Doppler ultrasonographic measurements of the lateral digital palmar artery in pregnant mares.

Cardiovascular changes have been reported in late pregnancy in mares. However, there are no data on changes in peripheral blood flow. Doppler ultrasound represents a sensitive method for assessing the blood flow directed to the hoof. The aims of this study were to evaluate the blood flow parameters of the lateral palmar digital artery (LPDA) in pregnant mares and to assess intra- and interrater agreement between two observers with different levels of experience. The LPDAs of pregnant Italian Standardbred mares were examined. The vessels were located with B-mode ultrasound and analyzed with color and pulsed wave Doppler. The following parameters were recorded by the operators: heart rate (HR), peak systolic velocity (PSV), end-diastolic velocity (EDV), and resistive index (RI). Measurements were performed between 2 and 3 months of gestation (T1), in the last month of pregnancy (T2) and a week after delivery (T3). Seventeen mares aged 3-18 years met the inclusion criteria. Ultrasound examinations of the LPDA were subjectively easy to perform and well tolerated by the mares. Interrater and intrarater agreement were good and moderate, respectively. The HR was higher at T2 than at T1 and T3. The PSV and RI changed significantly during pregnancy, with higher values at T2 and T3, whereas the EDV remained unchanged throughout the examination. Doppler examination showed that peripheral flow changes were present in mares in late pregnancy. However, the persistence of higher values after delivery invites further investigation to assess the correlation between metabolic/endocrine changes related to pregnancy and Doppler parameters.

El papel del eco Doppler en el acceso vascular: una herramienta imprescindible / The role of echo-Doppler in the management of vascular access: an essential tool

El acceso vascular para hemodiálisis es fundamental para el paciente con insuficiencia renal crónica terminal. La fís-tula arteriovenosa nativa es superior a la protésica y esta al catéter venoso central (CVC) por su mayor permeabilidady su menor tasa de complicaciones y reintervenciones. El envejecimiento de la población hace que sea un reto. Lacreación y el mantenimiento del acceso vascular son fundamentales para estos pacientes. En este contexto, el ecoDoppler va a ser de gran ayuda a la hora de planificar y de mantener el acceso vascular en el mapeo prequirúrgico,en la planificación preoperatoria, durante la operación y en el seguimiento para el diagnóstico de la disfunción yde la valoración de la maduración. En este artículo describimos nuestra metodología y los criterios ecográficos cuya evaluación consideramosnecesaria.(AU)

Vascular access for hemodialysis is essential for patients with terminal chronic renal failure. Autologous arterio-venous fistula is superior to the prosthetic one and the latter to the central venous catheter (CVC) due to its greaterpermeability and its lower rate of complications and reinterventions. The elderly population makes it a challenge.The creation and maintenance of vascular access is essential for these patients. In this context, echo-Doppler will beessential when planning and maintaining vascular access, both in pre-surgical mapping, in pre-operative planning,intra-operatively and in follow-up for the diagnosis of dysfunction and evaluation of maturation. In this article we describe our methodology and the ultrasound criteria that we consider necessary to evaluate.(AU)

True relationship between tricuspid annular motion and velocity displacement components: Potential role in assessing right ventricular decoupling.

BACKGROUND: Although measures of longitudinal displacement of the tricuspid annulus measured by M-mode as tricuspid annular systolic plane excursion (TAPSE) and systolic velocity by tissue Doppler imaging (TA TDI s) are routinely used for assessment of right ventricular (RV) systolic function; these measures describe different phenomena and should not be used interchangeably. METHODS: Previously published data was used to determine the individual relationship between TAPSE and TA TDI s with increasing pulmonary artery systolic pressures (PASP). RESULTS: In this retrospective analysis, 488 patients were divided into 2 groups based on TAPSE (Group 1: <1.8 cm and Group 2: ≥1.8 cm). A robust correlation (R = .79) between TAPSE and TA TDI s noted for the entire population. However, a statistically lower correlation (R = .43) was seen between Group 1 and Group 2 (R = .65; p < .0047). With increasing pulmonary pressures, only PASP (p < .0001) and TA TDI s (p < .0001) discriminated between low and normal TAPSE/PASP values. Suggesting that a TA TDI s/PASP ratio would be most useful than TAPSE/PASP with a specificity of 80%. CONCLUSIONS: Significant differences exist between TAPSE and TA TDI s, particularly at low TAPSE values with increased PASP, were uncoupling occurs. Our data seems to suggest that TA TDI s/PASP would be most useful than TAPSE/PASP ratio. Future studies should address, if abnormalities in the material properties along the RV free wall account for these differences seen between TAPSE and TA TDI s.

