Índice de pulsatilidad de la arteria uterina entre las 11 y 14 semanas de gestación, como predictor de preeclampsia / Pulsatility index of the uterine artery between 11 and 14 weeks of gestation, as a predicator of preeclampsia

Introducción: El índice de pulsatilidad de la arteria uterina puede usarse para estimar el riesgo de preeclampsia. En el segundo y tercer trimestre del embarazo. Objetivo: Generar conocimiento sobre el índice de pulsatilidad de las arterias uterinas en la predicción de la preeclampsia en gestantes entre 11 y 14 semanas. Materiales y métodos: Es un estudio descriptivo de búsqueda bibliografía y se ha realizado en Pubmed, Medline, Scielo, bibliotecas de universidades nacionales e internacionales. Resultados: La media del índice de pulsatilidad en las gestantes con preeclampsia encontrado fue variada que va de 1.92 a 2.41, teniendo como puntos de corte de IP > 1.71 (p<0,05), en el doppler color de la arteria uterina a las 11-14 semanas de gestación. La asociación de pre-eclampsia según el índice de pulsatilidad de la arteria uterina entre las 11 y 14 semanas, es un buen método para el cribado de mujeres en riesgo de desarrollar preeclampsia, ya que presenta una sensibilidad, especificidad, VPP y VPN variada, pero suficiente para aceptarlo como método predictor de pre-eclampsia. Conclusiones: Existe suficiente evidencia que concluye que el uso del índice de pulsatilidad por ecografía doppler de la arteria uterina es un método adecuado para la detección a las 11 a 14 semanas de gestación en mujeres para desarrollar pre-eclampsia. (AU)

Introduction: The pulsatility index of the uterine artery can be used to estimate the risk of preeclampsia. In the second and third trimesters of pregnancy. Objective: To generate knowledge about the pulsatility index of the uterine arteries in the prediction of preeclampsia in pregnant women between 11 and 14 weeks. Materials and methods: It is a descriptive study of literature search and has been carried out in Pubmed, Medline, Scielo, libraries of national and international universities. Results: The average pulsatility index in pregnant women with pre-eclampsia was varied ranging from 1.92 to 2.41, having as cut-off points of IP> 1.71 (p <0.05), in the color doppler of the uterine artery at 11- 14 weeks gestation. The association of pre-eclampsia according to the pulsatility index of the uterine artery between 11 and 14 weeks, is a good method for screening women at risk of developing preeclampsia, since it has a varied sensitivity, specificity, PPV and NPV, but enough to accept it as a predictive method of pre-eclampsia. Conclusions: There is sufficient evidence to conclude that the use of the pulsatility index by Doppler ultrasound of the uterine artery is a suitable method for detection at 11 to 14 weeks gestation in women to develop pre-eclampsia. (AU)

Utilidad y aplicación del ecodoppler en el embarazo de alto riesgo / Utility and application of ecodoppler in high risk pregnancy

Introducción: La detección de alteraciones en la circulación fetal y materna advierte sobre las alteraciones hemodinámicas que comienza a sufrir el feto. Si la edad gestacional garantiza la viabilidad fetal no se requiere prolongar la gestación, evitando complicaciones por hipoxia crónica. Sin embargo, en fetos con inmadurez pulmonar se esperan trastornos más severos por alteraciones en el sistema venoso fetal. En embarazos de alto riesgo, la ecografía fetal con Doppler es el método de elección debido a su alta sensibilidad que, además de ser no invasivo y accesible, permite la identificación de alteraciones que ponen en riesgo la vida del feto, ayudando al diagnóstico y monitoreo de las mismas. Su buen uso reduce el riesgo de muerte fetal en casos de alto riesgo. La evaluación de las arterias uterinas en el tamizaje de patologías del embarazo es de utilidad en preeclampsia, restricción de crecimiento intrauterino, desprendimiento de placenta y muerte fetal. El estudio de la morfología de onda de la arteria umbilical se utiliza ante sospecha de hipoxia, siendo el mejor indicador para interrupción de la gestación ante la presencia de anomalías, mientras que los cambios en la velocimetría de la arteria cerebral media son de utilidad en la evaluación de fetos con insuficiencia placentaria y anemia. El índice cerebro-placentario es el marcador más sensible para diagnosticar la redistribución cerebral como primer fenómeno adaptativo del feto ante la injuria. El estudio del sistema venoso fetal detecta estados más avanzados de hipoxia fetal, acompañados de acidemia e insuficiencia cardíaca. Objetivo: Describir aspectos a evaluar con EcoDoppler fetal para identificar alteraciones sugerentes de patología materno-fetal. Destacar su utilidad en embarazos de alto riesgo. Revisión de bibliografía actualizada. Materiales y Método: Para la localización de la bibliografía se utilizaron varias fuentes documentales, abarcando una búsqueda crítica en internet desde Google Académico, incluyendo artículos publicados a partir del año 2002, utilizando los descriptores: ecografía, ecoDoppler, embarazo, control prenatal, preeclampsia, restricción del crecimiento intrauterino. Se seleccionaron aquellos documentos que informasen sobre los aspectos físicos del ecoDoppler, aplicación del ecoDoppler en embarazos de alto riesgo y metodología del estudio

