[Enoxaparin sodium for pharmacological prevention of postoperative venous thromboembolic complications in urological patients].

INTRODUCTION: Currently, there are paucity of reports on the success of medical prevention of venous thromboembolic complications after urological procedures. AIM: To evaluate the efficiency of enoxaparin sodium for prevention of postoperative venous thromboembolic complications in urological patients. MATERIALS AND METHODS: According to the medical records of 151 men and women aged 22 to 92 years old who were undergone to elective surgical treatment in April 2021, the results of the thrombin generation assay and ultrasound study of the inferior vena cava were retrospectively analyzed. All patients were divided into 6 study groups depending on the degree of risk of postoperative venous thromboembolism (very low, low, moderate, high, very high and extremely high). The data obtained during the thrombin generation assay in patients from different groups were compared with those in healthy volunteers (n=30, control group) and evaluated in dynamics. In addition, intergroup comparison was done. RESULTS: All study participants prior to surgery had a significant increase in peak thrombin and endogenous thrombin potential (ETP) by 5-26% and 13.5-21.5%, respectively. The postoperative findings were as following: 1) one hour after the procedure, a significant (by 9-28.6%) decrease in the normal bleeding time (Lag time); 2) a significant increase in the peak thrombin by 4.8-10.6% 1 hour after surgery and by 11-40.2% at the end of the first postoperative week; 3) reducing the time to peak thrombin (ttPeak) by 13-15%; 4) increase in ETP. According to the ultrasonic data, all study participants had no signs of thrombosis of the inferior vena cava system. CONCLUSION: In urological patients requiring surgical treatment, before and after procedure, there is almost always a shift in the hemostasis towards the predominance of the blood coagulation system. Under such conditions, to prevent the development of postoperative VTE, it is expedient and pathogenetically justified to use enoxaparin sodium in a single dose of 0.4 ml or 4000 anti-Xa IU administered once a day s/c 24 hours before the procedure and till full activation of a patient.

[Ultrasound anatomy of masticatory muscles. (Experimental and clinical study)]. / Ul'trazvukovaya anatomiya zhevatel'nykh myshts. (Eksperimental'no-klinicheskoe issledovanie).

PURPOSE: To describe the ultrasound anatomy of the masticatory muscles based on a comparison of the results of macroscopic and ultrasound studies of the masticatory muscles in vitro. MATERIAL AND METHODS: In the experimental part, a macropreparation of the masticatory muscle was studied; in a clinical example, an ultrasound of the masticatory muscles was performed on a patient with normal occlusion using the author's methods for analyzing echograms. RESULTS: The ultrasound anatomy of the masticatory muscles is described based on a comparison of data from the study of a macroscopic specimen and ultrasound images of the masticatory muscle of an experimental animal. Using a clinical example of a patient with normal occlusion, the results demonstrate the usage of the authors' developments in describing ultrasound images of the masticatory muscles. CONCLUSION: The study resulted in an algorithm for describing ultrasound images of masticatory muscles, including methods for qualitative and quantitative assessment of ultrasound images using proprietary developments involving elements of artificial intelligence technologies.

Is the fixation of single incision TVT-S tape as good as that of transobturator tape? An ultrasound study of randomized trial results.

INTRODUCTION: TVT-Secur (TVT-S) was the first single-incision sling available on the market and was soon found to have less efficacy than mid-urethral slings. Our aim was to assess the position and tape descent following TVT-O and TVT-S H in a U procedure and, based on this evaluation, to find the possible reason for lower TVT-S surgery efficacy. METHODS: We conducted an ultrasound study of a randomised trial with a 3-year follow-up that took place between 2007 and 2009 and included 197 women with urodynamic stress urinary incontinence. Of these, 67 were allocated to receive the TVT-O procedure, 64 to TVT-S in the H position, and 65 in the U position. Patients underwent a complete urogynaecological and ultrasound examination. The positions of the bladder neck and the tape after surgery were assessed and the data obtained compared between groups. RESULTS: Our primary study showed a significantly higher rate of positive stress tests in the TVT-S groups compared to the TVT-O group. After surgery, there was no difference between the position of the tape at rest and at maximal Valsalva between the groups. In TVT-O patients, the mean length of the upper tape margin descent increased from 6 mm on the 1st day after surgery to 9 mm 3 months after surgery and remained stable afterwards. For TVT-S patients, there was a further increase of up to 15 mm in tape descent after 3 months. CONCLUSIONS: Our results show that the lower efficacy of TVT-S might be due to inadequate fixation and increasing tape descent.

Pancreatic Ultrasound: State of the Art.

