Preoperative carotid duplex scanning in patients undergoing coronary artery bypass grafting

Abstract Objective: The aim of this study was to determine the prevalence and risk factors of carotid artery stenosis (CAS) using carotid duplex ultrasound in patients undergoing coronary artery bypass grafting (CABG). Methods: This retrospective study was conducted between January 2017 and January 2018 and included 166 consecutive patients [130 males (78.31%), 36 females (21.69%); mean age: 64.25±9.78 years] who underwent elective and isolated CABG. Patients who had significant CAS (≥50% stenosis) were compared with patients who had non-significant CAS (<50% stenosis). Logistic regression analysis was applied across the selected parameters to identify risk factors for significant CAS. Results: Of all patients, 36 (21.68%) had CAS ≥50% and 8 (4.81%) had unilateral carotid stenosis ≥70%. Carotid endarterectomy/CABG was performed simultaneously in five (3.01%) patients. None of these patients had cardiac and neurological problems during the postoperative period. The overall incidence of cerebrovascular accident (CVA) after CABG was 1.20% (n=2). Age (P=0.011) and history of CVA (P=0.035) were significantly higher in the CAS ≥50 group than in the CAS <50 group. Significant CAS was identified as a risk factor for postoperative CVA (P=0.013). Conclusion: Age and history of CVA were identified as risk factors for significant CAS. Furthermore, significant CAS was identified as a risk factor for postoperative CVA. For this reason, carotid screening is recommended for patients undergoing CABG even in the absence of associated risk factors.

Incidencias de las malformaciones congénitas renales fetales diagnosticadas por ultrasonografía bidimensional / Incidents of fetal renal congenital malformations diagnosed by two-dimensional ultrasonography

Introducción: Las malformaciones congénitas, como defectos estructurales primarios de un órgano, parte de él o de zonas más extensas del organismo, resultan de una alteración inherente en el desarrollo, que se hace evidente al examen físico del feto y del recién nacido, antes o posterior al nacimiento, cuando se hace patente el defecto funcional de un órgano interno afectado anatómicamente. Objetivo: Caracterizar las malformaciones congénitas renales fetales diagnosticadas por ultrasonografía bidimensional, atendidas durante 2015 y 2016. Métodos: Se realizó un estudio descriptivo, longitudinal y prospectivo en el Centro Provincial de Genética Médica de Santiago de Cuba. Se seleccionó la muestra por el método aleatorio simple para un total de 59 gestantes (34 de 2015 y 25 de 2016), a las que se les diagnosticó algún tipo de malformación congénita renal embriofetal. Resultados: La malformación congénita renal que predominó fue la hidronefrosis, seguida de riñón poliquístico. En los hallazgos morfológicos por ecosonografía predominaron las afecciones del parénquima renal. El sexo fetal de mayor incidencia fue el masculino. La edad gestacional donde incidieron las afecciones renales en gestantes fue de 25 y más semanas, con edad materna entre 20 y 35 años, sin reportar factores genéticos. Los factores de riesgo externos de origen materno que más incidieron fueron la hipertensión arterial, el hábito de fumar y la diabetes. Conclusiones: Se mostraron los principales hallazgos morfológicos ultrasonográficos de los diferentes tipos de malformaciones congénitas renales encontradas, así como se identificaron los diferentes factores de riesgo presentes en las embarazadas. Se observó un predominio de las gestantes a temprana edad con hidronefrosis como el tipo de malformación congénita más frecuente(AU)

Introduction: Congenital malformations, as primary structural defects of an organ, part of it or larger areas of the organism, result from an inherent alteration in development, which is evident from the physical examination of the fetus and the newborn, before or after birth, when the functional defect of an anatomically affected internal organ becomes apparent. Objective: To characterize fetal renal congenital malformations diagnosed by two-dimensional ultrasonography during 2015 and 2016. Methods: A descriptive, longitudinal and prospective study was conducted at the Provincial Center of Medical Genetics in Santiago de Cuba. The sample was selected by simple random method for a total of 59 pregnant women (34 from 2015 and 25 from 2016). They were diagnosed with some type of embryo-fetal renal congenital malformation. Results: The congenital renal malformation that predominated was hydronephrosis, followed by polycystic kidney. In the morphological findings by echocardiography, renal parenchymal conditions predominated. Male fetal sex had the highest incidence. The gestational age where renal conditions affected pregnant women was 25 weeks and more, with maternal age ranging 20 and 35 years, without reporting genetic factors. Smoking and diabetes were the external risk factors of maternal origin that most affected high blood pressure. Conclusions: The main ultrasonographic morphological findings of the different types of congenital renal malformations found were shown, as well as the different risk factors present in pregnant women. A predominance of pregnant women at early age with hydronephrosis was observed as the most common type of congenital malformation(AU)

