Your browser doesn't support javascript.
loading
Show: 20 | 50 | 100
Results 1 - 4 de 4
Filter
Add more filters










Database
Language
Publication year range
1.
Int Angiol ; 29(3): 239-43, 2010 Jun.
Article in English | MEDLINE | ID: mdl-20502410

ABSTRACT

AIM: Although there are studies reporting that carotid endarterectomy (CEA) is recommended before or concomitant to coronary artery bypass grafting (CABG) in patients with severe carotid stenosis, controversies still exist. Carotid artery stenting (CAS) has been recently introduced as an alternative revascularization therapy in high-risk patients. The aim of this study was to demonstrate, whether CAS is safe as an alternative treatment to carotid CEA, in asymptomatic candidates for CABG surgery. METHODS: Forty-one patients with severe carotid and coronary artery disease were studied. The mean age was 65 years; 91% were males. Within 1 week of the CAS intervention all patients underwent CABG surgery. A brain protection device was used in all CAS interventions. Balloon PTA and stenting was performed in all subjects. Adjunctive therapy with heparin was used during the procedure and clopidogrel was started immediately after cardiac surgery. Patients were assessed neurologically before and after the procedure (immediately after the CAS, at 24h, at 30 days, at 3, 6 and 12 months). The primary end point was the incidence of TIA, stroke, or death at 30 days. RESULTS: Internal carotid artery lesions of > 80%, were reduced by CAS to < 20% in all cases, achieving a procedural success of 100%. There were no neurological complications, such as TIA and stroke, or death, up to 12 months follow up. One patient developed acute coronary syndrome the day after CAS and was treated accordingly. CONCLUSION: Our results show that CAS, with brain protection in asymptomatic patients undergoing CABG surgery is feasible and safe and could be a good alternative to CEA.


Subject(s)
Angioplasty, Balloon , Carotid Stenosis/therapy , Coronary Artery Bypass , Coronary Artery Disease/surgery , Endarterectomy, Carotid , Aged , Angioplasty, Balloon/adverse effects , Angioplasty, Balloon/instrumentation , Angioplasty, Balloon/mortality , Anticoagulants/therapeutic use , Carotid Stenosis/complications , Carotid Stenosis/diagnosis , Carotid Stenosis/mortality , Carotid Stenosis/surgery , Clopidogrel , Coronary Angiography , Coronary Artery Bypass/adverse effects , Coronary Artery Bypass/mortality , Coronary Artery Disease/complications , Coronary Artery Disease/diagnosis , Coronary Artery Disease/mortality , Endarterectomy, Carotid/adverse effects , Endarterectomy, Carotid/mortality , Feasibility Studies , Female , Heparin/therapeutic use , Humans , Ischemic Attack, Transient/etiology , Male , Middle Aged , Platelet Aggregation Inhibitors/therapeutic use , Severity of Illness Index , Stents , Stroke/etiology , Ticlopidine/analogs & derivatives , Ticlopidine/therapeutic use , Time Factors , Treatment Outcome , Ultrasonography, Doppler
2.
Nephrol Dial Transplant ; 15(2): 205-11, 2000 Feb.
Article in English | MEDLINE | ID: mdl-10648666

ABSTRACT

BACKGROUND: Ultrasound, genetic and clinical correlations are available for ADPKD-1, but lacking for ADPKD-2. The present study was carried out to address: (i) the age-related diagnostic usefulness of ultrasound compared with genetic linkage studies; (ii) the age-related incidence and prevalence of relevant symptoms and complications; and (iii) the age and causes of death in patients with ADPKD-2. METHODS: Two hundred and eleven alive subjects, from three ADPKD-2 families at 50% risk, were evaluated by physical examination, consultation of hospital records, biochemical parameters, ultrasound and with genetic linkage and DNA mutation analyses. Nineteen deceased and affected family members were also included in the study. RESULTS: Of the 211 alive members, DNA linkage studies and direct mutation analyses showed that 106 were affected and 105 were not. Ultrasound indicated 94 affected, 108 not affected and nine equivocal results in nine children under the age of 15. For all ages, the false-positive diagnostic rate for ultrasound was 7.5% and the false-negative rate was 12.9%. The difference between ultrasound and DNA findings was most evident in children aged 5-14 years where the ultrasound was correct in only 50% and wrong or inconclusive in the remaining 50%. The mean age of the 106 alive, ADPKD-2 genetically affected patients was 37.9 years (range: 6-66 years). Among them, 23.5% had experienced episodes of renal pain, 22.6% were treated for hypertension, 22.6% had experienced at least one urinary tract infection, 19.8% had nephrolithiasis, 11.3% had at least one episode of haematuria, 9.4% had asymptomatic liver cysts, 7.5% had developed chronic renal failure and 0.9% had reached end-stage renal failure. Of the 19 deceased members, nine died before reaching end-stage renal failure at a mean age of 58.7 years (range: 40-68 years), mainly due to vascular complications, while the remaining 10 died on haemodialysis at a mean age of 71.4 years (range: 66-82 years). CONCLUSIONS: DNA analysis is the gold standard for the diagnosis of ADPKD-2, especially in young people. Ultrasound diagnosis is highly dependent on age. Under the age of 14, ultrasound is not recommended as a routine diagnostic procedure, but ultrasound becomes 100% reliable in excluding ADPKD-2 in family members at 50% risk, over the age of 30. ADPKD-2 represents a mild variant of polycystic kidney disease with a low prevalence of symptoms and a late onset of end-stage renal failure.


