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PubMed2000

Aging affects the retrobulbar circulation differently in women and men.

BACKGROUND: While aging clearly has protean biological effects on every organ system, the differential effects of aging in women and men in the retrobulbar vasculature, to our knowledge, have never been investigated. Because glaucoma and age-related macular degeneration are closely linked to advanced age, we performed a cross-sectional study using color Doppler imaging of 4 retrobulbar vessels in both healthy women and men. OBJECTIVE: To define the influence of aging per se on ocular hemodynamics. METHODS: Women (n = 73) and men (n = 55), aged from 20 to 90 years, free of ocular and systemic disease, and with normal intraocular pressure, were recruited for this study. Postmenopausal women who were not receiving estrogen replacement therapy were also recruited. Studies involved color Doppler imaging analysis of the ophthalmic, central retinal, and nasal and temporal posterior ciliary arteries. Ophthalmic arterial peak systolic and end-diastolic velocities and a Pourcelot resistance index were determined for each vessel. RESULTS: In both sexes, ophthalmic arterial end-diastolic velocity decreased and the Pourcelot resistance index rose with advancing age (each P<. 001); peak systolic velocity in the ophthalmic vessel was age-independent. In contrast, central retinal arterial flow velocities were unaffected by age in both sexes. In the posterior ciliary arteries, in men, flow velocities and the Pourcelot resistance index were independent of age. However, in women, end-diastolic velocity decreased with age in both the nasal and temporal posterior ciliary vessel (each P<.05); peak systolic velocity was constant; the Pourcelot resistance index in each ciliary artery rose with advancing age (each P<.05). CONCLUSION: In healthy women and men, aging-induced changes in retrobulbar hemodynamics are comparable to alterations seen in patients with glaucoma or age-related macular degeneration, suggesting that vascular changes with senescence may contribute to increased risk for these diseases in older age. Arch Ophthalmol. 2000;118:1076-1080

Adult↗
PubMedDate not supplied

Delivering HIV services to vulnerable populations: a review of CARE Act-funded research.

This article summarizes key findings from evaluation and research studies that have received financial support from the HIV/AIDS Bureau of the Health Resources and Services Administration or from Ryan White Comprehensive AIDS Resources Emergency (CARE) Act grantees. These studies suggest that the CARE Act has improved but not equalized service accessibility, quality, and outcomes for different populations living with HIV disease. Evaluations of access to highly active antiretroviral therapy (HAART) found that uninsured patients, women, people of color, and injection drug users waited much longer than others to receive the new therapies. These disparities were not uniform across study sites, suggesting that clinic characteristics and geographic location have a major influence on prescribing patterns. Once patients gained access to HAART, health insurance status made little difference in clinical outcomes.

Acquired Immunodeficiency Syndrome↗
PubMed2004

Can color doppler predict the uniformity of HIFU-induced prostate tissue destruction?

BACKGROUND: Tissue blood perfusion influences the results of some hyperthermia and thermotherapy procedures, but its role in the outcome of prostate cancer treatment by high-intensity focused ultrasound (HIFU) has not been evaluated yet. We evaluated preoperative prostate color Doppler as a predictor of the efficacy of HIFU treatment. METHODS: Thirty-five patients underwent pre- and post-contrast color Doppler examination of the prostate before HIFU treatment. Specific software was used to calculate, on color Doppler images, the color pixel density (CPD), and the specific flow (SF, i.e., mean velocity x CPD) in different regions of interest. Post-treatment sextant biopsies were obtained in 31 patients, 5.8 +/- 2.8 months after HIFU treatment. RESULTS: No significant correlation was found between the uniformity of HIFU-induced tissue destruction observed on control biopsies and the pre-treatment CPD/SF values in any region of interest, either before or after contrast injection. On the other hand, history of radiation therapy was significantly associated with homogeneous tissue destruction and history of hormone therapy was significantly associated with incomplete tissue destruction. CONCLUSIONS: Color Doppler cannot predict the uniformity of HIFU-induced tissue destruction. History of radiation therapy was found to be a factor of favorable prognosis and history of hormone therapy was found to be a factor of poor prognosis in our population.

Aged↗
PubMed2006

Contrast sensitivity and color vision in HIV-infected individuals without infectious retinopathy.

