Lung ultrasonography as a tool to guide perioperative atelectasis treatment bundle in head and neck cancer patients undergoing free flap reconstructive surgeries: a preliminary observational study / Ultrassonografia pulmonar como ferramenta para orientar o tratamento perioperatório de atelectasia em pacientes com câncer de cabeça e pescoço submetidos a cirurgia reconstrutiva com retalho livre: um estudo observacional preliminar

Abstract Introduction: General anesthesia causes pulmonary atelectasis within few minutes of induction. This can have significant impact on postoperative outcome of cancer patients undergoing prolonged reconstructive surgeries. Objective: The purpose of this study was to evaluate the impact of sonographically detected perioperative atelectasis on the need for postoperative oxygen supplementation, bronchodilator therapy and assisted chest physiotherapy in patients undergoing free flap surgeries for head and neck carcinoma. Methods: Twenty eight head and neck cancer patients underwent bilateral pulmonary ultrasonographic assessments before and after lung surgery. Lung ultrasound scores, serum lactate, and PaO2/FiO2 ratio were measured both at the beginning and at end of the surgery. Patients were scanned in the supine position and the number of single and confluent B lines was noted. These values were correlated with the need for oxygen therapy, requirement of bronchodilators and total weaning time to predict the postoperative outcome. Other factors affecting weaning were also studied. Results: Among twenty eight patients, seven had mean lung ultrasound score of ≥10.5 which correlated with prolonged weaning time (144.56±33.5min vs. 66.7±15.7min; p = 0.005). The change in lung ultrasound score significantly correlated with change in PaO2/FiO2 ratio (r = −0.56, p = 0.03). Elevated total leukocyte count >8200 ΜL and serum lactate >2.1 mmoL/L also predicted prolonged postoperative mechanical ventilation. Conclusion: This preliminary study detected significant levels of perioperative atelectasis using point of care lung ultrasonography in head and neck cancer patients undergoing long duration surgical reconstructions. Higher lung ultrasound scores highlighted the need for frequent bronchodilator nebulizations as well as assisted chest physiotherapy and were associated with delayed weaning. We propose more frequent point of care lung ultrasonographic evaluations and use of recruitment maneuvers to reduce the impact of perioperative pulmonary atelectasis.

Resumo Introdução: A anestesia geral causa atelectasia pulmonar poucos minutos após sua indução. Isso pode ter um impacto significativo no resultado pós-operatório de pacientes com câncer submetidos a cirurgias reconstrutivas prolongadas. Objetivo: Avaliar o impacto das atelectasias perioperatórias detectadas por ultrassonografia na necessidade de suplementação pós-operatória de oxigênio, terapia broncodilatadora e fisioterapia respiratória assistida em pacientes com carcinoma de cabeça e pescoço submetidos a cirurgias com uso de retalho livre. Método: Foram submetidos a avaliações ultrassonográficas pulmonares bilaterais antes e após a cirurgia 28 pacientes com câncer de cabeça e pescoço. Os escores de ultrassonografia pulmonar, lactato sérico, razão PaO2/FiO2 foram medidos no início e no fim da cirurgia. Os pacientes foram avaliados na posição supina e o número de linhas B confluentes e únicas foi observado. Esses valores foram correlacionados com a necessidade de oxigenoterapia, necessidade de broncodilatadores e tempo total de desmame para predizer o resultado pós-operatório. Outros fatores que afetam o desmame também foram estudados. Resultados: Entre os 28 pacientes, sete apresentaram escore médio de ultrassonografia pulmonar ≥ 10,5, que se correlacionou com o tempo de desmame prolongado (144,56 ± 33,5 minutos vs. 66,7 ± 15,7 minutos; p = 0,005). A mudança no escore de ultrassonografia pulmonar correlacionou-se significantemente com a mudança na razão PaO2/FiO2 (r = −0,56, p = 0,03). A contagem total elevada de leucócitos > 8200 uLe o nível de lactato sérico >2,1 mmoL/L também previram ventilação mecânica pós-operatória prolongada. Conclusão: Este estudo preliminar detectou um nível significante de atelectasia perioperatória com ultrassonografia pulmonar no local de atendimento em pacientes com câncer de cabeça e pescoço submetidos a reconstruções cirúrgicas de longa duração. Escores mais altos de ultrassonografia pulmonar enfatizaram a necessidade de nebulizações broncodilatadoras frequentes e fisioterapia respiratória assistida e foram associados a desmame tardio. Propomos avaliações ultrassonográficas pulmonares mais frequentes no local de atendimento e o uso de manobras de recrutamento para reduzir o impacto das atelectasias pulmonares perioperatórias.

