bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Case Study Demonstrating the Utility of Duplex Ultrasonography as the Sole Imaging Modality in the Surveillance and Repair of Lower Extremity Arterial Bypass Grafts
Authors: Brown Sandra L. , Clay Amber L. , Upchurch Gilbert 
Published: March 2018

Introduction Traditionally, duplex ultrasonography has played a secondary role in the pre-operative assessment of lower extremity arterial bypass graft revision, being used more as a follow-up tool, with more expensive and invasive modalities being used primarily. This case demonstrates the accuracy and reliability of using duplex ultrasonography alone in the management of lower extremity bypass graft revision, as well as postoperative follow-up. Case Report A 76-year-old man was seen in the diagnostic vascular unit for 2-week postoperative assessment after a left common femoral artery (CFA) aneurysm repair. Five months previously he had undergone right lower extremity femoral-to-posteriortibia in situ bypass graft for superficial femoral artery occlusion and a popliteal artery aneurysm. Ankle brachial indices were performed at his 2-week follow-up and showed a significant decrease in the right ankle brachial index (ABI) from 0.79 to 0.41. A right lower extremity duplex ultrasonography was performed and revealed significantly decreased flow velocities within the graft secondary to an arteriovenous fistula (AVF) found at the midthigh. The patient was scheduled for ligation of the AVF to restore adequate flow to the right lower extremity. The right thigh AV fistula was marked with duplex ultrasonography immediately before surgery. An incision was made directly over the marked AVF site, and the vein graft was isolated, revealing a large posterior medial AV fistula. Postoperative ABIs were significantly increased to 0.85 on the right side. Conclusions This case demonstrates the usefulness, accuracy, and reliability of duplex ultrasonography in the management of lower extremity arterial bypass grafts. All preoperative decisions were made on the basis of noninvasive vascular laboratory studies.
Color Duplex Ultrasound Characteristics: Can we Predict Aortic Aneurysm Expansion following Endovascular Repair?
Authors: Nelms Courtney , Carter Kathleen , DeMasi Richard , Meier George 
Published: March 2018

Introduction The goal of aortic endovascular repair (EVAR) is to successfully exclude the aneurysm. Color duplex ultrasonography (CDU) is effective in the identification of endoleak and assessment of abdominal aortic aneurysm (AAA) morphology after EVAR. In a subset of patients with subtle endoleak, there is a characteristic appearance that predicts significant endoleak leading to AAA expansion. These endoleaks are difficult to detect by computed tomography (CT), and CDU and may represent the phenomenon known as endotension when endoleak is not identified. Methods All patients with several EVAR devices were prospectively followed with CDU for evaluation of endoleak at intervals during a 4-year period. All CDU exams were performed using Philips 5000, 3000, and IU22 systems according to protocol. Assessment of the AAA sac with spectral and color Doppler was used to identify endoleak. The B-mode echogenicity of the AAA sac was characterized for echogenicity and sac symmetry. The patients were followed with CT scan and/or angiography for confirmation of endoleaks. Results There were 12 patients with subtle Type II endoleaks and a characteristic texture by CDU identified from 1 month to 16 months after intervention. The endoleaks had low velocities within the sac ranging from 10 to 50 cm/sec with a bidirectional spectral Doppler waveform. An asymmetrical AAA sac with a “spongy” multiechogenic texture was a finding in all 12 patients. The endoleaks were difficult to detect by both CDU and CT scan because of the low velocities despite AAA sac enlargement in all patients. The average AAA sac enlargement was 4.4 mm. CT scan and/or angiography failed to detect endoleak in 6 of 12 patients positive by CDU for endoleak with AAA sac expansion. Conclusion CDU after EVAR can effectively detect the presence of endoleak and assess the B-mode characteristics of the AAA sac. Important clues such as low flow, sac expansion, sac asymmetry, and a “spongy” B-mode appearance are consistent with subtle endoleak that may lead to AAA expansion. When undetected, this type of endoleak may be misdiagnosed as endotension.
Quantitative Assessment of Chronic Venous Insufficiency Using Duplex Ultrasound and Air Plethysmography
Authors: Asbeutah Akram M. , Riha Andrea Z. , Cameron James D. , McGrath Barry P. 
Published: March 2018