PURPOSE: To investigate the relationship between abnormal contrast sensitivity and abnormal color vision among human immunodeficiency virus (HIV)-infected individuals who have normal visual acuity and to seek host factors that predict these abnormalities. DESIGN: Noninterventional, cross-sectional study. METHODS: We evaluated 71 HIV-infected subjects with visual acuity of 20/25 or better, clear media, and no vision-threatening retinal lesions. Visual function was determined using the Pelli-Robson contrast sensitivity test and the Farnsworth-Munsell 100-Hue color test (FM-100). Results were compared with published values for normal populations and to measures of HIV disease severity. We evaluated two levels of impairment for each visual function. "Mild dysfunction" was defined as > or =1 standard deviation (SD), but <2 SD from normal means. "Abnormal" was defined as > or =2 SD from normal means. RESULTS: The prevalences of abnormal contrast sensitivity and abnormal color vision were 7.0% and 9.9%, respectively. We did not identify relationships between impaired contrast sensitivity and impaired color vision. Impaired color vision was associated with increasing age (r = 0.36, P = .002). We could not identify significant correlations between either contrast sensitivity or color vision values and the following factors: current or nadir (lowest previous) CD4+ T-lymphocyte count, HIV blood level, and Karnofsky score. CONCLUSIONS: Abnormal contrast sensitivity and abnormal color vision can occur independently in HIV-infected individuals and can be present in the absence of severe immunosuppression.

Adult↗
PubMedDate not supplied

Sonographic and color Doppler sonographic diagnosis of acute osteomyelitis: report of one case.

Acute osteomyelitis in childhood is uncommon. Early diagnosis is often difficult. We present a 7-year-old boy with clinical manifestation of fever and progressive left thigh swelling for one week. Sonography of the left thigh showed periosteal thickening with subperiosteal abscess around the metaphysis of the left distal femur. Tc-99m bone scintigraphy showed increased uptakes at the left distal femur. Osteomyelitis was suspected from the examination of ultrasound and bone scan examinations. His symptoms were not relieved following systemic antibiotic therapy and a follow-up color Doppler sonography showed vascular flows within and around the periosteum indicating active inflammation. He finally received surgical drainage and the operative findings confirmed the diagnosis of osteomyelitis. In conclusion, ultrasound may be a helpful and convenient tool for establishing the early diagnosis of pediatric osteomyelitis. Ultrasound and color Doppler sonography can be used as clinical parameters to evaluate the disease severity and the progression of osteomyelitis in children.

Acute Disease↗
PubMed2000

Locally advanced breast carcinoma: computer assisted semiquantitative analysis of color Doppler ultrasonography in the evaluation of tumor response to neoadjuvant chemotherapy (work in progress).

We aimed to evaluate objectively the value of color Doppler flow imaging in the assessment of response of locally advanced breast cancer to primary medical treatment by using a computer assisted semiquantitative method. Prior to and after neoadjuvant treatment, 17 patients with locally advanced breast carcinoma were prospectively evaluated by physical examination and computer assisted semiquantitative color Doppler ultrasonography. The results of clinical and color Doppler examination were finally correlated to the histopathologic evaluation of tumor response. The degree of concordance between posttherapeutic histopathologic results, clinical examination, and color Doppler assessment was evaluated by kappa statistics. Concordance was 0.474 (0.135-0.813) between histopathologic results and clinical posttherapeutic assessment and 0.870 (0.627-1.113) between histopathologic results and semiquantitative color Doppler examination. Objective semiquantitative assessment of tumor vascularity as displayed by color Doppler ultrasonography has potential as a functional tool for measuring tumor response to neoadjuvant chemotherapy.

Adult↗
PubMed2006

Newer modalities of ultrasound imaging and treatment of the prostate.

Gray-scale ultrasound is widely used for assessing BPH and for obtaining prostate biopsies. However, it has limited value for evaluating cancer in the prostate. To improve ultrasound as an imaging modality of the prostate, many new technologies, such as color and power Doppler, 3-dimensional ultrasound of the prostate, and contrast-enhanced ultrasound have been developed. In addition, treatment modalities using ultrasound for the treatment of BPH have been developed. This review presents the recent developments in ultrasound of the prostate.

Humans↗
PubMedDate not supplied

Contrast-enhanced ultrasonography with SonoVue after infliximab therapy in Crohn's disease.

