Preoperative Color Doppler Ultrasonography Research Articles

Clinical characteristics and outcome of children with acute cryptorchid testicular torsion: A single-center, retrospective case series study

BackgroundCryptorchidism and testicular torsion (TT) are relatively common conditions in clinical practice; however, sparse information about cryptorchid TT is available in the current literature. MethodsWe retrospectively reviewed the clinical characteristics, treatment modalities, and long-term outcomes of pediatric patients treated for acute cryptorchid TT. ResultsWe found eight patients with unilateral acute cryptorchid TT with a prevalence of 8.9% (8/90) among all TT cases. The left testis was affected in six patients. The median age of patients at the time of the surgery was 65 months (interquartile range (IQR) 4–136 months). The median duration of symptoms was 16 h (IQR 9–25 h), while the median time to treatment was 60 min (IQR 59–63 min). The most common symptoms were pain (abdominal and inguinal) and inguinal mass with no palpable testis in the ipsilateral hemiscrotum. Preoperative color Doppler ultrasonography revealed absent or decreased testicular blood flow in the affected testes in 7/8 of patients. Various degrees of testicular torsion (median 540°, min 360°, max 1260°) were found during surgery. A necrotic testis that led to orchidectomy was found in 4/8 of patients. The median follow-up period was 42.6 months (IQR 12.5–71.2 months), revealing only one patient with testicular atrophy. The final testicular salvage rate was 35%. ConclusionsGreater awareness among caregivers and primary care physicians about acute cryptorchid TT is required to improve their timely diagnosis and treatment. A physical examination of the external genitalia and inguinal regions should be mandatory to attain a proper diagnosis and treatment without delay.

The value of color doppler ultrasonography combined with computed tomography angiography and magnetic resonance angiography in the preoperative quantification and classification of carotid body tumors: a retrospective analysis

BackgroundComputed tomography angiography (CTA) and magnetic resonance angiography (MRA) provide accurate vascular imaging information, but their use may be contraindicated. Color Doppler ultrasonography (CDU) provides simple, safe, noninvasive, and reproducible imaging. We therefore investigated the role of preoperative CDU combined with CTA and MRA in the quantification, typing, and diagnosis of carotid body tumors (CBTs).MethodsWe retrospectively analyzed patients with CBTs categorized into group A (type I [n = 1] and type II [n = 10]) or group B (type III [n = 56]) per the intraoperative Shamblin classification. CDU, CTA, and MRA characteristics of CBTs were observed, surgical results were correlated, and the diagnostic threshold of the CBT classification was calculated.ResultsCBTs were usually located at the common carotid artery bifurcation, encircling the carotid artery. An increased angle was found between the internal and external carotid arteries. On CDU, CBTs primarily presented as homogeneous hypoechoic masses with clear boundaries, rich flow signals, and a high-speed, low-resistance artery-like flow spectrum. CTA showed uniform or heterogeneous marked enhancement. MRA showed mixed T1 and slightly longer T2 signals and uniform or uneven obvious enhancement. With increases in the lesion size, amount of blood transfused, and operation time, the intraoperative classification level and possibility of skull-base invasion increased. When the maximum diameter of the lesion, the volume of the tumor, the distance between the upper margin of the tumor to the mastoid and the mandibular angle were 3.10 cm, 10.15 cm3, − 3.26 cm, and 0.57 cm, respectively, the largest Youden index was the best diagnostic boundary value for Shamblin type III tumors.ConclusionsCDU combined with CTA and MRA can accurately evaluate the size and classification of CBTs.

The Use of Conventional Lower-Frequency Color Doppler Ultrasound for Flap Planning in the Lower Extremity.

Handheld Doppler is often inaccurate in localization of perforators for pedicled and free flaps. Color Doppler ultrasound (CDU), in contrast, allows more accurate mapping and characterization of perforators to facilitate rapid flap harvest. Forty-seven flaps harvested from the lower extremity were evaluated preoperatively with CDU by a single surgeon with a conventional low-frequency ultrasound device (Philips Sparq, Cambridge, Mass). Flaps evaluated included profunda artery perforator flaps (n = 36), anterolateral thigh flaps (n = 2), pedicled propeller perforator flaps (n = 7), and toe transfers (n = 2). In all cases where a free profunda artery perforator or anterolateral thigh flap was used, the location of the dominant perforator visualized preoperatively correlated exactly with intraoperative findings. In cases where CDU was used preoperatively to locate a large perforator close to a lower extremity defect for reconstruction with a propeller perforator flap, all perforators could be used, and all flaps were successful. Preoperative CDU is particularly useful for flap planning where knowledge of the location of the dominant perforator is critical. This includes planning of thin and superthin free flaps, as well as freestyle perforator flaps. Our clinical experience suggests that this technology should be routinely adopted in certain aspects of reconstructive microsurgery.

