Practical aspects of ultrasound-guided regional anaesthesia

Ultrasound-guided regional anaesthesia is increasingly popular, offering the user a number of advantages over alternative methods of nerve localization (neurostimulation or paraesthesia). These include a more accurate understanding of individual patient anatomy, identification of needle tip position and the ability to assess local anaesthetic spread in relation to a target nerve. An understanding of the basic principles and commonly used terminologies of ultrasound scanning is a fundamental requirement when using this technology. The aim of this article is to outline these basic principles and explain the practical aspects of performing nerve blocks, using ultrasound, in order to achieve quick, safe and effective block performance with minimal procedural discomfort for the patient.     

Practical aspects of ultrasound-guided regional anaesthesia

Ultrasound-guided regional anaesthesia is increasingly popular, offering the user a number of advantages over alternative methods of nerve localization (neurostimulation or paraesthesia). These include a more accurate understanding of individual patient anatomy, identification of needle tip position and the ability to assess local anaesthetic spread in relation to a target nerve. An understanding of the basic principles and commonly used terminologies of ultrasound scanning is a fundamental requirement when using this technology. The aim of this article is to outline these basic principles and explain the practical aspects of performing nerve blocks, using ultrasound, in order to achieve quick, safe and effective block performance with minimal procedural discomfort for the patient.     

Central venous cannulation

Central venous cannulation using the basic principles of the Seldinger technique is a core skill for anaesthetists and critical care doctors in situations where intravenous access is difficult or multiple infusions are required. While potentially lifesaving, central venous cannulation carries the risk of serious morbidity (or even mortality). Mitigating these risks through aseptic technique, ultrasound guidance and timely management of complications is vital.     

Central venous cannulation

Central venous cannulation using the basic principles of the Seldinger technique is a core skill for anaesthetists and critical care doctors in situations where intravenous access is difficult or multiple infusions are required. While potentially lifesaving, central venous cannulation carries the risk of serious morbidity (or even mortality). Mitigating these risks through aseptic technique, ultrasound guidance and timely management of complications is vital.     

Osteopathic principles in the modern world

The value of osteopathic principles has been called into question in modern clinical practice. It is argued that osteopathic principles define osteopathy, with a refutation of some criticisms of principles based osteopathy. An example of the generic form of principles based practice is described.Without osteopathic principles, a tendency towards loss of identity and distinctive osteopathic practice follows. This is closely associated with modern themes of progress and evidence based practice. Loss of identity breaks the continuity needed for expert craft practice, and a shrinking of the clinical remit of manual osteopathy. It is argued that osteopathic principles represent a means to prevent contraction and drift of remit and methods. Without principles, osteopathy ceases to exist as a distinctive form of healthcare. This loss is questionable if osteopathy has particular utility in the relief of human suffering.     

Ultrasound: Basic understanding and learning the language

Ultrasound (US) use has rapidly entered the field of acute pain medicine and regional anesthesia and interventional pain medicine over the last decade, and it may even become the standard of practice. The advantages of US guidance over conventional techniques include the ability to both view the targeted structure and visualize, in real time, the distribution of the injected medication, and the capacity to control its distribution by readjusting the needle position, if needed. US guidance should plausibly improve the success rate of the procedures, their safety and speed. This article provides basic information on musculoskeletal US techniques, with an emphasis on the principles and practical aspects. We stress that for the best use of US, one should venture beyond the "pattern recognition" mode to the more advanced systematic approach and use US as a tool to visualize structures beyond the skin (sonoanatomy mode). We discuss the sonographic appearance of different tissues, introduce the reader to commonly used US-related terminology, cover basic machine "knobology" and fundamentals of US probe selection and manipulation. At the end, we discuss US-guided needle advancement. We only briefly touch on topics dealing with physics, artifacts, or sonopathology, which are available elsewhere in the medical literature.     

Acoustic Doppler sonography, color duplex ultrasound, and laser Doppler flowmetry as tools for successful autologous breast reconstruction

The sine qua non to best ensure viability of any autogenous tissues used for breast reconstruction is to maximize the appropriate circulatory pattern to that tissue. This overview of tools used in this regard, all based on the physical principles of the Doppler effect, compares the role today of acoustic Doppler sonography, color duplex ultrasound, and laser Doppler flowmetry for perforator identification and flap monitoring. The audible Doppler has recognized limitations, but remains the simplest and most universally available device to assist in this purpose. Laser Doppler flowmetry provides a reasonable system for both intraoperative and post-procedure objective monitoring of the chosen tissue transfer.     

