Determination of the time for improvement in semen parameters after varicocelectomy

This retrospective study aimed to determine the time for improvement in semen parameters after varicocelectomy. A total of 175 patients over 18 years of age, who underwent microscopic inguinal varicocelectomy in a tertiary centre between 2005 and 2016 and had post-operative follow-up data of at least 12 months, were included in the study. Serial semen analyses in the pre-operative period and at the post-operative third, sixth, ninth and 12th months were retrospectively documented. With respect to their pre-operative total motile sperm counts, the patients were classified into three subgroups as <5 million, 5–9 million and >9 million. In the overall cohort and the group with a total motile sperm count of >9 million, the semen parameters continued to improve up to the post-operative 12th month. No further significant improvement was observed after the post-operative third and sixth months for the patients with pre-operative total motile sperm counts of <5 million and 5–9 million respectively. For the candidates of varicocelectomy, the decision of treatment strategies, such as assisted reproductive technologies and waiting for spontaneous pregnancy can be based on the prediction of the time for improvement in semen parameters.     

CDFI在甲状腺疾病诊断中的临床应用价值探讨

目的探讨CDFI在甲状腺疾病诊断中的临床应用价值。方法笔者所在医院2006年1月～2010年6月应用CDFI检查甲状腺疾病132例,总结分析常见的甲状腺疾病如甲状腺腺瘤、甲状腺囊腺瘤、结节性甲状腺肿、甲状腺癌、甲状腺功能亢进症、亚急性甲状腺炎、桥本甲状腺炎的超声声像图表现及CDFI显示情况。结果 132例中经病理或实验室确诊124例,超声诊断符合率93.9%。甲状腺腺瘤、甲状腺囊腺瘤、结节性甲状腺肿、甲状腺癌、甲状腺功能亢进症、亚急性甲状腺炎、桥本甲状腺炎的超声声像图表现及CDFI显示各具特点。结论 CDFI能清晰显示甲状腺病变的大小、位置、囊实性变等,彩色多普勒超声及CDFI的应用提高了对甲状腺疾病的诊断率。     

The role of color Doppler ultrasound in prediction of the outcome of microsurgical subinguinal varicocelectomy

PURPOSE: Overdiagnosis and undertreatment of varicocele may be responsible for the poor outcome of varicocelectomy. In this study we used color Doppler ultrasound for accurate diagnosis and grading of varicocele, and for predicting the outcome of microsurgical subinguinal varicocelectomy. MATERIALS AND METHODS: A total of 104 patients undergoing microsurgical subinguinal varicocelectomy for treatment of infertility were included in this study. Patients were evaluated with routine history, physical examination, semen analysis, hormonal assessment and scrotal ultrasound, and Doppler. After varicocelectomy improvement index in sperm concentration was calculated by dividing the difference between the postoperative and preoperative sperm concentration by the preoperative sperm concentration. Improvement index greater than 0.5 is considered a good outcome. Statistical analysis was done to study the correlation between microsurgical varicocelectomy outcome and testicular vein diameter at the inferior pole of the testis, and the degree of reflux measured by color Doppler ultrasound. RESULTS: Improvement index in sperm concentration, motility and morphology more than 0.5 was achieved in 58.8%, 27.3% and 17.6% of cases, respectively. We found that patients with a testicular vein diameter at the inferior pole of the testis of more than 2.5 mm have a significantly higher improvement index in sperm concentration, motility and morphology than patients with a testicular vein diameter less than 2.5 mm (p = 0.006, 0.016 and 0.041, respectively). We also found that patients with clear reflux detected by color Doppler ultrasound at the inferior pole of the testis have a significantly higher improvement index in sperm concentration, motility and morphology than patients with reflux detected only in the supratesticular venous channels (p = 0.013, 0.015 and 0.045, respectively). CONCLUSIONS: Color Doppler ultrasound is a useful tool for accurate diagnosis and grading of varicocele, and for predicting the outcome of varicocelectomy. We recommend varicocelectomy in cases of testicular vein diameter greater than 2.5 mm and in cases of reflux detected at the veins at the lower pole of the testis.     

