bluuebunny/crossref_metadata_2025_split huggingface dataset:
Comparison of Automated Oscillometric Measurement of Ankle Brachial Index with Standard Doppler Measurement as a Screening Tool for Peripheral Artery Disease
Authors: Jayaraj Arjun , Blomberg Jane , Kohler Ted 
Published: March 2018

Objective —The use of continuous-wave Doppler ultrasound to determine ankle brachial index (ABI) is the gold standard for diagnosing asymptomatic peripheral artery disease. This method is labor intensive, requires training, and has considerable interobserver variability. Automated oscillometric measurement (AOM) of blood pressure is fast, simple, and generally available in clinics, but there are few studies of its usefulness for determination of the ABI. We compared these two methods to determine the usefulness of AOM as a screening tool. We also assessed the agreement between two different AOM devices. Methods —Seventy-four patients, including 33 diabetics, who presented to our vascular clinic to have their ABI measured were enrolled. A vascular nurse certified in ABI measurements (J.B.) performed blood pressure measurements in all four extremities by using the traditional Doppler method and two different automated oscillometric devices. The order of the three measurements was randomized. To avoid the effect of interrelated measures within each subject, we analyzed left and right legs separately (74 for each group). Measurements were grouped as abnormal (ABI = 0.90), normal (ABI 0.91–1.30), or elevated (ABI > 1.30). Agreement between Doppler measurements and oscillometric measurements was investigated by use of Pearson's χ2 analysis. In addition, correlation coefficients, including Spearman and Gamma statistic, were computed, as was the Kappa statistic, a measure of interrater agreement. Results —The correlation coefficients for comparison of Doppler with the two AOM devices were 0.70 and 0.73 ( p < 0.01). For the diabetics, correlation coefficients were 0.64 and 0.70 ( p < 0.01). The intermachine correlation ranged from 0.65 to 0.69 ( p < 0.01). As a screening tool oscillometric measurement had a sensitivity of 44%, specificity of 96%, positive predictive value of 87%, negative predictive value of 68%, and am accuracy of 73%. Kappa statistic was 0.41. Conclusions —Oscillometric measurement of ABI had good correlation with Doppler ultrasound measurements, and there was little difference between the two different machines tested. AOM has value as a rapid, initial screening examination in primary care clinics. When positive, the examination is a reliable indicator of atherosclerosis to identify patients who need intense risk factor modification. When negative, it is only moderately predictive of the absence of disease. Patients suspected of high risk for atherosclerosis who have negative examinations require further testing.
Outpatient Surveillance Protocol of Isolated Calf Deep-Vein Thrombosis
Authors: Cox Samantha , Moawad John A. , Marshall Lee A. , Petrinec Drazen , McShannic Joseph , Fink John A. 
Published: March 2018

Objectives This study aims to compare the management of isolated soleal, gastrocnemius, peroneal, and posterior tibial vein thrombosis among outpatients with serial duplex ultrasound (DUS) over 30 days, versus anticoagulation. Methods After obtaining IRB approval, a retrospective chart review was conducted from January 2009 to December 2010. A total of 15, 877 lower extremity DUS were performed. Inpatients, trauma patients, and patients with thrombi in or proximal to the popliteal vein were excluded to focus exclusively on an unprovoked outpatient population. Univariate and multivariate analyses were conducted as well as descriptive statistics of the data. Results The cohort consists of one hundred sixty-eight (n = 168) outpatients with isolated calf deep vein thrombosis (ICDVT). Thrombus was most frequently identified in the soleal vein (45%) followed by the peroneal (39%), gastrocnemius (29%), and the posterior tibial vein (23%). Following diagnosis of ICDVT, thirty-eight patients (n = 38) received anticoagulation. The remaining cohort (n = 130) underwent surveillance with serial DUS at 3, 10, and 30 days. Eleven percent (11%) propagated to the popliteal vein or proximally during surveillance, versus 8% following anticoagulation. Among those that propagated proximally, 85% propagated within two weeks of initial diagnosis. Proximal propagation ( p = 0.8328), pulmonary embolism ( p = 0.0537), and development of new thrombus in additional calf veins ( p = 0.1471) did not differ among those treated with anticoagulation or serial DUS. Conclusions Serial DUS without anticoagulation is safe management of ICDVT in unprovoked ambulatory outpatients.
Comparison of Subjective versus Objective Lower-Extremity Arterial Plethysmographic Waveform Analysis for the Identification of Hemodynamically Significant Inflow Disease
Authors: Scissons Robert P. , Toha Robert , Comerota Anthony 
Published: March 2018

