Autoantigens in human neuroblastoma cells.

Neuroblastoma cells are frequently used as targets in studies of autoimmune diseases of the nervous system. We examined the human neuroblastoma cell line, LAN-5, for the presence of autoantigens that react with naturally occurring autoantibodies in human sera. Antibodies to the HNK-1 and Gal(beta 1-3)GalNAc epitopes, which have been implicated in human autoimmune neuropathy and motor neuron disease, respectively, immunostained the surface of the neuroblastoma cells, and antibodies to the 200 kDa high molecular weight neurofilament protein (NFH) immunostained the cytoplasm and cell processes. The NHK-1 and Gal(beta 1-3)GalNAc epitopes were associated with several glycoprotein bands in Western blots of the neuroblastoma cells, and the HNK-1 epitope was also shared by a glycolipid which co-migrated with 3-sulfoglucuronyl paragloboside (SGPG) from peripheral nerve, indicating that SGPG is synthesized in neuronal cells. Northern blot analysis revealed a single RNA band of 4800 bp for NFH in normal brain but two RNA species of 4800 and 3800 bp in both neuroblastoma and adrenal cells, confirming their common origin. The neuroblastoma cells appear to contain antigens that bind to naturally occurring autoantibodies in human serum and might therefore be useful for detecting and investigating the effects of anti-neuronal antibodies. The antibody populations being investigated, however, should be distinguished from other autoantibodies which might be present in the patients' serum.

Percutaneous transluminal angioplasty of homograft renal artery stenosis in a 10-year-old girl.

Hypertension caused by 90% stenosis of a transplant renal artery was effectively treated by percutaneous transluminal angioplasty of the stenosed artery. Following dilation no pressure gradient existed across the stenosis. Hypertension had developed in a 10-year-old girl with caudal regression syndrome and recurrent pylonephritis five months following homograft transplantation for chronic renal failure. Since percutaneous transluminal angioplasty was performed, the blood pressure has remained within age-related normal limits.

A double-blind comparative study of Hexabrix and Renografin-76 in aortography and visceral arteriography.

A diatrizoate compound (Renografin-76) and low osmolality Hexabrix were compared in a double-blind study of 50 adults undergoing arteriographic examination. Subjective and objective assessment of pain reaction for each contrast injection rated lower overall for Hexabrix. Discomfort associated with Renografin was greatest for injections into extremity arteries. Hexabrix showed the least change in serum osmolality. No impairment of renal function was evidenced with either contrast media. No difference in the angiographic quality of the control agents was noted.

Long term follow-up of transcatheter embolization with autologous clot, oxycel and gelfoam in domestic swine.

Transcatheter embolization of the distal gastrosplenic artery as well as the distal right renal artery or one of its bifurcational branches was performed in 9 domestic swine. The animals were embolized with fresh autologous clot, oxycel or gelfoam in groups of 3. The embolic material was opacified with tantalum in several animals. At 4 months, none of the initial occlusions was sustained and recanalization without residuals was found in the left gastroepipolic artery with only one minor exception. Organized thrombi as sole vascular residuals regardless of embolic substance were found in both the terminal splenic artery as well as in the right renal artery distribution in various degrees together with infarcts in both organs. No trace of either oxycel or gelfoam remained, nor tissue reaction against either material. All 3 agents are therefore regarded equivalent in their long term effects and are not suitable for permanent vascular occlusion.

Mixing problems of low flow hepatic artery infusion. Improvement with small caliber double lumen balloon catheters.

The problem of inhomogeneous mixing encountered during hepatic artery (HA) chemotherapy infusion was assessed and a practical solution examined. A glass model of the human HA distribution was used to determine mixing homogeneity of low flow (1.4 mL/minute) dye infusion into pulsatile flow (280-300 mL/minute) of a fluid isoviscous to blood. Dye concentration in each of 16 HA branches was determined by photospectrometry. Dye infusion was carried out through 2-2.5F double lumen end hole or proximal side hole balloon catheters without balloon inflation, with balloon inflation maintaining full HA flow, and with the balloon inflated so that HA flow was reduced by 50%. The measurements taken without balloon inflation showed gross inhomogeneity of dye concentration in various branches. The inhomogeneity was not improved during balloon inflation as long as full HA flow was maintained. After balloon inflation reduced HA flow by 50%, dye mixing was improved significantly, with infusion through side hole catheters (alpha = .002) but not significantly (alpha = .2) with infusion through end hold catheters. This investigation suggests that the proposed technique might be useful for clinical application and deserves further evaluation in an in vivo system.