Confiabilidade da ultrassonografia de músculos esqueléticos em pacientes críticos de trauma / Reliability of skeletal muscle ultrasound in critically ill trauma patients

RESUMO Objetivo: Avaliar a segurança e a viabilidade da avaliação por ultrassonografia do quadríceps no pronto-socorro, e avaliar a confiabilidade intra e entre avaliadores para aquisição e análise de imagens de ultrassonografia da espessura e da ecogenicidade muscular em pacientes críticos de trauma. Métodos: Estudo de precisão diagnóstica realizado por meio de exames e avaliações feitos por profissionais de saúde com diferentes níveis de especialização. Dois examinadores (um especialista e um novato) procederam à aquisição de imagens de ultrassom de dez pacientes. Um avaliador experiente, cego quanto aos examinadores, quantificou as imagens obtidas. Em um grupo à parte de dez pacientes, dois avaliadores (um especialista e um novato) quantificaram a espessura do músculo quadríceps femoral, assim como sua ecogenicidade (métodos quadrado ou tracejado) em imagens adquiridas por um examinador. Resultados: Identificou-se excelente confiabilidade quanto à aquisição da imagem e à sua análise (coeficientes de correlação intraclasses > 0,987; p < 0,001). O erro padrão dos valores de mensurações variou de 0,01 a 0,06 cm, para a espessura muscular, e de 0,75 a 2,04 unidades arbitrárias, para ecogenicidade muscular. Os valores de ecogenicidade foram mais elevados quando se utilizou o método quadrado do que quando se utilizou o método tracejado (p = 0,003). Conclusão: A ultrassonografia é um método seguro, viável e confiável para avaliação muscular em pacientes críticos de trauma, independentemente do nível de especialização do avaliador.

ABSTRACT Objective: To evaluate the safety and feasibility of the ultrasound assessment of quadriceps in the emergency setting. To assess the intra- and interrater reliability for the acquisition and analysis of ultrasound images of muscle thickness and echogenicity in critically ill trauma patients between health professionals with different levels of expertise. Methods: Diagnostic accuracy study. Two examiners (expert and novice) acquired ultrasound images from ten patients; an experienced, blinded analyst quantified the images. In a separate group of ten patients, two analysts (expert and novice) quantified quadriceps muscle thickness and echogenicity (square or trace method) from images acquired by one examiner. Results: Excellent reliability was found for image acquisition and analysis (intraclass correlation coefficients > 0.987; p < 0.001). The standard error of the measurement values ranged from 0.01 - 0.06cm for muscle thickness and from 0.75 - 2.04 arbitrary units for muscle echogenicity. The coefficients of variation were < 6% for thickness and echogenicity. The echogenicity values were higher when using the square technique than when using the tracing technique (p = 0.003). Conclusion: Ultrasound is safe, feasible, and reliable for muscle assessment in critically ill trauma patients, regardless of the assessor's level of expertise.

Comparação entre as complicações da lipoabdominoplastia sem preservação da fáscia de Scarpa com abdominoplastia clássica: um estudo prospectivo cego / Complications of lipoabdominoplasty without Scarpa fascia preservation versus classic abdominoplasty: a prospective blind study

