Research advances on the techniques for diagnosing burn wound depth / 中华烧伤杂志

The accurate diagnosis of burn wound depth is particularly important for evaluating the disease prognosis of burn patients. In the past, the diagnosis of burn wound depth often relied on the subjective judgment of doctors. With the continuous development of diagnostic technology, the methods for judging the depth of burn wound have also been updated. This paper mainly summarizes the research progress in the applications of indocyanine green angiography, laser Doppler imaging, laser speckle contrast imaging, and artificial intelligence in the diagnosis of burn wound depth, and compares the advantages and disadvantages of these techniques, so as to provide ideas for accurate diagnosis of burn wound depth.

Antilipoperoxidative and anti-inflammatory efficacy of multifunctional sunscreens containing ferulic acid

Unprotected chronic exposure to ultraviolet radiation generates many harmful effects to human skin and UV filters are essential to health, however, traditional sunscreens do not provide enough protection against cutaneous oxidative stress, a process amplified by UV radiation. Therefore, is been proposed the development of multifunctional photoprotective formulations, acting in the absorption/reflection of UV radiation and assisting in cutaneous homeostasis. In the present study, ferulic acid is used in conjunction with two sunscreens, bemotrizinol and ethylhexyl triazone, for the determination of biosafety and efficacy methods, using techniques that better elucidate the effects of ferulic acid. Skin permeation assays were performed by applying a formulation containing the three substances in the stratum corneum of volunteers, which were removed by the tape stripping method (ex vivo) with follow quantification by high performance liquid chromatography (HPLC). The test was able to evaluate the penetration depth of the substances, characterizing them. In addition, the simultaneous quantification of the three substances was performed by a single and fast method, facilitating their analysis and improving the technique. Also, TBARS (thiobarbituric acid reactive substances) assays were performed in stratum corneum removed by tape stripping (ex vivo), evaluating the potential of cutaneous lipid peroxidation, with or without ferulic acid. To date, it is the first time that TBARS method is used to characterize the stratum corneum (ex vivo) and quantified by HPLC. The protocol developed may aid in the efficacy of antioxidant agents in studies aimed at elucidating the level of lipid peroxidation caused by drugs and cosmetics, and even in carrying out baseline studies characterizing different ethnicities and genders. As last, an anti-inflammatory in vivo assay with Laser Doppler flowmetry equipment was used to compare the sunscreen formulation with or without ferulic acid. Data indicated that the antioxidant reduced the angular coefficient of the perfusion units, mitigating the inflammatory effects. Furthermore, a significant difference was found between the genders, suggesting a more pronounced inflammatory reaction in women. Ferulic acid proved to be a valuable resource, besides being safe and raise the SPF of sunscreens, it also mitigates the effects of inflammation

A exposição crônica desprotegida à radiação ultravioleta (UV) contribui para o desenvolvimento de câncer de pele e os filtros solares são relevantes para evitar tais efeitos prejudiciais, porém, os protetores solares tradicionais não geram proteção suficiente contra o estresse oxidativo cutâneo. Logo, espera-se o desenvolvimento de formulações fotoprotetoras multifuncionais, atuando não somente na absorção e/ou reflexão da radiação UV, mas, também, auxiliando na homeostase cutânea, com presença de agentes antioxidantes. No presente estudo foi utilizado o ácido ferúlico conjuntamente com dois filtros solares, o bemotrizinol e a triazona de octila, para determinação de métodos de segurança e eficácia, utilizando técnicas que melhor elucidem e comprovem os efeitos do ácido ferúlico. Foram realizados ensaios de permeação cutânea pela aplicação tópica de formulação contendo as três substâncias em voluntários, sendo o estrato córneo retirado pelo método de tape stripping (ex vivo) com subsequente quantificação por cromatografia líquida de alta eficiência (CLAE). O ensaio pôde avaliar a profundidade de penetração das substâncias, caracterizando-as. Ademais, a quantificação simultânea das três substâncias foi efetuada por método único e rápido, facilitando análise com aprimoramento da técnica. Em adição, foi realizado ensaios de TBARS (substâncias reativas ao ácido tiobarbitúrico) em estrato córneo removido por tape stripping (ex vivo), para avaliar o potencial de peroxidação lipídica cutânea, contendo ou não o ácido ferúlico. Até o presente momento, é a primeira vez que o método TBARS é utilizado para caracterização do estrato córneo (ex vivo) e quantificada por CLAE. O protocolo desenvolvido pode auxiliar na eficácia de agentes antioxidantes, em estudos que visam elucidar o nível de peroxidação lipídica causada por medicamentos e cosméticos e, até mesmo, na realização de estudos de base, caracterizando etnias e gêneros. Ademais, um ensaio anti-inflamatório in vivo com equipamento de fluxometria Laser Doppler foi utilizado para comparar a formulação fotoprotetora com ou sem ácido ferúlico. Os dados indicaram que o antioxidante reduziu o coeficiente angular das unidades de perfusão, mitigando os efeitos inflamatórios. Ainda, foi identificada diferença entre os gêneros, sugerindo reação inflamatória mais pronunciada em mulheres. O ácido ferúlico provou ser um recurso valioso, além de ser seguro e elevar o FPS dos fotoprotetores, também atenuando os efeitos da inflamação

