RESUMO
OBJECTIVE: Serial Doppler ultrasonography and long-term neurodevelopmental follow-up outcomes were evaluated prospectively in neonates whose right common carotid artery (RCCA) was reconstructed after extracorporeal membrane oxygenation (ECMO). METHODS: Children with RCCA reconstruction (n = 34) were monitored for 3.5 to 4.5 years by Doppler ultrasonography for arterial patency, and 28 had IQ testing by 5 years. A comparison group consisted of 35 infants who had RCCA ligation after ECMO. Neonatal electroencephalograms and computed tomography/magnetic resonance imaging scans were also compared. RESULTS: Reconstructions were successful (<50% RCCA stenosis by Doppler ultrasonography) in 26 (76%) of 34 children, 3 (9%) had >/=50% stenosis, and 5 (15%) had occlusion. No significant differences were seen between reconstructed and ligated groups in neonatal complications or ECMO courses. Occurrence of marked neonatal electroencephalographic abnormalities did not differ between groups. Abnormalities on computed tomography/magnetic resonance imaging scans (4 of 31 vs 11 of 29, P =.025) and cerebral palsy (0 of 34 vs 5 of 35, P =.054) were more common in infants with RCCA ligation. No differences were seen in developmental or IQ scores between the 2 groups, and 4 in each group had cognitive handicaps (at least 1 IQ score <70). CONCLUSIONS: Most RCCA reconstructions remained patent, with 24% showing significant stenosis or occlusion. Compared with a historical control group, patients with RCCA reconstruction had fewer brain scan abnormalities and tended to be less likely to have cerebral palsy. RCCA reconstruction after venoarterial ECMO may improve outcome.
Assuntos
Artéria Carótida Primitiva/cirurgia , Oxigenação por Membrana Extracorpórea , Peso ao Nascer , Artéria Carótida Primitiva/diagnóstico por imagem , Eletroencefalografia , Seguimentos , Idade Gestacional , Humanos , Recém-Nascido , Testes de Inteligência , Ligadura , Imageamento por Ressonância Magnética , Resultado do Tratamento , Ultrassonografia , Grau de Desobstrução VascularRESUMO
Changes in color Doppler imaging measurements of renal artery blood flow velocity have been reported previously during fetal life and during the first week postnatally in term and preterm infants. This study reports longitudinal, developmental changes in renal artery and aortic blood flow velocities occurring postnatally, from birth to day 1 of life, at 1 week, and at 2 to 3 weeks of age in 14 premature babies (mean gestation, 30 +/- 4 (SD) weeks; birth weight, 1.45 +/- 0.57 kg), and identified by means of color Doppler imaging and pulsed Doppler spectral analysis. Results indicate that a significant increase in renal artery systolic blood flow velocity occurs within the first week of life (from 40 +/- 3 (SEM) cm/sec at birth or on day 1, to 53 +/- 3 cm/sec on day 7, to 51 +/- 4 cm/sec on day 14 to 21; repeated-measures analysis of variance, p = 0.004), concurrently with a significant increase in abdominal aortic blood flow velocities, both systolic (from 40 +/- 4 at birth or on day 1, to 70 +/- 8 on day 7, to 76 +/- 8 cm/sec on day 14 to 21; p <0.001) and diastolic (from 4 +/- 2 at birth or on day 1, to 11 +/- 2 on day 7, to 11 +/- 2 cm/sec on day 14 to 21; p = 0.00 1). Systemic blood pressure did not increase concomitantly during the some period. Neither the presence of respiratory distress syndrome or patent ductus arteriosus nor treatment with indomethacin altered developmental increases in observed renal artery blood flow velocities. The presence of an umbilical artery catheter in the high thoracic position in five infants, however, created turbulence at the level of the renal arteries, significantly increasing renal artery systolic flow velocity from 32 +/- 4 to 44 +/- 5 cm/sec (p = 0.009) and increasing renal resistive index from 0.90 +/- 0.03 to 0.96 +/- 0.04 (p = 0.046). These results suggest that renal artery blood flow velocity increases during the first postnatal week in preterm infants and is likely related to increases in aortic blood flow velocity and reduction in renal vascular resistance.
