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  December, 2012

Vertebral arteries, efficacy of colour doppler sonography in old people

 
 


Madam, ultrasound of the vertebral artery (VA) is a valuable technique, providing direct or indirect evidence of abnormal VA circulation, including lesions that lie proximal or distal to the VA itself.1 The overall accuracy of transcranial Doppler sonography in the diagnosis of middle cerebral artery spasm has not been established.2 A few studies have already been conducted about vertebral arteries in comparison with carotid arteries which can be attributed to difficulty of surgical techniques in vertebral arteries which hinders the application of maintaining treatment methods in most centers.3
We studied an 86-year-old man who had no clear signs of cerebral arteries disease and insufficiency symptoms of vertebrobasilar. Common and interior carotid arteries as well as vertebral arteries of both sides were evaluated by 7.5 MHz linear probe and using Hitachi set EUB-525. Doppler angle was set less than 60ยบ in. The measured parameters included passive systole velocity (PSV), end diastolic velocity (EDV), vascular resistance index (RI), and diameter measured and registered at second part of vertebral artery (V2) and C4-C5 segment.
Second part of the vertebral artery was completely visible. Diameter of the right vertebral artery was 3.24 and the left one was 3.52. PSV of the right and left sides was 35.77 and 36.29, respectively. Additionally, RI of the right vertebral was 0.71 and of the left one was 0.69.
The study demonstrated the efficacy of color Doppler sonography in evaluating vertebral arteries in an old person. High velocity observed at vertebral arteries origin likely demonstrates partial narrowness of the arteries at the point separating from subclavian which lead to relative increase of blood circulation velocity there. About 70% of vertebral arteries origin should be observed using advanced colour Doppler sonography sets and conducting the sonographies by experts.4 Of course, more previous studies have often been conducted on youths and observing their arteries is naturally easier than that of older people having meandered vessels.5 All studies are the same in one point, i.e., observing left vertebral artery origin is more difficult than the right one. The difference may root from unnatural separation of the left vertebral artery directly from the aorta arch, making its observation difficult or impossible.6

Abolhassan Shakeri, Mohamad Goldust
Department of Radiology,1 Medical Student, Student Research Committee,2 Tabriz university of medical sciences, Tabriz, Iran.
Corresponding Author: Mohamad Goldust.
Email: drmgoldust@yahoo.com


References

1. Yurdakul M, Tola M. Doppler criteria for identifying proximal vertebral artery stenosis of 50% or more. J Ultrasound Med 2011; 30: 163-8.
2. Vicenzini E, Ricciardi MC, Sirimarco G, Di Piero V, Lenzi GL. Extracranial and intracranial sonographic findings in vertebral artery diseases. J Ultrasound Med 2010; 29: 1811-23.
3. Hua Y, Meng XF, Jia LY, Ling C, Miao ZR, Ling F, et al. Color Doppler imaging evaluation of proximal vertebral artery stenosis. AJR Am J Roentgenol 2009; 193: 1434-8.
4. Wessels T, Mosso M, Krings T, Klotzsch C, Harrer JU. Extracranial and intracranial vertebral artery dissection: long-term clinical and duplex sonographic follow-up. J Clin Ultrasound 2008; 36: 472-9.
5. Mitrasinovic A, Radak S, Kolar J, Aleksic N, Otasevic P, Popovic M, et al. Color Doppler sonographic evaluation of flow volume of the internal carotid and vertebral arteries after carotid endarterectomy. J Clin Ultrasound 2010; 38: 238-43.
6. Trattnig S, Matula C, Karnel F, Daha K, Tschabitscher M, Schwaighofer B. Difficulties in examination of the origin of the vertebral artery by duplex and colour-coded Doppler sonography: anatomical considerations. Neuroradiology 1993; 35: 296-9.


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WHO/GOARN Request for technical assistance for Cholera Control in Northern Iraq

Request for assistance

WHO is requesting assistance from GOARN partners to identify the following cholera and diarrhoeal diseases expertise to support the Ministry of Health of Iraq in cholera risk assessment and immediate preparedness activities to improve the health outcomes of the Syrian refugees current living in camps in the Kurdistan region of Iraq.

  • two (2) epidemiologists
  • two (2) clinical management experts
  • one (1) environmental health expert (WATSAN)
  • one (1)laboratory expert

Duration

6 day mission starting 13 June 2014 (this excludes travel time).

Location

Northern Iraq (Kurdistan region).

Language requirements

All candidates must be fluent in English- written, spoken and comprehension. Fluency in Arabic is an asset. Knowledge, abilities and skills All candidates are expected to demonstrate the following

  • Ability to conceptualize and promote innovative strategies and policies.
  • Ability to communicate and write in a clear concise manner, and to develop effective guidelines.
  • Excellent negotiation and interpersonal skills complemented by ability to motivate and lead others and to promote consensus. Tact, discretion and diplomacy
  • Demonstrated ability for project appraisal, project management, monitoring and evaluation and project impact assessment.
  • Ability to work with host governments and their agents, INGOs and national NGOs an advantage.
  • Proven experience of managing a large workload and multiple priorities.
  • Ability to work in difficult conditions.

Support to the mission

WHO/GOARN will cover the travel and per diem (to cover daily expense in the field) expenses for the duration of their mission. GOARN missions do NOT offer salary, consultancy fees or any other form of remuneration.

WHO will provide appropriate logistics support for the field mission. Pre-deployment orientation/training may be required at WHO.

Partners offers of assistance

Partners are requested to reply with offers of assistance, together with CVs and details of the availability of staff for this mission by email to goarn@who.int latest by 30 May 2014. Details of all offers from partners and eventual deployments will be maintained on the GOARN SharePoint.

Operational Contacts

Mamunur Malik WHO EMRO malikm@who.int

William Perea WHO HQ pereaw@who.int

Patrick Drury GOARN druryp@who.int



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