Lachezar Grozdinski, Mario Stankev and Kocho Dimitrovski
Ultrasound Screening of Multifocal Atherosclerosis
Aim. The aim of our study was to perform ultrasound screening of multifocal atherosclerosis (MFA), in patients with coronary atherosclerosis.
Material and methods. Color duplex screening (CDS) and continuous wave (CW) doppler was used to study 32 clinically healthy persons and 87 patients with clinical data for ischemic heart disease (IHD).
Results. We have found high frequency of MFA simultaneously affecting coronary, carotid and femoral arteries. Intima-media thickness (IMT), which is a coronary atherosclerosis marker, had verifiable increasing in the common carotid artery (CCA) and common femoral artery (CFA) in the case of patients with chronic heart disease (CHD). In patients with CHD using ultrasound we established high frequency of clinically non-manifested asymptomatic stenosis and thromboses of the internal carotid artery (ICA) and common femoral artery, as well as aneurysms of the abdominal aorta (AAA). Markers for CHD with high sensitivity were the atherosclerosis plaques of ICA and CFA as well as IMT of the CFA. The most sensitive and specific markers for CHD were the combination of the IMT and atherosclerosis plaques of CCA, ICA and CFA.
Conclusion. Ultrasound diagnostic is the method of choice for simultaneous non-invasive screening of carotid, peripheral and MFA and has sensitive markers for coronary atherosclerosis.
Lachezar Grozdinski, Mario Stankev and Kocho Dimitrovski
Efficacy of the Carotid Endarterectomy in Asymptomatic and Symptomatic Carotid Stenosis and in Patients with Multifocal Atherosclerosis
Aim. The aim of the research was to study the effect of carotid endarterectomy (CEA) at patients with asymptomatic and symptomatic carotid stenosis, also in the patients with multifocal atherosclerosis (MFA): carotid stenosis in patients with peripheral arterial disease (PAD) of the limbs and ischemic heart disease (IHD).
Material and methods. Colour Duplex Doppler was used for screening of carotid pathology in 1104 patients with PAD, IHD, transitory ischemic attacks and an ischemic stroke. The group of 205 patients who had stenosis of a. carotis interna >60%, were divided into three subgroups - patients with asymptomatic carotid stenosis (ACS), patients with symptomatic carotid stenosis (SCS) and patients with multifocal atherosclerosis MFA.
Results. All 205 patients were subjected to CEA, conducted by a patch or shunt, which was successful performed at 201 patients (98%). Significant improvement of hemodynamic of the regional carotid as well as intracranial arteries on the side of the surgery was determined using Colour Duplex and Transcranial Doppler Sonography (TDS). At a second stage, after the successful CEA, a vascular reconstruction was carried out or an aorto-coronary bypass created in the case of patients with MFA.
Conclusion. CEA in the case of patients with asymptomatic and symptomatic carotid stenosis and a concurrent MFA is an efficient curative method of removing the carotid pathology with a minimum percentage of vascular complications.
Irena Rambabova Bushljetikj, Gjulsen Selim, Olivera Stojcheva Taneva, Sasho Dohchev, Oliver Stankov, Sotir Stavridis, Skender Saidi, Kocho Dimitrovski, Beti Zafirova Ivanovska, Nikolina Basic Jukic and Goce Spasovski
Introduction. Monitoring of graft function by creatinine concentrations in serum and calculated glomerular filtration rate (GFR) is recommended after kidney transplantation. KDIGO recommendations on the treatment of transplant patients advocate usage of one of the existing mathematical equations based on serum creatinine. We compared clinical application of three equations based on serum creatinine in monitoring the function of transplanted kidney. Methods. A total number of 55 adult patients who received their first renal allograft from living donors at our transplant center in between 2011-2014 were included into the study. Renal allograft GFR was estimated by the Cockroft-Gault, Nankivell and MDRD formula, and correlated with clinical parameters of donors and recipients. Results. The mean age of recipients was 35.7±9.5 (range 16-58), and the mean age of donors was 55.5±9.0 (34- 77) years. Out of this group of 55 transplant patients, 50(90.91%) were on hemodialysis (HD) prior to transplantation. HD treatment was shorter than 24 months in 37(74%) transplant patients. The calculated GFR with MDRD equation showed the highest mean value at 6 and 12 months (68.46±21.5; 68.39±24.6, respectively) and the lowest at 48 months (42.79±12.9). According to the Cockroft&Gault equation GFR was the highest at 12 months (88.91±24.9) and the lowest at 48 months (66.53±18.1 ml/min). The highest mean level (80.53±17.7) of the calculated GFR with the Nankivell equation was obtained at 12 months and the lowest (67.81±16.7 ml/min) at 48 months. The values of Pearson’s correlation coefficient between the calculated GFR and the MDRD at 2 years after transplantation according to donor’s age of r=-0.3224, correlation between GFR and the Cockfroft & Gault at 6 and 12 months and donor’s age (r=-0.2735 and r=-0.2818), and correlation between GFR and the Nankivell at 2 years and donor’s age of r=-0.2681, suggested a conclusion that calculated GFR was lower in recipients who had an older donors. Conclusion. Our analysis showed difference in the calculated GFR with different equations at the same time points. Using one mathematical equation during the total post-transplantation period would be a recommended method in order to eliminate the discrepancy in determining the stage of kidney failure.