Color Doppler Study Research Articles

Serial Assessment of Hemodynamic and Cerebrovascular Changes After Administration of Mannitol in Postoperative Neurosurgical Patients in the Intensive Care Unit: A Combined Transthoracic and Transcranial Color Doppler Study.

Mannitol is widely used in neurosurgical units to mitigate raised intracranial pressure and cerebral edema, crucial in postoperative management. Its hyperosmolar properties reduce brain extracellular fluid, thereby altering cerebral perfusion and cardiac dynamics. However, the temporal and combined effects of mannitol on cardiovascular and cerebrovascular parameters remain inadequately explored in postoperative settings. This prospective observational study enrolled 20 adult patients who underwent elective craniotomies for tumor excision. Mannitol was administered to the patients at a dose of 0.5 mg/kg/dose as a bolus dose over 20 to 30 minutes. The time interval was eight hours between the doses (scheduled dosing). Patients received their first dose of mannitol in the ICU after eight hours of intraoperative dose. The patients were given mannitol for two postoperative days and followed up for two days in the postoperative period. Transthoracic echocardiography and transcranial color Doppler were used to assess cardiovascular and cerebrovascular parameters at multiple intervals post-mannitol administration. Significant increases in mean flow velocities were observed bilaterally immediately post-mannitol administration on the first postoperative day, indicative of improved cerebral blood flow. However, these changes were transient, with no significant variations noted on the second postoperative day. Cerebrovascular resistance, as measured by the pulsatility index, showed non-significant changes bilaterally across both days. Cardiovascular parameters, including stroke volume and cardiac output, remained stable throughout the study period. Mannitol administration at 0.5 g/kg in postoperative neurosurgical patients transiently improves cerebral perfusion without causing significant hemodynamic instability. This study underscores the importance of monitoring both cerebrovascular and cardiovascular parameters post-mannitol administration to optimize patient management and outcomes.

Study the carotid Doppler and computed tomography of head in ischemic stroke patients

Background: A stroke is an episode of acute neurological dysfunction from either ischemic infarction or a collection of blood within the brain or ventricular system with resultant focal injury of the central nervous system. The estimated global incidence of stroke is 2–3/1000 person-years, with older patients and patients with carotid artery stenosis or atrial fibrillation having the highest risk. Hence, carotid studies may help with early prevention and management in patients. Aims and Objectives: We aimed to study the prevalence of carotid artery stenosis in acute ischemic stroke and the association of risk factors. Materials and Methods: This was a descriptive study conducted in the department of internal medicine over a period of 6 months. It was carried out in 125 ischemic stroke patients’ inpatient departments. The ischemic stroke was established with history, examination, and computed tomography (CT) with carotid color Doppler study for percentage of stenosis. Results: The 47 (37.6%) stroke patients had carotid stenosis <50% and 78 (62.4%) had >50%; out of them, 32% (40) had (≥50–69%) stenosis, 24% (30) exhibited 70–99%, and 6.4% (8) reported total occlusion. In the CT brain, lacunar infarcts were found in 42 (33.6%), normal and middle cerebral artery infarcts in 27 (21.6%), anterior cerebral artery infarcts in 17 (13.6%), and posterior cerebral artery infarcts in 12 (9.6%). In clinical profiles, 75 (60%) patients presented with right-sided hemiparesis, 50 (40%) with left-sided hemiparesis, 62 (49.6%) with loss of consciousness, 28 (22.4%) with dizziness, and 31 (24.8%) with motor aphasia. Conventional risk factors include hypertension in 68 (54.4%), diabetes in 39 (31.2%), dyslipidemia in 58 (46.4%), heart disease in 65 (52%), and smoking in 51 (40.8%). In the present study, the majority of patients found carotid stenosis >50%, lacunar infarcts were the most common CT findings, and right hemiparesis was common paresis. Hypertension was the most common risk factor among others, and all were significant (P<0.05) for the stroke. Conclusion: There is a high prevalence of carotid stenosis, with >50% in ischemic stroke patients with hypertension being the most common risk factor.

