[Percutaneous dilatation of renal artery stenosis with the balloon catheter. An experimental model].
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Biomedical subjects
Publications and source records attributed to E Lindstedt.
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In March 1971 a 32-year-old man with necrosis of the ureter to a kidney allotransplant underwent anastomosis of the transplant renal pelvis to the bladder. The kidney is functioning normally 9 years later. This surgical technique has been used recently in 3 additional case. Further applications of this procedure are suggested.
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An experimental model has been developed in the pig in order to evaluate the effect of percutaneous transluminal angioplasty on fibrous renal artery stenosis. Stenoses were induced by bilateral subtotal ligation with chromic catgut. Six weeks following ligation unilateral transluminal dilatation was performed in 9 pigs using Grüntzig balloon catheters. In only one case a serious complication occurred with rupture of the renal artery. Seven pigs with dilated stenoses were re-examined by angiography 8 to 10 weeks after dilatation. In 6 cases the stenoses were practically completely eliminated while in one cases a re-stenosis developed. Microscopy of the dilated arteries revealed several small and large ruptures of th internal elastic membrane.
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The flow in operatively created arteriovenous fistulas of 14 patients was calculated with Doppler and dye-dilution techniques. Good correlation was found between the 2 methods. Differences in the results and future examination techniques are discussed.
Quantitative Doppler flow velocity determinations were made combined with ultrasound estimation of the arterial diameter of the feeding vessel in arteriovenous fistulas of the arm used both for dialysis administration of cytostatics and parenteral nutrition. In 83 patients flow velocity alone was determined while the volume flow was calculated in 63. The effect of the length of the dialysis period and age of the fistula on the different parameters is discussed.
Twenty-five dialysis patients have been operated 27 times using a modified surgical technique with transposition of the basilic vein for construction of a forearm arteriovenous fistula. The vein is explored at the elbow and dissected free as far distally as possible using small transverse incisions. The vein is cut distally, taken out at the elbow and positioned in a straight, superficial narrow tunnel on the volar side of the forearm for anastomosis to the side of the radial or the ulnar artery. The operation was successful in 19 (76%) cases giving an easily accessible and well-functioning arterialised vein. The surgical technique is simple and is recommended as a primary procedure in patients where the cephalic or other radial or dorsal vein is not available, and as a secondary procedure after failure of a radiocephalic fistula. It is considered of special value for home dialysis patients.
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Polyestradiol phosphate is a polymeric ester of estradiol -17 beta and phosphoric acid. The large molecule has very weak estrogenic properties but is a strong inhibitor of several enzymes, e.g. acid and alkaline phosphatases and hyaluronidase. Given by injection it acts as a depot estrogen slowly releasing estradiol during several months. Given to male patients with prostatic carcinoma, it acts as weak inhibitor of gonadotrophins and testicular hormone production. For the treatment of prostatic carcinoma in 105 patients it gave good palliation and over-all survival 38% after five years. In a new series of 126 patients, polyestradiol phosphate was combined with ethinylestradiol. Over-all survival at five years in this group was 62%. It is suggested that polyestradiol phosphate is as effective as other estrogen therapy for prostatic carcinoma and that the combination with ethinylestradiol is superior to the single drug therapy.
Urographic abnormalities caused by renal artery aneurysms are discussed on the basis of seven cases. Angiography is the diagnostic procedure of choice to make the correct diagnosis. In cases of completely thrombosed aneurysms angiography may only demonstrate an avascular mass with displacement of vessels. At ultrasound examination renal artery aneurysms should be included in the differential diagnosis of echo-free renal masses.
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The use of jejunum in conduit urinary diversion may lead to electrolyte disturbances, characterized by hyponatremia, hypochloremia, hyperkalemia, acidosis, and azotemia, and a clinical picture of nausea, vomiting, dehydration, anorexia, and lethargy. Four out of six patients deviated with a jejunal loop developed this syndrome, the cause of which is discussed. It is concluded that the use of jejunum in urinary diversion should be avoided.
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