Positive Doppler Signal Research Articles

Effects of ELF-EMF Treatment on Depression

A 50-year-old male with no relevant clinical history presented sudden headache accompanied by nausea, which evolved with facial paresis and drowsiness with a computed tomography (CT) showing bilateral subarachnoid bleeding, being admitted to the intensive care unit. We performed a transcranial doppler ultrasonography (TCD) that showed the presence of a rounded image at M2 portion of the right middle cerebral artery (rMCA) that measured 20 mm × 21 mm with a positive color Doppler signal Figure 1.

Case report of arthritis caused by Legionella anisa and review of the literature

BackgroundLegionella spp. is recognized as a common cause of community acquired pneumonia, with Legionella pneumophila serogroup 1 being the most prevalent. At least 70 species are described so far but few are identified in pathogenic conditions. Data on extrapulmonary infections are scarce.Case presentationA 73-yar-old male with chronic lymphoid leukemia was hospitalized for an insidious wrist arthritis. Ultrasound of the wrist showed a carpal and radiocarpal fluid effusion with positive Doppler signal. While routine bacterial cultures remained sterile, 16S rRNA PCR identified Legionella anisa. Ciprofloxacin 500 mg twice a day for a period of six weeks improved arthritis with full recovery at the end of the treatment.ConclusionLegionella non pneumophila are a rare cause of septic arthritis especially found in immunosuppressed patients and identification of species could help clinician to adapt antibiotherapy.

Atteintes articulaires dans le syndrome de Sjögren primitif

Joint involvement is one of the most common extra-glandular manifestations in primary Sjögren's syndrome (pSS), affecting almost half of the patients with clinical arthritis in 16 %. Most commonly, these are symmetrical arthritis, affecting fewer than 5 joints. Ultrasound shows grade 1 or 2 synovitis, with a positive doppler signal in less than a fourth of cases, and tenosynovitis, mostly of the finger flexors. Radiographs should not show erosion. In presence of erosions on ultrasound or MRI, which may be found on MCP and wrists, RA with secondary SS should be excluded. Five to 10 % of patients with SSp have anti-CCP antibodies. The presence of anti-CCP antibodies does not necessarily exclude the diagnosis of SSp, but it should alert to the risk of further development of RA, therefore requiring radiographic follow-up even if the pSS has been evolving for many years. Joint involvement has a good prognosis and appears to be a predictor of a favourable clinical course. Treatment should be guided by the level of clinical activity and should be based on NSAIDs or corticosteroids ±hydroxychloroquine. Synthetic disease-modifying anti-rheumatic drugs should be offered for corticosteroid sparing.

Endonasal Acoustic Doppler Sonography in Predicting the Survival of Nasoseptal Flap Following Previous Irradiation.

Blood supply to the nasoseptal flap may be compromised in patients who had previous irradiation to the head and neck region, hence, affecting its viability. Here, we evaluate the role of an endonasal acoustic Doppler sonography in predicting the survival of the nasoseptal flap in this group of patients. Retrospective cohort. Retrospective review of patients with previous irradiation to the head and neck region who had undergone endoscopic endonasal surgeries requiring nasoseptal flap as reconstruction. Survival rates of nasoseptal flap were compared between groups where endonasal Doppler was used. A total of 28 patients were identified with previous irradiation to the head and neck region who had undergone endoscopic endonasal surgeries requiring nasoseptal flap as reconstruction. The overall survival rate of nasoseptal flap is 67.8% (19 out of 28). Endonasal acoustic Doppler was used in 17 of these patients, of which 13 patients had a positive signal. The flap survival rate in the Doppler-positive group compared to the non-Doppler group was significantly better at 100% vs 45.4% (P= .003). Among those where the endonasal Doppler was used, the flap survival rate with a negative doppler signal was significantly worse at 25%, compared with 100% flap survival in those with positive doppler signal (P= .006). The positive predictive value of a positive endonasal Doppler signal with flap survival is 100%. The use of endonasal acoustic Doppler may be useful in predicting the viability of nasoseptal flap in postirradiated patients who need a local mucosal flap coverage. 3 Laryngoscope, 133:244-247, 2023.

Is the Prognosis of Osgood-Schlatter Poorer Than Anticipated? A Prospective Cohort Study With 24-Month Follow-up.

