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1.
Pan Afr Med J ; 33: 264, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31693722

RESUMO

Introduction: The purpose of our study was to describe the epidemioclinical and ultrasonographic features of hydatidiform moles (HM) in Abidjan. Methods: We conducted a cross-sectional study in the Department of Radiology, University Teaching Hospital of Yopougon over a 6-year period (January 2011-December 2016). In this study we describe the epidemioclinical and ultrasonographic profile of patients with HM. Ultrasonographic exams were performed using a mixed-methods approach (intravaginal and subpubic) based on B-mode and Color Doppler by senior radiologists. Anatomopathological examination of uterine content was performed. Results: Out of 12190 obstetric ultrasound performed, twenty-five cases of HM were diagnosed reflecting a radiological referral rate of 0.2%. The average age of patients was 33.4 years, ranging from 22 to 50 years. There was no dominant age class. The main clinical signs associated with amenorrhea (100%) included abdominal mass 36% and vaginal bleeding 28%. Ultrasound showed hypertrophic uterus in 100% of cases, homogeneous uterus in 96% of cases and myomatous uterus in 4% of cases. MH had an average thickness of 42.7 mm with vesicular appearance in 68% of cases, "honeycomb" appearance in 16%, multicystic appearance in 12% and snowstorm appearance in 4%. MHs were classified as partial in 4% of cases, complete in 92% of cases and invasive in 4% of cases. Hypertrophic ovaries were found in 44% of cases with macrofollicles in 32% of cases and cysts in 8% of cases. Ultrasonographic diagnosis of HM was confirmed by anatomopathological examination in 100% of cases. Conclusion: HMs are rare in Abidjan and are dominated by the complete hydatidiform mole. Its occurrence at the extreme ages wasn't found.


Assuntos
Mola Hidatiforme/epidemiologia , Ultrassonografia Doppler em Cores/métodos , Neoplasias Uterinas/epidemiologia , Útero/diagnóstico por imagem , Adulto , Costa do Marfim , Estudos Transversais , Feminino , Hospitais Universitários , Humanos , Mola Hidatiforme/diagnóstico por imagem , Hipertrofia , Pessoa de Meia-Idade , Gravidez , Neoplasias Uterinas/diagnóstico por imagem , Adulto Jovem
2.
Medicine (Baltimore) ; 98(45): e17872, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31702654

RESUMO

RATIONALE: Ewing-like sarcoma (ELS)/undifferentiated round cell sarcoma (URCS) is a rare type of soft tissue sarcomas (STS), especially in infants, with poor prognosis. It is a so-called "small round cell" sarcoma, and has many features of Ewing sarcoma, but lacks rearrangements in EWSR1. The diagnosis and treatment of this kind of STS remains challenging. BCOR genetic abnormalities have been found in some Ewing-like sarcomas. PATIENT CONCERNS: This report presents an ELS case of a female infant, who was 2 months old when initially diagnosed, with the clinical stage of IIIA (G2T2N0M0). Histologic findings revealed an undifferentiated neoplasm composed of small round tumor cells with round, open chromatic nuclei, and scant cytoplasm in a sheet growth pattern. Fluorescence in situ hybridization (FISH) analysis showed absence of EWSR1 and ETV6 gene rearrangement. Molecular genetic testing found no established variants of clinical significance but variants of unknown significance in APC, KMT2D, and MSH6 were detected. Immunostaining revealed that the tumor cells were positive for TLE1 and BCOR, and negative for cytokeratin (AE1/AE3), Desmin, CD45, S100, CD31, HMB45, and SATB2. INI-1 was retained. DIAGNOSIS: Ewing-like sarcoma (ELS)/undifferentiated round cell sarcoma (URCS) INTERVENTIONS:: After initial diagnosis, the patient received 4 cycles of combination chemotherapy for 2 months. Radical amputation of left upper extremity was performed 3 months after diagnosis. Postoperative chemotherapy was continued for 6 cycles. OUTCOMES: The patient died of intracranial metastasis with hemorrhage in 13 months after initial diagnosis, 5 months after the last cycle of chemotherapy. LESSONS: ELS in infancy is extremely rare and has a poorer prognosis than Ewing sarcoma or infantile fibrosarcoma. APC and MSH6 variation might be related with the disease progression and predict a poorer prognosis. This rare case promotes better understanding of the disease and suggests a promising role for the combination chemotherapy regimen in treating infantile ELS. Importantly, it brings to light the possibility of intracranial metastasis, which requires proactive screening for timely detection.


