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Abstract
The use of point-of-care ultrasound (POCUS) performed by non-radiologists has become more widespread and is entering new arenas of clinical care. Children in particular are prime candidates for ultrasound, as they are both usually thinner than adults and are particularly at risk from the harmful effects of ionizing radiation. In this two-part article, we propose 10 uses of POCUS that pediatricians can apply to their practice in both inpatient and outpatient settings. [Pediatr Ann. 2020;49(3):e147-e152.].
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Garnitschnig L, Weinzirl J, Andrae L, Scheffers T, Ostermann T, Heusser P. Postprandial dynamics of splenic volume in healthy volunteers. Physiol Rep 2020; 8:e14319. [PMID: 31981412 PMCID: PMC6981305 DOI: 10.14814/phy2.14319] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Throughout the history of medicine, many functions have been attributed to the spleen and numerous researchers have focused on a postulated digestive function. Beginning in 1825, systematic animal studies showed evidence for a postprandial increase in splenic volume (SV) with a peak 30 min to five hours after food intake. Since the introduction of imaging techniques, two studies have been conducted on humans, revealing a decrease in SV 30 to 45 min postprandially. The aim of this study was to examine possible postprandial changes in SV over a period of seven hours. The ethics-approved, randomized crossover study included 10 healthy volunteers, who received a standardized meal (3,600 kJ) on one study day and fasted on the other. Sonographic measurements were obtained at six measurement points on each day. Thirty minutes after the meal, SV increased significantly by 38.2 ± 51.2 cm3 (17.3%; p = .04) compared to the baseline measurement and decreased gradually afterward. In males, SV 30 min after the meal was 70.2 ± 21.6 cm3 higher (p = .002) compared to the fasting condition and 60 min later it was still significantly increased. The apparent SV increase after food intake is discussed in relation to hemodynamic changes in the splanchnic region. It seems plausible that the spleen has a rhythmic and regulative function within the portal system, something which warrants further research and should be taken more into account in nutritional physiology.
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Affiliation(s)
- Lydia Garnitschnig
- Institute for Integrative MedicineFaculty of HealthWitten/Herdecke UniversityHerdeckeGermany
| | - Johannes Weinzirl
- Institute for Integrative MedicineFaculty of HealthWitten/Herdecke UniversityHerdeckeGermany
| | - Lukas Andrae
- Department of Internal MedicineCommunity Hospital HerdeckeHerdeckeGermany
| | - Tom Scheffers
- Institute for Integrative MedicineFaculty of HealthWitten/Herdecke UniversityHerdeckeGermany
| | - Thomas Ostermann
- Institute for Integrative MedicineFaculty of HealthWitten/Herdecke UniversityHerdeckeGermany
| | - Peter Heusser
- Institute for Integrative MedicineFaculty of HealthWitten/Herdecke UniversityHerdeckeGermany
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ACR Appropriateness Criteria® Palpable Abdominal Mass-Suspected Neoplasm. J Am Coll Radiol 2019; 16:S384-S391. [DOI: 10.1016/j.jacr.2019.05.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 05/15/2019] [Indexed: 01/13/2023]
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Michon A, Jammal S, Passeron A, De Luna G, Bomahou C, Jullien V, Pouchot J, Arlet JB, Ranque B. [Use of pocket-sized ultrasound in internal medicine (hospitalist) practice: Feedback and perspectives]. Rev Med Interne 2018; 40:220-225. [PMID: 30078545 DOI: 10.1016/j.revmed.2018.07.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 06/20/2018] [Accepted: 07/02/2018] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Point of care ultrasound (POCUS) is routinely used by intensivists and emergency physicians for many years. Its interest is not arguable any more for these specialists, despite the large variety of diseases they care. Hospitalists and internists also should find some interest in POCUS, which convenience and wide range of indications responds well to the variety of their practice. However, it is still not widely used in internal medicine departments. METHODS We here report our experience of using a pocket-sized ultrasound device in a French internal medicine department. The device used was a Vscan Dual Probe, GE, whose two probes and presets allow for cardiac, abdominal, pulmonary, obstetric, vascular, pulmonary, and superficial soft tissue exploration. One physician of the ward received a course for POCUS that was initially dedicated for emergency physicians. This study reports on the results of the examinations made between January and September 2015. For each examination performed, clinical usefulness was assessed at the time of patient discharge, by two independent physicians who reviewed the clinical course and the results of conventional imaging and rated their evaluation on a Likert scale. RESULTS One hundred and four examinations were evaluated. The mean duration of the ultrasound examination was 9±5minutes. The POCUS conclusions were corrected by disease course or the results of conventional imaging in 10 (9.6%) cases. The presets of the device: heart, soft tissue, lung, abdomen and vascular were used respectively in 32, 30, 21, 12 and 5% of the examinations. The main indications of POCUS examination were for identification of pleural, pericardial or peritoneal effusion, and to assess the central venous pressure by inferior vena cava examination. Eighteen examinations were performed for puncture of effusion. The retrospectively evaluated clinical benefit was clearly demonstrated in 78% of cases. The agreement between the two blinded assessors was good (kappa coefficient at 0.82). CONCLUSION Pocket-sized ultrasound device could be used in internal medicine wards. However, its limited performance compared to more sophisticated echography limits the possible explorations and their reliability, which encourages caution and makes critical the question of the initial training of doctors and medical students.
