Perspectives in Medicine最新文献

{"title":"Plaque angiogenesis identification with Contrast Enhanced Carotid Ultrasonography: Statement of the Consensus after the 16th ESNCH Meeting – Munich, 20-23 May 2011","authors":"Holger Poppert ,&nbsp;Edoardo Vicenzini ,&nbsp;Konrad Stock ,&nbsp;Eva Bartels","doi":"10.1016/j.permed.2012.04.001","DOIUrl":"10.1016/j.permed.2012.04.001","url":null,"abstract":"<div><p>Contrast Enhanced Carotid Ultrasonography (CCU) is capable of detecting angiogenesis within the carotid plaque as a potential index of plaque vulnerability. However, due to a lack of standard of examination technique and documentation, results are not sufficiently, reliably comparable.</p><p>To improve this situation and in order to support wide acceptance of this promising technique, experts in this field met in the Consensus conference in May 22, 2011, held during the 16th ESNCH Meeting (20–23 May 2011) in Munich, Germany, to discuss the limitations and problems and to determine guidelines for its proper use in scientific investigations and clinical practice.</p><p>The main results of this conference are presented here. The discussion is still in progress and individual conclusions may not reflect the opinion of all participants. It aims to provide a basis for a later comprehensive consensus statement.</p></div>","PeriodicalId":101010,"journal":{"name":"Perspectives in Medicine","volume":"1 1","pages":"Pages 51-53"},"PeriodicalIF":0.0,"publicationDate":"2012-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.permed.2012.04.001","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72852099","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Brain tissue perfusion monitoring using Sonopod for transcranial color duplex sonography","authors":"Toshiyuki Shiogai ,&nbsp;Mari Koyama ,&nbsp;Mayumi Yamamoto ,&nbsp;Kenji Yoshikawa ,&nbsp;Toshiki Mizuno ,&nbsp;Masanori Nakagawa","doi":"10.1016/j.permed.2012.03.001","DOIUrl":"10.1016/j.permed.2012.03.001","url":null,"abstract":"<div><h3>Objective</h3><p>We have introduced and improved a transducer holder, named the Sonopod, for transcranial color duplex sonography (TCDS) monitoring via both temporal/foraminal windows (TW/FW). The objective is to clarify clinical usefulness and identify problems in TCDS-Sonopod monitoring during the evaluation of brain tissue perfusion.</p></div><div><h3>Methods</h3><p>Brain tissue perfusion monitoring was evaluated in 11 patients (ages 31–94, mean 66). After a bolus intravenous Levovist^®, power modulation imaging (PMI) in all cases was evaluated in comparison with second harmonic imaging (SHI) in two cases at the diencephalic horizontal plain via the TWs on the basis of time–intensity curves (TICs) in five regions of interest (ROIs); bilateral basal ganglia (BG) and thalamus (Th), and contra-lateral temporal lobe (TL). After a SONOS5500 S3 transducer was installed in the Sonopod, acetazolamide (ACZ) cerebral vasoreactivity utilizing PMI was evaluated in 10 cases via the bilateral (five cases) and unilateral (five cases) TWs. A total of 30 TICs were evaluated before/after ACZ administration.</p></div><div><h3>Results</h3><p>(1) All patients could be monitored continuously by one examiner. (2) We confirmed that PMI proves superior to SHI in quantitative evaluation of the bilateral hemispheres via the unilateral TWs. (3) Brain tissue perfusion could be precisely quantified before/after ACZ in the same ROIs. (4) TIC base-line drifts during monitoring were observed in 4 (seven TICs) of 10 (30 TICs) patients. However, fixed-probe shifts during monitoring were easily readjustable and the TIC recovered to the base-line in all cases. (5) Due to re-fixation needed for contralateral TW monitoring, it was not possible to evaluate completely in the same ROIs.</p></div><div><h3>Conclusions</h3><p>TCDS-Sonopod monitoring succeeds in continuously and quantitatively evaluating precise and reproducible intracranial hemodynamics in the brain tissue.