Assuntos
Sarcoma/patologia , Neoplasias de Tecidos Moles/patologia , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Ciclofosfamida/uso terapêutico , Dactinomicina/uso terapêutico , Evolução Fatal , Feminino , Antebraço/diagnóstico por imagem , Humanos , Lactente , Sarcoma/diagnóstico por imagem , Sarcoma/tratamento farmacológico , Sarcoma/genética , Neoplasias de Tecidos Moles/diagnóstico por imagem , Neoplasias de Tecidos Moles/tratamento farmacológico , Neoplasias de Tecidos Moles/genética , Ultrassonografia Doppler em Cores , Vincristina/uso terapêutico
3.
Medicine (Baltimore) ; 98(45): e17876, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31702656

RESUMO

Radioiodine refractory (RAIR) is the major cause of thyroid cancer-related death. In order to avoid needless Radioiodine (RAI) therapy, recognizing the RAIR cases in time is important for the patients to obtain more time for the effective therapy.Evaluate the ultrasound features of cervical metastatic lymph node in patients with RAIR differentiated thyroid cancer (DTC).Seventeen adult patients with histologically confirmed locally advanced or metastatic RAIR-DTC were prospectively enrolled. The ultrasound (US) characteristics of cervical lesions in patients with the RAIR-DTC were compared with cervical lymph node metastasis from 59 non RAIR-DTC cases.Among the 17 patients, cervical lymph node metastasis was found in 15 patients (88.3%). The cervical lesions of RAIR-DTC (mean size, 2.0 cm) were larger than that in non RAIR-DTC group (mean size, 1.30 cm). More multiple lesions and more lesions with visible flow were found in the RAIR Group, while fewer hyperechogenic punctuations were found in RAIR group (P < .05). The distant metastasis rates showed that RAIR-DTC led to a poorer prognosis than those of patients in the non RAIR Group (P < .01).Ultrasound can help distinguish metastasized cervical lymph nodes of RAIR-DTC patients from non RAIR-DTC patients. For RAIR-DTC patients, a long-term US evaluation should be performed.


Assuntos
Metástase Linfática/patologia , Câncer Papilífero da Tireoide/patologia , Neoplasias da Glândula Tireoide/patologia , Adulto , Idoso , Estudos de Casos e Controles , Feminino , Humanos , Radioisótopos do Iodo/efeitos adversos , Metástase Linfática/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Câncer Papilífero da Tireoide/dietoterapia , Câncer Papilífero da Tireoide/terapia , Neoplasias da Glândula Tireoide/diagnóstico por imagem , Neoplasias da Glândula Tireoide/terapia , Ultrassonografia Doppler em Cores
4.
Artigo em Chinês | MEDLINE | ID: mdl-31623033

RESUMO

Objective:To investigate the hemodynamic changes of internal jugular vein(IJV) in patients with pulsatile tinnitus(PT) detected by color doppler sonography(CDS). To explore the correlation of PT with IJV drainage dominance and the value of CDS in the diagnosis of PT. Method:Two hundred and twenty-one patients with PT were examined with the CDS and IJV compression test. The hemodynamic data of the upper, middle and lower IJV were compared with both PT side and unaffected side. The correlation of the PT with the IJV drainage dominance was analyzed. Result:A total of 125 cases(56.6%) of 221 patients with PT underwent ultrasonic IJV compression test with positive results, 96 cases(43.3%) with negative results. In the positive compression test group, the tinnitus disappeared after IJV being completely compressed in 109 cases(87.2%), and in 16 cases(12.8%) after IJV being partial closure. The extent of sectional area reduction was: upper jugular vein(75.41 ±9.39)%, middle jugular vein(80.25±13.16)%, lower jugular vein(86.58± 7.53)%. The blood flow volume on the tinnitus side was obviously higher than that on the unaffected side(P=0.001). In the negative compression test group, there was no significant difference in blood flow volume between tinnitus side and unaffected side. In the IJV positive compression test group, 54 cases(43.2%) were IJV drainage dominance combined, and 71 cases(56.8%) were non-dominant combined. In the IJV negative compression test group, 24 cases(25%) were IJV drainage dominance combined, and 72 cases(75%) were non-dominant combined. Conclusion:The positive result of IJV compression test using CDS and the flow volume of IJV on the affected side significantly higher than that on the unaffected side contributed to the diagnosis of venous PT. In this study, the IJV non-dominant side was more common in the venous PT.


Assuntos
Veias Jugulares , Zumbido , Hemodinâmica , Humanos , Pressão , Ultrassonografia Doppler em Cores
5.
Radiologe ; 59(11): 1019-1034, 2019 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-31642935

RESUMO

B­mode and color Doppler ultrasound are standard radiological methods to quantify tissue echo texture and tissue perfusion. Microstructure and composition of tissue influence echo texture parameters and acoustic parameters, such as speed of sound, attenuation and backscatter and quantitative color Doppler image parameters are influenced by the hemodynamics in depictable vessels. Dynamic contrast-enhanced ultrasound enables quantification of tissue perfusion and ultrasound elastography assists in assessing tissue stiffness. B­mode texture analysis, analysis of high-frequency echo signals and quantitative color Doppler image analysis are able to contribute to the assessment of tissue microstructure but have so far not been implemented clinically due to their complexity. Dynamic contrast-enhanced ultrasound and ultrasound elastography have proven to be robust under clinical conditions.


