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Resumo Contexto A cirurgia de revascularização é proposta para restaurar o fluxo sanguíneo para o pé nos casos de isquemia crítica (IC) devido a doença arterial obstrutiva periférica dos membros inferiores (MMII). O uso de ultrassonografia com Doppler (USD) vem despontando nos últimos anos como um método de grande valor para o planejamento cirúrgico dessa intervenção. Objetivos Avaliar a relação entre o índice de resistência (IR), mensurado por meio de USD, e o sucesso hemodinâmico imediato da cirurgia de revascularização dos MMII em pacientes com IC. Métodos O tipo de estudo empregado foi a coorte prospectiva, na qual foram avaliados 46 pacientes portadores de IC dos MMII submetidos à operação de revascularização infrainguinal por angioplastia ou em ponte de agosto de 2019 a fevereiro de 2022. Todos os pacientes foram submetidos à avaliação clínica vascular, à USD com medida do IR das artérias distais dos MMII, à arteriografia dos MMII e à aferição do índice tornozelo-braquial (ITB) no período pré-operatório. No pós-operatório imediato, todos os pacientes foram submetidos à nova aferição do ITB. Resultados Entre os 46 pacientes avaliados, 25 (54,3%) eram do sexo masculino. A idade variou de 32 a 89 anos (média de 67,83). Quanto ao sucesso hemodinâmico, avaliado pela comparação do ITB pré e pós-operatório, constatou-se que 31 (67,4%) pacientes apresentaram sucesso hemodinâmico após cirurgia de revascularização (aumento do ITB em 0,15 ou mais). Foi observada correlação positiva (p ≤ 0,05) entre o IR da artéria distal revascularizada do MMII e o sucesso hemodinâmico imediato avaliado pela aferição do ITB (IR menor e sucesso hemodinâmico). Conclusões Na presente pesquisa foi observada uma correlação positiva entre o índice de resistência arterial distal e o sucesso hemodinâmico nas revascularizações dos membros inferiores, avaliada através do índice tornozelobraquial, de forma que, quanto menor foi o IR, maior o sucesso hemodinâmico obtido.
Abstract Background Revascularization surgery is used to attempt to restore blood flow to the foot in patients with critical ischemia (CI) caused by peripheral arterial occlusive disease of the lower limbs (LL). Ultrasonography with Doppler (USD) SAH emerged in recent years as a highly valuable method for planning this surgical intervention. Objectives To evaluate the relationship between the resistance index (RI), measured with USD, and immediate hemodynamic success of LL revascularization surgery in patients with CI. Methods The study design was a prospective cohort assessing 46 patients with LL CLI who underwent operations to perform infrainguinal revascularization by angioplasty or bypass from August 2019 to February 2022. All patients underwent preoperative clinical vascular assessment with USD including measurement of the RI of distal LL arteries, LL arteriography, and measurement of the ankle-brachial index (ABI). All patients had their ABI measured again in the immediate postoperative period. Results Forty-six patients were assessed, 25 (54.3%) of whom were male. Age varied from 32 to 89 years (mean: 67.83). Hemodynamic success was assessed by comparison of preoperative and postoperative ABI, showing that hemodynamic success was achieved in 31 (67.4%) patients after revascularization surgery (ABI increased by 0.15 or more). A positive correlation (p ≤ 0.05) was observed between the RI of the distal revascularized LL artery and immediate hemodynamic success assessed by ABI (lower RI and hemodynamic success). Conclusions This study observed a positive correlation between the resistance index of the distal artery and immediate hemodynamic success of lower limb revascularizations, as assessed by the ankle-brachial index, so that the lower the RI the greater the hemodynamic success achieved.
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SUMMARY OBJECTIVE: Round shape is generally considered to reduce the risk of malignancy according to recent guidelines. On the contrary, according to some reports, spherically shaped thyroid nodules are associated with a higher risk of malignancy. Thus, we aimed to evaluate the malignancy risk of solid round isoechoic nodules detected at thyroid ultrasonography and compare it with that of solid ovoid isoechoic nodules. METHODS: Between 2017 and 2022, solitary solid round isoechoic nodules with diameters ³10 and £25 mm at thyroid ultrasonography were retrospectively selected and enrolled in the study. Age, size, nodule volume, serum thyrotropin levels, thyroid antibody levels, and cytopathological and histopathological results were recorded. RESULTS: A total of 457 solitary solid isoechoechoic nodules from 457 patients (262 females and 195 males; median age, 59 [31-70] years) were selected, of which 203 were solid round isoechoic nodules, and 254 were solid ovoid isoechoic nodules. A total of 54 surgical operations were performed on 457 nodules, and 31 of them resulted in malignancy. From the 31 malignant results, 25 originated from solid round isoechoic nodules and the remaining 6 originated from solid ovoid isoechoic nodules (p<0.025). CONCLUSION: We found that round nodules have higher malignancy rates than ovoid nodules. We think that ultrasonographic risk stratification systems used to target the most suitable nodules for the necessary biopsies can be dynamically updated, and sphericity can be added as a parameter in patient-based decision-making.