Objective Segmental pressures and subjective air plethysmography waveform (APW) analysis commonly are used in the noninvasive diagnosis of lower-extremity peripheral arterial disease (PAD) and have been used historically to define the extent of PAD. A recent investigation identified objective thigh arterial pulse waveform characteristics for defining hemodynamically significant (>50% diameter) PAD above the level of the common femoral artery (INFLOW). The purpose of this study is to compare subjective and objective APW analysis methodologies for defining INFLOW. Methods Patients who underwent segmental APW analysis and arteriography within 30 days of their noninvasive procedure were studied. Objective APW characteristics obtained from the thigh cuff included acceleration time, maximum amplitude, waveform down-slope curvature, relative amplitude reduction, and gain compensation index. Arteriograms were the basis for comparisons of objective APW criteria versus subjective APW pattern recognition interpretations of INFLOW disease. Results A total of 107 extremities were analyzed. There were statistically significant differences in sensitivity, specificity, positive predictive and negative predictive values, and accuracy for identifying hemodynamically significant INFLOW disease using objective (85%, 93%, 85%, 93%, 91%) versus subjective (53%, 85%, 62%, 80%, 75%) APW analysis, p = 0.0110. Conclusions Objective APW analysis of thigh level waveform characteristics may improve the identification of INFLOW disease in patients undergoing physiologic testing for lower extremity PAD.
Early-Life Markers of Atherosclerosis Using Aortic and Carotid Intima-Media Thickness: An Assessment of Methods to Account for Child Size
Authors: McCloskey Kate , Vuillermin Peter , Carlin John B. , Skilton Michael R. , Raitakari Olli , Jachno Kim , Cheung Michael , Burgner David P. , Ponsonby Anne-Louise 
Published: March 2018

Background Distinguishing pathological from physiological relationships between vessel size and aortic intima-media thickness (aIMT) is an important challenge, especially in growing children. We examined the relationship between childhood vessel diameter and aIMT and assessed common analytic approaches used to address this relationship. Methods We analyzed aIMT in two population-derived cohorts; 6-week-old infants and 19-year-olds. We simulated datasets in which we assumed a simple physiological relationship between vessel diameter and aIMT, and then superimposed possible pathological effects on aIMT; (a) intrauterine growth retardation, (b) macrosomia and (c) both intrauterine growth retardation and macrosomia. Using simulated datasets and cohorts, we evaluated analytic strategies including those in which the relationship between vessel diameter and aIMT was (a) ignored, (b) adjusted for by dividing aIMT by weight, or (c) adjusted for using varying regression techniques. Results aIMT was found to increase in proportion to vessel diameter in both cohorts (138 μm/mm at 6 weeks and 52 μm/mm at 19 years of age). Simply dividing aIMT by weight produced negative associations with weight across all datasets. By contrast, adjusting for vessel diameter as a covariate enabled accurate distinction of the direction of the association between aIMT and weight in all simulated datasets. These results were replicated in the cohort studies for both aIMT and carotid intima-media thickness. Conclusion There is a physiological relationship between vessel diameter and aIMT. Simply dividing aIMT by weight may lead to incorrect assumptions regarding the relationship between weight and aIMT. However, the physiological relationship is appropriately estimated by including vessel diameter as a covariate in regression.
Anterior Tibial Artery Pseudoaneurysm: A Case Report and Literature Review
Authors: Charles-Harris Håkan 
Published: March 2018

