Higher Peak Systolic Velocity Research Articles

Quantitative Cardiac Assessment in Fetal Tetralogy of Fallot

The purpose of this study was to quantitatively assess cardiac function and biometric parameters in fetuses with a diagnosis of tetralogy of Fallot and compare them to those in healthy fetuses. Two hundred healthy fetuses and 20 fetuses with a diagnosis of classic tetralogy of Fallot were quantitatively assessed for 16 cardiac parameters, including morphologic characteristics and functions. All recruited fetuses were in the second trimester with correct gestational ages. The measured values that were out of normal reference ranges were considered abnormal. Rates of abnormalities of these parameters were compared between the groups. The significant parameters were further analyzed for their sensitivity, specificity, and likelihood ratio. Of the 16 parameters, rates of abnormalities in 7 parameters, including right ventricular wall thickness, peak systolic velocities (PSVs) in the pulmonary artery and aorta, time to peak velocity, or acceleration time, in the pulmonary artery, aortic valve diameter, pulmonary valve diameter, and aortic-to-pulmonary valve diameter ratio, were significantly higher in fetuses with tetralogy of Fallot (P < .001). The pulmonary artery PSV, pulmonary artery time to peak velocity, aortic valve diameter, pulmonary valve diameter, and aortic-to-pulmonary valve diameter ratio had high sensitivities (80.0%, 75.0%, 90.0%, 90.0%, and 100.0%, respectively) and specificities (95.5%, 97.0%, 94.5%, 96.0%, and 84.5%). In addition to a routine anatomic examination, quantitative assessment of fetal hemodynamics, especially an abnormally high PSV in the pulmonary artery, as well as a shortened acceleration time and abnormal valve size, might be very helpful for confirmation of the diagnosis in cases of suspected tetralogy of Fallot.

Peak Systolic Velocity Measured by Continuous-Wave Doppler Ultrasonography without Angle Correction in Patients with Internal Carotid Artery Stenosis

Peak systolic velocity (PSV) is measured with pulse-wave (PW) Doppler with angle correction in patients with internal carotid artery stenosis (ICAS). However, the correlation between conventional angiography and PSV shows considerable scattering. We hypothesized that measuring PSV without angle correction would lead to better inter-rater reliability. This hypothesis was tested using a sector probe and continuous-wave (CW) Doppler without angle correction. Consecutive patients with more than 50% ICAS were enrolled from a prospective database. PSV was measured with PW Doppler with angle correction (PW PSV) and CW Doppler without angle correction (CW PSV) by 2 examiners. The inter-rater reliabilities of PW PSV and CW PSV were analyzed by Spearman's rank correlation test. A total of 37 ICAS sites (median 67 [interquartile range 57-78] % stenosis) were enrolled. Measuring PSV using a sector probe insonating nearly parallel to the flow was feasible in all cases. Inter-rater reproducibility of CW PSV (Spearman's ρ = .810) was similar to that of PW PSV (Spearman's ρ = .796). When limited to patients with a PSV greater than 200 cm/s with both PW Doppler examinations (25 ICAS sites), inter-rater reliability was relatively higher for CW PSV (Spearman's ρ = .674) than for PW PSV (Spearman's ρ = .423). Measuring PSV with CW Doppler using a sector probe was feasible. Inter-rater reliability was similar between PW Doppler with angle correction and CW Doppler without angle correction in evaluating PSV in patients with ICAS. CW Doppler appears to have better inter-rater reproducibility than PW Doppler in assessing high PSV.

Ultrasound diagnosis and management of acquired uterine enhanced myometrial vascularity/arteriovenous malformations