</p></div>","PeriodicalId":101010,"journal":{"name":"Perspectives in Medicine","volume":"1 1","pages":"Pages 34-38"},"PeriodicalIF":0.0,"publicationDate":"2012-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.permed.2012.03.001","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86787508","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How to treat an asymptomatic carotid stenosis? The view of the neurologist","authors":"Dirk Sander ,&nbsp;Michael Valet","doi":"10.1016/j.permed.2012.02.025","DOIUrl":"10.1016/j.permed.2012.02.025","url":null,"abstract":"<div><p>The optimal treatment strategy for patients with asymptomatic carotid artery stenosis (ACS) is still a matter of debate. Based on a simplistic view, all stenosed vessels should be cleaned, and the earlier the better. Due to the improvements of medical management in patients with high-grade ACS, there is uncertainty as how to best manage these patients. Consequently, the cost-effectiveness of CEA in patients with ACS has been questioned. Therefore, the question arises how best medical treatment changes the risk of stroke in patients with ACS. This overview discussed the therapeutic options for ACS from a neurological point of view.</p></div>","PeriodicalId":101010,"journal":{"name":"Perspectives in Medicine","volume":"1 1","pages":"Pages 112-115"},"PeriodicalIF":0.0,"publicationDate":"2012-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.permed.2012.02.025","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89044931","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Imaging of plaque perfusion using contrast-enhanced ultrasound – Clinical significance","authors":"Edoardo Vicenzini ,&nbsp;Maria Fabrizia Giannoni ,&nbsp;Gaia Sirimarco ,&nbsp;Maria Chiara Ricciardi ,&nbsp;Massimiliano Toscano ,&nbsp;Gian Luigi Lenzi ,&nbsp;Vittorio Di Piero","doi":"10.1016/j.permed.2012.03.017","DOIUrl":"10.1016/j.permed.2012.03.017","url":null,"abstract":"<div><p>The identification of vulnerable and unstable carotid atherosclerotic lesions is up-to-date an important topic of research, in order to adopt the adequate strategy for preventing cerebrovascular events. Plaque inflammation, presence of adventitial vasa vasorum, intimal angiogenesis and plaque neovascularization have been identified in histological studies as indicators of the instability of the atheroma of carotid arteries in cerebrovascular patients and of coronary arteries in cardiovascular patents. Consequently, the identification “in vivo” of these pathophysiological aspects has been objective for the development of new imaging techniques. Ultrasound of carotid arteries, with ultrasound contrast agents, is not only able to provide an enhanced visualization of the arterial lumen and plaque morphology, but also allows to directly visualize adventitial vasa-vasorum and carotid plaque neovascularization. This technique and its clinical implications in the unstable plaque identification are discussed in the present paper.</p></div>","PeriodicalId":101010,"journal":{"name":"Perspectives in Medicine","volume":"1 1","pages":"Pages 44-50"},"PeriodicalIF":0.0,"publicationDate":"2012-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.permed.2012.03.017","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76192405","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ultrasonography of the peripheral nervous system","authors":"Henrich Kele","doi":"10.1016/j.permed.2012.02.047","DOIUrl":"10.1016/j.permed.2012.02.047","url":null,"abstract":"<div><p>With improvements in ultrasound (US) imaging equipment and refinements in scanning technique, an increasing number of peripheral nerves and related pathologic conditions can be identified. Modern US imaging supports the clinical examination and electrophysiologic testing in setting the diagnosis, and enhances this information by illuminating the morphological aspects and etiology of peripheral nerve pathology. US can readily be used for detection of nerve abnormalities caused by trauma, tumors, inflammation and a variety of nonneoplastic conditions, including compressive neuropathies. Well recognized advantages of the method such as the possibility of a dynamic examination, assessing long nerves segments in a short time, bed-side-availability, non-invasivity and low cost, make US the ideal imaging tool in peripheral nerve disease.</p></div>","PeriodicalId":101010,"journal":{"name":"Perspectives in Medicine","volume":"1 1","pages":"Pages 417-421"},"PeriodicalIF":0.0,"publicationDate":"2012-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.permed.2012.02.047","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85262433","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Asymmetry of cerebral autoregulation does not correspond to asymmetry of cerebrovascular pressure reactivity","authors":"Bernhard Schmidt ,&nbsp;Marek Czosnyka ,&nbsp;Jürgen Klingelhöfer","doi":"10.1016/j.permed.2012.02.026","DOIUrl":"10.1016/j.permed.2012.02.026","url":null,"abstract":"<div><h3>Background</h3><p>Small cerebral vessels respond to variations of cerebral perfusion pressure (CPP) by changes of vessel diameter inducing changes of blood flow resistance and keeping cerebral blood flow constant. This mechanism is called cerebral autoregulation (CA). Recently stronger reactions of CA during pressure increase than during decrease were reported. Aim of this study was to assess the symmetry behavior of CA during spontaneous CPP changes and compare it to cerebrovascular pressure reactivity (CVR).