RESUMEN
BACKGROUND: Concerns have been raised regarding the accuracy of the left internal thoracic artery (LITA) anastomosis performed during minimally invasive direct coronary artery bypass (MIDCAB). In a prospective study, we tested the hypothesis that transthoracic Doppler echocardiography is an adequate technique to determine LITA patency when compared to "gold standard" postoperative angiography. METHODS: Seventy-two consecutive patients with single left anterior descending (LAD) coronary artery stenosis were submitted to MIDCAB performed on a beating heart using the LITA. All patients underwent transthoracic Doppler Echocardiography and angiography before discharge. LITA was considered patent when diastolic fraction (DF) of time-velocity integral was equal or greater than 0.5. FitzGibbon grading system was used to evaluate LITA patency by angiography (A=excellent; B=stenosis reducing caliber of anastomosis or trunk to < 50% of grafted coronary artery; O=occlusion). RESULTS: Angiography showed that LITA was patent in 70 (97.2%) patients, 69 of them been graded A. Adequate image and flow signal of the LITA was achieved in 65 (90.3%) patients, been considered patent in 61 (93.8%) of them. Comparison between echocardiography and angiography in these 65 patients showed a specificity of 96.8% and a sensitivity of 50%. In 7 (9.7%) patients in whom no adequate echocardiography signal was obtained, the LITA graft was normal in six and occluded in one. CONCLUSIONS: For patients whose LITA graft can be imaged, transthoracic Doppler echocardiography is highly specific and is a valuable method for noninvasive evaluation of LITA graft patency after MIDCAB.
Asunto(s)
Estenosis Coronaria/cirugía , Ecocardiografía Doppler , Anastomosis Interna Mamario-Coronaria , Grado de Desobstrucción Vascular , Angiografía Coronaria , Puente de Arteria Coronaria , Estenosis Coronaria/diagnóstico por imagen , Humanos , Cuidados Posoperatorios , Estudios Prospectivos , Sensibilidad y EspecificidadRESUMEN
BACKGROUND: Contrast-enhanced color Doppler ultrasonography is a non-radiation-bearing tool that can be of value for assessment of inflammatory and vascular synovial changes in juvenile rheumatoid arthritis (JRA). OBJECTIVES: To evaluate the effect of contrast-enhanced color Doppler ultrasound (US) in the evaluation of synovial changes in the knees of children with JRA. MATERIALS AND METHODS: Sagittal color Doppler sonograms of 31 knees in 22 patients with JRA and of 10 knees in 5 control subjects were obtained before (at baseline) and after (at peak contrast phase) intravenous injection of SHU 508. Images were assessed for overall mean pixel intensity within the synovial tissue and for peak enhancement ratios [[(mean pixel intensity values at maximum contrast enhancement-unenhanced mean pixel intensity values)/unenhanced mean pixel intensity values] x 100]. The joints were classified into three groups by clinical/laboratory criteria: group A (active disease in the knee), n = 9; group B (quiescent disease with serum chemistry levels of active disease), n = 12 and group C (remission disease), n = 10. RESULTS: Mean color pixel intensity values were markedly increased by the use of US contrast agents in groups A (P = 0.004) and B (P = 0.0001), did not reach statistical significance in group C (P = 0.06) and remained essentially unchanged in the control group (P = 0.25). Enhancement ratios for the three groups of JRA patients were not different (P = 0.38) (mean +/- SD, 720% +/- 402 for group A, 731% +/- 703 for group B and 314% +/- 263 for group C). CONCLUSION: Contrast-enhanced color Doppler imaging holds promise for the detection of active synovial inflammatory disease in subclinical cases of JRA, thereby allowing earlier treatment and improved clinical outcome.
