Color Doppler Ultrasound Scan Research Articles

Особливості ренального кровотоку при гострому пошкодженні нирок у недоношених новонароджених дітей з гемодинамічно значущою відкритою артеріальною протокою

Hemodynamically significant patent ductus arteriosus (HSPDA) in premature infants leads to renal hypoperfusion due to the phenomenon of «stealing» of the systemic circulation, which can contribute to the development of acute kidney injury (AKI). The use of ultrasound Doppler sonography of the renal vessels can be effective in assessing renal blood flow and in the early diagnosis of acute renal failure. Purpose — to assess the prognostic significance of the state of renal blood flow in the first day of life in premature infants with HSPDA in the early diagnosis of AKI. Materials and methods. We examined 40 preterm infants (gestational age 29–36 weeks) with HSPDA. Distribution of the examined patients: the group with AKI — 23 children, the group without AKI — 17 children. The observation period was 10 days. The patients underwent echocardiography with Doppler analysis using a broadband microconvex probe with a frequency of 5–8 MHz (TOSHIBA Nemso XG) at 5–11 hours of life. Color Doppler ultrasound scanning of renal vessels was performed on the first, third and tenth days of life. The parameters of blood flow in the main renal and interlobar renal arteries were studied: peak systolic velocity (PSV) and end diastolic velocity (EDV) of blood flow, resistance index (RI). Diagnosis and stratification of AKI severity met the KDIGO neonatal modification criteria. Results. On the third to fifth day of life, AKI was diagnosed in 23 (57.5%) children, but already in the first day of life, compared with patients without AKI, a significant decrease in PSV parameters of blood flow in the main renal artery was noted (20.6±5.87 cm/sec versus 25.4±6.17 cm/sec in children without AKI, p<0.02). In addition, the main changes in the first day of life in patients with AKI were revealed at the level of the interlobar renal artery, namely: a decrease in PSV blood flow (11.10±3.329 cm/sec versus 18.48±3.014 cm/sec in children without AKI, p<0.001) and EDV of blood flow (2.83±2.063 cm/sec versus 6.16±2.447 cm/sec in children without AKI, p<0.001), increased RI (0.758±0.137 versus 0.666±0.1216 in children without AKI, p<0.02). On the third day of life at AKI, there was a disorder in the parameters of blood flow in the interlobaric renal artery, the value of which on the tenth day of life did not differ from the parameters of children without AKI. Conclusions. In premature infants with HSPDA, who were diagnosed with AKI on the third to fifth day of life, in the first day of life, there is a decrease in PSV blood flow parameters in the main renal artery, changes in blood flow in the interlobar renal artery, namely: a decrease in PSV and EDV blood flow, an increase in RI. Thus, the assessment of the state of blood flow in the interlobar renal artery on the first day of life in premature infants with HSPDA is of diagnostic value for the timely determination of the risk group for AKI. The research was carried out in accordance with the principles of the Helsinki declaration. The study protocol was approved by the Local ethics committee of all participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the authors. Key words: premature infants, patent ductus arteriosus, renal blood flow, acute kidney injury.

Long-term outcomes of endovenous laser ablation, n-butyl cyanoacrylate, and radiofrequency ablation for treatment of chronic venous insufficiency

