Fístula arteriovenosa pós-traumática aorto-renal: relato de caso / Traumatic aorto-renal arteriovenous fistula; a case report

Os autores descrevem um caso de fístula arteriovenosa pós-traumática entre aorta e veia renal esquerda, com evoluçäo de 18 anos. Na literatura mundial somente cinco casos säo descritos, mas nenhum com investigaçäo radiológica täo abrangente e evoluçäo täo longa. O estudo iniciou-se por arteriografia seguida de venocavografia, tomografia computadorizada e ultra sonografia. O paciente foi submetido a cirurgia e os achados cirúrgicos säo descritos. É ainda lembrada a discussäo existente a respeito do melhor método diagnóstico para patologias dessa natureza

Elemental and trace element distribution in medical samples: analysis by proton-induced X-ray emission.

The analysis of trace elements is performed by proton-induced X-ray emission. The process is most effective if the velocity of the exciting particles--protons--is similar to the velocity of the electron on its orbit in the simple atomic model of Bohr. For K-shell electrons of the elements with 15 less than or equal to z less than or equal to 40 this requires proton energies of a few MeV, available from electrostatic van de Graaf accelerator machines. After knocking out the K-shell electron, the empty place is filled up by electrons jumping from higher orbits with simultaneous emission of characteristic X-rays, which are registered with a cooled Si (Li) detector. By a set of electrodes the beam can be swept across the specimen surface. Therefore this method yields an excellent correlation of trace element distribution within the morphological structure of organic tissue. In the present study the sweep went along a line perpendicular to the arterial wall layers (aortic, renal artery and heart muscle) of normotensive and spontaneously hypertensive rats. Along this line all elements and trace elements are recorded simultaneously. These are P, S, Cl, K, Ca, Fe, Cu, Zn, Br and Sr. The trace element content of the aortic wall and the renal artery, of 22 spontaneously hypertensive and 11 normotensive rats and of human heart muscle was investigated. The results demonstrate that Zn was only detected in the muscle-containing layers of the arteries. There was no different distribution between hypertensive and normotensive rats. However, Ca2+ was mainly detected in the smooth muscle-containing tunica media of hypertensive rats.(ABSTRACT TRUNCATED AT 250 WORDS)

Alpha-2 adrenergic receptor localization in the rat heart and kidney using autoradiography and tritiated rauwolscine.

To study the distribution and characterization of alpha-2 adrenergic receptors in the rat heart and kidney, we used light microscopic autoradiography and a computer-based image analyzer to quantify the localization of [3H]rauwolscine (RAUW) binding. Scintillation spectrometry of frozen sections of rat kidney demonstrated rapid binding, saturability, stereospecificity and agonist and antagonist binding characteristic of an alpha-2 adrenergic receptor. For autoradiography, sections of rat kidney and heart were incubated in several concentrations of [3H]RAUW in the absence of (total binding) and in the presence of (nonspecific binding) 10(-5) M yohimbine. The sections were processed and grain density quantified using a computer-based image analyzer. The tubules in the renal cortex had significantly more specific [3H]RAUW labeling than either the renal glomeruli or the tubules in the renal medulla at all concentrations of [3H]RAUW used (P less than .0001). Nonspecific binding was significantly higher over the cortical tubules than either the glomeruli or the tubules in the renal medulla (P less than .0001). Scatchard analysis of specific grain densities determined that the tubules in the renal cortex had the highest density of any structure studied [maximum binding (Bmax) = 1182 grains/10(-2) mm2]. The glomeruli had a Bmax of 485 grains/10(-2) mm2, whereas the tubules in the renal medulla had a Bmax of 273 grains/10(-2) mm2. There were no significant differences among these three regions in the dissociation constant of the [3H]RAUW. When analyzing the heart, we found no specific [3H]RAUW labeling over either the cardiac myocytes or the myocardial arterioles.(ABSTRACT TRUNCATED AT 250 WORDS)

Postsynaptic D1 and D2 dopamine receptors are present in rabbit renal and mesenteric arteries.