Asunto(s)
Artritis Juvenil/diagnóstico por imagen , Articulación de la Rodilla/diagnóstico por imagen , Membrana Sinovial/diagnóstico por imagen , Ultrasonografía Doppler en Color/métodos , Medios de Contraste , Estudios de Factibilidad , Femenino , Humanos , Masculino , Polisacáridos , Líquido Sinovial , Membrana Sinovial/irrigación sanguíneaRESUMEN
The aims of this study were to establish Doppler criteria for identifying direct carotid-cavernous fistulae (DCCF), as well as the level of agreement between results obtained by Doppler mapping vs. angiography. Doppler mapping and angiography were used to assess the direction of flow in the superior ophthalmic veins and the resistivity index in the internal carotid arteries of 30 patients with DCCF. Both methods independently demonstrated reverse flow in superior ophthalmic vein ipsilateral to the DCCF in 22 patients and normal flow in another four. The mean resistivity index for internal carotid arteries with ipsilateral DCCF was significantly reduced (p = 0.0001) compared with that for contralateral internal carotid arteries without DCCF. A resistivity index value of 0.495 offered a sensitivity and specificity of 86.6% in diagnosing ipsilateral DCCF. These findings suggest that a resistivity index < 0.495 in the ipsilateral internal carotid artery, with or without reverse flow in the superior ophthalmic vein, is associated with a reasonable probability of diagnosing DCCF.
Asunto(s)
Fístula del Seno Cavernoso de la Carótida/diagnóstico por imagen , Ultrasonografía Doppler Dúplex , Adolescente , Adulto , Angiografía de Substracción Digital , Velocidad del Flujo Sanguíneo , Arteria Carótida Interna/diagnóstico por imagen , Seno Cavernoso/diagnóstico por imagen , Ojo/irrigación sanguínea , Femenino , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Factores de Riesgo , Sensibilidad y Especificidad , Resistencia Vascular , Venas/diagnóstico por imagenAsunto(s)
Búfalos , Leucosis Bovina Enzoótica/epidemiología , Virus de la Leucemia Bovina/aislamiento & purificación , Animales , Anticuerpos Antivirales/sangre , Brasil/epidemiología , Bovinos , Leucosis Bovina Enzoótica/sangre , Ensayo de Inmunoadsorción Enzimática/veterinaria , Femenino , Virus de la Leucemia Bovina/inmunología , Masculino , PrevalenciaRESUMEN
The description of a new index, the renal-segmental ratio (RSR), and the comparison of its performance with other conventional Doppler parameters for the detection of renal artery stenosis (RAS). A total of 96 renal units were studied with angiography and colour Doppler ultrasound (US) independently. The Doppler parameters applied were: 1. renal artery peak systolic velocity (RE-PSV), 2. renal-aortic ratio (RAR), 3. early systolic acceleration (ESA), and 4. renal-segmental ratio (RSR). The angiographic study was used as the "gold standard" for the identification of > or = 50% RAS. The results indicate that RSR (sensitivity: 93.33%, specificity: 89.47%) and RE-PSV (sensitivity: 83.33%, specificity: 89.47%) were the best criteria for RAS diagnosis (p values <0.05). The results show that colour Doppler US is a reliable diagnostic modality for RAS diagnosis. The new index (RSR) improves the effectiveness of the method.
Asunto(s)
Obstrucción de la Arteria Renal/diagnóstico por imagen , Arteria Renal/diagnóstico por imagen , Ultrasonografía Doppler en Color , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Angiografía de Substracción Digital , Velocidad del Flujo Sanguíneo , Femenino , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Curva ROC , Sensibilidad y Especificidad , Estadísticas no ParamétricasRESUMEN
OBJECTIVE: To analyze the effects of carotid endarterectomy on the retrobulbar circulation of patients with severe occlusive carotid artery disease (OCAD) by means of color Doppler imaging (CDI). DESIGN: Prospective. PARTICIPANTS: A total of 17 consecutive patients with severe OCAD and neurologic symptoms (with a history of transitory ischemic attack or cerebral vascular accident) participated. INTERVENTION: All 17 patients underwent carotid endarterectomy. The CDI of both orbits was performed by one masked investigator before surgery and at 1 week and 1 month after surgery. MAIN OUTCOME MEASURES: Peak systolic velocity, end diastolic velocity, and resistive index of the ophthalmic, central retinal, and temporal short posterior ciliary arteries were measured. The authors compared the hemodynamic parameters at all intervals. RESULTS: Peak systolic and end diastolic velocities in the ophthalmic, central retinal, and temporal short posterior ciliary arteries increased significantly 1 week and 1 month after carotid endarterectomy (P < 0.05). After surgery, the resistive indices in the central retinal and temporal short posterior ciliary arteries decreased significantly at both intervals (P < 0.05). The six patients who had reversed ophthalmic artery flow before surgery showed forward ophthalmic artery flow after carotid endarterectomy. The contralateral orbits showed no significant hemodynamic change after endarterectomy (P < 0.05). CONCLUSIONS: Hemodynamic changes in patients with severe OCAD undergoing carotid endarterectomy suggest improvement in the ipsilateral retrobulbar blood flow.
