Influence of intercostal muscles contraction on sonographic evaluation of lung sliding: a physiological study on healthy subjects

objectives: to investigate the following: (a) effects of intercostal muscle contraction on sonographic assessment of lung sliding and (b) inter-rater and intra-observer agreement on sonographic detection of lung sliding and lung pulse. methods: we used Valsalva and muller maneuvers as experimental models in which closed glottis and clipped nose prevent air from entering the lungs, despite sustained intercostal muscles contraction. twenty-one healthy volunteers underwent bilateral lung ultrasound during tidal breathing, apnea, hyperventilation, and muller and valsalva maneuvers. the same expert recorded 420 B-mode clips and 420 M-mode images, independently evaluated for the presence or absence of lung sliding and lung pulse by three raters unaware of the respiratory activity corresponding to each imaging. results: during muller and valsalva maneuvers, lung sliding was certainly recognized in up to 73.0% and up to 68.7% of imaging, respectively, with a slight to fair inter-rater agreement for muller maneuver and slight to moderate for valsalva. Lung sliding was unrecognized in up to 42.0% of tidal breathing imaging, and up to 12.5% of hyperventilation imaging, with a slight to fair inter-rater agreement for both. during apnea, interpretation errors for sliding were irrelevant and inter-rater agreement moderate to perfect. even if intra-observer agreement varied among raters and throughout respiratory patterns, we found it to be higher than inter-rater reliability. conclusions: Intercostal muscles contraction produces sonographic artifacts that may simulate lung sliding. clinical studies are needed to confirm this hypothesis. we found slight to moderate inter-rater agreement and globally moderate to almost perfect intra-observer agreement for lung sliding and lung pulse. trial registration: clinical trials.gov registration number. NCT02386696

Compression of the inferior vena cava in bowel obstruction

INTRODUCTION: We investigated whether (a) the inferior vena cava (IVC) is compressed in bowel obstruction and (b) some tracts are more compressed than others. METHODS: Two groups of abdominal computed tomography (CT) examinations were collected retrospectively. Group O (N = 69) scans were positive for bowel obstruction, group C (N = 50) scans were negative for diseases. IVC anteroposterior and lateral diameters (APD, LAD) were assessed at seven levels. RESULTS: In group C, IVC section had an elliptic shape (APD/LAD: .76 \ub1 .14), the area of which increased gradually from 1.9 (confluence of the iliac veins) to 3.1\u2009cm\ub2/m\ub2 of BSA (confluence of the hepatic veins) with a significant narrowing in the hepatic section. In group O, bowel obstruction caused a compression of IVC (APD/LAD: .54 \ub1 .17). Along its course, IVC section area increased from 1.3 to 2.5\u2009cm\ub2/m\ub2. At ROC curve analysis, an APD/LAD ratio lower than 0.63 above the confluence of the iliac veins discriminated between O and C groups with sensitivity of 74% and specificity of 96%. CONCLUSIONS: Bowel obstruction caused a compression of IVC, which involved its entire course except for the terminal section. APD/LAD ratio may be useful to monitor the degree of compression

Extensive congenital asymptomatic renal arteriovenous malformation

Renal arteriovenous malformations (AVM) are abnormal communications between the intrarenal arterial and venous systems. These lesions may present with a wide range of signs and symptoms, including hypertension and hematuria. We report a case of a 71-year-old woman with incidentally diagnosis of asymptomatic right renal AVM

Sclerotherapy with polidocanol microfoam in head and neck venous and lymphatic malformations

Objective. Polidocanol sclerotherapy of head and neck venous malformations (VMs) and lymphatic malformations (LMs) has been reported only in limited series. In this manuscript we evaluated the efficacy and safety of polidocanol sclerotherapy in a series of head and neck venous and lymphatic malformations. Methods. This retrospective observational study analysed data on 20 head and neck VMs and LMs that underwent to percutaneous or endoscopic intra-lesional 3% polidocanol microfoam sclerotherapy at our institution. Clinical response was ranked as excellent, moderate and poor based on volume reduction by MRI and resolution of symptoms. Results. The median volume decreased from 19.3 mL to 5.8 mL after sclerotherapy (mean volume reduction: 72.98 ± 16.1%). An excellent-moderate response was observed in 94.4% of cases. We observed a mean volume reduction of 79.5 ± 16.1 in macrocystic LMs, of 76.1 ± 13.0% in VMs, of 60.5 ± 10.9% in mixed lymphatic ones and 42.5% in microcystic lymphatic ones. Conclusions. Polidocanol sclerotherapy appears to be an effective and safe treatment for venous and lymphatic head and neck malformations. We observed the best responses in macrocystic LMs and VMs, whereas mixed lymphatic ones showed a moderate response and microcystic lymphatic ones a poor response

