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Preoperative evaluation of the extent of the renal tumor is of value in determining the prognosis of the patient and the most suitable therapy. CT and angiography were reviewed in 27 cases of renal carcinoma to evaluate tumor involvement of lymph nodes, renal vein, vena cava, and the perinephric space. In 26 of these cases the ultrasound examination was similarly reviewed. Comparison of ultrasound, CT, and angiography demonstrated that staging of renal tumors with ultrasound is mainly limited by its inability to demonstrate extrarenal infiltration. Both CT and ultrasound proved reliable in the demonstration of tumor spread to the renal vein and inferior vena cava. CT and angiography were equally effective in the evaluation of tumor extension; since CT is easier to perform, less invasive and less time consuming than angiography it should be the primary method for staging of renal neoplasms. Angiography offers detailed information on the vascular supply of the tumor important for the choice of surgical approach and should be performed only on special indications.

Adrenal angiography was performed in 8 patients with Sipple's syndrome. Seven patients had pheochromocytomas and one bilateral adrenal medullary hyperplasia. In 4 cases the pheochromocytomas were bilateral. The angiographic findings are discussed and it is concluded that no typical angiographic appearance of pheochromocytoma appears to exist.

Radiation doses to the skin, ovaries and testes were measured at urography and CT examinations of the kidneys and adrenals. The absorbed dose to the breasts and bone marrow at CT was estimated as well as the mean bone marrow dose at urography. The results were compared with previous measurements of absorbed doses and energy imparted at abdominal angiography including nephroangiography. CT of the kidneys involves a considerably lower risk for late biologic effects to the patient than urography and, in particular, angiography.

Antegrade spermatic phlebography was performed in 18 patients in connection with orchiectomy because of testicular expanding lesions and was compared with other diagnostic methods. Fifteen of the cases were teratomas or seminomas. In 6 patients metastases were demonstrated at phlebography and later confirmed. In one case no abnormality was found at phlebography, nor at CT, but at lymphography metastases were found in not enlarged lymph nodes. Due to technical error at phlebography one case was falsely considered abnormal. The technique is described and its use as a screening procedure for metastases is advocated.

The diagnostic approach to a renal mass including ultrasound, angiography and fine needle aspiration biopsy is reviewed on the basis of 23 cases. The value of the combination of these methods is emphasized especially in tumors which appear without echoes at ultrasround and avascular-hypovascular at angiography. The findings are correlated and some differential diagnostic problems discussed as well as the possible risk of spreading tumor cells at fine needle aspiration biopsy.

Angiographic findings in 21 cases of renal pelvic carcinoma are presented. Important characteristics include neovascularity, visible capillary phase, vascular encasement, wide pelviureteric artery and absence of arteriovenous shunting. Angiography may also be of value for the differential diagnosis of ureteric obstruction as demonstrated in 5 of 6 patients with carcinoma of the ureter.

Pharmacoangiography with four vasoactive drugs was performed in experimental renal and hepatic tumours in rats in order to compare their ability to demonstrate tumour vascularity. Three vasoconstrictors, angiotensin, norepinephrine and vasopressin, and one vasodilator, tolazoline, were tested, vasoconstrictors giving most diagnostic information and the difference in effect among these sometimes being small and probably dose-related. This diagnostic effect is based upon the primitive character of tumour vessels, being unable to react upon a vasoactive stimulus. Angiotensin turned out to be the superior drug which corresponds to clinical experiences of this drug.

Percutaneous transluminal renal angioplasty was performed in nine patients (10 kidneys). Immediately following dilatation of the renal artery stenosis, seven of ten kidneys increased in length by at least 0.5 cm (0.5-1.5 cm) indicating improved renal perfusion. This is an observation that does not seem to have been described before. Another, but rare, cause of renal enlargement following angioplasty is hematoma formation which was seen in one of the cases. All of the patients responded well to the treatment and five previously hypertensive patients became normotensive shortly after dilatation.

The angiographic findings in 34 patients with adrenal lesions were reviewed, including 11 adrenal metastases, 9 adrenal pheochromocytomas, 4 adrenal cortical carcinomas, 4 adrenal cortical adenomas, 3 cases of adrenal hyperplasia and 3 cases of adrenal invasion from carcinoma of the upper pole of the kidney. The results indicate differential diagnostic difficulties in distinguishing among these various entities by angiography.

Various doses of Pantopaque and Vascoray were injected percutaneously into the kidneys in 17 rabbits. Histologic examination of the kidneys at different time intervals following the injection demonstrated only slight injury to the renal parenchyma which could be related to the contrast media. Therefore, it seems reasonable to assume that the risk of causing renal damage by using Pantopaque in connection with renal cyst puncture is small.

