TCD在脑静脉系统血栓诊断及治疗监测中的意义

目的探讨经颅多普勒超声(TCD)在脑静脉系统血栓(CVT)诊断及治疗监测中的应用意义.方法采用TCD对经MRI以及DSA或MRV证实的35例CVT患者脑基底静脉(BVR)及其属支大脑中深静脉(DMCV)血流速度进行诊断性探测,并对其中13例经过溶栓治疗者进行动态监测.结果 BVR和DMCV流速分别为(64.1±21.9) cm/s和(70.1±27.4) cm/s,较正常值明显增高(P<0.01),但不受颅内压增高的影响(r=0.02,P＞0.05).经溶栓治疗后的两静脉血流速度明显下降(P<0.01).结论 TCD所显示的CVT患者BVR或DMCV血流速度的异常增高具有诊断意义,可为CVT的早期诊断和疗效监测提供无创而又费用低廉的检测方法.     

冠脉血流显像技术无创性评价肥厚型心肌病的冠脉血流及冠脉血流储备

目的 利用经胸壁冠脉血流显像技术探测肥厚型心肌病(HCM) 左冠状动脉前降支血流,评价冠脉血流 储备,并分析导致HCM 心肌缺血的原因。方法 测量10 例HCM 前降支远端冠脉动脉舒张期峰值血流速度 (Vmax) 及平均血流速度(Vmean) ,经静脉注射潘生丁,并测量达到最大充血状态时的Vmax、Vmean 及注射潘生丁 开始至达到最大充血状态的时间( T) ,计算冠脉血流储备(CFR) 并计算Vmax 及Vmean 与室间隔厚度( IVS) 的比值。 选择10 例正常人为对照组,测量静息及最大充血状态的Vmax 及Vmean ,并计算CFR。结果 静息状态HCM 组 Vmax 及Vmean 组明显高于正常组( P < 0. 001) ,最大充血状态时HCM 组与正常组间无差异( P > 0. 05) , T 明显延 迟( P < 0. 001) ,CFR 明显低于正常组( P < 0. 001) 。静息状态HCM 组Vmax/ IVS、Vmean/ IVS 明显低于正常组( P < 0. 01) ,最大充血状态时其比值更低( P < 0. 001) 。结论 经胸壁冠脉血流显像是一种准确有效地测量HCM 冠脉 血流,评价冠脉血流储备的无创性检测方法。导致HCM 患者CFR 减低的原因是冠状动脉小血管结构的改变使其 扩张能力减低。而HCM 心肌缺血与冠脉血流与室间隔厚度不适应及CFR 减低有关。     

采用多普勒检查老年高血压颈动脉变化

目的探讨多普勒检查老年高血压颈动脉变化的应用价值。方法将2014年2月~2015年2月于我院住院的37例老年高血压患者作为观察组,选择同期于我院体检的37例健康老年人作为对照组。采用多普勒检测两组颈动脉结构和血流动力学情况。通过比较两组颈总动脉和颈内动脉的内径、内膜中层厚度(IMT)、扩张性、坚硬度和颈动脉内斑块发生个数来评估多普勒对老年高血压患者颈动脉结构变化的检测情况;通过比较两组颈总动脉和颈内动脉的收缩期峰值血流速度(PSV)、舒张末期血流速度(EDV)、血管阻力指数(RI)、血管搏动指数(PI)、平均流速(Vmean)参数来评估多普勒对老年高血压患者颈动脉血流动力学的检测情况。结果观察组颈总动脉内径(7.45±1.09)mm、Vmean(23.76±3.83)cm/s较对照组(8.37±1.34)mm、(31.07±4.13)cm/s显著较低(P0.05),IMT(1.32±0.15)mm、PI(0.79±0.06)较对照组颈(0.86±0.13)mm、(0.71±0.04)显著较高(P0.05)。观察组颈内动脉内径(5.72±1.07)mm、Vmean(26.42±3.57)cm/s较对照组(6.63±1.01)mm、(33.24±4.21)cm/s显著较低(P0.05),IMT(1.18±0.13)mm、RI(0.76±0.07)较对照组(0.72±0.14)mm、(0.68±0.05)显著较高(P0.05)。观察组斑块数(21.34±3.45)个较对照组(9.76±2.38)个显著较高(P0.05)。结论多普勒检查可用于检测老年高血压颈动脉异常变化,对及时发现老年高血压患者动脉血管病变有一定的临床价值。     

