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Aim: In our study, we aimed to investigate the value of fetal epicardial fat thickness (EFT) and modified myocardial performance index (mod‐MPI) in fetal growth restriction (FGR) that develops after the 32nd week of gestation. Materials and Methods: Fifty‐six pregnant women who met the inclusion and exclusion criteria were included in the study and were divided into two groups: pregnancies diagnosed with FGR after the 32nd week of gestation (FGR group) and those without (control group). Demographic and obstetric histories, ultrasonographic and clinical characteristics, fetal EFT and mod‐MPI values, and neonatal outcomes of the groups were recorded, and comparisons were made between the groups. Additionally, the diagnostic performance of fetal EFT value in late FGR was investigated. Results: The FGR group had fetal EFT that was statistically significantly lower (1.11 ± 0.21 vs. 1.34 ± 0.23, p = 0.001). The FGR group had a significantly lower isovolumetric contraction time (ICT) (31.04 ± 6.88 vs. 35.14 ± 7.58, p = 0.048). The two groups' isovolumetric relaxation time (IRT), ejection time (ET), and mod‐MPI values (p values 0.871, 0.55, and 0.750, respectively) were comparable. Receiver operating characteristic (ROC) analysis at a cutoff of 1.2 revealed 76.1% sensitivity and 74.2% specificity, respectively, for the diagnostic performance of the fetal EFT value in late‐onset FGR. There was a positive predictive value (PPV) and negative predictive value (NPV) of 64.0% and 83.8%, respectively. Conclusion: We found that fetal EFT was significantly lower in FGR and may be useful in diagnosing FGR. However, we observed that mode‐MPI did not change in FGR. [ABSTRACT FROM AUTHOR]

Purpose: Robot-assisted systems offer an opportunity to support the diagnostic and therapeutic treatment of vascular diseases to reduce radiation exposure and support the limited medical staff in vascular medicine. In the diagnosis and follow-up care of vascular pathologies, Doppler ultrasound has become the preferred diagnostic tool. The study presents a robotic system for automatic Doppler ultrasound examinations of patients' leg vessels. Methods: The robotic system consists of a redundant 7 DoF serial manipulator, to which a 3D ultrasound probe is attached. A compliant control was employed, whereby the transducer was guided along the vessel with a defined contact force. Visual servoing was used to correct the position of the probe during the scan so that the vessel can always be properly visualized. To track the vessel's position, methods based on template matching and Doppler sonography were used. Results: Our system was able to successfully scan the femoral artery of seven volunteers automatically for a distance of 20 cm. In particular, our approach using Doppler ultrasound data showed high robustness and an accuracy of 10.7 (±3.1) px in determining the vessel's position and thus outperformed our template matching approach, whereby an accuracy of 13.9 (±6.4) px was achieved. Conclusions: The developed system enables automated robotic ultrasound examinations of vessels and thus represents an opportunity to reduce radiation exposure and staff workload. The integration of Doppler ultrasound improves the accuracy and robustness of vessel tracking, and could thus contribute to the realization of routine robotic vascular examinations and potential endovascular interventions. [ABSTRACT FROM AUTHOR]

Introduction: Preeclampsia is a multisystemic disorder with unknown cause in pregnant women that has dangerous complications for mother and fetus. Contradictory studies have been reported about increasing carotid artery intimal media thickness in the preeclamptic pregnant women. The present study was conducted with aim to compare carotid artery intima-media thickness of pregnant women with preeclampsia and healthy pregnant and non-pregnant women. Methods: This cross-sectional analytical study was performed in 2019 and 2020 on 21 preeclamptic pregnant women, 21 healthy pregnant with normal blood pressure and 21 non-pregnant women with normal blood pressure. The intima-media thickness of the carotid artery of the subjects was measured in 3 areas of the common carotid artery on both sides and its mean was recorded. Data were analyzed by SPSS software (version 16) and Kolmogorov-Smirnov, ANOVA, independent t, and Kruskal-Wallis tests. P<0.05 was considered significant. Results: Based on the results of Kruskal-Wallis test, the minimum, maximum and mean thickness of carotid artery intima media in preeclamptic pregnant women was (0.4, 0.8, 0.600), in healthy pregnant (0.3, 0.4, 0.300), and in non-pregnant women was (0.2, 0.5, 0.300) (P <0.001). Conclusion: The thickness of intima media of carotid artery was significantly different among the three groups. [ABSTRACT FROM AUTHOR]

Purpose: Neck and upper-back stiffness is encountered in daily life, with symptoms appearing as dullness or aches predominantly in the trapezius muscle (TM). Our previous study demonstrated that TM hardness as measured with a muscle hardness meter correlates well with transverse cervical artery (TCA) flow supplying the TM. Muscle hardness meters, however, cannot measure hardness in the TM alone. Meanwhile, recent advances in ultrasound elastography have enabled the evaluation of localized hardness in targeted tissues. The present study, therefore, aimed to clarify the relationship between TM hardness as measured by elastography and TCA hemodynamics as measured on Doppler sonography, with reference to daily symptoms of upper-back stiffness. Methods: The study population comprised 66 healthy young adults (32 males, 34 females; mean age, 21 ± 1 years). Relationships were evaluated between TM hardness as a negative correlate of strain ratio from elastography and TCA hemodynamics on Doppler sonography. Hemodynamics in the TCA were evaluated according to the frequency of neck and upper-back stiffness. Results: TM strain ratio correlated with peak systolic velocity (PSV) in the TCA (r = 0.273, p = 0.036), particularly in symptomatic subjects (r = 0.417, p = 0.022). PSV in the TCA decreased with increasing frequency of daily symptoms (p = 0.045). Conclusion: TCA hemodynamics correlated with muscle hardness when evaluating localized TM hardness. This relationship and low PSV in the TCA were evident in symptomatic subjects. These results suggest that PSV in the TCA is associated with neck and upper-back stiffness. [ABSTRACT FROM AUTHOR]

Background. Free perforating flaps are the most optimal for reconstruction of both upper and lower extremities. However, along with the obvious advantages of these flaps, there are also a number of difficulties associated with their more complex vascular anatomy and, as a consequence, more time-consuming dissection. This determines the need for a more thorough preoperative planning, including the mapping of perforating vessels and development of flap design. At the same time, the problems with intraoperative assessment of perfusion of perforating flaps and their monitoring in the postoperative period have not been solved. For these purposes, several instrumental methods of examination such as MRI and CT angiography, Doppler sonography, ICG and dynamic infrared thermography are used. Aim of the study — to evaluate the capabilities of dynamic infrared thermography (DIT) for mapping of perforating vessels when planning the design of perforating flaps, as well as for assessing their intra- and postoperative perfusion. Methods. We have analyzed the results of using DIT along with CT-angiography and Doppler sonography for preliminary mapping of perforating vessels in the design of 18 perforating flaps (ALT flap — 10, SCIP flap — 8) transplanted in 15 patients from 01.01.2022 to 30.07.2022. DIT was also used in all cases for intraoperative instrumental confirmation of flap perfusion and for its monitoring in the postoperative period. Results. A total of 39 perforating vessels were detected by CT angiography at the point of origin from the main arteries. DIT was used to detect the distal portions of 37 perforating vessels in 15 patients at the marking of 18 flaps. On average, 2.5 per ALT flap and 1.4 per SCIP flap. Thermographic examination time was approximately 10 minutes. Localization of all perforating vessels detected by DIT were first confirmed by Doppler sonography and then visualized intraoperatively during flap dissection. Intraoperatively, perfusion of all transplanted flaps was clearly confirmed by DIT. In the postoperative period, perfusion problems were clinically detected in 3 (16%) flaps and confirmed by DIT: venous stasis — 2 cases, arterial insufficiency — 1 case. In two patients (13%) with a body mass index of more than 35 (corresponding to class 2–3 obesity), the location of perforating vessels could not be determined by thermography and Doppler sonography. Also, in these patients DIT was ineffective for confirmation of flap perfusion intraoperatively and in the postoperative period. Conclusion. This study confirms that CT angiography, Doppler sonography and infrared thermography are complementary methods that allow to detect and visualize perforating arteries from their origin from a main artery to the site of their passage through the deep fascia (CT-angiography), as well as to determine their more accurate projection on the skin surface (DIT and Doppler sonography). DIT is also an auxiliary method for flap monitoring in the intraoperative and postoperative periods, which allows to engage nursing staff in postoperative monitoring.

