Americo Testa

Ultrasound M-mode assessment of diaphragmatic kinetics by anterior transverse scanning in healthy subjects.

The purpose of this study was to set an effective standardized method to assess diaphragmatic kinetics by ultrasound. Forty healthy volunteers were submitted to a B- and M-mode ultrasound study using a convex transducer positioned in the subcostal anterior area for transverse scanning. Ultrasound examination was completed in 38/40 cases (95%), spending on average <10 min for examination. The resting and forced diaphragmatic excursions were 18.4 ± 7.6 and 78.8 ± 13.3 mm, respectively, unrelated to demographic or anthropometric parameters: intraobserver variability on three successive measurements resulted in 6.0% and in 3.9%, respectively. An inexperienced sonographer completed the ultrasound examination in 37/40 cases, spending on average >15 min, with significant, although marginal, interobserver variability (31.9% and 14.7% for resting and forced diaphragmatic excursion, respectively). Bedside ultrasonography by an anterior subcostal transverse scanning on semi-recumbent patient proves to be a safe, feasible, reliable, fast, relatively easy and reproducible way to assess diaphragm movement.

The role of chest ultrasonography in the management of respiratory diseases: document II

Chest ultrasonography can be a useful diagnostic tool for respiratory physicians. It can be used to complete and widen the general objective examination also in emergency situations, at the patient’s bedside. The aim of this document is to promote better knowledge and more widespread use of thoracic ultrasound among respiratory physicians in Italy.This document II is focused on advanced approaches to chest ultrasonography especially in diagnosing sonographic interstitial syndrome with physical hypotheses about the genesis of vertical artifacts, differential diagnosis of cardiogenic pulmonary edema and non-cardiogenic pulmonary edema, raising diagnostic suspicion of pulmonary embolism, ultrasound characterization of lung consolidations and the use of ultrasonography to guide procedural interventions in pulmonology.Finally, document II focuses on chest ultrasonography as useful diagnostic tool in neonatal and pediatric care.

Early recognition of the 2009 pandemic influenza A (H1N1) pneumonia by chest ultrasound

IntroductionThe clinical picture of the pandemic influenza A (H1N1)v ranges from a self-limiting afebrile infection to a rapidly progressive pneumonia. Prompt diagnosis and well-timed treatment are recommended. Chest radiography (CRx) often fails to detect the early interstitial stage. The aim of this study was to evaluate the role of bedside chest ultrasonography (US) in the early management of the 2009 influenza A (H1N1)v infection.Methods98 patients who arrived in the Emergency Department complaining of influenza-like symptoms were enrolled in the study. Patients not displaying symptoms of acute respiratory distress were discharged without further investigations. Among patients with clinical suggestion of a community-acquired pneumonia, cases encountering other diagnoses or comorbidities were excluded from the study. Clinical history, laboratory tests, CRx, and computed tomography (CT) scan, if indicated, contributed to define the diagnosis of pneumonia in the remaining patients. Chest US was performed by an emergency physician, looking for presence of interstitial syndrome, alveolar consolidation, pleural line abnormalities, and pleural effusion, in 34 patients with a final diagnosis of pneumonia, in 16 having normal initial CRx, and in 33 without pneumonia, as controls.ResultsChest US was carried out without discomfort in all subjects, requiring a relatively short time (9 minutes; range, 7 to 13 minutes). An abnormal US pattern was detected in 32 of 34 patients with pneumonia (94.1%). A prevalent US pattern of interstitial syndrome was depicted in 15 of 16 patients with normal initial CRx, of whom 10 (62.5%) had a final diagnosis of viral (H1N1) pneumonia. Patients with pneumonia and abnormal initial CRx, of whom only four had a final diagnosis of viral (H1N1) pneumonia (22.2%; P < 0.05), mainly displayed an US pattern of alveolar consolidation. Finally, a positive US pattern of interstitial syndrome was found in five of 33 controls (15.1%). False negatives were found in two (5.9%) of 34 cases, and false positives, in five (15.1%) of 33 cases, with sensitivity of 94.1%, specificity of 84.8%, positive predictive value of 86.5%, and negative predictive value of 93.3%.ConclusionsBedside chest US represents an effective tool for diagnosing pneumonia in the Emergency Department. It can accurately provide early-stage detection of patients with (H1N1)v pneumonia having an initial normal CRx. Its routine integration into their clinical management is proposed.