Microcirculation changes in gingival tissue after ultrasonic tooth preparation in beagle dogs

Abstract Ultrasonic wave technology is widely used during dental treatments. We previously demonstrated that this method protects the gingival tissue. However, the physiological change on the gingival microvasculature caused by this method remains unclear. Objective The aim of this study was to investigate the relationship between the morphological and physiological effects on gingival microcirculation when preparing teeth, using the conventional dental turbine or ultrasonic method. Methodology The lower premolar teeth of beagle dogs were prepared along the gingival margin by using a dental turbine or ultrasonic wave instrument. Gingival vasculature changes were investigated using scanning electron microscopy for corrosion resin casts. Gingival blood flow at the preparation site was determined simultaneously by laser Doppler flowmetry. These assessments were performed immediately (Day 0), at 7 days and 30 days after tooth preparation. Results At day 0, in the turbine group, blood vessels were destroyed and some resin leaked. Furthermore, gingival blood flow at the site was significantly increased. In contrast, the ultrasonic group demonstrated nearly normal vasculature and gingival blood flow similar to the non-prepared group for 30 days after preparation. No significant alterations occurred in gingival circulation 30 days after either preparation; however, the turbine group revealed obvious morphological changes. Conclusions Based on multiple approach analyses, this study demonstrated that ultrasonic waves are useful for microvascular protection in tooth preparation. Compared with a dental turbine, ultrasonic wave instruments caused minimal damage to gingival microcirculation. Tooth preparation using ultrasonic wave instruments could be valuable for protecting periodontal tissue.

Penile microvascular endothelial function in hypertensive patients: effects of acute type 5 phosphodiesterase inhibition

The primary aim of this study was to evaluate penile endothelial microvascular function in patients with primary arterial hypertension and age-matched normotensive subjects using laser speckle contrast imaging (LSCI). Additionally, we analyzed the acute penile microvascular effects induced by oral phosphodiesterase type 5 inhibitor (sildenafil; SIL) administration. Endothelium-dependent microvascular reactivity was evaluated in the penises and forearms of hypertensive patients (aged 58.8±6.6 years, n=34) and age-matched healthy volunteers (n=33) at rest and 60 min following oral SIL (100 mg) administration. LSCI was coupled with cutaneous acetylcholine (ACh) iontophoresis using increasing anodal currents. Basal penile cutaneous vascular conductance (CVC) values were not significantly different between control subjects and hypertensive individuals. Penile CVC values increased significantly after SIL administration in control (P<0.0001) and hypertensive (P<0.0001) subjects. Peak CVC values were not different between the two groups during penile ACh iontophoresis before SIL administration (P=0.2052). Peak CVC values were higher in control subjects than in hypertensive subjects after SIL administration (P=0.0427). Penile endothelium-dependent microvascular function is, to some extent, preserved in patients presenting with primary arterial hypertension under effective anti-hypertensive treatment. LSCI may be a valuable non-invasive tool for the evaluation of penile vascular responses to phosphodiesterase type 5 inhibitor.

A novel effective method for the assessment of microvascular function in male patients with coronary artery disease: a pilot study using laser speckle contrast imaging

Evaluation of microvascular endothelial function is essential for investigating the pathophysiology and treatment of cardiovascular and metabolic diseases. Although laser speckle contrast imaging technology is well accepted as a noninvasive methodology for assessing microvascular endothelial function, it has never been used to compare male patients with coronary artery disease with male age-matched healthy controls. Thus, the aim of this study was to determine whether laser speckle contrast imaging could be used to detect differences in the systemic microvascular functions of patients with established cardiovascular disease (n=61) and healthy age-matched subjects (n=24). Cutaneous blood flow was assessed in the skin of the forearm using laser speckle contrast imaging coupled with the transdermal iontophoretic delivery of acetylcholine and post-occlusive reactive hyperemia. The maximum increase in skin blood flow induced by acetylcholine was significantly reduced in the cardiovascular disease patients compared with the control subjects (74 vs 116%; P<0.01). With regard to post-occlusive reactive hyperemia-induced vasodilation, the patients also presented reduced responses compared to the controls (0.42±0.15 vs 0.50±0.13 APU/mmHg; P=0.04). In conclusion, laser speckle contrast imaging can identify endothelial and microvascular dysfunctions in male individuals with cardiovascular disease. Thus, this technology appears to be an efficient non-invasive technique for evaluating systemic microvascular and endothelial functions, which could be valuable as a peripheral marker of atherothrombotic diseases in men.

