Coronary Venous Lead Implantation after an Evaluation by Virtual Histology Intravascular Ultrasound and Stenting of a Stenosis

We describe a patient who developed coronary vein (CV) stenosis shortly (<3 months) after an initial left ventricular (LV) lead implantation with significant fibrous tissue. The virtual histological intravascular ultrasound analysis was useful for characterizing the plaque component of the stenotic lesion and formulating the strategy. A summarized review of the CV angioplasty for LV lead implantations disclosed that CV stenosis was often found in patients who had a previous history of cardiac surgery or an LV lead implantation and that a stent implantation was required to deploy the LV lead in the targeted CV in some (9.3%) patients. (PACE 2013; 36:e59–e63)     

充血性心力衰竭门静脉与肝静脉多普勒血流频谱的观测

目的⑶观测充血性心力衰竭门静脉、肝静脉血流⒙为判定充血性心力衰竭肝淤血与心功能情况提供方法⒚方法⑶多普勒超声观测 ９３ 例心力衰竭患者及 ３０ 例正常人门静脉平均血流速度⒉ Ｐ Ｖ ⒕、门静脉频谱波动率⒉ Ｐ Ｒ⒕、门静脉内径⒉ Ｐ Ｄ⒕、肝静脉内径⒉ Ｈ Ｄ⒕⒙并与超声心动图检测结果比较⒚结果⑶充血性心衰患者临床心功能降低、心舒缩功能减低、 Ｈ Ｄ 扩张与门静脉 Ｐ Ｒ 减低有较好相关性⒙且 Ｐ Ｖ 减慢⒚结论⑶多普勒观测充血性心力衰竭肝静脉、门静脉血流变化⒙是判定充血性心力衰竭时肝脏淤血与心功能情况的可靠指标⒚     

二维及彩色多普勒超声诊断左肾静脉压迫综合征的临床价值

目的探讨二维及彩色多普勒超声对左肾静脉压迫综合征检测的临床价值。方法利用二维(2D)彩色多普勒血流显像(CDFI)及脉冲多普勒(PW)检测38例左肾静脉压迫综合征患者,观测仰卧位及右侧卧位其管腔内径、CDFI、PW频谱变化。结果38例患者左肾静脉均见不同程度受压变窄,内径(0.21±0.09)cm;压迫前扩张,内径(0.99±0.41)cm,与前者之比≥3,CDFI示血流色彩暗淡,PW呈低速连续性频谱;压迫后血流色彩明亮或混叠,呈高速湍流脉动频谱,右侧卧位压迫解除,压迫前管径回缩,血流速度增快,呈下腔静脉样脉动频谱,各测值与仰卧位比较P<0.01,有极显著差异。1例老年患者狭窄前扩张处见附壁絮状物回声。结论二维及彩色多普勒超声是检测左肾静脉压迫综合征有效、可靠的首选方法,右侧卧位对改善左肾血流动力学状态,指导临床有重要意义。     

超声造影对高强度聚焦超声联合肝动脉栓塞化疗治疗肝癌的疗效评价

目的探讨超声造影(CEUS)评价高强度聚焦超声(HIFU)联合肝动脉栓塞化疗(TAE)治疗肝恶性肿瘤疗效的应用价值。方法 24例肝癌患者,其中原发性肝癌15例,转移癌9例,治疗病灶总计31个,TAE治疗后1周内行HIFU治疗,于治疗前和治疗后7～14 d行CEUS检查,并与同期彩色多普勒超声(CDFI)、增强MRI检查结果比较。结果 CEUS观察31个病灶治疗覆盖区,19个(61.3%)在各期均为无增强,提示肿瘤完全灭活,12个(38.7%)病灶边缘或中央局部动脉期高增强,门脉期或延迟期减退为低增强,提示为肿瘤残存。以最终诊断为金标准,CEUS诊断准确性90.3%,增强MRI为93.5%,彩色多普勒超声为48.4%。CEUS与增强MRI在评价肿瘤灭活方面的敏感性、特异性、准确性差异均无统计学意义(P>0.05),CEUS对肿瘤灭活诊断的准确性高于CDFI(P<0.05)。结论 CEUS可较准确地判断HIFU联合TAE治疗后肿瘤灭活程度,可为肝癌治疗近期疗效评价提供依据,有较高临床应用价值。     

