Orwik

Peritubular capillary damage in acute humoral rejection: an ultrastructural study on human renal allografts.

The ultrastructural features of peritubular capillary (PC) damage was studied in 12 kidney allografts with acute humoral rejection (AHR). AHR manifested in diffuse linear PC staining for C4d, and histology consistent with Banff grade III in 7 recipie... expand abstractnts and Banff grade II in 5. Allografts with acute tubular necrosis served as controls. First biopsies (post-transplantation day 16.2 +/- 2.2): The intra-capillary exudate comprised monocytes (59%), polymorphonuclears (14%), lymphocytes (12%) and not otherwise specified mononuclears (15%). Three patterns of focal PC endothelial injury were observed: lysis, an increased rate of apoptosis and fragmentation. No correlation was found between the respective damage types and the inflammatory cell types or the Banff grades. Controls revealed endothelial swelling, detachment from basement membrane and fragmentation. Follow-up biopsies: Monocytes transformed into macrophages intra-luminally. The reparative changes comprised endothelial cytoplasmic protrusions, binucleated endothelial cells and capillary sprouts. Early transplant capillaropathy and transplant glomerulopathy were noted in 2 recipients. Literature data indicate that lysis is mediated by anti-HLA alloantibodies; apoptosis, demonstrated first in the present study, may be induced by non-HLA-type anti-endothelial antibodies. Fragmentation is caused by ischemia. Ongoing endothelial injury leads to transplant capillaropathy and transplant glomerulopathy, the characteristic lesions of chronic rejection. collapse abstract

A case of absent right and persistent left superior vena cava: echocardiographic diagnosis

A 49-year-old man underwent transthoracic echocardiography for atypical chest pain. A dilated coronary sinus was found and venous contrast echocardiography raised the suspicion of absent right and persistent left superior vena cava. Transesophageal e... expand abstractchocardiography showed no presence of right superior vena cava. The echocardiographic findings were confirmed by upper venous digital subtraction cavography. collapse abstract

Diagnostic role of secretin-enhanced MRCP in patients with unsuccessful ERCP.

AIM: To evaluate the value of MR cholangiopancreatography (MRCP) in patients in whom endoscopic retrograde cholangiopancreatography (ERCP) was unsuccessfully performed by experts in a tertiary center. METHODS: From January 2000 to June 2003, 22 patie... expand abstractnts fulfilled the inclusion criteria. The indications for ERCP were obstructive jaundice (n = 9), abnormal liver enzymes (n = 8), suspected chronic pancreatitis (n = 2), recurrent acute pancreatitis (n = 2), or suspected pancreatic cancer (n = 1). The reasons for the ERCP failure were the postsurgical anatomy (n = 7), duodenal stenosis (n = 3), duodenal diverticulum (n = 2), and technical failure (n = 10). MRCP images were evaluated before and 5 and 10 min after i.v. administration of 0.5 IU/kg secretin. RESULTS: The MRCP images were diagnosed in all 21 patients. Five patients gave normal MR findings and required no further intervention. MRCP revealed abnormalities (primary sclerosing cholangitis, chronic pancreatitis, cholangitis, cholecystolithiasis or common bile duct dilation) in 10 patients, who were followed up clinically. Four patients subsequently underwent laparotomy (hepaticojejunostomy in consequence of common bile duct stenosis caused by unresectable pancreatic cancer; hepaticotomy+Kehr drainage because of insufficient biliary-enteric anastomosis; choledochojejunostomy, gastrojejunostomy and cysto-Wirsungo gastrostomy because of chronic pancreatitis, or choledochojejunostomy because of common bile duct stenosis caused by chronic pancreatitis). Three patients participated in therapeutic percutaneous transhepatic drainage. The indications were choledocholithiasis with choledochojejunostomy, insufficient biliary-enteric anastomosis, or cholangiocarcinoma. CONCLUSION: MRCP can assist the diagnosis and management of patients in whom ERCP is not possible. collapse abstract

Sonographic follow-up after visceral artery stenting.