In-office bleaching effects on the pulp flow and tooth sensitivity – case series

Laser Doppler flowmetry (LDF) is a noninvasive method capable of evaluating variations in pulp blood flow (PBF) and pulp vitality. This method has thus far not been used to assess changes in blood flow after in-office bleaching. The aim of this case series report was to measure changes in PBF by LDF in the upper central incisor of three patients submitted to in-office bleaching. The buccal surfaces of the upper arch were bleached with a single session of 35% hydrogen peroxide gel with three 15-min applications. The color was recorded using a value-oriented Vita shade guide before in-office bleaching and one week after the procedure. The tooth sensitivity (TS) in a verbal scale was reported, and PBF was assessed by LDF before, immediately, and one week after the bleaching session. The lower arch was submitted to dental bleaching but not used for data assessment. A whitening degree of 3 to 4 shade guide units was detected. All participants experienced moderate to considerable TS after the procedure. The PBF readings reduced 20% to 40% immediately after bleaching. One week post-bleaching, TS and PBF were shown to be equal to baseline values. A reversible decrease of PBF was detected immediately after bleaching, which recovered to the baseline values or showed a slight increase sooner than one week post-bleaching. The LDF method allows detection of pulp blood changes in teeth submitted to in-office bleaching, but further studies are still required.

Intrauterine growth restriction in monochorionic-diamniotic twins / Restrição de crescimento intrauterino em gêmeos monocoriônicos diamnióticos.

Objective: to evaluate neonatal morbidity and mortality in monochorionic- -diamniotic (MCDA) twin pregnancies complicated by selective intrauterine growth restriction (sIUGR) and non-selective intrauterine growth resctriction (nsIUGR). Methods: neonatal morbidity parameters and mortality were analyzed in 34 twins with IUGR (< 10th percentile on twins’ growth charts): 18 with sIUGR and 16 with nsIUGR. The sIUGR group was made up of 18 pregnancies in which growth was restricted in only one fetus (n = 18). The nsIUGR group was composed of 8 pregnancies in which both fetuses presented restricted growth (n = 16). Cases of twin-to-twin transfusion syndrome and fetal malformation were not included in the study. Results: the MCDA twin pregnancies with sIUGR had a higher rate of orotracheal intubation (p = 0.001) and mechanical ventilation (p = 0.0006), as well as longer than average fasting time (p = 0.014) compared to those in which the fetuses had nsIUGR. A higher incidence was also observed of types II and III umbilical artery Doppler velocimetry patterns in the sIUGR cases (p = 0.002). There was no significant difference between the two groups as to mortality during pregnancy and the neonatal period (p = 0.09). Conclusion: in MCDA twin pregnancies, sIUGR presents more severe umbilical artery Doppler velocimetry abnormalities and worse morbidity than nsIUGR. .

Objetivo: avaliar a morbidade e mortalidade neonatal em gestações monocoriônicas e diamnióticas (MCDA) acometidas pela restrição de crescimento fetal seletiva (RCFS) e não seletiva (RCFNS). Métodos: os parâmetros de morbidade e mortalidade neonatais foram avaliados em 34 gêmeos com RCF (abaixo do percentil 10 de uma curva de crescimento para gêgêmeos): 18 com RCFS e 16 com RCFNS. O grupo com RCFS teve origem em 18 gestações, em que somente um feto apresentava RCF. O grupo com RCFNS teve origem em 8 gestações em que ambos os fetos apresentavam RCF. Foram excluídos deste estudo casos da síndrome da transfusão feto-fetal e malformações fetais. Resultados: os gêmeos de gestações MCDA com RCFS apresentaram maior frequência de entubação orotraqueal (p=0,001), ventilação mecânica (p=0,0006) e maior tempo em jejum durante internação (p=0,014), quando comparados aos gêmeos de gestações MCDA com RCFNS. No grupo com RCFS, também foram observados maior frequência de tipos II e III de dopplervelocimetria de artéria umbilical (p=0,002). Não houve diferença significativa entre os grupos quanto à mortalidade neonatal (p=0,09). Conclusão: em gestações gemelares MCDA, a RCFS representa maior frequência de alterações severas na velocimetria Doppler da artéria umbilical e piores resultados na morbidade neonatal. .

Laser Doppler anemometry measurements of steady flow through two bi-leaflet prosthetic heart valves / Velocimetria laser de escoamento permanente através de duas próteses cardíacas de duplo folheto

INTRODUCTION: In vitro hydrodynamic characterization of prosthetic heart valves provides important information regarding their operation, especially if performed by noninvasive techniques of anemometry. Once velocity profiles for each valve are provided, it is possible to compare them in terms of hydrodynamic performance. In this first experimental study using laser doppler anemometry with mechanical valves, the simulations were performed at a steady flow workbench. OBJECTIVE: To compare unidimensional velocity profiles at the central plane of two bi-leaflet aortic prosthesis from St. Jude (AGN 21 - 751 and 21 AJ - 501 models) exposed to a steady flow regime, on four distinct sections, three downstream and one upstream. METHODS: To provide similar conditions for the flow through each prosthesis by a steady flow workbench (water, flow rate of 17L/min.) and, for the same sections and sweeps, to obtain the velocity profiles of each heart valve by unidimensional measurements. RESULTS: It was found that higher velocities correspond to the prosthesis with smaller inner diameter and instabilities of flow are larger as the section of interest is closer to the valve. Regions of recirculation, stagnation of flow, low pressure, and flow peak velocities were also found. CONCLUSIONS: Considering the hydrodynamic aspect and for every section measured, it could be concluded that the prosthesis model AGN 21 - 751 (RegentTM) is superior to the 21 AJ - 501 model (Master Series). Based on the results, future studies can choose to focus on specific regions of the these valves.