Echocardiographic measurements and cardiac anatomy in healthy Western hognose snakes (Heterodon nasicus).

This study aims to describe the most important cardiac structures in the Heterodon nasicus through echocardiography and anatomical dissection. Echocardiographic and echo-Doppler measurements were performed on twenty healthy adult Heterodon nasicus (10.10). The values of the ventricular length, aortic diameter, pulmonary trunk diameter, the mean thickness of the interventricular septum, and thicknesses of the wall of the cavum pulmonale (Cav. P) and cavum arteriosum (Cav. A), were measured. The aortic flow and pulmonary trunk flow were recorded. Two dead specimens (1.1) were dissected. The male's pulmonary trunk diameter was bigger compared to the female's in both the long and short axis. The reproductive ecology of Heterodon nasicus has yet to be fully elucidated upon, however, male territorialism and dispersal from the hibernacula, and multiple male courtships toward a single female were described, hence, the more active reproductive activity of the male and the consequent sexual selection toward a higher aerobic performance can be hypothesised. A moderate interventricular right to left shunt was noticed in the Cav. V of all the specimens, which is considered normal and should not confuse the clinician. Congenital defects, cardiomyopathies, valvulopathies, and pericardial diseases are known to occur in ophidians and other reptiles. Reliable data and profound knowledge of the anatomy and physiology of the ophidian heart are fundamental for the in vivo diagnosis of cardiac diseases in snakes.

Echo-Doppler measures of right ventricular systolic function are affected by reduced left ventricular systolic function.

BACKGROUND: Objective right ventricular (RV) systolic function assessment is attained using a series of well-described and validated echo-Doppler measurements. However, how left ventricular (LV) systolic function influences these RV functional measurements has not been previously studied. Consequently, we conducted a retrospective proof-of-concept analysis to answer this important question. METHODS: A total of 100 echocardiographic studies were included and patients were divided into two groups according to their LV ejection fraction (LVEF). The following RV variables were acquired including, tricuspid annular systolic plane excursion (TAPSE), velocity of the systolic motion (TA TDI s'), RV outflow tract velocity time integral (VTI), pulmonary vascular resistance (PVR), and the TAPSE to pulmonary artery systolic pressure (PASP) ratio. RESULTS: Not only TAPSE, TA DI s', RVOT VTI, PVR, and TAPSE/PASP were all significantly different between patients with normal versus abnormal LVEF; but most importantly, RVOT VTI (p < .0001) was the best discriminatory variable in assessing normal versus abnormal LVEF followed by TAPSE (p = .0001). Using receiver operating characteristic curve analysis, an RVOT VTI value > 11 identified patients with a normal LVEF with a sensitivity of 90% and specificity of 76%. CONCLUSION: Based on our results, reduced LVEF affects the RV, likely mediated by mechanisms of interventricular dependence. Therefore, RV analysis cannot be performed in isolation as it not only reflects intrinsic RV systolic function but also, is dependent on LV systolic function. In cases of reduced LVEF, additional measures of RV assessment should be used to provide better objective assessments.

Utility of the tricuspid annular tissue doppler systolic velocity and pulmonary artery systolic pressure relationship in right ventricular systolic function assessment: A pilot study.

