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1.
Rev Assoc Med Bras (1992) ; 66(9): 1180-1186, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33027442

RESUMO

INTRODUCTION: The vascular evaluation of the erectile function through Color Duplex-Doppler Ultrasound (CDDU) of the penis can benefit the therapeutic decision-making process. Unfortunately, there is no standard procedure for CDDU conduction, a fact that results in high result-interpretation variability. OBJECTIVE: The aims of this review are to promote greater standardization during CDDU of the penis and discuss the fundamental principles for its accurate conduction. METHODS: CDDU is initially conducted with the penis in the flaccid state; the whole penis must be assessed (images at B mode) with a high-frequency linear transducer (7.5-18 MHz). Intracavernous injection of vasodilating agents (prostaglandin E1, papaverine, phentolamine) is performed to induce a rigid erection. Serial measurements at different times should be taken during the CDDU session and penile rigidity must be assessed in each evaluation. RESULTS: It is important to monitor the erection response after the vasoactive agent (hardness scale), and scanning during the best-quality erection should be contemplated. Manual self-stimulation, audiovisual sexual stimulation (AVSS), and vasoactive agent re-dosing protocols must be taken into account to reduce the influence of psychogenic factors and to help the patient to get the hardest erection possible. Such measurements contribute to the maximal relaxation of the erectile tissue, so the hemodynamic parameters are not underestimated. CONCLUSIONS: CDDU is a relevant specialized tool to assess patients with erectile dysfunction; therefore, this guideline will help to standardize and establish uniformity in its conduction and interpretation, taking into consideration the complexity and heterogeneity of CDDU evaluations of the penis.


Assuntos
Pênis , Disfunção Erétil , Hemodinâmica , Humanos , Masculino , Ereção Peniana , Ultrassonografia Doppler em Cores
2.
Rev Col Bras Cir ; 47: e20202481, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-32965301

RESUMO

OBJECTIVE: Endovascular treatment for femoropopliteal arterial disease has made revascularization procedures less invasive, but the self-expanding stents used can suffer great wear in arteries with extreme mobility. To evaluate the prevalence of fractures in stents implanted in the femoropopliteal segment, to identify predisposing factors and consequences on arterial patency. METHOD: between March and June 2019, thirty patients previously operated for femoropopliteal obstruction underwent stent X-rays in anteroposterior and lateral views to detect fractures and Doppler to analyze arterial patency. RESULTS: we observed 12 cases with fractures (33.3%): 1 type I (2.8%), 3 type II (8.3%), 5 type III (13.9%), 3 type IV (8.3%) and no type V. According to the TASC II we had 1 in group B (8.3%), 6 in group C (50%) and 5 in group D (41.6%) p <0.004. The number of stents per limb was 3.1 (± 1.3) in cases of fracture versus 2.3 (± 1.3) in cases without fracture (p = 0.08). The extension was 274.17mm (± 100.94) in cases of fracture and 230.83mm (± 135.44) in cases without fracture (p = 0.29). On Doppler we had: 17 patients (47.2%) without stenosis, 9 patients (25%) with stenosis> 50% and 10 patients (27.8%) with occlusion (p = 0.37). There was no correlation between fracture and arterial obstruction (p = 0.33). CONCLUSION: stent fractures are a frequent finding in the femoropopliteal area (33.3%), being more prevalent in cases of more advanced disease (C and D). There was no association between the finding of fracture and arterial obstruction.


Assuntos
Procedimentos Endovasculares/métodos , Doença Arterial Periférica , Doenças Vasculares Periféricas/terapia , Artéria Poplítea , Falha de Prótese , Stents , Ultrassonografia Doppler em Cores/métodos , Humanos , Perna (Membro)/irrigação sanguínea , Doenças Vasculares Periféricas/diagnóstico por imagem , Prevalência , Desenho de Prótese , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento , Grau de Desobstrução Vascular
3.
Medicine (Baltimore) ; 99(31): e21432, 2020 Jul 31.
Artigo em Inglês | MEDLINE | ID: mdl-32756152

RESUMO

INTRODUCTION: A cesarean scar pregnancy (CSP), when combined with an arteriovenous malformation (AVM), is a rare, but potentially life-threatening condition that may be associated with uncontrolled hemorrhage. Hysterectomy is indicated when conservative treatment fails. Preservation of fertility is challenging. PATIENT CONCERNS: We reported a 33-year-old woman with a CSP combined with an AVM who failed methotrexate administration as conservative treatment. DIAGNOSES: A CSP combined with an AVM was diagnosed via three-dimensional color Doppler angiogram and magnetic resonance imaging. INTERVENTIONS: Transvaginal removal of the ectopic gestation and repair of the uterine defect was performed without incident. OUTCOMES: The fertility of the patient was preserved and hysterectomy was avoided. CONCLUSION: Transvaginal fertility-sparing surgery may be successfully performed to prevent hysterectomy when conservative treatment fails in patients with a CSP combined with an AVM.


