Higher Peak Systolic Velocity Research Articles

Clinical Implications of Hepatic Hemodynamic Evaluation by Abdominal Ultrasonographic Imaging in Patients With Heart Failure.

BackgroundIt has been reported that liver stiffness assessed by transient elastography are correlated with right atrial pressure, which is associated with worse outcome in patients with heart failure (HF). We aimed to clarify clinical implications of hepatic hemodynamic evaluation (liver congestion and hypoperfusion) by abdominal ultrasonography in patients with HF.Methods and ResultsWe performed abdominal ultrasonography, right‐heart catheterization, and echocardiography, then followed up for cardiac events such as cardiac death or worsening HF in patients with HF. Regarding liver congestion, liver stiffness assessed by shear wave elastography (SWE) of the liver was significantly correlated with right atrial pressure determined by right‐heart catheterization (R=0.343; P<0.01), right atrial end‐systolic area, and inferior vena cava diameter determined by echocardiography. Regarding liver hypoperfusion, peak systolic velocity (PSV) of the celiac artery was correlated with cardiac index determined by right‐heart catheterization (R=0.291; P<0.001) and tricuspid annular plane systolic excursion determined by echocardiography. According to the Kaplan–Meier analysis, HF patients with high SWE and low PSV had the highest cardiac event rate (log‐rank P=0.033). In the Cox proportional hazard analysis, high SWE and low PSV were associated with high cardiac event rate (high SWE: hazard ratio [HR], 2.039; 95% CI, 1.131–4.290; low PSV: HR, 2.211; 95% CI, 1.199–4.449), and the combination of high SWE and low PSV was a predictor of cardiac events (HR, 4.811; 95% CI, 1.562–14.818).ConclusionsIntrahepatic congestion and hypoperfusion determined by abdominal ultrasonography (liver SWE and celiac PSV) are associated with adverse prognosis in patients with HF.

Abstract 460: Adventitial Delivery of Nanoparticle Hydrogel-calcitriol Attenuates Restenosis in a Murine Angioplasty Model

Background: Percutaneous transluminal angioplasty (PTA) is the first-line treatment for arteriovenous fistula (AVF) failure and immaturation. High rate of restenosis occurs post PTA procedure caused by venous neointimal hyperplasia (VNH), and decrease the durability of it. Failed AVF showed increased gene expression of Ier3. Poly lactic- co -glycolic acid nanoparticles (PLGA) loaded with 1,25-dihydroxyvitamin D 3 (1,25 NP) can inhibit Ier3 gene expression. Hypothesis: Adventitial delivery of 1,25 NP in hydrogel will reduce venous stenosis in a murine PTA model. Methods: Male C57BL/6J mice underwent partial nephrectomy at day -42 and arteriovenous fistula (AVF) creation at day -14. At day 0, mice were randomized to vehicle group (PTA + PLGA hydrogel) or treatment group (PTA + 1,25 NP hydrogel). Mice were euthanized at day 3 for gene expression analysis and at day 21 for histopathological analysis. Doppler ultrasound was performed weekly to evaluate AVF patency and function. Results: At day 3, PTA + 1,25 NP treated vessels had a significant decrease in the gene expression of Ier3 compared to controls. At day 21, 1,25 NP treated outflow veins had increased lumen vessel area, apoptosis, and higher peak systolic velocity, but decrease in neointimal area/media area ratio, fibroblasts, pro-inflammatory macrophages (M1), fibrosis (picrosirius red staining) and cellular proliferation. Conclusion: Adventitial delivery of 1,25 NP plus PTA has the ability to reduce restenosis and VNH formation. This protective effect is related to inhibition of Ier3 gene expression which modulates vascular inflammation and fibrosis post PTA.

Predictive Value of Abnormal Findings on Covered Transjugular Intrahepatic Portosystemic Shunt Baseline Doppler Sonography.

