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Since its initial description in 1996 by Yii and Niranjan, the internal pudendal perforator flap (also known as the Singapore flap, the gluteal fold flap, and the lotus petal flap) has become a workhorse in perineal soft tissue reconstruction. In 2001, Hashimoto described the presence of three to five perforators in the perineal anogenital triangle. The ischial tuberosity has thus become a useful anatomic landmark for the safe boundary of medial dissection during flap elevation, in order to avoid damaging the perforator vessels. The objective of the present study was to evaluate the perforators’ positions within the anogenital triangle by using color Doppler ultrasound. In a study of 15 subjects in the lithotomy position, we identified a total of 24 perforator vessels with a diameter greater than 5 mm. We noted the vessels’ positions using orthonormal measurements, according to the distance from the midline and the distance on a straight line between the two ischial tuberosities (i.e. consistent bony anatomic landmarks that are independent of the patient's height and body mass index). The mean distance between the ischial tuberosity and the internal pudendal perforator was 27.3 mm. Based on our present results, we consider that routine ultrasound identification and dissection of the perforators is not always required before pudendal flap harvesting. This decreases the operating time and simplifies the flap harvesting procedure.

Background: The primary aim was to assess the diagnostic accuracy of routine ultrasound assessment for gallbladder polyps. The secondary aim was to identify the characteristics that differentiate neoplastic polyps from nonneoplastic polyps. Methods: A total of 156 patients with histopathologically proven gallbladder polyps in 4 Dutch hospitals between 2003 and 2013 were included. Sensitivity and specificity of ultrasound for polyp size, number of polyps, and polyp type were assessed using histopathological findings as a reference standard. In addition, diagnostic accuracy of sonographic size ≥1 cm for neoplasia was assessed. Subgroup analysis for patients with polyps as primary indication for cholecystectomy was performed. The sonographic polyp characteristics on preoperative routine ultrasound were described. Results: Fifty-six percent of gallbladder polyps were preoperatively identified on ultrasound, of which 31% were neoplastic. Sensitivity and specificity of ultrasound to estimate polyp size were 93 and 43% (subgroup; 92 and 33%). Sensitivity and specificity of sonographic polyp size ≥1 cm for neoplasia were 86 and 32% (subgroup; 94 and 26%). No specific sonographic characteristics for neoplastic polyps could be established due to lack of reporting. Conclusion: Routine ultrasound assessment of polyps is associated with overestimation of polyp size and low specificity of sonographic size ≥1 cm for neoplasia, which contributes to surgical overtreatment of nonneoplastic polyps.

Objective To investigate the clinical value of ultrasound plus magnetic resonance imaging (MRI) for the diagnosis of breast masses and fibroids. Methods Clinical data for 357 patients with breast masses diagnosed at our hospital were analyzed retrospectively. The diagnostic performances were compared between 243 patients who underwent routine ultrasound examinations (control group) and 114 patients who underwent routine ultrasound plus MRI (test group). Results The overall accordance rates of routine ultrasound and routine ultrasound plus MRI for the diagnosis of breast masses, based on postoperative pathological diagnoses, were 70.78% (172/243) and 90.35% (103/114). The addition of MRI significantly improved the overall diagnostic performance of routine ultrasound for breast masses. The diagnostic accordance rate of routine ultrasound for the diagnosis of breast fibroids (fibroadenomas) was 74.12% (63/85 cases) compared with 93.94% (31/33 cases) for routine ultrasound plus MRI. The diagnostic performance of routine ultrasound plus MRI was therefore also significantly higher than routine ultrasound alone for diagnosing breast fibroids. Conclusions Routine ultrasound plus MRI can greatly improve the diagnostic accordance rates for breast masses and fibroadenomas.

PubMedID: 30836012 Background: Antenatal care is necessary for mother and infant by reducing or eliminating the risks which may occur in the antenatal and postnatal period. Ultrasound is one of the most commonly used examination methods in antenatal monitoring. Evaluating the expectations, experiences and reactions of both parents during routine ultrasound examinations is essential to provide the best antenatal care. Objective: This study aims to test the validity and reliability of the PEER-U scale developed for Sweden by Ekelin et al. Method: The PEER-U scale consists of before and after ultrasound scales. Four hundred and thirty-six parents participated in the study. Interviews were conducted with all participating parents in a private room 15 minutes before and five minutes after the ultrasound. Researchers analysed the PEER-U scale for language, content, construct, criterion-referenced validity and internal consistency reliability. Results: The Turkish version of PEER-U has 21 items in the before ultrasound scale and 21 items in the after ultrasound scale. Cronbach's alpha was 0.65 for the before ultrasound scale and 0.89 for the after ultrasound scale. Conclusion: The study determined that the Turkish version of the PEER-U scale is a valid and reliable scale for Turkish society. © 2019, © 2019 Society for Reproductive and Infant Psychology.

