scholarly journals Image quality and attenuation values of multidetector CT coronary angiography using high iodine-concentration contrast material: A comparison of the use of iopromide 300 and iopromide 370

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
A K M Darwish ◽  
M M Farouk ◽  
H Hafez ◽  
A Adel
Keyword(s):  
Image Quality ◽  
Pulmonary Artery ◽  
Coronary Arteries ◽  
Main Pulmonary Artery ◽  
Iodine Concentration ◽  
Ascending Aorta ◽  
P Value ◽  
Group A ◽  
The Mean ◽  
Attenuation Values

Abstract Background Iodine concentration is one of the main determinants of arterial enhancement in CTA, and current low-osmolar and iso-osmolar nonionic CM for intravascular administration still come in a handful of molecules, but a relatively wide range of different iodine concentrations. This gives the opportunity to optimize CTA protocols as a function of several factors such as patient characteristics, CT technology, and CM features in an attempt to maximize the diagnostic yield of CTA examinations while considering patient safety and avoiding unnecessary extra costs. Objective To compare image quality and attenuation values of multidetector CT coronary angiography (MDCT) between iopromide 300 and iopromide 370 and to evaluate whether the higher iodine contrast material has better image quality or not. Material and Methods Patients were prospectively enrolled and were randomized into two groups (group A, 30 patients received iopromide 300, iodine flux 1.2g I/s; group B, 30 patients received iomeprol 370, iodine flux 1.48g I/s). CT attenuation values were measured in the proximal end coronary arteries,ascending aorta and main pulmonary artery. The image quality of 15 coronary artery segments was graded by cardiologist in consensus with the use of a four-point scale (1 excellent enhancement to 4 poor enhancement). Non-parametric statistical approaches were used to compare the two groups. Results No statistically significant differences were found between the mean attenuation values (302 HU for iopromide 300 and 326 HU for iopromide 370, P = 0.175) in the coronary arteries in the two groups. The mean attenuation value of the proximal ascending aorta (AA)and main pulmonary artery (MPA) was found to be 345+/-63 HU and 241+/- 89 in group A respectively, whereas the mean attenuation value in proximal ascending aorta and main pulmonary artery in group B was found to be 348+/-74 and 238+/- 50 respectively. No significant difference was found between iopromide 300 and iopromide 370 in terms of contrast enhancement at the level of great arteries, P value AA = 0.826 and P value for MPA = 0.884. 92.9% of coronary arterial segments got score (range 1–2) in group A whereas 93.6 of coronary arterial segments got score (range 1-2) in group with no statistically significant difference P value = 0.755. Conclusion With the current CT technology iopromide 300 is not inferior to iopromide 370 in terms of coronary artery attenuation values and image quality. Iopromide 300 provides similar enhancement of coronary arteries and excellent image quality as compared with iopromide 370 using identical amount of total iodine with fewer cost and less estimated adverse effects owing to low iodine concentration of iopromide 300.

scholarly journals Measurement of Main Pulmonary Artery Diameter and its Ratio with Ascending Aorta in Indian Population by Multi Detector Computed Tomography

2020 ◽  
Author(s):  
Jyoti Gangadhar Dulli ◽  
HM Chandrashekar ◽  
J Naveen ◽  
Maskal Revanna Srinivas ◽  
Shreyas G Rao ◽  
...  
Keyword(s):  
Pulmonary Artery ◽  
Indian Population ◽  
Main Pulmonary Artery ◽  
Ascending Aorta ◽  
Diameter Ratio ◽  
P Value ◽  
Normal Range ◽  
Significant Difference ◽  
The Mean ◽  
Pulmonary Artery Diameter