Doppler ultrasound (DUS) is frequently performed as a screening and diagnostic modality to evaluate the transjugular intrahepatic portosystemic shunt (TIPS) for short- and intermediate-term complications of the procedure. However, the clinical significance of initial frequently observed abnormalities in flow velocities, gradient, and direction in patients with covered TIPS is less studied. A retrospective study was performed between January 2005 and December 2014, and all patients undergoing covered TIPS procedure for the management of portal hypertension were included. Abnormal DUS findings were defined as intrashunt peak systolic velocities (PSVs) less than 90 or greater than 190 cm/s, intrashunt gradient greater than 50 cm/s, and abnormal flow direction in the main, right, and/or left portal veins. A total of 283 patients with adequate clinical follow-up and baseline TIPS DUS were included in the study. Median follow-up was 18.2 months. During the follow-up period, portal hypertension symptoms recurred in 83 patients who underwent TIPS angiography and/or revision. Of the 83, 57 had an elevated portosystemic gradient (>12 mm Hg) requiring angioplasty/stenting. With regard to baseline ultrasound, low PSVs were present in 88 patients (31.1%), high PSVs in 44 patients (15.5%), and elevated gradient in 98 patients (34.6%). The rate of developing TIPS stenosis in the future was not higher in patients with abnormal DUS parameters. For example, 26 (19.7%) of 132 patients with abnormal TIPS velocities developed stenosis compared with 31 (20.5%) of 151 patients with normal velocities (P = 0.9). Based on these results, abnormal DUS findings observed on baseline TIPS ultrasound examination have low predictive value for future covered TIPS dysfunction and failure.

Spontaneous Resolution of Traumatic AV Malformation of the Uterus Following Hysteroscopic Cold Knife Evacuation of Retained Products of Conception

Uterine myometrial arteriovenous malformations (AVM) are reported on color doppler ultrasonography as mosaic pattern of blood flow with different peak systolic velocities (PSV) at different places. High PSV within the AVM may require arterial embolization as treatment. However, we present a case of traumatic AVM with incomplete abortion managed by hysteroscopic cold knife evacuation. This case report is of a young patient with off and on vaginal bleeding for 3 1/2 months following 2nd trimester spontaneous abortion. She had undergone dilation and evacuation (D & E) for incomplete abortion. Now the bleeding was heavy and intermittent not responding to medications. The subsequent TVS examination shows incomplete abortion with myometrial AVM with high PSV. Hysteroscopic cold knife removal of products of conception resulted in immediate resolution of Uterine AVM.

Utility of Doppler ultrasound in early-onset neonatal sepsis.

Background:Neonatal sepsis is an important cause of morbidity and mortality among newborns. As there is paucity of literature regarding early alteration of the cerebral blood flow (CBF) in neonatal sepsis our study aims to evaluate the changes in the CBF velocities and Doppler indices in neonates with early-onset neonatal sepsis (EONS) and to evaluate the predictive accuracy of cerebral blood flow velocities (CBFV) by using ultrasound Doppler as a diagnostic marker of EONS.Methods:This cross-sectional analytical study was conducted over a period of 2 years with 123 neonates enrolled in the study. The neonates were divided into two groups: Group I (with 54 neonates) - neonates with EONS and group II (with 69 neonates) - age-matched neonates without any signs of sepsis. Ultrasound Doppler examination was performed and the cerebral hemodynamics assessed in neonates during the first seventy two hours of life. Doppler indices and CBFV were measured in the internal carotid artery (ICA), middle cerebral artery (MCA), and vertebral artery (VA) of either side. Data were analyzed using the statistical program SPSS version 23.0 (SPSS Inc., Chicago, IL, USA). Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy were calculated at different selected cutoff values for CBFV parameters.Results:Lower resistance and higher peak systolic velocity and end diastolic velocity have been documented in neonates with EONS.Conclusion:Our study shows that the cerebral hemodynamics in neonates with EONS is altered which can be assessed bedside by noninvasive ultrasound Doppler examination.

A Comparison of Doppler Flow Parameters in the Ophthalmic Artery and Central Retinal Artery in Patients With Graves' Disease and Toxic Nodular Goiter.