Introdução: Abdominoplastia é um dos procedimentos cirúrgicos estéticos mais realizados. Seroma é a complicação local mais comum associada com abdominoplastia, com uma incidência média de 10%. A maior incidência de seroma pós-operatório (PO) ocorre no décimo primeiro dia PO. Ecografia abdominal é o método de escolha para o diagnóstico de seroma após abdominoplastia. Novas técnicas surgiram ao longo dos anos na tentativa de trazer melhores resultados estéticos com menos complicações, como lipoabdominoplastia descrita por Saldanha. Porém, estudos anatômicos recentes questionam a necessidade da manutenção da fáscia de Scarpa descrita na técnica de lipoabdominoplastia, descrevendo que em torno de 90% do sistema linfático abdominal está no plano subdérmico e 10% em um sistema linfático profundo justa-aponeurose abdominal. O objetivo é comparar a incidência de seroma na lipoabdominoplastia sem preservação da fáscia de Scarpa com a abdominoplastia clássica. Métodos: Coorte prospectiva, cega na qual serão analisados 40 pacientes consecutivos que realizaram abdominoplastia sem lipoaspiração associada (n = 20) ou lipoabdominoplastia (n = 20) no Hospital de Clínicas de Porto Alegre entre abril de 2016 e maio de 2017. Todos foram submetidos à ecografia de parede abdominal no 10o dia PO. Resultados: A incidência de seroma foi de 5% (n = 1) no grupo de abdominoplastia clássica e de 10% (n = 2) no grupo de lipoabdominoplastia, sem diferença estatística. Conclusão: Estes resultados, neste grupo de pacientes, mostram que não houve diferença estatística entre os dois grupos.

Introduction: Abdominoplasty is among the most commonly performed surgical procedures. Seroma is the most common local complication associated with abdominoplasty, with an average incidence of 10%. The highest incidence of postoperative (PO) seroma occurs on the eleventh postoperative day (POD). Abdominal ultrasound is the method of choice for diagnosing seroma after abdominoplasty. New techniques have emerged aiming to improve aesthetic results with fewer complications, such as lipoabdominoplasty described by Saldanha. However, recent anatomical studies have questioned the need for Scarpa fascia preservation recommended in the lipoabdominoplasty technique, describing that around 90% of the abdominal lymphatic system is in the subdermal plane, while the other 10% is in a deep lymphatic system near the abdominal aponeurosis. The objective is to compare the incidence of seroma in lipoabdominoplasty without Scarpa fascia preservation to that in classic abdominoplasty. Methods: Prospective blinded cohort in which 40 consecutive patients who underwent abdominoplasty without associated liposuction (n = 20) or lipoabdominoplasty (n = 20) at the Hospital de Clínicas of Porto Alegre between April 2016 and May 2017 were analyzed. All patients underwent abdominal wall ultrasonography on the tenth POD. Results: The incidence of seroma was 5% (n = 1) in the classic abdominoplasty group and 10% (n = 2) in the lipoabdominoplasty group, with no statistical difference. Conclusion: These results showed no statistically significant intergroup difference in seroma development.

Seguridad del ultrasonido obstétrico para la salud de la embarazada y el feto / Safety of obstetric ultrasonography for maternal and fetal health

El ultrasonido diagnóstico ha creado polémicas desde sus inicios y el ultrasonido obstétrico no ha estado fuera de la discusión. Existe una variada opinión que va desde una total inocuidad del método, pasando por los que tienen una opinión reservada sobre el tema y los que refieren que es perjudicial para el feto. Conociendo que los tejidos absorben las ondas sonoras y estos a su vez se convierten en energía térmica, mientras más alta sea esta, más riesgos tiene el feto de que se le cause bioefectos. El riesgo aumenta cuando la gestante presenta fiebre. Por otro lado, el personal que realiza el examen tiene escaso conocimiento a nivel mundial respecto a la salida acústica de los equipos que usan, los bioefectos y la seguridad del ultrasonido en general. Debemos tener presente el principio que consiste en usar densidades de energía tan bajas como razonablemente sea posible, para alcanzar datos e imágenes útiles para llegar al diagnóstico. Los profesionales de la salud deben seguir las guías sobre el uso del ultrasonido obstétrico, para prevenir una exposición indiscriminada de ondas sonoras sobre la madre o el feto(AU)

Diagnostic ultrasonography has always been a controversial topic, and obstetric ultrasound has not been outside the debate. Many different criteria have been held about the subject: some state that the method is totally safe, while others have a reserved opinion, and still others refer to negative effects on the fetus. Because tissues absorb sound waves, turning them into thermal energy, the higher the energy the more risks there will be of bioeffects on the fetus. The risk increases when pregnant women have a fever. On the other hand, the personnel performing the test have scarce knowledge about the acoustic output of the equipment they use, as well as the bioeffects and the safety of ultrasound in general. This is a worldwide fact. We should be aware of the need to use the lowest energy density reasonably required to obtain data and images useful for diagnosis. Health professionals should comply with the guidelines on the use of obstetric ultrasound to prevent unnecessary exposure to sound waves by mothers and fetuses(AU)

