Alterations in deglutition in children with congenital Zika virus syndrome / Alterações na deglutição em crianças com síndrome congênita do vírus Zika

ABSTRACT Purpose To characterize swallowing in children with congenital Zika virus syndrome in comparison to typical children. Methods This cross-sectional study enrolled 45 children diagnosed with congenital Zika virus syndrome and 45 others with typical development. Swallowing was evaluated through clinical feeding evaluations Protocolo de Avaliação Clínica da Disfagia Pediátrica and using acoustic swallowing parameters (Doppler sonar). Results The mean age of children with congenital Zika virus syndrome was 26.69 ± 4.46 months and the mean head circumference was 29.20 ± 1.98 cm. Moderate/severe oropharyngeal dysphagia was found in 32(71.1%) of the children with congenital Zika virus syndrome. Significant differences were found between the groups on clinical evaluation: Children with congenital Zika virus syndrome presented insufficient lip closure 42(93.3%) and altered tonus of the tongue 35(77.8%) and cheeks 34(75.6%). In the children in the comparison group, only 6(13.3%) presented insufficient lip closure and 1(2.2%) had inadequate tongue posture. Changes during swallowing with liquid and spoonable food were not observed in the comparison group. When liquid/food was offered, affected children presented difficulties in sipping movements 14(77.8%) and lip/spoon contact 35(75%). The presence of residual food in the oral cavity after swallowing 38(86.4%) and clinical signs indicative of laryngotracheal penetration/aspiration, such as coughing, gagging and/or labored breathing, were also notable. No differences were found between the groups with regard to the acoustic parameters evaluated instrumentally. Conclusion Children with congenital Zika virus syndrome present alterations in the oral phase of swallowing, as well as clinical signs indicative of pharyngeal phase impairment.

RESUMO Objetivo Caracterizar a deglutição das crianças com síndrome congênita do Zika vírus e comparar com crianças típicas. Método Estudo de delineamento transversal, com 45 crianças diagnosticadas com síndrome congênita do Zika vírus e 45 típicas. A deglutição foi avaliada por meio de avaliações clínicas da alimentação através do Protocolo de Avaliação Clínica da Disfagia Pediátrica e dos parâmetros acústicos da deglutição (sonar Doppler). Resultados A idade média das crianças com síndrome congênita do vírus Zika foi de 26,69 ± 4,46 meses e o perímetro cefálico médio foi de 29,20 ± 1,98 cm. Disfagia orofaríngea de moderada a grave foi observada em 32(71,1%) das crianças com síndrome congênita do Zika vírus, ao contrário do grupo comparação que não revelou alterações na deglutição. Nas crianças com síndrome congênita do Zika vírus foram verificados lábios entreabertos 42(93,3%) e tônus alterado em língua 35(77,8%) e bochechas 34(75,6%). Nas crianças do grupo comparação apenas 6(13,3%) apresentaram fechamento labial insuficiente e 1(2,2%) postura de língua inadequada. Alterações durante a deglutição com líquido e alimento pastoso não foram observadas no grupo comparação. Durante a oferta do alimento ocorreram dificuldades no movimento de sorver 14(77,8%), na captação da colher 35(75%), resíduo em cavidade oral 38(86,4%) e sinais clínicos indicativos de penetração/aspiração laringotraqueal como tosse, engasgo e respiração com esforço. Não foram encontradas diferenças nos parâmetros acústicos da avaliação instrumental. Conclusão as crianças com síndrome congênita do Zika vírus têm alterações nas fases oral e faríngea da deglutição, com sinais clínicos indicativos de penetração/aspiração laringotraqueal quando comparadas a crianças típicas.

