Absence Of Perfusion Research Articles

Ultrasound imaging of bowel obstruction in neonates.

Bowel obstruction (BO) in children has a wide differential diagnosis, ranging from non-urgent conditions to surgical emergencies. Abdominal radiographs are most often used as the first imaging modality for the evaluation of obstruction. However, for some indications, ultrasound can be the primary imaging modality. Therefore, it is incumbent on radiologists to recognize the types of bowel obstruction that can be recognized with US. Key sonographic features of BO include differential dilation of bowel loops, bowel wall thickening, and free fluid. "Do Not Miss" findings that indicate need for emergent treatment include volvulus, pneumoperitoneum, and/or signs of ischemia (bowel wall thinning and/or absent perfusion). The aim of this pictorial essay is to provide guidance on the sonographic technique and findings that enable identification of BO on US. Examples of neonatal BO on US, including common and less frequently encountered etiologies, are illustrated in this pictorial essay.

Real-time laser speckle contrast imaging measurement during normothermic machine perfusion in pretransplant kidney assessment.

Normothermic machine perfusion (NMP) provides a platform for pre-transplant kidney quality assessment that is essential for the use of marginal donor kidneys. Laser speckle contrast imaging (LSCI) presents distinct advantages as a real-time and noncontact imaging technique for measuring microcirculation. In this study, we aimed to assess the value of LSCI in visualizing renal cortical perfusion and investigate the additional value of dual-side LSCI measurements compared to single aspect measurement during NMP. Porcine kidneys were obtained from a slaughterhouse and then underwent NMP. LSCI was used to measure one-sided cortical perfusion in the first 100 min of NMP. Thereafter, the inferior renal artery branch was occluded to induce partial ischemia and LSCI measurements on both ventral and dorsal sides were performed. LSCI fluxes correlated linearly with the renal blood flow (R2 = 0.90, p < 0.001). After renal artery branch occlusion, absence of renal cortical perfusion could be visualized and semiquantified by LSCI. The overall ischemic area percentage of the ventral and dorsal sides was comparable (medianinterquartile range[IQR], 38 [24-43]% vs. 29 [17-46]%, p = 0.43), but heterogenous patterns between the two aspects were observed. There was a significant difference in oxygen consumption (mean ± standard deviation [SD], 2.57 ± 0.63 vs. 1.83 ± 0.49 mLO2 /min/100 g, p < 0.001), urine output (median [IQR], 1.3 [1.1-1.7] vs. 0.8 [0.6-1.3] mL/min, p < 0.05), lactate dehydrogenase (mean ± SD, 768 ± 370 vs. 905 ± 401 U/L, p < 0.05) and AST (mean ± SD, 352 ± 285 vs. 462 ± 383 U/L, p < 0.01) before and after renal artery occlusion, while no significant difference was found in creatinine clearance, fractional excretion of sodium, total sodium reabsorption and histological damage. LSCI fluxes correlated linearly with renal blood flow during NMP. Renal cortical microcirculation and absent perfusion can be visualized and semiquantified by LSCI. It provides a relative understanding of perfusion levels, allowing for a qualitative comparison between regions in the kidney. Dual-side LSCI measurements are of added value compared to single aspect measurement and renal function markers.

Morphometric characterization and temporal temperature measurements during hepatic microwave ablation in swine.

Heat-induced destruction of cancer cells via microwave ablation (MWA) is emerging as a viable treatment of primary and metastatic liver cancer. Prediction of the impacted zone where cell death occurs, especially in the presence of vasculature, is challenging but may be achieved via biophysical modeling. To advance and characterize thermal MWA for focal cancer treatment, an in vivo method and experimental dataset were created for assessment of biophysical models designed to dynamically predict ablation zone parameters, given the delivery device, power, location, and proximity to vessels. MWA zone size, shape, and temperature were characterized and monitored in the absence of perfusion in ex vivo liver and a tissue-mimicking thermochromic phantom (TMTCP) at two power settings. Temperature was monitored over time using implanted thermocouples with their locations defined by CT. TMTCPs were used to identify the location of the ablation zone relative to the probe. In 6 swine, contrast-enhanced CTs were additionally acquired to visualize vasculature and absence of perfusion along with corresponding post-mortem gross pathology. Bench studies demonstrated average ablation zone sizes of 4.13±1.56cm2 and 8.51±3.92cm2, solidity of 0.96±0.06 and 0.99±0.01, ablations centered 3.75cm and 3.5cm proximal to the probe tip, and temperatures of 50 ºC at 14.5±13.4s and 2.5±2.1s for 40W and 90W ablations, respectively. In vivo imaging showed average volumes of 9.8±4.8cm3 and 33.2±28.4cm3 and 3D solidity of 0.87±0.02 and 0.75±0.15, and gross pathology showed a hemorrhagic halo area of 3.1±1.2cm2 and 9.1±3.0cm2 for 40W and 90W ablations, respectfully. Temperatures reached 50ºC at 19.5±9.2s and 13.0±8.3s for 40W and 90W ablations, respectively. MWA results are challenging to predict and are more variable than manufacturer-provided and bench predictions due to vascular stasis, heat-induced tissue changes, and probe operating conditions. Accurate prediction of MWA zones and temperature in vivo requires comprehensive thermal validation sets.