Introduction: The detection of alterations in the fetal and maternal circulation warns about the hemodynamic alterations that the fetus begins to suffer. If gestational age guarantees fetal viability, it is not necessary to prolong gestation, avoiding complications due to chronic hypoxia. However, in fetuses with pulmonary immaturity more severe disorders are expected due to alterations in the fetal venous system. In high-risk pregnancies, fetal ultrasound with Doppler is the method of choice due to its high sensitivity that, in addition to being non-invasive and accessible, allows the identification of alterations that put the life of the fetus at risk, aiding diagnosis and monitoring from the same. Its good use reduces the risk of fetal death in high-risk cases. The evaluation of the uterine arteries in the screening of pathologies of pregnancy is useful in preeclampsia, intrauterine growth restriction, placental abruption and fetal death. The study of the wave morphology of the umbilical artery is used when hypoxia is suspected, being the best indicator for interruption of gestation in the presence of anomalies, while changes in the velocimetry of the middle cerebral artery are useful in the evaluation of fetuses with placental insufficiency and anemia. The brain-placental index is the most sensitive marker to diagnose cerebral redistribution as the first adaptive phenomenon of the fetus before injury. The study of the fetal venous system detects more advanced stages of fetal hypoxia, accompanied by acidemia and heart failure. Objective: Describe aspects to be evaluated with Fetal EcoDoppler to identify alterations suggestive of maternal-fetal pathology. Highlight its usefulness in high risk pregnancies. Review of updated bibliography. Materials and Method:Several documentary sources were used to locate the bibliography, covering a critical search on the Internet from Google Scholar, including articles published since 2002, using the descriptors: ultrasound, ecoDoppler, pregnancy, prenatal control, preeclampsia, intrauterine growth restriction . We selected those documents that reported on the physical aspects of ecoDoppler, application of ecoDoppler in high-risk pregnancies and study methodology.

Análise Dopplerfluxométrica e angiogênica de tumores mamários caninos / Dopplerfluxometric and angiogenic analysis of canine mammary tumors

Foi avaliado o comportamento de índices Doppler e a expressão de genes relacionados à neovascularização tumoral, visando caracterizar a vascularização das massas neoplásicas. Foram utilizadas 27 cadelas, com diagnóstico histopatológico de neoplasia mamária, sendo submetidas à avaliação Dopplerfluxométrica tumoral e à coleta de fragmentos neoplásicos para análise de expressão gênica de VEGF, FLT-1, FLK-1 e ATR1. Foram encontrados 22 tumores de origem epitelial (carcinomas) e cinco de origem mesenquimal (sarcomas). Observou-se correlação positiva entre o FLT-1 e as variáveis PS, PI e RI. O FLK-1 apresentou correlação igualmente positiva com os parâmetros PS e PI e uma tendência para RI, enquanto o VEGF retratou correlação positiva apenas com IP. O VEGF também mostrou correlação positiva com seus receptores, porém não apresentou correlação com o ATR1. O FLT-1 e o FLK-1 apresentaram ainda correlação positiva entre si e com o ATR1. Houve maior expressão média do VEGF nos tumores epiteliais do que nos mesenquimais. As variáveis PS, PI e RI, associadas com a expressão do VEGF e seus receptores, mostraram-se relevantes para caracterizar a neovascularização de tumores malignos, e a expressão diferenciada do VEGF entre os tipos tumorais pode ser um indicador auxiliar na caracterização de neoplasias mamárias malignas em cadelas.(AU)

The behavior of the tumor Doppler indexes and gene expression related to neovascularization was evaluated aiming to improve the characterization of neoplastic masses vascularization. Twenty-seven bitches with histopathological diagnosis of mammary neoplasia were submitted to tumor Dopplerfluxometric evaluation and collection of neoplastic fragments to analyze the gene expression of VEGF, FLT-1, FLK-1 and ATR1. Were found 22 epithelial (carcinomas) and five mesenchymal (sarcomas) tumors. Positive correlation was observed between FLT-1 and PS, PI and RI. FLK-1 presented a similar positive correlation with the PS and PI parameters, and a tendency for RI (r= 0.45, P= 0.07), whereas VEGF showed a positive correlation just with PI. VEGF also showed a positive correlation with its receptors, but did not present a correlation with ATR1. FLT-1 and FLK-1 also showed positive correlation with each other, and with ATR1. There was higher mean expression of VEGF in epithelial tumors than in mesenchymal ones. The PS, PI and RI associated with the expression of VEGF and its receptors have been shown to be relevant to characterize neovascularization of malignant tumors, and the differentiated expression of VEGF between the types of mammary tumors, may be an auxiliary indicator in the characterization of malignant breast cancers in bitches.(AU)

Influence of ultrasound contrast agents on spectral Doppler analysis in recipients of liver transplantation

BACKGROUND/AIMS: Clinical validation is required to determine whether Doppler measurements are comparable before and after administering ultrasound contrast agent (USCA). The purpose of this study is to explore whether the use of USCA affects spectral Doppler analysis in recipients of liver transplantation (LT). METHODS: For this study, 36 patients were examined using Doppler ultrasonography (US) along with a contrast-enhanced US for surveillance of vascular complications after LT. The following spectral Doppler US parameters were measured before and after administration of USCA: peak systolic velocity, end-diastolic velocity, resistive index, and systolic acceleration time of the graft hepatic artery; peak flow velocity of the graft portal vein; and peak flow velocity and venous pulsatility index of the graft hepatic vein. RESULTS: The mean peak systolic and end-diastolic velocities of the hepatic artery and the peak flow velocity of the portal and hepatic veins were increased after intravenously administration of the USCA, ranging from 10% to 13%. However, the changes were not statistically significant (P=0.097, 0.103, 0.128, and 0.190, respectively). There were no significant differences in other measured parameters, including the resistive index (P=0.205) and systolic acceleration time (P=0.489) of the hepatic artery and venous pulsatility index (P=0.494) of the hepatic vein. CONCLUSIONS: The measured velocities of graft hepatic vessels tended to increase after administration of USCA, but without statistical significance. The comparison of serial Doppler parameters with or without injection of USCA is valid during Doppler surveillance in recipients of LT.