Arteriovenous malformation is a short circuit between an organ's arterial and venous circulation. Arteriovenous malformations are classified as congenital and acquired. In the uterus, they may appear after curettage, cesarean delivery, and myomectomy among others. Their clinical feature is usually vaginal bleeding, which may be severe, if curettage is performed in unrecognized cases. Sonographically on 2-dimensional grayscale ultrasound scanning, the pathologic evidence appears as irregular, anechoic, tortuous, tubular structures that show evidence of increased vascularity when color Doppler is applied. Most of the time they resolve spontaneously; however, if left untreated, they mayrequire involved treatments such as uterine artery embolization or hysterectomy. In the past, uterine artery angiography was the gold standard for the diagnosis; however, ultrasound scanning has diagnosed successfully and helped in the clinical management. Recently, arteriovenous malformations have been referred to as enhanced myometrial vascularities. The purpose of this study was to evaluate the role of transvaginal ultrasound scanning in the diagnosis and treatment of acquired enhanced myometrial vascularity/arteriovenous malformations to outline the natural history of conservatively followed vs treated lesions. This was a retrospective study to assess the presentation, treatment, and clinical pictures of patients with uterine Enhanced myometrial vascularity/arteriovenous malformations that were diagnosed with transvaginal ultrasound scanning. We reviewed both (1) ultrasound data (images, measured dimensions, and Doppler blood flow that were defined by its peak systolic velocity and (2) clinical data (age, reproductive status, clinical presentation, inciting event or procedure, surgical history, clinical course, time intervals that included detection to resolution or detection to treatment, and treatment rendered). The diagnostic criteria were "subjective" with a rich vascular network in the myometrium with the use of color Doppler images and "objective" with a high peak systolic velocity of ≥20 cm/sec in the vascular web. Statistical analysis was performed and coded with statistical software where necessary. Twenty-seven patients met the diagnostic criteria of uterine enhanced myometrial vascularity/arteriovenous malformation. Mean age was 31.8 years (range, 18-42 years). Clinical diagnoses of the patients included 10 incomplete abortions, 6 missed abortions, 5 spontaneous complete abortions, 5 cesarean scar pregnancies, and 1 molar pregnancy. Eighty-nine percent of patients had bleeding (n= 24/27), although 1patient was febrile, and 2 patients were asymptomatic. Recent surgical procedures were performed in 55.5% patients (15/27) that included curettage (n= 10), cesarean deliveries (n= 5), or both (n= 1); 4 patients had a remote history of uterine surgery that included myomectomy. Treatment was varied and included expectant treatment alone in 48% of the patients with serial ultrasound scans and serum human chorionic gonadotropin until resolution (n= 13/27 patients), uterine artery embolization (29.6%; 8/27 patients), methotrexate administration (22.2%; 6/27 patients), hysterectomy (7.4%; 2/27 patients), and curettage (3.7%; 1/27 patients). Three patients required a blood transfusion. Of the 9 patients whose condition required embolization, the conditions of 7 patients resolved after the procedure although 1 patient's condition required operative hysteroscopy and 1 patient's condition required hysterectomy for intractable bleeding. Average peak systolic velocity after embolization in the 9 patients was 85.2 cm/sec (range, 35-170 cm/sec); the average peak systolic velocity of the 16 patients with spontaneous resolution was 58.5 cm/sec (range, 23-90 cm/sec). Acquired enhanced myometrial vascularity/arteriovenous malformations occurred after unsuccessful pregnancies or treatment procedures that included uterine curettage, cesarean delivery, or cesarean scar pregnancy. Triage of patients for expectant treatment vs intervention with uterine artery embolization based on their clinical status, which was supplemented by objective measurements of blood velocity measurement in the arteriovenous malformation, appears to be a good predictor of outcome. Ultrasound evaluation of patients with early pregnancy failure and persistent bleeding should be considered for evaluation of a possible enhanced myometrial vascularity/arteriovenous malformation.

Common carotid artery peak systolic velocity ratio predicts high-grade common carotid stenosis

Screening for common carotid artery (CCA) stenosis with duplex ultrasound (DUS) velocity criteria alone can be limited by within-patient and between-patients hemodynamic variability. This study aimed to evaluate inter-CCA velocity ratio criteria to predict high-grade CCA stenosis. This was a retrospective review of consecutive patients who underwent computed tomography angiography and DUS peak systolic velocity (PSV) measurements of bilateral CCAs, independently recorded, between 2008 and 2014. Patients with dampened CCA waveforms on DUS composed group B. The remainder without dampened waveforms constituted group A. Inter-CCA PSV ratios were calculated by dividing the higher CCA PSV by the lower one of the other side, so the ratios would always be ≥1. Ratios were subsequently paired with each respective unilateral CCA diameter stenosis and differential bilateral CCA diameter stenosis. A quadratic regression model was fitted to predict unilateral and differential stenosis. Receiver operating characteristic curve was used to determine optimal ratios for ≥50% and ≥80% CCA stenosis. The study excluded patients with carotid artery occlusion. From a total of 201 patients, 193 patients were included in group A and 8 in group B. Within group A, 31 patients had ≥50% unilateral stenosis and 17 had ≥50% differential stenosis. All stenoses ≥50% were identified on the same side with the higher PSV. Inter-CCA PSV ratio predicted ≥50% unilateral (r(2) = 0.536; P < .001) and differential stenosis (r(2) = 0.581; P < .001). In group B, all patients had ≥60% stenosis that was near or involved the vessel origin. An increasing inter-CCA PSV ratio showed a trend toward contralateral high-grade stenosis (r(2) = 0.596; P = .1). Receiver operating characteristic curves showed an optimal threshold CCA ratio ≥2.16 for ≥50% unilateral stenosis with 92% accuracy, 62% sensitivity, and 98% specificity (area under curve = 0.854; 95% confidence interval, 0.759-0.948) and a ratio ≥2.62 for ≥50% differential stenosis with 97% accuracy, 83% sensitivity, and 98% specificity (area under curve = 0.94; 95% confidence interval, 0.835-1). DUS-based CCA PSV ratio can accurately predict unilateral and differential high-grade CCA stenosis. Also, in patients with unilateral dampened waveforms, it implied contralateral severe proximal stenosis. This parameter should be further validated in prospective studies and may serve as an adjunct screening tool to detect high-grade CCA stenosis.

