Angiographic management of bleeding following transcolonoscopic polypectomy.
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Biomedical subjects
Publications and source records attributed to H M Goldstein.
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Twenty-four patients have undergone percutaneous transfemoral selective renal artery occlusion as part of their management for renal carcinoma. Preoperative infarction was performed in 7 cases. This facilitated surgery by eliminating the major blood supply to the tumor and resulted in collapse of the large collateral veins and created edema within the perirenal tissue. In 17 patients with visceral metastases, tumor infarction was performed in lieu of nephrectomy for control of the primary lesion and in hopes of stimulating an autoimmune response. The current status of this procedure s discussed in light of its indications, complications, and preliminary results.
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The angiographic features in 5 cases of carcinoid tumors of the small intestine are discussed. Findings included irregularity and narrowing of the distal mesenteric and intestinal arcade arterial branches, minimal parenchymal stain, and obstructed venous return. A stellate arterial configuration was not noted. In 2 cases in which epinephrine was employed, tumor staining of the primary lesions and their hepatic metastases was markedly enhanced. Possible mechanisms of action for the pharmacoangiographic effect of epinephrine are discussed.
Radiation-induced injury to the normal esophagus, stomach, and duodenum in patients with advanced cervical carcinoma who received high para-aortic lymph-node irradiation to an average tumor dose of 5,000 rads is discussed. Radiation esophagitis is usually the result of mediastinal irradiation for bronchogenic carcinoma. The most consistent radiological finding is abnormal motility, with esophageal stricture and/or ulceration occurrring less frequently. Radiation gastritis usually presents as pyloric ulceration or irregular contractions of the antrum, simulating gastric carcinoma. Postbulbar duodenal mucosal thickening, ulceration, and strictures may occur. Pertinent clinical features, pathogenesis, and pathological correlations are discussed.
Angiographic features are described in 5 patients with peripancreatic lymphomas who initially presented with clinical features of primary pancreatic disease. Each patient demonstrated a large hypovascular mass with considerable displacement of pancreatic and peripancreatic arteries and associated compression of adjacent veins. Smooth arterial encasement was present in 2 cases. Signs of mass out of proportion to signs of invasion mitigated against the diagnosis of carcinoma in each case. Other differential diagnostic considerations are pancreatic pseudocyst and cystadenoma.
Selective transcatheter arterial embolization was performed in 7 cancer patients with gastrointestinal or uterine bleeding. Most were bleeding from neoplastic tissue and were refractory to conservative management. Complete and permanent cessation of bleeding was obtained in 5 patients, including 3 with gastric bleeding, 1 with colonic bleeding, and in 1 with uterine bleeding. Successful arterial embolization allowed further treatment of the underlying disease which was particularly critical as these patients were poor surgical candidates. No significant or prolonged side effects were noted.
The arteriographic demonstration of a linear, striated arterial pattern in the anatomic course of the draining vein is reliable evidence of venous extension by a tumor and represents the supply to the intravenous component of the neoplasm. In addition to its previously described occurrence with hypernephromas, this report documents the characteristic angiographic appearance with hepatocellular tumors and a retroperitoneal osteosarcoma as reliable evidence of tumor extension into the inferior vena cava. It is possible that in some cases, the parallel arteries represent markedly enlarged vasa vasorum of the involved venous structure. The frequent invasion of the inferior vena cava by hepatomas and the importance of inferior vena cavography in their angiographic evaluation is also emphasized.
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