Doppler Ultrasound Scan Research Articles

Sevoflurane in the Acute Phase of Severe Traumatic Brain Injury

The aim of the study was to evaluate the usefulness and safety of sevoflurane in patients in the acute phase of severe traumatic brain injury (TBI).Materials and methods. A prospective, randomized, pilot clinical trial was conducted at the Sklifosovsky Research Institute for Emergency Medicine (Moscow) in adults with acute severe TBI, aged 18 years and older, undergoing intensive intracranial pressure (ICP)-guided therapy. To achieve the desired sedative effect, the inhaled anesthetic sevoflurane was administered in the main group, and standard doses of intravenous propofol were administered in the control group. ICP and cerebral oxygen extraction fraction (OEF) were monitored in all patients. Hemodynamic and respiratory support parameters, transcranial Doppler ultrasound scan, brain bioelectrical activity, brain CT scan, laboratory parameters, markers of inflammation, patients' need for sedation and mechanical ventilation, and length of ICU stay were also evaluated.Results. The use of inhalation sedation contributed to the reduction of ICP on day 2 (9.5 mmHg in the sevoflurane group and 17.3 mmHg in the propofol group, P=0.003) and day 3 (10 mmHg and 14.2 mmHg, respectively, P=0.005). BIS monitoring showed no significant difference in depth of sedation between groups on day 2 (60 vs. 48.5, P=0.070) and day 3 (61 vs. 46, P=0.095). Inhalation sedation reduced cerebral OEF on the injury side compared to propofol on day 2 (23.3 vs. 30.2%, P=0.006) and day 3 (22.7 vs. 31.2%, P<0.001). After 24 hours of sedation therapy, there was a significant difference in P/F (PaO₂/FiO₂) ratios between the groups. On days 1, 3, and 7, the sevoflurane group had P/F ratios of 340, 324, and 323 mmHg, while the propofol group had significantly lower ratios of 271, 278, and 275 mmHg (P<0.001). Pneumonia was documented in 9 cases in the sevoflurane group vs. 18 cases in the propofol group (P=0.028), and a similar trend was observed in the total number of infectious complications: 13 vs. 21 cases, respectively (P=0.046).Conclusion. Sevoflurane in the acute phase of severe TBI was not only safe, but also improved several vital functions, including ICP, blood pressure, P/F ratio, and also slowed brain metabolism via reduced oxygen consumption without affecting the depth of sedation according to BIS monitoring data. All of the above suggests that inhalation sedation may improve the prognosis for patient recovery. However, multicenter randomized clinical trials are needed to identify and verify all positive and negative effects of inhalation sedation in this patient population.

E043 Fast track giant cell arteritis service in a district general hospital using ultrasound doppler imaging

Abstract Background/Aims Giant cell arteritis (GCA) is the commonest large and medium artery vasculitis, a multisystem condition that results in significant comorbidity and mortality. Corticosteroids are pivotal in remission induction and maintenance therapy, but complications can arise either due to delayed treatment, or unnecessary treatment of GCA mimics. This renders quick diagnosis of GCA vital. Temporal artery biopsy (TAB) has traditionally been the golden standard diagnostic modality, but it requires a surgical setting, resulting in delays. Temporal artery ultrasound doppler scanning (TA UDS), however, has now been incorporated by both BSR and EULAR in their recommendations, offering a diagnostic tool with high specificity and sensitivity. Aims 1. To set up a fast track GCA diagnostic service in an one-stop-shop outpatient clinical setting with inhouse ultrasound; 2. To limit dependence of GCA diagnosis on TAB Methods We set up a dedicated GCA clinic at Eastbourne District General Hospital aiming to see patients within five days of referral. In the clinic, patients were categorised to low, moderate or high GCA risk via a pre-test probability score, and had TA UDS by an expert rheumatologist. We collected data on number of UDS performed, scan outcomes, and TAB requests over a 17-month period. Results Total number of referrals with suspected GCA was 147, mainly via general practice and ophthalmology, with 117 already having been started on corticosteroids by the referrer. Overall, 93% of patients were seen within five days of initial referral, with 32% within 72 hours of steroid commencement. We scanned 138 patients (94%) and diagnosed GCA in 41 (30%) of them. Of the nine we did not scan, six had very low probability score and were given alternative diagnoses; two were out of the window for diagnostics and GCA was diagnosed clinically; and one could not be scanned due to technical reasons, so a TAB was requested. Crucially, this was the only TAB requested during this period. Conclusion Our fast track service has facilitated prompt review of GCA referrals with the use of ultrasound, limiting the need for a TAB. The pathway enables both prompt commencement of appropriate steroid-weaning regimens in confirmed GCA, but also facilitates timely discontinuation of corticosteroids in patients with excluded GCA, thus minimising future complications either way. Typically, it takes more than three weeks to arrange a TAB. Moreover, ultrasound use avoids an invasive procedure with potential for surgical complications. From a healthcare system point of view, there are certain cost-saving implications in using ultrasound for GCA diagnosis. These can range from reduced demand for outpatient clinics, theatre slots and theatre staff, to minimisation of any future complications be it post-op, disease- or steroid- related. Finally, a service user survey, aiming to improve our pathway, documented improved patient satisfaction. Disclosure P. Kamperidis: None. A. Hall: None. H. Perera: None. S. Panthakalam: None.