INTRODUÇÃO: A caracterização hidrodinâmica in vitro de próteses de válvulas cardíacas fornece informações importantes quanto ao seu funcionamento, sobretudo se realizada por meio de métodos não-invasivos de anemometria. Uma vez obtidos os perfis de velocidade para cada válvula, é possível compará-las quanto ao seu desempenho hidrodinâmico. Neste primeiro estudo experimental de anemometria laser com válvulas mecânicas, as simulações foram realizadas em bancada de testes para escoamento permanente. OBJETIVO: Comparar perfis de velocidade unidimensional no plano central de duas próteses aórticas de duplo folheto St. Jude (modelos AGN 21 - 751 e 21 AJ - 501) submetidas a um regime de fluxo permanente, para quatro seções distintas, três à jusante e uma à montante. MÉTODOS: Proporcionar condições de similaridade para o escoamento através de cada prótese, por meio de bancada hidrodinâmica para escoamento permanente (água, à vazão de 17 L/min.) e, por meio de anemometria laser unidimensional, obter os perfis de velocidades para as mesmas seções e varreduras. RESULTADOS: Verificou-se que as maiores velocidades correspondem à prótese de diâmetro interno menor e que as instabilidades do fluxo são maiores à medida que a seção de interesse encontra-se mais próxima da válvula. Também foram verificadas as regiões de recirculação, de estagnação do fluxo e de baixa pressão, além dos picos de velocidade para o escoamento em questão. CONCLUSÕES: Sob o aspecto hidrodinâmico e para todas as seções de interesse, foi possível concluir a preferência da válvula de modelo AGN 21 - 751 (RegentTM) sobre a 21 AJ - 501 (Master Series). Os resultados obtidos permitiram escolher, para os próximos trabalhos, um foco de estudo mais específico para regiões concretas dessas próteses.

Comparação entre a Dopplermetria e o fluxo livre da artéria torácica interna de cães com e sem o uso de noradrenalina / Comparison between the Doppler flowmetry and the free flow of dog's internal thoracic artery with and without use norepinephrine

OBJETIVO: Este trabalho objetiva estudar comparativamente o fluxo livre e a dopplerfluxometria da artéria torácica interna de cães anestesiados com e sem a administração de noradrenalina endovenosa contínua. MÉTODOS: A amostra foi constituída de 10 cães mestiços, nos quais foram dissecadas as artérias torácicas internas direita e esquerda e avaliado seu fluxo; primeiramente, pela dopplerfluxometria e depois pelo fluxo livre. Foram registrados a pressão arterial média e o diâmetro das artérias no início do procedimento. As verificações do fluxo pelos dois métodos ocorreram em três tempos: tempo zero, 10 e 25 minutos. Após a primeira verificação no tempo zero, iniciou-se a infusão contínua de noradrenalina no átrio direito; as avaliações aos 10 e 25 minutos foram feitas da mesma forma que na primeira vez, nas mesmas artérias e pelos dois métodos, anotando-se os resultados, assim como a pressão arterial média correspondente. RESULTADOS: Os resultados da verificação de fluxo, entre Dopplermetria e fluxo livre, apresentaram-se similares; sendo os primeiros, nos tempos zero, 10 e 25 minutos, respectivamente, 183, 237 e 230,1 ml/min, comparados aos segundos, 168,6, 226,8 e 226,4 ml/min (P=0,285). A média das pressões arteriais dos três tempos e o diâmetro médio das artérias não apresentaram diferenças estatisticamente significativas entre os métodos, portanto, não influenciaram na comparação dos resultados. CONCLUSÃO: As avaliações, tanto da dopplerfluxometria quanto do fluxo livre, foram semelhantes nos três tempos verificados.

OBJECTIVE: This work aims to study comparatively the free flow and the Doppler flowmetry of the internal thoracic artery in anesthetized dogs, with and without continuous intravenous administration of norepinephrine. METHODS: The sample was made up of ten mongrel dogs, which dissected the left and right internal thoracic arteries and evaluated your stream; first, by Doppler flowmetry and then by free flow. The mean arterial pressure and the diameter of the arteries at the beginning of the procedure were registered. The workflow checks by two methods occurred in three times: time zero, 10 and 25 minutes. After the first check in time zero, the continuous infusion of norepinephrine in the right atrium; other checks were made in the same way that the first time, to 10 and 25 minutes, in the same arteries and by two methods, each one in his artery, noting the results, as well as the corresponding average blood pressure. RESULTS: The results of the scan of the stream, between Doppler flowmetry and free flow, there were similar; being the first, zero times, ten and twenty-five minutes, respectively, 183, 230.1 and 237 ml/min compared to seconds, 168.6, 226.8 and 226.4 ml/min (P = 0.285). The mean arterial pressures of three times and the average diameter of the arteries, showed no statistically significant differences between the methods, so did not influence on the comparison of the results. CONCLUSION: The evaluations, both from Doppler flowmetry and free flow, were similar in three times checked.