Abdominal Ultrasonography and Splenoportal Doppler Study for Predicting Oesophageal Varices in Patients Admitted with Chronic Liver Disease at a Tertiary Medical Hospital in Kolkata, India: A Cross-sectional Study

Introduction: Upper Gastrointestinal Endoscopy is considered the best screening tool for varices among patients with chronic liver disease. However, it is an expensive and invasive procedure that is not routinely available in rural India. Abdominal ultrasonography along with colour Doppler study is an inexpensive test commonly ordered for patients with chronic liver disease. Recent literature suggests that ultrasonographic parameters can be used to predict varices. Aim: To determine if ultrasonography of the entire abdomen and spleno-portal Doppler study findings can predict oesophageal varices in patients with chronic liver disease. Materials and Methods: The present hospital-based observational, cross-sectional study was conducted in the indoor ward of the Department of General Medicine at Medical College and Hospital, Kolkata, India, over a duration of one year from February 2021 to February 2022. Total 100 patients with chronic liver disease, admitted to the hospital ward, were included in the study. Child-Turcotte-Pugh (CTP) scores were obtained for all patients. Ultrasonographic and spleno-portal Doppler indices, such as liver size, spleen size, portal vein diameter, splenic vein diameter, peak systolic velocity of the portal vein, and portal vein/splenic vein diameter ratio, were measured alongside upper gastrointestinal endoscopy to detect varices. The data were analysed using Statistical Package for Social Sciences (SPSS) version 28.0. The Chi-square test was used to test for significant differences in proportions (categorical data), and the independent t-test and Analysis of Variance (ANOVA) with Tukey’s Post-hoc test were employed to test for significant differences in means (continuous data). Additionally, Receiver Operating Characteristic (ROC) curves were obtained for statistically significant parameters to predict the presence of varices. Results: The study enrolled 100 patients (63% males, 37% females) with a mean age of 49.19±14.965 years, ranging from 14 to 91 years. (median age of 52, range 14-91 years). Of these, 68 patients (68%) had oesophageal varices, while 32 (32%) did not. The study found that a mean spleen size of 13.55 cm, a mean portal vein diameter of 12.5 mm, and a mean splenic vein diameter of ≥9.05 mm were predictive of varices. Additionally, a mean portal vein/splenic vein diameter ratio of 1.6150 was also predictive of varices. However, there was no significant difference in mean liver size and peak systolic velocity between those with and without varices. Conclusion: The present study suggests that a spleen size, portal vein diameter, splenic vein diameter, and portal vein/splenic vein diameter ratio can be reliably used to predict oesophageal varices among patients with chronic liver disease.

Long-term Outcome of Laparoscopic Surgery for Nonpalpable Undescended Testis.

The aim of this study was to objectively assess the long-term results of laparoscopic orchidopexy in patients who were diagnosed clinically to have nonpalpable undescended testis (UDT). All operated cases of nonpalpable UDT from January, 2000, to January, 2014, were reviewed. After informed consent, all patients were subjected to a color Doppler ultrasound examination to assess the location of the testis, its size, blood supply, and consistency. The size of the testis, operated and nonoperated, was noted down in volume using the formula of 0.71 × length × breath × height. A total of 114 patients could be identified, who had undergone laparoscopy for nonpalpable UDT in the study period. Of these, 44 patients (54 units) underwent a color Doppler study to assess the testes. All the testes were found to lie in the scrotum with preserved blood supply. The volume of the operated unilateral testes (mean = 1.605 cm3) was smaller than the normal nonoperated side (mean = 2.524 cm3). The smaller testicular volume was observed in spite of maintained blood supply to the testes. In cases of bilateral UDT, both the testes were smaller in size (mean = 2.2 cm3), but were comparable to each other. In addition, the ultrasound examination revealed the presence of normal homogenous parenchyma of all the testes similar to the nonoperated side. Laparoscopic orchidopexy is a safe and effective option in the treatment of nonpalpable UDT. On a long-term basis, it is possible to achieve scrotal position along with preserved blood flow following laparoscopic orchidopexy in all patients suffering from nonpalpable UDT.

Buerger's Disease of Hand; my Experience with Phenol Chemical Neurolysis of Stellate Ganglion: Case Series of Six Patients.

