Doppler Examination Research Articles

#6282 MAKING DECISION OF VASCULAR ACCESS TYPE BASED ON UPPER ARM DOPPLER PARAMETERS AMONG INCIDENT HEMODIALYSIS PATIENTS: A SINGLE CENTER EXPERIENCE

Abstract Background and Aims Functional vascular access (VA) remains one of the most important problems related to successful hemodialysis (HD) treatments. Pivotal issue related to inadequate vascular access is decision making process of which type of VA should be created at start. Therefore, the aim of our study is to examine possible impact of Doppler examination of upper arm on decision of VA type creation. Method During 5 year period (January 2018th- December 2022th), 260 patients started hemodialysis in our department. Among them, 18 died during the first three months after HD was started, 3 were transferred to other hospitals for chronic HD program and 5 have created vascular access in other hospitals. So, we analyzed data for 234 patients (No=150, 63.6% males, mean age 62.6±13.8) which vascular access were created in our Center. We have divided them into two groups (Group A-patients with arterio-venous fistula (AVF) as first created VA and group B-patients with arterio-venous graft (AVG) or permanent central venous catheter (pCVK) as first created VA. From medical records, we have collected demographic data, type of created vascular access, Doppler parameters of upper arm and laboratory findings. Results Out of 234 patients, in Group A were167 patients (male No=109, 65.2%, mean age 61.0 years±13.8), while in group B were 67 patients(male No=40, 59.7% mean age 66.8 years±13.2). In table 1, demographic, laboratory and Doppler data is presented. We found that in Group A patients are statistically younger (61.0 years ±13.8 vs 66.8 years ±13.2, P = .004) and their vena cephalica (2.9mm± 2.5 vs 1.9mm±0.1, P = .000) and arteria radialis (2.2mm±0.4 vs 1.9mm±0.1, P = .002) are with better diameters. Also, their protein levels were statistically lower (69±9 vs 78±3, P = .036) and CRP levels higher (21.2±35.3 vs 8.1±2.1, P = .000) compared to Group B. Binary logistic regression revealed that there are no statistically significant variables that could impact decision to create AVF, but larger diameter of vena cephalica increase this decision over 13 fold (OR 13.497, CI 0.706-257.868, P = .084), and diameter of arteria radialis 17 fold (OR 17.073, CI 0.372-784-182, P = .146). Conclusion Diameteres of vena cephalica and arteria radialis could be the main variables in the planning of type of vascular access.

The Fetal Liver Afferent Venous Flow Volumes in Fetuses With Appropriate for Gestational Age Birth Weight.

The present study aimed: 1) to simultaneously investigate the relationship between blood flow volumes of the two fetal liver afferent venous systems of normally appropriate for gestational age newborns. 2) to establish the normal reference range centiles values that will serve as a basis for future investigations. A cross-sectional, prospective study of singleton low obstetric risk pregnancies. Doppler examination included the measurement of the umbilical and the main portal vein vessels' diameters and time-averaged maximum velocity. The absolute and per kilogram of estimated fetal weight flow volumes and the ratio between the placental and portal blood volume flow were calculated from these data. Three hundred and sixty-three pregnant women were included in the study. The umbilical and portal flow volumes' capacity to provide blood flow per kilogram of fetal weight, in the period of maximum fetal growth, was diverse. The placental flow decreased continuously from a mean of 121.2 mL/min/kg at the 20th week of gestation to 64.1 mL/min/kg at the 38th week of gestation. Meanwhile, the portal flow volume per kilogram of fetal weight increased from 9.6 mL/min/kg at 32 weeks of gestation to 10.3 at the 38th week of gestation. This resulted in a decrease in the umbilical to portal flow volume ratio from 13.3 to 9.6 during this period. Our results indicate that in the period of maximum fetal growth, the placental/portal ratio diminishes emphasizing the portal flow's predominance with low oxygen and nutrient supply to the liver.