Assuntos
Malformações Arteriovenosas/complicações , Malformações Arteriovenosas/cirurgia , Cicatriz/patologia , Preservação da Fertilidade/métodos , Adulto , Angiografia/métodos , Antimetabólitos Antineoplásicos/administração & dosagem , Antimetabólitos Antineoplásicos/uso terapêutico , Malformações Arteriovenosas/diagnóstico por imagem , Malformações Arteriovenosas/tratamento farmacológico , Cesárea/efeitos adversos , Cicatriz/cirurgia , Feminino , Humanos , Imageamento Tridimensional/métodos , Imagem por Ressonância Magnética/métodos , Metotrexato/administração & dosagem , Metotrexato/uso terapêutico , Gravidez , Gravidez Ectópica/cirurgia , Resultado do Tratamento , Ultrassonografia Doppler em Cores/métodos
4.
Zhonghua Yi Xue Za Zhi ; 100(32): 2507-2510, 2020 Aug 25.
Artigo em Chinês | MEDLINE | ID: mdl-32829597

RESUMO

Objective: To study the value of color doppler ultrasonography (CDU) in diagnosis of impending ruptured abdominal aortic aneurysm (IRAAA). Methods: A total of 35 cases with IRAAA which were identified by CDU in our department from June 2014 to June 2019 were retrospectively analyzed. All the patients were detected by computed tomographic angiography (CTA). The types, length of the neck of aneurysm, largest diameter, thrombosis, involvement of common iliac artery and impending ruptured conditions were compared. The postoperative patients were followed-up by CDU and CTA (mean time was 2.6 months). Results: Among 35 patients, CDU diagnosed that 5 cases were pararenal types and 30 cases were infrarenal types. CTA showed that 4 cases were pararenal types and 31 cases were infrarenal types. The misdiagnosis rate of CDU was 2.9% (1/35). CDU showed that bilateral common iliac arteries were involved in 21 cases, right common iliac arteries were involved in 3 cases, and left common iliac arteries were involved in 2 cases. CTA detected the same results. There was no statistical difference between CDU and CTA for detection of the largest anteroposterior diameter, transverse diameter and the thickness of thrombosis (P values were 0.354, 0.310 and 0.865). There was statistical difference in the detection of the length of the aneurysm's neck (P=0.006). CDU showed 3 cases of focal wall discontinuity, 4 cases of hyperattenuating crescent sign, 3 cases of thrombus fissuration and 2 cases of saclike protuberance, which were consistent with the detection of CTA. CDU showed that locally thin wall of aneurysm was detected in the rest of 23 cases. CTA showed 2 patients were negative. The misdiagnosis rate of CDU was 5.7% (2/35). Three cases did not undergo surgery. Open repairs (OR) were performed in 5 cases. Endovascular aneurysm repairs (EVAR) were performed in 27 cases. The postoperative patients were followed up by CDU and CTA at 1 month, 3 months, 6 months and 12 months. All the artificial blood vessels and stents were patent. Endoleak was observed in 5 cases. Aneurysm sac thrombosis was found in the rest of the cases. Conclusions: CDU plays an important role in the analysis and diagnosis of the size, range, and the impending ruptured symptoms of the aneurysm. It provides a reliable basis for IRAAA screening, diagnosis and postoperative follow-up, and has important clinical value.


Assuntos
Aneurisma da Aorta Abdominal/cirurgia , Implante de Prótese Vascular , Procedimentos Endovasculares , Endoleak , Humanos , Estudos Retrospectivos , Stents , Resultado do Tratamento , Ultrassonografia Doppler em Cores
5.
Medicine (Baltimore) ; 99(31): e21545, 2020 Jul 31.
Artigo em Inglês | MEDLINE | ID: mdl-32756211

RESUMO

Traditional open surgery (OS) is usually necessary when testicular torsion (TT) cannot be excluded by scrotal ultrasound. Scrotoscopy has been used as a minimally invasive technique to diagnose or treat scrotal diseases, and it may also play a role in diagnosing TT.A retrospective analysis was performed for patients with TT to evaluate the consistency of scrotoscopy and OS in the diagnosis of TT. In the cases where preoperational Color Doppler ultrasonography was performed, scrotoscopy, open surgery, and confirmed TT were included for future analysis.A total of 43 patients were studied. Twisted testes were retained in 11 cases (25.59%), and the remaining 32 patients (74.41%) underwent orchiectomy. There were significant differences in the diagnostic value between the grading of scrotoscopy and ultrasound, as well as between ultrasound grading and blood supply grading (BSG) (both P < .05). However, no significant difference was observed between the grading of scrotoscopy and BSG in traditional OS (P > .05), but a high degree of consistency existed between scrotoscopy grading and BSG in traditional OS (Kappa = 0.733, P ≤ .001).Our limited data indicate that the diagnosis of testicular torsion by scrotoscopy is highly consistent with that of traditional surgical exploration. Therefore, further studies are necessary to confirm its application value in the future. Scrotoscopy may have potential application value for the patients whom testicular torsion are insufficiently diagnosed but cannot be excluded.


Assuntos
Endoscopia/métodos , Escroto/cirurgia , Torção do Cordão Espermático/cirurgia , Procedimentos Cirúrgicos Urológicos Masculinos/métodos , Adolescente , Humanos , Masculino , Orquiectomia/efeitos adversos , Orquiectomia/métodos , Estudos Retrospectivos , Escroto/diagnóstico por imagem , Torção do Cordão Espermático/diagnóstico por imagem , Torção do Cordão Espermático/patologia , Ultrassonografia Doppler em Cores , Procedimentos Cirúrgicos Urológicos Masculinos/efeitos adversos , Procedimentos Cirúrgicos Urológicos Masculinos/instrumentação , Adulto Jovem
6.
Plast Reconstr Surg ; 146(2): 227-237, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32740566