Introduction: An increase in Pulmonary Artery (PA) pressure is associated with an increase in its diameter. Hence, it is necessary to know the normal range of Main Pulmonary Artery Diameter (MPAD). An attempt has been made to know the same among the Indian population. Aim: To determine the normal range of reference values for diameter of Main Pulmonary Artery (MPA) and its relation with Ascending Aorta (AA) in Indian population. Materials and Methods: A prospective cross-sectional study was conducted between October 2018 and September 2019 ((380 males, 120 females) between the age of 30-65 years). Data from the contrast CT scans of thorax of 500 subjects such as those patients with cough under evaluation, suspected lung nodule, chest wall lesions, primary or secondaries in the lung, etc., who visited the Department of Radio-diagnosis, in the Medical College of South India were analysed. Further, healthy population was also defined as those who were free from chronic cardiopulmonary illness in particular with regard to present study, which would affect the diameter of great vessels including that of PA and aorta. MPA and ascending aortic diameters were measured at the level of pulmonary artery bifurcation, viewed at fixed mediastinal window settings. Statistical Package for Social Sciences (SPSS) version 20, inferential statistics like Unpaired-t test were used to test the significant difference for variables between the two groups (males and females). The level of significance was set at 5%. Results: The MPADs of whole population ranged between 15.6-31.6 mm, with mean diameter of 23.08±2.81 mm. Correlation between age and MPAD was statistically significant (p-value <0.001), while sex-specific MPAD was not significant. The mean AA diameter was 27.15±2.6 mm. The mean AA diameter in males was 27.76±3.2 mm, and 26.67±2.0 mm in females with statistical significance (p-value 0.001) between the groups. The diameter ratio of MPA to AA was 0.85. Conclusion: In present study, the normal ranges of diameter of PA and its ratio with AA were defined among Indians. The diameter ratio of MPA to AA appears to be more important, as it tends to normalise the effects of anthropomorphic factors.

scholarly journals Doppler evaluation of the fetal pulmonary artery pressure

2019 ◽  
Vol 47 (2) ◽  
pp. 218-221
Author(s):  
Alberto Sosa-Olavarria ◽  
Jesús Zurita-Peralta ◽  
Claudio V. Schenone ◽  
Mauro H. Schenone ◽  
Fernando Prieto
Keyword(s):  
Pulmonary Artery ◽  
Pulmonary Artery Pressure ◽  
Main Pulmonary Artery ◽  
P Value ◽  
Review Of The Literature ◽  
Artery Pressure ◽  
Bivariate Correlation ◽  
Highly Correlated ◽  
Doppler Evaluation

Abstract Background The Doppler effect has allowed the characterization of several vessels in maternal-fetal circulation that have been used for practical purposes. Our review of the literature showed a paucity of information about fetal pulmonary artery pressure (FMPAP) and its behavior in regard to gestational age (GA). The objectives of the study were to evaluate a formula to calculate the main FMPAP and its correlation with GA. Methods A total of 337 fetuses without obvious pathology were studied prospectively using Doppler evaluation of the FMPAP. Using the fetal main pulmonary artery Doppler acceleration time (FMPAT), we obtained the FMPAP using the following formula: FMPAP=90 – (0.62×FMPAT). Regression analyses, Pearson’s bivariate correlation and paired sample t-test were used when appropriate. Results FMPAT increases while FMPAP decreases with GA. Pearson’s correlation coefficient for FMPAP and GA was −0.544 (P-value<0.001) and for FMPAT and GA was 0.556 (P-value<0.001). FMPAP and FMPAT were highly correlated (R=−0.972; P<0.001). Conclusion Pulmonary artery pressure in the fetus decreases with GA.

scholarly journals INTRAVENOUS REGIONAL ANESTHESIA (BIERS BLOCK);

2012 ◽  
Vol 19 (05) ◽  
pp. 710-714
Author(s):  
Muhammad ASGHER ◽  
ASIM GHAURI ◽  
MUHAMMAD ABDULLAH ◽  
Tariq Abassi
Keyword(s):  
Regional Anaesthesia ◽  
Military Hospital ◽  
P Value ◽  
Complete Evaluation ◽  
Intravenous Regional Anesthesia ◽  
Number Of Patients ◽  
Group A ◽  
The Mean ◽  
Group B ◽  
Intravenous Regional Anaesthesia

