[Interventional radiologic treatment of urinary transport disorders following kidney allotransplantation].
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Biomedical subjects
Publications and source records attributed to W Münster.
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In a retrospective study of 303 patients with renal cell carcinomas the prognostic influence of the percutaneous transvasal embolization of the renal artery was demonstrated. In form of the life-table-method we compared statistically the survival rates of preoperatively or palliatively embolized patients with such ones who were only nephrectomized or treated only symptomatically. In the tumour stages T2 and T3 the preoperative percutaneous transvasal embolization leads to a clearly higher survival rate; in stage T2 statistically significant. After palliative embolization the improvement of the prognosis is evident compared with the inoperable patients who were treated only symptomatically. The prognosis after palliative preoperative percutaneous transvasal embolization and retarded nephrectomy is not worse than after preoperative percutaneous transvasal embolization and immediate nephrectomy. The effect of the preoperative and palliative embolization improving the prognosis should incite all partners who up to now objected to this therapeutic method to reconsider their therapy concept.
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To assess changes in resting left ventricular function after reestablishment of myocardial perfusion, echocardiographic studies were performed before, at three resp. six days after as well as three months after successful PTCA in 19 patients and after coronary artery bypass grafting in 20 patients. Reference data were obtained from analog processing of values from 20 healthy control subjects. Baseline values (in addition to primary morphologic criteria) were indicative of a clearly functional selection pattern. As compared with those undergoing PTCA, patients who underwent bypass surgery had more unfavorable values for ejection fraction at rest. Immediately after the intervention, there was a consistent tendency to transiently reduced resting pump function. At three months, however, in both groups, cardiac performance had returned to control values and the global and regional parameters of contractility had either reached or exceeded the preoperative values. The mean values showed more improvement in the PTCA group, a finding most probably attributable to the more favorable baseline situation. Paradoxic septum motion was found frequently in those who had undergone bypass surgery. All patients with grafting to the right coronary artery were included in the latter group. Whether perioperative injury, the varying perfusion conditions or the pericardiotomy is responsible for this phenomenon, remains to be established.
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Within one year 15 women suffering from unexplained abdominal pain in the right upper quadrant were examined by sonography and hepatic arteriography. Ten benign liver tumours were detected. Symptoms, diagnostics and therapy are dealt with.
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The case of a 6-year-old girl is reported with severe hemorrhage and "false aneurysm" in the left hepatic lobe due to polytrauma. The diagnosis of the haemobilia which developed 6 weeks after the accident was established by arteriography and scintigraphy. Despite only conservative treatment no further bleeding recurred. Spontaneous restitution was controlled by arteriography and scintigraphy. A long-term follow-up after hepatic trauma is necessary because the haemobiliary syndrome may develop after an asymptomatic interval of several years.
Colicky pain in the gallbladder region, hematemesis, melena and jaundice are symptoms of hemobilia. The underlying cause can be an arterio-biliary or a porto-biliary fistula, resulting in hemorrhage into the duodenum. Shunting may be intra- or extrahepatic and may originate from trauma, or from biliary, pancreatic or vascular lesions. Since 1976 liver biopsies were done in 2221 patients; in 3 of these hemobilia occurred. In one case the artery involved could be obturated by transarterial placement of Ivalon particles; the two other cases recovered without special treatment. A review is given of 23 cases of hemobilia after liver biopsy, and treatment is discussed.
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