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Objective: This study sought to correlate the presence of pleural-based B-lines seen by emergency department ultrasound performed with the linear transducer with B-type natriuretic peptide (BNP) level in patients with suspected congestive heart failure.Methods: The study was a prospective convenience sample on adult patients in an academic, urban emergency department with over 100,000 annual patient visits. Adult patients with a BNP level ordered by the treating physician were prospectively enrolled by one of four physicians, blinded to the BNP level. The enrolling physicians included an emergency ultrasound director, two emergency ultrasound fellows, and a senior emergency medicine resident. Bedside ultrasound was performed using a 3-12 MHz linear broadband transducer in four lung fields. The serum BNP level was correlated with bilateral B-lines, defined as three or more comet-tail artifacts arising from the pleural line extending to the far field without a decrease in intensity on the right and left thorax.Results: Sixty three patients were consented and enrolled during a four-month period. Fifteen patients had the presence of bilateral B-lines. The median BNP in patients with bilateral B-lines was 1560 pg/mL (95% confidence interval (CI) 1141-3706 pg/mL), compared with 538 pg/mL (95% confidence interval 310-1917 pg/mL) in patients without B-lines. The distributions in the two groups differed significantly (p=0.0006). Based on the threshold level of BNP 500 pg/mL, the sensitivity of finding bilateral B-lines on ultrasound was 33.3% (95% CI: 0.19-0.50), and the specificity was 91.7% (95% CI: 0.73-0.99). In addition, bilateral B-lines were absent in all patients with a BNP500. Further research may show that it can be applied to quickly assess patients with undifferentiated dyspnea. [West J Emerg Med. 2011;12(1):102-106.]

Introduction: We compared the immediate cosmetic outcome of metallic foreign-body removal by emergency medicine (EM) residents with ultrasound guidance and conventional radiography.Methods: This single-blinded, randomized, crossover study evaluated the ability of EM residents to remove metallic pins embedded in pigs’ feet. Before the experiment, we embedded 1.5-cm metallic pins into numbered pigs’ feet. We randomly assigned 14 EM residents to use either ultrasound or radiography to help remove the foreign body. Residents had minimal ultrasound experience. After a brief lecture, we provided residents with a scalpel, laceration kit, a bedside portable ultrasound machine, nipple markers, paper clips, a dedicated radiograph technician, and radiograph machine 20 feet away. After removal, 3 board-certified emergency physicians, who were blinded to the study group, evaluated the soft-tissue model by using a standardized form. They recorded incision length and cosmetic appearance on the Visual Analogue Scale.Results: In total, 28 foreign bodies were removed. No significant difference in the time of removal (P¼ 0.12), cosmetic appearance (P ¼ 0.96), or incision length (P ¼ 0.76) was found.Conclusion: This study showed no difference between bedside ultrasound and radiography in assisting EM residents with metallic foreign-body removal from soft tissue. No significant difference was found in removal time or cosmetic outcome when comparing ultrasound with radiography.

Supreme political ambition has frequently been motivated by a single-minded quest to attain “power-over,“ which in itself may compensate for deep-rooted feelings of insecurity and humiliation. Authoritarian domination serves the grandiose, retaliatory narcissism of such powerful “leaders,” who subjectively experience sadistic satisfaction in destroying, and/or forcing into submission, “enemies” with little power to resist. In this paper, such latent motivations in the “foreign policy” of three recent leaders are examined. [ABSTRACT FROM AUTHOR]

The enigmatic figure of Wilhelm Reich (1897-1957), pioneering psychoanalyst turned “orgone biophysicist,” has eluded full understanding by previous psychological biographers such as Myron Sharaf. Such writers neglected the broader context of the history of Romantic science beginning in the late 18th century. Not only did Reich revive such discredited ideas in his post-psychoanalytic theories, but he was temperamentally drawn to a regressive fantasy of returning to childlike immediacy and ingenuousness. This longing was based largely in his paranoid view that adult human character is in itself a structure-of-defenses against direct contact with instinctual drives and sincere, genuine human contact. [ABSTRACT FROM AUTHOR]