Can Doppler or contrast-enhanced ultrasound analysis add diagnostically important information about the nature of breast lesions?

OBJECTIVES: Despite evidence suggesting that Doppler ultrasonography can help to differentiate between benign and malignant breast lesions, it is rarely applied in clinical practice. The aim of this study was to determine whether certain vascular features of breast masses observed by duplex Doppler and color Doppler ultrasonography (before and/or after microbubble contrast injection) add information to the gray-scale analysis and support the Breast Imaging-Reporting and Data System (BI-RADS) classification. METHODS: Seventy solid lesions were prospectively evaluated with gray-scale ultrasonography, color Doppler ultrasonography, and contrast-enhanced ultrasonography. The morphological analysis and lesion vascularity were correlated with the histological results. RESULTS: Percutaneous core biopsies revealed that 25/70 (17.5%) lesions were malignant, while 45 were benign. Hypervascular lesions with tortuous and central vessels, a resistive index (RI)≥0.73 before contrast injection, and an RI≥0.75 after contrast injection were significantly predictive of malignancy (p<0.001). CONCLUSION: The combination of gray-scale ultrasonography data with unenhanced or enhanced duplex Doppler and color Doppler US data can provide diagnostically useful information. These techniques can be easily implemented because Doppler devices are already present in most health centers. .

Short term outcomes of brachio - basilic fistula with immediate superficialization for haemodialysis in chronic renal failure patients

The aim of this study was to assess the immediate and early results of brachio-basilic shunts with immediate superficialization created for chronic haemodialysis. Twenty chronic renal failure patients who had failure of the primary A-V fistula and need a second method for angioaccess were enrolled in the study. Patients' selections were done after detailed history, physical examination, laboratory investigations, colour duplex evaluation of brachial artery and basilic vein and optimizations of the hemodynamic and coagulation status. Surgery was performed under appropriate anesthetic techniques. Antibiotics postoperatively may be used depending on the operating circumstances and considering the patients individual susceptibility to infection. No anticoagulation should be used at least 48 hours postoperatively. Maintenance of adequate hydration and blood pressure both during operation and in the post operative period is important. Follow up of patients for thirty days postoperatively regarding; any complications, Colored duplex for reevaluation of the shunt, and assessment of the feasibility of the shunt for dialysis. our study include 20 patients; 13 male and 7 female, their age ranging from 17 to 70 years and 70% of our patients were in the 5th or sex decade with undefined etiology of renal failure. 45% of our patients had other associated disease, while 55% had previous trials of AVF, 20% had failure of the procedure, and 35% had postoperative complications. The study showed that the age, size of vein and artery pre-operatively previous trials had no significant effect on the outcome of the shunt. While the diseases associated with chronic renal failure showed significant difference on the outcome of the shunt. the brachio basilic fistula with immediate superficialization is a reliable method for angioaccess for hemodialysis in patients suffering chronic renal failure had been losing their primary angioaccess or having poor superficial veins