Common Carotid Artery Peak-Systolic Velocity Ratio Predicts High-Grade Common Carotid Stenosis

Screening for common carotid artery (CCA) stenosis with duplex ultrasound (DUS) velocity criteria alone can be limited due to within-patient and between-patients hemodynamic variability. This study evaluated inter-CCA velocity ratio criteria to predict high-grade CCA stenosis. Retrospective review of consecutive patients who underwent computed tomography angiography (CTA) and DUS peak-systolic velocity (PSV) measurements of bilateral CCA, independently recorded, between 2008 and 2014. Patients with dampened CCA waveforms on DUS, readily indicating high-grade proximal stenosis, consistuted group B. The remainder without dampened waveforms constituted group A. Inter-CCA PSV ratios were calculated by dividing the higher CCA PSV to the lower one of the other side, so the ratios would always be >1. Ratios were subsequently paired with each respective unilateral CCA diameter stenosis (uDS) and differential bilateral CCA diameter stenosis (dDS). A quadratic regression model was fitted to predict uDS and dDS. Receiver operating characteristic curves were used to determine optimal ratios for ≥50% CCA stenosis. The study excluded patients with carotid artery occlusion. From 174 patients, 167 patients were included in group A and seven in group B. In group A, 31 patients had ≥50% uDS and 17 had ≥50% dDS. All stenoses ≥50% were identified on the same side with the higher PSV. Inter-CCA PSV ratio predicted ≥50% uDS (r2 = 0.57; P < .0001) and dDS (r2 = 0.75; P < .0001; Fig). In group B, all patients had ≥60% stenosis that involved the vessel origin. An increasing inter-CCA PSV ratio showed a trend toward contralateral high-grade stenosis (r2 = .54, P = .06). Receiver operating characteristic curves for ≥50% uDS showed an optimal threshold CCA ratio ≥1.96 with 93% accuracy, 75% sensitivity, and 97% specificity (area under curve, 0.857; 95% confidence interval, 0.755-0.958) and for ≥50% a dDS ratio ≥2.62 with 97% accuracy, 82% sensitivity, and 99% specificity (area under curve, 0.938; 95% confidence interval, 0.828-1.0). DUS-based CCA PSV ratio can accurately predict unilateral and differential high-grade CCA stenosis. Also, in patients with dampened waveforms, it implied contralateral severe proximal stenosis. This parameter should be further validated in prospective studies and is a promising adjunct screening tool to detect high-grade common carotid stenosis.

Regional differences of testicular artery blood flow in post pubertal and pre-pubertal dogs.

BackgroundMeasurement of testicular artery blood flow is used in several species to evaluate reproductive function and testicular and scrotal pathology. In dogs there are inconsistent reports about normal flow in post-pubertal dogs and no information concerning pre-pubertal dogs. The aim of this study was to describe regional differences in testicular artery blood flow in clinically normal post-pubertal and pre-pubertal dogs with no history of reproductive tract disease.ResultsThe post-pubertal dogs produced normal ejaculates throughout the study. In all dogs the three different regions of the artery were imaged and monophasic flow with an obvious systolic peak and flow throughout diastole was observed on every occasion. The highest peak systolic velocity (PSV) and end diastolic velocity (EDV) were measured within the distal supra-testicular artery and marginal artery whilst the lowest PSV and EDV were measured within the intra-testicular arteries. Flow measurements were not different between left and right testes and were consistent between dogs on different examination days. Calculated resistance index (RI) and pulsatility index (PI) were lowest in the intra-testicular arteries.The pre-pubertal dogs had significantly smaller testes than the post-pubertal dogs (p < 0.05) and were unable to ejaculate during the study. The three different artery regions were imaged at every examination time point, and flow profiles had a similar appearance to those of the post-pubertal dogs. PSV, EDV, RI and PI showed a similar trend to the post-pubertal dogs in that values were lowest in the intra-testicular arteries. Notably, values of PSV, EDV, RI and PI were significantly lower (p < 0.05) in pre-pubertal dogs compared with post-pubertal dogs.ConclusionsThis study demonstrated important regional and pubertal differences in testicular artery blood flow of dogs, and form the basis for establishing baseline reference values that may be employed for the purposes of clinical diagnosis.

Transcranial Doppler screening in sickle cell disease: The implications of using peak systolic criteria.