DAPAGLIFLOZIN MODULATES ADROPIN SERUM LEVELS IN PATIENTS WITH TYPE 2 DIABETES MELLITUS AND CHRONIC HEART FAILURE

Objective: To investigate an effect of sodium glucose linked transporter 2 (SGLT2) inhibitor dapagliflosin on the levels of adropin in patients with type 2 diabetes mellitus (T2DM) with chronic heart failure (HF). Design and method: The study is open label multicenter (private hospital Vita-Centre, Zaporozhye, Ukraine, EliteMedService, Zaporozhye, Ukraine and City Hospital #7, Zaporozhye, Ukraine) non-randomized cohort investigation. We prospectively enrolled 417 patients with T2DM and HF from entire cohort of 612 T2DM pa-tients. The eligible patients were treated with guided-recommended HF therapy de-pending on HF phenotypes, which included SGLT2 inhibitor dapagliflozin in a dose of 10 mg OD orally along with angiotensin receptor-neprilysin inhibitor (ARNI) / ACE inhibitors / angiotensin-II receptor blockers (ARBs), mineralocorticoid receptor antag-onist (MRA), beta-blockers. Anthropometrics, clinical data, Echocardiography / Doppler examinations and biomarkers assessments were performed at the baseline and over 6-month interval. Results: Over 6-month period after initial prescription of SGLT2 inhibitor dapagliflozin the levels of adropin in entire group demonstrated a significant growth up to 26.6% (from 237.4 [25%-75% IQR = 190.50–275.30] ng/mL to 300.2 [25%-75% IQR = 267.80–335.70] ng/mL, P = 0.04). In female subgroup, an increase in circulating level of adropin was sufficiently higher (from 269.5 [25%-75% IQR = 231.20–299.20] ng/mL to 365.2 [25%-75% IQR = 340.10–388.60] ng/mL, P = 0.01), when com-pared with male subgroup (from 211.2 [25%-75% IQR = 190.40–237.50] ng/mL to 259.6 [25%-75% IQR = 206.50–321.40] ng/mL, P = 0.16). Multivariate logistic regression analysis of entire group showed that relative changes of left ventricular (LV) ejection fraction (LVEF), left atrial volume index (LAVI), and E/e` were significantly associated with increased adropin levels. In fe-male subgroup, but not in male subgroup, relative changes of LVEF (P = 0.046), LAVI (P = 0.001) and E/e` (P = 0.001) exhibited their independent predictive values for adropin changes. Conclusions: The levels of adropin seem to be a predictor for favorable modification of hemodynamic perfor-mances that is independent from N-terminal brain natriuretic pro-peptide.

Four-dimensional imaging of umbilical-vein-to-right-atrium shunt in fetus with Type-I Abernethy malformation.

Videoclip S1: The four-chamber view showing dilated right atrium and significant herniation of the RFOA into the left atrium resulting in stretching of the primum septum resembling an ostium primum atrial septal defect. Videoclip S2: Four-chamber grayscale and color Doppler showing vigorous and bidirectional blood flow across the foramen ovale and reduced mitral inflow. Videoclip S3: Grayscale and color Doppler sweep from fetal upper abdomen to four-chamber view showing the umbilical vein draining directly into the right atrium. Videoclip S4: Sagittal color Doppler imaging of the fetal abdomen showing the anomalous extra-hepatic course of the umbilical vein draining directly into the right atrium. Videoclip S5: Axial four-chamber 4D STIC HD-live color silhouette volume rendering showing the extra-hepatic course of umbilical vein draining into the right atrium (hand symbol). Videoclips S6 and S7: Sagittal 4D STIC HD-live color silhouette volume rendering of the fetal abdomen showing the extra-hepatic course of the umbilical vein draining into the right atrium. The ductus venosus and intrahepatic portal venous system (right and left portal veins) were absent. Videoclip S8: Axial color Doppler examination of the fetal abdomen showing compensated liver perfusion by increased hepatic artery blood flow and end to side extrahepatic drainage of main portal vein to inferior vena cava. Videoclip S9: Oblique sagittal 4D STIC HD-live color silhouette volume rendering of the fetal abdomen showing the increased hepatic artery blood flow (hand symbol). Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

Congenital cardiac malformations in children with down syndrome: An echocardiographic based study.

