Neurovascular compression in essential hypertension: cause, consequence or unrelated finding?
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Adult↗
Biomedical subjects
P Eliás
Publications and source records attributed to P Eliás.
[Prenatal detection of congenital mezoblastic nephroma].
TYPE OF STUDY: Case report. SETTING: Department of Gynecology and Obstetrics, Department of Radiology, Department of Pathology, Department of Medical Genetics, Charles University Hospital, Hradec Králové. METHODS: The autors report a case of renal tumor in a fetus at 33 weeks of gestation detected by means of ultrasonography and magnetic resonance imaging. The pregnancy course was complicated by polyhydramnios. The female infant was born vaginally at 37 weeks of gestation. Postnatal nephrectomy confirmed prenatal diagnostic presumption - congenital mezoblastic nephroma. At follow-up at 12 months of age, the infant had no evidence of the disease. CONCLUSION: Detection of renal tumor in a fetus is rare. Congenital mezoblastic nephroma with the favourable prognosis is most probable diagnosis. Prenatal detection enables the prevention of complications (prematurity prevention, detection of the developing cardial decompensation and fetal hydrops) with the planning of labour and postnatal management.
Adult↗
[Diagnosis of spontaneous arteriovenous fistula complicating aortoiliac aneurysm using spiral CT. Report of 3 cases].
Acute spontaneous arterio-venous fistula complicating atherosclerotic abdominal aortic aneurysm (AAA) is rare. This life-threatening setting is observed in 1-2% of all AAAs and 2-4% of ruptured of AAAs. The triad of abdominal or lower back pain, pulsatile abdominal mass, and continual abdominal machinery-like bruit is seen only in half of cases. Currently, CT angiography is a noninvasive technique which enables a rapid and exact preoperative diagnosis. The authors describe three cases of aortoiliac aneurysm complicated by an acute arteriovenous fistula which were diagnosed using spiral CT.
Aged↗
Currarino triad: concurrent US and MRI diagnosis in the fetus and the mother.
We report an unusual case of the complete Currarino triad diagnosed in a fetus at 21 weeks' gestation by means of prenatal ultrasonography (US). The highly suspicious findings in the fetus were accompanied by analogous US findings in the mother who suffered from mild symptoms of up to that time unrecognized Currarino triad. Consecutively, magnetic resonance imaging (MRI) confirmed the findings simultaneously in the fetus and in her mother. This is the first report describing the prenatal diagnosis of Currarino triad without the background of positive family history. To our knowledge, the prenatal MRI findings of Currarino triad have not yet been published.
Abnormalities, Multiple↗
[Infectious aneurysm of the abdominal aorta caused by Salmonella: diagnosis, endovascular therapy].
The authors present a case of an infected abdominal aortic aneurysms by means of a minimally invasive endovascular method using a stent graft. This patient had already been treated by TIPS (transjugular intrahepatic portosystemic shunt) for repeated varicose bleeding due to liver cirrhosis. Standard surgical therapy of infected abdominal aneurysms and about advantages and possibilities of endovascular treatment with stent grafts are discussed. Regular follow-up of the patient and long-term antibiotics therapy are important for accurate assessment of an implanted stent graft into the infected abdominal aorta. Endovascular stent graft combined with antibiotic therapy may be an alternative to conventional open surgery in managing infected infrarenal abdominal aneurysms.
Aneurysm, Infected↗
Spontaneous regression of low-grade astrocytomas: an underrecognized condition?
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Astrocytoma↗
Extensive spinal epidural hematoma: a rare complication of aortic coarctation.
Development of collateral circulation belongs among the typical signs of aortic coarctation. Cerebral or spinal artery aneurysm formation with increased risk of subarachnoid hemorrhage represent the most common neurovascular complication of this disease. We report a case of a 20-year-old sportsman who developed acute non-traumatic paraplegia as a result of extensive spinal epidural hemorrhage from collateral vessels accompanying aortic coarctation which was unrecognized up to that time. To the best of our knowledge, acute spinal epidural hematoma as a complication of aortic coarctation has not been previously reported.
Adult↗
Value of Doppler sonography in revealing transjugular intrahepatic portosystemic shunt malfunction: a 5-year experience in 216 patients.
