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Shoulder and Knee Arthroscopy Access Point: Prospective Comparison of Sonographic and Palpatory Detection – Which Method is Better for Novices? 肩关节和膝关节镜检修点:超声和触诊检测的前瞻性比较--哪种方法更适合新手?
IF 3.2 Q2 Medicine Pub Date : 2024-04-04 DOI: 10.1055/a-2271-0098
A. Weimer, J. Weimer, Svenja Berthold, Stephan Stein, Lukas Müller, Holger Buggenhagen, Gerd Balser, Kay Stankov, M. Sgroi, G. Schmidmaier, Roman Kloeckner, Christian T Schamberger
Purpose Arthroscopy is one of the most common interventions in orthopedics. Hence it is important to train users early in order to ensure the safest possible identification of access portals (AP). This prospective study aimed to compare a palpatory (PalpMethod) with a sonographic (SonoMethod) method for AP location in the shoulder and knee joints. Materials and Methods The study included trainee doctors (n=68) attending workshops (lasting approx. 90 minutes). In these workshops a teaching video initially demonstrated the PalpMethod and SonoMethod of AP identification. An experienced operator first marked the access portals on the test subject with a UV pen (determined ideal point [DIP]). Adhesive film was then affixed to the puncture regions. Subsequently participants marked on shoulders and knees first the point determined by palpation, then the point determined by sonography. Analysis involved DIP visualization with a UV lamp and employed a coordinate system around the central DIP. In addition, participants completed an evaluation before and after the workshop. Results The analysis included 324 measurements (n=163 shoulders and n= 161 knees). The majority of participants had not previously attended any courses on manual examination (87.9%) or musculoskeletal ultrasound (93.9%). Overall, the markings participants made on the shoulder using the SonoMethod were significantly closer to the DIP than those made by the PalpMethod (Palp 18.8mm ± 14.5mm vs. Sono 11.2mm ± 7.2mm; p<0.001). On the knee, however, the markings made by the PalpMethod were significantly closer to the DIP overall (Palp 8.0mm ± 3.2mm vs. Sono 12.8mm ± 5.2mm; p<0.001). Conclusion The results show that the SonoMethod produces more accurate markings on the shoulder, while the PalpMethod is superior for the knee.
目的 关节镜手术是骨科最常见的介入手术之一。因此,必须尽早对使用者进行培训,以确保尽可能安全地识别入路(AP)。这项前瞻性研究旨在比较触诊法(PalpMethod)和超声波法(SonoMethod)在肩关节和膝关节中的 AP 定位方法。材料与方法 该研究包括参加讲习班(持续约 90 分钟)的见习医生(68 人)。在这些研讨会上,教学视频首先演示了PalpMethod和SonoMethod的AP识别方法。一名经验丰富的操作员首先用紫外线笔(确定的理想点 [DIP])在测试对象的通路端口上做标记。然后在穿刺区域粘贴胶膜。随后,受试者首先在肩部和膝盖上标记出通过触诊确定的点,然后再标记出通过超声波确定的点。分析涉及用紫外线灯观察 DIP,并采用围绕 DIP 中心的坐标系。此外,参加者还在研讨会前后完成了一项评估。结果 分析包括 324 次测量(肩关节 163 次,膝关节 161 次)。大多数学员以前未参加过任何徒手检查课程(87.9%)或肌肉骨骼超声课程(93.9%)。总体而言,参与者使用声纳法在肩部所做的标记明显比使用触觉法所做的标记更接近DIP(Palp 18.8mm ± 14.5mm vs. Sono 11.2mm ± 7.2mm; p<0.001)。然而,在膝关节上,PalpMethod 所做的标记总体上明显更接近 DIP(Palp 8.0mm ± 3.2mm vs. Sono 12.8mm ± 5.2mm;p<0.001)。结论 结果表明,SonoMethod 在肩部的标记更准确,而 PalpMethod 在膝部的标记更出色。
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引用次数: 0
Evidence-based Ultrasound Education? - A Systematic Literature Review of Undergraduate Ultrasound Training Studies. 循证超声教育?- 本科生超声培训研究的系统文献综述。
IF 1.3 Q3 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Pub Date : 2024-03-26 eCollection Date: 2024-01-01 DOI: 10.1055/a-2275-0702
Ricarda Neubauer, Claus Juergen Bauer, Christoph F Dietrich, Brigitte Strizek, Valentin Sebastian Schäfer, Florian Recker

