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willyskristina · 15 days ago

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Portable Ultrasound Market

Portable Ultrasound Market Size, Share, Trends: General Electric Company (GE Healthcare) Leads

Integration of Artificial Intelligence and Cloud-Based Solutions in Portable Ultrasound Devices

Market Overview:

The global portable ultrasound market is expected to develop at a CAGR of XX% between 2024 and 2031. The market will grow from USD XX billion in 2024 to USD YY billion by 2031. North America now dominates the market, accounting for the vast majority of worldwide sales. Key metrics include rising acceptance of point-of-care diagnostics, technological breakthroughs in portable ultrasound devices, and increased demand for low-cost imaging solutions.

The portable ultrasonography market is expanding rapidly, owing to an increased demand for quick and accurate diagnostic instruments in a variety of healthcare settings. Miniaturisation and image quality advancements are improving the capabilities of portable ultrasound devices, broadening their applications across numerous medical specialities.

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Market Trends:

The portable ultrasound industry is seeing a considerable increase in the integration of artificial intelligence (AI) and cloud-based technologies. These cutting-edge innovations expand the capabilities of portable ultrasound machines, improve image quality, and streamline operational operations. AI algorithms are being used to help with image interpretation, reduce operator dependency, and provide real-time coaching during exams. Deep learning systems, for example, can recognise and measure anatomical components automatically, thereby boosting diagnosis accuracy while reducing examination time. Cloud-based systems allow for remote storage, sharing, and analysis of ultrasound images, facilitating telemedicine applications and collaborative diagnosis. The growing desire for more efficient and reliable diagnostic tools in resource-constrained settings, as well as the necessity for seamless integration with hospital information systems, are driving this development. Major ultrasound manufacturers are making significant investments in AI and cloud technologies, resulting in a new generation of smart portable ultrasound devices with improved functionality and connection.

Market Segmentation:

The handheld ultrasound category has the highest market share in the portable ultrasound industry. These tiny devices enable unprecedented portability, allowing healthcare personnel to do ultrasound tests in a variety of situations, including emergency rooms and rural clinics. Handheld ultrasound devices have grown in popularity across a wide range of medical specialities due to their ease and versatility.

Recent developments in handheld ultrasound technology have strengthened its market dominance. For example, the emergence of wireless probes and smartphone-compatible ultrasound instruments have broadened the scope of mobile diagnostics. Research published in the Journal of the American College of Cardiology found that cardiologists' use of pocket-sized ultrasound equipment resulted in changes in patient management in 35% of cases, underscoring their clinical significance. Radiology is driving tremendous growth in the handheld ultrasound industry. The American College of Radiology reported that the use of handheld ultrasound equipment in radiology departments increased by 50% between 2019 and 2023. These devices are especially useful for bedside inspections, interventional treatments, and emergency situations where quick imaging is required.

Market Key Players:

General Electric Company (GE Healthcare)

Koninklijke Philips N.V.

Siemens Healthineers AG

Canon Medical Systems Corporation

Fujifilm Holdings Corporation

Samsung Electronics Co., Ltd. (Samsung Medison)

Name: Hari Krishna

Email us: [email protected]

Website: https://aurorawaveintellects.com/

#market growth #market insights #market trends

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myrawjcsmicasereports · 23 days ago

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Artificial intelligence based model for Automatic Real-Time and Non-Invasive Estimation of blood potassium level in pediatric patients by Hamid Mokhtari Torshizi1, Negar Omidi2 in Journal of Clinical Case Reports Medical Images and Health Sciences

1PhD student of Biomedical Engineering and Physics Department, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran 2Associate Professor of Cardiology, Department of Cardiology, School of Medicine, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran 3Rajaie Heart Center and Department of Pediatric Cardiology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran 4Digestive Disease Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran 5Associate professor, Department of Biomedical Engineering, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

*Corresponding author

Mohsen Ahmadi, MD , Associate professor, Department of Biomedical Engineering, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

DOI: 10.55920/JCRMHS.2023.05.001213

Abstract

Objective: During the last decade, heart disease has become the main cause of death worldwide. One of the main causes of mortality in pediatric patients, especially in the intensive care unit, is related to cardiac arrhythmia. An abnormal variation in blood electrolytes, such as potassium, contributes to mortality in pediatric patients. Continuous and real-time monitoring of potassium serum levels can prevent fatal arrhythmias but this is not currently practical. Our Real-Time and Non-Invasive ECG-related technique uses machine learning to estimate blood potassium with good accuracy.

Patients and Methods: Hospitalized patients in emergency department of the Rajai Cardiology and Medical Research Center and Tehran Heart Center were recruited from December 2021 to June 2022.The electrocardiographic(ECG) features of patients were evaluated. We defined 16 features for each signal and extracted them automatically. With the assistance of the correlation matrix, the dimension reduction operation was performed. Linear regression, polynomials, decision trees, random forests, and support vector machine(SVM) algorithms have been used to find the relationship between characteristics and serum potassium levels. Finally, we used a scatter plot and mean square error (MSE) to display the results.

Results: ECG of 428 patients was analyzed. Random Forest Regression algorithm has the best estimate with an MSE of 0.3.

Conclusion: Accurate estimation of serum potassium level based on ECG signals is possible. This can potentially be a useful tool in predicting serum potassium level in specific patients.

