Cohorte descriptiva de pacientes adultos con hipertensión portal en una institución de tercer nivel en Colombia / Descriptive cohort of adult patients with portal hypertension at a tertiary care institution in Colombia

Introducción. La hipertensión portal (HTP) se define como una elevación anormal de la presión venosa en el sistema portal que lleva al desarrollo de vías colaterales para desviar el flujo sanguíneo de la zona. Dentro de su etiología están las relacionadas con la cirrosis hepática y otras causas denominadas no cirróticas. El objetivo de este estudio fue evaluar los principales hallazgos demográficos, clínicos y paraclínicos en un grupo de pacientes con HTP, y determinar el uso de ayudas invasivas y no invasivas, y su disponibilidad para el diagnóstico y seguimiento de los pacientes en los centros que no cuentan con laboratorio de hemodinamia hepática, reflejando la dinámica de múltiples escenarios en Colombia. Metodología. Se realizó un estudio descriptivo de corte transversal, retrospectivo, en pacientes atendidos en una institución de tercer nivel del sur de Colombia, entre enero del año 2015 y diciembre del año 2020. Resultados. Se obtuvo una muestra de 61 pacientes en donde la mayoría de casos correspondían a hombres en la séptima década de la vida, procedentes del área urbana. La principal causa de consulta fue el sangrado digestivo (39,3 %), asociado a la presencia de telangiectasias (arañas vasculares) en el 37,2 %, seguido de circulación colateral (31,3 %) e ictericia (19,7 %). En la ecografía abdominal (realizada en el 57,4 % de los pacientes) predominaron la cirrosis (68 %) y la presencia de esplenomegalia (14,2 %), y en lospacientes con Doppler portal (realizado en el 16,4 %) se encontró hígado cirrótico (80 %) y dilatación portal (40 %). Con respecto a los hallazgos en la esofagogastroduodenoscopia predominó la presencia de várices esofágicas y gastritis crónica. Conclusión. El principal motivo de consulta fue el sangrado digestivo, en tanto que la cirrosis fue el antecedente y el hallazgo imagenológico más frecuente, seguido de las várices esofágicas. Se encontró que el uso de paraclínicos, ecografía abdominal, ecografía con Doppler portal y esofagogastroduodenoscopia fueron los más utilizados en el contexto clínico de los pacientes con el diagnóstico de HTP.

Introduction. Portal hypertension (PHT) is defined as an abnormal elevation of venous pressure in the portal system that leads to the development of collateral pathways to divert blood flow from the area. Within its etiology are those related to liver cirrhosis and other so-called non cirrhotic causes. The aim of this study was to evaluate the main demographic, clinical and paraclinical findings in a group of patients with PHT, and to determine the use of invasive and non-invasive aids, and their availability for the diagnosis and follow-up of patients in centers that do not have a hepatic hemodynamics laboratory, reflecting the dynamics of multiple scenarios in Colombia. Methodology. A descriptive, retrospective, cross-sectional, retrospective study was conducted in patients attended in a third level institution in Southern Colombia, between January 2015 and December 2020. Results. A sample of 61 patients was obtained where the majority of cases corresponded to men in the seventh decade of life, from the urban area. The main cause of consultation was digestive bleeding (39.3%), associated with the presence of telangiectasias (spider veins) in 37.2%, followed by collateral circulation (31.3%) and jaundice (19.7%). In abdominal ultrasound (performed in 57.4% of the patients), cirrhosis (68%) and the presence of splenomegaly (14.2%) predominated, and in patients with portal Doppler (performed in 16.4%), cirrhotic liver (80%) and portal dilatation (40%) were found. With respect to the findings in the esophagogastroduodenoscopy, esophageal varices and chronic gastritis were predominant. Conclusion. The main reason for consultation was gastrointestinal bleeding, while cirrhosis was the most frequent history and imaging finding, followed by esophageal varices. It was found that the use of paraclinics, abdominal ultrasound, ultrasound with portal Doppler and esophagogastroduodenoscopy were the most used in the clinical context of patients diagnosed with PHT.

Artéria ulnar superficial diagnosticada por ultrassom vascular: relato de caso / Superficial ulnar artery diagnosed by vascular ultrasound: case report

Resumo O maior ramo da divisão terminal da artéria braquial é a artéria ulnar, que se origina após a fossa cubital. Essa artéria usualmente tem trajeto profundo aos músculos do antebraço anterior e é responsável pela vascularização da musculatura superficial e profunda da região ulnar do antebraço e hipotênar da mão, sendo a principal responsável pela formação do arco palmar superficial após o retináculo dos flexores. Reportamos uma variação anatômica após diagnóstico com ultrassom vascular na qual a artéria ulnar situava-se em posição superficial no antebraço. A ocorrência da artéria ulnar superficial é rara, porém de grande importância para clínicos, cirurgiões e profissionais de enfermagem.

Abstract The largest branch of the terminal division of the brachial artery is the ulnar artery, which arises after the cubital fossa. This artery usually has a deep path in the muscles of the anterior forearm and is responsible for vascularization of the superficial and deep musculature on the ulnar side of the forearm and hypothenar area of the hand. We report an anatomical variant diagnosed by Doppler ultrasound in which the ulnar artery had a superficial position in the forearm. Occurrence of a superficial ulnar artery is rare, but it is an important fact for clinicians, surgeons, and nursing professionals.

