Role of Bowel Ultrasound in the Diagnosis and Follow-up of Patients with Crohn's Disease

Crohn's disease (CD) is an inflammatory chronic bowel disorder; it can involve the whole gastrointestinal tract, but its localization in the ileum or colon is most common. The reference standard for the diagnosis of CD is ileocolonoscopy with histologic assessment. The reference standard for the detection of any complications is surgery. However, imaging techniques have an important role both in the detection/localization of CD and in the follow-up of CD patients. In the last few years, the technical development of ultrasound equipment, the advent of new technologies such as elastography and mostly the increased expertise of sonographers have boosted the role of bowel ultrasound in assessment of the gastrointestinal tract. In fact, bowel ultrasound is particularly attractive thanks to its widespread availability, non-invasiveness, low cost and good reproducibility, as it can be easily repeated during follow-up. The aim of this article is to provide an extensive overview of the actual role of bowel ultrasound in the detection and follow-up of patients with CD.     

Usefulness of Contrast-Enhanced Ultrasound in Differentiating Inflammatory Bowel Disease From Colon Cancer

To evaluate the diagnostic performance of contrast-enhanced ultrasound (CEUS) in differential diagnosis of inflammatory bowel disease (IBD) and colon cancer, we enrolled 51 patients with thickened bowel walls (13 with IBD and 38 with colon cancer). Ultrasound and CEUS were performed and both qualitative and quantitative features were analyzed. The intestinal wall stratification was preserved in 63.6% of the IBD group but in only 2.6% of the colon cancer group (p?<0.01). On CEUS, disordered enhancement and heterogeneous enhancement were shown in only 9.1% and 0%, respectively, of the IBD group while in 94.7% and 78.9%, respectively, of the colon cancer group (p?<0.01). For quantitative analysis, compared to IBD, colon cancer showed later enhancement and slower wash-out with less speed to reach peak intensity (p?<0.05). In conclusion, CEUS may prove useful for the differential diagnosis of IBD and colon cancer, but more studies are required.     

原发性小肠淋巴瘤12例病例报道并文献复习

目的：探讨原发性小肠淋巴瘤临床特点,诊断及治疗。方法：在对2003—2008年确诊的12例原发性小肠淋巴瘤临床资料的回顾分析的基础上,复习近年文献并讨论。结果：腹痛或腹部不适（100%）,腹部肿块（50%）,腹胀（41.7%）是小肠淋巴瘤的最常见的临床表现,术前11例CT发现腹部肿瘤。12例全部行手术治疗;术后病理显示：12例均为非霍奇金淋巴瘤,其中B细胞淋巴瘤9例（75%）,T细胞淋巴瘤3例。结论：原发性小肠淋巴瘤临床表现不具有特异性,肠梗阻或腹部包块是最重要的诊断线索,确诊依赖病理,治疗采用手术为主的综合措施。     

Bowel Ultrasound State of the Art: Grayscale and Doppler Ultrasound,Contrast Enhancement,and Elastography in Crohn Disease

Bowel ultrasound (US) is accurate for assessing bowel inflammation and complications in Crohn disease. Additionally, contrast‐enhanced US provides a quantitative, objective measurement of inflammatory activity in inflammatory bowel disease, and shear wave elastography predicts the stiffness of bowel, an increase of which suggests less response to medical therapy, often necessitating surgery. Overall, bowel US is an excellent, safe, and repeatable choice for routine surveillance and for urgent imaging. We describe an approach to evaluating inflammatory bowel disease and review its features on standard grayscale US with Doppler imaging and show how contrast‐enhanced US and shear wave elastography can distinguish between inflammatory and fibrostenotic bowel.     

Sensitivity of Ultrasound for the Diagnosis of Tubo-Ovarian Abscess: A Case Report and Literature Review

Background: Tubo-ovarian abscess is a serious complication of pelvic inflammatory disease, with a high associated morbidity. Although tubo-ovarian abscess is not a rare entity, its diagnosis presents multiple challenges. Prior literature has suggested that pelvic ultrasound is now the “gold standard” in the diagnosis of tubo-ovarian abscess. Objective: Given the increasing use of ultrasound in the emergency department, it is important to understand the diagnostic value of transvaginal ultrasound in ruling in and ruling out important gynecologic emergencies. Our objective is to review the literature to evaluate the sensitivity and specificity of ultrasound in the diagnosis of tubo-ovarian abscess. Case Report: We review a case of a 31-year-old woman with frank peritonitis caused by a tubo-ovarian abscess diagnosed by contrast-enhanced computed tomography after an initial negative transvaginal ultrasound. Conclusion: We found evidence for lower sensitivity and specificity of ultrasound for the diagnosis of tubo-ovarian abscess than generally reported in the emergency medicine literature.     

