彩色多普勒超声及超声造影在肝移植术后血管并发症中的应用

目的探讨彩色多普勒超声（CDU）和超声造影（CEUS）在检测肝移植术后血管并发症中的应用价值并对两者进行比较。方法对肝移植术后患者常规行CDU检查，对CDU疑肝血管血流异常患者行超声造影检查，观察肝动脉、门静脉、下腔静脉及肝实质的血流灌注，对其中29例经数字减影血管造影术（DSA）或CT血管造影（CTA）／MR血管造影（MRA）证实病例的CDU及造影检查资料进行分析。结果术后血管并发症患者29例，其中肝动脉狭窄22例，肝动脉血栓闭塞3例（肝动脉血栓闭塞合并肝梗死2例），门静脉狭窄2例，下腔静脉狭窄1例，另1例为肝门部血肿并肝动脉、门静脉受压狭窄。CDU显示25例狭窄均有血流参数异常，但不能判断狭窄部位及程度，3例血栓闭塞者，动脉血流均未显示，但不能肯定诊断；超声造影可明确诊断肝动脉血栓闭塞，显示肝动脉、门静脉及下腔静脉狭窄，与DSA或CTA／MRA结果符合率分别为100％（3，3）、90．9％（20／22）、100％（2／2）及100％（1／1）。结论CDU与超声造影互为补充，有利于提高肝移植术后血管并发症的诊断准确性。     

Infantile fibrosarcoma misdiagnosed as vascular tumors

Clinical as well as radiologic diagnosis of infantile fibrosarcoma (IFS) is often a challenging problem due to similarities with tumors of vascular origin. Consequently, in the majority of cases, histological and immunohistochemical studies are considered gold standards for the final diagnosis. The two case reports and the review of literature discussed should increase the important features in the history and the presentation that increase the index of suspicion for IFS, as well as it highlights the important characteristics of imaging and laboratory studies that confirm its diagnosis.     

Lower-extremity venous stasis during laparoscopic cholecystectomy as assessed using color Doppler ultrasound

Lower-extremity venous stasis during laparoscopic cholecystectomy was evaluated in 16 patients by monitoring the blood velocity in the femoral vein and the femoral vein size (cross-sectional area) using color Doppler ultrasonography. The blood velocity in the femoral vein decreased significantly after the start of 10-mmHg abdominal insufflation in the supine position. When the patients were placed in a reverse Trendelenburg position during 10-mmHg insufflation, blood velocity in the femoral vein further decreased. However, velocity returned to the baseline after deflation. The cross-sectional area of the femoral vein was significantly elevated after the start of 10 mm Hg insufflation in the supine position. When patients were placed in the reverse Trendelenburg position during 10-mmHg insufflation, this parameter was further elevated, but returned to the baseline soon after deflation.These results indicate that femoral vein stasis during laparoscopic cholecystectomy can be minimized by reducing the pressure of abdominal insufflation and avoiding elevation of the patient's head as much as possible.     

彩色多普勒超声诊断周围型肝内胆管细胞癌的价值

目的 探讨彩色多普勒超声对周围型肝内胆管细胞癌的诊断价值.方法 回顾性分析95例经病理证实的周围型肝内胆管细胞癌,总结其彩色多普勒超声特征.结果 总共102个病灶,大小范围为20 mm×20 mm～130 mm×100 mm.灰阶图像上大部分病灶表现为回声不均匀(75个,73.5％)、边界模糊(70个,68.6％)、分叶状(55个,53.9％).彩色多普勒超声示大部分病灶能检测到血流(75个,73.5％),以簇状、短线状及彩点状血流为主,其中大部分血流的阻力指数大于0.6(65个,86.7％).102个病灶中,见条索样高回声的有37个(36.3％),后方回声出现轻度衰减的有29个(28.4％),出现“脐凹”现象的有22个(21.6％).超声诊断的符合率为84.2％(80/95).结论 周围型肝内胆管细胞癌的彩色多普勒超声表现具有一定的特征,充分认识其声像图特征可提高超声诊断的准确率.     

