- MeSH
- angiografie * metody MeSH
- angioplastika * metody MeSH
- arteriovenózní zkrat metody MeSH
- dialýza ledvin MeSH
- lidé MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- abstrakt z konference MeSH
The new clinical prediction score (SCORE) has been recently proposed for primary aldosteronism (PA) subtyping prior to adrenal vein sampling (AVS). This study aimed to compare that SCORE with previously published scores and their validation using a cohort of patients at our center who had had positive SIT confirming PA and had been diagnosed with either bilateral PA according to AVS or unilateral PA if biochemically cured after an adrenalectomy. Final diagnoses were used to evaluate the diagnostic performance of the proposed clinical prediction tools. Only Kamemura's model (with a maximum score of 4 points) and Kobayashi's score (with a maximum score of 12 points) reached 100% reliability for prediction of bilateral PA; however, with sensitivity of only 3%. On the other hand, the values of SCORE = 3 (with sensitivity of 48%), the SPACE score ≥18 (with sensitivity of 35%), the Kobayashi's score ≤2 (with sensitivity of 28%), and the Kocjan's score = 3 (with sensitivity of 28%) were able to predict unilateral PA with 100% probability. Furthermore, Umakoshi's and Young's models both reached 100% reliability for a unilateral PA with score = 4 and both predictive factors together respectively; however, the sensitivity was lower compared with previous models; 4% and 14%, respectively. None of the clinical prediction tools applied to our cohort predicted unilateral and bilateral subtypes together with the expected high diagnostic performance, and therefore can only be used for precisely defined cases.
- Publikační typ
- časopisecké články MeSH
Primary aldosteronism (PA) is the most frequent form of endocrine hypertension. Recently, frequent clinically significant adrenal insufficiency after adrenalectomy in subjects with PA has been reported, which may make the early postsurgical management difficult. We retrospectively searched for possible adrenal insufficiency in subjects who underwent adrenalectomy for PA and have measured cortisol in the early postoperative course. We included subjects with confirmed diagnosis of PA who underwent either posture testing (blood draw at 06:00 and 08:00) and/or adrenal venous sampling (AVS) (blood draw between 08:00 and 09:00) and have also measured cortisol after surgery (cortisol measured approximately at 07:00). Cortisol was measured by immunoassay. In this study, we identified 150 subjects (age 48.5 ± 10.3 years) with available cortisol values in the early postoperative course (median [25th percentile, 75th percentile]) 6 [5,6] days. Postoperative cortisol values (551 ± 148 nmol/l) were normal and significantly higher, compared to preoperative standing cortisol values (404 ± 150 nmol/l; (P < 0.001) and AVS cortisol values (493 ± 198 nmol/l; P = 0.009), and did not significantly differ from preoperative supine cortisol values. Postsurgical cortisol values were not different among subjects with or without abnormal dexamethasone suppression test or elevated urinary free cortisol pre-surgery, and were significantly higher in subjects with abnormal diurnal cortisol variability compared with subjects with normal diurnal variability. No patient presented with adrenocortical crisis in the later follow-up. In conclusion, postoperative cortisol values did not indicate any suspicion of possible adrenal insufficiency. To exclude possible adrenal insufficiency, it may be sufficient to measure morning cortisol in the early postoperative course.
- MeSH
- adrenalektomie MeSH
- adrenální insuficience * diagnóza etiologie chirurgie MeSH
- dospělí MeSH
- hydrokortison MeSH
- hyperaldosteronismus * komplikace diagnóza chirurgie MeSH
- lidé středního věku MeSH
- lidé MeSH
- retrospektivní studie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- přehledy MeSH
PURPOSE: Adrenal venous sampling (AVS) performed to distinguish unilateral and bilateral primary aldosteronism (PA) is invasive and poorly standardized. This study aimed to identify non-invasive characteristics that can select the patients with unilateral PA who could bypass AVS before surgery. METHODS: A single-center study collected a total of 450 patients with PA. Development and validation cohorts included 242 and 208 patients. The AVS was successful in 150 and 138 patients from the cohorts, and the unilateral PA was found in 96 and 94 patients, respectively. Clinical factors independently associated with lateralized AVS in multivariable logistic regression were used to construct a unilateral PA prediction score (SCORE). RESULTS: The proposed SCORE was calculated as a sum of the prevalence of adrenal nodule on computed tomography (2 points) and plasma/serum aldosterone concentration ≥ 165 ng/L after the saline infusion test (SIT) (1 point). Importantly, the SCORE = 3 points identified 48% of unilateral PA patients with a specificity of 100% in the development cohort. The zero rate of false-positive classifications was preserved with the same cut-off value in the validation cohort. CONCLUSIONS: AVS could be omitted before surgery in patients with typical Conn ́s adenoma provided the aldosterone concentration ≥ 165 ng/L after the SIT.
