The results of supraclavicular brachial plexus neurolysis (without first rib resection) in management of post-traumatic "thoracic outlet syndrome".

PubMed

Dellon, A L

1993-01-01

This study evaluated the effectiveness of a supraclavicular brachial plexus neurolysis, without a first rib resection, in relieving the symptom complex traditionally termed "thoracic outlet syndrome." The hypothesis to be tested was that patients with a history of trauma may sustain stretch-type injury and subsequent scarring in and about the brachial plexus which is left untreated during transaxillary first rib resection. This prospective study included 14 patients who each had a neurolysis of the five roots and three trunks of the brachial plexus, plus an anterior scalenectomy through a supraclavicular approach. The results were determined on 11 patients with a mean follow-up of 26.4 months. The results of surgery were five excellent (45 percent), five good (45 percent) and one who failed to improve (10 percent). It is concluded that, with a history of trauma, the symptom complex commonly referred to as "thoracic outlet syndrome" may be primarily due to entrapment of the brachial plexus at sites proximal to the interval between the first rib and the clavicle. It is suggested that: 1) the term "brachial plexus compression" best describes the syndrome without directing the surgeon to remove any one specific anatomic structure and 2) the supraclavicular approach permits excellent surgical exposure of the compressed neurovascular structures. An unexpected observation was the formation of the lower trunk from C8 and T1 proximal to the first rib in the majority of these patients.

Ultrasound confirmation of central venous catheter position via a right supraclavicular fossa view using a microconvex probe: an observational pilot study.

PubMed

Kim, Se-Chan; Heinze, Ingo; Schmiedel, Alexandra; Baumgarten, Georg; Knuefermann, Pascal; Hoeft, Andreas; Weber, Stefan

2015-01-01

Visualisation of a central venous catheter (CVC) with ultrasound is restricted to the internal jugular vein (IJV). CVC tip position is confirmed by chest radiography, intracardiac ECG or transoesophageal/transthoracic echocardiography (TEE/TTE). We explored the feasibility, safety and accuracy of a right supraclavicular view for visualisation of the lower superior vena cava (SVC) and the right pulmonary artery (RPA) as an ultrasound landmark for real-time ultrasound-guided CVC tip positioning via the right IJV. Ultrasound was then compared with chest radiography. An observational pilot study. Bonn, University Hospital, Germany. From July to October 2012. Fifty-one patients scheduled for elective surgery. Reasons for exclusion were emergency procedure, thrombosis or small IJV lumen and mechanical obstacle to guidewire advancement. In 48 patients, CVC insertion via the right IJV and progress of the guidewire into the lower SVC were continuously guided by an ultrasound transducer in the right supraclavicular fossa. CVC tip position in lower SVC and tip-to-carina distance were assessed with chest radiography as a reference method and additionally with TEE in cardiothoracic patients. Insertion depth was compared with intracardiac ECG and body-height formula. The guidewire tip was seen in the SVC of all patients. In four patients, the tip was not visible in proximity of the RPA. Chest radiography and TEE confirmed CVC tip position in the lower SVC (zone A). Bland-Altman analysis revealed an average of difference of 1.6 cm for ultrasound versus ECG (95% limit of agreement -2 to 5 cm) and an average of difference of 1 cm for ultrasound versus body-height formula (95% limit of agreement -2 to 4 cm). Ultrasound via a right supraclavicular view is a feasible, well tolerated and accurate approach and should be further explored. Chest radiography confirmed CVC position in the lower SVC.

Ultrasound-guided approach for axillary brachial plexus, femoral nerve, and sciatic nerve blocks in dogs.

PubMed

Campoy, Luis; Bezuidenhout, Abraham J; Gleed, Robin D; Martin-Flores, Manuel; Raw, Robert M; Santare, Carrie L; Jay, Ariane R; Wang, Annie L

2010-03-01

To describe an ultrasound-guided technique and the anatomical basis for three clinically useful nerve blocks in dogs. Prospective experimental trial. Four hound-cross dogs aged 2 +/- 0 years (mean +/- SD) weighing 30 +/- 5 kg and four Beagles aged 2 +/- 0 years and weighing 8.5 +/- 0.5 kg. Axillary brachial plexus, femoral, and sciatic combined ultrasound/electrolocation-guided nerve blocks were performed sequentially and bilaterally using a lidocaine solution mixed with methylene blue. Sciatic nerve blocks were not performed in the hounds. After the blocks, the dogs were euthanatized and each relevant site dissected. Axillary brachial plexus block Landmark blood vessels and the roots of the brachial plexus were identified by ultrasound in all eight dogs. Anatomical examination confirmed the relationship between the four ventral nerve roots (C6, C7, C8, and T1) and the axillary vessels. Three roots (C7, C8, and T1) were adequately stained bilaterally in all dogs. Femoral nerve block Landmark blood vessels (femoral artery and femoral vein), the femoral and saphenous nerves and the medial portion of the rectus femoris muscle were identified by ultrasound in all dogs. Anatomical examination confirmed the relationship between the femoral vessels, femoral nerve, and the rectus femoris muscle. The femoral nerves were adequately stained bilaterally in all dogs. Sciatic nerve block. Ultrasound landmarks (semimembranosus muscle, the fascia of the biceps femoris muscle and the sciatic nerve) could be identified in all of the dogs. In the four Beagles, anatomical examination confirmed the relationship between the biceps femoris muscle, the semimembranosus muscle, and the sciatic nerve. In the Beagles, all but one of the sciatic nerves were stained adequately. Ultrasound-guided needle insertion is an accurate method for depositing local anesthetic for axillary brachial plexus, femoral, and sciatic nerve blocks.

Phrenic palsy and analgesic quality of continuous supraclavicular vs. interscalene plexus blocks after shoulder surgery.

PubMed

Wiesmann, T; Feldmann, C; Müller, H H; Nentwig, L; Beermann, A; El-Zayat, B F; Zoremba, M; Wulf, H; Steinfeldt, T

2016-09-01

Hemidiaphragmatic palsy is a common consequence of the interscalene brachial plexus block. It occurs less commonly with the supraclavicular approach. Register data suggest that the analgesic quality of a supraclavicular blockade is sufficient for arthroscopic shoulder surgery, although data on the post-operative analgesic effect are lacking. After approval by the ethics committee, patients having arthroscopic shoulder surgery under general anaesthesia were randomized to receive a continuous interscalene or supraclavicular blockade. Phrenic nerve function was evaluated through ultrasound examination of the diaphragm in combination with spirometry. Pain scores at rest and activity etc. were determined before catheter insertion, during observation in the post- anaesthesia care unit (PACU) and on post-operative day 1 (POD1). The initial application of 10 ml of ropivacaine 0.2% was followed by continuous application of 4 ml of ropivacaine 0.2%, plus a patient controlled analgesia (PCA) bolus of 4 ml/h. One hundred and twenty patients were randomized, of which 114 data sets were analysed. Complete hemidiaphragmatic paresis occurred in 43% of the interscalene group vs. 24% in the supraclavicular group during PACU stay. Rates of dyspnoea and hoarseness were similar. Horner's syndrome occurred in 21% of the interscalene but only 3% of the supraclavicular group on POD1. Pain scores were comparable for pain at rest and during stress at each time point. This trial showed a significantly greater incidence of phrenic nerve palsy of the interscalene group in PACU, but not on POD1. Post-operative analgesic quality was similar in both groups. Continuous supraclavicular blockade is a suitable alternative to the continuous interscalene technique. © 2016 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

Arteriolymphatic Fistula: An Unusual Cause of Spontaneous Swelling in the Left Supraclavicular Region

DOE Office of Scientific and Technical Information (OSTI.GOV)

Karuppiah Viswanathan, Ashok Mithra, E-mail: ashokmithrakv@gmail.com; Irodi, Aparna; Keshava, Shyamkumar N., E-mail: aparna-shyam@yahoo.com

2016-09-15

An abnormal fistulous communication between an artery and lymphatic system is a rare occurrence. We report a 38-year-old male presenting with sudden onset, spontaneous, pulsatile swelling in the left supraclavicular region following a recent cardiac catheterisation via right femoral arterial access. On evaluation, he was found to have a femoral arteriolymphatic fistula. He was managed conservatively with ultrasound-guided compression with complete resolution of symptoms at follow-up. This case describes a hitherto unknown complication of percutaneous vascular cannulation presenting in an unusual manner, diagnosed with Doppler Ultrasonography and CT angiography and managed effectively with a non-invasive therapeutic image-guided manoeuvre.

Ultrasound-Guided Regional Anesthesia in a Glucose-6-Phosphate Dehydrogenase (G6PD)-Deficient Geriatric Trauma Patient

PubMed Central

Födinger, Agnes M.; Kammerlander, Christian; Luger, Thomas J.

2012-01-01

Objective: Glucose-6-phosphate dehydrogenase (G6PD) deficiency is a genetic enzymatic disorder causing hemolytic anemia. Exposure to drugs is considered to be the most common cause of acute hemolysis in patients with G6PD deficiency. Experience with regional anesthesia, in particular peripheral nerve blocks, is rarely described in patients with G6PD deficiency, but is of great clinical interest. For this reason, we now report on the successful management of ultrasound-guided axillary brachial plexus block in a patient with geriatric G6PD deficiency. Case report: A female, 75-year-old geriatric trauma patient with G6PD deficiency and a fracture of the left forearm, was scheduled for osteosynthesis of the left forearm. For surgery regional anesthesia with ultrasound-guided axillary brachial plexus block with 30 mL bupivacaine 0.5% was established. Surgical operation und postoperative course were uneventful and with no signs of hemolysis. Conclusion: Ultrasound-guided axillary brachial plexus block with bupivacaine was a safe and effective technique in this patient with G6PD deficiency. Peripheral nerve block is a major analgesic approach and of great value for anesthesiologists and surgeons, especially in our aging and multimorbid society. PMID:23569708

Correlation of nerve ultrasound, electrophysiological and clinical findings in chronic inflammatory demyelinating polyneuropathy.

PubMed

Kerasnoudis, A; Pitarokoili, K; Behrendt, V; Gold, R; Yoon, M-S

2015-01-01

We present the nerve ultrasound findings in chronic inflammatory demyelinating polyneuropathy (CIDP) and examine their correlation with electrophysiology and functional disability. A total of 75 healthy controls and 48 CIDP patients underwent clinical, sonographic and electrophysiological evaluation a mean of 3.9 years(SD+/-2.7) after disease onset. Nerve ultrasound revealed statistically significant higher cross-sectional area (CSA) values of the median (P<.0001), ulnar (P<.0001), radial (P<.0001), tibial (P<.0001), fibular nerve(P<.0001) in most of the anatomic sites and brachial plexus (supraclavicular, P<.0001;interscalene space, P = .0118),when compared to controls. The electroneurography documented signs of permanent axonal loss in the majority of peripheral nerves. A correlation between sonographic and electrophysiological findings was found only between the motor conduction velocity and CSA of the tibial nerve at the ankle (r = -.451, P = .007). Neither nerve sonography nor electrophysiology correlated with functional disability. The CSA of the median nerve in carpal tunnel and the ulnar nerve in Guyon's canal correlated with disease duration (P = .036, P = .027 respectively). CIDP seems to show inhomogenous CSA enlargement in brachial plexus and peripheral nerves, with weak correlation to electrophysiological findings. Neither nerve sonography nor electrophysiology correlated with functional disability in CIDP patients. Multicenter, prospective studies are required to proof the applicability and diagnostic values of these findings. Copyright © 2014 by the American Society of Neuroimaging.

A comparative study of clonidine and dexmedetomidine as an adjunct to bupivacaine in supraclavicular brachial plexus block.

PubMed

Tripathi, Archana; Sharma, Khushboo; Somvanshi, Mukesh; Samal, Rajib Lochan

2016-01-01

Various additives are mixed with local anesthetic agents to increase the quality of block in regional anesthesia. We compared clonidine and dexmedetomidine as an adjunct to bupivacaine in supraclavicular brachial plexus block with respect to the onset and duration of sensory and motor block and duration of analgesia. Sixty American Society of Anesthesiologists Grades I and II patients scheduled for various orthopedic surgeries of the upper limb under supraclavicular brachial plexus block were divided into two equal groups in a randomized, double-blind manner. Patients were assigned randomly to one of the two groups. In Group C (n = 30), 39 ml of 0.25% bupivacaine plus 1 ml (1 μg/kg) clonidine and in Group D (n = 30), 39 ml of 0.25% bupivacaine plus 1 ml (1 μg/kg) dexmedetomidine were given. The onset and duration of sensory and motor block, duration of analgesia, and quality of anesthesia were studied in both the groups. There was no statistically significant difference in the onset of sensory and motor block in both the groups. The durations of sensory and motor block were 316.67 ± 45.21 and 372.67 ± 44.48 min, respectively, in Group C, whereas they were 502.67 ± 43.78 and 557.67 ± 38.83 min, respectively, in Group D. The duration of analgesia was 349.33 ± 42.91 min, significantly less in Group C compared to 525.33 ± 42.89 min in Group D (P < 0.001). The quality of anesthesia was significantly better in dexmedetomidine group compared to clonidine group (P < 0.001). The addition of dexmedetomidine prolongs the durations of sensory and motor block and duration of analgesia and improves the quality of anesthesia as compared with clonidine when injected with bupivacaine in supraclavicular brachial plexus block.

A randomised, controlled, double-blind trial of ultrasound-guided phrenic nerve block to prevent shoulder pain after thoracic surgery.

PubMed

Blichfeldt-Eckhardt, M R; Laursen, C B; Berg, H; Holm, J H; Hansen, L N; Ørding, H; Andersen, C; Licht, P B; Toft, P

2016-12-01

Moderate to severe ipsilateral shoulder pain is a common complaint following thoracic surgery. In this prospective, parallel-group study at Odense University Hospital, 76 patients (aged > 18 years) scheduled for lobectomy or pneumonectomy were randomised 1:1 using a computer-generated list to receive an ultrasound-guided supraclavicular phrenic nerve block with 10 ml ropivacaine or 10 ml saline (placebo) immediately following surgery. A nerve catheter was subsequently inserted and treatment continued for 3 days. The study drug was pharmaceutically pre-packed in sequentially numbered identical vials assuring that all participants, healthcare providers and data collectors were blinded. The primary outcome was the incidence of unilateral shoulder pain within the first 6 h after surgery. Pain was evaluated using a numeric rating scale. Nine of 38 patients in the ropivacaine group and 26 of 38 patients in the placebo group experienced shoulder pain during the first 6 h after surgery (absolute risk reduction 44% (95% CI 22-67%), relative risk reduction 65% (95% CI 41-80%); p = 0.00009). No major complications, including respiratory compromise or nerve injury, were observed. We conclude that ultrasound-guided supraclavicular phrenic nerve block is an effective technique for reducing the incidence of ipsilateral shoulder pain after thoracic surgery. © 2016 The Association of Anaesthetists of Great Britain and Ireland.

User-guided automated segmentation of time-series ultrasound images for measuring vasoreactivity of the brachial artery induced by flow mediation

NASA Astrophysics Data System (ADS)

Sehgal, Chandra M.; Kao, Yen H.; Cary, Ted W.; Arger, Peter H.; Mohler, Emile R.

2005-04-01

Endothelial dysfunction in response to vasoactive stimuli is closely associated with diseases such as atherosclerosis, hypertension and congestive heart failure. The current method of using ultrasound to image the brachial artery along the longitudinal axis is insensitive for measuring the small vasodilatation that occurs in response to flow mediation. The goal of this study is to overcome this limitation by using cross-sectional imaging of the brachial artery in conjunction with the User-Guided Automated Boundary Detection (UGABD) algorithm for extracting arterial boundaries. High-resolution ultrasound imaging was performed on rigid plastic tubing, on elastic rubber tubing phantoms with steady and pulsatile flow, and on the brachial artery of a healthy volunteer undergoing reactive hyperemia. The area of cross section of time-series images was analyzed by UGABD by propagating the boundary from one frame to the next. The UGABD results were compared by linear correlation with those obtained by manual tracing. UGABD measured the cross-sectional area of the phantom tubing to within 5% of the true area. The algorithm correctly detected pulsatile vasomotion in phantoms and in the brachial artery. A comparison of area measurements made using UGABD with those made by manual tracings yielded a correlation of 0.9 and 0.8 for phantoms and arteries, respectively. The peak vasodilatation due to reactive hyperemia was two orders of magnitude greater in pixel count than that measured by longitudinal imaging. Cross-sectional imaging is more sensitive than longitudinal imaging for measuring flow-mediated dilatation of brachial artery, and thus may be more suitable for evaluating endothelial dysfunction.

Nalbuphine as an adjuvant to 0.25% levobupivacaine in ultrasound-guided supraclavicular block provided prolonged sensory block and similar motor block durations (RCT).

PubMed

Abdelhamid, Bassant Mohamed; Omar, Heba

2018-05-28

Prolonged postoperative analgesia with early motor recovery for early rehabilitation is a challenge in regional block. The purpose of this study is to evaluate the effect of adding 20 mg nalbuphine to 25 ml of 0.25% levobupivacaine in supraclavicular brachial plexus block. One hundred thirty-five (135) patients scheduled for hand and forearm surgeries with supraclavicular block were randomly allocated into three equal groups. Group L received 25 ml of 0.5% levobupivacaine + 1 ml normal saline; group H received 25 ml of 0.25% levobupivacaine + 1 ml normal saline; and group N received 25 ml of 0.25% levobupivacaine + 1 ml (20 mg) nalbuphine. Onset time and duration of sensory and motor block, and time to first analgesic dose were recorded. Sensory block onset was comparable between the three groups. Motor block onset in group L and group N was comparable (13.16 ± 3.07 and 13.84 ± 3.05 min, respectively) and was shorter than that in group H (15.71 ± 2 0.91 min). Sensory block duration in group L and group N was comparable (522.22 ± 69.57 and 533.78 ± 66.03 min, respectively) and was longer than that in group H (342.67 ± 92.80 min). Motor block duration in group N and group H was comparable (272.00 ± 59.45 and 249.78 ± 66.01 min, respectively) and was shorter than that in group L (334.67 ± 57.90 min). Time to first analgesic dose was significantly longer in group N (649.78 ± 114.76 min) than that of group L and group H (575.56 ± 96.85 and 375.56 ± 84.49 min, respectively) and longer in group L when compared to group H. Adding 20 mg nalbuphine to 25 ml of 0.25% levobupivacaine in supraclavicular block provided prolonged duration of sensory block with similar duration of motor block.

Ultrasound-guided fine needle aspiration in the diagnosis of peripheral nerve sheath tumors in 4 dogs

PubMed Central

da Costa, Ronaldo C.; Parent, Joane M.; Dobson, Howard; Ruotsalo, Kristiina; Holmberg, David; Duque, M. Carolina; Poma, Roberto

2008-01-01

Ultrasound-guided fine needle aspiration was used in establishing the diagnosis in 4 cases of malignant peripheral nerve sheath tumor. Sonographic and cytologic characteristics are discussed. Because of its availability and ease of use, axillary ultrasonography with fine needle aspiration can be an initial diagnostic step for suspected brachial plexus tumors. PMID:18320983

Design and Production of an Articulating Needle Guide for Ultrasound-Guided Needle Block Manufactured With a Three-Dimensional Printer: Technical Communication.

PubMed

Bigeleisen, Paul E

2017-05-15

Needle guides may allow the practitioner to align the needle with the probe when ultrasound-guided nerve block is performed. The author's goal was to design and fabricate an inexpensive ($1.90), disposable, needle guide that could articulate over a range from 85 degrees to 0 degrees with a three-dimension printer. Three-dimensional representations of an L50, L25, and C 60 ultrasound probe (Sono Site, Bothell, WA) were created using a laser scanner. Computer-aided design software (Solid Works, Waltham, MA) was used to design a needle bracket and needle guide to attach to these probes. A three-dimensional printer was used to fabricate the needle bracket and guide with acrylonitrile polybutadiene polystyrene. An echogenic needle was held in plane with the needle guide. The author performed a supraclavicular block in a morbidly obese patient. The needle was easily visualized. Similar guides that are commercially available cost as much as $400. A knowledge of computer-aided design is necessary for this work.

Dexamethasone as a ropivacaine adjuvant for ultrasound-guided interscalene brachial plexus block: A randomized, double-blinded clinical trial.

PubMed

Sakae, Thiago Mamôru; Marchioro, Patricia; Schuelter-Trevisol, Fabiana; Trevisol, Daisson José

2017-05-01

The purpose of this study was to evaluate the effect of intravenous or perineural dexamethasone added to ropivacaine on the duration of ultrasound-guided interscalene brachial plexus blocks (BPB). Randomized clinical trial. Sixty ASA physical status I-II patients with elective shoulder arthroscopic surgeries under interscalene brachial plexus blocks were randomly allocated to receive 20ml of 0.75% ropivacaine with 1ml of isotonic saline (C group, n=20), 20ml of 0.75% ropivacaine with 1ml (4mg) of perineural dexamethasone (Dpn group, n=20), or 20ml of 0.75% ropivacaine with 1ml of isotonic saline and intravenous 4mg dexamethasone (IV) (Div group, n=20). A nerve stimulation technique with ultrasound was used in all patients. The onset time and duration of sensory blocks were assessed. Secondary outcomes were pain scores (VAS) and postoperative vomiting and nausea (PONV). The duration of the motor and sensory block was extended in group Dpn compared with group Div and group C (P<0.05). In addition, within 24h, group Dpn presented lower levels of VAS and lower incidence of PONV as compared with the other groups. Moreover, there was a significant reduction on onset time between group Dpn and the other groups. Perineural 4mg dexamethasone was more effective than intravenous in extending the duration of ropivacaine in ultrasound-guided interscalene BPB. Moreover, Dpn has significant effects on onset time, PONV, and VAS. Copyright © 2017 Elsevier Inc. All rights reserved.

Short-term Clinical Results of Manipulation Under Ultrasound-Guided Brachial Plexus Block in Patients with Idiopathic Frozen Shoulder and Diabetic Secondary Frozen Shoulder.

PubMed

Ando, Akira; Hamada, Junichiro; Hagiwara, Yoshihiro; Sekiguchi, Takuya; Koide, Masashi; Itoi, Eiji

2018-01-01

This study examined the effectiveness of manipulation under ultrasound-guided brachial plexus block in patients with recalcitrant idiopathic frozen shoulder and diabetic secondary frozen shoulder (diabetic frozen shoulder). Forty-four idiopathic frozen shoulders and 10 diabetic frozen shoulders with failed conservative treatment for at least 3 months were included in this study. The manipulation was performed under ultrasound-guided brachial plexus block and visual analogue scale, range of motion, and Constant scores were measured before manipulation and at the last follow-up examination. No major complications were observed during the procedure. Sufficient improvement was not obtained in two patients during the procedure and to avoid complications, the procedure was discontinued and subsequently arthroscopic capsular release was performed. Visual analogue scale, range of motion towards all directions, and Constant scores were significantly improved after the manipulation in both the idiopathic frozen shoulder and diabetic frozen shoulder groups, however the diabetic group showed inferior results compared with those of the idiopathic group. This manipulation was effective and shortened the duration of symptoms in most of the idiopathic and diabetic frozen shoulders without major complications during the procedure. Diabetic frozen shoulder showed inferior clinical results and difficulty in recovery in range of motion, which indicated that diabetic frozen shoulder should be discussed as a different entity.

Real-time three-dimensional ultrasound-assisted axillary plexus block defines soft tissue planes.

PubMed

Clendenen, Steven R; Riutort, Kevin; Ladlie, Beth L; Robards, Christopher; Franco, Carlo D; Greengrass, Roy A

2009-04-01

Two-dimensional (2D) ultrasound is commonly used for regional block of the axillary brachial plexus. In this technical case report, we described a real-time three-dimensional (3D) ultrasound-guided axillary block. The difference between 2D and 3D ultrasound is similar to the difference between plain radiograph and computer tomography. Unlike 2D ultrasound that captures a planar image, 3D ultrasound technology acquires a 3D volume of information that enables multiple planes of view by manipulating the image without movement of the ultrasound probe. Observation of the brachial plexus in cross-section demonstrated distinct linear hyperechoic tissue structures (loose connective tissue) that initially inhibited the flow of the local anesthesia. After completion of the injection, we were able to visualize the influence of arterial pulsation on the spread of the local anesthesia. Possible advantages of this novel technology over current 2D methods are wider image volume and the capability to manipulate the planes of the image without moving the probe.

[The plexal hand (involvement of the hand in traumatic lesions of the brachial plexus in adults)].

PubMed

Alnot, J Y; Salon, A

1993-01-01

After spontaneous recovery following brachial plexus injuries, or after nerve regeneration following nervous surgery on traumatic brachial plexus, there usually is a variable residual distal deficit involving the hand and wrist. This deficit is defined by both a functional approach, and its anatomical nervous correspondence, in order to predict which motor muscles will be available for palliative surgery, and to establish the most reasonable therapeutic plan. Total palsy of the hand will only be mentioned, whereas three main presentations of the "plexic hand" are of a greater surgical interest and will be detailed: the "wrist drop", due to C5 C6 +/- C7 supra-clavicular lesions, the hand presenting with a deficit of digit flexion, pinch and intrinsic functions, due to C8 T1 +/- C7 supra-clavicular lesions, non-standardized deficits due to infra- and retro-clavicular lesions, whose therapeutic indications and prognosis are closer to more classical trunk palsies. The review of 44 "plexic hands" after distal palliative surgery indicates the need to modify the fundamental rules of tendinous transfer surgery, and suggests new principles properly adapted to the surgery of plexic hand palsies.

Application of Ultrasound-Guided Core Biopsy to Minimal-Invasively Diagnose Supraclavicular Fossa Tumors and Minimize the Requirement of Invasive Diagnostic Surgery

PubMed Central

Chen, Chun-Nan; Lin, Che-Yi; Chi, Fan-Hsiang; Chou, Chen-Han; Hsu, Ya-Ching; Kuo, Yen-Lin; Lin, Chih-Feng; Chen, Tseng-Cheng; Wang, Cheng-Ping; Lou, Pei-Jen; Ko, Jenq-Yuh; Hsiao, Tzu-Yu; Yang, Tsung-Lin

2016-01-01

Abstract Tumors of the supraclavicular fossa (SC) is clinically challenging because of anatomical complexity and tumor pathological diversity. Because of varied diseases entities and treatment choices of SC tumors, making the accurate decision among numerous differential diagnoses is imperative. Sampling by open biopsy (OB) remains the standard procedure for pathological confirmation. However, complicated anatomical structures of SC always render surgical intervention difficult to perform. Ultrasound-guided core biopsy (USCB) is a minimally invasive and office-based procedure for tissue sampling widely applied in many diseases of head and neck. This study aims to evaluate the clinical efficacy and utility of using USCB as the sampling method of SC tumors. From 2009 to 2014, consecutive patients who presented clinical symptoms and signs of supraclavicular tumors and were scheduled to receive sampling procedures for diagnostic confirmation were recruited. The patients received USCB or OB respectively in the initial tissue sampling. The accurate diagnostic rate based on pathological results was 90.2% for USCB, and 93.6% for OB. No significant difference was noted between USCB and OB groups in terms of diagnostic accuracy and the percentage of inadequate specimens. All cases in the USCB group had the sampling procedure completed within 10 minutes, but not in the OB group. No scars larger than 1 cm were found in USCB. Only patients in the OB groups had the need to receive general anesthesia and hospitalization and had scars postoperatively. Accordingly, USCB can serve as the first-line sampling tool for SC tumors with high diagnostic accuracy, minimal invasiveness, and low medical cost. PMID:26825877

Dexmedetomidine as an adjuvant to 0.5% ropivacaine in ultrasound-guided axillary brachial plexus block.

PubMed

Koraki, E; Stachtari, C; Kapsokalyvas, I; Stergiouda, Z; Katsanevaki, A; Trikoupi, A

2018-06-01

The aim of this study was to elucidate the effect of dexmedetomidine added to ropivacaine on the onset and duration of sensory and motor block and duration of analgesia of ultrasound-guided axillary brachial plexus block. Thirty-seven ASA physical status I-II patients with elective forearm and hand surgery under ultrasound-guided axillary brachial plexus block were randomly divided into 2 groups. Patients in ropivacaine-dexmedetomidine group (group RD, n = 19) received 15 mL of 0.5% ropivacaine with 100 μg (1 mL) dexmedetomidine, and patients in ropivacaine group (group R, n = 18) received 15 mL of 0.5% ropivacaine with 1 mL of normal saline. Onset time and duration of sensory and motor block and duration of analgesia were assessed. Duration of sensory block (U-value = 35, P < .001), duration of motor block (P = .001) and duration of analgesia (P < .001) were extended in group RD compared to group R. Onset time of sensory block in group RD was significantly faster than in group R (U-value = 65.5, P = .001). Onset time of motor block showed no significant difference between the 2 groups (U-value = 116.5, P = .096). Adverse reactions were reported only in group RD (bradycardia in 2 and hypotension in 3 patients). Our study indicated that dexmedetomidine 100 μg as adjuvant on ultrasound-guided axillary plexus block significantly prolonged the duration of sensory block and analgesia, as well as accelerated the time to onset of sensory block. These results should be weighed against the increased risks of motor block prolongation, transient bradycardia and hypotension and allow for attentive optimism, only if prolonged clinical trials provide a definitive answer. © 2017 John Wiley & Sons Ltd.

Ultrasound of the Brachial Plexus.

PubMed

Griffith, James F

2018-07-01

Examination of the brachial plexus with ultrasound is efficient because it allows many parts of the brachial plexus as well as the surrounding soft tissues to be assessed with high spatial resolution. The key to performing good ultrasound of the brachial plexus is being familiar with the anatomy and the common variants. That makes it possible to concentrate solely on the ultrasound appearances free of simultaneously wondering about the anatomy. Ultrasound of the brachial plexus is particularly good for assessing nerve sheath tumor, perineural fibrosis, metastases, some inflammatory neuropathies, neuralgic amyotrophy, and posttraumatic sequalae. It is limited in the assessment of thoracic outlet syndrome and in the acute/subacute trauma setting. This review addresses the anatomy, ultrasound technique, as well as pathology of the brachial plexus from the cervical foramina to the axilla. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Ultrasound-Guided Selective Versus Conventional Block of the Medial Brachial Cutaneous and the Intercostobrachial Nerves: A Randomized Clinical Trial.

PubMed

Magazzeni, Philippe; Jochum, Denis; Iohom, Gabriella; Mekler, Gérard; Albuisson, Eliane; Bouaziz, Hervé

2018-06-13

For superficial surgery of anteromedial and posteromedial surfaces of the upper arm, the medial brachial cutaneous nerve (MBCN) and the intercostobrachial nerve (ICBN) must be selectively blocked, in addition to an axillary brachial plexus block. We compared efficacy of ultrasound-guided (USG) versus conventional block of the MBCN and the ICBN. Eighty-four patients, undergoing upper limb surgery, were randomized to receive either USG (n = 42) or conventional (n = 42) block of the MBCN and the ICBN with 1% mepivacaine. Sensory block was evaluated using light-touch on the upper and lower half of the anteromedial and posteromedial surfaces of the upper arm at 5, 10, 15, 20 minutes after nerve blocks. The primary outcome was the proportion of patients who had no sensation in all 4 regions innervated by the MBCN and the ICBN at 20 minutes. Secondary outcomes were onset time of complete anesthesia, volume of local anesthetic, tourniquet tolerance, and quality of ultrasound images. In the USG group, 37 patients (88%) had no sensation at 20 minutes in any of the 4 areas tested versus 8 patients (19%) in the conventional group (P < 0.001). When complete anesthesia was obtained, it occurred within 10 minutes in more than 90% of patients, in both groups. Mean total volumes of local anesthetic used for blocking the MBCN and the ICBN were similar in the 2 groups. Ultrasound images were of good quality in only 20 (47.6%) of 42 patients. Forty-one patients (97.6%) who received USG block were comfortable with the tourniquet versus 16 patients (38.1%) in the conventional group (P < 0.001). Ultrasound guidance improved the efficacy of the MBCN and ICBN blocks. This study was registered at ClinicalTrials.gov, identifier NCT02940847.

[Efficacy and safety of ultrasound-guided or neurostimulator-guided bilateral axillary brachial plexus block].

PubMed

Xu, C S; Zhao, X L; Zhou, H B; Qu, Z J; Yang, Q G; Wang, H J; Wang, G

2017-10-17

Objective: To explore the efficacy and safety of bilateral axillary brachial plexus block under the guidance of ultrasound or neurostimulator. Methods: From February 2012 to April 2014, 120 patients undergoing bilateral hand/forearm surgery in Beijing Jishuitan Hospital were enrolled and anaesthetized with bilateral axillary brachial plexus block. All patients were divided into two groups randomly using random number table: the ultrasound-guided group (group U, n =60) and the neurostimulator-guidedgroup (group N, n =60). The block was performed with 0.5% ropivacaine. Patients' age, sex and operation duration were recorded. Moreover, success rate, performance time, onset of sensor and motor block, performance pain, patient satisfaction degree and the incidence of related complications were also documented. Venous samples were collected at selected time points and the total and the plasma concentrations of ropivacaine were analyzed with HPLC. Results: The performance time, the onset of sensor block and the onset of motor block of group U were (8.2±1.5), (14.2± 2.2)and (24.0±3.5)min respectively, which were markedly shorter than those in group N( (14.6±3.9), (19.9±3.8), (28.8±4.2)min, respectively), and the differences were statistically significant( t =11.74, 10.09, 6.73, respectively, all P <0.01). The performance pain score of group N was (25.5± 13.2), which was obviously more serious than group U (31.7± 11.2) and a significant statistical difference was detected ( t =2.856, P <0.05). The patient satisfaction degree of group U was 95.0%, which was significantly higher than group N (83.3%) and a markedly statistical difference was detected (χ(2)=4.227, P <0.05). Fifty min after performance, the total plasma concentration of ropivacaine of group U was(1.76±0.48)mg/L, which was significantly lower than group N (1.88±0.53)mg/L and a significant statistical difference was detected ( t =2.43, P <0.05), while no significant differences were detected at the other time points between two groups ( P >0.05). No analgesic was superadded and no other anesthesia methods were applied. No complications were detected perioperatively. Conclusions: The bilateral axillary brachial plexus block under the guidance of ultrasound or neurostimulator are both effective and safe for bilateral hand/forearm surgery. However, the ultrasound-guided block may be more clinically beneficial because of its shorter performance time, rapid onset and higher patient satisfaction degree.

Dexmedetomidine prolongs the effect of bupivacaine in supraclavicular brachial plexus block

PubMed Central

Agarwal, Sandhya; Aggarwal, Ritu; Gupta, Praveen

2014-01-01

Background: We compared the effects of adding dexmedetomidine to a 30 ml solution of 0.325% bupivacaine in supraclavicular brachial plexus block. Onset and duration of sensory and motor block along with the duration of analgesia were the primary endpoints. Materials and Methods: Fifty patients posted for upper limb surgeries were enrolled for a prospective, randomized, double-blind, placebo-controlled trial. Patients were divided into two groups, the control group S and the study group SD. In group S (n = 25), 30 ml of 0.325% bupivacaine + 1 ml normal saline; and in group SD (n = 25), 30 ml of 0.325% bupivacaine + 1 ml (100 μg) dexmedetomidine were given for supraclavicular brachial plexus block using the peripheral nerve stimulator. Onset and duration of sensory and motor blocks were assessed along with the duration of analgesia, sedation, and adverse effects, if any. Hemodynamic parameters, like heart rate (HR), systolic arterial blood pressure (SBP), and diastolic arterial blood pressure (DBP) were also monitored. Results: Demographic data and surgical characteristics were comparable in both the groups. The onset times for sensory and motor blocks were significantly shorter in SD than S group (P < 0.001), while the duration of blocks was significantly longer (P < 0.001) in SD group. Except for the initial recordings (at 0, 5, 10, and 15 min), heart rate levels in group SD were significantly lower (P < 0.001). SBP and DBP levels in SD group at 15, 30, 45, 60, 90 and 120 min were significantly lower than in S group (P < 0.001). In fact, when the percentage changes in HR/SBP/DBP were compared from 0-5/0-10/0-15/0-30/0-45/0-60/0-90/0-120 min in SD with S group, they came out to be highly significant (P < 0.001) in group SD. The duration of analgesia (DOA) was significantly longer in SD group than S group (P < 0.001). Except that, bradycardia was observed in one patient in the group SD, no other adverse effects were observed in either of the groups. Conclusion: Dexmedetomidine added as an adjuvant to bupivacaine for supraclavicular brachial plexus block significantly shortens the onset time and prolongs the duration of sensory and motor blocks and duration of analgesia. Patients in group SD were adequately sedated (modified Ramsay Sedation Score, RSS = 2/6 or 3/6) with no adverse effects except bradycardia in one patient of group SD. PMID:24574591

Open Anterior Release of the Superior Transverse Scapular Ligament for Decompression of the Suprascapular Nerve During Brachial Plexus Surgery.

PubMed

Elzinga, Kate E; Curran, Matthew W T; Morhart, Michael J; Chan, K Ming; Olson, Jaret L

2016-07-01

Reconstruction of the suprascapular nerve (SSN) after brachial plexus injury often involves nerve grafting or a nerve transfer. To restore shoulder abduction and external rotation, a branch of the spinal accessory nerve is commonly transferred to the SSN. To allow reinnervation of the SSN, any potential compression points should be released to prevent a possible double crush syndrome. For that reason, the authors perform a release of the superior transverse scapular ligament at the suprascapular notch in all patients undergoing reconstruction of the upper trunk of the brachial plexus. Performing the release through a standard anterior open supraclavicular approach to the brachial plexus avoids the need for an additional posterior incision or arthroscopic procedure. Copyright © 2016 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

[Neurological complications associated with ultrasound-guided interscalene and supraclavicular block in elective surgery of the shoulder and arm. Prospective observational study in a university hospital].

PubMed

Bilbao Ares, A; Sabaté, A; Porteiro, L; Ibáñez, B; Koo, M; Pi, A

2013-01-01

The incidence of postoperative neurological symptoms after performing interscalene block varies between 4 and 16%. The majority of cases are resolved spontaneously within a year, but some patients have their symptoms permanently. Our objective was to assess the incidence of postoperative neurological symptoms after performing the ultrasound-assisted interscalene and supraclavicular anaesthetic blocks. A prospective and observational study was conducted on consecutive patients who had undergone upper extremity surgery with an interscalene or supraclavicular block as an isolated technique, or as a complement to general anaesthesia. Seven days after the intervention, a telephone interview was conducted that focused on the detection of neurological symptoms in the operated limb. Further serial interviews were conducted on patients with symptoms (after the first, the third and the sixth month, and one year after surgery) until resolution of symptoms. Neurological evaluation was offered to those patients with persistent symptoms after one year. A total of 121 patients were included, on whom 96 interscalene blocks and 22 supraclavicular blocks were performed. Postoperative neurological symptoms were detected in 9.9% (95% CI, 5-15%) of patients during the first week. No significant differences were observed between interscalene (9%) and supraclavicular block (14%). After 3 months the symptoms persisted in 9 patients (7.4%), with symptoms remaining in 4 patients (3.3%) after 1.5 years. Electromyogram was performed on 3 patients who tested positive for nerve damage. A high incidence of postoperative neurological symptoms was observed, and a worrying percentage of permanence of them. There were no significant differences in incidence according to the type of block, or any features of the patient or the anaesthesia technique that were associated with the incidence of these symptoms, except a marginal relationship with age. These complications must be clearly explained to the patients before performing these blocks. Copyright © 2012 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Published by Elsevier España. All rights reserved.

Correlation between ultrasound imaging, cross-sectional anatomy, and histology of the brachial plexus: a review.

PubMed

van Geffen, Geert J; Moayeri, Nizar; Bruhn, Jörgen; Scheffer, Gert J; Chan, Vincent W; Groen, Gerbrand J

2009-01-01

The anatomy of the brachial plexus is complex. To facilitate the understanding of the ultrasound appearance of the brachial plexus, we present a review of important anatomic considerations. A detailed correlation of reconstructed, cross-sectional gross anatomy and histology with ultrasound sonoanatomy is provided.

The Supraclavicular Artery Perforator Flap: A Comparative Study of Imaging Techniques Used in Preoperative Mapping.

PubMed

Sheriff, Hemin Oathman; Mahmood, Kawa Abdullah; Hamawandi, Nzar; Mirza, Aram Jamal; Hawas, Jawad; Moreno, Esther Granell; Clavero, Juan Antonio; Hankins, Christopher; Masia, Jaume

2018-05-18

 The supraclavicular artery flap is an excellent flap for head and neck reconstruction. The aim of this study is to assess imaging techniques to define the precise vascular boundaries of this flap.  Six imaging techniques were used for supraclavicular artery mapping in 65 cases; handheld Doppler, triplex ultrasound, computed tomography angiography, magnetic resonance angiography, digital subtraction angiography, and indocyanine green angiography. We checked the site of the perforators, the course of a supraclavicular artery, and anatomical mapping of the supraclavicular artery.  Handheld Doppler identified perforators' sites in 80% of the cases but showed no results for the course of the vessel. Triplex ultrasound identified the site of perforators in 52.9%, and partial mapping of the course of a supraclavicular artery in 64.7% of the cases. Computerized tomography angiography showed the site of perforators in 60%, and the course of supraclavicular artery completely in 45%, and partially in an additional 30%of the cases examined. Magnetic resonance angiography showed negative results for all parameters. Digital subtraction angiography showed the partial course of a supraclavicular artery in 62.5%, but showed no perforators. Indocyanine green angiography showed the site of perforators in 60% and a partial course of supraclavicular artery distal to perforators in 60%.Anatomical mapping of the vessel was possible with computerized tomography angiogram completely in 45%, and partially in 30%, and was also possible with indocyanine green angiography partially in 60%.  Computerized tomography angiography showed best results in the mapping of the supraclavicular artery, but with an inability to define the perforator perfusion territories, and also with risks of irradiation, while indocyanine green angiography is a good alternative as it could precisely map the superficial course of the artery and angiosomes, with no radiation exposure. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Effects of arthroscopy-guided suprascapular nerve block combined with ultrasound-guided interscalene brachial plexus block for arthroscopic rotator cuff repair: a randomized controlled trial.

PubMed

Lee, Jae Jun; Hwang, Jung-Taek; Kim, Do-Young; Lee, Sang-Soo; Hwang, Sung Mi; Lee, Na Rea; Kwak, Byung-Chan

2017-07-01

The aim of this study was to compare the pain relieving effect of ultrasound-guided interscalene brachial plexus block (ISB) combined with arthroscopy-guided suprascapular nerve block (SSNB) with that of ultrasound-guided ISB alone within the first 48 h after arthroscopic rotator cuff repair. Forty-eight patients with rotator cuff tears who had undergone arthroscopic rotator cuff repair were enrolled. The 24 patients in group 1 received ultrasound-guided ISB and arthroscopy-guided SSNB; the remaining 24 patients in group 2 underwent ultrasound-guided ISB alone. Visual analogue scale pain score and patient satisfaction score were checked at 1, 3, 6, 12, 18, 24, and 48 h post-operatively. Group 1 had a lower visual analogue scale pain score at 3, 6, 12, 18, 24, and 48 h post-operatively (1.7 < 2.6, 1.6 < 4.0, 3.5 < 5.8, 3.6 < 5.2, 3.2 < 4.2, 1.3 < 2.0), and a higher patient satisfaction score at 6, 12, 18, 24, and 36 h post-operatively than group 2 (7.8 > 6.0, 6.2 > 4.3, 6.4 > 5.1, 6.9 > 5.9, 7.9 > 7.1). Six patients in group 1 developed rebound pain twice, and the others in group 1 developed it once. All of the patients in group 2 had one rebound phenomenon each (p = 0.010). The mean timing of rebound pain in group 1 was later than that in group 2 (15.5 > 9.3 h, p < 0.001), and the mean size of rebound pain was smaller in group 1 than that in group 2 (2.5 > 4.0, p = 0.001). Arthroscopy-guided SSNB combined with ultrasound-guided ISB resulted in lower visual analogue scale pain scores at 3-24 and 48 h post-operatively, and higher patient satisfaction scores at 6-36 h post-operatively with the attenuated rebound pain compared to scores in patients who received ultrasound-guided ISB alone after arthroscopic rotator cuff repair. The combined blocks may relieve post-operative pain more effectively than the single block within 48 h after arthroscopic cuff repair. Randomized controlled trial, Level I. ClinicalTrials.gov Identifier: NCT02424630.

Efficacy of Ultrasound-Guided Axillary Brachial Plexus Block for Analgesia During Percutaneous Transluminal Angioplasty for Dialysis Access

DOE Office of Scientific and Technical Information (OSTI.GOV)

Chiba, Emiko, E-mail: chibaemi23@comet.ocn.ne.jp; Hamamoto, Kohei, E-mail: hkouhei917@gmail.com; Nagashima, Michio, E-mail: nagamic00@gmail.com

PurposeTo evaluate the efficacy and safety of ultrasound (US)-guided axillary brachial plexus block (ABPB) for analgesia during percutaneous transluminal angioplasty (PTA) for dialysis access.Subjects and MethodsTwenty-one patients who underwent PTA for stenotic dialysis access shunts and who had previous experience of PTA without sedation, analgesia, and anesthesia were included. The access type in all patients was native arteriovenous fistulae in the forearm. Two radiologists performed US-guided ABPB for the radial and musculocutaneous nerves before PTA. The patients’ pain scores were evaluated using a visual analog scale (VAS) after PTA, and these were compared with previous sessions without US-guided ABPB. Themore » patient’s motor/sensory paralysis after PTA was also examined.ResultsThe mean time required to achieve US-guided ABPB was 8 min. The success rate of this procedure was 100 %, and there were no significant complications. All 21 patients reported lower VAS with US-guided ABPB as compared to without the block (p < 0.01). All patients expressed the desire for an ABPB for future PTA sessions, if required. Transient motor paralysis occurred in 8 patients, but resolved in all after 60 min.ConclusionUS-guided ABPB is feasible and effective for analgesia in patients undergoing PTA for stenotic dialysis access sites.Level of EvidenceLevel 4 (case series).« less

Unique Phrenic Nerve-Sparing Regional Anesthetic Technique for Pain Management after Shoulder Surgery

PubMed Central

Olsen, David A.; Amundson, Adam W.

2017-01-01

Background Ipsilateral phrenic nerve blockade is a common adverse event after an interscalene brachial plexus block, which can result in respiratory deterioration in patients with preexisting pulmonary conditions. Diaphragm-sparing nerve block techniques are continuing to evolve, with the intention of providing satisfactory postoperative analgesia while minimizing hemidiaphragmatic paralysis after shoulder surgery. Case Report We report the successful application of a combined ultrasound-guided infraclavicular brachial plexus block and suprascapular nerve block in a patient with a complicated pulmonary history undergoing a total shoulder replacement. Conclusion This case report briefly reviews the important innervations to the shoulder joint and examines the utility of the infraclavicular brachial plexus block for postoperative pain management. PMID:29410922

A technique for ultrasound-guided blood sampling from a dry and gel-free puncture area.

PubMed

Thorn, Sofie; Gopalasingam, Nigopan; Bendtsen, Thomas Fichtner; Knudsen, Lars; Sloth, Erik

2016-05-07

Vein punctures are performed daily to sample blood. Ultrasound (US) offers an alternative to the blind landmark technique for difficult vascular access. A challenge for this procedure is the presence of US gel in the puncture area. We present a technique for US-guided puncture from extremity veins not palpable or visible to the human eye, while keeping the puncture area dry and gel-free. Ten healthy volunteers underwent two US-guided vein punctures from veins that were neither palpable nor visible. One was drawn from an antebrachial vein and another from a brachial vein. A sterile barrier drape was made from a commercially available dressing and a piece of transparent sterile plastic. The barrier drape consists of an adhesive part placed on the skin designed for sonography and a free transparent flap constituting the barrier between the unsterile sonographic site and the sterile gel-free puncture site. The success rate for vein puncture was 100% in both locations. A total of 22 skin punctures were performed (11 antebrachial and 11 brachial). Gain output was increased 7% (4-12%), and 8% (4-15%), respectively, to compensate for attenuation of the US signal due to the drape. Alignment of the centre of the transducer with the long-axis of the target vein during the procedure was reported as a challenge. US-guided blood sampling from a brachial and antebrachial vein was possible with a 100% success rate, while ensuring a dry and gel-free venipuncture area on one side and the transducer on the other side of a sterile barrier.

True Brachial Artery Aneurysm Presenting as a Non-Pulsatile Mass.

PubMed

Pradhananga, A; Chao, X

2017-01-01

Brachial artery aneurysms are rare disease that can be encountered. It is divided into true and false. The frequency of true aneurysm of the brachial artery is so much unusual. So, we present a case of a 59 year old male who presented to us with complaint of mass in left upper limb since many years ago. Now, there was sudden onset of progressive pain with coldness, numbness, tingling sensation and blackish discolouration of skin from 8 hours. The left upper limb was pulseless and color Doppler ultrasound showed a non-pulsatile aneurysm at the mid level of left brachial artery associated with arterial occlusion in its distal branch by thrombus. The patient was successfully revascularised by interposing a saphenous vein graft. Thus,this case suggest that the prompt diagnosis of true brachial artery aneurysm by ultrasound or color Doppler ultrasound and the proper treatment by surgical repair can save limb from dangerous sequel Keywords: brachial artery aneurysm; color doppler ultrasound; true aneurysm; ultrasound.

[Brachial artery pseudoaneurysm: a rare but serious complication in hemodialysis patients with arteriovenous fistula].

PubMed

Mancini, Andrea; Castriotta, Giuseppe; Angelini, Pernina; Bozzi, Michele; Giancaspro, Vincenzo; La Raia, Elvira; Nisi, Maria Teresa; Proscia, Anna Rita; Tarantino, Giuseppe; Vitale, Ottavia; Cuzzola, Cristoforo

2017-06-01

A pseudoaneurysm or false aneurysm of the brachial artery is an uncommon occurrence in patients receiving hemodialysis with arteriovenous fistula (AVF). We describe the case of a 76-year-old woman presenting with a large, tender, pulsatile mass in the right antecubital region 10 cm from the AVF. B-mode ultrasound examination revealed a saccular hematoma. Color doppler showed a recirculation movement of blood, creating a two colors image called "Korean flag". The patient was transferred to the surgical unit where she first underwent ultrasound-guided compression and then surgical repair of the pseudoaneurysm. Two weeks after surgery the AVF was used again as an access for hemodialysis. Differentiating between a false and a true aneurysm based on ultrasound is not always straightforward. Doppler ultrasound findings can be decisive for the early diagnosis of a pseudoaneurysm to ensure proper treatment planning given the dangerous complications of ruptures. Treatment options include: compression, percutaneous thrombin injection, endovascular exclusion with covered stents, aneurysmectomy and surgical repair. Copyright by Società Italiana di Nefrologia SIN, Rome, Italy.

Definition of the supraclavicular and infraclavicular nodes: implications for three-dimensional CT-based conformal radiation therapy.

PubMed

Madu, C N; Quint, D J; Normolle, D P; Marsh, R B; Wang, E Y; Pierce, L J

2001-11-01

To delineate with computed tomography (CT) the anatomic regions containing the supraclavicular (SCV) and infraclavicular (IFV) nodal groups, to define the course of the brachial plexus, to estimate the actual radiation dose received by these regions in a series of patients treated in the traditional manner, and to compare these doses to those received with an optimized dosimetric technique. Twenty patients underwent contrast material-enhanced CT for the purpose of radiation therapy planning. CT scans were used to study the location of the SCV and IFV nodal regions by using outlining of readily identifiable anatomic structures that define the nodal groups. The brachial plexus was also outlined by using similar methods. Radiation therapy doses to the SCV and IFV were then estimated by using traditional dose calculations and optimized planning. A repeated measures analysis of covariance was used to compare the SCV and IFV depths and to compare the doses achieved with the traditional and optimized methods. Coverage by the 90% isodose surface was significantly decreased with traditional planning versus conformal planning as the depth to the SCV nodes increased (P < .001). Significantly decreased coverage by using the 90% isodose surface was demonstrated for traditional planning versus conformal planning with increasing IFV depth (P = .015). A linear correlation was found between brachial plexus depth and SCV depth up to 7 cm. Conformal optimized planning provided improved dosimetric coverage compared with standard techniques.

Ultrasound-guided axillary brachial plexus block versus local infiltration anesthesia for arteriovenous fistula creation at the forearm for hemodialysis in patients with chronic renal failure.

PubMed

Nofal, W H; El Fawal, S M; Shoukry, A A; Sabek, Eas; Malak, Wfa

2017-01-01

The primary failure rate for arteriovenous fistula (AVF) creation under local anesthesia for hemodialysis is about 30%. Axillary brachial plexus block (BPB) may improve blood flow through blood vessels used in fistula creation; it may improve the AVF blood flow and thus may reduce the primary failure rate after 3 months. Hundred and forty patients with chronic renal failure scheduled for AVF creation for hemodialysis were divided into two equal groups; Group 1 (AxBP-G) received ultrasound (US) guided axillary BPB, and Group 2 (LI-G) received local infiltration. We recorded the measurements of the brachial and radial arteries before and after anesthesia and the AVF blood flow in both groups at three different time points. Furthermore, the primary failure rate was recorded in each group and compared. After anesthesia, the mean radial artery blood flow in the AxBP-group was 3.52 ml/min more than the LI-group, and the brachial artery diameter was also 0.68 mm more than in the LI-group, both differences were statistically significant ( P < 0.05). There were significant increases ( P < 0.05) in the AVF blood flow in the AxBP-group more than the LI-group with mean differences of 29.6, 69.8, and 27.2 ml/min at 4 h, 1 week, and 3 months, respectively. The overall mean of AVF blood flow was 42.21 ml/min more in the AxBP group than the LI-group a difference which is statistically significant ( P < 0.001). The primary failure rate was 17% in the AxBP group versus 30% in the LI-group; however, this difference is not significant statistically ( P = 0.110). The US-guided axillary block increases AVF blood flow significantly more than local infiltration and nonsignificantly decreases the primary failure rate of the AVF after 3 months.

The diagnostic accuracy of 1.5T magnetic resonance imaging for detecting root avulsions in traumatic adult brachial plexus injuries.

PubMed

Wade, Ryckie G; Itte, Vinay; Rankine, James J; Ridgway, John P; Bourke, Grainne

2018-03-01

Identification of root avulsions is of critical importance in traumatic brachial plexus injuries because it alters the reconstruction and prognosis. Pre-operative magnetic resonance imaging is gaining popularity, but there is limited and conflicting data on its diagnostic accuracy for root avulsion. This cohort study describes consecutive patients requiring brachial plexus exploration following trauma between 2008 and 2016. The index test was magnetic resonance imaging at 1.5 Tesla and the reference test was operative exploration of the supraclavicular plexus. Complete data from 29 males was available. The diagnostic accuracy of magnetic resonance imaging for root avulsion(s) of C5-T1 was 79%. The diagnostic accuracy of a pseudomeningocoele as a surrogate marker of root avulsion(s) of C5-T1 was 68%. We conclude that pseudomeningocoles were not a reliable sign of root avulsion and magnetic resonance imaging has modest diagnostic accuracy for root avulsions in the context of adult traumatic brachial plexus injuries. III.

Pre-operative brachial plexus block compared with an identical block performed at the end of surgery: a prospective, double-blind, randomised clinical trial.

PubMed

Holmberg, A; Sauter, A R; Klaastad, Ø; Draegni, T; Raeder, J C

2017-08-01

We evaluated whether pre-emptive analgesia with a pre-operative ultrasound-guided infraclavicular brachial plexus block resulted in better postoperative analgesia than an identical block performed postoperatively. Fifty-two patients undergoing fixation of a fractured radius were included. All patients received general anaesthesia with remifentanil and propofol. Patients were randomly allocated into two groups: a pre-operative block or a postoperative block with 0.5 ml.kg -1 ropivacaine 0.75%. After surgery, all patients received regular paracetamol plus opioids for breakthrough pain. Mean (SD) time to first rescue analgesic after emergence from general anaesthesia was 544 (217) min in the pre-operative block group compared with 343 (316) min in the postoperative block group (p = 0.015). Postoperative pain scores were higher and more patients required rescue analgesia during the first 4 h after surgery in the postoperative block group. There were no significant differences in plasma stress mediators between the groups. Analgesic consumption was lower at day seven in the pre-operative block group. Pain was described as very strong at block resolution in 27 (63%) patients and 26 (76%) had episodes of mild pain after 6 months. We conclude that a pre-operative ultrasound-guided infraclavicular brachial plexus block provides longer and better analgesia in the acute postoperative period compared with an identical postoperative block in patients undergoing surgery for fractured radius. © 2017 The Association of Anaesthetists of Great Britain and Ireland.

Ultrasound-Guided Regional Anesthesia and Patient Safety: Update of an Evidence-Based Analysis.

PubMed

Neal, Joseph M

2016-01-01

In 2010, the American Society of Regional Anesthesia and Pain Medicine's evidence-based medicine assessment of ultrasound (US)-guided regional anesthesia (UGRA) analyzed the effect of this nerve localization technology on patient safety. That analysis focused on 4 important regional anesthesia complications: peripheral nerve injury, local anesthetic systemic toxicity (LAST), hemidiaphragmatic paresis (HDP), and pneumothorax. In the intervening 5 years, further research has allowed us to refine our original conclusions. This update reviews previous findings and critically evaluates new literature published since late 2009 that compares the patient safety attributes of UGRA with those of traditional nerve localization methods. As with the previous version of this exercise, analysis focused on randomized controlled trials that compared UGRA with an alternative neural localization method and case series of more than 500 patients. The Jadad score was used to grade individual study quality, and conclusions were graded as to strength of evidence. Of those randomized controlled trials identified by our search techniques, 28 compared the incidence of postoperative nerve symptoms, 27 assessed LAST parameters, 7 studied HDP, and 9 reported the incidence of pneumothorax. The current analysis strengthens our original conclusions that US guidance has no significant effect on the incidence of postoperative neurologic symptoms and that UGRA reduces the incidence and intensity of HDP but does so in an unpredictable manner. Conversely, emerging evidence supports the effectiveness of US guidance for reducing LAST across its clinical presentation continuum. The predicted frequency of pneumothorax has grown smaller in tandem with increased experience with US-guided supraclavicular block. This evidence-based review summarizes both the power and the limitations of UGRA as a tool for improving patient safety. Since the original 2010 publication of this analysis, evidence has continued to support the concept that ultrasound (US) guidance does not meaningfully affect the incidence of peripheral nerve injury (PNI) associated with regional anesthesia. Similar confirmatory evidence attests to US guidance reducing the incidence and intensity of hemidiaphragmatic paresis (HDP) but not eliminating it. Literature published since late 2009 reports the effective role of US guidance in reducing the incidence of local anesthetic systemic toxicity and allows calculation of a lower predicted frequency of pneumothorax associated with US-guided supraclavicular blocks.

Non-invasive assessment of peripheral arterial disease: Automated ankle brachial index measurement and pulse volume analysis compared to duplex scan.

PubMed

Lewis, Jane Ea; Williams, Paul; Davies, Jane H

2016-01-01

This cross-sectional study aimed to individually and cumulatively compare sensitivity and specificity of the (1) ankle brachial index and (2) pulse volume waveform analysis recorded by the same automated device, with the presence or absence of peripheral arterial disease being verified by ultrasound duplex scan. Patients (n=205) referred for lower limb arterial assessment underwent ankle brachial index measurement and pulse volume waveform recording using volume plethysmography, followed by ultrasound duplex scan. The presence of peripheral arterial disease was recorded if ankle brachial index <0.9; pulse volume waveform was graded as 2, 3 or 4; or if haemodynamically significant stenosis >50% was evident with ultrasound duplex scan. Outcome measure was agreement between the measured ankle brachial index and interpretation of pulse volume waveform for peripheral arterial disease diagnosis, using ultrasound duplex scan as the reference standard. Sensitivity of ankle brachial index was 79%, specificity 91% and overall accuracy 88%. Pulse volume waveform sensitivity was 97%, specificity 81% and overall accuracy 85%. The combined sensitivity of ankle brachial index and pulse volume waveform was 100%, specificity 76% and overall accuracy 85%. Combining these two diagnostic modalities within one device provided a highly accurate method of ruling out peripheral arterial disease, which could be utilised in primary care to safely reduce unnecessary secondary care referrals.

Supraclavicular Approach to Ultrasound-Guided Brachiocephalic Vein Cannulation in Children and Neonates

PubMed Central

Merchaoui, Zied; Lausten-Thomsen, Ulrik; Pierre, Florence; Ben Laiba, Maher; Le Saché, Nolwenn; Tissieres, Pierre

2017-01-01

The correct choice of intra vascular access in critically ill neonates should be individualized depending on the type and duration of therapy, gestational and chronological age, weight and/or size, diagnosis, clinical status, and venous system patency. Accordingly, there is an ongoing demand for optimization of catheterization. Recently, the use of ultrasound (US)-guided cannulation of the subclavian vein (SCV) has been described in children and neonates. This article gives an overview of the current use of US for achieving central venous catheter placement in the SCV or the brachiocephalic vein (BCV) in neonates. More than 1,250 catheters have been reported inserted in children and neonates for a cumulated success rate of 98.4% and the complication rate is reported to be low. The technical aspects of various approaches are discussed, and we offer our recommendation of an US-guided technique for SCV and BCV cannulation based on our experience in a large NICU setting. Although the cannulation the SCV or BCV does not substitute the use of peripherally inserted central catheters or umbilical venous central catheters in neonates, it is a feasible route in very small children who are in need of a large caliber central venous access. PMID:29051889

Does regional compared to local anaesthesia influence outcome after arteriovenous fistula creation?

PubMed

Macfarlane, Alan James Robert; Kearns, Rachel Joyce; Aitken, Emma; Kinsella, John; Clancy, Marc James

2013-08-19

An arteriovenous fistula is the optimal form of vascular access in patients with end-stage renal failure requiring haemodialysis. Unfortunately, approximately one-third of fistulae fail at an early stage. Different anaesthetic techniques can influence factors associated with fistula success, such as intraoperative blood flow and venous diameter. A regional anaesthetic brachial plexus block results in vasodilatation and improved short- and long-term fistula flow compared to the infiltration of local anaesthetic alone. This, however, has not yet been shown in a large trial to influence long-term fistula patency, the ultimate clinical measure of success.The aim of this study is to compare whether a regional anaesthetic block, compared to local anaesthetic infiltration, can improve long-term fistula patency. This study is an observer-blinded, randomised controlled trial. Patients scheduled to undergo creation of either brachial or radial arteriovenous fistulae will receive a study information sheet, and consent will be obtained in keeping with the Declaration of Helsinki. Patients will be randomised to receive either: (i) an ultrasound guided brachial plexus block using lignocaine with adrenaline and levobupivicaine, or (ii) local anaesthetic infiltration with lignocaine and levobupivicaine.A total of 126 patients will be recruited. The primary outcome is fistula primary patency at three months. Secondary outcomes include primary patency at 1 and 12 months, secondary patency and fistula flow at 1, 3 and 12 months, flow on first haemodialysis, procedural pain, patient satisfaction, change in cephalic vein diameter pre- and post-anaesthetic, change in radial or brachial artery flow pre- and post-anaesthetic, alteration of the surgical plan after anaesthesia as guided by vascular mapping with ultrasound, and fistula infection requiring antibiotics. No large randomised controlled trial has examined the influence of brachial plexus block compared with local anaesthetic infiltration on the long-term patency of arteriovenous fistulae. If the performance of brachial plexus block increases fistulae patency, this will have significant clinical and financial benefits as the number of patients able to commence haemodialysis when planned should increase, and the number of "redo" or revision procedures should be reduced. This study has been approved by the West of Scotland Research Ethics Committee 5 (reference no. 12/WS/0199) and is registered with the ClinicalTrials.gov database (reference no. NCT01706354).

Phrenic nerve block caused by interscalene brachial plexus block: breathing effects of different sites of injection.

PubMed

Bergmann, Lars; Martini, Stefan; Kesselmeier, Miriam; Armbruster, Wolf; Notheisen, Thomas; Adamzik, Michael; Eichholz, Rϋdiger

2016-07-29

Interscalene brachial plexus (ISB) block is often associated with phrenic nerve block and diaphragmatic paresis. The goal of our study was to test if the anterior or the posterior ultrasound guided approach of the ISB is associated with a lower incidence of phrenic nerve blocks and impaired lung function. This was a prospective, randomized and single-blinded study of 84 patients scheduled for elective shoulder surgery who fullfilled the inclusion and exclusion critereria. Patients were randomized in two groups to receive either the anterior (n = 42) or the posterior (n = 42) approach for ISB. Clinical data were recorded. In both groups patients received ISB with a total injection volume of 15 ml of ropivacaine 1 %. Spirometry was conducted at baseline (T0) and 30 min (T30) after accomplishing the block. Changes in spirometrical variables between T0 and T30 were investigated by Wilcoxon signed-rank test for each puncture approach. The temporal difference between the posterior and the anterior puncture approach groups were again analyzed by the Wilcoxon-Mann-Whitney test. The spirometric results showed a significant decrease in vital capacity, forced expiratory volume per second, and maximum nasal inspiratory breathing after the Interscalene brachial plexus block; indicating a phrenic nerve block (p <0.001, Wilcoxon signed-rank). A significant difference in the development of the spirometric parameters between the anterior and the posterior group could not be identified (Wilcoxon-Mann-Whitney test). Despite the changes in spirometry, no cases of dyspnea were reported. A different site of injection (anterior or posterior) did not show an effect in reducing the cervical block spread of the local anesthetic and the incidence of phrenic nerve blocks during during ultrasound guided Interscalene brachial plexus block. Clinical breathing effects of phrenic nerve blocks are, however, usually well compensated, and subjective dyspnea did not occur in our patients. German Clinical Trials Register (DRKS number 00009908 , registered 26 January 2016).

Intrathecal Spread of Injectate Following an Ultrasound-Guided Selective C5 Nerve Root Injection in a Human Cadaver Model.

PubMed

Falyar, Christian R; Abercrombie, Caroline; Becker, Robert; Biddle, Chuck

2016-04-01

Ultrasound-guided selective C5 nerve root blocks have been described in several case reports as a safe and effective means to anesthetize the distal clavicle while maintaining innervation of the upper extremity and preserving diaphragmatic function. In this study, cadavers were injected with 5 mL of 0.5% methylene blue dye under ultrasound guidance to investigate possible proximal and distal spread of injectate along the brachial plexus, if any. Following the injections, the specimens were dissected and examined to determine the distribution of dye and the structures affected. One injection revealed dye extended proximally into the epidural space, which penetrated the dura mater and was present on the spinal cord and brainstem. Dye was noted distally to the divisions in 3 injections. The anterior scalene muscle and phrenic nerve were stained in all 4 injections. It appears unlikely that local anesthetic spread is limited to the nerve root following an ultrasound-guided selective C5 nerve root injection. Under certain conditions, intrathecal spread also appears possible, which has major patient safety implications. Additional safety measures, such as injection pressure monitoring, should be incorporated into this block, or approaches that are more distal should be considered for the acute pain management of distal clavicle fractures.

Refinement of myotome values in the upper limb: Evidence from brachial plexus injuries.

PubMed

Bell, S W; Brown, M J C; Hems, T J

2017-02-01

We reviewed patients with partial supraclavicular brachial plexus injuries in order to refine the myotome values of the upper limb. Forty-two patients with defined partial injuries to the supraclavicular brachial plexus were reviewed from a prospective database. The injuries patterns covered C5, C5-6, C5-7, C5-8, C7-T1 and C8-T1 roots. Upper plexus injuries were classified on the basis of surgical exploration and intraoperative stimulation and lower plexus injuries from MRI. Flexor Carpi Radialis (FCR) was paralyzed in C5-7 injuries, in addition to paralysis of deltoid, supraspinatus, infraspinatus and biceps, when compared to C5-6 injuries. Complete paralysis of Flexor Digitorum Profundus (FDP) and Flexor Digitorum Superficialis (FDS) to all digits was identified in C7-T1 injuries. In C5-8 injuries weakness was noted in FDP of ulnar digits and intrinsics innervated by the ulnar nerve, while in C8-T1 injuries paralysis was noted in the FDP to the radial digits. All patients with C8-T1 injuries had paralysis of FDS and the thenar muscles. In upper plexus injuries paralysis of FCR indicated involvement of C7 root in addition to C5 and C6 roots. The results provide new detail of innervation of muscles acting on the hand. Flexor muscles and intrinsic muscles of the thumb and radial fingers (median nerve) have an important contribution from T1, while for those acting on the ulnar digits (ulnar nerve) the main contribution is from C8 with some input from C7. T1 also gives consistent innervation to extensor pollicis longus. A revised myotome chart for the upper limb is proposed. Copyright © 2015 Royal College of Surgeons of Edinburgh (Scottish charity number SC005317) and Royal College of Surgeons in Ireland. Published by Elsevier Ltd. All rights reserved.

Noninvasive Evaluation of Varying Pulse Pressures in vivo Using Brachial Sphymomanometry, Applanation Tonometry, and Pulse Wave Ultrasound Manometry.

PubMed

Li, Ronny X; Ip, Ada; Sanz-Miralles, Elena; Konofagou, Elisa E

2017-06-01

The routine assessment and monitoring of hypertension may benefit from the evaluation of arterial pulse pressure (PP) at more central locations (e.g. the aorta) rather solely at the brachial artery. Pulse Wave Ultrasound Manometry (PWUM) was previously developed by our group to provide direct, noninvasive aortic PP measurements using ultrasound elasticity imaging. Using PWUM, radial applanation tonometry, and brachial sphygmomanometry, this study investigated the feasibility of noninvasively obtaining direct PP measurements at multiple arterial locations in normotensive, pre-hypertensive, and hypertensive human subjects. Two-way ANOVA indicated a significantly higher aortic PP in the hypertensive subjects, while radial and brachial PP were not significantly different among the subject groups. No strong correlation (r 2 < 0.45) was observed between aortic and radial/brachial PP in normal and pre-hypertensive subjects, suggesting that increases in PP throughout the arterial tree may not be uniform in relatively compliant arteries. However, there was a relatively strong positive correlation between aortic PP and both radial and brachial PP in hypertensive subjects (r 2 = 0.68 and 0.87, respectively). PWUM provides a low-cost, non-invasive, and direct means of measuring the pulse pressure in large central arteries such as the aorta. When used in conjunction with peripheral measurement devices, PWUM allows for the routine screening of hypertension and monitoring of BP-lowering drugs based on the PP from multiple arterial sites.

Estimation of brachial artery volume flow by duplex ultrasound imaging predicts dialysis access maturation.

PubMed

Ko, Sae Hee; Bandyk, Dennis F; Hodgkiss-Harlow, Kelley D; Barleben, Andrew; Lane, John

2015-06-01

This study validated duplex ultrasound measurement of brachial artery volume flow (VF) as predictor of dialysis access flow maturation and successful hemodialysis. Duplex ultrasound was used to image upper extremity dialysis access anatomy and estimate access VF within 1 to 2 weeks of the procedure. Correlation of brachial artery VF with dialysis access conduit VF was performed using a standardized duplex testing protocol in 75 patients. The hemodynamic data were used to develop brachial artery flow velocity criteria (peak systolic velocity and end-diastolic velocity) predictive of three VF categories: low (<600 mL/min), acceptable (600-800 mL/min), or high (>800 mL/min). Brachial artery VF was then measured in 148 patients after a primary (n = 86) or revised (n = 62) upper extremity dialysis access procedure, and the VF category correlated with access maturation or need for revision before hemodialysis usage. Access maturation was conferred when brachial artery VF was >600 mL/min and conduit imaging indicated successful cannulation based on anatomic criteria of conduit diameter >5 mm and skin depth <6 mm. Measurements of VF from the brachial artery and access conduit demonstrated a high degree of correlation (R(2) = 0.805) for autogenous vein (n = 45; R(2) = 0.87) and bridge graft (n = 30; R(2) = 0.78) dialysis accesses. Access VF of >800 mL/min was predicted when the brachial artery lumen diameter was >4.5 mm, peak systolic velocity was >150 cm/s, and the diastolic-to-systolic velocity ratio was >0.4. Brachial artery velocity spectra indicating VF <800 mL/min was associated (P < .0001) with failure of access maturation. Revision was required in 15 of 21 (71%) accesses with a VF of <600 mL/min, 4 of 40 accesses (10%) with aVF of 600 to 800 mL/min, and 2 of 87 accesses (2.3%) with an initial VF of >800 mL/min. Duplex testing to estimate brachial artery VF and assess the conduit for ease of cannulation can be performed in 5 minutes during the initial postoperative vascular clinic evaluation. Estimation of brachial artery VF using the duplex ultrasound, termed the "Fast, 5-min Dialysis Duplex Scan," facilitates patient evaluation after new or revised upper extremity dialysis access procedures. Brachial artery VF correlates with access VF measurements and has the advantage of being easier to perform and applicable for forearm and also arm dialysis access. When brachial artery velocity spectra criteria confirm a VF >800 mL/min, flow maturation and successful hemodialysis are predicted if anatomic criteria for conduit cannulation are also present. Copyright © 2015 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

Comprehensive assessment of impaired peripheral and coronary artery endothelial functions in smokers using brachial artery ultrasound and oxygen-15-labeled water PET.

PubMed

Ochi, Noriki; Yoshinaga, Keiichiro; Ito, Yoichi M; Tomiyama, Yuuki; Inoue, Mamiko; Nishida, Mutsumi; Manabe, Osamu; Shibuya, Hitoshi; Shimizu, Chikara; Suzuki, Eriko; Fujii, Satoshi; Katoh, Chietsugu; Tamaki, Nagara

2016-10-01

Comprehensive evaluation of endothelium-dependent and endothelium-independent vascular functions in peripheral arteries and coronary arteries in smokers has never been performed previously. Through the use of brachial artery ultrasound and oxygen-15-labeled water positron emission tomography (PET), we sought to investigate peripheral and coronary vascular dysfunctions in smokers. Eight smokers and 10 healthy individuals underwent brachial artery ultrasound at rest, during reactive hyperemia [250mmHg cuff occlusion (flow-mediated dilatation (FMD)], and following sublingual nitroglycerin (NTG) administration. Myocardial blood flow (MBF) was assessed through O-15-labeled water PET at rest, during adenosine triphosphate (ATP) administration, and during a cold pressor test (CPT). Through ultrasound, smokers were shown to have significantly reduced %FMD compared to controls (6.62±2.28% vs. 11.29±2.75%, p=0.0014). As assessed by O-15-labeled water PET, smokers were shown to have a significantly lower CPT response than were controls (21.1±9.5% vs. 50.9±16.9%, p=0.0004). There was no relationship between %FMD and CPT response (r=0.40, p=0.097). Endothelium-independent vascular dilatation was similar for both groups in terms of coronary flow reserve with PET (p=0.19). Smokers tended to have lower %NTG in the brachial artery (p=0.055). Smokers exhibited impaired coronary endothelial function as well as peripheral brachial artery endothelial function. In addition, there was no correlation between PET and ultrasound measurements, possibly implying that while smokers may have systemic vascular endothelial dysfunction, the characteristics of that dysfunction may be different in peripheral arteries and coronary arteries. Copyright © 2016. Published by Elsevier Ltd.

A system for real-time measurement of the brachial artery diameter in B-mode ultrasound images.

PubMed

Gemignani, Vincenzo; Faita, Francesco; Ghiadoni, Lorenzo; Poggianti, Elisa; Demi, Marcello

2007-03-01

The measurement of the brachial artery diameter is frequently used in clinical studies for evaluating the flow-mediated dilation and, in conjunction with the blood pressure value, for assessing arterial stiffness. This paper presents a system for computing the brachial artery diameter in real-time by analyzing B-mode ultrasound images. The method is based on a robust edge detection algorithm which is used to automatically locate the two walls of the vessel. The measure of the diameter is obtained with subpixel precision and with a temporal resolution of 25 samples/s, so that the small dilations induced by the cardiac cycle can also be retrieved. The algorithm is implemented on a standalone video processing board which acquires the analog video signal from the ultrasound equipment. Results are shown in real-time on a graphical user interface. The system was tested both on synthetic ultrasound images and in clinical studies of flow-mediated dilation. Accuracy, robustness, and intra/inter observer variability of the method were evaluated.

The Valsalva manoeuvre versus tourniquet for venipuncture.

PubMed

Villa, Gianluca; Chelazzi, Cosimo; Giua, Rosa; Lavacchini, Laura; Tofani, Lorenzo; Zagli, Giovanni; Barbani, Francesco; De Gaudio, A Raffaele; Romagnoli, Stefano; Pinelli, Fulvio

2018-03-01

During ultrasound-guided cannulation, venous filling is required for venipuncture. Tourniquet with an elastic tube at the axilla is the most common method to induce venous stasis for cannulation of the deep veins of the arm. Although effective, this method might be associated with short- and long-term complications. Valsalva manoeuvre has been used to produce venous filling in other extrathoracic veins. The aim of this observational study is to demonstrate the effect of Valsalva manoeuvre in respect of the elastic tourniquet on venous distention during echography-guided cannulation of the deep veins of the arm. Sixty-nine patients scheduled for cannulation of basilic or brachial vein were prospectively observed. Vein diameters were recorded at rest and after 10 s of Valsalva or tourniquet placement. The mean difference between basilic vein diameters during tourniquet and Valsalva manoeuvre was 0.006 mm (95% confidence interval = -inf, 0.09) with a standard deviation of 0.5 mm (95% confidence interval = 0.5, 0.7; p > 0.01). The mean difference between brachial vein diameters during tourniquet and Valsalva manoeuvre was 0.04 mm (95% confidence interval = -0.23, 0.15) with a standard deviation of 0.8 mm (95% confidence interval = 0.7, 0.9; p > 0.01). This increase in cross-sectional basilic and brachial vein diameters was not different to that obtained with the elastic tube tourniquet.

The sensitivity of motor response to needle nerve stimulation during ultrasound guided interscalene catheter placement.

PubMed

Fredrickson, Michael J

2008-01-01

Neurostimulation during single shot interscalene block has a significant false negative motor response rate. Compared with tangential needle approaches for single shot block, interscalene catheter (ISC) placement commonly involves Tuohy needles inserted longitudinally to the brachial plexus. This study aimed to determine the sensitivity of neurostimulation during ultrasound-guided ISC needle placement, and the feasibility of an ultrasound-guided ISC needle endpoint. One hundred fifty-five consecutive nonstimulating ISCs were placed with the needle tip position confirmed by the sonographic spread of 5 mL dextrose 5%. Catheter advancement was then blind 2 to 3 cm past the needle tip. A 0.8 mA electrical stimulus at 2 Hz was applied throughout. When a satisfactory image was obtained, neurostimulation was ignored and the minimum motor response amplitude noted. If imaging was equivocal, a brief appropriate motor response at 0.8 mA was sought. A sustained response at <0.5 mA was only sought if imaging was suboptimal. Prior to surgery conducted under general anesthesia, 30 mL ropivacaine 0.5% was administered through the ISC. Catheter success was defined as a recovery room numerical rating pain score of

Intravenous dexamethasone and perineural dexamethasone similarly prolong the duration of analgesia after supraclavicular brachial plexus block: a randomized, triple-arm, double-blind, placebo-controlled trial.

PubMed

Abdallah, Faraj W; Johnson, James; Chan, Vincent; Murgatroyd, Harry; Ghafari, Mohammad; Ami, Noam; Jin, Rongyu; Brull, Richard

2015-01-01

Perineural dexamethasone prolongs the duration of single-injection peripheral nerve block when added to the local anesthetic solution. Postulated systemic mechanisms of action along with theoretical safety concerns have prompted the investigation of intravenous dexamethasone as an alternative, with decidedly mixed results. We aimed to confirm that addition of intravenous dexamethasone will prolong the duration of analgesia after single-injection supraclavicular block compared with conventional long-acting local anesthetic alone or in combination with perineural dexamethasone for ambulatory upper extremity surgery. Seventy-five patients were randomized to receive supraclavicular block using 30-mL bupivacaine 0.5% alone (Control), with concomitant intravenous dexamethasone 8 mg (DexIV), or with perineural dexamethasone 8 mg (DexP). Duration of analgesia was designated as the primary outcome. To test our hypothesis, the superiority of DexIV was first compared with Control and then with DexP. Motor block duration, pain scores, opioid consumption, opioid-related side effects, patient satisfaction, and block-related complications were also analyzed. Twenty-five patients per group were analyzed. The duration of analgesia (mean [95% confidence interval]) was prolonged in the DexIV group(25 hours [17.6–32.4]) compared with Control (13.2 hours [11.5–15.0]; P < 0.001) but similar to the DexP group (25 hours[19.5–30.5]; P = 1). [corrected] Both DexIV and DexP had reduced pain scores, reduced postoperative opioid consumption, and improved satisfaction compared with Control. In a single-injection supraclavicular block with long-acting local anesthetic, the effectiveness of intravenous dexamethasone in prolonging the duration of analgesia seems similar to perineural dexamethasone.

Full thickness skin grafts in periocular reconstructions: long-term outcomes.

PubMed

Rathore, Deepa S; Chickadasarahilli, Swaroop; Crossman, Richard; Mehta, Purnima; Ahluwalia, Harpreet Singh

2014-01-01

To evaluate the outcomes of eyelid reconstruction in patients who underwent full thickness skin grafts. A retrospective, noncomparative intervention study of patients who underwent periocular reconstruction with full thickness skin grafts between 2005 and 2011. One hundred consecutive Caucasian patients were included in the study, 54 women and 46 men. Mean follow up was 32 months. Indications for full thickness skin grafts were excision of eyelid tumors (98%) and cicatricial ectropion (2%). Site of lid defects were lower lid (60%), medial canthus (32%), upper lid (6%), and lateral canthus (2%). The skin graft donor sites were supraclavicular (44%), upper eyelid (24%), inner brachial (18%), and postauricular (14%).Early postoperative complications included lower eyelid graft contracture (1%) and partial failure (1%). Late sequelae included lower eyelid graft contracture (4%) and hypertrophic scarring (23%). Of the 23 patients with hypertrophic scar, 21 achieved good outcomes following massage with silicone gel and steroid ointment and 2 had persistent moderate lumpiness. No statistically significant association was found between graft hypertrophy and donor site or graft size. As high as 95% of all patients achieved good final eyelid position. Good color match was seen in 94% and graft hypopigmentation in 6%. An association between hypopigmentation and supraclavicular and inner brachial donor site was found to be statistically significant. Most patients (94%) achieved good eyelid position and color match. Majority (91%) of the early postoperative cicatricial sequelae can be reversed by massage, steroid ointment, and silicone gel application. Full thickness skin grafts have excellent graft survival rates and have minimal donor site morbidity.

Severe brachial plexopathy after an ultrasound-guided single-injection nerve block for total shoulder arthroplasty in a patient with multiple sclerosis.

PubMed

Koff, Matthew D; Cohen, Jeffrey A; McIntyre, John J; Carr, Charles F; Sites, Brian D

2008-02-01

DESPITE the known benefits of regional anesthesia for patients undergoing joint arthroplasty, the performance of peripheral nerve blocks in patients with multiple sclerosis (MS) remains controversial. MS has traditionally been described as an isolated disease of the central nervous system, without involvement of the peripheral nerves, and peripheral nerve blockade has been suggested to be safe. However, careful review of the literature suggests that MS may also be associated with involvement of the peripheral nervous system, challenging traditional teachings. There is a paucity of evidence with regard to safety in using peripheral nerve regional anesthesia in these patients. This makes it difficult to provide adequate "informed consent" to these patients. This case report describes a patient with MS who sustained a severe brachial plexopathy after a total shoulder arthroplasty during combined general anesthesia and interscalene nerve block.

Observations on the Use of Seprafilm® on the Brachial Plexus in 249 Operations for Neurogenic Thoracic Outlet Syndrome

PubMed Central

Hammond, Sharon L.; Rao, Neal M.

2007-01-01

Purpose Seprafilm® was initially used successfully as a membrane to reduce abdominal adhesions. Subsequently it was tried in a number of other areas to reduce postoperative scarring. Seprafilm® was employed in this study to see if it would reduce postoperative scarring after supraclavicular thoracic outlet decompression for neurogenic thoracic outlet syndrome (NTOS). Material and methods There were 249 operations for primary NTOS (185) and recurrent NTOS (64). Seprafilm® was applied to the nerve roots at the end of each procedure. Diagnosis was established by careful history and extensive physical exam consisting of several provocative maneuvers. Scalene muscle block confirmed the diagnosis. Results Success rates for primary operations, 1–2 years postoperation were 74% for scalenectomy without first rib resection and 70% for scalenectomy with first rib resection. For reoperations, success rate for scalenectomy and neurolysis after transaxillary rib resection was 78% whereas success rate for neurolysis after supraclavicular scalenectomy was 68%. Seprafilm® did not significantly improve overall results compared to our results 15 years ago, although in reoperations there was a trend toward improvement with Seprafilm®. Observations in 10 reoperations after use of Seprafilm® revealed that there were fewer adhesions between fat pad and nerve roots, making it much easier to find the nerve roots. Recurrence was because of scar formation around individual nerve roots. Conclusion Seprafilm® made reoperations easier by reducing scarring between scalene fat pad and brachial plexus. However, it did not prevent scar tissue forming around the individual nerve roots nor did it significantly lower the failure rate for primary operations. The trend supported the use of Seprafilm® in reoperations. PMID:18780049

Outcomes of Ultrasound-Guided Thrombin Injection of Nongroin Arterial Pseudoaneurysms.

PubMed

Valesano, Johnathan C; Schmitz, John J; Kurup, A Nicholas; Schmit, Grant D; Moynagh, Michael R; Atwell, Thomas D; Lewis, Bradley D; Lee, Robert A; Callstrom, Matthew R

2017-08-01

To evaluate success and complication rates of percutaneous ultrasound-guided thrombin injection of nongroin pseudoaneurysms (PSAs). Retrospective review of a prospectively maintained institutional database yielded 39 cases of arterial PSAs occurring at nongroin sites that were treated with percutaneous ultrasound-guided thrombin injection between 2000 and 2016 (average patient age 69.2 y ± 14.0). Of PSAs, 74.4% (29/39) arose in the upper extremities, and 92.3% (36/39) were iatrogenic. The brachial artery was the most commonly affected vessel (51.3% [20/39]), and arterial access was the most common cause (56.4% [22/39]). Average overall PSA size was 2.4 cm (range, 0.5-7.2 cm); average amount of thrombin injected was 320 IU (range, 50-2,000 IU). Technical success was defined as absence of flow within the PSA immediately after thrombin injection. Treatment success was defined as sustained thrombosis on follow-up imaging obtained at 1-3 days after treatment. Technical and treatment success rates of thrombin injections were 100% (39/39) and 84.8% (28/33), respectively. Longer term follow-up imaging (average 71 d; range, 12-201 d) was available for 7 of the treatment successes with 100% (7/7) showing sustained thrombosis. Comparing treatment successes and failures, there was no significant difference in average PSA size (2.3 cm vs 2.0 cm, P = .51) or average amount of thrombin injected (360 IU vs 180 IU, P = .14). There were no complications. Ultrasound-guided thrombin injection is a safe, efficacious treatment option for PSAs arising in nongroin locations. Copyright © 2017 SIR. Published by Elsevier Inc. All rights reserved.

Utility of ultrasound-guided injection of botulinum toxin type A for muscle imbalance in children with obstetric brachial plexus palsy: Description of the procedure and action protocol.

PubMed

García Ron, A; Gallardo, R; Huete Hernani, B

2017-03-24

Obstetric brachial plexus palsy (OBPP) usually has a favourable prognosis. However, nearly one third of all severe cases have permanent sequelae causing a high level of disability. In this study, we explore the effectiveness of ultrasound-guided injection of botulinum toxin A (BoNT-A) and describe the procedure. We designed a prospective, descriptive study including patients with moderate to severe OBPP who were treated between January 2010 and December 2014. We gathered demographic data, type of OBPP, and progression. Treatment effectiveness was assessed with the Active Movement Scale (AMS), the Mallet classification, and video recordings. We gathered a total of 14 133 newborns, 15 of whom had OBPP (1.6 per 1000 live births). Forty percent of the cases had severe OBPP (0.4/1000), a dystocic delivery, and APGAR scores < 5; mean weight was 4038g. Mean age at treatment onset was 11.5 months. The muscles most frequently receiving BoNT-A injections were the pronator teres, subscapularis, teres major, latissimus dorsi, and pectoralis major. All the patients who completed the follow-up period (83%) experienced progressive improvements: up to 3 points on the AMS and a mean score of 19.5 points out of 25 on the Mallet classification at 2 years. Treatment improved muscle function and abnormal posture in all cases. Surgery was avoided in 3 patients and delayed in one. Adverse events were mild and self-limited. Due to its safety and effectiveness, BoNT-A may be used off-label as an adjuvant to physical therapy and/or surgery in moderate to severe OBPP. Ultrasound may increase effectiveness and reduce adverse effects. Copyright © 2017 The Authors. Publicado por Elsevier España, S.L.U. All rights reserved.

