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2.
Cardiovasc Ultrasound ; 16(1): 22, 2018 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-30285774

RESUMO

BACKGROUND: The detection of regional wall motion abnormalities is the cornerstone of stress echocardiography. Today, stress echo shows increasing trends of utilization due to growing concerns for radiation risk, higher cost and stronger environmental impact of competing techniques. However, it has also limitations: underused ability to identify factors of clinical vulnerability outside coronary artery stenosis; operator-dependence; low positivity rate in contemporary populations; intermediate risk associated with a negative test; limited value of wall motion beyond coronary artery disease. Nevertheless, stress echo has potential to adapt to a changing environment and overcome its current limitations. INTEGRATED-QUADRUPLE STRESS-ECHO: Four parameters now converge conceptually, logistically, and methodologically in the Integrated Quadruple (IQ)-stress echo. They are: 1- regional wall motion abnormalities; 2-B-lines measured by lung ultrasound; 3-left ventricular contractile reserve assessed as the stress/rest ratio of force (systolic arterial pressure by cuff sphygmomanometer/end-systolic volume from 2D); 4- coronary flow velocity reserve on left anterior descending coronary artery (with color-Doppler guided pulsed wave Doppler). IQ-Stress echo allows a synoptic functional assessment of epicardial coronary artery stenosis (wall motion), lung water (B-lines), myocardial function (left ventricular contractile reserve) and coronary small vessels (coronary flow velocity reserve in mid or distal left anterior descending artery). In "ABCD" protocol, A stands for Asynergy (ischemic vs non-ischemic heart); B for B-lines (wet vs dry lung); C for Contractile reserve (weak vs strong heart); D for Doppler flowmetry (warm vs cold heart, since the hyperemic blood flow increases the local temperature of the myocardium). From the technical (acquisition/analysis) viewpoint and required training, B-lines are the kindergarten, left ventricular contractile reserve the primary (for acquisition) and secondary (for analysis) school, wall motion the university, and coronary flow velocity reserve the PhD program of stress echo. CONCLUSION: Stress echo is changing. As an old landline telephone with only one function, yesterday stress echo used one sign (regional wall motion abnormalities) for one patient with coronary artery disease. As a versatile smart-phone with multiple applications, stress echo today uses many signs for different pathophysiological and clinical targets. Large scale effectiveness studies are now in progress in the Stress Echo2020 project with the omnivorous "ABCD" protocol.


Assuntos
Estenose Coronária/diagnóstico por imagem , Estenose Coronária/fisiopatologia , Ecocardiografia sob Estresse/métodos , Insuficiência Cardíaca/diagnóstico por imagem , Ultrassonografia Doppler de Pulso/métodos , Idoso , Circulação Coronária/fisiologia , Ecocardiografia sob Estresse/normas , Feminino , Insuficiência Cardíaca/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Imagem Multimodal/métodos , Contração Miocárdica/fisiologia , Guias de Prática Clínica como Assunto , Sensibilidade e Especificidade , Volume Sistólico/fisiologia
4.
Artigo em Inglês | MEDLINE | ID: mdl-29389652

RESUMO

Quantitative blood velocity measurements, as currently implemented in commercial ultrasound scanners, are based on pulsed-wave (PW) spectral Doppler and are limited to detect the axial component of the velocity in a single sample volume. On the other hand, vector Doppler methods produce angle-independent estimates by, e.g., combining the frequency shifts measured from different directions. Moreover, thanks to the transmission of plane waves, the investigation of a 2-D region is possible with high temporal resolution, but, unfortunately, the clinical use of these methods is hampered by the massive calculation power required for their real-time execution. In this paper, we present a novel approach based on the transmission of plane waves and the simultaneous reception of echoes from 16 distinct subapertures of a linear array probe, which produces eight lines distributed over a 2-D region. The method was implemented on the ULAO-OP 256 research scanner and tested both in phantom and in vivo. A continuous real-time refresh rate of 36 Hz was achieved in duplex combination with a standard B-mode at pulse repetition frequency of 8 kHz. Accuracies of -11% on velocity and of 2°on angle measurements have been obtained in phantom experiments. Accompanying movies show how the method improves the quantitative measurements of blood velocities and details the flow configurations in the carotid artery of a volunteer.