Buerger's disease is common in 74.70% of cases in the lower limb but in 20.20% of cases, it is found in the upper limb or hand. The disease usually starts from pain in the finger/thumb or hand and then to more centrally.Patients presented with pain in the hand with gangrene of fingers. Pain aggravated on lifting hand above the shoulder level or above heart level in upright or lying in the bed, respectively. In almost all patients, there was a history of smoking except one and all patients had involvement of digits of the right or left hand. Diagnosis of Buerger's disease was made based on the history of smoking, weak or absent pulse, lack of bleeding, swelling, edema, blackening, stony hard fingers or thumb on clinical examination, and color Doppler study of the limb.In all patients, Stellate ganglion chemical neurolysis with 8% phenol was done at C7-T1 under fluoroscopic and radiocontrast dye (Iohexol 300) guidance.After successful neurolysis patients got excellent pain relief, their wounds started healing, the vascularity of the diseased part increased and the disease stopped progressing. Stellate ganglion chemical neurolysis with phenol in Peripheral vascular disease or Buerger's disease of hand is an effective method to stop the disease procession, promoting wound healing, controlling ischemic pain, and avoiding surgical amputation.

Evidence Based Classical Ayurveda Management the Epidydimal Cysts

Epididymal cysts are collection of fluid in a single sac (unilocular) or more than one (multilocular) as a result of dilatation of efferent epididymal tubules due to tubular obstruction with benign in nature and often bilateral in nature. It involves the development of fluid-filled sacs or cysts within the epididymis, a coiled tube located behind each testicle. An epididymal cyst, also known as a spermatocele that affects the male reproductive system. If it is not treated it may develop to an abscess and probably the destruction of the epididymis which can lead to infertility. In Ayurveda it can be under the heading Kaphaja Granthi. A 27-year-old male patient visited the outpatient department of Kayachikitsha with complaints of bilateral scrotal swelling with itching since six months. Patient was diagnosed on the basis of colour doppler of scrotum and it indicates bilateral epididymis head cyst with minimal fluid seen around left spermatic cord with herniation of omental fat on Valsalva. The patient was treated with classical management of Kapahaja Granthi described in texts, Vaman (medicated emesis), Virechana (therapeutic purgation) and followed by administered Arogyavardhini Vati 2 tablet each of 250mg twice a day in empty stomach, Kanchanara Guggulu two tablet each of 500mg twice a day after food with lukewarm water and Varunadi Kashaya 40ml once a day in morning empty stomach. After this treatment there was no scrotal swelling also the colour doppler study reveals normal colour doppler study with no significant abnormality noted. This case indicates the Ayurveda classical management given in texts can be helps to manage the condition like epidydimal cyst.

Meta-Analysis on Ultrasound Guided Hydrostatic Saline Enema Reduction of Childhood Intussusception

Abstract Background Ultrasound with color Doppler studies plays a promising role in both the diagnosis as well as the guided reduction of intussusception by using hydrostatic pressure with normal saline enema as we can directly visualize the whole process of the reduction with real time ultrasound. Aim of the Work The study aims to assess the role and benefits of the ultrasound as an alternative non-invasive method in the guidance of the hydrostatic reduction of intussusception in children. Material and Methods A systematic review and meta-analysis on published studies about ultrasound guided hydrostatic saline enema reduction of childhood intussusception carried out in the period between 2010 and 2020. for pediatric patients suffering intussusception and was performed in accordance with the PRISMA and PICO guidelines. An initial search was carried out using online databases: PubMed/MEDLINE, Google Scholar, Egyptian Knowledge Bank and Science direct. The following search terms was employed: “(Intussusception AND hydrostatic OR saline enema AND ultrasound OR ultrasonography). Results A total of 133 articles were identified after duplicates were removed, and 102 were then excluded as they did not meet the inclusion criteria. The 31 remaining full-text articles were reviewed, and 10 were excluded due to (outside our time interval or containing insufficient data or other reasons of exclusion). Thus, 21 articles were included in the systematic review. Conclusion Hydrostatic reduction should be the treatment of choice and the first line of management in all cases of intussusception unless it is contraindicated. It is a simple, safe, effective and radiation free technique. It is not time consuming, is cost effective and is associated with almost nil complications and minimal hospital stay.