Purpose Using noninvasive methods, we studied patients 5 years after they received an index deep vein thrombosis (DVT) to quantify venous reflux in the lower limb and to relate it to venous disease severity. Methods Thirty-eight patients (76 limbs) with DVT were studied 5 years after being diagnosed by ultrasound and/or venography and treated with warfarin through a hospital-in-the-home program. There were 15 men and 23 women, their average age (±SD) was 56.7 years (±16 years), and their average body mass index (±SD) was 28.8 (±5.7 kg/m2). The limbs were classified according to the clinical, etiologic, anatomic, and pathophysiologic (CEAP) clinical classification. There were 10 limbs in CEAP class 0, 28 in classes 1–3, and 22 in classes 4–6. Duplex ultrasound and air plethysmography (APG) techniques were used to assess venous reflux. A total of 14 limbs of healthy volunteers underwent APG of the lower limb for comparison. Results At follow-up, 60 limbs exhibited reflux, 35 in the DVT affected limb and 25 in the non-DVT limb. DUS indexes did not differentiate between venous disease severity in terms of reflux duration or reflux flow volume. APG indexes were significantly different, with venous filling index (VFI) being most discriminating. In limbs with skin changes, median (range) VFI was 3.5 mL/sec (1.6–17), compared with 1.5 ml/sec (0.6–3.4) in limbs with class 0, 2.1 ml/sec (0.6–11) in limbs with classes 1–3, and 0.8 ml/sec (0.6–1.7) in normal controls. Conclusion Duplex ultrasound provides excellent anatomical imaging, but its indexes lack discrimination in relation to disease severity. However, APG indexes do differ in relation to clinical venous disease severity, and VFI appear to be a useful index for following the progression of chronic venous insufficiency disease.
Diagnosing Lower-Extremity Deep Vein Thrombosis: Can an Emergent Referral System be Improved?
Authors: Giuca Janice , Danes Stratton , Drezner A. David 
Published: March 2018

Introduction —Clinical diagnosis of deep vein thrombosis (DVT) can be difficult. This fact, along with our litigious environment and the expediency of obtaining venous duplex ultrasound (VDU) studies, has led to the overuse of this examination. To improve the appropriateness of VDU orders from the emergency department (ED), a quality improvement project was initiated with the ED and vascular lab. Methods —A prospective study was conducted involving ED patients referred for lower-extremity VDU to diagnose DVT. The registered vascular technologist (RVT) assessed the patients before the examination by using a pretest probability (PTP) scoring system for DVT. The results were shared with the ED physicians at regular intervals. For the last 6 months of the project, the RVT made a pretest clinical impression of test outcome. The VDU results, the distribution of pretest scores and the results of the RVT's pretest impression were analyzed. Results —A total of 291 ED patients with suspected lower-extremity DVT were assigned a PTP score. Of all positive studies, 72% (36/50) had a high PTP score. A moderate PTP score lacked accuracy for predicting DVT, with 24% (12/50) of the positive and 42% (102/241) of negative exams in this group. A total of 36% (104/291) of the patients had a low PTP score, and the incidence of DVT was 2% (2/104) in this group. Of the total 291 patients, 177 patients had a RVT pretest clinical impression performed. The RVT impression was accurate for the presence of DVT 83% (24/29) of the time. The RVT correctly predicted that there was no DVT in 92% (136/148) of the negative exams. Furthermore, in the moderate PTP group, where the PTP score was not as predictive of the presence or absence of DVT, the RVT impression was accurate 89.5% (60/67) of the time. Conclusions —Although a moderate PTP score is not a reliable predictor of a positive VDU, a high score validates the need for a VDU, whereas a low score does not warrant the exam. If ED practitioners consistently used a pretest clinical scoring system, the number of negative examinations could be significantly reduced. In addition, the overall accuracy of the RVT's clinical impression demonstrates that experience in DVT diagnosis can likely improve patient selection for VDU.
Transthoracic Echocardiogram and Transcranial Doppler Detection of Emboli after foam Sclerotherapy of Leg Veins
Authors: Hansen Kristin , Morrison Nick , Neuhardt Diana L. , Salles-Cunha Sergio X. 
Published: March 2018