Hemodialysis catheter implantation in the axillary vein by ultrasound guidance versus palpation or anatomical reference

PubMed Central

Valencia, Cesar A Restrepo; Villa, Carlos A Buitrago; Cardona, Jose A Chacon

2013-01-01

Background We compared the results of four different methods of hemodialysis catheter insertion in the medial segment of the axillary vein: ultrasound guidance, palpation, anatomical reference, and prior transient catheter. Methods All patients that required acute or chronic hemodialysis and for whom it was determined impossible or not recommended either to place a catheter in the internal jugular vein (for instance, those patients with a tracheostomy), or to practice arteriovenous fistula or graft; it was then essential to obtain an alternative vascular access. When the procedure of axillary vein catheter insertion was performed in the Renal Care Facility (RCF), ultrasound guidance was used, but in the intensive care unit (ICU), this resource was unavailable, so the palpation or anatomical reference technique was used. Results Two nephrologists with experience in the technique performed 83 procedures during a period lasting 15 years and 8 months (from January 1997–August 2012): 41 by ultrasound guidance; 19 by anatomical references; 15 by palpation of the contiguous axillary artery; and 8 through a temporary axillary catheter previously placed. The ultrasound-guided patients had fewer punctures than other groups, but the value was not statistically significant. Arterial punctures were infrequent in all techniques. Analyzing all the procedure-related complications, such as hematoma, pneumothorax, brachial-plexus injury, as well as the reasons for catheter removal, no differences were observed among the groups. The functioning time was longer in the ultrasound-guided and previous catheter groups. In 15 years and 8 months of surveillance, no clinical or image evidence for axillary vein stenosis was found. Conclusion The ultrasound guide makes the procedure of inserting catheters in the axillary veins easier, but knowledge of the anatomy of the midaxillary region and the ability to feel the axillary artery pulse (for the palpation method) also allow relatively easy successful implant of catheters in the axillary veins. PMID:24143120

The utility of ultrasound in the assessment of traumatic peripheral nerve lesions: report of 4 cases.

PubMed

Zeidenberg, Joshua; Burks, S Shelby; Jose, Jean; Subhawong, Ty K; Levi, Allan D

2015-09-01

Ultrasound technology continues to improve with better image resolution and availability. Its use in evaluating peripheral nerve lesions is increasing. The current review focuses on the utility of ultrasound in traumatic injuries. In this report, the authors present 4 illustrative cases in which high-resolution ultrasound dramatically enhanced the anatomical understanding and surgical planning of traumatic peripheral nerve lesions. Cases include a lacerating injury of the sciatic nerve at the popliteal fossa, a femoral nerve injury from a pseudoaneurysm, an ulnar nerve neuroma after attempted repair with a conduit, and, finally, a spinal accessory nerve injury after biopsy of a supraclavicular fossa lesion. Preoperative ultrasound images and intraoperative pictures are presented with a focus on how ultrasound aided with surgical decision making. These cases are set into context with a review of the literature on peripheral nerve ultrasound and a comparison between ultrasound and MRI modalities.

Arterial and venous plasma levels of bupivacaine following peripheral nerve blocks.

PubMed

Moore, D C; Mather, L E; Bridenbaugh, L D; Balfour, R I; Lysons, D F; Horton, W G

1976-01-01

Mean arterial plasma (MAP) and peripheral mean venous plasma (MVP) levels of bupivacaine were ascertained in 3 groups of 10 patients each for: (1) intercostal nerve block, 400 mg; (2) block of the sciatic, femoral, and lateral femoral cutaneous nerves, with or without block of the obturator nerve, 400 mg; and (3) supraclavicular brachial plexus block, 300 mg. MAP levels were consistently higher than simultaneously sampled MVP levels, the highest levels occurring from bilateral intercostal nerve block. No evidence of systemic toxicity was observed. The results suggest that bupivacaine has a much wider margin of safety in humans than is now stated.

Influence of arm position on catheter placement during real-time ultrasound-guided right infraclavicular proximal axillary venous catheterization.

PubMed

Ahn, J H; Kim, I S; Shin, K M; Kang, S S; Hong, S J; Park, J H; Kim, H J; Lee, S H; Kim, D Y; Jung, J H

2016-03-01

Real-time ultrasound-guided infraclavicular proximal axillary venous catheterization is used in many clinical situations and provides the advantages of catheter stabilization, a reduced risk of catheter-related infection, and comfort for the patient without limitation of movement. However, unintended catheter tip dislocation and accidental arterial puncture occur occasionally. This study was designed to investigate the influence of arm position on catheter placement and complications. Patients were randomized to either the neutral group (n=240) or the abduction group (n=241). In the neutral group, patients were positioned with the head and shoulders placed in an anatomically neutral position and the arms kept by the side during catheterization. In the abduction group, the right upper arm was abducted at 90° from the trunk during catheterization. After real-time ultrasound-guided catheterization was carried out in the right infraclavicular proximal axillary vein, misplacement of the catheter and all complications were evaluated with ultrasound and chest radiography. The success rate of complete catheterization before evaluating the placement of the catheter was high in both groups (97.1 vs 98.8%, P=not significant). The incidence of accidental arterial puncture was not different (1.7 vs 0%, P=not significant). The incidence of misplacement of the catheter was higher in the neutral group than in the abduction group (3.9 vs 0.4%, P=0.01). There were no complications, such as haemothorax, pneumothorax, or injury to the brachial plexus and phrenic nerve, in either group. Upper arm abduction may minimize the risk of misplacement of the catheter during real-time ultrasound-guided infraclavicular proximal axillary venous catheterization. The trial was registered with the Clinical Trial Registry of Korea: https://cris.nih.go.kr/cris/index.jsp. Identifier: KCT0001417. © The Author 2015. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Comparison between Steroid Injection and Stretching Exercise on the Scalene of Patients with Upper Extremity Paresthesia: Randomized Cross-Over Study.

PubMed

Kim, Yong Wook; Yoon, Seo Yeon; Park, Yongbum; Chang, Won Hyuk; Lee, Sang Chul

2016-03-01

To compare the therapeutic effects on upper extremity paresthesia of intra-muscular steroid injections into the scalene muscle with those of stretching exercise only. Twenty patients with upper extremity paresthesia who met the criteria were recruited to participate in this single-blind, crossover study. Fourteen of 20 patients were female. The average age was 45.0 ± 10.5 years and duration of symptom was 12.2 ± 8.7 months. Each participant completed one injection and daily exercise program for 2 weeks. After randomization, half of all patients received ultrasound-guided injection of scalene muscles before exercise, while the other was invested for the other patients. After two weeks, there was a significant decrease of the visual analog scale score of treatment effect compared with baseline in both groups (6.90 to 2.85 after injection and 5.65 to 4.05 after stretching exercise, p<0.01). However, injection resulted in greater improvements than stretching exercise (p<0.01). The number of patients with successful treatment, defined as >50% reduction in post-treatment visual analog scale, was 18 of 20 (90.0%) after injection, compared to 5 of 20 (25.0%) after stretching exercise. There were no cases of unintended brachial plexus block after injection. Ultrasound-guided steroid injection or stretching exercise of scalene muscles led to reduced upper extremity paresthesia in patients who present with localized tenderness in the scalene muscle without electrodiagnostic test abnormalities, although injection treatment resulted in more improvements. The results suggest that symptoms relief might result from injection into the muscle alone not related to blockade of the brachial plexus.

Comparison between Steroid Injection and Stretching Exercise on the Scalene of Patients with Upper Extremity Paresthesia: Randomized Cross-Over Study

PubMed Central

Kim, Yong Wook; Yoon, Seo Yeon; Park, Yongbum; Chang, Won Hyuk

2016-01-01

Purpose To compare the therapeutic effects on upper extremity paresthesia of intra-muscular steroid injections into the scalene muscle with those of stretching exercise only. Materials and Methods Twenty patients with upper extremity paresthesia who met the criteria were recruited to participate in this single-blind, crossover study. Fourteen of 20 patients were female. The average age was 45.0±10.5 years and duration of symptom was 12.2±8.7 months. Each participant completed one injection and daily exercise program for 2 weeks. After randomization, half of all patients received ultrasound-guided injection of scalene muscles before exercise, while the other was invested for the other patients. Results After two weeks, there was a significant decrease of the visual analog scale score of treatment effect compared with baseline in both groups (6.90 to 2.85 after injection and 5.65 to 4.05 after stretching exercise, p<0.01). However, injection resulted in greater improvements than stretching exercise (p<0.01). The number of patients with successful treatment, defined as >50% reduction in post-treatment visual analog scale, was 18 of 20 (90.0%) after injection, compared to 5 of 20 (25.0%) after stretching exercise. There were no cases of unintended brachial plexus block after injection. Conclusion Ultrasound-guided steroid injection or stretching exercise of scalene muscles led to reduced upper extremity paresthesia in patients who present with localized tenderness in the scalene muscle without electrodiagnostic test abnormalities, although injection treatment resulted in more improvements. The results suggest that symptoms relief might result from injection into the muscle alone not related to blockade of the brachial plexus. PMID:26847305

DOE Office of Scientific and Technical Information (OSTI.GOV)

Lundstedt, Dan, E-mail: dan.lundstedt@gu.se; Division of Clinical Cancer Epidemiology, Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg; Gustafsson, Magnus

Purpose: To identify volume and dose predictors of paresthesia after irradiation of the brachial plexus among women treated for breast cancer. Methods and Materials: The women had breast surgery with axillary dissection, followed by radiation therapy with (n=192) or without irradiation (n=509) of the supraclavicular lymph nodes (SCLNs). The breast area was treated to 50 Gy in 2.0-Gy fractions, and 192 of the women also had 46 to 50 Gy to the SCLNs. We delineated the brachial plexus on 3-dimensional dose-planning computerized tomography. Three to eight years after radiation therapy the women answered a questionnaire. Irradiated volumes and doses were calculated andmore » related to the occurrence of paresthesia in the hand. Results: After treatment with axillary dissection with radiation therapy to the SCLNs 20% of the women reported paresthesia, compared with 13% after axillary dissection without radiation therapy, resulting in a relative risk (RR) of 1.47 (95% confidence interval [CI] 1.02-2.11). Paresthesia was reported by 25% after radiation therapy to the SCLNs with a V{sub 40} {sub Gy} ≥ 13.5 cm{sup 3}, compared with 13% without radiation therapy, RR 1.83 (95% CI 1.13-2.95). Women having a maximum dose to the brachial plexus of ≥55.0 Gy had a 25% occurrence of paresthesia, with RR 1.86 (95% CI 0.68-5.07, not significant). Conclusion: Our results indicate that there is a correlation between larger irradiated volumes of the brachial plexus and an increased risk of reported paresthesia among women treated for breast cancer.« less

Relation between digital peripheral arterial tonometry and brachial artery ultrasound measures of vascular function in patients with coronary artery disease and in healthy volunteers.

PubMed

Lee, Craig R; Bass, Almasa; Ellis, Kyle; Tran, Bryant; Steele, Savanna; Caughey, Melissa; Stouffer, George A; Hinderliter, Alan L

2012-03-01

Digital peripheral arterial tonometry (PAT) is an emerging, noninvasive method to assess vascular function. The physiology underlying this phenotype, however, remains unclear. Therefore, we evaluated the relation between digital PAT and established brachial artery ultrasound measures of vascular function under basal conditions and after reactive hyperemia. Using a cross-sectional study design, digital PAT and brachial artery ultrasonography with pulsed wave Doppler were simultaneously completed at baseline and after reactive hyperemia in both those with established coronary artery disease (n = 99) and healthy volunteers with low cardiovascular disease risk (n = 40). Under basal conditions, the digital pulse volume amplitude demonstrated a significant positive correlation with the brachial artery velocity-time integral that was independent of the arterial diameter, in both the healthy volunteer (r(s) = 0.64, p <0.001) and coronary artery disease (r(s) = 0.63, p <0.001) cohorts. Similar positive relations were observed with the baseline brachial artery blood flow velocity and blood flow. In contrast, no relation between the reactive hyperemia-evoked digital PAT ratio and either brachial artery flow-mediated dilation or shear stress was observed in either cohort (p = NS). In conclusion, these findings demonstrate that the digital PAT measures of vascular function more closely reflect basal blood flow in the brachial artery than reactive hyperemia-induced changes in the arterial diameter or flow velocity, and the presence of vascular disease does not modify the physiology underlying the digital PAT phenotype. Copyright © 2012 Elsevier Inc. All rights reserved.

Effect of Dexamethasone on Characteristics of Supraclavicular Nerve Block with Bupivacaine and Ropivacaine: A Prospective, Double-blind, Randomized Control Trial.

PubMed

Bindal, Deeksha; Narang, Neeraj; Mahindra, Rekha; Gupta, Himanshu; Kubre, Jyotsna; Saxena, Anudeep

2018-01-01

Dexamethasone as an adjuvant to bupivacaine and ropivacaine for supraclavicular brachial plexus (SCBP) block prolongs motor and sensory blockade. However, comparison of effect of dexamethasone (8 mg) when added to these two local anesthetics has not been well studied. This study was conducted to compare analgesic efficacy of dexamethasone as adjuvant to bupivacaine and ropivacaine in SCBP block. Nerve stimulator-guided SCBP block was given to 120 patients, randomly assigned to one of four groups: ( n = 30 in each group) Group B, BD, R, and RD received 30 ml (0.5%) bupivacaine + 2 ml saline, 30 ml (0.5%) bupivacaine + dexamethasone 8 mg, 30 ml (0.5%) ropivacaine + 2 ml saline, and 30 ml (0.5%) ropivacaine + dexamethasone 8 mg, respectively. Time for request of the first rescue analgesic, 24-h analgesic consumption, and different block characteristics were assessed. Student's t -test, Chi-square test, ANOVA were used for statistical analysis. Dexamethasone significantly prolonged time for request of the first rescue analgesic of both ropivacaine (1211.83 ± 32.86 vs. 283.17 ± 7.71 min){ p R, RD < 0.001} and bupivacaine (1205.17 ± 34.32 vs. 364.67 ± 16.50 min) {p B, BD < 0.001}. 24-h requirement for rescue analgesics was more in Groups B and R when compared to Groups BD and RD. The increase in duration of analgesia was more when Groups R and RD (928.66 min) were compared than Groups B and BD (840.5 min). Similar results were seen with onset times and duration of sensory and motor block. The addition of dexamethasone to bupivacaine and ropivacaine in SCBP block prolonged time for first rescue analgesia and reduced the requirement of rescue analgesics with faster onset and prolonged duration of sensory and motor block, with the effect being stronger with ropivacaine.

Comparison of the coracoid and retroclavicular approaches for ultrasound-guided infraclavicular brachial plexus block.

PubMed

Kavrut Ozturk, Nilgun; Kavakli, Ali Sait

2017-08-01

This prospective randomized study compared the coracoid and retroclavicular approaches to ultrasound-guided infraclavicular brachial plexus block (IBPB) in terms of needle tip and shaft visibility and quality of block. We hypothesized that the retroclavicular approach would increase needle tip and shaft visibility and decrease the number of needle passes compared to the coracoid approach. A total of 100 adult patients who received IBPB block for upper limb surgery were randomized into two groups: a coracoid approach group (group C) and a retroclavicular approach group (group R). In group C, the needle was inserted 2 cm medial and 2 cm inferior to the coracoid process and directed from ventral to dorsal. In group R, the needle insertion point was posterior to the clavicle and the needle was advanced from cephalad to caudal. All ultrasound images were digitally stored for analysis. The primary aim of the present study was to compare needle tip and shaft visibility between the coracoid approach and retroclavicular approach in patients undergoing upper limb surgery. The secondary aim was to investigate differences between the two groups in the number of needle passes, sensory and motor block success rates, surgical success rate, block performance time, block performance-related pain, patient satisfaction, use of supplemental local anesthetic and analgesic, and complications. Needle tip visibility and needle shaft visibility were significantly better in group R (p = 0.040, p = 0.032, respectively). Block performance time and anesthesia-related time were significantly shorter in group R (p = 0.022, p = 0.038, respectively). Number of needle passes was significantly lower in group R (p = 0.044). Paresthesia during block performance was significantly higher in group C (p = 0.045). There were no statistically significant differences between the two groups in terms of sensory or motor block success, surgical success, block-related pain, and patient satisfaction. The retroclavicular approach is associated with better needle tip and shaft visibility, reduced performance time and anesthesia-related time, less paresthesia during block performance, and fewer needle passes than the coracoid approach. TRıAL REGISTRY NUMBER: Clinicaltrials.gov (no. NCT02673086).

Adding a PECS II block for proximal arm arteriovenous access - a randomised study.

PubMed

Quek, K H; Low, E Y; Tan, Y R; Ong, A S C; Tang, T Y; Kam, J W; Kiew, A S C

2018-05-01

Brachial plexus block is often utilised for proximal arm arteriovenous access creation. However, the medial upper arm and axilla are often inadequately anaesthetised, requiring repeated, intraoperative local anaesthetic supplementation, or conversion into general anaesthesia. We hypothesised that the addition of a PECS II block would improve anaesthesia and analgesia for proximal arm arteriovenous access surgery. In this prospective, double-blinded, randomised proof-of-concept study, 36 consenting adults with end-stage renal disease aged between 21 and 90 years received either a combined supraclavicular and PECS II block (Group PECS, n = 18), or combined supraclavicular and sham block (Group SCB, n = 18) for proximal arm arteriovenous access surgery. Primary outcome was whether patients required intraoperative local anaesthetic supplementation by the surgeon. In Group PECS, 33.3% (6/18) needed local anaesthetic supplementation vs. 100% (18/18) in Group SCB. Group SCB had three times (RR 3.0, 95% CI 1.6-5.8; P < 0.001) the risk of requiring intraoperative local anaesthetic supplementation. Group PECS required lower volume of supplemental local anaesthetic compared to Group SCB (0.0 ml, IQR 0.0-6.3 ml vs. 15.0 ml, IQR 7.4-17.8 ml; P < 0.001). Group SCB had twice [RR 2.2, 95% CI 1.1-4.4; (P = 0.019)] the risk of needing additional sedation or analgesia. There were no significant differences between the groups with respect to postoperative visual analogue scale pain scores, time to first rescue analgesia or patient satisfaction. The results suggest that adding a PECS II block to a supraclavicular block improves regional anaesthesia for patients with end-stage renal disease undergoing proximal arm arteriovenous access surgery. © 2018 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

Effect of warming bupivacaine 0.5% on ultrasound-guided axillary plexus block. Randomized prospective double-blind study.

PubMed

Trabelsi, W; Ben Gabsia, A; Lebbi, A; Sammoud, W; Labbène, I; Kchelfi, S; Ferjani, M

2017-02-01

To evaluate the effect of warming bupivacaine 0.5% on ultrasound-guided axillary brachial plexus block. Prospective, randomized, double-blind. Eighty patients undergoing elective or emergency surgery beyond the distal third of the upper limb were divided into two groups of 40 patients: the warm group received 15mL bupivacaine 0.5% heated to 37°C; the cold group received 15mL 0.5% bupivacaine stored for at least 24hours in the lower compartment of a refrigerator at 13-15°C. Onset and duration of sensory and motor blocks were evaluated every 5minutes for 40minutes. Postoperative pain was evaluated at 1, 3, 6, 12 and 24hours. Effective analgesia time was recorded as the interval between anesthetic injection and the first analgesia requirement (VAS>30mm). Time to onset of sensory and motor block was significantly shorter in the warm group, and mean duration of sensory and motor block and of postoperative analgesia significantly longer. Warming bupivacaine 0.5% to 37°C accelerated onset of sensory and motor block and extended action duration. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

Radiation Therapy to the Plexus Brachialis in Breast Cancer Patients: Analysis of Paresthesia in Relation to Dose and Volume.

PubMed

Lundstedt, Dan; Gustafsson, Magnus; Steineck, Gunnar; Sundberg, Agnetha; Wilderäng, Ulrica; Holmberg, Erik; Johansson, Karl-Axel; Karlsson, Per

2015-06-01

To identify volume and dose predictors of paresthesia after irradiation of the brachial plexus among women treated for breast cancer. The women had breast surgery with axillary dissection, followed by radiation therapy with (n=192) or without irradiation (n=509) of the supraclavicular lymph nodes (SCLNs). The breast area was treated to 50 Gy in 2.0-Gy fractions, and 192 of the women also had 46 to 50 Gy to the SCLNs. We delineated the brachial plexus on 3-dimensional dose-planning computerized tomography. Three to eight years after radiation therapy the women answered a questionnaire. Irradiated volumes and doses were calculated and related to the occurrence of paresthesia in the hand. After treatment with axillary dissection with radiation therapy to the SCLNs 20% of the women reported paresthesia, compared with 13% after axillary dissection without radiation therapy, resulting in a relative risk (RR) of 1.47 (95% confidence interval [CI] 1.02-2.11). Paresthesia was reported by 25% after radiation therapy to the SCLNs with a V40 Gy ≥ 13.5 cm(3), compared with 13% without radiation therapy, RR 1.83 (95% CI 1.13-2.95). Women having a maximum dose to the brachial plexus of ≥55.0 Gy had a 25% occurrence of paresthesia, with RR 1.86 (95% CI 0.68-5.07, not significant). Our results indicate that there is a correlation between larger irradiated volumes of the brachial plexus and an increased risk of reported paresthesia among women treated for breast cancer. Copyright © 2015 Elsevier Inc. All rights reserved.

Ultrasound-guided axillary nerve block for ED incision and drainage of deltoid abscess.

PubMed

Lyons, Claire; Herring, Andrew A

2017-07-01

Deltoid abscesses are common and painful, often a consequence of injection drug use and seen frequently in emergency departments (EDs). The required incision and drainage can be completed successfully with effective pain relief using a peripheral nerve block. The brachial plexus nerve block works well, however it is technically complex with a low, but potentially serious, risk of complications such as phrenic nerve paralysis. Selective blockade of the axillary nerve eliminates the risks associated with a brachial plexus block, while providing more specific anesthesia for the deltoid region. Our initial experience suggests that the axillary nerve block (ANB) is a technically simple, safe, and effective way to manage the pain of deltoid abscesses and the necessary incision and drainage (I&D). The block involves using ultrasound guidance to inject a 20mL bolus of local anesthetic into the quadrangular space surrounding the axillary nerve (inferior to the posterolateral aspect of the acromion, near the overlap of the long head of triceps brachii and teres minor). Once injected the local will anesthetize the axillary nerve resulting in analgesia of the cutaneous area of the lateral shoulder and the deeper tissues including the deltoid muscle. Further research will clarify questions about the volume and concentration of local anesthetic, the role of injected adjuncts, and expected duration of analgesia and anesthesia. Herein we present a description of an axillary nerve block successfully used for deltoid abscess I&D in the ED. Copyright © 2017 Elsevier Inc. All rights reserved.

Coded excitation ultrasonic needle tracking: An in vivo study.

PubMed

Xia, Wenfeng; Ginsberg, Yuval; West, Simeon J; Nikitichev, Daniil I; Ourselin, Sebastien; David, Anna L; Desjardins, Adrien E

2016-07-01

Accurate and efficient guidance of medical devices to procedural targets lies at the heart of interventional procedures. Ultrasound imaging is commonly used for device guidance, but determining the location of the device tip can be challenging. Various methods have been proposed to track medical devices during ultrasound-guided procedures, but widespread clinical adoption has remained elusive. With ultrasonic tracking, the location of a medical device is determined by ultrasonic communication between the ultrasound imaging probe and a transducer integrated into the medical device. The signal-to-noise ratio (SNR) of the transducer data is an important determinant of the depth in tissue at which tracking can be performed. In this paper, the authors present a new generation of ultrasonic tracking in which coded excitation is used to improve the SNR without spatial averaging. A fiber optic hydrophone was integrated into the cannula of a 20 gauge insertion needle. This transducer received transmissions from the ultrasound imaging probe, and the data were processed to obtain a tracking image of the needle tip. Excitation using Barker or Golay codes was performed to improve the SNR, and conventional bipolar excitation was performed for comparison. The performance of the coded excitation ultrasonic tracking system was evaluated in an in vivo ovine model with insertions to the brachial plexus and the uterine cavity. Coded excitation significantly increased the SNRs of the tracking images, as compared with bipolar excitation. During an insertion to the brachial plexus, the SNR was increased by factors of 3.5 for Barker coding and 7.1 for Golay coding. During insertions into the uterine cavity, these factors ranged from 2.9 to 4.2 for Barker coding and 5.4 to 8.5 for Golay coding. The maximum SNR was 670, which was obtained with Golay coding during needle withdrawal from the brachial plexus. Range sidelobe artifacts were observed in tracking images obtained with Barker coded excitation, and they were visually absent with Golay coded excitation. The spatial tracking accuracy was unaffected by coded excitation. Coded excitation is a viable method for improving the SNR in ultrasonic tracking without compromising spatial accuracy. This method provided SNR increases that are consistent with theoretical expectations, even in the presence of physiological motion. With the ultrasonic tracking system in this study, the SNR increases will have direct clinical implications in a broad range of interventional procedures by improving visibility of medical devices at large depths.

Types and severity of operated supraclavicular brachial plexus injuries caused by traffic accidents.

PubMed

Kaiser, Radek; Waldauf, Petr; Haninec, Pavel

2012-07-01

Brachial plexus injuries occur in up to 5% of polytrauma cases involving motorcycle accidents and in approximately 4% of severe winter sports injuries. One of the criteria for a successful operative therapy is the type of lesion. Upper plexus palsy has the best prognosis, whereas lower plexus palsy is surgically untreatable. The aim of this study was to evaluate a group of patients with brachial plexus injury caused by traffic accidents, categorize the injuries according to type of accident, and look for correlations between type of palsy (injury) and specific accidents. A total of 441 brachial plexus reconstruction patients from our department were evaluated retrospectively(1993 to 2011). Sex, age, neurological status, and the type and cause of injury were recorded for each case. Patients with BPI caused by a traffic accident were assessed in detail. Traffic accidents were the cause of brachial plexus injury in most cases (80.7%). The most common type of injury was avulsion of upper root(s) (45.7%) followed by rupture (28.2%), complete avulsion (16.9%) and avulsion of lower root(s) (9.2%). Of the patients, 73.9% had an upper,22.7% had a complete and only 3.4% had a lower brachial plexus palsy. The main cause was motorcycle accidents(63.2%) followed by car accidents (23.5%), bicycle accidents(10.7%) and pedestrian collisions (3.1%) (p<0.001).Patients involved in car accidents had a higher percentage of lower avulsion (22.7%) and a lower percentage of upper avulsion (29.3%), whereas cyclists had a higher percentage of upper avulsion (68.6%) based on the data from the entire group of patients (p<0.001). Lower plexus palsy was significantly increased in patients after car accidents (9.3%,p<0.05). In the two main groups (car and motorcycle accidents),significantly more upper and fewer lower palsies were present. In the bicycle accident group, upper palsy was the most common (89%). Study results indicate that the most common injury was an upper plexus palsy. It was characteristic of bicycle accidents, and significantly more common in car and motorcycle accidents. The results also indicate that it is important to consider the potential of a brachial plexus injury after serious traffic accidents and to examine both upper extremities in detail even if some motor function is preserved.

"One-stop-shop" ultrasound diagnosis of functional, structural and physicomechanical properties of the brachial artery.

PubMed

Balzer, J; Boos, M; Rassaf, T; Heiss, Ch; Preik, M; Matern, S; Schoebel, F; Kelm, M; Lauer, T

2007-05-01

The pathogenesis of atherosclerosis comprises endothelial dysfunction, thickening as well as impaired compliance of the arterial vessel wall. Early assessment of these alterations of the vessel wall at the same site of the vascular tree has yet been hampered by the lack of highly sensitive diagnostic approaches suitable for clinical routine. We therefore aimed to develop and validate a single non-invasive examination of the brachial artery for simultaneous and highly accurate measurement of functional, structural and physicomechanical parameters of the brachial artery. 20 healthy individuals were investigated using high resolution ultrasound. Flow-mediated dilation (FMD), fractional diameter changes (FDC) and intima-media-thickness (IMT) were measured in the same segment of the brachial artery. Coefficients of variation, day-to-day-variability, between- and within-observer-variability were investigated in 5 individuals. All measurements were performed manually and by an automated PC-based analyzing system. Mean values for all measured parameters were 7.65 +/- 0.8% for FMD, 0.02 +/- 0.002 for FDC, 0.351 +/- 0.007 mm for IMT and followed an even distribution throughout the study population. Automated analysis of coefficient of variation, day-to-day-, between- and within-observer variabilities were: 0. 78%, 1.3%, 0.8%, 0.8% (FMD); 4.7%, 2.8%, 4.2%, 2.7% (FDC); 1.8%, 1.1%, 1.9%, 1.1% (IMT). Coefficient of variation, day-to-day-, between- and within-observer variabilities for the manual readings were significantly higher. Functional, structural and physicomechanical parameters of the brachial artery can be quantified consecutively, time-saving and highly reproducibly as an "one-stop-shop" in a single session using high resolution ultrasound with digitized post-processing. This highlights the future possibility of early, sensitive and non-invasive diagnostic testing of vascular function in patients prone to vascular disease.

Nitroglycerin mediated dilation evaluated by ultrasound is associated with sTWEAK in hemodialysis patients.

PubMed

Rusu, Crina Claudia; Ghervan, Liviu; Racasan, Simona; Kacsa, Ina; Moldovan, Diana; Potra, Alina; Bondor, Cosmina; Anton, Florin; Patiu, Ioan Mihai; Caprioara, Mirela Gherman

2016-03-01

The main cause of death in hemodialysis (HD) patients is cardiovascular disease. Ultrasound assessment of the brachial artery dysfunction is easily achievable and can non-invasively detect atherosclerosis in various stages. In HD patients the cardiovascular risk profile is different and the determinants of brachial arterial function can be distinct comparing with general population. The aim of the study is to assess the determinants of arterial brachial function (flow-mediated and nitroglycerin-mediated dilation) evaluated by ultrasound in HD patients and their relation with tumor necrosis factor-like weak inducer of apoptosis (sTWEAK) described as atherosclerotic marker in chronic kidney disease patients. We conducted a cross-sectional observational study on 54 hemodialysis patients. We recorded clinical and biological data and we measured sTWEAK serum levels by ELISA. We evaluated the arterial brachial function by measurement of flow-mediated and nitroglycerin-mediated dilation, using B mode ultrasound. The determinants of flow-mediated dilation were: Kt/V (r=0.47, p<0.001), LDL-cholesterol (r=0.29, p=0.04), and total cholesterol (r=0.31, p=0.02). Flow-mediated dilation correlated with nitroglycerin-mediated dilation (r=0.70, p<0.001). In multivariate analysis kt/V was the only significant predictor for flow-mediated dilation (p=0.04). Nitroglycerin-mediated dilation correlates with sTWEAK (r=-0.30, p=0.03), systolic blood pressure (r=-0.28, p=0.04) and pulse pressure (r=-0.31, p=0.02). In multivariate analysis sTWEAK was the only significant predictor for nitroglycerin-mediated dilation (p=0.04). The main determinant of nitroglycerin-mediated dilation was sTWEAK. In addition, decreased nitroglycerin-mediated dilation was associated with higher systolic blood pressure and pulse pressure. The main determinant of FMD was Kt/V. Increased flow-mediated dilation was associated with better dialysis efficiency and high total cholesterol and LDL-cholesterol.

Multicystic mesothelioma--a rare case of ascites: case report.

PubMed

Manuc, M; Lamatic, C; Pop, C; Dobrea, C; Becheanu, G; Grasu, M; Iosif, D; Diculescu, M

2007-01-01

We present the case of a 37-year-old male, admitted to our clinic with abdominal tenderness, right supraclavicular tumour, and ascites. The presence of ascites was incidentally reported 6 years before, but no other evaluation was done at that moment or during this period. Abdominal ultrasound and CT scan revealed moderate ascites, perivascular adenopathies, and multiple abdominal cystic lesions, while thoracic CT scan revealed the same lesions in mediastinum. Laboratory data were within normal limits, including the tumoral markers, and the tests for hydatid cysts. A biopsy from the right supraclavicular nodule was performed, and based on usual and immunohistochemical stains (calretinin, mesotheline, CK 5/6, CK 7, CK18 diffusely positive in mesothelial cells, and CEA -M, bcl-2 and vimentin negative), suggested the diagnosis of mesothelioma. Based on these results, the diagnosis of "multicystic mesothelioma" was made. The patient was referred for surgery.

Brachial Plexus Injury from CT-Guided RF Ablation Under General Anesthesia

DOE Office of Scientific and Technical Information (OSTI.GOV)

Shankar, Sridhar, E-mail: shankars@ummhc.org; Sonnenberg, Eric van; Silverman, Stuart G.

2005-06-15

Brachial plexus injury in a patient under general anesthesia (GA) is not uncommon, despite careful positioning and, particularly, awareness of the possibility. The mechanism of injury is stretching and compression of the brachial plexus over a prolonged period. Positioning the patient within the computed tomography (CT) gantry for abdominal or chest procedures can simulate a surgical procedure, particularly when GA is used. The potential for brachial plexus injury is increased if the case is prolonged and the patient's arms are raised above the head to avoid CT image degradation from streak artifacts. We report a case of profound brachial plexusmore » palsy following a CT-guided radiofrequency ablation procedure under GA. Fortunately, the patient recovered completely. We emphasize the mechanism of injury and detail measures to combat this problem, such that radiologists are aware of this potentially serious complication.« less

Audible handheld Doppler ultrasound determines reliable and inexpensive exclusion of significant peripheral arterial disease.

PubMed

Alavi, Afsaneh; Sibbald, R Gary; Nabavizadeh, Reza; Valaei, Farnaz; Coutts, Pat; Mayer, Dieter

2015-12-01

To determine the accuracy of audible arterial foot signals with an audible handheld Doppler ultrasound for identification of significant peripheral arterial disease as a simple, quick, and readily available bedside screening tool. Two hundred consecutive patients referred to an interprofessional wound care clinic underwent audible handheld Doppler ultrasound of both legs. As a control and comparator, a formal bilateral lower leg vascular study including the calculation of Ankle Brachial Pressure Index and toe pressure (TP) was performed at the vascular lab. Diagnostic reliability of audible handheld Doppler ultrasound was calculated versus Ankle Brachial Pressure Index as the gold standard test. A sensitivity of 42.8%, a specificity of 97.5%, negative predictive value of 94.10%, positive predictive value of 65.22%, positive likelihood ratio of 17.52, and negative likelihood ratio of 0.59. The univariable logistic regression model had an area under the curve of 0.78. There was a statistically significant difference at the 5% level between univariable and multivariable area under the curves of the dorsalis pedis and posterior tibial models (p < 0.001). Audible handheld Doppler ultrasound proved to be a reliable, simple, rapid, and inexpensive bedside exclusion test of peripheral arterial disease in diabetic and nondiabetic patients. © The Author(s) 2015.

Visualization Improves Supraclavicular Access to the Subclavian Vein in a Mixed Reality Simulator.

PubMed

Sappenfield, Joshua Warren; Smith, William Brit; Cooper, Lou Ann; Lizdas, David; Gonsalves, Drew B; Gravenstein, Nikolaus; Lampotang, Samsun; Robinson, Albert R

2018-07-01

We investigated whether visual augmentation (3D, real-time, color visualization) of a procedural simulator improved performance during training in the supraclavicular approach to the subclavian vein, not as widely known or used as its infraclavicular counterpart. To train anesthesiology residents to access a central vein, a mixed reality simulator with emulated ultrasound imaging was created using an anatomically authentic, 3D-printed, physical mannequin based on a computed tomographic scan of an actual human. The simulator has a corresponding 3D virtual model of the neck and upper chest anatomy. Hand-held instruments such as a needle, an ultrasound probe, and a virtual camera controller are directly manipulated by the trainee and tracked and recorded with submillimeter resolution via miniature, 6 degrees of freedom magnetic sensors. After Institutional Review Board approval, 69 anesthesiology residents and faculty were enrolled and received scripted instructions on how to perform subclavian venous access using the supraclavicular approach based on anatomic landmarks. The volunteers were randomized into 2 cohorts. The first used real-time 3D visualization concurrently with trial 1, but not during trial 2. The second did not use real-time 3D visualization concurrently with trial 1 or 2. However, after trial 2, they observed a 3D visualization playback of trial 2 before performing trial 3 without visualization. An automated scoring system based on time, success, and errors/complications generated objective performance scores. Nonparametric statistical methods were used to compare the scores between subsequent trials, differences between groups (real-time visualization versus no visualization versus delayed visualization), and improvement in scores between trials within groups. Although the real-time visualization group demonstrated significantly better performance than the delayed visualization group on trial 1 (P = .01), there was no difference in gain scores, between performance on the first trial and performance on the final trial, that were dependent on group (P = .13). In the delayed visualization group, the difference in performance between trial 1 and trial 2 was not significant (P = .09); reviewing performance on trial 2 before trial 3 resulted in improved performance when compared to trial 1 (P < .0001). There was no significant difference in median scores (P = .13) between the real-time visualization and delayed visualization groups for the last trial after both groups had received visualization. Participants reported a significant improvement in confidence in performing supraclavicular access to the subclavian vein. Standard deviations of scores, a measure of performance variability, decreased in the delayed visualization group after viewing the visualization. Real-time visual augmentation (3D visualization) in the mixed reality simulator improved performance during supraclavicular access to the subclavian vein. No difference was seen in the final trial of the group that received real-time visualization compared to the group that had delayed visualization playback of their prior attempt. Training with the mixed reality simulator improved participant confidence in performing an unfamiliar technique.

Retrieval of a subintimal fractured guide wire from the brachial artery following saphenous vein graft stenting.

PubMed

Danson, Edward J; Ward, Michael

2015-06-01

We present a case of a 58-year-old woman with diabetes mellitus with a history of angina, coronary artery bypass 24 years previously and who underwent retrieval of a fractured coronary buddy wire from the right brachial artery following attempted coronary intervention to a saphenous vein graft via the right radial route. Attempted removal of the guide wire had caused guide catheter-induced dissection of the vein graft in addition to a distal stent edge dissection before fracture in the brachial artery. The fractured end of the buddy wire was found to be in the subintimal space and could only be retrieved by advancing the wire into the subclavian artery by means of wrapping its free portion around the guiding catheter. Its fractured end could then be snared into the guiding catheter but could only be withdrawn from behind the stented segment in the vein graft by means of a trap balloon in the guiding catheter. Successful stenting of a guide catheter-induced dissection and distal stent edge dissection within the vein graft was then performed. This case highlights the hazards of deploying stents over buddy wires and of fractured guide wires in coronary intervention. © 2015 Wiley Periodicals, Inc. © 2015 Wiley Periodicals, Inc.

True Brachial Artery Aneurysm in a Patient with Vascular Access for Haemodialysis and Kidney Graft.

PubMed

Correia, Mafalda; Marinho, André; Mendes, Carolina; Antunes, Luís; Gonçalves, Óscar

2017-01-01

True brachial artery aneurysms are rare and some of them have been described as a late complication in patients with vascular access for haemodialysis and kidney graft. The purpose of this paper is to present a clinical case of a patient with a true brachial artery aneurysm and its following treatment. This case concerns a caucasian male patient with 43 years old who had vesicoureteral reflux at 7 years old, and subsequent end-stage renal disease, and started on haemodialysis at the age of twelve. The patient had homolateral radial and brachiocephalic arteriovenous fistulas (AVF), two sequential kidney grafts and was under immunosuppressant therapy for several years. As part of the medical history he also had bilateral amaurosis, Hepatitis B and C and was submitted to total parathyroidectomy and a following auto-transplant. In the latest years the patient presented with several aneurysms related to the vascular access. After the finding of an anastomotic false aneurysm and venous aneurysms complicating the AVF, the patient had removal of the aneurysms and ligation of the AVF. Later, he was diagnosed, in different times, with two true brachial artery aneurysms. At the time of the diagnosis of the first true aneurysm, the patient presented with local pain and occasional paraesthesias relative to compression symptoms. At physical examination the patient had a brachial pulsatile mass and a palpable radial pulse. The Doppler ultrasound exam revealed a true brachial artery aneurysm with 4,5 cm diameter. After two years, the patient was once again diagnosed with a true brachial artery aneurysm with 3,1 cm diameter. At this time the patient was asymptomatic and had palpable brachial mass and radial pulse. At the time of the diagnosis of the first true brachial aneurysm the patient was submitted to partial aneurysmectomy and brachiobrachial graft with PTFE 8. The patency of the graft persisted until the diagnosis of the second aneurysm. After two years, the patient was submitted to partial aneurysmectomy and axilobrachial graft with PTFE 8. During the follow-up period, the patient remained asymptomatic, had palpable radial pulse and the Doppler ultrasound exam confirmed the patency of the graft. The surveillance of patients with long duration AVF and kidney grafts might be advantageous in the early detection of arterial aneurysms. The surgical treatment in this group of patients is a first treatment option that is associated to a low morbidity.

8A.03: CONTINUOUS MONITORING OF HEMODYNAMICS IN THE SHORT ARM HUMAN CENTRIFUGE: A FEASIBILITY STUDY.

PubMed

Londono, F; Uytterhaegen, B; Kassel, R; Vanraemdonck, R; Beck, A; Comet, B; Runge, A; Segers, P

2015-06-01

The aim was to test the technical feasibility of a set up combining tonometry and ultrasound, designated as Continuous Physiological and Medical Monitoring (CPMM), for cardiovascular assessment on humans and to evaluate the ability to assess physiological changes induced by artificial gravity in the short arm human centrifuge (SAHC, Verhaert, Belgium) for detecting and preventing potential disorders induced by weightlessness. The project was developed under an European Space Agency (ESA) contract (4000101988/10/NL/EM) and with its support, by the company Verhaert in consortium with the Institute for Space Medicine and Physiology (MEDES) and Ghent University. Measurements were performed at MEDES facilities in 4 young (presumably) healthy volunteers (3 males). For two volunteers, the protocol was divided in three periods: acceleration, steady rotation velocity and deceleration, obtaining carotid pulsed wave (PW)-Mode ultrasound sequences. For another volunteer (female), carotid PW-Mode ultrasound images and brachial and radial tonometry signals were acquired at baseline and during steady rotation. For the fourth volunteer, carotid and femoral PW-Mode ultrasound images and brachial, radial and carotid tonometry signals were acquired at baseline and during an initial (velocity1) and a following faster (velocity2) rotation velocity (see figure on the following page). Carotid PW-Mode ultrasound imaging was obtained in all 4 volunteers during different steps of the protocol. Femoral ultrasound imaging presented more difficulties related mainly to the placement of the probe after baseline, even if in one case results were feasible. Tonometry was, generally, a bigger challenge due to the intrinsic sensitivity of the method. Overall, radial artery tonometry provided the best results, while brachial artery results were acceptable only in one occasion. Carotid tonometry was measured only for one subject with suitable results for processing. Tonometry measurements were feasible under a spin velocity limit, while PW-Mode ultrasound images were more robust and stable. Although general conclusions must be supported by a larger sample, suitable signals and locations were identified and a user friendly and mobile set-up was tested successfully and it is available for further research to identified and assess mechanisms and reflexes acting in physiological adaptation to various gravity conditions.(Figure is included in full-text article.).

Effects of posture on shear rates in human brachial and superficial femoral arteries

PubMed Central

Newcomer, S. C.; Sauder, C. L.; Kuipers, N. T.; Laughlin, M. H.; Ray, C. A.

2012-01-01

Shear rate is significantly lower in the superficial femoral compared with the brachial artery in the supine posture. The relative shear rates in these arteries of subjects in the upright posture (seated and/or standing) are unknown. The purpose of this investigation was to test the hypothesis that upright posture (seated and/or standing) would produce greater shear rates in the superficial femoral compared with the brachial artery. To test this hypothesis, Doppler ultrasound was used to measure mean blood velocity (MBV) and diameter in the brachial and superficial femoral arteries of 21 healthy subjects after being in the supine, seated, and standing postures for 10 min. MBV was significantly higher in the brachial compared with the superficial femoral artery during upright postures. Superficial femoral artery diameter was significantly larger than brachial artery diameter. However, posture had no significant effect on either brachial or superficial femoral artery diameter. The calculated shear rate was significantly greater in the brachial (73 ± 5, 91 ± 11, and 97 ± 13 s−1) compared with the superficial femoral (53 ± 4, 39 ± 77, and 44 ± 5 s−1) artery in the supine, seated, and standing postures, respectively. Contrary to our hypothesis, our current findings indicate that mean shear rate is lower in the superficial femoral compared with the brachial artery in the supine, seated, and standing postures. These findings of lower shear rates in the superficial femoral artery may be one mechanism for the higher propensity for atherosclerosis in the arteries of the leg than of the arm. PMID:18245564

Objective methods for achieving an early prediction of the effectiveness of regional block anesthesia using thermography and hyper-spectral imaging

NASA Astrophysics Data System (ADS)

Klaessens, John H. G. M.; Landman, Mattijs; de Roode, Rowland; Noordmans, Herke J.; Verdaasdonk, Rudolf M.

2011-03-01

An objective method to measure the effectiveness of regional anesthesia can reduce time and unintended pain inflicted to the patient. A prospective observational study was performed on 22 patients during a local anesthesia before undergoing hand surgery. Two non-invasive techniques thermal and oxygenation imaging were applied to observe the region affected by the peripheral block and the results were compared to the standard cold sensation test. The supraclavicular block was placed under ultrasound guidance around the brachial plexus by injecting 20 cc Ropivacaine. The sedation causes a relaxation of the muscles around the blood vessels resulting in dilatation and hence an increase of blood perfusion, skin temperature and skin oxygenation in the lower arm and hand. Temperatures were acquired with an IR thermal camera (FLIR ThermoCam SC640). The data were recorded and analyzed with the ThermaCamTMResearcher and Matlab software. Narrow band spectral images were acquired at selected wavelengths with a CCD camera either combined with a Liquid Crystal Tunable Filter (420-730 nm) or a tunable hyper-wavelength LED light source (450-880nm). Concentration changes of oxygenated and deoxygenated hemoglobin in the dermis of the skin were calculated using the modified Lambert Beer equation. Both imaging methods showed distinct oxygenation and temperature differences at the surface of the skin of the hand with a good correlation to the anesthetized areas. A temperature response was visible within 5 minutes compared to the standard of 30 minutes. Both non-contact methods show to be more objective and can have an earlier prediction for the effectiveness of the anesthetic block.

Surgical Missteps in the Management of Venous Thoracic Outlet Syndrome Which Lead to Reoperation.

PubMed

Archie, Meena M; Rollo, Johnathon C; Gelabert, Hugh A

2018-05-01

Surgical management of spontaneous subclavian thrombosis due to venous thoracic outlet syndrome (vTOS) results in durable relief of symptoms. The need to reoperate is rare. We report our experience with reoperation for vTOS. Patients evaluated for vTOS between 1996 and 2016 were identified in a prospective database. Data recorded included demographics, initial presentation, initial surgery, recurrent presentation, reoperation, and final outcomes. In all, 261 patients were evaluated for vTOS, of these, 246 patients underwent first rib resections. Ten (3.8%) patients required evaluation for recurrent vTOS symptoms. Prior management included thrombolysis (4) and anticoagulation alone (6). Prior surgical approaches included infraclavicular (2), supraclavicular (2) and transaxillary (6). One operation was complicated by a hemothorax, and one a brachial plexus injury. Indication for reoperation included congestive symptoms (6) and recurrent thrombosis (4). Evaluation included chest X-rays (10), venogram (8), intra-venous ultrasound (2), and computed tomography venography (3). Significant compression by remaining rib segments were identified in all: inadequate resection of the anterior first rib (7), inadequate resection of posterior rib segment (1), and erroneous resection of second rib (2). Reoperations include 7 transaxillary approaches, 1 medial claviculectomy, and 1 paraclavicular decompression. One phrenic nerve palsy occurred following paraclavicular decompression. All underwent postoperative venography and angioplasty. At final evaluation, 8 veins are patent and congestive symptoms resolved, and 1 crushed stent could not be reopened despite decompression. The incidence of reoperation for first rib resection in cases of vTOS is low and appears largely due to missteps during the initial operation. Awareness of potential errors including inadequacy of resection, intraoperative disorientation, and misunderstanding of the limitations of surgical approaches will result in fewer reoperations. Published by Elsevier Inc.

Brachial arteriovenous fistula as a complication of placement of a peripherally inserted central venous catheter: a case report and review of the literature.

PubMed

Tran, Hoang S; Burrows, Brian J; Zang, William A; Han, David C

2006-09-01

Peripherally inserted central venous catheter (PICC) lines have become a frequently used method of intravenous access for long-term administration of antibiotics, chemotherapy, and parenteral nutrition. Catheter-related complications involving the arterial tree are rare. We report a case of a 25-year-old woman with a history of difficult PICC line placement that presented with an arteriovenous fistula in the left arm. Duplex ultrasound confirmed the diagnosis of a brachial artery-to-brachial vein arteriovenous fistula (AVF), and the patient underwent surgical repair. To our knowledge, this is the first reported case of an AVF resulting from PICC line placement. Correction of AVF is indicated to alleviate symptoms as well as to prevent future complications.

Brachial artery vasomotion and transducer pressure effect on measurements by active contour segmentation on ultrasound

DOE Office of Scientific and Technical Information (OSTI.GOV)

Cary, Theodore W.; Sultan, Laith R.; Sehgal, Chandra M., E-mail: sehgalc@uphs.upenn.edu

Purpose: To use feed-forward active contours (snakes) to track and measure brachial artery vasomotion on ultrasound images recorded in both transverse and longitudinal views; and to compare the algorithm's performance in each view. Methods: Longitudinal and transverse view ultrasound image sequences of 45 brachial arteries were segmented by feed-forward active contour (FFAC). The segmented regions were used to measure vasomotion artery diameter, cross-sectional area, and distention both as peak-to-peak diameter and as area. ECG waveforms were also simultaneously extracted frame-by-frame by thresholding a running finite-difference image between consecutive images. The arterial and ECG waveforms were compared as they traced eachmore » phase of the cardiac cycle. Results: FFAC successfully segmented arteries in longitudinal and transverse views in all 45 cases. The automated analysis took significantly less time than manual tracing, but produced superior, well-behaved arterial waveforms. Automated arterial measurements also had lower interobserver variability as measured by correlation, difference in mean values, and coefficient of variation. Although FFAC successfully segmented both the longitudinal and transverse images, transverse measurements were less variable. The cross-sectional area computed from the longitudinal images was 27% lower than the area measured from transverse images, possibly due to the compression of the artery along the image depth by transducer pressure. Conclusions: FFAC is a robust and sensitive vasomotion segmentation algorithm in both transverse and longitudinal views. Transverse imaging may offer advantages over longitudinal imaging: transverse measurements are more consistent, possibly because the method is less sensitive to variations in transducer pressure during imaging.« less

Brachial artery vasomotion and transducer pressure effect on measurements by active contour segmentation on ultrasound.

PubMed

Cary, Theodore W; Reamer, Courtney B; Sultan, Laith R; Mohler, Emile R; Sehgal, Chandra M

2014-02-01

To use feed-forward active contours (snakes) to track and measure brachial artery vasomotion on ultrasound images recorded in both transverse and longitudinal views; and to compare the algorithm's performance in each view. Longitudinal and transverse view ultrasound image sequences of 45 brachial arteries were segmented by feed-forward active contour (FFAC). The segmented regions were used to measure vasomotion artery diameter, cross-sectional area, and distention both as peak-to-peak diameter and as area. ECG waveforms were also simultaneously extracted frame-by-frame by thresholding a running finite-difference image between consecutive images. The arterial and ECG waveforms were compared as they traced each phase of the cardiac cycle. FFAC successfully segmented arteries in longitudinal and transverse views in all 45 cases. The automated analysis took significantly less time than manual tracing, but produced superior, well-behaved arterial waveforms. Automated arterial measurements also had lower interobserver variability as measured by correlation, difference in mean values, and coefficient of variation. Although FFAC successfully segmented both the longitudinal and transverse images, transverse measurements were less variable. The cross-sectional area computed from the longitudinal images was 27% lower than the area measured from transverse images, possibly due to the compression of the artery along the image depth by transducer pressure. FFAC is a robust and sensitive vasomotion segmentation algorithm in both transverse and longitudinal views. Transverse imaging may offer advantages over longitudinal imaging: transverse measurements are more consistent, possibly because the method is less sensitive to variations in transducer pressure during imaging.

Brachial artery vasomotion and transducer pressure effect on measurements by active contour segmentation on ultrasound

PubMed Central

Cary, Theodore W.; Reamer, Courtney B.; Sultan, Laith R.; Mohler, Emile R.; Sehgal, Chandra M.

2014-01-01

Purpose: To use feed-forward active contours (snakes) to track and measure brachial artery vasomotion on ultrasound images recorded in both transverse and longitudinal views; and to compare the algorithm's performance in each view. Methods: Longitudinal and transverse view ultrasound image sequences of 45 brachial arteries were segmented by feed-forward active contour (FFAC). The segmented regions were used to measure vasomotion artery diameter, cross-sectional area, and distention both as peak-to-peak diameter and as area. ECG waveforms were also simultaneously extracted frame-by-frame by thresholding a running finite-difference image between consecutive images. The arterial and ECG waveforms were compared as they traced each phase of the cardiac cycle. Results: FFAC successfully segmented arteries in longitudinal and transverse views in all 45 cases. The automated analysis took significantly less time than manual tracing, but produced superior, well-behaved arterial waveforms. Automated arterial measurements also had lower interobserver variability as measured by correlation, difference in mean values, and coefficient of variation. Although FFAC successfully segmented both the longitudinal and transverse images, transverse measurements were less variable. The cross-sectional area computed from the longitudinal images was 27% lower than the area measured from transverse images, possibly due to the compression of the artery along the image depth by transducer pressure. Conclusions: FFAC is a robust and sensitive vasomotion segmentation algorithm in both transverse and longitudinal views. Transverse imaging may offer advantages over longitudinal imaging: transverse measurements are more consistent, possibly because the method is less sensitive to variations in transducer pressure during imaging. PMID:24506648

Ultrasound-Guided Out-of-Plane vs. In-Plane Interscalene Catheters: A Randomized, Prospective Study.

PubMed

Schwenk, Eric S; Gandhi, Kishor; Baratta, Jaime L; Torjman, Marc; Epstein, Richard H; Chung, Jaeyoon; Vaghari, Benjamin A; Beausang, David; Bojaxhi, Elird; Grady, Bernadette

2015-12-01

Continuous interscalene blocks provide excellent analgesia after shoulder surgery. Although the safety of the ultrasound-guided in-plane approach has been touted, technical and patient factors can limit this approach. We developed a caudad-to-cephalad out-of-plane approach and hypothesized that it would decrease pain ratings due to better catheter alignment with the brachial plexus compared to the in-plane technique in a randomized, controlled study. To compare an out-of-plane interscalene catheter technique to the in-plane technique in a randomized clinical trial. Eighty-four patients undergoing open shoulder surgery were randomized to either the in-plane or out-of-plane ultrasound-guided continuous interscalene technique. The primary outcome was VAS pain rating at 24 hours. Secondary outcomes included pain ratings in the recovery room and at 48 hours, morphine consumption, the incidence of catheter dislodgments, procedure time, and block difficulty. Procedural data and all pain ratings were collected by blinded observers. There were no differences in the primary outcome of median VAS pain rating at 24 hours between the out-of-plane and in-plane groups (1.50; IQR, [0 - 4.38] vs. 1.25; IQR, [0 - 3.75]; P = 0.57). There were also no differences, respectively, between out-of-plane and in-plane median PACU pain ratings (1.0; IQR, [0 - 3.5] vs. 0.25; IQR, [0 - 2.5]; P = 0.08) and median 48-hour pain ratings (1.25; IQR, [1.25 - 2.63] vs. 0.50; IQR, [0 - 1.88]; P = 0.30). There were no differences in any other secondary endpoint. Our out-of-plane technique did not provide superior analgesia to the in-plane technique. It did not increase the number of complications. Our technique is an acceptable alternative in situations where the in-plane technique is difficult to perform.

Delineation of Supraclavicular Target Volumes in Breast Cancer Radiation Therapy

DOE Office of Scientific and Technical Information (OSTI.GOV)

Brown, Lindsay C.; Diehn, Felix E.; Boughey, Judy C.

Purpose: To map the location of gross supraclavicular metastases in patients with breast cancer, in order to determine areas at highest risk of harboring subclinical disease. Methods and Materials: Patients with axial imaging of gross supraclavicular disease were identified from an institutional breast cancer registry. Locations of the metastatic lymph nodes were transferred onto representative axial computed tomography images of the supraclavicular region and compared with the Radiation Therapy Oncology Group (RTOG) breast cancer atlas for radiation therapy planning. Results: Sixty-two patients with 161 supraclavicular nodal metastases were eligible for study inclusion. At the time of diagnosis, 117 nodal metastasesmore » were present in 44 patients. Forty-four nodal metastases in 18 patients were detected at disease recurrence, 4 of whom had received prior radiation to the supraclavicular fossa. Of the 161 nodal metastases, 95 (59%) were within the RTOG consensus volume, 4 nodal metastases (2%) in 3 patients were marginally within the volume, and 62 nodal metastases (39%) in 30 patients were outside the volume. Supraclavicular disease outside the RTOG consensus volume was located in 3 regions: at the level of the cricoid and thyroid cartilage (superior to the RTOG volume), in the posterolateral supraclavicular fossa (posterolateral to the RTOG volume), and in the lateral low supraclavicular fossa (lateral to the RTOG volume). Only women with multiple supraclavicular metastases had nodal disease that extended superiorly to the level of the thyroid cartilage. Conclusions: For women with risk of harboring subclinical supraclavicular disease warranting the addition of supraclavicular radiation, coverage of the posterior triangle and the lateral low supraclavicular region should be considered. For women with known supraclavicular disease, extension of neck coverage superior to the cricoid cartilage may be warranted.« less

Flow mediated dilation of the brachial artery: an investigation of methods requiring further standardization

PubMed Central

Peretz, Alon; Leotta, Daniel F; Sullivan, Jeffrey H; Trenga, Carol A; Sands, Fiona N; Aulet, Mary R; Paun, Marla; Gill, Edward A; Kaufman, Joel D

2007-01-01

Background In order to establish a consistent method for brachial artery reactivity assessment, we analyzed commonly used approaches to the test and their effects on the magnitude and time-course of flow mediated dilation (FMD), and on test variability and repeatability. As a popular and noninvasive assessment of endothelial function, several different approaches have been employed to measure brachial artery reactivity with B-mode ultrasound. Despite some efforts, there remains a lack of defined normal values and large variability in measurement technique. Methods Twenty-six healthy volunteers underwent repeated brachial artery diameter measurements by B-mode ultrasound. Following baseline diameter recordings we assessed endothelium-dependent flow mediated dilation by inflating a blood pressure cuff either on the upper arm (proximal) or on the forearm (distal). Results Thirty-seven measures were performed using proximal occlusion and 25 with distal occlusion. Following proximal occlusion relative to distal occlusion, FMD was larger (16.2 ± 1.2% vs. 7.3 ± 0.9%, p < 0.0001) and elongated (107.2 s vs. 67.8 s, p = 0.0001). Measurement of the test repeatability showed that differences between the repeated measures were greater on average when the measurements were done using the proximal method as compared to the distal method (2.4%; 95% CI 0.5–4.3; p = 0.013). Conclusion These findings suggest that forearm compression holds statistical advantages over upper arm compression. Added to documented physiological and practical reasons, we propose that future studies should use forearm compression in the assessment of endothelial function. PMID:17376239

Dose-response studies of Ropivacaine in blood flow of upper extremity after supraclavicular block: a double-blind randomized controlled study.

PubMed

Li, Ting; Ye, Qiguang; Wu, Daozhu; Li, Jun; Yu, Jingui

2017-12-02

The sympathetic block of upper limb leading to increased blood flow has important clinical implication in microvascular surgery. However, little is known regarding the relationship between concentration of local anesthetic and blood flow of upper limb. The aim of this dose-response study was to determine the ED 50 and ED 95 of ropivacaine in blood flow after supraclavicular block (SB). Patients undergoing upper limb surgery and supraclavicular block were randomly assigned to receive 30ml ropivacaine in concentrations of 0.125%(A Group), 0.2%(B Group), 0.25%(C Group), 0.375%(D Group), 0.5%(E Group), or 0.75%(F Group) (n=13 per group). All patients received supraclavicular block (SB). Time average maximum velocity (TAMAX), cross-sectional area (CSA) of brachial artery and skin temperatures (T s ) were measured repeatedly at the same marked points, they were taken at baseline (before block, t 0 ) and at 30min after SB (t 1 ). Blood flow(BF) = TAMAX× CSA×60 sec.. Relative blood flow (ΔBF) = BF t1 / BF t0 . Success of SB was assessed simultaneously. Supplementary anesthesia and other adverse events (AE) were recorded. Significant increase in TAMAX, CSA, BF and T s were seen in all concentration groups at t 1 comparing with t 0 (P<0.001). There was an upward trend of TAMAX, CSA, BF with the increasing concentration of ropivacaine except T s . There was no significant different of T s at t 1 among different concentration group. The dose-response formula of ropivacaine on ΔBF was Y=1+3.188/(1+10^((-2.451-X) × 1.730)) and ED 50 /ED 95 (95%CI) were 0.35/1.94%(0.25-0.45/0.83-4.52), and R 2 (coefficient of determination) =0.85. ED 50 /ED 95 (95%CI) values of sensory block were 0.18/0.33% (0.15-0.21/0.27-0.51), R 2 =0.904. The dose-response curve between SB ropivacaine and the changes of BF was determined. The ED 50 /ED 95 of ropivacaine of ΔBF are 0.35/1.94% (0.25-0.45/0.83-4.52). TAMAX, CSA and BF consistently increased with ropivacaine concentration. The maximal sympathetic block needs higher concentration than that complete sensation block needs which may benefit for microvascular surgery. Clinicaltrials.gov NCT02139982 . Retrospectively registered (Date of registration: May, 2014).

Exercise-induced brachial artery vasodilation: effects of antioxidants and exercise training in elderly men

PubMed Central

Donato, Anthony J.; Uberoi, Abhimanyu; Bailey, Damian M.; Walter Wray, D.

2010-01-01

Aging, vascular function, and exercise are thought to have a common link in oxidative stress. Of the 28 subjects studied (young, 26 ± 2 yr; old, 71 ± 6 yr), 12 took part in a study to validate an antioxidant cocktail (AOC: vitamins C, E, and α-lipoic acid), while the remaining 8 young and 8 old subjects performed submaximal forearm handgrip exercise with placebo or AOC. Old subjects repeated forearm exercise with placebo or AOC following knee-extensor (KE) exercise training. Brachial arterial diameter and blood velocity (Doppler ultrasound) were measured at rest and during exercise. During handgrip exercise, brachial artery vasodilation in the old subjects was attenuated compared with that in young subjects following placebo (maximum = ∼3.0 and ∼6.0%, respectively). In contrast to the previously documented attenuation in exercise-induced brachial artery vasodilation in the young group with AOC, in the old subjects the AOC restored vasodilation (maximum = ∼7.0%) to match the young. KE training also improved exercise-induced brachial artery vasodilation. However, in the trained state, AOC administration no longer augmented brachial artery vasodilation in the elderly, but rather attenuated it. These data reveal an age-related pro-/antioxidant imbalance that impacts vascular function and show that exercise training is capable of restoring equilibrium such that vascular function is improved and the AOC-mediated reduction in free radicals now negatively impacts brachial artery vasodilation, as seen in the young. PMID:19966056

A pilot study of the relationship between Doppler-estimated carotid and brachial artery flow and cardiac index.

PubMed

Weber, U; Glassford, N J; Eastwood, G M; Bellomo, R; Hilton, A K

2015-10-01

We measured carotid and brachial artery blood flow by Doppler ultrasound in 11 human volunteers, and related these to cardiac index and to each other. The median (IQR [range]) carotid arterial blood flow was 0.334 (0.223-0.381 [0.052-0.563]) l.min(-1) on the right and 0.315 (0.223-0.369 [0.061-0.690]) l.min(-1) on the left. The brachial arterial blood flow was 0.049 (0.033-0.062 [0.015-0.204]) l.min(-1) on the right and 0.039 (0.027-0.054 [0.011-0.116]) on the left. Cardiac index was 3.2 (2.8-3.5 [1.9-5.4]) l.min(-1) .m(-2) . There was a moderate to good correlation between right-and left-sided flows (brachial: ρ = 0.45; carotid: ρ = 0.567). Brachial and carotid flow had no or a negative correlation with cardiac index (right brachial: ρ = -0.145, left brachial: ρ = -0.349; right carotid: ρ = -0.376, left carotid: ρ = -0.285). In contrast to some previous studies, we found that Doppler-estimated peripheral arterial blood flows only show a weak correlation with cardiac index and cannot be used to provide non-invasive estimates of cardiac index in man. © 2015 The Association of Anaesthetists of Great Britain and Ireland.

Risk of Subclinical Micrometastatic Disease in the Supraclavicular Nodal Bed According to the Anatomic Distribution in Patients With Advanced Breast Cancer

DOE Office of Scientific and Technical Information (OSTI.GOV)

Reed, Valerie K.; Cavalcanti, Jose L.; Strom, Eric A.

Purpose: To determine the anatomic distribution of gross supraclavicular nodes within the supraclavicular fossa using 2-deoxy-2-[F-18] fluoro-d-glucose (FDG) positron emission tomography/computed tomography (PET/CT) scans, and to evaluate likely coverage of specific regions of the supraclavicular fossa using standard radiation fields. Methods and Materials: We identified 33 patients with advanced or metastatic breast cancer who had a PET/CT scan demonstrating hypermetabolic supraclavicular lymph nodes in 2005. The locations of the involved lymph nodes were mapped onto a single CT set of images of the supraclavicular fossa. These lymph nodes were also mapped onto the treatment-planning CT dataset of 4 patients treatedmore » in our institution (2 patients with biopsy-proven supraclavicular nodes and 2 patients with clinically negative supraclavicular nodes). Results: We were able to determine the distribution of 52 supraclavicular lymph nodes in 32 patients. Of 32 patients, 28 (87%) had a history of metastatic disease, and 2 patients had isolated nodal recurrences. Five patients had supraclavicular nodes posterior to the vertebral body transverse process, and several lymph nodes were in close proximity to the medial field border, raising the possibility of geographic miss in these areas. Conclusions: In patients with locally advanced disease, increased coverage of the supraclavicular fossa medially and posteriorly may be warranted.« less

Automated analysis of brachial ultrasound time series

NASA Astrophysics Data System (ADS)

Liang, Weidong; Browning, Roger L.; Lauer, Ronald M.; Sonka, Milan

1998-07-01

Atherosclerosis begins in childhood with the accumulation of lipid in the intima of arteries to form fatty streaks, advances through adult life when occlusive vascular disease may result in coronary heart disease, stroke and peripheral vascular disease. Non-invasive B-mode ultrasound has been found useful in studying risk factors in the symptom-free population. Large amount of data is acquired from continuous imaging of the vessels in a large study population. A high quality brachial vessel diameter measurement method is necessary such that accurate diameters can be measured consistently in all frames in a sequence, across different observers. Though human expert has the advantage over automated computer methods in recognizing noise during diameter measurement, manual measurement suffers from inter- and intra-observer variability. It is also time-consuming. An automated measurement method is presented in this paper which utilizes quality assurance approaches to adapt to specific image features, to recognize and minimize the noise effect. Experimental results showed the method's potential for clinical usage in the epidemiological studies.

Ultrasound-guided fine needle aspiration versus core needle biopsy: comparison of post-biopsy hematoma rates and risk factors.

PubMed

Chae, In Hye; Kim, Eun-Kyung; Moon, Hee Jung; Yoon, Jung Hyun; Park, Vivian Y; Kwak, Jin Young

2017-07-01

To compare post-biopsy hematoma rates between ultrasound guided-fine needle aspiration and ultrasound guided-core needle biopsy, and to investigate risk factors for post-biopsy hematoma. A total of 5304 thyroid nodules which underwent ultrasound guided biopsy were included in this retrospective study. We compared clinical and US features between patients with and without post-biopsy hematoma. Associations between these features and post-biopsy hematoma were analyzed. Post-biopsy hematoma rate was 0.8% (43/5121) for ultrasound guided-fine needle aspiration and 4.9% (9/183) for ultrasound guided-core needle biopsy (P < 0.001). For ultrasound guided-fine needle aspiration, gender, age, size, presence of vascularity, and suspicious US features were not associated with post-biopsy hematoma according to experience level. Post-biopsy hematoma occurred significantly more with ultrasound guided-core needle biopsy (9/179, 5.0%) than with ultrasound guided-fine needle aspiration (9/1138, 0.8%) (P < 0.001) in experienced performers and ultrasound guided-core needle biopsy was the only significant risk factor for post-biopsy hematoma (adjusted Odds Ratio, 6.458, P < 0.001). Post-biopsy hematoma occurred significantly more in ultrasound guided-core needle biopsy than in ultrasound guided-fine needle aspiration and ultrasound guided-core needle biopsy was the only independent factor of post-biopsy hematoma in thyroid nodules.

Duplex-guided percutaneous transluminal angioplasty in iliac arterial occlusive disease.

PubMed

Krasznai, A G; Sigterman, T A; Welten, R J; Heijboer, R; Sikkink, C J J M; van de Akker, L H J M; Bouwman, L H

2013-11-01

Chronic renal insufficiency (CRI) is a growing global problem. PTA can be performed without nephrotoxic contrast, utilizing Doppler-ultrasound (Duplex) guidance. Duplex-guided infra-inguinal interventions and access-related interventions have been reported. Duplex-guided iliac interventions have not been performed to any extent because of the anatomic location. In our study we evaluated the safety and efficacy of Duplex-guided percutaneous transluminal angioplasty (DuPTA) in iliac arteries. From June 2012 until February 2013, 31 patients (35 iliac lesions), underwent DuPTA. Indications ranged from Rutherford 3 to 5. Preoperative evaluation included Ankle Brachial Index (ABI), Duplex and MRA. Procedural success was defined as crossing the lesion with a guidewire and dilating or stenting the lesion. Clinical success was defined as 50% reduction in peak systolic velocity (PSV) or clinical improvement. PSV was evaluated after PTA, then at 2 weeks. Clinical results were assessed 2 weeks after the procedure. Procedural success was achieved in 94% of patients (33/35), all of whom also had clinical success. Post-procedural PSV reduction showed an average improvement of 63% (431 cm/s to 153 cm/s). Mean preoperative ABI was 0.72 and improved to 0.88 postoperatively. PTA using Duplex-guidance in significant iliac stenosis is a safe method with major advantages in patients at high risk for developing contrast-induced nephropathy. Copyright © 2013 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.

MR-guided Focused Ultrasound for Uterine Fibroids

MedlinePlus

... Professions Site Index A-Z MR-guided Focused Ultrasound for Uterine Fibroids Magnetic Resonance-guided Focused Ultrasound ( ... are the limitations of MRgFUS? What is Focused Ultrasound of Uterine Fibroids? Magnetic Resonance-guided Focused Ultrasound ( ...

Validation of computational fluid dynamics-based analysis to evaluate hemodynamic significance of access stenosis.

PubMed

Hoganson, David M; Hinkel, Cameron J; Chen, Xiaomin; Agarwal, Ramesh K; Shenoy, Surendra

2014-01-01

Stenosis in a vascular access circuit is the predominant cause of access dysfunction. Hemodynamic significance of a stenosis identified by angiography in an access circuit is uncertain. This study utilizes computational fluid dynamics (CFD) to model flow through arteriovenous fistula to predict the functional significance of stenosis in vascular access circuits. Three-dimensional models of fistulas were created with a range of clinically relevant stenoses using SolidWorks. Stenoses diameters ranged from 1.0 to 3.0 mm and lengths from 5 to 60 mm within a fistula diameter of 7 mm. CFD analyses were performed using a blood model over a range of blood pressures. Eight patient-specific stenoses were also modeled and analyzed with CFD and the resulting blood flow calculations were validated by comparison with brachial artery flow measured by duplex ultrasound. Predicted flow rates were derived from CFD analysis of a range of stenoses. These stenoses were modeled by CFD and correlated with the ultrasound measured flow rate through the fistula of eight patients. The calculated flow rate using CFD correlated within 20% of ultrasound measured flow for five of eight patients. The mean difference was 17.2% (ranged from 1.3% to 30.1%). CFD analysis-generated flow rate tables provide valuable information to assess the functional significance of stenosis detected during imaging studies. The CFD study can help in determining the clinical relevance of a stenosis in access dysfunction and guide the need for intervention.

Vascular anatomy of the supraclavicular area revisited: feasibility of the free supraclavicular perforator flap.

PubMed

Cordova, Adriana; Pirrello, Roberto; D'Arpa, Salvatore; Jeschke, Johannes; Brenner, Erich; Moschella, Francesco

2008-11-01

The supraclavicular skin has been studied extensively and used as a pedicled flap for face and neck reconstruction. Its use as a free flap has not paralleled its use as a pedicled flap. The authors performed an anatomical investigation to assess the possibility of harvesting a free supraclavicular flap with the donor-site scar lying in the supraclavicular crease. In this article, the authors present the results of their anatomical study together with the preliminary clinical applications. Skin vascularization and feasibility of a free supraclavicular perforator flap were studied on 25 cadavers (15 fresh cadavers injected with colored latex at the Universiteé René Descartes in Paris; and 10 formalin-fixed, noninjected cadavers at the Innsbruck Medical University). The flap was used in two patients at the Plastic Surgery Department of the University of Palermo for a cutaneous facial reconstruction and intraoral reconstruction after cancer excision. An average of four perforators were consistently found in the supraclavicular area coming from the transverse cervical artery. Venous perforators drain into the superficial venous plexus rather than into the venae comitantes of the transverse cervical artery. Two flaps were successfully used based on these vessels. The vascularization of the supraclavicular skin depends on skin perforators coming from the transverse cervical artery and draining into the superficial venous plexus. Based on these vessels, a reliable free supraclavicular flap seems to be safe to harvest, with the scar hidden in the supraclavicular crease. The preliminary clinical applications of such a flap gave promising results, suggesting its potential applications.

Single, double or multiple-injection techniques for non-ultrasound guided axillary brachial plexus block in adults undergoing surgery of the lower arm.

PubMed

Chin, Ki Jinn; Alakkad, Husni; Cubillos, Javier E

2013-08-08

Regional anaesthesia comprising axillary block of the brachial plexus is a common anaesthetic technique for distal upper limb surgery. This is an update of a review first published in 2006 and updated in 2011. To compare the relative effects (benefits and harms) of three injection techniques (single, double and multiple) of axillary block of the brachial plexus for distal upper extremity surgery. We considered these effects primarily in terms of anaesthetic effectiveness; the complication rate (neurological and vascular); and pain and discomfort caused by performance of the block. We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library), MEDLINE, EMBASE and reference lists of trials. We contacted trial authors. The date of the last search was March 2013 (updated from March 2011). We included randomized controlled trials that compared double with single-injection techniques, multiple with single-injection techniques, or multiple with double-injection techniques for axillary block in adults undergoing surgery of the distal upper limb. We excluded trials using ultrasound-guided techniques. Independent study selection, risk of bias assessment and data extraction were performed by at least two investigators. We undertook meta-analysis. The 21 included trials involved a total of 2148 participants who received regional anaesthesia for hand, wrist, forearm or elbow surgery. Risk of bias assessment indicated that trial design and conduct were generally adequate; the most common areas of weakness were in blinding and allocation concealment.Eight trials comparing double versus single injections showed a statistically significant decrease in primary anaesthesia failure (risk ratio (RR 0.51), 95% confidence interval (CI) 0.30 to 0.85). Subgroup analysis by method of nerve location showed that the effect size was greater when neurostimulation was used rather than the transarterial technique.Eight trials comparing multiple with single injections showed a statistically significant decrease in primary anaesthesia failure (RR 0.25, 95% CI 0.14 to 0.44) and of incomplete motor block (RR 0.61, 95% CI 0.39 to 0.96) in the multiple injection group.Eleven trials comparing multiple with double injections showed a statistically significant decrease in primary anaesthesia failure (RR 0.28, 95% CI 0.20 to 0.40) and of incomplete motor block (RR 0.55, 95% CI 0.36 to 0.85) in the multiple injection group.Tourniquet pain was significantly reduced with multiple injections compared with double injections (RR 0.53, 95% CI 0.33 to 0.84). Otherwise there were no statistically significant differences between groups in any of the three comparisons on secondary analgesia failure, complications and patient discomfort. The time for block performance was significantly shorter for single and double injections compared with multiple injections. This review provides evidence that multiple-injection techniques using nerve stimulation for axillary plexus block produce more effective anaesthesia than either double or single-injection techniques. However, there was insufficient evidence for a significant difference in other outcomes, including safety.

[Definition of nodal volumes in breast cancer treatment and segmentation guidelines].

PubMed

Kirova, Y M; Castro Pena, P; Dendale, R; Campana, F; Bollet, M A; Fournier-Bidoz, N; Fourquet, A

2009-06-01

To assist in the determination of breast and nodal volumes in the setting of radiotherapy for breast cancer and establish segmentation guidelines. Materials and methods. Contrast metarial enhanced CT examinations were obtained in the treatment position in 25 patients to clearly define the target volumes. The clinical target volume (CTV) including the breast, internal mammary nodes, supraclavicular and subclavicular regions and axxilary region were segmented along with the brachial plexus and interpectoral nodes. The following critical organs were also segmented: heart, lungs, contralateral breast, thyroid, esophagus and humeral head. A correlation between clinical and imaging findings and meeting between radiation oncologists and breast specialists resulted in a better definition of irradiation volumes for breast and nodes with establishement of segmentation guidelines and creation of an anatomical atlas. A practical approach, based on anatomical criteria, is proposed to assist in the segmentation of breast and node volumes in the setting of breast cancer treatment along with a definition of irradiation volumes.

A comparative study of brachial plexus sonography and magnetic resonance imaging in chronic inflammatory demyelinating neuropathy and multifocal motor neuropathy.

PubMed

Goedee, H S; Jongbloed, B A; van Asseldonk, J-T H; Hendrikse, J; Vrancken, A F J E; Franssen, H; Nikolakopoulos, S; Visser, L H; van der Pol, W L; van den Berg, L H

2017-10-01

To compare the performance of neuroimaging techniques, i.e. high-resolution ultrasound (HRUS) and magnetic resonance imaging (MRI), when applied to the brachial plexus, as part of the diagnostic work-up of chronic inflammatory demyelinating neuropathy (CIDP) and multifocal motor neuropathy (MMN). Fifty-one incident, treatment-naive patients with CIDP (n = 23) or MMN (n = 28) underwent imaging of the brachial plexus using (i) a standardized MRI protocol to assess enlargement or T2 hyperintensity and (ii) bilateral HRUS to determine the extent of nerve (root) enlargement. We found enlargement of the brachial plexus in 19/51 (37%) and T2 hyperintensity in 29/51 (57%) patients with MRI and enlargement in 37/51 (73%) patients with HRUS. Abnormal results were only found in 6/51 (12%) patients with MRI and 12/51 (24%) patients with HRUS. A combination of the two imaging techniques identified 42/51 (83%) patients. We found no association between age, disease duration or Medical Research Council sum-score and sonographic nerve size, MRI enlargement or presence of T2 hyperintensity. Brachial plexus sonography could complement MRI in the diagnostic work-up of patients with suspected CIDP and MMN. Our results indicate that combined imaging studies may add value to the current diagnostic consensus criteria for chronic inflammatory neuropathies. © 2017 EAN.

Visualization of the Long Thoracic Nerve using High-Resolution Sonography.

PubMed

Lieba-Samal, D; Morgenbesser, J; Moritz, T; Gruber, G M; Bernathova, M; Michaud, J; Bodner, G

2015-06-01

The long thoracic nerve (LTN) innervates the serratus anterior muscle (SA) which plays an important role in shoulder function. Evaluation of the LTN has so far been restricted to clinical assessment and partly electromyography and neurography. Progress of high-resolution ultrasound (HRUS) increasingly enables visualization of small peripheral nerves and their pathologies. We therefore aimed at (a) clarifying the possibility of visualization of the LTN from its origin to the most distal point in the supraclavicular region visible and (b) developing an ultrasound protocol for routine use. We further present two cases of patients with LTN pathology. The study consisted of two parts: Part 1 included 4 non-enbalmed human bodies in whom the LTN (n = 8) was located and then marked by ink injection. Correct identification was confirmed by anatomical dissection. Part 2 included 20 healthy volunteers whose LTN (n = 40) was assessed independently by two radiologists. Identification of the LTN was defined as consensus in recorded images. LTN was clearly visible in all anatomical specimens and volunteers using HRUS and could be followed until the second slip of the serratus anterior muscle from the supraclavicular region. In anatomical specimens, dissection confirmed HRUS findings. For all volunteers, consensus was obtained. The mean nerve diameter was 1.6 mm ± 0.3 (range 1.1 - 2.1 mm) after the formation of the main trunk. We hereby confirm a reliable possibility of visualization of the LTN in anatomical specimens as well as in volunteers. We encourage HRUS of the LTN to be part of the diagnostic work-up in patients presenting with scapular winging, shoulder weakness or pain of unknown origin. © Georg Thieme Verlag KG Stuttgart · New York.

Comparison of two automatic methods for the assessment of brachial artery flow-mediated dilation.

PubMed

Faita, Francesco; Masi, Stefano; Loukogeorgakis, Stavros; Gemignani, Vincenzo; Okorie, Mike; Bianchini, Elisabetta; Charakida, Marietta; Demi, Marcello; Ghiadoni, Lorenzo; Deanfield, John Eric

2011-01-01

Brachial artery flow-mediated dilation (FMD) is associated with risk factors providing information on cardiovascular prognosis. Despite the large effort to standardize the methodology, the FMD examination is still characterized by problems of reproducibility and reliability that can be partially overcome with the use of automatic systems. We developed real-time software for the assessment of brachial FMD (FMD Studio, Institute of Clinical Physiology, Pisa, Italy) from ultrasound images. The aim of this study is to compare our system with another automatic method (Brachial Analyzer, MIA LLC, IA, USA) which is currently considered as a reference method in FMD assessment. The agreement between systems was assessed as follows. Protocol 1: Mean baseline (Basal), maximal (Max) brachial artery diameter after forearm ischemia and FMD, calculated as maximal percentage diameter increase, have been evaluated in 60 recorded FMD sequences. Protocol 2: Values of diameter and FMD have been evaluated in 618 frames extracted from 12 sequences. All biases are negligible and standard deviations of the differences are satisfactory (protocol 1: -0.27 ± 0.59%; protocol 2: -0.26 ± 0.61%) for FMD measurements. Analysis times were reduced (-33%) when FMD Studio is used. Rejected examinations due to the poor quality were 2% with the FMD Studio and 5% with the Brachial Analyzer. In conclusion, the compared systems show a optimal grade of agreement and they can be used interchangeably. Thus, the use of a system characterized by real-time functionalities could represent a referral method for assessing endothelial function in clinical trials.

Ultrasonographic percutaneous anatomy of the atlanto-occipital region and indirect ultrasound-guided cisternal puncture in the dog and the cat.

PubMed

Etienne, A-L; Audigié, F; Peeters, D; Gabriel, A; Busoni, V

2015-04-01

Cisternal puncture in dogs and cats is commonly carried out. This article describes the percutaneous ultrasound anatomy of the cisternal region in the dog and the cat and an indirect technique for ultrasound-guided cisternal puncture. Ultrasound images obtained ex vivo and in vivo were compared with anatomic sections and used to identify the landmarks for ultrasound-guided cisternal puncture. The ultrasound-guided procedure was established in cadavers and then applied in vivo in seven dogs and two cats. The anatomic landmarks for the ultrasound-guided puncture are the cisterna magna, the spinal cord, the two occipital condyles on transverse images, the external occipital crest and the dorsal arch of the first cervical vertebra on longitudinal images. Using these ultrasound anatomic landmarks, an indirect ultrasound-guided technique for cisternal puncture is applicable in the dog and the cat. © 2014 Blackwell Verlag GmbH.

Brachial plexus endoscopic dissection and correlation with open dissection.

PubMed

Lafosse, T; Masmejean, E; Bihel, T; Lafosse, L

2015-12-01

Shoulder endoscopy is evolving and becoming extra-articular. More and more procedures are taking place in the area of the brachial plexus (BP). We carried out an anatomical study to describe the endoscopic anatomy of the BP and the technique used to dissect and expose the BP endoscopically. Thirteen fresh cadavers were dissected. We first performed an endoscopic dissection of the BP, using classical extra-articular shoulder arthroscopy portals. Through each portal, we dissected as many structures as possible and identified them. We then did an open dissection to corroborate the endoscopic findings and to look for damage to the neighboring structures. In the supraclavicular area, we were able to expose the C5, C6 and C7 roots, and the superior and middle trunks in 11 of 13 specimens through two transtrapezial portals by following the suprascapular nerve. The entire infraclavicular portion of the BP (except the medial cord and its branches) was exposed in 11 of 13 specimens. The approach to the infraclavicular portion of the BP led directly to the lateral and posterior cords, but the axillary artery hid the medial cord. The musculocutaneous nerve was the first nerve encountered when dissecting medially from the anterior aspect of the coracoid process. The axillary nerve was the first nerve encountered when following the anterior border of the subscapularis medially from the posterior aspect of the coracoid process. Knowledge of the endoscopic anatomy of the BP is mandatory to expose and protect this structure while performing advanced arthroscopic shoulder procedures. Copyright © 2015 SFCM. Published by Elsevier Masson SAS. All rights reserved.

Supraclavicular skin temperature and BAT activity in lean healthy adults.

PubMed

van der Lans, Anouk A J J; Vosselman, Maarten J; Hanssen, Mark J W; Brans, Boudewijn; van Marken Lichtenbelt, Wouter D

2016-01-01

The 'gold standard' for measuring brown adipose tissue (BAT) in humans is [(18)F]FDG-PET/CT-imaging. With this technique subjects are exposed to ionizing radiation and are therefore limited in the number of scans that can be performed. We investigated the relation between supraclavicular skin temperatures and BAT activity values using a strictly temperature-controlled air-cooling protocol. Data of 36 male subjects was analyzed. BAT activity was evaluated by [(18)F]FDG-PET/CT-imaging and skin temperature was measured by means of wireless temperature sensors. Supraclavicular skin temperature dropped less compared to skin temperatures at other sites (all P values <0.01). A significant positive correlation was found between the change in supraclavicular skin temperature with BAT activity (R (2) 0.23), and the change in supraclavicular skin temperature and non-shivering thermogenesis (R (2) 0.18, both P values <0.01). The correlations indicate that supraclavicular skin temperature (changes) can potentially be used as a qualitative measure of BAT activity and BAT thermogenesis.

The European Society of Regional Anaesthesia and Pain Therapy/American Society of Regional Anesthesia and Pain Medicine Recommendations on Local Anesthetics and Adjuvants Dosage in Pediatric Regional Anesthesia.

PubMed

Suresh, Santhanam; Ecoffey, Claude; Bosenberg, Adrian; Lonnqvist, Per-Anne; de Oliveira, Gildasio S; de Leon Casasola, Oscar; de Andrés, José; Ivani, Giorgio

2018-02-01

Dosage of local anesthetics (LAs) used for regional anesthesia in children is not well determined. In order to evaluate and come to a consensus regarding some of these controversial topics, The European Society of Regional Anaesthesia and Pain Therapy (ESRA) and the American Society of Regional Anesthesia and Pain Medicine (ASRA) developed a Joint Committee Practice Advisory on Local Anesthetics and Adjuvants Dosage in Pediatric Regional Anesthesia. Representatives from both ASRA and ESRA composed the joint committee practice advisory. Evidence-based recommendations were based on a systematic search of the literature. In cases where no literature was available, expert opinion was elicited. Spinal anesthesia with bupivacaine can be performed with a dose of 1 mg/kg for newborn and/or infant and a dose of 0.5 mg/kg in older children (>1 year of age). Tetracaine 0.5% is recommended for spinal anesthesia (dose, 0.07-0.13 mL/kg). Ultrasound-guided upper-extremity peripheral nerve blocks (eg, axillary, infraclavicular, interscalene, supraclavicular) in children can be performed successfully and safely using a recommended LA dose of bupivacaine or ropivacaine of 0.5 to 1.5 mg/kg. Dexmedetomidine can be used as an adjunct to prolong the duration of peripheral nerve blocks in children. High-level evidence is not yet available to guide dosage of LA used in regional blocks in children. The ASRA/ESRA recommendations intend to provide guidance in order to reduce the large variability of LA dosage currently observed in clinical practice.

Effect of Locally Administered Dexmedetomidine as Adjuvant to Levobupivacaine in Supraclavicular Brachial Plexus Block: Double-blind Controlled Study.

