Sunday, September 7, 2014

Thyroid Ultrasound: Always A Great Option

I do a lot of thyroid U/S.  Many people have thyroid issues.  The go to the doctor because of malaise, or feeling tired.  Perhaps they go to the doctor for a check up and the physician feels a lump in the neck.  Many people blame obesity on a thyroid condition.  I will stay away from that.  I do believe that Fine Needle Aspiration with U/S guidance is a great tool in dealing with thyroid conditions.  Personally, if a nodule is heterogeneous, non-compressible, and icky looking, it needs a FNA.  I had a patient last week who tested positive by ultrasound.  She has follicular cancer.  She will be OK  We caught it in time I hope.  Look at the above picture and remember this is a picture of a nasty cancer.

In the retrospective review, researchers evaluated data of 465 patients with differentiated thyroid cancer (DTC) who underwent surgery at Memorial Sloan Kettering Cancer Center between January 2009 and December 2010. Fifty percent of participants underwent preoperative ultrasound of cervical neck lymph nodes, and 231 were not imaged preoperatively with ultrasound. The median follow-up was 29 months. 

 http://www.healio.com/endocrinology/thyroid/news/online/%7Bb4868556-14b2-4e31-a48a-38169b9ce1f4%7D/preoperative-neck-ultrasound-led-to-better-response-fewer-recurrences-among-dtc-patients

Surgeons View Using HF Ultrasound To Detect Lung Cancer In The Chest Wall

It seems that something new and wonderful happens everyday.  This article I will post a link to is great news on the inventiveness of medical professionals all over the world.  We in the ultrasound community have known that high frequency, high definition medical ultrasound can create great pictures, and inspire inventive solutions to medical dilemmas.  In the case of cancer, it is a wonderful area of research, and development we are doing.  Lung cancer is one of the most nasty and prevalent cancers in the world.  Enjoy reading the link.

http://www.unboundmedicine.com/medline/citation/25038014/Preoperative_Assessment_of_Chest_Wall_Invasion_in_Non_Small_Cell_Lung_Cancer_Using_Surgeon_Performed_Ultrasound_


Preoperative Assessment of Chest Wall Invasion in Non-Small Cell Lung Cancer Using Surgeon-Performed Ultrasound.

Abstract

BACKGROUND
Chest wall invasion in operable lung cancer upgrades the stage and can affect operative planning. Diagnosing chest wall invasion preoperatively is important in patient consent, in the choice of operative incision placement, and can be helpful in choosing an operative approach (open vs thoracoscopic). The objectives of this study were to determine the diagnostic accuracy of preoperative, surgeon-performed ultrasound (US) in assessing tumoral chest wall invasion (T3) in non-small cell lung cancer (NSCLC) patients and to compare its accuracy vs preoperative computed tomography (CT).

Sunday, July 20, 2014

OP ED Number 2

Yes, this is my second OP ED, aside from a recipe post.  I have much to celebrate.  One:  My son will be back in the USA from a missionary trip to Guatemala this afternoon (Yes he is a legal United States Resident).  They helped rebuild some community facilities in a small village there.  I will post the GO-PRO videos on my FB page. The image to the left is a picture of a volcanic lake in Guatemala called Atilan.  I went on a mission with a church 7 years ago to provide medical support there.  I taught a nurse and a physician to do limited and focused sonograms on the village people to triage them and get them to a hospital.  The living conditions are rather horrid by western standards.  The people there are chipper though, always with a grin, and a nice word.  They make do with little to nothing.  I brought an old GE ultrasound machine and taught these wonderful people how to use it for things like ectopic pregnancies, and acute abdominal pains, trauma etc.  It is not like these people here have a med-evac system.  To get to a proper hospital can take hours in a car or truck.  The trip was a great experience for me, and my son is now queuing up at the airport to come home.  This is his third journey.  My wife went on the first.  You can say we are all Guatemalan pros.  Trevor, My Son, I am PROUD.

Second:  I am working at a small hospital, and giving lectures on the side.  I cannot wait to visit the town of Kerrville, TX to present some education to the wonderful sonographers there at a specific large hospital!

 Of note: I have a student where I work.  She is doing very well with the limited education she got at a for profit fly-by-night ultrasound school in Houston.  On Wednesday of last week we had an educational meeting where I outlined what to do when she encounters a ruptured ectopic pregnancy.  Lord Have Mercy!  She was on call that very night and had a bleeder.  The abdominal cavity was filled with blood.  They did a great job and took her by air ambulance to a large hospital, and saved her life.  My sonographer student NAILED the diagnosis.  We are having a party for Logan on Monday morning.  A success like this defines both a teachers role, and a willingness of a student to learn, and act.  Logan, I am PROUD!

Sincerely, TJW

Visual Sound

Here is a great link to a visual way of understanding sound.  Sound is, in fact, a mechanical longitudinal wave of energy.
We sonographers take for granted that the transducer we place upon the patient is doing "something", but many of us do not understand the physical principles involved.  I will post a link to give us all a visual reference to what happens when a sound is created.  Enjoy.
Thanks Fluke Corp, and Nag on the Lake, and Gerard.



Saturday, July 5, 2014

Fatty Liver

Contrary to most people perceptions, liver failure is due to eating the wrong stuff, and not working out.  Walking, running, and getting out to have fun  America is a sloth society. Our ancestors would wake at 4 AM, and milk the cows, and tend to strenuous activities.  They worked off the calories we people take for granted.  Many Americans get up in the morning and eat like our ancestors did, get in a car, and go to work to stare at a computer.  They take a break to smoke out side the 15 foot radius imposed by liberal nicotine Nazis.  They drink coffee from machines with jail-house coffee blends.  They buy a coke from the machine.  (1.25 US).

