Penetrating injury of the common femoral vein followed by local deep vein thrombosis: A case report.

This case report discusses a unique scenario in which a 19-year-old patient with a penetrating wound in the common femoral vein developed deep vein thrombosis in response to life-threatening bleeding. The report highlights our thoughts on managing an isolated truncal venous injury leading to deep vein thrombosis, emphasizing the significance of surgical exploration in vascular trauma and the feasibility of employing non-invasive imaging diagnosis in preoperative planning.

Lateral geniculate artery pseudoaneurysm after arthroscopic medial meniscectomy.

Vascular complications after arthroscopy are rare and generally present as transient paresthesia most likely due to nervous injury or vasospasm. Rare cases of genicular artery injuries can occur and generally involve the medial genicular artery due to proximity to the right arthroscopic knee hook. This case, however, represents a rare lateral inferior genicular artery injury resulting in a symptomatic pseudoaneurysm. In addition, during the workup, the best visualization of the pseudoaneurysm was possible using duplex ultrasound. The diagnostic information seen on ultrasound was paramount and superseded the findings from conventional angiography and computed tomography angiography, both of which were nonspecific. In brief, this case not only highlights a rare surgical complication but also emphasizes the importance of duplex ultrasound compared with angiography and computed tomography in the workup of pseudoaneurysms.

A Critical Analysis of Methodology Pitfalls in Duplex Doppler Ultrasound in the Evaluation of Patients With Erectile Dysfunction: Technical and Interpretation Deficiencies.

BACKGROUND: Penile duplex Doppler ultrasound (PDDU) is a minimally invasive tool to evaluate erectile hemodynamics in patients with erectile dysfunction (ED). Despite decades of use, there is still a large variability in PDDU protocols, and a high rate of false diagnosis is reported. AIM: Review of PDDU methodology in the published literature addressing protocol heterogeneity, technical and interpretation challenges. METHODS: A PubMed literature search was performed using the search terms "penile doppler ultrasound", "penile duplex ultrasound" or "penile ultrasound", and "Erectile dysfunction". Studies were analyzed for the presence of the following elements in reporting of the PDDU protocol: (i) intracavernosal vasoactive agents used, (ii) use of a redosing protocol, (iii) means of rigidity assessment, (iv) report of at-home best-quality erection, (v) normative criteria for peak systolic velocity (PSV) and end-diastolic velocity (EDV), and (vi) use of time-based hemodynamics assessment. Inclusion criteria were studies available in English, from 2005 onwards, and with full text. Exclusion criteria were review, descriptive or short communication articles, animal studies, and studies in populations other than those with ED. OUTCOMES: A critical review of the heterogeneity in published literature was performed to guide a structured discussion of methodological challenges and to create a list of recommendations. RESULTS: Significant heterogeneity was seen in key methodological aspects. Fifty percent of studies reported the use of prostaglandin E1 only, and 12% of studies did not mention the agent used. Redosing as part of the PDDU protocol was mentioned in only 26% of studies. The majority (56%) did not mention any form of rigidity assessment. The most frequently used grading system was the Erection Hardness Score (14%). Overall, most studies (59%) used a timed-base protocol for hemodynamic assessment. No clear consensus was defined for normative criteria for PSV and EDV, 39% defining a normal PSV as ≥30 cm/s, and 57% using EDV values ≤5 cm/sec as normal. CLINICAL IMPLICATIONS: The absence of standardization has led to inadequate reporting of key factors which has rendered data interpretation and comparison between studies challenging. STRENGTHS AND LIMITATIONS: Our strengths include an extensive review of literature, with a structured analysis of the impact of each methodological pitfall. Our main limitation is the fact that protocol reporting, and not its application, was assessed. CONCLUSION: Despite its widespread use, analysis of the literature on PDDU use in the ED population shows marked protocol heterogeneity, rendering data interpretation a problem. Nascimento B, Miranda EP, Terrier JE, et al. A Critical Analysis of Methodology Pitfalls in Duplex Doppler Ultrasound in the Evaluation of Patients With Erectile Dysfunction: Technical and Interpretation Deficiencies. J Sex Med 2020;17:1416-1422.

Índice Ventricular De Levene Y Mensuración Del Tercer Ventrículo En Neonatos Ecuatorianos Mediante Ecografía Cerebral / Levene Ventricular Index And Measurement Of The Third Ventricle In Ecuadorian Neonates By Means Of Cerebral Ultrasound

Resumen Introducción: La aplicación del ultrasonido en la evaluación cerebral del neonato posibilita la mensuración de estructuras cerebrales. Objetivo: El objetivo de este trabajo es obtener las medidas del III ventrículo y del índice de Levene en un grupo de recién nacidos ecuatorianos, con la finalidad de determinar valores de normalidad que puedan ser utilizados en el trabajo diario del servicio de neonatología. Métodos: Se seleccionó un grupo de neonatos sin alteraciones neurológicas. A través de la fontanela anterior se determinó el índice de Levene. La mensuración del diámetro del III ventrículo se realizó a través de la ventana craneal temporal. Resultados: Se incluyeron en el estudio 66 pacientes con edad post menstrual de 37 semanas (rango 27-42 semanas), predominó el sexo masculino. El peso promedio al nacer fue de 2554 gramos. El valor medio del diámetro del III ventrículo es de 1,5 mm, rango entre 0,5 mm - 3,8 mm. El índice de Lindergaard promedio fue de 12,7 mm (8,2-27 mm). Tanto el diámetro del tercer ventrículo como el índice ventricular se vieron afectados por el peso al nacer. En relación con el momento del parto no existió diferencia significativa en el tamaño ventricular. Conclusiones: Comparado con los resultados de otras series nuestro estudio ofrece parámetros diferentes.