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Abstract Objectives: to evaluate the relationship between the ductus venosus (DV) and the variables of fetal growth in the first trimester in a Colombian pregnant population. Methods: a descriptive cross-sectional study was carried out with secondary data obtained from a multicenter study.526 patients were included between weeks 11 and 14 for gestational ultrasound follow-up attended in three health care institutions in Bogotá, Colombia, between May 2014 and October 2018. A bivariate descriptive analysis was carried out where the relationship between the characteristics of the DV in the first trimester and ultrasound findings. Results: the flow wave of the DV in the first trimester was normal in the entire sample, with a pulsatility index of the ductus venosus (DVPI) of 0.96±0.18. In addition, a negative correlation was found between the crown-rump length (CRL) and the DVPI (p<0.05). Conclusion: there is a relationship between the DVPI regarding the CRL, indicating an interest in this early marker in relation to fetal growth alterations; however, more studies are required to determine the usefulness of this variable with respect to fetal growth.
Resumen Objetivos: evaluar la relación entre el ductus venoso (DV) y las variables del crecimiento fetal en primer trimestre en una población de gestantes colombianas. Métodos: se realizó un estudio transversal descriptivo con datos secundarios obtenidos de un estudio multicéntrico. Se incluyeron 526 pacientes entre las semanas 11 a 14 para seguimiento ecográfico gestacional atendidas en tres instituciones prestadoras de salud en Bogotá, Colombia, entre mayo del 2014 y octubre del 2018. Se realizó un análisis descriptivo bivariado donde se evaluó la relación entre las características del DV en primer trimestre y los hallazgos ecográficos. Resultados: la onda de flujo del DV en primer trimestre fue normal en la totalidad de la muestra, con un índice medio de pulsatilidad del ductus venoso (IPDV) de 0,96±0.18. Se encontró una correlación negativa entre la longitud cefalocaudal (LCC) y el IPDV (p<0.05). Conclusión: existe una relación entre el IPDV respecto a la LCC, señalando un interés de este marcador temprano en relación con las alteraciones del crecimiento fetal, sin embargo, se requieren más estudios para determinar la utilidad entre esta variable respecto al crecimiento fetal
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Humans , Female , Pregnancy , Placental Insufficiency , Pregnancy Trimester, First , Ultrasonography, Doppler/methods , Pregnancy, High-Risk , Crown-Rump Length , Fetal Growth Retardation/diagnostic imaging , Hemodynamic Monitoring , Cross-Sectional Studies , ColombiaABSTRACT
Resumo Na esteira de estudos direcionados à placa aterosclerótica e em busca de variáveis quantificáveis que adicionem informações à tomada de decisão terapêutica, a avaliação a partir de elastografia shear wave (SWE) se apresenta como alternativa reprodutível e promissora. Utilizamos um único aparelho Logiq S8 (General Electric, Boston, Massachusetts, Estados Unidos) com um transdutor linear multifrequencial 8,5-11 MHz em 10 MHz em corte longitudinal. Consideramos critérios relevantes para a aquisição de imagem: adequada insonação longitudinal, diferenciação do complexo médio-intimal, delineamento de túnicas adventícias proximal e distal, lúmen vascular, boa visualização da placa aterosclerótica, ciclo em diástole ventricular e ausência de alterações incongruentes. A SWE é um método emergente e extremamente promissor no contexto da avaliação de placas carotídeas, podendo contribuir no futuro para a tomada de decisão terapêutica baseada em características relativas à placa aterosclerótica de forma reprodutível entre aparelhos e examinadores.
Abstract In the wake of studies targeting atherosclerotic plaques and searching for quantifiable variables that contribute additional information to therapeutic decision-making, plaque assessment using Shear Wave Elastography (SWE) is emerging as a reproducible and promising alternative. We used a single Logiq S8 device (General Electric, Boston, Massachusetts, United States) with an 8.5-11MHz multifrequency linear transducer at 10MHz in longitudinal section. We considered relevant criteria for image acquisition: adequate longitudinal insonation, differentiation of the intima-media complex, delineation of proximal and distal tunica adventitia and the vascular lumen, good visualization of the atherosclerotic plaque, cardiac cycle in ventricular diastole, and absence of incongruous changes. SWE is an emerging and extremely promising method for assessment of carotid plaques that may contribute to therapeutic decision-making based on characteristics related to the atherosclerotic plaque, with inter-device and inter-examiner reproducibility.
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Abstract Introduction Transthoracic echocardiography is a safe and readily available tool for noninvasive monitoring of Cardiac Output (CO). The use of the suprasternal window situated at the sternal notch can be an alternative approach for estimating blood flow. The present study aimed to compare two methods of CO calculation. We compared the descending aorta Velocity-Time Integral (VTI) measurement from the suprasternal window view with the standard technique to determine CO that uses VTI measurements from the LVOT (Left Ventricular Outflow Tract) view. We also aimed to find out whether after basic training a non-echocardiographer operator can obtain reproducible measurements of VTI using this approach. Methods In the first part of the study, 26 patients without known cardiovascular diseases were evaluated and VTI data were acquired from the suprasternal window by a non-echocardiographer and an echocardiographer. Next, 17 patients were evaluated by an echocardiographer only and VTI and CO measurements were obtained from suprasternal and apical windows. Data were analyzed using the Bland and Altman method (BA), correlation and regression. Results We found a strong correlation between measurements obtained by a non-expert and an expert echocardiographer and detected that an inexperienced trainee can acquire VTI measurements from the suprasternal window view. Regarding agreement between CO measurements, data obtained showed a positive correlation and the Bland and Altman analysis presented a total variation of 38.9%. Conclusion Regarding accuracy, it is likely that TTE (Transthoracic Echocardiogram) measurements of CO from the suprasternal window view are comparable to other minimally invasive techniques currently available. Due to its user-friendliness and low cost, it can be a convenient technique for obtaining perioperative hemodynamic measurements, even by inexperienced operators.