An ultrasound (US) study is often the first imaging approach in patients with abdominal symptoms or signs related to abdominal diseases, and it is often part of the routine workup. The pancreatic gland, despite its retroperitoneal site, can be efficiently examined with US thanks to advances in US technologies. Nowadays, a pancreatic US study could be considered complete if multiparametric, including the use of Doppler imaging, US elastography, and contrast-enhanced imaging for the study of a pancreatic mass. A complete US examination could contribute to a faster diagnosis, especially if the pancreatic lesion is incidentally detected, addressing second-step imaging modalities correctly.

[Multidisciplinary approach in urology. Current imaging studies in urology].

Imaging studies play a crucial role in the diagnosis of urologic diseases. X-ray and ultrasound studies are used as first-line diagnostic methods. Computed tomography and magnetic resonance imaging (MD-CT and MRI), radionuclide and hybrid methods allow to clarify diagnosis. Currently, the trend "from simple to complex" contributes to obtaining maximum information in the shortest possible time with a minimum cost.

Injury to the infrapatellar branch of the saphenous nerve during tendon graft harvesting for knee ligament reconstruction: An ultrasound simulation study.

The clinical anatomy of the infrapatellar branch of the saphenous nerve (IPBSN) is of particular importance during operations in the area of the knee, especially when material for anterior cruciate ligament reconstruction is harvested. The nerve can easily be injured during the harvesting procedure, leading to postoperative complications that reduce quality of life. Three different skin incisions are commonly used during hamstring tendon harvesting: horizontal, vertical, and oblique. The aim of this ultrasound simulation study was to assess the risk of IPBSN injury associated with the type of skin incision and the point-of-emergence of the IPBSN relative to the sartorius muscle. Thirty healthy volunteers (60 lower limbs) were recruited for identification of the IPBSN. When it was found, using a high-frequency ultrasound probe, three different 3 cm skin incisions over the pes anserinus were simulated. Vertical, horizontal, or oblique lines simulating incisions were marked over the pes anserinus and ultrasound was used to visualize the structures that could be injured during the marked incisions. The IPBSN was visualized in 58 lower limbs (96.7%). The results of the simulation study indicated that the vertical incision should be avoided during hamstring tendon harvesting, as it is associated with a significantly higher risk of injury (25.9%) to the IPBSN than the horizontal (3.5%) or oblique (8.6%) incisions. We recommend that a preoperative ultrasound assessment of IPBSN anatomy be performed to minimize the risk of iatrogenic injury to the nerve and associated complications. Clin. Anat. 30:868-872, 2017. © 2017 Wiley Periodicals, Inc.

Systemic and cerebral endothelial dysfunction in chronic migraine. A case-control study with an active comparator.

BACKGROUND AND OBJECTIVE: Unlike migraine and migraine with aura, little information exists regarding chronic migraine (CM) as a risk factor for cardiovascular disease. In this study we aim to determine whether an association between CM and endothelial dysfunction exists. METHODS: Individuals 18 years and older diagnosed with episodic migraine (EM) and CM according to ICHD criteria were studied. After an overnight fast and abstinence from vasoactive drugs, ultrasound studies were performed and blood samples taken from patients and matched controls according to internationally agreed on protocols. RESULTS: A total of 113 individuals were enrolled (35 CM, 37 EM, 41 controls). CM patients had a lower percentage of flow-mediated vasodilation (FMD; difference of means = 5.03%; p = 1.0E-6) and breath-holding index (BHI; difference of means 0.754; p = 2.0E-6), as well as increased carotid intima media thickness (cIMT; difference of means = 0.128 mm; p = 7.0E-5) than controls. The EM patients and controls comparison found similar, but less pronounced, differences: decreased BHI (p = 0.031), and increased cIMT (p = 0.028). Fibrinogen (r = 0.277; p = 0.006), C-reactive protein (r = 0.288; p = 0.003), and erythrocyte rate sedimentation (r = 0.298; p = 0.002) also correlated with cIMT, and inversely with BHImV and FMD. CONCLUSIONS: Migraine is associated with systemic and cerebral endothelial dysfunction demonstrated by ultrasound studies and biological markers. The degree of these changes was strongly associated with the severity of migraine. Our data indicate that migraine may be a cerebral disorder with systemic endothelial damage.

[Embryological aspects of clinical presentations of congenital lens and vitreous anomalies]. / Émbriologicheskie aspekty klinicheskikh proiavlenii vrozhdennykh izmenenii khrustalika i steklovidnogo tela.

