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POPULARITY
2 episodes with ultrasonography
2 episodes with ultrasonography
2 episodes with ultrasonography
2 episodes with ultrasonography
2 episodes with ultrasonography
2 episodes with ultrasonography
2 episodes with ultrasonography
2 episodes with ultrasonography
2 episodes with ultrasonography
Dr. Moira Davenport discusses the #9 article of 2023, “Ultrasonography or Radiography for Suspected Pediatric Distal Forearm Fractures,” which was originally published in The New England Journal of Medicine in May 2023. Dr. Jeremy Schroeder serves as the series host. Dr. Davenport is a member of the AMSSM Top Articles Subcommittee, and this episode is part of an ongoing mini journal club series highlighting each of the Top Articles in Sports Medicine from 2023, as selected for the 2024 AMSSM Annual Meeting. Ultrasonography or Radiography for Suspected Pediatric Distal Forearm Fractures https://www.nejm.org/doi/full/10.1056/NEJMoa2213883
Til and Whitney speak with fascial researcher, anatomist, and manual therapy teacher Antonio Stecco MD PhD about his research in to fascial properties, pain, and the effects of hands-on work, in this audience-favorite episode from our archives, where it originally ran as Ep. 53. Key Topics: Introduction to Dr. Antonio Stecco and his background in fascia research The role of the Stecco family in advancing fascia research Differences between superficial fascia and deep fascia The concept of fascial densification vs. fibrosis How manual therapy affects fascial lubrication and gliding The relationship between fascial stiffness/thickness and pain Mechanisms for long-lasting effects of fascial manipulation The importance of restoring proper biomechanics, not just treating pain The role of retinacula in proprioception and joint stability New MRI techniques for imaging fascial properties Molecular structure of hyaluronan in fascia Use of hyaluronidase injections for treating spasticity Resources for learning more about fascial manipulation Get the full transcript at Til or Whitney's sites! Whitney Lowe's site: AcademyOfClinicalMassage.com Til Luchau's site: Advanced-Trainings.com Resources discussed in this episode: Dr Stecco's research and publications (NYU) FM app on the Apple Store and Google Play Dr Stecco's site: fascialmanipulation.com Papers mentioned in the episode: Gerber et al., “A Systematic Comparison Between Subjects With No Pain and Pain Associated With Active Myofascial Trigger Points.” Langevin, Helene M. et al. “Reduced Thoracolumbar Fascia Shear Strain in Human Chronic Low Back Pain.” BMC Musculoskeletal Disorders 12, no. 1 (December 2011): 203. https://doi.org/10.1186/1471-2474-12-203. Stecco, Antonio at al. “Ultrasonography in Myofascial Neck Pain: Randomized Clinical Trial for Diagnosis and Follow-Up.” Surgical and Radiologic Anatomy 36, no. 3 (April 2014): 243–53. https://doi.org/10.1007/s00276-013-1185-2. Sponsor Offers: Books of Discovery: save 15% by entering "thinking" at checkout on booksofdiscovery.com. ABMP: save $24 on new membership at abmp.com/thinking. Advanced-Trainings: try a month of the amazing A-T Subscription free by entering “thinking” at checkout at a-t.tv/subscriptions/,. Academy of Clinical Massage: Grab Whitney's valuable Assessment Cheat Sheet for free at: academyofclinicalmassage.com/cheatsheet About Whitney Lowe | About Til Luchau | Email Us: info@thethinkingpractitioner.com (The Thinking Practitioner Podcast is intended for professional practitioners of manual and movement therapies: bodywork, massage therapy, structural integration, chiropractic, myofascial and myotherapy, orthopedic, sports massage, physical therapy, osteopathy, yoga, strength and conditioning, and similar professions. It is not medical or treatment advice.)
Dr. Adela Cope breaks down pelvic inflammatory disease, tubo-ovarian abscess, ovarian torsion, ectopic pregnancy and more in this densely packed chapter of Always on EM. Tune in as Alex and Venk also try to figure out which one has the correct mental model of PID and who will ask the first stupid question. CONTACTS X - @AlwaysOnEM; @VenkBellamkonda YouTube - @AlwaysOnEM; @VenkBellamkonda Instagram – @AlwaysOnEM; @Venk_like_vancomycin; @ASFinch Email - AlwaysOnEM@gmail.com LEARN MORE ABOUT RESIDENCY: https://youtu.be/gCQ0zimhhhY?si=NpsyTruGM9N_UpVM https://college.mayo.edu/academics/residencies-and-fellowships/emergency-medicine-residency-minnesota/ REFERENCES: Williams T, Mortada R, Porter S. Diagnosis and Treatment of Polycystic Ovary Syndrome. Am Fam Physician. 2016;94(2):106-113 Rutz M, Boulger C. Early Pregnancy. Sonoguide - American College of Emergency Physicians. Accessed 8/20/2024 (https://www.acep.org/sonoguide/basic/early-pregnancy) Rodgers SK, et al. A lexicon for first-trimester US: Society of radiologists in ultrasound consensus conference recommendations. Radiology. 2024; 312(2):e240122 Kreisel K, Flagg EW, Torrone E. Trends in pelic inflammatory disease emergnecy department visits, United STates, 2006-2013. Am J Obstet Gynecol 2018;218:117e1-e10 Adhikari S, Blaivas M, Lyon M. Role of bedside transvaginal ultrasonography in the diagnosis of tubo-ovarian abscess in the emergency department. JEM 2008. 34(4):429-433 Mohseni M, Simon LV, Sheele JM. Epidemiologic and clinical characteristics of tubo-ovarian abscess, hydrosalpinx, pyosalpinx, and oophoritis in emergency department patients. Cureus. 2020;12(11):e11647 CDC sexually transmitted infections treatment guidelines, 2021 - Pelvic Inflammatory Disease (PID) accessed 8-20-24 Linden JA. et al. Is the pelvic examination still crucial in patients presenting to the emergency department with vaginal bleeding or abdominal pain when an intrauterine pregnancy is identified on ultrasonography? A randomized tli. Annals of Emerg Med 2017(70):825-834 Stein JC, et al. Emergency physician ultrasonography for evaluating patients at risk for ectopic pregnancy: A Meta-Analysis. Annals of Emerg Med. 2010;56:674-683 Robertson JJ, Long B, Koyfman A. Emergency Medicine Myths: Ectopic pregnancy, evaluation, risk factors, and presentation. JEM. 2017(53)6819-828 Brown J, Fleming R, Aristizabal J, Rocksolana G. Does pelvic exam in the emergency department add useful information? West J Emerg Med. 2011;12(2):208-212 Lee R, Dupuis C, Chen B, Smith A, Kim YH. Diagnosing ectopic pregnancy in the emergency setting. Ultrasonography. 2018;37:78-87
Welcome to BCI Cattle Chat! The experts begin the show by discussing the pros and cons of pulling bulls during/after the breeding season. Dr. Phillip Lancaster continues this edition of Cattle Chat by relaying all the known information about Leaky gut – a new and peculiar disease to cattle production. BCI student Luis Feitoza closes out… Continue reading Removing Bulls, Leaky Gut, Ultrasonography
Get ahead with VETAHEAD and join Dr. Proença on 15 minutes of ZooMed (exotic animal medicine) content. Today, let's discover how ultrasonography is revolutionizing the diagnosis of otitis media in rabbits — no sedation required! We explore a recent 2022 JAVMA study demonstrating the feasibility and ease of this technique in live, non-sedated rabbits. Learn about the practical steps, equipment used, and the promising results that make this a game-changer for veterinary professionals. Tune in to find out how you can incorporate this cutting-edge method into your practice and improve the care for your furry patients! Do you want to access more ZooMed (exotics) knowledge directly from specialists? Come with us and #jointhemovement #nospeciesleftbehind Head to VETAHEAD Website Join our VETAHEAD Community Follow @the_vetahead on Instagram Subscribe to @vetahead channel on YouTube Follow @vetahead on Facebook
Nurses Out Loud with Nurses Michele, Jodi, Kimberly & Melissa - The Nurses address the highlights of National Nurses Week, the disadvantages of Mammograms in comparison to Ultrasonography, as well as alternative treatments for Osteoporosis utilizing the Juvent, MicroImpact Platform. This week's show also addresses Disease X and products to make sure listeners gather in their homes to be prepared...
Nurses Out Loud with Nurses Michele, Jodi, Kimberly & Melissa - The Nurses address the highlights of National Nurses Week, the disadvantages of Mammograms in comparison to Ultrasonography, as well as alternative treatments for Osteoporosis utilizing the Juvent, MicroImpact Platform. This week's show also addresses Disease X and products to make sure listeners gather in their homes to be prepared...
Event Objectives:List characteristics of point-of-care ultrasonography.Identify clinical scenarios in which the use of point-of-care ultrasonography can help guide optimal management.Describe how point-of-care ultrasonography can enhance physical exam skills, augment teamwork, and inspire learners, patients, and caretakers.Claim CME credit here!
Ronald A. Matthews joined Eastern University in 1992 and was appointed the 10th President of Eastern University effective March 1, 2018. Prior to this call, Dr. Matthews served as Professor of Music, Chair of the Music Department, and since 2010, Executive Director of the Fine and Performing Arts Division. Born and raised in Philadelphia, Dr. Matthews graduated from Central High School. Having received a Philadelphia Board of Education music scholarship, he did his undergraduate work in Church Music and Organ at Westminster Choir College where he graduated magna cum laude and received both the Senior Class Conducting Award and the Christian Leadership Award. Dr. Matthews received the Master of Music degree in Choral Conducting from Temple University, during which time he was invited to conduct the Jerusalem Chamber Orchestra for a recording project in Tel Aviv. At the age of 23, Dr. Matthews was invited to join the faculty of Nyack College as the Director of Choral Activities. He received his Doctor of Musical Arts degree from Combs College of Music in Composition with an emphasis in Orchestral Conducting. From 1982-1992, Dr. Matthews was the Chair of the Department of Music at what is now Cairn University. For several years, he was a Thomas F. Staley Foundation lecturer/artist and served on professional and denominational boards and task forces. From 2005 until 2018, he was the Pastor of Worship Arts at Church of the Saviour in Wayne, PA. Dr. Matthews has conducted, recorded, and performed in France, Germany, Ireland, Israel, Italy, Switzerland and the Vatican. He is a commissioned and published composer. He has performed and recorded regularly with his younger brother, Rev. Dr. Gary Matthews, in concerts and workshops throughout the United States and internationally. His older brother, Dr. John T. Matthews, is Professor of English at Boston University. Dr. Matthews' most recent release is a jazz piano Christmas recording, Holly and Ivory. Dr. Matthews is married to Pamela R. Matthews, who was raised in Oreland, PA and graduated from Springfield High School. She graduated from Chestnut Hill Hospital's School of Radiologic Technology. Mrs. Matthews is a registered Ultrasonographer and received her training in Ultrasonography from Jefferson University and Chestnut Hill Hospital. For over thirty years she worked in Obstetrics and Gynecology with Abington Hospital - Jefferson Health until 2017. She served as the President of the Home and School Association for the Upper Moreland Round Meadow Elementary School during which she raised funds for new playground equipment. For the Middle School, she organized a campaign resulting in the purchase of a new grand piano for the music program. Mrs. Matthews is an avid tennis player and is also interested in charitable and mission work. She has organized fundraising projects for Haiti and the Cherokee Indians in Cherokee, NC, and she has traveled to Cartagena, Colombia on a sports mission trip. Dr. and Mrs. Matthews have two adult sons.
In this episode, host Alyssa Watson, DVM, talks to Marc Seitz, DVM, DACVR, DABVP, about his recent Clinician's Brief articles, “Diagnosing Foreign Body Obstructions via Radiography” and “Diagnosing Foreign Body Obstructions via Ultrasonography.” Dr. Seitz shares excellent advice on how to use radiography to the fullest—even if it means getting a wooden spoon or carbonated beverage—and how to apply point-of-care ultrasound at the general practice level.Resources:https://www.cliniciansbrief.com/article/foreign-bodies-ultrasound-pocus-diagnosishttps://www.cliniciansbrief.com/article/foreign-bodies-diagnosis-gi-radiographContact us:Podcast@briefmedia.comWhere to find us:Youtube.com/@clinicians_briefCliniciansbrief.com/podcastsFacebook.com/cliniciansbriefTwitter: @cliniciansbriefInstagram: @clinicians.briefThe Team:Alyssa Watson, DVM - HostAlexis Ussery - Producer & Multimedia Specialist
Hashimoto's thyroiditis is an autoimmune condition that affects the thyroid. It isn't the same as hypothyroidism, but it is connected to it. Learn what Hashimoto's disease is and what you can do to help prevent it from potentially progressing into hypothyroidism. Featured Studies Our paper: https://pubmed.ncbi.nlm.nih.gov/35999903/ Our paper: https://pubmed.ncbi.nlm.nih.gov/36079838/ https://pubmed.ncbi.nlm.nih.gov/35743024/ https://pubmed.ncbi.nlm.nih.gov/3066320/ https://pubmed.ncbi.nlm.nih.gov/34766382/ https://pubmed.ncbi.nlm.nih.gov/28052092/ https://pubmed.ncbi.nlm.nih.gov/11836274/ https://pubmed.ncbi.nlm.nih.gov/760358/ https://pubmed.ncbi.nlm.nih.gov/14558922/ https://pubmed.ncbi.nlm.nih.gov/10779140/#:~:text=Ultrasonography%20(US)%20may%20demonstrate%20a,from%2019%25%20to%2095%25. https://pubmed.ncbi.nlm.nih.gov/18324487/ https://pubmed.ncbi.nlm.nih.gov/32743538/ https://pubmed.ncbi.nlm.nih.gov/20361146/ https://pubmed.ncbi.nlm.nih.gov/11836274/ https://pubmed.ncbi.nlm.nih.gov/35243857/ https://pubmed.ncbi.nlm.nih.gov/36743914/ https://pubmed.ncbi.nlm.nih.gov/25305308/ https://pubmed.ncbi.nlm.nih.gov/28900385/ https://pubmed.ncbi.nlm.nih.gov/28579842/ https://pubmed.ncbi.nlm.nih.gov/18562170/ https://pubmed.ncbi.nlm.nih.gov/32744579/ https://www.ncbi.nlm.nih.gov/books/NBK538260/ https://pubmed.ncbi.nlm.nih.gov/27607246/ Related Resources My articles: https://drruscio.com/blog/ My book: https://drruscio.com/getgutbook/ Courses, free guides, and more: https://drruscio.com/resources?utm_source=youtube&utm_medium=link&utm_campaign=drruscio.com_resources Timestamps 00:00 Intro 00:38 Hashimoto's defined 02:40 How to diagnose Hashimoto's 04:11 What to do to improve Hashimoto's 05:44 Hashimoto's symptoms 07:35 Interpreting lab ranges Get the Latest Updates Facebook - https://www.facebook.com/DrRusciodc Instagram - https://www.instagram.com/drrusciodc/ Pinterest - https://www.pinterest.com/drmichaelrusciodc DISCLAIMER: The information on this site is not intended or implied to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your physician or other qualified healthcare provider before starting any new treatment or discontinuing an existing treatment. Music featured in this video: "Modern Technology" by Andrew G, https://audiojungle.net/user/andrew_g *Full transcript available on YouTube by clicking the “Show transcript” button on the bottom right of the video.
Learn what works for Hashimoto's thyroiditis and what doesn't. Today I'll walk you through 3 research-backed treatments for Hashimoto's, and the 3 treatments you can avoid. Tune in. Featured Studies https://pubmed.ncbi.nlm.nih.gov/35999903/ https://pubmed.ncbi.nlm.nih.gov/36079838/ https://pubmed.ncbi.nlm.nih.gov/35743024/ https://pubmed.ncbi.nlm.nih.gov/11836274/ https://pubmed.ncbi.nlm.nih.gov/760358/ https://pubmed.ncbi.nlm.nih.gov/14558922/ https://pubmed.ncbi.nlm.nih.gov/10779140/#:~:text=Ultrasonography%20(US)%20may%20demonstrate%20a,from%2019%25%20to%2095%25. https://pubmed.ncbi.nlm.nih.gov/18324487/ https://academic.oup.com/jcem/article/84/2/561/2864306 https://pubmed.ncbi.nlm.nih.gov/28052092/ https://pubmed.ncbi.nlm.nih.gov/32805423/ https://pubmed.ncbi.nlm.nih.gov/20361146/#:~:text=Background%3A%20Anti%2Dthyroid%20peroxidase%20antibodies,positive%20titers%20of%20these%20antibodies. https://pubmed.ncbi.nlm.nih.gov/30078965/ https://pubmed.ncbi.nlm.nih.gov/37489370/ https://pubmed.ncbi.nlm.nih.gov/35243857/ https://pubmed.ncbi.nlm.nih.gov/27607246/ https://pubmed.ncbi.nlm.nih.gov/30215224/ https://pubmed.ncbi.nlm.nih.gov/28536577/ https://pubmed.ncbi.nlm.nih.gov/24154902/ https://pubmed.ncbi.nlm.nih.gov/34766382/ https://pubmed.ncbi.nlm.nih.gov/32588591/ https://pubmed.ncbi.nlm.nih.gov/36598468/#:~:text=The%20Paleo%20diet%20has%20been,shown%20positive%20results%20on%20AITD. https://pubmed.ncbi.nlm.nih.gov/31275780/ https://pubmed.ncbi.nlm.nih.gov/24885375/ https://pubmed.ncbi.nlm.nih.gov/35565695/ https://pubmed.ncbi.nlm.nih.gov/37554764/ https://pubmed.ncbi.nlm.nih.gov/28255299/ https://pubmed.ncbi.nlm.nih.gov/24224112/ https://pubmed.ncbi.nlm.nih.gov/33679732/ https://pubmed.ncbi.nlm.nih.gov/34871506/ https://pubmed.ncbi.nlm.nih.gov/34981556/ https://pubmed.ncbi.nlm.nih.gov/30285179/ What to Watch Next Rethinking Hypothyroidism with Dr Antonio Bianco: https://www.youtube.com/watch?v=n1jzvyEoLfI What is Thyroglobulin & What Does it Mean for Your Health? https://www.youtube.com/watch?v=JO93_vATSmM Related Resources Our Study: https://pubmed.ncbi.nlm.nih.gov/36079838/ My articles: https://drruscio.com/blog/ My book: https://drruscio.com/getgutbook/ Courses, free guides, and more: https://drruscio.com/resources?utm_source=youtube&utm_medium=link&utm_campaign=drruscio.com_resources Timestamps 00:00 Intro 02:04 What Hashimoto's Is and Isn't 03:08 A Dietary Process for Hashimoto's 05:33 Nutrients for Hashimoto's 09:45 An Overlooked Supplement for Autoimmunity 12:25 The WORST Dietary Advice 13:10 The Truth About Gluten 18:52 Treating the Numbers 20:57 Thyroid Antibodies Don't Equate to Symptoms 23:10 Hashimoto's Becoming Hypothyroidism Get the Latest Updates Facebook - https://www.facebook.com/DrRusciodc Instagram - https://www.instagram.com/drrusciodc Pinterest - https://www.pinterest.ca/drmichaelrusciodc DISCLAIMER: The information on this site is not intended or implied to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your physician or other qualified healthcare provider before starting any new treatment or discontinuing an existing treatment. Music featured in this video: "Modern Technology" by Andrew G, https://audiojungle.net/user/andrew_g *Full transcript available on YouTube by clicking the “Show transcript” button on the bottom right of the video.
