Transthoracic Ultrasound in the Detection of Interstitial Pulmonary Fibrosis in Patients with Rheumatic Connective Tissue Diseases.

INTRODUCTION: Rheumatic connective tissue diseases are commonly complicated with interstitial lung disease that is responsive to anti-inflammatory therapy and generally carries a better prognosis if diagnosed early. PURPOSE: The aim of our study was to determine the diagnostic value of lung ultrasound in the detection of interstitial pulmonary fibrosis in patients with rheumatic connective tissue diseases. METHODS: Sixty two subjects with rheumatic connective tissue diseases diagnosed according to the American College of Rheumatology criteria for each disease were enrolled (4 males, 58 females; mean age: 47.5 ± 8.9 years; range: 21 to 76 years). All subjects underwent high resolution computed tomography followed by transthoracic ultrasound for comet tail sign detection in order to predict the degree of lung fibrosis. The modified transthoracic ultrasound assessment was performed at 10 intercostal spaces level. The Warrick score was calculated according standard high-resolution chest computed tomography images that were evaluated independently from each other by a radiologist and a pulmonary disease specialist. RESULTS: A significantly positive correlation between transthoracic ultrasound and the severity of pulmonary involvement (Spearman's correlation coefficient = 0.68, p < 0.001), (LR = 70.4, p < 0.001) was found. When compared with standard high-resolution chest computed tomography as the gold standard method, the sensitivity, specificity, and positive and negative predictive value of transthoracic ultrasound was 69.9%, 84.8%, 93.5%, and 49.7%, respectively. CONCLUSIONS: Our study showed that the modified transthoracic ultrasound comet tails scoring system could be useful in the assessment of the pulmonary involvement in patients with rheumatic connective tissue diseases.

Bariatric Bypass Surgery to Resolve Complicated Childhood Morbid Obesity: Case Report Study.

Children obesity has become one of the most important public health problems in many countries worldwide. Although the awareness of childhood obesity as a modifiable health risk is high, but many societies do not prioritize this issue as a health care problem, which may lead to comorbidities and even premature death. Despite the rising interest in bariatric surgery for children, only laparoscopic sleeve gastrectomy (LSG) is being considered in resolving childhood obesity who failed other dietary or drug therapies; however many of LSG procedures failed to reduce the weight in children or resulted in complications postsurgery.Here, we present a novel bariatric procedure to clue out a female child 13 years old presented with Legg-Calvé-Perthes disease-associated morbid obesity. The surgical bariatric technique applied both fundal resection and surgical bypass in pediatric obesity using the Elbanna novel bariatric technique.Bariatric surgical bypass may be considered in complicated-childhood cases who failed all other options.

The Value of U/S to Determine Priority for Upper Gastrointestinal Endoscopy in Emergency Room.

In countries endemic for liver and GIT diseases, frequent emergency department (ED) patients contribute to a disproportionate number of visits consuming substantial amount of medical resources. One of the most frequent ED visits is patients who present with hypovolemic shock, abdominal pain, or confusion with or without signs of upper gastrointestinal bleeding (UGIB). The use of conventional two-dimensional ultrasound (2D-U/S) may provide immediate and useful information on the presence of esophageal varices, gastrointestinal tumors, and other GIT abnormalities.The current study investigated the feasibility of using (2D-U/S) to predict the source of UGIB in ED and to determine patients' priority for UGE.Between February 2003 and March 2013, we retrospectively reviewed the profiles of 38,551 Egyptian patients, aged 2 to 75 years old, who presented with a history of GI/liver diseases and no alcohol consumption. We assessed the value of 2D-U/S technology in predicting the source of UGIB.Of 38,551 patients presenting to ED, 900 patients (2.3%), 534 male (59.3%) and 366 female (40.7%) developed UGIB. Analyzing results obtained from U/S examinations by data mining for emergent UGE were patients with liver cirrhosis (LC), splenomegaly, and ascites (42.6% incidence of UGIB), followed by LC and splenomegaly (14.6%), LC only (9.4%), and was only 0.5% who had no morbidity finding by 2D-U/S.Ultrasonographic instrumentation increases the feasibility of predictive emergency medicine. The area has recently not only gained a fresh impulse, but also a new set of complex problems that needs to be addressed in the emergency medicine setting according to each priority.

Colon in the chest: an incidental dextrocardia: a case report study.

Diaphragmatic injury is an uncommon traumatic injury (<1%). Although most diaphragmatic injuries can be obvious (eg, herniation of abdominal contents on chest radiograph), some injuries may be subtle and imaging studies can be nondiagnostic in many situations. Patients with diaphragmatic hernia either traumatic or nontraumatic may initially have no symptoms or signs to suggest an injury to the diaphragm.Here, we report a case of a 75-year-old woman diagnosed with irritable bowel syndrome -associated dominant constipation, presented with shortness of breath, cough, expectoration, tachycardia, and chest pain. Dextrocardia was an incidental finding, diagnosed by electrocardiography, chest radiograph, and CT chest. Parts of the colon, small intestine, and stomach were within the thorax in the left side due to left diaphragmatic hernia of a nontraumatic cause. Acquired incidental dextrocardia was the main problem due to displacement of the heart to contralateral side by the GI (gastrointestinal) viscera (left diaphragmatic hernia).The patient was prepared for the laparoscopic surgical repair, using a polyethylene mesh 20 cm to close the defect, and the patient recovered with accepted general condition. However, 5 days postoperative, the patient passed away suddenly due to unexplained cardiac arrest.Intrathoracic herniation of abdominal viscera should be considered in patients presented with sudden chest pain concomitant with a history of increased intra-abdominal pressure.