BackgroundIn the present retrospective, single-center study, we evaluated the long-term effectiveness and reliability of endovenous laser ablation (EVLA), endovenous n-butyl cyanoacrylate (NBCA) application, and radiofrequency ablation (RFA) in the management of chronic venous insufficiency (CVI). MethodsThe medical records of patients who had undergone EVLA, NBCA, or RFA for CVI from January 1, 2014 to January 1, 2017 were reviewed. The medical records included data on sex, age, body mass index, American Society of Anesthesiologists score, and symptoms at admission. The great saphenous vein diameter, CEAP (Clinical, Etiology, Anatomy, and Pathophysiology) classification, and venous clinical severity score were also recorded. All the patients were followed up with physical examinations and color Doppler ultrasound scan at the first week and 6 and 12 months after treatment. After 12 months, the follow-up examinations were performed annually. ResultsA total of 232 patients who had undergone lower limb CVI surgical treatment (EVLA, n = 77; NBCA, n = 73; RFA, n = 82). The mean follow-up time was 67.5 ± 4.7 months. The procedure duration was significantly shorter for the NBCA group (13.5 minutes) vs that for the EVLA (31.7 minutes) and RFA (27.9 minutes) groups (P = .001). The pain score was highest in the EVLA group (P = .001). The EVLA group had also experienced a significantly greater incidence of complications and a longer time to return to daily activities (P = .001). The post hoc analysis revealed comparable occlusion success among the three groups on the first postoperative day and at 6, 12, and 24 months postoperatively. However, significantly better occlusion rates were found for RFA vs EVLA at 3 and 5 years of follow-up (P = .024 and P = .011, respectively). The success of NBCA and RFA was similar at 3 and 5 years of follow-up (P = .123 and P = .330, respectively). ConclusionsThe outcomes showed similar early postoperative occlusion success among all three CVI treatment techniques. However, RFA resulted in a significantly higher success rate compared with EVLA at 3 and 5 years of follow-up. Additionally, the NBCA and RFA procedures achieved comparable long-term success. However, EVLA was associated with significantly greater complication rates and pain scores and a longer time to return to daily activities. The NBCA procedure had a significantly shorter operation time compared with the other procedures.

Maternal Serum Placental Protein-13 Levels in the Prediction of Pregnancies with Abnormal Invasive Placentation.

To evaluate whether placental protein-13 (PP-13) measured in the serum of pregnant women could predict abnormal invasive placentation (AIP) detected by color Doppler ultrasound (US) and magnetic resonance imaging scan in addition to the routine US scan during the third trimester. The prospective case-control study included patients subdivided in 2 groups: 42 pregnant women with a singleton pregnancy at 28-32 weeks of gestation with only suspected AIP, and 32 healthy pregnant women. The serum PP-13 levels were measured in both groups using an enzyme-linked immunosorbent assay (ELISA) method and statistically compared. The cases of AIP were confirmed by placental histopathological examination and/or the uterus removed by hysterectomy after elective caesarean section. Serum PP-13 levels of pregnant women with AIP were significantly higher (p<0.001) than those of controls (650.32±387.33 vs. 231.43±94.33). Statistical analysis of maternal serum PP-13 levels above the threshold of 312 pg/ml (measured in the early third trimester) predicted AIP with 76.2% sensitivity and 75% specificity. Maternal serum PP-13 may have a role in the pathophysiology of AIP owing to its high serum value in the AIP group. The maternal serum dosage of PP-13 levels could improve pregnancy management in those patients suspected of having AIP.

Role of Color Doppler Ultrasound in Antenatal Diagnosis of Placenta Accreta in Patients with Previous Cesarean Scar

Morbidly adherent placenta is asignificant cause of maternal morbidity , mortality and massive obstetric hemorrhage. It is defined as an abnormal placental adherence either in whole or in part of the placenta to the underlying uterine wall. It is a potentially life threatening condition responsible for 7-10% of maternal mortality.Is to evaluate the accuracy of Color Doppler Ultrasonography in antenatal diagnosis of placenta previa accreta in patients with previous cesarean sections. The study included 60 pregnant females after 28 week of gestation from obstetrics and gynecology department of Banha University hospital during a period from (1st of December 2018 to 30th November 2019) with suspected history and ultrasonographic findings of placenta accreta. Gray-scale B-mode transabdominal sonography and Color Doppler Ultrasound scans were done. The overall accuracy of diffuse or focal lacunar flow was 73.3%, vascular lakes with turbulent flow 70%, Hypervascularity of serosa bladder interface 62% and markedly dilated vessel over peripheral sub-placental zone 71% in doppler ultrasound. Color Doppler does not appear to improve the accuracy of Gray-Scale so, it is suggested to use both Gray scale ultrasound and Color Doppler in all cases of placenta previa with previous C.S to find out features that suggest presence of placenta accreta

Diagnostic Value of Spectral CT Reconstruction Mode for Carotid Atherosclerotic Plaque Lesions