Subject(s)
Humans , Echocardiography/methods , Anesthesiologists , Cardiac Output/physiology , Heart , HemodynamicsABSTRACT
Abstract Background Giant cell arteritis (GCA) is the most common primary systemic vasculitis in people 50 years of age and over, and it is considered a medical emergency due to the potential risk of permanent visual loss. Color Doppler ultrasound (CDU) of the temporal arteries is a rapid, noninvasive method to diagnose GCA. This study aims to determine the diagnostic accuracy of the halo sign in temporal arteries by CDU in people with suspected GCA. Methods The systematic literature review included the search for publications in the following electronic databases: PubMed, Embase, CENTRAL, LILACS, WHO ICTRP, ClinicalTrials.gov, gray literature up to December 2022, and no date or language restrictions were applied. We analyzed studies including patients over 50 years of age with suspected GCA evaluating CDU of temporal arteries as a diagnostic tool against clinical diagnosis as a standard reference. Paper titles and abstracts were selected by two investigators independently for all available records. The quality of the studies was assessed using the Quality of Diagnostic Accuracy Studies tool (QUADAS-2) and the R software (version 4.2.1) was used for data analysis. The protocol of this review is registered with PROSPERO (CRD42016033079). Results Twenty-two studies including 2893 participants with suspected GCA who underwent temporal artery CDU were evaluated. The primary analysis results showed a sensitivity of 0.76 [95% confidence interval (95 CI) 0.69-0.81] and specificity of 0.93 (95 CI 0.89-0.95) when the halo sign was compared to clinical diagnosis. The sensitivity value of 0.84 (95 CI 0.72-0.92) and specificity of 0.95 (95 CI 0.88-0.98) were found in five studies involving 1037 participants that analyzed the halo sign and temporal artery compression sign. A sensitivity of 0.86 (95 CI 0.78-0.91) and specificity of 0.95 (95 CI 0.89-0.98) were found in four studies with 603 participants where the halo sign was evaluated CDU on temporal and axillary arteries. Conclusion The detection of the halo sign by CDU of temporal arteries has good accuracy for the diagnosis of cranial GCA. The compression sign in temporal arteries and the addition of axillary arteries assessment improves the diagnostic performance of CDU for GCA. Trial registration PROSPERO CRD42016046860.
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【Objective】 To investigate the efficacy of low intensity pulsed ultrasound (LIPUS) in the treatment of erectile dysfunction (ED). 【Methods】 A total of 121 ED patients treated during June 2020 and June 2022 were selected as the research objects. According to the International Erectile Index Score (IIEF-EF), the patients were divided into three subgroups:mild (17-25 points), moderate (11-16 points), and severe (0-10 points). The total effective rate, erectile hardness scale (EHS), sex life log questions (SEP), general assessment questionnaire (GAQ), peak systolic velocity (PSV), end diastolic velocity (EDV), and adverse reactions of the three groups before treatment, 4 weeks and 12 weeks after treatment were analyzed. 【Results】 A total of 119 patients completed the follow-up. There were significant increases in IIEF-EF and EHS at week 4 and 12 (P<0.05), and the total effective rate was 69.75% and 76.47%, respectively. The total effective rate was significantly higher in the mild and moderate groups than in the severe group at week 4 and 12 (P<0.05). The patients who answered "yes" to SEP2 and SEP3 accounted for 91.60% and 71.43%, respectively at week 4, and 92.44% and 78.15% at week 12, both significantly higher than the rates before treatment (52.10% and 27.73%, P<0.05). The proportion of patients who answered "yes" to GAQl and GAQ2 at week 4 were 84.87% and 71.43%, respectively, and were 82.35% and 70.59% respectively at week 12, with no significant difference. The PSV level significantly increased at week 12 compared to that before treatment [(48.85±14.11) cm/s vs. (41.42±14.90) cm/s] (P<0.05), while the EDV level significantly decreased [(-0.57±7.01) cm/s vs. (2.25± 5.68)cm/s] (P<0.05). 【Conclusion】 LIPUS can improve erectile function in ED patients without obvious adverse reactions.
