Introdução: O Doppler tecidual (DT) surgiu como uma técnica ecocardiográfica para registro das velocidades do miocárdio e evoluiu para a determinação da deformação miocárdica regional com medida do strain rate (SR) e strain longitudinal e radial unidimensionais. Nosso objetivo foi determinar padrões de normalidade em neonatos e analisar seqüencialmente esses índices em períodos de alta e baixa resistência vascular pulmonar. Casuística e Método: Selecionaram-se 55 crianças com idade média de 20,14 ± 14,0 horas, constituindo o Grupo I (G I). Um segundo exame foi realizado em 30 crianças que retornaram após 31,9 ± 2,9 dias de vida, constituindo o Grupo II (G II). As velocidades do DT pulsado foram obtidas em cortes transversais (R) e longitudinais (L) do ventrículo esquerdo (VE) em posições apical 4 e 2 câmaras e no VD (paredes livre e inferior). Foram medidas velocidades sistólicas (onda Sm), diastólica inicial (Em), diastólica final (Am) de pico e a relação Em/Am. Pelo menos três ciclos cardíacos consecutivos com taxa de quadros/s superior a 300 foram digitalmente obtidos nos cortes mencionados e analisados posteriormente utilizando programa específico para medida das curvas de SR/strain e seus componentes sistólico, diastólico inicial e final. Resultados: As velocidades demonstraram gradiente bem definido com redução progressiva na direção base-ápice do coração. As velocidades do VD foram superiores às do VE quando comparadas com as medidas nas paredes septal (S), anterior (A) e lateral (L). No GI verificamos diferença significativa entre as medidas do SR/strain sistólicos do segmento basal da parede S em relação à apical (-1,90 ± 0,61, - 25,90 ± 4,90 vs -1,66 ± 0,25, - 24,23 ± 3,08), p=0,04 e p=0,02 e do segmento médio em relação ao apical (p=0,01 e 0,02). A avaliação regional do VD demonstrou strain sistólico maior no segmento médio em relação ao basal (-33,20 ± 6,34 vs -28,38 ± 4,90, p=0,00) e em relação ao segmento apical (-33,20 ± 6,34 vs -31,95 ± 5,06, p=0,021). Os valores absolutos de SR/strain e todos os seus componentes foram maiores na direção R quando comparados com a L (SR sistólico 2,99 ± 0,78 s-1 vs (-)1,90 ± 0,60 s-1 strain sistólico 49,72% ± 12,86% vs (-) 25,86% ± 4,83 p=0,00). Quando comparamos os GI e GII verificamos redução do strain sistólico do VE na direção R e L nas paredes S, L e A em todos os segmentos. O SR sistólico reduziu apenas na porção basal da parede L (-1,91 ± 0,46 s-1 vs - 1,71 ± 0,33 s-1, p=0,02). O VD apresentou no GII aumento significativo do strain sistólico e diastólico inicial em todos os segmentos e paredes. O SR sistólico também apresentou aumento dos valores nos segmentos basal e médio de sua parede livre e na parede inferior. A correlação entre a onda Sm e SR/strain sistólicos não foi significativa. Conclusão: Os índices regionais de deformação miocárdica constituem técnica clínica reproduzível em neonatos e podem monitorar alterações seqüenciais fisiológicas da circulação neonatal precoce e tardia. São mais robustos que as velocidades na quantificação da função regional. / Background: Color Doppler myocardial imaging (CDMI) has emerged as an echocardiographic technique for determining myocardial velocities and has been further developed to allow the determination of one-dimension regional longitudinal and radial strain rate (SR)and strain. Our goal was to determine normal values in neonates and sequentially analyse these indices in periods of high and low pulmonary vascular resistance. Study population and methods: Fifty-five term newborns with mean age of 20.14 ± 14.0 hours were selected to be part of Group I (GI). A second echo study was performed on 30 children that had returned with 31.9 ± 2.9 days after birth, being Group II (GII). Pulsed wave Doppler tissue velocities (PWDTV) were obtained in short axis (R) and longitudinal (L) axis of the left ventricle (LV) in apical 4 and 2 chamber view and in 4 and 2 chamber of the right ventricle (RV), including RV free lateral and inferior walls. Peak systolic (Sm), peak early diastolic (Em) and peak late diastolic (Am) motion velocities and Em/Am ratio were measured. At least three consecutive cardiac cycles with frame rate more than 300 fps were