ABSTRACT
Abstract Background It has been observed that there is a high incidence of hemorrhoids in female patients with pelvic organ prolapse. Also, in these patients, hemorrhoidal disease improves after the surgical correction of the pelvic organ prolapse. Objective Our hypothesis was that a cause-effect relationship between pelvic organ prolapse, and hemorrhoids might be the key. The objective of this study was to find an element which connects these two conditions. Study Design We conducted a pilot study which consisted of two parts. An initial part, in which we asked several patients with grades III and IV pelvic organ prolapse and hemorrhoids, who have undergone surgery for prolapse, to determine the impact of the surgical restoration of the prolapsed organs on their hemorrhoidal disease. For the second part, on several patients with uncorrected uterine prolapse grades III and IV, we determined the resistive index of the hemorrhoidal branches within the rectal wall before and after manual reduction of the prolapse. Results First, more than 50% of patients who underwent uterine prolapse correction described an improvement of their hemorrhoidal disease of over 50%. Second, the resistive index of the hemorrhoidal branches was significantly lower after manual reduction of the prolapse. We consider that obstructed veins due to pelvic organ prolapse might induce the dilation of the hemorrhoids. The direct measurement of the resistive index of the hemorrhoidal branches allows us to directly assess the increased resistance in the rectal vascular system. Conclusion Venous stasis and impaired vascular flow might be the pathophysiological explanation for the association between pelvic organ prolapse and hemorrhoids. In these patients, the pathogenic treatment should aim at the restoration of a normal blood flow (prolapse surgical cure) instead of focusing on hemorrhoids only.(AU)
Subject(s)
Pelvic Organ Prolapse/surgery , Hemorrhoids/etiology , Rectum/blood supply , Ultrasonography, Doppler , Pelvic Organ Prolapse/complicationsABSTRACT
Introducción: La pileflebitis, trombosis séptica del sistema portal por cuadros inflamatorios agudos abdominales, se presenta con manifestaciones clínicas variables en dependencia de la causa de origen y por rama portal afectado. El diagnóstico incluye función hepática normal o ligeramente alterada con leucocitosis, hemocultivos positivos, eco doppler o tomografía computarizada que corrobore la enfermedad. Objetivo: Describir la pileflebitis como una complicación inusual en una paciente embarazada con apendicitis aguda, desde su concepto, fisiopatología, presentación clínica, diagnóstico y medidas terapéuticas. Caso clínico: Paciente femenina de 18 años, gestante, que refirió dolor abdominal de gran intensidad, acompañado de vómito y deposiciones diarreicas y tinte ictérico. Por tales motivos fue trasladada al Hospital General Docente Ambato. Se diagnosticó sepsis de origen abdominal por apendicitis aguda perforada, peritonitis generalizada complicada con pileflebitis. Se realizó intervención quirúrgica y resolución del cuadro clínico. Conclusiones: La pileflebitis presenta una gran dificultad diagnóstica, por lo que herramientas como la ecografía doppler y la tomografía computarizada son de ayuda en estos casos. Los pilares del tratamiento incluyen control del foco séptico abdominal y tratar la pileflebitis(AU)
Introduction: Pylephlebitis, septic thrombosis of the portal system due to acute abdominal inflammatory conditions, it presents with variable clinical signs depending on the cause of origin and the affected portal branch. Diagnosis includes normal or mildly impaired liver function with leukocytosis, positive blood cultures, Doppler echocardiography, or computed tomography confirming the disease. Objective: To describe pylephlebitis as an unusual complication in a pregnant patient with acute appendicitis, referring to its concept, pathophysiology, clinical presentation, diagnosis and therapeutic measures. Clinical case report: This is the case of an 18-year-old female pregnant patient, who had severe abdominal pain, accompanied by vomiting, diarrhea and jaundiced stools. For such reasons, she was transferred to the Ambato General Teaching Hospital. Sepsis of abdominal origin was diagnosed due to acute perforated appendicitis, generalized peritonitis complicated with pylephlebitis. Surgical intervention was performed and the clinical condition was solved. Conclusions: Pylephlebitis represents a great diagnostic difficulty, hence tools such as Doppler ultrasound and computed tomography are helpful in these cases. The mainstays of treatment include control of the abdominal septic focus and treating pylephlebitis(AU)
Subject(s)
Humans , Female , Adolescent , Appendicitis/complications , Peritonitis , Surgical Procedures, Operative , Echocardiography, Doppler , Vomiting , Tomography, X-Ray Computed , Ultrasonography, DopplerABSTRACT
Abstract Objective The purpose of the present study was to evaluate the rate of patency in the postoperative period of arterial injuries of the forearm secondary to penetrating trauma. The injuries were subjected to primary repair and examined with the Allen test and a handheld Doppler device, and the results were later confirmed with Doppler ultrasonography. Methods Eighteen patients were included, with a total of 19 arterial lesions, 14 ulnar lesions, and 5 radial lesions; one patient had lesions on both forearms. All patients underwent surgery and three clinical evaluations: the Allen test and assessment of arterial blood flow by a handheld Doppler device at 4 and 16 weeks after surgery and Doppler ultrasonography performed at 12 weeks after surgery. Results At the first clinical evaluation, 77% of the patients had patency based on the Allen test, and 72% had a pulsatile sound identified by the handheld Doppler device. In the second evaluation, 61% of the patients had patency based on the Allen test, and the rate of pulsatile sound by the handheld Doppler device was 72%, similar to that observed 2 months earlier. Based on the Doppler ultrasonography evaluation (~12 weeks after surgery), the success rate for arteriorrhaphy was 88%. Regarding the final patency (Doppler ultrasonography evaluation) and trauma mechanism, all patients with penetrating trauma had patent arteries. Conclusion We cde that clinical evaluation using a handheld Doppler device and the Allen test is reliable when a patent artery can be palpated. However, if a patent artery cannot be located during a clinical examination, ultrasonography may be required.