Purpose Patients with chronic venous insufficiency have been successfully treated with foam sclerotherapy. Reports of cerebral and respiratory symptoms after the foam procedure have been related to an open foramen ovale (PFO) between the right and left sides of the heart. This work evaluated the value of ultrasonography to demonstrate that bubbles may traverse a PFO and may be detected at the middle cerebral artery. Methods Patients describing cerebral or respiratory symptoms or suspected of having a PFO entered this study. Cerebral symptoms included visual disturbance, lightheadedness, dizziness and migraine. Respiratory problems included cough. A total of 20 patients had transthoracic echocardiography (TTE), and 12 had transcranial Doppler (TCD) of the middle cerebral artery. Results TTE detected bubbles in the left heart in 13 (65%) of 20 patients. The 12 TCDs were performed in nine patients with positive and three with negative TTE evaluation; five TCDs were positive for emboli at the middle cerebral artery. All five patients had positive transthoracic echocardiography. Conclusions This single-institution evaluation for quality control demonstrated that 1) patients with cerebral or respiratory symptoms after foam sclerotherapy may have PFO; and 2) patients with patent PFO may embolize the gas particles to the brain. Therefore, patients with known PFO must be evaluated before foam injection, and patients that are candidates for this treatment may have to be screened for PFO.
Evolving Patterns of Vascular Lab Testing in the Hospital and Private Lab Settings
Authors: Samson Russell H. , Ricci Kerri E. , Manire Ruth , Ramamurthy Rithika 
Published: March 2018

Introduction We evaluated laboratory use in a 600–bed community hospital and a private practice lab. The study spanned from 1996 to 2007. Method The hospital laboratory used 5 duplex scanners and 2 physiologic plethysmography units and was staffed by 7 technologists. The private laboratory expanded over time, growing from 4 technologists with 4 duplex scanners and 1 physiologic machine to 7 technologists, 7 duplex scanners, and 3 physiologic units in 2007. Results A total of 43.5% of tests performed in the hospital were venous tests in 1999 and 55.5% in 2007. Cerebrovascular scans decreased (32.8% to 23.1%). Lower-extremity arterial tests also decreased. Other tests were uncommon (394 tests, or 5.1%). In the private lab cerebrovascular duplex scans decreased from 36.9% to 24.4%. Lower-extremity physiologic studies remained stable. Aortic scans became more common. Lower-extremity venous scans accounted for 14.2% of studies in 1996 and 11.8% in 2007 but with twice the number of tests. Conclusion The hospital laboratory is predominantly involved in the diagnosis of venous thrombosis and cerebrovascular events. The less-used and uncommon studies such as upper-extremity arterial studies and dialysis access studies remain uncommon but are performed in greater volume in the private lab than the hospital.
Renal Artery Duplex Examinations in Neonates
Authors: Blackburn Donna R. , Astleford Patricia , Zurbano Nida , Dwyer Ann , Andrushkiv Myroslava , Pearce William H. 
Published: March 2018

Introduction Hypertension in neonates, although uncommon, may be the result of congenital renal artery stenosis, or, more frequently, coarctation of the aorta. Renal artery duplex examinations have been used in our institution to evaluate neonates. The purpose of this study was to evaluate the efficacy of duplex ultrasound in the evaluation of renal arteries and kidneys in neonates. Methods Eleven infants from January 2006 through January 2009 were studied with the use of color duplex ultrasound. Seven examinations were performed for hypertension, one for renal failure, one with increased creatinine, one for suspicion of renal vein thrombosis, and one for hematuria. Protocols were modified during this 3-year period and now consist of examining the kidneys, renal artery, and vein and aorta from both flanks with the use of a 9–3 MHz transducer. Results By the use of standard renal artery protocols, 8 neonates were found to be healthy, with the exception that all subjects had greater-than-expected aortic velocities. Two subjects (identical twins) had abnormal signals in the aorta and renal arteries consistent with proximal aortic obstruction. One infant in renal failure had high resistance signals in both kidneys consistent with renal parenchymal disease. Kidney size varied with infant weight and ranged from 2 to 4 cm. Symmetrical measurements were interpreted as normal. Conclusion This study demonstrates that duplex examinations in neonates is feasible and that minor adjustments in standard protocol and interpretation criteria allow for adequate assessment to evaluate for vascular causes of hypertension.
ECG Gating is Not Required for Brachial Artery Flow-Mediated Dilation Measurement
Authors: Jaffer Usman , Aslam Mohammed 
Published: March 2018