Assuntos
Velocidade do Fluxo Sanguíneo/fisiologia , Ultrassonografia Doppler de Pulso/métodos , Artérias Carótidas/diagnóstico por imagem , Humanos , Processamento de Imagem Assistida por Computador , Imagens de Fantasmas
5.
Ultrasound Med Biol ; 44(3): 593-601, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-29223701

RESUMO

The study described here investigated whether angle-independent vector flow imaging (VFI) technique estimates peak velocities in the portal vein comparably to pulsed wave Doppler (PWD). Furthermore, intra- and inter-observer agreement was assessed in a substudy. VFI and PWD peak velocities were estimated with from intercostal and subcostal views for 32 healthy volunteers, and precision analyses were conducted. Blinded to estimates, three physicians rescanned 10 volunteers for intra- and inter-observer agreement analyses. The precision of VFI and PWD was 18% and 28% from an intercostal view and 23% and 77% from a subcostal view, respectively. Bias between VFI and PWD was 0.57 cm/s (p = 0.38) with an intercostal view and 9.89 cm/s (p <0.001) with a subcostal view. Intra- and inter-observer agreement was highest for VFI (inter-observer intra-class correlation coefficient: VFI 0.80, PWD 0.3; intra-observer intra-class correlation coefficient: VFI 0.90, PWD 0.69). Regardless of scan view, VFI was more precise than PWD.


Assuntos
Veia Porta/fisiologia , Ultrassonografia/métodos , Adulto , Idoso , Velocidade do Fluxo Sanguíneo/fisiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Veia Porta/diagnóstico por imagem , Valores de Referência , Reprodutibilidade dos Testes , Ultrassonografia Doppler de Pulso/métodos
6.
J Clin Ultrasound ; 46(3): 202-208, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29193158

RESUMO

PURPOSE: To study the effects of terlipressin (TP) infusion on systemic perfusion, estimated with pulsed-wave Doppler ultrasonography of systemic arteries, in a population of extremely low birth-weight (ELBW) preterm infants with vasoactive-resistant ductus arteriosus. METHODS: This prospective, observational cohort included, during five years, 12 ELBW infants with hemodynamically significant patent ductus arteriosus and absent or reversed diastolic flow at Doppler ultrasonography of systemic arteries, despite treatment and high-dose vasoactive support. We measured flow velocity of the anterior cerebral, right renal, and superior mesenteric arteries before and after TP infusion. Changes were evaluated by Spearman's rho coefficient analysis, Wilcoxon signed-rank, and Friedman test. RESULTS: Time-averaged mean velocity of the renal artery (P = .028) increased, while renal pulsatility (P = .010) and resistance (P = .004) indexes, and cerebral artery resistance index (P = .021) decreased after TP infusion. Time-averaged mean velocity of the anterior cerebral artery proportionately increased with dopamine dose (rho = 0.678; P = .015), but showed opposite shifts after TP (rho = -0.662; P = .024). CONCLUSIONS: These changes suggest that TP may improve systemic perfusion in the ELBW infants with vasoactive-resistant ductus arteriosus.


Assuntos
Artérias Cerebrais/efeitos dos fármacos , Permeabilidade do Canal Arterial/fisiopatologia , Lipressina/análogos & derivados , Artéria Mesentérica Superior/efeitos dos fármacos , Artéria Renal/efeitos dos fármacos , Ultrassonografia Doppler de Pulso/métodos , Velocidade do Fluxo Sanguíneo/efeitos dos fármacos , Artérias Cerebrais/diagnóstico por imagem , Estudos de Coortes , Permeabilidade do Canal Arterial/tratamento farmacológico , Feminino , Humanos , Recém-Nascido de Peso Extremamente Baixo ao Nascer , Recém-Nascido , Recém-Nascido Prematuro , Doenças do Prematuro , Lipressina/farmacologia , Masculino , Artéria Mesentérica Superior/diagnóstico por imagem , Projetos Piloto , Estudos Prospectivos , Artéria Renal/diagnóstico por imagem , Terlipressina , Ultrassonografia Doppler de Pulso/efeitos dos fármacos , Vasoconstritores/farmacologia
7.
Neurol Res ; 39(9): 837-844, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-28689485

