Accuracy of transcranial Doppler sonography for predicting cerebral infarction in aneurysmal subarachnoid hemorrhage

PURPOSE: To evaluate the accuracy of transcranial Doppler (TCD) sonography using different criteria for predicting cerebral infarction due to symptomatic vasospasm. METHODS: We retrospectively evaluated the clinical and radiologic data of consecutive patients admitted with acute aneurysmal subarachnoid hemorrhage (SAH) in the anterior cerebral circulation between January 2001 and June 2002. TCD sonographic examinations were performed on alternate days up to 20 days after admission. Cerebral infarction was defined on CT as a new hypodensity in the vascular distribution with corresponding clinical symptoms. Vasospasm was diagnosed as mild or severe when TCD sonography revealed a mean blood flow velocity (MBFV) greater than 120 and 180 cm/s in the middle or anterior cerebral artery and in the intracranial part of the internal carotid artery, respectively. RESULTS: A total of 93 patients with aneurysmal SAH in the anterior cerebral circulation were included. Vasospasm was demonstrated by TCD sonography in 60 patients (64.5%) and was shown via multivariable logistic regression analysis to be predictive of cerebral infarction (OR 3.11, 95% CI 1.46-6.59), with an 82.6% and 69.6% sensitivity, a 41.4% and 77.1% specificity, a 31.7% and 50.0% positive predictive value, and an 87.9% and 88.5% negative predictive value when the MBFV was greater than 120 and 180 cm/s, respectively. CONCLUSIONS: Vasospasm on TCD was found to be predictive of symptomatic cerebral infarction on CT, but its positive predictive value remained low despite the adoption of restrictive TCD criteria for vasospasm.     

肝硬化食管静脉曲张破裂出血患者门静脉血流参数的变化

目的 探讨彩色多普勒超声预测肝硬化门静脉高压症(cirrhotic portal hypertension)患者食管静脉曲张破裂出血的应用价值.方法 肝硬化门静脉高压症患者81例,根据有无出血史分为出血组(36例),非出血组(45例).应用彩色多普勒超声分别检测两组的门静脉(pv)和脾静脉(sv)内径(Dpv、Dsv)、血流动力学参数并进行对比分析.结果 门静脉和脾静脉的内径、血流速度(Vpv、Vsv)及脾静脉的血流量(Qsv)在两组间差异均有统计学意义(P<0.05),但门静脉血流量(Qpv)在两组间差异无统计学意义(P>0.05).结论 彩色多普勒超声检测肝硬化门静脉高压症患者门静脉和脾静脉内径及血流动力学参数,对预测肝硬化门静脉高压时食管静脉曲张破裂出血是有价值的.     

Prenatal diagnosis of fetal adrenal masses: differentiation between hemorrhage and solid tumor by color Doppler sonography.

We present four cases of fetal adrenal masses detected by routine prenatal ultrasound, of which three were adrenal hemorrhages and one was a fetal neuroblastoma. The differential diagnoses of fetal adrenal mass include adrenal hemorrhage, neuroblastoma, adrenal and cortical renal cysts, pulmonary sequestrations, duplication of the renoureteral system and Beckwith-Wiedemann syndrome. These can pose a diagnostic and therapeutic dilemma. A systematic comparison of the pre- and postnatal sonographic features including color Doppler imaging may help to differentiate adrenal hemorrhage from neuroblastoma prenatally.     

Detection of fetal red cells in fetomaternal hemorrhage using a fetal hemoglobin monoclonal antibody by flow cytometry

BACKGROUND: The laboratory determination of the level of fetal cells in maternal circulation remains an important support in the obstetrical management of women with suspected uterine trauma and in the proper dose administration of anti-D for prevention of Rh hemolytic disease of the newborn. Limitations in the sensitivity and precision of the widely used manual Kleihauer-Betke test have prompted an increased utilization of flow cytometric methods for fetal cell detection in maternal blood samples. STUDY DESIGN AND METHODS: Murine monoclonal antibodies directed against fetal hemoglobin (HbF) were developed, conjugated to fluorescein isothiocyanate, and used in a multiparametric flow cytometric assay developed for the quantitation of fetal red cells. A rapid intracellular staining method using brief glutaraldehyde fixation and Triton X-100 permeabilization prior to monoclonal antibody incubation was developed, along with optimization of the flow cytometric analysis protocol for the analysis of 50,000 cells. The performance of the assay was assessed for linearity and precision and correlated with the Kleihauer-Betke acid elution method. RESULTS: The anti-HbF flow cytometric method showed good correlation with the Kleihauer-Betke method (r2 = 0.86) and superior precision with a CV < 15 percent for blood samples with > 0.1 percent fetal cells. Analysis of 150 blood samples from nonpregnant adults, including individuals with elevated HbF due to hemoglobinopathies and hereditary persistence of HbF, gave a mean value of 0.02 percent fetal cells, and all results were less than 0.1 percent. CONCLUSIONS: The anti-HbF flow cytometric method for detection of fetal cells offers a simple, reliable, and more precise alternative to the Kleihauer-Betke manual technique for the assessment of fetomaternal hemorrhage. The method has additional potential applications for the study of HbF levels or frequency of adult red cells with low levels of HbF (F cells) in individuals with hemoglobinopathies.     

