Panoramic radiography in the diagnosis of carotid artery atheromas and the associated risk factors

Atherosclerosis is a serious chronic disease, responsible for thousands of deaths worldwide and is characterized by thickening and loss of elasticity of the arterial walls, associated with the presence of atheromatous plaques. Various risk factors act directly on predisposition to the disease, among which the following are pointed out: diabetes mellitus, arterial hypertension and inadequate diet and eating habits. More recent researches have elucidated new risk factors acting in the development of this disease, such as, for example: periodontitis, chronic renal disease and menopause. The panoramic radiograph, commonly used in dental practice, makes it possible to see calcified atherosclerotic plaques that are eventually deposited in the carotid arteries. The aim of this review article was to emphasize the dentist's important role in the detection of carotid artery atheromas in panoramic radiographs and the immediate referral of patients affected by these calcifications to doctors. In addition, the study intended to guide the dentist, especially the dental radiologist, with regard to differential diagnosis, which should be made taking into consideration particularly the triticeal cartilage when it is calcified. © Henriques et al.

Foetal echoencephalography and Doppler ultrasonography of the middle cerebral artery in canine foetuses

Objectives: This study aimed to evaluate the characteristics of the brain and vascular indicesof the middle cerebral artery of canine foetuses. Methods: Twenty-five bitches were selected. Tissue development, echogenicity, echotexture and brain echobiometric data were studied, and the major structures were identified between the 5th and 8th gestational weeks. The area and volume of the brain mass (BMA and BMV), cranial area and volume (AC and VC), brain mass index (BMI) and brain volume index (BVI) were determined. A single ultrasound examination was performed during each studied week (6th, 7th and 8th). Doppler ultrasonography was performed to assess the maximum and minimum velocity, resistance and pulsatility index of middle cerebral artery of the foetuses. Results: Echoencephalography was performed to evaluate the morphological characteristics of the central nervous system. Cerebral echobiometry indicated an increase in area and volume of the hemispheres and cranium (P<0·001) but no changes in BMI or BVI over the gestational period studied. Doppler ultrasonography identified increases in peak systolic velocity (P=0·0188) and end diastolic velocity (P=0·0274) and decreases in resistance index (P=0·0002) and pulsatility index (P<0·001). Clinical Significance: Echoencephalography and spectral Doppler ultrasonography of the middle cerebral artery in canine foetuses might be a useful technique for prenatal care. © 2013 British Small Animal Veterinary Association.

Three-dimensional modeling and highly refined mesh generation of the aorta artery and its tunics

This paper describes strategies and techniques to perform modeling and automatic mesh generation of the aorta artery and its tunics (adventitia, media and intima walls), using open source codes. The models were constructed in the Blender package and Python scripts were used to export the data necessary for the mesh generation in TetGen. The strategies proposed are able to provide meshes of complicated and irregular volumes, with a large number of mesh elements involved (12,000,000 tetrahedrons approximately). These meshes can be used to perform computational simulations by Finite Element Method (FEM). © Published under licence by IOP Publishing Ltd.

Carotid artery atherosclerotic profile as a predictor of the aorta atherosclerotic profile in patients with cerebrovascular events

Background: It is well known that the presence of atheroma of the thoracic aorta is a risk factor for cerebrovascular events. We sought to evaluate whether the presence and the morphology of atherosclerotic plaque in the carotid artery detected by duplex ultrasonography is associated with disease in the proximal aorta visualized by transesophageal echocardiogram in patients with a cerebrovascular event. Methods: We carried out a cross-sectional prospective study including 147 consecutive patients with prior stroke or transient ischemic attack (TIA). Neurological evaluations were performed by an expert neurologist using clinical and tomographic diagnostic criteria including the definition of etiology and whether the patient suffered from stroke or TIA. Transthoracic and transesophageal echocardiograms and carotid artery duplex ultrasonography were performed by the same examiner. Patients with and without plaque in the carotid artery were compared using Student's t test or the χ2 test. Regression analysis was used to determine whether the presence of plaque in the carotid artery was predictive of the presence of plaque in the proximal aorta and to analyze the relationship between the echogenicity of carotid and aortic plaques. The significance level was set at p < 0.05. Results: All 147 patients (95 men) were included in the analysis. Patients' ages ranged from 23 to 85 years (65 ± 12.4 years). Most of the patients (58.5%) were Caucasian, while 41.5% were African-Brazilian. Arterial hypertension, diabetes and tobacco use were more frequent among patients with atherosclerotic plaque in the aorta. A normal carotid intima-media thickness halved the risk of atherosclerotic plaque in the aorta [odds ratio (OR) 0.46, 95% confidence interval (CI) 0.23-0.91; p = 0.026]. The presence of carotid plaque increased the risk of aortic plaque by 70-fold (OR 73.2, 95% CI 25.6-2,018.6; p < 0.001) in univariate analysis. The absence of atherosclerotic plaque in the carotid artery reduced the risk of plaque in the aorta to almost 0 (OR 0.014, 95% CI 0.004-0.041; p < 0.001). Considering the 86 patients with both aortic and carotid plaques, the presence of hypoechoic plaque in the carotid artery was a predictor of hypoechoic plaque in the aorta (OR 10.1, 95% CI 3.3-31.2; p < 0.001). Conclusions: The carotid artery atherosclerotic profile defined by ultrasonography is a strong predictor of the atherosclerotic profile of the proximal aorta. This should be taken into consideration before referring patients with acute cerebrovascular events for transesophageal echocardiogram. © 2013 S. Karger AG, Basel.

