Right cervical aortic arch and pseudocoarctation of the aorta associated with aneurysms and steal phenomena: US, CTA, and MRA findings.

A 55-year-old woman presented with right cervical aortic arch with pseudocoarctation of the aorta further complicated by the presence of multiple aneurysms and a high-grade stenosis at the origin of the left subclavian trunk from the aorta causing a discrepancy in blood pressure between the right and left arms. The branching pattern and the resulting complex steal syndromes involving the left carotid and the subclavian system are unique. The computed tomography angiography, magnetic resonance angiography, and Doppler ultrasound findings are described.

[Effect of propranolol on renal hemodynamics in patients with cirrhosis: assessment with Doppler US]. / Siroz hastalarinda propranololün renal hemodinamik etkileri: Doppler US ile degerlendirme.

PURPOSE: To determine the renal resistive index profile in cirrhotic patients before and after propranolol treatment and assess the effects of propranolol on renal hemodynamics. MATERIALS AND METHODS: Thirty-six patients with cirrhosis and ascites (decompensated group), 39 patients with cirrhosis but no ascites (compensated group) and 25 patients with normal renal and hepatic functions (control group) were studied. All had normal blood urea nitrogen and serum creatinine levels. The renal resistive index was calculated in all patients before and after oral propranolol treatment. RESULTS: Resistive index was significantly higher in the decompensated group (p<0.05) than in other groups. After propranolol treatment, resistive indices decreased in the compensated patients (p<0.05) but increased in the decompensated group (p<0.05). There was a slight but statistically insignificant increase in the control group. CONCLUSION: In patients with cirrhosis renal failure is a significant risk factor for liver transplantation. In these patients, Doppler sonography provides early detection of renal dysfunction even before renal function tests are abnormal. Doppler sonography is a useful noninvasive method to evaluate the effects of drugs on renal hemodynamics.

The effects of local and sustained release of fibroblast growth factor on testicular blood flow and morphology in spermatic artery--and vein-ligated rats.

BACKGROUND/PURPOSE: This study was carried out to evaluate the effects of local and sustained release of fibroblast growth factor (FGF) on testicular blood flow and morphology in spermatic artery--and vein-ligated rats. METHODS: Forty male Wistar albino rats weighting 300 +/- 20 g were allocated randomly into 5 groups consisting of 8 in each as follows: G-S (sham); G-C (control); and G-T0.85, G-T1.70, G-T2.55. After the ligation of the left spermatic artery and vein, 1 cm2 of unloaded and 0.85 microg, 1.70 microg, and 2.55 microg of FGF-loaded gelatin films were sutured on the left epididymis in G-C, G-T0.85, G-T1.70, and G-T2.55, respectively. After 30 days, bilateral capsular (CBF) and intratesticular (IBF) blood flows were evaluated by colored Doppler ultrasonography (CDUS) and testicular blood flow (TBF) by 133Xe clearance technique. Tunica albuginea and intertubular tissues were studied for the increase of peritesticular and intratesticular vessels. Mean intertubular vascular structure counts, seminiferous tubular diameters, testicular biopsy scores, and Leyding cell scores of each group were recorded and compared. RESULTS: CBF was present in all animals of G-S, G-T0.85, G-T1.70, and G-T2.55 groups in CDUS, and it was detected in 62% of the G-C rats (P < .05). However, IBF was present in only 25% of the G-C rats, and this percentage was increased from 50% up to 87.5% for treatment groups, and 100% for G-S rats, respectively. 133Xe clearance showed that TBF was significantly decreased in G-C compared with G-S (P < .05). In G-T2.55, TBF was significantly increased, but still could not reach the level of G-S. Although mean testicular weights were significantly decreased for controls (G-C), G-T0.85, and G-T1.70, almost no difference was observed between G-T2.55 and G-S. Although a slight increase in the vascular structures of tunica albuginea was present in G-C rats, a significant increase was observed in treatment groups. The mean number of intertubular vascular structures was significantly increased in treatment groups when compared with G-S and G-C (P < .05). Mean seminiferous tubular diameters and Leydig cell scores were decreased in G-C but significantly increased in treatment groups (P < .05). Mean testicular biopsy scores were increased in treatment groups compared with G-C but could not reach to sham levels. CONCLUSIONS: Ligation of the spermatic artery and vein has detrimental effects on the ipsilateral testicular blood flow and morphology. These effects may be reversed by local application of FGF.

