ABSTRACT
Early HAT is the most frequent and severe vascular complication following liver transplantation. It is one of the major causes of graft failure and mortality. Endovascular thrombolytic treatment in patients with thrombotic complications after liver transplantation is an attractive alternative to open surgery as lower morbidity and mortality rates are reported for it. PTA following transcatheter thrombolysis has been successfully used to treat HAT in adults. To the best of our knowledge, there have not been any reports of a successful transcatheter thrombolysis using interventional radiological techniques in a patient only four months old. The present report describes the successful endovascular emergency treatment of a HAT three days after DD split liver transplantation.
Subject(s)
Angioplasty, Balloon/methods , Arteries/pathology , Hepatic Artery/pathology , Liver Transplantation/adverse effects , Liver Transplantation/methods , Thrombolytic Therapy/methods , Thrombosis/therapy , Alagille Syndrome/therapy , Female , Graft Rejection , Hepatic Artery/surgery , Humans , Infant , Liver/diagnostic imaging , Liver/enzymology , Liver Cirrhosis/therapy , Treatment Outcome , Ultrasonography, Doppler, Color/methodsABSTRACT
OBJECTIVE: To assess the value of spectroscopic and perfusion MRI for glioma grading and for distinguishing glioblastomas from metastases and from CNS lymphomas. METHODS: The authors examined 79 consecutive patients with first detection of a brain neoplasm on nonenhanced CT scans and no therapy prior to evaluation. Spectroscopic MRI; arterial spin-labeling MRI for measuring cerebral blood flow (CBF); first-pass dynamic, susceptibility-weighted, contrast-enhanced MRI for measuring cerebral blood volume; and T1-weighted dynamic contrast-enhanced MRI were performed. Receiver operating characteristic analysis was performed, and optimum thresholds for tumor classification and glioma grading were determined. RESULTS: Perfusion MRI had a higher diagnostic performance than spectroscopic MRI. Because of a significantly higher tumor blood flow in glioblastomas compared with CNS lymphomas, a threshold value of 1.2 for CBF provided sensitivity of 97%, specificity of 80%, positive predictive value (PPV) of 94%, and negative predictive value (NPV) of 89%. Because CBF was significantly higher in peritumoral nonenhancing T2-hyperintense regions of glioblastomas compared with metastases, a threshold value of 0.5 for CBF provided sensitivity, specificity, PPV, and NPV of 100%, 71%, 94%, and 100%. Glioblastomas had the highest tumor blood flow values among all other glioma grades. For discrimination of glioblastomas from grade 3 gliomas, sensitivity was 97%, specificity was 50%, PPV was 84%, and NPV was 86% (CBF threshold value of 1.4), and for discrimination of glioblastomas from grade 2 gliomas, sensitivity was 94%, specificity was 78%, PPV was 94%, and NPV was 78% (CBF threshold value of 1.6). CONCLUSION: Perfusion MRI is predictive in distinguishing glioblastomas from metastases, CNS lymphomas and other gliomas vs MRI and magnetic resonance spectroscopy.
Subject(s)
Brain Neoplasms/classification , Brain Neoplasms/diagnosis , Magnetic Resonance Imaging/methods , Magnetic Resonance Spectroscopy/methods , Diagnosis, Differential , Female , Humans , Male , Middle Aged , Perfusion , Reproducibility of Results , Sensitivity and SpecificityABSTRACT
A 49-year-old man on anticoagulation treatment with phenprocoumon presented with acute right sided 7th and 8th cranial nerve palsy, acute hearing loss, headache, vertigo, and vomiting. CT and MRI revealed a cerebellopontine angle tumor 15mm in diameter and acute intratumoral hematoma. A cellular schwannoma composed predominantly of Antoni A tissue with dilated thin-walled vessels, surrounded by old hemorrhage with hemosiderin-laden macrophages was found histologically.
