E. Belgrano

Transcatheter Embolization of the Hypogastric Arteries in Cases of Bladder Hemorrhage from Advanced Pelvic Cancers: Followup in 9 Cases

Bilateral transcatheter embolization of the hypogastric arteries is effective hemostatic treatment for patients with chronic life-threatening bladder hemorrhage from advanced pelvic cancers. We reviewed 9 cases in which this procedure had been done to investigate the immediate results, clinical effects, complications and late results. The minimum followup is 1 year except for 4 patients who were followed until death, which occurred in less than 1 year. Bleeding relapse occurred in only 2 cases and another embolization procedure was done in 1 case without major complications. A considerable decrease in the size of the tumor was noted in 1 patient after the bilateral hypogastric arterial embolization procedure. A rare complication, the Brown-Séquards-like syndrome, is discussed.

Percutaneous Temporary Embolization of the Internal Pudendal Arteries in Idiopathic Priapism: 2 Additional Cases

We report 2 cases of successful treatment of priapism by transcatheter embolization of the internal pudendal arteries. Recovery of penile blood flow was confirmed by Doppler flowmetry and potency was preserved. Embolization with autologous clot is at least partially reversible and interventional angiography warrants consideration in the treatment of priapism.

T and B lymphocyte levels in renal cancer patients: influence of preoperative transcatheter embolization and radical nephrectomy.

The mean percentage of T and B lymphocytes in peripheral blood was tested in 6 patients with renal cancer before and after preoperative transcatheter embolization and radical nephrectomy. While no significant difference was found in B lymphocyte levels compared to those in healthy control subjects a clear impairment in circulating T lymphocyte levels was observed in renal cancer patients who had not been treated. This reduction in T lymphocyte levels persisted after embolization but there was a significant increase after radical nephrectomy.

The role of venography and sclerotherapy in the management of varicocele.

Venography has recently been introduced in routine diagnostic evaluation of varicocele, and a pathogenetic classification based on venographic findings has been proposed. Transcatheter sclerotization of the internal spermatic vein completes the angiographic management of varicocele. After venographic classification of 56 cases, the patients with type-1 varicocele (reno-spermatic reflux) were treated by transcatheter sclerotization (group A, 25 patients) or high inguinal surgical ligation (group B, 15 patients). The results were quite similar, whereas the cost/benefit ratio was favorable to sclerotherapy.

Idiopathic Priapism Successfully Treated by Unilateral Embolization of Internal Pudendal Artery

A case is described of idiopathic priapism successfully treated by transcatheter embolization of the left internal pudendal artery with autologous clots. The rationale for the use of this new approach in the treatment of priapism is discussed briefly.

Usefulness of preoperative transcatheter embolization in kidney tumors

In recent years preoperative transcatheter embolization has been used widely in the management of kidney tumors. However, the effective clinical usefulness of this method has not yet been proved. Forty cases of kidney tumors treated by preoperative embolization and radical nephrectomy are reviewed and compared with a homogeneous group of patients who did not undergo preoperative embolization. Intraoperative blood loss, postoperative complication, and survival rate were statistically evaluated according to tumor stage. Advantages and disadvantages of preoperative transcatheter embolization of kidney tumors are reviewed.

Cyanoacrylates in transcatheter renal embolization.

Isobutyl-2-cyanoacrylate and N-butyl-2-cyanoacrylate were used in experimental trans-catheter embolization of rat kidneys and in two patients as preoperative embolization of renal carcinoma. The agents produced an efficient and lasting embolization, with no evident complication; however, their usage is difficult and an appropriate dosage is also difficult.

Treatment of priapism by transcatheter embolization of internal pudendal arteries

Priapism can be successfully treated by unilateral or bilateral percutaneous transcatheter occlusion of the internal pudendal arteries. Occlusion should be reversible in order to avoid impotence. Embolization with autologous clot satisfies this requirement because of the clot lysis and consequent vessel recanalization. Three cases are extensively described which demonstrate the feasibility of the method and the ability to preserve sexual potency. The rationale for using interventional angiography in priapism is also discussed.

T lymphocytes inhibiting factors in renal cancer: Evaluation of differences between arterial and renal venous blood levels of E rosette forming cells

The cellular immune response has been reported to be impaired in patients with renal cancer and to be increased by removal of the tumor bulk. T lymphocyte levels in the vein of the neoplastic kidney were investigated in 4 patients to assess the presence of a T lymphocyte inhibiting factor produced by the tumor. T lymphocyte levels resulted in significantly decreased tumorous venous blood, whether compared to arterial, contralateral or peripheral blood. A similar result was not found in 10 control patients. Some hypotheses on the nature of this T lymphocyte inhibition are discussed.

PTH radioimmunoassay and loading tests in the diagnosis of patients with primary hyperparathyroidism.

PTH radioimmunoassay today represents an unreplaceable tool in the diagnosis of primary hyperparathyroidism. However, the diagnostic importance of its dosage on selective venous samples is still discussed. Herein, we report our experience of 47 patients operated on for primary hyperparathyroidism. The catheterization of neck veins was performed according to Doppman and co-workers. The PTH assay was carried out with COOH- and NH2-specific antisera. (In 5 cases an inhibition test with CaCl2 infusion was practiced during selective catheterization to preoperatively discriminate between adenoma and hyperplasia.) In 8 cases loading tests with EDTA and in 6 cases with CaCl2 were also performed in association with peripheral venous sampling, in an attempt to improve its sensibility. The 47 cases operated upon showed the following results: the peripheral PTH values were significantly raised in 60% of the cases; the selective PTH dosage with COOH-specific antiserum showed a parathyroid hyperfunction in 100% of the surgically confirmed cases, whereas with the NH2-specific antiserum an increased PTH rate was found only in 84%. A right preoperative localization was obtained in 73%. The value of loading tests is more difficult to evaluate and is discussed in detail.