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OBJECTIVE@#To investigate the value of real-time ultrasound guided placement of permanent internal jugular vein (IJV) catheterization in maintenance hemodialysis patients, and analyze its technical success and complication rate.@*METHODS@#We prospectively analyzed 63 patients (39 males, 24 females) who underwent permanent IJV cannulation with real-time ultrasound guidance from January to October in 2012. Under the real-time guidance of Logiq 5 color Doppler, we placed the tunneled cuffed catheters into the jugular vein by Seldinger technique. The number of needle punctures, technical success, the operation time, and complications were recorded. The patients were divided into a normal-risk group and a high-risk group: those who suffered multiple catheter insertions, previous difficulties during catheterization, poor compliance, obesity, impaired consciousness, skeletal deformity, disorder of haemostasis were regarded as high-risk patients.@*RESULTS@#Cannulation of IJV was done in all patients. Of the 63 catheters, 20 (31.7%) were placed in the high-risk patients; 60 (95.2%) were successfully placed at the first attempt, with the average number of punctures of (1.23±0.21) (range 1-3); Only 3 immediate complications (4.7%) developed; 3 (4.7%) catheter infections occurred in the course of using. Cannulation of IJV took longer time in the high-risk group than that in the normal-risk group [(30.6±0.11) min vs (19.1±0.09) min, P<0.05]. The number of needle punctures, percent of successful cannulation, and the frequency of immediate complications were similar in the high- and normal-risk groups. It was more likely to form catheter thrombosis during long-term use in the high-risk group (4/20, 20%) which might cause poor blood flow.@*CONCLUSION@#Permanent IJV cannulation under real-time ultrasound guidance is very safe with high success rates. Nephrologists can use this technique with ease and with minimal complications in both normal- and high-risk patients.
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Female , Humans , Male , Catheterization, Central Venous , Methods , Jugular Veins , Diagnostic Imaging , Prospective Studies , Renal Dialysis , UltrasonographyABSTRACT
Objective To investigate the clinical value and prenatal diagnosis feasibility of fetal aberrant right subclavian artery(ARSA) with fetal echocardiography.Methods The data of 39 fetuses with ARSA were retrospectively reviewed.The prenatal and postnatal medical records,including the presence of fetal abnormalities,cardiac defect,karyotype and the outcomes of each pregnancy were collected.Results The echocardiographic feature of ARSA was that an ARSA arises as a fourth branch of the arch,from the descending aorta behind the trachea,crosses the thorax between the trachea and the spine,to reach the right arm.The overall incidence of ARSA was 2.3 ％ (39/17 280),23 cases (59.0 ％) as an isolated malformation,16 cases (41.0％) combined with cardiac defect and extracardiac abnormalities,9 cases (23.1％) with chromosomal abnormalities.23 cases underwent termination of pregnancy,2 cases died in uterus and 14 cases were born live.Isolated ARSA group had lower incidence of chromosomal abnormalities (8.7％ vs 43.8 ％,P ＜ 0.05) and higher fetal survival rate (56.5％ vs 6.2％,P ＜0.05) than the combined detects group.Conclusions The fetus with ARSA complicated with aneuploid karyotype,cardiac defects and extracardiac anomalies are at hight risk of poor prognosis.
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Objective To discuss the clinical value of strain rate imaging in quantitatively evaluating segmental myocardial function of left ventricle in latent autoimmune diabetes in adult(LADA).Methods Thirty LADA without complication(LADA group),30 LADA patients with hypertension and normal geometric left ventricle(LADA+NLVH group)and 30 healthy people(control group)were enrolled.All patients had normal ejection fraction,normal fractional shortening and no cardiac symptoms.The strain rate in systolic,early and later diastolic periods were obtained from 3 consecutive heartbeats in 16 segments respectively.The parameters were quantitatively analyzed between the three groups.Results Compared with the control group,all of the measured parameter of LADA and LADA+NLVH were significantly lower(P＜0.05 or P＜0.01).Although the mean strain rate in early and later diastolic periods decreased significantly in LADA+NLVH group than in LADA group(P＜0.05),there was no significant difference in the mean systolic strain rate between the two groups (P＞0.05).Conclusions Strain rate imaging provides a sensitive and accurate tool to assess the left ventricular myocardial performance in patients with LADA.
