Perspectives in Medicine最新文献

{"title":"Relationship between refill-kinetics of ultrasound perfusion imaging and vascular obstruction in acute middle cerebral artery stroke","authors":"Manuel Bolognese,&nbsp;Dimitrios Artemis,&nbsp;Angelika Alonso,&nbsp;Michael G. Hennerici,&nbsp;Stephan Meairs,&nbsp;R. Rolf Kern","doi":"10.1016/j.permed.2012.01.004","DOIUrl":"10.1016/j.permed.2012.01.004","url":null,"abstract":"<div><h3>Background</h3><p>Ultrasound perfusion imaging (UPI) with bolus kinetic has been shown to be feasible at bedside for evaluation of perfusion deficits in stroke patients. Recent technical advances allow perfusion imaging with refill kinetics using a low mechanical index.</p></div><div><h3>Methods</h3><p>We examined 31 acute middle cerebral artery (MCA) stroke patients with transcranial color-coded duplex ultrasound (TCCD) and UPI. The refill of microbubbles was calculated from regions of interest in the ischemic area and the contralateral MCA territory by using the exponential function <em>y</em> <!-->=<!--> <em>A</em>(1<!--> <!-->−<!--> <em>e</em>^<em>βt</em>); <em>A</em> <!-->=<!--> <!-->acoustic intensity of the plateau (dB), <em>β</em> <!-->=<!--> <!-->slope (1/s).</p></div><div><h3>Results</h3><p>We found significantly lower values of <em>β</em> in the ischemic area compared with the contralateral MCA territory (0.75 vs. 1.05<!--> <!-->1/s, <em>p</em> <!-->&lt;<!--> <!-->0.05); particularly in patients with a pathological MCA flow pattern on TCCD (0.61 vs. 1.01, <em>p</em> <!-->&lt;<!--> <!-->0.01). There was a high interindividual variance without significant difference of the plateau of acoustic intensity (<em>A</em>) in any subgroup of patients.</p></div><div><h3>Discussion</h3><p>The slope parameter <em>β</em> of refill kinetics is useful for assessing brain perfusion in patients with acute stroke and pathological flow pattern of the ipsilateral MCA. The parameter <em>A</em>, however, seems more dependent from the quality of the temporal bone window.</p></div>","PeriodicalId":101010,"journal":{"name":"Perspectives in Medicine","volume":"1 1","pages":"Pages 39-43"},"PeriodicalIF":0.0,"publicationDate":"2012-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.permed.2012.01.004","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88977689","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 peripheral nerves – Clinical significance","authors":"Ulf Schminke","doi":"10.1016/j.permed.2012.03.012","DOIUrl":"10.1016/j.permed.2012.03.012","url":null,"abstract":"<div><p>Over the past two decades, high-resolution ultrasonography of peripheral nerves has been evolved as an adjunctive examination technique in clinical neurophysiology laboratories providing complementary information to electrodiagnostic studies. In addition to the information on nerve function, which are typically obtained by nerve conduction studies and electromyography, ultrasonography permits direct assessment of pathologic changes in nerve structure and/or in the adjacent tissue, as well. This article reviews the clinical significance of ultrasonography for the diagnostic evaluation of focal neuropathies, particularly entrapment neuropathies, traumatic nerve lesions, nerve sheath tumors, and several types of polyneuropathies. Ultrasonography offers neuromuscular clinicians a unique opportunity to conduct both complementary examination modalities by themselves without referring patients to another laboratory.</p></div>","PeriodicalId":101010,"journal":{"name":"Perspectives in Medicine","volume":"1 1","pages":"Pages 422-426"},"PeriodicalIF":0.0,"publicationDate":"2012-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.permed.2012.03.012","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78975298","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":"Moyamoya like arteriopathy: Neurosonological suspicion and prognosis in adult asymptomatic patients","authors":"Giovanni Malferrari ,&nbsp;Marialuisa Zedde ,&nbsp;Gianni De Berti ,&nbsp;Massimo Maggi ,&nbsp;Norina Marcello","doi":"10.1016/j.permed.2012.02.017","DOIUrl":"10.1016/j.permed.2012.02.017","url":null,"abstract":"<div><h3>Introduction</h3><p>The epidemiology and the prognosis of asymptomatic moyamoya arteriopathy is virtually unknown, mainly in white western population, while symptomatic moyamoya arteriopathy is a more known disease, both in children and in adult people. We are presenting a single centre case series of six asymptomatic adult people with a neurosonological (Transcranial Colour Coded Sonography – TCCS) suspicion of this type of cerebral arteriopathy, confirmed by Digital Subtraction Angiography (DSA).</p></div><div><h3>Patients and methods</h3><p>During a time period of three years we collected a series of six patients (5 female and 1 male, mean age 29.16<!