Correlation between the diameter of the main renal artery and the presence of an accessory renal artery: sonographic and angiographic evaluation.

OBJECTIVE: To evaluate whether the diameter of the main renal artery is an indicator of the presence of an accessory renal artery in sonographic examination. METHODS: Of cases undergoing renal intraarterial digital subtraction angiography for any reason, those with no renal arterial disease detected on digital subtraction angiography were included in the investigation. Accessory renal arteries were disclosed by digital subtraction angiographic examinations. The dimensions of the kidney were measured sonographically. The lowest, highest, and mean values of diameters of main renal arteries were determined by sonography and angiography in both the group with accessory renal arteries and the group without accessory renal arteries. RESULT: Of kidneys with sonographically normal dimensions, angiographic evaluation was made in 107, and sonographic evaluation was made in 97, the renal arteries of which could be visualized optimally. Both radiologic methods showed that diameters of main renal arteries were significantly smaller in the presence of the accessory renal artery (P < .001, Student t test, Mann-Whitney U test, and receiver operating characteristic curve). CONCLUSIONS: In sonographic examination, the presence of the main renal artery with a diameter smaller than usual in a kidney with normal dimensions is indicative of the presence of an accessory renal artery. Taking this into account, we can obtain higher rates of detection of accessory renal arteries in sonographic examinations.

Hemodynamic effect of transdermal glyceryl trinitrate on newly constructed arteriovenous fistula.

Transdermal glyceryl trinitrate (GTN) administration may have a beneficial effect in the creation of an arteriovenous fistula (AVF) by increasing blood flow through the access and by inhibiting platelet aggregation. We evaluated the hemodynamic effects of transdermal GTN administration on newly constructed arteriovenous fistula. Radiocephalic fistula at the wrist (Brescia fistula) was constructed as the initial vascular access in 31 uremia patients (study = 16, control = 15). The patient demographics and the etiology of chronic renal disease were similar in the two groups. None of the patients had severe vasculitis. The mean duration of chronic renal disease was 8 months (1-24 months). The diameter, blood flow rate, and blood output at the drainage vein and the subclavian vein were measured by duplex ultrasonography 24 hours after the procedure. The measurements were performed again with transdermal GTN (10 mg/24 hours adhesive patch) administration in the study group and, without any medication, in the control group 4 hours after the initial measurements were taken. In the study group, all of the hemodynamic parameters were significantly increased over the initial measurements (p <0.05) whereas in the control group all hemodynamic parameters were unchanged, except the diameter of the subclavian vein (p <0.05). The actual change in hemodynamic parameters was significant in the study group when compared to the control group (p <0.05). Our data showed that transdermal GTN administration at the forearm increases flow through the Brescia fistula.

Intrarenal arteriovenous fistula causing a "pseudonutcracker effect".

We report a case in which an intrarenal arteriovenous fistula caused the nutcracker effect. Color Doppler sonography of the left renal artery showed a peak systolic velocity of 150 cm/second and renoaortic ratio of 2.1. The left renal vein was significantly dilated, and the adjacent renal artery was kinked. A stenosis in the left renal vein at the aorto-mesenteric bifurcation was demonstrated, with a maximum velocity of 201 cm/second. Renal Doppler evaluation showed an area of high-velocity, low-resistance arterial flow consistent with an arteriovenous fistula in the inferior half of the left kidney. Angiography confirmed the fistula. The fistula was successfully occluded by coil embolization. Follow-up sonography showed almost complete obliteration of the fistula, regression of the renal vein dilatation, and a reduction in renal venous and arterial flow velocities. Given the reversibility of the fistula's effects, we suggest the term "pseudonutcracker effect" to describe this case.