RESUMO

BACKGROUND: Preoperative planning of microsurgical perforator free flaps continues to be a discussion topic among microsurgeons. The purpose of this study was to compare the ability of three methods of preoperative vascular mapping-hand-held Doppler imaging, color Doppler ultrasonography, and computed tomographic angiography-to detect perforators and their concordance with surgical findings. METHODS: A prospective study was performed to evaluate the sensitivity, specificity, and accuracy of hand-held Doppler imaging, color Doppler ultrasonography, and computed tomographic angiography to detect free flap perforators. Each patient undergoing a free flap reconstruction was studied preoperatively with the three methods, and the results were compared to the intraoperative findings. RESULTS: Fifty-three patients undergoing autologous tissue reconstruction were included. Most reconstructions (71.7 percent) were performed with anterolateral thigh flaps. The positive predictive value (color Doppler ultrasonography, 100 percent; computed tomographic angiography, 100 percent; hand-held Doppler imaging, 88.6 percent) and negative predictive value (color Doppler ultrasonography, 100 percent; computed tomographic angiography, 94.3 percent; hand-held Doppler imaging, 90.5 percent) rates were significantly different between methods. The high resolution of the color Doppler ultrasonography probe provided a direct vision of the vasculature arborization and efficiently detected vessels with diameters of less than 0.5 mm. The sensitivity, specificity, and accuracy of color Doppler ultrasonography were greater than those of both computed tomographic angiography and hand-held Doppler imaging. There was 100 percent concordance between color Doppler ultrasonography perforators and the surgical findings. CONCLUSIONS: Color Doppler ultrasonography provides a reproducible, harmless, and accurate way to visualize vascular anatomy. It has a high correlation with the surgical findings, signifying advantages over hand-held Doppler and computed tomographic angiography in sensitivity, specificity, and accuracy. CLINICAL QUESTION/LEVEL OF EVIDENCE: Diagnostic, II.


Assuntos
Angiografia por Tomografia Computadorizada/métodos , Computadores de Mão , Retalho Perfurante/irrigação sanguínea , Procedimentos Cirúrgicos Reconstrutivos/métodos , Ultrassonografia Doppler em Cores/métodos , Doenças Vasculares/cirurgia , Procedimentos Cirúrgicos Vasculares/métodos , Adulto , Idoso , Feminino , Seguimentos , Humanos , Masculino , Microcirurgia/métodos , Pessoa de Meia-Idade , Estudos Prospectivos , Curva ROC , Reprodutibilidade dos Testes , Resultado do Tratamento , Doenças Vasculares/diagnóstico
7.
Medicine (Baltimore) ; 99(34): e21341, 2020 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-32846755

RESUMO

This study investigated the clinicopathological traits and ultrasound features (including 2-dimensional and color Doppler ultrasound) of female genital system malignant lymphomas and explored the diagnostic performance of ultrasonography in this disease.Cases of female pelvic lymphoma diagnosed and treated at our hospital between July 2009 and July 2019 were included in this study. Pathological data and ultrasonic manifestations were assessed retrospectively to summarize the clinical traits and ultrasonic features of female genital system lymphoma (FGSL). Based on the results, recommendations for ultrasonography-based diagnosis of this disease are proposed.During the 10-year study period, 20 female patients were diagnosed with malignant lymphomas in the pelvic cavity based on postoperative pathology tests. The age of the patients ranged from 11 to 83 years, and no patients demonstrated specific clinical traits; however, examination of tumor biomarkers revealed that certain patients had elevated levels of CA125. Twenty-eight lesions were identified in the 20 patients, including 24 involving the reproductive system. The primary ultrasonic manifestations were hypoechoic or extremely hypoechoic solid lesions that were relatively large in size, had a relatively regular shape, and had clear boundaries. Certain patients had concurrent ascites, and although some lesions lacked blood supply, most lesions had medium to abundant blood flow, which was largely characterized by low resistance. Almost none of the lesions were definitively diagnosed preoperatively.Diagnosing malignant lymphomas in the female genital tract remains a considerable clinical challenge. Although certain clinical traits and ultrasonic features are associated with this disease and color Doppler ultrasonography might provide vital information indicating the presence of lymphoma, the final diagnosis depends on the clinical and pathological test results of the patients.


Assuntos
Neoplasias dos Genitais Femininos/diagnóstico por imagem , Linfoma/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Feminino , Humanos , Pessoa de Meia-Idade , Estudos Retrospectivos , Ultrassonografia Doppler em Cores
8.
PLoS One ; 15(8): e0237634, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32813729

RESUMO

INTRODUCTION: Subtalar joint (STJ) dysfunction can contribute to movement disturbances. Vibration energy with color Doppler imaging (VECDI) may be useful for detecting STJ stiffness changes. OBJECTIVES: (1) Support proof-of-concept that VECDI could detect STJ stiffness differences; (2) Establish STJ stiffness range in asymptomatic volunteers; (3) Examine relationships between STJ stiffness and foot mobility; and (4) Assess VECDI precision and reliability for examining STJ stiffness. METHODS: After establishing cadaveric testing model proof-of-concept, STJ stiffness (threshold units, ΔTU), ankle complex passive range-of-motion (PROM) and midfoot-width-difference (MFWDiff) data were collected in 28 asymptomatic subjects in vivo. Three reliability measurements were collected per variable; Rater-1 collected on all subjects and rater-2 on the first ten subjects. Subjects were classified into three STJ stiffness groups. RESULTS: Cadaveric VECDI measurement intra-rater reliability was 0.80. A significantly lower STJ ΔTU (p = .002) and ankle complex PROM (p < .001) was observed during the screw fixation versus normal condition. A fair correlation (r = 0.660) was observed between cadaveric ΔTU and ankle complex PROM. In vivo VECDI measurements demonstrated good intra-rater (0.76-0.84) versus poor inter-rater (-3.11) reliability. Significant positive correlations were found between STJ stiffness and both dorsum (r = .440) and posterior (r = .390) PROM. MFWDiff exhibited poor relationships with stiffness (r = .103) and either dorsum (r = .256) or posterior (r = .301) PROM. STJ stiffness ranged from 2.33 to 7.50 ΔTUs, categorizing subjects' STJ stiffness as increased (n = 6), normal (n = 15), or decreased (n = 7). Significant ANOVA main effects for classification were found based on ΔTU (p< .001), dorsum PROM (p = .017), and posterior PROM (p = .036). Post-hoc tests revealed significant: (1) ΔTU differences between all stiffness groups (p < .001); (2) dorsum PROM differences between the increased versus normal (p = .044) and decreased (p = .017) stiffness groups; and (3) posterior PROM differences between the increased versus decreased stiffness groups (p = .044). A good relationship was found between STJ stiffness and dorsum PROM in the increased stiffness group (r = .853) versus poor, nonsignificant relationships in the normal (r = -.042) or decreased stiffness (r = -.014) groups. CONCLUSION: PROM may not clinically explain all aspects of joint mobility. Joint VECDI stiffness assessment should be considered as a complimentary measurement technique.


