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BACKGROUND: Sepsis-associated brain dysfunction (SABD) is associated with high morbidity and mortality. The pathophysiology of SABD is multifactorial. One hypothesis is that impaired cerebral autoregulation (CAR) may result in brain hypoperfusion and neuronal damage leading to SABD. METHODS: We studied 100 adult patients with sepsis (July 2012-March 2017) (age = 62 [52-71] years; Acute Physiology and Chronic Health Evaluation II score on admission = 21 [15-26]). Exclusion criteria were acute or chronic intracranial disease, arrhythmias, extracorporeal membrane oxygenation, and known intra- or extracranial supra-aortic vessel disease. The site of infection was predominantly abdominal (46%) or pulmonary (28%). Transcranial Doppler was performed, insonating the left middle cerebral artery with a 2-MHz probe. Middle cerebral artery blood flow velocity (FV) and arterial blood pressure (ABP) signals were recorded simultaneously; Pearson's correlation coefficient (mean flow index [Mxa]) between ABP and FV was calculated using MATLAB. Impaired CAR was defined as Mxa > 0.3. RESULTS: Mxa was 0.29 [0.05-0.62]. CAR was impaired in 50 patients (50%). In a multiple linear regression analysis, low mean arterial pressure, history of chronic kidney disease and fungal infection were associated with high Mxa. SABD was diagnosed in 57 patients (57%). In a multivariable analysis, altered cerebral autoregulation, mechanical ventilation and history of vascular disease were independent predictors of SABD. CONCLUSIONS: Cerebral autoregulation was altered in half of the patients with sepsis and was associated with the development of SABD. These findings support the concept that cerebral hypoxia could contribute to the development of SABD., SCOPUS: ar.j, info:eu-repo/semantics/published

ObjectivesOptimal perinatal management of total anomalous pulmonary venous return (TAPVR) involves timely identification followed by surgical correction. Antenatal diagnosis, however, has long been a challenge. We aimed to identify consistent prenatal sonographic features in this condition in a large cohort in whom the diagnosis was made antenatally and confirmed postnatally.MethodsWe conducted a systematic retrospective review of the 2-dimensional and Doppler sonographic features that had helped make the diagnosis of TAPVR at our institution from 2001 to 2012.ResultsTwenty-six patients had prenatal diagnosis of TAPVR (mean gestational age, 24.1 weeks). Four of the fetuses with a prenatal diagnosis represented isolated cases of TAPVR; 22 had heterotaxy syndrome, additional cardiac abnormalities, or both. Prenatally diagnosed abnormal pulmonary venous connections were supracardiac (type I) in 18 cases, cardiac (type II) in 1, and infradiaphragmatic (type III) in 7. Lack of a visible connection of the pulmonary veins to the atrium (100%) and the presence of a visible venous confluence on axial 4-chamber views (96%) were the most consistent findings. Cardiac asymmetry and the presence of additional vertical venous channels on 3-vessel or axial abdominal views were also noted but less consistently. Abnormal pulmonary venous spectral Doppler findings were present in 25 of the 26 fetuses.ConclusionsThe diagnosis of TAPVR can be suspected on standard axial views included in second-trimester obstetric screening examinations of the fetal heart and confirmed on fetal echocardiography with the use of pulsed wave Doppler imaging. Clues recognizable on obstetric sonographic screening have the potential to contribute to increasing the diagnostic yield for prenatal detection of TAPVR.

В статье представлен опыт нефропротекции при остром повреждении почек (ОПП) вследствие тромбоза почечной артерии. Диагноз устанавливался на основании жалоб пациентов, данных анамнеза, УЗИ почек в режиме допплеровского картирования. Во всех случаях был выявлен тромбоз артерии единственно функционирующей почки, вторая почка была либо сморщена, либо отсутствовала. После уточнения диагноза немедленно выполнялось эндоваскулярное вмешательство, включающее селективный тромболизис, тромбоаспирацию и баллонную ангиопластику. Анурия до установления диагноза была длительной (5-7 суток). Несмотря на это, у всех больных восстановился диурез и функция почек, гемодиализная терапия не потребовалась. Таким образом, ОПП у этих больных может быть расценено как преренальное. Уточнение причины ОПП и проведение рентген-эндоваскулярного вмешательства позволило восстановить функцию почки и предотвратить необратимые изменения в ней (сморщивание)., Наведено досвід нефропротекції у 11хворих на гостре пошкодження нирок внаслідок тромбозу ниркової артерії єдино функціонуючей нирки. Діагностували ГПП завдяки виконанню комплексного ультразвукового дослідження з доплерографіею судин нирок. Виконували ендоваскулярне втручання, як то: селективний тромболізіс, тромбоаспірацію та балонну ангіопластику. Незважаючи на тривалу анурію (5-7 діб), у всіх хворих діурез та функція нирок відновилися, гемодіаліз не виконувався., The paper presents the results of nephroprotection in acute kidney injury (AKI) caused by renal artery thrombosis. Nephroprotection performed due to successful diagnostics and endovascular intervention. Diagnostics was based on patient`s complaints and anamnesis, ultrasonography combined with renal power Doppler analysis, using a duplex scanner. In all 11 cases was identified renal artery thrombosis in solitary functioning kidney, the second one was either wrinkled or absent. After verification of anuria cause endovascular intervention was immediately performed, including tromboaspiration, balloon angioplasty and local thrombolysis threw intraarterial catheter. The duration of anuria before intervention was from 5 to7 days. In all cases renal function recovered in a few days, renal replacement therapy was not required.Introduction. One of the infrequent, but significant and unrecognized causes of AKI is renal artery thromboembolism. Usually, AKI manifestated by anuria, develops only in the cases when occlusion of renal artery is bilateral or in a solitary functioning kidney. The main features of this disease are the difficulties in diagnostics and late beginning of treatment, with long-term anuria, for 5-7 days. A common protocol for diagnostics and treatment of renal artery thrombosis is absent. As methods for screening are recommended intravenous urography, radionuclide renography, contrast- enhanced computed tomography. Until recently, for suspected renal artery thrombosis patients were prescribed anticoagulant therapy and renal replacement therapy with hemodialysis, which became chronic, because of irreversible renal disfunction. Surgical treatment is only effective in the early hours. Outcome is often unfavorable. There is a high probability of hemorrhagic complications. For this reason, we decided to share with our successful experience of diagnostics and nephroprotection in AKI, caused by renal artery thrombosis solitary functioning kidney. In all cases the m