Background Anterior tibial artery pseudoaneurysm is a very uncommon complication after orthopedic surgery and trauma. A combined treatment modality using thrombin injection, coil embolization, and surgical approach is described and currently being evaluated compared with other treatment modalities. Patient Description This study reports the case of a 33-year-old man who presented in the office with a pulsatile mass just below the right knee. The patient with a history of trauma to his right leg during a motor vehicle accident underwent open reduction internal fixation of a proximal tibia-fibula fracture. Eight weeks later the patient had a pulsatile mass in the surgical area. A venous Doppler ultrasound was initially performed in the emergency room which revealed an incidental finding of a 5.60 cm × 3.54 cm pseudoaneurysm. Methods As modalities of treatment the patient had coil embolization as well as two separate sessions of thrombin injection with poor response. Finally, he underwent repair of the right anterior tibial artery pseudoaneurysm with a vein patch, which was successful. This case highlights different modalities that have been used to treat anterior tibial artery pseudoaneurysms. Conclusion Based on previous reported cases and our own case, we concluded that surgical approach is the most successful modality of treatment for proximal anterior tibial artery pseudoaneurysms.
Plaque Echolucency May Play a Critical Role in Predicting Cerebral Embolization in Patients Undergoing Carotid Angioplasty and Stenting
Authors: Chung Christine , Han Daniel , Gustavson Susan M. , Marin Michael L. , Faries Peter L. 
Published: March 2018

Introduction Despite ongoing studies, the relationship of plaque echomorphology with increased risk of stroke in patients undergoing carotid angioplasty and stenting (CAS) remains elusive. The aim of this study is to examine whether carotid plaque echolucency is associated with greater plaque instability as determined by the quantification of captured embolic debris in CAS patients. Methods A total of 41 consecutive CAS patients with high-grade carotid stenosis were prospectively evaluated. B-mode images for 21 patients were available for analysis. Plaque echolucency was determined by grayscale median (GSM), a computer-assisted measure of echogenicity. Images were standardized with a GSM value of 0–5 for the vessel lumen and 185–195 for the adventitia. Echolucent (EL) plaques were defined by GSM < 25, and echogenic (EG) plaques were defined by GSM ≥ 25. Protective filters were visualized by stereomicroscopy along three perpendicular axes and quantified through video imaging software. Because of heterogeneity in particle shape, individual particle sizes were determined by greatest length. Results Mean GSM was 45.5, and 10% plaques were echolucent. Particulate debris was detected in all filters. Plaques with lower GSM were associated with a greater number of particles (EL: 33.5 ± 10.6 particles, EG: 14.0 ± 10.3 particles; p = 0.02). Echolucent plaques also demonstrated particles of greater size: maximum size (EL: 3490 ± 1954 μm, EG: 1026 ± 1186 μm; p = 0.015) and number of particles >1000 μm (EL: 3.5 ± 2.1 particles, EG: 0.7 ± 1.4 particles; p = 0.019). Conclusions Echolucent carotid plaques, as determined by GSM, may cause increased embolization of greater-sized embolic debris during CAS. Our study confirms previous findings that suggest that a GSM cut-off point of 25 may be linked with the release of more embolic debris. Therefore, increased plaque echolucency may place patients at greater risk for perioperative embolic events, making patients with such lesion characteristics more likely to experience postprocedural neurologic complications.
A Study Comparing the Results of Duplex Ultrasound and Magnetic Resonance Venography to Diagnose Pelvic Vein Congestion in Conjunction with a Compression Syndrome
Authors: Kelly Donna M. , Sanford Deborah , Stoughton Julianne 
Published: March 2018

Purpose To compare the imaging modalities of duplex ultrasound (DU) and magnetic resonance venography (MRV) in determining the presence of the anatomy associated with compression syndromes as well as the presence of pelvic varices in patients with suspected pelvic vein congestion syndrome (PCS). Methods A prospective study of 29 patients (27 females and 2 males) with signs and symptoms of PCS as well as MTS. Each patient underwent a DU and an MRV, for the purpose of diagnosing the presence of nutcracker anatomy (NA) and May–Thurner anatomy (MTA). The images were graded in an effort to determine if either DU or MRV was a better workup modality for the diagnosis of PCS and the compression syndromes that can be associated with it. A blinded independent reviewer did the grading. Results The left renal vein was well visualized to evaluate for the presence or absence of NA 89% of the time with DU and 81% of the time with MRV. The left common iliac vein was well visualized for the presence or absence of MTA 93% of the time with DU and 76% of the time with MRV. Pelvic varices were well visualized in 100% of the time for both DU and MRV. With an experienced technologist performing the DU, our study has demonstrated that DU can consistently provide the needed imaging in a noninvasive and less-expensive manner while continuing to allow the clinician and patient to make a well-informed decision about their diagnosis and treatment.
Quantification of Soft Tissue Loss among Patients with Peripheral Arterial Disease
Authors: Ali Abbas S. , Baig Taha , Sadique Muhammad , Ali Mohammed , Qamar Asad U. 
Published: March 2018