To compare time average maximum mean velocity (TAMV) and peak systolic velocity (PSV) criteria of Trans Cranial Doppler (TCD) in their ability to predict abnormalities on magnetic resonance imaging (MRI)/magnetic resonance angiogram (MRA) in patients with sickle cell disease. A retrospective evaluation was performed of the outcomes in all patients with a Transcranial Doppler examination at our institution since the implementation of the hospital picture archiving and communication system (PACS) system in January 2003 through December 2012. All ultrasound imaging exams were performed by the same technologist with a 3 MHz transducer. Inclusion criteria was based upon the Transcranial Doppler procedure code in our PACS which had an indication of sickle cell disease in the history. The patient's age and gender along with the vessel with the highest time averaged mean velocity as well as the highest peak systolic velocity was recorded for analysis. A subset of the study cohort also had subsequent MR imaging and Angiograms performed within 6 mo of the TCD examination. MRI results were categorized as having a disease related abnormality (vessel narrowing, collateral formation/moya-moya, or abnormal fluid attenuation inversion recovery signal in parenchyma indicative of prior stroke) or normal. The MRI results formed the comparison standards for TCD exams in evaluating intracranial injury. Sensitivity and specificity for the two TCD criteria (TAMV and PSV) were calculated to determine which could be a better predictor for intracranial vasculopathy /clinically occult strokes. The study cohort for our institution was 110 patients with a total of 291 TCD examinations. These patients had a mean age of 7.6 years with a range from 2-18 years of age. Sixty-two of the 110 patients (56%) had two or more TCD exams. Thirty-seven patients (34%) had at least one MRI following a TCD examination. Of the 291 TCD examinations, 46 (16%) were conditional or abnormal by TAMV criteria. One hundred and sixteen (40%) were conditional or abnormal by PSV criteria. All studies that were abnormal by TAMV were also abnormal by PSV criteria. Seventy of the 116 (60%) studies which were conditional or abnormal by peak systolic criteria would not have been identified by time averaged mean maximum velocity criteria. The most frequent location of highest velocity measurement was noted to be in the middle cerebral artery regardless of whether it was measured by PSV or TAMV. From the 37 patients having one or more MRIs, 43 MRI exams were performed within 6 mo of a TCD examination. Twenty two (51%) MRIs had a disease related abnormality reported. When evaluating conditional or abnormal exams by PSV criteria against follow-up MRI/MRA, the sensitivity was 73% [16/(16 + 6)] and specificity was 81% [17/(4 + 17)]. When evaluating conditional or abnormal exams by TAMV criteria by follow-up MRI/MRA as the gold standard, the sensitivity was 41% [9/(9 + 13)] and the specificity was 100% [21/(21 + 0)]. In using conditional or abnormal criteria from PSV and TAMV to predict abnormalities on follow-up MRI/MR Angiogram, PSV was more sensitive (73% vs 41%) while TAMV was more specific (100% vs 81%). Based on the data obtained at our institution and using the assumption that the best screening test is the one with the highest sensitivity, the peak systolic velocity could be the measurement of choice for TCD screening.

Low prevalence of collateral cerebral circulation in the circle of Willis in patients with severe carotid artery stenosis and recent ischemic stroke.

IntroductionThe circle of Willis is thought to play a key role in development of collateral flow in patients with internal carotid artery stenosis (ICAS).AimTo assess flow in the circle of Willis in patients with recent ischemic stroke (IS).Material and methodsThe study included 371 patients, 102 symptomatic with severe ICAS and recent IS (within the last 3 months) (group I) and 269 asymptomatic with severe ICAS (group II). Flow in the middle (MCA), anterior (ACA) and posterior (PCA) cerebral arteries and pattern of the cross-flow through anterior (ACoA) and posterior (PCoA) communicating arteries were assessed with transcranial color-coded Doppler ultrasonography (TCCD).ResultsThe ACoA or PCoA was less prevalent in group I than in group II (54% vs. 78%, p < 0.001 and 20% vs. 42%, p < 0.001, respectively), resulting in lower peak-systolic velocity (PSV) in the MCA in group I vs. group II (p = 0.015). Any collateral pathway was present in 67% of patients in group I, compared to 86% in group II (p < 0.001). Both PSV and end-diastolic (EDV) flow velocity in the ACA were lower in patients with recent IS, compared to asymptomatic subjects (71 ±24 cm/s vs. 86 ±34 cm/s, p < 0.001 and 32 ±12 cm/s vs. 37 ±17 cm/s, p = 0.038, respectively). Presence of ACoA or PCoA and higher PSV in the MCA and ACA were associated with significant risk reduction of IS (RR = 0.28 (95% CI = 0.16–0.49, p < 0.001), RR = 0.28 (95% CI = 0.15–0.52, p < 0.001), RR = 0.97 (95% CI = 0.96–0.99, p < 0.001), RR = 0.99 (95% CI = 0.98–0.99, p < 0.032), respectively). However, ROC curves failed to show reliable MCA or ACA PSV cut-offs for IS risk assessment.ConclusionsThe ACoA and PCoA seem to play a key role in the evaluation of IS risk in subjects with severe ICAS.

