Leif Ekelund

Transcatheter obliteration of the renal artery by ethanol injection: Experimental results

The sclerosing effect of the introduction of 95% ethanol into the renal artery was evaluated in eight rabbits and one pig. Longtern occlusio of the renal artery with ensuing infarction of the kidney could be produced by a small, easily tolerated dose. Several inherent drawbacks of currently used embolic agents may be avoided with this technique, which is suggested for clinical trial.

Arteriovenous fistulae following percutaneous renal biopsy

Arteriovenous fistulae resulting from renal biopsy are presumed to be uncommon. Since the first cases were described in 1962 (BOIJSEN & KOHLER 1962, FERNSTROM & LINDBLOM 1962) further reports of this complication have appeared (ALwALL 1963, BLAKE et colI. 1963, BENNETT & WIENER 1965, KAUFMAN et coll, 1965, RILEY 1965, NILSSON & Ross 1967, CURRAN et colI. 1967, FAUST 1968, OCHSNER & BUSCH 1969). The largest clinical material was presented by BENNETT & WIENER (1965) , who reported 9 arteriovenous fistulae and 2 arterial aneurysms among 58 patients in whom renal biopsy had been performed. The total number of published cases of fistulae following renal biopsy now amounts to some 30. Experimental investigations in rabbits have indicated that the condition is easily produced by renal biopsy (EKELUND 1970). The present work was intended to investigate angiographically the frequency of such fistulae in patients who had, as well as in those who had not, been previously examined by percutaneous renal biopsy. Some of the angiographies were performed in a current program in which patients are examined both before and after renal biopsy. The examinations followed up in this program are still few in number and will be reported later.

Spontaneous closure of arteriovenous fistulae following percutaneous renal biopsy. An experimental investigation in the rabbit.

Only a few cases of spontaneous closure of renal arteriovenous fistulae secondary to renal biopsy have been reported (BENNETT & WIENER 1965, NILSSON & Ross 1967, EKELUND & LINDHOLM 1971). EKELUND (1970) demonstrated closure of such fistulae in two experimental cases. Five cases of spontaneous closure of fistulae caused by trauma other than biopsy (gunshot wounds, blunt trauma) have recently been published (HALPERN 1969). This tendency to spontaneous closure must be an important factor when deciding the treatment of postbiopsal arteriovenous fistulae (which are more common than formerly believed (EKELUND 1970)). An attempt to evaluate its frequency therefore appeared reasonable and prompted the present investigation.

Angiography in dimethylnitrosamine-induced rat renal tumours.

Experimental rat renal tumours, induced by dimethylnitrosamine (DMN), have been described by MAGEE & BARNES (1959,1962), ZAK et coll. (1960) and ARGUS & HOCH-LIGETI (1961). Angiographic investigations in vivo of experimentally induced renal tumours have not yet been reported. A method for selective catheterization of arteries in the rat has, however, recently been developed (EKELUND & OLIN 1970), and the present investigation is concerned with angiographic examinations of DMN-induced rat renal tumours as an experimental model. Material and Methods. Twenty-five white rats (Rattus norvegicus albinus ) of Wistar strain of both sexes with a weight of 100 to 150 g at the beginning of the experiment were used. They received DMN (Aldrich Chemical, USA), dissolved in arachis oil and mixed with corn pellets, for one week; the mean total dose of DMN per rat was estimated to be 200 mg/kg. The rats were then returned to a normal diet of commercial pellets. Fourteen rats were examined by angiography at 26 to 30 weeks (group I), and the remaining eleven rats at

Book Review: Computed Tomography of the Kidneys and AdrenalsComputed tomography of the kidneys and adrenals. Edited by SiegelmanStanley S., GatewoodOlga M. B. and GoldmanStanford M.. Churchill Livingstone, Edinburgh1984. Price: GBP 33.50