Reoperation treatment of persistent postoperative secondary hyperparathyroidism

Objective:To evaluate the clinical effect of reoperation in persistent hyperparathyroidism （PHPT） patients after operation of parathyroidectomy combined with autotransplantation（PTX+AT） on secondary hyperparathyroidism （SHPT） . Methods:18 PHPT patients who treated with reoperation after PTX+AT were enrolled in this study during the period from Aug 2012 to Dec 2021 in the Department of Otolaryngology Head and Neck Surgery of Peking University Civil Aviation School of Clinical Medicine, Civil Aviation General Hospital. The remaining parathyroid glands were located by preoperative colour Doppler ultrasonography, radionuclide imaging, enhanced CT and MR imaging in the neck region . Based on the imaging findings, the remaining parathyroid glands were removed in situ, and the missed ectopic or extra parathyroid glands were resected with an extended surgical scope according to the parathyroid dissection method. The surgical effect was evaluated by the changes of clinical symptoms, the dynamic change of serum intact paramyroidhomone（i-PTH） between preoperative and postoperative periods and the surgical complications. Results:All the 18 patients accepted successful operation. 30 parathyroid glands were resected confirmed by postoperative pathology, including 16 in situ and 14 ectopic glands（5 in superior mediastinum, 4 in thymus, 2 in posterior mediastinum ,2 in thyroid glands, 1 in carotid sheath）.Osteoarthropathy and skin itching were significantly relieved or even disappeared at 6 h after surgery. The levels of serum i-PTH, calcium and phosphorus reached the standards and muscle weakness was significantly improved 1 week after surgery. 16 patients presented hypocalcemia and returned to normal after supplement of calcium. Hoarseness due to temporary injury of laryngeal nerve was found in 6 cases. No serious complications or death occurred after the operation.There was no recurrence after 1 year follow-up. Conclusion:Reoperation is the first choice for SHPT patients complicated with persistent hyperparathyroidism. Multiple imaging examinations are used to locate the residual parathyroid, especially the ectopic gland. Expanded surgical scope is applied to resect all the residual parathyroid glands（ectopic, in situ and concealed parathyroid） according to the concept of dissection parathyroidectomy. The surgery is effective and safe. Patients'quality of life and long-term survival rate is improved.

Testicular regression syndrome: A retrospective analysis of clinical and histopathological features in 570 cases

This study aimed to analyze the clinical features and pathological findings of the largest reported case series of testicular regression syndrome (TRS). Data, including age, affected side, color Doppler ultrasound results, surgical methods, intraoperative conditions, and pathological examinations, of children with unilateral TRS who were treated in our center from December 2012 to November 2021 were retrospectively analyzed. A total of 570 patients were included in this study. The mean age at surgery was 38 (range, 5-193) months. There were 457 cases (80.2%) of left TRS. Preoperative color Doppler ultrasonography found nubbins in 172 cases (30.2%). The long diameter of the contralateral testis was 17.11 (±4.22) mm, and the volume was 0.81 (±1.15) ml. The long diameter was ≥1.6 cm in 62.0% of the patients (240/387) aged ≤3 years. Laparoscopy was performed as the initial surgical step in 513 cases, of which 96.7% of the children had closed internal rings. One or more lesions of fibrosis, hemosiderin, and calcification were found in 92.4% (474/513) of the excised remnants. Germ cells were present in 16 cases (3.1%). In conclusion, TRS is more common on the left side and is usually accompanied by a closed internal ring and compensatory hypertrophy of the contralateral testis. Germ cells are only present in cases where the spermatic vessels enters the internal ring. We recommend that further exploration and excision of the remnants may not be applicable in cases where only the vas deferens has entered the internal ring.

The Role of Color Doppler Ultrasonography in the Prevention of Thromboembolic Disease after Total Hip Replacement

Orthopedic and trauma surgery carries a high risk of deep vein thrombosis (DVT) in the lower limbs and acute pulmonary embolism (APE). In traumatology, the greatest risk is in hip fractures of the proximal extremity of the femur, especially those of the neck, and intertrochanteric fractures. In orthopedics the risk of thromboembolic complications (TEC) is particularly high in hip and knee surgery, especially in prosthetic replacement, as general factors are associated with local factors such as trauma to vessels and / or blood stasis which further aggravate the perioperative imbalance of the coagulation system. In particular, hip replacement surgery is the one that shows a higher frequency of DVT (especially affecting the proximal large vessels), and of TEC, so much so that pulmonary embolism is one of the main causes of death after this intervention. In this paper, we review the different instruments used for the diagnosis of DVT such as phlebography, radiolabeled fibrinogen collection test, impedance, plethysmography, ultrasound, nuclear magnetic resonance and computed tomography. We also discuss the different prophylaxis methods for DVT and subsequent PE prevention. Then, we performed an experimental study on 420 patient’s operated on for total hip replacement at the 1st Orthopedic Clinic of the University of Florence and other private clinics in the period between 1994-1996. These are 286 first cemented implants, 36 first hybrid implants, 38 first cementless implants and 60 hip replacement reviews. This study showed the importance of color doppler ultrasonography in the prevention of DVT in hip replacement patients and subsequent APE prophylaxis. Significant relationship was found between APE and the protocole used to follow up with the patients (Pvalue 0.0007). Patients in group 2 in which only clinical control (no preoperative color doppler ultrasonography assessment) was performed have higher risk for APE To Occur Than patients in group 1 to whom pre and post-operative color doppler ultrasonography was routinely applied.