Objective Tissue atrophy is known to occur amongst patients with peripheral arterial disease (PAD). We report quantification and assessment of severity of calf tissue atrophy amongst patients with PAD. Patient types Calf atrophy amongst patients who presented for peripheral transluminal angioplasty (PTA) at the Institute for Cardiovascular excellence (ICE) in 2012 was assessed using X-ray methods (n = 48). This cohort has the most severe PAD. Patients suspected of having PAD were assessed using lower extremity arterial ultrasound (LAU) and had their calves measured with a tape. This group had patients with (n = 355) and without (n = 245) PAD. Not all of those with PAD needed angiography and PTA thus these represent patients with moderate to severe PAD. The third cohort included patients from National Health and Nutritional Examination survey (NHANES) and included normal patients without PAD (n = 6391), those with abnormal ankle brachial index (ABI) (n = 422). These represent those with mild to moderate PAD. Amongst NHANES patients, those who either had no ABI or un-interpretable ABI were excluded from analysis (n = 2332). Calf Measurement Tape measurement of calf circumference followed the method adopted in NHANES and identified the widest portion of the calf with the patient in the seated position. Calf circumference from X-ray involved visualization of both edges of soft tissue at calf level. A visible catheter of known size in the same run was used for calibration. Using measured soft tissue diameter from X-ray calf circumference was calculated. Data Analysis Data analysis included descriptive statistics and generalized linear modeling after data cleaning and transformation. Results After adjusting for all other factors, the odds of having PAD per centimeter increase in calf circumference are 0.88. Compared with smokers, nonsmokers' odds of PAD are 0.42. Odds of PAD among nonhypertensives are 0.58 in comparison to the hypertensives. Implications of our findings Among patients who present to the doctors' office for routine assessment, if calf circumference width were to be measured as a part of physical examination using 36.5 cm as a cutoff to help identify PAD patients. These patients could then undergo a more careful assessment for PAD.
Leg Venous Ulcer Size Inversely Related to Number of Notable Perforating Veins: A Word of Caution
Authors: de Carvalho Abreu Jesus Antonio , Salles-Cunha Sergio Xavier 
Published: March 2018

Background Perforating vein ligation has been proposed for the treatment of chronic venous ulcers in the leg. Pubmed.org , however, showed a lack of increase in subfascial endoscopic perforator surgery (SEPS) publications, even before the popularization of perforating vein thermal or chemical ablation procedures. We renewed an investigation on perforating vein ligation surgery as part of venous ulcer treatment. The basic question was if ulcer size and number of notable perforating veins were related. Methods Leg perforating veins were detected by ultrasonography (US) and by clinical palpation in 118 legs of 104 subjects, mostly women (79, 76%). This group represented a sample of a mostly rural Brazilian population. Inclusion criterion was any “request for venous US at any stage of ulcer treatment.” Ulcer size in centimeters squared and number of detected perforating veins (NP) were compared using Pearson correlation coefficient p available with Excel. Results Average ulcer size was 13 ± 17 cm2 (1–100) for NP = 0–7, resulting in p = −0.18 for the 118 pairs of data. Subgroup averages were 16, 16, 11, 8, and 8 cm2 for NP = 0, 1, 2, 3, and ≥4 perforating veins detected (n = 32, 30, 29, 16, and 11, respectively), resulting in p = −0.94 for such averages and NP. Conclusion Ulcer size failed to correlate with number of detected perforating veins based on raw data but correlated inversely to such number if subgroup averages were compared. Average ulcer size was larger for subgroups of legs with lesser number of perforating veins. Arbitrary ligation of detectable perforating veins may result in ulcer size augmentation. Detailed research must continue to find criteria to indicate (a) ligation or (b) preservation of specific perforating veins either (a) detrimental or (b) contributory to venous ulcer healing.
Digital Traumatic Fistula and Arteriovenous Malformation in a Patient with Ulnar Nerve Compression Syndrome
Authors: Varjão de Oliveira Humberto , Salles-Cunha Sergio X. 
Published: March 2018