BACKGROUND: Tricuspid annular plane systolic excursion (TAPSE) to pulmonary artery systolic pressure (PASP) ratio has been validated as a valuable noninvasive measure of right ventricular (RV) elastance and systolic function. However, the more reliable TA systolic (s') velocity measure of RV systolic function compared to TAPSE has not been previously studied. METHODS: We conducted a pilot study using several variables of RV function in 50 patients with the main aim to determine which numerical expression between TA TDI s'/PASP and TAPSE/PASP ratio was most useful. RESULTS: In a stepwise multiple regression analysis, TA TDI s'/PASP ratio (p < .0002); LVOT VTI/RVOT VTI ratio (p < .0002); RVOT VTI (p < .0047); TAPSE/PASP ratio (p < .0259) and TA TDI e' (p < .0292) were best in discriminating normal versus abnormal RV systolic function. Using receiver operator curve analysis, cut-off values for both TA TDI s'/PASP (>3.9 mm/c/mmHg) had 82.1% sensitivity and 77.3% specificity while the TAPSE/PASP (>.61 mm/mmHg) had 89.3% sensitivity and 68.2% specificity in identifying normal RV function in our studied population. CONCLUSION: Our results indicate that TA TDI s'/PASP is a better mathematical expression when examining the relationship between RV contractility and RV resistance relationship. Furthermore, we also found that inclusion of RVOT VTI, RV diastolic properties, and left ventricular systolic function are important determinants of RV systolic function assessments and should be routinely included. Additional prospective studies are now needed to confirm these results using hemodynamic data.

Hemodynamic Doppler echocardiographic evaluation of permanent His bundle and biventricular pacing after AV nodal ablation.

placing after atrioventricular (AV) nodal ablation for permanent atrial fibrillation (AF) may include cardiac resynchronization therapy (CRT) with either His bundle pacing (HBP) or biventricular pacing (BVP), or conventional single site right ventricular apical pacing (RVAP). To determine the relationship between pacing method and hemodynamic outcome, we used Doppler echocardiographic methods to evaluate left ventricular (LV) hemodynamics after AV nodal ablation and either HBP, BVP, or RVAP. Method: 20 patients were evaluated > 6 months after AV nodal ablation, 10 each with chronic HBP or BVP, and all with RVAP lead. Doppler echocardiography was used to measure 3 parameters indicative of CRT: 1) LV dP/dt, 2) the LV pre-ejection interval, and 3) myocardial performance index, relative to intra-patient RVAP. Results: Primary endpoint of LV dP/dt on average improved by > 17% with both HBP and BVP, compared to RVAP. HBP but not BVP, had improvement across all three parameters. Conclusion: HBP provides LV electromechanical synchrony across multiple echo Doppler parameters. Both HBP and BVP were hemodynamically superior to RVAP following AV nodal ablation.

Gradient and pressure recovery of a self-expandable transcatheter aortic valve depends on ascending aorta size: In vitro study.

Objective: In this study we aimed to understand the role of interaction of the Medtronic Evolut R transcatheter aortic valve with the ascending aorta (AA) by evaluating the performance of the valve and the pressure recovery in different AA diameters with the same aortic annulus size. Methods: A 26-mm Medtronic Evolut R valve was tested using a left heart simulator in aortic root models of different AA diameter (D): small (D = 23 mm), medium (D = 28 mm), and large (D = 34 mm) under physiological conditions. Measurements of pressure from upstream to downstream of the valve were performed using a catheter at small intervals to comprehensively assess pressure gradient and pressure recovery. Results: In the small AA, the measured peak and mean pressure gradient at vena contracta were 11.5 ± 0.5 mm Hg and 7.8 ± 0.4 mm Hg, respectively, which was higher (P < .01) compared with the medium (8.1 ± 0.4 mm Hg and 5.2 ± 0.4 mm Hg) and large AAs (7.4 ± 1.0 mm Hg and 5.4 ± 0.6 mm Hg). The net pressure gradient was lower for the case with the medium AA (4.1 ± 1.2 mm Hg) compared with the small AA (4.7 ± 0.8 mm Hg) and large AA (6.1 ± 1.4 mm Hg; P < .01). Conclusions: We have shown that small and large AAs can increase net pressure gradient, because of the direct interaction of the Medtronic Evolut R stent with the AA (in small AA) and introducing higher level of turbulence (in large AA). AA size might need to be considered in the selection of an appropriate device for transcatheter aortic valve replacement.

