ABSTRACT
Objective: To evaluate the flow of the superior mesenteric artery and vein both by Doppler flowmetry and simultaneously, in normal controls and in cases of gastroschisis, as additional prognostic criteria. Methods: The venous/arterial index was determined by Doppler flowmetry; reference values for the superior mesenteric vessels were obtained from a group of 60 healthy fetuses of 30 to 34 weeks and 15 cases of gastroschisis. The flow rate wave (FRW) was obtained simultaneously from both the superior mesenteric artery and vein with an angle of insonation less than 60°; the vein velocity was divided by the systolic peak of the artery and the percentage index was calculated based on the velocity of both vessels. The equipment used was a Mylab™Twice from Esaote with a 3.5 MHz convex probe. Results: The superior mesenteric venous/arterial index value in the control group was 26% ± 6 (2SD). In 12 cases of gastroschisis, the index remained within the reference values, with favorable prognosis for primary reduction (9 with Svelitza technique and 3 with immediate neonatal primary reduction). In three cases, the venous/arterial index was below 20% (1%, 14% and 16% respectively), with unfavorable results; the worst case, where no venous flow was detected, required wide resection, presented short bowel syndrome and died at 6 months. Conclusions: The perfusion index of the eviscerated bowel, studied by the percentage between vein velocity and maximum mesenteric artery velocity, could have prognostic value for the flow conditions of afferent and efferent intestinal loops in gastroschisis.
Objetivo. Evaluar mediante flujometría Doppler y de manera simultánea el flujo de la arteria y vena mesentérica superior en casos normales y en aquellos portadores de gastrosquisis, como criterio adicional en el pronóstico. Métodos. Se determinó mediante flujometría Doppler el índice venoso/arterial, obteniendo los valores de referencia de los vasos mesentéricos superiores, en un grupo de 60 fetos sanos con 30 a 34 semanas de gestación y 15 casos portadores de gastrosquisis. Se obtuvo la onda de velocidad de flujo (OVF) simultáneamente de la arteria y de la vena mesentérica superior, con ángulo de insonación menor a 60°; la velocidad de la vena fue dividida entre el pico sistólico de la arteria y calculado el índice porcentual entre las velocidades de ambos vasos. El equipo utilizado fue un MyLab Twice de Esaote con transductor convexo de 3,5 MHz. Resultados. El valor del índice veno/arterial de los vasos mesentéricos superiores en el grupo control fue 26% ± 6 (2DE). En 12 casos de gastrosquisis, el índice se mantuvo dentro de los valores de referencia y con índice pronóstico favorable para reducción primaria (9 con técnica de Svelitza y 3 con reducción primaria neonatal inmediata) y, en tres casos, el índice porcentual veno/arterial se encontró por debajo del 20%, (1%, 14% y 16%), con resultados desfavorables. En el caso con mayor compromiso, no pudo detectarse flujo venoso y requirió de resección amplia, con síndrome de intestino corto y fallecimiento a los 6 meses. Conclusiones. El índice de perfusión de las asas intestinales evisceradas, estudiado mediante la relación porcentual entre las velocidades de la vena y velocidad máxima de la arteria mesentérica superior, podría ser considerada como un complemento pronóstico en las condiciones de flujos aferentes y eferentes en que se encuentran dichas asas, en los casos de gastrosquisis.
ABSTRACT
Adnexal torsion is a gynaecologic surgical emergency. Misdiagnosis or delay may lead to loss of the adnexa and may compromise fertility. Aim: To determine the most relevant findings for the diagnosis of adnexal torsion and the results of laparoscopic surgery. Methodology: A retrospective cohort study of 266 patients who underwent surgical treatment for adnexal torsion in our department from January 1994 to January 2014. Clinical, biological, ultasonographic, therapeutic and histological findings were analysed as well as risk factors and prognosis. Results: The mean age of patients was 33.1 years. Adnexal torsion occurred during pregnancy in 21 patients (7.8%). Abdominal pain was present in 91.7%, vomiting in 63.9% and fever in 19.1% of the cases. Ultrasonographic findings were: ovarian cysts (54.1%), complex mixed echogenicity masses (40.2%) and ovarian enlargement (5.6%). The pain-to-surgery interval varied from 4 hours to 26 hours. At surgery, the mean number of spiral turns was 2. Treatment was carried out by laparotomy in 87 patients (32.7%). The mean size of the adnexa treated by laparotomy was 10.7 cm. Laparoscopic surgery was performed in 137 patients (51.5%). The mean size of the adnexa treated by laparoscopy was 6.9 cm. Laparoscopic treatment was conservative in 77.3% of the cases. Conclusion: Adnexal torsion is a common gynaecologic emergency. Prompt diagnosis of adnexal torsion requires a combination of clinical, biological and sonographic investigation. The prognosis of adnexal torsion was potentially increased by the interval period before surgery. Laparoscopic treatment is the gold standard if possible.