OBJECTIVE: The purpose of the study was to evaluate the long-term clinical efficacy of Doppler sonography in revealing failure of transjugular intrahepatic portosystemic shunts (TIPS). SUBJECTS AND METHODS: During a 5-year period, 1192 Doppler examinations were performed in 216 patients with TIPS. No regular follow-up shunt venography was performed. Doppler examinations were retrospectively compared with the results of shunt revisions. Sonograms with negative findings were compared with the patients' clinical status so that the number of false-negative sonographic findings leading to an episode of shunt failure (recurrence of gastrointestinal bleeding or ascites) could be ascertained. Sonographic parameters assessed included diameter, velocity, flow volume, and congestion index of the portal vein; and shunt velocities. RESULTS: Doppler sonography revealed shunt occlusion in 25 of 26 angiographically proven cases (sensitivity, 96%). The combination of velocity criteria (peak intrashunt velocity > or =250 cm/sec, maximum velocity in the portal third of the shunt < or =50 cm/sec, or maximum portal vein velocity less than or equal to two thirds of the baseline value) revealed shunt stenosis in 103 of 110 cases (sensitivity, 94%). Doppler sonography missed a significant shunt stenosis that led to an episode of gastrointestinal bleeding or ascites recurrence in only seven cases. The congestion index of the portal vein showed significant differences between patent and malfunctioning shunts (p < 0.001). CONCLUSION: Doppler sonography is an effective primary imaging method for long-term follow-up of patients with TIPS.
Adolescent↗
[Chronic mesenteric ischemia].
Chronic mesenteric ischemia often called intestinal angina too, is the clinical syndrome that originates as a result of chronic obstruction of the splanchnic arteries. Intestinal angina is defined by the clinical triad of postprandial abdominal pain, sitophobia (fear of eating) and chronic weight loss. Postprandial abdominal pain is analogous to angina pectoris and calf claudication, two more common manifestations of episodic tissue hypoxia. The authors present the case-history of a 50-year-old woman with intestinal angina due to obliteration of the all three main splanchnic arteries. The authors describe the course of the disease and point out new diagnostic approaches in the diagnosis of chronic mesenteric ischemia (Doppler ultrasound of the splanchnic arteries, helical CT angiography of the splanchnic vasculature). In the discussion they point out the possible atypical clinical manifestation of chronic mesenteric ischemia and existence of gastric ulceration and chronic ischemic gastritis caused by chronic mesenteric ischemia.
Arteriosclerosis↗
Detailed evaluation of 2959 allogeneic and xenogeneic dense connective tissue grafts (fascia lata, pericardium, and dura mater) used in the course of 20 years for duraplasty in neurosurgery.
Surgical experience with 2959 allogeneic and xenogeneic dense connective tissue grafts (1767 of fascia lata, 909 of pericardium, and 283 of dura mater), used in 2665 neurosurgical operations performed in the course of 20 years (1976 to 1995) is reported. Duraplasty using either allogeneic or xenogeneic grafts has had a similar, and favourable clinical outcome. Nevertheless, the pliable deep frozen fascia lata grafts, which could be used in any location, have been reserved for sella turcica plugging, anterior cranial base plasty, aneurysmal wrapping, and surgery of lipomyelomeningocele. Pericardium and dura mater grafts were in the majority of cases used over the brain convexity and posterior cranial fossa. Ovine pericardium proved to be superior to bovine and allogeneic pericardia because of its workability, flexibility, reduced thickness, and better transparency. Postsurgical complications occurred in 7.3%, and they were: 1) cerebrospinal fluid fistulas in 2.8%; 2) meningites in 2.3% (aseptic 1.4%, bacterial 0.8%, and tumoural 0.1% meningites); 3) pseudomeningoceles in 2.2%; 4) wound infections in 0.6%; 5) malresorptive hydrocephalus in 0.5%; and 6) adhesions to nerve tissue in 0.5%. The majority of complications healed without surgery. Forty-eight grafts (1.6%) failed to fulfil the requirements of the surgeon, and 46 of them were re-operated upon. Though another thirty-nine grafts healed successfully, 39 shunts (1.5%) had to be performed for malresorptive hydrocephalus (0.9%), and/or for a big pseudomeningocele (0.6%). So, the pure complication rate in 2665 duraplasties was 3.1%. The complex evaluation of the allogeneic and xenogeneic grafts (fascia, pericardium, and dura mater), used for duraplasty in neurosurgery during the last 20 years proved them, as remarkably good, with a success rates of 96.9%.
Adult↗
Juxtarenal aortic aneurysm: endoluminal transfemoral repair?