Keywords: Serum potassium level, Machine learning, Regression model, Non-Invasive Estimation

Introduction

As one of the main electrolytes, potassium plays an important role in cellular membrane potential variations, especially in the heart (1). Normal cardiac function depends on regular sequential cardiac myocyte depolarization and repolarization. Any disruption in this circle may lead to cardiac conduction disorders and severe arrhythmia. The manifestation of these changes in the ECG signal is usually related to potassium concentration measured as potassium blood level (2). Children with cardiac and kidney diseases are more susceptible to the effects of potassium changes (3). Factors such as acute systemic illness, injection of potassium for electrolyte balance, and drugs and medicine intake can cause acute changes in potassium blood levels.

It should be noted that 98% of K+ is intracellular (140 mEq/l), and 2% is extracellular (3.8 to 5.0 mEq/l) (4). Hypokalemia is the most common electrolyte imbalance in cardiac patients, delaying ventricular repolarization and downgrading conduction velocity, especially at the atrioventricular node. This can lead to various arrhythmias, such as sinus bradycardia and atrioventricular block (5, 6). Also, hypokalemia can increase atrial and ventricular ectopic pulses and enhance digoxin’s toxic effect (7).

Until today, K+ levels have been measured in blood serum or plasma (for example: (8-12)). Blood sampling in children is a harmful process especially when frequent sampling is required. In some ICU conditions this much blood sampling results in anemia or unwanted cyanosis or apnea in children with congenital heart diseases. Furthermore, this method is invasive, expensive, and requires blood samples and some time to get the test results. On the other hand, Serum K+ measurements require clotting before analysis. Therefore, an abnormal potassium level may be reported due to hemolysis which occurs if long waiting periods before the analysis takes place. This can yield miss corrected blood samples (13-15).

In the face of these challenges, we recently designed a method for serum potassium concentration quantification ([K+]) from ECG analysis. In the past, many studies have been done on the heart signal with the help of machine learning algorithms (for example: (16-21)). In this study, our [K+] estimator was validated and tested on a large group of patients. Potassium value extraction using a single lead would permit its use in wearable, wireless ECG patches and possibly in implantable loop recorders and cardiac implantable electronic devices (pacemakers and defibrillators)

Methods

The studied community

In Total 428 hospitalized patients in the Rajai Cardiology and Medical Research Center and Tehran Heart Center emergency department were recruited from December 2021 to June 2022. The electrocardiographic (ECG) features of patients were evaluated. The patient’s serum K level, ECG, and serum sample were taken within 2 hours of admission. Patients having a history of heart failure, end stage renal disease, bundle branch block, strain pattern in ECG, premature ventricular contraction, and digoxin use were excluded from the study. A specialist nurse took ECGs which were stored in files based on age and gender. Patients whose ECGs had noise or artifacts for any reason were excluded from the study too. Information about the eligible patients, including their basic demographic information, has been collected through interviews and questionnaires.

Feature Extraction

We recorded each patient’s heart signal over 2.8 seconds using a Saadat ECG machine (12 channels). To analyze the heart signals, the data was transferred from the device’s memory to an external memory. We then developed a program in Python language on the Windows platform that can extract the amplitude and time values of P, Q, R, S, and T (the sequence of steps is shown in Figure 1). In total, 16 features were calculated using these points.

RtoT variable was defined as: The difference between the amplitude of the T wave and R wave

Dimensional reduction

The cross-correlation matrix was used for dimensionality reduction. For every two signal features with a correlation greater than 0.7, one was removed .

Preprocessing

We used z-score standardization according to the following formula:

is a data point (x1, x2 … xn)

is the sample mean

S is the sample standard deviation

2-5 Regression

A Regression model is one of the most common types of supervised learning in Machine Learning. When evaluating the linear relationship between the ECG characteristics and potassium serum level, we used the Pearson Correlation Coefficient and evaluated the non-linear relationship using Decision Trees and Random Forest algorithms. Python version 3 was used for cardiac signal processing.

SVR, Decision Tree, Random Forest, Linear Regression, and Polynomial Regression algorithms were used to test the linear and non-linear relationship between characteristics and potassium serum level. Based on the results, the Random Forest algorithm has the best performance in this research.

Random Forest:

It is a group learning method that involves combining several trees. Each tree is trained, and several random features are sampled at each tree node. The average of the regression results from all the decision trees is assigned to the final decision.

Model Validation:

In this study, we used 20% of the population as a test sample. The estimated potassium level was calculated from the obtained ECG data using the corresponding patient-specific potassium prediction model developed during the training phase. To assess the accuracy, we calculated the mean absolute error, which is the mean absolute value of the difference between the estimated and measured potassium for each patient.

Results

Among the 463 patients who were admitted to the hospitals in 1 years, 35 patients were excluded from the study due to high noise and distortion of the heart signal. In our community, 56% were boys and 44% were girls. The potassium chart of these patients is shown in Figure 2. The results of the cross-correlation matrix of data .

Based on the information in Figure 3, we remove one of the two parameters that correlate more than 0.7. PR, Ps, PT, Twidth, QS, QR, QT, RS, RT, ST, and RtoT are variables that we use to teach regression methods. Table 1 shows the efficiency of each regression algorithm based on the MSE. As indicated in the table, the polynomial method has the lowest accuracy, and the random forest method has the highest measurement accuracy.

