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Ezio Ventura - One of the best experts on this subject based on the ideXlab platform.
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effects of propranolol compared with clonidine on portal haemodynamics a double blind cross over study using Duplex Doppler Ultrasonography
European Journal of Gastroenterology & Hepatology, 1995Co-Authors: E Tincani, G. Cioni, F. Turrini, Renato Romagnoli, P Dalimonte, A Cristani, Ezio VenturaAbstract:Background: Patients with liver cirrhosis and large oesophageal varices run a high risk of digestive haemorrhage due to the rupture of oesophageal varices, an event associated with a high mortality. At present, the only treatment for the prevention of first bleeding from oesophageal varices on which there is general agreement is drug-based. In order to tailor drug treatment to the requirements of individual patients more precisely, an ever-increasing number of drugs is being investigated. Design: Double-blind cross-over study. Methods: Sixteen cirrhotic patients with large oesophageal varices were studied by means of Duplex-Doppler Ultrasonography to determine variations in portal haemodynamics after oral administration of 0.150 mg clonidine and to compare these with the variations observed after oral administration of 40 mg propranolol. Results: Propranolol caused a significant reduction in maximum portal flow velocity (P<0.001), whereas clonidine failed to cause any such variation (P=0.194). Considering as responders those patients who exhibited at least a 10% decrease in maximum portal flow velocity, 11 patients responded to propranolol; of these, three also responded to clonidine. No patient responded only to clonidine. Conclusion: The absence of any effects on the parameters of portal haemodynamics would appear to deny clonidine any significant role in preventing first bleeding resulting from the rupture of oesophageal varices.
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Effects of propranolol compared with clonidine on portal haemodynamics: a double-blind cross-over study using Duplex-Doppler Ultrasonography.
European journal of gastroenterology & hepatology, 1995Co-Authors: Tincani E, G. Cioni, P. D'alimonte, Cristani A, F. Turrini, Renato Romagnoli, Ezio VenturaAbstract:Background: Patients with liver cirrhosis and large oesophageal varices run a high risk of digestive haemorrhage due to the rupture of oesophageal varices, an event associated with a high mortality. At present, the only treatment for the prevention of first bleeding from oesophageal varices on which there is general agreement is drug-based. In order to tailor drug treatment to the requirements of individual patients more precisely, an ever-increasing number of drugs is being investigated. Design: Double-blind cross-over study. Methods: Sixteen cirrhotic patients with large oesophageal varices were studied by means of Duplex-Doppler Ultrasonography to determine variations in portal haemodynamics after oral administration of 0.150 mg clonidine and to compare these with the variations observed after oral administration of 40 mg propranolol. Results: Propranolol caused a significant reduction in maximum portal flow velocity (P
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Duplex-Doppler Ultrasonography in the assessment of portal hypertension. Utility of the measurement of maximum portal flow velocity.
European journal of radiology, 1993Co-Authors: D'alimonte P, Cristani A, Ezio Ventura, Cioni G, Alberto Ferrari, Renato RomagnoliAbstract:To assess the utility of Duplex-Doppler Ultrasonography (DDUS) in the evaluation of portal haemodynamics we studied 52 patients with compensated liver cirrhosis (mean age 53.9 ± 9.2 years, males 32, females 20) diagnosed by laparoscopy and biopsy. All patients underwent laparoscopy and oesophageal-gastro-duodenoscopy (OGDS): we postulated that haemodynamically significant portal hypertension (PH) was present if varices were detected at OGDS and/or if collateral veins were revealed at laparoscopy. DDUS was performed with a strictly standardized method and maximum portal flow velocity (PFV) was measured in all patients. Max-PFV ranged between 3.5 and 33.4 cm/s. Overall, 36 patients (69%) had a max-PFV lower than 20.3 cm/s (normal max-PFV range in our laboratory is 20.3–33.3 cm/s), while 16 patients (31%) had normal max-PFV values. Five patients (9.6%) had no signs of PH at laparoscopy and/or OGDS and all five had normal max-PFV values. The other 47 patients (90.4%) had collateral circuli at laparoscopy and 2947 (61.7%) exhibited also varices at OGDS: max-PFV was lower than 20.3 cm/s in 3647 patients (76.6%). The measurement of max-PFV demonstrated a 76.6% sensitivity and a 100% specificity in detecting PH, with 100% positive predictive value and 31% negative predictive value. Three patients with PH and apparently normal max-PFV values exhibited a recanalization of the umbilical vein. In conclusion, in cirrhotic patients: (1) a low max-PFV can be considered a sure sign of PH; (2) a normal max-PFV is less probative and may be interpreted in different ways: either (a) portal pressure is really normal or (b) portal pressure is high but collateral circuli originate distally from the sampling volume or (c) a hyperdynamic component exists.