Objective: To investigate the diagnostic value of spectral CT reconstruction mode for carotid atherosclerotic plaque lesions. Methods: From January 2017 to January 2019, 70 patients with carotid atherosclerotic plaque lesions in our hospital were selected as the research object. All patients were diagnosed with cervical vascular color Doppler ultrasound and spectral CT scan under spectral CT reconstruction mode. Taking the results of coronary angiography as the “gold standard”, the clinical value of the two examination methods in the diagnosis of carotid atherosclerotic plaque lesions was compared and analyzed. Results: Coronary angiography diagnosis confirmed that 33 of 70 patients with suspected carotid atherosclerotic plaque lesions had vulnerable plaques and 37 had stable plaques. The accuracy of Spectral CT examination of carotid artery plaque was 87.14% (61/70), sensitivity was 90.91% (30/33), specificity was 83.78% (31/37), and the positive predictive value was 83.33% (30 /36), the negative predictive value is 91.76% (31/34), which is higher than that of cervical vascular ultrasonography (61.43%, 60.61%, 56.76%, 57.89%, 65.63%), the difference is statistically significant (P&lt;0.05). Conclusion: The application of Spectral CT in the clinical diagnosis and treatment of carotid atherosclerotic plaque lesions with higher accuracy, sensitivity and specificity, is more significant and can provide a more reliable and effective imaging basis.

Diagnostic categorization of erectile dysfunction using duplex color doppler ultrasonography and significance of phentolamine redosing in abolishing false diagnosis of venous leak impotence: A single center experience.

Background and Aims:Erectile dysfunction (ED) is an inability to achieve and maintain erectile rigidity sufficient for satisfactory sexual performance. It is either organic or psychogenic in origin. This study was aimed at establishing vasculogenic causes among patients being evaluated for ED using Penile Doppler Ultrasound.Methods:Fifty-two consecutive patients with the clinical diagnosis of ED were evaluated with color Doppler ultrasound scan using a 7.5 MHz high-frequency linear transducer between July 2016 and June 2019. The examination was commenced 3 min after an intracavernosal injection with 10-20 μg of PGE1 and continued for 30 min. The measurements were obtained alternately from both deep penile arteries. The variables analyzed were the peak systolic velocity (PSV), end-diastolic velocity (EDV) and resistive index (RI), calculated as (PSV-EDV)/PSV. Erection Hardness was evaluated subjectively using the EH Score (EHS), a 5-point response score denoting how the patient would rate his erection. ED was subjectively assessed using the International Index of Erectile Function (IIEF-5) questionnaire. In patients with a diagnosis of vasculogenic ED, intracavernosal PGE1 injection was started with a 5 μg dose and then increased in 5 μg increments until the final dose of 20 μg was reached.Results:PSV of cavernosal arteries (CA) varied between 19.2 and 106.2 cm/s (mean: 43.8 ± 18.2) among the entire patients and between 19.7 and 80.2 cm/s (mean: 42.6 ± 11.3) among patients with arteriogenic ED. Arteriogenic ED was found in 8 patients (15.3%), while venogenic ED was observed in 12 patients, which constituted 23% of the entire study population and mixed arteriogenic-venogenic ED was found in 6 patients (11.5%) of the study population. DICC performed on patients diagnosed with venogenic ED on color Doppler ultrasonography revealed venous leakage and no statistically significant differences between results of DICC and color Doppler ultrasonography were found in EDV, RI, and PI measurements (P< 0.005). Among patients with venogenic ED and mixed arteriogenic-venogenic ED,2 patients had a normal erectile response and the remaining 16 received 2 mg phentolamine. A significant increase in PSV between baseline and 20 mg PGE1 (P < 0.001) was observed in all cases. Following phentolamine, there was a significant increase in grade of erection (P = 0.0001) and a significant reduction in the EDV (P = 0.0001). A reduction of the EDV to below 0.0 cm/s was observed in 12 patients. In patients with arteriogenic erectile dysfunction, mean (±standard deviation) duration of erection for consecutive doses of PGE15 μg, 10 μg, 15 μg, and 20 μg were 42.2±18.4, 55.4±24.1, 66.1 ± 31.1, and 83.3±36.7 minutes, respectively, with significant increase for each dose. In patients with veno-occlusive dysfunction, mean durations of erection significantly increased from 9.1±8.0 minutes at 10 μg to 19.2±9.8 minutes at 20 μg.Conclusion:In the current study, 50% of patients had vasculogenic ED and “false-positive’’ diagnosis of venous leakage was unmasked by phentolamine re-dosing. It is therefore imperative that patients with ED benefit from duplex color Doppler ultrasonography which is safe, cheap and non-ionizing diagnostic modality before initiating therapy as ED treatment is cause specific.

