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Biomedical subjects

F Losinno

Publications and source records attributed to F Losinno.

At least 19 recordsLinked to original sources
PubMed1994

Renal artery angioplasty for renovascular hypertension and preservation of renal function: long-term angiographic and clinical follow-up.

OBJECTIVE: Percutaneous transluminal angioplasty of stenoses of the renal artery can be used to treat hypertension and renal insufficiency. Although many studies have been published on the short-term results of this procedure, few long-term studies are available. SUBJECTS AND METHODS: One hundred ninety-five patients (123 men and 72 women 19-79 years old; mean age, 56 years) with stenosis of the renal artery and hypertension underwent renal percutaneous transluminal angioplasty at our institution. The stenosis was unilateral in 66% of patients, bilateral in 26%, and in a solitary functioning kidney in 8%. Renal insufficiency was present in 31% of patients. After renal percutaneous transluminal angioplasty, long-term clinical and angiographic follow-up was evaluated by life-table analysis. RESULTS: In patients with fibromuscular disease, blood pressure returned to normal in 57%, improved in 21%, and was unchanged in 21%. In patients with atherosclerotic stenosis, blood pressure returned to normal in 12%, improved in 51%, and was unchanged in 37%. After percutaneous transluminal angioplasty, renal function improved in 48% of patients with renal insufficiency due to bilateral stenosis or stenosis in the single functioning kidney, whereas none of the patients with unilateral stenosis of renal artery and renal insufficiency had any notable improvement. Long-term follow-up showed a high rate (82%) of patency of revascularized arteries and a low rate (21%) of hypertension recurrence at 5 years. CONCLUSION: Renal percutaneous transluminal angioplasty is useful for treating hypertension and for reestablishing renal function. Its effects on blood pressure and renal function are long-lasting in the large majority of patients.

Angioplasty, Balloon↗
PubMed1993

[Color-Doppler and angioplasty in renovascular hypertension].

Renovascular hypertension is defined as a kind of hypertension secondary to altered renal perfusion with the activation of the renin-angiotensin system. Since a large number of these patients benefits from treatment--be it medical, surgical or angioplastic--a non-invasive low-cost method allowing accurate screening was looked for. Color-Doppler was employed by many authors to evaluate renovascular hypertension, for both the early diagnosis of the condition and the evaluation of treatment results in renal artery stenoses. However, the authors agree that color-Doppler cannot play a major role in the screening of renovascular hypertension due to the various qualitative and quantitative variables not being adequately codified, to the lack of a single color-Doppler method and to the difficult comparison of the results from the different units. Nevertheless, improved results are promised by technological evolution, together with the possibility to codify color-Doppler variables more easily repeatable. B-mode units with 3.5 and 5 MHz probes were employed in the thinnest subjects. In 5-25% of cases accessory renal arteries were observed. After identifying the vessel to be studied with several spatial scans, the smallest possible sample volume (usually 3-5 mm) was positioned. The normal flowmetric range was 0.07-0.1 s: it must not exceed 0.16 s, with persistence of high diastolic flow. Some authors' criteria were followed to define either stenosis or renal artery obstruction; moreover, pulsatile flow index was considered, together with the resistive index, pulsatility index and stenosis index.

Angioplasty↗
PubMed1992

Prognostic value of captopril renal scintigraphy in renovascular hypertension.

This study evaluates the prognostic value of captopril renal scintigraphy in hypertensive patients undergoing renal artery revascularization. Preoperative studies of 51 patients were correlated with blood pressure results at 6- and 12-mo follow-up. Captopril-renal scintigraphy was carried out 1 hr after oral administration of 50 mg of captopril, using either 220 MBq of 99mTc-DTPA or 74 MBq of 99mTc-MAG3, followed by a baseline study in case of abnormal results. Evidence of amelioration or normalization in relation to captopril study was considered predictive of blood pressure control following treatment. Blood pressure response was favorable in 37 patients, but failed to show any improvement in 14. The scintigraphic test was positive in 33 patients (15 cured, 17 improved, 1 failed) and negative in 18 (3 cured, 2 improved, 13 failed). Sensitivity and specificity for renovascular hypertension was 86.5% and 93%, respectively. For blood pressure cure and improvement, the test had positive and negative predictive values of 97% and 72%, respectively. A positive preoperative captopril renal scintigraphic result is a strong predictor of hypertension curability by renal artery revascularization.

Adult↗
PubMed1992

[Renal artery stenosis. Doppler color study before and after angioplasty].

