confident in performing vascular USS. However, trainees were least confident in F-ECHO. Conclusions: There should be a dedicated USS and focused ECHO programme and a curriculum for the trainees in anaesthesia, critical care and emergency medicine and they should be encouraged to maintain a log book of their training experiences.

A 3-Year Study of Predictive Factors for Positive and Negative Appendicectomies

ABSTRACTBackground: Early and accurate identification or exclusion of acute appendicitis is the key to avoid the morbidity of delayed treatment for true appendicitis or unnecessary appendicectomy, respectively. We aim (i) to identify potential predictive factors for positive and negative appendicectomies; and (ii) to analyse the use of ultrasound scans (US) and computed tomography (CT) scans for acute appendicitis. Materials and Methods: All appendicectomies that took place at our hospital from the 1st of January 2013 to the 31st of December 2015 were retrospectively recorded. Test results of potential predictive factors of acute appendicitis were recorded. Statistical analysis was performed using Fisher exact test, logistic regression analysis, sensitivity, specificity, and positive and negative predictive values calculation. Results: 208 patients were included in this study. 184 patients had histologically proven acute appendicitis. The other 24 patients had either nonappendicitis pathology or normal appendix. Logistic regression analysis showed statistically significant associations between appendicitis and white cell count, neutrophil count, C-reactive protein, and bilirubin. Neutrophil count was the test with the highest sensitivity and negative predictive values, whereas bilirubin was the test with the highest specificity and positive predictive values (PPV). US and CT scans had high sensitivity and PPV for diagnosing appendicitis. Conclusions: No single test was sufficient to diagnose or exclude acute appendicitis by itself. Combining tests with high sensitivity (abnormal neutrophil count, and US and CT scans) and high specificity (raised bilirubin) may predict acute appendicitis more accurately.

ELECTROSURGICAL AND ULTRASOUND DISSECTION AND COAGULATION TISSUE EFFECT FEATURES DURING OPERATIONS ON STOMACH AND INTESTINES

The work is devoted to the problem of reducing intra- and postoperative complications in patients with surgical gastrointestinal tract pathology. The aim of the study is to comprehensively investigate electrosurgical and ultrasound dissection and coagulation features to prevent intra- and postoperative complications, improve the results of treatment of patients with surgical gastrointestinal tract pathology. The study included experimental and clinical parts. The use of ultrasound scanning in the main group of patients revealed significant advantages of this method compared to MES. This device allowed not only to carry out the dissection of the gastrointestinal tract organs, but also to mobilize them, thereby simplifying and speeding up the operation. Intersection of vessels of both omenta, small and large intestines mesentery vessels was carried out with alternating regimes of coagulation and cutting, while ligating only large blood vessels. The study showed that thanks to the use of ultrasound scanning it was possible to reduce the number of postoperative complications from 16.2% to 6.7%, postoperative mortality decreased from 6.11% to 1.55%, and postoperative bed-day decreased from an average of 17.5+ 3.75 to 12.5 + 2.58, which in the complex allowed to improve the parameters of treatment and rehabilitation of patients.

Evaluation of Dorsal Midline Discolorations with Physical Examination and Ultrasound

To assess the association between dorsal midline skin discolorations, tethering of the spinal cord, and the role of ultrasound screening of these stigmata, focusing specifically on vascular lesions. We conducted a prospective observational study of infants <6 months of age with suspicious dorsal midline skin stigmata. All were evaluated by physical examination and ultrasound scan. A subset also had a magnetic resonance imaging examination. We examined the association between small, red-shaded discolorations and their respective imaging findings. Among 100 cases with discolorations of vascular types, either isolated or combined with low-risk simple dimples or deviated gluteal folds, none had clinically significant pathologic findings requiring surgical intervention. Midline lumbar discolorations are more benign than previously thought. Despite the very low association of this group of stigmata with surgical implications, we still recommend the routine use of ultrasound scanning.

The management of symptomatic simple renal cysts in children

Abstract Renal cysts are being increasingly diagnosed in children due to the increasing use of ultrasound scanning (USS). Most are asymptomatic, but they may present with flank pain, haematuria, palpable mass or even urinary tract infections or urosepsis. There is a wide range of management options for symptomatic cysts, the choice of which depends on patient factors as well as surgeons' preference. In this case series, we present our experience in the management of five cases of symptomatic renal cysts which have been treated in varying ways, ranging from minimally invasive procedures to drain and sclerose the cysts, to more invasive procedures to excise and deroof the cysts.

EP27.08: Feasibility study on the use of ultrasound scan for the insertion of postpartum contraceptive device (PPIUD) following vaginal delivery

EP27.08: Feasibility study on the use of ultrasound scan for the insertion of postpartum contraceptive device (PPIUD) following vaginal delivery

Resuming the obsolete term "small head": when microcephaly occurs without cognitive impairment.

Microcephaly is defined as a head circumference measurement of 2 or 3 standard deviations below the mean for age and sex. However, distinguishing the value of -2 or -3 standard deviations as a cutoff is relevant in the clinical practice, since the limit of -3 standard deviations is more frequently associated with cognitive impairment. The use of ultrasound scans in pregnancy has allowed the identification of subjects with a measurement of the head circumference at the limit of the cutoff for gestational age, but who do not subsequently show cognitive delay. The same is true for newborns with a -2 to -3 standard deviations cutoff, and without anomalous clinical signs, for which a cognitive delay is not easily diagnosed. In this case, to define an infant as being affected by microcephaly (with a prognosis usually recognized as harmful) may be unnecessarily distressful for parents or caregivers. In the cases mentioned, resuming the word "small head" instead of microcephaly to define such subjects could be more appropriate and more appreciated.

Managing and feeding the pregnant ewe

Issues with nutritional management in late pregnancy can have potentially harmful effects on ewe body condition, ewe survival, ewe health, perinatal lamb mortality and lamb growth rates. Use of ultrasound scanning to determine fetal number and body condition scoring are key practical tools that can be used to feed pregnant ewes appropriately. Blood sampling for the assessment of nutritional status 3–4 weeks prior to the start of lambing can be used to rapidly identify problems, and correct them before they start to impact on flock profitability.

Thyroid cytology–histology correlation using the RCPath terminology for thyroid cytology reporting

AimsThe Royal College of Pathologists Thy1–5 thyroid cytology guidance, 2009, second edition 2016, invites audits of its use. This report documents the experience of one department, assessing percentage usage of...