The use of perioperative Doppler ultrasound as a screening test for acute tubular necrosis

For many years Doppler ultrasound has helped to identify the cause of renal allograft dysfunction. However, Doppler examinations were often performed after the onset of acute renal failure. In the present study we used Doppler ultrasound during grafting to follow changes in renovascular resistance. As early as 30 min after the renal artery had been unclamped, the calculated resistance index (RI) at the hilar part of the renal artery was significantly higher in the group of patients who developed acute tubular necrosis (ATN) than in the group of patients with early normalization of renal function (P=0.05). This result did not correlate with raised cold and warm ischemia times and serum creatinine level on discharge in patients who presented with ATN. RI higher than 0.730 min after unclamping allows for an identification of those grafts at greater risk for the development of ATN and should be an indication for the early introduction of intensive therapy.     

Application of Doppler technology as an aid in identifying vascular structures during laparoscopy.

BACKGROUND: Intraoperative ultrasound has been used extensively during open surgery to assess bowel viability, to identify vascular structures, and to assess for congenital abnormalities. The extension of this technology in laparoscopic procedures has been hampered by the size of the equipment and the significant learning curve that accompanies its use. METHODS: Using a readily available Parks Inst. Co. Doppler Probe (8.1 MHz) and a 15-inch section of thick-walled, 9.5-mm OD Stainless Steel tubing, a Laparoscopic Doppler Probe was constructed. The parts were separately gas-sterilized, and a small segment of Penrose drain was used to create an airtight seal. The probe was passed through a 10-mm port, allowing assessment of vascular structures. RESULTS: Two Laparoscopic Doppler Probes were available for evaluation during a 1-month period at our hospital. Surgeons were then surveyed at the end of the 1-month period as to the utility of the devices. CONCLUSIONS: The Laparoscopic Doppler probe was used to identify the cystic artery during gallbladder dissection, to assess mesenteric blood vessels during laparoscopic colectomy, and to identify femoral vessels during laparoscopic preperitoneal hernia repair. It was found to be quick to construct, easy to use, and provided useful information to the operating surgeon.     

超声多普勒在体表血管畸形诊治中的应用

探讨超声多普勒在体表血管畸形诊治中的作用。采用多普勒血流仪ＤＵＦ（Ｄｏｐｐｌｅｒｕｌｔｒａｓｏｎｉｃｆｌｏｗｍｅｔｅｒ）并结合彩色多普勒血流成像ＣＤＦＩ（Ｃｏｌｏｒｄｏｐｐｌｅｒｆｌｏｗｉｍａｇｉｎｇ）、血管造影ＳＡ（Ｓｅｌｅｃｔｉｖｅａｎｇｉｏｇｒａｐｈ）、术后组织学检查作自身对照２８例、３７个瘤体及ＤＵＦ术中应用１２例。ＤＵＦ对体表部位的高或低流量性病损的定性诊断与上述三种检查基本相符,其还能指导选择性结扎瘤体内的血管及术中避免损伤体表知名动脉,但不能提示病损结构和范围;ＣＤＦＩ除能提供病损区动、静脉血流信号外,尚可提示深部（肌层）病损情况,但不能显示病损的完整结构;ＳＡ既能提示病损的血流情况,也能显示病损大小和范围。总之,ＤＵＦ结合临床可初步明确体表血管畸形的高或低流量性病损,该方面诊断ＣＤＦＩ更为精确,ＣＤＦＩ与ＳＡ结合对血管异常的诊断和治疗是必要的。     

Intratesticular varicocele: evaluation using grey scale and color Doppler ultrasound

