Randomised controlled study to compare radiofrequency ablation with minimally invasive ultrasound-guided non-flush ligation and stripping of great saphenous vein in the treatment of varicose veins.

INTRODUCTION: Flush ligation at the saphenofemoral junction and stripping of the great saphenous vein is being increasingly replaced by endovenous methods such as radiofrequency or endovenous laser ablation for the treatment of varicose veins. These modalities are expensive and not widely available. A minimally invasive ultrasound-guided surgery with non-flush ligation and stripping under local anaesthesia is a cost-effective alternative with similar postoperative outcomes. MATERIALS AND METHODS: A total of 62 limbs (58 patients) with saphenofemoral junction incompetence underwent clinical evaluation including the CEAP clinical score, the venous clinical severity score, the venous disability score and venous doppler. Patients were randomly assigned to either group A (radiofrequency ablation) or group B (ultrasound-guided non-flush ligation and stripping of the great saphenous vein) for procedures under tumescent anaesthesia and ultrasound guidance. Patients were followed-up on days 7, 30 and 90 to assess primary (obliteration rates) and secondary (venous clinical severity score and venous disability score) outcomes. RESULTS: Both the groups showed 100% obliteration of the great saphenous vein at day 90. The venous clinical severity and venous disability scores significantly improved from day 0 to day 90 in both groups (p = 0.0001). There were no major complications. Group A showed significantly lower minor complications (p = 0.001). None required conversation to general anaesthesia. CONCLUSIONS: The ultrasound-guided non-flush ligation and stripping of the great saphenous vein are as efficacious as radio frequency ablation, with similar obliteration rates, improvement in disability scores and complication profile at a lower cost. It has the potential for wider availability in the community as most surgeons are conversant with the surgical procedure.

Comparison of Doppler-Guided Transanal Hemorrhoidal Dearterialization for Grade III and IV Hemorrhoids in Vietnam.

INTRODUCTION: This study aimed to assess the short- and long-term outcomes of Doppler-guided transanal hemorrhoidal dearterialization (THD) for grade III and IV hemorrhoidal disease in Vietnam. METHODS: In a prospective observational design, patients treated for grade III and IV hemorrhoidal disease with the THD method at the National Hospital of Traditional Medicine (Hanoi, Vietnam) were included between June 2012 and December 2013. Patients were evaluated postoperatively at the time they were discharged from the hospital (short-term outcome) and 6 months after surgery (long-term outcome). RESULTS: A total of 128 patients were enrolled in the study, 94 were classified with grade III disease and 34 with grade IV. Grade IV hemorrhoidal patients reported on average 18.2 years of disease symptom duration, while grade III hemorrhoidal patients reported 11.2 years. All patients with grade III and grade IV hemorrhoidal disease had good outcomes at discharge day and reported to return to work in a median of 6 days after THD. At long-term follow-up, the results were good for 80.9% of patients from grade III hemorrhoidal disease and 61.8% of patients from grade IV hemorrhoidal disease. Patient satisfaction with the procedure and outcomes was 93.6% for grade III and 85.3% for grade IV hemorrhoidal patients. CONCLUSIONS: The THD technique was shown to be safe for both grade III and IV hemorrhoidal patients. The THD technique showed better results with grade III hemorrhoidal patients as compared to grade IV hemorrhoidal patients.

[Clinical experience with the use of rivaroxaban in the treatment of cancer patients with venous thrombosis]. / Klinicheskii opyt primeneniia rivaroksabana v lechenii patsientov s ostrymi venoznymi trombozami na fone onkopatologii.

The urgency of the problem. The incidence of various thromboembolic complications in patients with oncopathology reaches 5-12%. When treating VTE in patients with oncology it is necessary to choose between two generally recognized alternatives. The recommended two-component scheme of the initiating phase of anticoagulant therapy with subsequent long-term admission of VKA is fraught with the development of clinically significant bleeding during the initial selection of the dose of warfarin and an increased risk of recurrence of VTE. Long-term parenteral use of LMWH is often negatively treated by patients and adversely affects compliance. For these reasons, enteral administration of new oral anticoagulants is promising for prolonged anticoagulant therapy in this category of patients. The paper cites three clinical cases of treatment of patients with acute venous thrombosis of deep veins against a background of different oncological processes. In the first case - the operated previously for cancer, in the second case - to be treated over oncological process and in the third case - in the primary cancer detection. DISCUSSION: The results of the studies of EINSTEIN-DVT and EINSTEIN-PE allow us to consider the use of rivaroxaban in the treatment of patients with VTE on the background of oncopathology. The possibility of its use from the first day, in our opinion, is a significant advantage, since it allows us to reveal the clinical effectiveness of anticoagulant therapy already during the first stage of treatment, since NOAKs does not imply the possibility of laboratory monitoring.

