HDliveFlow with HDlive Silhouette Mode for Diagnosis of Persistent Right Umbilical Vein and Single Umbilical Artery
01 Mar 2018-Donald School Journal of Ultrasound in Obstetrics & Gynecology (Jaypee Brothers Medical Publishing)-Vol. 12, Iss: 1, pp 1-3
TL;DR: The first experience using HDliveFlow with the HDlive silhouette mode for the diagnosis of a persistent right umbilical vein (PRUV) and single umbilicals artery (SUA) in a fetus at 28 weeks and 5 days of gestation is presented.
Abstract: We present our first experience using HDliveFlow with the HDlive silhouette mode for the diagnosis of a persistent right umbilical vein (PRUV) and single umbilical artery (SUA) in a fetus at 28 weeks and 5 days of gestation. Two-dimensional color Doppler showed a single left umbilical artery around the bladder, and PRUV originating from the umbilical cord. HDliveFlow with the HDlive silhouette mode clearly demonstrated SUA and PRUV, and the spatial connection of PRUV to the inferior vena cava through the ductus venosus was detected. The course of the fetal intra-abdominal vasculatures was clarified in detail. Moreover, visualization of the anatomical landmarks, such as the spine was possible using the HDlive silhouette mode. This technique might be a beneficial adjunctive tool for diagnosing fetal peripheral vascular anomalies with advantages over the use of conventional color Doppler alone.
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TL;DR: 3D-US probably have better diagnostic performance than 2D- US assessing malignancies in adnexal masses, however, betterdesigned studies are needed to draw definitive conclusions.
Abstract: Ab s t r Ac t Background: Adnexal masses are a common clinical problem in gynecology. Most adnexal masses are benign, but few of them are malignant. An accurate diagnosis is essential for adequate management. There is a possibility to make a distinction between benign and malignant adnexal masses using two-dimensional grayscale ultrasound (2D-US) and color Doppler ultrasound, which are the best imaging techniques for that purpose. Objective: To review current state-of-art of 3D/4D ultrasound in assessing ovarian masses. Materials and methods: Narrative review of literature published from 1995 to 2017 using 3D/4D ultrasound for assessing adnexal masses masses. Results: Three-dimensional ultrasound (3D-US) has become a routine practice in many gynecologic ultrasound laboratories because it overcomes the limitations of two-dimensional ultrasound (2D-US). This technique allows a surface rendering of the internal aspect of the cyst’s wall. It can also present the masses in new different ways, such as “inversion mode” or “silhouette mode” or it can represent the vascular tree of the tumor using a 3D reconstruction, or even allowing a unique way for estimating the amount of vessels within the tumor or a part of the tumor. The reproducibility of 3D-US performed by different sonographers has been assessed in several studies. All of them have found that this technique is reproducible among different observers. The main limitations of all the studies are a few cases compared to the high prevalence of malignancies. Conclusion: 3D-US probably have better diagnostic performance than 2D-US assessing malignancies in adnexal masses. However, betterdesigned studies are needed to draw definitive conclusions.
TL;DR: The HDliveFlow silhouette mode with HDlive silhouette mode may facilitate the preoperative diagnosis of SST as an additional diagnostic tool along with conventional 2D power Doppler sonography.
Abstract: We present our experience of using the HDliveFlow silhouette mode with HDlive silhouette mode to diagnose sclerosing stromal tumor (SST) of the ovary. Two-dimensional (2D) sonography showed an echogenic solid tumor with some anechoic areas inside the mass. Two-dimensional power Doppler depicted peripheral vascularity with a few central vessels inside the mass. HDliveFlow clearly showed abundant peripheral vascularization with several penetrating vessels (scrubbing-brush appearance). The HDliveFlow silhouette mode with HDlive silhouette mode revealed numerous peripheral vessels with some penetrating vessels and a few cysts inside the mass. Magnetic resonance imaging (MRI) was highly suggestive of SST. Laparoscopic right salpingo-oophorectomy was performed, and the histopathologic diagnosis was SST of the right ovary. The HDliveFlow silhouette mode with HDlive silhouette mode may facilitate the preoperative diagnosis of SST as an additional diagnostic tool along with conventional 2D power Doppler sonography.
TL;DR: HDR Flow with HDlive silhouette clearly demonstrated spatial relationships between bilateral kidneys and intra-abdominal vasculatures and may provide information on assessing the spatial recognition of fetal MCDK.
Abstract: We present our experience of HDlive silhouette features of a fetal multicystic dysplastic kidney (MCDK) at 31 weeks and 1 day of gestation. Two-dimensional sonography revealed a left MCDK larger than the right normal kidney. HDlive silhouette showed multiple cysts of various sizes in the left big kidney on the left side of the spine. HDlive Flow with HDlive silhouette clearly demonstrated spatial relationships between bilateral kidneys and intra-abdominal vasculatures. HDlive silhouette may provide information on assessing the spatial recognition of fetal MCDK.
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TL;DR: Dairy therapy remains the first line of treatment of high blood cholesterol, and drug therapy is reserved for patients who are considered to be at high risk for CHD, and the fundamental approach to treatment is comparable.
