Simultaneous balloon occlusion of the renal artery and hypothermic perfusion in in situ surgery of the kidney.

Renal ischemia and cooling may be achieved by intraluminal balloon occlusion and intermittent hypothermic perfusion using a double lumen, balloon-tipped catheter introduced into the renal artery percutaneously. This technique was used successfully in 26 of 31 extensive nephrolithotomies, eliminating the need for dissection and clamping of the renal artery and intricate surface cooling. Intrarenal operations could be performed as effectively as with clamp occlusion.

[Retrograde pancreatic phlebography with simultaneous balloon occlusion of portal and arterial flow. An experimental study (author's transl)].

The possibility of demonstrating the venous system of the entire pancreas by retrograde portal contrast injection with simultaneous balloon occlusion of the portal vein, coeliac axis and superior mesenteric artery was investigated in 12 dogs. In seven cases good filling of the larger pancreatic veins was obtained. Portal and arterial pressure relationships altered considerably during various experimental conditions.

[Fine needle puncture for antegrade pyelography and percutaneous nephropyelostomy (author's transl)].

A method for antegrade pyelography and pyelonephrostomy is described using a long, thin needle with a shorter, wider Seldinger cannula. Puncture with a thin needle reduces the risk during antegrade demonstration of the upper urinary tract and can also be used for puncturing collecting systems which are only slightly dilated. When necessary, the Seldinger cannula can be advanced over the needle; subsequently, with the aid of a J-wire, a nephropyelostomy can be performed.

Patency and transmission of Filaroides hirthi infection.

Filaroides hirthi lungworm infection was diagnosed by the recovery of 1st-stage larvae from the faeces of dogs with heavy, artificially induced infections using zinc sulphate flotation. Diagnosis of low-grade natural infections was infrequently achieved. Zinc sulphate flotation was demonstrated to be about 100 times as efficient as the Baermann technique in concentrating F.

[Intraluminal balloon occlusion of the renal artery: clinical applications and observations (author's transl)].

A method permitting percutaneous catheterization and temporary balloon occlusion of the human renal artery with a 5-F-Swan-Ganz-Catheter is presented. When properly performed, the arterial occlusion is reliable, low in complications, and less traumatizing to the vessel than external clamp occlusion. The technique was employed in 112 patients for occlusion of the renal artery prior to tumor nephrectomy, for attaining stop-flow conditions for improved nephrophlebography, for preventing the reflux of emboli at transarterial embolisation of inoperable kidney tumors, or, combined with simultaneous hypothermic perfusion via the second lumen of the catheter, in extensive kidney surgery necessitating ischemia.

[Tumors of the small intestine - clinical signs and symptoms, diagnosis and therapy (author's transl)].

66 patients suffering from tumors of the small intestine were operated upon between 1963 and 1976 in the Surgical Department of the University of Mainz Medical School. In 16 cases benign tumors were found (6 neurinoma, 4 leiomyoma, 4 lipoma, 2 polyps), in 50 cases the tumors were malignant (24 carcinoma, 20 sarcoma, 2 malignant schwannoma, 4 carcinoids). Only in 12 patients surgery was radical and no metastases found.

[Renal blood flow measurements by cine-angiodensitometry (author's transl)].

Angiodensitometry complements conventional renal angiography and provides important additional functional information without subjecting the patient to any further stress. Since blood flow through the renal arteries can be determined, it is an important method for the preoperative investigation of renal disease.

[Megacaliosis--diagnosis and differential diagnosis (author's transl)].

Megacaliosis is a renal dysplasia which is characterised by rudimentary papillae. The pathogenesis, clinical features and radiological appearances in fire cases are described and the differential diagnosis from other types of calyceal ectasia is discussed, In typical cases the diagnosis of megacaliosis can be made from the excretion urogram. We regard divided renal function studies as essential before making the diagnosis.

[Percutaneous, transhepatic thrombosis of the coronary vein in the treatment of bleeding oesophageal varices (author's transl)].

Percutaneous, transhepatic catheterisation of the portal vein in order to occlude the gastric coronary vein was carried out in six patients with bleeding oesophageal varices. Bleeding stopped in three patients, but in the other three ceased only temporarily. Complications were one pleural effusion and one haemothorax.

[Sclerosing of bleeding oesophageal varices (author's transl)].

Bleeding from oesophageal varices was stopped in two patients by percutaneous transhepatic transportal injection of 50% glucose and thrombin into the gastric coronary vein and the gastro-oesophageal varices draining into it. The only complication was a right-sided pleural effusion in one of the patients.