Correlação entre o índice de resistência vascular e a arteriografia na avaliação do leito arterial distal na isquemia crítica dos membros inferiores / Correlation between the vascular resistance index and arteriography for assessment of the distal arterial bed in chronic limb threatening ischemia

Resumo Contexto Pacientes com isquemia crítica (IC) dos membros inferiores (MMII) precisam de arteriografia para o planejamento da cirurgia de revascularização. A ultrassonografia Doppler (UD) não é invasiva e, através da aferição do índice de resistência (IR), pode fornecer informações sobre as artérias distais. Objetivos Correlacionar a Classificação Angiográfica de Rutherford com o IR na avaliação do leito arterial distal dos MMII. Métodos Estudo transversal, realizado em hospital público terciário, com 120 pacientes portadores de IC dos MMII, entre setembro de 2019 a abril de 2022. Foi comparado o IR das artérias da perna passíveis de serem receptoras de revascularização com a imagem obtida através da arteriografia dessas artérias em acordo com a Classificação Angiográfica de leito distal de Rutherford. Resultados Foram avaliados 120 MMII em 120 pacientes com idade média de 68,6 anos. A amostra foi composta de 50,0% de pacientes do sexo masculino. Na amostra, 90,0% pacientes encontravam-se na classe cinco de Rutherford. Os valores do IR encontrados para as artérias de perna apresentaram uma correlação positiva, estatisticamente significativa, quando comparados com a Classificação de Rutherford (tibial anterior, p< 0,01; tibial posterior, p = 0,012 e fibular, p = 0,034 e artéria dorsal do pé, p < 0,001). Conclusões Neste estudo, os IRs das artérias da perna obtidos através da ultrassonografia Doppler apresentaram uma correlação positiva quando comparados à classificação de Rutherford. Em pacientes com isquemia crítica, esse índice pode ser útil na avaliação do leito arterial distal dos membros inferiores.

Abstract Background Patients with chronic limb threatening ischemia (CLTI) of the lower limbs (LL) undergo arteriography for revascularization surgery planning. Doppler ultrasound (DU) is non-invasive and can provide information about the distal arteries through measurement of the resistance index (RI). Objectives To correlate the Rutherford Angiographic Classification with the RI for assessment of the distal arterial bed of the LL. Methods A cross-sectional study, conducted at a public tertiary hospital with 120 patients with LL CLTI, from September 2019 to April 2022. The RI of arteries that were candidates for revascularization was compared with the images of the same arteries obtained using arteriography, using the Rutherford Angiographic Classification of the distal bed. Results A total of 120 LL were assessed in 120 patients with a mean age of 68.6 years. The sample was 50.0% male and 90.0% of the patients in the sample were classified as Rutherford category five. The RI values found for the arteries of the leg exhibited a statistically significant positive correlation with the Rutherford Classification (anterior tibial, p< 0.01; posterior tibial, p = 0.012 fibular, p = 0.034; and dorsalis pedis, p < 0.001). Conclusions In this study, RIs for the arteries of the leg measured using Doppler ultrasound exhibited a positive correlation with the Rutherford Classification. This index could be useful for assessment of the distal arterial bed of the lower limbs of patients with chronic limb threatening ischemia.

Diagnostic value of a computer-assisted diagnosis system for the ultrasound features in thyroid nodules

ABSTRACT Objective: To explore the diagnostic value of the TUIAS (SW_TH01/II) computer-aided diagnosis (CAD) software system for the ultrasound Thyroid Imaging Reporting and Data System (TI-RADS) features in thyroid nodules. Materials and methods: This retrospective study enrolled patients with thyroid nodules in Shanghai East Hospital between January 2017 and October 2021. The novel CAD software (SW_TH01/II) and three sonographers performed a qualitative analysis of the ultrasound TI-RADS features in aspect ratio, margin irregularity, margin smoothness, calcification, and echogenicity of the thyroid nodules. Results: A total of 225 patients were enrolled. The accuracy, sensitivity, and specificity of the CAD software in "aspect ratio" were 95.6%, 96.2%, and 95.4%, in "margin irregularity" were 90.7%, 90.5%, and 90.9%, in "margin smoothness" were 85.8%, 88.5%, and 83.0%, in "calcification" were 83.6%, 81.7%, and 82.0%, in "homogeneity" were 88.9%, 90.6%, and 82.2%, in "major echo" were 85.3%, 88.0%, and 85.4%, and in "contains very hypoechoic echo" were 92.0%, 90.0%, and 92.4%. The analysis time of the CAD software was significantly shorter than for the sonographers (2.7 ± 1.6 vs. 29.7 ± 12.7 s, P < 0.001). Conclusion: The CAD system achieved high accuracy in describing thyroid nodule features. It might assist in clinical thyroid nodule analysis.

Sonographic evaluation of the commonest sites of placental localization in pregnant women in Umuahia, Abia State

Background:The Placenta is an organ of pregnancy that provides nutrition, excretory functions and oxygen to the fetus.Aim:The purpose of the study is to determine and provide information on the commonest sites of placental localization in pregnant women in their second and third trimesters in Umuahia, Abia state because there are few documented reports on the sonographic assessment of placental localization in Umuahia.Methodology:Prospective study of pregnant women in their second and third trimesters was carried out trans- abdominally using an ultrasound scan machine with a 3.5 MHz transducer. Placental localization was classified into anterior, posterior, fundal and low-lying, Ultrasonography was used because it is non-ionizing, cheap and readily available. Exclusion criteria; pregnant women with a history of Caesarian section, uterine fibroids and multiple gestation.Results:One hundred women between the ages of 20yrs and 42yrs with a mean age of 28.60±4.95 on their routine antenatal visit were used for the study. The women were in their second and third trimesters, and fetal gender distribution was 55 males and 45 females. Placental localization was classified into Anterior 44%, fundal 20%, posterior 30% and previa 3%.Conclusion:Anterior placentation was the commonest, followed by posterior, then fundal with placenta previa being the least site of placental localization. There was no statistical significance between placental localization and maternal age, gestational age, fetal weight, gender, fetal presentation and heart rate. Evaluation for placental localization in the second and third trimesters is important to rule out placenta previa.

