Doppler sonography is an effective primary imaging method for long-term follow-up of patients with TIPS.
Serum concentrations and urinary excretion of ciprofloxacin were studied in female and male volunteers following a single oral administration of 100 mg, 250 mg, 500 mg or 1000 mg. Serum and urine concentrations increased proportionally to the increasing dose administered but independently of sex. Twenty-five percent of the administered dose was excreted in the urine as unmetabolized ciprofloxacin within the first 24 hours after oral administration. Renal clearance averaged 5 ml/min X kg.
IntroductionRenovascular hypertension (RVH) is one of the most common causes of secondary arterial hypertension. Renal artery stenosis (RAS) is caused by atherosclerosis in 90 % of the RVH patients and fibromuscular dysplasia is found in the great majority of the remaining cases (10). As the renal revascularization might improve renal function and blood pressure control, the screening for the presence of significant renal artery stenosis (RAS) is recommended in selected patients with arterial hypertension. The main clinical clues suggesting RVH include: early or late onset of hypertension, difficult blood pressure control, coexisting atherosclerotic vascular disease and concomitant renal failure of uncertain aetiology (especially when associated with normal urinary sediment and/or precipitated by angiotensin converting enzyme inhibitors or angiotensin receptor blockers).Non-invasive tests are currently recommended for screening of patients with suspected RVH. However, even the use of the modern and sophisticated imaging techniques such as magnetic resonance imaging or computed tomography did not yield unequivocal results in the accurate assessment of renal arteries. While several smaller studies suggest high accuracy of MRA in the detection of RAS (8, 13), largest performed multicentre trial did not confirm these findings (14). Therefore, the intraarterial digital subtraction angiography (DSA) still remains the golden standard for the detection of RAS (9).In order to determine the clinical value of non-invasive approach in the screening for the significant renal artery stenosis in our centre, we decided to compare duplex ultrasonography (DUS) and magnetic resonance angiography (MRA) in patients with clinically high suspicion of RVH. While DUS was chosen because of low cost and wide availability, MRA did not expose the patients to the ionising radiation and offered decreased nephrotoxicity as well as risk of allergic reaction in comparison to computed tomography angiography or DSA. MethodsThe study included the patients with highly suspected RVH (1, 4) who required imaging of renal arteries. The imaging of renal arterial supply was performed by DUS, MRA and DSA in regard to the detection of significant renal artery stenosis and identification of abnormal anatomy of renal arteries. All the exams were done on daily clinical Summary: Objective: The aim of our study was to evaluate duplex ultrasonography (DUS) and magnetic resonance angiography (MRA) in detection of haemodynamically significant renal artery stenosis (RAS). Methods: The study included patients with high clinical suspicion of renovascular hypertension (RVH). The imaging of renal arteries was performed by DUS, MRA and digital subtraction angiography (DSA). Significant RAS was defined as maximum systolic velocity ≥ 180 cm/sec (DUS) or as 60% reduction of the endoluminal arterial diameter (MRA, DSA). The results of DUS and MRA were assessed in respect to the results of DSA. Results: Arterial supply of 186 kidneys in 94 patients was evaluated. DSA revealed...
A series of 314 posterior fossa duraplasties in children were performed at the Department of Neurosurgery, Hradec Králové, over the past 33 years. Computed tomographic (CT) imaging was used to compare the healing of various kinds of collagenic dural substitutes--allogeneic fascia lata, allogeneic dura mater and xenogeneic pericardium. Early (8 days to 3 months following surgery) and late (1-18 years following surgery) axial CT scans with sagittal reconstruction for duraplasty in 55 children were evaluated. In early postoperative CT scans, epidural collections of cerebrospinal fluid, sanguinolent liquid or haematoma and/or pseudocysts or pseudomeningoceles appeared. In late CT follow-up, calcifications and ossifications in the "suboccipital coverings complex" (SCC) gradually developed and pseudocysts or pseudomeningoceles rarely persisted. It is concluded, on the basis of perioperative, clinical, and CT examinations, that posterior fossa duraplasties in children formed an important anatomical barrier and regardless of the type of graft had a favourable outcome; CT was shown to be a suitable method for the demonstration of dural grafts at the site of craniectomies.