Left atrial reservoir strain improves diagnostic accuracy of the 2016 ASE/EACVI diastolic algorithm in patients with preserved left ventricular ejection fraction: insights from the KARUM haemodynamic database.

AIMS: This study aimed to investigate the incremental value offered by left atrial reservoir strain (LASr) to the 2016 American Society of Echocardiography/European Association of Cardiovascular Imaging (ASE/EACVI) diastolic algorithm to identify elevated left ventricular (LV) filling pressure in patients with preserved ejection fraction (EF). METHODS AND RESULTS: Near-simultaneous echocardiography and right heart catheterization were performed in 210 patients with EF ≥50% in a large, dual-centre study. Elevated filling pressure was defined as invasive pulmonary capillary wedge pressure (PCWP) ≥15 mmHg. LASr was evaluated using speckle-tracking echocardiography. Diagnostic performance of the ASE/EACVI diastolic algorithm was validated against invasive reference and compared with modified algorithms incorporating LASr. Modest correlation was observed between E/e', E/A ratio, and LA volume index with PCWP (r = 0.46, 0.46, and 0.36, respectively; P < 0.001 for all). Mitral e' and TR peak velocity showed no association. The ASE/EACVI algorithm (89% feasibility, 71% sensitivity, 68% specificity) demonstrated reasonable ability (AUC = 0.69) and 68% accuracy to identify elevated LV filling pressure. LASr displayed strong ability to identify elevated PCWP (AUC = 0.76). Substituting TR peak velocity for LASr in the algorithm (69% sensitivity, 84% specificity) resulted in 91% feasibility, 81% accuracy, and stronger agreement with invasive measurements. Employing LASr as per expert consensus (71% sensitivity, 70% specificity) and adding LASr to conventional parameters (67% sensitivity, 84% specificity) also demonstrated greater feasibility (98% and 90%, respectively) and overall accuracy (70% and 80%, respectively) to estimate elevated PCWP. CONCLUSIONS: LASr improves feasibility and overall accuracy of the ASE/EACVI algorithm to discern elevated filling pressures in patients with preserved EF.

Evaluación de la dinámica de la circulación arterial ocular por eco Doppler en pacientes con hipertensión arterial sistémica esencial / Echo Doppler evaluation of ocular arterial circulation dynamics in patients with systemic essential arterial hypertension

RESUMEN Objetivo: Evaluar los valores de referencia de la dinámica circulatoria arterial ocular de los pacientes con hipertensión arterial esencial. Métodos: Se realizó un estudio descriptivo y transversal en 105 pacientes hipertensos y en un grupo de 33 sujetos no hipertensos, con edades comprendidas entre 18 y 60 años, sin antecedentes de padecer diabetes mellitus ni enfermedades oculares como glaucoma, o haber recibido tratamiento quirúrgico por catarata, hipertensión ocular u otras. A todos se les realizó la toma de la presión arterial sistémica, el examen clínico oftalmológico y el ultrasonido Doppler a color de carótida y de los vasos orbitarios. Resultados: Se encontró un predominio de mujeres de piel blanca, entre la cuarta y quinta década de la vida. Existió un incremento del pico de velocidad sistólica, la velocidad final diastólica y el índice de resistencia en la arteria oftálmica, que fue desde un rango normal en el grupo de los no hipertensos a valores promedios elevados en el grupo de hipertensos, los cuales fueron más altos en los casos descontrolados. No se encontraron modificaciones en el análisis de estos parámetros en las arterias centrales de la retina ni en las ciliares posteriores cortas. Conclusiones: En la casuística estudiada, el incremento del pico de la velocidad sistólica en la arteria oftálmica pudiera estar relacionado con áreas de obstrucción vascular localizadas o con vasoespasmo. Se encontró una asociación entre el descontrol de la presión arterial y los valores elevados del índice de resistencia en la arteria oftálmica(AU)

