Abstract
This Portuguese-Norwegian collaboration used ultrasound to measure changes in distance between the rectus abdominis muscles in 38 post-partum women after specific exercises to reduce divarication. They found that ultrasound was a reliable measurement method and that abdominal crunch exercises (discouraged by some) seemed to yield the best results. The researchers recommend larger studies.
Perhaps unsurprisingly, this team found that a lack of training was the main obstacle to the use of ultrasound in developing countries, closely followed by a lack of reliable equipment. The survey also revealed that practitioners were open to the idea of distance learning and telesonography to aid their knowledge. It made me think of our great e-Learning for Healthcare ultrasound resource available only to NHS staff and students. I’m sure they would benefit from something similar.
This is a nice pictorial review of placental abnormalities and variants including malformations in development, vascularity and positioning. This article may be useful material for novices and may act as an educational refresher for more experienced practitioners.
The authors state that demonstration of just the ‘three-vessel view’ in the second trimester of pregnancy has a sensitivity of 91% when it comes to detecting great vessel abnormality. Pretty impressive. In their study, all cases of transposition of the great arteries and tetralogy of Fallot were identified using only this view. The last statistics I read stated that the ultrasound detection rate for transposition at 20 weeks is 17–20%. The three-vessel view is recommended as part of our UK 20-week assessment, so perhaps more focus on this view may result in more cases being detected.
Why some women develop bladder endometriosis is not fully understood although multiple theories have been postulated, including implantation of regurgitated endometrium and iatrogenic bladder endometriosis after Caesarean section. The findings and ultrasound appearances from this small but detailed study of 11 women suggest that it may be due to direct infiltration of adenomyosis from the anterior uterine surface into the bladder wall.
This study of 80 women with cervical cancer used clinical features, transvaginal tomographic ultrasound and MRI to pre-operatively stage the cancer and then compared findings with histology. Tomographic ultrasound had the superior accuracy (92.5%) of all three methods and was also reliable for measuring lesion depth.
This paper is useful for two reasons: it adds to the evidence for using ultrasound to diagnose appendicitis in children and, more importantly, describes a pathway for successful implementation of a new ultrasound imaging protocol despite the radiologists being heavily reliant on CT. Encouraging radiologists and other clinicians to abandon an established, successful imaging protocol is no mean feat and lessons learnt here may be applicable to other clinical situations such as implementing contrast-enhanced ultrasound services.
Here’s a useful and educational article describing congenital cystic adenomatous malformation of the lung (CCAM), a relatively common abnormality often detected at the 20-week scan. Diagnosis, complications and management are discussed.
Although only five patients feature in this short case series, all five children and adolescents had urinary tract stones detected by emergency physicians using bedside ultrasound. As a consequence, all avoided the expense and radiation burden associated with CT. Since renal colic in children is on the rise in North America, larger studies are recommended.
A small study of 21 suggests that contrast-enhanced ultrasound is better than B-mode alone for showing Rokitansky-Aschoff sinuses and a smooth outer gallbladder wall. These features aid diagnostic confidence when it comes to focal adenomyomatosis versus malignancy.
This large, multicentre retrospective study found that ultrasound-guided ultrasound ablation for single fibroids, multiple fibroids and patients with fibroids and adenomyosis was clinically effective and safe. Using the SIR classification system, only eight patients developed major complications, thus potentially making ultrasound ablation an attractive treatment option for some women.
Those of you who read this page regularly will know I’m a fan of any team that tries to produce its own training phantom. With a little innovation and imagination, such teaching aids can be economical and hugely beneficial to novice practitioners by raising levels of confidence and ability in a ‘safe’ environment. The method here is detailed enough to allow construction and involves coconut shells and gelatin.