Magnetic resonance imaging of marrow heterotopia in haemoglobinopathy.

The MRI findings of masses of MH in three patients suffering from thalassaemia major, sickle-cell anaemia and thalassaemia intermedia, respectively, are presented. There was good correlation between the MRI findings and the conventional radiology or CT appearance of the masses. The masses produced a low intensity signal, similar to that of the adjacent marrow of the thoracic spine, while they were surrounded by a high-intensity signal rim attributed to a layer of fat surrounding the masses. The latter MRI finding is thought to be characteristic of MH masses.

Long-term experience in percutaneous transluminal dilatation of renal artery stenosis.

Percutaneous transluminal dilatation was attempted in 65 patients with renovascular hypertension. In five cases (8 percent), percutaneous transluminal dilatation could not be performed for technical reasons. In the remaining 60 patients (35 with atherosclerotic stenosis and 25 with fibromuscular dysplasia), both mean systolic and diastolic pressure fell immediately after percutaneous transluminal dilatation and remained significantly lower for a period of up to five years. Cure rates after a mean control period of 21.6 months were higher in patients with fibromuscular dysplasia (50 percent) than in those with atherosclerotic stenosis (29 percent). Improvement of blood pressure was observed in 32 percent of patients with fibromuscular dysplasia and in 48 percent of patients with atherosclerotic stenosis. Follow-up angiography in 33 cases showed occlusion of the dilated artery in two patients and recurrence of slight renal artery stenosis in nine patients. Successful redilatation could be performed in five of these cases. Furthermore, renal vein renin determinations were only of limited diagnostic or prognostic value. These results document the good long-term effect of percutaneous transluminal dilatation in patients with renal artery stenosis. Percutaneous transluminal dilatation should, therefore, be the favored procedure in patients with renovascular hypertension.

[Renovascular hypertension: surgery, dilatation or drugs?]. / Renovaskuläre Hypertonie: Operation, Dilatation oder Medikamente?

The effect of various therapeutic procedures (surgery, percutaneous transluminal dilatation and antihypertensive drugs) was analyzed in 161 patients with renovascular hypertension. The results show that each of the three methods effectively lowers blood pressure. However, marked differences in pretreatment clinical and laboratory data among the three groups were observed, which were most probably caused by different selection criteria before submitting the patient to a given therapeutic regime. The findings also demonstrate that, on the basis of the present analysis, a direct comparison between surgery, dilatation and medical therapy is not possible.

[Fibromuscular renovascular hypertension: comparison of surgery, transluminal dilatation and drug therapy]. / Fibromuskuläre renovaskuläre Hypertonie: Vergleich von Operation, transluminaler Dilatation und medikamentöser Therapie.

82 patients with fibromuscular renovascular hypertension have been studied. 33 patients were treated surgically (group I), 28 underwent transluminal dilation (group II) and 21 received drug treatment (group III). After a follow-up period of 2.5 (0.1-7) years, blood pressure in group I had decreased from 207 +/- 27/128 +/- 17 mm Hg to 135 +/- 15/85 +/- 9 mm Hg after surgery (p less than 0.001). 1.3 (0.1-4) years after dilation, group II showed a decrease of blood pressure from 174 +/- 25/107 +/- 13 mm Hg to 143 +/- 26/88 +/- 12 mm Hg (p less than 0.001). Blood pressure in group III decreased under drug therapy from 203 +/- 41/122 +/- 16 mm Hg to 146 +/- 19/92 +/- 8 mm Hg (p less than 0.001). 52% of the surgical patients and 50% of the dilated patients were cured, whereas 45% and 39% respectively were improved and 3% and 11% respectively did not improve. In group III, under antihypertensive drug therapy, blood pressure normalized in 62% of the patients, 33% showed better values and 5% did not improve. The complication rate was 11% in group I and 3.3% in group II. In two patients dilation was technically impossible. In group III one patient (4.8%) showed a massive but reversible increase of serum creatinine under captopril. In 70% of all patients the renal vein renin ratio was greater than or equal to 1.5. However, this ratio was unreliable as a parameter to predict the blood pressure decrease with curative methods. It is concluded from the above that all three methods offered good to very good results.(ABSTRACT TRUNCATED AT 250 WORDS)

[Clinical and angiographic follow-up of vascular injuries of the major arteries of the extremities]. / Klinische und angiographische Verlaufskontrolle nach Gefässverletzungen grosser Extremitätenarterien.

Eighteen patients with major vessel trauma were reviewed three years after the accident. The follow-up included clinical examination and angiography. The morphological results were compared to the applied surgical technique of vessel repair. In all of our patients the blood supply to the injured extremity was clinically sufficient. Optimal morphological results were observed in our study in patients with transverse end-to-end-anastomoses with single stitch suture. If a direct anastomosis was not possible we generally used an autologous vein graft. The simultaneous repair of concomitant vein trauma diminishes the danger of a compartment syndrome.

Transluminal dilatation of experimental hydronephrosis in dogs: acute and chronic effects, haemodynamic changes, and histological findings.

