Clinical study of 2D Echo cardiography findings in stroke- ischemic patients

Background: The Echocardiography is the mainstay investigation tool used in stroke patients. Stroke has acquired third place as leading cause of death with ischemic stroke being very common among all the types of the stroke.Objective of the study was to evaluate 2D Echo cardiography findings in the stroke (ischemic) patients.Methods: Hospital based cross sectional study was carried out among the confirmed 50 patients of ischemic stroke. Routine investigations has been done to all the patients included in the study, specific investigations like 2D echo and CT brain (Plain), Doppler study of carotids and fasting lipid profile has been done.Results: Majority of the study subjects belonged to the age group of 60-69 years i.e. 36% followed by the age group of 50-59 years. The most common risk factor for this ischemic stroke found out in the present study was hypertension in 66% of the cases. The prevalence of ischemic stroke was 70% in the males and 30% in the females. Out of 50 cases, 43 cases i.e. 86% were having abnormal lipid profile. Bilateral carotid atherosclerosis (64%) is more common than the unilateral carotid atherosclerosis (36%) on color Doppler study. Mitral annular calcification was the most common finding in 2D ECHO study in 52% of the cases.Conclusions: Males are more affected than females. Hypertension and smoking are two major and predominant risk factors for stroke. Elderly age group is commonly affected. Bilateral carotid atherosclerosis is common finding on color Doppler study and Mitral annular calcification the most common finding in 2D ECHO study.

Restricción selectiva del crecimiento intrauterino (RCIUs)

La restricción de crecimiento intrauterino selectivo es una complicación de la gestación monocorial poco frecuente, caracterizada por el déficit de crecimiento de uno de los fetos, fenómeno que se explica principalmente por la distribución asimétrica del territorio placentario. La influencia de las anastomosis vasculares determina el tipo de evolución de cada caso. El estudio Doppler de la arteria umbilical del feto con restricción es la mejor maneja de valorar el comportamiento clínico y la posible evolución, con la finalidad de minimizar el riesgo de muerte intraútero y el daño cerebral que podrían sufrir ambos fetos.

Selective intrauterine growth restriction is arare complication of monochorionic gestation characterized by growth deficiency of one fetus, phenomenon due to asymmetric distribution of the placental territory; the influence of the vascular anastomosis determines the type of evolution in each case. Umbilical artery Doppler study ofthe restricted fetus determines the clinical status and possible outcome in order to minimize risk of intrauterine death and brain da mage in both fetuses.

Study of effect of Oligohydramnios on maternal and fetal outcome.

Background: Amniotic fluid acts like a cushion and helps in growth of fetus, decrease in amniotic fluid volume may lead to increased risk of intrauterine growth retardation (IUGR), meconium aspiration syndrome, severe birth asphyxia, low APGAR scores and congenital abnormities. Objective: This study was done to see effects of Oligohydramnios on fetal outcome in the form of neonatal morbidity and mortality and maternal morbidity. Material and Methods: Present study was done in 100 patients who have completed 28 weeks of pregnancy and above with oligohydramnios, selected randomly after satisfying inclusion and exclusion criteria. Detailed examination done and oligohydramnios was confirmed by measuring AFI on ultrasonography. Associated complications, type of delivery conducted, and fetal outcome for perinatal morbidity & mortality studied. Results: Common causes for Oligohydramnios were idiopathic (56%) and PIH (24%). Most common reason to perform caesarean was fetal distress. Oligohydramnios was related to higher rate of growth retardation and neonatal intensive care unit admission. Conclusion: Oligohydramnios is frequent occurring condition. This condition requires antepartum and intrapartum care. Due to oligohydramnios intrapartum complications, perinatal morbidity and mortality are increasing. Decision between vaginal delivery and caesarean section should be well balanced. Unnecessary maternal morbidity can be prevented. Timely intervention can reduce perinatal morbidity and mortality.

