BACKGROUND: We would like to present an unusual case of simultaneous stenosis of renal graft artery and vein diagnosed four months after transplantation. both treated by stent placement. Our aim is to point at the fact that renal graft venous stenosis is very rarely reported in the literature and - as it is not easy to diagnose by routine US - it could be overlooked. If early detected it can be treated by stent placement. CASE PRESENTATION: We present a case of 36-old-male with renal failure who received a kidney graft from deceased donor. The patient experienced delayed graft function. No rejection was found in the biopsy. Four months after transplantation the kidney function deteriorated to sCr 280 μmol/l. Graft artery stenosis together with graft vein stenosis was revealed. Both lesions were dilated with stent placement, the graft function returned to 230 μmol/l and became stable for 10 years. Ten years after stent placement graft function deteriorated to 300 μmol/l. An in stent restenosis of arterial stent was detected. It was successfully dilated by the balloon, the graft function returned to 230 μmol/l and stays stable for another 5 years. CONCLUSIONS: An unusual simultaneous transplanted kidney artery and vein stenosis treated by stent placement is presented. The patient had stable graft function for 15 years after the procedure with one re-intervention on arterial stent.
- Publikační typ
- časopisecké články MeSH
The effect of the ceiling-mounted radiation shielding on the amount of the scatter radiation was assessed under conditions simulating obese patients for clinically relevant exposure parameters. Measurements were performed in different projections and with different positions of the ceiling-mounted shielding: without shielding; shielding closest to the patient; and shielding closest to the physician performing the procedure. The protection provided by the shielding was assessed for cardiology when the femoral access is used and for radiology when the physician performs the procedure in the abdominal area. The results show that the use of the ceiling-mounted shielding can decrease the dose from the scatter radiation by 95% at the position of the performing physician. In cardiology, the impact is more pronounced when the left oblique projection is used. In radiology, a large decrease was observed for right oblique projections, compared to cardiology. The ceiling-mounted shielding should be placed as close to the physician as possible. The idea of creating the largest radiation shadow by placing the radiation shielding as close to the patient as possible does not provide as effective radiation protection of the operator as it might be thought.
- Publikační typ
- časopisecké články MeSH
- Klíčová slova
- kvalita obrazu, dynamický fantom,
- MeSH
- abdominální obezita * diagnostické zobrazování MeSH
- angiografie * klasifikace metody přístrojové vybavení MeSH
- dávka záření MeSH
- lidé MeSH
- morbidní obezita diagnostické zobrazování MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- srovnávací studie MeSH
This study was a retrospective analysis of patients with CLI who underwent infrapopliteal percutaneous transluminal angioplasty (PTA). The main goal was to evaluate clinical and morphological factors that influence the clinical outcome of PTA in long-term follow-up. A total of 1,445 PTA procedures were performed in 1,268 patients. Main indications for PTA included gangrene, nonhealing ulcers, or rest pain. The mean number of treated arteries was 1.77 artery/limb, and the majority of lesions were type TASC D. The technical success rate of PTA was 89% of intended-to-treat arteries. The main criterion of clinical success was functional limb salvage (LS). One-year follow-up involved 1,069 limbs. Primary and secondary 1-year LS rates were 76.1 and 84.4%, respectively. The effect of clinical and morphological parameters on the 1-year LS was that the only associated disease with an adverse effect on LS rate was DM combined with dialysis. Regarding limb preprocedural status, gangrene was clearly a negative predictor. The most important factor affecting LS was the number of patent arteries post-PTA: patients with 0, 1, 2, and 3 patent arteries had 1-year primary LS rates of 56.4, 73.1, 80.4, and 83%, respectively. Long-term follow-up of LS rates demonstrated secondary LS rates of 84.4, 78.8, and 73.3% at 1, 5, and 10 years. Every effort should be made to perform PTA for as many arteries as possible, even if TASC D type, to improve clinical outcome. Our study shows that repeat PTA is capable of keeping the long-term LS rate close to 75%.
