To elucidate the contribution of the renin-angiontensin system (RAS) to glomerular injury in salt-sensitive hypertension, we investigated the chronic effects of the angiotensin I-converting enzyme inhibitor cilazapril and the angiotensin II type 1-receptor antagonist (AT1a) TCV-116 in Dahl-Iwai rats. Dahl salt-sensitive (S) rats receiving 8% salt diet for 6 wk were simultaneously treated with cilazapril ( n = 6), TCV-116 ( n = 6), or saline ( n = 14). The 8% salt diet markedly increased systolic blood pressure (SBP), urinary protein, and N-acetyl-β-glucosaminidase (NAG) excretion compared with 0.3% salt-treated S ( n = 6) or salt-resistant ( n = 6) rats. Although neither cilazapril nor TCV-116 reduced the elevated SBP, TCV-116 significantly lowered urinary protein and NAG excretion. Histologically, 8% salt treatment in S rats induced progressive sclerotic and proliferative glomerular changes, which were ameliorated by both drugs. TCV-116 increased the glomerular diameter. Immunofluorescence demonstrated the increased level of type III collagen in the mesangium of 8% salt-treated S rats, which was completely reversed by TCV-116. Competitive RT-PCR of mRNA extracted from the glomeruli revealed that 8% salt treatment significantly increased the levels of proliferating cell nuclear antigen (PCNA) and platelet-derived growth factor B-chain and that TCV-116 significantly reduced the levels of PCNA and transforming growth factor-β1 (TGF-β1). Thus, although the chronic RAS-inhibition in salt-sensitive hypertension exerted a histologically renoprotective effect by both ways without lowering blood pressure, the RAS inhibition due to AT1a had more beneficial advantages of reducing proteinuria and attenuating the levels of glomerular TGF-β1 and extracellular matrix.
Materials and MethodsDynamic CT studies of 42 patients with HCC having angiographically proven arterioportal shunt were reviewed. Thirty-eight were men and four were women with an average age of 58 years. The proximal site of the portal vein opacified on a hepatic angiogram was as follows: portal trunk or more proximal in 10, first-order (main) branch in five, second-order branches in two, and third-order and smaller branches in 25 cases. CT was performed using a GE CT/T 8800 or 9000 with a scanning time of 1 1 or 5 sec, respectively. All the CT examinations were done before the angiograms. Dynamic study with various intervals of scan and numbers of slices was performed with a manual bolus injection of 60 ml of Conray 400 (sodium iothalamate). Except for two patients, the dynamic scan sequence was performed only once at the level of the tumor detected on plain CT or near the level of the hilum when tumor was not demonstrated on plain CT.One hundred cases of HCC lacking an arterioportal shunt on angiography and examined by dynamic CT study were reviewed as control group.
Gianturco expandable metallic stents were used for treating six patients with inferior vena cava (IVC) obstruction due to compression by large hepatic tumors and three patients with idiopathic obstruction of the hepatic IVC and Budd-Chiari syndrome who showed reocclusion or stenosis 3-21 months after previously performed percutaneous transluminal angioplasty (PTA). In all six patients with compression by hepatic tumors, stents dilated the IVC and debilitating edema of the lower body disappeared. In the three patients with idiopathic obstruction, stents were placed after repeat dilation of the lesions and Budd-Chiari syndrome did not recur during a follow-up period of 7-10 months. In two of the three, cavograms obtained 8 months after placement showed the channels to be open with minimal intimal thickening. Gianturco expandable metallic stents can correct IVC obstruction due to compression by hepatic tumors and are useful in preventing reocclusion of the IVC after PTA for the treatment of idiopathic obstruction. The authors recommend using tanem stents connected by at least two struts.
Segmental intensity differences (SIDs) in hepatic parenchyma free of tumor were noted in six patients with hepatic masses (hepatocellular carcinoma in five and metastatic liver cancer in one). Areas of SID were homogeneous in intensity. The intensity of the affected region was high in all six patients on T2-weighted magnetic resonance (MR) images and low in two on T1-weighted images. Three of five patients examined with plain computed tomography (CT) had corresponding segmental areas of low attenuation. Angiograms obtained in five patients showed occlusion of the intrahepatic portal vein, segmental staining corresponding to the region of the SID, or both. Twelve of 82 patients examined with MR imaging and angiography had similar findings on angiograms, and ten of them had abnormal intensity of anatomic distribution around or beside the liver tumors on MR images. MR imaging may be more sensitive than plain CT in the detection of secondary changes caused by intrahepatic portal flow stoppage.
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