Occurrence of peripheral arterial disease in a Belgian cohort of patients with cardiovascular history of atherothrombosis.

RATIONALE: Peripheral arterial disease (PAD) is an underestimated and under diagnosed disease with as much as 60% of the patients having at least one other vascular bed affected. PURPOSE: The study aimed to evaluate the prevalence of PAD defined by different means in high risk Belgian ambulatory patients. METHODS: Participating physicians were to include a least six consecutive high risk ambulant patients for atherothrombosis. Demographical data and cardiovascular risk factors were recorded. The Edinburgh Questionnaire was administered. A vascular examination, including palpation and blood pressure measurement of the relevant arteries was performed. RESULTS: 275 Belgian physicians included a total of 2831 patients with a mean age of 68.0 years. Sixty three point three percent (63.3%) of the patients had a history of coronary artery disease whereas 28.0% reported a history of cerebrovascular disease. Overall, 1777 patients (62.8%, 95% CI: 61-65%) had a PAD diagnosis with an even distribution among males and females and increasing with age. PAD, defined as an ABI (Ankle Brachial Index) < 0.9, was detected in 28.5% of the population. PAD defined as the presence of intermittent claudication with positive Edinburgh Questionnaire or as a history of peripheral vascular revascularisation, was detected in 12.4% and 8.1% of the population respectively. Sixty six point seven percent (66.7%) of the PAD patients reported walking pain. The presence of pulsation of the tibialis posterior and/or dorsalis pedis arteries was not predictive of an ABI > 0.9. In contrast, the absence of pulse of both arteries was correlated with an odds-ratio of 6.4 to 8.1 to find a pathological ABI. CONCLUSION: The prevalence of PAD in ambulant patients with a history of coronary artery disease or cerebrovascular disease varied from 62.8% (composite of intermittent claudication with Edinburgh Questionnaire positive, history of peripheral vascular revascularisation, ABI < 0.9) to 28.5% (ABI < 0.9). Sixty six point seven percent (66.7%) of the PAD population reported walking pain. The absence of pulsation of the tibialis posterior and dorsalis pedis arteries was correlated with an ABI < 0.9.

A case of human orf in an immunocompromised patient treated successfully with cidofovir cream.

Immunocompromised patients may have severe forms of infections. Since there is an increasing number of patients maintained under immunosuppressive therapy, we will be confronted with increasing frequency with these infectious problems. Effective treatments will be of great value. The case is described of a renal transplant with a giant orf lesion, which continued growing instead of regressing spontaneously as is observed usually. The treatment options in such patients are limited. It was decided to treat the patient with the antiviral drug cidofovir (HPMPC, Vistide. Topical cidofovir treatment resulted in complete regression of the lesion. This case is discussed in the context of the known literature on orf (ecthyma contagiosum).

Six months clinical, angiographic, and IVUS follow-up after PTFE graft stent implantation in native coronary arteries.

INTRODUCTION: Restenosis remains a problem even after stent implantation. An important breakthrough could be the use of graft stents, functioning as a mechanical barrier between the blood flow and the vessel wall, and possibly inducing less restenosis by more limited hyperplasia and minimal transgraft tissue penetration. OBJECTIVE: To assess the acute and 6 months clinical, angiographic and IVUS results of a new balloon expandable coronary polytetrafluoroethylene (PTFE) graft stent (Jomed). METHOD: Ten patients with a short (< or = 15 mm length) de novo proximal stenosis in a large (> or = 3 mm diameter) coronary artery were treated by elective implantation of a graft stent (19 mm stent, 15 mm graft). Clinical assessment, quantitative coronary angiography (QCA) and intracoronary ultrasound (IVUS) were performed before, immediately after and 6 months after implantation. A stress test was also done at 6 months. RESULTS: The coronary arteries treated were: RCA in 7 patients, LCX in 2 patients, LAD in 1 patient. Mean balloon size was 3.7 mm diameter, and mean inflation pressure was 18 atm (min. 12, max. 23). Additional stenting was needed in 3 patients. Two patients showed a minimal rise in CK (< 250 IU/l) and 1 patient needed a transfusion. No patient experienced a (sub)acute nor late thrombosis. As shown in the table, no restenosis was seen in the body of the graft stent. In 2 patients a restenosis was detected in the proximal and/or distal parts of the stent which are not covered by the graft. In 1 patient a restenosis was found outside the stent. All patients remained asymptomatic with a negative stress test at 6 months follow-up (FU). [table in text] CONCLUSIONS: A graft stent could indeed reduce the restenosis rate after stenting, in the part of the stent covered by the graft, but the uncovered distal and proximal parts are the weak points in this type of stent. For this reason, technical ameliorations in the construction of this graft stent are needed, e.g. a complete coverage of the stent by the PTFE graft and less rigidity of the stent causing reduced vessel trauma at the edges of the stent during implantation.