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Objective:To evaluate the hemodynamic changes and short-term (one year) outcomes after superficial temporal artery(STA)-middle cerebral artery (MCA) bypass by vascular ultrasonography.Methods:Operation group included a total of 41 hemispheres of 38 patients who underwent STA-MCA bypass for severe stenosis or occlusion of MCA or severe stenosis or occlusion of internal carotid artery(ICA), or Moyamoya disease at Xuanwu Hospital between August 2017 and June 2020. The following examinations were performed in all patients: cranial MRI, CT perfusion imaging, and cerebral angiography. All of the patients were retrospectively followed up for one year postsurgery. Normal group included a total of 40 hemispheres of 20 healthy people who had been examined by vascular ultrasonography of carotid artery and intracranial artery. Inner diameter, peak systolic velocity (PSV), end-diastolic velocity (EDV), mean velocity (MV), resistance index (RI), pulsatility index (PI) and flow of STA, PSV, EDV, MV, PI, RI of external carotid artery (ECA) and PSV, EDV, MV, PI, RI of MCA at 1 week, 6 months and 12 months after STA-MCA bypass of operation group were compared with normal group.Results:①Inner diameter, PSV, MV and flow of STA were increased significantly in operation group at 1 week, 6 and 12 months than normal group (all P<0.05). The flow of STA was decreased significantly from 1 week to 12 months after operation (all P<0.05), but Inner diameter, PSV and MV were only decreased gradually from 1 week to 12 months after operation (all P>0.05). ②STA/ECA PI and RI decreased significantly after operation compared with normal group (all P<0.01). Conclusions:Vascular ultrasonography is a non-invasive examination which can objectively evaluate the extracranial and intracranial hemodynamic changes after STA-MCA bypass, and provide reference effectiveness of the operation. The flow of STA has decreased gradually from 1 week to 12 months after operation to achieve the homeostasis, but it is still higher than normal.STA/ECA PI and RI can be a steady indirect pointer to show the fluency of bypass.
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Doppler ultrasonography is the main modality for imaging of hemodialysis AV ?stula as it is safe and non-invasive. This study is to measure the Arterio-venous (AV) ?stula blood ?ow during early postoperative period (0–7days) and assess its role in AV ?stula failure prediction. Doppler ultrasonography was used to estimate the blood ?ow in the AV ?stula of 50 patients at (0–7days) after the ?stula was made. The blood ?ow in ?stula during early postoperative period for ?stula failure was evaluated, and long term failure was predicted. Blood ?ow rates Method measured in arteriovenous ?stula created in upper extremity were measured in ?rst week and sixth week post-operative. Results After follow up evaluation out of 50 patients, 40 ?stulas considered to be matured; 10 considered failed. 30% failure were males and 70% were female. In early post operative period, cut off was set at 182 ml/min and the sensitivity of blood ?ow for prediction of ?stula failure is 98%, speci?city 90 %, PPV 95% and NPV 90%. Measurements of the AV ?stula blood Conclusion ?ow in proximal artery and draining vein with its diameter of lumen were noted in the early postoperative period has a role predicting AV ?stula failure. There is risk of failure if the blood ?ow less than 182 ml/min (day 0–7)
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Resumen Introducción: Los rangos de referencia de población específica para el índice de pulsatilidad medio de la arteria uterina (IPmAUt) durante el embarazo han demostrado valor en el cuidado prenatal. Objetivo: Construir valores de referencia para el IPmAUt durante el embarazo, personalizados por características maternas, medición transvaginal y presión arterial en una población mexicana. Métodos: Estudio transversal de 2286 embarazos normales de feto único en la Ciudad de México. La presión arterial y el IPmAUt se midieron mediante metodología estandarizada. Se construyeron rangos de referencia por gestación. Los efectos de las variables independientes se probaron mediante regresión lineal múltiple. Resultados: La mediana del IPmAUt entre las 11 y 41 semanas disminuyó de 1.714 a 0.523. El percentil 95 disminuyó de 2.600 a 0.653. La paridad sin preeclampsia previa representó el principal efecto sobre el IPmAUt. La presión arterial media tuvo efecto sobre el IPmAUt por interacción con la paridad. La preeclampsia previa tuvo efecto sobre el IPmAUt por interacción con las características maternas. Se obtuvo un factor de corrección para medición transvaginal. Conclusiones: El IPmAUt disminuye normalmente según la placentación y adaptación materna al embarazo. Los efectos de la paridad sobre la presión arterial y el IPmAUt podrían reflejar remodelación cardiovascular posterior a la gestación.
Abstract Introduction: Population-specific reference ranges for uterine artery (UtA) mean pulsatility index (PI) throughout pregnancy have been shown to be of value in antenatal care. Objective: To construct reference values for UtA mean PI throughout pregnancy, customized by maternal characteristics, transvaginal measurement and blood pressure in a Mexican population. Methods: Cross-sectional study in 2286 normal singleton pregnancies in Mexico City. Blood pressure and UtA mean PI were measured using standardized methodology. Reference ranges by gestation were constructed. The effects of independent variables were tested by multiple linear regression. Results: UtA mean PI median value between 11 and 41 weeks decreased from 1.714 to 0.523. The 95th percentile decreased from 2.600 to 0.653. Previous parity without preeclampsia had the main effect on UtA mean PI. Mean blood pressure had an effect on UtA mean PI by interaction with parity. Previous preeclampsia had an effect on UtA mean PI by interaction with maternal characteristics. A correction factor was obtained for transvaginal measurement. Conclusions: UtA mean PI usually decreases according to placentation and maternal adaptation to pregnancy. The effects of parity on blood pressure and UtA mean PI might reflect cardiovascular remodeling after gestation.
