Biomedical subjects
Publications and source records attributed to D P MacErlean.
Three cases are reported in which angiographic embolisation therapy was effective in arresting upper gastrointestinal bleeding secondary to metastatic hypernephroma. Each patient had histologically confirmed disseminated renal cell carcinoma and presented with recurrent haematemeses with a successful outcome following palliative embolisation therapy.
The ability of computed tomography during arterial portography (CTAP) to identify and segmentally locate 20 hepatic tumours was prospectively assessed in 7 patients undergoing hepatic resection. All eight lesions greater than 2.5 cm in diameter were detected, but only two out of four and two out of eight of those measuring 1-2.4 cm and < 1 cm respectively. The overall segmental localization accuracy for detected lesions was 91%. Our results highlight the insensitivity of CTAP to hepatic lesions smaller than 1 cm in size, but have shown the accuracy of segmental localization for detected lesions.
OBJECTIVE: A prospective study was performed to determine the value of high-resolution color Doppler sonography in the evaluation of palpable solid breast masses. SUBJECTS AND METHODS: One hundred thirty-one consecutive breast lesions were characterized as benign, malignant, or indeterminate on the basis of their sonographic appearance. The number of blood vessels was estimated, the Doppler spectrum for each vessel was characterized, and the maximum velocity was recorded. Mammography was performed in most cases. Histology was obtained in all cases. RESULTS: Predictions based on sonography alone were correct in 74% of benign lesions and 63% of malignant lesions (p < .001). Blood flow was demonstrated in 87% of malignant lesions and in 68% of benign lesions (p = .0105). Malignant lesions were larger than benign lesions (p = .004) and showed a significantly greater number of vessels (p < .001) and significantly higher maximum velocity (mean, 34.2 vs 19.2 cm/sec; p < .001). Patients with malignant lesions were significantly older (p < .001). When age, size of lesion, and sonographic morphology were controlled, the presence of blood flow did not aid in diagnosis. However, in lesions with blood flow, when spectral patterns and maximum velocity were analyzed, a logistic model combining these parameters with age, size, and sonographic morphology gave an overall sensitivity of 94%, specificity of 93%, and positive predictive value of 92%. Mammography yielded useful additional information, particularly for indeterminate lesions. CONCLUSION: Maximum velocity and spectral patterns on Doppler analysis are useful indicators of breast malignancy, but only if the patient's age, the size of the lesion, and the sonographic morphology are also considered. The best use of color flow imaging is in combination with mammography.
Hormonal evidence of widespread hypothalamic failure, including diabetes insipidus, hyperprolactinaemia, growth failure, hypothyroidism, and adrenal failure, was present in a boy of 14 years. Investigation with computerised axial tomography (CT) and metrizamide encephalography failed to identify any anatomical abnormality at the time of presentation. However, 18 months later papilloedema was noted at which time a suprasellar mass and gross dilatation of the ventricular system were readily identified using CT and a germinoma was subsequently diagnosed and treated. In the light of this experience we recommend that when "idiopathic" hypothalamic failure is diagnosed, imaging procedures, including CT or nuclear magnetic resonance examinations, should be repeated on at least one occasion, after an interval of approximately 6 months.
Demonstration of both iliofemoral arteries and their peripheral run-off is usually performed either by the translumbar approach, or by placing a pigtail catheter at the aortic bifurcation. A modified version of the old retrograde pressure method, simply using a cannula in one femoral artery, is described. There was considerable saving in materials, personnel and time. This method may once again be the method of choice in a busy radiology department.
Angiographic studies suggest that needle biopsy of the liver is invariably associated with some degree of haemorrhage (Wallace et al., 1972). The appearances of the liver on computed tomography after percutaneous biopsy have not been described. As an aid to the interpretation of scans in patients referred because of clinical complications of biopsy, we performed unenhanced computed tomography of the liver in 30 patients within 72 h of biopsy. None of these patients would ordinarily have been referred for computed tomography. Only one of the scans showed a parenchymal abnormality attributable to biopsy. We conclude that post-biopsy changes on unenhanced computed tomography scans of the liver are uncommon and that the needle tracks and vascular anomalies commented on by angiographers are not usually shown.
