Índice Ventricular De Levene Y Mensuración Del Tercer Ventrículo En Neonatos Ecuatorianos Mediante Ecografía Cerebral / Levene Ventricular Index And Measurement Of The Third Ventricle In Ecuadorian Neonates By Means Of Cerebral Ultrasound

Resumen Introducción: La aplicación del ultrasonido en la evaluación cerebral del neonato posibilita la mensuración de estructuras cerebrales. Objetivo: El objetivo de este trabajo es obtener las medidas del III ventrículo y del índice de Levene en un grupo de recién nacidos ecuatorianos, con la finalidad de determinar valores de normalidad que puedan ser utilizados en el trabajo diario del servicio de neonatología. Métodos: Se seleccionó un grupo de neonatos sin alteraciones neurológicas. A través de la fontanela anterior se determinó el índice de Levene. La mensuración del diámetro del III ventrículo se realizó a través de la ventana craneal temporal. Resultados: Se incluyeron en el estudio 66 pacientes con edad post menstrual de 37 semanas (rango 27-42 semanas), predominó el sexo masculino. El peso promedio al nacer fue de 2554 gramos. El valor medio del diámetro del III ventrículo es de 1,5 mm, rango entre 0,5 mm - 3,8 mm. El índice de Lindergaard promedio fue de 12,7 mm (8,2-27 mm). Tanto el diámetro del tercer ventrículo como el índice ventricular se vieron afectados por el peso al nacer. En relación con el momento del parto no existió diferencia significativa en el tamaño ventricular. Conclusiones: Comparado con los resultados de otras series nuestro estudio ofrece parámetros diferentes.

Abstract Introduction: The application of ultrasound in the brain evaluation of the neonate allows the measurement of brain structures. Objective: To obtain the sizes of the third ventricle and the ventricular index of Levene in a group of Ecuadorian neonates without neurological alterations. To establish normal ranges that can be used in the daily work of the neonatology service. Methods: A group of neonates without neurological alterations was studied. Through the anterior fontanelle, the Levene index was determined. The third ventricle's diameter was seized through the temporal cranial window. Results: Sixty-six patients of 37 weeks' gestational age at birth (range 27-42 weeks), predominantly male and an average weight at birth of 2554 grams, were included. The third ventricle's mean diameter was 1.5 mm (range: 0.5 mm - 3.8 mm). The average Lindergaard index was 12.7 mm (8.2-27 mm). Both, the diameter of the third ventricle and the ventricular index were affected by the birth weight of newborns. Regarding the moment of delivery, there was no significant difference in ventricular size. Conclusions: Compared with the results of other series, our study offers different parameters.

Evaluation of carotid artery dynamics & correlation with cardiac & hepatic iron in β-thalassaemia patients.

Background & objectives: Early atherosclerosis and vascular complication have been described in thalassaemia patients. There is lack of data or guidelines regarding monitoring of vascular health in thalassaemia. This study was conducted to compare carotid artery structural and functional indices such as carotid artery intima-media thickness (CIMT), stiffness index (SI) and Young’s elastic modulus (YEM) in β-thalassemia patients with age and sex matched controls, and to correlate these parameters with serum ferritin, cardiac iron, and hepatic iron. Methods: This cross-sectional study included 53 β-thalassaemia patients receiving regular blood transfusions. Carotid artery indices such as CIMT, SI, and YEM were calculated by duplex ultrasound and colour Doppler. Serum ferritin levels were measured by chemiluminescence. Cardiac and hepatic iron estimation were done using MRI T2* sequences analyzed by a special thalassaemia software. Results: Mean CIMT of cases and controls were 0.48 ± 0.04 and 0.44±0.02 mm, respectively and these were significantly different (P<0.001). Similarly significant differences were noted in SI and YEM of cases (2.45±0.79 and 96.12±34.85, respectively) as compared to controls (1.98±0.54 and 68.60±24.29, respectively) (P<0.001). There was significant inverse correlation between stiffness index and cardiac iron overload assessed by MRI cardiac T2* (P=0.03). Mean SI and YEM of cases were (2.1736 ± 0.2986 and 107.3± 41.6, respectively) significantly higher among non-splenectomized patients compared to splenectomized patients (2.0136 ± 0.263 and 86.9 ± 25.2, respectively) (P<0.05). Interpretation & conclusions: CIMT and arterial stiffness indices were significantly increased in β-thalassaemia patients compared to controls which was indicative of early atherogenic changes. This study supports the hypothesis that iron overload is a risk factor for early atherosclerosis and cardiovascular disease.

