Diagnostic Criteria for Renovascular Hypertension

Renovascular hypertension is a clinical situation characterized by high blood pressure in the presence of renal ischemia mainly related to atherosclerotic or fibromuscular dysplasic narrowing of the renal artery (ies). This diagnosis is often “a posteriori” validated, because the discovery of a significant renal artery stenosis is not obligatory responsible of the blood pressure elevation.

This article proposes a diagnostic strategy for exploring patient with this suspected secondary cause of hypertension before proposing an invasive approach (intra-arterial angiography) possibly followed by a revascularization. However, the methods for exploring such population are mainly based on patient characteristics and local expertise and habits. These must thus be individualized. First, clinical symptoms or signs frequently associated with hypertension and renal artery stenosis must be searched. If present, a non invasive and functional exploration of the renal arteries is to be proposed (Captopril radioisotope renography, colour duplex sonography) followed by magnetic resonance angiography or spiral computer tomography angiography if the clinical suspicion index is moderate or high. If this is very high, an intraarterial arteriography could immediately be performed if not too dangerous. On the opposite site, if the clinical index is low, it is recommended to follow clinically and to treat risk factors.     

西红康对实验性糖尿病肾病大鼠肾脏结构和功能的影响

目的：考察西红康对实验性糖尿病肾病大鼠肾脏结构和功能的影响。方法32只 Wistar 大鼠（雄性）随机分为模型组、西红康组、糖适平阳性组和正常对照组,每组8只,建立糖尿病肾病大鼠模型,对大鼠进行8周的治疗,检测记录治疗前后大鼠的血糖、体重和尿微量白蛋白,分别采用光学显微镜及透射电镜观察大鼠肾脏的结构变化。结果给药前,各组动物的血糖、体重和尿微量白蛋白中均无统计学差异（P ＞0．05）。给药8周后,血糖水平、体重和尿微量白蛋白指标,阳性组和西红康组相对于模型组均有统计学差异（P ＜0．05）。正常组大鼠肾脏肾小球结构完整,肾脏系膜细胞、滤过膜内皮细胞和足细胞均结构正常,模型组大鼠肾小球体积增大,系膜细胞发生中度增生,毛细血管基底膜结构模糊,内皮细胞胞质局部融合,阳性组和西红康组均能不同程度降低肾小球大小,缓解系膜细胞增生,毛细血管基底膜结构更为清晰,内皮细胞胞质融合程度下降。结论西红康可减轻实验性糖尿病肾病大鼠肾脏病理损害,改善肾脏功能。     

Ultrasound velocity criteria for carotid in-stent restenosis.

OBJECTIVE: To examine duplex ultrasound (US) criteria for carotid in-stent restenosis (ISR). BACKGROUND: Carotid artery stent (CAS) placement is an alternative to surgery for the treatment of carotid stenosis in high surgical risk patients. US is the primary method used to follow carotid stent patency. This study investigates US velocity measurements in carotid ISR. METHODS: Two hundred sixty consecutive patients with CAS placement from June 2000 to June 2004 were followed with serial US. ISR was determined by using the standard US velocity criteria for nonstented carotid artery using peak systolic velocity (PSV), end-diastolic velocity (EDV), and internal carotid artery to common carotid velocity ratio (ICA/CCA ratio). Patients suspected of having carotid ISR > or =50% by US, underwent invasive angiography with stenosis graded by NASCET criteria. Results were compared to patients with nonstented carotid artery stenosis using Two-tailed Student's t-test. RESULTS: PSV and ICA/CCA ratio increased to a greater degree in ISR. In 50-69% stenotic arteries, the mean ICA/CCA ratio was 2.76 +/- 0.7 in the ISR group compared to 2.04 +/- 0.3 in the nonstented carotid group (P < 0.05). In > or =70% stenotic arteries, there were increases in PSV (520 +/- 93 vs. 362 +/- 60, P < 0.05) and ICA/CCA ratio (7.58 +/- 2 vs. 4.51 +/- 1.3, P < 0.05) in ISR versus nonstented carotid arteries, respectively. CONCLUSION: PSV and ICA/CCA ratio in ISR increased to a greater extent for angiographic stenosis > or =50%. PSV 240 cm/sec and ICA/CCA ratio 2.45 are optimal thresholds for > or =50% ISR, and PSV 450 cm/sec and ICA/CCA ratio 4.3 are optimal thresholds for > or =70% ISR.     

Evaluation of coronary subclavian steal syndrome using sestamibi imaging and duplex scanning with observed vertebral subclavian steal

Coronary subclavian steal is defined as retrograde blood flow from the myocardium through the internal mammary artery graft, secondary to a proximal subclavian artery stenosis. The incidence of this syndrome in patients undergoing internal mammary artery grafts for coronary artery bypass is estimated to be 0.44%. Angiography remains the definitive diagnostic test for confirming this condition. We describe a noninvasive method for evaluating coronary subclavian steal syndrome in a 57-year-old man, with a 50-55% subclavian stenosis confirmed by angiography. Noninvasive evaluation using duplex scanning demonstrated normal vertebral artery blood flow. Technetium 99m-sestamibi (99mTc) imaging confirmed a fixed anterolateral defect. When left-arm isometric exercise was employed, retrograde vertebral artery blood flow was observed by Doppler imaging. A repeat 99mTc-sestamibi study documented an increase in tracer distribution in the anterolateral defect confirming reperfusion of the myocardium through the left internal mammary artery graft. The use of duplex scanning and 99mTc-sestamibi may serve as an adjunct in evaluating coronary subclavian steal syndrome as well as documenting transient vertebral subclavian steal in this patient population.     

Renal pelvis urothelial carcinoma of the upper moiety in complete right renal duplex: a case report

Urothelial carcinoma (UC) originated from renal pelvis is the common tumor of the urinary system, however, neoplasia of the renal pelvis in duplex kidneys is extremely rare, especially in the complete renal and ureteral duplex cases. We present the first case of renal pelvis UC of the upper moiety in a complete right renal duplex. This male patient has bilateral complete renal and ureteral duplex. To the best of our knowledge, this is the first reported case of renal pelvis UC in a complete renal duplex system. After this experience we feel that the diagnosis of renal pelvis UC in duplex kidneys is not so easy, and once the diagnosis is determined, the whole renal duplex units and bladder cuff or ectopic orifice should be excised radically.