彩色多普勒超声在周围动脉闭塞性疾病检查中的应用

目的：评价ＣＤＵＳ在周围动脉闭塞性疾病检查中的应用价值。方法：对５６例经血管造影对照或／和手术病理及临床住院确诊的病人进行彩色多普勒超声仪、连续波多普勒、肢体光电容积和节段动脉压检查，男４６例，女１０例，年龄为１９～８０岁。结果：ＣＤＵＳ与出院诊断的符合率为９８．２％；ＣＤＵＳ、ＣＷ、ＰＰＧ、ＳＢＰ对１１４条（处）病变血管的显示符合率分别为：９７．４％、６３．２％、４２．１％、６４．０％。结论：ＣＤＵＳ是周围动脉闭塞性疾病最佳无创伤检查方法之一。     

经直肠多普勒超声对BPH局部缺血的评估及意义

目的：通过经直肠彩色多普勒超声（color Doppler ultrasound,CDUS）检查BPH患者局部是否存在缺血改变,并探讨其临床意义.方法：经直肠CDUS检测56例BPH患者及12例年轻志愿者前列腺移行带血管阻力指数及血流灌注量,比较两组之间前列腺移行带血管阻力指数及血流灌注量之间的差异,并就BPH患者两侧前列腺移行带体积之间差异与其血管阻力指数及血流灌注量之间差异进行相关分析.结果：BPH患者前列腺移行带血管阻力指数平均为0.84,明显高于年轻志愿者0.55（P〈0.01）;而BPH患者移行带血流灌注量明显低于年轻志愿者（P〈0.01）;BPH患者两侧移行带体积差异与两侧移行带血管阻力指数之间差异呈正相关（r=0.713,P=0.01）,与两侧移行带血流灌注量呈负相关（r=-0.534,P=0.004）.年轻志愿者两侧前列腺移行带体积、血管阻力指数及血流灌注量之间差异无统计学意义.结论：BPH患者前列腺移行带存在缺血性改变,且缺血性改变程度与前列腺移行带体积明确相关,提示BPH与前列腺局部缺血性改变存在密切关系.     

Ultrasound role in assessment of vesicoureteral reflux endoscopic treatment results

IntroductionSince the beginning of the application of the RVU treatment, the use of the ultrasound was used taking into account two main indications/symptoms: a) identification of the complications; b) assessment of the result (visualization of the implanted material and the presence of the “uretheral jet” by means or through/of ecodoppler-color).ObjectiveTo determine the value of the ultrasound in the assessment of the result of the endoscopic treatment of the RVU and in the detection of its complications.Material and methodFrom 2001-2002 we have carried out the endoscopic treatment to an overall of 261 ureteral units of all degree and etiology. 246 were assessed post-operation with an ultrasound per month and all of them were evaluated with a cistography after 3 months. In a random sample of 92 units, the result of the isotopic cistography has been compared with the visualization of the implanted material in the bladder; and in a random sample of 56 units, the result of the isotopic cistography has been compared with the presence of ureteral jet in the study with ecodoppler-color after moisturizing of the patient. In order to do, we have done two corresponding comparative charts 2 x 2 and we have calculated the Sensibility and Specificity of the tests, as well as their predictive positive and negative values, the degree of similarity of both tests with the Kappa index, and the degree of statistical relevance with Chi squared.ResultsThe ultrasound did not show significant changes if compared to previous studies in 213 units (86,58 %) although in 5 patients an ectasia has been identified as attributed to the treatment. 3 of this patients have developed renoureteral pain, and in 2 pain has spontaneously disappeared as shown in later tests. The S and the E of the presence of implanted material is 94% and 10%respectively and its VPP and VPN of 80% and 10% and estadistical. The S and E of the jet visualization is 82% and 30%, with a VPP of 84% and a VPN of 27%, a level of statistical relevance of 0.836 and a degree of correlation of 0.121.ConclusionsUltrasound is not a useful technique in the assessment of the result of the endoscopic treatment of the RVU. The role it plays in the assessment of complications is a small one and its use is only indicated to confirm the suspicion of ectasia in those patients that present renoureteral pain     

Effect of venous reflux time on testosterone and semen parameters of infertile males after microscopic varicocelectomy

