State of Utah v. Christena White : Appellant\u27s Reply Brief to Appellee\u27s Brief

DISTRICT COURT NO. 021900588FS APPELLANT COURT NO. 20040201-C

Doppler ultrasound imaging of the carotid and vertebral arteries

Özet – Karotis arter hastalığının sıklığı yaş ve kardiyovasküler risk faktörlerine bağlı olarak artmaktadır. Belirgin karotis arter darlığı, inme ve diğer serebrovasküler olayların gelişimi ile yakından ilişkilidir. Doppler ultrasonografi, karotis ve vertebral arterlerin incelenmesinde kullanılan güvenilir, invaziv olmayan bir görüntüleme yöntemidir. Karotis arter sisteminin doğru bir şekilde değerlendirilmesi yeterli teknik bilgi ve deneyimi gerektirmektedir. Bu derlemede, karotis arter sisteminin Doppler ultrasonografi ile doğru bir şekilde nasıl değerlendirilmesi gerektiği hakkında bilgi verilmesi amaçlandı.Summary – The prevalence of carotid artery diseases increases with age and exposure to cardiovascular risk factors. Significant carotid artery stenosis is closely associated with the development of stroke and cerebrovascular events. Doppler ultrasound imaging is a noninvasive and useful modality for the examination of carotid and vertebral arteries. However, proper investigation of the carotid artery system requires sufficient technical knowledge and experience. This review gives information about the techniques of appropriate examination of the carotid artery system

Diagnostic algorithms in pulmonary hypertension

İstanbul Bilim Üniversitesi, Tıp Fakültesi.Pulmoner hipertansiyon prognozu kötü olan ciddi bir hastalıktır. Pulmoner hipertansiyonun tanısı ve değerlendirilmesi, hastalığın tanımında, tanı tekniklerinde ve takibinde son yıllarda yapılan değişikliklerle beraber hızla gelişmektedir. Pulmoner hipertansiyon ile birlikteliği bulunan farklı durumlar ve yeni tanı yöntemleri sistematik bir tanı algoritması oluşturma ihtiyacını doğurmuştur. Bu derleme, pulmoner hipertansiyona son yıllarda yapılan değişiklikleri de kapsayan tanı yaklaşımından bahsetmektedir.Pulmonary hypertension is a serious disease with a poor prognosis. The diagnosis and assessment of pulmonary hypertension is evolving rapidly with changes in the definition of the disease, diagnostic techniques and follow-up assessment. Different conditions associated with pulmonary hypertension and new diagnostic techniques have led to a need for a systematic diagnostic approach. This review article presents an update on alterations in the diagnostic algorithm

APICAL TROMBUS in a PATIENT WITH NORMAL LEFT VENTRICULAR SYSTOLIC FUNCTION

A 54-year old male patient presented to the emergency department with a painful right hand and diagnosed as right axillary artery occlusion with color Doppler ultrasound. The further multi-modality cardiac imaging tests showed an apical thrombus in left ventricle apex which does not have any wall motion abnormalities.</jats:p

Czynność mechaniczna lewego przedsionka u chorych, którzy przebyli zawał ściany przedniej serca: analiza na podstawie obrazowania wektorów prędkości