Assuntos
Técnicas de Imagem por Elasticidade , Ultrassonografia , Meios de Contraste , Humanos , Radiografia , Ultrassonografia Doppler em Cores
6.
An Bras Dermatol ; 94(4): 473-475, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31644625

RESUMO

Atrophoderma of Pasini and Pierini is a skin disorder affecting dermal collagen and is clinically characterized by well-defined plaques of depressed skin. Histopathological changes are subtle, and in most cases, the diagnosis requires a comparative study with healthy skin from the same anatomical site. High frequency ultrasound is a useful imaging method for diagnosis of atrophic skin changes. A case is presented in which ultrasound can support the clinical and the histopathological diagnosis of atrophoderma of Pasini and Pierini.


Assuntos
Derme/diagnóstico por imagem , Derme/patologia , Dermatopatias/diagnóstico por imagem , Dermatopatias/patologia , Ultrassonografia Doppler em Cores/métodos , Adulto , Atrofia/diagnóstico por imagem , Atrofia/patologia , Biópsia , Diagnóstico Precoce , Feminino , Humanos
7.
Praxis (Bern 1994) ; 108(12): 807-813, 2019 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-31530132

RESUMO

Color Doppler ultrasound is the diagnostic cornerstone of vascular assessment. Almost all arteries and veins of the human body are accessible to this diagnostic imaging, which as a result is very often used as first-line diagnostic test. Recent technological developments in high-end ultrasound machines enable us to optimize image quality in color-coded duplex ultrasound of arteries and veins. To obtain an optimal instrument setting, all relevant adjustments of imaging must be considered. In B-Mode ultrasound, the basic vascular imaging method, the most important settings to optimize are ultrasound frequency, gain, dynamic range, and focus, whereas color Doppler depends on angle supersonic sounding and its application in clinical practice. Most mistakes in measuring blood flow velocities, a frequent cause of misinterpretation, result from insufficient angle correction. Cardiac pathologies may result in typical changes of arterial and venous Doppler curves.


Assuntos
Cardiopatias , Ultrassonografia Doppler em Cores , Ultrassonografia Doppler Dupla , Artérias , Velocidade do Fluxo Sanguíneo , Cardiopatias/diagnóstico por imagem , Humanos , Ultrassonografia
8.
J Dermatol ; 46(10): 835-842, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31373042

RESUMO

Kaposiform hemangioendothelioma (KHE) and tufted angioma (TA) primarily occurring in infants are difficult to distinguish. This study evaluated ultrasonography (US) and magnetic resonance imaging (MRI) features of KHE and TA. Pathologically proven TA (n = 21) and KHE (n = 40 [11 KHE + Kasabach-Merritt phenomenon [KMP]]) occurring between January 2015 and December 2017 were reviewed. US (n = 61) and MRI (n = 50) findings were retrospectively evaluated. On US, KHE and TA lesions were subcutaneous, while 40% of KHE exhibited an infiltrative pattern extending into adjacent muscles. Of TA lesions, 42.9% were hyperechoic and 96.15% of KHE lesions exhibited mixed echogenicity. Of TA lesions, 76.2% exhibited well-defined margins and all KHE lesions exhibited ill-defined margins. The depth and vascular density of KHE and KHE + KMP were significantly increased compared with TA. The arterial peak systolic blood flow velocity of KHE + KMP was significantly higher than that in TA and KHE. KHE and KHE + KMP were significantly harder than TA on elastography. 3-D color Doppler revealed branch-shape blood flow for KHE and KHE + KMP lesions; for TA, it revealed a dot-like and striped pattern. Considering MRI findings, KHE and KHE + KMP were more likely to exhibit diffuse heterogeneous enhancement after contrast than TA. KHE was infiltrative and more likely to be thick, hypoechoic, ill-defined, richly vascular and hard than TA on US. KHE lesions were subcutaneous and reticular, with heterogeneous enhancement on MRI. Awareness of these features should prompt radiologists in the differential diagnosis of pediatric masses.


Assuntos
Hemangioendotelioma/diagnóstico por imagem , Hemangioma/diagnóstico por imagem , Síndrome de Kasabach-Merritt/diagnóstico por imagem , Sarcoma de Kaposi/diagnóstico por imagem , Neoplasias Cutâneas/diagnóstico por imagem , Adolescente , Adulto , Criança , Pré-Escolar , Meios de Contraste/administração & dosagem , Diagnóstico Diferencial , Técnicas de Imagem por Elasticidade/métodos , Feminino , Gadolínio DTPA/administração & dosagem , Hemangioendotelioma/cirurgia , Hemangioma/cirurgia , Humanos , Imagem Tridimensional , Lactente , Síndrome de Kasabach-Merritt/cirurgia , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Período Pré-Operatório , Estudos Retrospectivos , Sarcoma de Kaposi/cirurgia , Pele/irrigação sanguínea , Pele/diagnóstico por imagem , Neoplasias Cutâneas/cirurgia , Ultrassonografia Doppler em Cores , Adulto Jovem
9.
Medicine (Baltimore) ; 98(35): e16757, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31464905

