Percutaneous transhepatic removal of a giant bile-duct stone.
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Biomedical subjects
Publications and source records attributed to H A Mitty.
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The problems inherent in visualizing the adrenal glands are illustrated by the variety of imaging modalities that have been employed. Although urography has been the basic screening examination, one can make a sound argument for CT as the procedure of choice in the evaluation of the patient with suspected adrenal pathology. Angiography, venous sampling, and radionuclide studies continue to have a role in selected problem cases. This article reviews the usefulness of available modalities in the context of the clinical evaluation of adrenal disease.
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We describe a 24-cm long coaxial needle that has a 15-cm, beveled outer sleeve and accepts a 0.038-inch (0.097-cm) guidewire. A Luer-loc fastens the outer needle to the inner one. The outer sleeve has markings etched 1 cm apart to indicate the distance from the tip of the inner needle and that of the outer sleeve. This needle was designed to be used for percutaneous nephrostomy, particularly in the infant and in nondilated urinary systems.
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Our experience with nine patients in whom percutaneous transcatheter embolization was utilized in the extremities is presented. These include three patients with peripheral hemangiomas who were successfully embolized as the primary therapy; two patients who were embolized prior to surgery to minimize blood loss and shorten anesthesia time; two patients with neoplasm of an extremity as a means of palliation; and two patients with traumatic vascular lesions. Indications and potential complications are discussed, and the various embolic agents available are reviewed to define the options available to the angiographer and surgeons in planning therapy.
Horseshoe kidney may simulate adenopathy on ultrasound when the examiner is unaware of its presence. If an ultrasound examination demonstrates an isolated preaortic mass, this diagnosis should be considered. Sonographic features and confirmation of this diagnosis with a urogram or CT are discussed.
Percutaneous ureteral stents were used in the management of 24 patients with ureteral fistulas, strictures, and calculi. This technique provides control of the urinary stream and maintains ureteral caliber while healing occurs. It is a useful alternative to the retrograde cystoscopic or surgical approach.
Separation of the left gastric artery from the gastric air shadow is a diagnostic sign of lesser curvature gastric lesions. This finding is especially helpful in patients with large exophytic wall lesions in whom barium examination, CT and ultrasound are not diagnostic. This was demonstrated in two patients with large leiomyomas of the stomach.
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The adrenal and periadrenal venous systems are part of the portosystemic collateral pathways that may enlarge in portal hypertension. The cross-sectional image of the resulting enlarged venous channels may simulate an adrenal mass. Three examples of such computed tomographic (CT) scans are presented with selective venographic correlation. Patients with portal hypertension and suspected adrenal pathology may require enhanced or dynamic CT scans.
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Lymphography is often used in staging clinically localized carcinoma of the prostate, but has been criticized for lack of specificity and sensitivity. Strict criteria for metastases eliminate some false positives but increase the number of false negatives. In 50 cases, liberal criteria were used for an equivocal interpretation, and these nodal defects as well as positive defects were biopsied percutaneously with thin-needle aspiration and cytologic evaluation. Of 37 equivocal lymphograms, 18 (49%) had a positive biopsy establishing stage D disease without pelvic lymphadenectomy. The equivocal lymphogram is a important diagnostic category when it can be further evaluated by aspiration biopsy.
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