Radioanatomical Study of the Pedicle of the Superficial Circumflex Iliac Perforator Flap.

The superficial circumflex iliac perforator (SCIP) flap has many ideal features, such as fast dissection, possibility to harvest thin, pliable, wide skin island, and concealed donor site scar. In spite of these features, its use was limited because of the wide anatomical variation of the pedicle, which is relatively shorter and has a smaller caliber than other more popular perforator flaps. Several names were given to the branches and perforators in the literature, thus adding confusion to the understanding of its anatomy. We performed a surgical and a radioanatomical study of the SCIP pedicles analyzing high-resolution contrast-enhanced computed tomography (CT) scan of 95 groins, with particular attention to the deep branch (DB) of the superficial circumflex iliac artery (SCIA). Twenty-three of these patients were also studied by detecting the surgical anatomy during SCIP flap harvest. We employed a system of coordinates based on the line between pubic tubercle (PT) and anterior superior iliac spine (ASIS) to describe the position of the perforator of the DB. We found a 100% correlation between surgical and radiological findings. The length of the DB from the origin to the point in which its perforator pierced the sartorius fascia ranged from 1.6 to 6.5 cm, mean = 3.62 ± 0.92 cm. The distance between the origin of the DB and the inguinal ligament ranged from 1.1 to 7.5 cm, mean = 2.8 ± 1 cm. The perforator of the DB could be found in 91% of the cases within a box of 4 cm × 3 cm drawn caudally to the line joining the PT with the ASIS. This vessel can show a vertical or horizontal course in the subcutaneous layer. Our findings confirm other previous studies and add new information about the position and the course of the perforator of the DB of the SCIA. Important features of the SCIP pedicles can be investigated by the color Doppler ultrasound and CT scan.

Distribution of psychogenic and vascular impotence in a tertiary health-care center's cohort: A retrospective study using penile Doppler imaging

PurposeIn this study, we retrospectively reviewed the penile color Doppler ultrasound (PCDU) scans of the patients who had admitted to our clinic with erectile dysfunction and aimed to evaluate the contribution of penile Doppler scan results to the clinical decisions. Material–methodThe data of patients admitted to our outpatient clinic with complaints of erectile dysfunction (IIEF-5 score<22 or IIEF-EF score<26) between January 2005 and January 2018 were retrospectively evaluated. Patients whose testosterone level is lower than 280ng/ml or who had undergone radical prostatectomy were excluded from the analysis. ResultsThree thousand ninety patients were included in the study. The mean age of our patients was 55.05±13.05 years. In total, 2139 (69%) patients had normal PCDU findings, 351 (11%) patients had arterial insufficiency, 531 (17%) patients had venous insufficiency, and 69 (2%) patients had arterial insufficiency with concurrent venous leakage. When the patients were divided into 2 groups ≤40 years (Group 1) old and >40 years (Group 2) old; normal PCDU findings were found in 432 patients (84%) of the Group 1 patients and normal PCDU findings in 1707 (66%) patients of the Group 2 patients (p<0.0001). There were arterial insufficiency findings in 24 (4.7%) and 327 (12.7%) patients of the Group 1 and 2, respectively (p=0.002). ConclusionThe etiology is psychogenic in the majority of patients who present with ED complaints to the urology clinic. With age, the prevalence of psychogenic ED is decreasing but still more than organic.

A comparison of the therapeutic efficacy of superselective arterial embolization and watchful waiting in high-flow priapism