Measuring adenylate cyclase activity as a biochemical index of dopamine (DA) receptors, it was found that the selective D1 DA receptor agonist, SKF 82526, was able to stimulate the cAMP formation in rabbit renal and mesenteric arteries, an effect blocked by haloperidol and by SCH 23390. The D2 DA receptor agonist, bromocriptine, elicited a concentration-dependent inhibition of adenylate cyclase activity in both arteries of either normal or 6-hydroxydopamine pretreated rabbits, this effect being prevented by (-)-sulpiride but not by (+)-sulpiride. These data indicate that both D1 and D2 postsynaptic DA receptors, associated with stimulation or inhibition of adenylate cyclase activity, are present on the wall of rabbit renal and mesenteric arteries.

Neuropeptide Y: a novel renal peptide with vasoconstrictor and natriuretic activity.

A novel vasoconstrictor peptide, neuropeptide Y (NPY), has been identified in considerable quantities in the renal artery and kidney. Within the kidney, NPY was confined to the cortex and corticomedullary interface, the regions where the juxtaglomerular apparatus is most numerous. In the isolated perfused rat kidney, NPY caused a prompt dose-dependent increase in perfusion pressure and reduction in flow, with only a small fall in glomerular filtration rate (GFR). In spite of the reduced renal perfusion, a dose-dependent natriuresis was observed. This response contrasts to the response of this preparation to noradrenaline, which causes sodium reabsorption. The presence of a potent vasoconstrictor and natriuretic peptide within the rat renovascular system suggests that it may play a significant role in the control of renal function.

The susceptibility of renal arterial forks in rabbits to dietary-induced lipid deposition.

The major forks of the renal arteries from 21 rabbits fed a cholesterol-supplemented diet for periods of 1-90 d were examined electron-microscopically to compare the changes in the stem of the renal arteries with those at the first main fork. Lipid accumulated preferentially in the intimal pads or cushions at the fork. Matrix vesicles diminished in number and appeared to be transformed into enlarged membrane-bound vacuoles with electron-translucent contents. Foam cells were observed particularly beneath the endothelium. The lipid in endothelial and smooth muscle cells differed from that in the foam cells, indicating the likelihood of a different metabolic response. Interstitial lipid resembled an infiltration of the matrix with separation of the mural constituents but was not associated with the increased cellular degeneration, the progressive accumulation of matrix vesicles or the augmentation of the dystrophic basement membrane changes prominent in spontaneous atherosclerosis. In the arterial stems of 2 rabbits fed cholesterol for 62 and 90 d respectively, interstitial lipid deposition occurred without intimal proliferation.

Abnormalities of renin-containing cells in human glomerular and vascular renal diseases.

The distribution of renin was investigated by immunofluorescence in human kidney biopsy specimens (27 patients with lipoid nephrosis, 39 with Berger disease, 17 with membranous glomerulonephritis, 5 with thrombotic microangiopathy, and 7 with malignant nephroangiosclerosis). A semiquantitative assessment was carried out. Two ratios were found significatively increased in the study groups as compared with the control group: JGA + and JGA ++ which expressed, respectively, the number of fluorescent JGA in relation to the number of glomerular sections and the number of fluorescent JGA with more than six renin-containing cells (RCC) in relation to the number of immunoreactive JGA. Highest values were observed in patients with thrombotic microangiopathy and malignant nephroangiosclerosis (P less than 0.001). The above immunomorphological parameters were correlated with clinical and laboratory data. A positive dependency was found between JGA + and JGA ++ ratios and a low sodium diet, diuretic therapy and serum creatinine. A negative dependency was seen in the albumin and hemoglobin serum levels. No correlation was found with blood pressure values. These observations suggested that decreased plasma volume and impaired renal function could be factors leading to an increased renin production in the kidney.

Decreased fibrinolytic activity in vessels and ureters of rejecting human kidneys.

