Possibilities of ultrasonography in diagnosing causes of dyspnea in palliative care cancer patients

Dyspnea is an ailment which is relatively frequently reported by cancer patients, and it can be difficult todetermine the cause of the symptom at home hospice. Thanks to the application of mobile ultrasoundscanner, the physician can often determine the cause of dyspnea during a home visit, which makes itunnecessary to carry out diagnostic procedures at the hospital. The article presents two cases of femalepatients in whom the application of at-home ultrasound proved to be useful in determining the cause ofdyspnea. The first patient was diagnosed with pericardial tamponade at home — pericardial cavity puncturewas performed at the hospital — while in the case of the second patient, pneumonia was both diagnosedand monitored at home with the use of ultrasonography

PERAN PENALARAN LOGIKA DALAM PEMECAHAN MASALAH PAMALI DI LEMBANG RATTE KECAMATAN MASANDA

Dalam penelitian ini tujuan yang hendak dicapai adalah untuk menganalisis peran penalaran logika dalam pemecahan masalah pemali. Dengan metode penelitian kualitatif melalui teknik wawancara dan melakukan studi pustaka. Hasil penelitian ini adalah budaya atau tradisi, keunikan dalam suatu masyarakat tidak dapat kita pisahkan dari kehidupan kita. Salah satunya yaitu pemali. Pemali adalah sesuatu yang tidak boleh dilakukan dan ketika hal itu dilanggar akan menghasilkan sesuatu yang tidak baik. Namun hal ini tidak dapat dibuktikan apa hal ini benar adanya atau hanya sebuah mitos yang berkembang di masyarakat. Dalam tulisan ini ditemukan kesimpulan bahwa untuk menyikapi persoalan-persoalan yang demikian kita memerlukan cara berpikir yang logis. Dalam berpikir logis sendiri dibutuhkan penalaran. Masyarakat atau orang memerlukan penalaran yang baik untuk menyikapi masalaah pemali ini sehingga Setelah masyarakat menalar dengan baik mereka akan mendapatkan pengetahun baru dari pamali dan dapat menentukan bahwa hal itu dapat dilakukan, diyakini atau tidak

Severe hypocalcaemia in the course of the coeliac disease in a 34-year-old patient — a case report

An atypical form of a coeliac disease, with the predominance of others then gastrointestinal symptoms, is increasingly recognized in adult patients. Atypical symptoms includes: hypochromic anaemia, electrolytic disturbance, neurological symptoms, osteopenia, osteoporosis and others. The report presents a case of a 34-year-old male admitted to the Department of Internal Diseases, Connective Tissue Diseases and Geriatrics in Gdansk, due to a severe hypocalcaemia (4.92 mg/dl). The coeliac disease was diagnosed based on the clinical course, serologic tests and on the histopathological exam of the small intestine sample. The implementation of the gluten free-diet resulted in a significant clinical improvement of patient’s condition. Early diagnosis and implementation of the glutenfree diet are crucial for regaining a normal functioning and decreasing the risk of severe complications

A method description and feasibility study

A detailed transabdominal and transvaginal ultrasound examination, performed by an expert examiner, could render a similar diagnostic performance to computed tomography for assessing pelvic/abdominal tumor spread disease in women with epithelial ovarian cancer (EOC). This study aimed to describe and assess the feasibility of lung and intercostal upper abdomen ultrasonography as pretreatment imaging of EOC metastases of supradiaphragmatic and subdiaphragmatic areas. A preoperative ultrasound examination of consecutive patients suspected of having EOC was prospectively performed using transvaginal, transabdominal, and intercostal lung and upper abdomen ultrasonography. A surgical-pathological examination was the reference standard to ultrasonography. Among 77 patients with histologically proven EOC, supradiaphragmatic disease was detected in 13 cases: pleural effusions on the right (n = 12) and left (n = 8) sides, nodular lesions on diaphragmatic pleura (n = 9), focal lesion in lung parenchyma (n = 1), and enlarged cardiophrenic lymph nodes (n = 1). Performance (described with area under the curve) of combined transabdominal and intercostal upper abdomen ultrasonography for subdiaphragmatic areas (n = 77) included the right and left diaphragm peritoneum (0.754 and 0.575 respectively), spleen hilum (0.924), hepatic hilum (0.701), and liver and spleen parenchyma (0.993 and 1.0 respectively). It was not possible to evaluate the performance of lung ultrasonography for supradiaphragmatic disease because only some patients had this region surgically explored. Preoperative lung and intercostal upper abdomen ultrasonography performed in patients with EOC can add valuable information for supradiaphragmatic and subdiaphragmatic regions. A reliable reference standard to test method performance is an area of future research. A multidisciplinary approach to ovarian cancer utilizing lung ultrasonography may assist in clinical decision-making.publishersversionpublishe