Background. Prolonged pyrexia and weight loss are recognised paraneoplastic manifestations of renal cell carcinoma (RCC). Stauffer’s syndrome is a rarely described paraneoplastic manifestation, which is described early in the course of RCC. We report a patient who presented with unresolving fever with multiple pulmonary opacities with biochemical evidence of hepatic choleastasis and was later diagnosed to have metastatic RCC with Stauffer’s syndrome. Case Presentation. We report a 54-year-old female who was investigated for a poorly resolving fever and recent weight loss for two months. During her course of illness, she developed bilateral multiple opacifications in the chest radiograph with negative pyogenic, mycobacterial microbiological studies. Despite intravenous antibiotics, her fever continued. She was found to have elevated alkaline phosphatase and gamma-glutamyl transferase and she underwent imaging with ultrasound scan of abdomen twice, which did not reveal demonstrable abnormalities. Later, contrast CT of abdomen and chest was performed and detected a renal cell carcinoma of the right upper pole of the kidney with multiple lung metastases, which was concluded as a metastatic RCC with paraneoplastic Stauffer’s syndrome. Conclusion. Prolonged pyrexia with loss of weight and Stauffer’s syndrome could be features to suggest renal cell carcinoma in the absence of positive microbiological studies. Isoechoic RCC could be missed in routine ultrasonography. When a RCC is suspected in the setting of a pyrexia of unknown origin, ultrasound with doppler or a contrast CT should be requested to aid diagnosis.

Clinical/methodical issue Focal liver lesions are commonly seen during routine ultrasound examinations. Standard radiological methods With native ultrasound there are lesions that cannot be sufficiently characterized. In these cases additional imaging might be necessary. Methodical innovations With contrast-enhanced ultrasound (CEUS), focal liver lesions can be characterized with high diagnostic accuracy. After the ultrasound contrast agent has been injected into a peripheral vein, the examiner saves video loops of the arterial, portal venous and late contrast phases. Combing the findings of native and contrast-enhanced ultrasound allows not only assessment of the etiology as benign or malignant but also detailed characterization of the focal liver lesion in most cases. Performance Using CEUS, focal liver lesions can be characterized with a sensitivity of over 95% and a specificity of about 83%. Achievements The advantages of CEUS include that there is no radiation exposure and that the ultrasound contrast agent has no effects on the function of the liver, kidneys or the thyroid gland. The main limiting factors for CEUS are bowel gas and obesity of the patient. Practical recommendations CEUS can visualize micro- and macrovascularization of benign focal liver lesions in real time. It is a useful imaging modality in unclear cases.

Pregnancy in rudimentary horn is extremely rare and usually terminates in rupture during first and second trimester of pregnancy. Diagnosis of rudimentary horn pregnancy and its rupture is difficult and can be missed in routine ultrasound scan; and in majority of cases, it is detected after rupture. It requires high index of suspicion. We present a case report of a woman who was misdiagnosed as having missed miscarriage; and termination was attempted, which ended up in failure and rupture of rudimentary horn was the consequence followed by laparotomy. With advances in prenatal ultrasound in recent decades, it is prudent to detect such a life-threatening condition earlier resulting in a lower incidence of maternal morbidity and mortality.

Ultrasound is an extremely useful tool of thyroid investigation showing different aspects from previously unknown nodules to high-risk lesions requiring immediate surgery. We aim to introduce a pictorial assay of a series cases from two tertiary Romanian centres of endocrinology underling different scenarios from detection to management. All female patients associated normal thyroid function and lack thyroid antibodies while thyroid ultrasound proved essential in detection and follow-up the thyroid condition. Case 1 is a 49-year old subject admitted after an episode of palpitations and detected with a left thyroid nodule of 4.9 by 2.7 by 4.9 cm with inhomogeneous pattern and relatively regular shape requiring surgery. Case 2 is a 63-year old patient accusing dizziness and requiring Doppler ultrasound for carotid arteries that incidentally pointed a thyroid nodule. Ultrasound confirmed a right lobe nodule of 1.1 by 0.6 by 1 cm in association with another small thyroid nodule of 0.8 by 0.6 by 0.6 cm having egg shell peripheral calcifications. Fine needle aspiration was indicated and follicular aspects were identified. Case 3 is a 56-year old female admitted for menopausal osteopenia and routine ultrasound found a hypo-echoic nodule of 2.5 cm at right lobe. Case 4 is a 67-year female who was actually post-operatory confirmed with pT3aN1M0 papillary cancer starting from a first ultrasound evaluation of the thyroid. Case 5 is a 23-year old patient with a nodule detected by ultrasound three years ago and currently appreciated with a considerable increase even BETHESDA 2 was found initially through fine needle aspiration. Conclusion. As pointed by present series of cases, thyroid ultrasound represents an essential method in the hands of endocrinologists.