Thirty-sixth-month follow-up of first-in-human use of cyanoacrylate adhesive for treatment of saphenous vein incompetence.

OBJECTIVE: The objective of this study was to evaluate the long-term safety and effectiveness of endovenous cyanoacrylate (CA)-based closure of incompetent great saphenous veins. METHODS: This was a prospective, single-arm, single-center feasibility study conducted at the Canela Clinic (La Romana, Dominican Republic) to assess the effectiveness and safety of a CA-based adhesive for great saphenous vein closure at 36 months after treatment. Thirty-eight subjects were treated by injection of small boluses of CA under ultrasound guidance and without the use of perivenous tumescent anesthesia or postprocedure graduated compression stockings. Periodic scheduled follow-up was performed during 36 months. RESULTS: At month 36, there were 29 subjects who were available for follow-up. Complete occlusion of the treated veins was confirmed by duplex ultrasound in all subjects with the exception of two subjects showing recanalization at month 1 and month 3. Kaplan-Meier analysis revealed an occlusion rate at month 36 of 94.7% (95% confidence interval, 87.9%-100%). The mean Venous Clinical Severity Score (VCSS) improved from 6.1 ± 2.7 at baseline to 2.2 ± 0.4 at month 36 (P < .0001). Pain, edema, and varicosities (VCSS subdomains) improved in 75.9%, 62.1%, and 41.4% of subjects, respectively, at month 36. Overall adverse events were mild or moderate and self-limited. CONCLUSIONS: CA adhesive appears to be an effective and safe treatment for saphenous vein closure, with long-term occlusion rates comparable to those of other thermal and nonthermal methods and with no reported serious adverse events.

Manual Lymphatic Drainage in Blood Circulation of Upper Limb With Lymphedema After Breast Cancer Surgery.

OBJECTIVE: The purpose of this study was to assess blood flow after manual lymphatic drainage (MLD) in women who had received surgery for breast cancer and had post-axillary lymphadenectomy lymphedema. METHODS: Sixteen volunteers (mean age 64 ± 11.44 years) were divided into 2 groups. Those in group 1 received MLD without upper limb elevation, and those in group 2 received MLD with elevation of 30° of the upper limb. Blood flow velocity of the brachial vein and artery were measured using Doppler ultrasound before, immediately after, and 30 minutes after MLD, with and without 30° of upper limb elevation as defined by a random crossover design and an interval (washout) of 7 days. Comparison of data before and after MLD was evaluated by the Friedman test. RESULTS: There was a significant increase of blood flow velocity in the brachial vein after the therapeutic procedure with upper limb elevation. However, after 30 minutes the data returned to the pretreatment value. CONCLUSION: This preliminary study indicated that MLD promoted increased brachial vein velocity flow in the short term.

Intra- and Inter-rater Reliability of Peripheral Arterial Blood Flow Velocity by Means of Doppler Ultrasound.

OBJECTIVE: Although it is possible to find studies that analyze the velocity of blood flow in different arteries, the reliability of Doppler ultrasound on peripheral arteries has not yet been completely established. Our objective was to evaluate intra- and inter-rater reliability of the measurement of blood flow velocity by Doppler ultrasound of brachial, radial, popliteal, and posterior tibial arteries. METHODS: Fifty healthy individuals of both genders, aged between 18 and 45 years, were included in the study. For the evaluation of arterial blood flow velocity, a portable Doppler ultrasound device was used to measure the mean and maximum blood flow velocity of posterior tibial, popliteal, brachial, and radial arteries. Two examiners performed assessments of the same volunteers independently and twice, with an interval of 1 week between them. RESULTS: We found good to very good reliability for measuring the mean and maximum blood flow velocity of the arteries evaluated. The intraclass correlation coefficients ranged between 0.501 and 0.866, standard error of measurement ranged between 0.81 and 9.45 cm/s, and minimum detectable change ranged between 2.25 and 26.13 cm/s. CONCLUSION: The assessment of mean and maximum blood flow velocity of the brachial, radial, popliteal, and posterior tibial arteries by means of Doppler ultrasound presents acceptable reliability values, which supports the use of this evaluation method in research and clinical practice.

