[Thallium scintigraphy of the myocardium in evaluation of patients with insulin resistance syndrome and microvascular angina pectoris]. / Táliová spect scintigrafia myokardu v hodnotení pacientov so syndrómom inzulínovej rezistencie a mikrovaskulárnou anginou pectoris.

Insulin resistance syndrom (IR) is often associated with the syndrome of microvascular angina pectoris (MVAP) or with coronary artery disease (CAD). The authors quantified distribution and washout of 201Tl in heart (C), lungs (L) and liver (H) to evaluate the results 201Tl stress (s) and redistribution SPECT in 50 patients. They compared 2 groups of patients with laboratory verified IR (MVAP and CAD) and control group (CG) of patients with normal coronarography without any symptoms of IR. In Patients with IR and MVAP were found significantly more frequent local perfusion abnormalities then in CG. The index sL/C calculated by ROI analysis is significantly lower in controls, then in CAD. The index sC/H is lower in patients with IR (MVAP significantly) then in CG. The washout of 201Tl in CAD myocardium decreased and in MVAP liver increased. 201thalium scintigraphy is useful for separation of patients with MVAP and local perfusion abnormalities. This findings had probably prognostic value in patients with IR.

[The reflex sympathetic dystrophy syndrome of the lower extremities in patients after kidney transplantation--another complication of cyclosporin A therapy?]. / Syndróm reflexnej sympatikovej dystrofie dolných koncatín u pacientov po transplantácii oblicky--d'alsia komplikácia liecby cyklosporínom A?

The authors describe a new complication observed in patients after transplantation of the kidneys, characterized by intensive periarticular pain of the joints of the lower extremities, mostly with a symmetrical affection of the heels and knees, associated with vasomotor changes in the affected area, X-ray evidence of patchy osteoporosis and an increased periarticular activity of radionuclide on bone scans. The symptoms develop shortly after transplantation and recede within several months. The clinical findings, X-ray and scintigraphic changes are typical for the syndrome of reflex sympathetic dystrophy. The etiology of the syndrome remains obscure, the symptomatology recedes parallel with reduction of the dosage and levels of cyclosporin A.

Reflex sympathetic dystrophy of the lower limbs after kidney transplantation.

Reflex sympathetic dystrophy syndrome (RSDS) is a rarely described complication after different types of organ transplants. Three out of 147 kidney recipients treated at our center during the last 6 years developed severe bilateral symmetrical pain in the ankles and knees, with great difficulties in walking 2-3 months after kidney transplantation. Clinical examination revealed periarticular soft tissue swelling and vasomotor changes with no effusion. Patchy osteoporotic patterns were seen radiographically in clinically affected areas. Scintigraphy showed increased epiphyseal uptake of 99mTc with a periarticular distribution. Clinical symptoms, radiographic, and scintigraphic signs were compatible with so-called RSDS. The exact cause of the syndrome remained obscure. All patients received standard immunosuppression with cyclosporine A (CyA), azathioprine, and prednisone. Symptoms of RSDS improved when doses of CyA were reduced and blood levels declined; patients were treated with calcitonin and calcium channel blockers simultaneously. Non-steroidal antiinflammatory drugs were not effective in symptom relief. In all three cases, most probably spontaneous complete recovery was achieved over the course of 2-8 months; no one patient progressed to aseptic osteonecrosis.