Preoperative vascular evaluation of perforator flap of peroneal artery: A comparative study between CT angiography and colour Doppler ultrasound / 中华显微外科杂志

Objective:To compare the clinical value of CTA and CDU in perforator flap of peroneal artery.Methods:From February 2013 to October 2016, 47 patients who suffered with soft tissue defects and were hospitalised in the Department of Orthopaedics, the 920th Hospital of Joint Logistic Support Force of Chinese PLA were retrospectively reviewed and evaluated. All the defects were reconstructed by the perforator flap of peroneal artery. All patients received preoperative CTA and CDU scans before surgery. Appropriate perforator vessels were selected and the locating points in body surface and external diameters of the perforator vessels were recorded and compared with intraoperative findings. SPSS 22.0 statistical software was used for data analysis. P<0.05 was considered statistically significant. Results:The intraoperative coincidence rate of the proposed perforator vessels was 97.87% for CDU and 95.74% for CTA, with no significant difference between the 2 groups( P>0.05). It was found that the preoperative CTA and CDU measurements were consistent with the actual intraoperative measurements, and there was no significant difference between the 2 groups( P>0.05). For CTA combined with CDU, an intraoperative coincidence rate was 100% in the location of peroneal perforating vessels. All flaps were followed-up for 1 to 18(mean 13.5) months. All the flaps survived well with good texture and appearance without complication. Conclusion:CDU and CTA are reliable and useful in preoperative vascular evaluation of peroneal perforator flap, and both can be used in a complementary or combined manner.

Comparative study of infrared thermal imaging technology and colour Doppler ultrasound in the detection of perforator vessels before anterolateral femoral perforator flap / 中华显微外科杂志

Objective:To compare the reliability between infrared thermal imaging technology(IRT) and colour Doppler ultrasound (CDU) in the detection of perforators for anterolateral femoral perforator flap(ALTPF).Methods:From September, 2017 to September, 2019, a total of 25 patients(16 males and 9 females, aged 12-53 years old with an average age of 38.7 years old) underwent ALTPF surgery for the purpose of resurfacing and reconstruction. All patients had pedicled or free ALTPF sized from 5.0 cm×8.0 cm to 7.5 cm×30.0 cm. Among all cases, 21 received free flaps and 4 received pedicled flaps. All patients underwent routine IRT and CDU examinations to locate the perforators preoperatively.Results:Of the 25 patients, CDU detected 53 perforators and IRT detected 51 "hot spots". There were 50 "hot spots" that corresponded to the findings of CDU with a κ index at 0.712( P<0.05), representing a high degree of consistency. The sensitivity and specificity were 94.3% and 85.7%, respectively. Conclusion:IRT has a high consistency in detecting perforators for ALTPF in comparison with CDU. IRT features portable, low cost, non-invasive, and easy to operate. At the same time, IRT has advantages in the patients who have thin subcutaneous tissue. With higher accuracy, IRT is expected to become an important part of preoperative perforator navigation.

Doppler Evaluation of Vertebral Artery in Cervical Spondylosis - A Prospective Study in Rural Indian Set Up.

So far, evaluation of vertebral arteries has been done by angiography with a limited data on evaluation with duplex scanning of the vertebral arteries. We wanted to study the radiological features and vertebral artery Doppler characteristics, in patients aged above 35 years with a clinical diagnosis of cervical spondylosis. METHODSThis is a case control study with a total of 120 subjects aged over 35 years (60 subjects were cases with the clinical diagnosis of cervical spondylosis and the remaining 60 subjects were age matched controls). Vertebral artery colour Doppler was performed to record peak systolic velocity, time averaged maximum velocity, diameter of the segment in grey scale in millimetres and flow volume of the vertebral artery. Statistical analysis was done using chi square test, student t test and z test with p values < 0.05 being considered statistically significant. RESULTSMajority of patients in both groups were in the age group 41 - 50 years. Among cases 39 (65%) were males and 21 (35%) were females. Most of cases had vertebral artery diameters in the range of 3.0 - 3.5 mm seen both on right [21{35%}] as well as on left side [17 {28.3%}], and a similar finding was observed in controls as well. No statistical significance was observed amongst cases and control on either right or left side. Most of the cases had vertebral artery blood flow in the range of 51-100 mL/min both on right side [26 (43.3%)] and left side [22 (36.7%). On comparing vertebral artery blood flow in the range of ≤100 mL/min and >100 mL/min, the difference was statistically significant on the left side. On comparing the number of cases and controls according to the vertebral artery blood flow velocity ≤30 cm/s and >30 cm/sec on right side, p value was 0.009 and that on the left was 0.001, both of which are statistically significant. CONCLUSIONSVertebral artery diameter is not a very reliable sign in this degenerative condition. Vertebral artery flow volume is decreased at least in one vertebral artery. Vertebral artery blood flow velocity was significantly reduced in cervical spondylosis cases compared to controls both on right side (p=0.009) and left side (p= 0.001). This makes reduced vertebral artery blood flow velocity as a very strong sign in this condition. To conclude vertebral artery ultrasound is a very useful and reliable tool in evaluation of vertebrobasilar insufficiency cases.