Massive antenatal fetomaternal hemorrhage: evidence for long-term survival of fetal red blood cells

BACKGROUND: Massive fetomaternal hemorrhage (FMH) can lead to life-threatening anemia. Quantification based on flow cytometry with anti-hemoglobin F (HbF) is applicable in all cases but underestimation of large fetal bleeds has been reported. A large FMH from an ABO-compatible fetus allows an estimation of the life span of fetal red blood cells (RBCs) in the maternal circulation. CASE REPORT: The mother went to the obstetrician twice antepartum owing to symptoms assumed to be preeclampsia; that, however, was not found. She later delivered by cesarean section owing to diminished fetal movements. No fetal weight gain was observed during the last 2 weeks of pregnancy. STUDY DESIGN AND METHODS: Fetal RBCs were quantified by flow cytometry with anti-HbF, anti-Fy(a), anti-s, and anti-Jk(b) on a regular basis. RESULTS: The infant had anemia at delivery and an FMH was determined to be 314 +/- 17 mL (+/- SD) of whole blood. It is assumed that the two antenatal visits were associated with the FMH. Postpartum follow-up showed that fetal RBCs in the maternal circulation were detectable with anti-HbF up to 119 days. Quantification by flow cytometry based on anti-HbF was in agreement with quantification based on anti-Fy(a), anti-s, and anti-Jk(b), although they were less sensitive. CONCLUSION: ABO-compatible fetal RBCs from an FMH had a life span in the maternal circulation close to that of adult RBCs.     

The role of Doppler sonography in predicting severity of acute pancreatitis

PURPOSE: To investigate the role of Doppler sonography (DUS) examination of major abdominal arteries in predicting severity of acute pancreatitis (AP). METHODS: Twenty-nine patients diagnosed with AP and 14 controls were blindly and prospectively evaluated with Doppler sonography. Disease severity was defined clinically according to acute physiology and chronic health evaluation (APACHE II) score and was classified as severe for APACHE II score > or =8. DUS examination included the measurement of peak systolic velocity (PSV), end diastolic velocity (EDV), pulsatility index (PI), and resistance index (RI) of the celiac artery (CA) and superior mesenteric artery (SMA). Statistical analysis included Mann-Whitney U test, Student t test, and receiver operating characteristic curve analysis. RESULTS: Twelve patients had severe AP and 17 had mild AP. PSV, EDV, and PI of the CA and RI of the SMA were higher in the severe AP group than in the mild AP and control groups (p < 0.001 and p < 0.0001, respectively). The sensitivity and specificity were 100% and 94%, respectively, for a 87 cm/second CA PSV cutoff value, 75% and 100%, respectively, for a 22 cm/second CA EDV cutoff value, 92% and 82%, respectively, for a 1.29 CA PI cutoff value, and 100% and 100%, respectively, for a 0.86 SMA RI cutoff value. CONCLUSION: DUS can be useful in predicting the severity of AP in the early period of admission phase of the disease.     

Transvaginal color Doppler sonography for predicting response to concurrent chemoradiotherapy for locally advanced cervical carcinoma

PURPOSE: This study was conducted to evaluate the potential role of transvaginal color Doppler sonography (TVCD) in predicting response to concurrent chemoradiotherapy for locally advanced cervical cancer. METHODS AND MATERIALS: Tumor vascularity was assessed using TVCD before the start of concurrent chemoradiotherapy in 21 patients (median age, 47 years; range, 31-75 years) with histologically proven locally advanced cervical cancer. The lowest resistance index (RI), lowest pulsatility index (PI), and highest peak systolic velocity (PSV) from central vessels within the tumor were recorded and used for analysis. All patients were clinically evaluated by physical examination and CT scanning after completing the chemoradiotherapy protocol. Complete clinical response (CR) was determined when no residual tumor was found. Partial clinical response (PR) was determined when the tumor volume had decreased more than 50%. RESULTS: CR was achieved in 11 patients (52%), whereas 10 (48%) had PR. The initial median tumor volume was not statistically different between those with CR (26 cm3) and those with PR (28 cm3) (p = 0.71). RI was higher in those tumors with CR (median, 0.47) than in those with PR (median, 0.29) (p < 0.01). Likewise, PI was higher in tumors with CR (median, 0.81) than in those with PR (median, 0.41) (p < 0.01). No differences were found in PSV. The likelihood ratio for CR for tumors with a lowest RI of 0.35 or more was 2.7 (95% confidence interval, 1.8-3.6) and the likelihood ratio for CR for tumors with a lowest PI of 0.45 or more was 3.3 (95% confidence interval, 2.1-4.5). CONCLUSIONS: The results suggest that TVCD may be useful in predicting clinical response to concurrent chemoradiation in patients with locally advanced cervical cancer.     

