RESUMEN
A patient who had had been treated by surgery for spinal echinococcosis in a Mediterranean country emigrated to northern Europe. After surgery, the echinococcosis disseminated and he developed chronic lytic and sinus-draining hydatid disease of the left hip and neuromuscular weakness of the left lower extremity. Seventeen years after the spinal surgery, he was referred to our hip service for a possible total hip replacement (THR) after receiving adequate chemotherapy against echinococcosis for nearly 3 years. Because of the poor results reported by others, we decided against THR; two of the four previous patients described in the current literature who had THR died due to complications.
Asunto(s)
Enfermedades Óseas/microbiología , Equinococosis/complicaciones , Articulación de la Cadera/microbiología , Paraplejía/etiología , Adulto , Enfermedades Óseas/diagnóstico por imagen , Equinococosis/diagnóstico por imagen , Humanos , Masculino , Radiografía , Enfermedades de la Columna Vertebral/microbiologíaRESUMEN
OBJECTIVES: To determine the utility of percutaneous transluminal angioplasty (PTA) of the femoropopliteal segment in patients with claudication and critical leg ischaemia (CLI). DESIGN: Longitudinal observational study. SETTING: A university based vascular surgical centre. MATERIAL: Ninety-five patients with stenosing or occlusive arterial lesions of the femoropopliteal segment underwent 52 primary PTA for claudication and 50 primary PTA for CLI. METHODS: The procedure was considered haemodynamically successful when the increase of immediate postprocedural ABI was 0.15 or more. The criterion for haemodynamic success during follow-up was an ABI having not decreased by more than 0.15 from the immediate postprocedural level. The run-off arteries were graded according to the scoring system proposed by the SVS/ISCVS. RESULTS: Among the technically successful procedures (83%), the haemodynamic success rate was 77% at 1 month, 55% after 1 year, and 51% after 2 years. The cumulative haemodynamic success rates were 83%, 66% and 61% in claudicants, and 70%, 42%, and 38% in CLI (p = 0.03). In patients with a run-off score < or = 7.5, the success rates were 84%, 67%, and 60%, respectively, whereas in those with a crural score > 7.5 these were 61%, 39%, and 39%, respectively (p = 0.04). CONCLUSIONS: The haemodynamic results suggest that PTA to the femoropopliteal segment is seldom a procedure of choice for critically ischaemic legs with poor run-off. The run-off score is useful in identifying patients who may benefit from PTA.
Asunto(s)
Angioplastia de Balón , Arteria Femoral , Claudicación Intermitente/terapia , Isquemia/terapia , Pierna/irrigación sanguínea , Arteria Poplítea , Anciano , Angiografía , Interpretación Estadística de Datos , Femenino , Estudios de Seguimiento , Hemodinámica , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Programas Informáticos , Factores de TiempoRESUMEN
OBJECTIVES: To determine the value of the Ad Hoc scoring system (SVS/ISCVS) in predicting the immediate outcome of femoropopliteal saphenous vein grafts. DESIGN: Retrospective study. MATERIALS: One hundred and twenty patients underwent 132 primary femoropopliteal vein bypass procedures, 32 for claudication and 100 for critical leg ischemia (CLI). METHODS: The outflow arteries were graded according to the Ad Hoc scoring system (SVS/ISCVS). Postoperative immediate graft patency and leg salvage to the period of the first 30 days after surgery. RESULTS: Ninety-one per cent of claudicants and 83% of CLI patients had immediate patency. The overall 30-day patency rate was 85%. Leg salvage rate was 91% for the patients with CLI. Patients with score in the highest quartile were found to have a 8.7 times higher risk for immediate graft occlusion (p = 0.005). Multivariate analysis showed that the Ad Hoc score was predictive of immediate patency (p = 0.0006) and leg salvage (p = 0.0004). In patients with a score < or = 7.5 and in those with a score > 7.5, the patency rates were 95% and 66% (p = 0.001), and the leg salvage rates were 97% and 80%, (p = 0.004), respectively. CONCLUSIONS: The Ad Hoc scoring system is useful in predicting the immediate outcome of femoropopliteal saphenous vein grafts.