PubMed

Bisui, Bikash; Samanta, Swastika; Ghoshmaulik, Sumanta; Banerjee, Amit; Ghosh, Tirtha R; Sarkar, Suman

2017-01-01

Brachial plexus block is effective with good postoperative analgesia in upper limb surgery has gained importance as it safe, low cost, and maintains stable hemodynamics intraoperatively. To decrease the onset time and prolong the duration of nerve block bicarbonate, opioids (morphine, fentanyl, etc.), sympathomimetic agents (epinephrine, phenylephrine, etc.), α-2 agonists (clonidine and dexmedetomidine), calcium channel blocker (verapamil), magnesium sulfate, etc., were studied with local anesthetics and their isomers. For their sedative, analgesic, perioperative sympatholytic, and cardiovascular stabilizing effects with reduced anesthetic requirements, α-2 adrenergic receptor agonists, such as more potent and highly selective dexmedetomidine, have been the focus of interest for regional anesthesia. Intravenous dexmedetomidine infusion resulted in significant opioid-sparing effects as well as a decrease in inhalational anesthetic requirements. Animal studies proved that dexmedetomidine enhances sensory and motor blockade along with increased duration of analgesia. In humans, dexmedetomidine has also shown to prolong the duration of block and postoperative analgesia when added to local anesthetic in various regional blocks. Bupivacaine, the widely used local anesthetic in regional anesthesia, is available in a commercial preparation as a racemic mixture (50:50) of its two enantiomers: levobupivacaine, S (-) isomer and dextrobupivacaine, R (+) isomer. Severe central nervous system and cardiovascular adverse reactions reported in the literature after inadvertent intravascular injection or intravenous regional anesthesia have been linked to the R (+) isomer of bupivacaine. The levorotatory isomers were shown to have a safer pharmacological profile with less cardiac and neurotoxic adverse effects. The decreased toxicity of levobupivacaine is attributed to its faster protein binding rate. The pure S (-) enantiomers of bupivacaine, i.e., ropivacaine and levobupivacaine were thus introduced into the clinical anesthesia practice. Such an increased usage mandates the documentation of evidence-based literature with regard to risk and safety concerns as well as clinical issues related to levobupivacaine. This study is designed to assess the efficacy of adding dexmedetomidine to levobupivacaine during placement of supraclavicular brachial plexus blockade. This prospective observational double-blinded study was conducted over a 1-year period among randomly selected seventy ( n = 35) American Society of Anesthesiologists Classes I and II patients of ages between 18 and 60 years of both sexes scheduled to undergo upper limb surgery. With nerve locator, levobupivacaine (0.5%) 28 ml and 2 ml normal saline for Group L and levobupivacaine (0.5%) 28 ml and 0.75 μg/kg dexmedetomidine made up a solution of 2 ml, for Group D, a total 30 ml will be injected locally, in both the groups. Onset and duration of sensory and motor block will be assessed. One patient in Group L and two patients in Group D failed to achieve block within 30 min. Those three patients were then excluded from the analysis. Hence, the analysis was done by taking 34 patients in Group L and 33 patients in Group D. Onset of sensory and motor block was earlier in Group D (12.03 ± 0.85 and 13.58 ± 0.97) than Group L (14.32 ± 1.15 and 15 ± 0.98), and the difference is statistically significant ( P < 0.0001). Duration of sensory and motor block was longer in Group D (563.94 ± 15.60 and 495.15 ± 10.34) than Group L (368.53 ± 9.89 and 321.47 ± 7.84), and the difference is also statistically significant ( P < 0.0001). Duration of analgesia was longer in Group D (672.12 ± 11.39) than Group L (506.47 ± 9.497), and the difference is statistically significant ( P < 0.0001). Heart rate and mean arterial pressure were well maintained within the presumed range of significant variation, i.e., 20% from baseline, though at some point of time, intergroup comparison was statistically significant. Visual analog scale score compared at the time for administration of rescue analgesic between the groups come out to be statistically significant. Addition of 0.75 μg/kg dexmedetomidine to 0.5% levobupivacaine for supraclavicular plexus block shortens sensory and motor block onset time and extends sensory block, motor block, and analgesia duration.

Ultrasound measurement of peripheral endothelial dysfunction in type 2 diabetic patients: correlation with risk factors

PubMed Central

Bosevski, Marijan; Georgievska-Ismail, Ljubica

2010-01-01

The purpose of the study was to assess the endothelial dysfunction (ED) in type 2 diabetic patients ultrasonographicaly and estimate the correlation of ED with glycemia and other cardio-metabolic risk factors. 171 patient (age 60,0 + 8,5 years) with diagnosed type 2 diabetes and coronary artery disease (CAD) were randomly included in a cross sectional study. B-mode ultrasound system with a linear transducer of 7.5 MHz was used for evaluation of flow-mediated vasodilation in brachial artery (FMV). FMV was presented as a change of brachial artery diameter at rest and after limb ischemia, previously provoked by cuff inflation. Peripheral ED was found in 77,2% (132 patients). Multivariate logistic regression model defined: age (OR 1,071, 95% CI 1,003 1,143) and plasma cholesterol (OR 4,083 95%CI 1,080 17,017) as determinants for ED. Linear multivariate analysis presented duration of diabetes (Beta 0,173, Sig 0,024), and glycemia (Beta 0,132, Sig 0,044) to be associated independently with FMV value. Estimated factors influencing FMV might be potential therapeutic targets for presented endothelial dysfunction in type 2 diabetic patients with coronary artery disease. PMID:20507285

Ultrasound guided double injection of blood into cisterna magna: a rabbit model for treatment of cerebral vasospasm.

PubMed

Chen, Yongchao; Zhu, Youzhi; Zhang, Yu; Zhang, Zixuan; Lian, Juan; Luo, Fucheng; Deng, Xuefei; Wong, Kelvin K L

2016-02-06

Double injection of blood into cisterna magna using a rabbit model results in cerebral vasospasm. An unacceptably high mortality rate tends to limit the application of model. Ultrasound guided puncture can provide real-time imaging guidance for operation. The aim of this paper is to establish a safe and effective rabbit model of cerebral vasospasm after subarachnoid hemorrhage with the assistance of ultrasound medical imaging. A total of 160 New Zealand white rabbits were randomly divided into four groups of 40 each: (1) manual control group, (2) manual model group, (3) ultrasound guided control group, and (4) ultrasound guided model group. The subarachnoid hemorrhage was intentionally caused by double injection of blood into their cisterna magna. Then, basilar artery diameters were measured using magnetic resonance angiography before modeling and 5 days after modeling. The depth of needle entering into cisterna magna was determined during the process of ultrasound guided puncture. The mortality rates in manual control group and model group were 15 and 23 %, respectively. No rabbits were sacrificed in those two ultrasound guided groups. We found that the mortality rate in ultrasound guided groups decreased significantly compared to manual groups. Compared with diameters before modeling, the basilar artery diameters after modeling were significantly lower in manual and ultrasound guided model groups. The vasospasm aggravated and the proportion of severe vasospasms was greater in ultrasound guided model group than that of manual group. In manual model group, no vasospasm was found in 8 % of rabbits. The ultrasound guided double injection of blood into cisterna magna is a safe and effective rabbit model for treatment of cerebral vasospasm.

Neonatal brachial plexus palsy--management and prognostic factors.

PubMed

Yang, Lynda J-S

2014-06-01

Successful treatment of patients with neonatal brachial plexus palsy (NBPP) begins with a thorough understanding of the anatomy of the brachial plexus and of the pathophysiology of nerve injury via which the brachial plexus nerves stretched in the perinatal period manifest as a weak or paralyzed upper extremity in the newborn. NBPP can be classified by systems that can guide the prognosis and the management as these systems are based on the extent and severity of nerve injury, anatomy of nerve injury, and clinical presentation. Serial physical examinations, supplemented by a thorough maternal and perinatal history, are critical to the formulation of the treatment plan that relies upon occupational/physical therapy and rehabilitation management but may include nerve reconstruction and secondary musculoskeletal surgeries. Adjunctive imaging and electrodiagnostic studies provide additional information to guide prognosis and treatment. As research improves not only the technical aspects of NBPP treatment but also the ability to assess the activity and participation as well as body structure and function of NBPP patients, the functional outcomes for affected infants have an overall optimistic prognosis, with the majority recovering adequate functional use of the affected arm. Of importance are (i) early referral to interdisciplinary specialty clinics that can provide up-to-date advances in clinical care and (ii) increasing research/awareness of the psychosocial and patient-reported quality-of-life issues that surround the chronic disablement of NBPP. Copyright © 2014 Elsevier Inc. All rights reserved.

The blind pushing technique for peripherally inserted central catheter placement through brachial vein puncture.

PubMed

Lee, Jae Myeong; Cho, Young Kwon; Kim, Han Myun; Song, Myung Gyu; Song, Soon-Young; Yeon, Jae Woo; Yoon, Dae Young; Lee, Sam Yeol

2018-03-01

The objective of this study was to conduct a prospective clinical trial evaluating the technical feasibility and short-term clinical outcome of the blind pushing technique for placement of pretrimmed peripherally inserted central catheters (PICCs) through brachial vein access. Patients requiring PICC placement at any of the three participating institutions were prospectively enrolled between January and December 2016. The review boards of all participating institutions approved this study, and informed consent was obtained from all patients. PICC placement was performed using the blind pushing technique and primary brachial vein access. The following data were collected from unified case report forms: access vein, obstacles during PICC advancement, procedure time, and postprocedural complications. During the 12-month study period, 1380 PICCs were placed in 1043 patients. Of these, 1092 PICCs placed in 837 patients were enrolled, with 834 PICCs (76%) and 258 PICCs (34%) placed through brachial vein and nonbrachial vein access, respectively. In both arms, obstacles were most commonly noted in the subclavian veins (n = 220) and axillary veins (n = 94). Successful puncture of the access vein was achieved at first try in 1028 PICCs (94%). The technical success rate was 99%, with 1055 PICCs (97%) placed within 120 seconds of procedure time and 1088 PICCs (99%) having the tip located at the ideal position. Follow-up Doppler ultrasound detected catheter-associated upper extremity deep venous thrombosis (UEDVT) for 18 PICCs in 16 patients and late symptomatic UEDVT for 16 PICCs in 16 patients (3.1%). Catheter-associated UEDVT was noted for 28 PICCs (82%) and 6 PICCs (18%) placed through brachial vein and nonbrachial vein access, respectively. The incidence of obstacles and the procedure time (<120 seconds) differed significantly between brachial vein and nonbrachial vein access (P = .001). There was no statistically significant difference between brachial vein and nonbrachial vein access in the incidence of UEDVT (odds ratio, 0.68; 95% confidence interval, 0.59-3.52; P = .22). The placement of pretrimmed PICCs by the blind pushing technique and primary brachial vein access is technically feasible and may represent an alternative to the conventional PICC placement technique, having low incidences of UEDVT and other complications, with no significant difference in outcomes between brachial vein and nonbrachial vein access. Copyright © 2017 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

A review of randomised controlled trials comparing ultrasound-guided foam sclerotherapy with endothermal ablation for the treatment of great saphenous varicose veins.

PubMed

Davies, Huw Ob; Popplewell, Matthew; Darvall, Katy; Bate, Gareth; Bradbury, Andrew W

2016-05-01

The last 10 years have seen the introduction into everyday clinical practice of a wide range of novel non-surgical treatments for varicose veins. In July 2013, the UK National Institute for Health and Care Excellence recommended the following treatment hierarchy for varicose veins: endothermal ablation, ultrasound-guided foam sclerotherapy, surgery and compression hosiery. The aim of this paper is to review the randomised controlled trials that have compared endothermal ablation and ultrasound-guided foam sclerotherapy to determine if the level 1 evidence base still supports an "endothermal ablation first" strategy for the treatment of varicose veins. A PubMed and OVID literature search (until 31 January 2015) was performed and randomised controlled trials comparing endothermal ablation and ultrasound-guided foam sclerotherapy were obtained. Although anatomical success appeared higher with endothermal ablation than ultrasound-guided foam sclerotherapy, clinical success and patient-reported outcomes measures were similar. Morbidity and complication rates were very low and not significantly different between endothermal ablation and ultrasound-guided foam sclerotherapy. Ultrasound-guided foam sclerotherapy was consistently less expensive that endothermal ablation. All endovenous modalities appear to be successful and have a role in modern day practice. Although further work is required to optimise ultrasound-guided foam sclerotherapy technique to maximise anatomical success and minimise retreatment, the present level 1 evidence base shows there is no significant difference in clinical important outcomes between ultrasound-guided foam sclerotherapy and endothermal ablation. As ultrasound-guided foam sclerotherapy is less expensive, it is likely to be a more cost-effective option in most patients in most healthcare settings. Strict adherence to the treatment hierarchy recommended by National Institute for Health and Care Excellence seems unjustified. © The Author(s) 2015.

Determining Which Patients Require Irradiation of the Supraclavicular Nodal Area After Surgery for N1 Breast Cancer

DOE Office of Scientific and Technical Information (OSTI.GOV)

Yu, Jeong Il; Park, Won, E-mail: wonp68@skku.ed; Huh, Seung Jae

2010-11-15

Purpose: We designed this study to determine which patients have a high risk of supraclavicular node recurrence in N1 breast cancer previously treated with surgery but not having received supraclavicular radiation therapy (SCRT) and to identify which patients needed SCRT. Methods and Materials: We performed a retrospective review of 448 pathologic N1 breast cancer patients treated with mastectomy or breast-conserving treatment, but without SCRT, between 1994 and 2003. Mastectomy was performed in 302 patients (67.4%). The median number of axillary nodes dissected was 17 (range, 5-53). Systemic chemotherapy was administered in 443 patients (98.9%), and 144 patients received radiation aftermore » breast-conserving surgery. The median follow-up was 88 months (range, 15-170 months). Results: At follow-up, the treatment failed in 101 patients (22.5%), and 39 patients (8.7%) had supraclavicular node recurrence. Prognostic factors in supraclavicular node recurrence included lymphovascular invasion (p < 0.0001), extracapsular extension (p < 0.0001), the number of involved axillary nodes (p = 0.0003), and the level of involved axillary nodes (p = 0.012) in univariate and multivariate analyses. The total number of prognostic factors correlated well with supraclavicular node recurrence. In the analysis of 5-year supraclavicular node recurrence-free survival, patients with two or more factors showed a significantly higher recurrence rate than did patients with fewer than two factors (96.8% and 72.9%, respectively; p < 0.0001). Conclusions: The prognostic factors associated with supraclavicular node recurrence were lymphovascular invasion, extracapsular extension, and the number and level of involved axillary nodes. Patients with two or more prognostic factors might benefit from SCRT.« less

Short-term therapy with relatively low-dose cerivastatin improves endothelial function independently of its lipid-lowering effect: Evaluation of brachial artery vasodilatation using B-mode ultrasound imaging.

PubMed

Sakabe, Koichi; Fukuda, Nobuo; Nada, Teru; Onose, Yukiko; Soeki, Takeshi; Shinohara, Hisanori; Tamura, Yoshiyuki

2002-12-01

Administration of 0.4 to 0.8 mg of cerivastatin per day for 2 weeks has been reported to have pleiotropic effects and improve endothelial function. Whether low-dose cerivastatin would produce these rapid pleiotropic effects in the clinical setting remains uncertain, however. We investigated the effect of short-term therapy with relatively low-dose cerivastatin (0.15 mg/day) on endothelial function, thrombostatic parameters, and C-reactive protein (CRP) levels in hypercholesterolemic patients. Thirteen patients with LDL-cholesterol>160 mg/dl were treated with daily doses of 0.15 mg of cerivastatin for 2 weeks. Endothelial function, thrombostatic parameters (tissue-type plasminogen activator [t-PA], plasminogen activator inhibitor type 1 [PAI-1], and CRP were estimated at baseline and again after 2 weeks of treatment. Endothelial function was measured as flow-mediated vasodilation. Flow-mediated vasodilatation was assessed by measuring the percent change in the diameter of the brachial artery in response to reactive hyperemia using high-resolution ultrasound. Endothelium-independent vasodilatation was also measured using sublingual nitroglycerin. No major complications developed after the treatment. Total cholesterol decreased significantly, from 258±32 to 211±21 mg/dl, and LDL-cholesterol also decreased from 171±15 to 133±16 mg/dl after the treatment. Flow-mediated vasodilatation increased significantly, from 4.6±1.3 percent to 8.7±3.5 percent after 2 weeks of therapy, although endothelium-independent vasodilatation was not affected (9.5±2.4% vs 8.8±3.1%). No relation was found between percent change in flow-mediated vasodilatation and improvement in levels of LDL-cholesterol after therapy (r=0.07). PAI-1, t-PA, and CRP were not significantly changed by 2 weeks of therapy. (1) Evaluating vasodilation of the brachial artery with B-mode ultrasound imaging was useful in investigating the effect of statin on endothelial function. (2) Although no effect was detected in PAI-1, t-PA, or CRP, relatively low-dose cerivastatin therapy for 2 weeks improved endothelial function and lipid level independently and safely in hypercholesterolemic patients.

Folic Acid Supplementation Improves Vascular Function in Professional Dancers With Endothelial Dysfunction

PubMed Central

Hoch, Anne Z.; Papanek, Paula; Szabo, Aniko; Widlansky, Michael E.; Gutterman, David D.

2012-01-01

Objective To determine if folic acid supplementation improves vascular function (brachial artery flow-mediated dilation [FMD]) in professional dancers with known endothelial dysfunction. Design Prospective cross-sectional study. Setting Academic institution in the Midwestern United States. Subjects Twenty-two professional ballet dancers volunteered for this study. Main Outcome Measures Subjects completed a 3-day food record to determine caloric and micronutrient intake. Menstrual status was determined by interview and questionnaire. Endothelial function was determined as flow-induced vasodilation measured by high-frequency ultrasound of the brachial artery. A change in brachial diameter of <5% to hyperemic flow stimulus was defined a priori as endothelial dysfunction. Subjects with abnormal FMD took 10 mg of folic acid daily for 4 weeks, and FMD testing was then repeated. Serum whole blood was measured for folic acid levels before and after supplementation. Results Sixty-four percent of dancers (n = 14) had abnormal brachial artery FMD (<5%) (mean ± standard deviation, 2.9% ± 1.5%). After 4 weeks of folic acid supplementation (10 mg/day), FMD improved in all the subjects (7.1% ± 2.3%; P < .0001). Conclusions This study reveals that vascular endothelial function improves in dancers after supplementation with folic acid (10 mg/day) for at least 4 weeks. This finding may have clinically important implications for future cardiovascular disease risk prevention. PMID:21715240

Effect of breaking up sedentary time with callisthenics on endothelial function.

PubMed

Carter, Sophie E; Gladwell, Valerie F

2017-08-01

Periods of prolonged sitting impairs endothelial function in lower limb conduit arteries, which is attenuated with physical activity breaks. The effect of activity breaks on upper limb arteries has not been examined. This study assessed changes in brachial artery endothelial function following either a prolonged sitting period or breaking up this sedentary time by performing sets of callisthenics exercises. Ten healthy participants (6 men) completed 2 conditions in a counterbalanced order: (a) 1-h 26-min sitting, or (b) breaking up this period every 20 min by performing a set of 5 callisthenics exercises. Brachial artery endothelial function was assessed via ultrasound using the flow-mediated dilation (FMD) technique prior to and following each condition, while brachial shear rate (SR) was acquired after each set of callisthenics. There was no significant change in FMD over time (P = 0.09) or between conditions (P = 0.12). Compared to sitting, brachial SR increased following each set of callisthenics, with a significant difference after the third break (Sit: 33.94 ± 12.79 s -1 ; Callisthenics: 57.16 ± 30.48 s -1 , P = 0.02). Alterations in SR in the upper limbs suggest callisthenics may be an effective intervention to break up sedentary time and attenuate the potentially deleterious effects of prolonged sitting on cardiovascular health.

Breast feeding in infancy and arterial endothelial function later in life. The Cardiovascular Risk in Young Finns Study.

PubMed

Järvisalo, M J; Hutri-Kähönen, N; Juonala, M; Mikkilä, V; Räsänen, L; Lehtimäki, T; Viikari, J; Raitakari, O T

2009-05-01

Breast feeding in infancy may be associated with reduced cardiovascular morbidity in adulthood. We examined the association between breast feeding in infancy and arterial function and structure in adulthood in a population-based cohort of Finnish adults. Noninvasive ultrasound was used to measure brachial artery flow-mediated dilatation (FMD), carotid artery intima-media thickness (IMT) and carotid artery compliance (CAC) in 1667 young adults participating in the Cardiovascular Risk in Young Finns Study with data on early nutrition. Maximal FMD was higher in breast-fed men compared to formula-fed men (7.2+/-4.0 vs 5.9+/-3.4%, P=0.029) while no differences were seen between breast-fed and formula-fed women (8.9+/-4.5 vs 8.8+/-5.0%, P=0.84). In men, the multivariable correlates of FMD included the group variable for breast feeding (P=0.014), birth weight (P=0.043), waist circumference (P<0.001) and baseline brachial artery diameter (P<0.001). In women, the multivariable correlates of FMD were birth weight (P=0.02), waist circumference (P<0.001) and brachial artery baseline diameter (P<0.001). Breast feeding was not significantly associated with IMT or CAC in multivariable models. Adult men who have been breast fed have better brachial endothelial function compared to men who have been formula fed.

Ultrasound-Guided Fine Needle Aspiration Biopsy of the Thyroid

MedlinePlus

... News Physician Resources Professions Site Index A-Z Ultrasound-Guided Fine Needle Aspiration Biopsy of the Thyroid ... Needle Aspiration Biopsy of the Thyroid? What is Ultrasound-Guided Fine Needle Aspiration Biopsy of the Thyroid? ...

Ultrasound - Breast

MedlinePlus

... the patient. Because ultrasound images are captured in real-time, they can show the structure and movement of ... perform an ultrasound-guided biopsy . Because ultrasound provides real-time images, it is often used to guide biopsy ...

Assistive technology for ultrasound-guided central venous catheter placement.

PubMed

Ikhsan, Mohammad; Tan, Kok Kiong; Putra, Andi Sudjana

2018-01-01

This study evaluated the existing technology used to improve the safety and ease of ultrasound-guided central venous catheterization. Electronic database searches were conducted in Scopus, IEEE, Google Patents, and relevant conference databases (SPIE, MICCAI, and IEEE conferences) for related articles on assistive technology for ultrasound-guided central venous catheterization. A total of 89 articles were examined and pointed to several fields that are currently the focus of improvements to ultrasound-guided procedures. These include improving needle visualization, needle guides and localization technology, image processing algorithms to enhance and segment important features within the ultrasound image, robotic assistance using probe-mounted manipulators, and improving procedure ergonomics through in situ projections of important information. Probe-mounted robotic manipulators provide a promising avenue for assistive technology developed for freehand ultrasound-guided percutaneous procedures. However, there is currently a lack of clinical trials to validate the effectiveness of these devices.

Comparison of brown and white adipose tissues in infants and children with chemical-shift-encoded water-fat MRI.

PubMed

Hu, Houchun H; Yin, Larry; Aggabao, Patricia C; Perkins, Thomas G; Chia, Jonathan M; Gilsanz, Vicente

2013-10-01

To compare fat-signal fractions (FFs) and T2* values between brown (BAT) and white (WAT) adipose tissue located within the supraclavicular fossa and subcutaneous depots, respectively. Twelve infants and 39 children were studied. Children were divided into lean and overweight/obese subgroups. Chemical-shift-encoded water-fat magnetic resonance imaging (MRI) was used to quantify FFs and T2* metrics in the supraclavicular and adjacent subcutaneous adipose tissue depots. Linear regression and t-tests were performed. Infants had lower supraclavicular FFs than children (P < 0.01) but T2* values were similar (P = 0.5). Lean children exhibited lower supraclavicular FFs and T2* values than overweight children (P < 0.01). In each individual infant and child, supraclavicular FFs were consistently lower than adjacent subcutaneous FFs. Supraclavicular T2* values were consistently lower than subcutaneous T2* values in children, but not in infants. FFs in both depots were positively correlated with age and weight in infants (P < 0.01). In children, they were correlated with weight and body mass index (BMI) (P < 0.01), but not age. Correlations between T2* and anthropometric variables existed in children (P < 0.01), but were absent in infants. Cross-sectional comparisons suggest variations in FF and T2* values in the supraclavicular and subcutaneous depots of infants and children, which are potentially indicative of physiological differences in adipose tissue fat content, amount, and metabolic activity. Copyright © 2013 Wiley Periodicals, Inc.

Clinical Assessment of the Infant and Child Following Perinatal Brachial Plexus Injury

PubMed Central

Duff, Susan V.; DeMatteo, Carol

2015-01-01

STUDY DESIGN Literature review INTRODUCTION After perinatal brachial plexus injury (PBPI), clinicians play an important role in injury classification as well as the assessment of recovery and secondary conditions. Early assessment guides the initial plan of care and influences follow-up and long-term outcome. PURPOSE To review methods used to assess, classify and monitor the extent and influence of PBPI with an emphasis on guidelines for clinicians. METHODS We use The International Classification of Functioning, Disability, and Health (ICF) model to provide a guide to assessment after PBPI for rehabilitation clinicians. DISCUSSION With information gained from targeted assessments, clinicians can design interventions to increase the opportunities infants and children have for optimal recovery and to attain skills that allow participation in areas of interest. PMID:25840493

Ultrasound-guided synovial biopsy

PubMed Central

Sitt, Jacqueline C M; Wong, Priscilla

2016-01-01

Ultrasound-guided needle biopsy of synovium is an increasingly performed procedure with a high diagnostic yield. In this review, we discuss the normal synovium, as well as the indications, technique, tissue handling and clinical applications of ultrasound-guided synovial biopsy. PMID:26581578

Dosimetric evaluation of integrated IMRT treatment of the chest wall and supraclavicular region for breast cancer after modified radical mastectomy

DOE Office of Scientific and Technical Information (OSTI.GOV)

Yang, Bo; Wei, Xian-ding; Zhao, Yu-tian

2014-07-01

To investigate the dosimetric characteristics of irradiation of the chest wall and supraclavicular region as an integrated volume with intensity-modulated radiation therapy (IMRT) after modified radical mastectomy. This study included 246 patients who received modified radical mastectomy. The patients were scanned with computed tomography, and the chest wall (with or without the internal mammary lymph nodes) and supraclavicular region were delineated. For 143 patients, the chest wall and supraclavicular region were combined as an integrated planning volume and treated with IMRT. For 103 patients, conventional treatments were employed with 2 tangential fields for the chest wall, abutting a mixed fieldmore » of 6-MV x-rays (16 Gy) and 9-MeV electrons (34 Gy) for the upper supraclavicular region. The common prescription dose was 50 Gy/25 Fx/5 W to 90% of the target volume. The dosimetric characteristics of the chest wall, the supraclavicular region, and normal organs were compared. For the chest wall target, compared with conventional treatments, the integrated IMRT plans lowered the maximum dose, increased the minimum dose, and resulted in better conformity and uniformity of the target volume. There was an increase in minimum, average, and 95% prescription dose for the integrated IMRT plans in the supraclavicular region, and conformity and uniformity were improved. The V{sub 30} of the ipsilateral lung and V{sub 10}, V{sub 30}, and mean dose of the heart on the integrated IMRT plans were lower than those of the conventional plans. The V{sub 5} and V{sub 10} of the ipsilateral lung and V{sub 5} of the heart were higher on the integrated IMRT plans (p < 0.05) than on conventional plans. Without an increase in the radiation dose to organs at risk, the integrated IMRT treatment plans improved the dose distribution of the supraclavicular region and showed better dose conformity and uniformity of the integrated target volume of the chest wall and supraclavicular region.« less

Correlations of serum cystatin C and hs-CRP with vascular endothelial cell injury in patients with active systemic lupus erythematosus.

PubMed

Gao, Dong; Shao, Juan; Jin, Waishu; Xia, Xiujuan; Qu, Yan

2018-05-22

To investigate the correlations of serum cystatin C and high-sensitivity C-reactive protein (hs-CRP) with vascular endothelial cell injury in patients with active systemic lupus erythematosus (SLE). A total of 80 patients with SLE treated in our hospital from January 2016 to September 2017 were selected and randomly divided into stable-stage group (n=40) and active-stage group (n=40) using a random number table. The expressions of cystatin C and hs-CRPin stable and active stages were compared, and the inner diameters of brachial artery and levels of vascular endothelial growth factors in stable and active stages were also compared.The correlationsof expressions of cystatin C and hs-CRP in active stage with the inner diameter of brachial artery and vascular endothelial growth factor were analyzed. At the same time, the correlation between vascular endothelial growth factor and inner diameter of brachial artery in active stage was analyzed. The level of cystatin C in active stage was higher than that in stable stage (P<0.05), and the expression level of hs-CRP in active stage was also higher than that in stable stage (P<0.05). The inner diameter of brachial artery in active stage was smaller than that in stable stage (P<0.05), butthe level of vascular endothelial growth factor was higher than that in stable stage (P<0.05). The expressions of cystatin C and hs-CRP were negatively correlated with the inner diameter of brachial artery in active stage (P<0.05). The expressions of cystatin C and hs-CRP were positively correlated with vascular endothelial growth factor in active stage (P<0.05). Moreover, there was a negative correlation between vascular endothelial growth factor and inner diameter of brachial artery in active stage (P<0.05). Levels of cystatin C and hs-CRP are significantly increased in patients with active SLE, and the increase degrees are negatively correlated with the inner diameter of brachial artery under ultrasound, but positively correlated with the level of vascular endothelial growth factor in vivo.

Ultrasound-guided greater occipital nerve blocks and pulsed radiofrequency ablation for diagnosis and treatment of occipital neuralgia.

PubMed

Vanderhoek, Matthew David; Hoang, Hieu T; Goff, Brandon

2013-09-01

Occipital neuralgia is a condition manifested by chronic occipital headaches and is thought to be caused by irritation or trauma to the greater occipital nerve (GON). Treatment for occipital neuralgia includes medications, nerve blocks, and pulsed radiofrequency ablation (PRFA). Landmark-guided GON blocks are the mainstay in both the diagnosis and treatment of occipital neuralgia. Ultrasound is being utilized more and more in the chronic pain clinic to guide needle advancement when performing procedures; however, there are no reports of ultrasound used to guide a diagnostic block or PRFA of the GON. We report two cases in which ultrasound was used to guide diagnostic greater occipital nerve blocks and greater occipital nerve pulsed radiofrequency ablation for treatment of occipital neuralgia. Two patients with occipital headaches are presented. In Case 1, ultrasound was used to guide diagnostic blocks of the greater occipital nerves. In Case 2, ultrasound was utilized to guide placement of radiofrequency probes for pulsed radiofrequency ablation of the greater occipital nerves. Both patients reported immediate, significant pain relief, with continued pain relief for several months. Further study is needed to examine any difference in outcomes or morbidity between the traditional landmark method versus ultrasound-guided blocks and pulsed radiofrequency ablation of the greater occipital nerves.

Ultrasound-Guided Greater Occipital Nerve Blocks and Pulsed Radiofrequency Ablation for Diagnosis and Treatment of Occipital Neuralgia

PubMed Central

VanderHoek, Matthew David; Hoang, Hieu T; Goff, Brandon

2013-01-01

Occipital neuralgia is a condition manifested by chronic occipital headaches and is thought to be caused by irritation or trauma to the greater occipital nerve (GON). Treatment for occipital neuralgia includes medications, nerve blocks, and pulsed radiofrequency ablation (PRFA). Landmark-guided GON blocks are the mainstay in both the diagnosis and treatment of occipital neuralgia. Ultrasound is being utilized more and more in the chronic pain clinic to guide needle advancement when performing procedures; however, there are no reports of ultrasound used to guide a diagnostic block or PRFA of the GON. We report two cases in which ultrasound was used to guide diagnostic greater occipital nerve blocks and greater occipital nerve pulsed radiofrequency ablation for treatment of occipital neuralgia. Two patients with occipital headaches are presented. In Case 1, ultrasound was used to guide diagnostic blocks of the greater occipital nerves. In Case 2, ultrasound was utilized to guide placement of radiofrequency probes for pulsed radiofrequency ablation of the greater occipital nerves. Both patients reported immediate, significant pain relief, with continued pain relief for several months. Further study is needed to examine any difference in outcomes or morbidity between the traditional landmark method versus ultrasound-guided blocks and pulsed radiofrequency ablation of the greater occipital nerves. PMID:24282778

Clinical Utility and Pitfalls of Ultrasound Guided Foreign Body Removal in War Fighters

DTIC Science & Technology

2015-12-01

1 AD_________________ AWARD NUMBER: W81XWH-08-2-0162 TITLE: Clinical Utility and Pitfalls of Ultrasound Guided Foreign Body Removal in War...Clinical Utility and Pitfalls of Ultrasound Guided Foreign Body Removal in War Fighters 5a. CONTRACT NUMBER 5b. GRANT NUMBER: W81XWH-08-2-0162 5c...Purpose: To demonstrate that 1) ultrasound guided foreign body removal (USFBR) is superior to conventional surgery in the cadaver model, 2) USFBR can be

A new isocentric technique for exact geometric matching in the radiotherapy of the breast and ipsilateral supraclavicular fossa using dual asymmetric jaws.

PubMed

Romeo, Nando

2012-10-01

In some clinical situations breast or chest wall radiotherapy for cancer is given in association with supraclavicular fossa irradiation. Often the treatment is delivered by two tangential fields to the breast or chest wall and an anterior field that irradiates the supraclavicular region. The tissue between the breast or chest wall and the supraclavicular region may be under or overdosed, because of the junction between the two tangential fields and the anterior field. To present a new isocentric technique for exact geometric matching between the two tangential fields and the anterior field. Patients are positioned with both arms raised. Using three-dimensional trigonometry, two half-fields, with isocenter between the breast and the supraclavicular region, are easily matched. The tangential fields have a collimator rotation to protect the lung without additional shielding. The correct gantry, collimator and couch positions are defined for the anterior field to match the tangential fields. A general formula for exact geometric matching in radiotherapy of the breast and supraclavicular fossa is presented. The method does not require additional shielding to eliminate divergence other than the four independent jaws. The result is simple to implement in modern delivery facilities. Copyright © 2011 Associazione Italiana di Fisica Medica. Published by Elsevier Ltd. All rights reserved.

Ultrasound-Guided Renal Access for Percutaneous Nephrolithotomy: A Description of Three Novel Ultrasound-Guided Needle Techniques

PubMed Central

Chu, Carissa; Masic, Selma; Usawachintachit, Manint; Hu, Weiguo; Yang, Wenzeng; Stoller, Marshall; Li, Jianxing

2016-01-01

Abstract Ultrasound-guided renal access for percutaneous nephrolithotomy (PCNL) is a safe, effective, and low-cost procedure commonly performed worldwide, but a technique underutilized by urologists in the United States. The purpose of this article is to familiarize the practicing urologist with methods for ultrasound guidance for percutaneous renal access. We discuss two alternative techniques for gaining renal access for PCNL under ultrasound guidance. We also describe a novel technique of using the puncture needle to reposition residual stone fragments to avoid additional tract dilation. With appropriate training, ultrasound-guided renal access for PCNL can lead to reduced radiation exposure, accurate renal access, and excellent stone-free success rates and clinical outcomes. PMID:26414304

[Modern Management of Pancoast Tumour].

PubMed

Marra, Alessandro

2018-06-01

Pancoast or superior pulmonary sulcus tumour is a subset of lung carcinoma that invades the structures of the thoracic inlet - first ribs, distal roots of the brachial plexus, stellate ganglion, vertebrae, and subclavian vessels. The first symptom is usually shoulder pain; consequently, most patients are initially treated for osteoarthritis. Late diagnosis is common. Success of therapy depends on an accurate staging: standard imaging with CT scan of the chest, PET-CT scan, brain MRI are needed to rule out distant metastases, endobronchial ultrasound-guided needle biopsy (EBUS-TBNA) or mediastinoscopy are mandatory for reliable nodal staging. An MRI of the thoracic inlet allows to clearly define the boundaries of local invasion. Modern management of Pancoast tumour includes induction concurrent chemoradiotherapy followed by surgical resection. As compared with historical series treated by preoperative radiation, a trimodally approach did enhance complete resection rates and perhaps long-term survival - from about 30% 5-year survival rate to 60% in R0-resected patients. In patients who have unresectable but non-metastatic Pancoast tumours and appropriate performance status, definitive concurrent chemoradiotherapy and radiotherapy are recommended options. Georg Thieme Verlag KG Stuttgart · New York.

Video-assisted open supraclavicular sympathectomy following air embolism.

PubMed

Shpolyanski, G; Hashmonai, M; Rudin, M; Abaya, N; Kaplan, U; Kopelman, D

2012-01-01

Air embolism is a relatively rare complication of thoracoscopic surgery. Open supraclavicular sympathectomy was indicated to overcome the risk of re-embolization. A novel video-assisted technique was performed. conclusions: The previously prevalent open supraclavicular sympathectomy is a good choice for avoiding air embolism. Laparoscopic instrumentation and technology can be used to improve open procedures, especially when exposure and visibility are limited. Sometimes we should remember to use the experience of our teachers.

Brachial artery stiffness estimation using ARTSENS.

PubMed

Kiran, V Raj; Nabeel, P M; Joseph, Jayaraj; Sivaprakasam, Mohanasankar

2017-07-01

Central and peripheral arteries stiffening prominently affect hemodynamics thus increasing the risk of coronary heart disease, chronic kidney disease and end stage renal disease. There are several commercially available non-invasive measurement technologies for the evaluation of stiffness that are expensive, demand dedicated expertise and fall short for mass screening. Considering this, we have developed ARTSENS ® , a highly compact and portable image-free ultrasound device for evaluation of arterial stiffness. The capability of the device to perform accurate measurements of carotid artery stiffness has been validated through extensive in-vivo studies. In this paper we demonstrate the feasibility of using ARTSENS ® for measuring brachial artery stiffness. An inter-operator repeatability study was done based on in-vivo experiments on 9 young healthy subjects. The study included measurement of distension, end diastolic lumen diameter, arterial compliance and stiffness index performed both on carotid artery and brachial artery by two operators successively. The degree of agreement between the measurements made by operators has been investigated based on Bland-Altman plots and paired t-test. The measurements were populated within the limits of agreement. No statistically significant difference (p-values from paired t-test for end-diastolic diameter, distension, stiffness index, arterial compliance were 0.36, 0.24, 0.47 and 0.11 respectively) was seen for the brachial artery measurements performed by the two operators. The correlation between the measurement made by the operators was highly significant (r=0.86, p-value=0.003).

Thermal Resistance Anastomosis Device for the Percutaneous Creation of Arteriovenous Fistulae for Hemodialysis.

PubMed

Hull, Jeffrey E; Elizondo-Riojas, Guillermo; Bishop, Wendy; Voneida-Reyna, Yesenia L

2017-03-01

To evaluate the safety and efficacy of arteriovenous fistula (AVF) creation with a thermal resistance anastomosis device (TRAD). From January 2014 to March 2015, 26 patients underwent ultrasound (US)-guided percutaneous creation of proximal radial artery-to-perforating vein AVFs with a TRAD that uses heat and pressure to create a fused anastomosis. Primary endpoints were fistula creation, patent fistula by Doppler US, two-needle dialysis at the prescribed rate, and device-related complications. Technical success rate of fistula creation was 88% (23 of 26). Procedure time averaged 18.4 minutes (range, 5-34 min), and 96% of anastomoses (22 of 23) were fused. At 6 weeks, 87% of AVFs (20 of 23) were patent, 61% (14 of 23) had 400-mL/min brachial artery flow, 1 patient was receiving dialysis, 2 fistulae had thrombosed, and 1 patient had died unrelated to the procedure. Eighty percent (16 of 20), 70% (14 of 20), and 60% (12 of 20) of patients were receiving dialysis at 3, 6, and 12 months; 4 patients died, 3 fistulae failed, and one patient was lost to follow-up. Overall, 87% of AVFs (20 of 23) had an additional procedure at a mean of 56 days (range, 0-239 d), including balloon dilation in 43% (n = 10), brachial vein embolization in 26% (n = 6), basilic vein ligation in 17% (n = 4), venous transposition in 30% (n = 7), and valvulotomy in 4% (n = 1). There were no major complications related to the device. Percutaneous AVFs created with a TRAD met the safety endpoints of this study. Midterm follow-up demonstrated intact anastomoses and fistulae suitable for dialysis. Copyright © 2016 SIR. Published by Elsevier Inc. All rights reserved.

Guided Interventions for Prostate Cancer Using 3D-Transurethral Ultrasound and MRI Fusion

DTIC Science & Technology

2015-10-01

AWARD NUMBER: W81XWH-14-1-0461 TITLE: Guided Interventions for Prostate Cancer Using 3D-Transurethral Ultrasound and MRI Fusion PRINCIPAL...Sep 2014 - 28 Sep 2015 4. TITLE AND SUBTITLE 5a. CONTRACT NUMBER Guided Interventions for Prostate Cancer Using 3D- Transurethral Ultrasound and...Magnetic Resonance- Ultrasound (MR-US) fusion allows for specific targeting of the tumors in real-time during clinical interventions, outside of an MR

Ultrasound-guided high-intensity focused ultrasound ablation for treating uterine arteriovenous malformation.

PubMed

Yan, X; Zhao, C; Tian, C; Wen, S; He, X; Zhou, Y

2017-08-01

To explore HIFU treatment for uterine arteriovenous malformation. A case report. Gynaecological department in a university teaching hospital of China. A patient with uterine arteriovenous malformation. The diagnosis of uterine arteriovenous malformation was made through MRI. Ultrasound-guided high-intensity focused ultrasound (USgHIFU) ablation was performed. HIFU is effective in treating uterine arteriovenous malformation. The patient had reduction of the lesion volume and obvious symptom relief, without significant adverse effects. HIFU can be used as a new treatment option for uterine arteriovenous malformation. Ultrasound-guided high-intensity focused ultrasound ablation is effective in treating uterine arteriovenous malformation. © 2017 Royal College of Obstetricians and Gynaecologists.

Ultrasound- versus Palpation-Guided Injection of Corticosteroid for Plantar Fasciitis: A Meta-Analysis

PubMed Central

Yu, Aixi; Qi, Baiwen

2014-01-01

Background It is controversial whether ultrasound-guided injection of corticosteroid is superior to palpation-guided injection for plantar fasciitis. This meta-analysis was performed to compare the effectiveness of ultrasound-guided and palpation-guided injection of corticosteroid for the treatment of plantar fasciitis. Methods Databases (MEDLINE, Cochrane library and EMBASE) and reference lists were searched from their establishment to August 30, 2013 for randomized controlled trials (RCTs) comparing ultrasound-guided with palpation-guided injection for plantar fasciitis. The Cochrane risk of bias (ROB) tool was used to assess the methodological quality. Outcome measurements were visual analogue scale (VAS), tenderness threshold (TT), heel tenderness index (HTI), response rate, plantar fascia thickness (PFT), hypoechogenicity and heel pad thickness (HPT). The statistical analysis was performed with software RevMan 5.2 and Stata 12.0. When I2<50%, the fixed-effects model was adopted. Otherwise the randomized-effects model was adopted. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) system was used to assess the quality of evidence. Results Five RCTs with 149 patients were identified and analyzed. Compared with palpation-guided injection, ultrasound-guided injection was superior with regard to VAS, TT, response rate, PFT and hypoechogenicity. However, there was no statistical significance between the two groups for HPT and HTI. Conclusion Ultrasound-guided injection of corticosteroid tends to be more effective than palpation-guided injection. However, it needs to be confirmed by further research. PMID:24658102

Ultrasound-Guided Intervention for Treatment of Trigeminal Neuralgia: An Updated Review of Anatomy and Techniques

PubMed Central

Allam, Abdallah El-Sayed; Khalil, Adham Aboul Fotouh; Eltawab, Basma Aly; Wu, Wei-Ting

2018-01-01

Orofacial myofascial pain is prevalent and most often results from entrapment of branches of the trigeminal nerves. It is challenging to inject branches of the trigeminal nerve, a large portion of which are shielded by the facial bones. Bony landmarks of the cranium serve as important guides for palpation-guided injections and can be delineated using ultrasound. Ultrasound also provides real-time images of the adjacent muscles and accompanying arteries and can be used to guide the needle to the target region. Most importantly, ultrasound guidance significantly reduces the risk of collateral injury to vital neurovascular structures. In this review, we aimed to summarize the regional anatomy and ultrasound-guided injection techniques for the trigeminal nerve and its branches, including the supraorbital, infraorbital, mental, auriculotemporal, maxillary, and mandibular nerves. PMID:29808105

Transvaginal Ultrasound-Guided Biopsy of Deep Pelvic Masses: How We Do It.

PubMed

Plett, Sara K; Poder, Liina; Brooks, Rebecca A; Morgan, Tara A

2016-06-01

The purpose of this review is to discuss the rationale and indications for transvaginal ultrasound-guided biopsy. Transvaginal ultrasound-guided biopsy can be a helpful tool for diagnosis and treatment planning in the evaluation of pelvic masses, particularly when the anatomy precludes a transabdominal or posterior transgluteal percutaneous biopsy approach. A step-by-step summary of the technique with preprocedure and postprocedure considerations is included. © 2016 by the American Institute of Ultrasound in Medicine.

Cost-effectiveness of focused ultrasound, radiosurgery, and DBS for essential tremor.

PubMed

Ravikumar, Vinod K; Parker, Jonathon J; Hornbeck, Traci S; Santini, Veronica E; Pauly, Kim Butts; Wintermark, Max; Ghanouni, Pejman; Stein, Sherman C; Halpern, Casey H

2017-08-01

Essential tremor remains a very common yet medically refractory condition. A recent phase 3 study demonstrated that magnetic resonance-guided focused ultrasound thalamotomy significantly improved upper limb tremor. The objectives of this study were to assess this novel therapy's cost-effectiveness compared with existing procedural options. Literature searches of magnetic resonance-guided focused ultrasound thalamotomy, DBS, and stereotactic radiosurgery for essential tremor were performed. Pre- and postoperative tremor-related disability scores were collected from 32 studies involving 83 magnetic resonance-guided focused ultrasound thalamotomies, 615 DBSs, and 260 stereotactic radiosurgery cases. Utility, defined as quality of life and derived from percent change in functional disability, was calculated; Medicare reimbursement was employed as a proxy for societal cost. Medicare reimbursement rates are not established for magnetic resonance-guided focused ultrasound thalamotomy for essential tremor; therefore, reimbursements were estimated to be approximately equivalent to stereotactic radiosurgery to assess a cost threshold. A decision analysis model was constructed to examine the most cost-effective option for essential tremor, implementing meta-analytic techniques. Magnetic resonance-guided focused ultrasound thalamotomy resulted in significantly higher utility scores compared with DBS (P < 0.001) or stereotactic radiosurgery (P < 0.001). Projected costs of magnetic resonance-guided focused ultrasound thalamotomy were significantly less than DBS (P < 0.001), but not significantly different from radiosurgery. Magnetic resonance-guided focused ultrasound thalamotomy is cost-effective for tremor compared with DBS and stereotactic radiosurgery and more effective than both. Even if longer follow-up finds changes in effectiveness or costs, focused ultrasound thalamotomy will likely remain competitive with both alternatives. © 2017 International Parkinson and Movement Disorder Society. © 2017 International Parkinson and Movement Disorder Society.

Efficacy of ultrasound-guided thoracentesis catheter drainage for pleural effusion

PubMed Central

Cao, Weitian; Wang, Yi; Zhou, Ningming; Xu, Bing

2016-01-01

The factors influencing the efficacy of ultrasound-guided thoracentesis catheter drainage were investigated in the present study. A retrospective analysis of clinical data from 435 patients who presented with a pleural effusion was performed. Patients were divided into a control group and an intervention group. Thirty-seven patients in the control group were given standard care using pleural puncture to draw the excess fluid. The 398 patients in the intervention group were treated using ultrasound-guided thoracentesis catheter drainage. The rate of successful drainage of a pleural effusion was significantly higher (P<0.05), while the rate of complication was lower, in the ultrasound-guided thoracentesis cases compared to standard care treatment. In conclusion, ultrasound-guided thoracentesis catheter drainage is an efficient, safe and minimally invasive procedure to alleviate pleural effusion. The efficacy of the procedure is related to the separation of pleural effusion, drainage tube type and tube diameter. PMID:28105155

Technical tips to perform safe and effective ultrasound guided steroid joint injections in children.

PubMed

Parra, Dimitri A

2015-01-01

The aim of this article is to describe the technique used to perform ultrasound guided steroid joint injections in children in a group of joints that can be injected using ultrasound as the only image guidance modality. The technique is described and didactic figures are provided to illustrate key technical concepts. It is very important to be familiar with the sonographic appearance of the pediatric joints and the developing bone when performing ultrasound-guided joint injections in children.

[Clinical experience with the supraclavicular flap to reconstruct head and neck defects].

PubMed

Zhang, Bin; Yan, Dangui; Zhang, Yabing; Zhang, Xiwei; Wan, Hanfeng

2015-06-01

To evaluate the efficacy of pedicled supraclavicular artery island flaps for head and neck reconstruction. Reconstructive surgeries for head and neck oncologic defects were performed with the pedicled supraclavicular artery island flaps in 10 patients from May 2013 to December 2014 and the cases were review. Among them, 6 were performed for hypopharyngeal cancer, 2 for oral tongue cancer, 1 for oral base cancer and 1 for cervical esophageal cancer. The size of the flaps was measured in (5-8) cm × (6-12) cm. Seven flaps survived, one flap failured and two flaps had partial necrosis. Donor sites were closed primarily without morbidity. The pedicled supraclavicular artery island flap is an easy harvesting and reliable for head and neck reconstruction, especially suitable for otolaryngo-head and neck surgeon and maxillofacial surgeon in the local hospital.

Characterizing Methods of Measuring Flow-Mediated Dilation in the Brachial Artery

NASA Technical Reports Server (NTRS)

Callender, Ariane R.

2010-01-01

Regulation of vascular tone is one of the many important functions of the vascular endothelium. Endothelial dysfunction is a critical early event in the pathogenesis of atherosclerosis and occurs in the absence of angiographic disease. Flow-Mediated Dilation (FMD) is a noninvasive technique commonly used to evaluate endothelium-dependent vasodilation in humans and gauge the health of the cardiovascular system. Reductions in brachial artery FMD have been strongly correlated with disease progression and are predictive of future cardiac events. The flow stimulus for brachial artery FMD occurs as a result of the increased shear stress following deflation of an occlusion cuff around the upper arm. Using 2-dimensional ultrasound, changes in arterial diameter up to 5-minutes following cuff deflation are calculated from baseline image measurements. Along with pulsed Doppler measures of flow velocity through the artery, flow-mediated, endothelium-dependent vasodilation can be assessed. There is debate among investigators, however, about the proper positioning of the occlusion cuff during FMD testing. It is thought that placement of the cuff around the upper arm may not accurately reflect the impact of nitric oxide, a critically important molecule released as a result of the increased shear stress created by the FMD technique. Data suggest that the production of other endogenous metabolites may also contribute to FMD-related changes when positioning the cuff around the upper arm. To overcome the potential influence of such molecules, researchers now suggest that the occlusion cuff be placed below the elbow allowing a more precise estimate of nitric oxide mediated dilation. The purpose of this study is to compare the differences in FMD between the two methodologies of occlusion cuff placement. In addition, this study will determine the method that is easier for ultrasound technicians to perform and will produce a low coefficient of variance between technicians. Ultimately, the results of this study will help in tracking any adverse cardiovascular effects of spaceflight.

Point-of-Care Ultrasonography Findings and Care Use Among Patients Undergoing Ultrasound-Guided Shoulder Injections.

PubMed

Lee, Se Won; Tiu, Timothy; Roberts, Jeremy; Lee, Brian; Bartels, Matthew N; Oh-Park, Mooyeon

2018-01-01

The aims of the study were to assess the overall reduction of pain in patients undergoing ultrasound-guided shoulder injections and to characterize the preinjection point-of-care ultrasound findings and use of clinical services postinjection including the use of magnetic resonance imaging and surgeries. Data of 172 patients who underwent ultrasound-guided subacromial subdeltoid injection or glenohumeral joint injection were reviewed for preinjection point-of-care ultrasound findings, change in pain intensity at 2 mos from baseline, and use of care at 6 mos' postinjection. Pain intensity was measured by the numeric rating scale and a dichotomous report of global impression of significant improvement in pain. Responders were defined as those with 50% or more reduction in numeric rating scale or those with global impression of 50% or more improvement. There were 141 responders among the 172 patients analyzed. Full-thickness rotator cuff tears were higher in the ultrasound-guided subacromial subdeltoid injection group when compared with the glenohumeral joint injection group (P = 0.038) and abnormal bicipital tendon findings higher in the glenohumeral joint injection group (P = 0.016). There were no significant differences in specific abnormal U findings between responders versus nonresponders. Twelve patients had a shoulder magnetic resonance imaging and four patients underwent operative interventions after the injection. Overall pain reduction after ultrasound-guided shoulder injections was favorable in the short term. There was no specific preinjection point-of-care ultrasound findings associated with clinical pain reduction after injection. Additional imaging and operative intervention after ultrasound-guided shoulder injections seemed to be relatively low.

PLUS: open-source toolkit for ultrasound-guided intervention systems.

PubMed

Lasso, Andras; Heffter, Tamas; Rankin, Adam; Pinter, Csaba; Ungi, Tamas; Fichtinger, Gabor

2014-10-01

A variety of advanced image analysis methods have been under the development for ultrasound-guided interventions. Unfortunately, the transition from an image analysis algorithm to clinical feasibility trials as part of an intervention system requires integration of many components, such as imaging and tracking devices, data processing algorithms, and visualization software. The objective of our paper is to provide a freely available open-source software platform-PLUS: Public software Library for Ultrasound-to facilitate rapid prototyping of ultrasound-guided intervention systems for translational clinical research. PLUS provides a variety of methods for interventional tool pose and ultrasound image acquisition from a wide range of tracking and imaging devices, spatial and temporal calibration, volume reconstruction, simulated image generation, and recording and live streaming of the acquired data. This paper introduces PLUS, explains its functionality and architecture, and presents typical uses and performance in ultrasound-guided intervention systems. PLUS fulfills the essential requirements for the development of ultrasound-guided intervention systems and it aspires to become a widely used translational research prototyping platform. PLUS is freely available as open source software under BSD license and can be downloaded from http://www.plustoolkit.org.

Ultrasound-Guided 50% Ethyl Alcohol Injection for Patients With Malleolar and Olecranon Bursitis: A Prospective Pilot Study

PubMed Central

Hong, Ji Seong; Lee, Jin Hyung

2016-01-01

Objective To evaluate the feasibility and effect of ultrasound-guided ethyl alcohol injection on malleolar and olecranon synovial proliferative bursitis. Methods Twenty-four patients received ultrasound-guided 50% diluted ethyl alcohol injection at the site of synovial proliferative bursitis after aspiration of the free fluid. Results Swelling and symptoms significantly decreased in 13 of the 24 patients without any complications. Eleven patients had partial improvement in swelling and symptoms. Conclusion Ultrasound-guided alcohol injection could be an alternative therapeutic option before surgery in patients with chronic intractable malleolar and olecranon synovial proliferative bursitis. PMID:27152282

Ultrasound-Guided Vascular Access Simulator for Medical Training: Proposal of a Simple, Economic and Effective Model.

PubMed

Fürst, Rafael Vilhena de Carvalho; Polimanti, Afonso César; Galego, Sidnei José; Bicudo, Maria Claudia; Montagna, Erik; Corrêa, João Antônio

2017-03-01

To present a simple and affordable model able to properly simulate an ultrasound-guided venous access. The simulation was made using a latex balloon tube filled with water and dye solution implanted in a thawed chicken breast with bones. The presented model allows the simulation of all implant stages of a central catheter. The obtained echogenicity is similar to that observed in human tissue, and the ultrasound identification of the tissues, balloon, needle, wire guide and catheter is feasible and reproducible. The proposed model is simple, economical, easy to manufacture and capable of realistically and effectively simulating an ultrasound-guided venous access.

Comparison of the analgesic efficacy of ultrasound-guided rectus sheath block and local anesthetic infiltration for laparoscopic percutaneous extraperitoneal closure in children.

PubMed

Uchinami, Yuka; Sakuraya, Fumika; Tanaka, Nobuhiro; Hoshino, Koji; Mikami, Eri; Ishikawa, Taro; Fujii, Hitomi; Ishikawa, Takehiko; Morimoto, Yuji

2017-05-01

Ultrasound-guided rectus sheath block and local anesthetic infiltration are the standard options to improve postoperative pain for children undergoing surgery with a midline incision. However, there is no study comparing the effect of ultrasound-guided rectus sheath block with local anesthetic infiltration for children undergoing laparoscopic surgery. The aim of this trial was to compare the onset of ultrasound-guided rectus sheath block with that of local anesthetic infiltration for laparoscopic percutaneous extraperitoneal closure in children. We performed an observer-blinded, randomized, prospective trial. Enrolled patients were assigned to either an ultrasound-guided rectus sheath block group or a local anesthetic infiltration group. The ultrasound-guided rectus sheath block group (n = 17) received ultrasound-guided rectus sheath block with 0.2 ml·kg -1 of 0.375% ropivacaine per side in the posterior rectus sheath compartment. The local anesthetic infiltration group (n = 17) received local anesthetic infiltration with 0.2 ml·kg -1 of 0.75% ropivacaine. The Face, Legs, Activity, Cry, and Consolability (FLACC) pain scores were recorded at 0, 30, 60 min after arrival at the postanesthesia care unit. Of the 37 patients enrolled in this study, 34 completed the study protocol. A significant difference in the pain scale between the ultrasound-guided rectus sheath block group and local anesthetic infiltration group was found at 0 min (median: 0, interquartile range [IQR]: 0-1.5, vs median: 1, IQR 0-5, confidence interval of median [95% CI]: 0-3, P = 0.048), but no significant difference was found at 30 min (median: 1, IQR: 0-4 vs median: 6, IQR: 0-7, 95% CI: 0-5, P = 0.061), or 60 min (median: 0, IQR: 0-2 vs median: 1, IQR: 0-3, 95% CI: -1 to 1, P = 0.310). No significant difference was found in anesthesia time between the ultrasound-guided rectus sheath block and local anesthetic infiltration groups. No procedure-related complications were observed in either group. Ultrasound-guided rectus sheath block is a quicker way to control postoperative pain for pediatric patients undergoing laparoscopic extraperitoneal closure than local anesthetic infiltration, and thus may provide a clinical benefit. © 2017 John Wiley & Sons Ltd.

Preliminary study of ergonomic behavior during simulated ultrasound-guided regional anesthesia using a head-mounted display.

PubMed

Udani, Ankeet D; Harrison, T Kyle; Howard, Steven K; Kim, T Edward; Brock-Utne, John G; Gaba, David M; Mariano, Edward R

2012-08-01

A head-mounted display provides continuous real-time imaging within the practitioner's visual field. We evaluated the feasibility of using head-mounted display technology to improve ergonomics in ultrasound-guided regional anesthesia in a simulated environment. Two anesthesiologists performed an equal number of ultrasound-guided popliteal-sciatic nerve blocks using the head-mounted display on a porcine hindquarter, and an independent observer assessed each practitioner's ergonomics (eg, head turning, arching, eye movements, and needle manipulation) and the overall block quality based on the injectate spread around the target nerve for each procedure. Both practitioners performed their procedures without directly viewing the ultrasound monitor, and neither practitioner showed poor ergonomic behavior. Head-mounted display technology may offer potential advantages during ultrasound-guided regional anesthesia.

UBC-Nepal Expedition: acute alterations in sympathetic nervous activity do not influence brachial artery endothelial function at sea level and high altitude.

PubMed

Tymko, Michael M; Tremblay, Joshua C; Steinback, Craig D; Moore, Jonathan P; Hansen, Alex B; Patrician, Alexander; Howe, Connor A; Hoiland, Ryan L; Green, Daniel J; Ainslie, Philip N

2017-11-01

Evidence indicates that increases in sympathetic nervous activity (SNA), and acclimatization to high altitude (HA), may reduce endothelial function as assessed by brachial artery flow-mediated dilatation (FMD); however, it is unclear whether such changes in FMD are due to direct vascular constraint, or consequential altered hemodynamics (e.g., shear stress) associated with increased SNA as a consequence of exposure to HA. We hypothesized that 1 ) at rest, SNA would be elevated and FMD would be reduced at HA compared with sea-level (SL); and 2 ) at SL and HA, FMD would be reduced when SNA was acutely increased, and elevated when SNA was acutely decreased. Using a novel, randomized experimental design, brachial artery FMD was assessed at SL (344 m) and HA (5,050 m) in 14 participants during mild lower-body negative pressure (LBNP; -10 mmHg) and lower-body positive pressure (LBPP; +10 mmHg). Blood pressure (finger photoplethysmography), heart rate (electrocardiogram), oxygen saturation (pulse oximetry), and brachial artery blood flow and shear rate (Duplex ultrasound) were recorded during LBNP, control, and LBPP trials. Muscle SNA was recorded (via microneurography) in a subset of participants ( n = 5). Our findings were 1 ) at rest, SNA was elevated ( P < 0.01), and absolute FMD was reduced ( P = 0.024), but relative FMD remained unaltered ( P = 0.061), at HA compared with SL; and 2 ) despite significantly altering SNA with LBNP (+60.3 ± 25.5%) and LBPP (-37.2 ± 12.7%) ( P < 0.01), FMD was unaltered at SL ( P = 0.448) and HA ( P = 0.537). These data indicate that acute and mild changes in SNA do not directly influence brachial artery FMD at SL or HA. NEW & NOTEWORTHY The role of the sympathetic nervous system on endothelial function remains unclear. We used lower-body negative and positive pressure to manipulate sympathetic nervous activity at sea level and high altitude and measured brachial endothelial function via flow-mediated dilation. We found that acutely altering sympathetic nervous activity had no effect on endothelial function. Copyright © 2017 the American Physiological Society.

Can we use lower volume of local anesthetic for infraclavicular brachial plexus nerve block under ultrasound guidance in children?

PubMed

Ince, Ilker; Aksoy, Mehmet; Dostbil, Aysenur; Tuncer, Kutsi

2017-09-01

To determine if the infraclavicular brachial plexus block can be applied with lower volume of local anesthetic. Randomised, double-blinded clinical trial. 60 patients aged 5-15years with ASA I-II who underwent emergent or elective arm, forearm or hand operations were included in the study. Patients were divided into two groups randomly; standard volume local anesthetic administered group (Group S, n=30) and low volume anesthetic administered group (Group L, n=30). Postoperative pain scores, sensory and motor block durations were noted. Pain scores (Wong-Baker Face Scale) were evaluated and the results were detected to be similar at all times (30min, 1, 2, 4, 8, 12, 24h). Durations of motor block were 168(±16) minutes and 268(±15) minutes in Group L and Group S respectively and the difference was statistically significant (p<0.001). Durations of sensory block were 385(±26) and 402(±39) in Group L and Group S respectively and no statistically significant difference was detected (p=0.064). Similar block success, postoperative sensory block durations and pain scores could be obtained during infraclavicular brachial plexus in pediatric patients with lower local anesthetic volumes. Copyright © 2016 Elsevier Inc. All rights reserved.

Cost-utility analysis of great saphenous vein ablation with radiofrequency, foam and surgery in the emerging health-care setting of Thailand.

PubMed

Siribumrungwong, Boonying; Noorit, Pinit; Wilasrusmee, Chumpon; Leelahavarong, Pattara; Thakkinstian, Ammarin; Teerawattananon, Yot

2016-09-01

To conduct economic evaluations of radiofrequency ablation, ultrasound-guided foam sclerotherapy and surgery for great saphenous vein ablation. A cost-utility and cohort analysis from societal perspective was performed to estimate incremental cost-effectiveness ratio. Transitional probabilities were from meta-analysis. Direct medical, direct non-medical, indirect costs, and utility were from standard Thai costings and cohort. Probabilistic sensitivity analysis was performed to assess parameter uncertainties. Seventy-seven patients (31 radiofrequency ablation, 19 ultrasound-guided foam sclerotherapy, and 27 surgeries) were enrolled from October 2011 to February 2013. Compared with surgery, radiofrequency ablation costed 12,935 and 20,872 Baht higher, whereas ultrasound-guided foam sclerotherapy costed 6159 lower and 1558 Bath higher for outpatient and inpatient, respectively. At one year, radiofrequency ablation had slightly lower quality-adjusted life-year, whereas ultrasound-guided foam sclerotherapy yielded additional 0.025 quality-adjusted life-year gained. Because of costing lower and greater quality-adjusted life-year than other compared alternatives, outpatient ultrasound-guided foam sclerotherapy was an option being dominant. Probabilistic sensitivity analysis resulted that at the Thai ceiling threshold of 160,000 Baht/quality-adjusted life-year gained, ultrasound-guided foam sclerotherapy had chances of 0.71 to be cost-effective. Ultrasound-guided foam sclerotherapy seems to be cost-effective for treating great saphenous vein reflux compared to surgery in Thailand at one-year results. © The Author(s) 2015.

Comparison of Ultrasound-Guided and Fluoroscopy-Assisted Antegrade Common Femoral Artery Puncture Techniques

DOE Office of Scientific and Technical Information (OSTI.GOV)

Slattery, Michael M.; Goh, Gerard S.; Power, Sarah

PurposeTo prospectively compare the procedural time and complication rates of ultrasound-guided and fluoroscopy-assisted antegrade common femoral artery (CFA) puncture techniques.Materials and MethodsHundred consecutive patients, undergoing a vascular procedure for which an antegrade approach was deemed necessary/desirable, were randomly assigned to undergo either ultrasound-guided or fluoroscopy-assisted CFA puncture. Time taken from administration of local anaesthetic to vascular sheath insertion in the superficial femoral artery (SFA), patients’ age, body mass index (BMI), fluoroscopy radiation dose, haemostasis method and immediate complications were recorded. Mean and median values were calculated and statistically analysed with unpaired t tests.ResultsSixty-nine male and 31 female patients underwent antegrademore » puncture (mean age 66.7 years). The mean BMI was 25.7 for the ultrasound-guided (n = 53) and 25.3 for the fluoroscopy-assisted (n = 47) groups. The mean time taken for the ultrasound-guided puncture was 7 min 46 s and for the fluoroscopy-assisted technique was 9 min 41 s (p = 0.021). Mean fluoroscopy dose area product in the fluoroscopy group was 199 cGy cm{sup 2}. Complications included two groin haematomas in the ultrasound-guided group and two retroperitoneal haematomas and one direct SFA puncture in the fluoroscopy-assisted group.ConclusionUltrasound-guided technique is faster and safer for antegrade CFA puncture when compared to the fluoroscopic-assisted technique alone.« less

Consistent evaluation of an ultrasound-guided surgical navigation system by utilizing an active validation platform

NASA Astrophysics Data System (ADS)

Kim, Younsu; Kim, Sungmin; Boctor, Emad M.

2017-03-01

An ultrasound image-guided needle tracking systems have been widely used due to their cost-effectiveness and nonionizing radiation properties. Various surgical navigation systems have been developed by utilizing state-of-the-art sensor technologies. However, ultrasound transmission beam thickness causes unfair initial evaluation conditions due to inconsistent placement of the target with respect to the ultrasound probe. This inconsistency also brings high uncertainty and results in large standard deviations for each measurement when we compare accuracy with and without the guidance. To resolve this problem, we designed a complete evaluation platform by utilizing our mid-plane detection and time of flight measurement systems. The evaluating system uses a PZT element target and an ultrasound transmitting needle. In this paper, we evaluated an optical tracker-based surgical ultrasound-guided navigation system whereby the optical tracker tracks marker frames attached on the ultrasound probe and the needle. We performed ten needle trials of guidance experiment with a mid-plane adjustment algorithm and with a B-mode segmentation method. With the midplane adjustment, the result showed a mean error of 1.62+/-0.72mm. The mean error increased to 3.58+/-2.07mm without the mid-plane adjustment. Our evaluation system can reduce the effect of the beam-thickness problem, and measure ultrasound image-guided technologies consistently with a minimal standard deviation. Using our novel evaluation system, ultrasound image-guided technologies can be compared under equal initial conditions. Therefore, the error can be evaluated more accurately, and the system provides better analysis on the error sources such as ultrasound beam thickness.

Reactivity to low-flow as a potential determinant for brachial artery flow-mediated vasodilatation.

PubMed

Aizawa, Kunihiko; Elyas, Salim; Adingupu, Damilola D; Casanova, Francesco; Gooding, Kim M; Strain, W David; Shore, Angela C; Gates, Phillip E

2016-06-01

Previous studies have reported a vasoconstrictor response in the radial artery during a cuff-induced low-flow condition, but a similar low-flow condition in the brachial artery results in nonuniform reactivity. This variable reactivity to low-flow influences the subsequent flow-mediated dilatation (FMD) response following cuff-release. However, it is uncertain whether reactivity to low-flow is important in data interpretation in clinical populations and older adults. This study aimed to determine the influence of reactivity to low-flow on the magnitude of brachial artery FMD response in middle-aged and older individuals with diverse cardiovascular risk profiles. Data were analyzed from 165 individuals, divided into increased cardiovascular risk (CVR: n = 115, 85M, 67.0 ± 8.8 years) and healthy control (CTRL: n = 50, 30M, 63.2 ± 7.2 years) groups. Brachial artery diameter and blood velocity data obtained from Doppler ultrasound were used to calculate FMD, reactivity to low-flow and estimated shear rate (SR) using semiautomated edge-detection software. There was a significant association between reactivity to low-flow and FMD in overall (r = 0.261), CTRL (r = 0.410) and CVR (r = 0.189, all P < 0.05) groups. Multivariate regression analysis found that reactivity to low-flow, peak SR, and baseline diameter independently contributed to FMD along with sex, the presence of diabetes, and smoking (total R(2) = 0.450). There was a significant association between reactivity to low-flow and the subsequent FMD response in the overall dataset, and reactivity to low-flow independently contributed to FMD These findings suggest that reactivity to low-flow plays a key role in the subsequent brachial artery FMD response and is important in the interpretation of FMD data. © 2016 The Authors. Physiological Reports published by Wiley Periodicals, Inc. on behalf of the American Physiological Society and The Physiological Society.

Ultrasound-guided suprascapular nerve block: a correlation with fluoroscopic and cadaveric findings.

PubMed

Peng, Philip W H; Wiley, Michael J; Liang, James; Bellingham, Geoff A

2010-02-01

Previous work on the ultrasound-guided injection technique and the sonoanatomy of the suprascapular region relevant to the suprascapular nerve (SSN) block suggested that the ultrasound scan showed the presence of the suprascapular notch and transverse ligament. The intended target of the ultrasound-guided injection was the notch. The objective of this case report and the subsequent cadaver dissection findings is to reassess the interpretation of the ultrasound images when locating structures for SSN block. A 45-yr-old man with chronic shoulder pain received an ultrasound-guided SSN block using the suprascapular notch as the intended target. The position of the needle was verified by fluoroscopy, which showed the tip of the needle well outside the suprascapular notch. Similar ultrasound-guided SSN blocks were performed in two cadavers. Dissections were performed which showed that the needle tips were not at the suprascapular notch but, more accurately, were close to the SSN but at the floor of the suprascapular fossa between the suprascapular and spinoglenoid notch. Our fluoroscopic and cadaver dissection findings both suggest that the ultrasound image of the SSN block shown by the well-described technique is actually targeting the nerve on the floor of the suprascapular spine between the suprascapular and spinoglenoid notches rather than the suprascapular notch itself. The structure previously identified as the transverse ligament is actually the fascia layer of the supraspinatus muscle.

Ultrasound-guided peripheral nerve blockade.

PubMed

Chin, Ki Jinn; Chan, Vincent

2008-10-01

The use of ultrasound for peripheral nerve blockade is becoming popular. Although the feasibility of ultrasound-guided nerve blockade is now clear, it is uncertain at this time whether it represents the new standard for regional anesthesia in terms of efficacy and safety. The ability to visualize nerve location, needle advancement, needle-nerve interaction, and local anesthetic spread makes ultrasound-guided nerve block an attractive option. Study results indicate that these advantages can improve the ease of block performance, block success rates, and complications. At the same time there is evidence that ultrasound-guided regional anesthesia is a unique skill in its own right, and that proficiency in it requires training and experience. Ultrasound is a valuable tool that is now available to the regional anesthesiologist, and it is fast becoming a standard part of practice. It promises to be of especial value to the less experienced practitioner. Ultrasound does not in itself, however, guarantee the efficacy and safety of peripheral nerve blockade. Proper training in its use is required and we can expect to see the development of formal standards and guidelines in this regard.

Ultrasound-guided venous access for pacemakers and defibrillators.

PubMed

Seto, Arnold H; Jolly, Aaron; Salcedo, Jonathan

2013-03-01

Ultrasound guidance is widely recommended to reduce the risk of complications during central venous catheter placement. However, ultrasound guidance is not commonly utilized for implanting leads for cardiac rhythm management devices. We describe our technique of ultrasound-guided pacemaker implantation, including a novel pull-through technique that allows percutaneous guidewire insertion prior to the first incision. We review the literature and recent advances in ultrasound imaging technology that may facilitate the adoption of ultrasound guidance. Ultrasound guidance provides a safe and rapid technique for extrathoracic subclavian or axillary venous lead placement. © 2012 Wiley Periodicals, Inc.

X-ray–free Ultrasound-guided Percutaneous Nephrolithotomy: How to Select the Right Patient?

PubMed Central

Usawachintachit, Manint; Tzou, David T.; Hu, Weiguo; Li, Jianxing; Chi, Thomas

2017-01-01

OBJECTIVE To identify factors associated with successful ultrasound guidance for each surgical step of ultrasound-guided percutaneous nephrolithotomy (PCNL). PATIENTS AND METHODS Consecutive patients undergoing PCNL between March 2015 and June 2016 were prospectively enrolled. An attempt was made to use ultrasound guidance in renal access, tract dilation, and nephrostomy tube placement for each patient. For steps during which ultrasound guidance was unsuccessful, fluoroscopic screening was applied. Regression analysis identified patient characteristics associated with successful use of ultrasound guidance. RESULTS A total of 96 patients composed this cohort, with a mean body mass index of 28.7 kg/m2. Mean stone size was 33.1 ± 18.9 mm, and no hydronephrosis was found in 63.5% of cases. Fluoroscopic screening was required for renal access in 27 cases (28.1%), tract dilation in 38 (39.6%), and nephrostomy tube placement in 80 (83.3%). Multivariate analysis demonstrated that successful ultrasound guidance was significantly associated with the presence of hydronephrosis for renal access and the absence of staghorn calculi for tract dilation. Ultrasound-guided nephrostomy tube placement appeared linked to surgeon experience. CONCLUSION To achieve completely x-ray–free ultrasound-guided PCNL, the ideal patient should have a hydronephrotic collecting system with no staghorn stone present. For practitioners looking to adopt ultrasound guidance into their PCNL practice, these represent the most appropriate patients to safely initiate a surgical experience. PMID:27720776

Utility of rapid on-site cytologic evaluation during endobronchial ultrasound with a guide sheath for peripheral pulmonary lesions.

PubMed

Izumo, Takehiro; Matsumoto, Yuji; Sasada, Shinji; Chavez, Christine; Nakai, Toshiyuki; Tsuchida, Takaaki

2017-03-01

The utility of rapid on-site evaluation during endobronchial ultrasound with a guide sheath for peripheral pulmonary lesions is unclear. The aim of this study was to evaluate the role of rapid on-site evaluation during endobronchial ultrasound with a guide sheath for peripheral pulmonary lesions. Consecutive patients who underwent endobronchial ultrasound with a guide sheath for the diagnosis of peripheral pulmonary lesions at our hospital between September 2012 and July 2014 were included in this retrospective study. Cytology slides were air-dried, and modified Giemsa (Diff-Quik) staining was used for rapid on-site evaluation. Additional smears were prepared for Papanicolaou staining and tissue samples were placed in formalin for histologic evaluation. The results of rapid on-site evaluation were compared with the final diagnoses of endobronchial ultrasound with a guide sheath. A total of 718 cases were included in the study population. The sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of rapid on-site evaluation during endobronchial ultrasound with a guide sheath for peripheral pulmonary lesions was 88.6%, 65.9%, 81.2%, 77.7% and 80.1%, respectively. There were no procedure-related deaths. Rapid on-site evaluation during endobronchial ultrasound with a guide sheath had high sensitivity for peripheral pulmonary lesions. When carrying out rapid on-site evaluation of transbronchial biopsy samples from peripheral pulmonary lesions, careful interpretation and clinical correlation are necessary. © The Author 2016. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

Alzheimer disease in a mouse model: MR imaging-guided focused ultrasound targeted to the hippocampus opens the blood-brain barrier and improves pathologic abnormalities and behavior.

PubMed

Burgess, Alison; Dubey, Sonam; Yeung, Sharon; Hough, Olivia; Eterman, Naomi; Aubert, Isabelle; Hynynen, Kullervo

2014-12-01

To validate whether repeated magnetic resonance (MR) imaging-guided focused ultrasound treatments targeted to the hippocampus, a brain structure relevant for Alzheimer disease ( AD Alzheimer disease ), could modulate pathologic abnormalities, plasticity, and behavior in a mouse model. All animal procedures were approved by the Animal Care Committee and are in accordance with the Canadian Council on Animal Care. Seven-month-old transgenic (TgCRND8) (Tg) mice and their nontransgenic (non-Tg) littermates were entered in the study. Mice were treated weekly with MR imaging-guided focused ultrasound in the bilateral hippocampus (1.68 MHz, 10-msec bursts, 1-Hz burst repetition frequency, 120-second total duration). After 1 month, spatial memory was tested in the Y maze with the novel arm prior to sacrifice and immunohistochemical analysis. The data were compared by using unpaired t tests and analysis of variance with Tukey post hoc analysis. Untreated Tg mice spent 61% less time than untreated non-Tg mice exploring the novel arm of the Y maze because of spatial memory impairments (P < .05). Following MR imaging-guided focused ultrasound, Tg mice spent 99% more time exploring the novel arm, performing as well as their non-Tg littermates. Changes in behavior were correlated with a reduction of the number and size of amyloid plaques in the MR imaging-guided focused ultrasound-treated animals (P < .01). Further, after MR imaging-guided focused ultrasound treatment, there was a 250% increase in the number of newborn neurons in the hippocampus (P < .01). The newborn neurons had longer dendrites and more arborization after MR imaging-guided focused ultrasound, as well (P < .01). Repeated MR imaging-guided focused ultrasound treatments led to spatial memory improvement in a Tg mouse model of AD Alzheimer disease . The behavior changes may be mediated by decreased amyloid pathologic abnormalities and increased neuronal plasticity. © RSNA, 2014.

Noninvasive Label-Free Detection of Micrometastases in the Lymphatics with Ultrasound-Guided Photoacoustic Imaging

DTIC Science & Technology

2015-10-01

imaging can be used to guide dissection. We have also successfully integrated a programmable ultrasound machine (Verasonics Vantage ) and tunable pulsed...Mobile HE) with the programmable ultrasound machine (Verasonics Vantage ). We have synchronized the signals to enable interleaved acquisition of US

Ultrasound in regional anaesthesia.

PubMed

Griffin, J; Nicholls, B

2010-04-01

Ultrasound guidance is rapidly becoming the gold standard for regional anaesthesia. There is an ever growing weight of evidence, matched with improving technology, to show that the use of ultrasound has significant benefits over conventional techniques, such as nerve stimulation and loss of resistance. The improved safety and efficacy that ultrasound brings to regional anaesthesia will help promote its use and realise the benefits that regional anaesthesia has over general anaesthesia, such as decreased morbidity and mortality, superior postoperative analgesia, cost-effectiveness, decreased postoperative complications and an improved postoperative course. In this review we consider the evidence behind the improved safety and efficacy of ultrasound-guided regional anaesthesia, before discussing its use in pain medicine, paediatrics and in the facilitation of neuraxial blockade. The Achilles' heel of ultrasound-guided regional anaesthesia is that anaesthetists are far more familiar with providing general anaesthesia, which in most cases requires skills that are achieved faster and more reliably. To this ends we go on to provide practical advice on ultrasound-guided techniques and the introduction of ultrasound into a department.

Intraoperative Ultrasound for Peripheral Nerve Applications.

PubMed

Willsey, Matthew; Wilson, Thomas J; Henning, Phillip Troy; Yang, Lynda J-S

2017-10-01

Offering real-time, high-resolution images via intraoperative ultrasound is advantageous for a variety of peripheral nerve applications. To highlight the advantages of ultrasound, its extraoperative uses are reviewed. The current intraoperative uses, including nerve localization, real-time evaluation of peripheral nerve tumors, and implantation of leads for peripheral nerve stimulation, are reviewed. Although intraoperative peripheral nerve localization has been performed previously using guide wires and surgical dyes, the authors' approach using ultrasound-guided instrument clamps helps guide surgical dissection to the target nerve, which could lead to more timely operations and shorter incisions. Copyright © 2017 Elsevier Inc. All rights reserved.

Combined magnetic resonance imaging and ultrasound echography guidance for motion compensated HIFU interventions

NASA Astrophysics Data System (ADS)

Ries, Mario; de Senneville, Baudouin Denis; Regard, Yvan; Moonen, Chrit

2012-11-01

The objective of this study is to evaluate the feasibility to integrate ultrasound echography as an additional imaging modality for continuous target tracking, while performing simultaneously real-time MR- thermometry to guide a High Intensity Focused Ultrasound (HIFU) ablation. Experiments on a moving phantom were performed with MRI-guided HIFU during continuous ultrasound echography. Real-time US echography-based target tracking during MR-guided HIFU heating was performed with heated area dimensions similar to those obtained for a static target. The combination of both imaging modalities shows great potential for real-time beam steering and MR-thermometry.

Accuracy of ultrasound-guided nerve blocks of the cervical zygapophysial joints.

PubMed

Siegenthaler, Andreas; Mlekusch, Sabine; Trelle, Sven; Schliessbach, Juerg; Curatolo, Michele; Eichenberger, Urs

2012-08-01

Cervical zygapophysial joint nerve blocks typically are performed with fluoroscopic needle guidance. Descriptions of ultrasound-guided block of these nerves are available, but only one small study compared ultrasound with fluoroscopy, and only for the third occipital nerve. To evaluate the potential usefulness of ultrasound-guidance in clinical practice, studies that determine the accuracy of this technique using a validated control are essential. The aim of this study was to determine the accuracy of ultrasound-guided nerve blocks of the cervical zygapophysial joints using fluoroscopy as control. Sixty volunteers were studied. Ultrasound-imaging was used to place the needle to the bony target of cervical zygapophysial joint nerve blocks. The levels of needle placement were determined randomly (three levels per volunteer). After ultrasound-guided needle placement and application of 0.2 ml contrast dye, fluoroscopic imaging was performed for later evaluation by a blinded pain physician and considered as gold standard. Raw agreement, chance-corrected agreement κ, and chance-independent agreement Φ between the ultrasound-guided placement and the assessment using fluoroscopy were calculated to quantify accuracy. One hundred eighty needles were placed in 60 volunteers. Raw agreement was 87% (95% CI 81-91%), κ was 0.74 (0.64-0.83), and Φ 0.99 (0.99-0.99). Accuracy varied significantly between the different cervical nerves: it was low for the C7 medial branch, whereas all other levels showed very good accuracy. Ultrasound-imaging is an accurate technique for performing cervical zygapophysial joint nerve blocks in volunteers, except for the medial branch blocks of C7.

New Technique for the Preservation of the Left Common Carotid Artery in Zone 2a Endovascular Repair of Thoracic Aortic Aneurysm

DOE Office of Scientific and Technical Information (OSTI.GOV)

Juszkat, Robert, E-mail: radiologiamim@wp.pl; Kulesza, Jerzy; Zarzecka, Anna

2011-02-15

To describe a technique for the preservation of the left common carotid artery (CCA) in zone 2 endovascular repair of thoracic aortic aneurysm. This technique involves the placement of a guide wire into the left CCA via the right brachial artery before stent graft deployment to enable precise visualization and protection of the left CCA during the whole procedure. Of the 107 patients with thoracic endovascular aortic repair in our study, 32 (30%) had the left subclavian artery intentionally covered (landing zone 2). Eight (25%) of those 32 had landing zone 2a-the segment distally the origin of the left CCA,more » halfway between the origin of the left CCA and the left subclavian artery. In all patients, a guide wire was positioned into the left CCA via the right brachial artery before stent graft deployment. It is a retrospective study in design. In seven patients, stent grafts were positioned precisely. In the remaining patient, the positioning was imprecise; the origin of the left CCA was partially covered by the graft. A stent was implanted into the left CCA to restore the flow into the vessel. All procedures were performed successfully. The technique of placing a guide wire into the left CCA via the right brachial artery before stent graft deployment is a safe and effective method that enables the precise visualization of the left CCA during the whole procedure. Moreover, in case of inadvertent complete or partial coverage of the origin of the left CCA, it supplies safe and quick access to the artery for stent implantation.« less

Focused Ultrasound Surgery for Uterine Fibroids

MedlinePlus

... ultrasound surgery, your doctor may perform a pelvic magnetic resonance imaging (MRI) scan before treatment. Focused ultrasound surgery — also called magnetic resonance-guided focused ultrasound surgery or focused ultrasound ...

Supraclavicular skin temperature as a measure of 18F-FDG uptake by BAT in human subjects.

PubMed

Boon, Mariëtte R; Bakker, Leontine E H; van der Linden, Rianne A D; Pereira Arias-Bouda, Lenka; Smit, Frits; Verberne, Hein J; van Marken Lichtenbelt, Wouter D; Jazet, Ingrid M; Rensen, Patrick C N

2014-01-01

Brown adipose tissue (BAT) has emerged as a novel player in energy homeostasis in humans and is considered a potential new target for combating obesity and related diseases. The current 'gold standard' for quantification of BAT volume and activity is cold-induced 18F-FDG uptake in BAT. However, use of this technique is limited by cost and radiation exposure. Given the fact that BAT is a thermogenic tissue, mainly located in the supraclavicular region, the aim of the current study was to investigate whether cold-induced supraclavicular skin temperature and core body temperature may be alternative markers of BAT activation in humans. BAT volume and activity were measured in 24 healthy lean adolescent males (mean age 24.1±0.8 years), using cold-induced 18F-FDG uptake with PET-CT. Core body temperature was measured continuously in the small intestine with use of an ingestible telemetric capsule and skin temperature was measured by eighteen wireless iButtons attached to the skin following ISO-defined locations. Proximal and distal (hand/feet) skin temperatures markedly decreased upon cold exposure, while supraclavicular skin temperature significantly increased (35.2±0.1 vs. 35.5±0.1°C, p = 0.001). Furthermore, cold-induced supraclavicular skin temperature positively correlated with both total (R2 = 0.28, P = 0.010) and clavicular BAT volume (R2 = 0.20, P = 0.030) and clavicular SUVmax (R2 = 0.27, P = 0.010), while core body temperature did not. Supraclavicular skin temperature as measured by iButtons may have predictive value for BAT detection in adult humans. This is highly desirable considering the increasing interest in pharmacological interventions to stimulate BAT in human subjects. NTR 2473.

Curative Chemoradiotherapy in Patients With Stage IVB Cervical Cancer Presenting With Paraortic and Left Supraclavicular Lymph Node Metastases

DOE Office of Scientific and Technical Information (OSTI.GOV)

Kim, Ji-Yoon; Kim, Joo-Young; Kim, Jin Hee

2012-11-01

Purpose: To evaluate the efficacy and toxicity of concurrent chemoradiotherapy (CCRT) with curative intent in patients with stage IVB cervical cancer initially presenting with paraortic and left supraclavicular lymph node metastases. Methods and Materials: The medical records of 25 patients with both paraortic and left supraclavicular lymph nodal metastases (group I) were reviewed and compared with those of 101 women with paraortic lymph node metastases alone (group II). Group I received a mean 59.4 Gy to the paraortic and left supraclavicular areas and 50.4 Gy to the pelvis, followed by 30 Gy of high-dose-rate brachytherapy in 6 fractions. Group IImore » received the same dose to the paraortic area and pelvis followed by intracavitary brachytherapy. All patients received platinum-based chemotherapy simultaneously. Results: Of the 25 patients in group I, 16 (64%) experienced acute grade 3-4 hematologic toxicities, and 1 had a late grade 3 genitourinary toxicity. Complete responses, including the primary mass and pelvic, paraortic, and left supraclavicular lymph nodes, were observed in 13 patients (52%). At a median follow-up of 32 months for surviving patients, 3 experienced in-field failure, 6 showed distant failure, and 9 showed both. The 3-year overall and disease-free survival rates were 49% and 33%, respectively. In comparison, of the 101 patients in group II, 16 showed in-field failure, 14 experienced distant failure, and 11 showed both. The 3-year overall and disease-free survival rates were 69% and 57%, respectively. Conclusions: Curative CCRT is feasible in patients with stage IVB cervical cancer presenting with paraortic and left supraclavicular lymph nodal metastases, with acceptable late toxicity and high response rates, despite high rates of acute hematologic toxicity.« less

Comparison between ultrasound guided technique and digital palpation technique for radial artery cannulation in adult patients: An updated meta-analysis of randomized controlled trials.