Asunto(s)
Arteriopatías Oclusivas/fisiopatología , Enfermedades de las Arterias Carótidas/fisiopatología , Endarterectomía Carotidea , Ojo/irrigación sanguínea , Ultrasonografía Doppler en Color , Anciano , Anciano de 80 o más Años , Arteriopatías Oclusivas/cirugía , Circulación Sanguínea , Velocidad del Flujo Sanguíneo , Enfermedades de las Arterias Carótidas/cirugía , Arteria Carótida Interna/fisiopatología , Arteria Carótida Interna/cirugía , Arterias Ciliares/diagnóstico por imagen , Arterias Ciliares/fisiopatología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Arteria Oftálmica/diagnóstico por imagen , Arteria Oftálmica/fisiopatología , Estudios Prospectivos , Arteria Retiniana/diagnóstico por imagen , Arteria Retiniana/fisiopatologíaRESUMEN
In hemodialysis patients, large arteriovenous (AV) fistulas for vascular access may cause ventricular hypertrophy and high-output cardiac failure. The long-term cardiac consequences of functional AV fistulas in renal transplant patients are unclear. A precise knowledge of these consequences is important to decide if and when such fistulas should be closed in successfully transplanted patients. In this retrospective study including 61 stable renal transplant patients with adequate renal function (serum creatinine <2.0 mg/100 ml), echocardiography was performed in 39 patients with a functional AV fistula (group 1) and in 22 whose fistulas had been closed, for esthetic reasons, within 2 months postoperatively (group 2). The volume flow of the fistulas, measured in 22 randomly selected individuals of group 1, was 900 +/- 350 ml/min (range 500-1,600). Patients of group 1 were older (40 +/- 12 vs. 33 +/- 12 years, p < 0.05), had longer duration of the fistula (62 +/- 31 vs. 36 +/- 30 months, p < 0.05), higher body mass index (24 +/- 4 vs. 22 +/- 3 kg/m2, p < 0.05), systolic (154 +/- 24 vs. 138 +/- 18 mm Hg, p < 0.05) and diastolic (96 +/- 12 vs. 89 +/- 11 mm Hg, p < 0.05) blood pressure and increased left ventricular (LV) end-diastolic dimension (53 +/- 5 vs. 49 +/- 5 mm, p < 0.01). LV mass, cardiac index, ejection fraction and the proportion of patients with LV hypertrophy were comparable in the two groups. LV end-diastolic dimension was positively and independently influenced only by the presence of the AV fistula (p < 0.01) after adjusting for age, duration of the fistula, body mass index, systolic and diastolic blood pressure and the nature of the antihypertensive drugs used. In conclusion, the persistence of large, high-flow AV fistulas for prolonged periods of time had little impact on cardiac morphology and function of stable renal transplant patients with adequate renal function. The data do not support routine closure of these fistulas in all renal transplant patients.
Asunto(s)
Gasto Cardíaco Elevado/etiología , Catéteres de Permanencia/efectos adversos , Hipertrofia Ventricular Izquierda/etiología , Trasplante de Riñón , Adulto , Gasto Cardíaco Elevado/diagnóstico por imagen , Ecocardiografía Doppler , Femenino , Hemodinámica/fisiología , Humanos , Hipertrofia Ventricular Izquierda/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Análisis Multivariante , Valores de Referencia , Análisis de Regresión , Estudios Retrospectivos , Medición de Riesgo , Trasplante HomólogoRESUMEN
PURPOSE: We used duplex sonography in patients with recurrent varicose veins after surgical treatment to detect any residual stump of the great saphenous vein at the sapheno-femoral venous junction, and we compared these sonographic findings with surgical findings as the "gold standard." METHODS: We prospectively studied 65 patients (54 women and 11 men) who had recurrent varicose veins 1-30 years (mean, 11 years) after surgical exploration of the groin and ligature of the great saphenous vein at its junction with the femoral vein. Duplex scans were performed in all patients before surgical reexploration. Sonographic findings were compared with surgical findings. RESULTS: Duplex scanning revealed a residual stump in 47 patients (72%) and no stump in 15 patients (23%). Thirty-five (74%) of the 47 cases with a residual stump had reflux on duplex scans, and the remaining 12 cases (26%) showed no reflux. Findings in all 62 of these cases were confirmed by surgery. In only 3 patients (5%) did duplex scans fail to show a residual stump when surgery revealed a small residual stump without reflux. CONCLUSIONS: Duplex scanning is the noninvasive diagnostic technique of choice to detect any residual stump of the great saphenous vein and to diagnose valve failure at the sapheno-femoral venous junction in patients with recurrent varicose veins.