Despite a large number of studies previously conducted on educational concepts of ultrasound teaching in medical school, various controversial issues remain. Currently, recommendations for ultrasound curricula that aim to standardize ultrasound teaching are frequently based on expert panel advice instead of relying on valid evidence-based literature. In December 2022, a systematic literature review on the subject of undergraduate ultrasound education was conducted. All ultrasound studies listed in the PubMed and Google Scholar medical databases were filtered and analyzed with respect to various aspects of their methodological conduct and curricular implementation. A total of 259 publications were considered in the data synthesis, including 145 teaching studies in the field of undergraduate ultrasound education. The latter encompassed 58 (40%) studies that did not compare their ultrasound training to a control group. Furthermore, 84 (58%) of these studies did not assess knowledge prior to the applied ultrasound training, neglecting this factor's potential influence on study outcomes. Despite a great interest in the development and further implementation of ultrasound education during medical school, this process is still compromised by significant deficiencies in studies that have been conducted in the past. In order to provide a valid basis for curricular decisions, teaching studies should fulfill essential methodological requirements despite the multifactorial framework in which they are conducted. In the future, a guide for the design of ultrasound studies could be a useful aid for ultrasound enthusiasts and promote scientific knowledge gain.

尽管此前对医学院超声教学的教育理念进行了大量研究,但仍存在各种争议问题。目前,旨在规范超声教学的超声课程建议往往是基于专家小组的建议,而不是基于有效的循证文献。2022 年 12 月,一项关于本科超声教学的系统性文献综述展开了研究。对PubMed和Google Scholar医学数据库中列出的所有超声研究进行了筛选,并对其方法论实施和课程实施的各个方面进行了分析。数据综合共考虑了 259 篇出版物,其中包括 145 篇本科生超声波教育领域的教学研究。后者包括 58 项(40%)没有将超声培训与对照组进行比较的研究。此外,这些研究中有 84 项(58%)没有对应用超声培训前的知识进行评估,忽略了这一因素对研究结果的潜在影响。尽管人们对医学院校超声波教育的发展和进一步实施抱有极大的兴趣,但由于过去开展的研究存在重大缺陷,这一过程仍受到影响。为了给课程决策提供有效依据,尽管教学研究是在多因素框架下进行的,但仍应满足基本的方法学要求。未来,超声研究的设计指南将成为超声爱好者的有益帮助,并促进科学知识的获取。
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引用次数: 0
Neurosonology Survey in Europe and Beyond. 欧洲及其他地区的神经生理学调查。
IF 3.2 Q2 Medicine Pub Date : 2024-02-23 eCollection Date: 2024-01-01 DOI: 10.1055/a-2243-9625
Claudio Baracchini, Elsa Azevedo, Uwe Walter, João Sargento-Freitas, Branko Malojcic

Purpose  To provide an overview on education, training, practice requirements, and fields of application of neurosonology in Europe and beyond. Materials and Methods  National representatives and experts in neurosonology were surveyed regarding neurosonology requirements and practice in their countries. Descriptive statistics were used to report the data. Results  Between February 1 and March 31, 2023, 42/46 (91.3%) national representatives responded to our questionnaire and the completion rate was 100%. Most countries (71.4%) offer a neurosonology training program during neurology residency, but it is part of the undergraduate medical program only in 30.9%. National certification is available in 47.6% of the countries surveyed and most countries (76.2%) require certification to practice. In 50% of the countries, candidates are assessed by a board examination, while in 26.2% they just need to document their practice. There is no formal accreditation of neurosonology centers in 78.6% of the countries surveyed. Only a few require certified personnel and appropriate equipment. Adequate teaching and research activities are only rarely necessary elements for laboratory accreditation. Conclusion  Our results indicate that there is a substantial need for transnational harmonization of neurosonological standards to guarantee uniformity and quality of performance. This survey will also provide guidance to promote an international accrediting council and create a quality-controlled laboratory network for implementing neurosonology in clinical trials.

