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Some of the factors involved in the Sarvazyan method for recording ultrasound field distributions with special reference to the application of ultrasound in physiotherapy.

The mapping of ultrasound fields using the dye paper method is described. The mode of action by which the dye concentration is increased has been investigated. Microbubbles on the paper surface and microstreaming of dye solution seem to be essential features of the mapping method. The streaming is thought to inhibit the formation of a dye depletion layer near the paper to an extent dependent on local sound intensity A linear relation between streaming velocity and intensity is derived.

Coloring Agents↗

A feasibility study of high intensity focused ultrasound for liver biopsy hemostasis.

This study was conducted to demonstrate the feasibility of high intensity focused ultrasound (HIFU) application to control post-liver-biopsy hemorrhage. Anesthetized Yorkshire pigs (n = 3; mean weight = 23.0 kg) were used and the liver organ was exposed surgically by an open laparotomy. Core biopsies were performed on the hepatic parenchyma with 14-gauge (n = 41) and 18-gauge (n = 33) core biopsy needles. The focus of HIFU (4.23 MHz) field was applied for 15 to 45 s to the needle entry site in the liver immediately after needle retraction. Blood loss from a biopsy site was determined using surgical sponges as absorbent applied at the site. Mean blood loss for control sites was 6.16 g (14-gauge, n = 20) and 1.22 g (18-gauge, n = 10). Virtually no blood loss was measured for biopsies after HIFU application (n = 44) for using needles of both sizes. Our results indicate that intraoperative HIFU application could successfully induce hemostasis after liver biopsy in a porcine model.

Animals↗

Effectiveness of lipid microbubbles and ultrasound in declotting thrombosis.

The objectives of this study were to determine the effectiveness of lipid-encapsulated microbubbles and ultrasound (US) in recanalizing arteriovenous graft thrombi and the effect that tissue attenuation has on the success rate. A total of 55 thrombotic occlusions were created in four canines. The thrombosed grafts were randomly treated with two different 1-MHz US intensities, low (0.4 to 0.6 W/cm(2)) and high (10 W/cm(2)). Intragraft microbubbles were compared with intragraft saline and with the same dose of microbubbles given IV. IV microbubbles were also given both in the presence and absence of a tissue-mimicking phantom. High-intensity US (10 W/cm(2)) with intragraft microbubbles produced significantly higher patency and flow scores than did US with saline (p < 0.01). US with IV microbubbles had higher success rates in recanalizing thrombosed grafts than did US alone at all intensities. Attenuation reduced the rate at which successful recanalization occurred at both low and high intensities. US and microbubbles are capable of recanalizing acute arteriovenous graft thromboses. Higher intensities may be needed in the presence of tissue attenuation.

Acute Disease↗

The antivascular action of physiotherapy ultrasound on murine tumors.

This study was aimed at determining if physiotherapy ultrasound (US) affected the fragile and leaky angiogenic blood vessels in a tumor. In 22 C3HV/HeN mice, a subcutaneous melanoma (K1735(22)) was insonated (1, 2 or 3 min) with continuous 1-MHz low-intensity (spatial-average temporal-average = 2.28 W cm(-2)), physiotherapy US. Contrast-enhanced (0.1 mL Optison) power Doppler US observations were made and histogram analyses of the images were performed. Before insonation, all but 7% of the tumor was perfused. The avascular area in tumors receiving 3-min treatment increased to 82% (p < 0.001). A linear regression analysis showed that each min of insonation led to a 25% reduction in tumor vascularity; the antivascular activity persisted for 24 h. Histology demonstrated disruption of vascular walls and tumor cell death in areas of vascular congestion and thrombosis. Physiotherapy US particularly targeted the vascular structures, and the effects on tumor cells appeared to be secondary to the resultant ischemia.

Albumins↗

Prostaglandin postscript: a personal reflection.

The long and arduous process that led to the development of ocular hypotensive prostaglandin derivatives over the past three decades has been reviewed several times. In this "postscript" to the second Survey of Ophthalmology supplement devoted to the ocular hypotensive effects of prostaglandin derivatives, only two aspects of this new approach to the medical management of glaucoma are discussed: 1) The implication of the observed prostaglandin-induced increase in iridial pigmentation with respect to the understanding of the role of prostaglandins and of iridial melanocytes in the protection against the damaging effects of light, and in the maintenance of normal intraocular microenvironment; and 2) The rationale behind the use of a combined formulation of a prostaglandin derivative and a beta-blocker for the protection against increased intraocular pressure. The need to consider not only target pressure, but also target mechanisms, in the selection of medical therapy regimen for any given glaucoma patient is emphasized.

Adrenergic beta-Antagonists↗

A randomized, double-blind, placebo-controlled comparison of emedastine 0.05% ophthalmic solution with loratadine 10 mg and their combination in the human conjunctival allergen challenge model.