Asunto(s)
Vena Safena/diagnóstico por imagen , Ultrasonografía Doppler Dúplex , Várices/diagnóstico por imagen , Adulto , Femenino , Vena Femoral/diagnóstico por imagen , Humanos , Ligadura , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Recurrencia , Vena Safena/cirugía , Ultrasonografía Doppler en Color , Várices/cirugíaRESUMEN
OBJECTIVE: To evaluate duplex ultrasonography for diagnosis of arterial trauma in limbs and neck. METHOD: Fifty-one wounds in 47 patients, with indication for arteriography, were prospectively studied and grouped according to the presence (PCS group: 21 wounds, 41.2%) or absence (ACS group: 30 wounds, 58.8%) of clinical signs of arterial injury. All underwent duplex ultrasonography and arteriography. RESULTS: Arteriography disclosed arterial injury in 21 wounds, of which 19 were visualized by duplex ultrasonography. In the other 30 wounds neither methods disclosed any arterial injury. The sensitivity of duplex ultrasonography was 90.5%, the specificity was 100% and the accuracy was 96.1%. In PCS group duplex ultrasonography showed 14 injuries (93.3%) and one false-negative result, and in ACS group, five injuries (83.3%) and one false-negative result in the ACS group. CONCLUSIONS: Duplex ultrasonography reproduces the results of arteriography as a non-invasive diagnostic method in trauma of the limbs and neck.
Asunto(s)
Traumatismos del Brazo/diagnóstico por imagen , Arterias/diagnóstico por imagen , Arterias/lesiones , Traumatismos de la Pierna/diagnóstico por imagen , Traumatismos del Cuello/diagnóstico por imagen , Ultrasonografía Doppler Dúplex , Adolescente , Adulto , Angiografía , Brazo/irrigación sanguínea , Niño , Preescolar , Femenino , Humanos , Pierna/irrigación sanguínea , Masculino , Persona de Mediana Edad , Cuello/irrigación sanguínea , Valor Predictivo de las Pruebas , Estudios Prospectivos , Sensibilidad y EspecificidadRESUMEN
The authors intend to elaborate a brucellosis eradication program which could be used in the Amazonian region, an area characterised by extremely extensive animal husbandry practices. Under such conditions, eradication by selection is the only feasible approach. Brucellosis has been successfully eradicated from a herd with 22.1% prevalence of infection by two serological surveys using an indirect ELISA and the complement fixation test.
Asunto(s)
Brucella abortus/inmunología , Brucelosis Bovina/prevención & control , Pruebas de Aglutinación/veterinaria , Crianza de Animales Domésticos , Animales , Anticuerpos Antibacterianos/sangre , Brasil/epidemiología , Brucelosis Bovina/epidemiología , Bovinos , Pruebas de Fijación del Complemento/veterinaria , Ensayo de Inmunoadsorción Enzimática/veterinaria , Femenino , Prevalencia , Selección GenéticaRESUMEN
The high prevalence of brucellosis is one of the most serious animal health problems affecting cattle and buffalo herds of the Amazonian region. Modern diagnostic methods are not used or not even known, and thus test results are not available in that region. Therefore, in this study a total of 878 selected sera were subjected to comparative examination by five different serological tests (buffered plate agglutination test, tube agglutination test, complement fixation test, indirect ELISA, competitive ELISA). Indirect ELISA gave the highest number of positive results, except in samples derived from the Marajó island, for which the competitive ELISA proved to be the most sensitive. The sensitivity of the classical tests (agglutination, complement fixation) was markedly lower than that of the two ELISAs. After vaccination of 2-month-old heifer calves with the B19 vaccine, all tests showed a 50-60% seropositivity, which disappeared within four months.
