Association of ultrasound morphological features with serum β subunit human chorionic gonadotrophin and histopathology among sonologically diagnosed cases of gestational trophoblastic neoplasia in a tertiary hospital / Philippine Journal of Obstetrics and Gynecology

Background@#Gestational trophoblastic neoplasia (GTN) presents as vascular mass of varying morphology on ultrasound and confirmed through quantitative serum β subunit human chorionic gonadotrophin (β‑hCG). In regions with limited access to β‑hCG, ultrasound plays a crucial role in the initial diagnosis for timely management.@*Objectives@#This study aimed to investigate the associations between ultrasound vascular morphologic features, serum β‑hCG levels, and histopathology in GTN cases.@*Methodology@#A cross‑sectional review was conducted on 113 cases with ultrasound impression of GTN over an 8‑year period. The patient data were extracted from case records, and ultrasound images were categorized based on the distinct features. Associations with β‑hCG levels and histopathology were analyzed using the Chi‑square test and Mann–Whitney U‑test. Statistical significance was set at P < 0.05.@*Results@#A significant association was observed between ultrasound category and serum β‑hCG (P < 0.0001). The compact and diffuse types were more prevalent with β‑hCG levels between 104 to <105 mIU/mL, while the lacunar type was common among patients with ≥105 mIU/mL. However, there was no significant association between ultrasound categories and mean β‑hCG levels. Regarding histopathology, the lacunar type was more common in invasive moles, whereas the compact and diffuse types tended to be seen with choriocarcinoma, although these were not statistically significant (P = 0.182).@*Conclusions@#Morphologic types of GTN by gray scale and Doppler ultrasound vary across the different levels of serum β‑hCG and may suggest the histopathological diagnosis. This study provides valuable insights into the ultrasonographic characteristics of GTN, which can aid in its diagnosis and management.

Ductus venosus as a marker of fetal growth in first trimester in a population of Colombian pregnant women / Ductus venoso como marcador de crecimiento fetal en primer trimestre en una población de gestantes colombianas

Abstract Objectives: to evaluate the relationship between the ductus venosus (DV) and the variables of fetal growth in the first trimester in a Colombian pregnant population. Methods: a descriptive cross-sectional study was carried out with secondary data obtained from a multicenter study.526 patients were included between weeks 11 and 14 for gestational ultrasound follow-up attended in three health care institutions in Bogotá, Colombia, between May 2014 and October 2018. A bivariate descriptive analysis was carried out where the relationship between the characteristics of the DV in the first trimester and ultrasound findings. Results: the flow wave of the DV in the first trimester was normal in the entire sample, with a pulsatility index of the ductus venosus (DVPI) of 0.96±0.18. In addition, a negative correlation was found between the crown-rump length (CRL) and the DVPI (p<0.05). Conclusion: there is a relationship between the DVPI regarding the CRL, indicating an interest in this early marker in relation to fetal growth alterations; however, more studies are required to determine the usefulness of this variable with respect to fetal growth.

Resumen Objetivos: evaluar la relación entre el ductus venoso (DV) y las variables del crecimiento fetal en primer trimestre en una población de gestantes colombianas. Métodos: se realizó un estudio transversal descriptivo con datos secundarios obtenidos de un estudio multicéntrico. Se incluyeron 526 pacientes entre las semanas 11 a 14 para seguimiento ecográfico gestacional atendidas en tres instituciones prestadoras de salud en Bogotá, Colombia, entre mayo del 2014 y octubre del 2018. Se realizó un análisis descriptivo bivariado donde se evaluó la relación entre las características del DV en primer trimestre y los hallazgos ecográficos. Resultados: la onda de flujo del DV en primer trimestre fue normal en la totalidad de la muestra, con un índice medio de pulsatilidad del ductus venoso (IPDV) de 0,96±0.18. Se encontró una correlación negativa entre la longitud cefalocaudal (LCC) y el IPDV (p<0.05). Conclusión: existe una relación entre el IPDV respecto a la LCC, señalando un interés de este marcador temprano en relación con las alteraciones del crecimiento fetal, sin embargo, se requieren más estudios para determinar la utilidad entre esta variable respecto al crecimiento fetal

Efeitos do tratamento manipulativo osteopático na hemodinâmica e na qualidade de vida de gestantes no terceiro trimestre: coorte prospectiva / Effects of osteopathic manipulative treatment on the hemodynamics and quality of life of pregnant women in the third trimester: prospective cohort

