Download the Free Unbound MEDLINE PubMed App to your smartphone or tablet.
Available for iPhone, iPad, iPod touch, and Android.
- Surgical intervention versus expectant management for endometrial polyps in subfertile women. [JOURNAL ARTICLE]
- Cochrane Database Syst Rev 2014 Aug 30.:CD009592.
Endometrial polyps, which are benign growths of the endometrium, may be a factor in female subfertility. Possible mechanisms include physical interference with gamete transport, alteration of the endometrial milieu and unresponsiveness to the cyclical global endometrial changes. As such polyps remain mostly asymptomatic, their diagnosis is often incidental during routine investigations prior to embarking on assisted reproductive treatment. Transvaginal sonography, hysterosalpingography and saline infusion sonography are the diagnostic tools most commonly employed. However, hysteroscopy remains the gold standard for diagnosis, as well as for treatment. Due to the possible effect of endometrial polyps on fertility, their removal prior to any subfertility treatment is widely practiced.To determine the effectiveness and safety of removal of endometrial polyps in subfertile women.Electronic databases were searched, including the Cochrane Menstrual Disorders and Subfertility Group Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, PsycINFO, CINAHL and trial registers. The reference lists of identified articles were checked. The last search was performed on 30 July 2014.Only randomised controlled trials, reporting pregnancy or live birth rates and complication rates as primary or secondary outcomes, in which polyps were removed surgically prior to treatment of subfertility were eligible for inclusion. The diagnosis of endometrial polyps was required to be made by transvaginal ultrasound, hysterosalpingography, saline infusion, sono-hysterography or hysteroscopy. Any surgical technique of polyp removal was acceptable, with no intervention in the control groups.Two review authors independently screened the titles, abstracts and full articles to assess their suitability for inclusion in this review. Quality assessment was attempted independently by two authors with discrepancies being settled by consensus or consultation with a third review author.No data extraction was performed due to the absence of useable data in the one eligible study. If there had been data to include, two review authors would have independently extracted the data from the studies using a data extraction form designed and pilot tested by the authors. Any disagreements would have been resolved by discussion or by a third review author.Only one randomised controlled trial of endometrial polypectomy was identified for inclusion. However, a single set of data could not be extracted from this study due to internal inconsistencies of the results reported. Attempts to contact the authors to resolve the issue were unsuccessful, by phone, post and e-mail.Removal of endometrial polyps in subfertile women is commonly being performed in many countries with an aim to improve the reproductive outcome. We did not identify any analysable randomised trials which would allow us to reach any sound scientific conclusions on the efficacy of endometrial polypectomy in subfertile women. Well designed, methodologically sound, randomised controlled trials are urgently needed.
- A Meta-Analysis of B-Mode Ultrasound, Doppler Ultrasound, and Computed Tomography to Diagnose Pediatric Ovarian Torsion. [JOURNAL ARTICLE]
- Eur J Pediatr Surg 2014 Aug 30.
Purpose Ovarian torsion (OT) is a true surgical emergency that requires prompt diagnosis and therapy. There are conflicting reports on the accuracy of different imaging modalities for OT. In this study, we performed a meta-analysis of all the published studies on B-mode ultrasound (US, morphological criteria), Doppler US (DUS, flow criteria), and computed tomography (CT) for the diagnosis of OT. Methods The medical literature from 1987 to 2013 was searched for studies that evaluated US, DUS, CT, or combination of these techniques to diagnose OT in children using PubMed/MEDLINE database. The studies were screened and included if the quality criteria were met. Data were extracted using a standardized form. Reported sensitivities and specificities were pooled with 95% confidence intervals using a RevMan version 5.1 software (The Cochrane Collaboration, Oxford, United Kingdom). Results A total of 18 US studies with 716 combined patients were included, along with 15 DUS studies comprising of 1,021 patients, and 5 CT studies with a total of 107 patients. All studies reported sensitivities, while only few selected studies also reported specificities. Using morphological criteria on B-mode US (including absolute or relative ovarian size, echotexture, location, and configuration) yielded high sensitivity and specificity (average 92 and 96%, respectively); DUS was highly specific, but lacked sensitivity, while CT was the least sensitive test. CT specificities could not be calculated from the available data. Conclusion This study found considerable variability of the reported sensitivities and specificities for the diagnosis of OT across all evaluated imaging modalities. Interestingly, B-mode US was the most sensitive and specific examination to detect OT. Some authors reported high diagnostic accuracy of DUS as well, but these findings have not been universally reproduced. CT had low overall sensitivity and is not recommended for the workup of suspected OT.