Objectives To assess the accuracy and effectiveness of routine screening for vasa previa, to describe our experience, and to assess factors that contribute to missed cases of vasa previa. Methods A retrospective descriptive study of all cases of vasa previa from a single maternal-fetal medicine service between 2009 and 2017 was performed. Ultrasound findings and obstetric and neonatal outcomes were reviewed and analyzed. Results Thirty-five cases of vasa previa were identified. Most cases (33 of 35 [94.3%]) were diagnosed antenatally. All 33 cases that followed our screening protocol were diagnosed antenatally and had favorable outcomes. Two cases that did not follow our protocol were not diagnosed antenatally and were delivered emergently. The mean gestational age ± SD at delivery of antenatally diagnosed cases was 34.9 ± 1.69 weeks. All neonates survived. Conclusions Routine ultrasound screening for vasa previa using American Institute of Ultrasound in Medicine criteria will almost universally lead to good outcomes and prevent perinatal mortality.

Background The aim of the study was to investigate if expecting parents wanted to know the sex of the fetus during ultrasound examination and if they had discussed it with the midwife. Another aim was to explore any interest in sex selection. Methods A longitudinal survey in early and late pregnancy among 2393 women in Sweden. Results Almost all (95.8%, n = 2289) women had discussed sex determination with the partner before the ultrasound scan, and 57% (n = 1356) of women and their partners wanted to find out the fetal sex. The expecting parents mostly initiated a discussion with the midwife (46%, n = 1088), but 10% (n = 229) stated that the midwives initiated the discussion. Few (5%, n = 118) expressed a potential interest in selecting sex of a baby. Women who were interested in sex determination did not differ from those who were not, with respect to age, origin, education, parity, level of pregnancy planning, or importance of religion, but women who had chosen another fetal diagnostic method were more interested in sex determination and in potential sex selection. Conclusions Half of women and their partners wanted to know the fetal sex, and 5% were interested in sex selection. This high interest in sex determination is a challenge, since present national guidelines do not include sex determination as an option.

Key Clinical Message Bardet–Biedl syndrome (BBS) is a ciliopathy that is responsible for multiple visceral abnormalities. This disorder is defined by a combination of clinical signs, many of which appear after several years of development. BBS may be suspected antenatally based on routine ultrasound findings of enlarged hyperechogenic kidneys and postaxial polydactyly.

Background: Studies showed that pregnant women generally value routine ultrasounds in the first two trimesters because these provide reassurance and a chance to see their unborn baby. This, in turn, might help to decrease maternal anxiety levels and increase the bond with the baby. However, it is unclear whether pregnant women hold the same positive views about a third trimester routine ultrasound, which is increasingly being used in the Netherlands as a screening tool to monitor fetal growth. The aim of this study was to explore pregnant women's experiences with a third trimester routine ultrasound. Methods: We held semi-structured interviews with fifteen low-risk pregnant women who received a third trimester routine ultrasound in the context of the Dutch IUGR RIsk Selection (IRIS) study. The IRIS study is a nationwide cluster randomized controlled trial carried out among more than 13,000 women to examine the effectiveness of a third trimester routine ultrasound to monitor fetal growth. For the interviews, participants were purposively selected based on parity, age, ethnicity, and educational level. We performed thematic content analysis using MAXQDA. Results: Most pregnant women appreciated a third trimester routine ultrasound because it provided them confirmation that their baby was fine and an extra opportunity to see their baby. At the same time they expressed that they already felt confident about the health of their baby, and did not feel that their bond with their baby had increased after the third trimester ultrasound. Women also reported that they were getting used to routine ultrasounds throughout their pregnancy, and that this increased their need for another one. Conclusions: Pregnant women seem to appreciate a third trimester routine ultrasound, but it does not seem to reduce anxiety or to improve bonding with their baby. Women's appreciation of a third trimester routine ultrasound might arise from getting used to routine ultrasounds throughout pregnancy. We recommend to examine the psychological impact of third trimester routine ultrasounds in future studies. Results should be taken into consideration when balancing the gains, which are as yet not clear, of introducing a third trimester routine ultrasound against unwanted side effects and costs.