Objective Compare the efficacy of superselective arterial embolization with observation in the treatment of HFP caused by trauma. Methods From Jan, 2013 to Dec, 2017, 6 traumatic HFP patients were involved into the study, the age range from 18 to 44 years old, with an average age of 26.2 years. The fistula was measured by doppler ultrasonography before the treatment with its longest diameter, and which ranges from 0.8 to 1.4 cm, the average diameter is 1.14 cm. All patients are divided into two groups according to their treatment. Operation group: 4 patients underwent the pudendal artery superselective gelatin sponge vascular embolization. Control group: 2 cases were treated with local cold compressing under watchful waiting. In control group, patients are treated by local cold compress with ice bag for 3 weeks: 15 mins×10 times every day. The erectile hardness of the patients was observed and the fistula was evaluated by doppler ultrasonography 3 weeks later, and all the patients were reexamined by doppler ultrasonography 1 year later. The erectile hardness was divided into four grades according to the patient's subjective feelings: grade Ⅰ, the penis was enlarged but not rigid; grade Ⅱ, the penis had hardness, but not enough to insert into the vagina; grade Ⅲ, the penis could be inserted into the vagina, but not to achieve complete erection; grade Ⅳ, the penis fully erect and firm. The erectile function was evaluated with the International Index of Erectile Function-5(IIEF-5) after 1-year′s follow-up. Results 4 patients in the operation group were operated successfully without obvious complications after operation. Median follow-up time of all the patients was 21 months (5-50). In group operation, 4 cases of surgical patients did not have the recurrence of priapism. There was no obvious abnormality in the color doppler ultrasound of penis. The score of IIEF-5 was 25, 24, 24 and 23, respectively. Postoperative erectile function made a complete recovery. In group observation, 2 patients under watchful waiting still have gradeⅡ-Ⅲ sustained priapism, IIEF-5 score is 21 and 19 respectively, the penis color doppler ultrasound scan still showed the change of arteriovenous fistula. Conclusion Superselective arterial embolization is effective in the treatment of HFP, and the recovery of sexual function is better after operation compared with watchful waiting. Key words: Priapism; Artery embolization; Watchful waiting; Sexual function; Follow-up

Preliminary study of image processing techniques for the detection of varicocele based on 2D ultrasound images

Varicocele is quite common among male population but can only be confirmed and treated through surgery which may affect the fertility. While ultrasound (color Doppler technique) can be used to diagnose the varicocele, the need to perform the Valsalva maneuver technique when performing the color Doppler ultrasound scanning might make patient become uncomfortable. Therefore, this preliminary study has been done to see whether any image processing techniques can be used to enhance the 2D ultrasound image to help the diagnosis. The purpose of this study is to enhance the ultrasound image of 2D varicocele testicle by using image enhancement and edge detection. The images used are the retrospective images of the normal testicle, and testicle with varicocele and severe varicocele (dilated vein). The image enhancement was done using median filter while the edges were detected using Sobel operator. Based on the analysis, sobel technique does an excellent job to show the varicocele region especially the dilated vein. To summarise, further image processing methods could be applied using different image processing techniques as the analysis could be helpful in giving the urologist the second opinion during diagnosis of varicocele before the surgery.

Recurrent varices after surgery: a clinical and color-Doppler ultrasound scan analysis.

To evaluate clinical pictures, symptoms and etiology of recurrent varices after surgery (REVAS) through a clinical and color-Doppler-ultrasound scan (CDUS) analysis. During a three-year period, data about 9043 consecutive outpatients were collected. Among these, 160 patients (1.8%) were affected by REVAS. Data about risk factors, types of primary vein surgery, symptoms, clinical and CDUS characteristics were analyzed using the Clinical, Etiology, Anatomy and Pathophysiology (CEAP), Stonebridge and Perrin classifications in order to evaluate clinical and anatomical varices patterns. Family history for chronic venous disease (90%), sedentary lifestyle (61.9%) and obesity (11.9%) were the most representative risk factors. REVAS symptoms were rather heterogeneous, although only 10% of cases was fully asymptomatic. CEAP classification showed a prevalence of C2 and C3 class (56.3% and 35% respectively). About half of inguinal REVAS was connected from a great saphenous vein residual stump (Stonebridge type 1). Lower limb perforating veins resulted associated to REVAS in 43.8% of cases. REVAS remain a major and still unsolved problem in patients following varicose veins surgery. Their clinical pictures and symptoms are heterogeneous and require a watchful analysis in order to identify both etiology and natural history.

Ultrasound Diagnosis of Clinically Unsuspected Ureteral Stone Presenting as Acute Scrotum

Ureteral colic is not generally included in the differential diagnoses of acute scrotal pain, although ureteral pathology is a recognized cause of pain referred to the scrotum. We report 3 patients presenting with acute scrotal pain who had normal scrotal color Doppler ultrasound scans; subsequent ultrasound of the ipsilateral kidney revealed hydronephrosis, which ultimately led to the clinically unsuspected diagnosis of ureteral colic. We conclude that ureteral colic should be included in the differential diagnosis of acute scrotal pain, and we further suggest that a survey ultrasound of the kidney on the side of the pain should be performed in patients presenting with acute scrotal pain and a normal color Doppler ultrasound examination of the scrotum.