Asunto(s)
Angiografía , Arteria Femoral/cirugía , Arteria Poplítea/cirugía , Vena Safena/trasplante , Grado de Desobstrucción Vascular , Anciano , Femenino , Oclusión de Injerto Vascular/diagnóstico por imagen , Oclusión de Injerto Vascular/cirugía , Humanos , Claudicación Intermitente/fisiopatología , Claudicación Intermitente/cirugía , Periodo Intraoperatorio , Isquemia/fisiopatología , Isquemia/cirugía , Pierna/irrigación sanguínea , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias , Reoperación , Estudios Retrospectivos , Factores de RiesgoRESUMEN
BACKGROUND: Chronic rejection is a major problem in renal transplantation. Various experimental models have been developed to study vasculopathy of chronic rejection. However, animal models resembling the clinical situation of renal transplantation with combination therapy of basic immunosuppression are not available. The aim of this study was to find an experimental model of a donor-recipient rat strain combination that, under triple drug immunosuppressive treatment (methylprednisolone, cyclosporine, and azathioprine), would develop chronic rejection within a few weeks. METHODS: Renal transplantations were performed in strain combinations of DA-->AO, PVG-->BN, and DA-->BN. In each group, 5-8 animals received triple drug treatment of methylprednisolone (2 mg/kg), azathioprine (2 mg/kg), and cyclosporine (5 mg/kg) daily, 5-10 animals were left without treatment, and 6 syngenic transplantations were performed. The grafts were monitored with ultrasound-guided fine needle aspiration biopsies to quantify the inflammation in the graft. Graft histology was performed in parallel and quantified by using the chronic allograft damage index (CADI). RESULTS: In nonimmunosuppressed animals, irreversible acute rejection with a high peak of inflammation appeared in every strain combination within 5-8 days. In triple drug-treated rats, the DA-->AO combination demonstrated a prolonged acute rejection but no characteristic chronic changes, and the PVG-->BN combination showed practically no inflammation and did not develop any signs of chronic rejection within 60 days (CADI: 2.7+/-2.1), but the DA-->BN combination showed an early, mild inflammatory response 5-7 days after transplantation and developed chronic rejection within 40-60 days after transplantation (CADI: 7.9+/-3.1). Syngenic animals showed no inflammation or histological alterations (CADI: 1.7+/-2.0). CONCLUSIONS: In conclusion, in the DA-->BN combination with triple drug treatment, early mild inflammation was followed by the development of chronic rejection and can be used as an experimental model that resembles the clinical situation in renal transplantation.
Asunto(s)
Rechazo de Injerto/tratamiento farmacológico , Inmunosupresores/uso terapéutico , Trasplante de Riñón , Animales , Azatioprina/uso terapéutico , Biopsia con Aguja , Ciclosporina/uso terapéutico , Quimioterapia Combinada , Rechazo de Injerto/patología , Riñón/patología , Trasplante de Riñón/patología , Masculino , Metilprednisolona/uso terapéutico , Ratas , Ratas Endogámicas BNAsunto(s)
Rechazo de Injerto/inmunología , Inmunosupresores/uso terapéutico , Trasplante de Riñón/inmunología , Animales , Azatioprina/uso terapéutico , Biopsia con Aguja , Enfermedad Crónica , Ciclosporina/uso terapéutico , Quimioterapia Combinada , Rechazo de Injerto/patología , Inflamación , Trasplante de Riñón/patología , Metilprednisolona/uso terapéutico , Ratas , Ratas Endogámicas BN , Ratas Endogámicas , Trasplante Homólogo , Trasplante IsogénicoRESUMEN
BACKGROUND: Cytomegalovirus (CMV) infection is thought to be a risk factor of chronic rejection. In clinical studies and animal models, mainly concerning graft vasculopathy, CMV has been demonstrated to enhance allograft arteriosclerosis. In this study we have investigated the effect of CMV on the early inflammatory response and graft histology in an experimental model of renal transplantation in a rat strain combination that develops chronic rejection under triple-drug immunosuppression. METHODS: Renal transplantations were performed in a rat strain combination of DA-->BN receiving triple-drug treatment (2 mg/kg methylprednisolone, 2 mg/kg azathioprine, 5 mg/kg cyclosporine daily subcutaneously). One group of immunosuppressed animals was infected with rat CMV, the Maastricht