Assuntos
Recém-Nascido Prematuro/fisiologia , Artéria Renal/fisiologia , Análise de Variância , Anti-Inflamatórios não Esteroides/uso terapêutico , Aorta Abdominal/fisiologia , Velocidade do Fluxo Sanguíneo/efeitos dos fármacos , Pressão Sanguínea , Cateterismo Periférico , Inibidores de Ciclo-Oxigenase/uso terapêutico , Diástole , Permeabilidade do Canal Arterial/tratamento farmacológico , Permeabilidade do Canal Arterial/fisiopatologia , Seguimentos , Idade Gestacional , Hemorreologia , Humanos , Indometacina/uso terapêutico , Recém-Nascido , Estudos Longitudinais , Síndrome do Desconforto Respiratório do Recém-Nascido/fisiopatologia , Sístole , Ultrassonografia Doppler em Cores , Ultrassonografia Doppler de Pulso , Artérias Umbilicais/fisiologia , Resistência VascularRESUMO
OBJECTIVE: Right common carotid artery (RCCA) ligation after extracorporeal membrane oxygenation by venoarterial bypass may contribute to lateralized cerebral injury. Reconstruction of this artery after extracorporeal membrane oxygenation has proved feasible but has not been evaluated for neurologic outcome in any substantial series of infants. METHODS: We evaluated RCCA reconstruction in 47 infants treated with ECMO and compared their cerebrovascular and neuroanatomic imaging findings, electroencephalograms, and developmental outcomes with those of 93 infants who had no reconstruction. SUMMARY RESULTS: Color Doppler blood flow imaging revealed that carotid artery patency was usually obtained after RCCA reconstruction. Right internal carotid and bilateral anterior and middle cerebral arterial blood flow velocities were generally higher, and were more symmetrically distributed in infants with reconstructed RCCA. Electroencephalography did not disclose an increased risk of deterioration or marked abnormalities in infants after reconstruction, nor were neuroimaging findings consistent with an increased number of either focal or generalized abnormalities. Neurodevelopmental follow-up revealed no differences in the incidence of delays between those with a reconstructed RCCA and those with a ligated RCCA during the first year of life. CONCLUSIONS: Reconstruction of the RCCA after extracorporeal membrane oxygenation may facilitate normal distribution of cerebral blood flow through the circle of Willis, and may augment both left and right middle cerebral artery blood flow immediately after decannulation. The long-term consequences of either ligation or reconstruction of the RCCA will require careful scrutiny, however, before either course is recommended routinely.
Assuntos
Artéria Carótida Primitiva/cirurgia , Circulação Cerebrovascular , Oxigenação por Membrana Extracorpórea , Velocidade do Fluxo Sanguíneo , Encéfalo/diagnóstico por imagem , Artéria Carótida Primitiva/diagnóstico por imagem , Artéria Carótida Primitiva/fisiologia , Artérias Cerebrais/diagnóstico por imagem , Artérias Cerebrais/fisiologia , Desenvolvimento Infantil , Ecoencefalografia , Eletroencefalografia , Oxigenação por Membrana Extracorpórea/efeitos adversos , Seguimentos , Humanos , Recém-Nascido , Doenças do Sistema Nervoso/etiologia , Insuficiência Respiratória/terapia , Tomografia Computadorizada por Raios XRESUMO
The imaging findings associated with internal abdominal hernia have been reported for plain radiography, barium studies, arteriography and computed tomography. The authors present a case in which the ultrasonographic findings indicated left paraduodenal hernia. In the investigation of an abdominal mass, the presence of changing cystic or tubular internal components and a surrounding membrane should arouse suspicion of an internal hernia.