彩色多普勒能量显像技术在糖尿病视网膜病变研究中的应用

目的:研究糖尿病视网膜病变患者视网膜血流动力学改变。方法:采用彩色多普勒能量成像的方法,对30例正常人和71例糖尿病患者视网膜中央动脉的血流进行了检测。结果:糖尿病患者视网膜中央动脉血流速度均较对照组降低(P<0.05～0.01)。阻力指数(RI)比对照组增高(P<0.05)。糖尿病合并增殖性视网膜病变的患者(C组)VPS、Vmean比糖尿病无视网膜病变患者(A组)降低(P<0.05)。结论:糖尿病患者的视网膜血流动力学异常,对糖尿病视网膜病变的早期诊断、防治有重要意义。     

颈动脉超声在分析影响缺血性脑血管病变严重程度的危险因素中的应用

目的:通过颈动脉超声检测探究正常人与缺血性脑血管病变(ischemic cerebral vascular disease,ICVD)颈动脉轻度狭窄、中度狭窄、重度狭窄患者血流动力学参数、动脉粥样硬化斑块分型、指数、积分以及颈内和颈总动脉内膜中层厚度和血流速度增长百分比等指标,分析导致ICVD加重的危险因素,为临床上诊断ICVD及其严重程度提供有力的技术支持。方法:采用病例对照研究方法,应用Beckman全自动生化分析仪检测各组研究对象总胆固醇(total cholesterol,TC)、三酰甘油(triglyceride,TG)、低密度脂蛋白(low density lipoprotein,LDL)、高密度脂蛋白水平(highdensity lipoprotein deficiency,HDL);采用颈动脉超声仪检测各组对象颈动脉血管内径(vessel diameter,VD)、平均血流速度(mean flow velocity,MFV)、舒张末期最低血流速度(end-diastole velocity,EDV)、收缩期最大血流速度(peak systohcvelocity,PSV)、颈总动脉和颈内动脉内膜中层厚度(intima-media thickness,IMT);分析计算各组对象动脉粥样硬化指数(atherosclerosis index,AI)、斑块积分以及血流速度增长百分比;采用SPSS运用logistic回归模型分析影响ICVD变严重程度的危险因素。结果:ICVD颈动脉轻度狭窄、中度狭窄、重度狭窄患者TC、TG、LDL明显高于正常对照组,HDL低于正常对照组,ICVD三个组别之间TC、TG、LDL、HDL均有统计学差异(P<0.05);ICVD组别与正常对照组相比,VD、MFV、EDV、PSV明显升高,但四组间无明显统计学差异(P>0.05);ICVD患者动脉粥样硬化的发生部位主要是颈总动脉,并以软斑为主;ICVD组别与正常对照组相比,AI、斑块积分、颈总动脉和颈内动脉IMT明显增加,且ICVD组别之间AI、斑块积分、颈总动脉和颈内动脉IMT也有明显差异(P<0.05);ICVD组别与正常对照组相比,屏气前后血流速度增长百分比明显下降,且ICVD组别之间血流增长速度百分比也有明显差异(P<0.05);影响ICVD严重程度的危险因素主要包括AI、颈总动脉和颈内动脉IMT、颈总动脉和颈内动脉血流增长速度百分比、斑块积分、软斑。结论:应用颈动脉超声分析影响ICVD严重程度的危险因素,有助于早诊断和防止ICVD的病情恶化,提高患者的生命质量。     

