Efficacy and safety of rilmenidine for arterial hypertension.

To assess the long-term acceptability and efficacy of rilmenidine (S 3341), patients with placebo-resistant hypertension (diastolic blood pressure [BP] greater than or equal to 95 mm Hg and less than 115 mm Hg) were included in an open 1-year treatment study. Eight examinations allowed treatment adaptation if diastolic BP remained greater than or equal to 90 mm Hg (monotherapy with rilmenidine, 1 or 2 mg/day, followed by the addition of a diuretic, then tritherapy). Three hundred seventeen patients, aged 58.0 +/- 0.7 years, were included. Two hundred sixty-nine were followed for 1 year and 48 withdrew from the trial without any symptom suggesting a withdrawal syndrome: 4 because of adverse effects; 6, lack of efficacy despite triple therapy; 9, intercurrent diseases; 10, noncompliance independent of adverse effects; 18, personal reasons not associated with treatment; and 1, lost to follow-up. On the 12th month, the decrease in supine systolic and diastolic BP reached 25 and 17 mm Hg with monotherapy (n = 150), 26 and 17 mm Hg with double therapy (n = 90) and 20 and 15 mm Hg with triple therapy (n = 29). BP was normalized (diastolic BP less than or equal to 90 mm Hg) on months 6 and 12 in 80 and 84% of the patients, respectively. Monotherapy was maintained in 66 and 60% of these patients, respectively, two-thirds being treated with 1 mg once daily. Adverse effects with monotherapy were mainly observed at the beginning of treatment in 3 to 8%: dry mouth, asthenia, gastralgia, palpitations, drowsiness, insomnia; other adverse effects were rare (1 to 2%).(ABSTRACT TRUNCATED AT 250 WORDS)

Functional evaluation of extracardiac ventriculopulmonary conduits and of the right ventricle with magnetic resonance imaging and velocity mapping.

Extracardiac ventriculopulmonary conduits tend to deteriorate over time, developing both obstruction and regurgitation. In this prospective study, magnetic resonance imaging (MRI) was compared with Doppler echocardiography to determine whether MRI improves the noninvasive evaluation of conduit patients. Twenty-five patients (median age 10 years, range 2.5 to 32) were investigated 27 times with Doppler echocardiography and an MRI protocol with spin echo sequences for morphology, velocity mapping, and multislice gradient echo technique for right ventricular volume measuring. Cardiac catheterization data were available in 6 patients. Echocardiography could assess the morphology of the conduits in 6 patients, whereas MRI demonstrated all conduits efficiently. Doppler echocardiography could evaluate the occurrence of regurgitation in 18 patients and could quantify peak velocity in 20 of the patients. A technically adequate MRI velocity mapping was obtained in 25 patients. There was good agreement between MRI and Doppler echocardiography in establishing or not establishing regurgitation, but Doppler echocardiography was less reliable in evaluating the degree of regurgitation. The correlation between peak velocity determined with Doppler and magnetic resonance imaging was r = 0.63 [corrected]. Correlations between catheterization pressure gradients and noninvasive techniques were r = 0.97 for magnetic resonance imaging [corrected] versus catheterization, and r = 0.86 [corrected] for Doppler versus catheterization. MRI can provide complete information on the morphology and function of extracardiac ventriculopulmonary conduits, as well as of the right ventricle. If the results of MRI and echocardiography with Doppler are in agreement, heart catheterization and angiography can be avoided, even in patients considered for conduit replacement.

Sleep apnea syndrome--an alternative treatment to tracheostomy.

Two patients with obstructive sleep apnea syndrome had polygraphic recordings demonstrated upper airway obstruction and sleep with extremely short sleep latency, severely disturbed nightsleep resulting in sleep deprivation, and excessive daytime sleepiness. Radiological investigation showed the upper airway obstruction to be caused by the tongue falling back occluding the pharynx. Nasopharyngeal intubation relieved the symptoms. The patients were trained to perform this treatment themselves every night, demonstrating that this treatment is an attractive alternative to the conventional tracheotomy.

Percutaneous nephrostomy in infants and children.

