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Biomedical subjects

J H Sumkin

Publications and source records attributed to J H Sumkin.

23 records · Page 2Linked to original sources
PubMed1989

Liver transplant rejection: value of the resistive index in Doppler US of hepatic arteries.

The authors prospectively evaluated the accuracy of the resistive index (RI) in Doppler ultrasound (US) for the detection of the increased vascular resistance that theoretically occurs with acute liver transplant rejection. RIs were calculated for the proximal hepatic artery and a more distal hepatic artery branch in 67 liver transplant recipients. Biopsies were performed within 24 hours of transplantation, with no intervening therapy. Examination of biopsy specimens by a single pathologist revealed findings of no, minimal, or moderate to severe rejection. RIs in hepatic arteries showed no significant differences among the three pathologic groups. No correlation was found between the RI and improved or worsened rejection in 11 patients who underwent biopsy and US more than once. RIs in hepatic arteries are of no value in the prediction of liver transplant rejection.

Acute Disease↗
PubMed1989

Periportal low-attenuation areas on CT: value as evidence of liver transplant rejection.

CT scans of liver transplants may show periportal areas that are lower in attenuation than adjacent portal veins and liver. These areas appear as low-density rims that surround or parallel the portal vein and its intrahepatic branches as well as the immediate subhepatic portal area. In order to determine the value of periportal low attenuation as an indicator of rejection, we reviewed the CT scans of 37 liver transplant patients with biopsy evidence of either acute rejection (12 patients) or nonspecific change without rejection (25 patients). Low-attenuation areas around peripheral portal branches were identified in six of 12 patients with rejection and in four of 25 patients with nonspecific change (sensitivity, 50%; specificity, 84%; accuracy, 73%). The correlation between peripheral periportal low attenuation and rejection was statistically significant (p less than .05). Periportal low attenuation in a central location was seen in eight of 12 patients with acute rejection and in 14 of 25 patients with nonspecific change (sensitivity, 67%; specificity, 44%; accuracy, 51%). The correlation was not statistically significant. Low-attenuation areas were evident on scans obtained either with or without IV contrast enhancement. Periportal low-attenuation areas are commonly seen on CT scans of liver transplants. Peripheral areas correlate with acute rejection, but other factors probably contribute to their occurrence. Central areas do not correlate with acute rejection. Low sensitivity and relatively low accuracy limit the usefulness of peripheral periportal low attenuation as a sign of acute liver allograft rejection.

Adult↗
PubMed1988

Pseudoaneurysms complicating organ transplantation: roles of CT, duplex sonography, and angiography.

In a retrospective study of proved pseudoaneurysms (PAs) in 15 patients with transplanted organs (11 liver, three kidney, one pancreas), the results of computed tomography (CT), duplex sonography, and angiography were reviewed. Of the 15 cases of PA, eight occurred at the arterial anastomosis and seven were nonanastomotic. Three of the eight anastomotic PAs were caused by infection. Of the seven nonanastomotic PAs, four were caused by percutaneous biopsy, two were caused by infection, and one was of undetermined cause. In nine (60%) of the 15 patients the PAs were incidentally detected at imaging studies performed for other reasons. Diagnosis requires a high degree of suspicion. CT was performed in nine cases and duplex sonography in ten. The diagnosis of PA was made with CT in six (67%) patients and with duplex sonography in five (50%). CT and duplex sonography could not enable diagnosis when the PA was small, when the arterial anastomosis was not included in the field of study, or when enhancement with intravenously administered contract material was suboptimal. Angiography depicted the PAs in all 15 patients. In three liver transplant recipients with gastrointestinal tract bleeding, the causative PAs were detected only with angiography.

Adult↗
PubMed1988

Duplex sonography of hepatic artery thrombosis after liver transplantation.

When hepatic artery thrombosis occurs after liver transplantation, another transplantation is required to ensure the patient's survival. Because of the importance of establishing this diagnosis, we reviewed the results of duplex sonography in 37 angiographically or surgically proved cases of hepatic artery thrombosis after liver transplantation. There were 20 children and 17 adults. Ten of the 20 children had angiographically documented hepatopetal arterial collaterals. Such collaterals were not seen in the adult patients. This subset of patients was evaluated separately to determine if intrahepatic arterial blood flow reestablished by collaterals after hepatic artery thrombosis was a cause of false-negative Doppler studies. Thirty-four (92%) of the 37 cases of hepatic artery thrombosis were correctly identified by Doppler. A Doppler pulse was not identified in any of the children with arterial collaterals. We conclude that duplex sonography is sensitive in detecting hepatic artery thrombosis after liver transplantation. Furthermore, the presence of blood flow in hepatopetal arterial collaterals does not cause false-negative examinations.

Adolescent↗