Considering that most of our studied patients have a potassium level between 4 and 4.5, we use the scatter diagram to get better feedback than regression methods. Figure 4, shows the scatter diagram for different approaches.

Another important goal of this study is to calculate the importance of each feature in determining the level of potassium. In Figure 5, the importance of each feature by the random forest algorithm is shown in percentage terms. Figure 6 shows how the decision tree algorithm yields decisions.

How to allocate blood serum potassium level based on the input characteristics in the decision tree algorithm

Discussion

Acute electrolyte disturbance especially hyperkalemia in pediatrics is life-threatening and requires prompt attention. As well as the correct determination of K level, the on-time result is also critical because many children with acute ill conditions need immediate medical attention. Blood sampling is a well-known reliable method for the evaluation of this electrolyte. Yet, evaluation of K level has always been desirable and attempts have been made for K level determination with high accuracy and sensitivity.

The effect of potassium on the ECG cardiac signal has been known for many years (22-24). So far, several studies, generally based on T-wave morphology, have been conducted to determine serum potassium levels (25-29). ECG markers, which are defined as a specific time interval or range of neural signals, are prone to noise (30). To solve this problem, many studies have investigated T wave morphology over a long period of time (31-33). Major challenges with these studies have been the definition of morphologies based on complex mathematical rules, the long time to calculate optimal parameters (several hours), and the low statistical population.

Another group of studies has investigated blood potassium based on ECG and using deep learning algorithms. In this class of studies, only hyperkalemia is detected at high potassium levels.

The purpose of this study is to design and validate an online and non-invasive potassium level extraction technique based on machine learning algorithm. We allocated 2.8 seconds to determine the serum level of potassium. This time interval ensures that several cardiac cycles are considered. Another strength of this study is the application of two stages of filtering to remove the effect of unwanted distortion on heart signal parameters. Therefore, if a part of the signal is distorted, the result of evaluating the potassium level is still reliable. Another advantage of this method is that only one lead is considered. This helps to commercialize the mentioned method and assess the potassium level remotely. Considering the high number of subjects in the studied population, it can be assumed that all T-wave morphologies were covered. We are developing our algorithm in such a way that we can analyze different types of ECG signals.

So far, attempts have been made to measure blood potassium levels using cardiac signals. Shakil Aslam and her colleagues conducted a study on 74 end-stage renal disease (ESRD) patients in 2002 (22). In their study, they tried to provide a linear relationship between T-wave amplitude or T-wave to R-wave ratio and the serum level of potassium in a patient's blood. In the same way that Szerlip et al. (34), could not provide a relationship between the T wave to R wave ratio and the level of serum potassium in the blood of individuals.

In 2018, with the introduction of two parameters, T-right slope, and T-amp, a group of researchers tried to discover the potassium serum level with ECG (35). By examining two parameters (T-amp and T-right slope) on five lead waveforms (V3, V4, V5, V6, and II), they found that T-wave-based features were not correlated with serum potassium level.

Omar Z. Yasin, MD, and her colleagues investigated the potassium serum level and heart signal of 21 dialysis patients (36). The average absolute error between estimated and blood potassium was 0.38- 0.32 mEq/L. The sample size of our study and the wide range of serum potassium levels are the strengths of our work compared to theirs.

John J. Dillon and his colleagues tried to quantify the amount of potassium using the cardiac signal and the serum level of potassium in the blood of 12 patients (29). They used the following variables for the regression operator in their work: The slope of the T wave down stroke (T right slope), the amplitude of the T wave (T amplitude), the center of gravity (COG) of the T wave (T COG), the ratio of the amplitude of the T wave to the amplitude of the R wave (T/R amplitude), and the center of gravity of the last 25% of the area under the T wave curve (T4 COG). However, they have recommended the use of the cardiac signal as a non-invasive method. Yet, due to the small sample size of their study, more research is required. In our study, we tried to overcome the weaknesses of previous studies by considering a large statistical population with a wide range of serum potassium levels, more features of the cardiac signal, and applying machine learning methods.

The high statistical community of this study has made it possible to examine all the clinical factors of the cardiac signal. Based on the results presented in Figures 5 and 6, the PT parameter is considered as the most important influencing factor in predicting the amount of potassium. This means that the combination of PQ, QRS, and ST intervals is influential. However, the second most important parameter in determining serum potassium levels is the difference in R and T wave amplitudes. This finding is similar to studies that have considered the slope of the T wave as an important parameter in the determination of serum potassium.

As shown in Figure 4, the linear and polynomial methods that were used in most studies do not have adequate predictive power. Although the Polynomial method has high accuracy in the training phase, it has the lowest accuracy in the test phase (Table 1). This is caused by the phenomenon of overfitting. The linear method also predicts all values in the range of 4 to 4.5 mmol. Although the decision tree method works well for wide potassium levels, it is not suitable for low potassium (under 4 mmol). Prediction of potassium level through the SVR method only works somewhat well in medium values. But the random forest method has solved the problem of the decision tree algorithm to a great extent, and has improved the detection of potassium in low amounts. Finally, it can be said that in this study, the random forest algorithm is more efficient than other algorithms.

Besides to potassium, other factors such as other electrolytes and the location of the leads affect the cardiac signal. Despite the presence of all the sources influencing the cardiac signal, we managed to calculate the serum potassium level with an average error of 0.3 in this study. Perhaps, in future studies, the effect of other electrolytes on ECG can be processed and by considering their effects on the cardiac signal, an increase in the accuracy of predicting blood potassium can be attained.