Abstract Introduction: The application of ultrasound in the brain evaluation of the neonate allows the measurement of brain structures. Objective: To obtain the sizes of the third ventricle and the ventricular index of Levene in a group of Ecuadorian neonates without neurological alterations. To establish normal ranges that can be used in the daily work of the neonatology service. Methods: A group of neonates without neurological alterations was studied. Through the anterior fontanelle, the Levene index was determined. The third ventricle's diameter was seized through the temporal cranial window. Results: Sixty-six patients of 37 weeks' gestational age at birth (range 27-42 weeks), predominantly male and an average weight at birth of 2554 grams, were included. The third ventricle's mean diameter was 1.5 mm (range: 0.5 mm - 3.8 mm). The average Lindergaard index was 12.7 mm (8.2-27 mm). Both, the diameter of the third ventricle and the ventricular index were affected by the birth weight of newborns. Regarding the moment of delivery, there was no significant difference in ventricular size. Conclusions: Compared with the results of other series, our study offers different parameters.

Plantar vein thrombosis and pulmonary embolism.

Plantar vein thrombosis is an unusual and under-diagnosed condition that affects the plantar deep venous system. Current ultrasound investigation protocols for deep venous thrombosis neglect this entity. To our knowledge, there are only seven reports in the literature of 20 patients with plantar vein thrombosis detected with sonography without an associated pulmonary embolism. We present a case report of a patient with a plantar vein thrombosis associated with pulmonary embolism. Patients who present with pain and/or swelling of the foot should undergo ultrasound examination and careful evaluation for respiratory symptoms.

Morphological and hemodynamic patterns of carotid stenosis treated by endarterectomy with patch closure versus stenting: a duplex ultrasound study

OBJECTIVES: A duplex ultrasound study was performed to investigate morphological and hemodynamic patterns of carotid stenoses treated by endarterectomy with patch closure versus stenting. MATERIALS AND METHOD: Twenty-nine carotid stenoses were treated with stenting and 65 with patch closure. Duplex ultrasound parameters (luminal diameter, mm; peak systolic velocity and end-diastolic velocity, cm/s) were measured 24 hours after the procedures and also at 12 months post-procedure. Residual stenoses (immediately postprocedure) and restenoses (within 12 months of procedure) were defined as narrowings of >50 percent on duplex ultrasound examination. RESULTS: In stented patients, the luminal diameter of the proximal internal carotid artery increased in the interval between the 24-hour and 12-month post-procedure studies, while in the patch closure patients, the diameter decreased. Carotid hemodynamics normalized immediately after both patching and stenting and remained relatively stable thereafter up to 12 months. No statistically elevated flow velocities (in the absence of residual stenosis or restenosis) were observed in the patched or stented carotid arteries. No significant differences in residual stenosis rates were observed between the stenting group (3 cases, 10.34 percent) and the patch closure group (1 case, 1.53 percent, P = 0.08). At 12 months, 2 stenting patients (6.88 percent) and 2 patch closure patients (3.07 percent) had $50 percent restenosis (P = 0.58). One case of late stroke due to restenosis was observed in the stenting group; the patient died 12 months postoperatively, before receiving new intervention. CONCLUSION: Measurements over time in luminal diameter signalized differences in arterial remodeling mechanisms between patched and stented carotids. Both stenting and patch closure were associated with carotid patency and flow restoration. This study does not support a general approach to new velocity criteria indiscriminately applied to stented or patched carotids.

Pseudo-aneurisma de artéria tibial posterior pós-tratamento de fratura de perna com fixador externo: relato de caso e revisão da literatura / Pseudoaneurysm of the posterior tibial artery after external fixation for leg fracture: case report and review of the literature

Este trabalho descreve um caso de pseudo-aneurisma da artéria tibial posterior devido ao uso de fixador externo para tratamento de fratura dos ossos da perna (técnica de Ilizarov), bem como as técnicas utilizadas para seu tratamento. A compressão guiada por ultra-som e a injeção de trombina guiada por ultra-som foram realizadas, sem sucesso. O tratamento definitivo do pseudo-aneurisma e reconstrução arterial foi conseguido através do tratamento cirúrgico clássico, usando enxerto interposto de veia safena magna homóloga invertida. As indicações, vantagens e desvantagens das técnicas de tratamento não invasivo (compressão guiada por ultra-som e injeção de trombina guiada por ultra-som) e as possíveis causas de sua incapacidade na obliteração do pseudo-aneurisma são discutidas. Também foi realizada a revisão de casos de pseudo-aneurisma da artéria tibial posterior na literatura médica, encontrando-se apenas um caso semelhante, entre 24 publicados.

We describe a case of pseudoaneurysm in the posterior tibial artery following treatment for tibial and fibula fractures using external fixation (Ilizarov technique), as well as the techniques used for its treatment. Ultrasound-guided compression and ultrasound-guided thrombin injection were unsuccessfully performed. Definite treatment of pseudoaneurysm and arterial reconstruction was achieved through the traditional surgical treatment, using interposed graft of inverted homologous great saphenous vein. Indications, advantages and disadvantages of noninvasive treatment techniques (ultrasound-guided compression and ultrasound-guided thrombin injection) and the possible causes of their inability in obliterating the pseudoaneurysm are discussed. A literature review of pseudoaneurysms of the posterior tibial artery was also carried out, resulting in only one similar case out of 24 published cases.