Resumo Objetivo O objetivo deste estudo foi avaliar a taxa de perviedade pós-operatória de lesões arteriais do antebraço secundárias a traumatismo penetrante. As lesões foram submetidas a reparo primário e examinadas com o teste de Allen e um dispositivo Doppler portátil; posteriormente, os resultados foram confirmados à ultrassonografia com Doppler. Métodos Dezoito pacientes foram incluídos, com um total de 19 lesões arteriais, 14 lesões ulnares e 5 lesões radiais; um paciente tinha lesões em ambos os antebraços. Todos os pacientes foram submetidos à cirurgia e três avaliações clínicas: o teste de Allen e a avaliação do fluxo sanguíneo arterial com um dispositivo portátil de Doppler na 4ª e 16ª semanas após a cirurgia e ultrassonografia com Doppler 12 semanas após o procedimento. Resultados Na primeira avaliação clínica, 77% dos pacientes apresentavam perviedade segundo o teste de Allen e 72% apresentavam som pulsátil identificado pelo Doppler portátil. Na segunda avaliação, 61% dos pacientes apresentaram perviedade com base no teste de Allen e a taxa de som pulsátil ao Doppler portátil foi de 72%, semelhante à observada 2 meses antes. À ultrassonografia com Doppler (cerca de 12 semanas após a cirurgia), a taxa de sucesso da arteriorrafia foi de 88%. Em relação à perviedade final (avaliação por ultrassonografia com Doppler) e mecanismo de trauma, todos os pacientes com traumatismo penetrante apresentavam artérias pérvias. Conclusão Concluímos que a avaliação clínica com um dispositivo Doppler portátil e o teste de Allen é confiável caso a artéria pérvia possa ser palpada. No entanto, a ultrassonografia pode ser necessária em caso de impossibilidade de localização de uma artéria pérvia durante o exame clínico.
Subject(s)
Humans , Ulnar Artery/injuries , Ultrasonography, Doppler , Forearm InjuriesABSTRACT
Introducción: Los tumores de las glándulas salivales son infrecuentes en la población en general y comprenden menos del 3% de los tumores de cabeza y cuello1 . En pediatría el 90% corresponden a tumores de la glándula parótida,2 siendo en su mayoría tumores benignos. Objetivo: Describir la incidencia de tumores parotídeos en un centro de referencia, haciendo hincapié en la variabilidad etiológica y la presentación por grupos etarios. Materiales y métodos: Se trata de un estudio de cohorte retrospectivo de pacientes menores de 18 años con tumores de parótida en un periodo de 10 años: de 2011 a 2021, seguidos en el Servicio de Cirugía General Pediátrica del Hospital Italiano de Buenos Aires. Se incluyeron todos los pacientes pediátricos que presentaron tumor en la región parotídea seguidos o tratados en este centro, se excluyeron aquellos que no se pudieron recabar los datos de forma completa. Las variables analizadas fueron edad, sexo, forma de presentación, estudios complementarios, tipo de tratamiento, histología, complicaciones. Resultados: Se analizaron un total de 33 pacientes, de estos un 64% (N = 21) fueron mujeres, con una relación mujer/hombre de 1,7. La media de edad al diagnóstico fue de 8.5 años, siendo 2 de diagnóstico prenatal y hasta los 18 años. La localización fue en un 57% (N = 19) izquierda, el 43% restante derecha. La forma de presentación más frecuente fue la masa palpable en región parotídea 75% (N=25), en dos pacientes fue un hallazgo en estudios por imágenes: resonancia prenatal y otro por resonancia de cerebro. Conclusiones: en pediatría, a diferencia de la población adulta, se presentan una gran variedad de diagnósticos, que incluye desde lesiones vasculares hasta tumores malignos. Debido a que las lesiones parotídeas malignas son clínicamente indistinguibles de las benignas, es importante establecer un diagnóstico preciso. Esta serie representa esta diversidad etiológica en pediatría, así como la distribución etaria comparada con la descrita por la literatura
Introduction: Salivary gland tumors are rare in the general population and comprise less than 3% of head and neck tumors1. In pediatrics, 90% correspond to tumors of the parotid gland,2 being mostly benign tumors. Objective: To describe the incidence of parotid tumors in a reference center, emphasizing the etiological variability and the presentation by age groups. Materials and methods: Tis is a retrospective cohort study of patients under 18 years of age with parotid tumors over a period of 10 years: from 2011 to 2021, followed up at the Pediatric General Surgery Service of the Italian Hospital of Buenos Aires. All pediatric patients who presented tumor in the parotid region followed up or treated in this center were included, those who could not collect the data completely were excluded. Te variables analyzed were age, sex, form of presentation, complementary studies, type of treatment, histology, and complications. Results: A total of 33 patients were analyzed, of which 64% (N = 21) were women, with a female/male