RESUMO

OBJECTIVES: The present study analyzed the effect of therapy with therapeutic ultrasound on the sciatic nerve after compression injury, comparing two similar doses of SATA. METHODS: In total, 32 Wistar rats were used, divided into the following groups: CG - control; IG - compression injury of the sciatic nerve; IGCU - injury and continuous ultrasound; and IGPU - injury and 20% pulsed ultrasound. The treatment with ultrasound started on the 3rd postoperative day, with a frequency of 1 MHz, 0.4 W/cm² (SATA) for IGCU. IGPU received 2.0 W/cm2 (SATP), with 20% of the active cycle, for 3 minutes. The treatment was performed on a daily basis, totaling 15 days of therapy. Evaluations were performed for functional, histological, and morphometric forms. RESULTS: Both the Sciatic Functional Index and the withdrawal threshold and grip strength failed to show an advantage of using therapeutic ultrasound. For the morphometric evaluations of nerve fiber diameter and axons, myelin sheath thickness, and G quotient and nerve fiber estimates, IGPU values were estimated to be significantly lower. The morphological analysis revealed intense inflammatory response and neovascularization, as well as degeneration of axons and the myelin sheath, for the injury group and IGCU; however, IGPU showed greater tissue disorganization. CONCLUSION: There were no significant differences, showing functional or nocicepitive recovery of the treated groups, including with characteristics pointing to the pulsed group with worse results.


Assuntos
Neuropatia Ciática/terapia , Ultrassonografia Doppler de Pulso/métodos , Animais , Modelos Animais de Doenças , Teste de Esforço , Seguimentos , Força da Mão/fisiologia , Masculino , Medição da Dor , Ratos , Ratos Wistar , Neuropatia Ciática/fisiopatologia , Índice de Gravidade de Doença , Estatísticas não Paramétricas , Fatores de Tempo , Resultado do Tratamento
9.
Ann Thorac Surg ; 104(5): 1583-1589, 2017 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-28619541

RESUMO

BACKGROUND: This study sought to determine whether assessment of the renal resistive index (RRI) can predict the short-term reversibility of acute kidney injury (AKI) after repair of acute type A aortic dissection (TAAD). METHODS: This prospective study included 62 patients undergoing repair of acute TAAD. Doppler-based RRIs were obtained preoperatively, immediately after the surgical procedure, and 6, 24, and 48 hours postoperatively. The occurrence of AKI was evaluated daily according to Acute Kidney Injury Network criteria. Persistent AKI was defined as AKI lasting longer than 3 days. The association between the maximum RRI level at different time points and persistent AKI was analyzed by the receiver-operating characteristic curve. RESULTS: Of the 62 patients, 22 (35.5%) had no AKI, 21 (33.9%) had transient AKI, and 19 (30.6%) had persistent AKI. The maximum RRI was 0.67 ± 0.03 (0.62 to 0.71), 0.71 ± 0.05 (0.59 to 0.79), and 0.78 ± 0.05 (0.70 to 0.92) in the no AKI, transient AKI, and persistent AKI groups, respectively. The maximum level of RRI was significantly correlated with that of SCr during the first 48 hours postoperatively (rho = 0.606; p < 0.001). RRI could predict persistent AKI with an area under the receiver-operating characteristic curve of 0.918 (95% confidence interval, 0.850 to 0.986; p < 0.001). A postoperative RRI of 0.725 or higher was a marker for early detection of persistent AKI with high sensitivity and specificity (94.7% and 72.1%, respectively). CONCLUSIONS: An elevated maximum RRI may be a predictor of persistent AKI after repair of acute TAAD. This is helpful for management decision making and improving the prognosis of patients with AKI.


Assuntos
Lesão Renal Aguda/diagnóstico por imagem , Aneurisma Dissecante/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Resistência Vascular/fisiologia , Procedimentos Cirúrgicos Vasculares/efeitos adversos , Lesão Renal Aguda/etiologia , Lesão Renal Aguda/mortalidade , Idoso , Aneurisma Dissecante/complicações , Aneurisma Dissecante/diagnóstico por imagem , Aneurisma da Aorta Torácica/complicações , Aneurisma da Aorta Torácica/diagnóstico por imagem , Estudos de Coortes , Angiografia por Tomografia Computadorizada/métodos , Intervalos de Confiança , Creatinina/sangue , Feminino , Humanos , Testes de Função Renal , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Cuidados Pós-Operatórios/métodos , Valor Preditivo dos Testes , Estudos Prospectivos , Curva ROC , Medição de Risco , Índice de Gravidade de Doença , Taxa de Sobrevida , Resultado do Tratamento , Ultrassonografia Doppler de Pulso/métodos , Procedimentos Cirúrgicos Vasculares/métodos
10.
J Manipulative Physiol Ther ; 40(4): 255-262, 2017 05.
Artigo em Inglês | MEDLINE | ID: mdl-28390708

