Microsporidia are currently considered emerging pathogens responsible for life-threatening infections in organ transplant recipients. Here, we describe the first cases of intestinal microsporidiosis by Enterocytozoon bieneusi genotype D in two non-HIV-infected renal transplant recipients from Spain. Previously reported cases of microsporidiosis in organ transplant recipients have also been reviewed, highlighting the necessity of considering organ transplant recipients a risk group for microsporidiosis. A systematic search for these parasites is recommended in cases of persistent diarrhea and in the differential diagnosis of other syndromes, such as chronic fever of unknown etiology.

Colour coded Duplex ultrasound is the diagnostic tool of choice in case of suspicion of a deep vein thrombosis of the leg. In the hand of an experienced examiner a thrombosis can be confirmed or excluded, but also differential diagnoses can be detected. In this article we show you how to perform a systematic ultrasound examination of the leg veins.

Summary:Background: Increased fl ow in the subclavian artery feeding a vascular access for hemodialysis can induce steal phenomena in the vertebral (VA) and internal mammary artery (IMA). The aim of this study was to describe the hemodynamic effects of access fl ow on the VA and IMA in patients with native fi stulas and grafts. Patients and methods: Peak systolic (PSV) and end diastolic (EDV) velocity measurements of the VA, IMA and carotid arteries, as well as fl ow volume measurements of the subclavian artery, were performed. Flow measurements at the side of the vascular access were compared with the contralateral side. Fifty-fi ve patients were consecutively included, most with a radio-cephalic fi stula on the left arm with a mean shunt volume of 1156 ml/min. Results: Pathologic fl ow patterns were observed in the ipsilateral VA in four patients (7.3 %); contralateral VA fl ow was normal in all patients. Peak systolic velocity of the VA was signifi cantly decreased at the side of the shunt arm with a PSV of 42.6 ± 11.8 cm/s compared to 48.4 ± 15.6 cm/s contralateral (p < 0.05). The IMA fl ow pattern were normal in all patients. The PSV of the IMA was signifi cantly decreased (p < 0.01) at the side of the shunt arm (87.5 ± 29.1 cm/s) compared to the non-shunt arm (95.9 ± 27.4 cm/s). Conclusion: We describe signifi cant hemodynamic effects of fi stulas to the vertebral and internal mammary arteries. Doppler spectral analysis of the vertebral and internal mammary arteries should be integrated in ultrasound, especially in patients with cerebrovascular or cardiac symptoms.

Background/Aim: Patients after kidney transplants are at risk of cardiovascular morbidity. An elevated resistance index (RI) is associated with renal graft failure, while a decreased RI can be due to a renal artery stenosis. The RI can also be measured in the carotid artery. Whether a correlation between intrarenal RI after kidney transplant in adult patients and the RI of the internal carotid artery exists is still unclear. Patients and Methods: In this prospective cross-sectional study, RI of kidney transplants and of the internal carotid artery were measured with duplex sonography. Carotid intima-media thickness as well as the Framingham risk score and the Augmentation index, all known markers of atherosclerosis, were assessed. Correlations between the RI in Carotid artery and the RI of the kidney transplant were based on Spearmen test with the level of significance set at p<0.05. Results: Ninety-eight consecutive patients [60% male, mean age of 48.7 (±15.6)] were included. The mean interval after transplantation was 27.5 (±8.5) months and mean serum creatinine was 308 (±220.3) mmol/ml The RI of the internal carotid artery and the renal transplant were significantly correlated (p<0.05). A correlation between the RIs and the Augmentation Index was found. Conclusion: The RI of the kidney transplant is correlated with the RI of the carotid artery and to markers of general atherosclerosis. This observation may be helpful to identify patients after kidney transplant with higher risk for cardiovascular events and gain indirect information on transplant renal artery stenosis.Kidney transplant is the most frequently performed organ transplant (1). Computed tomography (CT) and coronary Angio-CT are used for risk stratification in kidney transplant candidates for risk stratification before transplantation (2). It is the treatment of choice in end-stage renal disease (ESRD) and is ideally performed before initiation of hemodialysis (3). It is also more cost-effective than long-term dialysis (4). Color-coded Doppler sonography (CCDS) is part of the postoperative surveillance (5). The surveillance may start as early as during, but should be initiated immediately after transplant (6). Besides the diagnosis of arterial or venous obstruction, the intrarenal vascular resistance, called Resistance Index (RI) is measured (7). While the RI can be difficult to measure in orthotope kidneys it is often easier to assess in the more superficial transplant in the iliac fossa. Nonetheless, accessibility can be limited due to different factors such as pain, obesity, flatulence amongst others. The RI has been a proven to be sensitive marker of graft dysfunction, but is unspecific (8). The RI of the kidney transplant adapts rapidly to the host ( 9). An elevated RI of 0.80 (normal range=0.6-0.7) or higher indicates an unfavorable prognosis of renal function as well as increased mortality (10). A decreased RI can be a sign for a renal stenosis (11). RI measurement is observer dependent (12). There is a significant association between an incr...