ABSTRACT Objective: Evaluate the reference values for ocular arterial circulation dynamics in patients with essential arterial hypertension. Methods: A descriptive cross-sectional study was conducted of 105 hypertensive patients and a group of 33 non-hypertensive subjects aged 18-60 years with no antecedents of diabetes mellitus or ocular conditions such as glaucoma or having undergone cataract surgery, ocular hypertension or others. All the patients underwent systemic arterial pressure measurement, clinical ophthalmological examination and color Doppler carotid and orbital ultrasonography. Results: A predominance was observed of the female sex, white skin color and age between the fourth and fifth decades of life. There was an increase in peak systolic velocity, end diastolic velocity and the resistive index in the ophthalmic artery, which ranged from normal in the non-hypertensive group to high average levels in the hypertensive group, higher in uncontrolled cases. Analysis of these parameters did not find any change in central retinal or short posterior ciliary arteries. Conclusions: In the cases studied, the peak systolic velocity increase in the ophthalmic artery could be related to localized vascular obstruction areas or vasospasm. An association was found between uncontrolled arterial pressure and high resistive index values in the ophthalmic artery(AU)

Objective Assessment of Venous Pulse Wave Velocity in Healthy Humans.

Central venous pressure and volume status are relevant parameters for characterization of a patient's hemodynamic condition; however, their invasive assessment is affected by various risks while non-invasive approaches provide limited and subjective indications. Here we explore the possibility of assessing venous pulse wave velocity (vPWV), a potential indicator of venous pressure changes. In eight healthy patients, pressure pulses were generated artificially in the leg veins by rapid compression of the foot, and their propagation was detected at the level of the superficial femoral vein with Doppler ultrasound. Changes in leg venous pressure were obtained by raising the trunk from the initial supine position by 30° and 60°. vPWV increased from 1.78 ± 0.06 m/s (supine) to 2.26 ± 0.19 m/s (60°) (p < 0.01) and exhibited an overall linear relationship with venous pressure. These results indicate that vPWV can be easily assessed, and is a non-invasive indicator of venous pressure changes.

Effects of Venous Angioplasty on Cerebral Lesions in Multiple Sclerosis: Expanded Analysis of the Brave Dreams Double-Blind, Sham-Controlled Randomized Trial.

PURPOSE: To evaluate if jugular vein flow restoration in various venographic defects indicative of chronic cerebrospinal venous insufficiency (CCSVI) in multiple sclerosis (MS) patients can have positive effects on cerebral lesions identified using magnetic resonance imaging (MRI). MATERIALS AND METHODS: The Brave Dreams trial ( ClinicalTrials.gov identifier NCT01371760) was a multicenter, randomized, parallel group, double-blind, sham-controlled trial to assess the efficacy of jugular venoplasty in MS patients with CCSVI. Between August 2012 and March 2016, 130 patients (mean age 39.9±10.6 years; 81 women) with relapsing/remitting (n=115) or secondary/progressive (n=15) MS were randomized 2:1 to venography plus angioplasty (n=86) or venography (sham; n=44). Patients and study personnel (except the interventionist) were masked to treatment assignment. MRI data acquired at 6 and 12 months after randomization were compared to the preoperative scan for new and/or >30% enlargement of T2 lesions plus new gadolinium enhancement of pre-existing lesions. The relative risks (RR) with 95% confidence interval (CI) were estimated and compared. In a secondary assessment, venograms of patients who underwent venous angioplasty were graded as "favorable" (n=38) or "unfavorable" (n=30) for dilation according to the Giaquinta grading system by 4 investigators blinded to outcomes. These subgroups were also compared. RESULTS: Of the 130 patients enrolled, 125 (96%) completed the 12-month MRI follow-up. Analysis showed that the likelihood of being free of new cerebral lesions at 1 year was significantly higher after venoplasty compared to the sham group (RR 1.42, 95% CI 1.00 to 2.01, p=0.032). Patients with favorable venograms had a significantly higher probability of being free of new cerebral lesions than patients with unfavorable venograms (RR 1.82, 95% CI 1.17 to 2.83, p=0.005) or patients in the sham arm (RR 1.66, 95% CI 1.16 to 2.37, p=0.005). CONCLUSION: Expanded analysis of the Brave Dreams data that included secondary/progressive MS patients in addition to the relapsing/remitting patients analyzed previously showed that venoplasty decreases new cerebral lesions at 1 year. Secondary analysis confirmed the efficacy of the Giaquinta grading system in selecting patients appropriate for venoplasty who were more likely to be free from accumulation of new cerebral lesions at MRI.