Objective: To compare the analgesic effects of combination of 0.5% Lidocaine plus Ketorolac in intravenous regionalanaesthesia technique with those of Lidocaine (0.5%) alone to prevent post operative pain after intravenous regional anaesthesia (Biersblock). Study design: Randomized Control Trial. Place and duration of study: The study was carried out at Department of Anaesthesiology,Intensive Care and pain management, Combined Military hospital, Rawalpindi from July 2008 to February 2009. Patients and Methods: Thestudy was conducted after complete evaluation of risk / benefit ratio to the patients. On the basis of random number method the patients weredivided into two equal groups (group A and group B). The number of patients in each group was 75. Group A was assigned Lidocaine in a dose of200mg 40ml of 0.5% solution and group B was assigned injection Ketorolac 30mg added to Lidocaine in a dose of 200mg 40ml of 0.5% solution.The patients were kept in post anaesthesia care unit for two hours and pain intensity was measured by visual analogue scale(VAS) on 15,30minutes,1hour, 1.5 and at 2 hours after the cuff deflation. The analgesic efficacy recorded on the basis of visual analog scale of two groups, wascompared using student’s t - test. p value of less than 0.05 was considered statistically significant. Results: In group A 33 males and 42 femaleswere enrolled for the study while in group B there were 38 males and 37 females. The mean age of the patients in group A was 34.31 ± 6.03years while in group B was 32.99 ± 6.08 years. Patients were also classified according to ASA classification in which 87 patients were classifiedas ASA – I and 63 patients as ASA – II. Group B which received Ketorolac in addition to Lidocaine for Bier’s block had low visual analogue scoresas compared to group A which received only Lidocaine for Bier’s block. P values obtained after the comparison of the mean VAS of two groupsat 15 minutes, 30 minutes, 1 hour, 1.5 hours and 2 hours were all less than 0.05 (0.002 for 15 minutes, 0.004 for 30 minutes, 0.001 for 1 hour,0.004 for 1.5 hours and 0.001 for 2 hours). Conclusions: Ketorolac improves the postoperative analgesia markedly when used with Lidocainein intravenous regional anaesthesia.

scholarly journals DECISION MAKING FOR DEVICE CLOSURE IN ADULTS WITH ‘HYPERTENSIVE PDA’–NON-INVASIVE CRITERIA: IMMEDIATE RESULTS

2021 ◽  
Vol 70 (Suppl-4) ◽  
pp. S762-67
Author(s):  
Ahsan Beg ◽  
Abdul Malik ◽  
Amjad Mahmood ◽  
M Younas ◽  
Fakher -e- Fayaz
Keyword(s):  
Pulmonary Hypertension ◽  
Retrospective Study ◽  
Pulmonary Artery ◽  
Main Pulmonary Artery ◽  
Tertiary Care ◽  
Referral Hospital ◽  
Device Closure ◽  
X Ray ◽  
Non Invasive ◽  
The Mean