RESUMO

OBJECTIVES: The purpose of this study was to determine the within-session and between-sessions reliability of measuring the vertebral artery blood flow velocities in people with cervicogenic dizziness using Doppler ultrasound at both upper and lower cervical levels. METHODS: Outcome measures were taken on 2 occasions 3 weeks apart with no active treatment provided in between the assessments on 12 participants. Pulsed-wave Doppler ultrasound was used to quantify time-averaged mean velocities through the vertebral artery at upper cervical (C0-1) and lower cervical vertebrae (C5-6). The clinical outcome measures were also recorded in people with cervicogenic dizziness. The intraclass correlation coefficient (ICC) was used to determine the within-session and between-session repeatability. Paired t test was used to determine the differences in the time-averaged mean velocities of blood flow at the same site of the vertebral artery and the clinical outcome measures in 2 sessions 3 weeks apart. RESULTS: In people with cervicogenic dizziness, there was no significant change in both clinical outcome measures and the time-averaged mean velocities when the patients were measured 3 weeks apart (P > .05). This study identified good within-session (ICC: 0.903-0.967) and between-session (ICC: 0.922-0.984) repeatability in measuring the vertical blood flow velocities in patients with cervicogenic dizziness when the clinical outcome measures were unchanged. CONCLUSIONS: This study supports the use of Doppler ultrasound to identify changes in mean vertebral arterial blood flow velocities before and after intervention in people with cervicogenic dizziness in future studies.


Assuntos
Vértebras Cervicais/diagnóstico por imagem , Tontura/diagnóstico por imagem , Doenças da Coluna Vertebral/complicações , Ultrassonografia Doppler de Pulso/métodos , Artéria Vertebral/diagnóstico por imagem , Adulto , Velocidade do Fluxo Sanguíneo/fisiologia , Vértebras Cervicais/fisiopatologia , Estudos de Coortes , Tontura/etiologia , Tontura/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Reprodutibilidade dos Testes , Medição de Risco , Índice de Gravidade de Doença , Doenças da Coluna Vertebral/diagnóstico por imagem , Doenças da Coluna Vertebral/terapia , Fatores de Tempo
11.
Rev. logop. foniatr. audiol. (Ed. impr.) ; 37(1): 38-42, ene.-mar. 2017. tab, ilus, graf
Artigo em Espanhol | IBECS | ID: ibc-159758

RESUMO

El sonar Doppler es una herramienta que permite captar lo que sucede durante la etapa faríngea de la deglución, siendo el sonido percibido y observado un reflejo parcial de la actividad motora que se desencadena. El presente trabajo indaga acerca de las posibilidades del sonar Doppler y su aplicación en la evaluación funcional de la deglución. Se desarrolla un diseño de investigación observacional y retrospectivo, bajo la metodología de revisión sistemática a partir de material bibliográfico, investigaciones y publicaciones de artículos de revistas en inglés, portugués y español, consultando las bases de datos PubMed, SciELO, EBSCO Host, Scopus, Springer, Cochrane, además de revistas especializadas en ASHA, MedLine, CEFAC y Redalyc. Aunque la fiabilidad y validez en el uso del sonar Doppler para la evaluación funcional de la etapa faríngea de la deglución no están aseguradas, podría llegar a brindar enorme ayuda en el diagnóstico de las aspiraciones y/o penetraciones durante el proceso deglutorio. Se insiste en una constante revisión de la metodología para la detección correcta de los sonidos de la deglución y su posterior análisis e interpretación clínica (AU)


Sonar Doppler is a tool that can capture what happens during the pharyngeal stage of swallowing, being the sound perceived and the noting a partial reflection of the motor activity that is triggered. This paper focuses on the possibilities of sonar Doppler and its application in functional assessment of swallowing. The design of this research is retrospective and observational, developed under the systematic review methodology, from bibliographical material, pieces of research and publications of journal articles in English, Portuguese and Spanish, taking the databases of PubMed, SciELO, EBSCO Host, Scopus, Springer, Cochrane, besides specialized magazines in ASHA, MedLine, CEFAC and Redalyc. Although the reliability and validity in the use of sonar Doppler for the functional evaluation of the pharyngeal stage of swallowing are uncertain, it could provide enormous help in diagnosing aspirations and/or penetrations during the swallowing process. We insist on a constant review of the methodology for the correct detection of sounds of swallowing and subsequent analysis and clinical interpretation (AU)