RESUMO

RATIONALE: Parotid gland adenolymphoma is one of the most common benign tumors in parotid gland, and mainly treated by surgery. Despite the widespread of ultrasound-guided percutaneous microwave ablation, there is no report concerning its application in parotid gland adenolymphoma. Herein, we reported a 2-year follow-up result of a male patient underwent ultrasound-guided percutaneous microwave ablation for parotid gland adenolymphoma. PATIENT CONCERNS: A 73-year-old man was admitted due to a hypoechoic nodule measuring 2.67 × 1.42 × 1.35 cm in posterior-inferior area of parotid gland with a high flow velocity in color Doppler flow imaging. DIAGNOSE: The lesion was pathologically diagnosed as parotid gland adenolymphoma. INTERVENTIONS: Ultrasound-guided percutaneous microwave ablation was performed to the tumor due to the fact that the patient refused to receive an open surgery in consideration of older age. OUTCOMES: The ablation procedure lasted about 2 minutes and 15 seconds, without significant adverse effect. The reduction ratios of tumor at postoperative 1 and 3-month were 53% and 82%, respectively. The tumor was fully absent at postoperative 8-month evaluation. Finally, there was no evident recurrence at postoperative 24-month evaluation. LESSONS: Ultrasound-guided percutaneous microwave ablation is a safe and effective treatment for parotid gland adenolymphoma, which may serve as a novel alternative approach for patients unsuitable for open surgery.


Assuntos
Adenolinfoma/terapia , Micro-Ondas/uso terapêutico , Neoplasias Parotídeas/terapia , Ultrassonografia de Intervenção/métodos , Adenolinfoma/diagnóstico por imagem , Idoso , Humanos , Masculino , Neoplasias Parotídeas/diagnóstico por imagem , Ablação por Radiofrequência , Terapia por Radiofrequência , Resultado do Tratamento , Carga Tumoral , Ultrassonografia Doppler em Cores/métodos
10.
Praxis (Bern 1994) ; 108(10): 679-684, 2019 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-31387491

RESUMO

Vascular Color-Coded Duplex Ultrasound in Practice: Artifacts Abstract. Ultrasound artifacts are technical phenomena which may cause diagnostic mistakes and do not correlate with the real target organ. These optical and acoustic phenomena of color-coded duplex ultrasound are very common in the real world and may lead to misinterpretations and diagnostic errors. The twinkling artifact, for example, imitates high-flow velocities and turbulences, which may lead to the misdiagnosis of a high-grade stenosis or of vascularization. Mirror image artifacts may irritate the sonographer and cause an impression of an additional - really not existing - vessel. The "seagull cry", whose origin is not well understood, is usually found in the region of a high-grade stenosis.


Assuntos
Artefatos , Ultrassonografia Doppler em Cores , Erros de Diagnóstico , Humanos , Ultrassonografia Doppler Dupla
11.
Medicine (Baltimore) ; 98(33): e16846, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31415410

RESUMO

RATIONALE: Primary epiploic appendagitis (PEA) is a rare cause of acute abdomen caused by spontaneous torsion or venous thrombosis of epiploic appendices, it commonly manifests with acute lower quadrant pain, thus may mimic acute diverticulitis, appendicitis, or mesenteric infarction. PATIENT CONCERNS: In this case report, we report a 44 years old man who presented with persistent sharp pain in the left lower quadrant abdomen, Laboratory tests were mostly normal, contrast enhanced computed tomography (CECT) revealed a slightly high density shadow with fat foci in the middle was presented around the local descending colon, accompanied by the adjacent peritoneal thickening. DIAGNOSES: He was diagnosed with PEA as confirmed by an abdominal contrast enhanced computed tomography (CECT) scan. INTERVENTIONS: He was followed up in the clinic without any dietary restrictions, antibiotic or analgesic drugs use. OUTCOMES: The abdominal pain gradually subsided a week later, and there were no recurrence of the symptoms during follow-up. LESSONS: In our case, the diagnosis of PEA using CECT allows the patient to avoid surgery and other invasive treatment.