The Importance of Manual Detorsion in Intravaginal Testicular Torsion

Abstract Objective The aim of the present prospective clinical study was to highlight the importance of the proper application of the manual detorsion (MD) in cases of intravaginal testicular torsion. Major complications such as ischemia, reperfusion injury and testicular compartment syndrome could be avoided. Materials and Methods From January 2017 to February 2018, 26 boys aged between 8 and 16 years underwent surgical treatment for intravaginal testicular torsion (ITT) (14 left- and 12 right-sided). Diagnosis was made upon clinical criteria (both symptoms and signs); sudden onset of scrotal pain (n = 26, 100%), nausea and vomiting (n = 25, 96,15%), abdominal pain (n = 3, 11,53%), high testicular position (n = 21, 80,77%), absence of the cremasteric reflex (n = 26, 100%), harshness of the twisted testicle (TT) (n = 24, 87.5%), alteration on axis or orientation of the TT (n = 24, 94,31%), and pain during palpation (n = 26, 100%). Two cases presented with neglected scrotum leading to inability to evaluate the intrascrotal structures. Major ultrasonographic findings were the following: absence of perfusion, heterogeneity of the parenchyma and identification of the Whirlpool sign. Therefore, our study group consisted of 15 out of the 26 cases, in which the initial assessment at the Emergency Department occurred within the first 3-7 hours after the onset of ITT. Results Based on high clinical suspicion and ultrasonographic documentation of the ITT, MD was performed in all those cases. Pain alleviation followed immediately, while significant improvement of the clinical picture of the suffering scrotum was also observed. Successful detorsion was documented via ultrasonography. After completion of the preoperative assessment, bilateral orchidopexy was performed. All patients had an uneventful postoperative course and were discharged home on the second postoperative day. Conclusion In conclusion, we hereby document that MD is a safe, non-invasive method, easy to learn for every clinician. It can be applied immediately after the diagnosis of the ITT, converting a highly urgent surgery into an elective one. Of course, surgical exploration of intrascrotal structures constitutes a crucial final step.

NEONATAL THROMBOSIS ASSOCIATED WITH FETAL VASCULAR MALPERFUSION: A CASE REPORT

Background: Fetal vascular malperfusion refers to placental lesions indicating reduced or absent perfusion of the villous parenchyma by the fetus. Fetal vascular malperfusion remains an underrecognized condition that is associated with adverse perinatal outcomes. It may also predispose infants to thromboembolic events. There are few cases described of inferior vena cava and renal vein thrombosis in an asymptomatic newborn. Case presentation: We report the case of an asymptomatic female neonate delivered at 32 weeks of gestation to a mother with type 1 diabetes and preeclampsia. Prenatal diagnosis of renal vein and inferior vena cava thrombosis was made at 30 weeks. Thrombophilia work-up was negative. Diagnosis was guided by the placental pathological examination that showed thrombosis of several fetal vessels of the chorionic plate, high-grade poor perfusion lesions and distal villous hypoplasia, suggestive of Fetal vascular malperfusion. Treatment with low-molecular-weight heparin was effective in the complete resolution of the thrombus and preservation of renal function. Conclusion: This case emphasizes the importance of placental pathological examination in the presence of fetal abnormalities. Fetal vascular malperfusion may cause unrecognized neonatal thrombosis, which may result in growth impairment or organic dysfunction. Pregnant women with known risk factors for Fetal vascular malperfusion should be monitored more closely, both antenatally and postnatally, to detect possible placental and fetal target organ involvement at an early stage.

