Steven H. Cornell

Patterns of Collateral Flow in Renal Ischemia

The presence of collateral vessels to the kidney in obstructive renal artery disease has been noted both in animals and in man. Nevertheless, the pattern of the collateral circulation has not been studied in detail, and it has been correctly stated that “little is known of the extrarenal collateral arterial circulation in man” (6). Our interest in this problem. prompted us to analyze the pathways of collateral flow. Methods and Materials Four dogs were subjected to a right nephrectomy, followed a week later by application of a Goldblatt clamp to the left renal artery.3 About seven weeks after the second procedure, when hypertension had developed in all animals, left renal arteriography was performed, utilizing percutaneous transfemoral intra-aortic catheterization. Ten cubic centimeters of 76 per cent Renografin was injected into the aorta with a mechanical injector in about three-fourths of a second. Observations were made in 24 clinical subjects with main renal artery stenosis and collateral channels. I...

Neurofibromatosis of the Renal Artery An Unusual Cause of Hypertension

multiple neurofibromatosis of von Recklinghausen is characterized by areas of cutaneous pigmentation and multiple tumors of the nervous system. Neurofibromas are most common along the peripheral nerves, being subcutaneous in site, but have also been described in the gastrointestinal and genitourinary tracts (1, 2). Meningiomas and gliomas are associated with neurofibromatosis, as are vascular anomalies such as cavernous hemangiomas. It has been suggested that neurofibromatosis is related to neurocutaneous disorders, such as the Sturge-Weber syndrome and von Hippel-Lindaus disease. It is well established that pheochromocytomas occur relatively frequently in patients with neurofibromatosis (3). That neurofibromatosis may be the cause of renal artery abnormalities and hypertension is not well known. The subject was recently reviewed by Halpern and Currarino (4) who found 7 previously reported cases and added 3 of their own. Of the 10 patients, 1 was not operated upon, 2 remained hypertensive after surgery, ...

Myocardial Sinusoids in Pulmonary Valvular Atresia

Pulmonary atresia with intact ventricular septum is a rare congenital cardiac lesion comprising less than one per cent of all congenital cardiac abnormalities (7). Nevertheless, in an infant who is cyanotic and in distress during the neonatal period this condition is more likely to be present than tricuspid atresia or tetralogy of Fallot (8). The major anatomical abnormality is fusion of the pulmonary valve cusps into a membrane which does not allow blood to leave the right ventricle in the usual manner. The systemic return to the right atrium is shunted into the left atrium through a patent foramen ovale or an atrial septal defect. The left ventricle pumps into the systemic circulation and also into the lungs by way of a patent ductus arteriosus. Clinically, there are neonatal cyanosis and dyspnea. No murmurs are heard in most cases. Occasionally, a systolic murmur may be produced by tricuspid insufficiency or the patent ductus arteriosus. The second heart sound is single and is produced by closure of th...

Calcium in the fluid of mediastinal bronchogenic cyst: a new roentgenographic finding.

Mediastinal bronchogenic cysts are quite rare. Roentgenographically, they have the appearance of a smooth-walled fluid-containing sac. Their location may be carinal, hilar, paratracheal, or paraesophageal. In reviewing the English literature, no mention of calcium in association with these cysts could be found. As a matter of fact, the absence of calcium in the wall is listed as a point in their differentiation from dermoid cysts (9). The purpose of this communication is to report 2 cases of calcium-containing bronchogenic cysts which have been seen at this hospital. Case Reports Case I: A 45-year-old white woman was seen because of indigestion of one-year duration and a pressure type of discomfort beneath the lower end of the sternum. She also complained of dysphagia with food sticking in the distal esophagus and the sensation of a lump at that site. During the four months prior to admission, she had lost ten pounds. Cholecystography and an upper gastrointestinal examination had been performed elsewhere ...

Aneurysm of the membranous interventricular septum.