[Recanalization of lower-limb deep veins as an index of efficacy of treatment for acute venous thrombosis]. / Rekanalizatsiia glubokikh ven nizhnikh konechnostei kak pokazatel' éffektivnosti lecheniia ostrogo venoznogo tromboza.

The authors analysed the results of examination and treatment of a total of 102 patients presenting with iliofemoral venous thrombosis. During treatment, ultrasonographic duplex scanning was used to determine the localization of the proximal margin of thrombotic masses, the time of appearing of the first signs of recanalization, its degree at various levels of the deep venous system, as well as alteration in velocity of the venous blood flow in the deep veins of the lower limbs. The dynamics of clinical symptoms was assessed by the visual analogue scale. Clinical and instrumental examination was performed on day 10, and then 1, 3, 6 and 12 months after the beginning of treatment. The patients were subdivided into three groups. Group One comprised 38 patients receiving therapy with low-molecular-weight heparin (enoxaprin) followed by switching to indirect anticoagulants (warfarin) combined with venotonics (original highly-purified diosmin 600 mg once daily). Group Two was composed of 33 patients receiving rivaroxaban at a dose of 15 mg twice daily for 3 weeks, followed by 20 mg once daily. Group Tree patients (n=31) were also given rivaroxaban according to the above-described standard regimen but in combination with venotonics (original highly-purified diosmin 600 mg once daily). The obtained findings showed that prescribing rivaroxaban to patients from the first day of the disease made it possible to considerably improve and accelerate the processes of restoration of patency of deep veins of lower extremities as compared with the patients taking vitamin K antagonists (warfarin). In patients receiving rivaroxaban, there were no cases of residual thrombotic occlusions of the major veins, and recanalization in three fourths of patients was assessed as good and in the remaining third as moderate. In the warfarin group, occlusion in the iliac veins was noted to persist persisted in 13% of patients, with good recanalization observed only in half of the patients. Addition of venotonics (original highly-purified diosmin) to anticoagulants from the first day demonstrated safety of this therapeutic regimen (with no cases of clinically significant haemorrhagic complications revealed) and its high efficacy as compared with monotherapy with rivaroxaban. A combination of diosmin with rivaroxaban turned out more efficient than a combination of diosmin with warfarin.

[Quality of life of patients with venous thromboses in different variants of anticoagulant therapy].

The CIVIQ questionnaire was used to evaluate quality of life of patients presenting with deep vein thrombosis of lower limbs in different variants of anticoagulant therapy. The study included a total of 170 patients who were depending on the variant of anticoagulant therapy subdivided into 3 groups: Group One (comprising 48 patients) taking rivaroxaban as monotherapy; Group Two (consisting of 73 subjects) receiving low molecular weight heparin (enoxaparin sodium) followed by adjusting the warfarin dose, and Group Three (including 49 patients) receiving low molecular weight heparin (enoxaparin sodium) followed by rivaroxaban. The total value of the level of quality of life in all groups showed a tendency towards restoration. However, patients taking warfarin during the follow-up period were found to have negative dynamics by the 6th month of treatment. It was revealed that quality of life on all parameters was higher in patients taking rivaroxaban and lower in those taking warfarin. The parameters of the physical component of health turned out to depend upon the degree of recanalization of the thrombus. After 6 months of anticoagulant therapy patients taking rivaroxaban (Groups One and Three) were found to have good recanalization in 87.5 and 87.7% of cases, respectively, while in Group Two being observed in 54.8% of patients only. Taking an anticoagulant at a fixed dose not requiring laboratory control (rivaroxaban) increases patient compliance, thus leading to improvement of both mental and social wellbeing.

Post Splenectomy Outcome in ß-Thalassemia.

OBJECTIVES: To evaluate changes in annual blood transfusion requirements and complications after splenectomy in patients with ß-thalassemia. METHODS: Forty post-splenectomy ß-thalassemic patients aged 8-33 y, receiving regular blood transfusions and chelation therapy were included and non transfusion dependant patients were excluded from this retrospective cross-sectional study. Details about their surgery, transfusion requirements, and platelet levels were recorded on a standard proforma. All patients underwent a B-mode and color-coded duplex sonography of the hepatoportal system during the study period. RESULTS: The average ferritin level in the year prior to the study was 4432 mcg/L (range 480-12,200 mcg/L). The annual blood transfusion requirement in the first year and 5 y post splenectomy [mean ± SD (138.41 ± 90.38 ml/kg/y); (116 ± 41.44 ml/kg/y)] were significantly different from requirements before splenectomy [(mean ± SD) 294.85 ± 226 ml/kg/y; p value <0.001]. There was a significant rise in platelet counts within 24 h post splenectomy with a mean rise of 4,51,000/mm(3) (p value < 0.001). During the follow up period, infections were noted in 50 % of patients, with malaria (18.75 %) being the most common. Doppler study of the portal system in one case showed portal vein thrombosis. CONCLUSIONS: A significant sustained fall in annual blood transfusion requirement and a rise in platelet counts occurred post-splenectomy. Increase in annual blood transfusion requirement should be investigated to find the cause.