Background:Osgood-Schlatter disease (OSD), an apophyseal injury of the tibial tuberosity, affects up to 1 in 10 adolescents. This condition has previously been assumed to be innocuous and to self-resolve with limited intervention.Purpose:To investigate the 24-month prognosis of OSD and examine if ultrasound (US) classification is associated with outcomes.Study Design:Case series; Level of evidence, 4.Methods:This study included a preregistered prospective cohort of 51 adolescents (aged 10-14 years) diagnosed with OSD who were evaluated for 24 months. The primary outcome at 24-month follow-up was whether participants continued to experience OSD-related knee pain. Baseline US scans were collected and characterized by OSD type (De Flaviis classification) as well as maturation of the tibial tuberosity. Secondary outcomes included sports participation, Knee injury and Osteoarthritis Outcome Score (KOOS) Sport/Recreation subscale, and health-related quality of life (European Quality of Life–5 Dimensions–Youth [EQ-5D-Y]). All participants were invited for re-examination by US at follow-up.Results:A total of 51 patients preregistered for the study, with 90% (n = 46) available at follow-up. Of these 46 participants, 37% (n = 17) still reported knee pain due to OSD. In this subgroup, the median duration since symptom onset was 42 months (interquartile range, 38-51 months). More than 1 in 5 participants reported stopping sport due to knee pain, and those who continued to experience knee pain reported significantly worse KOOS Sport/Recreation scores at follow-up compared with patients with no knee pain (mean 74 [95% CI, 63-84] vs 91 [95% CI, 85-97]). Participants with continued OSD-related pain also had lower health-related quality of life (mean difference in EQ-5D-Y, 0.11 [95% CI, 0.06-0.13]). Higher De Flaviis classification at baseline was significantly associated with an increased risk of knee pain at 2 years. Diagnostic US at follow-up demonstrated primarily tendon changes (thickening, positive Doppler signal), as well as an ununited ossicle in 32% of participants who underwent US scanning at follow-up.Conclusion:Over one-third of the study participants had knee pain at 2-year follow-up, which was associated with lower sports related function and health related quality of life. This questions the assumption that all patients with OSD experience quick recovery. Participants without any changes on imaging at baseline were less likely to report pain at follow-up.

​Color Doppler Ultrasonographic Characteristics of Embryonic Development and Mortality in Dairy Cows

Background: Embryonic mortality is one of the major factors leading to reproductive failure, decreased fertility and delayed pregnancy in cattle. Method: The study was aimed for investigating the incidence of embryonic mortality(EM), differentiate embryonic development and mortality based on color Doppler ultrasonographic characteristics. Different characteristics correlated were corpus luteum(CL) vascularity, embryonic development and EM features, monitored on day 21 post-insemination. Result: The overall incidence of EM was recorded to be 25%, with 15% and 10% mortality occurred between days 21-28 and 28-35 of gestation. Color Doppler analysis stated that, the CL in pregnant cows had a higher percentage of luteal tissue with positive Doppler signals on initial examination (day 21) differing significantly (P less than 0.01) from non-pregnant and consistently increased till the end of the examination. However, cows with EM had a significantly lower CL vascularity than pregnant (P less than 0.05) but significantly higher (P less than 0.05) than non-pregnant cows on day 21. Embryos from pregnant cows (detected by 28 days) increased in size along the days of examination. However, cows diagnosed with EM showed signs (day 28), which included reduced intra-uterine allantoic fluid, absence of embryo proper with an embryonic heartbeat, hyperechoic free-floating embryonic debris in the uterus and distorted allanto-chorionic membrane. In conclusion, the present study firmly supports color Doppler ultrasonography in diagnosis of pregnant cows based on CL vascularity, visualizing the different characteristics signs of EM, and detecting non-pregnant animals undergoing EM as early as day 21.