Evaluation of Factors Affecting the Renal Doppler Waveform with the Use of an Electrical Circuit Model

PURPOSE: We have evaluated the influence of several variables such as vascular compliance and resistance and heart rate on the resistive index by the use of an electrical circuit model that simulates renal blood flow. MATERIALS AND METHODS: To analyze the renal artery Doppler waveform, we modeled the renal blood-flow circuit with an equivalent simple electrical circuit containing resistance, inductance and capacitance. The relationship between impedance and resistance and compliance of the circuit was derived from well-known equations including Kirchhoff's current law for an alternating current circuit. Simulated velocitytime profiles for pulsatile flow were generated by the use of Mathematica software (Wolfram Research, Champaign, IL USA) and the influence of resistance, compliance and pulse rate on waveforms and the resistive index were evaluated. RESULTS: Resistance and compliance altered the waveforms independently. The impedance of the circuit increased with increasing proximal compliance, proximal resistance and distal resistance. Impedance decreased with increasing distal compliance. The resistive index of the circuit decreased with increasing proximal compliance and resistance. The resistive index increased with increasing distal compliance and resistance. These results showed no tendency of a positive correlation between the impedance and resistive indices. The pulse rate is an extrinsic factor that also influences the resistive index. CONCLUSIONS: By the use of this simulation study using an electrical circuit model, a better understanding of the Doppler waveform and resistive index was achieved and the study findings may be useful in various clinical settings.

Change of Cerebral Blood Flow during Tilt Tests in Children with Vasovagal Syncope

PURPOSE: Syncope appears to be common. However, the mechanism of syncope is not clear. Increased vagal activity and withdrawal of sympathetic stimulation cause hypotension, bradycardia and finally loss of consciousness. The purpose of this study was to evaluate changes of cerebral blood flow velocity, blood pressure, and heart rate during tilt test in children with vasovagal syncope. METHODS: Sixty four children with a past history of syncope were evaluated. The stand up test was performed for 15 minutes after a rest at supine position for 10 minutes, followed by an 80 degrees tilt test lasting 45 minutes. If presyncope(lightheadedness, nausea, blurred vision, or sweating) or syncope occurred, the study was discontinued. 12-lead electrocardiography, echocardiography, and electroencephalography were performed. Transcranial Doppler study was performed at the middle cerebral artery with 2 MHz continuous Doppler probe in 10 children with positive tilt test. Systolic, diastolic, mean cerebral blood flow velocity, integral, and pulsatility index were measured with blood pressure, heart rate, and O2 saturation. RESULTS: The positive rate of tilt test was 31.3%(20/64). Systolic, diastolic, and mean cerebral blood flow velocity decreased significantly in absence of hypotension or bradycardia during presyncope. Time velocity integral of cerebral artery also decreased significantly. CONCLUSION: Decreased cerebral blood flow velocity can predict the presyncope manifestation. Impairment of autoregulation of cerebral blood flow might play an important role in the pathophysiology of vasovagal syncope.

(Longitudinal Follow-up of Middle Cerebral Artery Stenosis with Transcranial Doppler Ultrasonography: Preliminary Study)

BACKGROUND: The natural history of intracranial arterial stenoses, particularly the middle cerebral artery (MCA), remains unknown. To monitor the progression of MCA stenoses over time, we conducted a prospective study using transcranial Doppler (TCD) study. METHODS: We performed TCD study on 14 stroke patients with angiographically documented MCA stenosis. The findings were compared to repeat TCD studies conducted more than 2 months apart with respect to changes in mean flow velocities (mFV) of the stenotic segment. RESULTS: Fourteen patients (13 men and 1 woman; mean age, 51 years) with 18 MCA stenoses were identified. During a mean follow-up period of 7.7 months, mFV corresponding to the areas of stenosis was increased in 7 (39%) arteries, demonstrating TCD evidence of stenosis progression. Three of those with MCA stenosis progression detected on TCD were confirmed with magnetic resonance angiogram. Flow velocities were not significantly changed in the remainder of the stenotic MCAs. Two patients whose MCA stenosis progressed also showed the suspicious development of new stenosis (mFV increase 119% and 41%, respectively) in the initially normal contralateral MCA. CONCLUSION: These findings suggest that MCA stenoses are dynamic lesions, and that they can evolve and cause further reductions of the arterial diameters after relatively short periods of time. TCD can noninvasively detect these changes.

The Measurement of Blood Flow of Anterior Cerebral Artery in Premature Newborns Using Duplex Dopple Ultrasonography / 영남의대학술지

We measured the blood flow velocity of the anterior cerebral artery via anterior fontanelle approach of fifty five preterm neonates with duplex Doppler sonography and analyzed the waveform and calculated pulsatility index were increased with increasing gestational age, birth weight, and age of the neonate, but resistive indices decreased. In sick babies, characteristic resistive index increment were seen in patients with intraventricular hemorrhage, but no statistical difference was seen in patients with respiratory distress syndrome. Our results suggest that duplex Doppler sonography is a use ful noninvasive means of monitoring cerebrohemodynamics in normal pretem neonates and flow change of sick babies.