Intratesticular varicocele is a rare condition with a variable clinical and ultrasound presentation. The purpose of this study was to evaluate the grey scale and color Doppler appearances of intratesticular varicocele (ITV). Herein we present seven new cases of intratesticular varicocele. From 2003 to 2005 we evaluated 342 patients referred to our department for routine andrological evaluation by scrotal color Doppler ultrasound. We detected seven entirely asymptomatic cases of ITV by use of grey scale ultrasound. In color Doppler sonography the patients showed retrograde blood flow, either spontaneously or during Valsalva manoeuvre. In all seven cases left side ITV with testicular volume disproportion between the right and left testis (2 ml) was found. Five patients had an extratesticular varicocele. In all patients the diameters of intratesticular vein were less than 2 mm. Intratesticular varicocele is a clinically occult lesion that may occur in association with extratesticular varicocele. Further investigations are needed to clarify its clinical significance, however, considering the temperature mediated damage on the affected testis, it is our opinion that all ITV must be considered for treatment even if an extratesticular varicocele is not present.     

Acoustic Doppler sonography, color duplex ultrasound, and laser Doppler flowmetry as tools for successful autologous breast reconstruction

The sine qua non to best ensure viability of any autogenous tissues used for breast reconstruction is to maximize the appropriate circulatory pattern to that tissue. This overview of tools used in this regard, all based on the physical principles of the Doppler effect, compares the role today of acoustic Doppler sonography, color duplex ultrasound, and laser Doppler flowmetry for perforator identification and flap monitoring. The audible Doppler has recognized limitations, but remains the simplest and most universally available device to assist in this purpose. Laser Doppler flowmetry provides a reasonable system for both intraoperative and post-procedure objective monitoring of the chosen tissue transfer.     

Comprehensive laparoscopic approach to pediatric varicocele based on preoperative color Doppler ultrasound assessment

Background This study aimed to assess whether laparoscopic treatment for any kind of varicocele is possible after preoperative identification of refluxing veins by color Doppler ultrasound (CDUS). Methods At the authors’ institution, 98 patients with a median age of 11.3 years (range, 7.1–16 years) were evaluated for a left varicocele. Preoperatively, all the patients underwent ultrasound scan assessment of testicular volume and CDUS to rule out reflux into the internal spermatic vein (ISV), deferential vein, or cremasteric vein. In all the patients, laparoscopic division of the spermatic artery and veins was performed as close as possible to the internal inguinal ring. The other vessels were coagulated and divided if shown to be refluxing on CDUS. Results Color Doppler ultrasound showed reflux only in the ISV in 87 cases (88.7%), but in both the ISV and the deferential in the remaining 11 cases (11.2%). During a median follow-up period of 18 months (range, 6–49 months), none of the authors’ patients experienced varicocele recurrence either clinically or according to CDUS scanning. The median left testicular volume increased significantly postoperatively. Conclusion The proposed technique based on laparoscopic interruption of the ISV and testicular artery very close to the internal inguinal ring, meticulous CDUS assessment to rule out reflux in the deferential vein, and coagulation of refluxing deferential veins allows successful laparoscopic treatment of most varicoceles.     

Chest wall tumors presenting as breast lumps

Two recently seen patients presenting with large breast lumps that proved to be pure mesenchymal tumors arising from the underlying chest wall are presented. One tumor proved to be a giant cell tumor of soft tissue and the other an osteogenic sarcoma. It is suggested that these two cases may not be unique and that some mesenchymal breast tumors might have their origin in the chest wall. Breast computed tomography (CT) scans would help identify similar cases.     

非临床型乳腺肿瘤在超声引导钢丝穿刺定位下的切除

目的探讨对非临床型乳腺肿瘤的处理方法。方法对非临床型乳腺肿瘤,术前在超声图像监视下．将乳腺定位钢丝穿刺置于病灶内或其附近,行肿瘤的切除活检,待病理诊断结果确定进一步治疗方案。结果32例（38处病灶）经超声引导下钢丝穿刺定位后全部准确完整切除,38处病灶术中冰冻分片病理报告与术后石腊切片病理结果相符有36处。结论超声引导下细钢丝穿刺定位乳腺小肿瘤后行病灶切除活检术,是处理非临床型乳腺肿瘤安全、准确、实用的方法。     

Routine Doppler ultrasound for the detection of clinically unsuspected vascular complications in the early postoperative phase after orthotopic liver transplantation

