Echo Signs Research Articles

RISK FACTORS IN THE DEVELOPMENT OF LIVER ABSCESSES AND DIAGNOSTIC STRATEGY IN THEIR SUSPECTED PRESENCE

Introduction: The main risk aetiological factors of liver abscesses and development of precision liver ultrasound recommendations to detect signs of possible abscess formation were studied.Material and methods: 248 patients of both sexes aged 4-81 years with liver abscesses were analyzed. Medical history, physical examination, clinical laboratory tests, hydrogen breath test with, ultrasound examination, if necessary - computed tomography and fine needle diagnostic biopsy under ultrasound guidance were carried out..Results and discussion: It was established that liver abscesses are aetiologically heterogeneous, in which the largest in the group was pylephlebitic (64.1%), posttraumatic (14.5%), cholangiogenic (12.5%) and contact abscesses (1.2 %). In connection with the effacement or nonspecific clinical picture, often severe condition of the patient, the prevalence of symptoms in some cases of other diseases, liver abscesses may not be promptly diagnosed.Conclusion: The presence of clinical and laboratory signs of suppurate inflammatory processes, risk factors such as the presence of bacterial overgrowth syndrome, inflammatory diseases of the intestines, history of the use of proton pump inhibitors, diseases in association with cholestasis, surgery, history of trauma, abscesses of other locations, it is recommended that precision liver ultrasound should be carried out to detect possible echo signs of liver abscesses.

Evaluation of the Resources tibialis anterior muscle of the shin in Patients with Achondroplasia during Lengthening (Ultrasound Examination)

The purpose of the study was the determination of echo signs of the resourcesof tibialis anterior muscle of the shin in patients (6-18 years old) with achondroplasia. The patients were examined before treatment and in the process of shin lengthening ondays 10, 20, 30, 60 and 90 after distraction initiation with Ilizarov apparatus. Mean lengthening made up 9±2cm. Ultrasound examination was performed on VOLUSON-730PRO (Austria) and AVISUS Hitachi (Japan) systems. Echo signs indicative of the reduction of the resources of tibialis anterior muscle of the shin during lengthening, i.e. violation of typical muscular striation, change in the direction of muscular fibers bands, thinningof intermuscular septum, decrease in contractile muscular response by 90±5% and increase in acoustic density by 45% as compared with the initial level, were identified. At the exhaustion of reserve potential of tibialis anterior muscle of the shin the effect of “frosted glass” was visualized, with the exception of patients with achondroplasia aged 6-1- years in whom marked destructive changes in tibialis anterior muscle of the shin during the first months of distraction were associated not only with tissue alteration but with insufficient physiological maturity of the organism.

Evaluation of the Resources tibialis anterior muscle of the shin in Patients with Achondroplasia during Lengthening (Ultrasound Examination)

The purpose of the study was the determination of echo signs of the resourcesof tibialis anterior muscle of the shin in patients (6-18 years old) with achondroplasia. The patients were examined before treatment and in the process of shin lengthening ondays 10, 20, 30, 60 and 90 after distraction initiation with Ilizarov apparatus. Mean lengthening made up 9±2cm. Ultrasound examination was performed on VOLUSON-730PRO (Austria) and AVISUS Hitachi (Japan) systems. Echo signs indicative of the reduction of the resources of tibialis anterior muscle of the shin during lengthening, i.e. violation of typical muscular striation, change in the direction of muscular fibers bands, thinningof intermuscular septum, decrease in contractile muscular response by 90±5% and increase in acoustic density by 45% as compared with the initial level, were identified. At the exhaustion of reserve potential of tibialis anterior muscle of the shin the effect of “frosted glass” was visualized, with the exception of patients with achondroplasia aged 6-1- years in whom marked destructive changes in tibialis anterior muscle of the shin during the first months of distraction were associated not only with tissue alteration but with insufficient physiological maturity of the organism.

