The results indicate that lower Hb level prior to radiotherapy for glioblastoma can adversely influence prognosis. This finding deserves further evaluation.
Primary endovascular therapy for acute embolic SMA occlusion with on-demand laparotomy is a recommended algorithm used in our centre to treat SMA occlusion. This combined approach for the treatment of AMI is associated with in-hospital mortality rate of 27.0 %.
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...
Metastasis size, extent of tumour, technical complexity of surgery and the completeness of preoperative embolization had an important effect on the amount of peroperative blood loss. The evaluation of the benefits of preoperative embolization only on the basis of blood loss is not an adequate method.
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