Biomedical subjects
Publications and source records attributed to B A Sacks.
Retained stones may be found in patients who have undergone operations for multiple renal calculi. These stones often produce morbidity and must be removed. The authors describe a technique using a nephrostomy tube, placed during the initial operation, to extract stones percutaneously.
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Parathyroid adenomas in an ectopic location, either the mediastinum or high in the neck, can be relatively easily identified arteriographically because the lesions are separate from the thyroid gland and therefore are not confused with it. However, in most cases in which the adenoma is situated adjacent to thyroid tissue (85%-90%), arteriographic identification, particularly when the lesion is small, may be extremely difficult. Cineangiography during parathyroid arteriography has been found extremely helpful in positive identification of these juxtathyroidal adenomas. Movement of the head from side to side and swallowing maneuvers during cine recording of a selective arteriogram allow determination of the location of a suspicious "blush" in relation to the thyroid gland. As a rule, parathyroid adenomas stain densely in the tissue phase, are nearly always posterior to the thyroid, and separate from thyroid tissue on swallowing. In 10 of 14 parathyroid arteriographic examinations, cinearteriography was useful in confirming or excluding a parathyroid adenoma.
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Coexistent caval and portal hypertension was recognized on preoperative angiographic study of a patient with cirrhosis and variceal bleeding. This hemodynamic situation can preclude adequate reduction of portal hypertension by portasystemic shunt and can result in fatal postoperative bleeding. Resection of a very large caudate lobe effectively reduced caval pressure and allowed a direct solution to the problem by portacaval anastomosis, rather than by more complex shunts or by nonshunting procedures previously suggested as alternatives.
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A modification in the introduction of the Kimray-Greenfield filter is described. Rather than advancing the stylet toward the Luer-lok assembly and thereby discharging the filter, the authors propose positioning the carrier containing the closed filter farther into the inferior vena cava, then withdrawing the catheter and carriage while holding the stylet in place. This method reduces the chance for damaging the caval wall.
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.
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A new sign for the diagnosis of lipohemarthrosis on vertical beam lateral knee radiographs depends upon visualization of the joint capsule due to the presence of fat lying both within and outside of the joint. Recognition of lipohemarthrosis on routine knee radiographs may aid in the diagnosis of subtle tibial plateau fractures.
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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.
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.