Angioplasty for the treatment of visceral ischemia.

PURPOSE: To evaluate percutaneous transluminal angioplasty (PTA) in the treatment of visceral ischemia. PATIENTS AND METHODS: Over a 14-year period, 25 focal visceral artery stenoses were treated with PTA in 16 patients with acute or chronic visceral ischemia. Thirteen patients were women and three were men, with a mean age of 64.7 years (range, 54-79 years). PTA was performed in seven celiac arteries, 17 superior mesenteric arteries, and one inferior mesenteric artery. RESULTS: PTA was technically successful in 14 of 16 patients (88%). Two patients were lost to follow-up. Nine of 12 patients (75%) demonstrated primary patency with relief of clinical symptoms at a mean follow-up of 2.3 years (range, 0.3-5 years). The remaining three patients underwent successful repeat PTA for recurrent symptoms. There was one postprocedural death, and one patient subsequently underwent successful surgical bypass for recurrent visceral ischemia. CONCLUSIONS: Angioplasty of the visceral arteries may provide relief for select patients with intestinal ischemia, but redilation may be required in some patients.

Stereotactic needle biopsy of nonpalpable breast masses.

One hundred two patients with nonpalpable breast masses that presented as mammographic densities with or without calcification were studied consecutively. Using the Stereotix stereotactic device, fine-needle aspirations were obtained with subsequent hook-wire placement followed by surgical excision. Pathology results were reached separately and then compared to the cytologic diagnoses. For patients with adequate cytologic material, sensitivity was 95% and specificity was 100%. There were six suspicious or equivocal diagnoses: three were determined to be benign, while three were malignant. There was inadequate tissue in 13%. Although this technique had limitations, for patients with adequate cytologic and histologic material the accuracy was excellent.

Spontaneous renal rupture: evaluation by computerized tomography.

We report an unusual case of spontaneous renal rupture, including intrarenal and perirenal hemorrhage, which was evaluated by computerized tomography. Various causes of spontaneous rupture are discussed and a possible mechanism in this patient is suggested.

A comparison of Hexabrix and Renografin 60 in peripheral arteriography.

Fifty-one patients were analyzed after a randomized double-blind study comparing Hexabrix and Renografin 60 in peripheral arteriography. The arteriographic studies and the volumes of contrast material used in both groups were similar. Hexabrix caused significantly less pain and discomfort than Renografin 60, and the diagnostic quality of the radiographs was comparable. A slightly higher incidence of minor side effects was noted in the Hexabrix group, mostly nausea and vomiting and urinary retention.

A nonoperative technique for establishment of a gastrostomy in the dog.

Gastrostomies have been performed nonoperatively under local anaesthesia using a simultaneous percutaneous and endoscopic approach. This technique has been modified to be done under fluoroscopy without the need for endoscopy. The technique and results in five dogs are described.

A comparison of hexabrix and Renografin 60 in peripheral arteriography.

Fifty-one patients were analyzed after a randomized double-blind study comparing Hexabrix and Renografin 60 in peripheral arteriography. The arteriographic studies and the volumes of contrast material used in both groups were similar. Hexabrix caused significantly less pain and discomfort than Renografin 60, and the diagnostic quality of the radiographs was comparable. A slightly higher incidence of minor side effects was noted in the Hexabrix group, mostly nausea and vomiting and urinary retention.

The cervical split: a pseudofracture.

A horizontal lucent line projecting over a cervical vertebral body on lateral radiographs and simulating a fracture is described. The pseudofracture line results from the lucency between contiguous proliferative osteophytes at the uncinate process/vertebral articulation. Associated disc space narrowing was seen in all of our eleven cases. The origin of this pseudofracture line, cases illustrating this phenomenon, and additional projections helpful for clarification are presented.

Deep venous thrombosis: predictive value of signs and symptoms.

The clinical history, signs, symptoms, and laboratory and radiographic results of 154 consecutive patients who had contrast phlebography for evaluation of deep venous thrombosis were evaluated retrospectively to determine their relationship to deep venous thrombosis. Malignancy, history of recent blood transfusions, recent surgery, congestive heart failure, immobility, and infection exhibited the strongest correlation with acute thrombophlebitis. Receiver operating characteristic curves were constructed to demonstrate the additive value of certain signs and symptoms in predicting the development of or protection from deep venous thrombosis. With these curves, a cutoff point can be selected for this population that will aid in determining which patients should undergo further diagnosis and/or treatment in the evaluation of deep venous thrombosis.

Ultrasound evaluation of pelvic pain.

A rapid examination method for female subjects with acute pelvic pain was developed for potential clinic or emergency distinction of medical and surgical disorders. A 95% diagnostic accuracy was achieved in separating retrospectively 102 consecutive patients into "hospital" or "outpatient" categories. It is recommended that ultrasound be used routinely in the initial evaluation of acute pelvic pain. The procedure complements and may be considered an extension of the traditional physical examination.

Echocardiographic diagnosis of left ventricular thrombi.

Left ventricular thrombi have not been commonly recognized by M-mode or by cross-sectional echocardiographic techniques despite their frequency at postmortem examination in patients dying of cardiovascular disease. We discuss two patients, with left ventricular throbmi recognized echocardiographically and confirmed by pathologic and/or angiographic evaluation, whose M-mode and cross-sectional echocardiographic abnormalities add to the variable spectrum of appearance of left ventricularl thrombi. The sensitivity and specificity of echocardiographic techniques in the diagnosis of intracardiac thrombi are discussed.

Two dimensional echocardiography in differentiating right atrial and tricuspid valve mass lesions.

Atrial myxoma has been diagnosed on the basis of a characteristic M mode echocardiographic pattern of a mass of echoes appearing, with a lag phase, beneath the anterior leaflet of the mitral or tricuspid valve in diastole. However, this pattern is not specific for an atrial tumor. Two patients are described with tricuspid leaflet endocarditic vegetations whose M mode echocardiograms were strikingly similar to the M mode tracing from a patient with a large right atrial myxoma. In a fourth patient, artifact, resulting from the failure of lateral resolution of the atrial wall, was also capable of producing a mass of echoes appearing, with a lag phase, beneath the anterior tricuspid valve leaflet in diastole. In each patient, two dimensional echocardiography confirmed the presence or absence of a right-sided mass lesion and defined more precisely the location of the echocardiographic density relative to the right atrium and tricuspid valve. Because two dimensional echocardiography is capable of detecting anatomic relations in two distance dimensions and of visualizing movement of intracardiac structures relative to one another in real time, it can play an important role in the identification and differential diagnosis of intracardiac mass lesions.

Portal vein aneurysm.

While there have been a few references to portal vein aneurysm in the world literature, this is the first report in United States radiologic literature. During a routine evaluation for fever in one patient, an ultrasound examination suggested this unusual entity at the junction of the splenic and superior mesenteric vein. It was later confirmed by angiography. Two other patients were being investigated angiographically for gastrointestinal bleeding when portal vein aneurysms were discovered. In contrast to the central location of the first patient's aneurysm, the latter two were more distal in the portal tree. The literature is reviewed and different etiologic hypothesis discussed.