Selective low-dose streptokinase infusion in the treatment of acute transplant renal vein thrombosis

A renal transplant recipient developed acute renal transplant vein thrombosis following surgery for a total hip replacement. As an alternative to standard surgical therapy, the patient was treated with selective intravenous low-dose infusion of streptokinase at doses of 5,000–20,000 units/h. The infusion was continued for 120 h with constant monitoring of PT, PTT, and fibrinogen levels. Therapy resulted in excellent preservation of renal function without complications. Low-dose selective infusion of streptokinase should be considered a potential alternative therapy for acute transplant renal vein thrombosis.     

Selective streptokinase fibrinolysis in femoro-iliac arterial obstruction

Percutaneous transluminal angioplasty of iliac and femoral arteries was in 17 patients combined with selective intra-arterial streptokinase treatment. The patients were divided into two groups, one given low dose long-term therapy and the other high dose short-term therapy. The experiences obtained during an observation period of over one year revealed greater benefit from high dose short-term therapy. It seems that the major cause of complications must be attributed to the development of a high level of streptokinase antibodies during low dose long-term therapy.     

Popliteal artery perforation during low dose intra-arterial streptokinase infusion

There has been a recent increase in the use of low dose intra-arterial streptokinase infusion for the management of patients with acute peripheral arterial occlusions. Though serious complications using this technique occur less frequently than when using systemic thrombolytic therapy, a case is reported where the catheter used to infuse streptokinase perforated the popliteal artery 36 hours after the infusion commenced. The use of softer arterial catheters and restriction of patient movement where possible may prevent the recurrence of this previously unreported hazard.     

Intraarterial low-dose streptokinase infusion in the treatment of acute renal thromboembolism

A case of acute renal thromboembolism treated by intraarterial low dose streptokinase infusion is reported. The treatment appears effective, safe and less-invasive then surgery, with quick relief of pain and normalisation of blood pressure and renal function. It is concluded that intraarterial infusion of thrombolytic agents should be attempted first in the treatment of renal arterial thrombo-embolism.     

Angioplasty with streptokinase infusion of a totally occluded dacron femoropopliteal graft

Total occlusion of a right femoropopliteal reinforced Dacron bypass graft in a 75-year-old man was manifested by at rest right calf and foot pain. The patient was treated using a combination of percutaneous transluminal angioplasty (PTA) with streptokinase infusion. The graft was reopened and dilated successfully, resulting in total abatement of the patient's symptoms. Percutaneous transluminal angioplasty may be an important alternative in treatment of patients with occluded bypass grafts.     

Salpingitis isthmica nodosa: radiologic and clinical correlates

Salpingitis isthmica nodosa (SIN) is thought to be an inflammatory condition of the fallopian tubes and is strongly associated with infertility and an increased risk of ectopic pregnancy. The diagnosis is best made radiographically at hysterosalpingography (HSG), where the characteristic finding consists of multiple nodular diverticular spaces in close approximation to the true tubal lumen. We reviewed 1,194 HSGs performed over a five year period and identified 45 patients who had SIN (4%). There was a high rate of primary infertility (37.5%) and ectopic pregnancy (9.4%). Of 70 involved tubes, 62 (89%) had evidence of associated inflammation on historic, radiologic, surgical, or histologic grounds. We conclude that SIN is a disorder most likely acquired during the fertile years, and that the lesion is either a direct consequence of infection or that--once present--it predisposes the patient to subsequent infections.     

Intraarterial infusion of low-dose streptokinase after acute thromboembolization of the right renal artery

Acute arterial thromboembolization is a well-recognized complication following myocardial infarction. Intraarterial infusion of thrombolytic agents is a relatively new method of treating such thromboembolic occurrences. We describe a patient who was successfully treated with low-dose, intraarterial streptokinase infusion following occlusion of the right renal artery 1 week after an acute myocardial infarction.     

Thrombolysis of a partially occluding superior mesenteric artery thromboembolus by infusion of streptokinase

Occlusion of the superior mesenteric artery by thromboembolism is an uncommon cause of acute intestinal ischemia but carries a high mortality. This report describes a case of mesenteric thromboembolism in an 80 year old woman treated successfully by selective lowdose infusion of Streptokinase over 17 hours. Only twelve previous cases have been reported in the world literature. Selective thrombolytic therapy appears effective in the treatment of mesenteric thromboembolism, particularly in elderly patients with a high operative risk.     

Hypervascular gastric masses: CT findings and clinical correlates

OBJECTIVE: This article focuses on masses that are hypervascular on IV contrast-enhanced CT. CONCLUSION: The rising use of dual-phase IV contrast-enhanced CT will result in an increase in incidental detection of hypervascular gastric masses. Radiologists must be aware of the range of abnormalities that may appear as a hyperenhancing gastric mass because the differential diagnosis includes both benign and malignant lesions.     