Objective: To find out the prevalence and pattern of congenital heart diseases (CHDs) in children with Down syndrome (DS). Study Design: Cross-sectional study. Setting: Department of Pediatrics, Rai Medical College Teaching Hospital, Sargodha, Pakistan. Period: January 2021 to December 2022. Material & Methods: A total of 165 children of either gender, aged 1 month to 12 years with DS diagnosed with the help of typical clinical features and confirmation by cytogenetic studies were analyzed. Children diagnosed with DS were further evaluated for cardiac assessment as per 2-D echocardiographic and Doppler examinations. The prevalence of CHDs was noted among children with DS. Results: In a total of 165 children with DS, 86 (52.1%) were male. The mean age was noted to be 1.8±1.2 years while 106 (64.2%) children were aged below 1 year. The existence of CHDs was found to be in 56 (33.9%). Among 56 children with CHDs, ventricular septal defect (VSD), atrial septal defect (ASD) and tetralogy of fallot (TOF) were the commonest forms of CHDs noted in 16 (28.6%), 12 (21.4%) and 9 (16.1%) children respectively. Conclusion: High prevalence of CHDs in children with Down syndrome was noted. The VSD and ASD were the most common forms of CHDs among children with Down syndrome.

P130 FINGER ISCHEMIA IN A YOUNG LADY: EXPECT THE UNEXPECTED FROM A PAPILLARY FIBRO–ELASTOMA

Abstract Case presentation: In December 2022, A 32–y old women presented to the emergency department of our institution for pain and acrocyanosis of the 3rd and 4th finger of the right hand, compared abruptly 10 hours before. Physical examination was otherwise normal, she was apyretic. Her previous medical history was unremarkable, she did not take any medication and was a light smoker. Blood samples including blood count, platelets, coagulation tests, liver and kidney function, and inflammatory markers were normal. An echocardiogram was prescribed to rule out significant cardiovascular disease. The exam showed: normal left and right ventricular dimensions and systolic function, and absence of significant valvular disease. A highly mobile, iso–echoic mass was noted inside the left ventricle, with a major diameter of 8 mm; it was attached to the antero–lateral papillary muscle, not involving the mitral valve leaflets, and it had a frond–like appearance. Findings were consistent with a fibroelastoma (PFE; figure 1, 2). Doppler examination excluded pathology of ascending aorta, right subclavian artery, and demonstrated patency of arteries of the right arm and right hand. The case was compatible with peripheral embolization from the cardiac mass. A cardiac CT scan confirmed the echo findings and ruled out significant coronary disease. The patient underwent cardiac surgery two days later. With median sternotomy and cardiopulmonary bypass, the left ventricle was reached through aortotomy. A multilobular yellowish mass was seen attached to the antero–lateral papillary muscle, and was completely resected (figure 3); chordae tendineae were preserved. Macroscopic examination (figure 3) and histological findings confirmed the diagnosis of PFE. Post operative course was unremarkable. Discussion PFEs are benign tumors most commonly involving aortic valve, followed by mitral valve; atypical origins including mitral subvalvular apparatus, as in our case, has seldom been described. Most cases of PFE are asymptomatic, limited in dimensions and discovered incidentally. Interestingly, Raynaud phenomenon was at first suspected as cause of acrocyanosis in our patient, but it was inconsistent with biochemical findings, so that an echocardiogram was prescribed. Echo and CT aspects of the mass were typical for PFE, and it appeared at high embolic risk being pedunculated and highly mobile. Given the peripheral ischemic event occurred, prompt surgical resection was performed successfully.

Evaluation of the relation between cerebroplacental ratio, umbilical-cerebral ratio, and cerebro-placental-uterine ratio with the occurrence of adverse perinatal outcomes in pregnancies complicated by fetal growth restriction

