Biomedical subjects
Publications and source records attributed to R N Rankin.
Umbilical vein collaterals frequently occur in patients with portal hypertension, with the vessels usually connected to the left portal system. An umbilical vein collateral draining the right intrahepatic portal system was found in a patient with portal hypertension. This observation has not been previously reported and probably represents persistence of the embryonic right umbilical vein.
Dilatation of 23 surgically created gastrointestinal tract stomata in 21 patients has been performed using angioplasty techniques. A success rate of 44% was achieved in nine patients with gastric stapling and Marlex mesh wrapping of the greater curve stoma. In 13 patients with gastric stapling, and either sutured gastro-gastrostomy or roux-en-y gastro-jejunal bypass, a success rate of 77% was achieved. In one patient with a jejunostomy, stenosis dilatation was also successful.
A 34-year-old woman presented with postpartum renal cortical necrosis. Contrast-enhanced computerized tomography (CT) of her kidneys showed a narrow subcapsular band of increased density that was separated from the medulla by a distinct band of decreased density. This is analogous to the decreased cortical nephrogram seen on arteriography. The CT scan may be a useful, non-invasive diagnostic procedure in renal cortical necrosis.
Problems in ultrasonography in patients with fatty infiltration of the liver include the possible misinterpretation of small, solid, focal lesions within the liver as being cystic; attributing the relative sonolucency of the pancreas to pancreatitis in the absence of pancreatic disease; and an inability to display normal right renal anatomy using the liver as a "window." Recognition of these problems and careful attention to equipment settings and scanning techniques should prevent errors.
The authors describe their technique of embolization, using detachable balloons to produce endovascular occlusion in three patients with multiple pulmonary arteriovenous fistulas and in one patient with a large peripheral aneurysm. The results were satisfactory. The clinical presentation and treatment course in each of the four patients are described and the role of this form of therapy is discussed. This method of endovascular occlusion is particularly appropriate for treating pulmonary arteriovenous fistulas and aneurysms because placement of the balloon is precise, permanent and localized and the flow of the balloon in the fistula or aneurysm can be directed.
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Percutaneous transluminal angioplasty has been applied to the treatment of transplant renal artery stenosis in 3 patients, 2 with severe hypertension resistant to medical therapy, and one with graft dysfunction related to the presence of the stenosis in the early post-transplant period. The clinical courses of the patients before and after angioplasty are illustrated and the usefulness of the technique in this difficult situation stressed.
Nine cases of suspected aortoenteric fistula in patients with previous aortic reconstructive surgery and gastrointestinal bleeding collected over 5 years were reviewed. Five cases had angiographic evidence of a fistula, later proven at surgery. One patient had a negative angiogram but a fistula was found at surgery. In two cases angiography demonstrated different bleeding sites and in one patient a bleeding source was found by a nonangiographic method. Therefore three (33%) of nine patients had sources of gastrointestinal bleeding other than aortoenteric fistula.
A case of primary chylopericardium is reported, and the usefulness of combined computed tomography and lymphangiography diagnosis of lymphatic leakage is demonstrated.
Gas formation was observed in the infarcted tissues of 2 patients after renal tumor embolization. There was no clinical evidence of abscess, which would have required special treatment, at the site of infarction. This is postulated to be part of the post-infarction syndrome, analogous to the appearance of gas in the fetal tissues after intra-uterine death.
A 19-year-old woman developed an aneurysm of the left superior gluteal artery following laparoscopy. Percutaneous insertion of a balloon catheter into the neck of the aneurysm for 48 hours resulted in permanent thrombosis of the aneurysm. Use of balloon catheters in the management of surgically inaccessible vascular lesions in discussed.
Of 112 patients admitted with acute upper gastrointestinal bleeding, the presumed bleeding site was detected in 61-5% of cases by radiology and in 57% of cases on endoscopy. Thirty-one patients who had barium-meal examination were operated on and the surgical and radiological findings agreed in 26 (84%). Twenty-three patients who had endoscopy were operated on and the surgical and endoscopic findings agreed in 15 (65%). In 10 cases radiology detected a lesion not identified on endoscopy and in nine endoscopy detected a lesion not seen at radiology. We suggest that when there are two potential sources of bleeding radiology as well as endoscopy can detect the actively bleeding lesion. The supplementary nature of radiology and endoscopy is emphasised and we conclude that both methods should be used if there is any doubt at the initial radiological or endoscopic examination about the source of the bleeding.
Ovarian hyperstimulation syndrome is well recognized clinically, usually in association with drug therapy for infertility. The ultrasonic appearance of the ovarian cystic enlargment in ten patients with the findings on follow-up in six patients is described. The role of ultrasound in this condition is shown to be in diagnosis, for staging, and follow-up.
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PURPOSE: To assess the anatomic feasibility of percutaneous portacaval shunt formation. MATERIALS AND METHODS: One hundred contrast material-enhanced computed tomographic (CT) scans were retrospectively reviewed. The distance and direction from the inferior vena cava (IVC) to the main portal vein (MPV) were measured. Anatomic structures intervening between the IVC and the MPV, and related to the MPV were also noted. RESULTS: The distance between the IVC and the MPV was less than 1 cm in most cases. The direction from the IVC to the upper, middle, and lower thirds of the MPV was predictable and lay within a relatively narrow range. At the middle MPV, there were no intervening structures between the IVC and the MPV in most cases. Intervening structures included the liver at the upper MPV and nodes at the lower MPV. The most common structures related to the MPV included the liver, hepatic artery, and gallbladder (upper MPV); liver, stomach, and pancreas (middle MPV); and pancreas, duodenum, and celiac axis (lower MPV). CONCLUSIONS: These results indicate a short distance and predictable direction between the IVC and MPV. If aberrant vessels and a prominent caudate lobe are excluded, there appears to be a relatively safe cavo-portal route (with respect to neighboring and intervening structures) at the level of the middle MPV. These findings indicate that percutaneous portacaval shunting may be worthy of further experimental study.
PURPOSE: The authors report their experience with the translumbar inferior vena cava (IVC) approach for central venous access during a 6-year period at three teaching hospital sites. PATIENTS AND METHODS: Twenty-nine percutaneous IVC central venous access catheters were inserted in 22 patients during a 6-year period in the radiology departments of three teaching hospital sites. All patients had undergone unsuccessful attempts at conventional central venous access. Information was gathered by retrospective radiologic and hospital chart review. RESULTS: All attempted placements were successful. Catheters were in place for a total of 3,510 catheter days. The average length of catheter placement was 121 days (range, 14-536 days). Life-table analysis predicted catheter function rates of 55% and 29% at 6 and 12 months, respectively. Three procedure-related complications occurred. A lower pole branch of the right renal artery was inadvertently entered with a 22-gauge needle during attempted IVC puncture in one patient without clinical sequelae. A second patient developed a small groin hematoma at the femoral venous puncture site, which resolved spontaneously. A third patient developed a moderate retroperitoneal hematoma, which resolved without specific intervention. The sepsis rate was 2.8 infections per 1,000 catheter days with an average time to infection of 127 days (range, 10-536 days). CONCLUSION: In the authors' experience of 29 translumbar central venous catheter insertions, all attempts were successful. Percutaneous central venous access via the IVC is a safe and effective option for patients in whom more conventional access is not possible.