ratio of 1.7. Te mean age at diagnosis was 8.5 years, with 2 prenatal diagnoses and up to 18 years. Te location was 57% (N = 19) left, the remaining 43% right. Te most frequent form of presentation was a palpable mass in the parotid region 75% (N=25), in two patients it was a finding in imaging studies: prenatal MRI and another by brain MRI. Conclusions: in pediatrics, unlike the adult population, a wide variety of diagnoses are presented, ranging from vascular lesions to malignant tumors. Because malignant parotid lesions are clinically indistinguishable from benign ones, it is important to establish an accurate diagnosis. Tis series represents this etiological diversity in pediatrics, as well as the age distribution compared to that described in the literature
Subject(s)
Humans , Infant , Child, Preschool , Child , Adolescent , Parotid Neoplasms/surgery , Parotid Neoplasms/etiology , Parotid Neoplasms/therapy , Retrospective Studies , Cohort Studies , Ultrasonography, Doppler , Early DiagnosisSubject(s)
Humans , Male , Female , Child , Adolescent , Adult , Aortic Coarctation , Sleep Apnea, Obstructive , Cushing Syndrome , Hyperaldosteronism , Hypertension/diagnosis , Hypertension/etiology , Pheochromocytoma/physiopathology , Spironolactone/administration & dosage , Adrenalectomy/methods , Ultrasonography, Doppler/instrumentation , Blood Pressure Monitoring, Ambulatory/methodsABSTRACT
Background:The co-existence of diabetes mellitus (DM) and hypertension (HTN) has been rising globally with subclinical atherosclerotic complications. These vascular changes can be detected using carotid ultrasonography. Objectives: To determine and compare the carotid arterial structural wall changes and blood flow velocities of adults with co-existing DM and HTN with age-and sex-matched non-diabetic, non-hypertensive controls. Methods: A cross-sectional comparative study of 300 participants comprising 200 adults with co-existing DM and HTN and 100 age-and sex-matched controls was done. Their carotid arteries were examined bilaterally for plaques, carotid intima media thickness (CIMT) and flow velocities peak systolic velocity (PSV), end diastolic velocity (EDV), pulsatility index (PI) and resistive index (RI) using 412MHz linear array transducer. Visceral obesity and serum lipids were also assessed. Results: The mean age of the subjects was 56.13 ± 6.93 years; they comprised 38% males and 62% females. The subjects' CIMT was statistically significantly higher (p = 0.001) with a three-fold mean increase (45.5%) compared to the controls (13.7%). Lower flow velocities but higher indices were also observed in the subjects. Strong and significant correlations were observed between EDV and PI r =-0.663, p=>0.001), EDV and RI (r = -0.661, p=>0.001) and PI and RI (r =0.988, p= >0.001)among the subjects. Conclusion: Significant reduction in flow velocities with increased CIMT may be an early indication of subclinical atherosclerosis. Therefore, carotid ultrasonography should be mandatory in individuals at risk for early detection and possible prevention of atherosclerotic complications.
Subject(s)
Humans , Male , Female , Middle Aged , Blood Flow Velocity , Carotid Artery Diseases , Ultrasonography, Doppler , Diabetes Mellitus, Type 2 , HypertensionABSTRACT
Resumo A artéria femoral profunda, devido às suas características anatômicas, se encontra protegida da maioria dos traumatismos vasculares. Relatamos um caso de pseudoaneurisma de ramo perfurante da artéria femoral profunda, associado à fístula arteriovenosa, secundário a rotura completa do músculo vasto medial em paciente jogador de futebol. A ressonância magnética demonstrou lesão muscular associada a pseudoaneurisma, e a angiotomografia confirmou a presença de pseudoaneurisma associado a fístula arteriovenosa de ramo da artéria femoral profunda. Foi realizado tratamento endovascular da fístula através da embolização com micromolas fibradas e drenagem cirúrgica do hematoma muscular. O paciente evoluiu bem, sem queixas clínicas no 30º dia de pós-operatório e também após 1 ano.
Abstract Due to its anatomical characteristics, the deep femoral artery is protected from most vascular injuries. We report a case of a soccer player with pseudoaneurysm of a perforating branch of the deep femoral artery, associated with an arteriovenous fistula and secondary to complete rupture of the vastus medialis muscle. Magnetic resonance imaging showed muscle damage associated with a pseudoaneurysm and angiotomography confirmed the presence of a pseudoaneurysm associated with a deep arteriovenous fistula of a branch of the deep femoral artery. Endovascular treatment of the fistula was performed by embolization with fibrous microcoils and surgical drainage of the muscle hematoma. The patient recovered well, was free from clinical complaints on the 30th postoperative day and also after 1 year.
