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Although operative treatment of Wilms' tumors has become more straightforward as a result of advances in preoperative treatment and precise diagnosis, vascular involvement by the tumor can cause serious problems at operation. These problems can be more easily managed if they have been identified pre-operatively and the level of the intravascular tumor thrombus has been defined. In this study we propose a classification of intravascular involvement of Wilms' tumors suggesting the clinical consequences and operative strategy. In our series of 84 patients we treated 7 (8.3%) with preoperatively diagnosed intracaval tumor thrombus using ultrasound as the most sensitive non-invasive diagnostic technique. The surgical therapy depends on the stage; stage III and stage IV should be operated in cooperation with the cardiovascular surgeon in deep hypothermic circular arrest.

These data compare favorably with reported patency rates for traditionally harvested saphenous veins. Endoscopic saphenous vein harvesting, in addition to previous favorable reports on pain, complications, and costs, is now shown to provide comparable or better patency rates in comparison with traditionally harvested veins.

Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is a hereditary cerebral vasculopathy progressing to subcortical dementia, caused by multiple lacunar infarcts and ischemic white matter degeneration. Migraine with aura, epileptic seizures and affective disorders are frequent additional symptoms of CADASIL. The causative mutations of the Notch3 gene are located on chromosome 19p13.1. There is complete penetrance of this disorder, although individual expression of symptoms may vary. Manifestation of CADASIL is usually in the 3rd decade, but some individuals remain asymptomatic close to the age of 60. MRI displays a marked leukoencephalopathy in affected individuals as early as in the age of 20. Frontal and subcortical hypoperfusion in demented individuals was demonstrated by SPECT-studies. The prevalence of CADASIL is still not known. To date there is no causative therapy.

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