Characterization of the normal fetal circulatory system of the ductus venosus using sound complexity parameters

The aim of this study was to characterize the normality of the fetal circulatory system through the time between ventricular systoles of the ductus venosus in the three gestational trimesters in healthy fetuses using nonlinear methods of the complexity of the signal. A prospective cohort study was conducted at the Instituto de Medicina Integral Prof. Fernando Figueira (IMIP) from December 2019 to May 2020. Pregnant women between 11 and 14 weeks, with intrauterine pregnancy and healthy fetus were included. Patients with multiple gestation, positive screening for congenital malformation, including heart disease, and under 18 years of age were excluded. Doppler velocimetry ultrasonography of the ductus venosus was performed between the 11th and 14th weeks, 20th and 24th weeks, and 28th and 32nd weeks of gestation, and then the sound signal was extracted and segmented from the videos. To compare the means between the gestational trimesters of the approximate entropy (ApEn) and Lempel-Ziv complexity (CLZ) of the time between ventricular systoles, the Friedman test was used, with a significance level of 5%. No statistically significant difference was found between the 1st, 2nd, and 3rd trimesters regarding the mean ApEn (P=0.281) and CLZ (P=0.595) of the time between ventricular systoles of the ductus venosus. Ductus venosus systolic time was not sensitive to differentiate fetal cardiovascular dynamics between gestational trimesters. This study pioneered the characterization of cardiovascular normality by nonlinear parameters of the fetal ductus venosus in all three trimesters.

Evidencias del Ácido Acetilsalicílico (Aspirina) en la prevención de la preeclampsia: revisión narrativa

Objetivo . Describir los métodos usados para predecir preeclampsia y cómo prevenirla usando ácido acetilsalicílico (aspirina) a dosis bajas de acuerdo con las recomendaciones de las principales organizaciones de ginecología y obstetricia. Metodología . Se realizaron búsquedas en PubMed y Cochrane Library desde el 1 de enero de 2020 al 1 de mayo de 2022, con los términos "pre-eclampsia", "trastornos hipertensivos en el embarazo" e "hipertensión y embarazo". Nos enfocamos en los análisis y recomendaciones de las más reconocidas organizaciones internacionales de ginecología y obstetricia, independiente del idioma original. Resultados . Para la predicción de preeclampsia se usan dos estrategias que pretenden encontrar la población con más riesgo basada en: 1) hallazgos clínicos de riesgo por condiciones antes del embarazo o propias del embarazo, y 2) un algoritmo de múltiples factores que incluye hallazgos clínicos, presión arterial, biomarcador y Doppler de arteria uterina. Usando ambas estrategias se encuentra efectividad variable de la aspirina en prevenir la preeclampsia. Se considera las dosis más efectivas entre 50 y 150 mg, siendo 81 mg la más recomendada en la actualidad. La dosis de 150 mg por día ha mostrado efectividad en la preeclampsia lejos del término; sin embargo, se considera que tiene más efectos secundarios. Conclusiones . Las más prestigiosas y reconocidas organizaciones de ginecología y obstetricia y de salud recomiendan aspirina a dosis bajas para prevenir la preeclampsia, preferiblemente al iniciar el segundo trimestre de gestación y mantenerla hasta las 36 a 37 semanas.

Objective: To describe the methods used to predict preeclampsia and how to prevent it using low-dose acetylsalicylic acid (aspirin) according to the recommendations of the main obstetrics and gynecology organizations. Methodology: We searched PubMed and Cochrane Library from January 1, 2020, to May 1, 2022, using the terms "pre-eclampsia", "hypertensive disorders in pregnancy" and "hypertension and pregnancy". We focused on the analyses and recommendations from the most recognized international obstetrics and gynecology organizations, independent of the original language. Results: For the prediction of preeclampsia, two strategies are used that aim to find the population at highest risk based on: 1) clinical findings of risk for pre-pregnancy or pregnancy conditions, and 2) a multi-factor algorithm that includes clinical findings, blood pressure, biomarker and uterine artery Doppler. Using both strategies, variable effectiveness of aspirin in preventing preeclampsia is found. The most effective dose range between 50-150 mg, with 81 mg being the most recommended at present. The dose of 150 mg per day has shown effectiveness in preeclampsia far from term; however, it is considered to have more side effects. Conclusions: The most prestigious and recognized obstetrics and gynecology and health organizations recommend low-dose aspirin to prevent preeclampsia, preferably at the beginning of the second trimester of pregnancy and maintained until 36-37 weeks.