The 1,470-nm bare-fiber diode laser ablation of the great saphenous vein and small saphenous vein at 1-year follow-up using 8-12 W and a mean linear endovenous energy density of 72 J/cm.

PURPOSE: To demonstrate 1-year outcomes after low-energy endovenous laser ablation (EVLA) of incompetent saphenous veins with linear endovenous energy density (LEED) of 80 J/cm or lower with the use of a 1,470-nm diode laser. MATERIALS AND METHODS: Incompetent saphenous veins in 236 patients (355 limbs; Clinical/Etiology/Anatomy/Pathophysiology classifications of C2-C4) were treated by EVLA with a bare-tipped 1,470-nm laser with LEED no greater than 80 J/cm (mean, 72.4 J/cm) and laser power of 8-12 W. Patients were evaluated clinically and with duplex ultrasonography at 1 week and 1, 3, 6, and 12 months after EVLA to assess the technical and clinical success and complication rates. RESULTS: In the 355 limbs, the technical success rate was 100%. The great saphenous vein (GSV) remained occluded in all 229 limbs (100%) after 1 week, 202 of 203 limbs (99.5%) after 1 month, 157 of 158 limbs after 3 months (99.3%), all 99 limbs after 6 months (100%), and all 41 limbs after 1 year (100%). The small saphenous vein (SSV) remained occluded in all 103 limbs (100%) after 1 week, all 94 limbs (100%) after 1 month, 68 of 69 limbs (98.5%) after 3 months, 40 of 41 limbs (97.5%) after 6 months, and all 14 limbs after 1 year (100%). Two GSVs and two SSVs were recanalized and underwent repeated EVLA. No major complications occurred, although bruising (21% of cases), pain (15%), and paresthesia (4%) were observed. CONCLUSIONS: Low-energy EVLA with the use of a 1,470-nm laser with LEED of 80 J/cm or lower is an effective, safe, and technically successful option for the treatment of incompetent saphenous veins.

Massage therapy restores peripheral vascular function after exertion.

OBJECTIVE: To determine if lower extremity exercise-induced muscle injury reduces vascular endothelial function of the upper extremity and if massage therapy (MT) improves peripheral vascular function after exertion-induced muscle injury. DESIGN: Randomized, blinded trial with evaluations at 90 minutes, 24 hours, 48 hours, and 72 hours. SETTING: Clinical research center. PARTICIPANTS: Sedentary young adults (N=36) were randomly assigned to 1 of 3 groups: (1) exertion-induced muscle injury and MT (n=15; mean age ± SE, 26.6 ± 0.3); (2) exertion-induced muscle injury only (n=10; mean age ± SE, 23.6 ± 0.4), and (3) MT only (n=11; mean age ± SE, 25.5 ± 0.4). INTERVENTION: Participants were assigned to exertion-induced muscle injury only (a single bout of bilateral, eccentric leg press exercise), MT only (30-min lower extremity massage using Swedish technique), or exertion-induced muscle injury and MT. MAIN OUTCOME MEASURES: Brachial artery flow-mediated dilation (FMD) was determined by ultrasound at each time point. Nitroglycerin (NTG)-induced dilation was also assessed (0.4 mg). RESULTS: Brachial FMD increased from baseline in the exertion-induced muscle injury and MT group and the MT only group (7.38%±.18% to 9.02%±.28%, P<.05 and 7.77%±.25% to 10.2%±.22%, P<.05, respectively) at 90 minutes and remained elevated until 72 hours. In the exertion-induced muscle injury only group, FMD was reduced from baseline at 24 and 48 hours (7.78%±.14% to 6.75%±.11%, P<.05 and 6.53%±.11%, P<.05, respectively) and returned to baseline after 72 hours. Dilations of NTG were similar over time. CONCLUSIONS: Our results suggest that MT attenuates impairment of upper extremity endothelial function resulting from lower extremity exertion-induced muscle injury in sedentary young adults.