OBJECTIVE: The aim of this study was to evaluate the sonographic features of stents and the flow parameters of the visceral arteries after stent implantation. METHODS: Since 1996, 34 stenoses of the visceral arteries (2 mesenteric, 4 celiac trunk, an... expand abstractd 28 renal arteries) in 28 patients have been treated with metallic stent implantation in the Department of Radiology of Szeged Medical University. All these patients were regularly followed sonographically. For the diagnosis of restenosis, previously published criteria were used. RESULTS: All the mesenteric and celiac stents could be visualized, but none of the renal stents were clearly seen sonographically. The flow parameters could be established in all cases. Sonographic examination revealed 1 occlusion, 2 restenoses, and 1 stent displacement. All these abnormalities were confirmed by other imaging modalities. CONCLUSIONS: Sonography is a useful tool in the follow-up of patients after visceral artery stenting. Despite the fact that none of the renal artery stents were visualized directly, the flow parameters could be evaluated, and the pathologic changes were found. collapse abstract

Diagnostic value of secretin-enhanced magnetic resonance cholangiopancreatography (S-MRCP) after unsuccessful endoscopic retrograde cholangiopancreatography (ERCP)

BACKGROUND AND AIMS: To evaluate the value of S-MRCP in patients in whom ERCP performed by experts in a tertiary center were unsuccessful. PATIENTS AND METHODS: From January 2000 to June 2003, 22 patients fulfilled the inclusion criteria. The indicat... expand abstractions for ERCP were obstructive jaundice (n = 9), abnormal liver enzymes (n = 8), suspected chronic pancreatitis (n = 2), recurrent pancreatitis (n = 2) or suspected pancreatic cancer (n = 1). The reasons for the ERCP failure were postsurgical anatomy (n = 7), duodenum stenosis (n = 3), duodenal diverticulum (n = 2), or technical failure (n = 10). MRCP images were evaluated before and 5 and 10 min after the i.v. administration of 0.5 IU/kg secretin. RESULTS: The MRCP images were diagnostic in all but 1 patient. Five patients gave normal MR fadings and required no further intervention. S-MRCP detected abnormalities (primary sclerosing cholangitis, chronic pancreatitis, cholangitis, cholecystolithiasis or common bile duct dilatation) in 10 patients, who were followed up clinically. Four patients subsequently underwent laparotomy (hepatico-jejunostomy owing to common bile duct stenosis caused by unresectable pancreatic cancer; hepaticotomy + Kehr drainage because of narrow biliary-enteric anastomosis; choledocho-jejunostomy, gastro-jejunostomy and Wirsungo-gastrostomy in consequence of chronic pancreatitis or choledocho-jejunostomy because of common bile duct stenosis caused by chronic pancreatitis). Three patients participated in therapeutic percutaneous transhepatic drainage; the indications were choledocholithiasis in one patient choledocho-jejunostomy anastomosis, narrow biliary-enteric anastomosis, or cholangiocarcinoma. CONCLUSION: S-MRCP is the method of choice in cases where ERCP is not possible. collapse abstract