Assuntos
Hérnia Ventral/diagnóstico por imagem , Idoso , Feminino , Humanos , UltrassonografiaRESUMO
Surviving preterm infants of less than 34 weeks' gestation who were selected on the basis of serial cranial ultrasonographic findings during their nursery course had repeated neurologic and developmental examinations during late infancy and early childhood that established the presence (n = 46) or absence (n = 205) of spastic forms of cerebral palsy. Of the 205 infants without cerebral palsy, 22 scored abnormally low on standardized developmental testing during early childhood. The need for mechanical ventilation beginning on the first day of life (n = 92) was significantly related to gestational age, birth weight, Apgar scores, patent ductus arteriosus, grade III/IV intracranial hemorrhage, large periventricular cysts, and the development of cerebral palsy. In the 192 mechanically ventilated infants, vaginal bleeding during the third trimester, low Apgar scores, and maximally low PCO2 values during the first 3 days of life were significantly related to large periventricular cysts (n = 41) and cerebral palsy (n = 43), but not to developmental delay in the absence of cerebral palsy (n = 18). The severity of intracranial hemorrhage in mechanically ventilated infants was significantly associated with gestational age and maximally low measurements of PCO2 and pH, but not with Apgar scores or maximally low measurements of PO2. Logistic regression analyses controlling for possible confounding variables disclosed that PCO2 values of less than 17 mm Hg during the first 3 days of life in mechanically ventilated infants were associated with a significantly increased risk of moderate to severe periventricular echodensity, large periventricular cysts, grade III/IV intracranial hemorrhage, and cerebral palsy. Neurosonographic abnormalities were highly predictive of cerebral palsy independent of PCO2 measurements.(ABSTRACT TRUNCATED AT 250 WORDS)
Assuntos
Encefalopatias/etiologia , Paralisia Cerebral/etiologia , Desenvolvimento Infantil , Recém-Nascido Prematuro , Respiração Artificial/efeitos adversos , Encefalopatias/sangue , Encefalopatias/diagnóstico por imagem , Dióxido de Carbono/sangue , Hemorragia Cerebral/diagnóstico por imagem , Hemorragia Cerebral/etiologia , Paralisia Cerebral/sangue , Pré-Escolar , Cistos/diagnóstico por imagem , Cistos/etiologia , Ecoencefalografia , Humanos , Lactente , Recém-Nascido , Doenças do Prematuro/sangue , Doenças do Prematuro/diagnóstico por imagem , Doenças do Prematuro/terapia , Insuficiência Respiratória/sangue , Insuficiência Respiratória/terapia , Fatores de RiscoRESUMO
In this study of 249 preterm infants of less than 34 weeks' gestation, the relationships between maximal serum total bilirubin concentrations during the neonatal period, neonatal cranial ultrasonographic abnormalities, and severe neurodevelopmental sequelae are described. The subjects, who were selected on the basis of serial cranial ultrasonographic findings, had repeated neurologic and developmental examinations during late infancy and early childhood that established the presence (n = 45) or absence (n = 204) of spastic forms of cerebral palsy. Of the 204 subjects without cerebral palsy, 23 scored abnormally low on standardized developmental testing during early childhood. All but seven of the subjects with cerebral palsy had grade III/IV intracranial hemorrhage or moderate to severe periventricular echogenicity or both, ultrasonographic abnormalities that probably reflect a disruption in the blood-brain barrier as well as extravasation of blood into brain tissue; however, analysis of the data did not suggest that these cranial ultrasonographic abnormalities increased either the maximum serum bilirubin concentration during the neonatal period or the susceptibility of the subjects to neurologic damage from hyperbilirubinemia. Also, there was no evidence to suggest that bilirubinemia in the range studied (2.3 to 22.5 mg/100 mL total serum bilirubin) was causally related to cerebral palsy, early developmental delay, or the development of periventricular cysts in this population of preterm infants.(ABSTRACT TRUNCATED AT 250 WORDS)
Assuntos
Bilirrubina/sangue , Paralisia Cerebral/epidemiologia , Deficiências do Desenvolvimento/epidemiologia , Doenças do Prematuro/diagnóstico por imagem , Recém-Nascido Prematuro/crescimento & desenvolvimento , Índice de Apgar , Peso ao Nascer , Hemorragia Cerebral/diagnóstico por imagem , Pré-Escolar , Humanos , Lactente , Recém-Nascido , Doenças do Prematuro/diagnóstico , Icterícia Neonatal/diagnóstico , Leucomalácia Periventricular/diagnóstico por imagem , Fatores de Risco , UltrassonografiaRESUMO
To determine whether flow through the subclavian artery might be affected during extracorporeal membrane oxygenation (ECMO), 40 neonates were examined with color Doppler ultrasound during and after ECMO. Retrograde flow in the right vertebral artery, noted in 12 of the 40 neonates (30%), was consistent with vertebral steal. Brachial systolic velocity was significantly less (P less than .01) on the right than on the left side in neonates both with and without vertebral steal. When the arterial cannula was removed after ECMO, vertebral artery flow became antegrade with symmetric velocity. Brachial velocities became symmetric in infants without vertebral steal, but mild asymmetry persisted in neonates who had had vertebral steal. Only one neonate had clinical signs of arm ischemia, which resolved promptly after removal of the cannula. No surviving neonates (n = 11) had neurologic findings related to the vertebrobasilar insufficiency over a 12-22-month period of observation. Vertebral steal appears to be common during ECMO and is resolved after removal of the cannula.