PubMed

Bhattacharjee, Sulagna; Maitra, Souvik; Baidya, Dalim K

2018-06-01

Possible advantages and risks associated with ultrasound guided radial artery cannulation in-comparison to digital palpation guided method in adult patients are not fully known. We have compared ultrasound guided radial artery cannulation with digital palpation technique in this meta-analysis. Meta-analysis of randomized controlled trials. Trials conducted in operating room, emergency department, cardiac catheterization laboratory. PubMed and Cochrane Central Register of Controlled Trials (CENTRAL) were searched (from 1946 to 20th November 2017) to identify prospective randomized controlled trials in adult patients. Two-dimensional ultrasound guided radial artery catheterization versus digital palpation guided radial artery cannulation. Overall cannulation success rate, first attempt success rate, time to cannulation and mean number of attempts to successful cannulation. Odds ratio (OR) and standardized mean difference (SMD) or mean difference (MD) with 95% confidence interval (CI) were calculated for categorical and continuous variables respectively. Data of 1895 patients from 10 studies have been included in this meta- analysis. Overall cannulation success rate was similar between ultrasound guided technique and digital palpation [OR (95% CI) 2.01 (1.00, 4.06); p = 0.05]. Ultrasound guided radial artery cannulation is associated with higher first attempt success rate of radial artery cannulation in comparison to digital palpation [OR (95% CI) 2.76 (186, 4.10); p < 0.001]. No difference was seen in time to cannulate [SMD (95% CI) -0.31 (-0.65, 0.04); p = 0.30] and mean number of attempt [MD (95% CI) -0.65 (-1.32, 0.02); p = 0.06] between USG guided technique with palpation technique. Radial artery cannulation by ultrasound guidance may increase the first attempt success rate but not the overall cannulation success when compared to digital palpation technique. However, results of this meta-analysis should be interpreted with caution due presence of heterogeneity. Copyright © 2018 Elsevier Inc. All rights reserved.

Enhanced Lesion Visualization in Image-Guided Noninvasive Surgery With Ultrasound Phased Arrays

DTIC Science & Technology

2001-10-25

81, 1995. [4] N. Sanghvi et al., “Noninvasive surgery of prostate tissue by high-intensity focused ultrasound ,” IEEE Trans. UFFC, vol. 43, no. 6, pp...ENHANCED LESION VISUALIZATION IN IMAGE-GUIDED NONINVASIVE SURGERY WITH ULTRASOUND PHASED ARRAYS Hui Yao, Pornchai Phukpattaranont and Emad S. Ebbini...Department of Electrical and Computer Engineering University of Minnesota Minneapolis, MN 55455 Abstract- We describe dual-mode ultrasound phased

In-plane ultrasonic needle tracking using a fiber-optic hydrophone

DOE Office of Scientific and Technical Information (OSTI.GOV)

Xia, Wenfeng, E-mail: wenfeng.xia@ucl.ac.uk; Desjardins, Adrien E.; Mari, Jean Martial

Purpose: Accurate and efficient guidance of needles to procedural targets is critically important during percutaneous interventional procedures. Ultrasound imaging is widely used for real-time image guidance in a variety of clinical contexts, but with this modality, uncertainties about the location of the needle tip within the image plane lead to significant complications. Whilst several methods have been proposed to improve the visibility of the needle, achieving accuracy and compatibility with current clinical practice is an ongoing challenge. In this paper, the authors present a method for directly visualizing the needle tip using an integrated fiber-optic ultrasound receiver in conjunction withmore » the imaging probe used to acquire B-mode ultrasound images. Methods: Needle visualization and ultrasound imaging were performed with a clinical ultrasound imaging system. A miniature fiber-optic ultrasound hydrophone was integrated into a 20 gauge injection needle tip to receive transmissions from individual transducer elements of the ultrasound imaging probe. The received signals were reconstructed to create an image of the needle tip. Ultrasound B-mode imaging was interleaved with needle tip imaging. A first set of measurements was acquired in water and tissue ex vivo with a wide range of insertion angles (15°–68°) to study the accuracy and sensitivity of the tracking method. A second set was acquired in an in vivo swine model, with needle insertions to the brachial plexus. A third set was acquired in an in vivo ovine model for fetal interventions, with insertions to different locations within the uterine cavity. Two linear ultrasound imaging probes were used: a 14–5 MHz probe for the first and second sets, and a 9–4 MHz probe for the third. Results: During insertions in tissue ex vivo and in vivo, the imaged needle tip had submillimeter axial and lateral dimensions. The signal-to-noise (SNR) of the needle tip was found to depend on the insertion angle. With the needle tip in water, the SNR of the needle tip varied with insertion angle, attaining values of 284 at 27° and 501 at 68°. In swine tissue ex vivo, the SNR decreased from 80 at 15° to 16 at 61°. In swine tissue in vivo, the SNR varied with depth, from 200 at 17.5 mm to 48 at 26 mm, with a constant insertion angle of 40°. In ovine tissue in vivo, within the uterine cavity, the SNR varied from 46.4 at 25 mm depth to 18.4 at 32 mm depth, with insertion angles in the range of 26°–65°. Conclusions: A fiber-optic ultrasound receiver integrated into the needle cannula in combination with single-element transmissions from the imaging probe allows for direct visualization of the needle tip within the ultrasound imaging plane. Visualization of the needle tip was achieved at depths and insertion angles that are encountered during nerve blocks and fetal interventions. The method presented in this paper has strong potential to improve the safety and efficiency of ultrasound-guided needle insertions.« less

Complications and adequacy of transplant kidney biopsies: A comparison of techniques.

PubMed

Plattner, Brett W; Chen, Pauline; Cross, Richard; Leavitt, Matthew A; Killen, Paul D; Heung, Michael

2018-05-01

Kidney biopsies are an essential tool in the diagnosis and management of kidney diseases, particularly in kidney transplant recipients. Biopsies carry a risk for serious complications and not all biopsies achieve adequate tissue. We examined the impact of kidney biopsy technique on complications and biopsy adequacy. The cohort consisted of consecutive kidney transplant patients undergoing biopsy by one of three techniques: ultrasound localization, real-time ultrasound guidance, and ultrasound-guided trocar placement. Variables of interest included patient characteristics and procedural characteristics. The primary outcome was serious complication attributable to kidney biopsy, and the secondary outcome was biopsy adequacy as defined by Banff criteria. Among 263 patients undergoing biopsy, 27 (10.3%) had a complication (14 with gross hematuria, 10 requiring blood transfusion, 3 requiring an unplanned interventional radiology procedure, 1 kidney loss; no deaths). Complications were more common among patients biopsied using ultrasound-guided trocar compared to real-time ultrasound and ultrasound localization (21.4% vs 7.9% vs 7.1%, respectively, p = 0.008). After adjusting for patient and procedure characteristics, technique was no longer significantly associated with complication. Biopsy adequacy was significantly higher when using ultrasound localization and real-time ultrasound compared to ultrasound-guided trocar (84.6% vs 86.8% vs 69.6%, p = 0.029), and this finding persisted in adjusted analysis. Kidney biopsy complications appear to be similar when using any of the three techniques examined in our study. However, ultrasound-guided trocar technique may yield lower biopsy adequacy when compared to non-trocar techniques.

Towards enabling ultrasound guidance in cervical cancer high-dose-rate brachytherapy

NASA Astrophysics Data System (ADS)

Wong, Adrian; Sojoudia, Samira; Gaudet, Marc; Yap, Wan Wan; Chang, Silvia D.; Abolmaesumi, Purang; Aquino-Parsons, Christina; Moradi, Mehdi

2014-03-01

MRI and Computed Tomography (CT) are used in image-based solutions for guiding High Dose Rate (HDR) brachytherapy treatment of cervical cancer. MRI is costly and CT exposes the patients to ionizing radiation. Ultrasound, on the other hand, is affordable and safe. The long-term goal of our work is to enable the use of multiparametric ultrasound imaging in image-guided HDR for cervical cancer. In this paper, we report the development of enabling technology for ultrasound guidance and tissue typing. We report a system to obtain the 3D freehand transabdominal ultrasound RF signals and B-mode images of the uterus, and a method for registration of ultrasound to MRI. MRI and 3D ultrasound images of the female pelvis were registered by contouring the uterus in the two modalities, creating a surface model, followed by rigid and B-spline deformable registration. The resulting transformation was used to map the location of the tumor from the T2-weighted MRI to ultrasound images and to determine cancerous and normal areas in ultrasound. B-mode images show a contrast for cancer vs. normal tissue. Our study shows the potential and the challenges of ultrasound imaging in guiding cervical cancer treatments.

Short- and long-term black tea consumption reverses endothelial dysfunction in patients with coronary artery disease.

PubMed

Duffy, S J; Keaney , J F; Holbrook, M; Gokce, N; Swerdloff, P L; Frei, B; Vita, J A

2001-07-10

Epidemiological studies suggest that tea consumption decreases cardiovascular risk, but the mechanisms of benefit remain undefined. Endothelial dysfunction has been associated with coronary artery disease and increased oxidative stress. Some antioxidants have been shown to reverse endothelial dysfunction, and tea contains antioxidant flavonoids. Methods and Results-- To test the hypothesis that tea consumption will reverse endothelial dysfunction, we randomized 66 patients with proven coronary artery disease to consume black tea and water in a crossover design. Short-term effects were examined 2 hours after consumption of 450 mL tea or water. Long-term effects were examined after consumption of 900 mL tea or water daily for 4 weeks. Vasomotor function of the brachial artery was examined at baseline and after each intervention with vascular ultrasound. Fifty patients completed the protocol and had technically suitable ultrasound measurements. Both short- and long-term tea consumption improved endothelium- dependent flow-mediated dilation of the brachial artery, whereas consumption of water had no effect (P<0.001 by repeated-measures ANOVA). Tea consumption had no effect on endothelium-independent nitroglycerin-induced dilation. An equivalent oral dose of caffeine (200 mg) had no short-term effect on flow-mediated dilation. Plasma flavonoids increased after short- and long-term tea consumption. Short- and long-term black tea consumption reverses endothelial vasomotor dysfunction in patients with coronary artery disease. This finding may partly explain the association between tea intake and decreased cardiovascular disease events.

Association Between the Female Athlete Triad and Endothelial Dysfunction in Dancers

PubMed Central

Hoch, Anne Z.; Papanek, Paula; Szabo, Aniko; Widlansky, Michael E.; Schimke, Jane E.; Gutterman, David D.

2013-01-01

Objective To determine the prevalence of the 3 components of the female athlete triad [disordered eating, menstrual dysfunction, low bone mineral density (BMD)] and their relationships with brachial artery flow-mediated dilation in professional dancers. Design Prospective study. Setting Academic institution in the Midwest. Participants Twenty-two professional ballet dancers volunteered for this study. Interventions The prevalence of the female athlete triad and its relationship to endothelial dysfunction. Main Outcome Measures Subjects completed questionnaires to assess disordered eating and menstrual status/history. They also completed a 3-day food record and wore an accelerometer for 3 days to determine energy availability. Serum baseline thyrotropin, prolactin, and hormonal concentrations were obtained. Bone mineral density and body composition were measured with a GE Lunar Prodigy dual-energy X-ray absorptiometry. Endothelial function was determined as flow-mediated vasodilation measured by high-frequency ultrasound in the brachial artery. An increase in brachial diameter <5% to hyperemic flow stimulus was defined a priori as endothelial dysfunction. Results Seventeen dancers (77%) had evidence of low/negative energy availability. Thirty-two percent had disordered eating (EDE-Q score). Thirty-six percent had menstrual dysfunction and 14% were currently using hormone contraception. Twenty-three percent had evidence of low bone density (Z-score < −1.0). Sixty-four percent had abnormal brachial artery flow-mediated dilation (<5%). Flow-mediated dilation values were significantly correlated with serum estrogen and whole-body and lumbar BMD. All the 3 components of the triad plus endothelial dysfunction were present in 14% of the subjects. Conclusions Endothelial dysfunction was correlated with reduced BMD, menstrual dysfunction, and low serum estrogen. These findings may have profound implications for cardiovascular and bone health in professional women dancers. PMID:21358502

Gestrinone combined with ultrasound-guided aspiration and ethanol injection for treatment of chocolate cyst of ovary.

PubMed

Wu, Xiaoyun; Xu, Yun

2015-05-01

The aim of this study was to determine clinical performance of gestrinone combined with ultrasound-guided aspiration and ethanol injection in treating chocolate cyst of ovary. Sixty-eight patients enrolled in this study were randomly divided into two groups: control group and combination treatment group. In the control group, 34 patients were treated with ultrasound-guided aspiration and ethanol injection. In the combination treatment group, 34 patients received gestrinone p.o. following ultrasound-guided aspiration and ethanol injection. The recurrence rate of chocolate cyst was 10-fold lower in the combination treatment group (2.94%, 1/34) than in the control group (29.4%, 10/34) at 12 months. The effective rate for reduction of chocolate cyst was significantly higher in the combination treatment group (94.12%, 32/34) than in the control group (64.71%, 22/34) (P = 0.009). Gestrinone combined with ultrasound-guided aspiration and ethanol injection therapy is an effective treatment for ovarian chocolate cyst with low recurrence rate. © 2014 The Authors. Journal of Obstetrics and Gynaecology Research © 2014 Japan Society of Obstetrics and Gynecology.

Guiding intramuscular diaphragm injections using real-time ultrasound and electromyography.

PubMed

Sarwal, Aarti; Cartwright, Michael S; Mitchell, Erin; Williams, Koudy; Walker, Francis O; Childers, Martin K

2015-02-01

We describe a unique method that combines ultrasound and electromyography to guide intramuscular diaphragm injections in anesthetized large animals. Ultrasound was used to visualize the diaphragm on each side of spontaneously breathing, anesthetized beagle dogs and cynomolgus macaques. An electromyography (EMG) needle was introduced and directed by ultrasound to confirm that the needle entered the muscular portion of the diaphragm, and methylene blue was injected. Injection accuracy was confirmed upon necropsy by tracking the spread of methylene blue. All methylene blue injections were confirmed to have been placed appropriately into the diaphragm. This study demonstrates the feasibility and accuracy of using ultrasound and EMG to guide injections and to reduce complications associated with conventional blind techniques. Ultrasound guidance can be used for clinical EMG of the diaphragm. Future applications may include targeted diaphragm injections with gene replacement therapy in neuromuscular diseases. © 2014 Wiley Periodicals, Inc.

Guiding Intramuscular Diaphragm Injections Using Real-time Ultrasound & Electromyography

PubMed Central

Sarwal, Aarti; Cartwright, Michael S.; Mitchell, Erin; Williams, Koudy; Walker, Francis O.; Childers, Martin K.

2014-01-01

Introduction We describe a unique method that combines ultrasound and electromyography to guide intramuscular diaphragm injections in anesthetized large animals. Methods Ultrasound was used to visualize the diaphragm on each side of spontaneously breathing, anesthetized beagle dogs and cynomolgus macaques. An electromyography needle was introduced and directed by ultrasound to confirm that the needle entered the muscular portion of the diaphragm, and methylene blue was injected. Injection accuracy was confirmed upon necropsy by tracking the spread of methylene blue. Results All methylene blue injections were confirmed to have been placed appropriately into the diaphragm. Conclusions This study demonstrates the feasibility and accuracy of using ultrasound and EMG to guide injections and to reduce complications associated with conventional blind techniques. Ultrasound guidance can be used for clinical electromyography of the diaphragm. Future applications may include targeted diaphragm injections with gene replacement therapy in neuromuscular diseases. PMID:25354257

Remotely Guided Breast Sonography for Long-Term Space Missions: A Case Report and Discussion.

PubMed

Silva-Martinez, Jackelynne P; Sorice Genaro, Andreia; Wen, Hui Annie; Glauber, Naama; Russomano, Thais

2017-12-01

Space radiation can cause different types of cancers in crewmembers, especially during long-term space missions. To date, a complete bilateral breast ultrasound has not been performed at the International Space Station (ISS). A breast screening imaging technique could be a useful tool for early identification of breast cancer in astronauts. We hypothesized that breast ultrasound performed by a crewmember while being remotely guided by a specialist from the ground could be an essential tool for medical diagnosis in space. This project aimed to test an ultrasound screening protocol for breast tissue using real-time remotely guided telemedicine techniques. One female volunteer, with no previous medical experience, performed a self-scanned bilateral breast ultrasound exam guided by a remote sonographer. Dynamic ultrasound images were collected using a 25 mm broadband linear array transducer. To simulate fluid shift on the volunteer during microgravity, the bed was tilted -6°. Recorded ultrasound images were analyzed by radiologists, comparing the findings with a gold standard. The experiment demonstrated that real-time remotely guided sonography exam is feasible and can yield meaningful clinical results. This case study showed that remotely guided breast ultrasound can be performed and might become an important tool for diagnosis of breast cancer in space missions. The results cannot be generalized based on one subject, and additional research is warranted in this area in addition to its validation on the ISS. This technique, however, has potential for use as part of preventive medicine procedures for long-term space missions at the ISS, and eventually for human settlements on the Moon and Mars.

Novel ultrasound-responsive chitosan/perfluorohexane nanodroplets for image-guided smart delivery of an anticancer agent: Curcumin.

PubMed

Baghbani, Fatemeh; Chegeni, Mahdieh; Moztarzadeh, Fathollah; Hadian-Ghazvini, Samaneh; Raz, Majid

2017-05-01

Ultrasound-responsive nanodroplets are a class of new emerging smart drug delivery systems which provide image-guided nano-therapy of various diseases, especially cancers. Here, we developed multifunctional smart curcumin-loaded chitosan/perfluorohexane nanodroplets for contrast-ultrasound imaging and on-demand drug delivery. The nanodroplets were synthesized via nanoemulsion process. The optimal formulation with the size of 101.2nm and 77.8% curcumin entrapment was chosen for release study and cytotoxicity evaluation. Sonication at the frequency of 1MHz, 2W/cm 2 for 4min triggered the release of 63.5% of curcumin from optimal formulation (Cur-NDs-2). Ultrasound aided release study indicated that the concentration of perfluorohexane and the degree of acoustic droplet vaporization play important role in ultrasound-active drug release. B-mode ultrasound imaging confirmed strong ultrasound contrast of chitosan nanodroplets even at low concentrations via droplet to bubble transition. Finally, cytotoxicity of the ultrasound-responsive nanodroplets in the presence of ultrasound was evaluated in-vitro on 4T1 human breast cancer cells. Cell growth inhibitory effects of curcumin-loaded nanodroplets significantly increased by ultrasound exposure. According to the obtained results, these ultrasound responsive curcumin-loaded chitosan/perfluorohexane nanodroplets have a great potential for imaged-guided cancer therapy. Copyright © 2016 Elsevier B.V. All rights reserved.

Brachial blood flow under relative levels of blood flow restriction is decreased in a nonlinear fashion.

PubMed

Mouser, J Grant; Ade, Carl J; Black, Christopher D; Bemben, Debra A; Bemben, Michael G

2018-05-01

Blood flow restriction (BFR), the application of external pressure to occlude venous return and restrict arterial inflow, has been shown to increase muscular size and strength when combined with low-load resistance exercise. BFR in the research setting uses a wide range of pressures, applying a pressure based upon an individual's systolic pressure or a percentage of occlusion pressure; not a directly determined reduction in blood flow. The relationship between relative pressure and blood flow has not been established. To measure blood flow in the arm under relative levels of BFR. Forty-five people (18-40 years old) participated. Arterial occlusion pressure in the right arm was measured using a 5-cm pneumatic cuff. Blood flow in the brachial artery was measured at rest and at pressures between 10% and 90% of occlusion using ultrasound. Blood flow decreased in a nonlinear, stepped fashion. Blood flow decreased at 10% of occlusion and remained constant until decreasing again at 40%, where it remained until 90% of occlusion. The decrease in brachial blood flow is not proportional to the applied relative pressure. The prescription of blood flow restriction should take into account the stimulus provided at each relative level of blood flow. © 2017 Scandinavian Society of Clinical Physiology and Nuclear Medicine. Published by John Wiley & Sons Ltd.

Cost-Effectiveness Comparison of Imaging-Guided Prostate Biopsy Techniques: Systematic Transrectal Ultrasound, Direct In-Bore MRI, and Image Fusion.

PubMed

Venderink, Wulphert; Govers, Tim M; de Rooij, Maarten; Fütterer, Jurgen J; Sedelaar, J P Michiel

2017-05-01

Three commonly used prostate biopsy approaches are systematic transrectal ultrasound guided, direct in-bore MRI guided, and image fusion guided. The aim of this study was to calculate which strategy is most cost-effective. A decision tree and Markov model were developed to compare cost-effectiveness. Literature review and expert opinion were used as input. A strategy was deemed cost-effective if the costs of gaining one quality-adjusted life year (incremental cost-effectiveness ratio) did not exceed the willingness-to-pay threshold of €80,000 (≈$85,000 in January 2017). A base case analysis was performed to compare systematic transrectal ultrasound- and image fusion-guided biopsies. Because of a lack of appropriate literature regarding the accuracy of direct in-bore MRI-guided biopsy, a threshold analysis was performed. The incremental cost-effectiveness ratio for fusion-guided biopsy compared with systematic transrectal ultrasound-guided biopsy was €1386 ($1470) per quality-adjusted life year gained, which was below the willingness-to-pay threshold and thus assumed cost-effective. If MRI findings are normal in a patient with clinically significant prostate cancer, the sensitivity of direct in-bore MRI-guided biopsy has to be at least 88.8%. If that is the case, the incremental cost-effectiveness ratio is €80,000 per quality-adjusted life year gained and thus cost-effective. Fusion-guided biopsy seems to be cost-effective compared with systematic transrectal ultrasound-guided biopsy. Future research is needed to determine whether direct in-bore MRI-guided biopsy is the best pathway; in this study a threshold was calculated at which it would be cost-effective.

Musculoskeletal ultrasound: how to treat calcific tendinitis of the rotator cuff by ultrasound-guided single-needle lavage technique.

PubMed

Lee, Kenneth S; Rosas, Humberto G

2010-09-01

The purpose of this video article is to illustrate the ultrasound appearance of calcium deposition in the rotator cuff and provide a detailed step-by-step protocol for performing the ultrasound-guided single-needle lavage technique for the treatment of calcific tendinitis with emphasis on patient positioning, necessary supplies, real-time lavage technique, and steroid injection into the subacromial subdeltoid bursa. Musculoskeletal ultrasound is well established as a safe, cost-effective imaging tool in diagnosing and treating common musculoskeletal disorders. Calcific tendinitis of the rotator cuff is a common disabling cause of shoulder pain. Although most cases are self-limiting, a subset of patients is refractory to conservative therapy and requires treatment intervention. Ultrasound-guided lavage is an effective and safe minimally-invasive treatment not readily offered in the United States as an alternative to surgery, perhaps because of the limited prevalence of musculoskeletal ultrasound programs and limited training. On completion of this video article, the participant should be able to develop an appropriate diagnostic and therapeutic algorithm for the treatment of calcific tendinitis of the rotator cuff using ultrasound.

Transcranial MR-Guided Focused Ultrasound: A Review of the Technology and Neuro Applications

PubMed Central

Ghanouni, Pejman; Pauly, Kim Butts; Elias, W. Jeff; Henderson, Jaimie; Sheehan, Jason; Monteith, Stephen; Wintermark, Max

2015-01-01

MR guided focused ultrasound is a new, minimally invasive method of targeted tissue thermal ablation that may be of use to treat central neuropathic pain, essential tremor, Parkinson tremor, and brain tumors. The system has also been used to temporarily disrupt the blood-brain barrier to allow targeted drug delivery to brain tumors. This article reviews the physical principles of MR guided focused ultrasound and discusses current and potential applications of this exciting technology. PMID:26102394

DOE Office of Scientific and Technical Information (OSTI.GOV)

Huang, Eugene H.; Strom, Eric A.; Valero, Vicente

Purpose: To evaluate the locoregional efficacy of multimodality treatment for breast cancer patients who present with ipsilateral supraclavicular (SCV) disease without systemic metastases. Methods: We retrospectively reviewed the data from 71 patients with ipsilateral SCV involvement at presentation. SCV involvement in 16 patients (23%) was diagnosed by ultrasound examination only, without palpable disease. All patients were treated with curative intent using neoadjuvant chemotherapy, mastectomy or breast-conserving surgery (BCT), and radiotherapy. Results: The 5-year SCV control, locoregional control (LRC), disease-free survival, and overall survival rate was 90%, 77%, 30%, and 47%, respectively. Patients with persistent SCV disease after neoadjuvant chemotherapy bymore » physical examination had a lower rate of LRC (64% vs. 86%, p = 0.026), as did those with persistent SCV disease by ultrasound examination (66% vs. 96%, p = 0.007). Of those with a complete response of SCV disease by physical examination after neoadjuvant chemotherapy, those with persistently abnormal ultrasound findings had significantly worse disease-free survival (0% vs. 55%, p = 0.03). BCT was not associated with lower rates of LRC (82% for BCT vs. 76% for mastectomy, p = 0.80). Conclusion: Radiotherapy achieved excellent LRC after surgery for patients with ipsilateral SCV metastases who achieved a complete response of the SCV disease after neoadjuvant chemotherapy. For patients who achieved a complete response of the SCV disease by physical examination, ultrasonography of the SCV fossa may help assess the risk of disease recurrence. SCV involvement should not be considered a contraindication for BCT.« less

Identification of a new supraclavicular brown fat depot in mice

USDA-ARS?s Scientific Manuscript database

The rediscovery of brown adipose tissue (BAT) in healthy adult humans raises the possibility of utilizing BAT to combat obesity and its related metabolic disorders. Adult humans possess limited amounts of BAT with the most thermoactive depot located in the supraclavicular area of the neck. Understan...

Brachial artery responses to ambient pollution, temperature, and humidity in people with type 2 diabetes: a repeated-measures study.

PubMed

Zanobetti, Antonella; Luttmann-Gibson, Heike; Horton, Edward S; Cohen, Allison; Coull, Brent A; Hoffmann, Barbara; Schwartz, Joel D; Mittleman, Murray A; Li, Yongsheng; Stone, Peter H; de Souza, Celine; Lamparello, Brooke; Koutrakis, Petros; Gold, Diane R

2014-03-01

Extreme weather and air pollution are associated with increased cardiovascular risk in people with diabetes. In a population with diabetes, we conducted a novel assessment of vascular brachial artery responses both to ambient pollution and to weather (temperature and water vapor pressure, a measure of humidity). Sixty-four 49- to 85-year-old Boston residents with type 2 diabetes completed up to five study visits (279 repeated measures). Brachial artery diameter (BAD) was measured by ultrasound before and after brachial artery occlusion [i.e., flow-mediated dilation (FMD)] and before and after nitroglycerin-mediated dilation (NMD). Ambient concentrations of fine particulate mass (PM2.5), black carbon (BC), organic carbon (OC), elemental carbon, particle number, and sulfate were measured at our monitoring site; ambient concentrations of carbon monoxide, nitrogen dioxide, and ozone were obtained from state monitors. Particle exposure in the home and during each trip to the clinic (home/trip exposure) was measured continuously and as a 5-day integrated sample. We used linear models with fixed effects for participants, adjusting for date, season, temperature, and water vapor pressure on the day of each visit, to estimate associations between our outcomes and interquartile range increases in exposure. Baseline BAD was negatively associated with particle pollution, including home/trip-integrated BC (-0.02 mm; 95% CI: -0.04, -0.003, for a 0.28 μg/m3 increase in BC), OC (-0.08 mm; 95% CI: -0.14, -0.03, for a 1.61 μg/m3 increase) as well as PM2.5, 5-day average ambient PM2.5, and BC. BAD was positively associated with ambient temperature and water vapor pressure. However, exposures were not consistently associated with FMD or NMD. Brachial artery diameter, a predictor of cardiovascular risk, decreased in association with particle pollution and increased in association with ambient temperature in our study population of adults with type 2 diabetes. Zanobetti A, Luttmann-Gibson H, Horton ES, Cohen A, Coull BA, Hoffmann B, Schwartz JD, Mittleman MA, Li Y, Stone PH, de Souza C, Lamparello B, Koutrakis P, Gold DR. 2014. Brachial artery responses to ambient pollution, temperature, and humidity in people with type 2 diabetes: a repeated-measures study. Environ Health Perspect 122:242-248; http://dx.doi.org/10.1289/ehp.1206136.

A successful model to learn and implement ultrasound-guided venous catheterization in apheresis.

PubMed

Gopalasingam, Nigopan; Thomsen, Anna-Marie Eller; Folkersen, Lars; Juhl-Olsen, Peter; Sloth, Erik

2017-12-01

Apheresis treatments can be performed with peripheral venous catheters (PVC), although central venous catheters (CVC) are inserted when PVCs fail or patient with history of difficult vascular access prior to the apheresis. Ultrasound guidance for PVC has shown promising results in other settings. To investigate if ultrasound guidance for PVC could be implemented among apheresis nurses. Second, how implementation of ultrasound guidance affected the number of CVCs used for apheresis per patient. Apheresis nurses completed a systematic training program for ultrasound-guided vascular access. All independent catheterizations were registered during the implementation stage. The number of CVCs in the pre- and postimplementation stages of the ultrasound guidance was compared. Six nurses completed the training program within a median of 48 days (range 38-83 days). In 77 patients, 485 independent ultrasound-guided PVC placements were performed during the implementation stage. All apheresis treatments (485/485) were accomplished using PVCs without requiring CVC as rescue. During the preimplementation stage, 125 of 273 (45.8%) procedures required a CVC for completion of apheresis procedures; during the postimplementation stage only 30 of 227 (13.2%) procedures required a CVC (p < 0.001). In the postimplementation stage, no CVCs were placed as rescue caused by failed PVCs but were only placed for patients where the ultrasound machine was unavailable. It indicates an effective success rate of 100% for ultrasound-guided PVC use. This study showed that ultrasound guidance could be implemented among apheresis nurses as a routine tool eliminating the need of CVC as a rescue. © 2017 Wiley Periodicals, Inc.

Comparison of clinical marking and ultrasound-guided injection of Botulinum type A toxin into the masseter muscles for treating bruxism and its cosmetic effects.

PubMed

Quezada-Gaon, Natacha; Wortsman, Ximena; Peñaloza, Osvaldo; Carrasco, Juan Eduardo

2016-09-01

Botulinum toxin type A has been used for treating the hypertrophy of the masseter muscles and its cosmetic effects. Ultrasound is increasingly used in dermatology, along with the guidance of mini-invasive procedures. To evaluate the role of ultrasound for guiding the application of Botulinum A toxin in patients with cosmetic alterations due to bruxism, correlate the clinical landmarks with the ultrasound findings, and study the effect on the symptoms, cosmetics, and quality of life. Twenty individuals with bruxism and cosmetic alterations underwent an ultrasound-guided injection of Botulinum toxin type A in each masseter muscle. Clinical and ultrasound marking of the procedure was compared. Clinical and sonographic evaluation was performed at the time of injection and 3 months later. Ten normal individuals underwent ultrasound of the masseter muscles as a control group. Up to 65% of individuals showed anatomical variants of the salivary glands. The method for clinically marking the skin showed a frequently erroneous location of the anterior point (up to 40% of cases) that was proven by ultrasound to be out of the muscle. In 20% of cases, ultrasound showed that the needle should be longer to enter the muscle. After injection, most of the patients demonstrated a decrease of the symptoms and cosmetic and quality of life improvements. Ultrasound can be a potent tool for guiding the injection of Botulinum toxin into the masseter muscles. It may contribute to a more personalized procedure, better cosmetic results, and help to avoid potential complications. © 2016 Wiley Periodicals, Inc.

Relationship of femoral artery ultrasound measures of atherosclerosis with chronic kidney disease.

PubMed

Hsu, Simon; Rifkin, Dena E; Criqui, Michael H; Suder, Natalie C; Garimella, Pranav; Ginsberg, Charles; Marasco, Antoinette M; McQuaide, Belinda J; Barinas-Mitchell, Emma J; Allison, Matthew A; Wassel, Christina L; Ix, Joachim H

2017-12-22

Chronic kidney disease (CKD) is strongly associated with peripheral artery disease (PAD). Detection of subclinical PAD may allow early interventions for or prevention of PAD in persons with CKD. Whether the presence of atherosclerotic plaque and femoral intima-media thickness (IMT) are associated with kidney function is unknown. We performed a cross-sectional observational study of 1029 community-living adults. We measured superficial and common femoral artery IMT and atherosclerotic plaque presence by ultrasound. Estimated glomerular filtration rate (eGFR; continuous) and eGFR <60 mL/min/1.73 m 2 (binary) were evaluated as outcomes. Mean age was 70 ± 10 years, mean eGFR was 78 ± 17 mL/min/1.73 m 2 , and 156 (15%) individuals had eGFR <60 mL/min/1.73 m 2 ; 260 (25%) had femoral artery plaque. In models adjusted for demographics and cardiovascular risk factors, individuals with femoral artery plaque had mean eGFR approximately 3.0 (95% confidence interval, -5.3 to -0.8) mL/min/1.73 m 2 lower than those without plaque (P < .01). The presence of plaque was also associated with a 1.7-fold higher odds of eGFR <60 mL/min/1.73 m 2 (95% confidence interval, 1.1-2.8; P < .02). Associations were similar in persons with normal ankle-brachial index. The directions of associations were similar for femoral IMT measures with eGFR and CKD but were rendered no longer statistically significant with adjustment for demographic variables and cardiovascular disease risk factors. Femoral artery plaque is significantly associated with CKD prevalence in community-living individuals, even among those with normal ankle-brachial index. Femoral artery ultrasound may allow evaluation of relationships and risk factors linking PAD and kidney disease earlier in its course. Copyright © 2017 Society for Vascular Surgery. All rights reserved.

Ultrasound-guided injection of triamcinolone and bupivacaine in the management of De Quervain's disease.

PubMed

Jeyapalan, Kanagaratnam; Choudhary, Surabhi

2009-11-01

The aim of this study was to describe the technique and usefulness of ultrasound-guided intrasynovial injection of triamcinolone and bupivacaine in treatment of de Quervain's disease. A total of 17 patients with symptomatic De Quervain's disease were included in this study. The procedure involved confirmation of diagnosis with ultrasound followed by guided injection of a mixture of 20 mg of triamcinolone (40 mg/ml) and 1 ml of 0.5% bupivacaine. Ultrasound guidance with a high resolution 15-Mhz footprint probe was used for injection into the first dorsal extensor compartment tendon sheath (E1). The response to ultrasound-guided injection was ascertained at the post procedure outpatient clinic appointment according to the follow-up clinic notes. There were 14 female and 3 male patients aged 29 to 74 years. Mean duration of symptoms was 8.9 months. One patient had an atypical septum in the first extensor compartment and the extensor pollicis brevis alone was involved. The mean post-injection follow-up was at 6.75 weeks. One patient was lost to follow-up. Fifteen out of 16 patients had significant symptomatic relief (93.75%). There were no immediate or delayed complications. Recurrence of symptoms was seen in 3 (20%) patients. Ultrasound-guided injection of triamcinolone and bupivacaine is safe and useful in controlling symptoms of De Quervain's disease. Correct needle placement with ultrasound guidance avoids intratendinous injection as well as local complications like fat atrophy and depigmentation.

Patterns of nodal metastases on 18F-FDG PET/CT in patients with esophageal squamous cell carcinoma are useful to guide treatment planning of radiotherapy.

PubMed

Liu, Chia-Ju; Cheng, Jason Chia-Hsien; Lee, Jang-Ming; Cheng, Mei-Fang; Tzen, Kai-Yuan; Yen, Ruoh-Fang

2015-05-01

The aim of the study was to examine the patterns of lymph node metastases from esophageal squamous cell carcinoma (ESCC) and compare the laterality of lymphatic metastasis in cervical, supraclavicular, and paratracheal areas using F-FDG PET/CT. The data of 75 patients who underwent F-FDG PET/CT for staging of ESCC between January 2011 and March 2012 were reviewed. Fourteen groups of lymph nodes from the neck to abdomen were defined. Lateralization of the upper thoracic lymph nodes was defined in reference to the midline of the trachea. Frequencies of positive lymph nodes were used to determine the pattern of lymphatic spread and compare the lateralization of metastases in the cervical and upper thoracic regions. The right paratracheal region was the most frequent site of metastasis among all patients. Left paratracheal and paragastric nodes were more frequent in upper and lower third ESCC, respectively. Upward and downward lymphatic spread was equal in mid third ESCC. In all patients, there was a trend toward more frequent lymph node metastasis on the right side than the left side for the supraclavicular and paratracheal regions. Further stratified analysis with tumor location found that right paratracheal node metastasis was significantly associated with mid third ESCC (P = 0.03). Remote nodal metastasis was found in 10.5% of patients with upper third ESCC and 13% of patients with lower third ESCC, respectively. Remote nodal metastasis was associated with higher SUV of the primary tumor (P = 0.02) and worse survival (P = 0.03). Receiver operating characteristic analysis showed a cutoff SUV of 14.8 for predicting remote lymph node metastases. PET/CT provides important information before radiotherapy planning. Mid and lower third ESCC tends to metastasize to the right paratracheal/supraclavicular lymph nodes. Remote nodal metastases on PET/CT correlated with higher primary tumor SUV and worse survival.

Treatment of Parkinson's disease in rats by Nrf2 transfection using MRI-guided focused ultrasound delivery of nanomicrobubbles

DOE Office of Scientific and Technical Information (OSTI.GOV)

Long, Ling; Cai, Xiaodong; Guo, Ruomi

Parkinson's disease (PD) is a very common neurological disorder. However, effective therapy is lacking. Although the blood-brain-barrier (BBB) protects the brain, it prevents the delivery of about 90% of drugs and nucleotides into the brain, thereby hindering the development of gene therapy for PD. Magnetic resonance imaging (MRI)-guided focused ultrasound delivery of microbubbles enhances the delivery of gene therapy vectors across the BBB and improves transfection efficiency. In the present study, we delivered nuclear factor E2-related factor 2 (Nrf2, NFE2L2) contained in nanomicrobubbles into the substantia nigra of PD rats by MRI-guided focused ultrasound, and we examined the effect ofmore » Nrf2 over-expression in this animal model of PD. The rat model of PD was established by injecting 6-OHDA in the right substantia nigra stereotactically. Plasmids (pDC315 or pDC315/Nrf2) were loaded onto nanomicrobubbles, and then injected through the tail vein with the assistance of MRI-guided focused ultrasound. MRI-guided focused ultrasound delivery of nanomicrobubbles increased gene transfection efficiency. Furthermore, Nrf2 gene transfection reduced reactive oxygen species levels, thereby protecting neurons in the target region. - Highlights: • MRI-guided focused ultrasound enhances gene transfection into the brain of rats. • Increased Nrf2 expression protects neurons in the rat model of PD. • Nrf2 protects neurons in PD by inhibiting ROS production.« less

Disinfection of a probe used in ultrasound-guided prostate biopsy.

PubMed

Rutala, William A; Gergen, Maria F; Weber, David J

2007-08-01

Transrectal ultrasound (TRUS)-guided prostate biopsies are among the most common outpatient diagnostic procedures in urology clinics and carry the risk of introducing pathogens that may lead to infection. To investigate the effectiveness of procedures for disinfecting a probe used in ultrasound-guided prostate biopsy. The effectiveness of disinfection was determined by inoculating 10(7) colony forming units (cfu) of Pseudomonas aeruginosa at the following 3 sites on the probe: the interior lumen of the biopsy needle guide, the outside surface of the biopsy needle guide, and the interior lumen of the ultrasound probe where the needle guide passes through the transducer. Each site was investigated separately. After inoculation, the probe was immersed in 2% glutaraldehyde for 20 minutes and then assessed for the level of microbial contamination. The results demonstrated that disinfection (ie, a reduction in bacterial load of greater than 7 log(10) cfu) could be achieved if the needle guide was removed from the probe. However, if the needle guide was left in the probe channel during immersion in 2% glutaraldehyde, disinfection was not achieved (ie, the reduction was approximately 1 log(10) cfu). Recommendations for probe disinfection are provided and include disassembling the device and immersing the probe and the needle guide separately in a high-level disinfectant.

An alternative method for facial resurfacing: supraclavicular skin prefabrication by perforator fascia flap.

PubMed

Hocaoğlu, Emre

2014-01-01

Prefabrication of supraclavicular skin provides a useful source for flaps congruent with the face skin. Among various vascular sources that have been used for this purpose, anterolateral thigh fascia seems to represent a greater value because of having a long and strong vascular pedicle and negligible donor-site morbidity. In this regard, we present a technical report on using the lateral circumflex femoral artery perforator flap harvest technique in preparing an anterolateral thigh fascia flap for the prefabrication of the supraclavicular skin. The technique proved successful in resurfacing the facial skin of a young female patient with a giant congenital melanocytic hairy nevus on the left side of her face.

Prospective evaluation of magnetic resonance imaging guided in-bore prostate biopsy versus systematic transrectal ultrasound guided prostate biopsy in biopsy naïve men with elevated prostate specific antigen.

PubMed

Quentin, Michael; Blondin, Dirk; Arsov, Christian; Schimmöller, Lars; Hiester, Andreas; Godehardt, Erhard; Albers, Peter; Antoch, Gerald; Rabenalt, Robert

2014-11-01

Magnetic resonance imaging guided biopsy is increasingly performed to diagnose prostate cancer. However, there is a lack of well controlled, prospective trials to support this treatment method. We prospectively compared magnetic resonance imaging guided in-bore biopsy with standard systematic transrectal ultrasound guided biopsy in biopsy naïve men with increased prostate specific antigen. We performed a prospective study in 132 biopsy naïve men with increased prostate specific antigen (greater than 4 ng/ml). After 3 Tesla functional multiparametric magnetic resonance imaging patients were referred for magnetic resonance imaging guided in-bore biopsy of prostate lesions (maximum 3) followed by standard systematic transrectal ultrasound guided biopsy (12 cores). We analyzed the detection rates of prostate cancer and significant prostate cancer (greater than 5 mm total cancer length or any Gleason pattern greater than 3). A total of 128 patients with a mean ± SD age of 66.1 ± 8.1 years met all study requirements. Median prostate specific antigen was 6.7 ng/ml (IQR 5.1-9.0). Transrectal ultrasound and magnetic resonance imaging guided biopsies provided the same 53.1% detection rate, including 79.4% and 85.3%, respectively, for significant prostate cancer. Magnetic resonance imaging and transrectal ultrasound guided biopsies missed 7.8% and 9.4% of clinically significant prostate cancers, respectively. Magnetic resonance imaging biopsy required significantly fewer cores and revealed a higher percent of cancer involvement per biopsy core (each p <0.01). Combining the 2 methods provided a 60.9% detection rate with an 82.1% rate for significant prostate cancer. Magnetic resonance imaging guided in-bore and systematic transrectal ultrasound guided biopsies achieved equally high detection rates in biopsy naïve patients with increased prostate specific antigen. Magnetic resonance imaging guided in-bore biopsies required significantly fewer cores and revealed a significantly higher percent of cancer involvement per biopsy core. Copyright © 2014 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

In-Bore MR-Guided Biopsy Systems and Utility of PI-RADS.

PubMed

Fütterer, Jurgen J; Moche, Michael; Busse, Harald; Yakar, Derya

2016-06-01

A diagnostic dilemma exists in cases wherein a patient with clinical suspicion for prostate cancer has a negative transrectal ultrasound-guided biopsy session. Although transrectal ultrasound-guided biopsy is the standard of care, a paradigm shift is being observed. In biopsy-naive patients and patients with at least 1 negative biopsy session, multiparametric magnetic resonance imaging (MRI) is being utilized for tumor detection and subsequent targeting. Several commercial devices are now available for targeted prostate biopsy ranging from transrectal ultrasound-MR fusion biopsy to in bore MR-guided biopsy. In this review, we will give an update on the current status of in-bore MRI-guided biopsy systems and discuss value of prostate imaging-reporting and data system (PIRADS).

MR-Guided Pulsed High-Intensity Focused Ultrasound Enhancement of Gene Therapy Combined With Androgen Deprivation and Radiotherapy for Prostate Cancer Treatment

DTIC Science & Technology

2009-09-01

first statement of work is to determine if high intensity focused ultrasound ( HIFU ) increases the cellular uptake of AS-MDM2, AS-bcl-2 and AS-PKA...Drug Delivery in Prostate Tumor in vivo Using MR Guided Focused Ultrasound (MRg HIFU ). WC, IFMBE Proceedings 25: pp341-344, 2009 6...pharmaceutical agents in the treatment target. In the model system proposed, pulsed high intensity focused ultrasound ( HIFU ) is hypothesized to improve

The role of ultrasound guidance in pediatric caudal block

PubMed Central

Erbüyün, Koray; Açıkgöz, Barış; Ok, Gülay; Yılmaz, Ömer; Temeltaş, Gökhan; Tekin, İdil; Tok, Demet

2016-01-01

Objectives: To compare the time interval of the procedure, possible complications, post-operative pain levels, additional analgesics, and nurse satisfaction in ultrasonography-guided and standard caudal block applications. Methods: This retrospective study was conducted in Celal Bayar University Hospital, Manisa, Turkey, between January and December 2014, included 78 pediatric patients. Caudal block was applied to 2 different groups; one with ultrasound guide, and the other using the standard method. Results: The time interval of the procedure was significantly shorter in the standard application group compared with ultrasound-guided group (p=0.020). Wong-Baker FACES Pain Rating Scale values obtained at the 90th minute was statistically lower in the standard application group compared with ultrasound-guided group (p=0.035). No statistically significant difference was found on the other parameters between the 2 groups. The shorter time interval of the procedure at standard application group should not be considered as a distinctive mark by the pediatric anesthesiologists, because this time difference was as short as seconds. Conclusion: Ultrasound guidance for caudal block applications would neither increase nor decrease the success of the treatment. However, ultrasound guidance should be needed in cases where the detection of sacral anatomy is difficult, especially by palpations. PMID:26837396

Sonothrombolysis of Intra-Catheter Aged Venous Thrombi Using Microbubble Enhancement and Guided Three Dimensional Ultrasound Pulses

PubMed Central

Kutty, Shelby; Xie, Feng; Gao, Shunji; Drvol, Lucas K; Lof, John; Fletcher, Scott E; Radio, Stanley J; Danford, David A; Hammel, James M; Porter, Thomas R

2010-01-01

Central venous and arterial catheters are a major source of thrombo-embolic disease in children. We hypothesized that guided high mechanical index (MI) impulses from diagnostic three-dimensional (3D) ultrasound during an intravenous microbubble infusion could dissolve these thrombi. An in vitro system simulating intra-catheter thrombi was created and then treated with guided high MI impulses from 3D ultrasound, utilizing low MI microbubble sensitive imaging pulse sequence schemes to detect the microbubbles (Perflutren Lipid Microsphere, Definity®, Lantheus). Ten aged thrombi over 24 hours old were tested using 3D ultrasound coupled with a continuous diluted microbubble infusion (Group A), and ten with 3D ultrasound alone (Group B). Mean thrombus age was 28.6 hours (range 26.6–30.3). Groups A exhibited a 55 ± 19 % reduction in venous thrombus size, compared to 31±10 % for Group B (p=0.008). Feasibility testing was performed in 4 pigs, establishing a model to further investigate the efficacy. Sonothrombolysis of aged intra-catheter venous thrombi can be achieved with commercially available microbubbles and guided high MI ultrasound from a diagnostic 3D transducer. PMID:20696549

Analysis of "dry" mesothelioma with ultrasound guided biopsies.

PubMed

Stigt, Jos A; Boers, James E; Groen, Harry J M

2012-12-01

Image-guided sampling of the thickened pleura is a sensitive approach in patients with malignant pleural mesothelioma with pleural effusion. Malignant pleural mesothelioma presenting without effusion however is more of a diagnostic challenge. In this study we report the diagnostic yield and complications of ultrasound-guided cutting needle biopsies in this particular category of patients. A retrospective database analysis from September 2007 until January 2012 was performed in 56 patients with malignant pleural mesothelioma. Clinical characteristics and results of diagnostic evaluations were analysed. Of the 56 patients with malignant pleural mesothelioma, 20 patients presented without pleural effusion of with locular effusion. Ultrasound-guided cutting needle biopsy was performed in 14/20 patients with a diagnostic accuracy of 80%. Only 1 patient had mild haemoptysis immediately following biopsies. Diagnosing patients with pleural thickenings suspect for malignant mesothelioma without pleural effusion or with loculated pleural effusion is effective and safe with ultrasound-guided cutting needle biopsies. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Ultrasound-Guided Treatment of Peripheral Nerve Pathology.

PubMed

Dettori, Nathan; Choudur, Hema; Chhabra, Avneesh

2018-07-01

High-resolution ultrasound serves as a fast, accessible, reliable, and radiation-free tool for anatomical and dynamic evaluation of various peripheral nerves. It can be used not only to identify and diagnose peripheral nerve and perineural pathology accurately but also to guide various nerve and perineural interventions. We describe the normal and pathologic appearances of peripheral nerves, the pathologies commonly affecting the individual peripheral nerves, and the current ultrasound-guided peripheral nerve interventions and techniques. Future directions are also highlighted. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Impact of Focused Ultrasound-enhanced Drug Delivery on Survival in Rats with Glioma

NASA Astrophysics Data System (ADS)

Treat, Lisa Hsu; Zhang, Yongzhi; McDannold, Nathan; Hynynen, Kullervo

2009-04-01

Malignancies of the brain remain difficult to treat with chemotherapy because the selective permeability of the blood-brain barrier (BBB) blocks many potent agents from reaching their target. Previous studies have illustrated the feasibility of drug and antibody delivery across the BBB using MRI-guided focused ultrasound. In this study, we investigated the impact of focused ultrasound-enhanced delivery of doxorubicin on survival in rats with aggressive glioma. Sprague-Dawley rats were implanted with 9 L gliosarcoma cells in the brain. Eight days after implantation, each rat received one of the following: (1) no treatment (control), (2) a single treatment with microbubble-enhanced MRI-guided focused ultrasound (FUS only), (3) a single treatment with i.v. liposomal doxorubicin (DOX only), or (4) a single treatment with microbubble-enhanced MRI-guided focused ultrasound and concurrent i.v. injections of liposomal doxorubicin (FUS+DOX). The survival time from implantation to death or euthanasia was recorded. We observed a modest but significant increase in median survival time in rats treated with combined MRI-guided focused ultrasound chemotherapy, compared to chemotherapy alone (p<0.001). There was no significant improvement in survival between those who received stand-alone chemotherapy and those who did not receive any treatment (p>0.10). Our study demonstrates for the first time a therapeutic benefit achieved with ultrasound-enhanced drug delivery across the blood-brain barrier. This confirmation of efficacy in an in vivo tumor model indicates that targeted drug delivery using MRI-guided focused ultrasound has the potential to have a major impact on the treatment of patients with brain tumors and other neurological disorders.

Long-axis view for ultrasound-guided central venous catheter placement via the internal jugular vein.

PubMed

Mahan, Angel F; McEvoy, Matthew D; Gravenstein, Nikolaus

2016-04-01

In modern practice, real-time ultrasound guidance is commonly employed for the placement of internal jugular vein catheters. With a new tool, such as ultrasound, comes the opportunity to refine and further optimize the ultrasound view during jugular vein catheterization. We describe jugular vein access techniques and use the long-axis view as an alternative to the commonly employed short-axis cross-section view for internal jugular vein access and cannulation. The long-axis ultrasound-guided internal jugular vein approach for internal jugular vein cannulation is a useful alternative technique that can provide better needle tip and guidewire visualization than the more traditional short-axis ultrasound view.

WE-G-12A-01: High Intensity Focused Ultrasound Surgery and Therapy

DOE Office of Scientific and Technical Information (OSTI.GOV)

Farahani, K; O'Neill, B

More and more emphasis is being made on alternatives to invasive surgery and the use of ionizing radiation to treat various diseases including cancer. Novel screening, diagnosis, treatment and monitoring of response to treatment are also hot areas of research and new clinical technologies. Ultrasound(US) has gained traction in all of the aforementioned areas of focus. Especially with recent advances in the use of ultrasound to noninvasively treat various diseases/organ systems. This session will focus on covering MR-guided focused ultrasound and the state of the art clinical applications, and the second speaker will survey the more cutting edge technologies e.g.more » Focused Ultrasound (FUS) mediated drug delivery, principles of cavitation and US guided FUS. Learning Objectives: Fundamental physics and physical limitations of US interaction with tissue and nanoparticles The alteration of tissue transport using focused ultrasound US control of nanoparticle drug carriers for targeted release The basic principles of MRI-guided focused ultrasound (MRgFUS) surgery and therapy the current state of the art clinical applications of MRgFUS requirements for quality assurance and treatment planning.« less

Ultrasound-Guided Single-Injection Infraclavicular Block Versus Ultrasound-Guided Double-Injection Axillary Block: A Noninferiority Randomized Controlled Trial.

PubMed

Boivin, Ariane; Nadeau, Marie-Josée; Dion, Nicolas; Lévesque, Simon; Nicole, Pierre C; Turgeon, Alexis F

2016-01-01

Single-injection ultrasound-guided infraclavicular block is a simple, reliable, and effective technique. A simplified double-injection ultrasound-guided axillary block technique with a high success rate recently has been described. It has the advantage of being performed in a superficial and compressible location, with a potentially improved safety profile. However, its effectiveness in comparison with single-injection infraclavicular block has not been established. We hypothesized that the double-injection ultrasound-guided axillary block would show rates of complete sensory block at 30 minutes noninferior to the single-injection ultrasound-guided infraclavicular block. After approval by our research ethics committee and written informed consent, adults undergoing distal upper arm surgery were randomized to either group I, ultrasound-guided single-injection infraclavicular block, or group A, ultrasound-guided double-injection axillary block. In group I, 30 mL of 1.5% mepivacaine was injected posterior to the axillary artery. In group A, 25 mL of 1.5% mepivacaine was injected posteromedial to the axillary artery, after which 5 mL was injected around the musculocutaneous nerve. Primary outcome was the rate of complete sensory block at 30 minutes. Secondary outcomes were the onset of sensory and motor blocks, surgical success rates, performance times, and incidence of complications. All outcomes were assessed by a blinded investigator. The noninferiority of the double-injection ultrasound-guided axillary block was considered if the limits of the 90% confidence intervals (CIs) were within a 10% margin of the rate of complete sensory block of the infraclavicular block. At 30 minutes, the rate of complete sensory block was 79% in group A (90% CI, 71%-85%) compared with 91% in group I (90% CI, 85%-95%); the upper limit of CI of group A is thus included in the established noninferiority margin of 10%. The rate of complete sensory block was lower in group A (proportion difference of 12% [95% CI, 2-22]; P = 0.0091), as was surgical success rate (82% [95% CI, 74%-89%] vs 93% [95% CI, 86%-97%]; proportion difference of 11% [95% CI 1-20]; P = 0.0153). Sensory block onset also was slower in group A (log rank test P = 0.0020). Performance times were faster in group I (231 seconds [95% CI, 213-250]) than in group A (358 seconds [95% CI, 332-387]; P < 0.0001). No statistically significant difference was observed for vascular puncture, paresthesia during block performance, or procedure-related pain. No neurologic complication was noted at follow-up. We failed to demonstrate that the rate of complete sensory block of the double-injection axillary block is noninferior to the single-injection infraclavicular block. However, the rate of complete sensory block at 30 minutes is statistically significantly lower with the axillary block. The ultrasound-guided single-injection infraclavicular block thus seems to be the preferred technique over the axillary for upper arm anesthesia.

Supraclavicular Skin Temperature as a Measure of 18F-FDG Uptake by BAT in Human Subjects

PubMed Central

van der Linden, Rianne A. D.; Pereira Arias-Bouda, Lenka; Smit, Frits; Verberne, Hein J.; van Marken Lichtenbelt, Wouter D.

2014-01-01

Background Brown adipose tissue (BAT) has emerged as a novel player in energy homeostasis in humans and is considered a potential new target for combating obesity and related diseases. The current ‘gold standard’ for quantification of BAT volume and activity is cold-induced 18F-FDG uptake in BAT. However, use of this technique is limited by cost and radiation exposure. Given the fact that BAT is a thermogenic tissue, mainly located in the supraclavicular region, the aim of the current study was to investigate whether cold-induced supraclavicular skin temperature and core body temperature may be alternative markers of BAT activation in humans. Subjects/Methods BAT volume and activity were measured in 24 healthy lean adolescent males (mean age 24.1±0.8 years), using cold-induced 18F-FDG uptake with PET-CT. Core body temperature was measured continuously in the small intestine with use of an ingestible telemetric capsule and skin temperature was measured by eighteen wireless iButtons attached to the skin following ISO-defined locations. Results Proximal and distal (hand/feet) skin temperatures markedly decreased upon cold exposure, while supraclavicular skin temperature significantly increased (35.2±0.1 vs. 35.5±0.1°C, p = 0.001). Furthermore, cold-induced supraclavicular skin temperature positively correlated with both total (R2 = 0.28, P = 0.010) and clavicular BAT volume (R2 = 0.20, P = 0.030) and clavicular SUVmax (R2 = 0.27, P = 0.010), while core body temperature did not. Conclusions Supraclavicular skin temperature as measured by iButtons may have predictive value for BAT detection in adult humans. This is highly desirable considering the increasing interest in pharmacological interventions to stimulate BAT in human subjects. Trial Registration NTR 2473 PMID:24922545

Ultrasound-Guided Percutaneous Tenotomy of Biceps Tendon: Technical Feasibility on Cadavers.

PubMed

Sconfienza, Luca Maria; Mauri, Giovanni; Messina, Carmelo; Aliprandi, Alberto; Secchi, Francesco; Sardanelli, Francesco; Randelli, Pietro Simone

2016-10-01

We tested the technical feasibility of ultrasound-guided percutaneous tenotomy of the long head of the biceps tendon (LHBT) in cadavers. Both shoulders of two fresh cadavers were scanned anteriorly to evaluate the extra-articular portion of the LHBT. Under ultrasound monitoring, a scalpel was advanced obliquely up to touch the superficial medial side of the LHBT, cutting it until the tendon was not visible anymore. Ultrasound evaluation was repeated after the procedure, and anatomic dissection was performed. The procedure was 100% feasible: four cuts were made to completely sever the tendon; the duration was less than 1 min. Skin incision measured 5 mm in two cases and 6 mm in two cases. Anatomic dissection confirmed complete tendon cut in all cases with proximal and distal tendon stumps very close to each other. Ultrasound-guided percutaneous LHBT tenotomy was 100% technically feasible in cadavers with a quick procedure and minimal cutaneous incision. Copyright © 2016 World Federation for Ultrasound in Medicine & Biology. Published by Elsevier Inc. All rights reserved.

A multimodal image guiding system for Navigated Ultrasound Bronchoscopy (EBUS): A human feasibility study

PubMed Central

Hofstad, Erlend Fagertun; Amundsen, Tore; Langø, Thomas; Bakeng, Janne Beate Lervik; Leira, Håkon Olav

2017-01-01

Background Endobronchial ultrasound transbronchial needle aspiration (EBUS-TBNA) is the endoscopic method of choice for confirming lung cancer metastasis to mediastinal lymph nodes. Precision is crucial for correct staging and clinical decision-making. Navigation and multimodal imaging can potentially improve EBUS-TBNA efficiency. Aims To demonstrate the feasibility of a multimodal image guiding system using electromagnetic navigation for ultrasound bronchoschopy in humans. Methods Four patients referred for lung cancer diagnosis and staging with EBUS-TBNA were enrolled in the study. Target lymph nodes were predefined from the preoperative computed tomography (CT) images. A prototype convex probe ultrasound bronchoscope with an attached sensor for position tracking was used for EBUS-TBNA. Electromagnetic tracking of the ultrasound bronchoscope and ultrasound images allowed fusion of preoperative CT and intraoperative ultrasound in the navigation software. Navigated EBUS-TBNA was used to guide target lymph node localization and sampling. Navigation system accuracy was calculated, measured by the deviation between lymph node position in ultrasound and CT in three planes. Procedure time, diagnostic yield and adverse events were recorded. Results Preoperative CT and real-time ultrasound images were successfully fused and displayed in the navigation software during the procedures. Overall navigation accuracy (11 measurements) was 10.0 ± 3.8 mm, maximum 17.6 mm, minimum 4.5 mm. An adequate sample was obtained in 6/6 (100%) of targeted lymph nodes. No adverse events were registered. Conclusions Electromagnetic navigated EBUS-TBNA was feasible, safe and easy in this human pilot study. The clinical usefulness was clearly demonstrated. Fusion of real-time ultrasound, preoperative CT and electromagnetic navigational bronchoscopy provided a controlled guiding to level of target, intraoperative overview and procedure documentation. PMID:28182758

Feasibility of Retrograde Ureteral Contrast Injection to Guide Ultrasonographic Percutaneous Renal Access in the Nondilated Collecting System.

PubMed

Usawachintachit, Manint; Tzou, David T; Mongan, John; Taguchi, Kazumi; Weinstein, Stefanie; Chi, Thomas

2017-02-01

Ultrasound-guided percutaneous nephrolithotomy (PCNL) has become increasingly utilized. Patients with nondilated collecting systems represent a challenge: the target calix is often difficult to visualize. Here we report pilot study results for retrograde ultrasound contrast injection to aid in percutaneous renal access during ultrasound-guided PCNL. From April to July 2016, consecutive patients over the age of 18 years with nondilated collecting systems on preoperative imaging who presented for PCNL were enrolled. B-mode ultrasound imaging was compared with contrast-enhanced mode with simultaneous retrograde injection of Optison™ via an ipsilateral ureteral catheter. Five patients (four males and one female) with renal stones underwent PCNL with retrograde ultrasound contrast injection during the study period. Mean body mass index was 28.3 ± 5.6 kg/m 2 and mean stone size was 24.5 ± 12.0 mm. Under B-mode ultrasound, all patients demonstrated nondilated renal collecting systems that appeared as hyperechoic areas, where it was difficult to identify a target calix for puncture. Retrograde contrast injection facilitated delineation of all renal calices initially difficult to visualize under B-mode ultrasound. Renal puncture was then performed effectively in all cases with a mean puncture time of 55.4 ± 44.8 seconds. All PCNL procedures were completed without intraoperative complications and no adverse events related to ultrasound contrast injection occurred. Retrograde ultrasound contrast injection as an aide for renal puncture during PCNL is a feasible technique. By improving visualization of the collecting system, it facilitates needle placement in challenging patients without hydronephrosis. Future larger scale studies comparing its use to standard ultrasound-guided technique will be required to validate this concept.

Success of ultrasound-guided versus landmark-guided arthrocentesis of hip, ankle, and wrist in a cadaver model.

PubMed

Berona, Kristin; Abdi, Amin; Menchine, Michael; Mailhot, Tom; Kang, Tarina; Seif, Dina; Chilstrom, Mikaela

2017-02-01

The objectives of this study were to evaluate emergency medicine resident-performed ultrasound for diagnosis of effusions, compare the success of a landmark-guided (LM) approach with an ultrasound-guided (US) technique for hip, ankle and wrist arthrocentesis, and compare change in provider confidence with LM and US arthrocentesis. After a brief video on LM and US arthrocentesis, residents were asked to identify artificially created effusions in the hip, ankle and wrist in a cadaver model and to perform US and LM arthrocentesis of the effusions. Outcomes included success of joint aspiration, time to aspiration, and number of attempts. Residents were surveyed regarding their confidence in identifying effusions with ultrasound and performing LM and US arthrocentesis. Eighteen residents completed the study. Sensitivity of ultrasound for detecting joint effusion was 86% and specificity was 90%. Residents were successful with ultrasound in 96% of attempts and with landmark 89% of attempts (p=0.257). Median number of attempts was 1 with ultrasound and 2 with landmarks (p=0.12). Median time to success with ultrasound was 38s and 51s with landmarks (p=0.23). After the session, confidence in both US and LM arthrocentesis improved significantly, however the post intervention confidence in US arthrocentesis was higher than LM (4.3 vs. 3.8, p<0.001). EM residents were able to successfully identify joint effusions with ultrasound, however we were unable to detect significant differences in actual procedural success between the two modalities. Further studies are needed to define the role of ultrasound for arthrocentesis in the emergency department. Copyright © 2016 Elsevier Inc. All rights reserved.

Combined photon-electron beams in the treatment of the supraclavicular lymph nodes in breast cancer: A novel technique that achieves adequate coverage while reducing lung dose

DOE Office of Scientific and Technical Information (OSTI.GOV)

Salem, Ahmed, E-mail: ahmed.salem@doctors.org.uk; Mohamad, Issa; Dayyat, Abdulmajeed

2015-10-01

Radiation pneumonitis is a well-documented side effect of radiation therapy for breast cancer. The purpose of this study was to compare combined photon-electron, photon-only, and electron-only plans in the radiation treatment of the supraclavicular lymph nodes. In total, 13 patients requiring chest wall and supraclavicular nodal irradiation were planned retrospectively using combined photon-electron, photon-only, and electron-only supraclavicular beams. A dose of 50 Gy over 25 fractions was prescribed. Chest wall irradiation parameters were fixed for all plans. The goal of this planning effort was to cover 95% of the supraclavicular clinical target volume (CTV) with 95% of the prescribed dosemore » and to minimize the volume receiving ≥ 105% of the dose. Comparative end points were supraclavicular CTV coverage (volume covered by the 95% isodose line), hotspot volume, maximum radiation dose, contralateral breast dose, mean total lung dose, total lung volume percentage receiving at least 20 Gy (V{sub 20} {sub Gy}), heart volume percentage receiving at least 25 Gy (V{sub 25} {sub Gy}). Electron and photon energies ranged from 8 to 18 MeV and 4 to 6 MV, respectively. The ratio of photon-to-electron fractions in combined beams ranged from 5:20 to 15:10. Supraclavicular nodal coverage was highest in photon-only (mean = 96.2 ± 3.5%) followed closely by combined photon-electron (mean = 94.2 ± 2.5%) and lowest in electron-only plans (mean = 81.7 ± 14.8%, p < 0.001). The volume of tissue receiving ≥ 105% of the prescription dose was higher in the electron-only (mean = 69.7 ± 56.1 cm{sup 3}) as opposed to combined photon-electron (mean = 50.8 ± 40.9 cm{sup 3}) and photon-only beams (mean = 32.2 ± 28.1 cm{sup 3}, p = 0.114). Heart V{sub 25} {sub Gy} was not statistically different among the plans (p = 0.999). Total lung V{sub 20} {sub Gy} was lowest in electron-only (mean = 10.9 ± 2.3%) followed by combined photon-electron (mean = 13.8 ± 2.3%) and highest in photon-only plans (mean = 16.2 ± 3%, p < 0.001). As expected, photon-only plans demonstrated the highest target coverage and total lung V{sub 20} {sub Gy}. The superiority of electron-only beams, in terms of decreasing lung dose, is set back by the dosimetric hotspots associated with such plans. Combined photon-electron treatment is a feasible technique for supraclavicular nodal irradiation and results in adequate target coverage, acceptable dosimetric hotspot volume, and slightly reduced lung dose.« less

[The Role of Supraclavicular lymph node dissection in Breast Cancer Patients with Synchronous Ipsilateral Supraclavicular Lymph Node Metastasis].

PubMed

Zhang, W; Qi, X M; Chen, A X; Zhang, P; Cao, X C; Xiao, C H

2017-05-23

Objective: In this study, we evaluated the effect of supraclavicular lymph node dissection in breast cancer patients who presented with ipsilateral supraclavicular lymph node metastasis (ISLM) without distant metastasis. Methods: A total of 90 patients with synchronous ISLM without distant metastasis between 2000 and 2009 were retrospectively analyzed. Patients were retrospectively divided into two groups, namely supraclavicular lymph node dissection group(34 patients) and non-dissection group(56 patients), according to whether they underwentsupraclavicular lymph node dissection or not.The Kaplan-Meier method was applied to analyze the locoregional relapse free survival (LRFS) and overall survival(OS). Results: Median follow-upwas 85 months(range, 6 to 11 months). Local recurrence in 32 cases, 47 cases of distant metastasis, of which 25 patients were accompanied by both locoregional relapse and distant metastasis. Of the 32 patients with locoregional relapse, 11 patients were in the lymph node dissection group and 21 patients in the control group. Of the 47 patients with distant metastases, 17 were treated with lymph node dissection, 30 in the control group. Thirty-two patients died in the whole group and 16 patients underwentlymph node dissection and 16 patients didn't. There was no significant difference between the rate of 5-year LRFS and 5-year OS ( P =0.359, P =0.246). For patients of ER negative, the 5-year loco-regional relapse free survival rates were 63.7% and 43.3% in supraclavicular lymph node dissection group and control group, respectively. The 5-year overall survival rates were 52.1% and 52.3%, respectively, and there were no statistically significant differences ( P =0.118, P =0.951). For patients of PR negative, the 5-yearloco-regional relapse free rates were 59.8% and 46.2%, respectively, and the 5-year overall survival rates were 50.6% and 43.2%, respectively, and there was no significant difference between the two groups ( P =0.317, P =0.973). The 5-year recurrence-free survival rates of human epidermal growth factor receptor 2 (HER2)-positive patients were 61.2% and 48.0%( P =0.634), respectively, and the 5-year overall survival rates were 37.2% and 65.4%( P =0.032). Forty-seven patients suffered distant metastases and the 5-year metastases free survival rates were 37.3% and 38.5% in supraclavicular lymph node dissection group and control group, respectively. Conclusion: Supraclavicular lymph node dissection maybe an effective approach to improve the loco-regional control for the patients with ISLM, especially for ER negative and PR negative subtypes, but it might has adverseeffects for the patients with negative HER2 status.

Pathological fracture of the patella due to an atypical located aneurysmal bone cyst: verification by means of ultrasound-guided biopsy.

PubMed

Plaikner, Michaela; Gruber, Hannes; Henninger, Benjamin; Gruber, Leonhard; Kosiol, Juana; Loizides, Alexander

2016-03-01

We report on a rare case of an atypical located aneurysmal bone cyst (ABC) in the patella presenting with pathological fracture after trauma. Using all available diagnostic modalities and by means of ultrasound-guided core-needle biopsy an unclear and suspected pathological fractured cystic bone lesion in the patella of a young man could be further clarified. The acquired images suggested the diagnosis of a pathological fractured aneurysmal bone cyst after mild trauma. However, due to the extraordinary location and clinical presentation the diagnosis was secured by means of ultrasound-guided biopsy through a small cortical gap. As shown in this rare case of an atypical aneurysmal bone cyst of the patella, the quite seldom but sometimes possible ultrasound-guided biopsy of intraosseous lesions can help to achieve the diagnostic clarification and should also be taken into account as a non-standard procedure.

Ultrasound-guided percutaneous injection of methylene blue to identify nerve pathology and guide surgery.

PubMed

Osorio, Joseph A; Breshears, Jonathan D; Arnaout, Omar; Simon, Neil G; Hastings-Robinson, Ashley M; Aleshi, Pedram; Kliot, Michel

2015-09-01

OBJECT The objective of this study was to provide a technique that could be used in the preoperative period to facilitate the surgical exploration of peripheral nerve pathology. METHODS The authors describe a technique in which 1) ultrasonography is used in the immediate preoperative period to identify target peripheral nerves, 2) an ultrasound-guided needle electrode is used to stimulate peripheral nerves to confirm their position, and then 3) a methylene blue (MB) injection is performed to mark the peripheral nerve pathology to facilitate surgical exploration. RESULTS A cohort of 13 patients with varying indications for peripheral nerve surgery is presented in which ultrasound guidance, stimulation, and MB were used to localize and create a road map for surgeries. CONCLUSIONS Preoperative ultrasound-guided MB administration is a promising technique that peripheral nerve surgeons could use to plan and execute surgery.

Ultrasound image-guided therapy enhances antitumor effect of cisplatin.

PubMed

Sasaki, Noboru; Kudo, Nobuki; Nakamura, Kensuke; Lim, Sue Yee; Murakami, Masahiro; Kumara, W R Bandula; Tamura, Yu; Ohta, Hiroshi; Yamasaki, Masahiro; Takiguchi, Mitsuyoshi

2014-01-01

The aim of this study was to clarify whether ultrasound image-guided cisplatin delivery with an intratumor microbubble injection enhances the antitumor effect in a xenograft mouse model. Canine thyroid adenocarcinoma cells were used for all experiments. Before in vivo experiments, the cisplatin and microbubble concentration and ultrasound exposure time were optimized in vitro. For in vivo experiments, cells were implanted into the back of nude mice. Observed by a diagnostic ultrasound machine, a mixture of cisplatin and ultrasound contrast agent, Sonazoid, microbubbles was injected directly into tumors. The amount of injected cisplatin and microbubbles was 1 μg/tumor and 1.2 × 10(7) microbubbles/tumor, respectively, with a total injected volume of 20 μl. Using the same diagnostic machine, tumors were exposed to ultrasound for 15 s. The treatment was repeated four times. The combination of cisplatin, microbubbles, and ultrasound significantly delayed tumor growth as compared with no treatment (after 18 days, 157 ± 55 vs. 398 ± 49 mm(3), P = 0.049). Neither cisplatin alone nor the combination of cisplatin and ultrasound delayed tumor growth. The treatment did not decrease the body weight of mice. Ultrasound image-guided anticancer drug delivery may enhance the antitumor effects of drugs without obvious side effects.

The Utility of Teleultrasound to Guide Acute Patient Management.

PubMed

Becker, Christian; Fusaro, Mario; Patel, Dhruv; Shalom, Isaac; Frishman, William H; Scurlock, Corey

Ultrasound has evolved into a core bedside tool for diagnostic and management purposes for all subsets of adult and pediatric critically-ill patients. Teleintensive care unit coverage has undergone a similar rapid expansion period throughout the United States. Round-the-clock access to ultrasound equipment is very common in today's intensive care unit, but 24/7 coverage with staff trained to acquire and interpret point-of-care ultrasound in real time is lagging behind equipment availability. Medical trainees and physician extenders require attending level supervision to ensure consistent image acquisition and accurate interpretation. Teleintensivists can extend the utility of ultrasound by supervising and guiding providers without or with only partial training in ultrasound, and also by extending direct trainee ultrasound supervision to time periods when no direct bedside attending supervisor is available, and when treatment decisions otherwise would have been made without supervision and feedback on image acquisition and interpretation. Nursing staff without ultrasound training can also be directed to perform basic ultrasound exams, which may have immediate diagnostic and/or treatment consequences, thereby overcoming access barriers in the absence of physicians or physician extenders. We discuss 4 real-life clinical scenarios in which teleintensivist supervision extended and standardized bedside ultrasound exams to guide management decisions which significantly impacted patient outcomes.

Ultrasound criteria and guided fine-needle aspiration diagnostic yields in small animal peritoneal, mesenteric and omental disease.

PubMed

Feeney, Daniel A; Ober, Christopher P; Snyder, Laura A; Hill, Sara A; Jessen, Carl R

2013-01-01

Peritoneal, mesenteric, and omental diseases are important causes of morbidity and mortality in humans and animals, although information in the veterinary literature is limited. The purposes of this retrospective study were to determine whether objectively applied ultrasound interpretive criteria are statistically useful in differentiating among cytologically defined normal, inflammatory, and neoplastic peritoneal conditions in dogs and cats. A second goal was to determine the cytologically interpretable yield on ultrasound-guided, fine-needle sampling of peritoneal, mesenteric, or omental structures. Sonographic criteria agreed upon by the authors were retrospectively and independently applied by two radiologists to the available ultrasound images without knowledge of the cytologic diagnosis and statistically compared to the ultrasound-guided, fine-needle aspiration cytologic interpretations. A total of 72 dogs and 49 cats with abdominal peritoneal, mesenteric, or omental (peritoneal) surface or effusive disease and 17 dogs and 3 cats with no cytologic evidence of inflammation or neoplasia were included. The optimized, ultrasound criteria-based statistical model created independently for each radiologist yielded an equation-based diagnostic category placement accuracy of 63.2-69.9% across the two involved radiologists. Regional organ-associated masses or nodules as well as aggregated bowel and peritoneal thickening were more associated with peritoneal neoplasia whereas localized, severely complex fluid collections were more associated with inflammatory peritoneal disease. The cytologically interpretable yield for ultrasound-guided fine-needle sampling was 72.3% with no difference between species, making this a worthwhile clinical procedure. © 2013 Veterinary Radiology & Ultrasound.

Feasibility of Prostate Cancer Diagnosis by Transrectal Photo-acoustic Imaging

DTIC Science & Technology

2013-03-01

prostate. Transrectal ultrasound has been used as a guiding tool to direct tissue needle biopsy for prostate cancer diagnosis; it cannot be utilized for...tool currently available for prostate cancer detection; needle biopsy is the current practice for diagnosis of the disease, aiming randomly in the...developing an integrated approach between ultrasound and optical tomography, namely, transrectal ultrasound - guided diffuse optical tomography (TRUS

Sonoanatomy relevant for ultrasound-guided central neuraxial blocks via the paramedian approach in the lumbar region

PubMed Central

Karmakar, M K; Li, X; Kwok, W H; Ho, A M-H; Ngan Kee, W D

2012-01-01

Objectives The use of ultrasound to guide peripheral nerve blocks is now a well-established technique in regional anaesthesia. However, despite reports of ultrasound guided epidural access via the paramedian approach, there are limited data on the use of ultrasound for central neuraxial blocks, which may be due to a poor understanding of spinal sonoanatomy. The aim of this study was to define the sonoanatomy of the lumbar spine relevant for central neuraxial blocks via the paramedian approach. Methods The sonoanatomy of the lumbar spine relevant for central neuraxial blocks via the paramedian approach was defined using a “water-based spine phantom”, young volunteers and anatomical slices rendered from the Visible Human Project data set. Results The water-based spine phantom was a simple model to study the sonoanatomy of the osseous elements of the lumbar spine. Each osseous element of the lumbar spine, in the spine phantom, produced a “signature pattern” on the paramedian sagittal scans, which was comparable to its sonographic appearance in vivo. In the volunteers, despite the narrow acoustic window, the ultrasound visibility of the neuraxial structures at the L3/L4 and L4/L5 lumbar intervertebral spaces was good, and we were able to delineate the sonoanatomy relevant for ultrasound-guided central neuraxial blocks via the paramedian approach. Conclusion Using a simple water-based spine phantom, volunteer scans and anatomical slices from the Visible Human Project (cadaver) we have described the sonoanatomy relevant for ultrasound-guided central neuraxial blocks via the paramedian approach in the lumbar region. PMID:22010025

Real-time ultrasound-guided spinal anesthesia using the SonixGPS® needle tracking system: a case report.

PubMed

Wong, Simon W; Niazi, Ahtsham U; Chin, Ki J; Chan, Vincent W

2013-01-01

The SonixGPS® is an electromagnetic needle tracking system for ultrasound-guided needle intervention. Both current and predicted needle tip position are displayed on the ultrasound screen in real-time, facilitating needle-beam alignment and guidance to the target. This case report illustrates the use of the SonixGPS system for successful performance of real-time ultrasound-guided spinal anesthesia in a patient with difficult spinal anatomy. A 67-yr-old male was admitted to our hospital to undergo revision of total right hip arthroplasty. His four previous arthroplasties for hip revision were performed under general anesthesia because he had undergone L3-L5 instrumentation for spinal stenosis. The L4-L5 interspace was viewed with the patient in the left lateral decubitus position. A 19G 80-mm proprietary needle (Ultrasonix Medical Corp, Richmond, BC, Canada) was inserted and directed through the paraspinal muscles to the ligamentum flavum in plane to the ultrasound beam. A 120-mm 25G Whitacre spinal needle was then inserted through the introducer needle in a conventional fashion. Successful dural puncture was achieved on the second attempt, as indicated by a flow of clear cerebrospinal fluid. The patient tolerated the procedure well, and the spinal anesthetic was adequate for the duration of the surgery. The SonixGPS is a novel technology that can reduce the technical difficulty of real-time ultrasound-guided neuraxial blockade. It may also have applications in other advanced ultrasound-guided regional anesthesia techniques where needle-beam alignment is critical.

MRI-guided focused ultrasound surgery in musculoskeletal diseases: the hot topics

PubMed Central

Napoli, Alessandro; Sacconi, Beatrice; Battista, Giuseppe; Guglielmi, Giuseppe; Catalano, Carlo; Albisinni, Ugo

2016-01-01

MRI-guided focused ultrasound surgery (MRgFUS) is a minimally invasive treatment guided by the most sophisticated imaging tool available in today's clinical practice. Both the imaging and therapeutic sides of the equipment are based on non-ionizing energy. This technique is a very promising option as potential treatment for several pathologies, including musculoskeletal (MSK) disorders. Apart from clinical applications, MRgFUS technology is the result of long, heavy and cumulative efforts exploring the effects of ultrasound on biological tissues and function, the generation of focused ultrasound and treatment monitoring by MRI. The aim of this article is to give an updated overview on a “new” interventional technique and on its applications for MSK and allied sciences. PMID:26607640

Outcomes of ultrasound guided renal mass biopsies.

PubMed

Sutherland, Edward L; Choromanska, Agnieszka; Al-Katib, Sayf; Coffey, Mary

2018-06-01

The purpose of this study was to evaluate the rate of nondiagnostic ultrasound-guided renal mass biopsies (RMBs) at our institution and to determine what patient, procedural, and focal renal mass (FRM) factors were associated with nondiagnostic ultrasound-guided RMBs. Eighty-two ultrasound-guided renal mass biopsies performed between January 2014 and October 2016 were included in our study. Biopsy outcomes (diagnostic vs. nondiagnostic) and patient, procedural, and FRM characteristics were retrospectively reviewed and recorded. Univariate statistical analyses were performed to identify biopsy characteristics that were indicative of nondiagnostic biopsy. Ultrasound-guided RMBs were diagnostic in 70 out of 82 cases (85%) and non-diagnostic in 12 cases (15%). Among the diagnostic biopsies, 54 (77%) were malignant cases, 94% of which were renal cell carcinoma (RCC). Of the 12 nondiagnostic cases, the final diagnosis was RCC in 4 cases and angiomyolipoma in one case; seven of the nondiagnostic cases were lost to follow-up. A weak association (p = 0.04) was found between the number of needle passes and the biopsy outcome. None of the remaining collected RMB characteristics showed a significant correlation with a diagnostic or nondiagnostic RMB. Six patients (7%) experienced complications. Ultrasound-guided renal mass biopsy is a safe and effective method for the diagnosis of renal masses with a low rate of nondiagnostic outcomes. A nondiagnostic biopsy should not be treated as a surrogate for a diagnosis since a significant number of patients with nondiagnostic biopsies have subsequently been shown to have renal malignancies. Repeat biopsy should be considered in such cases.

Pre-procedure ultrasound-guided paramedian spinal anaesthesia at L5–S1: Is this better than landmark-guided midline approach? A randomised controlled trial

PubMed Central

Srinivasan, Karthikeyan Kallidaikurichi; Leo, Anne-Marie; Iohom, Gabriella; Loughnane, Frank; Lee, Peter J

2018-01-01

Background and Aims: Routine use of pre-procedural ultrasound guided midline approach has not shown to improve success rate in administering subarachnoid block. The study hypothesis was that the routine use of pre-procedural (not real time) ultrasound-guided paramedian spinals at L5-S1 interspace could reduce the number of passes (i.e., withdrawal and redirection of spinal needle without exiting the skin) required to enter the subarachnoid space when compared to the conventional landmark-guided midline approach. Methods: After local ethics approval, 120 consenting patients scheduled for elective total joint replacements (Hip and Knee) were randomised into either Group C where conventional midline approach with palpated landmarks was used or Group P where pre-procedural ultrasound was used to perform subarachnoid block by paramedian approach at L5-S1 interspace (real time ultrasound guidance was not used). Results: There was no difference in primary outcome (difference in number of passes) between the two groups. Similarly there was no difference in the number of attempts (i.e., the number of times the spinal needle was withdrawn from the skin and reinserted). The first pass success rates (1 attempt and 1 pass) was significantly greater in Group C compared to Group P [43% vs. 22%, P = 0.02]. Conclusion: Routine use of paramedian spinal anaesthesia at L5-S1 interspace, guided by pre-procedure ultrasound, in patients undergoing lower limb joint arthroplasties did not reduce the number of passes or attempts needed to achieve successful dural puncture. PMID:29416151

High-resolution Imaging of Neural Anatomy and Pathology of the Neck.

PubMed

Lee, Jeong Hyun; Cheng, Kai-Lung; Choi, Young Jun; Baek, Jung Hwan

2017-01-01

The neck has intricately connected neural structures, including cervical and brachial plexi, the sympathetic system, lower cranial nerves, and their branches. Except for brachial plexus, there has been little research regarding the normal imaging appearance or corresponding pathologies of neural structures in the neck. The development in imaging techniques with better spatial resolution and signal-to-noise ratio has made it possible to see many tiny nerves to predict complications related to image-guided procedures and to better assess treatment response, especially in the management of oncology patients. The purposes of this review is to present imaging-based anatomy of major nerves in the neck and explain their relevant clinical significance according to representative pathologies of regarded nerves in the neck.

Magnetic Resonance-Guided High-Intensity Focused Ultrasound Ablation of Osteoid Osteoma: A Case Series Report.

PubMed

Rovella, Marcello S; Martins, Guilherme L P; Cavalcanti, Conrado F A; Bor-Seng-Shu, Edson; Camargo, Olavo P; Cerri, Giovanni G; Menezes, Marcos R

2016-04-01

Osteoid osteoma is painful benign tumor. The aim of this study was to report our initial experience using magnetic resonance-guided focused ultrasound to treat osteoid osteomas. This retrospective single-center study included four patients treated with magnetic resonance-guided focused ultrasound. They presented with severe pain with reduced quality of life and a poor response to clinical treatment. The pre- and post-treatment evaluation comprised computed tomography and magnetic resonance imaging and focused on quality of life and the impact of pain on daily activities. After treatment, three patients had complete pain resolution with no recurrence. One patient had a recurrence of symptoms after 2 wk and underwent a new successful treatment with increased energy levels. On average, 13 sonications were administered (8-18 sonications/treatment) with an average energy of 2,003 J (range: 1,063-3,522 J). Magnetic resonance-guided focused ultrasound appears to be a feasible, tolerable and effective treatment in selected patients with osteoid osteomas. Copyright © 2016 World Federation for Ultrasound in Medicine & Biology. Published by Elsevier Inc. All rights reserved.

Transurethral ultrasound-guided laser-induced prostatectomy

NASA Astrophysics Data System (ADS)

Babayan, Richard K.; Roth, Robert A.

1991-07-01

A transurethral ultrasound-guided Nd:YAG laser delivery system has been developed for use as an alternative approach to the treatment of benign prostatic hyperplasia. The TULIP system has been extensively tested in canine models and is currently undergoing FDA trials in humans.

Efficacy of ultrasound-guided percutaneous needle treatment of calcific tendinitis.

PubMed

Vignesh, K Nithin; McDowall, Adam; Simunovic, Nicole; Bhandari, Mohit; Choudur, Hema N

2015-01-01

The purpose of this study was to conduct a systematic review of the efficacy of ultrasound-guided needle lavage in treating calcific tendinitis. Two independent assessors searched medical databases and screened studies for eligibility. Eleven articles were included. Heterogeneity among included studies precluded meta-analysis. Results of randomized controlled trials suggested no difference in pain relief between needle lavage and other interventions, but the studies were of low quality. Additional high-quality evidence is required to determine the relative efficacy of ultrasound-guided needle lavage in the management of calcific tendinitis of the rotator cuff.

Non-malignant breast papillary lesions - b3 diagnosed on ultrasound--guided 14-gauge needle core biopsy: analysis of 114 cases from a single institution and review of the literature.

PubMed

Bianchi, Simonetta; Bendinelli, Benedetta; Saladino, Valeria; Vezzosi, Vania; Brancato, Beniamino; Nori, Jacopo; Palli, Domenico

2015-07-01

One-hundred-fourteen consecutive cases of breast ultrasound-guided 14-gauge needle core biopsy (14G NCB) performed from January 2001 to June 2013 and diagnosed as non-malignant papillary lesion (PL)-B3, were reviewed and compared with definitive histological diagnosis on surgical excision (SE) to evaluate the diagnostic accuracy of ultrasound-guided 14G NCB. PL with epithelial atypia on 14G NCB were associated to malignancy on definitive histological diagnosis on SE in 22 (7 DCIS and 15 invasive carcinomas) of 46 cases with an underestimation rate of 47.8 %, while 9 (4 DCIS and 5 invasive carcinomas) cases out of 68 cases of PL without epithelial atypia were upgraded to carcinoma with an underestimation rate of 13.2 %. In cases of PL with epithelial atypia on ultrasound-guided 14G NCB, SE appears mandatory due to the high risk of associated malignancy. The diagnosis of PL without epithelial atypia on ultrasound-guided 14G NCB does not exclude malignancy at subsequent SE, consequently further assessment (by surgical or vacuum-assisted excision) is recommended to avoid the risk of delaying a diagnosis of malignancy, although this tends to be lower (1 in 8 patients).

[Medical assessments and measurements in ELSA-Brasil].

PubMed

Mill, Jose Geraldo; Pinto, Karina; Griep, Rosane Härter; Goulart, Alessandra; Foppa, Murilo; Lotufo, Paulo A; Maestri, Marcelo K; Ribeiro, Antonio Luiz; Andreão, Rodrigo Varejão; Dantas, Eduardo Miranda; Oliveira, Ilka; Fuchs, Sandra C; Cunha, Roberto de Sá; Bensenor, Isabela M

2013-06-01

The article describes assessments and measurements performed in the Brazilian Longitudinal Study for Adult Health (ELSA-Brasil). Some assessments including anthropometric assessment, casual blood pressure measurement, and ankle-brachial index have an established clinical application while others including pulse wave velocity, heart rate variability, and carotid intima-media thickness have no established application and do not have reference values for healthy Brazilian population but may be important predictors of cardiovascular outcomes. Blood pressure measurement following postural change maneuver was included in the ELSA-Brasil because it has not been much tested in epidemiological studies. Innovative approaches were developed for assessing the ankle-brachial index using an automatic device instead of the mercury column to measure blood pressure and for assessing the anterior-posterior diameter of the right lobe of the liver by ultrasound for quantitative assessment of nonalcoholic fatty liver disease. All ELSA-Brasil subjects were younger (35 years or more) than those included in other cohorts studying subclinical atherosclerosis. The inclusion of younger individuals and a variety of assessments make the ELSA-Brasil a relevant epidemiology study nationwide and worldwide.