The introduction of biological treatments like monoclonal anti TNF-a antibodies (infliximab), is changing the clinical history of Crohn's disease (CD). The effects of these therapies are monitored emplying clinical indexes of active disease, laboratory parameters, endoscopy and histology, and also with imaging techniques. A new ultrasound contrast agent, SonoVue (Bracco SpA, Milano, Italy), is opening new perspectives in the study of microvasculature of several organs. Aim of this study is to evaluate by SonoVue enhanced ultrasonography (US) the occurrence of modifications in bowel wall microvasculature of CD patients and to correlate them with parameters of disease activity and to follow up the findings during infliximab therapy. After performing a basal color-doppler ultrasonography, the study of the affected bowel loop is performed after i.v. injection of SonoVue and the enhancement is evaluated on a qualitative basis. We report on the preliminary results obtained in twenty patients, eight of which have been treated with three infusions of infliximab (induction cycle) and evaluated at baseline and after the treatment. While at baseline we describe a positive correlation of SonoVue enhancement of the affected bowel loop with CRP, alpha1-glycoprotein and white blood cell number, after infliximab treatment in 6/8 cases a definite improvement was detected. Ultrasonographic evaluation of the changes of bowel wall enhancement after i.v. SonoVue during infliximab therapy might represent an useful, not invasive and relatively low cost imaging modality for the clinical monitoring of activity of small bowel Crohn's disease.

Adult↗
PubMed1983

Microcomputer produced anaglyphs for evaluation and therapy of binocular anomalies.

An Atari 800 microprocessor with a color television monitor was used to produce red-green anaglyphs. These computer produced anaglyphs allow for rapid manipulation of vergence stimuli which allow the doctor greater control in diagnosis and therapy of binocular anomalies. Additionally, computer controlled stimuli allow for animation, and delivery of reinforcing aspects. The present paper describes a system in use.

Computers↗
PubMed2003

Power Doppler assessment of vascular changes during fracture treatment with low-intensity ultrasound.

OBJECTIVE: To study the use of power Doppler sonography for assessing changes in vascularity during treatment of fracture sites with low-intensity ultrasound. METHODS: In 6 dogs (3 pairs), subcutaneous dissection of the midshaft of the ulna allowed symmetrical osteotomies to be made with a reciprocation saw. Three dogs were treated and 3 were used as controls. The fracture site was subjected to 1.5-MHz low-intensity ultrasound (30 mW/cm2) for 20 minutes daily from a therapeutic ultrasonic device. Gray scale sonography was performed to evaluate the fracture site. Power Doppler sonography was used to assess flow patterns at the fracture site and surrounding soft tissue. A sonographic contrast agent was administered intravenously. The dose was 0.2 mL/kg. RESULTS: Power Doppler sonography showed an increase in flow around the fracture site in the treated dogs compared with that in control dogs. Color pixel values on day 7 were 3-fold higher in treated legs than control legs and on day 11 were 33% higher in treated legs than control legs. Enhancement after contrast agent administration was consistently higher in treated legs than control legs. CONCLUSIONS: Power Doppler sonography showed increased vascularity around the fracture sites in treated dogs with and without contrast agent administration.

Animals↗
PubMed2006

Total knee replacement: prevention of deep-vein thrombosis using pharmacological (low-molecular-weight heparin) and mechanical (intermittent foot sole pump system) combined prophylaxis. Preliminary results.

AIM: The aim of this study was to determine the role of combined mechanical and pharmacological prophylaxis in the prevention of deep venous thrombosis (DVT) after total knee replacement (TKR). DESIGN: prospective case series study. METHODS: Between October 2002 and June 2003, 38 total knee procedures were carried out on 34 patients (4 patients had bilateral TKR). To exclude the presence of a concomitant DVT echo-color-flow of the legs was performed between 2 and 1 week prior to surgery, in the postoperative period (before discharging) and 30 days after surgery. Patients received one daily subcutaneous injection of nadroparin calcium (dosage adapted to body-weight). An intermittent foot sole pump (IFSP) was applied in the recovery room postoperatively, in both feet for about 5 h a day and all night long, and continued at home until the 15(th) day. RESULTS: No major perioperative or rehabilitation phase-related complications were observed (2 patients required manual drainage of blood clots from the wound). The incidence of DVT was 7.9% (3 cases). In one of these cases we observed a previous DVT so it was classified as rethrombosis. All were successfully treated with therapeutic introduced low molecular weight heparin (LMWH) therapy. No pulmonary embolism or deaths associated with the use of LMWH or IFSP were observed. CONCLUSIONS: In our experience the combined prophylaxis with nadroparin calcium and IFSP significantly reduced the incidence of DVT.

Aged↗
PubMed2007

Blood flow occlusion via ultrasound image-guided high-intensity focused ultrasound and its effect on tissue perfusion.