目的 概述欧洲及其他地区神经电生理学的教育、培训、实践要求和应用领域。材料和方法 对各国神经电生理学的代表和专家进行了关于本国神经电生理学要求和实践的调查。数据报告采用描述性统计方法。结果 在 2023 年 2 月 1 日至 3 月 31 日期间,42/46(91.3%)个国家的代表回复了我们的问卷,完成率为 100%。大多数国家(71.4%)在神经病学住院医师培训期间提供神经电生理学培训课程,但只有 30.9% 的国家将其作为本科医学课程的一部分。在接受调查的国家中,47.6%的国家提供国家认证,大多数国家(76.2%)要求获得认证后才能执业。在 50% 的国家中,候选人要通过委员会考试进行评估,而在 26.2% 的国家中,他们只需提供执业证明文件即可。在接受调查的国家中,78.6%的国家没有对神经超声中心进行正式认证。只有少数国家要求有经过认证的人员和适当的设备。充足的教学和研究活动很少成为实验室认证的必要条件。结论 我们的调查结果表明,亟需跨国统一神经电生理标准,以保证工作的统一性和质量。这项调查还将为促进国际认证委员会的发展提供指导,并为在临床试验中实施神经电生理学建立一个质量受控的实验室网络。
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引用次数: 0
Esophageal Leiomyoma: Case Report. 食管子宫肌瘤:病例报告
IF 3.2 Q2 Medicine Pub Date : 2024-02-08 eCollection Date: 2024-01-01 DOI: 10.1055/a-2221-6110
Olga Kharlamova, Maksym Zhayvoronok
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引用次数: 0
Minimally Invasive Repositioning of a Frontal Sinus Anterior Wall Fracture Using Intraoperative Sonographic Guidance 利用术中超声引导微创复位额窦前壁骨折
IF 3.2 Q2 Medicine Pub Date : 2024-01-26 DOI: 10.1055/a-2223-5552
M. Rink, L. Symeou, Thomas Kühnel, C. Bohr, Julian Künzel
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引用次数: 0
Bedside Clinical Hand-held Ultrasound in an Internal Medicine Department: The "Bed Med-Us" Experience of Codogno and its Clinical Utility in the Management of Diagnosis and Therapy in 1007 Patients. 内科床旁临床手持超声波:Codogno 的 "Bed Med-Us "经验及其在 1007 名患者的诊断和治疗管理中的临床实用性。
IF 3.2 Q2 Medicine Pub Date : 2024-01-05 DOI: 10.1055/a-2196-1599
Francesco Giangregorio, Emilio Mosconi, Maria Grazia Debellis, Eliana Palermo, Stella Provini, Manuela Mendozza, Laura Ricevuti, Ciro Esposito

Purpose Handheld ultrasound (HH-US) answers simple clinical questions in emergencies. We performed conventional US with HH-US at the patient's bedside (BED) during a medical visit (MED) (BED MED-US). The purpose of this prospective study is to estimate BED MED-US reliability, its clinical impact in helping the clinician to formulate correct diagnoses, and its ability to save time and money. Materials and Methods 1007 patients (519 M; age:76.42) were assessed (from March 2021 to November 2022) in one or more districts. Final diagnosis was determined with clinical and reference tests (chest RX/CT, abdominal CT, endoscopy, etc.). Sensitivity, specificity, LR+ and LR-, and corresponding AUROC were evaluated. HH-US diagnoses were classified as: confirmation (HH-US revealed the sonographic signs that confirmed the clinical diagnosis) (CO), exclusion (HH-US excluded the presence of the ultrasound signs of other pathologies, in the clinical differential diagnosis) (EX), etiological (HH-US reaches diagnosis in clinically doubtful cases) (ET), or clinically relevant incidental (HH-US diagnoses that change the patient's process completely) (INC). Results HH-US reliability: true-pos: 752; true-neg: 242; false-pos: 7; false-neg: 6 (sens: 99.1%, spec: 97.6%, LR+: 98.5; LR-: 00.15, AUROC: 0.997); clinical impact: CO-diagnosis: 21%; EX: 25%; ET: 47%; INC: 7%; saved time and money: approximately 35,572 minutes of work and 9324 euros. Conclusion BED MED-US is a reliable clinical imaging system, with an important clinical impact both in diagnosis (etiological in 47%, incidental in 7%) and in the management of personnel resources.