Acoustic analysis of swallowing sounds in tracheostomized patients affected by traumatic brain injury / Análise acústica de sons da deglutição em pacientes traqueostomizados acometidos por traumatismo cranioencefálico

ABSTRACT Purpose: to demonstrate the feasibility of using the acoustic analysis of swallowing sounds as a combined method in the clinical assessment of tracheostomized patients affected by traumatic brain injury. Methods: an observational, cross-sectional study. A total of 10 adult patients, in the mean age of 43.6 years, participated. They were hospitalized in wards, semi-intensive, or intensive care units, from May to July 2016. The inclusion criterion involved being affected by traumatic brain injury, confirmed with a CT scan. The Speech Therapy Tracheal Decannulation Protocol was used in the clinical assessment, as well as the cervical auscultation with the Doppler sonar. Fisher's test was used, resulting in no significant relationship (p > 0.05) between the variables analyzed in the two consistencies and decannulation. Results: the presence of an acoustic signal of laryngeal elevation was observed, as well as noise between the swallowings, and acoustic signal suggestive of residue in 50% of the patients for the consistencies tested. When the peak frequency, mean wave time, presence of residue in between swallowings, and acoustic signal suggestive of residues were correlated with decannulation (Table 5), no significant correlation was verified (p > 0.05) between the variables analyzed in the two consistencies and the decannulation. Conclusion: the study suggests that it is feasible to use the Doppler sonar as a combined method in the clinical assessment of dysphagia for the decannulation of patients affected by traumatic brain injury.

RESUMO Objetivo: demonstrar a viabilidade do uso da análise acústica dos sons da deglutição como método conjugado à avaliação clínica em pacientes traqueostomizados acometidos por traumatismo cranioencefálico. Métodos: estudo observacional do tipo transversal. Participaram deste estudo 10 pacientes adultos, com idade média de 43,6 anos internados em leito hospitalar, unidades de terapias intensivas ou semi-intensivas, no período de maio a julho de 2016. O critério para inclusão foi ser acometido por traumatismo cranioencefálico, confirmado por tomografia axial computadorizada. Foi aplicado o Protocolo Fonoaudiológico de Decanulação Traqueal para a avaliação clínica e a ausculta cervical por meio do Sonar Doppler. Foi aplicado o Test Fischer e não foi encontrada relação significante (p>0,05), entre as variáveis analisadas nas duas consistências e na decanulação. Resultados: foi observada a presença de sinal acústico de elevação laríngea, presença de ruído entre as deglutições, presença de sinal acústico sugestivo de resíduo em 50% dos pacientes, para as consistências testadas. Quando correlacionados a relação entre frequência de pico, tempo médio da onda, presença de resíduo entre as deglutições, sinal acústico sugestivo de resíduos e decanulação (Tabela 5), verificou-se que não existe correlação significante (p>0,05) entre as variáveis analisadas nas duas consistências e a decanulação. Conclusão: o estudo sugere que o uso do Sonar Doppler é viável como método conjugado na avaliação clínica das disfagias para a decanulação de pacientes acometidos por traumatismo cranioencefálico.

Utilidad de la monitorización de los colgajos microquirúrgicos / Utility of monitoring microvascular flaps

Objetivo: Evaluar el uso de una sonda Doppler para verificar la permeabilidad y el flujo de la anastomosis en colgajos microquirúrgicos. Material y método: Serie descriptiva prospectiva de los pacientes en los cuales se realizó reconstrucción con colgajo microquirúrgico en la Clínica Alemana entre marzo de 2013 y marzo de 2015, en los cuales se utilizó un monitor Doppler arterial postanastomótico (Coock® Swartz Doppler probe). Resultados: Se registraron 20 pacientes con colgajos microquirúrgicos. Se realizaron 10 colgajos antebraquiales, 7 fíbulas (4 con testigo cutáneo y 3 sin), 2 anterolaterales de muslo y uno recto abdominal. Se realizaron 6 reexploraciones en pabellón. En un caso hubo sospecha tanto clínica como por el cambio en la señal del Doppler; en 4 solo sospecha clínica, y en uno solo por cambio en la señal Doppler. Los hallazgos fueron edema del colgajo en un paciente y 5 hematomas. No hubo pérdida de colgajos. Se utilizó el monitor Doppler por un promedio de 9,5 días. Conclusión: Este método de evaluación no reemplaza a la observación cínica, pero representa una herramienta más para la toma de decisiones en el postoperatorio de este tipo de reconstrucciones en cabeza y cuello.