Na gestação várias mudanças pelas quais as mulheres passam são capazes de intervir no seu estado de saúde. Estudos relatam que a incapacidade do corpo de algumas gestantes de acomodarem o crescimento uterino estaria na raiz de problemas na hemodinâmica materno-fetal. A busca por terapêuticas não medicamentosas vem crescendo dentro da área da saúde nos últimos anos. O tratamento manipulativo osteopático é uma terapêutica integrativa complementar de saúde reconhecida pela organização mundial de saúde e aceita pelo sistema único de saúde brasileiro. Método: Trata-se de uma coorte prospectiva realizada com 80 pacientes do ambulatório de pré-natal e da enfermaria de gestantes do Instituto Fernandes Figueira/Fiocruz entre julho de 2021 e setembro de 2022. Foram realizados dois estudos, um estudo transversal com 51 grávidas para avaliar os efeitos hemodinâmicos materno-fetais após o tratamento manipulativo osteopático através da dopplervelocimetria nas gestantes e um estudo prospectivo com 64 gestantes para avaliar a influência do tratamento manipulativo osteopático sobre a intensidade das dores lombar e pélvica, assim como mudanças na sua qualidade de vida. População: foram investigadas gestantes no terceiro trimestre de gestação, acima de 18 anos, e excluídas as gestantes com ruptura prematura de membrana, com malformações fetais, com fetos múltiplos e trabalho de parto ativo. Resultados: Os resultados do estudo transversal após o tratamento manipulativo não foram significantes estatisticamente. No estudo prospectivo, as gestantes foram divididas em dois grupos ≤ 3 e ≥ 4. Observou-se uma melhora significante estatisticamente na intensidade das dores lombar e pélvica em ambos os grupos. Houve melhora nos dois grupos nos índices de qualidade de vida, sendo que no grupo≥ 4 atendimentos todos os resultados foram estatisticamente significativos. Conclusão: a análise dos dados do estudo considerou que o tratamento manipulativo osteopático é seguro para o feto e para gestantes portadoras de comorbidades, não afetando os sinais vitais maternos e nem a circulação uteroplacentária e feto-placentária. Os dados também apontaram que o tratamento osteopático foi eficaz na redução da intensidade da dor lombar e pélvica e efetivo na melhora da qualidade de vida das gestantes.

During pregnancy, several changes women undergo can affect their health status. Studies related to the inability of the body of some pregnant women to accommodate uterine growth would be at the root of problems in maternal-fetal hemodynamics. The search for non-drug treatments has grown in the health area recently. Manipulative osteopathic treatment is a complementary, integrative health therapy recognized by the world health organization and accepted by the Brazilian single health system. Method: This prospective cohort study was carried out with 80 patients from the prenatal clinic and the pregnant women's ward of Instituto Fernandes Figueira/Fiocruz between July 2021 and September 2022. Two studies were carried out, a cross-sectional study with 51 pregnant women to evaluate the maternal-fetal hemodynamic effects after osteopathic manipulative treatment through Doppler velocimetry in pregnant women and a prospective study with 64 pregnant women to evaluate the influence of osteopathic manipulative treatment on the intensity of lumbar and pelvic pain, as well as changes in their quality of life. Population: pregnant women in the third trimester of pregnancy, over 18 years old, were investigated, and pregnant women with premature membrane rupture, fetal malformations, multiple fetuses, and active labor were excluded. Results: The results of the cross-sectional study after manipulative treatment were not statistically significant. Pregnant women were divided into two groups ≤ 3 and ≥ 4 in the prospective study. There was a statistically significant improvement in lumbar and pelvic pain intensity in both groups. There was an improvement in both groups in the quality-of-life indices, and in the group≥ four consultations, all results were statistically achieved. Conclusion: an analysis of the study data found that osteopathic manipulative treatment is safe for the fetus and pregnant women with comorbidities, not affecting maternal signs or uteroplacental and fetal-placental circulation. The data also showed that osteopathic treatment effectively reduced the intensity of lumbar and pelvic pain and improved the quality of life of pregnant women.

Urgent liver retransplantation due to transmission of intrahepatic cholangiocarcinoma by donor: the first report in the literature / Retransplante de fígado urgente devido à transmissão de colangiocarcinoma intra-hepático pelo doador: o primeiro relato da literatura

ABSTRACT BACKGROUND: Liver transplantation represents the best therapeutic modality in end-stage chronic liver disease, severe acute hepatitis, and selected cases of liver tumors. AIMS: To describe a double retransplant in a male patient diagnosed with Crohn's disease and complicated with primary sclerosing cholangitis, severe portal hypertension, and cholangiocarcinoma diagnosed in the transplanted liver. METHODS: A 48-year-old male patient diagnosed with Crohn's disease 25 years ago, complicated with primary sclerosing cholangitis and severe portal hypertension. He underwent a liver transplantation in 2018 due to secondary biliary cirrhosis. In 2021, a primary sclerosing cholangitis recurrence was diagnosed and a liver retransplantation was indicated. Recipient's hepatectomy was very difficult by reason of complex portal vein thrombosis requiring extensive thromboendovenectomy. Intraoperative ultrasound with liver doppler evaluation was performed. Two suspicious nodules were incidentally diagnosed in the donor's liver and immediately removed for anatomopathological evaluation. RESULTS: After pathological confirmation of carcinoma, probable cholangiocarcinoma, at frozen section, the patient was re-listed as national priority and a new liver transplantation was performed within 24 hours. The patient was discharged after 2 weeks. CONCLUSIONS: The screening for neoplasms in donated organs should be part of our strict daily diagnostic arsenal. Moreover, we argue that, for the benefit of an adequate diagnosis and the feasibility of a safer procedure, the adoption of imaging tests routine for the liver donor is essential, allowing a reduction of the costs and some potential risks of liver transplant procedure.