Objective: To find the mean pulmonary artery pressures (PAP) in adults (>12 years) Patent Ductus Arteriosus (PDA) with ‘reversible pulmonary hypertension’ after the device closure. Residual PDA and immediate complications (embolization, pulse loss, obstruction in the aorta or pulmonary artery) are to be reported. Study Design: Retrospective study. Place and Duration of Study: Tertiary Care Referral Hospital, from Aug 2007 to Jun 2020. Methodology: This retrospective study is descriptive. Data collected by convenience sampling from 3 tertiary care referral hospital. 981 patients were undergone PDA device closure during the period from Aug 2007 to June 2020. After informed consent, an initial assessment was done by history, clinical examination, x-ray chest PA view, electrocardiography (ECG), and transthoracic echocardiography (TTE). Reversible pulmonary hypertension was labeled based on non-invasive criteria including room air saturation >93% and cardiomegaly on x-ray chest. Patients who had <93% and normal heart size on x-ray chest were excluded. The lower limit for age was 12 years. Results: Nine Hundred Eighty One patients had undergone PDA device closure. 32 (n=32/981 3.3%) had fulfilled our inclusion criteria. The mean age was 22 ± 9 (13–45) years. Mean weight was 41 ± 11 (25-66) kg. Successful device closure was done in 30 patients (93.7%). Mean diameter of PDA was 7 ± 0.1 (4.5-13 mm. Mean PAP decreased from 59 ± 13 mmHg to 38 ± 19 mmHg (p<0.05). Commonest device used was Shasma duct occluder (n=16/32 50%) followed by Occlutech Duct Occluder (n=7/32 21.9%), while 2 had muscular VSD device (n=5/32 15.6%). In 2 patients, there was an underestimation of the size of PDA so the device was retrieved and replaced with another larger one successfully. Two patients had the device fully dropped into the main pulmonary artery before it was released. Larger size device was not available at that time so the patients were referred for surgery. None of our patients had device embolization or residual shunt on echo performed next day to the procedure. Neither any patient had residual pulmonary hypertension on echocardiography. There was no significant obstruction in the aorta in any patients. Two patients had mild left pulmonary artery obstruction. There was no significant obstruction in the aorta in any of our patients. There was pulse loss in 3 patients which were treated successfully with heparin infusion with no residual damage. Conclusion: Device closure is a feasible option in adults with hypertensive PDA while the decision of reversibility is based on non-invasive criteria.

Comparison of letrozole and clomiphene citrate efficacy in terms of ovulation induction and pregnancy rate.

2021 ◽  
Vol 28 (05) ◽  
pp. 749-754
Author(s):  
Nadia Sharif ◽  
Uzma Manzoor ◽  
Saadia Bano ◽  
Uzma Shahzaad
Keyword(s):  
Pregnancy Rate ◽  
Ovulation Induction ◽  
Endometrial Thickness ◽  
Controlled Trial ◽  
Clomiphene Citrate ◽  
Epidemiological Data ◽  
P Value ◽  
Group A ◽  
The Mean ◽  
Group B

Objective: To compare the efficacy of Letrozole and clomiphene citrate in Patients of Anovulation polycystic ovarian syndrome with Infertility. Study Design: Randomized Controlled Trial Setting: Department of Obstetrics and Gynecology Independent Medical College Faisalabad. Period: 30-09-2019 to 29-6-2020. Material & Methods: This study included 100 patients with 50 patients in each group. Group A received 2.5 to 5mg letrozole in each cycle from day 3 to 7. Group B received clomiphene citrate 50 to 100 mg incremental dose depending on ovarian response. Both Drugs were given for consecutive 3 to 6 cycles to see response. Main outcome Measure included optimal follicle size (> 18mm), endometrial thickness, and pregnancy rate. Epidemiological data and efficacy outcome measures were recorded on a Performa. Statistical analysis was done using SPSS version 13. Chi-square test applied and p-value <o.o5 was considered significant. Both group included primary infertility patients. Results: The mean age of patients was 28.03+ 3.02 years. Mean age of group A patients was 29.04+3.44 and 28.47+3.90 group B patients. Mono ovulation in group A patients (88.9%) and 27 in group b patients (60.0%). The mean endometrial thickness was 9.6mm + 1.6 in letrozole group and 6.9mm + 1.2 in clomiphene citrate group A. In group A 18% got pregnant from Letrozole group and 1.1% from the group B. Conclusion: Efficacy was significantly higher in group A Patients received letrozole as compared to patients echo received clomiphene citrate. The effects of Letrozole showed better outcome in terms of Ovulation Induction Endometrial Thickness and Pregnancy rate.