肝门部胆管癌患者术前行门静脉栓塞的护理

目的研究肝门部胆管癌患者术前行门静脉栓塞（portal vein embolization,PVE）的疗效及护理方法。方法回顾分析2008年1月至2009年6月某院23例经CT或MRI确诊的肝门部胆管癌患者行术前PVE治疗的疗效及护理经验。结果患者在PVE15d后血清总蛋白（total protein,TP）、白蛋白（albumin,ALB）、总胆红素（total bilirubin,TB）、丙氨酸氨基转移酶（alanine aminotransferase,ALT）等各项指标均较术前有所改善,23例肝门部胆管癌患者行PVE后无一例死亡,仅1例患者发生胆漏、5例患者有发热症状。结论肝门部胆管癌患者术前行PVE能促进肝功能的恢复,增加手术安全性和手术切除率,加强PVE后的护理和积极处理并发症是患者尽早康复的关键。     

动脉血管腔内超声显像的三维重建

超声诊断动脉血管病变日益广泛。血管腔内显象技术的应用，可从二维血管腔成像成为三维（立体）显示。为了能更好显示动脉血管的三维形态，我们建立了血管腔内超声显象的计算机三维重建系统。通过计算机三维重建表面提取法，依次标出每个切面中冠状动脉的内膜面和外膜面，最后得到其数字化了的三维图像。结果显示，经计算机三维重建的５０个正常人离体右冠状动脉血管腔内超声切面，其形态和实际十分接近。     

彩色多普勒超声对难治性甲亢甲状腺动脉栓塞治疗监测的意义

目的：探讨应用彩色多普勒超声监测甲状腺动脉栓塞术前，术后，甲状腺的声像学特征及血流变化规律的意义。方法：10例难治性甲亢患者行甲状腺动脉栓塞术，分别于术前，术后1个月，术后3个月对患者进行彩色多普勒超声监测，观察甲状腺的大小，实质回声，血供及各血流参数的变化情况。结果：术前甲状腺腺体弥漫性肿大，血供丰富，呈“火海征”，各血流参数明显升高；术后甲状腺腺体缩小，血供明显减少，各血流参数明显降低。术后1个月与术前比较，各项监测内容均存在显著性差异（P＜0．05－0．001），术后3个月与术后1个月比较，各项监测内容继续有所变化，但差异不显著（P＞0．05）。结论：彩色多普勒超声对甲亢甲状腺动脉栓塞术后的疗效观察，判断转归具有重要价值。     

Ultrasound Investigation of Leg Position to Enhance Femoral Vein Exposure for Cannulation

Background

Femoral venous access is an essential part of patient care in the emergency department (ED). However, current medical literature and texts have not dealt with it much using actual patient anatomy.

Objectives

This study aimed to show that manipulation of the lower extremities may alter the anatomy to a more favorable position for cannulation.

Methods

Ultrasound examination was conducted on a prospective sample of ED patients to evaluate anatomical variance of the femoral artery and vein overlap as well as the change in femoral vein diameter with leg position. Bilateral measurements of the diameter of the vein were taken at three different leg positions (straight, abduction, and abduction with external rotation).

Results

This study enrolled a total of 132 ED patients. Of these, 122 (92%) patients showed some degree of overlap on the right and 126 (95%) patients showed some degree of overlap on the left. There was a statistically significant decrease in the percentage of overlap when moving the leg from a straightened position to an abducted position, and an additional decrease when moving the leg into an abducted and externally rotated position. There was also a statistically significant increase in the size of the femoral vein with each of these positions.