Direct percutaneous embolization of renal pseudoaneurysm

To describe and evaluate a novel method of direct ultrasound [US] guided percutaneous embolization of renal pseudoaneurysm. Elevn patients with severe hematuria were included in this study during the period from February 2005 to February 2006. They included five patients with penetrating renal trauma, two patients post-renal biopsy and four patients after percutaneous nephrolithotripsy. Diagnostic duplex US of the pseudoaneurysm was performed. The size of the pseudoaneurysm and its neck were determined. A solution of Gelfoam particles was prepared in sterile saline solution and under US guidance, the tip of the needle was inserted into the aneurysm and slowly Gelfoam particles solution was injected. During the injection of Gelfoam, the pseudoaneurysm initially filled with an echo genic thrombus, decreasing thereby the color flow detected by US. The needle was removed when no flow in the pseudoaneurysm was detectable. The patient was kept for 30 minutes in the department and then discharged home. Follow up by color Doppler US every 2 to 4 weeks. In 10 patients bleeding was effectively controlled with direct embolization in a single session and did not need any further intervention, while one patient needed endovascular embolization due to recurrent severe hematuria after 24 hours. The amount of the injected Gelfoamn particles [1-2 mm diameter] was from 1 to 3 ml, according to the size of the pseudoaneurysm. No complication was observed secondary to embolization procedure. Re-bleeding did not occur in any patient during their follow-up period that ranged from 3-12 months. Direct ultrasound guided percutaneous embolization of renal pseudoanureysm is a new method for treating renal pseudoaneurysm. It avoids the side effects of contrast media, hazards of irradiation and complications of angiographic catheterization. Moreover, it saves the patient the risk of surgical interference to control bleeding by partial or total nephrectomy specially in patients with solitary kidney. it has been proved to be a rapid, effective, feasible, tissue preserving, and likely to reduce morbidity and mortality. Therefore, it is recommended to be a first line of treatment of actively bleeding renal pseudoaneurysms

Distal revascularization-interyal ligation [DRIL] versus banding for simulataneous correction of steal, and preservation of A-V hemodialysis access

Ischemic steal syndrome secondary to a hemodialysis arteriovenous access is a potentially serious complication. Two types of the syndrome are recognized; the immediate, and delayed type. This condition occurs due to marked decrease or reversal of flow in the arterial segment distal to the A-V fistula, induced by the low resistance of the fistula outflow. Of the work: To compare the efficacy of two methods used in managing A-V dialysis access steal; DRIL, versus banding. Twenty six patients presenting with manifestations of steal following creation of a function A V shunt access. Fourteen patients underwent DRIL, and twelve patients underwent banding of the first 3-4 cm of the access beginning, adjacent to the A-V shunt Pre and post operative color Duplex for measuring the flow rates in proximal and distal arterial segment, and the flow rates in the access. Intraoperative pressure measurement were recorded before and after correction in the proximal and distal arterial segment using an invasive line. Acute steal cases were 26.9% compared to 73.1% delayed presentation. The sudden loss of part of the arterial flow into the access, in the presence of inefficient colla might be responsible for that. The distal arterial pressure improved significantly postoperatively in both groups. The major difference between the 2 groups was in the patency rate measured at 6 months postoperatively. It was 66.7% for banding, compared to 92.9% for DRIL although the results did not reach stastical significance. Thrombosis in a case occurred on third postoperative day, the others thrombosed between 2-6 months post correction. Diabetes effect on steal was well demonstrated in this aeries [88.5%] as well as female predominance [69.2%]. Banding had good results when the venous limb was dilated with associated compensatory proximal arterial hypertrophy which allowed narrowing of the outflow venous tract to 6-7 mm, with good palpable distal pulse, and good thrill at the fistula site. However, if infection is excluded, the DRJL results might have approached 100%, still, it showed higher patency trend

The method and new advance in diagnosing erectile dysfunction / 法医学杂志

Recently, we have a further understanding on the pathogeny of erectile dysfunction, and with the application of so many new technologies, such as color Doppler ultrasound, electrical impedance, evoked potential, sensor etc. The diagnosis of ED becomes more and more scientific and convenient. Today we make a review on all kinds of diagnosing methods in order to recognise it more clearly and to provide some more precise and practical way for forensic evaluation in future.