Interview with Oreste Davide Gentilini, MD, author of Sentinel Lymph Node Biopsy vs No Axillary Surgery in Patients With Small Breast Cancer and Negative Results on Ultrasonography of Axillary Lymph Nodes: The SOUND Randomized Clinical Trial. Hosted by Jack West, MD. Related Content: Sentinel Lymph Node Biopsy vs No Axillary Surgery in Patients With Small Breast Cancer and Negative Results on Ultrasonography of Axillary Lymph Nodes
Interview with Oreste Davide Gentilini, MD, author of Sentinel Lymph Node Biopsy vs No Axillary Surgery in Patients With Small Breast Cancer and Negative Results on Ultrasonography of Axillary Lymph Nodes: The SOUND Randomized Clinical Trial. Hosted by Jack West, MD. Related Content: Sentinel Lymph Node Biopsy vs No Axillary Surgery in Patients With Small Breast Cancer and Negative Results on Ultrasonography of Axillary Lymph Nodes
Welcome to Episode 7 of the BSCOS Paediatric Orthopaedic Digest (POD)cast with guest Mr Alwyn Abraham @AlwynUK from Leicester Royal Infirmary! He's a true all-rounder as a paediatric orthopaedic & adult limb reconstruction surgeon, current clinical lead, Training Programme Director & keen on global health including developing a partnership with Gondar, North Ethiopia! We scoured 35 journals & highlighted the most impactful studies that we feel can change practice or improve outcomes in Paediatric Orthopaedics. Follow Updates on @BSCOS_UK REFERENCES: 1. The Incidence of Posttraumatic Stress Symptoms in Children. May et al. J Am Acad Orthop Surg Glob Res Rev. August 2023. PMID: 37579777 2. Comparison of Clinical Prediction Rules in Pre-school Aged Children With Septic Hip Arthritis Due to Different Pathogens. Hagedoorn et al. J Pediatr Orthop. September 2023. PMID: 37253715 3. Surgical treatment of septic arthritis of the hip in children: arthrotomy compared with repeated aspiration-lavage. Cohen et al. Int Orthop. June 2023. PMID: 36899196 4. How common are refractures in childhood? Amilon et al. Bone Joint J. August 2023. PMID: 37524339 5. Slow-motion smartphone video improves interobserver reliability of gait assessment in ambulatory cerebral palsy. Brodke et al. J Child Orthop. June 2023. PMID: 37565008 6. The role of Gender in Operative Autonomy in orthopaedic Surgical Trainees (GOAST). Downie S, BORCo Collaborative et al. Bone Joint J. July 2023.PMID: 37399113. 7. Surgeon Sex and Long-Term Postoperative Outcomes Among Patients Undergoing Common Surgeries. Wallis et al. JAMA Surg. August 2023. PMID: 37647075 8. Faster Rate of Correction with Distal Femoral Transphyseal Screws Versus Plates in Hemiepiphysiodesis for Coronal-Plane Knee Deformity: Age- and Sex-Matched Cohorts of Skeletally Immature Patients. McGinley et al. J Bone Joint Surg Am. August 2023. PMID: 37418510. 9. Peri-Implant Fracture After Distal Femur Percutaneous Epiphysiodesis Using Transphyseal Screws. Shaw KG & Sanders J. J POSNA. May 2023. 10. Predicting Rates of Angular Correction After Hemiepiphysiodesis in Patients With X-Linked Hypophosphatemic Rickets. Grote et al. J Pediatr Orthop. July 2023. PMID: 36952253 11. Ultrasonography or Radiography for Suspected Pediatric Distal Forearm Fractures. Snelling et al (BUCKLED Trial Group). N Engl J Med. June 2023. PMID: 37256975 12. Reliability and Reference Norms of Single Heel-Rise Test Among Children: A Cross-sectional Study. Mishra et al. J Foot Ankle Surg. May-June 2023. PMID: 36396548 Follow Hosts: @AnishPSangh @AlpsKothari @Pranai_B See you all in December for the Christmas 2023 Episode!!!
Reference: Snelling et al. Ultrasonography or radiography for suspected pediatric distal forearm fractures. New England Journal of Medicine June 2023 Date: July 19, 2023 Guest Skeptic: Dr. Casey Parker is a Rural Generalist that includes in his practice emergency medicine, anesthesia, and critical care. He is also a fully-fledged ultrasonographer. Casey currently splits his time […] The post SGEM#415: Buckle Down for some Ultrasound to Diagnosis Distal Forearm Fractures first appeared on The Skeptics Guide to Emergency Medicine.
Caffeinators, get your tea and biscuits ready because we're going across the pond for this episode! We recently sat down with Jack Pye, RVN, Cert VNECC, to discuss life as an RVN in the UK! Spoiler alert, as with many of our international series episodes, it's not unlike life as veterinary technician in the US! We talk about title protection, paths to licensure, legislation, specialization, the veterinarian-RVN relationship, and so much MORE! Jack now spends much of his time in Ultrasonography and teaching that to his veterinary nurse colleagues, and we talk about some of the uniqueness of that and the challenges he faces there, as well! This episode really covers a lot of ground in the life of an RVN in the UK-be sure to catch this one! Show Links: LinkedIn Profile: https://www.linkedin.com/in/jack-pye-rvn-certvnecc-a5b446a1/?locale=pt_BR IMV Imaging: https://www.imv-imaging.com/en/ https://www.facebook.com/JackPyeRVN https://www.tiktok.com/@jackpye https://www.instagram.com/pye_rvn Our Links: Follow us on Facebook: https://www.facebook.com/vettechcafe Follow us on Instagram: https://www.instagram.com/vettechcafepodcast Follow us on LinkedIn: https://www.linkedin.com/company/vet-tech-cafe Like and Subscribe on YouTube: https://www.youtube.com/channel/UCMDTKdfOaqSW0Mv3Uoi33qg Our website: https://www.vettechcafe.com/ Vet Tech Cafe Merch: https://www.vettechcafe.com/merch If you would like to help us cover our podcast expenses, we'd appreciate any support you give through Patreon. We do this podcast and our YouTube channel content to support the veterinary technicians out there and do not expect anything in return! We thank you for all you do.
This month we are joined by the wonderful Sally Griffin, European specialist in diagnostic imaging, who holds particular interest and expertise in ultrasonography of cats. From anatomy and approach, to sizes and sampling, listen in on our conversation around the particulars of feline ultrasonography. Whether you have scanned a cat or not, tune into this podcast today and challenge yourself to do more, or have a go!
Drs Stanley Cohen and Christopher Ritchlin discuss advances in basic research for psoriatic arthritis, including new research using a humanized mouse model, combination therapy trials, and more. Relevant disclosures can be found with the episode show notes on Medscape (https://www.medscape.com/viewarticle/984269). The topics and discussions are planned, produced, and reviewed independently of advertisers. This podcast is intended only for US healthcare professionals. Resources Psoriatic Arthritis https://emedicine.medscape.com/article/2196539-overview Transcriptional Signature Associated With Early Rheumatoid Arthritis and Healthy Individuals at High Risk to Develop the Disease https://pubmed.ncbi.nlm.nih.gov/29584756/ DC-STAMP: A Key Regulator in Osteoclast Differentiation https://pubmed.ncbi.nlm.nih.gov/27018136/ Psoriatic Dactylitis: Current Perspectives and New Insights in Ultrasonography and Magnetic Resonance Imaging https://pubmed.ncbi.nlm.nih.gov/34204773/ Transcriptome Fact Sheet https://www.genome.gov/about-genomics/fact-sheets/Transcriptome-Fact-Sheet Tumor Necrosis Factor Inhibitors https://www.ncbi.nlm.nih.gov/books/NBK482425/ Inverse Psoriasis https://www.psoriasis.org/inverse-psoriasis/ Prediction of Psoriatic Arthritis Tool (PRESTO): Development and Performance of a New Scoring System for Psoriatic Arthritis Risk https://acrabstracts.org/abstract/prediction-of-psoriatic-arthritis-tool-presto-development-and-performance-of-a-new-scoring-system-for-psoriatic-arthritis-risk/ Efficacy of Guselkumab, a Selective IL-23 Inhibitor, in Preventing Arthritis in a Multicentre Psoriasis At-Risk Cohort (PAMPA): Protocol of a Randomised, Double-Blind, Placebo Controlled Multicentre Trial https://pubmed.ncbi.nlm.nih.gov/36564123/ Use of IL-23 Inhibitors for the Treatment of Plaque Psoriasis and Psoriatic Arthritis: A Comprehensive Review https://pubmed.ncbi.nlm.nih.gov/33301128/ Association Between Biological Immunotherapy for Psoriasis and Time to Incident Inflammatory Arthritis: A Retrospective Cohort Study https://www.thelancet.com/journals/lanrhe/article/PIIS2665-9913(23)00034-6/fulltext Prevention of Psoriatic Arthritis: The Next Frontier https://www.thelancet.com/pdfs/journals/lanrhe/PIIS2665-9913(23)00055-3.pdf Ultrasound Power Doppler and Gray Scale Joint Inflammation: What They Reveal in Rheumatoid Arthritis https://pubmed.ncbi.nlm.nih.gov/31304659/ Consensus Terminology for Preclinical Phases of Psoriatic Arthritis for Use in Research Studies: Results From a Delphi Consensus Study https://pubmed.ncbi.nlm.nih.gov/33589818/ Rheumatoid Arthritis Pathogenesis, Prediction, and Prevention: An Emerging Paradigm Shift https://pubmed.ncbi.nlm.nih.gov/32602263/ Abatacept Reverses Subclinical Arthritis in Patients With High-Risk to Develop Rheumatoid Arthritis -- Results From the Randomized, Placebo-Controlled ARIAA Study in RA-at risk Patients https://acrabstracts.org/abstract/abatacept-reverses-subclinical-arthritis-in-patients-with-high-risk-to-develop-rheumatoid-arthritis-results-from-the-randomized-placebo-controlled-ariaa-study-in-ra-at-risk-patients/ Etanercept in the Treatment of Psoriatic Arthritis and Psoriasis: A Randomised Trial https://pubmed.ncbi.nlm.nih.gov/10972371/ Arthritis Mutilans https://pubmed.ncbi.nlm.nih.gov/23430715/ Usage of C-Reactive Protein Testing in the Diagnosis and Monitoring of Psoriatic Arthritis (PsA): Results From a Real-World Survey in the USA and Europe https://pubmed.ncbi.nlm.nih.gov/35032324/ Disease Modifying Anti-Rheumatic Drugs (DMARD) https://pubmed.ncbi.nlm.nih.gov/29939640/ Combination Therapy of Apremilast and Biologic Agent as a Safe Option of Psoriatic Arthritis and Psoriasis https://pubmed.ncbi.nlm.nih.gov/30499418/
Ultrasonography in the prediction of gout flares: a 12-month prospective observational studyDr Edoardo Cipolletta (Polytechnic University of Marche, Italy) joins Marwan Bukhari to discuss the March Editor's choice article on ultrasonography in the prediction of gout flares. Here, Dr Cipolletta discusses whether ultrasonography adds to the value of clinical findings in estimating the risk of flares in patients with gout.You can read this article [https://doi.org/10.1093/rheumatology/keac367] in Rheumatology. Keywords: Ultrasound, US, gout, imaging, rheumatology, rheumatologist, gout flares, gout patientsThanks for listening to Talking Rheumatology Research! Join the conversation on Twitter using #TalkingRheumResearch, tweet us @RheumJnl, or find us on Instagram. Want to read more rheumatology research? Explore Rheumatology and Rheumatology Advances in Practice.
Season 4, Episode 1. In our inaugural episode for season 1, Chuck and Chris welcome Amy Moore and Dominic Power to discuss nerve! Specifically, in this journal club format we review 4 recent JHS European articles as a format to discuss current concepts in diagnosis and treatment of carpal tunnel syndrome. Amy and Dom share their extensive experience and insights in this collaborative effort between The Upper Hand Podcast, Journal of Hand Surgery European, the British Society for Surgery of the Hand, and FESSH. Enjoy!Carita, et al High- resolution ultrasound in the diagnosis of failed carpal tunnel decompression: a study of 35 cases. JHS Eur 47:364-68, 2022Mackenzie, et al. Carpal tunnel decompression in patients with normal nerve conduction studies. JHS Eur 45: 260-4, 2020Asserson, et al. Return to work following ultrasound guided thread carpal tunnel release versus open carpal tunnel release: a comparative study. JHS Eur 47: 359-63, 2022Ratasvuori, et al. Ultrasonography for the diagnosis of carpal tunnel syndrome: correlation of clinical symptoms, cross- sectional areas and electroneuromyography. JHS Eur 47: 369-74, 2022Subscribe to our newsletter: https://wustl.us6.list-manage.com/subscribe?u=c6fe13919f69cbe248767c4e8&id=10e0c1dd85See http://www.practicelink.com for more information from our partner on job search and career opportunities. Please complete NEW Survey: https://forms.office.com/Pages/ResponsePage.aspx?id=taPMTM1xbU6XS02b65bG1s4ZpoRI9wlPhXnSF2MnEXxURVRNVDNBMEVSMU1CWFpIQVA4SEtMTFcyMS4uAs always, thanks to @iampetermartin for the amazing introduction and conclusion music.Listings at theupperhandpodcast.wustl.edu
Does the advent of new portable ultrasounds create opportunities for POCUS in both low-resource countries and combat support hospitals? Raj Gupta (@dr_rajgupta) joins leaders from the #ASRAGlobalHealth SIG (Mark Brouillette and Lena Dohlman) and #ASRAPOCUS SIG (Melissa Byrne) to discuss clinical applications, handhelds, limitations and barriers, and more. Streamed 8/23/2022. Guests:- Mark Brouillette, MD (@markbrouillette)-Commander Brendan Byrne, MD-Melissa Byrne, DO, MPH (@dr_melissabyrne)-Lena Dohlman, MD, MPH -Omar Hyder, MD, MS-Moses Siaw-Frimpong, MDReferences:Hilbert-Carius P, Struck MF, Rudolph M, et al. Point-of-care ultrasound (POCUS) practices in the helicopter emergency medical services in Europe: results of an online survey. Scand J Trauma Resusc Emerg Med. 2021;29(1):124. https://doi.org/10.1186/s13049-021-00933-yDuncan PGA, Mackey J. Point-of-care ultrasound at Role 1: is it time for a rethink? BMJ Mil Health. 2020;166(6):406-10. https://doi.org/10.1136/bmjmilitary-2020-001466Sullivan JF, Polly M, Roman JW, et al. Utility of point of care ultrasound in humanitarian assistance missions. Mil Med. 2021;186(Suppl 1):789-94. https://doi.org/10.1093/milmed/usaa348Savell SC, Baldwin DS, Blessing A, et al. Military use of point of care ultrasound (POCUS). J Spec Oper Med. 2021;21(2):35-42. https://doi.org/10.55460/AJTO-LW17Dohlman LE, Kwikiriza A, Ehie O. Benefits and barriers to increasing regional anesthesia in resource-limited settings. Local Reg Anesth. 2020;13:147-58. https://doi.org/10.2147/LRA.S236550LinksPrehospital, Austere and Tactical Ultrasound: https://www.acep.org/emultrasound/subcommittees/prehospital-austere-tactical-ultrasound/asra.com/sigs/globalasra.com/sigs/pocus________________Thanks to The Preps from Philadelphia, PA for the music: “Hindsight" and “Left Behind". The band features Steve Breslin on vocals/guitars, Bryan Schwenk on guitars/vocals, Jeff Frederick on bass, and Eric Schwenk on drums.
This month, VN Times editor Rachael Buzzel is joined by locum RVN Jack Pye, who specialises in emergency and critical care and has a passion for ultrasonography. Jack is also a member of BVNA council, sits on the VN Times editorial board, and is a regular guest, contributor and official quizmaster on VN Happy Hour. He joins Rachael to discuss his love for ultrasonography; from the lightbulb moment to speaking at BVNA Congress and now offering CPD in practices all around the country. __________________
This month, VN Times editor Rachael Buzzel is joined by locum RVN Jack Pye, who specialises in emergency and critical care and has a passion for ultrasonography. Jack is also a member of BVNA council, sits on the VN Times editorial board, and is a regular guest, contributor and official quizmaster on VN Happy Hour. He joins Rachael to discuss his love for ultrasonography; from the lightbulb moment to speaking at BVNA Congress and now offering CPD in practices all around the country. __________________
Dr. Manisha Bahl interviews Dr. Jon Jacobson to discuss Ultrasonography of Superficial Soft-Tissue Masses: Society of Radiologists in Ultrasound Consensus Conference Statement. Jacobson et al. Radiology 2022; 304:18–30. Dr. Nikita Consul's Radiology In a Minute article summary on Fully Automated Abdominal CT Biomarkers for Type 2 Diabetes Using Deep Learning. Tallam et al. Radiology 2022; 304:85–95.
Referências Bibliográficas1- Abdel Razek AA, Soliman NY, Elkhamary S, Alsharaway MK, Tawfik A. Role of diffusion-weighted MR imaging in cervical lymphadenopathy. Eur Radiol. 2006;16 (7): 1468-77. 2- Ahuja A, Ying M. Sonographic evaluation of cervical lymphadenopathy: is power Doppler sonography routinely indicated? Ultrasound Med Biol. 2003; 29 (3): 353-9.3- Chong V. Cervical lymphadenopathy: what radiologists need to know. cancer imaging. 2004; 4 (2): 116-20.4- Dudea SM, Lenghel M, Botar-Jid C, Vasilescu D, Duma M. Ultrasonography of superficial lymph nodes: benign vs. malignant. Med Ultrason. 2012; 14 (4): 294-306.5- Gonçalves FG, Ovalle JP, Grieb DFJ, Torres CI, Chankwosky J, DelCarpio-O'Donovan R. Diffusion in the head and neck: an assessment beyond the anatomy. Radiol Bras. 2011; 44 (5): 308–314.6- Gupta A, Rahman K, Shahid M, Kumar A, Qaseem SM, Hassan SA, et al. Sonographic assessment of cervical lymphadenopathy: role of high-resolution and color Doppler imaging. Head Neck. 2011; 33 (3): 297-302.7- Hoang JK, Vanka J, Ludwig BJ, Glastonbury CM. Evaluation of cervical lymph nodes in head and neck cancer with CT and MRI: tips, traps, and a systematic approach. AJR. 2013; 200 (1): W17-25.8- Ludwig BJ, Wang J, Nadgir RN, Saito N, Castro-Aragon I, Sakai O. Imaging of cervical lymphadenopathy in children and young adults. AJR. 2012; 199 (5): 1105-13.9- Mouawad F, Rysman B, Russ G, Benoudiba F, Garcia G, Abgral R, Zerdoud S, et al. Cystic form of cervical lymphadenopathy. Guidelines of the French Society of Otorhinolaryngology - Head and Neck Surgery (SFORL). Part 1: Diagnostic procedures for lymphadenopathy in case of cervical mass with cystic aspect. Eur Ann Otorhinolaryngol Head Neck Dis. 2019; 136 (6): 489-496.10- Rodriguez-Takeuchi SR, Renjifo ME, Medina FJ. RadioGraphics 2019; 39:2023–203711- Testa ML, Chojniak R, Sene LS, Damascena AS. Diffusion-weighted magnetic resonance imaging: biomarker for treatment response in oncology. Radiol Bras. 2013; 46 (3): 178–180.12- Ying M, Ahuja A, Brook F. Accuracy of sonographic vascular features in differentiating different causes of cervical lymphadenopathy. Ultrasound Med Biol. 2004; 30 (4): 441-7.13- Ying M, Bhatia KS, Lee YP, Yuen HY, Ahuja AT. Review of ultrasonography of malignant neck nodes: greyscale, Doppler, contrast enhancement and elastography. Cancer Imaging. 2014;13 (4): 658-669.
This month Jack Pye RVN joins us on the podcast to discuss the ever expanding role of Veterinary Nurses in practice and how they can use their skillset to progress from supporting the patient to performing the ultrasound scan.
In today's podcast episode, we will discuss Point of Care Ultrasonography (POCUS). We examine key trends in technology, the relationship of POCUS to consultative ultrasonography, growing clinical applications, and challenges with POCUS. Our guest is Dr. Jose Luis Diaz-Gomez. Dr. Diaz- Gomez is the Chief of Transplant, Cardiovascular, and Mechanical Support Critical Care, and Director of Critical Care Echocardiography at Baylor, St. Luke's Medical Center in Houston, Texas. He is a Senior Faculty in Cardiovascular Anesthesia and Critical Care at Baylor College of Medicine. Additional Resources: Point of Care Ultrasonography. By J.L. Diaz-Gomez et al. New England Journal of Medicine 2021: https://bit.ly/3JftVPt Multi-organ point of care ultrasound for COVID-19 (PoCUS4COVID). Expert Consensus: https://bit.ly/3mrXvaF Society of Critical Care Medicine Resources for critical care ultrasound: https://bit.ly/3yZsW1m Point of care ultrasonography Certification – CHEST: https://bit.ly/32bZfyd Books Mentioned in this Episode: The Myth of Artificial Intelligence: Why Computers Can't Think the Way We Do. By Erik Larson: https://amzn.to/3ySWDRm Essentialism: The Disciplined Pursuit of Less. By Greg McKeown: https://amzn.to/3EfVeFT
Til and Whitney speak with fascial researcher, anatomist, and manual therapy teacher Antonio Stecco MD PhD about his research in to fascial properties, pain, and the effects of hands-on work. Get the full transcript at Til or Whitney's sites! Resources discussed in this episode: Dr Stecco's research and publications (NYU) FM app on the Apple Store and Google Play Dr Stecco's site: fascialmanipulation.com Papers mentioned in the episode: Gerber et al., “A Systematic Comparison Between Subjects With No Pain and Pain Associated With Active Myofascial Trigger Points.” Langevin, Helene M. et al. “Reduced Thoracolumbar Fascia Shear Strain in Human Chronic Low Back Pain.” BMC Musculoskeletal Disorders 12, no. 1 (December 2011): 203. https://doi.org/10.1186/1471-2474-12-203. Stecco, Antonio at al. “Ultrasonography in Myofascial Neck Pain: Randomized Clinical Trial for Diagnosis and Follow-Up.” Surgical and Radiologic Anatomy 36, no. 3 (April 2014): 243–53. https://doi.org/10.1007/s00276-013-1185-2. Whitney Lowe's Online Clinical & Orthopedic Massage Courses Til Luchau's site: Advanced-Trainings.com Sponsor Offers: Books of Discovery: save 15% by entering "thinking" at checkout on booksofdiscovery.com. ABMP: save $24 on new membership at abmp.com/thinking. Handspring Publishing: save 20% by entering “TTP” at checkout at handspringpublishing.com. About Whitney Lowe | About Til Luchau | Email Us: info@thethinkingpractitioner.com (The Thinking Practitioner Podcast is intended for professional practitioners of manual and movement therapies: bodywork, massage therapy, structural integration, chiropractic, myofascial and myotherapy, orthopedic, sports massage, physical therapy, osteopathy, yoga, strength and conditioning, and similar professions. It is not medical or treatment advice.)