Purpose: Despite unquestionable clinical usefulness of Clinical Activity Score, the evaluating system needs frequent supplementation. One of such diagnostic tools is Doppler imaging that is used for the analysis of flow in the retrobulbar vessels. The improvement of the reliability and sensibility of measurements could make Doppler imaging an everyday clinical tool and improve the efficacy of treatment in patients with active thyroid-associated orbitopathy. However, the systemic influence of hyperthyroidism on the orbital vessels can falsify the assessment of local inflammation severity.Methods: To eliminate the influence of systemic hyperthyroidism on orbital vessels, we compared peak systolic velocity (PSV), end-diastolic velocity (EDV), and resistance index (RI) in the central retinal artery (CRA), and ophthalmic artery (OA) in patients with hyperthyroidism in the course of Graves' disease without any detectable orbital changes, (CAS = 0) and toxic nodular goiter.Results: There were no statistically significant differences between the patients with Graves' disease and toxic nodular goiter in terms of the examined parameters in either of the arteries. However, higher PSV and RI and lower EDV in the CRA as well as higher PSV and EDV and unchanged RI in the OA were found in the patients with Graves' diseases and toxic nodular goiter.Conclusion: Hyperthyroidism and hyperthyroidism-induced hyperkinetic flow have a systemic influence on the orbital vessels, irrespective of the cause of hyperthyreosis. Thus, it is necessary to compare the flow parameters in retrobulbar vessels in Graves' patients with the toxic nodular goiter patients to eliminate the systemic influence of hyperthyroidism on the orbital vessels.

H19 is not hypomethylated or upregulated with age or sex in the aortic valves of mice.

Epigenetic dysregulation of long noncoding RNA H19 was recently found to be associated with calcific aortic valve disease (CAVD) in humans by repressing NOTCH1 transcription. This finding offers a possible epigenetic explanation for the abundance of cases of CAVD that are not explained by any clear genetic mutation. In this study, we examined the effect of age and sex on epigenetic dysregulation of H19 and subsequent aortic stenosis. Cohorts of littermate, wild‐type C57BL/6 mice were studied at developmental ages analogous to human middle age through advanced age. Cardiac and aortic valve function were assessed with M‐mode echocardiography and pulsed wave Doppler ultrasound, respectively. Bisulfite sequencing was used to determine methylation‐based epigenetic regulation of H19, and RT‐PCR was used to determine changes in gene expression profiles. Male mice were found to have higher peak systolic velocities than females, with several of the oldest mice showing signs of early aortic stenosis. The imprinting control region of H19 was not hypomethylated with age, and H19 expression was lower in the aortic valves of older mice than in the youngest group. These results suggest that age‐related upregulation of H19 is not observed in murine aortic valves and that other factors may initiate H19‐related CAVD in humans.

Augmented Velocity Index: A New Doppler Index Associated with Arterial Stiffness

Augmented Velocity Index (Avi) is a new Doppler index developed to quantify velocity changes at the late systolic peak. We examined its reliability, association with arterial stiffness and cardiovascular risk factors. The Avi is calculated as (late systolic peak velocity − early systolic peak velocity)/(highest peak systolic velocity − end-diastolic velocity). Fifty volunteers (mean age ± standard deviation: 43.5 ± 14.2 y, men: 52%) without known medical illnesses or drug use were recruited. Carotid Doppler waveforms with measurements of Avi were recorded. Carotid pressure waveforms were obtained by applanation tonometry for measurement of the Augmentation Index (AI). Clinical measurements including body mass index (BMI) and blood pressure (BP) were assessed, and fasting blood was taken for measurement of glycemia and lipid profile. Another 15 volunteers (age range: 22–60 y, men: 33.3%) were recruited to study the reliability of Avi measurement. The results revealed that carotid Avi closely correlated with the index of arterial stiffness, AI (r = 0.76, p < 0.001) on Pearson correlation. On multiple linear regression analysis, Avi remained a significant independent determinant of AI after adjustments for clinical variables. The Avi had significant associations with cardiovascular risk factors (age, BMI, total cholesterol, low-density lipoprotein cholesterol, systolic and diastolic BP). The intra-class correlation coefficients for inter-observer and intra-observer reliability of Avi measurements were 0.93 (95% confidence interval [CI]: 0.8–0.98) and 0.97 (95% CI: 0.92–0.99) respectively. In conclusion, the Avi is a reproducible new Doppler index, independently associated with arterial stiffness in terms of the AI, which initially correlated with cardiovascular risk factors.

Early Doppler Ultrasound in the Superior Mesenteric Artery and the Prediction of Necrotizing Enterocolitis in Preterm Neonates.