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Affiliation(s)
- A Michon
- Service de médecine interne, hôpital européen Georges-Pompidou, université Paris Descartes, Assistance publique-Hôpitaux de Paris, 20, rue Leblanc, 75908 Paris cedex 15, France.
| | - S Jammal
- Service de radiologie, hôpital européen Georges-Pompidou, université Paris Descartes, Assistance publique-Hôpitaux de Paris, 20, rue Leblanc, 75908 Paris cedex 15, France
| | - A Passeron
- Service de médecine interne, hôpital européen Georges-Pompidou, université Paris Descartes, Assistance publique-Hôpitaux de Paris, 20, rue Leblanc, 75908 Paris cedex 15, France
| | - G De Luna
- Unité des maladies génétiques du globule rouge, hôpital Henri-Mondor, université Paris Est Créteil, Assistance publique-Hôpitaux de Paris, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil cedex, France
| | - C Bomahou
- Service de médecine interne, hôpital européen Georges-Pompidou, université Paris Descartes, Assistance publique-Hôpitaux de Paris, 20, rue Leblanc, 75908 Paris cedex 15, France
| | - V Jullien
- Service de médecine interne, hôpital européen Georges-Pompidou, université Paris Descartes, Assistance publique-Hôpitaux de Paris, 20, rue Leblanc, 75908 Paris cedex 15, France
| | - J Pouchot
- Service de médecine interne, hôpital européen Georges-Pompidou, université Paris Descartes, Assistance publique-Hôpitaux de Paris, 20, rue Leblanc, 75908 Paris cedex 15, France
| | - J-B Arlet
- Service de médecine interne, hôpital européen Georges-Pompidou, université Paris Descartes, Assistance publique-Hôpitaux de Paris, 20, rue Leblanc, 75908 Paris cedex 15, France
| | - B Ranque
- Service de médecine interne, hôpital européen Georges-Pompidou, université Paris Descartes, Assistance publique-Hôpitaux de Paris, 20, rue Leblanc, 75908 Paris cedex 15, France
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Sánchez Barrancos IM, Guerrero García FJ, Rico López MDC, Fernández Rodríguez V, Vegas Jiménez T, Alonso Roca R, Domínguez Tristancho D. [Usefulness and reliability of abdominal point of care ultrasound in family practice (2): Large abdominal vessels, spleen, nephrourological and gynecological ultrasound]. Aten Primaria 2018; 50:430-442. [PMID: 29858122 PMCID: PMC6837077 DOI: 10.1016/j.aprim.2018.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 02/26/2018] [Indexed: 10/28/2022] Open
Abstract
This article is a continuation of the review initiated in the previous issue about the usefulness of point of care ultrasound in Primary Care, completing the scenarios of large abdominal vessels, spleen, nephrourological and gynecological ultrasound.
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Affiliation(s)
- Ignacio Manuel Sánchez Barrancos
- Médico especialista en Medicina Familiar y Comunitaria; Miembro del Grupo de Trabajo de Ecografía, Sociedad Española de Medicina Familiar y Comunitaria; Consultorio local de Membrilla, Centro de Salud Manzanares 2, Gerencia de Atención Integrada de Manzanares, Ciudad Real, España.