Ultrasonography is an evolving skill in critically ill patients. We provide a large number of statements regarding the required ultrasonographic basic skills for the management of critically ill patients. Original article: Speakers: https://rdcu.be/cClco (Basic ultrasound head-to-toe skills for intensivists in the general and neuro intensive care unit population: consensus and expert recommendations of the European Society of Intensive Care Medicine) Chiara ROBBA. Anesthesia and Intensive Care, Ospedale Policlinico San Martino, IRCCS per l'Oncologia e le Neuroscienze, Genoa (IT) and Department of Surgical Sciences and Integrated Diagnostics (DISC), Genoa (IT). Chair, ESICM Neuro Intensive Care Section. Adrian WONG. Department of Critical Care, King's College Hospital, London (UK). Chair, ESICM Social Media & Digital Content Committee. Antoine VIEILLARD-BARON. Intensive Care Medicine Unit, Assistance Publique-Hôpitaux de Paris, University Hospital Ambroise Paré, Billancourt, Boulogne (FR) and INSERM UMR-1018, CESP, Team Kidney and Heart, University of Versailles Saint-Quentin en Yvelines, Villejuif (FR). ESICM Secretary. Laura GALARZA. Hospital General Universitario, Castellón (ES); Chair-Elect, ESICM NEXT Committee
I denne episoden snakker vi med forsker Camilla Illidi som jobber ved Brunel University i London. Hovedtematikken vil være lungefunksjon og pustemekanikk. Puster vi riktig? Kan vi trene diafragma? Hjelper disse "maskene" som enkelte utøvere har på seg? Alt dette med mer får du svar på i denne episoden! God lytting! Kontaktinformasjon: Instagram Researchgate Referanser: Illidi, C. R., Stang, J., Melau, J., Hisdal, J., & Stensrud, T. (2021). Does Cold-Water Endurance Swimming Affect Pulmonary Function in Healthy Adults?. Sports 2021, 9, 7. Illidi, C. R. (2021). Ultrasonography for the assessment of contractile properties of fresh and fatigued diaphragm muscle in healthy humans (Doctoral dissertation, Brunel University London). Fernández-Lázaro, D., Gallego-Gallego, D., Corchete, L. A., Fernández Zoppino, D., González-Bernal, J. J., García Gómez, B., & Mielgo-Ayuso, J. (2021). Inspiratory Muscle Training Program Using the PowerBreath®: Does It Have Ergogenic Potential for Respiratory and/or Athletic Performance? A Systematic Review with Meta-Analysis. International Journal of Environmental Research and Public Health, 18(13), 6703. Pollock, N. W. (2008). Breath-hold diving: performance and safety. Diving Hyperb Med, 38(2), 79-86.
"POCUS Spotlight: Focused Cardiac Ultrasonography," by Ana Sjaus, MD FRCPC, Assistant Professor, Department of Anesthesiology, Pain Management and Perioperative Medicine, Dalhousie University, Halifax, Nova Scotia, Canada; and Hari Kalagara, MD, FCARCSI, EDRA, Assistant Professor, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Jacksonville, Florida. From ASRA News, August 2021. See original article at www.asra.com/asra-news for figures and references. This material is copyrighted.
CanadiEM Journal Club E04 Systematic reviews and meta analyses show notes Welcome back to Journal Club by CanadiEM! In this episode we go over an approach to systematic reviews and meta analyses based on Oxford centre of EBM, and learn about diagnosing pneumothorax with ultrasound vs X-ray Using the Oxford centre of EBM tool, we will ask: What question(s) did the systematic review address? Is it likely that important, relevant studies were missed? Were the criteria used to select articles for inclusion appropriate? Were the included studies sufficiently valid for the type of question asked? Were the results similar from study to study? What were the results? What is the clinical significance of the results? and then a clinical pearl on pneumothorax!! Hosts: Dakoda Herman Jayneel Limbachia Jake Domm Paper: “Chest ultrasonography versus supine chest radiography for diagnosis of pneumothorax in trauma patients in the emergency department” Cochrane Database of Systematic Reviews by Chan KK, Joo DA, McRae AD, Takwoingi Y, Premji ZA, Lang E, Wakai A What question(s) did the systematic review address? P: Trauma patients in the ER I: chest ultrasonography by non rad physicians C: Chest xray O: diagnosis of pneumothorax, improved patient safety Secondary: investigate potential sources of hetero such as type of CUS operator, type of trauma, type of US probe on test accuracy T: inception to 10 April 2020 Is it unlikely that important, relevant studies were missed? This study included prospective, paired comparative accuracy studies in which patients were suspected of having pneumothorax. Patients must have undergone both CUS by a frontline non-radiologist and CXR, as well as CT of the chest or tube thoracostomy as the reference standard. The authors carried out systematic searches in the following electronic databases: Cochrane Database of Systematic Reviews; Cochrane Central Register of Controlled Trials; MEDLINE; Embase; Cumulative Index to Nursing and Allied Health Literature (CINAHL) Plus; Database of Abstracts of Reviews of EIects; Web of Science core collection (which includes: Science Citation Index Expanded; Social Sciences Citation Index; Arts & Humanities Citation Index; Conference Proceedings Citation Index - Science; Conference Proceedings Citation Index - Social Sciences & Humanities; and Emerging Sources Citation Index; and Clinicaltrials.gov from database creation to April 2020. The authors also handsearched reference lists of included articles and reviews, retrieved via electronic searching, for potentially eligible studies. Additionally, they carried out forward citation searching of relevant articles in Google Scholar and looked at the “Related articles” on PubMed. They did not limit the search to Englsih language only and included articles published in all languages. Their search strategy in volved the use of MeSH terms such as Pneumothorax, Radiography, Ultrasonography, and focused assessment with ultrasonography for trauma. They also used many text words. Using this search strategy 3473 records were identified. 1180 duplicated records were removed, leaving 2293 records to be screened. These records were screened by two of the authors for their relevance, when there was a discrepancy a third author decided whether to include the record or not. 2268 records were excluded, leaving 25 full-text articles that were assessed for eligibility. 12 studies were excluded - 5 missing CUS/CXR/CT chest/chest tube, 4 CUS not performed by frontline non-radiologist physicians, 2 wrong patient population, 1 wrong study design. A total of 13 studies were included in qualitative and quantitative analysis. 9 studies using patients as units of analysis included in primary analysis. 4 studies using lung fields as units of analysis included in secondary analysis. Authors provide a nice figure depicting this. Authors did not contact experts for unpublished data but were very thorough and transparent in their search strategy. I think it is unlikely that important, relevant studies were missed. Were the criteria used to select articles for inclusion appropriate? The authors of this study clearly outlined their study inclusion and exclusion criteria. They included prospective, comparative accuracy studies in which patients were suspected of having pneumothorax. They included trauma patients in the emergency department setting. Patients must have undergone both CUS by frontline non-radiologist physicians and CXR as index tests, as well as CT of the chest or tube thoracostomy as the reference standard. The two main index tests were CUS completed by a frontline nonradiologist physician and CXR, both being performed in the supine position. If data on specific CUS findings (such as the absence of lung sliding, absence of B-lines or comet-tail artefact, presence of lung point, and absence of lung pulse) were available, they planned to assess the diagnostic accuracy of these individual CUS findings. The target condition was traumatic pneumothorax of any severity. They defined a pneumothorax identified on CT scan of the chest or via clinical findings of a rush of air or bubbling in a chest drain after tube thoracostomy as the reference standard. The authors excluded studies involving participants with already diagnosed pneumothorax (i.e. case-control studies); studies involving participants with nontraumatic pneumothorax; studies involving participants who had already been treated with tube thoracostomy; and studies in which a frontline non-radiologist physician did not perform CUS. These criteria were appropriate for inclusion. However, many studies did differ in their units of measurement - lung fields vs. patients, which could introduce significant bias into the results of individual studies. Were the included studies sufficiently valid for the type of question asked? The authors used the QUADAS-2 tool to assess risk of bias and the applicability of each included study. This tool assesses risk of bias in four domains: patient selection; index tests; reference standard; and flow and timing. In addition, they examined concerns about applicability in the first three domains. They tailored the tool to their review question - one of the signalling questions in the patient selection domain was not applicable because they excluded case-control studies; therefore they deleted this question from the tool. Two review authors performed the assessments independently. They discussed and resolved any disagreements that arose through consultation with a third review author. They included a figure describing their assessments of study quality. Of the nine studies that we included in the primary analysis: One had a low risk of bias, two had an unclear risk, and six had high risk of bias in the patient selection domain, mostly due to convenience sampling or inappropriate exclusion criteria, such as excluding haemodynamically unstable patients, lack of access to CUS, chest wall injuries precluding CUS, or if CT was not indicated. The risk of bias in the interpretation of CUS results was low in five studies, unclear in two studies, and high in two studies; this was related to unclear blinding methodology of outcome assessors interpreting CUS and CXR results. The risk of bias in the interpretation of CXR results was low in two studies, unclear in six studies, and high in one study; this was largely due to unclear blinding methodology of outcome assessors interpreting CXR and CT results, as in some studies it was not clear whether radiologists had access to both imaging results or not. The risk of bias introduced in interpretation of the reference standard results was low in three studies but unclear in the remainder for similar concerns regarding blinding methodology. The risk of bias in the flow and timing domain was low in two studies, unclear in four studies, and high in three studies; this was due to the exclusion of patients based on missing CT data or unclear/inappropriate time intervals between CUS, CXR, and CT. They judged applicability concerns regarding patient selection as low for six studies but high for three studies; this was due to the exclusion of haemodynamically unstable patients or lack of access to CUS despite the study focusing on comparing CUS. They judged one included study to have unclear concern regarding applicability of the reference standard used as there was insuIicient reporting of the method of assessment. They deemed all other domains for applicability concerns as low risk for all studies. Studies that used lung fields as their unit of analysis had several limitations including missing CUS data for some lung fields and using two CUS tests (one for each lung field) compared to one CXR (for both lungs) on the same patient. Inherently, there would be an inability to blind the CUS operator during collection of CUS data while performing the two CUS tests (one on each side of the patient), as well as during the interpretation of the CXR and CT results between the two lung fields. By analysing lung fields separately, it is diIicult to ascertain whether patient characteristics, past medical history, or traumatic injury pattern could have affected one or both lungs and may have confounded the diagnostic accuracy. Out of the four studies included in the secondary analysis: The risk of bias in the patient selection domain was low in one study, unclear in two studies, and high in one study; this was due to inappropriate exclusion criteria, such as excluding haemodynamically unstable patients or chest wall injuries precluding CUS, or due to unclear sampling technique. The risk of bias introduced in interpreting CUS results was low in two studies and unclear in two studies due to lack of clarity about blinding of the outcome assessors interpreting CUS and CXR results. The risk of bias introduced in interpreting CXR and CT results to be low in one study, unclear in two studies, and high in one study; this was again due to definite unblinded interpretation of test results or unclear blinding methodology of outcome assessors interpreting CXR and CT results. The risk of bias in the flow and timing domain was low in two studies and high in two studies due to missing patient data. They judged applicability concerns in the patient selection domain as low for two studies, unclear for one study, and high for one study, due to unclear patient selection methods and exclusion of haemodynamically unstable patients or chest wall injuries precluding CUS. They judged one study to have unclear concern regarding applicability of the reference standard, as blinding of the outcome assessor interpreting the results of CUS, CXR, and CT was unclear. We deemed all other domains as 'low concern' for all studies. The authors were thorough in their assessment of each study's quality and discussed how this may have impacted the results. The most common area of bias seemed to be in patient selection where 11/13 studies were judged to be at unclear or high risk of bias. Were the results similar from study to study? Substantial heterogeneity in sensitivity analysis of supine CXR Based on Figure 4, Forest plot: Sensitivity ranged from 0.09 to 0.75 Wide and non overlapping confidence intervals are suggestive of high variability between studies Limits the evidence But they do not list the reasons for why such heterogeneity exists Some possibilities for the heterogeneity include the high or unclear risk of bias of included studies There is no I squared statistic shown - a statistical measure that confirms the presence of significant heterogeneity in a meta-analysis Results of the study: Included 13 studies, 1271 trauma patients with 410 who had a pneumothorax 9 studies used patients as unit of analysis 4 studies used lung field as unit of analysis Most studies were high or unclear risk of bias - 11/13 CUS sensitivity and specificity: 0.91 (95% CI: 0.85 - 0.94) and 0.99 (95% CI: 0.97 - 1.00) CXR sensitivity and specificity: 0.47 (95% CI: 0.31 - 0.63) and 1.00 (95% CI: 0.97 - 1.00) Difference in sensitivity: 0.44 (95% CI: 0.27 - 0.61) Practise Changing? This is an excellently executed Systematic Review that makes the most of the limited evidence available and presents such in a transparent way. The results of this study suggest that CUS has better sensitivity in detecting pneumothorax in the emergency department than CXR, and comparable specificity. This publication adds to the body of research that is building in support of US in the primary care setting, and promotes a change in culture as US adoption rates grow. Clinical pearl: Pneumothorax, or, air in the pleural space, is a fairly common complication of thoracic traumas, occurring 15-50% of the time. History: If you're able to get a history, and often you won't be able to, you'll hear about a Sudden, severe, chest pain, sometimes referred to shoulder and maybe associated pleuritic pain or SOB. On Exam: Exam findings range from nothing to respiratory distress and shock. May have decreased chest wall motion, subcutaneous emphysema, or poprock skin, hyperresonance, or decreased or absent breath sounds on the affected side. Imaging: traditionally via x-ray or US depending on physician. On xray: Absence of lung markings beyond the edge of the lung. The edge of the scapula or upper ribs are often mistaken for a pneumothorax. On US: Scan over the most upright part of the patient's chest. if supine go right over the top of their chest (third or fourth intercostal space in the midclavicular line and is repeated on both sides) and if upright scan the apices. Looking for lung sliding and the classic “seashore sign” in M-mode in normal lungs, or absence of lung sliding and “barcode sign” seen in pneumothorax. There are tons of good videos online to take a look at. CT is gold standard, but rarely necessary - Rush of air on thoracostomy is also diagnostic. - Treatment: varies based on severity, from no treatment if patient tolerating well, to drains and chest tubes, to needle or finger thoracostomy for immediate decompression if pneumothorax clinically indicated and hypotension.
CanadiEM Journal Club E04 Systematic reviews and meta analyses show notes Welcome back to Journal Club by CanadiEM! In this episode we go over an approach to systematic reviews and meta analyses based on Oxford centre of EBM, and learn about diagnosing pneumothorax with ultrasound vs X-ray Using the Oxford centre of EBM tool, we will ask: What question(s) did the systematic review address? Is it likely that important, relevant studies were missed? Were the criteria used to select articles for inclusion appropriate? Were the included studies sufficiently valid for the type of question asked? Were the results similar from study to study? What were the results? What is the clinical significance of the results? and then a clinical pearl on pneumothorax!! Hosts: Dakoda Herman Jayneel Limbachia Jake Domm Paper: “Chest ultrasonography versus supine chest radiography for diagnosis of pneumothorax in trauma patients in the emergency department” Cochrane Database of Systematic Reviews by Chan KK, Joo DA, McRae AD, Takwoingi Y, Premji ZA, Lang E, Wakai A What question(s) did the systematic review address? P: Trauma patients in the ER I: chest ultrasonography by non rad physicians C: Chest xray O: diagnosis of pneumothorax, improved patient safety Secondary: investigate potential sources of hetero such as type of CUS operator, type of trauma, type of US probe on test accuracy T: inception to 10 April 2020 Is it unlikely that important, relevant studies were missed? This study included prospective, paired comparative accuracy studies in which patients were suspected of having pneumothorax. Patients must have undergone both CUS by a frontline non-radiologist and CXR, as well as CT of the chest or tube thoracostomy as the reference standard. The authors carried out systematic searches in the following electronic databases: Cochrane Database of Systematic Reviews; Cochrane Central Register of Controlled Trials; MEDLINE; Embase; Cumulative Index to Nursing and Allied Health Literature (CINAHL) Plus; Database of Abstracts of Reviews of EIects; Web of Science core collection (which includes: Science Citation Index Expanded; Social Sciences Citation Index; Arts & Humanities Citation Index; Conference Proceedings Citation Index - Science; Conference Proceedings Citation Index - Social Sciences & Humanities; and Emerging Sources Citation Index; and Clinicaltrials.gov from database creation to April 2020. The authors also handsearched reference lists of included articles and reviews, retrieved via electronic searching, for potentially eligible studies. Additionally, they carried out forward citation searching of relevant articles in Google Scholar and looked at the “Related articles” on PubMed. They did not limit the search to Englsih language only and included articles published in all languages. Their search strategy in volved the use of MeSH terms such as Pneumothorax, Radiography, Ultrasonography, and focused assessment with ultrasonography for trauma. They also used many text words. Using this search strategy 3473 records were identified. 1180 duplicated records were removed, leaving 2293 records to be screened. These records were screened by two of the authors for their relevance, when there was a discrepancy a third author decided whether to include the record or not. 2268 records were excluded, leaving 25 full-text articles that were assessed for eligibility. 12 studies were excluded - 5 missing CUS/CXR/CT chest/chest tube, 4 CUS not performed by frontline non-radiologist physicians, 2 wrong patient population, 1 wrong study design. A total of 13 studies were included in qualitative and quantitative analysis. 9 studies using patients as units of analysis included in primary analysis. 4 studies using lung fields as units of analysis included in secondary analysis. Authors provide a nice figure depicting this. Authors did not contact experts for unpublished data but were very thorough and transparent in their search strategy. I think it is unlikely that important, relevant studies were missed. Were the criteria used to select articles for inclusion appropriate? The authors of this study clearly outlined their study inclusion and exclusion criteria. They included prospective, comparative accuracy studies in which patients were suspected of having pneumothorax. They included trauma patients in the emergency department setting. Patients must have undergone both CUS by frontline non-radiologist physicians and CXR as index tests, as well as CT of the chest or tube thoracostomy as the reference standard. The two main index tests were CUS completed by a frontline nonradiologist physician and CXR, both being performed in the supine position. If data on specific CUS findings (such as the absence of lung sliding, absence of B-lines or comet-tail artefact, presence of lung point, and absence of lung pulse) were available, they planned to assess the diagnostic accuracy of these individual CUS findings. The target condition was traumatic pneumothorax of any severity. They defined a pneumothorax identified on CT scan of the chest or via clinical findings of a rush of air or bubbling in a chest drain after tube thoracostomy as the reference standard. The authors excluded studies involving participants with already diagnosed pneumothorax (i.e. case-control studies); studies involving participants with nontraumatic pneumothorax; studies involving participants who had already been treated with tube thoracostomy; and studies in which a frontline non-radiologist physician did not perform CUS. These criteria were appropriate for inclusion. However, many studies did differ in their units of measurement - lung fields vs. patients, which could introduce significant bias into the results of individual studies. Were the included studies sufficiently valid for the type of question asked? The authors used the QUADAS-2 tool to assess risk of bias and the applicability of each included study. This tool assesses risk of bias in four domains: patient selection; index tests; reference standard; and flow and timing. In addition, they examined concerns about applicability in the first three domains. They tailored the tool to their review question - one of the signalling questions in the patient selection domain was not applicable because they excluded case-control studies; therefore they deleted this question from the tool. Two review authors performed the assessments independently. They discussed and resolved any disagreements that arose through consultation with a third review author. They included a figure describing their assessments of study quality. Of the nine studies that we included in the primary analysis: One had a low risk of bias, two had an unclear risk, and six had high risk of bias in the patient selection domain, mostly due to convenience sampling or inappropriate exclusion criteria, such as excluding haemodynamically unstable patients, lack of access to CUS, chest wall injuries precluding CUS, or if CT was not indicated. The risk of bias in the interpretation of CUS results was low in five studies, unclear in two studies, and high in two studies; this was related to unclear blinding methodology of outcome assessors interpreting CUS and CXR results. The risk of bias in the interpretation of CXR results was low in two studies, unclear in six studies, and high in one study; this was largely due to unclear blinding methodology of outcome assessors interpreting CXR and CT results, as in some studies it was not clear whether radiologists had access to both imaging results or not. The risk of bias introduced in interpretation of the reference standard results was low in three studies but unclear in the remainder for similar concerns regarding blinding methodology. The risk of bias in the flow and timing domain was low in two studies, unclear in four studies, and high in three studies; this was due to the exclusion of patients based on missing CT data or unclear/inappropriate time intervals between CUS, CXR, and CT. They judged applicability concerns regarding patient selection as low for six studies but high for three studies; this was due to the exclusion of haemodynamically unstable patients or lack of access to CUS despite the study focusing on comparing CUS. They judged one included study to have unclear concern regarding applicability of the reference standard used as there was insuIicient reporting of the method of assessment. They deemed all other domains for applicability concerns as low risk for all studies. Studies that used lung fields as their unit of analysis had several limitations including missing CUS data for some lung fields and using two CUS tests (one for each lung field) compared to one CXR (for both lungs) on the same patient. Inherently, there would be an inability to blind the CUS operator during collection of CUS data while performing the two CUS tests (one on each side of the patient), as well as during the interpretation of the CXR and CT results between the two lung fields. By analysing lung fields separately, it is diIicult to ascertain whether patient characteristics, past medical history, or traumatic injury pattern could have affected one or both lungs and may have confounded the diagnostic accuracy. Out of the four studies included in the secondary analysis: The risk of bias in the patient selection domain was low in one study, unclear in two studies, and high in one study; this was due to inappropriate exclusion criteria, such as excluding haemodynamically unstable patients or chest wall injuries precluding CUS, or due to unclear sampling technique. The risk of bias introduced in interpreting CUS results was low in two studies and unclear in two studies due to lack of clarity about blinding of the outcome assessors interpreting CUS and CXR results. The risk of bias introduced in interpreting CXR and CT results to be low in one study, unclear in two studies, and high in one study; this was again due to definite unblinded interpretation of test results or unclear blinding methodology of outcome assessors interpreting CXR and CT results. The risk of bias in the flow and timing domain was low in two studies and high in two studies due to missing patient data. They judged applicability concerns in the patient selection domain as low for two studies, unclear for one study, and high for one study, due to unclear patient selection methods and exclusion of haemodynamically unstable patients or chest wall injuries precluding CUS. They judged one study to have unclear concern regarding applicability of the reference standard, as blinding of the outcome assessor interpreting the results of CUS, CXR, and CT was unclear. We deemed all other domains as 'low concern' for all studies. The authors were thorough in their assessment of each study's quality and discussed how this may have impacted the results. The most common area of bias seemed to be in patient selection where 11/13 studies were judged to be at unclear or high risk of bias. Were the results similar from study to study? Substantial heterogeneity in sensitivity analysis of supine CXR Based on Figure 4, Forest plot: Sensitivity ranged from 0.09 to 0.75 Wide and non overlapping confidence intervals are suggestive of high variability between studies Limits the evidence But they do not list the reasons for why such heterogeneity exists Some possibilities for the heterogeneity include the high or unclear risk of bias of included studies There is no I squared statistic shown - a statistical measure that confirms the presence of significant heterogeneity in a meta-analysis Results of the study: Included 13 studies, 1271 trauma patients with 410 who had a pneumothorax 9 studies used patients as unit of analysis 4 studies used lung field as unit of analysis Most studies were high or unclear risk of bias - 11/13 CUS sensitivity and specificity: 0.91 (95% CI: 0.85 - 0.94) and 0.99 (95% CI: 0.97 - 1.00) CXR sensitivity and specificity: 0.47 (95% CI: 0.31 - 0.63) and 1.00 (95% CI: 0.97 - 1.00) Difference in sensitivity: 0.44 (95% CI: 0.27 - 0.61) Practise Changing? This is an excellently executed Systematic Review that makes the most of the limited evidence available and presents such in a transparent way. The results of this study suggest that CUS has better sensitivity in detecting pneumothorax in the emergency department than CXR, and comparable specificity. This publication adds to the body of research that is building in support of US in the primary care setting, and promotes a change in culture as US adoption rates grow. Clinical pearl: Pneumothorax, or, air in the pleural space, is a fairly common complication of thoracic traumas, occurring 15-50% of the time. History: If you're able to get a history, and often you won't be able to, you'll hear about a Sudden, severe, chest pain, sometimes referred to shoulder and maybe associated pleuritic pain or SOB. On Exam: Exam findings range from nothing to respiratory distress and shock. May have decreased chest wall motion, subcutaneous emphysema, or poprock skin, hyperresonance, or decreased or absent breath sounds on the affected side. Imaging: traditionally via x-ray or US depending on physician. On xray: Absence of lung markings beyond the edge of the lung. The edge of the scapula or upper ribs are often mistaken for a pneumothorax. On US: Scan over the most upright part of the patient's chest. if supine go right over the top of their chest (third or fourth intercostal space in the midclavicular line and is repeated on both sides) and if upright scan the apices. Looking for lung sliding and the classic “seashore sign” in M-mode in normal lungs, or absence of lung sliding and “barcode sign” seen in pneumothorax. There are tons of good videos online to take a look at. CT is gold standard, but rarely necessary - Rush of air on thoracostomy is also diagnostic. - Treatment: varies based on severity, from no treatment if patient tolerating well, to drains and chest tubes, to needle or finger thoracostomy for immediate decompression if pneumothorax clinically indicated and hypotension.