Conclusions

In conclusion, we defined a comprehensive noninvasive method for evaluating of k level in pediatrics based on ECG signal. This study may start a noninvasive portable method for the determination of K level by monitoring ECG signal results and fast measurement of k level changes in response to systemic conditions in acute ill adult and child groups.

#Serum potassium level #Machine learning #Regression model #Non-Invasive Estimation #Journal of Clinical Case Reports Medical Images and Health Sciences #jcrmhs

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literaturepublishers22 · 1 year ago

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Journal of Clinical Images

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Journal Homepage: https://www.literaturepublishers.org/

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Manuscript Submission

Authors may submit their manuscripts through the journal's online submission portal: https://www.literaturepublishers.org/submit.html

(or) Send an e-mail attachment to the Editorial Office E-mail Id: [email protected]

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literaturepublisher23 · 1 year ago

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Journal of Clinical and Medical Images

Journal of Clinical and Medical Images illustrations is a peer-reviewed, high impact factor medical journal established Internationally which provides a platform to publish Clinical Images, Clinical Case Reports, Medical Case Reports, Case Series (series of 2 to 6 cases) and Clinical Videos pertaining to medical conditions.

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drrichardzelman · 1 year ago

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Dr. Richard Zelman - A Luminary in Cardiology and Interventional Cardiology

Dr Richard Zelman, has indelibly left his mark on the world of cardiology and interventional cardiology. As a pioneering cardiologist, he has not only launched numerous cardiac programs in Massachusetts, but he has also successfully introduced life-saving procedures to community hospitals, transforming countless lives in the process.

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His remarkable achievements have their roots in an impressive educational background. He received his medical degree from the prestigious University of Texas Health Science Center. To further his expertise in cardiology, he completed his residency in internal medicine at the well-respected Boston Medical Center. These formative experiences laid the groundwork for his illustrious career, imbuing him with the medical acumen and refined skills that would define his extraordinary contributions to cardiology and interventional cardiology.

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Moreover, his work extends far beyond the confines of the operating room. He is known for his compassionate care, taking the time to explain complex procedures to his patients and their families in simple, understandable terms. He goes above and beyond to ensure his patients are educated about their health conditions and treatment options, fostering a relationship of trust and respect.

Dr Richard Zelman’s patient-centric approach to healthcare is a defining aspect of his praxis. He firmly believes in a comprehensive approach to patient care, one that extends beyond diagnosis and treatment. His practice philosophy is built on the foundation of empathy, respect, and a keen understanding of his patients' unique experiences. Open communication is a cornerstone of his approach, and he is known for his ability to explain complex medical concepts in ways that are easily understood by patients and their families. His compassionate demeanor helps to alleviate the anxiety often experienced by patients undergoing cardiovascular treatment, fostering a comforting environment of trust and mutual respect. This all-encompassing dedication to patient care not only improves outcomes but also bolsters patient satisfaction, further reinforcing his reputation as a remarkable presence in the field of cardiology.

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Dr Richard Zelman's contributions to cardiology are immense and far-reaching. His pioneering work in launching cardiac programs, conducting groundbreaking research, and implementing innovative cardiac procedures have made him a beacon in the field. His commitment to patient care, education, and research serves as a shining example for future generations of medical professionals.

#dr richard zelman

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literaturepublisher10 · 1 year ago

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Journal of Clinical and Medical Case Reports

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Authors are requested to submit their manuscript by using Online Manuscript Submission Portal:

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literaturepublishersjournal · 1 year ago

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Journal of Clinical Images

Journal of Clinical Images accepting articles in the form of clinical images, medical images, clinical images journal, medical images journal, clinical image journal submission. Journal of Clinical Images accepted by Clinical Images and Case Reports Journal with the aim of publishing the clinical images that are related to all the fields of Medicine. The purpose of this journal is to spread the knowledge of novel discoveries and interventions in various fields of science & medicine. The clinical images of fields like surgery, cardiology, dermatology, orthopaedics etc. are included in this journal.

Journal Homepage: https://www.literaturepublishers.org/

Manuscript Submission

Authors may submit their manuscripts through the journal's online submission portal: https://www.literaturepublishers.org/submit.html

(or) Send an e-mail attachment to the Editorial Office E-mail Id: [email protected]

#Journal of Clinical Images

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dhcovid19 · 1 year ago

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COVID & Cardiovascular Issues

2023-08-31 | UK scientists find link between proteins related to blood clots and long Covid | (Nature Medicine) 2023-08-21 | COVID-19 may trigger new-onset high blood pressure | (Hypertension) 2023-08-09 | Long Covid May Affect Organs Like The Heart And Kidneys After Lungs Recover, New Research Says | (Science Translational Medicine) 2023-04-26 | Study suggests mild COVID-19 can have harmful effects on cardiovascular health | (Journal of Clinical Medicine) 2023-04-19 | Severe COVID-19 infection can lead to life-threatening heart rhythm disorder; Here’s why | conference presentation 2023-03-20 | Ovarian Vein Thrombosis: A Sequela of COVID-Associated Coagulopathy | (Cureus) 2023-03-10 | How Does COVID-19 Affect the Heart? (Current Cardiology Reports) 2023-01-25 | Could getting Covid raise cholesterol? Two recent studies show a link between Covid and higher cholesterol levels in the following year | (The Lancet - Diabetes & Endocrinology & The Lancet - Infectious Diseases) 2022-10-26 | Even a mild case of COVID can put you at higher risk for blood clots and death, according to a new study | (Heart) 2022-10-24 | COVID-19 Surges Linked to Spike in Heart Attacks | (Journal of Medical Virology) --- Current Preprint Items https://www.biorxiv.org/content/10.1101/2023.08.14.553245v1