三维能量多普勒超声预测宫颈癌动脉化疗栓塞疗效

目的探讨三维能量多普勒超声在宫颈癌动脉化疗栓塞疗效预测中的应用价值。方法对26例病理证实的宫颈癌患者分别于动脉化疗栓塞前及化疗栓塞后4周行三维能量多普勒超声检查,测定肿瘤体积及肿瘤内血管形成指数(VI)、血流指数(FI)、血管形成-血流指数(VFI)3项血管参数值,并记录肿瘤的临床病理特征;化疗后4周依据国际抗癌联盟疗效判断标准将患者分为有效组和无效组,比较两组患者化疗栓塞前肿瘤体积及肿瘤内部血管参数的差异,研究肿瘤体积及肿瘤内部血管参数与动脉化疗栓塞疗效间的关系。结果 26例宫颈癌患者动脉化疗栓塞后,完全缓解2例,部分缓解18例,病情稳定4例,病情进展2例,动脉化疗栓塞有效率为76.9%(20/26),无效率为23.1%(6/26);有效组化疗前肿瘤体积、VI、FI及VFI分别为(40.3±23.2)ml、(5.4±3.5)%、40.9±4.3和2.3±1.6;无效组化疗前肿瘤体积、VI、FI及VFI分别为(30.2±20.8)ml、(11.3±4.2)%、44.0±3.9和5.1±2.2;无效组化疗前VI及VFI明显高于有效组相应血管参数值,差异有统计学意义(P<0.05),而两组间肿瘤体积及FI比较差异均无统计学意义。结论三维能量多普勒超声获得的血管参数在宫颈癌动脉化疗栓塞疗效预测中有一定的临床应用价值。     

经颅多普勒超声对基底节区脑出血动态监测的临床意义

经颅多普勒超声 (TCD)通常用来评价脑梗塞和蛛网膜下腔出血患者的颅内血管的血流动力学改变 ,脑出血后颅内压升高 ,亦引起脑血流动力学的改变 ,但TCD评价脑出血患者的临床意义尚存在争议 ,我们对 4 0例基底节区脑出血患者进行TCD检测 ,报告如下。1　资料与方法1.1　对象　脑出血患者 4 0例 ,其中男 2 2例 ,女 18例 ,年龄37～ 80岁 ,平均 (5 6± 13)岁 ,均符合 1996年中华神经科学会、中华神经外科学会制定的脑出血的诊断标准[1] ,并经头颅CT证实为基底节区出血 ,于脑出血发病 1～ 3天内行TCD检查 ,2周后复查。1.2　方法　采用床边TCD…     

Massive fetomaternal hemorrhage: clearance of fetal red blood cells after intravenous anti-D prophylaxis monitored by flow cytometry

BACKGROUND: The clearance of D+ red blood cells (RBCs) from the circulation in D- individuals mediated by passively administered anti-D occurs by opsonization with the antibody and subsequent removal in the spleen. Few data exist on the kinetics of clearance of large volumes of D+ RBCs from the maternal circulation by anti-D in clinical cases of massive fetomaternal hemorrhage (FMH). CASE REPORT: A 33-year-old D- woman delivered a D+ female infant by emergency cesarean section for suspected fetal anemia. A massive FMH, initially estimated to be approximately 142 mL of RBCs, was found. In addition to the standard dose of intramuscular (IM) anti-D (300 microg) given immediately after delivery, 2700 microg of anti-D was administered intravenously (IV). The clearance of D+ fetal cells from the maternal circulation was monitored by flow cytometry in samples obtained on a daily basis using anti-D. The mother had no detectable anti-D 6 months after delivery. RESULTS: No clearance of fetal cells was apparent after the insufficient dose of IM anti-D. The IV administration of anti-D caused accelerated clearance of D+ fetal RBCs with a t1/2 of 24.5 hours. D+ reticulocytes comprised 4.2 percent of all D+ cells in the maternal circulation at delivery suggesting acute fetal blood loss. CONCLUSIONS: The approach used in this report allowed a detailed analysis of the kinetics related to the clearance of fetal D+ RBCs. Simultaneous measurements of fetal reticulocytes and fetal RBCs in maternal blood may establish the timing of an FMH.     