The team have a chat about ideas for improving your veterinary ultrasonography skills - it's really not the Dark Art you might think it is!
He completed residency and fellowship at Stanford University. Since 2009 he has served as Clinical Associate Professor Director Inpatient Pain Service and Director Stanford comprehensive interdisciplinary pain program. He is the Past President World Academy of Pain Medicine United (formerly Ultrasonography) and also presented at 100 national and 40 international meetings including workshops on ultrasound and peripheral nerve stimulation quarterly. https://einarottestad.com/ This podcast is powered by Pinecast.
Episode 43: Testicular Cancer. Testicular cancer screening and diagnosis (basics), chlorthalidone vs hydrochlorothiazide, and jokes.Today is March 8, 2021. For many years, we have heard about the superiority of chlorthalidone over hydrochlorothiazide to control hypertension, but in clinical practice, hydrochlorothiazide is prescribed more often as the initial therapy for most patients with hypertension as compared to chlorthalidone. As a matter of fact, the Microsoft Word automatic corrector detects hydrochlorothiazide as a correct word, but flags chlorthalidone as misspelled. Also, we know how to abbreviate hydrochlorothiazide (HCTZ), but did you know that chlorthalidone has an abbreviation as CTD?We have been neglecting chlorthalidone regardless its apparent effectivity. In January 2006, the American Heart Association published on its journal Hypertension, a comparison between chlorthalidone and hydrochlorothiazide to control hyperension[1]. A randomized, single-blinded, 8-week active treatment, crossover study compared 12.5mg/day chlorthalidone (force-titrated to 25 mg/day at week 4) and HCTZ 25mg/day (force-titrated to 50mg/day at week 4) in untreated hypertensive patients. 24-hour BP monitoring was assessed at baseline and week 8 plus standard office BP readings every 2 weeks. 30 patients completed the active treatment period. At week 8 there was a greater reduction in baseline systolic blood pressure with chlorthalidone 25mg vs HCTZ 50mg. The effectiveness of chlorthalidone was evidenced by ambulatory blood pressure measurement (ABPM) although this difference was not apparent with office BP measurements. It was a short duration study with a small sample size.More recently, in January 2021, the Journal of Hypertension, which is the official journal of the International Society of Hypertension and the European Society of Hypertension[2], published on PDF a more comprehensive review of these long-time rivals. According to the short version of this article, there is no difference in the short-term net clinical benefit between CTD and HCTZ, BUT long-term available data suggests that CTD is better at reducing major adverse cardiovascular events (MACE) over HCTZ. Stay tuned for the final version of this study.Way to go chlorthalidone!______________________________This is Rio Bravo qWeek, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California. Our program is affiliated with UCLA, and it’s sponsored by Clinica Sierra Vista, Let Us Be Your Healthcare Home. Page BreakQuestion of the Month: Polyarthralgiaby Claudia Carranza A 49-year-old female comes to clinic reporting bilateral wrist and ankle pain for 1 month. The pain is worse with movement and responds well to ibuprofen. She denies joint swelling, warmth, or morning stiffness. She reports feeling more fatigued than usual this past month. You note on her chart that she was diagnosed with COVID-19 approximately 6 weeks ago for which she did not need to be hospitalized. She denies history of diabetes, thyroid disease, lupus, rheumatoid arthritis, trauma, or anemia. She denies fecal, urinary, or vaginal bleeding, no headaches, chest pain, SOB or dizziness. Exam is remarkable for a “tired look” and tenderness to palpation at bilateral wrist and ankles. No signs of inflammation on joints is noted. What do you think is the etiology of this patient’s symptoms and what workup would you order (if any)? Let’s repeat the question: What do you think is the etiology of the symptoms in a 49-year-old female who complains of symmetrical POLYARTHRALGIA and fatigue for 1 month, and what workup would you order (if any)? Clue: Listen carefully to the history of the patient. Send us your answer to rbresidency@clinicasierravista.org before March 22, 2021. The winner will receive a prize.“I am not my body. My body is nothing without me.” Tom Stoppard____________________________Testicular Cancer Testicular cancer is the most common solid tumor among males 15 to 34 years of age, with an estimated 8,850 new cases and 410 deaths in the past years. The good news is that with effective treatment, the overall five-year survival rate is 97%[3]. Risk factors. Cryptorchidism: The relative risk of developing testicular cancer ranges from 2.9 to 6.3; the risk is increased in both testes, although the risk is much higher in the ipsilateral testis (6.3 vs. 1.7). Among these patients, the risk of cancer increases when orchiopexy is delayed until after puberty or never performed compared with early orchiopexy. Even after early orchiopexy, the risk of testicular cancer remains elevated compared with the general population. Personal or family history of testicular cancer: Patients with a personal history of testicular cancer have a 12-times greater risk of developing a contralateral testicular cancer than the general population. However, the greatest risk is in the first five years after diagnosis. Patients with a father or brother with testicular cancer have a 3.8- and 8.6-times greater risk, respectively. Infertility: Men with infertility have an increased risk of testicular cancer, with a standardized incidence ratio of 1.6 to 2.8, although the underlying mechanism is unclear. HIV: Human immunodeficiency virus infection/AIDS increases the risk of seminoma, but this is negated with highly active antiretroviral treatment. Inconclusive risk: Associations between testicular cancer and marijuana use, inguinal hernia, diet, maternal smoking, and body size are inconclusive. Not a risk factor: Testicular microlithiasis, vasectomy, and scrotal trauma are not risk factors for testicular cancer. Screening for testicular cancer. The U.S. Preventive Services Task Force, National Cancer Institute, and American Academy of Family Physicians recommend against screening for testicular cancer (by a clinician or through self-examination) in asymptomatic adolescents and adults because of its low incidence and high survival rate. The American Cancer Society states that a testicular examination should be part of a routine cancer-related checkup but does not include a recommendation on regular testicular self-examinations for all men.Assessment of suspected testicular cancer patient.History and physical exam are the foundation for the diagnosis. Men with symptoms should receive a complete history and physical examination. Scrotal ultrasonography is the preferred initial imaging study. Testicular cancer may present as a painless scrotal mass, an incidental radiologic finding, posttraumatic symptom, or scrotal pain. Less commonly, presenting symptoms may indicate metastatic disease. Symptoms of testicular cancer include scrotal symptoms such as acute pain in the testis or scrotum, scrotum or abdomen discomfort or aches, painless mass of the testis, scrotal heaviness and swelling. Symptoms related to metastasis are non-specific and depend on the location of metastasis, including dyspepsia, abdominal pain or discomfort, gynecomastia, headaches, low back pain, neck mass, chest pain, cough, dyspnea, and hemoptysis.Testicular changes may be detected by the patient or by a sex partner. Epididymitis is an important part of the differential diagnosis of a scrotal mass.The normal testis is 3.5 to 5 cm in length, smooth, homogenous, movable, and detached from the epididymis. Hard, firm, or fixed areas within or adjacent to the testes are abnormal and warrant further evaluation. Physical examination should also include evaluation of the inguinal and supra-clavicular lymph nodes, the abdomen, and the chest for gynecomastia (related to tumor secretion of beta human chorionic gonadotropin). If a solid intratesticular mass is discovered, orchiectomy is both diagnostic and therapeutic. Imaging.Scrotal ultrasonography is the preferred initial imaging study for evaluating a testicular mass.Ultrasonography has a sensitivity of 92% to 98% and specificity of 95% to 99.8%. A solid intratesticular mass on ultrasonography warrants rapid referral for radical inguinal orchiectomy because this procedure provides pathologic diagnosis and is the cornerstone of treatment.Staging. Staging through chest radiography, chemistry panel, liver function tests, and tumor markers guides treatment. Active surveillance, chemotherapy, retroperitoneal lymph node dissection, and radiation therapy are treatment options following orchiectomy. For patients desiring future fertility, sperm banking should be discussed early in the course of treatment. Treatment. Radical inguinal orchiectomy, including removal of the spermatic cord to the internal inguinal ring, is the primary treatment for any malignant tumor found on surgical exploration of a testicular mass. Testis-sparing surgery is generally not recommended but may be performed for a small tumor in one testis or for small bilateral tumors. Orchiectomy may be delayed if life-threatening metastases require more urgent attention. The risk of testicular cancer recurrence is greatest within two to three years of primary treatment, and surveillance is continued for up to five years.Classification of Testicular Tumors: Germ cell tumors (95% of all testicular cancers)Derived from germ cell neoplasia in situSeminomaNonseminoma (nonseminomatous germ cell tumors)Embryonal carcinomaYolk sac tumor (postpubertal)Trophoblastic tumors (e.g., choriocarcinoma, placental site trophoblastic tumor)Teratoma (postpubertal) with or without malignant transformationMixed and unclassified germ cell tumorsNot derived from germ cell neoplasia in situSpermatocytic tumorTeratoma (prepubertal)Yolk sac tumor (prepubertal)Sex cord–stromal tumors (< 5% of all testicular cancers)Leydig cell tumorSertoli cell tumorGranulosa cell tumorMixed and unclassified sex cord–stromal tumorsMixed germ cell and stromal tumors (proportion of all testicular cancers not well defined) GonadoblastomaMiscellaneous tumors (proportion of all testicular cancers not well defined) Ovarian epithelial-type tumors Hemangioma Hematolymphoid tumors Tumors of the collecting duct and rete testis (adenocarcinoma)Differential diagnosis of testicular cancer.Tip 1: Testicular torsion is one of the most important differential diagnosis of testicular cancer. Testicular torsion is an emergency, and the presentation is quite different than cancer as it presents with acute, sudden, severe, unilateral testicular pain. Patients are very apprehensive to the exam. The scrotum may appear discolored and swollen; and the affected testicle is typically horizontal and at a higher position than expected in the scrotum. The treatment is surgical. In isolated areas, where surgery cannot be performed in a 2-hour period, a manual testicular detorsion can be attempted with appropriate analgesia and/or sedation. Try to rotate the affected testicle twice, 360 degrees, from medial to lateral. A “drop” of the testicle in the scrotum is felt with relief of pain. One-third of patients need detorsion to the opposite direction, from lateral to medial instead. Tip 2: Epididymitis presents as a pain for about 1-2 weeks. Tenderness is located behind the testicle and patient may complain of dysuria as well. Perform a urine test or urethral swab for gonorrhea and chlamydia. In patients younger than 35, consider empiric treatment while you wait for the results with ceftriaxone PLUS doxycycline or azithromycin. In patients older than 35, consider gram negative coverage with levofloxacin or trimethoprim-sulfamethoxazole. Tip 3: Consider other causes of infection in testis or scrotum, including viruses such as mumps (in unvaccinated populations) and even tuberculosis. If you are curious, read my article about it in PubMed titled “A Case of Testicular Granulomatous Inflammation Mistaken for Malignancy: Tuberculosis Identified Post Orchiectomy”[4]. Tip 4: Epidydimal cyst, spermatocele, and hydrocele are asymptomatic or minimally symptomatic, they are not located in the testis, but you can palpate a distinctive mass posterior or higher than the testis. You can try transillumination of these masses, and they should be translucent. Confirm with testicular ultrasound if in doubt. Tip 5: A testicular hematoma can happen after blunt trauma, but don’t be fooled by the history of traumas as up to 10% of testicular cancers may be discovered after trauma. Perform ultrasound and tumor markers to establish a diagnosis. Tip 6: A scrotal hernia may cause concerns in a patient. Clinically, the inguinal canal appears full and the mass in the scrotum is reported to improve with rest. If the mass is exquisitely tender and not reducible, emergent evaluation by surgery is warranted to rule out hernia strangulation, especially if scrotal pain is accompanied by abdominal distension, abdominal pain, nausea, and vomiting. ____________________________For your Sanity: Jokesby Anonymous Medical AssistantsHow does a deaf gynecologist communicate? They read lips!How do you get a squirrel to like you? Act like a nut.Why did the math book look so sad? It had a lot of problems.Why can’t a nose be 12 inches long? Because then it’d be a foot.What’s brown and sticky? A stick.Why did the rope go to the doctor? Because it had a knot on the stomach.Why did the mattress go to the doctor? Because it had Spring fever. Now we conclude our episode number 43 “Testicular cancer”, marking our podcasts one year anniversary!. Dr. RAVA covered the recommendations given by USPSTF and the American Cancer Society regarding screening for testicular cancer. Screening in asymptomatic adults is mostly not recommended but it can be a part of a cancer-related checkup. As part of our introduction today, we mentioned effective chlorthalidone is in preventing major adverse cardiovascular events. Our question of the month is still on, and we look forward to reading your answers. The question is: What is the etiology of polyarthralgia in a 49-year-old woman with pain on wrists and ankles for 1 month, and what work up would you order (if any)? The listener who sends the best answer will win a prize! Remember, even without trying, every night you go to bed being a little wiser.Thanks for listening to Rio Bravo qWeek. If you have any feedback about this podcast, contact us by email RBresidency@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. This podcast was created with educational purposes only. Visit your primary care physician for additional medical advice. This week we thank Hector Arreaza, Valerie Civelli, Sapna Patel, Manjinder Samra, Dr. RAVA, and voluntarily-unidentified medical assistants. Audio edition: Suraj Amrutia. See you next week! _____________________References:Roush, George C.a; Messerli, Franz H. Chlorthalidone versus hydrochlorothiazide, Journal of Hypertension: January 19, 2021 - Volume Publish Ahead of Print - Issue - doi: 10.1097/HJH.0000000000002771. https://journals.lww.com/jhypertension/Abstract/9000/Chlorthalidone_versus_hydrochlorothiazide__major.96738.aspx Ernst, Michael E., Barry L. Carter, Chris J. Goerdt et al., American Heart Association, Hypertension, Volume 47, Issue 3, 1 March 2006, Pages 352-358, https://doi.org/10.1161/01.HYP.0000203309.07140.d3 Baird DC, Meyers GJ, Hu JS. Testicular Cancer: Diagnosis and Treatment. Am Fam Physician. 2018 Feb 15;97(4):261-268. PMID: 29671528. https://www.aafp.org/afp/2018/0215/p261.html Civelli VF, Heidari A, Valdez MC, Narang VK, Johnson RH. A Case of Testicular Granulomatous Inflammation Mistaken for Malignancy: Tuberculosis Identified Post Orchiectomy. J Investig Med High Impact Case Rep. 2020 Jan-Dec;8:2324709620938947. doi: 10.1177/2324709620938947. PMID: 32618206; PMCID: PMC7493239. https://pubmed.ncbi.nlm.nih.gov/32618206/
References1.Flores DV, Goes PK, Gomez CM, Umpire DF, Pathria MN. Imaging of the Acromioclavicular Joint: Anatomy, Function, Pathologic Features, and Treatment. Radiographics. 2020;40(5):1355-82.2.Ha AS, Petscavage-Thomas JM, Tagoylo GH. Acromioclavicular joint: the other joint in the shoulder. AJR Am J Roentgenol. 2014;202(2):375-85.3.Goes PCK, Pathria MN. Radiographic/MR Imaging Correlation of the Shoulder. Magn Reson Imaging Clin N Am. 2019;27(4):575-85.4.Faruch Bilfeld M, Lapegue F, Chiavassa Gandois H, Bayol MA, Bonnevialle N, Sans N. Ultrasound of the coracoclavicular ligaments in the acute phase of an acromioclavicular disjonction: Comparison of radiographic, ultrasound and MRI findings. Eur Radiol. 2017;27(2):483-90.5.Antonio GE, Cho JH, Chung CB, Trudell DJ, Resnick D. Pictorial essay. MR imaging appearance and classification of acromioclavicular joint injury. AJR Am J Roentgenol. 2003;180(4):1103-10.6.Precerutti M, Formica M, Bonardi M, Peroni C, Calciati F. Acromioclavicular osteoarthritis and shoulder pain: a review of the role of ultrasonography. J Ultrasound. 2020;23(3):317-25.7.Peetrons P, Bedard JP. Acromioclavicular joint injury: enhanced technique of examination with dynamic maneuver. J Clin Ultrasound. 2007;35(5):262-7.8.Park J, Chai JW, Kim DH, Cha SW. Dynamic ultrasonography of the shoulder. Ultrasonography. 2018;37(3):190-9.9.Veen EJD, Donders CM, Westerbeek RE, Derks RPH, Landman EBM, Koorevaar CT. Predictive findings on magnetic resonance imaging in patients with symptomatic acromioclavicular osteoarthritis. J Shoulder Elbow Surg. 2018;27(8):e252-e8.