Acoustic analysis of oropharyngeal swallowing using Sonar Doppler / Análise acústica da deglutição orofaríngea utilizando Sonar Doppler

ABSTRACT INTRODUCTION: During the aging process, one of the functions that changes is swallowing. These alterations in oropharyngeal swallowing may be diagnosed by methods that allow both the diagnosis and biofeedback monitoring by the patient. One of the methods recently described in the literature for the evaluation of swallowing is the Sonar Doppler. OBJECTIVE: To compare the acoustic parameters of oropharyngeal swallowing between different age groups. METHODS: This was a field, quantitative, study. Examination with Sonar Doppler was performed in 75 elderly and 72 non-elderly adult subjects. The following acoustic parameters were established: initial frequency, first peak frequency, second peak frequency; initial intensity, final intensity; and time for the swallowing of saliva, liquid, nectar, honey, and pudding, with 5- and 10-mL free drinks. RESULTS: Objective, measurable data were obtained; most acoustic parameters studied between adult and elderly groups with respect to consistency and volume were significant. CONCLUSION: When comparing elderly with non-elderly adult subjects, there is a modification of the acoustic pattern of swallowing, regarding both consistency and food bolus volume.

RESUMO INTRODUÇÃO: Durante o processo de envelhecimento, uma das funções que sofre modificação é a deglutição. Estas alterações na deglutição orofaríngea podem ser diagnosticadas por métodos que permitem tanto o diagnóstico quanto o monitoramento e biofeedback ao indivíduo. Um dos métodos descrito na literatura recentemente para a avaliação da deglutição é o Sonar Doppler. OBJETIVO: O objetivo desse estudo foi comparar os parâmetros acústicos da deglutição orofaríngea entre faixas etárias distintas. MÉTODO: Estudo de campo, quantitativo. O exame com o Sonar Doppler foi aplicado em 75 idosos e 72 adultos. Estabeleceram-se os parâmetros acústicos: frequência inicial, frequência do primeiro pico, frequência do segundo pico, intensidade inicial, intensidade final e tempo, para as deglutições de saliva, liquido, néctar, mel e pudim, com gole livre, 5 mL e 10 mL. RESULTADOS: Obtiveram-se dados objetivos e mensuráveis, apresentando significância para a maioria dos parâmetros acústicos estudados entre o grupo de idosos e adultos em relação à consistência e volume. CONCLUSÃO: Verificamos que há modificação do padrão acústico da deglutição, tanto em relação à consistência quanto a volume do bolo alimentar, quando comparados adultos idosos e não idosos.

Avaliação farmacológica da detomidina no trato reprodutivo de éguas (Equus caballus)

A Detomidina é um agonista de receptores α2-adrenérgico, derivado imidazólico alcalóide, disponível sobre a fórmula de cloridrato, apresentarelação de seletividade entre receptor α2/α1de 260/1. O experimento foi conduzido para investigar a interferência da detomidina sobre o trato reprodutivo equino. Foram utilizadas vinte e cinco éguas sem raça definida (SRD), não prenhes, com idade entre 4 a 10 anos e peso de 350 a 450 Kg. As 25 éguas foram divididas de forma aleatória em 5 grupos, sendo que 3 grupos foram submetidos respectivamente a doses de 6, 9 e 12μg/kgde detomidina.Nos outros dois grupos, um deles foi aplicado Ioimbina em dose 0,10mg/Kg com antecedência de 20 minutos da aplicação de 6μg/kg de detomidina e o outro grupocontrole. Foram realizadas ultrassonográfias no modo B e Doppler do trato reprodutivo de éguas. O índice de pulsatilidade(IP), resistência (IR) e pulso arterial uterino direito (PAUD), bem como a avaliação subjetiva do útero e mesométrio de suprimento sanguíneo, não apresentaram diferençasignificativa(P0,0001) aos 10 minutos e 4,9±0,18mm (P>0,0001) aos 15 minutos, respectivamente...

The Detomidine is an agonist of α2-adrenergic receptors, derived imidazole alkaloid, available on the hydrochloride formula, is related to selectivity between receptor α2/α1of 260/1. The experiment was conducted to investigate the interference of detomidine on equine reproductive tract. Twenty-five mares were used mongrel, not pregnant, aged between 4-10 years old and weighing 350-450kg. The 25 mares were divided randomly into 5 groups, with 3 groups were submitted at doses of the detomidineof 6, 9 and 12μg/kg,respectively. In the other two groups, one applied yohimbine dose of 0.10 mg/kg 20 minutes prior to the application of 6μg/kg detomidine and in control group. All they were made sonographic evaluations in B mode and Doppler of the reproductive tract of mares. The pulsatility index (PI), resistance index (RI) and uterine blood right wrist (UBRW) and the subjective evaluation of the uterus and mesometriumblood supply, showed no significant difference (P0.0001) to 5 minutes, 2.7 ± 0.26 (P>0.0001) after 10 minutes and 4.9 ± 0.18 mm (P>0.0001) after 15 minutes, respectively...

