Hyperbaric oxygen therapy for painful bladder syndrome/interstitial cystitis resistant to conventional treatments: long-term results of a case series in Japan

<p>Abstract</p> <p>Background</p> <p>There is no confirmed strategy for treating painful bladder syndrome/interstitial cystitis (PBS/IC) with unclear etiology. Therefore, a pilot study was carried out to evaluate the efficacy and safety of hyperbaric oxygen (HBO) therapy in treatment-resistant PBS/IC patients.</p> <p>Methods</p> <p>HBO treatment (2.0 ATA for 60 minutes/day × 5 days/week for 2 or 4 weeks) was performed on 11 patients with severe symptoms that had not been improved by previous therapy regimens between December 2004 and July 2009.</p> <p>Results</p> <p>Seven of the 11 patients demonstrated persistent improvement in symptoms during the 12 months after HBO treatment. These responders demonstrated a decrease in the pelvic pain scale and urgency scale from 7.7 ± 1.0 and, 6.6 ± 0.9 to 3.4 ± 2.5 and 4.3 ± 2.4 after 12 months, respectively (p < 0.05). The total score of the interstitial cystitis symptom index and 24-hour urinary frequency demonstrated a significant sustained decrease from the baseline. Two responders, who received an additional course of HBO 12 and 13 months after initial treatment, respectively, did not suffer impairment for more than two years. There was one case of transient eustachian tube dysfunction and three cases of reversible exudative otitis media as a consequence of HBO treatment.</p> <p>Conclusions</p> <p>HBO is a potent treatment for PBS/IC patients resistant to conventional therapy. It was well tolerated and provided maintained amelioration of pain, urgency and urinary frequency for at least 12 months.</p

The use of ultrasound in educational settings: what should we consider when implementing this technique for visualisation of anatomical structures?

Ultrasound is a well-established medical imaging technique with pioneering work conducted by Professor Ian Donald and his colleagues at the University of Glasgow, from the mid-1950s onwards, in terms of introducing it as a diagnostic tool in the field of obstetrics and gynaecology. Since then, ultrasound has been extensively used in clinical and research settings. There are few imaging techniques that have undergone such a fast and thriving evolution since their development. Nowadays, diagnostic ultrasound benefits from two-dimensional (2D), three-dimensional (3D), four-dimensional (4D), and a variety of Doppler modes with technologically advanced transducers (probes) producing images of high anatomical fidelity. In the future, there may even be a place for ultrasound in molecular imaging allowing for visualisation at the microscale. Ultrasound is characterised by real-time non-invasive scanning, relative ease of administration, and lack of ionising radiation. All of these features, make ultrasound an appealing option in educational settings for learning topographic anatomy and potentially enhancing future clinical practice for vocational learners. Sophisticated, but relatively inexpensive, portable handheld devices have also contributed to point-of-care ultrasound (POCUS) becoming the norm for bedside and pre-hospital scanning. It has been argued that ultrasound will become the next stethoscope for healthcare professionals. For this to become a reality, however, training is required on increasing familiarity with knobology, correct use of the machine and transducers, and accurate interpretation of anatomy followed by identification of pathologies. The above require incorporation of ultrasound teaching in undergraduate curricula, outwith the realm of opportunistic bedside learning, accompanied by consideration of ethical topics such as the management of incidental findings and careful evaluation of its pedagogical impact cross-sectionally and longitudinally

Adaptive windowing in contrast-enhanced intravascular ultrasound imaging

Intravascular ultrasound (IVUS) is one of the most commonly-used interventional imaging techniques and has seen recent innovations which attempt to characterize the risk posed by atherosclerotic plaques. One such development is the use of microbubble contrast agents to image vasa vasorum, fine vessels which supply oxygen and nutrients to the walls of coronary arteries and typically have diameters less than 200 µm. The degree of vasa vasorum neovascularization within plaques is positively correlated with plaque vulnerability. Having recently presented a prototype dual-frequency transducer for contrast agent-specific intravascular imaging, here we describe signal processing approaches based on minimum variance (MV) beamforming and the phase coherence factor (PCF) for improving the spatial resolution and contrast-to-tissue ratio (CTR) in IVUS imaging. These approaches are examined through simulations, phantom studies, ex vivo studies in porcine arteries, and in vivo studies in chicken embryos. In phantom studies, PCF processing improved CTR by a mean of 4.2 dB, while combined MV and PCF processing improved spatial resolution by 41.7%. Improvements of 2.2 dB in CTR and 37.2% in resolution were observed in vivo. Applying these processing strategies can enhance image quality in conventional B-mode IVUS or in contrast-enhanced IVUS, where signal-to-noise ratio is relatively low and resolution is at a premium