Centralização cerebral materna na pré-eclâmpsia: revisão sistemática / Maternal cerebral centralization in pre-eclampsia: systematic review

A pré-eclâmpsia é uma doença de alta morbimortalidade com grande impacto na saúde pública. Ainda não há métodos efetivos para seu rastreamento e também não foi elucidada a sua fisiopatologia. O objetivo do presente estudo foi analisar artigos na literatura que avaliaram a possibilidade do fenômeno de "centralização cerebral materna" por meio do Doppler da artéria oftálmica em gestantes normais e gestantes com pré-eclâmpsia. A revisão sistemática da literatura envolveu artigos indexados das bases de dados Medline via PubMed e Biblioteca Virtual em Saúde (BVS), publicados entre 1989 a 2011. Por meio da estratégia de busca, localizaram-se 540 artigos, dos quais 505 foram obtidos na base de dados Medline e 35 na BVS. Selecionaram-se 16 artigos, sendo que 5 deles fazem referência a gestantes normais, 1 a gestante com pré-eclâmpsia e 10 comparam gestantes normais com pré-eclâmpsia. Em conclusão, os estudos encontrados indicam que gestantes com pré-eclâmpsia apresentam vasodilatação com hiperfluxo da artéria oftálmica, o que pode caracterizar um fenômeno de centralização cerebral materna

Pre-eclampsia is a high morbidity disease, with a significant impact in public health. There are no effective methods, as yet, to track this disease, and the pathophysiology has not yet been made clear. The objective of this study was to analyze articles found in the literature, evaluating the possibility of pregnant women presenting with the maternal cerebral centralization phenomenon, through Doppler imaging of the ophthalmic artery in women with normal pregnancy and those presenting with signs of pre-eclampsia. A systematic review of the literature involved articles found in the Medline (PubMed) database and in the Biblioteca Virtual em Saúde (BVS - Virtual Library on Health), published between 1989 and 2011. The search strategy employed by the author yielded 540 articles, of which 505 came from the Medline database and 35 from the BVS. Therefore, 16 articles were selected for this study, being 5 of them refer to normal pregnancies, 1 to pregnancies in which the woman presented with pre-eclampsia and 10 compared normal pregnancies with pregnant women presenting with pre-eclampsia. To sum up, the studies on this topic indicate that pregnant women exhibiting pre-eclampsia symptoms present with vasodilation with hyperflow in the ophthalmic artery, which can be characterized a maternal cerebral centralization phenomenon

Repeatability of the evaluation of systemic microvascular endothelial function using laser doppler perfusion monitoring: clinical and statistical implications

OBJECTIVE: An awareness of the repeatability of biological measures is required to properly design and calculate sample sizes for longitudinal interventional studies. We investigated the day-to-day repeatability of measures of systemic microvascular reactivity using laser Doppler perfusion monitoring. METHODS: We performed laser Doppler perfusion monitoring in combination with skin iontophoresis using acetylcholine and sodium nitroprusside as well as post-occlusive reactive and thermal hyperemia twice within two weeks. The repeatability was assessed by calculating the within-subject standard deviations, limits of agreement, typical errors and intra-class correlation coefficients between days 1 and 2. The ratio of the within-subject standard deviation to the mean values obtained on days 1 and 2 (within-subject standard deviation/GM) was used to determine the condition with the best repeatability. RESULTS: Twenty-four healthy subjects, aged 24.6 + 3.8 years, were recruited. The area under the curve of the vasodilatory response to post-occlusive reactivity showed marked variability (within-subject standard deviation/GM = 0.83), while the area under the curve for acetylcholine exhibited less variability (within-subject standard deviation/ GM = 0.52) and was comparable to the responses to sodium nitroprusside and thermal treatment (within-subject standard deviations/GM of 0.67 and 0.56, respectively). The area under the blood flow/time curve for vasodilation during acetylcholine administration required the smallest sample sizes, the area under the blood flow/time curve during post-occlusive reactivity required the largest sample sizes, and the area under the blood flow/time curves of vasodilation induced by sodium nitroprusside and thermal treatment required intermediate sizes. CONCLUSIONS: In view of the importance of random error related to the day-to-day repeatability of laser Doppler perfusion monitoring, we propose an original and robust statistical methodology for use in designing prospective clinical studies.