彩色多普勒超声定量参数预测胎儿生长受限的列线图模型

目的：探讨彩色多普勒超声定量参数预测胎儿生长受限(FGR)的应用价值,并构建定量列线图模型以指导临床应用。方法：前瞻性选择2019年03月至2022年03月于我院分娩的单胎孕妇共140例为研究对象,孕妇年龄21~44岁,分娩孕周28~40周。根据胎儿出生体重小于对应孕周第10百分位将其分为FGR组40例和无FGR组100例。采用彩色多普勒超声定量检测胎儿脐动脉 (UA)、大脑中动脉(MCA)和静脉导管(DV)的血流参数。结果：FGR组孕妇妊娠期并发症和剖宫产比无FGR组增多,分娩孕周减小,UA搏动指数(UA-PI)、阻力指数(UA-RI)、收缩期最大血流速度/舒张末期血流速度(UA-S/D)增加,UA舒张期缺失或者倒置增多,而MCA-PI、MCA-RI、MCA-S/D、DV-心房收缩谷流速(DV-a)和心室收缩峰流速(DV-S)降低,差异均有统计学意义(P＜0.05)。多因素Logistic回归分析显示,孕妇妊娠期并发症(OR=5.659,95%CI=4.235~6.675,P＜0.001)、分娩孕周＜37周(OR=5.001,95%CI=3.657~6.123,P＜0.001)、UA-PI≥第95百分位(OR=3.527,95%CI=2.532~5.021,P=0.001)、UA舒张期缺失或者倒置(OR=3.321,95%CI=2.127~4.528,P=0.006)和MCA-PI＜第5百分位(OR=2.857,95%CI=1.965~3.635,P=0.011)是影响FGR发生的独立危险因素。R软件建立定量列线图模型,总分220分。受试者工作曲线(ROC)显示,列线图预测FGR的曲线下面积(AUC)为0.876。结论：彩色多普勒超声是筛查和诊断FGR的首选方法,孕妇妊娠期并发症、分娩孕周＜37周、UA-PI≥第95百分位、UA舒张期缺失或者倒置和MCA-PI＜第5百分位是影响FGR发生的独立危险因素。通过建立定量列线图模型能够指导临床早期识别FGR高危患儿并辅助诊断,有重要的应用价值。     

流式细胞术产前非侵入性定量检测胎-母出血的研究

目的　建立产前非侵入性定量检测RhD阴性孕妇胎 母出血的流式细胞术实验方法。方法　RhD阴性红细胞与RhD阳性红细胞按一定比例混合 ,用抗 D作为一抗结合D+ 红细胞 ,以羊抗人IgGF(ab′) 2 FITC作为二抗 ,连接抗 D ,应用流式细胞术检测D+ 红细胞占D-红细胞的比例 ,建立抗 D及抗人IgGF(ab′) 2 FITC的量效关系 ,确定两者最佳使用剂量。在此实验条件下 ,进行流式细胞术检测值与实际值的相关性分析 ,判定可以检测出的D-红细胞中混有D+ 红细胞的准确出血量范围 ,应用建立的流式细胞术方法测定 9例RhD阴性孕妇外周血中的胎 母出血量。结果　抗 D的有效使用剂量为 1∶4 0 0稀释 ,10 0 μl/5× 10 6细胞 ;羊抗人IgGF(ab′) 2 FITC的有效使用剂量为 2 5 μg/5× 10 6细胞 ;流式细胞术测定比例与已知实际比例的相关系数r =0 998;准确检测的胎 母出血量为 (0 .6～ 30 )ml。 9例RhD阴性孕妇外周血中除 2例未检出D+ 细胞而无法判断外 ,其余 7例均检测出胎 母出血 ,胎 母出血量为 (1.2～ 6 .4 8)ml。结论　针对孕期发生胎 母出血反应的RhD阴性孕妇 ,可以应用流式细胞术方法在产前准确无损伤地定量检测胎 母出血量 ,指导临床预防、治疗Rh新生儿溶血病     