The occurrence of bronchioloalveolar lung cancer among our patients

INTRODUCTION: One of the subtypes of pulmonary adenocarcinoma, bronchioloalveolar carcinoma (BAC), is mentioned as the lung cancer of non-smoking women. We have studied the clinical characteristics of BAC and its surgical treatment. METHODS AND PATIE... expand abstractNTS: Between 1992 and 2001, lung resections for BAC were performed on 101 patients: 55 men and 46 women, average age 59.7 years. Thirty-two of the patients were non-smokers, and 69 were active smokers. In 1992 the incidence of BAC was 17.5% of all adenocarcinomas, whereas in 2001 it had risen to 51.6%. The operations involved 76 lobectomies, 12 pulmonectomies, 11 wedge resections and 2 explorative thoracotomies. RESULTS: The surgical mortality was 0.9%. The final histologic findings revealed that 82.1% of the tumours were in stages I or II, with 33.7% of the total in stage I/A. The average 5-year survival was 64.3%. Survival for women 75%, was significantly better than that for men, 51% (p=0.045). A significant difference was not found in the 5-year survival rate for multiple tumours or for BAC cases of different histological types. CONCLUSIONS: The incidence of BAC, which occurs relatively frequently among women, and exhibits a relatively favourable course, has tended to increase in recent years. A majority of these tumours are removed in an early stage. The survival is not significantly poorer in the event of multiple tumours. collapse abstract

Liver abscess caused by Stenotrophomonas maltophilia: report of a case.

We report the case of a melioidosis-like abscess of the liver caused by Stenotrophomonas (Xanthomonas) maltophilia infection in a Chinese man living in Hungary. Although this appears to be the first documentation of a liver abscess of this origin in ... expand abstracta nonimmunocompromised patient, our case report demonstrates that this common facultative pathogen can also cause liver abscess and sepsis. After repeated negative blood cultures, histological examinations of liver biopsies suggested the possibility of chronic melioidosis, but the microbiological examination performed directly on the same specimen identified a Stenotrophomonas maltophilia infection. Surgical drainage was performed and sulphamethoxazole/trimethoprim therapy was commenced, after which the patient recovered fully. The facultative pathogen S. maltophilia, which most often causes nosocomial infections, may cause severe sepsis and liver abscess. We wish to draw attention to the fact that the antibiotic sensitivity of S. maltophilia is not necessarily the same in vivo and in vitro. This can create difficulties in both diagnosis and treatment. collapse abstract

Bronchioloalveolar lung cancer: occurrence, surgical treatment and survival.

OBJECTIVE: The prevalence of pulmonary adenocarcinoma has risen worldwide. Bronchioloalveolar carcinoma (BAC) was studied with regard to whether it exhibits a similar tendency, and its typical features were analysed. METHODS: Between 1992 and 2001, 2... expand abstract78 lung resections were carried out for adenocarcinoma. Of these, 67 (24.1%) proved to involve BAC. Whereas BAC accounted for 6.9% of the cases in 1992, in 2001 the proportion was 46.9%. There were 37 men (55.2%) and 30 women (44.7%); the average age was 60.5 years. 58.2% of them had no complaints. Of the 26 non-smokers, 69.2% were women; of the 41 smokers, 29.2% were women. In consequence of the tumour, 49 lobectomies, three bilobectomies, six pneumonectomies and nine wedge resections were performed. RESULTS: The surgical mortality was 1.6%. The pathology revealed that 26 (38.8%) tumours were in stage I/A. In 15 cases (22.4%), tuberculosis (TB) could be revealed besides the BAC: by skin tests in four cases, by CT in three cases, by case history in four cases, and by pathology in four cases. For the overall group of 67 patients, the 5-year survival rate was 61.9%, and the mean survival time was 75.7 months. The 5-year survival rate among the women (74%) was significantly better than that among the men (37%) (P=0.030). There was no significant difference in survival with regard to the multiple BAC (85%). The 5-year survival rate was significantly worse in the mixed BAC group (20%) than in the non-mucinous (62.7%) and in mucinous (59%) group. The overall 5-year survival rate among the smokers and TB patients was 61 and 79%, respectively, which is higher than that among the non-smokers (47%) and non-TB patients (56%). The survival rate for the wedge resection cases was 37%, which was lower than that for the cases involving major resections (60%) (P=0.939). CONCLUSION: BAC has a favourable survival, particularly in women. In spite of this, resection smaller than lobectomy is recommended only as a compromise. A multiple appearance does not imply a worse survival. The best survival rate was found in the non-mucinous BAC among the histological groups. TB seems to be frequent among BAC patients. collapse abstract

Color Doppler ultrasound for monitoring free flaps in the head and neck region.