Ultrasound evaluation of common carotid artery blood flow in the Labrador retriever

Background: Doppler ultrasound (DUS) examination provides quantitative and qualitative information concerning the blood flow in veins and arteries, enabling their morphological evaluation and the collection of hemodynamic data. Dogs and cats as well as humans may display neurological signs of brain hypoperfusion secondary to common carotid alterations. Hence, DUS examination might aid in the differential diagnosis of neurological disorders of ischemic origin, among other causes. The objective of this study was to register normal values for systolic peak velocity, minimum diastolic velocity, diameter and resistance index of both common carotid arteries of 12 healthy Labrador retriever dogs between 2 and 5 years of age. By gathering these values, we might be able to improve the sensitivity of hemodynamic studies in clinically important brain disorders. Results: There were no statistical differences between the values for the right and left vessels: the systolic peak velocity was 75.8 ± 16 cm/s, minimum diastolic velocity was 12.2 ± 4 cm/s, common carotid diameter was 0.545 ± 0.063 cm, and resistance index was 0.83 ± 0.07. Conclusions: The results of this study might be used to establish normal parameters for Labrador retriever dogs and thus help in the diagnosis of neurological disorders associated with alterations of the carotid arteries. Similar studies must be performed to evaluate the same parameters in other dog breeds of different sizes and skull conformations. © 2013 Svicero et al.; licensee BioMed Central Ltd.

Echobiometrics kidney and renal artery triplex doppler of canine fetuses

O objetivo deste estudo foi avaliar, por meio da ultrassonografia convencional modo B, as características sonográficas e a biometria dos rins de fetos caninos, bem como determinar os índices vasculares da artéria renal dos conceptos ao Doppler Triplex. Foram utilizadas 24 fêmeas Shi-tzu e Pugs pesando de quatro a 10 kg e com idade entre quatro e seis anos. Ao modo B, a ecobiometria renal fetal, a regularidade da superfície renal, a ecotextura e a relação córtico-medular foram avaliadas durante a quinta, sexta, sétima e oitava semanas gestacionais. Ao Doppler Triplex, durante o mesmo período em que se realizou o exame convencional, foram determinados o pico de velocidade sistólica (PVS), a velocidade diastólica final (EDV) e o índice de resistência vascular (RI) e de pulsatividade (PI). Ao modo B, não foram detectadas alterações em rins fetais, e à ecobiometria renal dos fetos, foi possível determinar medidas renais importantes, verificando-se aumento das biometrias no decorrer do desenvolvimento fetal (P<0,0001). Ao Doppler Triplex, determinaram-se os índices vasculares da artéria renal fetal, sendo que os valores para PSV e EDV aumentaram no decorrer das semanas gestacionais (P<0,05) e permaneceram constantes para PI e RI (P>0,05). Concluiu-se que o modo B e o Doppler Triplex são ferramentas importantes para a avaliação do desenvolvimento renal fetal, com a utilização da ecobiometria renal e avaliação dos indices vasculares da artéria renal de fetos caninos.

Scrotal Thermography and Doppler Ultrasonography of the Testicular Artery of Buffaloes Subjected to Environmental Heat Stress