Resistive index as a predictor of kidney dysfunction and hepatorenal syndrome in different stages of liver cirrhosis

Renal hemodynamic changes begin early in the course of liver disease-related functional kidney failure The hallmark - change is intense intra-renal vasoconstnction associated with reduced renal blood flow and elevated renal arterial vascular resistance. Nitric oxide has been proposed to constitute a mediator of both the hyperdynamic circulation and renal failure in patients with advanced hepatic disease. The aim of this study was to evaluate the renal hemodynamic changes by renal duplex Doppler ultrasound and nitric oxide as predictors of kidney dysfunction and hepatorenal syndrome [HRS] in patients with liver cirrhosis. Twenty five patients with liver cirrhosis without ascites, 25 patients had liver cirrhosis with ascites, 25 patients with HRS and, 25 patients with end stage renal disease [ESRD] without liver disease, and 25 normal subjects as control group were enrolled in this study, they were age and sex matched. All the participants were subjected to lull medical history clinical examination, routine investigations, in addition to duplex Doppler ultrasound on the intra-renal arteries to detect the resistive index [RI] and measurement of the stable end product of nitric oxide [serum nitrate]. The highest values of RI of intra renal arteries and serum nitric oxide were found in patients with ESRD. RI of intra-renal arteries and serum nitric oxide levels were significantly higher in patients with HRS than in cirrhotic patients [ascitic and non ascitic] and control group. Also our study revealed that RI and serum nitric oxide were significantly higher in the non ascitic phase of liver cirrhosis than normal control group but increased more with the development of ascites, and reached higher value in patients with HRS. The study revealed a highly significant direct correlation between serum nitric oxide and RI of intra-renal arteries among the studied cirrhotic patients. An increased renal RI can predict development of HRS independent of liver disease severity and is better predictor than the individual parameters of the child-Pugh classifications

Prevalence of carotid atherosclerosis in patients with coronary artery disease

Many studies have identified the relationship between carotid atherosclerosis and coronary artery diseases. The rationale for testing carotid artery stenosis in patients with coronary artery disease, have several benefits for early detection of asymtomatic carotid stenosis. The aim of this study is to evaluate the prevalence of carotid artery patients with coronary artery disease. The study included 102 patients proved to be ischemic heart disease angiography, underwent carotid duplex. These patients classified into two groups according to carotid duplex result, group A [negative duplex] and group B [positive carotid duplex]. All patients were subjected to the following:-Full history taking, thorough clinical examination, laboratory investi-gation, 12 leads surface ECG, echocardiography, coronary angiography and carotid duplex. Age was significantly higher in group B than in group A. No statistically significant difference between both groups as regard EF% and history of myocardial infarction. There was close association between carotid atherosclerosis and multivessel coronary artery disease. Carotid atherosclerosis and degree of stenosis in. left carotid artery was significantly higher than in right one. From this study we concluded that there was a close relationship between coronary and carotid atherosclerosis both sharing more or Less, the same risk factors [smoking, diabetes mellitus, hypertension, hyperlipidemia and left ventricular hypertrophy], the degree of carotid atherosclerosis can be used as non invasive procedure for assessment of patients prepared for coronary angiogram

Thyroid dysfunction in type 2 diabetes

The association between diabetes mellitus and thyroid disorders was always a matter of medical interest. The explanation of that association is still debatable whether through metabolic, immune, vascular or multifactorial. The aim of the present study was to identify subjects at risk of clinical or subclinical thyroid dysfunction by other investigation modalities in diabetics. Forty seven type 2 diabetic patients 21 men and 26 women with age xx ranging from 40-70 years and 20, age, sex and weight matched healthy control subjects were subjected to: estimation of fasting, postprandial plasma glucose. Estimation of serum free T3 and T4 and TSH by radioimmunoassay. Thyroid scan dynamic and static using technetium[99m]. Thyroid colour coded duplex Doppler study of the inferior thyroid arteries. Exclusion criteria included drugs that interfere with thyroid functions. As regards Technetium thyroid scan: the perfusion index [PERI] was significantly higher in patients compared to control subjects [p-value < 0.009]. A negative correlation was found between the duration of DM and the functional index which was statistically significant in diabetic women [r = -0.4264, p=0.03]. Thirty percent of patients were detected to have dynamic thyroid scan characteristics of thyroiditis with marked increase of the perfusion index, marked decrease of the functional index till zero and replacement of slope II and III with a plateau. As regard duplex Doppler Results: the mean pulsatility [PI] and resistivity [RI] indices were found to be higher in patients with thyroiditis [as evident by thyroid scan]. The peak systolic, diastolic, end diastolic and mean velocities where statistically lower in those patients compared to control. The mean value of pulsatility and resistivity indices were significantly higher in patients with subclinical hypothyroid state than control subjects, whereas, thyroid gland volume, blood flow and blood velocities showed no statistically significant difference. Tc[99m] dynamic thyroid scan and duplex Doppler sonography detected hypofunction and abnormal perfusion while the thyroid hormones were still on the low normal side. So, it is recommended to use these investigation tools in following up patients with long standing diabetes specially in those who show clinical or laboratory evidence of thyroiditis, [such as neck pain, thyroid swelling or elevated ESR]. A condition which is not uncommon in patients with Type 2 diabetes

