Midterm Outcomes of Angioplasty for Pediatric Renovascular Hypertension

PurposeTo evaluate the midterm outcomes of percutaneous transluminal renal angioplasty (PTRA) for pediatric renovascular hypertension (RVH).Materials and MethodsThe clinical data of patients who underwent PTRA for RVH in the authors’ hospital from 2012 to 2019 were retrospectively analyzed. Postprocedural blood pressure, glomerular filtration rate (GFR) of the affected kidney, restenosis, and complications were closely monitored.ResultsPTRA was performed in a total of 30 children (20 boys and 10 girls), with a mean age of 7.3 years ± 0.7 (range, 40 days to 13.9 years) and a mean weight of 25.0 kg ± 2.3 (range, 3.4–53 kg). The median follow-up period was 26.5 months (range, 1 month to 7.5 years). Technical success was achieved in 26 (86.7%) of the 30 patients. Restenosis developed in 3 patients (10.0%). Only 1 patient underwent stent implantation, and the stent fractured 8 months later, requiring further intervention. There were no other complications. In terms of clinical benefit of blood pressure control after the initial PTRA procedure, 15 patients (50%) were cured and 7 patients (23.3%) showed improvement. There was no significant difference in the etiology, lesion location, and lesion length between patients with clinical benefit and failure (P = .06, P = .202, and P = .06, respectively). GFR of the affected kidney was significantly improved from 19.9 mL/min ± 11.2 to 38.1 mL/min ± 11.9 at the 6-month follow-up after PTRA (P < .001).ConclusionsThe overall results of PTRA for pediatric RVH caused by different etiologies are promising. PTRA not only provided a clinical benefit of blood pressure control in 73.3% of the patients but also significantly improved the function of the affected kidney.     

两种艾灸法对二肾一夹型高血压大鼠血压和血管内皮细胞内分泌功能的影响

目的:应用两种艾灸疗法治疗两肾一夹肾血管性高血压大鼠(2K1C-RHR),评价这两种艾灸疗法的降压作用,并对其降压机理作初步的探讨。方法:建立2K1C-RHR模型,并将其随机分为六组:灸法Ⅰ组(百会、神阙、足三里)、灸法Ⅱ组(关元、涌泉、足三里)、卡托普利组、灸法Ⅰ+卡托普利组、灸法Ⅱ+卡托普利组、高血压对照组,另设正常对照组。经过10天治疗后,测量血压,并测定血浆中内皮素(ET)、一氧化氮(NO)。结果:高血压对照组的收缩压(SBP)、舒张压(DBP)明显高于正常对照组,各治疗组的SBP、DBP明显低于高血压对照组(P<0.01),各治疗组间则没有明显差异(P>0.05)。血浆NO含量各组间没有明显差异(P>0.05)。各治疗组与正常对照组的血浆中ET含量明显低于高血压对照组(P<0.01)。各治疗组ET/NO比值接近正常对照组(P>0.05)且明显低于高血压对照组(P>0.05)。结论:两种艾灸疗法有良好的降压作用,其降压机理与及纠正ET与NO的失衡状态有关。     

Extrinsic compression of the renal artery by diaphragmatic crus

Extrinsic compression of the renal artery due to a fibromuscular band originating from the diaphragm was encountered in a 26-year-old patient who had systemic hypertension associated with stenosis and kinking of one of her renal arteries. After surgical decompression, the renal artery assumed a normal expansion with disappearance of hypertension. Six other cases of extrinsic compression of the renal artery have been found in the literature. Surgical treatment is mandatory in all cases because the mechanism that causes the lesion makes percutaneous transluminal angioplasty illusory.     

经皮腔内肾动脉成形术及自体肾移植治疗肾血管性高血压(附7例报告)

自1980到1986年,我院泌尿外科对4例单纯右侧肾动脉狭窄(RAS)性和3例双侧RAS性高血压病人进行了治疗。7例右侧 RAS皆进行了自体肾移植治疗,其中3例双侧RAS者采用PTA治疗,全部病人术后8天内血压皆恢复正常,随诊10个月到6年,无复发且都恢复工作。1例17岁女孩,术后2年结婚,又2年生一女孩,母女健在血压维持正常。     