目的 手持式超声波(HH-US)可解答急诊中的简单临床问题。我们在就诊期间(MED)在病人床边(BED)用 HH-US 进行了传统超声检查(BED MED-US)。这项前瞻性研究的目的是评估 BED MED-US 的可靠性、其在帮助临床医生做出正确诊断方面的临床效果以及其节省时间和金钱的能力。材料和方法 在一个或多个地区对 1007 名患者(519 名男性;年龄:76.42 岁)进行了评估(从 2021 年 3 月到 2022 年 11 月)。通过临床和参考检查(胸部 RX/CT、腹部 CT、内窥镜检查等)确定最终诊断。对敏感性、特异性、LR+ 和 LR- 以及相应的 AUROC 进行了评估。HH-US 诊断分为:确诊(HH-US 发现的超声波征象证实了临床诊断)(CO)、排除(HH-US 在临床鉴别诊断中排除了其他病变的超声波征象)(EX)、病因诊断(HH-US 在临床可疑病例中得出诊断)(ET)或临床相关附带诊断(HH-US 诊断完全改变了患者的病程)(INC)。结果 HH-US 可靠性:true-pos:真阳性:752 例;真阴性:242 例;假阳性:7 例;假阴性:6 例:7; false-neg: 6 (sens: 99.1%, spec: 97.6%, LR+: 98.5; LR-: 00.15, AUROC: 0.997);临床影响:临床影响:CO-诊断:21%;EX:25%;ET:47%;INC:7%;节省的时间和金钱:约 35,572 分钟的工作时间和 9324 欧元。结论 BED MED-US 是一种可靠的临床成像系统,在诊断(47% 为病因诊断,7% 为偶然诊断)和人力资源管理方面都具有重要的临床影响。
{"title":"Bedside Clinical Hand-held Ultrasound in an Internal Medicine Department: The \"Bed Med-Us\" Experience of Codogno and its Clinical Utility in the Management of Diagnosis and Therapy in 1007 Patients.","authors":"Francesco Giangregorio, Emilio Mosconi, Maria Grazia Debellis, Eliana Palermo, Stella Provini, Manuela Mendozza, Laura Ricevuti, Ciro Esposito","doi":"10.1055/a-2196-1599","DOIUrl":"https://doi.org/10.1055/a-2196-1599","url":null,"abstract":"<p><p><b>Purpose</b> Handheld ultrasound (HH-US) answers simple clinical questions in emergencies. We performed conventional US with HH-US at the patient's bedside (BED) during a medical visit (MED) (BED MED-US). The purpose of this prospective study is to estimate BED MED-US reliability, its clinical impact in helping the clinician to formulate correct diagnoses, and its ability to save time and money. <b>Materials and Methods</b> 1007 patients (519 M; age:76.42) were assessed (from March 2021 to November 2022) in one or more districts. Final diagnosis was determined with clinical and reference tests (chest RX/CT, abdominal CT, endoscopy, etc.). Sensitivity, specificity, LR+ and LR-, and corresponding AUROC were evaluated. HH-US diagnoses were classified as: confirmation (HH-US revealed the sonographic signs that confirmed the clinical diagnosis) (CO), exclusion (HH-US excluded the presence of the ultrasound signs of other pathologies, in the clinical differential diagnosis) (EX), etiological (HH-US reaches diagnosis in clinically doubtful cases) (ET), or clinically relevant incidental (HH-US diagnoses that change the patient's process completely) (INC). <b>Results</b> HH-US reliability: true-pos: 752; true-neg: 242; false-pos: 7; false-neg: 6 (sens: 99.1%, spec: 97.6%, LR+: 98.5; LR-: 00.15, AUROC: 0.997); clinical impact: CO-diagnosis: 21%; EX: 25%; ET: 47%; INC: 7%; saved time and money: approximately 35,572 minutes of work and 9324 euros. <b>Conclusion</b> BED MED-US is a reliable clinical imaging system, with an important clinical impact both in diagnosis (etiological in 47%, incidental in 7%) and in the management of personnel resources.</p>","PeriodicalId":44852,"journal":{"name":"Ultrasound International Open","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2024-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10829908/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139673248","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Persistent Funic Presentation And Sonographic Assesment Of The Risk For Umbilical Cord Prolapse. 脐带脱垂风险的持续绒毛表现和超声评估
IF 3.2 Q2 Medicine Pub Date : 2023-12-14 eCollection Date: 2023-01-01 DOI: 10.1055/a-2097-5143
Ioakeim Sapantzoglou, Alexandros Psarris, Panagiota Diamantopoulou, Antonis Koutras, Thomas Ntounis, Savia Pittokopitou, Ioannis Prokopakis, Panagiotis Antsaklis, Marianna Theodora, Michail Sindos, Ekaterini Domali, Alexandros Rodolakis, Georgios Daskalakis
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引用次数: 0
Structured Reporting of Head and Neck Sonography Achieves Substantial Interrater Reliability. 头颈部声像图的结构化报告实现了实质性的询问可靠性。
IF 3.2 Q2 Medicine Pub Date : 2023-10-05 eCollection Date: 2023-01-01 DOI: 10.1055/a-2173-3966
Benjamin Philipp Ernst, Carla Dörsching, Alessandro Bozzato, Jennis Gabrielpillai, Sven Becker, Matthias Frank Froelich, Benedikt Kramer, Christoph Sproll, Mirco Schapher, Miguel Goncalves, Naglaa Mansour, Benedikt Hofauer, Wieland H Sommer, Felix von Scotti, Johannes Matthias Weimer, Julian Künzel