strain (10(5) plaque-forming units intraperitoneally), and the other group was left uninfected. As a positive control for alloresponse, one group of recipients received neither immunosuppression nor virus. Syngenic transplantations with triple-drug treatment and CMV were used as negative controls. The grafts were monitored by frequent ultrasound-guided fine-needle aspiration biopsies, and the intragraft inflammation was quantified in detail by the increment method and expressed in corrected increment units (CIU). Graft histology was performed in parallel. RESULTS: Nonimmunosuppressed animals developed acute rejection with a high peak of inflammation (7.9+/-3.2 CIU), a typical blast response, and lymphocytosis followed by infiltration of macrophages and necrosis within 7 days. Triple drug-treated animals had a short, mild inflammatory response (3.3+/-1.4 CIU at the peak) in the graft 3-5 days after transplantation but ended up with histological changes characteristic of chronic rejection with vasculopathy and fibrosis 40-60 days later. Triple drug-treated animals with CMV demonstrated a significantly stronger inflammation (4.5+/-1.8 CIU, P<0.01) than those without, and lymphoid activation continued longer and was followed by infiltration of macrophages in the graft. CMV infection of the graft was demonstrated by viral culture and antigen detection. In histology, chronic rejection with intimal thickening of arteries and arterioles and medial necrosis of large arteries was seen at 14 days, ending up with remarkable graft fibrosis within 20 days after transplantation. CONCLUSION: CMV prolonged and increased graft inflammation and accelerated chronic rejection of renal allografts under triple-drug treatment.
Asunto(s)
Infecciones por Citomegalovirus/complicaciones , Inmunosupresores/uso terapéutico , Trasplante de Riñón/inmunología , Animales , Azatioprina/uso terapéutico , Biopsia con Aguja , Enfermedad Crónica , Ciclosporina/uso terapéutico , Rechazo de Injerto/microbiología , Rechazo de Injerto/prevención & control , Trasplante de Riñón/patología , Linfocitos/patología , Masculino , Metilprednisolona/uso terapéutico , Ratas , Ratas Endogámicas BN , Ratas EndogámicasAsunto(s)
Infecciones por Citomegalovirus/fisiopatología , Rechazo de Injerto/fisiopatología , Trasplante de Riñón , Complicaciones Posoperatorias , Animales , Biopsia con Aguja , Enfermedad Crónica , Infecciones por Citomegalovirus/inmunología , Quimioterapia Combinada , Rechazo de Injerto/patología , Inmunosupresores/uso terapéutico , Inflamación , Trasplante de Riñón/inmunología , Trasplante de Riñón/patología , Ratas , Ratas Endogámicas BN , Ratas Endogámicas , Trasplante HomólogoRESUMEN
OBJECTIVES: To determine the incidence and pathophysiology of erectile dysfunction (ED) in patients with aortoiliac occlusive disease (AIOD) and the effects of aortofemoral surgery, including endarterectomy (E) and reconstruction (R), on erectile function (EF). DESIGN: Evaluation of EF before and 3 months after surgery. METHODS: 31 out of 40 male patients scheduled for aortofemoral surgery were given multiple choice questionnaires and penile dynamic Colour Doppler Ultrasonography. RESULTS: Of the 31 who agreed to enter the study five (16%) were found to be potent and 26 (84%) to suffer from ED. This was purely arteriogenic in 8% of the cases, purely venogenic in 23%, combined arteriogenic and venogenic in 53%, and neurogenic in 16%. Twenty patients returned for postoperative evaluation of EF, nine who had undergone E and 11 who had undergone R. Improvement of EF, in terms of increased penile arterial inflow, occurred in seven patients, six who had undergone E and one who had undergone R. EF remained unchanged in nine patients, three who had undergone E and six who had undergone R. Deterioration of EF occurred in four patients, all who had undergone R, and was attributable to decreased arterial inflow in two cases and to neurogenic surgical injury in the other two. CONCLUSIONS: The majority of patients with AIOD suffers from ED. Reduced penile arterial inflow and cavernovenous leakage are equally important in the pathophysiology of ED in patients with AIOD, suggesting that atherosclerosis may also compromise the penile veno-occlusive mechanism. Endarterectomy seems more likely than reconstruction to improve or maintain EF.
