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Weinrebe W, Kreppenhofer S, Dietrich CF. [Geriatric ultrasound : Prospective evaluation of ultrasound as extended screening in acute geriatric patients]. Z Gerontol Geriatr 2023; 56:647-652. [PMID: 36478131 DOI: 10.1007/s00391-022-02144-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Accepted: 11/08/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND The aim of this study was to evaluate ultrasound as a routinely used procedure and extended physical examination in geriatric patients in acute care. METHODS Prospective study of 86 patients using ultrasound as a screening examination (abdomen, basal sections of the thorax, thyroid glands) under comparative use of a hand-held ultrasound device (HHUSD) and a high-end ultrasound (HEUS = gold standard). RESULTS In 20/86 (23.2%) clinically relevant findings with therapeutic consequences were found (pleural effusion, urinary retention, choledocholithiasis metatases, colon tumor). In 22/86 (25.6%) patients, additional questions existed besides the screening indication: tumor search (9.3%), anemia (5.8%), liver value elevation (5.8%), dyspnea (5.8%), splenic pathologies (2.3%), weight loss (1.2%), infectious focus (1.2%), diarrhea (1.2%), intra-abdominal hematoma (1.1%), abdominal aortic aneurysm (1.2%). The most common sonographic findings included: cholecystolithiasis (32.6%); right pleural effusion (31.4%), thyroid nodules (30.2%), renal cysts (27.9%), and fatty liver (26.7%). There were significant differences in sizing between HHUSD and HEUS (kidneys, pancreatic corpus and pancreatic caudal diameters, portal vein, left hepatic vein) without diagnostic relevance. CONCLUSION The extended screening by ultrasound provided important answers to classical questions in geriatrics (e.g. urinary retention, volume deficiency/pleural effusion) in many cases. The new findings had therapeutic consequences in one fifth of the patients. The HHUSD can be used in screening.
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Affiliation(s)
- W Weinrebe
- Departement für Allgemeine Innere Medizin, Spital Campus Bern, Hirslanden, Schänzlistr. 39, 3013, Bern, Schweiz.
| | - S Kreppenhofer
- Medizinische Klinik II, Caritas-Krankenhaus Bad Mergentheim, Bad Mergentheim, Deutschland
| | - C F Dietrich
- Departement für Allgemeine Innere Medizin, Spital Campus Bern, Hirslanden, Schänzlistr. 39, 3013, Bern, Schweiz
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Musolino AM, Tomà P, De Rose C, Pitaro E, Boccuzzi E, De Santis R, Morello R, Supino MC, Villani A, Valentini P, Buonsenso D. Ten Years of Pediatric Lung Ultrasound: A Narrative Review. Front Physiol 2022; 12:721951. [PMID: 35069230 PMCID: PMC8770918 DOI: 10.3389/fphys.2021.721951] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 11/17/2021] [Indexed: 12/04/2022] Open
Abstract
Lung diseases are the most common conditions in newborns, infants, and children and are also the primary cause of death in children younger than 5 years old. Traditionally, the lung was not thought to be a target for an ultrasound due to its inability to penetrate the gas-filled anatomical structures. With the deepening of knowledge on ultrasound in recent years, it is now known that the affected lung produces ultrasound artifacts resulting from the abnormal tissue/gas/tissue interface when ultrasound sound waves penetrate lung tissue. Over the years, the application of lung ultrasound (LUS) has changed and its main indications in the pediatric population have expanded. This review analyzed the studies on lung ultrasound in pediatrics, published from 2010 to 2020, with the aim of highlighting the usefulness of LUS in pediatrics. It also described the normal and abnormal appearances of the pediatric lung on ultrasound as well as the benefits, limitations, and possible future challenges of this modality.