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Abstract Background: Nail psoriasis occurs frequently in patients with psoriatic disease, it can lead to functional impairment, pain, discomfort, decreased quality of life and can also be a predictor for the development of arthritis. Early recognition of this condition can provide early and effective treatment and prevent structural impairment. This study aims to identify nail ultrasonographic characteristics in three groups: psoriasis (PsO), psoriatic arthritis (PsA) and controls patients, to determine if the ultrasonography (US) can identify early signs of nail psoriatic impairment or local inflammation. We conducted nail US to determine nail matrix resistance index (NMRI), nail bed resistance index (NBRI), and power Doppler (PD) and grayscale (GS) parameters in these 3 groups. Methods: Single-center, cross-sectional study. GS, PD, and spectral doppler images of bilateral 2nd and 3rd fingernails were acquired from 35 PsO, 31 PsA, and 35 controls patients. An US equipment with an 18 MHz linear transducer for GS and 8.0 MHz for PD was used. PD, NMRI, NBRI, nail plate thickness (NPT), nail bed thickness (NBT), nail matrix thickness (NMT), and morphostructural characteristics of the trilaminar structure (TS) were evaluated in saved images, blind. Results: Mean NMRI and NBRI did not differ between groups. Linear regression analysis detected no relationships between PsO or PsA and NMRI or NBRI. Nail PD grade did not differ between groups. Type I and IV TS changes were more frequent in PsO; types II and III changes were more frequent in PsA (p < 0.001). NPT was greater in PsA and PsO groups than controls: PsA 0.73 ± 0.14 mm, PsO 0.72 ± 0.15 mm, Controls 0.67 ± 0.10mm (p = 0.001). Conclusion: Echographic TS characteristics of the nail plate and NPT evaluated by GS are useful and can distinguish PsO and PsA nails from controls. NMRI, NBRI, and US nail microcirculation parameters could not distinguish psoriatic nails. Trial registration: 72762317.4.0000.5327 (Certificate of Presentation of Ethical Appreciation - CAAE -Plataforma Brasil) Avaiable in https://plataformabrasil.saude.gov.br/login.jsf
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The objectives of this study were to characterize the endometritis induced in mares using color Doppler ultrasonography and traditional exams. Experiment 1. Mares (n=20) were submitted to intrauterine inoculation with Escherichia coli. Uterine evaluation was performed at M0 and M1. Experiment 2. Animals were divided into two groups: control group (n=10), and treated group (n=10) using phytotherapeutic solution. In both groups, the uterine evaluation was performed at time T1, T2, and T3. Experiment 3: Uterine evaluation was compared after antibiotic therapy, phytotherapy, and M0. For statistical analysis, the Tukey test, t Student, and Anova test were applied. Experiment 1. The mean values of vascularization at M1 were significantly higher than those obtained at M0 (P<0.05). Bacterial growth was observed in all samples collected. Experiment 2. The mean value of vascularization at time T1 in both groups was significantly higher (P<0.05) compared to M2 and M3. Experiment 3. After antibiotic therapy, the vascularization of the body and uterine horns was not equivalent to the vascularization presented at M0. We can conclude that it was not possible to correlate results obtained by color Doppler ultrasonography with the traditional findings for the diagnosis of endometritis.(AU)
Os objetivos deste estudo foram caracterizar a endometrite induzida em éguas utilizando-se a ultrassonografia com Doppler colorido e exames tradicionais. Experimento 1: as éguas (n=20) foram submetidas à inoculação intrauterina com Escherichia coli. A avaliação uterina foi realizada em M0 e M1. Experimento 2: os animais foram divididos em dois grupos: grupo controle (n=10) e grupo tratado (n=10), sendo usada solução fitoterápica. Nos dois grupos, a avaliação uterina ocorreu nos momentos T1, T2 e T3. Experimento 3: a avaliação uterina foi comparada após antibioticoterapia, fitoterapia e M0. Para análise estatística, foram aplicados os testes de Tukey, t de Student e ANOVA. Experimento 1: os valores médios de vascularização em M1 foram significativamente maiores que os obtidos no M0 (P<0,05). Houve crescimento bacteriano em todas as amostras coletadas. Experimento 2: o valor médio da vascularização no tempo T1 nos dois grupos foi significativamente maior (P<0,05) do que o obtido em M2 e M3. Experimento 3: após antibioticoterapia, a vascularização do corpo e dos cornos uterinos não era equivalente à vascularização apresentada em M0. Pode-se concluir que não foi possível correlacionar os resultados obtidos pela ultrassonografia com Doppler colorido com os achados tradicionais para o diagnóstico de endometrite.(AU)
Subject(s)
Animals , Female , Endometritis/chemically induced , Endometritis/veterinary , Endometritis/diagnostic imaging , Horses , Perfusion/veterinary , Ultrasonography, Doppler/veterinary , Escherichia coliABSTRACT
Venous thrombosis (VT) of deep vein is a life-threatening condition which may lead to sudden death as an immediate complication due to formation of thrombo-embolism. VT is associated with various risk factors such as prolonged immobilization, inflammation, and/or coagulation disorders including muscular or venous injury. Deep venous thrombosis (DVT) frequently occurs in the lower limb. Successful treatment of DVT exclusively with homeopathic remedies has rarely been recorded in peer-reviewed journals. The present case report intends to record yet another case of DVT in an old patient totally cured exclusively by the non-invasive method of treatment with micro doses of potentized homeopathic drugs selected on the basis of the totality of symptoms and individualization of the case. Since this report is based on a single case of recovery, results of more such cases are warranted to strengthen the outcome of the present study.