Impacto da hormonioterapia associada ao escore de predição de Wells no diagnóstico de trombose venosa profunda em mulheres submetidas a ecografia vascular / Impact of hormone therapy linked to wells prediction score in the diagnosis of deep vein thrombosis in women submitted to vascular ultrasound

Introdução: A trombose venosa profunda (TVP) apresenta elevada morbimortalidade. O escore de Wells foi elaborado para melhorar a capacidade diagnóstica pré-teste para TVP. O objetivo deste estudo foi ajustar o escore de Wells para pacientes brasileiras e incluir a variável hormonioterapia (HT), comparando acurácia e poder de reclassificação do novo escore com o original de Wells. Método: Estudo observacional transversal em que foi realizada regressão logística para incluir a variável hormonioterapia (HT) ao Escore de Wells, criando um novo escore (escore HT), que foi calibrado e ajustado para a população estudada. A qualidade dos dados foi avaliada pela estatística Kappa. Resultados: Foram estudadas 461 pacientes com idade de 56,1 ± 20,8, das quais 103 tiveram diagnóstico ecográfico de TVP. O escore HT incluiu sete variáveis, pacientes que obtiveram pontuação de -4 a 0 foram consideradas de baixo risco; de 1 a 3, moderado risco; e de 4 a 11, alto risco para TVP, com calibração adequada (valor p = 0,59). A área sob a curva ROC para o escore HT foi 0,92 (IC 95% 0,90 - 0,95) e para o escore de Wells foi de 0,87 (IC 95% 0,84 – 0,91), mostrando diferença estatisticamente significativa (p < 0,05).Conclusão: A inclusão da hormonioterapia a um modelo de predição clínica demonstrou maior acurácia comparativamente ao modelo de Wells.

Introduction: Deep venous thrombosis (DVT) presents high morbidity and mortality. The Wells score is designed to improve the pretest diagnosing capacity for DVT. The purpose of this study was to adjust the Wells score for Brazilian patients and include the variable hormone therapy (HT), comparing accuracy and power of reclassification of the new score with Wells’ original score.Methods: Cross-sectional observational study in which logistic regression was performed to include the variable hormone therapy (HT) to the Wells score, creating a new score (HT score), which has been calibrated and adjusted for the population studied. Data quality was evaluated by the Kappa statistics.Results: We studied 461 patients aged 56.1 ± 20.8, of which 103 had sonographic diagnosis of DVT. The HT score included seven variables: patients who achieved a score of -4 to 0 are considered low risk; 1 to 3, moderate risk; and 4 to 11, high risk for DVT, withproper calibration (p = 0.59). The area under the ROC curve for the HT score was 0.92 (95% CI 0.90 — 0.95) and for the Wells score it was 0.87 (95% CI 0.84 — 0.91), showing a statistically significant difference (p < 0.05).Conclusion: The inclusion of hormone therapy into a clinical prediction model showed higher accuracy compared to the model of Wells.

Síndrome de VOMIT (Victim of Modern Imaging Technology) en pacientes con trauma de abdomen cerrado que consultaron en la Unidad de emergencia del Hospital General ISSS sometidos a LPE periodo enero 2012 a diciembre 2014 / VOMIT (Victim of Modern Imaging Technology) syndrome in patients with blunt abdominal trauma who consulted in the Emergency Unit of the General Hospital of the ISSS submitted to exploratory laparotomy from January 2012 to December 2014