Prospective study of bone loss in pre- and post-menopausal women on L-thyroxine therapy for non-toxic goitre.

Hyperthyroidism is associated with increased bone turnover and bone resorption, but the effects of suppressive doses of thyroxine in treating non‐toxic goitre remain unclear. We carried out a longitudinal study to evaluate the effect on bone of L‐thyroxine (L‐T4) therapy in women with non‐toxic goitre.

Sonographic Detection of Spontaneous Pneumomediastinum

Spontaneous pneumomediastinum is an uncommon benign disease that mainly affects young, tall, and thin male patients without evidence of trauma or other underlying pulmonary disease. It is a condition caused by an increase of intrathoracic pressure and air leaking from the trachea, bronchi, alveoli, or esophagus into the mediastinum. Although it is often a self-limiting disease, it requires admission to a hospital to exclude potentially severe underlying diseases. 1 In healthy individuals, it has been related to vomiting, pregnancy, singing, physical efforts, cocaine or ecstasy (3,4-methylenedioxy-N-methylamphetamine) use, and scuba diving. Diagnosis of pneumomediastinum is generally performed by means of chest radiography, but in up to 30% of cases that may be not diagnostic, particularly in emergency settings, 2,3 and computed tomography (CT) may be needed to confirm the diagnosis. We report a case of self-resolving spontaneous pneumomediastinum that was missed by chest radiography in which the diagnosis was suggested by neck sonography.

Prevalence of obesity in young adults with acute lymphoblastic leukemia

SummaryWe studied the hormonal pattern of nine patients with acute lymphoblastic leukemia. The patients were treated with standard therapeutic regimens. They were overweight by a mean of 52% at the end of the consolidation treatment, and this persisted after a followup of 2 years. The only endocrine alteration observed was a moderate decrease in serum testosterone levels in male patients. The other parameters studied were in the normal range. We conclude that prolonged treatment with high doses of corticosteroids, which have a depressive effect on metabolism, was responsible for the obesity.

Triplication of α-globin genes is responsible for unusual α113Leu/α113His-globin chain ratios in sheep

By investigations at the DNA and protein level, it has been shown that in sheep a previously detected, presumed quantitative allele of theIIα113His gene, displaying a reduced efficiency (called theIIα113His↓ gene), is carried by a chromosome bearing three α-globin loci. In particular, five sheep having an α113Leu/α113His-chain ratio of about 13:1 (13:1 phenotype) possessed the —Iα113Leu—IIα113Leu—/—Iα113Leu—IIα113Leu —IIIα113His↓ genotype. One sheep showing a α113Leu/α113His-chain ratio of about 3:1 (3:1 phenotype) had the —Iα113Leu—IIα113His—/—Iα113Leu—IIα113Leu —IIIα113His↓ genotype, while one sheep having a chain ratio of about 6:1 (6:1 phenotype) carried the —Iα113Leu—IIα113Leu—IIα113His↓—/—Iα113Leu—IIα113Leu —IIIα113His↓ genotype. Nineteen sheep, displaying the common phenotypes, all possessed the αα/αα gene arrangement. Furthermore, the possible location of the gene with reduced efficiency and the expression of the three genes in the triple α-globin loci chromosome are discussed.