Subject(s)
Polycystic Kidney, Autosomal Dominant/diagnostic imaging , Polycystic Kidney, Autosomal Dominant/genetics , Acute Kidney Injury/etiology , Adolescent , Adult , Aging/physiology , Cause of Death , Child , Child, Preschool , DNA/genetics , DNA Mutational Analysis , False Negative Reactions , False Positive Reactions , Female , Genetic Linkage , Humans , Kidney Failure, Chronic/etiology , Liver Diseases/etiology , Male , Middle Aged , Polycystic Kidney, Autosomal Dominant/classification , Polycystic Kidney, Autosomal Dominant/complications , Ultrasonography/standards , Urologic Diseases/etiology
3.
Neuroradiology ; 39(7): 506-11, 1997 Jul.
Article in English | MEDLINE | ID: mdl-9258929

ABSTRACT

Our aim was to explore the possibility of delineation of the facial nerve within the parotid gland and to differentiate between superficial and deep parotid lesions in relationship to it, using ultrasound, CT, MRI, MRI sialography (MRIS) and CT sialography (CTS). We examined 47 patients with clinically suspected parotid tumours by US, 31 of them also by CT, MRI and CTS, and 13 by MRIS as well. Low-intensity curvilinear structures seen on T1-weighted MRI were delineated better after intraductal gadolinium injection and proved to represent parotid ducts on CTS. Using the main parotid duct as a landmark, we distinguished parotid lesions as deep or superficial to the facial nerve by T1-weighted MRI images in 69% and by MRIS in all cases. The facial nerve itself was indistinguishable from the parotid gland in all our imaging methods.


Subject(s)
Diagnostic Imaging , Facial Nerve/pathology , Parotid Diseases/diagnosis , Parotid Gland/pathology , Parotid Neoplasms/diagnosis , Adolescent , Adult , Aged , Aged, 80 and over , Child , Child, Preschool , Diagnosis, Differential , Female , Humans , Image Enhancement , Infant , Magnetic Resonance Imaging , Male , Middle Aged , Sialography , Tomography, X-Ray Computed , Ultrasonography
4.
Acta Radiol ; 37(5): 720-6, 1996 Sep.
Article in English | MEDLINE | ID: mdl-8915283

ABSTRACT

PURPOSE: To evaluate the significance of preoperative localization of abnormal parathyroid glands to the surgical outcome in patients with primary hyperparathyroidism. MATERIAL AND METHODS: Thirty-nine patients with primary hyperparathyroidism were studied preoperatively with US (39 patients), CT (30 patients) and MR imaging (18 patients). The overall diagnostic accuracy for US was 87%, CT 66% and MR 94%. In patients with a single parathyroid adenoma US was the most cost-effective localization technique with a detection rate of 96%. CT had a lower detection rate (78%) but was of particular value for fairly large ectopic adenomas in the root of the neck. MR imaging was a good confirmatory test (93%). In patients with multiple gland disease (primary hyperplasia and multiple adenomas), no single localization study alone was sufficient. Combination of all 3 studies, however, alerted the physician to the presence of disease in more than one gland in 87% of these patients. CONCLUSION: US, CT and MR imaging followed by surgery performed by an experienced surgeon provided good clinical results in 39 patients with primary hyperparathyroidism. Preoperative localization was especially useful in patients with primary parathyroid hyperplasia or multiple adenomas and in patients with ectopic parathyroid adenomas in the root of the neck. We recommend identification of all abnormal parathyroid glands prior to surgery.


Subject(s)
Adenoma/diagnosis , Hyperparathyroidism/diagnosis , Parathyroid Neoplasms/diagnosis , Adenoma/complications , Adenoma/surgery , Diagnostic Imaging , Female , Humans , Hyperparathyroidism/etiology , Male , Middle Aged , Parathyroid Neoplasms/complications , Parathyroid Neoplasms/surgery , Preoperative Care
SELECTION OF CITATIONS
SEARCH DETAIL
...