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Relevance of reduced portal flow velocity, low platelet count and enlarged spleen diameter in the non-invasive diagnosis of compensated liver cirrhosis.
The European journal of medicine, 1993Co-Authors: Cioni G, Tincani E, Cristani A, D'alimonte P, Paolo Ventura, G. Abbati, Vignoli A, R. Romagnoli, Ezio VenturaAbstract:OBJECTIVES The aim of this prospective study was to identify the combination of parameters best able to predict the diagnosis of compensated cirrhosis. METHODS One hundred and fourteen patients with suspected chronic compensated liver disease were divided, on the basis of bioptical findings, into two groups: group A, without cirrhosis (n = 58) and group B, with cirrhosis (n = 56). A number of biochemical parameters, the extent of oesophageal varices, spleen size, portal vein diameter and maximum and mean portal flow velocity measured by Duplex-Doppler Ultrasonography were taken into account in a binary forward-stepwise multiple logistic regression analysis. RESULTS Only three variables were present in the final regression equation, maximum portal flow velocity affording the highest correlation with the histological diagnosis of cirrhosis (p = 0.0007), with an overall predictive value of 87.7%. When associated with the bipolar diameter of the spleen (p = 0.0169) and the number of platelets (p = 0.0487), the predictive value rose to 94.7%. If all three parameters were normal, a non-cirrhotic liver disease was most likely (96% probability); if two or three of the parameters were abnormal, liver cirrhosis was almost certain (98% probability); if only one parameter was abnormal, the clinical diagnosis was uncertain. CONCLUSIONS This study emphasizes the usefulness of Duplex Doppler Ultrasonography in the non-invasive diagnosis of compensated cirrhosis.
John P Mulhall - One of the best experts on this subject based on the ideXlab platform.
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Penile Duplex Doppler Ultrasonography
Atlas of Office Based Andrology Procedures, 2016Co-Authors: John P Mulhall, Lawrence C. JenkinsAbstract:The Duplex Doppler ultrasound is a procedure to evaluate erectile hemodynamics. Doppler ultrasound is combined with an intracavernosal injection of vasoactive agents to evaluate penile blood flow. This test evaluates arterial inflow, as well as venous outflow.
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mp43 18 assessing the impact of audio visual sexual stimulation avss on the need for repeat vasoactive agent injection during penile Duplex Doppler Ultrasonography
The Journal of Urology, 2015Co-Authors: Lawrence C. Jenkins, Joseph Narus, Amparo Camacho, Christian J Nelson, John P MulhallAbstract:INTRODUCTION AND OBJECTIVES: The accuracy of penile Duplex Doppler Ultrasonography (DDUS) is optimized using a repeat vasoactive agent-redosing schedule. AVSS has been proposed as a means to achieve complete smooth muscle relaxation during DDUS thus minimizing the need for repeat intracavernosal injections (ICI). Clinical experience has taught us that while some patients are comfortable utilizing adult movies for AVSS, some are not. Our goal was to identify if AVSS decreased the number of ICI needed to achieve optimal penile rigidity. METHODS: Prior to DDUS patients were counseled regarding the potential utility of AVSS during the study. A variety of adult movies were available to the patients. No mandate was made to use AVSS, rather patients were encouraged to view the material only if they felt comfortable doing so. Penile rigidity was recorded on a 10-point scale (0 no tumescence, 10 maximal rigidity) by a single examiner. Patients received repeated ICI up to a total of 3 injections until they achieved rigidity equivalent to their best rigidity at home or until their end-diastolic velocities (EDV) were negative. The number of ICI required to achieve this was compared between those men who opted to use AVSS vs those who opted not to do so. RESULTS: Mean age of 168 men 1⁄4 54 14 years. 87 men used AVSS 81 men did not. Median number of vascular risk factors (VRF) 1⁄4 0 (IQR1⁄41), mean VRF 1⁄4 0.77 1.0, with no difference between the two groups. 27% had an abnormal DUS (8% arteriogenic ED, 18% venous leak, 2% mixed vasculogenic ED), evenly distributed across the two groups. Mean number of ICI used was not significantly different between groups (AVSSþ 1⁄41.9; AVSS1⁄4 1.8 1, p1⁄40.71). Median ICI number 1⁄4 2 for each group. There was a trend toward a higher percentage of men in the AVSS group needing phenylephrine reversal compared to the no AVSS group (43% vs. 30%, p1⁄40.08, RR 1⁄4 1.43, 95% CI: 0.95-2.17). CONCLUSIONS: One should expect an equivalent need for repeat ICI during DDUS in patients who opt to utilize AVSS compared to those who do not. It is possible that patients using AVSS may be more likely to need erection reversal after DDUS completion.