Abstract 14050: A Giant Free-Floating Ball Thrombus or a Tiny Fibroelastoma: Which Causes Multiple Strokes?

Background: Left atrial (LA) thrombus is not rare in patients with mitral valve stenosis, but in patients with nonvalvular atrial fibrillation on anticoagulation, the formation of a "ball thrombus" in the LA is uncommon. Case: A 73-year-old man with nonvalvular atrial fibrillation on eliquis presented with frequent syncope and slurred speech. .The appearance of the infarcts on brain MRI and involvement of different vascular territories suggests embolic phenomena as the cause. On transthoracic echo a large, highly mobile echo density in the left atrium was noted. Transesophageal echo revealed smoke in the left atrium and the left atrial appendage. A large round mobile echo density mass measuring 4.7 cm X 3.6 cm was seen in left atrium with no attachment to left atrium. A mobile round density measuring 0.7x0.7 cm was seen on the right coronary cusp. Absence of perfusion, no enhancement, and high signal intensity on T1 and T2 weighted images on cardiac MRI was suggestive organized clot in left atrium. Decision-making: Both masses were removed successfully. Pathology confirmed a large intact spherical organized clot from the LA and a small fibroelastoma attached to the aortic leaflet. Conclusion: This was a rare case of giant round-shaped left atrium thrombus, which occurred in a patient with nonvalvular atrial fibrillation on anticoagulation. An aortic fibroelastoma was also discovered by transesophegeal echo as another potential cause of stroke. The left atrial thrombus is thought to have developed from a small mural thrombus caused by prolonged blood stagnation, which gets rounded by the sculpting impact of multiple complex encounters with the atrial wall. This may then detach from the LAA and form a floating "ball thrombus.

Outcomes in pediatric patients with documented delays between ileocolic intussusception diagnosis and therapeutic enema attempt: evaluation of reduction efficacy and complication rate.

Ileocolic intussusception is considered a pediatric emergency, with concerns for risk of significant morbidity in children with a prolonged intussusception state. Emergent therapy is standard of care, as prior studies have shown poor outcomes in patients with long delays (> 24h) before intervention. Various factors can result in shorter delays, and there are limited studies evaluating outcomes in these patients. This study aimed to determine if there were differences in reduction success rates associated with short in-hospital time delays. This study is to determine enema success rate and morbidity in patients with documented time delays between intussusception diagnosis and therapeutic enema. A retrospective evaluation of pediatric patients with intussusception at a single children's hospital between 2007 and 2019 was performed. Patient's records were reviewed for time of symptom onset, radiologic diagnosis, and attempted enema. Ultrasounds and radiographs were reviewed for bowel obstruction, free peritoneal fluid, trapped fluid around the intussusceptum, and absent bowel wall perfusion. Patients were evaluated for efficacy of reduction attempt, requirement for surgical reduction, and complications including bowel resection and bowel perforation. There were 175 cases of ileocolic intussusception requiring enema reduction. Successful reduction occurred in 72.2% (13/18) of cases performed within 1h of diagnosis; 74.3% (78/105) between 1 and3 h; 73.2% (30/41) between 3 and 6h; and 81.2% (9/11) with greater than 6h. Need for bowel resection was not associated with short delays between diagnosis and reduction attempts (p = .07). There was no difference in intussusception reduction efficacy or complication rate in patients with increasing time between imaging diagnosis of ileocolic intussusception and reduction attempt, including delay intervals up to 8h.

Thrombolysis as a treatment for transplant renal artery thrombosis - a report of three unsuccessful cases and an overview of reported cases.