Subject(s)
Humans , Male , Adult , Arteriovenous Fistula/therapy , Aneurysm, False , Quadriceps Muscle/injuries , Femoral Artery/injuries , Rupture , Angiography , Magnetic Resonance Spectroscopy , Ultrasonography, Doppler , Embolization, Therapeutic , Femoral Artery/diagnostic imaging , Endovascular ProceduresABSTRACT
Se presenta el caso clínico de un paciente de 21 años de edad, con antecedente de herniorrafia inguinal derecha, quien asistió a consulta de control y refirió presentar una induración y dolor en la región dorsal del pene con 4 días de evolución, que había comenzado después de una relación sexual en la cual consumió marihuana. En el examen físico se encontró la vena dorsal del pene engrosada, dura y dolorosa a la palpación. Se le diagnosticó una enfermedad de Mondor del pene. La ecografía Doppler confirmó la tromboflebitis de esta vena. El paciente recibió tratamiento médico y evolucionó satisfactoriamente.
The case report of a 21 years patient with history of right inguinal herniorrhaphy is presented, who attended control visit and he made reference to an induration and pain in the dorsal region of the penis with 4 days of evolution that had begun after a sexual relationship in which he consumed marihuana. In the physical exam the penis dorsal vein was found thicken, hard and painful to the palpation. He was diagnosed a Mondor disease of the penis. The Doppler scanning confirmed the thrombophlebitis of this vein. The patient received medical treatment and had a favorable clinical course.
Subject(s)
Penis/injuries , Thrombophlebitis/diagnostic imaging , Ultrasonography, Doppler , HerniorrhaphyABSTRACT
Objetivo: Determinar los hallazgos por eco-Doppler orbitario en pacientes con glaucoma primario de ángulo abierto según factores de riesgo aterosclerótico. Métodos: Se realizó un estudio observacional descriptivo y transversal en 300 órbitas de 150 pacientes con diagnóstico de glaucoma primario de ángulo abierto. A todos los casos se les realizó tonometría de contorno dinámico y tomografía de coherencia óptica. Se identificaron mediante interrogatorio y por el laboratorio clínico los factores de riesgo aterosclerótico: hipertensión arterial, tabaquismo, diabetes mellitus tipo 2, dislipidemia, obesidad y consumo excesivo de alcohol. Se les realizó ultrasonido orbitario y Doppler carotídeo, y solo en caso de resultar normales se procedió a evaluar mediante eco-Doppler las arterias oftálmica, central de la retina y ciliares posteriores temporales. Resultados: La edad media de los sujetos estudiados fue de 62,3 años. El 55,3 por ciento correspondió al sexo femenino y el 47,3 por ciento al color blanco de la piel. El número de factores de riesgo mostró una correlación lineal moderada, positiva y significativa con el índice de resistencia, mientras que con las velocidades dicha correlación resultó ser negativa. Todos los factores de riesgo expresaron efectos dañinos sobre la hemodinámica del flujo ocular, la presión intraocular y el grosor de las capas de fibras neurorretinianas temporales. Tras ajustar para la edad, esta negativa influencia continuó siendo relevante en la mayoría de los casos. Conclusiones: Los aspectos vasculares del glaucoma deben integrarse a la práctica clínica de esta afección, lo que ayudará a que el enfoque sea más completo, y redundará en un mejor pronóstico de la enfermedad(AU)
Objective: Determine the orbital echo-Doppler findings in patients with primary open angle glaucoma according to atherosclerotic risk factors. Methods: A cross-sectional observational descriptive study was conducted of 300 orbits of 150 patients diagnosed with primary open angle glaucoma. All the cases underwent dynamic contour tonometry and optical coherence tomography. Interrogation and clinical laboratory testing led to identification of the following atherosclerotic risk factors: arterial hypertension, smoking, diabetes mellitus type 2, dyslipidemia, obesity and excessive alcohol consumption. Orbital and carotid Doppler ultrasounds were performed, and only if they were normal they would be followed by echo-Doppler evaluation of the ophthalmic, central retinal and posterior temporal ciliary arteries. Results: Mean age of the study subjects was 62.3 years. 55.3 percent were female and 47.3 percent had white skin. The number of risk factors showed a moderate, positive and significant linear correlation with the resistive index, and a negative correlation with the velocities. All the risk factors expressed harmful effects on ocular flow hemodynamics, intraocular pressure and the thickness of temporal neuroretinal fibers. After adjusting for age, this negative influence continued to be relevant in most cases. Conclusions: The vascular aspects of glaucoma should be incorporated into the clinical management of this condition. This will make the approach more thorough and help achieve a better diagnosis(AU)
Subject(s)