Doppler flowmetry can be successfully employed to assess arterial patency after percutaneous transluminal angioplasty (PTA). The aim of this study was to assess color Doppler sensitivity in detecting renal artery stenosis prior to percutaneous angioplasty (PTRA) and vessel patency after it. Eleven patients (7 males and 4 females) affected with renal artery stenosis, unilateral in 9 cases and bilaterally in 2, underwent color-Doppler evaluation 1 day before and 7 days after PTRA. The operator was unaware of dilatation results. A total of 13 stenoses were treated. The qualitative and quantitative parameters we employed were: a) broadening of the spectrum, b) peak systolic frequency > 4000 Hz, c) stenosis index > 50%. Before PTRA, mean systolic peak at the stenosis was 7978 (range 4050-12500 Hz), while stenosis index was 71.9% (range 48-89%). After PTRA complete recovery was observed in 5 cases, no improvement in 1 and incomplete recovery in 7. Doppler results were in agreement with those of angiography in 6/13 while partial agreement only was seen in 7/13. Our results, although obtained in a small and highly selected group of patients, would seem to support the value of color-Doppler for the follow-up of patients after PTRA.

Adult↗
PubMed1991

[Percutaneous nephrostomy in neoplasm patients: when?].

The management of cancer patients with a lesion in its end stage is a clinical problem a satisfactory solution to which has not been found yet, because of the ethical and legal problems involved. The authors analyzed the survival rates of 218 patients with advanced neoplastic disease and obstructive renal failure who had undergone external/internal urinary diversion. One month after the procedure 20% of the patients were dead. The figure rose to 75% at 6 months and reached 98% at one year. Urinary diversion in cancer patients with renal failure is aimed not only at avoiding death and assuring a prolonged survival, but also at providing a good quality of life. Several clinical criteria are therefore analyzed which are used in the selection of patients to submit to nephrostomy. The most important factors seem to be the actual stage of the tumor, its primary location, the possibility of an effective antineoplastic therapy, and the patient's consent. Randomized long-term studies are still necessary to analyze not only survival rates but also quality of life after urinary diversion for obstructive renal failure.

Adult↗
PubMed1991

Use of technetium-99m-MAG3 for renal scintigraphy after angiotensin-converting enzyme inhibition.

Technetium-99m-mercaptoacetyltriglycine (99mTc-MAG3) was tested in 82 hypertensive patients submitted to renal scintigraphy 1 hr after oral premedication with 50 mg of Captopril. Baseline studies were obtained only for those patients showing abnormal findings in the provocative study. All patients underwent renal arteriography. Sensitivity and specificity for the detection of renal artery stenosis (RAS) greater than 50% were 89% and 91%, respectively. After Captopril administration, tracer parenchymal transit time increased significantly in ischemic kidneys (334 +/- 93 sec in baseline conditions versus 468 +/- 96 sec after Captopril, p less than 0.001) but not in kidneys with no RAS or RAS less than 50% (243 +/- 46 sec versus 271 +/- 95 sec, p = ns). False-positive responses were mostly bilateral and associated with a marked decrease in blood pressure. Technetium-99m-MAG3 is an effective compound for detecting RAS greater than or equal to 50% with Captopril renal scintigraphy. Performing the provocative test as a first step considerably reduced the number of scintigraphic studies required.

Administration, Oral↗
PubMed1991

[Duplex and Doppler color echocardiography for the study of renovascular hypertension. Comparison with arteriography].

Doppler US was employed to examine 46 patients with suspected renovascular hypertension (RVI) to detect stenosis/occlusion of the renal artery. In 25 cases duplex-Doppler technique was used, in 19 color-Doppler US, and 2 patients were examined with both methods. Doppler US was always performed before angiography which was considered as the reference gold standard. Using duplex-Doppler US, the diagnosis of renal artery stenosis was based on qualitative (spectral analysis of the waveform and absence of flow signal in cases of renal artery occlusion), and semiquantitative parameters (resistive index). Diagnostic accuracy of duplex US--which was compared with that of angiography--was 83%, its sensitivity was 91.6%, and specificity was 85%. With color-Doppler, two additional quantitative parameters were used (peak systolic frequency shift at the stenosis and stenosis index). In this group of patients sensitivity was 70%, specificity was 100%, and accuracy 85%. The good diagnostic yield of the method is counter-balanced by some limitations--e.g., operator dependence and long examination time (30-40 minutes, especially with duplex US). In the authors' opinion, Doppler technique can be used in the diagnosis of RVI, even though further study is necessary to exactly define diagnostic parameters, and to verify reproducibility and both inter- and intra-observer repeatibility. Technological progress may in the future reduce both difficulty and time of the examination.

Adult↗
PubMed1989

Evaluation of hypertensive patients by means of captopril enhanced renal scintigraphy with technetium-99m DTPA.

One-hundred five hypertensive patients underwent conventional renal scintigraphy followed 2 or 3 days later by Captopril-enhanced renal scintigraphy, performed 1 hr after premedication with 50 mg of Captopril per os. All patients were then submitted to renal arteriography, performed within 15-30 days. Fifty-five patients had no renal artery stenosis, 29 had unilateral disease, and 21 bilateral. Overall, 34/37 patients were diagnosed by the provocative test as having at least one renal artery affected by a stenosis greater than 50%. Of those with no stenosis (n = 55) or stenosis less than 50% (n = 13) only two cases were falsely positive. Thus sensitivity was 92% and specificity 97%. For single kidney identification with stenosis greater than 50%, sensitivity of renal scintigraphy after Captopril administration was 94% and specificity 98%. Captopril enhanced renal scintigraphy is thus suggested as the first test to be performed in hypertensive patients referred for renal scintigraphic studies. Only those cases with equivocal results require a baseline study for better assessment.