[Ultrasound-guided peripheral catheterization].

PubMed

Salleras-Duran, Laia; Fuentes-Pumarola, Concepció

2016-01-01

Peripheral catheterization is a technique that can be difficult in some patients. Some studies have recently described the use of ultrasound to guide the venous catheterization. To describe the success rate, time required, complications of ultrasound-guided peripheral venous catheterization. and patients and professionals satisfaction The search was performed in databases (Medline-PubMed, Cochrane Library, CINAHL and Cuiden Plus) for studies published about ultrasound-guided peripheral venous catheterization performed on patients that provided results on the success of the technique, complications, time used, patient satisfaction and the type of professional who performed the technique. A total of 21 studies were included. Most of them get a higher success rate 80% in the catheterization ecoguide and time it is not higher than the traditional technique. The Technical complications analyzed were arterial puncture rates and lower nerve 10%. In all studies measuring and comparing patient satisfaction in the art ecoguide is greater. Various professional groups perform the technique. The use of ultrasound for peripheral pipes has a high success rate, complications are rare and the time used is similar to that of the traditional technique. The technique of inserting catheters through ultrasound may be learned by any professional group performing venipuncture. Finally, it gets underscores the high patient satisfaction with the use of this technique. Copyright © 2015 Elsevier España, S.L.U. All rights reserved.

American Medical Society for Sports Medicine (AMSSM) position statement: interventional musculoskeletal ultrasound in sports medicine.

PubMed

Finnoff, Jonathan T; Hall, Mederic M; Adams, Erik; Berkoff, David; Concoff, Andrew L; Dexter, William; Smith, Jay

2015-02-01

The use of diagnostic and interventional ultrasound has significantly increased over the past decade. A majority of the increased utilisation is by non-radiologists. In sports medicine, ultrasound is often used to guide interventions such as aspirations, diagnostic or therapeutic injections, tenotomies, releases and hydrodissections. Critically review the literature related to the accuracy, efficacy and cost-effectiveness of ultrasound-guided injections (USGIs) in major, intermediate and small joints; and soft tissues. Systematic review of the literature. USGIs are more accurate than landmark-guided injections (LMGIs; strength of recommendation taxonomy (SORT) Evidence Rating=A). USGIs are more efficacious than LMGIs (SORT Evidence Rating=B). USGIs are more cost-effective than LMGIs (SORT Evidence Rating=B). Ultrasound guidance is required to perform many new procedures (SORT Evidence Rating=C). The findings of this position statement indicate there is strong evidence that USGIs are more accurate than LMGI, moderate evidence that they are more efficacious and preliminary evidence that they are more cost-effective. Furthermore, ultrasound-guided (USG) is required to perform many new, advanced procedures and will likely enable the development of innovative USG surgical techniques in the future. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Utility and versatility of the supraclavicular artery island flap in head and neck reconstruction.

PubMed

González-García, José A; Chiesa-Estomba, Carlos M; Sistiaga, Jon A; Larruscain, Ekhiñe; Álvarez, Leire; Altuna, Xabier

The supraclavicular island flap is a rotational pedicled flap and may have some advantages in head and neck reconstruction compared with free-tissue transfer when this kind of reconstruction is not affordable or recommended. We present our experience during the year 2016 in the application of the supraclavicular island flap in five cases as an alternative to microvascular reconstruction in several defects after resection of head and neck tumours. In two patients, the flap was used to close the surgical pharyngostoma after total laryngectomy with partial pharyngectomy. In one patient, it was used in lateral facial reconstruction after partial resection of the temporal bone. In one case, it was used to close a skin defect after total laryngectomy with prelaryngeal tissue extension. And in the last case to close a neck skin defect after primary closure of a pharyngo-cutaneous fistula. There were no flap complications, and the result was satisfactory in all cases. The supraclavicular artery island flap is useful and versatile in head and neck reconstruction. Operating room time in aged patients or those with comorbidities will be reduced compared to free flaps. The surgical technique is relatively easy and can be used for skin and mucosal coverage. The supraclavicular island flap could be a recommended option in head and neck reconstruction, its use seems to be increasing and provides a safe and time-saving option to free flaps in selected patients. Copyright © 2017 Elsevier España, S.L.U. and Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello. All rights reserved.

[Contrast-enhanced ultrasound (CEUS) and image fusion for procedures of liver interventions].

PubMed

Jung, E M; Clevert, D A

2018-06-01

Contrast-enhanced ultrasound (CEUS) is becoming increasingly important for the detection and characterization of malignant liver lesions and allows percutaneous treatment when surgery is not possible. Contrast-enhanced ultrasound image fusion with computed tomography (CT) and magnetic resonance imaging (MRI) opens up further options for the targeted investigation of a modified tumor treatment. Ultrasound image fusion offers the potential for real-time imaging and can be combined with other cross-sectional imaging techniques as well as CEUS. With the implementation of ultrasound contrast agents and image fusion, ultrasound has been improved in the detection and characterization of liver lesions in comparison to other cross-sectional imaging techniques. In addition, this method can also be used for intervention procedures. The success rate of fusion-guided biopsies or CEUS-guided tumor ablation lies between 80 and 100% in the literature. Ultrasound-guided image fusion using CT or MRI data, in combination with CEUS, can facilitate diagnosis and therapy follow-up after liver interventions. In addition to the primary applications of image fusion in the diagnosis and treatment of liver lesions, further useful indications can be integrated into daily work. These include, for example, intraoperative and vascular applications as well applications in other organ systems.

Minimally Invasive Ultrasound-Guided Carpal Tunnel Release: Preliminary Clinical Results.

PubMed

Henning, P Troy; Yang, Lynda; Awan, Tariq; Lueders, Daniel; Pourcho, Adam M

2018-04-02

Ultrasound-guided carpal tunnel release was performed on 14 patients (18 wrists) using dynamic expansion of the transverse safe zone. Our patient population included able-bodied patients and those with impairments. The first 8 cases (12 wrists) underwent the procedure in an operating room, the remainder in an outpatient setting. No complications occurred, and all patients were able to immediately resume use of their hands without therapy. Improvements in the Quick Form of the Disabilities of the Arm, Shoulder, and Hand Index and Boston Carpal Tunnel Questionnaire at 3 months were comparable to results reported with mini-open and endoscopic release. Our results show that ultrasound-guided carpal tunnel release can be safely and effectively performed in an outpatient setting. © 2018 by the American Institute of Ultrasound in Medicine.

Propogation loss with frequency of ultrasound guided waves in a composite metal-honeycomb structure

NASA Astrophysics Data System (ADS)

Saxena, Indu F.; Baid, Harsh K.; Guzman, Narciso; Kempen, Lothar U.; Mal, Ajit

2009-05-01

Non-destructive testing of critical structural components is time consuming, while necessary for maintaining safe operation. Large aerospace structures, such as the vertical stabilizers of aircraft undergo inspection at regular intervals for damage diagnostics. However, conventional techniques for damage detection and identification before repair can be scheduled are conducted off-line and therefore can take weeks. The use of guided ultrasound waves is being investigated to expedite damage detection in composites. We measure the frequency dependent loss of ultrasonic guided waves for a structure comprising a boron-nitride composite skin sandwiching an aluminum honeycomb. A wide range of ultrasound frequencies propagate as measured using PZTs, with the lowest attenuation observed about 200-250 kHz. These measurements are confirmed using optical fiber Bragg grating arrays used as ultrasound transducers.

Regeneration of Full-Thickness Rotator Cuff Tendon Tear After Ultrasound-Guided Injection With Umbilical Cord Blood-Derived Mesenchymal Stem Cells in a Rabbit Model.

PubMed

Park, Gi-Young; Kwon, Dong Rak; Lee, Sang Chul

2015-11-01

Rotator cuff tendon tear is one of the most common causes of chronic shoulder pain and disability. In this study, we investigated the therapeutic effects of ultrasound-guided human umbilical cord blood (UCB)-derived mesenchymal stem cell (MSC) injection to regenerate a full-thickness subscapularis tendon tear in a rabbit model by evaluating the gross morphology and histology of the injected tendon and motion analysis of the rabbit's activity. At 4 weeks after ultrasound-guided UCB-derived MSC injection, 7 of the 10 full-thickness subscapularis tendon tears were only partial-thickness tears, and 3 remained full-thickness tendon tears. The tendon tear size and walking capacity at 4 weeks after UCB-derived MSC injection under ultrasound guidance were significantly improved compared with the same parameters immediately after tendon tear. UCB-derived MSC injection under ultrasound guidance without surgical repair or bioscaffold resulted in the partial healing of full-thickness rotator cuff tendon tears in a rabbit model. Histology revealed that UCB-derived MSCs induced regeneration of rotator cuff tendon tear and that the regenerated tissue was predominantly composed of type I collagens. In this study, ultrasound-guided injection of human UCB-derived MSCs contributed to regeneration of the full-thickness rotator cuff tendon tear without surgical repair. The results demonstrate the effectiveness of local injection of MSCs into the rotator cuff tendon. The results of this study suggest that ultrasound-guided umbilical cord blood-derived mesenchymal stem cell injection may be a useful conservative treatment for full-thickness rotator cuff tendon tear repair. ©AlphaMed Press.

Regeneration of Full-Thickness Rotator Cuff Tendon Tear After Ultrasound-Guided Injection With Umbilical Cord Blood-Derived Mesenchymal Stem Cells in a Rabbit Model

PubMed Central

Park, Gi-Young; Lee, Sang Chul

2015-01-01

Rotator cuff tendon tear is one of the most common causes of chronic shoulder pain and disability. In this study, we investigated the therapeutic effects of ultrasound-guided human umbilical cord blood (UCB)-derived mesenchymal stem cell (MSC) injection to regenerate a full-thickness subscapularis tendon tear in a rabbit model by evaluating the gross morphology and histology of the injected tendon and motion analysis of the rabbit’s activity. At 4 weeks after ultrasound-guided UCB-derived MSC injection, 7 of the 10 full-thickness subscapularis tendon tears were only partial-thickness tears, and 3 remained full-thickness tendon tears. The tendon tear size and walking capacity at 4 weeks after UCB-derived MSC injection under ultrasound guidance were significantly improved compared with the same parameters immediately after tendon tear. UCB-derived MSC injection under ultrasound guidance without surgical repair or bioscaffold resulted in the partial healing of full-thickness rotator cuff tendon tears in a rabbit model. Histology revealed that UCB-derived MSCs induced regeneration of rotator cuff tendon tear and that the regenerated tissue was predominantly composed of type I collagens. In this study, ultrasound-guided injection of human UCB-derived MSCs contributed to regeneration of the full-thickness rotator cuff tendon tear without surgical repair. The results demonstrate the effectiveness of local injection of MSCs into the rotator cuff tendon. Significance The results of this study suggest that ultrasound-guided umbilical cord blood-derived mesenchymal stem cell injection may be a useful conservative treatment for full-thickness rotator cuff tendon tear repair. PMID:26371340

Magnetic resonance imaging for detecting root avulsions in traumatic adult brachial plexus injuries: protocol for a systematic review of diagnostic accuracy.

PubMed

Wade, Ryckie G; Takwoingi, Yemisi; Wormald, Justin C R; Ridgway, John P; Tanner, Steven; Rankine, James J; Bourke, Grainne

2018-05-19

Adult brachial plexus injuries (BPI) are becoming more common. The reconstruction and prognosis of pre-ganglionic injuries (root avulsions) are different to other types of BPI injury. Preoperative magnetic resonance imaging (MRI) is being used to identify root avulsions, but the evidence from studies of its diagnostic accuracy are conflicting. Therefore, a systematic review is needed to address uncertainty about the accuracy of MRI and to guide future research. We will conduct a systematic search of electronic databases alongside reference tracking. We will include studies of adults with traumatic BPI which report the accuracy of preoperative MRI (index test) against surgical exploration of the roots of the brachial plexus (reference standard) for detecting either of the two target conditions (any root avulsion or any pseudomeningocoele as a surrogate marker of root avulsion). We will exclude case reports, articles considering bilateral injuries and studies where the number of true positives, false positives, false negatives and true negatives cannot be derived. The methodological quality of the included studies will be assessed using a tailored version of the QUADAS-2 tool. Where possible, a bivariate model will be used for meta-analysis to obtain summary sensitivities and specificities for both target conditions. We will investigate heterogeneity in the performance of MRI according to field strength and the risk of bias if data permits. This review will summarise the current diagnostic accuracy of MRI for adult BPI, identify shortcomings and gaps in the literature and so help to guide future research. PROSPERO CRD42016049702 .

Evaluation of a simplified augmented reality device for ultrasound-guided vascular access in a vascular phantom.

PubMed

Jeon, Yunseok; Choi, Seungpyo; Kim, Heechan

2014-09-01

To investigate whether a novel ultrasound device may be used with a simplified augmented reality technique, and to compare this device with conventional techniques during vascular access using a vascular phantom. Prospective, randomized study. Anesthesiology and Pain Medicine departments of a university-affiliated hospital. 20 physicians with no experience with ultrasound-guided techniques. All participants performed the vascular access technique on the vascular phantom model using both a conventional device and the new ultrasound device. Time and the number of redirections of the needle until aspiration of dye into a vessel of the vascular phantom were measured. The median/interquartile range of time was 39.5/41.7 seconds versus 18.6/10.0 seconds (P < 0.001) and number of redirections was 3/3.5 versus 1/0 (P < 0.001) for the conventional and novel ultrasound devices, respectively. During vascular access in a vascular phantom model, the novel device decreased the time and the number of redirections significantly. The device successfully improved the efficiency of the ultrasound-guided vascular access technique. Copyright © 2014 Elsevier Inc. All rights reserved.

Ultrasound-guided microwave ablation in the treatment of benign thyroid nodules in 435 patients

PubMed Central

Qian, Lin-Xue; Liu, Dong; Zhao, Jun-Feng

2017-01-01

The objective of the present study was to investigate the effectiveness and safety of ultrasound-guided microwave ablation in the treatment of benign thyroid nodules. A total of 474 benign thyroid nodules in 435 patients who underwent ultrasound-guided microwave ablation from September 2012 to August 2015 were included. Nodule volume and thyroid function were measured before treatment and at 1, 3, 6, and 12 months and subsequently after every 6 months. The nodule volume reduction rate and changes of thyroid function were evaluated. The volume of all thyroid nodules significantly decreased after ultrasound-guided microwave ablation. The average volume was 13.07 ± 0.95 ml before treatment, and 1.14 ± 0.26 ml at 12-months follow-up. The mean volume reduction rate was 90% and the final volume reduction rate was 94%. The volume reduction rate of mainly cystic nodules was significantly higher than that of simple solid and mainly solid nodules (all P < 0.05). The pretreatment volume of nodules was positively correlated with the final volume reduction rate at final follow-up (P = 0.004). No serious complications were observed after treatment. In conclusion, ultrasound-guided microwave ablation is an effective and safe technique for treatment of benign thyroid nodules, and has the potential for clinical applications. Impact statement Ultrasound-guided MWA is an effective and safe technique for the treatment of benign thyroid nodules. It can significantly reduce the nodule volume, improve the patients’ clinical symptoms, has less complication, guarantees quick recovery, meets patients' aesthetic needs, and shows less interference on the physiological and psychological aspects of the body. MWA should be a good complement to traditional open surgery and has potentials in clinical applications. PMID:28847173

Ultrasound-guided microwave ablation in the treatment of benign thyroid nodules in 435 patients.

PubMed

Liu, Yu-Jiang; Qian, Lin-Xue; Liu, Dong; Zhao, Jun-Feng

2017-09-01

The objective of the present study was to investigate the effectiveness and safety of ultrasound-guided microwave ablation in the treatment of benign thyroid nodules. A total of 474 benign thyroid nodules in 435 patients who underwent ultrasound-guided microwave ablation from September 2012 to August 2015 were included. Nodule volume and thyroid function were measured before treatment and at 1, 3, 6, and 12 months and subsequently after every 6 months. The nodule volume reduction rate and changes of thyroid function were evaluated. The volume of all thyroid nodules significantly decreased after ultrasound-guided microwave ablation. The average volume was 13.07 ± 0.95 ml before treatment, and 1.14 ± 0.26 ml at 12-months follow-up. The mean volume reduction rate was 90% and the final volume reduction rate was 94%. The volume reduction rate of mainly cystic nodules was significantly higher than that of simple solid and mainly solid nodules (all P < 0.05). The pretreatment volume of nodules was positively correlated with the final volume reduction rate at final follow-up ( P = 0.004). No serious complications were observed after treatment. In conclusion, ultrasound-guided microwave ablation is an effective and safe technique for treatment of benign thyroid nodules, and has the potential for clinical applications. Impact statement Ultrasound-guided MWA is an effective and safe technique for the treatment of benign thyroid nodules. It can significantly reduce the nodule volume, improve the patients' clinical symptoms, has less complication, guarantees quick recovery, meets patients' aesthetic needs, and shows less interference on the physiological and psychological aspects of the body. MWA should be a good complement to traditional open surgery and has potentials in clinical applications.

Ultrasound-guided synovial Tru-cut biopsy: indications, technique, and outcome in 111 cases.

PubMed

Sitt, Jacqueline C M; Griffith, James F; Lai, Fernand M; Hui, Mamie; Chiu, K H; Lee, Ryan K L; Ng, Alex W H; Leung, Jason

2017-05-01

To investigate the diagnostic performance of ultrasound-guided synovial biopsy. Clinical notes, pathology and microbiology reports, ultrasound and other imaging studies of 100 patients who underwent 111 ultrasound-guided synovial biopsies were reviewed. Biopsies were compared with the final clinical diagnosis established after synovectomy (n = 43) or clinical/imaging follow-up (n = 57) (mean 30 months). Other than a single vasovagal episode, no complication of synovial biopsy was encountered. One hundred and seven (96 %) of the 111 biopsies yielded synovium histologically. Pathology ± microbiology findings for these 107 conclusive biopsies comprised synovial tumour (n = 30, 28 %), synovial infection (n = 18, 17 %), synovial inflammation (n = 45, 42 %), including gouty arthritis (n = 3), and no abnormality (n = 14, 13 %). The accuracy, sensitivity, and specificity of synovial biopsy was 99 %, 97 %, and 100 % for synovial tumour; 100 %, 100 %, and 100 % for native joint infection; and 78 %, 45 %, and 100 % for prosthetic joint infection. False-negative synovial biopsy did not seem to be related to antibiotic therapy. Ultrasound-guided Tru-cut synovial biopsy is a safe and reliable technique with a high diagnostic yield for diagnosing synovial tumour and also, most likely, for joint infection. Regarding joint infection, synovial biopsy of native joints seems to have a higher diagnostic yield than that for infected prosthetic joints. • Ultrasound-guided Tru-cut synovial biopsy has high accuracy (99 %) for diagnosing synovial tumour. • It has good accuracy, sensitivity, and high specificity for diagnosis of joint infection. • Synovial biopsy of native joints works better than biopsy of prosthetic joints. • A negative synovial biopsy culture from a native joint largely excludes septic arthritis. • Ultrasound-guided Tru-cut synovial biopsy is a safe and well-tolerated procedure.

3D ultrasound imaging in image-guided intervention.

PubMed

Fenster, Aaron; Bax, Jeff; Neshat, Hamid; Cool, Derek; Kakani, Nirmal; Romagnoli, Cesare

2014-01-01

Ultrasound imaging is used extensively in diagnosis and image-guidance for interventions of human diseases. However, conventional 2D ultrasound suffers from limitations since it can only provide 2D images of 3-dimensional structures in the body. Thus, measurement of organ size is variable, and guidance of interventions is limited, as the physician is required to mentally reconstruct the 3-dimensional anatomy using 2D views. Over the past 20 years, a number of 3-dimensional ultrasound imaging approaches have been developed. We have developed an approach that is based on a mechanical mechanism to move any conventional ultrasound transducer while 2D images are collected rapidly and reconstructed into a 3D image. In this presentation, 3D ultrasound imaging approaches will be described for use in image-guided interventions.

A Randomized Double-Blinded Trial on the Effects of Ultrasound Transducer Orientation on Teaching and Learning Ultrasound-Guided Regional Anesthesia.

PubMed

Lam, Nicholas C K; Baker, Elizabeth B; Fishburn, Steven J; Hammer, Angie R; Petersen, Timothy R; Mariano, Edward R

2016-07-01

Learning ultrasound-guided regional anesthesia skills, especially needle/ beam alignment, can be especially difficulty for trainees, who can often become frustrated. We hypothesized that teaching novices to orient the transducer and needle perpendicular to their shoulders will improve performance on a standardized task, compared to holding the transducer and needle parallel to the shoulders. This study compared the effects of transducer orientation on trainees' ability to complete a standardized ultrasound-guided nerve block simulation. The time to task completion and percentage of the attempt time without adequate needle visualization were measured. Participants were right-handed healthy adults with no previous ultrasound experience and were randomly assigned to training in either transducer and needle alignment in a coronal plane, parallel to the shoulders (parallel group) or transducer and needle alignment in a sagittal plane, perpendicular to the shoulders (perpendicular group). Participants used ultrasound to direct a needle to 3 targets in a standardized gelatin phantom and repeated this task 3 times. Their efforts were timed and evaluated by an assessor, who was blinded to group assignment. Data were analyzed on 28 participants. The perpendicular group was able to complete the task more quickly (P < .001) and with a smaller proportion of time lost to inadequate needle visualization (P < .001). Ultrasound-guided regional anesthesia trainees complete a standardized task more quickly and efficiently when instructed to hold the transducer and needle in an orientation perpendicular to their shoulders.

[An easy, safe and affective method for the treatment of intussusception: ultrasound-guided hydrostatic reduction].

PubMed

Ülger, Fatma Esra Bahadır; Ülger, Aykut; Karakaya, Ali Erdal; Tüten, Fatih; Katı, Ömer; Çolak, Mustafa

2014-03-01

Intussusception is one of the important causes of intestinal obstruction in children. Hydrostatic reduction under ultrasound guidance is a popular treatment method for intussusception. In the present study, we aimed to explain the demographic characteristics of and treatment approaches in patients diagnosed with intussusception by ultrasound. Forty-one patients diagnosed with intussusception by ultrasound between August 2011 and May 2013 were retrospectively analyzed. Twenty-four of these patients who had no contraindications had been treated with ultrasound-guided hydrostatic reduction. Twenty-four of the patients were male and 17 were female, a 1.4/1 male-to-female ratio. The majority of the patients were between the ages of 6-24 months and 2-5 years. The mean age was 31.12±26.32 months (range 3-125). Patients were more frequently diagnosed in April and May. Seventeen patients who had clinical contraindications enrolled directly for surgery. In 20 of the 24 patients who underwent ultrasound-guided hydrostatic reduction, reduction was achieved. Three experienced recurrence. In two of these patients, successful reduction was achieved with the second attempt. The remaining patient was enrolled for surgery. Hydrostatic reduction was performed 26 times on these 24 patients, and in 22, success was achieved (84.6%). No procedure-related complications occurred in the patients. Ultrasound-guided hydrostatic reduction, with its high success rates and lack of radiation risk, should be the first choice therapeutic approach for children diagnosed with intussusception.

Brachial Artery Responses to Ambient Pollution, Temperature, and Humidity in People with Type 2 Diabetes: A Repeated-Measures Study

PubMed Central

Luttmann-Gibson, Heike; Horton, Edward S.; Cohen, Allison; Coull, Brent A.; Hoffmann, Barbara; Schwartz, Joel D.; Mittleman, Murray A.; Li, Yongsheng; Stone, Peter H.; de Souza, Celine; Lamparello, Brooke; Koutrakis, Petros; Gold, Diane R.

2014-01-01

Background: Extreme weather and air pollution are associated with increased cardiovascular risk in people with diabetes. Objectives: In a population with diabetes, we conducted a novel assessment of vascular brachial artery responses both to ambient pollution and to weather (temperature and water vapor pressure, a measure of humidity). Methods: Sixty-four 49- to 85-year-old Boston residents with type 2 diabetes completed up to five study visits (279 repeated measures). Brachial artery diameter (BAD) was measured by ultrasound before and after brachial artery occlusion [i.e., flow-mediated dilation (FMD)] and before and after nitroglycerin-mediated dilation (NMD). Ambient concentrations of fine particulate mass (PM2.5), black carbon (BC), organic carbon (OC), elemental carbon, particle number, and sulfate were measured at our monitoring site; ambient concentrations of carbon monoxide, nitrogen dioxide, and ozone were obtained from state monitors. Particle exposure in the home and during each trip to the clinic (home/trip exposure) was measured continuously and as a 5-day integrated sample. We used linear models with fixed effects for participants, adjusting for date, season, temperature, and water vapor pressure on the day of each visit, to estimate associations between our outcomes and interquartile range increases in exposure. Results: Baseline BAD was negatively associated with particle pollution, including home/trip–integrated BC (–0.02 mm; 95% CI: –0.04, –0.003, for a 0.28 μg/m3 increase in BC), OC (–0.08 mm; 95% CI: –0.14, –0.03, for a 1.61 μg/m3 increase) as well as PM2.5, 5-day average ambient PM2.5, and BC. BAD was positively associated with ambient temperature and water vapor pressure. However, exposures were not consistently associated with FMD or NMD. Conclusion: Brachial artery diameter, a predictor of cardiovascular risk, decreased in association with particle pollution and increased in association with ambient temperature in our study population of adults with type 2 diabetes. Citation: Zanobetti A, Luttmann-Gibson H, Horton ES, Cohen A, Coull BA, Hoffmann B, Schwartz JD, Mittleman MA, Li Y, Stone PH, de Souza C, Lamparello B, Koutrakis P, Gold DR. 2014. Brachial artery responses to ambient pollution, temperature, and humidity in people with type 2 diabetes: a repeated-measures study. Environ Health Perspect 122:242–248; http://dx.doi.org/10.1289/ehp.1206136 PMID:24398072

Pregnancies following ultrasound-guided drainage of tubo-ovarian abscess.

PubMed

Gjelland, Knut; Granberg, Seth; Kiserud, Torvid; Wentzel-Larsen, Tore; Ekerhovd, Erling

2012-07-01

To study fertility among women treated by means of ultrasound-guided drainage and antibiotics for tubo-ovarian abscess (TOA). Retrospective cohort study. A tertiary referral center. One hundred women of reproductive age treated for TOA between June 1986 and July 2003. Transvaginal ultrasound-guided drainage of TOA was performed in all patients. The procedure was repeated if a substantial amount of pus was seen using ultrasonography 2-5 days after the initial aspiration, and repeated later if necessary. Frequency of naturally conceived pregnancies. Twenty of 38 (52.6%; 95% CI 36.5-68.9%) women who intended to have a child achieved pregnancy naturally and became mothers. In addition, 7 (50%) of 14 women who were not on birth control on a regular basis became pregnant. No ectopic pregnancies were registered. Ultrasound-guided drainage of TOA in combination with antibiotics seems to preserve fertility in approximately half of the patients. Copyright © 2012 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

Effectiveness of ultrasound-guided injections combined with shoulder exercises in the treatment of subacromial adhesive bursitis.

PubMed

Gasparre, Giuseppe; Fusaro, Isabella; Galletti, Stefano; Volini, Silvia; Benedetti, Maria Grazia

2012-05-01

The aim of this study was to evaluate whether the association of exercises for the shoulder with ultrasound-guided injection into the bursa significantly improves the treatment outcome in adhesive bursitis. Two groups of 35 patients, one treated with ultrasound-guided injection (UGI) and the other one with ultrasound-guided injection and home exercise program (UGI-exercise) for 1 month, were assessed for pain and shoulder function before treatment, 1 and 3 months post-treatment. Fourteen patients in UGI group and 23 patients in the UGI-exercises group were completely free of pain after 1 month (p = 0.031). At 3 months' follow-up, patients in the UGI-exercise group showed a significant improvement with respect to the other group (p = 0.005). No differences were found in function assessment. The UGI combined with shoulder exercises in the treatment of subacromial adhesive bursitis is effective to ensure a more frequent complete pain relief in the medium term.

B-Mode ultrasound pose recovery via surgical fiducial segmentation and tracking

NASA Astrophysics Data System (ADS)

Asoni, Alessandro; Ketcha, Michael; Kuo, Nathanael; Chen, Lei; Boctor, Emad; Coon, Devin; Prince, Jerry L.

2015-03-01

Ultrasound Doppler imaging may be used to detect blood clots after surgery, a common problem. However, this requires consistent probe positioning over multiple time instances and therefore significant sonographic expertise. Analysis of ultrasound B-mode images of a fiducial implanted at the surgical site offers a landmark to guide a user to the same location repeatedly. We demonstrate that such an implanted fiducial may be successfully detected and tracked to calculate pose and guide a clinician consistently to the site of surgery, potentially reducing the ultrasound experience required for point of care monitoring.

Molecular Endoscopic Ultrasound for Diagnosis of Pancreatic Cancer

PubMed Central

Bournet, Barbara; Pointreau, Adeline; Delpu, Yannick; Selves, Janick; Torrisani, Jerome; Buscail, Louis; Cordelier, Pierre

2011-01-01

Endoscopic ultrasound-guided fine needle aspiration-biopsy is a safe and effective technique in diagnosing and staging of pancreatic ductal adenocarcinoma. However its predictive negative value does not exceed 50% to 60%. Unfortunately, the majority of pancreatic cancer patients have a metastatic and/or a locally advanced disease (i.e., not eligible for curative resection) which explains the limited access to pancreatic tissue specimens. Endoscopic ultrasound-guided fine needle aspiration-biopsy is the most widely used approach for cytological and histological material sampling in these situations used in up to two thirds of patients with pancreatic cancer. Based on this unique material, we and others developed strategies to improve the differential diagnosis between carcinoma and inflammatory pancreatic lesions by analysis of KRAS oncogene mutation, microRNA expression and methylation, as well as mRNA expression using both qRT-PCR and Low Density Array Taqman analysis. Indeed, differentiating pancreatic cancer from pseudotumoral chronic pancreatitis remains very difficult in current clinical practice, and endoscopic ultrasound-guided fine needle aspiration-biopsy analysis proved to be very helpful. In this review, we will compile the clinical and molecular advantages of using endoscopic ultrasound-guided fine needle aspiration-biopsy in managing pancreatic cancer. PMID:24212643

Teaching medical students ultrasound-guided vascular access - which learning method is best?

PubMed

Lian, Alwin; Rippey, James C R; Carr, Peter J

2017-05-15

Ultrasound is recommended to guide insertion of peripheral intravenous vascular cannulae (PIVC) where difficulty is experienced. Ultrasound machines are now common-place and junior doctors are often expected to be able to use them. The educational standards for this skill are highly varied, ranging from no education, to self-guided internet-based education, to formal, face-to-face traditional education. In an attempt to decide which educational technique our institution should introduce, a small pilot trial comparing educational techniques was designed. Thirty medical students were enrolled and allocated to one of three groups. PIVC placing ability was then observed, tested and graded on vascular access phantoms. The formal, face-to-face traditional education was rated best by the students, and had the highest success rate in PIVC placement, the improvement statistically significant compared to no education (p = 0.01) and trending towards significance when compared to self-directed internet-based education (p<0.06). The group receiving traditional face-to-face teaching on ultrasound-guided vascular access, performed significantly better than those not receiving education. As the number of ultrasound machines in clinical areas increases, it is important that education programs to support their safe and appropriate use are developed.

Comparison of a GPS needle-tracking system, multiplanar imaging and 2D imaging for real-time ultrasound-guided epidural anaesthesia: A randomized, comparative, observer-blinded study on phantoms.

PubMed

Menacé, Cécilia; Choquet, Olivier; Abbal, Bertrand; Bringuier, Sophie; Capdevila, Xavier

2017-04-01

The real-time ultrasound-guided paramedian sagittal oblique approach for neuraxial blockade is technically demanding. Innovative technologies have been developed to improve nerve identification and the accuracy of needle placement. The aim of this study was to evaluate three types of ultrasound scans during ultrasound-guided epidural lumbar punctures in a spine phantom. Eleven sets of 20 ultrasound-guided epidural punctures were performed with 2D, GPS, and multiplanar ultrasound machines (660 punctures) on a spine phantom using an in-plane approach. For all punctures, execution time, number of attempts, bone contacts, and needle redirections were noted by an independent physician. Operator comfort and visibility of the needle (tip and shaft) were measured using a numerical scale. The use of GPS significantly decreased the number of punctures, needle repositionings, and bone contacts. Comfort of the physician was also significantly improved with the GPS system compared with the 2D and multiplanar systems. With the multiplanar system, the procedure was not facilitated and execution time was longer compared with 2D imaging after Bonferroni correction but interaction between the type of ultrasound system and mean execution time was not significant in a linear mixed model. There were no significant differences regarding needle tip and shaft visibility between the systems. Multiplanar and GPS needle-tracking systems do not reduce execution time compared with 2D imaging using a real-time ultrasound-guided paramedian sagittal oblique approach in spine phantoms. The GPS needle-tracking system can improve performance in terms of operator comfort, the number of attempts, needle redirections and bone contacts. Copyright © 2016 Société française d'anesthésie et de réanimation (Sfar). Published by Elsevier Masson SAS. All rights reserved.

Evaluating the functional outcomes of ultrasound-guided botulinum toxin type A injections using the Euro-musculus approach for upper limb spasticity treatment in post-stroke patients; an observational study.

PubMed

Buyukavci, Raikan; Akturk, Semra; Ersoy, Yüksel

2018-02-07

Ultrasound-guided botulinum toxin type A injection is an effective treatment for spasticity. Euro-musculus spasticity approach is a new method for administering injections to the correct point of the correct muscle. The clinical outcomes of this practical approach is not yet available in the literature. The purpose of this study was to evaluate the effects on spasticity and the functional outcomes of ultrasound guided botulinum toxin type A injections via the Euro-musculus spasticity approach to treat upper limb spasticity in post-stroke patients. An observational study. Inpatient post-stroke patients. Twenty five post-stroke patients with post-stroke upper limb spasticity were recruited. The ultrasound-guided botulinum toxin type A injections were administered into the spastic target muscles using the Euro-musculus spasticity approach, and all of the patients were enrolled in rehabilitation programmes after the injections. This research included the innervation zone and injection site figures and ultrasound images of each muscle in the upper limb. The degree of spasticity was assessed via the Modified Ashworth Scale and the upper limb motor function via the Fugl Meyer Upper Extremity Scale at the baseline and 4 and 12 weeks after the botulinum toxin type A injection. Significant decreases in the Modified Ashworth Scale scores of the upper limb flexor muscle tone measured 4 and 12 weeks after the botulinum toxin type A injection were found when compared to the baseline scores (p<0.025). When compared with the baseline Fugl Meyer Upper Extremity subgroup scores, the sitting position, wrist and total scores at 4 and 12 weeks were significantly improved (p<0.025). However, only the Fugl Meyer Upper Extremity hand scores were significantly improved 12 weeks after the injection (p<0.025). Ultrasound-guided botulinum toxin type A injection via the Euro- musculus spasticity approach is a practical and effective method for administering injections to the correct point of the correct muscle. Ultrasound-guided botulinum toxin type A injections combined with rehabilitation programmes decrease spasticity and improve the upper extremity motor functions in stroke patients. This new approach for ultrasound- guided botulinum toxin type A injection is very practical and effective method for upper extremity spasticity.

Ultrasound Guidance and Monitoring of Laser-Based Fat Removal

PubMed Central

Shah, Jignesh; Thomsen, Sharon; Milner, Thomas E.; Emelianov, Stanislav Y.

2009-01-01

Background and Objectives We report on a study to investigate feasibility of utilizing ultrasound imaging to guide laser removal of subcutaneous fat. Ultrasound imaging can be used to identify the tissue composition and to monitor the temperature increase in response to laser irradiation. Study Design/Materials and Methods Laser heating was performed on ex vivo porcine subcutaneous fat through the overlying skin using a continuous wave laser operating at 1,210 nm optical wavelength. Ultrasound images were recorded using a 10 MHz linear array-based ultrasound imaging system. Results Ultrasound imaging was utilized to differentiate between water-based and lipid-based regions within the porcine tissue and to identify the dermis-fat junction. Temperature maps during the laser exposure in the skin and fatty tissue layers were computed. Conclusions Results of our study demonstrate the potential of using ultrasound imaging to guide laser fat removal. PMID:19065554

[Percutaneous renal puncture guide by a novel real-time needle-tracking ultrasound system for percutaneous nephrolithotomy: analysis of 16 cases].

PubMed

Ma, Kai; Huang, Xiao-bo; Xiong, Liu-lin; Xu, Qing-quan; Xu, Tao; Ye, Hai-yun; Yu, Lu-ping; Wang, Xiao-feng

2014-08-18

To evaluate the feasibility and efficacy of percutaneous renal puncture in percutaneous nephrolithotomy guided by novel needle-tracking ultrasound system. From may to october 2013, 16 cases of percutaneous nephrolithotomy were performed under the guidance of ultrasound system. The clinical data including the time of completing percutaneous renal puncture, the color of urine sucked out from the kidney calices, and the complications were analyzed retrospectively. Of the 16 patients, 18 percutaneous renal access were established guided by ultrasound system. All of them were successtul for the first time, and the average time of completing percutaneous renal punctures was (26.90 ± 11.37) s (15 to 54 s). After the operation, the hemoglobin decreased by (9.56 ± 5.27)%(1.41% to 24.06%), and no complications occurred except for postoperative fever in 2 case. The novel ultrasound system is a safe and effective technique that can reduce the technical difficulty of percutaneous renal puncture in percutaneous nephrolithotomy.

Anaesthetics, steroids and platelet-rich plasma (PRP) in ultrasound-guided musculoskeletal procedures

PubMed Central

La Marra, Alice; Arrigoni, Francesco; Mariani, Silvia; Zugaro, Luigi; Splendiani, Alessandra; Di Cesare, Ernesto; Reginelli, Alfonso; Zappia, Marcello; Brunese, Luca; Duka, Ejona; Carrafiello, Giampaolo; Masciocchi, Carlo

2016-01-01

This review aims to evaluate the role of anaesthetics, steroids and platelet-rich plasma (PRP) employed with ultrasound-guided injection in the management of musculoskeletal pathology of the extremities. Ultrasound-guided injection represents an interesting and minimally invasive solution for the treatment of tendon and joint inflammatory or degenerative diseases. The availability of a variety of new drugs such as hyaluronic acid and PRP provides expansion of the indications and therapeutic possibilities. The clinical results obtained in terms of pain reduction and functional recovery suggest that the use of infiltrative procedures can be a good therapeutic alternative in degenerative and inflammatory joint diseases. PMID:27302491

Anaesthetics, steroids and platelet-rich plasma (PRP) in ultrasound-guided musculoskeletal procedures.

PubMed

Barile, Antonio; La Marra, Alice; Arrigoni, Francesco; Mariani, Silvia; Zugaro, Luigi; Splendiani, Alessandra; Di Cesare, Ernesto; Reginelli, Alfonso; Zappia, Marcello; Brunese, Luca; Duka, Ejona; Carrafiello, Giampaolo; Masciocchi, Carlo

2016-09-01

This review aims to evaluate the role of anaesthetics, steroids and platelet-rich plasma (PRP) employed with ultrasound-guided injection in the management of musculoskeletal pathology of the extremities. Ultrasound-guided injection represents an interesting and minimally invasive solution for the treatment of tendon and joint inflammatory or degenerative diseases. The availability of a variety of new drugs such as hyaluronic acid and PRP provides expansion of the indications and therapeutic possibilities. The clinical results obtained in terms of pain reduction and functional recovery suggest that the use of infiltrative procedures can be a good therapeutic alternative in degenerative and inflammatory joint diseases.

In-line positioning of ultrasound images using wireless remote display system with tablet computer facilitates ultrasound-guided radial artery catheterization.

PubMed

Tsuchiya, Masahiko; Mizutani, Koh; Funai, Yusuke; Nakamoto, Tatsuo

2016-02-01

Ultrasound-guided procedures may be easier to perform when the operator's eye axis, needle puncture site, and ultrasound image display form a straight line in the puncture direction. However, such methods have not been well tested in clinical settings because that arrangement is often impossible due to limited space in the operating room. We developed a wireless remote display system for ultrasound devices using a tablet computer (iPad Mini), which allows easy display of images at nearly any location chosen by the operator. We hypothesized that the in-line layout of ultrasound images provided by this system would allow for secure and quick catheterization of the radial artery. We enrolled first-year medical interns (n = 20) who had no prior experience with ultrasound-guided radial artery catheterization to perform that using a short-axis out-of-plane approach with two different methods. With the conventional method, only the ultrasound machine placed at the side of the head of the patient across the targeted forearm was utilized. With the tablet method, the ultrasound images were displayed on an iPad Mini positioned on the arm in alignment with the operator's eye axis and needle puncture direction. The success rate and time required for catheterization were compared between the two methods. Success rate was significantly higher (100 vs. 70 %, P = 0.02) and catheterization time significantly shorter (28.5 ± 7.5 vs. 68.2 ± 14.3 s, P < 0.001) with the tablet method as compared to the conventional method. An ergonomic straight arrangement of the image display is crucial for successful and quick completion of ultrasound-guided arterial catheterization. The present remote display system is a practical method for providing such an arrangement.

Comparison of Stereotactic and Ultrasound-guided Biopsy of Solid Supratentorial Tumor: A Preliminary Report

PubMed Central

Satyarthee, Guru Dutta; Chandra, P. Sarat; Sharma, Bhawani S.; Mehta, V. S.

2017-01-01

Introduction: The computed tomography (CT) guided stereotactic biopsy (STB) is considered as method of choice for biopsy of intracranial mass lesions. However, it's disadvantages are frame fixation, time requirement for transportation between CT scan suit to the operation theater with added much higher equipment cost in the relatively resource scarred developing country. Ultrasound-guided biopsy (USGB) is relatively simpler, economical, less time consuming, and real-time procedure. Clinical Materials and Methods: Thirty-seven consecutively admitted patients with supratentorial brain tumors, who underwent biopsy of the lesion using CT compatible stereotactic and ultrasound-guided (USGB) procedure formed cohort of the study. Based on location and size of the lesions, the cases were divided into two groups, superficial and deep. Twenty-two patients underwent ultrasound-guided biopsy and 15 with STB. Results: The diagnostic yield of STB was 93% and 91% for ultrasound-guided biopsy. The mean operation time of STB group was 149.00 min and 94 min for USGB, which was statistically significant. Two cases in each group developed hematoma; however, one case in USGB group needed surgical evacuation. The real-time monitoring detected two hematoma intraoperatively, which were further also confirmed on postoperative CT scan head. Conclusions: The ultrasound-guided biopsy procedure (USGB) was simple, relatively shorter time-consuming procedure and equally efficacious and utilizing economical equipment and can act as a safer alternative to CT STB process for biopsy of the intracranial mass lesion. Furthermore, USGB also provided intra-operative real-time monitoring, which provided clue for close monitoring in the postoperative period after completion of biopsy to look for development of fresh hematoma development not only at the biopsy site but also along the biopsy track and adjoining area. Perhaps, a longer period of ultrasonic monitoring following the procedure would be of greater help to detect hematoma formation, which is one of the most common complications of the biopsy procedure. PMID:29114280

Use of Lymph Node Ultrasound Prior to Sentinel Lymph Node Biopsy in 384 Patients with Melanoma: A Cost-Effectiveness Analysis.

PubMed

Olmedo, D; Brotons-Seguí, M; Del Toro, C; González, M; Requena, C; Traves, V; Pla, A; Bolumar, I; Moreno-Ramírez, D; Nagore, E

2017-12-01

Locoregional lymph node ultrasound is not typically included in guidelines as part of the staging process prior to sentinel lymph node biopsy (SLNB). The objective of the present study was to make a clinical and economic analysis of lymph node ultrasound prior to SLNB. We performed a retrospective study of 384 patients with clinical stage I-II primary melanoma who underwent locorregional lymph node ultrasound (with or without ultrasound-guided biopsy) prior to SLNB between 2004 and 2015. We evaluated the reliability and cost-effectiveness of the strategy. Use of locorregional lymph node ultrasound avoided SLNB in 23 patients (6%). Ultrasound had a sensitivity of 46% and specificity of 76% for the detection of metastatic lymph nodes that were not clinically palpable. False negatives were significantly more common in patients aged over 60 years and in tumors with a thickness of less than 2mm. The staging process using SLNB and ultrasound with ultrasound-guided biopsy produced an increase of €16.30 in the unit price. Our cost-effectiveness analysis identified the staging protocol with ultrasound and SLNB as the dominant strategy, with a lower cost-effectiveness ratio than the alternative, consisting of SLNB alone (8,095.24 vs. €28,605.00). Ultrasound with ultrasound-guided biopsy for the diagnostic staging of melanoma prior to SLNB is a useful and cost-effective tool. This procedure does not substitute SLNB, though it does allow to avoid SLNB in a not insignificant proportion of patients. Copyright © 2017 AEDV. Publicado por Elsevier España, S.L.U. All rights reserved.

12th WINFOCUS world congress on ultrasound in emergency and critical care.

PubMed

Acar, Yahya; Tezel, Onur; Salman, Necati; Cevik, Erdem; Algaba-Montes, Margarita; Oviedo-García, Alberto; Patricio-Bordomás, Mayra; Mahmoud, Mustafa Z; Sulieman, Abdelmoneim; Ali, Abbas; Mustafa, Alrayah; Abdelrahman, Ihab; Bahar, Mustafa; Ali, Osama; Lester Kirchner, H; Prosen, Gregor; Anzic, Ajda; Leeson, Paul; Bahreini, Maryam; Rasooli, Fatemeh; Hosseinnejad, Houman; Blecher, Gabriel; Meek, Robert; Egerton-Warburton, Diana; Ćuti, Edina Ćatić; Belina, Stanko; Vančina, Tihomir; Kovačević, Idriz; Rustemović, Nadan; Chang, Ikwan; Lee, Jin Hee; Kwak, Young Ho; Kim, Do Kyun; Cheng, Chi-Yung; Pan, Hsiu-Yung; Kung, Chia-Te; Ćurčić, Ela; Pritišanac, Ena; Planinc, Ivo; Medić, Marijana Grgić; Radonić, Radovan; Fasina, Abiola; Dean, Anthony J; Panebianco, Nova L; Henwood, Patricia S; Fochi, Oliviero; Favarato, Moreno; Bonanomi, Ezio; Tomić, Ivan; Ha, Youngrock; Toh, Hongchuen; Harmon, Elizabeth; Chan, Wilma; Baston, Cameron; Morrison, Gail; Shofer, Frances; Hua, Angela; Kim, Sharon; Tsung, James; Gunaydin, Isa; Kekec, Zeynep; Ay, Mehmet Oguzhan; Kim, Jinjoo; Kim, Jinhyun; Choi, Gyoosung; Shim, Dowon; Lee, Ji-Han; Ambrozic, Jana; Prokselj, Katja; Lucovnik, Miha; Simenc, Gabrijela Brzan; Mačiulienė, Asta; Maleckas, Almantas; Kriščiukaitis, Algimantas; Mačiulis, Vytautas; Macas, Andrius; Mohite, Sharad; Narancsik, Zoltan; Možina, Hugon; Nikolić, Sara; Hansel, Jan; Petrovčič, Rok; Mršić, Una; Orlob, Simon; Lerchbaumer, Markus; Schönegger, Niklas; Kaufmann, Reinhard; Pan, Chun-I; Wu, Chien-Hung; Pasquale, Sarah; Doniger, Stephanie J; Yellin, Sharon; Chiricolo, Gerardo; Potisek, Maja; Drnovšek, Borut; Leskovar, Boštjan; Robinson, Kristine; Kraft, Clara; Moser, Benjamin; Davis, Stephen; Layman, Shelley; Sayeed, Yusef; Minardi, Joseph; Pasic, Irmina Sefic; Dzananovic, Amra; Pasic, Anes; Zubovic, Sandra Vegar; Hauptman, Ana Godan; Brajkovic, Ana Vujaklija; Babel, Jaksa; Peklic, Marina; Radonic, Vedran; Bielen, Luka; Ming, Peh Wee; Yezid, Nur Hafiza; Mohammed, Fatahul Laham; Huda, Zainal Abidin; Ismail, Wan Nasarudin Wan; Isa, W Yus Haniff W; Fauzi, Hashairi; Seeva, Praveena; Mazlan, Mohd Zulfakar

2016-09-01

A1 Point-of-care ultrasound examination of cervical spine in emergency departmentYahya Acar, Onur Tezel, Necati SalmanA2 A new technique in verifying the placement of a nasogastric tube: obtaining the longitudinal view of nasogastric tube in addition to transverse view with ultrasoundYahya Acar, Necati Salman, Onur Tezel, Erdem CevikA3 Pseudoaneurysm of the femoral artery after cannulation of a central venous line. Should we always use ultrasound in these procedures?Margarita Algaba-Montes, Alberto Oviedo-García, Mayra Patricio-BordomásA4 Ultrasound-guided supraclavicular subclavian vein catheterization. A novel approach in emergency departmentMargarita Algaba-Montes, Alberto Oviedo-García, Mayra Patricio-BordomásA5 Clinical ultrasound in a septic and jaundice patient in the emergency departmentMargarita Algaba-Montes, Alberto Oviedo-García, Mayra Patricio-BordomásA6 Characterization of the eyes in preoperative cataract Saudi patients by using medical diagnostic ultrasoundMustafa Z. Mahmoud, Abdelmoneim SuliemanA7 High-frequency ultrasound in determining the causes of acute shoulder joint painMustafa Z. MahmoudA8 Teaching WINFOCUS Ultrasound Life Support Basic Level 1 for Providers in resource-limited countriesAbbas Ali, Alrayah Mustafa, Ihab Abdelrahman, Mustafa Bahar, Osama Ali, H. Lester Kirchner, Gregor ProsenA9 Changes of arterial stiffness and endothelial function during uncomplicated pregnancyAjda Anzic, Paul LeesonA10 Cardiovascular haemodynamic properties before, during and after pregnancyAjda Anzic, Paul LeesonA11 An old man with generalized weaknessMaryam Bahreini, Fatemeh RasooliA12 Ultrasonography for non-specific presentations of abdominal painMaryam Bahreini, Houman HosseinnejadA13 Introduction of a new imaging guideline for suspected renal colic in the emergency department: effect on CT Urogram utilisationGabriel Blecher, Robert Meek, Diana Egerton-WarburtonA14 Transabdominal ultrasound screening for pancreatic cancer in Croatian military veterans: a retrospective analysis from the first Croatian veteran's hospitalEdina Ćatić Ćuti, Stanko Belina, Tihomir Vančina, Idriz KovačevićA15 The challenge of AAA: unusual case of obstructive jaundiceEdina Ćatić Ćuti, Nadan RustemovićA16 Educational effectiveness of easy-made new simulator model for ultrasound-guided procedures in pediatric patients: vascular access and foreign body managementIkwan Chang, Jin Hee Lee, Young Ho Kwak, Do Kyun KimA17 Detection of uterine rupture by point-of-care ultrasound at emergency department: a case reportChi-Yung Cheng, Hsiu-Yung Pan, Chia-Te KungA18 Abdominal probe in the hands of interns as a relevant diagnostic tool in revealing the cause of heart failureEla Ćurčić, Ena Pritišanac, Ivo Planinc, Marijana Grgić Medić, Radovan RadonićA19 Needs assessment of the potential utility of point-of-care ultrasound within the Zanzibar health systemAbiola Fasina, Anthony J. Dean, Nova L. Panebianco, Patricia S. HenwoodA20 Ultrasonographic diagnosis of tracheal compressionOliviero Fochi, Moreno Favarato, Ezio BonanomiA21 The role of ultrasound in the detection of lung infiltrates in critically ill patients: a pilot studyMarijana Grgić Medić, Ivan Tomić, Radovan RadonićA22 The SAFER Lasso; a novel approach using point-of-care ultrasound to evaluate patients with abdominal complaints in the emergency departmentYoungrock Ha, Hongchuen TohA23 Awareness and use of clinician-performed ultrasound among clinical clerkship facultyElizabeth Harmon, Wilma Chan, Cameron Baston, Gail Morrison, Frances Shofer, Nova Panebianco, Anthony J. DeanA24 Clinical outcomes in the use of lung ultrasound for the diagnosis of pediatric pneumoniasAngela Hua, Sharon Kim, James TsungA25 Effectiveness of ultrasound in hypotensive patientsIsa Gunaydin, Zeynep Kekec, Mehmet Oguzhan AyA26 Moderate-to-severe left ventricular ejection fraction related to short-term mortality of patients with post-cardiac arrest syndrome after out-of-hospital cardiac arrestJinjoo Kim, Jinhyun Kim, Gyoosung Choi, Dowon ShimA27 Usefulness of abdominal ultrasound for acute pyelonephritis diagnosis after kidney transplantationJi-Han LeeA28 Lung ultrasound for assessing fluid tolerance in severe preeclampsiaJana Ambrozic, Katja Prokselj, Miha LucovnikA29 Optic nerve sheath ultrasound in severe preeclampsiaGabrijela Brzan Simenc, Jana Ambrozic, Miha LucovnikA30 Focused echocardiography monitoring in the postoperative period for non-cardiac patientsAsta Mačiulienė, Almantas Maleckas, Algimantas Kriščiukaitis, Vytautas Mačiulis, Andrius MacasA31 POCUS-guided paediatric upper limb fracture reduction: algorithm, tricks, and tipsSharad MohiteA32 Point-of-care lung ultrasound: a good diagnostic tool for pneumonia in a septic patientZoltan Narancsik, Hugon MožinaA33 A case of undergraduate POCUS (r)evolutionSara Nikolić, Jan Hansel, Rok Petrovčič, Una Mršić, Gregor ProsenA34 The Graz Summer School for ultrasound: from first contact to bedside application: three-and-a-half-day undergraduate ultrasound training: résumé after two years of continuous developmentSimon Orlob, Markus Lerchbaumer, Niklas Schönegger, Reinhard KaufmannA35 Usefulness of point-of-care ultrasound in the emergency room in a patient with acute abdominal painAlberto Oviedo-García, Margarita Algaba-Montes, Mayra Patricio-BordomásA36 Use of bedside ultrasound in a critically ill patient. A case reportAlberto Oviedo-García, Margarita Algaba-Montes, Mayra Patricio-BordomásA37 Diagnostic yield of clinical echocardiography for the emergency physicianAlberto Oviedo-García, Margarita Algaba-Montes, Mayra Patricio-BordomásA38 Focused cardiac ultrasound in early diagnosis of type A aortic dissection with atypical presentationChun-I Pan, Hsiu-Yung Pan, Chien-Hung WuA39 Detection of imperforated hymen by point-of-care ultrasoundHsiu-yung Pan, Chia-Te KungA40 Developing a point-of-care ultrasound curriculum for pediatric nurse practitioners practicing in the pediatric emergency departmentSarah Pasquale, Stephanie J. Doniger, Sharon Yellin, Gerardo ChiricoloA41 Use of transthoracic echocardiography in emergency setting: patient with mitral valve abscessMaja Potisek, Borut Drnovšek, Boštjan LeskovarA42 A young man with syncopeFatemeh Rasooli, Maryam BahreiniA43 Work-related repetitive use injuries in ultrasound fellowsKristine Robinson, Clara Kraft, Benjamin Moser, Stephen Davis, Shelley Layman, Yusef Sayeed, Joseph MinardiA44 Lung ultrasonography in the evaluation of pneumonia in childrenIrmina Sefic Pasic, Amra Dzananovic, Anes Pasic, Sandra Vegar ZubovicA45 Central venous catheter placement with the ultrasound aid: two years' experience of the Interventional unit, Division of Intensive Care Medicine, KBC ZagrebAna Godan Hauptman, Marijana Grgic Medic, Ivan Tomic, Ana Vujaklija Brajkovic, Jaksa Babel, Marina Peklic, Radovan RadonicA46 Duplicitas casui: two patients admitted due to acute liver failureVedran Radonic, Ivan Tomic, Luka Bielen, Marijana Grgic MedicA47 A pilot survey on an understanding of Bedside Point-of-Care Ultrasound (POCUS) among medical doctors in internal medicine: exposure, perceptions, interest, and barriers to trainingPeh Wee MingA48 Unusual case of defecation syncopeNur hafiza Yezid, Fatahul Laham MohammedA49 A case report of massive pulmonary embolism; a multidisciplinary approachZainal Abidin Huda, Wan Nasarudin Wan Ismail, W.Yus Haniff W.Isa, Hashairi Fauzi, Praveena Seeva, Mohd Zulfakar Mazlan.

Real-time computed tomography dosimetry during ultrasound-guided brachytherapy for prostate cancer.

PubMed

Kaplan, Irving D; Meskell, Paul; Oldenburg, Nicklas E; Saltzman, Brian; Kearney, Gary P; Holupka, Edward J

2006-01-01

Ultrasound-guided implantation of permanent radioactive seeds is a treatment option for localized prostate cancer. Several techniques have been described for the optimal placement of the seeds in the prostate during this procedure. Postimplantation dosimetric calculations are performed after the implant. Areas of underdosing can only be corrected with either an external beam boost or by performing a second implant. We demonstrate the feasibility of performing computed tomography (CT)-based postplanning during the ultrasound-guided implant and subsequently correcting for underdosed areas. Ultrasound-guided brachytherapy is performed on a modified CT table with general anesthesia. The postplanning CT scan is performed after the implant, while the patient is still under anesthesia. Additional seeds are implanted into "cold spots," and the resultant dosimetry confirmed with CT. Intraoperative postplanning was successfully performed. Dose-volume histograms demonstrated adequate dose coverage during the initial implant, but on detailed analysis, for some patients, areas of underdosing were observed either at the apex or the peripheral zone. Additional seeds were implanted to bring these areas to prescription dose. Intraoperative postplanning is feasible during ultrasound-guided brachytherapy for prostate cancer. Although the postimplant dose-volume histograms for all patients, before the implantation of additional seeds, were adequate according to the American Brachytherapy Society criteria, specific critical areas can be underdosed. Additional seeds can then be implanted to optimize the dosimetry and reduce the risk of underdosing areas of cancer.

Guided Interventions for Prostate Cancer Using 3D-Transurethral Ultrasound and MRI Fusion

DTIC Science & Technology

2017-06-01

standard transrectal ultrasound (TRUS) probe, a TUUS probe, and MRI. (a) (b) Figure 2: 3D printed prostate phantom mold (a), and pelvis phantom mold...with prostate agar phantom in place (b). The TUUS phantoms were prepared using a standard recipe [ii] for the prostate and the 3D printed mold...AWARD NUMBER: W81XWH-14-1-0461 TITLE: Guided Interventions for Prostate Cancer Using 3D -Transurethral Ultrasound and MRI Fusion PRINCIPAL

The American Society of Regional Anesthesia and Pain Medicine, the European Society of Regional Anaesthesia and Pain Therapy, and the Asian Australasian Federation of Pain Societies Joint Committee recommendations for education and training in ultrasound-guided interventional pain procedures.

PubMed

Narouze, Samer N; Provenzano, David; Peng, Philip; Eichenberger, Urs; Lee, Sang Chul; Nicholls, Barry; Moriggl, Bernhard

2012-01-01

The use of ultrasound in pain medicine for interventional axial, nonaxial, and musculoskeletal pain procedures is rapidly evolving and growing. Because of the lack of specialty-specific guidelines for ultrasonography in pain medicine, an international collaborative effort consisting of members of the Special Interest Group on Ultrasonography in Pain Medicine from the American Society of Regional Anesthesia and Pain Medicine, the European Society of Regional Anaesthesia and Pain Therapy, and the Asian Australasian Federation of Pain Societies developed the following recommendations for education and training in ultrasound-guided interventional pain procedures. The purpose of these recommendations is to define the required skills for performing ultrasound-guided pain procedures, the processes for appropriate education, and training and quality improvement. Training algorithms are outlined for practice- and fellowship-based pathways. The previously published American Society of Regional Anesthesia and Pain Medicine and European Society of Regional Anaesthesia and Pain Therapy education and teaching recommendations for ultrasound-guided regional anesthesia served as a foundation for the pain medicine recommendations. Although the decision to grant ultrasound privileges occurs at the institutional level, the committee recommends that the training guidelines outlined in this document serve as the foundation for educational training and the advancement of the practice of ultrasonography in pain medicine.

Endoscopic ultrasound-guided biliary drainage

PubMed Central

Chavalitdhamrong, Disaya; Draganov, Peter V

2012-01-01

Endoscopic ultrasound (EUS)-guided biliary drainage has emerged as a minimally invasive alternative to percutaneous and surgical interventions for patients with biliary obstruction who had failed endoscopic retrograde cholangiopancreatography (ERCP). EUS-guided biliary drainage has become feasible due to the development of large channel curvilinear therapeutic echo-endoscopes and the use of real-time ultrasound and fluoroscopy imaging in addition to standard ERCP devices and techniques. EUS-guided biliary drainage is an attractive option because of its minimally invasive, single step procedure which provides internal biliary decompression. Multiple investigators have reported high success and low complication rates. Unfortunately, high quality prospective data are still lacking. We provide detailed review of the use of EUS for biliary drainage from the perspective of practicing endoscopists with specific focus on the technical aspects of the procedure. PMID:22363114

Supraclavicular artery perforator flap in management of post-burn neck reconstruction: clinical experience

PubMed Central

Ismail, H.; Elshobaky, A.

2016-01-01

Summary Anterior cervical contractures of the neck represent a great challenge for plastic and reconstructive surgeons. Necks can be reconstructed with a wide range of surgical techniques, including chimeric flaps, supercharged flap, pre-expanded flaps, “superthin” flaps and perforator flaps. The supraclavicular flap is easy to harvest without the need for free tissue transfer. It provides a relatively large flap for neck resurfacing with tissue very similar to that of the neck. Between January 2013 and March 2015, 20 patients suffering from postburn neck contracture underwent reconstruction with 20 unilateral supraclavicular artery perforator flaps. Nineteen patients had post-burn neck contractures (9 cases type Іc, 10 cases type Пc) while only one had post-burn granulation tissue in the neck. We harvested fifteen flaps from the right side and five from the left. Size of the reconstructed defect ranged from 23x10 to14x6, and flap size varied from 25/11 to 16/7cm. Period of follow up ranged from 27-2months (average 12.3). Nineteen flaps survived well (95% survival rate): only one was lost due to iatrogenic extensive dissection over the pedicle. Five cases showed distal superficial epidermolysis, and 2 cases showed 2 cm complete distal necrosis. All patients were managed conservatively. Our results coincide with other literature results confirming the efficacy and rich vascularity of this flap. In all cases with distal partial necrosis, flaps were 23 cm or more. We recommend that supraclavicular flaps of more than 22 cm in length are not harvested immediately and that flaps are expanded before harvesting. Expanding the supraclavicular flap increases its surface area and decreases donor site morbidity. PMID:28149252

Accuracy of glenohumeral joint injections: comparing approach and experience of provider.

PubMed

Tobola, Allison; Cook, Chad; Cassas, Kyle J; Hawkins, Richard J; Wienke, Jeffrey R; Tolan, Stefan; Kissenberth, Michael J

2011-10-01

The purpose of this study was to prospectively evaluate the accuracy of three different approaches used for glenohumeral injections. In addition, the accuracy of the injection was compared to the experience and confidence of the provider. One-hundred six consecutive patients with shoulder pain underwent attempted intra-articular injection either posteriorly, supraclavicularly, or anteriorly. Each approach was performed by an experienced and inexperienced provider. A musculoskeletal radiologist blinded to technique used and provider interpreted fluoroscopic images to determine accuracy. Providers were blinded to these results. The accuracy of the anterior approach regardless of experience was 64.7%, the posterior approach was 45.7%, and the supraclavicular approach was 45.5%. With each approach, experience did not provide an advantage. For the anterior approach, the experienced provider was 50% accurate compared to 85.7%. For the posterior approach, the experienced provider had a 42.1% accuracy rate compared to 50%. The experienced provider was accurate 50% of the time in the supraclavicular approach compared to 38.5%. The providers were not able to predict their accuracy regardless of experience. The experienced providers, when compared to those who were less experienced, were more likely to be overconfident, particularly with the anterior and supraclavicular approaches. There was no statistically significant difference between the 3 approaches. The anterior approach was the most accurate, independent of the experience level of the provider. The posterior approach produced the lowest level of confidence regardless of experience. The experienced providers were not able to accurately predict the results of their injections, and were more likely to be overconfident with the anterior and supraclavicular approaches. Copyright © 2011 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved.

High-Intensity Focused Ultrasound: Current Status for Image-Guided Therapy

PubMed Central

Copelan, Alexander; Hartman, Jason; Chehab, Monzer; Venkatesan, Aradhana M.

2015-01-01

Image-guided high-intensity focused ultrasound (HIFU) is an innovative therapeutic technology, permitting extracorporeal or endocavitary delivery of targeted thermal ablation while minimizing injury to the surrounding structures. While ultrasound-guided HIFU was the original image-guided system, MR-guided HIFU has many inherent advantages, including superior depiction of anatomic detail and superb real-time thermometry during thermoablation sessions, and it has recently demonstrated promising results in the treatment of both benign and malignant tumors. HIFU has been employed in the management of prostate cancer, hepatocellular carcinoma, uterine leiomyomas, and breast tumors, and has been associated with success in limited studies for palliative pain management in pancreatic cancer and bone tumors. Nonthermal HIFU bioeffects, including immune system modulation and targeted drug/gene therapy, are currently being explored in the preclinical realm, with an emphasis on leveraging these therapeutic effects in the care of the oncology patient. Although still in its early stages, the wide spectrum of therapeutic capabilities of HIFU offers great potential in the field of image-guided oncologic therapy. PMID:26622104

Backscattering analysis of high frequency ultrasonic imaging for ultrasound-guided breast biopsy

NASA Astrophysics Data System (ADS)

Cummins, Thomas; Akiyama, Takahiro; Lee, Changyang; Martin, Sue E.; Shung, K. Kirk

2017-03-01

A new ultrasound-guided breast biopsy technique is proposed. The technique utilizes conventional ultrasound guidance coupled with a high frequency embedded ultrasound array located within the biopsy needle to improve the accuracy in breast cancer diagnosis.1 The array within the needle is intended to be used to detect micro- calcifications indicative of early breast cancers such as ductal carcinoma in situ (DCIS). Backscattering analysis has the potential to characterize tissues to improve localization of lesions. This paper describes initial results of the application of backscattering analysis of breast biopsy tissue specimens and shows the usefulness of high frequency ultrasound for the new biopsy related technique. Ultrasound echoes of ex-vivo breast biopsy tissue specimens were acquired by using a single-element transducer with a bandwidth from 41 MHz to 88 MHz utilizing a UBM methodology, and the backscattering coefficients were calculated. These values as well as B-mode image data were mapped in 2D and matched with each pathology image for the identification of tissue type for the comparison to the pathology images corresponding to each plane. Microcalcifications were significantly distinguished from normal tissue. Adenocarcinoma was also successfully differentiated from adipose tissue. These results indicate that backscattering analysis is able to quantitatively distinguish tissues into normal and abnormal, which should help radiologists locate abnormal areas during the proposed ultrasound-guided breast biopsy with high frequency ultrasound.

Intravascular ultrasound guided directional atherectomy versus directional atherectomy guided by angiography for the treatment of femoropopliteal in-stent restenosis.

PubMed

Krishnan, Prakash; Tarricone, Arthur; K-Raman, Purushothaman; Majeed, Farhan; Kapur, Vishal; Gujja, Karthik; Wiley, Jose; Vasquez, Miguel; Lascano, Rheoneil A; Quiles, Katherine G; Distin, Tashanne; Fontenelle, Ran; Atallah-Lajam, Farah; Kini, Annapoorna; Sharma, Samin

2018-01-01

The aim of this study was to compare 1-year outcomes for patients with femoropopliteal in-stent restenosis using directional atherectomy guided by intravascular ultrasound (IVUS) versus directional atherectomy guided by angiography. This was a retrospective analysis for patients with femoropopliteal in-stent restenosis treated with IVUS-guided directional atherectomy versus directional atherectomy guided by angiography from a single center between March 2012 and February 2016. Clinically driven target lesion revascularization was the primary endpoint and was evaluated through medical chart review as well as phone call follow up. Directional atherectomy guided by IVUS reduces clinically driven target lesion revascularization for patients with femoropopliteal in-stent restenosis.

Accuracy of non-operative identification of the sentinel lymph node using combined gamma and ultrasound scanning.

PubMed

Whelehan, P; Vinnicombe, S J; Brown, D C; McLean, D; Evans, A

2014-08-01

To assess how accurately the sentinel lymph node (SLN) can be identified percutaneously, using gamma probe and ultrasound technology. Women with breast cancer, scheduled for wide local excision or mastectomy with SLN biopsy (SLNB), were included. Peri-areolar intradermal injection of technetium-99 nanocolloid was performed on the morning of surgery and 1-2 ml of blue dye was injected in the peri-areolar region once the patient was anaesthetized. Prior to surgery, a gamma probe was used over the skin to identify any hot spot that could represent a SLN. Ultrasound, guided by the hot spot, was then used to visualize potential SLNs and guide the insertion of a localizing wire. The accuracy in localizing the SLN by preoperative gamma-probe guided ultrasonography was assessed by comparison to SLNB. A SLN was correctly identified and marked using gamma-probe guided ultrasonography in 44 of 59 cases (75%; 95% CI: 63-86%). This study supports the case for investigating percutaneous gamma probe and ultrasound guided interventions in the axilla in women with breast cancer, as a potential alternative to surgical SLNB. Copyright © 2014 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

Selective local anesthetic placement using ultrasound guidance and neurostimulation for infraclavicular brachial plexus block.

PubMed

Bowens, Clifford; Gupta, Rajnish K; O'Byrne, William T; Schildcrout, Jonathan S; Shi, Yaping; Hawkins, Jermel J; Michaels, Damon R; Berry, James M

2010-05-01

In this study, we performed the infraclavicular block with combined ultrasound guidance and neurostimulation to selectively target cords to compare the success rates of placing a single injection of local anesthetic either in a central or peripheral location. Two hundred eighteen patients were enrolled in a consecutive, prospective study. Patients were randomized to injection of local anesthetic either centrally (posterior cord) or peripherally (medial or lateral cord) using ultrasound guidance and neurostimulation. Supervised senior anesthesiology residents or attending anesthesiologists performed the blocks. Both intent-to-treat and treatment-received analyses were used to compare central and peripheral placement efficacy. The overall success rate was significantly higher for the central placements than peripheral placements (96% vs 85%, P = 0.004). Individual cord success rates were as follows: posterior 99%, lateral 92%, and medial 84% (P = 0.001). The central group required attending physician intervention more frequently (27% vs 6%, P < 0.001). Postoperative pain scores of < or =3 were more likely with central placement (100% vs 94%, P = 0.012). Central placement of a single injection of local anesthetic targeted at the posterior cord resulted in a higher success rate for infraclavicular block.

Practical utility of thermodilution versus doppler ultrasound to measure hemodialysis blood access flow.

PubMed

Fontseré, Néstor; Mestres, Gaspar; Barrufet, Marta; Burrel, Marta; Vera, Manel; Arias, Marta; Masso, Elisabeth; Cases, Aleix; Maduell, Francisco; Campistol, Josep M

2013-01-01

The current clinical guidelines recommend indirect access blood flow (Qa) measurement as one of the most important components in vascular access maintenance programs. The best-know methods are doppler ultrasound (DU) and saline dilution method. This study evaluates the efficiency of Qa measurement with thermodilution method (TD) in comparison with the DU. Transversal study in 64 patients in hemodialysis (41 men); mean age 59.9 years with 54 AVFs and 10 PTFE. Qa reference value was obtained with DU in brachial artery (AVFs) or at the zone of arterial puncture (AVGs). Bland-Altman and interclass correlation coefficient (ICC) were used to study accuracy. Mean values obtained with DU-Qa were 1426 ± 753 mL/min AVFs and 1186 ± 789 mL/min AVGs. The mean Qa with TD was 1372 ± 770 AVFs (bias 54.6; ICC 0.923) and 1176 ± 758 AVGs (bias 10.2; ICC 0.992). In the subgroup of 28 patients with radiocephalic latero-terminal AVFs the DU-Qa was 1232 ± 767 mL/min. The Qa was in radial artery 942 (ICC 0.805); radial-ulnar artery 1103 (ICC 0.973); cephalic vein 788 (ICC 0.772) and TD 1026 (ICC 0.971). We detected 5 cases of significant stenosis. After endovascular treatment the Kt was 79 liters (61; p=0.043) and TD-Qa 895 mL/min (663; p=0.043). TD represents a good indirect method of Qa measurement. In the subgroup of patients with radiocephalic AVFs, Qa measurements in the radial and ulnar artery are more accurate. Therefore, in this situation the TD method obtained an excellent correlation in comparison to brachial artery.

Ultrasound for the Anesthesiologists: Present and Future

PubMed Central

Terkawi, Abdullah S.; Karakitsos, Dimitrios; Elbarbary, Mahmoud; Blaivas, Michael; Durieux, Marcel E.

2013-01-01

Ultrasound is a safe, portable, relatively inexpensive, and easily accessible imaging modality, making it a useful diagnostic and monitoring tool in medicine. Anesthesiologists encounter a variety of emergent situations and may benefit from the application of such a rapid and accurate diagnostic tool in their routine practice. This paper reviews current and potential applications of ultrasound in anesthesiology in order to encourage anesthesiologists to learn and use this useful tool as an adjunct to physical examination. Ultrasound-guided peripheral nerve blockade and vascular access represent the most popular ultrasound applications in anesthesiology. Ultrasound has recently started to substitute for CT scans and fluoroscopy in many pain treatment procedures. Although the application of airway ultrasound is still limited, it has a promising future. Lung ultrasound is a well-established field in point-of-care medicine, and it could have a great impact if utilized in our ORs, as it may help in rapid and accurate diagnosis in many emergent situations. Optic nerve sheath diameter (ONSD) measurement and transcranial color coded duplex (TCCD) are relatively new neuroimaging modalities, which assess intracranial pressure and cerebral blood flow. Gastric ultrasound can be used for assessment of gastric content and diagnosis of full stomach. Focused transthoracic (TTE) and transesophageal (TEE) echocardiography facilitate the assessment of left and right ventricular function, cardiac valve abnormalities, and volume status as well as guiding cardiac resuscitation. Thus, there are multiple potential areas where ultrasound can play a significant role in guiding otherwise blind and invasive interventions, diagnosing critical conditions, and assessing for possible anatomic variations that may lead to plan modification. We suggest that ultrasound training should be part of any anesthesiology training program curriculum. PMID:24348179

[Prognostic analysis of plantar fasciitis treated by pneumatic ballistic extracorporeal shock wave versus ultrasound guided intervention].

PubMed

Huo, Xiu-Lin; Wang, Ke-Tao; Zhang, Xiao-Ying; Yang, Yi-Tian; Cao, Fu-Yang; Yang, Jing; Yuan, Wei-Xiu; Mi, Wei-Dong

2018-02-20

To compare the medium- and long-term effect of pneumatic ballistic extracorporeal shock wave versus ultrasound-guided hormone injection in the treatment of plantar fasciitis. The clinical data were collected from patients with plantar fasciitis admitted to PLA General Hospital pain department from September, 2015 to February, 2017. The patients were randomly divided into ultrasound-guided drug injection group and shock wave group. The therapeutic parameters including the numerical rating scale (NRS) scores in the first step pain in the morning, American Orthopedic Foot and Ankle Society (AOFAS) Ankle Hindfoot Scale, and thickness of the plantar fascia were monitored before and at 1 week, 1 month, 3 months, and 6 months after the treatment. The recurrence rate, effectiveness, and patient satisfaction were compared between the two groups at 6 months after the treatment. Thirty-nine patients were enrolled in shock wave group and 38 patients in ultrasound group. The NRS scores in the first step pain in the morning were lowered after treatment in both groups (P<0.05), and the scores were significantly lower in ultrasound group than in shock wave group at 1 week and 1 month (P<0.01), but significantly higher in ultrasound group than in shock wave group at 3 and 6 months after treatment (P<0.05). The AOFAS functional scores were increased in both groups (P<0.05) at 6 months after treatment, was significantly lower in ultrasound group than in shock wave group than group B (90.44∓13.27 vs 75.76∓21.40; P<0.05). The effective rates in shock wave group and ultrasound group were 92.31% and 76.32%, respectively (P<0.05). Recurrence was found in 1 patient (2.56%) in shock wave group and in 8 (21.05%) in ultrasound group (P<0.05). The patient satisfaction scores were significantly higher in shock wave group than in ultrasound group (8.13∓2.67 vs 6.63∓3.75, P=0.048). Pneumatic ballistic extracorporeal shock achieves better medium- and long-term outcomes than ultrasound-guided hormone injection in the treatment of plantar fasciitis.

Mondor's disease of the breast as a complication of ultrasound-guided core needle biopsy: management and review of the literature.

PubMed

Salemis, Nikolaos S; Vasilara, Georgia; Lagoudianakis, Emmanuel

2015-01-01

Mondor's disease is a rare benign and self-limiting condition characterized by thrombophlebitis of the superficial veins of the anterolateral thoracoabdominal wall. We describe a case of Mondor's disease of the breast as a complication of an ultrasound-guided core needle biospy. The patient presented with a palpable cord-like structure in her left breast, associated with severe pain and tenderness. She was treated concervatively and complete resolution was observed after four weeks. We conclude that emergency clinicians and interventional breast radiologists should be aware of Mondor's disease as a potential complication of ultrasound-guided core needle biopsy of the breast.

Targeted Ultrasound-Guided Perineural Hydrodissection of the Sciatic Nerve for the Treatment of Piriformis Syndrome.

PubMed

Burke, Christopher J; Walter, William R; Adler, Ronald S

2018-05-01

Piriformis syndrome is a common cause of lumbar, gluteal, and thigh pain, frequently associated with sciatic nerve symptoms. Potential etiologies include muscle injury or chronic muscle stretching associated with gait disturbances. There is a common pathological end pathway involving hypertrophy, spasm, contracture, inflammation, and scarring of the piriformis muscle, leading to impingement of the sciatic nerve. Ultrasound-guided piriformis injections are frequently used in the treatment of these pain syndromes, with most of the published literature describing injection of the muscle. We describe a safe, effective ultrasound-guided injection technique for the treatment of piriformis syndrome using targeted sciatic perineural hydrodissection followed by therapeutic corticosteroid injection.

Delphi Method Validation of a Procedural Performance Checklist for Insertion of an Ultrasound-Guided Internal Jugular Central Line.

PubMed

Hartman, Nicholas; Wittler, Mary; Askew, Kim; Manthey, David

2016-01-01

Placement of ultrasound-guided central lines is a critical skill for physicians in several specialties. Improving the quality of care delivered surrounding this procedure demands rigorous measurement of competency, and validated tools to assess performance are essential. Using the iterative, modified Delphi technique and experts in multiple disciplines across the United States, the study team created a 30-item checklist designed to assess competency in the placement of ultrasound-guided internal jugular central lines. Cronbach α was .94, indicating an excellent degree of internal consistency. Further validation of this checklist will require its implementation in simulated and clinical environments. © The Author(s) 2014.

Septic bursitis after ultrasound-guided percutaneous treatment of rotator cuff calcific tendinopathy.

PubMed

Sconfienza, Luca Maria; Randelli, Filippo; Sdao, Silvana; Sardanelli, Francesco; Randelli, Pietro

2014-08-01

Calcific tendinopathy of the rotator cuff is a common condition. Ultrasound-guided percutaneous aspiration is one of several options to treat this condition. The main advantages of this procedure are short duration, good outcome, and low cost. Furthermore, only minor complications have been reported in the literature, namely, vagal reactions during the procedure and mild postprocedural pain. We report the first case of septic bursitis after ultrasound-guided percutaneous treatment of calcific tendinopathy. Although this is generally considered a very safe procedure, a risk of infection should be taken into account. Copyright © 2014 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

Treatment of great auricular neuralgia with real-time ultrasound-guided great auricular nerve block

PubMed Central

Jeon, Younghoon; Kim, Saeyoung

2017-01-01

Abstract Rationale: The great auricular nerve can be damaged by the neck surgery, tumor, and long-time pressure on the neck. But, great auricular neuralgia is very rare condition. It was managed by several medication and landmark-based great auricular nerve block with poor prognosis. Patient concerns: A 25-year-old man presented with a pain in the left lateral neck and auricle. Diagnosis: He was diagnosed with great auricular neuralgia. Interventions: His pain was not reduced by medication. Therefore, the great auricular nerve block with local anesthetics and steroid was performed under ultrasound guidance. Outcomes: Ultrasound guided great auricular nerve block alleviated great auricular neuralgia. Lessons: This medication-resistant great auricular neuralgia was treated by the ultrasound guided great auricular nerve block with local anesthetic agent and steroid. Therefore, great auricular nerve block can be a good treatment option of medication resistant great auricular neuralgia. PMID:28328811

Vascular Alterations in Axillary and Brachial Vessels in Patients with Axillary Web Syndrome After Breast Cancer Surgery.

PubMed

Furlan, Cintia; Matheus, Carolina Nascimben; Jales, Rodrigo Menezes; Derchain, Sophie; Sarian, Luís Otávio

2018-06-01

Surgical manipulations of the axilla may cause a condition known as Axillary Web Syndrome (AWS). The systems compromised and the sequence of events leading to this syndrome remains unknown. This study evaluated clinical, surgical, and vascular factors associated with onset and duration of AWS after breast cancer surgery. In this prospective study, 155 women were included. They were submitted to a physical examination that consisted of ultrasound Doppler of axillary and brachial vessels and the evaluation of AWS in 1, 3, and 6 months after breast cancer surgery. Women with advanced disease had a significantly higher incidence of AWS than those with early stage breast cancer (p = 0.02). In addition, women who underwent mastectomy or axillary lymph node dissection (ALND) had a significantly higher incidence of AWS in the 1-month (p < 0.01; p < 0.01) and 3-months (p < 0.01; p = 0.02) assessment rounds, respectively. The cross-sectional area of brachial artery was significantly smaller (p = 0.04) in women with AWS at the 3-months postoperative visit. The peak systolic velocity and the blood flow of the axillary artery was significantly higher in women with AWS 6 months after surgery (p < 0.03 and p = 0.02 respectively). Our study confirm the combined changes of lymphatic and vascular systems in woman with AWS, since AWS was associated with more extensive dissection of axillary lymph nodes, compromised lymph nodes, and with abnormalities of the vascular parameters.

In-vivo ultrasound and photoacoustic image- guided photothermal cancer therapy using silica-coated gold nanorods.

PubMed

Kim, Seungsoo; Chen, Yun-Sheng; Luke, Geoffrey P; Emelianov, Stanislav Y

2014-05-01

In nanoparticle-augmented photothermal therapy, evaluating the delivery and spatial distribution of nanoparticles, followed by remote temperature mapping and monitoring, is essential to ensure the optimal therapeutic outcome. The utility of ultrasound and photoacoustic imaging to assist photothermal therapy has been previously demonstrated. Here, using a mouse xenograft tumor model, it is demonstrated in vivo that ultrasound-guided photoacoustic imaging can be used to plan the treatment and to guide the therapy. To evaluate nanoparticle delivery and spatial distribution, three-dimensional ultrasound and spectroscopic photoacoustic imaging of a mouse with a tumor was performed before and after intravenous injection of silica-coated gold nanorods. After injection and sufficient circulation of nanoparticles, photothermal therapy was performed for 5 min using an 808-nm continuous-wave laser. During the photothermal therapy, photoacoustic images were acquired continuously and used to measure the temperature changes within tissue. A heterogeneous distribution of temperature, which was spatially correlated with the measured distribution of nanoparticles, indicated that peak temperatures of 53°C were achieved in the tumor. An Arrhenius thermal damage model determined that this thermal deposition would result in significant cell death. The results of this study suggest that ultrasound and photoacoustic imaging can effectively guide photothermal therapy to achieve the desired thermal treatment.

Value of Artisanal Simulators to Train Veterinary Students in Performing Invasive Ultrasound-Guided Procedures

ERIC Educational Resources Information Center

Hage, Maria Cristina F. N. S.; Massaferro, Ana Beatriz; Lopes, Érika Rondon; Beraldo, Carolina Mariano; Daniel, Jéssika

2016-01-01

Pericardial effusion can lead to cardiac tamponade, which endangers an animal's life. Ultrasound-guided pericardiocentesis is used to remove abnormal liquid; however, it requires technical expertise. In veterinary medical education, the opportunity to teach this procedure to save lives during emergencies is rare; therefore, simulators are…

Perioperative ultrasound-guided wire marking of calcific deposits in calcifying tendinitis of the rotator cuff.

PubMed

Sigg, Andreas; Draws, Detlev; Stamm, Axel; Pfeiffer, Michael

2011-03-01

The identification of a calcific deposit in the rotator cuff can often cause difficulties. A new technique is described to identify the calcific deposit perioperatively with a ultrasound-guided wire. The technique allows a safe direct marking of calcific deposits making the procedure faster especially in difficult cases.

Endobronchial ultrasound-guided transbronchial needle injection for local control of recurrent non-small cell lung cancer.

PubMed

Khan, Farrah; Anker, Christopher J; Garrison, Garth; Kinsey, C Matthew

2015-01-01

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is an established technique for the diagnosis of thoracic malignancies. Non-ultrasound-guided transbronchial needle injection has been used previously to deliver chemotherapeutic agents. To use endobronchial ultrasound-guided transbronchial needle injection (EBUS-TBNI) to achieve local control of recurrent early-stage lung cancer. A 63-year-old man presented with recurrent early stage non-small cell lung carcinoma after chemotherapy and external beam radiation. We used EBUS-TBNI to deliver cisplatin into the tumor located outside the airway. This procedure was performed on three separate occasions without complication. EBUS-TBNI resulted in resolution of fluorodeoxyglucose avidity, measured by positron emission tomography-computed tomography, in the region at 4 weeks. However, at 5 months, there was evidence of distal recurrence. This is the first description of EBUS-TBNI to treat local recurrence of lung cancer and one of the first reports of the use of EBUS for intratumoral therapy. Additional research is warranted to determine the clinical usefulness and safety of this therapeutic approach.

Evaluation of the eZono 4000 with eZGuide for ultrasound-guided procedures.

PubMed

Gadsden, Jeff; Latmore, Malikah; Levine, Daniel M

2015-05-01

Ultrasound-guided procedures are increasingly common in a variety of acute care settings, such as the operating room, critical care unit and emergency room. However, accurate judgment of needle tip position using traditional ultrasound technology is frequently difficult, and serious injury can result from inadvertently advancing beyond or through the target. Needle navigation is a recent innovation that allows the clinician to visualize the needle position and trajectory in real time as it approaches the target. A novel ultrasound machine has recently been introduced that is portable and designed for procedural guidance. The eZono 4000™ features an innovative needle navigation technology that is simple to use and permits the use of a wide range of commercially available needles, avoiding the inconvenience and cost of proprietary equipment. This article discusses this new ultrasound machine in the context of other currently available ultrasound machines featuring needle navigation.

Comparison of ultrasound-guided posterior transversus abdominis plane block and lateral transversus abdominis plane block for postoperative pain management in patients undergoing cesarean section: a randomized double-blind clinical trial study.

PubMed

Faiz, Seyed Hamid Reza; Alebouyeh, Mahmoud Reza; Derakhshan, Pooya; Imani, Farnad; Rahimzadeh, Poupak; Ghaderi Ashtiani, Maryam

2018-01-01

Due to the importance of pain control after abdominal surgery, several methods such as transversus abdominis plane (TAP) block are used to reduce the pain after surgery. TAP blocks can be performed using various ultrasound-guided approaches. Two important approaches to do this are ultrasound-guided lateral and posterior approaches. This study aimed to compare the two approaches of ultrasound-guided lateral and posterior TAP blocks to control pain after cesarean section. In this double-blind clinical trial study, 76 patients scheduled for elective cesarean section were selected and randomly divided into two groups of 38 and underwent spinal anesthesia. For pain management after the surgery, one group underwent lateral TAP block and the other group underwent posterior TAP block using 20cc of ropivacaine 0.2% on both sides. Pain intensity was evaluated based on Numerical Analog Scale (NAS) at rest and when coughing, 2, 4, 6, 12, 24 and 36 hours after surgery. The pain at rest in the posterior group at all hours post surgery was lower than the lateral group, especially at 6, 12 and 24 hours after the surgery and the difference was statistically significant ( p =0.03, p <0.004, p =0.001). The results of this study show that ultrasound-guided posterior TAP block compared with the lateral TAP block was more effective in pain control after cesarean section.

Ultrasound-guided stellate ganglion blocks combined with pharmacological and occupational therapy in Complex Regional Pain Syndrome (CRPS): a pilot case series ad interim.