The normal anatomy is displayed in an ultrasoundoriented way with surface anatomy as well as transverse sectional anatomy, oblique, and sagittal sectional anatomy. The schematic drawings are of an eminent quality. The main part of the book is divided into six sections: the normal liver, focal liver disease, diffuse liver disorders, the biliary system, the pancreas and the spleen. Every ultrasound image is completed with a schematic drawing and an indication of the plane of the ultrasound scan. The notes accompanying the images contain many sound remarks and make the book easy to use for teaching purposes. The different sections include descriptions of normal anatomy, variations, typical ultrasound appearance of certain lesions, explanatory diagrams and comments of great value covering the different aspects of ultrasound imaging. The large number of images and different cases along with comments from a most experienced doctor in ultrasound makes the book useful not only to the unexperienced but it can also be highly recommended to everyone working with, or learning ultrasound of the upper abdomen and should be close at hand at any diagnostic department.

Book Review: Computed Tomography of the Retroperitoneum. An Anatomical and Pathological Atlas with Emphasis on the Fascial PlanesComputed tomography of the retroperitoneum. An anatomical and pathological atlas with emphasis on the fascial planes. By FeldbergM. A. M., Martinus Nijhoff Publishers, Boston1983.

After it has become clear that vesicoureteral reflux represents a significant cause of nephropathy and consequently of, e.g., hypertension and chronic renal failure, the trilogy vesicoureteral reflux/intrarenal reflux/reflux nephropathy have gained considerable experimental and clinical interest. In 1982 the second workshop on reflux nephropathy was held at Santa Barbara, California, and the present book is proceedings from the meeting. The workshop concentrated on two main themes 1) factors relating directly to vesicoureteral reflux, and 2) the manifold clinical facets and was divided into 7 sections. A section consisted of I to 7 papers followed by a terminating debate similar to the well-known proceedings of the first workshop on Bermuda in 1978. A workshop designed for later publication places a considerable responsibility on the organizers as regards selection of the limited number of participants. Ifproceedings of a meeting shall be of general interest, the organizers must know every essential new work on the subject, not only from the United States and England, to obtain a balanced view. Generally the organizers (the editors?) have succeeded. In the reviewers opinion subjects (as for example intrarenal reflux, the role of glomerulosclerosis, pathologic findings, transplantation, variations in the diagnostic techniques, and surgical techniques) could have been included or dealt with from other points of view. Furthermore, a few important investigators are not represented in the list of contributors; their participation could have given a broader view. Nevertheless the editors should be congratulated with the accomplishment of the workshop/book, and it is hoped that a third workshop is being prepared for 1986. The majority of papers are well-written. A few major points from the book should be mentioned. It seems now that the radiologic methods for diagnosing vesicoureteral reflux and reflux nephropathy (micturating cystourethrography and urography) are being replaced by radionuclides due to their high diagnostic and follow-up potential. However, the diagnosis of vesicoureteral reflux will still require catherization of the bladder, a potential way of introducing urinary tract infection. The controversy concerning sterile reflux causing scarring has now been solved, and everyone must accept that scars can occur in the high pressure situation. It seems more and more likely that plasma-renin plays a role in the development of hypertension. In some infants astonishing high pressures are recorded in connection with dysfunctional voiding. This may be an important area for further research. Preliminary results appear to justify the proposed simplification of classification of bladder dysfunction. Uri-quick home urine culture kit seems to be a reliable and simple method for urinary tract infection surveillance and screening in children. The role of Tamrn-Horsfall protein for the development of reflux nephropathy is still controversial. The reports on the role of P. fimbriae, which occur exclusively in E. coli, in connection with pyelonephritis are premature. Preliminary results from a controlled study with a 2year observation period showed that neither chemotherapy nor surgical intervention are likely to exert any essential influence on the development of the parenchymal scarring. The results of 5 and 10years and of the international reflux study are awaited. The clinical facets on reflux nephropathy/vesicoureteral reflux (from diagnosis through course and complications to the end stages) involve all ages and several medical disciplines, e.g. pathology, nephrology, pediatrics, urology, radiology, and general practioners. The book is highly recommended to colleagues in these fields. It can never be stressed to often that reflux nephropathy can be prevented and that the critical period of the generation of this disease for the majority of patients is the first years of life. Henrik S. Thomsen