Novel compression stockings for DVT prevention after joint replacement: a Doppler ultrasound follow-up study

Tumeurs glomiques sous-unguéales des doigts : diagnostic échographique

To assess the feasibility of emergency physicians' (EPs') performing color-flow Doppler ultrasonographic vascular studies in the ED to diagnose deep venous thrombosis (DVT), after a modest training program. A retrospective observational review was performed of the performance of color-flow Doppler ultrasonographic vascular studies by EPs. Prior to the study period, venous Doppler studies were not available at off-hours. Two attending EPs were trained by the hospital's vascular laboratory by observing studies and then performing 25-30 studies successfully. They were then available to examine all patients presenting to the ED at off-hours who were suspected of having DVT. Patients were admitted or released from the ED based on the examination results. All patients were to have formal vascular laboratory studies the next day. The study was performed at a university hospital ED and evaluated all patients who underwent off-hour examinations from January 1993 to February 1994. The examiners were aware of the clinical scenario. Of 23 eligible patients, 15 completed the protocol with a follow-up next-day study. Based on the follow-up study, the ED examination was 100% sensitive (7 true positives) and 75% specific (6 true negatives). The 2 false-positive studies were for patients with old DVT. The 8 patients without follow-up studies were not included in the analysis, although 4 of these patients had negative studies and unremarkable clinical outcomes. These preliminary findings suggest that Doppler ultrasonographic studies of the lower extremity veins by EPs can be used to make admission decisions when formal studies are not available. Confirmatory studies should be performed. EPs may overread acute thrombosis in the setting of old venous disease. Issues of cost and logistics remain to be resolved.

Introduction: There are significant chances of maturation failure in arteriovenous fistulas (AVFs) made for vascular access for hemodialysis. AVFs are usually assessed for maturation 6 weeks after the operation. Significant time is lost for performing a salvage radiological procedure or making an alternative AVF, in case the AVF fails to mature. Materials and Methods: This prospective observational study was conducted to predict the chances of maturation of AVF by Doppler ultrasound (USG) study. One hundred and thirty-seven patients in whom native AVF was made as a vascular access procedure for hemodialysis were included in the study. In five patients, palpable thrill was absent after 48 h of operation and were excluded from the study. The velocity of the blood, diameter of the vessel, and depth of the vessel from the skin were assessed by USG Doppler 3 weeks after the operation and were correlated with AVF maturation. Results: Successful maturation occurred in 114 (86.3%) AVF. The flow rate of the blood and depth of the vein were statistically different in successful and unsuccessful AVF maturation for both the groups of radial artery (RA) and brachial artery (BA) based AVF. For RA AVF, successful maturation was predicted by the flow rate of 539 mL/min (sensitivity 95% and specificity 83%) and 4.2 mm diameter of the vein (sensitivity 93% and specificity 100%). For BA AVF, successful maturation was predicted by the flow rate of 456 mL/min (sensitivity 93% and specificity 100%) and 5.7 mm diameter of the vein (sensitivity 77% and specificity 100%). The measurement of flow and depth at 3 weeks after AVF may predict the maturation of AVF. Conclusion: It will be beneficial to do a USG Doppler study 3 weeks after making AVF, as the measurement of flow may predict the maturation of AVF.

Interventional percutaneous trans-splenic approach in the management of portal venous occlusion after living donor liver transplantation

To determine whether measurements with transcranial Doppler ultrasonography (US) of resistive indexes (RIs) of basal cerebral arteries with pressure provocation can be used to identify infants and children with craniosynostosis who have abnormal intracranial compliance and to study the effects of surgery on compliance. Transcranial Doppler US was performed through the temporal squama, fontanels, and existing skull defects prior to and immediately following cranioplasty. Twenty-four studies were performed in six patients with multisuture synostosis, and 61 studies were performed in 26 patients with single-suture synostosis. Study findings were compared with those of 23 control subjects and were characterized as normal or abnormal on the basis of age-specific normal criteria for RI. In multisuture synostosis, results of six of the nine preoperative transcranial Doppler US studies were abnormal. During postoperative follow-up, three recurrences requiring reoperation occurred, one of which was detected with abnormal transcranial Doppler US findings. In single-suture synostosis, results of seven of the 26 preoperative transcranial Doppler US studies were abnormal, and all occurred in young infants with sagittal and unicoronal synostosis. Immediate effects of surgery were variable. All patients with sagittal synostosis had a significant immediate postoperative increase in RI, which normalized during postoperative follow-up. There was no significant difference in RI between patients with successfully treated craniosynostosis and control subjects. Transcranial Doppler US can be used to identify patients with craniosynostosis with decreased intracranial compliance, and it is a suitable noninvasive test to monitor the effects of surgery on compliance.

