RESUMO
This is a prospective comparative study of magnetic resonance imaging (MRI) of the deep veins versus contrast venography in consecutive patients treated for various injuries to their lower extremities, showing no clinical symptoms of deep vein thrombosis. The majority of examinations referred to in this study were performed according to the following methodology: First, the patient was subjected to MRI. Subsequently, within a 24-h interval, he/she was subjected to contrast venography. The acquired results were compared in a blinded manner. The diagnostic indices for MRI were calculated on the assumption that the results of contrast venography were sure to give an accurate indication of either presence or absence of thrombosis. Thirty-six patients were included in the study, of which 27 (15 males) completed it. The overall incidence of distal deep venous thrombosis (DVT) was 22% (6/27). One patient showed extension of a crural thrombus into the popliteal vein. MRI did not detect any of the thrombi. This lack of result was ascribed to failure to fully demonstrate all segments of the crural veins. However, MRI did show three proximal thrombi in the superficial femoral vein, which were not shown by the venograms. Thus, both the sensitivity and specificity of MRI were 0%, so MRI proved to be of no value in the diagnosis of asymptomatic deep venous thrombosis in this study.
Assuntos
Traumatismos da Perna/complicações , Imageamento por Ressonância Magnética/normas , Trombose Venosa/diagnóstico , Adulto , Idoso , Diagnóstico Diferencial , Reações Falso-Negativas , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Flebografia/normas , Projetos Piloto , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Método Simples-Cego , Trombose Venosa/etiologiaRESUMO
OBJECTIVES: Existing algorithms of risk of coronary heart disease (CHD) do not pertain to patients with familial hypercholesterolaemia (FH), whose arteries have been exposed to hypercholesterolaemia since birth. We studied a cohort of FH patients to compare four diagnostic models of CHD: traditional risk factors of CHD (age, sex, cholesterol, hypertension, smoking and body mass index), cholesterol year score, and aortic as well as coronary calcium measured by spiral computed tomography (CT). SUBJECTS: We invited 88 individuals with molecularly defined FH of whom 80 (91%) decided to participate. RESULTS: Analysis of receiver operating characteristic curves showed that the age-adjusted coronary calcium score was more strongly associated with clinical manifestations of CHD than were traditional risk factors (P < 0.002), cholesterol year score (P << 0.0001), and the age-adjusted aortic calcium score (P < 0.0004). CONCLUSIONS: Age-adjusted coronary calcium score shows promise as an indicator of CHD in FH patients.
Assuntos
Doenças da Aorta/genética , Calcinose/genética , Doença da Artéria Coronariana/genética , Hipercolesterolemia/genética , Adulto , Fatores Etários , Idoso , Doenças da Aorta/diagnóstico por imagem , Calcinose/diagnóstico por imagem , Estudos de Coortes , Angiografia Coronária , Doença da Artéria Coronariana/diagnóstico por imagem , Feminino , Humanos , Hipercolesterolemia/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Curva ROC , Fatores de Risco , Tomografia Computadorizada por Raios XRESUMO
Most studies of the pathogenesis of coronary heart disease occur between gene variants and biochemical or physiological variables known to be atherogenic. In many situations, however, the gene products are not necessarily known. We studied 17 families (n = 122) with mutations in the low density lipoprotein (LDL) receptor gene as a model in which to test formally for linkage directly between an atherogenic genotype and ischemic heart disease (IHD) or aorto-coronary calcified atherosclerosis. In each family one of three different mutations was found: the Trp66-Gly mutation, the Trp23-Stop mutation, or a ten kilobase deletion removing exons 3-6 of the LDL receptor gene. Genomic DNA was used to determine these mutations by either enzymatic cleavage assays or Southern blotting. Aorto-coronary calcification was significantly associated with age and plasma cholesterol. Sex, hypertension, BMI and smoking were not associated with aorto-coronary calcification. Nonparametric analysis indicated significant linkage of the LDL receptor gene locus to aortic (p < 0.00005) and to aorto-coronary calcified atherosclerosis (p < 0.00001). Assuming a dominant mode of inheritance, significant linkage was detected for aortic (LOD = 3.89) and aorto-coronary calcified atherosclerosis (LOD = 4.10). We suggest that the atherogenicity of variations in other genes could be assessed by a similar approach.
Assuntos
Arteriosclerose/genética , Calcinose/genética , Doença da Artéria Coronariana/genética , Hiperlipoproteinemia Tipo II/genética , Modelos Genéticos , Adulto , Doenças da Aorta/etiologia , Doenças da Aorta/genética , Doenças da Aorta/patologia , Arteriosclerose/etiologia , Arteriosclerose/patologia , Calcinose/complicações , Cardiomiopatias/etiologia , Cardiomiopatias/genética , Cardiomiopatias/patologia , Doença da Artéria Coronariana/etiologia , Doença da Artéria Coronariana/patologia , Feminino , Ligação Genética , Genótipo , Heterozigoto , Humanos , Hiperlipoproteinemia Tipo II/complicações , Masculino , Pessoa de Meia-Idade , Mutação , Receptores de LDL/genéticaRESUMO
Intracranial oncotic aneurysms are very rare. Only twelve reported cases were from choriocarcinoma. We present a new case with two aneurysms disappearing after chemotherapy, the second in the literature but the first case with persistence of all arteries.