Asunto(s)
Anticuerpos Antibacterianos/sangre , Vacuna contra la Brucelosis/inmunología , Brucella/inmunología , Brucelosis Bovina/diagnóstico , Pruebas de Aglutinación/veterinaria , Animales , Brasil/epidemiología , Brucelosis Bovina/epidemiología , Brucelosis Bovina/inmunología , Bovinos , Pruebas de Fijación del Complemento/veterinaria , Ensayo de Inmunoadsorción Enzimática/veterinaria , Femenino , Masculino , Prevalencia , Reproducibilidad de los Resultados , Sensibilidad y EspecificidadRESUMEN
OBJECTIVE: This study aimed to evaluate the retrobulbar circulatory effects of reversed ophthalmic artery flow (ROAF) on the ophthalmic artery branches by means of color Doppler imaging. DESIGN: The design was a case-controlled study. PARTICIPANTS: Among 56 consecutive patients with severe (>70% stenosis) occlusive carotid artery disease, 15 patients (26.8%) with ROAF were identified. The control group consisted of 15 patients with similar degrees of carotid artery stenosis and forward ophthalmic artery flow. INTERVENTION: Arteriography and measurement of the retrobulbar hemodynamic parameters with color Doppler imaging were performed. MAIN OUTCOME MEASURES: Blood flow velocities and resistive index in the ophthalmic, central retinal, and temporal short posterior ciliary arteries were measured. RESULTS: Arteriography confirmed the diagnosis of ROAF in all 15 patients. There was no patient with ROAF diagnosed by arteriography and not diagnosed by color Doppler imaging. The frequency of bilateral severe occlusive carotid artery disease was significantly higher in the ROAF group (40%) compared to the control group (6.6%) (P = 0.04). Patients with ROAF showed significantly reduced vascular resistance in the ophthalmic artery (P = 0.03), higher vascular resistance, and lower blood flow velocities in the central retinal and temporal short posterior ciliary arteries (P < 0.05). CONCLUSION: This study suggests that patients with ROAF show a steal phenomenon, characterized by a shunt to the low-resistance intracranial circuit and reduction of retrobulbar blood flow.
Asunto(s)
Arteria Carótida Interna/fisiopatología , Estenosis Carotídea/fisiopatología , Circulación Colateral , Arteria Oftálmica/fisiopatología , Ultrasonografía Doppler en Color , Anciano , Velocidad del Flujo Sanguíneo , Estudios de Casos y Controles , Arterias Ciliares/diagnóstico por imagen , Arterias Ciliares/fisiopatología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Arteria Oftálmica/diagnóstico por imagen , Arteria Retiniana/diagnóstico por imagen , Arteria Retiniana/fisiopatologíaRESUMEN
OBJECTIVE: The purpose of the study was to evaluate the ophthalmologic findings and to analyze the retrobulbar hemodynamics of patients with severe (greater than 70% stenosis) occlusive carotid artery disease (OCAD) by means of color Doppler imaging (CDI). DESIGN: A case-controlled study. PARTICIPANTS: Fifty-six consecutive patients with severe OCAD and an age- and sex-matched control group consisting of 56 healthy patients without OCAD were studied. INTERVENTION: All 112 patients underwent a complete ophthalmologic examination. Color Doppler imaging of both orbits was performed by one masked investigator. MAIN OUTCOME MEASURES: Peak systolic velocity, end diastolic velocity, and the resistive index of the ophthalmic, central retinal, and temporal short posterior ciliary arteries were measured. The authors compared the hemodynamic parameters measured in patients with severe OCAD with those obtained in the control group. The hemodynamic parameters of patients with asymmetric OCAD (stenosis > 70% in one internal carotid artery and stenosis < 50% in the contralateral artery) were also compared. In an attempt to determine risk factors associated with the ocular ischemic syndrome (OIS), the authors compared patients with severe OCAD and OIS with patients with severe OCAD without OIS. RESULTS: Peak systolic and end diastolic velocities in the ophthalmic, central retinal, and temporal short posterior ciliary arteries were significantly lower in patients with severe OCAD (P < 0.01). The mean resistive indices in the central retinal and temporal short posterior ciliary arteries were higher in the group with severe OCAD (P < 0.01). Similar results were obtained in the analysis of 25 patients with asymmetric carotid stenosis. Younger age (P = 0.012), severe bilateral OCAD (P = 0.01), high-grade carotid stenosis (P = 0.013), and reversed ophthalmic artery flow (P = 0.038) were significant risk factors for OIS. CONCLUSIONS: Patients with severe OCAD show hemodynamic changes that suggest reduced retrobulbar blood flow. Patients with severe bilateral OCAD, high-grade carotid stenosis, and reversed ophthalmic artery flow may have a greater risk of developing OIS.