A Case of Rotational Vertebral Artery Syndrome Diagnosed with Color Doppler-Assisted Carotid Duplex Sonography Imaging / 대한이비인후과학회지

Rotational vertebral artery syndrome (RVAS) is characterized by recurrent attacks of paroxysmal vertigo, nystagmus, and syncope elicited by head-rotation induced compression of the dominant vertebral artery (VA). Although the cause of RVAS could be explained by transient ischemic attacks within the vertebrobasilar territory, the exact underlying mechanism of the certain specific unilateral lesion of superior vestibular labyrinth responsible for the unidirectional nystagmus is still unclear. This study reports on a patient with right VA hypoplasia, in whom rightward head rotation led to stereotypic clinical symptoms of RVAS including recurrent attacks of vertigo and prominent right beating nystagmus. This patient could be diagnosed with color Doppler-assisted carotid duplex sonography imaging without using of dynamic neck angiography. Carotid duplex ultrasound is rapidly applicable, readily available, safe, real-time monitoring, noninvasive imaging procedure. Color Doppler-assisted carotid duplex sonography imaging therefore should be considered as the first-line diagnostic method in the detection of RVAS.

The Prevalence of Extra-cranial Carotid Artery Disease in Chronic Heart Failure.

Background: The prevalence of carotid disease in patients with heart failure (HF) has not been described. This may be of importance for the implementation of novel interventions for heart failure that require surgery close to the carotid artery. Objective: The aim of this study was to determine the prevalence of extra-cranial carotid artery stenosis (ECAS) in patients with HF. Methods: The study population comprised consecutive, patients with chronic stable HF due to left ventricular systolic dysfunction (LVSD). Patients were invited to have an ultrasound duplex scan of the internal and common extra-cranial carotid arteries (ECA) and stenoses were classified as minor if <50%, moderate if 50-69% and severe if >70%. Results: Of 102 patients, the median age was 73 (IQR: 66-78) years and 95 were men. Ten patients had moderate ECAS of whom one also had severe ECAS in the contra-lateral artery. Thirteen patients gave a prior history of stroke or transient ischaemic attack. Of patients with ECAS, only three (30%) had had a neurological event and only three (23%) of those with a neurological event had moderate or severe ECAS (95% CI; 6-55%). Most neurological events had occurred in patients without ECAS. Conclusion: There is a moderately high prevalence of ECAS in patients with HF. However, most patients with chronic heart failure (CHF) who have had a neurological event do not have ECAS and most patients with ECAS do not have neurological symptoms. The value of screening for and management of ECAS in patients with HF remains to be established.

Morphological and hemodynamic patterns of carotid stenosis treated by endarterectomy with patch closure versus stenting: a duplex ultrasound study

OBJECTIVES: A duplex ultrasound study was performed to investigate morphological and hemodynamic patterns of carotid stenoses treated by endarterectomy with patch closure versus stenting. MATERIALS AND METHOD: Twenty-nine carotid stenoses were treated with stenting and 65 with patch closure. Duplex ultrasound parameters (luminal diameter, mm; peak systolic velocity and end-diastolic velocity, cm/s) were measured 24 hours after the procedures and also at 12 months post-procedure. Residual stenoses (immediately postprocedure) and restenoses (within 12 months of procedure) were defined as narrowings of >50 percent on duplex ultrasound examination. RESULTS: In stented patients, the luminal diameter of the proximal internal carotid artery increased in the interval between the 24-hour and 12-month post-procedure studies, while in the patch closure patients, the diameter decreased. Carotid hemodynamics normalized immediately after both patching and stenting and remained relatively stable thereafter up to 12 months. No statistically elevated flow velocities (in the absence of residual stenosis or restenosis) were observed in the patched or stented carotid arteries. No significant differences in residual stenosis rates were observed between the stenting group (3 cases, 10.34 percent) and the patch closure group (1 case, 1.53 percent, P = 0.08). At 12 months, 2 stenting patients (6.88 percent) and 2 patch closure patients (3.07 percent) had $50 percent restenosis (P = 0.58). One case of late stroke due to restenosis was observed in the stenting group; the patient died 12 months postoperatively, before receiving new intervention. CONCLUSION: Measurements over time in luminal diameter signalized differences in arterial remodeling mechanisms between patched and stented carotids. Both stenting and patch closure were associated with carotid patency and flow restoration. This study does not support a general approach to new velocity criteria indiscriminately applied to stented or patched carotids.