The use of microvascular free flaps has become established as a very reliable reconstructive technique following tumor surgery or trauma in the head and neck region. Occasionally, flap compromise may occur which will require immediate re-exploration.... expand abstract Early diagnosis of vascular insufficiency is essential. Clinical signs are not always reliable. Numerous systems have been described for monitoring the viability of microsurgical free flaps. The authors consider that color Doppler ultrasound is one of the most useful diagnostic tools. Three cases are reviewed in which this technique aided the decision whether re-exploration was necessary. collapse abstract

Thoracic core needle biopsy using ultrasound guidance.

This article demonstrates the usefulness of ultrasound (US)-guided core needle biopsy in the diagnosis of thoracic lesions. Between January 1997 and June 2000, 45 US-guided core needle biopsies were performed in the department of radiology. This meth... expand abstractod was chosen in every case when the lesion abutted the chest wall. Conventional histologic examinations supplemented by immunohistochemical methods were performed. The location and size of the mass, the number of samplings, the needle size, the histologic results, and any complications were recorded. Twenty-two lesions reached the anterior, six reached the lateral, and 14 reached the posterior chest wall. Biopsies were performed on three masses from the supraclavicular region. The mean diameter was 4.5 cm and the number of passes was 1.8; 18-G, 16-G, and 14-G needles were used in 41, two, and two cases, respectively. In 43 of the 45 cases (95.68%), an exact histologic diagnosis could be provided. In two cases, only necrotic tissue was seen in the biopsy sample. No major complications occurred. Minor complications, including pain and collaptiform weakness, were documented in four patients. Ultrasound-guided core needle biopsy of thoracic lesions is a safe, quick, and accurate method. For diagnosing thoracic lesions, a single sample with an 18-G biopsy needle is sufficient to achieve a final diagnosis when using appropriate histologic methods. collapse abstract

Uterine artery embolization for the conservative management of leiomyoma

Uterine leiomyoma, a benign, monoclonal tumor derived from a single myometrial cell, is one of the most frequent diseases in the female reproductive system. However, the factors involved in its initiation and growth remain poorly understood. Most com... expand abstractmonly, it results in dysmenorrhea, menorrhagia, urinary tract and neurological symptoms, and abdominal distension. Additionally, it may cause infertility, late miscarriage or other severe complications in pregnancy. The conventional treatment for fibroids has been hysterectomy. However, many women do not like to lose their uterus and potential fertility. Myomectomy and medical treatment with GnRH analogue are accepted as alternative organ-conserving methods with limited efficacy. Selective embolization of uterine arteries might therefore have a significant role in the management of the disease. The purpose of this study was to determine the effectiveness of uterine embolization as primary therapy in the management of myomas. Uterine arterial embolization was performed in 3 patients with symptomatic leiomyomas. The uterus and fibroids were objectively evaluated with ultrasound and MRI. The efficacy and safety convinced the authors that this promising technique is at present the only reasonable alternative method in organ-conserving therapy. It is less invasive than surgery, it can restore fertility, it is well tolerated and the recovery time is shorter than that following surgical procedures. This preliminary experience is sufficient to encourage gynecologists to introduce the method in Hungary. collapse abstract

Treatment of renal artery stenoses with stent implantation

The authors report on their experience with the treatment of renovascular hypertension by stent implantation. In the past 4 years different types of stents (Palmaz [9], Palmaz-Corinthian [4], Memotherm [1] and AVE [1]) were implanted into 15 renal ar... expand abstractteries of 11 patients. The indication was primary in 8 cases, and secondary in 3 patients, because of restenosis of a previously dilated renal artery. 14 stents were implanted into narrowed renal arteries, and in the remaining one case a stent was placed in an occluded renal artery immediately after recanalization. The technical success was 100%. In all but the recanalized case in which the renal artery was occluded, stents are still open. On the basis of this experience and the literature, the authors suggest the more extensive usage of this less invasive method. collapse abstract

Ureter diverticulum of transplanted kidney. Case report.