磁共振导航高强度聚焦超声的临床应用及进展

磁共振导航高强度聚焦超声（MRgHIFU）是基于磁共振导航下解剖定位、实时测温和高强度聚焦超声组合的无创治疗方法,相对于外科手术更具优势。该技术已在临床应用于子宫肌瘤、子宫腺肌症、乳腺肿瘤、疼痛性骨转移、前列腺癌、肝肿瘤、脑肿瘤的消融治疗,而在功能性神经外科治疗和急性脑血管意外治疗领域中的临床前研究也在进行之中。本文对MRgHIFU的治疗原理、临床应用现状及进展进行综述。     

超声弹性成像技术在前列腺癌诊断中的价值

超声弹性成像技术是一种获取组织弹性信息的新型成像技术,可以直接或间接反映组织内部的弹性模量等力学属性的差异,从而更清楚地显示、定位病变及鉴别病变性质。随着超声弹性成像技术的迅速发展及在临床实践中的广泛应用,已经成为一个研究热点,而目前国内外关于超声弹性成像在前列腺癌诊断中的研究报道尚不多。本文介绍了目前前列腺癌的诊断方法、超声弹性成像原理及发展,对近年超声弹性成像在前列腺癌诊断中的研究现状及进展进行了概述,并总结了其诊断价值及将来研究发展趋势。     

The role of ultrasound in the assessment of osteoporosis: A review

Osteoporosis is now being recognized as a silent epidemic and there is an increasing need to improve its diagnosis and management. Quantitative ultrasound (QUS) measurement [broadband ultrasound attenuation (BUA) and velocity] is emerging as an alternative to photon absorptiometry techniques in the assessment of osteoporosis. The fundamental principles governing ultrasound measurements are discussed, and some of the commercially available clinical systems are reviewed, particularly in relation to data acquisition methods. A review of the published in vivo and in vitro data is presented. The general consensus is that ultrasound seems to provide structural information in addition to density. The diagnostic sensitivity of ultrasound measurement of the calcaneus in the prediction of hip fracture has been shown by recent large prospective studies to be similar to hip bone mineral density (BMD) measured with dual-energy X-ray absorptiometry (DXA) and superior to spine BMD. Ultrasound has also been shown to correlate better with the type of hip fracture (intertrochanteric or cervical) than BMD and to provide comparable diagnostic sensitivity to spine BMD in vertebral fractures. It has also been observed that combining the results of both ultrasound and DXA BMD significantly improved hip fracture prediction. Areas where further research is required are identified.     

基于三维超声成像的软组织外科导航技术的临床应用进展

近年来医学影像技术飞速发展,通过将多模式的医学图像整合到手术导航系统中,可以有效提高外科手术的精确性和灵活性,增加手术安全性并缩短手术时间。我们对近年来新兴的基于三维超声成像的软组织外科导航技术,在医学外科领域的应用现状进行综述,系统阐述了其原理、临床应用及优缺点。     

High intensity focused ultrasound: The fundamentals,clinical applications and research trends

Diagnostic ultrasound has been clinically used for decades. More recently, high intensity focused ultrasound (HIFU) has been developed for therapeutic use as a non-invasive technique for tissue ablation. HIFU is also being investigated for advanced applications at the cellular level. Under guidance by magnetic resonance or ultrasound imaging, HIFU can achieve precise biological effects in tissue with a high safety profile. In this article, we discuss the basic principles, advantages and limitations of HIFU. We will also address the food and drug administration (FDA) approved clinical applications in the United States and highlight active HIFU research with promising clinical outcomes.     

Monitoring arterial blood pressure

The accurate measurement of a patient's arterial blood pressure is vital as it enables clinicians to deliver safe and appropriate care. Blood pressure is a key measurement of haemodynamic status and is a marker of adequate organ perfusion and tissue flow. This article reviews the physical principles of both non-invasive and invasive methods of arterial blood pressure measurement. Recent developments in ‘continuous’ non-invasive monitoring techniques are also outlined.     

Present indications and future expectations of ultrasound in surgery

Summary With the improvement of resolution in the ultrasound image, this technique has become more and more popular as a diagnostic means in various fields of medicine. Surgeons use diagnostic ultrasound pre-, intra- and postoperatively. Preoperatively, it is mainly employed for tumour staging, differential diagnosis of the acute abdomen, assessment of intra-abdominal and intrathoracic fluid in polytrauma and lately for arthrosonography. Intraoperative ultrasound has developed into one of the most important tools in intraoperative decision making in surgery of the liver, the bile ducts and the pancreas. Adenomas of the parathyroid glands may represent an indication for intraoperative ultrasound. Postoperative ultrasound has become increasingly important in the follow-up of tumour patients and the monitoring of patients in the intensive care unit. Interventional sonography can either be diagnostic or therapeutic. Both pre- and postoperatively, it can be used to help acquire material for microbiological, chemical and cytological examination. On the other hand, it is applied for drainage of abscesses and pancreatic pseudocysts, as well as pleural and intra-abdominal fluid collections. The main problem for the surgeon beginning to work with ultrasound today is the lack of training facilities with an experienced teacher. This is the origin of most of the other problems, such as quality control, 24-h service and interobserver-variations. With the new technologies already available or being developed, ultrasound is bound to gain even more importance for the surgeon in the future. Presented at the International Congress on Surgical Endoscopy, Ultrasound, and Interventional Techniques, Berlin 1988     