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Affiliation(s)
- Anna Maria Musolino
- Pediatric Emergency Unit, Department of Emergency and General Pediatrics, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Paolo Tomà
- Department of Imaging, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Cristina De Rose
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Eugenio Pitaro
- Pediatric Emergency Unit, Department of Emergency and General Pediatrics, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Elena Boccuzzi
- Pediatric Emergency Unit, Department of Emergency and General Pediatrics, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Rita De Santis
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Rosa Morello
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Maria Chiara Supino
- Pediatric Emergency Unit, Department of Emergency and General Pediatrics, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Alberto Villani
- General Pediatric and Infectious Disease Unit, Internal Care Department, Bambino Gesù Children’s Hospital, Rome, Italy
| | - Piero Valentini
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Danilo Buonsenso
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie, Università Cattolica del Sacro Cuore, Rome, Italy
- Global Health Research Institute, Istituto di Igiene, Università Cattolica del Sacro Cuore, Rome, Italy
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Sperandeo M, Quarato CMI, Frongillo E, Tinti MG, Carpagnano E. Ultrasound lung surface: Basic considerations of ultrasound physics. Australas J Ultrasound Med 2019; 22:225-226. [PMID: 34760561 PMCID: PMC8411735 DOI: 10.1002/ajum.12139] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Affiliation(s)
- Marco Sperandeo
- Interventional Ultrasound Unit of Internal MedicineIRCCS Fondazione Casa Sollievo della Sofferenza HospitalFoggiaItaly
| | | | | | - Maria Giulia Tinti
- Department of GeriatricIRCCS Fondazione Casa Sollievo della Sofferenza HospitalFoggiaItaly
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Sartini S, Frizzi J, Borselli M, Sarcoli E, Granai C, Gialli V, Cevenini G, Guazzi G, Bruni F, Gonnelli S, Pastorelli M. Which method is best for an early accurate diagnosis of acute heart failure? Comparison between lung ultrasound, chest X-ray and NT pro-BNP performance: a prospective study. Intern Emerg Med 2017; 12:861-869. [PMID: 27401330 DOI: 10.1007/s11739-016-1498-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2016] [Accepted: 06/26/2016] [Indexed: 01/06/2023]
Abstract
Acute heart failure is a common condition among adults presenting with dyspnea in the Emergency Department (ED), still the diagnosis is challenging as objective standardized criteria are lacking. First line work-up, other then clinical findings, is nowadays made with lung ultrasound imaging study, chest X-ray study and brain natriuretic peptide (BNP) level determination; however, it is not clear which is the best diagnostic test to be used and whether there is any real benefit for clinical judgement. We set up this study to compare the performances of these three diagnostic tools; furthermore, we combined them to find the best possible approach to dyspneic patients. This is a prospective observational study based in the ED. We enrolled adults presenting with dyspnea not trauma-related, they underwent lung ultrasound, and chest X-ray studies, and NT pro-BNP level determination. Then we compared the results with the diagnosis of acute heart failure established by an independent panel of experts. 236 patients were enrolled in the study. We find sensitivity and specificity for lung ultrasound of 57.73 and 87.97 %, for chest X-ray 74.49 and 86.26 %, for NT pro-BNP 97.59 and 27.56 %, respectively. Combining together the chest X-ray and lung ultrasound, we find the best overall performance with 84.69 % sensitivity, 77.69 % specificity and 87.07 % negative predictive value. From our results, we could not identify the "best test" to diagnose acute heart failure in an emergency setting, although we could suggest that a stepwise workup combining chest X-ray and lung ultrasound at first, then for those negative, a determination of NT pro-BNP assay would be a reasonable approach to the dyspneic patient.
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Affiliation(s)
- Stefano Sartini
- IRCCS AOU San Martino, Genoa, Italy.