Introduction: Fetal growth restriction (FGR) is a major obstetric complication associated with an increased risk of adverse perinatal outcomes. Objectives: This study aimed to evaluate the relationship between Doppler parameters, including the cerebroplacental ratio (CPR), umbilicocerebral ratio (UCR), and cerebro-placental-uterine ratio (CPUR), with adverse perinatal outcomes in singleton pregnancies complicated by FGR. Patients and Methods: This was a prospective study of 100 women with a singleton pregnancy 28 and 36.8 weeks of gestation was complicated by FGR and mild abnormalities. Feto-maternal Doppler examinations were conducted by the CPR, UCR, and CPUR parameters. Adverse outcomes were defined as Apgar score <7 at 5 minutes, preterm birth <37-week, neonatal intensive care unit (NICU) admission, fetal distress, and emergency cesarean section. These outcome parameters were checked with the results of the last ultrasound which performed 1-2 weeks before delivery. Results: Mean umbilical artery pulsatility index (UA-PI) (1.18±0.31 versus 1.04±0.21, P=0.010) and mean uterine arteries (UtAs)-PI (1.18±0.45 versus 0.96±0.36, P=0.20) were significantly higher in pregnancies that experienced adverse perinatal outcomes than those that did not experience them. Mean CPUR (1.82±1.03 versus 2.25±0.83, P=0.039) was significantly lower in pregnancies that experienced adverse perinatal outcomes versus those that did not. In binary multivariate logistic regression analysis, CPR, UCR, and CPUR parameters were evaluated with adverse perinatal outcomes. Only CPUR had a significant relationship with adverse perinatal outcomes. CPUR had a substantial relationship with Apgar score <7 at 5 minutes (OR: 0.13; 95% CI: 0.02-0.63; P=0.012). Conclusion: CPUR is a new Doppler ratio associated with adverse perinatal outcomes in FGR pregnancies with minimal abnormalities.

Erken Gebelikte Vajinal Kanamanın İlk Trimester Tarama Testi, Uterin Arter Doppler İndeksleri ve Perinatal Sonuçlara Etkisi

Aim: We aimed to prospectively investigate the effect of first trimester vaginal bleeding on first trimester screening test, uterine artery (UtA) Doppler results and perinatal outcomes. Material and Methods: Fifty cases that presented with vaginal bleeding in the first trimester between 2019 and 2020 constituted the early vaginal bleeding (abortus imminens-threatened abortion) group and fifty cases without a history of vaginal bleeding in pregnancy constituted the control group. Demographic datas were noted at the first visit. Both groups were followed up until birth. First trimester screening test (double screening test) between 11-14 weeks and UtA Doppler examination between 20-24 weeks of gestation was performed. Perinatal outcomes and values of nuchal translucency (NT), free β human chorionic gonadotropin (f β-hCG), pregnancy-associated plasma protein A (PAPP-A), and UtA Doppler were compared between the two groups. Results: There was no statistically significant difference was found between the two groups in terms of NT and PAPP-A among the first trimester screening test results (p=0.741 and p=0.937, respectively). In the group with threatened miscarriage, f β-hCG value was numerically higher, but there was no statistically significant difference (1.24±0.59 vs. 1.1±0.93, p=0.057). In the Doppler examination of the UtA, there was no statistically significant difference between the groups in terms of systolic/diastolic ratio, pulsatility index, resistive index and the presence of a notch (p=0.713, p=0.528, p=424, p=0.538, respectively). Perinatal complication rate was statistically significantly higher in the study group (p=0.013; Odds Ratio:3.2, 95% CI 1.2-8.3). Conclusion: Contrary to some different studies, we believe that first trimester screening test parameters or uterine artery Doppler flow indices do not have a place in predicting perinatal outcomes of pregnant women with a history of vaginal bleeding in the first trimester. In addition, early vaginal bleeding does not significantly affect screening parameters. Perinatal complication rate was found to be statistically significantly higher in the group with a history of threatened miscarriage.

Pulse wave Doppler ultrasound of umbilical cord in experimentally induced pregnancy toxemia in sheep

Contrary to its widespread use in human cases, the use of Doppler ultrasonography is only recently becoming prevalent in farm animals. This study aimed to determine the effects of maternal metabolic and clinical changes on fetal hemodynamics during pregnancy toxemia with the doppler examination of umbilical cord. In the study twenty ewes with a single healthy fetus were included in the study. At the end of the 120th day of pregnancy, 20 single-bearing pregnant ewes were randomly categorized into two groups. Ewes in the control group were fed to meet all nutritional requirements. On the other contrary, the experimental ewes were fed to meet equivalent to 50 % of the daily needs and then fasted for 96 h. Doppler ultrasonographic examinations of umbilical cord were performed once every two days and once a day during fasting. Beta hydroxybutyric acid (BHBA) concentration was measured by taking blood from sheep on examination days. Pulse systolic velocity (PSV), end diastolic velocity (EDV), PSV/EDV, pulsatility index (PI), resistance index (RI), and fetal heart rate (FHR) as well as BHBA values and how those parameters has changed over time (time by treatment effect) due to energy deprivation during pregnancy were evaluated using repeated measure analysis of variance. No clinical signs were observed in both toxemia and control groups during restricted feeding. BHBA concentration increased and there was a significant time, time by treatment and main effect of treatment effect between groups. No significant main effect of treatment and time by treatment interaction was observed in the changes of PI, RI, FHR, and systolic/diastolic velocity values over time in both groups. FHR was reduced over time, and there was a significant time effect in FHR in both groups. Although doppler indices didn't increase, both PSV and EDV values increased significantly in the pregnancy toxemia group compared with the controls (Time P = 0.03, time by treatment interaction P < 0.05) and the main effect of treatment P < 0.05). The marked increase in blood velocities (PSV and EDV) in the umbilical cord is probably due to the compensatory functioning for excessive energy deprivation of the fetus. Therefore, PSV and EDV might be a valuable indicator for evaluating the fetus's health status during the management of the PT.