Thrombolysis has been suggested as a feasible method to treat arterial renal transplant thrombosis under conditions of short duration of ischemia. Data on maximal duration of ischemia that are still feasible to treat are scarce. We retrospectively analysed our experience involving three attempts to utilize thrombolysis to treat transplant renal artery thrombosis. We searched through literature on PubMed and compared the data we found with our own experience. In case number 1 of our cohort, thrombolysis was initiated 12 hours after the onset of thrombosis and had to be ceased after five hours due to the formation of a haematoma. Perfusion of the graft was restored but it did not regain function, most likely due to long ischemia time. In case number 2, an attempt to use thrombolysis was unsuccessful due to failure to cross the graft artery occlusion with a guidewire. Thrombosis was most likely caused by chronic rejection of the graft. In case number 3, thrombolysis restored arterial patency but, due to an onset of ischemia, which lasted 2 to 3 days, did not lead to restoration of graft function. The prolonged ischemia period in case three occurred, at least in part, due to failure to perform an ultrasound scan when the patient was first admitted. We can confirm that thrombolysis for transplant renal artery thrombosis seems to be feasible only when the condition has a short duration. In the event of sudden deterioration of graft function, the absence of perfusion must always be ruled out by ultrasound scan.

Intraoperative monitoring of femoral head perfusion in adult femoral neck fractures.

Objectives:To validate a novel intraoperative method of quantifying femoral head perfusion in adult patients with femoral neck fractures and to determine whether the lack of a perfusion waveform correlates with the development of osteonecrosis, nonunion, or reoperation.Design:Prospective cohort.Setting:Level 1 trauma center.Patients/Participants:Nineteen patients with 20 acute femoral neck fractures treated with hip-preserving surgical fixation. All patients underwent intraoperative quantification of femoral head perfusion.Intervention:Intraoperative quantification of femoral head perfusion pressure and waveform utilizing an intracranial pressure monitor.Main outcome measurements:Radiographic union, avascular necrosis, revision surgery.Results:Nineteen patients (8 male, 11 female, average age 56 ± 21 years) with 20 femoral neck fractures were enrolled. Eight fractures were stable (Garden 1-2/OTA B1.1–1.3) and 12 were unstable (Garden 3-4/OTAB2.1–3.3). A waveform was present in 12 of 20 cases. The average pressures were systolic 36.8 mm Hg, diastolic 30.8 mm Hg, pulse pressure 6.0 mm Hg. A perfusion waveform was significantly associated with advanced age (P = 0.02) and accompanied by trend toward stable fracture patterns. There were 4 deaths during the 1-year follow-up period (20%), and there were 5 conversions to total hip arthroplasty (25%). There was no significant association between revision surgery or death with the absence of a waveform.Conclusions:Our study demonstrated the feasibility of a relatively low cost, minimally invasive, technique to quantify femoral head perfusion. In our limited sample, the absence of perfusion did not correlate with our main outcomes; however, the trend toward correlation with increased fracture displacement was as expected. A larger cohort of patients will be needed to detect a significant difference between those with and without a perfusion waveform with regards to our primary outcomes. Further study is needed to delineate the role such data may play in medical decision making at the time of index surgery.Level of Evidence:Prognostic Level II.

Abstract 14990: Pulmonary Vein Stenosis After Epicardial Atrial Fibrillation Ablation and Epicardial Left Atrial Appendage Occlusion: A Diagnostic Dilemma and Challenges in Management

Background: Pulmonary vein stenosis is a dreaded complication of endocardial atrial fibrillation (AF) ablation but rare after epicardial ablation and has not been reported after epicardial left atrial appendage occlusion (LAAO). Case: A 55-year-old male was referred to our tertiary hospital for management of left superior pulmonary vein (LSPV) stenosis causing dyspnea on exertion. About 2 years prior to presentation, he underwent quadruple coronary artery bypass grafting for non-ST elevation myocardial infarction along with modified Cox-Maze procedure with pulmonary vein and posterior wall isolation as well as epicardial LAAO with AtriClip for history of paroxysmal AF. At our institute, V/Q scan showed ventilation-perfusion mismatch and absent perfusion of the left upper lobe (Figure 1A). Cardiac CT showed persistent LSPV occlusion (Figure 1B). TEE showed atrial appendage occluded with a clip and no flow was observed from LSPV (Figure 1C). After multidisciplinary discussion between cardiology and cardiothoracic surgery teams, surgical approach to remove the AtriClip was deemed futile as it was placed 2 years ago and less likely to result in resolution of stenosis. Thus, an endovascular approach was attempted with left atrial and pulmonary vein angiography showing LSPV to be 100% occluded (Figure 1D). Pulmonary vein recanalization was attempted but was not successful. Conclusion: Our case highlights the importance of recognition of PVS as a possible complication after epicardial LAAO as early intervention can improve patient outcomes. PVS has been previously described with Maze procedure but that patient was successfully treated with catheter-balloon angioplasty. Given 100% occlusion and difficulty with recanalization makes epicardial ablation a less likely cause of occlusion in our case. More careful application of Atriclip protocols might be necessary to prevent this potential complication.

