RESUMO
The management of stroke has undergone significant development over the past 15 years. Perhaps the single most important landmark has been the approval by the Food and Drug Administration of intravenous (IV) tissue plasminogen activator (t-PA) for the treatment of ischemic stroke. However, the approval of this drug has not met with unanimous support by the medical community and, at present, only a minority of stroke patients receive t-PA. Although this is partly due to the fact that many patients do not meet criteria for treatment with IV t-PA, others simply do not arrive at medical facilities sufficiently early to be safely managed using thrombolysis. The appropriate use of IV t-PA in the treatment of ischemic stroke requires proper selection of patients and strict adherence to clinical protocols of treatment. The ideal stroke patient for treatment with IV t-PA is one who suffers occlusion of a small artery that leads to a disabling deficit.
Assuntos
Acidente Vascular Cerebral/tratamento farmacológico , Ativador de Plasminogênio Tecidual/uso terapêutico , Encéfalo/patologia , Encéfalo/fisiopatologia , Humanos , Infusões Intra-Arteriais , Infusões Intravenosas , Seleção de Pacientes , Acidente Vascular Cerebral/patologia , Acidente Vascular Cerebral/fisiopatologia , Fatores de TempoRESUMO
A simple, accurate test with no morbidity and effective for the detection of urinary tract obstruction in patients with normal and impaired renal function would be of significant clinical use. We herein evaluate the ability of 99mtechnetium diethylenetriaminepentaacetic acid to detect the presence or absence of obstruction. Of 107 patients who underwent recent studies 31 had confirmation of the presence or absence of obstruction by excretory urography, retrograde pyelography or other definitive procedures. Patients were studied in the posterior projection wtih perfusion images after intravenous injection of 20 millicuries 99mtechnetium diethylenetriaminepentaacetic acid. Static images of the urinary tract were obtained from 1 to 30 minutes after injection with delayed images up to 24 hours. Obstruction were defined as abnormal retention of activity in the collecting system persisting in the delayed images. Diethylentriaminepentaacetic acid identified correctly 13 of 13 patients proved to have obstruction and 17 of 18 without obstruction. One falsely positive result was owing to pyelocaliectasis. These data indicate a sensitivity of 100 per cent, specificity of 94 per cent and accuracy of 97 per cent.
