Association between Flow-Mediated Dilation and Skin Perfusion Pressure with Peripheral Artery Disease in Hemodialysis Patients.

Flow-mediated dilation (FMD) is used to noninvasively assess the health of blood vessels and it has been shown to have a similar predictive ability for cardiovascular disease to traditional risk factors. Skin perfusion pressure (SPP) refers to the blood pressure required to restore capillary or microcirculatory flow after controlled occlusion and the return of flow. SPP has been shown to be an important measurement when making clinical decisions for patients with limb ischemia and to be a predictor of the likelihood of wound healing. Peripheral artery disease is common in hemodialysis (HD) patients. However, little is known about the association between FMD or SPP and peripheral artery disease. The aim of this study was to evaluate the association between FMD and SPP with brachial-ankle pulse wave velocity (baPWV) and ankle-brachial index (ABI) in HD patients in Taiwan, an area with a high rate of ESRD. This study was conducted at a regional hospital in southern Taiwan. ABI and baPWV values were measured using an ABI automated device. FMD and SPP were measured using ultrasound and a microvasculature blood flow monitor, respectively. Eighty patients were enrolled in this study. Compared to the patients with an ABI ≥ 0.95, those with an ABI < 0.95 had lower SPP of the feet (dorsal and plantar portions, both p < 0.001). After multivariable adjustments, low triglycerides (p = 0.033) and high calcium-phosphate product (p = 0.018) were significantly associated with low FMD. Further, low ABI (p = 0.001) and low baPWV (p = 0.036) were significantly associated with low SPP of dorsal portions. Old age (p = 0.005), low high-density lipoprotein cholesterol (p = 0.016), and low ABI (p = 0.002) were significantly associated with low SPP of plantar portions. This study demonstrated an association between FMD and SPP with peripheral artery disease in HD patients. Patients with low ABI and baPWV had a high risk of low SPP of the feet. However, there was no significant correlation between FMD and ABI or baPWV.

Spontaneous esophageal rupture following perforated peptic ulcer: a report of two cases.

BACKGROUND: Spontaneous esophageal rupture, also called Boerhaave's syndrome, is relatively uncommon but may result in high morbidity and mortality. Synchronous presentation of spontaneous esophageal rupture and perforated peptic ulcer was rare and may contribute to the difficulty of achieving a correct diagnosis. CASE PRESENTATION: We reported two patients with spontaneous esophageal rupture following perforated peptic ulcer. Both patients were successfully treated with thoracoscopic primary repair of esophageal rupture. The first patient underwent peptic ulcer repair via laparotomy. The second patient underwent laparoscopic duodenorrhaphy. Both patients resumed oral intake smoothly and were discharged uneventfully. CONCLUSION: Minimally invasive approaches are safe and feasible for both esophageal rupture and perforated peptic ulcer in patients diagnosed within 24 h and without shock.

An Improved Element Design for 64-Channel Planar Imaging.

Investigation of highly accelerated MRI has developed into a lively corner in the hardware and methodology arena in recent years. At the extreme of (one-dimensional) acceleration, our group introduced Single Echo Acquisition (SEA) imaging, in which the need to phase encode a 64×N(readout) image is eliminated and replaced with the well-localized spatial information obtained from an array of 64 very narrow, long, parallel coils. The narrow coil width (2mm) that facilitates this is accompanied by a concomitant constraint on the useful imaging depth. This note describes a 64-element planar array, constructed within the same 8×13cm total footprint as the original SEA array, still enabling full acceleration in one dimension, but with an element design modified to increase the imaging depth. This was accomplished by lowering the outer conducting legs of the planar pair with respect to the center conductor and adding a geometric decoupling configuration away from the imaging field of view. The element has been called a dual-plane pair in that the current carrying rungs in the imaging FOV function exactly as the planar pair, but are simply placed in two separate planes (sides of PCB in this case).

Highly parallel transmit/receive systems for dynamic MRI.

Dynamic MRI continues to grow in interest and capability with the introduction of 64 and 128 channel receivers, and, more recently, 8 and 16 channel parallel transmitters. This talk will describe progress in developing a 64 channel transmitter and applications in high-speed MR imaging, reaching 1000 frames per second.

An insertable P-31 RF coil for dual-frequency magnetic resonance imaging & spectroscopy.

Application of nuclear magnetic resonance spectroscopy in metabolic studies usually includes simultaneous excitation at two different frequencies. RF coupling between the two coils has been a problem in the past, resulting in reduced field strength from the (1)H coil. A modular surface coil was designed and constructed for (1)H and (31)P at 4.7 Tesla; RF traps were designed and optimized to minimize the field-degrading coupling current, and trap performance was analyzed in terms of improvement in signal-to-noise-ratio and field sensitivity pattern of the proton coil. The modular design in conjunction with the optimized traps permits the possibility of insertion of the phosphorus coil as an 'add on' into any other hydrogen coil.

A simple approach to overcoming mutual coupling effects in some transmit array coils for magnetic resonance imaging.

Single Echo Acquisition (SEA) is a method of completely parallel MR imaging that uses coil elements for spatial localization during receive, replacing the need for phase encoding repetitions. In this receive-only form, SEA imaging requires the use of a phase compensation gradient, the value of which is dependent on coil geometry, imaging distance from the elements, and element orientation. Operation of the arrays in transmit-receive mode, while adding significant complexity, is one potential method of eliminating the restrictions imposed by the phase compensation gradient. This abstract examines a straightforward current-splitting technique to enable parallel transmission for studying the complicated field interactions of these array coils in transmit mode.