A case of peripartum cardiomyopathy presenting as bilateral acute limb ischaemia and gangrene.

Peripartum cardiomyopathy (PPCM) is a condition of unknown etiology that presents as heart failure due to left ventricular systolic dysfunction in the last of month of pregnancy and up to six months after giving birth. PPCM predisposes towards thrombo-embolism and an acute limb ischaemia can be a manifestation of this disease. We present a case of a 23-year-old lady presenting an acute lower limb ischaemia four months post-partum. Doppler ultrasound showed bilateral femoral emboli and cardiac ECHO showed a 24% ejection fraction. Amputation was performed on both limbs, below her right knee and above her left knee. The patient was started on heart failure medication and her symptoms improved with diuretic therapy, confirming the diagnoses of PPCM. It is important to recognise acute limb ischaemia as a rare manifestation of PPCM, as a timely diagnosis and effective treatment of the disease can improve the prognosis. We believe this is the first case to be reported in medical literature from Pakistan of a patient presenting PPCM with bilateral acute limb ischaemia and gangrene.

[Acute carpal tunnel syndrome caused by a thrombosis of a persistent median artery: 2 case reports]. / Canal carpien aigu : penser à la thrombose de l'artère persistante du nerf médian !

Carpal tunnel syndrome is a common peripheral neuropathy, usually idiopathic or post-traumatic due to the compression of the median nerve. Numbness and paresthesias in the median nerve distribution are the most common symptoms associated with this condition. Persistent median artery is a rare anatomic variation, thrombosis of this additional artery can be responsible for an acute carpal tunnel syndrome, and patients frequently complain about coldness and acute hand swelling. These unusual features must lead clinicians to think of a vascular cause. The diagnosis can be easily confirmed by using ultrasound doppler, but CT-scan and MRI are sometimes helpful. We describe 2 cases of acute carpal tunnel syndrome due to thrombosed persistent median artery, including a case of thromboangiitis obliterans. These thrombosis might also be due to traumatic causes. No guidelines are currently available to help physicians for the management of carpal tunnel syndrome from thrombosed persistent median artery. Antiplatelet therapy, statin, anticoagulant might be helpful, and surgery has sometimes be reported as effective.

Aterosclerosis carotídea en el infarto cerebral aterotrombótico del territorio vascular homónimo / Carotid atherosclerosis in atherothrombotic cerebral infarction of the homonymous vascular territory

Introducción: El eco-Doppler carotídeo es la prueba de elección en el estudio inicial y de seguimiento del ictus aterotrombótico. Objetivo: Describir los hallazgos ecográficos en ambos ejes carotídeos en pacientes con infarto cerebral aterotrombótico del territorio vascular homónimo. Métodos: Se realizó una investigación observacional con todos los pacientes (63), que acudieron al Hospital Militar Central "Dr. Carlos J. Finlay", entre octubre del 2012 y septiembre del 2013, con diagnóstico clínico y tomográfico de infarto cerebral aterotrombótico de territorio anterior, a los que se les realizó eco-Doppler carotídeo. Resultados: Se contabilizaron mayor cantidad de placas de ateromas en el eje carotídeo homolateral al ictus aterotrombótico (54,3 por ciento) y la gran mayoría de estos fueron inestables (98,4 por ciento). La placa tipo III (50 por ciento), la irregularidad del contorno (54,1 por ciento) y la estenosis menor del 49 por ciento (57,6 por ciento) fueron los hallazgos ecográficos que dominaron en el eje contralateral al infarto. En ambas carótidas también fueron las placas tipo III (47,1 por ciento), la irregularidad de los contornos (51,6 por ciento), las estenosis no significativas (54,3 por ciento) y la inestabilidad de estas (94,4 por ciento), las que predominaron. Conclusiones: La aterosclerosis carotídea en el ictus aterotrombótico describe mayoritariamente placas tipo III irregulares, que provocan estenosis menores del 49 por ciento en ambos ejes carotídeos y la inestabilidad es casi constante, con una incidencia ligeramente mayor en el eje carotídeo homolateral al infarto. La frecuencia del resto de las cualidades de las placas de ateromas enunciadas, domina levemente en el eje carotídeo contralateral(AU)