Conventional radiography and CT examination of the dorsolumbar spine were performed in 9 cases of vertebral fractures before and after Harrington instrumentation. The findings were correlated with neurologic symptoms and signs and the role of a commonly observed retropulsed vertebral body fragment in the development of compression symptoms of the spinal cord or cauda equina is discussed.

Clinical and roentgenologic findings in 100 hypertensive patients with fibromuscular disease of the renal arteries are presented and compared with the experiences obtained from previously reported large series. Frequency of bilateral disease and abnormal findings at urography, involvement of segmental arteries and occurrence of extrarenal manifestations are reported. A striking female preponderance is noted, and there is evidence that the disease inflicts middle-aged rather than young women.

Fibrous renal artery stenosis was induced by subtotal ligation with chromic catgut. Six weeks following unilateral ligation, transluminal balloon dilatation was performed in 8 pigs. Angiography was performed 8 to 10 weeks after dilatation, and at post-mortem 20 weeks after dilatation. Intra-arterial blood pressure and renal venous renin activity were measured before and at the repeat examination after dilatation and the morphologic changes in the arterial wall were evaluated at microscopy. Restenosis developed in 2 renal arteries, while successful dilatation was achieved in 6 cases.

Palliative occlusion of the arterial renal tumour supply was performed in 10 patients and the follow up is reported. Nine of the patients had no subsequent nephrectomy. Spongostan (99% gelatin) was used as the embolic material in 4 patients with the addition of steel coils in 2. Bucrylate was used in 6 cases. Six patients are alive with survival rates presently ranging from 3 to 24 months after embolization. Improvement of the survival time cannot be estimated but local symptoms such as hematuria and pain may be treated in those patients with renal tumours who are not considered for surgery.

Stenotic renal artery anastomoses were produced in pigs in order to investigate the effects of transluminal angioplasty. Six weeks after surgery unilateral dilatation with a modern balloon catheter was performed in 8 pigs. These animals were reexamined with angiography and pressure gradient recording 8 to 10 weeks after dilatation and with post-mortem angiography 8 to 10 weeks later. Only 2 arteries had minimal residual stenoses, while in 6 arteries the stenoses were completely eliminated. Microscopic examination showed thinning of the fibrotic vessel wall, with defects in the internal elastic lamina.

A new type of balloon catheter for rapid nephrostomy track dilatation from 3 to 10 mm is described. The balloon has a length of 10 cm, which means that the tract can be dilated in its entire length in one step. The catheter system is recommended for use, especially in patients previously not operated upon.

Angiotensin in a dose of 0.5 to 1.0 microgran injected into the renal artery of healthy kidneys initially decreased renal blood flow and increased the appearance time and mean transit time of dye and contrast medium as examined by a dye dilution technique and angiography. The initial phase is followed by a reactive hyperemia. The increased vascular resistance is probably localized peripherally on the arterial side of the vascular tree. Optimum dose is 0.5 to 1.0 microgram angiotensin in diagnosis of renal tumours. Optimum interval between drug administration and angiography is 10 to 60 s.

Four to five ml of absolute ethanol was injected into a segmental hepatic artery in eight pigs to study the occlusive effect on the hepatic arterial system. Liver cell damage was indicated by a transient moderate elevation of liver enzymes. Follow-up angiography at various time intervals showed persistent occlusion of intrahepatic arteries at different levels in all pigs and occlusion of the common hepatic artery in four. Reconstitution of the intrahepatic arterial circulation via abundant intrahepatic collaterals was, however, observed. Microscopic examinations demonstrated arterial thrombi and necroses in the vascular walls as well as a great variation in the extent of liver parenchymal damage.

Urographic abnormalities caused by renal artery aneurysms are discussed on the basis of seven cases. Angiography is the diagnostic procedure of choice to make the correct diagnosis. In cases of completely thrombosed aneurysms angiography may only demonstrate an avascular mass with displacement of vessels. At ultrasound examination renal artery aneurysms should be included in the differential diagnosis of echo-free renal masses.

The effect on the renal parenchyma caused by rapid dilatation of a nephrostomy track to 24 F to 30 F was studied on 9 kidneys in 5 pigs. Angiography at different intervals up to 5 weeks was used in combination with histology. Moderate bleeding and short lacerations were observed around the puncture site in all kidneys. Complications included one transient pyelovenous reflux, one organized abscess following perforation of the upper pole, and two cases of hydronephrosis caused by abscess and inflammation. These infections were probably due to the prevailing sanitary conditions. No arteriovenous fistula formation was seen. Minimal scars were encountered after 4 to 5 weeks follow-up. Transparenchymal access to the pelvocaliceal system through percutaneously established large tracks seems to cause limited damage which resolves in minor scars provided perforations are avoided by an optimum technique and infections are prevented or treated appropriately.

