Experiência inicial com ultrassom Doppler com contraste por microbolhas em adição ao ultrassom Doppler convencional para seguimento de correção endovascular de aneurisma de aorta abdominal / Initial experience with Duplex scan combined with contrast-enhanced ultrasound for follow-up of endovascular abdominal aortic aneurysm repair

Resumo Contexto O ultrassom contrastado por microbolhas (CMUS) é uma modalidade diagnóstica de acurácia bem demonstrada por estudos internacionais para seguimento de reparo endovascular do aneurisma de aorta abdominal (EVAR). Não existem, no entanto, estudos nacionais focados nesse método de seguimento. Objetivos O objetivo deste estudo foi relatar a experiência inicial com CMUS em um hospital terciário, traçando uma comparação dos achados do CMUS com o ultrassom Doppler convencional (USGD), com o intuito de verificar se a adição de contraste ao protocolo padrão de controle ultrassonográfico incorreu alteração nos achados. Métodos Entre 2015 e 2017, 21 pacientes em seguimento de EVAR foram submetidos ao USGD seguido de CMUS. Foram avaliados os achados de exame referentes à identificação de complicações, bem como à capacidade de identificação da origem da endofuga. Resultados Entre os 21 casos avaliados, 10 complicações foram evidenciadas no total: sete pacientes apresentaram endofuga (33,3%); dois pacientes apresentaram estenose em ramo de endoprótese (9,52%); e um paciente apresentou dissecção em artéria ilíaca externa (4,76%). Em 21 pacientes avaliados, o uso combinado dos métodos identificou 10 casos de complicações pós-EVAR. Em seis dos sete casos de endofugas (85,71%), o uso dos métodos combinados foi capaz de identificar a origem. O USGD isolado falhou na identificação da endofuga em dois casos (28,5%), identificando achados duvidosos em outros dois casos (28,5%), que obtiveram definição diagnóstica após associação do CMUS. Conclusões O CMUS é uma técnica de fácil execução, a qual adiciona subsídios ao seguimento de EVAR infrarrenal.

Abstract Background Microbubble contrast enhanced ultrasound (CEUS) is an accurate diagnostic method for follow-up after endovascular abdominal aortic aneurysm repair (EVAR) that has been well-established in international studies. However, there are no Brazilian studies that focus on this follow-up method. Objectives The objective of this study was to report initial experience with CEUS at a tertiary hospital, comparing the findings of CEUS with those of conventional Doppler ultrasound (DUS), with the aim of determining whether addition of contrast to the standard ultrasonographic control protocol resulted in different findings. Methods From 2015 to 2017, 21 patients in follow-up after EVAR underwent DUS followed by CEUS. The findings of these examinations were analyzed in terms of identification of complications and their capacity to identify the origin of endoleaks. Results There was evidence of complications in 10 of the 21 cases examined: seven patients exhibited endoleaks (33.3%); two patients exhibited stenosis of a branch of the endograft (9.52%); and one patient exhibited a dissection involving the external iliac artery (4.76%). In the 21 patients assessed, combined use of both methods identified 10 cases of post-EVAR complications. In six of the seven cases of endoleaks (85.71%), use of the methods in combination was capable of identifying the origin of endoleakage. DUS alone failed to identify endoleaks in two cases (28.5%) and identified doubtful findings in another two cases (28.5%), in which diagnostic definition was achieved after employing CEUS. Conclusions CEUS is a technique that is easy to perform and provides additional support for follow-up of infrarenal EVAR.

Pressão arterial sistólica em cães anestesiados: concordância entre mensurações por dois métodos não invasivos / Systolic blood pressure in anesthetized dogs: agreement between measurements by two noninvasive monitors