Colour doppler sonography of the penis in the evaluation of erectile dysfunction: Our experience in Abuja, Nigeria.

Erectile dysfunction (ED) is an inability to achieve and maintain erectile rigidity sufficient for satisfactory sexual performance. It is either organic or psychogenic in origin. This study was aimed at establishing vasculogenic causes among patients being evaluated for ED using triplex Doppler Ultrasound. This study was conducted at the Department of Radiology, Federal Medical Centre, Abuja, Nigeria from July 2015 to January 2017. Thirty-five consecutive patients with the clinical diagnosis of ED were evaluated with colour Doppler ultrasound scan using a high-frequency linear transducer. The penile scan was done before and after intracavernosal injection of 10-20 μg prostaglandin E1. The waveforms of cavernosal arteries (CAs) were obtained alternately using angle of inclination ≤60°. The spectral waveforms and peak systolic velocities (PSV) of the CA were documented at 5-min intervals, from 5 to 50 min. PSV of CA varied between 19.5 and 104.4 cm/s (mean: 42.4 ± 17.6) among the entire patients and between 19.5 and 24.7 cm/s (mean: 21.9 ± 1.7) among patients with arteriogenic ED. Arteriogenic ED was found in six patients (17%), while venogenic ED was observed in ten patients, which constituted 29% of the entire participants. None had combined arteriogenic and venogenic ED. Peyronie's disease was observed in seven patients, and none of these had vasculogenic ED. About 46% of the patients had vasculogenic ED. It is therefore imperative that patients with ED benefit from this safe, cheap and non-ionising diagnostic modality before initiating therapy as ED treatment is cause specific.

Testicular torsion in a patient with four testes and the ultrasound findings

Introduction: Polyorchidism is a rare medical condition, which is presence of more than two testes within the scrotum. Triorchidism is the more common form and the diagnosis is made with ultrasonography. One of the common anomalies associated with polyorchidism is testicular torsion. Case Report: We report a case with four testes and testicular torsion in one testis. Conclusion: Testicular torsion in patients with polyorchidism is extremely rare and color Doppler ultrasound scan is the main diagnostic tool. (This page in not part of the published article.) International Journal of Case Reports and Images, Vol. 7 No. 3, March 2016. ISSN – [0976-3198] Int J Case Rep Images 2016;7(3):178–180. www.ijcasereportsandimages.com Jahangiri et al. 178 CASE REPORT OPEN ACCESS Testicular torsion in a patient with four testes and the ultrasound findings Alborz Jahangiri, Arash Moghadam

Scrotal doppler ultrasound evaluation in Zaria, Nigeria

Introduction: The superficial location of the scrotal contents makes them ideally suited for sonographic examination. The development of high-frequency, real-time greyscale scanners along with Doppler facility has enhanced the diagnostic accuracy of scrotal sonographic examinations. Objectives: To determine the pattern and utility of Doppler ultrasound in the assessment of patients with scrotal pathologies in Zaria, Nigeria. Methodology: This retrospective study was carried out over a period of 36 months (February 2012 to January 2015) at the Radiology Department of Ahmadu Bello University Teaching Hospital, Zaria, Nigeria, on patients who presented for scrotal sonography on account of scrotal pathology. After a brief examination, colour Doppler ultrasound scan (CDUS) was performed. The clinical diagnosis and final ultrasound diagnosis were compared to determine the sensitivity and specificity of the later. Results: A total of 115 patients were scanned. Nearly 55.6% presented on account of primary infertility. Varicocele (45), hydrocele (31), epididymo-orchitis (8), epididymal cyst (6), microlithiasis (6) and others (6) were frequent Doppler findings. Only 12 cases were normal scan. Overall sensitivity of CDUS in diagnosing varicocele and hydrocele was 100% each, respectively. Conclusion: Doppler ultrasonography is an excellent, safe and reliable method for evaluating patients with scrotal diseases. It is especially important in conditions such as varicocele and hydrocele where accurate diagnosis is required in the management of infertility.

