Color Doppler Imaging of the Orbital Vessels in Ankylosing Spondylitis.

PURPOSE: To analyze the hemodynamic features of orbital blood flow velocities using Doppler ultrasonography in ankylosing spondiylitis (AS) patients, as well as to compare these results with those of healthy controls. METHODS: 33 AS patients and 32 healthy controls were consecutively included in the study groups. The same radiologist performed ocular blood flow measurements. Peak systolic velocity (PSV), end diastolic velocity (EDV), and resistive index (RI) were measured in the central retinal artery (CRA), posterior ciliary arteries (PCAs), and ophthalmic artery (OA). Resistive index was used to assess arterial resistance; it was automatically calculated as RI [(PSV-EDV)/PSV]. RESULTS: There were no significant differences in the PSV, EDV, and RI of the OA, CRA, and PCAs between AS patients and controls. CONCLUSION: This result suggests no possible contributory role of vascular structures in formation of uveitis in AS. We believe that our preliminary results need to be complemented with further studies, particularly including AS patients with uveitis and rheumatic diseases with other ocular involvement.

Breast arterial calcifications and carotid intima-media thickness and haemodynamics: Is there any association?

OBJECTIVE: In this study, we aimed to research the relation between breast arterial calcifications (BACs) detected on mammography and two well-known markers of cardiovascular diseases-carotid artery intima-media thickness (C-IMT) and haemodynamics parameters like carotid peak-systolic velocity (PSV), end-diastolic velocity (EDV) and resistive index (RI). METHODS: The study group consisted of 50 consecutive BAC (+) women and the control group consisted of 55 BAC (-) women. In all participants, BAC was diagnosed using mammography and C-IMT was measured using B-mode and Doppler ultrasonography. BAC was defined as two linear calcification depositions in a conical periphery or as calcific rings at the mammographic evaluation. Doppler spectrum samples were obtained from 2 cm proximal to the main carotid artery bifurcation. RESULTS: Postmenopausal female patients ranging in age from 40 to 86 included in this study. When the groups were adjusted for age, a statistically significant difference was found between mean C-IMT of BAC (+) and BAC (-) groups (0.81 ± 0.2 vs. 0.69 ± 0.2 mm; p<0.001). No significant differences were observed between BAC (+) and BAC (-) groups in terms of PSV, EDV, RI. CONCLUSION: The findings of the present study suggest that BAC, diagnosed by mammography, is independently associated with C-IMT. C-IMT measurement is suggested as a useful tool to detect early atherosclerotic changes. However, haemodynamic variables (PSV, EDV, RI) were not statistically different between the BAC (+) and BAC (-) groups. Prospective larger cohort studies are needed to further elucidate whether BAC is an independent risk factor for cardiovascular disease.

Role and importance of Doppler ultrasound in the diagnosis of pulmonary sequestration: report of two adolescent cases.

Pulmonary sequestration is a rare pulmonary parenchymal anomaly. The localization of the aberrant artery and its relation with sequestration are of importance in the process of diagnosis in the preoperative period. The feeding artery can be identified by color Doppler ultrasonography. We report two cases of pulmonary sequestration in two adolescents, aged 11 and 13 years old, and this report documents the use of in which color Doppler ultrasound demonstrated the abnormal feeding artery. Color Doppler ultrasonography, a noninvasive and radiation-free imaging modality should be considered in the diagnostic algorithm of pulmonary sequestration.

Relationship between breast arterial calcifications detected on mammography and brachial artery intima-media thickness.