Conclusions

Up to 95% of people have some degree of overlap of the femoral vein by the femoral artery. By positioning the leg in an abducted and externally rotated position, the amount of overlap is reduced and the diameter of the vein is increased, maximizing the percentage of the vein available for cannulation.     

动脉粥样硬化兔斑块易损性的血管内超声评价

目的应用血管内超声（IVUS）技术评价易损斑块的影像学特征。方法30只实验兔给予球囊损伤腹主动脉＋高脂饲料喂养，12周末将实验兔随机分为A、B两组，在A组腹主动脉斑块处转染携带人野生型P53基因的重组腺病毒载体，2周后给予所有兔中国斑点蝰蛇毒（CRVV）和组胺触发，14周末进行体表超声、血管内超声和病理学检查。结果A组斑块破裂率较B组显著增高（P〈0．05）。IVUS示斑块破裂组的血管外弹力膜面积（EEMA）、斑块面积（PA）、管腔面积狭窄百分率（LAS%）及偏心指数（EI）显著大于未破裂组（P〈0．01～0．05）；斑块破裂组的内一中膜厚度（IMT）、收缩期峰值流速（Vp）显著大于未破裂组，而平均回声强度的校正值（AIIc％）显著低于未破裂组（P均〈0．05）。结论应用野生型P53基因转染可导致斑块的不稳定性，IVUS能够准确识别易损斑块，为临床早期发现易损斑块并预测斑块破裂提供了可靠的方法。     

彩色多普勒超声在左肾静脉压迫综合征诊断中的应用

目的探讨彩色多普勒超声对左肾静脉压迫综合征的可靠性和实用性。方法利用彩色多普勒超声对22例左肾静脉压迫综合征患者及19例正常者进行对照检查,分别检查腹主动脉(AO)与肠系膜上动脉(SMA)之间左肾静脉受压处前后径(b)、受压处前方左肾静脉最宽处内径(a),受压处左肾静脉内峰值血流速度(Vp)、峰值血流加速时间(AT)。结果全部受检者均可见AO与SMA之间的LRV不同程度受压,但两组间b、a/b、Vp及AT有显著性差异(P<0.01)。结论彩色多普勒超声是诊断左肾静脉压迫综合征快速、可靠和有效的方法。     

Preventing the Collapse of a Peripheral Vein During Cannulation: An Evaluation of Various Tourniquet Techniques on Vein Compressibility

Background

Venous access can occasionally be difficult to obtain secondary to near-complete compressibility of peripheral veins in some patients.

Objective

This study utilizes ultrasound to assess vein compressibility with different tourniquet techniques commonly available in the emergency department.

Methods

After approval by the Institutional Review Board, a prospective single-center study was conducted assessing the compressibility of basilic veins with ultrasound. Compressibility was assessed at baseline, use of one proximal tourniquet, two tourniquets (one distal and one proximal), and a proximal blood pressure cuff inflated to 150 mm Hg. Vein compressibility was rated as complete, moderate, or mild after light pressure was applied with the ultrasound probe.

Results

One hundred healthy patients were recruited into the study. Ninety-eight subjects had completely compressible basilic veins at baseline. When one tourniquet and two tourniquets were applied, 62 and 31 participants, respectively, demonstrated completely compressible veins. Fisher's exact test comparing one vs. two tourniquets revealed no difference between these two techniques (p = 0.4614). Only two participants continued to have a completely compressible vein after application of the blood pressure cuff with statistical significance by Fisher's exact test compared to both tourniquet groups (p < 0.0001).

Conclusions

Both tourniquets and blood pressure cuffs can decrease the compressibility of peripheral veins. Although no difference was identified between one and two tourniquets, utilization of blood pressure cuffs significantly decreased compressibility. The findings of this study can be utilized in the emergency department when attempting to obtain peripheral venous access, specifically supporting the use of blood pressure cuffs to decrease compressibility.     