Concordance between Doppler and pulsed-wave Doppler tissue imaging in estimation of the degree of left ventricular dysfunction and correlating it to the degree of chronic obstructive pulmonary disease

Objective: As a consequence of leftward shift of the interventricular septum and of pericardial restraint, related to the degree of right ventricular dilation, alveolar hypoxia and related pulmonary vascular changes, left ventricular function is influenced by chronic obstructive pulmonary disease [COPD]. The aim of this study was to assess the prevalence of echocardiographic abnormalities by conventional echocardiography and Doppler tissue imaging [DTI] in COPD patients according to the degree of disease severity

Methods: We enrolled forty consecutive patients with COPD and twenty matched control. Twenty of the patients were suffering from mild form of COPD, twenty were suffering from severe form of COPD as decided by pulmonary function test and arterial blood gases and twenty apparently healthy non COPD control persons were subjected to echocardiographic assessment to left ventricular diastolic and systolic functions by conventional echocardiography and DTI at the mitral annulus

Results: There were no significant statistical difference between the three groups as regards the age and the gender. There were significant statistical differences between the patients and the control as regards the diastolic functions of the left ventricle. E and A waves obtained by conventional Doppler and by DTI showed significant statistical difference between mild, severe forms of COPD and control subjects. The degree of diastolic dysfunction increased significantly with increase of the severity of COPD

Conclusion: Left ventricular diastolic function is significantly affected in patients with COPD and the degree of affection is related to the severity of COPD

Cortical Auditory Event Related Potentials (P300) for Frequency Changing Dynamic Tones

BACKGROUND AND OBJECTIVES: P300 has been studied with a variety of stimuli. However, the nature of P300 has not been investigated for deviant stimuli which change its characteristics from standard stimuli after a period of time from onset. SUBJECTS AND METHODS: Nine young adults with normal hearing participated in the study. The P300 was elicited using an oddball paradigm, the probability of standard and deviant stimuli was 80% and 20% respectively. Six stimuli were used to elicit P300, it included two pure-tones (1,000 Hz and 2,000 Hz) and four tone-complexes (tones with frequency changes). Among these stimuli, 1,000 Hz tone served as standard while others served as deviant stimuli. The P300 was recorded in five separate blocks, with one of the deviant stimuli as target in each block. Electroencephalographic was recorded from electrode sites Fz, Cz, C3, C4, and Pz. Latency and amplitude of components of the cortical auditory evoked potentials were measured at Cz. RESULTS: Waveforms obtained in the present study shows that, all the deviant stimuli elicited obligatory P1-N1-P2 for stimulus onset. 2,000 Hz deviant tone elicited P300 at a latency of 300 ms. While, tone-complexes elicited acoustic change complex (ACC) for frequency changes and finally elicited P300 at a latency of 600 ms. In addition, the results showed shorter latency and larger amplitude ACC and P300 for rising tone-complexes compared to falling tone-complexes. CONCLUSIONS: Tone-complexes elicited distinct waveforms compared to 2,000 Hz deviant tone. Rising tone-complexes which had an increase in frequency elicited shorter latency and larger amplitude responses, which could be attributed to perceptual bias for frequency changes.

Examen Doppler de la insuficiencia venosa de miembros inferiores: consenso entre especialistas / Doppler examination of lower limb venous insufficiency: consensus among specialists

Se logró un consenso entre especialistas del Diagnóstico por Imágenes y cirujanos flebólogos en el protocolo de realización de los estudios Doppler para la insuficiencia venosa de miembros inferiores (MMII), incluyendo un acuerdo sobre la fisiopatología de la enfermedad, la nomenclatura y diámetros de los vasos que componen los distintos sistemas venosos y los parámetros Doppler a utilizar en la confección del informe de los estudios. Se realizó una reunión entre 6 cirujanos vasculares y 10 especialistas en Diagnóstico por Imágenes, donde se discutieron los distintos ítems planteados. Además, durante el encuentro se realizaron dos estudios Doppler de miembros inferiores a manera de ejemplo y se elaboró un documento preliminar con los puntos acordados. El resultado de este encuentro multidisciplinario es el punto de partida para comenzar a manejar una terminología común que permita mejorar el diagnóstico y la conducta terapéutica de esta patología

A consensus among Diagnostic Imaging specialists and vascular surgeons on a protocol for carrying out Doppler studies for lower limb venous insufficiency is presented. This includes an agreement on the pathophysiology of the disease, the nomenclature and vessel diameters that make up the different venous systems, as well as the Doppler parameters to be used in the for reporting the studies. A meeting was held with 6 vascular surgeons and 10 imaging specialists in which these different items were discussed. Two Doppler studies of the lower limbs were performed during this meeting as an example, and a draft document was prepared on the points agreed

Cambios hemodinámicos por doppler en fetos con retardo del crecimiento intrauterino de 26-34 semanas a 24 y 48 horas de la administración materna de betametasona / Hemodynamic changes detected by doppler between 26-34 weeks pregnancies with iugr 24 and 48 hours after betamethasone administration

Identificar cambios en el índice de pulsatilidad (IP) de las arterias umbilical y cerebral media después de aplicar betametasona en pacientes con retardo del crecimiento intrauterino (RCIU) entre 26 y 34 semanas. Métodos: 22 pacientes hospitalizadas con embarazos únicos entre las 26 y 34 semanas asociadas con RCIU, con indicación de maduración pulmonar que no se encontraban en trabajo de parto, recibieron protocolo completo de maduración, toma de doppler fetoplacentario inicial y a las 24 y 48 horas. Resultados: 68,2% presentaron trastorno hipertensivo del embarazo, 81,8% (n:18) negaron enfermedad crónica asociada, no se documentaron anomalías fetales mayores ni se sospechó infección fetal. El promedio del IP de la arteria umbilical al ingreso fue 1,62 (DE 0,41) y de la cerebral media 1,97 (DE 0,61). En el doppler de 48 horas se observaron cambios del IP en la umbilical (p =0.0079) y la cerebral media (p=0.0149), respecto al basal. Conclusiones: en RCIU entre las semanas 26 y 34 hay variaciones con significación estadística del IP en el doppler de las arterias umbilical y cerebral media que no siempre se asociaron con cambios en la estadificación del doppler actual y no tienen importancia clínica. La hipertensión gestacional asociada puede ser un factor de confusión. Palabras clave: cambios hemodinámicos, doppler, retardo del crecimiento intrauterino, betametasona. Abreviaturas: IP, índice de pulsatilidad: RCIU, retardo en el crecimiento intrauterino...

