Arterial blood supply of the left lobe of the canine pancreas. I. Anatomic variations relevant to segmental transplantation.

The anatomy of the arterial blood supply of the left lobe of the pancreas was studied in 70 beagles. It was found to be supplied by one small artery only, which was called the pancreatic artery. The pancreatic artery originated from the splenic artery (type I) in 56 dogs (80%). However, it originated from the cranial mesenteric artery (type II) in 14 dogs (20%). In the presence of type I anatomy, the surgical technique for segmental pancreatic transplantation can, in general, be performed in a routine fashion. In the presence of type II anatomy, a modification should be applied. This modification is described and illustrated. It is concluded that the pancreatic artery should always be identified at operation, and that the specific surgical procedure chosen should depend upon the anatomy found. In addition, ischemic necrosis of segmental pancreatic grafts can only be explained by vascular thrombosis if the pancreatic artery has been recognized and preserved with certainty at transplantation.

Iohexol vs. ioxaglate in lower extremity angiography: a comparative randomized double-blind study in 80 patients.

The aim of this study was to detect clinically relevant differences between iohexol 300 mgI/ml and ioxaglate 320 mgI/ml in lower extremity arteriography. In this randomized double-blind study, 40 patients were examined with iohexol and 40 patients with ioxaglate. Adverse events were evaluated by recording the time of onset and the duration of possible adverse events: during or immediately following the contrast medium injections, after 6 h, and after 24 h following these injections. Heat and pain were scored on visual analog scales. The amount of contrast medium and possible thromboembolic complications were noted. Image quality was evaluated. There were no significant differences in the total amounts of contrast agent administered (ioxaglate mean 121.5 ml vs. iohexol 125.1 ml), scores for heat (ioxaglate mean 6.1 vs. iohexol 6.1) and pain (both agents mean 2.35). Nausea/vomiting was noticed significantly more frequently with ioxaglate (ioxaglate seven patients vs. iohexol one patient (chi 2, P < 0.05)). Thromboembolic complications were not detected. Opacification of vessels was optimal in all patients. No clues were found indicating that one of the agents was better tolerated 6-24 h after the procedure than the other. Nausea/vomiting occurred significantly more frequent with ioxaglate; no further clinically relevant differences were detected.

Computed tomographic demonstration of a bileoma.

The authors present a case of a massive extrahepatic bile collection diagnosed by Computerized Tomography (CT). The appearance could not be differentiated from a subcapsular haematoma or hepatic cyst. Percutaneous aspiration not only confirmed the diagnosis but also cured the patient. Previous ultrasound examination had been misinterpreted as normal due to omission of A scale review.

Systemic infection with Nocardia asteroides cured with amoxicillin/clavulanic acid, erythromycin and ultrasound-guided transcutaneous aspiration.

A case is presented of systemic nocardiosis. The patient was completely cured by unconventional antibiotic therapy and simple transcutaneous needle aspiration.

Mycotic aneurysm after aortic bifurcation prosthesis.

Fever in the presence of an intravascular graft will focus the clinical investigation on an infection of this graft. This case report describes an uncommon cause of fever in a 75-year-old patient, namely a mycotic aneurysm of the aortic stump.

[Renal artery reconstruction for renovascular hypertension]. / Nierarteriereconstructie wegens renovasculaire hypertensie.

Between 1959 and 1983, 172 patients were treated for hypertension by reconstruction of a renal artery. Reconstruction was preferably performed with autologous material. In a selected group of 29 patients with lesions in the distal renal artery or the hilar branches, an extracorporeal reconstruction with autotransplantation was performed. After a mean follow-up of 8.4 years the hypertension was cured or improved in 82% of the patients. In patients with an arteriosclerotic renal artery stenosis this result was favourably influenced by a short duration of hypertension before the operation. Their life expectancy after the operation was clearly favourably influenced by a beneficial blood pressure response even if arteriosclerotic lesions of coronary arteries, extracranial vessels and/or peripheral vessels were present before the renovascular operation. In selected patients, renal artery reconstruction for treatment of hypertension yields excellent short-term and long-term results, not only with regard to the blood pressure response but also with respect to the patients' life expectancy.

Hepatic artery bolus infusion chemotherapy with mitomycin C. Angiographic results and complications.

Superselective catheterization of the hepatic artery and subsequent infusion of chemotherapeutic agents is an accepted treatment of inoperable hepatic neoplasms. In this article the results of 85 hepatic arterial infusions in 37 patients with biopsy-proven malignancies of the liver, treated in a period of 4 years, are described. Treatment consisted of a bolus injection of mitomycin C for a 10-min period. In 9 catheterizations (10.6%) a dissection of the hepatic artery occurred, followed by occlusion in 5 cases (5.8%). Gastric ulcers were seen in 2 patients, without evidence of displacement of the catheter. In 1 patient the catheter did displace leading to toxic gastritis, and subsequent pulmonary complications led to the patient's death. The response rate appeared to be 42% for colorectal cancer and 70% for breast cancer. The median duration of the response in colorectal cancer and breast cancer was 4 and 10 months, respectively.

Severe atherosclerotic changes, including aortic occlusion, associated with hyperhomocysteinaemia and antiphospholipid antibodies.