To assess the role of routine Doppler ultrasound in the detection of clinically unsuspected vascular complications in the early postoperative phase after orthotopic liver transplantation (OLT), the findings of 858 routinely performed Doppler ultrasound examinations were analyzed in 268 transplants. At various time intervals after OLT, we encountered 46 abnormal Doppler findings: hepatic artery (thrombosis), portal vein [anastomotic stenosis, (non)occlusive thrombosis or reversed flow], inferior vena cava [anastomotic stenosis with reversed flow, no flow, or (non)occlusive thrombosis], and hepatic veins (to-and-fro flow or stenosis with reversed flow) in 14, 20, 9, and 2 transplants, respectively. Most of these abnormal Doppler findings were confirmed by angiography, cavography, or surgery. The positive predictive value for hepatic artery thrombosis (HAT) was 12 out of 14, or 86 %. In the first 2 weeks after OLT, routine Doppler ultrasound revealed 20 of the 46 abnormal findings (43 %). Clinically unsuspected complications of the hepatic artery, portal vein, inferior vena cava, and hepatic veins were found in 9 of the 14 (64 %), 6 of the 20 (30 %), 3 of the 9 (33 %), and 2 of the 2 (100 %) transplants, respectively. The highest incidence – nine vascular complications – was found on the 1st day. On each of the remaining days (except for the 2nd and 9th days), one or two vascular complications were detected. HAT was found mainly in the 1st week. Vascular complications developed independently or concomitantly. We conclude that routine Doppler ultrasound is very important for the detection of clinically unsuspected vascular complications, particularly HAT, in the first 2 weeks after OLT. We recommend routine Doppler ultrasound of all hepatic vessels every 3 days in the early postoperative phase after OLT. Special attention should be paid to the 1st day. Received: 29 August 1997 Revised after revision: 10 February 1998 Accepted: 2 March 1998     

彩色多普勒超声在氩氦刀治疗肿瘤中的应用

目的观察氩氦刀靶向冷冻治疗肿瘤术中彩色多普勒超声的应用价值。方法氩氦刀靶向冷冻治疗各种恶性肿瘤27例,共31例次。利用彩色多普勒超声检查肿瘤并设计布置冷冻探头,结合穿刺引导架进行引导并实时监控冷冻过程,进行后期复查。所有患者术后当日或次日接受增强CT检查,计算冰球覆盖率。结果 27例中,24例接受一次冷冻治疗,3例患者因肿瘤过大及肿瘤分散接受多次治疗。根据病灶大小确定冷冻探头布置方案。冰球表现为半圆形后伴声影,在前15min冰球迅速增大,15～20min冰球增大不明显,随着肿瘤体积增大而冰球覆盖率逐渐减小。结论氩氦刀靶向冷冻治疗肿瘤中,彩色多普勒超声技术可进行实时监控,具有较高临床应用价值。     

The role of GLUT1 immunostaining in the diagnosis and classification of liver vascular tumors in children

Background/Aim

GLUT1 is an erythrocyte-type glucose transporter protein typically expressed in cutaneous proliferating hemangioma. Immunostaining for GLUT1 is becoming valuable for predicting the outcome of vascular skin tumors. Liver vascular tumors (LVTs) are a serious challenge for pediatric surgeons because of their often severe and sometimes unpredictable clinical course. To improve therapeutic strategies, we designed this study in which we tested in pathology specimens of LVT the hypothesis that GLUT1 expression could be useful to understand and classify LVT.

Material and methods

In the last 10 years, we treated 20 children with LVT. Pathology specimens from biopsy, excision, or autopsy were available in 11 of them. The paraffin sections were immunostained for GLUT1 and also for Ki-67 to assess the proportion of proliferating cells. Patients were divided into 2 groups: GLUT1-positive (n = 4) and GLUT1-negative (n = 7) that were compared for age at diagnosis, survival, and proportion of proliferating cells. Nonparametric and χ² tests were used for statistical analysis as appropriate.