Manifestations of cold sensitivity – a case series

ABSTRACT Objectives: To characterise cold sensitivity using a semi-structured interview, physical examination, thermal quantitative sensory testing (QST), and laser speckle contrast analysis (LASCA). Methods: Eight women and four men, ages 22–74, with cold sensitivity were interviewed and examined by an occupational physician. Thermal perception thresholds were established using QST, on the pulp of the index and little finger of the most affected hand. Skin perfusion in the dorsum of the hand was measured using LASCA, at baseline, after two-minute 12°C water immersion, and during rewarming. Results: The physical examination yielded few findings indicative of vascular or neurosensory pathology. One subject (8%) had impaired thermal perception thresholds. LASCA at baseline showed absent proximal-distal perfusion gradients in six subjects (50%), and a dyshomogeneous perfusion pattern in five (42%). Perfusion on a group level was virtually unchanged by cold stress testing (median 52.5 PU; IQR 9.0 before versus 51.3 PU; IQR 27.2 afterwards). Conclusions: Physical examination and thermal QST offered little aid in diagnosing cold sensitivity, which challenges the neurosensory pathophysiological hypothesis. LASCA indicated disturbances in microvascular regulation and could prove a useful tool in future studies on cold sensitivity.

Portable gamma-camera for the diagnosis of brain death diagnosis

ObjectiveTo evaluate the feasibility of using the Sentinella® portable gamma-camera for the diagnosis of brain death (BD). DesignA prospective, observational feasibility study was carried out. SettingIntensive Care Unit of a third level hospital. PatientsConsecutive recording was made of the adults diagnosed with brain death based on clinical criteria following admission to the Intensive Care Unit in the period from January to December 2017. InterventionsThe procedure was performed at the patient bedside with the intravenous administration of technetium 99 metastable hexamethylpropylene amine oxime. The absence of perfusion in the cerebral hemispheres and brainstem was described as a pattern consistent with BD. The diagnosis was correlated to the transcranial Doppler and/or electroencephalographic findings. ResultsA total of 66.1% of the patients were men with an average age of 60 years [IQR: 51–72]. The most frequent causes resulting in BD were hemorrhagic stroke (48.2%, n=27), followed by traumatic brain injury (30.4%, n=17), ischemic stroke (10.7%, n=6) and post-cardiac arrest anoxic encephalopathy (7.1%, n=4). A clinical diagnosis of BD was made in all cases, and the portable gamma-camera confirmed the diagnosis in 100% of the patients with a pattern characterized by the absence of brain perfusion. In addition, the results were compared with the transcranial Doppler findings in 46 patients, confirming the presence of diastolic reverberation and/or systolic peaks. The electroencephalographic tracing was obtained in 10 cases, with the appearance of electrical silence, due to the absence of an acoustic window in the transcranial Doppler study. ConclusionsA portable gamma-camera could be a useful and feasible tool for the diagnosis of BD.

Clinical validation of a novel thermophysical bladder model designed to improve the accuracy of hyperthermia treatment planning in the pelvic region

Purpose: Hyperthermia treatment planning for deep locoregional hyperthermia treatment may assist in phase and amplitude steering to optimize the temperature distribution. This study aims to incorporate a physically correct description of bladder properties in treatment planning, notably the presence of convection and absence of perfusion within the bladder lumen, and to assess accuracy and clinical implications for non muscle invasive bladder cancer patients treated with locoregional hyperthermia.Methods: We implemented a convective thermophysical fluid model based on the Boussinesq approximation to the Navier–Stokes equations using the (finite element) OpenFOAM toolkit. A clinician delineated the bladder on CT scans obtained from 14 bladder cancer patients. We performed (1) conventional treatment planning with a perfused muscle-like solid bladder, (2) with bladder content properties without and (3) with flow dynamics. Finally, we compared temperature distributions predicted by the three models with temperature measurements obtained during treatment.Results: Much higher and more uniform bladder temperatures are predicted with physically accurate fluid modeling compared to previously employed muscle-like models. The differences reflect the homogenizing effect of convection, and the absence of perfusion. Median steady state temperatures simulated with the novel convective model (3) deviated on average −0.6 °C (−12%) from values measured during treatment, compared to −3.7 °C (−71%) and +1.5 °C (+29%) deviation for the muscle-like (1) and static (2) models, respectively. The Grashof number was 3.2 ± 1.5 × 105 (mean ± SD).Conclusions: Incorporating fluid modeling in hyperthermia treatment planning yields significantly improved predictions of the temperature distribution in the bladder lumen during hyperthermia treatment.

