PURPOSE: The pulsatility index (PI), measured by transcranial Doppler (TCD), is a surrogate marker for distal vascular resistance in cerebral arteries, and elevated plasma total homocysteine (tHcyt) is regarded as a cause of ischemic stroke, including lacunar infarction. We investigated the relationship between the PI of cerebral arteries and plasma tHcyt in patients with lacunar infarction. MATERIALS AND METHODS: Plasma tHcyt level and TCD examination were performed in 94 patients with lacunar infarction. Mean flow velocity (MFV) and PI were assessed at the ipsilateral middle cerebral artery (MCA) and contralateral MCA, relative to the infarction, and the basilar artery (BA). Multivariate regression analysis was conducted between log-transformed tHcyt levels (logHcyt) and the PI of individual arteries. RESULTS: There was a significant correlation between logHcyt and the PI in all tested arteries (ipsilateral MCA: r=0.21, p=0.03; contralateral MCA: r=0.21, p=0.04; BA: r=0.35, p=0.01). In multivariate regression analysis, this significance remained unchanged after adjusting for vascular risk factors, creatinine, hematocrit and platelet count (ipsilateral MCA: beta=0.26, p=0.01; contralateral MCA: beta=0.21, p=0.04; BA: beta=0.39, p=0.001). There was no significant association between logHcyt and MFV of individual arteries. CONCLUSION: A significant association between plasma tHcyt and the PI of cerebral arteries indicates that homocysteine plays a role in the increase of distal arterial resistance in lacunar infarction.
Aged ; Basilar Artery/ultrasonography ; Cerebral Arteries/physiopathology/*ultrasonography ; Female ; Hematocrit ; Homocysteine/*blood ; Humans ; Male ; Middle Aged ; Middle Cerebral Artery/ultrasonography ; Regression Analysis ; Risk Factors ; Stroke, Lacunar/*blood/physiopathology/ultrasonography ; Ultrasonography, Doppler, Transcranial ; Vascular Resistance

OBJECTIVETo investigate the value of middle cerebral artery (MCA) and umbilical artery (UA) resistance index in predicting fetal hypoxia in fetuses with umbilical cord around the neck in late pregnancy.

METHODSEighty normal fetuses between 38 and 40 weeks of gestation and 88 fetuses with umbilical cord around neck were measured for MCA and UA pulsatility index (PI), resistance index (RI) and the peak-systolic/diastolic ratio (S/D) by means of color Doppler ultrasonography, and the resistance index ratio was calculated. Fetuses with umbilical cord around neck were estimated according to the measured normograms for the presence of fetal hypoxia, and the results were evaluated by diagnostic test.

RESULTSSignificant differences were found in MCA and UA resistance index ratio between the groups (P<0.01). There was no significant difference in the resistance index ratio between the normal group and around the neck (one round) group (P>0.05), but significant difference was found between normal group and around the neck (two rounds and more) group (P<0.01), and between the two arounds and one round groups (P<0.05). The sensitivity and specificity of MCA and UA resistance index and resistance index ratio in predicting fetal hypoxia of fetuses with umbilical cord around neck was 43%, 85%, 92%, 83%, 89%, and 100%, respectively.

CONCLUSIONMCA and UA resistance index ratio is a better indicator than its resistance index in predicting fetal hypoxia of fetuses with umbilical cord around neck, and may help in early detection of fetal hypoxia for a diagnosis before fetal distress.

Adult ; Female ; Fetal Hypoxia ; diagnosis ; etiology ; physiopathology ; Humans ; Middle Cerebral Artery ; diagnostic imaging ; embryology ; physiopathology ; Pregnancy ; Pregnancy Complications ; diagnostic imaging ; Pregnancy Trimester, Third ; Ultrasonography, Doppler ; Ultrasonography, Prenatal ; Umbilical Arteries ; diagnostic imaging ; physiopathology ; Young Adult

BACKGROUNDThe offspring of women with gestational diabetes mellitus (GDM) are prone to macrosomia. However, birth weight is difficult to be correctly estimated by ultrasound because of fetal asymmetric growth characteristics. This study aimed to investigate the correlations between fetal hemodynamics, fetal growth indices in late pregnancy, and birth weight in GDM.