Placement of an Inferior Vena Cava Filter usingTransabdominal Duplex Scan Guidance: Report of Two Cases

An inferior vena cava (IVC) filter is a useful treatment to prevent a pulmonary embolism (PE) in patients with DVT. Since the introduction of IVC filters more than 30 years ago, there has been a steady improvement in the design, ease and safety of the delivery system. The use of a temporary filter has also increased as performing thrombolysis and thrombectomy has increased. Today all of the commonly used filters can be placed via a peripheral vein by using the standard percutaneous Seldinger (Ed note: check the spelling) technique. However this typically requires fluoroscopy, intravenous contrast agents, radiation exposure and transport of the patient to the interventional or operating suite. As the multiple trauma injured or critically-ill intensive care unit patients often require inotropic and ventilator support, transporting these patients to these facilities can be hazardous. The following report describes two cases of VTE patients who underwent percutaneous placement of an IVC filter with using duplex ultrasound guidance. Identification of the renal vein and artery is important to decide the infrarenal level. The first case was an 84 years female with right ilio-femoral DVT and pulmonary embolism. To prevent recurrence of PE, we decided to insert an IVC filter. The second case was a 47 years female with right femoral DVT together with left pulmonary embolism and infarction. She also had thrombocytopenia, which is a contraindication for anticoagulation. IVC filter insertion can be safely performed under ultrasound guidance. This technique will reduce the risk and complexity of inserting an IVC filter in selected multiple injured trauma patients.

Pseudo-aneurisma de artéria tibial posterior pós-tratamento de fratura de perna com fixador externo: relato de caso e revisão da literatura / Pseudoaneurysm of the posterior tibial artery after external fixation for leg fracture: case report and review of the literature

Este trabalho descreve um caso de pseudo-aneurisma da artéria tibial posterior devido ao uso de fixador externo para tratamento de fratura dos ossos da perna (técnica de Ilizarov), bem como as técnicas utilizadas para seu tratamento. A compressão guiada por ultra-som e a injeção de trombina guiada por ultra-som foram realizadas, sem sucesso. O tratamento definitivo do pseudo-aneurisma e reconstrução arterial foi conseguido através do tratamento cirúrgico clássico, usando enxerto interposto de veia safena magna homóloga invertida. As indicações, vantagens e desvantagens das técnicas de tratamento não invasivo (compressão guiada por ultra-som e injeção de trombina guiada por ultra-som) e as possíveis causas de sua incapacidade na obliteração do pseudo-aneurisma são discutidas. Também foi realizada a revisão de casos de pseudo-aneurisma da artéria tibial posterior na literatura médica, encontrando-se apenas um caso semelhante, entre 24 publicados.

We describe a case of pseudoaneurysm in the posterior tibial artery following treatment for tibial and fibula fractures using external fixation (Ilizarov technique), as well as the techniques used for its treatment. Ultrasound-guided compression and ultrasound-guided thrombin injection were unsuccessfully performed. Definite treatment of pseudoaneurysm and arterial reconstruction was achieved through the traditional surgical treatment, using interposed graft of inverted homologous great saphenous vein. Indications, advantages and disadvantages of noninvasive treatment techniques (ultrasound-guided compression and ultrasound-guided thrombin injection) and the possible causes of their inability in obliterating the pseudoaneurysm are discussed. A literature review of pseudoaneurysms of the posterior tibial artery was also carried out, resulting in only one similar case out of 24 published cases.

Duplex Ultrasound-Guided of Balloon Angioplasty Femoral Artery

PURPOSE: To evaluate initial technical success, procedural complication rate, and early patency of duplex sound guided angioplasty we studied 10 consecutive cases. METHOD: From June to August 2005, 10 patients (all male, mean age 64.8) underwent duplex sound guided femoral balloon angioplasty. The common femoral artery was cannulated under ultrasound guidance. Under continued ultrasound guidance a guide wire was introduced into the proximal superficial femoral artery. After the guide wire crossed the diseased segment, a balloon catheter was introduced and then the balloon catheter was inflated. Completed duplex examinations and ABI (ankle/brachial artery pressure index) were obtained in all cases. RESULT: Critical ischemia was included for the procedure in 60% and disabling claudication in remaining 40%. Anatomical lesions were identified at the superficial femoral artery in 90% of cases and at the deep femoral artery in remaining 10%. The lesion characteristics were critical stenosis in 80% of case and occlusion in 20%. For seven patients it was performed as a single therapeutic procedure; however, for three patients it was performed as an added procedure for bypass surgery. Technical success was noted in 100% of cases with an average increase of ABI of 0.4. CONCLUSION: Duplex ultrasound guided balloon angioplasty appears to be a safe and effective technique for the treatment of infrainguinal arterial occlusive disease. Technical advantages include accurate selection of the proper size balloon and confirmation of the adequacy of the technique by hemodynamic and imaging parameters as well as the avoidance of radiation exposure. But needs long term follow up.