References1.Flores DV, Goes PK, Gomez CM, Umpire DF, Pathria MN. Imaging of the Acromioclavicular Joint: Anatomy, Function, Pathologic Features, and Treatment. Radiographics. 2020;40(5):1355-82.2.Ha AS, Petscavage-Thomas JM, Tagoylo GH. Acromioclavicular joint: the other joint in the shoulder. AJR Am J Roentgenol. 2014;202(2):375-85.3.Goes PCK, Pathria MN. Radiographic/MR Imaging Correlation of the Shoulder. Magn Reson Imaging Clin N Am. 2019;27(4):575-85.4.Faruch Bilfeld M, Lapegue F, Chiavassa Gandois H, Bayol MA, Bonnevialle N, Sans N. Ultrasound of the coracoclavicular ligaments in the acute phase of an acromioclavicular disjonction: Comparison of radiographic, ultrasound and MRI findings. Eur Radiol. 2017;27(2):483-90.5.Antonio GE, Cho JH, Chung CB, Trudell DJ, Resnick D. Pictorial essay. MR imaging appearance and classification of acromioclavicular joint injury. AJR Am J Roentgenol. 2003;180(4):1103-10.6.Precerutti M, Formica M, Bonardi M, Peroni C, Calciati F. Acromioclavicular osteoarthritis and shoulder pain: a review of the role of ultrasonography. J Ultrasound. 2020;23(3):317-25.7.Peetrons P, Bedard JP. Acromioclavicular joint injury: enhanced technique of examination with dynamic maneuver. J Clin Ultrasound. 2007;35(5):262-7.8.Park J, Chai JW, Kim DH, Cha SW. Dynamic ultrasonography of the shoulder. Ultrasonography. 2018;37(3):190-9.9.Veen EJD, Donders CM, Westerbeek RE, Derks RPH, Landman EBM, Koorevaar CT. Predictive findings on magnetic resonance imaging in patients with symptomatic acromioclavicular osteoarthritis. J Shoulder Elbow Surg. 2018;27(8):e252-e8.
In this podcast Cris Navas de Solis discusses the article ‘Real-time telehealth using ultrasonography is feasible in equine practice’.
Alongside the many thousands of Cochrane Reviews of the effects of interventions, our reviews of diagnostic test accuracy, or DTA, provide evidence to help clinicians choose between different techniques for diagnosing a health problem. In July 2020, we published the new DTA review on ultrasound versus x-ray for diagnosing pneumothorax in trauma patients. Here's lead author, Kenneth Chan from the Department of Emergency Medicine in the University of Calgary in Canada, to tell us what they found.
Alongside the many thousands of Cochrane Reviews of the effects of interventions, our reviews of diagnostic test accuracy, or DTA, provide evidence to help clinicians choose between different techniques for diagnosing a health problem. In July 2020, we published the new DTA review on ultrasound versus x-ray for diagnosing pneumothorax in trauma patients. Here's lead author, Kenneth Chan from the Department of Emergency Medicine in the University of Calgary in Canada, to tell us what they found.
https://pemplaybook.org/?p=2211
References1. Kim HS, Joo SH, Han ZA, Kim YW. The nerve/tunnel index: a new diagnostic standard for carpal tunnel syndrome using sonography: a pilot study. J Ultrasound Med. 2012; 31(1):23-9.2. Liao YY, Lee WN, Lee MR, Chen WS, Chiou HJ, Kuo TT, et al. Carpal tunnel syndrome: US strain imaging for diagnosis. Radiology. 2015; 275 (1): 205-14.3. Bianchi S, Hoffman DF, Tamborrini G, Poletti PA. Ultrasound Findings in Less Frequent Causes of Carpal Tunnel Syndrome. J Ultrasound Med. 2020.4. Chen YT, Williams L, Zak MJ, Fredericson M. Review of Ultrasonography in the Diagnosis of Carpal Tunnel Syndrome and a Proposed Scanning Protocol. J Ultrasound Med. 2016;35(11):2311-24.5. Azman D, Hrabac P, Demarini V. Use of Multiple Ultrasonographic Parameters in Confirmation of Carpal Tunnel Syndrome. J Ultrasound Med. 2018;37(4):879-89.6. Roll SC, Evans KD, Li X, Freimer M, Sommerich CM. Screening for carpal tunnel syndrome using sonography. J Ultrasound Med. 2011;30(12):1657-67.7. Yoshii Y, Zhao C, Amadio PC. Recent Advances in Ultrasound Diagnosis of Carpal Tunnel Syndrome. Diagnostics (Basel). 2020;10(8).8. Klauser AS, Halpern EJ, De Zordo T, Feuchtner GM, Arora R, Gruber J, et al. Carpal tunnel syndrome assessment with US: value of additional cross-sectional area measurements of the median nerve in patients versus healthy volunteers. Radiology. 2009;250(1):171-7.9. Kutlar N, Bayrak AO, Bayrak IK, Canbaz S, Turker H. Diagnosing carpal tunnel syndrome with Doppler ultrasonography: a comparison of ultrasonographic measurements and electrophysiological severity. Neurol Res. 2017;39(2):126-32.10. Bagga B, Sinha A, Khandelwal N, Modi M, Ahuja CK, Sharma R. Comparison of Magnetic Resonance Imaging and Ultrasonography in Diagnosing and Grading Carpal Tunnel Syndrome: A Prospective Study. Curr Probl Diagn Radiol. 2020;49(2):102-15.
Learn which exam maneuvers are worthwhile and which ones are worthless in your approach to shortness of breath. In our evidence based series on the physical exam, we discuss the approach to the dyspneic patient with Dr. Brian Garibaldi (Hopkins, SBM), associate professor of pulmonary and critical care medicine at Johns Hopkins, and co-president of the Society of Bedside Medicine. We discuss the physical exam’s effect on our differential diagnosis, maneuvers that are commonly taught, and some simple tests with great data that may go overlooked. Be prepared, this episode may take your breath away! Credits Written and Produced by: Justin Berk, MD, MPH, MBA and Sam Masur, MD Infographic: Sam Masur, MD, Beth Garbitelli Cover Art: Beth Garbitelli Hosts: Stuart Brigham, MD; Matthew Watto, MD, FACP; and Paul Williams, MD, FACP Editor:Justin Berk MD; Clair Morgan of nodderly.com Guest(s): Brian Garibaldi, MD Sponsors: National Internal Medicine Day Help ACP celebrate National Internal Medicine Day on October 28th. Visit https://www.acponline.org/NIMD20 to learn how you can show your internal medicine pride. Be sure to tag @ACPInternists and use the hashtags #NationalInternalMedicineDay, #IMProud, and #IMEssential. VCU Health CE The Curbsiders are partnering with VCU Health Continuing Education to offer FREE continuing education credits for physicians and other healthcare professionals. Visit curbsiders.vcuhealth.org and search for this episode to claim credit. Note: A free VCU Health CloudCME account is required in order to seek credit. Time Stamps Sponsor – National Internal Medicine Day, The American College of Physicians Sponsor – VCU Health Continuing Education 00:00 Intro, disclaimer, guest bio Sponsor – National Internal Medicine Day, The American College of Physicians 03:47 Introduction to evidence-based exam, pre-test probability, and likelihood ratios 05:29 Case from Kashlak Memorial 06:51 Dr. Garibaldi’s initial maneuvers for the dyspneic patient 11:33 Recapping the exam maneuvers 14:05 Likelihood ratios for common maneuvers 18:25 Over 6/Under 6 maneuvers 25:30 Recap of Dr. Garibaldi’s go-to maneuvers 28:19 Role of labs and diagnostic imaging 31:03 Role of point-of-care ultrasound (POCUS) 34:10 Friday at 5pm 36:31 Take home points 39:25 Outro Sponsor – VCU Health Continuing Education Links* Stanford 25: Teaching and promoting bedside exam skills to students, residents and healthcare professionals both in person and online The 5 Minute Moment at the Society of Bedside Medicine The POCUS Atlas: Evidence Based Point of Care Ultrasound Goal Listeners will feel confident how to optimally use the physical exam to guide clinical decision-making in patients presenting with dyspnea. Learning objectives After listening to this episode listeners will… Describe the effectiveness of the exam when it comes to aiding diagnosis in a patient with dyspnea Identify specific exam maneuvers that can aid clinical decision-making Identify exam maneuvers that may not offer more information compared to imaging such as POCUS Disclosures This episode was made with assistance from the Society of Bedside Medicine and funding from the New York Academy Medicine. Dr Garibaldi reports no relevant financial disclosures. The Curbsiders report no relevant financial disclosures. Citation Masur S, Garibaldi BT, Watto M, Williams P, Brigham S, Berk J. #236 Physical Exam Series: Approach to Shortness of Breath. The Curbsiders Internal Medicine Podcast. https:/www.thecurbsiders.com/episode-list. Original Air Date October 12, 2020. References Mochizuki K et al. Importance of respiratory rate for the prediction of clinical deterioration after emergency department discharge: a single-center, case-control study. Acute Med Surg. Nov 2016. doi:10.1002/ams2.252 Sarkar M et al. Physical signs in patients with chronic obstructive pulmonary disease. Lung India. 2019. doi:10.4103/lungindia.lungindia_145_18 Fagan TJ. Letter: Nomogram for Bayes theorem. N Engl J Med. 1975;293(5):257. doi:10.1056/NEJM197507312930513 Simel, David, et al. Rational Clinical Examination, McGraw-Hill Professional Publishing, 2009. ProQuest Ebook Central McGee, Steven. Evidence-based physical diagnosis [4th edition] Elsevier, 2018. Clinical Key Benbassat, J., Baumal, R. Narrative Review: Should Teaching of the Respiratory Physical Examination Be Restricted Only to Signs with Proven Reliability and Validity?. J GEN INTERN MED 25, 865–872 (2010). https://doi.org/10.1007/s11606-010-1327-8 Al Deeb M et al. Point-of-care ultrasonography for the diagnosis of acute cardiogenic pulmonary edema in patients presenting with acute dyspnea: a systematic review and meta-analysis. Acad Emerg Med. 2014;21(8):843-852. doi:10.1111/acem.12435 Yousefifard et al. Screening Performance Characteristic of Ultrasonography and Radiography in Detection of Pleural Effusion; a Meta-Analysis. Emerg (Tehran). 2016;4(1):1-10. Martindale et al. Diagnosing Acute Heart Failure in the Emergency Department: A Systematic Review and Meta-analysis. Acad Emerg Med. 2016;23(3):223-242. doi:10.1111/acem.12878 Caldentey et al. Prognostic value of the physical examination in patients with heart failure and atrial fibrillation: insights from the AF-CHF trial (atrial fibrillation and chronic heart failure). JACC Heart Fail 2014.. doi:10.1016/j.jchf.2013.10.004 Tags Physical exam, dyspnea, shortness of breath, auscultation, PMI, percussion, heart failure, wheeze, POCUS, COPD, JVD, hepatojugular reflux, observation, asymmetry, Brian Garibaldi, practice, pallor, lung, heart, hands.
Master your breast cancer screening spiel, cultivate your approach to the breast mass, and empower your patients with empathetic shared decision-making (which we know you’re all already fabulous at)! On this fantastic episode, we are joined by Dr. Nancy Keating @NancyKeatingMD, policy wonk and primary care doc extraordinaire at Brigham and Women’s Hospital. This episode is rife with drama, as the ACS butts heads with the USPTF and the ACR, and you have to figure out what’s right for the patient by talking with them--almost as exciting as that moment on Grey’s when Izzie cuts the...anyway, I won’t ruin a key plot point in the most excellent medical show of all time, all in a day’s work, here at The Curbsiders. Enjoy! Listeners can claim Free CE credit through VCU Health at http://curbsiders.vcuhealth.org/ (CME goes live at 0900 ET on the episode’s release date). Show Notes | Subscribe | Spotify | Swag! | Top Picks | Mailing List | thecurbsiders@gmail.com | Free CME! Credits Producer and Writer: Nora Taranto MD Show Notes: Nora Taranto MD, Isabel Valdez PA Infographic: Nora Taranto MD Cover Art: Kate Grant, MD Hosts: Stuart Brigham MD, FACP; Matthew Watto MD, FACP; Paul Williams MD, FACP, Nora Taranto MD Editor: Matthew Watto MD (written materials); Clair Morgan of nodderly.com Reviewer: Arielle Medford MD Guest: Nancy Keating MD, MPH Sponsors Provider Solutions & Development Provider Solutions & Development is a community of experts dedicated to offering guidance and career coaching to physicians and clinicians throughout their entire career journey. With exclusive access to hundreds of opportunities across the nation, reach out today to begin the search for your perfect practice: www.psdrecruit.org/curbsiders. VCU Health CE The Curbsiders are partnering with VCU Health Continuing Education to offer FREE continuing education credits for physicians and other healthcare professionals. Visit curbsiders.vcuhealth.org and search for this episode to claim credit. Note: A free VCU Health CloudCME account is required in order to seek credit. Time Stamps Sponsor - Provider Solutions & Development www.psdrecruit.org/curbsiders. Sponsor - VCU Health Continuing Education 00:30 Intro & Guest Bio 03:27 Guest one-liner 05:27 Best Advice for Women in Medicine 07:34 Picks of the Week Sponsor - Provider Solutions & Development www.psdrecruit.org/curbsiders. 10:00 Case 1: Brenda Cantwell and Breast Lump DDx 13:39 Clinical Breast Exam vs Self Breast Exam 17:26 Practical Tips for the Clinical Breast Exam 21:50 Imaging to Evaluate the Breast Lump 26:36 Demystifying BIRADS 28:36 Epidemiology Potpourri 33:02 Breast Pain without a Mass 34:30 Case 2: Mammie Gram and Breast Screening 46:03 Average Risk vs High Risk Screening 47:18 Breast Risk Prediction Tools 48:51 Breast Density 53:16 Imaging Modalities 61:28 Shared Decision Making in Screening 68:04 Case 3: Ms Britta Lumpworth and When to Stop Screening Mammograms 74:42 Take Home Points and Outro Sponsor - VCU Health Continuing Education Links* Evicted: Poverty and Profit in the American City by Matthew Desmond Run The List podcast ACOG Practice Bulletin 179, 2017 Elmore et al, Ten Year Risk of False Positive Screening Mammograms and Clinical Breast Examinations, N Engl J Med, 1998. Thomas, et al, Randomized trial of breast self-exam in Shanghai: final results. JNCI, 2002. Semagliazov et al, Results of a prospective randomized investigation [Russia] to evaluate the significance of self-examination for the early detection of breast cancer, Vopr Onkol, 2003. Fuller, M. S., Lee, C. I., & Elmore, J. G. Breast cancer screening: an evidence-based update. The Medical clinics of North America, 2015. Chan et al, False-negative rate of combined mammography and ultrasound for women with palpable breast masses. Breast Cancer Res Treat, 2015. ACS Recommendations for the Early Detection of Breast Cancer, 2020. USPTF Breast Cancer Screening Recommendations, 2016. Henderson et al, Breast Examination Techniques, 2020. Kolb et al. Comparison of the performance of screening mammography, physical exam, and breast ultrasound and evaluation of factors that influence them: an analysis of 27.825 patient evaluations, Radiology, 2002. Mammogram Interpretation, Chapter 2. Radiology Key.Com. Flobbe et al, The Additional Diagnostic Value of Ultrasonography in the Diagnosis of Breast Cancer. Arch Intern Med, 2003. ACS Understanding Mammogram Readings, 2019. Bittner, Guide to mammography reports: BIRADS terminology, Am Fam Physician, 2010. Seer cancer statistics review, 1975-2017. 2020. Anders CK et al, Breast carcinomas arising at a young age: unique biology or a surrogate for aggressive intrinsic subtypes?. Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2011 ACS How Common is Breast Cancer? SEER Lifetime Risk (%) of Dying from Cancer by Site and Race/Ethnicity: Females, Total US, 2014-2016 Garcia et al, Cardiovascular disease in women: clinical perspectives, Circ res, 2017. Cancer Statistics Center: Breast Statistics. Independent UK Panel on Breast Cancer Screening, The Benefits and harms of breast cancer screening: an independent review, Lancet, 2012. CDC Breast Cancer Screening Guidelines 2020 ACS Breast Cancer Screening Guidelines, 2015 USPTF Breast Cancer Screening Recommendations, 2016. ACR Breast Cancer Screening Update, 2018. Canadian Task Force Breast Cancer Screening Recommendations UK-NHS Breast Cancer Screening Recommendations Biller-Andorno et al. Perspective: Abolishing Mammography Screening Programs? A View from the Swiss Medical Board, N Eng J Med, 2014. Nelson et al, Effectiveness of Breast Cancer Screening: Systematic Review and Meta-analysis to Update the 2009 US PTF Recommendation, Ann Intern Med, 2016. Miller et al, Twenty five year follow-up for breast cancer incidence and mortality of the Canadian National Breast Screening Study: randomised screening trial, BMJ, 2014. Breast Cancer Risk Assessment Tool (NCI) BCSC Breast Cancer Risk Assessment Tool Health Decision/University of Wisconsin Decision Tool Harding Center for Risk Literacy Fact Box Keating et al, Breast Cancer Screening in 2018: Time for Shared Decision Making, Jama Insights, 2018. ePrognosis life expectancy calculator *The Curbsiders participates in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising commissions by linking to Amazon. Simply put, if you click on our Amazon.com links and buy something we earn a (very) small commission, yet you don’t pay any extra. Goal Listeners will learn how to evaluate a breast lump in the primary care clinic, what the guidelines recommend for asymptomatic breast cancer screening, and how to engage a patient in shared-decision making given the data available on mammograms. Learning objectives After listening to this episode listeners will… Triage and evaluate the Breast Lump Perform breast cancer risk assessment Recall the Guideline Recommendations for Breast Cancer Screening and how they vary Engage patients in conversation about breast cancer screening Perform Shared-Decision Making in deciding when to start mammogram screening and when to stop Disclosures Dr. Keating reports no relevant financial disclosures. The Curbsiders report no relevant financial disclosures. Citation Taranto, N, Keating, NL, Williams PN, Brigham SK, Valdez I, Medford A, Watto MF. “#234 The Breast Lump, and Breast Cancer Screening”. The Curbsiders Internal Medicine Podcast. https://thecurbsiders.com/episode-list. Final publishing date: September 28, 2020. Tags Breast Cancer, Mammogram, Breast Lump, Mass, Cancer Screening, USPTF, American Cancer Society, Screening Guidelines, Controversy, Tomosynthesis, Shared Decision Making , primary care, assistant, care, doctor, education, family, FOAM, FOAMim, FOAMed, health, hospitalist, hospital, internal, internist, meded, medical, medicine, nurse, practitioner, professional, primary, physician, resident, student
REFERENCES1.Bianchi S, Martinoli C, de Gautard R, Gaignot C. Ultrasound of the digital flexor system: Normal and pathological findings(). J Ultrasound. 2007;10(2):85-92.2.DP G. Green's Operative Hand Surgery.3.Hauger O, Chung CB, Lektrakul N, Botte MJ, Trudell D, Boutin RD, et al. Pulley system in the fingers: normal anatomy and simulated lesions in cadavers at MR imaging, CT, and US with and without contrast material distention of the tendon sheath. Radiology. 2000;217(1):201-12.4.Makkouk AH, Oetgen ME, Swigart CR, Dodds SD. Trigger finger: etiology, evaluation, and treatment. Curr Rev Musculoskelet Med. 2008;1(2):92-6.5.Guerini H, Pessis E, Theumann N, Le Quintrec JS, Campagna R, Chevrot A, et al. Sonographic appearance of trigger fingers. J Ultrasound Med. 2008;27(10):1407-13.6.Tagliafico A, Resmini E, van Holsbeeck MT, Derchi LE, Ferone D, Martinoli C. Sonographic depiction of trigger fingers in acromegaly. J Ultrasound Med. 2009;28(11):1441-6.7.Drossos K, Remmelink M, Nagy N, de Maertelaer V, Pasteels JL, Schuind F. Correlations between clinical presentations of adult trigger digits and histologic aspects of the A1 pulley. J Hand Surg Am. 2009;34(8):1429-35.8.Sato J, Ishii Y, Noguchi H. Comparison of the Thickness of Pulley and Flexor Tendon Between in Neutral and in Flexed Positions of Trigger Finger. Open Orthop J. 2016;10:36-40.9.Miyamoto H, Miura T, Isayama H, Masuzaki R, Koike K, Ohe T. Stiffness of the first annular pulley in normal and trigger fingers. J Hand Surg Am. 2011;36(9):1486-91.10.Sbernardori MC, Mazzarello V, Tranquilli-Leali P. Scanning electron microscopic findings of the gliding surface of the A1 pulley in trigger fingers and thumbs. J Hand Surg Eur Vol. 2007;32(4):384-7.11.Tanaka Y, Gotani H, Yano K, Sasaki K, Miyashita M, Hamada Y. Sonographic evaluation of effects of the volar plate on trigger finger. J Orthop Sci. 2015;20(6):999-1004.12.Cordiner-Lawrie S, Diaz J, Burge P, Athanasou NA. Localized amyloid deposition in trigger finger. J Hand Surg Br. 2001;26(4):380-3.13.Matthews A, Smith K, Read L, Nicholas J, Schmidt E. Trigger finger: An overview of the treatment options. JAAPA. 2019;32(1):17-21.14.Kim HR, Lee SH. Ultrasonographic assessment of clinically diagnosed trigger fingers. Rheumatol Int. 2010;30(11):1455-8.15.Chuang XL, Ooi CC, Chin ST, Png MA, Wong SK, Tay SC, et al. What triggers in trigger finger? The flexor tendons at the flexor digitorum superficialis bifurcation. J Plast Reconstr Aesthet Surg. 2017;70(10):1411-9.16.Sato J, Ishii Y, Noguchi H, Takeda M. Sonographic appearance of the flexor tendon, volar plate, and A1 pulley with respect to the severity of trigger finger. J Hand Surg Am. 2012;37(10):2012-20.17.Jacob D, Cohen M, Bianchi S. Ultrasound imaging of non-traumatic lesions of wrist and hand tendons. Eur Radiol. 2007;17(9):2237-47.18.Sato J, Ishii Y, Noguchi H, Takeda M. Sonographic analyses of pulley and flexor tendon in idiopathic trigger finger with interphalangeal joint contracture. Ultrasound Med Biol. 2014;40(6):1146-53.19.Spirig A, Juon B, Banz Y, Rieben R, Vogelin E. Correlation Between Sonographic and In Vivo Measurement of A1 Pulleys in Trigger Fingers. Ultrasound Med Biol. 2016;42(7):1482-90.20.Gruber H, Peer S, Loizides A. The "dark tendon sign" (DTS): a sonographic indicator for idiopathic trigger finger. Ultrasound Med Biol. 2011;37(5):688-92.21.Mogami R, Pereira Vaz JL, de Fatima Barcelos Chagas Y, de Abreu MM, Torezani RS, de Almeida Vieira A, et al. Ultrasonography of Hands and Wrists in the Diagnosis of Complications of Chikungunya Fever. J Ultrasound Med. 2018;37(2):511-20.22.Kaeley GS. Visualization of Enthesitis by Ultrasound: a Key Diagnostic Tool in Spondyloarthropathy Diagnosis and Management. Curr Rheumatol Rep. 2020;22(9):48.23.Tinazzi I, McGonagle D, Aydin SZ, Chessa D, Marchetta A, Macchioni P. 'Deep Koebner' phenomenon of the flexor tendon-associated accessory pulleys as a novel factor in tenosynovitis and dactylitis in psoriatic arthritis. Ann Rheum Dis. 2018;77(6):922-5.24.Sapundzhieva T, Karalilova R, Batalov A. Hand ultrasound patterns in rheumatoid and psoriatic arthritis: the role of ultrasound in the differential diagnosis. Rheumatol Int. 2020;40(6):837-48.25.Tinazzi I, McGonagle D, Macchioni P, Aydin SZ. Power Doppler enhancement of accessory pulleys confirming disease localization in psoriatic dactylitis. Rheumatology (Oxford). 2020;59(8):2030-4.