ObjectivesOptimal perinatal management of total anomalous pulmonary venous return (TAPVR) involves timely identification followed by surgical correction. Antenatal diagnosis, however, has long been a challenge. We aimed to identify consistent prenatal sonographic features in this condition in a large cohort in whom the diagnosis was made antenatally and confirmed postnatally.MethodsWe conducted a systematic retrospective review of the 2-dimensional and Doppler sonographic features that had helped make the diagnosis of TAPVR at our institution from 2001 to 2012.ResultsTwenty-six patients had prenatal diagnosis of TAPVR (mean gestational age, 24.1 weeks). Four of the fetuses with a prenatal diagnosis represented isolated cases of TAPVR; 22 had heterotaxy syndrome, additional cardiac abnormalities, or both. Prenatally diagnosed abnormal pulmonary venous connections were supracardiac (type I) in 18 cases, cardiac (type II) in 1, and infradiaphragmatic (type III) in 7. Lack of a visible connection of the pulmonary veins to the atrium (100%) and the presence of a visible venous confluence on axial 4-chamber views (96%) were the most consistent findings. Cardiac asymmetry and the presence of additional vertical venous channels on 3-vessel or axial abdominal views were also noted but less consistently. Abnormal pulmonary venous spectral Doppler findings were present in 25 of the 26 fetuses.ConclusionsThe diagnosis of TAPVR can be suspected on standard axial views included in second-trimester obstetric screening examinations of the fetal heart and confirmed on fetal echocardiography with the use of pulsed wave Doppler imaging. Clues recognizable on obstetric sonographic screening have the potential to contribute to increasing the diagnostic yield for prenatal detection of TAPVR.

type:Text, Synovial vascularization in metacarpophalangeal joints of a patient with rheumatoid arthritis treated with leukocytapheresis (LCAP) was evaluated by Doppler sonography. After the treatment with LCAP, evaluation with American College of Rheumatology core set showed improvement, and the levels of C-reactive protein and serum amyloid A protein decreased. Power Doppler sonography demonstrated a reduction of color flow signals of the joints, and spectral Doppler sonography demonstrated an increase in vascular resistant, indicating a reduction of vessel's permeability. This is the first report evaluating a synovial vascularization and blood flow of the joints by Doppler sonography before and after LCAP therapy. Doppler sonography might be one of the useful methods for evaluating the therapeutic response of LCAP.

Objective: The abdominal compartment syndrome is a potentially life-threatening condition with frequent renal involvement. There are few if any means of inferring subclinical effects before organ dysfunction. Because intrarenal pressure correlates with renal sonographic indices in other renal diseases, the purpose of this study was to determine the relationship between increasing intraabdominal hypertension and renal vascular flow velocities in a porcine model using renal Doppler ultrasound. Design: Animal study. Setting: University research laboratory. Subjects: Eight anesthetized, mechanically ventilated, well-hydrated, 30-kg female Yorkshire pigs. Interventions: Intraabdominal hypertension was induced by instillation of warmed intraperitoneal saline through a midline laparoscopic port. Intraabdominal pressure (IAP) was continuously monitored directly from the peritoneum and indirectly from the bladder. IAP was varied from 0 to 50 mm Hg in increments of 5 mm Hg. At each IAP level, gray-scale, color, and spectral Doppler renal arcuate artery ultrasound was obtained and resistive index (RI) and peak airway pressure calculated. Measurements and Main Results: Excellent agreement between direct and indirect IAP was found (bias, 0.032 mm Hg; 95% limits, -5.5 to 5.6 mm Hg). A linear relationship between RI and indirect IAP was observed and was defined by the regression equation: RI = 0.553 + 0.0104 × bladder pressure. There was a trend toward different RIs between left and right kidneys (p = .052) at the same IAP. RI varied in a linear fashion at low peak airway pressure and demonstrated an inflection point with steeper subsequent slope after peak airway pressure of 30 cm H2O. RI values rapidly returned to near baseline after abdominal decompression. Conclusions: In this model, the renal artery RI correlated strongly and linearly with the severity of intraabdominal hypertension, making renal Doppler ultrasound a potential noninvasive screening tool for the renal effec