The objective of this study was to compare qualitative cytomorphology and morphometric characteristics of parotid gland tumor cells, with the aid of a computer-assisted system of image analysis. Routine qualitative cytologic and quantitative morphometric results from 64 parotid gland tumors were compared. Ultrasound (US)-guided fine-needle aspiration (FNA) specimens were taken from 54 patients. Eleven conventionally used morphometric parameters were studied: area, perimeter, convex area, convexity, maximal and minimal radius, length, breadth, form factor (FF), elongation factor, and nuclear- cytoplasmatic (N/C) ratio. Two newly introduced nuclear form factors were also measured: area symmetry factor and perimeter symmetry factor. The following nuclear morphometric parameters were significantly different between malignant and benign tumors: area, perimeter, convex area, convexity, maximal and minimal radius, length, breadth, FF, elongation factor, area symmetry factor, and perimeter symmetry factor. Comparing the cutoff values and receiver operating characteristic (ROC) curves the following nuclear morphometric parameters were found most useful in separating benign from malignant tumors: area, perimeter, convex area, maximal radius, length, and FF. The following whole cell morphometric parameters were significantly different between malignant and benign tumors: minimal and maximal radius, convexity, breadth, FF, and elongation factor. N/C ratio was significantly higher in malignant tumors. The quantitative morphometric analysis is a useful tool in the cytological differentiation between benign and malignant parotid gland tumors. Computerized image analysis may add to morphological evaluation by turning qualitative data into quantitative values.
PurposePulmonary arteriovenous malformations (PAVM) are the direct communications between the pulmonary arteries and veins. These malformations can cause serious complications, and most of these patients should be treated. Herein we present our experience in the treatment of 18 cases of PAVM, treated with endovascular embolisation.Material and methodsEighteen patients with PAVMs underwent endovascular embolisation during a five-year period. Eight were male and 10 were female, with ages ranging from 16 to 65 years. Standard steel coils and vascular plug were used for embolisation.ResultsEmbolisation was successful in 17 of 18 patients. Coiling was used in 10 patients, vascular plug in five, and both materials in two patients. All symptomatic patients with successful embolisation lost all their symptoms after treatment. Control angiography after embolisation showed a closure of AV shunt without migration of embolic material in all patients. Post-embolisation syndrome developed in four patients and late onset of pleural pain in three patients. There was no connection between pleural reaction and type of PAVM and embolic material.ConclusionsEndovascular PAVM treatment is a minimally invasive, highly successful method with a low rate of only transitory complications.
Denervacija bubrežnih arterija (DBA) minimalno je invazivan način liječenja refraktorne rezistentne hipertenzije (RH) kojom se smanjuje tonus simpatičkog živčanog sustava selektivnom ablacijom živčanih ogranaka u stijenci bubrežnih arterija. DBA je dodatna metoda liječenja RH na optimalno liječenje kombiniranom antihipertenzivnom terapijom koja uključuje 3 i više lijekova iz različitih antihipertenzivnih skupina uključujući diuretik. 1-3 Nakon isključenja sekundarnih uzroka, neadekvatnog mjerenja arterijskog tlaka (AT) i nesuradljivosti, pacijenti se uključuju u postupak pripreme za DBA. Svi pacijenti prije DBA imaju MSCT (MR) angiografiju bubrežnih arterija radi isključenja anatomskih zapreka. U sklopu premedikacije DBA provodi se antitrombotska terapija, heparinizacija, analgezija (10-20 mg morfija i.v.) i sedacija koju provodi hipertenziolog u sali, uz interventnog radiologa koji postavlja uvodnicu promjera 2 mm (6 Fr) u femoralnu arteriju. Kroz uvodnicu se uvodi kateter za kateterizaciju bubrežnih arterija (angiografija) te se kroz kateter ubrizgava nitroglicerin kako bi se spriječila mogućnost nastanka spazma arterije. Nakon toga uvodi se Symplicity ablacijski kateter s kružnom elektrodom na vrhu kojom se isporučuje radiofrekventna struja na točke ablacije (4-8), koja se izvodi od distalnog prema proksimalnom dijelu, povlačenjem katetera i rotiranjem vrha duž cirkumferencije bubrežnih arterija. Generator radiofrekventne struje mjeri impedanciju između vrha katetera i stijenke žile i isporučuje energiju 120 sekundi koliko traje pojedinačna DBA. Za statističku analizu korišten je program STATISTICA 10, 2011 softwer, uz razinu značajnosti P < 0,001. DBA je provedena u 9 pacijenata (prosječne dobi 63 ± 6 godina, 7 žena/2 muškarca), koji su praćeni na kontrolama 1, 3, 6 i 12 mjeseci. Početne vrijednosti AT bile su 195 ± 21 za sistolički/ 107 ± 26 mmHg za dijastolički. Prosječni broj antihipertenzivnih lijekova 6,7 ±1. Nakon DBA prati se značajno smanjenje AT (sistolički: 145 ± 13; 140 ± 17; 141 ± 15; 135 ± 12 / dijastolički: 84 ± 6; 82 ± 9; 79 ± 9; 72 ± 6 mmHg) uz P < 0,001. Najznačajniji pad AT bilježen je u bolesnika s apnejom u snu (30 % pacijenata, sniženje AT za više od 26,5/14,7 mmHg), te u bolesnika kojima je učinjena ablacija na više od 6 točaka na svakoj bubrežnoj arteriji (60 % pacijenata). Unutar 6 mjeseci prosječan broj antihipertenzivnih lijekova ostao je nepromijenjen (važno da se objektivizira učinak DBA). Broj antihipertenzivnih lijekova je smanjen nakon 6 i 12 mjeseci (4,5±1). Tijekom DBA bol je bila kupirana, nije zabilježeno neposrednjih niti kasnijih komplikacija DBA (MSCT/ MR bubrežnih arterija nakon 6-12 mjeseci), bubrežna funkcija je bila stabilna (procijenjen eGFR unutar G2 stadija prije i poslije DBA). Dokazana je dugoročna sigurnost i učinkovitost DBA na smanjenje AT u bolesnika s refraktornom RH čime se omogućuje bolja kontrola hipertenzije, a time i smanjenje rizika od kardiovaskularne smrtnosti. Ingrid Prkačin
Background: Percutaneous mechanical thrombectomy (PMT) is a well-established technique for treatment of acute arterial and venous thrombosis which inevitably leads to intravascular erythrocyte hemolysis, resulting in hemoglobinuria. Case presentation: We present a case of 66-year-old Caucasian female with subclavian artery aneurysm causing distal embolization and hand ischemia. The aneurysm was treated with stent graft, but with a subsequent graft thrombosis 3 months later. After graft recanalisation, AngioJet PMT was performed which resulted in dialysisrequiring acute kidney injury. Conslusion: Only several cases of acute kidney injury following AngioJet PMT have been published in literature. To our knowledge, this is the first reported case of dialysis-requiring AKI after PMT for peripheral arterial thrombosis. Until there is sufficient evidence and recommendation on preventing AKI in this setting, we believe that by being aware of the risk and by monitoring of patient, one might minimize the damage in case it occurs.
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