RESUMO RACIONAL: O transplante de fígado representa a melhor modalidade terapêutica na doença hepática crônica terminal, hepatite aguda grave e casos selecionados de tumores hepáticos. OBJETIVOS: Descrever um retransplante duplo em paciente do sexo masculino, diagnosticado com doença de Crohn e complicado com colangite esclerosante primária, hipertensão portal grave e colangiocarcinoma diagnosticado no fígado transplantado. MÉTODOS: Paciente do sexo masculino, 48 anos, diagnosticado com doença de Crohn há 25 anos e complicado com colangite esclerosante primária e hipertensão portal grave. Foi submetido a um transplante de fígado em 2018 devido a cirrose biliar secundária. Em 2021, foi diagnosticada recidiva de colangite esclerosante primária e indicado retransplante hepático. A hepatectomia do receptor foi de alta complexidade devido à trombose complexa da veia porta, exigindo extensa tromboendovenectomia. Foi realizada ultrassonografia intraoperatória com doppler hepático. Dois nódulos suspeitos foram diagnosticados incidentalmente no fígado do doador e imediatamente removidos para avaliação anatomopatológica. RESULTADOS: Após confirmação patológica de carcinoma, provável colangiocarcinoma, pela congelação, o paciente foi relistado como prioridade nacional, e novo transplante hepático foi realizado em 24 horas. O paciente teve alta após 2 semanas. CONCLUSÕES: O rastreamento de neoplasias em órgãos doados deve fazer parte de nosso estrito arsenal diagnóstico diário. Além disso, defendemos que, em benefício de um diagnóstico correto e da viabilidade de um procedimento mais seguro, a adoção de uma rotina de exames de imagem é essencial em doadores hepáticos, permitindo a redução dos custos e alguns riscos potenciais do procedimento de transplante hepático.

Pelvic arteriovenous malformation involving the uterine and internal iliac vessels with concomitant true aneurysm of uterine artery diagnosed through color Doppler ultrasound / Philippine Journal of Obstetrics and Gynecology

Background@#Pelvic arteriovenous malformations (AVMs) are rare but carries life-threatening consequences.@*Case Report@#A 47-year-old multipara who had previously undergone four cesarean sections came for re-evaluation of a malignant ovarian new growth. She was asymptomatic. Repeat ultrasound revealed normal ovaries, and a cystic structure at the left adnexa with abundant mixing of colors, turbulent flow and pulsative waveforms on spectral Doppler. It arises from serpentine tubular structures from the uterine isthmus. Uterine artery aneurysm was considered. Magnetic resonance angiography confirmed the findings of aneurysm and pelvic arteriovenous malformation. The patient underwent a hysterectomy with ligation and excision of aneurysm. Histopathologic findings showed pelvic AVM and a true aneurysm of the uterine artery.@*Conclusion@#Ultrasound with color Doppler is a low-cost and readily available tool for gynecologists for the diagnosis and management of pelvic AVM.

Revisión bibliográfica: ecografía intraparto / Review: intrapartum ultrasound

The evaluation of labor is the clinical process by which variables are analyzed in order to determine whether the patient is in labor, which by definition includes regular uterine contractions that increase in frequency and intensity, associated with dilation cervical. This is done through the anamnesis and physical examination, specifically through the evaluation of contractions and vaginal examination, the latter is intended to specify the degree of dilation, cervical effacement that the patient presents and also allows to a certain degree, establish the presentation, attitude and variety of position in which the fetus is located. From this premise, it is proposed that vaginal examination, since it is operator dependent, is not an objective evaluation, therefore, there is a need to reach consensus on the evaluation, and in order to carry it out, evaluation with ultrasound is proposed, which has as a purpose to objectify the variety of position and presentation of the fetus. Due to the above, this article aims to capture the knowledge that is currently possessed about the uses and methodology that intrapartum ultrasound presents.

Hallazgos de retinopatía diabética por ecografía Doppler arterial oftálmico en pacientes con diabetes mellitus tipo 2 / Findings of Diabetic Retinopathy by Ophthalmic Arterial Doppler Ultrasound in Patients with Type 2 Diabetes Mellitus

Objetivo: Determinar los hallazgos de retinopatía diabética por ecografía doppler arterial oftálmico en pacientes con diabetes mellitus tipo 2. Métodos: Se efectuó un estudio observacional descriptivo y transversal en 200 órbitas de 100 pacientes diabéticos, a los que se les realizó fondo de ojo para diagnóstico y gradación de la retinopatía diabética. Por interrogatorio y examen físico se determinó el tiempo de diagnóstico de la diabetes y la presencia o ausencia de obesidad. Además, se les hizo ultrasonido orbitario y Doppler carotídeo, y solo en caso de resultar normales, se procedió a evaluar mediante ecografía doppler a las arterias oftálmicas. Resultados: Predominaron los diabéticos entre 40 y 60 años, el sexo masculino, los casos sin retinopatía diabética, y el grupo de más de 10 años de diagnóstico de la diabetes. Se demostró una disminución de la velocidad del flujo y un incremento de la resistencia vascular a nivel de las arterias oftálmicas, en tanto se evidenció asociación significativa de estos parámetros hemodinámicos con el envejecimiento, la presencia o ausencia de obesidad, el tiempo de diagnóstico de la diabetes y la severidad de la retinopatía diabética. Sin embargo, no se encontró asociación significativa con el sexo. Conclusiones: La valoración mediante ecografía doppler de las arterias oftálmicas, haría más completo el estudio y seguimiento de los pacientes con diabetes mellitus tipo 2(AU)