PURPOSE: Although breast arterial calcification (BAC) was shown to be related with coronary artery disease (CAD), hypertension (HT), diabetes mellitus (DM) and carotid intima-media thickness (C-IMT), but the association between BAC and brachial intima-media thickness (B-IMT) has not been evaluated yet. Our aim was to investigate whether associations existed between BAC and measure B-IMT and atherosclerosis (AS) by comparing these patients with healthy control subjects. METHODS: A Total of 75 patients were included in the study. Subjects with or without BAC were assigned into one of two groups and those with a BAC were graded. Main brachial artery IMT was measured. RESULTS: When the effect of age was partialled out statistically, we found a statistically significant difference in mean B-IMT between BAC (+) (0.54 ± 0.09) and BAC (-) (0.45 ± 0.08) groups (p = 0.001) after the groups were adjusted for age. CONCLUSIONS: In conclusion, even though the relationship between B-IMT and BAC was significant, like the relationship between C-IMT and BAC, significant age difference between BAC (+) and BAC (-) groups and no significant relationship between BAC and time after menopause, after adjustment for age, suggest a strong association between BAC and age rather than AS. This can be elucidated by pathological correlation studies in larger series of subjects.

Bronchial wall thickness in toll collectors.

There is an increasing concern about the possible adverse effects of diesel exhaust particulates on human health. In a diesel exposed occupational group composed of 120 toll collectors, a cross-sectional study was performed to evaluate the chest radiographs and 40 toll collectors were selected for computed tomography examination according to hyperinflation and linear markings. The wall thicknesses and luminal diameters of trachea, main bronchi, and segmental bronchi of right apical and posterior basal segments were measured with manual tracing method. The walls of right upper bronchus in exsmoker toll collectors were significantly thicker than those of nonsmokers (p=0.011). A positive correlation was observed between age and the right upper bronchus wall thickness (r=0.577, p=0.000). An inverse correlation was found between the working duration and the diameter of right main bronchus (r=-0.366, p=0.020). A positive correlation was seen between smoking and the right upper bronchus wall thickness (r=0.457, p=0.005). Diesel exposure might have a role in increase of thickness of large airways wall and a decrease in the diameters of large airways. Studies in this area are needed to protect the population under the diesel exposure risk.

The thickness of the ligamentum flavum in relation to age and gender.

Hypertrophy of the ligamentum flavum (LF) can reduce the diameter of the spinal canal posteriorly. Such stenosis may significantly compress the dural sac and nerve roots, resulting in symptoms, even without a bulging anulus fibrosus or herniated nucleus pulposus. We conducted an anatomical study to determine the influence of age and gender on the thickness of the LF at the lower lumbar levels using magnetic resonance imaging (MRI). The thickness of 1,280 ligaments was determined at the L4-L5 and L5-S1 levels from MRIs. We screened 320 patients (152 males [47.5%] and 168 females [52.5%]) between 21 and 82 years of age. There were no significant differences in LF thickness with respect to gender (P > 0.05). Age was not correlated with the thicknesses of the LF. The left LF at the L4-L5 and L5-S1 levels was significantly thicker than on the right side (P < 0.05). Furthermore, the LF thicknesses at L5-S1 bilaterally were significantly greater than on the corresponding sides at L4-L5 (P < 0.05). The LF is an important anatomical structure, which might cause low back or leg pain. Therefore, the thickness of the LF should be measured and evaluated carefully in the case of spinal stenosis.

Predictors of time to remission and treatment failure in patients with Graves' disease treated with propylthiouracil.

PURPOSE: Propylthiouracil is one of the thionamides used in the treatment of Graves' disease. The drug has serious side effects and long-term treatment might be needed to achieve remission. We designed this study to evaluate the clinical and thyroid Doppler characteristics that might predict time to remission and treatment failure in propylthiouracil treated Graves' patients. METHODS: 26 patients, among 134 presenting to our university hospital outpatient clinic between Feb -July 2007 and with first time diagnosis of clinical thyroid dysfunction, were clinically and ultasonographically diagnosed with Graves' disease. Doppler parameters, serum thyrotropin, free thyroxine and free triiodothyronine were measured at the beginning of the study and thyroid studies were repeated every 4 weeks until remission. Propylthiouracil 300 mg/day was started for each patient at the time of diagnosis and doses were titrated according to repeat thyroid studies. Patients were treated and followed up for 18 months. RESULTS: Treatment failure was associated with smoking (P = 0.001) and male gender (P= 0.037). Stepwise multiple regression analysis revealed that age, free thyroxine and superior thyroid artery flow rate were predictors of time to remission (P= 0.001, 0.002 and 0.003, respectively). CONCLUSION: The time to remission in Graves patients treated with propylthiouracil can be predicted using age, serum free thyroxine and superior thyroid artery flow rate. This may help early consideration of alternative treatment for the patients requiring prolonged treatment for remission or for those who fail medical treatment. This would decrease unnecessary, long-term propylthiouracil exposure with its serious side effects.