Ultrasound Features of Trigger Finger: Review of the Literature

Trigger finger is a common pathologic condition of the digital pulleys and flexor tendons in the hand. The key clinical finding is a transient blockage of the digit when it is flexed with subsequent painful snapping when it is extended. Imaging is a helpful guide for establishing the severity of the disease, identifying the underlying cause, and deciding the appropriate management. This narrative review aims to recall the anatomic and pathologic bases and describe the ultrasound features of trigger finger, also including common ultrasound findings and complications after therapy. Ultrasound enables an accurate static and dynamic evaluation of trigger finger as well as a comparison with the adjacent normal digits and thus should be considered the radiologic modality of first choice for its diagnosis.     

胰腺炎性假瘤的影像学表现3例报告并文献复习

目的　探讨胰腺炎性假瘤的影像学表现 ,以提高对其认识。方法　复习 3例胰腺炎性假瘤的超声、CT表现 ,并与病理结果进行对照研究。结果　B超均表现为边界清楚、内部呈不均匀低回声之球形病灶 ;CT平扫 1例为低等混杂密度 ,1例为均匀等密度 ,另 1例为囊性伴新近出血 ;增强后 2例相当于延迟期扫描 ,显示病变实质有轻及中度强化 ,另 1例囊性病灶之囊壁于静脉期及延迟期有轻度强化。结论　胰腺炎性假瘤的影像表现与肿块内纤维化和炎细胞浸润程度有关 ,但缺乏特征性。当胰腺内出现单发肿块性病变时 ,应将其列入鉴别诊断范畴。     

Jacob病:1例报告和文献复习

目的：探讨Jacob病的临床特征．诊断．治疗及病理学特点。方法：对1例Jacob病患者进行分析并结合文献回顾，结果：Jacob病是指下领骨喙突增大并颧弓内侧形成假关节的一种疾病，好发于13-62岁．平均26岁，全景片可清晰的显示颧突形态的改变．而CT．三维CT更直观显示增大喙窦与颧弓的位置关系，多数患者可通过口内进路手术切除增大的喙突．少数因喙突增生过大或双侧增大需选择冠状切口、根据骨和软骨的比例不同．增生的喙突有不同的病理诊断。结论：Jacob病临床相当少见．其病因病理需要进一步研究。     

Point-of-Care Ultrasound to Diagnose Colitis in the Emergency Department: A Case Series and Review of the Literature

BackgroundColitis refers to an inflammatory process of the colon, composed of a variety of different etiologies including inflammatory bowel disease, infectious colitis, ischemic colitis, and allergic colitis. Usually, abdominal computed tomography (CT) is the gold standard in diagnosing the various forms of colitis. However, by the use of point-of-care ultrasound (POCUS), one may occasionally be able to discern wall thickening, pericolic fluid, and adjacent hyperechoic mesenteric fat. One may also see abscesses, fistulae, or ascites.Case SeriesThis is a series of 6 patients who had findings consistent with colitis seen on POCUS performed by an emergency physician. These were confirmed by abdominal CT with contrast. Early detection by POCUS was able to lead to a rapid diagnosis and to expedite treatment.Why Should an Emergency Physician Be Aware of This?The ability to detect findings of colitis by POCUS can be quickly learned by the emergency physician with a strong background in basic ultrasound. For many of the different subtypes of colitis, the initial treatment in the emergency department is the same: i.v. antibiotics, i.v. fluids, and “bowel rest” by maintaining the patient in nothing-by-mouth status. For the stable patient with high clinical suspicion of an infectious etiology of colitis, ultrasound can help confirm the diagnosis and rule out other etiologies. This may be especially important in certain populations such as children and young women, where one can avoid a significant amount of radiation being directed toward the pelvic area.     

My Treatment Approach to Management of the Pregnant Patient With Inflammatory Bowel Disease

Inflammatory bowel disease (IBD) is frequently diagnosed in women of childbearing age. Of paramount concern are questions about the effect of the disease on a woman's ability to conceive and carry the pregnancy safely to term, as well as the effect of the disease and its therapies on the health of the fetus. For health care providers, there is also the issue of medication dose adjustments and management of flares during pregnancy. Growing experience with IBD in pregnancy suggests that most women will have good outcomes; however, concerns and uncertainty remain for both the patient and the physician. This article outlines our approach to the treatment of these patients with respect to preconception counseling and management during pregnancy and the postpartum period.     

Evaluating Microalbuminuria in Children with Sickle Cell Disease: Review of the Literature

Microalbuminuria, an early marker of renal injury, may begin early in sickle cell disease (SCD). We conducted a retrospective chart review of 205 patients with SCD. Clinical data and treatment regimens were reviewed. Data were analyzed to determine prevalence and correlates of microalbuminuria and proteinuria. Thirty-one patients (15.2%) had microalbuminuria. Proteinuria, hematuria, age, height, weight, and systolic blood pressure were significantly associated with microalbuminuria. Age was the strongest predictor. We propose that all children with SCD be screened by annual urinalysis and careful blood pressure monitoring at each clinic visit for early identification of children at risk for renal injury.     

