A brief history of Doppler ultrasound in the diagnosis of peripheral vascular disease

The history of Doppler ultrasound in peripheral vascular diagnosis is considered in terms of basic developments, clinical applications and impact on medical practice. Many early developments occurred at Osaka University in Japan and the University of Washington in the United States. Through progressive steps, Doppler ultrasound technology has provided clinical applications in blood-flow sensing, waveform analysis, localizing blood flow and two-dimensional (2-D) mapping of blood flow. An important advance was the development of duplex and color Doppler scanning. Real time velocity measurements and flow mapping have led to many clinical applications. Two important applications have been detection and grading of atherosclerotic plaques in the internal carotid artery and the diagnosis of deep venous thrombosis. Doppler ultrasound is the preferred noninvasive imaging method for each of these clinical problems. The recent reaffirmation of carotid endarterectomy as the appropriate management for certain categories of carotid atherosclerotic occlusive disease has led to guidelines for selecting patients for carotid endarterectomy. New Doppler ultrasound criteria are being developed to identify categories of stenosis that relate to these guidelines. The establishment of Doppler ultrasound has led to training programs for technologists and physicians, certification of technologists and establishment of standards and quality control measures for vascular laboratories.

What was the disease of the legs that afflicted King Asa?

BACKGROUND/OBJECTIVE

The elderly have suffered from pain in their legs, which may be associated with various diseases, for thousands of years. This report analyzes the disease that afflicted the biblical King Asa (the third king of the house of Judah who reigned between 867 and 906 BCE).

RESULTS

The sentence 'Nevertheless in the time of his old age he was diseased in his legs' indicates that King Asa suffered from disease in his legs. Among numerous diseases, peripheral vascular disease, gout, and degenerative osteoarthritis were most likely to affect the King's legs. And among these diseases, the diagnosis of peripheral vascular disease is the most acceptable.

CONCLUSION

This report shows that the roots of contemporary modern gerontology can be traced back to biblical times.

External leg compression in the treatment of vascular disease

In summary, external compression of the limbs is a mode of therapy that has enjoyed a long history in the treatment of venous and arterial disease. Evidence suggests that its beneficial effects are mediated through enhancement of venous and arterial blood flow, promotion of vasodilation, enhancement of fibrinolysis, and, in the case of obstructive arterial disease, promotion of the development of collateral circulation. The utility of external leg compression in the prevention of deep venous thrombosis and in the management of chronic venous stasis disease has been well documented, and it has become an accepted treatment for these disorders. The use of pneumatic compression in the treatment of atherosclerotic peripheral vascular and cardiovascular disease is less widespread and its indications are less well defined. Though the work of a few investigators in each of these areas shows striking benefits of the technique, further investigation in these areas is warranted. Potential benefits to patients of external limb compression therapy include its non-invasive nature, its ability to be applied in an out-patient setting, and long-term cost savings through possible avoidance of hospitalization and invasive procedures.

[Physical diagnostics--peripheral arterial diseases]

In a patient with a high a priori risk of peripheral vascular disease, the positive predictive value of an abnormal physical diagnostic examination is high. In patients with a low prior probability of peripheral vascular disease, the physical examination makes little contribution to the diagnosis or exclusion of arterial insufficiency. For this purpose the ankle-brachial systolic pressure index is preferable. Peripheral arterial disease is unlikely when this index is normal. However, a low ankle-brachial index necessitates further investigations to determine possible arterial insufficiency in the lower extremities.

Computed tomographic angiography: historical perspective and new state-of-the-art using multi detector-row helical computed tomography

Since its clinical introduction in 1991, volumetric computed tomography scanning using spiral or helical scanners has resulted in a revolution for diagnostic imaging. In addition to new applications for computed tomography, such as computed tomographic angiography and the assessment of patients with renal colic, many routine applications such as the detection of lung and liver lesions have substantially improved. Helical computed tomographic technology has improved over the past eight years with faster gantry rotation, more powerful X-ray tubes, and improved interpolation algorithms, but the greatest advance has been the recent introduction of multi detector-row computed tomography scanners. These scanners provide similar scan quality at a speed gain of 3-6 times greater than single detector-row computed tomography scanners. This has a profound impact on the performance of computed tomography angiography, resulting in greater anatomic coverage, lower iodinated contrast doses, and higher spatial resolution scans than single detector-row systems.