S0557 The Role of Endoscopic Doppler Probe in the Management of Bleeding Peptic Ulcers: A Systematic Review and Meta-Analysis

INTRODUCTION: Forrest classification for ulceration has significant intra and inter-observer variability. The endoscopic doppler probe (DOP-US) identifies arterial blood flow at the base to direct therapy. To the best of our knowledge, the efficacy of DOP-US in decreasing peptic ulcer rebleeding has not been systematically evaluated. We performed the first systematic review and meta-analysis to evaluate the role of the DOP-US in bleeding peptic ulcers. METHODS: Three reviewers independently and in duplicate searched PubMed, Medline, CENTRAL, EMBASE, Scopus, Web of Sciences and clinical trial registries from inception until December 2019 evaluating the use of through the scope doppler probe in peptic ulcer bleeding using key words such as “doppler endoscopic probe”, “through the scope doppler”, “peptic ulcer”, “non-ultrasound probe”, “doppler US”, “gastroduodenal ulcers”. Primary outcomes were the overall rebleeding rate with the use of DOP-US probe and comparison of rebleeding rate in patients with DOP-US versus standard visual evaluation. The specific inclusion criteria for the systematic review and meta-analysis were: (1) all Randomized Control Trials (RCTs) or prospective studies or retrospective studies in patients more than 18 years of age with peptic ulcer related hemorrhage (2) use of through-the-scope DOP-US as intervention for management of upper gastrointestinal bleeding before endoscopic intervention to risk stratify lesions (3) full text articles available in English language. RESULTS: Seven studies were included after a thorough search was concluded using the key words. This yielded a total of 723 patients included in the analysis with a total of 576 patients undergoing DEP evaluation to guide endoscopic therapy. The pooled analysis of studies using DOP-US prior to endoscopic therapy revealed an overall rebleeding rate of 7.6% (95% Confidence interval (CI) 4.8-11.8%). Rebleeding Rate are significantly lower with the use of DOP-US as compared to visual evaluation alone (OR 0.34,95% CI 0.18-0.66; P = 0.001). Further studies are needed as the total included studies were less than ten and publication bias cannot be accurately ascertained. CONCLUSION: The first systematic review and meta-analysis showed that the DOP-US is a beneficial tool in the management of bleeding ulcers and adds valuable information to visual evaluation.Figure 1.: Forrest plot showing a pooled overall rebleeding rate with the use of doppler probe prior to endoscopic therapy in all cases.Figure 2.: Forrest plot showing rebleeding rate in cases with doppler probe versus endoscopic evaluation of peptic ulcer.Figure 3.: Forrest plot demonstrating odds of rebleeding with endoscopic therapy based on doppler signal (positive doppler signal versus negative doppler signal).

Endoscopic ultrasound to support the diagnosis of submucosal tumors in the upper gastrointestinal tract

Background and Objectives: Submucosal tumors are generally discovered accidentally. Endoscopic ultrasound is a valuable technique in the diagonsis and management of submucosal tumors, however, there is still little research about the role of endoscopic ultrasound in diagnosing this pathology in Viet Nam. The purpose of this study was to research about endoscopic ultrasound to support the diagnosis of submucosal tumors in the upper gastrointestinal tract. Subjects and methods: This is a cross sectional study on 76 patients were diagnosed submucosal tumors of the upper gastrointestinal tract by endoscopic ultrasound at the Gastrointestinal Endoscopy Center, Hue University of Medicine and Pharmacy Hospital from May 2017 to July 2019. Results: In 76 patients, epigastric pain was most common (57.9%), followed by nausea or vomiting (15.8%); and asymptomatic (39.5%). Submucosal tumors located in the stomach (44.7%), esophagus (40.8%) and duodenum (14.5%). The overlying mucosa: 88.2% with the smooth mucosa, 9.2% with the umbilication (9.2%) and 2.6% with the mucosal ulceration. Mean size was 14.6 ± 9.1 mm. The muscularis mucosa was 47.4%, the submucosa was 13.2%, the muscularis propria was 32.9%. 61.8% with hypoechoic; 5.3% with hyperechoic; 22.4% with anechoic and 10.5% with mixed echoic. 82.9% with homogeneous tumor and 17.1% with heterogeneous tumor. All tumors have a smooth margin. 5.3% with positive Doppler signal and 94.7% with negative Doppler signal. Conclusion: Endoscopic ultrasound can provide information about size, location, structure, margin, Doppler signal and this is a highly valuable technique in the diagnosis of submucosal tumors of the upper gastrointestinal tract. Key words: Submucosal Tumor (SMT), Endoscopic Ultrasound, GastroIntestinal Stromal Tumor