Ureteric jets were studied with conventional duplex Doppler (79 patients) and with color Doppler flow imaging (22 patients). Correlation with voiding cystourethrography (VCUG), performed ont he same day, was obtained in all patients. Thirty-six patients with normal VCUG results and normal renal and bladder ultrasound (US) studies served as the control group for 39 patients with vesicoureteric reflux (VUR) and 26 patients with urinary tract disorders other than reflux. The site of the ureteric orifice and duration, direction, and turbulence of the jets were recorded. Duration varied from 0.4 sec to 7.5 sec and depended largely on fluid intake. Duration varied in an individual patient by up to 2 sec from one jet to another. The direction of the normal jet was anteromedial and upward. Jets from refluxing ureters can appear normal. Severe renal parenchymal scarring reduced frequency and amplitude of the jets. Doppler analysis of the ureteric jet does not allow diagnosis or exclusion of VUR. Color Doppler was more sensitive in demonstrating ureteric jets than was gray-scale, real-time US and facilitated the study, but it was equally unable to help predict reflux.

Category: Midfoot/Forefoot Introduction/Purpose: Total joint replacement (TJR) and arthrodesis (A) are treatment options for severe osteoarthritis of the 1st metatarsophalangeal joint (MTP1). The aim of this study was to compare outcome (clinical and pedographic) of JTR (Roto-Glide, Implants International, Thornaby-On-Tees, UK) and A of MTP1. Methods: All patients that completed follow-up of at least 24 months after TJR and A of MTP1 before November 5, 2017 were included in the study. The data was extracted from a prospectively acquired database starting November 1, 2011 including all operatively treated patient at the authors´ institution. Exclusion criteria were bilateral treatment (n=24), additional procedures at other toes (n=34), A for revision of TJR (n=12), TJR exchange (n=5), and not completed minimum-24-month-follow-up (n=20). Preoperatively and at follow-up, radiographs and/or weight-bearing computed tomographies were obtained. Degenerative changes were classified in four degrees. Standard dynamic pedography was performed (percentage force at 1st metatarsal/1st toe from force of entire foot). Visual-Analogue-Scale Foot and Ankle (VAS FA) and MTP1 range of motion for dorsi-/plantarflexion (ROM) were registered. All parameters were compared between TJR and A and between preoperatively and follow-up. Results: From November 24, 2011 until October 31, 2015, 19 TJR and 38 A were performed. Parameters (average values if not stated otherwise) for TJR/A were preoperatively: mean age 59/60 years; 5(26%)/10(26%) male; height 167/166 cm; weight 73/74 kg; degree degenerative changes 3.3/3.1; ROM 10.3/0/18.8°//10.8/0/19.2°; percentage force 1st metatarsal/1st toe 7.8/14.5//8.4/15.2; VAS FA 45.5/44.9. Follow-up time on average 37.4/32.6 and range 25.3-71.3/24.1-67.1 months. VAS FA at follow-up was 71.7/69.4; percentage force 1st metatarsal/1st toe 15.6/5.5//16.5/10.5; ROM 35.4/0/20.5°//10.2/0/0. Parameters did not differ between TJR and A (each p>.05) except higher force percentage 1st toe and lower ROM for A at follow-up (each p<.05). VAS FA and pedography parameters improved for TJR and A between preoperatively and follow-up, ROM increased for TJR and decreased for A (each p<.05). Conclusion: TJR and A were performed in similar patient cohorts regarding demographic parameter, degree of degenerative changes, ROM, pathological pedographic pattern, and validated clinical scores (VAS FA). Both improved pathological pedographic pattern and VAS FA at minimum follow-up of 24 months. TJR additionally improved ROM and showed better pedographic pattern (and not different to physiological pattern) than A. TJR was similar to A except better ROM and better pedographic pattern. Survival rate of TJR was 100% up to 6 years. In this study, TJR was a valuable alternative to A for treatment of severe MTP1 osteoarthritis.

Computational methods to automate the initial interpretation of lower extremity arterial Doppler and duplex carotid ultrasound studies

Objective/Background: The objective of this study was to study the complications and failure rate after creating an arteriovenous fistula in patients suffering from end-stage renal disease (chronic renal failure). It was also intended to study the importance of preoperative Clinical assessment/physical examination of the patient; and if the vessels for anastomosis appeared to be of a doubtful size, then a doppler study was done to ensure that the vein is of adequate size for creation of a good fistula. Method: In this study 121 cases of end-stage renal disease (chronic renal failure) who needed vascular access for hemodialysis were taken. Ultrasound Doppler study was conducted in those patients whose vessels (for anastomosis) appeared to be of small size on Clinical examination. In the study, the arteriovenous fistulae were created under local anesthesia observing all aseptic precautions. Results: Most commonly, the difficulty encountered during surgery was when the caliber of the vein was small i.e. less than 2.5 mm. An arteriovenous fistula was created only when the size of the vein was at least 2.0 mm. When the size of the vein was small, then a longitudinal incision was given in the vein or Cheatlemanouvre was undertaken to perform the anastomosis. In 4 of the 121 cases when radiocephalic fistula was attempted, we had to convert to brachio-cephalic. No major complication was encountered during the surgery or post-operatively. Some patients (five) had redness and inflammation. Inflammation and redness subsided with antibiotics and it resulted in satisfactory recovery. The fistulas started well showing good thrill. After 30 days, 106 out of 121 AV fistulas created were functioning very well with a patency rate of 87.6%. Conclusion: There was no major complication after creating an arteriovenous fistula. It is important to do a thorough physical examination before surgery so that the vessel is assessed. In doubtful cases, an ultrasound doppler study should be done to know the size and patency of the vessel. We should also take relevant history especially of hypertension, diabetes, i/v canulation, etc.