Особливості перебігу вагітності та пологів у жінок із ранньою та пізньою формами затримки росту плода

Purpose - to determine the features of the course of pregnancy and childbirth in women who had complications from the group of major obstetric syndromes (MОS), which were clinically manifested by early and late forms of fetal growth retardation syndrome (GRS). Materials and methods. A prospective analysis of the characteristics of the course of pregnancy and childbirth was conducted in 99 women who had complications from the group of MОS and were clinically manifested by fetal GRS, of which the Group I - 21 pregnant women with an early form of GRS, the Group II - 78 pregnant women with a late form of GRS. The diagnosis of GRS was established on the basis of ultrasound and Doppler examination data using percentile curves. Statistical processing of research results was carried out using standard Microsoft Excel 5.0 and Statistica 6.0 programs. Results. The analysis of the course of the II trimester in the Group II of pregnant women showed that the threat of termination of pregnancy occurred in 22 (28.2%) cases, with the transition to isthmic-cervical insufficiency and was 5 (6.4%) cases. An increase in the frequency of arterial hypertension was noted up to 3 (14.3%) cases in the Group I of pregnant women, while acute respiratory diseases in 6 (7.7%) cases and gestational pyelonephritis in 4 (5.1%) cases occurred only in the Group II female patients. The diagnosis of placental insufficiency and GRS was made more often in the Group I and amounted to 6 (5.8%) cases. In the III trimester of pregnancy in the examined patients, it was found that the diagnosis of placental insufficiency was in 7 (33.3%) patients, preeclampsia in 6 (28.6%) pregnant women and arterial hypertension in 3 (14.3%) patients and met reliably more often in the Group I (p&lt;0.05), and such complications as fetal distress in 4 (5.1%) cases, acute respiratory diseases in 6 (7.7%) cases occurred only in the Group II. It was established that in the group with the early form of GRS, the average delivery time was 31 weeks, and in the group with the late form of GRS - 39 weeks. The frequency of delivery by caesarean section in the Group I was significantly higher and amounted to 13 (61.9%) cases against 21 (26.9%) cases in the Group II (p&lt;0.05). Conclusions. The course of pregnancy in women with various forms of the GRS syndrome has its own characteristics, namely: with the early form of the GRS, pregnancy is significantly more often complicated by the threat of termination, gestational anemia, bacterial vaginosis, early development of placental insufficiency, and preeclampsia, which in turn leads to a significant increase in the frequency of cesarean delivery autopsy in case of premature pregnancy. The research was conducted according to principles of Declaration of Helsinki. Protocol of research was proved by local ethical committee, mentioned in institution’s work. Women’s informed consent was obtained for the study. No conflict of interests was declared by the authors.

Medium-Term Results of Staged Laparoscopic Traction Orchiopexy for Intra-abdominal Testes: A Multicenter Analysis