To identify changes in the pulsatility index (PI) of the umbilical and middle cerebral arteries after betamethasone administration in pregnancies at 26-34 gestational weeks with intrauterine growth retardation (IUGR). Methods: the study comprised 22 hospitalized women with singleton pregnancies at 26- 34 weeks with IUGR, not in labor, with indication of fetal lung maturity enhancement who received a complete treatment protocol and an initial fetoplacental Doppler repeated after 24 and 48 hours. Results: pregnancy-induced hypertension was present in 68.2%, 81.8% (n: 18) denied having an associated chronic illness, no major fetal anomalies or suspicion of fetal infection were documented. The average PI of the umbilical artery at admission was 1.62 (SD 0.41) and of the middle cerebral artery 1.97 (SD 0.61). PI changes observed in the Doppler performed after 48 hours were (p =0.0079) in the umbilical artery and (p=0.0149) in the middle cerebral artery, compared with baseline PI. Conclusions: there are statistically significant variations of Doppler PI in the umbilical and middle cerebral arteries in IUGR between week 26 and 34 which were not always related with changes of current Doppler stages and have no clinical importance. The associated gestational hypertension may constitute a confounding factor...

The role of the acoustic radiation force in color Doppler twinkling artifacts

PURPOSE: The aim of this experimental study was to evaluate whether the acoustic radiation force (ARF) is a potential source of twinkling artifacts in color Doppler images. METHODS: Color Doppler images were obtained using a clinical ultrasonic scanner (Voluson e, GE Healthcare) for a high contrast (+15 dB) circular scattering phantom at pulse repetition frequencies (PRFs) ranging from 0.1 to 13 kHz. Ultrasound transmissions resulting in ARF were measured using a hydrophone at the various PRFs considered. The influence of ARF on the appearance of twinkling colors was examined via the common parameter PRF. This methodology is based on the fact that alternating positive and negative Doppler shifts induced by the ARF are centered at a PRF twice the maximum Doppler frequency on the color scale bar, whereas the twinkling color aliasing is expected to remain similar regardless of PRF. RESULTS: Color twinkling artifacts were observed to be most conspicuous at the lowest PRF of 0.1 kHz. The extent of twinkling rapidly decreased as the PRF increased, eventually disappearing when the PRF > or =0.6 kHz. The measured ultrasound transmissions, however, were found to be insensitive to the PRF, and therefore it can be inferred that the PRF was insensitive to the ARF. CONCLUSION: Based on our experimental observations, the ARF may not be a source of color Doppler twinkling artifacts.

The evaluation of swallowing in patients with spinocerebellar ataxia and oropharyngeal dysphagia: A comparison study of videofluoroscopic and sonar doppler

Introduction: Spinocerebellar ataxia (SCA) is a degenerative disease that can cause loss of coordination of voluntary muscle movement such as that required for swallowing. Aims: The purposes of this cross-sectional and comparative case study were: (1) to assess the severity of dysphagia through a videofluoroscopic swallow study, and (2) to compare differences in frequency, intensity, and duration of sound waves produced during swallowing in normal and SCA patients by using sonar Doppler. Method: During swallow evaluation using videofluoroscopy, a sonar Doppler transducer was placed on the right side of the neck, at the lateral edge of the trachea, just below the cricoid cartilage to capture the sounds of swallowing in 30 SCA patients and 30 controls. Result: The prevalence in the dynamic evaluation of swallowing videofluoroscopy was by changes in the oral phase of swallowing. The analysis of variance of the averages found in each variable - frequency, intensity and duration of swallowing - shows there was a significant correlation when compared to the healthy individual curve. Conclusion: The study demonstrates the prevalence of oral dysphagia observed in dynamic videofluoroscopic swallow evaluation. In patients with SCA, the mean initial frequency (IF), initial intensity (II), and final intensity (FI) were higher and the time (T) and peak frequency (PF) were lower, demonstrating a pattern of cricopharyngeal opening very close to that found in normal populations...

Characterization of Swallowing Sounds with the Use of Sonar Doppler in Full-Term and Preterm Newborns

Technological advances have provided a large variety of instruments to view the swallowing event, aiding in the evaluation, diagnosis, and monitoring of disturbances. These advances include electromyography of the surface, dynamic video fluoroscopy, and most recently sonar Doppler. Objective  To characterize swallowing sounds in typical children through the use of sonar Doppler. Method: Thirty newborns participated in this prospective study. All newborns received breast milk through either their mother's breasts or bottles during data collection. The newborns were placed in either right lateral or left lateral positions when given breast milk through their mother's breasts and in a sitting position when given a bottle. There were five variables measured: initial frequency of sound wave (FoI), frequency of the first peak of the sound wave (FoP1), frequency of the second peak of the sound wave (FoP2), initial intensity and final sound wave (II and IF), and swallowing length (T), the time elapsed from the beginning until the end of the analyzed acoustic signal measured by the audio signal, in seconds. Results: The values obtained in the initial frequency of the babies had a mean of 850 Hz. In terms of frequency of first peak, only three presented with a subtle peak, which was due to the elevated larynx position. Conclusion: The use of sonar Doppler as a complementary exam for clinical evaluations is of upmost importance because it is nonintrusive and painless, and it is not necessary to place patients in a special room or expose them to radiation...

