Bilateral renal artery stenosis and renovascular hypertension

Experience with the diagnostic evaluation and operative management of 38 hypertensive patients having bilateral renal revascularization is presented. Twenty-four patients had atherosclerotic occlusions and 14 had fibromuscular dysplasia. Renal vein renin assays (RVRA) and/or split renal function studies (SRFS) were performed in 37 of the 38 patients before operation. Although RVRA was negative in 29 percent and SRFS negative in 31 percent, 24 of 26 patients (92 percent) having both tests done had at least one positive study. Twenty-one patients had simultaneous bilateral repairs and 12 had staged bilateral reconstructions. The incidence of technical failures in these two groups was 21 and 9 percent, respectively. Excluding three uncorrected technical failures and two patients with recurrent branch renal artery lesions, 90 percent of patients with atherosclerosis and all patients with fibromuscular dysplasia had a favorable blood pressure response to operation. This study supports the use of both RVRA and SRFS in the diagnostic evaluation of hypertensive patients with renal artery stenosis. If these functional tests lateralize to one side, repair of that side only is recommended. If the functional studies do not lateralize, operation is suggested only when hypertension is severe and is not controlled readily with medications. In this circumstance reconstruction of the side that appears to be diseased most severely is recommended. Contralateral repair is undertaken only when hypertension persists and when repeat functional studies lateralize to the unoperated side.

Renal carcinoma discovered incidentally by arteriography during evaluation for hypertension

Since June 1, 1971 patients undergoing evaluation for hypertension have been evaluated with rapid sequence excretary urography, abdominal aortography and selective renal arteriography. Renal venous assays have been done in selected patients. Through July 31, 1974, 812 arteriographic studies in new hypertensive patients have been done. In 6 of these patients renal tumors were discovered by arteriography only and were not suggested by symptoms, urinalysis nor diagnosed on hypertensive excretory urography. This high incidence surprised us and we hope others will review their arteriographic series of hypertensive patients.

Sources of self-esteem and the person X situation controversy

This study investigated various sources of self-esteem contributing to a global measure of self-esteem. Self-esteem scores for 79 male and 56 female undergraduates on a sentence completion test were analyzed by content area and sources of self-esteem were found. As predicted, sex differences were found for major sources of self-esteem. Results were discussed in terms of the utility of the self-esteem construct in interactions of persons and situations.

Cochlear tuning properties: concurrent basilar membrane and single nerve fiber measurements

Removal of perilymph from the cochlea has been reported to destroy the sharp tuning of cochlear neurons. That these changes are mechanical in origin is refuted by the concurrent recording of sharp neural tuning with broad basilar membrane responses from the same region of the partially drained cat cochlea. A second cochlear filter is therefore necessary.

Postoperative motility of the large intestine in man

Motor activity of the colon in the immediate postoperative period has been studied in human subjects using radiotelemetering capsules, radioopaque markers and serial abdominal radiographs. Following operations outside the abdomen there is a delay of about 16 hours before colonic activity returns. After abdominal operations the delay is from 40 to 48 hours. The length of an operation has no significant effect upon the duration of colonic ileus. The amount of postoperative analgesia has no significant effect upon the duration of colonic ileus. Gaseous distension after laparotomy is confined to the colon.

Determination of plasma and tissue levels of tyramine by radioimmunoassay

Antibodies were prepared against tyramine. The antigen was prepared as follows: p-Aminohippuric acid was coupled to mBSA using a carbodiimide reagent. The amino group was diazotized an attached to the aromatif ring of TYR. The immunogen in Freund's complete adjuvant was injected into rabbits. The specificity of the resulting antibody was determined by radioimmunoassay. Using random-labeled TYR-3H, TYR, its metabolites, phenethylamine analogs, catecholamines, and certain amino acids were evaluated by a competitive binding assay method. With this technique 4 ng of TYR inhibited the binding of TYR-3H by 50%. The radioimmunoassay of TYR was used to measure the plasma, urine, and tissue levels of TYR in rabbits. The plasma disappearance curve of TYR revealed a biphasic pattern with t1/2 of 2 min and 54 min. The highest concentration of TYR was found in adrenals and spleen. The factthat the major metabolites of TYR and a series of pharmacologically important sympathomimetics and catecholamines did not interfere, makes the radioimmunoassay of TYR a useful, simple, sensitive, and spedific method for the direct analysis of TYR in biological meterials.

Surgical management of carotid body tumor

Carotid body tumor or chemodectoma is a slow-growing lesion; it should be diagnosed early to facilitate the technical surgical resection. When these lesions are large, the routine use of a carotid internal bypass shunt is advocated for their safe removal. With the newer vascular approaches, specifically the carotid internal bypass shunt, resection can be performed with acceptable risks. A patient with large bilateral carotid body tumors had successful resection of both these lesions.

Saphenous vein aortorenal bypass grafts: Serial arteriographic study

One-hundred and eight autologous saphenous veins were used to construct an aortorenal bypass in 94 patients and were followed from five months to nine years. There were three operative deaths. Twelve grafts thrombosed. In seven patients the thrombosis was demonstrated in the early postoperative period. In the other five patients an early postoperative arteriogram was not done, the thrombosis was first demonstrated arteriographically 4(1/2)-9 months following operation. In the latter patients it is impossible to determine when the thrombosis occurred. No graft demonstrated to be patent in the early postoperative period was subsequently found to be thrombosed. Therefore it is likely that almost all thromboses occurred in the immediate postoperative period and were the result of technical errors in the arterial reconstruction. A total of 130 followup arteriograms were done in 75 patients with 89 patent grafts. Long term, serial followup arteriograms were done in 29 patients with 39 vein grafts. Three different patterns were observed: 1) the vein graft maintained its initial size and configuration (62%); 2) the vein graft underwent uniform dilatation throughout its length (20%); and 3) the dilatation progressed to aneurysmal proportions (5%). Significant suture line stenosis developed in one patient who also had recurrent renovascular hypertension. Progression of severity of "apparently insignificant" stenosis or development of a new lesion in the contralateral renal artery was observed in 12 of the 29 patients (41%). These patients serve to emphasize the fact that nephrectomy is ill-advised in patients with renovascular hypertension except under the most demanding circumstances. Finally, there is an urgent need for a careful comparative study of the grafts that are currently being used to construct aortorenal bypasses.