BackgroundStaged laparoscopic traction orchiopexy (SLTO) is a novel technique for the intra-abdominal testis (IAT) based on elongation of the testicular vessels without separating them. This multicenter study evaluated the medium-term results of this technique. MethodsData of SLTO performed in three pediatric surgical centers between 2013 and 2020 were analyzed retrospectively. In 2021, physical and Doppler ultrasound examinations were performed to determine the position and viability of testes. Success was defined as an intra-scrotal testicle without atrophy. ResultsSLTO was performed on 48 cases (55 testes, 7 bilateral). Mean age at first stage was 2.9 (0.8–12.6) years. High intra-abdominal testes were found in 16.4% and in 60% morphological abnormalities were observed. To fix the testes to the abdominal wall monofilament suture was used in 67.3%, braided in 29.1%. Mean time between the two stages was 16.4 weeks; three testes required redo traction.Perioperative complications occurred in 21 patients (38.2%) including insufficient fixation (11), testicular atrophy (4), wound complications (4), adhesion of the spermatic cords (1) and hydrocele (1). In case of insufficient fixation monofilament sutures were used in 90.9%.In 2021 38 patients (43 testes) had physical and 36 patients (41 testes) had ultrasound examinations. Mean follow-up was 2.7 (0.34–7.9) years. Altogether five atrophies were identified, and three testicular ascents (7.0%) occurred. The overall success rate was 82.2%. ConclusionsSLTO may be a feasible alternative to conventional treatments of IATs. Additionally, braided suture seems to be a better option to fix the testicle to the abdominal wall. Level of EvidenceLEVEL IV.

Using Laser Speckle Contrast Imaging to Quantify Perfusion Quality in Kidney and Pancreas Grafts on Vascular Reperfusion: A Proof-of-Principle Study.

This study was registered in ClinicalTrials.gov (NCT04202237). The Moor FLPI-2 blood flow imager was used in 4 patients (1 Simultaneous Pancreas and Kidney, 2 deceased, and 1 living donor kidney transplants) during reperfusion to capture reperfusion data. The following parameters were measured: flux (average speed × concentration of moving red blood cells in the sample volume), doppler centroid, total and valid pixels, valid rate, and total and valid area. Flux data were analyzed with Moor FLPI analysis software. The perfusion characteristics and flux images correlated with initial graft function. LSCI is a safe, noncontact imaging modality that provides real-time, accurate, high-resolution, full field blood flow images and a wide range of flux data to objectively quantify organ reperfusion intraoperatively in kidney/kidney-pancreas transplantation. This modality could be used to develop a robust numerical quantification system for the evaluation and reporting of intraoperative organ perfusion, and aid intraoperative decision-making. Perfusion data could be combined with biomarkers and immunological parameters to more accurately predict graft outcomes.

Preoperative percutaneous Onyx embolization of carotid body paragangliomas with balloon test occlusion.

The study aims to analyze our first experience with direct percutaneous embolization of carotid body tumors (CBTs) using ethylene-vinyl alcohol copolymer (Onyx) along with balloon test occlusion (BTO). A retrospective preliminary single-center study was conducted at the Otorhinolaryngology and Head and Neck Surgery Department and the Medical Imaging Department of the University Teaching Hospital. A consecutive series of three patients with CBTs was treated at the local institution between October 2018 and June 2019. All three patients underwent preoperative percutaneous embolization using ethylene-vinyl alcohol copolymer (Onyx 18) with the addition of BTO. Outcome measures were the percentage of tumor devascularization, intraoperative blood losses, and operation times. BTO was evaluated by clinical neurological examination and neurosonological transcranial Doppler examination of the middle cerebral artery (MCA). Devascularization of all three tumors was complete or near complete. All three tumors were surgically extirpated with excellent surgical outcomes. The blood losses were minimal, and the average operation time was 2 h and 8 min. BTO was positive in one patient, which was valuable additional information on carotid branches ligation limitations. The other two patients showed negative BTOs with the result of safety of eventual carotid arteries ligations. Preoperative direct percutaneous embolization of CBT with Onyx is a highly effective procedure that significantly facilitates surgery. BTO provides valuable additional information on the most appropriate and safe surgical approach.