The role of emergency ultrasound in the diagnosis of acute non-traumatic epigastric pain

The epigastrium is the site where pain coming from both abdominal and extraabdominal organs is frequently referred. Although acute or chronic diseases of the stomach, duodenum, liver, pancreas and biliary tree are the most common causes of acute epigastric pain, several other entities, potentially more severe, should also be suspected and investigated. Clinical bedside ultrasonography (US) is actually the first-line imaging in acute epigastric pain patients presenting to the hospital Emergency Department (ED) because it is rapid, noninvasive, relatively inexpensive and focused, repeatable and reliable. Moreover, the systematic use of emergency US as a complement to routine management might save economic resources by avoiding further costs for complications and substantially reducing the time for making an accurate diagnosis. The purpose of this paper is to review the US spectrum of the most common diseases responsible for acute epigastric pain onset. We also propose a focused, well codified US protocol, that we call the “

Intraoperative transvaginal ultrasound examination during myomectomy

approach”, based on our clinical experience and the current literature for acute non-traumatic epigastric pain evaluation in an emergency setting. Its systematic application by the emergency physician may reduce the wait for diagnosis and the over-usage of second-line radiological techniques, including computed tomography, as well as to increase the diagnostic accuracy with potential benefits for patient (safety), physician (efficacy) and the institution (efficiency).

The ‘Dark Side' of Chronic Obstructive Pulmonary Disease

Intraoperative ultrasound techniques have been used for a long time in some surgical areas, especially in liver surgery, where some authors describe the role of intraoperative ultrasound during radiofrequency ablation or hepatic resection in the assessment of the risk of post-treatment hepatocellular carcinoma recurrence [1]. However, in gynecology, these methods are not yet commonly employed. The present case shows one of the possible applications of intraoperative transvaginal ultrasound. A 40-year-old woman was referred to our Hospital for heavy bleeding and uterine myomas. Ultrasound examination showed a fundic subserous myoma (45 mm in size), a posterior subserous myoma (33 mm in size), a left lateral intramural myoma (35 mm in size), and a right lateral intramural myoma (25 mm in size) with minimal distortion of the uterine cavity. On laparoscopy, the surgeon confirmed the presence of the two subserous myomas and the left lateral intramural myoma and removed them by minilaparotomy. After myomectomies, by laparoscopic view, the surgeon appreciated an irregular area on the posterior wall of the uterus, but he was uncertain of the diagnosis (Fig. 1a). Thus, an ultrasound examiner was involved to investigate intraoperatively this area confirming, with a transvaginal probe, the presence of a right deep intramural myoma of 25 mm in size touching the endometrial cavity and with a free myometrial margin of 4 mm (Fig. 1b). During ultrasound examination, the gas was slightly reduced, but no saline was inflated in the pelvis. The intraoperative ultrasound findings showed no substantial differences compared to those described before surgery. The ultrasound examiner guided the surgeon to find the location of the myomas, to define the relationship of the myoma with the endometrial cavity and the site of the hysterotomy incision (Supplementary video). Histological diagnosis confirmed fibroids and the post-operative ultrasound examination described a regular uterine profile without any residual fibroids. Uterine myomas are the most frequent gynecologic disease, with a recurrence rate after conservative surgery until 51–62% at 5 years [2]. This depends on the ability to perform a correct “radical” surgical approach which is strongly influenced by number, size, localization of myomas and distance between myomas, uterine serosa, and endometrium [3]. An appropriate preoperative evaluation is required to obtain an optimal surgical procedure, and transvaginal ultrasound is the most used diagnostic method, due to its feasibility and availability. However, some fibroids are difficult to detect during surgery, especially when the palpation is not possible or limited, as during laparoscopy or minilaparotomy. Recently, intraoperative ultrasound examination has been proposed in this setting as a useful method to guide the surgeon during myomectomy. Paul et al. demonstrated that intraoperative transvaginal ultrasound is helpful to the surgeon for identifying deeper myomas making the surgery more effective [4]. Other authors reported cases of an intraoperative ultrasound using a laparoscopic probe to guide surgeon to identify the correct placement of the uterine incision during laparoscopic myomectomy [5, 6]. Others Electronic supplementary material The online version of this article (https ://doi.org/10.1007/s4047 7-018-0310-9) contains supplementary material, which is available to authorized users.