The oscillometric monitor is a noninvasive method used for measuring blood pressure in dogs and cats. Despite widely used, there is a large variability in the accuracy of oscillometric monitors, which may also be influenced by the location of the blood pressure cuff. The Doppler ultrasound is another non-invasive method that was shown to measure blood pressure with good accuracy and precision in small animals. The present study aimed to determine the agreement between systolic arterial pressure (SAP) measured by the Prolife P12 oscillometric monitor with 2 cuff locations and the Doppler ultrasound in anesthetized dogs. Dogs scheduled for routine anesthetic procedures were included in the study, which was carried out in 2 phases. In Phase 1, SAP values measured by the Doppler were compared with those measured by the Prolife P12 monitor with the cuff placed at the thoracic limb for both methods. In Phase 2, SAP values measured by the Doppler were compared with those measured by the Prolife P12 monitor, with the cuff placed at the thoracic limb for the Doppler and at the base of the tail for the P12. The cuff width corresponded to approximately 40% of limb or tail circumference. On all occasions, 3 consecutive measurements of SAP were recorded, followed by a single measurement of SAP by the P12, and then other 3 measurements were performed with the Doppler. The arithmetic mean of the 6 SAP measurements with the Doppler was compared with the SAP value measured by the P12 monitor (paired measurements). Agreement between SAP values measured by the Doppler and the P12 monitor was analyzed by the Bland Altman method for calculation of the bias (Doppler - P12) and standard deviation (SD) of the bias. The percentages of differences between the methods with an error ≤ 10 mmHg and ≤ 20 mmHg and Pearson's correlation coefficients were also calculated. Results were compared with the criteria from the American College of Veterinary Internal Medicine (ACVIM) for validation of noninvasive blood pressure methods. A total of 33 dogs were included in Phase 1 and 15 were included in Phase 2. During Phases 1 and 2, 179 and 87 paired measurements were recorded, respectively. Most of the measurements were recorded during normotension (SAP = 90-130 mmHg): 113/179 in Phase 1 and 52/87 in Phase 2. The bias (± SD) for Phases 1 and 2 were -2.7 ± 14.1 mmHg and 7.2 ± 25.8 mmHg. The percentages of differences ≤ 10 mmHg and ≤ 20 mmHg were: Phase 1, 61% and 83%; Phase 2, 41% and 70%. Correlation coefficients were 0.81 and 0.67 for Phases 1 and 2, respectively. According to the ACVIM criteria, maximum values accepted for bias are 10 ± 15 mmHg, the percentages of differences ≤ 10 mmHg and ≤ 20 mmHg should be ≥ 50% and ≥ 80%, respectively, and the correlation coefficient should be ≥ 0.9. When the blood pressure cuff was placed at the thoracic limb, SAP values measured by the P12 monitor met most of the ACVIM criteria, demonstrating good agreement with SAP values measured by the Doppler. The only requirement not met was the correlation coefficient which was 0.81 whereas the recommended is ≥ 0.9. Conversely, when the cuff was placed at the base of the tail, SAP values measured by the P12 monitor did not meet most of the ACVIM criteria indicating that, in anesthetized dogs, SAP measurements with the P12 monitor should be performed with the cuff placed at the thoracic limb. One limitation of this study was that most measurements fell in the normotensive range and the results should not be extrapolated for hypotensive and hypertensive conditions. In conclusion, the Prolife P12 oscillometric monitor demonstrated good agreement with SAP values measured by the Doppler and provides acceptable values in normotensive anesthetized dogs.(AU)

Desfecho perinatal no crescimento intrauterino restrito seletivo em gestações gemelares monocoriônicas acompanhadas de forma expectante / Perinatal outcome in selective intrauterine growth restriction in monochorionic twin pregnancies followed expectantly

Objetivo: Avaliar a morbimortalidade perinatal de gestações gemelares monocoriônicas afetadas por Crescimento Intrauterino Restrito Seletivo (CIUR-s), de acordo com o padrão de fluxo ao Doppler na artéria umbilical do gêmeo menor. Métodos: Esse estudo de coorte retrospectiva tem como objetivo avaliar o desfecho perinatal de gestações gemelares monocoriônicas afetadas por CIUR-s e conduzidas de forma expectante, analisando os resultados de acordo com o padrão Doppler da artéria umbilical do gêmeo menor (Tipo I: persistentemente positivo / Tipo II: persistentemente ausente ou reverso / Tipo III: intermitentemente ausente ou reverso), desde o período pré-natal até a alta hospitalar. Setenta e cinco gestações gemelares monocoriônicas diamnióticas com CIUR-s foram incluídas nesse estudo, no qual definimos restrição seletiva de crescimento como peso fetal estimado (PFE) abaixo do terceiro percentil para a idade gestacional ou ou pela presença de pelo menos dois dos quatro parâmetros contributivos: PFE abaixo do décimo percentil, circunferência abdominal abaixo do percentil 10, índice de pulsatilidade da artéria umbilical do gêmeo menor acima do percentil 95 ou discordância entre os pesos fetais estimados de 25% ou mais. Os desfechos perinatais incluíram morte perinatal, lesão neurológica, retinopatia da prematuridade (ROP), displasia broncopulmonar (DBP), enterocolite necrosante (ECN) e sepse. Resultados: A taxa de mortalidade foi de 1,33% nessa coorte. A taxa de morbidade geral foi de 28,66%, com menor incidência em gestações gemelares do Tipo I. Conclusão: Esse estudo mostra que o CIUR-s Tipo I apresenta menor morbidade do que os Tipos II e III em conduta expectante.