This study investigated the induction of tissue necrosis by arterial blood flow occlusion using ultrasound image-guided high-intensity focused ultrasound (HIFU). We constructed a prototype HIFU transducer in combination with an imaging probe that provided color Doppler imaging and ultrasound contrast imaging. The HIFU beam was aimed into a branch of the renal artery in vivo. The renal artery branches of eight rabbits were occluded by HIFU at an intensity of 4 kW/cm(2) (from 2 to 10 times of each sonication for 5 s). When the HIFU exposure was successful, complete cessation of blood flow was observed by color Doppler imaging with success rate of 100% (8/8). Furthermore, lack of perfusion was observed in the renal cortex with a contrast-enhanced image. Postmortem histologic evaluation showed a wedge-shaped area of infarction in six of seven cases, corresponding to the lack of the contrast medium in the ultrasound image. These results demonstrated that ultrasound image-guided HIFU can be used to induce arterial occlusion, thus producing infarction and necrosis of the perfused tissue.

Albumins↗
PubMed2002

[Hemodynamics monitoring of liver transplantation with color Doppler ultrasound].

By hemodynamic monitoring of liver transplantation with Color Doppler ultrasound, we observed the hemodynamic changes pre- and post-operatively and the patency of the anastomotic vessels, to detect or exclude the presence of complications, then assess the prognosis. We measured the hepatic blood flow after orthotopic liver transplantation in recent 6 cases, and observed the patency of anastomostic vessels and the hemodynamic improvement of the portal vein and hepatic arteries. The abnormal liquid and solid echoes were not found around the transplantated liver in all 6 cases. The echoes of hepatic parenchyma and tububes were normal. The direction and speed of blood flow were also normal. Five of anastomoses of portal vein in 6 cases were patent. The rest one was a little stenosed, and the speed of local blood flow was a little faster. There were 11 patent ones and 1 mildly stenosed in the 12 anastomoses of inferior venae cavae. The speed index(SI) and resistance index(RI) of hepatic arterial blood flow distal to the anastomoses were all normal. Liver transplantation is the redical therapying of portal hypertension, and the color Doppler ultrasound is the best non-invasived method for monitoring the hemodynamic changes of transplantated liver.

Adult↗
PubMed2004

Indocyanine green angiography in ocular tuberculosis.

PURPOSE: To assess indocyanine green (ICG) angiography as a method for evaluating the extent of choroidal involvement and to compare ICG angiography with fundus fluorescein angiography (FFA) in ocular tuberculosis. METHODS: FFA and ICG angiography were performed on two patients who had ocular tuberculosis findings during fundus examination. The patients were given topical dexamethasone phosphate, topical cyclopentolate, and oral prednisolone acetate in addition to systemic antimicrobial therapy. Both examinations were repeated after treatment. RESULTS: In one patient, two hypofluorescent lesions that corresponded to the choroidal tuberculomas were noted with ICG angiography. Only one lesion was found during ophthalmoscopic examination and FFA. After treatment, these lesions persisted, but became less hypofluorescent. In the other patient, ICG angiography showed a hypofluorescent choroidal lesion corresponding to the choroidal tuberculoma that was larger than its appearance on FFA. This lesion remained hypofluorescent in all phases of ICG angiography and became less hypofluorescent after treatment. CONCLUSIONS: ICG angiography is a useful method to determine the extent of the choroidal lesion and the stage of disease and to evaluate treatment results in tuberculosis patients.

Antitubercular Agents↗
PubMed1998

New perspectives in head and neck sonography by signal-enhanced color Doppler sonography.

Ultrasound contrast agent is used in color Doppler flow imaging for signal enhancement in perfused vessels. We present our experience with its use in the head and neck area and the results obtained. Up until now, 30 patients with carcinomas of the oral cavity or the maxillary sinus, tumors of the mandible and metastatic or inflammatory lymph nodes have been examined. Conventional B-scan sonography was supplemented by non-contrast color Doppler flow imaging. Depending on the indication, 2.5 g Levovist in bolus or 4 g fractionated was injected intravenously in a concentration of 300 or 400 mg/ml. The administration of the contrast agent was tolerated by all patients without any side effects and in all cases led to a remarkable enhancement of the Doppler signals. About 15 to 30 s after injection, an enhancement in perfused vessels was detected. The fractioned injection of 4 g led to a lengthening of signal enhancement up to more than 10 min and to the possibility of examining more parts with a single application of contrast agent. In 64% of the lymph nodes, vessels could only be identified with the administration of Levovist. The general vessel topography could be better evaluated in 83% of the cases. The lymph-node-supplying vessels were identified in 8 of 11 patients after the injection of contrast media. Additional information, which was gained in 17 patients, increased the certainty of diagnosis or of the therapeutic concept. In three cases, the examinations with the signal enhancer resulted in a change in therapy. By applying signal enhancer in color Doppler sonography the fields of examination in the head and neck areas can be expanded.

Blood Flow Velocity↗