Purpose Ultrasound examinations are often criticized for having higher examiner dependency compared to other imaging techniques. Compared to free-text reporting, structured reporting (SR) of head and neck sonography (HNS) achieves superior time efficiency as well as report quality. However, there are no findings concerning the influence of SR on the interrater reliability (IRR) of HNS. Materials and Methods Typical pathologies (n=4) in HNS were documented by video/images by two certified head and neck ultrasound instructors. Consequently, structured reports of these videos/images were created by n=9 senior physicians at departments of otolaryngology or maxillofacial surgery with DEGUM instructors on staff. Reports (n=36) were evaluated regarding overall completeness and IRR. Additionally, user satisfaction was assessed by a visual analog scale (VAS). Results SR yielded very high report completeness (91.8%) in all four cases with a substantial IRR (Fleiss' κ 0.73). Interrater agreement was high at 87.2% with very good user satisfaction (VAS 8.6). Conclusion SR has the potential to ensure high-quality examination reports with substantial comparability and very high user satisfaction. Furthermore, big data collection and analysis are facilitated by SR. Therefore, process quality, workflow, and scientific output are potentially enhanced by SR.

目的超声检查经常被批评为与其他成像技术相比具有更高的检查依赖性。与自由文本报告相比,头颈部超声(HNS)的结构化报告(SR)实现了卓越的时间效率和报告质量。然而,还没有发现SR对HNS的参与者间可靠性(IRR)的影响。材料和方法HNS的典型病理(n=4)由两名经认证的头颈部超声讲师通过视频/图像记录。因此,这些视频/图像的结构化报告是由耳鼻喉科或颌面外科的n=9名高级医生在DEGUM教员的指导下创建的。对报告(n=36)的总体完整性和内部收益率进行了评估。此外,用户满意度通过视觉模拟量表(VAS)进行评估。结果SR在所有四个病例中都产生了非常高的报告完整性(91.8%),具有显著的IRR(Fleiss'κ0.73)。询问者一致性高达87.2%,用户满意度非常好(VAS 8.6)。结论SR有可能确保高质量的检查报告,具有实质性的可比性和非常高的用户满意度。此外,SR有助于大数据的收集和分析。因此,SR有可能提高流程质量、工作流程和科学产出。
{"title":"Structured Reporting of Head and Neck Sonography Achieves Substantial Interrater Reliability.","authors":"Benjamin Philipp Ernst,&nbsp;Carla Dörsching,&nbsp;Alessandro Bozzato,&nbsp;Jennis Gabrielpillai,&nbsp;Sven Becker,&nbsp;Matthias Frank Froelich,&nbsp;Benedikt Kramer,&nbsp;Christoph Sproll,&nbsp;Mirco Schapher,&nbsp;Miguel Goncalves,&nbsp;Naglaa Mansour,&nbsp;Benedikt Hofauer,&nbsp;Wieland H Sommer,&nbsp;Felix von Scotti,&nbsp;Johannes Matthias Weimer,&nbsp;Julian Künzel","doi":"10.1055/a-2173-3966","DOIUrl":"10.1055/a-2173-3966","url":null,"abstract":"<p><p><b>Purpose</b> Ultrasound examinations are often criticized for having higher examiner dependency compared to other imaging techniques. Compared to free-text reporting, structured reporting (SR) of head and neck sonography (HNS) achieves superior time efficiency as well as report quality. However, there are no findings concerning the influence of SR on the interrater reliability (IRR) of HNS. <b>Materials and Methods</b> Typical pathologies (n=4) in HNS were documented by video/images by two certified head and neck ultrasound instructors. Consequently, structured reports of these videos/images were created by n=9 senior physicians at departments of otolaryngology or maxillofacial surgery with DEGUM instructors on staff. Reports (n=36) were evaluated regarding overall completeness and