RESUMO
OBJECTIVE: The abdominal compartment syndrome is a potentially life-threatening condition with frequent renal involvement. There are few if any means of inferring subclinical effects before organ dysfunction. Because intrarenal pressure correlates with renal sonographic indices in other renal diseases, the purpose of this study was to determine the relationship between increasing intraabdominal hypertension and renal vascular flow velocities in a porcine model using renal Doppler ultrasound. DESIGN: Animal study. SETTING: University research laboratory. SUBJECTS: Eight anesthetized, mechanically ventilated, well-hydrated, 30-kg female Yorkshire pigs. INTERVENTIONS: Intraabdominal hypertension was induced by instillation of warmed intraperitoneal saline through a midline laparoscopic port. Intraabdominal pressure (IAP) was continuously monitored directly from the peritoneum and indirectly from the bladder. IAP was varied from 0 to 50 mm Hg in increments of 5 mm Hg. At each IAP level, gray-scale, color, and spectral Doppler renal arcuate artery ultrasound was obtained and resistive index (RI) and peak airway pressure calculated. MEASUREMENTS AND MAIN RESULTS: Excellent agreement between direct and indirect IAP was found (bias, 0.032 mm Hg; 95% limits, -5.5 to 5.6 mm Hg). A linear relationship between RI and indirect IAP was observed and was defined by the regression equation: RI = 0.553 + 0.0104 x bladder pressure. There was a trend toward different RIs between left and right kidneys (p = .052) at the same IAP. RI varied in a linear fashion at low peak airway pressure and demonstrated an inflection point with steeper subsequent slope after peak airway pressure of 30 cm H2O. RI values rapidly returned to near baseline after abdominal decompression. CONCLUSIONS: In this model, the renal artery RI correlated strongly and linearly with the severity of intraabdominal hypertension, making renal Doppler ultrasound a potential noninvasive screening tool for the renal effects of intraabdominal hypertension. Further studies are warranted.
Assuntos
Cavidade Abdominal , Modelos Animais de Doenças , Hipertensão , Artéria Renal/fisiopatologia , Índice de Gravidade de Doença , Resistência Vascular , Animais , Viés , Síndromes Compartimentais/complicações , Síndromes Compartimentais/diagnóstico , Síndromes Compartimentais/fisiopatologia , Feminino , Hipertensão/complicações , Hipertensão/diagnóstico , Hipertensão/fisiopatologia , Hipertensão Renal/diagnóstico por imagem , Hipertensão Renal/etiologia , Hipertensão Renal/fisiopatologia , Análise dos Mínimos Quadrados , Modelos Lineares , Programas de Rastreamento , Monitorização Fisiológica , Projetos Piloto , Valor Preditivo dos Testes , Artéria Renal/diagnóstico por imagem , Circulação Renal , Suínos , Ultrassonografia Doppler , Cateterismo UrinárioAssuntos
Encéfalo/diagnóstico por imagem , Metanol/intoxicação , Tomografia Computadorizada por Raios X , Adulto , Overdose de Drogas , Humanos , Masculino , Necrose/diagnóstico por imagem , Intoxicação/tratamento farmacológico , Intoxicação/terapia , Putamen/diagnóstico por imagem , Putamen/patologia , Diálise Renal , Fatores de TempoRESUMO
Unenhanced helical CT has emerged as the imaging technique of choice for the investigation of patients presenting with acute flank pain and suspected nephroureteric stone disease. There are several signs identifiable on unenhanced CT that support a diagnosis of stone disease. However, there are many pitfalls, that may confound a correct diagnosis. Some of the common pitfalls, together with methods to avoid such occurrences, will be discussed. A review of some of the common alternative diagnoses that may mimic the symptoms of nephroureteric stone disease is illustrated.