Asunto(s)
Enfermedades de la Aorta/cirugía , Arteriopatías Oclusivas/cirugía , Arteria Ilíaca , Impotencia Vasculogénica/etiología , Complicaciones Posoperatorias/etiología , Aorta Abdominal/cirugía , Endarterectomía , Arteria Femoral/cirugía , Estudios de Seguimiento , Humanos , Arteria Ilíaca/cirugía , Impotencia Vasculogénica/diagnóstico por imagen , Impotencia Vasculogénica/epidemiología , Impotencia Vasculogénica/fisiopatología , Incidencia , Masculino , Persona de Mediana Edad , Erección Peniana/fisiología , Complicaciones Posoperatorias/epidemiología , Estudios Prospectivos , Factores de Tiempo , Ultrasonografía Doppler en ColorAsunto(s)
Rechazo de Injerto/diagnóstico por imagen , Rechazo de Injerto/diagnóstico , Trasplante de Riñón/diagnóstico por imagen , Trasplante de Riñón/patología , Enfermedad Aguda , Animales , Biopsia con Aguja , Rechazo de Injerto/prevención & control , Inmunosupresores/administración & dosificación , Trasplante de Riñón/efectos adversos , Ratas , Ratas Endogámicas BN , Trasplante Homólogo , UltrasonografíaRESUMEN
The efficacy of thrombolysis was retrospectively studied in patients with acute on chronic ischaemia in the lower extremity. A total number of 68 thrombolytic treatments were given to 65 patients, 58 (85%) because of native arterial occlusions and 10 (15%) because of occluded grafts. Tissue plasminogen activator was the lytic agent used in all patients. In native arteries, thrombolysis alone was successful in 15 (52%) out of 29 legs, whereas 22 (85%) out of 26 thrombolyses followed by angioplasty or surgery were effective. Thrombolysis alone was successful in two and failed in five out of 10 occluded grafts. Patency was achieved by combination with surgery in the other three cases. Twelve-month patency was 34% after thrombolysis alone and 69% (P < 0.05) when combined with surgery or angioplasty. The 30-day mortality rate was 9%. Thrombolysis can be used alone in acute on chronic ischaemia in the lower extremities. The immediate and the long-term results are clearly improved when thrombolysis is combined with angioplasty or reconstructive surgery to treat the underlying cause.
Asunto(s)
Isquemia/terapia , Pierna/irrigación sanguínea , Activadores Plasminogénicos/uso terapéutico , Terapia Trombolítica , Activador de Tejido Plasminógeno/uso terapéutico , Enfermedad Aguda , Adulto , Anciano , Anciano de 80 o más Años , Angioplastia de Balón , Enfermedad Crónica , Femenino , Estudios de Seguimiento , Humanos , Infusiones Intraarteriales , Isquemia/diagnóstico por imagen , Isquemia/etiología , Pierna/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Activadores Plasminogénicos/administración & dosificación , Radiografía , Estudios Retrospectivos , Tromboembolia/complicaciones , Tromboembolia/diagnóstico por imagen , Tromboembolia/terapia , Activador de Tejido Plasminógeno/administración & dosificación , Resultado del TratamientoRESUMEN
Doppler ultrasound (DU) with angiographic correlation was performed in 19 hypertensive renal transplant recipients suspected for transplant artery stenosis. DU included calculation of the intrarenal resistive index (RI) and measurement of the maximum systolic velocity in the transplant artery. All 10 cases having a pathologically low RI (< or = 0.6) had a > or = 50% stenosis; specificity and positive predictive values were thus 100%. There were 5 false-negative diagnoses, sensitivity 67%. The measurement of maximum systolic velocity was feasible in only 15 cases (79%). Using a cut-off point of 2 m/s the sensitivity was 91% and there were 4 false-positive cases and one false-negative case. Balloon percutaneous transluminal angioplasty (PTA) was performed in 13 cases, of which 9 were successful. In all successful cases RI was < 0.6 after PTA. We conclude that low RI (< 0.6) is highly suggestive for transplant artery stenosis. RI may serve as an indicator of the hemodynamic success of PTA.
