Percutaneous transluminal angioplasty of transplant renal artery stenosis

<p><b>INTRODUCTION</b>This study aimed to assess the outcome of percutaneous transluminal angioplasty (PTA) as the primary treatment for transplant renal artery stenosis (TxRAS).</p><p><b>MATERIALS AND METHODS</b>A retrospective review of PTA of TxRAS from April 1999 to December 2008 was performed. Twenty-seven patients (17 males (M):10 females (F)) with the mean age of 49.5 years underwent PTA of TxRAS in the review period. Indications for PTA were suboptimal control of hypertension (n=12), impaired renal function (n=6) and both suboptimal control of hypertension and impaired renal function (n=9). All patients had doppler ultrasound scans prior to their PTA. In addition, 5 of these patients had computed tomography angiography (CTA) and another 7 had magnetic resonance angiography (MRA) evaluation. Mean follow-up period was 57.0 months (range, 7 to 108 months).</p><p><b>RESULTS</b>The stenotic lesions were located proximal to the anastomosis (n=2), at the anastomosis (n=15), and distal to the anastomosis (n=14). Technical success rate was 96.3%. One case was complicated by extensive dissection during PTA, resulting in subsequent graft failure. The overall clinical success rate was 76.9%. Seven out of 26 patients had restenoses (26.9% of cases). These were detected at a mean of 14.3 months post angioplasty (range, 5 to 38 months). All 7 patients underwent a second PTA successfully. Three of these patients required more than 1 repeat PTA.</p><p><b>CONCLUSION</b>PTA is safe and effective in the management of symptomatic TxRAS and should be the primary treatment of choice. Close surveillance for restenosis is required and when diagnosed, re-angioplasty can be performed.</p>

Stent-assisted percutaneous angioplasty for extra-cranial carotid disease:experience at Singapore General Hospital

<p><b>INTRODUCTION</b>This study aims to analyse the results of carotid stenting in a tertiary referral centre in Singapore.</p><p><b>MATERIALS AND METHODS</b>Retrospective analysis of all carotid artery stenting (CAS) cases in a single centre from March 1997 to December 2008 was performed. Sixty successful procedures were performed in 61 patients, with bilateral stenting in 1 patient, and 2 failed procedures. The majority were Chinese (78.7%) and males (77.0%), with a high proportion having hypertension (82.0%) and hypercholesterolaemia (78.7%). The majority (91.8%) of patients were high surgical risk candidates, primarily due to cardiac risk factors. Ten patients (16.4%) had prior neck irradiation for nasopharyngeal carcinoma, and 3 patients each (4.9%) had previous endarterectomy and contralateral occlusion. A distal embolic protection device was used in 71.7% of cases.</p><p><b>RESULTS</b>Technical success was 96.8%. The 30-day stroke and death rate was 13.8%, comparable to reported results for this high surgical risk population.</p><p><b>CONCLUSION</b>CAS is a technically feasible and a relatively safe alternative to endarterectomy to treat extracranial carotid stenosis, especially in patients who are inoperable or at high surgical risk.</p>

A knowledge-attitudes-practices study on AIDS/HIV infection in intravenous drug users at Yangon Drug Dependency Treatment and Research Unit

A Standardized questionnaire was administered to 198 new and 112 recurrent cases of intravenous drug users enrolled at the Drug Dependency Treatment and Research Unit in Yangon to elicit knowledge about, attitudes towards and practices on AIDS/HIV infection. The respondents were all males, with the mean age of 26 years among new and 28 years among recurrent cases. Over 90 Percent of both groups resided in Yangon City. Recurrent users had higher level of knowledge abot correct mode of transmission of HIV infection than new cases. For instance, over 73 Percent of recurrent and about 50 Percent of new cases knew that HIV infection could not be transmitted via air or drinking water. 93-97 Percent of recurrent patients believed that transmission of HIV infection was possible through blood, sexual contact or IV drug use against 85-92 Percent of new cases. Concerning drug suing and sexual behaviours, recurrent cases took more frequent injections per day, prefered to be alone during drug use, did not take more care in cleansing syringes and needles, but had lesser contact with sex workers than new ones. The findings are compared with those of similar studies in other risk groups. The implications of the study are discussed.