Undervaluation of rheumatoid arthritis activity under interleukin-6 inhibitor therapy

A 62-year-old female patient with advanced rheumatoid arthritis was admitted for assessment of disease activity. Patient was currently under treatment with Tocilizumab and Cyclosporine A (3mg/kg). Her history of hepatitis C and elevated transaminases (treated with Methotrexate) rendered her ineligible for this standard therapeutic option. Several other DMARDs (Azathioprine, Sulfasalazine, Hydroxychloroquine) and biological therapies (Etanercept, Certolizumab) had proven ineffective.
 On admission, patient reported increased morning pain and stiffness of hand joints. Clinical examination revealed fourteen swollen joints with no tenderness at compression and typical signs of advanced rheumatoid arthritis: ulnar deviation of fingers, interosseous muscle atrophy, swan neck deformity, impaired prehension. Laboratory investigations showed normal CRP (1.83 mg/L) and slightly increased ESR (44 mm/h) values. DAS28-CRP=2.7 (low activity), DAS28-ESR=4.12 (moderate activity). Hand and wrist radiographs were characteristic of advanced stage disease: bone erosions, joint spaces narrowing, metacarpophalangeal subluxations, juxta-articular osteoporosis. Ultrasound of hand joints revealed signs of active disease with positive Doppler signal.
 During hospitalisation the patient received pain relieving treatment (Dexamethasone, Lornoxicam). On discharge, Cyclosporine A dose was increased to 5mg/kg. The timeliness of a different biological treatment will be assessed after 3 months, in case of persistent disease activity.
 The present case highlights the risk of disease activity undervaluation in patients undergoing biological therapy with interleukin-6 inhibitors if the standard DAS28-CRP score is used [1],[2],[3], due to their additional inhibitory effect on hepatic CRP production. It is advised that in such cases, articular ultrasound and DAS28-ESR score should be considered for a more accurate assessment.

Sonographic synovitis in primary knee osteoarthritis patients and its relation to biomarkers of inflammation and oxidative stress

Aim of the workTo determine the relation between knee synovitis detected by ultrasound (US) and biomarkers of inflammation and oxidative stress in primary knee osteoarthritis (KOA) patients. Patients and methodsThe study included 40 patients with primary KOA and 40 age and sex matched control. Patients were evaluated using Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score. Laboratory investigations included high-sensitivity C-reactive protein (hsCRP), matrix metalloproteinase-mediated breakdown of CRP (CRPM), nitric oxide (NO), hydrogen peroxide (H2O2) and malondialdehyde (MDA). High resolution US examination of knee joints (grey-scale and power Doppler) was done for assessment of synovitis. ResultsThe patients were 37 females and 3 males, the mean age was 45.5 ± 9.25 years, 50% were housewives. Tenderness was grade 1 in 45%, 2 in 40% and 3 in 15%; 82.5% has swelling and 87.5% had crepitus; the WOMAC score was 57 (5–112); pain-index 10 ± 4.2; stiffness index 6.0 ± 2.01 and physical function 41 ± 13.55. Sonographically, 29(72.5%) had grey-scale synovitis (effusion and synovial hypertrophy) and 5(12.5%) patients had a positive Doppler signal. The serum levels of the hsCRP, CRPM, NO, H2O2 and MDA were signficantly increased in the patients compared to the control (p < 0.001 for all). There was no significant difference of the studied laboratory parameters according to the presence and absence of the sonographic findings. ConclusionsAlthough the serum levels of both inflammatory and oxidative stress biomarkers were significantly higher in OA patients compared to the control, there was no correlation with the sonographic findings of synovitis.