METHODSA total of 147 women with GDM and 124 normal controls (NC) were enrolled in this study. Fetal hemodynamic indices, including the systolic/diastolic ratio (S/D), resistance index (RI), pulsatility index (PI) of umbilical artery (UA), middle cerebral artery (MCA), and renal artery (RA), were collected. Fetal growth indices, including biparietal diameter (BPD), head circumference (HC), abdominal circumference (AC), and femur length, were also measured by ultrasound. Birth weight, newborn gender, and maternal clinical data were collected.

RESULTSThe independent samples t-test showed that BPD, HC, and AC were larger in GDM than in NC (P < 0.05). Fetal hemodynamic indices of the UA and MCA were lower (P < 0.05), but those of the RA were higher (P < 0.001) in GDM than in NC. Birth weight was higher in GDM than in NC (P < 0.001). Pearson's correlation analysis showed that hemodynamic indices of the UA were negatively correlated with birth weight, BPD, HC, and AC in both groups (P < 0.05). MCA (S/D, PI, and RI) was negatively correlated with birth weight, HC, and AC in GDM (r = -0.164, -0.206, -0.200, -0.226, -0.189, -0.179, -0.196, -0.177, and - 0.172, respectively, P< 0.05), but there were no correlations in NC (P > 0.05). RA (S/D, PI, and RI) was positively correlated with birth weight in GDM (r = 0.168, 0.207, and 0.184, respectively, P< 0.05), but there were no correlations in NC (P > 0.05).

CONCLUSIONFetal hemodynamic indices in late pregnancy might be helpful for estimating newborn birth weight in women with GDM.

Adult ; Birth Weight ; physiology ; Cerebral Arteries ; physiology ; Diabetes, Gestational ; physiopathology ; Female ; Fetal Development ; physiology ; Hemodynamics ; physiology ; Humans ; Infant, Newborn ; Male ; Pregnancy ; Pregnancy Outcome ; Renal Artery ; physiology ; Ultrasonography, Prenatal ; Umbilical Arteries ; physiology

OBJECTIVETo discuss the mechanism of cerebral vessel spasm caused by concussion and the effect of Nimodipine on concussion.

METHODSA total of 224 patients who were treated from March 1995 to October 1999 were divided into two groups randomly, ie, Nimodipine group (113 cases) and control group (111 cases). Middle cerebral artery (MCA), basilar artery (BA) and the average peak forward velocity of cerebral blood flow were observed by color three-dimensional transcranial Doppler (3D-TCD) within 24 hours after admission and at the end of 3-6 days of treatment. Cerebral blood flow changes, characteristics and treatment effect were analyzed and determined by clinical main symptom disappearance rate.

RESULTSIn concussion, cerebral blood flow was divided into 3 phases: cerebral blood flow low infusion dilation phase, cerebral blood vessel spasm phase and cerebral blood flow recovery phase. In the Nimodipine group, clinical main symptom disappearance rate was higher than that in the control group in the cerebral spasm and recovery phases with a significant difference (P < 0.01).

CONCLUSIONSCerebral vessel spasm, hypoxia and ischemia lesion are the main pathological changes. Whether cerebral dysfunction is reversible or not is mainly determined by spasm time of cerebral blood vessel. Nimodipine has a good effect on releasing spasm and diminishing the cerebral blood flow velocity. It not only improves curative effect on concussion, but also reduces and prevents concussion sequelae. Hence, concussion patients who have cerebral spasm confirmed by 3D-TCD should be given Nimodipine routinely and early.

Adolescent ; Adult ; Aged ; Blood Flow Velocity ; Brain Concussion ; complications ; diagnostic imaging ; Cerebral Arteries ; diagnostic imaging ; drug effects ; Cerebrovascular Circulation ; drug effects ; Dose-Response Relationship, Drug ; Drug Administration Schedule ; Drug Therapy, Combination ; Female ; Follow-Up Studies ; Humans ; Infusions, Intravenous ; Injury Severity Score ; Male ; Mannitol ; administration & dosage ; Middle Aged ; Nimodipine ; administration & dosage ; Reference Values ; Treatment Outcome ; Ultrasonography, Doppler, Transcranial ; Vasospasm, Intracranial ; drug therapy ; etiology ; physiopathology