Both endoscopic ultrasonography （EUS）-guided choledochoduodenostomy （EUS-CDS） and EUSguidedhepaticogastrostomy （EUS-HGS） are relativelywell established as alternatives to percutaneoustranshepatic ...biliary drainage （PTBD）. Both EUSCDSand EUS-HGS have high technical and clinicalsuccess rates （more than 90%） in high-volume centers.Complications for both procedures remain high at10%-30%. Procedures performed by endoscopistswho have done fewer than 20 cases sometimes resultin severe or fatal complications. When learning EUSguidedbiliary drainage （EUS-BD）, we recommend amentor＇s supervision during at least the first 20 cases.For inoperable malignant lower biliary obstruction,a skillful endoscopist should perform EUS-BD beforeEUS-guided rendezvous technique （EUS-RV） andPTBD. We should be select EUS-BD for patientshaving altered anatomy from malignant tumors beforeballoon-enteroscope-assisted endoscopic retrogradecholangiopancreatography, EUS-RV, and PTBD. Ifboth EUS-CDS and EUS-HGS are available, we shouldselect EUS-CDS, according to published data. EUSBDwill potentially become a first-line biliary drainageprocedure in the near future.
This narrative review focuses on thoracic ultrasonography (lung and pleural) with the aim of outlining its utility for the critical care clinician. The article summarizes the applications of thoracic ...ultrasonography for the evaluation and management of pneumothorax, pleural effusion, acute dyspnea, pulmonary edema, pulmonary embolism, pneumonia, interstitial processes, and the patient on mechanical ventilatory support. Mastery of lung and pleural ultrasonography allows the intensivist to rapidly diagnose and guide the management of a wide variety of disease processes that are common features of critical illness. Its ease of use, rapidity, repeatability, and reliability make thoracic ultrasonography the “go to” modality for imaging the lung and pleura in an efficient, cost effective, and safe manner, such that it can largely replace chest imaging in critical care practice. It is best used in conjunction with other components of critical care ultrasonography to yield a comprehensive evaluation of the critically ill patient at point of care.
Objective
This study aimed to identify the sonographic features of pathologically confirmed onychopapilloma cases.
Methods
High‐frequency up to 24 MHz and ultra‐high frequency‐ultrasound up to 71 MHz ...examinations were performed and correlated with their clinical and pathologic presentations.
Results
Twenty‐two cases met the criteria. Clinical presentations revealed longitudinal erythronychia in 63.3% of cases. The ultrasound examinations identified a hypoechoic band in the nail bed (86.3%), nail plate abnormalities including upward displacement (68.2%) and thickening (68.1%), focal hyperechoic focal spots on the nail plate (50%) and irregularities of the ventral plate (33.3%).
Color Doppler imaging showed no hypervascularity of the nail bed in all studies. These findings correlate with histological characteristics of onychopapilloma, including nail bed acanthosis, papillomatosis, and layered hyperkeratosis. Recurrence occurred in two cases after surgery, with tumors showing proximal extension in the matrix region on ultrasound not evident during clinical examination.
Conclusion
High‐frequency and ultra‐high‐frequency can provide anatomical information in onychopapilloma that could enhance understanding and management.
In the last 30 years, the contrast-to-noise ratio (CNR) has been used to estimate the contrast and lesion detectability in ultrasound images. Recent studies have shown that the CNR cannot be used ...with modern beamformers, as dynamic range alterations can produce arbitrarily high CNR values with no real effect on the probability of lesion detection. We generalize the definition of CNR based on the overlap area between two probability density functions. This generalized CNR (gCNR) is robust against dynamic range alterations; it can be applied to all kind of images, units, or scales; it provides a quantitative measure for contrast; and it has a simple statistical interpretation, i.e., the success rate that can be expected from an ideal observer at the task of separating pixels. We test gCNR on several state-of-the-art imaging algorithms and, in addition, on a trivial compression of the dynamic range. We observe that CNR varies greatly between the state-of-the-art methods, with improvements larger than 100%. We observe that trivial compression leads to a CNR improvement of over 200%. The proposed index, however, yields the same value for compressed and uncompressed images. The tested methods showed mismatched performance in terms of lesion detectability, with variations in gCNR ranging from -0.08 to +0.29. This new metric fixes a methodological flaw in the way we study contrast and allows us to assess the relevance of new imaging algorithms.
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