Evaluation of cerebral hemodynamic alterations by transcranial Doppler in neonatal sepsis

Background Transcranial Doppler is a noninvasive approach with high temporal resolution, permitting continuous cerebral blood flow velocity recording through major cerebral arteries. Aim To determine cerebral blood flow (CBF) changes in neonatal sepsis (NS) by ultrasound (US) Doppler examination. Patients and methods This prospective case–control trial was conducted on 60 neonates who were divided into two groups: group I (sepsis): 32 neonates with NS diagnosed by clinical and laboratory data and group II (control): 28 healthy neonates with gestational age and sex matched. All cases underwent detailed antenatal and natal history, clinical and laboratory investigations and transcranial Doppler examination with assessment of CBF. Results As regards anterior cerebral artery (ACA) and middle cerebral artery (MCA), peak systolic velocity (PSV) (cm/s) and end-diastolic velocity (EDV) (cm/s) were significantly increased in the sepsis group than in the control group (P&lt;0.001), but both resistive index and pulsatility index were significantly decreased, in the sepsis group than in the control group (P&lt;0.001). Validity of MCA PSV with a cut-off point of 55.4 detects a sensitivity of 94% and specificity of 86%; validity of MCA EDV with a cutoff point of 18 detects a sensitivity of 94% and specificity of 89%; validity of ACA PSV with a cutoff point of 49.3 detects a sensitivity of 88% and specificity of 93%; validity of ACA EDV with a cutoff point of 21 detects a sensitivity of 91% and specificity of 93%. Conclusion NS was found to elevate both PSV, EDV, decrease resistivity, and pulsatility indices causing an elevated CBF and a decreased resistance.

A Scoping Review of Cerebral Doppler Arterial Waveforms in Infants.

Cerebral Doppler ultrasound has been an important tool in pediatric diagnostics and prognostics for decades. Although the Doppler spectrum can provide detailed information on cerebral perfusion, the measured spectrum is often reduced to simple numerical parameters. To help pediatric clinicians recognize the visual characteristics of disease-associated Doppler spectra and identify possible areas for future research, a scoping review of primary studies on cerebral Doppler arterial waveforms in infants was performed. A systematic search in three online bibliographic databases yielded 4898 unique records. Among these, 179 studies included cerebral Doppler spectra for at least five infants below 1 y of age. The studies describe variations in the cerebral waveforms related to physiological changes (43%), pathology (62%) and medical interventions (40%). Characteristics were typically reported as resistance index (64%), peak systolic velocity (43%) or end-diastolic velocity (39%). Most studies focused on the anterior (59%) and middle (42%) cerebral arteries. Our review highlights the need for a more standardized terminology to describe cerebral velocity waveforms and for precise definitions of Doppler parameters. We provide a list of reporting variables that may facilitate unambiguous reports. Future studies may gain from combining multiple Doppler parameters to use more of the information encoded in the Doppler spectrum, investigating the full spectrum itself and using the possibilities for long-term monitoring with Doppler ultrasound.

Eagle Syndrome with Internal Carotid Artery Compression causing Recurred Syncope: A Case Report.

We herein report a 54-year-old man with eagle syndrome who presented with repeated episodes of syncope, especially after moving his head to a downward position. Computed tomography with contrast revealed a bilateral elongated styloid process. The left internal carotid artery was obviously compressed by the left elongated styloid processes. A transcranial Doppler examination detected a significantly decreased blood flow velocity in the left middle cerebral artery when the patient slightly lowered his head position. After surgery, the positional cerebral blood flow alteration disappeared. No further similar syncope episodes have been reported to date.

Prevalence of mitral valve regurgitation in 102 asymptomatic Chinese Crested dogs

IntroductionMitral regurgitation (MR) is one of the main features of myxomatous mitral valve disease (MMVD), which is the most common heart disease in dogs. Myxomatous mitral valve disease affects many small breed dogs, and some breeds such as Cavalier King Charles Spaniels, Dachshunds, Yorkshire terriers, and Miniature Schnauzers have been studied more in detail. Breed-specific information regarding MMVD is valuable for providing appropriate advice on management and breeding. Data, based on insurance statistics in Sweden, show that Chinese Crested dogs (CCD) are twice as likely to visit the veterinarian for a heart-related problem than other breeds. AnimalsOne-hundred two privately owned, healthy CCD were recruited via the Swedish CCD club. Materials and methodsThis was a prospective observational study, in which clinical examinations, blood pressure measurements, and echocardiographic and Doppler examinations were performed in all dogs. Pulsed wave tissue Doppler imaging was performed in 87 dogs. ResultsMitral regurgitation was present in 39 (38%) dogs, whereas a systolic murmur was present in 35 (34%) dogs. Mitral valve prolapse was present in 32 (31%) dogs. Tricuspid regurgitation was found in 29 (28%) dogs. Dogs in the MR group were older (median 9.5 years), and males were overrepresented compared with the non-MR group. Differences were also found between groups regarding left atrial size and transmitral E wave velocity. ConclusionsThe prevalence of MR in CCD is similar to reports in other small breeds. Whether the MR detected in these dogs is a sign of MMVD is unknown.