La tecnología se ha extendido a todas las áreas de la medicina, incluida la imagenología El síndrome V.O.M.I.T "VICTIM OF MODERN IMAGING TECHNOLOGY", describe el conjunto de consecuencias adversas secundarias a la mala aplicación e interpretación imagenológica, vinculadas al diagnóstico, tratamiento ó pronóstico de los pacientes politraumatizados que ingresan al Servicio de Emergencia. Es una entidad clínica en si misma dentro del capítulo de errores médicos y los servicios de emergencia son áreas de riesgo para que suceda. Sin duda, es imprescindible conocerlo, medirlo y plantear medidas preventivas. En nuestro medio la real incidencia de este problema se desconoce. Es por eso que la pregunta de nuestra investigación es: ¿Con que frecuencia la decisión de realizar una laparotomía exploradora en trauma cerrado de abdomen, con claras indicaciones clínicas se ve retrasada en espera de estudios de imagenología? Nuestra hipótesis era que La toma de conducta quirúrgica en trauma cerrado de abdomen en la unidad de emergencia del Hospital General del Seguro Social está siendo retrasada por el Síndrome de V.O.M.I.T. la cual fue verdadera. Es por esto que el objetivo general de nuestro estudio fue demostrar la presencia y frecuencia de este síndrome. Para ello recolectaremos del libro de procedimientos de Sala de Operaciones de la Unidad de Emergencia del Hospital General (ISSS) los números de expedientes de los pacientes que fueron sometido a Laparotomía Exploradora con diagnostico trauma cerrado de abdomen, en el periodo de Enero 2012 a Diciembre 2014 posteriormente se revisaron dichos expedientes y analizaron los datos los cuales se presentan posteriormente

Lesão vascular iatrogênica pós-punção de veia femoral pela técnica de Seldinger / Post punching iatrogenic vascular lesion of the femoral vein by the seldinger technique

Uma complicação decorrente da cateterização femoral é o pseudoaneurisma de artéria femoral, cujo diagnóstico pode ser realizado com o emprego da ecografia vascular com Doppler colorido, podendo ainda esse método orientar quanto à terapêutica mais adequada.

Endocrinological response of rabbit after exposure of ovaries to diagnostic ultrasound

To study the serum progesterone and estradiol level in rabbit after exposed of their ovaries to ultrasound waves. Experimental study. NIH, Islamabad, Army Medical College Rawalpindi from Mar 2006 to Sep 2006. Forty, adult, non pregnant female rabbits [Oryctolagus cuniculus strain] weighing 900 gm to 1500 gm were used. They were divided in four groups, each containing ten rabbits, Group I was taken as control. Ovaries of other three groups [group II, III and IV] were exposed to ultrasound [frequency of 3.5 MHz and intensity of 96 dB for two minutes] for 3, 6 and 12 days respectively. Two milliliter of blood samples was withdrawn after 24 hours of last exposure. Progesterone and Estrogen levels in serum were analyzed by Chemiluminescence's method. Initial serum Progesterone and Estrogen levels in rabbits not exposed to ultrasound were compared with ultrasound exposed serum levels. The estradiol level decreased significantly in group IV [P= 0.014] and progesterone level increased significantly in group III [P=0.011]. The current study has revealed that exposure to ultrasound produces changes in hormonal level, if used for longer duration

Função luteal em caprinos: características morfológicas, endócrinas e atributos de imagem / Función luteal en caprinos: características morfológicas, endocrinas y atributos de imagen / Goat luteal function: morphological, endocrine and ultrasonographic characteristics

Este estudo objetivou estabelecer características morfológicas e endócrinas da dinâmica luteal de fêmeas nulíparas da raça Toggenburg, e avaliar a função luteal utilizando a análise de atributos de imagens ultrassonográficas. A dinâmica luteal foi acompanhada por ultrassonografia transretal. A ecotextura luteal foi determinada em um software próprio. Cada ponto da imagem (pixel) foi quantificado dentro de uma escala de cinza (0=preto e 255=branco). Os CLs foram primeiramente detectados no dia 5,00±0,19 (D0=estro), com área média de 0,63±0,07cm2 e aumentaram progressivamente (P<0,001) até o D9, atingindo uma área máxima de 1,26±0,08cm2. A concentração plasmática de P4 aumentou progressivamente até o D9, não apresentando aumento significativo até o momento da luteólise, e 24hs depois atingiu valores inferiores a 1 ng/mL. Diferentemente, a área luteal diminuiu de forma mais lenta e gradual. Houve uma correlação significativa (P<0,05) entre a área luteal e a concentração de P4 durante o processo de luteogênese e de luteólise (r=0,63 e r=0,50, respectivamente). As alterações morfológicas, histológicas e bioquímicas observadas no CL, durante o ciclo estral, refletiram sobre a ecotextura luteal. Houve uma correlação positiva (P<0,05) entre o valor médio dos pixels e a área luteal durante a luteogênese e luteólise (r=0,34 e r=0,26, respectivamente), assim como com a P4 (r=0,24 e r=0,37, respectivamente). Estas características demonstram que a dinâmica luteal em cabras Toggenburg segue padrões semelhantes às observadas em outras raças e outras espécies e que a quantificação do valor médio dos pixels apresenta um potencial para a avaliação da função luteal na espécie caprina

