Three-dimensional gray scale ultrasonographic imaging of the celiac axis: preliminary report.
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The vessels of the celiac axis were evaluated in 16 healthy volunteers with three-dimensional gray scale ultrasonography. Sonographic volume data sets were obtained from both sagittal and transverse planes. The visualization of specific branches of the celiac artery (hepatic, splenic, left gastric, gastroduodenal, left hepatic, right hepatic, right gastric) was evaluated, and each vessel was placed in one of four categories on the basis of the appearance of the specific vessel and image clarity (not seen, poorly seen, adequately seen, well seen). Each vessel was evaluated on an initial two-dimensional scan and on a second scan using the entire volume to optimize and follow the designated vessel using rotating, referencing, and scrolling display capabilities. The ability to manipulate an entire volume improved visualization of the selected vessels as noted by an improved score. The proportion of vessels in the "not seen" and "poorly seen" categories decreased from the initial scan (62.5%) to the scan utilizing the entire volume (36%). Alternatively, the percentage of vessels in the "adequately seen" to "well seen" categories improved from 37.50% on the initial examination to 64% on the scans using the entire volume to depict vascular anatomy. The optimal plane to image each vessel depended on the course of a specific vessel. For optimal imaging of all the selected vessels, both sagittal and transverse volume acquisitions and both sagittal and transverse planes were needed. Three-dimensional imaging provided a new imaging plane (coronal) that was useful in following and identifying vessels, especially those vessels coursing in a right to left direction. Vascular variants were identified by this technique in two of 16 subjects. Vascular imaging was improved with three-dimensional ultrasonography, and this imaging method may provide additional assistance in decision making when evaluating abdominal vessels. (+info)
Vasorelaxant effect of thiopentone in isolated human epigastric arteries.
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The experiments were designed to elucidate the mechanism of thiopentone-induced inhibition of contractile responses in isolated human epigastric arteries. Segments of human epigastric arteries were obtained from patients who underwent elective or emergency caesarean section, placed in standard physiological salt solution (PSS), cut into rings at 3 mm intervals and suspended in organ baths for recording of isometric contractions at 37 degrees C, and pH 7.4. Three protocols were employed to examine the inhibitory effect of thiopentone: (a) concentration-dependent effect on 10(-7) M noradrenaline (NA)- or high-K+ (40 mM)-induced contractions: (b) effect on NA-induced extra-and intracellular Ca(2+)-dependent contractions and (c) effect on the dose-response curve when Ca2+ is restored to Ca(2+)-depleted rings in Ca(2+)-free 40 mM K(+)-depolarizing medium. Thiopentone (1 x 10(-6) -4 x 10(-3) M) caused concentration-dependent relaxation of both NA- and high-K(+)-induced contractions. The magnitudes of both precontractions were not significantly different but the IC50 values for thiopentone relaxation of high-K+ contractions were significantly lower than for NA contractions. Thiopentone (10(-4) M) significantly attenuated the phasic (intracellular Ca2+ dependent) contractile responses to 10(-5) M NA in Ca(2+)-free PSS as well as the tonic (extracellular Ca2+ dependent) contractions upon restoration of Ca2+. In contrast, nifedipine (1 microM) did not modify the phasic response but significantly attenuated the tonic response. Thiopentone (10(-4) M) also almost completely abolished concentration-dependent Ca(2+)-induced contractions in K(+)-depolarized Ca(2+)-depleted rings. The results suggest that in the smooth muscle of human epigastric arteries, thiopentone-induced relaxation is non-specific and is associated with impairment of Ca2+ supply from both extracellular and intracellular pools. (+info)
Inferior epigastric artery pseudoaneurysm: a complication of paracentesis.
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Two patients had inferior epigastric artery pseudoaneurysms after therapeutic paracentesis for ascites caused by portal hypertension. The first patient, a 62-year-old man, had a two-week history of left lower quadrant pain, tenderness, and nonpulsatile mass after a paracentesis for ascites. A left inferior epigastric artery pseudoaneurysm measuring 10 cm in diameter and 20 cm in length was diagnosed by means of Duplex ultrasound and arteriography. The patient was treated with percutaneous embolization, with successful thrombosis of the pseudoaneurysm. The second patient, a 33-year-old woman, had a six-week history of left lower quadrant pain, tenderness, and nonpulsatile mass after a paracentesis for ascites. Computerized tomography and arteriography showed a left inferior epigastric artery pseudoaneurysm, measuring 7 cm in diameter and 9 cm in length. The patient was treated with percutaneous embolization with successful thrombosis of the pseudoaneurysm. Both patients were discharged in good condition 2 days after embolization. Inferior epigastric artery pseudoaneurysm is a complication of paracentesis, and percutaneous embolization may be preferable to surgical repair in patients with chronic liver failure and portal hypertension. (+info)