#covid-19 #cardiovascular

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casereportsjournal · 2 years ago

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Cardiovascular Journal accepting images in Cardiovascular Journal, imaging in Cardiovascular Journal, case reports in Cardiovascular Journal, videos in Cardiovascular Journal, research articles in Cardiovascular Journal accepting Cardiovascular case reports for publication.

#Cardiovascular Journal #Cardiology Journal #Journal of Cardiology #Clinical Cardiology Case Reports Journal #Case Reports in Clinical Cardiology Journal #Clinical Cardiology Journal

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cambridgepublishers · 2 years ago

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#Cardiovascular Journal #Cardiology Journal #Journal of Cardiology #Clinical Cardiology Case Reports Journal #Case Reports in Clinical Cardiology Journal #Clinical Cardiology Journal

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cambridge-publishers · 1 year ago

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Open-Access Journal of Heart Case Reports

The journal is committed to providing a platform for disseminating vital research findings and case reports concerning various cardiac conditions and their management strategies. With its rigorous peer-review process, the journal ensures that only high-quality studies are published, contributing significantly to advancing knowledge and understanding in the field. Moreover, being an open-access publication, it enables healthcare professionals across the globe to access and benefit from this valuable information without any financial barriers.

The Peer-Reviewed Journal of Heart Case Reports is a prestigious medical publication that focuses on showcasing and analyzing unique cases related to heart conditions. It provides valuable insights into rare or challenging cases, highlighting clinical approaches, new treatments, and potential research avenues.

Open-Access Journal of Heart Case Reports

The Open-Access Journal of Heart Case Reports is a prestigious publication that focuses on advancing the field of cardiology and providing valuable insights into heart-related medical conditions. With its commitment to open access, this journal ensures that its high-quality content is accessible to researchers, practitioners, and other stakeholders worldwide.

The journal publishes a wide range of case reports detailing exceptional clinical cases, novel diagnostic approaches, innovative treatment strategies, or unique surgical techniques related to cardiovascular diseases. These case reports are rigorously reviewed by experts in the field, guaranteeing the accuracy and credibility of the information presented. By disseminating detailed and well-documented case studies, the Open-Access Journal of Heart Case Reports empowers healthcare professionals with vital knowledge that can help improve patient care outcomes. This journal plays a crucial role in bridging gaps in research by facilitating the exchange of ideas among cardiologists and fostering collaboration between various healthcare institutions globally.

The journal focuses on publishing case reports related to various heart conditions, providing valuable insights into rare or unique cases, diagnostic approaches, treatment strategies, and patient outcomes. The journal aims to contribute to the improvement of cardiac care and patient outcomes worldwide.

The collaboration with Cambridge City Publishers further adds credibility and trustworthiness to the journal's content. Ultimately, the Journal of Heart Case Reports serves as an invaluable resource for cardiologists, researchers, and medical practitioners seeking evidence-based insights into complex cardiovascular conditions.

Manuscript Submission

Authors are requested Journal of Heart Case Reports to submit their manuscript by using Online Manuscript Submission Portal: https://www.cardiologycasereportsjournal.org/journal/Heart-Journal:-Case-Reports.html

(or) also invited to submit through the Journal E-mail Id: [email protected]

#JournalofHeartCaseReports #HeartCaseReportsJournal

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jcrmhscasereports · 2 years ago

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Massive volume overload with severe pulmonary edema during hysteroscopy: a case report by F.Fiedler in Journal of Clinical Case Reports Medical Images and Health Sciences

INTRODUCTION

One of the most serious problems of therapeutic hysteroscopic procedures nowadays depending on a distending media in use, remains a fluid overload with concomitant electrolyte imbalance. This rare but very life threatening condition remains of great concern and requires interdisciplinary management from experts of different fields such as anesthesiology, intensive care, cardiology and nephrology.

The irrigating media plays an essential role during hysteroscopic operations because it distends a uterine cavity and so provides a necessary visibility. There are gasous and liquid types of media. The Carbon dioxide is obsolete because it provides insufficient visibility and can lead to severe complications such as embolism or systemic accumulation due to its high solubility.

The liquid ones vary according to their osmolality, viscosity and electrolyte content, respectively an overload can cause different kinds of pathological settings.

Depending on the type of current (monopolar vs. bipolar) the irriganting fluid may or may not content electrolytes. The electrolyte-free, low-viscosity fluids, such as Mannitol/ Sorbitol mixture, Glycin 1,5%, Glucose 5%, Sorbitol 3% are standard media in monopolar surgery. The excessive absorption can lead to a hypoosmolal hyperhydratation (also known as transurethral resection syndrome of prostate in urology patients) resulting in severe overload and dilutional hyponatriaemia, which can be a cause of different neurological clinical sequelae such as grand-mal-seizures and cerebral edema up to a brainstem herniation.