A clinical study on varicose veins of lower limb, surgical management and functional outcome at a tertiary care hospital of South India

Background: Varicose veins defined as dilated, tortuous, subcutaneous veins ≥3 mm in diameter, measured in the upright position with demonstrable reflux. Though the history of varicose veins dates prehistorically, the advances in diagnosis and new management modalities gained attention recently. The aim of the present study was to study the clinical profile, risk factors and their association, different types of surgical procedures employed and complications associated with varicose veins.Methods: A one year observational after ethical committee approval was conducted by department of general surgery at ACSR Medical College. Cases fulfilling the inclusion criteria were clinically examined and duplex ultrasound colour Doppler was performed for diagnosing the varicose veins and findings of site of incompetence was noted. All the cases were operated and followed up for six months period. The results were tabulated and analyzed in Microsoft Excel for any corrections.Results: Eighty cases with 66.25% males and 33.75% females with mean age of 40.24 years and majority (40%) were in 41 to 50 years group. 60% of cases had varices in right limb and long saphenous vein was involved in 52.5% of cases.85% had dilated veins, perforator incompetence was noted below the knee in 30% of cases. 41.25% of cases saphenofemoral flush ligation with stripping of long saphenous vein. Wound infection was the common postoperative complication.Conclusions: Operative line of management should be the first line of treatment even though conservative management relieves the symptoms but always requires a definitive management.

Role of obstetric colour doppler studies in predicting perinatal outcome in pregnancy induced hypertension

Background: Pregnancy induced hypertension (PIH) is associated with adverse perinatal outcome. Multi vessel colour Doppler studies are useful in these cases for timely intervention. The aim of present study was to know the significance of umbilical, middle cerebral and uterine artery Doppler in PIH and to analyse their role in predicting perinatal outcome.Methods: This is a study of 150 pregnant women with pregnancy induced hypertension (PIH). These patients were evaluated with colour Doppler and were followed subsequently for any adverse perinatal outcome.Results: Out of 150 cases 70% of cases were found in 20-30 years age group. 98 cases had abnormal uterine artery Doppler indices accounting for 65.3%, while 52 cases had a normal Doppler index accounting for 34.3%. Out of 150 cases, 94 (64.6%) cases had abnormal middle cerebral artery. In our study 53 cases had abnormal umbilical artery Doppler indices accounting for 35.4%, while 97 cases had a normal Doppler index accounting for 64.6%. Out of 150 cases in our study 27 cases had Reversal of a wave in ductus venosus waveform that is in 18%. In this study total 5 cases (35.7%) of perinatal mortality were seen.Conclusions: The knowledge of various doppler parameters may help to improve pregnancy outcome and identification of PIH at earliest gestation age as compared to other antepartum test modalities.