Comparison of ultrasound-, palpation-, and scintigraphy-guided steroid injections in the treatment of plantar fasciitis.

BACKGROUND: The aim of the study was to compare the efficacies of steroid injections guided by scintigraphy, ultrasonography, and palpation in plantar fasciitis. METHODS: A total of 35 heels of 27 patients were randomly assigned to three steroid injection groups: palpation-guided (pg), ultrasound-guided (ug), and scintigraphy-guided (sg). Patients were evaluated for pain intensity before the injections and at the last follow-up of 25.3 months with a 100-mm visual analog scale (VAS). RESULTS: There were significant improvements in plantar fascia thickness, fat pad thickness, and VAS. Among the three groups of ug-pg, ug-sg, and pg-sg there were no statistically significant differences after treatment (P = 0.017, MWU = 36.5; P = 0.023, MWU = 29.5; and P = 0.006, MWU = 13, respectively). CONCLUSIONS: The ug, pg, and sg injections were effective in the conservative treatment of plantar fasciitis. We are of the opinion that steroid injections should be performed, preferably with palpation or ultrasonographic guidance.

Doppler waveforms of the hepatic veins in children with diffuse fatty infiltration of the liver.

OBJECTIVE: The aim of this study was to investigate the effect of fatty infiltration of the liver (FIL) on the Doppler waveform pattern in the hepatic veins of obese children. METHODS: In this prospective study, 59 patients with diffuse FIL and 45 normal healthy children who served as control group underwent hepatic vein B-mod and duplex Doppler sonography. The Doppler sonography spectrum of the right hepatic vein was classified into three groups: triphasic waveform, biphasic waveform, and monophasic or flat waveform. RESULTS: There was a statistically significant difference in the phasicity of hepatic venous flow between patients and control subjects (p<0.001). The Doppler flow pattern in the right hepatic vein was triphasic in 28 (47.5%), biphasic in 28 (47.5%), and monophasic in 3 (5%) children with fatty liver, while it was triphasic in 43 (95.6%) and biphasic in 2 (4.4%) control subjects. There was an inverse correlation between the sonographic grade of fatty infiltration of the liver and the phasicity of hepatic venous flow (r=-0.479, p<0.001). CONCLUSIONS: Abnormal right hepatic vein Doppler waveform, biphasic as well as monophasic, can be seen in healthy obese children with diffuse FIL.

Pituitary hyperplasia mimicking pituitary macroadenoma in two adolescent patients with long-standing primary hypothyroidism: case reports and review of literature.

We report two cases with primary autoimmune hypothyroidism and an ectopic thyroid gland causing pituitary enlargement mimicking pituitary macroadenoma. One of the cases presented with complaints of headache and short stature and the other case with a complaint of menorrhagia. In both cases, the pituitary mass and symptoms resolved with levothyroxine replacement. Normal menses resumed. However, pituitary dynamic tests revealed persistent growth hormone and gonadotropin deficiency in one case and growth hormone deficiency in the other. To our knowledge, this is the first report in an adolescent of hypogonadotropic hypogonadism, growth hormone deficiency, and menorrhagia associated with pituitary hyperplasia secondary to primary hypothyroidism. The recognition of the association between reversible pituitary hyperplasia and primary hypothyroidism might eliminate unnecessary surgery.

Portal vein hemodynamics in patients with non-alcoholic fatty liver disease.