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Introducción: La ecografía Doppler de las arterias uterinas es una técnica propuesta para predecir el riesgo de preeclampsia, retardo del crecimiento intrauterino y otras alteraciones perinatales adversas. Objetivos: Determinar la frecuencia de gestantes con alteración en las arterias uterinas durante el primer trimestre e identificar la presencia de preeclampsia/eclampsia, así como sus principales características clínicas. Métodos: Se efectuó un estudio descriptivo y longitudinal de 168 gestantes en el primer trimestre de embarazo, pertenecientes al municipio de Tercer Frente en Santiago de Cuba, evaluadas en una pesquisa de Genética realizada en el Policlínico Docente Cruce de los Baños, de abril a noviembre de 2018. A todas se les realizó ecografía Doppler para calcular el índice de pulsatilidad de las arterias uterinas. Resultados: En la casuística, 16 pacientes presentaron alterado el índice de pulsatilidad y, de ellas, solo en 3 se desarrolló preeclampsia, para 18,7 %; la edad promedio en estas últimas fue de 29 años y 2 eran nulíparas (66,6 %). Respecto al índice de pulsatilidad, el promedio fue de 2,5. Conclusiones: Se mantuvo un estrecho seguimiento, hasta el parto, de las pacientes con resultados patológicos, y se destacó la importancia de estudiar el índice de pulsatilidad de las arterias uterinas durante el primer trimestre del embarazo, sobre todo en las nulíparas.
Introduction: The Doppler echography of the uterine arteries is a technique suggested to predict the risk of pre-eclampsia, the intrauterine growth retardation and other adverse perinatal disorders. Objectives: To determine the frequency of pregnant women with disorder in the uterine arteries during the first trimester and to identify the pre-eclampsia/eclampsia presence, as well as their main clinical characteristics. Methods: A descriptive and longitudinal study of 168 pregnant women in the first trimester of pregnancy, belonging to the Tercer Frente municipality in Santiago de Cuba was carried out, they were evaluated by investigation of Genetics in Cruce de los Baños Teaching Polyclinic from April to November, 2018. To determine the pulsatility index of the uterine arteries, a Doppler echography was carried out. Results: In the case material 16 patients presented this parameter altered and just 3 pregnant women presented pre-eclampsia, for 18.7 %; the average age of these last ones was of 29 years and 2 were nonparous (66.6 %). Regarding the pulsatility index, the average was of 2.5. Conclusions: There was a close follow up of the patients with pathological results, until the childbirth, and the importance of studying the pulsatility index of the uterine arteries in the first trimester of the pregnancy, mainly in the nonparous, was emphasized.
Subject(s)
Pre-Eclampsia/diagnostic imaging , Pulsatile Flow , Ultrasonography, Doppler , Eclampsia/diagnostic imaging , Fetal Growth Retardation/diagnostic imaging , PregnancyABSTRACT
Resumo A ultrassonografia vascular com Doppler é um método não invasivo útil no diagnóstico e planejamento terapêutico da doença oclusiva das artérias podais. A artéria pediosa dorsal é a continuação direta da artéria tibial anterior e tem trajeto retilíneo no dorso do pé, dirigindo-se medialmente ao primeiro espaço intermetatarsiano, onde dá origem a seus ramos terminais. A artéria tibial posterior distalmente ao maléolo medial se bifurca e dá origem às artérias plantar lateral e plantar medial. A plantar medial apresenta menor calibre e segue medialmente na planta do pé, enquanto a plantar lateral é mais calibrosa, seguindo um curso lateral na região plantar e formando o arco plantar profundo, o qual se anastomosa com a artéria pediosa dorsal através da artéria plantar profunda. A avaliação das artérias podais pode ser realizada de maneira não invasiva com exame de eco-Doppler, com adequado nível de detalhamento anatômico.
Abstract Vascular Doppler ultrasound is a noninvasive method that can help in diagnostic and therapeutic planning in case of pedal arterial obstructive disease. The dorsalis pedis artery is the direct continuation of the anterior tibial artery and follows a straight course along the dorsum of the foot, leading medially to the first intermetatarsal space, where it gives off its terminal branches. The posterior tibial artery forks distal to the medial malleolus and gives rise to the lateral plantar and medial plantar arteries. The medial plantar artery has a smaller caliber and runs medially in the sole of the foot, while the lateral plantar artery is of larger caliber, following a lateral course in the plantar region and forming the deep plantar arch, which anastomoses with the dorsalis pedis artery via the deep plantar artery. The arteries of the foot can be assessed noninvasively with Doppler, providing an adequate level of anatomical detail.
