ABSTRACT
OBJECTIVE: analysis of Doppler Duplex (DD) contribution to renal artery percutaneous angioplasty (ATL) follow-up. METHOD: between 1983 and 1989, SO ATL were performed in 47 subjects with renovascular hypertension. Their average age was 50 +/- 12 years. The lesions were fibromuscular dysplasia (n = 20) and atherosclerosis (n = 27). The DD was performed simultaneously with arteriography (A degrees) (considered the gold standard), when the stenosis was discovered (n = 32), before (n = 32) and after (n = 39) ATL, and during the follow-up between the 6th and 12th month (n = 38). RESULTS: during the initial exploration, the concordance between DD and A degrees is 78% and the sensitivity of DD for the diagnosis of stenosis is 90%. ATL was performed once on the basis of DD alone, that showed a tight and significant stenosis with dysplasia, when A degrees failed to detect it. ATL confirmed the lesion and was successful, and hypertension cured. The concordance DD-A degrees before and after ATL is respectively 88% and 77%. At the late control, the concordance is 92%, the sensitivity 73% and the specificity 85% for all stenosis. While maintaining a good specificity, DD recognized the 3 tight found by the A degrees control. The complications encountered during ATL were diagnosed by DD most of the time: all the local complications at the site of entry (n = 5), all the dissections with obliteration (n = 2) and 5 of the 8 dissections without obliteration of the renal artery. CONCLUSION: the detection and the lesional assessment of post-ATL complications are facilitated by DD. The good sensitivity of DD combined with satisfactory specificity will allow the reduction of angiographic surveillance by taking advantage of a non-invasive method.
Subject(s)
Angioplasty, Balloon , Hypertension, Renovascular/therapy , Renal Artery Obstruction/diagnostic imaging , Adult , Angioplasty, Balloon/adverse effects , Blood Flow Velocity , Female , Follow-Up Studies , Humans , Hypertension, Renovascular/physiopathology , Male , Middle Aged , Radiography , Renal Artery Obstruction/therapy , Retrospective Studies , Thrombosis/diagnostic imaging , Thrombosis/therapy , UltrasonographyABSTRACT
Haemophagocytic sinus histiocytosis usually presents as cervical lymphadenopathy developing in a context of severe inflammatory reaction. The lymph nodes contain numerous large cytophagic histiocytes capable of absorbing all kinds of blood cells, and diffuse plasmocytic infiltrates. Other organs may be involved, notably the skin and bones, as in the case presented here. The course of the disease if prolonged, irrespective of the treatment administered.