Plasminogen activator (PA) activity was determined with a histochemical fibrin slide technique in renal arteries, veins and ureters in 62 transplanted kidneys and again at transplantectomy in 12 transplants who later underwent irreversible rejection. At transplantation PA activity was the same whether the grafts later rejected or not. There was a significantly decreased PA activity in the vessels and ureters in rejected transplants. The role of the fibrinolytic system as a pathogenetic factor in rejected kidneys is discussed.

[C-type murine leukemia virus and the pathogenesis of necrotizing arteritis and glomerulonephritis in MRL/1 mice].

A comparative immunopathological and electron microscopic study of vasculitis and glomerulonephritis in autoimmune mice (B/W F1, SL/Ni, MRL/1) was performed. The pathogenesis of vasculitis in B/W F1 mice is due to the deposition of circulating murine leukemia virus (MuLV) gp70-immune complexes in the subendothelial space of vascular walls. Whereas, the vasculitis in SL/Ni mice is mediated by the budding of MuLV particles from vascular smooth muscle cells and the humoral immune response (Gross natural antibody) to virions and MuLV related cell surface antigens of vascular smooth muscle cells. The vasculitis in MRL/1 mice seems to be mediated mainly by the deposition of gp 70-immune complexes in vascular walls. However, the perivascular infiltration of thy1 . 2 antigen positive T-lymphocytes in an early stage of vasculitis suggests that the cellular immune response is, at least in part, important for the initiation of vasculitis in MRL/1 mice. The collective evidence suggests that several immunologic mechanisms are at works in the production of naturally occurring vasculitides in B/W F1, SL/Ni, and MRL/1 mice. The common pathogenesis of glomerulonephritis in B/W F1, SL/Ni and MRL/1 mice is the deposition of circulating gp70-immune complexes in the glomeruli. In addition, in the case of SL/Ni mice, glomerulonephritis is in some part initiated by local formations of the immune complex in the mesangium. The occurrence of vasculitis in MRL/1 mice is markedly accelerated by the treatment of methoxamine hydrochloride (Mexan), as was shown previously in SL/Ni mice.

Vascular dopamine receptors: Demonstration and characterization by in vitro studies.

Substantial evidence has accumulated that in certain vascular beds dopamine produces its relaxant effect through stimulation of specific dopamine receptors. The goal of this review is to describe several in vitro models (perfused mesenteric vessels of the dog; renal, mesenteric, splenic, coronary and cerebral arterial strips of rabbits, dogs and cats; perfused kidney of the rat) recently developed to demonstrate such specific relaxations induced by dopamine and dopaminomimetics. On these models studies on structure-activity relationship for activation of the dopamine receptor resulted in the following order of potency for agonists: SK&F 38393 (partial agonist) greater than epinine greater than A-6, 7-DTN greater than or equal to dopamine greater than N, N-di-n-propyl-dopamine (partial agonist) greater than apomorphine (partial agonist). The dopamine receptor antagonists (+)-butaclamol, cis-alpha-flupenthixol, metoclopramide, droperidol and bulbocapnine were found to competitively antagonize dopamine induced relaxation. In addition, in two isolated organ systems (rabbit mesenteric artery, rat perfused kidney) stereospecificity of the vascular dopamine receptor was demonstrated with the isomers of butaclamol. With the development of several in vitro models demonstrating a specific antagonism against dopamine induced relaxation an important requirement for definition of a specific dopamine receptor if fulfilled according to classical pharmacological criteria. Thus, there can be do doubt on the existence of post-synaptic dopamine receptors mediating vasodilation in certain vascular tissues.

Deposits of immunoglobulins and C3 in the walls of human renal arteries.

Ninety-one renal biopsies were examined by immunofluorescent staining for the presence of C3 and immunoglobulins in the walls of renal arteries (RAW), tubules and glomeruli. The diseases studied were non-systemic renal immune complex diseases, systemic diseases with kidney involvement, renal diseases with minimal pathological changes and histological normal kidneys. In a high percentage of cases C3 and, to a lesser degree, deposits of immunoglobulins were found in the RAW, the deposits being found both in immunological and non-immunological diseases. Deposits of C3 but not of C4, C1q, fibrinogen, and immunoglobulins were found in the RAW of 11 normal kidneys examined.