智能三维超声成像在胎儿领域的应用进展

胎儿产前超声检查对胎位和诊断医师的技术水平依赖性较强,尤其当胎儿存在复杂的心脏和颅脑结构异常时,超声检查难度更大。智能三维超声可对容积数据进行"自动"分析和测量,简化操作流程,获得诊断所必须的标准切面,减少对操作医师技术的依赖性,提高对疾病的诊断准确率。本文对智能三维超声成像技术在胎儿心脏切面、颅脑正中矢状面、颈项透明层切面的自动获取及参数自动测量等方面的应用特点和新进展进行综述。     

体外超声吸脂500例

目的　探讨体外超声吸脂术的疗效、安全性以及寻求各部位术后体围变化的规律。方法　对 5 0 0例患者的 5 95个部位进行体外超声吸脂术。记录各部位人均注入肿胀麻醉液量及吸出的纯脂肪量 ,并经 1～ 3个月跟踪调查 ,记录各部位术前术后体围的变化 ,对各部位各体围测量点的体围缩小值进行比较和统计学分析。结果　腰腹部、大腿部注入的麻醉液及吸出的脂肪量最高 ,各部位术后均有不同程度的体围缩小 ,随肥胖程度加重 ,腰腹部体围变化越为明显 ,最小腰围、脐围、最大腰围的变化有逐渐减少的趋势 ,但当最小腰围超过 111cm以后 ,术后以脐围的改变最为明显 ,大腿部以及上臂部以中上段改变最为明显。术中术后患者出血量较少 ,痛苦程度轻 ,术后恢复较迅速 ,皮肤平坦 ,无严重并发症发生。患者术后各部位未见反弹迹象 ,结论　体外超声吸脂术安全可靠 ,效果确切 ,受术者易接受。吸脂术后体围的变化可能有规律可循 ,对指导术前咨询以及效果预测有一定的临床意义。     

ACUTE APPENDICITIS IN CHILDREN: WHEN DOES ULTRASOUND HELP?

Fifty-six patients with possible appendicitis were evaluated clinically and by ultrasound. Ultrasound examination visualized the appendix in 18 of the patients evaluated and showed another pathology in six others. It was useful when the clinical picture was not clear (25 patients) as it showed an inflamed appendix in 10 patients. This was of particular value when there was another critical illness making clinical evaluation difficult (three patients), and for the diagnosis of other unsuspected pathological conditions (six patients). It did not affect the line of management when the clinical picture was clear enough to diagnose or exclude acute appendicitis.     

经直肠超声引导前列腺穿刺活检方案的合理选择

经直肠超声(TRUS)引导前列腺穿刺活检是前列腺癌诊断和制定合理治疗方案的常规手段。制定扩大前列腺系统性穿刺方案时需综合考虑患者的年龄、前列腺体积及健康状况等因素。在系统性穿刺活检的基础上结合靶向性穿刺活检可提高前列腺癌的阳性率。     

Ultrasound for anaesthetists

With the increasing use of ultrasound in operating theatres, critical care units and accident and emergency departments it is important that operators are aware of the fundamentals, which underpin these imaging systems. Failure to do so can result in inadequate examination and potential clinical errors. The basic physics and technology of ultrasound are outlined. The principles of Doppler ultrasound are described and the methods in which Doppler data are displayed are considered. The parameters that can be modified by the operator and the effects these have on the resultant image are discussed. Advice is given on how to set up an ultrasound system and optimize the image. Examples are given of the use of ultrasound in the clinical environment with emphasis on the type of application most likely to be encountered by the anaesthetist.     

超声造影在诊断卵巢肿瘤中的应用

卵巢恶性肿瘤是妇科常见的肿瘤,早期发现、早期诊断具有重要意义。超声造影（CEUS）可更好地显示肿瘤微小血管及缓慢血流,更准确地评价肿瘤内血流分布,有助于提高卵巢良、恶性肿瘤的诊断准确性。本文对CEUS在卵巢肿瘤诊断中的应用进行综述。