Artery stenosis in the transplanted kidney is the most frequent vascular complication; hypertension onset or worsening may be associated and, at an end stage, also renal insufficiency. The diagnosis must be early and accurate and provide guidelines for medical, interventional or surgical therapy. To assess the diagnostic reliability or MRA, 27 patients were examined. On the basis of clinical, biochemical, pharmacological (Captopril test) and instrumental (color-Doppler US) examinations, the artery of the transplanted kidney was considered normal in 6 patients and stenotic in 21. In the control group, MRA results were in agreement with color-Doppler findings. On the contrary, in 8 of 21 abnormal conditions, the two techniques were in disagreement. Digital angiography, considered as the gold standard, was performed in any questionable case, confirming a slight overestimation of the stenoses by MRA (3 cases) and 2 false positives by color-Doppler US. The authors believe color-Doppler US to be a reliable technique for screening stenosed arteries in the transplanted kidney. MRA is proposed as a complementary investigation useful to define stenosis type and to provide guidelines for treatment.

Adult↗

PubMedDate not supplied

[Do clinical or physiopathological parameters exist for rationalizing the demand for thoracic radiograms in patients admitted to an intensive care unit].

To rationalize the demand of chest radiography in Intensive Care Unit patients, 423 radiographs of 35 patients were studied prospectively. The radiologic findings were compared with clinical data, blood gas analysis and laboratory data. No significant correlation was demonstrated between pulmonary radiographic changes and patient clinical conditions classified as unchanged, improving and worsening. In contrast, a good correlation (R = 0.65; p < 0.001) was observed between the chest radiographic score of pulmonary changes and the PaO2/FiO2 ratio. Changes in this parameter may be a good reason to perform bedside chest radiographs, whereas this exam appears rather useless when PaO2/FiO2 ratio is unchanged.

Adolescent↗

PubMedDate not supplied

[Malignant mesothelioma of the pleura: correlations between thoracoscopy and radiology].

The frequency of malignant pleural mesothelioma has increased greatly in the past three decades; it is a tumor of great clinical, epidemiologic and therapeutical interest. Therapy should not be started before the tumor has been correctly diagnosed and staged with thoracoscopy and computed tomography (CT) which have replaced plain chest radiography. To help optimize the combination of these techniques, the authors report on their experience in 37 patients examined with conventional radiology and then with thoracoscopy. In 26 patients with CT findings of malignant pleural mesothelioma, the authors compared thoracoscopy and CT findings in the assessment of neoplastic spread to the parietal (stage IA) and/or visceral (stage IB) pleura. CT appears to be the technique of choice after plain chest radiography: if the suspected malignant pleural mesothelioma is classified as stage II, III or IV, thoracoscopy should be used only for histologic confirmation. Conversely, in stages IA and IB, thoracoscopy--besides histology--should be used to confirm malignant spread to the visceral pleura.

Adult↗

PubMedDate not supplied

[Magnetic resonance angiography with TOF-TONE tridimensional sequences in the study of steno-occlusive diseases of the renal arteries. Comparison with digital angiography].

The authors examined 32 patients (68 renal arteries in all) with suspected renovascular hypertension with MRA (3D TOF-TONE sequences) and DSA. MRA visualization of the renal vessels was considered good in 96.8%, 91.6%, 76.6% and 16.6% of cases for the ostium, the proximal third, the distal third and the hilum, respectively. MRA correctly assessed the 4 occlusions in our series and 19/20 atherosclerotic stenoses, all in proximal site. In proximal stenosis detection, MRA had 100% sensitivity and 98% specificity in atherosclerotic sclerosis-occlusion grading considering a 50% caliber reduction as the cut-off value. The two techniques were in agreement in 68% of cases; MRA overestimated stenosis grade in 25% of cases. The 3D TOF-TONE sequence is a reliable diagnostic tool in the study of the proximal tract of the renal arteries, but its major limitation remains in distal tract studies. Nevertheless, this technique has elective indications in a selected group of patients, namely the elderly with hypertension and impaired renal function.

Adolescent↗