The purpose of this study was to reveal the correlation between superior mesenteric artery (SMA) blood flow in the first 12 hours of life and the risk of necrotizing enterocolitis (NEC) in preterm neonates. We conducted a prospective study. There were 104 preterm neonates included in our study. The SMA blood flow of each neonate was measured during the first 12 hours of life if the hemodynamic situation was stable. The results of Doppler ultrasound were confidential to the neonatologists and nurses. All of the demographics, comorbidities, and outcomes were recorded and analyzed. Among all of the demographics and comorbidities, the gestational age was related to the measurements of SMA blood flow. We conducted a single-factor analysis of the occurrence of NEC, including the peak systolic velocity (PSV), end-diastolic velocity, time-averaged mean velocity, differential velocity (DV), resistive index, and pulsatility index. A higher PSV (median [interquartile range], 54.165 [42.423-68.463] versus 42.195 [34.278-48.553] cm/s; P = .027) and DV (median [interquartile range], 47.445 [35.010-60.043] versus 32.565 [27.545-39.073] cm/s; P = .020) were significantly related to the risk of NEC. In the logistic analysis including gestational age, PSV, and DV, NEC was significantly associated with gestational age (odds ratio [95% confidence interval], 0.644 [0.456-0.908]; P = .012) and DV (odds ratio [95% confidence interval], 1.144 [1.058-1.237]; P < .01). The area under the receiver operating characteristic curve for the DV was 0.768, with sensitivity 0.875 and specificity 0.604. The cutoff value of the DV was 34.835 cm/s. From this single-center study, we can see the promising value of Doppler ultrasound for the prediction of NEC, but further research is needed.

Hemodynamic Characteristics Associated With Paraclinoid Aneurysm Recurrence in Patients After Embolization.

Objective: To investigate the hemodynamic features before and after embolization of paraclinoidal aneurysms using hemodynamic numerical simulation and the influence of embolization on recurrence after embolization.Methods: From January 2016 to December 2017, we enrolled a total of 113 paraclinoidal aneurysms treated with embolization. They were divided into recurrent group and stable group depending on follow-up results. An aneurysm model was generated based on 3D-DSA before and after embolization. The hemodynamic characteristics were analyzed between two groups using Computational fluid dynamic (CFD).Results: In the recurrent group, the peak systolic WSS, OSI and velocity around the aneurysm neck areas prior to embolization were 20.47 ± 3.04 Pa, 0.06 ± 0.02 and 0.07 ± 0.03 m/s, respectively. These values were 23.50 ± 4.11 Pa, 0.06 ± 0.01 and 0.11 ± 0.02 m/s, respectively in the stable group (P > 0.05). The WSS, OSI, velocity around the same areas in the recurrent group after embolization were 35.59 ± 8.75 Pa, 0.07 ± 0.02 and 0.12 ± 0.03 m/s, respectively (P < 0.01). In the stable group, the WSS, OSI and velocity were 13.08 ± 2.89 Pa, 0.04 ± 0.01 and 0.07 ± 0.02 m/s, respectively (P < 0.01). After embolization, the WSS, OSI and velocity around the aneurysm neck areas in the recurrent group were significantly higher than those in the stable group.Conclusions: High peak systolic WSS, OSI and velocity around aneurysm neck areas after embolization of paraclinoidal aneurysms may be important factors leading to recurrence.

Sonographic grading of recurrent stenosis after carotid stenting and stented peripheral arteries

The increasing endovascular treatment of arterial stenoses requires reliable sonographic criteria for the detection of recurrent stenosis. Placement of a stent reduces the vessel lumen and is assumed to lead to greater rigidity, thereby causing more pulsatile blood flow and a higher peak systolic velocity (PSV). In vitro experiments and clinical trials with duplex ultrasound follow-up after percutaneous transluminal angioplasty (PTA) of the internal carotid artery with carotid artery stenting (CAS) provide inconsistent data on the magnitude of the increase in PSV of in-stent restenosis. They range from unchanged PSV up to 30% higher increases in PSV measurement values compared to those established for stenosis grading in native carotid stenoses. In stented leg arteries, studies even show somewhat lower PSV values compared with stenosis in unstented vessels. The option of applying the continuity law, so far not mentioned in the international literature, allows more accurate grading of in-stent restenosis. This method relates the PSV measured at the site of in-stent restenosis to the prestenotic PSV measured within the stent, thereby eliminating the need to take altered hemodynamics in stented arteries versus unstented arteries into account.

Unexpected middle cerebral artery peak systolic velocity values in the normal fetal population. Are they a matter of concern?