产前超声诊断胎儿肾上腺出血1例

本文报道了一例产前超声联合磁共振诊断胎儿（孕24+5周）肾上腺出血——一种胎儿期的少见疾病。后期序贯超声显示该血肿逐渐变小,围产期及新生儿期超声均显示该血肿消失,提示肾上腺出血自发愈合,避免了不必要的手术探查。本病例提示结合典型声像图特征及病情演变过程有助于产前诊断胎儿肾上腺出血。适当的产前评估和严密的超声监测,对病情监测、治疗方案的选择及预后评估具有重要临床指导价值。     

气管切开术后继发气管内大出血死亡1例

随着对呼吸道病理、生理功能的深入了解 ,气管切开已成为长时间昏迷病人抢救治疗的重要手段之一。气管切开后继发大出血临床较为少见。现就继发此并发症的 1例病人报道如下。1　病例介绍　　病人 ,男 ,2 2岁 ,因头部外伤后昏迷 40min于 2 0 0 3年 9月13日急诊入院。先后行右额颞部硬膜下血肿清除并去骨瓣减压术、右颞顶部硬膜下血肿清除术。因病人呈持续昏迷状态 ,于 9月 19日行气管切开 ,根据病情给予静脉补液维持水电解质平衡、抗炎、止血、脱水、营养神经、高压氧等综合治疗。因病人反复发热 ,经痰液培养确诊肺部感染。留置套管一个半月…     

Doppler sonography of normal fetal vertebral and internal carotid arteries during pregnancy

PURPOSE: The aim of this study was to determine the resistance index (RI) in the fetus in both the vertebral artery and the internal carotid artery and to evaluate the relationship of those RIs with that of the umbilical artery. METHODS: In this prospective study, color Doppler examinations of the vertebral, internal carotid, and umbilical arteries were performed in fetuses with normal growth between 17 and 41 weeks' gestational age. For every week, the 10th, 50th, and 90th percentiles of the RIs in the 3 arteries plus the ratios of the RIs of the vertebral and umbilical arteries and of the internal carotid and umbilical arteries were calculated. RESULTS: In 225 examinations in 114 women, the vertebral and internal carotid arteries showed similar RI patterns, with higher RIs at mid gestation. The only difference was that the RIs in the internal carotid artery reached maximum values at a slightly later gestational age (26-28 weeks) than did those in the vertebral artery (24-25 weeks). Also, the RIs in the vertebral artery were slightly higher than were those in the internal carotid artery. RI values in the umbilical artery decreased progressively throughout gestation. Conversely, the ratios of the RIs in the vertebral and umbilical arteries and those of the RIs in the internal carotid and umbilical arteries increased slightly until the end of pregnancy, with the former ratios always higher than the latter ones. CONCLUSIONS: In normal fetuses, the pattern of blood flow resistance in the vertebral artery resembles that in the internal carotid artery. However, compared with the internal carotid artery, the vertebral artery shows higher absolute RIs with maximum values appearing earlier in the course of pregnancy.     

Embolization for massive urethral hemorrhage

Priapism is the term given to a prolonged, painful penile erection, unaccompanied by sexual desire. Most cases of priapism occur as a result of engorgement of the cavernous body of the penis due to intrinsic or extrinsic venous outflow obstruction, which is termed veno-occlusive priapism. However, in a small number of patients, the cause is related to uncontrolled arterial inflow due to trauma and resultant laceration of cavernosal arteries. This form of disease has been termed high-flow priapism and usually occurs in association with genitoperineal trauma. Most incidents of high-flow arteriogenic priapism result from genitoperineal trauma, such as that caused by sliding on a wooden bar or falling astride a ladder. We experienced a patient with a high-flow priapism due to urethral trauma caused by a misplaced Foley catheter. The treatment consisted of superselective arterial embolization of the bilateral internal pudendal arteries using metallic microcoils, which resulted in the subsequent detumescence of the penis with no complications. This case showed that bilateral arteriocavernosal fistulae can be successfully treated by superselective arterial embolization.     

Prenatal diagnosis and management of a massive fetal ovarian hemorrhagic cyst torsion with secondary fetal anemia

We report the case of one of the largest prenatally detected fetal hemorrhagic cyst with ovarian torsion and fetal anemia leading to subsequent cesarean section delivery and further unilateral oophorectomy of the neonate. Usually, fetal ovarian cysts tend to resolve spontaneously within the first months after birth. There is no need of surgical treatment for such simple cysts. Routine sonographic examinations are obligatory, because in some cases complications such as massive hemorrhage, cyst rupture, or ovarian torsion with following infarction can occur. With the occurrence of these complex cyst signs by sonographic investigation, subsequent intervention should be considered by an interdisciplinary team. © 2013 Wiley Periodicals, Inc. J Clin Ultrasound 42:219–222, 2014