Purpose: To determine the findings of diabetic retinopathy by ophthalmic arterial Doppler ultrasound in patients with type 2 diabetes mellitus. Methods: A descriptive and cross-sectional observational study was carried out in 200 orbits of 100 diabetic patients, who underwent fundus examination for diagnosis and grading of diabetic retinopathy. The time of diagnosis of diabetes and the presence or absence of obesity were determined by interrogation and physical examination. In addition, orbital ultrasound and carotid Doppler were performed, and only if they were normal, the ophthalmic arteries were evaluated by Doppler ultrasound. Results: Diabetic patients between 40 and 60 years of age, from the male gender, cases without diabetic retinopathy, and the group with more than 10 years of diagnosed diabetes predominated. A decrease in flow velocity and an increase in vascular resistance at the level of the ophthalmic arteries were demonstrated, while a significant association of these hemodynamic parameters with aging, presence or absence of obesity, time of diagnosis of diabetes and severity of diabetic retinopathy was evidenced. However, no significant association was found as to gender. Conclusions: Doppler ultrasound assessment of the ophthalmic arteries would make the study and follow-up of patients with type 2 diabetes mellitus more complete(AU)

Caracterización clínica, hemodinámica y ecográfica de pacientes diabéticos con enfermedad arterial crónica en miembros inferiores / Clinical, hemodynamic and echographic characterization of diabetic patients with arterial chronic disease in lower limbs

Introducción: La diabetes mellitus es la enfermedad crónica considerada como una de las mayores emergencias sanitarias del siglo XXI en el mundo, que puede desencadenar algunas complicaciones y problemas graves para la salud. Objetivo: Caracterizar a pacientes diabéticos con enfermedad arterial crónica en miembros inferiores según variables clínicas, hemodinámicas y ecográficas. Métodos: Se realizó un estudio observacional, descriptivo y transversal de los 178 pacientes diabéticos con diagnóstico clínico de enfermedad arterial crónica en miembros inferiores, quienes fueron atendidos en el Servicio de Imagenología del Hospital General Docente Dr. Juan Bruno Zayas Alfonso de Santiago de Cuba desde enero de 2017 hasta diciembre de 2019, a los cuales se les realizó examen hemodinámico mediante el índice tobillo-brazo y ecografía Doppler arterial. Resultados: En la investigación primaron los adultos mayores (41,6 %) del sexo femenino (54,0 %), la claudicación intermitente como principal síntoma (57,3 %), el sector femoropoplíteo (34,8 %) según la topografía exacta de las lesiones, así como la estenosis significativa (53,9 %) y la enfermedad arterial periférica moderada (58,3 %). Conclusiones: La mayoría de los pacientes presentó una estenosis significativa detectada por ecografía Doppler, en correspondencia con el diagnóstico de enfermedad arterial periférica moderada por el índice tobillo-brazo. La ecografía Doppler también aportó la topografía exacta de las lesiones.

Introduction: The diabetes mellitus is the chronic disease considered as one of the highest sanitary emergencies in the XXI century in the world that can trigger some complications and serious health problems. Objective: To characterize diabetic patients with arterial chronic disease in lower limbs according to clinical, hemodynamic and ultrasound variables. Methods: An observational, descriptive and cross-sectional study of the 178 diabetic patients with clinical diagnosis of arterial chronic disease in lower limbs was carried out, who were assisted in the Imaging Service of Dr. Juan Bruno Zayas Alfonso General Hospital in Santiago de Cuba from January, 2017 to December, 2019, to whom hemodynamic exam by means of the ankle-brachial index and arterial Doppler ultrasound was carried out. Results: In the investigation there was a prevalence of the elderly (41.6 %) from the female sex (54.0 %), the intermittent abandonment as main symptom (57.3 %), the femoropopliteal sector (34.8 %) according to the exact topography of the lesions, as well as the significant stenosis (53.9 %) and the moderate peripheral arterial disease (58.3 %). Conclusions: Most of the patients presented a significant stenosis according to Doppler ultrasound, in correspondence with the diagnosis of moderated peripheral arterial disease by the ankle-brachial index. The Doppler ultrasound also contributed the exact topography of the lesions.

Hallazgos de la ecografía Doppler arterial oftálmica en pacientes con hipertensión arterial primaria / Ophthalmic Arterial Doppler Ultrasound Findings in Patients with Primary Arterial Hypertension

Objetivo: Determinar los hallazgos por ecografía Doppler arterial oftálmica en pacientes con hipertensión arterial primaria. Métodos: Se efectuó un estudio observacional descriptivo y transversal con 202 órbitas de 101 pacientes hipertensos, a los que se les realizó fondo de ojo para diagnóstico y gradación de la retinopatía hipertensiva. Por interrogatorio y examen físico se identificaron como factores de riesgo aterosclerótico el consumo excesivo de alcohol y la obesidad. Además, se les hizo ultrasonido orbitario y Doppler carotídeo, y solo en caso de resultar normales, se procedió a evaluar mediante ecografía Doppler las arterias oftálmicas. Resultados: Predominaron los hipertensos entre 40 y 60 años de edad, el sexo masculino, el color mestizo de piel, los casos sin retinopatía hipertensiva, y el grupo entre 10 y 20 años de diagnosticada la hipertensión. Se demostró un incremento de la velocidad del flujo y de la resistencia vascular a nivel de las arterias oftálmicas. En tanto, se evidenció asociación significativa de estos parámetros hemodinámicos con el envejecimiento y el tiempo de diagnóstico de la hipertensión. Sin embargo, no se comprobó asociación significativa con el sexo, el color de la piel, y la presencia o ausencia de obesidad, consumo excesivo de alcohol, y retinopatía hipertensiva independientemente de su gravedad. Conclusiones: La evaluación de las arterias oftálmicas mediante ecografía Doppler permite hacer un estudio y seguimiento más integral de los pacientes con hipertensión arterial primaria(AU)