Jeffrey P Carpenter - One of the best experts on this subject based on the ideXlab platform.
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Determination of sixty percent or greater carotid artery stenosis by Duplex Doppler Ultrasonography.
Journal of vascular surgery, 1995Co-Authors: Jeffrey P Carpenter, Frank J. Lexa, Julia T. DavisAbstract:Abstract Purpose: The Asymptomatic Carotid Atherosclerosis Study, demonstrating the benefit of carotid endarterectomy for symptom-free patients with 60% or greater carotid artery stenosis, has given rise to the need for development of screening parameters for detection of these lesions. Traditional Duplex categories (50% to 79%, 80% to 99%) are not applicable. We sought to develop Duplex criteria for determination of 60% or greater carotid artery stenosis by comparison with arteriography. Methods: The Duplex scans and arteriograms of 110 patients (210 carotid arteries), obtained within 1 month of each other, were reviewed by blinded readers. Arteriographic stenosis was determined by the method of the Asymptomatic Carotid Atherosclerosis Study. Duplex measurements of peak systolic velocity (PSV) and end-diastolic velocity (EDV) were recorded, and ratios of velocities in the internal and common carotid arteries (ICA, CCA) were calculated. Sensitivity, specificity, positive and negative predictive values (PPV, NPV), and accuracy were determined, and receiver-operator characteristic curves were generated. Results: Interobserver agreement for measurement of arteriographic stenosis was "almost perfect" (κ = 0.86). The criteria determined for detection of 60% or greater stenosis were as follows: PSV ICA >170 cm/sec (sensitivity 98%, specificity 87%, PPV 88%, NPV 98%, accuracy 92%), EDV ICA > 40 cm/sec (sensitivity 97%, specificity 52%, PPV 86%, NPV 86%, accuracy 86%), PSV ICA /PSV CCA > 2.0 (sensitivity 97%, specificity 73%, PPV 78%, NPV 96%, accuracy 76%), EDV ICA /EDV CCA > 2.4 (sensitivity 100%, specificity 80%, PPV 88%, NPV 100%, accuracy 88%). If all of the above criteria were met, 100% accuracy was achieved. Conclusion: It is concluded that 60% or greater carotid artery stenosis can be reliably determined by Duplex criteria. The use of receiver-operator characteristic curves allows the individualization of Duplex criteria appropriate to specific clinical situations of patient screening for lesions (high sensitivity and NPV) or use as a sole preoperative imaging modality (high PPV). Individual vascular laboratories must validate their own results. (J VASC SURG 1995;22:697-705.)
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magnetic resonance venography for the detection of deep venous thrombosis comparison with contrast venography and Duplex Doppler Ultrasonography
Journal of Vascular Surgery, 1993Co-Authors: Jeffrey P Carpenter, George A Holland, Richard A Baum, Rodney S Owen, Judith T Carpenter, Constantin CopeAbstract:Abstract Purpose: Contrast venography is the gold standard for diagnosis in deep venous thrombosis (DVT); however, this technique is invasive and requires the use of potentially hazardous contrast agents. Although Duplex Doppler Ultrasonography is accurate in the evaluation of lower extremity DVT, it is less accurate in the assessment of the pelvic and intraabdominal veins. Magnetic resonance venography (MRV) has recently been developed, and our purpose was to determine whether MRV could accurately demonstrate DVT when compared with Duplex scanning and contrast venography. Methods: Eighty-five patients underwent contrast venography and MRV from the inferior vena cava to the popliteal veins to rule out DVT. Thirty-three of these patients also underwent Duplex scanning. Blinded readings of these studies were compared for the presence or absence and extent of venous thrombosis. Results: DVT was documented by contrast venography in 27 (27%) venous systems. Results of MRV and contrast venography were identical in 98 (97%) of 101 venous systems, whereas results of Duplex scanning and contrast venography were identical in 40 (98%) of 41 venous systems. All DVTs identified by contrast venography were detected by MRV and Duplex scanning. The discrepancies were due to false-positive MRV (3) and Duplex scanning (1) results. When compared with contrast venography, MRV had a sensitivity of 100%, specificity of 96%, positive predictive value of 90%, and negative predictive value of 100%. For Duplex scanning the sensitivity was 100%, specificity was 96%, positive predictive value was 94%, and negative predictive value was 100%. Conclusions: It is concluded that MRV is an accurate noninvasive venographic technique for the detection of DVT. (J VASC SURG 1993;18:734-41.)
