On April 18 the FDA released an alert regarding Other-Sonic Generic Ultrasound Transmission Gel, manufactured by Pharmaceutical Innovations Inc. The ultrasound gel was found to be contaminated with Pseudomonas aeruginosa and Klebsiella oxytoca.
U.S. Marshals, acting at the request of the Food and Drug Administration, have seized Other-Sonic Generic Ultrasound Transmission Gel located at Pharmaceutical Innovations Inc. in Newark, N.J., after an FDA analysis found that product samples contained dangerous bacteria. The seizure included all lots of the gel product manufactured between June 2011 and December 2011….The FDA received a report involving 16 surgical patients infected with Pseudomonas aeruginosa. The patients had transesophageal ultrasound procedures, while undergoing heart valve replacement, using Other-Sonic Generic Ultrasound Transmission Gel.
Yes, that first line said “U.S. Marshals.” The FDA does not mess around. So take a minute and check your gel! Maybe a good time to wipe the whole machine down while you are at it.
We are pleased to present our annual critical care ultrasound pre-conference course at the Clinical Decision Making in Emergency Medicine symposium in Ponte Vedra, Florida on Wednesday, June 20. Each year this intensive, hands on course features ultrasound faculty from across the country working in small groups with live models and plenty of hands-on scanning time.
Emergency physician, intensivist, and Mount Sinai Emergency Ultrasound Fellowship graduate Dr. Robert Arntfield is making news at his new home, London Health Sciences Center (LHSC) in Ontario, Canada. Dr. Arntfield and his department have set up a hardware and software infrastructure for bedside ultrasound which allows for electronic data storage and retrieval, robust QA, teaching and research.
LHSC’s website has this to say:
Dr. Rob Arntfield, an ED physician and intensivist at LHSC, recently completed a year-long fellowship at The Mount Sinai Hospital in New York, learning and integrating cutting edge point-of-care ultrasound applications into the care of the critically ill patient. Since his return to LHSC, Arntfield has been working with Dr. Drew Thompson, also an LHSC ED physician, to develop new quality assurance training standards to enhance residentsâ€™ knowledge and use of this important patient care technology
Although we tend to suspect torsion only in cases where there is ovarian enlargement, cyst, etc., there are a number of studies that show these are not reliable (sensitive or specific) indicators of torsion. Radiology reports often seem to hedge and note that ovarian torsion is a clinical diagnosis because the test characteristics of ultrasound are not that great even when you include flow, adnexal size, free fluid, and other factors in combination.
Children (<15 years old) are at greater risk of torsing normal ovaries (up to 50% of torsion cases), but even in women of childbearing age 8-19% of cases are associated with normal ovaries. Doppler flow has demonstrated great sensitivity and specificity for torsion by some authors but was much less valuable in this retrospective study.
In this recent study, abnormal ovarian location, abnormal flow and free fluid were the best predictors of torsion; ovarian mass or cyst actually didn’t help rule in or out the diagnosis.
Bottom line: normal ovaries do not rule out torsion. Doppler flow may not be sensitive or specific enough either. So use (dare we say it?) clinical judgement.