Biomedical subjects
Publications and source records attributed to R L Gordon.
A new access route for insertion of a feeding jejunostomy using a percutaneous transhepatic approach is described in a case with advanced antral cancer. Standard PTC techniques and angiographic catheters were used.
Transluminal dilatation of seven left subclavian arteries and one right subclavian artery was attempted in seven patients. Dilatation was successful in four left subclavian arteries and the single right subclavian artery treated. Five of the patients suffered from cerebral symptoms as well as ischemia of the upper limb, one had only cerebral symptoms and another had only arm claudication. All patients also had significantly reduced systolic blood pressures in the brachial artery. Standard techniques for percutaneous transluminal angioplasty (PTA) were employed, using the femoral route six times and the axillary route four times. No complications occurred. All patients were permanently given a maintenance dose of antiplatelet treatment with dipyridamole 75 mg tds after PTA. Follow-up of up to 36 months, indicates that angioplasty can be accomplished in the stenosed subclavian artery with relatively little hazard. Patients with hemodynamically significant stenoses should be considered for PTA if their symptoms and signs warrant such therapy.
Carcinoma of the common bile duct is generally a slow-growing tumour which causes death by hepatic failure and ascending cholangitis secondary to obstruction. Internal drainage by surgical placement of a T-tube bypassing the tumour is widely employed, but survival times are generally short, averaging 9.9 months. The interventional radiologist can offer considerable prolongation of life with reduced hospitalization by means of percutaneous tube cleaning and catheter replacement. A case is presented where survival has been prolonged to 37 months by routine radiological catheter care.
A fungating cutaneous tumor arising at the site of exit of a T-tube is described. The tube had been inserted to bypass an adenocarcinoma of the common bile duct. The tumor arose 30 months after operation and is the first such case recorded. Multiple percutaneous changes of the T-tube may be the causative factors.
A peripheral pulmonary artery aneurysm appeared as a solitary, smooth and discrete coin lesion in the lung. The aneurysm was surgically resected. Various etiologies possibly responsible for this entity are discussed. The complications of transthoracic needle aspiration biopsy are reviewed, with emphasis on the hazards of puncturing a vascular lesion, as well as suggested steps to avoid this complication.
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A bleeding intrarenal aneurysm secondary to pyelolithotomy was treated successfully by super-selective catheterization of the feeding arteries and embolization using stainless steel Gianturco coils. Three therapeutic procedures were performed because of recurrent hemorrhage. The advantages of this mode of treatment are that it is well tolerated, relatively safe and allows maximal preservation of functioning renal tissue.
Magnetic resonance imaging (MRI) is a new medical tool that may revolutionize the field of diagnostic radiology. It uses no ionizing radiation and may be suitable for imaging all parts of the body. MRI is undergoing rapid development, and early experience with magnets of varying strength is beginning to accumulate in the radiologic literature. We present our initial experience with MRI using a powerful 0.5 Tesla magnet.
Two patients, one with bile duct stones above a strictured biliary-enteric anastomosis, and the second with posttraumatic intra- and extrahepatic bile duct strictures, were treated via the percutaneous transhepatic route. The stones were removed and the strictures dilated. Surgery was unnecessary in the first patient, and in the second, exploratory laparotomy confirmed the efficacy of percutaneous transhepatic dilatation.
With the introduction of new imaging modalities the optimal protocol for the evaluation of renal tumors is under close review. Angiographers frequently are faced with the question of whether to proceed to inferior venacavography following a selective renal angiogram that demonstrates a patent renal vein. We report a case of renal cell carcinoma in which the main renal vein was shown by ultrasound to be unequivocally patent but at the same time there was considerable tumor extension into the inferior vena cava. The necessity of full examination of the inferior vena cava, either by venacavography or ultrasound, in all cases of renal cell carcinoma is stressed.
A 72-year-old woman with a single kidney and renal calculi was admitted as an emergency with sepsis and anuria. Renal drainage was established by percutaneous nephrostomy (PTN) as an emergency procedure. A nephrostogram showed multiple lucent stones and a single opaque calculus in the renal pelvis. The definitive treatment of the mixed calculi was carried out through the PTN. The lucent stones were dissolved by alkaline irrigation and the opaque stone removed by a biliary basket via the dilated tract. The safety and simplicity of PTN as an emergency procedure and its use for definitive treatment with the avoidance of surgery are stressed.
Continuous retroperitoneal bleeding may be an immediate life-threatening complication of pelvic fractures. While surgical control of the bleeding vessels has been advocated in these cases, today angiographic embolization of the branches of the internal iliac arteries is proving to be the treatment of choice. This is a relatively simple, safe, prompt and effective method of controlling the hemorrhage. It avoids the disadvantages of surgery, general anesthesia, loss of the tamponade effect of the retroperitoneum when opened, and the not uncommon difficulty of identifying and ligating the bleeding vessels. Two cases in which massive retroperitoneal bleeding associated with pelvic fractures was controlled by angiographic embolization are described, illustrating the importance of early angiography.
A 9 1/2-year-old boy was found to have a mass occupying the lower pole of his left kidney, six years after his right kidney had been removed because of a Wilms' tumour. Investigation of the mass included angiography which demonstrated a mass with pathological arteries. Open biopsy of the mass revealed histological changes of nonspecific nephritis. It is probable that this nephritis was a result of radiation damage potentiated by concurrent treatment with actinomycin D, which he had received six years ago.
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Direct cannulation of the deep venous system of the leg was performed in 74 children (79 legs). Both abnormal anatomy and the functional status of the deep venous system were studied. Fifteen legs were normal and 64 exhibited disease of the communicating veins; 33 of the latter patients also had deep venous disease. The communicating veins were described as typical or atypical; a classification comprising two typical and three atypical types is suggested. Four types of deep venous disease were found: (1) aplasia, (b) ectasia, (c) absence of valves, and (d) post-thrombophlebitic obstruction. Normal and abnormal patterns of function are described, and the importance of these findings in treatment and prognosis is discussed.
The radiographic findings on barium enema in 42 patients with endometriosis were reviewed and correlated with those at surgical and laparoscopic examination. Radiographic abnormalities were detected in 27 patients. In nine patients, purely extrinsic mass effect was identified; bowel wall involvement in these patients was not present at laparoscopy. In 16 of 18 patients subsequently shown to have bowel wall involvement, mass effect with fine mucosal crenulation was identified. Annular or polypoid involvement was also noted. Mass effect with crenulation, although not entirely specific, appears to be a characteristic finding in patients with bowel wall involvement due to endometriosis.
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The temperature sensitive allele recA200 has been cloned into the multiple copy number plasmid pBR322 and the gene product isolated. The purified RecA200 protein is temperature sensitive in ability to cleave the phage lambda and LexA repressors in vitro and also in ability to promote a successful search for homology between single stranded DNA and a homologous duplex leading to D-loop formation. However, at the non-permissive temperature the RecA200 protein has approximately wild type single stranded DNA dependent ATPase activity and ability to promote pairing between homologous single DNA strands. The demonstration that the temperature sensitivity in vivo can be correlated with the temperature sensitive cleavage of the lambda and LexA repressors in vitro and also with D-loop formation shows that these in vitro reactions, which require large amounts of RecA protein, are not carried out by trace amounts of contaminating proteins.