Objective: To evaluate perinatal morbidity and mortality of monochorionic twin pregnancies affected by Selective Intrauterine Growth Restriction (sIUGR), according to the Doppler flow pattern in the umbilical artery of the smaller twin. Methods: This retrospective cohort study aims to assess the perinatal outcome of monochorionic twin pregnancies affected by this disorder and conducted expectantly, analyzing the results according to the umbilical artery Doppler pattern of the smaller twin (Type I: persistently forward / Type II: persistently absent or reversed / Type III: intermittently absent or reversed, from prenatal period to hospital discharge. Seventy five monochorionic diamniotic twin pregnancies with sIUGR were included in this study, in which we defined selective growth restriction as estimated fetal weight (EFW) of one twin less than the third centile or in the presence of at least two out of four contributory parameters: EFW less than the 10th percentile when associated with AC of one twin less than the 10th centile, EFW discordance of 25% or more, and umbilical artery (UA) pulsatility index (PI) of the smaller twin above the 95th centile. Perinatal outcomes included perinatal death, neurological injury, retinopathy of prematurity (ROP), bronchopulmonary dysplasia (BPD), necrotizing enterocolitis (NEC) and sepsis. Results: The mortality rate was 1.33% in this cohort. Overall morbidity rate was 28.66%, with lower incidence in Type I twin pregnancies. Conclusion: This study shows that sIUGR Type I has lower morbidity than Types II and III in expectant management.

High frequency ultrasound with color Doppler in dermatology

Abstract: Ultrasonography is a method of imaging that classically is used in dermatology to study changes in the hypoderma, as nodules and infectious and inflammatory processes. The introduction of high frequency and resolution equipments enabled the observation of superficial structures, allowing differentiation between skin layers and providing details for the analysis of the skin and its appendages. This paper aims to review the basic principles of high frequency ultrasound and its applications in different areas of dermatology.

Ultrassonografia e Doppler do trato gastrointestinal / Doppler ultrasound and make gastrointestinal tract

A obra ensina as técnicas deste tipo de exame de forma detalhada, analisando os aspectos normais e anormais das alterações ultrassonográficas do trato gastrointestinal, assim como as alterações Doppler que acarretam oferecendo conhecimento amplo, detalhado e útil sobre a matéria. A autora é reconhecida por sua técnica meticulosa do protocolo ultrassonográfico, que lhe garantiu a obtenção de ilustrações pertinentes a cada caso com alta qualidade visual.“Este é um assunto pouco abordado na área de Ultrassonografia, em Congressos ou até em livros especializados. Mas o tema vem ganhando importância devido à grande disseminação do exame ultrassonográfico na prática clínica, permitindo que a patologia intestinal seja detectada casualmente em rastreamentos de rotina. Estudos realizados recentemente permitiram caracterizar uma grande variedade de patologias intestinais detectáveis e diagnosticáveis pela ultrassonografia ao ponto do método ter um papel importantíssimo na investigação primária em algumas condições. Entre eles a apendicite, a diverticulite aguda e a Doença de Crohn”, explica a médica.Segundo a doutora as sondas ultrassonográficas de alta resolução ampliaram o universo diagnóstico e a precisão da avaliação de toda a parede intestinal e suas patologias (além da mucosa, o que não é possível com a endoscopia convencional). O trato gastrointestinal é um assunto do qual a especialista tem larga experiência na prática clínica de mais de 20 anos. Agora, pretende compartilhar com a classe médica seu aprendizado. Dedicou-se a escrevê-lo nos últimos dois anos. “Para você ter uma idéia, a parte de Doppler, por exemplo, estudada internacional”.

