[Abdominal injury].
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Biomedical subjects
Publications and source records attributed to K Ido.
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A case of renal arteriovenous fistula (A-V fistula) treated by transcatheter embolization using absolute ethanol is reported. The catheter was superselectively placed in the proximal renal artery supplying cirsoid vessels and 15 ml of absolute ethanol was injected into the renal artery at a rate of 1 ml per second. Ten minutes after injection, complete occlusion of the fistula was confirmed. The postembolization syndrome was mild, particularly back pain and fever were mitigated. Repeat arteriogram after 3 months demonstrated persistent occlusion of the fistula. From this experience and a review of the literature, we postulate that the advantages of therapeutic embolization with ethanol for A-V fistula compared with other embolization techniques are the following: (1) persistence of arterial occlusion extending to the peripheral vessels, (2) less frequent possibility of recanalization and collateral formation, (3) less systemic toxicity even if ethanol has escaped into the systemic circulation through A-V fistula, and (4) no danger of accidental embolization of other arteries. Herein, we also review briefly the literature concerning both mechanism and feature of action of ethanol injected into the artery.
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Staging of malignant tumors of the nasal cavity and paranasal sinuses by computed tomography (CT) was studied in a total of 49 patients, 33 with squamous cell carcinoma and 16 with tumors of other histologic types. Involved sites by the tumor were studied, and clinical staging was made using CT findings alone according to AJC classification for maxillary sinus tumors. Surgical findings for comparison were available for most cases. Of 33 squamous cell carcinomas and of 16 tumors with other histologic types, the maxillary sinus was the site of origin in 29 and eight, respectively. Of these 37 maxillary sinus tumors, 11 were staged T3, 26, T4, and none was staged T1 or T2. None of these tumors were down staged, and one T3 was upstaged after surgical procedures, although all sinuses were not explored in some cases. Sinusitis due to obstruction was indistinguishable from the tumor without bone destruction. And the determination of the site of origin was difficult in some cases. Despite these, CT should be used for pretreatment evaluation of the tumors of these sites.
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Ultrasonically guided percutaneous puncture of pancreatic cyst was performed on 4 patients with ultrasonically scanned cystic mass lesions in the left upper quadrant, and biochemical and cytological analyses of the aspirated cystic fluids were proved fairly diagnostic. In pseudocyst, the aspirated fluid revealed very high concentration of amylase, malignant cells being not recognized cytologically. In cystadenocarcinoma, the aspirated fluid revealed low concentrations of amylase and high concentrations of LDH and CEA, malignant cells being definitely recognized. This method is of great value for differential diagnosis of cystic diseases of the pancreas.
We have developed a new fibercholangioscope (FDS-CP), which is introduced into the common bile duct via the sphincterotomized papilla of Vater under the rope-way guidance of a balloon catheter. The scope was successfully inserted into the common bile duct in all 12 cases tried and was proved efficient for clinical use. The time required for introduction was 5 min on the average for a balloon catheter and 8 min for the scope to be introduced into common bile duct. The instrument has made it possible to perform precise observations and accurate biopsy of the common bile duct and parts of the main hepatic duct. It is also possible to perform therapeutical trials of removing stones located in the extrahepatic and intrahepatic bile ducts.
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