The pulsatile portal vein in cases of congestive heart failure: correlation of duplex Doppler findings with right atrial pressures

To better understand portal vein pulsatility in congestive heart failure, the authors compared portal vein spectral patterns to right atrial pressures measured with a Swan-Ganz catheter in 17 adult patients suspected of having congestive heart failure. Portal vein pulsatility was also evaluated in 17 healthy adults. A pulsatility score (scale, 1-5) based on a ratio of minimum to peak portal vein velocity was assigned. A score of 1 indicated continuous, monophasic flow, while a score of 5 indicated that flow reversal was observed with each cardiac cycle. All 17 healthy volunteers had portal vein pulsatility scores of 2 or less. Among the 17 patients suspected of having congestive heart failure, seven had normal right atrial pressure (less than 10 mm Hg) and pulsatility scores of 2 or less. Among the 10 patients with a right atrial pressure of 10 mm Hg or greater, six had pulsatility scores of 3 or greater (sensitivity, 60%; specificity, 100%). Greater than 50% of the variation in portal vein score is explained by changes in right atrial pressure. Review of echocardiograms in 13 of 17 patients showed no significant correlation between the degree of tricuspid regurgitation and portal vein score. Portal vein pulsatility is a sign of elevated systemic venous pressure.     

Duplex Doppler sonography in renal allografts: the significance of reversed flow in diastole

This study was undertaken to assess the significance of diastolic flow reversal seen on duplex Doppler sonograms of patients with renal transplant dysfunction. Earlier studies have evaluated the causes of increased vascular resistance in renal transplants. None, however, have investigated specifically the subset of patients in whom impedance in the renal microcirculation has increased to the degree that retrograde arterial flow is present. In our series, 533 consecutive scans in 270 patients were reviewed. The patients were referred for evaluation of renal transplant dysfunction during a 25-month period. Doppler samples were obtained from main, segmental, and, when possible, arcuate arteries. An episode of reversed diastolic flow was identified in nine patients. Correlation was made with clinical, laboratory, histologic (biopsy in six patients, nephrectomy in three patients), and imaging studies (DTPA scintigraphy in seven patients, angiography in one patient). On the basis of histologic and nephrectomy results, we determined that among the nine patients, four had acute tubular necrosis, three had acute rejection, and two had renal vein thrombosis. One of these patients had both severe rejection and renal vein thrombosis. One additional patient had neither biopsy nor nephrectomy and was not included in the diagnostic groups listed here. Our study suggests that reversed diastolic flow is not specific for either acute rejection or acute tubular necrosis. Reversal of diastolic flow, however, is a poor prognostic sign; nephrectomy was imminent in three of the nine patients. Furthermore, two (22%) patients had renal vein thrombosis, whereas renal vein thrombosis was not found in any of the 261 patients without reversed diastolic flow. Duplex Doppler examinations with reversed diastolic flow should suggest renal vein thrombosis.     

Sonographic findings after surgical ablation of the endometrium.

OBJECTIVE. Endometrial ablation is a new surgical technique that is an alternative to hysterectomy in women with dysfunctional uterine bleeding. The endometrium is either coagulated or resected in an attempt to render the patient amenorrheic. Because of the newness of the procedure, no report of radiologic findings after endometrial ablation has been published. Accordingly, the sonographic appearance of the uterus after endometrial ablation is described. MATERIALS AND METHODS. Using transvaginal sonography, we examined a select group of 16 women, seven of whom were symptomatic after endometrial ablation. All patients had a preoperative diagnosis of menorrhagia not responsive to conventional hormonal therapy and no evidence of cancer. RESULTS. In the seven symptomatic patients, sonography showed that postoperatively two had hematometra, one had a nonviable intrauterine pregnancy, and four had residual islands of functioning endometrial tissue alone or in combination with hematometra. In nine asymptomatic patients, postoperative sonography showed seven had normal findings except for leiomyomata and two had residual islands of functioning endometrial tissue. CONCLUSION. Sonographic examination of the uterus after endometrial ablation provides a method for evaluating symptomatic patients and for identifying any remaining endometrium that could later become symptomatic.     

Color Doppler imaging of the hepatic vasculature.