Congenital and postoperative aneurysms of the membranous interventricular septum are being reported with increasing frequency since the advent of routine left ventricular angiocardiography. The first case diagnosed during life was reported by Steinberg in 1957 (1), and in 1965 the fifth case diagnosed in vivo was described by Kasparian (2). Recently, Jain and Rosenthal reported 10 cases encountered over a two-year period (3). During the past three years, we have seen 17 congenital and 3 postoperative aneurysms of the membranous interventricular septum. It is our impression that these aneurysms are more common than previous communications indicate, and for this reason we are reporting the findings observed in our 20 patients. Case Material The clinical findings, cardiac catheterization data, and angiocardiograms were studied in 20 cases of aneurysm of the membranous interventricular septum, and the subsequent course was also reviewed. We arbitrarily divided these cases into congenital and postoperative ane...

Spasticity of the Lower Extremities Following Abdominal Aortography

DURING THE five-year period of 1964 to 1969, 1,014 abdominal aortographies were performed at the University of Iowa Hospitals. Five patients experienced transient spasticity of the legs following the injection of contrast material. The records and aortograms have been reviewed in an attempt to find a possible factor contributing to this complication. All 5 patients reacted in approximately the same way, as illustrated by the following case. Case Report A number 240 PE catheter was inserted percutaneously into the femoral artery of a 47-year-old hypertensive woman. The catheter was advanced into the abdominal aorta to the level of L1, and a tip occluder was inserted. To check for proper position of the catheter tip, two test injections were made manually, with 10ml of 60 per cent meglumine diatrizoate (Renografin) injected each time. Approximately five minutes later 40 ml of sodium-meglumine diatrizoate (Renovist) was injected in one and one-half seconds with a pressure injector. Five minutes following the...

Angiographic and Catheterization Findings in Patients with Difficulties After Total Correction of Tetralogy of Fallot

Tetralogy of fallot is an anatomically complex intracardiac defect resulting in right-to-left or bidirectional shunts at the ventricular level and decreased pulmonary blood flow. The peripheral arterial unsaturation varies with the size of the interventricular defect and its anatomic relationship to the enlarged aortic root, as well as with the severity of the right ventricular outflow obstruction. The muscular hypertrophy of the right ventricle may be pronounced. Total repair of the anomaly achieves physiologic correction by separation of the intracardiac streams and by relief of the pulmonic stenosis. The repair may or may not result in perfect anatomic or entirely normal intracardiac pressure relationships. Of 124 patients operated upon, there were 102 long-term survivors in this series. Twelve of these were restudied by cardiac catheterization and angiocardiography performed from two months to ten years after total correction of the defects. The most common indication for re-examination was the presen...

Angiocardiography in Endocardial Cushion Defects

The feasibility of making a specific diagnosis of endocardial cushion defect by angiocardiography was first reported by Baron et al. (1). They thoroughly described and illustrated the embryology and anatomy of this condition as did Van Mierop et al. in an earlier report (2). These endocardial defects result from abnormal development of the embryonic mesenchymal atrioventricular cushions. They range in severity from the atrial septal defect of the ostium primum type to complete persistence of the atrioventricular canal. Their exact preoperative diagnosis is of importance to the surgeon in view of the greater complexity of repair and the less favorable prognosis as compared to uncomplicated septal defects. Since November 1963, we have seen the characteristic roentgenographic appearance in 11 cases. In all of these the clinical and cardiac catheterization findings were in agreement with the angiocardiograms. The electrocardiogram was strongly suggestive in all but 2 instances. Although we believe that the di...

Renal angiography after revascularization operations.

Repeat angiography was performed in seven hypertensive patients on whom a variety of renal revascularization procedures had been carried out. The operations included endarterectomy with patch grafting, saphenous vein or prosthetic tube grafts from aorta to distal renal artery, and splenorenal anastomosis. The renal artery stenoses were attributed to arteriosclerosis in four patients, fibrous dysplasia in two, and arteritis in one. Four patients had only one side operated, and in three bilateral operations were performed. The patients ranged in age from fourteen to sixty-seven years, and the repeat angiograms were done from two months to six years postoperatively. The indication for repeat angiography was persistent hypertension in all but one patient who had unexplained abdominal pain. The subsequent management of each patient was determined to a large extent by the angiographic findings. Case Reports Case I: A 50-year-old woman with headaches and fatigue gave a history of hypertension known for five year...