21 patients with thoracic empyema were treated at this clinic over a period of 3 years. 15 patients had metapneumonic empyema, 2 empyema associated with sepsis, and 4 postsurgical empyema. In 12 patients the underlying illness was chronic disease while 9 patients were thus far in good health. The most frequent causative pathogens were staphylococci and streptococci, together with anaerobic bacteria. One patient died of the underlying disease. Three cases of metapneumonic empyema healed completely with antibiotics only. Closed chest tube drainage with small chest tube was performed 13 times and was successful 11 times with a mean drainage duration of 13 days. Six patients underwent surgery (early decortication in 4 instances, late decortication in 2). The surgical indication was in 4 instances multilocular of the empyema which inhibited chest tube drainage, imminent loss of function in 1 case and unsuccessful drainage in a case of bronchopleural fistula in 1 instance. Apart from high-dose antibiotic therapy, earliest possible drainage is of crucial importance in the treatment of thoracic empyema. Surgery should be considered only in uncomplicated empyema if drainage is impossible for technical reasons.

The value of thoracic computed tomography in the staging of non-small cell bronchogenic carcinoma is evaluated. In 57 patients post thoracotomy and in 8 patients who had undergone mediastinoscopy, the preoperative T and N stages determined by CT were compared with the intraoperative stage. With respect to the T3 stage, 49 CT results out of a total of 57 were correct, 6 were false positive and 2 false negative. This corresponds to a sensitivity of 67% and a specificity of 88%. With respect to the N2 stage, 55 out of 65 results were correct, 8 were false positive and 2 false negative, corresponding to a sensitivity of 87% and a specificity of 84%. We conclude that in N2-negative CTs mediastinoscopy can be omitted, while in CT-positive patients histological verification appears to be necessary. The diagnosis of T3 should be carried out with caution: in doubtful cases surgical exploration is recommended.

While percutaneous transluminal angioplasty (PTA) of renal artery stenoses was introduced five years ago in adults1as a therapeutic modality for renal vascular hypertension with lasting success,2to our knowledge, the application of PTA in children with this diagnosis has not been reported. We report the long-term effects of PTA of two renal artery stenoses in a 5-year-old boy with renovascular hypertension. Report of a Case.—A 4½-year-old boy (weight, 17.5 kg; height, 105.5 cm) had a history of dizzy spells, headache, and three seizures during the previous month. Blood pressure was 180/130 mm Hg; urinalysis findings were normal. Stenoses in the left renal artery and in a right renal polar branch were shown angiographically (Fig 1, left), and renovascular hypertension was diagnosed after exclusion of other causes. The systemic renin activity was elevated (40 ng/mL/hr). The boy underwent bilateral PTA on Oct 23, 1980, while he was

In a 4.5-year-old boy (17.5 kg, 105.5 cm) with dizzy spells, headache, and epileptic attacks a blood pressure of 180/130 mm Hg was observed. Stenoses in the left renal artery and in a right renal polar branch were shown angiographically (Fig. 1a, arrows), and renovascular hypertension was diagnosed after exclusion of other causes. Systemic renin was elevated (40 ng/ml per hour). The boy underwent bilateral percutaneous transluminal angioplasty (PTA) under general anesthesia on 23 October 1980. A F-8 guiding catheter (custom-made prototype by Schneider and Co., Zurich) was introduced through the femoral artery, and a Grüntzig coronary dilatation catheter (balloon width 3.7 mm) was applied. After dilatation both stenoses were widely patent (Fig. 1b). Blood pressure dropped to normal values within 4 h (110/80). During the follow-up of 1.5 years the blood pressure remained normal without any antihypertensive therapy except atenolol for the initial 2 months following PTA. Systemic renin was normal (9.4 ng/ml per hour) 6 months after PTA. Angiography performed 1.5 years after PTA revealed patent renal arteries at the two dilated sites (Fig. 1c, arrows).