颈动脉超声在缺血性脑血管病患者颈动脉病变检测中的应用

目的:探讨颈动脉超声在缺血性脑血管病(ischemic cerebrovascular disease,ICVD)患者颈动脉病变检测中的应用。方法:应用彩色多普勒超声对82例ICVD患者和40例健康体检者进行颈动脉超声检查并测定血管反应性(vascular reactivity,VR)。比较2组研究对象的颈动脉内–中膜厚度(intima-media thickness,IMT)、斑块总积分、斑块总面积及脑血流量等情况。结果:ICVD患者中颈总动脉及颈内动脉重度狭窄组患者的血管内径(vessel diameter,VD)、IMT、收缩期最大血流速度(peak systolic velocity,PSV)、舒张末期最低血流速度(end-diastolic velocity,EDV)、平均血流速度(mean flow velocity,MFV)均显著高于对照组(P0.01);颈动脉无狭窄组患者及轻、中、重度狭窄组患者的VR均低于对照组(P0.05);ICVD组患者IMT、颈动脉斑块积分、斑块总面积显著高于对照组(P0.01)。结论:应用颈动脉超声检测ICVD患者的颈动脉病变程度,有助于了解ICVD的不同状态以判断病程及预后,对ICVD的治疗具有重要意义。     

胸背动脉血流动力学的彩色多普勒超声研究

目的　研究正常人胸背动脉 (TDA)血流动力学。方法　应用彩色多普勒血流显像测量 12 0个正常人 2 40条胸背动脉主干血流参数 ,包括收缩期最大血流速度 (Vmax) ,平均血流速度 (Vmean) ,舒张期最小血流速度 (Vmin) ,搏动指数(PI)和阻力指数 (RI) ,做统计学分析。结果　正常人胸背动脉血流参数 95 %参考值范围 :Vmax 2 8.46～ 60 .2 6cm/s ,Vmean 6.80～ 2 2 .84cm /s ,Vmin 1.16～ 6.76cm/s ,PI 1.78～ 3 .3 4,RI 0 .84～ 0 .95。TDA血流参数左右无显著性差异 ;男性血流速度高于女性 (P <0 .0 5 ) ;老年组 ( 60～ 79岁 )各项血流参数与青年组 ( 2 0～ 3 9岁 )、中年组 ( 4 0～ 5 9岁 )比较均有显著性差异。结论　提出了正常TDA的基础参数 ,为背阔肌肌瓣皮和皮瓣的临床应用提供了科学、客观的对照标准。     

经胸冠脉血流显像评价冠心Ⅱ号对正常人冠脉血流动力学的影响

目的观察中药复方冠心Ⅱ号对正常人冠脉血流动力学的影响,探讨经胸冠脉血流显像(CAFI)技术在中药药理学研究中的应用价值.方法应用经胸冠脉血流显像技术,检测12例健康男性口服冠心Ⅱ号前、后冠脉左前降支(LAD)的舒张期最大血流速度(Vmax)、平均血流速度(Vmean)及舒张期血流速度时间积分(VTI)的变化,并以饮用等量水作自身对照.结果 CAFI检测成功率为91.7%.冠脉血流Vmax和VTI在服药30、60、90 min及120 min时较服药前明显增加,Vmean在服药后60、90 min及120 min较服药前显著增快(P＜0.05).结论增加冠脉血流量可能是冠心Ⅱ号治疗冠心病心绞痛的机制之一,经胸冠脉血流显像技术能无创、准确地检测冠脉血流动力学变化,可作为临床上评价冠心病药物疗效的新方法.     