PubMed

Wei, Karin; Feldmann, Robert E; Brascher, Anne-Kathrin; Benrath, Justus

2014-12-01

This preliminary and retrospective pilot case series examines a treatment concept consisting of ultrasound-guided stellate ganglion blocks (SGBs) combined with pharmacological and occupational therapy in patients with complex regional pain syndrome (CRPS) of the hand. Efficacy of combined treatment concepts and safety of ultrasound-guided SGB have not been sufficiently investigated yet. A total number of 156 blocks were evaluated in 16 patients with CRPS in a retrospective analysis. All patients received pharmacotherapy and a standard regimen of occupational therapy offered simultaneously to the SGBs. Changes in both spontaneous and evoked pain levels were assessed by numerical pain rating score before and after the last blockade of a series. Side effects were documented. The overall mean pain reduction was 63.2% regarding spontaneous and 45.3% regarding evoked pain. Mild complications, such as hoarseness or dysphagia, occurred in 13.5% of the blocks (21 SGBs). Serious complications, such as plexus paresis or accidental puncture of vessels or other structures, did not occur. Time between symptom onset and start of treatment did not affect the extent of pain reduction. The combination of ultrasound-guided SGB and simultaneous pharmacological and occupational therapy showed encouraging treatment results under conditions of this pilot case series. Assessment of efficacy of this combined treatment concept and safety of ultrasound-guided SGB require further prospective clinical studies with larger number of participants. Wiley Periodicals, Inc.

'X-ray'-free balloon dilation for totally ultrasound-guided percutaneous nephrolithotomy.

PubMed

Zhou, Tie; Chen, Guanghua; Gao, Xiaofeng; Zhang, Wei; Xu, Chuanliang; Li, Lei; Sun, Yinghao

2015-04-01

The objective of the study was to evaluate the feasibility and safety of balloon dilation for 'X-ray'-free ultrasound-guided percutaneous nephrolithotomy (PCNL). From January 2012 to December 2012, patients underwent 'X-ray'-free ultrasound-guided PCNL with Amplatz dilator (Group A). From January 2013 to April 2014, patients underwent 'X-ray'-free ultrasound-guided PCNL with balloon dilator (Group B). For balloon dilation, a 10 F fascial dilator was used to dilate the tract. Subsequently, the 6 F nephrostomy balloon (8 mm in diameter) was indwelled along the guidewire with a marked length equal to the dilation depth. Under the monitoring of ultrasound, the location of balloon was secured and disappearance of balloon waist was confirmed when the balloon was inflated at a pressure of 20 atm. A total of 163 patients were involved in this study. Of 81 procedures in Group A, 45 procedures were performed by a senior urologist while 36 procedures by a resident. Of 82 patients in Group B, 47 procedures were performed by the same senior urologist while 35 procedures by another resident. For the senior urologist, there was no statistically significant difference between two groups in calyx of entry, stone-free rate, decline of hemoglobin and hematocrit, operation time and hospitalization. But for the residents, there was less decline of hemoglobin and hematocrit, tract development time and hospitalization in Group B compared to Group A (0.6 vs. 1.7 g/dl, p = 0.001; 2.3% vs. 5.5%, p = 0.003; 10.1 vs. 11.0 min, p = 0.027; 7.8 vs. 13.9 days, p < 0.001). Balloon dilation method introduced in this study is compensable for tract development when 'X-ray'-free ultrasound-guided PCNL is performed. Modified techniques make totally ultrasound guidance for PCNL feasible, easy and safe. In addition, such a procedure is preferable for initial operators because of less hemorrhage complication.

Neurologic Outcomes After Low-Volume, Ultrasound-Guided Interscalene Block and Ambulatory Shoulder Surgery.

PubMed

Rajpal, Gaurav; Winger, Daniel G; Cortazzo, Megan; Kentor, Michael L; Orebaugh, Steven L

2016-01-01

Postoperative neurologic symptoms after interscalene block and shoulder surgery have been reported to be relatively frequent. Reports of such symptoms after ultrasound-guided block have been variable. We evaluated 300 patients for neurologic symptoms after low-volume, ultrasound-guided interscalene block and arthroscopic shoulder surgery. Patients underwent ultrasound-guided interscalene block with 16 to 20 mL of 0.5% bupivacaine or a mix of 0.2% bupivacaine/1.2% mepivacaine solution, followed by propofol/ketamine sedation for ambulatory arthroscopic shoulder surgery. Patients were called at 10 days for evaluation of neurologic symptoms, and those with persistent symptoms were called again at 30 days, at which point neurologic evaluation was initiated. Details of patient demographics and block characteristics were collected to assess any association with persistent neurologic symptoms. Six of 300 patients reported symptoms at 10 days (2%), with one of these patients having persistent symptoms at 30 days (0.3%). This was significantly lower than rates of neurologic symptoms reported in preultrasound investigations with focused neurologic follow-up and similar to other studies performed in the ultrasound era. There was a modest correlation between the number of needle redirections during the block procedure and the presence of postoperative neurologic symptoms. Ultrasound guidance of interscalene block with 16- to 20-mL volumes of local anesthetic solution results in a lower frequency of postoperative neurologic symptoms at 10 and 30 days as compared with investigations in the preultrasound period.

A Single Center Evaluation of the Diagnostic Accuracy of Multiparametric Magnetic Resonance Imaging against Transperineal Prostate Mapping Biopsy: An Analysis of Men with Benign Histology and Insignificant Cancer following Transrectal Ultrasound Biopsy.

PubMed

Pal, Raj P; Ahmad, Ros; Trecartan, Shaun; Voss, James; Ahmed, Shaista; Bazo, Alvaro; Lloyd, Jon; Walton, Thomas J

2018-03-01

In this study we evaluated the diagnostic performance of transrectal ultrasound guided biopsy and multiparametric magnetic resonance imaging to detect prostate cancer against transperineal prostate mapping biopsy as the reference test. Transrectal ultrasound guided biopsy, multiparametric magnetic resonance imaging and transperineal prostate mapping biopsy were performed in 426 patients between April 2012 and January 2016. Patients initially underwent systematic 12 core transrectal ultrasound guided biopsy followed 3 months later by 1.5 Tesla, high resolution T2, diffusion-weighted, dynamic contrast enhanced multiparametric magnetic resonance imaging. Two specialist uroradiologists blinded to the results of transperineal prostate mapping biopsy allocated a PI-RADS™ (Prostate Imaging-Reporting and Data System) score to each multiparametric magnetic resonance imaging study. Transperineal prostate mapping biopsy with 5 mm interval sampling, which was performed within 6 months of multiparametric magnetic resonance imaging, served as the reference test. Transrectal ultrasound guided biopsy identified 247 of 426 patients with prostate cancer and 179 of 426 with benign histology. Transperineal prostate mapping biopsy detected prostate cancer in 321 of 426 patients. On transperineal prostate mapping biopsy 94 of 179 patients with benign transrectal ultrasound guided biopsy had prostate cancer and 95 of 247 with prostate cancer on transrectal ultrasound guided biopsy were identified with cancer of higher grade. Using a multiparametric magnetic resonance imaging PI-RADS score of 3 or greater to detect significant prostate cancer, defined as any core containing Gleason 4 + 3 or greater prostate cancer on transperineal prostate mapping biopsy, the ROC AUC was 0.754 (95% CI 0.677-0.819) with 87.0% sensitivity (95% CI 77.3-97.0), 55.3% specificity (95% CI 50.2-60.4) and 97.1% negative predictive value (95% CI 94.8-99.4). Multiparametric magnetic resonance imaging is a more accurate diagnostic test than transrectal ultrasound guided biopsy. However, a significant proportion of ISUP (International Society of Urological Pathology) Grade Group 2 prostate cancer remained undetected following multiparametric magnetic resonance imaging. Although multiparametric magnetic resonance imaging could avoid unnecessary biopsy in many patients with ISUP Grade Group 3 or greater prostate cancer, at less stringent definitions of significant cancer a substantial proportion of prostate cancer would remain undetected after multiparametric magnetic resonance imaging. Copyright © 2018 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

Tunnels and grooves for supraclavicular nerves within the clavicle: review of the literature and clinical impact.

PubMed

Natsis, Konstantinos; Totlis, Trifon; Chorti, Angeliki; Karanassos, Marinos; Didagelos, Matthaios; Lazaridis, Nikolaos

2016-08-01

Perforation of the clavicle by supraclavicular nerves is a common anatomical variation. This variation has been reported in several studies based on post-mortem, surgical and radiologic findings, with an overall frequency between 1 and 6.6 %. The penetrating branch passes either through a bony tunnel or a groove on the superior surface of the bone. Entrapment neuropathy of the perforating branch is a documented clinical entity reported in the literature. The intraosseous course of the supraclavicular nerves makes them vulnerable to injury in case of clavicular fractures or during surgical manipulations of these fractures. Furthermore, this variation should be taken into account during the interpretation of chest and shoulder radiographs. The purpose of the current study is to perform an extended review of the relevant literature, highlighting the clinical impact of this variation, as well as to incorporate our own findings into them.

Intravascular ultrasound guided directional atherectomy versus directional atherectomy guided by angiography for the treatment of femoropopliteal in-stent restenosis

PubMed Central

Krishnan, Prakash; Tarricone, Arthur; K-Raman, Purushothaman; Majeed, Farhan; Kapur, Vishal; Gujja, Karthik; Wiley, Jose; Vasquez, Miguel; Lascano, Rheoneil A.; Quiles, Katherine G.; Distin, Tashanne; Fontenelle, Ran; Atallah-Lajam, Farah; Kini, Annapoorna; Sharma, Samin

2017-01-01

Background: The aim of this study was to compare 1-year outcomes for patients with femoropopliteal in-stent restenosis using directional atherectomy guided by intravascular ultrasound (IVUS) versus directional atherectomy guided by angiography. Methods and results: This was a retrospective analysis for patients with femoropopliteal in-stent restenosis treated with IVUS-guided directional atherectomy versus directional atherectomy guided by angiography from a single center between March 2012 and February 2016. Clinically driven target lesion revascularization was the primary endpoint and was evaluated through medical chart review as well as phone call follow up. Conclusions: Directional atherectomy guided by IVUS reduces clinically driven target lesion revascularization for patients with femoropopliteal in-stent restenosis. PMID:29265002

Percutaneous Treatment of Iatrogenic Pseudoaneurysms by Cyanoacrylate-Based Wall-Gluing

DOE Office of Scientific and Technical Information (OSTI.GOV)

Del Corso, Andrea, E-mail: adelcorso2000@hotmail.com; Vergaro, Giuseppe

Purpose. Although the majority of iatrogenic pseudoaneurysms (PSAs) are amenable to ultrasound (US)-guided thrombin injection, patients with those causing neuropathy, claudication, significant venous compression, or soft tissue necrosis are considered poor candidates for this option and referred to surgery. We aimed to test the effectiveness and feasibility of a novel percutaneous cyanoacrylate glue (NBCA-MS)-based technique for treatment of symptomatic and asymptomatic iatrogenic PSA. Material and Methods. During a 3-year period, we prospectively enrolled 91 patients with iatrogenic PSA [total n = 94 (femoral n = 76; brachial n = 11; radial n = 6; axillary n = 1)]. PSA weremore » asymptomatic in 66 % of cases, and 34 % presented with symptoms due to neuropathy, venous compression, and/or soft tissue necrosis. All patients signed informed consent. All patients received NBCA-MS-based percutaneous treatment. PSA chamber emptying was first obtained by US-guided compression; superior and inferior walls of the PSA chamber were then stuck together using NBCA-MS microinjections. Successfulness of the procedure was assessed immediately and at 1-day and 1-, 3-, and 12-month US follow-up. Results. PSA occlusion rate was 99 % (93 of 94 cases). After treatment, mean PSA antero-posterior diameter decrease was 67 {+-} 22 %. Neuropathy and vein compression immediately disappeared in 91 % (29 of 32) of cases. Patients with tissue necrosis (n = 6) underwent subsequent outpatient necrosectomy. No distal embolization occurred, nor was conversion to surgery necessary. Conclusion. PSA treatment by way of NBCA-MS glue injection proved to be safe and effective in asymptomatic patients as well as those with neuropathy, venous compression, or soft-tissue necrosis (currently candidates for surgery). Larger series are needed to confirm these findings.« less

Laparoscopic-guided abdominal wall nerve blocks in the pediatric population: a novel technique with comparison to ultrasound-guided blocks and local wound infiltration alone.

PubMed

Landmann, Alessandra; Visoiu, Mihaela; Malek, Marcus M

2018-03-01

Abdominal wall nerve blocks have been gaining popularity for the treatment of perioperative pain in children. Our aim was to compare a technique of surgeon-performed, laparoscopic abdominal wall nerve blocks to anesthesia-placed, ultrasound-guided abdominal wall nerve blocks and the current standard of local wound infiltration. After institutional review board approval was obtained, a retrospective chart review was performed of pediatric patients treated at a single institution during a 2-year period. Statistics were calculated using analysis of variance with post-hoc Bonferonni t tests for pair-wise comparisons. Included in this study were 380 patients who received ultrasound-guided abdominal wall nerve blocks (n = 125), laparoscopic-guided abdominal wall nerve blocks (n = 88), and local wound infiltration (n = 117). Groups were well matched for age, sex, and weight. There was no significant difference in pain scores within the first 8 hours or narcotic usage between groups. Local wound infiltration demonstrated the shortest overall time required to perform (P < .0001). Patients who received a surgeon-performed abdominal wall nerve block demonstrated a shorter duration of hospital stay when compared to the other groups (P = .02). Our study has demonstrated that laparoscopic-guided abdominal wall nerve blocks show similar efficacy to ultrasound-guided nerve blocks performed by pain management physicians without increasing time in the operating room. Copyright © 2017 Elsevier Inc. All rights reserved.

Ultrasound-guided interventional procedures around the shoulder.

PubMed

Messina, Carmelo; Banfi, Giuseppe; Orlandi, Davide; Lacelli, Francesca; Serafini, Giovanni; Mauri, Giovanni; Secchi, Francesco; Silvestri, Enzo; Sconfienza, Luca Maria

2016-01-01

Ultrasound is an established modality for shoulder evaluation, being accurate, low cost and radiation free. Different pathological conditions can be diagnosed using ultrasound and can be treated using ultrasound guidance, such as degenerative, traumatic or inflammatory diseases. Subacromial-subdeltoid bursitis is the most common finding on ultrasound evaluation for painful shoulder. Therapeutic injections of corticosteroids are helpful to reduce inflammation and pain. Calcific tendinopathy of rotator cuff affects up to 20% of painful shoulders. Ultrasound-guided treatment may be performed with both single- and double-needle approach. Calcific enthesopathy, a peculiar form of degenerative tendinopathy, is a common and mostly asymptomatic ultrasound finding; dry needling has been proposed in symptomatic patients. An alternative is represented by autologous platelet-rich plasma injections. Intra-articular injections of the shoulder can be performed in the treatment of a variety of inflammatory and degenerative diseases with corticosteroids or hyaluronic acid respectively. Steroid injections around the long head of the biceps brachii tendon are indicated in patients with biceps tendinopathy, reducing pain and humeral tenderness. The most common indication for acromion-clavicular joint injection is degenerative osteoarthritis, with ultrasound representing a useful tool in localizing the joint space and properly injecting various types of drugs (steroids, lidocaine or hyaluronic acid). Suprascapular nerve block is an approved treatment for chronic shoulder pain non-responsive to conventional treatments as well as candidate patients for shoulder arthroscopy. This review provides an overview of these different ultrasonography-guided procedures that can be performed around the shoulder.

Adopting Ultrasound Guidance for Prone Percutaneous Nephrolithotomy: Evaluating the Learning Curve for the Experienced Surgeon

PubMed Central

Usawachintachit, Manint; Masic, Selma; Allen, Isabel E.; Li, Jianxing

2016-01-01

Abstract Objectives: To define the learning curve associated with adopting ultrasound guidance for prone percutaneous nephrolithotomy (PCNL) for the experienced surgeon. Methods: A prospective cohort study of consecutive patients undergoing PCNL with ultrasound guidance for renal tract access and dilation was performed. Clinical data reviewed included success in gaining renal access with ultrasound guidance, total fluoroscopic screening time, and radiation exposure dose. PCNL cases performed with fluoroscopic guidance matched for stone size served as control cases. Results: One hundred consecutive ultrasound-guided procedures performed by a single experienced endourologist were divided into five experience groups. Significant improvement in renal access success rate with ultrasound was seen after 20 cases (p < 0.05). Total fluoroscopic screening time, radiation exposure dose, and operative time were also statistically significantly improved over the study period. When compared with fluoroscopy-guided PCNL, significant decreases in total fluoroscopic screening time (33.4 ± 35.3 seconds vs 157.5 ± 84.9 seconds, p < 0.05) and radiation exposure (7.0 ± 8.7 mGy vs 47.8 ± 45.9 mGy, p < 0.05) were seen. No differences in complication rates were found. Conclusions: Ultrasound-guided renal access for PCNL can be performed effectively after 20 cases. Transition to the use of ultrasound will quickly reduce radiation exposure for patients and intraoperative personnel. PMID:27150671

Examples of Radiation-Emitting Products

MedlinePlus

... Ultrasonography • Doppler ultrasound • Color doppler ultrasound • Hyperthermia • Diathermy/physical therapy • Bone healing • Lithotripsy • Phacoemulsifier • Needle guide • Bone density measuring • Geriatric bath (ultrasound) • Hearing aid • Many scientific uses • Nondestructive ...

Ultrasound measurement of the brachial artery flow-mediated dilation without ECG gating.

PubMed

Gemignani, Vincenzo; Bianchini, Elisabetta; Faita, Francesco; Giannarelli, Chiara; Plantinga, Yvonne; Ghiadoni, Lorenzo; Demi, Marcello

2008-03-01

The methods commonly used for noninvasive ultrasound assessment of endothelium-dependent flow-mediated dilation (FMD) require an electrocardiogram (ECG) signal to synchronize the measurements with the cardiac cycle. In this article, we present a method for assessing FMD that does not require ECG gating. The approach is based on temporal filtering of the diameter-time curve, which is obtained by means of a B-mode image processing system. The method was tested on 22 healthy volunteers without cardiovascular risk factors. The measurements obtained with the proposed approach were compared with those obtained with ECG gating and with both systolic and end-diastolic measurements. Results showed good agreement between the methods and a higher precision of the new method due to the fact that it is based on a larger number of measurements. Further advantages were also found both in terms of reliability of the measure and simplification of the instrumentation. (E-mail: gemi@ifc.cnr.it).

Effect of Isometric Hand Grip Exercises on Blood Flow and Placement of IV Catheters for Administration of Chemotherapy.

PubMed

Ozkaraman, Ayse; Yesilbalkan, Öznur Usta

2016-04-01

Complications may occur in the subcutaneous or subdermal tissues during IV administration of chemotherapy related to blood flow and catheter placement. Daily isometric hand grip exercises were evaluated for their effect on blood flow in the vessels of the nondominant arm before placement of IV catheters and the success rate of IV catheter placement on the first attempt. The study focused on patients with non-Hodgkin lymphoma receiving the first and second cycles of chemotherapy. The intervention group performed daily isometric hand grip exercises before chemotherapy with peripheral catheter insertion. The control group performed routine activities only. Blood flow was measured by ultrasound in the brachial artery (BA) and brachial vein (BV) of the nondominant arm before the first (T1) and second (T2) cycles of chemotherapy. Blood flow slightly increased in the intervention group at T2 compared to T1. In the control group, blood flow decreased in the BA and did not change in the BV at T2 compared to T1. The success rate for first-attempt placement of a peripheral IV catheter was the same for the intervention and control groups.

Real-time ultrasound-guided spinal anesthesia using the SonixGPS ultrasound guidance system: a feasibility study.

PubMed

Niazi, A U; Chin, K J; Jin, R; Chan, V W

2014-08-01

Real-time ultrasound-guided neuraxial blockade remains a largely experimental technique. SonixGPS® is a new needle tracking system that displays needle tip position on the ultrasound screen. We investigated if this novel technology might aid performance of real-time ultrasound-guided spinal anesthesia. Twenty patients with body mass index < 35 kg/m(2) undergoing elective total joint arthroplasty under spinal anesthesia were recruited. Patients with previous back surgery and spinal abnormalities were excluded. Following a pre-procedural ultrasound scan, a 17G proprietary needle-sensor assembly was inserted in-plane to the transducer in four patients and out-of-plane in 16 patients. In both approaches, the trajectory of insertion was adjusted in real-time until the needle tip lay just superficial to the ligamentum flavum-dura mater complex. At this point, a 25G 120 mm Whitacre spinal needle was inserted through the 17G SonixGPS® needle. Successful dural puncture was confirmed by backflow of cerebrospinal fluid from the spinal needle. An overall success rate of 14/20 (70%) was seen with two failures (50%) and four failures (25%) in the in-plane and out-of-plane groups respectively. Dural puncture was successful on the first skin puncture in 71% of patients and in a single needle pass in 57% of patients. The median total procedure time was 16.4 and 11.1 min in the in-plane and out-of-plane groups respectively. The SonixGPS® system simplifies real-time ultrasound-guided spinal anesthesia to a large extent, especially the out-of-plane approach. Nevertheless, it remains a complex multi-step procedure that requires time, specialized equipment, and a working knowledge of spinal sonoanatomy. © 2014 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

Ultrasound-guided thoracenthesis: the V-point as a site for optimal drainage positioning.

PubMed

Zanforlin, A; Gavelli, G; Oboldi, D; Galletti, S

2013-01-01

In the latest years the use of lung ultrasound is increasing in the evaluation of pleural effusions, because it makes follow-up easier and drainage more efficient by providing guidance on the most appropriate sampling site. However, no standardized approach for ultrasound-guided thoracenthesis is actually available. To evaluate our usual ultrasonographic landmark as a possible standard site to perform thoracenthesis by assessing its value in terms of safety and efficiency (success at first attempt, drainage as complete as possible). Hospitalized patients with non organized pleural effusion underwent thoracenthesis after ultrasound evaluation. The point showing on ultrasound the maximum thickness of the effusion ("V-point") was chosen for drainage. 45 ultrasound guided thoracenthesis were performed in 12 months. In 22 cases there were no complications; 16 cases of cough, 2 cases of mild dyspnea without desaturation, 4 cases of mild pain; 2 cases of complications requiring medical intervention occurred. No case of pneumothorax related to the procedure was detected. In all cases drainage was successful on the first attempt. The collected values of maximum thickness at V-point (min 3.4 cm - max 15.3 cm) and drained fluid volume (min 70 ml - max 2000 ml) showed a significative correlation (p < 0.0001). When the thickness was greater or equal to 9.9 cm, drained volume was always more than 1000 ml. The measure of the maximum thickness at V-point provides high efficiency to ultrasound guided thoracentesis and allows to estimate the amount of fluid in the pleural cavity. It is also an easy parameter that makes the proposed method quick to learn and apply.  

A Randomized Controlled Trial Evaluating the See, Tilt, Align, and Rotate (STAR) Maneuver on Skill Acquisition for Simulated Ultrasound-Guided Interventional Procedures.

PubMed

Lam, Nicholas C K; Fishburn, Steven J; Hammer, Angie R; Petersen, Timothy R; Gerstein, Neal S; Mariano, Edward R

2015-06-01

Achieving the best view of the needle and target anatomy when performing ultrasound-guided interventional procedures requires technical skill, which novices may find difficult to learn. We hypothesized that teaching novice performers to use 4 sequential steps (see, tilt, align, and rotate [STAR] method) to identify the needle under ultrasound guidance is more efficient than training with the commonly described probe movements of align, rotate, and tilt (ART). This study compared 2 instructional methods for transducer manipulation including alignment of a probe and needle by novices during a simulated ultrasound-guided nerve block. Right-handed volunteers between the ages of 18 and 55 years who had no previous ultrasound experience were recruited and randomized to 1 of 2 groups; one group was trained to troubleshoot misalignment with the ART method, and the other was trained with the new STAR maneuver. Participants performed the task, consisting of directing a needle in plane to 3 targets in a standardized gelatin phantom 3 times. The performance assessor and data analyst were blinded to group assignment. Thirty-five participants were recruited. The STAR group was able to complete the task more quickly (P < .001) and visualized the needle in a greater proportion of the procedure time (P = .004) compared to the ART group. All STAR participants were able to complete the task, whereas 41% of ART participants abandoned the task (P = .003). Novices are able to complete a simulated ultrasound-guided nerve block more quickly and efficiently when trained with the 4-step STAR maneuver compared to the ART method. © 2015 by the American Institute of Ultrasound in Medicine.

New piezocrystal material in the development of a 96-element array transducer for MR-guided focused ultrasound surgery

NASA Astrophysics Data System (ADS)

Qiu, Zhen; Habeshaw, Roderick; Fortine, Julien; Huang, Zhihong; Démoré, Christine; Cochran, Sandy

2012-11-01

Piezocrystal materials have been recognized as having better performance than piezoelectric ceramics, and have thus been widely adopted in ultrasound imaging arrays. Although their behaviour is susceptible to temperature and pressure, their large electromechanical coupling coefficients and other excellent piezoelectric properties also offer the potential for further improvements in the efficiency of therapeutic ultrasound transducers. Furthermore, new piezocrystals with modified compositions have been developed recently to increase their tolerance to temperature and pressure. In this work, a prototype of faceted bowl transducer was designed and manufactured as a proof of concept to explore practical issues associated with adoption of piezocrystals for magnetic resonance imaging guided focused ultrasound surgery.

[Ultrasound-guided rectus sheath block for upper abdominal surgery].

PubMed

Osaka, Yoshimune; Kashiwagi, Masanori; Nagatsuka, Yukio; Oosaku, Masayoshi; Hirose, Chikako

2010-08-01

Upper abdominal surgery leads to severe postoperative pain. Insufficient postoperative analgesia accompanies a high incidence of complications. Therefore, postoperative analgesia is very important. The epidural analgesia has many advantages. However it has a high risk of epidural hematoma in anticoagulated patients. Rectus sheath block provided safer and more reliable analgesia in recent years, by the development of ultrasound tools. We experienced two cases of the rectus sheath block in upper abdominal surgery under ultrasound guidance. Ultrasound guided rectus sheath block can reduce the risk of peritoneal puncture, bleeding, and other complications. Rectus sheath block is very effective to reduce postoperative pain in upper abdominal surgery as an alternative method to epidural anesthesia in anticoagulated patients.

SU-F-J-55: Feasibility of Supraclavicular Field Treatment by Investigating Variation of Junction Position Between Breast Tangential and Supraclavicular Fields for Deep Inspiration Breath Hold (DIBH) Left Breast Radiation

DOE Office of Scientific and Technical Information (OSTI.GOV)

Zhao, H; Sarkar, V; Paxton, A

Purpose: To explore the feasibility of supraclavicular field treatment by investigating the variation of junction position between tangential and supraclavicular fields during left breast radiation using DIBH technique. Methods: Six patients with left breast cancer treated using DIBH technique were included in this study. AlignRT system was used to track patient’s breast surface. During daily treatment, when the patient’s DIBH reached preset AlignRT tolerance of ±3mm for all principle directions (vertical, longitudinal, and lateral), the remaining longitudinal offset was recorded. The average with standard-deviation and the range of daily longitudinal offset for the entire treatment course were calculated for allmore » six patients (93 fractions totally). The ranges of average ± 1σ and 2σ were calculated, and they represent longitudinal field edge error with the confidence level of 68% and 95%. Based on these longitudinal errors, dose at junction between breast tangential and supraclavicular fields with variable gap/overlap sizes was calculated as a percentage of prescription (on a representative patient treatment plan). Results: The average of longitudinal offset for all patients is 0.16±1.32mm, and the range of longitudinal offset is −2.6 to 2.6mm. The range of longitudinal field edge error at 68% confidence level is −1.48 to 1.16mm, and at 95% confidence level is −2.80 to 2.48mm. With a 5mm and 1mm gap, the junction dose could be as low as 37.5% and 84.9% of prescription dose; with a 5mm and 1mm overlap, the junction dose could be as high as 169.3% and 117.6%. Conclusion: We observed longitudinal field edge error at 95% confidence level is about ±2.5mm, and the junction dose could reach 70% hot/cold between different DIBH. However, over the entire course of treatment, the average junction variation for all patients is within 0.2mm. The results from our study shows it is potentially feasible to treat supraclavicular field with breast tangents.« less

Ultrasound-Guided Forearm Nerve Blocks: A Novel Application for Pain Control in Adult Patients with Digit Injuries

PubMed Central

Patricia Javedani, Parisa; Amini, Albert

2016-01-01

Phalanx fractures and interphalangeal joint dislocations commonly present to the emergency department. Although these orthopedic injuries are not complex, the four-point digital block used for anesthesia during the reduction can be painful. Additionally, cases requiring prolonged manipulation or consultation for adequate reduction may require repeat blockade. This case series reports four patients presenting after mechanical injuries resulting in phalanx fracture or interphalangeal joint dislocations. These patients received an ultrasound-guided peripheral nerve block of the forearm with successful subsequent reduction. To our knowledge, use of ultrasound-guided peripheral nerve blocks of the forearm for anesthesia in reduction of upper extremity digit injuries in adult patients in the emergency department setting has not been described before. PMID:27555971

Ultrasound-Guided Drainage of Supralevator Hematoma in a Hemodynamically Stable Patient.

PubMed

Mukhopadhyay, Debjani; Jennings, Paul E; Banerjee, Mamta; Gada, Ruta

2015-12-01

Paravaginal hematomas can be life-threatening. In patients with intact vaginal walls and perineum, they may pose a diagnostic and therapeutic challenge. Supralevator hematomas are much less common than infralevator hematomas. We present a case of puerperal hemorrhagic shock after a normal vaginal delivery in a low-risk parous woman resulting from an occult supralevator hematoma. Because the woman was hemodynamically unstable initially, she underwent a vaginal surgical drainage. A week later, the supravaginal hematoma reformed. At this time the patient was hemodynamically stable, and ultrasound-guided drainage was performed, which resulted in complete resolution of the hematoma within 10 days. In a clinically stable puerperal patient, ultrasound-guided drainage of a supralevator hematoma resulted in rapid and complete resolution of symptoms.

A pitfall during endobronchial ultrasound-guided transbronchial forceps biopsy of the mediastinal lymph nodes.

PubMed

Krenke, Rafal; Korczynski, Piotr; Gorska, Katarzyna; Chazan, Ryszarda

2014-03-01

The high diagnostic yield and favorable safety profile of endobronchial ultrasound-guided transbronchial forceps biopsy of the mediastinal lymph nodes have been recently demonstrated. We report an unusual technical problem during endobronchial ultrasound-guided transbronchial forceps biopsy that could be a prerequisite for severe complications. A rupture of the steering band precluded closure of the forceps jaws opened in the subcarinal lymph node. A solution to the problem is presented, together with other procedure-related complications reported in the literature. The report emphasizes that a dysfunction of the forceps steering band can result in severe complications when it occurs during transbronchial sampling of mediastinal lesions. Copyright © 2014 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

Acute Calcific Bursitis After Ultrasound-Guided Percutaneous Barbotage of Rotator Cuff Calcific Tendinopathy: A Case Report.

PubMed

Kang, Bo-Sung; Lee, Seung Hak; Cho, Yung; Chung, Sun Gun

2016-08-01

Ultrasound-guided percutaneous barbotage is an effective treatment for rotator cuff calcific tendinopathy, providing rapid and substantial pain relief. We present the case of a 49-year-old woman with aggravated pain early after ultrasound-guided barbotage of a large calcific deposit in the supraspinatus tendon. Subsequent examination revealed a thick calcification spreading along the subacromial-subdeltoid bursa space, suggesting acute calcific bursitis complicated by barbotage. Additional barbotage alleviated her pain completely. Therefore, a high index of suspicion for acute calcific bursitis is required in patients with unresolved or aggravated pain after barbotage. Repeated barbotage could be effective for this condition. Copyright © 2016 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

Ultrasound-guided thrombin injection of genicular artery pseudoaneurysm.

PubMed

Rachakonda, Aditya; Qato, Khalil; Khaddash, Tamim; Carroccio, Alfio; Pamoukian, Vicken; Giangola, Gary

2015-07-01

Pseudoaneurysm is a rare complication after arthroscopic procedures involving the knee. A 38-year-old man presented 1 month after right-knee arthroscopy with a 2-cm pulsating mass on the medial side of the right knee. Duplex ultrasound evaluation revealed 2.5 × 2.1-cm pseudoaneurysm just distal to the patella with arterialized flow communicating with the inferior medial genicular artery. Ultrasound-guided thrombin injection was performed in an office setting, and the resolution of active flow within the pseudoaneurysm was confirmed with duplex ultrasonography. Copyright © 2015 Elsevier Inc. All rights reserved.

Case report: ultrasound-guided continuous thoracic paravertebral block for outpatient acute pain management of multilevel unilateral rib fractures.

PubMed

Murata, Hiroaki; Salviz, Emine Aysu; Chen, Stephanie; Vandepitte, Catherine; Hadzic, Admir

2013-01-01

A 61-year-old man with multiple unilateral rib fractures (T3-T8) gained the ability to breathe deeply and to ambulate after ultrasound-guided continuous thoracic paravertebral block and was discharged home after being observed for 15 hours after the block. The ultrasound guidance was helpful in determining the site of rib fractures and the optimal level for catheter placement. This report also discusses the management of analgesia using continuous paravertebral block in an outpatient with trauma.

Endoscopic ultrasonography guided drainage: Summary of consortium meeting, May 21, 2012, San Diego, California

PubMed Central

Kahaleh, Michel; Artifon, Everson LA; Perez-Miranda, Manuel; Gaidhane, Monica; Rondon, Carlos; Itoi, Takao; Giovannini, Marc

2015-01-01

Endoscopic retrograde cholangiopancreatography (ERCP) is the preferred procedure for biliary and pancreatic drainage. While ERCP is successful in about 95% of cases, a small subset of cases are unsuccessful due to altered anatomy, peri-ampullary pathology, or malignant obstruction. Endoscopic ultrasound-guided drainage is a promising technique for biliary, pancreatic and recently gallbladder decompression, which provides multiple advantages over percutaneous or surgical biliary drainage. Multiple retrospective and some prospective studies have shown endoscopic ultrasound-guided drainage to be safe and effective. Based on the currently reported literature, regardless of the approach, the cumulative success rate is 84%-93% with an overall complication rate of 16%-35%. endoscopic ultrasound-guided drainage seems a viable therapeutic modality for failed conventional drainage when performed by highly skilled advanced endoscopists at tertiary centers with expertise in both echo-endoscopy and therapeutic endoscopy PMID:25624708

Endobronchial ultrasound-guided transbronchial needle aspiration of thyroid: Report of two cases and systematic review of literature

PubMed Central

Madan, Karan; Mittal, Saurabh; Hadda, Vijay; Jain, Deepali; Mohan, Anant; Guleria, Randeep

2016-01-01

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a minimally invasive and safe technique for a sampling of mediastinal lesions. Indications for EBUS-TBNA have gradually expanded since its introduction. The usual approach to cytological sampling of the thyroid gland is percutaneous ultrasound-guided fine needle aspiration (US-FNA) performed under local anesthesia. US-FNA may be risky or not feasible in intrathoracic/substernal thyroid location. Feasibility of aspirating thyroid lesions with EBUS-TBNA has been occasionally reported. We report two patients wherein EBUS-TBNA was utilized for thyroid lesion aspiration and definitive diagnosis. We highlight the utility and safety of EBUS-TBNA in the evaluation of intrathoracic thyroid lesions wherein image-guided percutaneous aspiration may be risky/sometimes impossible to perform. A systematic review of literature has also been performed summarizing and discussing the issues pertaining to EBUS-TBNA of the thyroid gland. PMID:27891005

Simulation and training of ultrasound supported anaesthesia: a low-cost approach

NASA Astrophysics Data System (ADS)

Schaaf, T.; Lamontain, M.; Hilpert, J.; Schilling, F.; Tolxdorff, T.

2010-03-01

The use of ultrasound imaging technology during techniques of peripheral nerve blockade offers several clinical benefits. Here we report on a new method to educate residents in ultrasound-guided regional anesthesia. The daily challenge for the anesthesiologists is the 3D angle-depending handling of the stimulation needle and the ultrasound probe while watching the 2D ultrasound image on the monitor. Purpose: Our approach describes how a computer-aided simulation and training set for ultrasound-guided regional anesthesia could be built based on wireless low-cost devices and an interactive simulation of a 2D ultrasound image. For training purposes the injection needle and the ultrasound probe are replaced by wireless Bluetooth-connected 3D tracking devices, which are embedded in WII-mote controllers (Nintendo-Brand). In correlation to the tracked 3D positions of the needle and transducer models the visibility and position of the needle should be simulated in the 2D generated ultrasound image. Conclusion: In future, this tracking and visualization software module could be integrated in a more complex training set, where complex injection paths could be trained based on a 3D segmented model and the training results could be part of a curricular e-learning module.

Clinical and sonographic risk factors and complications of shoulder dystocia - a case-control study with parity and gestational age matched controls.

PubMed

Parantainen, Jukka; Palomäki, Outi; Talola, Nina; Uotila, Jukka

2014-06-01

To examine the clinical risk factors and complications of shoulder dystocia today and to evaluate ultrasound methods predicting it. Retrospective, matched case-control study at a University Hospital with 5000 annual deliveries. The study population consisted of 152 deliveries complicated by shoulder dystocia over a period of 8.5 years (January 2004-June 2012) and 152 controls matched for gestational age and parity. The data was collected from the medical records of mothers and children and analyzed by conditional logistic regression. Incidences and odds ratios were calculated for risk factors and complications. Antenatal ultrasound data was analyzed when available by conditional logistic regression to test for significant differences between study groups. Birthweight (OR 12.1 for ≥4000 g; 95% CI 4.18-35.0) and vacuum extraction (OR 3.98; 95% CI 1.25-12.7) remained the most significant clinical risk factors. Only a trend of an association of pregestational or gestational diabetes was noticed (OR 1.87; 95% CI 0.997-3.495, probability of type II error 51%). Of the complications of shoulder dystocia the incidence of brachial plexus palsies was high (40%). Antenatal ultrasound method based on the difference between abdominal and biparietal diameters had a significant difference between cases and controls. The impact of diabetes as a risk factor has diminished, which may reflect improved screening and treatment. Antenatal ultrasound methods are showing some promise, but the predictive value of ultrasound alone is probably low. Copyright © 2014. Published by Elsevier Ireland Ltd.

Axillary brachial plexus block duration with mepivacaine in patients with chronic renal failure. Case-control study.

PubMed

Mojica, V; Nieuwveld, D; Herrera, A E; Mestres, G; López, A M; Sala-Blanch, X

2017-04-01

Regional anaesthesia is commonly preferred for arteriovenous fistula (AVF) creation. Previous studies suggest a shorter block duration in patients with chronic renal failure, maybe because of the changes in regional blood flow. The aim of our study was to evaluate the duration of the axillary block with 1.5% mepivacaine in patients with chronic renal failure scheduled for AVF compared with healthy controls. Patients scheduled for AVF creation for the first time (GIRC) were included. They were compared with patients without renal failure (GC), with similar anthropometric characteristics. Ultrasound-guided axillary blocks with 20mL of 1.5% mepivacaine were performed on all patients. We evaluated onset time, humeral artery diameter and blood flow before and after the block, as well as the block duration. Twenty-three patients (GIRC: 12 and GC: 11) were included. No differences between groups were observed in block duration (GIRC: 227±43min vs GC: 229±27min; P=.781), or in onset time (GIRC: 13±5min vs GC: 12.2±3min; P=.477). The humeral blood flow before and after block was significantly lower in the GIRC (pre-block: GIRC: 52±21ml/min GC: 100±62ml/min; P=.034 and p ost block: GIRC: 130±57ml/min and GC: 274±182ml/min; P=.010). There was no significant correlation between the duration of the block and the preblock humeral blood flow (Spearman Rho: 0.106; P=.657) or the postblock humeral blood flow (Spearman Rho: 0.267; P=.254). The duration of the axillary block with 1.5% mepivacaine in patients with chronic renal failure was similar to that of the control patients. The duration of axillary brachial plexus block seems not to be related to changes in regional blood flow. Copyright © 2016 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.

Which is your choice for prolonging the analgesic duration of single-shot interscalene brachial blocks for arthroscopic shoulder surgery? intravenous dexamethasone 5 mg vs. perineural dexamethasone 5 mg randomized, controlled, clinical trial.

PubMed

Chun, Eun Hee; Kim, Youn Jin; Woo, Jae Hee

2016-06-01

The aim of this study was to compare the effect of intravenous (I.V.) dexamethasone with that of perineural dexamethasone on the prolongation of analgesic duration of single-shot interscalene brachial plexus blocks (SISB) in patients undergoing arthroscopic shoulder surgery. We performed a prospective, randomized, double-blind, placebo-controlled study. Patients undergoing elective arthroscopic shoulder surgery with ultrasound-guided SISB were enrolled and randomized into 2 groups. A total volume of 12 mL of the study drug was prepared with a final concentration of 0.5% ropivacaine. In the I.V. group, patients received SISB using ropivacaine 5 mg mL with normal saline (control) with dexamethasone 5 mg I.V. injection. In the perineural group, patients received SISB using ropivacaine 5 mg mL with dexamethasone 5 mg, with normal saline 1 mL I.V. injection. The primary outcome was the time to the first analgesic request, defined as the time between the end of the operation and the first request of analgesics by the patient. The secondary outcomes included patient satisfaction scores, side effects, and neurological symptoms. Patients were randomly assigned to 1 of the 2 groups using a computer-generated randomization table. An anesthesiologist blinded to the group assignments prepared the solutions for injection. The patients and the investigator participating in the study were also blinded to the group assignments. One hundred patients were randomized. Data were analyzed for 99 patients. One case in the I.V. group was converted to open surgery and was therefore not included in the study. Perineural dexamethasone significantly prolonged analgesic duration (median, standard error: 1080 minutes, 117.5 minutes) compared with I.V. dexamethasone (810 minutes, 48.1 minutes) (P = 0.02). There were no significant differences in side effects, neurological symptoms, or changes in blood glucose values between the 2 groups. Our results show that perineural dexamethasone 5 mg is more effective than I.V. dexamethasone 5 mg with regard to analgesic duration of SISB for arthroscopic shoulder surgery.

Internal Medicine Point-of-Care Ultrasound Curriculum: Consensus Recommendations from the Canadian Internal Medicine Ultrasound (CIMUS) Group.

PubMed

Ma, Irene W Y; Arishenkoff, Shane; Wiseman, Jeffrey; Desy, Janeve; Ailon, Jonathan; Martin, Leslie; Otremba, Mirek; Halman, Samantha; Willemot, Patrick; Blouw, Marcus

2017-09-01

Bedside point-of-care ultrasound (POCUS) is increasingly used to assess medical patients. At present, no consensus exists for what POCUS curriculum is appropriate for internal medicine residency training programs. This document details the consensus-based recommendations by the Canadian Internal Medicine Ultrasound (CIMUS) group, comprising 39 members, representing 14 institutions across Canada. Guiding principles for selecting curricular content were determined a priori. Consensus was defined as agreement by at least 80% of the members on POCUS applications deemed appropriate for teaching and assessment of trainees in the core (internal medicine postgraduate years [PGY] 1-3) and expanded (general internal medicine PGY 4-5) training programs. We recommend four POCUS applications for the core PGY 1-3 curriculum (inferior vena cava, lung B lines, pleural effusion, and abdominal free fluid) and three ultrasound-guided procedures (central venous catheterization, thoracentesis, and paracentesis). For the expanded PGY 4-5 curriculum, we recommend an additional seven applications (internal jugular vein, lung consolidation, pneumothorax, knee effusion, gross left ventricular systolic function, pericardial effusion, and right ventricular strain) and four ultrasound-guided procedures (knee arthrocentesis, arterial line insertion, arterial blood gas sampling, and peripheral venous catheterization). These recommendations will provide a framework for training programs at a national level.

Supraclavicular Artery Flap for Head and Neck Oncologic Reconstruction: An Emerging Alternative

PubMed Central

Shenoy, Ashok; Patil, Vijayraj S.; Prithvi, B. S.; Chavan, P.; Halkud, Rajshekar

2013-01-01

Aim. Head and Neck oncologic resections often leave complex defects which are challenging to reconstruct. The need of the hour is a versatile flap which has the advantages of both a regional flap (viz. reliable and easy to harvest) and a free flap (thin, pliable with good colour match). In this a study we assessed the usefulness of the supraclavicular artery flap in head and neck oncologic defects. Materials and Method. The flap was used as a pedicled fasciocutanous and was based on the transverse supraclavicular artery. We assessed this reconstructive option for complications as well as its and functional out comes. Results. Eleven cases underwent supraclavicular artery flap between 20011-2012 of which 5 were males and 6 females. Mean defect size was 5 cm × 6 cm. Nine donor sites were closed primarily and 1 required split skin grafting. We encountered one complete flap loss which was attributed to a band of constricting skin bridge over the vascular pedicle in a defect involving lateral third of midface. Two patient developed pharyngeocutaneous fistula (without flap loss) out of 3 patients who underwent augmentation pharyngoplasty post Near total laryngectomy. Conclusion. Supra clavicular artery flap is a thin versatile, reliable, easy to harvest, with good cosmetic and functional outcome at both ends (recipient and donor) for reconstructing head and neck oncologic defects. PMID:24490064

Casualty Evacuation in the Contemporary Operating Environment

DTIC Science & Technology

2002-05-20

HIFU ), or Focused Ultrasound ( FUS ), can be used to rapidly kill tissue (directly applicable to cancer treatment, for example) and to stop internal...132 Peter Kaczkowski, Development of a High-Intensity Focused Ultrasound System for Image-guided Ultrasound Surgery...spatial dimension, with acquisition and display occurring nearly in real time.135 Recent research has shown that High Intensity Focused Ultrasound

Treatment of Partial Rotator Cuff Tear with Ultrasound-guided Platelet-rich Plasma.

PubMed

Sengodan, Vetrivel Chezian; Kurian, Sajith; Ramasamy, Raghupathy

2017-01-01

The treatment of symptomatic partial rotator cuff tear has presented substantial challenge to orthopaedic surgeons as it can vary from conservative to surgical repair. Researches have established the influence of platelet rich plasma in healing damaged tissue. Currently very few data are available regarding the evidence of clinical and radiological outcome of partial rotator cuff tear treated with ultrasound guided platelet rich plasma injection in English literature. 20 patients with symptomatic partial rotator cuff tears were treated with ultrasound guided platelet rich plasma injection. Before and after the injection of platelet rich plasma scoring was done with visual analogue score, Constant shoulder score, and UCLA shoulder score at 8 weeks and third month. A review ultrasound was performed 8 weeks after platelet rich plasma injection to assess the rotator cuff status. Our study showed statistically significant improvements in 17 patients in VAS pain score, constant shoulder score and UCLA shoulder score. No significant changes in ROM were noted when matched to the contra-lateral side ( P < 0.001) at the 3 month follow-up. The study also showed good healing on radiological evaluation with ultrasonogram 8 weeks after platelet rich plasma injection. Ultrasound guided platelet rich plasma injection for partial rotator cuff tears is an effective procedure that leads to significant decrease in pain, improvement in shoulder functions, much cost-effective and less problematic compared to a surgical treatment.

Value of cytopathologist-performed ultrasound-guided fine-needle aspiration as a screening test for ultrasound-guided core-needle biopsy in nonpalpable breast masses.

PubMed

Lieu, David

2009-04-01

Fine-needle aspiration (FNA) of breast masses in the United States has been on the decline for the last decade and has been largely replaced by ultrasound-guided core-needle biopsy (UG-CNB). Some studies show core-needle biopsy (CNB) is superior to FNA in terms of absolute sensitivity, specificity, and inadequate rate. However, the importance of a skilled aspirator, experienced cytopathologist, and immediate cytological evaluation (ICE) in FNA is often not considered. CNB is more expensive, invasive, risky, and painful than FNA. This prospective study examines the value of cytopathologist-performed ultrasound-guided FNA (UG-FNA) with ICE as a screening test for cytopathologist-performed UG-CNB on nonpalpable or difficult-to-palpate solid breast masses visible on ultrasound. One hundred twenty consecutive nonpalpable or difficult-to-palpate presumably solid breast masses in 109 female patients from January2, 2008 to June 30, 2008 underwent cytopathologist-performed UG-FNA with ICE. Twenty cases were converted to cytopathologist-performed UG-CNB because ICE was inadequate, hypocellular, atypical, suspicious, or malignant. Patients with clearly benign cytology did not undergo UG-CNB. UG-FNA with ICE reduced the percentage of patients undergoing UG-CNB by 87%. A new role for cytopathologist-performed UG-FNA of nonpalpable breast masses has been identified.

Medical Ultrasound Technology Research and Development at the University of Washington Center for Industrial and Medical Ultrasound

DTIC Science & Technology

2003-10-02

provide a world-class, advanced research center for bioengineering development and graduate education in high-intensity, focused ultrasound ( HIFU ). This...convenient, and robust. These technological enhancements have enabled the development of HIFU arrays and image-guided ultrasound systems for greater... Ultrasound (CIMU). The many disparate facilities and technical capabilities available to CIMU staff and students were integrated and enhanced to

Fiber optic photoacoustic probe with ultrasonic tracking for guiding minimally invasive procedures

NASA Astrophysics Data System (ADS)

Xia, Wenfeng; Mosse, Charles A.; Colchester, Richard J.; Mari, Jean Martial; Nikitichev, Daniil I.; West, Simeon J.; Ourselin, Sebastien; Beard, Paul C.; Desjardins, Adrien E.

2015-07-01

In a wide range of clinical procedures, accurate placement of medical devices such as needles and catheters is critical to optimize patient outcomes. Ultrasound imaging is often used to guide minimally invasive procedures, as it can provide real-time visualization of patient anatomy and medical devices. However, this modality can provide low image contrast for soft tissues, and poor visualization of medical devices that are steeply angled with respect to the incoming ultrasound beams. Photoacoustic sensors can provide information about the spatial distributions of tissue chromophores that could be valuable for guiding minimally invasive procedures. In this study, a system for guiding minimally invasive procedures using photoacoustic sensing was developed. This system included a miniature photoacoustic probe with three optical fibers: one with a bare end for photoacoustic excitation of tissue, a second for photoacoustic excitation of an optically absorbing coating at the distal end to transmit ultrasound, and a third with a Fabry-Perot cavity at the distal end for receiving ultrasound. The position of the photoacoustic probe was determined with ultrasonic tracking, which involved transmitting pulses from a linear-array ultrasound imaging probe at the tissue surface, and receiving them with the fiber-optic ultrasound receiver in the photoacoustic probe. The axial resolution of photoacoustic sensing was better than 70 μm, and the tracking accuracy was better than 1 mm in both axial and lateral dimensions. By translating the photoacoustic probe, depth scans were obtained from different spatial positions, and two-dimensional images were reconstructed using a frequency-domain algorithm.

Feasibility of ultrasound-guided epidural access at the lumbo-sacral space in dogs.

PubMed

Liotta, Annalisa; Busoni, Valeria; Carrozzo, Maria Valentina; Sandersen, Charlotte; Gabriel, Annick; Bolen, Géraldine

2015-01-01

Epidural injections are commonly performed blindly in veterinary medicine. The aims of this study were to describe the lumbosacral ultrasonographic anatomy and to assess the feasibility of an ultrasound-guided epidural injection technique in dogs. A cross sectional anatomic atlas of the lumbosacral region and ex vivo ultrasound images were obtained in two cadavers to describe the ultrasound anatomy and to identify the landmarks. Sixteen normal weight canine cadavers were used to establish two variations of the technique for direct ultrasound-guided injection, using spinal needles or epidural catheters. The technique was finally performed in two normal weight cadavers, in two overweight cadavers and in five live dogs with radiographic abnormalities resulting of the lumbosacral spine. Contrast medium was injected and CT was used to assess the success of the injection. The anatomic landmarks to carry out the procedure were the seventh lumbar vertebra, the iliac wings, and the first sacral vertebra. The target for directing the needle was the trapezoid-shaped echogenic zone between the contiguous articular facets of the lumbosacral vertebral canal visualized in a parasagittal plane. The spinal needle or epidural catheter was inserted in a 45° craniodorsal-caudoventral direction through the subcutaneous tissue and the interarcuate ligament until reaching the epidural space. CT examination confirmed the presence of contrast medium in the epidural space in 25/25 dogs, although a variable contamination of the subarachnoid space was also noted. Findings indicated that this ultrasound-guided epidural injection technique is feasible for normal weight and overweight dogs, with and without radiographic abnormalities of the spine. © 2014 American College of Veterinary Radiology.

Long-term follow-up of ultrasound-guided botulinum toxin-A injections for sialorrhea in neurological dysphagia.

PubMed

Barbero, Pierangelo; Busso, Marco; Tinivella, Marco; Artusi, Carlo Alberto; De Mercanti, Stefania; Cucci, Angele; Veltri, Andrea; Avagnina, Paolo; Calvo, Andrea; Chio', Adriano; Durelli, Luca; Clerico, Marinella

2015-12-01

Literature provides reports only of a limited follow-up single injection of botulinum toxin-A (BoNT-A) in patients with sialorrhea. The aim of our study is to evaluate the long-lasting efficacy and safety of ultrasound-guided BoNT-A injections for severe sialorrhea secondary to neurological dysphagia. We enrolled 38 severe adult sialorrhea patients referred consecutively to the neurology unit and performed bilateral parotid and submandibular gland BoNT-A injections under ultrasound guidance. The outcomes of the study were reduction of sialorrhea, duration of therapeutic effect, and subjective patient- and caregiver-reported satisfaction. A total of 113 BoNT-A administrations were given during the study period with a mean duration of follow-up of 20.2 ± 4.4 months. We observed a significant decrease from baseline in mean number of daily aspirations and a significant improvement in patient- and caregiver-reported outcomes following ultrasound-guided BoNT-A injections (p < 0.001 vs baseline for all comparisons) and the mean duration of the efficacy was 5.6 ± 1 months. No major treatment-related adverse events occurred and a low incidence of minor adverse events was reported. This study confirms the long-lasting efficacy and safety of ultrasound-guided BoNT-A injections for sialorrhea, regardless of the causative neurological disorder. These results should encourage the use of BoNT-A in the treatment of severe sialorrhea and highlight the role of ultrasound guidance to obtain optimal results in terms of safety and reproducible outcomes.

Ultrasound-guided, percutaneous peripheral nerve stimulation: technical note.

PubMed

Chan, Isaac; Brown, Anthony R; Park, Kenneth; Winfree, Christopher J

2010-09-01

Peripheral nerve stimulation is a form of neuromodulation that applies electric current to peripheral nerves to induce stimulation paresthesias within the painful areas. To report a method of ultrasound-guided, percutaneous peripheral nerve stimulation. This technique utilizes real-time imaging to avoid injury to adjacent vascular structures during minimally invasive placement of peripheral nerve stimulator electrodes. We describe a patient that presented with chronic, bilateral foot pain following multiple foot surgeries, for whom a comprehensive, pain management treatment strategy had failed. We utilized ultrasound-guided, percutaneous tibial nerve stimulation at a thigh level to provide durable pain relief on the right side, and open peripheral nerve stimulation on the left. The patient experienced appropriate stimulation paresthesias and excellent pain relief on the plantar aspect of the right foot with the percutaneous electrode. On the left side, we were unable to direct the stimulation paresthesias to the sole of the foot, despite multiple electrode repositionings. A subsequent, open placement of a left tibial nerve stimulator was performed. This revealed that the correct electrode position against the tibial nerve was immediately adjacent to the popliteal artery, and was thus not appropriate for percutaneous placement. We describe a method of ultrasound-guided peripheral nerve stimulation that avoids the invasiveness of electrode placement via an open procedure while providing excellent pain relief. We further describe limitations of the percutaneous approach when navigating close to large blood vessels, a situation more appropriately managed with open peripheral nerve stimulator placement. Ultrasound-guided placement may be considered for patients receiving peripheral nerve stimulators placed within the deep tissues, and not easily placed in a blind fashion.

[Assessment of amylase and lipase levels following puncture biopsy and fine needle aspiration guided by endoscopic ultrasound in pancreatic lesions].

PubMed

Membrillo-Romero, Alejandro; Gonzalez-Lanzagorta, Rubén; Rascón-Martínez, Dulce María

Puncture biopsy and fine needle aspiration guided by endoscopic ultrasound has been used as an effective technique and is quickly becoming the procedure of choice for diagnosis and staging in patients suspected of having pancreatic cancer. This procedure has replaced retrograde cholangiopancreatography and brush cytology due to its higher sensitivity for diagnosis, and lower risk of complications. To assess the levels of pancreatic enzymes amylase and lipase, after the puncture biopsy and fine needle aspiration guided by endoscopic ultrasound in pancreatic lesions and the frequency of post-puncture acute pancreatitis. A longitudinal and descriptive study of consecutive cases was performed on outpatients submitted to puncture biopsy and fine needle aspiration guided by endoscopic ultrasound in pancreatic lesions. Levels of pancreatic enzymes such as amylase and lipase were measured before and after the pancreatic puncture. Finally we documented post-puncture pancreatitis cases. A total of 100 patients who had been diagnosed with solid and cystic lesions were included in the study. Significant elevation was found at twice the reference value for lipase in 5 cases (5%) and for amylase in 2 cases (2%), none had clinical symptoms of acute pancreatitis. Eight (8%) of patients presented with mild nonspecific pain with no enzyme elevation compatible with pancreatitis. Pancreatic biopsy needle aspiration guided by endoscopic ultrasound was associated with a low rate of elevated pancreatic enzymes and there were no cases of post-puncture pancreatitis. Copyright © 2016 Academia Mexicana de Cirugía A.C. Publicado por Masson Doyma México S.A. All rights reserved.

Safety of Ultrasound-Guided Botulinum Toxin Injections for Sialorrhea as Performed by Pediatric Otolaryngologists.

PubMed

Shariat-Madar, Bahbak; Chun, Robert H; Sulman, Cecille G; Conley, Stephen F

2016-05-01

To evaluate incidence of complications and hospital readmission as a result of ultrasound-guided botulinum toxin injections to manage sialorrhea. Case series with chart review. Children's Hospital of Wisconsin. A case series with chart review was performed of all cases of ultrasound-guided injection of botulinum toxin by pediatric otolaryngologists from March 5, 2010, to September 26, 2014,. Primary outcomes included complications such as dysphagia, aspiration pneumonia, and motor paralysis. Secondary outcomes included hospitalization, intubation, and nasogastric tube placement. There were 48 patients, 111 interventions, and 306 intraglandular injections identified. Botulinum toxin type A and type B were utilized in 4 and 107 operative interventions, respectively. Type A was injected into 4 parotid and 4 submandibular glands, utilizing doses of 20 U per parotid and 30 U per submandibular gland. Type B was injected into 98 parotid and 200 submandibular glands, with average dosing of 923 U per parotid and 1170 U per submandibular gland, respectively. There were 2 instances of subjectively worsening of baseline dysphagia that self-resolved. No cases were complicated by aspiration pneumonia or motor paralysis. No patients required hospital readmission, intubation, or nasogastric tube placement. Prior published data indicated 16% complication incidence with ultrasound-guided injection of botulinum toxin. Our study found a low complication rate (0.6%) with ultrasound-guided injections of botulinum toxin to manage sialorrhea, without cases of aspiration pneumonia or motor paralysis. Of 306 intraglandular injections, there were 2 cases of worsening baseline subjective dysphagia that self-resolved. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2016.

Ultrasound as a Screening Tool for Central Venous Catheter Positioning and Exclusion of Pneumothorax.

PubMed

Amir, Rabia; Knio, Ziyad O; Mahmood, Feroze; Oren-Grinberg, Achikam; Leibowitz, Akiva; Bose, Ruma; Shaefi, Shahzad; Mitchell, John D; Ahmed, Muneeb; Bardia, Amit; Talmor, Daniel; Matyal, Robina

2017-07-01

Although real-time ultrasound guidance during central venous catheter insertion has become a standard of care, postinsertion chest radiograph remains the gold standard to confirm central venous catheter tip position and rule out associated lung complications like pneumothorax. We hypothesize that a combination of transthoracic echocardiography and lung ultrasound is noninferior to chest radiograph when used to accurately assess central venous catheter positioning and screen for pneumothorax. All operating rooms and surgical and trauma ICUs at the institution. Single-center, prospective noninferiority study. Patients receiving ultrasound-guided subclavian or internal jugular central venous catheters. During ultrasound-guided central venous catheter placement, correct positioning of central venous catheter was accomplished by real-time visualization of the guide wire and positive right atrial swirl sign using the subcostal four-chamber view. After insertion, pneumothorax was ruled out by the presence of lung sliding and seashore sign on M-mode. Data analysis was done for 137 patients. Chest radiograph ruled out pneumothorax in 137 of 137 patients (100%). Lung ultrasound was performed in 123 of 137 patients and successfully screened for pneumothorax in 123 of 123 (100%). Chest radiograph approximated accurate catheter tip position in 136 of 137 patients (99.3%). Adequate subcostal four-chamber views could not be obtained in 13 patients. Accurate positioning of central venous catheter with ultrasound was then confirmed in 121 of 124 patients (97.6%) as described previously. Transthoracic echocardiography and lung ultrasound are noninferior to chest x-ray for screening of pneumothorax and accurate central venous catheter positioning. Thus, the point of care use of ultrasound can reduce central venous catheter insertion to use time, exposure to radiation, and improve patient safety.

The pattern of lymphatic metastasis of breast cancer and its influence on the delineation of radiation fields

DOE Office of Scientific and Technical Information (OSTI.GOV)

Yu Jinming; Li Gong; Li Jianbin

2005-03-01

Purpose: The delineation of radiation fields should cover the clinical target volume (CTV) and minimally irradiate the surrounding normal tissues and organs. This study was designed to explore the pattern of lymphatic metastasis of breast cancer and indications for radiotherapy after radical or modified radical mastectomy and to discuss the rational delineation of radiation fields. Methods and materials: Between September 1980 and December 2003, 78 breast cancer patients receiving extended radical mastectomy in the Margottini model and 61 cases with complete data were analyzed to investigate the internal mammary lymphatic metastatic status. Between March 1988 and December 1988, 46 patientsmore » with clinical negative supraclavicular nodes received radical mastectomy plus supraclavicular lymph node dissection. The supraclavicular lymph nodes and axillary lymph nodes were labeled as S and levels I, II, or III, respectively, and examined pathologically. Between January 1996 and April 1999, 412 patients who had radical or modified radical mastectomy underwent the pathologic examination of axillary or levels I, II, or III nodes. Results: The incidence of internal mammary lymph node metastasis was 24.6%. It was 36.7% for the patients with positive axillary lymph nodes and 12.9% for the patients with negative axillary lymph nodes. All the metastatic internal mammary lymph nodes were located at the first, second, and third intercostal spaces. Skipping metastasis of the supraclavicular and axillary lymph nodes was observed in 3.8% and 8.1% of patients, respectively. Conclusions: According to our data, we suggest that the radiation field for internal mammary lymph nodes should exclude the fourth and fifth intercostal spaces, which may help to reduce the radiation damage to heart. It is unnecessary to irradiate the supraclavicular lymph nodes for the patients with negative axillary level III nodes, even with positive level I and level II nodes.« less

Presence of brown adipose tissue in an adolescent with severe primary hypothyroidism.

PubMed

Kim, Mimi S; Hu, Houchun H; Aggabao, Patricia C; Geffner, Mitchell E; Gilsanz, Vicente

2014-09-01

Brown adipose tissue (BAT) generates heat during adaptive thermogenesis in response to cold temperature. Thyroid hormone (TH) receptors, type 2 deiodinase, and TSH receptors are present on brown adipocytes, indicating that the thyroid axis regulates BAT. It is unknown whether absent TH in humans would down-regulate development of BAT and its thermogenic function. The objective of the study was to examine BAT by magnetic resonance imaging (MRI) and infrared thermal imaging (IRT) in a pediatric patient with severe primary hypothyroidism before and after TH treatment. This study was a case report with longitudinal follow-up in a tertiary center. BAT fat fraction (FF) by MRI and skin temperature by IRT were measured. An 11.5-year-old female was severely hypothyroid (TSH, 989 μIU/mL; free T4, 0.10 ng/dL; low thyroglobulin, 3.0 ng/mL). Low MRI measures of FF (56.1% ± 3.7%) indicated that BAT was abundantly present in the supraclavicular fossa. IRT showed higher supraclavicular temperature (36.0°C ±0.16°C) than the suprasternal area (34.3°C ± 0.19°C). After 2 months of TH replacement, she was euthyroid (TSH, 4.3 μIU/mL; free T4, 1.49 ng/dL; T3, 102 ng/dL) at which time supraclavicular BAT decreased (increased FF 60.7% ± 3.8%). IRT showed a higher, more homogeneous skin temperature throughout the upper thorax (supraclavicular, 37.1°C ± 0.23°C; suprasternal, 36.4°C ± 0.13°C). The overall size of the supraclavicular fat depot decreased from 84.79 cm(3) to 41.21 cm(3). These findings document the presence of BAT and thermogenesis in profound hypothyroidism and suggest a role for TSH and/or TRH as a potential regulator of BAT.

Feasibility of MRI-guided Focused Ultrasound as Organ-Sparing Treatment for Testicular Cancer

NASA Astrophysics Data System (ADS)

Staruch, Robert; Curiel, Laura; Chopra, Rajiv; Hynynen, Kullervo

2009-04-01

High cure rates for testicular cancer have prompted interest in organ-sparing surgery for patients with bilateral disease or single testis. Focused ultrasound (FUS) ablation could offer a noninvasive approach to organ-sparing surgery. The objective of this study was to determine the feasibility of using MR thermometry to guide organ-sparing focused ultrasound surgery in the testis. The testes of anesthetized rabbits were sonicated in several discrete locations using a single-element focused transducer operating at 2.787MHz. Focal heating was visualized with MR thermometry, using a measured PRF thermal coefficient of -0.0089±0.0003 ppm/° C. Sonications at 3.5-14 acoustic watts applied for 30 seconds produced maximum temperature elevations of 10-80° C, with coagulation verified by histology. Coagulation of precise volumes in the testicle is feasible with MRI-guided focused ultrasound. Variability in peak temperature for given sonication parameters suggests the need for online temperature feedback control.

Photoacoustic-guided ultrasound therapy with a dual-mode ultrasound array

NASA Astrophysics Data System (ADS)

Prost, Amaury; Funke, Arik; Tanter, Mickaël; Aubry, Jean-François; Bossy, Emmanuel

2012-06-01

Photoacoustics has recently been proposed as a potential method to guide and/or monitor therapy based on high-intensity focused ultrasound (HIFU). We experimentally demonstrate the creation of a HIFU lesion at the location of an optical absorber, by use of photoacoustic signals emitted by the absorber detected on a dual mode transducer array. To do so, a dedicated ultrasound array intended to both detect photoacoustic waves and emit HIFU with the same elements was used. Such a dual-mode array provides automatically coregistered reference frames for photoacoustic detection and HIFU emission, a highly desired feature for methods involving guidance or monitoring of HIFU by use of photoacoustics. The prototype is first characterized in terms of both photoacoustic and HIFU performances. The probe is then used to perform an idealized scenario of photoacoustic-guided therapy, where photoacoustic signals generated by an absorbing thread embedded in a piece of chicken breast are used to automatically refocus a HIFU beam with a time-reversal mirror and necrose the tissue at the location of the absorber.

Focused Ultrasound Surgery in Oncology: Overview and Principles

PubMed Central

McDannold, Nathan J.; Hynynen, Kullervo; Jolesz, Ferenc A.

2011-01-01

Focused ultrasound surgery (FUS) is a noninvasive image-guided therapy and an alternative to surgical interventions. It presents an opportunity to revolutionize cancer therapy and to affect or change drug delivery of therapeutic agents in new focally targeted ways. In this article the background, principles, technical devices, and clinical cancer applications of image-guided FUS are reviewed. © RSNA, 2011 PMID:21436096

Value of Artisanal Simulators to Teach Ultrasound-Guided Percutaneous Biopsy Using a Tru-Cut Needle for Veterinary and Medical Students

ERIC Educational Resources Information Center

de Araújo Setin, Raíza; Fortes Cirimbelli, Carolina; Mazeto Ercolin, Anna Carolina; Pires, Sâmara Turbay; Disselli, Tamiris; Ferrarini Nunes Soares Hage, Maria Cristina

2018-01-01

The present study aimed to evaluate the applicability of artisanal simulators to teach veterinary and medical students the ultrasound-guided percutaneous biopsy using a tru-cut needle. The artisanal simulators consisted of bovine liver between two layers of commercially available grape gelatin. Students were paired, with one doing the biopsy and…

Ultrasound guided electrical impedance tomography for 2D free-interface reconstruction

NASA Astrophysics Data System (ADS)

Liang, Guanghui; Ren, Shangjie; Dong, Feng

2017-07-01

The free-interface detection problem is normally seen in industrial or biological processes. Electrical impedance tomography (EIT) is a non-invasive technique with advantages of high-speed and low cost, and is a promising solution for free-interface detection problems. However, due to the ill-posed and nonlinear characteristics, the spatial resolution of EIT is low. To deal with the issue, an ultrasound guided EIT is proposed to directly reconstruct the geometric configuration of the target free-interface. In the method, the position of the central point of the target interface is measured by a pair of ultrasound transducers mounted at the opposite side of the objective domain, and then the position measurement is used as the prior information for guiding the EIT-based free-interface reconstruction. During the process, a constrained least squares framework is used to fuse the information from different measurement modalities, and the Lagrange multiplier-based Levenberg-Marquardt method is adopted to provide the iterative solution of the constraint optimization problem. The numerical results show that the proposed ultrasound guided EIT method for the free-interface reconstruction is more accurate than the single modality method, especially when the number of valid electrodes is limited.

Ultrasound-guided injection of botulinum toxin A in the treatment of iliopsoas spasticity

PubMed Central

Sconfienza, L.M.; Perrone, N.; Lacelli, F.; Lentino, C.; Serafini, G.

2008-01-01

Purpose Intramuscular injection of botulinum toxin A (BTX-A) is a common treatment for iliopsoas muscle spasticity, but it is not easy to position the needle in this muscle without guidance. In this paper we describe an ultrasound-guided technique for the intramuscular injection of BTX-A to treat spasticity of the iliopsoas muscle. Its effectiveness was assessed in 10 patients. Method and materials The ultrasound-guided technique for BTX-A injection was used on 10 patients. The needle was inserted into the muscle belly at an angle of 45° along the longitudinal axis of the muscle when allowed by patient's condition. Results In all cases, the iliopsoas muscle was easily identified and both the iliac and psoas components were assessed. Introduction of the needle and drug injection were entirely carried out under ultrasonographic guidance. The procedure was successful in all patients, even in those with a high-grade spasticity, and general anesthesia was not required. Conclusions This ultrasound-guided technique allows accurate guidance for the injection of BTX-A, and it can be considered as an alternate supportive therapy in patients with spasticity and dystonia. PMID:23396653

Establishing intensivist-driven ultrasound at the PICU bedside--it's about time*.

PubMed

Su, Erik; Pustavoitau, Aliaksei; Hirshberg, Elliotte L; Nishisaki, Akira; Conlon, Thomas; Kantor, David B; Weber, Mark D; Godshall, Aaron J; Burzynski, Jeffrey H; Thompson, Ann E

2014-09-01

To discuss pediatric intensivist-driven ultrasound and the exigent need for research and practice definitions pertaining to its implementation within pediatric critical care, specifically addressing issues in ultrasound-guided vascular access and intensivist-driven echocardiography. Intensivist-driven ultrasound improves procedure safety and reduces time to diagnosis in clinical ultrasound applications, as demonstrated primarily in adult patients. Translating these applications to the PICU requires thoughtful integration of the technology into practice and would best be informed by dedicated ultrasound research in critically ill children.

Ultrasound physics and instrumentation for pathologists.

PubMed

Lieu, David

2010-10-01

Interest in pathologist-performed ultrasound-guided fine-needle aspiration is increasing. Educational courses discuss clinical ultrasound and biopsy techniques but not ultrasound physics and instrumentation. To review modern ultrasound physics and instrumentation to help pathologists understand the basis of modern ultrasound. A review of recent literature and textbooks was performed. Ultrasound physics and instrumentation are the foundations of clinical ultrasound. The key physical principle is the piezoelectric effect. When stimulated by an electric current, certain crystals vibrate and produce ultrasound. A hand-held transducer converts electricity into ultrasound, transmits it into tissue, and listens for reflected ultrasound to return. The returning echoes are converted into electrical signals and used to create a 2-dimensional gray-scale image. Scanning at a high frequency improves axial resolution but has low tissue penetration. Electronic focusing moves the long-axis focus to depth of the object of interest and improves lateral resolution. The short-axis focus in 1-dimensional transducers is fixed, which results in poor elevational resolution away from the focal zone. Using multiple foci improves lateral resolution but degrades temporal resolution. The sonographer can adjust the dynamic range to change contrast and bring out subtle masses. Contrast resolution is limited by processing speed, monitor resolution, and gray-scale perception of the human eye. Ultrasound is an evolving field. New technologies include miniaturization, spatial compound imaging, tissue harmonics, and multidimensional transducers. Clinical cytopathologists who understand ultrasound physics, instrumentation, and clinical ultrasound are ready for the challenges of cytopathologist-performed ultrasound-guided fine-needle aspiration and core-needle biopsy in the 21st century.

Analgesic efficacy of transversus abdominis plane block in neonates and early infants for colostomy and reversal of colostomy.

PubMed

Chen, Chee Kean; Teo, Shu Ching; Phui, Vui Eng; Saman, Mat Ariffin

2015-01-01

The application of ultrasound-guided transversus abdominis plane (TAP) block in paediatric population is gaining popularity among anaesthetists. We present a case series of ultrasound-guided TAP block in ten neonate and infants undergoing colostomy and reversal of stoma. Classical TAP as described by Hebbard was carried out and a maximum dosage of 1ml/kg of 0.25% levobupivacaine was injected. Pain score was assessed using Neonatal Infant Pain Scale for 24 hours. In all patients, the block was successful with minimal hemodynamic changes intraoperatively and no additional systemic analgesia was needed intraoperative and immediate postoperatively. Ultrasound-guided TAP block has an important role in providing safe and effective analgesia for colostomy creation and reversal of stoma surgeries in paediatric population.

OCT/PS-OCT imaging of brachial plexus neurovascular structures

NASA Astrophysics Data System (ADS)

Raphael, David T.; Zhang, Jun; Zhang, Yaoping; Chen, Zhongping; Miller, Carol; Zhou, Li

2004-07-01

Introduction: Optical coherence tomography (OCT) allows high-resolution imaging (less than 10 microns) of tissue structures. A pilot study with OCT and polarization-sensitive OCT (PS-OCT) was undertaken to image ex-vivo neurovascular structures (vessels, nerves) of the canine brachial plexus. Methods: OCT is an interferometry-based optical analog of B-mode ultrasound, which can image through non-transparent biological tissues. With approval of the USC Animal Care and Use Committee, segments of the supra- and infraclavicular brachial plexus were excised from euthanized adult dogs, and the ex-vivo specimens were placed in cold pH-buffered physiologic solution. An OCT beam, in micrometer translational steps, scanned the fixed-position bisected specimens in transverse and longitudinal views. Two-dimensional images were obtained from identified arteries and nerves, with specific sections of interest stained with hematoxylin-eosin for later imaging through a surgical microscope. Results: with the beam scan direction transverse to arteries, the resulting OCT images showed an identifiable arterial lumen and arterial wall tissue layers. By comparison, transverse beam OCT images of nerves revealed a multitude of smaller nerve bundles contained within larger circular-shaped fascicles. PS-OCT imaging was helpful in showing the characteristic birefringence exhibited by arrayed neural structures. Discussion: High-resolution OCT imaging may be useful in the optical identification of neurovascular structures during attempted regional nerve blockade. If incorporated into a needle-shaped catheter endoscope, such a technology could prevent intraneural and intravascular injections immediately prior to local anesthetic injection. The major limitation of OCT is that it can form a coherent image of tissue structures only to a depth of 1.5 - 2 mm.

Color Doppler Sonographic and Cadaveric Study of the Arterial Vascularity of the Lateral Upper Arm Flap.

PubMed

Sun, Ruimei; Ding, Yu; Sun, Chuanzheng; Li, Xiaojiang; Wang, Jinde; Li, Lei; Yang, Jie; Ren, Yanxin; Zhong, Zhaoming

2016-04-01

To determine the importance of adequate preoperative assessment with color Doppler sonography to assist in the successful transfer of lateral upper arm flaps by studying the lateral upper arm flap with color Doppler sonography and analyzing the anatomic features of the radial collateral artery. A clinical case-control study was performed. The radial collateral artery was studied with color Doppler sonography in 15 healthy volunteers. The origins, courses, variations, and locations of the perforators of the radial collateral artery were recorded. The results and data from the color Doppler sonographic investigation were compared with an anatomic study that was performed on 22 adult cadaveric upper limb specimens. The volunteer group (14 of 15 volunteers) and the cadaveric group (19 of 22 upper arm specimens) clearly showed that the branch pattern of the arterial supply was as follows: brachial artery → deep brachial artery → radial collateral artery → posterior radial collateral artery → myocutaneous perforator. Variations in the origin of the radial collateral artery were identified in 1 volunteer bilaterally and in 3 upper arm specimens. The diameters of the artery and vein measured at the distal insertion of the deltoid and the origin of the deep brachial artery were not significantly different between the volunteer and cadaver groups (P > .05). Due to the difference in measuring methods, the length of the vascular pedicles was significantly different between the groups (P < .05). Color Doppler sonography can facilitate the preoperative assessment of the origin, course, variations, and locations of the radial collateral artery and therefore may increase the success rate of lateral upper arm flap transfer. © 2016 by the American Institute of Ultrasound in Medicine.

Acrania/encephalocele sequence (exencephaly) associated with 92,XXXX karyotype: early prenatal diagnosis at 9(+5) weeks by 3D transvaginal ultrasound and coelocentesis.

PubMed

Tonni, Gabriele; Ventura, Alessandro; Bonasoni, Maria Paola

2009-09-01

A 27-year-old pregnant woman was diagnosed by 3D transvaginal ultrasound as carrying a fetus of 9(+5) weeks gestation affected by acrania/encephalocele (exencephaly) sequence. A 2D transvaginal ultrasound-guided aspiration of 5 mL of extra-coelomic fluid was performed under cervical block before uterine suction. Conventional cytogenetic analysis demonstrated a 92,XXXX karyotype. Transvaginal 2D ultrasound-guided coelocentesis for rapid karyotyping can be proposed to women who are near to miscarriage or in cases where a prenatal ultrasound diagnosis of congenital anomaly is performed at an early stage of development. Genetic analysis can be performed using traditional cytogenetic analysis or can be aided by fluorescence in situ hybridization (FISH). Coelocentesis may become an integral part of first trimester armamentarium and may be clinically useful in the understanding of the pathogenesis of early prenatally diagnosed congenital anomalies.

Racial differences of endothelial function and plasma endothelin 1 level in preclinical Tibetan and Han male population.

PubMed

Yang, B; Zhao, H; Zhang, J; Jiang, B; Li, C W; Cao, Y K; Cao, F

2016-07-01

The differences in endothelial function between Tibetan and Han nationality population have not been fully investigated. The aim of this work is to investigate the differences in endothelial function and plasma endothelin 1 (ET-1) concentration between Tibetan and Han male population. Totally 272 Tibetan male subjects aged 42.9 ± 9.4 years were enrolled in this study to stand for Tibetan population. All of them were native residents in Lhasa City. And 580 Qinghai-Tibet Railway constructors with Han nationality aged 41.8 ± 11.1 years were enrolled in this study to stand for Han nationality population. All of them were male subjects and lived in Lhasa City for at least 1 year. All subjects lived in the same high-altitude area (the altitude of Lhasa is 3658 m). Height, weight, waist circumference, hip circumference, systolic blood pressure, diastolic blood pressure were evaluated. Body mass index (BMI) was calculated. Brachial artery flow-mediated dilation (FMD) was measured in the fasting state using high-resolution B-mode ultrasound. Computer-assisted analysis software was used to calculate brachial artery diameters. Venous blood was sampled for the measurement of total cholesterol (CH), triglyceride (TG), high density lipoprotein cholesterol (HDL), low density lipoprotein cholesterol (LDL) and HbA1c. Plasma ET-1 was quantitated using a commercially available ELISA kits. Totally 272 Tibetan subjects and 580 Han nationality subjects were enrolled in this study. BMI and waist-hip ratio in Tibetan subjects were much higher than those in Han subjects (p < 0.01). LDL cholesterol level and plasma ET-1 concentration in Tibetan subjects were significantly higher than Han subjects (p < 0.01). The baseline brachial artery diameter in Tibetan group was much higher than that of Han group (p < 0.01). The absolute and percent changes in brachial artery diameter were lower in Tibetan population compared with Han population (p < 0.01). The linear regression analysis showed that LDL cholesterol, and plasma ET-1 were correlated with FMD (p < 0.01). Endothelial function and plasma ET-1 concentration were different between Tibetan and Han male populations.

Impact of acute caffeine ingestion on endothelial function in subjects with and without coronary artery disease.

PubMed

Shechter, Michael; Shalmon, Guy; Scheinowitz, Mickey; Koren-Morag, Nira; Feinberg, Micha S; Harats, Dror; Sela, Ben Ami; Sharabi, Yehonatan; Chouraqui, Pierre

2011-05-01

Although coffee is a widely used, pharmacologically active beverage, its impact on the cardiovascular system is controversial. To explore the effect of acute caffeine ingestion on brachial artery flow-mediated dilation (FMD) in subjects without coronary artery disease (CAD; controls) and patients with CAD, we prospectively assessed brachial artery FMD in 40 controls and 40 age- and gender-matched patients with documented stable CAD on 2 separate mornings 1 week to 2 weeks apart. After overnight fasting, discontinuation of all medications for ≥12 hours, and absence of caffeine for >48 hours, participants received capsules with caffeine 200 mg or placebo. One hour after drug ingestion, participants underwent brachial artery FMD and nitroglycerin-mediated dilation (NTG) using high-resolution ultrasound. As expected, patients with CAD were more often diabetic, hypertensive, obese, dyslipidemic, and smoked more than controls (p <0.01 for all comparisons). Aspirin, Clopidogrel, angiotensin-converting enzyme inhibitors, β blockers, and statins were significantly more common in patients with CAD than in controls (p <0.01 for all comparisons). At baseline, FMD, but not NTG, was significantly lower in patients with CAD compared to controls. Acute caffeine ingestion significantly increased FMD (patients with CAD 5.6 ± 5.0% vs 14.6 ± 5.0%, controls 8.4 ± 2.9% vs 18.6 ± 6.8%, p <0.001 for all comparisons) but not NTG (patients with CAD 13.0 ± 5.2% vs 13.8 ± 6.1%, controls 12.9 ± 3.9% vs 13.9 ± 5.8%, p = NS for all comparisons) and significantly decreased high-sensitivity C-reactive protein (patients with CAD 2.6 ± 1.4 vs 1.4 ± 1.2 mg/L, controls 3.4 ± 3.0 vs 1.2 ± 1.0 mg/L, p <0.001 for all comparisons) in the 2 groups compared to placebo. In conclusion, acute caffeine ingestion significantly improved endothelial function assessed by brachial artery FMD in subjects with and without CAD and was associated with lower plasma markers of inflammation. Copyright © 2011 Elsevier Inc. All rights reserved.

[Significance of heterogenity in endothelium-dependent vasodilatation occurrence in healthy individuals with or without coronary risk factors].

PubMed

Polovina, Marija; Potpara, Tatjana; Giga, Vojislav; Ostojić, Miodrag

2009-10-01

Brachial artery flow-mediated dilation (FMD) is extensively used for non-invasive assessment of endothelial function. Traditionally, FMD is calculated as a percent change of arterial diameter from the baseline value at an arbitrary time point after cuff deflation (usually 60 seconds). Considerable individual differences in brachial artery temporal response to hyperemic stimulus have been observed, potentially influenced by the presence of atherosclerotic risk factors (RF). The importance of such differences for the evaluation of endothelial function has not been well established. The aim of the study was to determine the time course of maximal brachial artery endothelium-dependent dilation in healthy adults with and without RF, to explore the correlation of RF with brachial artery temporal response and to evaluate the importance of individual differences in temporal response for the assessment of endothelial function. A total of 115 healthy volunteers were included in the study. Out of them, 58 had no RF (26 men, mean age 44 +/-14 years) and 57 had at least one RF (29 men, mean age 45 +/-14 years). High-resolution color Doppler vascular ultrasound was used for brachial artery imaging. To determine maximal arterial diameter after cuff deflation and the time-point of maximal vasodilation off-line sequential measurements were performed every 10 seconds from 0 to 240 seconds after cuff release. True maximal FMD value was calculated as a percent change of the true maximal diameter from the baseline, and compared with FMD value calculated assuming that every participant reached maximal dilation at 60 seconds post cuff deflation (FMD60). Correlation of different RF with brachial artery temporal response was assessed. A maximal brachial artery endothelium-dependent vasodilation occurred from 30-120 seconds after cuff release, and the mean time of endothelium-dependent dilation was 68 +/-20 seconds. Individuals without RF had faster endothelium-dependent dilation (mean time 62 +/-17 seconds), and a shorter time-span (30 to 100 seconds), than participants with RF (mean time 75 +/-21 seconds, time-span 40 to 120 seconds) (p < 0.001). Time when the maximal endothelium-dependent dilation occurred was independently associated with age, serum lipid fractions (total cholesterol, LDL and HDL cholesterol), smoking, physical activity and C-reactive protein. True maximal FMD value in the whole group (6.7 +/-3.0%) was significantly higher (p < 0.001) than FMD60 (5.2 +/-3.5%). The same results were demonstrated for individuals with RF (4.9 +/- 1.7% vs 3.1 +/- 2.3%, p < 0.001) and without RF (8.4 +/- 2.9% vs 7.2 +/- 3.2%, p < 0.05). The temporal response of endothelium-dependent dilation is influenced by the presence of coronary FR and individually heterogeneous. When calculated according to the commonly used approach, i.e. 60 seconds after cuff deflation, FMD is significantly lower than the true maximal FMD. The routinely used measurement time-points for FMD assessment may not be adequate for the detection of true peak vasodilation in individual persons. More precise evaluation of endothelial function can be achieved with sequential measurement of arterial diameter after hyperemic stimulus.

Single-operator real-time ultrasound-guided spinal injection using SonixGPS™: a case series.

PubMed

Brinkmann, Silke; Tang, Raymond; Sawka, Andrew; Vaghadia, Himat

2013-09-01

The SonixGPS™ is a novel needle tracking system that has recently been approved in Canada for ultrasound-guided needle interventions. It allows optimization of needle-beam alignment by providing a real-time display of current and predicted needle tip position. Currently, there is limited evidence on the effectiveness of this technique for performance of real-time spinal anesthesia. This case series reports performance of the SonixGPS system for real-time ultrasound-guided spinal anesthesia in elective patients scheduled for joint arthroplasty. In this single-centre case series, 20 American Society of Anesthesiologists' class I-II patients scheduled for lower limb joint arthroplasty were recruited to undergo real-time ultrasound-guided spinal anesthesia with the SonixGPS after written informed consent. The primary outcome for this clinical cases series was the success rate of spinal anesthesia, and the main secondary outcome was time required to perform spinal anesthesia. Successful spinal anesthesia for joint arthroplasty was achieved in 18/20 patients, and 17 of these required only a single skin puncture. In 7/20 (35%) patients, dural puncture was achieved on the first needle pass, and in 11/20 (55%) patients, dural puncture was achieved with two or three needle redirections. Median (range) time taken to perform the block was 8 (5-14) min. The study procedure was aborted in two cases because our clinical protocol dictated using a standard approach if spinal anesthesia was unsuccessful after three ultrasound-guided insertion attempts. These two cases were classified as failures. No complications, including paresthesia, were observed during the procedure. All patients with successful spinal anesthesia found the technique acceptable and were willing to undergo a repeat procedure if deemed necessary. This case series shows that real-time ultrasound-guided spinal anesthesia with the SonixGPS system is possible within an acceptable time frame. It proved effective with a low rate of failure and a low rate of complications. Our clinical experience suggests that a randomized trial is warranted to compare the SonixGPS with a standard block technique.

MR signal-fat-fraction analysis and T2* weighted imaging measure BAT reliably on humans without cold exposure.

PubMed

Holstila, Milja; Pesola, Marko; Saari, Teemu; Koskensalo, Kalle; Raiko, Juho; Borra, Ronald J H; Nuutila, Pirjo; Parkkola, Riitta; Virtanen, Kirsi A

2017-05-01

Brown adipose tissue (BAT) is compositionally distinct from white adipose tissue (WAT) in terms of triglyceride and water content. In adult humans, the most significant BAT depot is localized in the supraclavicular area. Our aim is to differentiate brown adipose tissue from white adipose tissue using fat T2* relaxation time mapping and signal-fat-fraction (SFF) analysis based on a commercially available modified 2-point-Dixon (mDixon) water-fat separation method. We hypothesize that magnetic resonance (MR) imaging can reliably measure BAT regardless of the cold-induced metabolic activation, with BAT having a significantly higher water and iron content compared to WAT. The supraclavicular area of 13 volunteers was studied on 3T PET-MRI scanner using T2* relaxation time and SFF mapping both during cold exposure and at ambient temperature; and 18 F-FDG PET during cold exposure. Volumes of interest (VOIs) were defined semiautomatically in the supraclavicular fat depot, subcutaneous WAT and muscle. The supraclavicular fat depot (assumed to contain BAT) had a significantly lower SFF and fat T2* relaxation time compared to subcutaneous WAT. Cold exposure did not significantly affect MR-based measurements. SFF and T2* values measured during cold exposure and at ambient temperature correlated inversely with the glucose uptake measured by 18 F-FDG PET. Human BAT can be reliably and safely assessed using MRI without cold activation and PET-related radiation exposure. Copyright © 2017 Elsevier Inc. All rights reserved.