Objectives Brachial artery flow-mediated dilation is a well-established technique in the noninvasive assessment of endothelial function. Endothelial dysfunction is thought to be a potential precursor of atherosclerosis. In this study we compared the electrocardiogram (ECG) R-wave-gated acquisition of brachial artery measurement versus averaged measurement throughout the cardiac cycle. Study Design Cohort study: participant data was analyzed by use o the ECG-gated and nongated techniques and then analyzed. Materials and Methods Patients with peripheral vascular disease were studied. Upper limb ischemia was caused by inflating a blood pressure cuff at the right upper arm for 3 minutes. Brachial artery diameter measurements were taken in longitudinal section using a Sonosite Titan ultrasound machine with a 38 mm 5–10 MHz broadband linear array transducer. Results Twenty-three participants were tested (10 lower limb claudicants and 13 healthy volunteers). There was good correlation between ECG R-wave gated and nongated measurement R2 = 0.58 and Pearson's correlation coefficient was 0.762 ( p < 0.0001). Bland and Altman's method demonstrated good agreement and no heteroscedastic error. Conclusions We suggest that the use of automated image acquisition and analysis throughout the cardiac cycle to be preferable to ECG-gated acquisition. This may be important in the design of clinical trials involving noninvasive assessment of endothelial function.
Ultrasound Mapping of Arterial and Venous Patterns of the Upper Extremities in Patients with End-Stage Renal Disease
Authors: Salles-Cunha Sergio X. , Neuhardt Diana L. , Pohle-Schulze Barbara , Neuhardt Marresa , Straight Nicole 
Published: March 2018

Objectives We sought to (1) to determine prevalence of high brachial artery bifurcation, forearm cephalic-arm cephalic connection, forearm cephalic-arm basilic vein alternate connection, and levels of basilic-brachial vein junction; and (2) to compare average diameters of forearm and arm cephalic and basilic venous segments according to the results of ultrasound mapping of the upper extremities (UE). Methods Consecutive ultrasound mappings were performed in 100 UE of 23 women, 69 ± 12 (47–84), and 27 men, 62 ± 12 (34–79) years of age. Brachial, radial and ulnar arteries and cephalic and basilic veins were scanned from wrist to axilla. Results Brachial artery bifurcation at the proximal/mid arm was noted in 25 UE of 18 subjects. Arm (a) or forearm (f) cephalic (ce) or basilica (ba) veins were absent in 18 (ace), 15 (fce), 10 (aba), and 14 (fba) UE, respectively. A forearm cephalic-arm cephalic vein connection was noted in 67 UE; of these, 9 (13.6%) also had a significant forearm cephalic-arm basilic connection. A primary forearm cephalic-arm basilic connection was noted in 5 UE, one with a secondary connection to the arm cephalic vein. The basilic joined the brachial vein at the proximal, proximal-mid, mid, mid-distal and distal arm in 29, 17, 26, 4, and 2 UE; a complex connection to radial/ulnar veins was noted in 14 UE. Average diameters were 4.2 ± 1.4 (1.2–7.8), 3.1 ± 1.1 (0.6–6.3), 2.9 ± 0.9 (1.4–4.9), and 2.2 ± 0.9 (0.7–4.5) mm for the arm basilic, arm cephalic, forearm cephalic and forearm basilic veins. Conclusions A significant prevalence of anatomical anomalies was noted, justifying mapping of the upper extremity vasculature prior to planning an arteriovenous fistula or prosthetic graft in patients with end-stage renal disease.
Standing versus Supine Evaluation for Superficial Venous Reflux
Authors: Carty George A. , Steele Janelle L. , Clemens John 
Published: March 2018

Objective —The established belief in the absolute need to perform duplex ultrasound evaluations for venous insufficiency in the standing position continues to be, in our view, an unsettled issue. To our knowledge the circumstances when a supine examination is both accurate and advantageous have not been prospectively evaluated or definitively resolved. The primary purpose of this study was to address this problem. Methods —To address this issue, 645 lower-limb venous segments were examined in 72 consecutive patients, first supine and subsequently in the standing position. Valsalva maneuver and manual compressions were used as provocative maneuvers. Measurements of reflux duration were recorded. Reflux was considered positive if the measurement was ≥0.5 sec. The length of the examination as well as the degree of patient and examiner ease and comfort also were noted. Results —We observed that when reflux at the saphenofemoral junction in the initial supine examination was ≥1.13 sec in duration, reflux ≥0.5 sec was always present during the standing examination ( p < 0.001). We also noted that reflux duration at all levels was consistently greater in the supine position with a tendency for such differences to increase distally. Conclusion —Testing in the standing position only needs to be performed if the initial supine evaluation demonstrates reflux <1.13 sec in duration.
Estrogen and Progesterone Receptors in Colorectal Cancer and Surrounding Mucosa
Authors: Raigoso P. , Sanz L. , Vizoso F. , Llana B. , Quintela I. , Roibás A. , Vérez P. , García-Muñiz J.L. 
Published: March 2018

