mode with linear transducer od 5–7.5 MHz as well. Upper limb arteries are traced longitudinally by Color Dopplerultrasonography from distal subclavian artery (a.subclavia) till the radial (a.radialis) and ulnar arteri- es (a.ulnaris). Arterial segments in which disturbance in color appearance is detected require additional asse- sment by B-mode and spectral doppler, for detection of stenosis or occlusion. Stenosis is considered hemodi- namically significant if more 50%, and stenosis disco- vered by ultrasonography before vascular access crea- tion, requires angiography (golden standard in blood vessels imaging) (13, 14).
The study group consisted of 47 patients (12 males and 35 females) presenting with unilateral renal or ureteral calculi and uri- nary tract obstruction (hydronephrosis) de- tected by an intravenous pyelogram (37 pa- tients) and/or Dopplerultrasonography (35 patients). Only patients presenting normal renal function detected by creatinine clear- ance were enrolled in the study. Previous urinary tract infection and surgical proce- dures were considered as exclusion criteria. Written consent to participate in the study was obtained from each patient, and the study was approved by the Ethics Commit- tee of Universidade Federal de São Paulo. After an initial clinical evaluation, all 47 patients were submitted to both DTPA and DMSA scans. A possible association of the presence of unilateral functional deficit with calculus size, duration of obstruction and calculus localization was determined. The obstruction period was defined as the time from the date of the radiological diagnosis of obstruction by an intravenous pyelogram and/ or ultrasonography to the date of the first scintigraphic evaluation.
Dopplerultrasonography can be applied to noninvasi- vely evaluate the uterine and ovarian vasculature in vivo. Studies applying this method in women have concluded that the uterine hemodynamics show cyclical changes throughout the menstrual cycle. The uterine arteries of infertile women showed increased resistance during the midluteal phase compared with those in fertile controls. Pregnancy rates were reduced during cycles with elevated uterine resistance (Ziegler et al. 1999). In the present stu- dy, a decrease in uterine blood perfusion was observed two days prior to ovulation. This parameter remained unchan- ged until ovulation. One day after ovulation, uterine perfu- sion gradually increased. This pattern was similar to those described in women (Ziegler et al. 1999), cows (Bollwein et al. 2000) mares (Bollwein et al. 1998, Bollwein et al. 2002) and capuchin monkeys (Domingues et al. 2007).
In large animals, Dopplerultrasonography is a non-invasive real time pulse-wave technique recen- tly used for the transrectal study of the reproductive system hemodynamics. The introduction of this technology in current researches has allowed reevaluating previously conceptions considered definitive regarding the physiology of reproduction. This method had showed to be effective and useful for the evaluation of the in vivo equine reproductive tract increasing the diagnostic, monitoring, and predictive capabilities of theriogenology in mares . Color-Doppler ultrasonic imaging is based in the Doppler effect principle that proposes the change in frequency of a wave for an observer moving relative to the source of the respective wave (Figure
Objective: To investigate superior mesenteric artery flow measurement by Dopplerultrasonography as a means of characterizing inflammatory activity in Crohn’s disease. Materials and Methods: Forty patients were examined and divided into two groups – disease activity and remission – according to their Crohn’s disease activity index score. Mean superior mesenteric artery flow volume was calculated for each group and correlated with Crohn’s disease activity index score. Results: The mean superior mesenteric artery flow volume was significantly greater in the patients with active disease (626 ml/min ± 236 × 376 ml/min ± 190; p = 0.001). As a cut off corresponding to 500 ml/min was utilized, the superior mesenteric artery flow volume demonstrated sensitivity of 83% and specificity of 82% for the diagnosis of Crohn’s disease activity. Conclusion: The present results suggest that patients with active Crohn’s disease have increased superior mesenteric artery flow volume as compared with patients in remission. Superior mesenteric artery flow measurement had a good performance in the assessment of disease activity in this study sample.
Based on these studies, the need was perceived for new research that generates information to facilitate diagnosis for the wild animal clinical veterinarian, because these species have been little studied to date and are a great perspective for the biodiversity of the planet. Although there is knowledge of abdominal organ in B scan, it is essential to obtain ultrasound parameters in Dopplerultrasonography because these would serve as reference for the diagnosis of various abnormalities. The objective of the present study was the B scan and Doppler ultrasound characterization of the abdominal organs of healthy agouti reared in captivity. The results of this study could contribute to providing new information regarding ultrasound morphology and the hemodynamic parameters of abdominal blood vessels of this wild species in the scientific environment. Furthermore, this research would serve as a strong base for initial illness diagnosis and will favor a more effective clinical surgical approach with ecological conservation of these wild rodents.