IRR. Additionally, user satisfaction was assessed by a visual analog scale (VAS). <b>Results</b> SR yielded very high report completeness (91.8%) in all four cases with a substantial IRR (Fleiss' κ 0.73). Interrater agreement was high at 87.2% with very good user satisfaction (VAS 8.6). <b>Conclusion</b> SR has the potential to ensure high-quality examination reports with substantial comparability and very high user satisfaction. Furthermore, big data collection and analysis are facilitated by SR. Therefore, process quality, workflow, and scientific output are potentially enhanced by SR.</p>","PeriodicalId":44852,"journal":{"name":"Ultrasound International Open","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2023-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/d4/e5/10-1055-a-2173-3966.PMC10556873.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41146766","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Caesarean Scar Pregnancy: Single Dose of Intrasac Ultrasound-Guided Methotrexate Injection Seems to be a Safe Option for Treatment. 剖腹产瘢痕妊娠:单剂量囊内超声引导甲氨蝶呤注射似乎是一种安全的治疗选择。
IF 1.3 Q3 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Pub Date : 2023-09-18 eCollection Date: 2023-01-01 DOI: 10.1055/a-2137-8318
Angeliki Rouvalis, Panagiotis Vlastarakos, Georgios Daskalakis, Abraham Pouliakis, Sofoklis Stavrou, Maria Tsiriva, Maria Giourga, Angeliki Gerede, Kalliopi Pappa, Themos Gregoriadis, Dimitrios-Efthymios Vlachos, Alexandros Rodolakis, Ekaterini Domali

Objective: The purpose of the study was to assess the efficacy of local ultrasound-guided methotrexate injection in patients with caesarean section scar pregnancy, to chart the course of beta-human chorionic gonadotropin levels (HCG) after treatment, and to see if HCG levels are correlated with clinical presentation.

Methods: Between May 2018 and January 2021, data were collected retrospectively from the Early Pregnancy Unit of a tertiary hospital.

Results: Our clinic assessed 20 patients; one disputed terminating the pregnancy and was not included in the research. The remaining 19 patients, with a median age of 34 years, received intragestational sac methotrexate injection under ultrasound guidance. 7w3d was the median gestational age. These women had one to four previous caesarean sections, with a mean of 1.60±9. Patients with caesarean scar pregnancy most typically presented with spotting (42.1%), whereas 26.3% were asymptomatic. Except in cases of pain, the symptomatic women's HCG levels were lower than in the non-symptomatic women. The level of HCG in patients with pain was approximately double that of non-pain patients (p=0.2557). In our series, intragestational sac methotrexate injection was effective in 17/19 women, or 89.5% (95%CI: 75.7-100%). HCG levels were undetectable in 97.6±30 days on average (minimum: 42 days, maximum: 147 days).

Conclusion: Caesarean scar pregnancy is a rare possibly fatal condition with no consensus on the optimal treatment. An experienced Early Pregnancy Unit member performing local methotrexate injections under ultrasound guidance is a feasible and successful strategy in clinically stable patients.