- , Via Marco Perennio 24/c, 52100, Arezzo, AR, Italy.
| | - Jacopo Frizzi
- Emergency Department, Hospital of Lucca, Lucca, Italy
| | - Matteo Borselli
- Emergency Department, San Bortolo Hospital of Vicenza, Vicenza, Italy
| | | | - Carolina Granai
- Emergency Department, University Hospital of Siena, Siena, Italy
| | - Veronica Gialli
- Emergency Department, University Hospital of Siena, Siena, Italy
| | | | - Gianni Guazzi
- Department of Emergency Radiology, University Hospital of Siena, Siena, Italy
| | - Fulvio Bruni
- Emergency Department, University Hospital of Siena, Siena, Italy
| | - Stefano Gonnelli
- Internal Medicine Department, University Hospital of Siena, Siena, Italy
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Interrigi MC, Trovato FM, Catalano D, Trovato GM. Emergency thoracic ultrasound and clinical risk management. Ther Clin Risk Manag 2017; 13:151-160. [PMID: 28223817 PMCID: PMC5308587 DOI: 10.2147/tcrm.s126770] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
PURPOSE Thoracic ultrasound (TUS) has been proposed as an easy-option replacement for chest X-ray (CXR) in emergency diagnosis of pneumonia, pleural effusion, and pneumothorax. We investigated CXR unforeseen diagnosis, subsequently investigated by TUS, considering its usefulness in clinical risk assessment and management and also assessing the sustainability of telementoring. PATIENTS AND METHODS This observational report includes a period of 6 months with proactive concurrent adjunctive TUS diagnosis telementoring, which was done using freely available smartphone applications for transfer of images and movies. RESULTS Three hundred and seventy emergency TUS scans (excluding trauma patients) were performed and telementored. In 310 cases, no significant chest pathology was detected either by CXR, TUS, or the subsequent work-up; in 24 patients, there was full concordance between TUS and CXR (ten isolated pleural effusion; eleven pleural effusion with lung consolidations; and three lung consolidation without pleural effusion); in ten patients with lung consolidations, abnormalities identified by CXR were not detected by TUS. In 26 patients, only TUS diagnosis criteria of disease were present: in 19 patients, CXR was not diagnostic, ie, substantially negative, but TUS detected these conditions correctly, and these were later confirmed by computed tomography (CT). In seven patients, even if chest disease was identified by CXR, such diagnoses were significantly modified by ultrasound, and CT confirmed that TUS was more appropriate. The overall respective individual performances of CXR and TUS for the diagnosis of a pleural-pulmonary disease in emergency are good, with accuracy >95%. CONCLUSION About 20% of pneumonia cases were detectable only by CXR and 20% only by TUS and not by CXR; ie, about 40% of patients may have been misdiagnosed if, by chance, only one of the two tools had been used. The concurrent use of TUS and CXR increases the overall sensitivity and specificity. The contribution of expert telementoring and final reappraisal is a valuable and sustainable element for emergency physicians' training and performance, contributing reasonably to mitigation of clinical risks.
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Affiliation(s)
| | - Francesca M Trovato
- Accident and Emergency Department, Ospedale Civile, Ragusa
- Department of Clinical and Experimental Medicine, The School of Medicine, University of Catania
| | - Daniela Catalano
- Department of Clinical and Experimental Medicine, The School of Medicine, University of Catania
- Postgraduate School of Clinical Ultrasound, Department of Clinical and Experimental Medicine, Azienda Ospedaliero-Universitaria Policlinico, University of Catania
| | - Guglielmo M Trovato
- Department of Clinical and Experimental Medicine, The School of Medicine, University of Catania
- Postgraduate School of e-Learning and ICT in Health Sciences, The School of Medicine, University of Catania, Catania, Italy
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Jacob J, Tost J, Miró Ò, Herrero P, Martín-Sánchez FJ, Llorens P. Impact of chronic obstructive pulmonary disease on clinical course after an episode of acute heart failure. EAHFE-COPD study. Int J Cardiol 2016; 227:450-456. [PMID: 27838130 DOI: 10.1016/j.ijcard.2016.11.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 11/02/2016] [Accepted: 11/03/2016] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To study if the coexistence of chronic obstructive pulmonary disease (COPD) in patients diagnosed with acute heart failure (AHF) at the emergency department (ED) has an impact on short- and long-term outcomes. METHOD The EAHFE-COPD study included patients who attended in 34 Spanish EDs for AHF. We compared patients with AHF plus COPD with patients with AHF in whom COPD was neither diagnosed nor excluded by functional respiratory tests (FRT). Outcome analysis included all-cause mortality, prolonged hospitalization, and ED revisit. Crude results were adjusted by differences between patients with and without COPD. RESULTS We included 8099 patients with AHF, 2069 having COPD (25.6%; AHF-COPD-known). Compared with AHF-COPD-unknown, AHF-COPD-known differed in 20 variables. After adjusting for differences between the two groups, AHF-COPD-known patients showed no significant differences in 30-day mortality (OR=0.89; 95% CI=0.71-1.11), prolonged hospitalization in general wards (OR=1.04; 95% CI=0.89-1.22) or SSU (OR=1.38; 95% CI=0.97-1.97), and 1-year mortality (HR: 1.02; 95% CI=0.89-1.17), but showed a higher 30-day revisit rate (OR=1.32; 95% CI=1.13-1.54). CONCLUSIONS In patients attending the ED for AHF, the coexistence of COPD is only associated with an increased risk of short-term ED revisit, but not prolonged hospitalization and short- or long-term mortality.