--> <!-->+<!--> <!-->8.45 years) with a neurosonological suspicion and a neuroradiological diagnostic confirmation of moyamoya type arteriopathy. All patients underwent TCCS, brain magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) and DSA, besides the differential diagnosis of immunological or infectious etiology. The mean follow-up was 1.8 years.</p></div><div><h3>Results and discussion</h3><p>All patients but one had a bilateral internal carotid artery (ICA) stenosis at terminus and M1 middle cerebral artery (MCA) multiple stenoses. There is only one young patient with an atypical unilateral pathway and narrowing of extracranial ICA with prominent posterior cerebral artery (PCA) compensation. No clinical events occurred during the follow-up and also brain MRI failed to find new ischemic lesions, compared with the baseline examination.</p></div><div><h3>Conclusions</h3><p>Asymptomatic cerebral moyamoya arteriopathy is an infrequent but underestimated condition in young white people. More prognostic informations are needed in order to define the natural course and propose the treatment.</p></div>","PeriodicalId":101010,"journal":{"name":"Perspectives in Medicine","volume":"1 1","pages":"Pages 257-260"},"PeriodicalIF":0.0,"publicationDate":"2012-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.permed.2012.02.017","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80065332","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":"B-mode sonography of the optic nerve in neurological disorders with altered intracranial pressure","authors":"Jochen Bäuerle,&nbsp;Max Nedelmann","doi":"10.1016/j.permed.2012.01.001","DOIUrl":"10.1016/j.permed.2012.01.001","url":null,"abstract":"<div><p>B-mode sonography of the optic nerve is a promising new technique in the field of neurology. It may serve as an additional diagnostic tool in different diseases with altered intracranial pressure. The aim of this article is to give an overview on this technique and on its possible clinical applications.</p></div>","PeriodicalId":101010,"journal":{"name":"Perspectives in Medicine","volume":"1 1","pages":"Pages 404-407"},"PeriodicalIF":0.0,"publicationDate":"2012-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.permed.2012.01.001","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79066280","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":"Volume flow rate","authors":"Disya Ratanakorn,&nbsp;Jesada Keandaoungchan","doi":"10.1016/j.permed.2012.03.008","DOIUrl":"10.1016/j.permed.2012.03.008","url":null,"abstract":"<div><p>Vascular imaging of carotid and vertebral arteries may not be sufficient to evaluate the patients with stroke and other cerebrovascular disorders. Cerebral blood flow measurement can add information to increase the accuracy in diagnosis, assessment, and plan of management in these patients. There are many noninvasive quantitative methods to measure cerebral blood flow including volume flow rate measured by ultrasound. This article addresses mainly the different ultrasound techniques to measure cerebral blood flow. Clinical applications, volume flow rate in normal and abnormal conditions with a case example, and advantage and disadvantage of the ultrasound techniques are also described.</p></div>","PeriodicalId":101010,"journal":{"name":"Perspectives in Medicine","volume":"1 1","pages":"Pages 203-206"},"PeriodicalIF":0.0,"publicationDate":"2012-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.permed.2012.03.008","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76944827","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":"Transcranial Doppler in acute stroke management – A “real-time” bed-side guide to reperfusion and collateral flow","authors":"Christopher Levi ,&nbsp;Hossein Zareie ,&nbsp;Mark Parsons","doi":"10.1016/j.permed.2012.02.044","DOIUrl":"10.1016/j.permed.2012.02.044","url":null,"abstract":"<div><h3>Introduction</h3><p>Assessment of cerebral hemodynamics with transcranial Doppler (TCD) can provide real-time, bed-side assessment of important prognostic variables in acute stroke such as the status of collateral flow and vessel recanalization status. In acute middle cerebral artery (MCA) occlusion, anterior cerebral artery (ACA) flow diversion (FD) is correlated with leptomeningeal collateral flow and may be a clinically useful prognostic indicator. Continuous TCD monitoring of MCA recanalization may also provide useful prognostic information including changes in flow pattern and the occurrence of microembolic signals (MES). We present studies examining associations between ACA FD, MCA recanalization and MES patterns on the characteristics of ischemia and infarction in acute MCA stroke.