Diastolic bicycle stress echocardiography: Normal reference values in a middle age population

After obtaining their written informed consent, 60 consecutive healthy subjects (F/M = 14/46, age = 53.3 ± 8.4 years), with normal blood pressure, not taking any cardiovascular medication, without ischemic heart disease or cardiac symptoms, and not exhibiting echo signs of stress inducible ischemia, were studied. Obese (body mass index N30 kg/m 2 ) and diabetic subjects were also excluded. All subjects underwent a standard echo Doppler exam (Vivid 7, GE, Horten, USA) at rest, during and after a symptom-limited, graded bicycle exercise (25W 3 minute increment) by a cycle ergometer (ebyke, GE Healthcare, Milwaukee, USA) in semi-supine position (45°), with head tilt of 0° to 20° (to obtain the best echo view for imaging), until exhaustion. Blood pressure, obtained by a cuff sphygmomanometer, and 12-lead ECG were monitored. Echocardiographic images were acquired in apical 4-, 2- and 3-chamber views and also in parasternal long-axis view. EF was calculated measuring end-diastolic and end-systolic volumes by the biplane method. LV diastolic evaluation included transmitral inflow parameters (E and A peak-velocities, E/A ratio, E velocity deceleration timeandpulsed TissueDoppler e' velocityatseptalandmitralannulus). The e' velocity was averaged (septal e' + lateral ee'/2) and the E/ee' ratio was computed (using septal ee', lateral ee' and average ee') both at rest and immediately after exercise. Fig. 1 displays the method to calculate E/ee' ratio both at rest and immediately after the completion of bicycle exercisein a normal subject. Continuousvariables were summarized asmean± SD.Parametersof diastolic function were alsopresented as the 95% of their confidence interval. Differences of variables between rest and peak exercise were computed by Student's paired t-test. Statistical significance was defined for p b 0.05.

Results of Emergency Postoperative Re-Angiography After Cardiac Surgery Procedures

The purpose of this study was to evaluate the diagnostic and therapeutic role of emergency coronary angiography (ECA) in the setting of acute ischemic or hemodynamic instability after cardiac surgery. Between January 2005 and September 2014 we prospectively collected data from a consecutive cohort of 5,275 patients who underwent cardiac surgery. Patients who underwent ECA due to new ST-segment changes on electrocardiogram (ECG), ventricular arrhythmias, cardiac arrest or hemodynamic collapse, new changes in regional wall motion, or any other relevant suspect of myocardial ischemia during postoperative intensive care unit stay were included. Forty patients (0.7% of the overall population) were enrolled. Nineteen patients (47.5%) received isolated coronary surgery, 21 (52.5%) underwent valve or aortic or combined operations. The most common indications to ECA were new ECG or echo signs of acute ischemia (62.5%). The mean time from primary operation to ECA was 51 hours (27 minutes to 9 days). Graft failure was found in 17 cases (42.5%), native coronary artery occlusion in 7 (20%), and coronary spasm in 5 (12.5%). No pathologic alterations were found in 7 cases (17.5%). Three patients (7.5%) underwent reoperation (group 1), 15 (37.5%) underwent percutaneous interventions (PCI) (group 2), and 22 (55%) were managed conservatively (group 3). In-hospital mortality was 100% in group 1, 6% in group 2, and 0% in group 3; 93% of the patients who underwent PCI had complete resolution of the ischemic or hemodynamic problems. No complications related to angiography occurred. Kaplan-Meier survival curves differed significantly according to the post-angiography management. At multivariate analysis combined surgery and the strategy of treatment were independent predictors of long-term mortality. Emergency coronary angiography is safe and allows diagnosis and resolution of the instability in the great majority of cases. An ECA should be the first-line measure in case of acute ischemic or hemodynamic instability after cardiac surgery.

