Application Value of Contrast-Enhanced Ultrasound In The Diagnosis of Intermediate Trophoblastic Tumours

Background: As the rarest gestational trophoblastic neoplasia (GTN), intermediate trophoblastic tumours (ITTs) are very difficult to diagnose before surgery due to the lack of specificity of clinical manifestations. Routine colour Doppler ultrasonography is currently the simplest and reproducible imaging method for diagnosing ITTs, but it is not as specific as other tumours. Through the research and analysis of colour Doppler ultrasound images (CDFI) and contrast-enhanced ultrasonography (CEUS) images of ITTs, the ultrasound characteristics and CEUS perfusion characteristics are summarized, and these findings can provide a reference for the correct diagnosis of ITTs.Methods: Seven ITT patients were diagnosed and treated in our institution from January 2016 to August 2020, and the clinical data of all patients were retrospectively collected and analysed. Two sonographers who had worked for more than 5 years analysed the characteristics of the ultrasound and CEUS. Among them, the characteristics of CEUS are summarized and analysed from the four aspects of contrast enhancement method, time, boundary, and intensity. All cases were diagnosed with pathological support by ITTs.Results: The most common clinical symptoms of ITT are vaginal bleeding and amenorrhea. The serum ß-human chorionic gonadotropin (serum-hCG) level was mainly a low-grade increase, but to determine whether the serum-hCG level can be used as one of the indicators for monitoring ITT recurrence or metastasis, a large sample data analysis is needed. The lesion location, internal echo changes, and blood flow signals of ITTs were not significantly specific compared with those of other GTNs. However, the CEUS performance of ITTs has certain characteristic changes, in which the enhancement mode was mainly regional enhancement, the arterial phase showed slow, equal-slightly high enhancement, and the enhanced bounders were not very clear. Compared with the CEUS performance of other GTNs, it has a certain specificity.Conclusions: Certain characteristic changes in CEUS of ITTs, combined with clinical features, can provide help for the accurate diagnosis of ITT.Trial registration: For non-clinical or non-health care intervention on human participants of what the article reports.

Evaluation of radial and ulnar artery blood flow after radial artery decannulation using colour Doppler ultrasound

Background There is a lack of reports in the literature regarding changes in radial artery blood flow after decannulation. The objective of this study was to investigate changes in radial and ulnar artery blood flow after radial artery decannulation using Doppler ultrasound and to explore the factors that influence radial artery blood flow recovery. Methods In current observational study, we used colour Doppler ultrasound to measure the cross-sectional area of the radial (SR) and ulnar artery (SU) and peak systolic velocity of the radial (PSVR) and ulnar artery (PSVU) for both hands at four time points in patients with radial artery cannulation: pre-cannulation (T0), 30 min after decannulation (T1), 24 h after decannulation (T2), and 7 days after decannulation (T3). Repeated measures analysis of variance and logistic regression analysis were performed to analyse the data. Results Overall, 120 patients were included in the present study. We obtained the following results on the side ipsilateral to the cannulation: compared with T0, the ratio of PSVU/PSVR increased significantly at T1 and T2 (p < 0.01); compared with T1, the ratio of PSVU/PSVR decreased significantly at T2 and T3 (p < 0.01); compared with T2, the ratio of PSVU/PSVR decreased significantly at T3 (p < 0.01). Female sex (OR, 2.76; 95% CI, 1.01–7.57; p = 0.048) and local hematoma (OR 3.04 [1.12–8.25]; p = 0.029) were factors that were significantly associated with the recovery of radial artery blood flow 7 days after decannulation. Conclusions There was a compensatory increase in blood flow in the ulnar artery after ipsilateral radial artery decannulation. Female sex and local hematoma formation are factors that may affect the recovery of radial artery blood flow 7 days after catheter removal.

Clinical evaluation and management of scrotal swelling

Background: The present study was conducted with the main purpose to identify the mode of presentation, various treatment modalities and outcome of these with their complications.Methods: This prospective study was carried out on a total of 100 subjects presented with scrotal swellings. Exhibiting symptoms were noted including discomfort, painless swelling, urine symptoms and fever. Questionnaires were used to analyse all the predisposing factors of patients, which were then categorized as idiopathic, urinary problems, trauma or previous history. Ultrasound as well as colour Doppler was carried out on all subjects. The options for treatment were either surgical or conservative. The cases treated were recorded accordingly and follow up was done.Results: The majority of study patients, that is, 56%, suffered with scrotal swelling on the right side, followed by left (40%) and bilateral side (4%). 63% of the subjects were presented with symptoms of painless swelling. Whereas 27% of the study subjects were presented with symptoms of pain and fever and 10% of them showed only the symptoms of pain. The majority of study subjects, that is, 71% were treated with surgical modality. Whereas 29% with conservation modality. The most common USG finding found among the study subjects was hydrocoele (37%). 37 (37.0%) subjects having hydrocoele suffered postoperative complications.Conclusions: Younger age group and manual labourers were more prone to scrotal swellings. Few of the operated cases developed postoperative complications like epididymoorchitis. There is a resurgence of thorough clinical examination to establish a diagnosis in patients with scrotal swelling.