ABSTRACT
Ultrasound is a sound wave beyond the audible frequency. Owing to technological development, the extent of use of ultrasound in orthopaedics is expanding. Ultrasound is produced by a piezoelectric effect and matter is requires for propagation. According to the characteristics of matter, the velocity of propagation differs and the images are the overall result of the interaction of reflection, refraction, absorption, scattering, transmission, and attenuation. The most important device is the transducer, which differs according to the array of piezoelectric elements and shapes the way it used and where it is used. Mode B is currently the most common image and many images which help to make diagnosis easier, such as doppler flow imaging, extended field of view imaging, compound imaging and three-dimensional imaging, are under developments. Ultrasound produces variable artifacts and during interpretation of ultrasound images, artifacts could interfere with correct diagnosis. In order to avoid creation of artifacts, profound knowledge of each artifact is needed. Therefore, precise understanding and interpretation of the ultrasound image is essential for proper diagnosis and use of ultrasound.
Subject(s)
Absorption , Artifacts , Comprehension , Imaging, Three-Dimensional , Sound , Transducers , UltrasonographyABSTRACT
An extratesticular scrotal epidermal cyst is a very rare condition and few cases of extratesticular scrotal epidermal cyst with radiologic findings have been reported. Therefore, we report here on a rare case with ultrasonographic and MRI findings. A 70-year-old male patient was admitted with a palpable mass in the left scrotum. A well-defined heterogeneous hypoechoic mass with scattered echogenic reflectors in the scrotum was identified on ultrasonography. The cystic mass showed high signal intensity on T2-weighted images, low signal intensity on T1-weighted images, and diffusion restriction on diffusion weighted images.
Subject(s)
Humans , Male , Diffusion , Epidermal Cyst , ScrotumABSTRACT
Objective To evaluate the effects of femoral artery wall thickness, stillness and ankle brachium index(ABI) on clinical manifestation of peripheral vascular disease(PVD) in type 2 diabetes mellitus. Methods According to the presence of lower limb and reduced ABI (ABI<0.9), 151 patients with type 2 diabetes were divided into group of patients with and without PVD symptoms, and group of patients with and without reduced ABI. Intima-media thickness of femoral artery (FA-IMT) and stiffness of femoral artery (FA-β) were measured by ultrasound. FA-IMA and FA-β of femoral arteries were compared between group of patients with and without PVD symptoms as well as between group of patients with and without reduced ABI. Correlation between FA-IMT and FA-β was analyzed. Factors affecting symptoms of lower limb and ABI were evaluated by multiple logistic regression analysis. Results FA-IMT and FA-β in group of PVD symptoms were higher than those in group without PVD symptoms. Similarly, patients with reduced ABI had greater FA-IMT and FA-β than those without. However,there was no correlation between FA-IMT and FA-β in group of PVD symptoms. Multiple logistic regression analysis indicated that the presence of PVD symptoms was associated closely with increased FA-β, whereas reduced ABI was associated closely with FA-IMT. Conclusions The stiffening of arterial wall has a significant impact on PVD manifestations,particularly on the leg symptoms in patients with type 2 diabetes.
ABSTRACT
OBJECTIVE: The purposes of this study were to investigate the findings of various diagnostic tools for shoulder pain in hemiplegic patients and to compare the results of each diagnostic tool. METHOD: Sixty shoulders in hemiplegic patients with shoulder pain were evaluated by physical examination, visual analogue scale, plain X-ray, arthrogram, ultrasonography and 3-phasic bone scan. RESULTS: The subluxation of shoulder on X-ray was found in 45 patients. The abnormal findings of arthrogram were 39 patients and the most common finding was adhesive capsulitis. The abnormal findings of ultrasonography were 45 patients and the most common finding was supraspinatus tendinitis. In cases of shoulder subluxation on X-ray, manycases were associated with supraspinatus tendinitis on ultrasonography and with adhesive capsulitis on arthrogram. In comparison with the arthrogram and ultrasonography, partial and complete rotator cuff tear findings show consistency. And patients with adhesive capsulitis on arthrogram show significantly high incidence of biceps tendinitis finding on ultrasonography. CONCLUSION: In hemiplegic patients with shoulder pain, the ultrasonography is more valuable and useful as an invasive diagnositc method for the evaluation of rotator cuff tendinitis especially when there is subluxation in X-ray and adhesive capsulitis in physical examination.