Biomedical subjects
Publications and source records attributed to M L Goldman.
Because of its sensitivity to minor variations in radiographic density and its ability to eliminate overlapping because of the cross-sectional display, computed tomography (CT) of the skeletal system may yield valuable information that may not be apparent on plain film or radionclide examination of bone lesions. The authors present five case illustrations in which CT examination of bone was particularly helpful in the evaluation of the patient.
Explore the source record for details and available documents.
In a comparative study of the diagnostic value of epinephrine renal venography (ERV) and angiography in eight patients with severe inflammatory disease of the kidneys, the spectrum of abnormalities exhibited by ERV was more striking than the angiographic findings. Complete disorganization of the renal venous architecture with linear streaking of contrast agent is a sign of renal inflammatory disease. ERV is a useful adjunctive diagnostic procedure in cases of a nonfunctioning kidney.
The transjugular technique facilitates various diagnostic and therapeutic procedures in the liver. Even in patients with defective hemostasis, severe ascites, or marked obesity, liver biopsy or cholangiography can be performed with relative safety. It also provides an alternative route for entry into the portal system.
A 70mm spot-film camera was modified for use in small-animal studies. The film is exposed directly by x rays and yields a high-quality image.
Transcatheter embolization with bucrylate, a tissue adhesive, was performed in 16 patients with massive upper-gastrointestinal bleeding. Control of arterial bleeding from the stomach was achieved in 6 of 8 patients, and from the duodenum in 3 of 4. Embolization of gastric veins resulted in temporary control of esophageal variceal bleeding in 3 of 4 patients. Histological study showed no evidence of bucrylate causing histotoxicity in 2 patients. Because bucrylate polymerizes rapidly, a localized vascular occlusion mimicking a surgical ligation is produced. Because collateral vessels are not occluded. localized tissue ischemia is unlikely. Tissue adhesives are, however, difficult to use.
Transcatheter intra-arterial tissue adhesives are effective agents for producing medical splenectomy in dogs. Because of the rapid polymerization of the tissue adhesive, localized occlusion of the splenic artery mimicking a surgical ligation can be achieved leaving the intrasplenic vessels patent. Splenic infarction without evidence of infection was accomplished.
Carcinoma of the pancreas and chronic pancreatitis may be extremely difficult to differentiate by standard diagnostic methods preoperatively as well as at the operating table. Operative pancreatic biopsy may have a high morbidity, rare mortality, and can be misleading. Percutaneous aspiration biopsy may be of great potential benefit. It provides additional histological material not usually available, and an accurate diagnosis of malignancy can be made. In select patients a needless laparotomy may be avoided. It appears to be a safe procedure that should be considered in the evaluation of the patient with suspected pancreatic malignancy in which a mass lesion is demonstrated by ultrasonography, computerized tomography, angiography, or retrograde pancreatography.
The feasibility of transjugular entry into the portal vein for catheterization and obliteration of the left gastric vein is demonstrated in a human. This technique may play a significant role in the nonsurgical management of bleeding esophageal varices.
Two methods of controlling life-threatening hemorrhage are infusion of vasospastic agents and embolization of the bleeding vessel. Gelfoam powder, Gelfoam sponge, and isobutyl cyanoacrylate have been used to control severe arterial and variceal hemorrhage from the upper gastrointestinal tract. The authors summarize their results and discuss gastric necrosis, a serious complication.
A patient is presented who lived to age 60 with complete interruption of the aorta associated with Noonan's syndrome. On chest x-ray there were calcified mediastinal masses and bilateral rib notching. Angiography demonstrated complete interruption of the aorta with markedly dilated tortuous intercostal arteries. The roentgenographic studies are correlated with the surgical and pathological findings. Noonan's syndrome is discussed.
A case of extensive gastric necrosis after therapeutic transcatheter embolization of the left gastric artery with fragments of gelatin sponge for recurrent massive upper gastrointestinal hemorrhage is reported. Although future modifications in technique and in choice of embolic agents undoubtedly will be forthcoming, postembolic ischemic necrosis may prove to be a major limitation of this technique. Until more widespread experience is accumulated and the frequency of postembolic ischemic necrosis is known, it would seem prudent to reserve this procedure for those patients presenting prohibitive surgical risks.
Fifty consecutive chemotherapeutic infusions for cancer via precutaneously introduced arterial catheters were reviewed to determine the frequency of angiographic and clinical complications related to the indwelling catheter. Fibrin cloaking along the catheter was found in 20 patients studied by pull-out arteriography and was unassociated with clinical symptoms. Major thrombus formation occurred around the catheter tip in 28% of the infused vessels, all within the hepatic artery. Clinical symptoms developed in only three patients where thrombosis of the hepatic artery had propagated into the celiac axis. Systemic heparinization did not reduce the incidence of thrombus formation but did increase the incidence of mild gastrointestinal bleeding. Several factors may reduce the incidence of complications, such as puncture of a large artery, use of soft, pliable, and small diameter catheters, proper free position of the catheter in the infused vessel, regular angiographic checkups for catheters position, and early evidence of thrombus formation.
A patient with malignant hypertension and acute renal failure underwent percutaneous renal biopsy which resulted in the creation of an arteriovenous fistula that communicated with the renal pelvis. Successful segmental embolization with gelatin sponge (Gelfoam) was achieved via a transcatheter approach.
Experience with the use of epinephrine renal venography in 60 patients with various renal disease is reviewed. The technique offers an important supplement to selective arteriography. It is of particular value in the diagnosis of avascular infiltrative tumors of the renal parenchyma and pelvis. Further, it is of value in the detailed demonstration of renal vein thrombosis and in seeking the cause of unexplained gross hematuria. It can also aid in evaluating expansile avascular renal masses and renal parenchymal disease. The authors found only a relatively low value for epinephrine renal venography in the diagnosis of hypervascular renal tumors and the early detection of venous extension of hypernephromas.
Isobutyl 2-cyanoacrylate (IBC) delivered selectively in small doses produced immediate occlusion of the injected arteries in dogs without significant undesired sequelae. In one patient, pelvic hemorrhage was promptly stopped by a similar technique. In another patient, who was on chronic renal dialysis and judged too ill for nephrectomy, IBC occluded both renal arteries and terminated a life-threatening renal protein loss.
Explore the source record for details and available documents.
Explore the source record for details and available documents.