Crescent‐shaped skin paddle for a fibular flap: Avoiding skin grafting at the donor site

A fibular osteocutaneous flap is the mainstay of oromandibular reconstruction. This report aimed to present a crescent-shaped skin paddle, a novel fibular skin paddle designed to achieve both sufficient intraoral lining and primary closure of the donor site. A 3-5-cm-wide crescent-shaped skin paddle was harvested according to the locations of the distal septocutaneous perforators on preoperative color Doppler sonography. This narrow skin paddle fits well morphologically into the mucosal defect, enabling a reliable intraoral lining. This advantage becomes more evident when the mandibular defect crosses the midline or extends posteriorly to the maxillary tuberosity as the shape of the mucosal defect becomes arcuate. Primary closure of the donor site is easier to achieve because the required width of the crescent-shaped skin paddle is minimized. This method reduces donor-site morbidity associated with skin grafting while ensuring safe intraoral closure with a fibular osteocutaneous flap.

Establishing a jugular-femoral venous route for recanalization of complicated inferior vena cava in Budd\u2013Chiari Syndrome after transfemoral access failure

Recanalization of inferior vena cava (IVC) with complete obstruction, old thrombosis or long segmental stenosis/obstruction (complicated IVC) via transfemoral access may fail in patients with Budd-Chiari syndrome (BCS). In this study, 34 consecutive patients with BCS underwent recanalization of complicated IVC occlusion via jugular-femoral venous (JFV) route establishment. BCS with complicated IVC was detected by reviewing preoperative color Doppler ultrasonography or computed tomography (CT) venography, and confirmed by intraoperative venography. Clinical data on technical success, complications, and follow-up outcomes were analyzed. Except for one patient received surgical repair of rupture IVC after recanalization, technical success of IVC recanalization was achieved in remaining 33 (97.1%) patients. No perioperative deaths was found. Three complications were observed during recanalization, for a complication rate of 8.8%. Bleeding of the femoral vein was observed in one patient, and two patients showed bleeding of IVC. The IVC lesion diameter and blood flow of the distal IVC increased significantly after the procedure. Twenty-four patients (77.4%) were clinically cured, and four patients (12.9%) showed clinical improvement. The 1-year, 3-year, 5-year primary patency rates were 85.9%, 76.4% and 70.0%, respectively. The 5-year secondary patency rate was 96.8%. There were three deaths during follow up, and the 5-year survival rate was 90.0%. In conclusion, JFV route establishment and angioplasty for complicated IVC is safe and effective for patients with BCS after transfemoral access failure.

Treatment of chronic lateral ankle instability by double-band anatomical reconstruction of the anterior talofibular ligament's fibular enthesis.

Anterior talofibular ligament (ATFL) injury is one of the most common injuries in sports medicine, resulting in chronic lateral ankle instability (CLAI). The patients' daily life may be seriously affected by ankle osteoarthritis and other irreversible damages, if the ATFL injury is not treated in time and drags on. Patients with ATFL injury who show no significant recovery after 3-6 months of conservative treatment should consider surgical treatment as soon as possible to restore ankle stability and function. This study aims to investigate the effect of double-bands anatomical reconstruction of the ATFL's fibular enthesis for the treatment of CLAI. A retrospective review was conducted on 67 patients diagnosed with CLAI in the Department of Sports Medicine, Xiangya Hospital, Central South University from January 2015 to January 2018, including 42 males and 25 females, aged from 17 to 41 years old, with disease course of (12.6±3.2) months. Of the 67 patients, 29 left ankles and 38 right ankles were included in this study. Patients suffered from repeated sprains which leaded to pain, swelling and obvious ankle relaxation. There were obvious tenderness at the ATFL insertion and the calcaneal fibular ligament insertion. Both the anterior ankle drawer test and the varus stress test were positive. Other ankle disorders were excluded by X-ray. Preoperative color Doppler ultrasonography and magnetic resonance examination were performed to observe ATFL injury. All the patients had surgical indications and no obvious contraindications, and they were treated with arthroscopic debridement and double-bundle anatomical reconstruction of the AFTL's fibular enthesis under anesthesia. Postoperative routine nursing and standardized rehabilitation exercise were recommended. Outpatient follow-up was conducted at 3, 6, 12, and 24 months postoperatively. American Orthopaedic Foot and Ankle Society (AOFAS) scores, Karlsson Ankle Functional (KAF) score, and the Japanese Society for Surgery of the Foot (JSSF) scale were used to evaluate the clinical outcomes. Intraoperative arthroscopic examination of 67 patients showed inflammatory synovial hyperplasia in 52 cases (77.6%), obvious osteophyte hyperplasia in 12 cases (17.9%), talus osteochondral injury of grade II-III in 23 cases (34.3%), and cartilage injury of grade IV in 5 cases (7.5%). All operations were carried out successfully, and both the anterior ankle drawer test and the varus stress test were negative under anesthesia after surgery. The anchors were in good position. Among them, 3 patients (4.5%) got temporary superficial peroneal nerve palsy and skin numbness at ankle joint after surgery, which gradually recovered within 2 weeks. There were no serious perioperative complications such as infection and suppurative arthritis. Postoperative follow-up was conducted for 12-24 (15.64±3.17) months. At the last follow-up, all patients were walking normally. Most patients had no pain or occasionally mild pain. Ankle function and motion were restored without re-instability. Sixty-four patients (95.5%) worked and exercised as before the surgery. Standing X-ray examination indicated normal joint space without stenosis, and the internal fixation was in good position. Postoperative AOFAS scores (94.78±6.37) were significantly better than the preoperative scores (64.17±12.43, P<0.01). Besides, the KAF scores and the JSSF ankle/hindfoot scale before surgery were significantly increased (KAF: 91.04±11.36 vs 59.74±13.63, P<0.01; JSSF: 95.32±10.21 vs 66.92±14.38, P<0.01). Arthroscopic debridement and double-bands anatomical reconstruction of the ATFL's fibular enthesis for the treatment of CLAI gains beneficial short-term effects for its minimal invasion and quick recovery.

