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Split Renal Function After Captopril in Unilateral Renal Artery Stenosis
_DISEASES OF BLOOD VESSELS; :i-IYPERTEN-StON A:t~~D RE~~-JOVASCULfa.R SURGERY
carcinoma. The authors treated 13 patients with primary hepatocellular carcinoma using a solution containing 10 to 30 mg. doxorubicin plus 10 mg. nimustine hydrochloride, 1.0 to 1.5 ml. 60 per cent Urografin and 4.0 to 6.0 ml. lipiodol. The results show that all 13 patients had visible contrast medium in the neoplastic lesion of the liver on plain x-ray and computerized tomography (CT), which was confirmed histologically without evidence of lipiodol in the normal liver tissue. Of 7 patients whose a-fetoprotein levels were elevated before therapy 6 had a marked decrease soon after treatment. The tumor decreased in size on a CT scan after chemotherapy in 2 patients. Five patients underwent hepatic resection following lipiodolization. The resected specimen showed deposit of contrast medium by Softex photography. Complete necrosis of the main hepatocellular carcinoma nodule was noted in 2 patients. The other 2 patients showed partially necrotic areas. These data indicate that lipiodolization was effective in 10 of 13 patients (77 per cent) with reference to serum a-fetoprotein levels, hepatic imaging studies and/or pathological examination. There was no response in 3 patients. No serious complications occurred during and after lipiodolization. F. T. A. 4 figures, 1 table, 16 references
DISEASES OF BLOOD VESSELS, HYPERTENSION AND RENOV ASCULAR
621
Jirasmus The Netherlands Brit. Med. J., 288: 886-890 (Mar. 24) 1984 In 7 of 14 patients with unilateral renal artery stenosis the renal extraction ratios of miodine (1'1 1 I) sodium iodohippurate and 125 I-thalamate were reduced greatly on the affected side by administration of 50 mg. captopril. After long-term captopril therapy (150 mg. daily) the uptake of 99 mtechnetium-diethylenetriaminepentaacetic acid by the affected kidney, which was determined by scintillation camera renography, became almost zero. This finding indicated a severely reduced glomerular filtration rate. Function of the affected kidney returned on discontinuation of treatment. The authors believe that the reduced extraction of i:n Isodium iodohippurate probably reflected a shortened plasma transit time through the kidney owing to intrarenal vasodilation, and that the reduced extraction of 12·0 I-thalamate reflected a low filtration fraction, suggesting that the vasodilation was at least partly at the level of the postglomerular arterioles. Captopril had little effect on the contralateral kidney and on the kidneys of 17 patients with essential hypertension, while serum creatinine concentration showed minor changes. The authors state that radioisotope renography should be performed after captopril treatment is begun in patients with renal artery stenosis, and in patients given captopril as a third line drug when renal artery stenosis has not been excluded. E. D. W. 4 figures, 3 tables, 25 references
SURGERY Chronic Aortitis Following Furosemide Therapy
Treatment of Renal Artery Embolism
8. C. SOMMERS, T. E. HIGGINS AND B. J. KIMELBLATT, Departments of Pathology and Pharmacology, Lenox Hill Hospital, Port Chester, New York
G. G. NICHOLAS AND W. E. DEMUTH, JR., Department of Surgery, Milton S. Hershey Medical Center, The Pennsylvania State University, Hershey, Pennsylvania
Arch. Path. Lab. Med., 108: 293-294 (Apr.) 1984
Arch. Surg., 119: 278-281 (Mar.) 1984
The authors noted chronic aortitis in a cluster of 6 autopsy specimens during an 8-week interval in 1974 and launched an investigation of the possible cause. Sections of thoracic aorta from 100 consecutive adult autopsies performed in 1974 were compared to similar series in 1965 and 1980. The 100 consecutive adult autopsy specimens reviewed from 1965 were chosen from a time before the introduction of furosemide in the hospital pharmacy. There was a statisticaliy significant increase in the instances of chronic nonspecific aortitis after the introduction of furosemide diuretic therapy. Of 48 patients with aortitis 41 had taken furosemide and 7 had not, which also was a significant difference. Aortitis occurred in 34 per cent of 120 individuals who received furosemide. The authors postulate an immune or hypersensitivity reaction to the furosemide-albumin hapten, with localization of reactive lymphocytic and plasma cells around dilated vasa vasorum of the aortic media. The changes described were not severe nor were they associated with atherosclerotic plaques. Nonspecific chronic aortitis is an incidental microscopic pathological finding and is not considered to be of clinical importance to date. P. M. H. 1 figure, 1 table, 7 references