REFERENCES1.Bianchi S, Martinoli C, de Gautard R, Gaignot C. Ultrasound of the digital flexor system: Normal and pathological findings(). J Ultrasound. 2007;10(2):85-92.2.DP G. Green's Operative Hand Surgery.3.Hauger O, Chung CB, Lektrakul N, Botte MJ, Trudell D, Boutin RD, et al. Pulley system in the fingers: normal anatomy and simulated lesions in cadavers at MR imaging, CT, and US with and without contrast material distention of the tendon sheath. Radiology. 2000;217(1):201-12.4.Makkouk AH, Oetgen ME, Swigart CR, Dodds SD. Trigger finger: etiology, evaluation, and treatment. Curr Rev Musculoskelet Med. 2008;1(2):92-6.5.Guerini H, Pessis E, Theumann N, Le Quintrec JS, Campagna R, Chevrot A, et al. Sonographic appearance of trigger fingers. J Ultrasound Med. 2008;27(10):1407-13.6.Tagliafico A, Resmini E, van Holsbeeck MT, Derchi LE, Ferone D, Martinoli C. Sonographic depiction of trigger fingers in acromegaly. J Ultrasound Med. 2009;28(11):1441-6.7.Drossos K, Remmelink M, Nagy N, de Maertelaer V, Pasteels JL, Schuind F. Correlations between clinical presentations of adult trigger digits and histologic aspects of the A1 pulley. J Hand Surg Am. 2009;34(8):1429-35.8.Sato J, Ishii Y, Noguchi H. Comparison of the Thickness of Pulley and Flexor Tendon Between in Neutral and in Flexed Positions of Trigger Finger. Open Orthop J. 2016;10:36-40.9.Miyamoto H, Miura T, Isayama H, Masuzaki R, Koike K, Ohe T. Stiffness of the first annular pulley in normal and trigger fingers. J Hand Surg Am. 2011;36(9):1486-91.10.Sbernardori MC, Mazzarello V, Tranquilli-Leali P. Scanning electron microscopic findings of the gliding surface of the A1 pulley in trigger fingers and thumbs. J Hand Surg Eur Vol. 2007;32(4):384-7.11.Tanaka Y, Gotani H, Yano K, Sasaki K, Miyashita M, Hamada Y. Sonographic evaluation of effects of the volar plate on trigger finger. J Orthop Sci. 2015;20(6):999-1004.12.Cordiner-Lawrie S, Diaz J, Burge P, Athanasou NA. Localized amyloid deposition in trigger finger. J Hand Surg Br. 2001;26(4):380-3.13.Matthews A, Smith K, Read L, Nicholas J, Schmidt E. Trigger finger: An overview of the treatment options. JAAPA. 2019;32(1):17-21.14.Kim HR, Lee SH. Ultrasonographic assessment of clinically diagnosed trigger fingers. Rheumatol Int. 2010;30(11):1455-8.15.Chuang XL, Ooi CC, Chin ST, Png MA, Wong SK, Tay SC, et al. What triggers in trigger finger? The flexor tendons at the flexor digitorum superficialis bifurcation. J Plast Reconstr Aesthet Surg. 2017;70(10):1411-9.16.Sato J, Ishii Y, Noguchi H, Takeda M. Sonographic appearance of the flexor tendon, volar plate, and A1 pulley with respect to the severity of trigger finger. J Hand Surg Am. 2012;37(10):2012-20.17.Jacob D, Cohen M, Bianchi S. Ultrasound imaging of non-traumatic lesions of wrist and hand tendons. Eur Radiol. 2007;17(9):2237-47.18.Sato J, Ishii Y, Noguchi H, Takeda M. Sonographic analyses of pulley and flexor tendon in idiopathic trigger finger with interphalangeal joint contracture. Ultrasound Med Biol. 2014;40(6):1146-53.19.Spirig A, Juon B, Banz Y, Rieben R, Vogelin E. Correlation Between Sonographic and In Vivo Measurement of A1 Pulleys in Trigger Fingers. Ultrasound Med Biol. 2016;42(7):1482-90.20.Gruber H, Peer S, Loizides A. The "dark tendon sign" (DTS): a sonographic indicator for idiopathic trigger finger. Ultrasound Med Biol. 2011;37(5):688-92.21.Mogami R, Pereira Vaz JL, de Fatima Barcelos Chagas Y, de Abreu MM, Torezani RS, de Almeida Vieira A, et al. Ultrasonography of Hands and Wrists in the Diagnosis of Complications of Chikungunya Fever. J Ultrasound Med. 2018;37(2):511-20.22.Kaeley GS. Visualization of Enthesitis by Ultrasound: a Key Diagnostic Tool in Spondyloarthropathy Diagnosis and Management. Curr Rheumatol Rep. 2020;22(9):48.23.Tinazzi I, McGonagle D, Aydin SZ, Chessa D, Marchetta A, Macchioni P. 'Deep Koebner' phenomenon of the flexor tendon-associated accessory pulleys as a novel factor in tenosynovitis and dactylitis in psoriatic arthritis. Ann Rheum Dis. 2018;77(6):922-5.24.Sapundzhieva T, Karalilova R, Batalov A. Hand ultrasound patterns in rheumatoid and psoriatic arthritis: the role of ultrasound in the differential diagnosis. Rheumatol Int. 2020;40(6):837-48.25.Tinazzi I, McGonagle D, Macchioni P, Aydin SZ. Power Doppler enhancement of accessory pulleys confirming disease localization in psoriatic dactylitis. Rheumatology (Oxford). 2020;59(8):2030-4.
Tuft Fracture Yeh PC et al. Pediatric Hand Fractures. Techniques in Orthopaedics. 2009. Seymour Fracture Nellans et al. Pediatric Hand Injuires. Hand Clin. 2013 November ; 29(4): 569–578 Yeh PC et al. Pediatric Hand Fractures. Techniques in Orthopaedics. 2009. Mallet Fracture Adolescent with mallet finger and Kirschner wire fixation. Nellans et al. Pediatric Hand Injuires. Hand Clin. 2013 November ; 29(4): 569–578 Mallet finger in splint. Yeh PC et al. Pediatric Hand Fractures. Techniques in Orthopaedics. 2009. Volar Plate Injury Yeh PC et al. Pediatric Hand Fractures. Techniques in Orthopaedics. 2009. Central Slip Injury Lee SA et al. Ultrasonography of the finger. Ultrasonography 2016; 35(2): 110-123. Yeh PC et al. Pediatric Hand Fractures. Techniques in Orthopaedics. 2009. Rotational Deformity A, B: Relatively normal appearance; C: in flexion, rotational abnormality evident. Liao CY et al. Pediatric Hand and Wrist Fractures. Clin Plastic Surg 46 (2019) 425–436 Yeh PC et al. Pediatric Hand Fractures. Techniques in Orthopaedics. 2009. Extra-Octave Fracture Mims L et al. Extra-Octave Fracture in a 14-Year-Old Basketball Player. Journal of Pediatrics. 2017; 186: P206-206 Same boy, after reduction and ulnar splint Same boy, on follow-up at 17 days Ulnar Collateral Ligament Injury Yeh PC et al. Pediatric Hand Fractures. Techniques in Orthopaedics. 2009. Bennett Fracture radiopaedia.org Rolando Fracture wikipedia.org Selected References Kiely AL et al. The optimal management of Seymour fractures in children and adolescents: a systematic review protocol. Systematic Reviews. 2020; 9 (150). Liao CY et al. Pediatric Hand and Wrist Fractures. Clin Plastic Surg 46 (2019) 425–436 Lin JS et al. Treatment of Acute Seymour Fractures. J Pediatr Orthop. 2009; 39(1):e23-e27. Mims L et al. Extra-Octave Fracture in a 14-Year-Old Basketball Player. Journal of Pediatrics. 2017; 186: P206-206 Mohseni M et al. Ulnar Collateral Ligament Injury. Stat Pearls. 2020 Nellans et al. Pediatric Hand Injuires. Hand Clin. 2013 November ; 29(4): 569–578 Pattni A et al. Volar Plate Avulsion Injury. Eplasty. 2016; 16: ic22. Stevenson J et al. The use of prophylactic flucloxacillin in treatment of open fractures of the distal phalanx within an accident and emergency department: a double-blind randomized placebo-controlled trial. The Journal of Hand Surgery: British & European. 2003; 28(5): 388-394 Yeh PC et al. Pediatric Hand Fractures. Techniques in Orthopaedics. 2009
References:1.Expert Panel on Women's I, Brown DL, Packard A, Maturen KE, Deshmukh SP, Dudiak KM, et al. ACR Appropriateness Criteria((R)) First Trimester Vaginal Bleeding. J Am Coll Radiol. 2018;15(5S):S69-S77.2.Wang PS, Rodgers SK, Horrow MM. Ultrasound of the First Trimester. Radiol Clin North Am. 2019;57(3):617-33.3.Phillips CH, Wortman JR, Ginsburg ES, Sodickson AD, Doubilet PM, Khurana B. First-trimester emergencies: a radiologist's perspective. Emerg Radiol. 2018;25(1):61-72.4.Murugan VA, Murphy BO, Dupuis C, Goldstein A, Kim YH. Role of ultrasound in the evaluation of first-trimester pregnancies in the acute setting. Ultrasonography. 2020;39(2):178-89.5.Knez J, Day A, Jurkovic D. Ultrasound imaging in the management of bleeding and pain in early pregnancy. Best Pract Res Clin Obstet Gynaecol. 2014;28(5):621-36.6.Promes SB, Nobay F. Pitfalls in first-trimester bleeding. Emerg Med Clin North Am. 2010;28(1):219-34, x.7.Dighe M, Cuevas C, Moshiri M, Dubinsky T, Dogra VS. Sonography in first trimester bleeding. J Clin Ultrasound. 2008;36(6):352-66.8.Leite J, Ross P, Rossi AC, Jeanty P. Prognosis of very large first-trimester hematomas. J Ultrasound Med. 2006;25(11):1441-5.9.Stein MW, Ricci ZJ, Novak L, Roberts JH, Koenigsberg M. Sonographic comparison of the tubal ring of ectopic pregnancy with the corpus luteum. J Ultrasound Med. 2004;23(1):57-62.
References:1.Expert Panel on Women's I, Brown DL, Packard A, Maturen KE, Deshmukh SP, Dudiak KM, et al. ACR Appropriateness Criteria((R)) First Trimester Vaginal Bleeding. J Am Coll Radiol. 2018;15(5S):S69-S77.2.Wang PS, Rodgers SK, Horrow MM. Ultrasound of the First Trimester. Radiol Clin North Am. 2019;57(3):617-33.3.Phillips CH, Wortman JR, Ginsburg ES, Sodickson AD, Doubilet PM, Khurana B. First-trimester emergencies: a radiologist's perspective. Emerg Radiol. 2018;25(1):61-72.4.Murugan VA, Murphy BO, Dupuis C, Goldstein A, Kim YH. Role of ultrasound in the evaluation of first-trimester pregnancies in the acute setting. Ultrasonography. 2020;39(2):178-89.5.Knez J, Day A, Jurkovic D. Ultrasound imaging in the management of bleeding and pain in early pregnancy. Best Pract Res Clin Obstet Gynaecol. 2014;28(5):621-36.6.Promes SB, Nobay F. Pitfalls in first-trimester bleeding. Emerg Med Clin North Am. 2010;28(1):219-34, x.7.Dighe M, Cuevas C, Moshiri M, Dubinsky T, Dogra VS. Sonography in first trimester bleeding. J Clin Ultrasound. 2008;36(6):352-66.8.Leite J, Ross P, Rossi AC, Jeanty P. Prognosis of very large first-trimester hematomas. J Ultrasound Med. 2006;25(11):1441-5.9.Stein MW, Ricci ZJ, Novak L, Roberts JH, Koenigsberg M. Sonographic comparison of the tubal ring of ectopic pregnancy with the corpus luteum. J Ultrasound Med. 2004;23(1):57-62.
The Journal of Rheumatology's Editor-in-Chief Earl Silverman talks about this month's selection of articles that are most relevant to the clinical rheumatologist. This month's selections include: Longterm, Real-world Safety of Adalimumab in Rheumatoid Arthritis: Analysis of a Prospective US-based Registry by Leslie R. Harrold, Jenny Griffith, Patrick Zueger, Heather J. Litman, Bernice Gershenson, Syed S. Islam, Christine J. Barr, Dianlin Guo, Jonathan Fay and Jeffrey D. Greenberg https://doi.org/10.3899/jrheum.190260 Imaging Techniques: Options for the Diagnosis and Monitoring of Treatment of Enthesitis in Psoriatic Arthritis by Catherine Bakewell, Sibel Zehra Aydin, Veena K. Ranganath, Lihi Eder and Gurjit S. Kaeley https://doi.org/10.3899/jrheum.190512 Association of Poverty Income Ratio with Physical Functioning in a Cohort of Patients with Systemic Lupus Erythematosus by Courtney Hoge, C. Barrett Bowling, S. Sam Lim, Cristina Drenkard and Laura C. Plantinga https://doi.org/10.3899/jrheum.190991 Sleep Quality Is Related to Worsening Knee Pain in Those with Widespread Pain: The Multicenter Osteoarthritis Study by Zhaoli Dai, Tuhina Neogi, Carrie Brown, Michael Nevitt, Cora E. Lewis, James Torner and David T. Felson https://doi.org/10.3899/jrheum.181365 The Relationship Between Physical Examination and Ultrasonography of Large Entheses of the Achilles Tendon and Patellar Tendon Origin by Sibel Zehra Aydin, Sibel Bakirci, Esen Kasapoglu, Concepcion Castillo-Gallego, Fatıma Arslan Alhussain, Zoe R. Ash, Esra Kurum, Dennis McGonagle, Helena Marzo-Ortega, Dafna Gladman and Lihi Eder https://doi.org/10.3899/jrheum.190169 To read the full articles visit www.jrheum.org Music by David Hilowitz
Episode 38: Andy McDonald chats to Scott Epsley the Philadelphia 76ers Medical Director. Scott is an Australian Physiotherapist who has previously worked for Georgetown University, Medstar Sports Medicine and consulted to numerous sporting organisations including the Washington Wizards, Australian Womens Field Hockey and professional athletes across a wide range of sports including basketball, cycling, indy car, golf, and sprinting. Scott is also an RMSK Certified Musculoskeletal Sonographer with a passion for clinical diagnostics and bone stress injuries. In this episode Andy & Scott discuss: Scott’s background & role Ultrasonography in sports medicine Bone Injuries with Ultrasonography Bone Stress Injuries Understanding the bone tissueSymptomsMedical managementPhases & remodellingMonitoringLoading & rehabReturn-to-play Where you can find Scott: LinkedInTwitter Smartletics Tempo AppApple App StoreGoogle App Store Website Keep up to date with everything that is going on with the podcast by following Inform Performance on: InstagramTwitterOur Website Our Team Andy McDonaldBen Ashworth
Dr. Paula Ferrada joins us on Rounds this week to discuss several topics ranging from a circulation first approach in hemodynamically unstable trauma patients to the importance of inclusion, diversity, and equity in surgery & medicine. Clinical pearls, invaluable insight, and career advice for learners at different stages of their careers round out a fantastic episode that you'll want to share with your friends and colleagues.
In this VETgirl online veterinary CE podcast, we review lung utlrasonography use in coughing dogs. Coughing is a common clinical sign associated with a variety of respiratory etiologies in dogs, including dynamic airway collapse, bronchitis, pneumonia, heartworm disease, and neoplasia. Congestive heart failure (CHF) is commonly reported to be associated with coughing in dogs, although there is much debate as to whether this clinical sign could actually be directly attributable to pulmonary edema (which is generally interstitial or alveolar in location) given the distribution of cough receptors primarily in the large airways. It is possible that coughing in dogs with congestive heart failure is due to cardiogenic airway compression, or concurrent primary respiratory disease.
In this VETgirl online veterinary CE podcast, we review lung utlrasonography use in coughing dogs. Coughing is a common clinical sign associated with a variety of respiratory etiologies in dogs, including dynamic airway collapse, bronchitis, pneumonia, heartworm disease, and neoplasia. Congestive heart failure (CHF) is commonly reported to be associated with coughing in dogs, although there is much debate as to whether this clinical sign could actually be directly attributable to pulmonary edema (which is generally interstitial or alveolar in location) given the distribution of cough receptors primarily in the large airways. It is possible that coughing in dogs with congestive heart failure is due to cardiogenic airway compression, or concurrent primary respiratory disease.
Dr. Centor discusses the appropriate use of focused bedside cardiac ultrasonography with Dr. Renee Dversdal of Oregon Health and Science University.
