Diagnosis of renovascular disease by extra- and intrarenal Doppler parameters.

It is still a matter of debate as to which parameters should be used for noninvasive diagnosis of renovascular disease by renal Doppler sonography (RDS). The accuracy of RDS in the detection of renal artery stenosis (RAS) was tested in 95 consecutive, moderate to severe hypertensive patients (I-II World Health Organization [WHO] stages). Reno-aortic ratio (RAR) for peak systolic velocity (PSV) was also calculated to assist in the diagnosis of significant (>50%) RAS. Paired receiver-operating characteristic (ROC) analysis was plotted for evaluating the relationship between sensitivity and specificity for each parameter. In a subset of 57 kidneys, the influence of blood pressure and age on intraparenchymal parameters was evaluated. Measurements of maximal peak systolic velocity (PSV) at the site of stenosis, RAR for PSV, and minimum acceleration index in the main renal artery showed high accuracy (areas under the ROC curve 0.97, 0.88, and 0.80, respectively). Among intraparenchymal parameters, early systolic acceleration showed the best area under the ROC curve (0.90), but provided a low positive predictive value (29%) and was significantly influenced by blood pressure (multiple r=0.56; p=0.001). Pulsatility and resistive indices were found to be less powerful as absolute values, and both significantly influenced by blood pressure and age (multiple r=0.60 and 0.50; p=0.001, p=0.02, respectively). However, interindividual variance of intrarenal indices should be minimized by calculation of side difference, although this procedure would become misleading or impossible in patients with bilateral RAS or a single kidney, respectively. These results support the use of extraparenchymal parameters for noninvasive detection of RAS, and emphasize that intrarenal parameters cannot be considered as absolute values.

Ovarian varicocele: ultrasonic and phlebographic evaluation.

The aim of this work is to suggest a new diagnostic approach to the "female varicocele syndrome" which utilizes transvaginal ultrasonography. The presence of circular or linear anechogenic structures with a diameter greater than 5 mm, which were found in transverse and oblique sections of the lateral fornices, was indicative of pelvic varices. The vascular nature of these structures was confirmed with the Valsalva's maneuver and in the upright position. The presence of "pelvic varices" was confirmed by retrograde phlebography of the left ovarian vein in 46% of the cases. In such cases the parity was greater than in subjects without "pelvic varices" (chi square = 12.75, p less than 0.001), and the principal symptoms were characterized by pelvic pains and menstrual cycle disorders.

Radiologic anatomy of the genital venous system in female patients with varicocele.

The diagnosis of varicocele in a female patient is difficult clinically. Until recently, only celioscopy and uterine phlebography were helpful. We have developed a new method for diagnosis of the pelvic varicocele using retrograde phlebography of the ovarian and iliac veins. Thirty-three women with pelvic pains and disorders of the menstrual cycle have been studied. In 15 patients, an insufficiency of the left ovarian vein was revealed. In three of the patients, an analogous insufficiency of the right ovarian vein was also recognized, along with chronic bilateral stasis in the pampiniform plexes. An insufficiency of the left iliac vein was present in seven of the patients without ovarian varicocele. The average age of the women without ovarian reflux was lower (22.5 years) than that of women with reflux (36.6 years) (p less than 0.01). In this last group of patients, the number of pregnancies was greater (30 children) than in the group without reflux (two children) (chi-square = 12.75; p less than 0.001). This indicates how parity plays an important role in the determination of the appearance of a varicocele. We conclude that the diagnosis of pelvic varicocele may be made by a new diagnostic method represented by retrograde phlebography of the ovarian and iliac veins. The use of it in patients with chronic pelvic pains and disorders of the menstrual cycle of unknown nature can be done routinely.

[Role of gonadal phlebography in the diagnosis of cryptorchidism]. / Ruolo della flebografia gonadica nella diagnostica del criptorchidismo.

The authors describe the diagnostic procedures for testicular localization in patients with non palpable undescended testes. They consider the procedures as invasive and non invasive. The first procedures include ultrasonography, C.T. and N.M.R., the second ones laparoscopy, selective arteriography and venography of the spermatic vessels. Anatomy of spermatic venous system and catheterization techniques are described. Conclusions are that when non invasive procedures fail to localize the testis, gonadal venography is the procedure of choice for the correct diagnosis. Preoperative testicular localization often reduces the extent of surgical exploration and the anesthesia time. These patients have to undergo surgical treatment also when gonadal venography shows a blinding end vein in the inguinal canal, because of the intra-abdominal testis possible degeneration.

[Diagnostic value of pan-cavography in obstructed central venous return of intrinsic causes]. / Contributo diagnostico della pan-cavografia nell'ostacolo al ritorno venoso centrale da cause intrinseche.

The authors, after having analyzed the clinical patterns and the causes producing cava syndrome, propose a sequential diagnostic approach to it, whose course makes use of radiological procedures more or less invasive, and of endoscopic and histobioptic techniques. Among radiological investigations pan-cavography has allowed the authors to formulate the diagnosis of limited venous return because of intrinsic causes, conferring so an aetiological connotation and a physiopathological correlation indispensable for a correct and rapid therapy of the uncommon "intrinsic cava syndrome" of two patients, suffering respectively from "idiopathic thrombosis of superior vena cava, concerning also the beginning of inferior vena cava" and from "Fiedler cardiomyopathy".