Colour Doppler study of blood flow in the portal vein in relation to blood flow in the milk vein, milk yield and body condition of dairy cows during dry period and lactation

In dairy cows, the liver supports the increased nutrient demands of the udder for milk production. Blood flow is key for the transport of these nutrients. This study investigated portal vein blood flow volume (PVBFVol) in relation to daily milk yield (DMY), milk vein blood flow volume (MVBFVol) and body condition parameters of high-producing dairy cows, starting from late lactation, throughout dry period, and consecutive early lactation. Seventeen repeated examinations were performed on 19 Holstein cows and 313 measurement days were finally included. Vein morphology and blood flow were examined via B-mode and spectral Doppler (triplex) ultrasonography, respectively. Body condition parameters recorded were body condition score (BCS), backfat thickness (BFT) measurement with ultrasonography, heart girth circumference (HG) and withers height (WH). Longitudinal relationship of PVBFVol with MVBFVol, DMY, BCS, BFT, HG and WH was analyzed with linear mixed models, with random intercept effects, using restricted cubic splines. A significant increase of 8.28% (p < 0.01) in PVBFVol appeared for every 1 L/min increase in MVBFVol in the univariable model. PVBFVol presented a significant negative association with BCS (p < 0.01) and BFT (p = 0.02), while interaction with production stage was significant, too. PVBFVol significantly increased by 0.38% (p = 0.04) for every 1 kg increase in DMY in the multivariable model. In conclusion, the increased PVBFVol during lactation accompanies the escalation in metabolic activity of the liver and the increased blood circulation through the udder, coping with the udder's escalating nutrient demands for milk synthesis.

Sonographic diagnosis and evaluation in patients with superficial radial arteries.

The superficial radial artery (SRA) is a rare congenital anomaly in the forearm. However, it can be detected incidentally via trauma, intraoperative findings, angiography, or ultrasonography. In addition, intra-arterial infusion of intravenous medications and difficulties in radial artery catheterization may occur in cases of the SRA. Between December 2016 and July 2020, anomalous branches of radial arteries were found incidentally in nine patients at the preoperative visit and identified during ultrasound-guided radial artery puncture in 21 patients when radial artery catheterization using the palpation method proved difficult. Ultrasound examinations were performed for diagnosis and evaluation of these 30 patients. All anomalous branches of the radial artery were SRAs; 11 (37%), 13 (43%), 6 (20%) were present on the right side, on the left side, and bilaterally, respectively. All SRAs ran close to the cephalic vein. The vascular diameters of the radial arteries were the smallest in the radial artery distal to the SRA bifurcation (followed by in the SRA) and the largest in the radial artery proximal to the bifurcation (p < .001). In two cases, color Doppler study revealed that both the blood flow and color Doppler signal of the SRA disappeared with compression of the radial artery proximal to the SRA bifurcation. Because the SRA runs very close to the cephalic vein, a tourniquet applied to the arm may easily lead to intravenous catheter misplacement into the SRA. In addition, the small radial artery distal to the SRA bifurcation causes difficulty in radial artery catheterization. Furthermore, SRA cases may have falsely normal Allen's test results. Therefore, the authors recommend that the SRA must be identified before vascular puncture for safe vascular catheterization in the forearm.

P312 Retrospective study using ultrasonography in predicting clinical relapse of Crohn's disease