Objective: The aim of this study was to investigate in the fetus the relationship between unexpected high middle cerebral artery peak systolic velocity (middle cerebral artery (MCA) peak systolic velocity (PSV)) values and hemoglobin (Hgb) levels in normal pregnancies without conditions leading to fetal anemia.Material and methods: This was a prospective study of 922 singleton low-risk pregnant women attending the maternity of La Fe Hospital between 35 and 41 weeks. Multiple pregnancies and pregnancies with growth restriction, smallness, macrosomia or conditions leading to fetal anemia were excluded. During each examination, a biometry and a Doppler examination of the umbilical artery pulsatility index (umbilical artery (UA) pulsatility index (PI)), MCA PI and MCA PSV were performed. MCA PSV was converted into multiples of median (MoM), and birth weight (BW) into centiles adjusting for gender. All pregnancies delivered in a 2-week interval since examination. In order to explain Hgb levels at birth, a correlation between MCA PSV MoM and Hgb was performed and Hgb levels of fetuses with normal MCA PSV and abnormal MCA PSV were compared, using 1.3 MoM as cut-off for mild anemia. Finally, a multivariate linear regression analysis was performed including MCA PSV MoM and several Doppler and clinical parameters.Results: The univariate analysis showed no correlation between the MCA PSV MoM and the umbilical artery Hgb (r2 = 0.026, p = .1237) while a weak correlation was found with the umbilical vein Hgb (r2 = 0.0053, p = .027). Also, fetuses with values of MCA PSV MoM <1.3 MoM did not differ in terms of artery and vein Hgb with those presenting values >1.3 MoM (p = .99 and p = .61, respectively). Finally, both prediction models explaining arterial and venous Hgb presented very weak predictive accuracies (R Squared: 0.0965 and R Squared: 0.106) indicating a low possibility to diagnose fetal anemia in otherwise normal fetuses based on clinical and sonographic data.Conclusion: In normal pregnancies that are not suffering from conditions leading to fetal anemia, unexpected high MCA PSV values do not necessarily reflect the presence of this condition. Active management in this circumstance might result in unjustified higher rates of labor induction and operative delivery.

Carotid near-occlusion can be identified with ultrasound by low flow velocity distal to the stenosis.

Most carotid near-occlusions are indistinguishable from conventional ≥ 50% stenosis on ultrasound, demonstrating high peak systolic velocity (PSV) in the stenosis. To study whether the velocity distal to the stenosis can separate high PSV near-occlusion from conventional ≥ 50% stenosis. We included patients with ≥ 50% carotid stenosis with high PSV (≥125 cm/s), examined with both computed tomography angiography (CTA) and ultrasound within 30 days, and a distal velocity measurement was performed. Based on CTA, cases were divided into three groups: conventional stenosis; near-occlusion without full collapse (NwoC; normal-appearing albeit small distal artery); and near-occlusion with full collapse (NwC; threadlike distal artery). Distal Doppler ultrasound flow velocities were compared between these groups. Sixty patients were included: 33 patients with conventional stenosis; 20 patients with NwoC; and seven patients with NwC. Mean distal PSV was 93, 63, and 21 cm/s ( P < 0.001) and mean distal end-diastolic velocity was 30, 24, and 5 cm/s ( P < 0.001), respectively. A distal PSV < 50 cm/s was 63% sensitive and 94% specific for separating both types of near-occlusion from conventional stenosis. In high PSV carotid stenoses, the distal velocity was lower in near-occlusions than conventional carotid stenosis. Distal velocities warrant further investigation in diagnostic studies.

Abstract WP386: Age-Dependent Ultrasonographic Changes After Indirect Revascularization Surgery in Patients With Moyamoya Disease

Objective: Pediatric patients with moyamoya disease (MMD) were supposed to have better neovascularization by indirect revascularization than adult patients with MMD, but the evidence was limited. The aim of this study was to assess age-dependent ultrasonographic changes after indirect revascularization in moyamoya patients. Methods: We prospectively enrolled moyamoya patients receiving indirect revascularization and ultrasonographic exams before and after surgery at 1, 3, and 6 months. The sonographic parameters included peak-systolic velocity (PSV), end-diastolic velocity (EDV), flow resistance, and flow volume (FV) in the superficial temporal artery (STA) and external carotid artery (ECA). The values and percentage changes of the sonographic parameter at the aforementioned time points were compared between pediatric and adult patients. Results: There were 47 hemispheres in pediatric and 16 hemispheres in adult patients with MMD receiving indirect revascularization. Before surgery, adult patients had higher EDV, lower resistance, and larger FV in the STA and ECA compared to pediatric patients (all p &lt;0.05). After surgery, pediatric patients had higher PSV in the STA and ECA compared to adults, but the resistances of these 2 arteries remained higher in pediatric patients than that in adults (all p &lt;0.05). The percentage changes of PSV in the STA at 3 and 6 months, FV in the STA at 3 months, as well as PSV and FV in the ECA at 6 months in pediatric patients were all larger than those in adult patients (all p &lt;0.05). Conclusion: Pediatric patients with MMD had larger increase of PSV and FV in the STA and ECA after indirect revascularization than adult patients.