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Objective To investigate the clinical significance of velocity vector imaging(VVI)in evaluating the left ventricular(LV)segmental longitudinal systolic function in patients with coronary artery disease(CAD).Methods In 25 patients with myocardial ischemia,28 patients with myocardial infarction,26 patients with coronary lumen stenosis＜50%,according to coronary arteriography and electrocardiogram,the myocardial segments of LV were divided into 4 groups:ischemic segments group,infarcted segments group,non-ischemic segments group and normal segments group.Twenty-eight healthy subjects were selected as control group.Dynamic imaging of all subjects were collected,the systolic peak strain(Smax)and strain rate(SRmax),the time to peak strain(PTs)and the time to peak strain rate(PTsr)were measured respectively.Results Smax and SRmax of the ischemic segments and infracted segments were significantly lower than those of the control group respectively,PTs and PTsr of the ischemic segments and infracted segments were significantly longer than those of the control group respectively.Smax and SRmax of infarcted segments were significantly lower than those of the ischemic segments,there were no differences of PTs and PTsr between ischemic segments and infracted segments.Smax and SRmax cutoff of -14.08%,-0.83 s-1 for detecting ischemic segments and cutoff of -6.65%,-0.38 s-1 for detecting infracted segments,respectively,gave an optimal sensitivity and specificity.Conclusions VVI is a kind of novel noninvasive-tool to quantitatively assess LV regional systolic function in CAD patients.It is competent to differentiate between the ischemic segments and infarcted segments.
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Objective To assess the characteristic of left ventricular(LV) twist changed from infancy to the elder,in order to determine the normal value of LV twist in different age group.Methods After acquired basal and apical LV short-axis images in 293 healthy volunteers (aged 15 days to 72 years) by 2-dimensional echocardiography, speckle tracking echocardiography was used to analysis LV twist motion offline.The peak apical rotation (PAr), peak basal rotation (PBr), peak LV twist (Ptw), peak LV twist normalized by LV length ( PtwN), peak untwisting velocity ( PutwV), isovolumic untwisting% ( Iutw% ) in different group were compared.Results Reliable LV twist measurements were obtained in 274 volunteers.Different LV twist values were noted according to age.Ptw increased gradually with advancing age, when normalized by LV length, PtwN showed higher values before 3 years old and 25 to 45 years old.PutwV increased with aging from infancy to 25 years old, and leveled off from 25 to 45 years old, then decreased with advancing age.Iutw% was lowest before 3 years old,and increased gradually from 25 to 45 years old,then decreased with aging.Conclusions speckle tracking echocardiography can be used to noninvasively and exactly assess LV twist with high feasibility.The effect of aging on LV twist may reflect the process of maturational and adaptive modulation of LV torsional biomechanics from infancy to the elder.
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Objective To evaluate the clinic value of five different ultrasonographic fetal parameters for prenatal diagnosis of pulmonary hypoplasia.Methods Two hundred and seventy-one normal singleton pregnancies with well-established dates between 20 and 40 weeks of gestation were studied to establish normal reference range of five different ultrasonographic fetal parameters.The five parameters,which could reflect fetal lung mass,were as follows:lung area/body weight ratio,lung area,thoracic circumference/abdominal circumference ratio,lung area/thoracic area ratio and lung area/head circumference.Thirty pregnancies with risk factors for pulmonary hyperplasia were studied for the usefulness of five parameters.Two or more standard deviations below the mean control group measurement were considered abnormal.The prenatal ultrasonic diagnoses of pulmonary hyperplasia were confirmed at neonatal follow-up examinations,on autopsy and by pathologic findings.Results Lung area and lung area/head circumference increased with gestational age,lung area/body weight ratio decreased with gestational age.The relationships among the two ratios(thoracic circumference/abdominal circumference ratio,lung area/thoracic area ratio)and gestational age were relatively constant. Abnormal lung area/body weight ratio had a higher diagnostic accuracy than other parameters.Sensitivity of the parameters,including lung area,lung area/body weight ratio,thoracic circumference/abdominal circumference ratio,lung area/thoracic area ratio and lung area/head circumference were 83%,97%,50%,70% and 87%,respectively.Sensitivity of the lung area/bedy weight ratio was 95%(20/21 fetuses);specificity,9/9 fetuses;positive predictive value,100% (20/20fetuses);negative predictive value,9/10;and accuracy 97% (29/30 fetuses).Conclusion Lung area/body weight ratio is a good predictor of pulmonary hypoplasia.