Evaluation of flow hemodynamics by color-Doppler following two different brachial arterial repair techniques.

OBJECTIVES: We compared the clinical and hemodynamic results following surgical repair of traumatic brachial artery injury using two different techniques micro- and macrovascular repair. MATERIALS AND METHODS: This was a retrospective study of 27 patients who had sustained penetrating, clean cut injuries of the brachial artery. Macrovascular techniques and a saphenous vein graft was used in 13 patients, while 14 patients were treated by primary microsurgical technique. Postoperatively, patients were followed for a mean of 26 months. All patients had color Doppler examination of the brachial artery, digital artery pressures and transcutaneous oxygen saturation determined. RESULTS: Clinical results based on distal pulses, Allens test and digital pressures were similar in the two groups. Color Doppler showed 8/13 anastomotic stenoses in macrovascular vein grafted repairs and 2/14 in microvascular repairs (p<0.05). The ratio of flow velocity proximal compared distal to the injury was significantly decreased in patients who had macrovascular repairs. CONCLUSION: Using ratio between proximal and distal site of anastomosis maximal peak systolic velocity as a objective color Doppler parameter, we were able to demonstrate differences in the hemodynamic status following macrovascular repair with vein grafts and microvascular primary repair. The results emphasize the importance of using a standard repair technique for similar injuries rather than the preference of the surgeon.

Forearm arterial vein grafting: problems and alternative solutions.

We aimed to evaluate patency rates following forearm arterial reconstruction and suggest improvements. Thirty-two vein grafted reconstructions (using saphenous and dorsal hand veins) were evaluated for patency and development of symptoms using clinical examination, Colour-Doppler Sonography and angiography. Overall patency was 59%, with no significant difference between saphenous and dorsal hand veins. Stasis, turbulence, decrease in blood velocity, change in flow pattern, stenosis in the anastomotic area or increase in compliance was detected in 10 patent grafts, but was not associated with symptoms. Six out of 13 non-patent grafted patients had severe or troublesome symptoms associated with accompanying nerve regeneration. To improve patency, careful microsurgical techniques, 'fit vein' and valveless grafts should be used. Dorsal hand veins are most appropriate for short defects. Patency should be evaluated soon after reconstruction.

CT findings of non-functioning neuroendocrine pancreatic tumors.

Neuroendocrine tumors are rare neoplasms of the pancreas, representing 0.5% of all pancreatic tumors. Approximately, one-third of neuroendocrine tumors are hormonally inactive and called non-functioning neuroendocrine tumors. As these tumors remain clinically silent in their course of growth, they may attain great sizes without causing apparent clinical findings and commonly present in advanced stage. We report three cases of non-functioning neuroendocrine tumors with large sizes and discuss the radiological findings.

Lipoma of the pancreas: MRI findings.

Lipomas of the pancreas are very rare. Focal fatty infiltration of the pancreas is an entity that should be differentiated from a pancreatic lipoma. In this report the MRI findings of an incidentally found pancreatic lipoma are presented and the role of MRI in the differentiation of pancreatic lipoma and focal fatty infiltration of the pancreas is discussed.

Effects of CO2 pneumoperitoneum on the basilar artery.

BACKGROUND: Laparoscopic surgery provides many benefits to the patients. The purpose of this study was to evaluate cerebral blood flow changes and the possibility of ischemia-reperfusion injury occurring during carbon dioxide (CO(2)) pneumoperitoneum. METHODS: Forty-eight New Zealand white rabbits were divided into four experimental and two control groups. Rabbits were subjected to CO(2) pneumoperitoneum with an intraabdominal pressure of 8 and 15 mmHg for 60 or 180 min as designed for experimental groups. We then assessed the changes in physiological and transcranial Doppler ultrasonographic parameters, as well as brain malondialdehyde levels. RESULTS: Transcranial Doppler sonography of the basilar artery revealed elevated mean velocity and decreased resistance index and pulsatility index values with the longer-duration and higher-pressure CO(2) pneumoperitoneum. However, there were no statistically significant difference in m alondialdehyde values. CONCLUSION: Elevated intraabdominal pressure by CO(2)-pneumoperitoneum, which does not lead to ischemia-reperfusion injury of the brain tissue, results in increased cerebral blood flow and reduced cerebrovascular resistance as an autoregulatory cerebral answer for CO(2).

Color doppler sonography in the follow-up of giant glutealaneurysm embolization.

False aneurysm of the gluteal artery is uncommon and may develop secondary to penetrating gluteal injury or pelvic trauma. The use of color Doppler sonography may allow the initial diagnosis of gluteal pseudoaneurysms and provide information about the success of the interventional radiological procedures. In this study, color Doppler sonographic examination demonstrated the failure of the endovascular treatment of a giant superior gluteal artery pseudoaneurysm. The second intervention of super-selective coil embolization provided optimal thrombosis and eliminated the need for open surgery.

The prediction of papaverine induced priapism by color Doppler sonography.