Use of Point-of-Care Ultrasound to Facilitate Guidance and Intrauterine Placement of a Foley Urinary Catheter to Tamponade Life-Threatening Postprocedure Hemorrhage Caused by Disseminated Intravascular Coagulation

BackgroundSevere vaginal hemorrhage caused by disseminated intravascular coagulation (DIC) after dilation and evacuation is a rare but life-threatening situation that can be difficult to manage. Obtaining hemostasis in such a patient with heavy vaginal bleeding secondary to DIC can be difficult. One technique involves the use of a urinary bladder catheter inserted into the uterus that is inflated to apply pressure on the endometrium, allowing for tamponade of the bleeding.Case ReportA 36-year-old female gravida 2 para 0 at 21 weeks’ gestation presented to the emergency department after being transferred from another facility for a higher level of care available at our facility, after a dilation and evacuation procedure that was indicated because of intrauterine fetal demise. The physical examination was significant for an ill-appearing female with active heavy vaginal bleeding. Resuscitation was initiated with packed red blood cells, cryoprecipitate, and platelets. Because of her thrombocytopenia, the development of DIC was suspected. Point-of-care ultrasound (POCUS) was performed and showed a thickened endometrial stripe with evidence of multiple anechoic foci, which were thought to represent intrauterine clots. To tamponade the bleeding, a 30-cc standard Foley urinary bladder catheter was placed into the uterus, using POCUS for guidance, to attempt to induce hemostasis via tamponade of the bleeding after inflation of the catheter balloon. Placement of an intrauterine urinary catheter to enable tamponade can be useful for the management of uncontrolled hemorrhage, but can be difficult to accomplish without use of POCUS for guidance. POCUS enabled us to accomplish accurate intrauterine placement of the urinary catheter and confirmation of a properly placed catheter balloon within the uterus.Why Should an Emergency Physician be Aware of This?Menorrhagia in the emergency department can be difficult to manage, especially in the setting of DIC. Placement of an intrauterine urinary catheter can be useful in management but may be difficult for the inexperienced provider. POCUS can be used to guide the catheter into place and confirm the location once the balloon is inflated.     

超声引导药物注射结合高强度聚焦超声治疗门静脉癌栓的初步临床观察

目的：探讨超声引导下门脉癌栓穿刺注射结合高频聚焦超声(HIFU)技术治疗门脉癌栓的安全性和有效性。方法：8例合并门脉主支癌栓的原发性肝癌患者在超声引导下穿刺在癌栓内注人碘油化疗药物混悬液并接受HIFU治疗。结果：1例患者出现肠系膜上静脉异位栓塞，无其它相关并发症出现，X-线摄片示门脉癌栓内碘油致密沉积，MRI或CT检查示门脉癌栓血供消失，随访4例患者门脉癌栓缩小或消失。结论：超声引导下门脉癌栓内药物注射结合HIFU技术是一种安全和有效治疗门脉癌栓的方法。     

彩色多普勒超声在肝癌肝动脉和门静脉双重栓塞治疗中的应用价值

本文应用彩色多普勒血流显像观察肝癌肝动脉栓塞（ＴＡＥ）及肝动脉和门静脉双重栓塞（ＴＡＥ＋ＰＶＥ）治疗前后肿瘤血供和声像图的变化以及二者之间的关系。结果显示ＴＡＥ后，肿瘤门静脉供血从２０．９％增加到５５．６％。在ＴＡＥ基础上行ＰＶＥ治疗，使肿瘤动脉供血和门静脉供血均明显减少。肝癌化疗栓塞后肿瘤缩小程度与血供减少程度密切相关。经双重栓塞治疗的肝癌患者临床预后优于单纯经ＴＡＥ治疗者。结果表明彩色多普勒超声在指导临床介入件治疗药物用量和评价介入性治疗效果起重要作用。     