Ultrasound evaluation of biopsy proven malignant breast mass

Background: Breast cancer is the most common malignancy in female worldwide. Ultrasound (US) is a safe and easily available modality for evaluation of breasts in females of all age groups. It can detect characteristic features of breast malignancy with high degree of accuracy. This study was undertaken with the aims to evaluate the ultrasonographic features of malignant breast mass, to identify the most commonly encountered gray scale ultrasound findings and to study the role of Doppler ultrasound in those cases.Methods: The study was conducted in Dr B. Borooah Cancer Institute, Guwahati from January 2018 to January 2019. Gray scale ultrasound including Doppler study was done in all the female patients coming with palpable breast lump or with nipple discharge and images were archived. The archived images of a total number of 108 patients with biopsy report positive for malignancy were retrospectively studied and the ultrasound findings were evaluated.Results: Most common gray scale ultrasound features for malignant breast masses were hypoechoic mass, taller than wide, irregular shape, having spiculated margins, neither posterior acoustic enhancement nor shadowing, presence of intralesional microcalcifications and surrounding echogenic halo. Hypervascularity, noticeable difference in waveform pattern between central and peripheral vessels, high resistance flow pattern with absent or reversal of diastolic flow were the common Doppler findings.Conclusions: Combination of Doppler with gray scale ultrasound has emerged as a very important technique in diagnosing malignant breast mass with high accuracy.

Role of colour Doppler in evaluation of venous abnormalities of lower limb

Background: Venous abnormalities of lower limb are a fairly common cause of morbidity. Although clinical diagnosis is the cornerstone of the diagnosis of lower limb venous disease, Colour Doppler ultrasound has become the investigation of choice to confirm the diagnosis. This study evaluated the role of Colour Doppler ultrasound in various venous pathologies of the lower limb and the sonographic findings were correlated with surgical and clinical findings.Methods: 100 patients of all age groups of either sex presenting with clinically suspected entities affecting venous system of the lower limb were selected for this study.Results: Our study showed a definite male preponderance (65%) with an incidence of 41% in the age group of 21-40 years. Isolated varicose veins had an incidence of 58% followed by isolated deep vein thrombosis (DVT) (29%), varicose veins with thrombophlebitis (5%), DVT with thrombophlebitis (5%), DVT with varicose veins (2%) and hematoma (1%). The findings correlated with surgery and gave a sensitivity of 100%.Conclusions: Colour Doppler ultrasound is unique due to its feasibility, accessibility and cost effectiveness. Its dynamism is also exploited by various maneuvers done by the patients, radiologist and the machine parameters to bring about changes in blood flow to reach the exact diagnosis.

Ocular doppler imaging: opening a new window in decoding glaucoma

Background: In the aetiopathogenesis of multifactorial glaucoma autoregulation of ocular blood flow plays an important role as failure of autoregulation may lead to progression of disease. Aim of this study to understand this better this study was designed to investigate the quantum of these abnormalities and their likely role in pathogenesis and prognosis of primary open angle glaucoma(POAG).Methods: This is a case control study design which involved 67 POAG patients and 67 matched controls. The parameters assessed includes peak systolic velocity(PSV), end diastolic velocity(EDV) and resistive index(RI) of ophthalmic artery(OA) and central retinal artery(CRA) of patients having POAG with age and sex matched healthy subjects. The data obtained was statistically analysed using IBM SPSS 21.Results: The study showed decreased PSV of 31.7 cm/s vs 42.7 cm/s(p=0.0001) and EDV11.7 cm/s vs 19.8 cm/s(p=0.002) with increased RI 0.63 vs 0.53(p=0.000) in  OA and PSV of 15.2 cm/s vs 21.4 cm/s(p=0.001) and EDV4.7 cm/s vs 11.7 cm/s(p=0.003) with increased RI 0.69 vs 0.45(p=0.000) in CRA in both eyes in POAG patients as compared to healthy controls.Conclusion: The study has shown the promising application of ocular Doppler in evaluating POAG patients. However, more such studies are needed with larger study sample and on follow up basis for better understanding glaucoma hemodynamics and applicability of ocular Doppler in management of glaucoma.

Role Of B–Mode Ultrasound In The Evaluation Of Orbital Masses.

Introduction: Blindness and Vision impairment cause significant morbidity amongst Indian population. According to WHO estimates, about 20.5 % people in India are categorized as blind while 22.2 % people have low vision. The orbital masses owing to the small anatomical volume of orbit can cause devastating consequences. Ultrasound and colour doppler are useful in analysis of orbital masses with real time evaluation, excellent soft tissue resolution, localisation, and benign or malignant nature of masses. This study evaluates the role of ultrasound in orbital masses.Aim: To study the role of ultrasound in evaluation and identification of orbital masses.Study design & settings: Prospective observational study in ultrasound unit of a rural hospital in central India.Materials and methods: Atotal of 316 consenting patients were studied for 1 year using high frequency linear and curved probes. Statistical analysis was done using SPSS software (IBM Inc.)Results:Out of the 316 patients, total 15 cases were identified to have orbital masses. Most common orbital mass lesions observed were lacrimal gland tumours. Most of the masses were extraconal in location and most common ultrasound appearance of the lesions was solid with most of the malignant masses showing vascularity on colour doppler imaging.Conclusion:Ultrasound can identify and characterize orbital masses based on appearance and echotexture with accurate localisation. It is cheap and easily available with no radiation hazards Pre-operative ultrasound and Colour Doppler evaluation of orbit can help in predicting prognosis of the disease.