International audience; As knowledge continues to develop, regular updates are necessary concerning recommendations for practice. The recommendations for the management of melanoma stages I to III were drawn up in 2005. At the request of the Société Française de Dermatologie, they have now been updated using the methodology for recommendations proposed by the Haute Autorité de Santé in France. In practice, the principal recommendations are as follows: for staging, it is recommended that the 7th edition of AJCC be used. The maximum excision margins have been reduced to 2 cm. Regarding adjuvant therapy, the place of interferon has been reduced and no validated emerging medication has yet been identified. Radiotherapy may be considered for patients in Stage III at high risk of relapse. The sentinel lymph node technique remains an option. Initial examination includes routine ultrasound as of Stage II, with other examinations being optional in stages IIC and III. A shorter strict follow-up period (3 years) is recommended for patients, but with greater emphasis on imaging.

Summary:. A distal deep vein thrombosis is generally believed to be clinically unimportant because of a low incidence of pulmonary emboli. To the author’s knowledge, a symptomatic pulmonary embolism has not been reported in association with an isolated calf deep vein thrombosis in a plastic surgery outpatient. This case report provides the clinical details of a pulmonary embolism occurring after routine ultrasound detection of a distal deep vein thrombosis. Proximal deep venous thromboses originate in the calf and are dangerous because they frequently embolize. Ultrasound surveillance provides early detection of subclinical distal deep vein thromboses. Anticoagulation is initiated, suppressing propagation of the thrombosis to the deep veins of the thigh, and reducing the risk of a catastrophic pulmonary embolism.

Background The prognosis and early neonatal management of the VACTERL association depend mainly on the severity of malformations ascertained prenatally. Methods Here we reviewed the spectrum of clinical features observed in cases of VACTERL association ascertained prenatally through ultrasound examination but examined at birth and compared them with cases ascertained postnatally. Results From 1995 to 2011, a total of 19 cases of VACTERL association were observed in our center; 10 were ascertained prenatally and confirmed after birth whereas 9 were ascertained only after birth. The types and frequencies of malformations observed prenatally were as follows: renal malformations (45%), tracheoesophageal fistula (44%), cardiac malformations (20%), vertebral (13%), and limb (11%) defects. Anal atresia was never detected using routine prenatal ultrasound examination. Conclusion Further studies of fetuses with the VACTERL association are necessary to better delineate the malformations spectrum observed prenatally to improve the early recognition of the VACTERL association. Birth Defects Research (Part A) 103:880–886, 2015. © 2015 Wiley Periodicals, Inc.

Often overlooked during routine ultrasound evaluation of a normal pregnancy, the placenta forms the biologic interface between the mother and fetus and is critical to fetal growth and development. Malformations in development, positioning, and vascularity can have profound implications for both maternal and fetal well-being. As such, a judicious inspection of the placenta is warranted as an integral part of every screening or emergent prenatal ultrasound. Herein, we present a pictorial review of a variety of placental pathologic conditions including abnormalities in positioning, adherence, vascularity, and hemorrhage as well as potential peri-placental masses and gestational trophoblastic disease, all of which are readily encountered in a busy emergency radiology practice.

von Meyenburg complex (VMC) is a ductal plasia of terminal or end branches of intrahepatic biliary radicals. These are multiple biliary hamartomas (MBH) which are of total benign in nature. Very rarely, patient reports with some complaints related to liver or any other alarming complaints. This is found as accidental finding in routine ultrasound and contrast enhanced computed tomography (CECT) studies. We present one such case of a 73-year-old male who came for routine ultrasound examination and was found to be having multiple small cysts in liver and kidneys. He was subjected to triple phase CECT abdomen for further evaluation. VMC was diagnosed as incidental finding and was further confirmed by magnetic resonance imaging (MRI). The entity becomes important as this has to be differentiated from other lesions especially metastasis.