Transcranial colour dupplex sonography in pre and post shunt assessment of hydrocephalus

The submitted study was concerned with the role of transcranial Doppler [TCD] in diagnosis and postoperative follow up of hydrocephalus. TCD was performed in 40 hydrocephalic infants [mean age = 6.95 month], as well as 40 control subjects [mean age = 4.4 month]. Patients clinically suspected of being hydrocephalic were examined transcranially in B-mode to estimate ventricular size, configuration and cerebral parenchyma, while the coloured Doppler examination focused on the velocity rates and resistive index [RI]. Patients with hydrocephalus proved to have larger ventricular systems and higher RI in comparison to their normal counterparts. The hydrocephalic patients were shunted and post-shunt TCD was performed [after an average interval of 28 days], reassessing the pre-shunt parameters and locating the position of the placed shunt. The patients with well-functioning shunts show significant decrease in the RI almost back to normal. As regards ventricular size, a less significant change was doccumented. In infected infants the RI remained high or even increased and the CSF echopattern was turbid, with echogenic ventricular lining. From the above data, we conclude that the TCD has a reliable role in the diagnosis and post shunt assessment of hydrocephalus

role of combination therapy in the treatment of impotent patients with inadequate response to sildenafil and intracorporal injection monotherapy

We studied the efficacy of combination therapy in impotent patients with inadequate response to sildenafil and intracorporal injection monotherapy. Patients and Methods: Enrolled in this study were 23 impotent patients 28-55 years old [mean 46.7] with inadequate response to both sildenafil and intracorporal injection monotherapy. All patients underwent detailed history and physical examination, FBS determination, penile duplex doppler ultrasound and pharmaco-cavernosometry. A trial of combination therapy using oral sildenafil [50-100 mg] and intracorporal injection of trimixture [28 mg/ml papaverine, 0.58 mg/ml phentolamine and 10 micro ug alprostadil]. The response was evaluated and side effects recorded. The etiology of erectile dysfunction in the studied group was venogenic in 56.52%, arteriogenic in 21.73% and combined anteriogenic and venogenic in 21.73%. Seven out of these 23 patients [30.43%] responded to combination therapy either by complete erection in 4 patients or by moderate rigidity enough for intromission in 3. Non responders showed a higher FME and EDV than those responding to combined therapy. These differences in FME and EDV were statistically highly significant between both groups. All patients not responding to both oral sildenafil and intracorporal injection monotherapy had vasculogenic etiology for impotence. Combination treatment may potentially salvage one third of cases refractory to single modality treatment

Utility of doppler study of the arterial system of the upper limb prior to radial artery harvesting in coronary bypass candidates

Preoperative evaluation of the arterial system of the non-dominant upper limb in RA harvesting candidates to estimate the compliance of the ulnar artery to receive the entire flow from the brachial artery for better case selection to avoid post-operative ischaemic complications in the used upper limb. Doppler and/or Power Doppler examination were performed prior to surgery to evaluate the arterial system of the non-dominant upper limbs of 32 patients admitted as candidates for radial artery harvesting for coronary bypass surgery. The state of radial artery removal was imitated by RAC at the wrist. The PSV, EDV and RI were estimated under basal conditions and during RAC. The readings were collected, tabulated and compared to previous reports and accordingly some of the candidates were excluded from RA harvesting owing to significant expectations of upper limb ischaemic manifestations following RA removal. Doppler and/or power Doppler is a very useful preoperative screening test for better selection of candidates for RA harvesting for coronary bypass surgery to avoid post-operative upper limb ischaemic manifestations following RA removal

