Impact of endovascular treatment on clinical status and health-related quality of life.

BACKGROUND AND AIMS: Investigating the impact of percutaneous transluminal angioplasty (PTA) on clinical status and health related quality of life in patients with claudication and critical limb ischaemia (CLI). MATERIAL AND METHODS: 61 patients and 64 limbs underwent a primary PTA (30 claudication and 34 CLI cases). Clinical status was graded according to Ahn and Rutherford and ankle/brachial index (ABI). Quality of life was assessed using the Nottingham Health Profile (NHP) preoperatively, one month and one year after the procedure. Triplex scan evaluation of the treated arterial segment was carried out postoperatively and one year after the procedure. RESULTS: Claudication: 24/27 patients underwent one-year follow up, after which 20/24 had no claudication. In triplex evaluation 17 (63.0%) treated segments were open with 0-50% restenosis, 9 (33.3%) with 51-99% restenosis and one (3.7%) was occluded. CLI: 13/34 (38.2%) patients underwent one-year follow-up after which eight patients (61.5%) were asymptomatic and five (38.1%) had claudication. In triplex evaluation there was 0-50% restenosis in 6 (46.2%) segments treated with PTA and 51-99% restenosis in 7 (53.8%) segments. 21 (61.8%) patients did not conclude the one year follow up: 7 had died, 5 had undergone bypass surgery and 6 an amputation and 3 did not attend the follow-up up for unknown reasons. Quality of life: For CLI patients, improvement was observed in the domain of pain, which continued throughout the follow-up period. Among the claudicants, the domain of physical mobility was improved at one month's follow-up, but this effect disappeared during the following year and could not be seen at one the one- year follow-up. CONCLUSIONS: Technical success and one-year results in claudication are good, and the rate of complications is low. However, although PTA resulted in an immediate improvement in the quality of life, this effect was not seen in the long term. In critical limb ischemia there was a group of patients in whom PTA led to a significant benefit in terms of limb salvage and quality of life.

Magnetic resonance imaging of the femoral neck cortex.

PURPOSE: To determine the in vivo precision and accuracy of magnetic resonance imaging (MRI) in evaluating the thin (approximately mm) femoral neck cortex. MATERIAL AND METHODS: Hip regions of 30 volunteers were scanned with standard 1.5 T MRI twice with repositioning, and the images of the narrow-neck cross-sections were obtained. Two radiologists independently delineated periosteal and endosteal cortical boundaries, and several structural variables were determined. For precision, 95% limits of agreement and coefficients of variation were calculated. Accuracy was determined with phantoms. RESULTS: In vivo precision of the directly delineated measurements varied from 0.9% (periosteal circumference) to 1.6% (total area), while the precision of the calculated variables remained poorer, from 7.3% (cortical to total area ratio) to 15.1% (torsional rigidity). The root-mean-square error of the cortical thickness measurement was 0.15 mm. CONCLUSION: Thin cortical bone at the narrowest location of the femoral neck can be delineated precisely and accurately with a standard clinical 1.5 T MRI device. MRI provides a feasible tool for the assessment of mechanically important cortical bone at the femoral neck and may be of clinical utility in assessing hip fragility.

Value of ultrasonography in acute renal failure: analysis of qualitative features in patients with nephropathia epidemica.

PURPOSE: To assess the value of renal ultrasonography (US) and the frequency of qualitative pathology in patients with nephropathia epidemica (NE) and to determine whether these features are related to the clinical course of NE. MATERIAL AND METHODS: Renal US was undertaken in 23 hospital-treated NE cases during the acute phase of the disease (first study). A second US study was performed 3-6 months later. Captured US images were used in the analysis. RESULTS: From acute to control phase the overall rating of kidney status improved in 20 patients, parenchymal swelling decreased and corticomedullary border differentiation improved in 21, echogenicity decreased in 18, and patchy pattern in parenchymal echo-texture decreased in 15. The severity of findings in US evinced some association with fluid volume overload, high blood pressure level and blood leukocyte count, and severe clinical renal insufficiency. The degree of parenchymal swelling had more statistically significant associations with clinical course than other US features. CONCLUSION: Qualitative US features are as sensitive as quantitative US parameters in assessment of NE patients' clinical course and recovery, assuming that a comparative study is available. US using only qualitative features is fairly limited in evaluating NE patients' clinical situation.

Renal ultrasound findings and their clinical associations in nephropathia epidemica. Analysis of quantitative parameters.

PURPOSE: To evaluate renal US findings in patients with nephropathia epidemica (NE) and to determine whether changes in these findings are related to the clinical course of NE. MATERIAL AND METHODS: Renal US was undertaken in 23 hospital-treated NE patients during the acute phase of their disease (first study). The second US study was performed 3-6 months later. RESULTS: The resistive index (RI) was abnormal in 12 patients and fluid collections (perirenal, pleural, pericardial, ascites) were found in 13 patients in the first study. Renal length decreased in every patient, cortical parenchymal thickness in 19 patients and RI in 18 patients from the first to the second studies. The mean change was significant in all parameters. Increased RI and presence of fluid collections in the first study as well as a greater change in length and RI between the first and the second studies were associated with high maximum daily urine excretion, substantial change in body weight between the anuric and polyuric phases, high maximum serum creatinine and urea concentration, high blood leukocyte count and low hematocrit value. CONCLUSION: Renal US changes occurred in every patient with NE. The severity of the findings was associated with fluid volume overload and degree of clinical renal insufficiency.