Treatment of renal artery embolism is controversial. Various therapeutic modalities directed toward resolution of arterial occlusion include anticoagulation, renal artery embolectomy, intra-arterial injection of streptokinase and percutaneous transluminal angioplasty. Between 1973 and 1981 the authors performed renal artery embolectomy on 5 renal units in 4 patients. The authors present their results in the 4 patients and review the literature on the subject between 1970 and 1982. Of the 4 patients treated 3 had unilateral and l had bilateral embolism. Of the 5 affected kidneys 4 were salvaged. A review of the literature showed no significant difference between the outcome of patients with segmental or main renal artery embolism who were treated with anticoagulants and those who underwent renal artery embolectomy. Salvage of the kidney was similar in patients with unilateral renal artery embolism who underwent anticoagulation and renal artery embolectomy. Renal artery embolectomy resulted in renal salvage in 90 per cent of the patients with embolism in a solitary kidney or with bilateral embolism (total parenchymal involvement). However, anticoagulant therapy under similar circumstances yielded significantly poor results. Consequently, it appears that renal artery embolectomy has an important role in patients with total renal parenchymal involvement. The potential usefulness of intra-arterial infusion of streptokinase in patients with renal artery embolism has been emphasized recently. This technique also can be combined with percutaneous transluminal angioplasty should residual stenosis of the renal artery exist.
Split Renal Function After Captopril in Unilateral Renal Artery Stenosis G. J. WENTING, H. L. TAN-TJIONG, F. H. M. DERKX, J. H.B. DE BRUYN, A. J. MAN IN'T VELD AND M. A. D. H. SCHALEKAMP, Department of Internal Medicine I, Univer-
carcinoma. The authors treated 13 patients with primary hepatocellular carcinoma using a solution containing 10 to 30 mg. doxorubicin plus 10 mg. nimustine hydrochloride, 1.0 to 1.5 ml. 60 per cent Urografin and 4.0 to 6.0 ml. lipiodol. The results show that all 13 patients had visible contrast medium in the neoplastic lesion of the liver on plain x-ray and computerized tomography (CT), which was confirmed histologically without evidence of lipiodol in the normal liver tissue. Of 7 patients whose a-fetoprotein levels were elevated before therapy 6 had a marked decrease soon after treatment. The tumor decreased in size on a CT scan after chemotherapy in 2 patients. Five patients underwent hepatic resection following lipiodolization. The resected specimen showed deposit of contrast medium by Softex photography. Complete necrosis of the main hepatocellular carcinoma nodule was noted in 2 patients. The other 2 patients showed partially necrotic areas. These data indicate that lipiodolization was effective in 10 of 13 patients (77 per cent) with reference to serum a-fetoprotein levels, hepatic imaging studies and/or pathological examination. There was no response in 3 patients. No serious complications occurred during and after lipiodolization. F. T. A. 4 figures, 1 table, 16 references
DISEASES OF BLOOD VESSELS, HYPERTENSION AND RENOV ASCULAR
621
Jirasmus The Netherlands Brit. Med. J., 288: 886-890 (Mar. 24) 1984 In 7 of 14 patients with unilateral renal artery stenosis the renal extraction ratios of miodine (1'1 1 I) sodium iodohippurate and 125 I-thalamate were reduced greatly on the affected side by administration of 50 mg. captopril. After long-term captopril therapy (150 mg. daily) the uptake of 99 mtechnetium-diethylenetriaminepentaacetic acid by the affected kidney, which was determined by scintillation camera renography, became almost zero. This finding indicated a severely reduced glomerular filtration rate. Function of the affected kidney returned on discontinuation of treatment. The authors believe that the reduced extraction of i:n Isodium