Evaluation of Fine Needle Biopsy (FNB) for Endoscopic Ultrasound (EUS)-guided tissue acquisition of pancreatic masses to negate the need for rapid on-site evaluation: A randomized control trial

Background and Objectives@#The benefits of rapid on-site evaluation (ROSE) of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) of solid masses have not been convincingly shown in large, randomized trials. New equipment using EUS-guided fine needle biopsy (FNB) allows for more material to be acquired that may obviate the need for ROSE. This study aimed to evaluate if EUS-FNB without ROSE was non-inferior to EUS-FNA with ROSE in solid pancreatic masses (SPMs). @*Methods@#Patients with SPMs requiring tissue sampling were randomly assigned to undergo either EUS-FNA with ROSE or EUS-FNB without ROSE. The touch-imprint cytology technique was used to perform ROSE. The primary endpoint was diagnostic accuracy and secondary endpoints were specimen quality, complication rates, and procedure time. @*Results@#Seventy-eight patients were randomized and analyzed (39 EUS-FNA with ROSE and 39 EUS-FNB without ROSE). Non-significantly different diagnostic accuracies were noted in both groups (97% with ROSE and 100% without ROSE, P < 0.371). The bloodiness of histologic samples and complication rates were not significantly different between groups. A significantly shorter mean sampling procedural time was noted for EUS-FNB over EUS-FNA with ROSE (30.4 ± 10.4 vs 35.8 ± 9.8 minutes, P < .02). @*Conclusions@#EUS-FNB demonstrated equal diagnostic accuracy with shorter procedure times in evaluating SPMs compared to EUS-FNA with ROSE. These new-generation FNB needles may obviate the need for ROSE.

Clinical observation of Van Herick method for evaluating anterior chamber angle width / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To explore a more convenient and accurate method for evaluating the anterior chamber angle width based on the Van Herick method.METHODS:A total of 58 patients(69 eyes)with age-related cataract who visited our hospital between January and December 2021 were included. They were divided into the chamber angle width ≥1/2 corneal thickness(CT)group(44 eyes of 37 cases)and &#x0026;#x003C;1/2CT group(25 eyes of 21 cases)according to the Van Herick method. The central anterior chamber depths and the peripheral anterior chamber angle degrees were measured by ultrasound biomicroscopy.RESULTS: There were statistically significant differences in central anterior chamber depth between the two groups(2.64±0.27 mm vs. 2.23±0.29 mm, P&#x0026;#x003C;0.01), and the differences of chamber angle degrees of quadrants of superior, temporal, inferior and nasal compared between two groups were all statistically significant(P&#x0026;#x003C;0.01). The difference of chamber angle degrees of quadrants of superior and inferior in chamber angle width ≥1/2CT group was not statistically significant(P&#x0026;#x003E;0.05), while the differences of chamber angle degrees of other quadrants were all statistically significant(P&#x0026;#x003C;0.05). The differences of chamber angle degrees of quadrants of superior and nasal, temporal and the chamber angle degrees of quadrants of inferior and temporal were all statistically significant in chamber angle width &#x0026;#x003C;1/2CT group(P&#x0026;#x003C;0.05).CONCLUSION: In the overall evaluation of the anterior chamber angle, it would be more simple, fast and accurate when evaluating the temporal chamber angle width and inferior quadrant of chamber angle width by using the Van Herick method under silt lamp.

Characteristics of anterior segment structure in first-degree relatives of patients with primary angle-closure glaucoma / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To investigate the characteristics of anterior segment structure in first-degree relatives of patients with primary angle-closure glaucoma(PACG).METHODS: A total of 48 first-degree relatives of PACG patients aged 40-60 who were treated in the Affiliated Eye Hospital of Nanchang University from September 2020 to October 2022 were selected as the observation group. Additionally, 40 cases(40 eyes)of healthy individuals without glaucoma and family history of glaucoma at the same age group were collected as the control group. They were divided into younger group(40-49 years old)and elder group(50-60 years old). All subjects were examined with ultrasound biomicroscopy(UBM)and were measured using camera measure software. The parameters mainly included anterior chamber depth(ACD), anterior chamber area(ACA), anterior chamber width(ACW), anterior segment depth(ASD), angle open distance(AOD500), trabecular iris angle(TIA), trabecular iris area(TISA500), lens vault(LV), iris curve(IC), iris thickness(IT500), scleral ciliary process angle(SCPA), and iris ciliary process distance(ICPD).RESULTS: ACD, ACA, AOD500, TISA500 and TIA in the observation group were lower than those of the control group, and LV and IC were higher than those of the control group(all P&#x0026;#x003C;0.05). ACD, ACA, AOD500, TISA500, and TIA of the elder group were lower than those in the age-matched control group, while LV and IC were larger than those of the age-matched control group(all P&#x0026;#x003C;0.05). ACD, AOD500, TISA500, and TIA of the younger observation group were smaller than those of the age-matched control group, but LV and IC were significantly larger than those of the age-matched control group(all P&#x0026;#x003C;0.05). ACD, ACA, AOD500, TISA500 and TIA of the elder observation group were significantly lower than those of the younger observation group, and LV and IC were significantly larger than those of the younger observation group(all P&#x0026;#x003C;0.05). There was a difference in the distribution of ACD between the observation group and the control group(P&#x0026;#x003C;0.05), and the proportion of moderate to severe shallow anterior chambers was 10 times that of the control group. Correlation analysis showed that TISA500 was positively correlated with ACD and ACA, and negatively correlated with LV and IC, and TISA500 was mainly influenced by LV. IC had a positive correlation with LV and a negative correlation with ACD and ACA.CONCLUSION: First-degree relatives of PACG with normal axial length have a high risk of angle closure. The anterior segment structures of first-degree relatives of PACG are more crowded than normal individuals, and the lens forward shift may be the initial influencing factor for narrow angle.