Aim: To evaluate Doppler probe to assure the flow through the anastomoses at free flaps used in head and neck surgery. Material and method: Descriptive prospective series, of every patient that receive a free flap reconstruction at Clinica Alemana between March 2013 and March 2015, in which a Doppler monitor (Coock® Swartz Doppler probe) on the arterial anastomoses was used. Results: 20 patients with free flaps were recorded. 10 radial flaps, 7 fibulas (4 with a skin paddle and 3 without), 2 antero lateral thigh flaps and 1 abdominis rectus flap. 6 reexplorations were done. In one case the suspicion was clinical, with change in the Doppler signal, 4 patients just clinical suspicion and 1 just because a change in the Doppler signal. The findings were flap edema in 1 patient and 5 hematomas. We didn’t loss any flap. The Doppler monitor was used for an average of 9.5 days. Conclusion: The Doppler monitor doesn’t replace the clinical observation but represents another tool for the decision making during the post operative period in this kind of head and neck reconstructions.

The evaluation of swallowing in patients with spinocerebellar ataxia and oropharyngeal dysphagia: A comparison study of videofluoroscopic and sonar doppler

Introduction: Spinocerebellar ataxia (SCA) is a degenerative disease that can cause loss of coordination of voluntary muscle movement such as that required for swallowing. Aims: The purposes of this cross-sectional and comparative case study were: (1) to assess the severity of dysphagia through a videofluoroscopic swallow study, and (2) to compare differences in frequency, intensity, and duration of sound waves produced during swallowing in normal and SCA patients by using sonar Doppler. Method: During swallow evaluation using videofluoroscopy, a sonar Doppler transducer was placed on the right side of the neck, at the lateral edge of the trachea, just below the cricoid cartilage to capture the sounds of swallowing in 30 SCA patients and 30 controls. Result: The prevalence in the dynamic evaluation of swallowing videofluoroscopy was by changes in the oral phase of swallowing. The analysis of variance of the averages found in each variable - frequency, intensity and duration of swallowing - shows there was a significant correlation when compared to the healthy individual curve. Conclusion: The study demonstrates the prevalence of oral dysphagia observed in dynamic videofluoroscopic swallow evaluation. In patients with SCA, the mean initial frequency (IF), initial intensity (II), and final intensity (FI) were higher and the time (T) and peak frequency (PF) were lower, demonstrating a pattern of cricopharyngeal opening very close to that found in normal populations...

Characterization of Swallowing Sounds with the Use of Sonar Doppler in Full-Term and Preterm Newborns

Technological advances have provided a large variety of instruments to view the swallowing event, aiding in the evaluation, diagnosis, and monitoring of disturbances. These advances include electromyography of the surface, dynamic video fluoroscopy, and most recently sonar Doppler. Objective  To characterize swallowing sounds in typical children through the use of sonar Doppler. Method: Thirty newborns participated in this prospective study. All newborns received breast milk through either their mother's breasts or bottles during data collection. The newborns were placed in either right lateral or left lateral positions when given breast milk through their mother's breasts and in a sitting position when given a bottle. There were five variables measured: initial frequency of sound wave (FoI), frequency of the first peak of the sound wave (FoP1), frequency of the second peak of the sound wave (FoP2), initial intensity and final sound wave (II and IF), and swallowing length (T), the time elapsed from the beginning until the end of the analyzed acoustic signal measured by the audio signal, in seconds. Results: The values obtained in the initial frequency of the babies had a mean of 850 Hz. In terms of frequency of first peak, only three presented with a subtle peak, which was due to the elevated larynx position. Conclusion: The use of sonar Doppler as a complementary exam for clinical evaluations is of upmost importance because it is nonintrusive and painless, and it is not necessary to place patients in a special room or expose them to radiation...