Abstract Background Endoscopy is the standard modality for inflammatory bowel disease, but it is invasive and poorly tolerated. On the other hand, trans-abdominal ultrasonography (US) is minimally invasive, inexpensive, and has excellent characteristics not found in other examinations, such as the ability to detect minute changes in the intestinal wall. It would be clinically useful if US could predict clinical relapse. Methods Of 185 patients with CD who underwent US between April 2011 and April 2021, we retrospectively evaluated 75 patients who were in clinical remission (CDAI &amp;lt; 150) at the time of their first US at our hospital for clinical relapse and maintenance of remission at 1 year after the procedure. The severity of US was evaluated by US-CD (0-52 points in total), which divided the intestine into four segments(ileum, right-sided colon, transverse colon, and left-sided colon) and was calculated the following US parameters: bowel wall thickness (BWT) (0–3), loss of stratification (0–2), degree of blood flow signaling by a color Doppler study (0–3), presence of increasing echogenicity mesentery (0–2), and intestinal stenosis (0–3). US images were analyzed and interpreted in a consensus manner by two technologists with more than 10 years of experience, blinded to the patient's clinical information. Results Of the 75 cases, 58 were males and 17 were females with a median age of 30 years (range 18-58), median BMI of 20.6 kg/square meter (range 16.2-32.5), 23 cases were ileal type, 47 cases were ileocolonic type, and 5 cases were colonic type. Sixty-eight patients remained in clinical remission during the observation period, and 7 patients had clinical relapse (CDAI &amp;gt; 150). The median CDAI at US was 71 (range 14-143), median CDAI at relapse was 189 (range 151-288), and median observation period was 365 days (range 6-365). The median time to relapse was 193 days (range 166-288). ROC analysis was performed on the US-CD, and the highest AUC of 0.820 was obtained when the cutoff value was 11. Six patients in the relapse group and 20 patients in the remission maintenance group had US-CD of 11 or higher, and 1 patient in the relapse group and 48 patients in the remission maintenance group had a score of less than 11. The sensitivity was 85.7%, specificity was 70.6%, positive predictive value was 23.1%, and negative predictive value was 98%. Logistic regression analysis identified "US-CD 11 or higher" as a factor contributing to clinical relapse (p=0.018). Conclusion US-CD ≥11 is a prognostic predictor of clinical relapse in CD.

Doppler Ultrasonographic Evaluation of Erectile Dysfunction in a Northern Nigerian Tertiary Hospital.

Colour duplex Doppler is a noninvasive tool for the evaluation of the vascular mechanism of erectile dysfunction (ED). It can be used to determine the integrity of the vascular mechanism and to differentiate between arterial and venous insufficiency. To identify the vasculogenic causes of ED and subclassify them into arteriogenic, venogenic, or mixed to assist in predicting the clinical outcome. A retrospective study was conducted at the Department of Radiology, ABUTH Zaria, from records of patients who had presented to the Doppler suite with symptoms of ED available between July 2020 and August 2022. A total of 23 patients were involved in this study. The age range was 25-66 years. The majority of the patients were seen in age groups 51-60 years and 41-50 years with 48% (11) and 22% (5), respectively. Only 3 (13%) of the patients were found to have normal penile Doppler study, 12 (52%) patients were found to have arteriogenic, and another 4 (17.4%) patients were found to have venogenic cause. In four (17.4%) patients, there was mixed/inconclusive picture. Among the nine (39%) patients with Peyronie's disease, only one showed normal Doppler study. The incidence of vasculogenic cause of ED was found to increase with age. The colour Doppler study is an important noninvasive nonionizing radiation tool for swift evaluation of penile erectile function and, thus, helps in classifying ED causes into structural, vascular, or possibly psychogenic, hence guiding the clinicians on the therapeutic options.

Doppler Sonography of Umbilical Artery throughout Pregnancy in Sheep

The Color Doppler study on 6 pregnant ewes was conducted twice a week from Days 20 to 60 post-mating, then at weekly intervals till the end of experiment by the transrectal and transabdominal ultrasonography. In order to evaluate the waveforms and velocity blood flow patterns, peak systolic velocity (PSV), end diastolic velocity (EDV), pulsatility index (PI) and resistive index (RI), were measured. Data were nalysed by employing SPSS 21. The PSV and EDV increased from 38 to 139 days of gestation. The PI and RI of blood flow showed a non-significant decrease throughout gestation.

Evaluation of Morphological Changes in Hepatic Parenchyma, Bile Ducts, and Hepatic Vasculature in Patients with Oriental Cholangiohepatitis using Ultrasonography