A lipid-poor plaque and asymptomatic status in women are associated with higher peak systolic velocity on duplex ultrasound after carotid endarterectomy

Objectives. Recurrent stenosis is a drawback of carotid endarterectomy (CEA), and may lead to recurrent symptoms and reintervention. Restenosis can be detected by duplex ultrasound scanning (DUS) with cutoff values based on peak systolic velocity (PSV), which vary among vascular laboratories. On short term, histological carotid plaque characteristics have shown to predict DUS-based restenosis rates. Therefore, we aimed to analyze the association of both plaque and patient characteristics with continuous PSV values in the carotid artery at different timepoints during follow-up after CEA. Methods. 760 atherosclerotic plaques of 725 patients, who underwent CEA between 2003 and 2011, were analyzed for smooth muscle cells, collagen, macrophages, lipid core, plaque hemorrhage, and vessel density. Patients underwent DUS at 3 and 12 months follow-up and yearly thereafter. The association between plaque and patient characteristics and mean PSV was analyzed in a multivariable analysis, at 3 months and total (mid-term) follow-up. Results. Patients with a large lipid core in their plaque (n = 170) had significantly lower PSVs at 3 months follow-up; 109 cm/s, 95% confidence interval (CI): 103–116 versus 118 cm/s, 95% CI: 114–122, (P = 0.03) for no or small lipid core (n = 454). After mid-term follow-up (median duration of 2.5 years, interquartile range 1.7–4.3), these PSV values were not significantly different (115 vs. 111 cm/s, P = 0.278). Presence of contralateral stenosis, female sex, and asymptomatic presentation in women were independently associated with higher PSVs at mid-term follow-up. Conclusions. Dissection of a lipid-poor plaque showed an independent association with higher PSVs in the internal carotid artery 3 months after CEA, not after mid-term follow-up. In women, significantly higher PSVs were found after midterm follow-up, especially if they were asymptomatic.

Correlation between Colour Duplex and Technetium-99m Thyroid Scan in Identifying the Cause of Toxic Goitre

Introduction: Differentiation between thyroiditis induced thyrotoxicosis and Graves' disease is important for selection of proper therapy. It is often difficult to make this distinction without performing thyroid scintigraphy. Color flow Doppler sonography (CFDS) is gaining importance for the functional evaluation of the thyroid disorders. We aimed to determine the value of CFDS for the etiological diagnosis of thyrotoxicosis. Patients and methods: Thirty patients with clinical and lab signs of hyperthyroidism (12 Graves' disease and, 18 patients with Hashimoto's thyroiditis) with 10 euthyroid controls were evaluated.Etiological diagnosis was carried out using standard methods. Conventional grey scale sonography was done, followed by CFDS. Doppler patterns of the glands were scored and peak systolic velocity (PSV) measurements were obtained from superior and inferior thyroid arteries. Results were correlated to isotope scanning which was used as a golden standard. Results: Vascular patterns were significantly more prominent, and the mean PSV values were significantly higher in the Graves' Disease patients compared to the thyroiditis patients than controls. CFDS could differentiate the untreated Graves' Disease from the thyroiditis which had similar grey scale findings but higher vascular patterns and significantly higher PSV values, sensitivity = 96.6%, specificity= 96.6 %, and P>0.001 Conclusion: As an inexpensive, fast, and noninvasive imaging procedure, CFDS could be helpful in the initial clinical evaluation and may avoid scintigraphy in a substantial number of thyrotoxic patients.

Is a Low End-Diastolic Velocity Parameter Enough to Exclude an 80–99% Internal Carotid Artery Stenosis?

Introduction —High resistive internal carotid artery (ICA) waveforms (high peak systolic velocity &gt;250 cm/sec with low end-diastolic velocity (EDV) &lt;125 cm/sec, having an external carotid artery waveform appearance) are uncommon and present a diagnostic challenge for intervention. Most ICA stenotic classifications rely on a greater EDV to delineate a critical stenosis of 80–99%. Methods —Review of a multiple-laboratory, single-center, Intersocietal Accreditation Commission-accredited, noninvasive vascular laboratory database for ICA carotid examinations performed from January 1, 2008 to November 1, 2012, with a positive stenotic range &gt;60%. Medical records, archived ultrasound images, and correlative imaging studies were reviewed. Results —A total of 843 carotid duplex studies (1,686 arteries) positive for &gt;60% stenoses of at least one side were reviewed. There were 102 duplex studies with high resistive ICA waveforms that were identified. Of these, 35 duplex studies had 40 correlative results, and 67 duplex studies did not have any correlative results. Of the 35 correlated duplex studies, median age was 78 years (range, 53–86 years). Gender distribution was 57% male. The median age of the male subjects was 77 years with a range of 63–82 years and the median age of female subjects was 73 years old with a range of 53–86 years. Seven of the 35 patients presented with symptoms of visual disturbance, transient ischemic attack, or syncope (21% symptomatic). Side distribution was 12 males and 8 females had right-side involvement, and 7 males and 7 females had left-side involvement. There was one female patient who had bilateral involvement. This provides us with 36 duplex ultrasound studies to correlate. Mean PSV was 369 cm/sec (range, 187–492 cm/sec). Mean EDV was 89 cm/sec (range 18–130 cm/sec). Average ICA/common carotid artery ratio was 6.2 (range, 3.2–12.5). Correlative computed tomography angiography was available for 12 of the studies, angiography for 10 of the studies, and surgical findings for 18 of the 35 studies. Conclusion —Assessing all Doppler parameter used to categorize an ICA stenotic range may be beneficial in determining the need for patient intervention. Sonographer impression of audible clues and cardiac history is helpful to the interpreting physician reviewing 2D images and waveforms.