This report gives a general overview of embryological features of the human eye. Key literature sources published during the last century on evaluation of congenital changes in the vitreous body and identification of signs of its 'underdevelopment' in certain types of congenital cataracts have been studied. The said changes were analyzed in terms of general pathology of the human body as well as local morphological manifestations. According to the authors, such an approach justifies the need for comparison of clinical manifestations of congenital lens and vitreous changes with possible embryonic defects.

Ultrasound findings associated to gallbladder carcinoma.

OBJECTIVE: This article reviews the most relevant ultrasound findings associated with gallbladder cancer. MATERIAL AND METHOD: A descriptive and retrospective study was made of clinical features and imaging studies in patients subjected to surgery for gallbladder neoplasm in the Reina Sofía General University Hospital (Murcia) during the time period 2000-2011. RESULTS: A total of 15 cases of gallbladder cancer were found during the study period, 9 of whom were women. The mean age was 77 years (range 61-96). Pain was the principal complaint. The patients had cholelithiasis in 13 cases, smoking in 2 cases, and obesity in 3 cases. The ultrasound showed gallbladder wall thickening (>4mm) in 8 cases, intraluminal mass in 4, scleroatrophic gallbladder in 2, and mass replacing the gallbladder in one. Only in 4 cases was the suspicion of gallbladder carcinoma established preoperatively. According to the pTNM staging, 4 patients were carcinoma in situ (Tis), one case T1a, 6 cases T2, 3 cases T3 and one case T4. In 7 cases, the only evidence was the preoperative ultrasound, and in 8 the study was completed with an abdominal CT. CONCLUSION: Early diagnosis of gallbladder cancer is rare. The ultrasound diagnostic approach is difficult; only a localized thickening coexisting with gallstones seems to be significant, and requires a biopsy. The image of a mass and a stone occupying the gallbladder is associated with later stages of the disease.

The impact of ankle movements on venous return flow: A comparative study.

OBJECTIVE: To compare the haemodynamic effects of different ankle movements combined ankle and toe movements on the femoral vein of the lower extremity. METHODS: 28 healthy volunteers participated in the study. Doppler ultrasound was used to measure peak systolic velocity and time-averaged mean velocity of the common femoral vein during ankle dorsiflexion, ankle dorsiflexion with simultaneous toe extension, ankle plantarflexion, and ankle plantarflexion with simultaneous toe flexion. RESULTS: In comparison to the resting state, both ankle alone or ankle combined with toe movement showed statistically significant differences (p < .01). However, there were no significant difference in the velocity of the common femoral vein between ankle alone and ankle combined with toe movement (p > .05). It is noteworthy that dorsiflexion of the ankle resulted in the highest peak velocity of blood flow. CONCLUSION: The impact of ankle movement, with or without toe movement, the velocity of the common femoral vein is not significantly correlated.

Iatrogenic Ulnar Nerve Neuropathy Following Reverse Total Shoulder Arthroplasty: Electrodiagnostic Findings in 18 Patients.

Background A reverse total shoulder arthroplasty (RTSA) is often recommended for rotator cuff pathology and may be associated with a myriad of complications, including prosthetic instability, infection, humeral problems, and glenoid loosening. Neurological injuries following an RTSA are infrequent and are usually related to brachial plexus or proximal nerve injury in the affected arm. Iatrogenic ulnar nerve neuropathy is exceedingly rare. Aims This study describes the clinical and electrodiagnostic (EDX) features of 18 patients with ulnar nerve neuropathy complicating RTSA. Materials and methods All patients underwent EDX studies, and 14 had an ultrasound (US) study. Results All patients complained of numbness, tingling, hyperalgesia, and/or allodynia in the distribution of the ulnar nerve. Eight (44%) patients reported hand weakness, and one (6%) noted wasting of the intrinsic hand muscles. Decreased pinprick sensation in the ulnar nerve distribution was detected in all patients. Seventeen (94%) patients had weakness of the ulnar nerve-innervated intrinsic hand muscles. All patients had focal slowing of the motor conduction of the ulnar nerve across the elbow. Sensory potentials were either absent or of a low amplitude over the digital and/or dorsal cutaneous branch of the ulnar nerve in all patients. Twelve (86%) patients showed an increase in the cross-sectional area (CSA) of the ulnar nerve at the elbow; six (43%) had a hypoechoic ulnar nerve. Ulnar nerve neuropathy was confirmed at the elbow in all 18 patients. Of the 14 (78%) patients who underwent surgical intervention for ulnar nerve neuropathy following an RTSA, only four had complete symptom resolution. Conclusions Surgeons should be cognizant of ulnar nerve neuropathy as a potential complication of an RTSA and take precautions to avoid damage to the ulnar nerve intraoperatively. EDX and US studies should be performed to confirm and assess the site and severity of the injury.