Repercusión de la anemia materna sobre el pico de velocidad sistólica de la arteria cerebral media fetal / Impact of maternal anemia on the systolic velocity peak in fetal middle cerebral artery

Determinar la relación entre el grado de afectación fetal y anemia materna mediante la velocimetría Doppler de la arteria cerebral media, en hijos de madres anémicas. Estudio prospectivo, observacional y analítico, de 35 pacientes entre 26 y 28 semanas de gestación de las cuales 15 con diagnóstico de anemia (hemoglobina menor de 11 g por ciento y hematocrito menor de 33 por ciento) constituyeron el grupo de estudio y 20 el grupo control. Previo consentimiento informado, se estableció el índice cerebro-placentario. Se excluyeron pacientes que presentaran patologías que generan hipoxia severa crónica. En la Unidad de perinatología del Hospital Universitario de Caracas. La edad promedio fue de 28 años para el grupo de estudio y de 27,39 años para el grupo control, la edad gestacional de 27,02 semanas para ambos grupos. En los antecedentes familiares predominó la diabetes en ambos grupos, seguidos de hipertensión arterial. El promedio de hemoglobina y hematocrito fue de 10,21 g por ciento y 31,23 por ciento para el grupo de estudio y de 12,05 g por ciento y 36,21 por ciento para el grupo control. El pico de velocidad sistólica de la arteria cerebral media fetal fue de 34,47 cm/seg para el grupo de estudio y de 34,43 cm/seg para el grupo control; los valores promedio de sístole-diástole de arteria cerebral media, S/D: 4,84 y S/D: 5,62, arteria umbilical S/D: 2,87 y S/D:2,96 e índices cerebro- placentarios de 1,71 y 1,91, para grupos de estudio y control respectivamente, no arrojaron diferencias estadísticamente significativas. Tampoco hubo diferencia estadística cuando se compararon los grupos según el número de gestas, peso y sexo fetales. En el estudio realizado la anemia materna no afectó directamente la circulación fetal. No existe afectación fetal, ni elementos de hipoxia en pacientes hijos de madres anémicas

To determine the relationship between the degree of fetal affectation and maternal anemia by Doppler velocimetry middle cerebral artery in anemic mothers. Prospective, observational and analytical study, of 35 patients between 26 and 28 weeks of gestation, including 15 diagnosed with anemia (hemoglobin less than 11 g percent and hematocrit <33 percent) constituted the study group and 20 the control group. After informed consent cerebro-placental index was established. We excluded patients who had severe pathologies leading to chronic hypoxia. Unidad de perinatologia del Hospital Universitario de Caracas. The mean age was 28 years for the study group and 27.39 years for the control group, the gestational age of 27.02 weeks for both groups. The predominant family history was diabetes in both groups, followed by hypertension. The average hemoglobin and hematocrit was 10.21 g percent and 31.23 percent for the study group and 12.05 g percent and 36.21 percent for the control group. The peak systolic velocity of the fetal middle cerebral artery was 34.47 cm / sec for the study group and 34.43 cm / sec for the control group, the average values of systole-diastole of middle cerebral artery, S / D: 4.84 and S / D: 5.62, umbilical artery S / D: 2.87 and S / D: 2.96 and cerebro-placental indices of 1.71 and 1.91, for study groups and control respectively, yielded no statistically significant differences. There was also no statistical difference when comparing the groups according to the number of pregnancies, fetal weight and sex. The maternal anemia study did not directly affect the fetal circulation. There fetal impairment, or elements of hypoxia in patients anemic mothers

Avaliação do fluxo na artéria renal fetal entre a 22ª e a 38ª semana em gestações normais / Evaluation of blood flow in the fetal renal artery between the 22nd and 38th week in normal pregnancies

OBJETIVO: descrever os valores encontrados para o índice de resistência (IR), índice de pulsatilidade (IP) e relação sístole/diástole (S/D) das artérias renais fetais em gestações sem complicações entre a 22ª e a 38ª semana de gestação e avaliar se estes valores variam durante esse período. MÉTODOS: estudo observacional, no qual 45 fetos de gestações não-complicadas foram avaliados na 22ª, 26ª, 30ª, 34ª e 38ª semanas gestacional. Os exames ultra-sonográficos com Doppler foram feitos por um único observador que utilizou aparelho com transdutor de 4 a 7 MHz. Para a aquisição do traçado de velocidade das artérias renais, uma amostra, com tamanho entre 1 e 2 mm, foi posicionada no terço médio da artéria renal para avaliação através da ultra-sonografia com Doppler pulsado, sempre por um único observador. A avaliação do IR, do IP e da relação S/D das artérias renais (direita e esquerda) foi realizada a partir de três ondas consecutivas utilizando-se o modo automático. Para demonstrar diferença nos valores dos índices com a variação da idade gestacional, comparamos os valores obtidos nas diferentes idades gestacionais através do teste ANOVA com medidas repetidas no tempo (repeated measures ANOVA) com pós-teste de Tukey. RESULTADOS: Não houve diferença significativa entre a artéria renal direita e a esquerda quando se compararam o IR, o IP e a relação S/D. Entretanto, observou-se modificação dos valores destes parâmetros entre a 22ª semana (IR=0,9 ± 0,02; IP=2,44 ± 0,2; relação S/D=11,6 ± 2,2; média ± desvio padrão do valor médio da artéria renal direita e esquerda) e a 38ª semana (IR=0,8 ± 0,03; IP=2,1 ± 0,2; relação S/D=8,7 ± 2,3) de idade gestacional. CONCLUSÕES: os parâmetros avaliados (IR, IP e relação S/D) apresentam valores decrescentes entre a 22ª e a 38ª semana, sem diferença entre os lados direito e esquerdo do feto.