Importancia de la rehabilitación precoz de los cuerpos cavernosos tras prostatectomía radical

ObjectivesPrimary: to evaluate the importance of early rehabilitation of the corpus cavernosum on erectile function after radical prostatectomy. Secondary: to analyse the factors associated with better response. Material and methodRetrospective study in patients treated with intracavernous injections after radical prostatectomy between 1 January 2006 and 31 December 2008. We included patients lacking a history of erectile dysfunction prior to surgery, not responding to phosphodiesterase-5 inhibitors. All patients underwent colour echo-doppler after injection of prostaglandin E1 10-20mg. The outcomes of these 2 groups were then compared according to how early rehabilitation began after surgery (early, <6 months, or late, >6 months). ResultsThere were 82 patients included in the study. In the multivariate analysis, predictive factors of good response to treatment were: early onset of rehabilitation (OR: 0.06; 95% CI: 0.014-0.26), higher peak systolic velocity during the test (OR: 1.01; 95% CI: 1.01-1.1) and favourable histopathological stage (OR: 0.15; 95% CI 95%: 0.036-0.6). The colour echo-doppler procedure after prostaglandin E1 injection showed abnormal values more frequently in the late-onset than in the early group (89.5% [n=34] vs. 65.9% [n=29]; P=.01). Corporal veno-occlusive dysfunction was presented by 40.2% (n=33) of subjects, with the late-onset group presenting higher values (5.53±1.4cm/sec) than the early group (4.75±1.03cm/sec) (P=.005). The presence of functional erections at 18 months’ follow-up was higher in the early onset group (P<.001). ConclusionsAccording to this study, early erectile dysfunction rehabilitation after radical prostatectomy achieves better results than late rehabilitation in patients.

Abstract 295: Sodium Restriction Increases Ophthalmic Artery Systolic Velocity in Healthy Subjects

Changes in ocular blood flow occur in systemic diseases. A high peak systolic velocity (PSV) in the ophthalmic artery (OA) has been observed in diabetes mellitus and hypertension, conditions often associated with high tissue renin-angiotensin system (RAS) activity and reduced renal plasma flow (RPF). Since our group has demonstrated that sodium restriction ( a high RAS state ) is associated with a decrease in RPF which is correctable with ACE inhibition, we hypothesized that sodium restriction would result in higher ophthalmic PSV. Sixteen healthy volunteers (age 46.2±13.2, male 69%, white 75%, BMI 26±3.7) were placed on a low sodium (LS) diet (10 mmol/day) for 1 week followed by high sodium (HS) diet (200 mmol/day). Sodium balance was assessed by 24hr urine collection. BP, RPF (PAH clearance) and OA hemodynamic measurements (Multigon, NY) were made after overnight fasting and rest in the supine position. Sodium restriction did not affect BP (systolic/diastolic LS: 121/73 ± 12/7 vs HS: 122/72 ± 15/9 mmHg, mean ± SD, NS) or heart rate (69 ± 16 vs 70 ± 15/min, NS). As expected, RPF was lower on LS compared with HS (599.2 ± 89.8 vs 633.4 ± 93.5ml/min/1.73 m 2 , p=0.006). Sodium restriction was associated with higher OA peak (38.8 ± 6.4 vs 33.2 ± 6.0 cm/sec, p=0.018) and mean (19.7±2.9 vs 17.1±3.5, p=0.003) systolic velocity ( Figure ). There was no change in end-diastolic velocity (10.6±2.5 vs 9.7±2.4, p=0.266) with sodium restriction. In conclusion, sodium restriction was associated with an increase in OA peak and mean systolic velocity in healthy individuals. Further studies are required to investigate the potential relevance of our results to diabetic and hypertensive retinopathy.

Reversible cerebral vasoconstriction syndrome in HELLP syndrome

Introduction: reversible cerebral vasoconstriction syndrome (rcVs) is characterized by severe and hyperacute headaches with or without additional focal neurological deficits, and evidence of vasoconstriction of cerebral arteries which resolves spontaneously within 1–3 months. However, the precise mechanism of rcVs is not fully understood. case report: We report a 33-year-old postpartum woman with rcVs with HELLP syndrome and eclampsia. Magnetic resonance angiography (MrA) of head revealed transient segmental stenosis and dilatation. Especially, most part of the middle cerebral artery (McA) was irregularly thinner at the acute phase than have ever previously reported. transcranial color flow imaging (tccFI) showed the highest peak systolic velocity of middle cerebral artery that has ever reported in rcVs cases (330 cm/s). Histologically, the large areas that showed cytotoxic edema on magnetic resonance imaging at acute phase, which indicated possible infarction at the chronic

Invited commentary

Invited commentary

Elevated body mass index correlates with higher seminal plasma interleukin 8 levels and ultrasonographic abnormalities of the prostate in men attending an andrology clinic for infertility.