- Publikační typ
- časopisecké články MeSH
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- MeSH
- ascites etiologie MeSH
- endovaskulární výkony metody MeSH
- karcinoid komplikace MeSH
- lidé MeSH
- portální hypertenze etiologie chirurgie MeSH
- samoexpandibilní metalické stenty MeSH
- somatostatin aplikace a dávkování MeSH
- vena mesenterica * chirurgie patologie MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
- Publikační typ
- abstrakt z konference MeSH
Cíl: Cílem naší studie bylo porovnat střednědobou průchodnost a ekonomickou výhodnost prosté balónkové angioplastiky, implantace stentu a implantace stentgraftů v léčbě stenóz dialyzačních zkratů. Metodika: Mezi červencem 2013 a květnem 2015 jsme zařadili do tří větví prospektivní randomizované studie celkem 46 pacientů (věk 67 ? 14 let, 33 % mužů) s časnou restenózu venózní anastomózy nebo odvodné žíly protetického dialyzačního zkratu. U 14 pacientů jsme provedli prostou balónkovou angioplastiku (PTA), 14 pacientům byl implantován stent a 18 pacientům stent-graft. Dva pacienti byli ze studie vyřazeni (jeden s implantovaným stentgraftem a jeden s prostou PTA), protože u nich nebyla v prvních 3 měsících po výkonu provedena angiografie. Mezi skupinami jsme porovnali primární průchodnost intervenovaného segmentu a hemodialyzačního zkratu celkově. Pacienti, kteří dokončili sledování po 12 měsících, byli zahrnuti do ekonomické analýzy. Výsledky: Dvanáctiměsíční primární průchodnost intervenovaného segmentu byla 0% u PTA, 29% u stentů, a 76% u stent-graftů (p < 0,0001). Šestiměsíční, resp. dvanáctiměsíční primární průchodnost zkratu celkově byla 8% a 0% u PTA, 50% a 14% u stentů, 47% a 35% u stentgraftů (p = 0,014 a p = 0,007). Průměrný počet rePTA sledovaného místa byl 2,89 u PTA 1,64 u stentů a 0,6 u stentgraftů (p = 0,0008). Průměrný počet všech rePTA byl 6,0 u PTA, 3,73 u stentů, 2,4 u stentgraftů (p = 0,0094). Průměrné náklady na udržení průchodnosti zkratu v prvním roce zahrnující i vstupní intervenci činily 215 054 Kč u PTA, 182 297 Kč u stentů a 161 934 Kč u stentgraftů. Závěr: Implantace stentgraftů do stenóz venózní anastomózy a odvodně žíly protetických hemodialyzačních zkratů vykazuje signifikantně lepší primární průchodnost, méně reintervencí a nižší finanční náklady v porovnání s prostou PTA a stentingem.
Aim: The aim of our study is to compare mid-term patency and cost-effectiveness of balloon angioplasty and implantation of stent or stent graft in the treatment of hemodialysis arteriovenous graft restenosis. Methods: Between July 2013 and May 2015, 46 patients (age 67 ? 14 years, 33% males) were randomized into three study arms for treatment of an early recurrent hemodialysis shunt restenosis located in the venous anastomosis of a prosthetic graft or in the outflow vein (index segment). Fourteen patients were treated with balloon angioplasty (PTA), 14 patients with stenting and 18 patients with implantation of a stent-graft. Two patients (one with stent-graft and one with PTA) were excluded because no follow-up angiography was performed in the first three months after the procedure. Primary patency rates of the index segment and the hemodialysis shunt were compared among the groups and patients who completed a twelve month follow-up were included in the cost analysis. Results: The twelve-month primary patency of the index segment was 0% for PTA group, 29% for stent group and 76% for stent graft group (p < 0.0001). Six-month primary patency of vascular access was 8% for PTA group, 50% for stent group and 47% for stent graft group (p = 0.014). Twelve-month primary patency of vascular access was 0% for PTA group, 14% for stent group and 35% for stent graft group (p = 0.007). The mean number of reinterventions of the index segment was 2,89 by PTA group, 1,64 by stent group and 0,6 by stent graft group. The mean number of all vascular access reinterventions was 6,0 by PTA group, 3,73 by stent group and 2,4 by stent graft group (p = 0.0094). The mean cost for all endovascular interventions during the 12 months follow-up including primary interventions and all reinterventions was 215 054 CZK by PTA group, 182 297 CZK by stent group and 161 934 CZK by stent graft group. Conclusion: Treatment of an early recurrent hemodialysis shunt restenosis located in the venous anastomosis of a prosthetic graft or in the outflow vein by stent graft implantation results in significantly better primary patency, decreased need for reinterventions, and lower cost of the endovascular treatment in the first year after the primary intervention compared to PTA and stenting.
- MeSH
- analýza nákladů a výnosů statistika a číselné údaje MeSH
- angioplastika ekonomika statistika a číselné údaje MeSH
- arteriovenózní zkrat MeSH
- cévní protézy ekonomika statistika a číselné údaje MeSH
- dialýza ledvin MeSH
- dítě MeSH
- klinická studie jako téma statistika a číselné údaje MeSH
- lidé středního věku MeSH
- lidé MeSH
- okluze cévního štěpu etiologie chirurgie radiografie MeSH
- prospektivní studie MeSH
- průchodnost cév MeSH
- recidiva MeSH
- senioři MeSH
- stenty ekonomika statistika a číselné údaje MeSH
- výsledek terapie MeSH
- Check Tag
- dítě MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- práce podpořená grantem MeSH
- randomizované kontrolované studie MeSH
- srovnávací studie MeSH
- Publikační typ
- abstrakt z konference MeSH