SPECT对缺血性脑血管病远隔缺血预适应的疗效评价研究

目的探讨单光子发射计算机断层(SPECT)显像对缺血性脑血管病(ICVD)患者在远隔缺血预适应疗效评价中的应用价值。方法 50例单侧颅内外动脉重度狭窄或闭塞的缺血性脑血管病患者,远隔缺血预适应(RIPC)治疗前后分别行SPECT脑血流灌注和脑葡萄糖代谢显像,分析RIPC治疗前后脑血流灌注及脑葡萄糖代谢显像病灶数量、脑血流量及脑代谢率的差异。结果 50例ICVD患者RIPC治疗后脑血流灌注异常病灶数量减少,47例(94.0%)血流灌注有不同程度增高;3例(6.0%)脑血流灌注增高患者有不同程度减低。50例ICVD患者RIPC治疗后脑葡萄糖代谢异常病灶数量增加,40例代谢减低的患者有34例(68.0%)不同程度代谢增高;10例代谢增高的患者有6例(12.0%)不同程度代谢减低。50例ICVD患者RIPC治疗前后SPECT显像比较,患侧额、顶、颞、枕叶、基底节和丘脑的血流灌注显著增高(P0.05);额、颞、枕叶、基底节和丘脑的葡萄糖代谢显著增高(P0.01),顶叶葡萄糖代谢增高无显著性差异(P0.05)。结论 SPECT脑血流灌注及脑葡萄糖代谢显像对评价RIPC治疗ICVD的疗效有重要价值。     

脉冲多普勒取样容积位置对胎儿肺动脉血流频谱参数影响的研究

目的通过将脉冲多普勒取样容积(SV)放置在胎儿肺动脉瓣口三个不同位置(a:内侧,靠近主动脉侧;b:肺动脉瓣口中间;c:外侧,远离主动脉侧)分别获得胎儿肺动脉血流频谱,探讨不同的SV位置对胎儿肺动脉血流频谱参数的影响,从而为更准确的测量提供参考依据。方法选取424例正常胎儿,根据不同孕周分成5组,20~23+6周,24~27+6周,28~31+6周,32~35+6周,36~40+6周,分别测量其肺动脉瓣口三个位置(a、b、c)的速度时间积分(VTI)、最大血流速度(Vmax)、平均血流速度(Vmean)、最大压差(PGmax)、平均压差(PGmean)、射血时间(ET)、加速时间(AT)、加速时间与射血时间的比值(AT/ET)。不同孕周间VTI、Vmax、Vmean、PGmax、PGmean、ET、AT、AT/ET组间比较采用方差分析,各参数与孕周的关系进行Pearson相关分析,所有孕周不同取样容积位置(a、b、c)的比较采用配对t检验。结果不同孕周间VTI、Vmax、Vmean、PGmax、PGmean、AT、AT/ET组间比较差异均有统计学意义(P=0.000),且均与孕周呈线性相关,a组与b组、b组与c组比较AT、AT/ET、Vmax、Vmean有统计学意义(P=0.000),a组与c组比较AT、AT/ET、Vmax、Vmean无统计学意义(P0.05)。结论 SV位置的不同会对胎儿肺动脉血流频谱参数产生影响。     

Effect of hyperventilation on the cerebral blood flow and metabolism in patients with craniocerebral trauma

Cerebral blood flow and metabolism were studied in 44 patients with acute severe craniocerebral injuries (contusions of the brain and removal of intracranial hematomas) with consciousness depression (moderate coma), hospitalized in intensive neurological care wards. Oxygen supply to the brain was repeatedly evaluated (acid-base status of the jugular vein blood, oxygen arterio-venous difference, oxygen extraction coefficient), oxymetry of the brain was repeatedly carried out, and vital functions were monitored over the entire period of disease. Cerebral blood flow was monitored by rheoencephalography, which helped timely detect the changes in cerebral blood flow in patients with craniocerebral injuries during different ventilation protocols used in intensive care. All studies were carried out during three stages: 1) initial stage, when the patients were brought to intensive neurological care wards after surgical intervention, and during normoventilation (paCO2 36-40 mm Hg; 2) moderate hyperventilation (paCO2 35-26 mm Hg); and 3) pronounced hyperventilation (paCO2 25-20 mm Hg). Specific changes in the cerebral blood flow during the acute period of craniocerebral injury were detected during different ventilation regimens in 2 groups of patients: group 1 with lethal outcomes and group 2 with positive changes.     