Asunto(s)
Trasplante de Riñón/diagnóstico por imagen , Obstrucción de la Arteria Renal/diagnóstico por imagen , Ultrasonografía Doppler , Resistencia Vascular , Adulto , Femenino , Humanos , Hipertensión Renovascular/diagnóstico , Hipertensión Renovascular/etiología , Trasplante de Riñón/efectos adversos , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Arteria Renal/diagnóstico por imagen , Arteria Renal/fisiopatología , Obstrucción de la Arteria Renal/complicaciones , Obstrucción de la Arteria Renal/etiología , Sensibilidad y EspecificidadRESUMEN
In 25 renal allografts out of 253 with graft dysfunction a reversed diastolic blood flow was observed at duplex ultrasonography during the first post-transplant month. Eleven grafts were lost and 14 survived. The cause of graft loss was arterial thrombosis (n = 1), venous thrombosis or obstruction (n = 4), steroid resistant acute rejection (n = 4) and acute tubular necrosis (ATN) (n = 2). The cause of graft dysfunction in the surviving grafts was ATN (n = 7) and acute allograft rejection (n = 7). Grafts with only peak-like or low velocity continuous diastolic flow reversal had a better prognosis (3 out of 15 were lost) than grafts with any other type of reversed flow pattern (8 out of 10 were lost). This difference was statistically significant (p < 0.01).
Asunto(s)
Trasplante de Riñón/diagnóstico por imagen , Trasplante de Riñón/fisiología , Circulación Renal/fisiología , Biopsia con Aguja , Velocidad del Flujo Sanguíneo/fisiología , Diástole , Rechazo de Injerto/diagnóstico por imagen , Rechazo de Injerto/patología , Rechazo de Injerto/fisiopatología , Supervivencia de Injerto , Humanos , Trasplante de Riñón/patología , Necrosis Tubular Aguda/diagnóstico por imagen , Necrosis Tubular Aguda/patología , Necrosis Tubular Aguda/fisiopatología , Pronóstico , Tromboflebitis/diagnóstico por imagen , Tromboflebitis/patología , Tromboflebitis/fisiopatología , Ultrasonografía , Insuficiencia Venosa/diagnóstico por imagen , Insuficiencia Venosa/patología , Insuficiencia Venosa/fisiopatologíaRESUMEN
Immunohistochemical studies of human atherosclerotic lesions have demonstrated the occurrence of fibrin deposition and its degradation in the arterial wall. We studied fibrinogen, the generation of thrombin, and the degradation of fibrin in 40 patients with stable peripheral arterial occlusive disease of varying severity, as assessed by the ankle/brachial pressure index and duplex ultrasonography and/or angiography. Circulating fibrinogen (functional and immunological), fibrinopeptide A, thrombin-antithrombin III complex, and D-dimer were measured. The severity of atherosclerosis was associated with both fibrinogen (both functional and immunological) and D-dimer (r = .57, P < .0002, and r = .57, P < .0001, respectively). Fibrinogen and D-dimer showed a significant positive correlation (r = .50, P < .001). Generation of thrombin was detected in 24 patients (60%) by fibrinopeptide A and levels of thrombin-antithrombin III complex. As a sign of coagulation activation and fibrinolysis, we found that thrombin-antithrombin III complex and the degradation of cross-linked fibrin were progressively associated with the extent of vascular disease. The plasmin-mediated fibrin breakdown contributed to increased levels of circulating fibrinogen, an established risk factor for thrombotic complications. The significant correlations between fibrinogen/D-dimer and the severity of atherosclerosis support previous pathological studies and imply that local degradation of cross-linked fibrin is involved in the progression of atherosclerosis.
Asunto(s)
Arteriosclerosis/sangre , Fibrina/metabolismo , Fibrinógeno/metabolismo , Enfermedades Vasculares Periféricas/sangre , Adulto , Anciano , Anciano de 80 o más Años , Antitrombina III/metabolismo , Arteriosclerosis/diagnóstico por imagen , Femenino , Productos de Degradación de Fibrina-Fibrinógeno/metabolismo , Fibrinólisis , Fibrinopéptido A/metabolismo , Humanos , Masculino , Persona de Mediana Edad , Péptido Hidrolasas/metabolismo , Enfermedades Vasculares Periféricas/diagnóstico por imagen , Radiografía , UltrasonografíaRESUMEN
A case of spontaneous perforation of the rectum by a locally advanced prostatic carcinoma is described. The mechanisms of rectal involvement by prostatic carcinoma are discussed, focusing attention on the difficulties in differential diagnosis with primary carcinoma of the rectum.