Endoscopic Ultrasound-Directed Transgastric Endoscopic Retrograde Cholangiopancreatography in a Patient with Gastric Bypass. Report of the First Local Case

We describe the first case in our environment of endoscopic ultrasound (EUS)-assisted transgastric endoscopic retrograde cholangiopancreatography in a patient with gastric bypass surgery. The procedure was performed with a side-viewing duodenoscope through a jejunogastrostomy using apposing stents, placed with EUS assistance, and a standard technique and instruments.

Se describe el primer caso en nuestro medio de colangiopancreatografía retrógrada endoscópica transgástrica asistida por endosonografía en una paciente con cirugía de baipás gástrico. El procedimiento se realizó con duodenoscopio de visión lateral a través de una yeyunogastrostomía por stent de aposición, emplazado con asistencia endosonográfica y con una técnica e instrumental estándar.

UDC- COVID 19: herramienta digital para predecir el retiro de la ventilación mecánica invasiva de pacientes con COVID-19

En diciembre de 2019 las Autoridades de la República Popular China, comunicaron a la OMS varios casos de neumonía de etiología desconocida en Wuhan, una ciudad situada en la provincia china de Hubei. Una semana más tarde confirmaron que se trataba de un nuevo coronavirus que fue denominado SARS-CoV-2, este virus causa diversas manifestaciones clínicas englobadas bajo el término COVID-19. El presente trabajo presenta un prototipo de aplicación con el nombre UDC-COVID19 que propone una herramienta digital sobre la base de una revisión actualizada de la evaluación ultrasonográfica del diafragma como elemento predictivo para retirar la ventilación mecánica invasiva en pacientes con COVID-19, proporcionando una excelente herramienta digital para la evaluación de la estructura y función dinámica diafragmática, es precisa, reproducible, sin radiación ionizante, fácil de realizar a la cabecera del paciente y costo efectiva en pacientes críticamente enfermos.

In December 2019, the Authorities of the People's Republic of China reported to the WHO several cases of pneumonia of unknown etiology in Wuhan, a city located in the Chinese province of Hubei. A week later, they confirmed that it was a new coronavirus called SARS-CoV-2, which causes various clinical manifestations encompassed under the term COVID-19. The present work presents an application prototype with the name UDC-COVID19 that proposes a digital tool based on an updated review of the ultrasonographic evaluation of the diaphragm as a predictive element to withdraw invasive mechanical ventilation in patients with COVID-19, providing an excellent digital tool for the evaluation of the diaphragmatic structure and dynamic function since it is precise, reproducible, without ionizing radiation, easy to perform at the patient's bedside and cost effective in critically ill patients; mechanical ventilation.

Utilización del ultrasonido como herramienta para el diagnóstico y tratamiento en cirugía de tórax

Objetivo: presentar la utilización de la guía ecográfica en el tórax para realizar biopsias y colocación de drenajes, ya sean pleurales o pericárdicos. Material y método: se realizaron 124 procedimientos ecoguiados en el Instituto del Tórax del Hospital Maciel, desde enero de 2014 hasta agosto de 2022. Resultados: se evaluaron franja etaria, tipo de procedimiento y rentabilidad diagnóstica en los procedimientos ecoguiados. Se realizaron 69 punciones con fines diagnósticos, 48 colocaciones de drenajes pleurales bajo apoyo ecográfico y 7 drenajes pericárdicos. Conclusión: la realización de procedimientos ecoguiados en el tórax es una herramienta diagnóstica y terapéutica segura, con buen rendimiento y mínimas complicaciones.

Objective: To present the use of ultrasound guidance to perform thorax biopsies and place drainages, whether pleural or pericardial. Method: A total of 124 ultrasound-guided procedures were performed at the Thoracic Institute, Maciel Hospital, from January 2014 to August 2022. Results: The results were assessed based on age group, type of procedure, and diagnostic yield in the ultrasound-guided procedures. There were 69 diagnostic punctures, 48 ultrasound-guided pleural drainage placements, and 7 pericardial drainages. Conclusions: The performance of ultrasound-guided thoracic procedures are a safe diagnostic and therapeutic tool with excellent efficacy and minimal complications.

Objetivo: fica no tórax para realização de biópsias e colocação de drenos pleurais ou pericárdicos. Materiais e métodos: foram realizados 124 procedimentos guiados por ultrassom no Instituto del Tórax do Hospital Maciel no período de janeiro de 2014 a agosto de 2022. Resultados: foram avaliadas faixa etária, tipo de procedimento e rentabilidade diagnóstica em procedimentos guiados por ultrassom. Foram realizadas 69 punções para fins diagnósticos, 48 colocações de drenos pleurais sob suporte ultrassonográfico e 7 drenos pericárdicos. Conclusão: a realização de procedimentos guiados por ultrassom no tórax é uma ferramenta diagnóstica e terapêutica segura, com bom desempenho e complicações mínimas.

Anatomic barriers to paraspinal blocks: a cadaver case series

Abstract The paraspinal space is intriguing in nature. There are several needle tip placements described in compact anatomical spaces. This has led to an incertitude regarding the appropriate anatomic locations for needle tip positions. Through our cadaver models we try to resolve the issues surrounding needle tip positions clarifying anatomical spaces and barriers. Further we propose an anatomical classification based on our findings in cadaveric open dissections and cross and sagittal sections.

