The technical advantage of colour Doppler energy sonography (CDE) results in a higher sensitivity for blood flow detection than in conventional colour Doppler sonography (CDI). We compared the ...efficiency of CDE versus CDI in the detection of blood flow signals in asymptomatic patients after renal transplantation. 10 asymptomatic voluntary patients after renal transplantation were evaluated with CDI and subsequently with CDE by two examiners. Filter, scale and gate setting were kept constant, the Doppler gain was increased individually in every patient until background noise just did not derange the image. The assessment of blood flow signal was done using a self defined score system. CDI showed Doppler signal in the interlobar vessels in all 10 patients and blood flow signal in arcuate arteries and adjacent portions of interlobular vessels in nine of 10 patients. We were not able to detect blood flow related signal in the more peripheral medullary and cortical vessels. CDE obtained blood flow signal in interlobar and interlobular vessels in all patients. In addition, Doppler signal was observed in all patients in small medullary and cortical vessels. CDE increases detection of blood flow related signal in peripherally located small medullary and cortical vessels. There was no improvement in the evaluation of blood flow in interlobar vessels but marked improvement in blood flow detection in small peripherally located vessels. CDE cannot completely replace CDI in the sonographic evaluation of vascular complications in renal transplants, but should be used as an additional measure to rule out pathology in small peripheral renal vessels.
We report the results of surgical treatment of iliofemoral vein thrombosis in 49 pregnant women in a seven years period. The patients mean age was 26.5 years (range 18-41 years). Isolated descending ...pelvic vein thrombosis (PVT) occurred between the 20th and 36th week of pregnancy and was located predominantly left sided. 89.8% of PVT developed in the late period of gestation, three cases of pelvic vein thrombosis were diagnosed after vaginal delivery. An iliac vein spur in one patient and an AT-III deficiency in two cases were registered as additional risk factors. After venous catheter thrombectomy an arteriovenous fistula between the superficial femoral artery and the femoral vein was performed to increase blood flow and velocity in the pelvic veins. Abdominal delivery was performed simultaneously, if thrombosis occurred after the 34th week of pregnancy. Late re-thrombosis was registered in 4 patients (9.0%) after a mean follow-up of 42 months. We have seen symptoms of mild, not life threatening pulmonary embolism in two patients on the first postoperative day (complication rate 4.0%). Re-occlusion rate was high (3/5) after surgical thrombectomy carried out between the 20th and 26th week of gestation. Risk factors were an AT III deficiency in two cases and the continued compression syndrome of the pelvic veins caused by the enlarging uterus. In the late period of gestation surgical thrombectomy of PVT is the preferential method of treatment in selected patients with good therapeutical results. The operation reduces the risk of future venous insufficiency and post-thrombotic syndrome in the young female patients.
We report a 58-year-old woman with Peutz-Jeghers syndrome and episodic abdominal pain over a period of 30 years, possibly due to recurrent duodenojejunal intussusception, which eventually led to ...complete duodenal and biliary obstruction and associated mesothelioma.