Sixteen consecutive patients with renovascular hypertension were treated by transluminal dilatation and observed during 6 - 39 months (mean 21.8 months). Poststenotic renal artery pressure increased (p less than 0.001) and the renal arteries were patent on angiograms taken immediately after dilatation. In 13 patients, angiography was repeated 2 - 9 months later; at that time the selective renal vein renin ratio had decreased (p less than 0.001). At the end of the follow-up, blood pressure was improved or normal in 14 cases. One of the eight patients with atherosclerosis was normotensive without treatment, compared with five of six patients with fibromuscular dysplasia (p less than 0.05). The results in two cases with vasculitis are uncertain. The four patients with relapses, one after intimal catheter dissection, were treated successfully by redilatation. Thus, renovascular hypertension can be improved by transluminal dilatation in patients with atherosclerosis and in patients with fibromuscular dysplasia with lasting success and a low morbidity rate.

Percutaneous transluminal dilatation was attempted in five patients with stenotic angioaccess fistulas (one arterial, two venous, two anastomotic) constructed for chronic hemodialysis. Follow-up in 1–13 months showed that in four patients the intervention restored patency of the fistula, while in the fifth patient the stenosis could not be traversed. Transluminal dilatation may be performed in appropriate cases to obviate the need for surgery.

Demonstration of new methods in the treatment of renal artery stenosis appears justified if one takes into account that the overall results of conventional surgical treatment are less than satisfactory. Reimplantation of the renal artery, renal auto-transplantation and transluminal dilatation are examples of new approaches. The early results of a series of transluminal dilatations are encouraging and are presented here for consideration.