Avaliação da função endotelial em pacientes com esclerose sistêmica limitada por meio do eco Doppler da artéria braquial / Evaluation of endothelial function in patients with limited systemic sclerosis by use of brachial artery Doppler ultrasound

OBJETIVO: O objetivo deste estudo foi comparar a resposta dilatadora dependente e independente do endotélio em pacientes portadores de esclerose sistêmica limitada (ESL) com aquela de indivíduos sadios de mesmo gênero, idade e cor. MÉTODOS: Vinte mulheres adultas, não obesas, não tabagistas, não diabéticas, não dislipidêmicas, não hipertensas, que preencheram os critérios para esclerose sistêmica (ES) segundo o American College of Rheumatology, foram submetidas ao exame de Doppler de artéria braquial do membro superior direito. Foi analisada a resposta dilatadora, dependente do endotélio, após isquemia induzida com esfigmomanômetro por cinco minutos no braço direito, e a resposta dilatadora, independente do endotélio, após administração de 300 mcg de nitroglicerina (NTG) sublingual. Esses resultados foram comparados com a resposta obtida em indivíduos sadios. RESULTADOS: O diâmetro longitudinal da artéria braquial (DAB) foi significativamente menor na fase basal 1 nos pacientes com ESL (3,57 ± 0,52 mm e 3,93 ± 0,39 mm, respectivamente no grupo paciente (P) e grupo-controle (C), P = 0,005). Não foi encontrada diferença estatisticamente significativa entre a velocidade das hemácias (VH) após isquemia/hiperemia reativa (HR) e após NTG (110,2 ± 43,86 cm/s vs. 102,0 ± 25,89 cm/s e 63,80 ± 17,69 cm/s vs. 65,4 ± 12,90 cm/s nos grupos P e C, após HR e NTG, respectivamente). Também não foi encontrada diferença significativa entre o DAB após HR e após NTG (3,77 ± 0,59 mm vs. 4,14 ± 0,49 mm e 4,44 ± 0,64 mm vs. 4,70 ± 0,58 mm nos grupos P e C, após HR e NTG, respectivamente). CONCLUSÃO: Embora o grupo de pacientes com ESL tenha apresentado menor DAB basal, a resposta dilatadora dependente e independente do endotélio se manteve preservada em ambos os grupos.

OBJECTIVES: The aim of this study was to compare the brachial artery endothelium-dependent and endothelium-independent dilating responses in patients with limited systemic sclerosis (LSSc) with those of healthy subjects of the same gender, age and color. METHODS: Twenty adult, non-obese, non-smoker, non-diabetic, non-dyslipidemic, and non-hypertensive women, who fulfilled the American College of Rheumatology criteria for the diagnosis of SSc, were submitted to right brachial artery Doppler ultrasound. The vasodilating responses were analyzed as follows: the endothelium-dependent dilating response, after a 5-minute ischemia in the right arm; and the endothelium-independent dilating response, after administering 300 mcg of nitroglycerin (NTG) sublingually. The results were compared with the response obtained in healthy subjects. RESULTS: Brachial artery longitudinal diameter was significantly low at baseline 1: 3.57 ± 0.52 mm and 3.93 ± 0.39 mm for the LSSc group and the control group, respectively, P = 0.005. The vascular reactivity after the ischemia/reactive hyperemia and the NTG showed no significant difference between the groups (8.60 ± 5.45 mm vs. 9.26 ± 5.91 mm and 25.01 ± 12.55 mm vs. 19.59 ± 7.94 mm for the LSSc and control groups, respectively). Also, no statistically significant difference was found between red blood cell velocity (RBCV) after reactive hyperemia and NTG (110.2 ± 43.86 cm/s vs. 102.0 ± 25.89 cm/s and 63.80 ± 17.69 cm/s vs. 65.4 ± 12.90 cm/s in the LSSc and control groups, respectively). CONCLUSION: Although the LSSc group showed lower brachial artery diameter, the endotheliumdependent and the endothelium-independent dilating responses were preserved in both groups.

Índices de resistência e pulsatilidade das artérias uterinas no primeiro e segundo trimestres de gestações normais / Uterine arteries resistance and pulsatility indices at the first and second trimesters of normal pregnancies