Assuntos
Abdome Agudo/diagnóstico , Colo Descendente/diagnóstico por imagem , Doenças do Colo/diagnóstico por imagem , Abdome Agudo/terapia , Adulto , Apendicite/diagnóstico , Colo Descendente/patologia , Doenças do Colo/patologia , Doenças do Colo/terapia , Tratamento Conservador , Diagnóstico Diferencial , Diverticulite/diagnóstico , Humanos , Masculino , Ultrassonografia Doppler em Cores
12.
Medicine (Baltimore) ; 98(26): e16166, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31261546

RESUMO

RATIONALE: The placenta membranacea (PM) is a rare type of placental abnormality, which is associated with placenta previa, antepartum hemorrhage (APH), postpartum hemorrhage (PPH), chorioamnionitis, fetal growth restriction (FGR), preterm birth even stillbirth. The purpose of this case report is to summarize the characteristics and analyze the relevant factors of PM. PATIENTS CONCERNS: Repetitive B-ultrasound of the first patient demonstrated a thin placenta covering the most part of uterine wall, which completely covers the internal cervical ostium for 22 weeks. B-ultrasound of the second patient showed placenta partially covering the internal cervical ostium and fetus small for gestation age for 23 days. The third patient complained of abdominal pain and vaginal discharge for 1 day. DIAGNOSES: Diagnosis of PM is based on Doppler ultrasound apparatus, and confirmed by pathology. INTERVENTIONS AND OUTCOMES: In the first patient, elective cesarean section was performed. The second patient required termination of pregnancy due to poor postnatal outcome. The third patient underwent intrauterine fetal death. Of these 3 cases, one delivered a term fetus by cesarean section complicated with placenta previa and placenta accreta, one terminated the pregnancy because of serious fetal growth retardation, and the other underwent intrauterine fetal death. LESSONS: High-resolution color Doppler ultrasound apparatus can improve the diagnostic accuracy, and close antenatal surveillance followed by proper arrangement of delivery may improve neonatal outcomes.


Assuntos
Placenta/anormalidades , Adulto , Diagnóstico Diferencial , Feminino , Humanos , Placenta/diagnóstico por imagem , Placenta/patologia , Gravidez , Resultado da Gravidez , Ultrassonografia Doppler em Cores , Ultrassonografia Pré-Natal , Adulto Jovem
13.
Vasc Endovascular Surg ; 53(7): 609-612, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31309863

RESUMO

The subclavian steal syndrome (SSS), also called subclavian steal steno-occlusive disease, is defined as reversal of the vertebral artery flow secondary to significant hemodynamically ipsilateral occlusion or stenosis of the proximal subclavian artery. It is usually seen secondary to atherosclerosis and aberrant right subclavian artery (ARSA), resulting in SSS which is even less common. Aberrant right subclavian artery is a kind of vascular anomaly associated with coarctation of the aorta (CoA). It usually originates from the descending aorta distal to the site of CoA. Here, we present a young man who was a case of ARSA and CoA. He developed SSS after transcatheter aortic stenting secondary to unusual origin of ARSA from the site of CoA. Awareness of this rare anomaly helps to overcome this complication in patients undergoing interventional stenting for CoA and ARSA with anomalous origin.


Assuntos
Coartação Aórtica/terapia , Anormalidades Cardiovasculares/complicações , Procedimentos Endovasculares/instrumentação , Stents , Artéria Subclávia/anormalidades , Adulto , Coartação Aórtica/complicações , Coartação Aórtica/diagnóstico por imagem , Coartação Aórtica/fisiopatologia , Aortografia/métodos , Anormalidades Cardiovasculares/diagnóstico por imagem , Anormalidades Cardiovasculares/fisiopatologia , Anormalidades Cardiovasculares/cirurgia , Angiografia por Tomografia Computadorizada , Procedimentos Endovasculares/efeitos adversos , Humanos , Masculino , Artéria Subclávia/diagnóstico por imagem , Artéria Subclávia/fisiopatologia , Artéria Subclávia/cirurgia , Síndrome do Roubo Subclávio/diagnóstico por imagem , Síndrome do Roubo Subclávio/etiologia , Síndrome do Roubo Subclávio/fisiopatologia , Resultado do Tratamento , Ultrassonografia Doppler em Cores
14.
Urologiia ; (3): 114-121, 2019 Jul.
Artigo em Russo | MEDLINE | ID: mdl-31356023

RESUMO

Recurrent and bilateral varicocele represent two least studied aspects of the disease. There is no recommendation in current urological and andrological guidelines in various countries on the diagnosis and treatment of such patients. The first experience of successful surgical treatment of a patient with recurrent varicocele due to May-Thurner syndrome is presented in this paper. The patient had a severe form of the disease and admitted with the varicocele recurrence after 5 previous intervention with chronic pelvic pain syndrome, erectile dysfunction, chronic calculous prostatitis and varicose veins of the pelvic organs. The patient underwent balloon angioplasty and stenting of the left iliac vein on 28th March, 2017 in the City hospital named after E.O. Mukhin. There was almost complete resolution of pelvic pain in the immediate postoperative period (within 1 hour). One week after surgery the patient noted a recovery of erection without any therapy. Three months later, a 45% reduction in the maximum diameter of the prostatic veins was noted according to transrectal ultrasound (TRUS) as well as a lack of antegrade blood flow according to the color Doppler TRUS at rest and during Valsalva's test. There was no deterioration of symptoms during follow-up. Overall, the venous blood flow in prostate was decreased which accompanied by the reducing in pain syndrome and restoration of sexual function without medical therapy. The reduction of diameter of testicular and epididymal varicose veins was seen 6 months after surgery. The diameter of veins of pampiniform plexus in supine position at rest was less than 2 mm. There was no retrograde flow neither in supine, nor in stand position during Valsalva maneuver. Thus, X-ray endovascular angioplasty and stenting of the iliac veins in case of arterio-venous crossing at the lower level is a pathogenetically justified and highly effective treatment of varicocele and varicose veins of the pelvic organs in men.