Objective: To determine ophthalmic arterial Doppler ultrasound findings in patients with primary arterial hypertension. Methods: A descriptive and cross-sectional observational study was carried out with 202 orbits of 101 hypertensive patients, who underwent fundus examination for diagnosis and grading of hypertensive retinopathy. By interrogation and physical examination, excessive alcohol consumption and obesity were identified as atherosclerotic risk factors. In addition, orbital ultrasound and carotid Doppler were performed, and only if they were normal, the ophthalmic arteries were evaluated using Doppler ultrasound. Results: Hypertensive patients between 40 and 60 years of age, male, mixed skin color, cases without hypertensive retinopathy, and the group between 10 and 20 years after hypertension diagnosis predominated. An increase in flow velocity and vascular resistance at the level of the ophthalmic arteries was demonstrated. Meanwhile, a significant association of these hemodynamic parameters with aging and time of diagnosis of hypertension was evidenced. However, no significant association was found with gender, skin color, and the presence or absence of obesity, excessive alcohol consumption, and hypertensive retinopathy regardless of its severity. Conclusions: Evaluation of the ophthalmic arteries using Doppler ultrasound allows a more comprehensive study and follow-up of patients with primary arterial hypertension(AU)

Una mirada a la seguridad del ultrasonido en ecotomografía obstétrica / A look at the safety of ultrasound in obstetric echotomography

Resumen Los índices térmico y mecánico son estimadores de riesgo fetal en una ecografía y se deben controlar sus valores minimizando la exposición. Comparamos los valores de los índices térmico y mecánico obtenidos en exámenes ecográficos obstétricos de pacientes gestantes, con el valor recomendado por la comunidad internacional. Se realizó la estimación de estos índices en 421 ecografías obstétricas en 2019. Los valores fueron comparados entre ellos y con el valor recomendado para cada índice y según el modo de visualización (B, Doppler color y Doppler espectral). Del total de la muestra, para el índice térmico en modo Doppler color un 0,24% superó el valor estándar recomendado y en modo Doppler espectral un 2,85%. Para el índice mecánico se sobrepasó el valor recomendado en modo B en un 11,16%, en un 8,08% en modo Doppler color y, por último, en un 0,48% para el modo Doppler espectral. Los índices mecánico y térmico en esta muestra de exámenes ecográficos obstétricos se encuentran en promedio bajo el valor de referencia. Sin embargo, existe un número importante de casos en que se superan las normas, lo que debe ser una voz de alerta para la comunidad médica.

Abstract The thermal and mechanical indices are the best estimators of fetal risk in an ultrasound and their values should be controlled in order to minimize exposure as much as possible. We compared the values of the thermal and mechanical indices obtained in obstetric ultrasound examinations of pregnant patients, with the value recommended by the international community. These indices were estimated in 421 obstetric ultrasounds during 2019. The estimated values were compared with each other and with the recommended value for each index and according to the display mode (B, color Doppler and spectral Doppler). Of the total sample, for the thermal index in color Doppler mode, 0.24% exceeded the recommended standard value and 2.85%. in spectral Doppler mode. For the mechanical index, the recommended value was exceeded in B mode by 11.16%, in 8.08% in color Doppler mode and, finally, by 0.48% for spectral Doppler mode. The mechanical and thermal indices in this sample of obstetric ultrasound examinations are on average below the reference value. However, there is a significant number of cases in which the standards are exceeded, which should be a warning to the medical community.

Doppler ultrasound testing suggests hemorrhoids in females may be a consequence of impaired blood flow Associated with pelvic organ prolapse

Abstract Background It has been observed that there is a high incidence of hemorrhoids in female patients with pelvic organ prolapse. Also, in these patients, hemorrhoidal disease improves after the surgical correction of the pelvic organ prolapse. Objective Our hypothesis was that a cause-effect relationship between pelvic organ prolapse, and hemorrhoids might be the key. The objective of this study was to find an element which connects these two conditions. Study Design We conducted a pilot study which consisted of two parts. An initial part, in which we asked several patients with grades III and IV pelvic organ prolapse and hemorrhoids, who have undergone surgery for prolapse, to determine the impact of the surgical restoration of the prolapsed organs on their hemorrhoidal disease. For the second part, on several patients with uncorrected uterine prolapse grades III and IV, we determined the resistive index of the hemorrhoidal branches within the rectal wall before and after manual reduction of the prolapse. Results First, more than 50% of patients who underwent uterine prolapse correction described an improvement of their hemorrhoidal disease of over 50%. Second, the resistive index of the hemorrhoidal branches was significantly lower after manual reduction of the prolapse. We consider that obstructed veins due to pelvic organ prolapse might induce the dilation of the hemorrhoids. The direct measurement of the resistive index of the hemorrhoidal branches allows us to directly assess the increased resistance in the rectal vascular system. Conclusion Venous stasis and impaired vascular flow might be the pathophysiological explanation for the association between pelvic organ prolapse and hemorrhoids. In these patients, the pathogenic treatment should aim at the restoration of a normal blood flow (prolapse surgical cure) instead of focusing on hemorrhoids only.(AU)