The purpose of this study was to establish morphological and endocrine characteristics of luteal dymanics in Nuliparous Toggenburg goats, and evaluate luteal function by using computer-assisted ultrasonographic image analysis. Luteal dynamics was conducted by transrectal ultrasonography. Luteal echotexture was determined with the use of customized software, in which each image dot (pixel) received a numeric value ranging from 0 (black) to 255 (white). Corpora lutea were first visualized on day 5.00±0.19 with a average area of 0.63±0.07 cm2, and progressively increased in size (P<0.001) until the day 9, when reached a maximum area of 1.26±0.08 cm2. Plasma progesterone also increased until day 9 and no significant increase was observed until luteolysis - it reached values below 1 ng/mL after 24 h. Differently, the luteal area decreased in size slowly and gradually. Significant correlation (P<0.05) between progesterone levels and luteal area was observed during the processes of luteogenesis and luteolysis (r = 0.63 and r = 0.50, respectively). Morphological, edocrinological and biochemical changes noticed in CL during the estrous cycle reflected on the luteal echotexture. Positive correlation (P<0.05) was observed between the mean pixel value and the luteal tissue area during luteogenesis and luteolysis (r = 0.34 e r = 0.26, respectively), and also between mean pixel value and plasma progesterone level (r = 0.24 e r = 0.37, respectively). These characteristics showed that the luteal dynamics in Toggenbur goats present patterns similar to those noticed in other goat breeds and species and that pixel value quantification plays a potential role for the luteal function evaluation in goats

Este estudio tuvo como objetivo establecer características morfológicas y endocrinas de la dinámica luteal de hembras nulíparas de raza Toggenburg, y evaluar la función luteal utilizando el análisis de atributos de imágenes ultrasonográficas. La dinámica luteal fue acompañada por ultrasonografía transrectal. La ecotextura luteal fue determinada en un software propio. Cada punto de la imagen (pixel) fue cuantificado según una escala gris (0=negro y 255=blanco). Los CLs fueron primeramente detectados en el día 5,00±0,19 (D0=estro), con área media de 0,63±0,07cm2 y aumentaron progresivamente (P<0,001) hasta el día D9, alcanzando área máxima de 1,26±0,08cm2. La concentración plasmática de P4 se incrementó progresivamente hasta el día D9, no presentando aumento significativo hasta el momento de la luteólisis, y tras 24hs alcanzó valores inferiores a 1 ng/mL. Diferentemente, el área luteal disminuyó de forma más lenta y gradual. Hubo una correlación significativa (P<0,05) entre el área luteal y la concentración de P4 durante el proceso de "luteogênese" y de luteólisis (r=0,63 y r=0,50, respectivamente). Las alteraciones morfológicas, histológicas y bioquímicas observadas en el CL durante el ciclo estral, reflejaron sobre la ecotextura luteal. Hubo una correlación positiva (P<0,05) entre el valor medio de los pixels y el área luteal durante la "luteogênese" y luteólisis (r=0,34 e r=0,26, respectivamente), así como con la P4 (r=0,24 e r=0,37, respectivamente). Estas características demuestran que la dinámica luteal en cabras Toggenburg sigue patrones semejantes a las observadas en otras razas y otras especies, y que la cuantificación del valor medio de los pixels presenta un potencial para la evaluación de la función luteal en la especie caprina