Power Doppler ultrasonography in the early diagnosis of primary/idiopathic adhesive capsulitis: an exploratory study.

OBJECTIVE: The purpose of this exploratory study was to determine if increased vascularity in the rotator interval area of the glenohumeral joint capsule could be visualized with power Doppler ultrasonography (PDUS) in patients with a clinical diagnosis of early-stage adhesive capsulitis. METHODS: Demographic and clinical characteristics from a consecutive series of 41 patients diagnosed with early-stage adhesive capsulitis were recorded and examination with PDUS was undertaken. Images were reviewed by 3 musculoskeletal radiologists, and consensus was determined on the presence of increased signal in the rotator interval area. RESULTS: Consensus was achieved on the presence of increased signal in 12 (29%) of the 41 cases. Participants with an increased PDUS signal did not demonstrate a characteristic set of identifying features, suggesting that those with increased vascularity may not constitute a distinct subgroup. CONCLUSION: This study found that some patients diagnosed with early-stage adhesive capsulitis demonstrated increased vascularity in the rotator interval area when examined with PDUS. These findings suggest that PDUS may have the potential to assist in the identification of increased vascularization in early stages of this disorder. Further research in the use of PDUS in diagnosing early-stage adhesive capsulitis is warranted.

Complications and limitations related to periprostatic local anesthesia before TRUS-guided prostate biopsy.

PURPOSE: To assess the frequency of complications specifically related to local anesthetic infiltration prior to transrectal ultrasound (TRUS)-guided prostate biopsy. METHODS: A total of 200 patients receiving 10 cm(3) (5 cm(3) on each side) of 2% lidocaine injected around the periprostatic nerve plexus under TRUS guidance before prostate biopsy were included. Various complications presumed to be associated with local anesthesia were noted during and after the biopsy procedure. Two weeks later, periprostatic tissue integrity and vascularization were re-examined with TRUS Doppler examination to assess for fibrosis or infection. RESULTS: The most common finding was pain due to puncture with the needle used for local anesthesia (27%). Also recorded were the need for repeated injections during the biopsy procedure (4.5%), symptoms associated with systemic lidocaine toxicity (2%), urinary incontinence (1.5%), and degradation of the image resolution due to anesthetic injection (1%). Increased vascularization within the periprostatic region was uncommon (2%) on the 2-week follow-up examination. No TRUS finding consistent with rectal wall hematoma or other periprostatic change and no erectile dysfunction associated with the procedure occurred. There was a significant difference in overall pain scores between the subgroups of patients (p < 0.001). CONCLUSION: TRUS-guided periprostatic nerve blockade is an effective method for relieving discomfort from prostate biopsy with very few complications.

Doppler sonography of the inferior and superior mesenteric arteries in ulcerative colitis.

PURPOSE: The purpose of this study was to evaluate the Doppler sonographic blood-flow parameters and spectral patterns in the inferior mesenteric artery (IMA) and superior mesenteric artery (SMA) in patients with active and inactive (remission-phase) ulcerative colitis (UC). METHODS: The IMAs and SMAs of 25 patients with active-phase UC (group 1), 19 patients with remission-phase UC (group 2), and 22 healthy, asymptomatic subjects (control group) were evaluated by duplex Doppler sonography. The 25 patients in group 1 were categorized into 2 subgroups on the basis of the extent of disease as determined by double-contrast barium enema x-ray study and colonoscopy. The first subgroup (group 1a) consisted of 11 patients with active involvement of the left colon from the rectum to the splenic flexure. The second subgroup (group 1b) consisted of 14 patients with active involvement of the entire colon. The peak systolic velocity (PSV), end-diastolic velocity (EDV), mean velocity (Vmean), resistance index (RI), and pulsatility index (PI) were determined from the Doppler spectral analysis. The inner diameter and cross-sectional area of the IMA and SMA were measured, and the blood-flow volume was calculated. The results were compared between the patient groups and control subjects. RESULTS: In the IMA, the mean blood-flow volume, mean PSV, mean EDV, and Vmean were significantly higher, the mean PI was significantly lower, and the mean diameter and the mean cross-sectional area were significantly larger in group 1 than in group 2 or in the control group (p < 0.001). The mean PSV and the Vmean of the IMA were significantly higher in group 1a than in group 1b (p < 0.05). The mean blood-flow parameters in the SMA were not significantly different between groups 1 and 2 or between either group 1 or group 2 and the control subjects. The mean EDV in the SMA was significantly higher and the mean PI and the mean RI were significantly lower in group 1b than in group 1a (p < 0.01). CONCLUSIONS: Duplex Doppler sonography of the IMA and SMA can be used to evaluate inflammatory disease of the large bowel, to assess disease extent, and to document response to therapy.