通气程度对颅脑损伤患者脑氧供需平衡的影响

背景不适当的过度通气可能诱使脑血管收缩,导致脑低灌流和氧供需失衡.目的探讨过度通气对严重颅脑伤患者颈内静脉球血氧饱和度、脑动静脉氧含量差和脑静动脉血乳酸差的影响.设计病例分析.单位汕头大学医学院第一附属医院麻醉科.对象选择汕头大学医学院第一附属医院2002-01/07收治的严重颅脑损伤急诊手术患者16例进行观察.方法颅脑损伤手术患者全身麻醉后,调节呼吸频率使二氧化碳分压达30 mm Hg并维持15 min,然后提高呼吸频率使二氧化碳分压达到25 mm Hg亦维持15 min,再降低呼吸频率以使二氧化碳分压恢复至30 mm Hg同样维持15 min,改变吸入氧浓度以使血氧分压稳定在100～150 mm Hg,并于上述二氧化碳分压改变并维持15 min后,分别采集动脉和颈内静脉球血液进行血气分析.调高吸入氧浓度将血氧分压增至200～250 mm Hg,再重复上述通气调节依此将二氧化碳分压改变为30→25→30mm Hg,测定颈内静脉球血氧饱和度、脑动静脉氧含量差及脑静动脉血乳酸差.主要观察指标血氧分压和二氧化碳分压变化对颈内静脉球血氧饱和度、脑动静脉氧含量差和脑静动脉血乳酸差的影响.结果16例患者符合标准并完成数据采集.当动脉血氧分压为100～150 mm Hg及200～250 mm Hg,动脉血二氧化碳分压从30 mm Hg降至25 mm Hg时,可使颈内静脉球血氧饱和度明显降低、脑动静脉氧含量差明显升高,但血氧分压200～250mm Hg与血氧分压100～150mm Hg相比,颈内静脉球血氧饱和度的绝对值均明显较高,脑动静脉氧含量差绝对值明显较低.与基础值相比,血氧分压100～150 mm Hg、二氧化碳分压30 m Hg及25mmHg和血氧分压200～250 mm Hg、二氧化碳分压25 mm Hg时,脑静动脉血乳酸差均明显升高.结论较高动脉血氧水平(血氧分压200～250 mm Hg)和中度过度通气(二氧化碳分压30mm Hg)对脑氧供需平衡无明显影响.     

Doppler evaluation of external iliac vein hemodynamic changes caused by lymphocele after lymphadenectomy for cervical cancer

PURPOSE: To use Doppler sonography to assess the hemodynamic changes in the external iliac vein (EIV) compressed by a pelvic lymphocele after pelvic lymphadenectomy in patients with cervical cancer. MATERIALS AND METHODS: Postoperative gray-scale and Doppler sonographic examinations were performed in 71 women after pelvic lymphadenectomy. Twenty healthy women served as controls. When present, the lymphocele was graded on a scale of 1 to 4 based on the percentage of the circumference of iliac vessels in contact with the lymphocele (ie, circumferential contiguity) (grade 1, 0-24%; grade 2, 25-49%; grade 3, 50-74%; grade 4, 75-100%), and in 3 groups according to its maximum diameter (group A, 1-40 mm; group B, 41-60 mm; group C, >60 mm). EIV velocity was measured, and waveform modulation by respiratory movements was analyzed. RESULTS: There were 40 lymphoceles in 22 patients. The mean (+/-SD) EIV velocity was 24.5 +/- 14.8 cm/s in the control group, 38.2 +/- 5.9 cm/s in group 1, 69.2 +/- 29.4 cm/s in group 2, 105.75 +/- 12.36 cm/s in group 3, and 139.5 +/- 33.79 cm/s in group 4. Spontaneous EIV blood flow could not be detected in 2 cases in the later group. EIV flow modulation was significantly lower in patients with greater lymphocele contiguity or diameter. CONCLUSIONS: Post-pelvic lymphadenectomy causes EIV extrinsic compression that results in upstream blood stasis, potentially increasing the risk for deep vein thrombosis.     