Carotid near-occlusion frequently has high peak systolic velocity on Doppler ultrasound.

Carotid near-occlusion is a tight atherosclerotic stenosis of the internal carotid artery (ICA) resulting in decrease in diameter of the vessel lumen distal to the stenosis. Near-occlusions can be classified as with or without full collapse, and may have high peak systolic velocity (PSV) across the stenosis, mimicking conventional >50% carotid artery stenosis. We aimed to determine how frequently near-occlusions have high PSV in the stenosis and determine how accurately carotid Doppler ultrasound can distinguish high-velocity near-occlusion from conventional stenosis. Included patients had near-occlusion or conventional stenosis with carotid ultrasound and CT angiogram (CTA) performed within 30days of each other. CTA examinations were analyzed by two blinded expert readers. Velocities in the internal and common carotid arteries were recorded. Mean velocity, pulsatility index, and ratios were calculated, giving 12 Doppler parameters for analysis. Of 136 patients, 82 had conventional stenosis and 54 had near-occlusion on CTA. Of near-occlusions, 40 (74%) had high PSV (≥125cm/s) across the stenosis. Ten Doppler parameters significantly differed between conventional stenosis and high-velocity near-occlusion groups. However, no parameter was highly sensitive and specific to separate the groups. Near-occlusions frequently have high PSV across the stenosis, particularly those without full collapse. Carotid Doppler ultrasound does not seem able to distinguish conventional stenosis from high-velocity near-occlusion. These findings question the use of ultrasound alone for preoperative imaging evaluation.

OP31.07: Papillary bladder carcinoma of low‐malignant potential during pregnancy: 2D and 3D ultrasonography

Bladder neoplasm detected during pregnancy is a rare condition. The cardinal symptoms dysuria and hematuria are often mistakenly attributed to the pregnancy complications. Ninety percent of cases in women under 40 fortunately belong to superficial papillary urothelial neoplasm of low malignant potential (PUNLMP), known even as transitional cell cancer (TCC). Cigarette smoking, frequent urinary tract infections and environmental chemical carcinogens exposure are the most important risk factors for bladder carcinoma. A healthy 28-year-old pregnant primigravida woman, non-smoker, presented in gestational week 30+3 with intermittent painless macrohematuria, interpreted as vaginal bleeding. She underwent gynecological examinations twice without detection of any signs of bleeding. At the third examination an irregular papillary bladder neoplasm was suspected on 2D ultrasound. 3D image of the neoplasm was rendered using HDlive and the volume was measured. Colour and spectral Doppler shown a moderate vascularity with high peak systolic velocity (PSV=28cm/sec) inside of the neoplasm. Cystoscopy confirmed a suspicious neoplasm. Urine cytology was negative. In gestational week 34+0 an emergency Caesarean section was performed due to failure of induction of labour. Three days later a transurethral resection of neoplasm (TUR-B) was performed, uneventfully. Histology shown non-invasive papillary urothelial cancer (stage pTaG1). No adjuvant therapy was needed. Follow-up with cystoscopy, 4 and 10 months after treatment, were negative. Despite the rarity of bladder carcinoma during pregnancy an examination of urinary bladder should always be performed in case of atypical genital bleeding. Different diagnostic imaging as 2D and 3D ultrasound, followed by cystoscopy are sufficient and comfortable diagnostic modalities for bladder neoplasm during pregnancy. Transurethral resection of non-invasive bladder carcinoma can be performed safely either during pregnancy or after delivery.