Localization of metalloporphyrin-induced "specific" enhancement in experimental liver tumors: comparison of magnetic resonance imaging, microangiographic, and histologic findings.

RATIONALE AND OBJECTIVES: We investigated the tumor specificity of gadolinium mesoporphyrin (Gd-MP) and manganese tetraphenylporphyrin (Mn-TPP) as magnetic resonance (MR) imaging contrast agents. METHODS: Fifteen rats with multiple hepatocellular carcinomas and eight rats with implanted Novikoff hepatomas were given intravenous injections of either Gd-MP or Mn-TPP at 0.05 mmol/kg, which was compared with nonspecific gadopentetate dimeglumine (0.3 mmol/kg). T1-weighted spin-echo images were obtained before and up to 48 hr after injection and compared with corresponding microangiograms and histologic specimens. The relative enhancement of organs and tumors was plotted as a function of time. RESULTS: Initially, both metalloporphyrins behaved as nonspecific agents, similar to gadopentetate dimeglumine, and enhanced the tumor by perfusion and diffusion. However, metalloporphyrins, but not gadopentetate dimeglumine, caused a delayed (> or = 3 hr) enhancement in some compartments of certain lesions. The MR imaging-microangiography-histology matching technique revealed that those compartments were actually nonviable components, including necrosis (n = 10), thrombosis (n = 7), and cystic secretion (n = 3), but not viable tumor tissue. CONCLUSION: Metalloporphyrins did not prove to be tumor specific. However, the observed affinity for nonviable tissue has elicited other potential applications for these agents.

Effect of manganese dipyridoxal diphosphate on liver magnetic resonance imaging and serum bilirubin in rats with removable biliary obstruction.

RATIONALE AND OBJECTIVES: It is known that manganese dipyridoxal diphosphate (Mn-DPDP) causes persisting liver enhancement in cholestatic rats, that free Mn++ plus bilirubin induces intrahepatic cholestasis, and that free Mn++ is released in vivo after Mn-DPDP injection. Hence, there is a concern about potential secondary intrahepatic cholestasis in patients who have biliary obstruction. In this study, we further investigated this issue. METHODS: Removable total biliary obstruction (RTBO) was induced in 12 rats. Six of them (group A) received Mn-DPDP (25 mumol/kg). The others (group B) served as control animals. The data from serial magnetic resonance imaging and serum bilirubin tests were compared. RESULTS: Without Mn-DPDP, a minimal increase of the liver intensity was observed in both groups because of cholestasis. In group A, the intensity of the liver was strongly enhanced with Mn-DPDP but normalized within 48 hr after removal of the obstruction. In both groups, total bilirubin levels increased up to 131.67 mumol/l 2 days after RTBO but rapidly decreased within 4 hr and almost normalized within 24 hr after removal of the obstruction, suggesting a lack of Mn-DPDP influence on the bilirubin level. CONCLUSION: We found that Mn-DPDP did not cause secondary intrahepatic cholestasis. Retained Mn++ is likely eliminated after restoration of bile flow. These results indicate that Mn-DPDP can be used in patients who have obstructive jaundice as long as it is followed by successful bile drainage.

Time-of-flight MR angiography of the brain: comparison of acquisition techniques in healthy volunteers.

OBJECTIVE: The saturation phenomenon that limits vessel visibility in unenhanced time-of-flight MR angiograms can be overcome by the injection of MR contrast agents that shorten the T1 of the blood. Unlike the situation with unenhanced MR angiographic acquisitions, in which the MR parameters must be carefully adjusted to reduce saturation effects, optimization procedures for contrast-enhanced MR angiography focus on the acquired shortening of the T1 of the blood and the time evolution of the T1 over the entire measurement. To improve the quality of contrast-enhanced time-of-flight MR angiographic acquisitions in the brain, we compared different acquisition techniques that exploit shortening of the T1 of the blood. SUBJECTS AND METHODS: High-resolution MR angiographic examinations were done with a 1-T MR system for 12 healthy volunteers. Doses of 0.1 and 0.2 mmol of gadopentetate dimeglumine per kilogram of body weight were injected on two separate days to allow for identical timing of the comparative studies after contrast material injection. The effects of dose of contrast material, MR parameters (TR and flip angle), method of injecting the contrast material (monophasic, biphasic, or continuous slow injection), and K-space acquisition schemes (regular schemes versus collecting the central K-space lines near the beginning or the end of the acquisition) were studied. RESULTS: Higher doses provided better MR angiograms. The flip angle and the TR had to be adjusted on the basis of the Ernst equation and therefore depended on an estimation of the averaged T1 value over the entire measurement. Comparison of the different K-space acquisition schemes confirmed that the evolution of the T1 of the blood over the entire measurement time is important, especially for longer measurements. There was no noticeable difference between the MR angiograms acquired with monophasic or biphasic injections. These injection schemes provided more detailed MR angiograms than did continuous slow injection over the entire measurement. CONCLUSION: Our results show that the quality of contrast-enhanced MR angiograms can be remarkably increased when acquisition techniques that exploit the short T1 of the blood are used.