Brief Reports1 January 1979Treatment of Renovascular Hypertension by Transluminal Renal Artery DilatationFELIX MAHLER, M.D., ALEX KRNETA, M.D., MICHAEL HAERTEL, M.D.FELIX MAHLER, M.D., ALEX KRNETA, M.D., MICHAEL HAERTEL, M.D.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-90-1-56 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptPercutaneous transluminal angioplasty has proved valuable in the treatment of atherosclerotic occlusive disease of femoral and iliac arteries (1, 2). The application of this technique has recently been extended to the coronary arteries (3), and we have developed a method for transluminal dilatation of renal artery stenoses. We report here the case of a patient whose hypertension appears to have been cured by this technique.A 50-year-old woman was admitted to hospital in 1977 because of hypertension. In July her blood pressure was 240/120 mm Hg, and methyldopa therapy, 750 mg daily, was started. At examination her blood pressure was...References1. DOTTERRÖSCHANDERSONANTONOVICROBINSON CJJRM: Transluminal iliac artery dilatation. Nonsurgical catheter treatment of atheromatous narrowing. JAMA 230:117-124, 1974 CrossrefMedlineGoogle Scholar2. GRÜNTZIG A: Die Perkutane Transluminale Rekanalisation Chronischer Arterienverschlüsse mit Einer Neuen Dilatationstechnik. Baden-Baden, G. Witzstrock, 1977 Google Scholar3. GRÜNTZIG A: Transluminal dilatation of coronary-artery stenosis (letter). Lancet 1:263, 1978 CrossrefMedlineGoogle Scholar4. ABRAMS H: Angiography, vol. 2, 2nd ed. Boston, Little, Brown and Co., 1971, pp. 860-863 Google Scholar5. WEIDMANNDE CHÂTELSCHIFFMANNBACHMANNBERETTA-PICCOLIZIEGLERVETTERREUBI PRAECWWF: Interrelations between age and plasma renin, aldosterone and cortisol, urinary catecholamines, and the body sodium/volume state in normal man. Klin Wochenschr 55:725-733, 1977 CrossrefMedlineGoogle Scholar6. MAYOBERHAUSENKIRSCH PEW: Sie seitengetrennte Bestimmung des effektiven Nierenplasmastroms mit Radioisotopen. Klinische Vergleichsuntersuchungen mit der PAH-Clearance. Dtsch Med Wochenschr 96:152-155, 1971 CrossrefMedlineGoogle Scholar7. SHAPIROMCDONALDSCHEIB ARE: Renal arterial stenosis and hypertension. II. Current criteria for surgery. Am J Cardiol 37:1065-1068, 1976 CrossrefMedlineGoogle Scholar8. FOSTERMAXWELLFRANKLINBLEIFERTRIPPELJULIANDECAMPVARADY JMSKOOPP: Renovascular occlusive disease. Results of operative treatment. JAMA 231:1043-1048, 1975 CrossrefMedlineGoogle Scholar9. FERGUSON R: Cost and yield of the hypertensive evaluation. Experience of a community-based referral clinic. Ann Intern Med 82:761-765, 1975 LinkGoogle Scholar10. GRÜNTZIGKUHLMANNVETTERLÜTOLFMEIERSIEGENTHALER AUWUBW: Treatment of renovascular hypertension with percutaneous transluminal dilatation of a renal-artery stenosis. Lancet 1:801-802, 1978 CrossrefMedlineGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAuthors: FELIX MAHLER, M.D.; ALEX KRNETA, M.D.; MICHAEL HAERTEL, M.D.Affiliations: Inselspital Bern Switzerland PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byInterventions for Renovascular HypertensionBalloon Angioplasty – The Legacy of Andreas Grüntzig, M.D. (1939–1985)Nonatherosclerotic Obstructive Vascular Diseases of the Mesenteric and Renal ArteriesCardiac benefits of renal artery stentingCardiac benefits of renal artery stentingInterventional Treatment of Renal Artery StenosisRenal artery interventionCritical review of indications for renal artery stenting: Do randomized trials give the answer?Geschichte der interventionellen AngiologieThe hypertensive patient with hypokalaemia: the search for hyperaldosteronismParaaortic DiseasesNon-Arteriosclerotic Arterial DiseasesInterventional Radiology of Peripheral Vascular DiseasesVascular surgery in SwitzerlandEntwicklung der interventionellen RadiologieZur Geschichte der Katheterbehandlung der arteriellen VerschlußkrankheitLong-Term Results of Percutaneous Transluminal Renal AngioplastyTransluminale Dilatation und andere nichtoperative Kathetertechniken in der Behandlung der renovaskulären HypertonieTechnique and Results of Percutaneous Renal Artery Dilatation (PTRD)Long-term experience in percutaneous transluminal dilatation of renal artery stenosisPercutaneous transluminal renal angioplasty in nonatherosclerotic renovascular hypertension. 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DONOHUE, M.D.Indications for Transluminal Arterial Dilatation in Peripheral Vascular Occlusive DiseasePERCUTANEOUS TRANSLUMINAL ANGIOPLASTY FOR SEVERE RENOVASCULAR HYPERTENSION DUE TO RENAL-ARTERY MEDICAL FIBROPLASIA 1 January 1979Volume 90, Issue 1Page: 56-57KeywordsAngioplastyBlood pressureCathetersCoronary arteriesFemoral arteriesHypertensionPercutaneous transluminal coronary angioplastyRenal arteriesRenal diseasesStenosis ePublished: 1 December 2008 Issue Published: 1 January 1979 PDF downloadLoading ...

Three case histories are presented in order to demonstrate the hazards of apparently well-placed pleural chest tubes. In one instance of ruptured diaphragm the dislocated and distended stomach imitated a pneumothorax, thus inviting thoracic drainage; in two other cases the drainage of a massive hematothorax accelerated the oncome of hemorrhagic shock.

Renal autotransplantation seems to be of great value as a means of renal revascularization in hypertension of renovascular origin, especially in those cases in which the preceding angioplastic procedure have resulted in failure or in cases with peripheral or difficult stenoses of the renal artery. One case is reported with a coarctation of the abdominal aorta involving both kidney arteries. The patient was treated by bypass operation and kidney autotransplantation. Two years later both kidneys are functioning normally and the patient is normotensive.

The quality of life following kidney transplantation is examined. For this reason a total of 38 patients were questioned. There were three subgroups: 18 adults and 10 children with excellent kidney function and 10 patients in whom nephrectomy had to be performed after rejection of the transplanted organ. The extent and importance of the changes of various criteria considered essential for judgement of the quality of life are illustrated. Adults and children alike consider the improvement of drinking and eating habits, improvement of physical fitness and of the capability to deal with psychological problems as the essence of their greater joy in life. For children there are added advantages at school and in the choice of their occupational activity. In conclusion there is a definite improvement of the quality of life following renal transplantation.