Regional infusion of urokinase into occluded lower-extremity bypass grafts: long-term clinical results

The initial outcome, long-term patency rate, and rate of limb salvage were studied in patients after regional urokinase infusion for treatment of thrombosed lower-extremity grafts. Seventy-one infusions were performed in 53 patients. Complete clot lysis occurred in 75% of grafts, with establishment of antegrade blood flow in 66%. Variables that favorably influenced clot lysis and the reestablishment of antegrade blood flow through the graft were a short duration of occlusion and a suprainguinal graft position. The median duration of patency after infusion and adjunctive therapy was 162 days, with 75% limb salvage at 301 days. No statistically significant variables that influenced the length of patency were identified. These long-term patency results are inferior to the reported results in suprainguinal grafts after reoperation. They appear similar to reported results for occluded infrainguinal grafts treated with thrombectomy and patch grafting.     

Quantitative US attenuation in normal liver and in patients with diffuse liver disease: importance of fat

Two methods are used to estimate ultrasound attenuation in liver. These were based on amplitude change and frequency change as a result of depth dependent attenuation. Evaluation of the two methods against a family of calibrated phantoms yielded correlation coefficients of 0.98 and 0.99, respectively. Liver attenuation in 26 control subjects was 0.50 and 0.52 dB/MHz/cm, respectively. Liver attenuation was estimated in 50 patients who later underwent liver biopsy. Comparison with quantitative histologic results showed that the presence of fat alone accounted for the increased attenuation associated with cirrhosis. Similar high attenuation values were found in patients with fatty infiltration. Fibrosis alone did not result in elevated liver attenuation. Cirrhotics without fatty infiltration had attenuation similar to that of the controls. Mechanisms of action are discussed.     

Calcification in pulmonary nodules: detection with dual-energy digital radiography

The authors undertook a clinical study to determine the accuracy of dual-energy digital radiography in revealing nodule calcification because calcification in a pulmonary nodule almost excludes the possibility of malignancy. Over a 6-month period, 61 patients with pulmonary nodules (less than or equal to 3 cm) or masses (greater than 3 cm) were examined on a prototype scanned projection unit using a dual-energy detector. In 49 of 61 patients, nodules were noncalcified, and in 12, they were calcified. In 57 patients, the benignancy or malignancy of nodules was established beyond reasonable doubt by pathologic confirmation in 38 and by strong inference in 19 (four patients with noncalcified solitary pulmonary nodules either refused further investigation or surgery or their follow-up was too short to permit exclusion of malignancy). Dual-energy radiography was found to be highly accurate in assessing the presence or absence of calcification in pulmonary nodules and thus in determining their benignancy or possible malignancy.     

Lichen sclerosus et atrophicus and autoimmunity in 250 women

Whilst the aetiology and pathogenesis of lichen sclerosus et atrophicus (LSA) remain unknown, it has been established that patients with LSA have an increased incidence of autoantibodies (Goolamali et al. , 1974) and autoimmune related disorders (Harrington & Dunsmore, 1981; Meyrick Thomas, Ridley & Black, 1983, 1984).
As only a proportion of patients with LSA exhibit such a tendency to autoimmune related phenomena, we have sought to determine whether there are any differences in the natural history of LSA in patients having autoantibodies or autoimmune related diseases (personally or in a first degreee relative) compared with those without such features.
We have studied 250 women with histologically confirmed LSA. Fifty-two (208%) had a personal history of one or more autoimmune related diseases (vitiligo, alopecia areata, pernicious anaemia, insulin-dependent diabetes mellitus, thyroid disease, bullous pemphigoid); 55 (22%) gave a family history of such autoimmune related disorders; and 109 (436%) had one or more autoantibody in a titre 1:20 or greater.
There was a slightly different distribution of age at onset of LSA in the group of patients with an autoimmune related disorder compared with the patients with no associated conditions, but no significant differences were found between those patients with, and those without, autoimmune related phenomena with regard to duration of LSA, onset of LSA in relation to puberty or menopause, site(s) of involvement with LSA and malignant change in LSA-involved skin.
We conclude that the tendency to develop autoimmune related phenomena does not reflect a difference in the natural history of LSA in such patients.     

Pseudoportal Doppler signal in the partially obstructed inferior vena cava

The Doppler spectrum of the normal inferior vena cava (IVC) shows a majority of flow toward the right atrium, with wide variations in flow velocity and direction owing to effects of the cardiac and respiratory cycles. Seventeen subjects underwent duplex sonography: nine children after liver transplantation, two children with right upper quadrant neuroblastoma, and six healthy control subjects. In six children the spectrum obtained from the IVC bore a strong resemblance to the unidirectional, low-velocity, continuous-flow pattern associated with the portal vein; these children included two children with biliary atresia and cirrhosis, two liver transplant recipients, and two children with IVC compression by neoplasm. In healthy children and adults, a pseudoportal Doppler signal in the IVC can be generated by subcostal right upper quadrant compression. The pseudoportal IVC appears to be a sign of partial IVC obstruction. Knowledge of this potential pitfall and meticulous morphologic imaging can help prevent mistaking the IVC for a patent portal vein.