Color Doppler ultrasound and arteriovenous fistulas for hemodialysis

Native arteriovenous fistula (AVF) is the vascular access of choice for hemodialysis patients. Compared with grafts and central venous catheters, AVFs last longer and are associated with fewer complications. The widespread use of the Doppler ultrasound (DUS) has increased the number of patients who are eligible for AVF by facilitating the identification of vessels that are suitable for fistula construction (preoperative vascular mapping). DUS can also extend native AVF survival by improving the early detection of complications (post-operative surveillance). It is the only imaging modality that furnishes both morphological and functional data on the native vascular access, and it is also the only imaging tool that can be used directly by the surgeon, an indisputable advantage. This review examines the numerous roles played by DUS in the construction and postoperative follow-up of AVFs, including preoperative vascular mapping, AVF maturation, and surveillance.     

Early closure of posthysterectomy vesicovaginal fistulas

This report presents the results of early closure of 11 posthysterectomy vesicovaginal fistulas, using a modified transvaginal approach. Early repair of this complication is acceptable and probably desirable. Review of the English literature indicate that these 11 patients comprise the single largest series of patients treated by early vaginal repair.     

彩色多普勒超声诊断乳腺叶状肉瘤1例

患者女,48岁,一周前感觉右乳疼痛,自检发现右乳外上象限一约黄豆大小包块,压痛明显,活动度好;左乳外上象限有一直径约3.0cm包块,活动度好,略有压痛感。10年前曾行右乳纤维腺瘤切除。查体:双侧乳腺对称,外观正常,无乳头凹陷。左乳外上象限可触及一圆形包块,大小约3.0cm×2.0cm,边界清,质地中等,与周围组织无粘连,无压痛,局部皮肤无凹陷等。右乳外侧可触及一黄豆大小结节,质地中等,可移动。双侧腋窝、锁骨下未触及肿大淋巴结。实验室检查:CEA2.0ng/ml,血清CA-1537.9u/ml,余未见异常。彩色多普勒超声显示:右乳可见大小分别为1.1cm×0.8cm、0.…     

移植肾肾动脉狭窄的彩色多普勒超声诊断

目的 探讨运用多项彩色多普勒超声（CDUS）指标综合诊断移植肾肾动脉狭窄（TRAS）的的新标准。方法 回顾性分析20例经数字减影血管造影（DSA）证实的TRAS的CDUS指标：移植肾肾动脉收缩期峰值血流速度（PSV）、肾动脉与髂外动脉PSV比值（RIR）、肾动脉与叶间动脉PSV比值（峰值流速后比）和叶间动脉阻力指数（RI）;并与对照组相应指标对比。结果 TRAS组与对照组的上述4项指标之间均存在显著统计学差异（P〈0．001）。新标准具有良好的敏感性（100％）和较高的特异性。结论 新标准能够提高CDUS对TRAS的诊断率。     

Repair of vesicovaginal fistulas: simultaneous transvaginal-transvesical approach.

The records of 91 patients with vesicovaginal fistulas at the Ochsner Clinic between 1942 and 1974 were reviewed. The fistulas were managed in several ways: spontaneous closure, palliative operation, urinary diversion, transvesical repair, transvaginal repair, and a combined transvaginal-transvesical procedure. The latter had a 100% success rate in the eight patients in whom it was used. The technic of this procedure is described and the indications are expanded to include (1) large fistulas, (2) fistulas near the ureteral orifice, (3) if other abdominal or urologic surgery is being done, (4) if transvesical approach is being used, (5) previous failed attempts at correction, (6) difficulty of access by vaginal approach, and (7) fistulas resulting from transurethral resection of the bladder neck.     

Hyperechoic focal bacterial nephritis: findings on contrast-enhanced Colour Doppler ultrasound.

We report a case of atypical focal bacterial nephritis (lobar nephronia) simulating a renal mass on gray-scale ultrasound, describing the findings on Colour Doppler ultrasound before and after administration of a galactose-based ultrasound contrast agent.     

