Resistive index changes after ESWL, the impact of age

In eighty-six patients, the resistive index using colored duplex sonography was measured for the arcuate and interlobar arteries before and after ESWL in the upper, middle and lower segment of the treated and the contralateral kidney. A statistically significant increase in post- therapeutic resistive index was found, but it remained within the physiologic range in the treated kidney and there was a statistically insignificant increase in the contralateral kidney. This increase is more pronounced in the young aged patients as well as in the elderly patients than the middle aged patients. All these changes returned to pre-ESWL level within two weeks and were maintained at the same level for eight weeks. It was concluded that shock wave lithotripsy caused reversible increase in the intrarenal vascular resistance. The extremes of age are more liable to such changes than middle aged patients. The second ESWL session must be postponed two weeks after the first one

Assessment of carotid artery stenosing lesions using color duplex ultrasound

The study population consisted of 646 carotid artery in 323 cases with 174/149 male/female ratio and a mean age of 54.6 +/- 3.9 years. They included cases with transient ischemic attack [TIA, 176 cases], developed stroke [CVA, 21 cases], cases with non-focal symptoms [NFS, 38 cases], cases with asymptomatic cervical bruit [CB, 58 cases] and normal volunteers [30 cases]. It was concluded that the best documented clinical indication for carotid duplex sonography is the detection of high grade stenosis in patients with TIA or stroke with good recovery. Particular attention should be paid for the study of the plaque morphology for detection of risky lesions that warrant surgical intervention. Excellent argument can be made for examination of asymptomatic persons particularly in the presence of any of the risky factors [hypertension, heart disease, smoking or diabetes]. These cases have to be scheduled for follow up duplex examination as a prophylactic measure to avoid if any future cerebral ischemic lesions is anticipated

Assessment of the role of transthoracic ultrasound technques in diagnosis of congnital heart diseases

This study was carried out on 50 cases with congenital heart diseases. They were assessed clinically, examined with conventional chest radiography, 2-dimensional echocardiography, spectral Doppler wave from tracing and color flow mapping. Conventional chest radiography in spite of being least specific, skilled interpretation of chest radiography had disclosed important morphological changes including chamber size changes which was true in more than 50% of the cases and particular attention paid to the pulmonary vasculature which aid in correctly suggesting the degree of shunt to some extent. M- mode echocardiography was most successful in assessing cardiac chambers size changes in all cases. Combination of 2-dimensional echocardiography and spectral Doppler tracing was of great help in obtaining both the anatomical and physiological information

Value of colour-duplex scanning compared with arteriography for assessment of lower extrimity arterial diseases

This study aimed to emphasize the role of colored duplex ultrasound and its capabilities in detecting normal lower limb arterial tree and different morphological alterations caused by arterial diseases using contrast arteriography as the standard test to evaluate the results. Using it, atherosclerotic lesions, hemodynamically significant stenosis [>50% diameter reduction] and occlusions of the arteries both in the pelvic region and in the thigh-knee regions were detected. The study revealed that its high sensitivity [91%] and specificity [74%] for diagnosis and quantifying lower limb arterial diseases. It is more sensitive for femoropopliteal segments diseases [95%] than aortoiliac inflow system [85%]. Also, it is more sensitive to occlusion [95%] than stenosis [84%]. Aneurysms of the arterial tree, aortoiliac or peripheral were accurately diagnosed and assessed with 100% accuracy. It demonstrated the flow pattern inside it, thrombosis within it and its relation to important visceral arteries [renal and mesenteric arteries]

Arteriovenous fistulas evaluation by colour duplex sonography

Color Doppler imaging was used to identify and localize arteriovenous fistulas in eleven patients: Seven traumatic, three congenital and one spontaneous. In all, there was a local region of persistent intra-arterial flow throughout the cardiac cycle [high diastolic component profile] at the site of the fistula. Turbulent pulsatile venous flow was detected at the site of fistula. The communication tunnel between the artery and vein was successfully identified. Arteriography was used to confirm the color duplex findings. It failed to show the arteriovenous fistula itself in four cases in whom the diagnosis was dependent upon the indirect evidences; namely, early venous filling, increased number and size of arterial branchs in the region and rapid clearance of contrast media and it confirmed carotico-cavernous fistula in one case. Transorbital axial CT examination was used to confirm the cases with clinical suggestion of carotico-cavernous fistula. It was essentially unremarkable with superior ophthalmic vein dilatation in one patient in whom CDI revealed the presence of superior ophthalmic vein thrombosis

Evaluation of the congestion index and other portal vein haemodynamic parameters in portal hypertensive gastropathy