OBJETIVO: Determinar os índices de resistência (IR) e pulsatilidade (IP) nas artérias uterinas durante o primeiro e segundo trimestres de gestação. MATERIAIS E MÉTODOS: Realizamos estudo prospectivo longitudinal em 44 mulheres normais, da 8ª a 12ª e na 22ª semanas de gestação. A dopplervelocimetria foi realizada em ambas as artérias uterinas por meio do IR e do IP. Utilizamos volume de amostra de 1 a 2 mm, filtro de 50 a 70 Hz e ângulo de insonação abaixo de 60°. RESULTADOS: O IR e o IP da artéria uterina no primeiro trimestre foram maiores da 8ª a 12ª do que na 22ª semana de gestação. O IR e o IP da artéria uterina, no primeiro trimestre, com incisura foram de 0,83 ± 0,07 e 2,32 ± 0,79, e sem incisura, de 0,71 ± 0,16 e 1,61 ± 0,78, respectivamente. No segundo trimestre, o IR e o IP da artéria uterina com incisura foram de 0,59 ± 0,09 e 1,03 ± 0,32, e sem incisura, de 0,44 ± 0,09 e 0,63 ± 0,19, respectivamente. CONCLUSÃO: Estabelecemos os valores de referência do IR e do IP das artérias uterinas de gestantes normais no primeiro e segundo trimestres de gestação.

OBJECTIVE: To determine uterine artery resistance index (RI) and pulsatility index (PI) during the first and second trimesters of pregnancy. MATERIALS AND METHODS: The authors developed a prospective longitudinal study with 44 healthy women at their 8th-12th and 22nd gestational weeks. Doppler velocimetry was utilized for evaluating RI and PI of both uterine arteries, with a sample volume of 1 to 2 mm, a 50-70 Hz filter, and an insonation angle < 60°. RESULTS: At 8th-12th gestational weeks, the uterine artery RI and PI were higher than at the 22nd gestational week. At the first trimester uterine artery RI and PI were, respectively, 0.83 ± 0.07 and 2.32 ± 0.79 with a notch, and 0.71 ± 0.16 and 1.61 ± 0.78, without a notch. At the second trimester, uterine artery RI and PI were, respectively, 0.59 ± 0.09 and 1.03 ± 0.32 with a notch, and 0.44 ± 0.09 and 0.63 ± 0.19 without a notch. CONCLUSION: Reference values for uterine arteries RI and PI at the first and second trimesters of pregnancy were established.

Doppler sonar analysis of swallowing sounds in normal pediatric individuals / Análise dos sons da deglutição pelo sonar Doppler em indivíduos normais na faixa etária pediátrica

Among the methods for assessing swallowing sounds - videofluoroscopy modified barium study, fiberoptic swallowing endoscopy, neck auscultation through a microphone, accelerometer and, more recently, the Doppler sonar - we have chosen the latter. AIM: to analyze swallowing sounds by cervical auscultation using Doppler sonar, in a population between 2 and 15 years without oro-pharyngeal dysfunction. STUDY DESIGN: cross-sectional historical cohort. MATERIALS AND METHODS: we investigated 90 individuals in Curitiba (2006/2007). The population was separated by age into 3 groups: from 2 to 5 years, from 5 to 10 years of age and from 10 to 15 years of age. We obtained the average values for frequency, intensity and swallowing duration for saliva, liquid and pasty foods). RESULTS: objective and measurable data were obtained. Significance related to gender was found in certain age groups and consistencies, under all the studied variables, except swallowing time. CONCLUSION: neck auscultation using Doppler sonar is a sensitive method to detect swallowing sounds. There was swallowing interference associated with saliva and the other tested food types and with the biological development of the age range being studied. It is an easy to apply method, not expensive and non-invasive.

Dentre a variabilidade de métodos para o estudo da deglutição temos a videofluoroscopia dinâmica da deglutição, a endoscopia da deglutição e a ausculta cervical através do microfone, acelerômetro e mais recentemente pelo sonar Doppler. OBJETIVO: Analisar os sons da deglutição em indivíduos entre mais de dois e 15 anos de idade sem disfagia orofaríngea obtidos na ausculta cervical pelo sonar Doppler. FORMA DE ESTUDO: Estudo de coorte histórica com corte transversal. MATERIAL E MÉTODO: estudaram-se 90 indivíduos em Curitiba (2006/2007). Aplicaram-se as subfaixas mais de dois a cinco, mais de cinco a 10 e mais de 10 a 15 anos de idade. Estabeleceram-se as médias nas variáveis de frequência, intensidade e tempo para as deglutições de saliva e de consistências líquida e pastosa. RESULTADOS: Obtiveram-se dados objetivos e mensuráveis, encontrando-se significância em relação ao sexo em algumas subfaixas etárias e consistências estudadas em todas as variáveis, exceto no tempo de deglutição. CONCLUSÃO: A ausculta cervical pelo sonar Doppler é um método sensível para detectar os sons da deglutição. Houve interferência na deglutição relacionada com a saliva e as consistências alimentares testadas e com o desenvolvimento biológico da faixa etária em questão. É um método de fácil aplicação, barato e não invasivo.