a b s t r a c t Aims of the study were to evaluate the routine ultrasound scanning plus subjective mus- cle scoring system for meat sheep in Austria in terms of (1) their ability to predict carcass quality and composition, (2) the repeatability of ultrasound scanning and (3) a comparison of three anatomical scanning sites. Lambs of six breeds (n = 189; mean bodyweight 39 kg) were scored for the muscling of their shoulder, back and hindquarter and were scanned with an ultrasound device for back fat and longissimus dorsi muscle depth lateral of the spine at 10th/11th (US1) and 13th (US2) thoracic vertebrae as well as at 3rd/4th (US3) lum- bar vertebrae. Each ultrasound picture was taken twice within a few minutes to check on within operator repeatability. After slaughter the carcasses were classified according to the EUROP system and back fat and muscle depth were measured on a carcass cross section, and 36 carcasses were dissected to lean meat, fat and bone to evaluate carcass composi- tion. Relationships between carcass and dissection traits and routine performance testing traits (live weight, fat and muscle depth at US3) were evaluated based on partial regression coefficients additionally considering breed, sex (carcass traits only) and birth type as fixed effects. Further, fat and muscle depth at scan sites US1 and US2 were fitted alternatively and Pearson's correlation coefficients were calculated. Correlations between ultrasonic and carcass measures ranged from r = 0.60 (muscle depth at US1 and EUROP conformation class) to r = 0.84 (muscle depth at US1 and muscle depth at carcass). Repeatabilities for muscle and backfat thickness ranged from 0.90 to 0.95. The results support the usefulness of the cur- rently routine ultrasound scans as relatively easy method to predict carcass composition in live lambs of different breeds. Muscle scans are valuable to estimate amount of carcass lean and EUROP conformation class, but fat scans have greater power to predict the fattiness of the carcass as well as lean percentage. Subjective muscle scoring of live animals seems to be mainly influenced by the fattiness of the animal. The comparison of three anatomical scanning sites did not give definite results. US1 seems to be favourable for estimating mus- cle depth, for the prediction of lean and in terms of repeatability whereas US2 and US3 had small advantages in scanning fat depth and in the prediction of EUROP classification and carcass fat.

ObjectiveTo explore procedures for providing information, assessment and documentation about ultrasound soft markers in Sweden. DesignDescriptive, quantitative, cross-sectional survey. SampleEighty-two percent of all obstetric ultrasound clinics in Sweden (covering >90% of routine fetal ultrasound examinations). MethodsPostal questionnaire survey between December 2010 and January 2011. Main outcome measuresItems about provision of information, risk estimation, and follow-up strategies in relation to observed ultrasound soft markers. ResultsMore than 96% of all fetal routine ultrasound examinations were performed at 15-21 gestational weeks, primarily by midwives. Half of the clinics replying wanted prospective parents to be provided with information, but 38 (78%) of the clinics did not routinely inform about assessment of soft markers before the examination. Follow up and decisions on whether to give information when soft markers were found were based on the number and type of the observed markers, whether other structural deviations existed, and on the woman's age and anxiety level. Only at eight clinics (17%) were parents informed about all soft marker findings. At 13 clinics (28%) observed markers were documented/recorded, even though the women were not informed. ConclusionsInformation regarding the assessment and importance of observed soft markers seems to be inconsistent and insufficient. Provision of information and documentation of findings appear to be handled differently at obstetric ultrasound clinics. This suggests that Swedish ethical principles relating to healthcare and ultrasound examinations are incompletely followed and national guidelines appear to be necessary.

Background Bladder exstrophy is a rare malformation. Prenatal diagnosis is usually an incidental finding on routine ultrasound examination. Triple-X syndrome (karyotype 47,XXX) is the most frequent sex chromosome aneuploidy in live-born females (approximately 1 in 1000). The diagnosis is often not made because women with 47,XXX karyotype have no or hardly any clinical symptoms during life. Methods Prenatal diagnosis of triple X karyotype is usually an incidental finding when an invasive prenatal diagnosis is performed for other reasons. Results Here, we report on two cases with bladder exstrophy and triple-X syndrome, one in a fetus and one in an adult. In view of two previous reports of this association in literature, causality of these two conditions should be considered. Conclusion A gene dosage effect as possible underlying mechanisms will be discussed. Birth Defects Research (Part A) 100:797–800, 2014. © 2014 Wiley Periodicals, Inc.

Objectives: The purpose of this study was to determine the accuracy of sonographer predictions of fetal gender during routine ultrasounds. Primarily, the study sought to investigate the accuracy of predictions made in the first trimester, as requests from parents wanting to know the gender of their fetus at this early scan are becoming increasingly common. Second and third trimester fetuses were included in the study to confirm the accuracy of later predictions. In addition, the mother's decision to know the gender was recorded to determine the prevalence of women wanting prenatal predictions. Methods: A prospective, cross sectional study was conducted in a specialist private obstetric practice in the Illawarra, NSW. A total of 640 fetuses across three trimesters were examined collectively by seven sonographers. Fetal gender was predicted using the sagittal plane only in the first trimester and either the sagittal or transverse plane in later trimesters. Phenotypic gender confirmation was obtained from hospital records or direct telephone contact with women postnatally. Results: Results confirmed 100% accuracy in predictions made after 14 weeks gestation. The overall success rate in the first trimester group (11–14 weeks) was 75%. When excluding those scans where a prediction could not be made, success rates increased to 91%. Results were less accurate for fetuses younger than 12 weeks, with an overall success rate of 54%. Male fetuses under 13 weeks were more likely to have gender incorrectly or unable to be assigned. After 13 weeks, success rates for correctly predicting males exceeded that of female fetuses. Statistical differences were noted in the success rates of individual sonographers. Sixty seven percent of women were in favour of knowing fetal gender from ultrasound. Publicly insured women were more likely to request gender disclosure than privately insured women. Conclusions: Sonographic gender determination provides high success rates in the first trimester. Results vary depending on sonographer experience, fetal age and fetal gender. Practice guidelines regarding gender disclosure should be developed. Predictions prior to 12 weeks should be discouraged.