Color Doppler Ultrasound versus Computed Tomography Angiography for Preoperative Anterolateral Thigh Flap Perforator Imaging: A Systematic Review and Meta-Analysis.

The anterolateral thigh (ALT) perforator flap is a commonly used flap with a predictable, though often variable, perforator anatomy. Preoperative imaging with color Doppler ultrasound (CDU) and computed tomography angiography (CTA) of ALT flap perforators can be a useful tool for flap planning. This study provides a complete review and analysis of the relevant preoperative ALT imaging literature. Studies related to preoperative CDU and CTA imaging were reviewed, and information related to imaging method, sensitivity, false-positive rates, and perforator course identification (musculocutaneous vs. septocutaneous) were analyzed. A total of 23 studies related to preoperative ALT flap CDU and CTA imaging were included for review and analysis. Intraoperative perforator identification was compared with those found preoperatively using CDU (n = 672) and CTA (n = 531). Perforator identification sensitivity for CDU was 95.3% (95% CI: 90.9-97.6%) compared with the CTA sensitivity of 90.4% (95% confidence interval [CI]: 74.4-96.9%). The false-positive rate for CDU was 2.8% (95% CI: 1.1-4.5%) compared with 2.4% (95% CI: 0.7-4.1%) for CTA. Accuracy of perforator course identification was 95.5% (95% CI: 93.6-99.2%) for CDU and 96.9% (95% CI: 92.7-100.1%) for CTA. CDU provides the reconstructive surgeon with greater preoperative perforator imaging sensitivity compared with CTA; however, false-positive rates are marginally higher with preoperative CDU. Preoperative imaging for ALT flap design is an effective tool, and the reconstructive surgeon should consider the data presented here when selecting a flap imaging modality.

Usefulness of Color Doppler Ultrasonography for the Preoperative Evaluation of Thin Anterolateral Thigh Flap Perforators

Purpose: The anterolateral thigh flap is commonly applied to various body sites for reconstruction. However, surgeons often struggle against unexpected locations and the nature of perforator vessels during surgery. Thus, this study aimed to assess the accuracy and usefulness of color Doppler ultrasonography as a preoperative tool for the perforator position and course of anterolateral thigh flaps.Methods: A prospective study involving 77 anterolateral thigh flaps was conducted between March 2016 and February 2021. Among them, 37 perforators (group A) were detected using the preoperative color Doppler ultrasound, and the other 40 perforators (group B) were tested using a hand-held Doppler only. All patients in group A underwent color Doppler ultrasonography performed by a radiologist at our institution. The nature and course of the perforator vessels were recorded, and their precise locations were plotted in an orthonormal coordinate system.Results: A total of 37 anterolateral thigh perforator flaps (group A) were successfully dissected. The median distance between the preoperative color Doppler ultrasonography and the real location during surgery of the perforators was 7.50 mm, which was statistically smaller than 10 mm (p&lt;0.001). This preoperative ultrasound test also had a success rate of 94.6% to determine the nature of the perforators (musculocutaneous type vs. septocutaneous type).Conclusion: Preoperative color Doppler ultrasonography provides a harmless, reliable, and accurate technique for visualizing the vascular anatomy of anterolateral thigh flaps. It has a high correlation with surgical findings, allowing surgeons to cope with variable vascular anatomy.

Standardize routine angiography assessment of leg vasculatures before fibular flap harvest: lessons of congenital and acquired vascular anomalies undetected by color Doppler and physical examinations.