Duplex Ultrasound-Guided of Balloon Angioplasty Femoral Artery

PURPOSE: To evaluate initial technical success, procedural complication rate, and early patency of duplex sound guided angioplasty we studied 10 consecutive cases. METHOD: From June to August 2005, 10 patients (all male, mean age 64.8) underwent duplex sound guided femoral balloon angioplasty. The common femoral artery was cannulated under ultrasound guidance. Under continued ultrasound guidance a guide wire was introduced into the proximal superficial femoral artery. After the guide wire crossed the diseased segment, a balloon catheter was introduced and then the balloon catheter was inflated. Completed duplex examinations and ABI (ankle/brachial artery pressure index) were obtained in all cases. RESULT: Critical ischemia was included for the procedure in 60% and disabling claudication in remaining 40%. Anatomical lesions were identified at the superficial femoral artery in 90% of cases and at the deep femoral artery in remaining 10%. The lesion characteristics were critical stenosis in 80% of case and occlusion in 20%. For seven patients it was performed as a single therapeutic procedure; however, for three patients it was performed as an added procedure for bypass surgery. Technical success was noted in 100% of cases with an average increase of ABI of 0.4. CONCLUSION: Duplex ultrasound guided balloon angioplasty appears to be a safe and effective technique for the treatment of infrainguinal arterial occlusive disease. Technical advantages include accurate selection of the proper size balloon and confirmation of the adequacy of the technique by hemodynamic and imaging parameters as well as the avoidance of radiation exposure. But needs long term follow up.

Incidence of Deep Vein Thrombosis in Spinal Cord Injury

OBJECTIVE: The purpose of this retrospective study was to evaluate the incidence of deep vein thrombosis (DVT) in spinal cord injury (SCI). METHOD: We analyzed the incidence of DVT and factors that alter its risk in 263 SCI patients. The injury status of each SCI subject was categorized as either motor complete or motor incomplete and either quadriplegic or paraplegic. The cause of injury was categorized as either traumatic or nontraumatic. Duplex ultrasound was performed in the clinically DVT suspected patients. No patient had been started on anticoagulant prophylaxis prior to diagnosis of DVT. RESULTS: Fifteen patients (5.7%) had a diagnosed DVT and one patient (0.4%) had a diagnosed pulmonary embolism. Motor complete lesion and quadriplegic status were better predictors of DVT than motor incomplete lesion and paraplegic status. Cause of injury and existence of spasticity were not statistically correlated with the incidence of DVT. Accuracy of clinical diagnosis was 45.4%. All cases of the diagnosed DVT was located proximal veins (iliac and femoral veins). Ten of 15 DVTs (66.6%) were detected earlier than 2 months after SCI. CONCLUSION: Incidence of DVT in SCI patients were 5.7%. Motor complete lesion and quadriplegic status were suggested as significant predictors of DVT in SCI patients.

Evaluating feasibility of colour duplex ultrasound in the detection of renal arteries

The author studied 104 renal arteries of healthy people and 106 renal arteries of hypertension patients by color Duplex ultrasound and DSA, and then compared these findings. Results: color Duplex ultrasound can detect 96% of renal arteries. Ultrasound can be used to study renal arteries with 3 positions gave high rate of detection: anterior abdominal position 96%, right subcostal position 94%, and translumbar position 98%