Yang-il Park - One of the best experts on this subject based on the ideXlab platform.
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Efficacy of virtual glasses in audio-visual sexual stimulation during penile color Duplex Doppler Ultrasonography.
European urology, 2002Co-Authors: Kwangsung Park, Dong Deuk Kwon, Yang-il ParkAbstract:Abstract Objective: To examine whether audio–visual sexual stimulation (AVSS) with virtual glasses is effective in improving the recording of penile hemodynamics during penile color Duplex Doppler Ultrasonography. Patients and Methods: A total of 64 consecutive patients with erectile dysfunction underwent penile color Duplex Doppler Ultrasonography after intracavernosal injection of 10–20μg prostaglandin E1 and subsequent genital stimulation. AVSS with virtual glasses and earphones was applied when peak systolic velocities (PSV) were less than 35cm/s or end diastolic velocities (EDV) were more than 5cm/s. PSV, EDV and the resistive index of both cavernosal arteries were continuously monitored. Clinical erectile response was assessed with visual inspection and manual palpation. Results: AVSS with virtual glasses was performed on 40 of 64 patients. AVSS improved the clinical erectile response in 26 (65%) of 40 patients. Doppler Ultrasonography without AVSS identified 11 (27.5%), 5 (12.5%), and 24 (60%) patients with arteriogenic, veno-occlusive, and mixed-type impotence, respectively. However, after real-time AVSS 15 (37.5%), 7 (17.5%), 8 (20%), and 10 (25%) patients demonstrated non-vasculogenic, arteriogenic, veno-occlusive, and mixed-type impotence, respectively. Real-time AVSS improved the Doppler wave forms in 65% of cases. Conclusion: AVSS with virtual glasses improves the recording of physiologic erectile response and may be used as a valuable tool during penile color Duplex Doppler Ultrasonography.
Ju-ton Hsieh - One of the best experts on this subject based on the ideXlab platform.
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Feasability of a novel audio-video sexual stimulation system: an adjunct to the use of penile Duplex Doppler Ultrasonography for the investigation of erectile dysfunction.
The journal of sexual medicine, 2010Co-Authors: Yuh-chen Kuo, Shih-ping Liu, Jyh-horng Chen, Hong-chiang Chang, Vincent F.s. Tsai, Ju-ton HsiehAbstract:ABSTRACT Introduction Penile color Doppler Ultrasonography (CDUS) with pharmacotesting has become an important tool for evaluating vascular erectile dysfunction (ED), and audio-visual sexual stimulation (AVSS) has been suggested to be helpful in assisting the performance of CDUS during the examination. Aim To investigate the feasibility of using a novel, remotely controllable AVSS system to assist CDUS. Methods This prospective randomized cross-over study recruited 60 consecutive ED patients. Each patient received three randomized sessions of CDUS under different conditions—AVSS, intracavernous injection (ICI) of alprostadil 20 microgram, or AVSS plus ICI. Clinical responses (rigidity) and penile vascular parameters including peak systolic velocity (PSV), end diastolic velocity (EDV), and resistive index (RI) were measured. At the end of the study, patients were asked about how they perceived the AVSS system in generating sexual arousal. Main Outcome Measures PSV, EDV, RI, and rigidity. Results Fifty-eight ED patients (aged 21–79) underwent 174 sessions of CDUS. The mean PSV and maximal rigidity of patients under ICI alone were significantly greater than those of patients under AVSS alone (48.25 ± 22.78 vs. 36.54 ± 23.25 cm/second and 65.00 ± 23.93% vs. 43.28 ± 31.79%, respectively; both P P P = 0.082). EDV or RI was of no significant difference among the different conditions. Ultrasonographic diagnoses of ED under different conditions varied substantially. Fifty-four (93%) patients considered the AVSS system “very satisfactory” or “satisfactory” in evoking sexual arousal. Conclusions The novel, remotely controllable AVSS system is well accepted by patients and, in conjunction with ICI, helps to produce higher PSV for patients undergoing CDUS. Kuo YC, Liu SP, Chen JH, Chang HC, Tsai VFS, and Hsieh JT. Feasability of a novel audio-video sexual stimulation system: An adjunct to the use of penile Duplex Doppler Ultrasonography for the investigation of erectile dysfunction.