PURPOSE: We identified color Doppler sonography findings that are useful for predicting priapism in patients after the intracavernous injection of diagnostic papaverine. MATERIALS AND METHODS: We evaluated 72 men with erectile dysfunction by color Doppler sonography after the diagnostic injection of papaverine. Cavernous artery waveforms were recorded, and peak systolic and diastolic velocity of the recorded waveforms was measured. In cases of priapism color Doppler sonography findings were retrospectively evaluated to identify any finding that would predict priapism. RESULTS: Priapism was observed in 8 of the 72 patients (11.1%). In 6 of 8 priapism cases there was no blood flow in the cavernous artery during or after adequate erection, including after minutes 5, 10 and 20 in 3, 1 and 2, respectively. This absence of encoding was not relieved even after all stimuli were removed. In 2 patients who later presented with complaints of priapism the Doppler study was completed normally and all parameters were acquired without any cessation of blood flow in the cavernous artery. The persistent disappearance of color and pulse encoding in the cavernous artery predicted priapism with 75% sensitivity, 100% specificity, a positive and negative predictive value of 100% and 96.9%, respectively, and 97% accuracy. CONCLUSIONS: The persistence of absent blood flow in the cavernous artery even after the elimination of all stimuli during penile color Doppler ultrasound is a reliable predictor of priapism. The finding is accurate enough to initiate treatment for priapism to avoid further delay.

Aneurysmal dilatation of the paraumbilical vein in an infant.

The paraumbilical veins are one of the most common collateral pathways developing in portal hypertension. Aneurysmal dilatation of a patent paraumbilical vein is a very unusual finding. We report the first infant case of a paraumbilical vein aneurysm and its Doppler ultrasound findings.

Palliation of malignant esophageal strictures: initial results with self-expanding uncovered nitinol coil stents.

The purpose of this study was to determine the efficacy of the uncovered coil stents in patients with malignant dysphagia. Coiled spring-shaped uncovered self-expanding metallic Esophacoil stents (Instent, Eden Prairie, Minnesota) were placed in 11 patients (9 men and 2 women; age range 38-77 years, mean age 60.5 years) with malignant esophageal strictures and dysphagia, under fluoroscopic guidance. Dysphagia was graded on a scale of 0 to 4 (0 = no dysphagia; 1 = dysphagia to normal solids; 2 = dysphagia to soft solids; 3 = dysphagia to solids and liquids; 4 = complete dysphagia, inability to swallow saliva). Two patients had received radiation therapy, 4 had had chemotherapy, and 5 had had a combination of both radiation and chemotherapy before stent palliation. Control clinical examinations and endoscopic or barium swallow studies were performed every 4 weeks until the patient died. The stents were well tolerated by all patients and were effective in 9 of 11 patients with malignant dysphagia. Complications of the procedure included incomplete opening of the stent in 1 case, migration in 1 case, transient pain in 8 cases, reflux in 3 cases and minor gastrointestinal bleeding in 2 cases. Stent migration in 1 case resulted in surgical intervention and incomplete opening of the stent allowed only partial improvement of dysphagia in 1 case. The quality of life significantly improved in all other patients. Mean survival time of the patients was 73 days (range 34-125 days) and no significant tumor ingrowth was detected during the follow-up period. Insertion of an Esophacoil has a good palliative effect on dysphagia in patients with malignant esophageal strictures with few complications. Although the stent is uncovered, tumor ingrowth and overgrowth were not observed in our study, possibly because of previous treatments.

Asymptomatic ureteral varices: detection by Doppler sonography.

Retroperitoneal ectatic or varicose veins may cause ureteral extrinsic pressure defects. Doppler sonography may be helpful in the characterization of these vascular lesions. We report the sonographic findings in a case of asymptomatic idiopathic left ureteral varices.

Esophageal duplication cyst coexisting with Bochdalek's hernia and polysplenia.

Esophageal duplication cyst, Bochdalek's hernia and polysplenia are uncommon congenital anomalies which have not been reported to be associated with each other. We present the radiological aspects of an unusual coexistence of these three congenital anomalies in a 4-month-old girl.

Subclavian artery aneurysm with oesophagoarterial fistula.

Aneurysms of the subclavian artery are rare. Fistula formation between the subclavian artery and the oesophagus has been described in aberrant subclavian artery and oesophageal foreign body. However, a fistula between a non-aberrant subclavian artery aneurysm and the oesophagus has not been previously reported. In this report, an unusual case of subclavian artery aneurysm with a fistula to the oesophagus causing intractable haematemesis is presented with the angiographic findings.

Bilateral epididymal Candida abscesses: sonographic findings and sonographically guided fine-needle aspiration.

We report the case of a 67-year-old diabetic man who presented 2 months after transurethral prostate surgery with impaired consciousness, urinary incontinence, and recurrent urinary tract infections that did not respond to antibiotic treatment. Sonographic findings suggested abscess formation (enlarged, heterogeneous epididymides and a central hypoechoic area in the head of the left epididymis). Aspirates obtained from sonographically guided needle biopsy were purulent. Staining showed budding yeast forms, and Candida albicans grew in culture. Systemic candidiasis was diagnosed. The patient underwent bilateral epididymo-orchiectomy, and pathologic analysis of resected specimens showed bilateral epididymal necrosis and disseminated abscess formation.