Biomedical subjects
Publications and source records attributed to C Zollikofer.
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Twenty-four men aged 20-67 years (mean 42 years) were examined by selective arteriography for secondary impotence. The angiographic technique used as well as the normal anatomy and its variations are described. Arterial occlusive disease of vessels leading to the penis and the corpora cavernosa was found in 71% of the patients examined. This high incidence of arterial occlusive disease corresponds with the findings of other authors. The significance of these findings is discussed. In our limited experience of 3 patients, arterial anastomosis from the inferior epigastric artery to the corpora cavernosa has not been successful.
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Angiodysplasia of the colon is being recognized with increasing frequency as a source of lower gastrointestinal bleeding in the elderly. In one patient with colonic angiodysplasia, superselective segmental embolization of the ileo-colic artery with Ivalon resulted in the cessation of bleeding without causing bowel infarction. However, because of the development of collateral branches to the angiodysplastic malformation, bleeding recurred. While colectomy remains the treatment of choice in younger patients, in high risk patients embolization with a permanent embolic material, such as Ivalon, is an attractive alternative.
Numerous methods of measuring regional myocardial wall motion are in use. A critical comparison is needed to assess the strengths, weaknesses, accuracy, and precision of these methods. This paper reports the evaluation of five methods using computer-assisted interactive graphics. Fifty cines were selected: 16 from normal subjects, and 34 from patients with proven cardiovascular diseases. Tracings were made of the opacified left ventricle in end systole and diastole and digitized. All fifty cines were analyzed by five methods using computer-implemented graphic techniques. The results included a display of the silhouettes, which were translated and rotated according to various methods. In addition, the percent contraction for eleven myocardial regions was tabulated and displayed. The sixteen cines from normal subjects were used to derive a range of "house" normal values for region contraction patterns with which the measurements from the 34 abnormal patients were compared. The five methods were evaluated by comparing results from the computer-aided analysis with the visual assessment of two experienced radiologists. One method was found, the results from which agreed with the radiologists' visual impression for every case. This computer-aided method was quantitative and reproducible. Consequently, it can give information which supplements the visual impression.
In a controlled randomized clinical trial the effect of the secretory inhibitors Cimetidine and pirenzepine on the visibility of the areolar gastricae in barium studies of the upper gastrointestinal tract was examined. Both drugs improved the radiological imaging of the areolar tidine reduced the amount of radiologically visible fasting gastric contents. Thus, factors other than the volume alone of gastric secretions appear to play a major role in the quality of imaging of the gastric fine relief.
The abdominal aortas in eight dogs were successfully occluded with a combination of stainless steel coils and compressed Ivalon (polyvinyl alcohol). There was no evidence of recanalization up to six months later. This combination is useful for the embolization of large arteries and arteriovenous fistulas.
A new transjugular technique for spermatic venography and nonsurgical transcatheter occlusion of incompetent spermatic veins is described. With this technique, the left spermatic vein was easily catheterized in 28 of 30 patients examined, and in 21 patients the vein could be occluded. Right spermatic vein catheterization was attempted in 25 patients. Right-sided spermatic vein occlusion was successful in 17 of 24 patients. The vein could not be selectively entered only twice. Bilateral incompetence of the spermatic veins in men with primary sterility is the rule rather than the exception. Valvular incompetence does not necessarily produce a clinically detectable varicocele. Bilateral venography is indicated in all men with abnormal spermiograms.
Eight patients with isolation of a subclavian artery are described. Isolation of subclavian artery is defined as a loss of continuity between the subclavian artery and aorta but with persistent connection to the homolateral pulmonary artery through a ductus arteriosus. The connecting ductus arteriosus may or may not be patent. As the pulmonary vascular resistance is usually lower than the systemic resistance, the isolated subclavian artery is perfused by subclavian steal, and if the connecting ductus arteriosus is patent, flow occurs from the subclavian artery into the pulmonary artery. In this material and in all reported cases, isolation of subclavian artery has always been associated with other anomalies of the aortic arch, such as right aortic arch or bilateral ductus. Its frequent association with intracardiac defects, usually the tetralogy of Fallot, makes its recognition clinically important. Thoracic aortography with delayed filming is the only procedure that allows consistent diagnosis of this rare anomaly during life.
The radiographic and pathologic features of 13 cases of mycotic aneurysm of the aorta were reviewed retrospectively. In four cases the mycotic aneurysm was associated with bacterial endocarditis following aortic valve replacement, and in nine cases it was associated with spontaneous bacterial endocarditis. Postmortem examination revealed that the mycotic aneurysm was most frequently found in cases with bicuspid aortic valves. In all cases the chest radiograph revealed cardiomegally, usually with pulmonary vascular congestion. In the six patients in whom the diagnosis was established angiographically, the aneurysm was manifested by an irregular saccular collection of contrast medium under one of the coronary arteries. Mycotic aneurysms must be differentiated from other lesions with similar angiographic findings, such as a congenital aneurysm of the sinus of Valsalva, prolapse of an aortic cusp through a membranous ventricular septal defect, and a congenital aortic-left ventricular tunnel.
For surgical treatment of patients with tracheoesophageal fistulas the localization of the aortic arch is great practical importance. Aortography and CT scanning have been advocated as the radiographic techniques of choice. The location of the aortic arch can be diagnosed on a chest x-ray by the deviation of the trachea alone. A barium swallow is not required. The optimal radiographic technique for this purpose was investigated in phantom studies and tested in animals and newborns. It is proposed that in addition to the standard chest x-ray a high kvp film with hardened beam (1 mm copper -- 1 mm aluminum) be added in order to demonstrate the tracheal deviation. The additional x-ray exposure to the infant is negligible; and the technique is simple, reliable, and noninvasive.
For surgical treatment of patients with FMD of the renal arteries an optimal angiographic study is necessary. Preferably aortography as well as selective magnification renal angiography should be carried out. Oblique views may be necessary to demonstrate the peripheral extension into segmental branches, collateral circulation, the presence of aneurysms, and/or associated complications as AV fistulas, infarctions, intramural hematomas and pseudoaneurysms.
Cystic degeneration of the adventitia is a rare entity occurring most commonly in the popliteal artery: only a few cases involving the external iliac, femoral, radial, and ulnar arteries have been reported. The authors describe 2 cases, one of which appears to be the first report of the disease in the external iliac artery in a child.
Therapeutic embolization of pulmonary arteriovenous fistulas is described as an alternate method of treatment for patients with diffuse pulmonary involvement in whom resection is not feasible.
The abdominal aorta was dilated with a pair of 9-mm balloon catheters in a patient with Leriche syndrome. The bilateral pressure gradient, initially 60 mm Hg, disappeared even after papaverine was injected. Balloon dilatation of the abdominal aorta may be an effective, safe nonsurgical technique, particularly in localized, noncalcified atheromata, and does not carry the risk of impotence seen with surgical endarterectomy or bypass.
The St. Jude valve prosthesis has radiopaque leaflets which can be seen by cinefluoroscopy to determine their in vivo movement. Laboratory and clinical experience with visualization of various components of the prosthesis is described.