Obesity is associated with a systemic, low-grade inflammatory state. Although the relationship between obesity and semen parameters or prostate diseases has been previously investigated, the association between body mass index (BMI), prostate inflammatory diseases and color- Doppler ultrasound (CDU) of the male genital tract (MGT) has been poorly studied. To evaluate the association between BMI and CDU features of the MGT, signs and symptoms of prostate inflammation, semen parameters. We studied 222 men seeking medical care for couple infertility. According to the World Health Organization classification, subjects were divided into 3 groups: normal weight (no.=131, BMI=18.5-24.9 kg/m2), overweight (no.=71, BMI=25.0-29.9 kg/m2), obese (no.=20, BMI≥30.0 kg/m2). All patients underwent simultaneous testosterone evaluation and seminal analysis, including interleukin 8 (sIL-8), along with scrotal and transrectal CDU, before and after ejaculation. Prostatitis symptoms were evaluated by National Institutes of Health- Chronic Prostatitis Symptom Index questionnaire. After adjusting for age and testosterone levels, higher BMI was significantly related to higher prostate volume and several CDU features of the prostate, including macro-calcifications, inhomogeneity, higher arterial peak systolic velocity (the latter adjusted also for blood pressure), but not with abnormalities of testis, epididymis, seminal vesicles. Furthermore, higher BMI and BMI class were significantly related to higher sIL-8, a reliable surrogate marker of prostate inflammatory diseases, even after adjustment for age. Conversely, no associations among BMI, clinical symptoms of prostatitis or semen parameters were observed. Subjects with higher BMI might develop CDU and biochemical signs suggestive of prostate inflammation, although not clinically overt.

Spontaneous regression of initially elevated peak systolic velocity in renal transplant artery

There is limited knowledge about the incidence, clinical implication and spontaneous course of transplant renal artery stenosis detected early after renal transplantation. We performed Doppler ultrasound examination of the transplant artery(s) 2 months after transplantation in 98 consecutive patients and peak systolic velocity (PSV) was measured. All patients with an elevated PSV ≥1.8 m/s were reexamined 20 months later and clinical data were followed for 3 years. At the initial examination 2 months after transplantation 15 recipients had a PSV ≥1.8 m/s, mean value for PSV 2.5 (1.8-3.6) m/s, whereas 83 recipients had a normal PSV of 1.3 (0.7-1.7) m/s (P<0.01). At baseline there were no statistical significant differences in clinical parameters between the high PSV versus normal PSV recipients. Twenty (15-28) months after transplantation 14 patients with initial elevated PSV were re-examined. There was an overall mean reduction in PSV of 0.5 (-0.7 to 1.2) m/s from 2.4 (1.8-3.4) m/s to 1.9 (1.2-3.1) m/s (P=0.02). Detection of a high PSV early after transplantation did not affect graft function or blood pressure 3 years after engraftment. We conclude that a high PSV, at 2 months after engraftment, seems to be more of an 'incidental finding' that should be re-challenged and carefully interpreted.

Percutaneous transluminal renal stenting for transplant renal artery stenosis

Renal transplantation is a well-accepted therapeutic option for patients with end stage renal disease. Renal artery stenosis occurring in a transplanted kidney is a potentially serious condition and adversely affects graft survival and prognosis. The objective of this study is to document the immediate and intermediate term clinical results of renal stenting in this rare subset of renal artery stenosis. There is limited data about the effectiveness of renal stenting in transplant renal artery stenosis. Eight patients, aged between 22 and 51 (42.5 ± 9.25) years, were referred to our tertiary care interventional cardiology services for renal intervention. The diagnosis of transplant renal artery stenosis was based on clinical presentation (uncontrolled hypertension (n = 4, 50%), worsening renal function (n = 3, 37.5%) or flash pulmonary oedema (n = 1, 12.5%)] and Doppler ultrasound. All patients had live donor renal transplant using end to end anastomosis 2 to 11 (6.25 ± 3.24) months prior to intervention. Angiography revealed discrete stenosis at the anastomotic site. Intrarenal stenting performed from femoral access using 6 F accessories produced excellent angiographic results. There were no access site or procedure related complications. The intervention produced excellent immediate and intermediate term clinical results. In three patients, there was stabilization of renal function during 62 ± 9.16 months of follow-up with decrease in serum creatinine by 38.86 ± 6.62 %; P = 0.0476. In four patients with refractory hypertension, excellent blood pressure control was achieved with a reduction in mean blood pressure by 25.95 ± 5.48 mm Hg (from 122.4 ± 5.7 to 96.45 ± 2.45 mm Hg; P = 0.0002) during 65.25 ± 23.79 months follow-up. There was decrease in antihypertensive drug requirement from 3.75 ± 0.5 to 1.75 ± 0.5. During follow-up, Doppler ultrasound documented a high peak systolic velocity in one asymptomatic patient with well controlled blood pressure and preserved renal function. Sustained benefits of percutaneous revascularization were supported by normal Doppler parameters in the remaining patients. Percutaneous renal stenting provides excellent angiographic and clinical results sustained at intermediate term follow-up in patients with symptomatic transplant renal artery stenosis.