Color doppler assessment of extra cranial carotid arteries in carotid artery disease with correlation of risk factors in predicting cerebro vascular accident in patients with carotid atheromatous disease

Background: Stroke is a clinical syndrome, which describes a sudden neurological deficit of presumed vascular origin. The risk factors for stroke are diabetes mellitus, smoking, alcohol and hypertension. Colour doppler ultrasound is one of the important tool for the evaluation of exracranial insufficiency of the carotid arteries. This study was performed to assess the carotid arteries with the help of color doppler in carotid artery disease.Methods: Of the 100 patients who had come to our department during the study period with symptoms of cerebrovascular disease such as transient episodes of neurological dysfunction, sudden weakness or numbness, hemiparesis, focal neurological deficits, sudden loss of consciousness, altered sensorium, aphasia, slurring of speech, diminution or loss of vision were included into the study. CT scan of brain and color doppler evaluation for the extracranial carotid arteries was done for all the patients to assess the atheromatous disease of extracranial carotid arteries and comparison with brain changes in cerebrovascular disease patients.Results: Of the 100 patients included into the study, 51% were males and 49% were females. 59% of the patients were above 61 years of age, 24% of them were between 51-60 years and 12% were between 41-50 years. 82% of the patients had the presence of atherosclerotic plaque while 18% had increased intima-media thickness without the plaque. Among the patients with atherosclerotic plaque, 63.4% had diabetes and 68.3% had hypertension. <50% stenosis was seen among 45.1% of the patients while 36.6% had between 50-70%. Near total occlusion was seen in 6.1% of the patients.Conclusions: The color Doppler sonography is a useful tool in evaluation of extra cranial course of carotid vessels. It is a non-invasive, cheap, faster modality without any side effects. Therefore, it could be used in predicting CVA in patients with carotid atheromatous disease.

Comparison of the effects of colour Doppler ultrasonography and X-ray plain film radiography in diagnosis of upper urinary tract calculi / 中国医学装备

Objective:To analyze the diagnostic value of colour Doppler ultrasonography and X-ray plain film radiography in upper urinary tract calculi.Methods: 97 cases of upper urinary tract calculi were randomly selected in our hospital between 2012 January and 2013 January, who were examined by colour Doppler ultrasound and X-ray film and then the results were analysed and compared.Results: In the 97 cases with colour Doppler ultrasound, 92 cases were the positive renal calculi, and the effective diagnosis rate was 94.8%. And then in the 97 cases with X-ray film, 67 cases were the positive renal calculi, and the effective diagnosis rate was 69.1%. The positive diagnosis rate in the group with colour Doppler ultrasound was higher than that in the group with X-ray film (x2=16.34,P<0.05). In the 97 cases with colour Doppler ultrasound, 52 cases were the positive ureteral calculi, and the effective diagnosis rate is 53.6%. And then in the 97 cases with X-ray film, 69 cases were the positive ureteral calculi and the effective diagnosis rate was 71.1%. The positive diagnosis rate in X-ray film group was higher than that in the group with colour Doppler ultrasound (x2=10.65, P<0.05).Conclusion: In diagnosis of upper urinary tract calculi, the diagnosis rate of renal calculi is higher by colour Doppler ultrasound and the diagnosis rate of ureteral calculi is higher by X-ray film. Both methods have advantages and disadvantages in inspection, and we should combine them in clinical practice.

Congenital Renal Aneurysmal Arterio-Venous Malformation, mimicking Hydronephrosis; Doppler USG and MDCT Features.

Renal Arteriovenous malformations are very rare and accurate diagnosis ensures proper treatment of the patients. We report a 24 year young female patient of large AVM, presenting with pain in right lumbar region, detected on ultrasound and Multidetector computed tomography.