Humans , Female , Middle Aged , Glaucoma, Open-Angle/diagnosis , Risk Factors , Ultrasonography, Doppler/methods , Tomography, Optical Coherence/methods , Epidemiology, Descriptive , Cross-Sectional Studies , Observational Studies as Topic , Intraocular PressureABSTRACT
The doppler-guided transanal hemorrhoidal dearterialization technique associated with mucopexy is a noninvasive surgical option used to treat hemorrhoidal disease (HD). Objective: To compare and analyze the results using a variation of the doppler-guided transanal hemorrhoidal dearterialization technique with the technique of selective hemorrhoidal dearterialization with high mucopexy in the treatment of HD. Method: A total of 292 patients who underwent surgical treatment for grade II, III and IV HD from March 2012 to December 2017 were studied. From this total, 110 (37.6%) patients underwent a conventional doppler-guided transanal hemorrhoidal dearterialization with mucopexy (CD), and 182 (62.3%) underwent selective hemorrhoidal dearterialization with highmucopexy (SHeLF). In the group of patients undergoing CD, 4 patients (3.64%) had grade II HD, 82 (74.55%) grade III, and 24 (21.82%) grade IV. In the group submitted to SHeLF, 18 (9.89%) patients had grade II HD, 86 (47.25%) had grade III, and 65 (35.71%) had grade IV. The same surgeon operated all patients under spinal anesthesia. In patients undergoing CD, six arterial branches have been dearterialized, while in patients undergoing SHeLF, the hemorrhoidary nipples submitted to a dearterialization were selected (from 1 to 5) by intraoperative evaluation followed by high rectal mucopexy. In the postoperative period, the following parameters were evaluated: pain, tenesmus, bleeding, and recurrence. Moderate results to severe pain was a postoperative complaint reported by 13 (11.82%) patients undergoing CD, and by 19 (10.44%) undergoing SHeLF. Intense tenesmus was reported by 26 (23.64%) patients undergoing CD and by 7 (3.85%) undergoing SHeLF. Three patients (2.73%) undergoing CD and 1 (0.55%) undergoing SHeLF evolved with postoperative bleeding. One patient (0.55%) in the group undergoing CD required surgical review of hemostasis. Six patients (5.45%) who underwent CD and 8 (4.39%) who underwent SHeLF were reoperated due to disease recurrence. Conclusion: Comparing statistics, patients undergoing the SHeLF technique have less postoperative pain, tenesmus and postoperative bleeding when compared with CD. (AU)
Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Hemorrhoids/therapy , Treatment Outcome , Ultrasonography, Doppler , Hemorrhoidectomy/methodsABSTRACT
INTRODUCCIÓN: La aneuploidía más común entre los recién nacidos vivos es el síndrome de Down (SD). En estos niños el crecimiento está disminuido, con una frecuencia del 25% de restricción del crecimiento intrauterino, pero no se ha establecido el papel de la insuficiencia placentaria. El objetivo es estudiar la resistencia placentaria a través del Doppler de arteria umbilical con índice de pulsatilidad (IP) y el tiempo medio de desaceleración (t/2), y el posible efecto de la insuficiencia placentaria en fetos con SD. MÉTODO: Se realizó Doppler en la arteria umbilical en 78 fetos con SD, se midieron el IP y el t/2, y se compararon los resultados con los pesos de nacimiento. RESULTADOS: Se estudiaron 78 fetos con SD con 214 mediciones Doppler. El t/2 y el IP estaban alterados en el 71,5% y el 65% de las mediciones, respectivamente. La incidencia de t/2 alterado aumenta con la edad gestacional desde un 28,6% a las 15-20 semanas hasta un 89,3% sobre las 36 semanas (p < 0,01); cifras similares se observan para el IP. La clasificación de los pesos fue: 64% adecuados, 12% grandes y 24% pequeños para la edad gestacional. La última medición de t/2 antes del parto era normal en el 17% y estaba alterada en el 83%. En el caso del IP, los valores fueron normales en el 27% y anormales en el 73%. El peso de nacimiento, la edad gestacional y el porcentaje de niños adecuados para la edad gestacional eran significativamente mayores en el grupo con Doppler normal que en el grupo con Doppler alterado. El z-score del t/2 estaba marcadamente alterado (−2.23), pero el del peso de nacimiento solo estaba algo disminuido (−0,39). La mortalidad perinatal fue del 10%, significativamente mayor cuando el flujo diastólico era ausente o reverso. CONCLUSIONES: El estudio demuestra que los fetos con SD tienen una alta incidencia de alteración del Doppler umbilical para el IP y el t/2, lo cual sugiere una insuficiencia placentaria grave. Este deterioro parece iniciarse hacia el final del segundo trimestre y aumenta con la edad gestacional. Sin embargo, en estos fetos, la insuficiencia placentaria produce una ligera caída en el crecimiento fetal. Como hipótesis general pensamos que en los fetos con SD hay datos claros de insuficiencia placentaria, pero habría algún factor que les protegería de una restricción grave del crecimiento.