PURPOSE: to describe values found for the resistance index (RI), pulsatility index (PI) and the systole/diastole (S/D) ratio of fetal renal arteries in non-complicated gestations between the 22nd and the 38th week, and to evaluate whether those values vary along that period. METHODS: observational study, where 45 fetuses from non-complicated gestations have been evaluated in the 22nd, 26th, 30th and 38th weeks of gestational age. Doppler ultrasonography has been performed by the same observer, using a device with 4 to 7 MHz transducer. For the acquisition of the renal arteries velocity record, a 1 mm to 2 mm probe has been placed in the mean third of the renal artery for the evaluation through pulsed Doppler ultrasonography. The measurement of RI, PI and S/D ratio from three consecutive waves was performed with the automatic mode. To detect significant differences in the indexes' values along gestation, we have compared values obtained at the different gestational ages, through repeated measures ANOVA, followed by Tukey's post-hoc test. RESULTS: There were no significant differences between the right and left renal arteries, when the RI, IP and S/D ratio were compared. Nevertheless, a change in the values of these parameters has been observed between the 22nd week (RI=0.9 ± 0.02; PI=2.4 ± 0.02; S/D ratio=11.6 ± 2.2; mean ± standard deviation of the combined mean values of the right and left renal artery) and the 38th week (RI=0.8 ± 0.03; PI=2.1 ± 0.2; S/D ratio=8.7 ± 2.3) of gestation. CONCLUSIONS: the parameters evaluated (RI, PI and S/D ratio) have presented decreasing values between the 22nd and 38th, with no difference between the fetus's right and left sides.

Valor de la flujometría Doppler de la arteria cerebral media en la predicción y seguimiento de la anemia fetal por isoinmunización Rh / Value of the middle brain artery Doppler flowmetry in the prediction and follow-up of fetal anemia due to Rh isoimmunization

La enfermedad hemolítica perinatal por isoinmunización Rh permanece como una de las causas más frecuentes de anemia fetal. La amniocentesis y la cordocentesis han sido usadas por muchos años para el diagnóstico y seguimiento de la anemia fetal. Estas técnicas son consideradas como invasivas y muchas complicaciones se asocian a su uso. El diagnóstico no invasivo de la anemia fetal se ha realizado a través de la ultrasonografìa Doppler. Basados en evidencia reciente, el estudio Doppler de la arteria cerebral media en su velocidad sistólica pico (ACM-VPS) podría evaluar con gran exactitud el grado de anemia fetal en la isoinmunizaciòn Rh. Esta prueba permite además el diagnóstico de la anemia fetal debido a otras etiologías, evita procedimientos invasivos innecesarios y por tanto, pudiera disminuir la morbilidad y mortalidad perinatales.

Perinatal hemolytic disease due to Rh isoimmunization is still one of the most common causes of fetal anemia. Amniocentesis and chordocentesis have been used for many years for the diagnosis and follow-up of fetal anemia. These techniques are considered as invasive, and many complications are associated with their use. The noninvasive diagnosis of fetal anemia has been made through Doppler ultrasonography. Based on recent evidence, middle cerebral artery peak systolic velocity (MCA-PSV) could evaluate with great accuracy the degree of fetal anemia in Rh isoimmunization. This test also allows the diagnosis of fetal anemia due to other etiologies, prevents the application of unnecessary invasive procedures and, therefore, may reduce perinatal morbidity and mortality.

Valor de la flujometría Doppler de arterias uterinas para la predicción de algunas complicaciones en gestantes con hipertensión arterial crónica / Value of uterine artery Doppler flowmetry for the prediction of some complications in pregnant women with chronic arterial hypertension

La hipertensión arterial crónica (HTAc) durante la gestación se asocia con un incremento del riesgo de preeclampsia y restricción del crecimento fetal (RCIU). Con el objetivo de evaluar el valor de la flujometría Doppler de las arterias uterinas a las 24 semanas en la predicción de estas complicaciones, se realizó un estudio prospectivo y descriptivo en 222 gestantes con HTAc atendidas en el Hospital Ramón González Coro de Ciudad de La Habana. Se estudió la asociación entre la presencia de muesca diastólica después de las 24 semanas, el índice de pulsatilidad (IP) y la relación sístole/diástole (S/D) anormales; con la ocurrencia de RCIU y preeclampsia, se determinó la sensibilidad, especificidad, valor predictivo positivo (VPP) y negativo (VPN) de la prueba para estos eventos. La sensibilidad de la muesca diastólica para la aparición de RCIU fue del 78,6 por ciento y el VPN del 98,4 por ciento, mientras que para la preeclampsia los valores fueron 64 por ciento y 94,1 por ciento respectivamente. El IP anormal, tuvo una sensibilidad del 85,7 por ciento y un VPN de 98,9 por ciento para la predicción de la aparición de RCIU; mientras que para la preeclampsia los valores fueron de 71,0 por ciento y 95,0 %, respectivamente. La S/D anormal tuvo una sensibilidad de 64,3 por ciento y un VPN de 96,3por ciento en la predicción de RCIU; y para la aparición de preeclampsia, los valores fueron de 58,1 por ciento y de 90,4 por ciento respectivamente. Los VPN elevados indican el valor del Doppler de las arterias uterinas en la predicción de la ausencia de resultados adversos en gestantes con HTAc.

