Combining cost-effective advantages with bedside real-time imaging, ultrasound is a powerful adjunct to standard clinical assessment in the management of polytrauma when it is administered at the point of care.
Grey-scale ultrasound has an important diagnostic role in nephrology. The absence of ionizing radiations and nephrotoxicity, rapidity of execution, excellent repeatability, the possibility to perform the test at the patient's bed and the low cost represent important advantages of this technique. Paired with real-time sonography and colour-power-Doppler contrast-enhanced ultrasound (CEUS) reduces the diagnostic gap with computed tomography (CT) and magnetic resonance (MR) and represents a major step in the evolution of clinical ultrasound. Although there are several situations in which contrast-enhanced CT and MR are indicated (i.e. evaluation of cystic or ischemic lesions, traumatisms and ablative therapies of the native and transplanted kidney), the use of CT contrast media presents a high risk of contrast-induced nephropathy (i.e. in elderly people, subjects with comorbidities and those with renal dysfunction), while gadolinium-based RM contrast agents are contraindicated for the risk of nephrogenic systemic fibrosis (i.e. in patients with severe renal dysfunction). In these situations, CEUS may be a viable alternative, however, as any technique associated with the infusion of pharmacological substances, the potential advantages and risks of CEUS should be critically evaluated. In this regard, the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) has published the guidelines for the use of CEUS for the kidney imaging and the International Contrast Ultrasound Society (ICUS) has been recently founded. The aim of this review is to offer an updated overview of the potential applications of CEUS in nephrology, reporting some indications and possible risks associated to its use.
Small bowel obstruction (SBO) is a common condition requiring urgent attention that may involve surgical treatment. Imaging is essential for the diagnosis and characterization of SBO because the clinical presentation and results of laboratory tests may be nonspecific. Ultrasound is an excellent initial imaging modality for assisting physicians in the rapid and accurate diagnosis of a variety of pathologies to expedite management. In the case of SBO diagnosis, ultrasound has an overall sensitivity of 92% (95% CI: 89–95%) and specificity of 93% (95% CI: 85–97%); the aim of this review is to examine the criteria for the diagnosis of SBO by ultrasound, which can be divided into diagnostic and staging criteria. The diagnostic criteria include the presence of dilated loops and abnormal peristalsis, while the staging criteria are represented by parietal and valvulae conniventes alterations and by the presence of free extraluminal fluid. Ultrasound has reasonably high accuracy compared to computed tomography (CT) scanning and may substantially decrease the time to diagnosis; moreover, ultrasound is also widely used in the monitoring and follow-up of patients undergoing conservative treatment, allowing the assessment of loop distension and the resumption of peristalsis.
Introduction: This paper reports data from a cognitive survey on the diffusion, practice and organization of ultrasound (US) in emergency medicine departments (EMDs) in Italy. The study was carried out by the Emergency Medicine Section of the Italian Society for Ultrasound in Medicine and Biology (SIUMB) in collaboration with the Italian Society for Emergency Medicine and Urgent Care (SIMEU). Methods: We created a questionnaire with 10 items, relating to 4 thematic areas. The questionnaires were administered from September 2007 to February 2008, by email, telephone or regular mail. In August 2008 the data were subjected to nonparametric statistical analysis (Spearman's Rho and Pearson's chi-square e software SPSS). Results: We analyzed 170 questionnaires from the EMDs of all Italian regions. A US scanner is present in 64.7% of the ERs, emergency US (E-US) is practiced only in 47.6% of the ERs, and only in 24% of these more than 60% of the ER team members have training in US. The diffusion of US in other operative units of the EMDs ranges from 8.2% to 26.5%. Discussion: The presence of a US scanner in the ER is essential for the practice and training and is correlated with the level of the EMD. The use of US appears to be less common in less equipped hospitals, regardless of the size of the ER and the availability of radiological services. Wider diffusion of US and greater integration with other services for the installment of the required equipment is to be hoped for.Sommario Introduzione: Riportiamo i dati di un'indagine conoscitiva sulla diffusione, pratica e organizzazione dell'ecografia (US) nei dipartimenti di emergenza (EMDs) in Italia. Questo studio è stato condotto dalla Sezione di Ecografia di Urgenza Emergenza della Società Italiana di Ecografia in Medicina e Biologia (SIUMB) in collaborazione con la Società Italiana di Medicina di Emergenza e Urgenza (SIMEU). Metodi: Abbiamo creato un questionario con 10 campi, relativi a 4 aree tematiche. I questionari sono stati somministrati nel periodo settembre 2007-febbraio 2008, via e-mail, telefono o posta ordinaria. I dati sono stati analizzati con metodi statistici non parametrici nell'Agosto 2008. Risultati: Abbiamo analizzato 170 questionari provenienti dagli EMDs di tutte le regioni italiane. Un ecografo è presente nel 64,7% dei Pronto Soccorso, l'ecografia d'emergenza (E-US) è praticata solo nel 47,6% dei Pronto Soccorso, e solo nel 24% di questi più del 60% dei membri dell'èquipe è formata in ecografia. La diffusione degli US in altre Unità Operative degli EMDs va dall'8,2% al 26,5%. Discussione: La presenza di un ecografo in Pronto Soccorso è essenziale per la pratica e la formazione e è correlata al livello del Dipartimento di Emergenza (I o II). L'uso dell'Ecografia sembra essere minore negli ospedali meno attrezzati, indipendentemente dalla grandezza del Pronto Soccorso e dalla disponibilità di Servizi di Radiologia. Si auspica una maggiore diffusione dell'ecografia e una maggiore integrazione con altri servizi quanto all'allocazione delle ...
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