Echocardiographic features of congestive heart failure in patients with chronic obstructive pulmonary disease

Aim. To optimize echocardiographic diagnosis of congestive heart failure in patients with chronic obstructive pulmonary disease (COPD). Methods. Several modes of echocardiography using HD 11XE (Philips, USA) ultrasound scanner, 24-hour ECG monitoring using Microvit MT-101 (Schiller, Switzerland) 3-channel recorder and spirometry using АFD-02-«МFP» (Russia) machine were performed in 157 patients aged 39-76 years (male - 114, female - 43) who were divided into the following subgroups: (1) patients with COPD alone, (2) patients with COPD and concomitant arterial hypertension, (3) patients with COPD and concomitant ischemic heart disease, (4) patients with ischemic heart disease, (5) healthy controls. Results. 55.4% of patients with COPD had clinical signs of congestive heart failure (with signs of isolated diastolic dysfunction in 85.7% of patients with congestive heart failure). Diastolic dysfunction was associated with increase of peak isovolumic velocity (IVV) and even more significant decrease of peak early (Ea) and late (Aa) diastolic annular tricuspid vale velocities ratio at pulsed Doppler tissue imaging compared to patients without congestive heart failure. In patients with isolated COPD and isolated diastolic dysfunction echo signs of right ventricle dilatation, and in patients with COPD and concomitant ischemic heart disease - also of pulmonary artery trunk dilatation and hypertrophy of both ventricles were significantly more frequent. Systolic dysfunction was found only in patients with COPD and concomitant ischemic heart disease, causing longitudinal systolic dysfunction of the right ventricle seen as a reduction of systolic excursion and peak systolic (Sa) annular velocity, increased Myocardial Performance Index (Tei Index) and corrected isovolumic relaxation time, as well as hypertrophy of both ventricles and left ventricular dilatation. Conclusion. Echocardiography (Doppler tissue imaging) can be used for congestive heart failure diagnosis verification in patients with COPD.

A Novel Two‐Dimensional Echocardiographic Finding in Cardiac Amyloidosis

A number of echocardiographic findings characteristic of cardiac amyloidosis (CA) have been described, each with limitations. A distinctive wall motion pattern of preserved myocardial thickening at left ventricular apex with hypokinesis in basal and midsegments was observed in two patients with biopsy proven CA. Following this observation, endomyocaradial biopsy files beginning in 2007 were reviewed. Seven consecutive patients with documented CA were identified. Two-dimensional (2D) echocardiograms for each were reviewed in consensus by two experienced echocardiographers. Clinical and electrocardiographic data were obtained from chart review. All patients were men with class II-IV heart failure. Six had light chain CA, 1 senile CA. Six patients had coronary angiography. One had a 60% left anterior descending coronary artery stenosis. Five had nonobstructive disease. Echocardiograms for all seven patients demonstrated the distinctive pattern of preserved myocardial thickening at apex with hypokinesis in basal and midsegments. Reduced ejection fraction was present in six and increased wall thickness and myocardial echogenicity in seven. Other echo signs of amyloid were variably present. Three had low voltage on electrocardiogram. A distinctive 2D echocardiographic pattern of preserved segmental wall motion at left ventricular apex with hypokinesis in basal to midsegments was consistently identified in seven consecutive patients with endomyocardial biopsy-proven CA.

Aspects of Information Communications Technology for Better Medical Control

The 3G mobile phone has propagation problems in urban areas and experiences severe congestion after major disasters in supporting mobile eHealth. We expect a Quasi-zenith satellite with nationwide coverage. In near future, the data transmission of image of pharygoscopy, motion picture of light reflex, 12-leads ECG, automated ultrasonic echo and vital signs from ambulances shall be performed to assist medical control. For example, Thrombolytic agents are reportedly effective even when injected into a vein, if injected in the early stages of acute myocardial infarction, which will reduce medical costs, resulting in high-quality services available uniformly across the nation. This paper describes Japanese aspects of mobile eHealth to support ambulatory applications.