Transvaginal ultrasound - noninvasive method for the prediction of response to concurrent chemoradiotherapy in cases of cervical cancer

The objective of this paper is to study the differences in tumor size, color score and Doppler indices prior, during and after the treatment with concurrent chemoradiotherapy in cases of locally advanced cervical carcinoma and to predict the response to the treatment. The study group comprised fifty-two patients with histologically confirmed invasive carcinoma of the cervix. All patients were scheduled for concurrent chemoradiotherapy and were assessed by transvaginal ultrasound before the initiation, before 4th course of chemotherapy and 3 months after the therapy. Maximum cervical tumor length, anterior-posterior diameter and width have been measured and tumor volume was calculated. Complete clinical response (CR) was defined when no residual tumor was found. Partial clinical response (PR) was determined when the tumor volume had decreased more than 50 %. Intratumoral blood flow was subjectively evaluated by Color Doppler examination, the lowest resistance index (RI) and the highest peak systolic velocity (PSV) were used for the analysis. The results of this study demonstrate that transvaginal ultrasound is a valuable non-invasive diagnostic tool for the assessment of the response to concurrent chemoradiotherapy in cases of advanced cervical cancer.

Role of transcranial Doppler and FOUR score in assessment of sepsis-associated encephalopathy

Background Monitoring of the septic complications on the brain is useful in management and in attenuating the effect of sepsis-related cerebral complications on outcome. Patients and methods A transcranial Doppler probe was applied through the temporal bone window at both sides of the skull within the first day of diagnosing sepsis for 10 s. The values of the brain side with the highest peak systolic velocity (PSV) and end diastolic velocity (EDV) were registered. We calculated the pulsatility index (PI) as follows: PI=(PSV−EDV)/mean velocity; the neurological status was evaluated 6 h after sedation cessation, using Glasgow Coma Scale and Full Outline of UnResponsiveness score. Results There was a significant difference in the PI between conscious patients and patients suffering from sepsis-associated encephalopathy. Conclusion PI is a predictor of sepsis-associated encephalopathy in septic patients.

Effect of Adventitial Dissection of Superficial Temporal Artery on the Outcome of Superficial Temporal Artery-Middle Cerebral Artery Bypass in Moyamoya Disease.

Superficial temporal artery-middle cerebral artery (STA-MCA) has been used for the treatment of occlusive cerebrovascular disease including moyamoya disease. The effect of STA-MCA bypass depends not only on the patency of anastomosis, but also on integrity and functional capacity of the donor artery. In the present prospective study, we investigated the effect of extensive stripping STA adventitia and fasciae on hemodynamic function in STA-MCA bypass of moyamoya disease patients. Twenty patients (n=8 in control group, n=12 in stripping group) of moyamoya disease were subjected to STA-MCA end-to-side direct anastomosis. Perfusion unit (PU) values of the cortex were measured and recorded using a Laser Doppler flowmetry (LDF) for 5 days. Computed tomography perfusion was performed to determine blood flow before and after bypass. No patient experienced significant neurologic deficits associated with neurosurgical complications. LDF demonstrated that adventitial stripping group had higher cerebral blood flow increase than control group. The adventitia stripping group tends to have higher rate of increased cerebral perfusion after bypass than non-stripping group. Furthermore, the ultrasound examination at 3 days after bypass demonstrated that the adventitial stripping group has a tendency of bigger STA and higher peak systolic velocity than control group. Our result suggests that stripping adventitia of STA improves hemodynamics of STA-MCA bypass in moyamoya disease.

Color Doppler Ultrasound Imaging in the Assessment of Iliac Endofibrosis.

Endofibrosis (EF) of the iliac arteries is a flow-limiting condition typically seen in highly trained endurance athletes. Thirty-seven athletes (74 limbs) were referred to our department with suspected EF. All patients had a pre- and postexercise color Doppler ultrasound (CDU) of the iliac arteries. Doppler waveform and peak systolic velocity (PSV) and end-diastolic velocity (EDV) were assessed pre- and postexercise. Endofibrosis was diagnosed with CDU in 24 athletes (29 limbs). Arterial wall and course abnormalities were detected at rest in 20 (67%) symptomatic limbs of athletes with and 4 (22%) symptomatic limbs of athletes without EF. Postexercise abnormal waveforms of the stenotic/damped type were seen in the iliac arteries in all 29 limbs of athletes diagnosed with EF. These waveform changes were accompanied by high PSV (>350 cm/s) and EDV (>150 cm/s), with (n = 10; 34%) or without (n = 19; 66%) the evidence of reduced arterial lumen caliber. Color Doppler ultrasound can be used to detect EF.