stored in digital format from the mentioned views for offline analysis by using dedicated software for measuring peak systolic and peak early and late diastolic SR/strain. Results: PWTDV have shown a well-defined gradient with progressive peak reduction from base to apex. RV velocities were higher than those of the LV whem compared to septal (S), anterior (A) and lateral (L) walls. In GI there was a significant difference between systolic SR/strain measurement of basal S segment in relation to apical (-1.90 ± 0.61, -25.90 ± 4.90 vs -1.66 ± 0.25, - 24.23 ± 3.08), p=0.04 e p=0.02 and from the mid in relation to the apical segment (p=0.01 e 0.02). Regional RV longitudinal function showed that systolic strain recorded from the mid segment was significantly higher than that recorded from the basal segment (-33.20 ± 6.34 vs -28.38 ± 4.90, p=0.00) and that from the apical segment (-33.20 ± 6.34 vs ?31.95 ± 5.06, p=0.021). The absolute and all components of SR/strain were significantly higher in R direction when compared to the L ones (systolic SR 2.99 ± 0.78 s-1 vs (-)1.90 ± 0.60 s-1 systolic strain 49.72% ± 12.86% vs (-)25.86% ± 4.83 p=0.00). When comparing data from GI and GII, we noticed reduction of LV systolic strain in the second group for both R and L, in all segments of S, L and A walls. Systolic SR showed reduction of the values in GII only in the basal segment of the L wall (-1.91 ± 0.46 s-1 vs ?1.71 ± 0.33s-1, p=0.02). Regional RV function showed systolic and early diastolic strain significantly higher in all segments of wall in GII. Systolic SR also showed higher values in the basal and mid segments of RV free lateral and inferior wall in GII when comparing to GI. The correlation between peak systolic velocity Sm and peak systolic SR/strain was not significant. Conclusion: Regional myocardial deformation indices are reproducible clinical techniques in neonates and can monitor physiological sequential circulatory changes of the early and late neonatal period. They are more robust than velocities in the quantification of the regional myocardial function.

Current technology used to diagnose hearing disorders is limited. This is mostly due to the fact that the auditory structures are very small and not easily accessible with existing imaging technologies. The objective of this dissertation was to investigate the potential of high-frequency ultrasound as a tool for exploring the anatomy of the auditory system. Three studies were conducted in order to demonstrate the feasibility of high-frequency ultrasound as a diagnostic technology for hearing disorders. In the first study, an in-house developed 50 MHz annular array-based ultrasound system was used to provide ex-vivo images of auditory structures in cadaveric temporal bones. It was shown that the spatial resolution was sufficient to visualize a high level of detail of the ossicular bones of the middle ear as well as intra-cochlear structures of the inner ear. In the second study, a 50 MHz 1.26? pitch phased array ultrasound transducer was designed for imaging intra-cochlear structures through the round window membrane. As this element pitch results in large grating lobe artifacts, novel transmit beamforming techniques were developed to suppress grating lobes resulting from this large-pitch array. Theoretical techniques using the impulse-response simulation method and experimental verification using high-frequency linear array ultrasound system (Vevo 2100, VisualSonics, Canada) showed that these techniques were able to suppress grating lobe levels up to 40 dB. In the third study, a needle mounted 45 MHz single-element ultrasound probe was fabricated in order to measure the vibrations of intra-cochlear structures on human cadavers. Basilar membrane velocimetry measurements were successfully performed using pulsed-wave Doppler ultrasound in the frequency range between 100 Hz-2 KHz. The measured velocity of the basilar membrane and the round window membrane showed that the middle ear resonance frequency near 1 KHz was present over multiple temporal bones. This is the first work that has explored the human auditory system with high resolution ultrasonic visualization and Doppler velocimetry.