Impacto del PET/CT en el diagnóstico de insulinoma

Introducción: La tomografía de emisión de positrones es una técnica diagnóstica no invasiva que permite tomar imágenes del organismo que muestra el metabolismo de los órganos del cuerpo. Objetivo: Destacar el valor de la PET/CT en el diagnóstico imagenológico prequirúrgico del enfermo. Presentación de caso: Se presentó un paciente masculino de 39 años sin antecedentes de importancia, con un cuadro de hipoglucemias severas de 5 años de evolución, a pesar de los múltiples estudios imagenológicos se incluyó la ecoendoscopía digestiva, lo que no fue posible evidenciar la lesión tumoral. Se le realiza PET/CT cuyo resultado fue crucial para localizar el tumor, se le dio al paciente la oportunidad de un tratamiento quirúrgico y la demostración anatomopatológica de insulinoma. Conclusiones: Los insulinomas son tumores pancreáticos poco frecuentes que provocan hiperinsulinismo endógeno y son difíciles de visualizar debido a su tamaño por las técnicas de imágenes convencionales, por lo que el PET/CT es un estudio bastante efectivo para localizar la lesión tumoral, y así realizar un procedimiento quirúrgico.

Introduction: Positron emission tomography is a non-invasive diagnostic technique, allowing images of the body to be taken that show the metabolism of the body's organs. Objective: To highlight the value of PET/CT in the pre-surgical imaging diagnosis of the patient. Case presentation: We report the case of a 39-year-old male patient with no significant medical history, but a 5-year history of severe hypoglycemia. Despite multiple imaging studies, digestive ultrasound endoscopy was included, which was not possible to demonstrate the tumor lesion. PET/CT was performed, the result of which was crucial in locating the tumor. The patient was given the opportunity for surgical treatment and the pathological demonstration of insulinoma. Conclusions: Insulinomas are rare pancreatic tumors that cause endogenous hyperinsulinism and are difficult to visualize due to their size using conventional imaging techniques, therefore PET/CT is a fairly effective study to locate the tumor lesion, and thus perform a surgical procedure.

La antropometría aplicada en el ultrasonido como herramienta para la medición de la composición corporal

La caracterización antropométrica de los individuos aporta información para la evaluación de su estado de salud, en particular la composición corporal -aspecto esencial en la valoración nutricional y funcional-, donde el ultrasonido adquiere cada vez más valor en el análisis de estos componentes. El propósito de esta investigación es sistematizar los referentes sobre el estudio de la composición corporal a través de las mediciones del tejido adiposo subcutáneo por ultrasonido. Se realizó una investigación documental cuyo objeto de estudio fueron los artículos publicados en las bases de datos SciELO, EBSCO y PubMed, entre enero de 2020 y octubre de 2022. Se encontró que existen diferentes centros investigativos que han desarrollado estudios sobre la composición corporal medida a través de ultrasonido, mayormente en la última década. Las principales escuelas se encuentran en Francia, Estados Unidos, Brasil y Austria. Las aplicaciones de estos estudios se encuentran en la nutrición, el deporte, la salud en general, y poblaciones particulares como niños, adolescentes, militares e individuos con sobrepeso u obesidad. Por tanto, se considera que el ultrasonido es un método indirecto de medición de la composición corporal, que ha sido empleado para medir la estructura del tejido y ha demostrado ser una técnica precisa para medir el grosor de la grasa subcutánea.

The anthropometric characterization of individuals provides information for the evaluation of their health status, in particular body composition -a fundamental aspect in nutritional and functional assessment- where ultrasound acquires increasingly more value in the analysis of these components. The purpose of this study is to systematize the references on the study of body composition through measurements of subcutaneous adipose tissue by ultrasound. A documentary research was carried out whose object of study was the scientific articles published in the SciELO, EBSCO and PubMed databases, between January 2020 and October 2022. It was found that different research centers have developed studies on body composition measured through ultrasound, mainly in the last decade. The main schools are located in France, the United States, Brazil and Austria. The applications of these studies are found in nutrition, sports, health in general and in particular populations such as children, adolescents, military personnel, and overweight or obese individuals. Therefore, ultrasound is considered to be an indirect method of measuring body composition, which has been used to measure tissue structure and has proven to be an accurate technique for measuring the thickness of subcutaneous fat.

Effect of Endo-Z bur or Bladesonic ultrasonic tip on the adaptation of filling material. A micro-CT study

Abstract This study aimed to evaluate the effect of apicoectomy performed with a bur or an ultrasonic tip on the adaptation of the filling material to root canal dentin. Twenty human mandibular incisors were selected and prepared with a ProDesign Logic system up to diameter 40/.05. The root canals were filled with Bio-C Sealer (Angelus, PR, Brazil) using the single cone technique and were stored at 37ºC and 95% relative humidity for 7 days. After this period, the apicoectomy of the 3 millimeters of the root apex was performed using Endo-Z bur (Dentsply Sirona) or Bladesonic ultrasonic tip (Helse Ultrasonic, Santa Rosa de Viterbo, Brazil) (n=10). The specimens were scanned by micro-computed tomography (micro-CT; SkyScan 1176) with a voxel size of 8.74 µm after obturation and after apicoectomy. The percentage of voids at the interface between the filling material and the root canal wall was evaluated in the apical 4 mm of the root after apicoectomy, besides the time cutting to both devices. The data obtained were submitted to paired and unpaired t-tests (α = 0.05). Endo-Z and Bladesonic increased the percentage of voids between the filling material and the dentin after apicectomy (p<0.05), and they were similar (p>0.05). Endo-Z has a shorter time to perform apicoectomy compared to Bladesonic (p<0.05). Apicectomies with Endo-Z or Bladesonic could harm the material/dentin interface, while the Endo-Z bur was faster than the Bladesonic ultrasonic tip.