Comparison of cerebral blood flow by radionuclide cerebral angiography and by microspheres in cats.

BACKGROUND: Radionuclide cerebral angiography is commonly used as an adjunct to the diagnosis of brain death. Despite its acceptance as a diagnostic tool, it is not clear whether the absence of cerebral blood flow by radionuclide cerebral angiography denotes a complete lack of cerebral blood flow. METHODS: To compare cerebral blood flow estimated by radionuclide cerebral angiography with cerebral blood flow measured by the radiolabeled microsphere technique, we systematically varied cerebral perfusion pressure (mean arterial BP minus intracranial pressure) in anesthetized cats by infusing artificial cerebral spinal fluid into the lateral ventricle to increase intracranial pressure. We measured cerebral blood flow with both techniques as cerebral perfusion pressure was decreased from its baseline of 111 +/- 10 mm Hg to 20, 10, 5, 0, and less than 0 mm Hg, causing a stepwise decrease in cerebral blood flow. RESULTS: We found a correlation by regression analysis (r2 = .47, p less than .05) between radionuclide cerebral angiography and microsphere measurements of cerebral blood flow, when both blood flow measurements were expressed as a percentage of baseline values. However, if 20% of baseline flow was assigned as a cut-off point for critically low cerebral blood flow (based on human studies), radionuclide cerebral angiography was only 33% sensitive to detect critically reduced cerebral blood flow and had a positive predictive accuracy (of low-flow interpretation) of only 60%. Radionuclide cerebral angiography was unable to demonstrate a complete lack of cerebral blood flow, even in two instances when cerebral blood flow by microspheres was less than 0.1% of baseline. CONCLUSIONS: We conclude that the ability of radionuclide cerebral angiography to quantify low cerebral blood flow is poor, and that this technique may not identify severely reduced cerebral blood flow.     

Umbilical vein blood flow in fetuses with normal and lean umbilical cord.

OBJECTIVE: To evaluate whether umbilical vascular coiling is correlated with the umbilical vein blood flow profile and to investigate if this is different between fetuses with a lean and those with a normal umbilical cord. METHODS: Consecutive women with a singleton gestation who delivered at term and who underwent an ultrasound examination within 24 h from delivery were studied. Umbilical cord and vessel areas were calculated. Umbilical vein blood flow parameters were obtained by digital color Doppler velocity profile integration. After delivery, the umbilical coiling index was calculated. RESULTS: One hundred and sixteen women were studied. Twelve (10.3%) had a lean umbilical cord (area < 10th centile). A significant correlation was found between the umbilical coiling index and the umbilical vein blood flow (r = 0.67, P < 0.001). A significant difference between fetuses with and without a lean cord was found in terms of: umbilical coiling index (0.18 +/- 0.08 vs. 0.29 +/- 0.09, P < 0.005), cord area (87.6 +/- 5.1 mm2 vs. 200.6 +/- 34.6 mm2, P < 0.001), Wharton's jelly amount (25.7 +/- 10.3 mm2 vs. 122.1 +/- 33.4 mm2, P < 0.001), umbilical vein blood flow (93.7 +/- 17.8 ml/kg per min vs. 126.0 +/- 23.4 ml/kg per min, P < 0.001), and umbilical vein blood flow mean velocity (6.6 +/- 2.7 cm/s vs. 9.0 +/- 3.6 cm/s, P < 0.05). The proportion of fetuses with an umbilical vein blood flow < 80 ml/kg per min was higher when the cord was lean than when it was normal (25% vs. 1.9%, P < 0.01). CONCLUSIONS: Lean umbilical cords differ from normal cords not only from a structural point of view but also in the umbilical vein blood flow characteristics. This could explain the increased incidence of intrapartum complications and fetal growth restriction among fetuses with a lean and/or hypocoiled cord.     