Orientador: Eunice Oba / Resumo: Estratégias que busquem resultados reprodutivos superiores em búfalos devem ser pesquisadas. Para tanto, a gonadotrofina coriônica equina (eCG) vem sendo estudada apresentando resultados satisfatórios em búfalas, porém os mecanismos envolvidos na ação da eCG não foram totalmente esclarecidos. A termografia digital por infravermelho apresenta importância no estudo das variações de temperaturas da vulva durante o ciclo estral, podendo auxiliar na detecção do estro nesta espécie. O objetivo do presente estudo foi avaliar as variações morfológicas e de vascularização dos folículos e corpo lúteo (CL) e nas concentrações plasmáticas de progesterona (P4) e cortisol durante protocolo hormonal para a sincronização da ovulação com e sem eCG. Também objetivou-se avaliar a influência da fase reprodutiva e do clima sobre a temperatura da superfície da vulva em búfalas Murrah. Os animais foram aleatoriamente divididos em dois grupos, grupo com eCG (eCG, n=20) e grupo sem eCG (controle, n=20). No primeiro dia do protocolo hormonal (Dia 0), as vacas receberam um dispositivo intravaginal de P4 e administração de benzoato de estradiol. No dia 9, removeu-se o dispositivo de P4, administrou-se PGF2α em todas as búfalas e eCG nos animais do grupo eCG. No dia 11, foi administrado GnRH. A partir do dia 9, foram realizadas ultrassonografias doppler no período da tarde e termografia digital pela manhã e à tarde, diariamente até o dia 16 e depois nos dias 20, 24, 28 e 32, visando avaliar o desenvolvim... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Strategies that seek better reproductive results in buffaloes should be researched. Thus, equine chorionic gonadotrophin (eCG) was studied presenting satisfactory results when used in buffalo during the breeding season and anestrous period, but the mechanisms involved in the reproductive improvement observed with the eCG implementation were not fully understood. The superficial digital thermography may be important in the study of temperature variations of the vulva inherent to the estrous cycle, and may help in the detection of estrus in this species. The objective of the present study was to evaluate the morphological and irrigation alterations in the follicles and corpus luteum (CL) and the changes in plasma concentrations of progesterone (P4) during hormonal protocol for ovulation synchronization with and without eCG. As well the aim of this study was to evaluate the influence of the reproductive phase and the climate on the superficial vulvar temperature in Murrah buffaloes. The animals were randomly divided into two groups, group with eCG (eCG, n = 20) and group without eCG (control, n = 20). On the first day of the hormonal protocol (Day 0), cows received an intravaginal P4 device and estradiol benzoate administration. On day 9, the P4 device was removed, PGF2α was administered in all buffaloes and eCG in eCG group. On day 11, GnRH was administred. From day 9, Doppler ultrasonography was daily performed in the afternoon and digital thermography in the morning and after... (Complete abstract click electronic access below) / Doutor

Introdução: O Doppler tecidual (DT) surgiu como uma técnica ecocardiográfica para registro das velocidades do miocárdio e evoluiu para a determinação da deformação miocárdica regional com medida do strain rate (SR) e strain longitudinal e radial unidimensionais. Nosso objetivo foi determinar padrões de normalidade em neonatos e analisar seqüencialmente esses índices em períodos de alta e baixa resistência vascular pulmonar. Casuística e Método: Selecionaram-se 55 crianças com idade média de 20,14 ± 14,0 horas, constituindo o Grupo I (G I). Um segundo exame foi realizado em 30 crianças que retornaram após 31,9 ± 2,9 dias de vida, constituindo o Grupo II (G II). As velocidades do DT pulsado foram obtidas em cortes transversais (R) e longitudinais (L) do ventrículo esquerdo (VE) em posições apical 4 e 2 câmaras e no VD (paredes livre e inferior). Foram medidas velocidades sistólicas (onda Sm), diastólica inicial (Em), diastólica final (Am) de pico e a relação Em/Am. Pelo menos três ciclos cardíacos consecutivos com taxa de quadros/s superior a 300 foram digitalmente obtidos nos cortes mencionados e analisados posteriormente utilizando programa específico para medida das curvas de SR/strain e seus componentes sistólico, diastólico inicial e final. Resultados: As velocidades demonstraram gradiente bem definido com redução progressiva na direção base-ápice do coração. As velocidades do VD foram superiores às do VE quando comparadas com as medidas nas paredes septal (S), anterior (A) e lateral (L). No GI verificamos diferença significativa entre as medidas do