Introduction: Carotid echo-Doppler is the test of choice in the initial and follow-up study of atherothrombotic stroke. Objective: To describe echographic findings in both carotid axes in patients with atherothrombotic cerebral infarction of the homonymous vascular territory. Methods: Sixty-three patients underwent an observational and cross-sectional investigation at Dr. Carlos J. Finlay Central Military Hospital from October 2012 to September 2013. They have a clinical and tomographic diagnosis of atherothrombotic cerebral infarct from the previous territory and the underwent a carotid echo-Doppler. Results: We recorded higher number of atheromatous plaques in the homolateral carotid axis at atherothrombotic stroke (54.3 percent) and the majority was unstable (98.4 percent). Type III plate (50 percent), irregularity of the contour (54.1 percent) and less than 49 percent stenosis (57.6 percent) were the echographic findings that dominated the axis contralateral to the infarction. In both carotids, type III plaques (47.1 percent), irregularity of the contours (51.6 percent), non-significant stenosis (54.3 percent) and instability (94.4 percent) predominated. Conclusions: Carotid atherosclerosis in atherothrombotic stroke mostly describes the presence of irregular, type III plaques that cause stenosis of less than 49 percent in both carotid axes. The instability of them is almost constant, with a slightly higher incidence in the homolateral carotid axis to infarction. The frequency of the rest of the qualities of the listed atheromatous plaques slightly dominates in the contralateral carotid axis(AU)

[Renal artery stenosis long time after renal denervation for resistant hypertension]. / Sténose de l'artère rénale à distance d'une dénervation rénale pour HTA résistante.

The onset of renal artery stenosis following a renal denervation is rare and occurs in the first few months after renal denervation. We report the onset of renal artery stenosis a long time after the renal denervation for resistant hypertension. This is a 74 year-old patient who stopped smoking in 1980 and who was treated for dyslipidemia with a revascularized coronary artery disease in 2011, a well-stabilized peripheral arterial disease since 2001, a stable asymptomatic carotid atheroma and a good kidney function. His hypertension known since 1995 became resistant. After the control of renal arteries by angio-CT scan, he had a renal denervation in October 2012. His blood pressure decreased 3 months later confirmed by self-blood pressure monitoring (SBPM) and ambulatory blood pressure monitoring (ABPM) with a CT scan with a non-significant renal artery stenosis in January 2014. He remained normotensive under treatment until July 2015 but his hypertension became uncontrolled at the end of 2015 then resistant and severe confirmed by SBPM in April 2017, despite a 5-drug antihypertensive treatment associated to atorvastatin and clopidogrel confirmed by SBPM in April 2017. A left post-ostial renal artery stenosis with decrease in size of left kidney and cortex as compared to 2011 was detected at CT and treated by angioplasty. It was associated with a rapid decrease in blood pressure but unfortunately a new increase related to a restenosis occurred at the end of 2017, which justified a new angioplasty. Discussion about the etiology and the management of this renal post-denervation late stenosis.

[Non-palpable testicular tumors in adults: A management based on imaging? Issue from the French Urologic Association Genital Cancer committee's edit]. / Tumeurs testiculaires non palpables chez l'adulte : vers une prise en charge guidée par l'imagerie ? Une mise au point du Groupe organe génitaux externes du comité de cancérologie de l'Association française d'urologie.