In this prospective study we have quantified by means of ELISA-methods the cytosolic content of estrogen (ER) and progesterone receptors (PgR) in tumoral tissue and paired normal mucosa from 163 patients with resectable colorectal cancer. Survival analysis was performed in a subgroup of 120 patients and the mean follow-up period was 24.9 months. The cutoff for ER and PgR levels was set at 1 fmol/mg protein. On the basis of this cutoff 20.9% of the cancers were ER positive and 25.8% were PgR positive; normal adjacent tissue presented ER in 18.4% and PgR in 24.5%. Our results did not show any significant correlation between ER and PgR levels in neoplastic tissues. Howewer, a correlation was found in normal mucosa samples (p=0.02). Statistical analysis showed that there was no correlation between tumor ER and PgR content and patient age or sex, tumor location, Dukes’ stage, histological differentiation, DNA ploidy status and S-phase fraction. Furthermore, the results did not show any statistical differences in relapse-free and overall survival curves calculated for patients classified according to the hormone receptor content of their tumors. ER and PgR were detected at low levels in normal and neoplastic colorectal tissues without any significant relationship to either clinicopathological tumor characteristics or patient outcome. Their possible role in colorectal cancer remains to be elucidated.
Serum Neutrophil Gelatinase-Associated Lipocalin in Patients with Colorectal Liver Metastases: Preliminary Results of An Exploratory Prospective Study
Authors: Martí Josep , Fuster Josep , Hotter Gina , Solà Anna M. , Deulofeu Ramón , Modolo Maria Marta , Loera Marco Antonio , Ferrer Joana , Fondevila Constantino , García-Valdecasas Juan Carlos 
Published: March 2018

Purpose To quantify preoperative serum neutrophil gelatinase-associated lipocalin (NGAL) levels in patients undergoing curative resection of colorectal liver metastases and to assess the relationship between NGAL levels and prognostic features in these patients. Methods From April 2005 to August 2007, 32 patients operated on for first curative resection of colorectal liver metastases underwent determination of preoperative serum NGAL. Patients were divided into four homogeneous clinical groups and into two risk groups based on their clinical risk scores. NGAL levels were corrected by simultaneous creatinine levels to avoid bias due to renal failure. Results Higher values of corrected NGAL levels (CNL) were found in patients of the high-risk group (94.53±56.18 vs 57.87±24.49, p=0.014). Patients with more than three tumor nodules had higher values of CNL compared to patients with three or fewer nodules (101.78±56.35 vs 58.57±27.24, p=0.008). Patients with disease involving both hepatic lobes had higher CNL levels than those with involvement of a single lobe (106.5±59.13 vs 59.01±26.69, p=0.005). Patients with higher clinical risk scores had significantly higher CNL. Conclusions CNL are associated with the considered prognostic clinical factors and scores, suggesting a possible role for CNL as a prognosis-related indicator and a neoplastic tissue volume marker in patients with colorectal liver metastases.
CA-549 Serum Levels in Breast Cancer Monitoring
Authors: Zamagni C. , Martoni A. , Cacciari N. , Bellanova B. , Vecchi F. , Pannuti F. 
Published: March 2018

CA-549 serum levels were assessed in 288 patients, 156 with early breast cancer (after surgery) and 132 with advanced breast cancer. CA-549 was abnormal (> 12 U/ml) in 25/156 patients (16%) without clinical signs of disease after surgery (median 9 U/ml), in 49/60 patients (82%) with disease in progression (P) (median 50 U/ml), in 19/27 patients (70%) with stationary disease (NC) (median 14 U/ml), in 25/33 patients (76%) with partial remission (PR) (median 18 U/ml) and in 4/12 patients (33%) with complete remission (CR) (median 9 U/ml). CA-549 serum levels correlated mainly with the extent of disease and secondarily with the prevalent metastatic site, higher values being observed in patients with visceral involvement (median 32.5 U/ml). CA-549 serum levels were also assessed in 51 patients at the start of treatment and at the time of objective evaluation: the results underline the concordance of CA-549 behavior with the clinical outcome in 71% of the cases. We conclude that CA-549 is a useful marker for monitoring breast cancer patients during the advanced stages of the disease.