Quantitative Doppler evaluation of the splenoportal venous system in various stages of cirrhosis: differences between right and left portal veins

PURPOSE: The purpose of our study was to evaluate the relationship between the splenoportal hemodynamics in patients with cirrhosis and the stage of the disease. METHODS: Patients with cirrhosis were grouped according to modified Child-Pugh scoring into stages A, B, and C of cirrhosis. A control group of healthy volunteers was included. After gastroenterologic clinical and laboratory examinations, all participants underwent a splenoportal Doppler sonographic evaluation in which the vessels' diameter, area, and blood flow velocity were measured and blood flow rate and the congestion index in the splenoportal venous system were calculated. RESULTS: Seventy-five patients with cirrhosis (25 women and 50 men) were enrolled; the control group consisted of 30 healthy volunteers (15 women and 15 men) with no liver disease. The mean age (+/- standard deviation) of the patients was 54.4 +/- 14.8 years (range, 13-80 years) and of the control subjects was 47.3 +/- 14.5 years (range, 18-72 years). No significant differences in vessel diameter, blood flow velocity, and blood flow rate were found in the main and left portal veins between the study group and the control group. In the right portal vein, we found decreases in the vessel diameter, blood flow velocity, and blood flow rate, and in the splenic vein, we found increases in vessel diameter and blood flow rate. The congestion index was increased in the main portal and splenic veins but was unchanged in the left portal vein. CONCLUSIONS: Although our data indicate that there is no difference in Doppler sonographic parameters of the main portal vein according to Child-Pugh scores, the hemodynamic differences between the left and right branches of the portal vein may be clinically useful in patients with cirrhosis.     

Hepatic vein oxygenation, liver blood flow, and the rate of ethanol metabolism in recently abstinent alcoholic patients

Abstract. To determine whether hepatic hypoxia is associated with hepatocellular necrosis in alcoholics, oxygen tension in the hepatic vein and hepatic blood flow were determined in thirteen patients without overt clinical liver disease. Ethanol metabolic rate was also assayed as an index of liver metabolism. Hepatic blood flow and ethanol metabolic rate were also determined in six normal volunteers. According to liver histology patients were separated into two groups, with and without hepatocellular necrosis. Alcoholics with necrosis showed a higher ( P < 0–002) ethanol metabolic rate (405±0–23 mmol/kg/h) than those without necrosis (2–46±0–34). Hepatic blood flow in the total group of alcoholics was not significantly different from controls; in the group with necrosis it was lower (651-7±44-6 ml/min/m²) than in the group without necrosis (878-3±81-6; P < 0025). Hepatic vein pO₂ was lower ( P < 001) in patients with hepatocellular necrosis (31-7±0–68 mmHg) than in patients without necrosis (35-7±0–99). In the whole group, a significant negative correlation ( r = -0 76, P < 0–003) was observed between hepatic vein pO₂ and ethanol metabolic rate. Acute administration of ethanol (21-7 mmol/kg) did not alter hepatic blood flow in six normal individuals nor in five alcoholic patients, although an increase in hepatic vein pO₂ was observed in the latter. The changes observed in hepatic vein pO₂, functional hepatic blood flow, and ethanol metabolic rate which correlate with hepatocellular necrosis, may be of pathogenic importance in alcoholic liver disease.     