HbA1c, Coronary atheroma progression and cardiovascular outcomes.

BACKGROUND AND AIMS: We tested the hypothesis that on-treatment HbA1c levels independently associate with coronary atheroma progression and major adverse cardiovascular events (MACE: death, myocardial infarction, cerebrovascular accident, coronary revascularization, or hospitalization for unstable angina) rates. METHODS: We performed a post-hoc pooled analysis of data from seven prospective, randomized trials involving serial coronary intravascular ultrasonography (IVUS). The percent atheroma volume (PAV) was calculated as the proportion of the entire vessel wall occupied by atherosclerotic plaque. Using multivariable mixed modeling, we determined the association of on-treatment HbA1c with annualized change in PAV. Cox proportional hazard models were used to assess the association of HbA1c with incidence of MACE. RESULTS: Among 3,312 patients (mean age 58.6±9years, 28.4%women) average on-treatment HbA1c was 6.2±1.1%. Overall, there was no net significant annualized change in PAV (0.12±0.19%, p = 0.52). In a fully adjusted multivariable analysis (following adjustment of age, sex, body mass index, systolic blood pressure, smoking, low- and high-density lipoprotein cholesterol, triglyceride levels, peripheral vascular disease, trial, region, and baseline PAV), higher on-treatment HbA1c levels were independently associated with annualized changes in PAV [beta-estimate (95% confidence interval): 0.13(0.08, 0.19), p < 0.001]. On-treatment HbA1c levels were independently associated with MACE [hazard ratio (95% confidence interval): 1.13(1.04, 1.23), p = 0.005]. CONCLUSIONS: Independent of achieved cardiovascular risk factor control, greater HbA1c levels significantly associate with coronary atheroma progression rates and clinical outcomes. These results support the notion of a direct, specific effect of glycemic control upon coronary atheroma and atherosclerotic events, supporting the rationale of therapies designed to directly modulate it.

The influence of labor epidural analgesia on maternal, uteroplacental and fetoplacental hemodynamics in normotensive parturients: a prospective observational study.

BACKGROUND: Epidural analgesia provides sufficient analgesia during labor but can cause hypotension despite various prophylactic measures. We studied its effects on pre-placental, fetoplacental, and fetal hemodynamics using Doppler ultrasound. The primary endpoint was the pulsatility index of the umbilical artery at 30 min after establishing epidural analgesia. Secondary endpoints included maternal blood pressures and neonatal outcome data. METHODS: We included healthy parturients at a cervical dilation ≥2 cm, with or without a request for epidural analgesia (n=32 per group). Ultrasound studies of the uterine arteries, umbilical artery and fetal middle cerebral artery were performed before insertion of the epidural catheter, and 30, 60 and 90 min after; the same time-points were assessed in the non-epidural control group. Maternal blood pressure was measured by a continuous non-invasive arterial pressure monitor. RESULTS: Ultrasound studies detected no significant differences in pulsatility indices over time in any blood vessel. In contrast to the control group, maternal blood pressures were significantly lower for all measures after the onset of analgesia compared with baseline values (mean systolic pressure decreased from 132.7 ±â€¯15.9 mmHg to 123.1 ±â€¯14.4 mmHg at 30 min, P=0.003). The mean pH value of the umbilical arterial blood was 7.29 (±0.06) in the epidural group versus 7.31 (±0.08) in the control group (P=0.33). The median Apgar score at 5 min was 10 in both groups. CONCLUSIONS: Pre-placental, fetoplacental and fetal hemodynamics remained stable despite a statistically significant decrease in maternal blood pressure in laboring parturients receiving epidural analgesia.

Fetal cardiac axis in non-anomalous pregnancies: does fetal gender or maternal body mass index (BMI) matter?