SR/strain sistólicos do segmento basal da parede S em relação à apical (-1,90 ± 0,61, - 25,90 ± 4,90 vs -1,66 ± 0,25, - 24,23 ± 3,08), p=0,04 e p=0,02 e do segmento médio em relação ao apical (p=0,01 e 0,02). A avaliação regional do VD demonstrou strain sistólico maior no segmento médio em relação ao basal (-33,20 ± 6,34 vs -28,38 ± 4,90, p=0,00) e em relação ao segmento apical (-33,20 ± 6,34 vs -31,95 ± 5,06, p=0,021). Os valores absolutos de SR/strain e todos os seus componentes foram maiores na direção R quando comparados com a L (SR sistólico 2,99 ± 0,78 s-1 vs (-)1,90 ± 0,60 s-1 strain sistólico 49,72% ± 12,86% vs (-) 25,86% ± 4,83 p=0,00). Quando comparamos os GI e GII verificamos redução do strain sistólico do VE na direção R e L nas paredes S, L e A em todos os segmentos. O SR sistólico reduziu apenas na porção basal da parede L (-1,91 ± 0,46 s-1 vs - 1,71 ± 0,33 s-1, p=0,02). O VD apresentou no GII aumento significativo do strain sistólico e diastólico inicial em todos os segmentos e paredes. O SR sistólico também apresentou aumento dos valores nos segmentos basal e médio de sua parede livre e na parede inferior. A correlação entre a onda Sm e SR/strain sistólicos não foi significativa. Conclusão: Os índices regionais de deformação miocárdica constituem técnica clínica reproduzível em neonatos e podem monitorar alterações seqüenciais fisiológicas da circulação neonatal precoce e tardia. São mais robustos que as velocidades na quantificação da função regional. / Background: Color Doppler myocardial imaging (CDMI) has emerged as an echocardiographic technique for determining myocardial velocities and has been further developed to allow the determination of one-dimension regional longitudinal and radial strain rate (SR)and strain. Our goal was to determine normal values in neonates and sequentially analyse these indices in periods of high and low pulmonary vascular resistance. Study population and methods: Fifty-five term newborns with mean age of 20.14 ± 14.0 hours were selected to be part of Group I (GI). A second echo study was performed on 30 children that had returned with 31.9 ± 2.9 days after birth, being Group II (GII). Pulsed wave Doppler tissue velocities (PWDTV) were obtained in short axis (R) and longitudinal (L) axis of the left ventricle (LV) in apical 4 and 2 chamber view and in 4 and 2 chamber of the right ventricle (RV), including RV free lateral and inferior walls. Peak systolic (Sm), peak early diastolic (Em) and peak late diastolic (Am) motion velocities and Em/Am ratio were measured. At least three consecutive cardiac cycles with frame rate more than 300 fps were stored in digital format from the mentioned views for offline analysis by using dedicated software for measuring peak systolic and peak early and late diastolic SR/strain. Results: PWTDV have shown a well-defined gradient with progressive peak reduction from base to apex. RV velocities were higher than those of the LV whem compared to septal (S), anterior (A) and lateral (L) walls. In GI there was a significant difference between systolic SR/strain measurement of basal S segment in relation to apical (-1.90 ± 0.61, -25.90 ± 4.90 vs -1.66 ± 0.25, - 24.23 ± 3.08), p=0.04 e p=0.02 and from the mid in relation to the apical segment (p=0.01 e 0.02). Regional RV longitudinal function showed that systolic strain recorded from the mid segment was significantly higher than that recorded from the basal segment (-33.20 ± 6.34 vs -28.38 ± 4.90, p=0.00) and that from the apical segment (-33.20 ± 6.34 vs ?31.95 ± 5.06, p=0.021). The absolute and all components of SR/strain were significantly higher in R direction when compared to the L ones (systolic SR 2.99 ± 0.78 s-1 vs (-)1.90 ± 0.60 s-1 systolic strain 49.72% ± 12.86% vs (-)25.86% ± 4.83 p=0.00). When comparing data from GI and GII, we noticed reduction of LV systolic strain in the second group for both R and L, in all segments of S, L and A walls. Systolic SR showed reduction of the values in GII only in the basal segment of the L wall (-1.91 ± 0.46 s-1 vs ?1.71 ± 0.33s-1, p=0.02). Regional RV function showed systolic and early diastolic strain significantly higher in all segments of wall in GII. Systolic SR also showed higher values in the basal and mid segments of RV free lateral and inferior wall in GII when comparing to GI. The correlation between peak systolic velocity Sm and peak systolic SR/strain was not significant. Conclusion: Regional myocardial deformation indices are reproducible clinical techniques in neonates and can monitor physiological sequential circulatory changes of the early and late neonatal period. They are more robust than velocities in the quantification of the regional myocardial function.