Abstract Background Doppler ultrasonography is essential to provide insights into hemodynamic alterations and liver function changes in pre-cirrhotic and cirrhotic patients. Utilizing Doppler examinations, this study aims to explore the correlation between hepatic arterial hemodynamics and Model for end-stage liver disease (MELD) scores in chronic liver disease patients. Methods A study of 50 chronic liver disease patients included sonographic assessments, measuring liver, portal vein size, and flow. Hepatic artery velocity, resistive index (RI), pulsatility index (PI), and acceleration time (AT) were evaluated. Biochemical parameters (serum bilirubin, creatinine, INR) were used to calculate MELD scores, compared with different Doppler sonographic parameters. Results The study found a mean peak systolic velocity (PSV) of 107.42 ± 48.10, with end-diastolic velocity (EDV) of 26.40 ± 14.68, RI of 0.74 ± 0.06, and PI of 1.47 ± 0.24. The mean MELD score was 19.28 ± 6.09. Correlations between MELD scores and PSV, EDV, RI, PI, and AT did not yield statistically significant correlations. 80% of subjects displayed high RI (> 0.7) values in the hepatic artery, and a significant correlation was found between portal vein thrombosis and hepatic artery PSV and RI (p

Abstract Background Conventionally, diuretic isotope renogram is used to establish and quantify severity of the obstruction in pelvi-ureteric junction obstruction. Doppler ultrasonography too assesses obstruction by evaluating the resistive index (RI) and resistive index ratio (RIR) in the intrarenal vasculature of the kidneys. This study aimed to note correlation between RI, RIR on Doppler ultrasonography and perfusion index (PI) on diuretic isotope renogram in suspect unilateral pelvi-ureteric junction obstruction in infants. A prospective study (2016–2019) in infants with suspect unilateral hydronephrosis, i.e. anteroposterior pelvic diameter (APPD) > 15 mm, divided into Group A (0–6 months) and Group B (6–12 months) based on the age at diagnosis. The RI, RIR and PI were noted at diagnosis, at 3 and 6 months, post-interventions and the correlation assessed. Results 37/94 with hydronephrosis were included in the study. 30 among these underwent surgical intervention. A decrease in RI and RIR and increase in PI following surgery were documented at follow-up. Also, the improvement was statistically more significant in the first 3 months following intervention. Conclusions An increased RI and RIR and a decreased PI are good indicators of obstruction in unilateral hydronephrosis in infants. The decline in RI with increase in PI following relief of obstruction shows a positive correlation between the two. Doppler sonography may be effective in monitoring unilateral hydronephrosis with unobstructed or equivocal renogram curves and consequently negate the need for repeated nuclear scans.

Background: Doppler ultrasonography is essential to provide insights into hemodynamic alterations and liver function changes in pre-cirrhotic and cirrhotic patients. Utilizing Doppler examinations, this study aims to explore the correlation between hepatic arterial hemodynamics and Model for end-stage liver disease (MELD) scores in chronic liver disease patients. Methods: A study of 50 chronic liver disease patients included sonographic assessments, measuring liver, portal vein size, and flow. Hepatic artery velocity, resistive index (RI), pulsatility index (PI), and acceleration time (AT) were evaluated. Biochemical parameters (serum bilirubin, creatinine, INR) were used to calculate MELD scores, compared with different Doppler sonographic parameters. Results: The study found a mean peak systolic velocity (PSV) of 107.42 ± 48.10, with end-diastolic velocity (EDV) of 26.40 ± 14.68, RI of 0.74 ± 0.06, and PI of 1.47 ± 0.24. The mean MELD score was 19.28 ± 6.09. Correlations between MELD scores and PSV, EDV, RI, PI, and AT did not yield statistically significant correlations. 80% of subjects displayed high RI (> 0.7) values in the hepatic artery, and a significant correlation was found between portal vein thrombosis and hepatic artery PSV and RI (p < 0.05). Conclusions: Hepatic artery RI and PSV show a significant correlation with portal vein thrombosis. Doppler ultrasonography, while not directly tied to MELD scores, is valuable for non-invasive liver disease monitoring when invasive methods are impractical. Further research is needed to unravel the relationships between hemodynamic changes, MELD scores, and clinical outcomes in a broader patient population. [ABSTRACT FROM AUTHOR]

Background: Conventionally, diuretic isotope renogram is used to establish and quantify severity of the obstruction in pelvi-ureteric junction obstruction. Doppler ultrasonography too assesses obstruction by evaluating the resistive index (RI) and resistive index ratio (RIR) in the intrarenal vasculature of the kidneys. This study aimed to note correlation between RI, RIR on Doppler ultrasonography and perfusion index (PI) on diuretic isotope renogram in suspect unilateral pelvi-ureteric junction obstruction in infants. A prospective study (2016–2019) in infants with suspect unilateral hydronephrosis, i.e. anteroposterior pelvic diameter (APPD) > 15 mm, divided into Group A (0–6 months) and Group B (6–12 months) based on the age at diagnosis. The RI, RIR and PI were noted at diagnosis, at 3 and 6 months, post-interventions and the correlation assessed. Results: 37/94 with hydronephrosis were included in the study. 30 among these underwent surgical intervention. A decrease in RI and RIR and increase in PI following surgery were documented at follow-up. Also, the improvement was statistically more significant in the first 3 months following intervention. Conclusions: An increased RI and RIR and a decreased PI are good indicators of obstruction in unilateral hydronephrosis in infants. The decline in RI with increase in PI following relief of obstruction shows a positive correlation between the two. Doppler sonography may be effective in monitoring unilateral hydronephrosis with unobstructed or equivocal renogram curves and consequently negate the need for repeated nuclear scans. [ABSTRACT FROM AUTHOR]