This study was conducted aiming to evaluate the congestion index and other portal vein hemodynamic parameters using Echo-Doppler in portal hypertensive gastropathy patients. 40 patients with liver cirrhosis [20 with esophageal varices and 20 with portal hypertensive gastropathies, 12 mile and 8 severe] in addition to 20 healthy persons as a control subjected to Echo-Doppler study using Hitachi 415 with pulsed transducer 3.5 Mhz. The findings showed that here was a significant increase in the congestion index of the portal vein in cases of portal hypertensive gastropathy than in cases with esophageal varices only. Also, there was a significnat increase in the congestion index in severe gastropathy than mild gastropathy. So, it can be concluded that the congestion index paralleled the severity of portal hypertensive gastropathy and can be used as a simple and safe parameter in following up these patients and to assess the efficacy of therapy

Gastric emptying and anthroduodenal motility study of patients with functional ulcer like dyspepsia: correlation with histopathological findings and helicobacter pylori

13 patients complaining of functional ulcer like dyspepsia and 8 volunteers healthy persons with comparable age and sex were studied for gastric emptying tests by B-mode sonography and antroduodenal study by colored duplex. Gastro duodenoscopy was done for each patient, biopsies were taken from antrum and corpus. The results showed that there is a correlation between delayed gastric emptying and severity of symptoms. Histopathological examination of biopsies sowed chronic gastritis in all cases and H. pylori infection in 92.3%. So, it is concluded that H. pylori may play a role in the pathogenesis of functional ulcer like dyspepsia

value of selection and comparison of two lines of treatment of primary varicose veins [using coloured duplex scan]

Rational treatment of superficial venous disease requires delineation of points of reflux. However, a considerable controversy exists over the need to strip the great saphenous vein [GSV] in treatment of primary varicose veins [PVV]. This study evaluated and compared the value of physical examination, Doppler ultrasonography and colored duplex scanning in selecting patients with PVV due to reflux of sapheno-femoral junction [SFJ]. Also, the benefit of SFJ ligation alone versus SFJ ligation plus stripping of the GSV in treatment of PVV due to reflux of SFJ, was compared. A total number of 102 limbs in 82 patients were initially evaluated, and selected group of 78 limbs in 62 patients were divided into group A [42 limbs] who had SFJ ligation plus GSV stripping and group B [36 limbs] who had SFJ ligation alone. Both physical examination and Doppler ultrasonography proved to be specific [100%], but less sensitive [52.6% and 74.3%, respectively] in diagnosing reflux of SFJ compared to duplex scanning. The postoperative follow up scans showed a significant superiority of stripping the GSV plus SFJ ligation in abolishing any residual reflux after operation

value of mammography for early detection of contralateral breast cancer

Cancer breast is concidered as one of the most common causes of death among females. Early detection before the disease is symptomatic is the best way to improve survival rate and health state of the affected women. Mammography remains the gold standard technique in breast cancer imaging due to its ability to detect clinically occult disease. The senstivity of the procedure in detecting a non symptomatising contralateral breast involvement in patients with breast cancer in our study was 100%. The percentage of bilaterality in our series was 88% [71372] patients. From these findings and those reported in the litrature by other authors, we conclude that screening mammography to the contralateral breast in symptomatic patients is a must and routine technique for early detection and presumably better prognosis

Evaluation of the efficacy of compressive stockings, sclerotherapy and surgical ligation in treatment of venous ulcers [Using coloured Doppler venous imaging]

Juxta ulcer high pressured subcutaneous veins adversely affect venous stasis ulceration. In this study we prospectively evaluated the efficacy of either sclerotherapy or surgical ligation of subcutaneous veins as an adjunct to compressive elastic stockings in treatment of venous ulcers. A total number of 52 patients with perimalleolar ulcer were examined with coloured venous duplex scan. A selected group of 38 patients with juxta ulcer subcutaneous veins were randomized into 3 groups, In group I [n = 10] compressive stockings [CS] was the only treatment. In group II [n = 14] repeated sclerotherapy of the juxta ulcer veins were added to CS, while in group III [n = 14] surgical ligation of these veins was performed plus CS. The results showed that in group III the time required for both 50% and near 100% healing was significantly less than the other two groups. The exact mechanism of action for this treatment is not clear, however this study suggests that obliteration of these subcutaneous veins hastens healing of venous ulcers

Comparative study of computed tomography and water soluble myelography in lumbar disc lesions

The advent of computed tomography has revolutionized the radiological work-up of lumbar spine disorders. It is a simple non-invasive technique which is able to display the bony and soft tissue constituents of the lumbar spine. In this work, twenty patients with various disc lesions were selected. Each case was examined separately by CT and myelography. The results of both techniques were discussed and compared. CT was proved to be as accurate or slightly more higher, ideal and reliable method for demonstration and evaluation of intervertebral disc lesions, as myelography. Axial CT accuracy exceeds that of water soluble myelography in assessing disc herniation at L [5]-S [1] disc level, lateral disc herniation and study of levels distal to complete block to myelographic contrast column. Myelography is superior to CT in showing nerve root sleeves amputation