Accuracy of maximal acceleration time of pedal arteries to diagnose critical limb-threatening ischemia.

Maximal acceleration time of distal arteries of the foot (ATmax) is correlated to ankle-brachial index (ABI) and toe-brachial index (TBI), and seems very promising in diagnosing severe peripheral artery disease (PAD) and especially critical limb-threatening ischemia (CLTI). Our goal was to confirm the cut-off value of 215 ms to predict a toe pressure (TP) ⩽ 30 mmHg. A 4-month retrospective study was conducted on patients addressed for suspicion of PAD. Demographic data, ABI, TBI, and Doppler ultrasound scanning parameters of the dorsal pedis and lateral plantar arteries (DPA and LPA) were recorded. A total of 137 patients with 258 lower limbs were included. ATmax was highly correlated to TBI (r = -0.89, p < 0.001). With the cut-off value of 215 ms, ATmax was effective to diagnose TP ⩽ 30 mmHg with a sensitivity of 93% [95% CI 77-99], a specificity of 96% [95% CI 92-98], a positive predictive value of 73% [95% CI 56-86], a negative predictive value of 99% [95% CI 97-100], and an area under the receiver operating characteristics curve of 0.99 [95% CI 0.98-1.00]. ATmax also showed promising results to rule out PAD in healthy patients. ATmax is a reliable diagnostic tool to diagnose low TP and could be a new easily performed hemodynamic criterion for diagnosis of CLTI.

Clinical Profile and middle cerebral artery velocity of children with sickle cell anaemia seen in UUTH, Uyo, Akwa Ibom state, Nigeria.

The risk of stroke in individuals with Sickle Cell Anaemia (SCA) can be assessed by routine non-invasive measurement of their cerebral blood flow using a Transcranial Doppler (TCD) ultrasound scan. This study aimed to determine the difference in blood flow velocity parameters in the middle cerebral artery (MCA) of children with sickle cell anaemia compared to a normal age-matched population. This was a hospital-based comparative cross-sectional study among 40 SCA patients aged 3-16 years, in steady state and 40 age and sex-matched HbAA healthy subjects. This study lasted from June to October 2019. Medical history was retrieved using a structured questionnaire. The time-averaged mean of maximum velocity (TAMMV) of the right and left MCA was measured using non-imaging TCD. The mean age ± SD of the SCA patients was 9.1 ± 4.4 years. The SCA patients and sex and age-matched HbAA group consisted of 23 (57.5%) males and 17 (42.5%) females respectively. SCA patients had a significantly lower mean ± SD haemoglobin (Hb) than the controls (7.1 ± 1.1g/dl vs 11.1 ± 1.4g/dl; p<0.001). The right MCA of the patients with SCA had a significantly higher mean flow velocity compared to the controls (94.1 ± 23.1 vs 55.0 ± 8.8cm/sec, p<0.001). The mean TAMMV recorded in the SCA subjects were significantly higher than that of the non-SCA subjects. There is a need to ensure that TCD ultrasound is employed as a routine screening tool for stroke risk among SCA patients in Nigerian tertiary health institutions.

Risk Stratification of Foetuses based on Estimated Foetal Weight less than the 40th Percentile and Evaluation of Perinatal Outcomes using Third-trimester Obstetric Ultrasound: A Prospective Cohort Study