Abstract: THE SECOND report of the Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel II, or ATP II) presents the National Cholesterol Education Program's updated recommendations for cholesterol management. It is similar to the first in general outline, and the fundamental approach to treatment of high blood cholesterol is comparable. This report continues to identify low-density lipoproteins (LDL) as the primary target of cholesterol-lowering therapy. As in the first report, the second report emphasizes the role of the clinical approach in primary prevention of coronary heart disease (CHD). Dietary therapy remains the first line of treatment of high blood cholesterol, and drug therapy is reserved for patients who are considered to be at high risk for CHD. However, the second report contains new features that distinguish it from the first. These include the following: Increased emphasis on See also pp 3002 and 3009.
28,495 citations
TL;DR: It is proposed that one of the major long-term consequences of inadequate early nutrition is impaired development of the endocrine pancreas and a greatly increased susceptibility to the development of Type 2 diabetes.
Abstract: In this contribution we put forward a novel hypothesis concerning the aetiology of Type 2 (non-insulin dependent) diabetes mellitus. The concept underlying our hypothesis is that poor foetal and early post-natal nutrition imposes mechanisms of nutritional thrift upon the growing individual. We propose that one of the major long-term consequences of inadequate early nutrition is impaired development of the endocrine pancreas and a greatly increased susceptibility to the development of Type 2 diabetes. In the first section we outline our research which has led to this hypothesis. We will then review the relevant literature. Finally we show that the hypothesis suggests a reinterpretation of some findings and an explanation of others which are at present not easy to understand.
3,107 citations
TL;DR: It is proposed that the epidemiological associations between poor fetal and infant growth and the subsequent development of type 2 diabetes and the metabolic syndrome result from the effects of poor nutrition in early life, which produces permanent changes in glucose-insulin metabolism.
Abstract: The thrifty phenotype hypothesis proposes that the epidemiological associations between poor fetal and infant growth and the subsequent development of type 2 diabetes and the metabolic syndrome result from the effects of poor nutrition in early life, which produces permanent changes in glucose-insulin metabolism. These changes include reduced capacity for insulin secretion and insulin resistance which, combined with effects of obesity, ageing and physical inactivity, are the most important factors in determining type 2 diabetes. Since the hypothesis was proposed, many studies world-wide have confirmed the initial epidemiological evidence, although the strength of the relationships has varied from one study to another. The relationship with insulin resistance is clear at all ages studied. Less clear is the relationship with insulin secretion. The relative contribution of genes and environment to these relationships remains a matter of debate. The contributions of maternal hyperglycaemia and the trajectory of postnatal growth need to be clarified.
2,520 citations
TL;DR: The “fetal origins” hypothesis states that coronary heart disease and the disorders related to it originate through adaptations that the fetus makes when it is under-nourished, which allow the fetus to survive and continue to grow but at the price of a shortened life.
Abstract: Background. Many human fetuses and infants have to adapt to a limited supply of nutrients, and in doing so they permanently change their physiology and metabolism. These programmed changes may be the origins of a number of diseases in later life, including coronary heart disease, stroke, diabetes and hypertension. Coronary heart disease. We have become accustomed to the idea that coronary heart disease, the commonest cause of death in the Western world, may result from the “unhealthy” lifestyle that is associated with increasing affluence. The influences of this “unhealthy” lifestyle (e. g. obesity, cigarette smoking, dietary fat, stress), however, go only a small way towards explaining why increasing affluence in the Third world is so regularly followed by epidemics of the disease, or why in the Western world these epidemics have risen steeply to become the commonest cause of death but thereafter have declined. Neither do they explain why the highest rates of coronary heart disease in Western countries occur among the poor? Fetal origins. Answers to these questions may come from an understanding of how the structure of the heart and processes such as blood pressure regulation and the way the body handles sugar and fat are established in the womb. The “fetal origins” hypothesis states that coronary heart disease and the disorders related to it – hypertension, adult-onset diabetes and stroke – originate through adaptations that the fetus makes when it is under-nourished. Unlike adaptations made in adult life those made during early development tend to have permanent effects on the body's structure and function – a phenomenon sometimes referred to as programming. They allow the fetus to survive and continue to grow but at the price of a shortened life.
1,135 citations
TL;DR: Because previous methods of making roentgenograms of the knee in the axial projection were found to be unsatisfactory, a simple, accurate, and reproducible technique was devised to measure patellofemoral joint congruence.
Abstract: Because previous methods of making roentgenograms of the knee in the axial projection were found to be unsatisfactory, a simple, accurate, and reproducible technique was devised. With the patient supine, the knees are flexed 45 degrees over the end of the table and the legs are supported. The central x-ray beam is inclined downward 30 degrees from the horizontal to strike the film cassette (placed distal to the patellae) at a right angle. The congruence angle , which measures the relationship of the patellar articular ridge to the intercondylar sulcus, was created to measure patellofemoral joint congruence. More than 16 degrees of lateral subluxation of the patella was found to be abnormal at the ninety-fifth percentile in 100 normal subjects.
946 citations