Evaluation of a Standardized Program for Training Practicing Anesthesiologists in Ultrasound-Guided Regional Anesthesia Skills.

PubMed

Mariano, Edward R; Harrison, T Kyle; Kim, T Edward; Kan, Jack; Shum, Cynthia; Gaba, David M; Ganaway, Toni; Kou, Alex; Udani, Ankeet D; Howard, Steven K

2015-10-01

Practicing anesthesiologists have generally not received formal training in ultrasound-guided perineural catheter insertion. We designed this study to determine the efficacy of a standardized teaching program in this population. Anesthesiologists in practice for 10 years or more were recruited and enrolled to participate in a 1-day program: lectures and live-model ultrasound scanning (morning) and faculty-led iterative practice and mannequin-based simulation (afternoon). Participants were assessed and recorded while performing ultrasound-guided perineural catheter insertion at baseline, at midday (interval), and after the program (final). Videos were scored by 2 blinded reviewers using a composite tool and global rating scale. Participants were surveyed every 3 months for 1 year to report the number of procedures, efficacy of teaching methods, and implementation obstacles. Thirty-two participants were enrolled and completed the program; 31 of 32 (97%) completed the 1-year follow-up. Final scores [median (10th-90th percentiles)] were 21.5 (14.5-28.0) of 30 points compared to 14.0 (9.0-20.0) at interval (P < .001 versus final) and 12.0 (8.5-17.5) at baseline (P < .001 versus final), with no difference between interval and baseline. The global rating scale showed an identical pattern. Twelve of 26 participants without previous experience performed at least 1 perineural catheter insertion after training (P < .001). However, there were no differences in the monthly average number of procedures or complications after the course when compared to baseline. Practicing anesthesiologists without previous training in ultrasound-guided regional anesthesia can acquire perineural catheter insertion skills after a 1-day standardized course, but changing clinical practice remains a challenge. © 2015 by the American Institute of Ultrasound in Medicine.

Ultrasonography in Acupuncture-Uses in Education and Research.

PubMed

Leow, Mabel Qi He; Cui, Shu Li; Mohamed Shah, Mohammad Taufik Bin; Cao, Taige; Tay, Shian Chao; Tay, Peter Kay Chai; Ooi, Chin Chin

2017-06-01

This study aims to explore the potential use of ultrasound in locating the second posterior sacral foramen acupuncture point, quantifying depth of insertion and describing surrounding anatomical structures. We performed acupuncture needle insertion on a study team member. There were four steps in our experiment. First, the acupuncturist located the acupuncture point by palpation. Second, we used an ultrasound machine to visualize the structures surrounding the location of the acupuncture point and measure the depth required for needle insertion. Third, the acupuncturist inserted the acupuncture needle into the acupuncture point at an angle of 30°. Fourth, we performed another ultrasound scan to ensure that the needle was in the desired location. Results suggested that ultrasound could be used to locate the acupuncture point and estimate the depth of needle insertion. The needle was inserted to a depth of 4.0 cm to reach the surface of the sacral foramen. Based on Pythagoras theorem, taking a needle insertion angle of 30° and a needle insertion depth of 4.0 cm, the estimated perpendicular depth is 1.8 cm. An ultrasound scan corroborated the depth of 1.85 cm. The use of an ultrasound-guided technique for needle insertion in acupuncture practice could help standardize the treatment. Clinicians and students would be able to visualize and measure the depth of the sacral foramen acupuncture point, to guide the depth of needle insertion. This methodological guide could also be used to create a standard treatment protocol for research. A similar mathematical guide could also be created for other acupuncture points in future. Copyright © 2017. Published by Elsevier B.V.

Theoretical Analysis of the Accuracy and Safety of MRI-Guided Transurethral 3-D Conformal Ultrasound Prostate Therapy

NASA Astrophysics Data System (ADS)

Burtnyk, Mathieu; Chopra, Rajiv; Bronskill, Michael

2009-04-01

MRI-guided transurethral ultrasound therapy is a promising new approach for the treatment of localized prostate cancer. Several studies have demonstrated the feasibility of producing large regions of thermal coagulation adequate for prostate therapy; however, the quantitative assessment of shaping these regions to complex 3-D human prostate geometries has not been fully explored. This study used numerical simulations and twenty manually-segmented pelvic anatomical models derived from high-quality MR images of prostate cancer patients to evaluate the treatment accuracy and safety of 3-D conformal MRI-guided transurethral ultrasound therapy. The simulations incorporated a rotating multi-element planar dual-frequency ultrasound transducer (seventeen 4×3 mm elements) operating at 4.7/9.7 MHz and 10 W/cm2 maximum acoustic power. Results using a novel feedback control algorithm which modulated the ultrasound frequency, power and device rate of rotation showed that regions of thermal coagulation could be shaped to predefined prostate volumes within 1.0 mm across the vast majority of these glands. Treatment times were typically 30 min and remained below 60 min for large 60 cc prostates. With a rectal cooling temperature of 15° C, the rectal wall did not exceed 30EM43 in half of the twenty patient models with only a few 1 mm3 voxels above this threshold in the other cases. At 4.7 MHz, heating of the pelvic bone can become significant when it is located less than 10 mm from the prostate. Numerical simulations show that MRI-guided transurethral ultrasound therapy can thermally coagulate whole prostate glands accurately and safely in 3-D.

Treatment of Partial Rotator Cuff Tear with Ultrasound-guided Platelet-rich Plasma

PubMed Central

Sengodan, Vetrivel Chezian; Kurian, Sajith; Ramasamy, Raghupathy

2017-01-01

Background: The treatment of symptomatic partial rotator cuff tear has presented substantial challenge to orthopaedic surgeons as it can vary from conservative to surgical repair. Researches have established the influence of platelet rich plasma in healing damaged tissue. Currently very few data are available regarding the evidence of clinical and radiological outcome of partial rotator cuff tear treated with ultrasound guided platelet rich plasma injection in English literature. Materials and Methods: 20 patients with symptomatic partial rotator cuff tears were treated with ultrasound guided platelet rich plasma injection. Before and after the injection of platelet rich plasma scoring was done with visual analogue score, Constant shoulder score, and UCLA shoulder score at 8 weeks and third month. A review ultrasound was performed 8 weeks after platelet rich plasma injection to assess the rotator cuff status. Results: Our study showed statistically significant improvements in 17 patients in VAS pain score, constant shoulder score and UCLA shoulder score. No significant changes in ROM were noted when matched to the contra-lateral side (P < 0.001) at the 3 month follow-up. The study also showed good healing on radiological evaluation with ultrasonogram 8 weeks after platelet rich plasma injection. Conclusion: Ultrasound guided platelet rich plasma injection for partial rotator cuff tears is an effective procedure that leads to significant decrease in pain, improvement in shoulder functions, much cost-effective and less problematic compared to a surgical treatment. PMID:28900553

Ultrasound-Guided Pulsed Radiofrequency Stimulation of Posterior Tibial Nerve: A Potential Novel Intervention for Recalcitrant Plantar Fasciitis.

PubMed

Wu, Yung-Tsan; Chang, Chih-Ya; Chou, Yu-Ching; Yeh, Chun-Chang; Li, Tsung-Ying; Chu, Heng-Yi; Chen, Liang-Cheng

2017-05-01

To evaluate the therapeutic benefit of ultrasound-guided pulsed radiofrequency (PRF) stimulation at the posterior tibial nerve (PTN) in patients with recalcitrant plantar fasciitis (PF). A prospective, randomized, double-blinded, placebo-controlled trial (12-wk follow-up). Outpatient local medical center settings. Patients (N=36) with recalcitrant PF underwent randomization, and all were included in the final data analysis. Patients in the PRF group were treated with 1 dose of ultrasound-guided PRF stimulation at the PTN, and those in the control group received 1 dose of 2% lidocaine, 0.5mL, injected at the PTN under ultrasound guidance. The visual analog scale (first-step and overall pain), American Orthopedic Foot-Ankle Society (AOFAS) ankle-hindfoot scale, and ultrasonographic thickness of the plantar fascia were evaluated at 1, 4, 8, and 12 weeks after treatment. Thirty-six patients (20 feet per group) completed the study. The PRF group had a significantly larger improvement in first-step pain, overall pain, and AOFAS score (all P<.001), as well as plantar fascia thickness (P<.05), compared with those of the control group at all observed time points. This study shows that ultrasound-guided PRF stimulation at the PTN is effective for treating recalcitrant PF. This simple, reproducible method could be a novel strategy for managing recalcitrant PF. Copyright © 2016 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Real-time visualization of ultrasound-guided retrobulbar blockade: an imaging study.

PubMed

Luyet, C; Eichenberger, U; Moriggl, B; Remonda, L; Greif, R

2008-12-01

Retrobulbar anaesthesia allows eye surgery in awake patients. Severe complications of the blind techniques are reported. Ultrasound-guided needle introduction and direct visualization of the spread of local anaesthetic may improve quality and safety of retrobulbar anaesthesia. Therefore, we developed a new ultrasound-guided technique using human cadavers. In total, 20 blocks on both sides in 10 embalmed human cadavers were performed. Using a small curved array transducer and a long-axis approach, a 22 G short bevel needle was introduced under ultrasound guidance lateral and caudal of the eyeball until the needle tip was seen 2 mm away from the optic nerve. At this point, 2 ml of contrast dye as a substitute for local anaesthetic was injected. Immediately after the injection, the spread of the contrast dye was documented by means of CT scans performed in each cadaver. The CT scans showed the distribution of the contrast dye in the muscle cone and behind the posterior sclera in all but one case. No contrast dye was found inside the optic nerve or inside the eyeball. In one case, there could be an additional trace of contrast dye behind the orbita. Our new ultrasound-guided technique has the potential to improve safety and efficacy of the procedure by direct visualization of the needle placement and the distribution of the injected fluid. Furthermore, the precise injection near the optic nerve could lead to a reduction of the amount of the local anaesthetic needed with fewer related complications.

Breast cancer: determining the genetic profile from ultrasound-guided percutaneous biopsy specimens obtained during the diagnostic workups.

PubMed

López Ruiz, J A; Zabalza Estévez, I; Mieza Arana, J A

2016-01-01

To evaluate the possibility of determining the genetic profile of primary malignant tumors of the breast from specimens obtained by ultrasound-guided percutaneous biopsies during the diagnostic imaging workup. This is a retrospective study in 13 consecutive patients diagnosed with invasive breast cancer by B-mode ultrasound-guided 12 G core needle biopsy. After clinical indication, the pathologist decided whether the paraffin block specimens seemed suitable (on the basis of tumor size, validity of the sample, and percentage of tumor cells) before sending them for genetic analysis with the MammaPrint® platform. The size of the tumors on ultrasound ranged from 0.6cm to 5cm. In 11 patients the preserved specimen was considered valid and suitable for use in determining the genetic profile. In 1 patient (with a 1cm tumor) the pathologist decided that it was necessary to repeat the core biopsy to obtain additional samples. In 1 patient (with a 5cm tumor) the specimen was not considered valid by the genetic laboratory. The percentage of tumor cells in the samples ranged from 60% to 70%. In 11/13 cases (84.62%) it was possible to do the genetic analysis on the previously diagnosed samples. In most cases, regardless of tumor size, it is possible to obtain the genetic profile from tissue specimens obtained with ultrasound-guided 12 G core biopsy preserved in paraffin blocks. Copyright © 2015 SERAM. Published by Elsevier España, S.L.U. All rights reserved.

Ultrasound-guided percutaneous fine-needle aspiration of 545 focal pancreatic lesions.

PubMed

Zamboni, Giulia A; D'Onofrio, Mirko; Idili, Antonio; Malagò, Roberto; Iozzia, Roberta; Manfrin, Erminia; Mucelli, Roberto Pozzi

2009-12-01

The purpose of this study was to assess the accuracy and short-term complication rate of ultrasound-guided fine-needle aspiration cytologic sampling of focal pancreatic lesions. We reviewed 545 consecutive ultrasound-guided fine-needle aspiration cytologic sampling procedures for focal pancreatic lesions from January 2004 through June 2008. The procedures were performed with a 20- or 21-gauge needle. The onsite cytopathologist evaluated the appropriateness of the sample and made a diagnosis. We reviewed the final diagnosis and the radiologic and medical records of all patients for onset of complications during or within 7 days of the procedure. The study sample included 262 women and 283 men (mean age, 62 years; range, 25-86 years). The head or uncinate process of the pancreas was the location of 63.0% of the lesions, and 35.2% of the lesions were located in the body or tail of the pancreas. The site of 10 lesions (1.8%) was not specified. Sampling was diagnostic in 509 of the 545 cases (93.4%). Excluding the 36 nondiagnostic samples, ultrasound-guided fine-needle aspiration cytologic sampling had 99.4% sensitivity, 100% specificity, and 99.4% accuracy. In 537 of the 545 cases (98.5%), the procedure was uneventful. In two cases, abdominal fluid was found after the procedure that was not present before the procedure. Six patients experienced postprocedural pain without abnormal findings at subsequent imaging. No major complications occurred. Ultrasound-guided cytologic sampling is safe and accurate for the diagnosis and planning of management of focal pancreatic lesions. With a cytologist on site, the rate of acquisition of samples adequate for diagnosis is high, reducing the need for patient recall.

TU-B-210-00: MR-Guided Focused Ultrasound Therapy in Oncology

DOE Office of Scientific and Technical Information (OSTI.GOV)

NONE

MR guided focused ultrasound (MRgFUS), or alternatively high-intensity focused ultrasound (MRgHIFU), is approved for thermal ablative treatment of uterine fibroids and pain palliation in bone metastases. Ablation of malignant tumors is under active investigation in sites such as breast, prostate, brain, liver, kidney, pancreas, and soft tissue. Hyperthermia therapy with MRgFUS is also feasible, and may be used in conjunction with radiotherapy and for local targeted drug delivery. MRI allows in situ target definition and provides continuous temperature monitoring and subsequent thermal dose mapping during HIFU. Although MRgHIFU can be very precise, treatment of mobile organs is challenging and advancedmore » techniques are required because of artifacts in MR temperature mapping, the need for intercostal firing, and need for gated HIFU or tracking of the lesion in real time. The first invited talk, “MR guided Focused Ultrasound Treatment of Tumors in Bone and Soft Tissue”, will summarize the treatment protocol and review results from treatment of bone tumors. In addition, efforts to extend this technology to treat both benign and malignant soft tissue tumors of the extremities will be presented. The second invited talk, “MRI guided High Intensity Focused Ultrasound – Advanced Approaches for Ablation and Hyperthermia”, will provide an overview of techniques that are in or near clinical trials for thermal ablation and hyperthermia, with an emphasis of applications in abdominal organs and breast, including methods for MRTI and tracking targets in moving organs. Learning Objectives: Learn background on devices and techniques for MR guided HIFU for cancer therapy Understand issues and current status of clinical MRg HIFU Understand strategies for compensating for organ movement during MRgHIFU Understand strategies for strategies for delivering hyperthermia with MRgHIFU CM - research collaboration with Philips.« less

Ultrasound-Guided Core-Needle Versus Vacuum-Assisted Breast Biopsy: A Cost Analysis Based on the American Society of Breast Surgeons' Mastery of Breast Surgery Registry.

PubMed

Grady, Ian; Vasquez, Tony; Tawfik, Sara; Grady, Sean

2017-03-01

To evaluate the cost-efficacy of vacuum-assisted ultrasound-guided breast biopsy instruments compared to ultrasound-guided 14-gauge spring-loaded core-needle biopsy. The American Society of Breast Surgeons' Mastery of Breast Surgery Registry was reviewed. Biopsy findings, any rebiopsy, and the instrument used were abstracted for 31,451 ultrasound-guided biopsy procedures performed between 2001 and July 2014. Rates of cancer diagnosis and rebiopsy were calculated for each instrument. A linear mathematical model was developed to calculate total cost per cancer diagnosis, including procedural costs and the costs of any additional surgical rebiopsy procedures. Mean cost per cancer diagnosis with confidence limits was then determined for 14-gauge spring-loaded core-needle biopsy and 14 different vacuum-assisted instruments. For 14-gauge spring-loaded core-needle biopsy, mean cost per cancer diagnosis was $4346 (4327-$4366). For the vacuum-assisted instruments, mean cost per cancer diagnosis ranged from a low of $3742 ($3732-$3752) to a high of $4779 ($4750-$4809). Vacuum-assisted instruments overall were more cost-effective than core with a mean cost per cancer diagnosis of $4052 ($4038-$4067) (p < 0.05). Tethered vacuum-assisted instruments performed best with a mean cost per cancer diagnosis of $3978 ($3964-$3991) (p < 0.05). Nontethered devices had a mean cost per cancer diagnosis of $4369 ($4350-$4388), a result no better than core (p < 0.05). Ultrasound-guided vacuum-assisted breast biopsy had a lower mean cost per cancer diagnosis than 14-gauge spring-loaded core-needle biopsy. This advantage was only seen in tethered vacuum-assisted instruments. Within device families, larger instruments tended to outperform smaller instruments.

Magnetic resonance imaging-guided focused ultrasound treatment of symptomatic uterine fibroids: impact of technology advancement on ablation volumes in 115 patients.

PubMed

Trumm, Christoph G; Stahl, Robert; Clevert, Dirk-André; Herzog, Peter; Mindjuk, Irene; Kornprobst, Sabine; Schwarz, Christina; Hoffmann, Ralf-Thorsten; Reiser, Maximilian F; Matzko, Matthias

2013-06-01

The aim of this study was to assess the impact of the advanced technology of the new ExAblate 2100 system (Insightec Ltd, Haifa, Israel) for magnetic resonance imaging (MRI)-guided focused ultrasound surgery on treatment outcomes in patients with symptomatic uterine fibroids, as measured by the nonperfused volume ratio. This is a retrospective analysis of 115 women (mean age, 42 years; range, 27-54 years) with symptomatic fibroids who consecutively underwent MRI-guided focused ultrasound treatment in a single center with the new generation ExAblate 2100 system from November 2010 to June 2011. Mean ± SD total volume and number of treated fibroids (per patient) were 89 ± 94 cm and 2.2 ± 1.7, respectively. Patient baseline characteristics were analyzed regarding their impact on the resulting nonperfused volume ratio. Magnetic resonance imaging-guided focused ultrasound treatment was technically successful in 115 of 123 patients (93.5%). In 8 patients, treatment was not possible because of bowel loops in the beam pathway that could not be mitigated (n = 6), patient movement (n = 1), and system malfunction (n = 1). Mean nonperfused volume ratio was 88% ± 15% (range, 38%-100%). Mean applied energy level was 5400 ± 1200 J, and mean number of sonications was 74 ± 27. No major complications occurred. Two cases of first-degree skin burn resolved within 1 week after the intervention. Of the baseline characteristics analyzed, only the planned treatment volume had a statistically significant impact on nonperfused volume ratio. With technological advancement, the outcome of MRI-guided focused ultrasound treatment in terms of the nonperfused volume ratio can be enhanced with a high safety profile, markedly exceeding results reported in previous clinical trials.

Ultrasound-guided central venous catheterization in cancer patients improves the success rate of cannulation and reduces mechanical complications: A prospective observational study of 1,978 consecutive catheterizations

PubMed Central

2010-01-01

Background A central venous catheter (CVC) currently represents the most frequently adopted intravenous line for patients undergoing infusional chemotherapy and/or high-dose chemotherapy with hematopoietic stem-cell transplantation and parenteral nutrition. CVC insertion represents a risk for pneumothorax, nerve or arterial punctures. The aim of this prospective observational study was to explore the safety and efficacy of CVC insertion under ultrasound (US) guidance and to confirm its utility in clinical practice in cancer patients. Methods Consecutive adult patients attending the oncology-hematology department were eligible if they had solid or hematologic malignancies and required CVC insertion. Four types of possible complication were defined a priore: mechanical, thrombotic, infection and malfunctioning. The patient was placed in Trendelenburg's position, a 7.5 MHZ puncturing US probe was placed in the supraclavicular site and a 16-gauge needle was advanced under real-time US guidance into the last portion of internal jugular vein. The Seldinger technique was used to place the catheter, which was advanced into the superior vena cava until insertion into right atrium. Within two hours after each procedure, an upright chest X-ray and ultrasound scanning were carried out to confirm the CVC position and to rule out a pneumotorax. CVC-related infections, symptomatic vein thrombosis and malfunctioning were recorded. Results From December 2000 to January 2009, 1,978 CVC insertional procedures were applied to 1,660 consecutive patients. The procedure was performed 580 times in patients with hematologic malignancies and 1,398 times those with solid tumors. A single-needle puncture of the vein was performed on 1,948 of 1,978 procedures (98.48%); only eighteen attempts among 1,978 failed (0.9%). No pneumotorax, no major bleeding, and no nerve puncture were reported; four cases (0.2%) showed self-limiting hematomas. The mean lifespan of CVC was 189.7 +/- 18.6 days (range 7-701). Symptomatic deep-vein thrombosis of the upper limbs developed in 48 patients (2.42%). Catheter-related infections occurred in 197 (9.96%) of the catheters inserted. They were successfully treated with antibiotics and only in 48 (2.9%) patients definitive CVC removal was required for infection and/or thrombosis or malfunctioning. Conclusions This study represents the largest published series of consecutive patients with cancer undergoing CVC insertion under US guidance; this procedure allowed the completion of the therapeutic program for 1,930/1,978 (97.6%) of the catheters inserted. The absence of pneumotorax and other major complications indicates that US guidance should be mandatory for CVC insertion in patients with cancer. PMID:20958986

Mixed reality ultrasound guidance system: a case study in system development and a cautionary tale.

PubMed

Ameri, Golafsoun; Baxter, John S H; Bainbridge, Daniel; Peters, Terry M; Chen, Elvis C S

2018-04-01

Real-time ultrasound has become a crucial aspect of several image-guided interventions. One of the main constraints of such an approach is the difficulty in interpretability of the limited field of view of the image, a problem that has recently been addressed using mixed reality, such as augmented reality and augmented virtuality. The growing popularity and maturity of mixed reality has led to a series of informal guidelines to direct development of new systems and to facilitate regulatory approval. However, the goals of mixed reality image guidance systems and the guidelines for their development have not been thoroughly discussed. The purpose of this paper is to identify and critically examine development guidelines in the context of a mixed reality ultrasound guidance system through a case study. A mixed reality ultrasound guidance system tailored to central line insertions was developed in close collaboration with an expert user. This system outperformed ultrasound-only guidance in a novice user study and has obtained clearance for clinical use in humans. A phantom study with 25 experienced physicians was carried out to compare the performance of the mixed reality ultrasound system against conventional ultrasound-only guidance. Despite the previous promising results, there was no statistically significant difference between the two systems. Guidelines for developing mixed reality image guidance systems cannot be applied indiscriminately. Each design decision, no matter how well justified, should be the subject of scientific and technical investigation. Iterative and small-scale evaluation can readily unearth issues and previously unknown or implicit system requirements. We recommend a wary eye in development of mixed reality ultrasound image guidance systems emphasizing small-scale iterative evaluation alongside system development. Ultimately, we recommend that the image-guided intervention community furthers and deepens this discussion into best practices in developing image-guided interventions.

Toward a real-time system for temporal enhanced ultrasound-guided prostate biopsy.

PubMed

Azizi, Shekoofeh; Van Woudenberg, Nathan; Sojoudi, Samira; Li, Ming; Xu, Sheng; Abu Anas, Emran M; Yan, Pingkun; Tahmasebi, Amir; Kwak, Jin Tae; Turkbey, Baris; Choyke, Peter; Pinto, Peter; Wood, Bradford; Mousavi, Parvin; Abolmaesumi, Purang

2018-03-27

We have previously proposed temporal enhanced ultrasound (TeUS) as a new paradigm for tissue characterization. TeUS is based on analyzing a sequence of ultrasound data with deep learning and has been demonstrated to be successful for detection of cancer in ultrasound-guided prostate biopsy. Our aim is to enable the dissemination of this technology to the community for large-scale clinical validation. In this paper, we present a unified software framework demonstrating near-real-time analysis of ultrasound data stream using a deep learning solution. The system integrates ultrasound imaging hardware, visualization and a deep learning back-end to build an accessible, flexible and robust platform. A client-server approach is used in order to run computationally expensive algorithms in parallel. We demonstrate the efficacy of the framework using two applications as case studies. First, we show that prostate cancer detection using near-real-time analysis of RF and B-mode TeUS data and deep learning is feasible. Second, we present real-time segmentation of ultrasound prostate data using an integrated deep learning solution. The system is evaluated for cancer detection accuracy on ultrasound data obtained from a large clinical study with 255 biopsy cores from 157 subjects. It is further assessed with an independent dataset with 21 biopsy targets from six subjects. In the first study, we achieve area under the curve, sensitivity, specificity and accuracy of 0.94, 0.77, 0.94 and 0.92, respectively, for the detection of prostate cancer. In the second study, we achieve an AUC of 0.85. Our results suggest that TeUS-guided biopsy can be potentially effective for the detection of prostate cancer.

Endoscopic ultrasound-guided choledochoduodenostomy after a failed or impossible ERCP.

PubMed

Mora Soler, Ana María; Álvarez Delgado, Alberto; Piñero Pérez, María Concepción; Velasco-Guardado, Antonio; Marcos Prieto, Héctor; Rodríguez Pérez, Antonio

2018-05-01

endoscopic ultrasound-guided biliary drainage (EUS-BD) is an alternative to percutaneous trans-hepatic biliary drainage (PTBD) in cases of failed endoscopic retrograde cholangiopancreatography (ERCP). this is a retrospective description of six cases of endoscopic ultrasound-guided biliary drainage via choledochoduodenostomy (EUCD), as well as the clinical characteristics, endoscopic procedure, complications and monitoring. all cases had malignant distal biliary obstruction. The procedure was concluded with good drainage in four out of six patients. Two late complications were recorded that were caused by stent migration and there were no deaths related with the procedure. The average monitoring period was six months. EUCD can be considered as a valid therapeutic choice in some selected cases and when performed by a team of expert endoscopists in cases of failed ERCP drainage or as an alternative to PTBD. However, the procedure has some associated complications.

Magnetic resonance guided high-intensity focused ultrasound ablation of musculoskeletal tumors

PubMed Central

Avedian, Raffi S.; Gold, Garry; Ghanouni, Pejman; Pauly, Kim Butts

2015-01-01

This article reviews the fundamental principles and clinical experimental uses of magnetic resonance guided high-intensity focused ultrasound (MRgHIFU) ablation of musculoskeletal tumors. MRgHIFU is a noninvasive treatment modality that takes advantage of the ability of magnetic resonance to measure tissue temperature and uses this technology to guide high-intensity focused ultrasound waves to a specific focus within the human body that results in heat generation and complete thermal necrosis of the targeted tissue. Adjacent normal tissues are spared because of the accurate delivery of thermal energy, as well as, local blood perfusion that provides a cooling effect. MRgHIFU is approved by the Food and Drug Administration for the treatment of uterine fibroids and is used on an experimental basis to treat breast, prostate, liver, bone, and brain tumors. PMID:26120376

Ultrasound-guided central venous access using Google Glass.

PubMed

Wu, Teresa S; Dameff, Christian J; Tully, Jeffrey L

2014-12-01

The use of ultrasound during invasive bedside procedures is quickly becoming the standard of care. Ultrasound machine placement during procedures often requires the practitioner to turn their head during the procedure to view the screen. Such turning has been implicated in unintentional hand movements in novices. Google Glass is a head-mounted computer with a specialized screen capable of projecting images and video into the view of the wearer. Such technology may help decrease unintentional hand movements. Our aim was to evaluate whether or not medical practitioners at various levels of training could use Google Glass to perform an ultrasound-guided procedure, and to explore potential advantages of this technology. Forty participants of varying training levels were randomized into two groups. One group used Google Glass to perform an ultrasound-guided central line. The other group used traditional ultrasound during the procedure. Video recordings of eye and hand movements were analyzed. All participants from both groups were able to complete the procedure without difficulty. Google Glass wearers took longer to perform the procedure at all training levels (medical student year 1 [MS1]: 193 s vs. 77 s, p > 0.5; MS4: 197s vs. 91s, p ≤ 0.05; postgraduate year 1 [PGY1]: 288s vs. 125 s, p > 0.5; PGY3: 151 s vs. 52 s, p ≤ 0.05), and required more needle redirections (MS1: 4.4 vs. 2.0, p > 0.5; MS4: 4.8 vs. 2.8, p > 0.5; PGY1: 4.4 vs. 2.8, p > 0.5; PGY3: 2.0 vs. 1.0, p > 0.5). In this study, it was possible to perform ultrasound-guided procedures with Google Glass. Google Glass wearers, on average, took longer to gain access, and had more needle redirections, but less head movements were noted. Copyright © 2014 Elsevier Inc. All rights reserved.

A randomised crossover study to compare the cross-sectional and longitudinal approaches to ultrasound-guided peripheral venepuncture in a model.

PubMed

Griffiths, James; Carnegie, Amadeus; Kendall, Richard; Madan, Rajeev

2017-12-01

Ultrasound-guided peripheral intravenous access may present an alternative to central or intraosseous access in patients with difficult peripheral veins. Using venepuncture of a phantom model as a proxy, we investigated whether novice ultrasound users should adopt a cross-sectional or longitudinal approach when learning to access peripheral veins under ultrasound guidance. This result would inform the development of a structured training method for this procedure. We conducted a randomised controlled trial of 30 medical students. Subjects received 35 min of training, then attempted to aspirate 1 ml of synthetic blood from a deep vein in a training model under ultrasound guidance. Subjects attempted both the cross-sectional and longitudinal approaches. Group 1 used cross-sectional first, followed by longitudinal. Group 2 used longitudinal first, then cross-sectional. We measured the time from first puncture of the model's skin to aspiration of fluid, and the number of attempts required. Subjects also reported difficulty ratings for each approach. Paired sample t-tests were used for statistical analysis. The mean number of attempts was 1.13 using the cross-sectional approach, compared with 1.30 using the longitudinal approach (p = 0.17). Mean time to aspiration of fluid was 45.1 s using the cross-sectional approach and 52.8 s using the longitudinal approach (p = 0.43). The mean difficulty score out of 10 was 3.97 for the cross-sectional approach and 3.93 for the longitudinal approach (p = 0.95). We found no significant difference in effectiveness between the cross-sectional and longitudinal approaches to ultrasound-guided venepuncture when performed on a model. We believe that both approaches should be included when teaching ultrasound-guided peripheral vascular access. To confirm which approach would be best in clinical practice, we advocate future testing of both approaches on patients.

Evaluation of cost-effectiveness from the funding body's point of view of ultrasound-guided central venous catheter insertion compared with the conventional technique.

PubMed

Noritomi, Danilo Teixeira; Zigaib, Rogério; Ranzani, Otavio T; Teich, Vanessa

2016-01-01

To evaluate the cost-effectiveness, from the funding body's point of view, of real-time ultrasound-guided central venous catheter insertion compared to the traditional method, which is based on the external anatomical landmark technique. A theoretical simulation based on international literature data was applied to the Brazilian context, i.e., the Unified Health System (Sistema Único de Saúde - SUS). A decision tree was constructed that showed the two central venous catheter insertion techniques: real-time ultrasonography versus external anatomical landmarks. The probabilities of failure and complications were extracted from a search on the PubMed and Embase databases, and values associated with the procedure and with complications were taken from market research and the Department of Information Technology of the Unified Health System (DATASUS). Each central venous catheter insertion alternative had a cost that could be calculated by following each of the possible paths on the decision tree. The incremental cost-effectiveness ratio was calculated by dividing the mean incremental cost of real-time ultrasound compared to the external anatomical landmark technique by the mean incremental benefit, in terms of avoided complications. When considering the incorporation of real-time ultrasound and the concomitant lower cost due to the reduced number of complications, the decision tree revealed a final mean cost for the external anatomical landmark technique of 262.27 Brazilian reals (R$) and for real-time ultrasound of R$187.94. The final incremental cost of the real-time ultrasound-guided technique was -R$74.33 per central venous catheter. The incremental cost-effectiveness ratio was -R$2,494.34 due to the pneumothorax avoided. Real-time ultrasound-guided central venous catheter insertion was associated with decreased failure and complication rates and hypothetically reduced costs from the view of the funding body, which in this case was the SUS.

The Agreement between Auscultation and Lung Ultrasound in Hemodialysis Patients: The LUST Study.

PubMed

Torino, Claudia; Gargani, Luna; Sicari, Rosa; Letachowicz, Krzysztof; Ekart, Robert; Fliser, Danilo; Covic, Adrian; Siamopoulos, Kostas; Stavroulopoulos, Aristeidis; Massy, Ziad A; Fiaccadori, Enrico; Caiazza, Alberto; Bachelet, Thomas; Slotki, Itzchak; Martinez-Castelao, Alberto; Coudert-Krier, Marie-Jeanne; Rossignol, Patrick; Gueler, Faikah; Hannedouche, Thierry; Panichi, Vincenzo; Wiecek, Andrzej; Pontoriero, Giuseppe; Sarafidis, Pantelis; Klinger, Marian; Hojs, Radovan; Seiler-Mussler, Sarah; Lizzi, Fabio; Siriopol, Dimitrie; Balafa, Olga; Shavit, Linda; Tripepi, Rocco; Mallamaci, Francesca; Tripepi, Giovanni; Picano, Eugenio; London, Gérard Michel; Zoccali, Carmine

2016-11-07

Accumulation of fluid in the lung is the most concerning sequela of volume expansion in patients with ESRD. Lung auscultation is recommended to detect and monitor pulmonary congestion, but its reliability in ESRD is unknown. In a subproject of the ongoing Lung Water by Ultra-Sound Guided Treatment to Prevent Death and Cardiovascular Complications in High Risk ESRD Patients with Cardiomyopathy Trial, we compared a lung ultrasound-guided ultrafiltration prescription policy versus standard care in high-risk patients on hemodialysis. The reliability of peripheral edema was tested as well. This study was on the basis of 1106 pre- and postdialysis lung ultrasound studies (in 79 patients) simultaneous with standardized lung auscultation (crackles at the lung bases) and quantification of peripheral edema. Lung congestion by crackles, edema, or a combination thereof poorly reflected the severity of congestion as detected by ultrasound B lines in various analyses, including standard regression analysis weighting for repeated measures in individual patients (shared variance of 12% and 4% for crackles and edema, respectively) and κ-statistics (κ ranging from 0.00 to 0.16). In general, auscultation had very low discriminatory power for the diagnosis of mild (area under the receiver operating curve =0.61), moderate (area under the receiver operating curve =0.65), and severe (area under the receiver operating curve =0.68) lung congestion, and the same was true for peripheral edema (receiver operating curve =0.56 or lower) and the combination of the two physical signs. Lung crackles, either alone or combined with peripheral edema, very poorly reflect interstitial lung edema in patients with ESRD. These findings reinforce the rationale underlying the Lung Water by Ultra-Sound Guided Treatment to Prevent Death and Cardiovascular Complications in High Risk ESRD Patients with Cardiomyopathy Trial, a trial adopting ultrasound B lines as an instrument to guide interventions aimed at mitigating lung congestion in high-risk patients on hemodialysis. Copyright © 2016 by the American Society of Nephrology.

Consideration of Dose Limits for Organs at Risk of Thoracic Radiotherapy: Atlas for Lung, Proximal Bronchial Tree, Esophagus, Spinal Cord, Ribs, and Brachial Plexus

DOE Office of Scientific and Technical Information (OSTI.GOV)

Kong, Feng-Ming, E-mail: fengkong@med.umich.edu; Ritter, Timothy; Quint, Douglas J.

2011-12-01

Purpose: To review the dose limits and standardize the three-dimenional (3D) radiographic definition for the organs at risk (OARs) for thoracic radiotherapy (RT), including the lung, proximal bronchial tree, esophagus, spinal cord, ribs, and brachial plexus. Methods and Materials: The present study was performed by representatives from the Radiation Therapy Oncology Group, European Organization for Research and Treatment of Cancer, and Soutwestern Oncology Group lung cancer committees. The dosimetric constraints of major multicenter trials of 3D-conformal RT and stereotactic body RT were reviewed and the challenges of 3D delineation of these OARs described. Using knowledge of the human anatomy andmore » 3D radiographic correlation, draft atlases were generated by a radiation oncologist, medical physicist, dosimetrist, and radiologist from the United States and reviewed by a radiation oncologist and medical physicist from Europe. The atlases were then critically reviewed, discussed, and edited by another 10 radiation oncologists. Results: Three-dimensional descriptions of the lung, proximal bronchial tree, esophagus, spinal cord, ribs, and brachial plexus are presented. Two computed tomography atlases were developed: one for the middle and lower thoracic OARs (except for the heart) and one focusing on the brachial plexus for a patient positioned supine with their arms up for thoracic RT. The dosimetric limits of the key OARs are discussed. Conclusions: We believe these atlases will allow us to define OARs with less variation and generate dosimetric data in a more consistent manner. This could help us study the effect of radiation on these OARs and guide high-quality clinical trials and individualized practice in 3D-conformal RT and stereotactic body RT.« less

Endoscopic ultrasound-guided transmural drainage of postoperative pancreatic collections.

PubMed

Tilara, Amy; Gerdes, Hans; Allen, Peter; Jarnagin, William; Kingham, Peter; Fong, Yuman; DeMatteo, Ronald; D'Angelica, Michael; Schattner, Mark

2014-01-01

Pancreatic leak is a major cause of morbidity after pancreatectomy. Traditionally, peripancreatic fluid collections have been managed by percutaneous or operative drainage. Data for endoscopic ultrasound (EUS)-guided drainage of postoperative fluid collections are limited. Here we report on the safety, efficacy, and timing of EUS-guided drainage of postoperative peripancreatic collections. This is a retrospective review of 31 patients who underwent EUS-guided drainage of fluid collections after pancreatic resection. Technical success was defined as successful transgastric deployment of at least one double pigtail plastic stent. Clinical success was defined as resolution of the fluid collection on follow-up CT scan and resolution of symptoms. Early drainage was defined as initial transmural stent placement within 30 days after surgery. Endoscopic ultrasound-guided drainage was performed effectively with a technical success rate of 100%. Clinical success was achieved in 29 of 31 patients (93%). Nineteen of the 29 patients (65%) had complete resolution of their symptoms and collection with the first endoscopic procedure. Repeat drainage procedures, including some with necrosectomy, were required in the remaining 10 patients, with eventual resolution of collection and symptoms. Two patients who did not achieve durable clinical success required percutaneous drainage by interventional radiology. Seventeen (55%) of 31 patients had successful early drainage completed within 30 days of their operation. Endoscopic ultrasound-guided drainage of fluid collections after pancreatic resection is safe and effective. Early drainage (<30 days) of postoperative pancreatic fluid collections was not associated with increased complications in this series. Copyright © 2014 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

Pocket ultrasound device as a complement to physical examination for ascites evaluation and guided paracentesis.

PubMed

Keil-Ríos, Daniel; Terrazas-Solís, Hiram; González-Garay, Alejandro; Sánchez-Ávila, Juan Francisco; García-Juárez, Ignacio

2016-04-01

The pocket ultrasound device (PUD) is a new tool that may be of use in the early detection of ascites. Abdominal ultrasound-guided paracentesis has been reported to decrease the rate of complications due to the procedure, but must be performed in a healthcare setting; this new tool may be a useful on an ambulatory basis. The aim of this study was to determine the diagnostic usefulness of the PUD in the diagnosis of ascites and the safety of guided paracentesis. We conducted a retrospective study that included adult patients suspected of having ascites and in whom an evaluation was performed with the PUD to identify it. Concordance with abdominal ultrasound (AUS) was determined with the Kappa coefficient. Sensitivity (Se), specificity (Sp) and likelihood ratios (LR) were determined and compared with physical examination, AUS, computed tomography and procurement of fluid by paracentesis. Complications resulting from the guided paracentesis were analyzed. 89 participants were included and 40 underwent a paracentesis. The PUD for ascites detection had 95.8 % Se, 81.8 % Sp, 5.27 +LR and 0.05 -LR. It had a concordance with AUS of 0.781 (p < 0.001). Technical problems during the guided paracentesis were present in only two participants (5 %) and three patients (7.5 %) developed minor complications that required no further intervention. There were no severe complications or deaths. This study suggests that the PUD is a reliable tool for ascites detection as a complement to physical examination and appears to be a safe method to perform guided paracentesis.

In-Plane Ultrasound-Guided Knee Injection Through a Lateral Suprapatellar Approach: A Safe Technique.

PubMed

Chagas-Neto, Francisco A; Taneja, Atul K; Gregio-Junior, Everaldo; Nogueira-Barbosa, Marcello H

2017-06-01

This study aims to describe a technique for in-plane ultrasound-guided knee arthrography through a lateral suprapatellar approach, reporting its accuracy and related complications. A retrospective search was performed for computed tomography and magnetic resonance reports from June 2013 through June 2015. Imaging studies, puncture descriptions, and guided-procedure images were reviewed along with clinical and surgical history. A fellowship-trained musculoskeletal radiologist performed all procedures under sterile technique and ultrasound guidance with the probe in oblique position on the lateral suprapatellar recess after local anesthesia with the patient on dorsal decubitus, hip in neutral rotation, and 30 to 45 degrees of knee flexion. A total of 86 consecutive subjects were evaluated (mean, 55 years). All subjects underwent intra-articular injection of contrast, which was successfully reached in the first attempt in 94.2% of the procedures (81/86), and in the second attempt in 5.8% (5/86) after needle repositioning without a second puncture. There were no postprocedural reports of regional complications at the puncture site, such as significant pain, bleeding, or vascular lesions. Our study demonstrates that in-plane ultrasound-guided injection of the knee in semiflexion approaching the lateral suprapatellar recess is a safe and useful technique to administer intra-articular contrast solution, as an alternative method without radiation exposure.

Delay and Standard Deviation Beamforming to Enhance Specular Reflections in Ultrasound Imaging.

PubMed

Bandaru, Raja Sekhar; Sornes, Anders Rasmus; Hermans, Jeroen; Samset, Eigil; D'hooge, Jan

2016-12-01

Although interventional devices, such as needles, guide wires, and catheters, are best visualized by X-ray, real-time volumetric echography could offer an attractive alternative as it avoids ionizing radiation; it provides good soft tissue contrast, and it is mobile and relatively cheap. Unfortunately, as echography is traditionally used to image soft tissue and blood flow, the appearance of interventional devices in conventional ultrasound images remains relatively poor, which is a major obstacle toward ultrasound-guided interventions. The objective of this paper was therefore to enhance the appearance of interventional devices in ultrasound images. Thereto, a modified ultrasound beamforming process using conventional-focused transmit beams is proposed that exploits the properties of received signals containing specular reflections (as arising from these devices). This new beamforming approach referred to as delay and standard deviation beamforming (DASD) was quantitatively tested using simulated as well as experimental data using a linear array transducer. Furthermore, the influence of different imaging settings (i.e., transmit focus, imaging depth, and scan angle) on the obtained image contrast was evaluated. The study showed that the image contrast of specular regions improved by 5-30 dB using DASD beamforming compared with traditional delay and sum (DAS) beamforming. The highest gain in contrast was observed when the interventional device was tilted away from being orthogonal to the transmit beam, which is a major limitation in standard DAS imaging. As such, the proposed beamforming methodology can offer an improved visualization of interventional devices in the ultrasound image with potential implications for ultrasound-guided interventions.

Ultrasound-guided breast-sparing surgery to improve cosmetic outcomes and quality of life. A prospective multicentre randomised controlled clinical trial comparing ultrasound-guided surgery to traditional palpation-guided surgery (COBALT trial)

PubMed Central

2011-01-01

Background Breast-conserving surgery for breast cancer was developed as a method to preserve healthy breast tissue, thereby improving cosmetic outcomes. Thus far, the primary aim of breast-conserving surgery has been the achievement of tumour-free resection margins and prevention of local recurrence, whereas the cosmetic outcome has been considered less important. Large studies have reported poor cosmetic outcomes in 20-40% of patients after breast-conserving surgery, with the volume of the resected breast tissue being the major determinant. There is clear evidence for the efficacy of ultrasonography in the resection of nonpalpable tumours. Surgical resection of palpable breast cancer is performed with guidance by intra-operative palpation. These palpation-guided excisions often result in an unnecessarily wide resection of adjacent healthy breast tissue, while the rate of tumour-involved resection margins is still high. It is hypothesised that the use of intra-operative ultrasonography in the excision of palpable breast cancer will improve the ability to spare healthy breast tissue while maintaining or even improving the oncological margin status. The aim of this study is to compare ultrasound-guided surgery for palpable tumours with the standard palpation-guided surgery in terms of the extent of healthy breast tissue resection, the percentage of tumour-free margins, cosmetic outcomes and quality of life. Methods/design In this prospective multicentre randomised controlled clinical trial, 120 women who have been diagnosed with palpable early-stage (T1-2N0-1) primary invasive breast cancer and deemed suitable for breast-conserving surgery will be randomised between ultrasound-guided surgery and palpation-guided surgery. With this sample size, an expected 20% reduction of resected breast tissue and an 18% difference in tumour-free margins can be detected with a power of 80%. Secondary endpoints include cosmetic outcomes and quality of life. The rationale, study design and planned analyses are described. Conclusion The COBALT trial is a prospective, multicentre, randomised controlled study to assess the efficacy of ultrasound-guided breast-conserving surgery in patients with palpable early-stage primary invasive breast cancer in terms of the sparing of breast tissue, oncological margin status, cosmetic outcomes and quality of life. Trial Registration Number Netherlands Trial Register (NTR): NTR2579 PMID:21410949

Comparison of a novel real-time SonixGPS needle-tracking ultrasound technique with traditional ultrasound for vascular access in a phantom gel model.

PubMed

Kopac, Daniel S; Chen, Jerry; Tang, Raymond; Sawka, Andrew; Vaghadia, Himat

2013-09-01

Ultrasound-guided percutaneous vascular access for endovascular procedures is well established in surgical practice. Despite this, rates of complications from venous and arterial access procedures remain a significant cause of morbidity. We hypothesized that the use of a new technique of vascular access using an ultrasound with a novel needle-guidance positioning system (GPS) would lead to improved success rates of vascular puncture for both in-plane and out-of-plane techniques compared with traditional ultrasound. A prospective, randomized crossover study of medical students from all years of medical school was conducted using a phantom gel model. Each medical student performed three ultrasound-guided punctures with each of the four modalities (in-plane no GPS, in-plane with GPS, out-of-plane no GPS, out-of-plane with GPS) for a total of 12 attempts. The success or failure was judged by the ability to aspirate a simulated blood solution from the model. The time to successful puncture was also recorded. A poststudy validated NASA Task Load Index workload questionnaire was conducted to assess the student's perceptions of the two different techniques. A total of 30 students completed the study. There was no significant difference seen in the mean times of vascular access for each of the modalities. Higher success rates for vascular access using the GPS for both the in-plane (94% vs 91%) and the out-of-plane (86% vs 70%) views were observed; however, this was not statistically significant. The students perceived the mental demand (median 12.0 vs 14.00; P = .035) and effort to be lower (mean 11.25 vs 14.00; P = .044) as well as the performance to be higher (mean 15.50 vs 14.00; P = .041) for the GPS vs the traditional ultrasound-guided technique. Students also perceived their ability to access vessels increased with the aid of the GPS (7.00 vs 6.50; P = .007). The majority of students expressed a preference for GPS (26/30, 87%) as opposed to the traditional counterpart. Use of the novel SonixGPS needle-tracking ultrasound system (UltraSonix, Richmond, BC, Canada) was not associated with a higher success rate of vascular puncture compared with the traditional ultrasound-guided technique. Assessment of mental task load significantly favored the use of the ultrasound GPS over the traditional ultrasound technique. Copyright © 2013 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.

Prostate tissue ablation with MRI guided transurethral therapeutic ultrasound and intraoperative assessment of the integrity of the neurovascular bundle

NASA Astrophysics Data System (ADS)

Sammet, Steffen; Partanen, Ari; Yousuf, Ambereen; Wardrip, Craig; Niekrasz, Marek; Antic, Tatjana; Razmaria, Aria; Sokka, Sham; Karczmar, Gregory; Oto, Aytekin

2017-03-01

OBJECTIVES: Evaluation of the precision of prostate tissue ablation with MRI guided therapeuticultrasound by intraoperative objective assessment of the neurovascular bundle in canines in-vivo. METHODS: In this ongoing IACUC approved study, eight male canines were scanned in a clinical 3T Achieva MRI scanner (Philips) before, during, and after ultrasound therapy with a prototype MR-guided ultrasound therapy system (Philips). The system includes a therapy console to plan treatment, to calculate real-time temperature maps, and to control ultrasound exposures with temperature feedback. Atransurethral ultrasound applicator with eight transducer elements was used to ablate canine prostate tissue in-vivo. Ablated prostate tissue volumes were compared to the prescribed target volumes to evaluate technical effectiveness. The ablated volumes determined by MRI (T1, T2, diffusion, dynamic contrast enhanced and 240 CEM43 thermal dose maps) were compared to H&E stained histological slides afterprostatectomy. Potential nerve damage of the neurovascular bundle was objectively assessed intraoperativelyduring prostatectomy with a CaverMap Surgical Aid nerve stimulator (Blue Torch Medical Technologies). RESULTS: Transurethral MRI -guided ultrasound therapy can effectively ablate canine prostate tissue invivo. Coronal MR-imaging confirmed the correct placement of the HIFU transducer. MRI temperature maps were acquired during HIFU treatment, and subsequently used for calculating thermal dose. Prescribed target volumes corresponded to the 240 CEM43 thermal dose maps during HIFU treatment in all canines. Ablated volumes on high resolution anatomical, diffusion weighted, and contrast enhanced MR images matched corresponding histological slides after prostatectomy. MRI guidance with realtime temperature monitoring showed no damage to surrounding tissues, especially to the neurovascular bundle (assessed intra-operatively with a nerve stimulator) or to the rectum wall. CONCLUSIONS: Our study demonstrates the effectiveness and precision of transurethral ultrasound ablation of prostatic tissue in canines with MRI monitoring and guidance. The canine prostate is an excellent model for the human prostate with similar anatomical characteristics and diseases. MRI guidance with real-time, intraoperative temperature monitoring reduces the risk of damaging critical surrounding anatomical structures in ultrasound therapy of the prostate.

Ultrasound-Guided Abrams Pleural Biopsy vs CT-Guided Tru-Cut Pleural Biopsy in Malignant Pleural Disease, a 3-Year Follow-up Study.

PubMed

Sivakumar, Parthipan; Jayaram, Deepak; Rao, Deepak; Dhileepan, Vignesh; Ahmed, Irfan; Ahmed, Liju

2016-12-01

Conventional Abrams biopsy shows low sensitivity in suspected malignant pleural disease. There are limited data on the improvement in sensitivity by adding in image guidance. This retrospective study compares the diagnostic sensitivity of Abrams biopsy using ultrasound guidance with CT-guided Tru-Cut biopsy in suspected malignant pleural disease. Data were collected from 2006 to 2012 of patients who underwent image-guided biopsies for suspected non-tuberculous pleural disease. Data were collected on the result of the initial biopsy and final patient diagnosis as of June 2015. Sixty-three patients underwent image-guided Abrams biopsy and 29 underwent CT-guided Tru-Cut biopsies. The sensitivity of Abrams was 71.43 % compared to 75 % in the CT-guided Tru-Cut group. Specificity was 100 % in both groups. Image-guided Abrams biopsies demonstrate comparable diagnostic sensitivity in malignant pleural disease to CT-guided Tru-Cut biopsy.

High-intensity focused ultrasound (HIFU) array system for image-guided ablative therapy (IGAT)

NASA Astrophysics Data System (ADS)

Kaczkowski, Peter J.; Keilman, George W.; Cunitz, Bryan W.; Martin, Roy W.; Vaezy, Shahram; Crum, Lawrence A.

2003-06-01

Recent interest in using High Intensity Focused Ultrasound (HIFU) for surgical applications such as hemostasis and tissue necrosis has stimulated the development of image-guided systems for non-invasive HIFU therapy. Seeking an all-ultrasound therapeutic modality, we have developed a clinical HIFU system comprising an integrated applicator that permits precisely registered HIFU therapy delivery and high quality ultrasound imaging using two separate arrays, a multi-channel signal generator and RF amplifier system, and a software program that provides the clinician with a graphical overlay of the ultrasound image and therapeutic protocol controls. Electronic phasing of a 32 element 2 MHz HIFU annular array allows adjusting the focus within the range of about 4 to 12 cm from the face. A central opening in the HIFU transducer permits mounting a commercial medical imaging scanhead (ATL P7-4) that is held in place within a special housing. This mechanical fixture ensures precise coaxial registration between the HIFU transducer and the image plane of the imaging probe. Recent enhancements include development of an acoustic lens using numerical simulations for use with a 5-element array. Our image-guided therapy system is very flexible and enables exploration of a variety of new HIFU therapy delivery and monitoring approaches in the search for safe, effective, and efficient treatment protocols.

Ultrasound-guided interventional therapy for recurrent ovarian chocolate cysts.

PubMed

Wang, Lu-Lu; Dong, Xiao-Qiu; Shao, Xiao-Hui; Wang, Si-Ming

2011-10-01

The aim of this study was to determine the effectiveness of ultrasound-guided interventional therapy in the treatment of postoperative recurrent chocolate cysts. The 198 patients enrolled in this study were divided into three groups. In group 1, the saline washing group, the cavity of the cyst was washed thoroughly with warm saline. In group 2, the ethanol short-time retention group, after washing with saline, the cyst was injected with 95% ethanol with a volume of half of the fluid aspirated from the cyst. Ten minutes later, the rest of the ethanol was aspirated. In group 3, the ethanol retention group, the procedures were the same as with the ethanol short-time retention group, except that 95% of the ethanol was retained in the cyst. An ultrasound examination was performed in the third, sixth and 12th months after therapy. The chocolate cyst cure rate was significantly higher in the ethanol retention group (96%, 66/69) than in the ethanol short-time retention group (82%, 56/68) and no case was cured in the first group (saline washing). We conclude that ultrasound-guided injection and 95% ethanol retention are an effective therapy for the treatment of postoperative recurrent chocolate cysts. Copyright © 2011 World Federation for Ultrasound in Medicine & Biology. Published by Elsevier Inc. All rights reserved.

Ultrasound-guided injection for plantar fasciitis: A brief review

PubMed Central

Nair, AS; Sahoo, RK

2016-01-01

Plantar fasciitis (PF) is a distressing condition experienced by many patients. Although self-limiting, it tends to become a chronic ailment if the precipitating factors are not addressed. One of the modality of treating PF is intra-lesional corticosteroid injection. This was done using palpation technique earlier but nowadays many specialists use ultrasound (US) imaging as a guide to give injection accurately instead of inadvertently damaging the plantar fascia or injecting into surrounding soft tissue, both of which can have serious implications. We did a literature search in Medline, Scopus, and Embase databases to find out articles describing US-guided corticosteroid injection for treating PF and whether guided injection was effective than injection given by palpation. PMID:27833490

From acute to chronic postsurgical pain: the significance of the acute pain response.

PubMed

Blichfeldt-Eckhardt, Morten Rune

2018-03-01

The thesis comprises an overview and four papers, all published or submitted for publication in international peer-reviewed scientific journals.
 
Chronic pain after surgery is a common and debilitating complication after many types of surgery. The cause and pathology behind is still mainly uncovered, though several risk factors have been proposed. One of the strongest risk factors for persistent postsurgical pain is the intensity of the acute pain response though the mechanisms involved remain unsettled. The acute pain response consists of several different types of pain (i.e. somatic pain, visceral pain, referred pain, neuropathic pain). It's uncovered whether some components of the acute pain response are closer correlated to chronic pain than others and whether treatment of acute pain can change the risk of developing chronic pain.
 The aim of the thesis was to investigate which components of the acute pain response, was correlated to chronic postsurgical pain in patients for cholecystectomy and lobectomy.
 Furthermore, to study the type and time course of ipsilateral shoulder pain after lobectomy and whether an ultrasound-guided supraclavicular phrenic nerve block was effective in preventing acute and chronic shoulder pain after major thoracic surgery.
 Paper I is based on a prospective, observational, multicenter, cohort study, in which 100 patients for cholecystectomy was examined preoperatively, 1 week postoperatively and 3, 6, and 12 months postoperatively for pain, psychological factors and signs of hypersensitivity.
 Paper II and III are based on a prospective, observational, cohort study, in which 60 patients for lobectomy ware examined preoperatively, 4 days postoperatively and 12 months postoperatively for pain, psychological factors and signs of hypersensitivity. 
Paper IV is based on a prospective, randomized, double-blind and placebo-controlled trial, where 76 patients were randomized to receive ultrasound guided supraclavicular phrenic nerve block with a blinded study solution (ropivacaine or saline). The primary endpoint was pain within the first 6 hours after surgery. Secondary endpoints included pain the following days and after 3 months.
 
Paper I: Nine patients developed chronic unexplained pain 12 months postoperatively. In a multivariate analysis, cumulated visceral pain during the first week and number of preoperative biliary pain attacks were identified as independent risk factors for unexplained pain 12 months after surgery. There were no consistent signs of increased hypersensitivity in the referred pain area before or after the operation in patients with chronic pain. 
Paper II: Sixteen patients developed chronic pain 12 months postoperatively. In a multivariate analysis thoracic pain during activity was the only significant predictor of chronic pain 12 months after surgery. Shoulder pain, referred pain and overall pain was not significant predictors. There were no signs of general hypersensitivity 12 months after surgery. 
Paper III: Forty-seven (78%) of patients experienced postoperative shoulder pain, but only 25 patients (42%) experienced clinically relevant pain (NRS > 3). On postoperative day 4, 19 (32%) of patients suffered shoulder pain, but only 4 (7%) suffered clinically relevant pain. Only 4 patients (8%) suffered chronic shoulder pain. Ipsilateral shoulder pain of the

 
musculoskeletal type is more intense than referred ipsilateral shoulder pain, though referred shoulder pain is more common. Surgical approach was not related to incidence of shoulder pain or type of pain.
 Paper IV: Shoulder pain within 6 hours of the operation was reported in 9 patients (24%) in the treatment group versus 26 (68%) in the placebo group (p<0.0001). Absolute and relative risk reductions were 44% (95% CI 22-67%) and 65% (95% CI 41-80%), respectively. No major complications, including respiratory compromise, were observed. Subsequent treatment with a nerve catheter was effective during the first 36 hours after surgery, but because of loss of nerve catheter or early submission of patients, data concerning pain the following days and after 3 months were inconclusive. Articles published in the Danish Medical Journal are “open access”. This means that the articles are distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits any non-commercial use, distribution, and reproduction in any medium, provided the original author(s) and source are credited.

High-frequency ultrasound imaging for breast cancer biopsy guidance

PubMed Central

Cummins, Thomas; Yoon, Changhan; Choi, Hojong; Eliahoo, Payam; Kim, Hyung Ham; Yamashita, Mary W.; Hovanessian-Larsen, Linda J.; Lang, Julie E.; Sener, Stephen F.; Vallone, John; Martin, Sue E.; Kirk Shung, K.

2015-01-01

Abstract. Image-guided core needle biopsy is the current gold standard for breast cancer diagnosis. Microcalcifications, an important radiographic finding on mammography suggestive of early breast cancer such as ductal carcinoma in situ, are usually biopsied under stereotactic guidance. This procedure, however, is uncomfortable for patients and requires the use of ionizing radiation. It would be preferable to biopsy microcalcifications under ultrasound guidance since it is a faster procedure, more comfortable for the patient, and requires no radiation. However, microcalcifications cannot reliably be detected with the current standard ultrasound imaging systems. This study is motivated by the clinical need for real-time high-resolution ultrasound imaging of microcalcifications, so that biopsies can be accurately performed under ultrasound guidance. We have investigated how high-frequency ultrasound imaging can enable visualization of microstructures in ex vivo breast tissue biopsy samples. We generated B-mode images of breast tissue and applied the Nakagami filtering technique to help refine image output so that microcalcifications could be better assessed during ultrasound-guided core biopsies. We describe the preliminary clinical results of high-frequency ultrasound imaging of ex vivo breast biopsy tissue with microcalcifications and without Nakagami filtering and the correlation of these images with the pathology examination by hematoxylin and eosin stain and whole slide digital scanning. PMID:26693167

A Guide to Analysing Tongue Motion from Ultrasound Images

ERIC Educational Resources Information Center

Stone, Maureen

2005-01-01

This paper is meant to be an introduction to and general reference for ultrasound imaging for new and moderately experienced users of the instrument. The paper consists of eight sections. The first explains how ultrasound works, including beam properties, scan types and machine features. The second section discusses image quality, including the…

Line fiducial material and thickness considerations for ultrasound calibration

NASA Astrophysics Data System (ADS)

Ameri, Golafsoun; McLeod, A. J.; Baxter, John S. H.; Chen, Elvis C. S.; Peters, Terry M.

2015-03-01

Ultrasound calibration is a necessary procedure in many image-guided interventions, relating the position of tools and anatomical structures in the ultrasound image to a common coordinate system. This is a necessary component of augmented reality environments in image-guided interventions as it allows for a 3D visualization where other surgical tools outside the imaging plane can be found. Accuracy of ultrasound calibration fundamentally affects the total accuracy of this interventional guidance system. Many ultrasound calibration procedures have been proposed based on a variety of phantom materials and geometries. These differences lead to differences in representation of the phantom on the ultrasound image which subsequently affect the ability to accurately and automatically segment the phantom. For example, taut wires are commonly used as line fiducials in ultrasound calibration. However, at large depths or oblique angles, the fiducials appear blurred and smeared in ultrasound images making it hard to localize their cross-section with the ultrasound image plane. Intuitively, larger diameter phantoms with lower echogenicity are more accurately segmented in ultrasound images in comparison to highly reflective thin phantoms. In this work, an evaluation of a variety of calibration phantoms with different geometrical and material properties for the phantomless calibration procedure was performed. The phantoms used in this study include braided wire, plastic straws, and polyvinyl alcohol cryogel tubes with different diameters. Conventional B-mode and synthetic aperture images of the phantoms at different positions were obtained. The phantoms were automatically segmented from the ultrasound images using an ellipse fitting algorithm, the centroid of which is subsequently used as a fiducial for calibration. Calibration accuracy was evaluated for these procedures based on the leave-one-out target registration error. It was shown that larger diameter phantoms with lower echogenicity are more accurately segmented in comparison to highly reflective thin phantoms. This improvement in segmentation accuracy leads to a lower fiducial localization error, which ultimately results in low target registration error. This would have a profound effect on calibration procedures and the feasibility of different calibration procedures in the context of image-guided procedures.

Endoscopic ultrasound guided drainage of pancreatic fluid collections: Assessment of the procedure, technical details and review of the literature

PubMed Central

Puri, Rajesh; Thandassery, Ragesh Babu; Alfadda, Abdulrahman A; Kaabi, Saad Al

2015-01-01

Endoscopic ultrasound (EUS) guided drainage of pancreatic fluid collections (PFC) has become increasingly popular and become first line management option in many centers. Use of therapeutic echoendoscopes has greatly increased the applicability of EUS guided transmural drainage. Drainage is indicated in symptomatic PFCs, PFC related infection, bleed, luminal obstruction, fistulization and biliary obstruction. EUS guided transmural drainage of PFCs is preferred in patients with non bulging lesions, portal hypertension, bleeding tendency and in those whom conventional drainage has failed. In the present decade significant progress has been made in minimally invasive endoscopic techniques. There are newer stent designs, access devices and techniques for more efficient drainage of PFCs. In this review, we discuss the EUS guided drainage of PFCs in acute pancreatitis. PMID:25901214

The Second American Society of Regional Anesthesia and Pain Medicine Evidence-Based Medicine Assessment of Ultrasound-Guided Regional Anesthesia: Executive Summary.

PubMed

Neal, Joseph M; Brull, Richard; Horn, Jean-Louis; Liu, Spencer S; McCartney, Colin J L; Perlas, Anahi; Salinas, Francis V; Tsui, Ban Chi-Ho

2016-01-01

In 2009 and again in 2012, the American Society of Regional Anesthesia and Pain Medicine assembled an expert panel to assess the evidence basis for ultrasound guidance as a nerve localization tool for regional anesthesia. The 2012 panel reviewed evidence from the first advisory but focused primarily on new information that had emerged since 2009. A new section was added regarding the accuracy and reliability of ultrasound for determining needle-to-nerve proximity. Jadad scores are used to rank study quality. Grades of recommendations consistent with their level of evidence are provided. The panel offers recommendations based on synthesis and analysis of literature related to (1) the technical capabilities of ultrasound equipment and its operators, (2) comparison of ultrasound to other methods of nerve localization with regard to block characteristics, (3) comparison of block techniques where ultrasound is the sole nerve localization modality, and (4) major complications. Assessment of evidence strength and recommendations are made for upper- and lower-extremity, truncal, neuraxial, and pediatric blocks. Scientific evidence from the past 5 years has clarified and strengthened our understanding of ultrasound-guided regional anesthesia as a nerve localization tool. High-level evidence supports ultrasound guidance contributing to superior characteristics with selected blocks, although absolute differences with the comparator technique are often relatively small (especially for upper-extremity blocks). The clinical meaningfulness of these differences is likely of variable importance to individual practitioners. The use of ultrasound significantly reduces the risk of local anesthetic systemic toxicity as well as the incidence and intensity of hemidiaphragmatic paresis, but has no significant effect on the incidence of postoperative neurologic symptoms. WHAT'S NEW IN THIS UPDATE?: This evidence-based assessment of ultrasound-guided regional anesthesia reviews findings from our 2010 publication and focuses on new meta-analyses, randomized controlled trials, and large case series published since 2009. New to this exercise is an in-depth analysis of the accuracy and reliability of ultrasound guidance for identifying needle-to-nerve relationships. This version no longer addresses ultrasound for interventional pain medicine procedures, because the growth of that field demands separate consideration. Since our 2010 publication, new information has either supported or strengthened our original conclusions. There is no evidence that ultrasound is inferior to alternative nerve localization methods.

Endoscopic ultrasound-guided transesophageal thoracentesis for minimal pleural effusion.

PubMed

Rana, Surinder Singh; Sharma, Ravi; Gupta, Rajesh

2018-06-19

Pleural effusion is a common finding both in patients with benign and malignant diseases of pleura and lung with diagnostic thoracentesis establishing the diagnosis in the majority of cases. The diagnostic thoracentesis can be done either blindly or under the guidance of ultrasound or computed tomography. However, minimal pleural effusion is difficult to sample even under image guidance. Endoscopic ultrasound (EUS) is known to detect smaller volume of pleural effusion and, thus, can help in guiding thoracentesis. To analyze the safety and efficacy of EUS-guided diagnostic thoracentesis in patients with undiagnosed minimal pleural effusion retrospectively. Retrospective analysis of the data of patients with minimal pleural effusion, who underwent EUS-guided transesophageal diagnostic thoracentesis over last 2 years, was performed. Thirteen patients (11 male; mean age 46.7 ± 16.2 years) with undiagnosed minimal pleural effusion underwent successful EUS-guided transesophageal diagnostic thoracentesis using a 22-G needle. Seven (53%) patients had fever on presentation whereas two presented with cough and loss of appetite. Eight to 54 mL fluid was aspirated with an attempt to completely empty the pleural cavity. There were no complications of the procedure. EUS-guided diagnostic thoracentesis is a safe and effective alternative for evaluating patients with minimal pleural effusion.

Defining the reliability of sonoanatomy identification by novices in ultrasound-guided pediatric ilioinguinal and iliohypogastric nerve blockade.

PubMed

Ford, Simon; Dosani, Maryam; Robinson, Ashley J; Campbell, G Claire; Ansermino, J Mark; Lim, Joanne; Lauder, Gillian R

2009-12-01

The ilioinguinal (II)/iliohypogastric (IH) nerve block is a safe, frequently used block that has been improved in efficacy and safety by the use of ultrasound guidance. We assessed the frequency with which pediatric anesthesiologists with limited experience with ultrasound-guided regional anesthesia could correctly identify anatomical structures within the inguinal region. Our primary outcome was to compare the frequency of correct identification of the transversus abdominis (TA) muscle with the frequency of correct identification of the II/IH nerves. We used 2 ultrasound machines with different capabilities to assess a potential equipment effect on success of structure identification and time taken for structure identification. Seven pediatric anesthesiologists with <6 mo experience with ultrasound-guided regional anesthesia performed a total of 127 scans of the II region in anesthetized children. The muscle planes and the II and IH nerves were identified and labeled. The ultrasound images were reviewed by a blinded expert to mark accuracy of structure identification and time taken for identification. Two ultrasound machines (Sonosite C180plus and Micromaxx, both from Sonosite, Bothell, WA) were used. There was no difference in the frequency of correct identification of the TA muscle compared with the II/IH nerves (chi(2) test, TA versus II, P = 0.45; TA versus IH, P = 0.50). Ultrasound machine selection did show a nonsignificant trend in improving correct II/IH nerve identification (II nerve chi(2) test, P = 0.02; IH nerve chi(2) test, P = 0.04; Bonferroni corrected significance 0.17) but not for the muscle planes (chi(2) test, P = 0.83) or time taken (1-way analysis of variance, P = 0.07). A curve of improving accuracy with number of scans was plotted, with reliability of TA recognition occurring after 14-15 scans and II/IH identification after 18 scans. We have demonstrated that although there is no difference in the overall accuracy of muscle plane versus II/IH nerve identification, the muscle planes are reliably identified after fewer scans of the inguinal region. We suggest that a reliable end point for the inexperienced practitioner of ultrasound-guided II/IH nerve block may be the TA/internal oblique plane where the nerves are reported to be found in 100% of cases.

Focused ultrasound guided relocation of kidney stones.

PubMed

Abrol, Nitin; Kekre, Nitin S

2015-01-01

Complete removal of all fragments is the goal of any intervention for urinary stones. This is more important in lower pole stones where gravity and spatial orientation of lower pole infundibulum may hinder spontaneous passage of fragments. Various adjuvant therapies (inversion, diuresis, percussion, oral citrate, etc.) are described to enhance stone-free rate but are not widely accepted. Focused ultrasound-guided relocation of fragments is a recently described technique aimed at improving results of intervention for stone disease. Purpose of this review is to discuss development of this technology and its potential clinical applications. Pubmed search was made using key words "Focused ultrasound" and "kidney stone". All English language articles were reviewed by title. Relevant studies describing development and application of focused ultrasound in renal stones were selected for review. Focused ultrasound has proven its efficacy in successfully relocating up to 8 mm stone fragments in vitro and in pigs. Relocation is independent of stone composition. The latest model allows imaging and therapy with a single handheld probe facilitating its use by single operator. The acoustic energy delivered by the new prototype is even less than that used for extracorporeal shock wave lithotripsy. Therapeutic exposure has not caused thermal injury in pig kidneys. Focused ultrasound-guided relocation of stones is feasible. Though it is safe in application in pigs, technology is awaiting approval for clinical testing in human beings. This technology has many potential clinical applications in the management of stone disease.

Ultrasound-guided intrasphincteric botulinum toxin injection relieves obstructive defecation due to Hirschsprung's disease and internal anal sphincter achalasia.

PubMed

Church, Joseph T; Gadepalli, Samir K; Talishinsky, Toghrul; Teitelbaum, Daniel H; Jarboe, Marcus D

2017-01-01

Chronic obstructive defecation can occur in patients with Hirschsprung Disease (HD) and internal anal sphincter (IAS) achalasia. Injection of Botulinum Toxin (BoTox) into the IAS can temporarily relieve obstructive defecation, but can be challenging when performed by tactile sense alone. We compared results of BoTox injections with and without ultrasound (US) guidance. We retrospectively reviewed BoTox injections into the IAS for obstructive defecation over 5years. Analyzed outcomes included short-term improvement, defined as resolution of enterocolitis, new ability to spontaneously defecate, and/or normalization of bowel movement frequency 2weeks post-operatively, as well as requirement of more definitive surgical therapy (myotomy/myomectomy, colectomy, colostomy, cecostomy/appendicostomy, and/or sacral nerve stimulator implantation). Outcomes were compared using t-test and Fisher's Exact test, with significance defined as p<0.05. Twelve patients who underwent BoTox injection were included, including 5 patients who underwent injections both with and without ultrasound. Ten underwent an ultrasound-guided injection (13 injection procedures), 5 of whom had HD. Seven underwent an injection without ultrasound guidance (17 injection procedures), 5 of whom had HD. Procedures performed with US resulted in greater short-term improvement (76% versus 65% without ultrasound) and less requirement of a definitive procedure for obstructive defecation (p<0.05). US-guided BoTox injection is safe and effective for obstructive defecation, and may decrease the need for a definitive operation. III. Copyright © 2017 Elsevier Inc. All rights reserved.

Consider use of a collateral venous circuit before abandoning the arteriovenous fistula--the experience of a complex vascular access case.

PubMed

Gołębiowski, Tomasz; Kusztal, Mariusz; Wątorek, Ewa; Garcarek, Jerzy; Letachowicz, Krzysztof; Weyde, Wacław; Klinger, Marian

2014-07-01

We describe a 65-year-old woman with diabetes on hemodialysis maintenance, with a number of complications associated with high-flow arteriovenous fistula (AVF, anastomosis between brachial artery and medial vein of the forearm) requiring an extended diagnostic and individual approach. The patient was admitted to our hospital because of pain, edema of the limb, hand ischemia, and infection caused by steal syndrome. To reduce fistula flow, banding of the proximal cephalic vein was performed. Simultaneously because of necrosis, amputation of the fifth finger was necessary. Following this procedure, the cephalic vein on the arm thrombosed. The fistula was patent through the collateral circuit, which was diagnosed in detail during the late course. A long course of antibiotics and sessions in a hyperbaric chamber allowed limb rescue. Single-needle dialysis was carried out because of problems in finding an appropriate second place. After an episode of bleeding from the puncture site caused by ulceration, we were forced to search for an alternative needling point. On the basis of ultrasound scans, an anatomic schema of the blood circuit was created. The fistula demonstrated flow from the brachial artery resulting in retrograde flow in the section of the cephalic vein distal to the anastomosis in the upper forearm. This was then seen to drain in an antegrade direction via the median vein of the forearm after the 2 vessels connected in the mid forearm. Using the diagram, 2 alternative places for needling were found and it allowed the adequate hemodialysis to be continued. Complex and complicated cases associated with native AVF could be resolved using simple diagnostic tools to preserve the fistula use for hemodialysis. Both clinical examination and ultrasound scan with the Doppler option appear to be valuable methods for finding the optimal cannulation place. Copyright © 2014 Elsevier Inc. All rights reserved.

Lower-limb hot-water immersion acutely induces beneficial hemodynamic and cardiovascular responses in peripheral arterial disease and healthy, elderly controls.

PubMed

Thomas, Kate N; van Rij, André M; Lucas, Samuel J E; Cotter, James D

2017-03-01

Passive heat induces beneficial perfusion profiles, provides substantive cardiovascular strain, and reduces blood pressure, thereby holding potential for healthy and cardiovascular disease populations. The aim of this study was to assess acute responses to passive heat via lower-limb, hot-water immersion in patients with peripheral arterial disease (PAD) and healthy, elderly controls. Eleven patients with PAD (age 71 ± 6 yr, 7 male, 4 female) and 10 controls (age 72 ± 7 yr, 8 male, 2 female) underwent hot-water immersion (30-min waist-level immersion in 42.1 ± 0.6°C water). Before, during, and following immersion, brachial and popliteal artery diameter, blood flow, and shear stress were assessed using duplex ultrasound. Lower-limb perfusion was measured also using venous occlusion plethysmography and near-infrared spectroscopy. During immersion, shear rate increased ( P < 0.0001) comparably between groups in the popliteal artery (controls: +183 ± 26%; PAD: +258 ± 54%) and brachial artery (controls: +117 ± 24%; PAD: +107 ± 32%). Lower-limb blood flow increased significantly in both groups, as measured from duplex ultrasound (>200%), plethysmography (>100%), and spectroscopy, while central and peripheral pulse-wave velocity decreased in both groups. Mean arterial blood pressure was reduced by 22 ± 9 mmHg (main effect P < 0.0001, interaction P = 0.60) during immersion, and remained 7 ± 7 mmHg lower 3 h afterward. In PAD, popliteal shear profiles and claudication both compared favorably with those measured immediately following symptom-limited walking. A 30-min hot-water immersion is a practical means of delivering heat therapy to PAD patients and healthy, elderly individuals to induce appreciable systemic (chronotropic and blood pressure lowering) and hemodynamic (upper and lower-limb perfusion and shear rate increases) responses. Copyright © 2017 the American Physiological Society.

Passive Markers for Tracking Surgical Instruments in Real-Time 3-D Ultrasound Imaging

PubMed Central

Stoll, Jeffrey; Ren, Hongliang; Dupont, Pierre E.

2013-01-01

A family of passive echogenic markers is presented by which the position and orientation of a surgical instrument can be determined in a 3-D ultrasound volume, using simple image processing. Markers are attached near the distal end of the instrument so that they appear in the ultrasound volume along with the instrument tip. They are detected and measured within the ultrasound image, thus requiring no external tracking device. This approach facilitates imaging instruments and tissue simultaneously in ultrasound-guided interventions. Marker-based estimates of instrument pose can be used in augmented reality displays or for image-based servoing. Design principles for marker shapes are presented that ensure imaging system and measurement uniqueness constraints are met. An error analysis is included that can be used to guide marker design and which also establishes a lower bound on measurement uncertainty. Finally, examples of marker measurement and tracking algorithms are presented along with experimental validation of the concepts. PMID:22042148

Reproducibility of Ultrasound-Guided High Intensity Focused Ultrasound (HIFU) Thermal Lesions in Minimally-Invasive Brain Surgery

NASA Astrophysics Data System (ADS)

Zahedi, Sulmaz

This study aims to prove the feasibility of using Ultrasound-Guided High Intensity Focused Ultrasound (USg-HIFU) to create thermal lesions in neurosurgical applications, allowing for precise ablation of brain tissue, while simultaneously providing real time imaging. To test the feasibility of the system, an optically transparent HIFU compatible tissue-mimicking phantom model was produced. USg-HIFU was then used for ablation of the phantom, with and without targets. Finally, ex vivo lamb brain tissue was imaged and ablated using the USg-HIFU system. Real-time ultrasound images and videos obtained throughout the ablation process showing clear lesion formation at the focal point of the HIFU transducer. Post-ablation gross and histopathology examinations were conducted to verify thermal and mechanical damage in the ex vivo lamb brain tissue. Finally, thermocouple readings were obtained, and HIFU field computer simulations were conducted to verify findings. Results of the study concluded reproducibility of USg-HIFU thermal lesions for neurosurgical applications.

Ultrasound in Arthritis.

PubMed

Sudoł-Szopińska, Iwona; Schueller-Weidekamm, Claudia; Plagou, Athena; Teh, James

2017-09-01

Ultrasound is currently performed in everyday rheumatologic practice. It is used for early diagnosis, to monitor treatment results, and to diagnose remission. The spectrum of pathologies seen in arthritis with ultrasound includes early inflammatory features and associated complications. This article discusses the spectrum of ultrasound features of arthritides seen in rheumatoid arthritis and other connective tissue diseases in adults, such as Sjögren syndrome, lupus erythematosus, dermatomyositis, polymyositis, and juvenile idiopathic arthritis. Ultrasound findings in spondyloarthritis, osteoarthritis, and crystal-induced diseases are presented. Ultrasound-guided interventions in patients with arthritis are listed, and the advantages and disadvantages of ultrasound are discussed. Copyright © 2017 Elsevier Inc. All rights reserved.

High-flow vascular malformation treatment using ultrasound-guided laser combined with polidocanol sclerotherapy.

PubMed

Zhang, Yan; Zhou, Ping; Li, Lan; Li, Jia-le

2015-07-01

The current treatment for vascular malformations includes surgery, sclerotherapy, and embolization. However, each method has its limitations, such as recurrence, complications, scarring, and radiation exposure. Therefore, identifying an effective, minimally invasive treatment that reduces lesion recurrence is particularly important. We describe in detail a patient who received treatment with ultrasound-guided laser interruption of feeding vessels combined with polidocanol sclerotherapy after the recurrence of forearm high-flow vascular malformation.

Simulators for training in ultrasound guided procedures.

PubMed

Farjad Sultan, Syed; Shorten, George; Iohom, Gabrielle

2013-06-01

The four major categories of skill sets associated with proficiency in ultrasound guided regional anaesthesia are 1) understanding device operations, 2) image optimization, 3) image interpretation and 4) visualization of needle insertion and injection of the local anesthetic solution. Of these, visualization of needle insertion and injection of local anaesthetic solution can be practiced using simulators and phantoms. This survey of existing simulators summarizes advantages and disadvantages of each. Current deficits pertain to the validation process.

Ultrasound-guided peripheral nerve interventions for common pain disorders

PubMed Central

Krishna Prasad, B P; Joy, Binu; Raghavendra, Vijayakumar A; Toms, Ajith; George, Danny; Ray, Brijesh

2018-01-01

There are a number of common pain disorders that can be managed effectively by injections around or ablation of peripheral nerves. Ultrasound is a universally available imaging tool, is safe, cost-effective, and is excellent in imaging many peripheral nerves and guiding needles to the site of the nerves. This article aims to present an overview of indications and techniques of such procedures that can be effectively performed by a radiologist. PMID:29692534

Ultrasound-Guided Percutaneous Drainage of Neonatal Pyometrocolpos Under Local Anesthesia

DOE Office of Scientific and Technical Information (OSTI.GOV)

Algin, Oktay, E-mail: droktayalgin@gmail.com; Erdogan, Cuneyt; Kilic, Nizamettin

2011-02-15

Hydrometrocolpos is an uncommon congenital disorder with cystic dilatation of the vagina and uterus that occurs as a result of accumulated secretions from the reproductive tract due to distal genital tract obstruction. Secondary infection may also occur, resulting in pyometrocolpos, a potentially lethal disease. Immediate drainage of the cystic mass in patients determined to have pyometrocolpos is required to prevent or treat uropathy and septicemia until definitive corrective surgery can be performed. We report an unusual cause of obstructive uropathy in three infants: pyometrocolpos due to lower genital tract atresia. Ultrasound-guided percutaneous drainage of the pyometrocolpos resulted in dramatically improvedmore » clinical and laboratory findings in these patients. Ultrasound-guided percutaneous drainage under local anesthesia is a simple, minimally invasive, safe, and effective procedure that facilitates later successful corrective surgery and avoids the need for more complex drainage procedures.« less

Randomized controlled study of the safety and efficacy of nitrous oxide-sedated endoscopic ultrasound-guided fine needle aspiration for digestive tract diseases.

PubMed

Wang, Cai-Xia; Wang, Jian; Chen, Yuan-Yuan; Wang, Jia-Ni; Yu, Xin; Yang, Feng; Sun, Si-Yu

2016-12-14

To evaluate the efficacy and safety of nitrous oxide-sedated endoscopic ultrasound-guided fine needle aspiration. Enrolled patients were divided randomly into an experimental group (inhalation of nitrous oxide) and a control group (inhalation of pure oxygen) and heart rate, blood oxygen saturation, blood pressure, electrocardiogram (ECG) changes, and the occurrence of complications were monitored and recorded. All patients and physicians completed satisfaction questionnaires about the examination and scored the process using a visual analog scale. There was no significant difference in heart rate, blood oxygen saturation, blood pressure, ECG changes, or complication rate between the two groups of patients ( P > 0.05). However, patient and physician satisfaction were both significantly higher in the nitrous oxide compared with the control group ( P < 0.05). Nitrous oxide-sedation is a safe and effective option for patients undergoing endoscopic ultrasound-guided fine needle aspiration.

Regional lymph node staging in breast cancer: the increasing role of imaging and ultrasound-guided axillary lymph node fine needle aspiration.

PubMed

Mainiero, Martha B

2010-09-01

The status of axillary lymph nodes is a key prognostic indicator in patients with breast cancer and helps guide patient management. Sentinel lymph node biopsy is increasingly being used as a less morbid alternative to axillary lymph node dissection. However, when sentinel lymph node biopsy is positive, axillary dissection is typically performed for complete staging and local control. Axillary ultrasound and ultrasound-guided fine needle aspiration (USFNA) are useful for detecting axillary nodal metastasis preoperatively and can spare patients sentinel node biopsy, because those with positive cytology on USFNA can proceed directly to axillary dissection or neoadjuvant chemotherapy. Internal mammary nodes are not routinely evaluated, but when the appearance of these nodes is abnormal on imaging, further treatment or metastatic evaluation may be necessary. Copyright © 2010 Elsevier Inc. All rights reserved.

Yield and complications in percutaneous renal biopsy. A comparison between ultrasound-guided gun-biopsy and manual techniques in native and transplant kidneys.

PubMed

Nyman, R S; Cappelen-Smith, J; al Suhaibani, H; Alfurayh, O; Shakweer, W; Akhtar, M

1997-05-01

To compare the yield and complications of ultrasound-guided gun-biopsy and manual Tru-Cut techniques in percutaneous renal biopsy. A total of 448 biopsies were reviewed. They comprised 124 manual and 131 gun-biopsies in native kidneys, and 111 manual and 82 gun-biopsies in transplant kidneys. The gun-biopsies were performed under real-time ultrasound (US) guidance. The manual technique used US mainly for marking the position of the kidney. There was a significantly higher diagnostic yield and fewer complications in the gun-biopsy group. A total of 8 major complications were found, all in the manual group. Provided that the operator is experienced in US scanning, a switch from the manual technique to real-time US-guided gun-biopsy will result in the improvement of diagnostic accuracy together with a reduced risk of complications.

Ultrasound guided electrochemotherapy for the treatment of a clear cell thymoma in a cat

PubMed Central

Spugnini, Enrico Pierluigi; Menicagli, Francesco; Pettorali, Michela; Baldi, Alfonso

2017-01-01

A twelve-year-old male castrated domestic shorthair cat was presented for rapidly progressing respiratory distress. The cat was depressed, tachypneic and moderately responsive. Ultrasonography showed a mediastinal mass associated with a significant pleural effusion that needed tapping every five to seven days. Ultrasound guided biopsy yielded a diagnosis of clear cell thymoma upon histopathology. After complete staging procedures, the owner elected to treat the cat with electrochemotherapy (ECT) using systemic bleomycin. Two sessions of ultrasound guided ECT were performed at two week intervals with trains of biphasic electric pulses applied using needle electrodes until complete coverage of the area was achieved. The treatment was well tolerated and resulted in partial remission (PR). Additional sessions were performed on a monthly basis. The cat is still in PR after fourteen months. ECT resulted in improved local control and should be considered among the available adjuvant treatments in pets carrying visceral tumors. PMID:28331834

Optimizing MR imaging-guided navigation for focused ultrasound interventions in the brain

NASA Astrophysics Data System (ADS)

Werner, B.; Martin, E.; Bauer, R.; O'Gorman, R.

2017-03-01

MR imaging during transcranial MR imaging-guided Focused Ultrasound surgery (tcMRIgFUS) is challenging due to the complex ultrasound transducer setup and the water bolus used for acoustic coupling. Achievable image quality in the tcMRIgFUS setup using the standard body coil is significantly inferior to current neuroradiologic standards. As a consequence, MR image guidance for precise navigation in functional neurosurgical interventions using tcMRIgFUS is basically limited to the acquisition of MR coordinates of salient landmarks such as the anterior and posterior commissure for aligning a stereotactic atlas. Here, we show how improved MR image quality provided by a custom built MR coil and optimized MR imaging sequences can support imaging-guided navigation for functional tcMRIgFUS neurosurgery by visualizing anatomical landmarks that can be integrated into the navigation process to accommodate for patient specific anatomy.

Ergonomic task analysis of ultrasound-guided femoral nerve block: a pilot study.

PubMed

Ajmal, Muhammad; Power, Susan; Smith, Tim; Shorten, George D

2011-02-01

To apply ergonomic task analysis to the performance of ultrasound-guided (US-guided) femoral nerve block (FNB) in an acute hospital setting. Pilot prospective observational study. Orthopedic operating room of a regional trauma hospital. 15 anesthesiologists of various levels of experience in US-guided FNB (estimated minimum experience < 10 procedures; maximum about 50 procedures, and from basic trainees to consultants); and 15 patients (5 men and 10 women), aged 77 ± 15 (mean ± SD yrs) years. MEASUREMENTS/OBSERVATIONS: A data capture "tool", which was modified from one previously developed for ergonomic study of spinal anesthesia, was studied. Patient, operator, and heterogeneous environmental factors related to ergonomic performance of US-guided FNB were identified. The observation period started immediately before commencement of positioning the patient and ended on completion of perineural injection. Data were acquired using direct observations, photography, and application of a questionnaire. The quality of ergonomic performance was generally suboptimal and varied greatly among operators. Eight (experience < 10 procedures) of 15 operators excessively rotated their head, neck, and/or back to visualize the image on the ultrasound machine. Eight operators (experience < 10 procedures) performed the procedure with excessive thoracolumbar flexion. Performance of US-guided FNB presents ergonomic challenges and was suboptimal during most of the procedures observed. Formal training in US-guided peripheral nerve blockade should include reference to ergonomic factors. Copyright © 2011 Elsevier Inc. All rights reserved.