Many Americans eat at work.  They call out for FAST FOOD.  I am guilty.  I work my buns off, and when I am hungry I will eat any thing.  But I work.
Our kids are not mowing yards anymore.  The Illegals are doing that.  Our kids are sloths eating Capn crunch, and other crap.

We are seeing many kids with high blood pressure, and obesity because of a poor diet.  Liver failure is a horrid end to our children's lives.  Please.  Feed our kids something other than KFC. Our kids Are obese and very lazy.  This was a Public Service Announcement paid for by my 44 year old parrot.  Be well, and love your relatives.http://www.cdc.gov/healthyyouth/obesity/facts.htm

  • Childhood obesity has more than doubled in children and quadrupled in adolescents in the past 30 years.1, 2
  • The percentage of children aged 6–11 years in the United States who were obese increased from 7% in 1980 to nearly 18% in 2012. Similarly, the percentage of adolescents aged 12–19 years who were obese increased from 5% to nearly 21% over the same period.1, 2
  • In 2012, more than one third of children and adolescents were overweight or obese.1

Thanks CDC


A New Way To Monitor Patients With End Stage Liver Disease

This is not a subject I like to talk about.  End stage liver disease.  These patients are very ill, and not happy.  Sonographers deal with many issues but a large part of our job is the hepato-biliary system.  How many times have I been called in for a RUQ sonogram?  In many cases, the cause of discomfort is gallstones, or choleycystitis. In many cases it is liver failure.
Cholecystitis (Greek, -cholecyst, "gallbladder", combined with the suffix -itis, "inflammation") is inflammation of thegallbladder, which occurs most commonly due to obstruction of the cystic duct with gallstones (cholelithiasis). Blockage of the cystic duct with gallstones causes accumulation of bile in the gallbladder and increased pressure within the gallbladder. Concentrated bile, pressure, and sometimes bacterial infection irritate and damage the gallbladder wall, causing inflammation and swelling of the gallbladder. Inflammation and swelling of the gallbladder can reduce normal blood flow to areas of the gallbladder, which can lead to cell death due to insufficient oxygen. Not everyone who has gallstones will go on to develop cholecystitis.

http://en.wikipedia.org/wiki/Cholecystitis

Many sonographers have night mares about being called in for gall bladder attacks.  The surgeon does nothing  till 4 PM the next day. He asks the ED doctor to admit the patient. I must come out at 3 AM to evaluate a sick person with abdominal pain. Gosh I hate those late night calls when nothing is done!
  Here is something we sonographers want to look at.  Though many of us are beyond endoscopic ultrasound, it is a great read.  The link is pretty much technical, but interesting if you are into ways to look at the nasty way liver failure can take you down.  Portal hypertension is what most educated sonographers are aware of.  We can measure the diameter of the main portal vein on a sonogram.  A diameter of over 1.7 cm indicates portal pressure is elevated.  Most liver disease is caused by fatty liver disease, a subject for another post.  Here is a link to portal measurements by ultrasound.

http://www.ajronline.org/doi/pdf/10.2214/ajr.139.3.497


Now to the post. Looks like doctors can measure the restive index in esophageal varacies using ultrasound. Great.  Read the link.  TW

In patients with cirrhosis, esophageal varices are commonly observed, with an estimated prevalence of 50%[1]. After esophageal varices have formed, the annual risk for bleeding can range from 10% to 30%[2,3]. In patients with decompensated cirrhosis, acute esophageal variceal bleeding (EVB) represents a predominant cause for morbidity and mortality. Due to the increased risk of fatality in cirrhotic patients with EVB, the risk status in patients must be routinely evaluated such that the appropriate prophylactic therapy is administered to prevent variceal bleeding events.

http://www.wjgnet.com/1007-9327/full/v20/i22/6989.htm

Tuesday, June 24, 2014

Ultrasound Opens Blood Brain Barrier

The brain has been traditionally a difficult part of the body to treat disease because of a barrier that prevents, viruses, bacteria, and many medications from entering, and treating diseased parts of the brain.  This has been frustrating for ages.  Tumors, and diseases such as Alzheimer's have hidden behind this barrier since our origins.  The brain Has this "Great wall of China" as a protective measure because the neural tissue has little room for defense mechanisms within the "Keep".  This is why we have a fortified wall tho keep invaders out.  Now Ultrasound allows medicine to breach certain soncated areas of brain tissue to allow medications to enter into the brain tissue itself.  Trials are under-way to see if this is a safe and effective way of allowing medications to treat brain disease.  This is certainly a great leap in terms of treating brain lesion, and may open up other doors in many areas.  Here is an article from Sonoworld to explain the science:

KULLERVO HYNYNEN is preparing to cross neuroscience's final frontier. In July he will work with a team of doctors in the first attempt to open the blood-brain barrier in humans – the protective layer around blood vessels that shields our most precious organ against threats from the outside world.
If successful, the method would be a huge step in the treatment of pernicious brain diseases such as cancer, Parkinson's and Alzheimer's, by allowing drugs to pass into the brain.
The blood-brain barrier (BBB) keeps toxins in the bloodstream away from the brain. It consists of a tightly packed layer of endothelial cells that wrap around every blood vessel throughout the brain. It prevents viruses, bacteria and any other toxins passing into the brain, while simultaneously ushering in vital molecules such as glucose via specialised transport mechanisms.

Thanks Sonoworld and New Scientist!