Pitfalls in Carotid Doppler Interpretation and How to Avoid Them.

Imaging pitfalls commonly occur in carotid Doppler ultrasound and may lead to false positive diagnosis of stenosis, missed diagnosis of stenosis, and errors in grading stenosis severity. These pitfalls may result from suboptimal technique and/or patient-specific factors including coexisting cardiovascular pathology, contralateral high-grade stenosis/occlusion, tortuous vessels, tandem lesions, long-segment stenosis, nearly occlusive stenosis, and heavily calcified plaque. Awareness of these pitfalls and careful assessment of the extent of plaque on grayscale and color Doppler as well as analysis of the spectral Doppler waveforms can help avoid misinterpretation of the carotid Doppler examination.

High-Frequency Ultrasound in Diagnosis and Treatment of Non-Melanoma Skin Cancer in the Head and Neck Region

Non-melanoma skin cancer is one of the most frequently diagnosed cancers in the human body and unfortunately the incidence continues to increase. NMSC is represented by the basal cell carcinomas (BCCs) and squamous cell carcinomas (SCCs), which are the most prevalent forms, and basosquamous cell carcinomas (BSC) together with Merkel cell carcinoma (MCC), which are rare types but with a very aggressive pattern and poor prognosis. The pathological diagnosis is hard to assess without a biopsy, even by the dermoscopy. Moreover, the staging can be problematic because there is no access clinically to the thickness of the tumor and the depth of the invasion. The aim of this study was to evaluate the role of ultrasonography (US), which is a very efficient imaging method, non-irradiating and cheap, in diagnosis and treatment of non-melanoma skin cancer in the head and neck region. Thirty-one patients with highly suspicious malignant lesions of the head and neck skin were evaluated in the Oral and Maxillo-facial Surgery Department and Imaging Department in Cluj Napoca, Romania. All tumors were measured with three transducers: 13 MHz, 20 MHz and 40 MHz. Doppler examination and elastography were also used. The length, width, diameter, thickness, the presence of necrosis, status of regional lymph nodes, the presence of hyperechoic spots, strain ratio and vascularization were all recorded. After that, all patients were treated by surgical resection of the tumor and reconstruction of the defect. Immediately after surgical resection, all tumors were measured again after the same protocol. The resection margins were evaluated by all three types of transducers in order to detect malignant involvement and the results were compared with the histopathological report. We found that the 13 MHz transducers offered a big picture of the tumor but the level of details, in the form of the presence of the hyperechoic spots, is reduced. We recommend this transducer for evaluation of surgical margins or for the large skin tumors. The 20 and 40 MHz transducers are better for viewing the particularities of malignant lesions and for an accurate measurement; however, in the case of large size lesions, assessing all three dimensions of the tumor can be difficult. The intralesional hyperechoic spots are present in case of BCC and they can be used for differential diagnosis of BCC.

Resistivity index mapping in Kidney based on ultrasensitive Pulsed-Wave Doppler and automatic spectrogram envelope detection.

In recent years, ultrasensitive Pulsed-Wave Doppler (uPWD) ultrasound (US) has emerged as an alternative imaging approach for microcirculation imaging and as a complementary tool to other imaging modalities, such as positron emission tomography (PET). uPWD is based on the acquisition of a large set of highly spatiotemporally coherent frames, which allows high-quality images of a wide field of view to be obtained. In addition, these acquired frames allow calculation of the resistivity index (RI) of the pulsatile flow detected over the entire field of view, which is of great interest to clinicians, for example, in monitoring the transplanted kidney course. This work aims to develop and evaluate a method to automatically obtain an RI map of the kidney based on the uPWD approach. The effect of time gain compensation (TGC) on the visualization of vascularization and aliasing on the blood flow frequency response, was also assessed. A pilot study conducted in patients referred for renal transplant Doppler examination showed that the proposed method provided relative errors of about 15% for RI measurements with respect to conventional pulsed-wave (PW) Doppler.