Primary hepatic carcinoid tumor.

OBJECTIVES: To describe a rare case of primary carcinoid tumor of the liver and its management. CLINICAL PRESENTATION AND INTERVENTIONS: A 44-year-old Nigerian male presented with a big inoperable liver mass, which proved to be a carcinoid tumor by fine needle aspiration cytology. Extensive search for a primary lesion including laparotomy and peroperative ultrasound failed to find a primary lesion in the gastrointestinal tract and pancreas. Percutaneous embolization of the tumor followed by complete dearterializations of the liver seemed to have halted the growth of the tumor. The patient remained well with normal liver function tests for 56 months when he decided to go back to his country. CONCLUSION: The result showed that dearterializations of a primary inoperable carcinoid of the liver offered good palliation.

A quantitative index for the measurement of the tortuosity of blood vessels.

We propose a novel index for quantitating arterial tortuosity, based on second differences of the coordinates of the vessel midline. The index is independent of the magnification of the image and of sampling frequency. We have demonstrated its validity as an indicator of changes in morphology using simulated shapes. It is superior to two other putative indices based on vessel elongation and the variance of differences in the vessel midline coordinates, presented previously in the literature. The proposed index is easily generalised to three dimensions, allowing a true three-dimensional tortuosity index to be calculated from biplane angiograms or serial tomographic slices. It has a number of clinical applications. Preliminary data, using 82 aortograms from radiographic archives, showed a significant correlation between the tortuosity of the abdominal aorta and subject age (r=0.684, P<0.001). For this group, increased tortuosity was especially evident for subjects above 40 yr of age.

The spectrum of renal disease associated with microscopic polyangiitis and classic polyarteritis nodosa in Kuwait.

BACKGROUND: This study was conducted to examine prospectively the epidemiological profile of renal disease associated with microscopic polyangiitis (MPA) and classic polyarteritis nodosa (classic PAN) in Kuwait and its clinicopathological correlation. METHODS: Between 1 January 1993 and 31 December 1996, all patients referred to Al-Amiri renal centre were subjected to renal biopsy and/or arteriography if they manifested systemic manifestations of vasculitis or had rapid or unexplained renal failure with or without proteinuria. Patients who fulfilled the criteria of MPA and classic PAN, according to the Chapel Hill Consensus Conference (CHCC), were included in the study. RESULTS: Over those 4 years, 47 patients were diagnosed as having such vasculitides, 22 of whom were Kuwaiti nationals. This gave an average annual incidence of 45 cases/million adult Kuwaiti nationals (95% CI, 27-64). Histological examination revealed necrotizing glomerulonephritis (GN) in 11 patients and crescentic GN in 13, while isolated small- and/or medium-sized-arteritis were evident in six more patients. In 10 of the remaining patients; bands of fibrosis alternating with healthy renal tissue were seen and on arteriography non-atherosclerotic stenoses, infarctions, and/or microaneurysms were evident. The remaining seven patients were diagnosed by arteriography alone, five of whom had bilateral small kidneys. Constitutional manifestations of vasculitis were present in 32 patients (68%) and multisystem involvement in 19 (40%). ANCA levels were high in 24 (55%) of the 44 patients tested and seropositivity, as an antimyeloperoxidase, was a constant finding. Only six patients presented with rapidly progressive renal failure, while 31 presented with chronic renal disease, 18 of whom had protein excretion in excess of 2 g/day. CONCLUSIONS: These findings emphasize the limited role of clinical assessment in establishing a definite diagnosis of renal vasculitis and put in question its value in retrospective analysis of causes of ESRD in different populations.

Takayasu's arteritis in Kuwait.

The present study describes the epidemiological profile and clinical features of Takayasu's arteritis (TA) in Kuwait, as well as its association with other autoimmune diseases and primary hypercoagulable states. Thirteen patients were included from its start on 1 January 1989 till 30 June 1994. Diagnosis of TA was established by angiographic studies. Twelve patients were Arabs and 7 were Kuwaiti nationals. Five patients were males and renal disease secondary to isolated involvement of the abdominal aorta (TA, type II) was the main presentation in 4 patients. Coagulation tests were performed in 7 patients and included antiphospholipid antibody (aPL) assay as well as protein S, protein C and antithrombin III activity. Only one manifested recurrent thrombosis and laboratory tests confirmed the presence of a hypercoagulable state secondary to aPL and protein S deficiency. Serological tests of systemic lupus erythematosis (SLE) were positive in this patient. These data indicate that TA is not a rare disease in the Arabic population. In our study, female predominance was not a common feature of TA and renal disease secondary to TA type II disease was commonly encountered. The association of TA with SLE and primary hypercoagulable states was not a consistent finding in our patients with TA, and hence, the proposed role for thrombotic vasculopathy in the pathogenesis and progression of this disease was unfounded.

Experiences with DSA in the diagnosis of pulmonary embolism.

DSA pulmonary angiography was performed in 90 cases during the last two and half years and proved the presence of pulmonary emboli in 41 cases. The superiority of DSA pulmonary angiography is stressed comparing to other diagnostic methods (chest radiogram, laboratory and isotopic studies).

[Anatomy of the hand arteries based on angiographic studies (author's transl)]. / A kéz artériáinak anatómiája angiographiás vizsgálatok alapján.

The authors report conclusions drawn from anatomical studies on ninety-two hand angiographies. The superficial and deep volar arcs were classified according to Coleman and Anson. The superficial arc was found to be incomplete in 66.3%, the deep arc in 9.8% of all cases. Variations in ramification of the digital arteries were divided in two groups, as they belonged to either the ulnar or the radial arterial system. In the view of the extreme variability of the arterial network, the authors warn against operations on the hand arteries without angiography.

[Pathological sagittal shifting of vertebral bodies]. / A csigolyatestek nyílirányú kóros helyzetváltozásai.

The results of the lumbar spine examinations performed in one year and a half are evaluated by the authors. The types of the sagittal positional changes of the vertebral bodies are discussed in detail. The importance of the functionally centrated and lateral telephotographs in the diagnosis of the antepositional olisthesis and the retropositional retrolisthesis is pointed out, and the indication and the differential diagnostical value of the oblique roentgenograms are dealt with.