Influence of renal angiography in living potential kidney donors

The angiograms of 258 potential kidney donors were retrospectively reviewed to assess the influence of angiography for deciding whether or not to accept the potential donor for nephrectomy and which kidney to use for transplantation. Twenty-five potential donors were rejected. In only 8 of these was angiography necessary to reveal the pathology. Angiography was found to be important in deciding which kidney to donate. In 81 donors the right kidney was used for donation and in 50 this decision was based on findings at angiography.

Side effects and complications after hepatic artery embolization in the carcinoid syndrome

Twenty patients with histologically verified carcinoid liver metastases underwent a total of 24 liver artery embolizations by means of interventional radiologic techniques. There were no deaths. The postembolization syndrome, consisting of fever, abdominal pain, nausea, and vomiting, occurred in all the patients. Severe complications were rare, the most serious being multiple hepatic abscesses with septicemia in one patient, septicemia in another, and mild acute pancreatitis in a third. All these three patients recovered without any sequels from the embolization, and none required surgical intervention. The hepatic abscesses were drained percutaneously, guided by ultrasound. Hepatic artery embolization seems justified in patients with disabling symptoms from the carcinoid syndrome, as long as alternative therapy with the same benefit but fewer complications is not available.

Extended experience with recombinant alpha-2b interferon with or without hepatic artery embolization in the treatment of midgut carcinoid tumours. A preliminary report

Thirty-six patients with histologically verified midgut carcinoid tumours and liver metastases were included in a prospective study with daily interferon therapy 5 x 10(6) IU s.c. for one or two years. All had the primary tumour removed at laparotomy, and whenever technically possible, an embolization of the hepatic arteries was performed prior to interferon start. Recombinant human alpha 2b interferon from Schering-Plough was employed. When interferon was given alone, 24% responded after one year, judged from a 50% reduction in excretion of 5-hydroxyindoleacetic acid in the urine. Three patients had died. Stable disease was found in 43%, while 19% progressed. Survival rate was 40% after 5 years from start of therapy. The median survival time from start of therapy was 3 years and 4 months. When embolization of the liver arteries had been performed prior to the start of interferon treatment, the response rate was 60% after one year, 20% had stable disease and 20% progressed. Survival rate was 75% up to 5 years of observation. We conclude that interferon is an effective treatment of malignant metastatic midgut carcinoid and that survival might be prolonged compared with historical controls. Embolization of the liver arteries seems to increase the response rate after one year. Kaplan-Meier plots suggest prolonged survival when interferon treatment is combined with embolization.

Computed tomography after modified Whipple procedure with pancreatic duct occlusion

Eighty-two CT examinations performed on 28 patients who had undergone a modified Whipple procedure including pancreatic duct occlusion were reviewed. Reduction of the antero-posterior diameter of the body and tail of the pancreatic remnant was observed on consecutive scans in 8 patients (29%). Decreasing liver attenuation was seen in 4 patients (14%) postoperatively, and pseudocysts in the pancreatic remnant in 6 (21%). In 10 examinations performed because of suspected intraabdominal abscess postoperatively, abscess was diagnosed in 2 patients. In 62 routine follow-up CT examinations, significant positive findings were diagnosed in 5 patients: tumor recurrence or metastases in 4, and a large pseudocyst in one. CT is of value in the early postoperative phase to reveal postoperative complications and in the follow-up of patients with specific symptoms indicating tumor recurrence or metastases.

[Primary sclerosing cholangitis and inflammatory bowel disease]

Primary sclerosing cholangitis (PSC) is a syndrome of unknown etiology, characterized by fibrosis and inflammation of the intra- and extrahepatic bile ducts. PSC is usually seen in association with inflammatory bowel disease, particularly in younger patients with extensive ulcerative colitis. Crohn's disease is seen in more than 10% of all patients with PSC. The bowel disease may produce no symptoms in some patients, and the clinical course is usually silent. The development and widespread use of endoscopic retrograde cholangiopancreaticography (ERCP) have enabled us to diagnose the disease far more often than was possible only a decade ago, and also to recognize that PSC has a much wider clinical and pathologic spectrum than previously realized. Most patients with concomitant ulcerative colitis and persistently abnormal liver function tests are likely to have PSC. Patients with PSC usually have a cholestatic biochemical profile, whereas the histologic features of the liver biopsy are variable and often nonspecific. Cholangiography displaying strictures and beading is diagnostic of the disease. The prognosis is variable, with a benign clinical course in many patients. However, an increased rate of cholangiocarcinoma is found in PSC, as is an increased rate of colonic cancer in patients with PSC and ulcerative colitis.

Elimination of iohexol, a low osmolar nonionic contrast medium, by hemodialysis in patients with chronic renal failure

The dialyzability of iohexol was examined in patients with chronic renal failure on long-term hemodialysis treatment. Eight patients had iohexol (Omnipaque 240 or 350 mg I/ml) injected in doses between 98 and 1,493 mg I/kg body weight (BW) 25 h (mean time) before start of hemodialysis. Dialysance of iohexol was 81 +/- 15 ml/min (mean +/- SD) compared to 120 +/- 16.8 ml/min for creatinine. Elimination half-life for iohexol during hemodialysis was 3.9 +/- 1.1 h while plasma clearance was 64 +/- 17 ml/min. The distribution volume calculated (0.25 +/- 0.05 liters/kg BW) confirms previous observations with distribution in the extracellular fluid only. Before the start of hemodialysis 36 +/- 28% of the dose injected was eliminated, indicating some extrarenal elimination. After 4 h of hemodialysis 72 +/- 11% of the dose was removed.