Assuntos
Pé/fisiopatologia , Artropatias/fisiopatologia , Articulação Talocalcânea/fisiopatologia , Ultrassonografia Doppler em Cores/métodos , Adulto , Fenômenos Biomecânicos , Feminino , Pé/diagnóstico por imagem , Humanos , Artropatias/diagnóstico por imagem , Masculino , Movimento , Estudo de Prova de Conceito , Amplitude de Movimento Articular , Reprodutibilidade dos Testes , Articulação Talocalcânea/diagnóstico por imagem , Vibração , Adulto Jovem
9.
Medicine (Baltimore) ; 99(27): e21129, 2020 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-32629747

RESUMO

RATIONALE: The left internal jugular vein has a higher possibility of anatomical variation than the right side. Therefore, the complication risk during cannulation is expected to be higher. PATIENT CONCERNS: A 74-year-old woman was scheduled for elective surgery for left upper lobe wedge resection. We observed an anatomical abnormality at the location of the common carotid artery (CCA) and left internal jugular vein (IJV). DIAGNOSIS: During the ultrasound, the left IJV was detected at the medial side of the CCA, and this anatomical variation was confirmed by color Doppler ultrasonography. Enhanced chest computed tomography showed that the left CCA ran across the left IJV from medial to lateral at the level of the clavicle. INTERVENTION: A triple-lumen central venous catheter was inserted at the right IJV to avoid complications caused by the anatomical variation. OUTCOMES: There were no intraoperative or postoperative complications. LESSONS: Anesthesiologists should consider anatomical variation during central venous cannulation, especially with the left IJV approach. Because of anatomical variation, ultrasound-guided intervention is highly recommended to prevent procedure-related complications.


Assuntos
Cateterismo Venoso Central/métodos , Veias Jugulares/diagnóstico por imagem , Aspergilose Pulmonar/cirurgia , Ultrassonografia de Intervenção/métodos , Idoso , Variação Anatômica , Artéria Carótida Primitiva/diagnóstico por imagem , Feminino , Humanos , Veias Jugulares/anatomia & histologia , Aspergilose Pulmonar/diagnóstico por imagem , Aspergilose Pulmonar/patologia , Tórax/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento , Ultrassonografia Doppler em Cores/métodos
10.
Niger Postgrad Med J ; 27(3): 242-247, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32687126

RESUMO

Giant prostatic enlargement often referred to as giant prostatic hyperplasia (GPH) is a rare condition described as a massive prostatic enlargement >500 g. Up until now, the total number of GPH reported worldwide in medical literature is < 30. To the best of our knowledge, only one case of a giant prostate has been reported in Nigeria. We report a case of a giant prostatic enlargement treated by open simple retropubic prostatectomy in a 73-year-old man who was suffering from lower urinary tract symptoms and persistent visible (gross) haematuria necessitating repeated blood transfusions. Transrectal ultrasound (TRUS) scan revealed a markedly enlarged prostate measuring 565 ml with a suspicious nodule and prostate-specific antigen level of 48.5 ng/ml. He had a 20-core TRUS-guided prostatic biopsy which showed benign prostatic hyperplasia. We performed a retropubic open simple prostatectomy for complete enucleation of the adenoma. Specimen weighed 512.5 g with dimensions of 17 cm × 16 cm and a volume of 528 ml. Histological examination showed prostatic fibromuscular hyperplasia with a focus of adenocarcinoma. The patient had an uneventful post-operative recovery and was discharged within a week post-surgery. Urethral catheter was removed after 2 weeks with satisfactory outcome.


Assuntos
Hematúria/etiologia , Prostatectomia , Hiperplasia Prostática/diagnóstico por imagem , Hiperplasia Prostática/cirurgia , Retenção Urinária/etiologia , Adenoma , Idoso , Humanos , Masculino , Nigéria , Próstata/patologia , Hiperplasia Prostática/patologia , Resultado do Tratamento , Ultrassonografia Doppler em Cores
11.
Eur J Vasc Endovasc Surg ; 60(3): 443-450, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32605854