Subject(s)
Humans , Arteries , Echocardiography, Doppler , Foot/blood supply , Tibial Arteries/anatomy & histology , Foot/anatomy & histologyABSTRACT
The etiology of posterior circulation ischemic stroke caused by bilateral vertebral artery dissection ( VAD) is often difficult to detect. In this study, the authors report a case of posterior circulation ischemic stroke with a history of excessive back elevation of the neck. The dissection of bilateral vertebral arteries was detected by carotid Doppler ultrasonography and further confirmed by magnetic resonance imaging and high-resolution magnetic resonance imaging. After 6 months of standard administration of dual antiplatelet therapy, recanalization of the bilateral vertebral artery was achieved. It proves that the early diagnosis and standardized medical treatment of VAD can significantly improve patients' prognosis.
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Resumen Objetivo: Describir los hallazgos en resonancia magnética (RM) de encéfalo en pacientes menores de 65 años que fueron estudiados por Doppler transcraneal (DTC) con contraste de microburbujas, con antecedentes de accidente cerebrovascular (ACV) criptogénico y sospecha de foramen oval permeable (FOP). Materiales y métodos: Este estudio transversal retrospectivo incluyó pacientes de ambos sexos, menores de 65 años. Resultados: Nuestra muestra (n = 47, 47% masculino y 53% femenino, edad media de 42 años) presentó señales transitorias de alta intensidad (HITS, por su sigla en inglés) positivo en el 61,7% y HITS-negativo en el 38,3%. En pacientes HITS-positivo, predominaron las lesiones a nivel de las fibras en U subcorticales, únicas o múltiples con distribución bilateralmente simétrica. En pacientes con HITS moderados, predominaron las lesiones en el territorio vascular de la circulación posterior. Conclusión: En pacientes menores de 65 años con ACV criptogénico y lesiones en fibras en U subcorticales, únicas o múltiples con distribución bilateral y simétrica, debe tenerse en cuenta un FOP como posible causa de dichas lesiones.
Abstract Objectives: To analyze the findings on brain magnetic resonance imaging (MRI) in patients less than 65 years of age with history of cryptogenic stroke and suspected patent foramen ovale (PFO) who were studied with Contrast-Transcranial Doppler. Materials and Methods: This transversal retrospective study included both, men and women less than 65 years of age. Results: Our sample (n = 47, 47% male and 53% female, average age 42 years old) had High Intensity Transient Signals (HITS)-positive in 61.7% and HITS-negative in 38.3%. In HITS-positive patients, lesions were predominantly located on the subcortical U fibers, lone or multiple bilateral symmetric distributions. In patients with moderate-severity HITS, the posterior circulation was the most affected. Conclusion: In patients less than 65 years of age with cryptogenic stroke with lesions affecting the subcortical U fibers, with unique or multiple bilateral symmetric distributions, a PFO should be considered as an underlying cause.
Subject(s)
Humans , Male , Female , Middle Aged , Brain , Brain Injuries , Brain Injuries/diagnostic imaging , Magnetic Resonance Spectroscopy , Wounds and Injuries , Magnetic Resonance Imaging , Causality , Retrospective Studies , Ultrasonography, Doppler, Transcranial/methods , Stroke , Foramen Ovale, PatentABSTRACT
Background: In view of the fact that Brightness (B)-mode ultrasound findings in patients with renal parenchymal disease are profoundly non-specific, this study was carried out to determine the efficiency of color Doppler sonography for assessing renal function. In this series, the relationship between the resistive index (RI) of renal interlobar artery and serum creatinine level was analyzed for any relevant association of this color Doppler index with the serum creatinine level.Methods: In this prospective cross-sectional study, 40 patients with renal parenchymal disease having serum creatinine level >1.4 mg/dL were chosen midst routine revisits. The control group comprised of 40 normal subjects with serum creatinine levels <1.4 mg/dL. After assessing the kidneys of these subjects with gray-scale ultrasound for presence of any stones, hydronephrosis, and/or space occupying lesions instead of, they were subsequently interrogated with color Doppler sonography and RI calculated.Results: The mean serum creatinine levels±SD in the case and control groups were 6.7±0.7 mg/dL and 1.0±0.4 mg/dL, respectively. The mean±SD resistive index (RI) was 79.0%±1.8% in the diseased group and 60.3%±0.7% in the healthy subjects (p<0.001). The correlation between the RI and the serum creatinine level was statistically significant (p<0.001).Conclusions: Resistive index (RI) measurement by color doppler ultrasonography is a reasonable prognosticator of functional outcome in patients with renal parenchymal disease.