Endoluminal transfemoral repair of an abdominal aortic aneurysm by a stent graft placement requires a segment of the nondilated infrarenal aorta of at least 15 mm long for safe stent graft attachment. The possibility of endoluminal treatment of a juxtarenal abdominal aortic aneurysm with partially covered spiral Z stent was assessed in experiment and in three clinical cases. In the experiment, the noncovered spiral Z stent was placed into the abdominal aorta, across the origins of renal arteries and mesenteric arteries, in six dogs. In the clinical cases, a partially covered stent graft was attached in 3 patients with the juxtarenal abdominal aortic aneurysm (of the group of 12 patients with abdominal aortic aneurysm). The stent grafts were attached with proximal uncovered parts across the origins of the renal arteries. In experiment, the renal artery occlusions or stenoses were not observed 36 months after stent placement, and in clinic, 3 patients with the juxtarenal aortic aneurysm were successfully treated by stent graft placement. There were no signs of flow impairment into the renal arteries 14 months after stent graft implantation. This approach can possibly expand the indications for endoluminal grafting in the treatment of juxtarenal aortic aneurysms in patients who are at high risk for surgery.
Aged↗
[Cysts and pseudocysts of the spleen in children].
A cyst in the upper pole of the spleen was diagnosed in three children. In all the pole of the spleen was resected -in two instances it contained a cyst, in one a pseudocyst. The postoperative course was without complications. All patients had scintigraphic check-up examinations, in all three instances functional lienal tissue was found which did not differ much as to its size from that of a normal spleen. In cysts situated in the splenic pole the authors consider partial resection of the affected portion of the spleen as the optimal surgical method. In cysts of other portions of the spleen it would be better to select a different surgical procedure, e.g. enucleation of the cysts, partial decapsulation of the cyst or percutaneous puncture of the cyst combined, if necessary, with sclerotization.
Adolescent↗
[Endovascular treatment of abdominal aortic aneurysms. Morphology of aneurysms as one of the deciding indicating factors].
Endovascular treatment of aneurysms of the abdominal aorta is based on intravascular bridging of the aneurysm using of an endovascular prosthesis. The prosthesis must be safely anchored above and below the sac of the aneurysm in the non-dilated artery. Therefore the indication of endovascular treatment depends on the morphology of the aneurysm. The objective of the work was to analyse the morphology of the aneurysm with regard to the possibility of endovascular treatment. The morphology of the aneurysm was evaluated with regard to the angiographic examination and examination by computed tomography. The following parameters were investigated: diameter and length of the proximal and distal neck, diameter of the sac in two planes, diameter and tortousity of the iliac arteries, tortousity of the infrarenal aorta. A total of 70 patients with aneurysms of the abdominal aorta were examined. The patients were divided into three groups according to the morphology of the aneurysm. I. infrarenal aneurysms not affecting common iliac artery (n = 20) 28.5%, II. infrarenal aneurysms affecting common iliac artery (n = 38) 54.2%, III. juxtarenal aneurysms regardless of the affection of common iliac arteries (n = 12) 17.1%. Of the total of 70 examined patients 24 (34.2%) with infrarenal aneurysm and 6 (8.57%) with juxtarenal aneurysm were suitable for endovascular treatment.
Angiography, Digital Subtraction↗
[Transjugular intrahepatic portosystemic shunt (TIPS) in the treatment of symptomatic portal hypertension].
BACKGROUND: A transjugular intrahepatic portosystemic shunt (TIPS) is the creation of a percutaneous portosystemic anastomosis which is used as an alternative method of surgical portosystemic shunts and endoscopic treatment in the therapy of complications of portal hypertension. The objective of the present work was to summarize experience with TIPS in 100 patients. METHODS AND RESULTS: In 1992-1995 the authors treated 100 patients with symptomatic portal hypertension by TIPS. To create the shunt in 84% patients a spiral Z stent was used, in the remainder a Wallstent. In 86% patients the indication for TIPS was haemorrhage associated with portal hypertension and in 14% refractory ascites. TIPS was implemented in 98% patients. The pressure in the portal vela was not reduced on average to 58% of the original value. Haemorrhage was not stopped in one of 7 patients. Haemorrhage from varices reappeared in 7% patients indicated on account of repeated haemorrhage and was always associated with the finding of chronic stenosis of the shunt. The mortality in conjunction with the procedure was 4%, the mortality within 30 days after operation was 8%. Uncontrollable encephalopathy developed in 3% of the patients. Primary patency of the shunt created by the spiral Z stent was 85% after 6 months, after 12 months 72% and thus does not differ from primary patency when Wallstents are used, as reported in the literature. CONCLUSIONS: TIPS is an effective method to reduce the pressure in the portal vein in portal hypertension. The main limiting factor of the method is stenosis of the shunt due to hyperplasia of the neointima. Stenoses of the shunt can be effectively dilated by percutaneous balloon angioplasty.