- The value of ultrasonography and Doppler sonography in prognosticating long-term outcomes among full-term newborns with perinatal asphyxia. [Journal Article]
- Medicina (Kaunas) 2014; 50(2):100-10.
The aim of the study was to determine the correlation of hypoxic-ischemic (HI) brain injury in full-term neonates detected via ultrasonography (USG) and blood flow parameters evaluated via Doppler sonography (DS) with long-term outcomes of mental and neuromotor development at the age of 1-year.In total, 125 full-term neonates (78 subjects of case group and 47 subjects of control group) were studied. During the first five days of life, the subjects daily underwent cerebral USG and DS. At the age of 1-year the neuromotor condition and mental development was evaluated.The HI injury groups detected during USG significantly correlated with the mental development groups (r=0.3; P=0.01) and the neurological evaluation groups (r=0.3; P<0.001). In the presence of brain swelling (edema) and thalamus and/or basal ganglia (E/T/BG) injury, USG demonstrated high accuracy values when prognosticating spastic quadriparesis and severe mental development impairment in 1-year-old subjects: sensitivity - 100%, specificity - 93-100%, positive predictive value (PPV) - 60-100%, and NPV - 100%. In subjects with spastic quadriparesis, mean end-diastolic velocity (Vd) values were significantly higher (P≤0.05), and mean resistive index (RI) values were significantly lower (P<0.05) than those in subjects with normal neuromotor development. In subjects with severe mental retardation, mean Vd values in ACA were statistically significantly higher, and mean RI values in ACA and ACM were statistically significantly lower than those in subjects with normal mental development.Hypoxic-ischemic brain changes detected during ultrasonography and cerebral blood flow parameters associated with long-term outcomes of mental and neuromotor development at the age of 1-year.
- Physiologic and Management Implications of Obesity in Critical Illness. [JOURNAL ARTICLE]
- Ann Am Thorac Soc 2014 Aug 29.
Obesity is highly prevalent in the United States and is becoming increasingly common worldwide. The anatomic and physiologic changes that occur in obese individuals may have an impact across the spectrum of critical illness. Obese patients may be more susceptible to hypoxemia and hypercapnea. During mechanical ventilation, elevated end-expiratory pressures may be required to improve lung compliance and prevent ventilation-perfusion mismatch due to distal airway collapse. Several studies have shown an increased risk of organ dysfunction such as the acute respiratory distress syndrome and acute kidney injury in obese patients. Predisposition to ventricular hypertrophy and increases in blood volume should be considered in fluid management decisions. Obese patients have accelerated muscle losses in critical illness making nutrition essential, though the optimal predictive equation to estimate nutritional needs or formulation for obese patients is not well established. Many common intensive care unit medications are not well-studied in obese patients, necessitating understanding of pharmacokinetic concepts and consultation with pharmacists. Obesity is associated with higher risk of deep venous thrombosis and catheter-associated blood stream infections, likely related to greater average catheter dwell times. Logistical issues such as blood pressure cuff sizing, ultrasound assistance for procedures, diminished quality of some imaging modalities, and capabilities of hospital equipment such as beds and lifts are important considerations. Despite the physiologic alterations and logistical challenges involved, it is not clear whether obesity has an effect on mortality or long-term outcomes from critical illness. Effects may vary by type of critical illness, obesity severity, and obesity-associated comorbidities.
- What do carotid intima-media thickness and plaque add to the prediction of stroke and cardiovascular disease risk in older adults? The cardiovascular health study. [Journal Article]
- J Am Soc Echocardiogr 2014 Sep; 27(9):998-1005.e2.