A Study of Endometrial Pathology by Transvaginal Color Doppler Ultrasonography and its Correlation with Histopathology in Post-menopausal Women.

Objective: Endometrial carcinoma is the most common gynaecological malignancy. Approximately 80% of endomentrial carcinoma occur in post-menopausal women. Present study aimed to evaluate the role of transvaginal ultrasonography and colour flow imaging in diagnosing endometrial pathologies especially endometrial carcinoma and later its confirmation by histopathology. Methods: 38 women presenting with history of at least 6 months amenorrhoea followed by bleeding per vaginum were included in the study. Transvaginal colour Doppler (TVS) followed by fractional curettage was done in all cases and cervical biopsy was done in selected cases. Uterine size, endometrial thickness and blood flow indices (RI, PI) were measured. Analysis of data was done using ‘z’ test and ‘t’ test. Results: Out of 38 women maximum number of cases (39.47%) were between 50 – 55 years. Using 4 mm of endometrial thickness as cut off value for discriminating normal and abnormal endometrium, sensitivity, specificity, PPV and NPV were 94.12%, 50%, 95.12% and 50% respectively (p < 0.05). No case of endometrial carcinoma was detected when the endometrium was <4 mm, making the sensitivity as 100%, NPV 100%, specificity 13.33% and PPV 23.53%. Using RI = 0.81 as cut off value for discriminating benign and malignant endometrium, sensitivity was 62.5%, specificity 53.33%, PPV – 26.3% and NPV as 84.2%. Conclusion: Transvaginal sonographic (TVS) evaluation of endometrial thickness (ET) is a reliable method of screening women with post-menopausal bleeding. Conservative approach may be offered to women showing ET of less than 4 mm and high impedance to flow in uterine and endometrial vessels.

Laparoscopic ovarian ligament plication in pregnancy / Plicatura laparoscópica del ligamento ovárico en el embarazo

This 32-year old patient presented at seven weeks gestation with severe left-sided lower abdominal pain. This was against the background of a previous history of left salpingectomy from a ruptured ectopic gestation seven years previously. Transvaginal sonographic evaluation revealed a viable seven week intrauterine embryo, a 2 cm left corpus luteum cyst and Doppler studies revealed reduced internal flow. This led the way for a conservative approach via laparoscopy of untwisting the pedicle to restore blood flow. In this case, the ovarian ligament was shorted using 1/0 vicryl and the pregnancy went to term.

Esta paciente de 32 años se presentó en la séptima semana de gestación con un severo dolor abdominal en el lado inferior izquierdo. Esto ocuría teniendo la paciente por antecedente una historia previa de salpingectomía izquierda a partir de la ruptura de un embarazo ectópico siete años antes. La evaluación sonográfica transvaginal reveló un embrión intrauterino viable de siete semanas, un quiste del 2 cm en el cuerpo lúteo izquierdo, y los estudios de Doppler revelaron un flujo interno reducido. Esto abrió el camino para un abordaje conservador vía laparoscopia encaminada a deshacer la torsión del pedículo y restablecer así el flujo sanguíneo. En este caso, el ligamento ovárico fue acortado usando vicryl 1/0, y el embarazo continuó a término.

Rosai Dorfman Disease - Case Report of a Patient with Fatal Outcome.

Rosai Dorfman disease is an uncommon benign condition presenting with massive enlargement of cervical lymph nodes. We describe one such young female patient with similar presentation who had an aggressive course with fatal outcome.

Intrahepatic Portal Vein Aneurysm: Incidental Ultrasound Diagnosis of an Uncommon Entity.

Portal vein aneurysm is a relatively uncommon entity. It is often an incidental, asymptomatic finding. This pathology is increasingly encountered with frequent use of radiological imaging modalities. We report a case of intrahepatic portal vein aneurysm diagnosed incidentally on ultrasonography in a case of acute gastritis. Recognition of this finding can help to avoid confusion with abdominal masses of other etiologies.