Assuntos
Cateterismo/efeitos adversos , Oxigenação por Membrana Extracorpórea/efeitos adversos , Insuficiência Vertebrobasilar/diagnóstico por imagem , Artéria Basilar/fisiopatologia , Velocidade do Fluxo Sanguíneo , Artéria Braquial/fisiopatologia , Artérias Carótidas/fisiopatologia , Humanos , Recém-Nascido , Ultrassonografia , Artéria Vertebral/fisiopatologia , Insuficiência Vertebrobasilar/etiologia , Insuficiência Vertebrobasilar/fisiopatologiaRESUMO
Endoluminal sonography of the urinary tract was performed by using endoluminal ultrasound transducers contained within 2-mm-diameter catheters. The catheters were inserted into the urinary bladder via the urethra and advanced into the ureters and renal pelvis under cystoscopic control; then, cross-sectional images of the bladder, ureters, and renal pelvis were obtained. Two dogs and seven human patients were studied. In one dog, a 4.5-mm pseudopolyp, which was surgically created in the bladder wall, was successfully imaged; in the other, stones 2 mm or larger inserted into the bladder were identified. Of the seven patients, sonography showed stones embedded in the renal parenchyma (one patient) and the mucosa of the distal ureter (one patient). These were ultimately confirmed by their eventual removal. In a third, sonography showed a tumor of the distal ureter and identified the depth of the tumor. This was confirmed by biopsy. In a fourth, sonography clearly showed a crossing vessel as the cause for narrowing of the proximal ureter. In a fifth, sonography showed that the cause of a ureteral stricture was idiopathic. In the last two cases, sonography did not reveal a cause for hematuria. In these last three cases, negative sonographic results were confirmed by direct ureteroscopic examinations and follow-up studies. Our observations based on this limited study suggest that endoluminal sonography is a useful procedure for diagnosing diseases of the urinary tract. Further study is warranted.
Assuntos
Doenças Urológicas/diagnóstico por imagem , Adulto , Idoso , Animais , Cães , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ultrassonografia , Cálculos Urinários/diagnóstico por imagem , Sistema Urinário/diagnóstico por imagem , Neoplasias Urológicas/diagnóstico por imagemRESUMO
Color Doppler imaging (CDI) is a recent advance in ultrasonography. It allows simultaneous two-dimensional structural imaging and evaluation of blood-flow characteristics. The velocity information of the scan is extracted and added to the images as color information. A total of 20 normal eyes and 30 patients with intraocular tumors were examined with this technique. The central retinal artery, the posterior cliliary arteries, the opthalmic artery and the central retinal vein could be located in all patients. In the intraocular tumors blood flow was detected reliably. Spectrum analysis of the displayed vessels allows semiquantitative assessment of blood flow in these vessels. This new technique of color Doppler imaging offers a new modality to study ocular and orbital blood flow.