Focal nodular hyperplasia (FNH) is a hepatic disease first described in 1958. The existence of an accessible and minimally invasive imagistic investigation to establish the diagnosis in a large number of cases would be desirable, especially because once diagnosed, the disease needs no treatment. We present the case of a young woman with long term use of oral contraceptives in which the diagnosis of FNH was established at a routine ultrasound. Evolution of disease during the pregnancy and the atypical imagistic aspect of liver lesions raised many problems of differential diagnosis.

Right Heart Catheterization (RHC) by femoral approach is associated with several complications and thus delayed discharge. Ultrasound-guided access has been demonstrated to decrease vascular complications, the number of attempts and access time. Antecubital peripheral venous access has been

Hepatoblastoma is an uncommon fetal neoplasm that may represent an isolated malignancy or a component of a familial cancer or syndromic diagnosis.A large fetal liver mass was detected on routine ultrasound examination of a 23-year-old woman with thyroid nodules and hypertension. Inferior vena cava compression prompted delivery; postnatal biopsy revealed hepatoblastoma. Maternal thyroid biopsy revealed papillary carcinoma. Neonatal and maternal cytomolecular analysis revealed APC gene disruption at 5q22.2. Pedigree analysis exposed multigenerational colon cancer and thyroid cancer, which in conjunction with genetic testing is consistent with familial adenomatous polyposis.This is a novel means of familial adenomatous polyposis diagnosis. Obstetricians and perinatologists should be alert for familial cancer or syndromic diagnoses presenting as fetal neoplasms.

Objective: to describe the experiences of immigrant parents of an ultrasound examination in the second trimester of pregnancy, highlighting information, communication, thoughts, feelings and well-b ...

Objective. We evaluated whether routine ultrasound examination may illustrate gallbladder abnormalities, including acute acalculous cholecystitis (AAC) in the intensive care unit (ICU).Patients and Methods. Ultrasound monitoring of the GB was performed by two blinded radiologists in mechanically ventilated patients irrespective of clinical and laboratory findings. We evaluated major (gallbladder wall thickening and edema, sonographic Murphy’s sign, pericholecystic fluid) and minor (gallbladder distention and sludge) ultrasound criteria.Measurements and Results. We included 53 patients (42 males; mean age57.6±2.8years; APACHE II score21.3±0.9; mean ICU stay35.9±4.8days). Twenty-five patients (47.2%) exhibited at least one abnormal imaging finding, while only six out of them had hepatic dysfunction. No correlation existed between liver biochemistry and ultrasound results in the total population. Three male patients (5.7%), on the grounds of unexplained sepsis, were diagnosed with AAC as incited by ultrasound, and surgical intervention was lifesaving. Patients who exhibited ≥2 ultrasound findings (30.2%) were managed successfully under the guidance of evolving ultrasound, clinical, and laboratory findings.Conclusions. Ultrasound gallbladder monitoring guided lifesaving surgical treatment in 3 cases of AAC; however, its routine application is questionable and still entails high levels of clinical suspicion.

This paper studies human gallbladder (GB) smooth muscle contractions. A two-state cross-bridge model was used to estimate the apparent attachment and detachment rate constants, as well as increased Ca2+ concentration from the peak active stress during the isometric contraction. The active stress was computed from a mechanical model based entirely on non-invasive routine ultrasound scans. In the two-state cross-bridge model, the two apparent rate constants, representing the total attached/detached cross-bridges, respectively, were estimated using active stress prediction for 51 subjects undergoing cholecystokinin-provocation test, together with estimates from the four-state cross-bridge model for a swine carotid, bovine tracheal and guinea pig GB smooth muscles. The study suggests that the apparent rate constants should be patient-specific, i.e. patients with a lower stress level are characterized by smaller apparent rate constants. In other words, the diseased GB may need to develop fast cycling cross-bridges to compensate in the emptying process. This is a first step towards more quantitative and non-invasive measures of GB pain, and may provide useful insight in understanding GB motility and developing effective drug treatments.