BACKGROUND: When selecting treatment for allergic conjunctivitis, a primary concern is whether to choose local or systemic therapy. OBJECTIVE: This study compared the efficacy of topical emedastine 0.05% ophthalmic solution with that of oral loratadine 10 mg and their combination in the conjunctival allergen challenge model of allergic conjunctivitis. METHODS: This was a single-center, randomized, double-masked, placebo-controlled, parallel-group study. At visit 1, eligible subjects underwent conjunctival allergen challenge to identify the dose required to elicit a positive allergic reaction. After 7 days, subjects returned for visit 2, at which the allergen dose was confirmed. At visit 3, which took place 2 weeks later, subjects were randomized to receive either emedastine plus placebo capsules, loratadine plus placebo eyedrops, or both emedastine and loratadine. One hour after receiving study drug, subjects were challenged with allergen in both eyes. Allergic signs and symptoms were graded using standardized 5-point scales. The primary efficacy variables were itching and conjunctival hyperemia. Secondary efficacy variables were ciliary and episcleral hyperemia, chemosis, lid swelling, and tearing. Itching was graded subjectively at 3, 5, and 10 minutes after challenge. All other variables were assessed at 5, 10, and 20 minutes after challenge. RESULTS: Eighty subjects (mean age, 43.68 years) were randomized to receive study treatment. Forty subjects (20 men, 20 women) received emedastine plus placebo capsules, 20 (7 men, 13 women) received loratadine plus placebo eyedrops, and 20 (12 men, 8 women) received both active treatments. In the between-group efficacy comparison at visit 3, the difference in itching and hyperemia scores between emedastine and loratadine was statistically significant at all time points (all, P < 0.05). Efficacy scores for the combination of emedastine and loratadine were significantly better than those for loratadine alone at 2 of 3 time points for itching and all time points for hyperemia (P < 0.05). The combination was significantly better than emedastine alone at I of 3 time points for itching and 6 of 9 time points for hyperemia (P < 0.05). CONCLUSION: In this study, emedastine was more efficacious than loratadine for reducing the itching and redness associated with allergic conjunctivitis in the human conjunctival allergen challenge model.

Adult↗

Catheter-directed thrombolysis with transjugular access in portal vein thrombosis secondary to pancreatitis.

A case of portal vein thrombosis (PVT) secondary to pancreatitis is presented. Patient was treated with catheter-directed thrombolysis using urokinase solution. Because the percutaneous transhepatic approach is associated with higher risk of hemorrhage we used the catheter-directed thrombolysis via the transjugular intrahepatic access to restore the patency of the thrombosed portal vein. This case shows that catheter-directed thrombolysis with transjugular approach can be effectively used in the treatment of PVT.

Catheterization↗

Effects of a pure antiestrogen and progesterone on estrogen-mediated alterations of blood flow and progesterone receptor expression in the aorta of ovariectomized rabbits.

There is ample evidence from epidemiological studies that estrogen-replacement therapy protects postmenopausal women against cardiovascular disease. One explanation for this beneficial effect could be the improvement of blood flow under estrogen therapy. By using ultrasound and Doppler color flow mapping we demonstrated in the aorta of ovariectomized rabbits a significant dose-dependent increase in blood flow after treatment with 17beta-estradiol. An increase in blood flow was already observed within 1 h of estradiol treatment and lasted until the end of a 14-day treatment phase. Progesterone did not attenuate the effects of 17beta-estradiol on aortic blood flow. The pure estrogen receptor antagonist ZM 182780, however, dose-dependently reversed the effect of 17beta-estradiol on blood flow after the 14-day treatment phase, but was not able to antagonize the rapid 17beta-estradiol effect on blood flow after 1 h. After killing the animals mRNA and protein expression of the progesterone receptor (PR), a known estrogen-responsive gene in classic target organs, were examined. Analogous to the blood flow results the PR mRNA level increased dose-dependently after 17beta-estradiol treatment, whereas ZM 182780 was able to reverse this effect. Immunohistochemical localization of PR in the aortic wall revealed an increase in immunoreactivity in fibroblasts of the adventitia after 17beta-estradiol treatment. ZM 182780, and to a lesser degree progesterone, reversed the 17beta-estradiol-induced increase in PR immunoreactivity. PR immunoreactivity was further detected in endothelial and smooth muscle cells, but the various hormonal treatments had no discernible effect on the PR mRNA level in these cellular compartments. Our findings in the aorta of OVX rabbits suggest that (a) 17beta-estradiol exhibits a rapid effect on arterial tone, (b) the pure estrogen receptor antagonist ZM 182780 inhibits the 17beta-estradiol effect on blood flow and PR mRNA and (c) progesterone does not attenuate the beneficial effect of estrogens on arterial tone.

Animals↗

Cataract Image Analysis System.

A system for sequential colour video capture and analysis of lens opacities is described. A sensitive RGB (Red-Green-Blue) camera is coupled to a 486 DX2/66 IBM-compatible computer to obtain high-resolution images of cataracts. Vacuoles, retro-dots, suture opacities, wedge opacities, cortical and posterior subcapsular opacities and nuclear sclerosis can be digitised and subjected to various analysis systems and colour prints obtained. The size and number of vacuoles and opacities can be determined by selecting areas of interest, and line tracings of whole lens, isolated opacities or nuclear sclerosis can be separated by analysis into 16.8 million plus colour gradients. The Cataract Image Analysis System represents a precise and new digitised procedure for cataract documentation and may be of value in determining cataract progression and evaluation of medical therapy.

Cataract↗