Semiquantitative assessment of lower limb atherosclerosis from routine angiographic images.

In the present report a score system is introduced with the aim of analysing routine angiographic images. The system consists of a vectorial score, which codes the pattern of occlusions, stenoses and plaques, and of an additive score describing the severity of the lesions visualised. The technique is suitable for computerised data analysis.

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.

Renal venous renin activity in various forms of curable renal hypertension.

The diagnostic and predictive value of renal venous renin determinations was investigated in 73 patients who had various forms of hypertension associated with unilateral renal disease and who were operated upon. Patients with fibromuscular hyperplasia showed a markedly higher cure rate than cases with arteriosclerotic renal artery stenosis (64% vs. 25%) and were less frequently not improved (4% vs. 12%). Patients with unilateral (non-vascular) small kidney and patients with unilateral hydronephrosis showed comparable high cure rates (53% and 50%, respectively), whereas in no patient with a unilateral renal cyst did postoperative blood pressure return to normal. In the present study no statistically significant correlation was found between postoperative pressure reduction and PRA-ratios in either the whole group of patients or in the various subgroups. A negative PRA-ratio (less than or equal to 1.4) was found in 36% of all cured patients. In particular, cured patients with fibromuscular hyperplasia showed a high percentage (38%) of falsely negative tests. As expected, characteristic differences were observed in simple clinical data between cured and improved patients. Patients with normal postoperative blood pressure were significantly young (34.7 +/- 13.6 years) than improved cases (47.3 +/- 10.8 years; P less than 0.001) and cured patients showed lower preoperative blood pressure values (192 +/- 29/119 +/- 15) than improved ones (214 +/- 31/126 +/-117 mm Hg). Thus our results document a limited prognostic value of renal venous renin determination in patients with hypertension due to unilateral renal disease.

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.

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.

[Venographic and laboratory investigation of pheochromocytoma (author's transl]. / Phlebographisch-laborchemische Phäochromozytomabklärung.

Twenty-eight patients with the clinical diagnosis of pheochromocytoma were studied by adrenal venography and catecholamine determination in selective venous blood sampling. Results of this technique are correlated to pathologic findings. 87% of the existing pheochromocytomas were correctly identified. In cases with corresponding venographic and laboratory results correct preoperative tumor localization was established in 97%. False interpretations are discussed in relation to the phlebographic findings and the assay of the catecholamines.

[The arteriographic appearances of the hypothenar hammer syndrome (author's transl)]. / Das arteriographische Bild des Hypothenar-Hammer-Syndroms.

The characteristic angiographic appearances found in the superficial palmar arch are described in five cases of the hypothenar hammer syndrome. The symptoms depend on the anatomical peculiarities of the arteries in the hand, the extent of the causative lesion and the condition of the peripheral digital arteries. The condition is probably more common than is thought. It can be differentiated from other vascular abnormalities of the hand by angiography.

[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.