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Ultrasound primary care

Andrei V Alexandrov, Martin Köhrmann, Lauri Soinne, Georgios Tsivgoulis, Andrew D Barreto, Andrew M Demchuk, Vijay K Sharma, Robert Mikulik, Keith W Muir, Gordon Brandt, John Alleman, James C Grotta, Christopher R Levi, Carlos A Molina, Maher Saqqur, Dimitris Mavridis, Theodora Psaltopoulou, Milan Vosko, Jochen B Fiebach, Pitchaiah Mandava, Thomas A Kent, Anne W Alexandrov, Peter D Schellinger
BACKGROUND: Pulsed-wave ultrasound increases the exposure of an intracranial thrombus to alteplase (recombinant tissue plasminogen activator), potentially facilitating early reperfusion. We aimed to ascertain if a novel operator-independent transcranial ultrasound device delivering low-power high-frequency ultrasound could improve functional outcome in patients treated with alteplase after acute ischaemic stroke. METHODS: We did a multicentre, double-blind, phase 3, randomised controlled trial (CLOTBUST-ER) at 76 medical centres in 14 countries...
April 2019: Lancet Neurology
André L N Gobatto, Milena A Link, Davi J Solla, Estevão Bassi, Paulo F Tierno, Wellingson Paiva, Fabio S Taccone, Luiz M Malbouisson
BACKGROUND: Anemia is frequent among patients with traumatic brain injury (TBI) and is associated with an increased risk of poor outcome. The optimal hemoglobin concentration to trigger red blood cell (RBC) transfusion in patients with TBI is not clearly defined. METHODS: All eligible consecutive adult patients admitted to the intensive care unit (ICU) with moderate or severe TBI were randomized to a "restrictive" (hemoglobin transfusion threshold of 7 g/dL), or a "liberal" (threshold 9 g/dL) transfusion strategy...
March 12, 2019: Critical Care: the Official Journal of the Critical Care Forum
Elizabeth Morgan, Kathleen O'Connell, Maurine Thomson, Susan Boyd, Jeanine Sandy
A 7 yr, 6 mo old male neutered Australian cattle dog cross presented to a referral hospital with a large abdominal mass. An abdominal ultrasound revealed multifocal lesions throughout the liver, which were suspicious for intrahepatic metastasis, with no evidence of extrahepatic metastatic disease. Cytology indicated neoplasia of epithelial origin, with neuroendocrine neoplasia the primary suspicion. The patient was started on a maximally tolerated chemotherapy protocol of doxorubicin and metronomic cyclophosphamide...
March 14, 2019: Journal of the American Animal Hospital Association
Surujpal Teelucksingh, Mohanchan Shastri Motilal, Henry Bailey, Scott Peter Sookhai, Justin Sooknanan, Sherry Ann Soongoon-Padarath, Andrea Sookram, Jonathan Kieran Spann, Danielle Justina Stewart, Sunita Sudama, Anil V Surujbally, Chelsea Diedra Kanhai
OBJECTIVES A previous Trinidadian survey highlighted the investigative and therapeutic approaches selected by general practitioners (GPs) in managing thyrotoxicosis. The main objective of this study was to compare practice with existing guidelines. METHODS In this cross-sectional study a pretested de novo questionnaire was self-administered to GPs throughout Trinidad. The survey evaluated GPs' choices in management of thyrotoxicosis cases and compared their responses to the 2016 American Thyroid Association guidelines as well as with those previously reported locally...
March 13, 2019: Endocrine Practice
M Deandrea, P Trimboli, F Garino, A Mormile, G Magliona, M J Ramunni, L Giovanella, P P Limone
CONTEXT: Radiofrequency ablation (RFA) of benign thyroid nodules has been gaining consensus. However, solid information on its long-term efficacy is yet to be obtained. OBJECTIVE: To analyze the long-term results of single-session RFA. DESIGN: Retrospective longitudinal observational study. SETTING: Primary care center. PATIENTS OR OTHER PARTICIPANTS: Adult outpatients who underwent a single-session RFA and post-treatment follow-up of at least three years...
March 12, 2019: Journal of Clinical Endocrinology and Metabolism
Poonam Singh Jariwala, Kaarthigeyan Kalaniti, Neil Wonko, Sibasis Daspal, Veronica Mugarab Samedi
Pneumomediastinum (PM), or a mediastinal air leak, is a known morbidity in neonates. Among predisposing factors, the most significant are mixed lung diseases, such as pneumonia or meconium aspiration syndrome, with coexisting atelectasis and airway obstruction. We report an unusual presentation of significant spontaneous pneumomediastinum in a term newborn delivered by elective cesarean section with no history of active resuscitation at birth. Timely diagnosis of SPM is important for both management and prognosis...
