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Serra C, Dajti E, De Molo C, Montaguti E, Porro A, Seidenari A, Angilletta E, Bernardi V, Salsi G, Bakken SM, Montagnani M, Mazzella G, Azzaroli F. Utility of Doppler-Ultrasound and Liver Elastography in the Evaluation of Patients with Suspected Pregnancy-Related Liver Disease. J Clin Med 2023; 12. [PMID: 36836188 DOI: 10.3390/jcm12041653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 02/11/2023] [Accepted: 02/17/2023] [Indexed: 02/22/2023] Open
Abstract
Grayscale abdomen ultrasound (US) is routinely performed in pregnant women with suspected pregnancy-related liver dysfunction, but its diagnostic yield is very low. We aimed to investigate the association between Doppler-US findings, liver stiffness measurement (LSM) and different causes of pregnancy-related liver dysfunction. This is a prospective cohort study of pregnant women referred to our tertiary center for any suspected gastrointestinal disease between 2017 and 2019 and undergoing Doppler-US and liver elastography. Patients with previous liver disease were excluded from the analysis. For group comparisons of categorical and continuous variables, the chi-square test or Mann-Whitney test, and the McNemar test were used, as appropriate. A total of 112 patients were included in the final analysis, of whom 41 (36.6%) presented with suspected liver disease: 23 intrahepatic cholestasis of pregnancy (ICP), six with gestational hypertensive disorders and 12 cases with undetermined causes of elevated liver enzymes. Values of LSM were higher and significantly associated with a diagnosis of gestational hypertensive disorder (AUROC = 0.815). No significant differences at Doppler-US or LSM were found between ICP patients and controls. Patients with undetermined causes of hypertransaminasemia showed higher hepatic and splenic resistive indexes than controls, suggesting splanchnic congestion. The evaluation of Doppler-US and liver elastography is clinically useful in patients with suspected liver dysfunction during pregnancy. Liver stiffness represents a promising non-invasive tool for the assessment of patients with gestational hypertensive disorders.
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Nokovitch L, Peyrachon B, Chaux-Bodard AG, Poupart M, Roux PE, Devauchelle B, Deneuve S. Reverse blood flow in cervicofacial veins after venous ligations: Potential implications in microsurgery. J Plast Reconstr Aesthet Surg 2020; 74:2042-2049. [PMID: 33455872 DOI: 10.1016/j.bjps.2020.12.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 12/10/2020] [Accepted: 12/19/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION The consequences on the cervicofacial venous circulation of major cervicofacial vein ligations are poorly known. We aimed to highlight by using Doppler Ultrasound flow differences in the cervicofacial venous network in the case of unilateral or bilateral ligation of main venous collector trunks (external jugular vein [EJV] and internal jugular vein [IJV]) METHODS: A Doppler ultrasound was performed on 10 healthy volunteers, 8 patients with previous bilateral ligation of the EJV, 8 with a unilateral ligation of the EJV, and 8 with a unilateral ligation of the EJV and IJV, after modified radical neck dissection. The diameter, the flow direction and the peak systolic velocity (PSV) of the superficial temporal vein, the facial vein (FV) and the IJV were measured. RESULTS Healthy patients had a similar right and left PSV for all the veins studied, with always antegrade flows. Patients with previous ligations had some significant right/left differences and retrograde flows. CONCLUSION A redistribution of venous blood flow on the contralateral side of the face and neck seems to take place in the case of unilateral ligation of the EJV and/or IJV. Retrograde flows are sometimes observed in the case of previous ligation of the EJV and/or IJV and might compromise the success of venous microanastomoses.