Envolvimento macrovascular e esclerose sistêmica: [revisão] / Macrovascular involvement and systemic sclerosis: [review]

Este artigo tem como objetivo revisar os aspectos descritos na literatura sobre o acometimento da macrovasculatura na esclerose sistêmica e avaliar a ocorrência e distribuição das alterações macrovasculares nos pacientes com esclerose sistêmica através do eco-Doppler e do índice tornozelo-braço, além da associação desses achados com as características demográficas, forma clínica, tempo de evolução da doença, fenômeno de Raynaud (FR), alterações digitais, ulcerações de membros, reabsorção de falange, amputação, bem como fatores de risco e antecedentes da doença ateromatosa. O estudo foi prospectivo, do tipo série de casos, constituído de 20 pacientes, sendo 19 do sexo feminino, com idade média de 46,30 anos. Todos os pacientes tinham fenômeno de Raynaud objetivo, 85 por cento a forma clínica difusa, 55 por cento alteração de polpa digital, 15 por cento úlcera atual de membros, 25 por cento reabsorção de falange, nenhuma amputação e 70 por cento de um a quatro fatores de risco. Foram estudadas pelo eco-Doppler as artérias aorta e carótida, dos membros inferiores e superiores, para a avaliação de espessamento do complexo íntimo-medial e presença de placas e aneurismas. Nas artérias dos membros inferiores, foi também realizado o índice tornozelo-braço. O índice tornozelo-braço foi normal em todos os pacientes; entretanto, 12 (60 por cento) destes apresentaram doença macrovascular pelo eco-Doppler, sendo nove (45 por cento) na aorta, seis (30 por cento) nas carótidas, uma (5 por cento) nas artérias dos membros superiores e sete (35 por cento) nas dos membros inferiores. Observou-se associação entre doença macrovascular e alterações de polpas digitais (p = 0,0045). A doença macrovascular foi identificada em 60 por cento dos pacientes através do eco-Doppler, mas não pelo índice tornozelo-braço, que foi normal em todos. Verificou-se associação significante da doença macrovascular com as alterações atuais de polpas digitais, o que não ocorreu ...

The objectives of this article are to review aspects described in the literature on macrovasculature onset in systemic sclerosis and to assess occurrence and distribution of macrovascular alterations in patients with systemic sclerosis using Doppler ultrasound and ankle-brachial index. In addition, the article evaluates the association of these findings with demographic characteristics, clinical form, clinical course of the disease, Raynauds phenomenon, digital changes, limb ulcers, reabsorption of phalanges, amputation, and risk factors and antecedents of atheromatous disease. A prospective, case series study of 20 patients was performed. The sample was comprised of 19 women, with a mean age of 46.30 years. All patients had objective Raynauds phenomenon, 85 percent were diffuse, 55 percent had digital pulp changes, 15 percent current limb ulcer, 25 percent reabsorption of phalange, no amputations, and 70 percent presented one to four risk factors. Studies were performed by color Doppler ultrasound of the aortic and carotid arteries and lower and upper limb arteries to assess thickening of the intima-media complex, presence of plaques and aneurysms. Ankle-brachial index was also performed in lower limb arteries. Ankle-brachial index was normal in all patients, but 12 (60 percent) had macrovascular disease assessed by Doppler ultrasound, nine (45 percent) of these in the aorta, six (30 percent) in the carotid arteries, one (5 percent) in the upper limb arteries, and seven (35 percent) in lower limb arteries. There was an association between macrovascular disease and digital pulp changes (p = 0.0045). Macrovascular disease was identified in 60 percent of the patients via Doppler ultrasound, but not via ankle-brachial index, which resulted normal in all patients. There was a significant association between macrovascular disease and current digital pulp changes, which did not occur with the other variables.