Ultrasonografia doppler de arterias uterinas entre las 11 a 14 semanas de edad gestacional, como predictor de preeclampsia / Doppler ultrasound of uterine arteries between 11 to 14 weeksÆ gestation as a preacher of preeclampsia

OBJETIVO: Conocer las características de la ultrasonografía doppler de arterias uterinas entre las 11 a 14 semanas de gestación y su relación con la preeclampsia. MATERIAL Y MÉTODO: Estudio prospectivo, de corte transversal realizado en el Servicio de Obstetricia del Hospital Nacional A. Loayza entre el 01 junio 2008 y el 31 de mayo 2010. Con gestantes, que acudieron entre las 11 a 14 semanas de EG y firmaron el consentimiento informado. A todas se les realizó ecografía doppler, y fueron seguidas hasta el parto. Se revisaron las historias clínicas y los datos se recopilaron. Se excluyeron a las gestantes con diagnóstico ecográfíco de malformaciones congénitas o que terminaron en aborto. El Análisis estadístico se realizó con los paquetes SPSS 17 y MS Excel 2003, con IC de 95%, se usó el Test Chi cuadrado o Fisher y regresión logística multivariada. RESULTADOS: Ingresaron 280 gestantes, de las cuales 48 (17.1%) desarrollaron preeclampsia. Hubo asociación significativa con: antecedente de hipertensión arterial o preeclampsia (p<0.01). Por ecografía doppler se halló: índice de resistencia (IR) promedio de 0.75 ± 0.11, índice de pulsatilidad (IP) promedio de 1.76 ± 0.52. 144 gestantes (51.4%) presentaron Notch bilateral y el IP > 2.35 se presentó en 40 (14%), de las que 32, presentaron preeclampsia (p<0.0001), con una Sensibilidad de 66.7%, especificidad de 96.5%, VPP de 80% y VPN de 93.3%. CONCLUSIONES: El IP > 2.35, entre las 11 a 14 semanas de EG, predijo la preeclampsia.

OBJETIVE: Know the characteristics of Doppler ultrasound of uterine arteries between 11 to 14 weeksÆ gestation as a preacher of preeclampsia. MATERIALS AND METHOD: Prospective study, transversal performed in the Obstetrician Service to Hospital Nacional A. Loayza (June 1, 2008 to May 31, 2010). With pregnant women attending between 11 to 14 weeksÆgestation and signed informed consent. They all Doppler ultrasound and were followed until delivery. Medical records were reviewed and data were taken.Were excluded pregnant women with suspected birth or abortion. Statistical analysis was performed with SPSS 17 and MS Excel 2003, CI 95%. Chi square Test or Fisher and Multivariate logistic regression. RESULTS: 280 pregnant women admitted, 48 (17.1%) developed preeclampsia. Significant association with history of high pressure or preeclampsia (p<0.01). Was found by Doppler ultrasound: Resistance Index (RI) average 0.75 ± 0.11, Pulsatility Index (PI) average 1.76 ± 0.52. 144 pregnant women (51.4%) Notch had bilateral and PI>2.35 was present in 40 (14%), of which 32 showed preeclampsia (p<0.0001). With sensibility 66.7%, specificity 96.5%, PPV 80% and NPV 93.3%. CONCLUSIONS: PI > 2.35 between 11 to 14 weeksÆ gestation predicted the preeclampsia.

Determinación de los valores normales del índice de tei (índice de performance miocárdico) y otros parámetros ecocardiográficos doppler de la función ventricular izquierda en caninos sanos / Determination of tei index (index of myocardial performance) and other ecocadiography Doppler parameters of left ventricular function in healthy dogs

La falla cardiaca está relacionada con anormalidades en la contracción y relajación ventricular. Estudios recientes han mostrado que en la mayoría de los pacientes con insuficiencia cardiaca coexisten alteraciones de la función sistólica y diastólica, y en algunos casos la función sistólica es normal pero la falla cardiaca es generada por disfunción ventricular diastólica. El índice de performance miocárdico (tiempo de contracción isovolumétrica sumado al tiempo de eyección ventricular dividido el tiempo de eyección, “Índice de Tei”) ha sido descrito como una manera más efectiva para el análisis de la Disfunción Miocárdica Global que otros parámetros de función sistólica y diastólica. Con base en estos antecedentes, los autores determinaron el valor normal del índice de Tei para el ventrículo izquierdo en caninos sanos en la ciudad de Bogotá (2.600 msnm) con el objeto de utilizar dicho valor como índice de la función sistodiastólica. Se obtuvo un valor medio de 0,33 con un desvío estándar de 0,10. Asimismo pudo verificarse que no existe correlación con la frecuencia cardiaca, peso corporal ni con la fracción de eyección ventricular izquierdo (P<0,05)...