Ultrasonographic observation of intestinal mobility of dogs after acupunctural stimulation on acupoints ST-36 and BL-27.

objectives of this study were to observe normal peristalsis and mixing (or segmental movements) and to evaluate an acupuncture stimulation (ST-36 and BL-27) on the intestinal (duodenum) motility in normal dogs using duplex Doppler sonography. Fifteen healthy Beagle dogs were used for this experiment after the administration of warm saline and pellet feeding. The duodenal motility was examined using duplex Doppler sonography. Six hours after the pellet feeding, an electroacupuncture stimulation at ST-36 and BL-27 was applied and the duodenal motility was examined using duplex Doppler sonography pre-stimulation, during the stimulation and post-stimulation. After saline and pellet administration, the duplex Doppler sonograms showed 3 types of peristalsis and a mixing type (or segmental movement) of duodenum motility. In the peristalsis types, most yielded high-amplitude signals which had one high peak (type-1), two high peaks (type-2), and three high peaks (type-3) and lasted more than 1.3 seconds. Mixing type of duodenum motility had weak signals and were lasted more than 1.5 seconds. Among the peristalsis types, the type 1 and type 2 were predominant and the type 3 was rarely observed. The frequency of intestinal motility stimulated by ST-36 acupoint was increased during the acupuncture stimulation (20% increase compared to the basal value) and decreased (7% decrease compared to the basal value) after stimulation. The frequency of intestinal motility stimulated by BL-27 acupoint was decreased during the acupuncture stimulation (31% decrease compared to the basal value) and increased (18% increase compared to the basal value) after stimulation. There was a significant increase between the value found in during and the post-stimulation tests. We conclude that duplex Doppler studies permit a graphic visualization of intestinal movements which can be qualitatively and quantitatively analyzed using this technique, it is possible to evaluate the gastrointestinal motility after an acupuncture

Ultrasonographic observation of intestinal mobility of dogs after acupunctural stimulation on acupoints ST-36 and BL-27

The objectives of this study were to observe normal peristalsis and mixing (or segmental movements) and to evaluate an acupuncture stimulation (ST-36 and BL-27) on the intestinal (duodenum) motility in normal dogs using duplex Doppler sonography. Fifteen healthy Beagle dogs were used for this experiment after the administration of warm saline and pellet feeding. The duodenal motility was examined using duplex Doppler sonography. Six hours after the pellet feeding, an electroacupuncture stimulation at ST-36 and BL-27 was applied and the duodenal motility was examined using duplex Doppler sonography pre-stimulation, during the stimulation and post-stimulation. After saline and pellet administration, the duplex Doppler sonograms showed 3 types of peristalsis and a mixing type (or segmental movement) of duodenum motility. In the peristalsis types, most yielded high-amplitude signals which had one high peak (type-1), two high peaks (type-2), and three high peaks (type-3) and lasted more than 1.3 seconds. Mixing type of duodenum motility had weak signals and were lasted more than 1.5 seconds. Among the peristalsis types, the type 1 and type 2 were predominant and the type 3 was rarely observed. The frequency of intestinal motility stimulated by ST-36 acupoint was increased during the acupuncture stimulation (20% increase compared to the basal value) and decreased (7% decrease compared to the basal value) after stimulation. The frequency of intestinal motility stimulated by BL-27 acupoint was decreased during the acupuncture stimulation (31% decrease compared to the basal value) and increased (18% increase compared to the basal value) after stimulation. There was a significant increase(p<0.01) between the value found in during and the post-stimulation tests. We conclude that duplex Doppler studies permit a graphic visualization of intestinal movements which can be qualitatively and quantitatively analyzed using this technique, it is possible to evaluate the gastrointestinal motility after an acupuncture stimulation.

Doppler sonographic confirmation of thalamic and basal ganglia vasculopathy in three infants with trisomy 13.

A prospective review of 1746 head sonographic examinations performed from July 1993 to December 1995 revealed three scans that demonstrated a linear, branching echogenic pattern within the thalamus or basal ganglia. All three of these patients had trisomy 13. This finding has been described previously and is presumed to be of vascular causation. Doppler evaluation of the thalamus and basal ganglia in our three cases confirmed the vascular nature of the echogenic, branching pattern.