Objective: The objective of this study is to study the morphological changes in hepatic parenchyma, to characterize the intra and extrahepatic ductal changes and to study the morphological changes in vasculature of the liver in patients with oriental cholangiohepatitits (OCH). Materials and Methods: All documented or newly diagnosed cases of OCH, referred to the department of radiodiagnosis and imaging from Departments of Surgical Gastroenterology and Medical Gastroenterology were evaluated by ultrasonography (USG) and color Doppler study. The dilatation of the intrahepatic as well as extra-hepatic ducts was noted. The morphological changes in the liver parenchyma as well as hepatic vasculature were studied. Results: USG showed calculi in 53 (98.1%) cases, ductal dilatation in 52 (96.3%), and worms within biliary ducts in 10 cases (18.5%). Among parenchymal changes, atrophy was seen in 9 cases (16.6%), space-occupying lesion was seen in seven cases (12.9%), and peri-portal echogenicity in 10 cases (18.5%). Significant association was found between atrophic segments and reduced/absent blood flow in the affected segmental portal venous branches. Conclusion: USG is the preferred primary examination. Further imaging depends on the USG findings, the patient's symptomatology, the clinical problems, and the intended mode of treatment. Advances in Knowledge: USG plays a pivotal role in the evaluation of oriental cholangiohepatitis in the low resource settings where higher modalities like MRI are not available, especially in the remote areas of developing countries, as it has high degree of accuracy in the diagnosis of OCH.

Ruptured Spontaneous Heterotopic Pregnancy Presenting with Hemoperitoneum: a case report

Heterotopic pregnancy (HP) is the coexistence of intrauterine (IU) and extrauterine (EU) gestation. It is rare and potentially fatal condition if not correctly treated or diagnosed. In this case report, we present a 33-year-old woman with a 16-week topical pregnancy with spontaneous rupture of an ectopic pregnancy (EP) in the uterine tube. At first, the patient had diffused abdominal pain, specifically in the lower abdominal level and tachycardia. The evaluation of the fetus showed no signs of distress. Abdominal and transvaginal ultrasound (US) show free intraperitoneal fluid, a normal-looking IU gestation with a positive fetal heart rate consistent with a fetal age of approximately 16 weeks, signs of parenchymal vascular hypoflux of the spleen on the color doppler study, associated with a splenic vein with low vascular amplitude flow. General surgery team were requested and to rule out aneurysm of splenic vessels as a source of bleeding she had an abdominal angiotomography that showed a moderate amount of free fluid, ectasia of gonadal and uterine vessels, with no signals of active bleeding and no spleen changes. No signs of EP were identified in this exam. The patient had hemodynamic deterioration with maintenance of abdominal girth. An emergency exploratory laparotomy was performed under general anesthesia through a supra and subumbilical incision, leading to a finding of a ruptured EP. There was a 3 cm right tubal ruptured ectopic pregnancy. A total right salpingectomy was performed with removal of the hemoperitoneum and peritoneal lavage. The patient recovered uneventfully and was discharged from the hospital within 5 days.

THE STUDY OF PORTAL VEIN THROMBOSIS PATIENTS WITH CHRONIC LIVER DISEASE

BACKGROUND: Portal vein thrombosis in the general population is a rare event, but it occurs relatively frequent in patients with cirrhosis and its prevalence increases with severity of the disease. The causal relationships and clinical presentation are often complex .As PVT may cause short term as well as long term complications, correct management by adopting adequate diagnostic and therapeutic measures is paramount OBJECTIVE: To nd out the incidence of portal vein thrombosis in Chronic Liver disease patients and factors and complications associated with it . MATERIALAND METHODS:All the patients of chronic liver disease attending department of General Medicine, Jayarogya Hospital patients were evaluated for detailed history, abdominal ultrasonography, portal vein colour doppler studies ,coagulation prole and other biochemical prole. RESULTS: In this study 9% of patient developed PVT with commonest etiology being chronic alcohol intake. Chronic alcohol intake is a signicant etiological factor for the development of PVTin patients of preexisting CLD. Hemetemesis, Encephalopathy, Splenomegaly and ascites were found signicantly higher proportion in PVT group when compared with non PVT group. Portal vein thrombosis could worsen the rate of hepatic decompensation and survival of cirrhosis. CONCLUSION: Portal vein thrombosis is considered to be a signicant complication of liver cirrhosis. Portal vein thrombosis could hasten the rate of decompensation and worsen the survival of cirrhotic patient. Prognostic value of PVTis cirrhosis remain a grey zone.