Evaluations of Repaired Artery Patency in Forearm Wounds Using the Allen Test, Handheld Doppler and Doppler Ultrasonography / Avaliações do lúmen da artéria reparada em lesões do antebraço usando o teste de Allen, Doppler portátil e ultrassonografia com Doppler

Abstract Objective The purpose of the present study was to evaluate the rate of patency in the postoperative period of arterial injuries of the forearm secondary to penetrating trauma. The injuries were subjected to primary repair and examined with the Allen test and a handheld Doppler device, and the results were later confirmed with Doppler ultrasonography. Methods Eighteen patients were included, with a total of 19 arterial lesions, 14 ulnar lesions, and 5 radial lesions; one patient had lesions on both forearms. All patients underwent surgery and three clinical evaluations: the Allen test and assessment of arterial blood flow by a handheld Doppler device at 4 and 16 weeks after surgery and Doppler ultrasonography performed at 12 weeks after surgery. Results At the first clinical evaluation, 77% of the patients had patency based on the Allen test, and 72% had a pulsatile sound identified by the handheld Doppler device. In the second evaluation, 61% of the patients had patency based on the Allen test, and the rate of pulsatile sound by the handheld Doppler device was 72%, similar to that observed 2 months earlier. Based on the Doppler ultrasonography evaluation (~12 weeks after surgery), the success rate for arteriorrhaphy was 88%. Regarding the final patency (Doppler ultrasonography evaluation) and trauma mechanism, all patients with penetrating trauma had patent arteries. Conclusion We cde that clinical evaluation using a handheld Doppler device and the Allen test is reliable when a patent artery can be palpated. However, if a patent artery cannot be located during a clinical examination, ultrasonography may be required.

Resumo Objetivo O objetivo deste estudo foi avaliar a taxa de perviedade pós-operatória de lesões arteriais do antebraço secundárias a traumatismo penetrante. As lesões foram submetidas a reparo primário e examinadas com o teste de Allen e um dispositivo Doppler portátil; posteriormente, os resultados foram confirmados à ultrassonografia com Doppler. Métodos Dezoito pacientes foram incluídos, com um total de 19 lesões arteriais, 14 lesões ulnares e 5 lesões radiais; um paciente tinha lesões em ambos os antebraços. Todos os pacientes foram submetidos à cirurgia e três avaliações clínicas: o teste de Allen e a avaliação do fluxo sanguíneo arterial com um dispositivo portátil de Doppler na 4ª e 16ª semanas após a cirurgia e ultrassonografia com Doppler 12 semanas após o procedimento. Resultados Na primeira avaliação clínica, 77% dos pacientes apresentavam perviedade segundo o teste de Allen e 72% apresentavam som pulsátil identificado pelo Doppler portátil. Na segunda avaliação, 61% dos pacientes apresentaram perviedade com base no teste de Allen e a taxa de som pulsátil ao Doppler portátil foi de 72%, semelhante à observada 2 meses antes. À ultrassonografia com Doppler (cerca de 12 semanas após a cirurgia), a taxa de sucesso da arteriorrafia foi de 88%. Em relação à perviedade final (avaliação por ultrassonografia com Doppler) e mecanismo de trauma, todos os pacientes com traumatismo penetrante apresentavam artérias pérvias. Conclusão Concluímos que a avaliação clínica com um dispositivo Doppler portátil e o teste de Allen é confiável caso a artéria pérvia possa ser palpada. No entanto, a ultrassonografia pode ser necessária em caso de impossibilidade de localização de uma artéria pérvia durante o exame clínico.

Pileflebitis como complicación de apendicitis aguda en paciente gestante / Pylephlebitis as a Complication of Acute Appendicitis in a Pregnant Patient

Introducción: La pileflebitis, trombosis séptica del sistema portal por cuadros inflamatorios agudos abdominales, se presenta con manifestaciones clínicas variables en dependencia de la causa de origen y por rama portal afectado. El diagnóstico incluye función hepática normal o ligeramente alterada con leucocitosis, hemocultivos positivos, eco doppler o tomografía computarizada que corrobore la enfermedad. Objetivo: Describir la pileflebitis como una complicación inusual en una paciente embarazada con apendicitis aguda, desde su concepto, fisiopatología, presentación clínica, diagnóstico y medidas terapéuticas. Caso clínico: Paciente femenina de 18 años, gestante, que refirió dolor abdominal de gran intensidad, acompañado de vómito y deposiciones diarreicas y tinte ictérico. Por tales motivos fue trasladada al Hospital General Docente Ambato. Se diagnosticó sepsis de origen abdominal por apendicitis aguda perforada, peritonitis generalizada complicada con pileflebitis. Se realizó intervención quirúrgica y resolución del cuadro clínico. Conclusiones: La pileflebitis presenta una gran dificultad diagnóstica, por lo que herramientas como la ecografía doppler y la tomografía computarizada son de ayuda en estos casos. Los pilares del tratamiento incluyen control del foco séptico abdominal y tratar la pileflebitis(AU)