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Ultrasonography was used to diagnose, localize and direct the percutaneous transabdominal needle aspiration of 10 pancreatic pseudocysts in 9 patients. Thirty-four aspirations were performed without complication. In 9 pseudocysts no other treatment was necessary, and in all patients relief of pain or obstructive symptoms when present was obtained. None of the cysts have recurred with a mean follow-up of 26 months.
Therapeutic arterial embolisation was performed in 48 patients. Gelfoam, Oxycel, Bucrylate, Gianturco wire coils and lyophilised dura mater were used. Indications included control of acute haemorrhage, pre-operative vascular reduction, palliation of inoperable lesions, or to render such lesions operable, and elective definitive treatment. The technique was not considered to be of significant value as a pre-operative measure but was successful for the control of haemorrhage, the management of inoperable lesions and as an elective definitive treatment for various unusual lesions. One patient died and three had complications. The choice of occlusive material is discussed and depends upon the nature and vascularity of the lesion and whether short- or long-term occlusion is required.
Ethanol was used to embolize the hepatic artery in 7 dogs, producing occlusion proportional to the dose employed. On follow-up angiography at 1 and 4 weeks, occlusion was unchanged or more pronounced, indicating that such embolization is permanent. Because ethanol is nonviscous and easy to use, it is effective in occluding the hepatic arterial system. Perisinusoidal fibrosis is produced.
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Primary lesions of bowel wall were biopsied transabdominally in 7 patients. Adequate material for histological diagnosis was obtained in all. In 3 patients previous biopsy performed at endoscopy had failed to establish a diagnosis. In 2 others the area biopsied, i.e., gallbladder, was inaccessible to endoscopy and confirmation would have otherwise required laparotomy. No complications occurred.
Traditional management of abdominal abscess is according to classical surgical methods. Catheter or needle drainage of these abscesses, using ultrasound both as an imaging modality and as a monitor of technique, offers a safe and rapid method of drainage of all types of abdominal abscess and eliminates surgery in many patients. Eleven abdominal and retroperitoneal abscesses were satisfactorily drained under ultrasound control in ten patients. No abscess recurred, but in three patients subsequent surgery was performed, in one because the abscess was multiloculated, and in the other two to exclude underlying malignancy.
Five pancreatic pseudocysts were managed by percutaneous transabdominal needle aspiration under ultrasound guidance. Thirteen aspirations were performed without complication. In four cysts this was the sole treatment required. None of these cysts have recurred, with a follow-up of between 6 and 12 months. Surgery of acute pseudocysts can be postponed or eliminated by this technique. Relief of pain and of obstructive symptoms can be obtained and time gained, when necessary, for maturation of the cyst wall.
Percutaneous fine needle aspiration biopsy was performed in 38 patients. Adequate material for histological diagnosis was obtained in all. No false positive results were obtained and there was only one false negative result. The procedure was without complication in all patients. The biopsy material was obtained by the radiologist in the X-ray department following localisation of the lesion by ultrasound. The advantages of the early use of this technique in the evaluation of patients presenting with suspected mass lesions in the abdomen and retroperitoneum are described, and its contribution to the formulation of further patient management stressed.
Transcatheter embolisation was performed in 16 patients with hypernephroma, using either Oxycel, Gelfoam, or steel wire coil(s). Thirteen patients proceeded to early nephrectomy. Surgery was facilitated in four patients with large hypervascular tumours, three of whom had vena caval occlusion. Patients with small, or only moderately vascular tumours, did not benefit from the technique as assessed at nephrectomy. The technique was used as a palliative procedure in three patients, haematuria stopped in two, and abolition of high-output heart failure was achieved in one. Owing to the danger of this technique, it is suggested that its use be restricted to (a) rendering patients with large hypervascular tumours more suitable for surgery, and (b) in palliation of inoperable patients who have symptoms such as severe haematuria. The effect of the technique on survival time remains uncertain.
Bronchial artery embolization is a useful palliative treatment for life-threatening haemoptyses where surgery is contra-indicated. Patients presenting with haemoptyses complicating cystic fibrosis and aspergilloma have been embolized. Control of haemoptysis was achieved in the former, but late recurrence of haemoptysis in the latter led to asphyxiation.
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