Purpose: Taking a short rest after lunch suppresses increases in blood flow to the digestive organs and maintains blood flow to the brain in the afternoon, possibly providing beneficial effects in preventing post-prandial drowsiness. The present study investigated sex-dependent influences on changes in hemodynamics produced by taking a short rest after lunch. Methods: Subjects comprised 20 healthy young adults (10 men, 10 women; mean age 21 ± 1 years). Doppler sonography was performed to measure blood flow in the superior mesenteric artery (SMA) and common carotid artery (CCA) before and after lunch every hour on each day, with and without a 15-min rest with eyes closed after lunch. Blood pressure and heart rate (HR) were also measured. Results: For both men and women, peak systolic velocity (PSV) in the SMA was suppressed by taking a rest. PSV in the CCA in men was increased at 0.5 h after lunch in the resting condition but was decreased in the non-resting condition (median 109%, interquartile range [IQR] 102–120% vs. median 98%, IQR 90–107%; P = 0.037). No such differences were observed in women. Although post-prandial increases in HR were observed in women, a similar increase was only found for men in the resting condition. Conclusion: An increase in CCA blood flow was observed only in men. The present study suggests that a short rest after lunch could better promote the maintenance of blood flow to the brain in men than in women. [ABSTRACT FROM AUTHOR]

Purpose: Accurate surgical reconstruction of arterial vascular supply is a crucial part of living kidney transplantation (LDKT). The presence of multiple renal arteries (MRA) in grafts can be challenging. In the present study, we investigated the impact of ligation versus anastomosis of small accessory graft arteries on the perioperative outcome. Methods: Clinical and radiological outcomes of 51 patients with MRA out of a total of 308 patients who underwent LDKT with MRA between 2011 and 2020 were stratified in two groups and analyzed. In group 1 (20 patients), ligation of accessory arteries (ARAs) and group 2 (31 patients) anastomosis of ARAs was performed. Results: Significant differences were observed in the anastomosis-, surgery-, and warm ischemia time (WIT) in favor of group 1. Students t-test showed comparable serum creatinine levels of 2.33 (± 1.75) to 1.68 (± 0.83) mg/dL in group 1 and 2.63 (± 2.47) to 1.50 (± 0.41) mg/dL in group 2, were seen from 1 week to 1 year after transplant. No increased rates of Delayed graft function (DGF), primary transplant dysfunction and transplant rejection were seen, but graft loss and revision rates were slightly higher when the ARAs were ligated. Analysis of Doppler sonography revealed that segmental perfusion deficits tend to regenerate during the clinical course. Conclusion: Ligation of smaller accessory renal arteries may not affect the outcome of living kidney transplantation, except for a minor increase in the reoperation rate. Segmental perfusion deficits of the graft seem to regenerate in most cases as seen in Doppler sonography. [ABSTRACT FROM AUTHOR]

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Abstract Objective Early identification of sickle renovascular changes via renal Doppler sonography among sickle cell disease patients to help in early diagnosis and interventions to prevent progression to end-stage renal disease. Methods Forty-five SCD children were included along with 45 healthy control children. Renal Doppler sonography (PI and RI) was performed on all subjects. Laboratory investigations were done: Hb electrophoresis, complete blood picture with blood indices, reticulocyte count, liver enzymes (ALT and AST), HCV serology, serum ferritin, and lactate dehydrogenase (LDH). Urine analysis and albumin/creatinine ratio in urine were done for all patients as well. Results The study group consisted of 45 SCD patients, 27 (60%) males with a mean age of 12 years (± 3 years). By performing renal Doppler sonography, it was found that all study groups had significantly higher Doppler indices (resistivity index and pulsatility index) compared to the control group. Results of renal Doppler sonography revealed that the main renal pulsatility index was positively correlated with the main renal resistance index (r = 0.454, p = 0.002). Conclusion Doppler indices (resistance index and pulsatility index) were of value to assess reno-vascular changes in SCD, Thus, renal Doppler indices could be an early technique in the assessment of sickle renovascular changes, so treatment can be started at an early stage before progressive affection of renal function.

Abstract Background and aims Neurovascular ultrasound (nvUS) of the epiaortic arteries is an integral part of the etiologic workup in patients with ischemic stroke. Aortic valve disease shares similar vascular risk profiles and therefore not only presents a common comorbidity, but also an etiologic entity. The aim of this study is to investigate the predictive value of specific Doppler curve flow characteristics in epiaortic arteries and the presence of aortic valve disease. Methods Retrospective, single-center analysis of ischemic stroke patients, both receiving full nvUS of the extracranial common- (CCA), internal- (ICA) and external carotid artery (ECA) and echocardiography (TTE/TEE) during their inpatient stay. A rater blinded for the TTE/TEE results investigated Doppler flow curves for the following characteristics: ‘pulsus tardus et parvus’ for aortic valve stenosis (AS) and ‘bisferious pulse’, ‘diastolic reversal’, ‘zero diastole’ and ‘no dicrotic notch’ for aortic valve regurgitation (AR). Predictive value of these Doppler flow characteristics was investigated using multivariate logistic regression models. Results Of 1320 patients with complete examination of Doppler flow curves and TTE/TEE, 75 (5.7%) showed an AS and 482 (36.5%) showed an AR. Sixty-one (4.6%) patients at least showed a moderate-to-severe AS and 100 (7.6%) at least showed a moderate-to-severe AR. After adjustment for age, coronary artery disease, arterial hypertension, diabetes mellitus, smoking, peripheral arterial disease, renal failure and atrial fibrillation, the following flow pattern predicted aortic valve disease: ‘pulsus tardus et parvus’ in the CCA and ICA was highly predictive for a moderate-to-severe AS (OR 1158.5, 95% CI 364.2–3684.8, p

Objective: Early identification of sickle renovascular changes via renal Doppler sonography among sickle cell disease patients to help in early diagnosis and interventions to prevent progression to end-stage renal disease. Methods: Forty-five SCD children were included along with 45 healthy control children. Renal Doppler sonography (PI and RI) was performed on all subjects. Laboratory investigations were done: Hb electrophoresis, complete blood picture with blood indices, reticulocyte count, liver enzymes (ALT and AST), HCV serology, serum ferritin, and lactate dehydrogenase (LDH). Urine analysis and albumin/creatinine ratio in urine were done for all patients as well. Results: The study group consisted of 45 SCD patients, 27 (60%) males with a mean age of 12 years (± 3 years). By performing renal Doppler sonography, it was found that all study groups had significantly higher Doppler indices (resistivity index and pulsatility index) compared to the control group. Results of renal Doppler sonography revealed that the main renal pulsatility index was positively correlated with the main renal resistance index (r = 0.454, p = 0.002). Conclusion: Doppler indices (resistance index and pulsatility index) were of value to assess reno-vascular changes in SCD, Thus, renal Doppler indices could be an early technique in the assessment of sickle renovascular changes, so treatment can be started at an early stage before progressive affection of renal function. [ABSTRACT FROM AUTHOR]

Herein we present the case of a 33-year nulliparous woman at 21 weeks of gestation with mitral valve vegetation resulting from infective endocarditis. Due to the mother's critical condition caused by consecutive thromboembolic events, surgery with cardiopulmonary bypass was indicated. During surgery the fetus was monitored by a specialized obstetrician who repetitively measured the Doppler indices of the umbilical artery, Ductus venosus and uterine artery. Right after CO 2 was insufflated into the operating area, the Doppler monitoring showed an increased Pulsatility Index of the Umbilical artery right before fetal distress with bradycardia occurred. A subsequent maternal arterial blood gas analysis showed an acidosis with hypercapnia. Consequently, the CO 2 insufflation was stopped and the gas flow on the Heart Lung Machine increased. After regaining homeostasis of acidosis, the Doppler Indices and fetal heart rate recovered. The remaining surgery and postoperative course were uneventful. At the 37 weeks of gestation a healthy boy was delivered by Cesarean section and at the age of two years, the neurodevelopment was assessed, which indicated normal development in mental cognition, language and motoric. This report presents a periodic Doppler examination of the maternal and fetal circulation during surgery on CPB while also discussing the possible impact of fetal monitoring in managing open cardiac surgery in pregnancy. [ABSTRACT FROM AUTHOR]