Lipoprotein [a] as an independent risk factor in ischemic[thombotic] strokes

The role of lipoprotein [a] [LP[a]] in cerebral infarction is still ill defined. The present study aimed at finding a correlation between LP[a] and severity of cerebral strokes as well as degree of carotid stenosis based on LP[a] level. A hundred and sixty cases were included in this study; 120 patients with cerebral infarction of more than 3 months duration [to exclude effect of acute phase reactant] and 40 cases matched for age, sex and body mass index as control. Patients with cardiac, hepatic, renal, connective tissue diseases or diabetes mellitus were excluded from this study. Complete lipid profile, echocardiography, carotid duplex, C.T. and/or MM [Brain] were done for all cases. Modified Ranking scale for assessment of severity of strokes and step with logistic regression analysis for all lipid parameters were used as predictors of developing stroke. We found that there is a correlation between both degree of carotid stenosis, and severity of cerebral strokes with LP [a] plasma level rather than all other lipid parameters. We can conclude that LP [a] is an independent risk factor for cerebral ischemic strokes, and can be used as a predictor of developing stroke

Value of grayscale and duplex Doppler ultrasonography in the non-invasive assessment of children with chronic liver disease

Ultrasonograghy [US] has become an integral part of examination of the liver in many clinical settings. The aim of our study was to investigate the value of grayscale and duplex Doppler US in the non-invasive assessment of the abdominal morphological and portal hemodynamic changes in 25 Egyptian children with chronic liver disease [CLD] and to demonstrate any relationship with the etiology and "severity" of their disease. All patients had thorough interrogation, physical examination, laboratory investigations and percutaneous liver biopsy to diagnose the etiology and "severity" of their CLD. Thirteen patients had established cirrhosis and 12 had chronic hepatitis without cirrhosis After an overnight fast, abdominal grayscale and duplex Doppler US were carried out for all patients as well as 30 healthy, age and sex matched controls. Prominent caudate lobe was a constant US finding in all patients with cirrhosis. Thickened lesser amentum was present in 69.2% of cirrhotics in comparison to 33.3% of chronic hepatitis. Loss of the normal triphasic oscillation of the hepatic vein waveform was detected in 53.8% of cirrhotics in comparison to 8.3% of chronic hepatitics and none of the controls. Portal vein flow velocity was significantly lower in patients compared to controls and still significantly lower in cirrhotics than chronic hepatitics. Congestion index [CI] was significantly higher in the group with cirrhosis compared with both chronic hepatitis and control groups. Both portal vein flow velocity and CI showed significant negative correlation with portal vein diameter as well as with splenic size. Child-Pugh's staging of CLD showed a positive correlation with both abnormal hepatic vein waveform and abnormal direction of portal blood flow; also there was a powerful significant negative correlation with both hepatic vein and portal vein flow velocity but no correlations with the etiology of CLD. In conclusion, grayscale and duplex Doppler US can non-invasively detect significant morphological and portal hemodynamic changes in children with CLD. Some of these changes could be correlated with the stage or "severity" of liver disease rather than its etiology

Ultrasonographic observation of intestinal mobility of dogs after acupunctural stimulation on acupoints ST-36 and BL-27