Transcatheter embolization with microfibrillar collagen in swine.

Transcatheter embolization of the gastrosplenic and renal arteries was performed in 7 domestic swine with suspensions of microfibrillar collagen (MFC), a recently developed topical hemostatic agent. Embolized vessels remained occluded 2 days following embolization. Recanalization occurred by 14 days, although some occlusion in distal vessel persisted at 3 months. Pathologically a marked granulomatous arteritis was noted at 14 days which resolved by 3 months. Gastric ulcers or infarcts were present in two animals. The severe vasculitis and gastric pathology observed with MFC in this study would seem to preclude its use as a general embolic agent. It may be useful, however, in the preoperative embolization of neoplasms, especially in pediatric patients since its physical characteristics allow it to be easily injected through small diameter catheters.

Metrizamide, the ideal radiopaque filling material for detachable silicone balloon embolization.

Porcine visceral and extremity arteries were embolized with detachable silastic balloons; 10 balloons were filled with isoosmolar metrizamide, five were filled with 30% meglumine-sodium diatrizoate and five were filled with 3:1 mixtures of blood and 76% meglumine-sodium diatrizoate. Follow-up radiographs were obtained weekly for 2 weeks, at 4 weeks and at 5 months. At 3 months, arteriography was performed. All balloons occluded the vessel completely upon detachment. Balloons filled with metrizamide did not change their volume or radiopacity during the entire observation period and all remained inflated. The balloons filled with diatrizoate salts enlarged by osmotic growth during the first two weeks and there was a decrease in opacity. Thereafter, one balloon filled with 30% diatrizoate salt solution and one filled with blood-76% diatrizoate deflated. In the former, the embolized artery remained occluded, while in the latter, the vessel reopened and the balloon was found incorporated into the vessel wall at the site of detachment. It is concluded that isoosmolar metrizamide is an ideal filler for detachable silastic balloons since it does not lead to changes in volume or radiopacity and also guarantees long-term vascular occlusion.

Therapeutic embolization with detachable silicone balloons: long-term effects in swine.

Twenty-one embolizations were performed in 12 swine using a detachable silicone balloon-catheter system. In 11 embolizations, balloons were filled with 60% meglumine sodium diatrizoate (R-60); 30% meglumine sodium diatrizoate (R-30) was used in 10 embolizations. Serial radiographs were obtained to determine the duration of balloon inflation. Repeat angiography and autopsy examinations were performed three to six months following embolization. Eighty percent of balloons filled with R-30 were still inflated after 10 days, as opposed to 27% of the balloons filled with R-60. Balloons which remained inflated for more than 10 days caused permanent occlusion of the embolized arteries. The vessels were occluded precisely at the point at which the balloons were initially attached. Pathologically, the occluded vessels exhibited organized thrombi with minimal inflammation. Detachable balloons appear to be an effective, safe method of performing selective vascular occlusion in many circulatory systems. Careful control of the volume and osmolarity of the contrast medium used to inflate the balloons produces permanent arterial occlusion.

Organ ablation by fluid emboli. An experimental study comparing two solidifying liquids.

Embolization for ablation of organs and tumor infarction requires uniform permanent occlusion of the distal vasculature. This is best accomplished through the use of solidifying liquids. The study on 15 dogs reported here compares the degree of peripheral vascular embolization and its relation to tissue infarction both acutely and chronically following embolization of the renal arteries with two solidifying liquids, a low viscosity silicone and the occlusion gel Ethibloc. Silicone produced quite uniform distal distribution including 50 to 80% (mean 66%) of renal glomeruli, whereas Ethibloc occluded more proximally and reached only 10 to 50% (mean 22%) of all glomeruli. After three months complete cortical infarction of all nine kidneys embolized with silicone was found, whereas two of the three kidneys embolized with Ethibloc retained nests of viable glomeruli. Balloon occlusion of the entire renal artery inflow during embolization prevented distal venous emboli whereas partial inflow occlusion allowed systemic venous embolization. It is concluded that due to its more uniform distal penetration low viscosity silicone is a more suitable embolization agent than Ethibloc for organ ablation. Total arterial inflow occlusion during embolization effectively prevents systemic venous embolization.

A simple method to measure mesenteric arteriovenous shunt flow during arteriography.