自发性脑卒中诱导原癌基因c－fos在大鼠脑内的表达

用免疫组织化学（ＡＢＣ）方法，对易卒中型肾血管性高血压大鼠高血压晚期自发形成脑卒中时以及高血压早期和中期脑内ｃ－ｆｏｓ原癌基因蛋白（ＦＯＳ）的表达进行了观察．在高血压晚期，假手术组不出现脑卒中，但个别大鼠的扣带皮质和梨状皮质出现微弱的ＦＯＳ表达；手术组都出现脑卒中，其中３例脑内未见ＦＯＳ表达，４例则于大脑皮质、海马、黑质和下丘脑等处出现程度不等的ＦＯＳ表达．高血压早期，手术组和假手术组的下丘脑、隔核、中脑中央灰质和丘脑室旁核出现分布状态和强弱都相似的ＦＯＳ表达．高血压中期，手术组和假手术组脑内未见ＦＯＳ表达．本研究结果提示：（１）高血压晚期，自发性脑卒中能诱导ｃ－ｆｏｓ在脑内的广泛表达，脑内不同部位ＦＯＳ表达的机制和功能意义不同，本文对其进行了讨论；（２）腹部手术能诱导下丘脑等与内脏功能调节有关的功能区ＦＯＳ的表达；（３）高血压早期和中期，通过ｃ－ｆｏｓ表达的方法未能发现高血压对大鼠脑功能活动的影响。     

Percutaneous transluminal renal angioplasty in patients with solitary kidney

We report our experience with percutaneous transluminal angioplasty of renal arteries (PTRA) in solitary kidney patients. Our series includes 31 patients (mean age: 52 years). 7 with solitary kidney following surgical nephrectomy and 24 with functioning solitary kidney. PTR indicated in presence of stenoses ranging from 60–95 % of vessel lumen. Procedure, with 29 patients were technically successful and mean values for stenosis dropped from 77 % to 33 %. In order to assess the results technically, changes in arterial blood pressure (according to Martin's classification) and creatinine levels were considered. Of 25 followed-up patients, 13 were cured (52%), 8 improved (32%),and 4 were unchanged (16%%). Complications were observed during procedures in five patients (16. 1 % ), superimposing that of nonsolitary kidney patients. Good revasculariiation, reduction of blood pressure, preservation or even improvement of renal function and low complications, make PTRA the best procedure with solitary kidney patients.     

Takayasu''s aortitis with renovascular hypertension

We report a case of Takayasu's disease with severe renovascular hypertension in a girl from Eritrea. In the "burn-out" phase after the erythrocyte sedimentation rate had normalized, reconstructive vascular surgery was performed as further progression of the disease seemed unlikely. However, probably due to her growth, the graft rotated and a second operation was successfully performed.     

丁苯酞对实验性动脉血栓形成性脑梗死的治疗作用

目的:观察丁苯酞(恩必普)对实验性动脉血栓形成性脑梗死的治疗作用.方法:按已定型的双肾双夹法建立易卒中型肾血管性高血压大鼠(RHRSP)模型,用光化学法造成大脑中动脉闭塞(MCAO)致大脑中动脉血栓形成.94只MCAO大鼠随机分为丁苯酞治疗组、生理氯化钠溶液(NS)对照组各47只,另取3只RHRSP作为假手术组.治疗组于MCA闭塞d1起po丁苯酞150 mg·kg-1,bid,给药10 d.每日行神经行为学评分, d10处死大鼠取脑进行TTC染色及常规病理检查,观察局部血栓梗死灶微血管等的变化.结果:丁苯酞治疗1～6d的神经行为学评分均明显增加(如d4治疗组(17.14±0.38)分, NS组(15.29±1.11)分,P<0.05);治疗组梗死面积为(6.94±2.11)mm2,梗死灶占前脑面积百分比在治疗组为(1.82±0.50)%,均显著低于NS组[(8.90±1.96)mm2和 (2.40±0.65)%,均为P<0.05];治疗组局部血栓变小、梗死灶及周围微血管增生也显著多于NS组(79% vs 62%,P<0.05),灶内出血发生率减少.结论:丁苯酞可改善病灶局部循环,减小梗死面积,减轻脑组织损伤,恢复神经功能.     

Percutaneous high-speed rotational atherectomy (Rotablator™) of a restenosed ostial renal artery: A case report

This case report describes the feasibility and potential benefit of the use of a high-speed rotational atherectomy device (the Rotablator?) in the treatment of renovascular hypertension in a patient with a recorded restenosis of an ostial renal artery lesion following standard balloon angioplasty.