Study Design: A Retrospective Cohort Study. Objective: To introduce a new Doppler sonography-assisted pedicle screw fixation technique that enables vertebral artery (VA) monitoring during surgery and compares the accuracies of Doppler sonography-assisted cervical pedicle screw fixation and the conventional technique. Methods: This retrospective study was performed on 164 consecutive patients that underwent pedicle-based screw fixation from C2 to C6 between January 2013 and August 2020. Surgery was performed without intraoperative Doppler sonography in 84 cases (the Control group) or with intraoperative Doppler sonography in 80 cases (the Doppler group). Proper positioning of pedicle screws was graded, and the incidences of VA injury and screw breach in the Control and Doppler groups were compared. Results: Three hundred and ninety-nine screws were placed in the 164 patients (Doppler, 186 screws; Control, 213 screws). The percentages of well-positioned screws in the two groups were significantly different (Doppler, 97.8%; Control, 85.0%). There were two cases of VA injury in the Control group, an incidence of 2.4%, but no case in the Doppler group. Conclusion: Doppler sonography can be used intraoperatively to help guide the trajectory of the cervical pedicle screw insertion. It can detect the VA inside the screw trajectory and may reduce the risk of VA injury during cervical pedicle screw fixation. [ABSTRACT FROM AUTHOR]

Background and aims: Neurovascular ultrasound (nvUS) of the epiaortic arteries is an integral part of the etiologic workup in patients with ischemic stroke. Aortic valve disease shares similar vascular risk profiles and therefore not only presents a common comorbidity, but also an etiologic entity. The aim of this study is to investigate the predictive value of specific Doppler curve flow characteristics in epiaortic arteries and the presence of aortic valve disease. Methods: Retrospective, single-center analysis of ischemic stroke patients, both receiving full nvUS of the extracranial common- (CCA), internal- (ICA) and external carotid artery (ECA) and echocardiography (TTE/TEE) during their inpatient stay. A rater blinded for the TTE/TEE results investigated Doppler flow curves for the following characteristics: 'pulsus tardus et parvus' for aortic valve stenosis (AS) and 'bisferious pulse', 'diastolic reversal', 'zero diastole' and 'no dicrotic notch' for aortic valve regurgitation (AR). Predictive value of these Doppler flow characteristics was investigated using multivariate logistic regression models. Results: Of 1320 patients with complete examination of Doppler flow curves and TTE/TEE, 75 (5.7%) showed an AS and 482 (36.5%) showed an AR. Sixty-one (4.6%) patients at least showed a moderate-to-severe AS and 100 (7.6%) at least showed a moderate-to-severe AR. After adjustment for age, coronary artery disease, arterial hypertension, diabetes mellitus, smoking, peripheral arterial disease, renal failure and atrial fibrillation, the following flow pattern predicted aortic valve disease: 'pulsus tardus et parvus' in the CCA and ICA was highly predictive for a moderate-to-severe AS (OR 1158.5, 95% CI 364.2–3684.8, p < 0.001). 'No dicrotic notch' (OR 102.1, 95% CI 12.4–839.4, p < 0.001), a 'bisferious pulse' (OR 10.8, 95% CI 3.2–33.9, p < 0.001) and a 'diastolic reversal' (OR 15.4, 95% CI 3.2–74.6, p < 0.001) in the CCA and ICA predicted a moderate-to-severe AR. The inclusion of Doppler flow characteristics of the ECA did not increase predictive value. Conclusions: Well defined, qualitative Doppler flow characteristics detectable in the CCA and ICA are highly predictive for aortic valve disease. The consideration of these flow characteristics can be useful to streamline diagnostic and therapeutic measures, especially in the outpatient setting. [ABSTRACT FROM AUTHOR]

The Achilles tendon is the thickest tendon in the human body. Due to its superficial location and the high prevalence of its pathologies, the Achilles tendon is one of the most frequently sonographed tendons. As a cost-effective and quickly available diagnostic tool, sonography has become indispensable as an examination method for "achillodynia", which occurs in both athletes and non-athletes alike. With modern, high-resolution ultrasound devices, the ultrastructure of the Achilles tendon can be shown in such detail that the term "sonohistology" was formed. Using Doppler sonography and elastography, tendon characteristics which no other modality is capable to show can be visualized. Ultrasound has also been established in the guidance of therapeutic interventions for Achilles tendon disorders. In this article, the sonopathology of the most common Achilles tendon disorders – degenerative and traumatic – are addressed. [ABSTRACT FROM AUTHOR]

Abstract Bow Hunter's syndrome is a rare condition in which vertebrobasilar circulatory insufficiency develops because of neck rotation. We report a patient with Bow Hunter's syndrome diagnosed by Doppler sonography. This report demonstrates the important role of Doppler sonography in diagnosis of Bow Hunter's syndrome.

Transient global amnesia (TGA) is a self-limiting neurological condition that temporarily affects patients’ ability to access and store memories. So far, its etiology is unknown; however, ischemic origin has been discussed in the past. We present the case of a 61-year-old female with clinical appearance of TGA. MRI and duplex scan revealed punctiform and patchy ischemic lesions in both temporal lobes and right vertebral artery dissection, suggesting basilar artery embolism as the underlying cause. Our case report shows that TGA can be a symptom of ischemic lesions in the hippocampus and patients with presentation of additional focal neurologic symptoms or atypical distribution or appearance of the diffusion-weighted image (multiple/patchy) lesions should get ischemic stroke diagnosis and treatment.

Background Progesterone is increasingly being used in women at high risk for preterm labor and for maintenance tocolysis. Ultrasound evaluation of uterine in pregnant women in the second trimester of pregnancy can be a predictor of birth complications. Objective To study the effect of vaginal progesterone on uterine by doppler sonography among women in the second and third trimesters of pregnancy who are at risk of preterm labor. Patients and methods A prospective study was carried out on 60 patients attending Obstetrics and Gynecology Department, Menoufia Teaching Hospital, Menoufia, Egypt, during the period from March 2019 to March 2020. The patients were admitted to the hospital for preterm labor, which was arrested by acute tocolysis within 48 h. All participants were subjected to routine baseline investigations and Doppler flow assessment. Results There was a highly statistically significant difference (P < 0.001) in uterine artery pulsatility index (PI) before and after treatment (P = 0.000). Uterine artery PI decreased significantly after treatment (0.817 ± 0.16) than before treatment (0.969 ± 0.27). Uterine artery PI decreased significantly after treatment than before treatment in different periods of gestation (weeks). Moreover, there was no statistically significant difference (P>0.05) between the studied women as change in umbilical artery PI before and after treatment in different periods of gestation (weeks). Moreover, uterine artery PI was significantly correlated (P < 0.05) with period of gestation (week) before and after progesterone treatment. Conclusion Uterine artery pulsatility index (PI) decreased significantly after progesterone treatment than before treatment in different periods of gestation (weeks). Umbilical artery PI and middle cerebral artery Doppler PI were not significant different among the studied patients before and after progesterone treatment in different periods of gestation (weeks). Uterine artery PI and middle cerebral artery Doppler PI were negatively associated with period of gestation (week) before and after progesterone treatment.