Introduction: Perinatal mortality and morbidities constitute a burden on society and healthcare system. One of the major identifiable causes of these conditions in India is Low Birth Weight (LBW) and preterm births. Small for Gestational Age (SGA) infants account for almost 46.9% of LBW infants. They are prone to the morbidities of preterm birth and are the second major contributor to perinatal mortality. Recent studies have reported that higher screening performance for SGA can be achieved through ultrasonographic foetal biometry and Doppler studies during the third trimester. Aim: To stratify foetuses with Estimated Foetal Weight (EFW) below the 40th centile, as determined by obstetric ultrasound, into three categories (low, intermediate, and high-risk), and study the perinatal outcomes in each category. Materials and Methods: The present prospective cohort study was conducted in the Department of Obstetrics and Gynaecology at Vardhaman Mahavir Medical College and Safdarjung Hospital, New Delhi, India from November 2020 to April 2022. A total of 280 antenatal women, at a gestational period between 35 to 36+6 weeks with singleton pregnancies, were studied and based on the foetal biometry and Doppler parameters, women were classified into low (Group A), intermediate (Group B) and high risk (Group C) categories. Risk categorisation was based on EFW and Doppler indices. The low-risk group underwent an ultrasound Doppler scan after four weeks, the intermediate-risk group after two weeks, and the high-risk group was scanned weekly. The high-risk group was delivered at 39 weeks of gestation. Perinatal outcomes, neonatal weights, adverse neonatal outcomes {such as Neonatal Intensive Care Unit (NICU) admissions exceeding 48 hours}, stillbirths, and neonatal deaths were recorded. The Area under Curve (AUC) cut-off for EFW percentiles on ultrasonography was calculated as a predictor for SGA foetuses requiring NICU admissions. Concurrent admissions in the NICU of neonates delivered to unregistered pregnant mothers, who were not screened during the antenatal period, were also recorded. The Chi-square test was used to compare categorical data between groups. The receiver operating characteristic curve was used to determine the cut-off for foetal weight to predict NICU admission. A p-value of &lt;0.05 was considered statistically significant. Results: Among the study population, 231 (82.6%) were between 21-30 years of age, and 250 (88.87%) had a normal Body Mass Index (BMI) with a mean age of 25.78±3.90 years. On risk categorisation, 71 (25.1%), 82 (29%), and 127 (45.9%) women were in the high, intermediate, and low-risk categories, respectively. All the neonates in the high-risk group were classified as SGA according to the INTERGROWTH 21st growth chart. Among the neonates, 18 (6.4%) weighed below 2100 g, 35 (12.4%) weighed between 2101 to 2200 g, 62 (22.3%) weighed between 2201 to 2400 g, and 165 (59%) weighed above 2401 g. NICU admissions occurred in 25 (35.2%), 10 (12%), and 5 (3.8%) neonates in the high, intermediate, and low-risk groups, respectively (p-value &lt; 0.001). At a cut-off of EFW (g) less than or equal to 2122 g (between the 10th and 20th centile) during the first ultrasound, it predicted SGA neonates requiring NICU admissions with a sensitivity of 80% and a specificity of 70%. No stillbirths or neonatal mortality occurred in the study group. Conclusion: A single third-trimester obstetric ultrasound, along with Doppler measurements, should be performed at 35 to 36 weeks as an important adjunct for identifying and stratifying the risk of singleton foetuses. Close monitoring and timely delivery can help reduce adverse perinatal outcomes in SGA foetuses.

Fetal Vein of Galen Aneurysmal Malformation (VGAM) Detected at 36 Weeks: Review of Literature and Case Report

Abstract Vein of Galen malformation is a rare intracranial vascular lesion most often concomitant with poor prognosis when associated with high-output cardiac failure. We present a case that was diagnosed late in the third trimester, but due to the limitations in our local settings, immediate operative intervention could not be done. A 24-year-old primigravida was sent for a routine 36-week obstetric ultrasound scan (USS), which revealed a midline cystic structure with mosaic color signals on a duplex Doppler USS within the fetal head. The unavailability of fetal magnetic resonance venography (MRV) delayed confirmation until the postnatal period. An MRV done on the second day of delivery showed a dilated, tortuous midline structure in the region of the vein of Galen, which confirmed the findings. Echocardiography revealed multiple cardiac lesions. Although, both antenatally and at birth, there was no cardiac failure, the baby died on the seventh day of life from possible cardiac compromise.

THE STUDY OF ASSOCIATIONS BETWEEN IL1Β C3953T GENE POLYMORPHISM AND CLINICAL-NEUROLOGICAL, NEUROIMAGING, HEMODYNAMIC CHARACTERISTICS AND COGNITIVE DYSFUNCTION IN PATIENTS WITH POST-INFECTIOUS ENCEPHALOPATHY

The aim: To investigate potential associations between the C3953T polymorphic variant of the interleukin-one beta (IL1β) gene and clinical-neurological, neuroimaging, hemodynamic characteristics, as well as cognitive dysfunction in patients with post-infectious encephalopathy (PIE).&#x0D; Materials and methods: A total of 128 patients with post-infectious encephalopathy (PIE) who were receiving inpatient treatment in the neurological departments of the Communal Non-commercial Enterprise “Ternopil Regional Clinical Psychoneurological Hospital” of Ternopil Regional Council,” Ternopil, Ukraine, were examined and included in the retrospective analysis in 2021–2022. The molecular-genetic testing was performed for 26 patients in the molecular genetics laboratory of the State Institution “Reference Centre for Molecular Diagnostics of the Ministry of Health of Ukraine,” Kyiv. The control group consisted of 12 people, who were representative in age and gender. Statistical processing of the results was performed using the STATISTICA 10.0 software.&#x0D; Results: Analysis of the dependence of neuroimaging changes on the frequency of genotypes of the C3953T polymorphic variant of the IL1β gene in patients with PIE showed a significant relationship between their frequency distribution and the presence/absence of gliosis phenomena (p=0.009). Thus, gliosis was detected in all carriers of the T/T genotype C3953T polymorphic variant of the IL1β gene. Analyzing the dependence of changes obtained during the transcranial Doppler ultrasound scanning of cerebral vessels on the polymorphic variant C3953T of the IL1β gene in patients with PIE, all carriers of the T/T genotype were diagnosed with angiospasm (p=0.038) and vertebrobasilar insufficiency (p=0.010).&#x0D; Conclusions: Results suggest the reasonability of further researching the interaction between IL1β and glial cells and changes in the cognitive functioning of cytokine genotypes with larger sample sizes that may help explain the pathophysiological mechanisms leading to cognitive impairment in patients with PIE.