Assuntos
Humanos , Masculino , Feminino , Deglutição/fisiologia , Deglutição/efeitos da radiação , Transtornos de Deglutição/epidemiologia , Transtornos de Deglutição , Espectrografia do Som/métodos , Fonética , Ultrassonografia Doppler de Pulso/instrumentação , Ultrassonografia Doppler de Pulso/métodos , Estudos Retrospectivos , Reprodutibilidade dos Testes
12.
Klin Med (Mosk) ; 95(2): 132-5, 2017.
Artigo em Russo | MEDLINE | ID: mdl-30303665

RESUMO

A method for diagnostics of systolic function of the right ventricle of the heart in patients with cardiovascular disease is proposed. Its application expands possibilities for detecting disorders of the discharge RV function using a conventional pulsed wave Doppler ultrasonography.


Assuntos
Doenças Cardiovasculares , Ventrículos do Coração/diagnóstico por imagem , Adulto , Idoso , Doenças Cardiovasculares/classificação , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/fisiopatologia , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Ultrassonografia Doppler de Pulso/métodos , Disfunção Ventricular Direita/diagnóstico , Disfunção Ventricular Direita/fisiopatologia
13.
J Cardiothorac Vasc Anesth ; 31(3): 847-852, 2017 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-28017677

RESUMO

OBJECTIVE: To investigate whether an elevated preoperative renal resistive index (RRI) predicts acute kidney injury (AKI) in patients undergoing cardiac surgery. DESIGN: Prospective cohort study. SETTING: University hospital. PARTICIPANTS: Cohort of 96 adult cardiac surgical patients. INTERVENTIONS: Resistive index was measurement the day before surgery. MEASUREMENTS AND MAIN RESULTS: Renal Doppler was used to measure the resistive index in renal cortical or arcuate arteries the day before surgery. An elevated RRI was defined as≥0.7. AKI was defined as an absolute increase in postoperative compared with preoperative serum creatinine levels by≥26 µmol/L or a relative increase by≥50% or a postoperative urine output<0.5 mL/kg for 6 hours or longer. The relative risk of AKI in patients with an elevated RRI compared with those without an elevated RRI was analyzed using logistic regression. Among patients with an RRI<0.7, 6 (16%) developed AKI compared with 21 (36%) with an RRI≥0.7. The mean increases in postoperative serum creatinine levels were 12 µmol/L in those with an RRI<0.7 and 30 µmol/L in those with an RRI≥0.7. The crude odds ratio for AKI in patients with an RRI≥0.7 was 3.03 (1.09-8.42) compared with those with an RRI<0.7. After multivariable adjustment, the odds ratio was 2.95 (0.97-9.00). CONCLUSIONS: Patients with an elevated preoperative RRI have an increased risk of developing AKI after cardiac surgery. In combination with other markers, the RRI might be a tool for identifying patients with an increased risk of developing AKI.


Assuntos
Lesão Renal Aguda/fisiopatologia , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Rim/fisiopatologia , Complicações Pós-Operatórias/fisiopatologia , Cuidados Pré-Operatórios/métodos , Lesão Renal Aguda/diagnóstico por imagem , Lesão Renal Aguda/etiologia , Idoso , Estudos de Coortes , Feminino , Humanos , Rim/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/etiologia , Valor Preditivo dos Testes , Estudos Prospectivos , Fatores de Risco , Ultrassonografia Doppler de Pulso/métodos
14.
Physiol Rep ; 4(21)2016 11.
Artigo em Inglês | MEDLINE | ID: mdl-27905299