Objective: To assess the diagnostic value of biomarkers: microbiological, molecular and biological, immunological biomarkers, characteristic of various types of recurrent myoma-associated growth.Materials and Methods: Seventy women of reproductive age with recurrent uterine myoma and its combination with adenomyosis after conservative treatment in the Clinic of Kuban State Medical University were examined. Methods: microbiological examination, sonography, Doppler sonography, histology, immunohistochemistry, morphometry.Results: The type of recurrent myoma-associated growth was proved to be dependent on molecular and biological characteristics of tumors, the presence of infection and blood perfusion. It was indicated that women with recurrence of myoma-associated growth of a “false” type were characterized by high rates of infections (the presence of reproductive losses, chronic inflammatory diseases of the pelvic organs) and significant bacterial contamination of the genital tract biotopes. Blood perfusion features were identified for true and “false” types of recurrent myoma-associated growth based on Doppler sonography data, which were consistent with features of tumor vessel morphometry. Analysis of uterine myoma histological types and their vascularization features showed correlation of forms with a high proliferative potential of a tumor on a molecular and cellular level to moderate and high expression of steroid hormone receptors in combination with Ki67, a significant diameter of the lumen of the vessels with the highest VI and VFI values.Conclusions: A comprehensive study of women with uterine hyperplasia determines the possibility of prediction of pathogenetic variants of recurrent myoma-associated tissue growth and adequate choice of treatment options and rehabilitation course.

Bow Hunter's syndrome is a rare condition in which vertebrobasilar circulatory insufficiency develops because of neck rotation. We report a patient with Bow Hunter's syndrome diagnosed by Doppler sonography. This report demonstrates the important role of Doppler sonography in diagnosis of Bow Hunter's syndrome. [ABSTRACT FROM AUTHOR]

Even though thrombophilias are associated with negative pregnancy outcomes (PO), there is not a consensus of when thrombophilias should be screened for, or how they affect placental vascularization during pregnancy. Therefore, the main aim of this study was to discover inherited thrombophilias (IHT) in the first trimester in women with otherwise no indications for thrombophilia screening, based on their vascularization parameters. LMWH treatment in improvement of placental vascularization and PO was also assessed. Finally, the classification of thrombophilias based on observed obstetric risks was proposed. Women were included in study based on their poor gestational sac and later utero-placental juncture vascularization signal and screening for inherited thrombophilias. LMWH were then initiated and Resistance index of Uterine artery (RIAU) was followed alongside PO (preterm birth, preeclampsia, placental abruption, intrauterine growth reduction). Study group consisted of women with combined inherited thrombophilias. Control group consisted of patients with inherited thrombophilias who have received LMWH therapy since pregnancy beginning. Out of 219 women, 93 had IHT, and 43 had combined IHT. All pregnancies both in both groups ended up with live births. Vaginal birth was more present in the control group (p <.001), and all women in study group delivered by CS. Premature birth was present in 8.4% of patients in control group, and in 32.55% of the patients in the study (p <.001). PE wasn't noted, and only 1 case of PA in control group. In the control group, 6.5% patients had IUGR, and 32.55% in the study group (p <.05). Based on RIAU and PO, thrombophilia categories were established: S (severe), MO (moderate), MI (mild) and L (low). Higher risk thrombophilias had higher RIAU later in the pregnancy, earlier pregnancy termination and Intrauterine Growth Reduction (IUGR). Thrombophilias should be considered and screened when poor vascularization is noted early in the pregnancy with Doppler sonography. Intervention with LMWH prevents adverse PO in these patients. [ABSTRACT FROM AUTHOR]

In view of the inherent limitations associated with performing dynamic contrast enhanced‐magnetic resonance imaging (DCE‐MRI) in clinical settings, current study was designed to provide a proof of principle that Doppler sonography and DCE‐MRI derived perfusion parameters yield similar hemodynamic information from metastatic lymph nodes in squamous cell carcinomas of head and neck (HNSCCs). Strong positive correlations between volume fraction of plasma space in tissues (Vp) and blood volume (r = 0.72, p = 0.02) and between Vp and %area perfused (r = 0.65, p = 0.04) were observed. Additionally, a moderate positive correlation trending towards significance was obtained between volume transfer constant (Ktrans) and %area perfused (r = 0.49, p = 0.09). [ABSTRACT FROM AUTHOR]

Background Progesterone is increasingly being used in women at high risk for preterm labor and for maintenance tocolysis. Ultrasound evaluation of uterine in pregnant women in the second trimester of pregnancy can be a predictor of birth complications. Objective To study the effect of vaginal progesterone on uterine by doppler sonography among women in the second and third trimesters of pregnancy who are at risk of preterm labor. Patients and methods A prospective study was carried out on 60 patients attending Obstetrics and Gynecology Department, Menoufia Teaching Hospital, Menoufia, Egypt, during the period from March 2019 to March 2020. The patients were admitted to the hospital for preterm labor, which was arrested by acute tocolysis within 48 h. All participants were subjected to routine baseline investigations and Doppler flow assessment. Results There was a highly statistically significant difference (P < 0.001) in uterine artery pulsatility index (PI) before and after treatment (P = 0.000). Uterine artery PI decreased significantly after treatment (0.817 ± 0.16) than before treatment (0.969 ± 0.27). Uterine artery PI decreased significantly after treatment than before treatment in different periods of gestation (weeks). Moreover, there was no statistically significant difference (P0.05) between the studied women as change in umbilical artery PI before and after treatment in different periods of gestation (weeks). Moreover, uterine artery PI was significantly correlated (P < 0.05) with period of gestation (week) before and after progesterone treatment. Conclusion Uterine artery pulsatility index (PI) decreased significantly after progesterone treatment than before treatment in different periods of gestation (weeks). Umbilical artery PI and middle cerebral artery Doppler PI were not significant different among the studied patients before and after progesterone treatment in different periods of gestation (weeks). Uterine artery PI and middle cerebral artery Doppler PI were negatively associated with period of gestation (week) before and after progesterone treatment. [ABSTRACT FROM AUTHOR]