Results

Mean age at diagnosis was higher in GLUT1-positive group, although not statistically significant in comparison with GLUT1-negative (308 ± 515 vs 70 ± 51 days, respectively). Three of 4 children in GLUT1-positive group died versus 1 of 7 in the GLUT1-negative group (not significant). All GLUT1-positive tumors were multicentric hemangiomata without central necrosis and only 1 with large vessels. Among GLUT1-negative tumors, 5 were solitary masses and 2 were multicentric (the value of the last 2 specimens was uncertain), 2 had central necrosis, and 2 had large vessels. Proliferation index was 18% ± 1.42% and 1.42% ± 0.97%, respectively, in each group (P < .05).

Conclusions

GLUT1-positive tumors have significantly higher proliferation rates than negative ones. Mortality tended to be higher in children with GLUT1-positive tumors. Positive GLUT1 immunostaining is likely specific for proliferating hemangioma, and it predicts the typical course of proliferation followed by involution.     

Doppler ultrasound and calcification score: improving vascular access surveillance

Abstract

Aim: Vascular access (VA) dysfunction limits hemodialysis delivery, which increases morbidity and mortality. The most com mon cause of VA failure is thrombosis, due to flow limiting stenosis resulting from neointimal hyperplasia. This occurs not only due to hemodynamic factors but also by systemic ones related to vascular atherosclerosis, inflammation and calcification, which has developed a simple vascular calcification score (SVCS) predictor of vascular calcification and arterial stiffness. The NKF-K/DOQ recommends several diagnostic procedures for VA surveillance. Blood access flow (Qa) has predictive power for the detection of stenosis. Our aim was to evaluate the role of systemic factors, especially SCVS, on Qa. Material and methods: Transversal study in 50 patients. Qa value was obtained with Blood Temperature Monitor and Doppler method. Pearson coefficient evaluated correlation between them. Clinical, lab and radiological variables were recorded and non-parametric tests evaluated how both Qa varied with them. Results: Pearson’s corelation between DU-Qa and TD-Qa was 0.851 (p-value <0.001). DU-Qa varied significantly with age (p?=?0.012), VA type (p?=?0.021), SCVS (p?=?0.030), intra-access arterial pressure (p?=?0.015) and time on dialysis (p?=?0.002). BTM-Qa varied significantly with diabetes status (p?=?0.027), age (p?=?0.017), first VA status (p?=?0.036), intra-access arterial pressure (p?=?0.028) and dialysis time (p?=?0.001). Nevertheless, gender, hypertensive status and analitical parameters did not change the flow values. Conclusion: Higher SVCS was associated only with lower DU-Qas, giving this method an advantage towards the indirect one. Additionally, a simple method like SVCS may be used to guide new surveillance recommendations accordingly to risk stratification.     

聚焦超声治疗婴幼儿血管瘤60例

目的 探讨聚焦超声治疗婴幼儿血管瘤的效果及适宜能量参数.方法 80例婴幼儿血管瘤采用区组随机分组法分成4组,每组20例,A、B、C3组采用聚焦超声治疗仪以3～5 mm/s速度连续辐照血管瘤表面,频率9 MHz,脉冲1 000 Hz,重叠10％,扫描5个来回,功率分别为3.5、4.0、4.5W,治疗3次为1个疗程,每次治疗间隔1个月,D组为空白对照组,仅随访观察.观察A、B、C3组治疗结束6个月后效果及辐照区皮肤破溃、瘢痕发生率,并与D组同期结果对照.结果 1个疗程结束6个月后,A、B、C3组分别治愈7、9、8例,基本治愈9、8、10例,好转4、3、2例,总有效率均为100％,D组仅好转5例,经统计学分析,A、B、C3组治疗效果明显好于D组(P＜0.05),但A、B、C3组间治疗效果比较差异无统计学意义(P＞0.05);B、C组分别有4、6例出现皮肤破溃及瘢痕,经统计学分析B、C组皮肤破溃及瘢痕发生率明显高于A、D组(P<0.05).结论 聚焦超声辐照是治疗婴幼儿血管瘤的有效方法之一,能量以不超过3.5W为宜.     

