ABSTRACT
Background: Sonotherapy is used in carpal tunnel syndrome (CTS) treatment; continuous or pulsed ultrasound waves are commonly used. The aim was to assess the short and long-term effects of CTS treatment using continuous and pulsed ultrasound waves. Methods: This study was a randomized clinical trial. Forty-eight patients with mild and moderate CTS (20 unilateral and 28 bilateral) were subjected to complex physiotherapy. Complex physiotherapy included whirlpool massage, neuromobilization, and sonotherapy (continuous wave and pulsed wave ultrasound). The patients were randomly placed in two treatment groups and were subjected to sonotherapy with continuous or pulsed ultrasound waves. Seventy-six hands were assessed before, immediately after, and one year after treatment. Outcome measures included the Boston Carpal Tunnel Questionnaire (CTS SSS & FSS), computer-measured global handgrip force, provocative and functional tests, assessments of vegetative disorders, and sensation disorders. Results: Significant improvements in symptoms and parameters were observed after sonotherapy in both groups immediately after and one year after treatment. Long–term effects of CTS SSS & FSS for pulsed-wave amounted to p=0.0018, p=0.0001 while p=0.0003, p=0.0021 for continuous wave, respectively. Between the groups, a statistically significant difference was found in the change of muscle strength (p=0.0374) and Luthy's sign result (p=0.0262) between examination one and examination 3. Conclusions: Short and long-term effects of continuous and pulsed ultrasound wave in CTS treatment is comparable. Effects are influenced by energy density transmitted to tissues. Pulsed wave appears more effective in the long-term in improving the condition of hand muscles.
ABSTRACT
This study was performed to identify the relationships between hepatic vein (HV) measurements, including flow velocity and waveform, using pulsed-wave (PW) Doppler ultrasonography, and the severity of tricuspid regurgitation (TR) in dogs. The study included 22 dogs with TR and 7 healthy dogs. The TR group was subdivided into 3 groups according to TR jet profile obtained by echocardiography. The hepatic venous waveform was obtained and classified into 3 types. A variety of HV measurements, including the maximal velocities of the atrial systolic, systolic (S), end ventricular systolic, and diastolic (D) waves and the ratio of the S- and D- wave velocities (S/D ratio), were acquired. TR severity was significantly correlated with the S- (r = −0.380, p = 0.042) and D- (r = 0.468, p = 0.011) wave velocities and the S/D ratio (r = −0.747, p < 0.001). Receiver operating characteristic curve analysis revealed the highest sensitivity and specificity for the S/D ratio (89% and 75%, respectively) at a threshold of 0.97 with excellent accuracy (AUC = 0.911, p < 0.001). In conclusion, PW Doppler ultrasonography of the HV can be used to identify the presence of significant TR and to classify TR severity in dogs.
Subject(s)
Animals , Dogs , Echocardiography , Hepatic Veins , ROC Curve , Sensitivity and Specificity , Tricuspid Valve Insufficiency , Ultrasonography, DopplerABSTRACT
Meios de contraste iodado podem promover efeitos hemodinâmicos relacionados à vasoconstrição intrarrenal prolongada e redução da perfusão, predispondo à hipóxia e isquemia medular. Alterações de resistência vascular renal podem representar os primeiros sinais de mudança funcional desse órgão. A técnica Doppler pulsado é considerada acessível, não invasiva e permite avaliar a dinâmica vascular dos rins, por meio da aferição dos índices de resistividade (IR) e pulsatilidade (IP). Contudo, na espécie canina, a aquisição de traçados espectrais pode ser penosa devido às dificuldades de varredura e captação de sinal Doppler, sobretudo em relação ao rim direito, devido à sua localização dorsocranial na cavidade abdominal, o que prolonga substancialmente a realização do exame. O objetivo deste estudo é comprovar que a avaliação Doppler pulsado das artérias intrarrenais do rim esquerdo de cães representa a repercussão hemodinâmica renal da administração intravenosa de meios de contraste iodado não sendo necessária a realização do exame nos dois rins. Foram avaliados ambos os rins de seis cadelas adultas em quatro momentos distintos: antes da infusão intravenosa do contraste radiológico e após 1,5 horas, 24 horas e 48 horas, por meio da análise subjetiva da morfologia, ecogenicidade cortical e grau de perfusão renais e análise objetiva do comprimento, volume e resistência vascular intrarrenais (IR e IP). Os parâmetros avaliados ao modo B e Doppler dos rins direito e esquerdo não apresentaram diferenças estatisticamente significativas entre si em cada momento avaliado. Assim, constatou-se que o exame ultrassonográfico Doppler pulsado do rim esquerdo representou a repercussão hemodinâmica renal da aplicação intravenosa de meios de contraste iodado, desde que morfometria, morfologia, ecogenicidade cortical e perfusão de ambos os rins fossem consideradas semelhantes na abordagem ultrassonográfica inicial...