The purpose of this study was to determine whether gestational age-specific levels of the cerebroplacental ratio (CPR) as a third-trimester ultrasound marker has benefits in the prediction of perinatal morbidity and mortality on foetuses with late-onset foetal growth restriction (FGR). A retrospective study of singleton pregnancies diagnosed with late-onset FGR was performed. Of 407 pregnancies meeting our inclusion criteria, 313 had normal (Group 1) and 94 had abnormal CPR (Group 2). Both groups were similar in age, gestational age at diagnosis, body mass index and parity. There was a significant association between the presence of oligohydramnios and abnormal CPR. Mean gestational age at delivery and mean neonatal birth weight were significantly lower in Group 2. Neonatal intensive care unit admission, foetal distress, low 5–minute Apgar score <7, and low cord pH < 7.1 rates were significantly higher in Group 2. There was one neonatal death in both groups. Multivariable regression analysis demonstrated that, in the prediction of APO, there was a significant contribution from neonatal birth weight <10th percentile, CPR <5th percentile and oligohydramniosis. Our findings revealed that CPR value less than 5th centile can be used as a predictor of APO in late-onset FGR. What is already known on this subject? Low cerebroplacetal ratio (CPR) is a marker of failure to reach the growth potential regardless of foetal weight. What do the results of this study add? The CPR can be used as an adequate predictor of adverse perinatal outcome in pregnancies with late-onset foetal growth restriction. What are the implications of these findings for clinical practice and/or further research? Routine calculation and report of CPR during basic ultrasound examination may help to identify foetuses with FR with a higher risk of adverse perinatal outcome. Future prospective studies on pregnancies with FGR with oligohydroamnios or normal amniotic fluid volume should focus on determining CPR threshold. [ABSTRACT FROM AUTHOR]

With а high degree of stenosis or occlusion of the proximal (before the separation of vertebral artery) segment of subclavian artery, the blood supply to the ipsilateral upper extremity is from the vertebrobasilar system via pendular or retrograde blood flow in the ipsilateral vertebral artery thereby bypassing the stenotic area. This hemodynamic condition is known as subclavian steal syndrome (SSS). There are different variants of SSS, determining the clinical symptoms, which can vary from oligo- to pronounced symptoms due to manifestations with symptoms of vertebro-basilar insufficiency - recurrent vertigo, drop attacks, reduced hearing, tinnitus, positional nystagmus and headache, as well as symptoms of hypoperfusion of the corresponding upper extremity - numbness, trophic disorders, changes in arterial pressure and pulse rate. Colorcoded Duplex Ultrasound (CDUS) is a basic noninvasive screening method that could differentiate the SSS variant and provide comprehensive information on the hemodynamic characteristics of blood flow in the vertebral and carotid arteries. We present a systematic analysis on the topic and the clinicalpractical application of CDUS in a series of clinical cases from our practice. [ABSTRACT FROM AUTHOR]

Background: Peripheral arterial disease is defined as a clinical disorder in which there is a stenosis or occlusion of the arteries of the limbs. The most common etiology is ischemia due to occlusive disease. The objective of this study is to assess the severity of lower-limb peripheral arterial diseases based on various Doppler parameters. Methods: This descriptive cross-sectional study comprised 55 patients with clinical signs and symptoms of lower-limb peripheral arterial disease. Both inpatients and outpatients attending the authors' institute were taken up for the study. In this study, Doppler sonography was performed using 3–12 MHz linear array and 1–7 MHz curvilinear array transducers (SAMSUNG RS80A Ultrasound System). Results: Out of 55 patients, Doppler sonography demonstrated echogenic plaques in 32 patients and corkscrew collaterals in 15 patients. Monophasic waveform with peak systolic velocity ratio of >2:1 was found in 42 patients, which is consistent with significant stenoses. Conclusion: Our study shows that Duplex Doppler sonography aided by color Doppler sonography can accurately locate the site and severity of stenosis/occlusion. It is safe, cost-effective, repeatable, and noninvasive.

Purpose: Drowsiness is often experienced in the afternoon after lunch. Decreases in blood flow to the brain secondary to increases in blood flow to the digestive organs after food intake could represent an underlying cause. As various beneficial effects of short rests on mental activities have been reported, the present study investigated hemodynamics using Doppler sonography of the common carotid artery (CCA) and superior mesenteric artery (SMA) after lunch, comparing resting and non-resting cases. Methods: Subjects comprised 24 healthy young adults (10 men, 14 women; mean age 22 ± 1 years). Sonography was performed to measure blood flow before and after lunch on each day, with and without a 15-min lying rest with eyes closed after lunch in each subject. Results: The timing of the peak velocity–time integral in the SMA in resting cases was delayed to 1.5 h after lunch compared to 0.5 h in non-resting cases. Although end-diastolic velocity in the CCA decreased after lunch, this decrease was suppressed in resting cases compared to non-resting cases even 4.5 h after lunch (median 96%, interquartile range [IQR] 83–102% vs. median 87%, IQR 77–92%; P = 0.037). Mean velocity (MV) in the CCA maintained unchanged after lunch in resting cases (P = 0.318), whereas non-resting cases showed decreased MV after lunch (P < 0.001). Conclusion: These findings suggest that a short lying rest with eyes closed suppresses increases in blood flow to the digestive organ and maintains blood flow to the brain after lunch. These hemodynamic changes might help explain the benefits of afternoon rests. [ABSTRACT FROM AUTHOR]

To report our experience in early prenatal diagnosis of six cases of tricuspid valve dysplasia (TVD) and to delineate echocardiographic features. This was a retrospective study which included all the women who attended our clinic for early fetal screening sonography, between 2001 and 2018. The ultrasound screening was done at 11–16 weeks of gestation, and included an anatomic fetal scan and Doppler imaging. The diagnosis of TVD was done based on sonographic features visualized on four chamber view and color mapping of the valve. Complete fetal echocardiography was carried out to rule out additional heart malformations. Out of 34,933 early prenatal transvaginal ultrasound screening examinations, six cases of TVD were diagnosed. Five of the pregnancies were terminated as per parental request, and one fetus was delivered at term and died shortly after birth. In three fetuses a chromosomal analysis was performed, one had trisomy 21, one had an abnormal CGH, and the third had a normal karyotype. In two fetuses an autopsy was performed and the diagnosis of TVD was confirmed in both. Early prenatal detection of TVD is possible and may aid in parental counseling. Larger studies, examining the outcome of TVD should be considered. [ABSTRACT FROM AUTHOR]

Transient global amnesia (TGA) is a self-limiting neurological condition that temporarily affects patients' ability to access and store memories. So far, its etiology is unknown; however, ischemic origin has been discussed in the past. We present the case of a 61-year-old female with clinical appearance of TGA. MRI and duplex scan revealed punctiform and patchy ischemic lesions in both temporal lobes and right vertebral artery dissection, suggesting basilar artery embolism as the underlying cause. Our case report shows that TGA can be a symptom of ischemic lesions in the hippocampus and patients with presentation of additional focal neurologic symptoms or atypical distribution or appearance of the diffusion-weighted image (multiple/patchy) lesions should get ischemic stroke diagnosis and treatment. [ABSTRACT FROM AUTHOR]

C-Reactive protein and erythrocyte sedimentation rate are crucial parameters used to monitor giant cell arteritis (GCA). Given that tocilizumab is approved for the treatment of GCA, these parameters are less sensitive because of the effects of interleukin-6 receptor blockade. Thus, the optimal method for monitoring GCA patients undergoing tocilizumab therapy, especially patients exhibiting a persistent thickened vessel wall in large vessels, remains unclear. Contrast-enhanced ultrasonography (CEUS) can increase the visibility of tissue perfusion by slow blood flow, which cannot be detected by power color doppler. We used CEUS to investigate patients with active and inactive GCA of the large vessels (active large vessel arteritis [aLVV]/inactive large vessel arteritis [iLVV]) who were not administered tocilizumab in this proof-of-concept study. After injection of the ultrasound contrast agent, the contrasted area (CA) of large vessels in a transverse section was calculated twice: first when the lumen was contrasted completely and once again 4-8 s later. We investigated the value of increase in CA that exhibited the best sensitivity and specificity for aLVV. Twenty-four patients were included in this study: 15 with aLVV and 9 with iLVV. The CA increased from 32.2 ± 16.8 to 52.5 ± 21.3 mm2 (p < 0.0001) in aLVV. The mean CA remained unchanged in iLVV. The best cutoff value to differentiate between aLVV and iLVV was a ≥25% increase in CA with a sensitivity and specificity of 91.7% and 100%, respectively. Our study indicates that CEUS can detect aLVV with high sensitivity and specificity. Incorporation of CEUS into routine clinical practice might result in a good method for monitoring disease activity in LVV in GCA patients. The limitation of our study was the small number of patients and the lack of investigator blinding to clinical data. [ABSTRACT FROM AUTHOR]