In the present study the feasibility and effectiveness of transureteral dilatation with a double-lumen balloon-tipped dilatation catheter was investigated. In 6 dogs with experimentally induced unilateral fibrotic stenosis and hydronephrosis a total of 13 dilatations were performed through a cutaneous ureteroneostomy. The stenosis diameter could markedly be distended from 1.7 +/- 0.9 to 4.8 +/- 1.6 mm (p less than 0.001). The pyelon size changed not significantly during the intervention. Follow-up urographies 1 week after dilatation revealed partial or total restenosis in all but 2 dogs. The stenosis diameter had decreased by 2.6 +/- 1.5 mm (p less than 0.01). The mean pyelon size changed only slightly (28.2 +/- 14.7 vs. 26.1 +/- 6.2 cm2). In the 2 dogs with persistent distension of the stenosis a reduction in pyelon size was achieved. Blood pressure during acute ureteral ligation showed no change. Follow-up studies after 1 week revealed a significant fall of the mean arterial pressure from 100 +/- 22 to 83 +/- 19 mm Hg (p less than 0.005), which was also seen at the long-term follow-up in 5 dogs 13 +/- 8 weeks after ureteral ligation. Histological analysis showed mild to severe inflammation and distension of the collecting system and mild to moderate inflammation, atrophy, and glomerular cysts in the renal parenchyma. Interestingly, the 2 dogs with a successful result of dilatation showed no relevant inflammation in the dilated stenotic segment. In conclusion, transureteral dilatation of experimental ureteral stenosis with a balloon catheter proved to have an impressive acute effect.(ABSTRACT TRUNCATED AT 250 WORDS)

Problem cases in renovascular hypertension.

The clinical course and response to therapy of 16 patients with various complex forms of renovascular hypertension were investigated. Reconstructive surgery and/or transluminal dilatation was either ineffective (n = 5) or could not be performed for technical reasons (n = 11). The group contained 7 patients with multilocular fibromuscular disease involving both renal arteries, two cases with multiple arteriosclerotic vascular occlusions, 3 patients with branch renal artery aneurysms, 3 with renal artery stenosis in a solitary kidney and one patient with renal artery stenosis and contraction of the contralateral kidney due to a non-vascular cause. With antihypertensive treatment, particularly with the angiotensin converting enzyme inhibitor captopril (n = 7), blood pressure could be reduced from 214 +/- 40/124 +/- 23 mm Hg to 145 +/- 23/88 +/- 9 mm Hg (P less than 0.001). In 11 of the 16 patients (69%) the values decreased to less than 160/95 mm Hg. These results suggest that, in complex forms of renovascular hypertension, antihypertensive treatment may be a potent therapeutic alternative if surgery and/or transluminal dilatation can not be performed or seem to have too high a risk.

A new concept of priapism based on the results of arteriography and cavernosography.

Four patients with priapism - 3 with idiopathic and 1 with post-traumatic etiologies - were examined by arteriography and cavernosography. The findings of these examinations as well as distinct clinical findings suggest that there are 2 different types of priapism. One is characterized by severe blood stasis within the corpora cavernosa with resulting compression of the deep arteries of the penis and reduction of arterial blood flow. In the other type, arterial flow into the corpora cavernosa and drainage into the veins are substantially increased. In this type, long-standing priapism does not seem to produce fibrosis of the corpora cavernosa with resulting impotence.

[Renovascular hypertension: comparison between transluminal dilatation and surgical procedures]. / Renovaskuläre Hypertonie: Vergleich zwischen transluminaler Dilatation und operativen Verfahren.

Percutaneous transluminal dilatation (PTD; n = 45) was compared with surgical procedures (n = 51) in 96 patients with renovascular hypertension. Since cases with atherosclerotic stenosis (ASS) are known to show a different response to surgery than those with fibromuscular dysplasia (FMD), group-specific analysis was performed. In their two subgroups (ASS and FMD) both surgical and dilated patients showed comparable mean age and sex distribution and serum creatinine. However, differences were observed in mean duration of hypertension and in pretreatment blood pressure values: surgical patients with ASS and FMD showed a lower mean duration of hypertension (operation: ASS 3.2, FMD 1.9 years; PTD: ASS 5.1, FMD 3.4 years) and higher mean blood pressure values (surgery: ASS 207/121, FMD 209/126 mm Hg; PTD: ASS 199/115, FMD 175/108 mm Hg). After a mean observation period of 2.6 years mean blood pressure fell in the surgery group to 147/90 mm Hg in the 26 cases with ASS, and to 139/87 mm Hg in the 25 patients with FMD. In dilated cases respective blood pressure values were 145/90 mm Hg (ASS, n = 17) and 132/84 mm Hg (FMD, n = 11). These results show a comparable blood pressure lowering effect for surgery and dilatation in renovascular hypertension. In cases with lengthy stenosis or involvement of primary branches of the renal artery and in those with aortic or poststenotic renal aneurysm a surgical technique should be performed, whereas in the remaining cases PTD represents a favourable procedure.

Arteriography of the penis in secondary impotence.

Twenty-four men aged 20-67 years (mean 42 years) were examined by selective arteriography for secondary impotence. The angiographic technique used as well as the normal anatomy and its variations are described. Arterial occlusive disease of vessels leading to the penis and the corpora cavernosa was found in 71% of the patients examined. This high incidence of arterial occlusive disease corresponds with the findings of other authors. The significance of these findings is discussed. In our limited experience of 3 patients, arterial anastomosis from the inferior epigastric artery to the corpora cavernosa has not been successful.