OBJECTIVES: Authors present a case of successful surgical treatment of a ureter diverticulum observed 3 months after kidney transplantation. METHODS: The fluid collection was detected by ultrasound. Percutaneous drainage was performed, after that the... expand abstract excretion of 4 litres of fluid was observed during 12 hours. This finding clearly indicated the connection with the urinary system. This fact was proved and precisely localised by contrast filling of the lesion under fluoroscopic control. RESULTS: Resection of the ureter diverticulum was performed, and the patient recovered fully, there was no change observed in the graft function during the whole procedure. CONCLUSION: The ureter diverticulum is a rare complication after kidney transplantation: the present case is the only one observed among more then 600 kidney transplantations performed during 20 years in our centre. collapse abstract

Shear rate estimation using a clinical ultrasound scanner.

Wall shear stress is a factor in the development of atherogenesis, thrombus formation, and embolization, but its existence is very difficult to determine with ultrasonography. Instead, we estimated shear rates using a clinical ultrasound scanner and ... expand abstractcompared results from vessels with and without stenoses. Velocity profiles were obtained from color M-mode images on a P700 scanner. Maximum shear rates were calculated off-line as the maximum velocity gradients. In vitro, studies were performed on a flow phantom with a vessel containing a 50% stenosis. Shear rates within the stenosis were significantly higher than those obtained outside the stenosis (P < 0.00001) and varied more than the peak velocities. In vivo, the internal carotid artery of 10 volunteers and 13 patients (with stenoses) was studied. The mean shear rate was 414 s(-1) +/- 154.5 s(-1) in normal vessels and 687 s(-1) +/- 263.5 s(-1) in stenotic vessels (P = 0.00017). In conclusion, shear rate estimates can be obtained with a clinical ultrasound scanner from color M-mode images. Shear rates estimated in vessels with stenoses are significantly higher than those obtained in normal vessels in vitro as well as in vivo. collapse abstract

Renal allograft rupture: a clinicopathologic study of 37 nephrectomy cases in a series of 628 consecutive renal transplants.

Transbronchial catheterization: a method for outpatient angiographic examination

The authors report on their own experiences with a not unknown, but not widely used catheter technique. On the basis of 607 transbrachial angiographies, they have established the possibilities and occasional dangers of this method. They conclude that... expand abstract the transbrachial technique is suitable not only for aortography, but also for selective angiography and vascular interventions. In cases involving cooperative patients, this method can furnish a basis for the angiography of outpatients. collapse abstract

Value of CT-guided biopsy compared to fluoroscopy-guided transthoracic biopsy and bronchoscopic sampling in the diagnosis of pulmonary nodules

CT-guided histological sampling is nowadays used routinely in the differential diagnosis of focal lung diseases with no characteristic morphology. The aim of this study was to determine the value of the method. CT-guided core biopsy was performed in ... expand abstract25 patients with pulmonary nodules. 16 patients underwent bronchoscopy where cytological sampling was also carried out, while 5 patients underwent fluoroscopically guided biopsy. The histological diagnosis resulting from CT-guided biopsy specimens was compared with the findings from the other diagnostic procedures (bronchoscopy or fluoroscopically guided biopsy), with the results of surgery and/or chemotherapy and with the follow-up data. The result of CT-guided biopsy was true in 20/25 and falls in 5/25 cases. Of the 16/25 patients undergoing bronchoscopy, 13/16 gave negative results. In 11/16 cases, the result of the CT-guided biopsy was positive. The fluoroscopically guided biopsy was negative in 4/5 cases, and in 3/5 of these cases the diagnostic CT-guided biopsies proved positive. Our results demonstrate the better diagnostic value of CT-guided core biopsy relative to fluoroscopically guided biopsy or bronchoscopic sampling in those cases where the size and localization of the nodule make it inaccessible with the latter two methods. collapse abstract