Assuntos
Síndrome de May-Thurner , Varicocele , Varizes , Humanos , Masculino , Síndrome de May-Thurner/diagnóstico por imagem , Síndrome de May-Thurner/terapia , Ultrassonografia Doppler em Cores , Varizes/diagnóstico por imagem , Varizes/terapia , Veias
15.
Pediatr Cardiol ; 40(6): 1275-1283, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31300841

RESUMO

Risk of superior vena cava (SVC) obstruction following repair of anomalous right upper pulmonary veins in children is unclear. The incidence and outcome of subclinical obstruction remained unknown. Retrospective single institutional study (07/1993-02/2017) in a pediatric population (N = 42, median age 3.9-year, range 0.1-15.3 years). 33 (79%) children had repair without SVC translocation ("non-Warden") and 9 (21%) had Warden-type surgery. Echocardiographic SVC obstruction was defined as (I) turbulent flow across SVC and (II) continuous flow pattern without return to baseline velocity (0 m/s); severe obstruction was defined as loss of distinct biphasic profile ± mean gradient ≥ 5 mmHg. 3 (7%) patients required intra-operative revision due to obstruction (non-Warden: 1, Warden: 2). After discharge, 2 (5%) patients required reintervention (3 and 6-month post-op) for severe symptomatic obstruction (non-Warden: 1, Warden-type: 1). Both patients responded to balloon angioplasty with symptomatic resolution (one required repeat catheter reintervention). 10 (24%) patients had subclinical echocardiographic obstruction (2, 22% Warden vs. 8, 24% non-Warden; p = 1.0; 8 of 10 patients had mild gradient), which resolved and remained well without reintervention. At follow-up (mean 7.2-year, range 0-23 years), all patients were alive. Freedom from SVC reintervention at 10 and 20-year is 95% (97% at 10, 20-year in non-Warden and 89% at 5, 8-year in Warden-type group; log-rank p = 0.34). Surgical repair for anomalous right upper pulmonary veins is associated with risk of SVC obstruction in children. The need for reintervention for severe obstruction is rare at late follow-up. Patients with subclinical obstruction remain asymptomatic and demonstrate echocardiographic improvement.


Assuntos
Veias Pulmonares/cirurgia , Síndrome de Cimitarra/cirurgia , Síndrome da Veia Cava Superior/etiologia , Veia Cava Superior/cirurgia , Adolescente , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Criança , Pré-Escolar , Ecocardiografia , Feminino , Seguimentos , Humanos , Lactente , Masculino , Veias Pulmonares/anormalidades , Estudos Retrospectivos , Síndrome da Veia Cava Superior/diagnóstico por imagem , Resultado do Tratamento , Ultrassonografia Doppler em Cores , Veia Cava Superior/anormalidades
16.
Medicine (Baltimore) ; 98(29): e16458, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31335703

RESUMO

We evaluated the clinical value of the cerebroplacental ratio (CPR) in predicting neonatal acidosis according to the gestational weeks in late pregnancy.From July 2016 to June 2017, 1018 neonates without acidosis and 218 neonates with acidosis (confirmed postpartum) underwent a prenatal examination and hospital delivery at 28 to 41 weeks in our hospital. The CPR was calculated as the ratio of the prenatal middle cerebral artery-pulsation index (MCA-PI) to the umbilical artery-pulsation index (UA-PI).In neonates without acidosis, the fetal UA-PI decreased with increased gestational age during late pregnancy. Similarly, the MCA-PI decreased with increased gestational age, and decreased significantly during the full pregnancy term. Additionally, the CPR peaked in the middle of the late pregnancy period and then decreased. In contrast, in neonates with acidosis, the prenatal UA-PI increased significantly, MCA-PI declined significantly, and CPR declined significantly in relation to normal values (P < .05). For the prediction of neonatal acidosis, the UA-PI was suitable after 32 weeks and the MCA-PI was suitable before 37 weeks. The cutoff values of the CPR for the prediction of neonatal acidosis at 28 to 31 weeks, 32 to 36 weeks, and 37 to 41 weeks were 1.29, 1.36, and 1.22, respectively. Unlike the UA-PI and MCA-PI, the CPR was suitable as an independent predictor of neonatal acidosis at all late pregnancy weeks. In neonates with acidosis, the z score of the UA-PI increased significantly, whereas the z scores of the MCA-PI and CPR decreased significantly, in relation to normal values (P < .05).The CPR can be used to evaluate the adverse status of fetuses during late pregnancy, providing an early prediction of neonatal acidosis.


