Portable bedside ultrasound: the visual stethoscope of the 21st century

Over the past decade technological advances in the realm of ultrasound have allowed what was once a cumbersome and large machine to become essentially hand-held. This coupled with a greater understanding of lung sonography has revolutionized our bedside assessment of patients. Using ultrasound not as a diagnostic test, but instead as a component of the physical exam, may allow it to become the stethoscope of the 21st century

Ultrasound confirmation of guidewire position may eliminate accidental arterial dilatation during central venous cannulation

<p>Abstract</p> <p>Background</p> <p>Ultrasound guidance during central line insertion has significantly reduced complications associated with this procedure and has led to it being incorporated as standard of care in many institutions. However, inadvertent arterial penetration and dilation remains a problem despite ultrasound guidance and can result in significant morbidity and even mortality. Dynamic ultrasound confirmation of guidewire position within the vein prior to dilation may help to prevent and even eliminate this feared complication.</p> <p>Methods</p> <p>A prospectively collected database of central line insertions for one author utilizing this novel technique was retrospectively reviewed for all incidents of arterial dilation over a period from September 2008 to January 2010.</p> <p>Results</p> <p>During the study period 53 central lines were inserted with no incidents of arterial dilation.</p> <p>Conclusions</p> <p>Ultrasound confirmation of guidewire position has the potential to reduce or eliminate the morbidity and mortality of arterial dilation during central line placement.</p

New Optic Nerve Sonography Quality Criteria in the Diagnostic Evaluation of Traumatic Brain Injury.

BACKGROUND: New sonographic quality criteria to optimize optic nerve sheath diameter (ONSD) measurements were suggested. The latter were correlated to elevated intracranial pressure (ICP) in traumatic brain injury (TBI). AIM: We investigated whether ONSD measurements were correlated to simultaneous ICP measurements in severe TBI. METHODS: Forty patients with severe TBI (Marshall Scale ≥II and GCS ≤8) participated in the study. All patients had an intraparenchymal ICP catheter inserted, while ONSD was measured bilaterally, upon admission and over the next 48 hours, based on the new sonographic criteria. A total of 400 ONSD measurements were performed, while mean ONSD values of both eyes were used in the analysis. RESULTS: ONSD measurements were strongly correlated to ICP values (r=0.74, p < 0.0001). Receiver operator curve (ROC) analysis revealed that the ONSD cutoff value for predicting elevated ICP was 6.4 mm when using the mean of both eyes (AUC = 0.88, 95% CI = 0.80 to 0.95; sensitivity = 85.3%, specificity = 82.6%). Linear regression analysis nested models revealed that sex (p=0.006) and height (p=0.04) were significant predictors of ONSD values. CONCLUSION: When applying the new sonographic quality criteria, ONSD is strongly correlated to ICP in severe TBI. Whether to use such criteria to monitor ONSD as a proxy for ICP trend in TBI remains to be further explored.Peer Reviewe

Genomic Dissection of Bipolar Disorder and Schizophrenia, Including 28 Subphenotypes

publisher: Elsevier articletitle: Genomic Dissection of Bipolar Disorder and Schizophrenia, Including 28 Subphenotypes journaltitle: Cell articlelink: https://doi.org/10.1016/j.cell.2018.05.046 content_type: article copyright: © 2018 Elsevier Inc

Anterograde colonic stent placement via a cecostomy tube site

Colonic stents have been used as a method of relieving colonic obstruction since 1991. They are classically inserted in a retrograde fashion via the rectum and are deployed under a combination of endoscopic and fluoroscopic guidance. A unique case is presented where the colonic stent was passed in an anterograde fashion through a recently created cecostomy tube site as a method of palliation to relieve an obstructing hepatic flexure tumour