Asunto(s)
Adenocarcinoma/complicaciones , Perforación Intestinal/etiología , Neoplasias de la Próstata/complicaciones , Enfermedades del Recto/etiología , Anciano , Anciano de 80 o más Años , Neoplasias del Colon/diagnóstico , Diagnóstico Diferencial , Humanos , Perforación Intestinal/diagnóstico , Masculino , Invasividad Neoplásica , Enfermedades del Recto/diagnósticoRESUMEN
The aim of this study was to find out the normal response of the duplex Doppler (DD) parameter resistance index (RI) during a high dose prostaglandin E1 (40 micrograms) induced erection and to evaluate the clinical usefulness of DD scanning in the diagnosis of cavernovenous leakage (CVL). The results of DD scanning and cavernometry were compared in 10 potent control subjects and 82 impotent patients RI was > or = 1 in all control subjects later than 10 min after the intracavernous injection and RI at 20 min after the injection (RI20) was chosen as a clinical parameter. An inverse correlation (r = -0.69, p < 0.001) between RI20 and the maintenance flow (MF) at 150 mm Hg (MF150) was demonstrated. Sensitivity and specificity of RI20 (values < 1 indicating CVL) as a test of CVL (MF150 > 18 ml/min) were 89% and 86%, respectively. In conclusion, the measurement of RI20 in DD scanning after an adequate pharmaco-stimulation is a reliable, noninvasive method in the diagnosis of CVL.
Asunto(s)
Disfunción Eréctil/diagnóstico por imagen , Erección Peniana/fisiología , Pene/irrigación sanguínea , Adolescente , Adulto , Anciano , Alprostadil , Humanos , Masculino , Persona de Mediana Edad , Pene/diagnóstico por imagen , Flujo Sanguíneo Regional , UltrasonografíaRESUMEN
The aim of this study was to find out the normal range of penile duplex Doppler parameters with pharmacostimulation of 40 micrograms prostaglandin E1 and to assess the repeatability and clinical value of the method. Maximal systolic velocity increase (SVImax) is presented as a new flow parameter. 10 potent and 82 impotent patients were investigated. Peak systolic velocity values were significantly higher when recorded at proximal than at distal penis. Repeatability of SVImax was fairly good (coefficient of variation = 0.18). SVImax ranged from 32 to 100 cm/s in 10 control subjects. The distribution of SVImax values in patients grouped according to the number of arteriosclerotic risk factors indicates that this parameter may be useful in the diagnosis of arteriogenic impotence.
Asunto(s)
Alprostadil , Disfunción Eréctil/diagnóstico por imagen , Pene/diagnóstico por imagen , Adolescente , Adulto , Anciano , Alprostadil/farmacología , Arterias , Velocidad del Flujo Sanguíneo/efectos de los fármacos , Disfunción Eréctil/diagnóstico , Disfunción Eréctil/etiología , Disfunción Eréctil/fisiopatología , Humanos , Inyecciones , Masculino , Persona de Mediana Edad , Erección Peniana/efectos de los fármacos , Pene/irrigación sanguínea , Pene/efectos de los fármacos , Pene/fisiopatología , Reología , Estimulación Química , Factores de Tiempo , UltrasonografíaRESUMEN
Forty-five kidney transplant recipients with delayed onset of diuresis due to acute tubular necrosis (ATN) were examined with duplex ultrasonography (DU). Resistive index (RI) was measured on the 4th post-transplant day. Eleven grafts (24%) developed acute rejection. Mean RI prior to rejection of the 4th postoperative day in these grafts was 0.97 and in the 34 grafts which did not develop rejection mean RI was 0.82. There were 2/26 rejections (8%) in the group of grafts with an initial RI below 0.9 and 9/19 rejections (47%) in the group of grafts with RI of 0.9 or above on the 4th post-transplant day. Six months postoperatively there were 2/26 nonfunctioning grafts in the group with lower initial RI values (less than 0.9) and 6/19 nonfunctioning grafts in the group with higher indices (greater than or equal to 0.9). In nonfunctioning grafts a high initial RI (greater than or equal to 0.9) indicates that these grafts will be prone to developing acute rejection.