The isotonic solutions such as NaCl 0,9% or Ringer-Lactat on the other hand, are golden standard in bipolar hysteroscopic procedures and its systemic absorption can cause an isoosmolal hyperhydratation associated with hyperchloremic acidosis and pulmonary edema up to acute respiratory distress syndrome.

In this case report we will describe a particular clinical setting of excessive fluid overload with severe pulmonary edema in a 38-years-old female after a hysteroscopy and resectoscopy.

PATIENT’S MEDICAL HISTORY

38-years-old black woman, 55kg, presented herself for a hypermenorrhea caused by multiple submucous and intramural myomas. Due to longlasting, intense bleedings she developed iron-deficiency-anemia with hemoglobin level of 8,8g/dl. The anemia has been treated with iron infusions, vitamin-B12 and folic acid. However she was well adapted and didn’t show tachycardia or any kind of anemia- related symptoms.

Further on she suffered from infertility most likely caused by Uterus myomatosus, which had been previously treated by hysteroscopic and laparoscopic myomectomy.

Further preoperative assessment revealed an occasional smoker but otherwise healthy patient and routine laboratory analysis were unremarkable except for earlier mentioned anemia. The previous general anaesthesias were uneventful and she was classified as ASA II- patient. The premedication consisted of 7,5mg Midazolam p.o.

THE PROCEDURE AND INTRAOPERATIVE SETTING

After the general anesthesia has been inducted, consisting of 200mg Propofol, 0,2mg Fentanyl and 6mg Cisatracurium, patient was intubated uneventfully. A single-shot-antibiotic with 2g Cefazolin was administered before surgical start. Further anaesthesia was maintained with Sevoflurane (endexpiratory concentration 1,2 vol%) during low-flow-volume-controlled-ventilation.

The hysteroscopy was performed with a physiological saline solution as a distending medium administered by Karl Storz Hamou Endomat pump in hysteroscopy modul within preselected pressure- (max.150mmHg) and flow- range (max.400ml/min). The resectoscope had an active suction channel and myomectomy was facilitated with bipolar current.

After a resection time of 35 minutes the operating procedure became complicated due to big intracavitary myomas, consequently a larger amount of distending media was required to keep the visibility during the hysteroscopy. The efflux of the irrigating fluid wasn’t monitored because of the high amount lost in the sterile drapes.

In the meantime the patient developed mild tachycardia with descrete ST-depressions, that disappeared after deepening the anaesthesia. Further on she developed high respiratory pressures and the accurate examination of the patient lying in Trendelenburg position and in a dark operating theatre revealed swollen face that was missinterpreted as Quincke-edema and immediately treated with 4mg Dimetinden, 50mg Ranitidin and 500mg Prednisone.

The immediate termination of the procedure revealed a general swelling of a patient especially in abdominal and facial region. The uterus perforation was denied by the gynaecologist but due to threatening abdominal compartment syndrome an urgent laparoscopy was preformed, which revealed 2,5l of intraabdominal fluid. At that point the gynaecologist declared 9l deficit between the in- and outflow of the irrigating fluid.

Meanwhile the ventilation was severly impeded by massive pulmonary edema and 1,5l clear fluid was suctioned from the endotrachal tube. The oxygen saturation dropped to 53% and the inspiratory peak pressure reached up to 60 mmHg. The diuresis was stimulated by 80mg furosemid.

Under full mechanical ventilation support with high positive endexpiratory pressure and analgosedation we transferred the patient to the ICU.

ICU-MANAGEMENT

By the admission to the ICU the arterial blood gas analysis revealed

pH 6,95

pO2 92,2 mmHg

pCO2 58 mmHg

SO2 87%

HCO3 12,7 mmHg

BE -17,8 mmHg

Hb 6,5 g/dl

K+ 2,9mmol/l

Na+ 142 mmol/l

Lactat acid 4,27 mmol/l

The combined (hyperchloremic and respiratory) acidosis reached it’s peak later, when HCO3 dropped to 6,9 mmHg and was treated aggressively by 200mg HCO3 8,4%. The potassium substitution was administered via central venous line.

Noradrenaline was used to stabilize the circulation and the volume therapy was monitored with invasive hemodynamic monitoring (PICCOR), which revealed hypovolemia (GEDI 444 ml/m2) and pulmonary edema (ELWI 13 ml/kg) despite sufficient systemic vascular resistance (SVRI 3949 dyn*s*cm-5*m2) and good pump function (Cardiac Index 3,34 l/min/m2).

The 30,6 C° body temperature was treated with an active warming system for the next 18h until the normal temperature was reached.

The intraabdominal pressure was measured by bladder pressure monitoring (14 mmHg).

The oxygenation increased with forced diuresis and positive endexpiratory pressure ventilation (12 cmH2O).

Figure 1: Chest X-ray reveals pulmonary edema after ICU admission

After 24h of fully controlled mechanical ventilation and 6800ml of diuresis the sedation medication was terminated and the patient extubated uneventfully. No further ventilation support or vasoactive medication was required. The patient recovered in the matter of 72 hours and was discharged from the hospital on the day 7 with a mild arterial hypertension, that was treated by Hydrochlorthiazide 25mg a day.