</p></div><div><h3>Methods</h3><p>In 238 patients with traumatic brain injury or stroke, correlation indices between CPP and cerebral blood flow velocity (CBFV) were calculated during periods of increasing (upMx) and decreasing CPP (downMx). The indices range from −1 to +1, values ≤0 indicating intact, values &gt;0 indicating impaired autoregulation. Similar correlation between arterial blood pressure (ABP) and ICP was calculated during increasing (upPRx) and decreasing ABP (downPRx), negative values indicating intact, positive values indicating impaired CVR. Only recordings with strong pressure changes (CPP/ABP<!--> <!-->&gt;<!--> <!-->10<!--> <!-->mmHg) were evaluated.</p></div><div><h3>Results</h3><p>CA was assessed in 62 patients. On average (mean<!--> <!-->±<!--> <!-->SD) upMx was 0.06<!--> <!-->±<!--> <!-->0.52, downMx was 0.15<!--> <!-->±<!--> <!-->0.55 (<em>P</em> <!-->&lt;<!--> <!-->0.005). CVR was assessed in 47 patients. On average upPRx was 0.45<!--> <!-->±<!--> <!-->0.43, downPRx was 0.38<!--> <!-->±<!--> <!-->0.48 (<em>P</em> <!-->&lt;<!--> <!-->0.05). In 40 patients both Mx and PRx were calculated. On average upMx was 0.21<!--> <!-->±<!--> <!-->0.55 and downMx was 0.27<!--> <!-->±<!--> <!-->0.56 (<em>P</em> <!-->=<!--> <!-->0.05), upPRx was 0.35<!--> <!-->±<!--> <!-->0.43 and downPRx was 0.27<!--> <!-->±<!--> <!-->0.47 (<em>P</em> <!-->&lt;<!--> <!-->0.05).</p></div><div><h3>Conclusions</h3><p>During pressure increase the autoregulatory response was significantly stronger than during decrease, while in contrast the cerebrovascular reactivity was significantly weaker. The reason for this opposed behavior remains unclear and needs further exploration.</p></div>","PeriodicalId":101010,"journal":{"name":"Perspectives in Medicine","volume":"1 1","pages":"Pages 285-289"},"PeriodicalIF":0.0,"publicationDate":"2012-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.permed.2012.02.026","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81780686","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sonothrombolysis: Current status","authors":"Peter D. Schellinger ,&nbsp;Carlos A. Molina","doi":"10.1016/j.permed.2012.02.023","DOIUrl":"10.1016/j.permed.2012.02.023","url":null,"abstract":"<div><p>This contribution summarizes the past and present status of ultrasound-facilitated thrombolysis (sonolysis) with and without the use of microspheres. Different ultrasound techniques are addressed and advantages as well as pitfalls are discussed.</p></div>","PeriodicalId":101010,"journal":{"name":"Perspectives in Medicine","volume":"1 1","pages":"Pages 11-13"},"PeriodicalIF":0.0,"publicationDate":"2012-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.permed.2012.02.023","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88699805","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adaptation of cerebral pressure-velocity hemodynamic changes of neurovascular coupling to orthostatic challenge","authors":"Pedro Castro ,&nbsp;Rosa Santos ,&nbsp;João Freitas ,&nbsp;Bernhard Rosengarten ,&nbsp;Ronney Panerai ,&nbsp;Elsa Azevedo","doi":"10.1016/j.permed.2012.02.052","DOIUrl":"10.1016/j.permed.2012.02.052","url":null,"abstract":"<div><p>Neurovascular coupling (NVC), analysed by a control system approach, was shown to be unaffected by orthostatic challenge, but data is lacking regarding the mechanism of this interplay and the behaviour of other cerebrovascular reactivity parameters. We investigated the changes in different pressure–velocity models during functional transcranial Doppler (TCD), under different orthostatic conditions.</p><p>Thirteen healthy volunteers performed a reading test stimulation task in sitting, supine and head-up tilt (HUT) positions. CBF velocity was monitored with TCD in the posterior cerebral artery, and blood pressure was monitored with Finapres. Cerebrovascular resistance index (CVRi) was compared to a two-parameter model including resistance-area product (RAP) and critical closing pressure (CrCP), in the maximal and in the stable phases of flow response to visual stimulation.</p><p>All cerebrovascular resistance parameters decreased with visual stimulation but the magnitude of their variation in each orthostatic condition was not similar. From supine to HUT, CrCP variation decreased (both maximal and stable phase <em>p</em> <!