Fibular flaps have been widely used for mandibular and maxillary reconstructions. On occasion, anatomical variants of fibular arteries (FA) will be encountered. Although anatomical variants of FA during fibular harvest have been reported, controversy exists regarding whether simple color Doppler ultrasonography (CDU) and physical examinations (PE) are sufficient for early preoperative detection. A 10-year retrospective analysis in our department was performed to find the patients with various FA anomalies confirmed by computed tomography angiography (CTA) or intraoperative findings. A total number of 19 FA anomalies were found either pre- or intraoperatively in 16 patients, in whom three cases were with bilateral FA variants. Type IIIC variants, also called arteria peronea magna (great peroneal artery), were confirmed in two legs, while the majority (13 legs) had type IIIA hypoplastic/aplastic posterior tibialis arteries (PTA). Four legs had new type IIID (low FA and PTA bifurcations). Preoperative CDU and PE only suspected anomalies in two legs. Six cases proceeded with using the affected fibulas, within whom vascular grafts were used in half of them for lengthening the FA pedicle. Local ischemia, partial soleus muscle necrosis, and claudication were reported in one. Routine CTA before every fibular harvest, rather than simple PE and CDU, should be added for screening contraindications and ensuring safety for fibular flap harvest.

Application of contrast-enhanced ultrasound-assisted superficial inferior epigastric artery perforator flap to repair oral and maxillofacial defects

To investigate the application value of contrast-enhanced ultrasound (CEUS) technique to assist the repair of oral and maxillofacial defects by superficial inferior epigastric artery perforator flap. Sixteen oral cancer patients, 10 males and 6 females, who were to undergo superficial inferior epigastric artery perforator flap repair between June 2018 and February 2020, were selected, with an average age of 55.8 years (range, 24-77 years). There were 13 cases of squamous cell carcinoma, 2 cases of adenoid cystic carcinoma, and 1 case of mucinous epidermis-like carcinoma. The color Doppler ultrasound (CDUS) and CEUS were used to screen the superficial inferior epigastric artery, assisted in the design of the flap, and compared it with the actual intraoperative exploration. The sensitivity, specificity, positive predictive value, and negative predictive value of CEUS and CDUS examinations were analyzed. Fourteen of 16 patients were repaired with superficial inferior epigastric artery perforator flap, and 2 patients were repaired with superficial iliac artery flap because the source artery was not found. After surgery, regular follow-up was performed to check for disease recurrence and metastasis and to evaluate the appearance of the patien's donor area, the recovery of transoral feeding function, and the presence of complications. Comparison of preoperative CDUS and CEUS findings and intraoperative exploration showed that CEUS had 100% sensitivity, specificity, positive predictive value, and negative predictive value for vascular exploration of the superficial inferior epigastric artery perforator flap, compared with 57%, 100%, 100%, and 25% for CDUS. The preoperative CDUS identified 25 penetrating vessels in 14 cases repaired with superficial inferior epigastric artery flaps. All vessel signals were enhanced by CEUS enhancement, and an additional 11 penetrating vessels were identified confirmed intraoperatively. The preoperative CEUS measurements of the initial diameter of superficial arteries in the abdominal wall were significantly higher than both CDUS and intraoperative measurements ( P<0.05); the difference in peak systolic velocity between CEUS and CDUS measurements was significant ( t=3.708, P=0.003). One case of superficial epigastric artery perforator flap developed venous embolism crisis at 48 hours after operation, the wound healing delayed. The other incisions in donor sites healed by first intention. All the patients were followed up 3-12 months, with an average of 8 months. No recurrence or metastasis appeared during the follow-up. There was no serious complications such as abdominal wall hernia, the location of abdominal scarring was hidden, and transoral feeding was resumed. The superficial inferior epigastric artery perforator flap with small injury in supply area and hidden scar location is a better choice for repairing oral and maxillofacial defects. The use of CEUS technique to assist the preoperative design of the superficial inferior epigastric artery perforator flap has good feasibility and high accuracy.

Clinical analysis of 12 cases of spontaneous uterine rupture caused by placenta percreta

