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T Grist

Publications and source records attributed to T Grist.

5 recordsLinked to original sources
PubMed1999

Peripheral vascular disease and renal transplant artery stenosis: a reappraisal of transplant renovascular disease.

BACKGROUND: Renal transplant artery stenosis (RTAS) continues to be a problematic, but potentially correctable, cause of post-transplant hypertension and graft dysfunction. Older transplant recipients, prone to peripheral vascular disease (PVD), may have pseudoRTAS with PVD involving their iliac system. METHODS: We retrospectively analyzed 819 patients who underwent kidney transplantation between 1993 and 1997 to determine the contribution of pseudoRTAS to renal transplant renovascular disease. Univariate analyses were performed for donor and recipient variables, including age, weight, gender, race, renal disease, cholesterol and creatinine values, human leukocyte antigen (HLA) matching, cytomegalovirus (CMV) infection, and immunosuppressive medications. Significant variables were then analyzed by a Cox proportional hazards model. RESULTS: Ninety-two patients (11.2%) underwent renal transplant arteriogram (Agram) or magnetic resonance angiography (MRA) for suspected RTAS. RTAS or pseudoRTAS, defined as one or more hemodynamically significant lesions in the transplant artery or iliac system, was evident in 44 patients (5.4%). Variables significantly associated with RTAS by univariate analysis were weight at the time of transplant (p = 0.0258), male gender (p = 0.034), discharge serum creatinine > 2 mg/dL (p = 0.0041), and donor age (p = 0.0062). Variables significantly associated with pseudoRTAS by univariate analysis were weight at the time of transplant (p = 0.0285), recipient age (p = 0.0049), insulin-dependent diabetes mellitus (IDDM; p = 0.0042), panel reactive antibody (PRA) at transplant (p = 0.018), and body mass index (p = 0.04). Weight at transplant and donor age remained significantly associated with an increased risk for RTAS in a multivariate stepwise Cox proportional hazards model. IDDM, transplant PRA, weight at transplant, and donor age were significantly associated with an increased risk for pseudoRTAS in a multivariate stepwise Cox proportional hazards model. Importantly, both RTAS and pseudoRTAS were associated with poorer graft survival (p < 0.007 for each). CONCLUSIONS: Renal transplant renovascular disease encompasses pre-existing PVD acting as pseudoRTAS, as well as classical RTAS. Efforts to identify and correct renal transplant renovascular disease of either nature are important, given its negative impact on graft survival.

Adult↗
PubMed1997

Diabetic muscular infarction. Preventing morbidity by avoiding excisional biopsy.

Focal infarction of skeletal muscle is a complication of diabetes mellitus. In the appropriate clinical setting and with characteristic magnetic resonance imaging (MRI) findings, prompt diagnosis can prevent unnecessary morbidity by avoiding excisional biopsy. We report a case of diabetic muscular infarction presenting as a painful thigh mass and review diagnostic and management principles.

Adult↗
PubMed1996

Extracranial intravascular vasodilatory response to acetazolamide and magnetic resonance angiography.

Cerebral vasodilatory testing provides an important measure of both the hemodynamic significance of arterial occlusive disease and the adequacy of collateral pathways. This study measured the extracranial intravascular volume flow rate response to acetazolamide using phase-contrast magnetic resonance angiography. From 10 patients with unilateral carotid transient ischemic attacks (TIAs), a total of 18 extracranial carotid arteries (10 symptomatic, 8 asymptomatic, 2 occluded) and 19 extracranial vertebral arteries were studied. Patients were free of large-vessel intracranial stenoses, evident areas of ischemic infarction, evident areas of nonspecific white matter change, and hemodynamic or low-flow induction of TIA symptomatology. Asymptomatic carotid volume flow rates rose from 151 +/- 19 (standard error of mean) to 220 +/- 26 ml/min while symptomatic flow rates rose from 106 +/- 22 to 145 +/- 25 ml/min. Dominant vertebral volume flow rates rose from 128 +/- 23 to 160 +/- 22 ml/min while nondominant rates rose from 40 +/- 12 to 61 +/- 15 ml/min. Carotid volume flow rates were inversely proportional to percent stenosis for both baseline (r = 0.51, p < 0.02) and acetazolamide (r = 0.81, p < 0.001) data. Baseline-plus-acetazolamide volume flow rate techniques safely measure intravascular vasodilatory responses. Intracranial measurement techniques are being developed to further study cerebrovascular reserve using phase-contrast magnetic resonance angiography.

Acetazolamide↗