Women's perception of transvaginal sonography in a tertiary hospital in Nigeria

Available studies suggest that pregnant women's views on the desirability of routine ultrasound are influenced by their perceptions of its potential benefits and concern about possible adverse effects. To assess women's views of transvaginal sonography and to determine any correlation between their perception of the procedure and their prior knowledge and experience of it. Radiology department, federal medical centre, Asaba, Niger Delta, Nigeria. We surveyed women presenting with various gynecologic problems or complications of the first trimester. Data collection was by self-administered questionnaires using convenience sampling technique on women attending the clinic over a period of one year. Only women who had transvaginal sonography were included. A total of 250 women were recruited and interviewed. Transvaginal sonography was considered not embarrassing by 76%, acceptable by 86%, not painful by 87.2% and not stressful by 82% of the women. There were no statistically significant differences in the women's perception of the procedure whether they had prior knowledge and previous experience of the procedure or not [P > 0.05]. The majority of the women perceived transvaginal sonography favourably. Their perception of the procedure was favourable whether they had prior knowledge and previous experience of it or not

Assessment of genomic damage in medical personnel exposed to ionizing radiation and ultrasound by mean of FISH

Establishing a diagnosis of acute coronary syndrome in the clinical setting remains a challenging task. The advent of testing for cardiac biomarkers such as myoglobin, creatine kinase [CK-MB], and the troponins has facilitated this process. Unfortunately, although these blood markers are extremely sensitive for the identification of patients with myocardial necrosis, their ability to identify patients with acute coronary ischaemia remains limited. During myocardial ischaemia, several changes occur in the amino terminus of ischaemia, several changes occur in the aminot terminus of albumin. Therefore, if reliable, an assay measuring IMA might represent a promising marker for early identification of patients with myocardial ischaemia. To assess the role of IMA and its predictive value for early diagnosis of patients with acute coronary syndromes. Seventy three patients with suspected ACS attending the emergency department at Assiut university hospital were included in addition to -sex and age matched -20 healthy control subjects. All patients were presented within 6h of the typical chest pain episode with negative troponin and normal serum albumin levels. Any patient with liver diseases, renal failure, anaemia, malignancy, acute infections, peripheral vascular diseases, cerebral ischaemia and physical exercise within the last 48 hours was excluded. Full history, clinical examination and standard 12 lead ECG, laboratory investigations including CPK, IMA, CRP, lipogram, kidney and liver functions were done. Twenty two patients were diagnosed as non ischaemic chest pain [NICP] and 51 cases as ACS. CPK and troponin levels were normal in all groups at presentations but 6 hours later CPK levels were significantly higher in ACS patients if compared with NICP or control groups [p<0.000]. on the other hand, IMA levels were statistically significantly high in ACS group only [p<0.000] with a good negative predictive value to diagnose NICP [86.3%]. Moreover, IMA levels were statistically significantly higher in patients finally diagnosed as unstable angina [UA] than those who diagnosed as non ST elevation myocardial infarction [NSTEMI] [p<0.04] meanwhile, it is insignificantly higher than that in STEMI patients. The sensitivity of IMA to predict ACS cases [94.1%] was higher than that of ECG [78.4%] and CPK at presentation [14.7%] and after 6 hours [54.7%]. On the other hand, the specificity of IMA, ECG, CPK at presentation and 6 hours later [86.4%, 90.9%, 86.4% and 97% respectively]. IMA can be used at the emergency setting to exclude the diagnosis of ADS. Moreover, the use of IMA as a diagnostic biomarker in addition to standard markers of myocardial injury is very useful for the evaluation of patients with suspected ACSMedical personnel are without doubt exposed to many biological and chemical agents [e.g., ionizing radiation, ultraviolet light rays, ultrasound, alkylating agents, anesthetic gases and antineoplastic agents] which are efficient inducers of chromosomal aberrations. X-ray and ultrasound are used extensively in many branches of modern medicine. X-rays, together with gamma rays and UV light are all part of the electromagnetic spectrum. Their interaction with biologic material depends on the frequency of wavelength of the radiation. At the short wavelengths of X-rays, electromagnetic radiation has sufficient energy to produce ionization as a result of the removal of electrons from atoms, and are thus called ionizing radiation. Ultrasound [term used to describe mechanical vibrations at frequencies above the human limit of audibility] has experienced phenomenal growth in medical diagnosis in recent years and it is usable in many sensitive circumstances where X-rays might be damaging. The aim of the present study is to assess genomic damage produced by occupational exposure to X-rays and ultrasound equipment using FISH technique using the whole chromosome paint probes for chromosome 1 and 2. Our study revealed chromosomal aberration in 2 personnel exposed to ionizing radiation, continuously for more than 10 years, in the form of absent signaling of chromosomes 2 which denotes total loss [monosomy] of this chromosome. In conclusion, our results may not provide significant proof of the cytogenetic damage caused by occupational exposure to ionizing radiation and ultrasound, however it may prove useful for future human population studies in this field and surely concluded that the necessity of following safety rules in fields dealing with radiations