- MeSH
- angioplastika metody MeSH
- arteria poplitea MeSH
- bérec krevní zásobení MeSH
- dospělí MeSH
- endovaskulární výkony MeSH
- ischemie terapie MeSH
- Kaplanův-Meierův odhad MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- následné studie MeSH
- průchodnost cév MeSH
- retrospektivní studie MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- výsledek terapie MeSH
- záchrana končetiny metody statistika a číselné údaje MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
Význam a postavení kalciového skóre jsou poměrně dobře známé. Podstata kalciového skóre spočívá v poloze pomocné metody při rozhodování o indikaci koronární angiografie. V tomto případu popisujeme průběh diagnostiky u nemocné s bolestmi na hrudi, s přítomností určitých rizikových momentů a pozitivním zátěžovým testem typu němé ischémie. Kalciové skóre bylo vysoce pozitivní: stupeň kalcifikací dokonce znemožnil provedení CT koronární angiografie. Koronární angiografie provedená obvyklým invazivním způsobem však byla v tomto případě zcela negativní. Kalciové skóre zde nebylo vzhledem k typu kalciových depozit užitečným pomocníkem.
The role of the calcium scoring system seems to be well known. It is regarded as an auxiliary method that assists in decision making in coronary angiography indication. In this case report we describe a diagnostic process step by step in a patient with chest pain, presence of some risk factors as well as positive silent ischemia type treadmill test. The calcium score was highly positive, moreover the type of calcium depositions avoided CT coronary angiography. Standard invasive coronary angiography was quite negative. The calcium scoring method in this particular case was not a useful helper due to the specific type of calcium depositions.
- MeSH
- bolesti na hrudi diagnóza MeSH
- diagnostické techniky kardiovaskulární MeSH
- echokardiografie MeSH
- ergometrie MeSH
- hodnocení rizik MeSH
- kardiovaskulární nemoci MeSH
- koronární angiografie MeSH
- lidé MeSH
- prediktivní hodnota testů MeSH
- senioři MeSH
- vápník diagnostické užití MeSH
- zátěžový test MeSH
- Check Tag
- lidé MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
OBJECTIVE: Multidetector-row CT (MDCT) and contrast-enhanced echocardiography (CEE) are being increasingly used for assessment of left ventricular (LV) function. Excellent spatial and contrast resolution of MDCT allows this evaluation along with coronary angiography. CEE improves the accuracy of 2D echocardiography. Data on side-by-side comparison of both techniques for assessment of LV size and function in subjects with a non-dilated or dilated left ventricle are limited. METHODS AND RESULTS: Our study population included 64 patients. Group I included 31 patients with an implanted pacemaker who had a non-dilated left ventricle with preserved systolic function. Group II comprised 33 patients with dilated cardiomyopathy and severe systolic LV dysfunction. LV end-diastolic and end-systolic volumes (LVEDV, LVESV) and ejection fraction (LVEF) were assessed using both CEE and short-axis MDCT. The results obtained by both techniques were compared by linear regression and Bland-Altman analysis. Additionally, intra- and interobserver reproducibility was assessed. Both CEE and MDCT measurements highly correlated (r = 0.61-0.94). However, CEE significantly underestimated LVEDV and LVESV, and this bias was higher with enlarged LV volumes. LVEF was overestimated by CEE in both groups with a higher bias in the group with preserved systolic function. Both intra- and interobserver reproducibility was significantly better for MDCT, the worst reproducibility was observed for CEE in group I. CONCLUSION: Despite a high correlation between MDCT and CEE measurements, CEE provides consistently lower volumes and higher LVEF. This suggests that both methods are not completely interchangeable. Reproducibility of CEE is inferior to reproducibility of MDCT, especially in non-dilated left ventricles with preserved function.
- MeSH
- dilatační kardiomyopatie patofyziologie ultrasonografie MeSH
- funkce levé komory srdeční MeSH
- koronární angiografie metody MeSH
- lidé středního věku MeSH
- lidé MeSH
- počítačová rentgenová tomografie metody MeSH
- reprodukovatelnost výsledků MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- srdeční komory ultrasonografie MeSH
- tepový objem MeSH
- vylepšení obrazu MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- práce podpořená grantem MeSH
- srovnávací studie MeSH
- Publikační typ
- abstrakt z konference MeSH