Comparison of harmonic scalpel versus Milligan Morgan technique in haemorrhoidectomy patients

2021 ◽  
Author(s):  
Muhammad Ahmad ◽  
Syed Tatheer Abbas ◽  
Amna Javaid ◽  
Naveed Arshad ◽  
Falak Shair
Keyword(s):  
Wound Healing ◽  
Operative Time ◽  
Harmonic Scalpel ◽  
Controlled Trial ◽  
P Value ◽  
Randomized Controlled ◽  
Group A ◽  
The Mean ◽  
Complete Wound Healing ◽  
Group B

Objectives: To assess the comparison of harmonic scalpel versus Milligan Morgan technique in patients undergoing haemorrhoidectomy. Methodology: This randomized controlled trial study was conducted at General Hospital, Lahore, from March 2019 to September 2019. Informed consent was obtained from eligible 60 patients. Patients were randomly divided into two equal groups. In group-A, haemorrhoidectomy was conducted according to the harmonic scalpel method. In group-B, open haemorrhoidectomy was performed by the Milligan Morgan procedure. Data was assembled through a designed questionnaire and investigated via SPSS version 25. Data were stratified for descriptive statistics, level of haemorrhoids and period of haemorrhoids. Post-stratification, independent sample t-test was used. Results: Mean age of both groups patients were 44.6±7.6 and 43.8±8.2 years, respectively. In group-A, mean operative time was 20.8±2.8 minutes, while 26.5±2.8 minutes in group-B, which was statistically significant with p-value of 0.001. In group-A, mean convalescence period was 9.7±2.9 days, while 13.4±3.7 days in group-B, which was statistically significant with p-value of 0.001. The mean convalescence period with harmonic scalpel method was 7.4 days (range 5–14, SD 3.6) versus 18.6 days (range 7–30, SD 5.4) with Milligan Morgan technique (P?0.001). This research observed that harmonic scalpel method required almost six weeks for complete wound healing, whereas in  Milligan Morgan technique, complete wound healing was achieved after three months (P<0.05). Conclusion: Harmonic scalpel haemorrhoidectomy found an advantageous method when assessing the operative time and convalescence period. Hence, Harmonic scalpel haemorrhoidectomy can be adapted as a safe and effective alternative method for treating symptomatic haemorrhoids. Continuous...

scholarly journals Coronary computed tomography angiography (CCTA): effect of bolus-tracking ROI positioning on image quality

2020 ◽  
Author(s):  
Heiner Nebelung ◽  
Thomas Brauer ◽  
Danilo Seppelt ◽  
Ralf-Thorsten Hoffmann ◽  
Ivan Platzek
Keyword(s):  
Image Quality ◽  
Left Atrium ◽  
Coronary Arteries ◽  
Coronary Computed Tomography Angiography ◽  
Pulmonary Arteries ◽  
Ascending Aorta ◽  
Triple Rule Out ◽  
Comparable Image Quality ◽  
Rule Out

Abstract Objectives The aim of the study was to evaluate the effect of bolus-tracking ROI positioning on coronary computed tomography angiography (CCTA) image quality. Methods In this retrospective monocentric study, all patients had undergone CCTA by step-and-shoot mode to rule out coronary artery disease within a cohort at intermediate risk. Two groups were formed, depending on ROI positioning (left atrium (LA) or ascending aorta (AA)). Each group contained 96 patients. To select pairs of patients, propensity score matching was used. Image quality with regard to coronary arteries as well as pulmonary arteries was evaluated using quantitative and qualitative scores. Results In terms of the coronary arteries, there was no significant difference between both groups using quantitative (SNR AA 14.92 vs. 15.46; p = 0.619 | SNR LM 19.80 vs. 20.30; p = 0.661 | SNR RCA 24.34 vs. 24.30; p = 0.767) or qualitative scores (4.25 vs. 4.29; p = 0.672), respectively. With regard to pulmonary arteries, we found significantly higher quantitative (SNR RPA 8.70 vs. 5.89; p < 0.001 | SNR LPA 9.06 vs. 6.25; p < 0.001) and qualitative scores (3.97 vs. 2.24; p < 0.001) for ROI positioning in the LA than for ROI positioning in the AA. Conclusions ROI positioning in the LA or the AA results in comparable image quality of CT coronary arteriography, while positioning in the LA leads to significantly higher image quality of the pulmonary arteries. These results support ROI positioning in the LA, which also facilitates triple-rule-out CT scanning. Key Points • ROI positioning in the left atrium or the ascending aorta leads to comparable image quality of the coronary arteries. • ROI positioning in the left atrium results in significantly higher image quality of the pulmonary arteries. • ROI positioning in the left atrium is feasible to perform triple-rule-out CTA.