Iodinated contrast media can provide hemodynamic effects related to prolonged intrarenal vasoconstriction and reduced perfusion, predisposing to hypoxia and medular ischemia. Changes in the renal vascular resistance may represent the first sign of impaired renal function. Pulsed wave Doppler sonography is low cost, non-invasive and allows renal hemodynamic evaluation by resistivity (RI) and pulsatility (PI) indices. However in dogs, spectral Doppler waveform may be hard to obtain due to scanning difficulties and lack of signal Doppler. This fact occurs mostly in the right kidney because of its cranial and dorsal position in the abdominal cavity and may prolong the exam. The purpose of this study is to prove that the pulsed wave Doppler interrogation of the canine left kidney intrarenal arteries represent the renal hemodynamic effects of intravenous administration of iodinated contrast media and is not necessary to perform the exam in both kidneys. Right and left kidneys of six adult dogs were evaluated at four different times: before intravenous contrast infusion and after 1.5 hours, 24 hours and 48 hours, subjectively by using renal morphology, cortical echogenicity and renal perfusion, and objectively by using renal length, renal volume and intrarenal vascular resistance (RI and PI). No significant differences were noted between the parameters assessed by B mode and Doppler sonography of the right and left kidney in each evaluated moment. Thus, it was noted that pulsed wave Doppler sonographic evaluation of the left kidney represented the renal hemodynamic response of intravenous iodinated contrast media administration, only if both kidneys presented similar morphometry, morphology, cortical echogenicity, and perfusion during the first assessment...
Subject(s)
Animals , Female , Dogs , Kidney , Ultrasonography, Doppler, Pulsed , Ultrasonography, Doppler, Pulsed/veterinary , Ultrasonography , Ultrasonography/veterinary , Renal Artery , Hemodynamics , Contrast MediaABSTRACT
Avaliaram-se com Doppler pulsátil os fluxos das valvas aórtica (AO) e pulmonar (Pul) por meio de análise qualitativa (presença de regurgitações valvares e características do espectro avaliado) e quantitativa, com obtenção de parâmetros ecocardiográficos como velocidades máxima (V. Max.) e média (V. Me.), integral de velocidade (VTI), tempo de aceleração (TA) e ejeção (TE), de 30 cães considerados clinicamente sadios por meio de exames físico, laboratoriais, eletrocardiográfico, ecocardiográfico (modos uni e bidimensional), radiográfico de tórax e mensuração da pressão arterial sistêmica. Obtiveram-se os seguintes resultados para os referidos parâmetros: V.max. AO= 1,22± 19,38m/s; V. Me. AO= 0,72± 0,08m/s; VTI AO= 0,14± 0,02m; TA AO= 38,80± 11,29ms; TE AO= 197,90± 24,77ms; V. Max. Pul= 0,95± 0,18m/s; V. Me. Pul= 0,63± 0,10m/s; VTI Pul= 0,13± 0,02m; TA Pul= 70,97± 18,87ms; TE Pul= 203,70± 28,98ms. Em apenas três animais observou-se regurgitação pulmonar. Alguns parâmetros apresentaram correlação negativa com a variável freqüência cardíaca (VTI AO, TE AO, VTI Pul, TA Pul, TE Pul); outros correlação positiva com a variável peso (VTI AO, TA AO, TE AO, VTI Pul, TE Pul,) e não se observou influência da variável sexo na maioria dos parâmetros avaliados. Na comparação entre os dois fluxos, observaram-se V. Max. AO e V. Me. AO maiores que V. Max. Pul. e V. Me. Pul., respectivamente, VTI AO maior que VTI Pul, e TA AO menor que TA Pul.