Swyer-James-MacLeod Syndrome: A case report in an adult and review of the literature

Swyer-James-MacLeod Syndrome (SJMS) is a rare, unilateral lung disease represented by radiographic translucency of the lung parenchyma secondary to the diminution of the pulmonary vasculature and to the overdistention of the alveoli. It is an uncommon sequela of post-infectious bronchiolitis obliterans (BO) in childhood. Patients with SJMS are often diagnosed in childhood and typically present with recurrent respiratory tract infections. Symptoms during childhood can be mild or absent, leading to a delayed diagnosis in adulthood. SJMS is characterized by the destruction of the small bronchioles and agenesis or hypoplasia of the pulmonary arteries leading to hypoperfusion of the pulmonary parenchyma, resulting in characteristic chest imaging findings of unilateral hyperlucency or translucence.Swyer and James first described this syndrome in 1953. It is a rare disease that can be can be caused by an infection with adenoviruses (types 3, 7, or 21) or Bordetella pertussis, a foreign body in the airway and hydrocarbon inhalation. We present a case of SJMS in whom the adult patient had been misdiagnosed with chronic obstructive pulmonary disease (COPD). She was eventually diagnosed with SJMS based on chest x-ray and chest CT findings of unilateral lung hyperlucency, as well as with scintigraphic findings showing virtually absent perfusion to the left lower lobe of the lung.

Portable gamma-camera for the diagnosis of brain death diagnosis.

To evaluate the feasibility of using the Sentinella® portable gamma-camera for the diagnosis of brain death (BD). A prospective, observational feasibility study was carried out. Intensive Care Unit of a third level hospital. Consecutive recording was made of the adults diagnosed with brain death based on clinical criteria following admission to the Intensive Care Unit in the period from January to December 2017. The procedure was performed at the patient bedside with the intravenous administration of technetium 99 metastable hexamethylpropylene amine oxime. The absence of perfusion in the cerebral hemispheres and brainstem was described as a pattern consistent with BD. The diagnosis was correlated to the transcranial Doppler and / or electroencephalographic findings. A total of 66.1% of the patients were men with an average age of 60 years [IQR: 51-72]. The most frequent causes resulting in BD were hemorrhagic stroke (48.2%, n=27), followed by traumatic brain injury (30.4%, n=17), ischemic stroke (10.7%, n=6) and post-cardiac arrest anoxic encephalopathy (7.1%, n=4). A clinical diagnosis of BD was made in all cases, and the portable gamma-camera confirmed the diagnosis in 100% of the patients with a pattern characterized by the absence of brain perfusion. In addition, the results were compared with the transcranial Doppler findings in 46 patients, confirming the presence of diastolic reverberation and / or systolic peaks. The electroencephalographic tracing was obtained in 10 cases, with the appearance of electrical silence, due to the absence of an acoustic window in the transcranial Doppler study. A portable gamma-camera could be a useful and feasible tool for the diagnosis of BD.

Fibrosing Mediastinitis: a Rare Cause of Unilateral Absent Lung Perfusion on a V/Q Scan.

We report a case of a 29-year-old female with a history of asthma, post-partum ARDS, and pulmonary hypertension who presents with severe shortness of breath. The patient describes her shortness of breath as progressive over the past 10years. Chest radiography and CT angiography of the thorax showed findings consistent with fibrosing mediastinitis with severe stenosis of the left main pulmonary artery. This resulted in appearance of unilateral absent left lung perfusion on quantitative Tc-99-MAA perfusion and Xe-133 ventilation (V/Q) scan.