Adolescent↗
[Polyester-covered spiral Z stent. Initial clinical experience with endovascular treatment of aortic aneurysms].
The authors present their initial clinical experience with endovascular treatment of an aneurysm of the abdominal aorta using of a polyester covered spiral Z stent. Since May 1995 they treated by the endoluminal route 13 patients with aneurysms of the abdominal aorta and 1 patient with thoracic aneurysm. In patients with a subrenal aneurysm (n = 10) the stent graft was anchored below renal arteries origins. In patients with a juxtarenal aneurysm (n = 3) the stent graft was anchored across the renal arteries origins. All patients were followed up by angiography, computed tomography and ultrasonography. In one patient with a subrenal aneurysm dislocation of the stent graft during implantation occurred. In the remaining patients it proved possible to exclude the aneurysm successfully. One patient with an juxtarenal aneurysm died 6 days after surgery. The cause of death was not associated with the aneurysm or surgery. In patients with juxtarenal aneurysms the authors did not observe changes of renal functions or occlusion of the renal artery in the course of 12 months.
Aged↗
[Endoluminal grafts in the therapy of aneurysms of the abdominal aorta. Experimental results].
In 1991 a new method of treatment of aneurysms of the abdominal aorta was published. The method is based on bridging the sac of the aneurysm by an endoluminal graft. The graft is a stent provided with a special vascular prosthesis. The endoprosthesis is inserted by means of a catheter from arteriotomy of the common femoral artery. The objective of the submitted work was to test the possibility to use a polyester covered spiral Z stent in the treatment of aneurysms of the abdominal aorta. For experiments six dogs were used weighing 12-18 kg. In the experimental animals an artificial aneurysm of the abdominal aorta was induced. Then the authors interposed surgically into the subrenal section of the abdominal aorta a special polyester knitted prosthesis imitating the shape of the aneurysm. Two weeks after surgery angiography of the abdominal aorta was performed. After angiography the authors introduced from arteriotomy of the superficial femoral artery an endoluminal graft into the artificial aneurysm. The graft bridged the aneurysm on the inside and this led to thrombosis of the sac of the aneurysm. The state of the graft and aneurysm was checked sonographically and angiographically. The graft was successfully used in all experimental animals. Angiographic check-up examinations revealed that application of the graft led to immediate exclusion of the sac of the aneurysm. In two experimental animals the graft was inserted in an excessively cranial position. It did not bridge the aneurysm throughout its length. Reflux of blood in the distal part persisted and filled the residual cavity of the sac of the aneurysm.(ABSTRACT TRUNCATED AT 250 WORDS)
Animals↗
[Subacute thrombosis of the abdominal aorta with suprarenal involvement and successful treatment with pharmacomechanical fibrinolysis].
In a 43-year-old patient with Ebstein's anomaly and a history of acute myocardial infarction by means of duplex ultrasonography and aortography the diagnosis of thrombotic occlusion of the a aorta was established, starting above the insertion of the renal arteries and reaching as far as the bifurcation of the aorta and the common iliac arteries. In the clinical picture dominated complete anuria with uraemia and marked hyperkaliaemia as a result of ischaemic affection of the extremities due to thrombosis of the aorta; at the onset of hospitalization also left ventricular failure with hyperhydration and later also signs of the hyperviscous syndrome. The latter developed after repeated haemofiltrations which led to a rise of the originally high haemoglobin and haemotocrit values a result of a righ-left shunt in Ebstein's anomaly. After improvement of the clinical condition local fibrinolytic treatment of the aortal thrombosis with urokinase (total dose 2,160,000 u. administered within 24 hours) was provided. The thrombus with a total length of 13.5 cm was dissolved except for a residual portion of 10 mm located in the area of insertion of the right renal artery. After dissolution of the thrombus it proved possible to restore the blood flow into the left kidney a and lower extremities, but not into the right kidney because of the residual thrombus. Seventy-two hours after terminated fibrinolysis - and after 31 days of anuria - the diuresis was restored and after a polyuric stage normalization of mineral, urea levels was restored and the creatinine value was slightly above the upper normal range. Concurrently with fibrinolytic therapy angioplasty of the aorta was carried out and a stent was placed on the left iliac artery. The clinical condition of the patient was improving, the patient started to mount stairs. Death occurred suddenly and the cause was cardiac failure due to very serious congenital heart disease.
Adult↗
Bleeding to adrenal glands in adults.
At the Department of Urology in Hradec Králové five patients were treated in 1991 to 1993 with bleeding to the adrenal glands. We present our reports of these patients and stress the difficulty of preoperative diagnosis.
Adrenal Gland Diseases↗