</p></div><div><h3>Methods</h3><p>Patients studied were consecutive sub-6<!--> <!-->h from onset internal carotid artery (ICA) territory ischemic stroke cases. A subset of these cases with MCA occlusion were studied with 2<!--> <!-->h of continuous MCA monitoring. All patients underwent baseline multimodal computed tomographic (CT) scanning, baseline diagnostic TCD, and 24<!--> <!-->h post stroke magnetic resonance (MR) imaging. All MCA occlusion patients studied with continuous monitoring were treated with intravenous thrombolysis. ACA flow diversion was defined as ipsilateral mean velocity of 30% or greater than the contralateral artery. Recanalization status was assessed using the Thrombolysis In Brain ischemic (TIBI) grading system and MES counted “off-line” by experienced observers. Leptomeningeal collateralisation (LMC) was graded on CT angiography. Infarct core and penumbral volumes were defined using CT perfusion thresholds. Infarct volume, reperfusion, and vessel status were measured at 24<!--> <!-->h using MR techniques. In patients undergoing recanalization monitoring, comparison was made between those with and without major reperfusion. Multivariable regression analysis was performed to assess for any associations between ACA flow diversion, TIBI grades and MES on infarction controlling for other important clinical variables.</p></div><div><h3>Results</h3><p><em>Flow diversion</em>: 53 patients qualified for FD analysis. ACA FD was associated with good collateral flow on CT angiography (<em>p</em> <!-->&lt;<!--> <!-->0.001) and was an independent predictor of admission infarct core volume (<em>p</em> <!-->&lt;<!--> <!-->0.001), and 24<!--> <!-->h infarct volume (<em>p</em> <!-->&lt;<!--> <!-->0.001). The likelihood of a favourable outcome (modified Rankin score 0–2) was higher (Odds ratio<!--> <!-->=<!--> <!-->27.5, <em>p</em> <!-->&lt;<!--> <!-->0.001) in those with flow diversion.</p><p><em>Recanalization monitoring</em>: 27 patients with MCA occlusion treated with intravenous thrombolysis were included in the analysis of recanalization patterns (16 cases with major reperfusion, 11 cases of non-reperfusion). Major TIBI grade improvement (<e","PeriodicalId":101010,"journal":{"name":"Perspectives in Medicine","volume":"1 1","pages":"Pages 185-193"},"PeriodicalIF":0.0,"publicationDate":"2012-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.permed.2012.02.044","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77346940","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":"Diagnosis of non-atherosclerotic carotid disease","authors":"Arijana Lovrencic-Huzjan","doi":"10.1016/j.permed.2012.03.004","DOIUrl":"10.1016/j.permed.2012.03.004","url":null,"abstract":"<div><p>Non-atherosclerotic carotid disease in an uncommon group of angiographic defects. It includes the entities: Takayasu's arteritis, giant cell arteritis, fibromuscular disease, moyamoya syndrome, arterial dissection and extracranial carotid aneurysms. Due to advance in imaging techniques, they are being increasingly identified. Growing awareness of diverse clinical picture along with advances in imaging technologies enables early diagnosis. Although catheter angiography is a gold standard in diagnosing most of these diseases, neurosonological tests serve as an excellent screening tool, and are suitable for monitoring. Brain MR and MRA are sometimes essential for confirmation of the diagnosis. Mortality rates are low and functional outcome is generally good if the disease is diagnosed early.</p></div>","PeriodicalId":101010,"journal":{"name":"Perspectives in Medicine","volume":"1 1","pages":"Pages 244-249"},"PeriodicalIF":0.0,"publicationDate":"2012-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.permed.2012.03.004","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76151342","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":"Effect of helium on cerebral blood flow: A n = 1 trial in a healthy young person","authors":"Sanne M. Zinkstok ,&nbsp;Daniela Bertens ,&nbsp;Jelle R. de Kruijk ,&nbsp;Selma C. Tromp","doi":"10.1016/j.permed.2012.02.009","DOIUrl":"10.1016/j.permed.2012.02.009","url":null,"abstract":"<div><p>Several experimental studies have shown that noble gases can have neuroprotective effects in cerebral ischemia. The exact mechanism is unknown; increased cerebral blood flow may play a role. In order to investigate this concept we performed a <em>n</em> <!-->=<!--> <!-->1 trial measuring cerebral blood flow velocity by means of transcranial Doppler (TCD) in a healthy young woman inhaling air or heliox. Peak systolic velocity, mean flow velocity and pulsatility index were measured in the right middle cerebral artery, and oxygen saturation and heart rate were measured with pulse oximetry. After a baseline of 3<!