Objective —Ulnar nerve compression, the Guyon's canal syndrome, is more unusual than carpal tunnel disorders. An exceptional case of a patient with vascular and neurogenic signs and symptoms is described. Patient Presentation —A 26-year-old female physiotherapist presented with neurogenic and arteriovenous signs and symptoms involving the right hand. The patient described fourth finger and wrist pain with flexion, and pain and itching extending to arm and forearm. Sensations worsened when exposed to air conditioning. Enlarged vessels were noted in the medial aspect of the fourth digit; trauma occurred 8 years earlier during attempts to open a nail polish container. Methods —Color flow, duplex-Doppler ultrasonography (US) of the subclavian to digital vessels was performed using 3- to 13-MHz transducers. Interpretation focused on flow waveforms obtained with the hand open and closed, having the left extremity as reference. Thermography was performed with camera Flir 15, room temperature at 21°C (70°F) and relative humidity at 48%. Results —Right subclavian to digital arteries had high diastolic flow with opened hand. Hand closure interrupted diastolic flow except in the ulnar circulation to the fourth digit. Common digital arteries feeding digits 3–4 and 4–5 had significantly more diastolic flow than the artery feeding digits 2–3. Diastolic flow through a dilated ulnar artery despite hand closure was associated to a millimetric arteriovenous fistula in the fourth finger. Hyperthermia saturating at 35°C (95°F) showed channel-like images over the ulnar nerve and artery and fourth digit, compared with 20°C (68°F) for digit 2. Conclusions —US and thermography demonstrated high flow and hyperthermia associated with a fourth digit fistula and abnormal vessels, and ulnar artery dilatation likely associated with ulnar nerve injury. A coadjuvant diagnosis of Guyon's canal syndrome at the wrist was raised.
Patterns of Venous Reflux in 1,027 Lower Limbs with Primary Varicose Veins
Authors: Carrison Victoria , Tompkins Brooke , Fronek Lisa , Loerzel Nicole , Bunke Nisha 
Published: March 2018

Objective The purpose of this study was to investigate the anatomical patterns of superficial venous reflux in patients presenting with primary varicose veins. Methods Ultrasound scans, detailed vein maps, and histories of patients presenting to a single vein center were retrospectively reviewed. Patients included in the study were those presenting with primary varicose veins and classified as clinical, etiologic, anatomic, and pathophysiologic classes 2 through 4. Patients with histories of venous intervention, malformations, active ulcerations, or deep system abnormalities were excluded from this study. Results Overall, 1,027 limbs of 617 patients met the inclusion criterion. The male to female ratio was 1:6.0. Varicose veins were attributed to reflux in the great saphenous vein (GSV) 66% (n = 679) of the time. When GSV reflux was present, the saphenofemoral junction was incompetent 83% of the time. Six percent of varicose veins were attributed to the anterior accessory saphenous vein. Small saphenous vein (SSV) reflux was demonstrated in 34.8% (n = 357). The thigh extension of the SSV and vein of Giacomini demonstrated reflux in 7% (n = 69) and 1% (n = 15) of limbs, respectively. Reflux of nonsaphenous origin was present in 19% (n = 198) of limbs (isolated tributary reflux). Conclusion The variations of superficial venous reflux in patients presenting with primary varicose veins are diverse and complex. Therefore, thorough duplex ultrasound is necessary in all patients with primary varicose veins to evaluate the precise source of reflux to determine therapeutic options.
Parkinson’s disease in adults
Authors: Forster Danielle A 
Published: March 2018

Parkinson’s disease (PD) is a common neurodegenerative condition that is characterised by progressive motor dysfunction and associated non-motor features. Affecting up to 160 people in 100 000 in the UK, PD has a profound impact on a patient’s quality of life and that of their carers. With the number of affected patients predicted to rise by 28% by 2020, it is important for GPs to recognise the features of PD and have some understanding of both pharmacological treatment and non-pharmacological management. Increased recognition can achieve timely specialist referral and early initiation of treatment, and may help reduce symptoms, improve the patient’s quality of life and reduce healthcare costs. This article aims to raise awareness of the features of PD and provide a summary of management strategies currently recommended by the National Institute for Health and Care Excellence.