Background: The contribution of the left atrium (LA) to left ventricular (LV) function increases in myocardial infarction (MI).Aim: To evaluate LA function by using volume measurements and a novel strain imaging method, namely velocity vector imaging (VVI), in patients with acute anterior MI.Methods: Twenty-four patients with previous anterior MI (aged 63.8 ± 4.2 years, 56% men) and 30 healthy controls (aged 60.7 ± 5.3 years, 60% men) were enrolled. LA volume measurements and VVI-derived LA peak systolic strain (S), strain rate (SRs), early diastolic (ESRd) and late diastolic strain rate (LSRd) were measured. LV diastolic function was analysed by pulsed wave-Doppler and tissue velocity ımaging.Results: LA maximum volume index was increased in patients compared to controls (28.83 ± 7.2 vs. 19.72 ± 6.27 mL/m2,p = 0.0001). As LA active emptying volume index and fraction were increased (6.16 ± 0.7 vs. 5.46 ± 0.99 mL/m2, p = 0.009 and 22.16 ± 3.07 vs. 16.78 ± 2.93%, p = 0.0001, respectively), passive emptying volume index and fraction were decreased in the patient group (6.09 ± 0.57 vs. 7.57 ± 0.61 mL/m2, p = 0.0001 and 45.76 ± 6.86 vs. 56.45 ± 5.36%, p = 0.0001, respectively). However, total emptying volume index of the LA was similar between the two groups. VVI-derived LA peaksystolic S, SRs and ESRd were impaired in the patient group. LA LSRd was similar between the groups. LA active empty ingfraction was positively correlated with LV diastolic dysfunction and negatively correlated with LV systolic dysfunction.Conclusions: We demonstrated increased LA booster function and decreased LA conduit and reservoir functions in patients with prior anterior MI. Improvement in LA booster function correlated with the degree of LV systolic and diastolic dysfunction, suggesting a compensatory response of the LA.Wstęp: Wpływ czynności lewego przedsionka (LA) na czynność lewej komory (LV) zwiększa się w przypadku wystąpienia zawału serca (MI).Cel: Celem badania była ocena czynności LA na podstawie pomiarów parametrów objętościowych i nowych metod obrazowania odkształceń mięśnia sercowego, obrazowania wektorów prędkości (VVI) u chorych z ostrym MI ściany przedniej.Metody: Do badania włączono 24 chorych, którzy przebyli MI ściany przedniej (wiek: 63,8 ± 4,2 roku, 56% mężczyzn) i 30 zdrowych osób stanowiących grupę kontrolną (wiek: 60,7 ± 5,3 roku, 60% mężczyzn). Zmierzono parametry objętościowe LA i wykorzystano metodę VVI do oceny maksymalnego odkształcenia (S, strain) LA w czasie skurczu, tempa odkształcenia w czasie skurczu (SRs, strain rate), a także wczesnorozkurczowe (ESRd) i późnorozkurczowe (LSRd) tempo odkształcenia. Czynność rozkurczową LV oceniano na podstawie obrazowania metodą tkankowej echokardiografii doplerowskiej.Wyniki: U pacjentów po MI wskaźnik maksymalnej objętości LA był większy niż w grupie kontrolnej (28,83 ± 7,2vs. 19,72 ± 6,27 ml/m2; p = 0,0001). Ponieważ objętość i frakcja aktywnego opróżniania LA były zwiększone (odpowiednio 6,16 ± 0,7 vs. 5,46 ± 0,99 ml/m2.Wnioski: Wykazano, że u pacjentów, którzy przebyli MI, nastąpiło zwiększenie wspomagającej czynności LA i ograniczenie roli LA jako drogi przepływu oraz zbiornika. Poprawa wspomagającej czynności LA korelowała ze stopniem dysfunkcji skurczoweji rozkurczowej LV, co wskazuje na kompensacyjną odpowiedź LA

Assessment of subclinical left ventricular systolic function using strain imaging in the follow-up of patients with chronic mitral regurgitation

WOS: 000411505100006PubMed ID: 28694396Objective: Determining optimal timing for surgery in asymptomatic mitral regurgitation (MR) remains a challenge. The aim of this study was to evaluate subclinical changes in left ventricular (LV) systolic functions using velocity vector imaging (VVI) during follow-up of patients with chronic mitral regurgitation (MR). Methods: A total of 54 patients (mean age: 57.9 +/- 8 years; 55% male) with moderate-to-severe MR and normal LV ejection fraction (EF), and 30 healthy controls (mean age: 56 +/- 6.5 years; 55% male) were evaluated using conventional echocardiography and VVI at baseline. Results: At the end of 12 months, measurements of 45 MR patients were repeated. There was no significant change in LV dimensions or EF on follow-up. LV peak systolic strain and strain rate (SR) were decreased in patients with MR compared with controls (strain: 16.29 +/- 3.30 to 23.4 +/- 1.9; p=0.0001 and SR: 0.93 +/- 0.39 to 4.9 +/- 0.6; p=0.0001) at baseline. Impairment was more significant on follow-up. (strain: 13.76 +/- 2.68 and SR: 0.27 +/- 0.14; p=0.0001). Conclusion: VVI-derived strain imaging might be used in the assessment of subclinical LV dysfunction and its progression during follow-up of patients with chronic MR especially in the decision of optimal timing for surgery