ABSTRACT
Six patients with advanced cirrhosis and portal hypertension had life-threatening upper gastrointestinal hemorrhage from esophageal varices. The varices were obliterated angiographically, using the transjugular approach, after which an intrahepatic portosystemic shunt was created in each case by inflating the balloon of a Grüntzig dilatation catheter in the needle tract between the portal and hepatic veins. All of the patients were expected to succumb quickly to their severe liver disease and massive variceal bleeding, but three of the six survived the initial hemorrhage, and two of these were discharged from hospital. There was an initial reduction of portal venous pressure of 10-15 mm Hg in all patients. All six shunts were patent angiographically 12 hr after the procedure. Two patients had venograms 5 days later and both shunts were patent. All six patients died within 6 months, but in three of the four postmortem examinations the shunts were easily identified and shown to be patent, the last of these 6 weeks after the procedure. These findings suggest that the technique could be of therapeutic value in the management of patients with portal hypertension.
Subject(s)
Assisted Circulation/methods , Catheterization/methods , Hepatic Veins , Hypertension, Portal/therapy , Portal Vein , Aged , Catheters, Indwelling , Esophageal and Gastric Varices/complications , Female , Gastrointestinal Hemorrhage/complications , Gastrointestinal Hemorrhage/therapy , Hepatic Veins/diagnostic imaging , Humans , Hypertension, Portal/complications , Liver Cirrhosis/complications , Male , Middle Aged , Phlebography , Portal Vein/diagnostic imagingABSTRACT
Percutaneous transluminal dilatation of 80 renal artery stenoses was attempted in 68 patients. The procedure was technically successful in 58 (85%) patients. Fifty (86%) of the 58 patients were initially cured or improved. Life-table analysis of this group gives a cumulative success rate of 81% for a 3 year period. Hypertension recurred in only seven patients. There were no deaths related to the procedure, but four major complications occurred, including two secondary nephrectomies.
Subject(s)
Angioplasty, Balloon/methods , Renal Artery Obstruction/therapy , Adolescent , Adult , Aged , Angioplasty, Balloon/adverse effects , Female , Follow-Up Studies , Humans , Hypertension, Renovascular/etiology , Hypertension, Renovascular/therapy , Male , Middle Aged , Nephrectomy , Renal Artery , Renal Artery Obstruction/complicationsABSTRACT
Nephrotomographic and angiographic features of adult polycystic kidney disease (Potter type 3) are well documented, although comments on plain film findings are scant. In 34 patients with adult polycystic kidney disease, we found non-visualization of 75% or more of the renal outlines on the abdominal plain film. This finding should raise the possibility of underlying polycystic disease.
Subject(s)
Kidney/diagnostic imaging , Polycystic Kidney Diseases/diagnostic imaging , Adolescent , Adult , Female , Humans , Male , Middle Aged , RadiographyABSTRACT
On rare occasions, arteriography of a renal cell carcinoma shows tumor vessels following the course of the renal vein and vena cava. In our cases, surgical exploration and microscopic examination showed that this appearance was due to tumor vessels arising from within the renal tumor and extending intraluminally within the venous system to supply the tumor.