Asunto(s)
Arteriopatías Oclusivas/fisiopatología , Enfermedades de las Arterias Carótidas/fisiopatología , Arterias Ciliares/fisiología , Arteria Oftálmica/fisiología , Arteria Retiniana/fisiología , Anciano , Arteriopatías Oclusivas/diagnóstico por imagen , Velocidad del Flujo Sanguíneo/fisiología , Enfermedades de las Arterias Carótidas/diagnóstico por imagen , Estudios de Casos y Controles , Arterias Ciliares/diagnóstico por imagen , Femenino , Humanos , Isquemia/diagnóstico por imagen , Isquemia/fisiopatología , Masculino , Persona de Mediana Edad , Arteria Oftálmica/diagnóstico por imagen , Estudios Prospectivos , Flujo Sanguíneo Regional , Arteria Retiniana/diagnóstico por imagen , Síndrome , Ultrasonografía Doppler en ColorRESUMEN
Color Doppler imaging allows simultaneous bidimensional imaging and Doppler evaluation of blood flow in orbital vessels. We report 4 cases in which color Doppler imaging was used to diagnose and monitor carotid cavernous fistulas. In all cases, color Doppler imaging demonstrated dilated, arterialized superior ophthalmic veins; these findings were confirmed by angiography. Two patients underwent embolization with complete regression of the clinical findings. After embolization, color Doppler imaging revealed normal, laminar flow in the superior ophthalmic vein. This noninvasive technique represents a safe and fast method that is useful in the diagnosis and post-treatment follow-up of carotid cavernous fistulas.
Asunto(s)
Fístula Arteriovenosa/diagnóstico por imagen , Arterias Carótidas/anomalías , Enfermedades de las Arterias Carótidas/diagnóstico por imagen , Seno Cavernoso/anomalías , Órbita/irrigación sanguínea , Ultrasonografía Doppler en Color , Adulto , Anciano , Angiografía , Fístula Arteriovenosa/fisiopatología , Fístula Arteriovenosa/terapia , Velocidad del Flujo Sanguíneo , Arterias Carótidas/diagnóstico por imagen , Enfermedades de las Arterias Carótidas/fisiopatología , Enfermedades de las Arterias Carótidas/terapia , Seno Cavernoso/diagnóstico por imagen , Embolización Terapéutica , Femenino , Estudios de Seguimiento , Humanos , Masculino , VenasRESUMEN
With the objective of analyzing the postaneurysmal peak systolic velocity (PSV) in ophthalmic arteries, duplex scanning was analyzed in 28 carotid-ophthalmic artery segments after exclusion of ipsilateral carotid stenosis. For comparison, the angiographic study of the extracranial and intracranial carotid system was utilized as the "gold standard." A subgroup of 7 subjects with 8 ophthalmic arteries with aneurysms identified where the artery leaves the internal carotid artery presented with PSVs significantly reduced (mean PSVs 17.95 +/- 7.99 cm/s) compared to the mean PSVs in the healthy group (27.95 +/- 5.54 cm/s) (p = 0.006). A PSV of less than 19 cm/s offered a sensitivity of 80% and a specificity of 100% in diagnosing ophthalmic artery aneurysms. We conclude that duplex scan is diagnostically useful in the identification of patients with ophthalmic artery aneurysms when severe ipsilateral carotid stenosis is excluded.