Study on acute deep venous thrombosis of lower limb / 中国现代普通外科进展

Objective: To evaluate the superiority in diagnosing DVT between venography and duplex ultrasound, and the effectiveness of C-reactive protein (CRP) as a biomarker. Methods: Firstly,the iliac - femoral vein of the dog left hind leg was isolated,and then, the thrombosis model was established by infusing the thrombin after breaking endangium.The recanalization of thrombosis was assessed by duplex ultrasound and venography, and the expression of serum hsCRP was also examined. From 2006 to 2008, 77 patients with acute DVT proximal to the knee joint were admitted. The interval between the onset of DVT and admission was 1-21 days. They were treated mainly with urokinase and low molecular weight heparin for 2 weeks. The assessment of each patient including clinical manifestation, venography, duplex ultrasound and serum highly sensitive C-reactive protein (hsCRP) were performed immediately after admission and 4 weeks after discharge. Results: After medical therapy for 2 weeks, the clinical features prominently subsided in 49 patients, improved in 23 and didn’t ameliorate in 5.4 weeks after discharge, venography showed clot regression in 15 patients; while in the remaining 62 patients the occluded venous lumen were not visualized, duplex ultrasound showed partial lysis of the thrombosis. At admission, the hsCRP was 28.91?29.4mg/L, and it dropped to 8.13?12.7mg/L at 4 weeks after discharge. Conclusion:Duplex ultrasound was effective to assess DVT. The hsCRP was positively related to the severity of DVT.

Analysis of Duplex Ultrasonography Flow Parameters against Time in Vasculogenic Impotent Patients / 대한비뇨기과학회지

To evaluate the effect of time factor on the duplex flow measurements of the cavernosal artery we examined 30 patients with suspecting vasculogenic impotence by color flow duplex ultrasonographic evaluation. The cavernosal artery peak systolic flow velocity (PSV), end diastolic flow velocity ( EDV) and resistance index (RI) were determined bilaterally at preinjection, and 5, 10 and 15 min. following the intracavernosal injection(ICI) of PGEl(10ug) and phentolamine (0.2mg) mixture. We classified the patients based on the underlying vasculogenic status into normal (NL group; n=8), arteriogenic impotence with or without venogenic incompetency (AI group; n=11) and venogenic incompetency alone (VI group; n=11). The PSV in NL group was greatest at 5 min. postinjection (45.8+/-12.0cm/s) and declined significantly with time (30.0+/-5.8 cm/s) (p <0.06 ) and also significantly greater than the value obtained by the AI group at each time interval (p<0.01) with the greatest difference at 5 min. post injection. The EDV in NL group was low (0.75+/-0.96 cm/s) at preinjection and increased initially postinjection to 7.5+/-7.9 cm/s at 5 min. postinjection but then declined significantly (p<0.05). The EDV in VI group was significantly greater than that of NL at each time intervals (p<0.05) with the greatest value recorded at 10 min. post injection (l5.0 =5.5 cm/s). The RIs in all the group did not vary with time following ICI but that of NL was significantly lower than that of VI at each time intervals (p<0.01 ). Our data suggest that serial measurement of flow parameters, especially EDV as the indirect marker of veno-occlusive function, is necessary for the comprehensive understanding of hemodynamic vascular process of vasculogenic impotence since the duplex ultrasonographic flow parameters dynamically interact against time following ICI.

The Effect of Measurement Location of the Blood Flow Parameters on Their Values During Penile Duplex Sonography / 대한비뇨기과학회지

Although several reference values of the cavernosal arterial flow velocity were reported for defining the normal vascular condition including good arterial inflow and corporal venoocclusive function, still we have some confusions and limitations to interpret the results because of lack of standardization of some various factors relating to performing duplex scanning. Here in, we evaluated the effect of cavernosal arterial location that is measured by Doppler spectrum on the values of blood flow velocity. 36 patients with suspecting vasculogenic impotence entered the study. Color duplex sonography was performed in all patients. We obtained velocity measurements at 3 to 8 min intervals in both cavernosal arteries for at least 20 min after injection of PGE1 10ug. The cavernosal artery peak systolic flow velocity (PSV) and end diastolic flow velocity (EDV) were measured at two portions. the base over the ascending portion of cavernosal artery( 'Proximal') and midshaft( 'Distal') of the penis in each session. We classified the patients based on the results of Proximal values of duplex parameters into normal(maximal PSV>30 cm/sec and minimal EDV30cm/sec and minimal EDV>5cm/sec; VI group n= 16). When we compared PSV values between two portions of measurement in each group all the Distal PSV values were significantly lower than Proximal(p0.05). If we considered only Distal values for patient grouping 63% of VI group and 50% of NL group had maximal PSV values less than 25cm/sec that would be reclassified into arterial insufficiency. On the other hand, resistance index(RI) values remained unchanged regardless of measurement location in all groups. With the above results we can conclude that there is an obvious difference of blood flow velocities between two portions of measurement(Proximal vs Distal) and Proximal value is more reliable than Distal when we diagnose with previously reported normal reference value (PSV>30-35cm/sec).