Focal changes of the spleen in one case of Gaucher disease--assessed by ultrasonography, CT, MRI and angiography

Focal lesions of the spleen in one case of Gaucher disease are demonstrated by ultrasonography, CT, MRI and angiography. The sonographic and angiographic features differ from the findings presented in previous reports. The Gaucher manifestations in the spleen as demonstrated by CT, do not seem to have been reported previously. An earlier report on the MR findings in the liver and spleen in this disease did not disclose any focal abnormalities. In this case, ultrasonography and MRI revealed a targetlike configuration of the focal lesions. An attempt is made to analyze the more complex patterns disclosed by MRI against the background of the manifestations by the other imaging modalities and previous reports.

Chronic pancreatitis in patients with sclerosing cholangitis and ulcerative colitis

In the 4-year period 1980-83 sclerosing cholangitis was demonstrated in 7 out of 151 patients with ulcerative colitis hospitalized in our department. Total ulcerative colitis was demonstrated in all patients with sclerosing cholangitis, whereas abnormal pancreatograms compatible with chronic pancreatitis were seen in four of these patients. According to the criteria of Kasugai, one had minimal, two moderate, and one advanced changes of chronic pancreatitis. Although three of four patients had been treated with drugs known to induce pancreatitis (sulfasalazine and corticosteroids), it is tempting to assume that ulcerative colitis, sclerosing cholangitis, and pancreatitis, when seen in combination, are manifestations of autoimmune diseases with a genetic predisposition. A mechanical mechanism for the development of chronic pancreatitis in sclerosing cholangitis must also be considered.

The pancreatic ducts in primary biliary cirrhosis and sclerosing cholangitis

Endoscopic retrograde pancreatograms were examined in a consecutive series of patients with cholestatic disease caused either by primary biliary cirrhosis (PBC) (35 patients) or by sclerosing cholangitis (SC) (38 patients). The pancreatic ducts were abnormal in three of the patients with PBC but in none with SC. Gallstone disease occurred concomitantly in the two patients with most advanced pancreatic involvement. The liver disease was classified as advanced PBC in 11 of the 35 patients. Symptoms of hepatobiliary disease were scarce in most SC patients. Eight of the 38 patients had histologically verified biliary cirrhosis. SC was associated with extensive, but most often inactive or mild, colitis in 97% (ulcerative colitis in 34 and Crohn's disease in 3 patients). Three of these patients had concomitant cholangiocarcinoma.

Cholangiography in rabbits before and after papillotomy

The gallbladder and the function of the sphincter of Oddi were studied after papillotomy (EPT) in New Zealand white rabbits. Intravenous cholangiography (IVC) was performed before and after papillotomy. After papillotomy, IVC showed gallbladder opacification in one of seven test animals, whereas gallbladder filling occurred in all six control animals. The bile ducts were not visualized in any of the test animals, whereas five of six controls showed contrast filling of the bile ducts. Reflux cholangiography was performed after EPT and showed free reflux of contrast from the duodenum to the bile ducts. These findings indicate that papillotomy results in the insufficiency of the sphincter mechanism of the ampulla of Vater, and hence intravenous cholangiography may not be valid for showing the gallbladder and the bile ducts after papillotomy.

Abdominal ultrasonography in patients with uncharacteristic abdominal symptoms

Ultrasonography (US) was performed in a prospective study of 48 patients with uncharacteristic abdominal symptoms. All patients had been examined in other hospitals, but no diagnosis had been established. Pathologic US findings were encountered in five patients: fatty liver in two patients, gallstones in one patient, ovarian cyst in one, and liver metastases in another patient. US may be used as a diagnostic approach in patients with uncharacteristic abdominal complaints when conventional X-ray examinations are negative. In patients with psychosomatic disease a negative US result may be of importance in the psychiatric approach to these patients' disease.

Tolerability of iohexol after injection into healthy volunteers

The effects of iohexol, a new non-ionic contrast medium, after intravenous injection into humans are reported. After injection of small doses into 2 subjects, iohexol was injected intravenously into 20 healthy male volunteers in doses of 125 to 500 mg I/kg body weight. A large number of physiologic, biochemical, hematologic and pharmacokinetic parameters were analysed. The results indicated that iohexol was well tolerated and that clinical trials in patients could be undertaken.

Computed tomography and angiography in carcinoid liver metastases

Fifteen patients with carcinoid metastases in the liver were examined with computed tomography (CT). In 13 patients, liver metastases were demonstrated, while 2 patients had a normal liver at CT. The attenuation of the metastases was lower than that of the liver parenchyma in 12 patients, higher in one. Angiography was performed on 10 patients, and liver metastases were diagnosed in 9. Eight patients had hypervascular metastases with dense accumulation of contrast medium. In one patient, displacement of the intrahepatic arteries was the only sign of an expansive process. In one patient, previously treated with ligation of the common hepatic artery, no signs of liver metastases could be revealed at angiography but were evident at CT.

Computer tomography of the abdomen in patients with uncharacteristic abdominal disturbances

Computer tomography (CT) was performed on 48 patients with uncharacteristic abdominal disturbances. Pathological CT findings were encountered in five patients, namely hepatic steatosis in three patients, liver metastases in one, and occlusion of the inferior vena cava in one. CT may be indicated in patients with uncharacteristic abdominal disorders when other investigations are negative. In some patients the negative result of the CT examination for organic disease was of great importance for the psychiatric approach to these patients' psychosomatic disease. In spite of this, the positive yield of abdominal CT seems to be highest when other less expensive examinations or tests have suggested abnormality of abdominal organs.