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Affiliation(s)
- Javier Jacob
- Servicio de Urgencias, Hospital Universitari de Bellvitge, IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain.
| | - Josep Tost
- Servicio de Urgencias, Consorci Sanitari de Terrassa, Terrassa, Barcelona, Spain
| | - Òscar Miró
- Área de Urgencias, Hospital Clínic, Barcelona, Spain; Grupo de investigación "Urgencias: procesos y patologías", IDIBAPS, Barcelona, Spain
| | - Pablo Herrero
- Servicio de Urgencias, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Francisco Javier Martín-Sánchez
- Servicio de Urgencias, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Pere Llorens
- Servicio de Urgencias-UCE y UHD, Hospital General Universitario de Alicante, Alicante, Spain
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Trovato GM. Thoracic ultrasound: A complementary diagnostic tool in cardiology. World J Cardiol 2016; 8:566-574. [PMID: 27847557 PMCID: PMC5088362 DOI: 10.4330/wjc.v8.i10.566] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Revised: 04/20/2016] [Accepted: 08/01/2016] [Indexed: 02/06/2023] Open
Abstract
Clinical assessment and workup of patients referred to cardiologists may need an extension to chest disease. This requires more in-depth examination of respiratory co-morbidities due to uncertainty or severity of the clinical presentation. The filter and integration of ecg and echocardiographic information, addressing to the clues of right ventricular impairment, pulmonary embolism and pulmonary hypertension, and other less frequent conditions, such as congenital, inherited and systemic disease, usually allow more timely diagnosis and therapeutic choice. The concurrent use of thoracic ultrasound (TUS) is important, because, despite the evidence of the strict links between cardiac and respiratory medicine, heart and chest US imaging approaches are still separated. Actually, available expertise, knowledge, skills and training and equipment’s suitability are not equally fitting for heart or lung examination and not always already accessible in the same room or facility. Echocardiography is useful for study and monitoring of several respiratory conditions and even detection, so that this is nowadays an established functional complementary tool in pulmonary fibrosis and diffuse interstitial disease diagnosis and monitoring. Extending the approach of the cardiologist to lung and pleura will allow the achievement of information on pleural effusion, even minimal, lung consolidation and pneumothorax. Electrocardiography, pulse oximetry and US equipment are the friendly extension of the physical examination, if their use relies on adequate knowledge and training and on appropriate setting of efficient and working machines. Lacking these premises, overshadowing or misleading artefacts may impair the usefulness of TUS as an imaging procedure.