The role of ultrasonography and biopsy following kidney transplantation

Several complications can occur during both the early and late postoperative periods after kidney transplantation. The methods used to follow up 575 kidney transplanted patients, (transplantations performed between October 1979 and November 1997) in ... expand abstractthe early (within 6 weeks) and late postoperative periods have been assessed. The diagnostic value of core biopsies and ultrasound examinations, the prevalence of complications, and the applicability of the diagnostic tools in the evaluation of the graft status and viability were analyzed. In the early postoperative period, graft rupture occurred more frequently after biopsy than in the late period (7.4% vs 0.82%), this leading graft loss in 18 of 20 cases. The sonographically diagnosed morphologic and functional changes were also analyzed. Sonography proved a very accurate method for the detection of perirenal fluid collections and masses and severe vascular complications. The data demonstrated that biopsy is indicated in the early postoperative period when the result of sonography is doubtful. In the late postoperative period, biopsy should be performed in every case. collapse abstract

Rupture of the transplanted kidney: a clinicopathologic study of 37 nephrectomy cases.

The diagnosis and treatment of intratesticular varicocele.

A case of varicocele is reported. The dilated veins were situated in the left testis. The diagnosis required color Doppler sonography. Successful treatment was performed by transcatheter embolization of the left spermatic vein. The control sonogram r... expand abstractevealed complete regression. A literature search yielded only three previous cases of intratesticular varicocele. No data were found on the treatment of this entity. collapse abstract

Drugs acting on calcium channels modulate the diuretic and micturition effects of dexmedetomidine in rats.

The purpose of this study was to assess the effects of calcium channel antagonist, verapamil, and agonist, Bay K 8644, on the alpha 2-adrenoceptor agonist, dexmedetomidine-induced (300 micrograms kg-1 subcutaneously) diuresis and overflow incontinenc... expand abstracte, in rats. Ultrasonography study revealed that verapamil (2.5 mg kg-1 subcutaneously) or Bay K 8644 (0.5 mg kg-1 intraperitoneally) coadministrations delayed dexmedetomidine-induced bladder filling and significantly prolonged the latency of urination (P < 0.05). Bay K 8644 decreased relative bladder volume and stopped continuous urination from dexmedetomidine, whereas verapamil had neither effect. However, none of the drugs eliminated the overflow incontinence. Dexmedetomidine alone increased the hourly and total (for 4 hours) urine volume. Bay K 8644 (0.5 or 1 mg kg-1) dose-dependently decreased the diuretic effect of dexmedetomidine (P < 0.01). Verapamil (0.5, 1 or 2.5 mg kg-1) dose-dependently decreased urine volume in the first hour (P < 0.01), and thereafter potentiated the diuretic effect of dexmedetomidine. Simultaneous determinations of mean arterial blood pressure (MAP) and urine output after dexmedetomidine and the highest dose of verapamil coadministration demonstrated a significant correlation between these variables (r = 0.537; P < 0.001). MAP of 100 mmHg or less was associated with a urine output significantly lower (P < 0.001) than that at higher pressures. Thus, hypotension during the first hour after dexmedetomidine-verapamil may explain the transient reduction in urination during this period. We conclude that modulation of calcium channel affects dexmedetomidine actions on both urine formation and micturition. Since both alpha 2-adrenoceptor agonists and calcium channel blockers have frequently been used for antihypertensive therapy and as adjuvant drugs during anesthesia, these interactions may have some practical importance. collapse abstract

An ultrasonographic method for the evaluation of dexmedetomidine on micturition in intact rats.