BACKGROUND: Help in management of non-palpable testicular tumors. French Urologic Association Genital cancer committee's Edit. OBJECTIVES: To review their characterization at imaging findings of non-palpable testicular tumors. DOCUMENTARY SOURCES: Literature review (PubMed, Medline) of urological and radiological studies dealing with testicular tumors using keywords: non-palpable/incidental testicular tumors; color Doppler ultrasound; US elastography; magnetic resonance imaging; contrast enhanced sonography; partial surgery. RESULTS: Color Doppler is the basic exam. The size, the presence of microlithts/microlithiasis/macrocalcifications, the vascular architecture are major semiological findings to suggest the benign or the malignant nature of the lesion. Other techniques like multiparametric MRI, contrast-enhanced sonography, sonographic elastography are still in evaluation. The frequency of benign tumors such as Leydig cell tumors lead to preservation management, through improved characterization, monitoring or tumorectomy. LIMITS: Non-randomized study - a very few prospective studies. CONCLUSION: The era of total orchiectomy for any uncertain testicular lesion is over. We try the challenge of characterization, and define management's algorithms based on the suspected nature of the tumors.

[Quality standards for ultrasonographic assessment of peripheral vascular malformations and vascular tumors. Report of the french society for vascular medicine. 2018 Update]. / Standards de qualité pour la pratique de l'examen écho-Doppler dans l'étude des malformations et tumeurs vasculaires. Rapport de la Société française de médecine vasculaire (SFMV) : actualisation 2018.

The quality standards of the French Society of Vascular Medicine for the ultrasonographic assessment of vascular malformations are based on the two following requirements: (1) technical know-how: mastering the use of ultrasound devices and the method of examination; (2) medical know-how: ability to adapt the methods and scope of the examination to its clinical indication and purpose, and to rationally analyze and interpret its results. AIMS OF THE QUALITY STANDARDS: To describe an optimal method of examination in relation to the clinical question and hypothesis. To homogenize practice, methods, glossary, and reporting. To provide good practice reference points, and promote a quality process. ITEMS OF THE QUALITY STANDARDS: The 3 levels of examination; their clinical indications and goals. The reference standard examination (level 2), its variants according to clinical needs. The minimal content of the examination report; the letter to the referring physician (synthesis, conclusion and proposal for further investigation and/or therapeutic management). Commented glossary (anatomy, hemodynamics, semiology). Technical bases. Setting and use of ultrasound devices. Here, we discuss ultrasonography methods of using of ultrasonography for the assessment of peripheral vascular malformations and tumors (limbs, face, trunk).

[Left ventricular hypertrophy in chronic hemodialysis patients at CNHU-HKM of Cotonou]. / Hypertrophie ventriculaire gauche chez les hémodialysés chroniques du CNHU-HKM de Cotonou.

INTRODUCTION: Left ventricular hypertrophy (LVH) is a predictor of mortality in hemodialysis. It takes a very high proportion among cardiovascular complications. OBJECTIVE: It was to determine the frequency of LVH and identify its associated factors among chronic hemodialysis patients of CNHU-HKM. METHODS: This is a cross-sectional, descriptive and analytical, which took place 1st February to 31st October 2014. The sample consisted of patients aged over 15 years, chronic hemodialysis for at least 3 months. LVH is defined by a Left Ventricular Mass Index (LVMI)>115 g/m2 for men and >95 g/m2 in women. Doppler ultrasound was performed during 15 to 20 hours after the last hemodialysis session. Factors associated as sociodemographic characteristics, history, biological data, dialysis parameters were sought by logistic regression univariate analysis. The significance level was less than 0.05. RéSULTS: The sample size was 141 patients, 39% of women with a sex-ratio of 1.6. The average age was 50.1±12.3 years. The frequency of hypertension was 67.4%; diabetes: 14.9%; smoking: 9.2%; the rise of the pre-dialysis blood pression: 46.8%. The frequency of LVH was 54.6% and the associated factors were: the elevation of the predialysis blood pression (P=0.04), obesity (P=0.01), central catheter (P=0.03), anemia (P=0.02) and cardiomegaly (P<0.001). CONCLUSION: LVH is frequent in hemodialysis of CNHU-HKM. It is necessary to optimize the hemodialysis sessions and to achieve better management of associated factors.