Acretismo diagnóstico prenatal mediante ultrasonido y resonancia magnética y su correlación histopatológica en Barranquilla (Colombia) / Placenta accreta: prenatal diagnosis by ultrasonography and magnetic resonance imaging correlated with histopathological results in Barranquilla, Colombia

Introducción: el acretismo y percretismo se asocian con antecedentes de placentas previas y cesáreas anteriores, las cuales se han incrementado en nuestro medio. Por este motivo, su detección anteparto es fundamental en el propósito de disminuir el riesgo de morbimortalidad materna. Objetivo: evaluar la utilidad del ultrasonido (US) y la resonancia magnética (RM) en el diagnóstico prenatal de este trastorno adherencial placentario. Metodología: el presente es un estudio de cohorte prospectivo que incluyó a once mujeres en tercer trimestre de embarazo con antecedentes de placenta previa y cesárea anterior, a las cuales se les practicó US transabdominal y transvaginal, Doppler color y resonancia magnética, buscando signos de acretismo, los cuales fueron comparados con los hallazgos durante el parto y la histopatología. Resultados: el ultrasonido mostró una sensibilidad de 70% (IC95% 35,4-91,9). En contraste, el Doppler color y la resonancia magnética evidenciaron una sensibilidad de 90% (IC 95% 54,1-99,5). Conclusión: en pacientes con placenta previa y cesárea anterior, el US y el Doppler color surgen como una herramienta útil en la detección de acretismo placentario; sin embargo, se requieren mayores estudios para confirmar su validez diagnóstica.

Introduction: An increased risk of placenta accreta and placenta percreta is associated with patients having had previous caesarean deliveries or placenta previa; such conditions have been increasing of late. Prenatal detection may be helpful in reducing maternal morbidity and mortality. Objective: evaluating the usefulness of ultrasound (US) and magnetic resonance (MR) for prenatal detection of abnormal placental separation. Methodology: this was a prospective study which included 11 patients in the third trimester of pregnancy having a history of previou scaesarean and placenta previa. Transabdominal and transvaginal US, colour Doppler and MR were thus performed, seeking signs of placenta accreta; these were compared to histopathological findings and data from when birth was given. Results: US and MR had 70% sensitivity (95% CI 35.4-91.9) whilst colour Doppler had 90% sensitivity (95%CI 54.1-99.5). Conclusions: US and colour Doppler US might be useful, highly sensitive techniques for detecting abnormal adherence of the placenta in patients having a history of placenta previa and previous caesarean deliveries. Further studies are required for confirming their diagnostic validity.

Colour Doppler ultrasonic investigation for determining the variation of blood flow in elderly people

Doppler ultrasound had been used for measuring kidney blood flow circulating KBFC on 360 subjects (720 kidneys). Depending on the age, in young men of control group, KBFC of male subject 1164.620 ± 184.932 ml/minute, of female 1235.00 ± 194.795 ml/minute, in both 2 gender 1199.811 ± 192.144 ml/minute. In comparing with the control subjects, the KBFC began to vary, decreased 6.91% in medium age subjects, in the senil subjects the decrease was obvious 11.79%, in the elderly: very obvious 27.27%. The age had had a strictly negative relation to KBFC variation.

The Diagnostic Value of the Color Doppler Ultrasonic Detection in Distinguishing Malignant and Benign Kidney Tumors / 中国医师杂志

0 55). The Vmax and Vmin of the patients were singnificantly higher than those of healthy people. The RI of healthy subjects was higher than that of the patients. The Vmax and Vmin of the kidney with tumor was singnificantly higher than that of the other normal kidney side. Conclusion The hemodynamic features of the kidney tumors and kidney artery were valuable to the differential diagnosis of the malignant and benign kidney tumors.

Clinical Value of CDFI-based Pretherapeutic Score in Selecting Medical Treatment of Ectopic Pregnancy / 中国医师杂志

Objective To explore the clinical value of colour doppler flow imaging (CDFI) in selecting the ectopic pregnancy(EP) suitable for medical treatment. Methods 50 cases of ectopic pregnancy with hematodynamic stability were injected with a single dose of 50mg/m 2 MTX after CDFI examination. All patients were followed up until clinical results were confirmed. The CDFI characteristics of the failure and the success cases were analysed in combination with their serum HCG levels, and a CDFI-based pretherapeutic score were designed. Results CDFI could reflect the viability of ectopic fetus directly.There was a significant difference in the successful rate of medical treatment of ectopic pregnancy among the patients with various types of CDFI images and the various levels of serum HCG (P10 had the high failure rate, thus medical treatment of ectopic pregnancy is not recommended to them.