Female Sexual Dysfunction in Diabetes: Mechanisms, Diagnosis and Treatment

: Female sexual dysfunction (FSD) is an underinvestigated comorbidity of diabetes mellitus, often not evaluated in diabetes clinics. Diabetic women should be encouraged to talk about this topic by their diabetologist, because these problems could be comorbid to cardio-metabolic alterations, as it happens in the male counterpart. This review summarizes evidence on sexual dysfunction characteristics in diabetic women, exploring possible underlying pathogenic mechanisms. The role of hypoglycemic drugs in this context was also evaluated. To date, no specific questionnaire has been designed for the assessment of sexual dysfunctions in diabetic female patients but the use of colour-doppler ultrasound of clitoral arteries has been highlighted as a useful tool for the assessment of cardiovascular risk in these women. Similarly, no specific guidelines are available for the treatment of FSD in the diabetic population but patients should be supported to have a healthy lifestyle and, in the absence of contraindications, can benefit from already approved treatments for FSD.

TO ASSESS SAFETY OF WITHHOLDING ANTITHROMBOTIC THERAPY IN PATIENTS WITH LOW OR INTERMEDIATE PROBABILITY OF PULMONARY EMBOLISM

Background & Method: The study was carried out in the Department of Radio diagnosis, Index Medical College, Hospital & Research Centre, Indore, M.P. including 100 chronic bedridden patients with an aim to assess safety of withholding antithrombotic therapy in patients with low or intermediate probability of pulmonary embolism. Result: Males represented about 62% of the entire sample. Majority of male patients were in age group 50 and above. Majority (29%) of female patients were of age group of 20 to 40 yrs. On the basis of B-mode sonography and colour Doppler 20% patients were diagnosed to have acute deep vein thrombosis and 12 % patients were diagnosed to have chronic deep vein thrombosis. Out of 100 chronic bedridden patients in the study, 40% were suspected to have deep vein thrombosis on the basis of clinical signs,45% had a positive d-dimer test, 28% were positive on impedence plethysmography. 30% patients were diagnosed to have deep vein thrombosis by B mode sonography and 32% were diagnosed to have deep vein thrombosis by colour Doppler. Conclusion: Only 32 patients were positive for deep vein thrombosis out of 100 patients so it is safe to withhold unnecessary anticoagulation therapy in all chronic bed ridden patients because even after 3 month follow up only 1% patients were positive. Impedence plethysmography is less sensitive than ultrasonography and D-dimer test is more sensitive but it lacks specificity so ultrasound and colour Doppler is more sensitive in clinically suspected DVT patients. Ultrasonography and colour Doppler is better predictor of DVT because it is more sensitive and specific, non-invasive, painless, widely available, easy to use, less expensive, no ionizing radiation. Keywords: antithrombotic, pulmonary &embolism.

The Use of Doppler Ultrasound to Diagnose Deep Vein Thrombosis of the Lower Limbs

In most cases of pulmonary embolism, death occurs as a result of deep vein thrombosis (DVT) of the lower extremities. Therefore, to avoid DVT complications and sequel, DVT must be diagnosed as early as possible and this can be achieved via B-mode and colour Doppler imaging. The present paper seeks to investigate the suitability of the imaging method of ultrasound for lower extremity DVT diagnosis and to explore the outcomes of the use of this method in DVT cases. To this end, the paper undertakes a retrospective descriptive study of 50 cases of ultrasound-based diagnosis of DVT at King Khalid Hospital in the period between January 2019 and August 2020. Half of the cases were subjected to compression, colour, and duplex ultrasound, 14 cases were subjected to compression and duplex ultrasound, and 11 cases were subjected to compression and colour Doppler. The mean age across all cases was 46.2±19.9 years. The majority of cases (56%) were in the age range 22-41 years old (n=28), while 28% of cases were in the age range 42-61 years old (n=14), 6% of cases were in the age range 62-81 years old (n=3), and 10% of cases were in the age range 82-102 years old (n=5). Regarding sex, females accounted for 60% of cases, while males accounted for the rest of 40%. Furthermore, in 90% of cases (n=45), just one lower extremity was affected, whereas in 10% of cases (n=5), both lower extremities were affected. Regarding thrombus location, it was found mostly in the area above the knee, particularly the popliteal vein (34%), common femoral vein (18%), and superficial femoral vein (20%). Moreover, 2% of cases presented thrombus in the calf vein. In 26% of cases, multiple veins were affected. DVT was acute in 76% of cases (n=38) and chronic in 24% of cases (n=12). It is concluded that symptomatic and at-risk cases benefit from the use of ultrasound for DVT diagnosis. The suitability of this method stems from its lack of invasiveness and capability to assess thrombus location, magnitude, and stage.