OBJECTIVES: To determine if cardiac axis obtained at an early ultrasound study (11-15 weeks) differs from that obtained at a late ultrasound study (18-22 weeks) in the same fetus and to evaluate the impact of fetal gender and/or maternal body mass index (BMI). METHODS: Cardiac axes of 324 non-anomalous fetuses at 11-15 weeks gestation were measured, with follow-up measurements obtained at 18-22 weeks. Comparisons were performed based on gestational age period, fetal gender and obese/non-obese maternal status. RESULTS: (1) Mean fetal cardiac axis did not change between 11 and 15 weeks; p = 0.8, (2) mean fetal cardiac axis was more levorotated at 11-15 weeks than measurements obtained at 18-22 weeks; 48.1 ± 7.1° versus 43.7 ± 8.9°; p < 0.0001, (3) male fetuses had less levorotated cardiac axis than female fetuses in late ultrasound studies but there was no difference between them at early ultrasound studies; 18-22 weeks male fetus, 42.7 ± 9.3° versus female fetus, 45.2 ± 8.3°; p = 0.02 and 11-15 weeks male fetus, 48.1 ± 7.0° versus female fetus, 48.4 ± 7.4°, p = 0.7, respectively, and (4) similar trends with the overall study population were observed in the comparison between fetuses of obese and non-obese women. CONCLUSION: Fetal cardiac axis remains stable at 11-15 weeks, becoming less levorotated at 18-22 weeks. This may be attributed to increments in fetal lung volume. The differences in cardiac axis measurements between male and female fetuses examined at 18-22 weeks may also be attributable to differences in increment of fetal lung volume during this gestational age period.

[Regional hemodynamic changes in nodular goiter].

The goal of the present study was to evaluate the clinical and diagnostic value of regional hemodynamic changes in the thyroid vessels and carotid beds in patients with different forms of nodular goiter in order to optimize further follow-up and treatment. The study covered 120patients aged 25 to 40years (mean age 32.82±0.36 years) who had nodular goiter. A control group comprised 30 women comparable by age (mean age 32. 06±0. 44 years), who had a morphologically and functionally unchanged thyroid. After examined, the patients with nodular goiter were divided into group according to the identified morphological forms. Group 1 consisted of25 (20.8%) women (mean age 34.85±0.89 years) with signs of nodular malignancies; Group 2 included 35 (29.2%) patients (mean age 32.08±0.78years) with detected adenomas; Group 3 comprised 40 (33.3%) patients (mean age 33.6±1.08years) with colloidal nodules, and Group consisted 20 (16.7%) women (mean age 32.87±0.9 years) with signs of cysts. The study and comparison of the linear and volume parameters of arterial ducts to the euthyroid loves in nodular pathology were made, by taking into account the site of an abnormal focus and its morphological structure. The linear and volumetric bloodflow rates in the thyroid arteries ipsilaterally to the abnormal nodular of any morphological structure were found to be significantly higher (p < 0.05). Changes were revealed in blood flow parameters in the carotid bed in relation to the morphological structure of nodules.

[Prediction of surgical treatment for differentiated thyroid carcinoma].

The purpose of the study was to determine the influence of various factors on the prediction of surgical treatment for differentiated thyroid carcinoma (TC). The long-term results of surgical treatment were studied in 266 patients with differentiated forms of TC who had been operated on at the Surgical Department of the Endocrinology Research Center in 2000-2003. To solve the put problem, the authors identified the following factors that may influence the prediction of surgical treatment for differentiated TC forms, as shown by the data available in the literature; these included gender, age, the morphological characteristics and size of a tumor, the scope and procedure of surgical intervention, the presence of metastases, postoperative radioactive iodine therapy, and suppressive levolhyroxine therapy. The investigation established the most important/actors significantly influencing the prediction of surgical treatment for differentiated TC forms. It showed the high probability of metastases being in the cervical VI lymph nodes unchanged, as evidenced by preoperative ultrasound study. The optimal algorithm was developed for the treatment of patients with differentiated TC forms - thyroidectomy, by removing fat and lymph nodes of the VI-level neck in combination with radioactive iodine therapy and suppressive L-T4 therapy.

[Thyroid structural changes: results of a screening ultrasound study of a Moscow population].

То assess the prevalence and pattern of thyroid disease in Moscow, a mild iodine-deficiency area, the authors examined a random sample of 1103 individuals (1004 females and 99 males) during 14 months. The examinees' age ranged from 17 to 80 years; the mean age was 36.7±14.05; median was 37 years. The survey involved a physical examination with thyroid palpation, brief history data collection, and thyroid ultrasound study on a "Mysono"portable apparatus with a 7.5-MHz linear transducer, operating on a real-time basis. Among the examinees the echographic signs of these or those thyroid changes were found in 36% of cases. The most common abnormalities were focal thyroid tissue changes, whose prevalence was 12.4%. Thyroid nodular masses were encountered at a slightly less frequency (10.5%). Of them, nodular and multinodular goiter accounted for 6 and 4.5%, respectively. The third group of changes is presented by a diffuse decrease in thyroid tissue echogenicity (9%). Diffuse goiter was less frequently identified; its frequency was 5%. A minor proportion (0.1%) of the examinees had a history of operations for this or that thyroid disease.