Recommendations for ultrasonographic assessment of renal arteries.

The present clinical practice recommendations are addressed to physicians of all specialties, who perform Doppler ultrasound examinations of the kidneys on a daily basis, and in particular to specialists in radiology and imaging diagnostics. The recommendations were based on the Ultrasonography Standards of the Polish Ultrasound Society and current scientific reports consistent with Evidence Based Medicine. The paper discusses patient preparation protocol, examinat ion technique with particular emphasis on patient's position allowing to obtain proper Doppler angle of insonation, as well as diagnostic limitations of the technique. Normal blood flow parameters as well as those indicating hemodynamically significant stenosis are also presented. Although the 2013-2014 American guidelines for renal artery duplex sonography (AIUM Practice Parameter for the Performance of Native Renal Artery Duplex Sonography and AIUM Practice Guideline for the Performance of an Ultrasound Examination of Solid-Organ Transplants), which were the basis for many national recommendations, have not been significantly updated to date, a large body of scientific research indicates the need for revision of current Doppler ultrasound standards and parameters, particularly for patients receiving endovascular treatment due to renovascular hypertension. Therefore, the paper refers to the current issue of ultrasound scan interpretation in patients receiving endovascular stenting, after transplantation of kidney, as well as in pediatric patients.The present clinical practice recommendations are addressed to physicians of all specialties, who perform Doppler ultrasound examinations of the kidneys on a daily basis, and in particular to specialists in radiology and imaging diagnostics. The recommendations were based on the Ultrasonography Standards of the Polish Ultrasound Society and current scientific reports consistent with Evidence Based Medicine. The paper discusses patient preparation protocol, examinat ion technique with particular emphasis on patient's position allowing to obtain proper Doppler angle of insonation, as well as diagnostic limitations of the technique. Normal blood flow parameters as well as those indicating hemodynamically significant stenosis are also presented. Although the 2013­2014 American guidelines for renal artery duplex sonography (AIUM Practice Parameter for the Performance of Native Renal Artery Duplex Sonography and AIUM Practice Guideline for the Performance of an Ultrasound Examination of Solid-Organ Transplants), which were the basis for many national recommendations, have not been significantly updated to date, a large body of scientific research indicates the need for revision of current Doppler ultrasound standards and parameters, particularly for patients receiving endovascular treatment due to renovascular hypertension. Therefore, the paper refers to the current issue of ultrasound scan interpretation in patients receiving endovascular stenting, after transplantation of kidney, as well as in pediatric patients.

Potential value of three-dimensional ultrasonography in diagnosing muscle injuries in comparison to two-dimensional examination--preliminary results.

BACKGROUND: Two-dimensional ultrasonography (2D-US) has become a widely used and accepted diagnostic tool in musculoskeletal disorders. Its utility in the evaluation of muscle injury and pathology is generally recognised. In contrast, the place and role of three-dimensional US imaging (3D-US) in the diagnostic work-up of musculoskeletal conditions are still not recognised even though 3D-US is a well-established technique in, for example, obstetrics. The aim of this study was to find out if it is possible to assess lesions of muscles more accurately and with more detail using the 3D technique in comparison to 2D imaging. MATERIAL AND METHODS: The study involved 14 patients aged 16-39 years (mean age 24.8 yrs) with muscle injuries and 2 volunteers to determine the best technique of performing the examination and acquiring images that can best visualise the structure of muscles. The 2D and 3D images were compared with respect to visualisation of lesions and their size. It was also investigated whether the additional third "Z" plane could furnish relevant information regarding the visible lesion. RESULTS: The results of evaluation of features and size of the lesions in the muscles were very similar and reliable with both modalities. For small lesions, measurements of their size differed slightly. The differences were bigger for bigger lesions. Additional information leading to re-classification of the type of the lesion or more precise delineation of its margins was obtained in 6 of the 14 cases (42.8%). The duration of a 3D study was usually longer with bigger lesions. The 3D-reconstructed model helped in better visualising and understanding the anatomical relations of the injured muscle with surrounding tissues. Recording data as volume scans made possible later re-assessment of images and their independent verification by a consultant at any desired time. CONCLUSIONS: 1. 3D US imaging is as reliable and accurate as the 2D technique in the assessment of muscle injuries. In some cases, especially with smaller lesions, the borders and type of the lesion are better visualized with the additional third plane. Additional information regarding the location of the lesions in the frontal plane can be obtained with 3D imaging. It is more difficult to assess whole lesions of greater size requiring two or more volume scans. The acquisition of volume data enables the reading of images at any desired time and also makes it possible to ask a consultant to verify the findings.

Percutaneous thrombin injection to complete SMA pseudoaneurysm exclusion after failing of endograft placement.

Visceral aneurysms are potentially life-threatening vascular lesions. Superior mesenteric artery (SMA) pseudoaneurysms are a rare but well-recognized complication of chronic pancreatitis. Open surgical repair of such an aneurysm, especially in patients after previous surgical treatment, might be dangerous and risky. Stent graft implantation makes SMA pseudoaneurysm exclusion possible and therefore avoids a major abdominal operation. Percutaneous direct thrombin injection is also one of the methods of treating aneurysms in this area. We report a first case of percutaneous ultrasound-guided thrombin injection to complete SMA pseudoaneurysm exclusion after an unsuccessful endograft placement. Six-month follow-up did not demonstrate any signs of aneurysm recurrence.

Liposomal heparin spray: a new formula in adjunctive treatment of superficial venous thrombosis.

The objective of this study was to assess the efficacy and safety of liposomal heparin spray-a new formula of topical heparin delivery. This was a randomized, multicenter, controlled open clinical trial with 2 parallel groups. Forty-six outpatients with clinical signs of superficial venous thrombosis (SVT) were treated with either topical liposomal heparin spraygel (LHSG) (Lipohep Forte Spraygel, 4 puffs of 458 IU tid (n = 22) or with low-molecular-weight heparin (LMWH) (Clexane 40 mg once a day (n = 24), administered subcutaneously (sc). Main outcome measures were efficacy parameters (improvement of local symptoms-pain control and planimetric evaluation of erythema size, duplex Doppler assessment of thrombus regression) and safety parameters (documentation of adverse events, with particular reference to deep vein thrombosis [DVT] by duplex sonography, and patients' and investigators' assessment of drug tolerance). Patients' and investigators' subjective assessment of efficacy of treatment and change in basic biochemical parameters were defined as secondary outcome measures. Statistical analysis was performed with use of Wilcoxon test, Mann-Whitney U-test and Chi-square test. Regression of SVT-related symptoms, including pain, erythema, and thrombus presence, was shown as comparable in LHSG and LMWH groups. These results were corroborated by efficacy assessment by investigators and patients. Three cases of deep venous thrombosis in heparin spraygel and 1 in heparin sc group were reported. No significant adverse reactions were observed in the spraygel group, but 1 serious allergic reaction was observed in the LMWH group. Tolerance of new formula heparin was assessed as good. Heparin spraygel-a new topical mode of heparin application, seems a promising method of heparin delivery. This initial study has demonstrated comparable efficacy and safety of LHSG and LMWH in local treatment of SVT. These findings should be confirmed by further extensive study that will reach appropriate statistical power to support such conclusion, for despite heparin treatment, significant risk of DVT was demonstrated in both groups.