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ABSTRACT Introduction: The treatment of hemorrhoidal disease by conventional technique is associated with significant morbidity, mainly represented by the postoperative pain and the late return to daily activities. A technique of hemorrhoidal dearterialization associated with rectal mucopexy is a minimal invasive surgical option that has been used to treat the hemorrhoidal disease and reduce its inconveniences. Objective: To analyze the seven-year results of hemorrhoidal dearterialization associated with rectal mucopexy in the treatment of hemorrhoidal disease. Methods: This study analyzed 407 patients with hemorrhoids grade II, III and IV, who underwent the technique of hemorrhoidal dearterialization in the Luzia de Pinho Melo Hospital, during the period between December 2010 and December 2017. Twenty-seven patients (6.6%) had hemorrhoidal disease of the grade II, 240 (59.0%) grade III, and 117 (28.8%) grade IV. In 23 patients (5.7%), the grade was not found. All patients were operated by the same surgeon under spinal anesthesia. The 407 patients underwent dearterialization, with a varying ligation of one to six arterial branches followed by rectal mucopexy by uninterrupted suture. Eighty-two (20.14%) required removal of concomitant perianal piles or external hemorrhoids and/or fibrosed. In the postoperative follow-up the following parameters were evaluated: pain, tenesmus, bleeding, prolapse, thrombosis, and recurrence. Results: The tenesmus was postoperative complaint reported by 93.6% of patients. Forty-three (10.5%) presented intense tenesmus and 44 (22%), moderate to intense pain. Four (0.98%) patients presented more intense bleeding in postoperative follow up; none of the patients required blood transfusions. The prolapse occurred in 18 (4.42%) patients, thrombosis in 11 (2.7%), and there were 19 (4.67%) recurrences that were reoperated in this period. Conclusion: The hemorrhoidal dearterialization technique presents good results, with light and easy-to-resolve complications and little postoperative pain.
RESUMO Introdução: O tratamento da doença hemorroidária pelas técnicas convencionais cursa com significante redução da qualidade de vida do doente, principalmente relacionada à dor pós-operatória e ao considerável tempo de afastamento do trabalho. A técnica de desarterialização hemorroidária associada à mucopexia retal é uma opção cirúrgica pouco invasiva, a qual é utilizada com o objetivo de tratar a doença hemorroidária e reduzir seus inconvenientes. Objetivo: Analisar os resultados encontrados após sete anos de seguimento em doentes submetidos à técnica da desarterialização hemorroidária associada à mucopexia para o tratamento da doença hemorroidária. Método: Foram estudados 407 portadores de doença hemorroidária de graus II, III e IV, submetidos à técnica da desarterialização hemorroidária no Hospital das Clínicas Luzia de Pinho Melo de Mogi das Cruzes, durante o período de Dezembro de 2010 a Dezembro de 2017. Vinte e sete doentes (6,6%) apresentavam doença hemorroidária de grau II, 240 (59,0%) do grau III e 117 (28,8%) do grau IV. Em 23 doentes (5,7%) não foram encontradas a classificação nos prontuários. Todos os doentes foram operados pelo mesmo cirurgião e sob anestesia raquidiana. Os 407 doentes foram submetidos à desarterialização, variando de um até seis ramos arteriais seguidos de mucopexia por sutura contínua. Oitenta e dois (20,14%) necessitaram ressecções associadas por plicomas ou hemorroidas externas. No pós-operatório foram avaliados os seguintes parâmetros: dor, tenesmo, sangramento, prolapso, trombose e recidiva. Resultados: O tenesmo foi a queixa pós-operatória referida por 93,36% dos doentes. Quarenta e três (10,5%) apresentaram tenesmo intenso e 44 (22%) de moderado a intenso. Quatro (0,98%) doentes apresentaram sangramento de maior intensidade no pós-operatório e em 1 (0,5%) houve necessidade de hemostasia cirúrgica, em nenhum deles houve necessidade de reposição sanguínea. O prolapso ocorreu em 18 (4,42%) doentes, trombose em 11 (2,7%) e houve 19 (4,67%) recidivas reoperados durante o período. Conclusão: A desarterialização hemorroidária apresenta bons resultados, complicações leves e de fácil resolução e pouca dor pós-operatória.
Subject(s)
Humans , Male , Female , Arteries/surgery , Ultrasonography, Doppler , Hemorrhoidectomy , Hemorrhoids/surgery , Pain, Postoperative , Anesthesia, SpinalABSTRACT
Background: Currently about 35 million Indians are reported to suffer from diabetes mellitus, a significant proportion of whom are either undiagnosed or diagnosed but undertreated leading to poor glycemic control. This leads to accelerated development of macrovascular complications like Peripheral Vascular Disease (PVD). As most of the patients are asymptomatic, hence, early detection and treatment of PVD in patients with diabetes mellitus carries utmost importance.Methods: The present study was undertaken in SGRDIMSAR, Amritsar on 100 patients of type 2 Diabetes Mellitus with asymptomatic PVD. The diagnostic accuracy of Ankle-Brachial Index (ABI) and pulse oximetry as a screening tool was compared against Color Doppler ultrasonography as the reference standard.Results: The sensitivity, specificity, positive predictive value and negative predicted value of pulse oximetry to diagnose asymptomatic PVD in diabetics was found to be 98.31% (95% CI: 90.91-99.96), 41.46% (95% CI: 26.32- 57.89), 70.73% (95% CI: 65.08-75.81) and 94.44% (95%CI: 70.19-99.19) respectively. The sensitivity, specificity, positive predictive value and negative predicted value of ABI to diagnose asymptomatic PVD in diabetics was found to be 77.97% (95% CI: 65.27-87.71), 97.56% (95% CI: 87.14-99.94), 97.87% (95% CI: 86.85-99.69) and 75.47% (95% CI: 65.51-83.29) respectively.Conclusions: Pulse oximetry is better than ABI for the screening for asymptomatic PVD among diabetics. However, ABI is more accurate as compared to pulse oximetry in diagnosing asymptomatic PVD in diabetics.