The objectives of this study were to observe normal peristalsis and mixing (or segmental movements) and to evaluate an acupuncture stimulation (ST-36 and BL-27) on the intestinal (duodenum) motility in normal dogs using duplex Doppler sonography. Fifteen healthy Beagle dogs were used for this experiment after the administration of warm saline and pellet feeding. The duodenal motility was examined using duplex Doppler sonography. Six hours after the pellet feeding, an electroacupuncture stimulation at ST-36 and BL-27 was applied and the duodenal motility was examined using duplex Doppler sonography pre-stimulation, during the stimulation and post-stimulation. After saline and pellet administration, the duplex Doppler sonograms showed 3 types of peristalsis and a mixing type (or segmental movement) of duodenum motility. In the peristalsis types, most yielded high-amplitude signals which had one high peak (type-1), two high peaks (type-2), and three high peaks (type-3) and lasted more than 1.3 seconds. Mixing type of duodenum motility had weak signals and were lasted more than 1.5 seconds. Among the peristalsis types, the type 1 and type 2 were predominant and the type 3 was rarely observed. The frequency of intestinal motility stimulated by ST-36 acupoint was increased during the acupuncture stimulation (20% increase compared to the basal value) and decreased (7% decrease compared to the basal value) after stimulation. The frequency of intestinal motility stimulated by BL-27 acupoint was decreased during the acupuncture stimulation (31% decrease compared to the basal value) and increased (18% increase compared to the basal value) after stimulation. There was a significant increase(p<0.01) between the value found in during and the post-stimulation tests. We conclude that duplex Doppler studies permit a graphic visualization of intestinal movements which can be qualitatively and quantitatively analyzed using this technique, it is possible to evaluate the gastrointestinal motility after an acupuncture stimulation.

Prevalence and predictors of renal artery stenosis detected by renal duplex sonography in type 2 diapetes mellitus

Diabetes mellitus [DM] is a risk factor for atherosclerosis that may lead to renal artery stenosis [RAS]. This study aimed to screen type 2 diabetic patients for presence of RAS and to identify the main predictors of its presence. The study included 473 patients [204 males and 269 females], aged 40 years or more with a well established DM of more than 5 years duration. Data about smoking, hypertension, diabetic retinopathy, ischemic heart, cercbrovascular and peripheral vascular diseases, macro and microalbuminuria, impaired kidney function and dyslipidemia were collected using history taking, physical examination and appropriate laboratory investigations. Renal ultrasonography and duplex renal scans were obtained for each patient under standardized conditions to determine the size and volume of the kidneys and to evaluate dynamics of the renal blood flow to diagnose RAS. The prevalence of RAS among all patients was 5.9%, and was 11.7% in those with hypertension. Logistic regression analysis was performed to examine and control for the joint effect of multiple factors potentially predicting presence of RAS. The odds ratio [OR] of RAS for the hypothesized predictors were determined to assess the significance of the association. There was a significant association between RAS and presence of abdominal bruit [OR=11.3], difference of length between the two kidneys [OR=3.4], age of patients [OR= 1.6] and duration of DM [OR= 1.1]. RAS is a common complication in type 2 DM. Type 2 DM patients should be scheduled for regular renal duplex check up and this may be done more frequently in patients with certain features that predict presence of RAS

Distal leinorenal shunt [DSRS]: maneouvers to overcome difficulties and make-shift

This study is meant to evaluate the technical difficulties faced during operative procedure of distal Splenorenal Shunt [DSRS] and the possibilities for shifting to other shunt procedures. 21 patients recruited from 65 cases of [DSRS]. In these cases we faced certain difficulties situations and we shifted the shunt accordingly. All our patients were classified according to Child into A and B category. Early postoperative duplex study was done to evaluate the function ofshunt and follow up endoscopic examination was done to evaluate the status of varices. Preoperative angiographic and duplex evaluation of the case can help deciding the proper plan for surgery

Perspectives in shunt surgery in portal hypertensive bleeders [a new technique]

This study is meant to evaluate the use of inferior mesenteric vein as a natural narrow lumen conduit in shunting procedures of splenectomised bleeders and as a modification of original distal spleno-renal shunt [DSRS] in non splenectomised patients [genuine bleeders]. Twenty patients with bleeding esophageal varices were included in this study Ten were splenectomised and ten were genuine hypertensive bleeders. The last group was admitted for warren shunt [distal spleno-renal shunt] and had been shifted to the new technique according to difficult operative situation. Follow up clinically, by duplex and endoscopically was showing encouraging results. Further future application and study will judge the validity of what we call the shunt of future viz. [the inferior mesentrico-renal shunt] The inferior mesenteric vein represents a natural conduit that already present in the field of operation of [DSRS] and can be used as an alternative in difficult cases meant for [DSRS] or for post- splenectomised bleeders as an alternative to H gortex graft