Using colored Doppler, mammary artery was identified and evaluated. Subsequently, pulsed Dopplerultrasonography was used to determine the systolic peak velocity (SPV), end diastolic velocity (EDV), vascular resistance index (RI = [SPV-EDV] / SPV) and pulsatility index (PI = [SPV-EDV]/mean velocity) of the mammary artery. The calipter was then positioned in an area of the vessel to measure the spectral trace of the vascular flow, determining the indexes automatically (Feliciano et al., 2012).
Transabdominal ultrasonography proved very useful in advanced pregnancy and uterine torsion cases where it was very difficult to assess the status of fetus manually. Acoustic shadowing or areas of low-amplitude echoes created by bony structures such as vertebrae and ribs were readily visible in the trans- abdominal scanning. The fetal heart was observed within the cranial, cone-shaped thorax, with fetal heartbeat being clearly visible in all the animals of the control group (Figure-3). In the current study, the fetus was found dead at the time of presentation in 95% (19/20) of uterine torsion cases, and in 5% (1/20) cases, fetus was live. Fetus was live in 100% cases in the control group. The uterine torsion case, in which fetus was live, its heartbeat recorded was 134 beats per minute (bpm). Fetal heartbeats recorded in normal advanced pregnant buffaloes was 111.90±3.31 bpm (mean±standard error [SE]).
Background: Deep vein thrombosis is a common disease among people who are immobilized. Immobility is inherent to paraplegia and leads to venous stasis, which is one of the factors covered by Virchow’s triad describing its development. Trauma is the primary cause of paraplegia and is currently increasing at a rate of 4% per year. Objective: To determine the prevalence of deep vein thrombosis in paraplegic patients whose paraplegia was caused by traumas, using color Dopplerultrasonography for diagnosis. Methods: his was a cross-sectional observational study of 30 trauma-induced paraplegia patients, selected after analysis of medical records at the neurosurgery department of a University Hospital in Curitiba, Brazil, and by a proactive survey of associations that care for the physically disabled. he prevalence of deep vein thrombosis was analyzed using 95% conidence intervals. Results: Spinal cord trauma was the cause of paraplegia in 29 patients. he most common cause of trauma was gunshot wounding, reported by 17 patients. Deep vein thrombosis was diagnosed by color Dopplerultrasonography in 14 patients in the sample. he most often afected vein was the posterior tibial, in 11 patients. he left lower limb was involved three times more often than the right. Edema was observed in 25 individuals, cyanosis in 14, ulcers in 8 and localized increase in temperature in 13. Conclusions: Deep vein thrombosis was prevalent, occurring in 46.7% of the patients.
Background: Diagnosis of abdominal aortic aneurysm (AAA) is usually incidental, and surgical treatment, when indicated, may be open or endovascular. he drawbacks of computed angiotomography (CTA) and the advantages of Dopplerultrasonography have led to the development of alternative follow-up protocols, comparing the two methods. Objective: To determine validity indices for Dopplerultrasonography and to correlate them with CTA results in a group of patients who had undergone elective endovascular treatment of AAAs. Material and methods: hirty-three patients were selected. he following three items were evaluated: 1) presence or absence of endoleak; 2) presence of blood low in the aortoiliac segment; and 3) maximum AAA diameter. Results: For the detection of endoleak, Dopplerultrasonography showed a sensitivity of 54.5%, a speciicity of 92.8%, a positive predictive value of 85.7%, a negative predictive value of 92.8%, and an overall accuracy of 76%. For the evaluation of blood low in the aortoiliac segment, values were 100, 97.8, 80, 97.8, and 98%, respectively. Maximum AAA diameter was similarly measured by both methods, with statistically signiicant diferences (mean diference: 1.98 mm). Pearson’s correlation coeicient was 0.97, showing that Dopplerultrasonography and CTA yielded similar results. Conclusion: Dopplerultrasonography showed good validity indices and a moderate correlation with CTA in the postoperative evaluation of patients undergoing endovascular treatment of AAAs.
OBJECTIVE: To evaluate the interobserver reproducibility of vascular indices obtained with three-dimensional power Doppler (3D power Doppler) ultrasonography at the first trimester of gestation. MATERIALS AND METHODS: The present reproducibility study involved 32 healthy pregnant women with 7 to 10 weeks and 6 days of gestation. The VOCAL (Virtual Organ Computer-aided AnaLysis) method was utilized to calculate embryos volume, with a 12° rotational angle. Subsequently, the software automatically displayed three 3D power Doppler vascular indices: vascularization index (VI), flow index (FI) and vascularization and flow index (VFI). In order to calculate the interobserver variability, an investigator performed a second blind measurement of the 32 embryos, and another investigator performed a third blind measurement of the same volumes. The interclass correlation coefficient (ICC) and Bland-Altman plots were utilized for statistical analysis. RESULTS: A good interobserver reproducibility was observed in relation to the three vascular indices. The VI presented ICC = 0.9 and mean difference between measurements = –1.1. For the FI, the ICC was 0.9 and mean difference = –0.5. The VFI presented ICC = 0.9 and mean difference = –1.1. CONCLUSION: The vascular indices, particularly the FI, obtained with 3D power Dopplerultrasonography at the first trimester of gestation demonstrated a high reproducibility.