Young age - an unusual finding of Hurthle cell carcinoma

Hürthle cell carcinoma is a rare thyroid neoplasm which originates from the follicular epithelium of the thyroid gland and is considered a true rarity in young patients. A 30 year-old woman was admitted to our department with palpable anterior cervical mass due to enlarged thyroid. The ultrasound revealed a large thyroid nodule with central hypoechogenicity, peripheral hyperechogenicity and positive Doppler signal. The patient had no distinguishable lateral cervical lymphadenopathy. The TI-RADS calculation (thyroid image reporting data system) classified the nodule as TR4 (4 points), which indicated a fine needle aspiration biopsy (FNAB), declined by the patient. Total thyroidectomy was performed and the histological findings associated with immunohistochemical study revealed the diagnosis of Hürthle cell carcinoma with capsular and vascular invasion. Because the microscopic vascular invasion was &lt; 4 foci the patient was classified as low-risk group. Even so, due to the young age she was referred to radioactive iodine therapy for completion of curative treatment. This case illustrates the difficulties in the management of thyroid nodules with suspicious features on ultrasound, in the absence of FNAB exploration, and the unusual presence of Hürthle cell carcinoma in a young age patient, knowing the 6th decade is the average age for this rare type of thyroid neoplasm.

Predictive features for histology of gastric subepithelial lesions.

- Gastric subepithelial lesion is a relatively common diagnosis after routine upper endoscopy. The diagnostic workup of an undetermined gastric subepithelial lesion should take into consideration clinical and endoscopic features. - We aimed to investigate the association between patients' characteristics, endoscopic and echographic features with the histologic diagnosis of the gastric subepithelial lesions. - This is a retrospective study with 55 patients, who were consecutively diagnosed with gastric subepithelial lesions, from October 2008 to August 2011. Patients' characteristics, endoscopic and echografic features of each gastric subepithelial lesion were analysed. Histologic diagnosis provided by EUS-guided fine needle aspiration or endoscopic/surgical resection was used as gold standard. - The probability of gastrointestinal stromal tumors to be located in the cardia was low (4.5%), while for leiomyoma it was high (>95%). In addition, there was a higher risk of gastrointestinal stromal tumors in patients older than 57 years (OR 8.9; 95% CI), with lesions ≥21 mm (OR 7.15; 95% CI), located at 4th layer (OR 18.8; 95% CI), with positive Doppler sign (OR 9; 95% CI), and irregular outer border (OR 7.75; 95% CI). - The location of gastric subepithelial lesions in the gastric cardia lowers the risk of gastrointestinal stromal tumors. While gastric subepithelial lesions occurring in elderly patients, located in the gastric body, with positive Doppler signal and irregular outer border increase the risk of gastrointestinal stromal tumors.

Ultrasound abnormalities in septic arthritis are associated with functional outcomes

ObjectivesTo describe the ultrasound abnormalities seen in septic arthritis and to assess their associations with clinical, biological, and radiological outcomes. MethodsWe prospectively included 34 patients with septic arthritis of a native joint (knee, n=19; shoulder, n=6; hip, n=4; ankle, n=3; or wrist, n=2). Ultrasonography was performed to record synovial-membrane thickness and vascularity, joint effusion, and abnormalities of adjacent soft tissues, at baseline then 4days, 2weeks, and 3months later. Motion-range limitation of the affected joint was evaluated after 3months. Radiography was performed at inclusion and after 3months. ResultsMean age was 63.7±17.6years. After 3months, 20 (58.8%) patients had motion-range limitation with worsening of the total radiological score (P<0.001). The proportion of patients with synovitis was very high initially (96.4% at baseline, 96.3% after 4days, and 100% after 2weeks) then diminished to 77.8% after 3months (P=0.051). Synovial-membrane thickness was significantly higher after 4days and 2weeks compared to baseline (median, +17.3% and +20%, respectively; P=0.015) and was significantly lower after 3months compared to the earlier time points (median, −31.5%, P=0.015). A positive Doppler signal was common at baseline (n=18, 64.3%) then significantly less so after 3months (n=7, 25.9%; P=0.04). An unchanged or higher Doppler grade after 2weeks compared to baseline was associated with motion-range limitation at last follow-up (P=0.033). ConclusionWe report the first study on ultrasound evidence of synovitis, joint effusion, and soft tissue alterations at baseline and over time in patients with septic arthritis. Persistent synovitis and joint effusion 3months after starting antibiotic therapy was not associated with treatment failure. However, Doppler signal changes over the first 2weeks were associated with the 3-month functional outcome.