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8
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Trovato FM, Catalano D, Trovato GM. Thoracic ultrasound: An adjunctive and valuable imaging tool in emergency, resource-limited settings and for a sustainable monitoring of patients. World J Radiol 2016; 8:775-784. [PMID: 27721940 PMCID: PMC5039673 DOI: 10.4329/wjr.v8.i9.775] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Revised: 07/11/2016] [Accepted: 08/01/2016] [Indexed: 02/06/2023] Open
Abstract
Imaging workup of patients referred for elective assessment of chest disease requires an articulated approach: Imaging is asked for achieving timely diagnosis. The concurrent or subsequent use of thoracic ultrasound (TUS) with conventional (chest X-rays-) and more advanced imaging procedures (computed tomography and magnetic resonance imaging) implies advantages, limitations and actual problems. Indeed, despite TUS may provide useful imaging of pleura, lung and heart disease, emergency scenarios are currently the most warranted field of application of TUS: Pleural effusion, pneumothorax, lung consolidation. This stems from its role in limited resources subsets; actually, ultrasound is an excellent risk reducing tool, which acts by: (1) increasing diagnostic certainty; (2) shortening time to definitive therapy; and (3) decreasing problems from blind procedures that carry an inherent level of complications. In addition, paediatric and newborn disease are particularly suitable for TUS investigation, aimed at the detection of congenital or acquired chest disease avoiding, limiting or postponing radiological exposure. TUS improves the effectiveness of elective medical practice, in resource-limited settings, in small point of care facilities and particularly in poorer countries. Quality and information provided by the procedure are increased avoiding whenever possible artefacts that can prevent or mislead the achievement of the correct diagnosis. Reliable monitoring of patients is possible, taking into consideration that appropriate expertise, knowledge, skills, training, and even adequate equipment’s suitability are not always and everywhere affordable or accessible. TUS is complementary imaging procedure for the radiologist and an excellent basic diagnostic tool suitable to be shared with pneumologists, cardiologists and emergency physicians.
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9
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Trovato GM. Simplicity is the ultimate sophistication. PR electrocardiographic intervals for smart forecasting of decline in renal function. Atherosclerosis 2015; 240:550-1. [DOI: 10.1016/j.atherosclerosis.2014.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Revised: 10/21/2014] [Accepted: 11/04/2014] [Indexed: 11/26/2022]
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Assessment of lung ultrasound artifacts (B-lines): incremental contribution to echocardiography in heart failure? JACC Cardiovasc Imaging 2015; 7:635. [PMID: 24925334 DOI: 10.1016/j.jcmg.2013.11.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Accepted: 11/21/2013] [Indexed: 02/06/2023]
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Trovato GM, Sperandeo M, Catalano D. Ultrasound diagnosis of acute pulmonary edema: the oblivion of a great future behind us. Acad Emerg Med 2015; 22:244-5. [PMID: 25640171 DOI: 10.1111/acem.12584] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Guglielmo M. Trovato
- Department of Medical and Pediatric Sciences; The State University of Catania; Catania Italy
| | - Marco Sperandeo
- Department of Internal Medicine; IRCCS Casa Sollievo della Sofferenza; San Giovanni Rotondo Italy
| | - Daniela Catalano
- Department of Medical and Pediatric Sciences; The State University of Catania; Catania Italy
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12
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Trovato GM, Sperandeo M. The resistible rise of B-line lung ultrasound artefacts. Respiration 2015; 89:175-6. [PMID: 25592165 DOI: 10.1159/000369037] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Affiliation(s)
- Guglielmo M Trovato
- Department of Medical and Pediatric Sciences, University of Catania, Catania, Italy
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13
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Trovato GM, Catalano D, Sperandeo M. M-mode: a valuable tool in cardiology, is not yet ready to use in pneumology. Respiration 2014; 88:518. [PMID: 25402592 DOI: 10.1159/000367813] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Affiliation(s)
- Guglielmo M Trovato
- Department of Internal Medicine, AOU Policlinico VE, University of Catania, Catania, Italy
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14