Utilización del doppler en masas tumorales de la muñeca / Use of doppler in tumor masses of the wrist

El Doppler no es el estudio de elección en el inicio de la evaluación de los tumores de la muñeca. No obstante su utilizacion es indispensable para la valoración y el diagnóstico diferencial de los mismos, ya que la mayoría de éstos presentan relación con estructuras vasculares de la región y/o se encuentran vascularizados. Por lo tanto el Doppler es un método indispensable en el algoritmo diagnóstico de estas patologías y en ciertas ocasiones es determinante para la categorización definitiva de la lesión.

Doppler de arterias renales: parte 3 / Renal artery doppler: part 3

En esta última parte del artículo se describe el uso de doppler en patología venosa renal y trombosis venosa renal.

Linfangioma axilar: presentación de un caso / Axillary lymphangioma: case report

Los linfangiomas son dilataciones de linfáticos, conformando quistes dentro de los tejidos blandos. Incidencia de 1/6000 recién nacidos vivos. El 75% se desarrollan en el cuello, el resto en la axila. Su desarrollo varía según su localización. De cualquier forma, lleva a la falta de drenaje de la linfa, produciendo estasis, dilatación y masas quísticas de tamaños variables. El aspecto típico es una masa líquida asimétrica, multitabicada y de paredes delgadas. Con Doppler no se demuestra flujo arterial ni venoso. Se debe realizar un scan detallado fetal, cariotipo y ecocardiografía en todos los casos, principalmente en aquellos de ubicación cervical. No existe consenso sobre la evaluación de la salud fetal. En general en los de ubicación axilar y otras localizaciones que no sean cervicales, el pronóstico es bueno, empeora en el caso de cariotipo anormal, ascitis, derrame pleural o hidrops. El tratamiento puede ser expectante o resección quirúrgica.

Doppler de arterias renales: parte 2 / Renal artery doppler

En esta parte del artículo se describen la fisiopatología y etiología de la estenosis renal, así como metodología y técnicas para su idenficación por ultrasonido...

Doppler de arterias renales: parte 1 / Renal artery doppler: part 1

El doppler de arterias renales es una herramienta para valorar la presencia de estenosis en éstas arterias, de las que permite una evaluación anatómica completa. Se describen distintas técnicas de estudio, y aspectos anatómicos de las arterias.

Interequipment Variability of Doppler Ultrasonographic Indices in Patients with Liver Cirrhosis / 대한간학회지

BACKGROUNDS/AIMS: Doppler ultrasongraphy is used to evaluate hemodynamic alternations in patients with liver cirrhosis. Purpose of this study was to determine the interequipment variability of Doppler indices in portal and splenic vein in cirrhosis. METHODS: Blood velocity, diameter, flow and congestive index in portal and splenic vein were measured by Doppler ultrasonography in 30 patients with cirrhosis using two different machines. RESULTS: Portal venous velocities measured by HDI-5000 and SSD-5000 were 8.72+/-3.69 cm/sec, 12.21+/-2.84 cm/sec, respectively which showed significant difference (P<0.001). Measured portal blood flows and congestive indices also had significant difference between HDI-5000 and SSD-5000 (P<0.01). Splenic venous velocity by HDI-5000 was 8.55+/-2.71 cm/sec, which was lower than that of 12.32+/-3.11 cm/sec by SSD-5000 (P<0.001). Splenic blood flows measured by HDI-5000 and SSD-5000 were 390.73+/-260.98 mL/min, 595.01+/-346.53 mL/min, respectively, showing significant difference (P=0.015). However, no differences were in the diameters of portal and splenic vein between HDI-5000 and SSD-5000. CONCLUSION: Doppler indices in portal and splenic vein showed significant interequipment variability. Therefore, in liver cirrhosis, hemodynamic investigations using different Doppler ultrasonographic machines is inappropriate.

O uso do Color Doppler em oftalmologia / The use of Color Doppler in ophthalmology

A ultrassonografia doppler é um método näo evasivo e confiável que pode ser empregado na análise da velocidade do fluxo sanguíneo. A introduçäo do Color Doppler permitiu, pela primeira vez, a observaçäo simultânea de imagens de estruturas anatômicas em tempo real e do fluxo vascular codificado por cores de vasos normalmente além do poder de resoluçäo de outros métodos. Este trabalho visa introduzir o uso deste método propedêutico em nosso meio, detalhando os princípios físicos envolvidos, assim como técnica e principais indicaçöes oftalmológicas.