DISCUSSION

The isoosmolar hyperhydratation due to massive absorption of irrigating fluid, also known as Operative Hysteroscopy Intravascular Absorption Syndrome (OHIA) is a life threatening complication of the bipolar resectoscopic procedures.

There are three different manners the distending fluid can be absorbed:

the fluid instillation in peritoneal cavity via fallopian tubes causing a high amount of free abdominal fluid, which can lead up to an abdominal compartment syndrome

the absorption via endo- and myometrium causing a massive subcutan fluid overload

the intravascular absorption due to exceed of the venous vascular pressure of endometrium by an irrigating fluid pressure causing expansion of plasma volume and consequently intravascular fluid overload.

This case report shows a massive absorption of distending fluid mostly throughout the endometrium causing generalized and later on pulmonary edema and throughout fallopian tubes causing acute abdomen. The delayed diagnosis of this complication was due to unreported imbalance between the irrigating fluid instilled (12 litres) and the volume recovered (3 litres) from the patient. Other conditions that impeded the early diagnosis were darkened operating theatre because of the hysteroscopy and Trendelenburg position of the patient, fully covered in warm sheets in order to prevent hypothermia.

The threatening abdominal compartment was promptly treated by an urgent laparoscopy and the patient responded very well to a complex symptom-orientated intensive care therapy. A mild arterial hypertension is a residual symptom of a massive NaCl-absorption and respectively delayed sodium and water excretion and is expected to disappear within days.

The top priority is the prevention of the excessive absorption and once this complication occurred, its rapid, correct diagnosis as well as early-goal-therapy is essential. The fundamental knowledge of different distending media and its possible complications must be considered by the gynecologist and anesthesiologist. Once the distending medium has been determined, certain strategy must be applied in order to avoid the massive fluid overload. The exact amount of administered and removed irrigating fluid must be accurately monitored, which can be impeded be different factors such as spilling the media on the floor or in sterile sheets, not exact amount of media in the bag (varies up to 5%), difficult estimation of not-used fluid in the bag. The irrigation pressure limit should be lower then the mean arterial pressure whenever possible and complicated operative procedures that take longer time such as myomectomy require splitting in two sessions.

As soon as the difference of instilled and recovered amount reaches the limit, that should be set a priori or a patient starts showing symptoms, the measurement of electrolytes, osmolality and arterial blood gasses should be preformed and the procedure terminated as soon as possible.

For more information: https://jmedcasereportsimages.org/about-us/

For more submission : https://jmedcasereportsimages.org/

#hysteroscopic #therapeutic #electrolyte imbalance #Carbon dioxide #monopolar vs. bipolar #urology #hypoosmolal #hyperchloremic #myomatosus #occasional #Hamou Endomat #F.Fiedler #jcrmhs

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libramonthlyhoroscope1 · 2 years ago

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Dream with a broken heart

Dreaming with a broken heart: the importance of Takotsubo cardiomyopathy as a perioperative etiology of anesthetic-related cardiopulmonary dysfunction.

Medical literature often refers to rare disorders as zebras , but in the recent paper by Varutti et al.regarding a rare etiology of perioperative hemodynamic dysfunction, the disease name, Takotsubo, is translated from the Japanese as “Octopus Trap”. This maritime nomenclature is not due to the disease’s rare incidence within perioperative settings, but is a description of the shape the heart conforms to, with resulting cardiopulmonary instability. Not only is the inclusion of Takotsubo cardiomyopathy within the anesthesiologists’ differential diagnosis important, but also the addition of a novel potential etiology for this disease represents an important contribution to the medical literature.

Dream with a broken heart

Maintaining an extensive differential diagnosis list is even more important when the patient presenting with symptoms is considered low-risk by history, but is scheduled to undergo a non-cardiac procedure. The determination as to the risk profile of a patient for perioperative cardiac events during scheduled noncardiac surgery can be made using the guidelines published by the Journal of The American College of Cardiology, with the most recent update having been published in December 2014. Given the preoperative history and test results of the patient described in the current report, the anesthesiologist who referred to the guidelines would have had decreased suspicion for the eventual postoperative course of this patient.

The postoperative course observed in the setting of ECG changes and increased plasma levels of troponin I point to a potential acute coronary syndrome. Takotsubo cardiomyopathy has been estimated to represent 1–2% of patients with suspected acute coronary syndrome in the cardiology literature. The most common symptom is chest pain, observed in 70–90% of patients, with dyspnea and pulmonary edema seen less commonly . Stress, whether psychological or emotional, typically occurs in conjunction with the symptoms, leading to the alternative description of the disease as “broken-heart syndrome”. Other potential etiologies have focused on sudden and massive catecholamine release leading to coronary artery spasm, tachycardia, ST segment depression and hypertension (the “catecholamine heart” syndrome).

While many potential pathophysiological mechanisms have been described, no definitive pathophysiological mechanism has yet been determined. Proposed mechanisms include multi-vessel epicardial coronary spasm, coronary endothelial dysfunction, catecholamine cardiotoxicity, and neurogenic stunned myocardium. The lack of definitive mechanism combined with masquerading symptoms can make the diagnosis within the perioperative period challenging. Perioperative Takotsubo cardiomyopathy has been described in the preoperative, intraoperative, and postoperative periods, associated with both emotional and iatrogenic catecholamine surges with surgery or the anticipation thereof.

