腎動脈撮影像の臨床的観察
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The renal arteriography has four methods, i.e., translumbar aort o graphy, retrograde aortography, selective renal arteriography, and intravenous aortography. The author attempted clinical observations on 262 cases of translumbar aortography and 34 cases of intravenous aortography which he had performed at Kyoto Univ. during his stay there, the period of April 1953 through June 1961. Especially, the clinical value on the dynamic x-ray diagnosis by application of the seriography was discussed with given instances. 1. Clinical Observations on Renal Arteriography b y Translumbar Abdominal Aortography There were included not only urologic diseases as renal tumor and urolithiasis etc., but also renal hypertension etc., in 262 cases which the translumbar aortography had been employed. The single shoot was made on most cases, and the seriography was taken in 79 cases which included both methods the seriographic apparatus was used in 73 cases and ODELCA mirror camera was used in 6 cases. The 16 mm x-ray cinematography was taken in 8 cases for the purpose of dynamic x-ray diagnosis. Side reactions of the aortograph y were found only in 15 cases. The most of them were the irritative symptoms caused by the contrast media, and it was demonstrated that 76% Urografin (Schering) was most nonirritating. No such severe symptoms, as have been described in other references, were observed. The times of the appearances of the pictures which were shown by seriography were as follows : the shadow of the renal artery appeared during 1.0-3.0 sec., nephrogram during 2.0,-6.0 sec., renal vein during 4.0-6.0 sec., renal calyces and pelves during 50.0-60.0 sec. after the beginning of injection respectively. Some other arteries in the abdo m inal cavity as well as the renal artery appeared by this method. I n cases of renal tumor, irregular pooling pictures of contrast media in the neoplastic area appeared well, and it was shown that the picture appeared and disappeared later than the shadow of the renal artery by means of seriography. In a case of solitary cyst of the kidney, a v ascularity in the cystic area and bow-shaped blood vessels around the area appeared clearly by this method. In a cases of hydronephrosis, function of the dise a s ed kidney was well estimated and an aberrant artery obstructing the ureter was visualized by this method. A case of horse-shoe kidney was demonstrated, being one o f congenital anomalies of the kidney. In a cases of Goldblatt's hypertension a picture of the renal artery stenosis was demonstrated. In a case of abdominal aortic aneurysm, the slowed circulation in the aneurysmal part was shown but the renal arteries were normally demonstrated. 2. Clinical Observations on R e n a l A rteriography by Intravenous Abdominal Aortography This method was performed on 34 cases, mos t of whom were renal tuberculosis, urolithiasis and renal tumors etc. The single shoot was emplo y ed in most cases, and the seriography was taken in 5 cases and the 16 mm x-ray cinematography in 2 cases. The author hopes that applications of the seriography will be made in these cases to obtain clearer pictures of the renal artery. The appearance of the picture of the renal artery in seriography was during 7.0-15.0 sec. following the beginning of injection, and nephrogram appeared during 8.0-16.0 sec. and renal calyces and pelves at 90 sec. The pictures of renal artery and nephrogram in a case of ureteral calculus were demonstrated. It was shown by the seriographic method that pictures of the renal artery and nephrogram appeared late in case of the aortic aneurysm located above the renal arteryies. The intravenous aortography is more simple and more safe than the tr a n slumbar one, and has some other excellent clinical values. However, the former is somewhat inferior to the latter in a point of the contrast density of the picture. This research had been performed during the author's stay at the Kyoto University. Grateful acknowledgement is made to Prof. T. Inada for his constant interest and guidance, to the staff of the departmet of Urology and x-ray technicians of the Kyoto University for much assistance throughout this investigaiton. Thanks are also due to the NichidokuYakuhin Co., Ltd. and to the Shimadzu-seisaku Co., Ltd. for generous supply of materials and instruments.
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