Lung Ultrasonography in the Monitoring of Intraoperative Recruitment Maneuvers

Introduction: Postoperative respiratory failure is a serious problem in patients who undergo general anesthesia. Approximately 90% of mechanically ventilated patients during the surgery may develop atelectasis that leads to perioperative complications. Aim: The aim of this study is to determine whether it is possible to optimize recruitment maneuvers with the use of chest ultrasonography, thus limiting the risk of respiratory complications in patients who undergo general anesthesia. Methodology: The method of incremental increases in positive end-expiratory pressure (PEEP) values with simultaneous continuous ultrasound assessments was employed in mechanically ventilated patients. Results: The study group comprised 100 patients. The employed method allowed for atelectasis reduction in 91.9% of patients. The PEEP necessary to reverse areas of atelectasis averaged 17cmH2O, with an average peak pressure of 29cmH2O. The average PEEP that prevented repeat atelectasis was 9cmH2O. A significant improvement in lung compliance and saturation was obtained. Conclusions: Ultrasound-guided recruitment maneuvers facilitate the patient-based adjustment of the process. Consequently, the reduction in ventilation pressures necessary to aerate intraoperative atelectasis is possible, with the simultaneous reduction in the risk of procedure-related complications

Czy głowica liniowa jest pomocna w diagnostyce chorób zajmujących przestrzeń śródmiąższową płuc?

In a lung ultrasound examination, interstitial lung lesions are visible as numerous B-line artifacts, and are best recorded with the use of a convex probe. Interstitial lung lesions may result from many conditions, including cardiogenic pulmonary oedema, non-cardiogenic pulmonary oedema, or interstitial lung disease. Hence difficulties in the differential diagnostics of the above clinical conditions. This article presents cases of patients suffering from interstitial lung lesions discovered in the course of lung ultrasound examination. The patients were examined with a 3.5–5.0 MHz convex probe and a 7.0–11.0 MHz linear probe. Ultrasound images have been analysed, and differences in the imaging with both probes in patients with interstitial lung lesions have been detailed. The use of a linear probe in patients with interstitial lung lesions (discovered with a convex or a micro-convex probe) provides additional information on the source of the origin of the lesions.Zmiany śródmiąższowe płuc w badaniu ultrasonograficznym prezentują się jako liczne artefakty linii B, rejestrowane najlepiej przy pomocy sondy konweksowej. Przyczyn zmian śródmiąższowych płuc może być wiele: kardiogenny obrzęk płuc, niekardiogenny obrzęk płuc oraz zmiany w przebiegu śródmiąższowych chorób płuc. Powoduje to trudności w diagnostyce różnicowej powyższych stanów klinicznych. W artykule przedstawiono serię przypadków pacjentów, u których w badaniu ultrasonograficznym płuc stwierdzono zmiany śródmiąższowe płuc. Badania wykonano przy pomocy sondy konweksowej (3,5–5,0 MHz) oraz liniowej (7,0–11,0 MHz). Dokonano analizy obrazów ultrasonograficznych oraz wskazano różnice w obrazowaniu obiema głowicami w grupie pacjentów ze zmianami śródmiąższowymi w płucach. Zastosowanie sondy liniowej u pacjentów ze stwierdzonymi (przy pomocy sondy konweksowej lub mikrokonweksowej) zmianami śródmiąższowymi płuc wnosi nowe informacje na temat źródła ich pochodzenia. Artykuł w wersji polskojęzycznej jest dostępny na stronie http://jultrason.pl/index.php/wydawnictwa/volume-17-no-6