RESUMO

Therapeutic approaches to block the progression from acute kidney injury to chronic kidney disease are currently lacking. Endothelin-1 (ET-1) is a powerful vasoconstrictor, induced by hypoxia, and previously implicated in renal ischemia-reperfusion (IR) injury. This study tested the hypothesis that blunting the vascular influence of ET-1, either through endothelin ETA receptor blockade (ABT-627) or vascular endothelial cell deletion of ET-1 (VEET KO), would improve recovery of renal perfusion and repair of injury following a severe ischemic insult in mice (45 min unilateral renal ischemia). Male C57Bl/6 mice receiving vehicle or ABT-627 commencing 2 days prior to surgery, and VEET KO mice and wild-type littermates (WT) underwent 45 min unilateral renal IR surgery followed by 28 days recovery. Renal blood velocity was measured by pulsed-wave Doppler ultrasound before and after surgery. Renal blood velocity was not significantly different between pairs of groups before surgery. Unilateral IR induced a marked reduction in renal blood velocity of the IR kidney at 24 h postsurgery in all groups, which partially recovered but remained below baseline at 28 days post-IR. Despite the lack of effect on renal blood velocity, ETA receptor blockade significantly attenuated the atrophy of the post-IR kidney, whereas this was not significantly affected by lack of endothelial ET-1 expression. These data suggest that although blockade of the ETA receptor is mildly beneficial in preserving renal mass following a severe ischemic insult, this protective effect does not appear to involve improved recovery of renal perfusion.


Assuntos
Lesão Renal Aguda/metabolismo , Endotelina-1/genética , Endotelina-1/fisiologia , Rim/metabolismo , Traumatismo por Reperfusão/metabolismo , Traumatismo por Reperfusão/fisiopatologia , Lesão Renal Aguda/cirurgia , Animais , Atrasentana , Velocidade do Fluxo Sanguíneo/fisiologia , Modelos Animais de Doenças , Progressão da Doença , Antagonistas dos Receptores de Endotelina/farmacologia , Isquemia , Rim/irrigação sanguínea , Rim/fisiologia , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Modelos Animais , Pirrolidinas/farmacologia , Insuficiência Renal Crônica/metabolismo , Traumatismo por Reperfusão/complicações , Traumatismo por Reperfusão/diagnóstico por imagem , Ultrassonografia Doppler de Pulso/métodos , Regulação para Cima/genética
15.
BMC Cardiovasc Disord ; 16(1): 202, 2016 10 26.
Artigo em Inglês | MEDLINE | ID: mdl-27784271

RESUMO

BACKGROUND: Ankle-brachial pressure index-systolic (ABI-s) can be falsely elevated in the presence of calcified lower limb arteries in some diabetic patients and therefore loses its value in this cohort of patients. We aim at investigating the feasibility of using the diastolic (ABI-d) instead of ABI-s to calculate the ABI in diabetic patients with calcified limb arteries. METHODS: A total of 51 patients were chosen from the diabetic foot clinic. Twenty six of these patients had calcified leg arteries by Duplex scan (Group A) and 25 patients did not have calcifications in their leg arteries (Group B). Twenty five healthy volunteers were enrolled in the study for group C and they were matched with other participants from group B and A in age and sex. ABI measurement was performed using "boso ABI-system 100 machine". Systolic ABI (ABI-s) and diastolic ABI (ABI-d) were calculated based on bilateral brachial and ankle oscillometric pressures. ABI is considered normal when it is ≥0.9. Repeated measures ANOVA test was used to test for comparing mean scores for ABI-s and ABI-d across the three groups. Statistical significance is considered when P < .05. RESULTS: The mean age of all participants (±SD) was 64.30 ± 7.1 years (range, 50-82 years). ABI-s mean ± SD was 1.3 ± 0.10 (range, 1.18-1.58) in group A patients, 1.07 ± 0.05 (range, 1-1.16) in group B patients, and 1.06 ± 0.05 (range, 1-1.16) in group C volunteers. While ABI-d mean ± SD was 1.07 ± 0.05 (range, 1.1-1.17) in group A patients, 1.06 ± 0.05 (1-1.14) in group B patients, and 1.05 ± 0.04 (range, 1.01-1.14) in group C volunteers. In group A, repeated measures ANOVA test showed statistical significant difference between ABI-s and ABI-d (P < 0.001) whereas in group B & C was not (P > 0.05). CONCLUSIONS: ABI-d may be helpful and can be used as a complementary measure instead of ABI-s in falsely elevated ABI caused by partial incompressible vessel.