实时超声造影技术评价肝移植术前门静脉通畅性的研究

目的比较实时超声造影（CEUS）技术和普通超声（B型超声及彩色多普勒超声，B—US）评价门静脉通畅性的优劣。方法对32例B—US怀疑门静脉主干或其一级分支有栓塞的患者行CEUS检查。结果肝移植手术、三维动态增强磁共振血管成像或螺旋CT门静脉成像证实26例患者中20例门静脉栓塞、6例门静脉通畅。（1）B—US诊断信心评分（8．26±1．98）分；CEUS为（9．38±0．95）分；（2）B—US敏感性88．2％，特异性33．3％，准确性69．2％；CEUS敏感性82．4％，特异性100％，准确性88．5％；（3）在鉴别栓子性质及栓塞程度方面，CEUS可显示的14例门静脉栓塞中，CEUS可全部予以鉴别（100％）；而B—US可显示的15例门静脉栓塞中，仅能鉴别8例（53．3％）。结论肝移植术前评价门静脉通畅性时，CEUS技术可获得较B—US更高的诊断水平，提供更丰富的诊断信息，是B—US有益的补充。     

不稳定型心绞痛患者斑块易损性的血管内超声评价

目的应用血管内超声（IVUS）技术评价不稳定型心绞痛患者易损斑块的影像学特征。 方法对11例稳定型心绞痛，17例不稳定型心绞痛患者和11例正常对照者进行血脂、体表血管超声和血管内超声检查。 结果两组心绞痛患者的血清总胆固醇（TC）、低密度脂蛋白胆固醇（LDL—C）和内膜一中层厚度（IMT）显著高于正常对照组（P〈0.05）。IVUS示不稳定型心绞痛组病变处血管外弹力膜面积（EEMA）、斑块面积（PA）、管腔面积狭窄百分率（LAS％）、偏心指数（EI）及重构指数（RI）均显著高于稳定型心绞痛组（P〈O，01～O，05），Logistic回归分析显示IMT、PA和RI具有显著性差异。 结论IMT、PA和RI是预测冠状动脉AS斑块易损性的重要指标，IVUS在易损斑块的早期识别中具有独特的优势。     

Prenatal Diagnosis of a Retroesophageal Left Brachiocephalic Vein: Two Case Reports

A retroesophageal left brachiocephalic vein is an extremely rare anomaly and has only been reported in 6 postnatal cases. Two prenatally diagnosed cases are reported. On the 3‐vessel view, the vein appears as an aberrant vessel transversely coursing behind the aorta and trachea, which subsequently drains into the superior vena cava, giving rise to a U‐shaped configuration. On color Doppler sonography, the U sign is bicolored. This anomaly should prompt the sonographer to carefully assess for other congenital heart defects, suggest consideration for genetic testing, and alert the cardiologist because it could affect central line procedures and cardiac interventions after delivery.     

Non-contact High-Frequency Ultrasound Microbeam Stimulation for Studying Mechanotransduction in Human Umbilical Vein Endothelial Cells

We describe how contactless high-frequency ultrasound microbeam stimulation (HFUMS) is capable of eliciting cytoplasmic calcium (Ca²⁺) elevation in human umbilical vein endothelial cells. The cellular mechanotransduction process, which includes cell sensing and adaptation to the mechanical micro-environment, has been studied extensively in recent years. A variety of tools for mechanical stimulation have been developed to produce cellular responses. We developed a novel tool, a highly focused ultrasound microbeam, for non-contact cell stimulation at a microscale. This tool, at 200 MHz, was applied to human umbilical vein endothelial cells to investigate its potential to elicit an elevation in cytoplasmic Ca²⁺ levels. It was found that the response was dose dependent, and moreover, extracellular Ca²⁺ and cytoplasmic Ca²⁺ stores were involved in the Ca²⁺ elevation. These results suggest that high-frequency ultrasound microbeam stimulation is potentially a novel non-contact tool for studying cellular mechanotransduction if the acoustic pressures at such high frequencies can be quantified.