Outcome of percutaneous transluminal angioplasty in diabetic patients with critical limb ischaemia.

OBJECTIVE: We investigated the clinical outcome of percutaneous transluminal angioplasty (PTA) which has not been fully established in diabetic patients with critical limb Ischaemia (CLI) compared with non-diabetics. DESIGN AND PATIENTS: A total of 73 limbs of 52 patients (50 limbs of 34 diabetic patients and 23 limbs of 18 non-diabetics) who underwent PTA for CLI (Rutherford-Becker category 4, 5 or 6) were enrolled. Rates of amputation and restenosis, and ankle brachial index (ABI), were assessed before and after PTA during a 36-month follow-up period. RESULTS: Diabetic patients had a higher rate of major amputations after PTA (10 vs. 0%, P<0.05); however, total amputation (12.0 vs. 8.7%, P=0.62) and restenosis rates (4.0 vs. 8.7%, P=0.38) were not significantly different compared with non-diabetic patients. ABI at 3 months after PTA was significantly improved in both diabetic and non-diabetic patients (0.70±0.20 vs. 0.93±0.19, P<0.01 in diabetic patients; 0.69±0.25 vs. 0.92±0.17, P<0.01 in non-diabetics). Improved ABI was maintained for 36 months in both groups and did not show a significant difference (0.88±0.21 vs. 0.89±0.20, P=0.89). CONCLUSION: Our results, showing that the outcome of PTA in diabetic patients is not inferior to that in non-diabetics, suggest the potential benefit of primary PTA, instead of bypass surgery, for CLI in diabetic patients who are at high risk of perioperative complications.

Combined use of QuantiFERON-TB Gold assay and chest computed tomography in a tuberculosis outbreak.

OBJECTIVE: To evaluate the value of the QuantiFERON-TB Gold (QFT-G) assay and chest computed tomography (CT), in addition to the conventional use of the tuberculin skin test (TST) and chest radiography (CXR), in a contact investigation of a tuberculosis (TB) outbreak. DESIGN: In a contact investigation of a TB outbreak in a high school, TST and CXR were performed on all 1044 employees and students. QFT-G was performed on TST-positive subjects, and CT on QFT-G-positive subjects and students with TST > or =20 mm. RESULTS: TST was positive in 388 subjects (37.2%), while QFT-G was positive in 7.6% (30/394). CXR showed abnormal findings suggestive of TB in 10 (1.0%) subjects, all of whom were TST-positive and six of whom were QFT-G-positive. Findings suggestive of active TB were noted in 17 (32.7%) of 52 subjects by CT. Collectively, among 21 (1.1%) TB patients, all were TST-positive, 12 (57.1%) were QFT-G-positive and active TB was diagnosed by CT, and not by CXR, in 11 subjects. CONCLUSION: Compared to the conventional approach, the additional use of QFT-G in TST-positive subjects and chest CT in subgroups with a high probability of infection was found to be more effective in the differentiation between active TB, latent TB and non-infected subjects in a contact investigation.

Newly developed ulcer-like projection (ULP) in aortic intramural haematoma on follow-up CT: is it different from the ULP seen on the initial CT?

AIM: To show whether the clinical and radiological features of newly developed ulcer-like projections (nULPs) in an aortic intramural haematoma (IMH) on follow-up computed tomography (CT) images, are different from those of the initial ULPs (iULPs) on the initial CT images. MATERIALS AND METHODS: A review of the radiological database revealed 98 patients with IMH with at least two follow-up CT examinations with a follow-up period of more than 1 month. The patients were divided into four groups: patients without iULPs or nULPs throughout the follow-up periods (group A); patients with iULPs on the initial CT images (group B); patients with nULPs on follow-up CT images but without iULPs on the initial CT images (group C); and patients with both iULPs and nULPs (group D). The type of IMH, aortic diameter, thickness of the haematoma, and complications were analysed. The clinical and CT findings and complications in the four groups were compared. RESULTS: Forty-two patients had no iULPs nor nULPs (group A); 27 patients had 45 iULPs on the initial CT images (group B); 16 patients had 17 nULPs on follow-up CT images without any ULP on the initial CT images (group C); and 21 nULPs developed in 13 patients with iULPs (group D). There was no significant difference in the demographic or initial CT findings in the four groups. There was no statistical difference in the incidence of complications between groups B (59.3%), group C (62.5%), and group D (69.2%; p=0.830), but there was a significant difference in the incidence of complications between the patients without any ULPs (21.5% in group A) and those with ULPs (62.5% in groups B, C, and D). CONCLUSION: There were no significant differences in the CT findings or complications between the patients with iULPs and nULPs. Regardless of the developing time of the ULPs, the incidence of complications of IMH in patients with ULPs was higher than that in those without ULPs. Careful and regular follow-up CT examinations are needed for patients with ULPs.

Concomitant multiple revascularizations in supra-aortic arteries: short-term results in 50 patients.

BACKGROUND AND PURPOSE: The outcome for simultaneous revascularization of more than 1 supra-aortic arterial stenosis has not been evaluated because of concerns regarding the increased risk of additional procedures. We evaluated the feasibility and safety of concomitant multiple supra-aortic arterial revascularizations (CMSAR). MATERIALS AND METHODS: We retrospectively evaluated 50 consecutive patients who underwent CMSARs with angioplasty and stent placement. The study included a separate lesion group (LG) (n = 28), ipsilateral LG (n = 17) including adjacent (n = 6) and remote (n = 11) tandem lesions, and triple LG (n = 5). We assessed the procedural success (defined as residual stenosis <30%) and periprocedural event rate (ER) (minor or major stroke, and death). We compared the ERs in the lesion (ipsilateral vs separate) and symptom (unstable vs stable) pattern groups with the Fisher exact test. RESULTS: Procedural success was achieved in all patients (50/50). Periprocedural events within 30 days were noted in 5 (10%). ER within 2 days after the procedure was higher in the ipsilateral LG (4/17) than in the separate LG (0/28) (P = .016). Major events consisting of a major stroke and a death occurred in 2 patients in the unstable group (4%) and was more common in the unstable (2 of 7) than in the stable group (0/38) (P = .029). During the mean 11-month follow-up period, there was 1 symptomatic recurrence. CONCLUSION: CMSARs are feasible with a high procedural success rate resulting in a favorable short-term outcome. However, they must be carefully performed in ipsilateral LG, especially in patients in the unstable group.