A quantitative method for external detection of mesenteric arteriovenous shunts was developed. 99mTc-Human Serum Albumin Microspheres (15--30 microns) were injected into the superior mesenteric artery of dogs through an angiographic catheter, followed by external scintillation counting of the liver activity, which represented the shunted spheres. Thereafter, 99mTc-sulfur colloid was injected identically and the liver activity counted again. The liver net count after sulfur colloid represented a 100% shunt, when a correction factor for the actual liver uptake was applied. The a shunt rate was calculated. Eleven animal studies were performed and shunt rates similar to previous in vitro determinations were obtained. This method is suitable for clinical investigation and can conveniently be applied to mesenteric arteriography.

Ruptured lumbar artery pseudoaneurysm: an unusual cause of retroperitoneal hemorrhage.

A patient with a functioning renal transplant presented for treatment 8 years after operation with acute retroperitoneal hemorrhage ipsilateral to the allograft. A ruptured false aneurysm of the lumbar artery was identified and was treated initially with balloon catheter occlusion, then operative ligation, with satisfactory result.

Traumatic pseudoaneurysm of the thoracic aorta in close proximity to the anterior spinal artery: a therapeutic dilemma.

Operative therapy is generally advocated for the management of chronic traumatic pseudoaneurysms of the aorta. A potential complication of both thoracic and abdominal aortic aneurysmectomies is paraplegia secondary to infarction or ischemia of the spinal cord. The present report describes a patient with a traumatic aneurysm of the lower thoracic aorta immediately adjacent to the origin of the anterior spinal artery, both delineated angiographically. In this particular situation, it was elected to follow the patient because the aneurysm was asymptomatic, small, and chronic, and because the risk of spinal cord injury associated with aneurysmectomy was estimated to be high. Serial computerized tomography (CT) scanning was used as a means of measuring the exact aneurysm size. Operation will be recommended if the aneurysm produces symptoms or enlarges, as demonstrated by CT scans.

Long-term results of aortoiliac angioplasty.

Results of percutaneous transluminal angioplasty of 141 iliac arteries in 112 patients are reported, with a follow-up period extending to 36 months. Initial technical success was achieved in 95.7%, 1-year patency in 91.3%, and accumulated 2- and 3-year patency in 89%. The role of outflow disease and ankle:arm index measurement and the importance of eliminating or significantly reducing the intra-arterial pressure gradients are discussed.

Interventional radiology.

Interventional radiology is defined as a radiologic subspecialty and the services provided are tabulated in this article; those services relevant to internists are described in greater detail. This article is intended as a survey, and the authors encourage the reader to consult the references provided for a more in-depth review.

Percutaneous biliary drainage for high obstruction.

PBD is the preferred route of palliative drainage for patients with high biliary obstruction. The frequency of bifurcational obstruction in this setting requires familiarity with drainages from both the right and the left transhepatic approach. The preferred right transhepatic approach is fluoroscopically guided; on the left, ultrasonography is the guidance of choice. Large caliber drainage catheters are required, and dilatation of the necessary transhepatic tracts is extremely painful unless adequate inhalation anesthesia or, preferably, epidural anesthesia, is provided. Long-term biliary drainage requires a choice between internal-external external drainage catheters and endoprostheses that is made by considering the patient's life expectancy and his or her adjustment to a stent extending to the outside. The feasibility of corrective procedures if an internal-external drainage catheter or an endoprosthesis becomes blocked needs to be considered before definitive placement. The interventional radiologist becomes intimately involved in the follow-up care of patients and frequently has to direct appropriate patient evaluation. Familiarity with antibiotic regimens is important.

[Therapeutic embolization in the extracranial head and neck region with a new detachable balloon system (author's transl)]. / Therapeutische Embolisationen im extrakraniellen Kopf- und Halsbereich mit einem neuen System abstossbarer Silikonballone.

A system of detachable silicone balloons for therapeutic vascular embolization is described together with applications in the extracranial head and neck. Embolization was performed in 8 cases, 5 of which were preoperative and 3 for definitive treatment. The preoperative embolizations were to reduce intraoperative blood loss and to facilitate limited surgery. Advantages of detachable balloon embolization are flow directibility, selectivity and correctibility prior to balloon detachment. These advantages are used best in the case of AV-fistulas. The present balloon system allows occlusion of vessels 1--4 mm in diameter. Balloons are filled with isoosmolar contrast material.

Percutaneous nephrostomy drainage in the management of neonatal anuria secondary to renal candidiasis.

We report a case of anuria in a premature neonate secondary to bilateral ureteropelvic junction obstructions related to Candida bezoars. Percutaneous decompression and drainage of both kidneys contributed significantly to the successful management of renal candidiasis in this patient. A review of the literature is presented.