This study aimed to search whether there is a link between reflux flow and hormonal profile. Data of 250 patients were retrospectively investigated. Pre-operative and 6th month semen analyses of these patients' results were compared with pre-operative and post-operative 6th month serum levels of testosterone. Based on the venous flow on pre-operative Doppler ultrasonography, patients were divided into two groups. Patients with a venous flow ≤4 s were assigned to Group 1 and those with a venous flow >4 s to Group 2. Venous reflux time cut-off was calculated as 4 s using ROC curve according to the increase in testosterone level. When venous reflux time was selected as approximately 4.0 s, ROC had 79.8% sensitivity and 72.8 specificity. The probability of a post-operative increase in testosterone is high in patients with a venous reflux time longer than 4 s.     

彩色多普勒超声在诊断子宫圆韧带病变中的应用

目的探讨彩色多普勒超声在子宫圆韧带病变诊断和鉴别诊断中的应用价值。 方法回顾性分析2013年1月至2018年12月,首都医科大学附属北京朝阳医院西院105例（113条）超声诊断为圆韧带病变患者的临床资料及超声图像表现,与术后诊断结果对比。 结果临床术后证实圆韧带囊肿共66例（69条）,均合并腹股沟疝,其中68条为斜疝,彩色多普勒超声正确诊断圆韧带囊肿61例（64条）。超声表现圆韧带积液合并圆韧带增粗者2例（2条）,经手术及病理证实为子宫内膜异位症合并斜疝。超声诊断为圆韧带静脉曲张合并斜疝1例（1条）,斜疝术后复查静脉曲张消失。超声诊断的圆韧带囊肿合并疝1例（1条）,手术证实为斜疝合并圆韧带囊性病变（性质不明）。超声正确描述圆韧带区交通性积液21例（24条）,术后均证实为斜疝。 结论彩色多普勒超声在诊断圆韧带病变中具有较高的应用价值,特别是对圆韧带囊肿的诊断率较高。圆韧带病变中圆韧带囊肿发生率相对较高。圆韧带病变和腹股沟斜疝的发生关系密切。     

糖尿病早期肾损害的彩色多普勒超声研究

目的：探讨彩色多普勒超声肾血流测定对诊断糖尿病早期肾损害的价值。方法：以尿白蛋白排泄率（UAER）作为早期肾损害指标,对60例糖尿病患在26例正常人行彩色多普勒超声肾血流检查,结果：小叶间动脉收缩期峰值流速（Vs),弓状动脉及小叶间动脉舒张末期流速（Vd)的减慢是糖尿病患最早出现的肾内血流动力学改变;有肾脏早期损害的糖尿病患肾血流频谱参数特点是肾内弓状动脉,小叶间动脉的Vs和肾内各分支动脉的Vd明显减低,肾内各分支动脉的阻力指数（RI）明显增高,RI与糖尿病患肾功能损害程度相关。结论：彩色多普勒超声肾血流检测是早期诊断糖悄病肾损害的简便,可靠的方法。     

彩色多普勒高频超声对精索静脉曲张不育者的诊断价值

目的探讨精索静脉曲张不育症患者彩色多普勒超声的诊断价值。方法用彩色多普勒超声观测38例精索静脉曲张不育患者的精索静脉内径和血液反流持续时间,结合精液质量评估患者的生育能力。结果 (1)患侧精索静脉内径增宽,血液反流。(2)精索静脉的内径与生育力指数呈负相关。结论做为精索静脉血流动力学改变的参数,彩色多普勒超声可提供管腔结构。结合精液检查,有助于评估精索静脉曲张患者的生育力损害程度。     

Color Doppler US Evaluation of Feeding Artery after Balloon Angioplasty of the Drainage Vein in Dysfunctional Hemodialysis AVF

