Purpose Subjects and Methods, Results and Discussion, Conclusion
This study was conducted to investigate the usefulness of tibial blood flow measurement (TBF) as the predictor of retreatment for critical ischemic limbs (CL) undergoing endovascular treatment (EVT). Our study population consisted of 273 CL with infrainguinal disease undergoing TBF before and after EVT in our hospital from August 2008 to October 2010. TBF was performed at the distal anterior and posterior tibial arteries using Duplex (Logiq E9). They were assigned to 55 CL with re-EVT (Re-EVT Group) and 218 CL without re-EVT (Control Group) within one year. We compared the several parameters of TBF between the both groups. In the both groups, there were observed positive correlations between the volume of TBF before and after EVT, and between the increment of TBF and the volume of TBF after EVT. The volume of TBF after EVT and the increment of TBF were significantly greater in Re-EVT Group than in Control Group (p<0.001). According to the cutoff values, TBF after EVT>37.0 ml/min or the increment of TBF>20.8 ml/min could divide the both groups with sensitivity 72% and specificity 62%. TBF before and after EVT might become the predictor of re-EVT for CL within one year.

View full abstract

A 62-year-old woman was brought into our hospital because of intermittent abdominal pain. Transabdominal ultrasonography (US) revealed the regional thickening of the jejunal wall, transmural hyper echoic line and localized fluid collection with mobile hyperechogenic spots (i.e. free air), which suggested the characteristic appearance of microperforation of small intestine due to ileus. Contrast enhanced computed tomography (CE-CT) showed a dilated jejunum and regional thickening of its wall, but, no evidence of exact cause of obstruction. Free air could not be demonstrated with CE-CT scan. A short time later, emergency operation was performed. Intraoperative photograph revealed jejunum 50 cm from the ligament of Treitz with ischemic change. Resected specimen revealed mucosal ulcerations and diffuse dark discoloration of the ischemic segment of the intestine. It was suspected clinically circumscribed peritonitis due to micreperforation of the jejunum. The cause of ileus was hard object such as food bolus (including some beans). The histological examination showed transmurally and severely ischemic change with necrosis, dense inflammatory cell infiltration, abscess formation and hemorrhage.
Small intestinal perforation is an emergency medical situation that presents as an acute abdominal pain, and it is only rarely diagnosed clinically. It is difficult to diagnose the perforation of small intestine because of poor organic lesion and anatomical factor. US may be superior to CT in the detection sensitivity of minimal free air and encapsulated small fluid collection.
Ultrasonography plays an important role in establishing preoperative diagnosis of microperforation of small intestine

View full abstract

A 71 years-old woman presented progressive dyspnea on exertion and palpitation. She had a history gastrectomy because of gastric cancer a year before. Before operation, she had been pointed out an ECG abnormalities and she had been on medication. A chest X-ray showed cardiac enlargement (CTR=77%) without pulmonary congestion and an ECG showed complete left bundle branch block. Laboratory data showed slightly elevation of serum concentration of LDH and uremic acid. Echocardiography showed non-dilated hypertrophied left ventricle with slightly depressed systolic function (EF=45%). Although a transmitral Doppler flow pattern showed an impaired relaxation pattern, it dramatically changed to a pseudo-normal pattern after passive leg lifting stress test. It indicates severe left ventricular diastolic function exists in this patient. From these findings, we suspected the diagnosis as a cardiac amyloidosis. We re-examined gastric specimen obtained during gastrectomy staining with Congo red and found a lot of perivascular amyloid infiltration. In conclusion, passive leg lifting test is a safe and useful test for the diagnosis of severe left ventricular diastolic dysfunction in cases of difficult to diagnose resting examination merely.

View full abstract