[Current status of preoperative localization in primary hyperparathyroidism (author's transl)].

Since Seldinger demonstrated in 1953 parathyroid adenomas by arteriography, numerous localizing procedures have been advocated. Based on our experience with selective venous sampling for measurement of parathyroid hormone by radioimmunoassay, selective arteriography, pneumomediastinography and scanning with 75Se-selenomethionine, a survey on localization techniques used up to now is given and their value and applications are discussed. Preoperative localization of parathyroid tissue should be limited to patients with previous unsuccessful surgery.

[The results of transvenous cholangiography (contrast media)].

Transvenous cholangiography is a method for the direct demonstration of the biliary passages described by Hanafee and Weiner; its main indication is in the investigation of obstructive jaundice. This method, which does not require immediate subsequent operation, was used in 41 patients. In three patients catheterisation of hepatic veins was unsuccessful.

[Occlusion of the renal artery by intra-arterial injection of thrombin in a case of inoperable renal tumour (author's transl)].

In a 53-year-old man with an inoperable metastasizing renal carcinoma embolic occlusion of the renal circulation was achieved by injection of thrombin (600 NIH units) through a balloon catheter into the renal artery. With short-term administration of analgesics and under anti-biotic cover the post-embolic course ran without complications. The general condition of the patient is good and macrohaematuria had, at the time of the report, not recurred for two months.

[Thyroid phlebography and selective venous sampling for parathormone estimations in primary hyperparathyroidism (author's transl)].

Selective venous sampling for parathormone estimations has become an important method in the diagnosis of primary hyperparathyroidism and, together with thyroid phlebography, is an accurate means for localising hormone active parathyroid tissue. Thirty-three patients were examined by this technique and in 25 of these an exploration was carried out subsequently. Twenty-one had primary hyperparathyroidism.

[Results of post mortem thyroid gland phlebography (author's transl)].

The anatomic course and variation of the thyroid veins used for retrograde thyroid phlebography were studied in 70 post mortem thyroid phlebograms. Comparison with pathological and anatomical findings showed good agreement in benign diseases of the thyroid with lesions of more than 1 cm. Infiltrating malignant changes could not be delineated with certainty and a post mortem proven parathyroid adenoma was also missed.

[Retrograde renal phlebography with balloon occlusion of the renal artery. Technique and scope of a new method (author's transl)].

A new method of retrograde phlebography of the kidney is described; it is carried out by using a balloon catheter in the renal artery for occluding the circulation. The procedure has been carried out in 13 patients without complication. Early experience has provided very good results in the diagnosis of malignant renal tumours; invasion into the venous system can be demonstrated radiologically.

Ballon occlusion of the renal artery in tumor nephrectomy.

A method of preoperative intraluminal occlusion of the renal artery in cases of kidney tumors using a 5F Swan-Ganz ballon catheter is presented. The procedure was used in 26 tumor nephrectomies without complications and resulted in marked facilitation of the operation in 70 per cent of the cases.

[Technique and results in adrenal phlebography (author's transl)].

Following a brief description of the anatomy of the adrenal gland the technique of adrenal phlebography is explained. So far this method has been used in 118 patients. This examination is indicated in cases with suspected hormon - active disease of the adrenal glands and to rule out spaceoccupying lesions as well as metastases in the adrenal gland.

[Localization diagnosis of epithelial-body tumors through selective determination of parathyroid hormone. Surgical sequelae of a new method].

A new method for the localisation of abnormal parathyroid tissue is reported. This is carried out by selective venous blood sampling from the thyroid veins and the large veins of the neck. Parathyroid hormone levels are measured by radioimmunoassay.

[Transvenous cholangiography in the differential diagnosis of biliary stasis (author's transl)].

Transvenous cholangiography is an alternative to the direct puncture of the biliary tract. It was successfully performed in 13 of 21 patients of a personal series. The method does not require stand-by facilities for operation and is suitable for differentiating intra- from extrahepatic causes of biliary stasis, as well as for the demonstration of cause and localization of obstructive jaundice.

[Echinococcus multilocularis causing extensive biliary obstruction (author's transl)].

Infection of man by Echinococcus multilocularis occurs relatively seldom, most commonly localizing in the liver in the manner of a malignant tumour. A case of alveolar hydatid disease is reported presenting with extensive biliary obstruction, and a large cavitation in the liver due to necrosis. A review of epidemiology, clinical and roentgenological findings is given.