Efeito do ultrasom terapêutico nas anastomoses colônicas. Estudo experimental em ratos / The efect of ultrasound therapy on the colonic anastomosis: experimental study in rats in rats

Objetivou-se conhecer a influência do ultra-som na cicatrização colônica em ratos e avaliar os fios de aço e náilon na vigência desta terapia. Utilizou-se 64 ratos machos Wistar divididos em protocolos. Protocolo 1 com 32 ratos submetidos a anastomose colônica com fio de náilon divididos em 2 grupos C (controle), e T (terapêutico). O grupo T realizou a terapia com ultra-som de alta freqüência, na região dorsal. O subgrupo sacrificado no 3o dia, recebeu ultra-som no 1o e 2o dias pós-operatório. E o no 7o, terapia no 4o, 5o e 6o P.O. No Protocolo 2 anastomoses com aço, subdivididos da mesma forma. E no Protocolo 3 comparou-se os grupos T do náilon e aço. Avaliou-se pressão de ruptura à insuflação (PRI) e estudo histológico. Resultados: Protocolo 1 no 3o dia a PRI foi maior no grupo T (p=0,001) e no 7o dia não houve diferença (p=0,0950). No Protocolo 2 no 3o dia não houve diferença na PRI (p=0,3060) e no 7o dia a PRI foi maior no C (p=0,0010). No Protocolo 3 no 3o dia a PRI foi maior no NáilonT (p=0,0010) e no 7o dia não houve diferença (p=0,3100). Concluiu-se que o ultra-som não influencia a cicatrização de anastomoses feitas com náilon e não compromete a viabilidade das feitas com aço

Utilidad de la ecografía endorrectal en el cáncer del recto / Endorectal ultrasound in the preoperative staging of rectal tumors

La ecografía endorrectal es actualmente el método de elección para estadificar los tumores rectales, desde el punto de vista de sus factores pronósticos más importantes: el grado de invasión de la pared rectal, y el compromiso de los ganglios linfáticos. La elección correcta del método terapéutico depende del conocimiento de la extensión de la enfermedad. Esta monografía tiene como objeto valorar la utilización de la ecografía endorrectal en la estadificación preoperatoria del cáncer del recto, además de explicitar brevemente la técnica y características del método, y su comparación con otros métodos.

Changes in mouse behavior induced by fetal exposure to diagnostic ultrasound.

Pregnant Swiss albino mice were exposed to diagnostic ultrasound (3.5 MHz, 65mw, ISPTP = 1 W/cm2, ISATA = 240 W/cm2) for 10 min on day 14, 16 or 17 of gestation to assess any changes in physiological reflexes (pinna detachment, eye opening and fur development) and postnatal mortality. Changes in locomotor activity by open field test and dark/bright arena test and learning and memory by hole board test were also recorded. No change was observed in physiological reflexes and postnatal mortality. However there were significant alterations in behavior in all the three exposed groups. These results demonstrate that ultrasound exposure during the late fetal period can impair brain function in adult mouse.

Diagnóstico prenatal por ultrasonografía: Estudio aleatorio de 3,000 pacientes / Prenatal diagnosis by ultrasonography: At random study of 3,000 cases

Se estudiaron 3,000 pacientes embarazadas de enero a diciembre de 1990 en el Hospital de Ginecoobstetricia Tlatelolco, con equipo de tiempo real en modo B y transductor lineal de 3.5 MHz y se detectaron, al azar, malformaciones fetales, algunas de las cuales hubieran pasado inadvertidas al nacimiento, con el consiguiente retraso en el tratamiento y aumento artificial de la tasa de morbimortalidad perinatal.(au)