Massive facial edema and airway obstruction secondary to acute postoperative sialadenitis or "anesthesia mumps": a case report

This is an Open Access article distributed under the terms of the Creative Commons Attribution Licens

Conventional CT versus Dedicated CT Angiography in DIEP Flap Planning: A Feasibility Study

The deep inferior epigastric perforator (DIEP) flap is used with increasing frequency in post-mastectomy breast reconstruction. Preoperative mapping with CT angiography (CTa) is crucial in reducing surgical complications and optimizing surgical techniques. Our study\u2019s goal was to investigate the accuracy of conventional CT (cCT), performed during disease staging, compared to CTa in preoperative DIEP flap planning. In this retrospective, single-center study, we enrolled patients scheduled for mastectomy and DIEP flap breast reconstruction, subjected to cCT within 24 months after CTa. We included 35 patients in the study. cCT accuracy was 95% (CI 0.80\u20130.98) in assessing the three largest perforators, 100% (CI 0.89\u2013100) in assessing the dominant perforator, 93% (CI 0.71\u20130.94) in assessing the perforator intramuscular course, and 90.6% (CI 0.79\u20130.98) in assessing superficial venous communications. Superficial inferior epigastric artery (SIEA) caliber was recognized in 90% of cases (CI 0.84\u20130.99), with an excellent assessment of superficial inferior epigastric vein (SIEV) integrity (96% of cases, CI 0.84\u20130.99), and a lower accuracy in the evaluation of deep inferior epigastric artery (DIEA) branching type (85% of cases, CI 0.69\u20130.93). The mean X-ray dose spared would have been 788 \ub1 255 mGy/cm. Our study shows that cCT is as accurate as CTa in DIEP flap surgery planning

Il monitoraggio dei movimenti e delle deformazioni con tecniche geomatiche di basso costo

L’osservazione dell’evoluzione di fenomeni di dissesto ha una importanza strategica sul nostro territorio. Un importante precursore di fenomeni franosi è il movimento o la deformazione degli stessi: tali parametri possono essere osservati con tecniche geomatiche. Le misure topografiche o GNSS con ricevitori geodetici (multi-frequenza e multi-costellazione) sono ormai ben consolidate nel trattamento e nella precisione. La realizzazione di sistemi basati su questi sensori non è tuttavia a basso costo, specie se consideriamo tecniche GNSS applicate su molti punti di controllo per una descrizione dettagliata del fenomeno, o installazioni soggette a pericoli oggettivi e dunque da considerarsi praticamente “a perdere”. Ricevitori GNSS singola frequenza sono oggi reperibili a costi minori di cento euro e possono, sotto opportune ipotesi e ingegnerizzazioni, costituire alternative ai ricevitori geodetici. Nell’ambito di un progetto di ricerca finanziato da CSI Piemonte per lo studio di tecnologie di monitoraggio a basso costo, sono stati sviluppati sistemi di acquisizione, trasmissione ed elaborazione dati basati su sensori GNSS singola frequenza di minuscole dimensioni. Il sistema costituisce una sorta di piccola stazione permanente GNSS, integrata con accelerometri per la stima di inclinazione e vibrazioni e con sensori meteorologici. È corredata di micro PC con processore ARM e interfacce di comunicazione wireless a lungo raggio per la trasmissione in tempo reale delle misure. Il sistema risulta caratterizzato da consumi elettrici molto contenuti ed è di rapida installazione in siti anche complessi dal punto di vista dell’accesso, dell’alimentazione e comunicazione. Vengono esposti nella nota i risultati delle prove di accuratezza dei sensori GNSS eseguite in laboratorio, le procedure di calibrazione dei sensori e la loro ingegnerizzazione, oltre ai primi risultati sulle installazioni situate nel nord del Piemonte su alcune zone di dissesto

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

An unusual case of acute pancreatitis and gastric outlet obstruction associated with wandering spleen treated by laparoscopic splenopexy.

Wandering spleen (WS) is an uncommon condition, usually asymptomatic, often recognized as an incidental finding. When symptoms occur, they can vary, although acute abdominal pain is the most common presentation in the pediatric population. In some cases, WS can become a dangerous condition because of the risk of splenic ischemia from persistent pedicle torsion. We describe a case of WS in a 3-year-old boy presenting with vomiting, abdominal swelling, and acute pancreatitis; the diagnosis was obtained by ultrasound and computed tomography. Laparoscopic splenopexy was successfully performed through an extraperitoneal pocket and a Vicryl mesh. To the best of our knowledge, the combination of gastric outlet obstruction and acute pancreatitis has never been reported as presenting symptoms of WS