Resumo O objetivo deste estudo foi avaliar o efeito da apicectomia realizada com broca ou inserto ultrassônico na adaptação do material obturador á dentina do canal radicular. Vinte incisivos inferiores humanos extraídos foram selecionados e preparados com o sistema ProDesign Logic até o diâmetro 40/.05. Os canais radiculares foram obturados com Bio-C Sealer (Angelus, PR, Brasil) por meio da técnica de cone único e foram armazenados em estufa a 37ºC e umidade relativa de 95% por 7 dias. Após esse período, foi realizada apicectomia dos 3 milímetros apicais utilizando broca Endo-Z (Maillefer - Dentsply) ou inserto ultrassônico BladeSonic (Helse Ultrasonic, Santa Rosa de Viterbo, Brasil) (n=10). Os espécimes foram escaneados por meio de microtomografia computadorizada (micro-CT; SkyScan 1176) com tamanho de voxel de 8,74 µm após obturação e após apicectomia. Please, correct this sentece to O percentual de falhas na interface entre o material obturador e a parede dentinaria foi avaliado nos 4 mm apicais da raiz apos apicectomia, alem do tempo de corte para ambos dispositivos. Os dados obtidos foram submetidos aos testes t pareado e não pareado (α = 0,05). Endo-Z e Bladesonic aumentaram o percentual de vazios entre o material obturador e a parede da dentina após apicectomia (p<0.05), sendo semelhantes entre si (p>0.05). Endo-Z demonstrou menor tempo para realizar apicectomia em comparação com Bladesonic (p<0.05). Apicectomias com Endo-Z ou Bladesonic podem prejudicar a interface material obturador/dentina, sendo a broca Endo-Z mais rápida que a ponta ultrassônica Bladesonic.

Ultrasound identification of the cricothyroid membrane. Systematic review and meta-analysis

Introduction: The no-ventilation no-oxygenation situation is extremely important due to its high mortality. In these cases, open cricothyroidotomy is indicated. Around fifty percent of the difficulties are the result of inadequate identification of the cricothyroid membrane (CTM). Objective: To determine whether ultrasonography is superior to palpation to identify the CTM at the first attempt. Methods: A systematic review and a meta-analysis were conducted on the identification of the cricothyroid membrane versus palpation in Medline/Central and Embase. Clinical controlled trials and observational studies were included. Two authors independently and in duplicate selected the studies, assessed the biases and extracted the data; a random effects meta-analysis was successfully conducted for the correct identification of the CTM. The risk of bias was assessed and the certainty of the evidence was qualified. CRD42021223961. Results: 464 studies were included of which 15 met the eligibility criteria; 6 were clinical trials y 9 were observational. Ultrasound is superior to palpation in the detection of the CTM (RR 1.88, 95 % CI 1.05-3.36) according to the clinical trials, and it was also superior in observational studies (RR 1.76, 95 % CI 1.36-2.28). The association was preserved in the sensitivity analyses. Conclusions: Ultrasonography is superior to palpation for the correct identification of the TCM, though the certainty of the evidence is low. Further studies with better methodology are needed to improve both certainty and precision.

Introducción: La situación de no ventilación-no oxigenación es de gran importancia dada su elevada mortalidad. En dichos casos, la cricotiroidotomía abierta está indicada. Cerca de la mitad de las dificultades son causadas por inadecuada identificación de la membrana cricotiroidea (MCT). Objetivo: Determinar si la ultrasonografía es superior a la palpación para identificar la MCT al primer intento. Métodos: Se realizó una revisión sistemática y metaanálisis de identificación de membrana cricotiroidea versus palpación en Medline/Central y Embase. Se incluyeron ensayos clínicos controlados y estudios observacionales. Dos autores de manera independiente y por duplicado realizaron la selección de estudios, la evaluación de sesgos y la extracción de datos, se efectuó un metaanálisis de efectos aleatorios con el éxito de identificación correcta de la MCT. Se evaluó el riesgo de sesgos y se calificó la certeza de la evidencia. CRD42021223961. Resultados: Se incluyeron 464 estudios de los cuales 15 cumplieron criterios de elegibilidad, 6 fueron ensayos clínicos y 9 observacionales. La ecografía es superior a la palpación para detección de la MCT (RR 1,88, IC 95 % 1,05-3,36) según los ensayos clínicos y, similarmente, fue superior para los estudios observacionales (RR 1,76, IC 95 % 1,36-2,28); la asociación se conservó en los análisis de sensibilidad. Conclusiones: La ultrasonografía es superior a la palpación para detectar correctamente la MCT, aunque con baja certeza de la evidencia. Se requieren más estudios con mejor calidad metodo-lógica para mejorar la certeza y la precisión.

Drainage of Pancreatic Pseudocysts Using Lumen-apposing Metal Stents (LAMS): Experience in Two Referral Centers in Colombia

Introduction: Endoscopic ultrasound (EUS)-guided drainage and luminal-apposing metal stents (LAMS) are the options for managing symptomatic pancreatic pseudocysts. Aim: To evaluate the effectiveness and safety of LAMS for EUS-guided drainage of symptomatic pancreatic pseudocysts in two referral centers in Colombia. Materials and methods: A multicenter prospective cohort study between June 2019 and December 2021 included 13 patients diagnosed with symptomatic pancreatic pseudocysts who underwent EUS-guided drainage with LAMS. Technical success, clinical success, and successful stent removal were evaluated as outcomes. Safety outcomes included stent-related adverse events and general adverse events. Follow-up was carried out for eight weeks, collecting data on stent removal. Results: The average age was 53.4 years; 8/13 were men. The mean size of the pseudocyst was 9.56 ± 2.3 cm. Technical success was 100%, and clinical success was 92.3%. The stents were removed on average after 8 ± 2 weeks. The mean procedural time from puncture to stent deployment was 3.2 ± 2.4 minutes. In the imaging check-up, the collections had adequate drainage in all cases. There was a low frequency of complications; bleeding was documented in one case requiring surgery. Conclusions: LAMS is safe and effective in managing symptomatic pancreatic pseudocysts, reducing hospital stay and cost overruns. Clinical symptomatology prevails in the surgery decision.

