Elective embolization for prevention of hemorrhage from renal angiomyolipomas.

PURPOSE: Among angiomyolipomas 4 cm or larger, 82%-94% are symptomatic and 50%-60% bleed spontaneously. Up to one-third of patients with these lesions present in shock. The effectiveness of elective embolization was evaluated in the prevention of bleeding from large (> or = 4 cm) angiomyolipomas while sparing the normal renal parenchyma. PATIENTS AND METHODS: Five cases from the authors' institution and 21 cases from the literature were reviewed retrospectively. RESULTS: Embolization as the sole means of treatment was effective in 90% of patients over a follow-up period from 2 months to 7 years (mean, 21 months). There were no complications at the authors' institution. Serious procedure-related complications reported in the literature were limited to two cases of aneurysm rupture and two necrotic tumors requiring percutaneous drainage. CONCLUSION: Embolization of renal angiomyolipomas is safe and well tolerated and may be of benefit in preventing life-threatening hemorrhage.

Double-blind study of the safety, tolerance, and diagnostic efficacy of iopromide as compared with iopamidol and iohexol in patients requiring aortography and visceral angiography.

RATIONALE AND OBJECTIVES: Nonionic contrast media have been shown to be more effective, better tolerated, and safer than standard high-osmolality contrast media when given intravascularly. The aim of this study was to assess the diagnostic efficacy, tolerance, and safety of a new nonionic contrast agent, iopromide (370 mg I/mL), in comparison with two available similar agents, iopamidol (370 mg I/mL) and iohexol (350 mg I/mL), in two randomized, double-blind clinical studies of patients undergoing abdominal aortography and visceral angiography. METHODS: The iopromide group included 80 patients, and the comparator group consisted of 36 iopamidol and 45 iohexol patients. The quality and diagnostic efficacy of all three contrast agents was rated equally as either good or excellent. RESULTS: On a scale of 0 (none) to 3 (severe) for heat and pain, respectively, the mean scores were 1.08 and 0.43 for iopromide in comparison with 1.15 and 0.35 for the comparator media. Minor adverse clinical experiences were noted in 23% of the iopromide group versus 20% of the comparator group. Nausea and vomiting were more common in the comparator group (7% versus 3%), and headache was noted only in the iopromide group (4%). There were no clinically significant changes in laboratory values in any group. Three severe adverse experiences occurred, but all were deemed unrelated to the contrast agents. CONCLUSION: Based on the results of this study, iopromide appears to be efficacious, safe, well tolerated, and comparable with iohexol and iopamidol for use in abdominal aortography and visceral angiography.

Percutaneous fenestration of a type I aortic dissection for relief of lower extremity ischemia.

A 36-year-old patient underwent successful percutaneous fenestration of a type I aortic dissection which had caused occlusion of the right common iliac artery and ischemia of the right lower extremity. The patient is currently (6 months post-fenestration) ambulating without any signs of vascular compromise. The technique may be useful in patients who are at high risk for surgical procedures.

Clover leaf inferior vena cava filter: in vitro evaluation of filter deployment and comparison of emboli-capturing ability.

A new self-centering stainless steel inferior vena cava filter (clover leaf filter) that can be delivered percutaneously through a 10-F catheter has been developed. The filter is loaded into an angiographic catheter as a set of straightened wires that are mechanically deformed into a predetermined clover leaf shape when the device is delivered. The filter can be deployed easily and effectively into the simulated vena cava. Emboli-capturing efficiency of the new filter was compared in vitro to that of the Greenfield and Bird's Nest inferior vena cava filters. All three filters captured all large 5 x 100-mm, potentially fatal emboli. The clover leaf filter captures more of the smaller (5 x 20-mm and 3 x 20-mm) emboli than the Greenfield filter and less than the Bird's Nest filter.

Concomitant development of granulocytosis and enhancement of metastases formation in tumor-bearing mice.

The experiments reported here show concomitant development of granulocytosis and enhancement of metastasis formation in C3Hf/Kam mice bearing NFSA fibrosarcoma. Both phenomena developed at approximately 2 weeks after s.c. transplantation of tumor cells, at a time when the tumor was approximately 10 mm in diameter. The number of granulocytes in the blood doubled approximately every 3.5 days, reaching about 30 times control levels shortly before the death of the mice. The magnitude of the metastasis enhancement formation by i.v. injection of tumor cells was three to four times the control value. Mice bearing NFSA had a significant increase in the number of endogenous CFUs. Plasma from NFSA-bearing mice and medium from cultured NFSA cells stimulated in vitro growth of granulocyte and macrophage colonies from normal bone marrow cell precursors, and induced granulocytosis upon i.v. injection into normal mice. This shows that NFSA tumor secretes factor(s) with potent granulopoietic activity. Injection of plasma from tumor-bearing animals followed by i.v. injection of NFSA cells did not lead to the enhancement of metastasis, implying that granulocytosis might be rather concomitant manifestation than a causative factor of the enhancement of metastasis formation. Importance of granulocytosis as a paraneoplastic manifestation during tumor growth is discussed.