Objective: To investigate the clinical characteristics and early identification of spontaneous rupture of uterus caused by placenta percreta. Methods: The clinical data of 12 patients with spontaneous uterine rupture caused by placenta percreta and admitted to the First Affiliated Hospital of Zhengzhou University from June 2014 to December 2019 were collected. The age, gestational age, gestational history, clinical manifestations, diagnostic methods, uterine operation history, rupture location, surgical method, treatment and outcome were analyzed. Results: (1) General condition: the median age of pregnant women was 37 years (range: 30-43 years), and the median gestational week of uterine rupture was 29+6 weeks (range: 18+3-36+3 weeks). (2) Clinical manifestation: among the 12 pregnant women, 9 showed different degrees of abdominal pain; chest distress accompanied by waist soreness, abdominal distension in 2 cases; one asymptomatic pregnant women was found with uterine rupture during elective cesarean section. Preoperative color Doppler ultrasonography indicated that 9 of the 12 pregnant women had peritoneal effusion, and 6 of them underwent diagnostic peritoneal puncture or posterior vault puncture for non-clotting blood extraction. (3) Uterine operation history and rupture location: among the 12 cases of spontaneous rupture of uterus caused by placenta percreta pregnant women, 10 had placenta previa after cesarean section, including 4 cases of rupture at the incision of the original cesarean section, 3 cases of rupture at the penetrating placental implantation of the lower segment of the anterior wall of the uterus, and 1 case of placenta percreta occurred at the myomectomy site of the right angle of the uterus. Among the 2 pregnant women with spontaneous uterine rupture caused by penetrating placental implantation without a history of cesarean section, 1 case with history of multiple abortions, and uterine rupture occurred at the bottom of the palace, 1 had rupture of placental penetrating implantation after hysteroscopic electroresection of endometrial polyps, and the uterine rupture occurred at the anterior wall of the lower segment of the uterus. (4) Maternal and fetal outcomes: 11 pregnant women were injected with suspension RBC and 1 pregnant woman was not injected with blood products. Nine cases underwent hysteroplasty and 3 cases underwent subtotal hysterectomy. There were 11 maternal survivors and 1 maternal death; 7 neonates survived and 6 stillbirths. Conclusions: Uterine rupture caused by placenta percreta is of great harm to mother and infant, due to its heterogeneity in clinical manifestations, which increases the possibility of misdiagnosis. For pregnant women with risk factors of placenta percreta, early diagnosis should be made during pregnancy. For those who have been diagnosed with placenta percreta, when there is typical or atypical uterine rupture, doctors should be alert to the occurrence of uterine rupture.

Новый фактор послеоперационного венозного тромбоза в онкологии: миф или реальность?

Введение. Эндовенозная термическая абляция (ЭТА) поверхностных вен, включая лазерную абляцию или радиочастотную абляцию, широко применяется в лечении варикозной болезни нижних конечностей. Учитывая высокую частоту встречаемости варикозной болезни, частоту венозных тромбоэмболических осложнений (ВТЭО) после данного вмешательства, логично предположить, что выполнение ЭТА увеличит риск возникновения послеоперационного венозного тромбоза у онкологических больных. Существует недостаток данных о частоте ВТЭО в онкохирургии при ЭТА в анамнезе. Цель исследования: оценить влияние ранее проведенной ЭТА поверхностных вен нижних конечностей на послеоперационные ВТЭО в онкохирургии. Материалы и методы. Одноцентровое исследование с ретроспективным анализом онкологических больных на хирургическом этапе лечения злокачественных опухолей абдоминальной, гинекологической или урологической локализации проведено с мая 2013 г. по ноябрь 2018 г. В исследование были включены 36 пациентов, перенесших ЭТА более 3 мес назад (319 мес). Ультразвуковое дуплексное исследование вен нижних конечностей проводили перед операцией (за 110 дней) по поводу онкологического заболевания всем пациентам. Полная облитерация ствола большой подкожной вены (БПкВ) обнаружена в 66,7 случаев (n 24), реканализация в 33,3 (n 12). Все пациенты получали стандартную антикоагулянтную профилактику (надропарин по 0,4 мл/сут подкожно). Проведен морфологический анализ 3 случаев послеоперационного венозного тромбоза. Результаты. ВТЭО возникли в 20,8 (n 5) случаев при полной облитерации БПкВ, в 66,7 (n 8) с реканализацией ствола (95 ДИ 1,37,7) в послеоперационном периоде. Реканализация вены увеличила частоту развития послеоперационного венозного тромбоза в 3,2 раза. Заключение. ВТЭО часто возникают после неполной облитерации при ЭТА в отдаленном периоде при наличии дополнительных факторов риска. Учитывая широкое распространение данного типа операций во флебологии и возможность серьезных осложнений, необходимы дальнейшие исследования частоты венозного тромбоза при ЭТА в анамнезе у онкологических больных и определение стратегии профилактики ВТЭО. Introduction. Endovenous thermal ablation of saphenous vein (EVTA SV) including laser ablation or radiofrequency ablation widely used in varicose veins treatment of the lower extremities. EVTA SV can increase the risk of postoperative venous thrombosis in cancer patients. There is a deficiency of data examining rates of thrombotic events (VTE) in oncological patients. Aim: to assess influence of previously performed EVTA SV on postoperative VTE in oncosurgery. Materials and methods. This was a single centre study with retrospective analysis of consecutive oncological patients who underwent abdominal, gynecological or urological surgery from May 2013 to November 2018. 36 patients were included who underwent EVTA SV more than 3 month ago (319 months). Duplex ultrasound (DUS) was performed before oncological surgery (110 days). Complete SV obliteration was found in 66.7 of cases (n 24), recanalization in 33.3 (n 12). All patients had standard anticoagulant prophylaxis nadroparin 0.4 ml per day. We performed a morphologic analysis of 3 VTE cases. Results. Thrombotic complications occurred in 20.8 (n 5) of cases with complete SV obliteration, in 66.7 (n 8) with recanalization (95 CI 1.37.7). Recanalization of SV increased rate of postoperative cancer-associated VTE in 3.2 times. Conclusion. Thrombotic events occur frequently following incomplete obliteration after procedures EVTA SV. Taken account of the high rate of this procedures and the potential for serious consequences, further research is needed on VTE сomplications in oncology and their management.