Estudo longitudinal dos valores normais do tempo de aceleração na artéria cerebral média fetal na segunda metade da gestação / Longitudinal study about the normal values of the acceleration time on the fetal middle cerebral artery in the second half of the pregnancy

Objetivo: Determinar os valores normais do tempo de aceleração na artéria cerebral média entre a 22a e a 38a semanas de gestação e sua relação com a freqüência cardíaca fetal. Material e métodos: Foi feito um estudo prospectivo e longitudinal no qual 33 fetos de gestantes normais foram avaliados por meio da ultra-sonografia. Os exames dopplervelocimétricos foram realizados por um único observador em um mesmo equipamento. O traçado dopplervelocimétrico foi obtido com volume de amostra de 1 mm e posicionado na artéria cerebral média anterior o mais próximo da calota craniana. O ângulo de insonação foi de 50 a 190 e o filtro de parede utilizado de 50-100 Hz. Resultados: O tempo de aceleração foi de 40 milissegundos na 22a e 26a semanas; 50 milissegundos na 30a e 34a semanas e 60 milisegundos na 38a semana. Observamos aumento significante apenas na 30a semana de gesta- ção (p < 0,05). Conclusão: As medidas dopplervelocimétricas do TAACM de fetos normais podem ser comparadas com valores dopplervelocimétricos desse índice em gestações de alto risco, principalmente quando houver anormalidades cardíacas fetais (AU)

Objective: To determine the normal values of the acceleration time on the middle cerebral artery between 22 and 38 weeks of pregnancy and its relation with the fetal cardiac output. Material and methods: A prospective and longitudinal observational study was conducted on 33 fetuses of normal pregnant women evaluated by ultrasonography. Doppler ultrasound examination was performed by a single observer with the same equipment. The Doppler tracing was obtained with a sample volume of 1 mm and placed on the anterior middle cerebral artery as close as possible to the skullcap. The insonation angle was kept between 5o and 19o and the wall filter was adjusted to a frequency of 50-100 Hz. Results: The acceleration time was 40 milliseconds on the 22nd and 26th week, 50 milliseconds on 30th and 34th week and 60 milliseconds during the 38th week. The values were significantly higher only during the 30a gestational week (p<0,05). Conclusion: The Doppler velocimetry values of the TAACM of normal fetuses can be compared with Doppler velocimetry values of this index in high-risk pregnancy, specially when there is fetal cardiac anomalies (AU)

Mechanism simulation of blood cell velocity measurement by Doppler ultrasonic blood equipment / 医疗卫生装备

VB programme and flash technique are used to visually display physical mechanism of blood cell velocity measurement in vein taken by Doppler ultrasonic blood equipment.

Fractal and its Applicaton in Medical Doppler Ultrasound / 中华超声影像学杂志

Fractal is a new conception.In this paper some knowledge of fractal is first described.Our research work of fractal application in Doppler ultrasound technique is reported.

Study on left ventricular diastolic function in the patients with coronary artery disease by tissue Doppler imaging and color Doppler echocardiography / 第二军医大学学报

Objective: To study left ventricular diastolic function (LVDF) in patients with coronary artery disease(CAD) by tissue Doppler imaging (TDI) and color Doppler echocardiography. Methods: The maximum velocity ( V max ) and time velocity integration(TVI) in early and late diastolic stage of mitral valve orifice of 80 patients with CAD and 79 normal subjects were measured by color Doppler echocardiography at apical 4 chamber view. Meanwhile, the V max and/or TVI of the myocardial motion spectrum of left ventricular lateral wall near the mitral valve annulet were measured by TDI. These data were compared and analysed by statistical method. Results: In the normal subjects, the older the subject, the lower the V max and TVI of early diastolic stage, the higher the V max and TVI of late diastolic stage. In CAD group, changes were not associated with ages and were affected by the degree of the myocardial pathology. The LVDF couldn't be exactly judged by color Doppler echocardiography when pseudonormalization blood flow spectrum appeared, but TDI technique was relatively sensitive. Any regional myocardial motion could be measured by TDI according to the examiner's design. Conclusion: LVDF by color Doppler echocardiography is simple and convenient. TDI technique can be used for determining overall LVDF and left ventricular systolic function. [