RESUMO

OBJECTIVE: Duplex ultrasound (DUS) is used for routine surveillance of stents in iliocaval veins, but direct visualisation is often challenging. Duplex ultrasound criteria for detecting venous stent obstruction (VSO) have not been defined to date. METHODS: A nested case control study of 120 patients (42 ± 17 years, 53% women, mean 2.7 ± 1.8 stents) was performed, and the performance of various duplex parameters for detecting VSO (defined as > 50% lumen diameter reduction or occlusion) was tested, confirmed by biplane venography or intravascular ultrasound (IVUS). Forty patients with VSO (25 with stent occlusion, 15 with >50% in stent stenosis) were matched to 80 control patients by age, gender and index diagnosis who fulfilled the following criteria: (1) ongoing symptom control (Villalta score < 5), (2) good image quality of entire stent segment, (3) spontaneous colour Doppler signal > 50% of lumen in entire stent segment, (4) at least two DUS where the baseline DUS was obtained within 24 h after successful venous intervention. RESULTS: The best test was the combination of peak flow velocity and flow pattern analysis at the stent inlet. A peak flow velocity >10 cm/s and a flow pattern spontaneously modulated by respiration ruled out VSO with a specificity of 93.7% (95% CI 86.0%-97.3%). A peak flow velocity ≤10 cm/s or any Doppler flow pattern other than spontaneously modulated by respiration was 92.1% (95% CI 79.2%-97.3%) sensitive to detect VSO. CONCLUSION: The combination of peak flow velocity and analysis of Doppler flow pattern at the stent inlet is accurate to diagnose or rule out stent occlusion. Indirect criteria should always be combined with direct visualisation of iliocaval stents since those may be less sensitive for detecting stent stenosis.


Assuntos
Procedimentos Endovasculares/instrumentação , Veia Ilíaca/diagnóstico por imagem , Stents , Ultrassonografia Doppler em Cores , Doenças Vasculares/terapia , Veia Cava Inferior/diagnóstico por imagem , Adulto , Velocidade do Fluxo Sanguíneo , Bases de Dados Factuais , Procedimentos Endovasculares/efeitos adversos , Feminino , Humanos , Veia Ilíaca/fisiopatologia , Masculino , Pessoa de Meia-Idade , Flebografia , Valor Preditivo dos Testes , Sistema de Registros , Estudos Retrospectivos , Resultado do Tratamento , Doenças Vasculares/diagnóstico por imagem , Doenças Vasculares/fisiopatologia , Grau de Desobstrução Vascular , Veia Cava Inferior/fisiopatologia , Adulto Jovem
12.
J Investig Med High Impact Case Rep ; 8: 2324709620931239, 2020.
Artigo em Inglês | MEDLINE | ID: covidwho-564936

RESUMO

On December 31, 2019, the World Health Organization was informed of a cluster of cases of pneumonia of unknown cause detected in Wuhan City, Hubei Province, China. The pneumonia was caused by a virus called SARS-Cov-2 (severe acute respiratory syndrome coronavirus 2), which was later named coronavirus infectious disease 2019 (COVID-19). The symptoms most commonly reported by patients affected by COVID-19 include fever, dry cough, and shortness of breath. In this report, we present a case of a 57-year-old woman who presented to the clinic's infectious department with swelling, pain, warmth, and redness in the left leg who was treated with therapeutic heparin. There were no typical and distinguished symptoms of COVID-19, and she had no risk factor for deep vein thrombosis. Then chest X-ray revealed bilateral patchy ground-glass opacity, and computed tomography angiography was performed to rule out pulmonary thromboembolism, which showed no evidence of thrombosis. Left lower limb venous color Doppler ultrasound revealed dilatation and thrombosis in the external iliac and left iliac veins up to the level of the bifurcation of the common iliac veins, as well as thrombosis to the superficial and small saphenous veins. Because of ground-glass opacity and lymphopenia, nasal swabs were used for sampling, and SARS-CoV-2 nucleic acid was detected by reverse transcription polymerase chain reaction (RT-PCR). This case aims to arouse the medical staff's awareness of deep vein thrombosis as a clinical symptom of COVID-19 even if the patient has no typical symptoms of COVID-19.


Assuntos
Infecções por Coronavirus/complicações , Linfopenia/etiologia , Pneumonia Viral/complicações , Trombose Venosa/etiologia , Anticoagulantes/uso terapêutico , Antimaláricos/uso terapêutico , Antivirais/uso terapêutico , Betacoronavirus , Cloroquina/uso terapêutico , Técnicas de Laboratório Clínico , Angiografia por Tomografia Computadorizada , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/diagnóstico por imagem , Infecções por Coronavirus/tratamento farmacológico , Combinação de Medicamentos , Feminino , Heparina/uso terapêutico , Humanos , Veia Ilíaca/diagnóstico por imagem , Lopinavir/uso terapêutico , Pulmão/diagnóstico por imagem , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/diagnóstico por imagem , Pneumonia Viral/tratamento farmacológico , Embolia Pulmonar/diagnóstico , Radiografia Torácica , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Ritonavir/uso terapêutico , Veia Safena/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Ultrassonografia Doppler em Cores , Trombose Venosa/diagnóstico por imagem , Trombose Venosa/tratamento farmacológico
13.
J Investig Med High Impact Case Rep ; 8: 2324709620931239, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32493073