¡Gracias por escuchar! En este episodio repaso algunos conceptos relevantes sobre la dactilítis, una manifestación común en espondiloartritis. Les pido amablemente que califiquen este episodio en iTunes, o dejen sus comentarios en esta página. El podcast se encuentra disponible también en Spotify y a través de la aplicación gestora de podcasts de su elección.Abajo enlisto referencias útiles, algunas mencionadas en el episodio: Olivieri, I., Scarano, E., Padula, A., Giasi, V. & Priolo, F. Dactylitis, a term for different digit diseases. Scand. J. Rheumatol. 35, 333–340 (2006). Gladman, D. D., Ziouzina, O., Thavaneswaran, A. & Chandran, V. Dactylitis in psoriatic arthritis: prevalence and response to therapy in the biologic era. J. Rheumatol. 40, 1357–1359 (2013). Ritchlin, C. T., Colbert, R. A. & Gladman, D. D. Psoriatic arthritis. N. Engl. J. Med. 376, 957–970 (2017). Rothschild, B. M., Pingitore, C. & Eaton, M. Dactylitis: implications for clinical practice. Semin. Arthritis Rheum. 28, 41–47 (1998). Taylor, W. J. et al. Classification criteria for psoriatic arthritis: development of new criteria from a large international study. Arthritis Rheum. 54, 2665–2673 (2006). Rudwaleit, M. et al. The Assessment of Spondyloarthritis International Society classification criteria for peripheral spondyloarthritis and for spondyloarthritis in general. Ann. Rheum. Dis. 70, 25–31 (2011). Brockbank, J. E., Stein, M., Schentag, C. T. & Gladman, D. D. Dactylitis in psoriatic arthritis: a marker for disease severity? Ann. Rheum. Dis. 64, 188–190 (2005). Kavanaugh, A., Helliwell, P. & Ritchlin, C. T. Psoriatic arthritis and burden of disease: patient perspectives from the population-based multinational assessment of psoriasis and psoriatic arthritis (MAPP) survey. Rheumatol. Ther. 3, 91–102 (2016). Kaeley, G. S., Eder, L., Aydin, S. Z., Gutierrez, M. & Bakewell, C. Dactylitis: a hallmark of psoriatic arthritis. Semin. Arthritis Rheum. 48, 263–273 (2018). McGonagle, D., Conaghan Philip, G. & Emery, P. Psoriatic arthritis: a unified concept twenty years on. Arthritis Rheum. 42, 1080–1086 (2001). Tinazzi, I. et al. ‘Deep Koebner’ phenomenon of the flexor tendon-associated accessory pulleys as a novel factor in tenosynovitis and dactylitis in psoriatic arthritis. Ann. Rheum. Dis. 77, 922 (2018). Pattison, E., Harrison, B. J., Griffiths, C. E., Silman, A. J. & Bruce, I. N. Environmental risk factors for the development of psoriatic arthritis: results from a case-control study. Ann. Rheum. Dis. 67, 672–676 (2008). Ng, J., Tan, A. L. & McGonagle, D. Unifocal psoriatic arthritis development in identical twins following site specific injury: evidence supporting biomechanical triggering events in genetically susceptible hosts. Ann. Rheum. Dis. 74, 948–949 (2015). Jacques, P. et al. Proof of concept: enthesitis and new bone formation in spondyloarthritis are driven by mechanical strain and stromal cells. Ann. Rheum. Dis. 73, 437–445 (2014). Jacques, P. & McGonagle, D. The role of mechanical stress in the pathogenesis of spondyloarthritis and how to combat it. Best Pract. Res. Clin. Rheumatol. 28, 703–710 (2014). Thorarensen, S. M. et al. Physical trauma recorded in primary care is associated with the onset of psoriatic arthritis among patients with psoriasis. Ann. Rheum. Dis. 76, 521–525 (2017). Wilkins, R. A., Siddle, H. J., Redmond, A. C. & Helliwell, P. S. Plantar forefoot pressures in psoriatic arthritis-related dactylitis: an exploratory study. Clin. Rheumatol. 35, 2333–2338 (2016). Tan, A. L. & McGonagle, D. The need for biological outcomes for biological drugs in psoriatic arthritis. J. Rheumatol. 43, 3–6 (2016). Mumtaz, A. et al. Development of a preliminary composite disease activity index in psoriatic arthritis. Ann. Rheum. Dis. 70, 272–277 (2011). Helliwell, P. S. et al. The development of candidate composite disease activity and responder indices for psoriatic arthritis (GRACE project). Ann. Rheum. Dis. 72, 986–991 (2013). Ramiro, S., Smolen, J. S., Landewe, R., van der Heijde, D. & Gossec, L. How are enthesitis, dactylitis and nail involvement measured and reported in recent clinical trials of psoriatic arthritis? A systematic literature review. Ann. Rheum. Dis. 77, 782–783 (2017). Salvarani, C. et al. A comparison of cyclosporine, sulfasalazine, and symptomatic therapy in the treatment of psoriatic arthritis. J. Rheumatol. 28, 2274–2282 (2001). Antoni, C. E. et al. Sustained benefits of infliximab therapy for dermatologic and articular manifestations of psoriatic arthritis: results from the infliximab multinational psoriatic arthritis controlled trial (IMPACT). Arthritis Rheum. 52, 1227–1236 (2005). Clegg, D. O. et al. Comparison of sulfasalazine and placebo in the treatment of psoriatic arthritis. A Department of Veterans Affairs Cooperative Study. Arthritis Rheum. 39, 2013–2020 (1996). Helliwell, P. S. et al. Development of an assessment tool for dactylitis in patients with psoriatic arthritis. J. Rheumatol. 32, 1745–1750 (2005). Healy, P. J. & Helliwell, P. S. Measuring dactylitis in clinical trials: which is the best instrument to use? J. Rheumatol. 34, 1302–1306 (2007). Chandran, V. et al. International multicenter psoriasis and psoriatic arthritis reliability trial for the assessment of skin, joints, nails, and dactylitis. Arthritis Rheum. 61, 1235–1242 (2009).Mease, P. et al. Effect of certolizumab pegol on signs and symptoms in patients with psoriatic arthritis: 24-week results of a phase 3 double-blind randomised placebo-controlled study (RAPID-PsA). Ann. Rheum. Dis. 73, 48–55 (2014). Fournie, B. et al. Extrasynovial ultrasound abnormalities in the psoriatic finger. Prospective comparative power-doppler study versus rheumatoid arthritis. Joint Bone Spine 73, 527–531 (2006). Benjamin, M. & McGonagle, D. The anatomical basis for disease localisation in seronegative spondyloarthropathy at entheses and related sites. J. Anat. 199, 503–526 (2001). Kane, D., Greaney, T., Bresnihan, B., Gibney, R. & FitzGerald, O. Ultrasonography in the diagnosis and management of psoriatic dactylitis. J. Rheumatol. 26, 1746–1751 (1999). Tinazzi, I. et al. Comprehensive evaluation of finger flexor tendon entheseal soft tissue and bone changes by ultrasound can differentiate psoriatic arthritis and rheumatoid arthritis. Clin. Exp. Rheumatol. 36, 785–790 (2018). McGonagle, D., Gibbon, W. & Emery, P. Classification of inflammatory arthritis by enthesitis. Lancet 352, 1137–1140 (1998). Olivieri, I. et al. Dactylitis in patients with seronegative spondylarthropathy. Assessment by ultrasonography and magnetic resonance imaging. Arthritis Rheum. 39, 1524–1528 (1996).Olivieri, I. et al. Toe dactylitis in patients with spondyloarthropathy: assessment by magnetic resonance imaging. J. Rheumatol. 24, 926–930 (1997). Olivieri, I. et al. Fast spin echo-T2-weighted sequences with fat saturation in dactylitis of spondylarthritis. No evidence of entheseal involvement of the flexor digitorum tendons. Arthritis Rheum. 46, 2964–2967 (2002). Healy, P. J., Groves, C., Chandramohan, M. & Helliwell, P. S. MRI changes in psoriatic dactylitis extent of pathology, relationship to tenderness and correlation with clinical indices. Rheumatology 47, 92–95 (2008). Tan, A. L. et al. High-resolution MRI assessment of dactylitis in psoriatic arthritis shows flexor tendon pulley and sheath-related enthesitis. Ann. Rheum. Dis. 74, 185–189 (2015). FitzGerald, O., Haroon, M., Giles, J. T. & Winchester, R. Concepts of pathogenesis in psoriatic arthritis: genotype determines clinical phenotype. Arthritis Res. Ther. 17, 115 (2015). McHugh, K. & Bowness, P. The link between HLA-B27 and SpA—new ideas on an old problem. Rheumatology 51, 1529–1539 (2012). Ritchlin, C. T. et al. Treatment recommendations for psoriatic arthritis. Ann. Rheum. Dis. 68, 1387–1394 (2009). Coates, L. C. et al. Group for Research and Assessment of Psoriasis and Psoriatic Arthritis 2015 treatment recommendations for psoriatic arthritis. Arthritis Rheum. 68, 1060–1071 (2016). Gossec, L. et al. European League Against Rheumatism (EULAR) recommendations for the management of psoriatic arthritis with pharmacological therapies: 2015 update. Ann. Rheum. Dis. 75, 499–510 (2016). Coates, L. & Helliwell, P. S. Methotrexate efficacy in the Tight Control in Psoriatic Arthritis study. J. Rheum. 43, 356–361 (2016). Rose, S., Toloza, S., Bautista-Molano, W. & Helliwell, P. S. Comprehensive treatment of dactylitis in psoriatic arthritis. J. Rheumatol. 41, 2295–2300 (2014). Kavanaugh, A. et al. Efficacy and safety of ustekinumab in psoriatic arthritis patients with peripheral arthritis and physician-reported spondylitis: post-hoc analyses from two phase III, multicentre, double-blind, placebo-controlled studies (PSUMMIT-1/PSUMMIT-2). Ann. Rheum. Dis. 75, 1984–1988 (2016). Mease, P. et al. Tofacitinib or adalimumab versus placebo for psoriatic arthritis. N. Engl. J. Med. 377, 1537–1550 (2017). Kavanaugh, A. et al. Golimumab in psoriatic arthritis: one-year clinical efficacy, radiographic, and safety results from a phase III, randomized, placebo-controlled trial. Arthritis Rheum. 64, 2504–2517 (2012). Kavanaugh, A. & Mease, P. Treatment of psoriatic arthritis with tumor necrosis factor inhibitors: longer-term outcomes including enthesitis and dactylitis with golimumab treatment in the Longterm Extension of a Randomized, Placebo-controlled Study (GO-REVEAL). J. Rheumatol. Suppl. 89, 90–93 (2012). Antoni, C. E. et al. Two-year efficacy and safety of infliximab treatment in patients with active psoriatic arthritis: findings of the Infliximab Multinational Psoriatic Arthritis Controlled Trial (IMPACT). J. Rheumatol. 35, 869–876 (2008). Kavanaugh, A. et al. Infliximab maintains a high degree of clinical response in patients with active psoriatic arthritis through 1 year of treatment: results from the IMPACT 2 trial. Ann. Rheum. Dis. 66, 498–505 (2007). Baranauskaite, A. et al. Infliximab plus methotrexate is superior to methotrexate alone in the treatment of psoriatic arthritis in methotrexate-naive patients: the RESPOND study. Ann. Rheum. Dis. 71, 541–548 (2012). Carron, P. et al. Scintigraphic detection of TNF-driven inflammation by radiolabelled certolizumab pegol in patients with rheumatoid arthritis and spondyloarthritis. RMD Open 2, e000265 (2016). Nash, P. et al. Efficacy and safety of secukinumab administration by autoinjector in patients with psoriatic arthritis: results from a randomized, placebo-controlled trial (FUTURE 3). Arthritis Res. Ther. 20, 47 (2018). Mease, P. et al. Secukinumab improves active psoriatic arthritis symptoms and inhibits radiographic progression: primary results from the randomised, double-blind, phase III FUTURE 5 study. Ann. Rheum. Dis. 77, 890–897 (2018). Mease, P. J. et al. Ixekizumab, an interleukin-17A specific monoclonal antibody, for the treatment of biologic-naive patients with active psoriatic arthritis: results from the 24-week randomised, double-blind, placebo-controlled and active (adalimumab)-controlled period of the phase III trial SPIRIT-P1. Ann. Rheum. Dis. 76, 79–87 (2017). Wells, A. F. et al. Apremilast monotherapy in DMARD-naive psoriatic arthritis patients: results of the randomized, placebo-controlled PALACE 4 trial. Rheumatology 57, 1253–1263 (2018). Gladman, D. et al. Tofacitinib for psoriatic arthritis in patients with an inadequate response to TNF inhibitors. N. Engl. J. Med. 377, 1525–1536 (2017). Mease, P. J. et al. Efficacy and safety of abatacept, a T cell modulator, in a randomised, double-blind, placebo-controlled, phase III study in psoriatic arthritis. Ann. Rheum. Dis. 76, 1550–1558 (2017). Genovese Mark, C. et al. Apremilast in patients with active rheumatoid arthritis: a phase II, multicenter, randomized, double-blind, placebo-controlled, parallel-group study. Arthritis Rheum. 67, 1703–1710 (2015). Smolen, J. S. et al. A randomised phase II study evaluating the efficacy and safety of subcutaneously administered ustekinumab and guselkumab in patients with active rheumatoid arthritis despite treatment with methotrexate. Ann. Rheum. Dis. 76, 831–839 (2017). Kavanaugh, A. et al. Treatment of psoriatic arthritis in a phase 3 randomised, placebo-controlled trial with apremilast, an oral phosphodiesterase 4 inhibitor. Ann. Rheum. Dis. 73, 1020–1026 (2014). Kunwar, S., Dahal, K. & Sharma, S. Anti-IL-17 therapy in treatment of rheumatoid arthritis: a systematic literature review and meta-analysis of randomized controlled trials. Rheumatol. Int. 36, 1065–1075 (2016). da Silva Junior, G. B., Daher Ede, F. & da Rocha, F. A. Osteoarticular involvement in sickle cell disease. Rev. Bras. Hematol. Hemoter. 34, 156–164 (2012). Braum, L. S. et al. Characterisation of hand small joints arthropathy using high-resolution MRI — limited discrimination between osteoarthritis and psoriatic arthritis. Eur. Radiol. 23, 1686–1693 (2013). Tan, A. L., Grainger, A. J., Tanner, S. F., Emery, P. & McGonagle, D. A high-resolution magnetic resonance imaging study of distal interphalangeal joint arthropathy in psoriatic arthritis and osteoarthritis: are they the same? Arthritis Rheum. 54, 1328–1333 (2006). Tuttle, K. S., Vargas, S. O., Callahan, M. J., Bae, D. S. & Nigrovic, P. A. Enthesitis as a component of dactylitis in psoriatic juvenile idiopathic arthritis: histology of an established clinical entity. Pediatr. Rheumatol. Online J. 13, 7 (2015). Nash, P. et al. Ixekizumab for the treatment of patients with active psoriatic arthritis and an inadequate response to tumour necrosis factor inhibitors: results from the 24-week randomised, double-blind, placebo-controlled period of the SPIRIT-P2 phase 3 trial. Lancet 389, 2317–2327 (2017).Jeong, H. et al. Spondyloarthritis features in zymosan-induced SKG mice. Joint Bone Spine 85, 583–591 (2018).
deSouza IS et al. Accuracy of Physical Examination, Ankle-Brachial Index, and Ultrasonography in the Diagnosis of Arterial Injury in Patients With Penetrating Extremity Trauma: A Systematic Review and Meta-analysis. Acad Emerg Med. 2017 Aug;24(8):994-1017. doi: 10.1111/acem.13227. Review. PubMed PMID: 28493614. https://onlinelibrary.wiley.com/doi/full/10.1111/acem.13227
Author: Michael Hunt, MD Educational Pearls: Bedside transtracheal ultrasound to confirm proper endotracheal intubation is simple and effective Review of 17 studies showed transtracheal ultrasound was was 98.7% sensitive and 97.1% specific Curvilinear probe may be preferable as it provides a larger field of view Editor’s Note: rather than explain what you’re looking for… just go here References: Gottlieb M, Holladay D, Peksa GD. Ultrasonography for the Confirmation of Endotracheal Tube Intubation: A Systematic Review and Meta-Analysis. Ann Emerg Med. 2018 Dec;72(6):627-636. doi: 10.1016/j.annemergmed.2018.06.024. Epub 2018 Aug 14. PubMed PMID: 30119943. Summarized and edited by Erik Verzemnieks, MD
Jaspal Singh, MD, discusses the evolving role of diagnostic point-of-care ultrasonography in critical care pulmonology, how to integrate it into clinical practice, and how to get the most out of the investment.
Today’s episode of the Purdue Dairy Digest talks about the use of lung ultrasonography to assess health in calves. With pneumonia still a large health concern for dairy calves and the risk of pneumonia increasing as we see fluctuations in temperature and humidity, this may be a tool to use to determine the extent of lung damage on farms. Previous research has indicated that lung damage can be predictive of future performance of an animal. Listen to this podcast to learn a little bit more about how to use lung scans to determine health status of calves.
Back in Brian’s office as the studio was busy, different microphones though luckily a fabulous guest, Nell Fitzgerald, one of our lecturers in diagnostic imaging here at the RVC. We have a chat about the technical aspects of ultrasound and tips on how to get the best out of your machine if you are starting off, or if you are experienced but often wondered what those buttons are meant to do. We hope that you enjoy. There are some ultrasound courses run through the RVC CPD (other course providers are available, though not sure that they would all be given a 5-star rating!) https://www.rvc.ac.uk/study/cpd Some papers of interest: Lamb C, Boswood A Doppler ultrasound examination in dogs and cats In Practice 2005;27:183-189. Lamb C Doppler ultrasound examination in dogs and cats In Practice 2005;27:238-247. If you have any comments about this podcast, please get in touch: email dbarfield@rvc.ac.uk; tweet @dombarfield. We would greatly appreciate your time to rate us on Apple podcast or Acast and kindly write us a review.
Back in Brian’s office as the studio was busy, different microphones though luckily a fabulous guest. Nell Fitzgerald one of our lecturers in diagnostic imaging here at the RVC. We have a chat about the technical aspects of ultrasound and tips on how to get the best out of your machine if you are starting off, or if you are experienced but often wondered what those buttons are meant to do. We hope that you enjoy. There are some ultrasound courses run through the RVC CPD (other course providers are available, though not sure that they would all be given a 5-star rating!) https://www.rvc.ac.uk/study/cpd Some papers of interest: Lamb C, Boswood A Doppler ultrasound examination in dogs and cats In Practice 2005;27:183-189. Lamb C Doppler ultrasound examination in dogs and cats In Practice 2005;27:238-247. If you have any comments about this podcast, please get in touch: email dbarfield@rvc.ac.uk; tweet @dombarfield. We would greatly appreciate your time to rate us on Apple podcast or Acast and kindly write us a review.
Focal liver lesions often occur with or without an underlying liver disease. Contrast-enhanced ultrasonography can aid in characterizing liver lesions, potentially avoiding biopsy and computed tomography procedures. Contrast-enhanced ultrasonography has a high sensitivity and specificity for differentiating characteristics of liver lesions compared with noncontrast sonography. The different contrast characteristics aid in differentiating benign and malignant lesions. Malignant lesions tend to have washout of contrast in the venous phases, whereas benign lesions have hyperenhancement during the venous phases. Therefore, contrast-enhanced ultrasonography should be considered an essential component of the diagnostic process for diagnosing and following focal liver lesions.
In the November/December 2017 JDMS podcast, Associate Editor Sharlette D. Anderson and author Jennifer E. Bagley discuss her article "The Use of Contrast-Enhanced Ultrasonography for the Characterization of Focal Liver Lesions." To view this article, click here.