Transfontanelle pulsed Doppler measurement of blood flow velocity in the internal jugular vein, straight sinus, and internal cerebral vein in preterm and term neonates

This paper presents the range of normal blood flow velocity in different cerebral veins in early infancy measured by transfontanelle pulsed Doppler ultrasonography. The blood flow velocity of the internal jugular vein (38 infants), internal cerebral vein (28 infants), and straight sinus (18 infants) in a group of clinically stable neonates and young infants (body weight 1060-3750 g, age 1-86 d, gestational age 28-41 wk) is specified. The time mean of maximum velocity (Vma) of internal jugular vein was 8.4 +/- 4.7 cm/s, of internal cerebral vein 5.5 +/- 1.6 cm/s, and of straight sinus 12.6 +/- 7.8 cm/s. While the variability between infants was high, the reproducibility of the method was in the range of 4.4-10.2% for Vma. This compares well with studies on cerebral arteries and offers a noninvasive approach to the study of the venous cerebral hemodynamics in neonates undergoing intensive care.     

Flow volume in the jugular vein and related hemodynamics in the branches of the jugular vein

Venous reflux in the internal jugular vein branches (JB) was found frequently in patients of certain neurologic disorders. We hypothesized that the retrograde-flow in JB is associated with retrograde hypertension transmitted from the internal jugular vein (IJV), which presumably underlies those neurologic disorders. In this study, we used color-Doppler imaging to evaluate the dynamic venous flow patterns in the IJV and its branches in 50 normal individuals (21 men, 29 women; mean age: 40.9 +/- 14.9 y, range: 22 to 70 y). The flow-direction of all detected JB (n = 100) was flowing into the IJV at baseline. During the Valsalva maneuver (VM), 38 JB (38%) had a retrograde-flow. Retrograde-flow in JB was significantly associated with IJV valve incompetence (OR = 7.6; 95% CI = 2.6 to 21.8; p = 0.0002) and greater IJV blood flow volume (blood flow volume >670 mL/min) (OR = 6.6; 95% CI = 1.8 to 24.5; p = 0.0052), both of which may reflect higher IJV pressure transmission during VM. The sonographic findings can be used in the future studies of diseases that are suspected to be related with retrograde cerebral venous hypertension due to an elevated IJV venous pressure.     

Initial color Doppler findings in retinal vein occlusion

PURPOSE: We assessed early hemodynamic characteristics of various types of retinal vein occlusion using color Doppler imaging and spectral analysis. METHODS: We measured the maximum systolic and diastolic blood flow velocities and the resistance index (RI) in the central retinal artery and the maximum and minimum blood flow velocities in the central retinal vein of affected eyes and contralateral unaffected eyes in 102 adults (63 men and 39 women; mean age, 61 +/- 14.6 years) who presented with retinal vein occlusion. Sixty-three control subjects (27 men and 36 women; mean age, 50 +/- 22.1 years) were also investigated. RESULTS: No significant differences in hemodynamic characteristics were found between the control subjects' eyes and the patients' unaffected eyes. In the 18 cases of ischemic central retinal vein occlusion, the mean diastolic arterial flow velocity (p = 0.005) and venous flow velocity (p < 0.04) were lower and the mean RI was higher (p = 0. 0002) in the affected eyes than in the unaffected contralateral eyes. In the 51 cases of nonischemic central retinal vein occlusion, the mean diastolic arterial flow velocity (p < 0.0001) and venous flow velocity (p < 0.0001) also were lower and the mean RI (p < 0.0001) was higher in the affected eyes than in the unaffected contralateral eyes. These variables were different in the ischemic versus nonischemic types of central retinal vein occlusion. In the 33 cases of branch retinal vein occlusion, no significant differences were observed in arterial or venous blood flow velocities in the affected versus unaffected eyes. The mean RI in the affected eyes was significantly higher (p = 0.009) in patients with central versus branch retinal vein occlusion. CONCLUSIONS: These results suggest that previous arterial disorders were not involved in the pathogenesis of central retinal vein occlusion in these patients. The findings also support the value of Doppler imaging and spectral analysis in the diagnosis and evaluation of retinal vein occlusion and confirm the involvement of arterial flow in venous occlusion.