Adult↗
PubMed1988

[Diverticula of the female urethra. A radiological and ultrasound study].

The authors analyzed the clinical, radiographic and sonographic findings of diverticulum of the female urethra, reporting on 47 cases. Lower urinary tract infections, urgency and post-urinary dribbling were the most common symptoms. Either voiding cystourethrography or positive pressure urethrography was carried out in all patients, while US was performed in 18 cases only. Radiographs showed diverticula to be usually solitary (87%); their size ranged from 1 to 3 cm (72%). They were most commonly found in the mid-third of the urethra (83%), and stones were present in 12.7% of patients. Suprapubic and transrectal US demonstrated cystic lesions, usually dyshomogeneous, located under the bladder base and the uterine cervix. The authors believe that both examinations should be performed, as they provide with complementary information. X-ray study allows the evaluation of the exact number and position of diverticula, while US demonstrates both the extension of inflammatory changes and the size of diverticula not completely filled during voiding cystourethrography.

Adolescent↗
PubMed1988

[Angiographic study of the complications of vascular access in patients under hemodialysis].

Periodic hemodialysis requires the vascular access to be capable of functioning perfectly for a long time; therefore early diagnosis of the most common complications is very important. Fifty-four patients in dialysis treatment for end-stage renal failure (ESRF) were examined over a six-year period for vascular access (VA) complications. Eighty vascular accesses were studied: 68 arteriovenous fistulas and 12 arteriovenous grafts. The most frequent radiological investigation was phlebography, followed by arteriography by direct puncture of the humeral artery, and, in few cases only, by arteriography through femoral approach; the total number of radiographic examinations performed was 101. The most frequent complications were thromboses (50%) and stenoses (21%); aneurysms, pseudoaneurysms and radial artery steals were observed in 11% of the cases. Findings prove complications to depend neither on the type of VA (fistula, prosthesis) nor on its site (proximal, distal). In 50% of the cases angiography allowed a therapy to be adopted for VA recovery. Percutaneous transluminal angioplasty (PTA), performed on 3 patients, failed. Thus, in the authors' opinion, angiography is the method of choice for the evaluation of VA pathology, and surgery is the most efficient treatment for complications. Despite failures, PTA represents a valid alternative in the treatment of stenoses in larger vessels and prostheses.

Adult↗
PubMed1987

[Percutaneous transluminal dilatation of benign ureteral stenoses].

Ten benign ureteral strictures, in nine patients, were dilated with balloon catheter in conjunction with percutaneous nephrostomy. One patient had bilateral stenosis. The strictures followed ureteroileostomy (3 cases), uretero-uretero anastomosis (2 cases), ureteroneocystostomy (1 case), radical hysterectomy with associated ureteral fistula (1 case), post-surgical ureteral fistula (1 case) and benign long-standing stricture of unknown origin (1 case). Nine out of ten strictures were successfully dilated with disappearance of hydronephrosis. One patient underwent surgical correction of the stenosis. Dilation proved to be unsuccessful. The follow-up goes from 2 to 30 months and there is no evidence of obstruction.

Adult↗
PubMed1987

[Percutaneous nephropyelolithotomy].

The fact that one can perform a wide passage through the kidney percutaneously with the subsequent introduction of a 26 F nephroscope has radically changed the technique used to remove kidney stones. They may either be extracted directly with forceps or following ultrasonic lithotripsy. The authors report their experience of 39 cases, in 32 of which the method was successful, 3 complications have been reported. The advantages of this method, both for the patient and for the community, are discussed in comparison to the surgical pielolithotomy. The problems concerning the dose absorbed by the operator are also examined.

Adult↗
PubMed1982

Renal scintigraphy versus renal vein renin activity for identifying and treating renovascular hypertension.

This paper compares renal scintigraphy (RS) with renal vein renin activity (RVRA), intravenous pyelography (IVP), and peripheral plasma renin activity (pPRA) in a population of hypertensive subjects with suspect renovascular hypertension (RVH), of whom 30 underwent surgery, in order to evaluate (a) screening ability of RS for RVH, and (b) surgical prognosis of RS for RVH. RS agreed with arteriographic findings of arterial stenosis in 91% of patients and proved more sensitive as a screening test than IVP and pPRA. The false-negative rate of RS was 9% and the false-positive rate was 10%. In the patients who underwent surgery RS was positive in 89% and RVRA in 85% of those who benefited from surgery. In this series false-negatives for RS occurred only in the presence of extensive collateral circulation, where RVRA also gave the same result. In patients who had been operated on, the sensitivity and specificity of RS, compared to RVRA, were very high. Our work supports the view that RS is a good screening test in RVH; moreover, it seems to be as accurate as RVRA as a surgical prognostic method for curable RVH.

Adolescent↗