The process of spermatic division and differentiation (spermatogenesis) occurs with intratesticular temperature lower that the corporal temperature and for that is essential that the testicular thermoregulation mechanism occurs properly. For evaluation of the scrotal surface temperature can be used the infrared thermography or testicular sensors, besides that, can be evaluated the blood flux in the spermatic cord through the Doppler ultrasonography. Therefore the objective of this study was the evaluation of the scrotal thermography and Doppler flowmetry of the testicular artery of buffaloes subjected to environmental heat stress. For that were used seven healthy buffaloes, with age of 3 and 4 years, of the Murrah breed. For the surface scrotal temperature measurement (SST, degrees C) and superficial neck temperature (SNT, degrees C) was used the infrared termography (Infra Cam (TM) of the brand FLIR Systems Inc.), then Doppler flowmetry of the testicular artery in the region of the spermatic cord through the ultrasonography (Mylab 5, Esaote (R)) and measurement of the rectal temperature (RT, degrees C). The evaluations were done in two moments: moment 1 (M1) with all the animals in the shade (Temperature=32,2 degrees C) and moment 2 (M2) after 3 hours of exposure of animals to the sun (Temperature=38,7 degrees C To calculate the resistivity index (RI) and pulsatility index (PI), spectra were obtained from pulsed Doppler in three random regions of the testicular artery in the spermatic cord. Data were subjected to analysis of variance (ANOVA) followed by T test, using a significance level of 5%. There was an increase (p<0,05) of RT (37,4 +/- 0,4(a) vs 39,0 +/- 0,3(b); M1 and M2 respectively), SST (30,6 +/- 1,4(a) vs 35,2,0 +/- 1,0(b); M1 and M2 respectively) and SNT (33,1 +/- 2,5(a) vs 38,5,0 +/- 0,3(b); M1 e M2 respectively) e RI (0,67 +/- 0,1(a) vs 0,74 +/- 0,1(b); M1 e M2 respectively) in M2. Increasing trend was observed (0,05>p>0,01) in PI (1,10 +/- 0,4(a) vs 1,23 +/- 0,2(b); M1 and M2 respectively) in M2. The results of the present study allow us to conclude the healthy buffaloes have the scrotal average surface temperature 3 degrees C lower that the body temperature and that the exposure of 3 hours to sun in healthy buffaloes causes thermal stress to the animals and changes in its surface scrotal temperature, and the Doppler flowmetry of the testicular artery demonstrating the importance of thermal management for breeding buffaloes. Besides that, the thermography and the Doppler ultrasonography presented great potential to detect changes of testicular perfusion, being a promising additional test in the buffalo andrological evaluation.

Horner-s Syndrome following common carotid artery translocation in a horse: case report

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Analysis of renal function after on and off pump coronary artery bypass grafting

Cardiopulmonary bypass (CPB) is often associated with renal dysfunction, as measured by plasma creatinine levels and hemodialysis rates. Aim. To compare creatinine clearance (CrCl), estimated with the Cockroft and Gault formula, between patients undergoing off-pump coronary artery bypass grafting (OPCAB) versus on-pump CABG (on-CAB). Material and methods. Between April 2008 and April 2009, 119 patients underwent coronary bypass graft surgery. Fifty-eight (58) of these patients underwent OPCAB while 61 had on-CAB. Creatinine clearance, plasma creatinine levels, and clinical outcome were compared between the groups. A creatinine clearance value of 50 mL/minute was accepted as the lowest limit of normal renal function. Results. There were two hospital deaths caused by sepses after pulmonary infection. Creatinine clearance (Preoperative OPCAB 73,64±33,72 x on-CAB 75,70±34,30mL/min; discharge OPCAB 75,73±35,07 x on-CAB 79,07±34,71 mL/ min; p=0,609), and creatinine levels (Preoperative OPCAB 1,04±0,38 x on-CAB 1,13±0,53 mg/dL; discharge OPCAB 1,12±0,79 x on-CAB 1,04±0,29mg/dL; p=0,407) did not show statistically inter-group differences. Conclusion. Deterioration in renal function is associated with higher rates of postoperative complications. No significant difference in CrCl could be demonstrated between the groups.

Endovascular Treatment of Spontaneous Isolated Common and External Iliac Artery Dissections with Preservation of Pelvic Blood Flow

Spontaneous isolated dissection of iliac arteries is very rare, with few reports in the literature. Medical, surgical, and endovascular treatment modalities have all been used to manage iliac artery dissections. We report a case of symptomatic, isolated, spontaneous dissection of the common iliac and external iliac arteries. Both dissections were successfully treated by separate percutaneous stent-graft placement, preserving hypogastric artery flow. This technique is interesting because it provides adequate sealing of proximal and distal dissection sites while preserving hypogastric artery and pelvic flow.

A Randomized Trial of the Topical Effect of Antifibrinolytic Epsilon Aminocaproic Acid on Coronary Artery Bypass Surgery Without Cardiopulmonary Bypass

We assessed the effect of the topical application of epsilon-aminocaproic antifibrinolytic acid (EACA) on the pericardium of patients submitted to coronary artery bypass graft (CABG) without the use of cardiopulmonary bypass (CPB). This is a prospective, randomized, and double-blind study. We evaluated 26 patients with chronic coronary heart disease indicated for CABG without CPB (EACA and placebo groups). The analysis of the postoperative hematological results showed no difference between groups in hemoglobin and hematocrit. There was no difference between the groups regarding the postoperative bleeding through the drains in the first 24 hours, 48 hours, and accumulated loss until removal of drains. The use of EACA in patients undergoing CABG without CPB presented no difference in the reduction of the amount of bleeding and the need for blood transfusions.