Objectives To examine maternal attitudes towards prenatal diagnosis of idiopathic clubfoot and to determine the incidence of false-negative ultrasound examinations. Methods Surveys were mailed to mothers of patients with clubfoot born between 2000 and 2007 who were treated at either Sinai Hospital of Baltimore or Orthopaedic Hospital Speising. Exclusion criteria were underlying syndrome, genetic abnormality and multiple pregnancy. The survey asked the mother whether she had had any ultrasound examinations before her child was born, whether any of these had shown clubfoot, and whether she would have preferred to find out about her child's clubfoot before birth or after birth. Results Mothers completed 220 (USA, 105 surveys; Austria, 115 surveys) of 401 mailed surveys. The prenatal detection rate was 60% in the USA compared with 25% in Austria (P = 0.001). Overall, 74% of mothers indicated a preference for prenatal diagnosis and 24% indicated a preference for postnatal diagnosis of the condition. Of 92 patients diagnosed prenatally, 96% of mothers indicated a preference for a prenatal diagnosis. Of 128 patients diagnosed postnatally, 58% of mothers indicated a preference for prenatal diagnosis, 38% for postnatal diagnosis and 4% were undecided. Conclusions The diagnosis of clubfoot is still often missed during routine ultrasound examination. When a prenatal diagnosis is made, most mothers appreciate having this information. However, when prenatal diagnosis is missed, a significant proportion of mothers seem to accept the false-negative diagnosis retrospectively. Copyright © 2011 ISUOG. Published by John Wiley & Sons, Ltd.

Objective: The aim of this study is to determine the effect of scale/pulse repetition frequency (PRF) on the appearance of color Doppler twinkling artifact. Materials and Methods: We commenced this cross-sectional study for 20 months from November 2014 to July 2016. During routine ultrasound examination, we observed multiple case of twinkling artifact produced by renal stones, calcifications in the thyroid nodules, bony fragments and intestinal gases, etc., We observed twinkling artifact with low- and high-PRF settings in 500 different structures. A total of 500 other structures were included wherein there was no Doppler twinkling artifact produced by them, with usual optimum PRF settings. These structures were also evaluated with low- and high-PRF to determine the effect of PRF on twinkling artifact effectively. All the patients were examined according to the AIUM guideline for appropriate examination protocol. Data were collected from the observation of twinkling artifact with low- and high-PRF/scale and evaluated with the help of IBM SPSS 24 package, the results were summarized as follow. Results: Change in scale/PRF could not affect the twinkling artifact. The twinkling artifact observed with low-PRF was the same as seen with high-PRF. There was a significant agreement between low- and high-PRF in the production of color twinkling artifact. The kappa value of agreement was estimated as 0.96, whereas the Pearson's correlation was significant with the value of 0.001. Same twinkling artifact was created with low- and high-PRF, with no significant variation. Conclusion: Twinkling artifact is independent of PRF/Scale.

Objective To investigate women's expectations of routine ultrasound and experiences when soft markers were discovered: what the disclosure meant, how it affected them, how they experienced the information given and why they did or did not choose amniocentesis. Design Semi-structured, in-depth interviews were conducted with 11 women 25–30 weeks into the pregnancy, 7–13 weeks after the discovery of a soft marker. Findings Women lacked knowledge about the potential of the scan and detection of soft markers created strong emotional reactions that women thought could have been alleviated by prior information about potential findings. Information in connection with the scan was perceived as insufficient. Decision about amniocentesis was affected by attitudes to disability, anxiety about fetal loss due to the procedure, need for certainty by a diagnostic test, and partner's opinion. Conclusions Women were shocked by the unexpected and sometimes unwanted information on elevated risk for a chromosomal aberration for which they lacked any preparation. Because this event often has long-lasting effects on the pregnancy, models of information that are efficient in promoting informed decisions are imperative. Practice implications Both women and their partners need relevant information before and in connection with ultrasound scan to be able to make informed choices.

Gallstones are commonly observed after rapid weight loss, particularly after bariatric surgery. Preventive measures of gallstone formation and potential related complications are still debated. This study aimed to propose a standardized strategy according to the results of the literature. Thus, preventive measures should be determined according to patient status (evaluated clinically and by routine ultrasound) and the type of bariatric surgery. Cholecystectomy should be performed in patients with symptomatic gallstones irrespective of the planned operation, or for asymptomatic gallstones during a gastric by-pass. In other settings, ursodesoxycholic acid should be given postoperatively for 6 months.