Synovial changes detected by ultrasound in people with knee osteoarthritis – A meta-analysis of observational studies

Purpose: To examine the prevalence of synovial effusion, synovial hypertrophy and positive Doppler signal detected by ultrasound (US) in people with knee osteoarthritis (OA) or knee pain compared to that in the general population. Methods: A systematic literature search was undertaken in Medline, EMBASE, Allied and Complementary Medicine, PubMed Web of Science, and SCOPUS databases in May 2015. Frequencies of US abnormalities in people with knee OA/pain, in the general population or asymptomatic controls were pooled using the random effects model. Publication bias and heterogeneity between studies were examined. Quality assessment was performed using Newcastle-Ottava scale. Results: Twenty four studies in people with knee OA/pain (n=3173) and five studies of the general population (n=1007) met the inclusion criteria. The pooled prevalence of US effusion, synovial hypertrophy and positive Doppler signal in people with knee OA/pain were 51.5% (95%CI 40.2 to 62.8), 41.5% (26.3 to 57.5) and 32.7% (8.34 to 63.24), respectively, which were higher than those in the general population or asymptomatic controls (19.9% (95%CI 7.8% to 35.3%), 14.5% (0 to 58.81), and 15.8 (3.08 to 35.36), respectively). In addition, people with knee OA (ACR criteria or radiographic OA) had greater prevalence of US abnormalities than people with knee pain (pooled prevalence for effusion 58.7% (95% CI 47 to 69.9) and 26% (5.6 to 54.4), p=0.037, for synovial hypertrophy 49% (95% CI 30.5 to 67.6) and 15.2% (3.3 to 33.3), p=0.010 and for Doppler signal 43.8% (95% CI 11.7 to 79.0) and 4.8% (1.9 to 8.7), p=0.009, respectively). Sensitivity analysis in studies on people with knee OA/pain revealed that studies with sample size less than 100 reported significantly higher prevalence of effusion and synovial hypertrophy (p=0.034 and p=0.015, respectively). A significant difference was observed in prevalence of Doppler signal between higher (overall score ≥50%) and lower quality studies (pooled prevalence 6.0% (95%CI 2.4 to 10.9) and 77% (54.5 to 93.7), respectively) (Figure 1). A positive association between knee effusion and pain was reported in 7 of 10 studies. Most studies found no association between synovial hypertrophy and pain (4 of 6), and there were no data for DS. Conclusions: US detected effusion, synovial hypertrophy and Doppler signal are more common in people with knee OA/pain, compared to the general population. These abnormalities relate more to presence of OA structural changes than to pain.

Synovial changes detected by ultrasound in people with knee osteoarthritis – a meta-analysis of observational studies

SummaryObjectivesTo examine the prevalence of synovial effusion, synovial hypertrophy and positive Doppler signal (DS) detected by ultrasound (US) in people with knee osteoarthritis (OA) and/or knee pain compared to that in the general population.MethodA systematic literature search was undertaken in Medline, EMBASE, Allied and Complementary Medicine, PubMed Web of Science, and SCOPUS databases in May 2015. Frequencies of US abnormalities in people with knee OA/pain, in the general population or asymptomatic controls were pooled using the random effects model. Publication bias and heterogeneity between studies were examined.ResultsTwenty four studies in people with knee pain/OA and five studies of the general population or asymptomatic controls met the inclusion criteria. The pooled prevalence of US effusion, synovial hypertrophy and positive DS in people with knee OA/pain were 51.5% (95% CI 40.2 to 62.8), 41.5% (26.3–57.5) and 32.7% (8.34–63.24), respectively, which were higher than those in the general population or asymptomatic controls (19.9% (95%CI 7.8–35.3%), 14.5% (0–58.81), and 15.8 (3.08–35.36), respectively). People with knee OA (ACR criteria or radiographic OA) had greater prevalence of US abnormalities than people with knee pain (P = 0.037, P = 0.010 and P = 0.009, respectively).ConclusionsUS detected effusion, synovial hypertrophy and DS are more common in people with knee OA/pain, compared to the general population. These abnormalities relate more to presence of OA structural changes than to pain.

Low Wound Complication Rates for the Lateral Extensile Approach for Calcaneal ORIF When the Lateral Calcaneal Artery Is Patent.

