[Treatment of hypertension of renal origin by selective renal artery embolization].
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Biomedical subjects
Publications and source records attributed to C Veyret.
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PURPOSE: To compare ioxaglate and iobitridol for percutaneous transluminal renal angioplasty (PTRA) as regards thromboembolic complications, the quality of diagnosis, and renal and general safety. METHODS: One hundred and eighty-nine patients were prospectively studied, 98 of whom received ioxaglate, and 91, iobitridol. Twenty-two were secondarily excluded from the evaluation of thromboembolic complications as they did not undergo PTRA. RESULTS: Two hundred and two PTRAs were performed. The total volumes of contrast medium administered and the procedure durations were the same for each patient. In the ioxaglate group, four dissections (3 stents), one occlusive dissection, and two spasms occurred; in the iobitridol group, there were three dissections (all stented), one occlusive dissection (stented), and two spasms. The final angiograms showed four renal infarctions with ioxaglate (2 of which were in patients who were not anticoagulated), two with iobitridol. No significant difference was seen in the incidence of thromboembolic complications when the PTRA was performed after anticoagulation (n = 150; 3.9% vs 4%, p = 0.78); in the whole population, thromboembolic complications were more frequent in the ioxaglate group but the difference was not significant (5.7% vs 3.7%, p = 0.74). The quality of the diagnosis and the general and renal safety were the same in the two groups. CONCLUSION: Regarding the clotting phenomenon, we recorded as many thromboembolic complications with ioxaglate as with iobitridol.
The authors report a case of urinary calculi secondary to glafenine which posed a difficult problem in the radiological diagnosis. They review the literature of iatrogenic urinary calculi and discuss the place of radiology (Excretory Urography, Ultrasound and Computed Tomography) in the diagnosis.
This prospective study was carried out in order to assess the accuracy of ultrasound in the diagnosis of cirrhosis. One hundred and twenty eight alcoholic patients were included. A careful ultrasonographic examination of the liver was performed before liver biopsy (100 patients). In 15 cases, liver histology was normal, steatosis and/or fibrosis, cirrhosis were diagnosed in 13 and 72 cases respectively. Ultrasonic patterns were classified by the same examiner, according to several criteria: volume, irregular outline, coarse and fine bright echo pattern, attenuation of the ultrasound beam, splenomegaly, ascite, portal hypertension. Cirrhosis was diagnosed in 58 out of 72 patients (80.5%). Specificity was 78.5%, positive and negative predictive values were 90.6% and 61% respectively, and global efficacy was 80%. Irregular outline (0.66), hepatomegaly (0.66) and attenuation of the ultrasound beam (0.64) were the best signs. In case of fine bright echo pattern, the diagnosis of cirrhosis would be missed. The results suggest that ultrasonography is a good test for screening alcoholics for cirrhosis. Therefore, it is useful when liver biopsy is contra indicated or refused or when liver is not detected at the clinical examination.
Concerning two cases of biliary distomiasis, the authors describe the sonographic patterns leading to the ultrasonic diagnosis of this parasite. Gallbladder distomiasis appears as an echogenic, oval structure, without acoustic shadow. It characteristically displays mobility and variable shape. The aspect of common bile duct distomiasis is reported for the first time. It is a nonshadowing linear structure and however non specific.