Introduction: Pylephlebitis, septic thrombosis of the portal system due to acute abdominal inflammatory conditions, it presents with variable clinical signs depending on the cause of origin and the affected portal branch. Diagnosis includes normal or mildly impaired liver function with leukocytosis, positive blood cultures, Doppler echocardiography, or computed tomography confirming the disease. Objective: To describe pylephlebitis as an unusual complication in a pregnant patient with acute appendicitis, referring to its concept, pathophysiology, clinical presentation, diagnosis and therapeutic measures. Clinical case report: This is the case of an 18-year-old female pregnant patient, who had severe abdominal pain, accompanied by vomiting, diarrhea and jaundiced stools. For such reasons, she was transferred to the Ambato General Teaching Hospital. Sepsis of abdominal origin was diagnosed due to acute perforated appendicitis, generalized peritonitis complicated with pylephlebitis. Surgical intervention was performed and the clinical condition was solved. Conclusions: Pylephlebitis represents a great diagnostic difficulty, hence tools such as Doppler ultrasound and computed tomography are helpful in these cases. The mainstays of treatment include control of the abdominal septic focus and treating pylephlebitis(AU)

Tumores de parótida en población pediátrica: 10 años de experiencia / PAROTID TUMORS IN PEDIATRIC POPULATION: 10 YEARS OF EXPERIENCE

Introducción: Los tumores de las glándulas salivales son infrecuentes en la población en general y comprenden menos del 3% de los tumores de cabeza y cuello1 . En pediatría el 90% corresponden a tumores de la glándula parótida,2 siendo en su mayoría tumores benignos. Objetivo: Describir la incidencia de tumores parotídeos en un centro de referencia, haciendo hincapié en la variabilidad etiológica y la presentación por grupos etarios. Materiales y métodos: Se trata de un estudio de cohorte retrospectivo de pacientes menores de 18 años con tumores de parótida en un periodo de 10 años: de 2011 a 2021, seguidos en el Servicio de Cirugía General Pediátrica del Hospital Italiano de Buenos Aires. Se incluyeron todos los pacientes pediátricos que presentaron tumor en la región parotídea seguidos o tratados en este centro, se excluyeron aquellos que no se pudieron recabar los datos de forma completa. Las variables analizadas fueron edad, sexo, forma de presentación, estudios complementarios, tipo de tratamiento, histología, complicaciones. Resultados: Se analizaron un total de 33 pacientes, de estos un 64% (N = 21) fueron mujeres, con una relación mujer/hombre de 1,7. La media de edad al diagnóstico fue de 8.5 años, siendo 2 de diagnóstico prenatal y hasta los 18 años. La localización fue en un 57% (N = 19) izquierda, el 43% restante derecha. La forma de presentación más frecuente fue la masa palpable en región parotídea 75% (N=25), en dos pacientes fue un hallazgo en estudios por imágenes: resonancia prenatal y otro por resonancia de cerebro. Conclusiones: en pediatría, a diferencia de la población adulta, se presentan una gran variedad de diagnósticos, que incluye desde lesiones vasculares hasta tumores malignos. Debido a que las lesiones parotídeas malignas son clínicamente indistinguibles de las benignas, es importante establecer un diagnóstico preciso. Esta serie representa esta diversidad etiológica en pediatría, así como la distribución etaria comparada con la descrita por la literatura

Introduction: Salivary gland tumors are rare in the general population and comprise less than 3% of head and neck tumors1. In pediatrics, 90% correspond to tumors of the parotid gland,2 being mostly benign tumors. Objective: To describe the incidence of parotid tumors in a reference center, emphasizing the etiological variability and the presentation by age groups. Materials and methods: Tis is a retrospective cohort study of patients under 18 years of age with parotid tumors over a period of 10 years: from 2011 to 2021, followed up at the Pediatric General Surgery Service of the Italian Hospital of Buenos Aires. All pediatric patients who presented tumor in the parotid region followed up or treated in this center were included, those who could not collect the data completely were excluded. Te variables analyzed were age, sex, form of presentation, complementary studies, type of treatment, histology, and complications. Results: A total of 33 patients were analyzed, of which 64% (N = 21) were women, with a female/male ratio of 1.7. Te mean age at diagnosis was 8.5 years, with 2 prenatal diagnoses and up to 18 years. Te location was 57% (N = 19) left, the remaining 43% right. Te most frequent form of presentation was a palpable mass in the parotid region 75% (N=25), in two patients it was a finding in imaging studies: prenatal MRI and another by brain MRI. Conclusions: in pediatrics, unlike the adult population, a wide variety of diagnoses are presented, ranging from vascular lesions to malignant tumors. Because malignant parotid lesions are clinically indistinguishable from benign ones, it is important to establish an accurate diagnosis. Tis series represents this etiological diversity in pediatrics, as well as the age distribution compared to that described in the literature

Correlación clínico ecográfica de la enfermedad arterial periférica de miembros inferiores en diabéticos tipo 2 / Clinical ultrasound correlation of peripheral arterial disease of the lower limbs in type 2 diabetics