Objective. To evaluate the diagnostic utility of trophoblastic blood flow Doppler parameters in predicting an adverse pregnancy outcome.Material and Methods. This was a retrospective study of 218 pregnancies of women between 8 and 11 weeks’ gestation. Depending on the pregnancy outcome, patients were divided into 4 clinical groups. All women underwent an ultrasound examination using Voluson S8, Voluson E8 with high-quality grey scale, color flow mapping and pulsed-wave Doppler modes. We used a program for obstetric research with the following instrument settings: 100 MHz Doppler frequency, thermal index (TI) was

INTRODUCTION[|]The aim of this study was to assess initial changes in blood flow parameters of the ophthalmic artery (OA) in pediatric patients with type 1 diabetes mellitus (DM).[¤]METHODS[|]Sixty-three subjects were included in this prospective, cross-sectional, observational study. Thirty-one (49.2%) patients with type 1 DM without diabetic retinopathy formed the DM group. The control group comprised 32 (50.8%) healthy subjects. The OA of all of the patients was examined with Doppler ultrasonography. The main outcomes were peak systolic velocity (PSV), end diastolic velocity (EDV), pulsatility index (PI), and resistivity index (RI) measurements.[¤]RESULTS[|]The mean age at onset of type 1 DM was 10.7+-2.0 years and the mean duration was 11.4+-11.0 months. The mean PSV and EDV outcomes in both eyes were significantly higher in the control group than in the DM group, whereas, the mean PI and RI outcomes in both eyes were significantly higher in the DM group (p

Background: Based on the importance of varicocele, the aim of this is to compare the comparison between doppler sonography before and after laparoscopic lymphatic sparing varicocelectomy and microsurgical subinguinal varicocelectomy. Patients and Methods: Patients with primary varicocele who were referred to Ahwaz Imam Khomeini Hospital after informed consent were included. Primary information included varicocele severity, pain intensity, latency, Doppler sonography (Resistive index (RI), venous return, venous diameter before and after Valsalva) were obtained, and then patients were entered into one of the two groups of surgery. The admission duration, return to work duration, the pain and analgesic consumption, and the length of anxiety were recorded in patients. Patients were examined 3 months later, and the severity of varicocele in the examination, pain score, latency, Doppler sonography indices, sperm indices in both groups were registered. In the end, the information is entered into Statistical Package for the Social Sciences (SPSS) statistical software and evaluated. Results: We observed that the severity of varicocele (P = 0.34), pain (P = 0.45), latralite (P = 0.56), RI (P = 0.65), intravenous diameter (P = 0.75) did not show statistically significant difference between the two groups, also in evaluating these indices after surgery, there were significant differences between the two groups in pain (P = 0.04) and time for return to work (P = 0.036). Conclusions: The methods used in varicocelectomy did not have any effect on the outcome of the treatment. Accordingly, using any of these methods can improve the post-surgical state of the patients and promote the fertility performance and reduction of complications due to surgery in patients.

Background: Understanding vascularity and assessing the risk of post-traumatic avascular necrosis are crucial for predicting outcomes and identifying optimal treatment options in proximal humerus fractures (PHFs). Until now, Hertel et al have been the only researchers to evaluate the intraoperative perfusion of the humeral head after fracture using Doppler flowmetry in a central single drill hole within the head. This pilot study aims to standardize the evaluation of intraoperative perfusion measurements in different areas of the humeral head in patients with PHF., Methods: In this prospective pilot study, intraoperative semiquantitative Doppler perfusion measurements were conducted during plate osteosynthesis for PHF treatment in our institution between July 2021 and May 2022. The fracture morphology was classified radiologically according to Resch's criteria. Quality of reduction was determined postoperatively to be either anatomical, minor malreduced, or major malreduced according to Peters et al in conventional and computed tomography examinations. Medial hinge integrity and medial metaphyseal extension were assessed radiographically according to Hertel et al. Intraoperatively, after drilling screw holes through the plate, a Doppler probe was inserted through all nine drill holes on the humeral head and at least one on the humeral shaft to successively measure the presence of a pulse to indicate if perfusion is present., Results: A total of ten patients (mean age 59 years, range, 36-83) with a humeral head fracture (2 × 2GL, 3 × 3G, 2 × 4G, 2 × 4GL, 1 × 5aG according to Resch) were included. Nine of the ten patients showed a pulse signal on the humeral shaft. Overall, pulse-synchronous perfusion was detected using Doppler sonography in at least one hole in the humeral head of all patients. In patients with an intact medial hinge (N = 6), pulse-synchronous perfusion could be measured in almost twice as many humeral head holes on average (5.7 vs. 3.0 drill holes) compared to patients with a dislocated medial hinge (N = 4). In patients with metaphyseal extension (N = 3), pulse-synchronous perfusion was measured in an average of 6.7 humeral head holes compared to 3.7 holes in patients without metaphyseal extension (N = 7)., Conclusion: Semiquantitative, intraoperative Doppler flowmetry offers a noninvasive and rapid assessment of humeral perfusion which allows an understanding of humeral head perfusion, when used in a standardized fashion to measure flow in different areas of the humeral head., (© 2024 The Authors.)

Background: Peripheral arterial disease is defined as a clinical disorder in which there is a stenosis or occlusion of the arteries of the limbs. The most common etiology is ischemia due to occlusive disease. The objective of this study is to assess the severity of lower-limb peripheral arterial diseases based on various Doppler parameters. Methods: This descriptive cross-sectional study comprised 55 patients with clinical signs and symptoms of lower-limb peripheral arterial disease. Both inpatients and outpatients attending the authors' institute were taken up for the study. In this study, Doppler sonography was performed using 3-12 MHz linear array and 1-7 MHz curvilinear array transducers (SAMSUNG RS80A Ultrasound System). Results: Out of 55 patients, Doppler sonography demonstrated echogenic plaques in 32 patients and corkscrew collaterals in 15 patients. Monophasic waveform with peak systolic velocity ratio of >2:1 was found in 42 patients, which is consistent with significant stenoses. Conclusion: Our study shows that Duplex Doppler sonography aided by color Doppler sonography can accurately locate the site and severity of stenosis/occlusion. It is safe, cost-effective, repeatable, and noninvasive. [ABSTRACT FROM AUTHOR]