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Trovato GM. Sustainable medical research by effective and comprehensive medical skills: overcoming the frontiers by predictive, preventive and personalized medicine. EPMA J 2014; 5:14. [PMID: 25250099 PMCID: PMC4171719 DOI: 10.1186/1878-5085-5-14] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Accepted: 08/09/2014] [Indexed: 01/01/2023]
Abstract
Background Clinical research and practice require affordable objectives, sustainable tools, rewarding training strategies and meaningful collaboration. Method Our unit delivers courses on project design and management promoting ideas, useful skills, teaching and exploring implementation of networks and existing collaborations. We investigated the effectiveness of a sustainable approach of comprehensive diagnosis and care and its usefulness within concrete models of research project teaching methodology. Results The model of predictive, preventive and personalized medicine (PPPM) of adolescent hypertension, developed since 1976 and still active, was displayed. This is a paradigm of comprehensive PPPM aimed at the management of a recognized, but actually neglected, societal and clinical problem. The second model was addressed to the analysis of performance of an outpatient diagnostic and therapy unit and its relationship with the emergency department. Part of the patients, 4,057 cancer patients presenting at the emergency care, were addressed to the outpatient diagnostic and therapy unit for further assessment, treatment and follow-up. The stay in DH was 6.3 ± 2.1 non-consecutive days, with shortage of costs, vs. in-hospital stays. Research planning courses, based on these models, ensued in an increase of competitive project submission and successful funding. Discussion Active promotion of interdisciplinary knowledge and skills is warranted. Misleading messages and information are detrimental not only to healthy and sick people but, equally, to all health professionals: efforts for basing on evidence by research any statement are needed. The actual pre-requisite of personalized medicine is the coherent and articulated promotion of the professional quality of staff. Health professionals should and can be skilled in sustainable non-invasive diagnostic procedures, in non-pharmacological intervention, in translational research (from epidemiology to personalized therapy) and in timely dissemination of the information. Conclusion Recommendations are provided according to PPPM: proposed models are based on financial sustainability and patient's satisfaction criteria and are addressed to research projects and dissemination also by e-learning. The guidelines of the EU calls in personalized medicine are able to provide a critical added value by accurate planning, transparency of assessment and unbiased reports, dissemination and exploitation.
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Affiliation(s)
- Guglielmo M Trovato
- Dipartimento di Scienze Mediche e Pediatriche, Unità di Terapia e Diagnostica Medica non Invasiva AOU Policlinico-VE, University of Catania, 95124 Catania, Italy
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Trovato GM, Sperandeo M, Catalano D. Thoracic ultrasound: Possible complementary criteria for the assessment of pulmonary fibrosis. Ann Thorac Med 2014; 9:179. [PMID: 24987479 PMCID: PMC4073577 DOI: 10.4103/1817-1737.134077] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Affiliation(s)
- Guglielmo M Trovato
- Department of Medical and Pediatric Sciences, Diagnostic and Therapeutic Unit, University of Catania, Catania, Italy. E-mail:
| | - Marco Sperandeo
- Department of Internal Medicine, Diagnostic and Interventional Ultrasound Unit, Istituto di Ricovero e Cura a Carattere Scientifico, Casa Sollievo della Sofferenza Hospital, San Giovanni Rotondo, Italy
| | - Daniela Catalano
- Department of Medical and Pediatric Sciences, Diagnostic and Therapeutic Unit, University of Catania, Catania, Italy. E-mail:
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Maggi M, Pirri C, Foti T, Feragalli B, Cipriani C. Thoracic ultrasound in children: evidence and drawbacks. Pediatr Radiol 2014; 44:629-30. [PMID: 24563167 DOI: 10.1007/s00247-014-2901-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Accepted: 01/23/2014] [Indexed: 10/25/2022]
Affiliation(s)
- Michele Maggi
- Department of Emergency Medicine, IRCCS Ospedale Casa Sollievo della Sofferenza, Via dei Cappuccini, San Giovanni Rotondo, Foggia, Italy,
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Rademacher N, Pariaut R, Pate J, Saelinger C, Kearney MT, Gaschen L. Transthoracic lung ultrasound in normal dogs and dogs with cardiogenic pulmonary edema: a pilot study. Vet Radiol Ultrasound 2014; 55:447-52. [PMID: 24620777 DOI: 10.1111/vru.12151] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Accepted: 11/20/2013] [Indexed: 01/02/2023] Open