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Affiliation(s)
- L Nokovitch
- Oncologic Surgery Department, Centre Léon Bérard, Lyon, France.
| | - B Peyrachon
- Vascular Medicine Department, Hôpital Privé Jean Mermoz, Lyon, France
| | | | - M Poupart
- Oncologic Surgery Department, Centre Léon Bérard, Lyon, France
| | - P-E Roux
- Oncologic Surgery Department, Centre Léon Bérard, Lyon, France
| | - B Devauchelle
- Maxillo-Facial Surgery Department, University Hospital of Amiens, Amiens, France
| | - S Deneuve
- Oncologic Surgery Department, Centre Léon Bérard, Lyon, France
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Dominique I, Dariane C, Fourniol C, Le Guilchet T, Hurel S, Fontaine E, Mandron E, Audenet F, Mejean A, Timsit MO. Performing an early systematic Doppler-ultrasound fails to prevent hemorrhagic complications after complex partial nephrectomy. Ther Adv Urol 2019; 11:1756287219828966. [PMID: 30800173 PMCID: PMC6378436 DOI: 10.1177/1756287219828966] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 12/23/2018] [Indexed: 11/25/2022] Open
Abstract
Background: The aim of this work was to assess the clinical relevance of a systematic postoperative Doppler-ultrasound (DU) after complex partial nephrectomy (PN). Materials and methods: All patients who underwent open, laparoscopic or robotic PN from 2014 to 2017 at our institution were included. Postoperative hemorrhagic complications (HCs) were defined as the occurrence of blood transfusion, hemorrhagic shock, arterial embolization, or re-hospitalization for hematoma. DU was systematically performed between post-op day 4 and 7 for every complex tumor (RENAL score ⩾ 7). DU was considered positive in the presence of pseudoaneurysm (PA) or arteriovenous fistula (AVF). Results: Among 194 patients, 117 underwent DU (60.3%). We reported 22 HCs (11.3%) requiring 8 selective embolization procedures (4.1%). HCs occurred during the hospital stay in 17 patients (77.3%), thus directly diagnosed on a computed tomography scan. Among the five patients (22.7%) with HC occurring after hospital discharge, between day 7 to 15, four had a previously negative systematic DU. Overall, systematic DU was positive in only five patients (4.3%) with only one patient of 194 (0.5%) undergoing preventive embolization of a PA-AVF. The negative predictive values (NPVs) and positive predictive values of DU were respectively 96.5% and 5%, with 20% sensitivity and 96.5% specificity. Conclusions: Our results may suggest offering systematic DU in patients under antiplatelet therapies, with high tumor size (>T1b), or early postoperative hemoglobin variations. A high NPV of DU might be counterbalanced by its low sensibility. Since all secondary HCs occurred between postoperative day 7 to 15, our results may suggest differing DU in selected cases.
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Affiliation(s)
- Inès Dominique
- Department of Urology, Hôpital Européen Georges-Pompidou (HEGP), Assistance Publique Hôpitaux de Paris (APHP), Service d'Urologie, Hôpital Européen Georges-Pompidou, AP-HP, 20-40 rue Leblanc, Paris, 75015, France
| | - Charles Dariane
- Department of Urology, Hôpital Européen Georges-Pompidou (HEGP), Assistance Publique Hôpitaux de Paris (APHP), Paris, France Paris-Descartes University, Paris, France
| | - Cyril Fourniol
- Department of Urology, Hôpital Européen Georges-Pompidou (HEGP), Assistance Publique Hôpitaux de Paris (APHP), Paris, France Paris-Descartes University, Paris, France
| | - Thomas Le Guilchet
- Department of Urology, Hôpital Européen Georges-Pompidou (HEGP), Assistance Publique Hôpitaux de Paris (APHP), Paris, France Paris-Descartes University, Paris, France
| | - Sophie Hurel
- Department of Urology, Hôpital Européen Georges-Pompidou (HEGP), Assistance Publique Hôpitaux de Paris (APHP), Paris, France Paris-Descartes University, Paris, France
| | - Eric Fontaine
- Department of Urology, Hôpital Européen Georges-Pompidou (HEGP), Assistance Publique Hôpitaux de Paris (APHP), Paris, France Paris-Descartes University, Paris, France
| | - Eric Mandron
- Department of Urology, Hôpital Européen Georges-Pompidou (HEGP), Assistance Publique Hôpitaux de Paris (APHP), Paris, France Paris-Descartes University, Paris, France
| | - Francois Audenet
- Department of Urology, Hôpital Européen Georges-Pompidou (HEGP), Assistance Publique Hôpitaux de Paris (APHP), Paris, France Paris-Descartes University, Paris, France
