Biomedical subjects
Publications and source records attributed to A J Gerlock.
Endoscopic retrograde cholangiography was performed in a 32-year-old man with recurrent episodes of painless jaundice. There was demonstration of a large intraluminal mass causing partial obstruction of the common bile duct. The lesion proved to be a primary carcinoid tumor of the bile duct.
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A pseudoaneurysm of the pancreaticoduodenal artery secondary to chronic pancreatitis was erroneously diagnosed as a pancreatic pseudocyst by abdominal plain films, barium gastrointestinal studies, and abdominal ultrasound. Because of the operative findings, it was necessary to interrupt surgery undertaken to drain the presumed pseudocyst. Angiography is strongly recommended as a preoperative study in patients with sonolucent pancreatic masses to distinguish pseudoaneurysms of pancreatic vessels from pseudocyts.
A review of treatment methods used to control carotid cavernous sinus fistulae is presented. Three cases are described in which embolisation of the external carotid artery was done along with intracranial vascular procedures in the management of carotid cavernous fistulae.
An angiographically demonstrated case of total occlusion of the abdominal aorta by a malignant retroperitoneal tumor is presented. Surgical exploration revealed a diffuse tumor of the retroperitoneum involving the wall and lumen of the abdominal aorta and vena cava, respectively. Histologic and ultrastructural evaluation of the tumor established a diagnosis of malignant fibrous histiocytoma. Total occlusion of the abdominal aorta thus represents another angiographic finding in retroperitoneal tumors.
Six patients were evaluated by angiography for dorsalis pedis free flap transfer because the course of the dorsalis pedis artery could not be traced by palpation. Two were subsequently excluded because they showed vascular occlusions. Successful transfer depends on the dorsalis pedis artery and its branches being intact, while healing of the donor site depends on the function of the posterior tibial artery. Angiography was found to be helpful in determining both of these factors.
Angiography in the hemophilic patient is a safe and reliable procedure for recognition of surgically treatable vascular abnormalities. When untreated, these abnormalities can cause repeated bleeding and progressive joint destruction.
The radiographic appearance and clinical significance of gastric varices in the absence of esophageal varices and secondary to splenic vein occlusion were studied. Eighteen patients were evaluated through medical records, angiography, and barium studies of the stomach and esophagus. The presence of splenic vein occlusion was determined by arteriography in 18 patients and its etiology confirmed by surgery in 17 patients. This condition should be suspected in patients with chronic abdominal pain, weight loss, and iron deficiency anemia who show fundal polypoid filling defects or prominent gastric folds on an upper GI series.
Venography is a simple and rapid technique which can be used in the diagnosis of acute penetrating venous injury. Four cases of venous lesions are presented and indications for venography discussed. Findings consisted of bleeding from lacerations and partial or total occlusion from traumatic thrombosis.
Lidocaine (60 mg/100 ml) was added to contrast medium (120 ml of Conray-60) in an attempt to decrease pain associated with leg venography in 100 patients. No side effects were seen, and there was a marked reduction in pain as reported by four different examiners in two separate hospital populations.
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Twenty-six patients with painful ophthalmoplegia were classified as having the Tolosa-Hunt syndrome on the basis of their clinical findings and response to steroid therapy. All patients underwent orbital venography, a review of which forms the contents of this investigation. Orbital venography, a review of which forms the contents of this investigation. Orbital venograms were normal in 16 patients and abnormal in 10. The major abnormalities were (1) obstruction of the superior ophthalmic vein in its third segment without displacement; (2) collateral venous flow through small venous channels or collateral veins; and (3) poor opacification of the ipsilateral cavernous sinus.
Angiographic, surgical, and pathologic observations of 70 patients with single hypervascular renal cell carcinomas were reviewed. To correlate size and location with extension into the renal veins or inferior vena cava, the tumors were divided into three groups on the basis of size. Of the 32 group 1 tumors (3--5 cm), four showed venous extension. Three involved only the right renal vein, while one extended through the right renal vein into the inferior vena cava. Of the 24 group II tumors (5--7cm), 12 showed venous extension. Only one of these was confined to the right renal vein, while 11 extended through the renal vein into the inferior vena cava. Eight of the 13 group III tumors (greater than 7 cm) showed venous extension. Three of these were confined to the renal vein, while five extended through the right renal vein into the inferior vena cava. This investigation indicates that venous extension is more frequent with tumors of the right kidney and with tumors of larger size.
Ten adult dry skulls were radiographed in the lateral projection to evaluate the appearance of the opisthion, the posterior margin of the foramen magnum. The opisthion was seen on all 10 skulls and its position was confirmed by outlining it with barium paste. In cross section, it is a teardrop-shaped structure continuous with the internal occipital crest. A beak-shaped shadow anterior to the opisthion was also examined with the barium technique. It is an overlap shdow formed by the interior margin of the foramen magnum and the inferior border of the occipital bone on the same side. In a review of 50 random radiographs of the cervical spine, the opisthion was identified on 42 (84%) and the beak-shaped overlap shadow was seen on 28 (56%). The spinolaminal line, which delineates the posterior margin of the cervical spinal canal, was an unreliable indicator of the position of the opisthion in 17 (40%) of the 42 cases in which the opisthion could be identified.
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