Welcome to the Why Urology Podcast. This podcast is my personal exploration of the field of urology. My hope is that you learn something about your genitourinary tract, what can go wrong, and how your urologist can try to fix it. In episode 44 we explored how ultrasound is used in the field of urology. Almost every organ in the urology field can be visualized by ultrasound to try to identify tumors, cysts, infections, changes in blood flow, and other causes for aches, pains, and swelling. Ultrasonography utilizes the principles and physics of sound propagation and reflection to create the pictures that we see. A sound will travel through a substance until it reaches something of a different density. Sound will then be reflected as a form of echo. An ultrasound utilizes a transducer that emits ultrasonic waves through a person's body. When sound waves contact tissues of different density some are reflected back to the transducer which also acts as a receiver. By measuring the sound reflected back to the transducer a map of tissue density can be created and displayed on a screen print it as an image. This is episode number 45 and I want to introduce you to the “Father of Medical Ultrasound,” Dr. John J. Wild (1914-2009). Dr. John Wild is a man I would have like to have met in person. Dr. Wild wrote this of himself, "I think I must have come into this world with a propensity for making chaos out of order, since I always seem to be upsetting those concerned with maintaining conventional levels of orderliness and humbleness. . . . In my ultrasonic work I have met many people who did not believe the evidence of their own eyes even when the miracles of pulse-echo ultrasound were demonstrated to them." But others had a different opinion. I quote an obituary I found online: “To his patients, friends and some colleagues he is remembered as kind, entertaining, and galvanizingly brilliant.” According to another online obituary his discovery can be summed up as follows: “In 1949 he made the groundbreaking discovery that sonic energy (pulse-echo ultrasound) was reflected as echoes from soft biological tissues [when he] tinkered with military and aircraft equipment that included ultrasonic capabilities. Realizing the significance of the discovery, [he] went on to pioneer a new field of medicine, and produced the first real-time ultrasonic images of a living human patient.” In the 1600s, British polymath Robert Hooke predicted we would be able to listen to the internal sounds of a person to determine what ailed them. In the latter half of the 20th century Dr. John J. Wild made it happen. Let's hear how he did it. Bibliography https://en.wikipedia.org/wiki/Ultrasound https://en.wikipedia.org/wiki/Hearing_range https://hypertextbook.com/facts/2003/ChrisDAmbrose.shtml https://en.wikipedia.org/wiki/Robert_Hooke http://slphistory.org/wildjohn/ http://www.telegraph.co.uk/news/obituaries/medicine-obituaries/6216084/John-Wild.html?fb https://en.wikipedia.org/wiki/Animal_echolocation http://www.nytimes.com/2009/10/07/health/07wild.html http://www.startribune.com/obituaries/detail/12189928/?fullname=john-julian-wild http://www.ob-ultrasound.net/jjwildbio.html Inventive Minds: Creativity in Technology, edited by Robert J Weber and David N. Perkins, 1992. Chapter 6 written by John J Wild “The Origin of Soft Tissue Ultrasonic Echoing and Early Instrumental Application to clinical Medicine.” pg. 115.
Dr David Johnson provides clinicians with an overview of the new guidelines from the American Association for the Study of Liver Diseases (AASLD) on hepatocellular carcinoma.
I want to start this episode with a quote from Robert Hooke, a British natural philosopher, architect and polymath who lived and worked during the years 1635 to 1703. Hooke's personal story as a hardworking and honest, but ultimately irascible and enigmatic character is one I will save for another time but as I was working on this episode I found a quote attributed to him relevant to our topic for this episode. Robert Hooke wrote the following in the late 1600s: “It may be possible to discover the motions of the internal parts of bodies, whether animal, vegetable, or mineral, by the sound they make; that one may discover the works performed in the several offices and shops of a man's body, and thereby (sic) discover what instrument or engine is out of order…[I could proceed further, but methinks I can hardly forbear to blush when I consider how the most part of men will look upon this: but, yet again,] I have this encouragement, not to think all these things utterly impossible.” Today we will explore how Robert Hooke's prediction from the late 1600s has come true. In this episode, I'm going to be discussing a type of radiologic imaging used often in urology called ultrasonography or, more commonly, ultrasound. I recently had a moment to reflect on ultrasonography as one of my young partners and his wife are currently pregnant with their first child. Just to be technical here, she is doing the work of the pregnancy and he is taking on the responsibility of being anxious and excited. As only a nervous future father can do he was showing me the ultrasound that had been done of the 20-week-old baby in utero. The pictures, of course, showed the baby's development in striking detail. facial structures, small hands and feet, a beating heart, and last but not least, the picture that my partner and I examined with the most scrutiny…wait for it…the developing genitalia. That's right. It's a boy! According to one website describing ultrasound technology, ultrasound is marvelous for its ability to “peer inside patients with nary a needle or knife to be seen.” Although ultrasound lacks the resolution of CT scans or MRI scan, it also is easier and less costly to perform, doesn't have the ionizing radiation associated with CT imaging, and the results can be seen right away. No needle, no knife. Ultrasound technology has allowed us to identify distinct characteristics of a child in utero. We talked in episode number 41 with Dr. Chris Atalla about how we use the ultrasound technology during a robotic partial nephrectomy. Ultrasound is critical in defining, intraoperatively, the anatomic extent of endophytic masses during complex partial nephrectomy cases. Placing an ultrasound probe through a laparoscopic port directly on to the kidney during the surgery allows the surgeon to determine the tumor's location on the kidney, its depth within the parenchyma, and size and location relative to the renal vasculature and/or ureter to avoid injury to those structures during the procedure. The first reported use of ultrasound technology in urology was for characterization of renal masses into either cystic or solid. In 1970, Dr. Barry Goldberg and Dr. Howard Pollack presented at a meeting of the AUA in Philadelphia a report characterizing 150 renal masses into either cystic or solid based on A-mode ultrasound technology. In 144 of the 150 cases (96 per cent), the physical state of the mass, that is cystic, solid or complex in nature, was correctly predicted. This was a major breakthrough because, at that time, characterization of masses into the typically benign cyst or often cancerous solid mass typically required invasive procedures such as arteriography, aspiration, biopsy or surgical. The immediate advantage of being able to characterize a mass with a high degree of certainty without an invasive procedure was immediately apparent. The study that I am referencing can, at the time of this recording, still be found online along with a number of other groundbreaking articles from the Journal of Urology over the last hundred years at JU100.org. Ultrasound has become an important part of my nearly every day existence in the clinic where the determination of a renal lesion as being cystic or solid comes up nearly daily. Ultrasound is used for almost every organ that we deal with in urology as well. Let's looks at the different organs individually Kidneys: Renal ultrasound studies can show the size and position of the kidneys, blockage of the kidneys, kidney stones, blood flow to and from the kidney and, of course, kidney tumors and cysts. Renal Pelvis and Ureter: The renal pelvis is visualized for assessing drainage of the kidney. Obstruction is identified as dilation of the renal pelvis called hydronephrosis. Obstruction usually comes from a kidney stone but can be related to uretero-pelvic junction obstruction, acquired stricture, a tumor of the ureter, or external compression from an abdominal tumor or mass. The ureter is usually not well visualized along its entire course but the upper ureter and lower ureter can sometimes be assessed. Bladder: The most common reason for bladder ultrasound is to check the bladder's ability to empty. The urine that remains in the bladder after urinating is called the "post void residual.” If urine remains, there can be a problem such enlarged prostate, urethral stricture, bladder dysfunction or neurogenic bladder from conditions such as spinal cord injury or multiple sclerosis. Bladder ultrasound can also give information about the thickness of the bladder wall, diverticula of the bladder, bladder stones, and bladder cancers. Prostate: The most common reason for a prostate ultrasound (also called "transrectal ultrasound") is to biopsy men who might be at risk for prostate cancer with elevated PSA tests or prostate abnormalities felt by digital rectal examination. Prostate cancer can't be diagnosed by ultrasound alone so, a tissue sample or "biopsy" of the prostate is also done. Prostate ultrasound can also be used for benign problems as well, such as measuring the volume or size of the prostate to help plan treatment for BPH, or to look for prostate abnormalities or duct obstruction in men with infertility. Scrotum and Testicle: The main reason for scrotal ultrasound is to evaluate swelling, mass, and/or pain. Ultrasound is used to determine if mass is intra-testicular, extra-testicular, solid or cystic to check for testicular cancer. A fluid collection around the testis called a “hydrocele” can be evaluated. Cysts or spermatoceles of the epididymis can be detected. Large, varicose veins of the testicle called “varicoceles” may be found in cases of infertility. Assessing blood flow in the testis is used to evaluate for testicular torsion, a condition that requires immediate treatment. Female Urethra: Transvaginal ultrasound can be used to find a urethral diverticulum. A urethral diverticulum may cause urethral pain and frequent urinary tract infections. Penis: Evaluation of penile blood flow using a Doppler probe is used for evaluation of Peyronies Disease and Erectile Dysfunction. The Doppler can evaluate why a man has ED, diagnosing such problems as arterial insufficiency or venous leak. In cases of Peyronies Disease the extent of Peyronies plaque and degree of curvature can be evaluated to help guide treatment. What is ultrasonography or ultrasound? I want to take brief couple minutes to explain how an ultrasound creates the pictures that we see. Sound travels in waves through the air, the ground, and various other things such our body tissues as a vibration or wave. The number of vibrations per second is called frequency. Frequency varies for each pitch and is measured in hertz. One hertz is equal to one vibration per second. A sound with a low frequency will have a low pitch. A sound with a high frequency will have a high pitch. For reference, the piano's 88 keys span the frequencies 27.5 Hz (A0) to 4186 Hz (C8). A piano tuned to standard concert pitch puts middle C at a frequency around 261.63 A healthy human ear is said to be able to hear frequencies that range from 20 to 20,000 Hertz. Most bats can detect frequencies as high as 100,000 Hz. Elephants can hear sounds at 14–16 Hz, while some whales can hear sounds as low as 7 Hz (in water). Ultrasound refers to sound waves whose frequency is more than 20,000 cycles per second, any sound above human hearing. Any frequency that is below the human ear of 20 hz is known as infrasound. Bats use ultrasound for navigation, called echolocation. Bats send out an ultrasound signal while in flight. As sound travels if something gets in the way sound is reflected back in the form of an echo. The sound waves from the bat bounce of off structures in the bat's flight path and the bats receive the signal back. The bat has the ability to alter its flight to avoid hitting things based on the echoes it receives. Ultrasonography utilizes the principles of sound propagation and reflection to create the pictures that we see when we do an ultrasound Let's go back to my partner's wife. When she is having her ultrasound done, the ultra-sonographer will place a probe called a transducer on her abdomen. Within the transducer ultrasound waves are produced by applying an electrical current to a piezo-electric crystal contained inside. When the transducer is applied to the skin, the waves are transmitted through the contiguous tissues of the body. Any change, however slight, in the nature of the tissue causes some sound to be reflected toward the emitting transducer which also serves as a receiver. Got it? The transducer is sending out sound waves but also recording them as the sound waves are reflected back by the body tissues. The transmission of sound through tissue is determined by the specific acoustical impedance of that tissue. The junction of 2 tissues of different acoustical impedance or density is known as an acoustical interface, and the reflection of sound at an interface is known as an echo. The common form of ultrasound imaging that you and I know is called B-mode ultrasound which displays a dot of light depending on echo depth and intensity from the transducer. All of those dots of light, varying in intensity on a grid, creates a picture when contrasting dots of light and dark create an image on the screen. And those images can show striking detail, not only differentiating a renal mass into something cystic or solid but also allowing us to see, in utero, a baby in development. Amazing. In the 1600s Robert Hooke predicted we would determine the motions of the internal parts of the body by the sounds that they make. And he was right. When sound waves travel through our bodies we each echo back a different chorus based on our internal structure. My mother always said I marched to the sound of my own rhythm. I guess she was right all along.
Discussing the Paper: Smith-Bindman R, Aubin C, Bailitz J, Bengiamin RN, Camargo CA Jr, Corbo J, Dean AJ, Goldstein RB, Griffey RT, Jay GD, Kang TL, Kriesel DR, Ma OJ, Mallin M, Manson W, Melnikow J, Miglioretti DL, Miller SK, Mills LD, Miner JR, Moghadassi M, Noble VE, Press GM, Stoller ML, Valencia VE, Wang J, Wang RC, Cummings SR. Ultrasonography versus computed tomography for suspected nephrolithiasis. N Engl J Med. 2014 Sep 18;371(12):1100-10. DOI. PMID: 25229916. https://www.aliem.com/2015/author-insight-ultrasonography-versus-ct-for-suspected-nephrolithiasis-nejm/ Podcast Editor: David Yang
Todd Fraser, MD, speaks with Alexander B. Levitov, MD, FCCM, FCCP, RDCS. Dr. Levitov is a professor in the division of Pulmonary and Critical Care Medicine and Director of the Ultrasound Training Program at Eastern Virginia Medical School in Norfolk, Virginia.
Todd Fraser, MD, speaks with Alexander B. Levitov, MD, FCCM, FCCP, RDCS. Dr. Levitov is a professor in the division of Pulmonary and Critical Care Medicine and Director of the Ultrasound Training Program at Eastern Virginia Medical School in Norfolk, Virginia.
In this edition of the EVJ podcast, Sue Dyson discusses their paper, entitled 'Proximal suspensory desmopathy in hindlimbs: A correlative clinical, ultrasonographic, gross post mortem and histological study' and Laurie Goodrich discusses their paper 'A comparison of arthroscopy to ultrasonography for identification of pathology of the equine stifle'. These papers have been made free to access for 3 months.
Interview with Arun D. Singh, MD, author of Hepatic Ultrasonography for Surveillance in Patients With Uveal Melanoma
Ludwig Lin, MD, speaks with Michael Blaivas, MD, FACEP, FAIUM. Dr. Blaivas serves as a Professor of Medicine at the University of South Carolina School of Medicine.
Ludwig Lin, MD, speaks with Michael Blaivas, MD, FACEP, FAIUM. Dr. Blaivas serves as a Professor of Medicine at the University of South Carolina School of Medicine.
In this Journal Jam we have Dr. Michelle Lin from Academic Life in EM interviewing two authors, Dr. Rebecca Smith‑Bindman, a radiologist, and Dr. Ralph Wang an EM physician both from USCF on their article “Ultrasonography versus Computed Tomography for suspected Nephrolithiasis” published in the New England Journal of Medicine in 2014. There is currently a wide practice variation in the imaging work-up of the patient who presents to the ED with a high suspicion for renal colic. On the one extreme, some EM physicians use CT to screen all patients who present with renal colic, while on the other extreme, other EM physicians do not use any imaging on any patient who has had previous imaging. The role of POCUS and radiology department ultrasound as an alternative to CT in the work up of renal colic has not been clearly defined in the ED setting. This study was a pragmatic multi-centre randomized control trial of patients in whom the primary diagnostic concern was renal colic, that tried to answer the question: is there a significant difference in the serious missed diagnosis rate, serious adverse events rate, pain, return visits, admissions to hospital, radiation dose and diagnostic accuracy if the EM provider chose POCUS, radiology department ultrasound or CT for their initial imaging modality of choice. This Journal Jam is peer review by EMNerd's Rory Spiegel. [wpfilebase tag=file id=618 tpl=emc-play /] [wpfilebase tag=file id=619 tpl=emc-mp3 /] The post Journal Jam 3 – Ultrasound vs CT for Renal Colic appeared first on Emergency Medicine Cases.
In this Journal Jam we have Dr. Michelle Lin from Academic Life in EM interviewing two authors, Dr. Rebecca Smith‑Bindman, a radiologist, and Dr. Ralph Wang an EM physician both from USCF on their article “Ultrasonography versus Computed Tomography for suspected Nephrolithiasis” published in the New England Journal of Medicine in 2014. There is currently a wide practice variation in the imaging work-up of the patient who presents to the ED with a high suspicion for renal colic. On the one extreme, some EM physicians use CT to screen all patients who present with renal colic, while on the other extreme, other EM physicians do not use any imaging on any patient who has had previous imaging. The role of POCUS and radiology department ultrasound as an alternative to CT in the work up of renal colic has not been clearly defined in the ED setting. This study was a pragmatic multi-centre randomized control trial of patients in whom the primary diagnostic concern was renal colic, that tried to answer the question: is there a significant difference in the serious missed diagnosis rate, serious adverse events rate, pain, return visits, admissions to hospital, radiation dose and diagnostic accuracy if the EM provider chose POCUS, radiology department ultrasound or CT for their initial imaging modality of choice. This Journal Jam is peer review by EMNerd's Rory Spiegel. [wpfilebase tag=file id=618 tpl=emc-play /] [wpfilebase tag=file id=619 tpl=emc-mp3 /] The post Journal Jam 3 – Ultrasound vs CT for Renal Colic appeared first on Emergency Medicine Cases.
Drs. M.P. (Rien) Heijboer, orthopedic surgeon, works at the Dept at Orthopedic at the Erasamus Medical Centre in Rotterdam. He has extensive experience with sports-related injuries and has worked for more than 30 years as medical adviser of football club Feijenoord in Rotterdam. He is a member of the medical staff of the Dutch National Soccer Team and visited the world soccer championships in Brasil in 2014, which he describes as a "life-time experience"! He is president of the Dutch Orthopedic Society (NOV). He has a great interest in sports-related injuries and today Rien discusses his lifetime experience of managing difficult stress fractures in sport. Further reading: Surgical versus conservative treatment for high-risk stress fractures of the lower leg (anterior tibial cortex, navicular and fifth metatarsal base): a systematic review. http://bjsm.bmj.com/content/49/6/370.long Mallee WH, Weel H, van Dijk CN, van Tulder MW, Kerkhoffs GM, Lin CW. Br J Sports Med. 2015 Mar;49(6):370-376. doi: 10.1136/bjsports-2013-093246. Epub 2014 Aug 19. Review. Ultrasonography of fractures in sports medicine. http://bjsm.bmj.com/content/49/3/152.long Hoffman DF, Adams E, Bianchi S. Br J Sports Med. 2015 Feb;49(3):152-60. doi: 10.1136/bjsports-2014-094217. Epub 2014 Dec 24. Fifth metatarsal fractures among male professional footballers: a potential career-ending disease. http://bjsm.bmj.com/content/47/12/754.long Ekstrand J, van Dijk CN. Br J Sports Med. 2013 Aug;47(12):754-8. doi: 10.1136/bjsports-2012-092096. Epub 2013 Apr 9.
Two teams pit their wits in the finals armed with their ultrasonography experience and an ultrasound machine.
Aucune description disponible
Background: The term filariasis comprises a group of parasitic infections caused by helminths belonging to different genera in the superfamily Filaroidea. The human parasites occur mainly in tropical and subtropical regions, but filariae are also found in temperate climates, where they can infect wild and domestic animals. Humans are rarely infected by these zoonotic parasites. Patients and Methods: A 55-year-old patient presented with a new-onset, subcutaneous, non-tender palpable mass in the right axilla. Ultrasonography showed a 1.3-cm, solid, singular encapsulated node. Sonography of the breast on both sides, axilla and lymphatic drainage on the left side, lymphatic drainage on the right side, and mammography on both sides were without pathological findings. The node was excised under local anesthesia as the patient refused minimal invasive biopsy. Results: On histopathological examination, the tail of a parasite of the group of filariae was found. The patient revealed that she had stayed in Africa and Malaysia for professional reasons. 6 months before the time of diagnosis, she had also suffered from a fever and poor general condition after a trip abroad. The patient was referred for further treatment to the Institute for Tropical Medicine at the University of Dusseldorf, where a treatment with ivermectin was conducted on the basis of positive staining with antibodies against filariae. Conclusion: Our case demonstrates the importance of interdisciplinary collaboration between breast center, pathology, and other specialties such as microbiology and tropical medicine.
Mark A. Rosen, MD
Tierärztliche Fakultät - Digitale Hochschulschriften der LMU - Teil 05/07
The aim of this thesis was to evaluate the structure and function of the largest muscle of the equine back, the Longissimus dorsi muscle (LD) and investigate the usefulness of ultrasonography in determining LD architecture in live horses. Dissection of clinically normal horse and pony cadaver backs demonstrated the complex architecture of this muscle with its regional variations in diameter, muscle fibre length and pennation angle. The observed anatomical differences corresponded to regional differences in muscle activity pattern and the intensity of muscle activity in six horses examined. Electrmyographic measurements showed significant diffeneces at different anatomical locations, gait, speed and inclines. Ultrasonography was evaluated as a tool to visualize and quantify LD architecture in live horses. In the first ultrasonographic study the ultrasonographic anatomy of the LD was determined by matching ultrasonographic images to corresponding frozen sections in a cadaver. Inter- and intra-operator repeatability of ultrasound based muscle measurements showed that muscle thickness measurements were found to be reapeatable, pennation angle was not. The presented thesis contributes to understanding the biomechanics of the equine LD by illustrating the relationship between anatomy and function through integrating cadaveric data with measurements in live horses. In the second part the use of ultrasonography in determining LD architecture and functioin in live horses as future diagnostic tool was investigated and its usefulness and limitations established.
Mon, 1 Jan 1990 12:00:00 +0100 https://epub.ub.uni-muenchen.de/9094/1/9094.pdf Scriba, Peter Christian; Löhrs, U.; Hafermann, W.; Gutekunst, R. ddc:610, Med
Sun, 1 Jan 1989 12:00:00 +0100 https://epub.ub.uni-muenchen.de/8883/1/8883.pdf Scriba, Peter Christian; Mansky, T.; Hafermann, W.; Gutekunst, R. ddc
Thu, 1 Jan 1987 12:00:00 +0100 https://epub.ub.uni-muenchen.de/8545/1/8545.pdf Scriba, Peter Christian; Kavishe, F. P.; König, A.; Horn, K.; Gutekunst, R.; Pickardt, C. R.; Wächter, W. ddc:610, Med
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