Pyeloureteral Anastomosis as a Reconstructive Technique for Post-Renal Transplant Ureteral Stenosis.

Ureteral stenosis in renal transplant patients is a frequent urological complication that involves significant morbidity and may compromise graft function. Despite the common use of minimally invasive techniques, surgery continues to be the definitive treatment for ureteral stenosis, and pyeloureteral anastomosis is an infrequent but effective technique in the management of this pathology and has been described as a safe treatment with a low percentage of complications. This is a retrospective study of patients in whom surgical intervention via pyeloureteral anastomosis was carried out in our center in the last 12 years. A descriptive analysis of perioperative management, complications, and functional results is provided. A comparison of renal function at diagnosis and after surgery was made to evaluate the effectiveness of the procedure. Thirteen patients underwent surgery within the described time frame. Time to diagnosis of stenosis was 60 days [interquartile range (IQR) 31-368]. Creatinine at diagnosis was 2.2 mg/dL [IQR 1.9-3] with a glomerular filtration rate, estimated by the modification of diet in renal disease equation, of 29 mL/min/1.73 m2 [IQR 22.6-34.5]. Of these patients, 92.3% underwent percutaneous nephrostomy, and 38.5% also had a ureteral catheter. The mean duration of surgery was 265 minutes [IQR 240-300], and hospital stay was 9 days [IQR 7.5-16]. A double J was placed in all cases, which was maintained for 36 days [IQR 30-49]. Postoperative complications occurred in 15.4% of patients. Serum creatinine 1 year after surgery was 1.6 ± 0.4 mg/dL. Among the patients, 76.9% had no new pyelocalyceal dilatation on follow-up Doppler ultrasound scans at a mean follow-up time of 12 months. The restenosis rate was 23.1%, and all were successfully treated by endoscopic approach. There was an improvement in renal function figures at 1, 3, 6, and 12 months compared to renal function at diagnosis, both in terms of serum creatinine and glomerular filtration rate, with statistically significant results. Pyeloureteral anastomosis as a reconstructive technique of the urinary tract in renal transplant patients is an effective and reproducible technique with good long-term results.

Ovarian and uterine arteries blood flow velocities waveform, hormones and nitric oxide in relation to ovulation in cows superstimulated with equine chorionic gonadotropin and luteolysis induction 10 and 17 days after ovulation

To investigate the ovarian responses, ovarian and uterine hemodynamics, circulating ovarian hormones, and nitric oxide (NO) with their relations in superstimulated cows. Eight Holstein Friesian dry cows previously synchronized with CIDR underwent rectal Doppler ultrasound scanning and blood sampling after administrating eCG (1500 I.U) on day 10 of the second ovulation (day -5). Cows were treated with 12.5 mg prostaglandin F2α (PGF2α) on days 10 and 17 after ovulation. Estradiol, progesterone, and NO were measured. Results showed that from ≥ 13 follicles, five follicles ovulated from both ovaries. The ovulated follicles increased antrum colored area and colored area % till day -1. The developed corpora lutea (CLs) attained similar diameter, area, colored area, and colored area % from day 2 till day 15. The peak point of velocity (PSV) of uterine arteries decreased while that of ovarian arteries increased from day -4 to day 0. Both ovarian arteries diameter, resistance index (RI), PSV, end velocity (EDV) and systolic/diastolic ratio (S/D) positively correlated (P < 0.0001), but their pulsatility index (PI) negatively correlated (P < 0.0001). The uterine arteries PI, RI, PSV, EDV, time average velocity (TAMV) and S/D negatively correlated (P < 0.0001) but their diameters positively correlated. Estradiol increased but progesterone decreased from day -5 till day 0. After ovulation, P4 reached maximum values on day 9 and started to decrease till day 19.NO showed one peak on day -3 and another one from day 3 to day 9. Conclusions: Blood flow of ovarian arteries is different from uterine arteries and depended on pre- or post-ovulation.

Abstract 107: Longitudinal Associations Of Dietary Fructose And Psychological Stress With Vascular Aging Index And Incident Cardiovascular Disease Among Us Black And White Adults In The CARDIA Study

