Objectives Computerized tomography (CT) is the most accurate method for evaluating pelvic calcifications, which are of utmost importance for planning kidney transplantation (KT). The aim of our study was to evaluate the incidence and distribution of iliac artery calcifications and correlate the novel pelvic calcification score (PCS) with cardiovascular risk factors and graft and overall survival in KT patients. Methods We retrospectively included 118 KT patients operated at our institution with pretransplant pelvic CT. Calcification morphology, circumference and length of both common and external iliac arteries were independently scored by two uroradiologists. PCS was calculated as the total score sum of all three calcification features in all vessels. PCS correlation with graft and patient survival was performed. Results Calcification in at least one vascular segment was found in 79% of patients. PCS was significantly higher in male patients (p = 0.006), patients over 55 years (p < 0.001), and patients on haemodialysis (p = 0.016). Patients with a PCS >3 had significantly shorter graft and overall survival rates (p = 0.041 and p = 0.039, respectively). Conclusions The extent of iliac artery calcification in KT recipients quantified by PCS on pretransplant CT correlates with graft and overall patient survival. A PCS over three was associated with worse clinical outcomes and could become a possible prognostic factor. Advances in knowledge Our novel PCS is a robust method for quantifying iliac artery calcification burden. Since higher a PCS correlates with worse patient and graft survival, PCS has the potential to become a prognostic factor in kidney transplant patients.
Aim: To report the clinical courses of two patients, one with Hodgkin’s lymphoma (HL) and one with Non-Hodgkin’s lymphoma (NHL), who developed severe refractory acute respiratory distress syndrome (ARDS) and were treated with veno-venous extracorporeal membrane oxygenation (VV ECMO). Case report: Both patients developed chemotherapy-associated febrile neutropenia followed by pneumonia and ARDS, after which they were transferred to the intensive care unit. Their respiratory failure deteriorated despite endotracheal intubation with protective mechanical ventilation, at which point a decision for VV ECMO initiation was made. Both patients had complicated treatment courses and developed severe ECMO-associated complications. The most important complications of ECMO support in our HL patient were cardiac arrest; right atrial laceration with pericardial tamponade which needed surgical treatment; right leg ischemia which required transfemoral amputation; thrombosis within the membrane oxygenator; several septic episodes with severe hemodynamic instability; and right sided tension pneumothorax. Despite all difficulties, the patient was successfully weaned from ECMO. Unfortunately, he died prior to hospital discharge as a result of sepsis with multiple organ failure. The most significant ECMO-induced complications in our NHL patient were severe bleeding incidents, most notably diffuse oropharyngeal and continuous bilateral pulmonary hemorrhage; superimposed bacterial pneumonia; extensive pneumomediastinum and subcutaneous emphysema. Despite all therapeutic efforts, the patient died during ECMO treatment because of respiratory decompensation. Conclusions: The patients with hematologic malignancies (HMs) undergoing ECMO support have poor outcomes, with high rates of severe ECMO-induced complications. Further studies focusing on patient selection and issues concerning prevention, diagnosis and treatment of ECMO-associated complications are needed.
Cilj: Prikazati učestalost i raspodjelu kalcificiranosti ilijačnih arterija u pacijenata u kojih je učinjena transplantacija bubrega u našem transplantacijskom centru. Ispitanici i metode: Retrospektivnim istraživanjem bili su obuhvaćeni pacijenti u Kliničkom bolničkom centru Rijeka u kojih je između 1. siječnja 2015. godine i 31. prosinca 2018. godine učinjena transplantacija bubrega. Procjena kalcificiranosti ilijačnih arterija učinjena je uz pomoć kompjutorizirane tomografije (CT). Rezultati: U promatranom razdoblju u našem transplantacijskom centru učinjeno je 115 transplantacija bubrega, a 92 (80 %) pacijenata imalo je prijeoperacijski CT. Prosječna dob pacijenata bila je 60,3 godina, a 26 % pacijenata je imalo šećernu bolest kao osnovnu bolest. Arterijske kalcifikacije pronađene su u 72 (78 %) pacijenata. Kalcifikacije su najčešće pronađene na desnoj zajedničkoj ilijačnoj arteriji (63 pacijenata – 68,5 %), a najrjeđe na lijevoj vanjskoj ilijačnoj arteriji (23 pacijenta – 25 %). Zaključak: Većina naših pacijenata ima prisutne kalcifikacije na ilijačnim arterijama. Prijeoperacijsko utvrđivanje njihove raspodjele i proširenosti ima važnu ulogu prilikom planiranja transplantacije bubrega.
Amiloidoza srca nastaje uslijed nakupljanja nepravilno savijenih ili polimeriziranih bjelančevina, najčešće transtiretina ili lakih lanaca imunoglobulina u intersticiju miokarda. Bolest se još uvijek teško otkriva jer se na nju kao mogući uzrok zatajivanja srca rijetko pomišlja. Dijagnoza se postavlja na temelju kliničke slike, anamnestičkih podataka, nalaza srčanih biomarkera, promjena u elektrokardiogramu, ehokardiografskom nalazu i/ili magnetskoj rezonanciji, koji zajedno mogu upućivati na dijagnozu. Donedavno je biopsija miokarda bila jedina pouzdana dijagnostička metoda za dokaz ove bolesti. Nuklearna medicina nudi mogućnost neinvazivnog postavljanja dijagnoze, no samo u pacijenata koji zadovoljavaju određene kliničke kriterije. Koriste se radiofarmaci obilježeni gama i pozitronskim emiterima namijenjeni prikazu skeleta ili direktnoj vizualizaciji amiloidnih plakova koji se nakupljaju u miokardu zahvaćenom amiloidozom. Dijagnostička vrijednost scintigrafije ovisi o korištenju te metode u ispravnom kliničkom kontekstu te o poznavanju i postupanju prema dijagnostičkom algoritmu. Posljednjih se godina transtiretinska amiloidoza sve više prepoznaje kao uzrok zatajivanja srca, a razvijaju se i nove terapijske mogućnosti. Stoga je interes za dijagnostiku, posebno nuklearno-medicinske metode povećan, a provode se i brojna istraživanja, naročito u području PET/CT dijagnostike.
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