SummaryA male Arabian foal born with a cervical mass and no apparent clinical signs presented with a cervical vertebral anomaly and ventricular septal defect. Both congenital anomalies were diagnosed at age 3 weeks and rechecked at age 6 months with radiographs and ultrasonographic studies respectively. At 11 months, in addition to radiographs and Doppler ultrasonographic studies, a contrast ultrasonographic study and post mortem myelographic and computed tomographic studies of the cervical vertebral column revealed the appearance of this rare cervical vertebral anomaly and the severity of the ventricular septal defect. To the authors' knowledge, in the Arabian foal, both conditions have not been reported simultaneously in the same patient.

Should results of ultrasound doppler studies be reported in units of frequency or velocity?

To assess the efficacy of Doppler ultrasonography (US) as a noninvasive method for monitoring patency of the transjugular intrahepatic portosystemic shunt (TIPS). Twenty-nine patients who had received TIPS for bleeding esophagogastric varices and/or refractory ascites with portal hypertension underwent Doppler US studies within 2 weeks after TIPS. Further studies were performed in 15 of them at 6 months, in 9 at 1 year, and in 4 at 2 years for a total of 57 US studies. The US findings were compared with the angiographic findings obtained at the same time. In 45 of the 57 studies, shunt patency was found by Doppler US, correlating to 44 patencies and one occlusion on angiography. Doppler signal in the shunt could not be detected in 12 studies resulting in the diagnosis of shunt occlusion. This correlated with angiographic occlusion in 8 studies and patency in the remaining 4. All angiographically patent shunts that were occluded by Doppler US had various degrees of stenosis. A number of technical factors were found to be responsible for Doppler US false-positive or false-negative diagnoses, some related to the type of stent used. The Doppler US sensitivity was therefore 92%, the specificity 89%. Doppler US is a reliable noninvasive method to evaluate patency of TIPS.

BackgroundThyroid nodules are frequently detected by cervical ultrasound examinations. In follow-up studies, malignant as well as benign nodules may exhibit an increase in size.The objective of our investigation was to test whether histologically determined malignant and benign thyroid nodules show differences in growth rates above a defined significance level.MethodsA retrospective ultrasound cohort follow-up study from 4 to 132 months included 26 patients with differentiated carcinomas and 26 patients with adenomas of the thyroid gland. Significance levels were determined by intra- and interobserver variations of volumetric measurements in 25 individuals.ResultsIntra- and interobserver volumetric measurements were highly correlated (r = 0.99 and r = 0.98, respectively), with variations of 28 and 40%, respectively. The growth rates of malignant and benign nodules did not show differences with respect to two sonographic measurements (d = − 0.04, 95%CI(P): 0.41–0.85, P = 0.83). Using shorter increments and multiple measurements, growth rates of malignant nodules revealed significantly higher values (d = 0.16, 95%CI(P): 0.02–0.04, P = 0.039).ConclusionsThe growth rates of benign and malignant thyroid nodules do not appear to differ using two sonographic volumetric measurements. However, due to temporal changes in cellular proliferation and arrest, malignant nodules may exhibit higher growth rates with multiple assessments and shorter increments.

Hemodialysis works as a lifeline for end stage renal disease patients. Creation and maintenance of vascular access for dialysis is the mammoth task. Due to increased references related to vascular access; number of complications are faced in pre as well as post operative period of vascular access creation. Ultrasound and color Doppler study play a major role in imaging throughout this period. Pre operative vascular mapping is very crucial to help surgeon to determine the proper site and surgical technique for vascular access creation. Early and delayed post operative complications can also be diagnosed with ultrasound and color Doppler study. Here we have tried to cover all the important points which a radiologist should consider during pre operative vascular mapping and post operative evaluation of vascular access as well as any associated complications.

Doppler ultrasound is a noninvasive modality for portal hemodynamic study. However, inter-observer variability has been observed. This study has investigated ways to produce less inter-observer variability. Doppler ultrasound portal vein hemodynamic studies were carried out by three well-trained specialists on 20 healthy hospital staff members. The intra-hepatic, first branch, right portal vein, the hilar portal vein, and the extra-hepatic portal vein were chosen for study. With respect to the diameter of portal veins, a significant inter-observer variability was found for the first branch right portal vein and the extra-hepatic portal vein, but not for the hilar portal vein. For maximal portal vein velocity studies, inter-observer variability was not found at any location. A significant failure rate was noted for the measurement of extra-hepatic portal vein velocity. Only 8 volunteers had complete data from all of the three investigators. A significant variability was also noted for the average velocity of extra-hepatic portal vein. We conclude that Doppler ultrasound hemodynamic studies of the hilar portal vein has the most acceptable inter-observer variability and thus should be used for longitudinal portal hemodynamic studies.