Paralleling the rise in the incidence of obesity and diabetes worldwide, nonalcoholic fatty liver disease (NAFLD) is being increasingly recognized as one of the major causes of chronic liver disease. Doppler sonography is used as a diagnostic method in the non-invasive assessment of the hemodynamics of hepatic vascular flow in liver diseases. We investigated the effects of fatty infiltration in the liver on the Doppler flow hemodynamics of the portal vein. Doppler sonography of the liver and portal vein was performed in 60 subjects with NAFLD and 20 healthy volunteers (control). The patients were grouped into mild (grade 1), moderate (grade 2), and severe (grade 3) according to sonographic appearance of hepatosteatosis (n = 20 for each group). The vein pulsatility index (VPI), mean flow velocity (MFV), peak maximum velocity (V(max)), and peak minimum velocity (V(min)) of the portal vein were significantly lower in patients with NAFLD than those of the controls (p < 0.001). The VPI was 0.20 in the patients and 0.31 in the control. The MFV was 12.3 cm/sec in the patients and 16.5 cm/sec in the control group. The portal vein flow was found to be decreased as the grade of fatty infiltration increased for VPI (r = -0.946, p < 0.001), MFV (r = -0.951, p < 0.001). The alteration in Doppler waveform pattern of portal vein with fatty liver population suggests reduced vascular compliance in the liver.

Hydrocele of the canal of Nuck: sonographic and MRI appearances.

Hydrocele of the canal of Nuck is a rare disorder in females. A 50-year-old female presented with the complaint of swelling and occasional pain in the right groin. Sonographic examination revealed a proximal dilatation at the inguinal canal with a 3-cm ovoid, septated cystic lesion at the distal end. The mass appeared as a simple cyst on MRI. Valsalva's maneuver during real-time sonography helped differentiate the hydrocele of the canal of Nuck from an inguinal hernia.

Orbital blood flow velocities in patients with rheumatoid arthritis.

PURPOSE: To assess orbital blood flow changes in patients with rheumatoid arthritis using Doppler sonography. PATIENTS AND METHODS: The study comprised 35 patients who were diagnosed with RA and were treated at the Department of Physical Therapy and Rehabilitation at Duzce Medical School. A control group consisted of 35 healthy volunteers. Color Doppler imaging was used to measure peak systolic velocity (PSV) and end diastolic velocity (EDV), from which the resistance index (RI) was calculated in the ophthalmic artery (OA), central retinal artery (CRA), and posterior ciliary arteries (PCAs). RESULTS: In the OA, PSV, EDV, and RI were, respectively, 36.7 +/- 0.6 cm/sec, 9.7 +/- 0.2 cm/sec, and 0.73 in the control group versus 34.7 +/- 3.0 cm/sec, 9.1 +/- 1.1 cm/sec, and 0.74 in the patient group. In the CRA, they were, respectively, 11.8 +/- 1.7 cm/sec, 3.6 +/- 0.7 cm/sec, and 0.66 in the control group versus 11.1 +/- 1.7 cm/sec, 3.4 +/- 0.7 cm/sec, and 0.68 in the patient group. In the PCAs, they were, respectively, 13.2 +/- 1.2 cm/sec, 4.7 +/- 0.6 cm/sec, and 0.65 in the control group versus 12.4 +/- 1.2 cm/sec, 4.2 +/- 0.6 cm/sec, and 0.66 in the PCAs. PSV, EDV, and RI of the PCAs and OA and RI of the CRA were significantly different between patients and controls, whereas there was no difference in the serum levels of glucose, triglyceride, low-density lipoprotein cholesterol, and total cholesterol. In the patient group, there was a significant correlation between orbital blood flow and duration of disease. CONCLUSION: Ocular blood flow appears to be slightly lower in RA patients than in healthy controls, suggesting that RA is a systemic inflammatory disease that may also involve ocular vessels.

Evaluation of the thyroid blood flow with Doppler ultrasonography in healthy school-aged children.