目的:本研究旨在评估局部超声引导下注射甲氨蝶呤治疗剖宫产瘢痕妊娠的疗效,绘制治疗后β-人绒毛膜促性腺激素水平(HCG)的变化过程,并观察HCG水平是否与临床表现相关。方法:在2018年5月至2021年1月期间,从一家三级医院的早孕病房回顾性收集数据。结果:我们的诊所评估了20名患者;其中一人对终止妊娠提出了质疑,并没有被纳入研究。其余19名患者,中位年龄34岁,在超声引导下接受孕囊内注射甲氨蝶呤。7w3d为中位胎龄。这些妇女之前有一到四次剖腹产,平均值为1.60±9。剖腹产瘢痕妊娠患者最常见的是斑点(42.1%),而26.3%的患者没有症状。除疼痛外,有症状的妇女的HCG水平低于无症状的妇女。疼痛患者的HCG水平大约是非疼痛患者的两倍(p=0.2557)。在我们的系列中,孕囊内注射甲氨蝶呤对17/19名女性有效,或89.5%(95%可信区间:75.7-100%)。HCG水平平均在97.6±30天(最小:42天,最大:147天)内检测不到。经验丰富的早孕科成员在超声指导下进行局部甲氨蝶呤注射是临床稳定患者可行且成功的策略。
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引用次数: 0
Evaluation of IOTA-ADNEX Model and Simple Rules for Identifying Adnexal Masses by Operators with Varying Levels of Expertise: A Single-Center Diagnostic Accuracy Study. 评估IOTA-ADNEX模型和简单规则识别附件肿块由操作员具有不同水平的专业知识:单中心诊断准确性研究。
IF 3.2 Q2 Medicine Pub Date : 2023-01-01 DOI: 10.1055/a-2044-2855
Maria Giourga, Abraham Pouliakis, Panagiotis Vlastarakos, Sofoklis Stavrou, Maria Tsiriva, Angeliki Gerede, Georgios Daskalakis, Charalampos Voros, Petros Drakakis, Ekaterini Domali

Objectives The discrimination of ovarian lesions presents a significant problem in everyday clinical practice with ultrasonography appearing to be the most effective diagnostic technique. The aim of our study was to externally evaluate the performance of different diagnostic models when applied by examiners with various levels of experience. Methods This was a diagnostic accuracy study including women who were admitted for adnexal masses, between July 2018 and April 2021, to a Greek tertiary oncology center. Preoperatively sonographic data were evaluated by an expert gynecologist, a 6 th and a 1 st year gynecology resident, who applied the International Ovarian Tumor Analysis (IOTA) Simple Rules (SR) and Assessment of Different NEoplasias in the adneXa (ADNEX) model to discriminate between benign and malignant ovarian tumors. The explant pathology report was used as the reference diagnosis. Kappa statistics were used for the investigation of the level of agreement between the examined systems and the raters. Results We included 66 women, 39 with benign and 27 with malignant ovarian tumors. ADNEX (with and without "CA-125") had high sensitivity (96-100%) when applied by all raters but a rather low specificity (36%) when applied by the 1st year resident. SR could not be applied in 6% to 17% of the cases. It had slightly lower sensitivity, higher specificity, and higher overall accuracy, especially when applied by the 1st year resident (61% vs. 92%), compared to ADNEX. Conclusion Both ADNEX and SR can be utilized for screening in non-oncology centers since they offer high sensitivity even when used by less experienced examiners. In the hands of inexperienced examiners, SR appears to be the best model for assessing ovarian lesions.

目的卵巢病变的鉴别是临床实践中的一个重要问题,超声检查是最有效的诊断方法。我们研究的目的是外部评估不同的诊断模型的性能时,审查员应用不同水平的经验。方法:这是一项诊断准确性研究,包括2018年7月至2021年4月期间因附件肿块入住希腊三级肿瘤中心的女性。术前超声资料由妇科专家、第6年和第1年妇科住院医师评估,他们应用国际卵巢肿瘤分析(IOTA)简单规则(SR)和不同肿瘤在adneXa (ADNEX)模型中的评估来区分卵巢良恶性肿瘤。外植体病理报告作为诊断参考。Kappa统计用于调查被检查系统和评分者之间的协议水平。结果66例女性,其中良性卵巢肿瘤39例,恶性卵巢肿瘤27例。ADNEX(带或不带CA-125)在所有评分者中均具有高灵敏度(96-100%),但在第一年住院医师中应用时特异性较低(36%)。6% ~ 17%的病例不能应用SR。与ADNEX相比,它的敏感性略低,特异性更高,总体准确性更高,特别是在第一年住院医生中应用时(61%对92%)。结论ADNEX和SR均可用于非肿瘤中心的筛查,因为即使由经验不足的检查人员使用,它们也具有较高的灵敏度。在没有经验的检查人员手中,SR似乎是评估卵巢病变的最佳模型。
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Ultrasound International Open
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