This study evaluated aortic (AO) and pulmonary (Pul)valves flow with pulsed-wave Doppler by qualitative (presence of valvar insufficiency and characteristic of flow profile) and quantitative analysis, and the following echocardiographic parameters were obtained: peak (PV) and mean (MV) velocities, velocity-time integral (VTI), acceleration (AT) and ejection (ET) time. Thirty dogs were studied, and to be considered normal, physical, laboratory, electrocardiographic, echocardiographic (uni and bidimensional mode) exams, thoracic radiography, and measurement of the blood pressure were accomplished, and the following echocardiographic parameters were obtained: AO PV= 1.22± 19.38m/s; AO MV= 0.72± 0.08m/s; AO VTI= 0.14± 0.02m; AO AT= 38.80± 11.29ms; AO ET= 197.90± 24.77ms; Pul PV= 0.95± 0.18m/s; Pul MV= 0.63± 0.10m/s; Pul VTI= 0.13± 0.02m; Pul AT= 70.97± 18.87ms; Pul ET= 203.70± 28.98ms. Heart rate presented negative correlation with AO VTI, AO ET, Pul VTI, Pul AT, Pul ET, and the variable weight had positive correlation with AO VTI, AO AT, AO ET, Pul VTI, Pul ET, differently from the gender, that had no influence on the evaluated parameters. The comparison of aortic and pulmonary valves flow demonstrated AO PV and AO MV higher than Pul PV and Pul MV, respectively, AO VTI higher than Pul VTI, and Pul AT higher than AO AT.
Subject(s)
Animals , Dogs , Echocardiography, Doppler, Pulsed , Diagnostic Techniques, Cardiovascular/veterinary , Heart Diseases/veterinary , DogsABSTRACT
Objective To evaluate the distribution characteristics of left ventricular systolic dyssynchrony (LV-SD) in dilated cardiomyopathy (DCM) patients with chronic heart failure (CHF) and normal QRS wave width, by pulsed-wave Doppler tissue imaging (PW-DTI), and study its relation with left ventricular systolic function, ventricular remodeling, and functional mitral regurgitation (FMR). Methods The time to peak systolic velocity (Ts) in 12 left ventricular segments was evaluated by PW-DTI, from which the standard deviation (SD) of Ts in the 12 segments (Ts-SD) and maximum Ts difference (Ts-maxD) were calculated. Results Ts-SD and Ts-maxD in the 12 LV segments of the DCM patients with CHF were significantly higher than those of the healthy controls (P＜0.01). In DCM patients with CHF and normal QRS wave width, the incidence of LV-SD was 29.8% (14/47) and the inferior wall was the most frequent distribution site of contraction delay. Linear regression analysis revealed a negative correlation between Ts-SD, Ts-maxD, and left ventricular ejection fraction (LVEF) (P＜0.01), but a positive correlation between Ts-SD, Ts-maxD and left ventricular end-diastolic volume (LVEDV), lefe ventricular end-systolic volume (LVESV), New York Heart Association (NYHA) cardiac function, FMR (P＜0.01) in DCM patients with CHF. Conclusion LV-SD exists in DCM patients with normal QRS width. LV-SD aggravates the LV systolic function damage, which is closely associated with left ventricular remodeling. LV-SD may contribute to the FMR in DCM patients.