Potential role of bile duct collaterals in the recovery of the biliary obstruction: experimental study in rats using microcholangiography, histology, serology and magnetic resonance imaging.

Obstructive cholestasis induced in animals at the level of the lobar and common bile ducts is known to be reversible with time. This study was conducted not only to test the hypothesis that formation of bile duct collaterals is responsible for the recovery of biliary obstruction but also to assess the potential of hepatobiliary agent-enhanced magnetic resonance imaging for visualizing cholestasis. A total of 52 rats were divided into three groups with selective biliary obstruction, total biliary obstruction and sham surgery. We studied the evolution of cholestasis by correlating microcholangiographic, histological findings with the results of liver tests and hepatobiliary agent-enhanced magnetic resonance imaging. Lobar cholestasis undetected by liver tests but seen on magnetic resonance imaging as a difference between ligated and unligated lobes, occurred in 15 out of 20 rats subjected to selective biliary obstruction within 48 hr after ligation, and recovered later on as a result of the development of bile duct collaterals. Five rats failed to show local cholestasis as a result of the existence of interlobar accessory bile channels. All 18 total biliary obstruction-treated rats were cholestatic soon after ligation, as confirmed by high serum bilirubin and alkaline phosphatase levels and as documented by poor liver enhancement on magnetic resonance imaging. Cholestasis recovered within 4 wk with normalization of liver enhancement on magnetic resonance imaging as a result of the formation of bile duct collaterals (as demonstrated by microcholangiographic and histological study). Bile duct collateral formation is responsible for the recovery from obstructive cholestasis in rats. A similar mechanism might be present in conditions of bile duct obstruction without cholestasis. Hepatobiliary agent-enhanced magnetic resonance imaging is more sensitive than blood tests in detecting local cholestasis and can be used to monitor noninvasively the evolution of biliary obstruction.

Prolonged positive contrast enhancement with Gd-EOB-DTPA in experimental liver tumors: potential value in tissue characterization.

To evaluate the potential of the hepatobiliary magnetic resonance (MR) imaging contrast agent gadolinium EOB-DTPA (ethoxybenzyl diethylenetriaminepentaacetic acid) for the characterization of hepatic tumors, 79 primary and six implanted hepatomas in 38 rats were studied. MR imaging findings after administration of Gd-DTPA (0.3 mmol/kg) and Gd-EOB-DTPA (30 mumol/kg) were correlated with microangiographic and histologic findings. Gd-EOB-DTPA produced a strong liver enhancement, which caused prompt negative contrast enhancement (CE) in all implanted hepatomas and in 77 of 79 primary hepatomas. A positive CE that lasted up to 2 hours was found in two of 79 primary hepatomas, both of which were highly differentiated (grade I) hepatocellular carcinomas (HCCs). The rest were moderately differentiated to undifferentiated HCCs (grades II-IV). Rim enhancement, which corresponded histologically to peritumoral malignant infiltration sequestering normal hepatocytes, was seen around all implanted and some primary hepatomas. Positive tumor CE after administration of Gd-EOB-DTPA in this study is much less frequent but much more specific in comparison with the results of previous studies with manganese-DPDP (N,N'-dipyridoxylethylenediamine-N,N'-diacetate 5,5'-bis[phosphate]). These findings may help further discriminate hepatic tumors.

MR imaging evaluation of liver enhancement by Gd-EOB-DTPA in selective and total bile duct obstruction in rats: correlation with serologic, microcholangiographic, and histologic findings.

PURPOSE: To investigate the behavior and potential application of the hepatobiliary magnetic resonance (MR) imaging contrast agent gadolinium-ethoxybenzyl (EOB)-diethylene-triamine-pentaacetic acid (DTPA) in cholestasis. MATERIALS AND METHODS: Rat models of selective biliary obstruction (SBO) (n = 20) and total biliary obstruction (TBO) (n = 14) were used. Serial Gd-EOB-DTPA-enhanced MR images were obtained, and the findings were correlated with serologic, microcholangiographic, and histologic findings. RESULTS: In SBO rats, statistically significantly prolonged enhancement of ligated lobes occurred during the acute phase (P < .01) but was absent during the chronic phase owing to bile collateral vessels. In TBO rats, statistically significantly lower liver enhancement (P < .01) was observed as long as the obstruction persisted, until collateral bile ducts developed. CONCLUSION: The distinction between obstructed and unobstructed liver on Gd-EOB-DTPA-enhanced MR images suggests a novel application for visualizing cholestasis.