Asunto(s)
Aneurisma/diagnóstico por imagen , Arteria Oftálmica/diagnóstico por imagen , Ultrasonografía Doppler Dúplex , Adulto , Anciano , Análisis de Varianza , Aneurisma/complicaciones , Aneurisma/fisiopatología , Angiografía , Velocidad del Flujo Sanguíneo , Arteria Carótida Interna/diagnóstico por imagen , Reacciones Falso Positivas , Femenino , Humanos , Masculino , Persona de Mediana Edad , Arteria Oftálmica/fisiopatología , Reproducibilidad de los Resultados , Estudios Retrospectivos , Sensibilidad y EspecificidadRESUMEN
The study was carried out in ten patients with venous insufficiency of limbs verified by clinical standards, photopletismography and descending venogram witch, previous venous stasis ulcer and branquial/ankle doppler index greater than 0.9. The valvular closing time (VCT) was measured with Duplex scanning, at the level of popliteal vein bellow de lesser safenous vein entrance. The ten patients showed an initial VCT greater than 0.5 sec, with the utilization of the elastic compression and new measurement of VCT, seven showed a normalization of VCT (valves lower than 0.5 sec). The elastic compression of limbs is efficient in reducing the venous reflux and it could be evaluated individually with a non invasive test--The Duplex scanning.
Asunto(s)
Vendajes , Pierna/irrigación sanguínea , Insuficiencia Venosa/terapia , Humanos , Factores de Tiempo , Ultrasonografía Doppler Dúplex , Insuficiencia Venosa/diagnóstico por imagen , Presión VenosaRESUMEN
OBJETIVOS. Estudo em idosos de freqüência de aneurisma em artérias do abdome(AAA) e do diâmetro máximo da aorta abaixo das artérias renais naqueles sem dilataçäo arterial. MATERIAL E MÉTODOS. Foram estudados 411 indivíduos, 218 mulheres e 193 homens, com média de idade de 74,4 anos. Foram feitos o exame físico de abdome (EF) e a ultrasonografia de abdome (US), sendo este considerado o "padräo-ouro" de referência. Para a aorta, foi considerado aneurisma o diâmetro de artéria superior a 30 mm e, para as artérias ilíacas, o diâmetro máximo superior a 15mm. RESULTADOS. A US apontou a presença de aneurisma no território aortoilíaco em nove indivíduos, uma mulher e oito homens correspondendo a uma prevalência de 2,1 por cento, sendo 4,1 por cento em homens e 0,4 por cento em mulheres. Dois desses aneurismas estavam em artérias ilíacas ( um aneurisma em uma artéria ilíaca comum) e os demais sete na aorta abaixo das artérias renais. Os portadores de aneurisma de ilíaca säo homens. A prevalência do AAA foi de 1,7 por cento (7/411), sendo 3,1 por cento em homens e 0,4 por cento em mulheres. O EF indicou suspeita de presença de aneurisma em três desses pacientes. Outros seis pacientes näo tinham aneurisma. Considerando todos os aneurismas do território aortoilíaco, o EF teve sensibilidade de 33,3 por cento, especificidade de 99 por cento e valor preditivo positivo de 33,3 por cento. Considerando so AAA, a sensibilidade do EF foi de 42,8 por cento, a especificidade de 98,5 por cento e o valor preditivo positivo de 33 por cento. Nos 402 pacientes sem aneurisma arterial, o diâmetro máximo da aorta variou de 11 a 29 mm, com média de 16 ñ 21 mm. CONCLUSAO. A US é procedimento diagnóstico näo invasivo que deve ser utilizado em populaçäo idosa
Asunto(s)
Humanos , Masculino , Femenino , Anciano , Aneurisma de la Aorta Abdominal/diagnóstico , Aneurisma Ilíaco/diagnóstico , Anciano de 80 o más Años , Factores Sexuales , Estudios Transversales , Aneurisma de la Aorta Abdominal/etiología , Aneurisma de la Aorta Abdominal/fisiopatología , Enfermedad Coronaria/complicaciones , Aneurisma Ilíaco/fisiopatologíaRESUMEN
BACKGROUND: A study in old patients on the incidence of aneurysms in abdominal arteries (AAA) and on the maximum diameter of the aorta below the renal arteries in those patients without arterial dilatation. MATERIAL AND METHODS: The study comprised 411 individuals, 218 women and 153 men with an average age of 74.4 years. Physical examination of the abdomen (EF) and abdominal ultrasonography (US) were done, and the latter was considered the "golden standard" of reference. In relation to the aorta, it was considered as an aneurysm the maximum artery diameter larger than 30 mm and for the iliac arteries, the maximum diameter larger than 15 mm. RESULTS: The US showed the presence of aneurysm in the aortic-iliac territory in nine patients, one woman and eight men, corresponding to a prevalence of 2.1%, 4.1% in men and 0.4% in women. Two such aneurysms were in the iliac arteries (one aneurysm in a common iliac artery) and the other seven in the aorta below the renal arteries. The bearers of iliac aneurysm are men. The prevalence of the AAA was of 1.7% (7/411), 3.1% in men and 0.4% in women. The EF showed suspicion of the presence of aneurysm in 3 of these patients. The other 6 patients had no aneurysm. Considering all the aneurysms of the aortic-iliac territory, the EF had a sensitivity of 33.3%, a specificity of 99% and a positive prediction value of 33.3%. Considering only AAA, the sensitivity of the EF was 42.8%, the specificity 98.5%, and the positive prediction value, 33%. In the 402 patients without arterial aneurysm the maximum diameter of the aorta varied from 11 to 29 mm, with an average value of 16-21 mm. CONCLUSIONS: US is a non-invasive diagnostic procedure that should be used for the old age population.