Background: Cardiovascular diseases (CVD) is the leading cause of death and disability worldwide. CVD risk increases exponentially with age, largely due to pathophysiological changes within the vasculature. As per AHA’s Life’s Essential 8, modifiable lifestyle factors such as diet and psychological stress are important predictors of CVD. We designed this study to assess how dietary behaviors, specifically sucrose, fructose and sodium, and endured psychological stress in young adult men and women impact the vascular aging index (VAI) and CVD risk by mid-life. Methods: All data were obtained from the Coronary Artery Risk Development in Young Adults (CARDIA) Study. We used the data from black and white men and women (n=2656) who had undergone carotid artery ultrasound Doppler scans at visit 7 (year 20 of follow-up) and used these measures to calculate the VAI, as shown previously. Baseline demographics, dietary data and stress/depression measures (CES-D scores) were obtained from visits 1 (at enrollment, year 0) and 7 and compared (men vs. women) with Kruskal-Wallis and Pearson’s chi-square tests. Regression analyses were used to assess the predictive value of these variables on VAI. Cox regression analyses were conducted to assess the risk of fatal and non-fatal CVD, hypertensive CVD, and stroke. Results: Significant associations were found for fructose intake (expressed as percent total calories, P=0.042) and BP &gt;30/80 mmHg (P=0.025) at baseline with VAI in men but not women. Conversely, CES-D scores at baseline were significantly associated with VAI in women (P=0.014) but not men. On Cox regression analyses, baseline BMI was significantly associated with the incidence of any CVD (HR=1.065, P &lt;0.001), hypertensive CVD (HR=1.083, P&lt;0.001) and stroke (HR=1.068, P=0.002) 30 years later. Dietary fructose intake recorded in mid-life was significantly associated with the incidence of any CVD (HR=1.041, P=0.044), and having BP &gt;130/80 mmHg at baseline was associated with stroke (HR=1.996, P=0.029). No sex differences were noted in the Cox regression analyses. Conclusion: Our results suggest that in young adult black and white men but not women BMI and fructose consumption, but not sodium are associated with increased VAI and incidence of CVD by mid-life.

УЛЬТРАЗВУКОВЫЕ ХАРАКТЕРИСТИКИ КАРОТИДНЫХ И ПОЗВОНОЧНЫХ АРТЕРИЙ У ПАЦИЕНТОВ С СИНДРОМОМ ГИПЕРМОБИЛЬНОСТИ СУСТАВОВ

Background. The article presents current data on the syndrome of joint hypermobility. Aim. To study ultrasonic characteristics of carotid and vertebral arteries in patients with joint hypermobility syndrome. Material and methods. The study involved 538 students. The control group of practically healthy individuals consisted of 57 people, the group of patients with joint hypermobility syndrome included 105 people. The age of the examined patients ranged from 20 to 28 years (mean age 22 [21; 23] years). All examined patients underwent Doppler ultrasound and duplex scanning of the vertebral, common, internal and external carotid arteries. Results. Structural and anatomical features of the carotid and vertebral arteries in patients with joint hypermobility syndrome were revealed. Conclusions. High bifurcation of the common carotid artery on both sides was detected 7.9 times more often among the patients, than in the control group. High entry of the vertebral artery into the spinal canal was 3.3 times as common as among the controls. Tortuosity of the vertebral artery occurred 2.8 times more often than in the control group, including pathological tortuosity which occurred 4.9 times more often. The revealed structural features were not accompanied by hemodynamic changes.

Doppler ocular ultrasound in patients with type 2 diabetes mellitus

Purpose: To determine ocular blood flow parameters by Doppler ultrasound scanning in type 2 diabetic patients with different stages of diabetic retinopathy. Material and Methods: In this prospective study, forty-five patients (90 eyes) with type 2 diabetes mellitus were divided into three groups of 15 patients each: no diabetic retinopathy group (DR0), non-proliferative retinopathy (NPDR), and proliferative retinopathy (PDR) groups. Doppler indices such as systolic blood flow velocity (Vs), diastolic blood flow velocity (Vd), time-averaged maximum velocity (TAMXV), pulsatility index (PI) and resistivity index (RI) in the ophthalmic artery (OA), central retinal artery (CRA) and short posterior ciliary arteries (SPCA) were determined. ANOVA was used for quantitative comparisons between the three groups. Results: There was a significant (р less 0.05) decrease in (a) the Vs from 71.1 +- 20.6 cm/s in the DR0 group to 59.9 +- 16.7 cm/s in the NPDR group and 47.4 +- 16.4 cm/s in the PDR group, (b) Vd from 22.1 +- 6.9 cm/s to 17.0 +- 6.6 cm/s and 12.3 +- 5.9 cm/s, respectively; and (c) TAMXV from 37.2 +- 11.3 cm/s to 31.9 +- 9.1 cm/s and 25.3 +- 9.7 cm/s, respectively, and an increase in the RI from 0.69 +- 0.06 cm/s to 0.71 +- 0.09 cm/s and 0.75 +- 0.08 cm/s, respectively, in the OA. In addition, there was a significant decrease in the Vd from 9.9 +- 5.4 cm/s in the DR0 group to 8.1 +- 3.8 cm/s in the NPDR group and 5.5 +- 3.1 cm/s in the PDR group, and an increase in the PI from 1.34 +- 0.16 cm/s to 1.46 +- 0.28 cm/s and 1.54 +- 0.24 cm/s, respectively, and in the RI from 0.71 +- 0.06 cm/s to 0.75 +- 0.07 cm/s and 0.80 +- 0.05 cm/s, respectively, in the CRA. Moreover, there was a significant decrease in the Vd from 4.3 +- 1.6 cm/s in the DR0 group to 3.2 +- 2.0 cm/s in the NPDR group and 3.1 +- 2.2 cm/s in the PDR group, and an increase in the PI from 1.32 +- 0.21 cm/s to 1.37 +- 0.24 cm/s and 1.54 +- 0.26 cm/s, respectively, and in the RI from 0.76 +- 0.04 cm/s to 0.82 +- 0.06 cm/s and 0.82 +- 0.06 cm/s, respectively, in the SPCA. Conclusion: We found that the arteries examined in patients with diabetic retinopathy tended to have decreased blood flow velocities and increased resistivity and pulsatility indices, with the greatest changes observed in patients with PDR. In addition, the difference in mean values of most Doppler indices between the PDR and NPDR groups was larger than that between the NPDR and DR0 groups.

