Qualitative and quantitative gastric ultrasound assessment in highly skilled regional anesthesiologists

Background Pulmonary aspiration is a major complication in anesthesia, and various studies have shown that gastric sonography can reliably provide valuable information relative to both the qualitative and quantitative aspects of gastric content. This study aimed to determine the accuracy of ultrasound assessment of gastric content compared between two novice anesthesiologist gastric sonographers. Methods This prospective cohort study of two anesthesiologists learning to perform qualitative and quantitative ultrasound assessment of gastric content on healthy volunteers was conducted at Siriraj Hospital (Bangkok, Thailand). This trial was registered with ClinicalTrials.gov (reg. no. NCT04760106). Results Of the 50 enrolled participants, three were excluded due to study protocol violation. Each anesthesiologist performed a qualitative assessment on 47 participants for an overall total of 94 scans. There were 15 males and 32 females (age 42 ± 11.7 years, weight 61.2 ± 13.1 kg, height 160.7 ± 7.3 cm, and BMI 23.6 ± 4.3 kg/m2). The overall success rate for all gastric content categories was approximately 96%. From antral cross-sectional area measurement, as the ingested volume increased, there was a tendency toward increased deviation from the actual ingested volume. Interrater agreement between anesthesiologists was analyzed using intraclass correlation coefficients (ICCs). A larger fluid volume was found to be associated with a lower level of agreement between the two anesthesiologists. The ICCs were 0.706 (95% CI: −0.125 to 0.931), 0.669 (95% CI: −0.254 to 0.920), 0.362 (95% CI: −0.498 to 0.807) for the 100 ml, 200 ml, and 300 ml fluid volumes, respectively. The mean duration to perform an ultrasound examination for each gastric content category and for the entire examination did not differ significantly between anesthesiologists (p > 0.05). Conclusion Our results indicate that qualitative ultrasound assessment of gastric content is highly accurate and can be easily learned. In contrast, quantification of gastric volume by novice gastric sonographers is more complex and requires more training. Trial registration ClinicalTrials.gov no. NCT04760106 Date registered on Feb 11, 2021. Prospectively registered.

Doppler ultrasound assessment of minor atrial septal defects in patients with paradoxical embolism

Minor atrial septal defect (ASD) may be one of the pathways of paradoxical embolism in the brain. Few scientific papers have investigated the relationship between ASD (excluding patent foramen ovale) and the occurrence of ischemic stroke. There is no definite opinion as to how functionally important such shunts are and how the shunt changes with age. The review analyzes modern ideas about the probability of paradoxical embolism in small ASDs from the viewpoint of pathophysiology, and also demonstrates the technological capabilities of assessing the functional significance of such shunts based on our own clinical observations.

Sonographic Tophi and Inflammation Are Associated With Carotid Atheroma Plaques in Gout

Objective: Gout and cardiovascular disease are closely related, but the mechanism connecting them remains unknown. This study aims to explore whether urate crystal deposits and inflammation (assessed by ultrasound) are associated with carotid atherosclerosis.Methods: We included consecutive patients with crystal-proven gout newly presenting to a tertiary rheumatology unit. Patients under urate-lowering treatment were excluded. Ultrasound assessment was performed during intercritical periods. Musculoskeletal scans evaluated six joints and four tendons for urate crystal deposits (double contour, aggregates, and tophi), and power Doppler (PD) signal (graded 0–3) as a marker of local inflammation. The sum of locations showing deposits or a positive PD signal (≥1) was registered. Carotids were scanned for increased intima-media thickness (IMT) and atheroma plaques, according to the Mannheim consensus. Associations were analyzed using logistic regression.Results: The study included 103 patients showing sonographic crystal deposits at the examined locations (mean sum 9.9, minimum 2); tophi were the most frequent. Two-thirds of participants presented a positive PD signal (30.1% grade 2–3). In the carotid scans, 59.2% of participants showed atheroma plaques, and 33.0% increased IMT. Tophi (odds ratio [OR] 1.24; 95% confidence interval [CI] 1.03–1.50) and a positive PD signal (OR 1.67; 95% CI 1.09–2.56) were significantly associated with atheroma plaques, while an increased IMT showed no sonographic association.Conclusion: Sonographic crystal deposits and subclinical inflammation were consistently observed in patients with intercritical gout. Tophi and a positive PD signal were linked to carotid atherosclerosis. Our findings may contribute to understanding the complex relationship between gout and atherosclerosis.