Assuntos
Acidose/diagnóstico , Doenças do Recém-Nascido/diagnóstico , Artéria Cerebral Média/diagnóstico por imagem , Fluxo Pulsátil , Artérias Umbilicais/diagnóstico por imagem , Estudos de Casos e Controles , Diagnóstico Precoce , Feminino , Feto/metabolismo , Feto/fisiopatologia , Idade Gestacional , Humanos , Recém-Nascido , Doenças do Recém-Nascido/metabolismo , Doenças do Recém-Nascido/fisiopatologia , Valor Preditivo dos Testes , Gravidez , Diagnóstico Pré-Natal/métodos , Prognóstico , Ultrassonografia Doppler em Cores/métodos , Ultrassonografia Pré-Natal/métodos
17.
Rom J Ophthalmol ; 63(2): 188-192, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31334400

RESUMO

Purpose: To report a case with monocular transient vision loss (TVL) associated with Hyperhomocysteinemia. Methods: We present a case with persistent TVL attacks and high level of homocysteine. Results: A 32-year-old male had a history of episodes of recurrent monocular TVL. Extensive ophthalmic, systemic and laboratory studies were unremarkable with the exception of high plasma homocysteine level. He never experienced TVL during the 36-month follow-up after starting folate, B12 and B6 except for one episode in which he had discontinued the treatment for three months. Conclusion: This case may suggest hyperhomocysteinemia as one of the underlying causes of recurrent attacks of TVL without any known source of emboli.


Assuntos
Amaurose Fugaz/etiologia , Encéfalo/patologia , Homocisteína/sangue , Hiper-Homocisteinemia/complicações , Acuidade Visual , Adulto , Amaurose Fugaz/diagnóstico , Amaurose Fugaz/fisiopatologia , Biomarcadores/sangue , Humanos , Hiper-Homocisteinemia/sangue , Hiper-Homocisteinemia/diagnóstico , Embolia Intracraniana , Imagem por Ressonância Magnética , Masculino , Artéria Oftálmica/diagnóstico por imagem , Recidiva , Ultrassonografia Doppler em Cores
18.
BMC Neurol ; 19(1): 178, 2019 Jul 29.
Artigo em Inglês | MEDLINE | ID: mdl-31357950

RESUMO

BACKGROUND: B-mode and Color Doppler ultrasonography (CDUS) are the methods of choice for screening and determining the degree of Carotid artery stenosis. The evaluation of stenosis with calcification may be hampered by a common CDUS artifact known as acoustic shadow (AS). Our objective was to assess the change in reliability of CDUS readings in the presence of an AS artifact. METHODS: Single center retrospective observational study. Included were patients with either an AS artifact or high-grade stenosis (defined by peak systolic velocity (PSV) > 240 cm/s) demonstrated in CDUS, and had a CT angiography (CTA) done within 6 months of the sonographic exam. All subjects were identified through the Tel-Aviv Sorasky medical center (TASMC) CDUS unit registry from which clinical information was extracted. CDUS images were manually reviewed grading AS magnitude. All CTAs were reviewed and reconstructed for accurate assessment of percent stenosis and were used as gold standard. RESULTS: The study cohort included 227 consecutive patients (corresponding with 454 internal carotid arteries) meeting inclusion criteria. 43.2% of the arteries (n = 195) had an AS artifact present on CDUS, regardless of percent stenosis, with a large artifact present in 6.7% arteries (n = 30). Older age was significantly related to the presence of AS artifact (p < 0.001). In the study cohort as a whole there was a strong correlation between percent stenosis on CTA and PSV values (Pearson's r 0.672, p < 0.001) regardless of AS existence. The CDUS sensitivity and specificity for predicting severe stenosis were 82 and 73% respectively. The presence of a small AS slightly diminished the correlation between CDUS and CTA results without compromising CDUS reliability. A large AS severely affected the correlation between CDUS and CTA exams (Pearson's r = 0.24, p = 0.27) and reduced CDUS reliability with a sensitivity and specificity of 62%. CONCLUSION: The presence of a large AS severely degrades the accuracy of the routine CDUS measurements. In these cases, the patient should be referred to a CDUS exam including doppler-measurement of periorbital arteries and intracranial arteries in addition to other imaging modalities such as CTA or MRA in order to assess future stroke risk.