| | - Francisco José Guerrero García
- Médico especialista en Medicina Familiar y Comunitaria; Miembro del Grupo de Trabajo de Ecografía, Sociedad Española de Medicina Familiar y Comunitaria; Unidad de Gestión Clínica Gran Capitán, Distrito Sanitario Granada Metropolitano, Granada, España
| | - María Del Carmen Rico López
- Médico especialista en Medicina Familiar y Comunitaria; Miembro del Grupo de Trabajo de Ecografía, Sociedad Española de Medicina Familiar y Comunitaria; Centro Médico Adeslas, Almería, España
| | - Vicente Fernández Rodríguez
- Médico especialista en Medicina Familiar y Comunitaria; Miembro del Grupo de Trabajo de Ecografía, Sociedad Española de Medicina Familiar y Comunitaria; Centro de Salud Os Rosales, Estructura Organizativa de Xestión Integrada, A Coruña, España
| | - Tomás Vegas Jiménez
- Médico especialista en Medicina Familiar y Comunitaria; Miembro del Grupo de Trabajo de Ecografía, Sociedad Española de Medicina Familiar y Comunitaria; Centro de Salud San Fernando, Gerencia de Atención Primaria de Badajoz, Badajoz, España
| | - Rafael Alonso Roca
- Médico especialista en Medicina Familiar y Comunitaria; Miembro del Grupo de Trabajo de Ecografía, Sociedad Española de Medicina Familiar y Comunitaria; Centro de Salud Mar Báltico, Área Este, Madrid, España
| | - Daniel Domínguez Tristancho
- Médico especialista en Medicina Familiar y Comunitaria; Miembro del Grupo de Trabajo de Ecografía, Sociedad Española de Medicina Familiar y Comunitaria; Centro de Salud Santa Marta de los Barros, Gerencia de Atención Primaria de Badajoz, Badajoz, España
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Cessford T, Meneilly GS, Arishenkoff S, Eddy C, Chen LYC, Kim DJ, Ma IWY. Comparing Physical Examination With Sonographic Versions of the Same Examination Techniques for Splenomegaly. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2018; 37:1621-1629. [PMID: 29219201 DOI: 10.1002/jum.14506] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 09/18/2017] [Accepted: 09/20/2017] [Indexed: 05/15/2023]
Abstract
OBJECTIVES To determine whether sonographic versions of physical examination techniques can accurately identify splenomegaly, Castell's method (Ann Intern Med 1967; 67:1265-1267), the sonographic Castell's method, spleen tip palpation, and the sonographic spleen tip technique were compared with reference measurements. METHODS Two clinicians trained in bedside sonography patients recruited from an urban hematology clinic. Each patient was examined for splenomegaly using conventional percussion and palpation techniques (Castell's method and spleen tip palpation, respectively), as well as the sonographic versions of these maneuvers (sonographic Castell's method and sonographic spleen tip technique). Results were compared with a reference standard based on professional sonographer measurements. RESULTS The sonographic Castell's method had greater sensitivity (91.7% [95% confidence interval, 61.5% to 99.8%]) than the traditional Castell's method (83.3% [95% confidence interval, 51.6% to 97.9%]) but took longer to perform [mean ± SD, 28.8 ± 18.6 versus 18.8 ± 8.1 seconds; P = .01). Palpable and positive sonographic spleen tip results were both 100% specific, but the sonographic spleen tip method was more sensitive (58.3% [95% confidence interval, 27.7% to 84.8%] versus 33.3% [95% confidence interval, 9.9% to 65.1%]). CONCLUSIONS Sonographic versions of traditional physical examination maneuvers have greater diagnostic accuracy than the physical examination maneuvers from which they are derived but may take longer to perform. We recommend a combination of traditional physical examination and sonographic techniques when evaluating for splenomegaly at the bedside.
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Affiliation(s)
- Tara Cessford
- Departments of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Graydon S Meneilly
- Departments of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Shane Arishenkoff
- Departments of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Christopher Eddy
- Departments of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Luke Y C Chen
- Departments of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Daniel J Kim
- Departments of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Emergency Medicine, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Irene W Y Ma
- Department of Medicine and W21C Research and Innovation Center, University of Calgary, Calgary, Alberta, Canada
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Ma IWY, Arishenkoff S, Wiseman J, Desy J, Ailon J, Martin L, Otremba M, Halman S, Willemot P, Blouw M. Internal Medicine Point-of-Care Ultrasound Curriculum: Consensus Recommendations from the Canadian Internal Medicine Ultrasound (CIMUS) Group. J Gen Intern Med 2017; 32:1052-1057. [PMID: 28497416 PMCID: PMC5570740 DOI: 10.1007/s11606-017-4071-5] [Citation(s) in RCA: 103] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Revised: 04/05/2017] [Accepted: 04/13/2017] [Indexed: 11/29/2022]
Abstract
Bedside point-of-care ultrasound (POCUS) is increasingly used to assess medical patients. At present, no consensus exists for what POCUS curriculum is appropriate for internal medicine residency training programs. This document details the consensus-based recommendations by the Canadian Internal Medicine Ultrasound (CIMUS) group, comprising 39 members, representing 14 institutions across Canada. Guiding principles for selecting curricular content were determined a priori. Consensus was defined as agreement by at least 80% of the members on POCUS applications deemed appropriate for teaching and assessment of trainees in the core (internal medicine postgraduate years [PGY] 1-3) and expanded (general internal medicine PGY 4-5) training programs. We recommend four POCUS applications for the core PGY 1-3 curriculum (inferior vena cava, lung B lines, pleural effusion, and abdominal free fluid) and three ultrasound-guided procedures (central venous catheterization, thoracentesis, and paracentesis). For the expanded PGY 4-5 curriculum, we recommend an additional seven applications (internal jugular vein, lung consolidation, pneumothorax, knee effusion, gross left ventricular systolic function, pericardial effusion, and right ventricular strain) and four ultrasound-guided procedures (knee arthrocentesis, arterial line insertion, arterial blood gas sampling, and peripheral venous catheterization). These recommendations will provide a framework for training programs at a national level.
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Affiliation(s)
- Irene W Y Ma
- Department of Medicine, University of Calgary, Calgary, AB, Canada.
- W21C, University of Calgary, Calgary, AB, Canada.
| | | | | | - Janeve Desy
- Department of Medicine, University of Calgary, Calgary, AB, Canada
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