RESUMO

On December 31, 2019, the World Health Organization was informed of a cluster of cases of pneumonia of unknown cause detected in Wuhan City, Hubei Province, China. The pneumonia was caused by a virus called SARS-Cov-2 (severe acute respiratory syndrome coronavirus 2), which was later named coronavirus infectious disease 2019 (COVID-19). The symptoms most commonly reported by patients affected by COVID-19 include fever, dry cough, and shortness of breath. In this report, we present a case of a 57-year-old woman who presented to the clinic's infectious department with swelling, pain, warmth, and redness in the left leg who was treated with therapeutic heparin. There were no typical and distinguished symptoms of COVID-19, and she had no risk factor for deep vein thrombosis. Then chest X-ray revealed bilateral patchy ground-glass opacity, and computed tomography angiography was performed to rule out pulmonary thromboembolism, which showed no evidence of thrombosis. Left lower limb venous color Doppler ultrasound revealed dilatation and thrombosis in the external iliac and left iliac veins up to the level of the bifurcation of the common iliac veins, as well as thrombosis to the superficial and small saphenous veins. Because of ground-glass opacity and lymphopenia, nasal swabs were used for sampling, and SARS-CoV-2 nucleic acid was detected by reverse transcription polymerase chain reaction (RT-PCR). This case aims to arouse the medical staff's awareness of deep vein thrombosis as a clinical symptom of COVID-19 even if the patient has no typical symptoms of COVID-19.


Assuntos
Infecções por Coronavirus/complicações , Linfopenia/etiologia , Pneumonia Viral/complicações , Trombose Venosa/etiologia , Anticoagulantes/uso terapêutico , Antimaláricos/uso terapêutico , Antivirais/uso terapêutico , Betacoronavirus , Cloroquina/uso terapêutico , Técnicas de Laboratório Clínico , Angiografia por Tomografia Computadorizada , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/diagnóstico por imagem , Infecções por Coronavirus/tratamento farmacológico , Combinação de Medicamentos , Feminino , Heparina/uso terapêutico , Humanos , Veia Ilíaca/diagnóstico por imagem , Lopinavir/uso terapêutico , Pulmão/diagnóstico por imagem , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/diagnóstico por imagem , Pneumonia Viral/tratamento farmacológico , Embolia Pulmonar/diagnóstico , Radiografia Torácica , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Ritonavir/uso terapêutico , Veia Safena/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Ultrassonografia Doppler em Cores , Trombose Venosa/diagnóstico por imagem , Trombose Venosa/tratamento farmacológico
14.
Praxis (Bern 1994) ; 109(8): 566-571, 2020.
Artigo em Alemão | MEDLINE | ID: mdl-32517601

RESUMO

Color Doppler Sonography: Device Settings Determine the Quality of Diagnosis and the Occurrence of Artifacts Abstract. The major goal of the ultrasound examination is to find the right diagnosis. The correct setting of the device parameters is crucial for a reliable diagnosis. The examiner's knowledge of possible artifacts is helpful in evaluating the ultrasound images. Artifacts are not only present in B-mode sonography, but also in color Doppler sonography. Terms such as blooming, aliasing and twinkling refer to classic artifacts in color Doppler sonography. The causes of these artifacts and the possibilities of influencing them by device technology are presented and discussed. Exemplary images document the most important artifacts in color Doppler sonography.


Assuntos
Artefatos , Ultrassonografia Doppler em Cores , Humanos , Motivação , Ultrassonografia
15.
Zhonghua Shao Shang Za Zhi ; 36(6): 440-445, 2020 Jun 20.
Artigo em Chinês | MEDLINE | ID: mdl-32594702

RESUMO

Objective: To explore the effects of two dimensional gray-scale blood flow imaging (hereinafter referred to as " B-flow" ) combined with color Doppler flow imaging (CDFI) in guiding arterial puncture and catheterization through wounds in patients with large burns. Methods: Sixty-seven patients with large burns who met the inclusion criteria and hospitalized in the First Hospital of Jilin University from January 2017 to January 2019 were enrolled in the prospectively randomized control study. According to the random number table, CDFI alone group was allocated with 35 patients (23 males and 12 females) and B-flow+ CDFI group with 32 patients (22 males and 10 females), aged 19-60 and 18-58 years, respectively. According to the progress of the disease, arterial puncture and catheterization were performed in the right time. During the operation, CDFI was used alone for guidance in patients of CDFI alone group, while B-flow and CDFI were used together for guidance in patients of B-flow+ CDIF group. Based on the first time of catheterization, the catheterization location, one-time catheterization success rate, post-back stitching re-catheterization success rate, catheterization failure rate, catheterization duration, and incidences of wound sepsis, catheter-related bloodstream infection, and arterial thrombosis within post catheterization day (PCD) 3 of patients in the two groups were recorded. Data were statistically analyzed with the independent-sample t test, chi-square test or Fisher's exact probability test. Results: (1) All the patients underwent catheterization through wounds, and there was no statistically significant difference in catheterization location of patients between the two groups (χ(2)=0.574, P>0.05). The one-time catheterization success rate of patients in B-flow+ CDFI group was 81.25% (26/32), which was obviously higher than 51.43% (18/35) in CDFI alone group (χ(2)=6.594, P<0.05). The catheterization failure rate of patients in B-flow+ CDFI group was 3.12% (1/32), which was obviously lower than 20.00% (7/35) in CDFI alone group (P<0.05). The post-back stitching re-catheterization success rate of patients was similar between the two groups (χ(2)=1.029, P>0.05). (3) The catheterization duration of patients was (15.7±1.1) min in B-flow+ CDFI group, which was obviously shorter than (17.1±2.2) min in CDFI alone group (t=11.316, P<0.01). (4) Within PCD 3, the incidences of wound sepsis and catheter-related bloodstream infection of patients in CDFI alone group were 2.86% (1/35) and 0, close to 0 and 3.12% (1/32) in B-flow+ CDFI group (P>0.05); the incidence of arterial thrombosis of patients in B-flow+ CDFI group was 0, which was obviously lower than 20.00% (7/35) in CDFI alone group (P<0.05). Conclusions: Compared with CDFI alone, B-flow combined with CDFI can improve the success rate of arterial puncture and catheterization through wounds in large area burn patients, shorten the catheterization duration, and effectively reduce the incidence of arterial thrombosis after catheterization, with a good clinical application value.