RATIONALE AND OBJECTIVES: The purpose of this study was to review the authors' experience with percutaneous nephrostomy during an 11-year period, paying special attention to indications and outcomes. MATERIAL AND METHODS: The records of 71 percutaneous nephrostomy procedures performed on 59 children at the authors' institution from January 1987 through December 1997 were retrospectively reviewed. In these children, ultrasonography was used for puncture and fluoroscopy for catheter insertion. Local anesthesia with sedation was used and later replaced by general anesthesia. Loop-end catheters were employed. The smallest patient weighed 1,200 g, and the mean patient age was 3.4 years. RESULTS: The mean duration of drainage was 60 days, and the longest time was 11 months. Indications were mainly obstructions, with congenital obstruction (n = 28) and postoperative obstruction (n = 26) being the most common. Obstructive pyelitis, malignancy, stone, renal cystic disease, trauma, and neurogenic bladder disturbance were also indications. No complications such as loss of the kidney, serious infection, or hemorrhage of clinical importance were observed. Obstruction was successfully relieved in all patients, but 12 kidneys and five hemikidneys did not recover function and were eventually removed. CONCLUSION: The percutaneous nephrostomy procedure is a safe technique that can be used successfully for short- and longterm drainage in all children, even in small infants and those with solitary kidneys, and is a valuable adjunct to surgery.

Magnetic resonance imaging of the pediatric thorax: initial experience.

Magnetic resonance imaging (MRI) is particularly useful in the pediatric patient. No ionizing radiation is used; there are no complicating side effects; the technique is noninvasive and painless. We reviewed our experience using a 0.15 T. resistive imager for diagnostic MRI of the pediatric thorax. We studied 16 children, aged 8 days to 16 years, with various thoracic diseases. Correlation of the MRI findings with computerized tomography (CT) was obtained in 10 children and with the surgical findings in 8. Spatial resolution was slightly less with MRI than with CT. Medium and large vessels are well seen without contrast medium injection. Tissue characterization with MRI is superior to CT and the normal thymus is well seen. The long scanning time can be a problem in young children but can be overcome using intramuscular sedation. Cardiac gated imaging was successfully tested.

Digital vascular imaging in children. A preliminary report.

Whereas digital subtraction angiography (DSA) has been extensively used in adults, few reports have dealt with its application in children. We utilized DSA in 52 children, studying various vascular territories. Technically satisfactory studies were obtained in 89%. Motion artifacts is the foremost technical problem. Extremity DSA with arterial injection was highly successful in a number of cases. Thoracic vascular studies were also successful, as were studies of the head and neck, whereas renal and abdominal vessel studies were somewhat less successful. DSA with arterial injection may be expected to replace conventional angiographic studies in selected cases and appears to be an excellent screening method also in children.

[Digital imaging system are rapidly introduced in Swedish departments of radiography. This calls for new strategic planning]. / Digitala bildsystem införs nu snabbt på röntgenavdelningarna i Sverige. Detta ställer nya krav på beredskapsplaneringen.

Diagnostic radiology in Sweden is changing rapidly to digital (filmless) technique. The advantages are more rapid delivery of radiologic service, better working conditions and less negative effects on the environment. Teleradiology is also facilitated. The Swedish Board of Health and Welfare has investigated the speed with which this change is taking place. In 1998, 26 of the 118 departments of diagnostic radiology had already turned digital; it is estimated that in the near future at least five departments will become fully digital each year. For planning purposes, less emphasis should be put on the supply of radiographic film, and more on telecommunications, computer hardware and digital storage.

Angiography in giant cell tumors.

Angiography in 9 cases of giant cell tumors of bone is described. All cases had a greatly increased vascularity of the lesion, with concomitant increase in the diameter of the supplying arteries and draining veins. The arterial branching on the surface as well as within the tumor seemed specific of giant cell tumors. Arteriovenous shunting was marked. There was a marked, long-lasting, non-homogeneous tumor stain. Examination with angiotensin enhanced the pathologic findings. The angiographic appearance, often simulating malignancy, combined with the appearance of the skeletal films, make the diagnosis of giant cell tumor almost certain. Difficulties will be expereinced in differentiating giant cell tumors from metastatic deposits, especially in the spine.

Angiography of benign bone tumors.

Angiography of benign bone tumors has previously only been performed in a limited number of cases. Twenty-five cases of 9 different types of benign bone lesion are reported. They were avascular or slightly hypervascular. Absence of soft tissue involvement serves to differentiate benign from malignant bone tumors.

Cavography and lymphangiography in hodgkin's disease.

In a material of 89 patients with Hodgkin's disease, 98 combined examinations, including lymphangiography, cavography and urography, were performed. Lymphangiography disclosed signs of expansive lesion 33 times, cavography 21 times and urography 17 times. The diagnostic accuracy of lymphangiography was high. Routine cavography in Hodgkin's disease is not advocated; it may be restricted to cases with equivocal lymphographic findings.