Unilateral Atrial Ectopic Rhythm in a Golden Retriever

Background: Atrial ectopic rhythm is a type of supraventricular arrhythmia, originating in two distinct points in the atrial region. In the electrocardiographic (ECG) tracing, it is represented by independent depolarizations of sinus P waves and ectopic P waves. The occurrence of this disorder is rare, and the diagnosis criteria are the presence of the described waves within the basal rhythm. In humans, there have been reports related to severe heart failure with an unfavorable prognosis. The present report aimed to describe the clinical case of a dog with unilateral atrial ectopic rhythm without any underlying cardiac disorder.Case: A 8-year-old male golden retriever was brought to a veterinary clinic for a preoperative evaluation for lipoma removal in the right forelimb. On clinical examination, the owner stated that the patient was active, with no signs of easy fatigue or cough. The canine displayed normophagy, normodipsia, normoquezia, and normouria. On physical examination, he demonstrated a lymphatic temperament with tachypnea. The temperature and capillary filling time were within the normal range, with a normokinetic pulse. Cardiac auscultation revealed a mild grade I/VI murmur in mitral focus and an 80-bpm heart rate. Respiratory auscultation revealed the presence of harshy lung sounds. The cough reflex was positive; the Piparote test, negative. The blood test showed no noticeable changes in blood count and serum biochemistry. Systemic systolic blood pressure was 120 mmHg. On radiographic examination, no evidence of heart or lung abnormalities were identified. After the clinical evaluation, an ECG examination was performed; a unilateral atrial ectopic rhythm was observed with different frequencies between atrial and ventricular rhythm and with P (164°) and P waves (80°). On echocardiographic examination, no morphological abnormalities were seen, though trivial mitral insufficiency was identified in a color Doppler study. Blood was collected to measure electrolytes to check for possible electrolytic abnormalities; the results were within the normal range. The patient was released for and remained stable throughout the procedure, maintaining the rhythm detected during the transoperatory time. Upon reassessment in a new ECG examination, the arrhythmia persisted, suggesting that a primary lesion in the atrial tissue was present.Discussion: An atrial ectopic rhythm diagnosis requires a detailed study with the aim of ruling out heart diseases that may affect the propagation of the cardiac stimulus. However, no morphological or functional abnormalities of note that justified triggering stimuli for the ectopic rhythm were observed. In addition, based on the echocardiographic evaluation, myocardial function was preserved, supporting the canine’s release for the procedure. The suspicion of hydroelectrolytic alteration and hypoxia was present after discarding structural causes, though it was discarded due to normal laboratory results. The presence of ectopic P waves was due to the non-interference in the sinus P’ waves; consequently, they were found in the sinus heart rhythm. Upon assessing the ectopic P wave frequency, the atrial rhythm frequency was higher than the heart rate, juxtaposing the different irregular intervals within the atrial cycle. The rhythm alone may explain that its severity can be linked to the physical findings. This indicated that they did not influence the presentation of ectopia since the cardiac output, controlled by the sinus rhythm part, was responsible for maintaining the rhythm and the demand of the organism; the electrical conduction system, responsible for atrial systole, represents 15-25% of the blood ejection for the ventricular filling. Patients with rhythm disorders as described need guidance and follow-up for the early detection of clinical signs resulting from the destabilization of the condition.Keywords: atrial dissociation, supraventricular arrhythmia, electrocardiogram, dogs.

TO ANALYSE THE EFFICACY OF TRANSVAGINAL ULTRASONOGRAPHY AND COLOUR DOPPLER IN EVALUATION OF ADNEXAL MASSES

Objective- The objective of this study is to evaluate the transvaginal ultrasound and colour doppler sonography for differentiation between benign and malignant adnexal masses. Methods-In this study total 100 patients were selected from gynaecology OPD. At the end of this study there were 84 patients left and with some having bilateral adnexal masses, so total of 112 adnexal masses were evaluated. The transvaginal ultrasound (TVS) was used to study morphology of the adnexal masses and scoring was assigned using De Priest scoring system. The colour doppler study (CD-study) evaluates the presence or absence of blood ow within the adnexal mass, whether the ow is central or peripheral and the resistance index of the ow. The combined TVS morphological scoring and colour doppler study (TVS+CD) were used for evaluating the adnexal masses. The conrmatory diagnosis was made either by histopathological examination or ne needle cytological examination. The accuracy of TVS-morphological study and colour doppler sonography for differentiation of adnexal masses were assessed by calculating sensitivity, specicity, positive predictive value and negative predictive value. Conclusion-TVS-morphological scoring is one of the best tools for adnexal mass evaluation but when it is combined with colour doppler sonography its diagnostic accuracy increases.