Assuntos
Queimaduras , Adolescente , Adulto , Queimaduras/diagnóstico por imagem , Cateterismo , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Punções , Ultrassonografia Doppler em Cores , Adulto Jovem
16.
Angiology ; 71(8): 734-739, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32476444

RESUMO

The aim of the study was to research the relationship between carotid atherosclerosis markers and ultrasound parameters of Achilles tendons (AT). The study included 150 patients at high and very high cardiovascular risk (CVR). All patients underwent a carotid ultrasound scanning. We evaluated carotid plaque, carotid plaque score (cPS), carotid total plaque area (cTPA), and the percentage of stenosis. All patients underwent AT ultrasound with an assessment of thickness (Achilles tendon thickness [ATT]), width (Achilles tendon width), and cross-sectional area. An increase in the ATT ≥5.07 mm was associated with a 4.55-fold increase in the relative risk of carotid atherosclerosis (sensitivity 68.3% and specificity 62.5%). Direct correlations between the ATT and carotid stenosis (r = 0.277; P = .004), cPS (r = 0.225; P = .035), and cTPA (r = 0.305; P = .004) were determined. An increase in the mean ATT by 1 mm was associated with an increase in cTPA by 8.09 mm2 (95% CI: 2.26-13.9; P = .007) and carotid stenosis by 4.11% (95% CI: 0.64-7.60; P = .021). Thus, in patients with high and very high CVR, an increase in ATT is an independent predictor of carotid atherosclerosis. The ATT directly correlates with the markers of carotid plaque burden.


Assuntos
Tendão do Calcâneo/diagnóstico por imagem , Artérias Carótidas/diagnóstico por imagem , Estenose das Carótidas/diagnóstico por imagem , Placa Aterosclerótica , Ultrassonografia Doppler em Cores , Ultrassonografia Doppler de Pulso , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Índice de Gravidade de Doença
17.
Int J Cardiovasc Imaging ; 36(10): 1931-1939, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32506285

RESUMO

Pulse wave velocity (PWV) measured by ultrafast ultrasound imaging can early evaluate arteriosclerosis. The study aimed to establish normal reference range for ufPWV in healthy adults and explore its influencing factors, and evaluate the ufPWV changes on coronary slow flow (CSF). ufPWV at the beginning and end of systole (ufPWV-BS and ufPWV-ES, respectively) was measured in healthy adults (201 cases). CSF was diagnosed based on thrombolysis in myocardial infarction (TIMI) frame count during coronary angiography. ufPWV-BS and ufPWV-ES were compared between CSF (50 cases) and control groups (50 healthy age-, body mass index-, and blood pressure-matched adults). In healthy adults, average ufPWV-BS and ufPWV-ES was 5.36 ± 1.27 m/s and 6.99 ± 1.93 m/s, respectively. ufPWV-BS and ufPWV-ES positively correlated with age, body mass index, and blood pressure. ufPWV-BS and ufPWV-ES in the CSF group were higher than in the control group (ufPWV-BS, 6.05 ± 1.07 vs. 5.26 ± 0.89 m/s, P < 0.001; ufPWV-ES, 9.07 ± 1.84 vs. 6.84 ± 1.08 m/s, P < 0.001). Receiver operating characteristic curves showed that ufPWV-ES was more sensitive than ufPWV-BS. The normal reference range of ufPWV for healthy adults was established. Age, body mass index, and blood pressure were the main influencing factors. ufPWV was increased in the patients with CSF. The findings indicated that, in addition to reflecting atherosclerosis, ufPWV might also provide a basis for the noninvasive evaluation of microvascular impairment in the patients with CSF.


Assuntos
Doenças Cardiovasculares/diagnóstico por imagem , Artérias Carótidas/diagnóstico por imagem , Espessura Intima-Media Carotídea/normas , Circulação Coronária , Análise de Onda de Pulso/normas , Ultrassonografia Doppler em Cores/normas , Rigidez Vascular , Adulto , Fatores Etários , Idoso , Velocidade do Fluxo Sanguíneo , Doenças Cardiovasculares/fisiopatologia , Artérias Carótidas/fisiopatologia , Estudos de Casos e Controles , Angiografia Coronária , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Prospectivos , Valores de Referência , Reprodutibilidade dos Testes , Fatores Sexuais , Fatores de Tempo , Adulto Jovem
18.
Radiol Clin North Am ; 58(4): 765-779, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32471543

RESUMO

Vasculitides are a complex group of diseases sharing the defining feature of inflamed vessel walls. Vasculitides can be classified depending on the size of the predominantly affected vessels. Modern cross-sectional imaging methods have become a cornerstone in the diagnosis of vasculitis and may help in narrowing down differential diagnoses. This review presents the most important imaging modalities and typical findings in large and medium size vasculitis, implementing current imaging recommendations.


