J. Dautrebande

Hepatic heterogeneity on CT in Budd-Chiari syndrome: correlation with regional disturbances in portal flow.

A comparative study of the imaging findings of computed tomography (CT), selective arteriography, CT arteriography, and/or CT portography is presented in 4 patients with Budd-Chiari syndrome. Hepatic differences in attenuation and morphologic changes were generally found to be closely related with regional disturbances in portal flow. Areas with complete hepatic vein obstruction were hypodense on pre- and postcontrast scans, probably due to portal flow inversion. In 2 of 4 cases, these were subsequently atrophied, while areas receiving the remaining venous outflow appeared hypertrophied. They were markedly enhanced on postcontrast scans. Enhancement may be patchy due to portal and sinusoidal stasis.

Nontumorous attenuation differences on computed tomographic portography

Nineteen patients with suspected hepatic neoplasms underwent dynamic computed tomography (CT) and computed tomographic portography (CTP) in a preoperative setting. Nontumorous attenuation differences in the liver were observed in 8 patients (42%) with CTP and in 2 patients (10.5%) with dynamic CT (p<0.05).Although nontumorous attenuation differences are significantly more frequent with CTP than with dynamic CT, they are seldom a diagnostic problem because of their geographic pattern.

Treatment of renal graft artery stenosis. Comparison between surgical bypass and percutaneous transluminal angioplasty.

In order to compare saphenous bypass (SB) and percutaneous transluminal angioplasty (PTA) as treatment of renal graft artery stenosis (GAS), we have reviewed the results of both procedures in 33 patients treated consecutively by either SB (n = 16) or PTA (n = 17). All patients had become hypertensive within the first year after transplantation despite triple hypotensive drug therapy. SB was performed 17 (range 3-55) and PTA 19 (range 2-96) months after transplantation. SB failed in only 1 patient as a result of vascular thrombosis with graft loss. PTA was technically unsuccessful in 3 patients and was complicated by vascular branch thrombosis in 1 patient. Blood pressure decrease was similar in both groups: from 179/114 before SB to 147/90 (n = 15, P less than .001) at 6 months and 150/93 (n = 14, P less than .005) at 12 months after SB and from 177/110 before PTA to 149/93 (n = 13, P less than .01) at 6 months and 150/95 (n = 10, P less than .02) at 12 months. At 1 year, control of BP was improved in 85% of SB group patients and 74% of PTA group patients. Recurrent stenosis was documented in 3 PTA group patients: subsequently 1 had a successful SB and the 2 others a repeated PTA--successful in 1, unsuccessful in the other. We conclude that both methods are equally effective for BP control but that PTA entails a higher rate of initial failure and a significant rate of restenosis. However, because of technical ease and better tolerance, PTA emerges as the first-choice treatment of GAS, SB remaining indicated when PTA is not feasible or has failed.

REVERSIBLE RENAL ARTERY STENOSIS IN RENAL TRANSPLANTATION

Spontaneous regression of an arterial stenosis in a renal transplant recipient is documented. Implications of this observation and possible pathogenic mechanisms are discussed.

Diagnostic and therapeutic arteriography in exceptional cases of acute bleeding from upper GI tract

SummaryEmbolization in patients with acute bleeding from the upper digestive tract is an alternative therapeutic approach in patients at high surgical risk. During the past two years, eight patients were treated successfully and without complications. Five illustrating cases are presented in this report.RÉSUMÉL’embolisation dans les hémorragies digestives hautes aiguës est une alternative thérapeutique intéressante chez les patients à gros risque chirurgical. Durant ces 2 dernières années, 8 cas ont été traités avec succès et sans complication. 5 cas sont détaillés ici.ResumenLa embolización constituye una interesante alternativa terapéutica a la Cirugía en las hemorragias digestivas altas de pacientes con riesgo elevado. En los últimos dos años tratamos 8 casos con éxito y sin compilaciones. Exponemos los resultados de 5 de ellos.

Management and Follow-up of Descending Aortic Dissection

The management of 25 consecutive patients with descending aortic dissection is reported. Nineteen patients had medical therapy and 6 needed early surgical correc tions. Indications for early surgery are outlined. Nineteen patients were dis charged and 6 died in-hospital. The actuarial survival is 76% at 11 months and 50% at 4 years. The authors describe the factors susceptible to influence early and late out come.