Gallbladder perforation: a rare complication of postoperative chemotherapy of gastric cancer.

A middle-aged man presented 1 day after being discharged from hospital with completing the first course of postoperative chemotherapy. He suffered a sudden persistent high fever and chills. It was noted that he had a history of a total gastrectomy (with D2 lymphadenectomy) 1 month ago. His admission bloods revealed total bilirubin was 142.2umol/L , indirect bilirubin of 107.6umol/L and white cell count of 20.05×109/L. A color doppler ultrasound scan confirmed fluid and gas around liver and hilus lienis while the gallbladder cannot be detected. During Computed Tomography (CT) guided puncture positioning technology and setting a three-channel tube, about 400 ml of foul smell hazel turbid liquid was drained out. He was diagnosed as gallbladder perforation and he was underwent conservative treatment consist of drainage, banning diet, total parenteral nutrition and intravenous antibiotics. Then he recovered well within the subsequent 10 days and was discharged.

Value of color Doppler twinkling artifact and CT in distinguishing uric acid stones from cystine stones: an experimental study

Objective To quantitatively analyze the value of color Doppler twinkling artifact and CT in distinguishing urinary stone composition of uric acid from that of cystine, and to assess the ability of color Doppler twinkling artifact and CT to diagnose urinary stone composition of uric acid. Methods Artificial stones made of uric acid and cystine were inserted in porcine kidneys respectively. Color Doppler ultrasound and CT scanning were performed in vitro and twinkling artifact videos were recorded. The CT attenuation value, the width and length of twinkling artifact (TAW, TAL) were measured. The color pixels representing twinkling artifact intensity (TAI) were calculated. The differences between artificial cystine and artificial uric acid stones in TAW, TAL, TAI and CT attenuation value were compared. The receiver operating characteristic (ROC) curve was used to assess the ability of TAW, TAL, TAI and CT attenuation value to diagnose urinary stone composition of uric acid. Results The TAW [(4.16±1.54)mm vs (4.97±1.93)mm], TAL[(3.75±1.05)mm vs (5.12±2.51)mm] and TAI [(3 005.50±812.33) vs (5 433.86±2 505.81)] of artificial cystine stones were less than those of artificial uric acid stones while the CT attenuation value of artificial cystine stones [(573.75±110.10)HU vs (364.09±67.28)HU] were greater (P<0.05). The ROC curve was displayed to diagnose urinary stone composition of uric acid, and the area under curve of CT attenuation value was bigger than that of TAI (0.936 vs 0.817, Z=2.308, P=0.021). Combination of color Doppler twinkling artifact and CT value would dramatically increase the diagnostic accuracy to 98%. Conclusions Both color Doppler ultrasound and CT were reliable examinations for distinguishing urinary stone composition of cystine from that of uric acid. Combination of color Doppler ultrasound and CT would be good references to diagnose urinary stone composition of uric acid. Key words: Ultrasonography, Doppler, color; Calculi; Twinkling artifact; Tomography, X-ray computer

Improving testicular blood flow with electroacupuncture-like percutaneous nerve stimulation in an experimental rat model of testicular torsion.

The purpose of this study was to determine the blood-flow-enhancing effect of electroacupuncture (EA) in an experimental rat model of testicular torsion. At the first stage, 3D color Doppler ultrasound (3D-CDUS) scans were made to detect baseline perfusion of each testicle in 12 male albino Wistar rats. Then, the left testicles of all rats were twisted 180° clockwise, and 3D-CDUS recordings were repeated. In the next step, 10-Hz EA was applied for 5 min over the T13 and L4 dermatome territories in the study group of six rats. In the control group of six rats, acupuncture needles were inserted in the same manner, but EA was not applied. Baseline, posttorsion, and postintervention (EA and manual needling) 3D-CDUS perfusion recordings were interpreted as volumetric data, and group comparisons were performed. After EA, we observed statistically significant perfusion improvements in both the ipsilateral torsed and contralateral nontorsed testicles. In the control group, testicular perfusion did not show a significant change after manual needling. EA can improve testicular blood flow bilaterally in a rat model of unilateral testicular torsion at 180°.