The Role of Manual Detorsion in Pediatric Testicular Torsion During the Global COVID-19 Pandemic: Experience From 2 Centres

To evaluate the role of emergency manual detorsion as first line management for testicular torsion in the context of the COVID-19 pandemic. This retrospective observational study includes 90 pediatric patients ≤14 years old with diagnosis of testicular torsion made at 2 tertiary centers between October 2020 and June 2022. Variables examined included age, presentation delay, surgical wait time, number of attempts at manual testicular detorsion, and manual testicular detorsion success. All patients finally underwent surgery, including contralateral testicular fixation. Outcomes included predictors of successful manual detorsion, testicular findings at surgery, and operation time. Mean (SD) age at diagnosis was 11.51 (2.64) years. Mean presentation delay was 11.76 (13.79) hours. Detorsion was attempted in 72 (80%) patients, resulting successful in 58 (80.5%). Surgical wait time after successful manual detorsion was 22.85 (16.94) hours. On multivariable analysis, successful manual detorsion was associated with a presentation delay<6 hours (odds ratios [OR] 0.154, 95% confidence intervals (CI) 0.036-0.655, P = 0.01) and absence of scrotal edema (OR 0.171, 95% CI 0.038-0.769, P = 0.02). Vice versa, a heterogeneous echo-texture (OR 0.57, 95% CI 0.007-0.461, P = 0.007) and absent blood flow on Doppler ultrasound scan (OR 0.256, 95% CI 0.067-0.971, P = 0.045) were significantly associated with the likelihood of manual detorsion failure. In our experience, manual detorsion provided safe and effective emergency treatment for pediatric testicular torsion, especially in absence of edema and when presentation delay is <6 hours. This maneuver should be more widely attempted immediately after diagnosis as temporizing rescue.

Round ligament varicosity: a rare but important differential diagnosis of groin lumps during pregnancy.

Round ligament varicosity is rare and mainly reported during pregnancy. A systematic review of the literature identified 48 relevant studies reporting a total of 159 cases of round ligament varicosity, 158 of which were associated with pregnancy. Where reported, the mean age of the patients was 30.65 years, and 60.2% were of Asian ethnicity. The laterality of the condition was almost equally distributed, and nearly 50% presented with a painful groin lump. More than 90% of the patients were diagnosed via Doppler ultrasound scan of the affected groin. Conservative management was successful in more than 90% of the patients. Associated maternal complications are rare, with no mortality reported. No fetal complications or loss were reported. Round ligament varicosity can be misdiagnosed as a groin hernia, which may lead to unnecessary surgery during pregnancy. Therefore, increased awareness of this condition among clinicians is important.

The Role of Uterine Artery Doppler in the Second and Third Trimesters for Prediction of Preeclampsia and Fetal Growth Restriction Developed as a Consequence of Placental-Mediated Diseases.

The prospective study included 106 patients in whom ultrasound Doppler scans of uterine artery (UtA) were performed in the 2nd trimester between 20.0-23.6 weeks of gestation and the 3rd trimester between 28.0-32.6 weeks of gestation. In the second trimester, the average of the UtA-PI percentiles was statistically significant (p<0.05) in correlation with PE and SGA, as in the third trimester. Statistically significant (p<0.05) was also the correlation of UtA-PI >95 percentile with the development of PE and SGA. On the other hand, the present notch, in the two trimesters studied, analyzed as a single index, did not present a statistically significant association (p>0.05). The results of our study showed that UtA-PI Doppler is the best predictor of preeclampsia considering the association of intrauterine growth restriction, as most studies have found.

Abdominal Aortic Aneurysms: Epidemiological, Clinical and Echographic Aspects in The Health Structures of Lomé and At The Kara University Hospital (TOGO)