Purpose.?The aim of this study was to investigate flow rate and resistive index (RI) parameters of the feeding artery after balloon angioplasty of the drainage vein in dysfunctional hemodialysis arteriovenous fistula (AVF) due to venous stenosis/thrombosis.?Methods.?A cohort of 10 patients with native dysfunctional hemodialysis AVF was evaluated prospectively. Three of the 10 patients had a thrombosed drainage vein, and the remaining seven patients had a stenotic drainage vein. Flow rate and RI of the feeding artery of AVF were calculated by Color Doppler ultrasound (CDU) before and after balloon angioplasty and in the follow-up period. The flow rates and RI values before and after angioplasty and in the follow-up were compared.?Results.?Increased flow rate and decreased RI values were detected after balloon angioplasty in all patients. We detected restenosis or thrombosis of drainage vein in six of the patients in the follow-up period. Decreased flow rate and increased RI values compared with previous measurements were calculated in these patients.?Conclusions.?Increased flow rate and decreased RI in the feeding artery of native dysfunctional AVF were demonstrated in patients who underwent balloon angioplasty on the stenotic vein. If restenosis develops in the follow-up period, the previous high resistance flow pattern is observed again. Feeding artery flow parameters as calculated by CDU can be used as a simple indicator of possible drainage vein problems of native AVF.     

Color Doppler Ultrasound Detection and Classification of the Tangential Hepatic Vein before Laparoscopic Cholecystectomy

Background: Unexpected fatal bleeding from the gallbladder bed during laparoscopic cholecystectomy is often associated with injury to the middle hepatic vein. This paper studies whether preoperative color Doppler ultrasound is effective in reducing the risk of injury. Also a venous classification is suggested. Methods: Between June 1999 and February 2004, 2,146 patients undergoing laparoscopic cholecystectomy by standard method received preoperative color Doppler ultrasound examinations. The closest distance between the hepatic vein and the gallbladder was studied. Also, cases of liver cirrhosis, number of conversions to open cholecystectomy, intraoperative blood loss, operative time, complications, and hospital stay were recorded (group D). At the end of the study, we retrospectively reviewed the same parameter of another 2,146 patients who received laparoscopic cholecystectomy without preoperative color Doppler ultrasound between the period of March 1995 and June 1999 (group ND). Results: In group D, 108 patients had cirrhosis. Four hundred and ninety-six patients (27 cases of cirrhosis) had a closest distance of 1 mm or less between the vein and the gallbladder. There were two conversions to open cholecystectomy, but none related to gallbladder bed bleeding. In group ND, there were five conversions, including four cases of gallbladder bed bleeding from the middle hepatic vein and one case of severe adhesion. The conversion rate was significantly higher. In group ND, the mean intraoperative blood loss in the cases of liver cirrhosis was significantly greater. Also, the operative time of patients with the closest vein and gallbladder distance of 1 mm or less in group D was significantly longer. Conclusions: Color Doppler ultrasound is an effective method for detecting the presence of potential bleeders. Although the operative time will be a bit longer, the operation can be done under meticulous care and complete preparation, so that the conversion rate and the risk of fatal hemorrhage can be reduced, especially in patients with liver cirrhosis.     

Evaluation of the role of varicocelectomy including external spermatic vein ligation in patients with scrotal pain

OBJECTIVES: The aim of the present study was to assess and compare pre- and postoperative scrotal pain in patients with varicocele who underwent varicocelectomy with different approaches. METHODS: The study included 144 consecutive patients with left-sided varicocele who had left scrotal pain for more than 3 months. All patients underwent varicocele ligation using either a subinguinal or inguinal approach with or without external spermatic vein ligation. We asked the patients to complete an 'Assessment Questionnaire for Scrotal Pain' both before and after the surgery. RESULTS: The surgery was successful in 101 (83.4%) of the 121 patients available for follow up. Seventy-four (61.1%) patients reported the complete resolution of pain while 27 patients (22.3%) reported partial resolution. Symptoms worsened in a single case and pain persisted postoperatively in 19 cases (15.7%). There were no statistically significant differences in the characteristics of the pain and grade of varicocele between postoperative groups. A significant difference was observed in postoperative success between patients who had external spermatic vein ligation and those who did not, regardless of the surgical approach (inguinal or subinguinal). All patients who reported complete or partial resolution of pain stated that they would recommend surgery to relatives with the same problem. CONCLUSIONS: Varicocelectomy using either inguinal or subinguinal approaches is an effective and reasonable treatment option in this patient group and should include external spermatic vein ligation for a satisfactory outcome.     

