Stenosis and renographic characteristics in renovascular disease.

UNLABELLED: This study was designed to determine the degree of renal artery stenosis (RAS) which produces changes in renographic parameters. METHODS: The angiographic severity of luminal narrowing in RAS was compared to 131I-hippuran renographic characteristics in 72 patients who have been selected for renal angiography because of suspected renovascular hypertension. RESULTS: Significant differences in Tmax, T1/2 and counts under the curve to Tmax were apparent at 30% of arterial luminal narrowing when stenotic and nonstenotic kidneys were compared. In patients with unilateral RAS, the difference in counts under the Tmax curve between pairs of kidneys was also significantly different at 30% of stenosis. Patients with bilateral stenosis, on the other hand, could not be differentiated well from patients with essential hypertension because the Tmax value on either side or the difference of Tmax between the two kidneys and the values of the other parameters were similar, except for the difference in counts to Tmax. Based on these findings it seems that bilateral RAS does not "mimic" unilateral stenosis in renographic terms, but rather, resembles a normal situation. CONCLUSION: Significant renographic changes can occur at 30% of arterial luminal narrowing in renal artery disease.

[Ultrasonography of the leg veins is cost-effective and can be the preferred diagnostic study in suspected pulmonary embolism]. / Bij vermoeden van longembolie kan echografie van de beenvenen onderzoek van eerste keuze zijn omdat het kosteneffectief is.

OBJECTIVE: To determine whether compression ultrasound examination of both legs, to detect deep venous thrombosis, can be the examination of first choice in patients clinically suspected of pulmonary embolism, assuming that the therapy of thrombosis is the same as the therapy of embolism. DESIGN: Prospective study. SETTING: St. Clara Hospital, Rotterdam, the Netherlands. METHODS: 337 consecutive patients (157 women and 180 men, mean age 65 years, SD: 17.4) suspected of pulmonary embolism underwent compression ultrasound examination of the femoral and popliteal veins to detect deep venous thrombosis, and perfusion lung scintigraphy, with ventilation scintigraphy if indicated. Ultrasound examinations and lung scans were interpreted independently and blinded. A financial analysis of the various strategies was made. RESULTS: Deep venous thrombosis was demonstrated ultrasonographically in four (2%) of 208 patients with a normal lung scan, in four (9%) of 43 patients with a non-diagnostic lung scan, and in 30 (35%) of 86 patients with a high probability lung scan. By starting the diagnostic investigation with ultrasound examination 38 lung scans and chest X-rays would be saved at the cost of 294 extra ultrasound examinations. Because ultrasound examinations are relatively inexpensive a cost reduction of 3.4% would be realised, for the Netherlands approximately 1.4 million guilders. In the United States, however, costs would increase because of the high prices of ultrasound examinations. CONCLUSION: Compression ultrasound examination of both legs can be the examination of first choice in the Netherlands in patients suspected of pulmonary embolism, as it is cost effective.

Potassium supplements prevent serious hypokalaemia in colon cleansing.

The association between colonic cleansing and hypokalaemia was studied prospectively by monitoring the serum potassium levels in four groups of patients: groups 1 (55 patients), 2 (72 patients), and 3 (97 patients) received the same 2-day preparation of 15 g magnesium sulphate and 10 mg bisacodyl twice daily; group 4 (96 patients) received a 1-day preparation of 2.4 mg sennoside per kg of bodyweight. Groups 1 and 2 were on diuretics, but only group 2 received potassium supplementation. Serum potassium levels were measured before and after bowel preparation. Hypokalaemia was present prior to cleansing in six (11%), and after cleansing in 20 (36%) of the 55 patients in the group 1 patients on diuretics but without potassium supplements. There was, after cleansing, no significant fall in serum potassium in the group 2 patients on diuretics who received potassium supplements. No hyperkalaemia resulted from supplementation. A significant fall of the mean level of serum potassium occurred in patients in both group 3 (2-day-preparation) and group 4 (1-day-preparation). We conclude that both 1 day and 2 days of cleansing with cathartics may result in a significant fall in serum potassium, which can be prevented by oral potassium supplements. Potassium supplements (three times a day 15 ml of potassium chloride with 0.9 mmol K per ml during the preparation) in patients on diuretics may be prudent to avoid the risk of cardiac arrhythmia.

Painful irritable bowel syndrome and sigmoid contractions.

Fifteen patients with abdominal pain compatible with the irritable bowel syndrome (IBS) were examined by barium enema and pressure recording. Strong circular contractions of the sigmoid colon and pressure recordings correlated with the characteristic pain in 13 of the 15 patients. In 15 control patients no pain occurred. It is concluded that pain and high pressure are caused by strong circular sigmoidal contractions. Such findings enable the radiologist to contribute to the diagnosis of IBS.

[Motility of the sigmoid in irritable bowel syndrome and colonic diverticulosis]. / Motiliteit van het sigmoïd bij 'irritable bowel syndrome' en diverticulosis coli.

The results of pressure recording in patients with irritable bowel syndrome, diverticulosis and diverticulosis with pain were compared with the results in control subjects. The motility showed variable higher values in patients with irritable bowel syndrome. The motility was clearly higher in patients with diverticulosis and in patients with diverticulosis with pain. The patients with irritable bowel syndrome were younger than the patients in the two groups with diverticulosis. These findings are consistent with the hypothesis that the irritable bowel syndrome is an aetiologic factor in diverticulosis.

Total talar dislocation.

Five patients with the very rare injury of a total dislocation of the talus were retrospectively studied. Rapid open reduction had successfully been performed in all patients. The mean followup was 4.5 years. Two cases developed an avascular necrosis of the talus. No talectomy was performed. The clinical results were good in three and fair in two patients. It is concluded that the choice of treatment is a rapid open reduction. In case of an avascular necrosis of the talus, weight bearing must be postponed. A talectomy must be avoided.