We describe a simple, noninvasive, nontraumatic, and reproducible ultrasonographic method to determine the effect of the alpha 2-adrenoceptor agonist dexmedetomidine in anesthetic dose (300 micrograms/kg subcutaneously) on the micturition reflex in i... expand abstractntact rats. The bladder volumes were estimated by an ellipsoid equation. To validate the reliability of the method, an in vitro model assessment also was performed. The mean difference between estimated and instilled volumes were 27.3 microL (-21.61, 76.23). The highly significant correlation (r = 0.98, p < .001) indicates that the ultrasonography with the equation is a reliable tool. After the dexmedetomidine administration to intact rats, urine dribbling occurred at 30 +/- 4.8 min. The volume threshold for urination was 2100 +/- 100 microL. Although dribbling of the urine was observed almost continuously, significant differences were not observed between bladder volumes obtained at any time (from 10 to 100 min). This study indicates that the alpha 2-adrenoceptor agonist dexmedetomidine inhibits the micturition reflex in intact rats. The method described, which is both noninvasive and nonpainful, may therefore be widely used to quantify in small animals pharmacological effects on the urinary bladder. collapse abstract

Comparative analysis of ultrasonic studies, histopathological data and clinical parameters in dysfunctioning renal transplantation

The correlation of B mode and Doppler sonographic parameters and diagnoses established by histological examination of graft biopsies, nephrectomies and clinical data are discussed. 48 histological samples from 36 patients were reevaluated. The maximu... expand abstractm interval between sonography and histology was 36 hours. The Banff classification criteria were used during histological examinations. Doppler examination evaluation was based on the resistance index (RI). Reproducibility was controlled by means of intra- and interobserver variability in 10 patients. RI values higher than 75% were regarded as abnormal. On the basis of these observations and the literature data specific sonographic features can be detected in renal artery occlusion and renal vein thrombosis. In pyelonephritis, dilatation of the collecting system was frequent. No morphological changes were detected in cyclosporin-A nephrotoxicity and the Doppler signs were not characteristic for this disease. No differentiation was found between acute rejection and acute tubular necrosis. The noninvasive duplex sonographic examinations can provide very important information regarding the flow situation of a transplanted kidney. In some cases a definitive diagnosis can be achieved, but in other cases biopsy is the method of choice. collapse abstract

Anatomical bases of ultrasonic examination of the shoulder joint

Authors present the parts of the shoulder that can be represented by ultrasound. Beside the rotator cuff of accentuated significance (within this, first of all the tendon of the supraspinatus muscle) the subacromial bursa, the tendon of the long head... expand abstract of the biceps, the muscle-tendon junction of the infraspinatus muscle are analysed. It is stated that the ultrasonography is suitable for a reliable representation of the soft tissues, surrounding the shoulder joint, further in possession of literary data they see possibility for a very exact judgement of the pathological alterations, too. collapse abstract

The value of acetazolamide provocation combined with blood flow tests in the diagnosis of ischemic cerebrovascular diseases

In 28 (3 normal, 11 TIA, 14 completed stroke) patients 99mTc-HMPAO rCBF SPECT studies were performed at rest and after acetazolamide administration. For the investigations, a one-day protocol (the stress study directly followed the rest investigation... expand abstract) was used. The reconstructed and normalized slices were evaluated visually and semiquantitatively with a side difference analysis method. In the group of TIA patients, the abnormal results of the rCBF investigations increased from 55% to 82% after acetazolamide provocation. The corresponding results in the completed stroke group were 80% and 87%. After acetazolamide stimulation, hypoperfusion appeared or become more pronounced in the majority of the TIA group patients in contrast with the completed stroke patients with an unchanged or decreased perfusion abnormality. The semiquantitative evaluation method was mostly effective in the TIA group, where predominantly a one-sided cerebrovascular disorder was suspected. It was concluded that the 99mTc-HMPAO studies allow demonstration of the acetazolamide-induced cerebral perfusion alterations, and this method can be useful in the diagnosis and management of cerebrovascular disorders. collapse abstract