Color flow and image-directed Doppler ultrasound evaluation of iatrogenic arteriovenous fistulas in the groin

Color flow image-directed Doppler ultrasound was used to image 9 iatrogenic arteriovenous (AV) fistulas in the groin following femoral artery catheterization. Characteristic findings in the color images and spectral waveforms seen in most patients included (1) visible connection between the artery and vein (8 cases); (2) a multicolored speckled mass at the fistula site (7 cases); (3) spreading of color pixels into the extraluminal soft tissues (7 cases); (4) high diastolic flow in the arterial waveform proximal to the fistula site (7 cases); (5) decreased flow in the artery caudal to the fistula (5 cases); and (6) high velocity turbulent flow, sometimes with a pulsatile component, in the vein near the fistula (9 cases). The authors conclude that color flow imaging is useful in differentiating an AV fistula from other complications of femoral artery catheterization, such as pseudoaneurysm or hematoma.     

彩超检测糖尿病患者的腘动脉粥样硬化

目的 检测糖尿病患Guo动脉病变作为临床诊断的又一指标。方法 应用彩色多普勒血流显像对160例糖尿病患测定。其动脉内径、管壁厚度、最高血流速度、斑块。结果 160例糖尿病患（320条动脉）双侧动脉粥样硬化132例（264条），单侧动脉粥样硬化28例（28条左15条右13条），双侧斑块形成102例（204条）单侧斑块18例(18条）。结论 当临床出现下肢疼痛、间歇性跛行，甚至发生溃疡坏死时，应用二维彩色多普勒血流显像检测动脉病变对临床有其诊断价值。     

彩色多普勒超声对慢性血透自体动静脉瘘的血流动力学评价

目的利用彩色多普勒超声术前评估桡动脉、头静脉,选择最佳造瘘部位;术后监测桡动脉-头静脉瘘(RCF)是否成功和成熟状况,对瘘失败进行监测和预测。方法手腕部桡动脉-头静脉端-侧吻合手术的尿毒症患者68例,随机分成超声检查组33例(检查组)和物理检查组35例(对照组)。检查组观察手术前、术后1周及术后6个月桡动脉和头静脉的频谱特点、血管内径及血流动力学参数。结果检查组手术成功率(90.3%)高于对照组(80%)。RCF手术后1周的桡动脉内径、头静脉内径、收缩期峰值、舒张期峰值、平均速度、血流量均明显高于术前,阻力指数(RI)和搏动指数(PI)均明显低于术前。术后6个月比术后1周的头静脉内径和血流量明显增加。RCF手术成功后血流及频谱特点为高速、低阻力频谱。RCF失败者呈低速、高阻力特点。结论①术前超声多普勒对头静脉、桡动脉的检查可以提高手术成功率;②术后超声检查可以提示动静脉瘘成功与否并及时发现狭窄或栓塞。③超声检查可以监测瘘管通畅情况,血管直径、血流速度、血流量、PI、RI等可以作为预测瘘管失败的重要参考。     

彩色多普勒超声在血液透析患者动静脉内瘘并发症防治中的价值

目的 探讨彩色多普勒超声在稳定血液透析患者自体动静脉瘘（AVF）并发症防治中的价值。方法 对101例血液透析患者的AVF行超声检查,以二维超声观察桡动脉、头静脉及吻合口有无扩张及狭窄,管腔内有无血栓、斑块,血管周围有无血肿等情况;以多普勒超声观察血管内血流方向、血流充盈及血流速度。结果 31例AVF可见不同类型并发症,其中并发头静脉血栓13例（13/31,41.93%）,并发头静脉管腔狭窄7例（7/31,22.58%）,并发头静脉瘤样扩张4例（4/31,12.90%）,并发桡动脉硬化3例（3/31,9.68%）,并发造瘘口旁血肿3例（3/31,9.68%）,并发假性动脉瘤1例（1/31,3.23%）。13例AVF无法挽救而放弃;18例接受治疗,之后14例AVF并发症明显改善,4例因效果不佳而放弃原AVF通路;其中AVF并发头静脉单纯血栓治疗有效率为76.92%（10/13）,AVF并发头静脉狭窄治疗有效率为14.28%（1/7）,AVF并发内瘘血肿治疗有效率为100%（3/3）。结论 稳定血液透析患者的AVF常伴并发症,应用彩色多普勒超声对造瘘血管进行常规监测可及时发现并发症,指导临床干预治疗。     