Introducción: el drenaje guiado por ultrasonido endoscópico (USE) y el uso de stent metálico luminal de aposición (LAMS) son de elección en el manejo de los pseudoquistes pancreáticos sintomáticos. Objetivo: evaluar la efectividad y seguridad del LAMS para el drenaje por USE de pseudoquistes pancreáticos sintomáticos en dos centros de referencia en Colombia. Materiales y métodos: estudio de cohorte prospectivo multicéntrico entre junio de 2019 y diciembre de 2021, se incluyeron a 13 pacientes con diagnóstico de pseudoquistes pancreáticos sintomáticos sometidos a drenaje por USE con LAMS. Se evaluaron como desenlaces el éxito técnico, el éxito clínico y la extracción exitosa del stent. Y los desenlaces de seguridad incluyeron eventos adversos relacionados con el stent y los eventos adversos generales. Se realizó seguimiento a 8 semanas, en las que se recopilaron datos relacionados con el retiro del stent. Resultados: la edad promedio fue 53,4 años, 8/13 fueron hombres. El tamaño medio del pseudoquiste fue de 9,56 ± 2,3 cm. El éxito técnico fue del 100% y el éxito clínico fue 92,3%. Los stents fueron retirados en promedio a las 8 ± 2 semanas. El tiempo medio del procedimiento desde la punción hasta el despliegue del stent fue 3,2 ± 2,4 minutos. En el control imagenológico hubo un adecuado drenaje de las colecciones en todos los casos. Hubo baja frecuencia de complicaciones, se documentó sangrado en 1 caso con requerimiento quirúrgico. Conclusiones: el uso de LAMS es seguro y efectivo en el manejo de pseudoquistes pancreáticos sintomáticos, disminuye la estancia hospitalaria y sobrecostos. La sintomatología clínica prima en la decisión de intervención.

Impacto da pandemia de COVID-19 nos procedimentos de ultrassonografia endoscópica em uma unidade de endoscopia de alto volume no Brasil / The impact of the covid-19 pandemic on endoscopic ultrasound procedures in a high-volume endoscopy unit in brazil

ABSTRACT Background: Reports of the impact of the 2020 COVID-19 pandemic period/2020 on endoscopic ultrasound (EUS) are scarce. Objective: We analyzed the impact of the pandemic period/2020 on the demographics, indications, and number of diagnostic EUS (D-EUS) and interventional EUS (I-EUS) procedures performed in a high-volume endoscopy unit compared with the previous non-pandemic period/2019. Methods: We retrospectively reviewed the medical records of all patients undergoing D-EUS or I-EUS from March 1, 2019, to February 29, 2020 (non-pandemic period/2019) and from March 1, 2020, to February 28, 2021 (pandemic period/2020). Data compared between the study periods included sex, age, comorbidities, EUS findings and diagnosis, need for interventional procedures during EUS, and adverse events (AEs). Results were significant at P<0.05. Results: EUS procedures decreased from 475 in the non-pandemic period/2019 to 289 in the pandemic period/2020, accounting for a 39% reduction. In non-pandemic period/2019, 388 (81.7%) D-EUS and 88 (18.5%) I-EUS were performed, against 206 (71.3%) D-EUS and 83 (28.7%) I-EUS in pandemic period/2020 (P=0.001). Only 5/289 (1.7%) patients had COVID-19. Fewer patients with comorbidities underwent EUS during pandemic period/2020 due to lockdown measures (P<0.001). D-EUS decreased, whereas I-EUS increased (P<0.001). EUS-guided tissue acquisition (EUS-TA) was the most common I-EUS, performed in 83/289 (28.7%) patients in pandemic period/2020, against 88/475 (18.5%) in non-pandemic period/2019 (P=0.001). AEs did not differ significantly between the study periods. Conclusion: Pandemic Period/2020 had a moderate impact on reducing EUS procedures due to the risks involved. Although I-EUS increased, EUS-related AEs did not. Solid and cystic pancreatic tumors remained a major indication for EUS-TA even during the pandemic period/2020.

RESUMO Contexto: Os dados sobre o impacto da pandemia de COVID-19 2020 na ultrassonografia endoscópica (EUS) são escassos. Objetivo: Analisamos o impacto do período pandêmico/2020 na demografia, indicações e número das EUS diagnósticas (D-EUS) e intervencionistas EUS (I-EUS) realizados em uma unidade de endoscopia de alto volume e os comparamos com o período imediatamente anterior não-pandêmico/2019. Métodos: Revisamos retrospectivamente os prontuários de todos os pacientes submetidos a D-EUS ou I-EUS de 1 de março de 2019 a 29 de fevereiro de 2020 (período não-pandêmico/2019) e de 1º de março de 2020 a 28 de fevereiro de 2021 (período da pandemia/2020). Comparamos os dados entre os períodos do estudo incluímos o sexo, idade, comorbidades, achados e diagnóstico da EUS, necessidade de procedimentos intervencionistas durante a EUS e a ocorrência de eventos adversos (EAs). Os resultados foram significativos com P<0,05. Resultados: O número de ecoendoscopias diminuíram de 475 no período não-pandêmico/2019 para 289 no período pandêmico/2020, representando uma redução de 39%. No período não-pandêmico/2019 e pandêmico/2020 foram realizados 388 (81,7%) D-EUS e 88 (18,5%) I-EUS, contra 206 (71,3%) D-EUS e 83 (28,7%) I-EUS, respectivamente (P=0,001). Apenas 5/289 (1,7%) pacientes tinham COVID-19. Menos pacientes com comorbidades realizaram EUS durante o período pandêmico/2020 devido as medidas de bloqueio (P<0,001). D-EUS diminuiu, enquanto I-EUS aumentou (P<0,001). A EUS associada a aquisição tecidual (EUS-AT) foi a I-EUS mais comum, realizada em 83/289 (28,7%) pacientes no período pandêmico/2020, versus 88/475 (18,5%) no período não-pandêmico/2019 (P=0,001). Os EAs não diferiram significativamente entre os períodos do estudo. Conclusão: O período da pandemia/2020 teve impacto moderado na redução da EUS devido aos riscos envolvidos. Embora o I-EUS tenha aumentado, os EAs relacionados ao EUS não aumentaram. Os tumores pancreáticos sólidos e císticos permaneceram como uma das principais indicações para EUS-AT mesmo durante o período pandêmico/2020.