Duplex sonography added a new dimension to real-time sonographic imaging and can be used to characterize flow dynamics. Unfortunately, duplex sonography also has significant drawbacks, most of which are the result of the limited sampling ability of pulse-gated technology and the inability to provide a global display of Doppler information. Sonographic imaging of intraabdominal vessels has improved markedly with the advent of color Doppler techniques. This article reviews the use of color Doppler sonography in the evaluation of hepatic vessels. The complementary role of Doppler spectral analysis is also considered.     

Sertoli-Leydig cell tumour in an infertile patient after stimulated ovulation

A 36 year-old infertile female developed a stage IV (FIGO) ovarian carcinoma consisting of a poorly differentiated Sertoli-Leydig cell tumour after receiving one course of ovulation induction with follicle stimulating hormone (FSH), human menopausal gonadotrophin (HMG) and human chorionic gonadotrophin (HCG) followed by gonadotrophin-releasing hormone analogue (GnRHa). The patient died of liver metastasis and hepatic failure 4 1/2 months after first diagnosis, despite aggressive treatment consisting of debulking surgery and aggressive adjuvant chemotherapy.      

Large soft contact lenses in the management of leaking blebs.

PURPOSE: To investigate the efficacy of a new large permanent wear soft contact lens in the management of leaking blebs following trabeculectomy. METHODS: Twenty-four patients with leakage from a trabeculectomy bleb, both fornix based and limbal based, with and without mitomycin adjuvant, were treated with a 78% water content soft contact lens of 17.5 mm diameter, fit according to each patient's keratometry readings. RESULTS: The leakage from a conjunctival trabeculectomy bleb was successfully treated in 22 out of 24 patients. CONCLUSIONS: The 17.5 mm 78% water content permanent wear soft contact lens is a preferred method of management of leaking blebs when specifically tailored to the patient's corneal curvature.     

Cerebral blood flow relationships associated with a difficult tone recognition task in trained normal volunteers

Tone recognition is partially subserved by neural activity in the right frontal and primary auditory cortices. First we determined the brain areas associated with tone perception and recognition. This study then examined how regional cerebral blood flow (rCBF) in these and other brain regions correlates with the behavioral characteristics of a difficult tone recognition task. rCBF changes were assessed using H2(15)O positron emission tomography. Subtraction procedures were used to localize significant change regions and correlational analyses were applied to determine how response times (RT) predicted rCBF patterns. Twelve trained normal volunteers were studied in three conditions: REST, sensory motor control (SMC) and decision (DEC). The SMC-REST contrast revealed bilateral activation of primary auditory cortices, cerebellum and bilateral inferior frontal gyri. DEC-SMC produced significant clusters in the right middle and inferior frontal gyri, insula and claustrum; the anterior cingulate gyrus and supplementary motor area; the left insula/claustrum; and the left cerebellum. Correlational analyses, RT versus rCBF from DEC scans, showed a positive correlation in right inferior and middle frontal cortex; rCBF in bilateral auditory cortices and cerebellum exhibited significant negative correlations with RT These changes suggest that neural activity in the right frontal, superior temporal and cerebellar regions shifts back and forth in magnitude depending on whether tone recognition RT is relatively fast or slow, during a difficult, accurate assessment.      

Steady-state hydroxyflutamide plasma levels after the administration of two dosage forms of flutamide

Summary A bioavailability study of randomized crossover design was carried out in eight volunteers who were given a 48-h flutamide treatment consisting of 250-mg tablets three times daily or 400-mg sustained-release tablets twice daily, followed 3 weeks later by the alternative dosage form. Just before the last dose and 15 times during the subsequent 24 h, blood samples were obtained for the determination of plasma hydroxyflutamide (the active metabolite of flutamide) levels by high-performance liquid chromatography. No statistically significant differences between the two dosage forms were found for the lag time, rate of initial increase in concentration, peak plasma concentration, mean hydroxyflutamide concentration within one dosing interval or 24-h AUC value. One subject presented mild and transient nausea during both treatment periods. After the first treatment period (250-mg tablets), an increase in serum bilirubin was observed in another volunteer, who was withdrawn from the study. It may be concluded that both dosage forms were bioequivalent.     

Sympathetic ophthalmia following neodymium:YAG cyclotherapy

Neodymium:YAG cyclotherapy has been demonstrated to lower intraocular pressure dramatically in patients with uncontrolled glaucoma, with potentially fewer side-effects than cyclocryotherapy. We report the clinical course and histopathological features of a case of sympathetic ophthalmia occurring soon after YAG cyclotherapy.