Near-drowning and clinical laboratory changes

Opposite to clinical laboratory findings in experimental drowning of animals (erythrocytic lysis, hyperkalemia, and final cardial fibrillation) are the observations in drowned humans (increase of pCO2, hypoxic encephalopathy), which leads to a different pathophysiological interpretation of the drowning process. This process, however, is recently discussed again, therefore an additional study seemed to be recommended. In a retrospective study, 31 cases of near-drowning (23 cases: fresh water; 8 cases: brackish water) clinical laboratory data were analysed. While 21 of the cases were fatal with a delay of up to 180 days, 10 individuals survived the accident, four cases with severe neurological deficits. Data of pH, potassium, sodium, chloride, hemoglobin and total protein were collected during the very early post-drowning period. Nearly all cases (96%) revealed a reduction of pH due to hypoxic acidosis, and only two cases (6.5%) exhibited a slight hyperkalemia. The hemoglobin level was normal in most of the cases (83%) and slightly reduced in the others (17%) while the protein level was slightly reduced in most of the fatalities (80%). As a result of our investigation we have to state the lack of hyperkalemia as well as of an increase of the hemoglobin level indicate that there is no distinct intravascular red cell lysis due to influx of water into the vascular compartment. Therefore the death by drowning in humans in most cases is the result of a hypoxic cerebral process. A comparison with animal experiments obviously is not helpful because the drowning process in humans leads to an aspiration of only 2-4 ml water/kg, while in animal experiments more than 10 ml water/kg will be artificially aspirated leading to red cell lysis as well as to electrolyte disturbances and cardial fibrillation.     

Treatment of acute embolus of the superior mesenteric artery by topical infusion of streptokinase

Two patients with sudden onset of acute abdominal pain caused by embolic disease of the superior mesenteric artery (SMA) were evaluated angiographically. In one patient, the study was performed soon after the clinical onset of symptoms, and successful treatment with low-dose topical streptokinase infusion produced total lysis of the clot over a period of 30 h. In the second patient, the angiogram was obtained 6 days following the initial episode of pain. Radiographic and clinical findings indicated advanced gastrointestinal ischemia with bleeding which contraindicated the use of fibrinolytic therapy. Surgical resection of infarcted intestine was required. Early angiographic detection of acute mesenteric thrombus or embolus is crucial for the selection of patients for fibrinolytic therapy. Our cases suggest that with early diagnosis, streptokinase infusion is an alternative to surgical management of selected patients with acute mesenteric ischemia.     

Serum myoglobin determination: laboratory and clinical evaluation.

Quality assurance examination of a commercially available radioimmunoassay kit for determination of serum myoglobin level conformed the measurement to be accurate, precise, and reproducible under all assay performance variables. Initial clinical evaluation in patients admitted to the Coronary Care Unit revealed comparable diagnostic parameters and earlier detection when compared with the present standard indicator of myocardial necrosis, creatine phosphokinase MB isoenzyme. Interpretation that an elevated myoglobin reflects acute myocardial infarction should be made only in the appropriate clinical context.     

Computed tomography and lateral ventricular asymmetry: clinical and brain structural correlates

Asymmetry of the ventricles of the brain without an obvious cause is a common and intriguing radiologic finding. To understand this phenomenon better the authors conducted a 24-month study to compare clinical and structural manifestations of two groups of patients who had undergone head computed tomography (CT): group A comprised 249 patients with asymmetry of the lateral ventricles of the brain without space-occupying lesions, intracranial bleeding, recent infarction or trauma and group B comprised 266 patients with the above exclusion criteria but without ventricular asymmetry. The degree of ventricular asymmetry was classified as mild, moderate or severe, according to the ratio of the larger frontal horn diameter to the smaller one. The incidence of lateral ventricular asymmetry was 5.3%. The following clinical manifestations were more frequently present in group A: headaches (p = 0.002), seizures (p = 0.007) and positive human immunodeficiency virus (HIV) status (p = 0.02). Transient ischemic attacks were more prevalent in group B (p = 0.009). Independent predictors of headache were: younger age (p less than 0.001) and the degree of ventricular asymmetry (p = 0.02). Predictors of seizures were: younger age (p less than 0.001), ventricular asymmetry (p = 0.004) and the absence of septal deviation (p = 0.009). In group A, predictors of a higher degree of asymmetry were septal deviation (p less than 0.001) and older age (p = 0.008). The authors conclude that asymmetry of the lateral ventricles of the brain is a relatively common CT finding that has important clinical and brain structural correlates and deserves more attention in the field of imaging.     

Heterotopic bone formation: clinical, laboratory, and imaging correlation

The clinical findings, laboratory data, radiographs, and radionuclide studies of 50 patients referred for evaluation of possible heterotopic bone formation (HBF) were reviewed. HBF begins approximately 17 days following injury or neurologic insult, heralded by an acute rise in serum alkaline phosphatase (SAP), and increased vascularity on three-phase radionuclide bone imaging (RNBI). RNBI soft-tissue uptake is evident at 24 days and radiographic calcification is visible 1 wk later. Clinical signs and symptoms occur relatively late in the course of disease. HBF mimics thrombophlebitis and should be considered in all patients referred for venography if the clinical situation is appropriate. Serial SAP measurements and three-phase RNBI should allow early diagnosis in virtually all cases.     

Percutaneous cecostomy for Ogilvie syndrome: laboratory observations and clinical experience

Percutaneous cecostomy (PCC) was evaluated in dogs and cadavers and by means of review of intraperitoneal contrast material-enhanced computed tomographic (CT) scans and clinical experience in five patients with Ogilvie syndrome. It was shown that PCC can be accomplished with a variety of techniques (e.g. Seldinger or trocar puncture, tacking) and instruments (various types and sizes of retention and nonretention catheters). Anatomic studies revealed that the cecum is surrounded by the peritoneum for as much as 270 degrees of its circumference, so that a retroperitoneal approach to PCC would probably be unfeasible in most patients. PCC was effective in treating all five patients in this study, despite their advanced age and complicated medical conditions. Decompression of colonic gas was achieved with 8-12-F catheters, and no major complications occurred. Endoscopic decompression had been unsuccessfully attempted in four of the patients previously. It is concluded that PCC may be an important option in the treatment of Ogilvie syndrome and that the procedure may obviate surgery and be lifesaving in certain high-risk patients.