The aim of this study was to evaluate whether the addition of ultrasound carotid intima-media thickness (CIMT) measurements and risk categories of plaque help predict incident stroke and cardiovascular disease (CVD) in older adults.Carotid ultrasound studies were recorded in the multicenter Cardiovascular Health Study. CVD was defined as coronary heart disease plus heart failure plus stroke. Ten-year risk prediction Cox proportional-hazards models for stroke and CVD were calculated using Cardiovascular Health Study-specific coefficients for Framingham risk score factors. Categories of CIMT and CIMT plus plaque were added to Framingham risk score prediction models, and categorical net reclassification improvement (NRI) and Harrell's c-statistic were calculated.In 4,384 Cardiovascular Health Study participants (61% women, 14% black; mean baseline age, 72 ± 5 years) without CVD at baseline, higher CIMT category and the presence of plaque were both associated with higher incidence rates for stroke and CVD. The addition of CIMT improved the ability of Framingham risk score-type risk models to discriminate cases from noncases of incident stroke and CVD (NRI = 0.062, P = .015, and NRI = 0.027, P < .001, respectively), with no further improvement by adding plaque. For both outcomes, NRI was driven by down-classifying those without incident disease. Although the addition of plaque to CIMT did not result in a significant NRI for either outcome, it was significant among those without incident disease.In older adults, the addition of CIMT modestly improves 10-year risk prediction for stroke and CVD beyond a traditional risk factor model, mainly by down-classifying risk in those without stroke or CVD; the addition of plaque to CIMT adds no statistical benefit in the overall cohort, although there is evidence of down-classification in those without events.
- Association between idiopathic retroperitoneal fibrosis and autoimmune thyroiditis: A case-control study. [REVIEW]
- Autoimmun Rev 2014 Aug 27.
Idiopathic retroperitoneal fibrosis (IRF) is a rare disease often associated with autoimmune disorders. Whether IRF is associated with Hashimoto's thyroiditis (HT) is poorly understood and only addressed by case-reports. We evaluated the prevalence of HT in a large IRF cohort and in matched controls.We studied 73 consecutive patients with new-onset IRF and 71 controls. The association between HT and IRF was cross-sectionally evaluated in a referral center. Longitudinally, thyroid function tests were also performed. Serum concentrations of FT4, TSH, and anti-thyroperoxidase antibodies (AbTPO) were evaluated together with thyroid ultrasound (US). Lymphocytic infiltrates were characterized in thyroid nodule fine needle aspirates (FNAB). In patients undergoing thyroidectomy, thyroid histology was also reviewed.A higher prevalence of AbTPO positivity (P<0.03) and US findings suggestive of autoimmune thyroiditis (US-AIT) (P<0.0001) were found in IRF patients compared to controls. In the logistic regression analysis, the risk of AbTPO-diagnosed HT and that of US-AIT was significantly higher in IRF patients than in controls (ORs, 3.56, 95% CI 1.48-8.59, P=0.004 and 4.74, 95% C.I., 2.34-9.61, P<0.0001 in AbTPO-diagnosed HT and US-AIT, respectively). Thyroid histology in IRF patients showed either classical or the fibrous variant of HT. At the end of the follow-up (median, 45 and 36months in patients and controls, respectively), 25% of IRF patients and 3% of controls were receiving l-thyroxine.IRF patients have a higher risk of HT compared to controls. Thyroid function should be monitored in patients with IRF.
- Umbilical cord accidents and legal implications. [REVIEW]
- Semin Fetal Neonatal Med 2014 Aug 26.
Umbilical cord accidents (UCA) are a significant cause of stillbirth. Although infrequent, litigation may occur when there is a poor outcome associated with UCA. With advances in imaging, the ability to identify UCA by ultrasound and magnetic resonance imaging raises awareness of the risk of a poor outcome. Management of a pregnancy with an identified UCA may require more fetal surveillance by both the mother and caregiver. This is especially important if there is a previous history of UCA with or without stillbirth. UCA should be an acknowledged risk which is part of prenatal screening. In the event of a poor outcome associated with UCA, it is recommended that the patient be fully informed of all prenatal information including images. Excellent communication with parents who are looking for answers after a tragic outcome may help to decrease litigation risk.