Utilidad de la ecografía transvaginal para la predicción de parto prematuro luego de un cerclaje cervical: revisión de la literatura

Introducción : el tratamiento de la insuficiencia cervical es el cerclaje cervical. Pese a este tratamiento el riesgo de parto prematuro persiste elevado en mujeres con insuficiencia cervical. La mejor forma y utilidad del seguimiento ecográfico de mujeres cercladas es desconocida. El objetivo de esta revisión fue evaluar la capacidad pronóstica de la ecografía transvaginal para predecir riesgo de parto prematuro luego de un cerclaje cervical. Materiales y métodos : realizamos una revisión sistemática de la literatura incluyendo estudios que evaluaran el valor pronóstico de la ecografía transvaginal luego de un cerclaje cervical, para predecir parto prematuro. Resultados : incluimos 14 estudios en la revisión. El parámetro más frecuentemente asociado con parto prematuro fue la longitud cervical posterior al cerclaje, aunque con capacidad predictiva moderada. El punto de corte para definir pacientes en riesgo varió entre 15-28 mm. Conclusión : la longitud cervical disminuida posterior a un cerclaje se asocia con mayor riesgo de parto prematuro. No se ha establecido un valor de corte único ni la utilidad clínica del seguimiento ecográfico de mujeres cercladas.

Introduction : The management of cervical insufficiency involves a cervical cerclage. Despite this treatment, patients with cervical insufficiency remain at high risk of preterm delivery. The best method and utility of ultrasound monitoring for women with cervical cerclage is unknown. The objective of this revision was to evaluate the prognostic performance of ultrasonographic cervical assessment to predict preterm labor after a cervical cerclage. Material and methods : We conducted a systematic literature review, including studies that assessed the prognostic value of transvaginal ultrasound after cervical cerclage in predicting premature birth. Results : We included 14 studies in our review. The most frequently evaluated parameter was cervical length after the cerclage, although with only moderate predictive capacity. The length used to define prognosis varied from 15 to 28 mm. Conclusion : Short cervical length after a cerclage is associated with a higher risk of preterm delivery. A single cutoff value and the clinical utility of ultrasound monitoring for women with cervical cerclage have not been established.

Técnicas de imagen en la orbitopatía asociada al tiroides

La orbitopatía asociada al tiroides es la primera causa de afección inflamatoria orbitaria y de exoftalmo en adultos. Su progresión puede generar complicaciones, las cuales, ante un manejo inoportuno u omisión diagnóstica, pueden conllevar a disfunción visual irreversible. De aquí la importancia de garantizar un diagnóstico y tratamiento adecuados, para lo cual es fundamental un correcto manejo imagenológico. Con el propósito de actualizar y sistematizar el conocimiento sobre el diagnóstico por imágenes de la orbitopatía asociada al tiroides, se realizó una revisión de las publicaciones relacionadas con el tema de las últimas dos décadas. La búsqueda y la localización de la información se apoyaron en la elección de palabras clave/descriptores que configuraron su perfil. Además, se analizaron las ecografías, tomografías computarizadas y resonancias magnéticas de los pacientes diagnosticados con esta enfermedad en el Instituto Cubano de Oftalmología Ramón Pando Ferrer, durante los últimos 10 años. Todo lo investigado confirma que las técnicas de imagen son claves para establecer el diagnóstico de la oftalmopatía asociada al tiroides, pero jamás sustituirán a la historia clínica detallada y el examen físico minucioso. El médico se equivoca gravemente cuando pretende obviar la importancia del juicio clínico. La omisión de este principio, en el mejor de los casos, solo conducirá a diagnósticos casuales.

Thyroid-associated orbitopathy is the leading cause of orbital inflammatory disease and exophthalmos in adults. Its progression can generate complications, which, in case of inopportune management or diagnostic omission, can lead to irreversible visual dysfunction. Hence the importance of guaranteeing an adequate diagnosis and treatment, for which a correct imaging management is essential. With the purpose of updating and systematizing the knowledge on the imaging diagnosis of thyroid associated orbitopathy, a review of the publications related to the subject of the last two decades was carried out. The search and localization of the information was supported by the choice of keywords/descriptors that configured its profile. In addition, ultrasound scans, CT scans and MRI scans of patients diagnosed with this disease at the Cuban Institute of Ophthalmology Ramón Pando Ferrer, during the last 10 years, were analyzed. All that has been investigated confirms that imaging techniques are key to establish the diagnosis of thyroid-associated ophthalmopathy, but they will never replace a detailed clinical history and a thorough physical examination. The physician is seriously mistaken when he pretends to ignore the importance of clinical judgment. The omission of this principle will, at best, only lead to casual diagnoses.