Assuntos
Vasculite/diagnóstico por imagem , Adulto , Idoso , Vasos Sanguíneos/anatomia & histologia , Criança , Angiografia por Tomografia Computadorizada , Feminino , Arterite de Células Gigantes/diagnóstico por imagem , Humanos , Angiografia por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Síndrome de Linfonodos Mucocutâneos/diagnóstico por imagem , Tamanho do Órgão , Poliarterite Nodosa/diagnóstico por imagem , Tomografia por Emissão de Pósitrons , Arterite de Takayasu/diagnóstico por imagem , Ultrassonografia Doppler em Cores , Adulto Jovem
19.
J Vasc Res ; 57(4): 206-212, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32396894

RESUMO

BACKGROUND: Atherosclerosis has been extensively studied in thalassemia major (TM) and sickle cell disease but not yet in ß thalassemia intermedia (TI). Previous studies concerned with TM were performed in children. TI patients usually live longer and, thus, are more prone to complications of atherosclerosis. AIM: In our study, we applied color Doppler for the determination of arterial conduit and flow velocities in ß TI patients. METHODS: For central circulation, we measured right and left middle cerebral arteries (MCAs) and basilar artery (BA) mean flow velocity (MFV), pulsatility index (PI), and peak systolic velocity (PSV) as well as carotid intimal media thickness, and to assess peripheral circulation, we studied ankle/brachial index and posterior and anterior tibial arteries' (ATA, PTA) pressure and PSV. This was applied for 30 adult TI patients and 20 age-, sex-, and ethnic group-matched controls. RESULTS: Transcranial Doppler findings among cases and controls showed that the MFV, PSV of MCAs, and PSV, PI, and MFV of the BA were statistically higher in cases than controls. A comparison between splenectomized and nonsplenectomized patients showed that total leukocyte count, platelet count, lactate dehydrogenase, ferritin, PSV and MFV of the left MCA were all statistically higher in splenectomized cases. Differences between males and females with TI with respect to laboratory and Doppler findings were all statistically insignificant except for intima media thickness, PTA pressure, ATA pressure, and PSV. CONCLUSION: More than one parameter should be applied to assess atherosclerosis in TI. There is evidence of an increased risk of central ischemia rather than peripheral ischemia in these patients.


Assuntos
Artéria Braquial/diagnóstico por imagem , Doenças das Artérias Carótidas/diagnóstico por imagem , Espessura Intima-Media Carotídea , Arteriosclerose Intracraniana/diagnóstico por imagem , Artéria Cerebral Média/diagnóstico por imagem , Doença Arterial Periférica/diagnóstico por imagem , Artérias da Tíbia/diagnóstico por imagem , Ultrassonografia Doppler em Cores , Ultrassonografia Doppler Transcraniana , Talassemia beta/complicações , Adolescente , Adulto , Velocidade do Fluxo Sanguíneo , Artéria Braquial/fisiopatologia , Doenças das Artérias Carótidas/etiologia , Doenças das Artérias Carótidas/fisiopatologia , Estudos de Casos e Controles , Circulação Cerebrovascular , Egito , Feminino , Humanos , Arteriosclerose Intracraniana/etiologia , Arteriosclerose Intracraniana/fisiopatologia , Masculino , Artéria Cerebral Média/fisiopatologia , Doença Arterial Periférica/etiologia , Doença Arterial Periférica/fisiopatologia , Valor Preditivo dos Testes , Fluxo Pulsátil , Fatores de Risco , Fatores Sexuais , Esplenectomia , Artérias da Tíbia/fisiopatologia , Adulto Jovem , Talassemia beta/diagnóstico , Talassemia beta/cirurgia
20.
Am J Physiol Regul Integr Comp Physiol ; 319(1): R33-R42, 2020 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-32401627

RESUMO

Cerebral blood flow (CBF) is commonly inferred from blood velocity measurements in the middle cerebral artery (MCA), using nonimaging, transcranial Doppler ultrasound (TCD). However, both blood velocity and vessel diameter are critical components required to accurately determine blood flow, and there is mounting evidence that the MCA is vasoactive. Therefore, the aim of this study was to employ imaging TCD (ITCD), utilizing color flow images and pulse wave velocity, as a novel approach to measure both MCA diameter and blood velocity to accurately quantify changes in MCA blood flow. ITCD was performed at rest in 13 healthy participants (7 men/6 women; 28 ± 5 yr) with pharmaceutically induced vasodilation [nitroglycerin (NTG), 0.8 mg] and without (CON). Measurements were taken for 2 min before and for 5 min following NTG or sham delivery (CON). There was more than a fivefold, significant, fall in MCA blood velocity in response to NTG (∆-4.95 ± 4.6 cm/s) compared to negligible fluctuation in CON (∆-0.88 ± 4.7 cm/s) (P < 0.001). MCA diameter increased significantly in response to NTG (∆0.09 ± 0.04 cm) compared with the basal variation in CON (∆0.00 ± 0.04 cm) (P = 0.018). Interestingly, the product of the NTG-induced fall in MCA blood velocity and increase in diameter was a significant increase in MCA blood flow following NTG (∆144 ± 159 ml/min) compared with CON (∆-5 ± 130 ml/min) (P = 0.005). These juxtaposed findings highlight the importance of measuring both MCA blood velocity and diameter when assessing CBF and document ITCD as a novel approach to achieve this goal.


Assuntos
Circulação Cerebrovascular/fisiologia , Artéria Cerebral Média/diagnóstico por imagem , Artéria Cerebral Média/fisiologia , Ultrassonografia Doppler Transcraniana/métodos , Adulto , Circulação Cerebrovascular/efeitos dos fármacos , Feminino , Voluntários Saudáveis , Humanos , Masculino , Pessoa de Meia-Idade , Artéria Cerebral Média/efeitos dos fármacos , Nitroglicerina/farmacologia , Análise de Onda de Pulso , Ultrassonografia Doppler em Cores , Vasodilatação/efeitos dos fármacos , Vasodilatação/fisiologia , Vasodilatadores/farmacologia , Adulto Jovem
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