Japanese Telemedical Concept of Ambulatory Application

Transmission of in-ambulance data without inconveniencing or undue effort by the rescue crew-in other words, automation of in-ambulance activities (measurement/analysis, activity recording, message transmission)-is essential in implementing uniform medical control standards across the nation. However, the 3G mobile phone has propagation problems at urban area and severe congestions after major disaster to support mobile telemedicine. So we are expecting the Quasi-zenith satellite with nationwide coverage. In near future, we are expecting the data transmission of image of pharygoscopy, motion picture of light reflex, 12-leads ECG, automated ultrasonic echo and vital signs from ambulances to triage center. For example, Thrombolytic agents are reportedly effective even when injected into a vein, if injected in the early stages of acute myocardial infarction, that will reduce medical costs, resulting in high-quality services available uniformly across the nation. This paper describes our basic concept to support ambulatory application.

Skin Disorder Markings May Echo Signs of Abuse

Skin Disorder Markings May Echo Signs of Abuse

Acoustic evaluation of the vertical distribution of dwarf ayu Plecoglossus altivelis altivelis in Lake Biwa

SUMMARY: The vertical distribution of dwarf ayu Plecoglossus altivelis altivelis in the pelagic waters of Lake Biwa was evaluated from June to September in 1995–97 from eight acoustic surveys using a quantitative echosounder. In each survey, echoes from a depth range of 3 m to the sea bottom were collected at a station every 2.7 s for 24 h together with measurements of vertical profiles of water temperature and chlorophyll-a. The ayu's echoes were identified using an underwater video camera. The ayu were observed near the maximum chlorophyll-a depth and above the thermocline. Their density was highest at depths of 4–11 m with 2–4 individuals/m3 and was almost zero below 20 m. Echo signs were recorded as having a frequent duration of more than 1 h at night, whereas were of a shorter duration in the day. The fish stay in the epilimnion during the day without any clear vertical migration, but are distributed more uniformly at night. The advantages of remaining in the epilimnion are discussed in terms of food availability and predator avoidance.

Effects of surrounding conditions on boundary and internal echoes of simulated mass lesions: A phantom study

Ultrasonography has been widely used in the maxillofacial region because of the ability to demonstrate pathological conditions in real time without radiation exposure. However, echo patterns of mass lesions vary with the surrounding tissue conditions. To examine the effects of the various surrounding conditions on depiction of such lesions on echograms, we constructed a model, an echo phantom consisting of an agar object, with or without scattering (methylcellulose) or absorptive (barium sulfate) material, and a corresponding surrounding medium. The object's boundary clarity decreased with increasing concentration of either the surrounding scattering or absorptive media, whereas the internal echo intensity of the object also decreased only with increasing concentration of the surrounding absorptive medium. The object with absorptive material produced peripheral echoes at the border. These results suggest that care should be taken when boundary echoes are evaluated as echo signs of lesions.

Echocardiography in the diagnosis of hypertrophic obstructive cardiomyopathy

The role of echocardiography in the diagnosis of hypertrophic obstructive cardiomyopathy is reviewed. Salient features include a narrowed left ventricular outflow space, the increased thickness of the interventricular septum and the systolic anterior motion of the anterior mitral leaflet. The last may be present at rest, or it may be provoked with appropriate maneuvers. When all three features are demonstrated, a diagnosis of hypertrophic obstructive cardiomyopathy can be made with confidence. In the absence of resting or provocable systolic anterior motion, a diagnosis of nonobstructive cardiomyopathy may be entertained. An additional important echocardiographic feature of hypertrophic obstructive cardiomyopathy consists of an interventricular septal to posterior wall ratio in excess of 1.5, suggesting the asymmetric distribution of hypertrophy. Inert interventricular septum, aortic valve preclosure and a reduced diastolic slope of the anterior mitral leaflet are frequently present, but not specific for the condition. When hypertrophic obstructive cardiomyopathy is associated with other unrelated diseases, the index of suspicion may be raised even in the absence of all the “classic” echo signs. In response to treatment, it has been shown that beta adrenergic blockade only rarely results in abolition of systolic anterior motion, whereas successful ventriculomyotomy and/or myectomy more consistently suppresses systolic anterior motion. Longitudinal studies with echocardiography are expected to add new light on the patterns of progression of this obscure disorder.