iodohippurate probably reflected a shortened plasma transit time through the kidney owing to intrarenal vasodilation, and that the reduced extraction of 12·0 I-thalamate reflected a low filtration fraction, suggesting that the vasodilation was at least partly at the level of the postglomerular arterioles. Captopril had little effect on the contralateral kidney and on the kidneys of 17 patients with essential hypertension, while serum creatinine concentration showed minor changes. The authors state that radioisotope renography should be performed after captopril treatment is begun in patients with renal artery stenosis, and in patients given captopril as a third line drug when renal artery stenosis has not been excluded. E. D. W. 4 figures, 3 tables, 25 references
SURGERY Chronic Aortitis Following Furosemide Therapy
Treatment of Renal Artery Embolism
8. C. SOMMERS, T. E. HIGGINS AND B. J. KIMELBLATT, Departments of Pathology and Pharmacology, Lenox Hill Hospital, Port Chester, New York
G. G. NICHOLAS AND W. E. DEMUTH, JR., Department of Surgery, Milton S. Hershey Medical Center, The Pennsylvania State University, Hershey, Pennsylvania
Arch. Path. Lab. Med., 108: 293-294 (Apr.) 1984
Arch. Surg., 119: 278-281 (Mar.) 1984
The authors noted chronic aortitis in a cluster of 6 autopsy specimens during an 8-week interval in 1974 and launched an investigation of the possible cause. Sections of thoracic aorta from 100 consecutive adult autopsies performed in 1974 were compared to similar series in 1965 and 1980. The 100 consecutive adult autopsy specimens reviewed from 1965 were chosen from a time before the introduction of furosemide in the hospital pharmacy. There was a statisticaliy significant increase in the instances of chronic nonspecific aortitis after the introduction of furosemide diuretic therapy. Of 48 patients with aortitis 41 had taken furosemide and 7 had not, which also was a significant difference. Aortitis occurred in 34 per cent of 120 individuals who received furosemide. The authors postulate an immune or hypersensitivity reaction to the furosemide-albumin hapten, with localization of reactive lymphocytic and plasma cells around dilated vasa vasorum of the aortic media. The changes described were not severe nor were they associated with atherosclerotic plaques. Nonspecific chronic aortitis is an incidental microscopic pathological finding and is not considered to be of clinical importance to date. P. M. H. 1 figure, 1 table, 7 references
Treatment of renal artery embolism is controversial. Various therapeutic modalities directed toward resolution of arterial occlusion include anticoagulation, renal artery embolectomy, intra-arterial injection of streptokinase and percutaneous transluminal angioplasty. Between 1973 and 1981 the authors performed renal artery embolectomy on 5 renal units in 4 patients. The authors present their results in the 4 patients and review the literature on the subject between 1970 and 1982. Of the 4 patients treated 3 had unilateral and l had bilateral embolism. Of the 5 affected kidneys 4 were salvaged. A review of the literature showed no significant difference between the outcome of patients with segmental or main renal artery embolism who were treated with anticoagulants and those who underwent renal artery embolectomy. Salvage of the kidney was similar in patients with unilateral renal artery embolism who underwent anticoagulation and renal artery embolectomy. Renal artery embolectomy resulted in renal salvage in 90 per cent of the patients with embolism in a solitary kidney or with bilateral embolism (total parenchymal involvement). However, anticoagulant therapy under similar circumstances yielded significantly poor results. Consequently, it appears that renal artery embolectomy has an important role in patients with total renal parenchymal involvement. The potential usefulness of intra-arterial infusion of streptokinase in patients with renal artery embolism has been emphasized recently. This technique also can be combined with percutaneous transluminal angioplasty should residual stenosis of the renal artery exist.
Split Renal Function After Captopril in Unilateral Renal Artery Stenosis G. J. WENTING, H. L. TAN-TJIONG, F. H. M. DERKX, J. H.B. DE BRUYN, A. J. MAN IN'T VELD AND M. A. D. H. SCHALEKAMP, Department of Internal Medicine I, Univer-