ABSTRACT
OBJECTIVE: To evaluate the efficacy of densitometric analysis of cranial CT imaging in the measurement of areas with low cerebral blood flow and lack of hemodynamic reserve in patients undergoing carotid endarterectomy. PATIENTS AND METHODS: 40 consecutive patients undergoing carotid endarterectomy have been included in the study. All of them had preoperative cranial CT, pre and postoperative basal and acetazolamide SPECT. Cranial CT imaging after digitalization and computer processing were obtained with 4 densitometric patterns: 1). normal cerebral blood perfusion; 2). ischemic or low brain blood perfusion (patron I); 3). parenchyma without cerebral hemodynamic reserve (patron nR), and 4). brain infarction. RESULTS: 32 out of 40 (80 %) patients had abnormal densitometric patterns: 19 nR patterns (47.5 %), 11 I pattern (27.5 %) and 2 established brain infarction. The correlation between densitometric cranial TC imaging and SPECT was 92% when analyzing areas with hypoperfusion (S: 96.5 %; E: 82 %). Cranial CT detected 12/13 of patients who lacked cerebral hemodynamic reserve in the SPECT analysis (S: 74 %; E: 92 %; Vpp: 95 %). CONCLUSIONS: There is a good correlation between analysis of densitometric cranial TC imaging and SPECT in determining low cerebral blood flow areas and lack of cerebral hemodynamic reserve. This method could help to improve carotid surgery indications in patients with carotid stenosis.
Subject(s)
Brain , Endarterectomy, Carotid/methods , Tomography, X-Ray Computed , Aged , Brain/blood supply , Brain/diagnostic imaging , Brain/metabolism , Carotid Stenosis/physiopathology , Carotid Stenosis/surgery , Female , Hemodynamics/physiology , Humans , Male , Middle Aged , Tomography, Emission-Computed, Single-PhotonSubject(s)
Anti-HIV Agents/pharmacology , Drug Resistance, Microbial , HIV/drug effects , Anti-HIV Agents/therapeutic use , Drug Resistance, Microbial/genetics , Female , Genes, Viral , HIV/genetics , HIV/physiology , HIV Infections/drug therapy , Humans , Male , Microbial Sensitivity Tests/methods , Microbial Sensitivity Tests/statistics & numerical data , Practice Guidelines as Topic , Pregnancy , Pregnancy Complications, Infectious/drug therapy , Spain , Virus Replication/drug effects , Virus Replication/geneticsABSTRACT
A case of spontaneous acute infrarenal aortic dissection, with extension to the right common iliac artery and proximally to just below the origin of the renal arteries is presented. This dissection did not involve the visceral vessels nor the iliac system. The diagnosis was made with ultrasonography and computed tomography, without the need for angiography, and confirmed during surgical intervention, in which, prosthetic replacement of the affected segment was carried out.
Subject(s)
Aortic Aneurysm, Abdominal/surgery , Aortic Dissection/surgery , Acute Disease , Aortic Dissection/diagnosis , Aortic Dissection/pathology , Aorta, Abdominal/pathology , Aorta, Abdominal/surgery , Aortic Aneurysm, Abdominal/diagnosis , Aortic Aneurysm, Abdominal/pathology , Blood Vessel Prosthesis Implantation , Diagnostic Imaging , Humans , Iliac Artery/pathology , Iliac Artery/surgery , Male , Middle AgedSubject(s)
Candidiasis/diagnosis , Heroin Dependence/complications , Lumbar Vertebrae/microbiology , Osteomyelitis/microbiology , Spondylitis/microbiology , Thoracic Vertebrae/microbiology , Adult , Candida/isolation & purification , Candidiasis/complications , Heroin , Humans , Lumbar Vertebrae/diagnostic imaging , Male , Osteomyelitis/complications , Osteomyelitis/diagnosis , Psoas Abscess/complications , Psoas Abscess/microbiology , Radiography , Spondylitis/complications , Spondylitis/diagnosis , Thoracic Vertebrae/diagnostic imagingABSTRACT
We report a series of 37 patients with upper gastrointestinal fistulas, from a total of 90 postoperative fistulas, treated in our Department over a period of five years (1987-1991). 46% of these originated after peptic ulcer surgery. Most patients (54%) required surgical intervention mainly due to the presence of major intraabdominal sepsis, and only 12 (32.4%) had spontaneous fistula closure. Morbidity (59.4%) and mortality rates (32.4%) were high.
Subject(s)
Duodenal Diseases/etiology , Esophageal Diseases/etiology , Fistula/etiology , Gastric Fistula/etiology , Intestinal Fistula/etiology , Postoperative Complications/etiology , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Retrospective StudiesABSTRACT
Primary spleen angiosarcoma is a malignant neoplasia based on vascular tissue and it is a rare tumor (65 cases published). The clinical aspects are obscure and the specific diagnosis is made by laparotomy. The prognosis is very poor in any case and survival isn't more than two years, whenever the spleen undergoes spontaneous rupture in which case the survival should be less than six months. The splenectomy before rupture could increase survival. Patients with or without metastatic disease may be treated by chemotherapy but with poor results. Radiotherapy is used for relief the pain produced for bone metastasis.
Subject(s)
Hemangiosarcoma , Splenic Neoplasms , Hemangiosarcoma/diagnosis , Hemangiosarcoma/surgery , Humans , Male , Middle Aged , Splenic Neoplasms/diagnosis , Splenic Neoplasms/surgeryABSTRACT
The reactive hemophagocytic syndrome is a rare clinical-pathological entity which usually has a benign evolution and which is characterized by the systemic proliferation of mature histiocytes, with a great phagocytosis ability and which occurs in a secondary form in some infections and neoplasias and after the administration of certain drugs. We present a case of reactive hemophagocytic syndrome in a patient presenting a non-Hodgkin lymphoma, of crest malignancy, B immunoblastic and kappa monoclonal, with fatal evolution and in which the diagnosis was obtained after necropsy.
