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A 50-year-old man with the rare McLeod syndrome, associated with glomerular lesion to the end stage of chronic renal failure and death, is reported. McLeod syndrome is an X-linked recessive disorder on the basis of abnormal expression of the Kell blood group antigens and absence of erythrocyte surface Kx antigen. Most often the clinical and pathological findings are retinitis pigmentosa to blindness, progressive chronic neuropathy, cortical atrophy, dilated cardiomyopathy, and glomerular lesion with chronic renal failure. Among the laboratory parameters the most important are very low level of cholesterol and triglycerides, then various numbers of acanthocytes in peripheral blood smears and sometimes in urine (as in our case).

In order to validate ultrasonographic criteria for various degrees of carotid stenosis, patients who underwent digital subtraction angiography (DSA) of carotid arteries were retrospectively analyzed. Data on 91 patients with symptomatic carotid disease who first underwent ultrasonography followed by DSA were evaluated. Color Doppler criteria were previously set for four categories of internal carotid artery (ICA) stenosis: mild, moderate, severe, and occlusion. DSA classified ICA stenosis into the same categories. Spearman’s Rank Correlation Coefficient was calculated. Spearman’s Rank Correlation Coefficient between ultrasound and angiography in detecting various degrees of carotid stenosis was 0.86. Ultrasonographic criteria for detection of severe ICA stenosis showed a sensitivity of 75%, specificity of 98%, false positive ratio of 20%, false negative ratio of 25%, positive predictive value of 95%, negative predictive value of 85%, and accurate diagnosis of 88%. Ultrasonographic criteria for ICA occlusion showed a sensitivity of 82%, specificity of 98%, false positive ratio of 10%, false negative ratio of 18%, positive predictive value of 94%, negative predictive value of 95%, and accurate diagnosis of 95%. Our combination of various ultrasonographic parameters was sensitive for detection of various degrees of carotid stenosis, with a very high specificity, thus providing highly positive predictive values for such a classification. A lower sensitivity was obtained due to the lower sensitivity of angiography in detecting minimal flow in near-occluded ICAs., Podaci bolesnika u kojih je učinjena digitalna subtrakcijska angiografija (DSA) karotidnih arterija analizirani su kako bi se postavili ultrazvučni kriteriji za određivanje različitih stupnjeva karotidne stenoze. Procijenjeni su podaci za 91 bolesnika sa simptomatskom karotidnom bolešću u kojih je najprije učinjen obojeni dopler karotidnih arterija, a nakon toga DSA. Karotidne stenoze su svrstane prema ultrazvučnim kriterijima u četiri kategorije: blaga, umjerena, uznapredovala stenoza i okluzija. Prema DSA karotidne stenoze svrstane su u iste četiri kategorije. Stupanj korelacije testiran je pomoću Spearmanovog koeficijenta korelacije. Spearmanov koeficijent korelacije kategorija stenoze ultrazvuka i DSA bio je 0,86. Kombinacija ultrazvučnih kriterija za otkrivanje uznapredovale karotidne stenoze pokazala je osjetljivost od 75%, specifičnost od 98%, odnos lažno pozitivnih od 20%, odnos lažno negativnih od 25%, pozitivnu prediktivnu vrijednost od 95%, negativnu prediktivnu vrijednost od 85%, te točnost dijagnostičkog testa od 88%. Kombinacija ultrazvučnih kriterija za otkrivanje okluzije unutarnje karotidne arterije pokazala je osjetljivost od 82%, specifičnost od 98%, odnos lažno pozitivnih od 10%, odnos lažno negativnih od 18%, pozitivnu prediktivnu vrijednost od 94%, negativnu prediktivnu vrijednost od 95% i točnost dijagnostičkog testa od 95%. Naša kombinacija različitih ultazvučnih parametara pokazala se vrlo osjetljivom u otkrivanju različitih stupnjeva karotidne stenoze, s vrlo visokom specifičnošću i pozitivnom prediktivnom vrijednošću. Niža osjetljivost ultrazvuka dobivena je zbog slabije osjetljivosti angiografije u prikazu minimalnog protoka.