--> <!-->min breathing normal air, heliox (79% helium, 21% oxygen) was inhaled though an oral nasal mask for 5<!--> <!-->min, followed by a washout period of 5<!--> <!-->min breathing normal air. This protocol was repeated four times. No significant changes were observed in hemodynamic parameters, except for a small increase in pulsatility index during heliox inhalation (from 0.91 to 0.95; <em>p</em> <!-->=<!--> <!-->0.01).</p><p>In conclusion, inhalation of heliox does not influence cerebral blood flow in a healthy young person. Any beneficial effects of helium in stroke patients are more likely due to other neuroprotective effects than to hemodynamic changes.</p></div>","PeriodicalId":101010,"journal":{"name":"Perspectives in Medicine","volume":"1 1","pages":"Pages 301-303"},"PeriodicalIF":0.0,"publicationDate":"2012-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.permed.2012.02.009","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80430573","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":"Four-dimensional ultrasound calf muscle imaging in patients with genetic types of distal myopathy","authors":"Ekaterina Titianova ,&nbsp;Teodora Chamova ,&nbsp;Velina Guergueltcheva ,&nbsp;Ivailo Tournev","doi":"10.1016/j.permed.2012.02.018","DOIUrl":"10.1016/j.permed.2012.02.018","url":null,"abstract":"<div><h3>Purpose</h3><p>To demonstrate the capabilities of 4D ultrasound calf muscle imaging in patients with genetic types of distal myopathies (DMs).</p></div><div><h3>Methods</h3><p>Three patients with DM were studied: a 58-year-old man with Vocal Cord and Pharyngeal Weakness Distal Myopathy (VCPDM), a 36-year-old woman with Tibial Muscular Dystrophy (TMD) and a 27-year-old woman with Hereditary Inclusion Body Myopathy Type 2 (HIBM2). Their calf muscles were evaluated in rest and during maximal plantar flexion using 3D/4D ultrasound imaging. The results were compared to myosonograms of healthy controls.</p></div><div><h3>Results</h3><p>All patients had myopathic syndrome due to advanced muscular dystrophy. In comparison to controls abnormal calf muscle architectonics, reduced muscle contractility and a combination of spot-like hypo- and hyperechoic areas were established on 4D ultrasound imaging. The changes were associated with the degree of muscle atrophy, fat and fibrous tissue infiltration.</p></div><div><h3>Conclusions</h3><p>Four-dimensional myosonology gives additional information for muscle architectonics in patients with genetic types of DM. Further studies are needed to evaluate if the described findings are typical for specific genetic types of myopathy.</p></div>","PeriodicalId":101010,"journal":{"name":"Perspectives in Medicine","volume":"1 1","pages":"Pages 431-434"},"PeriodicalIF":0.0,"publicationDate":"2012-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.permed.2012.02.018","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81870479","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":"Measuring the degree of internal carotid artery stenosis","authors":"Gerhard-Michael von Reutern","doi":"10.1016/j.permed.2012.02.040","DOIUrl":"10.1016/j.permed.2012.02.040","url":null,"abstract":"<div><p>The use of ultrasonic methods to evaluate carotid disease differs from country to country. Most popular is the criterion of flow velocity in the stenosis, a criterion influenced by multiple other factors than narrowing of the artery. On the other side angiography does not reliably measure area reduction, responsible for the hemodynamic effect of a stenosis. Therefore correlations of velocity and the degree of stenosis as measured by angiography were never satisfying. In a recent international consensus a multiparametric approach has been proposed aiming to reduce possible errors. This article illustrates some of the possible errors measuring flow velocity with Doppler ultrasound and discusses the background for using multiple criteria. Ultrasound can be used for clinical decision making. This is possible in a clear cut high degree stenosis and in low degree disease. The advantage of Doppler ultrasound is to describe best the hemodynamic consequences of vessel narrowing. This may yield important additional information in combination with other imaging modalities.</p></div>","PeriodicalId":101010,"journal":{"name":"Perspectives in Medicine","volume":"1 1","pages":"Pages 104-107"},"PeriodicalIF":0.0,"publicationDate":"2012-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.permed.2012.02.040","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90220854","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}