Tratamiento con braquiterapia intersticial de alta tasa de dosis: en cáncer de mama precoz / Treatment with high doses interstitial brachytherapy: in early breast cancer

El cáncer representa un problema de salud pública. El cáncer de mama, es una entidad que aumenta su incidencia en el mundo. Esto ha llevado a nuevos enfoques terapéuticos quirúrgicos, químicos y radiantes. En el siguiente trabajo se hace mención del tratamiento con braquiterapia de alta tasa de dosis realizado en el Hospital Universitario de Mérida, en el servicio integral de oncología. Se evaluaron 148 pacientes con cáncer de mama en todos los estadios desde febrero 2007 hasta 30 mayo 2008. Se seleccionaron pacientes estadio I-IIANO MO, se analizaron las pacientes que reunieron los criterios de inclusión. En 19 pacientes (12,8 %) se cumplió braquiterapia intersticial hiperfraccionada con intervalo de 6 horas (800 cGy/día) 4 sesiones (400 cGy por fracción). Dosis total 3200 cGy. Con rango de seguimiento entre 18 meses y 2 meses y un promedio de 10 meses sin evidencia de recaída locorregional.

The breast cancer represents a public health problem. The breast cancer is entities which increase his incidence in the world. These problem do to a creation of new surgery, chemical and radiant therapeutically modes. In these work we mention the high dose brachytherapy tease doses realized in the University Merida Hospital in the integral service of oncology. We evaluated 148 patients with breast cancer disease in all the stage since February 2007 to May30 of 2008. We selected a 148 patients classified stage I-IIANO MO, and analyzed the patients with have inclusion therapeutically criterions. In 19 (12.8 %) patients were underwent to interstitial brachytherapy hyperfraccion with and interval to 6 hours (800 cGy/day) in 4 sessions (400 cGyfor fraction). Total doses applied was 3200 cGy. With a control range between 18 month and 2 month, and average of 10 month without any evidence of loco regional distress.

Doppler sonar analysis of swallowing sounds in normal pediatric individuals / Análise dos sons da deglutição pelo sonar Doppler em indivíduos normais na faixa etária pediátrica

Among the methods for assessing swallowing sounds - videofluoroscopy modified barium study, fiberoptic swallowing endoscopy, neck auscultation through a microphone, accelerometer and, more recently, the Doppler sonar - we have chosen the latter. AIM: to analyze swallowing sounds by cervical auscultation using Doppler sonar, in a population between 2 and 15 years without oro-pharyngeal dysfunction. STUDY DESIGN: cross-sectional historical cohort. MATERIALS AND METHODS: we investigated 90 individuals in Curitiba (2006/2007). The population was separated by age into 3 groups: from 2 to 5 years, from 5 to 10 years of age and from 10 to 15 years of age. We obtained the average values for frequency, intensity and swallowing duration for saliva, liquid and pasty foods). RESULTS: objective and measurable data were obtained. Significance related to gender was found in certain age groups and consistencies, under all the studied variables, except swallowing time. CONCLUSION: neck auscultation using Doppler sonar is a sensitive method to detect swallowing sounds. There was swallowing interference associated with saliva and the other tested food types and with the biological development of the age range being studied. It is an easy to apply method, not expensive and non-invasive.

Dentre a variabilidade de métodos para o estudo da deglutição temos a videofluoroscopia dinâmica da deglutição, a endoscopia da deglutição e a ausculta cervical através do microfone, acelerômetro e mais recentemente pelo sonar Doppler. OBJETIVO: Analisar os sons da deglutição em indivíduos entre mais de dois e 15 anos de idade sem disfagia orofaríngea obtidos na ausculta cervical pelo sonar Doppler. FORMA DE ESTUDO: Estudo de coorte histórica com corte transversal. MATERIAL E MÉTODO: estudaram-se 90 indivíduos em Curitiba (2006/2007). Aplicaram-se as subfaixas mais de dois a cinco, mais de cinco a 10 e mais de 10 a 15 anos de idade. Estabeleceram-se as médias nas variáveis de frequência, intensidade e tempo para as deglutições de saliva e de consistências líquida e pastosa. RESULTADOS: Obtiveram-se dados objetivos e mensuráveis, encontrando-se significância em relação ao sexo em algumas subfaixas etárias e consistências estudadas em todas as variáveis, exceto no tempo de deglutição. CONCLUSÃO: A ausculta cervical pelo sonar Doppler é um método sensível para detectar os sons da deglutição. Houve interferência na deglutição relacionada com a saliva e as consistências alimentares testadas e com o desenvolvimento biológico da faixa etária em questão. É um método de fácil aplicação, barato e não invasivo.

Envolvimento macrovascular e esclerose sistêmica: [revisão] / Macrovascular involvement and systemic sclerosis: [review]

Este artigo tem como objetivo revisar os aspectos descritos na literatura sobre o acometimento da macrovasculatura na esclerose sistêmica e avaliar a ocorrência e distribuição das alterações macrovasculares nos pacientes com esclerose sistêmica através do eco-Doppler e do índice tornozelo-braço, além da associação desses achados com as características demográficas, forma clínica, tempo de evolução da doença, fenômeno de Raynaud (FR), alterações digitais, ulcerações de membros, reabsorção de falange, amputação, bem como fatores de risco e antecedentes da doença ateromatosa. O estudo foi prospectivo, do tipo série de casos, constituído de 20 pacientes, sendo 19 do sexo feminino, com idade média de 46,30 anos. Todos os pacientes tinham fenômeno de Raynaud objetivo, 85 por cento a forma clínica difusa, 55 por cento alteração de polpa digital, 15 por cento úlcera atual de membros, 25 por cento reabsorção de falange, nenhuma amputação e 70 por cento de um a quatro fatores de risco. Foram estudadas pelo eco-Doppler as artérias aorta e carótida, dos membros inferiores e superiores, para a avaliação de espessamento do complexo íntimo-medial e presença de placas e aneurismas. Nas artérias dos membros inferiores, foi também realizado o índice tornozelo-braço. O índice tornozelo-braço foi normal em todos os pacientes; entretanto, 12 (60 por cento) destes apresentaram doença macrovascular pelo eco-Doppler, sendo nove (45 por cento) na aorta, seis (30 por cento) nas carótidas, uma (5 por cento) nas artérias dos membros superiores e sete (35 por cento) nas dos membros inferiores. Observou-se associação entre doença macrovascular e alterações de polpas digitais (p = 0,0045). A doença macrovascular foi identificada em 60 por cento dos pacientes através do eco-Doppler, mas não pelo índice tornozelo-braço, que foi normal em todos. Verificou-se associação significante da doença macrovascular com as alterações atuais de polpas digitais, o que não ocorreu ...