Kepenų arterijų anatominiai variantai yra dažni. Viena dažniausių aberantinių (netipiškai atsišakojančių) kepenų arterijų atsišakojimo vietų yra viršutinė pasaito arterija. Pastarosios arterijos kraujotaka yra įtakojama daugybės fiziologinių ir patologinių veiksnių. Literatūroje taip pat aprašyti pavieniai atvejai apie iš viršutinės pasaito arterijos atsišakojančios aberantinės kepenų arterijos įtaką viršutinės pasaito arterijos hemodinamikai, tačiau didesnės apimties įrodymais pagrįstų tyrimų šioje srityje iki šiol nebuvo atlikta. Todėl šio tyrimo tikslas buvo įvertinti, ar aberantinė kepenų arterija, atsišakojanti iš viršutinės pasaito arterijos, reikšmingai įtakoja pastarosios kraujagyslės hemodinamiką. Šiame tyrime kompiuterinės tomografijos angiografijos pagalba įvertinti kepenų arterijų anatominiai variantai, atrinkti pacientai doplerio ultragarso tyrimams. Pastaruoju metodu tirta viršutinės pasaito arterijos kraujotaka pacientams, kurių vieni turėjo aberantinę kepenų arteriją, atsišakojančią iš viršutinės pasaito arterijos, o kiti turėjo įprastą kepenų arterijų anatomiją. Vertinta aberantinės kepenų arterijos, atsišakojančios iš viršutinės pasaito arterijos, įtaka pastarosios arterijos hemodinamikai (rezistentiškumui). Remiantis tyrimo duomenimis nustatyta, kad kepenų arterijų anatominiai variantai yra dažni. Aberantinė kepenų arterija, atsišakojanti iš viršutinės pasaito arterijos, reikšmingai mažina pastarosios arterijos rezistentiškumą. Pateiktos praktinės... [toliau žr. visą tekstą] / Anatomical variants of hepatic arteries are frequent. One of the most common origins of aberrant (atypically branching) hepatic arteries is superior mesenteric artery. Many physiologic and pathologic features influence hemodynamics of the latter artery. There were some sporadic cases in literature about the influence of aberrant hepatic artery arising from superior mesenteric artery to the hemodynamics of the latter artery, but no evidence based large extent studies were performed. Therefore the aim of this study was to evaluate how significant the aberrant hepatic artery branching from the superior mesenteric artery influences the hemodynamics of superior mesenteric artery. Anatomical variants of the hepatic arteries were evaluated by computed tomography angiography also the candidates for Doppler ultrasound were selected. Doppler ultrasound was used to evaluate the hemodynamics of the superior mesenteric artery in patients with aberrant hepatic artery arising from the superior mesenteric artery and in those with typical hepatic artery anatomy. The influence of the aberrant hepatic artery arising from superior mesenteric artery to the hemodynamics (resistance) of the superior mesenteric artery was assessed. The results of the investigation show that anatomical variants of the hepatic arteries are frequent. The aberrant hepatic artery arising from superior mesenteric artery significantly lowers resistance of the superior mesenteric artery. Practical recommendations were set... [to full text]

Vergleich des Nabelschnur-Resistance-Index von monochorialen und dichorialen Geminischwangerschaften Burkhardt T, Kilavuz Ö, Vetter K Abteilung für Geburtsmedizin, Vivantes Krankenhaus Neukölln, Berlin Fragestellung: Ziel der Untersuchung war die Klärung, ob monochoriale Gemini andere Strömungsverhältnisse in der A. umbilicalis aufweisen als dichoriale. Methode: Prospektiv wurden die Aa. umbilicales bei 75 dichorialen und 30 monochorialen Geminischwangerschaften zwischen 15 und 38 Schwangerschaftswochen dopplersonographisch untersucht. Verglichen wurden die Messergebnisse der monochorialen mit den der dichorialen Zwillinge und denen von Einlingen in fünf Schwangerschaftsaltersgruppen (< 24, 24-27, 28-31, 32-35 und 36-39 SSW). Berücksichtigt wurden ausserdem fünf Fälle mit fetofetalem Transfusionssyndrom (FFTS). Ergebnis: Kein signifikanter Unterschied konnte zwischen den Medianwerten der monochorialen Gemini (mit und ohne FFTS) und denen der dichorialen Gemini bzw. denen der Einlinge festgestellt werden. Nachweisbar sind Unterschiede im Abfall des Resistance-Index im Schwangerschaftsverlauf. Benachbarte Altersgruppen gleicher Chorionizität weisen signifikante Sprünge (p / The Resistance-Index in the umbilical artery in dichorionic twins compared with monochorionic twins. Burkhardt T, Kilavuz Ö, Vetter K Department of Obstetrics, Vivantes Hospital Neukolln Berlin Objective: The aim of this study was to detect differences in the resistance-index in the umbilical artery between dichorionic and monochorionic twins. Additional, the resistance-index in twin pregnancies was compared