Background Patients after kidney transplant are at risk of cardiovascular morbidity. Surveillance of kidney transplants is mandatory to ensure a maximal transplant lifespan. Renal function is measured by levels of creatinine (clearance) while morphological aspects and other parameters like the kidney-size and Resistance Index are assessed with Duplex sonography. An elevated Resistance Index is associated with renal graft failure. The Resistance Index can also be measured in the carotid artery. It is uncertain whether a correlation between intrarenal RI after kidney transplant and the RI of the internal carotid artery exists. Material and Methods Resistance index of kidney transplants and of the carotid artery were measured with duplex sonography in adult patients after kidney transplant. Carotid intima-media thickness as well as the Framingham risk score and the Augmentation index, all known markers of atherosclerosis, were assessed. Statistical analysis was performed with STATA. Continuous data were expressed as means +/- standard deviation and compared by Kruskal-Wallis Test. Correlations between the RI in Carotid artery and the RI of the kidney transplant were based on Spearmen test with the level of significance set at p < 0.05. Results 98 consecutive patients (60% male, mean age of 48.7 (+/-15.6)) were included. Mean interval after transplantation was 27.5 (+/- 8.5) months and the mean serum creatinine was 308 (+/- 220.3) mmol/L. The RI of the internal carotid artery and the renal transplant were significantly correlated (p < 0.05). A strong correlation between the RIs and the Augmentation Index (AIx) was found. Conclusion The RI of the kidney transplant is correlated with the RI of the carotid artery and to markers of general atherosclerosis. This observation may be helpful to identify patients after kidney transplant with higher risk for cardiovascular events.

Ein 82-jähriger Mann stellt sich wegen eines Strömungsgeräusches über der rechten Arteria carotis zur Abklärung vor. Zerebrovaskuläre Ereignisse werden verneint. Bei der duplexsonografischen Untersuchung ergeben sich drei Befunde. FR AGEN▪ Welche Befunde sind es? ▪ Erlauben diese Befunde eine Verdachtsdiagnose?Wenn ja, welche? ▪ Sind Differenzialdiagnosen möglich?Wenn ja, welche?▶ Abb. 1 Duplexsonografische Darstellung des Abgangs der Arteria carotis externa rechts A und der linken Arteria vertebralis in ihrem intervertebralen Abschnitt mit einer weiteren Arterie dorsal des Gefäßes (B, siehe auch ▶ Video 1 in der online-Version). Ableitung der Dopplerkurven der Arteria vertebralis C und des zweiten "Gefäßes" D.

Summary: Background: Radiotherapy for head and neck cancer (HNC) represents a well-known predisposing factor for asymptomatic carotid artery lesions and acute cerebrovascular accidents. Our aim is to provide contemporary estimates on the prevalence, severity, and characteristics of carotid artery lesions in HNC survivors. Patients and methods: We prospectively included HNC patients who underwent radiotherapy and were free from the disease at the time of duplex ultrasound evaluation. Patients were re-contacted telephonically and those who agreed to participate were invited for an ambulatory visit when the investigators collected clinical information and performed duplex ultrasound examination based on a predefined protocol. Results: A total of 156 patients were included and underwent duplex ultrasound examination after a mean of 65.2 months from the last session of radiotherapy. A total of 36 patients (23.1%) had normal carotid arteries; mild, non-stenotic lesions were observed in 49.4% (n = 77) of patients; severe stenotic plaques were found in 27.5% (n = 43) of patients. One patient found with an asymptomatic occlusion of the left ICA. The prevalence of major cardiovascular risk factors and high radiation dose increased proportionally with plaque severity. Low echogenicity plaque was found in 59 (37.8%) patients on the right side and 57 (36.5%) on the left side; long segment plaque in 49 (31.4%) patients on the right side and in 47 (30.1%) on the left side; an atypical location of the lesions in 42 (26.9%) patients on the right side and in 48 (30.8%) on the left side. Conclusions: The prevalence of occlusion and severe stenosis after radiotherapy for HNC was very low in our study population. Low echogenicity plaque, long segment plaque, and an atypical location were common findings. Classic cardiovascular risk factors appear to have had a causative role: a routine screening of radiotherapy-treated patients might be necessary only in patients with concomitant cardiovascular risk factors or exposed to high-dose neck radiation.

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