Assuntos
Índice Tornozelo-Braço/métodos , Artéria Braquial/fisiopatologia , Calcinose/fisiopatologia , Pé Diabético/fisiopatologia , Extremidade Inferior/irrigação sanguínea , Oscilometria/métodos , Ultrassonografia Doppler de Pulso/métodos , Idoso , Idoso de 80 Anos ou mais , Pressão Sanguínea , Artéria Braquial/diagnóstico por imagem , Calcinose/diagnóstico , Pé Diabético/diagnóstico , Diástole , Estudos de Viabilidade , Feminino , Artéria Femoral/diagnóstico por imagem , Artéria Femoral/fisiopatologia , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Artéria Poplítea/diagnóstico por imagem , Artéria Poplítea/fisiopatologia , Sístole
16.
Am J Emerg Med ; 34(9): 1859-62, 2016 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-27431739

RESUMO

OBJECTIVE: Monitoring of patient's intravascular volume status without invasive measures remains challenging and unreliable. Our objective was to determine if corrected flow time (FTc) measurement could detect preload reduction with administration of nitroglycerin (NTG) as a surrogate for volume loss. METHODS: Post hoc FTc analysis was performed for a prospective cohort study of pulsed wave spectral Doppler measurements before and after administration of NTG. Patients enrolled were eligible for inclusion if they were admitted to a chest pain center for cardiac evaluation. Descriptive statistics, t tests, bivariate regression, and intraclass correlation coefficient were performed as appropriate. RESULTS: Fifty-four patients had Doppler measurements available for review. Mean FTc decreased from 339 milliseconds (95% confidence interval, 332-346) to 325 milliseconds (95% confidence interval, 318-331) with administration of 0.3 mg of sublingual NTG (P=.0001). Mean heart rate increased 5 beats/min with administration of NTG (P<.0001); however, there was no significant change in systolic or diastolic blood pressure. CONCLUSION: Corrected flow time was able to detect a significant difference in preload reduction with 0.3 mg of NTG. The FTc may be an early reliable noninvasive measure to detect changes in intravascular volume status.


Assuntos
Velocidade do Fluxo Sanguíneo/fisiologia , Volume Sanguíneo/efeitos dos fármacos , Artéria Braquial/diagnóstico por imagem , Doença da Artéria Coronariana/fisiopatologia , Nitroglicerina/administração & dosagem , Ultrassonografia Doppler de Pulso/métodos , Administração Sublingual , Artéria Braquial/fisiopatologia , Doença da Artéria Coronariana/diagnóstico , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Vasodilatadores/administração & dosagem
17.
ABC., imagem cardiovasc ; 29(2): 58-62, abr.-jun. 2016. ilus, graf
Artigo em Português | LILACS | ID: lil-786647

RESUMO

A síndrome do roubo da subclávia refere-se a uma desordem vascular na qual ocorre inversão do fluxo de sangue da artéria vertebral ipsilateral, decorrente de uma estenose proximal à sua origem, geralmente uma oclusão da artéria subclávia ou, mais raramente, do troncobraquiocefálico. É uma doença relativamente rara, relatadaem aproximadamente 6% dos pacientes assintomáticos com sopros cervicais. O Doppler pulsado (PW) é útil na análiseda artéria vertebral, registrando informações capazes de identificar a presença da Síndrome do Roubo da Subclávia. Com base nas alterações hemodinâmicas da artéria vertebralavaliadas pelo estudo com Doppler espectral, pode ser classificada nos tipos 1 (oculto), 2 (intermitente ou parcial)e 3 (completo). Com o advento da angioplastia transluminal percutânea e, em seguida, dos stents, muitos advogam essa combinação de procedimentos como o tratamento de escolha dos casos sintomático dessa síndrome.


Assuntos
Humanos , Artéria Vertebral/fisiopatologia , Síndrome do Roubo Subclávio/terapia , Ultrassonografia Doppler de Pulso/métodos , Angiografia/métodos , Fatores de Risco , Stents
19.
Radiología (Madr., Ed. impr.) ; 58(supl.2): 129-141, mayo 2016. ilus
Artigo em Espanhol | IBECS | ID: ibc-153299

RESUMO

La ecografía transfontanelar es una técnica diagnóstica ampliamente utilizada en el estudio de la neuroanatomía y patología propia del encéfalo neonatal gracias a sus múltiples ventajas, como la ausencia de radiaciones, disponibilidad, portabilidad y bajo coste. El desarrollo de equipos más potentes junto con la mejora de sondas microcurvadas y lineares de distintas frecuencias ha permitido una ostensible mejoría en la calidad de la imagen ecográfica del cerebro neonatal. Para obtener el máximo rendimiento de esta técnica es importante familiarizarse con la anatomía y patología neurológica de este grupo de edad. De hecho, es la primera técnica en el estudio de complicaciones a corto y medio plazo de los recién nacidos prematuros. En el neonato a término es muy útil para abordar múltiples situaciones clínicas, ya que permite seleccionar qué pacientes se beneficiarán de otras técnicas invasivas, más caras o que requieran sedación, como la resonancia magnética. Sus desventajas son ser operador dependiente y la necesidad de una adecuada ventana acústica. Tiene limitaciones en el estudio de la patología traumática obstétrica, la valoración de la patología malformativa compleja y el daño de la sustancia blanca. Con los conocimientos básicos de neurología neonatal, el equipamiento apropiado y una técnica cuidadosa que incluya el uso de distintas fontanelas, es un método fiable que permite el diagnóstico y seguimiento de patologías tanto congénitas como adquiridas en el neonato (AU)