PURPOSE: The aim of this longitudinal study was to investigate the value of uterine artery Doppler sonography during the second and third trimesters in the prediction of adverse pregnancy outcome in low-risk women. METHODS: From July 2011 to August 2012, a total of 205 singleton pregnant women presenting at our antenatal clinic were enrolled in this prospective study and were assessed for baseline demographic and obstetric data. They underwent ultrasound evaluation at the time of second and third trimesters, both included Doppler assessment of bilateral uterine arteries to determine the values of the pulsatility index (PI) and resistance index (RI) and presence of early diastolic notch. The endpoint of this study was assessing the sensitivity, speciicity, positive predictive value (PPV) and negative predictive value (NPV) of Dopplerultrasonography of the uterine artery, for the prediction of adverse pregnancy outcomes including preeclampsia, stillbirth, placental abruption and preterm labor. RESULTS: The mean age of cases was 26.4±5.11. The uterine artery PI and RI values for both second (PI: 1.1±0.42 versus 1.53±0.59, p=0.002; RI: 0.55±0.09 versus 0.72±0.13, p=0.000 respectively) and third-trimester (PI: 0.77±0.31 versus 1.09±0.46, p=0.000; RI: 0.46±0.10 versus 0.60±0.14, p=0.010 respectively) evaluations were signiicantly higher in patients with adverse pregnancy outcome than in normal women. Combination of PI and RI >95 th percentile and presence of
Objective: To evaluate the occurrence of reflux from the great saphenous vein by color Dopplerultrasonography in subjects undergoing treatment of insufficiency of the saphenofemoral junction by simple ligation or ligation with section of the saphenous arch. Methods Methods Methods Methods Methods: We performed 60 operations (in 45 subjects) of varicose insufficiency of the saphenofemoral junction (SFJ), belonging to the CEAP clinical classification of 2-5, who were randomly divided into two groups. A group called C, with ligature and section of the saphenous arch, and a group called L, with simple ligation of the saphenous vein and no sectioning of its arch. We then investigated the occurrence of reflux from the great saphenous vein in groups C and L through postoperative color Dopplerultrasonography at intervals of six months to one year. Results Results Results Results: Of the 60 limbs submitted to the approach of the saphenous arch, Results 57 were evaluated by postoperative doppler ultrasound, since two subjects (three limbs) did not return and were excluded from the study. The mean age was 54 years, with 93% females and predominance of CEAP classification 2 in 60.5%. Of the 57 operations for the treatment of reflux of the saphenous arch, 43.9% had reflux postoperatively,14.1% in group C and 29.8% in group L (p < 0,05). The relative risk of reflux of the saphenous arch in group L was 2.03 times higher compared with group C. Conclusion Conclusion Conclusion Conclusion Conclusion: the section of the arch of the great saphenous vein causes less postoperative reflux than simple ligation in treatment of insufficiency of the great saphenous vein.
An 83-year-old female patient with prior history of endovascular repair of an abdominal aortic aneurysm was admitted 15 days after onset of signiicant pain and edema in the left lower limb. Physical examination revealed edema with pitting involving the left knee and leg, discrete hyperemia and localized temperature increase, in addition to a pulsating mass in the popliteal area (Figure 1). Dopplerultrasonography of the lower limbs revealed a voluminous aneurysm of the popliteal artery and hematoma involving the popliteal fossa and the medial and anterior surfaces of the knee, with images compatible with a contained rupture causing compression of the popliteal vein. The patient had presented at a different service with the rupture around a week previously and had been treated for erysipelas; she had a high surgical risk and considerable cardiac arrhythmia, in addition to anemia (her hemoglobin level was 10). Surgery was performed via anterograde puncture of the common femoral artery and the aneurysm was accessed using a hydrophilic guide wire and multi-purpose catheter; the proximal zone was assessed and two Gore Viabahn covered stents were released and itted with the aid of an angioplasty balloon. During the endovascular surgical procedure it was possible to observe that the aneurysm had ruptured and that after repair it was completely excluded (Figures 2 and 3). The patient required one bag of concentrated red blood cells during the procedure. The patient’s signs and symptoms resolved completely after the procedure,
This was a prospective, cross-sectional study of a sample of 1,408 consecutive patients with complaints compatible with venous disease of the lower limbs. The age range of the sample was from 17 to 85 years, 1,286 of the patients were female and 122 were male. They were examined using color Dopplerultrasonography over a 6-month period. Data collected when taking patient histories and during physical examinations were recorded on a specially designed form.