January 2019: American Journal of Perinatology Reports
Joseph L McDevitt, Ravi N Srinivasa, Anthony N Hage, Jacob J Bundy, Joseph J Gemmete, Jeffrey Forris Beecham Chick
BACKGROUND: Endovascular stent reconstruction is the standard of care for chronic venous occlusive disease in adults, but it has not been reported in pediatric patients. OBJECTIVE: This study reports the technical success, complications, clinical outcomes, and stent patency of iliocaval stent reconstruction for chronic iliocaval thrombosis in pediatric patients. MATERIALS AND METHODS: Fourteen patients, 13 (93%) male with a mean age of 16...
March 9, 2019: Pediatric Radiology
Robert J Rectenwald, Carolyn M DeSimone, Roy W Sweat
Objective: This case report describes chiropractic treatment for a patient diagnosed with bow hunter syndrome with transient vision loss (TVL). Clinical Features: A 39-year-old woman presented to a chiropractic clinic with hand and arm numbness that began after she was injured in a motor vehicle collision 18 months earlier. The primary symptom was TVL that began 3 days after the motor vehicle collision. At that time, she had been diagnosed with bow hunter syndrome using dynamic angiography findings...
December 2018: Journal of Chiropractic Medicine
Zilma Silveira Nogueira Reis, Rodney Nascimento Guimarães, Maria Albertina Santiago Rego, Roberta Maia de Castro Romanelli, Juliano de Souza Gaspar, Gabriela Luiza Nogueira Vitral, Marconi Augusto Aguiar Dos Reis, Enrico Antônio Colósimo, Gabriela Silveira Neves, Marynea Silva Vale, Paulo de Jesus Hartamann Nader, Marta David Rocha de Moura, Regina Amélia Pessoa Lopes de Aguiar
INTRODUCTION: Recognising prematurity is critical in order to attend to immediate needs in childbirth settings, guiding the extent of medical care provided for newborns. A new medical device has been developed to carry out the preemie-test, an innovative approach to estimate gestational age (GA), based on the photobiological properties of the newborn's skin. First, this study will validate the preemie-test for GA estimation at birth and its accuracy to detect prematurity. Second, the study intends to associate the infant's skin reflectance with lung maturity, as well as evaluate safety, precision and usability of a new medical device to offer a suitable product for health professionals during childbirth and in neonatal care settings...
March 5, 2019: BMJ Open
Ashu Rastogi, Anil Bhansali, Shankar Ramachandran
The diabetic foot ulcer (DFU) healing rates remain dismally low. Therefore, many adjunctive therapies have been evaluated including ultrasound therapy. The prior studies with noncontact, low-frequency ultrasound were retrospective, single arm, unblinded, or with historical controls. The aim of the present study was to compare the efficacy of noncontact, low-frequency airborne ultrasound (Glybetac) therapy with sham therapy added to standard treatment in patients with neuropathic, clinically infected, or noninfected DFU (wound size >2 cm2 ), Wagner grades 2 and 3...
March 5, 2019: International Journal of Lower Extremity Wounds
Joanne Guay, Santhanam Suresh, Sandra Kopp
BACKGROUND: The use of ultrasound guidance for regional anaesthesia has become popular over the past two decades. However, it is not recognized by all experts as an essential tool, perhaps because it is unclear whether ultrasound reduces the risk of severe neurological complications, and the cost of an ultrasound machine (USD 22,000) is substantially higher than the cost of other tools. This review was published in 2016 and updated in 2019. OBJECTIVES: To determine whether ultrasound guidance offers any clinical advantage when neuraxial and peripheral nerve blocks are performed in children in terms of decreasing failure rate or the rate of complications...
February 27, 2019: Cochrane Database of Systematic Reviews
Qin Xiachuan, Zhou Xiang, Liu Xuebing, Luo Yan
This retrospective study aimed to use preoperative and contrast-enhanced ultrasound (CEUS) factors to assess and reveal risk factors of early recurrence (ER) in patients with hepatocellular carcinoma (HCC). We enrolled 141 patients with primary HCC who had undergone surgical resection. The assessment of the CEUS scan includes (a) the maximum diameter of the lesion, (b) the tumor echogenicity of gray-scale ultrasound (US), (c) the morphology of the tumor, (d) the margin of the tumor, (e) the peripheral hypoechoic halo, (f) tumor necrosis, (g) nutritional arteries shown by tumors, (h) ultrasonography for diagnosis of cirrhosis, and (i) the timer on the US screen displayed the time elapsed from the saline flush and was used to determine time to washout...
January 2019: Ultrasonic Imaging
Ricardo Castro-Ferreira, Rosa Barreira, Pedro Mendes, Pedro Couto, Fabiana Peixoto, Margarida Aguiar, Marina Neto, Dalila Rolim, José Pinto, Alberto Freitas, Paulo Gonçalves Dias, Armando Mansilha, José Fernando Teixeira, Sérgio Moreira Sampaio, Adelino Leite-Moreira
INTRODUCTION: The incidence of abdominal aortic aneurysm (AAA) repairs in Portugal is one of the lowest in the literature. This phenomenon can be justified either by a low prevalence of the disease or by its low detection rate. To date, the prevalence of the pathology is unknown. OBJECTIVES: To estimate the prevalence of AAA and its associated risk factors, in men ≥65 years old and to evaluate the population's disease awareness. METHODS: All males ≥65 years old registered in a portuguese primary health care unit were invited to participate...