Transfontanellar ultrasound is widely used to study neonatal neuroanatomy and disease. This technique has many advantages, such as the absence of ionizing radiation and its wide availability, portability, and low cost. The development of more powerful ultrasound scanners and improved microcurved and linear probes of different frequencies have resulted in improved image quality. To take full advantage of this technique, it is important to know the normal and pathologic anatomy in neonates. Transfontanellar ultrasound is the first-line technique for studying short-term and mid-term complications in premature newborns. In full-term newborns, it is very useful in many clinical situations, making it possible to select which patients will benefit from other techniques that are more invasive or more expensive, or that require sedation, such as MRI. The disadvantages of the technique are that it is operator dependent and that an appropriate acoustic window is necessary. It also has limitations in the study of obstetric trauma, in the evaluation of complex malformations, and in the assessment of damage to white matter. With a basic understanding of neonatal neurology, the appropriate equipment, and a careful technique taking advantage of the different fontanels, transfontanellar ultrasound is a reliable method that makes it possible to diagnose and follow up both congenital and acquired conditions in neonates (AU)


Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Fontanelas Cranianas , Ecoencefalografia/instrumentação , Ecoencefalografia/métodos , Ultrassonografia Doppler Transcraniana/instrumentação , Ultrassonografia Doppler Transcraniana/métodos , Ultrassonografia Doppler Transcraniana , Ultrassonografia Doppler Transcraniana/classificação , Ultrassonografia Doppler Transcraniana/ética , Ultrassonografia Doppler Transcraniana/normas , Doenças do Prematuro , Recém-Nascido Prematuro/fisiologia , Ultrassonografia Doppler de Pulso/métodos
20.
Medicine (Baltimore) ; 95(10): e3055, 2016 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-26962832

RESUMO

The aim of the study is to evaluate the relationship between Humphrey visual field progression and peripheral vascular endothelial function in patients with open-angle glaucoma (OAG), assessed by noninvasive endothelium-dependent flow-mediated vasodilation (FMD).Forty OAG patients, among which 22 had normal-tension glaucoma (NTG) and 18 had primary open-angle glaucoma (POAG) were enrolled. Each enrolled patient underwent a thorough ophthalmological examination including the Humphrey visual field test and measurement of FMD via high-resolution 2-dimensional ultrasonographic imaging of the brachial artery. Blood samples were evaluated for biochemistry and lipid profiles as well as levels of high-sensitivity C-reactive protein (hsCRP). The annual change of threshold sensitivity of the visual field in each test location were analyzed with pointwise linear regression. The correlation between long-term visual field progression and FMD was evaluated.A mean follow-up of 7.47 ±â€Š1.84 years revealed a faster progression rate over the superior visual field in all 40 OAG patients (superior field -0.24 ±â€Š0.67 dB/y, inferior field -0.10 ±â€Š0.59 dB/y, P = 0.37). However, only the annual sensitivity change of the inferior peripheral field showed correlation with baseline FMD. There was no significant difference in the change slope of visual field between NTG and POAG patients.A correlation between baseline brachial artery FMD and visual field progression was observed in the inferior peripheral field in patients with NTG and POAG. This result suggests that peripheral vascular endothelial dysfunction may be related to glaucoma progression.


Assuntos
Artéria Braquial/diagnóstico por imagem , Endotélio Vascular/fisiopatologia , Glaucoma de Ângulo Aberto/fisiopatologia , Pressão Intraocular/fisiologia , Vasodilatação/fisiologia , Campos Visuais/fisiologia , Adulto , Artéria Braquial/fisiopatologia , Progressão da Doença , Feminino , Glaucoma de Ângulo Aberto/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Ultrassonografia Doppler de Pulso/métodos , Testes de Campo Visual
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