布加氏综合征的彩色多普勒检查

目的　探讨彩色多普勒超声对布加氏综合征的诊断要点和临床价值,为临床诊治提供可靠依据。方法　用彩色多普勒超声诊断布加氏综合征住院病人33例。结果　肝静脉阻塞5例,肝段下腔静脉阻塞17例,二者同时病变11例,全部经血管造影或MRA、核素扫描及手术确诊。结论　彩色多普勒超声可明确判断血管阻塞部位、程度、范围及侧支循环,对诊断具有重要参考价值,并可指导临床治疗,应作为首选的诊断方法。     

带蒂大网膜移位修补膀胱阴道瘘的围手术期护理

目的 探讨带蒂大网膜移植修补膀胱阴道瘘病人的临床疗效及围手术期的护理要点.方法 对28例膀胱阴道瘘病人采用移位带蒂大网膜覆盖于膀胱和阴道瘘口修补后的创口之间,并通过改进围手术期的护理方法,有效地促进了瘘口愈合.结果 所有病人手术均获成功并痊愈出院.结论 带蒂大网膜移位修补膀胱阴道瘘,手术成功率高;加强围手术期的护理,尤其是重视术前心理疏导、局部清洁及术后妥善处理好各种引流管等,有助于减少膀胱阴道瘘病人围手术期并发症的发生.

Abstract：

Objective To investigate the therapeutic effects of which pedicled greater omentum displacement for the repair of vesicovaginal fistulas and perioperative care elements.Methods Twenty eight cases of vesicovaginal fistulas patients, with pedicled greater omentum displacement which covered the wound repaired between bladder and vesicovaginal fistula,and through improving the perioperative nursing, promoting fistula healing and increasing the cure rate.Results All the operations were successfully completed fully recouered.Conclusions The pedicled greater omentum displacement for the repair of vesicovaginal fistulas,which can improve the success rate of operation. Intensive perioperative care,with particular attention to preoperative psychological counseling after partial cleaning and properly handle the various drainage tubes,etc,which are help to reduce perioperative complications.     

Doppler ultrasound in the neonate

The use of Doppler ultrasound to assess both the changing haemodynamics of the neonatal circulation and the perfusion of the brain is reviewed. The brain is particularly susceptible to both ischaemic and haemorrhagic injury in preterm and asphyxiated infants. However, the unique characteristics of the transitional neonatal circulation, and of the cerebral vasculature, pose considerable problems in the interpretation of Doppler signals from intracranial arteries. A volumetric Doppler method which eliminates some of those problems is discussed. The same method allows full assessment of the cardiovascular status of the newborn infant, including estimation of ductal shunting and left ventricular output. Doppler ultrasound, if used with a full understanding of the inherant assumptions and limitations of the particular methodology, is likely to prove invaluable in investigating pathological cerebral and cardiac vascular events in the newborn.     

彩色多普勒能量图在甲状腺疾病诊断的研究

目的 评价彩色多普勒能量图(CDE)在甲状腺疾病诊断的临床应用价值。方法采用CDE对200例甲状腺疾病的血流进行观察，其中弥漫性甲状腺肿113例，甲状腺结节病变患者87例，共128个结节，行CDE和CDFI对照研究，了解结节的血流显示与分级情况。结果 甲亢组血供分布丰富63例，较丰富lO例；亚甲炎组血供分布较丰富8例；桥本氏甲状腺炎较丰富5例；亚甲低组丰富13例，较丰富9例；单纯性甲状腺肿大较丰富5例；甲状腺腺瘤大部分显示周边部血流丰富，呈环状分布，内部少血流；结节性甲状腺肿的结节周围血流呈星点状或结节间穿行或绕行；甲状腺低回声结节内有明显的砂粒样小钙化点，并且结节内部血供较丰富，血管走行扭曲、不规则，应警惕甲状腺癌。结论 应用彩色多普勒能量图能直接观察甲状腺体组织及结节血供情况和血流状态的改变，对甲状腺疾病诊断及鉴别诊断具有重要的研究应用价值。