OBJECTIVE: To determine the relationship between thyroid blood flow and anthropometric measurements, pubertal stage, and thyroid and gonadotropic hormones. MATERIALS AND METHODS: We examined 123 healthy school-aged children prospectively (69 boys (56.1%) and 54 girls (43.9%), 7-17 years old). Their sex, age, body weight, height, body mass index (BMI), and pubertal stage were determined. Serum thyrotropin, free thyroxine, luteinizing hormone, and follicle stimulating hormone were measured in both genders, along with testosterone in boys and estradiol in girls. The peak systolic velocity (PSV), resistance index (RI), and pulsatility index (PI) of the superior thyroid artery were determined. The correlations between the Doppler parameters and these factors were investigated. RESULTS: There were no differences in age, weight, height, BMI, thyroid volume, PSV, RI, or PI between boys and girls (P>0.05). The PSV and PI showed strong correlations with age, height, weight, puberty stage, thyroid volume, and BMI. The RI showed a strong inverse correlation with age, height, weight, puberty stage, and thyroid volume and a weak inverse correlation with the BMI. CONCLUSION: Determination of the thyroid arterial flow in normal healthy children is important during a Doppler ultrasound (US) examination. Doppler US parameters and their percentiles should be described in healthy children from different age groups, and these percentiles will aid in interpreting Doppler US in children.

Intima-media thickness of the common carotid artery in highway toll collectors.

PURPOSE: To assess the effects of exposure to exhaust particles on intima-media thickness of the common carotid artery in highway toll collectors. METHODS: Sixty-one highway toll collectors (HTCs) between 24 and 56 years of age (mean, 36.2 +/- 7.3) and 48 controls between 24 and 64 years of age (mean, 42.6 +/- 10.6) were evaluated with gray-scale sonography to measure intima-media thickness (IMT) of the common carotid artery (CCA). Subgroups were categorized according to duration of exhaust exposure and further divided according to tobacco use. RESULTS: CCA IMT was higher (0.8 +/- 0.2 mm) in HTCs than in the control group (0.6 +/- 0.1 mm; p < 0.001) and remained higher when subgroups with similar smoking habits were compared. In HTCs, IMT was greater when the number of years working in tollbooths was greater (p = 0.023). IMT was lower in HTCs with an exposure duration of < 10 years compared with a duration of 10-20 years (p = 0.017) or > 20 years (p value not significant). CONCLUSION: Air pollution has a widely acknowledged negative effect on humans. This study confirms that exposure to exhaust particles might cause wall thickening of carotid arteries.

The prevalence of venous insufficiency in patients with chronic obstructive pulmonary disease evaluated by color duplex ultrasonography.

OBJECTIVES: We hypothesized that in patients with chronic obstructive pulmonary disease (COPD) some extrapulmonary effects such as increase in intra-abdominal and intra-thoracic pressures, presence of cor pulmonale and pulmonary artery hypertension could cause venous insufficiency (VI) in the lower limbs. Our aim in this study was to assess the prevalence of VI in patients with COPD in comparison with healthy controls. METHODS: Thirty-nine male patients with COPD and 36 healthy male controls were evaluated for VI. All the participants were in the same age group and their smoking intensities were similar. Patients with COPD were classified as having mild, moderate, severe or very severe disease according to criteria of the Global Initiative for Chronic Obstructive Lung Disease. All the patients and control group were examined for unilateral or bilateral VI of the common femoral vein, superficial femoral vein, deep femoral vein and popliteal vein using color duplex ultrasonography. RESULTS: The prevalence of VI of the lower extremity in patients with COPD (69.2%) was significantly higher than in the healthy control group (41.7%). The prevalence increased as the COPD severity increased and VI was detected in all the patients with very severe COPD [mild COPD, 50.0% (2/4); moderate, 58.8% (10/17); severe, 75.0% (9/12); very severe, 100% (6/6)]. CONCLUSION: VI of the lower extremity appears more frequent in patients with COPD. We suggest ruling out COPD in patients with otherwise unexplained "primary" VI.

Floating ball appearance in ovarian cystic teratoma.

The presence of floating fat balls or globules in an ovarian cystic teratoma is an unusual finding. Herein, we present ultrasonographic and tomographic findings of a rarely reported case of cystic teratoma with a floating fat ball.