ZusammenfassungBei 31 Warmblutpferden mit Herzklappeninsuffizienzen wurden die klinischen und echokardiographischen Befunde der kardiologischen Erst-und Nachuntersuchung im Untersuchungsintervall von zwei bis acht Jahren verglichen. Die Pferde wurden als Turnier-(n = 14), Freizeitpferde (n = 16) und als Zuchtpferd (n = 1) genutzt. Insgesamt wurden bei der Erstuntersuchung 13 Pferde mit Leistungsabfall vorgestellt. Bei den meisten Patienten (n = 25) lag primär eine Mitralklappeninsuffizienz vor. Dabei handelte es sich bei 9 Pferden um eine isolierte Mitralklappeninsuffizienz. Bei 11 Pferden war sie mit einer Trikuspidalklappeninsuffizienz und bei 5 Pferden mit einer Aortenklappeninsuffizienz vergesellschaftet. Vier Pferde zeigten eine isolierte Trikuspidalklappeninsuffizienz. Bei 2 Pferden war diese mit einer Aortenklappeninsuffizienz kombiniert. Das durchschnittliche Alter der Pferde betrug bei der Nachuntersuchung 12 Jahre. Klinisch traten bei 39 % der Pferde (n = 12) bei der Nachuntersuchung geringgradige Verstärkungen der Herzgeräusche auf; das Allgemeinbefinden blieb ungestört. Bis auf drei hochgradig und einen mittelgradig herzkranken Patienten zeigten die meisten Pferde bei der kardiologischen Nachuntersuchung eine uneingeschränkte Leistungsfähigkeit. Die Dimensionen des rechten und linken Vorhofes und des linken Ventrikels vergrößerten sich im Untersuchungszeitraum durchschnittlich signifikant. Dabei fiel auf, dass vorrangig Pferde mit Mitralklappeninsuffizienz signifikante Vergrö-ßerungen des linken Vorhofes entwickelten. Tendentiell wurde in einem Untersuchungszeitraum von 2-8 Jahren, sowohl mit der gepulsten (PW-) und der kontinuierlichen (CW-) als auch mit der farbkodierten Dopplertechnik eine progrediente Veränderung der kardialen Hämo-dynamik bei den untersuchten Pferden festgestellt. Die Werte von Rückflussvolumina und Vena contracta, sowie die Flussprofile und die maximale Geschwindigkeit der Regurgitationsjets an der Mitralklappe vergrößerten sich im Zeitraum zwischen der Erst-und der Nachuntersuchung durchschnittlich signifikant. Eine Abhängigkeit der Progredienz von Herzklappeninsuffizienzen vom Alter und von der Nutzung der Pferde, vom Schweregrad der Herzerkrankung bei der Erstuntersuchung und vom Zeitraum zwischen der Erst-und der Nachuntersuchung wurde nicht nachgewiesen. Die vorliegende Studie zeigt, dass die Herzklappeninsuffizienzen (insbesondere Mitralklappeninsuffizienzen) bei den 31 untersuchten Pferden im Untersuchungszeitraum von zwei bis acht Jahren klinisch weitgehend kompensiert blieben, obwohl signifikante Verschlechterungen echokardiographischer Parameter auftraten.Schlüsselwörter: Warmblutpferd, Verlaufsuntersuchung, Echokardiographie, Herzklappeninsuffizienzm, Kardiologie Clinical and echocardiographic follow-up study in warm-blood horses with heart valve insufficiencyThe present study compares the clinical and echocardiographic findings of two cardiological examinations in 31 warm-blooded horses performed in a time interval varying from two to eight years. The horses were us...
Development of collateral circulation belongs among the typical signs of aortic coarctation. Cerebral or spinal artery aneurysm formation with increased risk of subarachnoid hemorrhage represent the most common neurovascular complication of this disease. We report a case of a 20-year-old sportsman who developed acute non-traumatic paraplegia as a result of extensive spinal epidural hemorrhage from collateral vessels accompanying aortic coarctation which was unrecognized up to that time. To the best of our knowledge, acute spinal epidural hematoma as a complication of aortic coarctation has not been previously reported.
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