Robotic active positioning for magnetic resonance-guided high-intensity focused ultrasound

NASA Astrophysics Data System (ADS)

Xiao, Xu; Huang, Zhihong; Volovick, Alexander; Melzer, Andreas

2012-11-01

Magnetic resonance (MR) guided High-intensity focused ultrasound (HIFU) is a noninvasive method producing thermal necrosis and cavitation at the position of tumors with high accuracy. Because the typical size of the high-intensity focused ultrasound focus are much smaller than the targeted tumor or other tissues, multiple sonications and focus repositioning become necessary for HIFU treatment. In order to reach a much wider range, manual repositioning or using MR compatible mechanical actuators could be used. The repositioning technique is a time consuming procedure because it needs a series of MR imaging to detect the transducer and markers preplaced on the mechanical devices. We combined an active tracking technique into the MR guided HIFU system. In this work, the robotic system used is the MR-compatible robotics from InnoMotion{trade mark, serif} (IBSMM, Engineering spol. s r.o. / Ltd, Czech) which is originally designed for MR-guided needle biopsy. The precision and positioning speed of the combined robotic HIFU system are evaluated in this study. Compared to the existing MR guided HIFU systems, the combined robotic system with active tracking techniques provides a potential that allows the HIFU treatment to operate in a larger spatial range and with a faster speed.

Ultrasound-guided cable-free 13-gauge vacuum-assisted biopsy of non-mass breast lesions

PubMed Central

Seo, Jiwoon; Jang, Mijung; Yun, Bo La; Lee, Soo Hyun; Kim, Eun-Kyu; Kang, Eunyoung; Park, So Yeon; Moon, Woo Kyung; Choi, Hye Young; Kim, Bohyoung

2017-01-01

Purpose To compare the outcomes of ultrasound-guided core biopsy for non-mass breast lesions by the novel 13-gauge cable-free vacuum-assisted biopsy (VAB) and by the conventional 14-gauge semi-automated core needle biopsy (CCNB). Materials and methods Our institutional review board approved this prospective study, and all patients provided written informed consent. Among 1840 ultrasound-guided percutaneous biopsies performed from August 2013 to December 2014, 145 non-mass breast lesions with suspicious microcalcifications on mammography or corresponding magnetic resonance imaging finding were subjected to 13-gauge VAB or 14-gauge CCNB. We evaluated the technical success rates, average specimen numbers, and tissue sampling time. We also compared the results of percutaneous biopsy and final surgical pathologic diagnosis to analyze the rates of diagnostic upgrade or downgrade. Results Ultrasound-guided VAB successfully targeted and sampled all lesions, whereas CCNB failed to demonstrate calcification in four (10.3%) breast lesions with microcalcification on specimen mammography. The mean sampling time were 238.6 and 170.6 seconds for VAB and CCNB, respectively. No major complications were observed with either method. Ductal carcinoma in situ (DCIS) and atypical ductal hyperplasia (ADH) lesions were more frequently upgraded after CCNB (8/23 and 3/5, respectively) than after VAB (2/26 and 0/4, respectively P = 0.028). Conclusion Non-mass breast lesions were successfully and accurately biopsied using cable-free VAB. The underestimation rate of ultrasound-detected non-mass lesion was significantly lower with VAB than with CCNB. Trial registration CRiS KCT0002267. PMID:28628656

Ultrasound-guided core needle biopsy in diagnosis of abdominal and pelvic neoplasm in pediatric patients.

PubMed

Wang, Hailing; Li, Fangxuan; Liu, Juntian; Zhang, Sheng

2014-01-01

Ultrasound-guided core needle biopsy of abdominal and pelvic masses in adults has gained tremendous popularity. However, the application of the same treatment in children is not as popular because of apprehensions regarding inadequate tissues for the biopsy and accidental puncture of vital organs. Data of the application of ultrasound-guided core needle biopsy in 105 pediatric patients with clinically or ultrasound-diagnosed abdominopelvic masses were reviewed. Diagnostic procedures were conducted in our institution from May 2011 to May 2013. The biopsies were conducted on 86 malignant lesions and 19 benign lesions. 86 malignant tumors comprised neuroblastomas (30 cases), hepatoblastomas (15 cases), nephroblastomas (11 cases), and primitive neuroectodermal tumors/malignant small round cells (6 cases). Among malignant tumor cases, only a pelvic primitive neuroectodermal tumor did not receive a pathological diagnosis. Therefore, the biopsy accuracy was 98.8 % in malignant tumor. However, the biopsies for one neuroblastomas and one malignant small round cell tumor were inadequate for cytogenetic analysis. Therefore, 96.5 % of the malignant tumor patients received complete diagnosis via biopsy. 19 benign tumors comprised mature teratoma (10 cases), hemangioendothelioma (3 cases), paraganglioma (2 cases), and infection (2 cases). The diagnostic accuracy for benign neoplasm was 100 %. Five patients experienced postoperative complications, including pain (2 patients), bleeding from the biopsy site (2 patients), and wound infection (1 patient). Ultrasound-guided core needle biopsy is an efficient, minimally invasive, accurate, and safe diagnostic method that can be applied in the management of abdominal or pelvic mass of pediatric patients.

Use of the cumulative sum method (CUSUM) to assess the learning curves of ultrasound-guided continuous femoral nerve block.

PubMed

Kollmann-Camaiora, A; Brogly, N; Alsina, E; Gilsanz, F

2017-10-01

Although ultrasound is a basic competence for anaesthesia residents (AR) there is few data available on the learning process. This prospective observational study aims to assess the learning process of ultrasound-guided continuous femoral nerve block and to determine the number of procedures that a resident would need to perform in order to reach proficiency using the cumulative sum (CUSUM) method. We recruited 19 AR without previous experience. Learning curves were constructed using the CUSUM method for ultrasound-guided continuous femoral nerve block considering 2 success criteria: a decrease of pain score>2 in a [0-10] scale after 15minutes, and time required to perform it. We analyse data from 17 AR for a total of 237 ultrasound-guided continuous femoral nerve blocks. 8/17 AR became proficient for pain relief, however all the AR who did more than 12 blocks (8/8) became proficient. As for time of performance 5/17 of AR achieved the objective of 12minutes, however all the AR who did more than 20 blocks (4/4) achieved it. The number of procedures needed to achieve proficiency seems to be 12, however it takes more procedures to reduce performance time. The CUSUM methodology could be useful in training programs to allow early interventions in case of repeated failures, and develop competence-based curriculum. Copyright © 2017 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.

Stiffness at shear-wave elastography and patient presentation predicts upgrade at surgery following an ultrasound-guided core biopsy diagnosis of ductal carcinoma in situ.

PubMed

Evans, A; Purdie, C A; Jordan, L; Macaskill, E J; Flynn, J; Vinnicombe, S

2016-11-01

The aim of this study is to establish predictors of invasion in lesions yielding an ultrasound-guided biopsy diagnosis of ductal carcinoma in situ (DCIS). Patients subjected to ultrasound-guided core biopsy yielding DCIS were studied. At shear-wave elastography (SWE) a threshold of 50 kPa was used for mean elasticity (Emean) to dichotomise the elasticity data between invasive and non-invasive masses. Data recorded included the mammographic and ultrasound features, the referral source, and grade of DCIS in the biopsy. The chi-square test was used to detect statistical significance. Of 57 lesions, 24 (42%) had invasion at excision. Symptomatic patients and patients with stiff lesions were more likely to have invasion than patients presenting through screening and with soft lesions (58% [14 of 24] versus 30% [10 of 33], p=0.03) and (51% [20 of 39] versus 22% [4 of 18], p=0.04). No other factors showed a relationship with invasion. Combining the two predictors of invasion improved risk stratification with symptomatic and stiff lesions having a risk of invasion of 67% (12 of 18) and soft lesions presenting at screening having only a 17% (2 of 12) risk of invasion (p=0.02). Stiffness on SWE and the referral source of the patient are predictors of occult invasion in women with an ultrasound-guided core biopsy diagnosis of DCIS. Copyright © 2016 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

A pilot study on the correlation between fat fraction values and glucose uptake values in supraclavicular fat by simultaneous PET/MRI.

PubMed

McCallister, Andrew; Zhang, Le; Burant, Alex; Katz, Laurence; Branca, Rosa Tamara

2017-11-01

To assess the spatial correlation between MRI and 18F-fludeoxyglucose positron emission tomography (FDG-PET) maps of human brown adipose tissue (BAT) and to measure differences in fat fraction (FF) between glucose avid and non-avid regions of the supraclavicular fat depot using a hybrid FDG-PET/MR scanner. In 16 healthy volunteers, mean age of 30 and body mass index of 26, FF, R2*, and FDG uptake maps were acquired simultaneously using a hybrid PET/MR system while employing an individualized cooling protocol to maximally stimulate BAT. Fourteen of the 16 volunteers reported BAT-positive FDG-PET scans. MR FF maps of BAT correlate well with combined FDG-PET/MR maps of BAT only in subjects with intense glucose uptake. The results indicate that the extent of the spatial correlation positively correlates with maximum FDG uptake in the supraclavicular fat depot. No consistent, significant differences were found in FF or R2* between FDG avid and non-avid supraclavicular fat regions. In a few FDG-positive subjects, a small but significant linear decrease in BAT FF was observed during BAT stimulation. MR FF, when used in conjunction with FDG uptake maps, can be seen as a valuable, radiation-free alternative to CT and can be used to measure tissue hydration and lipid consumption in some subjects. Magn Reson Med 78:1922-1932, 2017. © 2017 International Society for Magnetic Resonance in Medicine. © 2017 International Society for Magnetic Resonance in Medicine.

Brief reports: regional anesthesia needles can introduce ultrasound gel into tissues.

PubMed

Belavy, David

2010-09-01

Anesthesiologists may insert needles through ultrasound gel when performing ultrasound-guided regional anesthesia. In this study, it was determined whether needles carry gel into tissues. Ultrasound gel dyed blue was applied to pork rashers. Tuohy and short-bevel needles were passed through the gel and pork. The needles were then assessed for the presence of ultrasound gel. All needles, including those with stylets, carried gel and tissue within the lumen. Ultrasound gel may be injected around (and perhaps in) nerves during regional anesthesia procedures. Studies are needed to determine the implications of this practice.

Image-Guided Surgery of Primary Breast Cancer Using Ultrasound Phased Arrays

DTIC Science & Technology

2004-07-01

applications using high-intensity focused ultrasound ( HIFU ). We tems, Once the real-time imaging capability is available for have shown that this dual-mode...Arrays Emad S. Ebbini, PI Introduction High-intensity focus ultrasound ( HIFU ) is gaining wider acceptance in noninvasive or minimally invasive targeting of...Methods in Ultrasound Imaging, ISBI 2004, Arlington, VA, April 2004. III. Yao and Ebbini, "Real-Time Monitoring of the Transients of HIFU -Induced Lesions

Physics and instrumentation of ultrasound.

PubMed

Lawrence, John P

2007-08-01

A thorough understanding of the physics of ultrasound waves and the instrumentation will provide the user with a better understanding of the capabilities and limitations of ultrasound equipment. The ultrasound machine combines two technologies: image production (M-mode and 2-dimensional imaging) with Doppler assessment (continuous and pulse wave as well as color-flow mapping). These distinct technologies have been combined to provide the examiner with the ability to make accurate and comprehensive diagnoses and guide therapeutic intervention.

Posterior subscapular dissection: An improved approach to the brachial plexus for human anatomy students.

PubMed

Hager, Shaun; Backus, Timothy Charles; Futterman, Bennett; Solounias, Nikos; Mihlbachler, Matthew C

2014-05-01

Students of human anatomy are required to understand the brachial plexus, from the proximal roots extending from spinal nerves C5 through T1, to the distal-most branches that innervate the shoulder and upper limb. However, in human cadaver dissection labs, students are often instructed to dissect the brachial plexus using an antero-axillary approach that incompletely exposes the brachial plexus. This approach readily exposes the distal segments of the brachial plexus but exposure of proximal and posterior segments require extensive dissection of neck and shoulder structures. Therefore, the proximal and posterior segments of the brachial plexus, including the roots, trunks, divisions, posterior cord and proximally branching peripheral nerves often remain unobserved during study of the cadaveric shoulder and brachial plexus. Here we introduce a subscapular approach that exposes the entire brachial plexus, with minimal amount of dissection or destruction of surrounding structures. Lateral retraction of the scapula reveals the entire length of the brachial plexus in the subscapular space, exposing the brachial plexus roots and other proximal segments. Combining the subscapular approach with the traditional antero-axillary approach allows students to observe the cadaveric brachial plexus in its entirety. Exposure of the brachial dissection in the subscapular space requires little time and is easily incorporated into a preexisting anatomy lab curriculum without scheduling additional time for dissection. Copyright © 2014 Elsevier GmbH. All rights reserved.

Ultrasound- and MRI-Guided Prostate Biopsy

MedlinePlus

... which the MR images are fused with the real-time ultrasound images — an approach known as MRI/TRUS ... by a computer, which in turn creates a real-time picture on the monitor. One or more frames ...

[Branchiogen cyst at unusual age and in rare localization. A case report].

PubMed

Horvath, Dóra; Redl, Pál; Hegedűs, Csaba

2015-12-01

Branchiogen anomalies represent a heterogeneous group of developmental abnormalities, they arise from incomplete obliteration of branchial clefts and pouches during embriogenesis. Clinically they can present as a cyst, fistula or sinus. Second cleft lesions account for 95% of the branchial anomalies. Second branchial cleft cysts are usually located in the neck, along the anterior border of the stenocleidomastoid muscle, but they can be anywhere along the course of the second branchial fistula from the tonsillar fossa to the supraclavicular region. Their presence in the nasopharynx is extremely rare. Ultrasound, computed tomography (CT) or magnetic resonance imaging is recommended for diagnosis. Definitive treatment is surgical excision, these lesions do not regress spontaneously and often result recurrent infections. A 7 month old infant applied to a pediatrician with gastrointestinal viral infection. During examination a cystic mass was discovered in the right lateral nasopharyngeal wall, the lesion extended to the oropharynx. Marsupialisation was performed via transoral approach. In case of cystic lesion in the lateral epipharynx, branchial cleft cyst should be considered in the differential diagnosis.

Ultrasound Imaging and Guided Injection for the Lateral and Posterior Hip.

PubMed

Chang, Ke-Vin; Wu, Wei-Ting; Lew, Henry L; Özçakar, Levent

2018-04-01

Ultrasound has emerged as one of the most utilized tools to diagnose musculoskeletal disorders and to assist in interventions. Traditionally, sonographic examination of the hip joint has been challenging because most of the major structures are deeply situated, thus requiring the use of curvilinear transducer for better penetrance. The posterior lateral hip is a frequent area for musculoskeletal pain and nerve entrapments. Common disorders include greater trochanteric pain syndrome, gluteus medius tendinopathy, piriformis syndrome, pudendal neuralgia, and proximal hamstring tendinopathy. The present review article aims to delineate sonoanatomy of the posterior lateral hip and to exemplify several common ultrasound guided procedures at the greater trochanteric, gluteal, and ischial tuberosity regions.

Thermal fixation of swine liver tissue after magnetic resonance-guided high-intensity focused ultrasound ablation.

PubMed

Courivaud, Frédéric; Kazaryan, Airazat M; Lund, Alice; Orszagh, Vivian C; Svindland, Aud; Marangos, Irina Pavlik; Halvorsen, Per Steinar; Jebsen, Peter; Fosse, Erik; Hol, Per Kristian; Edwin, Bjørn

2014-07-01

The aim of this study was to investigate experimental conditions for efficient and controlled in vivo liver tissue ablation by magnetic resonance (MR)-guided high-intensity focused ultrasound (HIFU) in a swine model, with the ultimate goal of improving clinical treatment outcome. Histological changes were examined both acutely (four animals) and 1 wk after treatment (five animals). Effects of acoustic power and multiple sonication cycles were investigated. There was good correlation between target size and observed ablation size by thermal dose calculation, post-procedural MR imaging and histopathology, when temperature at the focal point was kept below 90°C. Structural histopathology investigations revealed tissue thermal fixation in ablated regions. In the presence of cavitation, mechanical tissue destruction occurred, resulting in an ablation larger than the target. Complete extra-corporeal MR-guided HIFU ablation in the liver is feasible using high acoustic power. Nearby large vessels were preserved, which makes MR-guided HIFU promising for the ablation of liver tumors adjacent to large veins. Copyright © 2014 World Federation for Ultrasound in Medicine & Biology. Published by Elsevier Inc. All rights reserved.

Primary malignant tumours of the bony pelvis: US-guided high intensity focused ultrasound ablation.

PubMed

Wang, Yang; Wang, Wei; Tang, Jie

2013-11-01

The aim of this review is to evaluate the value of ultrasound (US)-guided high intensity focused ultrasound (HIFU) ablation in the treatment of primary malignant tumours of the bony pelvis. Eleven patients with primary malignant tumours of the bony pelvis received US-guided HIFU ablation. The maximum tumour size ranged from 5.6 to 25.0 cm (median 10.5 cm). Treatment was curative in four patients and palliative in seven patients. During follow-up, the effectiveness of HIFU ablation was assessed by contrast-enhanced magnetic resonance (MR). Significant coagulative necrosis was obtained in all patients after scheduled HIFU ablations; the volume ablation ratio was 86.7% ± 12.5% (range 65-100%). Complete tumour necrosis was achieved in all patients receiving curative HIFU ablation. No major complications were encountered. No patients died of local tumour progression during follow-up. US-guided HIFU ablation may be a safe and effective minimally invasive technique for the local treatment of primary malignant tumours of the bony pelvis.

Prediction and near-field observation of skull-guided acoustic waves

NASA Astrophysics Data System (ADS)

Estrada, Héctor; Rebling, Johannes; Razansky, Daniel

2017-06-01

Ultrasound waves propagating in water or soft biological tissue are strongly reflected when encountering the skull, which limits the use of ultrasound-based techniques in transcranial imaging and therapeutic applications. Current knowledge on the acoustic properties of the cranial bone is restricted to far-field observations, leaving its near-field unexplored. We report on the existence of skull-guided acoustic waves, which was herein confirmed by near-field measurements of optoacoustically-induced responses in ex-vivo murine skulls immersed in water. Dispersion of the guided waves was found to reasonably agree with the prediction of a multilayered flat plate model. We observed a skull-guided wave propagation over a lateral distance of at least 3 mm, with a half-decay length in the direction perpendicular to the skull ranging from 35 to 300 μm at 6 and 0.5 MHz, respectively. Propagation losses are mostly attributed to the heterogenous acoustic properties of the skull. It is generally anticipated that our findings may facilitate and broaden the application of ultrasound-mediated techniques in brain diagnostics and therapy.

Prediction and near-field observation of skull-guided acoustic waves.

PubMed

Estrada, Héctor; Rebling, Johannes; Razansky, Daniel

2017-06-21

Ultrasound waves propagating in water or soft biological tissue are strongly reflected when encountering the skull, which limits the use of ultrasound-based techniques in transcranial imaging and therapeutic applications. Current knowledge on the acoustic properties of the cranial bone is restricted to far-field observations, leaving its near-field unexplored. We report on the existence of skull-guided acoustic waves, which was herein confirmed by near-field measurements of optoacoustically-induced responses in ex-vivo murine skulls immersed in water. Dispersion of the guided waves was found to reasonably agree with the prediction of a multilayered flat plate model. We observed a skull-guided wave propagation over a lateral distance of at least 3 mm, with a half-decay length in the direction perpendicular to the skull ranging from 35 to 300 μm at 6 and 0.5 MHz, respectively. Propagation losses are mostly attributed to the heterogenous acoustic properties of the skull. It is generally anticipated that our findings may facilitate and broaden the application of ultrasound-mediated techniques in brain diagnostics and therapy.

Therapeutic aspects of endoscopic ultrasound

NASA Astrophysics Data System (ADS)

Woodward, Timothy A.

1999-06-01

Endoscopic ultrasound (EUS) is a technology that had been used primarily as a passive imaging modality. Recent advances have enabled us to move beyond the use of EUS solely as a staging tool to an interventional device. Current studies suggest that interventional applications of EUS will allow for minimally invasive assessment and therapies in a cost-effective manner. Endoscopic ultrasound with fine needle aspiration (EUS-FNA) has been demonstrated to be a technically feasible, relatively safe method of obtaining cytologic specimens. The clinical utility of EUS- FNA appears to be greatest in the diagnosis and staging of pancreatic cancer and in the nodal staging of gastrointestinal and pulmonary malignancies. In addition, EUS-FNA has demonstrated utility in the sampling pleural and ascitic fluid not generally appreciated or assessable to standard interventions. Interventional applications of EUS include EUS-guided pseudocyst drainage, EUS-guided injection of botulinum toxin in the treatment of achalasia, and EUS- guided celiac plexus neurolysis in the treatment of pancreatic cancer pain. Finally, EUS-guided fine-needle installation is being evaluated, in conjunction with recent bimolecular treatment modalities, as a delivery system in the treatment of certain gastrointestinal tumors.

Minimal invasive complete excision of benign breast tumors using a three-dimensional ultrasound-guided mammotome vacuum device.

PubMed

Baez, E; Huber, A; Vetter, M; Hackelöer, B-J

2003-03-01

The aim of this study was to evaluate the use of three-dimensional (3D) ultrasonography in the complete excision of benign breast tumors using ultrasound-guided vacuum-assisted core-needle biopsy (Mammotome). A protocol for the management of benign breast tumors is proposed. Twenty consecutive patients with sonographically benign breast lesions underwent 3D ultrasound-guided mammotome biopsy under local anesthesia. The indication for surgical biopsy was a solid lesion with benign characteristics on both two-dimensional (2D) and 3D ultrasound imaging, increasing in size over time or causing pain or irritation. Preoperatively, the size of the lesion was assessed using 2D and 3D volumetry. During vacuum biopsy the needle was visualized sonographically in all three dimensions, including the coronal plane. Excisional biopsy was considered complete when no residual tumor tissue could be seen sonographically. Ultrasonographic follow-up examinations were performed on the following day and 3-6 months later to assess residual tissue and scarring. All lesions were histologically benign. Follow-up examinations revealed complete excision of all lesions of < 1.5 mL in volume as assessed by 3D volumetry. 3D ultrasonographic volume assessment was more accurate than 2D using the ellipsoid formula or assessment of the maximum diameter for the prediction of complete excision of the tumor. No bleeding or infections occurred postoperatively and no scarring was seen ultrasonographically on follow-up examinations. Ultrasound-guided vacuum-assisted biopsy allows complete excision of benign breast lesions that are

Full-length silicone insoles versus ultrasound-guided corticosteroid injection in the management of plantar fasciitis: a randomized clinical trial.

PubMed

Yucel, Ufuk; Kucuksen, Sami; Cingoz, Havva T; Anliacik, Emel; Ozbek, Orhan; Salli, Ali; Ugurlu, Hatice

2013-12-01

Plantar fasciitis often leads to disability. Optimal treatment for this clinical condition is still unknown. To compare the effectiveness of wearing a full-length silicone insole with ultrasound-guided corticosteroid injection in the management of plantar fasciitis. Randomized clinical trial. Forty-two patients with chronic unilateral plantar fasciitis were allocated randomly to have an ultrasound-guided corticosteroid injection or wear a full-length silicone insole. Data were collected before the procedure and 1 month after. The primary outcome measures included first-step heel pain via Visual Analogue Scale and Heel Tenderness Index. Other outcome measures were the Foot and Ankle Outcome Score and ultrasonographic thickness of the plantar fascia. After 1 month, a significant improvement was shown in Visual Analogue Scale, Heel Tenderness Index, Foot and Ankle Outcome Score, and ultrasonographic thickness of plantar fascia in both groups. Visual Analogue Scale scores, Foot and Ankle Outcome Score pain, Foot and Ankle Outcome Score for activities of daily living, Foot and Ankle Outcome Score for sport and recreation function, and plantar fascia thickness were better in injection group than in insole group (p < 0.05). Although both ultrasound-guided corticosteroid injection and wearing a full-length silicone insole were effective in the conservative treatment of plantar fasciitis, we recommend the use of silicone insoles as a first line of treatment for persons with plantar fasciitis.

[Ultrasound-guided microwave ablation with artificial pleural effusion for liver tumor adjacent to 
diaphragmatic dome].

PubMed

Tang, Tian; Gu, Shanzhi; Li, Guowen; Huang, Manping; Huang, Bin; Xiong, Zhengping

2017-02-28

To explore the value of ultrasound-guided microwave ablation with artificial pleural effusion for liver tumor adjacent to diaphragmatic dome.
 Methods: A total of 34 patients with liver tumors located at diaphragmatic dome in Hunan Provincial Tumor Hospital were recruited from January 2014 to October 2015. The number of lesions ≤3 or lesion diameter ≤5 cm was in line with the microwave ablation indications. B ultrasound-guided microwave ablation for the liver tumors was undertaken after the artificial pleural effusion being established. 3-4 weeks later after the microwave ablation, all patients were imaged with enhance CT or MRI. The effect of ablation and the complications were evaluated.
 Results: There were 49 lesions in 34 patients, including 30 cases (88.2%) of complete ablation (CA), 3 cases (8.8%) of partial ablation (PA) and one case with new lesions after ablation (2.9%). Thirty-four patients had (1 580±230.7) mL of pleural effusion volume, while one case had bloody pleural effusion. One case had a diaphragmatic thermal injury, and one case had a biliary tumor infection. All of them showed remission after symptomatic treatment. 
 Conclusion: Combination of ultrasound-guided microwave ablation with artificial pleural effusion is a safe and effective therapy for liver tumor adjacent to diaphragmatic dome.

Value of artisanal simulators to train veterinary students in performing invasive ultrasound-guided procedures.

PubMed

Hage, Maria Cristina F N S; Massaferro, Ana Beatriz; Lopes, Érika Rondon; Beraldo, Carolina Mariano; Daniel, Jéssika

2016-03-01

Pericardial effusion can lead to cardiac tamponade, which endangers an animal's life. Ultrasound-guided pericardiocentesis is used to remove abnormal liquid; however, it requires technical expertise. In veterinary medical education, the opportunity to teach this procedure to save lives during emergencies is rare; therefore, simulators are recommended for this practice. The present study aimed to create a model that can be made "at home" at low cost for ultrasound-guided pericardiocentesis training and to gather feedback about this model through questionnaires given to the participants. Eighteen professionals and thirty-six students were introduced to the simulator in pairs. After the simulation training session, participants filled out the questionnaire. Participants considered the model strong in the following areas: visualization of the pericardium, the heart, fluid in the pericardium, and fluid decrease during fictitious pericardiocentesis and its realism. They considered the model weak or moderate in the following areas: visualization of the surrounding tissues, difficulty of pericardial puncture, and visualization of the catheter. The professionals classified the realism of the experimental heart as moderate, whereas the undergraduate students classified it as strong. All participants believed that the experimental model could be useful in preparing for a future real situation. This model fulfills the need for a practical, realistic, and cost-effective model for ultrasound-guided pericardiocentesis training. Copyright © 2016 The American Physiological Society.

Management of hypertrophic pylorus stenosis with ultrasound guided single shot epidural anaesthesia--a retrospective analysis of 20 cases.

PubMed

Willschke, Harald; Machata, Anette-Marie; Rebhandl, Winfried; Benkoe, Thomas; Kettner, Stephan C; Brenner, Lydia; Marhofer, Peter

2011-02-01

To retrospectively describe the performance of ultrasound guided thoracic epidural anaesthesia under sedation for anaesthesia management of open pyloromyotomy. Anaesthesia management for hypertrophic pylorus stenosis (HPS) is usually performed under general anaesthesia with tracheal intubation. Only a few publications describe avoidance of tracheal intubation in infants by using spinal or caudal anaesthesia. The present retrospective analysis describes the performance of ultrasound guided thoracic epidural anaesthesia under sedation for anaesthetic management of open pyloromyotomy. Twenty consecutive infants scheduled for pyloromyotomy according to the Weber-Ramstedt technique were retrospectively analysed. After sedation with nalbuphine and propofol, an ultrasound guided single shot thoracic epidural anaesthesia was performed with 0.75 ml·kg(-1) ropivacaine 0.475%. Insufficient blockade was defined as increase of HR > 15% from initial value and/or any movements at skin incision. In those cases we were prepared for rapid sequence intubation according to the departmental standard. All pyloromyotomies could be performed under single shot thoracic epidural anaesthesia and sedation. One case of moderate oxygen desaturation was treated with intermittent ventilation via face mask. Thoracic epidural anaesthesia under sedation for pyloromyotomy has been a useful technique in this retrospective series of infants suffering from HPS. In 1/20 infants short term assisted ventilation via face mask was required. Undisturbed surgery was possible in all cases. © 2010 Blackwell Publishing Ltd.

Orbital Atherectomy Plaque Modification Assessment of the Femoropopliteal Artery Via Intravascular Ultrasound (TRUTH Study)

PubMed Central

Zavlunova, Susanna; Attubato, Michael J.; Martinsen, Brad J.; Mintz, Gary S.; Maehara, Akiko

2015-01-01

Objective: The Tissue Removal Assessment with Ultrasound of the SFA and Popliteal (TRUTH) study assessed the performance of the orbital atherectomy system (OAS) to treat femoropopliteal arteries, including determining its effect on plaque removal. Methods: Patients with symptomatic femoropopliteal peripheral arterial disease were treated with the OAS followed by adjunctive balloon angioplasty (BA). Intravascular ultrasound (IVUS) images were collected pre- and post-OAS and post-OAS BA. Patients were followed through 12 months post-procedure. Results: Twenty-nine lesions were treated with OAS-BA in 25 patients. The mean maximum balloon inflation pressure was 5.2 ± 1.2 atm. Virtual histology IVUS (VH-IVUS) analysis revealed at the maximum calcium ablation site that calcium reduction was responsible for 86% of the lumen area increase. The minimum lumen area increased from 4.0 mm2 to 9.1 mm2 (<.0001), and the percentage of area stenosis decreased from 76.9% to 43.0% (<.0001) after OAS-BA. At 12 months, the target lesion revascularization rate was 8.2%, and ankle–brachial index and Rutherford classification improved significantly from baseline through follow-up. Conclusion: The VH-IVUS analysis reveals that OAS modifies the calcified component of the plaque burden. It is hypothesized that calcium modification by OAS changes the lesion compliance, allowing for low pressure adjunctive BA. The clinical outcomes were favorable through 12-month follow-up. PMID:26490645

Orbital Atherectomy Plaque Modification Assessment of the Femoropopliteal Artery Via Intravascular Ultrasound (TRUTH Study).

PubMed

Babaev, Anvar; Zavlunova, Susanna; Attubato, Michael J; Martinsen, Brad J; Mintz, Gary S; Maehara, Akiko

2015-10-01

The Tissue Removal Assessment with Ultrasound of the SFA and Popliteal (TRUTH) study assessed the performance of the orbital atherectomy system (OAS) to treat femoropopliteal arteries, including determining its effect on plaque removal. Patients with symptomatic femoropopliteal peripheral arterial disease were treated with the OAS followed by adjunctive balloon angioplasty (BA). Intravascular ultrasound (IVUS) images were collected pre- and post-OAS and post-OAS BA. Patients were followed through 12 months post-procedure. Twenty-nine lesions were treated with OAS-BA in 25 patients. The mean maximum balloon inflation pressure was 5.2 ± 1.2 atm. Virtual histology IVUS (VH-IVUS) analysis revealed at the maximum calcium ablation site that calcium reduction was responsible for 86% of the lumen area increase. The minimum lumen area increased from 4.0 mm(2) to 9.1 mm(2) (<.0001), and the percentage of area stenosis decreased from 76.9% to 43.0% (<.0001) after OAS-BA. At 12 months, the target lesion revascularization rate was 8.2%, and ankle-brachial index and Rutherford classification improved significantly from baseline through follow-up. The VH-IVUS analysis reveals that OAS modifies the calcified component of the plaque burden. It is hypothesized that calcium modification by OAS changes the lesion compliance, allowing for low pressure adjunctive BA. The clinical outcomes were favorable through 12-month follow-up. © The Author(s) 2015.

An ultrasound needle insertion guide in a porcine phantom model.

PubMed

Whittaker, S; Lethbridge, G; Kim, C; Keon Cohen, Z; Ng, I

2013-08-01

We compared nerve blockade with and without the Infiniti(TM) needle guide in an ultrasound in-plane porcine simulation. We recruited 30 anaesthetists with varying blockade experience. Using the guide, the needle tip was more visible (for a median (IQR [range]) of 67 (56-100]) % of the time; and invisible for 2 (1-4 [0-19]) s) than when the guide was not used (respectively 23 (13-43 [0-80]) % and 25 (9-52 [1-198]) s; both p < 0.001). The corresponding block times were 8 (6-10 [3-28]) s and 32 (15-67 [5-225]) s, respectively; p < 0.001. The needle guide reduced the block time and the time that the needle was invisible, irrespective of anaesthetist experience. Anaesthesia © 2013 The Association of Anaesthetists of Great Britain and Ireland.

Abnormal Origin and Course of the Accessory Phrenic Nerve: Case Report.

PubMed

Paraskevas, George; Koutsouflianiotis, Konstantinos; Kitsoulis, Panagiotis; Spyridakis, Ioannis

In the current cadaveric study an unusual sizeable accessory phrenic nerve (APN) was encountered emerging from the trunk of the supraclavicular nerves and forming a triangular loop that was anastomosing with the phrenic nerve. That neural loop surrounded the superficial cervical artery which displayed a spiral course. The form of a triangular loop of APN involving the aforementioned artery and originating from the supraclavicular nerve to the best of our knowledge has not been documented previously in the literature. The variable morphological features of the APN along with its clinical applications are briefly discussed.

Image-Guided Surgery of Primary Breast Cancer Using Ultrasound Phased Arrays

DTIC Science & Technology

2005-07-01

dual-mode array is ing high-intensity focused ultrasound ( HIFU ) exhibit non- is used), perhaps a result of rectified diffusion. linear behavior that...applications using high-intensity focused ultrasound ( HIFU ). We tems. Once the real-time imaging capability is available for have shown that this dual-mode...INTRODUCTION two effects lead to echo time-shift that can be estimated High intensity focused ultrasound ( HIFU ) is a and have been shown to be related local

Ultrasound-Guided Angioplasty of Dysfunctional Vascular Access for Haemodialysis. The Pros and Cons

DOE Office of Scientific and Technical Information (OSTI.GOV)

García-Medina, J., E-mail: josegmedina57@gmail.com; García-Alfonso, J. J., E-mail: juanjozarandieta@gmail.com

PurposeTo describe the benefits and the disadvantages of angioplasty in dialysis fistulas using only ultrasound guidance.Materials and MethodsThis is a prospective study in 132 failing or non-maturing arteriovenous accesses that underwent 189 ultrasound-guided balloon angioplasties. The technical success was defined as non-use of X-ray fluoroscopy during the procedure.Results127 procedures (67%) were successfully completed without fluoroscopy. Most failures were due to difficulty to traverse aneurismal segments, as well as anastomotic stenoses. Including initial failures, the primary patency rates at 6, 12 months and 2 years were 75 ± 3, 41 ± 3 and 14 ± 2%, respectively.ConclusionEndovascular repair of the dysfunctional vascular access for haemodialysis under ultrasound guidance ismore » feasible and safe in roughly two-thirds of cases.« less

Derivation of a Performance Checklist for Ultrasound-Guided Arthrocentesis Using the Modified Delphi Method.

PubMed

Kunz, Derek; Pariyadath, Manoj; Wittler, Mary; Askew, Kim; Manthey, David; Hartman, Nicholas

2017-06-01

Arthrocentesis is an important skill for physicians in multiple specialties. Recent studies indicate a superior safety and performance profile for this procedure using ultrasound guidance for needle placement, and improving quality of care requires a valid measurement of competency using this modality. We endeavored to create a validated tool to assess the performance of this procedure using the modified Delphi technique and experts in multiple disciplines across the United States. We derived a 22-item checklist designed to assess competency for the completion of ultrasound-guided arthrocentesis, which demonstrated a Cronbach's alpha of 0.89, indicating an excellent degree of internal consistency. Although we were able to demonstrate content validity for this tool, further validity evidence should be acquired after the tool is used and studied in clinical and simulated contexts. © 2017 by the American Institute of Ultrasound in Medicine.

Ultrasound-guided piriformis muscle injection. A new approach.

PubMed

Bevilacqua Alén, E; Diz Villar, A; Curt Nuño, F; Illodo Miramontes, G; Refojos Arencibia, F J; López González, J M

2016-12-01

Piriformis syndrome is an uncommon cause of buttock and leg pain. Some treatment options include the injection of piriformis muscle with local anesthetic and steroids. Various techniques for piriformis muscle injection have been described. Ultrasound allows direct visualization and real time injection of the piriformis muscle. We describe 5 consecutive patients, diagnosed of piriformis syndrome with no improvement after pharmacological treatment. Piriformis muscle injection with local anesthetics and steroids was performed using an ultrasound technique based on a standard technique. All 5 patients have improved their pain measured by numeric verbal scale. One patient had a sciatic after injection that improved in 10 days spontaneously. We describe an ultrasound-guided piriformis muscle injection that has the advantages of being effective, simple, and safe. Copyright © 2016 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.

An ultrasound-guided fluorescence tomography system: design and specification

NASA Astrophysics Data System (ADS)

D'Souza, Alisha V.; Flynn, Brendan P.; Kanick, Stephen C.; Torosean, Sason; Davis, Scott C.; Maytin, Edward V.; Hasan, Tayyaba; Pogue, Brian W.

2013-03-01

An ultrasound-guided fluorescence molecular tomography system is under development for in vivo quantification of Protoporphyrin IX (PpIX) during Aminolevulinic Acid - Photodynamic Therapy (ALA-PDT) of Basal Cell Carcinoma. The system is designed to combine fiber-based spectral sampling of PPIX fluorescence emission with co-registered ultrasound images to quantify local fluorophore concentration. A single white light source is used to provide an estimate of the bulk optical properties of tissue. Optical data is obtained by sequential illumination of a 633nm laser source at 4 linear locations with parallel detection at 5 locations interspersed between the sources. Tissue regions from segmented ultrasound images, optical boundary data, white light-informed optical properties and diffusion theory are used to estimate the fluorophore concentration in these regions. Our system and methods allow interrogation of both superficial and deep tissue locations up to PpIX concentrations of 0.025ug/ml.

Plantar fascia: imaging diagnosis and guided treatment.

PubMed

McNally, Eugene G; Shetty, Shilpa

2010-09-01

Plantar fasciopathy is a common cause of heel pain. This article covers the imaging anatomy of the hindfoot, the imaging findings on ultrasound and magnetic resonance imaging (MRI) of plantar fasciopathy, plantar fibromas, trauma, Achilles tendonopathy, neural compression, stress fractures of the os calcis and other heel pad lesions. Thickening of the plantar fascia insertion more than 5 mm either on ultrasound or MRI is suggestive of plantar fasciopathy. Ultrasound is superior to MRI for diagnosis of plantar fibroma as small low signal lesions on MRI are similar to the normal plantar fascia signal. Ultrasound demonstrates low echogenicity compared with the echogenic plantar fascia. Penetrating injuries can appear bizarre due to associated foreign body impaction and infection. Achilles tendonopathy can cause heel pain and should be considered as a possible diagnosis. Treatment options include physical therapy, ECSWT, corticosteroid injection, and dry needling. Percutaneous US guided treatment methods will be described. Thieme Medical Publishers.

Ultrasound-guided percutaneous lavage of calcific bursitis of the medial collateral ligament of the knee: a case report and review of the literature.

PubMed

Del Castillo-González, Federico; Ramos-Álvarez, Juan José; González-Pérez, José; Jiménez-Herranz, Elena; Rodríguez-Fabián, Guillermo

2016-10-01

Calcification of the medial collateral ligament (MCL) of the knee is rare. The literature reports no positive outcomes when conservative treatment has been followed. This paper reports a case of such calcification and its treatment using ultrasound-guided percutaneous lavage (UGPL). A 66-year-old patient presented with medial knee pain. X-ray, ultrasound, and magnetic resonance (MR) examinations revealed calcific bursitis of the MCL, which was treated by UGPL. One month after treatment the patient was asymptomatic. X-ray, ultrasound, and MR examinations confirmed the almost complete disappearance of the calcification; only very tiny fragments remained. Calcific bursitis of the MCL of the knee is very uncommon, but should be taken into account in differential diagnoses for medial knee pain. UGPL is proposed as a treatment for this condition.

Ultrasound in Radiology: from Anatomic, Functional, Molecular Imaging to Drug Delivery and Image-Guided Therapy

PubMed Central

Klibanov, Alexander L.; Hossack, John A.

2015-01-01

During the past decade, ultrasound has expanded medical imaging well beyond the “traditional” radiology setting - a combination of portability, low cost and ease of use makes ultrasound imaging an indispensable tool for radiologists as well as for other medical professionals who need to obtain imaging diagnosis or guide a therapeutic intervention quickly and efficiently. Ultrasound combines excellent ability for deep penetration into soft tissues with very good spatial resolution, with only a few exceptions (i.e. those involving overlying bone or gas). Real-time imaging (up to hundreds and thousands frames per second) enables guidance of therapeutic procedures and biopsies; characterization of the mechanical properties of the tissues greatly aids with the accuracy of the procedures. The ability of ultrasound to deposit energy locally brings about the potential for localized intervention encompassing: tissue ablation, enhancing penetration through the natural barriers to drug delivery in the body and triggering drug release from carrier micro- and nanoparticles. The use of microbubble contrast agents brings the ability to monitor and quantify tissue perfusion, and microbubble targeting with ligand-decorated microbubbles brings the ability to obtain molecular biomarker information, i.e., ultrasound molecular imaging. Overall, ultrasound has become the most widely used imaging modality in modern medicine; it will continue to grow and expand. PMID:26200224

Risk Factors for Brachial Plexus Birth Injury

PubMed Central

Louden, Emily; Marcotte, Michael; Mehlman, Charles; Lippert, William; Huang, Bin; Paulson, Andrea

2018-01-01

Over the course of decades, the incidence of brachial plexus birth injury (BPBI) has increased despite advances in healthcare which would seem to assist in decreasing the rate. The aim of this study is to identify previously unknown risk factors for BPBI and the risk factors with potential to guide preventative measures. A case control study of 52 mothers who had delivered a child with a BPBI injury and 132 mothers who had delivered without BPBI injury was conducted. Univariate, multivariable and logistic regressions identified risk factors and their combinations. The odds of BPBI were 2.5 times higher when oxytocin was used and 3.7 times higher when tachysystole occurred. The odds of BPBI injury are increased when tachysystole and oxytocin occur during the mother’s labor. Logistic regression identified a higher risk for BPBI when more than three of the following variables (>30 lbs gained during the pregnancy, stage 2 labor >61.5 min, mother’s age >26.4 years, tachysystole, or fetal malpresentation) were present in any combination. PMID:29596309

[Ultrasound guided percutaneous nephrolithotripsy].

PubMed

Guliev, B G

2014-01-01

The study was aimed to the evaluation of the effectiveness and results of ultrasound guided percutaneous nephrolithotripsy (PNL) for the treatment of patients with large stones in renal pelvis. The results of PNL in 138 patients who underwent surgery for kidney stones from 2011 to 2013 were analyzed. Seventy patients (Group 1) underwent surgery with combined ultrasound and radiological guidance, and 68 patients (Group 2)--only with ultrasound guidance. The study included patients with large renal pelvic stones larger than 2.2 cm, requiring the formation of a single laparoscopic approach. Using the comparative analysis, the timing of surgery, the number of intra- and postoperative complications, blood loss and length of stay were evaluated. Percutaneous access was successfully performed in all patients. Postoperative complications (exacerbation of chronic pyelonephritis, gross hematuria) were observed in 14.3% of patients in Group 1 and in 14.7% of patients in Group 2. Bleeding requiring blood transfusion, and injuries of adjacent organs were not registered. Efficacy of PNL in the Group 1 was 95.7%; 3 (4.3%) patients required additional interventions. In Group 2, the effectiveness of PNL was 94.1%, 4 (5.9%) patients additionally underwent extracorporeal lithotripsy. There were no significant differences in the effectiveness of PNL, the volume of blood loss and duration of hospitalization. Ultrasound guided PNL can be performed in large pelvic stones and sufficient expansion of renal cavities, thus reducing radiation exposure of patients and medical staff.

Applied sonoanatomy of the posterior triangle of the neck

PubMed Central

Ihnatsenka, Barys; Boezaart, André P

2010-01-01

The posterior triangle of the neck is an area of the body frequently visited by regional anesthesiologists, acute and chronic pain physicians, surgeons of all disciplines, and diagnosticians. It houses the entire brachial plexus from the roots to the divisions, the scalene muscles, the cervical sympathetic ganglions, the major blood vessels to and from the brain, the neuroforamina and various other structures of more or less importance to these physicians. Ultrasound (US) offers a handy visual tool for these structures to be viewed in real time and, therefore, its popularity and the need to understand it. We will discuss pertinent clinical anatomy of the neck and offer a basic visual explanation of the often-difficult two-dimensional (2-D) images seen with US. PMID:21472066

Guiding tissue regeneration with ultrasound in vitro and in vivo

NASA Astrophysics Data System (ADS)

Dalecki, Diane; Comeau, Eric S.; Raeman, Carol H.; Child, Sally Z.; Hobbs, Laura; Hocking, Denise C.

2015-05-01

Developing new technologies that enable the repair or replacement of injured or diseased tissues is a major focus of regenerative medicine. This paper will discuss three ultrasound technologies under development in our laboratories to guide tissue regeneration both in vitro and in vivo. A critical obstacle in tissue engineering is the need for rapid and effective tissue vascularization strategies. To address this challenge, we are developing acoustic patterning techniques for microvascular tissue engineering. Acoustic radiation forces associated with ultrasound standing wave fields provide a rapid, non-invasive approach to spatially pattern cells in three dimensions without affecting cell viability. Acoustic patterning of endothelial cells leads to the rapid formation of microvascular networks throughout the volumes of three-dimensional hydrogels, and the morphology of the resultant microvessel networks can be controlled by design of the ultrasound field. A second technology under development uses ultrasound to noninvasively control the microstructure of collagen fibers within engineered tissues. The microstructure of extracellular matrix proteins provides signals that direct cell functions critical to tissue regeneration. Thus, controlling collagen microfiber structure with ultrasound provides a noninvasive approach to regulate the mechanical properties of biomaterials and control cellular responses. The third technology employs therapeutic ultrasound to enhance the healing of chronic wounds. Recent studies demonstrate increased granulation tissue thickness and collagen deposition in murine dermal wounds exposed to pulsed ultrasound. In summary, ultrasound technologies offer noninvasive approaches to control cell behaviors and extracellular matrix organization and thus hold great promise to advance tissue regeneration in vitro and in vivo.

Ultrasound-Guided Regional Anesthesia Simulation Training: A Systematic Review.

PubMed

Chen, Xiao Xu; Trivedi, Vatsal; AlSaflan, AbdulHadi A; Todd, Suzanne Clare; Tricco, Andrea C; McCartney, Colin J L; Boet, Sylvain

Ultrasound-guided regional anesthesia (UGRA) has become the criterion standard of regional anesthesia practice. Ultrasound-guided regional anesthesia teaching programs often use simulation, and guidelines have been published to help guide URGA education. This systematic review aimed to examine the effectiveness of simulation-based education for the acquisition and maintenance of competence in UGRA. Studies identified in MEDLINE, EMBASE, CINAHL, Cochrane Central Register of Controlled Trials, and ERIC were included if they assessed simulation-based UGRA teaching with outcomes measured at Kirkpatrick level 2 (knowledge and skills), 3 (transfer of learning to the workplace), or 4 (patient outcomes). Two authors independently reviewed all identified references for eligibility, abstracted data, and appraised quality. After screening 176 citations and 45 full-text articles, 12 studies were included. Simulation-enhanced training improved knowledge acquisition (Kirkpatrick level 2) when compared with nonsimulation training. Seven studies measuring skill acquisition (Kirkpatrick level 2) found that simulation-enhanced UGRA training was significantly more effective than alternative teaching methods or no intervention. One study measuring transfer of learning into the clinical setting (Kirkpatrick level 3) found no difference between simulation-enhanced UGRA training and non-simulation-based training. However, this study was discontinued early because of technical challenges. Two studies examined patient outcomes (Kirkpatrick level 4), and one of these found that simulation-based UGRA training improved patient outcomes compared with didactic teaching. Ultrasound-guided regional anesthesia knowledge and skills significantly improved with simulation training. The acquired UGRA skills may be transferred to the clinical setting; however, further studies are required to confirm these changes translate to improved patient outcomes.

Effectiveness of imaging-guided intra-articular injection: a comparison study between fluoroscopy and ultrasound.

PubMed

Furtado, Rita Nely Vilar; Pereira, Daniele Freitas; da Luz, Karine Rodrigues; dos Santos, Marla Francisca; Konai, Monique Sayuri; Mitraud, Sonia de Aguiar Vilela; Rosenfeld, Andre; Fernandes, Artur da Rocha Correa; Natour, Jamil

2013-01-01

Compare the effectiveness of ultrasound and fluoroscopy to guide intra-articular injections (IAI) in selected cases. A prospective study in our outpatient clinics at the Rheumatology Division at Universidade Federal de São Paulo (UNIFESP), Brazil, was conducted to compare the short-term (4 weeks) effectiveness of ultrasound and fluoroscopy-guided IAI in patients with rheumatic diseases. Inclusion criteria were: adults with refractory synovitis undergoing IAI with glucocorticoid. All patients had IAI performed with triamcinolone hexacetonide (20mg/ml) with varying doses according to the joint injected. A total of 71 rheumatic patients were evaluated (52 women, 44 whites). Mean age was 51.9 ± 13 years and 47 of them (66.2%) were on regular DMARD use. Analysis of the whole sample (71 patients) and hip sub-analysis (23 patients) showed that significant improvement was observed for both groups in terms of pain (P < 0.001). Global analysis also demonstrated better outcomes for patients in the FCG in terms of joint flexion (P < 0.001) and percentage change in joint flexion as compared to the USG. Likert scale score analyses demonstrated better results for the patients in the USG as compared to the FCG at the end of the study (P < 0.05). No statistically significant difference between groups was observed for any other study variable. Imaging-guided IAI improves regional pain in patients with various types of synovitis in the short term. For the vast majority of variables, no significant difference in terms of effectiveness was observed between fluoroscopy and ultrasound guided IAI.

MR-guided focused ultrasound robot for performing experiments on large animals

NASA Astrophysics Data System (ADS)

Mylonas, N.; Damianou, C.

2011-09-01

Introduction: In this paper an experimental MRI-guided focused ultrasound robot for large animals is presented. Materials and methods: A single element spherically focused transducer of 4 cm diameter, focusing at 10 cm and operating at 1 MHz was used. A positioning device was developed in order to scan the ultrasound transducer for performing MR-guided focused ultrasound experiments in large animals such as pig, sheep and dog. The positioning device incorporates only MRI compatible materials such as piezoelectric motors, Acrylonitrile Butadiene Styrene (ABS) plastic, brass screws, and brass pulleys. The system is manufactured automatically using a rapid prototyping system. Results: The system was tested successfully in a number of animals for various tasks (creation of single lesions, creation of overlapping lesions, and MR compatibility). Conclusions: A simple, cost effective, portable positioning device has been developed which can be used in virtually any clinical MRI scanner since it can be sited on the scanner's table. The propagation of HIFU can be via a lateral or superior-inferior approach. This system has the potential to be marketed as a cost effective solution for performing experiments in small and large animals.

Musculoskeletal ultrasound for interventional physiatry.

PubMed

De Muynck, M; Parlevliet, T; De Cock, K; Vanden Bossche, L; Vanderstraeten, G; Özçakar, L

2012-12-01

More and more physiatrists are interested in learning how to use musculoskeletal ultrasonography in their clinical practice. The possibility of high resolution, dynamic, comparative and repeatable imaging makes it an important diagnostic tool for soft tissue pathology. There is also growing interest to use sonography for guiding interventions such as aspirations and infiltrations. In daily practice these are often done blindly or palpation-guided. To improve the accuracy of interventions, fluoroscopy or computed tomography were traditionally used for guidance. Since sonography is non-ionizing, readily available and relatively low cost, it has become the first choice to guide many musculoskeletal interventions. Ultrasound allows real-time imaging of target and needle as well as surrounding vulnerable structures such as vessels and nerves. Many different techniques are proposed in the literature. Interventions under ultrasound guidance have been proven to be more accurate than unguided ones. Further studies are required to prove better clinical results and fewer complications. Infection is the most dreaded complication. This review wants to highlight technical aspects of ultrasound guidance of interventions and give a survey of different interventions that have been introduced, with emphasis on applications in Physical Medicine and Rehabilitation. Results and complications are discussed. Finally training requirements and modalities are presented.

Phased laser diode array permits selective excitation of ultrasonic guided waves in coated bone-mimicking tubes

NASA Astrophysics Data System (ADS)

Moilanen, Petro; Salmi, Ari; Kilappa, Vantte; Zhao, Zuomin; Timonen, Jussi; Hæggström, Edward

2017-10-01

This paper validates simulation predictions, which state that specific modes could be enhanced in quantitative ultrasonic bone testing. Tunable selection of ultrasonic guided wave excitation is useful in non-destructive testing since it permits the mediation of energy into diagnostically useful modes while reducing the energy mediated into disturbing contributions. For instance, it is often challenging to distinguish and extract the useful modes from ultrasound signals measured in bone covered by a soft tissue. We show that a laser diode array can selectively excite ultrasound in bone mimicking phantoms. A fiber-coupled diode array (4 elements) illuminated two solid tubes (2-3 mm wall thickness) embraced by an opaque soft-tissue mimicking elastomer coating (5 mm thick). A predetermined time delay matching the selected mode and frequency was employed between the outputs of the elements. The generated ultrasound was detected by a 215 kHz piezo receiver. Our results suggest that this array reduces the disturbances caused by the elastomer cover and so pave way to permit non-contacting in vivo guided wave ultrasound assessment of human bones. The implementation is small, inexpensive, and robust in comparison with the conventional pulsed lasers.

Real-Time Ultrasound-Guided Spinal Anaesthesia: A Prospective Observational Study of a New Approach

PubMed Central

Conroy, P. H.; Luyet, C.; McCartney, C. J.; McHardy, P. G.

2013-01-01

Identification of the subarachnoid space has traditionally been achieved by either a blind landmark-guided approach or using prepuncture ultrasound assistance. To assess the feasibility of performing spinal anaesthesia under real-time ultrasound guidance in routine clinical practice we conducted a single center prospective observational study among patients undergoing lower limb orthopaedic surgery. A spinal needle was inserted unassisted within the ultrasound transducer imaging plane using a paramedian approach (i.e., the operator held the transducer in one hand and the spinal needle in the other). The primary outcome measure was the success rate of CSF acquisition under real-time ultrasound guidance with CSF being located in 97 out of 100 consecutive patients within median three needle passes (IQR 1–6). CSF was not acquired in three patients. Subsequent attempts combining landmark palpation and pre-puncture ultrasound scanning resulted in successful spinal anaesthesia in two of these patients with the third patient requiring general anaesthesia. Median time from spinal needle insertion until intrathecal injection completion was 1.2 minutes (IQR 0.83–4.1) demonstrating the feasibility of this technique in routine clinical practice. PMID:23365568

The Agreement between Auscultation and Lung Ultrasound in Hemodialysis Patients: The LUST Study

PubMed Central

Torino, Claudia; Gargani, Luna; Sicari, Rosa; Letachowicz, Krzysztof; Ekart, Robert; Fliser, Danilo; Covic, Adrian; Siamopoulos, Kostas; Stavroulopoulos, Aristeidis; Massy, Ziad A.; Fiaccadori, Enrico; Caiazza, Alberto; Bachelet, Thomas; Slotki, Itzchak; Martinez-Castelao, Alberto; Coudert-Krier, Marie-Jeanne; Rossignol, Patrick; Gueler, Faikah; Hannedouche, Thierry; Panichi, Vincenzo; Wiecek, Andrzej; Pontoriero, Giuseppe; Sarafidis, Pantelis; Klinger, Marian; Hojs, Radovan; Seiler-Mussler, Sarah; Lizzi, Fabio; Siriopol, Dimitrie; Balafa, Olga; Shavit, Linda; Tripepi, Rocco; Mallamaci, Francesca; Tripepi, Giovanni; Picano, Eugenio; London, Gérard Michel

2016-01-01

Background and objectives Accumulation of fluid in the lung is the most concerning sequela of volume expansion in patients with ESRD. Lung auscultation is recommended to detect and monitor pulmonary congestion, but its reliability in ESRD is unknown. Design, setting, participants, & measurements In a subproject of the ongoing Lung Water by Ultra-Sound Guided Treatment to Prevent Death and Cardiovascular Complications in High Risk ESRD Patients with Cardiomyopathy Trial, we compared a lung ultrasound–guided ultrafiltration prescription policy versus standard care in high-risk patients on hemodialysis. The reliability of peripheral edema was tested as well. This study was on the basis of 1106 pre– and postdialysis lung ultrasound studies (in 79 patients) simultaneous with standardized lung auscultation (crackles at the lung bases) and quantification of peripheral edema. Results Lung congestion by crackles, edema, or a combination thereof poorly reflected the severity of congestion as detected by ultrasound B lines in various analyses, including standard regression analysis weighting for repeated measures in individual patients (shared variance of 12% and 4% for crackles and edema, respectively) and κ-statistics (κ ranging from 0.00 to 0.16). In general, auscultation had very low discriminatory power for the diagnosis of mild (area under the receiver operating curve =0.61), moderate (area under the receiver operating curve =0.65), and severe (area under the receiver operating curve =0.68) lung congestion, and the same was true for peripheral edema (receiver operating curve =0.56 or lower) and the combination of the two physical signs. Conclusions Lung crackles, either alone or combined with peripheral edema, very poorly reflect interstitial lung edema in patients with ESRD. These findings reinforce the rationale underlying the Lung Water by Ultra-Sound Guided Treatment to Prevent Death and Cardiovascular Complications in High Risk ESRD Patients with Cardiomyopathy Trial, a trial adopting ultrasound B lines as an instrument to guide interventions aimed at mitigating lung congestion in high-risk patients on hemodialysis. PMID:27660305

Non-Invasive Targeted Peripheral Nerve Ablation Using 3D MR Neurography and MRI-Guided High-Intensity Focused Ultrasound (MR-HIFU): Pilot Study in a Swine Model.

PubMed

Huisman, Merel; Staruch, Robert M; Ladouceur-Wodzak, Michelle; van den Bosch, Maurice A; Burns, Dennis K; Chhabra, Avneesh; Chopra, Rajiv

2015-01-01

Ultrasound (US)-guided high intensity focused ultrasound (HIFU) has been proposed for noninvasive treatment of neuropathic pain and has been investigated in in-vivo studies. However, ultrasound has important limitations regarding treatment guidance and temperature monitoring. Magnetic resonance (MR)-imaging guidance may overcome these limitations and MR-guided HIFU (MR-HIFU) has been used successfully for other clinical indications. The primary purpose of this study was to evaluate the feasibility of utilizing 3D MR neurography to identify and guide ablation of peripheral nerves using a clinical MR-HIFU system. Volumetric MR-HIFU was used to induce lesions in the peripheral nerves of the lower limbs in three pigs. Diffusion-prep MR neurography and T1-weighted images were utilized to identify the target, plan treatment and immediate post-treatment evaluation. For each treatment, one 8 or 12 mm diameter treatment cell was used (sonication duration 20 s and 36 s, power 160-300 W). Peripheral nerves were extracted < 3 hours after treatment. Ablation dimensions were calculated from thermal maps, post-contrast MRI and macroscopy. Histological analysis included standard H&E staining, Masson's trichrome and toluidine blue staining. All targeted peripheral nerves were identifiable on MR neurography and T1-weighted images and could be accurately ablated with a single exposure of focused ultrasound, with peak temperatures of 60.3 to 85.7°C. The lesion dimensions as measured on MR neurography were similar to the lesion dimensions as measured on CE-T1, thermal dose maps, and macroscopy. Histology indicated major hyperacute peripheral nerve damage, mostly confined to the location targeted for ablation. Our preliminary results indicate that targeted peripheral nerve ablation is feasible with MR-HIFU. Diffusion-prep 3D MR neurography has potential for guiding therapy procedures where either nerve targeting or avoidance is desired, and may also have potential for post-treatment verification of thermal lesions without contrast injection.

Pain related to robotic cholecystectomy with lower abdominal ports: effect of the bilateral ultrasound-guided split injection technique of rectus sheath block in female patients

PubMed Central

Kim, Jin Soo; Choi, Jong Bum; Lee, Sook Young; Kim, Wook Hwan; Baek, Nam Hyun; Kim, Jayoun; Park, Chu Kyung; Lee, Yeon Ju; Park, Sung Yong

2016-01-01

Abstract Background: Robotic cholecystectomy (RC) using port sites in the lower abdominal area (T12-L1) rather than the upper abdomen has recently been introduced as an alternative procedure for laparoscopic cholecystectomy. Therefore, we investigated the time course of different components of pain and the analgesic effect of the bilateral ultrasound-guided split injection technique for rectus sheath block (sRSB) after RC in female patients. Methods: We randomly assigned 40 patients to undergo ultrasound-guided sRSB (RSB group, n = 20) or to not undergo any block (control group, n = 20). Pain was subdivided into 3 components: superficial wound pain, deep abdominal pain, and referred shoulder pain, which were evaluated with a numeric rating scale (from 0 to 10) at baseline (time of awakening) and at 1, 6, 9, and 24 hours postoperatively. Consumption of fentanyl and general satisfaction were also evaluated 1 hour (before discharge from the postanesthesia care unit) and 24 hours postoperatively (end of study). Results: Superficial wound pain was predominant only at awakening, and after postoperative 1 hour in the control group. Bilateral ultrasound-guided sRSB significantly decreased superficial pain after RC (P < 0.01) and resulted in a better satisfaction score (P < 0.05) 1 hour after RC in the RSB group compared with the control group. The cumulative postoperative consumption of fentanyl at 6, 9, and 24 hours was not significantly different between groups. Conclusions: After RC with lower abdominal ports, superficial wound pain predominates over deep intra-abdominal pain and shoulder pain only at the time of awakening. Afterwards, superficial and deep pain decreased to insignificant levels in 6 hours. Bilateral ultrasound-guided sRSB was effective only during the first hour. This limited benefit should be balanced against the time and risks entailed in performing RSB. PMID:27495072

Pain related to robotic cholecystectomy with lower abdominal ports: effect of the bilateral ultrasound-guided split injection technique of rectus sheath block in female patients: A prospective randomised trial.

PubMed

Kim, Jin Soo; Choi, Jong Bum; Lee, Sook Young; Kim, Wook Hwan; Baek, Nam Hyun; Kim, Jayoun; Park, Chu Kyung; Lee, Yeon Ju; Park, Sung Yong

2016-08-01

Robotic cholecystectomy (RC) using port sites in the lower abdominal area (T12-L1) rather than the upper abdomen has recently been introduced as an alternative procedure for laparoscopic cholecystectomy. Therefore, we investigated the time course of different components of pain and the analgesic effect of the bilateral ultrasound-guided split injection technique for rectus sheath block (sRSB) after RC in female patients. We randomly assigned 40 patients to undergo ultrasound-guided sRSB (RSB group, n = 20) or to not undergo any block (control group, n = 20). Pain was subdivided into 3 components: superficial wound pain, deep abdominal pain, and referred shoulder pain, which were evaluated with a numeric rating scale (from 0 to 10) at baseline (time of awakening) and at 1, 6, 9, and 24 hours postoperatively. Consumption of fentanyl and general satisfaction were also evaluated 1 hour (before discharge from the postanesthesia care unit) and 24 hours postoperatively (end of study). Superficial wound pain was predominant only at awakening, and after postoperative 1 hour in the control group. Bilateral ultrasound-guided sRSB significantly decreased superficial pain after RC (P < 0.01) and resulted in a better satisfaction score (P < 0.05) 1 hour after RC in the RSB group compared with the control group. The cumulative postoperative consumption of fentanyl at 6, 9, and 24 hours was not significantly different between groups. After RC with lower abdominal ports, superficial wound pain predominates over deep intra-abdominal pain and shoulder pain only at the time of awakening. Afterwards, superficial and deep pain decreased to insignificant levels in 6 hours. Bilateral ultrasound-guided sRSB was effective only during the first hour. This limited benefit should be balanced against the time and risks entailed in performing RSB.

Real-time ultrasound-guided catheterisation of the internal jugular vein: a prospective comparison with the landmark technique in critical care patients

PubMed Central

Karakitsos, Dimitrios; Labropoulos, Nicolaos; De Groot, Eric; Patrianakos, Alexandros P; Kouraklis, Gregorios; Poularas, John; Samonis, George; Tsoutsos, Dimosthenis A; Konstadoulakis, Manousos M; Karabinis, Andreas

2006-01-01

Introduction Central venous cannulation is crucial in the management of the critical care patient. This study was designed to evaluate whether real-time ultrasound-guided cannulation of the internal jugular vein is superior to the standard landmark method. Methods In this randomised study, 450 critical care patients who underwent real-time ultrasound-guided cannulation of the internal jugular vein were prospectively compared with 450 critical care patients in whom the landmark technique was used. Randomisation was performed by means of a computer-generated random-numbers table, and patients were stratified with regard to age, gender, and body mass index. Results There were no significant differences in gender, age, body mass index, or side of cannulation (left or right) or in the presence of risk factors for difficult venous cannulation such as prior catheterisation, limited sites for access attempts, previous difficulties during catheterisation, previous mechanical complication, known vascular abnormality, untreated coagulopathy, skeletal deformity, and cannulation during cardiac arrest between the two groups of patients. Furthermore, the physicians who performed the procedures had comparable experience in the placement of central venous catheters (p = non-significant). Cannulation of the internal jugular vein was achieved in all patients by using ultrasound and in 425 of the patients (94.4%) by using the landmark technique (p < 0.001). Average access time (skin to vein) and number of attempts were significantly reduced in the ultrasound group of patients compared with the landmark group (p < 0.001). In the landmark group, puncture of the carotid artery occurred in 10.6% of patients, haematoma in 8.4%, haemothorax in 1.7%, pneumothorax in 2.4%, and central venous catheter-associated blood stream infection in 16%, which were all significantly increased compared with the ultrasound group (p < 0.001). Conclusion The present data suggest that ultrasound-guided catheterisation of the internal jugular vein in critical care patients is superior to the landmark technique and therefore should be the method of choice in these patients. PMID:17112371

Design and development of an ultrasound calibration phantom and system

NASA Astrophysics Data System (ADS)

Cheng, Alexis; Ackerman, Martin K.; Chirikjian, Gregory S.; Boctor, Emad M.

2014-03-01

Image-guided surgery systems are often used to provide surgeons with informational support. Due to several unique advantages such as ease of use, real-time image acquisition, and no ionizing radiation, ultrasound is a common medical imaging modality used in image-guided surgery systems. To perform advanced forms of guidance with ultrasound, such as virtual image overlays or automated robotic actuation, an ultrasound calibration process must be performed. This process recovers the rigid body transformation between a tracked marker attached to the ultrasound transducer and the ultrasound image. A phantom or model with known geometry is also required. In this work, we design and test an ultrasound calibration phantom and software. The two main considerations in this work are utilizing our knowledge of ultrasound physics to design the phantom and delivering an easy to use calibration process to the user. We explore the use of a three-dimensional printer to create the phantom in its entirety without need for user assembly. We have also developed software to automatically segment the three-dimensional printed rods from the ultrasound image by leveraging knowledge about the shape and scale of the phantom. In this work, we present preliminary results from using this phantom to perform ultrasound calibration. To test the efficacy of our method, we match the projection of the points segmented from the image to the known model and calculate a sum squared difference between each point for several combinations of motion generation and filtering methods. The best performing combination of motion and filtering techniques had an error of 1.56 mm and a standard deviation of 1.02 mm.

Conventional Landmark-Guided Midline Versus Preprocedure Ultrasound-Guided Paramedian Techniques in Spinal Anesthesia.

PubMed

Kallidaikurichi Srinivasan, Karthikeyan; Iohom, Gabriella; Loughnane, Frank; Lee, Peter J

2015-10-01

Multiple passes and attempts while administering spinal anesthesia are associated with a greater incidence of postdural puncture headache, paraesthesia, and spinal hematoma. We hypothesized that the routine use of a preprocedural ultrasound-guided paramedian technique for spinal anesthesia would reduce the number of passes required to achieve entry into the subarachnoid space when compared with the conventional landmark-guided midline approach. One hundred consenting patients scheduled for elective total joint replacements (hip and knee) were randomized into group C (conventional) and group P (preprocedural ultrasound-guided paramedian technique) with 50 in each group. The patients were blinded to the study group. All spinal anesthetics were administered by a consultant anesthesiologist. In group C, spinal anesthetic was done via the midline approach using clinically palpated landmarks. In group P, a preprocedural ultrasound scan was used to mark the paramedian insertion site, and spinal anesthetic was performed via the paramedian approach. The average number of passes (defined as the number of forward advancements of the spinal needle in a given interspinous space, i.e., withdrawal and redirection of spinal needle without exiting the skin) in group P was approximately 0.34 times that in group C, a difference that was statistically significant (P = 0.01). Similarly, the average number of attempts (defined as the number of times the spinal needle was withdrawn from the skin and reinserted) in group P was approximately 0.25 times that of group C (P = 0.0021). In group P, on an average, it took 81.5 (99% confidence interval, 68.4-97 seconds) seconds longer to identify the landmarks than in group C (P = 0.0002). All other parameters, including grading of palpated landmarks, time taken for spinal anesthetic injection, periprocedural pain scores, periprocedural patient discomfort visual analog scale score, conversion to general anesthetic, paresthesia, and radicular pain during needle insertion, were similar between the 2 groups. Routine use of paramedian spinal anesthesia in the orthopedic patient population undergoing joint replacement surgery, guided by preprocedure ultrasound examination, significantly decreases the number of passes and attempts needed to enter the subarachnoid space.

Magnetic resonance image guided transurethral ultrasound prostate ablation: a preclinical safety and feasibility study with 28-day followup.

PubMed

Burtnyk, Mathieu; Hill, Tracy; Cadieux-Pitre, Heather; Welch, Ian

2015-05-01

We determine the safety and feasibility of magnetic resonance image guided transurethral ultrasound prostate ablation using active temperature feedback control in a preclinical canine model with 28-day followup. After a long acclimatization period we performed ultrasound treatment in 8 subjects using the magnetic resonance image guided TULSA-PRO™ transurethral ultrasound prostate ablation system. Comprehensive examinations and observations were done before and throughout the 28-day followup, including assessment of clinically significant treatment related adverse events. In addition to gross pathology evaluation, extensive histopathological analysis was done to assess cell kill inside and outside the prostate. We evaluated prostate conformal heating by comparing the spatial difference between the treatment plan and the 55C isotherm measured on magnetic resonance imaging thermometry acquired during treatment. These findings were confirmed on contrast enhanced magnetic resonance imaging immediately after treatment and at 28 days. Clinically there were no adverse events in any of the 8 subjects throughout the 28-day followup. All subjects had normal urinary and bowel function. Gross necropsy and histology confirmed that the intended thermal cell kill was confined to the prostate. No surrounding tissue was damaged, including the rectum and the external urinary sphincter. Conformal heating was achieved with an average -0.9 mm accuracy and 0.9 mm precision. Contrast enhanced magnetic resonance imaging and histological analysis confirmed tissue ablation in targeted areas of the prostate. Urethral tissue was spared from thermal damage. Magnetic resonance image guided transurethral ultrasound is a safe, feasible procedure for accurate and precise conformal thermal ablation of prostate tissue, as demonstrated in a preclinical model with 28-day followup. Copyright © 2015 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

Contrast-Enhanced Ultrasound Guided Biopsy of Undetermined Abdominal Lesions: A Multidisciplinary Decision-Making Approach.

PubMed

Mao, Feng; Dong, Yi; Ji, Zhengbiao; Cao, Jiaying; Wang, Wen-Ping

2017-01-01

Aim. To investigate the value of contrast-enhanced ultrasound (CEUS) guided biopsy of undetermined abdominal lesions in multidisciplinary treatment (MDT) decision-making approach. Methods. Between Jan 2012 and Dec 2015, 60 consecutive patients (male, 37; female, 23; mean age, 51.3 years ± 14.6) who presented with undetermined abdominal lesions were included. CEUS and core needle percutaneous biopsy was performed under real-time CEUS guidance in all lesions. Data were recorded and compared with conventional ultrasound (US) guidance group ( n = 75). All CEUS findings and clinical data were evaluated in MDT. Results. CEUS enabled the delimitation of more (88.3% versus 41.3%) and larger (14.1 ± 10.7 mm versus 32.3 ± 18.5 mm) nonenhanced necrotic areas. More inner (20.0% versus 6.7%) and surrounding (18.3% versus 2.7%) major vessels were visualized and avoided during biopsies. CEUS-guided biopsy increased the diagnostic accuracy from 93.3% to 98.3%, with correct diagnosis in 57 of 60 lesions (95.0%). The therapeutic plan was influenced by CEUS guided biopsies findings in the majority of patients (98.3%). Conclusion. The combination of CEUS guided biopsy and MDT decision-making approach is useful in the diagnostic work-up and therapeutic management.

Influence of chronic endurance exercise training on conduit artery retrograde and oscillatory shear in older adults.

PubMed

Casey, Darren P; Schneider, Aaron C; Ueda, Kenichi

2016-10-01

With aging, there tends to be an increase in retrograde and oscillatory shear in peripheral conduit arteries of humans. Whether the increase in shear rate is due to the aging process or an effect of a less active lifestyle that often accompanies aging is unknown. Therefore, we examined whether chronic endurance exercise training attenuates conduit artery retrograde and oscillatory shear in older adults. Brachial and common femoral artery mean blood velocities and diameter were determined via Doppler ultrasound under resting conditions, and shear rate was calculated in 13 young (24 ± 2 years), 17 older untrained (66 ± 3 years), and 16 older endurance exercise-trained adults (66 ± 7 years). Brachial artery retrograde (-9.1 ± 6.4 vs. -12.6 ± 9.4 s(-1); P = 0.35) and oscillatory (0.14 ± 0.08 vs. 0.14 ± 0.08 arbitrary units; P = 0.99) shear were similar between the older trained and untrained groups, whereas brachial artery retrograde and oscillatory shear were greater in older untrained compared to young adults (-5.0 ± 3.4, 0.08 ± 0.05 s(-1) arbitrary units, P = 0.017 and 0.048, respectively). There was no difference between the young and older trained brachial retrograde (P = 0.29) and oscillatory (P = 0.07) shear. Common femoral artery retrograde (-6.3 ± 2.9 s(-1)) and oscillatory (0.21 ± 0.08 arbitrary units) shear were reduced in older trained compared to the older untrained group (-10.4 ± 4.1 and 0.30 ± 0.09 s(-1) arbitrary units, both P = 0.005 and 0.006, respectively), yet similar to young adults (-7.1 ± 3.5 and 0.19 ± 0.06 s(-1) arbitrary units, P = 0.81 and 0.87, respectively). Our results suggest that chronic endurance exercise training in older adults ameliorates retrograde and oscillatory shear rate patterns, particularly in the common femoral artery.

Analytical estimation of ultrasound properties, thermal diffusivity, and perfusion using magnetic resonance-guided focused ultrasound temperature data

PubMed Central

Dillon, C R; Borasi, G; Payne, A

2016-01-01

For thermal modeling to play a significant role in treatment planning, monitoring, and control of magnetic resonance-guided focused ultrasound (MRgFUS) thermal therapies, accurate knowledge of ultrasound and thermal properties is essential. This study develops a new analytical solution for the temperature change observed in MRgFUS which can be used with experimental MR temperature data to provide estimates of the ultrasound initial heating rate, Gaussian beam variance, tissue thermal diffusivity, and Pennes perfusion parameter. Simulations demonstrate that this technique provides accurate and robust property estimates that are independent of the beam size, thermal diffusivity, and perfusion levels in the presence of realistic MR noise. The technique is also demonstrated in vivo using MRgFUS heating data in rabbit back muscle. Errors in property estimates are kept less than 5% by applying a third order Taylor series approximation of the perfusion term and ensuring the ratio of the fitting time (the duration of experimental data utilized for optimization) to the perfusion time constant remains less than one. PMID:26741344

Endobronchial Ultrasound-guided Transbronchial Needle Injection of Liposomal Amphotericin B for the Treatment of Symptomatic Aspergilloma.

PubMed

Parikh, Mihir S; Seeley, Eric; Nguyen-Tran, Evelyn; Krishna, Ganesh

2017-10-01

Surgical treatment with lung resection has traditionally been the treatment of choice for pulmonary cavities containing aspergillomas that cause hemoptysis. Endobronchial ultrasound (EBUS) is a minimally invasive bronchoscopic technique that is commonly used for transbronchial needle aspiration of hilar and mediastinal lymph nodes as well as centrally located parenchymal lesions. Here, we describe a case of a 71-year-old woman who was found to have a cavitary lesion in the lung containing aspergillomas. Under direct ultrasound visualization with EBUS, liposomal amphotericin B was injected into the aspergillomas. These aspergillomas regressed after treatment. To our knowledge, this is the first reported treatment of aspergilloma with EBUS-guided transbronchial needle injection of liposomal amphotericin B.

Ultrasound-Guided Cryoanalgesia of Peripheral Nerve Lesions.

PubMed

Djebbar, Sahlya; Rossi, Ignacio M; Adler, Ronald S

2016-11-01

The real-time nature of ultrasound makes it ideally suited to provide guidance for a variety of musculoskeletal interventional procedures involving peripheral nerves. Continuous observation of the needle ensures proper placement and allows continuous monitoring when performing localized ablative therapy and therefore more accurate positioning of a cryoprobe, use of smaller needles, as well as access to small structures. We describe our experience performing cryoablative procedures. Patients undergoing cryoneurolysis have largely reported varying degrees of long-term pain relief and improvement in function; no serious complications have yet been identified. Ultrasound-guided cryoneurolysis can provide a useful, safe alternative to other ablative techniques to achieve long-term analgesia from painful peripheral nerve lesions. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Percutaneous Ultrasound-Guided TOPAZ Radiofrequency Coblation: A Novel Coaxial Technique for the Treatment of Recalcitrant Plantar Fasciitis-Our Experience.

PubMed

Shah, Amit; Best, Alistair J; Rennie, Winston J

2016-06-01

Various therapeutic options are available for treatment of recalcitrant plantar fasciitis. Studies using TOPAZ coblation (ArthroCare, Sunnyvale, CA) have had good early results. The current coblation technique involves a surgical incision or breach of the highly specialized plantar fat pad, which can be associated with risks. We describe a novel technique of ultrasound-guided percutaneous coblation with a lateral heel approach. Advantages include precise targeting of the plantar fascia by direct dynamic visualization of the coblation tip, a true percutaneous approach with a needle skin puncture (<5 mm), and preservation of the plantar fat pad by using a lateral heel approach. © 2016 by the American Institute of Ultrasound in Medicine.

Pain reduction and improvement of function following ultrasound-guided intra-articular injections of triamcinolone hexacetonide and hyaluronic acid in hip osteoarthritis.

PubMed

Araújo, J P; Silva, L; Andrade, R; Paços, M; Moreira, H; Migueis, N; Pereira, R; Sarmento, A; Pereira, H; Loureiro, N; Espregueira-Mendes, J

2016-01-01

The scientific literature has shown positive results regarding intra-articular injections of hyaluronic acid in osteoarthritic joints. When injecting in the hip joint, the guidance of ultrasound can provide higher injection accuracy and repeatability. However, due to the methodological limitations in the current available literature, its recommendation in the current practice is still controversial. This study shows that ultrasound-guided intra-articular injections of triamcinolone hexacetonide and hyaluronic acid can improve pain, function and quality of life in patients with symptomatic and radiographic hip osteoarthritis. In addition, the administration of triamcinolone hexacetonide and hyaluronic acid to the hip joint in these patients can delay the need for interventional surgery.

Optimal dose of perineural dexmedetomidine for interscalene brachial plexus block to control postoperative pain in patients undergoing arthroscopic shoulder surgery: A prospective, double-blind, randomized controlled study.

PubMed

Jung, Hong Soo; Seo, Kwon Hui; Kang, Jae Hyuk; Jeong, Jin-Young; Kim, Yong-Shin; Han, Na-Re

2018-04-01

Adjuvant perineural dexmedetomidine can be used to prolong the analgesic effect of interscalene brachial plexus block (ISB). We investigated the optimal dose of dexmedetomidine in ISB for postoperative analgesia in patients undergoing arthroscopic shoulder surgery. One hundred patients scheduled for elective shoulder arthroscopic surgery were enrolled in this randomized, double-blind study. Ultrasound-guided ISB was performed before general anesthesia using 22 mL of ropivacaine 0.5% combined with 1, 1.5, or 2 μg/kg of dexmedetomidine (group D1, D2, and D3, respectively) or with normal saline as a control (group R, n = 25 per group). The primary outcome was the duration of analgesia (DOA), numeric pain rating scale (NRS), and consumption of additional analgesics during 36 h after ISB. Secondary outcome included durations of motor and sensory block (DOM and DOS), hemodynamic variables and sedation and dyspnea scores. Ninety-seven patients completed the study. The DOS, DOM, and DOA were significantly longer in the dexmedetomidine groups than in group R. The DOA was significantly longer in group D3 than in groups D1 (P = .026) and D2 (P = .039). The DOA was 808.13 ± 179.97, 1032.60 ± 288.14, 1042.04 ± 188.13, and 1223.96 ± 238.06 min in groups R, D1, D2, and D3, respectively. The NRS score was significantly higher in group R than in the dexmedetomidine groups 12 h after ISB (P < .001) and significantly lower in group D3 than in the other groups 18 h after ISB (P = .02). The incidence of hypotension was higher in groups D2 and D3 than in group R during surgery (P = .008 and P = .011, respectively). There were no significant differences in consumption of rescue analgesics, sedation, and dyspnea scores between the study groups. Perineural dexmedetomidine 2 μg/kg could be the optimal dose in ISB for arthroscopic shoulder surgery in that it provides an adequate DOA. However, this dose was associated with increased risk of hypotension.

Lung cancer diagnosis and staging with endobronchial ultrasound-guided transbronchial needle aspiration compared with conventional approaches: an open-label, pragmatic, randomised controlled trial

PubMed Central

Navani, Neal; Nankivell, Matthew; Lawrence, David R; Lock, Sara; Makker, Himender; Baldwin, David R; Stephens, Richard J; Parmar, Mahesh K; Spiro, Stephen G; Morris, Stephen; Janes, Sam M

2015-01-01

Summary Background The diagnosis and staging of lung cancer is an important process that identifies treatment options and guides disease prognosis. We aimed to assess endobronchial ultrasound-guided transbronchial needle aspiration as an initial investigation technique for patients with suspected lung cancer. Methods In this open-label, multicentre, pragmatic, randomised controlled trial, we recruited patients who had undergone a CT scan and had suspected stage I to IIIA lung cancer, from six UK centres and randomly assigned them to either endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) or conventional diagnosis and staging (CDS), for further investigation and staging. If a target node could not be accessed by EBUS-TBNA, then endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) was allowed as an alternative procedure. Randomisation was stratified according to the presence of mediastinal lymph nodes measuring 1 cm or more in the short axis and by recruiting centre. We used a telephone randomisation method with permuted blocks of four generated by a computer. Because of the nature of the intervention, masking of participants and consenting investigators was not possible. The primary endpoint was the time-to-treatment decision after completion of the diagnostic and staging investigations and analysis was by intention-to-diagnose. This trial is registered with ClinicalTrials.gov, number NCT00652769. Findings Between June 10, 2008, and July 4, 2011, we randomly allocated 133 patients to treatment: 66 to EBUS-TBNA and 67 to CDS (one later withdrew consent). Two patients from the EBUS-TBNA group underwent EUS-FNA. The median time to treatment decision was shorter with EBUS-TBNA (14 days; 95% CI 14–15) than with CDS (29 days; 23–35) resulting in a hazard ratio of 1·98, (1·39–2·82, p<0·0001). One patient in each group had a pneumothorax from a CT-guided biopsy sample; the patient from the CDS group needed intercostal drainage and was admitted to hospital. Interpretation Transbronchial needle aspiration guided by endobronchial ultrasound should be considered as the initial investigation for patients with suspected lung cancer, because it reduces the time to treatment decision compared with conventional diagnosis and staging techniques. Funding UK Medical Research Council. PMID:25660225

[Thoracic Outlet Syndrome: is it always a surgical condition? Analysis of a series of 31 cases operated by the supraclavicular route].

PubMed

Socolovsky, Mariano; Di Masi, Gilda; Binaghi, Daniela; Campero, Alvaro; Páez, Miguel Domínguez; Dubrovsky, Alberto

2014-01-01

Thoracic Outlet Syndrome is a compression of the brachial plexus that remains highly controversial. Classification in True or Neurogenic Outlet (TTO) and Disputed or Non-neurogenic Outlet (DTO) is becoming very popular. The former is characterized by a muscular atrophy of the intrinsic muscles of the hand, while the latter has only sensitive symptoms. The purpose of this article is to analyze the results obtained in a series of 31 patients. All patients with diagnosis of Thoracic Outlet operated between January 2003 and December 2012 with a minimum follow-up of six months where included. Age, sex, symptoms, classification, preoperative studies results, complications and recurrences were analyzed. 31 surgeries performed in 30 patients, 9 with TTO (8 women, mean age 24.3 years) and 21 with DTO (18 women, mean age 37.4 years, 1 recurrence) were included. Ninety percent of patients presented neurophysiological and 66.6% imagenological preoperative disturbances. All TTO and only 36.7% of DTO showed clear pathological findings during surgical exploration. A high percentage (87,5% sensitive and 77.7% motor) of TTO ameliorated after surgical decompression. Only 45.5% of DTO showed permanent positive changes, 13.6% temporary, 36.6% no changes, and 4.5%(one case) showed deterioration after decompresive surgery. Complications after surgery were more frequent –but temporary- in TTO cases (33.3%), than in DTO (13.6%). TTO showed a favorable outcome after surgery. DTO showed a worst –but still positive- postoperative result if patients are selected properly. These data are in concordance with other recent reports.

Randomized controlled study of the safety and efficacy of nitrous oxide-sedated endoscopic ultrasound-guided fine needle aspiration for digestive tract diseases

PubMed Central

Wang, Cai-Xia; Wang, Jian; Chen, Yuan-Yuan; Wang, Jia-Ni; Yu, Xin; Yang, Feng; Sun, Si-Yu

2016-01-01

AIM To evaluate the efficacy and safety of nitrous oxide-sedated endoscopic ultrasound-guided fine needle aspiration. METHODS Enrolled patients were divided randomly into an experimental group (inhalation of nitrous oxide) and a control group (inhalation of pure oxygen) and heart rate, blood oxygen saturation, blood pressure, electrocardiogram (ECG) changes, and the occurrence of complications were monitored and recorded. All patients and physicians completed satisfaction questionnaires about the examination and scored the process using a visual analog scale. RESULTS There was no significant difference in heart rate, blood oxygen saturation, blood pressure, ECG changes, or complication rate between the two groups of patients (P > 0.05). However, patient and physician satisfaction were both significantly higher in the nitrous oxide compared with the control group (P < 0.05). CONCLUSION Nitrous oxide-sedation is a safe and effective option for patients undergoing endoscopic ultrasound-guided fine needle aspiration. PMID:28028373

Ultrasound-guided platelet-rich plasma injection for distal biceps tendinopathy.

PubMed

Barker, Scott L; Bell, Simon N; Connell, David; Coghlan, Jennifer A

2015-04-01

Distal biceps tendinopathy is an uncommon cause of elbow pain. The optimum treatment for cases refractory to conservative treatment is unclear. Platelet-rich plasma has been used successfully for other tendinopathies around the elbow. Six patients with clinical and radiological evidence of distal biceps tendinopathy underwent ultrasound-guided platelet-rich plasma (PRP) injection. Clinical examination findings, visual analogue score (VAS) for pain and Mayo Elbow Performance scores were recorded. The Mayo Elbow Performance Score improved from 68.3 (range 65 to 85) (fair function) to 95 (range 85 to 100) (excellent function). The VAS at rest improved from a mean of 2.25 (range 2 to 5) pre-injection to 0. The VAS with movement improved from a mean of 7.25 (range 5 to 8) pre-injection to 1.3 (range 0 to 2). No complications were noted. Ultrasound-guided PRP injection appears to be a safe and effective treatment for recalcitrant cases of distal biceps tendinopathy. Further investigation with a randomized controlled trial is needed to fully assess its efficacy.