The patient had images and the results of laboratory examinations: abdominal Dopplerultrasonography (13/6/ 2005): normal; abdominal computed tomography (9/2005): voluminous ascitis with pleural bilateral discharge, normal liver without any sign of portal hypertension, absence of peritoneal carcinomatosis or neoplasias; high digestive endoscopy (31/5/2005): normal and absence of esophageal varices; echocardiogram (26/1/05): slight concentric hypertrophy of the left ventricle, slight functional mitral valve insufficiency; echocardiogram (18/5/05): slight concentric hypertrophy of the right ventricle, slight functional mitral valve insufficiency, slight increase in the left atrium. The blood tests were negative for hepatitis B, hepatitis C, HIV, HTVL3, syphilis and chagas disease. Laboratory examinations (25/08/2005): Anti-DNA non- reagent; FAN non-reagent; Anti-smooth muscle Antibody INTRODUCTION
conducted in the San Diego area in 2003, assessed 2,211 participants with Dopplerultrasonography to determine whether they had functional disease and to correlate it with presence of visible venous changes, detecting an incidence of varicose veins equating to 23.3% of the sample. Additionally, the same study also observed that, when assessed with Dopplerultrasonography, 19% of the total sample had supericial functional disease. In the National Venous Screening Program, 28 23% of 2,234 people analyzed
Eighty-two male patients aged 52-86 years with lower urinary tract symptoms (LUTS) due to BPH were included in this study. Patients were randomly selected on the basis of their pre- sentation to the outpatient clinic of Benha Uni- versity Hospital, Egypt. Patients with prostati- tis, prostatic abscess, histologically confirmed prostate cancer, neurogenic bladder and bladder stones were excluded from the study. All patients were assessed by full history taking with spe- cial emphasis on International Prostate Symp- tom Score (IPSS). Physical examination included general examination, digital rectal examination (DRE), neurological examination especially bul- bocavernosus reflex (BCR), cremasteric reflex and anal reflex to screen for possible neurological in- sult. Uroflowmetry was done for all the patients at least twice. Urine analysis, routine laboratory tests and serum prostate specific antigen (PSA) were done for all patients. Imaging studies in- cluded plain X-ray KUB, abdomen and pelvic ultrasound to assess post-voided volume and to exclude other associated pathologies. Transrec- tal ultrasound (TRUS) of the prostate was done to estimate prostatic volume followed by power Dopplerultrasonography (PDUS) to identify the capsular arteries (Figure-1) and urethral arteries (Figure-2) of the prostate and to measure the RI in both right and left capsular arteries and ure- thral arteries. All sonographic examinations were done by the same radiologist.
Patients presented with clinical features of pain in scrotum, swelling of hemiscrotum, nausea vomiting, fever, urinary symptoms, abdominal pain and tender scrotum with erythema. Most common presentation was scrotal pain and scrotal swelling50 patients with age group <25 years were included in study. Scrotal pain was the most frequent presenting symptom of acute scrotum (98%) followed by Swelling of the hemiscrotum on the involved side present in 86% of the patients. Doppler ultrasound showed torsion of testis in 18 patients. On Scrotal exploration, torsion of spermatic cord was confirmed in 16 patients, one patient had torsion of appendix of testis and the other had Epididymo-orchitis. Thus the sensitivity and specificity of Dopplerultrasonography for testicular torsion was 86.9% and 92.6% respectively. 2 patients with equivocal Doppler findings, but strong clinical suspicion of testicular torsion were explored, and testis was found to be torsed in both two patients. Dopplerultrasonography showed Epididymo- orchitis in 22 patients, torsion of testicular appendage in 2 patients, Idiopathic scrotal edema in one, and in 5 pts no significant pathology found. All twenty patients of epididymo-orchitis, two patients of torsion of testicular appendage, and one patient of idiopathic scrotal edema were managed conservatively. At three weeks follow up, all the patients were free of symptoms. The sensitivity and specificity of Dopplerultrasonography for epididymo-orchitis was 95% and 100% respectively.
In spite of the unquestionable advan- tages of pressure gradient measurement, this method is invasive and not widely available because of its high cost and op- erator-dependence. Therefore, the chal- lenge of identifying a noninvasive marker for portal hypertension remains. Several authors have suggested that some param- eters of Dopplerultrasonography (DUS) might be of prognostic value, and may be useful in assessing the risk of esophageal varices bleeding. However, the technique is not often used for this purpose, and its clinical usefulness is under debate (9) .