The objectives of this article are to review aspects described in the literature on macrovasculature onset in systemic sclerosis and to assess occurrence and distribution of macrovascular alterations in patients with systemic sclerosis using Doppler ultrasound and ankle-brachial index. In addition, the article evaluates the association of these findings with demographic characteristics, clinical form, clinical course of the disease, Raynauds phenomenon, digital changes, limb ulcers, reabsorption of phalanges, amputation, and risk factors and antecedents of atheromatous disease. A prospective, case series study of 20 patients was performed. The sample was comprised of 19 women, with a mean age of 46.30 years. All patients had objective Raynauds phenomenon, 85 percent were diffuse, 55 percent had digital pulp changes, 15 percent current limb ulcer, 25 percent reabsorption of phalange, no amputations, and 70 percent presented one to four risk factors. Studies were performed by color Doppler ultrasound of the aortic and carotid arteries and lower and upper limb arteries to assess thickening of the intima-media complex, presence of plaques and aneurysms. Ankle-brachial index was also performed in lower limb arteries. Ankle-brachial index was normal in all patients, but 12 (60 percent) had macrovascular disease assessed by Doppler ultrasound, nine (45 percent) of these in the aorta, six (30 percent) in the carotid arteries, one (5 percent) in the upper limb arteries, and seven (35 percent) in lower limb arteries. There was an association between macrovascular disease and digital pulp changes (p = 0.0045). Macrovascular disease was identified in 60 percent of the patients via Doppler ultrasound, but not via ankle-brachial index, which resulted normal in all patients. There was a significant association between macrovascular disease and current digital pulp changes, which did not occur with the other variables.

[Determination of mitral valve area in patients with mitral stenosis by the flow convergence method: clinical application]

Classic echocardiographic methods to estimate mitral valve area [MVA] in the mitral stenosis [MS] has several limitations. Recently, the proximal isovelocity surface area [NSA] method has been shown lobe accurate for calculating MVA. This study sought to I] compare the accuracy of the PISA method to planimetry and Doppler pressure half-time [PHT] methods for echocardiographic estimation of MVA and 2] to evaluate the effect of atrial fibrillation [AF] and significant mitral regorgit4tjon [MR] on the accuracy of the NSA method. In 35 patients with rhumatic mitral stenosis, the mitral valve areas were determined by two-dimensional echocardiographic planimetry, pressure half-time and proximal flow convergence region. 19 patients had atrial fibrillation and 15 had associated mitral insufficiency a 2. The correlaton between PISA and planimetry areas was significant [r=0.83, p<.001]. The intraclass correlation coefficient was of 0.85 but with a large confidence interval [IC95%[0,68-0,91] explaining the significant underestimation of MVA by PISA method: 1,42 +/- 0,47 cm2 versus 1,56 +/- 0,41 cm2 respectively, [p<.001]-There was no signicant difference between PISA and PHT areas 1,42 +/- 0,47 cm2 versus I .43 +/- 0,46 cm. Underestimation of MVA par PISA method didn't have real clinical implication: the sensibility of diagnosing severe MS [MVA

Marcadores ecográficos de cromosomopatías en el I trimestre de la gestación: ductus venoso / Ultrasound markers of chromosomal defects in the first trimester of pregnancy: ductus venosus

La evaluación Doppler del flujo en el ductus venoso en el primer trimestre ha venido a contribuir con información clínica relevante en las orientaciones a los padres. No sólo se mostró eficaz en el rastreo de anomalías cromosómicas, como la trisomía 21, disminuyendo la tasa de procedimientos invasivos, sino también en el rastreo de cardiopatías congénitas, redefiniendo el grupo de alto riesgo a ser sometido a ecocardiografía precoz. Por su parte, un flujo anormal en el ductus venoso asociado a la translucencia nucal aumentada en uno o en ambos fetos de un embarazo monocoriónico parece una combinación sensible para rastrear precozmente el síndrome de transfusión feto fetal. En todas estas situaciones, el ductus venoso se muestra un marcador eficaz de insuficiencia/disfunción cardíaca.

Doppler evaluation of the flow in the ductus venosus in the first trimester of pregnancy has contributed with clinical information relevant for parents counselling. Not only was effective in tracking chromosomal abnormalities such as trisomy 21, decreasing the rate of invasive procedures, but also in tracking congenital heart disease, redefining the high risk group to be subjected to early echocardiography. Also, an abnormal flow in the ductus venous linked to the nuchal translucency increased in one or both fetuses of a monochorionic pregnancy seem a sensitive combination to early trace the feto-fetal transfusion syndrome. In all these situations, the ductus venous shows to be an effective marker of cardiac dysfunction or insufficiency.