ABSTRACT
Core needle biopsies are still widely performed to evaluate the pathologic suitability of a kidney allograft. Here, we report a case of pulsatile hematuria from a procurement core needle biopsy where the patient had to be taken emergently to interventional radiology for coil embolization immediately after organ reperfusion.
Subject(s)
Biopsy, Large-Core Needle/adverse effects , Hematuria/etiology , Kidney Transplantation , Tissue and Organ Harvesting/adverse effects , Transplants/surgery , Aged , Embolization, Therapeutic , Hematuria/therapy , Humans , MaleABSTRACT
BACKGROUND: Endothelial dysfunction assessed by brachial artery flow-mediated dilation (FMD) is a marker for early atherosclerotic vascular disease and future cardiovascular events. OBJECTIVE: To estimate the heritability of brachial artery FMD using a twin design. METHODS: We estimated the heritability of FMD using 94 middle-aged male twin pairs. FMD was measured by ultrasound, and traditional coronary heart disease risk factors were measured. Genetic modeling techniques were used to determine the relative contributions of genes and environment to the variation in FMD. RESULTS: The mean age of the twin participants was 54.9 +/- 2.8 years. The mean FMD was 0.047 +/- 0.030. The intraclass correlation coefficient was higher in MZ twins [0.38, 95% confidence interval (CI) 0.32-0.43] than in DZ twins (0.19, 95% CI 0.11-0.26), suggesting a role of genetic influence in FMD variation. Structural equation modeling showed that both genetic and unique environmental factors contributed significantly to the variation in FMD. The crude FMD heritability was 0.37 (95% CI 0.15-0.54). After adjustment for traditional cardiovascular risk factors, including age, total cholesterol, blood pressure, and body mass index, the heritability of FMD was 39% (95% CI 0.18-0.56). The remaining variation in FMD could be explained by individual-specific environment. CONCLUSION: This is the first study using twins to estimate the relative contributions of genetics and environment to the variation in FMD in a US population. Our results demonstrate a moderate genetic effect on brachial artery FMD, independent of traditional coronary risk factors. Our data also highlight the importance of unique environment on the variability in FMD.
Subject(s)
Atherosclerosis/genetics , Brachial Artery/physiopathology , Cardiovascular Diseases/genetics , Twins, Dizygotic/genetics , Twins, Monozygotic/genetics , Vasodilation/genetics , Atherosclerosis/complications , Atherosclerosis/physiopathology , Brachial Artery/diagnostic imaging , Cardiovascular Diseases/physiopathology , Genetic Predisposition to Disease , Humans , Male , Middle Aged , Models, Genetic , Pedigree , Regional Blood Flow/genetics , Registries , Risk Assessment , Risk Factors , Ultrasonography , United StatesABSTRACT
The terms 'conversion', 'hysteria' and 'conversion hysteria' were used interchangeably to describe a condition characterised by a single somatised symptom, often pseudo-neurological in nature. DSM-III (American Psychiatric Association, 1980) expanded the concept of conversion to generalised symptoms involving loss or alteration of physical functioning suggestive of a physical disorder, along with a clinical indication that the conversion was an expression of psychological conflict or need. The type of symptom or deficit should be specified as: with motor symptom or deficit, with sensory symptom or deficit, with seizure or convulsions, or with mixed presentation (Kaplan & Sadock, 2004).