Chronic arterial hypertension (CAH) during pregnancy is associated with an increased risk of preeclampsia and intrauterine growth restriction (IUGR). In order to evaluate the value of the uterine artery Doppler flowmetry at 24 weeks in the prediction of these complications, a prospective and descriptive study was conducted among 222 pregnant women with chronic arterial hypertension that received attention at Ramón Gonzalaez Coro Hospital, in Havana City. The association between the presence of diastolic notch at 24 weeks, the pulsatility index (PI), and the abnormal S/D ratio was studied The sensitivity, specificity, positive predictive value (PPV) and negative predicitive value (NPV) of the test for IUGR and preeclampsia were determined. The sensitivity of the diastolic notch for the appearance of IURG was 78.6 percent and the NPV was 98.4 percent, whereas for eclampsia, the values were 64 percent and 94.1 percent, respectively. The abnormal PI had a sensitivity of 85.7 percent and a NPV of 98.8 percent for the predicition of the appearance of IUGR. As to eclampsia, the values were 71.0 percent and 95.0 percent, respectively. Abnormal S/D ratio showed a sensitivity of 64.3 percent and a NPV of 96.3 percent in the prediction of IUGR. As regards the appearance of preeclampsia, the values were 58.1 percent and 90.4 percent, respectively. The high NPV indicated the value of the uterine artery Doppler to predict the absence of adverse results in expectants with chronic arterial hypertension.

Prediction of pre-eclampsia and neonatal outcome by the combined use of early second trimester maternal serum homocysteine and uterine artery doppler velocimetry

To evaluate the value of combining early second trimester maternal serum homocysteine and uterine artery doppler velocimetry in the prediction of pregnancies that subsequently develop pre-eclampsia as well as neonatal outcome. This prospective observational study was conducted on eighty seven pregnant mothers [in their 16-19 gestational weeks] at risk to develop pre-eclampsia. All enrolled women should have one or more risk factors to develop pre-eclampsia. Mothers with medical disorders during the current pregnancy were excluded. All participants were investigated with maternal serum homocysteine assay and Doppler analysis of both uterine arteries. Sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios were calculated for homocysteine levels, uterine artery resistance index, diastolic notch [unilateral, bilateral], and for the combination of both homocysteine levels and uterine artery Doppler studies. Pre-eclampsia had occurred in 28 out of the 87 participants [32.18%] of whom 17 cases were diagnosed as mild pre-eclampsia [19.54%] and 11 were diagnosed as severe disease [12.64%]. The mean +/- SD of uterine RI for all cases who developed severe pre-eclampsia was 0.62 +/- 0.09 while it was 0.58 +/- 0.06 in those who did not develop the disease all over their pregnancies and the difference was statistically significant [p=0.016]. Early diastolic notch was detected in 11 out of the 28 mothers who developed pre-eclampsia [39.29%; 5 unilateral and 6 bilateral] versus 4 out of the 59 women who passed uncomplicated pregnancies [6.78%; 2 unilateral and 2 bilateral]. This revealed a statistically significant different [p=0.001]. Serum levels of homocysteine was also significantly higher in cases who developed pre-eclampsia than controls. The median [range] of serum homocysteine in mothers who developed pre-eclampsia [mild and severe disease] was 6.24 [1.9 - 23.4] micro mol/l while in women passed uncomplicated pregnancy it was 5.1 [1.6-19.9] micro mol/l [p=0.024]. Out of all delivered neonates of preeclampsia mothers [31 neonates from 28 mothers], 9 neonates were classified to have poor prognosis [29.03%] all of them were from severe preeclamptic mothers. No early neonatal deaths were recorded. This prospective study confirms the value of combining early second trimester maternal serum homocysteine and uterine artery Doppler velocimetry in the prediction of pregnancies that subsequently develop pre-eclampsia as well as neonatal outcome

Dopplerfluxometria das artérias renais: valores normais das velocidades sistólica e diastólica e do índice resistivo nas artérias renais principais / Renal arteries Dopplerfluxometry: normal systolic and diastolic flow velocities and resistive index values in the main renal arteries / Renal arteries Dopplerfluxometry: normal systolic and diastolic flow velocities and resistive index values in the main renal arteries

Dopplerfluxometry of renal arteries has been used to estimate renal perfusion in humans. The aim of this study was to use Dopplerfluxometry technique to calculate the resistive index of main renal arteries in dogs, measuring their systolic and diastolic blood flow velocities. Twenty (10 males, 10 females), adult mongrel dogs, were used in this study. The dogs were submitted to Doppler sonographic evaluation of left and right main renal arteries. The systolic and diastolic blood flow velocities, expressed (in centimeters per second) as mean and standard deviation were 79.96± 8.82 and 28.86± 5.11 in the right main renal artery and 80.22± 6.99 and 29.62± 4.14 in the left main renal artery. The value of resistive index expressed as mean ± standard deviation was 0.64± 0.04 for the right main renal artery and 0.63± 0.028 in the left main renal artery.