| | - Arnaud Mejean
- Department of Urology, Hôpital Européen Georges-Pompidou (HEGP), Assistance Publique Hôpitaux de Paris (APHP), Paris, France Paris-Descartes University, Paris, France
| | - Marc Olivier Timsit
- Department of Urology, Hôpital Européen Georges-Pompidou (HEGP), Assistance Publique Hôpitaux de Paris (APHP), Paris, France Paris-Descartes University, Paris, France
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Schwarz CE, Preusche A, Wolf M, Poets CF, Franz AR. Prospective observational study on assessing the hemodynamic relevance of patent ductus arteriosus with frequency domain near-infrared spectroscopy. BMC Pediatr 2018; 18:66. [PMID: 29452581 PMCID: PMC5816508 DOI: 10.1186/s12887-018-1054-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Accepted: 02/07/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND What constitutes a hemodynamically relevant patent ductus arteriosus (hrPDA) in preterm infants is unclear. Different clinical and echocardiographic parameters are used, but a gold standard definition is lacking. Our objective was to evaluate associations between regional cerebral tissue oxygen saturation (rcStO2), fraction of tissue oxygen extraction (rcFtO2E) measured by frequency domain near-infrared spectroscopy (fd-NIRS) and their correlation to echocardiographic, Doppler-ultrasound, and clinical parameters in preterm infants with and without a hrPDA. METHODS In this prospective observational study, 22 infants < 1500 g (mean [± SD]: gestational age 28.6 [±1.8] weeks, birth weight 1076 [±284] g, median (interquartile range) postnatal age at measurement 7.6 (4.6-12.9) d) with a clinical suspicion of hrPDA were analysed. Twelve infants had left-to-right shunt through PDA, and in 6 of these the PDA was classified as hrPDA based on pre-defined clinical and echocardiographic criteria. fd-NIRS, echocardiographic and Doppler-ultrasound examinations were performed. After identification of blood hemoglobin (Hb) as confounding factor, rcStO2 and rcFtO2E were corrected for this effect. RESULTS Overall mean ± standard deviation (normalised to a median Hb of 13.8 mg/dl) was 57 ±5% for rcStO2 and 0.39 ±0.05 for rcFtO2E. Comparing no-hrPDA with hrPDA infants, there were no significant differences in mean rcStO2 (58 ±5% vs. 54 ±5%; p = .102), but in mean rcFtO2E (0.38 ±0.05 vs. 0.43 ±0.05; p = .038). Echocardiographic parameter and Doppler indices did not correlate with cerebral oxygenation. CONCLUSION Oxygen transport capacity of the blood may confound NIRS data interpretation. Cerebral oxygenation determined by fd-NIRS provided additional information for PDA treatment decisions not offered by routine investigations. Whether indicating PDA therapy based on echocardiography complemented by data on cerebral oxygenation results in better outcomes should be investigated in future studies.
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Affiliation(s)
- Christoph E Schwarz
- Department of Neonatology, University Children's Hospital, Calwerstr. 7, 72076, Tuebingen, Germany.
| | - Antonio Preusche
- Department of Neonatology, University Children's Hospital, Tuebingen, Germany
| | - Martin Wolf
- Department of Neonatology, University Hospital Zurich, Zurich, Switzerland
| | - Christian F Poets
- Department of Neonatology, University Children's Hospital, Tuebingen, Germany
| | - Axel R Franz
- Department of Neonatology, University Children's Hospital, Tuebingen, Germany.,Center for Pediatric Clinical Studies, University Children's Hospital, Tuebingen, Germany
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Li YL, Sun MJ, Fu BY. Two-case analysis of pseudo-Budd-Chiari syndrome. Shijie Huaren Xiaohua Zazhi 2008; 16:3131-3133. [DOI: 10.11569/wcjd.v16.i27.3131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Pseudo-Budd-Chiari syndrome usually occurs in patients with alcoholic liver disease, and its sonographic and radiographic findings were similar to that of Budd-Chiari syndrome. Moreover, venography showed no abnormal changes of inferior vena cava (IVC) and hepatic vein. This paper reports two cases who were admitted to hospital due to abdominal distention and debilitation. After laboratory examinations, Doppler-ultrasound detection, enhanced liver CT scan and IVC angiography, both of them were diagonosed with pseudo-Budd-Chiari syndrome.
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