Biomedical subjects
Publications and source records attributed to S R Cho.
We describe a patient with a chronic urinary cutaneous fistula following partial nephrectomy of a previously separated horseshoe kidney, who was treated successfully by stainless steel coil embolization of the renal artery. Thus, a major reoperation was avoided.
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We report a severely traumatized patient who developed massive bleeding through surgical drains in the postoperative period. Superselective dorsal pancreatic arteriography demonstrated extravasation of contrast material in the pancreatic bed. Embolization with Gel-foam particles successfully controlled this severe bleeding. Transcatheter embolization is the procedure of choice for controlling pancreatic bleeding in acutely traumatized patients.
Adrenal carcinomas are rare. We present four surgically and pathologically proved large right adrenal carcinomas studied by computed tomography, angiography, and other imaging modalities. Computed tomography demonstrated large nonhomogeneous right upper quadrant masses in all four cases, but the adrenal origin of the mass could not be ascertained by computed tomography in three patients due to the transverse display of the anatomy. Ultrasonography provided important additional information in these cases. Arteriography was diagnostic in each case by demonstrating minimal to marked tumor vascularity supplied by adrenal arteries. We also present, for differential diagnostic purposes, a proved benign adrenal hemorrhagic cyst with computed tomography and angiography findings indistinguishable from those of adrenal carcinomas. Computed tomography does not eliminate the need for angiography in patients with large right upper quadrant masses suspected of being an adrenal carcinoma.
Various diagnostic imagings in nine patients with mediastinal goiters were presented. The clinical manifestations of these patients were various, from totally asymptomatic to severe dyspnea. Six of the nine patients underwent surgical intervention, three were follicular adenomas and three were nodular goiters. A chest radiograph (positive in seven out of nine patients) provided the most valuable initial localization of a goiter mass to the anterior, middle, or posterior compartment. Esophagograms (performed in four patients) showed compression of esophagus by the mediastinal mass. I-131 scintigraphy (performed in seven patients) was capable of detection of functional (in three patients) vs nonfunctional status of thyroid status (in four patients). Angiography (performed in five patients), characterized by anatomic continuity with cervical thyroid gland, calcifications, well-defined border of masses and/or contrast enhancement, offered important roles to direct a diagnosis of intrathoracic goiter. The computed tomography becomes increasingly important because all mediastinal goiters are not radioiodine avid.
Intra-arterial, low-dose streptokinase therapy was administered to five patients with acute hand ischemia (2 to 48 hours' duration) and one patient with chronic hand ischemia (3 months' duration). In the five patients with acute ischemia excellent restoration of patency of occluded hand arteries was obtained, with complete recovery of hand function and avoidance of tissue loss despite the severity of these cases. In the remaining patient with an iatrogenic chronic occlusion, ischemia could not be relieved and bypass surgery was performed with satisfactory results noted at the 3-month follow-up examination. No complications were encountered during or after any of these procedures. The catastrophic consequences of hand ischemia, i.e., loss of limbs or digits, were avoided.
Linear tomography performed with the patient in the upright position is a horizontal beam examination useful for further evaluation of the gallbladder during oral cholecystography in cases of superimposed densities and for confirmation of lesions attached to the wall of the gallbladder.
Recurrent occlusive disease was found by noninvasive methods and confirmed arteriographically in 7 patients who had undergone endarterectomy for stenosis of one [5] or both iliac arteries [1] or the subclavian artery [1]. Three patients with iliac artery stenosis had percutaneous transluminal angioplasty (PTA) 1 to 5 years after endarterectomy. One patient with stenosis of the external iliac artery had PTA 4 years after endarterectomy, and dilatation was repeated 7 months later because of recurrence. One patient had 2 endarterectomies and 2 PTAs within 8 years for stenosis of the right common iliac artery. One patient had recanalization of the left common iliac artery 6 years after endarterectomy with low-dose streptokinase followed by PTA. Another patient underwent endarterectomy of the left subclavian artery 3 months after PTA and required further dilatation at 5 and 10 months because of recurrence. The authors conclude that endarterectomy does not preclude PTA (or vice versa) in patients with recurrent arterial occlusive disease.
Plain film abdominal radiographs of 100 cases of ultrasound-proved ascites were reviewed for findings of ascites. In addition, 100 nonascitic cases proved by sonography were reviewed to evaluate the specificity of these findings. We found that all the described plain film radiographic signs of ascites except the hepatic angle sign are insensitive though specific. The hepatic angle sign has a sensitivity of 84% and a specificity of 70%.
Intramural gastric diverticula are true diverticula, entirely contained within the wall of the stomach without deformity of the serosa. All of the 13 known reported cases are at the greater curvature of the distal antrum. This is true of our three cases as well. The unique location and characteristic change in shape with peristalsis distinguish them from pathological entities.
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We describe a simple technique to straighten the curved tip of a "J" guidewire when the plastic introducer is not readily available. This technique may expedite angiographic procedures.
Nongranulomatous ulcerative jejunoileitis is a rare cause of small intestinal ulceration. Clinical features include fever, pain, steatorrhea, and protein-losing enteropathy with an unremitting downhill course. Some cases have shown similarities to gluten-sensitive enteropathy. However, the small bowel barium study of these two diseases shows markedly divergent patterns.
The postoperative chest radiographic findings in 38 patients undergoing orthotopic (37 patients) and heterotopic (1 patient) cardiac transplantation were evaluated. Findings were correlated with those of echocardiograms, sputum and blood cultures, and lung and heart biopsies. The radiographic manifestations in the chest of these patients are classified in the following three main categories: (1) Newly formed cardiac silhouette findings due to the transplanted heart itself, i.e., changes in size and shape of the new heart and pericardial effusion resulting from the placement of a smaller heart in a larger pericardial sac. (2) Infectious complications due to bacteria, fungal, and other opportunistic agents secondary to immunosuppressive therapy, and (3) Usual postoperative complications following thoracotomy and open-heart surgery.
A 58-year-old woman with sarcoidosis had dyspnea found to be caused by a rare manifestation of that disease--tracheal stenosis. Tracheal dilatation has been beneficial.
A case of actinomycosis involving the pelvic cavity is reported. The patient had a pelvic mass clinically and radiographically. Barium enema examination showed a mass with extrinsic compression and fixed narrowing of the rectum with mucosal irregularity. A computed tomographic scan showed a pelvic mass displacing the rectum.