Marc N. Coel

Renal vasculature in essential hypertension: racial differences.

In an attempt to explain the greater morbidity from essential hypertension in the black as compared with the white race, we evaluated the intrarenal vasculature of 27 patients with hypertension (19 white and 8 black). All patients had mild-to-moderate hypertension (mean arterial pressure, 110 to 125 mm Hg), normal renal function, and minimal target-organ damage. All patients had selective renal angiograms, which were evaluated for arterial nephrosclerosis. Additionally, renal blood flow was estimated by the clearance of para-aminohippurate. Patient age, blood pressure, and plasma renin activity did not differ between the two races. Black hypertensives had significantly (P less 0.01) more severe nephrosclerosis than the white patients. Renal blood flow was lower (P less than 0.05) in black patients (390 +/- 35 ml/min - m2 body surface area) than white patients (473 +/- 19 ml/min - m2 body surface area). These findings may help to explain racial differences in morbidity and mortality from essential hypertension.

Aneurysms of the Small Pancreatic Arteries: A Cause of Upper Abdominal Pain and Intestinal Bleeding

Aneurysms of the smaller splanchnic arteries, though rare, are of great significance because of the high mortality rate associated with rupture of these vessels. Such aneurysms often occur in patients with pancreatitis or pancreatic pseudocysts. Four cases are presented to demonstrate the preoperative diagnosis of this entity by selective arteriography.

Salivary Secretion of Iodine after Urography

Salivary concentrations of total iodine and iodide of patients with and without renal insufficiency have been measured after injection of urographic contrast media. The results support the hypothesis of in vivo deiodination of urographic contrast materials under certain conditions and also indicate that these contrast media are secreted in the saliva in small amounts. Low concentrations of inorganic, presumably unbound iodide have been detected regularly in bottled contrast media, but these amounts are probably small compared to that resulting from in vivo deiodination.

Obstructive Nephrogram Due to Renal Vein Thrombosis

The unusual finding of a progressively increasing nephrogram during excretory urography developed in a patient with acute unilateral renal vein thrombosis. The appearance simulated the nephrogram seen with urinary tract obstruction. It is likely that contrast material accumulated in the tubules, collecting ducts, and interstitial tissues of the kidney. The pathophysiology is briefly discussed.

Percutaneous Catheter Transcaval Tumor Biopsy

An occult renal cell carcinoma producing phlegmasia cerulea dolens and total inferior vena caval obliteration was biopsied by suction on the catheter during right brachial venacavagraphy.

Renal vein renin activity in primary hypertension: variability and influence of contrast material.

Despite recognized limitations, the renal vein renin ratio (RVRR) remains the most commonly used index of surgical curability in hypertensive patients with renal artery stenosis. It is generally held that a ratio exceeding 1.5 forecasts a favorable response to surgery. Measurement of this ratio in 40 patients with essential hypertension (no arteriographically demonstrated stenosis) showed 8 (20%) with RVRR over 1.5, confirming an overlap of this ratio between patients with essential and renovascular hypertension. Intra-arterial injection of contrast material influenced renal vein renin activity (RVRA) in some individuals, but we were unable to demonstrate significant alterations in the group as a whole. Since the influence of intra-arterial contrast material on RVRA is variable and unpredictable, it appears unwise to collect renal venous blood for renin measurements soon after angiography.

Catheter Exchange in Tortuous Vessels During Selective Cerebral Angiography

Inability to advance double-curved catheters beyond the origin of tortuous arch vessels in a common problem in femorocerebral angiography in the aged or hypertensive patient. The authors describe a simple technique involving the use of an exchange guide wire and straight catheter which has proved to be safe and successful in such circumstances.