ABSTRACT
Left ventricular diastolic dysfunction plays an important role on heart failure progression. In order to obtain additional reference values of left ventricular diastolic parameters and investigate influence of common variables, peak E wave (peak E), peak A wave (peak A), E/A ratio (E/A), E wave deceleration time (EDT) and isovolumic relaxation time (IRVT) were studied in 40 clinically healthy dogs, by pulsed wave Doppler. The following values were obtained: peak E = 0.747 ± 0.117 m/s, peak A = 0.487 ± 0.062 m/s, E/A = 1.533 ± 0.198, EDT = 88.7 ± 9.2 ms and IRVT = 0.080 ± 0.009 s. Some parameters were influenced by heart rate (peak E, peak A and IRVT), by age (peak A and E/A) and by body weight (TRIV). Gender influence was absent. Values obtained can be used as reference for canine specimens but its interpretation should consider on the influence of related variables.
A disfunção diastólica do ventrículo esquerdo contribui de maneira importante para a progressão da insuficiência cardíaca. No intuito de obter valores de referência adicionais para os parâmetros diastólicos do ventrículo esquerdo e para investigar a influência de variáveis comuns, estudou-se, por meio de Doppler pulsátil, a velocidade máxima da onda E (Vmáx.E), a velocidade máxima da onda A (Vmáx.: A), a relação E/A (E/A), o tempo de desaceleração da onda E (TDE) e o tempo de relaxamento isovolumétrico (TRIV) em 40 cães clinicamente saudáveis. Os seguintes valores foram obtidos: Vmáx.E = 0,747±0,117m/s, Vmáx.A = 0,487±0,062m/s, E/A = 1,533±0,198, TDE = 88,7±9,2ms e TRIV = 0,080±0,009s. Alguns parâmetros foram influenciados pela freqüência cardíaca (Vmáx.E, Vmáx.A e TRIV), pela idade (Vmáx.A e E/A) e pelo peso corpóreo (TRIV). Não houve influência pelo sexo. Os valores obtidos podem ser utilizados como referência para a espécie canina, porém devem ser interpretados considerando-se a influência das variáveis descritas.
Subject(s)
Animals , Dogs , Heart Ventricles , Heart Failure, Diastolic/diagnosis , Ultrasonography, Doppler, PulsedABSTRACT
Objective: To assess the regional systolic and diastolic function of left ventricle before and after coronary stent implantation by pulsed wave Doppler tissue imaging (PW-DTI). Methods: Twenty-six patients with coronary artery disease ( CAD) involving only left anterior descending coronary artery ( LAD) were examined within 1-3 days before, 7 days and 30 days after coronary stenting with PW-DTI. Peak systolic , peak early diastolic, and peak late diastolic motion velocities ( Sm, Em, and Am respectively) were measured at 6 different sites on the basal and medial segments corresponding to the anteroseptal, postero-septal, lateral, anterior, inferior, and posterior walls of the left ventricle. Results:In corresponding segments depending on LAD blood flow supply, Sm was increased significantly 7 days after the stenting proce- dure. Em was also increased 7 days after the procedure in most of the corresponding segments. There were little changes in other segments that were independent on LAD blood flow supply. Conclusion: These findings suggest that there is an early improvement in the regional systolic and diastolic function of the left ventricle after the coronary stenting, and that PW-DTI techniques could evaluate quantitatively the regional ventricular performance in patients receiving percutaneous coronary intervention.
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Pulsed wave Doppler echocardiograpdy was performed in eighteen cases with chronic mitral regurgitation(CMR)and 21 normal individuals td detect the quantitative changes of the mitral diastolic flow spectrum.The results showed that the pseudonormalization of mitral flow spectrum in CMR was actually caused by impaired left ventricle(LV)active relaxation and decreased LV compliance:It thus masked the LV diastolic dysfunction in CMR.E-wave pressure gradiant(E-PG),A-wave pressure gradiant(A-PG),isovolumic relaxation time(IVRT),E deceleration time(E-DT)and LV filling time(LVFT)in CMR group were significantly different in from those in normal group(P<0.01).Therefore it is essential to integrate these parameters as the indexes to evaluate the LV diastolic dysfunction in CMR.