scholarly journals Advanced multimodality imaging of an anomalous vessel between the ascending aorta and main pulmonary artery in a dog

2014 ◽  
Vol 16 (1) ◽  
pp. 59-65 ◽  
Author(s):  
Lauren E. Markovic ◽  
Heidi B. Kellihan ◽  
Alejandro Roldán-Alzate ◽  
Randi Drees ◽  
Dale E. Bjorling ◽  
...  
Keyword(s):  
Pulmonary Artery ◽  
Multimodality Imaging ◽  
Main Pulmonary Artery ◽  
Ascending Aorta

A Comparative Study of the Main Pulmonary Artery and Ascending Aorta Biomechanical Behavior

2011 ◽  
Author(s):  
Bahar Fata ◽  
Elena Galdi ◽  
Michael S. Sacks
Keyword(s):  
Pulmonary Artery ◽  
Mechanical Behavior ◽  
Ductus Arteriosus ◽  
Main Pulmonary Artery ◽  
Blood Flow Rate ◽  
Biomechanical Properties ◽  
Ascending Aorta ◽  
External Diameter ◽  
Blood Flows ◽  
Biomechanical Behavior

During the prenatal period a state of physiologic pulmonary hypertension exists due to the equalization of pressures by the patent ductus arteriosus, resulting in similar wall thickness of the ascending aorta (AA) and main pulmonary artery (MPA). After birth, as the ductus arteriosus closes and pulmonary arterial pressure decreases, attenuation of medial smooth muscle occurs such that the ratio of medial thickness to external diameter decreases from about 25% in fetuses to less than 10% in infants 3 to 6 months of age. After the first year of life, thickness of the MPA is normally less than half that of the adjacent ascending aorta, although the diameters of the two great arteries remain the same relative to one another [1]. During homeostatic conditions, the total pulmonary and systemic blood flows are essentially identical. In spite of their comparable blood flow rate and common embryologic origin, the anatomic characteristics of these two segments of the cardiovascular system differ substantially [2]. Futhremore, both these arteries are affected by many congenital abnormalities and also are subject to hypertension. Knowledge of the normal biomechanical properties of these great arteries is important for surgical treamtment, angioplasty, and tissue engineering. It can also provide insight into the disease processes and is a prerequisite to the study of mechanical behavior during disease conditions. In this study we characterized the biaxial mechanical behavior of both arteries as a function of location, which has not been previously performed in the pulmonary trunk.

scholarly journals Successful sparing approach between the ascending aorta and the main pulmonary artery to the giant coronary aneurysm of the left main coronary artery

2020 ◽  
Vol 13 (4) ◽  
pp. e234203
Author(s):  
Ken Nakamura ◽  
Kouan Orii ◽  
Takayuki Abe ◽  
Hirofumi Haida
Keyword(s):  
Coronary Artery ◽  
Pulmonary Artery ◽  
Left Main Coronary Artery ◽  
Main Pulmonary Artery ◽  
Coronary Aneurysm ◽  
Ascending Aorta ◽  
Left Main ◽  
Giant Coronary Aneurysm

Coronary aneurysm located just above the left main coronary artery (LMT) is rare and difficult to treat. How the aneurysm is accessed is very important as it determines the result of the surgery. A 70-year-old man with a large coronary aneurysm (40 mm in diameter) in the LMT underwent surgery to prevent its rupture; however, there was severe adhesion. Initially, dissection of the ascending aorta or the pulmonary artery seemed necessary to access the aneurysm; however, the process was possible with limited dissection between the ascending aorta and the pulmonary artery, and we succeeded in firmly closing the LMT site of entry.

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