Role of Abdominal Ultrasonography in the assessment of Neonatal Necrotising Enterocolitis

Aim of workTo evaluate the role of ultrasound and color Doppler in diagnoses and predicting the outcome of necrotising enterocolitis patients at neonatal ICU. Subjects and methodsThirty neonates clinically diagnosed with NEC were examined, 51 ultrasound examinations were done including color Doppler sonography and findings were compared with laboratory data, clinical picture, staging, abdominal radiography and patient's outcome. ResultsBloody stools and abdominal discoloration correlated with highest risk, low PH and neutropenia and increased DAAS score matched poor outcome. echoegnic free fluid, thin bowel wall, absent wall perfusion, aprestalsis, dilated anechoic bowel, increased bowel perfusion and pneumatoses intestinalis matched adverse outcome. sonographic signs of pneumatoses intestinalis interrelated with radiographic signs. ConclusionUS was found to be highly sensitive and specific in diagnosing, staging and predicting the outcome of NEC patients, based on group of findings that were categorized per their risk ratio and correlated with outcome.

Fetal vascular malperfusion, an update.

Fetal vascular malperfusion is the most recent term applied to a group of placental lesions indicating reduced or absent perfusion of the villous parenchyma by the fetus. The most common etiology of malperfusion is umbilical cord obstruction leading to stasis, ischemia, and in some cases thrombosis. Other contributing factors may include maternal diabetes, fetal cardiac insufficiency or hyperviscosity, and inherited or acquired thrombophilias. Severe or high grade fetal vascular malperfusion is an important risk factor for adverse pregnancy outcomes including fetal growth restriction, fetal CNS injury, and stillbirth. Overall recurrence risk for subsequent pregnancies is low.

A new model of experimental hemispherotomy in young adult Rattus norvegicus: a neural tract tracing and SPECT in vivo study.

The objective of this study was to describe a new experimental model of hemispherotomy performed on laboratory animals. Twenty-six male young adult Wistar rats were distributed into two groups (surgery and control). The nonfluorescent anterograde neurotracer biotinylated dextran amine (BDA; 10,000 MW) was microinjected into the motor cortex area (M1) according to The Rat Brain in Stereotaxic Coordinates atlas to identify pathways and fibers disconnected after the experimental hemispherectomy. SPECT tomographic images of 99mTc hexamethylpropyleneamine oxime were obtained to verify perfusion in functioning areas of the disconnected and intact brain. A reproducible and validated surgical procedure is described in detail, including exact measurements and anatomical relationships. An additional 30 rodents (n = 10 rats per group) were divided into naïve, sham, and hemispherotomy groups and underwent the rotarod test. Cortico-cortical neural pathways were identified crossing the midline and contacting neuronal perikarya in the contralateral brain hemisphere in controls, but not in animals undergoing hemispherotomy. There was an absence of perfusion in the left side of the brain of the animals undergoing hemispherotomy. Motor performance was significantly affected by brain injuries, increasing the number of attempts to maintain balance on the moving cylinder in the rotarod test at 10 and 30 days after the hemispherotomy, with a tendency to minimize the motor performance deficit over time. The present findings show that the technique reproduced neural disconnection with minimal resection of brain parenchyma in young adult rats, thereby duplicating the hemispherotomy procedures in human patients.

CEUS – Anwendung am Hoden

The work-up of scrotal diseases forms an essential part of dailywork in urology. Sonography plays an important role in the diagnostic process, due to its wide availability and feasibility. Advantages of modern contrast-enhanced ultrasound (CEUS) are illustrated using examples of common testicular pathologies. Relevant studies regarding the application of CEUS on testicular pathologies are evaluated. PubMed and Medline were screened for reviews and clinical trials. In the differentiation of benign and malignant testicular lesions, contrast medium uptake, e. g. can exclude ahemorrhagic testicular cyst. Adifferentiation between benign and malignant testicular lesions due to pure enhancement is currently not possible. Evaluation of testicular abscesses, infarctions and infections depends on the assessment of vascularization. Following ascrotal trauma, evaluation of enhancement can distinguish between vital and non-vital areas. Acomplete absence of perfusion may support the diagnosis of testicular torsion. CEUS is afeasible instrument in the diagnostic work-up of testicular pathologies. Results from previous studies are promising. Regarding the application in cases of scrotal trauma, the method could play an essential role in the future. With regard to aclassification of unclear testicular lesions, further studies with alarger number of patients are needed in order to confirm previously described perfusion patterns.