Closed-Cell Stents Present With Higher Velocities on Duplex Ultrasound Compared With Open-Cell Stents After Carotid Intervention: Short- and Mid-Term Results

The purpose of this study was to evaluate the effect of carotid cell design on duplex ultrasound velocity readings in the immediate postoperative period and over time. A prospective database encompassing all patients treated with carotid artery stents between 2003 and 2008 was established and analyzed for stent type (closed-cell vs. open-cell), indications, and comorbidities. Patients were followed up clinically and with duplex ultrasound immediately after surgery, and every 6 months thereafter. Peak systolic velocities (PSV), end diastolic velocities (EDV), and internal carotid artery (ICA) to common carotid artery (CCA) ratios of PSV were recorded. A total of 214 interventions with 157 (73.3%) open-cell and 57 (26.7%) closed-cell types of carotid stents were performed in 205 patients. Two groups were similar regarding demographics, comorbidities, lesions characteristics, and stent length and diameter. The only difference was a significantly higher mean age (74.4 ± 10.1 vs. 70.9 ± 9.7 years; p = 0.027) and a history of myocardial infarction (34.5% vs. 15.6%; p = 0.004) in the closed-cell group versus open-cell group. Immediately after surgery PSV (115.9 ± 66.1 vs. 93.1 ± 38.7 cm/s; p = 0.003) and ICA/CCA ratio (2.08 ± 1.66 vs. 1.45 ± 0.52; p = 0.001) were significantly higher in closed-cell compared with open-cell group. This difference persisted during the follow-up period of 20.2 +/- 16.4 months; PSV (147.2 ± 108.8 vs. 110.0 ± 51.9; p = 0.003) and ICA/CCA ratio (2.61 ± 2.31 vs. 1.76 ± 0.81; p = 0.001). Patients with diabetes and calcified lesions had higher PSV and ICA/CCA ratio immediately after surgery (p > 0.05 and p < 0.05 for those with diabetes and calcified lesions, respectively) and over time. The number of readings showing significant restenosis (PSV >300 cm/s) over time were significantly higher in closed-cell 5 (8.7%) versus open-cell 1 (0.06%). EDV was not statistically different in the two groups (p > 0.05). Our study suggests that duplex criteria to screen for poststent restenosis may require modification according to stent-type. However, long-term effect of stent design on restenosis is still to be established.

Predictors of Cerebral Reperfusion Injury After Carotid Stenting: The Role of Transcranial Color-Coded Doppler Ultrasonography

To evaluate the possible role of transcranial color-coded Doppler ultrasonography (TCD) in predicting cerebral reperfusion injury (CRI) in patients undergoing carotid artery stenting (CAS) for internal carotid artery (ICA) stenosis. TCD was obtained in 210 patients (149 men; mean age 64.2+/-8.4 years, range 44-83) who underwent CAS for ICA stenosis averaging 86.7%+/-8.4%. Contralateral ICA occlusion or near occlusion (stenosis >90%) was present in 67 (31.9%) patients. TCD was performed before and 24 hours after CAS with assessment of peak systolic velocities (PSVs) in the ipsilateral middle cerebral artery (iMCA) and contralateral middle cerebral artery (cMCA). PSV ratios (PSVR) in the iMCA and cMCA were calculated from the PSVs before and after CAS. CRI syndrome occurred in 3 (1.4%) patients (2 intracranial bleedings, 1 subarachnoid hemorrhage). The mean iMCA and cMCA PSVRs were 2.66+/-0.19 and 4.16+/-2.77, respectively, in CRI patients, while the PSVRs in CAS patients without neurological sequelae were 1.56+/-0.46 and 1.21+/-0.39, respectively (both p<0.001). The combination of iPSVR>2.4 and cPSVR>2.4 occurred in 4 patients with bilateral ICA disease; 3 (75%) of them developed CRI (100% sensitivity and 99% specificity for CRI prediction). The following independent CRI predictors were identified: combined iPSVR>2.4 and cPSVR>2.4 (RR 2.06, CI 1.89 to 2.24; p<0.001), high cMCA PSV after CAS (RR 1.23, CI 1.13 to 1.34; p<0.001), and contralateral ICA occlusion (RR 1.13, CI 1.03 to 1.23; p = 0.007). TCD is an important tool in CRI risk evaluation. The combination of iPSVR>2.4 and cPSVR>2.4 is an independent CRI risk factor, along with contralateral ICA occlusion and high cMCA PSVs after CAS.