Asunto(s)
Rechazo de Injerto , Trasplante de Riñón/efectos adversos , Adulto , Diuresis , Femenino , Humanos , Riñón/diagnóstico por imagen , Trasplante de Riñón/inmunología , Trasplante de Riñón/fisiología , Necrosis Tubular Aguda/diagnóstico por imagen , Necrosis Tubular Aguda/etiología , Masculino , Persona de Mediana Edad , Pronóstico , UltrasonografíaRESUMEN
Duplex ultrasonography was used in the diagnosis of acute rejection in 150 renal transplant recipients during the early post-transplant period. In 85 patients (56%) the allograft implantation had a stable postoperative course (control group) while 34 patients (23%) had no initial graft function due to acute tubular necrosis (ATN). Acute rejection occurred in 31 grafts (21%). Doppler spectra were obtained from the intrarenal arterial branches. An average resistive index (RI) was calculated from the spectra. The RI values of the control group differed significantly from those in both ATN and rejection groups. However, there was no statistical difference between the RI values of the ATN and rejection groups. Using a cutoff point of RI greater than or equal to 0.9 the sensitivity and specificity of the diagnosis of an acute rejection were 48.4 and 92.4 percent, respectively. All grafts with stable function had an RI less than 0.9. Thus, resistive index shows a poor sensitivity and a less than 100 percent specificity in the diagnosis of rejection. However, an RI greater than or equal to 0.9 is diagnostic of some kind of pathologic condition, including rejection and ATN.
Asunto(s)
Rechazo de Injerto , Trasplante de Riñón , Riñón/diagnóstico por imagen , Humanos , Necrosis Tubular Aguda/diagnóstico por imagen , Valor Predictivo de las Pruebas , Sensibilidad y Especificidad , Factores de Tiempo , UltrasonografíaRESUMEN
The purpose of this study was to analyze radiographic signs of carpal bone instability in patients with an acutely injured wrist. There were 80 patients (52 women and 28 men) with a fall on the outstretched hand. Fifty patients had a fracture of the distal radius, and eight had a scaphoid fracture. The patients with a bone fracture showed a larger scapholunate angle than those without a fracture (P less than 0.001, t-test). However, only four of them showed true carpal bone instability: two patients with a scaphoid fracture and one with a radius fracture had dorsiflexion instability of the wrist and one patient with a radius fracture had dorsal subluxation of the wrist. In addition, one patient without any bone fracture had scapholunate dissociation, one form of carpal bone instability. Although carpal bone instability is not frequent in an acutely injured wrist, its signs should be remembered in the radiographic analysis of the traumatic wrist to prevent subsequent articular disorders.
Asunto(s)
Huesos del Carpo/diagnóstico por imagen , Traumatismos de la Muñeca/diagnóstico por imagen , Enfermedad Aguda , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Huesos del Carpo/lesiones , Femenino , Fracturas Óseas/complicaciones , Fracturas Óseas/diagnóstico por imagen , Humanos , Luxaciones Articulares/complicaciones , Luxaciones Articulares/diagnóstico por imagen , Inestabilidad de la Articulación/diagnóstico por imagen , Inestabilidad de la Articulación/etiología , Masculino , Persona de Mediana Edad , Radiografía , Fracturas del Radio/complicaciones , Fracturas del Radio/diagnóstico por imagenRESUMEN
The purpose of this study was to analyze how many angiographic projections are needed in the diagnosis of hemodynamically significant stenoses of the femoral bifurcation. A total of 134 femoral bifurcations were examined with triplanar angiography in 67 patients (45 men and 22 women). The patients, ranging in age from 42 to 81 years (mean 63), suffered from incapacitating symptoms of peripheral arterial disease. The contralateral posterior oblique projection proved to be the most valuable in the assessment of hemodynamically significant arterial stenoses of the femoral bifurcation. An AP projection added information on stenoses of the inlets of the deep femoral artery in 9% of cases and on stenoses of the inlets of the superficial femoral artery in 6% of cases. An arteriographic examination should be started with a contralateral posterior oblique projection and this view will suffice in most cases.