Catastrophic Antiphospholipid Syndrome after Orthotopic Liver Transplant.

Background: Catastrophic antiphospholipid syndrome (CAPS) is an autoimmune thrombogenic disorder of small and large vessels caused by autoantibodies against phospholipids and phospholipid-binding proteins. This severe form of antiphospholipid syndrome (APS) presents clinically with simultaneous life-threatening multiorgan thrombosis and the presence of two or more persistent antiphospholipid antibodies (APL) confirmed on testing 12 weeks apart. Case Presentation. We describe a case report of a 66-year-old woman with detected antinuclear antibodies (ANA) pretransplant diagnosed with CAPS following orthotopic liver transplant. The patient had acute respiratory failure; Doppler ultrasound and CT angiogram confirmed thrombosis in the hepatic artery, subsequent occlusion of the jump graft, and a splenic infarct. Hypercoagulability workup showed elevated levels of anticardiolipin IgG and beta-2-glycoprotein IgG/IgM and positive lupus anticoagulant, treated with steroids and anticoagulation. The patient was discharged after one month and was transitioned from heparin to life-long warfarin. Conclusion: Our patient provided a standard presentation of CAPS with abnormal pretransplant levels of antinuclear antibodies (ANA). Although there have been studies investigating the relationship between anticardiolipin antibodies and lupus anticoagulants and APS, the relationship between pretransplant positive ANA or antimitochondrial antibodies (AMA) and CAPS has yet to be explored. Further studies will be needed to determine the significance of these antibodies. We recommend preoperative APL testing for patients with positive ANA and AMA at preliver transplant presentation.

[Possibilities of the use of MR tomography-based cerebral blood volume maps in the diagnosis of brain tumors]. / Einsatzmöglichkeiten von kernspintomographischen Parameterbildern des zerebralen Blutvolumens in der Diagnostik von Hirntumoren.

PURPOSE: Today contrast enhanced MR imaging is a reliable method for detecting mostly distinguishing between different histological types of tumours. In this study we use a MR-based method to measure the regional cerebral blood volume (rCBV). Using this technique we try to judge the grading and vitality of the tumours. METHODS: 26 patients with various types of brain tumours were examined. To calculate rCBV-maps of one slice, low-dosed Gd-DTPA was injected as a bolus. Using the relaxation effect the obtained signal intensity-time curves were converted pixel-wise into rCBV images. For the tumours rCBV-ratios were calculated relative to the corresponding area in the contralateral hemisphere. RESULTS: In the investigated group all tumours were detected on the basis of a raised rCBV-ratio. Since only vital parts of the tumour are perfused, the rCBV maps may be used to determine the place of biopsy. CONCLUSIONS: The differential diagnosis of all histological tumour types was not possible on the basis of rCBV values. Distinction between low grade and high grade gliomas was also not significant. However, a low grade glioma can be excluded if the morphological images definitely indicate an astrocytoma and if the rCBV-ratio was higher than 2.