to the reference values of single pregnancies. Methods: In a prospective study Doppler recordings of the umbilical arteries of 75 dichorionic and 30 monochorionic twins were obtained. The Doppler examinations were performed between 15 and 38 weeks of gestation. According the gestational age the Doppler findings were divided in five week groups (< 24, 24-27, 28-31, 32-35 and 36-39 weeks) and were compared within placentation and between the different placentations. In five monochorionic twins a twin-to-twin transfusion syndrome (TTTS) was diagnosed. These five pairs were analyzed in a separate group. Results: There are no significant differences in the resistance index in the umbilical arteries in monochorial without TTTS and dichorial twins compared to the reference values of single pregnancies. Monochorial twins without TTTS compared with dichorial twins showed no significant increased resistance indices in the umbilical arteries. Dichorial twins showed significant (p

Objetivo: Avaliar os efeitos do citrato de sildenafila na circulação do clitóris em mulheres na pós-menopausa com disfunção orgástica avaliadas por Doppler. Casuística e métodos: Foram selecionadas 22 mulheres atendidas no Setor de Ginecologia Endócrina e Climatério da Clínica Ginecológica do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. Destas, 11 constituíram o grupo que recebeu 50mg de citrato de sildenafila (Grupo A) e outras 11 o grupo controle (Grupo B-placebo). Em todas aplicaram-se a entrevista Questionário de sexualidade HC e Escala de Griss. A circulação do clitóris foi avaliada por meio de Doppler nos tempos 0(T0), 1(T1) uma hora após a ingestão do comprimido e após 15 (T15) dias de tratamento. Resultados: Os resultados mostraram diferenças estatisticamente significativas, ao avaliarmos alterações nas medidas dos diferentes momentos (T0, T1,.T15), quando comparamos os 2 grupos (medicamento x placebo), utilizando-se os índices de resistência e velocidade. Conclusão: Podemos inferir melhora apresentada pelo grupo A (citrato de sildenafila), consideravelmente superior ao demonstrado pelo grupo B (placebo). / This study has as objective to evaluate the effects of Sildenafil Citrate in the circulation of the clitoris in women in post-menopause with orgastic dysfunction, appraised through color-pulse Doppler. 22 women were selected in the Endocrine Gynecology and Climacteric clinic of Hospital das Clínicas. 11 women received 50mg of Sildenafil Citrate (Group A) and 11 women received Placebo (Group B). All the women were submitted to the interview “Sexuality Questionnaire HC" and to GRISS Scale. The circulation of the clitoris was evaluated through Doppler in different moments: 0 (T0), 1(T1) one-hour after the ingestion of the tablet and 15 (T15) 15-days of treatment. The results showed differences, statistically significant, when evaluating the measures of the different moments (T0, T1, .T15). When comparing the 2 groups (medicine x placebo), using resistance and speed indexes, we can infer that the improvement presented by Group A (Sildenafil Citrate) is considerably superior to the improvement demonstrated by the Group B (placebo).

A crescente incidência da aterosclerose na população adulta e a obstrução da artéria renal são condições relacionadas à hipertensão renovascular. Independente das comorbidades presentes, a estenose de artéria renal é, por si só, importante causa de mortalidade cardiovascular. Frente a tal realidade, determinar o exame ou exames que possam identificar precocemente esta condição mórbida pode mudar a história natural da doença renovascular. Objetivo: Definir sensibilidade, especificidade, valor preditivo positivo e valor preditivo negativo dos exames não invasivos na estenose da artéria renal. Associar estes achados com a análise vascular quantitativa (QVA) das artérias renais. Métodos: Estudo prospectivo com 61 pacientes recrutados entre janeiro de 2008 e agosto de 2011. As características populacionais, os exames de ultrassom Doppler, cintilografia renal com DTPA e a tomografia computadorizada foram selecionados e seus resultados comparados à arteriografia digital das artérias renais e ao QVA. Resultados: A média das idades foi de 65,43 (DP 8,7) anos. Das variáveis relacionadas à população do estudo e comparadas à arteriografia, duas identificaram relação com a estenose da artéria renal, a disfunção renal e os triglicerídeos. A mediana do ritmo de filtração glomerular de 52,8 ml/min/m2 identificou uma razão de chance para estenose de artéria renal de até 10 vezes. Os triglicerídeos associaram-se a uma menor presença de estenose na artéria renal, p < 0,037. A análise da sensibilidade, especificidade, valor preditivo positivo e negativo dos diferentes testes diagnósticos permitiu identificar aquele que melhor detectava a estenose nos suspeitos e afastava nos sadios. O ultrassom doppler com sensibilidade de 82,90%, especificidade 70,00%, valor preditivo positivo 85,00% e preditivo negativo 66,70% e a angiotomografia com sensibilidade de 68,30%, especificidade 80,00%, valor preditivo positivo 87,50% preditivo negativo de 55,20%, foram os exames que permitiram predizer as maiores chances de estenose da artéria renal nos portadores e afastar na população sem estenose. A associação das características populacionais com o QVA, permitiu identificar duas novas variáveis, o sexo e a idade. A média do grau de estenose, 33,47% (DP 29,55) quantificada pelo QVA, identificou menores graus de estenose que na análise visual dos angiogramas. Exames não invasivos positivos em estenoses menores do que 60% da luz do vaso também foram identificados . Os resultados identificados pela curva ROC demonstraram respectivamente a arteriografia, a angiotomografia e o ultrassom Doppler como os exames com melhores chances em predizer estenose significativa da artéria renal. Conclusão: A angiotomografia e o ultrassom Doppler trouxeram qualidade e alta possibilidade no diagnóstico da estenose da artéria renal, com vantagem para o segundo, pois não há necessidade do uso de meio de contraste na avaliação de uma doença que, frequentemente, está acompanhada por portadores de disfunção renal, disfunção ventricular esquerda grave e diabetes melito. A incorporação de uma forma objetiva de medidas das artérias renais aprimora os resultados da angiografia invasiva. / The increasing incidence of atherosclerosis in adults and renal artery stenosis are conditions related to renovascular hypertension. Regardless all risk factors, renovascular stenosis is by itself an important cause of cardiovascular mortality. Choosing appropriate tests that can early identify this morbid condition can change the natural history of renovascular disease. Objective: To define sensitivity, specificity, positive and negative predictive value of non- invasive tests in renal artery stenosis. Associate these findings with the renal arteries quantitative vascular analysis (QVA). Methods: Prospective study with 61 patients selected between January 2008 and August 2011. The population characteristics, Doppler ultrasound scanning, DTPA renal scintigraphy and computed tomography were selected and their results compared with renal arteries digital angiography as well as the comparison to QVA. Results: The mean age was 65.43 (SD 8.7). The risk factors of the study population compared to angiography identified two variables: renal dysfunction and triglycerides. The median glomerular filtration rate of 52.8 ml/min/m2 identified an odds ratio for renal artery stenosis up to 10 times. Triglycerides were associated with lower presence of renal artery stenosis p < 0.037. The analysis of sensitivity, specificity, positive and negative predictive values of different diagnostic tests allowed the identification of the stenosis in the group of suspected patients and this possibility was discarded in the group of healthy patients. Doppler ultrasound scanning with 82.90% sensitivity, 70.00% specificity, 85.00% positive predictive value, 66.70% negative predictive value and computed tomography with 68.30% sensitivity, 80.00% specificity, 87.50% positive predictive value and 55.20% negative predictive value. These were the tests which supplied better chances to predict renal artery stenosis in patients with or without stenosis. The relationship of population characteristics with QVA identified two new variables, gender and age. The mean degree of stenosis 33.47% (SD 29.55) quantified by QVA identified lesser degrees of stenosis than in visual analysis of angiograms. Non- invasive positive stenoses less than 60% of vessel lumen were identified. The results identified by the ROC curve showed respectively angiography, computed tomography, and Doppler ultrasound scanning as better chances for predicting renal artery stenosis. Conclusion: Computed tomography, Doppler ultrasound scanning have brought high quality and ability in the diagnosis of renal artery stenosis, with an advantage to Doppler, which avoids the use of contrast medium in the evaluation of a disease that is often accompanied by patients with renal dysfunction, severe left ventricular dysfunction and diabetes mellitus. The introduction of new methodology to measure renal arteries will certainly improve the angiography results.