Objective To describe the epidemiological, clinical and arterial Doppler ultrasound aspects of abdominal aortic aneurysm (AAA). Material and methods This is a prospective study with descriptive and analytical aims carried out from January 2019 to March 2022 (3 years) at the cardiovascular exploration center (CEC) "Saint-Esprit" of the association of the people's doctors for the research on cardiovascular diseases (AMP-MCV), at the clinic "Le Printemps" and at the University Hospital of Kara. All patients who underwent arterial Doppler ultrasound of the lower limbs for any reason in these centers during the study period were included. Ultrasound scans were performed or confirmed by a physician with a diploma specializing in vascular Doppler ultrasound. Results We retained 32 Doppler ultrasound scans out of 739 performed for AAA with a frequency of 4.38%. The mean age was 73.5± 9.07 years. The sex ratio M/F was 1.4. The cardiovascular medical history (84.38%) found was: hypertension (33.33%), diabetes (18.52%), dyslipidemia (33.33%) and a combination of diabetes and hypertension (14.81%). The circumstances of discovery were: downstream MI ischemia (72%), incidental finding on abdominal ultrasound (15.63%) and De bakey sign (6.25%). The location of the aneurysms was subrenal (84.4%), suprarenal (9.4%) and both (6.2%). AAAs were fusiform (71.9%) and saccular (28.1%). The size of the aneurysms was greater than 5 cm in 78.17% of patients. High blood pressure increases the probability of the occurrence of subrenal AAA while dyslipidemia increases the occurrence of fusiform AAA. Diabetes increases the probability of occurrence of AAA larger than 7cm. AAAs were thrombosed in 75% of patients. There were extensions of the aneurysms to the iliac arteries in 70.59%. Downstream embolic complications represented 46.88%, in the form of occlusions and tight stenoses. Spontaneous mortality was 81.24%. Conclusion Arterial Doppler ultrasonography is a very important tool in the screening, positive and lesion diagnosis of AAA. The risk factors for AAA are: age over 60 years, male gender, hypertension, diabetes and dyslipidemia. Early detection remains essential, because the spontaneous prognosis is poor.

Diagnostic Challenge of d-dimer Negative Upper Extremity DVT

Studies suggest D-Dimer has a high sensitivity with negative predictive value for upper extremity DVT (UEDVT). Sensitivity is around 92% with a negative predictive value of 98%. UEDVT is an uncommon presentation with an incidence rate of 4-10%. Risk factors for UEDVT include thrombophilia, central venous catheters, malignancy, pacemakers and upper limb surgery and/or immobilisation. The use of scoring systems for assessing UEDVT risk is less well known and therefore poorly utilised. A scoring system similar to a Wells' score, known as Constans criteria, is a 2 level scoring system developed and first published in 2008. The Criteria considers, venous material in-situ, localised pain, unilateral oedema and plausibility of alternative cause. Score interpretation; -1 to 0 points (low probability of UEDVT 12%), 1 point (intermediate probability 20%), 2 to 3 points (high probability 70%). Kleinjan, et al., sought further improved upon this scoring tool by incorporating D-dimer results in the stratification of intermediate risk patients, asserting that its use can safely and effectively exclude venous thrombosis of the upper extremity. This case series shows 2 patients diagnosed with UEDVT. both patients had a Constans score of 1 therefore prompting use of D-Dimer results to stratify risk. Irrespective of negative D-dimer results, ultrasound doppler scans where performed and appropriate treatment given. The authors of this case series reviewed the limitations/interference factors of HemosIL HS D-Dimer reagent, along with 2 other D-Dimer reagents and subsequently developed recommendations which may be useful in interpretation of D-Dimers in clinical practice. Additionally, recommendation for cautious intrepretation of D-Dimer results in conjunction the Constans scoring tool with scores of 1 or less

A CROSS-SECTIONAL STUDY ON EVALUATION OF DIAGNOSTIC APPLICATIONS OF LINEAR SONOGRAPHIC TRANSDUCER IN VARIOUS DISEASES

Introduction: An ultrasonography scan is a medical test that uses high-frequency sound waves to produce live images of the body. Linear transducer is used to create the images of superficial organs. Superficial sonography used for diagnose various pathologies like Large vessel vasculitis, carpel tunnel syndrome, thyroiditis, carotid artery disease etc. The aim of this study is to evaluate the diagnostic application of linear sonographic transducer in various diseases of superficial organs. In the simple sense of word, Transducers are the devices that converts a form of energy into another. These devices have been throughout the history, taking an example of Pythagoras in 550 BC, who sited that pitch and frequency is co-related and this lead to creation of Sonometer, instrument used in music1. A major physics breakthrough occurred in 1880 when the brothers Jacque and Pierre Curie demonstrated the piezoelectric effect, which results in formation of Ultrasound transducer. Over 60 years later, Dr Karl Dussik of Austria in 1940s, becomes the first physician to use the ultrasound in medical diagnosis2.&#x0D; Research Methodology: In this prospective cross-sectional study 40 patients, prescribed for superficial organs ultrasonography (USG) (thyroid {neck}, musculoskeletal, and doppler) were included and stat for result was mean and percentage stats used. This was a quantitative prospective cross sectional study in which high frequency ultrasonography of a maximum of 40 patients with proper indication under taken. Ultrasonography is performed after taking proper history and relevant physical examination performed by the linear transducer (6 – 12 MHz). In this study convenience sampling was used as the sample was taken from a section of the population that was easily accessible or readily available to the researcher.&#x0D; Findings: Total 40 (100%) patient’s data used in this study who undergone the superficial organ examination (Musculoskeletal, Doppler, thyroid {neck}) during the period of study. Out of which 50% (20) patients undergo Thyroid ultrasonography, 25% (10) patients undergo musculoskeletal ultrasonography and 25% (10) patients undergo Doppler imaging ultrasonography. Result of scan collected and master chart is prepared. Author found that in thyroid ultrasonography scan 15% patients have swollen neck and pain was due to cervical varicocele, 12.5% patients have lymph nodes, 2.5% patients have goitre, 2.5% patients have thyroiditis, 2.5% patients have cyst, 2.5 % patients have thyroid mass, and 12.5% patients have normal study. In Doppler ultrasonography scans 5% patients have edema, 2.5% patients have varicocele, 5% patients have varicosities, 2.5% patients have periphery arterial disease and 5% patients have thrombus/plaque and 5% have normal scan with no findings. In musculoskeletal ultrasonography scans 22.5% patients have normal study with no significant findings and 2.5% patients have focal encepahalocele.&#x0D; Conclusion: It is concluded that ultrasound is the best modality to rule out the problems at any stage so that treatment can be started on behalf of reports of Ultrasonography scan in patients of superficial organs with various diseases, as it is fast and safe to patients, it does not include any ionizing radiation so female patients of reproductive age go through scan without any risk. And most common reason of swelling and pain in neck is cervical lymphadenopathy, lymph nodes, mass or goitre, and pain in joints and swelling is varicosities or thrombus in lower extremities and in musculoskeletal cranium study mostly has normal study with no significance but few have focal encepahalocele as per in this study.