Introducción: La enfermedad arterial periférica en pacientes ateroscleróticos diabéticos suele subdiagnosticarse, ya que la mayoría de la población afectada está asintomática. Objetivo: Correlacionar los signos clínicos y ultrasonográficos de la enfermedad arterial periférica de los miembros inferiores en los pacientes ateroscleróticos diabéticos. Métodos: Se hizo un estudio descriptivo y prospectivo en una muestra aleatoria de 209 pacientes diabéticos con enfermedad arterial periférica, según clasificación de Leriche-Fontaine. A estos se les realizó ecografía Doppler. El estudio estadístico se practicó mediante la aplicación del coeficiente de Kappa. Resultados: La enfermedad arterial periférica predominó en el sexo masculino con 60 años y más. En el 26,32 por ciento del miembro inferior izquierdo en tibial posterior se corroboró ausencia de pulso. Según cuadro clínico, por clasificación de Leriche-Fontaine, la más alta incidencia se encontró en el estadio IIb con 33,97 por ciento, seguido por el estadio II con 20,54 por ciento; y por clasificación ecográfica hubo una reducción del diámetro significativo en la pierna izquierda en arterias distales, con un coeficiente de Kappa de 0,927. Conclusiones: Existió una fuerte correlación clínico ecográfica en cuanto al grado de estenosis en la enfermedad arterial periférica de los pacientes diabéticos estudiados(AU)

Introduction: Peripheral arterial disease in diabetic atherosclerotic patients is usually underdiagnosed, since the majority of the affected population is asymptomatic. Objective: Correlate the clinical and ultrasonographic signs of peripheral arterial disease of the lower limbs in diabetic atherosclerotic patients. Methods: A descriptive and prospective study was conducted in a random sample of 209 diabetic patients with peripheral arterial disease, according to the Leriche-Fontaine classification. These underwent Doppler ultrasound. The statistical study was performed by applying the Kappa coefficient. Results: Peripheral arterial disease predominated in males aged 60 years and over. In 26.32 percent of the left lower limb in the posterior tibial, the absence of pulse was confirmed. According to the clinical picture, by Leriche-Fontaine classification, the highest incidence was found in stage IIb with 33.97 percent, followed by stage II with 20.54 percent; and by ultrasound classification there was a significant reduction in diameter in the left leg in distal arteries, with a Kappa coefficient of 0.927. Conclusions: There was a strong clinical ultrasound correlation regarding the degree of stenosis in peripheral arterial disease of the diabetic patients studied(AU)

Carotid doppler ultrasonography in patients with co-existing type 2 diabetes mellitus and hypertension in Nigeria

Background:The co-existence of diabetes mellitus (DM) and hypertension (HTN) has been rising globally with subclinical atherosclerotic complications. These vascular changes can be detected using carotid ultrasonography. Objectives: To determine and compare the carotid arterial structural wall changes and blood flow velocities of adults with co-existing DM and HTN with age-and sex-matched non-diabetic, non-hypertensive controls. Methods: A cross-sectional comparative study of 300 participants comprising 200 adults with co-existing DM and HTN and 100 age-and sex-matched controls was done. Their carotid arteries were examined bilaterally for plaques, carotid intima media thickness (CIMT) and flow velocities ­peak systolic velocity (PSV), end diastolic velocity (EDV), pulsatility index (PI) and resistive index (RI) using 4­12MHz linear array transducer. Visceral obesity and serum lipids were also assessed. Results: The mean age of the subjects was 56.13 ± 6.93 years; they comprised 38% males and 62% females. The subjects' CIMT was statistically significantly higher (p = 0.001) with a three-fold mean increase (45.5%) compared to the controls (13.7%). Lower flow velocities but higher indices were also observed in the subjects. Strong and significant correlations were observed between EDV and PI r =-0.663, p=>0.001), EDV and RI (r = -0.661, p=>0.001) and PI and RI (r =0.988, p= >0.001)among the subjects. Conclusion: Significant reduction in flow velocities with increased CIMT may be an early indication of subclinical atherosclerosis. Therefore, carotid ultrasonography should be mandatory in individuals at risk for early detection and possible prevention of atherosclerotic complications.

Pseudoaneurisma e fístula arteriovenosa da artéria femoral profunda após rotura completa do músculo vasto medial: tratamento endovascular / Pseudoaneurysm and arteriovenous fistula of the deep femoral artery after complete rupture of the vastus medialis muscle: endovascular treatment

Resumo A artéria femoral profunda, devido às suas características anatômicas, se encontra protegida da maioria dos traumatismos vasculares. Relatamos um caso de pseudoaneurisma de ramo perfurante da artéria femoral profunda, associado à fístula arteriovenosa, secundário a rotura completa do músculo vasto medial em paciente jogador de futebol. A ressonância magnética demonstrou lesão muscular associada a pseudoaneurisma, e a angiotomografia confirmou a presença de pseudoaneurisma associado a fístula arteriovenosa de ramo da artéria femoral profunda. Foi realizado tratamento endovascular da fístula através da embolização com micromolas fibradas e drenagem cirúrgica do hematoma muscular. O paciente evoluiu bem, sem queixas clínicas no 30º dia de pós-operatório e também após 1 ano.

Abstract Due to its anatomical characteristics, the deep femoral artery is protected from most vascular injuries. We report a case of a soccer player with pseudoaneurysm of a perforating branch of the deep femoral artery, associated with an arteriovenous fistula and secondary to complete rupture of the vastus medialis muscle. Magnetic resonance imaging showed muscle damage associated with a pseudoaneurysm and angiotomography confirmed the presence of a pseudoaneurysm associated with a deep arteriovenous fistula of a branch of the deep femoral artery. Endovascular treatment of the fistula was performed by embolization with fibrous microcoils and surgical drainage of the muscle hematoma. The patient recovered well, was free from clinical complaints on the 30th postoperative day and also after 1 year.