Diagnostic value for the fine needle aspiration biopsy and contrast-enhanced ultrasound in thyroid imaging reported and data system Grade 4 nodules

To study the clinical application value of ultrasound-guided fine needle aspiration biopsy (US-FNAB) and contrast-enhanced ultrasound (CEU) in the diagnosis of thyroid imaging reported and data system Grade 4 (TI-RADS 4) nodules. Methods: A retrospective analysis of 134 patients with thyroid nodules surgery were selected, and their results of preoperative color Doppler ultrasonography were TI-RADS 4. The data of US-FNAB and CEU before operation and the results of pathological section after operation were collected. The pathological results were taken as the gold standard, and the specimens obtained by US-FNAB puncture were used for HE staining and cytological diagnosis. The sensitivity, specificity, accuracy and the cost were calculated for CEU and US-FNAB, respectively. The diagnostic efficacy of the 2 methods was compared. Results: Of 134 thyroid nodules, there were 131 malignant nodules (97.76%) and 3 benign ones (2.24%). The sensitivity of US-FNAB and CEU were 87.02% and 93.89% respectively. The specificity of US-FNAB and CEU were 100.00% and 66.67%. The accuracy of US-FNAB and CEU were 87.31% and 93.28% respectively. Comparisons of the diagnostic accuracy were performed by χ2 test. There was no significant difference in sensitivity between CEU and US-FNAB (P>0.05). However, the sensitivity of US-FNAB and CEU were 87.50% and 100.00%, respectively, when the maximum diameter of nodule was less than 10 mm, and there was statistical significance (P<0.05). The sensitivity of US-FNAB and CEU were 92.73% and 85.45%, respectively, when the maximum diameter of nodule was more than 10 mm, and there was no statistical significance (P>0.05). The cost and risk of US-FNAB was higher than those of CEU. Conclusion: The sensitivity of US-FNAB is higher than that of CEU for thyroid nodules with the diameter larger than 10 mm. With high detection rate, good safety and low cost, CEU can still be used for thyroid nodules with the diameter less than 10 mm, which is diagnosed as negative nodules by US-FNAB.

Preoperative color Doppler ultrasonography predicts early recurrence in AFP-positive hepatocellular carcinoma.

The present study aimed to evaluate the hepatic hemodynamics of patients with α-fetoprotein (AFP)-positive hepatocellular carcinoma (HCC) and early recurrence (ER), as determined by color Doppler ultrasound. Screening with color Doppler ultrasound was performed in 150 patients with AFP-positive HCC, yielding 43 cases with postoperative ER. In addition, 35 healthy controls were enrolled in the study for comparison of the blood flow parameters between the healthy control and the HCC groups. Receiver operating characteristic curve analysis was performed to evaluate the predicted effect of Doppler for the ER of HCC. The average mean flow velocity of portal vein in patients with HCC (14.686±5.873 cm/s) was significantly lower in the HCC group compared with the healthy control group (17.631±3.569 cm/s; P=0.005). Additionally, the preoperative portal vein diameter in the HCC group was significantly higher compared with that in the healthy control group (P=0.001). Regarding the effect of surgery, the portal vein diameter was significantly increased in the patients postoperatively compared with preoperatively (P=0.003), while the pulsation and resistance indexes exhibited a decreasing trend in the postoperative group (P=0.001 and P=0.003, respectively). Notably, patients with HCC and ER presented with a higher resistance index (1.163±0.342) compared with the ER-free group (1.023±0.176; P=0.004). Furthermore, a significant difference in hepatic artery pulsation index was also observed between the ER group (0.673±0.075) and the ER-free group (0.624±0.056; P=0.018), indicating that an increased hepatic artery pulsation index may significantly predict the ER of HCC. In addition, areas under the curve of 0.683 and 0.700, respectively, suggested that the hepatic artery resistance and pulsation indexes may be used to diagnose ER in HCC (P=0.009 and P=0.004, respectively). Taken together, Doppler ultrasound provides a reliable and accurate quantification of hepatic hemodynamics for detecting ER in HCC with a good diagnostic accuracy.