Three patients are described with severe systemic atherosclerosis, including aortic occlusion, in the presence of a spectrum of risk factors, including hypercholesterolaemia, hypertension, a positive family history of cardiovascular problems, and hyperhomocysteinaemia. In all three patients high levels of anticardiolipin antibodies were found. The possible pathogenic role of antiphospholipid antibodies in atherosclerosis in the context of hyperhomocysteinaemia in these patients is discussed.

Reconstructive surgery for renovascular hypertension. II. Influence of patient selection and anatomical result on the blood pressure response after operation.

The results of renovascular surgery for renovascular hypertension are influenced markedly by patient selection. Our method of patient selection was based primarily on clinical characteristics rather than functional tests. To determine its effect on the results obtained by surgery, we studied all 115 patients in whom angiography showed that surgery had eliminated the renal artery stenosis. Six to 12 months after the operation, hypertension was cured or improved in 83 per cent of the patients and 17 per cent were classified as treatment failures. The results obtained for patients with stenosis caused by arteriosclerosis were similar to those found for patients with fibrodysplasia. Clinical characteristics (sex, blood pressure, duration of hypertension, creatinine level and extrarenal arteriosclerosis or target organ damage before surgery) were analysed separately. The characteristics of patients with a beneficial blood pressure response were not significantly different from those of patients who failed to respond, except for the blood pressure level itself. On the basis of our findings and the results of functional tests reported in the literature, we conclude that the decision to operate should be based on all of the clinical data available. Functional tests can be used to support the diagnosis of renovascular hypertension in selected patients. The presence of extrarenal arteriosclerosis before surgery is not associated with a poorer chance of a beneficial blood pressure response.

The influence of the surgical technique upon the short term and long term anatomic results in reconstructive operation for renovascular hypertension.

The anatomic results of reconstructive operation for renovascular disease was analyzed in 161 patients with hypertension who were treated between 1959 and 1983. Arteriosclerotic lesions in 103 patients were repaired by endarterectomy (58 per cent), autologous bypasses (27 per cent) and miscellaneous procedures (15 per cent). Fibrodysplastic lesions in 58 patients were treated by in situ procedures (54 per cent) and by extracorporeal repair and autotransplantation (46 per cent). The results were evaluated by means of angiography at both a short term and long term interval after the operation. Angiograms were taken of 79 per cent of the reconstructions at the short term interval and 65 per cent at the long term interval. For the short term interval, the failure rate of angiographically verified reconstructions was 5.7 per cent for arteriosclerotic and 5.8 per cent for fibrodysplastic lesions. The secondary nephrectomy rate was 3.4 and 4.5 per cent, respectively. Surgical expertise appeared to be an important factor, since all failures but one occurred during the first period of the study. Furthermore, the introduction of extracorporeal reconstruction reduced the failure rate for reconstructive operation for fibrodysplasia; residual lesions in the main renal artery did not occur and those of reconstructed hilar branches were only occasionally observed (6.9 per cent). For the long term interval, failure rates were 17 per cent for arteriosclerotic and 14 per cent for fibrodysplastic lesions. In this respect, the results obtained with endarterectomy and arterial bypasses were superior to those obtained with venous bypasses. We conclude that surgical technique is the most important factor for successful reconstruction and that the use of autologous materials, except autologous veins, is preferred.

Occluded hemodialysis shunts: Dutch multicenter experience with the hydrolyser catheter.

PURPOSE: To evaluate mechanical thrombectomy of occluded hemodialysis access shunts with a recently developed hydrodynamic device. MATERIALS AND METHODS: Sixty-five thrombosed hemodialysis access shunts were treated in 49 patients. The shunts were of three types: Brescia-Cimino fistulas (24 procedures), polytetrafluoroethylene (PTFE; Gore-Tex) loop grafts (18 procedures), and manufactured homologous vein loop grafts (23 procedures). Clots were removed by means of aspiration caused by the hydrodynamic effect of a high-velocity flow of saline through the catheter (Venturi effect). RESULTS: Successful declotting was achieved in 58 of 65 (89%) attempts. Early reocclusion occurred in 11 shunts and was successfully treated by means of repeat thrombectomy in five instances. Procedure time averaged 1-1 1/2 hours. The primary patency was similar for the three types of access shunts (P = .09), with a median of 14 weeks (including the initial treatment failures). Assisted patency for polytetrafluoroethylene loop grafts was better than that for the two other types (P = .002). Complications were encountered in 10 of 65 (15%) cases. These included formation of a large local hematoma that resulted in loss of a Brescia-Cimino fistula, two instances of arterial embolization, and one case of pulmonary embolization of thrombus material. CONCLUSION: Effectiveness of mechanical thrombectomy of occluded hemodialysis access shunts with the described hydrodynamic device is similar to that of alternative treatments such as thrombolysis.

Percutaneous transluminal renal angioplasty in children and adolescents.

Percutaneous transluminal renal angioplasty (PTRA) was performed in 12 children and adolescents with renal artery stenosis. Patients were divided into three groups: those with a short stenosis in the middle or distal part of the renal artery (n = 5), those with a short stenosis at or near the origin of the renal artery (n = 3), and those with a long stenosis at or near the origin (n = 4). The patients in the first group responded to PTRA. Those in the second group had a poor clinical response, and dilation was unsuccessful in the patients in the third group, who remained hypertensive. The location and length of the renal artery stenosis and its underlying cause appear to be important in determining the results of PTRA.