INTRODUCTION: The most common aneuploidy in live newborns is Down syndrome (DS), in these children growth is decreased, with a frequency of 25-36% of fetal growth restriction (FGR); however, it is not established the role of placental insufficiency. The objective is to study the Doppler of the umbilical artery with pulsatility index (PI) and half peak systolic velocity (hPSV) deceleration time and the possible role of placental insufficiency in fetuses with DS. METHOD: Doppler was performed in fetuses with DS, the umbilical artery and IP and hPSV were measured, and the results were compared with birth weights. RESULTS: 78 fetuses with DS were studied with 214 Doppler measurements. hPSV and the IP were altered in 71.5% and 65% of the measurements; the incidence of abnormal hPSV increases with gestational age from 28.6% between 15 to 20 weeks, to 89.3% over 36 weeks (p < 0.01), similar figures are observed with respect to the PI. The weight classification was: 24% of FGR, 12% of great for age and 64% of adequate for gestational age (AGA). The last measurement of hPSV before delivery was normal in 17% of the fetuses and was abnormal in 83%, in the case of PI the normal and abnormal values were 27 and 73%, respectively. Birth weight, gestational age, and the percentage of AGA children were significantly higher in the normal Doppler group than in the abnormal Doppler group. The hPSV z-score was markedly altered (−2.23), but the birth weight z-score is slightly decreased (−0.39). Perinatal mortality is 10% and is significantly higher when diastolic flow is absent or reverse. CONCLUSIONS: The study shows that DS fetuses have a high incidence of abnormal umbilical Doppler measured with IP and hPSV, which suggests severe placental insufficiency, this deterioration seems to start towards the end of the second trimester and increases with gestational age. However, in these fetuses, placental insufficiency causes a discrete drop in fetal growth. As a general hypothesis, we think that there is clear evidence of placental insufficiency in fetuses with DS, but there would be some factor that would protect these fetuses from severe growth restriction.
Subject(s)
Humans , Female , Pregnancy , Umbilical Arteries/diagnostic imaging , Down Syndrome/diagnostic imaging , Placental Insufficiency/etiology , Blood Flow Velocity , Pulsatile Flow , Ultrasonography, Prenatal , Gestational Age , Ultrasonography, Doppler , Deceleration , Fetal Growth Retardation/etiologyABSTRACT
Neurofibromatosis type 1 (NF1) is a genetic syndrome which typically presents with neurological manifestations. Some of the patients may also present with vasculopathies, among which arterial aneurysms and stenosis are the most common. Deep vein thrombosis (DVT) has rarely been described, and, to the best of our knowledge, the present is the first report of DVT due to venous compression by a neurofibroma in the setting of NF1. This is the case of a 23-year-old male with NF1 who experienced DVT due to compression of the left posterior tibial veins by a large tumor arising from the tibial nerve. The DVT was acutely treated with enoxaparin and then with rivaroxaban. Two months after the diagnosis, Doppler ultrasonography showed partial recanalization and persistence of the DVT. The patient was then referred to neurosurgery for surgical resection of the tumor. There were no complications during the procedure, and the patient did not present postoperative neurological deficits. The final histopathological diagnosis was of a benign neurofibroma. After one year of follow-up with vascular surgery, the patient presented no more episodes of DVT. In case there is a tumor compressing the deep vessels of the leg and promoting DVT, surgical resection with microsurgical techniques may be curative.
Subject(s)
Humans , Male , Young Adult , Neurofibromatosis 1/surgery , Neurofibromatosis 1/complications , Venous Thrombosis/etiology , Venous Thrombosis/drug therapy , Neurofibromatosis 1/diagnostic imaging , Enoxaparin/therapeutic use , Ultrasonography, Doppler/methods , Venous Thrombosis/diagnostic imaging , Rivaroxaban/therapeutic use , Neurofibroma/surgeryABSTRACT
This study used B-mode and Doppler ultrasonography to characterize the abdominal structures of healthy peccaries raised in captivity. Fifteen peccaries were used for this study. The urinary vesicle appeared as an ovoid structure, located in the abdominal and pelvic transition, with a hyperechogenic, thin, smooth, and regular wall. The kidneys presented retroperitoneal topography and had similar sizes. The kidney/aorta ratio had an average value of 10.53±15cm (right) and 10.23±0.12 (left). The right adrenal gland had a length of 1.93±0.34cm and diameter of 0.56±0.16cm. The left adrenal gland had a length of 1.85±0.42cm and diameter of 0.52±0.11cm. The spleen had a diameter of 1.13±0.18cm. The hepatic vein demonstrated polyphasic flow in pulsed Doppler, with two retrograde peaks and an anterograde peak with a flow velocity of 25.7±0.83cm/s. The abdominal aorta had a diameter of 0.58±0.05cm and a flow velocity of 115.17±5.32cm/s. The morphological and hemodynamic study of the abdominal structures of the peccary, observed through B-mode and Doppler ultrasonography, aided in identifying the size, shape, position, echogenicity, and echotexture of the abdominal organs and in making inferences about the normal parameters for these structures in this species.(AU)