The article describes a method for hearts of lower vertebrates in the early stages of their development. To achieve sufficient spatial resolution, the method uses an acoustic microscope with mechanical scanning of a focusing ultrasound transducer, the received signal of which is recorded as a function of spatial coordinates and time. The heart of weatherfish Misgurnus fissilis at the prelarval stage of development was examined with a pulsed acoustic microscope. The center frequency and duration of the envelope of the recorded reflected pulses were 70 MHz and 30 ns, respectively. Processing of the recorded spatiotemporal signal made it possible to visualize movement of tissues of the ventricle, atrium, and valves in the ventricular region of the heart, determine the period of heartbeats, and identify heart rhythm phases. It is shown that the characteristic sizes of the ventricle and atrium are 150–300 µm. The responses of moving blood elements were identified and the speed of their movement in different areas of the heart were measured as a function of time. It was found that the blood flow rate reaches a maximum of 2.5 mm/s in the diastolic period in the ventricular region of the heart. In other regions, peaks in the diastolic and systolic periods range from 1.5 to 0.8 mm/s. In accordance with the principle of high-power Doppler sonography, the change in density of moving blood elements was visualized as a function of time. [ABSTRACT FROM AUTHOR]

ObjectivesOptimal perinatal management of total anomalous pulmonary venous return (TAPVR) involves timely identification followed by surgical correction. Antenatal diagnosis, however, has long been a challenge. We aimed to identify consistent prenatal sonographic features in this condition in a large cohort in whom the diagnosis was made antenatally and confirmed postnatally.MethodsWe conducted a systematic retrospective review of the 2-dimensional and Doppler sonographic features that had helped make the diagnosis of TAPVR at our institution from 2001 to 2012.ResultsTwenty-six patients had prenatal diagnosis of TAPVR (mean gestational age, 24.1 weeks). Four of the fetuses with a prenatal diagnosis represented isolated cases of TAPVR; 22 had heterotaxy syndrome, additional cardiac abnormalities, or both. Prenatally diagnosed abnormal pulmonary venous connections were supracardiac (type I) in 18 cases, cardiac (type II) in 1, and infradiaphragmatic (type III) in 7. Lack of a visible connection of the pulmonary veins to the atrium (100%) and the presence of a visible venous confluence on axial 4-chamber views (96%) were the most consistent findings. Cardiac asymmetry and the presence of additional vertical venous channels on 3-vessel or axial abdominal views were also noted but less consistently. Abnormal pulmonary venous spectral Doppler findings were present in 25 of the 26 fetuses.ConclusionsThe diagnosis of TAPVR can be suspected on standard axial views included in second-trimester obstetric screening examinations of the fetal heart and confirmed on fetal echocardiography with the use of pulsed wave Doppler imaging. Clues recognizable on obstetric sonographic screening have the potential to contribute to increasing the diagnostic yield for prenatal detection of TAPVR.

Introduction. Purulent pyelonephritis is a complicated urinary tract infection with one of the most severe currents. It represents a serious clinical problem associated with the complexity of the choice of diagnosis and the optimal active treatment strategy, as well as the need for subsequent rehabilitation of this category of patients.Purpose of the study. Studying of the immediate and remote results of the kidneys` functional state in patients who have undergone purulent pyelonephritis using a differentiated approach to treatment tactics.Materials and methods. The study included 84 patients who underwent purulent pyelonephritis at the age of 15 to 70 years old and were treated at the Botkin City Clinical Hospital from 1999 to 2007. The patients were divided into three groups depending on the method of treatment: group 1 - open surgery of 18 patients (21.4%); group 2 - percutaneous drainage methods - 38 (45.3%); group 3 - conservative therapy - 28 (33.3%) patients. Examination of patients included dynamic nephroscintigraphy and complex ultrasound. It was performed in time after treatment after 12, 36 and 60, 84 months.Results. During the 7-year observation of patients, it was found that a more pronounced renal dysfunction and perfusion occurred during all periods of observation after undergoing open surgery according to Doppler sonography. Restoration of renal function occurred in shorter observation periods after the use of percutaneous kidney drainage and conservative treatment.Conclusion. Based on the data obtained, it can be concluded that a differentiated approach to the choice of tactics for the treatment of patients with purulent pyelonephritis is reasonable. Accordingly, it should be introduced into clinical practice of urological departments that provide emergency care to urological patients.

Abstract Background Sepsis-associated brain dysfunction (SABD) is associated with high morbidity and mortality. The pathophysiology of SABD is multifactorial. One hypothesis is that impaired cerebral autoregulation (CAR) may result in brain hypoperfusion and neuronal damage leading to SABD. Methods We studied 100 adult patients with sepsis (July 2012–March 2017) (age = 62 [52–71] years; Acute Physiology and Chronic Health Evaluation II score on admission = 21 [15–26]). Exclusion criteria were acute or chronic intracranial disease, arrhythmias, extracorporeal membrane oxygenation, and known intra- or extracranial supra-aortic vessel disease. The site of infection was predominantly abdominal (46%) or pulmonary (28%). Transcranial Doppler was performed, insonating the left middle cerebral artery with a 2-MHz probe. Middle cerebral artery blood flow velocity (FV) and arterial blood pressure (ABP) signals were recorded simultaneously; Pearson’s correlation coefficient (mean flow index [Mxa]) between ABP and FV was calculated using MATLAB. Impaired CAR was defined as Mxa > 0.3. Results Mxa was 0.29 [0.05–0.62]. CAR was impaired in 50 patients (50%). In a multiple linear regression analysis, low mean arterial pressure, history of chronic kidney disease and fungal infection were associated with high Mxa. SABD was diagnosed in 57 patients (57%). In a multivariable analysis, altered cerebral autoregulation, mechanical ventilation and history of vascular disease were independent predictors of SABD. Conclusions Cerebral autoregulation was altered in half of the patients with sepsis and was associated with the development of SABD. These findings support the concept that cerebral hypoxia could contribute to the development of SABD.

Objectives. The aim of the study was to analyze data and evidence from existing literature sources, regarding the topographic and morphometric features of the internal jugular vein, according to gender, age, laterality and its role in contemporary medicine. Materials and methods. Scientific publications which present information on the functional anatomy, morphological characteristics, functional features, application and paraclinical exploration of the internal jugular vein were analyzed. There were used local sources, elaborated by the collaborators of the department of anatomy and clinical anatomy, of the State University of Medicine and Pharmacy „Nicolae Testemițanu”, as well as international sources through the online platforms Google Scholar and PubMed. Keywords used in the search were: “internal jugular vein”, “internal jugular vein catheterization”, “internal jugular vein features”. Results. During search, 49 scientific publications were identified that report current information on the anatomical-morphometric features of the internal jugular vein and the applicative role of the vein in clinical practice. Conclusions. The obtained information reveals the importance of the addressed problem. This study was conducted to highlight the morphological, morphometric and functional features of the internal jugular vein, as well as its topographic appearance in patients of different ages and genders and to emphasize the most effective way to approach the nominated vein in case of its catheterization. Knowing that anatomically and functionally, the internal jugular vein is extremely varied, and its topography and diameter can vary greatly, its trajectory data, the relationship with neighboring vascular and nervous structures and its size will become valuable for anesthetists, radiologists and vascular surgeons. Some of the priority research directions are: the study of the topography, vein functions, study of the anatomical variants and anomalies, the studying of the catheterization and manipulations due to internal jugular vein positioning, possible complications following catheterization, exploration methods.