CT and angiography were performed in 21 patients with soft tissue tumors of the extremities (18 malignant and 3 benign) and the results were compared with the surgical and histopathologic findings. The tumor size was correctly evaluated at CT in 15 of 21 cases and at angiography in 17 of 21 cases. The main reason for overestimation of longitudinal tumor extent seems to be edema surrounding the poles of high grade malignant neoplasms. CT was superior to angiography in demonstrating the intra- or extramuscular tumor location. If only factors important for the surgical planning are considered, angiography yielded such information in 8 cases while CT was of critical value in the preoperative evaluation of 14 patients. It is concluded that CT should precede angiography in the examination of soft tissue tumors of the extremities. Angiography may be superior to CT in demonstrating vascular anatomy in relation to tumors of the medial thigh. With other tumor locations, angiography should be reserved for those lesions where vascular relationships are not adequately demonstrated at CT.

The diagnostic approach in cases of expanding renal lesions is reviewed on the basis of 106 patients with cystic lesions. Differential diagnostic aspects of cysts, tumor masses and cystic tumors are given. Ultrasound examination is considered to reduce the need of nephroangiography otherwise required. The value of nephroangiography with angiotensin in equivocal cases is emphasized.

Percutaneous, intraarterial traumatization of both renal arteries in 4 pigs using the stiff end of a guide-wire resulted in intimal lesions in 7 arteries. At repeat angiography healing was demonstrated in 4 of these arteries, suggesting that spontaneous restitution may be more common than usually believed. Balloon catheter dilatation of 2 stenotic segments initially increased the diameter of the stenoses but at repeat angiography both arteries were found to be occluded. Over-distension of the balloon in the renal artery resulted in pseudoaneurysm in one case and rupture in the other.

Absolute ethanol was used for renal ablation in 20 patients with carcinoma of the kidney. The procedure was followed by nephrectomy in 6 patients without metastases, all of whom are alive without evidence of recurrence 4 to 20 months after treatment. Fourteen patients with metastatic or locally advanced disease were embolized to palliate pain or hematuria without subsequent nephrectomy. Of these only 2 are alive, 4 and 18 months following the procedure. The technique for ethanol embolization is described and the use of occluding balloon catheters is recommended. No complications were encountered and the 'postembolization syndrome' was less marked as compared with a previous material of equal size where other methods of renal artery occlusion were employed. Microscopic examination in 10 of the infarcted kidneys showed extensive tumor necroses, sometimes with no evidence of viable tumor cells at all. Natural killer cell activity was determined before and 48 hours after renal artery occlusion in 7 patients, showing somewhat increased activity in 4. It is concluded that absolute ethanol is a safe, effective and easily administered agent for the infarction of renal tumors.

After transcatheter arterial embolization with Spongostan (99.3% gelatin-similar to gelfoam) in a group of rats with experimental hepatic tumours, the angiographic and microscopic findings were compared with those in a group of rats with non-embolized liver tumours. Partial recanalization of the hepatic artery was demonstrated already after 2 to 6 days. Reduced vascularization of tumours could be demonstrated after embolization and in a few animals even decrease in tumour size. Microscopy revealed a significantly greater extent of tumour necrosis in embolized tumours of large size. Necrosis of normal liver tissue was found to a varying degree in the embolized rats, while no ischemic injury was evident in livers of most non-embolized animals.

Transcatheter hepatic arterial embolization with Spongostan (99.3% gelatin) was performed in a group of normal rats. By repeat angiography could be demonstrated that arterial occlusions lasted for at least 1 to 8 days in most rats. Microscopy of these normal livers gave no evidence of parenchymatous liver injury. At postembolization angiography in a group of rats with experimental liver tumours it could be demonstrated that arterial supply of these tumours was temporarily completely arrested. Microscopy of some of these neoplasms revealed extensive necroses. The eventual future clinical applications of this procedure as an alternative to hepatic artery ligation is discussed.

Thirteen patients with renal carcinoma, primarily not operated upon, were re-evaluated 1 to 71 months after the first nephroangiography. Tumour progression could be demonstrated in 7 cases with a maximum linear diametric growth rate of 0.5 cm/2.5 months. The reasons for absence of growth in the remainder are not apparent, but probably related to the state of immunologic defense mechanism of the host.