Clinical application of anterolateral thigh flap in wound around the knee with descending genicular artery as the recipient vessel

Objective To explore the clinical application of anterolateral thigh flap transplantation in repairing wound around the knee with descending genicular artery as the recipient vessel, when anterior or posterior tibial vessel could not be utilized. Methods From January, 2015 to May, 2017, free anterolateral thigh flaps obtained from anastomosis of descending genicular artery and great saphenous vein were transplanted to repair the skin soft tissue defect around the knee combined with tendon and bone exposure in 7 patients, after preoperative color Doppler sonography ultrasound (CDU) for precise positioning. There were 4 males and 3 females, with the flap area ranging from 18.0 cm×8.0 cm-38.0 cm×8.0 cm. All of the donor sites were sutured directly. Postoperative followed-up was done termly. Results All the patients were followed-up for 6 to 14 months, with an average of 8.9 months. Typically, 2 cases had large defect areas, with distal flap necrosis of 6.0 cm and 4.0 cm, respectively, which were resected and achieved secondary skin graft healing on the residual surface. Additionally, 4 cases had completely survived flaps and achieved secondary skin graft healing on the residual surface. The remaining 1 case had completely survived flap, but the distal flap near the anteromedial tibia developed bone exposure as a result of the complicated osteomyelitis. As a result, the patient received gastrocnemius myocutaneous flap to repair the wound. Conclusion Anterolateral thigh flap transplantation in repairing skin soft tissue defect wound around the knee, with descending genicular artery as the recipient vessel, can achieve satisfactory clinical efficacy, which can serve as one choice for flap repair in wound around the knee. Key words: Anterolateral thigh flap; Descending genicular artery; Knee joint; Transplantation

Pre-operative Color Doppler Ultrasonography Predicts Endovenous Heat Induced Thrombosis after Endovenous Radiofrequency Ablation

The aim was to identify pre-operative color Doppler ultrasound (CDUS) variables predictive of post-operative endovenous heat induced thrombosis (EHIT) after radiofrequency ablation (RFA) of the saphenous veins. This was a single centre, observational study with retrospective analysis of consecutive patients treated from December 2010 to February 2017. Pre-operatively, the diameter of the sapheno-femoral junction (dSFJ), distance between epigastric vein and SFJ (dEV–SFJ), maximum great saphenous vein (GSV) diameter (mdGSV), diameter of the saphenous–popliteal junction (dSPJ), and mean small saphenous vein (SSV) diameter (adSSV) were measured. All patients received low molecular weight heparin (LWMH) at a prophylactic dose for a week. Post-operatively, CDUS was performed after 72 h, 1 week, and 3 months. Venous interventions on 512 patients were performed: 449 (87.7%) underwent RFA of the GSV (Group 1), and 63 (12.3%) of the SSV (Group 2). At Day 3 post-operatively, CDUS documented 100% complete closure of the treated saphenous vein segment. Overall, 40 (7.8%) cases of post-operative EHIT were identified: 29 in Group 1, and 11 in Group 2 (6.4% vs. 17.5%, P = .005). Deep venous thrombosis or pulmonary embolism did not occur in either group. At the 1 month follow up, all cases of EHIT regressed. In Group 1, on multivariate analysis, dEV–SFJ (OR, 1.13, P .036; 95% CI 1.01-1.27) was the only statistically significant predictor for EHIT. A dEV–SFJ distance of 4.5 mm yielded an 84% of sensitivity for EHIT prediction with a 72.4% positive predictive value. In Group 2, univariate analysis did not identify independent risk factors for EHIT occurrence. EHIT was higher than previously reported. The dEV–SFJ was the most significant predictor for EHIT in the GSV group. A greater distance between the tip of the radiofrequency catheter and the SFJ may decrease the risk of developing this complication.

Feasibility of Infrarenal Abdominal Aorta Balloon Occlusion in Pernicious Placenta Previa Coexisting with Placenta Accrete.

Objective To evaluate the efficacy and safety of prophylactic balloon occlusion of the infrarenal abdominal aorta in pernicious placenta previa coexisting with placenta accrete. Methods This retrospective study was performed in patients with placenta accreta complicated with pernicious placenta previa between January 2014 and December 2016 in Shengjing Hospital; 56 patients with a pathological diagnosis were included. The degree of placental invasion was evaluated by preoperative color Doppler ultrasonography and/or magnetic resonance imaging, and all patients in this study should undergo balloon occlusion preoperatively, which was a determination made by specific doctors. The control group consisted of 32 patients who underwent cesarean section alone, and the study group included 24 patients who underwent cesarean section with preoperative balloon occlusion. Prevention of hysterectomy was the primary outcome evaluated. The secondary outcomes include operative duration, estimated blood loss, blood transfusion, prothrombin time postoperatively, decrease in the hemoglobin level postoperatively, intensive care unit admission, pathological diagnosis, and total hospital stay (days), and these data were compared between the two groups. Additionally, the neonatal outcomes, premature delivery, Apgar scores at 1 minute and 5 minutes, neonatal birth weight, hospitalization, and mortality were compared. Results There was a significant difference in the rate of hysterectomy between the two groups (p<0.05). However, no differences were observed between the groups in any other outcomes. Conclusion The prophylactic use of infrarenal abdominal aortic balloon occlusion is an effective and safe option for treating pernicious placenta previa coexisting with placenta accreta.