Este estudo teve como objetivo utilizar as ultrassonografias de modo-B e Doppler para caracterizar as estruturas abdominais de um cateto sadio criado em cativeiro. Quinze catetos foram utilizados para este estudo. A vesícula urinária apareceu como uma estrutura ovoide, localizada na transição entre as partes abdominal e pélvica, com uma parede hiperecogênica, fina, lisa e regular. Os rins apresentaram topografia retroperitoneal e tamanhos semelhantes. A relação rim/aorta teve um valor médio de 10,53 ± 15cm (direita) e 10,23 ± 0,12cm (esquerda). A glândula adrenal direita tinha um comprimento de 1,93 ± 0,34cm e um diâmetro de 0,56 ± 0,16cm. A glândula suprarrenal esquerda tinha um comprimento de 1,85 ± 0,42cm e um diâmetro de 0,52 ± 0,11cm. O baço tinha um diâmetro de 1,13 ± 0,18cm. A veia hepática demonstrou fluxo polifásico no Doppler pulsátil, com dois picos retrógrados e um pico anterógrado com velocidade de fluxo de 25,7±0,83cm/s. A aorta abdominal tinha um diâmetro de 0,58 ± 0,05cm e uma velocidade de fluxo de 115,17±5,32cm/s. Os estudos morfológico e hemodinâmico das estruturas abdominais do queixada, observadas por meio das ultrassonografias modo-B e Doppler, auxiliaram na identificação do tamanho, da forma, da posição, da ecogenicidade e da ecotextura dos órgãos abdominais e na realização de inferências sobre os parâmetros de normalidade para as estruturas nas espécies.(AU)
Subject(s)
Animals , Artiodactyla/anatomy & histology , Abdomen/diagnostic imaging , Hemodynamics , Echocardiography, Doppler/veterinary , Ultrasonography, Doppler/veterinaryABSTRACT
Introdução: A iatrogenia é uma causa importante de morbimortalidade, logo, a prevenção quaternária (P4), ação que ceifa a cascata diagnóstica supérflua, foi incluída como exercício de boa prática. A medicina de família e comunidade (MFC) introjeta a P4 na vivência, sendo capaz de usar ciência aliada a habilidades de comunicação para conhecer as pessoas, resolvendo assim cerca de 85% das queixas, o que inclui as de origem vascular. Existe uma alta demanda no Sistema Único de Saúde (SUS) tanto na marcação de exames quanto no encaminhamento para especialistas focais no que tange às queixas circulatórias, mas nem sempre encaminhar é oportuno. Nesse cenário, a MFC funciona como um caminho para a P4. Objetivos: O objetivo do presente estudo foi avaliar as referências para cirurgia vascular e angiologia e as solicitações de ultrassonografia (USG) Doppler de vasos de unidades de saúde da família (USFs) de João Pessoa/PB, analisando as taxas de solicitações por população adulta (>18 anos) adscrita, nas unidades conveniadas ao programa de residência em medicina de família e comunidade (PRMFC) há mais de 1 ano, há menos de 1 ano e naquelas sem convênio com PRMFC, sob o olhar crítico da P4. Métodos: Trata-se de um estudo transversal a partir de dados fornecidos pela Central de Regulação da Secretaria Municipal de Saúde de João Pessoa (SMS/JP), entre janeiro de 2017 e agosto de 2018. Para realização dos cálculos de correlação entre as variáveis estudadas, utilizou-se o teste de Kruskall-Wallis através do software SPSS 21.0. Resultados: O número total de pedidos de exames em análise foi de 3.918, oriundos de 90 USF, que somam uma população adscrita maior de 18 anos de 332.819 pessoas. Solicitou-se 1 Doppler a cada 85 habitantes adultos. Os resultados do estudo sugerem que os médicos residentes solicitam mais exames que os médicos não residentes, mas por outro lado apresentam menor taxa de encaminhamento aos especialistas. Conclusões: Estes achados podem sugerir que os médicos residentes encaminham menos, o que pode estar relacionado ao aumento da resolubilidade da atenção primária à saúde (APS) e ao ensino da P4 sob orientação de um médico de família e comunidade preceptor. Entretanto, novos delineamentos de pesquisa são necessários para melhor elucidar esta hipótese.
Introduction: Iatrogenesis is an important cause of morbimortality and quaternary prevention (P4), an action that reduces the superfluous diagnostic cascade, was included as an exercise of good practice. Family practice projects P4 into practice, being able to use science combined with communication skills to know people, solving about 85% of complaints, including vascular discomforts. There is a high demand at Sistema Único de Saúde (SUS) both in scheduling exams and referrals to focal specialists with regard to circulatory complaints, but referring is not always appropriate. In this scenario, family practice works as a pathway to P4. Objectives: The aim of the present study was to evaluate the referrals for vascular surgery/angiologist and requests for Doppler ultrasonography (USG) of vessels from family health units (USF) in João Pessoa, PB, analyzing the rates of requests per registered adult population (>18-years-old) in the units affiliated to the family practice medical residency program (FPMRP) for more than a year, less than a year and in the non-affiliated ones, under P4's critical view. Methods: This is a cross-sectional study of data provided by the Regulation Center of the Municipal Health Department of João Pessoa, between January 2017 and August 2018. To perform the correlation calculations between the studied variables, Kruskall-Wallis' correlation test was used through the SPSS 21.0 software. Results: The total number of exam requests under analysis was 3,918, from 90 USF, which add up to an enrolled population over 18-years-old of 332,819 people. For every 85 adult inhabitants, one Doppler exam was requested. Data suggest that the resident doctors request more exams than the non-residents, but on the other hand they have lower rates of referrals to focal experts. Conclusions: These findings may suggest that resident physicians refer less, which may be related to the increase in the resolution of primary care and the teaching of P4 under the guidance of a family practice preceptor. However, new research designs are considered to better elucidate this hypothesis.