Distended left renal vein: CT/sonographic normal variant.

The left renal vein frequently demonstrates a marked variation in caliber between the part distal to the aorta and the part directly in front of the aorta. This is well seen on both computed tomography (CT) and sonography. This variation in caliber or distention is believed to be secondary to a "nutcracker " effect formed by the aorta posteriorly and the superior mesenteric artery anteriorly. The third part of the duodenum may also add to the pincer effect on the left renal vein. A series of 72 patients was examined for this variation and the relation of the caliber of the left renal vein to the anatomy of the aorta, superior vena cava, and duodenum. These patients were also evaluated for any possible relation between the presence of a distended left renal vein and a varicocele.

Contribuiçäo para o estudo do número das artérias renais no homem / Contribution for number study from renal artéries in man

Dissecando 30 cadáveres (60 rins), os autores encontraram 93 artérias, sendo 44 direitas e 49 esquerdas, todas elas orignando-se diretamente da aorta: únicas, 33 vezes (55% ); duplas, 21 (35,0% ); triplas, seis (10,0% ). estes dados, levaram os autores, a concluir que poderia ser considerado "normal" anatômico a ocorrência de uma (33 vezes em 60 rins, 55,0% ) ou duas (21 vezes, 35,0% ) artérias renais para um mesmo rim, independentemente das variáveis lado, sexo e grupo étnico. Mais de duas artérias de cada rim (seis vezes em 60 rins, 10,0% ) poderia, entäo, ser considerado como variaçäo

On the nature of fibrinolytic activity of arteries.

The plasminogen activator of the arterial wall was studied with the histochemical method of TODD. The plasminogen activator was removed from the sections after extraction with M-potassium thiocyanate. By this procedure we suggest that the activator demonstrated by the histochemical method is the same substance as that prepared by the extraction method with thiocyanate of ASTRUP and STAGE. However, a new fibrinolytic activity was restored after treatment of these extracted sections with streptokinase or urokinase. There were no differences in the different types of arteries examined and normal or atherosclerotic arteries. Similar findings were found when kidney or myocardial tissues were examined. It is suggested that the arterial and other tissues contain proactivator-plasminogen which is not extracted from the tissue by potassium thiocyanate and can adsorb streptokinase or urokinase.

Ultrastructure of proteoglycans in human renal arteries from end stage renal disease.

Although glycosaminoglycans, particularly proteoglycans, have been characterized biochemically in normal and diseased arteries, little is known regarding their ultrastructural characteristics in human arteries. The observations reported here were made in renal arteries from nephrectomy specimens from patients with endstage kidney disease and hypertension. By light microscopy, the diffusely thick intima is characterized by small, slender smooth muscle cells embedded in a finely fibrillar, strongly alcian-blue positive, intercellular matrix. Ultrastructurally, there is a loose meshwork of collagen fibrils, elastic units and abundant fibrillogranular units staining strongly with ruthenium red and identified as proteoglycans. These consist of ovoid or diamond-shaped electron-dense granules about 300-500 A in diameter, having fine filamentous processes.

The plasminogen activator of the arterial wall.

The plasminogen activator in 645 specimens of various human arteries--thoracic, abdominal aorta, carotic, pulmonary, renal, basilar, coronary - was studied using Todd's histochemical method. 92 cadavers were used, 1--18 hours post mortem from subjects aged from 272 days to 83 years. 45 specimens of pulmonary, renal and splenic arteries were obtained during surgery. The greatest fibrinolytic activity was within the adventitia. Intima occasionally showed very little fibrinolytic activity, or none at all. No statistically significant differences in plasminogen activator activity were found between the various arteries examined. A statistically significant increase in fibrinolysis in adventitia of atherosclerotic arteries was established. No correlation was found between the fibrinolytic activity of the arteries and their alkaline phosphatase content. Some properties of the plasminogen activator of the arterial vessel wall were evaluated. Influence of storage, inactivation with epsilonaminocaproic acid and extracted with potassium thiocyanate was studied.