Historically, the lateral extensile approach for calcaneal fracture osteosynthesis has had relatively high rates of wound healing problems. The vascular territory (angiosome) of the lateral foot is now known to be dependent upon the lateral calcaneal branch of the peroneal artery (LCBP artery). We postulated that patency of the LCBP artery may have a profound positive impact on incisional wound healing for calcaneal open reduction and internal fixation (ORIF). Ninety consecutive calcaneal fractures that met operative criteria were preoperatively evaluated for the presence of a Doppler signal in the LCBP artery and were followed for the development of wound healing problems. Among these 90 fractures, 85 had a positive preoperative Doppler signal along the course of the LCBP artery (94%) and 5 had no Doppler signal (6%). All patients underwent ORIF via a lateral extensile approach. Overall, incisional wound healing problems occurred in 6 of 90 calcaneal incisions (6.5%). All 5 feet that exhibited an absent Doppler signal in the LCPB artery developed an incisional wound healing complication (5/6, approximately 83%): 2 large apical wounds and 3 major dehiscence/slough. However, among the 84 feet that possessed a positive preoperative Doppler signal in the LCBP artery, there was only 1 (1/84, approximately 1%) incisional wound healing problem (P < .0001, Fischer's exact test). Smokers with a positive Doppler signal in the LCBP artery did not develop a wound healing complication. This study suggests a strong link to low incisional wound healing complications for the lateral extensile approach to the calcaneus when a preoperative Doppler signal is present in the LCBP artery. We believe this simple examination should be routinely performed prior to calcaneal ORIF. Level III, comparative case series.

AB0956 A Significant Proportion of Patients with Newly Diagnosed and Established Inflammatory Arthritis Have Positive Doppler Signal in Their Hand Joints in the Context of Normal C-Reactive Protein Levels

BackgroundUltrasound (US) assessment of small joints is a well-established method of investigation in inflammatory arthritis. Previous data suggest that there is a poor correlation with clinical examination, and has proved...

AB0783 Ultrasonography Lesions in Tunisian Hand Osteoarthritis

BackgroundHand osteoarthritis (HOA) is one of the three most common subsets of osteoarthritis. So far, HOA diagnosis has relied on clinical (pain and finger joint nodes) and radiological features. Conventional...

Hyperemia in Plantar Fasciitis Determined by Power Doppler Ultrasound

Cross-sectional observational study. To investigate the presence of soft tissue hyperemia in plantar fasciitis with power Doppler ultrasound. Localized hyperemia is an established feature of tendinopathy, suggesting that neurovascular in-growth may contribute to tendon-associated pain in some patients. The presence of abnormal soft tissue vascularity can be assessed with Doppler ultrasound, and a positive finding can assist with targeted treatment plans. However, very little is known regarding the presence of hyperemia in plantar fasciitis and the ability of routine Doppler ultrasound to identify vascular in-growth in the plantar fascia near its proximal insertion. This observational study included 30 participants with plantar fasciitis unrelated to systemic disease and 30 age- and sex-matched controls. Ultrasound examination was performed with a 13- to 5-MHz linear transducer, and power Doppler images were assessed by 2 blinded investigators. Hyperemia of the plantar fascia was present in 8 of 30 participants with plantar fasciitis and in 2 of 30 controls. The between-group difference for hyperemia, using a 4-point scale, was statistically significant, with participants with plantar fasciitis showing increased Doppler ultrasound signal compared to controls (Mann-Whitney U, P = .03). However, the majority of participants with plantar fasciitis with evidence of hyperemia demonstrated very mild color changes, and only 3 were found to have moderate or marked hyperemia. Mild hyperemia can occur with plantar fasciitis, but most individuals will not exhibit greater soft tissue vascularity when assessed with routine Doppler ultrasound. Clinicians treating plantar fasciitis should not consider a positive Doppler signal as essential for diagnosis of the condition but, rather, as a feature that may help to refine the treatment plan for an individual patient.

THU0416 The usefulness of a musculoskeletal ultrasound (MUS) scoring system for 22 hand joints examination for the detection of early undifferentiated inflammatory arthritis and treatment decisions making in established inflammatory arthritis

BackgroundThe ultrasound examination of the small joints in patients with inflammatory arthritis is extensively used in clinical routine at present despite the lack of a uniformly standardised scoring system.Objectives1) To...