Asunto(s)
Aneurisma de la Aorta Abdominal/epidemiología , Aneurisma Ilíaco/epidemiología , Factores de Edad , Anciano , Anciano de 80 o más Años , Aneurisma de la Aorta Abdominal/diagnóstico , Aneurisma de la Aorta Abdominal/etiología , Enfermedad Coronaria/complicaciones , Estudios Transversales , Femenino , Humanos , Aneurisma Ilíaco/diagnóstico , Masculino , Prevalencia , Factores SexualesRESUMEN
Para deteccao nao invasiva da presenca de doenca obstrutiva em arteria iliaca interna criou-se o teste de compressao das femorais. Este teste consiste na compressao da arcada inguinal com o polegar do examinador ate desaparecimento dos batimentos arteriais na regiao e distalmente no membro inferior correspondente, enquanto se ausculta o som na arteria dorsal peniana com estetoscopio ultra-sonico e se mede a pressao peniana. O teste foi considerado positivo quando houve abolicao do som na arteria peniana, ou reducao superior a 15 por cento na pressao peniana e, negativo, quando nao houve abolicao do som nem reducao da PP. Em 15 individuos normais, os 30 testes feitos, um para cada regiao inguinal, foram negativos. Em 23 pacientes com isquemia de membros inferiores selecionados pela analise de angiografias a que foram submetidos, foram realizados 39 testes, um em cada regiao inguinal em que havia batimento femoral. Houve abolicao do som na arteria dorsal peniana em 20 dos 22 testes em que a arteriografia mostrava obstrucao da arteria iliaca interna homolateral. Em 15 testes em que houve reducao da pressao peniana a arteriografia mostrava presenca de estenoses unica ou multiplas na arteria iliaca interna homolateral. Em dois casos com arteria iliaca interna homolateral pervia o teste foi negativo.
Asunto(s)
Humanos , Masculino , Adulto , Persona de Mediana Edad , Arteriopatías Oclusivas/diagnóstico , Arteria Femoral , Arteria Ilíaca , Anciano de 80 o más Años , Arteriopatías Oclusivas , Arteria Ilíaca , Pene/irrigación sanguínea , PresiónRESUMEN
For non-invasive detection of obstructive disease in the internal iliac artery, the femoral compression test was devised. This test consists in the compression of the inguinal arcade of the patient with the examiner's thumb, until the disappearance of the arterial beats in this region and peripherically in the correspondent lower limb, while one auscultates the sound in the dorsal penial artery with ultrasonic stethoscope and measures the penial pressure. The test was considered positive when there was abolition of sound in the penial artery, or reduction superior to 15% in the penial pressure. The test was negative when there was no abolition or reduction of sound and pressure, as referred respectively. In 15 normal individuals the 30 tests, one for each inguinal region, were negative. In 23 patients with ischemia of lower limbs registered by the analysis of angiographies to which they were submitted, there were 39 tests, one in each inguinal region, in which there was femoral pulsation. There was abolition of sound in the penial dorsal artery in 20 of 22 tests in which the arteriography showed obstruction of the homolateral internal iliac artery. In 15 tests, in which there was reduction of penial pressure, the arteriography showed presence of unique or multiple stenosis in the internal homolateral iliac artery. In two cases of patency of the internal homolateral iliac artery, the test was negative. The positivity of the test was significantly higher in patients with obstructive lesions of internal iliac artery when compared to normal individuals (p < 0.001, chi-square test).(ABSTRACT TRUNCATED AT 250 WORDS)