Pheochromocytoma and ipsilateral renal carcinoma diagnosed by angiography.
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Biomedical subjects
Publications and source records attributed to L Ekelund.
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The venographic appearance of the left circumaortic renal vein is described. This developmental abnormality is more common than may be evident from the radiological literature and awareness of its existance is important in the interpretation of the inferior vena cavogram and also for proper placement of the sampling catheter in renal vein renin collections.
In order to accelerate fetal lung maturation 46 pregnant women were given either dexamethasone or betamethasone intramuscularly during 3 consecutive days during 29--36 weeks of gestation. At birth, the infants appeared to have intact humoral immune function in that they could produce normal amounts of immunoglobulins in utero, and 2 fetuses responded with increased synthesis of IgA or IgM following premature rupture of the membranes. The clinical course did not show any increased incidence of puerperal or neonatal illness attributable to intrauterine infection.
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The primary symptoms and signs, indicating urography, in 369 patients with renal carcinoma have been reviewed. Gross haematuria was noted in 33%, signs of malignancy in 20% and in 13% metastases were first diagnosed. In 15% the renal tumor was an incidental finding at urography performed because of prostatism, cystopyelitis, hypertension and prostatic carcinoma. It is concluded that every urography must have such a high quality as to be able to evaluate the entire urinary system in all patients, as a renal carcinoma may be found at urography in any patient above the age of 30 years.
A case is presented of renal artery stenosis causing renin-dependent hypertension 11 1/2 years after irradiation for Wilms tumor. The literature was reviewed briefly for other cases of large artery damage after irradiation therapy.
The pharmacoangiographic effect of a vasoconstrictor (angiotensin) and a vasodilator (tolazoline) was compared in 18 patients with bone and soft-tissue tumors. Angiotensin was found to be the drug of choice in increasing diagnostic information on angiography. Ten to 15 mug of angiotensin seems to be a convenient dose in the axillary, iliac, and femoral arteries.
Renal venography was performed in 21 hypertensive patients, all of whom had the classical appearance of fibromuscular dysplasia of the renal arteries. None showed any evidence of fibromuscular dysplasia of the renal veins.
Angiotensin in a dose of 0.5 to 1.0 microgran injected into the renal artery of healthy kidneys initially decreased renal blood flow and increased the appearance time and mean transit time of dye and contrast medium as examined by a dye dilution technique and angiography. The initial phase is followed by a reactive hyperemia. The increased vascular resistance is probably localized peripherally on the arterial side of the vascular tree. Optimum dose is 0.5 to 1.0 microgram angiotensin in diagnosis of renal tumours. Optimum interval between drug administration and angiography is 10 to 60 s.
Transcatheter hepatic arterial embolization with Spongostan (99.3% gelatin) was performed in a group of normal rats. By repeat angiography could be demonstrated that arterial occlusions lasted for at least 1 to 8 days in most rats. Microscopy of these normal livers gave no evidence of parenchymatous liver injury. At postembolization angiography in a group of rats with experimental liver tumours it could be demonstrated that arterial supply of these tumours was temporarily completely arrested. Microscopy of some of these neoplasms revealed extensive necroses. The eventual future clinical applications of this procedure as an alternative to hepatic artery ligation is discussed.
The radiologic findings in 35 patients with renal amyloidosis (six primary and 29 secondary) are presented. Twenty of the patients with secondary amyloidosis had rheumatoid arthritis. Four patients had enlarged kidneys, 19 had contracted kidneys, and in nine it was possible to follow the decrease in renal size by repeat examinations. Earlier concepts that renal enlargement is typical for amyloidosis cannot be supported; this is probably only seen in the acute stage of the disease. Of 10 renal angiograms performed, all were abnormal. Renal amyloidosis should be considered in the differential diagnosis of contracted kidneys, especially if there is a clinical history of a chronic condition such as rheumatoid arthritis.
Eight cases of vascular lesions of the hand are presented to demonstrate the value of arteriography in these entities. Arteriography provides a valuable tool not only to establish a diagnosis but also for the preoperative planning of repair of injuried vessels in the hand.
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The operative or autopsy specimens of 20 cases of renal carcinoma, 10 cases of pancreatic carcinoma and 10 cases of malignant glioma were studied histopathologically and compared with the in vivo angiographic findings. The study was focused on the presence or not of newly formed tumor vessels trying to eludicate if the abnormal vessels seen on angiography are newly formed tumor vessels or altered preexisting vessels.
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Pharmacoangiography with four vasoactive drugs was performed in experimental renal and hepatic tumours in rats in order to compare their ability to demonstrate tumour vascularity. Three vasoconstrictors, angiotensin, norepinephrine and vasopressin, and one vasodilator, tolazoline, were tested, vasoconstrictors giving most diagnostic information and the difference in effect among these sometimes being small and probably dose-related. This diagnostic effect is based upon the primitive character of tumour vessels, being unable to react upon a vasoactive stimulus. Angiotensin turned out to be the superior drug which corresponds to clinical experiences of this drug.