Juxtaglomerular cell tumor.

A 15-year-old female with primary reninism presented with benign hypertension, normokalemia, normal aortagram and normal intravenous pyelogram. The diagnosis was suggested only by a remarkably elevated plasma renin activity (PRA). Selective catheterization of renal vein branches was necessary to make the diagnosis of a tumor. A local resection of the tumor resulted in normalization of blood pressure and PRA. Prior to the definitive surgery, oral propranolol was effective in lowering PRA and blood pressure.

Unusual cause of acute abdomen. Sickle cell trait and nonhypoxic splenic infarction.

Splenic infarction under hypoxic conditions is a well-known complication of sickle cell trait (Hgb AS). However, this case illustrates that it may occur without any clinical conditions of circumstances associated with decreased Pao2. In addition, sickle cell trait should be included in the differential diagnoses of splenic infarction even if the patient is not of African ancestry.

Structure of a juxtaglomerular cell tumor: the presence of a neural component: a light and electron microscopic study.

A 15-year-old girl with hypertension, markedly elevated plasma renin activity, and normal aortogram had a well encapsulated tumor nodule removed from the right kidney. Following surgery, the plasma renin activity and blood pressure became normal and have remained so for the past 12 months. The tumor consisted of juxtaglomerular cells filling the interstitium between endothelium-lined vascular spaces. Electron microscopy disclosed the presence in the interior of the tumor, of unmyelinated nerve bundles with varicosities containing the small, densely cored vesicles characteristic of adrenergic nerves. Nerve terminals were in contact with the juxtaglomerular tumor cells. No basement membrane material was interposed between the nerve endings and the tumor cell; the width of the gap between the two plasma membranes was approximately 150 A. The presence of sympathetic fibers in the juxtaglomerular cell tumor underscores the close biologic relationship between the sympathetic and renin systems.

Segmental intrarenal catheterization in renin-mediated hypertension.

Segmental renal vein blood was collected in 9 hypertensive patients who had a focal renal lesion on excretory urography and/or a high peripheral plasma renin activity. The main renal vein catheterization was normal in all patients. Segmental renal vein catheterization demonstrated a renin-producing lesion in 3 patients, all of whom were cured of the hypertension postoperatively. Segmental renal vein catheterization is safe and allows the recognition of increased renin production from focal lesions of the kidney that may not be demonstrated radiographically or by main vein catheterization.

Ultrasonic diagnosis of a popliteal artery aneurysm.

Ultrasound techniques are very effective in screening painful masses of the popliteal space. These techniques easily differentiate popliteal cysts from thrombophlebitis, and in addition permit sequential evaluation without patient discomfort or invasion. We report its use in diagnosing a popliteal artery aneurysm, another cause of a painful popliteal mass.

Fine needle cholangiography in the diagnosis of persistent jaundice. A case report.

The fine needle technic utilizes a sleeveless, thin, flexible needle for transhepatic cholangiography. This needle can enter small or normal bile ducts in a high percentage of patients. The value of fine needle cholangiography is illustrated in a patient with a stenosis of the common hepatic duct and a left hepatodochalduodenal fistula which eluded diagnosis by all other methods. The use of this technic is described as an alternative procedure to endoscopic retrograde cholangiography when the latter is technically impossible or as an adjunct to intraoperative extrahepatic cholangiography.

The value of preoperative saphenous venography for graft evaluation in femoral arterial occlusive disease.

We reviewed the results of preoperative bilateral ascending phlebography in 23 patients who had femoral arterial occlusive disease; seven of the 40 successful saphenous venograms showed significant abnormalities. Varicosities, congenital duplications, superficial or deep thrombophlebitis and saphenous vein length were clearly identifiable. Correlation of the radiographic sphenous diameter with the operative measurement was poor. Nevertheless, four of the 21 patients were spared unnecessary surgery because we had determined by preoperative venography a better vein for autograft than the ipsilateral saphenous vein.

Correlation of the ultrasonic appearance of the portal vein with abdominal arteriography.

The ultrasonic appearance and location of the portal vein is documented by correlation with abdominal arteriography. Five patients were studied by both methods. Various characteristic appearances of the portal vein are presented. The importance of localization of the portal vein during an ultrasonic pancreatic examination is discussed.

Value of gallbladder B-scan ultrasonography.

The gallbladder B-scans of 20 patients who had subsequent surgery were separated into three categories based upon certain sonographic criteria. Our data, in this limited series, revealed gallbladder pathology in each patient who had any one or combination of the following scan characteristics: (1) internal echos, (2) irregular wall, or (3) absence of recognizable gallbladder sonolucency. The category which demonstrated a normal sonographic gallbladder, namely a smooth wall and no internal echos, contained a number of false negatives which proved to have either small stone cholelithiasis or extraphepatic ductal obstruction. Within the described limitations, the B-scan can be a valuable test in confirming the significance of a radiographically nonvisualized gallbladder or in detecting a biliary tract lesion in a patient with a disease entity that precludes radiographic visualization by conventional techniques.

The 'septation sign' in multicystic dysplastic kidney.

The case report is presented of a neonate with a unilateral multicystic dysplastic kidney. An intravenous pyelogram revealed septations throughout this kidney with late pooling of contrast media within the cystic structures. The pathological data stresses the presence of normal appearing glomeruli interspersed between the dysplastic cystic parenchyma. The possible etiologies for the septation sign and pudding phenomenon are discussed.

Tuberculous enteritis. Review of a protean disease.

Prior to the advent of antituberculosis drugs, at least 70% of patients with far advanced pulmonary tuberculosis had tuberculous enteritis. Despite the effectiveness of drug therapy, overt cases of tuberculous enteritis occur in the United States and particularly among immigrants from endemic areas. Clinicians often forget to consider this entity. The patient may have no or minimal abdominal complaints. Vague abdominal distress, anorexia and weight loss can be overlooked because of the extensive pulmonary exudative or cavitary disease. Even after an enteric lesion is identified, often it is mistaken for other entities, particularly neoplasm or Crohn's disease. Obviously, the diagnosis is difficult but certain radiological criteria can be indicative of the disease. This report demonstrates the protean manifestations of this entity, the complications which occur despite drug therapy and the need for continued awareness of its existence.