A case of hydrocele repair: Legal aspect of consenting and post-operative complication

Introduction: The duties of a doctor are not only limited to providing medical treatment or surgical interventions to patients but also involve appropriate communication with them. Providing adequate information, addressing patients’ concerns, and respecting their decision making is all part of a doctors’ work ethics. The case describes a patient who had a hydrocele repair and developed early post-operative complications. The concern raised is whether adequate information regarding the procedure was given to the patient. Case Report: A 45-year-old medically healthy man was referred to the urology department by his general practitioner for an enlarging right-sided hydrocele. The main reason for seeking treatment was cosmetic. Due to the coronavirus (COVID-19) pandemic, he had a non-face-to-face urology clinic appointment only a few months later. After having discussed the various management options with the urologist, he opted to have a hydrocelectomy. On the day of the surgery, several months later, the operating surgeon consented the patient whereby he again explained the procedure and the associated risks. The surgery itself was uneventful, unfortunately, he developed early post-operative complications. He presented with increasing scrotal pain and swelling, features suggestive of an infected hematoma. He was managed conservatively with oral analgesia and antibiotics after which his symptoms improved. However, a Doppler ultrasound scan performed two weeks later, showed an avascular right testicle. He was immediately admitted to the hospital and was taken to theater for a scrotal orchidectomy. The outcome of the procedure was unexpected and even more undesirable cosmetically. The patient was dissatisfied and eventually lodged a formal complaint in the Patient Advice and Liaison Service (PALS). Conclusion: Post-operative complications can occur. However, providing patients with timely and adequate information ensures that the standard of care is met.

Appropriateness of Initial Course of Action in the Management of Blunt Trauma Based on a Diagnostic Workup Including an Extended Ultrasonography Scan

The extended Focused Assessment With Sonography for Trauma (E-FAST) has become a cornerstone of the diagnostic workup in patients with trauma. The added value of a diagnostic workup including an E-FAST to support decision-making remains unknown. To determine how often an immediate course of action adopted in the resuscitation room based on a diagnostic workup that included an E-FAST and before whole-body computed tomography scanning (WBCT) in patients with blunt trauma was appropriate. This cohort study was conducted at 6 French level I trauma centers between November 5, 2018, and November 5, 2019. Consecutive patients treated for blunt trauma were assessed at the participating centers. Data analysis took place in February 2022. Diagnostic workup associating E-FAST (including abdominal, thoracic, pubic, and transcranial Doppler ultrasonography scan), systematic clinical examination, and chest and pelvic radiographs. The main outcome criterion was the appropriateness of the observed course of action (including abstention) in the resuscitation room according to evaluation by a masked expert panel. Of 515 patients screened, 510 patients (99.0%) were included. Among the 510 patients included, 394 were men (77.3%), the median (IQR) age was 46 years (29-61 years), and the median (IQR) Injury Severity Score (ISS) was 24 (17-34). Based on the initial diagnostic workup, no immediate therapeutic action was deemed necessary in 233 cases (45.7%). Conversely, the following immediate therapeutic actions were initiated before WBCT: 6 emergency laparotomies (1.2%), 2 pelvic angioembolisations (0.4%), 52 pelvic binders (10.2%), 41 chest drains (8.0%) and 16 chest decompressions (3.1%), 60 osmotherapies (11.8%), and 6 thoracotomies (1.2%). To improve cerebral blood flow based on transcranial doppler recordings, norepinephrine was initiated in 108 cases (21.2%). In summary, the expert panel considered the course of action appropriate in 493 of 510 cases (96.7%; 95% CI, 94.7%-98.0%). Among the 17 cases (3.3%) with inappropriate course of action, 13 (76%) corresponded to a deviation from existing guidelines and 4 (24%) resulted from an erroneous interpretation of the E-FAST. This prospective, multicenter cohort study found that a diagnostic resuscitation room workup for patients with blunt trauma that included E-FAST with clinical assessment and targeted chest and pelvic radiographs was associated with the determination of an appropriate course of action prior to WBCT.