Varicose veins of the dorsum of hand and digits: A case report and review of literature

The localized varicosities of the hands and digits are quite rare with only a handful of cases reported in the literature. The cause of upper and lower limb varicosities are almost the same and the same treatment principles should be followed for both. Here, we report a case of 19-year-old male with localized varicosities of the dorsum of his hand and digits. Diagnosis was confirmed by color Doppler ultrasound scanning. He was managed by multiple ligations and excision of varicose veins with excellent results.

11 STRATEGIES TO MODULATE THE PERI-OVULATORY ENDOCRINE MILIEU BY CONTROLLING PROGESTERONE CONCENTRATIONS PRE- AND POST-INSEMINATION IN BEEF COWS

Recent evidence indicates that progesterone (P4) secretion from corpus luteum (CL) is affected by preovulatory follicle (POF) size and that increased circulating P4 during early diestrus has a positive effect on embryo development and pregnancy rates in cattle. Despite the embryotrophic effects, early administration of P4 may impair CL growth and anticipates luteolysis. Owing to develop favourable peri-ovulatory endocrine milieus to pregnancy success, we evaluated in beef cows (1) the effect of CL presence during dominant follicle growth on follicular vascularization, size and ovulation rate and (2) the effects of POF size and supplementation of long-acting P4 post-AI on CL development and regression. Sixty-six Nelore cows received an intravaginal P4 device and an injection of oestradiol benzoate on Day 10 (5–10 days post-oestrus), and were split to receive sodium cloprostenol [prostaglandin F2α (PGF2); large follicle (LF); n = 31) or not [small follicle (SF); n = 35]. Devices were removed and PGF2 was injected on Day 1.75. Ovulation was induced with a gonadotropin-releasing hormone (GnRH; buserelin acetate) on Day 0. Cows were inseminated twice on Days 0.5 and 1. Cows that ovulated were assigned to receive placebo (LF/control group, n = 14; and SF/control group, n = 9) or 150 mg of long-acting P4 on D4.5 (LF/P4 group, n = 13; and SF/P4 group, n = 12). Colour-Doppler ultrasound scanning was done on Days 10, 6, 2, 0.5, 1, 1.5, 4.5, 7.5, and 15.5. Structural luteolysis was detected by 25% decrease in CL area and 50% in luteal blood flow of subsequent scanning. Data were analysed for the main effects of POF size and supplementation and their interaction using the PROC MIXED procedure of SAS (SAS Institue Inc., Cary, NC, USA). Follicle diameter (mm) on Day 2 (11.4 ± 0.4 v. 8.4 ± 0.3) and POF (14.1 ± 0.3 v. 12.5 ± 0.3) were greater (P &lt; 0.05) in LF group. Percentage of luteal blood flow in follicle wall was greater (P &lt; 0.05) on Day 0.5 (33.9 ± 3.4 v. 22.8 ± 3.6) and 1 (48.9 ± 4.8 v. 28.3 ± 4.3) in the LF group. Ovulation rate was lower (P &lt; 0.05) in the SF group (60%, 21/35) than in the LF group (90%, 28/31), suggesting that a functional CL during dominant follicle growth is less favourable to pregnancy success due to 30% reduction in fertilizing potential of non-ovulated follicles. For luteal area (cm2), an effect (P &lt; 0.05) of POF size was detected on Day 4.5 (1.7 ± 0.1 v. 1.3 ± 0.1), 7.5 (2.8 ± 0.2 v. 2.2 ± 0.1), and 15.5 (2.5 ± 0.1 v. 2.2 ± 0.2) in the LF and SF groups, respectively. Luteal blood flow was greater (P &lt; 0.05) in the LF groups (40.4 ± 1.7 and 47.6 ± 3.4) than in the SF groups (35.7 ± 1.5 and 37.9 ± 4.1) on Day 4.5 and 15.5, respectively. This indicates that larger and more vascularized POF may be associated with greater CL vascularization in addition to greater CL size. The frequency of cows with early luteolysis did not differ (P &gt; 0.1) between P4-treated (5/25) and placebo-treated (1/23) cows. We suggest that the P4 supplementation did not severely induce early luteolysis in inseminated cows and that the P4-embryotrophic effects may down-regulate the mechanisms involved in the earlier luteolytic process caused by greater exposure of uterus to P4. Support for this study was provided by the São Paulo Research Foundation (FAPESP, Sao Paulo, Brazil) and Ourofino (Cravinhos, SP, Brazil).