Objetivo: Avaliar os efeitos do citrato de sildenafila na circulação do clitóris em mulheres na pós-menopausa com disfunção orgástica avaliadas por Doppler. Casuística e métodos: Foram selecionadas 22 mulheres atendidas no Setor de Ginecologia Endócrina e Climatério da Clínica Ginecológica do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. Destas, 11 constituíram o grupo que recebeu 50mg de citrato de sildenafila (Grupo A) e outras 11 o grupo controle (Grupo B-placebo). Em todas aplicaram-se a entrevista Questionário de sexualidade HC e Escala de Griss. A circulação do clitóris foi avaliada por meio de Doppler nos tempos 0(T0), 1(T1) uma hora após a ingestão do comprimido e após 15 (T15) dias de tratamento. Resultados: Os resultados mostraram diferenças estatisticamente significativas, ao avaliarmos alterações nas medidas dos diferentes momentos (T0, T1,.T15), quando comparamos os 2 grupos (medicamento x placebo), utilizando-se os índices de resistência e velocidade. Conclusão: Podemos inferir melhora apresentada pelo grupo A (citrato de sildenafila), consideravelmente superior ao demonstrado pelo grupo B (placebo). / This study has as objective to evaluate the effects of Sildenafil Citrate in the circulation of the clitoris in women in post-menopause with orgastic dysfunction, appraised through color-pulse Doppler. 22 women were selected in the Endocrine Gynecology and Climacteric clinic of Hospital das Clínicas. 11 women received 50mg of Sildenafil Citrate (Group A) and 11 women received Placebo (Group B). All the women were submitted to the interview “Sexuality Questionnaire HC” and to GRISS Scale. The circulation of the clitoris was evaluated through Doppler in different moments: 0 (T0), 1(T1) one-hour after the ingestion of the tablet and 15 (T15) 15-days of treatment. The results showed differences, statistically significant, when evaluating the measures of the different moments (T0, T1, .T15). When comparing the 2 groups (medicine x placebo), using resistance and speed indexes, we can infer that the improvement presented by Group A (Sildenafil Citrate) is considerably superior to the improvement demonstrated by the Group B (placebo).

Anatomical variants of hepatic arteries are frequent. One of the most common origins of aberrant (atypically branching) hepatic arteries is superior mesenteric artery. Many physiologic and pathologic features influence hemodynamics of the latter artery. There were some sporadic cases in literature about the influence of aberrant hepatic artery arising from superior mesenteric artery to the hemodynamics of the latter artery, but no evidence based large extent studies were performed. Therefore the aim of this study was to evaluate how significant the aberrant hepatic artery branching from the superior mesenteric artery influences the hemodynamics of superior mesenteric artery. Anatomical variants of the hepatic arteries were evaluated by computed tomography angiography also the candidates for Doppler ultrasound were selected. Doppler ultrasound was used to evaluate the hemodynamics of the superior mesenteric artery in patients with aberrant hepatic artery arising from the superior mesenteric artery and in those with typical hepatic artery anatomy. The influence of the aberrant hepatic artery arising from superior mesenteric artery to the hemodynamics (resistance) of the superior mesenteric artery was assessed. The results of the investigation show that anatomical variants of the hepatic arteries are frequent. The aberrant hepatic artery arising from superior mesenteric artery significantly lowers resistance of the superior mesenteric artery. Practical recommendations were set... [to full text] / Kepenų arterijų anatominiai variantai yra dažni. Viena dažniausių aberantinių (netipiškai atsišakojančių) kepenų arterijų atsišakojimo vietų yra viršutinė pasaito arterija. Pastarosios arterijos kraujotaka yra įtakojama daugybės fiziologinių ir patologinių veiksnių. Literatūroje taip pat aprašyti pavieniai atvejai apie iš viršutinės pasaito arterijos atsišakojančios aberantinės kepenų arterijos įtaką viršutinės pasaito arterijos hemodinamikai, tačiau didesnės apimties įrodymais pagrįstų tyrimų šioje srityje iki šiol nebuvo atlikta. Todėl šio tyrimo tikslas buvo įvertinti, ar aberantinė kepenų arterija, atsišakojanti iš viršutinės pasaito arterijos, reikšmingai įtakoja pastarosios kraujagyslės hemodinamiką. Šiame tyrime kompiuterinės tomografijos angiografijos pagalba įvertinti kepenų arterijų anatominiai variantai, atrinkti pacientai doplerio ultragarso tyrimams. Pastaruoju metodu tirta viršutinės pasaito arterijos kraujotaka pacientams, kurių vieni turėjo aberantinę kepenų arteriją, atsišakojančią iš viršutinės pasaito arterijos, o kiti turėjo įprastą kepenų arterijų anatomiją. Vertinta aberantinės kepenų arterijos, atsišakojančios iš viršutinės pasaito arterijos, įtaka pastarosios arterijos hemodinamikai (rezistentiškumui). Remiantis tyrimo duomenimis nustatyta, kad kepenų arterijų anatominiai variantai yra dažni. Aberantinė kepenų arterija, atsišakojanti iš viršutinės pasaito arterijos, reikšmingai mažina pastarosios arterijos rezistentiškumą. Pateiktos praktinės... [toliau žr. visą tekstą]