Abstract
Pulmonary edema is the most common complication of left-sided heart failure in dogs and early detection is important for effective clinical management. In people, pulmonary edema is commonly diagnosed based on transthoracic ultrasonography and detection of B line artifacts (vertical, narrow-based, well-defined hyperechoic rays arising from the pleural surface). The purpose of this study was to determine whether B line artifacts could also be useful diagnostic predictors for cardiogenic pulmonary edema in dogs. Thirty-one normal dogs and nine dogs with cardiogenic pulmonary edema were prospectively recruited. For each dog, presence or absence of cardiogenic pulmonary edema was based on physical examination, heartworm testing, thoracic radiographs, and echocardiography. A single observer performed transthoracic ultrasonography in all dogs and recorded video clips and still images for each of four quadrants in each hemithorax. Distribution, sonographic characteristics, and number of B lines per thoracic quadrant were determined and compared between groups. B lines were detected in 31% of normal dogs (mean 0.9 ± 0.3 SD per dog) and 100% of dogs with cardiogenic pulmonary edema (mean 6.2 ± 3.8 SD per dog). Artifacts were more numerous and widely distributed in dogs with congestive heart failure (P < 0.0001). In severe cases, B lines increased in number and became confluent. The locations of B line artifacts appeared consistent with locations of edema on radiographs. Findings from the current study supported the use of thoracic ultrasonography and detection of B lines as techniques for diagnosing cardiogenic pulmonary edema in dogs.
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Affiliation(s)
- Nathalie Rademacher
- Department of Veterinary Clinical Sciences Section of Diagnostic Imaging, Louisiana State University, School of Veterinary Medicine, Baton Rouge, LA, 70803
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Transthoracic ultrasound in the assessment of pleural and pulmonary diseases: use and limitations. Radiol Med 2014; 119:729-40. [PMID: 24496592 DOI: 10.1007/s11547-014-0385-0] [Citation(s) in RCA: 81] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2013] [Accepted: 08/22/2013] [Indexed: 12/16/2022]
Abstract
Interest in transthoracic ultrasound (US) procedures increased after the availability of portable US equipment suitable for use at the patient's bedside. It is possible to detect space-occupying lesions of the pleura, pleural effusion, focal or diffuse pleural thickening and subpleural lesions of the lung, even in emergency settings. Transthoracic US is useful as a guidance system for thoracentesis and peripheral lesion biopsy, where it minimises the occurrence of pneumothorax and haemorrhage. Transthoracic US imaging is strongly influenced by physical interaction of the ultrasonic beam at the tissue/air interface, which gives rise to reverberations classified as simple (A-line), "comet tail" and "ring down"(B-line) artifacts. Although these artifacts can be suggestive of a disease condition, they are essentially imaging errors present even in normal subjects and in empty-pleura post-pneumonectomy patients. In order to clarify some confusion and to report on the state of the art, we present a review of the literature on transthoracic US in diseases of the pleura and peripheral lung regions and our own clinical experience over 3 decades. The review focuses on quality assurance procedures and their value in diagnostic imaging and patient monitoring and warns against possible inappropriate indications and misleading information. Thoracic US is much more than "fishing for the moon in the well".
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Anderson KL, Fields JM, Panebianco NL, Jenq K, Marin J, Dean AJ. Reply: To PMID 23269716. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2014; 33:362-365. [PMID: 24449745 DOI: 10.7863/ultra.33.2.363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Sperandeo M, Trovato GM, Catalano D. Quantifying B-lines on lung sonography: insufficient evidence as an objective, constructive, and educational tool. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2014; 33:362-365. [PMID: 24449744 DOI: 10.7863/ultra.33.2.362] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Acute heart failure diagnosis by ultrasound: new achievements and persisting limitations. Am J Emerg Med 2013; 32:384-5. [PMID: 24462395 DOI: 10.1016/j.ajem.2013.12.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2013] [Accepted: 12/11/2013] [Indexed: 12/27/2022] Open
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