彩超及CTA对胡桃夹综合征的诊断价值

目的探讨彩超及CTA对胡桃夹综合征（NCS）的诊断价值。方法分析50例NCS患者及50例健康人的资料。结果主诉肉眼及镜下血尿31例;疲乏伴纳差4例;左精索静脉曲张10例;蛋白尿伴左腰不适5例。13例女性有盆底淤血征,男性均有不同程度左精索静脉曲张。彩超肠系膜上动脉（SMA）和腹主动脉（AO）夹角（a）（25.08±11.83）°vs.（48.73±25.82）°;左肾静脉（LRV）受压管径（D1）（2.45±1.28）vs.（3.48±1.02）cm,血流速度（V1）（0.38±0.16）vs.（0.48±0.13）m/s;LRV远端管径（D2）（8.55±2.63）vs.（7.43±2.03）cm,血流速度（V2）（0.28±0.21）vs.（0.94±0.43）m/s。21例CTA示SMA与AO夹角减小,1例示胰头部压迫,3例SMA分支及下方纤维结构压迫;1例后胡桃夹征（腹主动脉和脊柱之间压迫）,15例膀胱镜左输尿管口喷血。结论彩超初步筛选胡桃夹征,CTA更清晰显示LRV周围结构。     

超声造影在移植肾血管并发症中的应用价值

目的  评价超声造影(CEUS)在移植肾血管并发症中的应用价值。方法  回顾性分析临床怀疑有移植肾血管并发症的28例肾移植患者的普通超声和CEUS图像资料, 以CT血管造影(CTA)或数字减影血管造影(DSA)为诊断标准, 分析CEUS在移植肾血管并发症中的诊断价值。结果  28例患者均未发生造影剂相关不良反应。22例确诊发生血管并发症。CEUS正确诊断血管并发症17例, 漏诊5例移植肾动脉狭窄, 误诊1例移植肾局灶性梗死。CEUS诊断移植肾血管并发症的灵敏度、特异度、阳性预测值、阴性预测值及准确度分别为0.77、1.00、1.00、0.55及0.82。普通超声及CEUS诊断移植肾动脉狭窄的灵敏度、特异度、阳性预测值、阴性预测值及准确度分别为0.37和0.74, 0.89和1.00, 0.88和1.00, 0.40和0.64, 0.54和0.82。两者灵敏度、准确度比较差异均有统计学意义(均为P < 0.05)。结论  CEUS是诊断移植肾血管并发症的有效手段。     

Assessment of renal function with color Doppler ultrasound in autosomal dominant polycystic kidney disease

BACKGROUND: Measurement of renal blood flow by color Doppler ultrasound is useful for assessment of renal function in a variety of renal disorders. In autosomal dominant polycystic kidney disease (ADPKD), however, it might be difficult to visualize interlobar arteries because of deformity of renal structure. To evaluate the usefulness of color Doppler in ADPKD, parameters determined by blood flow examination were compared with the results of ordinal renal function tests. METHODS: Twenty-one patients with ADPKD were examined by color Doppler ultrasound measurement. In each patient, 10 interlobar arteries in both kidneys were investigated. Minimum blood flow velocity (Vmin), maximum blood flow velocity (Vmax), mean blood flow velocity (Vmean), acceleration, resistive index and pulsatility index were measured in relation to the results of creatinine clearance, serum creatinine, blood urea nitrogen and 15 and 120 min values of the phenolsulfonphthalein test. RESULTS: In all patients, interlobar arteries were able to be visualized and blood-flow profile was measured. Although variations of Vmin, Vmax, Vmean and acceleration were relatively large, the resistive index and pulsatility index varied little in each kidney. Mean values of Vmin (P < 0.005), Vmean (P < 0.05), resistive index (P < 0.005) and pulsatility index (P < 0.005) were well correlated to creatinine clearance with statistical significance. CONCLUSIONS: In ADPKD, color Doppler ultrasound measurement is a useful method for assessment of renal function and could be used for monitoring the dynamic state of renal blood flow as a non-invasive technique.