X-ray of the month: traumatic thrombosis of the left renal artery.
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Biomedical subjects
Publications and source records attributed to A J Gerlock.
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A case is presented of renal artery stenosis causing renin-dependent hypertension 11 1/2 years after irradiation for Wilms tumor. The literature was reviewed briefly for other cases of large artery damage after irradiation therapy.
Obstruction of the deep veins by thrombi causes the P.V.P. to become elevated. Monitoring this pressure can serve as an invaluable guide in evaluating the patency or obstruction of venous repairs.
A simple screening procedure is needed to fill the gap between the clinical examination and venography in patients suspected of having deep-vein thrombosis of the lower extremities. The author suggests that measurement of the pedal venous pressure (PVP) be used for this purpose. Measurements of PVP in 86 lower extremities and correlation with venography showed that all extremities with a PVP greater than 35 cm saline were shown to be abnormal on venography, indicating that measurement of PVP can be a satisfactory screening procedure.
Renal venography was performed in 21 hypertensive patients, all of whom had the classical appearance of fibromuscular dysplasia of the renal arteries. None showed any evidence of fibromuscular dysplasia of the renal veins.
Understanding the mechanisms by which clinical signs and symptoms are produced is a prerequisite to the correct appreciation of radiographic features. Radiographs of facial trauma are no different in this respect. This paper describes the specific clinical findings associated with each displaced bony fragment of the zygomatic complex fracture. Limitation of jaw movement and flattening of the cheek are produced by depressed fractures of the temporal process or zygomatic arch; unilateral epistaxis is a result of fractures of the zygomatic process of the maxilla or the floor of the orbit; paresthesia or anesthesia of the cheek results from fractures of the infraorbital process or orbital floor; unequal pupil heights is associated with fracture of the frontal process; and decreased extraocular muscle function with diplopia is caused by fractures of the orbital process, frontal process, or orbital floor. The clinical and radiographic findings are correlated with surgical management.
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A useful radiographic finding is described for the diagnosis of a flail mandible. The flail mandible removes forward support for the tongue, which may result in airway obstruction. Immediate radiographic diagnosis allows quick surgical correction of the fractured mandible and relief of the obstruction, decreasing the time during which an endotracheal or tracheostomy tube is needed to keep the airway open.
Nine patients without evidence of tubal patency at routine hysterosalpingography were given glucagon. Five of the 9 responded with tubal dilation and spill. Three of the 4 who did not respond had a positive history and clinical examination for pelvic inflammatory disease. Data regarding side effects in the 9 patients studied are presented.
Of 30 consecutive cases of penetrating injuries to the extremities studied both by arteriography and venography, five were found to have significant venous injuries. Three of these cases are presented to show the value of venography in detecting inadequate venous collateral circulation, intraluminal thrombus, and venous obstruction. It is suggested that preoperative venography will compliment arteriography, aid in the diagnosis of venous injuries, demonstrate variable venous anatomy, and outline other venous pathology outside of the area of trauma.
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This case report demonstrates the value of arterial management with embolization of hemorrhage following pelvic fracture. Surgical ligation and arterial embolization are briefly discussed as treatment modalities.
A case of successful removal of a catheter foreign body retained in the right atrium for 6 months is presented. The hooked catheter approach was used to retrieve the catheter from the right atrium. Due to the hook configuration of the retrievers, the catheter had to be surgically excised from the common femoral vein. Subsequently a system was developed and used successfully in other cases which eliminates the need for performance of a further surgical procedure to remove successfully the catheter or retrieval device.