The excellence and clinical utility of this case report stem from several facets of the presentation. The entire arc of the patient’s course, ranging from hemodynamic stability intraoperatively to deterioration postoperatively, is presented with completeness and attention to detail. A thorough overview of the diagnostic and treatment methodologies in the literature are described. In this report, the authors describe a favorable approach to clinical management – stabilization of cardiopulmonary status followed by immediate interrogation via cardiac echocardiography and coronary angiography, which has been described as the “best single tool” for diagnosis of Takotsubo cardiomyopathy. The proposed triggering mechanisms of intraoperative fluid overload and hypertensive crisis are novel within the literature. Alternative explanations, such as the effect of pneumoperitoneum on blood catecholamine levels, are presented for the reader’s consideration.

In conclusion, the report meets one of the seminal criteria proposed in a recent Anesthesia & Analgesia editorial by Hessel and London as to what is needed in the medical literature to help answer unresolved questions regarding rare case reports: the manuscript proposes a previously undescribed potential etiology of this rare, yet well-established perioperative syndrome.

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literaturepublisher23 · 1 year ago

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Journal of Clinical Images

Clinical Image Journal: Journal of Clinical Images accepting articles in the form of images, image case, clinical images journal, image of journal, clinical image illustrations journal, clinical research image journal, clinical research imaging journal etc. Journal paves a great platform to access the recent developments of the clinical and medical world and is employed for publishing the varied case reports & clinical images that pertains to many clinical and medical conditions. Clinical Image Journal: Journal of Clinical Images is an international peer reviewed open access journal focused on publishing the most complete, reliable source of research information, current developments, and clinically interesting, trainees and researchers in all surgical subspecialties, as well as clinicians in related fields. Clinical Image Journal: Journal of Clinical Images is internationally peer reviewed and provides major understanding of diagnosis of many diseases, their management and their therapeutic strategies that aims in improving health outcomes globally. Case reports and clinical images are required altogether areas of medicine and involves research using the human volunteers who are intended to contribute to the clinical and medical knowledge.

Journal Homepage: https://www.literaturepublishers.org/

Manuscript Submission

Authors are requested to submit their manuscript by using Online Manuscript Submission Portal:

(or) also invited to submit through the Journal E-mail Id: [email protected]

The mission of Clinical Image Journal: Journal of Clinical Images is to publish, in a timely manner, the very best clinical research around the world with special attention to the impact of medical imaging on patient care. Clinical Image Journal: Journal of Clinical Images publications cover all imaging modalities, radiology issues related to patients, policy and practice improvements, and clinically-oriented imaging physics and informatics. Clinical Image Journal: Journal of Clinical Images is a valuable resource for practicing radiologists, radiologists-in-training and other clinicians with an interest in imaging.

Papers are carefully peer-reviewed and selected by our experienced subject editors who are leading experts spanning the range of imaging sub-specialties, which include: Body Imaging- Breast Imaging- Cardiothoracic Imaging- Imaging Physics and Informatics- Molecular Imaging and Nuclear Medicine- Musculoskeletal and Emergency Imaging- Neuroradiology- Practice, Policy & Education- Pediatric Imaging- Vascular and Interventional Radiology.

Clinical Image Journal: Journal of Clinical Images Scope Case reports / Clinical Images can be prospective or retrospective and examine the effects of an intervention in more than one patient. All case reports and clinical Images submitted need to comply with the relevant reporting criteria. It is dedicated to publishing Medical Case Reports, Clinical Images, Case Series and Clinical Videos. The following classifications and topics related to it will be considered for publication in the Journal but not limited to the following fields.

Neurology Image Journal, Oncology Image Journal, Dentistry Image Journal, Surgery Image Journal, Cardiology Image Journal, Nutrition and Dietetics Image Journal, Ophthalmology Image Journal, Gastroenterology Image Journal, Internal Medicine Image Journal, Nephrology Image Journal, Palliative Care Image Journal, Physiotherapy Image Journal, Radiation Oncology Image Journal, Sleep Disorders Image Journal & Sleep Studies Image Journal, Anesthesiology Image Journal, Emergency Medicine Image Journal and Critical, Forensic Image Journal and Legal Medicine Image Journal, Infectious Disease Image Journal, Infertility Case reports, Neurological Surgery Image Journal, Obstetrics Image Journal and Gynecology Image Journal, Otolaryngology Image Journal, Pharmacology Image Journal and Therapeutics Image Journal, Physical Medicine Image Journal & Rehabilitation Image Journal, Radiology Image Journal, Dermatology Image Journal, Endocrinology Image Journal, Diabetes Image Journal & Metabolism Image Journal, Orthopedics Image Journal & Rheumatology Image Journal, Pathology- Anatomic & Clinical Image Journal, Pulmonary Image Journal Disease, Preventive Medicine Image Journal, Respiratory Medicine Image Journal, Urology Image Journal, Oral Medicine Image Journal, ENT Image Journal, Geriatric Medicine Image Journal, Maxillofacial Surgery Image Journal, Neonatology Image Journal, Nuclear Medicine Image Journal, Pain Management Image Journal, Pediatrics Image Journal, Psychiatry Image Journal, Sexual Health Image Journal, Vascular Medicine Image Journal, Family Medicine Image Journal and Public Health Image Journal, Allergy Image Journal & Immunology Image Journal, Diabetology Image Journal, Hematology Image Journal.

#Journal of Clinical Images #health #news #publisher

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