February 22, 2019: Annals of Vascular Surgery
Mahima Venkateswaran, Binyam Bogale, Khadija Abu Khader, Tamara Awwad, Ingrid K Friberg, Buthaina Ghanem, Taghreed Hijaz, Kjersti Mørkrid, J Frederik Frøen
BACKGROUND: The proportion of women attending four or more antenatal care (ANC) visits is widely used for monitoring, but provides limited information on quality of care. Effective coverage metrics, assessing if ANC interventions are completely delivered, can identify critical gaps in healthcare service delivery. We aimed to measure coverage of at least one screening and effective coverage of ANC interventions in the public health system in the West Bank, Palestine, and to explore associations between infrastructure-related and maternal sociodemographic variables and effective coverage...
2019: PloS One
Adam Gleason, Kristen Bishop, Yin Xi, David T Fetzer
OBJECTIVE: Unilateral left varicoceles are common and considered benign. Unilateral right varicoceles are reportedly associated with a pathologic process, namely malignancy affecting the retroperitoneum, for which further imaging is often recommended. The purpose of this study was to test the hypothesis that this correlation between unilateral right varicocele and malignancy may be weaker than once suggested, particularly in the absence of other clinical signs of malignancy. MATERIALS AND METHODS: Medical charts and imaging at one institution were reviewed for all patients reported to have right varicocele...
February 19, 2019: AJR. American Journal of Roentgenology
Christopher Dainton, Nikki Shah, Charlene H Chu
BACKGROUND: Short-term, primary care medical service trips (MSTs) frequently use inexpensive, portable point of care (POC) tests to guide diagnosis and treatment of patients in low-resource settings. However, the degree to which different POC tests are carried by organizations serving remote communities is currently unknown. OBJECTIVE: The aim of this study was to determine the prevalence of various POC tests used by MST-sending organizations operating in Latin America...
November 5, 2018: Annals of Global Health
Waseem A Abboud, Sahar Nadel, Sharon Hassin-Baer, Abigail Arad, Alex Dobriyan, Ran Yahalom
BACKGROUND: Drooling is the unintentional loss of saliva from the mouth, usually caused by poor coordination of the swallowing mechanism. It is commonly seen in patients with chronic neurologic disorders, such as Parkinson's disease, amyotrophic lateral sclerosis (ALS), cerebral palsy, and stroke, as well as in patients with cognitive impairment and dementia. OBJECTIVES: To evaluate the efficacy and safety of ultrasound-guided botulinum toxin injections into the parotid and submandibular salivary glands for the treatment of drooling...
February 2019: Israel Medical Association Journal: IMAJ
Brent A Becker, Shadi Lahham, Mark A Gonzales, Jason T Nomura, Michelle K Bui, Taylor A Truong, Barbara A Stahlman, John C Fox, Thompson Kehrl
OBJECTIVE: The main objective of this study was to evaluate the accuracy of emergency physician-performed point-of-care ultrasound (POCUS) for the diagnosis of small bowel obstruction (SBO) compared to computed tomography (CT). METHODS: We performed a prospective, multicenter, observational study examining a convenience sample of adult patients with potential SBO presenting to the emergency department (ED) between July 2014 and May 2017. Each emergency physician-performed POCUS was interpreted at the bedside and retrospectively by an expert reviewer...
February 14, 2019: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
Ahmed Dehal, Amanda N Graff-Baker, Brooke Vuong, Daniel Nelson, Shu-Ching Chang, Melanie Goldfarb, Anton J Bilchik
Accurate preoperative clinical staging is essential to optimize the treatment of rectal cancer. Primary surgical resection is typically indicated for stage I disease, whereas neoadjuvant therapy is recommended for stages II and III. The objective of this study is to examine the accuracy of clinical staging using current imaging modalities in predicting pathologic stage and, thus, selecting appropriate treatment. Adult patients with nonmetastatic rectal cancer who underwent primary surgical resection were identified from the National Cancer Database between 2006 and 2014...
October 1, 2018: American Surgeon
Nimrah Abbasi, Greg Ryan
Fetal pleural effusions can be associated with significant perinatal morbidity and mortality. When diagnosed antenatally, referral to a tertiary fetal medicine center is recommended for a detailed ultrasound evaluation for additional structural abnormalities or features suggestive of congenital infections or fetal anemia. The effusions should be characterized as unilateral or bilateral, and presence of hydrops and/or mediastinal shift should be documented. Additional testing should include fetal echocardiography, maternal testing for blood group and screen, hemoglobinopathies, and congenital infections...
January 12, 2019: Best Practice & Research. Clinical Obstetrics & Gynaecology
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