Telemetry Bed Usage for Patients with Low-Risk Chest Pain: An Updated Review of the Literature for the Clinician

BackgroundTelemetry monitoring in patients with low-risk chest pain continues to be highly used despite a 2011 literature review and recommendations by the Clinical Practice Committee (CPC) of the American Academy of Emergency Medicine that did not find quality data to support its use.ObjectiveTo update the medical literature review on the utility of telemetry monitoring in patients with low-risk chest pain and to offer evidence-based recommendations to emergency physicians.MethodsA PubMed literature search was performed for systematic reviews in English relevant to low-risk chest pain between 2011 and 2019 and then expanded to all citations by removing the systematic review criteria. Studies identified then underwent a structured review from which results could be evaluated in the context of the associated 2011 literature review and CPC recommendations.ResultsThe initial search yielded 2 potentially relevant studies, although none directly addressed telemetry. The expanded search resulted in 76 abstracts that were screened. Two addressed telemetry, including the last CPC statement, which were reviewed and recommendations given.ConclusionsNo further quality data were identified to support the use of telemetry monitoring in patients with low-risk chest pains. Telemetry monitoring is unlikely to benefit patients with low-risk chest pain with a low-risk HEART Score.     

Evidenced-Based Cognitive Rehabilitation for Persons With Multiple Sclerosis: An Updated Review of the Literature From 2007 to 2016

Objective

To update the clinical recommendations for cognitive rehabilitation of people with multiple sclerosis (MS), based on a systematic review of the literature from 2007 through 2016.

Reliability of Real‐time Ultrasound Imaging for the Assessment of Trunk Stabilizer Muscles: A Systematic Review of the Literature

Rehabilitative ultrasound (US) imaging is one of the popular methods for investigating muscle morphologic characteristics and dimensions in recent years. The reliability of this method has been investigated in different studies. As studies have been performed with different designs and quality, reported values of rehabilitative US have a wide range. The objective of this study was to systematically review the literature conducted on the reliability of rehabilitative US imaging for the assessment of deep abdominal and lumbar trunk muscle dimensions. The PubMed/MEDLINE, Scopus, Google Scholar, Science Direct, Embase, Physiotherapy Evidence, Ovid, and CINAHL databases were searched to identify original research articles conducted on the reliability of rehabilitative US imaging published from June 2007 to August 2017. The articles were qualitatively assessed; reliability data were extracted; and the methodological quality was evaluated by 2 independent reviewers. Of the 26 included studies, 16 were considered of high methodological quality. Except for 2 studies, all high‐quality studies reported intraclass correlation coefficients (ICCs) for intra‐rater reliability of 0.70 or greater. Also, ICCs reported for inter‐rater reliability in high‐quality studies were generally greater than 0.70. Among low‐quality studies, reported ICCs ranged from 0.26 to 0.99 and 0.68 to 0.97 for intra‐ and inter‐rater reliability, respectively. Also, the reported standard error of measurement and minimal detectable change for rehabilitative US were generally in an acceptable range. Generally, the results of the reviewed studies indicate that rehabilitative US imaging has good levels of both inter‐ and intra‐rater reliability.     

Lung Ultrasound for the Emergency Diagnosis of Pneumonia,Acute Heart Failure,and Exacerbations of Chronic Obstructive Pulmonary Disease/Asthma in Adults: A Systematic Review and Meta-analysis

Background

Lung ultrasound can accelerate the diagnosis of life-threatening diseases in adults with respiratory symptoms.

Advance Care Planning for Individuals With Chronic Obstructive Pulmonary Disease: A Scoping Review of the Literature

ContextIndividuals with chronic obstructive pulmonary disease (COPD) typically experience a gradual worsening of the illness in the years before death. Owing to difficulties in predicting the disease trajectory or the timing of acute exacerbations, advance care planning (ACP) may be of particular importance for individuals with COPD.ObjectivesThe objective of this study was to review and summarize the available literature on current practices around ACP in COPD.MethodsA scoping review of the literature was conducted following the Arksey and O'Malley framework. Original research studies of any design were included.ResultsTwenty-eight studies were included. Across studies, there was agreement that ACP should be incorporated into routine COPD management. There was evidence that this does not occur in everyday practice, with conversations tending to focus on day-to-day symptom management. Barriers included prognosis uncertainty, insufficient time and training, and a lack of protocols for who is responsible for initiating ACP. Facilitators included the use of transition points for identifying the appropriate time to initiate ACP, and an increased focus on ACP in professional education. The occurrence of repeated episodes of acute care was identified as a key transition point for identifying the palliative stage of COPD and an appropriate time to initiate ACP.ConclusionThe findings of this review confirm agreement among health care professionals and patients with COPD and their carers that ACP should be incorporated into routine COPD management. The use of transition points may help health care professionals overcome the barrier of prognosis uncertainty and identify patients who might benefit from ACP.