ABSTRACT
The intrauterine device (IUD) is gaining popularity as a reversible form of contraception. Ultrasonography serves as first-line imaging for the evaluation of IUD position in patients with pelvic pain, abnormal bleeding, or absent retrieval strings. This review highlights the imaging of both properly positioned and malpositioned IUDs. The problems associated with malpositioned IUDs include expulsion, displacement, embedment, and perforation. Management considerations depend on the severity of the malposition and the presence or absence of symptoms. Three-dimensional ultrasonography has proven to be more sensitive in the evaluation of more subtle findings of malposition, particularly side-arm embedment. Familiarity with the ultrasonographic features of properly positioned and malpositioned IUDs is essential.
ABSTRACT
Delayed splenic rupture following conservative management of splenic injury is an extremely rare complication. We report a case of an adult patient who presented with delayed splenic rupture necessitating splenectomy, 2 months following blunt abdominal trauma. Imaging at the initial presentation demonstrated only minimal splenic contusion and the patient was discharge following 24 hours of observation.
Subject(s)
Contusions/complications , Multiple Trauma/complications , Skiing/injuries , Spleen/injuries , Splenic Rupture/diagnostic imaging , Splenic Rupture/etiology , Wounds, Nonpenetrating/complications , Contusions/surgery , Hernia, Inguinal/etiology , Humans , Lacerations/complications , Lacerations/surgery , Lung Injury/complications , Male , Middle Aged , Multiple Trauma/diagnostic imaging , Multiple Trauma/surgery , Radiography , Splenectomy , Splenic Rupture/surgery , Wounds, Nonpenetrating/surgeryABSTRACT
We propose a mathematical model to describe the hemodynamic changes induced by a venous occlusion in a human limb. These hemodynamic changes, which include an increase in blood volume, a reduction in blood flow, and modifications to the oxygen saturation of hemoglobin, can all be measured noninvasively with near-infrared spectroscopy (NIRS). To test the model, we have performed NIRS measurements on the human forearm, specifically on the brachioradialis muscle, during venous occlusion induced by a pneumatic cuff inflated around the upper arm to pressures within the range 10-60 mmHg. We have found a good agreement between parameters measured by NIRS (total hemoglobin concentration and hemoglobin saturation) and the corresponding model parameters (capacitor voltage and arterial/capillary branch current). In particular, model and experiment indicate that the time constant for blood accumulation during venous occlusion (approximately 73-79 s) is much slower than the time constant for blood drainage following cuff release (approximately 5 s). These results indicate that this mathematical model can be a valuable analytical tool to characterize, optimize, and further develop diagnostic measurement schemes that use venous occlusion approaches.
Subject(s)
Blood Flow Velocity/physiology , Forearm/physiology , Models, Cardiovascular , Oximetry/methods , Plethysmography/methods , Veins/physiology , Venous Pressure/physiology , Adaptation, Physiological/physiology , Algorithms , Computer Simulation , Diagnosis, Computer-Assisted/methods , Forearm/blood supply , HumansABSTRACT
Muscle blood flow (MBF) and muscle oxygen saturation (SmO(2)) were measured at eight locations (four proximal, four distal) over a 4 x 8 cm(2) area of the vastus lateralis at rest and immediately after isometric, maximal quadriceps contraction using multichannel, frequency-domain, near-infrared spectroscopy. A venous occlusion was applied 20 s before the end of the exercise, so that the venous-occlusion-induced increase in total hemoglobin was recorded without any delay after the end of the exercise. Therefore, we were able to investigate the relationship between the exercise-induced changes in vastus lateralis MBF and SmO(2). After exercise, MBF increased significantly at each measured location. Comparing the MBF values measured at the end of exercise in the proximal and distal regions, we observed that only one proximal region had a significantly higher MBF than the corresponding distal one. The maximum desaturation measured during exercise was positively correlated with the postexercise to pre-exercise MBF ratio in both the proximal (P=0.016) and distal (P=0.0065) regions. These data confirm that frequency-domain tissue oximeters are noninvasive, powerful tools to investigate the spatial and temporal features of muscle blood flow and oxygenation, with potential applications in areas of pathophysiology.