Diagnostic accuracy of color doppler Ultrasonography and FNAC in differentiating benign and malignant cervical lymphadenopathies at Birat Medical College Teaching Hospital, Morang, Nepal

Introduction: Among various imaging modalities useful in diagnosis of cervical lymphadenopathies, Color Doppler ultrasound (CDUS) is useful to evaluate and determine the presence of vascularity, resistance, direction, and velocity of blood flow in lymph nodes. It can determine the morphological and vascular nature of lymphadenopathies which will further help in the differentiation between benign and malignant nodes. Methods: This study was conducted on 61 patients referred to the Department of radiodiagnosis and imaging of BiratMedcical College for an ultrasound of cervical lymphadenopathy. These patients had subsequently undergone FNAC examination. Color Doppler sonographic procedures were done with an 11L linear probe with a frequency of 4.5-12MHz and CDUS evaluation of lymph nodes for Resistive Index and Peak systolic velocity were carried out and correlated with FNAC findings. Results: Among 61 lymph nodes, 52 were benign and 9 were malignant in the Color Doppler study where the final diagnosis by FNAC showed 53 benign and 8 malignant nodes. RI above the cutoff value of 0.5 had 83.3% sensitivity, 79.6% specificity, 50% PPV and 95.1% NPV. PSV above the cutoff value of 16cm/sec had 66.6% sensitivity, 95.9% specificity, 80.0% PPV and 92.2% NPV with diagnostic accuracy of 91.8%. Conclusion: Morphological features of the nodes such as shape, absence of echogenic hilum, abnormal vascular pattern, and Doppler indices cutoff values of 0.5 and 16cm/s respectively for RI and PSV were sensitive and specific for the diagnosis of malignant lymph nodes.

Perinatal Outcomes in Premature Placental Calcification and the Association of a Color Doppler Study: Report from a Tertiary Care Hospital in Eastern India.

Introduction: Placental calcification, identified before the 36th week of gestational age, is known as premature placental calcification (PPC). PPC could be a clue for the poor fetal outcome. However, its association with adverse perinatal outcomes is yet to be confirmed. Objective: The primary objective was to determine and compare the perinatal outcomes in pregnancies with and without documented premature placental calcification. Methodology: The present study was a prospective cohort study performed from October 2017 to September 2019. We consecutively enrolled 494 antenatal women who presented to our antenatal OPD after taking consent to participate in our study. Transabdominal sonographies were conducted between 28–36 weeks of gestation to document placental maturity. We compared maternal and fetal outcomes between those who were identified with grade III placental calcification (n = 140) and those without grade III placental calcification (n = 354). Results: The incidence of preeclampsia, at least one abnormal Doppler index, obstetrics cholestasis, placental abruption, and FGR (fetal growth restriction) pregnancies were significantly higher in the group premature placental calcification. We also found a significantly increased incidence of Low APGAR (Appearance, Pulse, Grimace, Activity, and Respiration) scores, NICU (Neonatal Intensive Care Unit) Admission, Abnormal CTG (cardiotocography), meconium-stained liquor, and low birth weight babies in those with grade III placental calcification. Conclusion: Clinicians should be aware of documenting placental grading while performing ultrasonography during 28 to 36 weeks. Ultrasonographically, the absence of PPC can define a subcategory of low-risk pregnant populations which probably need no referral to specialized centers and can be managed in these settings.

The Role of Doppler Ultrasound in the Diagnosis of Postnatal Testicular Torsion in Children

The diagnostic significance of the color Doppler study of testicular blood flow in testicular torsion has been studied for about 40 years, however, the prognostic value of the results obtained is ambiguous, as are the actual imaging capabilities of the technique. Our own experience of 110 observations of testicular torsion in children older than the neonatal period allows us to draw statistically reliable conclusions. Made on equipment premium-class research made it possible to evaluate how visualization intratesticular vascular pattern, and whirpool-sign and submit the primitive model of the actual inversion, explaining the impossibility of rendering whirpool-sign with the greatest tight inversion. The dynamics of testicular blood flow was studied immediately after successful and unsuccessful manual detorsion and in the long term after operative detorsion and orchopexy. The publication contains a brief analysis of the literature and is extensively illustrated.