Objectives The aim was to describe midwives’ and nurses’ experiences when women are diagnosed with a missed miscarriage during a routine ultrasound scan in pregnancy weeks 18–20. Study designs A qualitative content analysis with an inductive approach and 13 semi-structured interviews were used for data collection from these three domains: midwives at an ultrasound department, midwives at a maternity clinic and nurses at a gynecological ward. Content analysis resulted in six codes, four categories and one primary theme. Main outcome measures The four categories identified were: the interviewees’ experiences of women’s reactions, support from the midwife and nurse, the interviewees’ experiences of men’s reactions and communication between care providers and women. The main theme focused on the interviewees’ noting that women had a premonition that something was wrong with their pregnancy. This could for example have been in the form of minor bleeding or the fact that pregnancy symptoms had receded and there were no movements by the fetus. The midwives carried out a follow-up with assessment. Conclusions Women need confirmation of their premonitions of a missed miscarriage so that a diagnosis can be made as early as possible in their pregnancy. Women and their partners who have suffered a missed miscarriage need extended support on an individual basis in addition to follow-up assistance as assessed by the midwives.

OBJECTIVE: To investigate parents' expectations, experiences and reactions, sense of coherence and anxiety before and after a second-trimester routine ultrasound examination, with normal findings. METHODS: Before and after ultrasound questionnaires including the scales parents' expectations, experiences and reactions to routine ultrasound examination (PEER-U state of mind index), sense of coherence (SOC) and state and trait anxiety inventory (STAI), were sent to a 1-year cohort of women and their partners. Replies received were 2183. RESULTS: Both parents had significantly less worried state of mind (PEER-U) after the examination than before. Women had a lower grade of state anxiety after than before, but for men there was no significant change. Before the ultrasound, women had a higher degree of worried state of mind, as well as a higher grade of state and trait anxiety and a lower sense of coherence, than men. The women showed a greater reduction in worried state of mind than the men after the ultrasound examination. There were no significant differences in sense of coherence before and after ultrasound. CONCLUSIONS: Women and men are affected in their psychological well-being in relation to a routine ultrasound examination, but their sense of coherence remains stable. Copyright (c) 2009 John Wiley & Sons, Ltd. (Less)

Objective To conceptualize women's and their partners' experiences and ways of handling the situation before, during, and after second trimester ultrasound examination with the diagnosis of a nonviable fetus. Design A grounded theory study. Setting A Swedish regional hospital. Participants Nine women and 6 men ( n =15) were interviewed within a year of the event. Results The core category was Unexpected change in life . Four categories that were encompassed by the core category emerged: (a) Deceived by a false sense of security ; (b) Confronting reality ; (c) Grieving ; and (d) Reorientation . Conclusion These parents were unprepared for the diagnosis of a nonviable fetus. In addition to the crisis reaction, they realized that the sense of security they had experienced was false. As different care givers were involved, the need for a care plan was evident. Support from care givers was a very important factor.

Background: Antenatal care services are well established in Germany, with at least 10 routine antenatal consultations per pregnancy. Although many individual antenatal screening procedures and tests have been assessed in clinical trials, little is known about the overall prevalence of suspicious findings in routine antenatal surveillance and about related effects on psychological maternal well-being. The objectives of this study were to evaluate the views of pregnant women on prevalence, type, and consequences of suspicious findings during antenatal care; to assess related worries and anxiety; and to compare the reports of risk factors by these women with the antenatal records. Methods: We enrolled 360 pregnant women participating in antenatal classes in the Rhein-Neckar area, Germany. They were followed up from the beginning of antenatal classes to the puerperium using self-administered structured questionnaires that covered previous antenatal consultations and related worries. The Spielberger State-Trait Anxiety Inventory was used to assess current and general levels of anxiety. Antenatal records were also analyzed. Postnatally, pregnancy outcomes were assessed by telephone interviews. Results: Two-thirds (67.2%) of antenatal care attendees reported suspicious or abnormal findings, almost half of which (45.1%) resulted from routine ultrasound scans. More than half (53.2%) of those with suspicious findings reported that they were acutely worried. The suspected problem often did not materialize: 13 (81.3%) of 16 suspected malformations and 34 (81%) of 42 suspected growth-retarded babies were in the normal range. Many suspicious findings reported by mothers were not documented in the antenatal records. Conclusions: Contrary to their expectation of reassurance, most antenatal care attendees are warned about possible abnormalities, which often lead to further investigations and cause considerable worries. More research is needed to evaluate the long-term impact and consequences of suspicious or false screening results in routine antenatal care. (BIRTH 35:1 March 2008)