-->=<!--> <!-->0.001). CVRi variation increased from sitting to HUT positions (maximal <em>p</em> <!-->=<!--> <!-->0.039; stable phase <em>p</em> <!-->=<!--> <!-->0.033). RAP variation to visual stimulation did not change between the three positions (maximal <em>p</em> <!-->=<!--> <!-->0.077; stable phase <em>p</em> <!-->=<!--> <!-->0.188).</p><p>A 2-parameter model of vascular resistance provided better discrimination for the effects of posture on NVC as shown by the adaptive changes in CrCP with orthostatic challenge, in comparison with the classical use of CVRi. These findings suggest that although NVC seemed unaffected by orthostatic challenge, more complex vasoregulative mechanisms are activated in different orthostatic conditions that could potentially be of diagnostic or prognostic value.</p></div>","PeriodicalId":101010,"journal":{"name":"Perspectives in Medicine","volume":"1 1","pages":"Pages 290-296"},"PeriodicalIF":0.0,"publicationDate":"2012-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.permed.2012.02.052","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91494829","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Italian multicenter study on venous hemodynamics in multiple sclerosis: Advanced Sonological Protocol","authors":"Giovanni Malferrari ,&nbsp;Massimo Del Sette ,&nbsp;Marialuisa Zedde ,&nbsp;Sandro Sanguigni ,&nbsp;Nicola Carraro ,&nbsp;Claudio Baracchini ,&nbsp;Marcello Mancini ,&nbsp;Erwin Stolz","doi":"10.1016/j.permed.2012.03.013","DOIUrl":"10.1016/j.permed.2012.03.013","url":null,"abstract":"<div><p>Because of the recent hypothesis of involvement of the venous hemodynamics in multiple sclerosis (MS), and because of the pitfalls of these studies, there is the need to achieve a definite conclusion from a large sample of subjects by using a strict and controlled neurosonological protocol. The aim of the advanced protocol, designed for a subgroup of the FISM study, is to analyze several items of the venous hemodynamics in order to obtain more pathophysiological data on venous circulation. <em>Advanced Ultrasound Protocol</em>: This is a multicenter, observational study. From a pool of about 1200 adults with MS, 400 healthy subjects and 400 subjects with other neurodegenerative disorders (2000 subjects in total) will be selected a population able to be examined by the advanced protocol. The examiner will always be blind on the clinical diagnosis, and the exams will be performed according to a standard protocol, whose measurements are mandatory for all participating centers. The advanced protocol is on a voluntary basis and it is optional. It includes, besides the basic one, measurements of blood flow volumes in carotid and vertebral arteries and in jugular and vertebral veins (inflow and outflow), with the definition of the drainage pattern. The ultrasound examination at each clinical site will be followed by a second centralized blinded evaluation. The prevalence of CCSVI in MS will be estimated, with confidence intervals at 95%, and compared with the prevalence in other groups. Moreover, multiple analysis will be done comparing venous hemodynamics in the three different groups.</p></div>","PeriodicalId":101010,"journal":{"name":"Perspectives in Medicine","volume":"1 1","pages":"Pages 399-403"},"PeriodicalIF":0.0,"publicationDate":"2012-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.permed.2012.03.013","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76127633","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Withdraw of statin improves cerebrovascular reserve in radiation vasculopathy","authors":"John J. Volpi ,&nbsp;Rasadul Kabir ,&nbsp;Zsolt Garami ,&nbsp;Pamela New","doi":"10.1016/j.permed.2012.02.020","DOIUrl":"10.1016/j.permed.2012.02.020","url":null,"abstract":"<div><p>Cerebrovascular reserve is impaired in radiation vasculopathy from radiation injury to small arteries and arterioles. Few interventions or medications have been shown to be effective in this disease. We report a unique finding in which a statin contributed to worsening of the cerebrovascular reserve.</p></div>","PeriodicalId":101010,"journal":{"name":"Perspectives in Medicine","volume":"1 1","pages":"Pages 309-310"},"PeriodicalIF":0.0,"publicationDate":"2012-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.permed.2012.02.020","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75750213","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}