A Rare Case of Allantoic Cyst with Patent Urachus in Fetus with a Microdeletion in 1q21.1q21.2 Region

An allantoic cyst is a rare malformation with a frequency of 3 in 1,000,000 that may be seen antenatally by ultrasound assessment when the connection between the cloaca (future bladder) and the allantois fails to regress. A patent urachus that presents as a cyst (allantoic) is usually considered not to be associated with chromosomal abnormalities, but if it is not repaired after birth this leads to complications such as urinary tract infections and stone formation. We present a case of a fetus diagnosed with allantoic cyst at the first trimester ultrasound assessment at 12 weeks gestation. The follow up scans showed a decrease in size of the allantoic cyst with no other obvious major defects and, when invasive testing (amniocentesis with microarray analysis) was performed, a rare microdeletion, 1q21.1q21.2 was identified (1.82 Mb deletion).

Ultrasonic diagnostics of vascular complications after laser procedures

A clinical case of treatment of rosacea with a high-intensity laser at different stages, performed under control of high-resolution ultrasound (HRU), is presented. According to clinical guidelines, patients in the erythematous stage of rosacea (stage I) undergo selective coagulation of superficial vessels with a neodymium laser. Diagnosis and determination of the severity of the disease are carried out based on the presence of primary and secondary elements of the rash. There are no criteria for ultrasound assessment of the skin and its vascularization in patients with rosacea. During ultrasound examination after 4 laser procedures in B-mode, the dermis is heterogeneous due to hypoechoic papillary and hyperechoic reticular layers, without signs of infiltrative changes, in the color Doppler mapping mode there is a pronounced vascularization of the papillary dermis in the area of interest, represented by multiple vessels in contrast to single vascular structures seen on ultrasound after two laser treatments. According to the results of ultrasound examination, a more severe degree of the disease was diagnosed, which served as the basis for prescribing therapy with systemic retinoids. Clinical observation demonstrates the capabilities of ultrasound in planning laser procedures in order to reduce the risk of complications, their early diagnosis and monitoring of treatment if they occur.

A Possible Role for Arterial Duplex and Hand Acceleration Time in Diagnosing and Managing Shock

Shock represents a state when arterial perfusion is inadequate to supply the needs of cellular respiration, leading to anerobic metabolism, acidosis, and cell death. Although typically described in terms of blood pressure and heart rate, these measures can both lead to delayed recognition of shock and under appreciation of the severity of end-organ malperfusion. Recently, there has been increased interest in monitoring peripheral perfusion both to detect early shock and monitor the response to treatment. However, current methods are variable and, in some cases, require specialized equipment. We present a case in which duplex ultrasound assessment of peripheral palmar acceleration time identified a post-hemorrhagic shock state before it was clinically apparent. Bedside arterial duplex and hand acceleration time may provide a simple tool to assess the degree of shock and response to intervention.

Dynamic Doppler Ultrasound Assessment of Tissue Perfusion Is a Better Tool than a Single Vessel Doppler Examination in Differentiating Malignant and Inflammatory Pancreatic Lesions

Dynamic tissue perfusion measurement (DTPM) and single vessel flow measurement (SVFM) were assessed in differentiating inflammatory and malignant lesions of the pancreas. Sixty-nine patients (age 62.0 ± 14.7; 33 Female and 36 Men; 40 with malignant and 29 with inflammatory lesions) in whom during the endoscopic ultrasound (EUS) of focal pancreatic lesions it was possible to adequately evaluate the flow in the color Doppler, and then perform a biopsy, were qualified for the study. The assessed DTPM parameters flow velocity (TFV), perfusion intensity (TPI), and resistive index (TRI) as well as the following SVFM parameters: flow velocity (FV), volume flow (VolF), and resistive index (RI) differed significantly between the malignant and inflammatory lesions (p < 0.005). TFV and TPI have slightly better discriminatory properties than the corresponding FV and VolF parameters (p < 0.10). Considering the Doppler parameters usually evaluated in a given method, the TPI = 0.009 cm/s (sensitivity 79%, specificity 92%, AUC 0.899, p < 0.001) was significantly better (p = 0.014) in differentiating between inflammatory and malignant pancreatic lesions in comparison to FV = 2.526 cm/s (sensitivity 79%, specificity 70%, AUC 0.731, p < 0.001). Tissue perfusion has better discriminatory properties in the differentiation of solid pancreatic lesions than the Doppler blood flow examination in the single vessel within the tumor.