Assuntos
Artefatos , Artéria Carótida Interna/diagnóstico por imagem , Estenose das Carótidas/diagnóstico por imagem , Ultrassonografia Doppler em Cores , Idoso , Idoso de 80 Anos ou mais , Artérias Carótidas , Artéria Carótida Primitiva/diagnóstico por imagem , Angiografia por Tomografia Computadorizada , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Estudos Retrospectivos , Sensibilidade e Especificidade
19.
Int J Gynaecol Obstet ; 147(1): 96-101, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31299100

RESUMO

OBJECTIVE: To elucidate classification of coiling of the umbilical cord around fetal neck (CUFN) by ultrasound and forming factors of entanglement angle of CUFN. METHODS: From January 2006 to December 2012, color Doppler ultrasonic was used to observe the blood flow vector of umbilical artery, and prospective descriptive observation was made for entanglement direction and type of 707 single fetuses taking prenatal examination in our hospital during the middle and late trimester of pregnancy and having umbilical cord echo around the neck. The relationship of position of fetus, position of placenta and entanglement direction of umbilical cord with the entanglement angle of umbilical cord is analyzed. RESULTS: Among the 707 fetuses, 634 had one circle of coiling, 43 had two circles of coiling, two had three circles of coiling, and 28 had CUFN. According to entanglement direction, 361 had entanglement from left to right and 318 had entanglement from right to left According to entanglement type, 305 were C-shaped type (43.14%), 85 were O-shaped type (12.02%), 289 were α-shaped type (40.88%), and 28 were L-shaped type (3.96%). CONCLUSION: Color Doppler ultrasound was used to detect the entanglement direction of umbilical cord and establish the five-type classification of umbilical cord around the neck, laying the foundation for the feasibility of establishing the normalization of diagnostic standard of umbilical cord around the neck.


Assuntos
Cordão Nucal/diagnóstico , Cordão Umbilical/diagnóstico por imagem , Adulto , Feminino , Feto/irrigação sanguínea , Humanos , Cordão Nucal/classificação , Cordão Nucal/patologia , Gravidez , Estudos Prospectivos , Ultrassonografia Doppler em Cores , Ultrassonografia Pré-Natal , Cordão Umbilical/irrigação sanguínea
20.
Arq. bras. med. vet. zootec. (Online) ; 71(3): 863-868, May-June 2019. ilus
Artigo em Inglês | LILACS, VETINDEX | ID: biblio-1011319

RESUMO

Portosystemic shunt (PSS) is an anomalous vascular connection between the portal venous system and the systemic circulation. These deviations connect the main portal vein (PV) or some portal branches to the vena cava (VC) or, less commonly, to the azygos vein (AV). The purpose of this case report was to describe the diagnosis of PSS in a dog classified as porto-azygos. This diagnosis is considered uncommon compared to other portosystemic shunts using ultrasonography and portography. The subject was a male dog, Yorkshire, 8 months old, presented neurological signs characterized by head press, ataxia, tremors and episodes of temporary blindness and deafness. Ultrasonographic examination revealed a dilated and curved anomalous vessel with approximately 0.6cm of diameter and turbulent flow seen through pulsed and color Doppler, and segmental dilation of the azygos vein. The portography revealed enhancement by iodinated contrast in the jejunal vein, the portal vein and an anomalous vessel flowing towards the azygos vein in the craniodorsal region of the abdomen. The PSS was surgically corrected with an ameroid constrictor. Ultrasonography and portography were effective at detecting and characterizing the portoazygos shunt despite some limitations.(AU)


Shunt portossistêmico (SPS) é uma comunicação vascular anômala entre o sistema venoso portal e a circulação sistêmica. Esses desvios comunicam a VP ou alguma de suas tributárias à veia cava ou, menos comumente, à veia ázigos (VA). O objetivo do presente estudo foi descrever o diagnóstico, por meio de ultrassonografia e portografia, de um caso de shunt extra-hepático em cão, classificado como portoázigos e considerado incomum quando comparado aos demais tipos de desvio portossistêmico. Um cão, macho, raça Yorkshire, oito meses de idade, chegou ao Hospital Veterinário da Universidade Federal de Minas Gerais apresentando sinais neurológicos, caracterizados por andar apoiando a cabeça na parede, ataxia, tremores, episódios de cegueira e surdez. Ao exame ultrassonográfico, observou-se vaso anômalo calibroso e tortuoso de aproximadamente 0,6cm de diâmetro e fluxo turbulento ao Doppler pulsado e colorido, bem como dilatação segmentar da VA. A portografia revelou realce de contraste iodado em veia jejunal, porta e vaso anômalo (shunt) seguindo em direção à VA em região dorsal do abdômen. Foi realizada a correção cirúrgica do SPS por meio de anel ameroide. A ultrassonografia e a portografia foram eficientes na detecção e caracterização do shunt portoázigos, mesmo que com algumas limitações.(AU)


Assuntos
Animais , Masculino , Cães , Derivação Portossistêmica Cirúrgica/veterinária , Doenças do Cão/diagnóstico por imagem , Portografia/veterinária , Ultrassonografia Doppler em Cores/veterinária
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