Chronic Pain and Disability in Diabetes
Medha N. Munshi, Lewis A. Lipsitz in Geriatric Diabetes, 2007
Measurement of ankle and brachial artery systolic blood pressures using a Doppler stethoscope and blood pressure cuffs allows calculation of the ankle/brachial index (ABI), which is normally 0.9 to 1.2. An ABI of less than 0.90 is 95% sensitive and 99% specific for the diagnosis of PAD. The lower the ABI, the more severe the restriction of arterial blood flow, and the more serious the ischemia. With ABIs between 0.25 and 0.4, resting pain and tissue loss are often found. Patients with calcified arteries from diabetes mellitus or renal failure occasionally have relatively noncompressible arteries leading to falsely elevated ABI values in the normal range. In addition to measuring arterial pressure in nonpalpable arteries, Doppler ultrasound methods allow characterization of the flow velocity waveform. Finding biphasic flow at the groin or monophasic flow more distally is evidence of arterial obstruction even when ABI measurements are falsely increased to normal levels because of calcification. Duplex ultrasonography combines Doppler frequency measurements with two-dimensional images of blood vessels. The severity of flow restriction induced by an arterial stenosis can be accurately assessed by this most comprehensive noninvasive method.
Life Care Planning for Spinal Cord Injury
Roger O. Weed, Debra E. Berens in Life Care Planning and Case Management Handbook, 2018
SCI patients are at substantially elevated risk for cardiovascular disease as they age with the sequelae of their injuries (Lavela et al., 2012). In fact, cardiovascular diseases currently account for approximately 46% of all deaths in SCI persons who are greater than 30 years post-injury (Szlachcic et al., 2007). There are a variety of factors that are responsible, including reduced HDL cholesterol levels, higher incidences of obesity, and less exercise relative to the general population. Non-ambulatory individuals are also at risk for the development of phlebitis, deep venous thromboses, and pulmonary emboli, resulting from reduced sympathetic tone and diminished venous return. Therefore, it is critical that preventative measures be taken that include the frequent use of anti-embolic hose as well as frequent lower extremity exercises to reduce venous stasis. Individuals who are at particular risk for the development of deep venous thromboses may require chronic anticoagulation or even placement of devices within the inferior vena cava that can prevent clots from entering the pulmonary vasculature. Furthermore, the clinician should have a low threshold for ordering screening tests, such as Doppler ultrasonography to evaluate for the presence of clots that would necessitate more aggressive management.
Wound Healing, Ulcers, and Scars
Ayşe Serap Karadağ, Lawrence Charles Parish, Jordan V. Wang in Roxburgh's Common Skin Diseases, 2022
Chronic venous disease can lead to three main dermatologic manifestations: Lipodermatosclerosis: A panniculitis characterized by inflammation of the subcutaneous fat, which causes painful hardening of the skin and an “inverted champagne bottle” appearance of the lower legs.Elephantiasis nostra verrucosa: Chronic venous insufficiency leading to dilation of superficial lower leg veins. With time, this leads to superimposed hyperkeratotic papulonodules and cutaneous hypertrophy (Figure 17.2). If left untreated, enlargement of the extremity may occur, which may lead to functional impairment. Venous stasis ulcers: Single or multiple shallow ulcers characterized by well-defined, irregularly shaped borders. Lesions most commonly occur around the medial calf or malleolus. Rarely, squamous cell carcinoma (SCC) can develop in long-standing ulcers.Laboratory studies: No laboratory studies are required to diagnose venous insufficiency or ulcerations. Duplex ultrasonography can assess the degree of venous insufficiency, show perforating veins, and rule out potential complications, such as deep vein thrombosis. Phlebography may also be performed in conjunction with x-ray, CT, or MRI. If the diagnosis remains uncertain, a skin biopsy can be performed for histologic examination.
Preoperative evaluation of moyamoya spontaneous anastomosis of combined revascularization donor vessels in adults by duplex ultrasonography
Published in British Journal of Neurosurgery, 2018
Li Chen, Bin Xu, Yong Wang, Yujun Liao, Huiwen Pan, Yi Wang
Duplex ultrasonography is a noninvasive, repeatable, and economical technique, which is widely applied in the diagnosis of cerebral diseases. Nowadays, duplex ultrasonography is the first choice to obtain images of the carotid artery and could also be applied to evaluate the cerebral hemodynamics.8 Several studies have focused on the use of ultrasonography in the direct revascularization,9,10 whereas the publications on indirect revascularization techniques are scarce. We previously reported the application of duplex ultrasonography in combined (direct/indirect) revascularization in adult moyamoya disease.11 In this study, we assessed the preoperative application of duplex ultrasonography in the analyses of spontaneous anastomoses from the external carotid artery (STA and MA) to the intracranial vessels.
Associations among temporal and large artery abnormalities on vascular ultrasound in giant cell arteritis
Published in Scandinavian Journal of Rheumatology, 2021
MA DiIorio, PS Sobiesczcyk, C Xu, W Huang, JA Ford, SS Zhao, DH Solomon, WP Docken, SK Tedeschi
Simultaneous colour Doppler and duplex ultrasonography was performed using an 8–18 MHz linear transducer (>15 MHz for temporal arteries, <15 MHz for large arteries) (LOGIQ S8 and E9 ultrasound systems; GE Healthcare, Chicago, IL, USA). The grey scale was set to the highest available frequency, with a dynamic range of 40–50 dB and focus set to approximately 5 mm below the skin surface. Colour Doppler was set to the highest frequency, with a pulse repetition frequency (PRF) of 2 kHz, for temporal arteries, and a lower frequency, with a PRF of 3.5 kHz, for large arteries. The frame rate was set as high as possible. The colour PRF was 2.5 kHz Doppler frequency shift and was readjusted throughout the examination with velocity changes. Colour gain was set such that colour covered the lumen entirely, and the colour box angle correction was set to minimize the isonation angle. Power Doppler was used if occlusion was suspected. Pulse Doppler settings were 2 kHz for temporal arteries and 3–5 kHz for large arteries, and were adjusted according to flow velocities. The Doppler sample volume size was the same diameter as the arterial lumen (0.7 mm for temporal arteries; 1 mm for large arteries) and was positioned in the middle of the vessel with an angle correction of 60 degrees or less.
Bilateral Fascicular Third Nerve Palsy in Posterior Circulation Stroke
Published in Neuro-Ophthalmology, 2019
Olaf Eberhardt, Mirjam Hermisson, Gisela Eberle-Strauss, Helge Topka
No angiographic or neurosonological pathology affecting the left vertebral artery was shown, in particular no signs of vertebral artery dissection. A diagnostic work-up to identify the source of embolic basilar artery occlusion made a cardioembolic origin probable. Transcranial ultrasound studies after agitated saline had been injected intravenously revealed a single embolic signal at rest and about 20 embolic signals following Valsalva manoeuvre. Right-to-left shunt following Valsalva manoeuvre due to patient foramen ovale was confirmed by transoesophageal echocardiography. A hypermobile septal aneurysm was present, but there was no intracardiac thrombus or aortic atheroma. Left ventricular function and flow velocity in the left atrial appendage were normal. Importantly, no crural venous thrombosis was detected by duplex ultrasonography. Apart from a single supraventricular run over only seven beats no relevant cardiac arrhythmia was detected in several 24-h electrocardiographies. Blood lipids, coagulation screening, and other blood tests were unremarkable, except for slight hyperuricaemia. Therapy with acetylsalicylic acid and a statin was initiated.
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