Introducción: La iatrogenia es una causa importante de morbilidad y mortalidad, por lo que se incluyó como ejercicio de buena práctica la prevención cuaternaria (P4), una acción que corta la cascada diagnóstica superflua. La medicina familiar y comunitaria (MFC) introduce la P4 en la práctica, siendo capaz de utilizar la ciencia aliada a las habilidades de comunicación para conocer a las personas, resolviendo así alrededor del 85% de las quejas, lo que incluye las quejas vasculares. En el Sistema Único de Salud (SUS) brasileño hay una gran demanda, tanto para programar exámenes como para derivar a los especialistas focales las dolencias circulatorias, pero la derivación no siempre es oportuna. En este escenario, la CBM funciona como una vía hacia la P4. Objetivo: El objetivo del presente estudio fue evaluar las referencias de cirugía vascular y angiología y las solicitudes de ultrasonografía Doppler (USG) de vasos de las unidades de salud de la familia (USF) de João Pessoa/PB, analizando las tasas de solicitudes por población adulta (>18 años) asignada, en las unidades asociadas al programa de residencia en medicina de la familia y de la comunidad (CFMRP) por más de 1 año, por menos de 1 año y en las que no tienen convenio con el CFMRP, bajo la visión crítica del P4. Métodos: Se trata de un estudio transversal de datos proporcionados por la Central de Regulación de la Secretaría Municipal de Salud de João Pessoa (SMS/JP), entre enero de 2017 y agosto de 2018. Se utilizó la prueba de Kruskall-Wallis para realizar los cálculos de correlación entre las variables estudiadas mediante el programa informático SPSS 21.0. Resultados: El número total de solicitudes de pruebas analizadas fue de 3.918, procedentes de 90 USF, que suman una población asignada mayor de 18 años de 332.819 personas. Se solicitó un Doppler por cada 85 habitantes adultos. Los resultados sugieren que los médicos residentes solicitan más pruebas que los no residentes, pero por otro lado tienen una tasa de derivación a especialistas más baja. Conclusiones: Estos resultados pueden sugerir que los médicos residentes derivan menos, lo que puede estar relacionado con la mayor resolutividad de la Atención Primaria de Salud (APS) y la enseñanza de la P4 bajo la dirección de un médico de familia y un preceptor comunitario. Sin embargo, se necesitan nuevos diseños de investigación para dilucidar mejor esta hipótesis.
Subject(s)
Humans , Adolescent , Adult , Primary Health Care , Referral and Consultation/statistics & numerical data , Vascular Surgical Procedures/statistics & numerical data , Ultrasonography, Doppler/statistics & numerical data , Quaternary Prevention , Internship and Residency , Cross-Sectional StudiesABSTRACT
ABSTRACT Background: Transanal hemorrhoidal dearterialization (THD) is safe and effective minimally invasive treatment for hemorrhoidal disease, but reports regarding recurrence and postoperative complications (pain and tenesmus) vary significantly. Aim: To evaluate if selective dearterialization and mucopexy at the symptomatic hemorrhoid only, without Doppler guidance, achieves adequate control of the prolapse and bleeding and if postoperative morbidity is reduced with this technique. Methods: Twenty consecutive patients with grade II and III hemorrhoids were treated with this new approach and were evaluated for postoperative complications and recurrence. Results: Control of prolapse and bleeding was achieved in all patients (n=20). Postoperative complications were tenesmus (n=2), external hemorrhoidal thrombosis (n=2) and urinary retention (n=2). After a mean follow-up of 13 months no recurrences were diagnosed. Conclusion: Selective dearterialization and mucopexy is safe and achieves adequate control of prolapse and bleeding and, by minimizing sutures in the anal canal, postoperative morbidity is diminished. Doppler probe is unnecessary for this procedure, which makes it also more interesting from an economic perspective.
RESUMO Racional: O tratamento da doença hemorroidária pela técnica de THD (Transanal Hemorrhoidal Dearterialization) é minimamente invasivo e tem se mostrado seguro e eficiente. No entanto, dados sobre a recorrência e complicações (dor e tenesmo) no pós-operatório são muito variáveis. Objetivo: Avaliar se a desarterialização e mucopexia seletiva, sem o uso de Doppler, é suficiente para o controle de sintomas e se a morbidade pós-operatória é menor com esta técnica. Métodos: Vinte pacientes foram tratados com essa técnica e avaliados sobre controle de sintomas, morbidade pós-operatória e recorrência. Resultados: Controle do prolapso e sangramento foi observado em todos pacientes (n=20). Complicações pós-operatórias foram: tenesmo (n=2), trombose hemorroidária externa (n=2), retenção urinária (n=2). Após um seguimento médio de 13 meses, nenhuma recorrência foi detectada. Conclusões: O procedimento de desarterialização e mucopexias seletivas é seguro e eficiente em termos de controle do prolapso e sangramento. Esta técnica resulta em menor morbidade cirúrgica, uma vez que diminui o número de suturas no canal anal, resultando em menos dor e tenesmo pós-operatório. Para este procedimento o uso de ultrassom Doppler é desnecessário, o que diminui custos e o torna mais atrativo do ponto de vista econômico.