多普勒能量图监测移植肾急性排斥

为探讨彩色多普勒能量图（ＣＤＥ）在监测移植肾急性排斥中的应用价值，对７１例移植肾作ＣＤＥ及常规彩色多普勒血流成像（ＣＤＦＩ）等检查，其中２２例经临床及病理证实发生了急性排斥（ＡＲ）。结果表明：根据ＣＤＥ可以诊断急性排斥，其灵敏度比ＣＤＦＩ高。若ＣＤＥ与ＣＤＦＩ结合，则诊断ＡＲ的准确性更进一步提高。多次ＣＤＥ检查动态观察移植肾可预测ＡＲ的转归和监测抗排斥的效果。认为ＣＤＥ检查是目前肾移植术后较实用的一种监测手段。     

经直肠彩色超声对前列腺癌诊断分析

目的：经直肠彩超检查,对照病理结果,探讨PCa的彩色多普勒超声表现和特征。方法：对经直肠彩超引导下穿刺活检确诊为PCa的30例患者35个恶性结节和BPH的25例患者42个增生结节的回顾,分析在二维声像图和彩色多普勒血流显像中的不同。结果：PCa结节出现在外周带为主,占86％（30／35）,内部以低回声多见,占88％（31／35）;BPH结节多出现在内腺,占81％（22／42）,内部高低回声均可见。BPH结节和PCa结节血供均增加,但PCa结节比BPH结节血流更丰富,动脉收缩期最高流速峰值、舒张末期血流峰速,加速指数、血流阻力指数明显增高,两者差异有统计学意义（P〈0．05）。结论：经直肠彩超有助于前列腺良恶病变的定性诊断,更有利于穿刺活检的准确定位。     

Does the ureteric jet Doppler waveform have a role in detecting vesicoureteric reflux?

Data reported in this issue of Pediatric Nephrology suggest that the ureteric jet Doppler waveform can predict the occurrence of vesicoureteric reflux (VUR). Many different methods are currently used to detect VUR, including traditional X-ray micturating cystourethrogram, indirect and direct nuclear imaging and contrast enhanced ultrasonography. These methods are invasive, do have some radiation burden and are also quite uncomfortable to paediatric patients. This relatively new non-invasive method is therefore of interest, but its efficacy needs to be confirmed in further studies and, in particular, in babies and infants before it can possibly be considered as a good method to provide clinical information on VUR. Once such studies have been performed, this method may also prove to be a useful approach to obtain modern knowledge on the occurrence of VUR in healthy children.     

Relationship between semen quality improvement after varicocelectomy and preoperative levels of hypophyseal and gonadal hormones

Evaluation of serum levels of FSH, LH, prolactin, testosterone and oestradiol is not predictive of the increases of sperm count after varicocelectomy. Increased level of oestradiol reflects the lack of possibility of sperm motility increase after varicocelectomy.     

The Key Role of Color Doppler Ultrasound in the Work‐up of Hemodialysis Vascular Access

Vascular access (VA) is the lifeline for the hemodialysis patient and the native arterio‐venous fistula (AVF) is the first‐choice access. Among the different tests used in the VA domain, color Doppler ultrasound (CD‐US) plays a key role in the clinical work‐up. At the present time, three are the main fields of CD‐US application: (i) evaluation of forearm arteries and veins in surgical planning; (ii) testing of AVF maturation; (iii) VA complications. Specifically, during the AVF maturation, CD‐US allows to measure the diameter and flow volume in the brachial artery and calculate the peak systolic velocity (PSV) of the arterial axis, anastomosis and efferent vein, to detect critical stenosis. The borderline stenosis, revealed by the discrepancies between access flow rate and PSV, should be followed up with subsequent tests to detect progression of stenosis; the cases with significant changes in brachial flow should be referred to angiography. In conclusion, clinical monitoring remains the backbone of any VA program. CD‐US is of utmost importance in a patient‐centered VA evaluation, because it allows the appropriate management of all aspects of VA care. These are the main reasons why we strongly advocate the adoption of a VA surveillance program based on CD‐US.