Subject(s)
Cerebral Hemorrhage/diagnostic imaging , Cerebral Hemorrhage/pathology , Neuroma, Acoustic/diagnostic imaging , Neuroma, Acoustic/pathology , Cerebral Hemorrhage/etiology , Facial Nerve Diseases/etiology , Humans , Male , Middle Aged , Neuroma, Acoustic/complications , Radiography , Vestibulocochlear Nerve Diseases/etiologySubject(s)
Arteriovenous Fistula/diagnosis , Central Nervous System Vascular Malformations/diagnosis , Dura Mater/abnormalities , Paraparesis/diagnosis , Spinal Cord Diseases/diagnosis , Arteriovenous Fistula/complications , Central Nervous System Vascular Malformations/complications , Humans , Magnetic Resonance Imaging , Male , Middle Aged , Paraparesis/etiology , Spinal Cord Diseases/complicationsABSTRACT
Chemical preconditioning, an emerging neuroprotective strategy described in recent years, results in preserved energy metabolism during hypoxia via yet unknown mechanisms. The hypoxic increase of NADH content is attenuated by preconditioning. The goal of the present study was to investigate whether attenuation of the hypoxic NADH increase is due to a shift between free and protein-bound NADH. NADH in solution has a fluorescence maximum at 469.2 nm. In untreated mouse hippocampal slices, lambda(control onset) is 456.2 +/- 5.3 nm in CA1 (mean +/- SD; p < 0.01 vs. solution) and 454.6 +/- 6.1 nm in CA3 [p < 0.01 vs. solution, not significant (NS) to lambda(control onset) in CA1]. In slices prepared from animals pretreated in vivo with 20 mg/kg 3-nitropropionate, lambda(preconditioning onset) is 439.2 +/- 5.0 nm (p < 0.001 vs. control) in CA1 and 434.2 +/- 6.4 nm in CA3 (p < 0.001 vs. control; NS to lambda(preconditioning onset) in CA1). In controls, the fluorescence maximum shifts to lambda(control hypoxia) 458.2 +/- 1.3 nm in CA1 (NS vs. onset) and 456.0 +/- 3.6 nm in CA3 (NS vs. onset). On preconditioning with 3-nitropropionate, lambda(preconditioning hypoxia) shifts to 446.4 +/- 4.3 nm in CA1 (p < 0.03 vs. onset) and 438.6 +/- 6.9 nm in CA3 (p < 0.03 vs. onset). Posthypoxic decay of free and protein-bound NADH is diminished after preconditioning. We conclude that the free NADH level is reduced on an increase of hypoxic tolerance by chemical preconditioning. Reduction of free NADH content is maintained during hypoxia after preconditioning.
Subject(s)
NAD/metabolism , Oxidative Phosphorylation/drug effects , Protein Binding , Animals , Cell Hypoxia , Enzyme Inhibitors/pharmacology , Hippocampus/chemistry , Hippocampus/metabolism , Male , Mice , NAD/analysis , Nitro Compounds , Propionates/pharmacology , Spectrometry, Fluorescence , Succinate Dehydrogenase/antagonists & inhibitors , Tissue DistributionABSTRACT
The epidemiology of hepatitis B in hospital personnel was studied by testing of sera from 3,770 employees of the Medical School of Hannover (Hannover, West Germany) for hepatitis B surface antigen (HBsAg) and its corresponding antibody (anti-HBs) by solid-phase radioimmunoassay. An average prevalence of 2.2% for HBsAg and 11.7% for anti-HBs was found. Physicians (18.2%), nurses (20.1%), and members of the cleaning service (26.3%) showed the highest frequencies of HBsAg or anti-HBs carriage. In a study of age- and sex-matched personnel, nurses showed a significantly (P less than 0.01) higher rate of infection than a control group with less exposure to infectious materials. The frequency of HBsAg or anti-HBs was highest in persons associated with dialysis (31.3%), anesthesiology (31.0%), ophthalmology (29.4%, neurosurgery (28.0%), and surgery (24.4%). The rate of infection was significantly higher in surgical departments (24.4%) than in nonsurgical ones (13.3%). Persons who had been nursing patients with hepatitis were significantly (P less than 0.05) more frequently carriers of HBsAg or anti-HBs than a comparable control group.