- Reciprocity principle for scattered fields from discontinuities in waveguides. [JOURNAL ARTICLE]
- Ultrasonics 2014 Aug 13.
This study investigates the scattering of guided waves from a discontinuity exploiting the principle of reciprocity in elastodynamics, written in a form that applies to waveguides. The coefficients of reflection and transmission for an arbitrary mode can be derived as long as the principle of reciprocity is satisfied at the discontinuity. Two elastodynamic states are related by the reciprocity. One is the response of the waveguide in the presence of the discontinuity, with the scattered fields expressed as a superposition of wave modes. The other state is the response of the waveguide in the absence of the discontinuity oscillating according to an arbitrary mode. The semi-analytical finite element method is applied to derive the needed dispersion relation and wave mode shapes. An application to a solid cylinder with a symmetric double change of cross-section is presented. This model is assumed to be representative of a damaged rod. The coefficients of reflection and transmission of longitudinal waves are investigated for selected values of notch length and varying depth.
- Probing single-cell mechanics with picosecond ultrasonics. [JOURNAL ARTICLE]
- Ultrasonics 2014 Aug 5.
The mechanical properties of cells play a key role in several fundamental biological processes, such as migration, proliferation, differentiation and tissue morphogenesis. The complexity of the inner cell composition and the intricate meshwork formed by transmembrane cell-substrate interactions demands a non-invasive technique to probe cell mechanics and cell adhesion at a subcell scale. In this paper we review the use of laser-generated GHz acoustic waves-a technique called picosecond ultrasonics (PU)-to probe the mechanical properties of single cells. We first describe applications to vegetal cells and biomimetic systems. We show how these systems can be used as simple models to understand more complex animal cells. We then present an opto-acoustic bio-transducer designed for in vivo measurements in physiological conditions. We illustrate the use of this transducer through the simultaneous probing of the density and compressibility of Allium cepa cells. Finally, we demonstrate that this technique can quantify animal-cell adhesion on metallic surfaces by analyzing the acoustic pulses reflected off the cell-metal interface. This innovative approach allows investigating quantitatively cell mechanics without fluorescent labels or mechanical contact to the cell.
- Iliohypogastric/ilioinguinal nerve block in inguinal hernia repair for postoperative pain management: comparison of the anatomical landmark and ultrasound guided techniques. [JOURNAL ARTICLE]
- Braz J Anesthesiol 2014 September - October; 64(5):350-356.
The purpose of this study is to compare the efficacy of iliohypogastric/ilioinguinal nerve blocks performed with the ultrasound guided and the anatomical landmark techniques for postoperative pain management in cases of adult inguinal herniorrhaphy.40 patients, ASA I-II status were randomized into two groups equally: in Group AN (anatomical landmark technique) and in Group ultrasound (ultrasound guided technique), iliohypogastric/ilioinguinal nerve block was performed with 20ml of 0.5% levobupivacaine prior to surgery with the specified techniques. Pain score in postoperative assessment, first mobilization time, duration of hospital stay, score of postoperative analgesia satisfaction, opioid induced side effects and complications related to block were assessed for 24h postoperatively.VAS scores at rest in the recovery room and all the clinical follow-up points were found significantly less in Group ultrasound (p<0.01 or p<0.001). VAS scores at movement in the recovery room and all the clinical follow-up points were found significantly less in Group ultrasound (p<0.001 in all time points). While duration of hospital stay and the first mobilization time were being found significantly shorter, analgesia satisfaction scores were found significantly higher in ultrasound Group (p<0.05, p<0.001, p<0.001 respectively).According to our study, US guided iliohypogastric/ilioinguinal nerve block in adult inguinal herniorrhaphies provides a more effective analgesia and higher satisfaction of analgesia than iliohypogastric/ilioinguinal nerve block with the anatomical landmark technique. Moreover, it may be suggested that the observation of anatomical structures with the US may increase the success of the block, and minimize the block-related complications.