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At least 235 records · Page 13Linked to original sources

Chronic paroxysmal hemicrania: orbital phlebography and steroid treatment. A case report.

A 62-year-old man with ankylosing spondylitis and with a 3-year history of chronic paroxysmal hemicrania is presented. Because of his ankylosing spondylitis naproxen was prescribed; this decreased the attacks of headache to about 50%. However, treatment with indomethacin and steroids eliminated the attacks completely, the former drug in 24 h but only when the drug was taken; the latter drug was completely effective after a week but with an effect that lasted half a year after the medication was stopped. Orbital phlebography showed changes similar to those previously observed in patients with Tolosa-Hunt syndrome and cluster headache. Venous vasculitis thus seems to be associated with all three disorders and may be a factor of etiologic significance.

Chronic Disease↗

[Retrograde renal phlebography with balloon occlusion of the renal artery. Technique and scope of a new method (author's transl)].

A new method of retrograde phlebography of the kidney is described; it is carried out by using a balloon catheter in the renal artery for occluding the circulation. The procedure has been carried out in 13 patients without complication. Early experience has provided very good results in the diagnosis of malignant renal tumours; invasion into the venous system can be demonstrated radiologically. In particular, in cases of carcinoma of the renal pelvis, this method represents a significant improvement of the hitherto unsatisfactory angiographic techniques.

Abdominal Injuries↗

[Painless phlebography (author's transl)].

The routine employment and wide indications for ascending phlebography for evaluating the deep and superficial systems prior to specific therapy makes it desirable that the patient should feel as little pain as possible. By using suitable measures before and after the examination, optimal position of the patient and appropriate choice of instruments, as well as local anaesthesia with a Dermo-Jet pressure injector, it is possible to render the examination almost completely painless.

Anesthetics, Local↗

[Transjugular puncture of the portal vein. Portography and selective phlebography of abdominal organs. An experimental study in dogs (author's transl)].

Transjugular transhepatic portography is a new method for catheterising the portal vein and its tributaries. In order to gather experience of the method before applying it clinically, the transvenous approach was studied in six dogs. Transjugular portography has the following advantages as compared with umbilical vein catheterization and percutaneous, transhepatic portal vein catherterisation: 1. Because of the relative positions of the jugular veins, vena cava and portal vein, manipulation of the catheter for selective phlebography is simpler. 2. There is no risk of a haemoperitoneum or bile peritonitis if a correct technique is used since the liver capsule remains intact. 3. In the presence of portal hypertension, it may be possible in future to create an intrahepatic portocaval shunt by the transjugular approach without a major operation. Sclerosis of oesophageal varices is possible, as it is with the other procedures.

Animals↗

[Sonography and phlebography in the investigation of the suprarenals (author's transl)].

Twelve patients were examined by sonography and phlebography; of these, ten had suprarenal tumours and two suprarenal hyperplasia. The value of sonography and its place compared with radiological examinations is discussed. Sonography is an informative method of screening and should be employed whenever there is clinical suspicion of enlargement of the suprarenals before other radiological methods are used.

Adolescent↗

[Characterization of an experimental venous thrombus model with MRI, phlebography and histology].

INTRODUCTION: Several magnetic resonance (MR) techniques designed to demonstrate the characteristic signal intensity of blood degeneration products of thrombi have been suggested, but the effect of thrombus organization on the MR display, in particular with regard to its temporal evolution, remains to be determined. It is the purpose of this study to develop a stagnation thrombus model in rabbits and to characterize thrombus at different ages with two (MR) imaging techniques, phlebography and histology. MATERIALS AND METHODS: Venous stagnation thrombi were induced in the external jugular veins of rabbits using a minimally invasive radiological technique to produce artificial embolic vascular occlusion and hypercoagulability. Twenty-five animals were divided into 5 groups of 5 animals, and each group underwent 1.5 T MR imaging at 1, 3, 5, 7 and 9 days after thrombus induction using a T1-weighted magnetization-prepared rapid gradient-echo sequence (MP-RAGE: TR 10.4 msec, TE 4.0 msec, FA 15 degrees ) and a T2-weighted fast low-angle shot sequence (FLASH: TR 54 msec, TE 18 msec, FA 15 degrees ). The thrombus length was measured on the T1-weighted images. Thrombus conspicuity, signal intensity, and heterogeneity on T2* weighted images were described using visual scales. Radiographic venography and histology served as reference methods. RESULTS: Thrombi were successfully induced in all animals. The overall thrombus length decreased from 43 +/- 9 (day 1 after induction) to 23 +/- 4 mm (day 9). On 3D-reconstructions of the T1-weighted images, the visible portion of the true thrombus length relative to the overall thrombus length was 0.16 +/- 0.3 (day 1), 0.24 +/- 0.3 (day 3), 0.38 +/- 0.5 (day 5), 0.06 +/- 0.1 (day 7) and 0.00 (day 9). Sixteen of 25 thrombi were detectable with the T2*-weighted technique. The overall thrombus signal intensity decreased with the age of the thrombus from day 1 to day 9. The histological evaluation showed that the rabbit thrombi closely resemble human thrombi morphologically. CONCLUSIONS: The thrombus model closely resembles the human venous stagnation thrombus of different organizational stages. With state-of-the-art MRI techniques, thrombi were only partially displayed with the visibility depending on thrombus age. The model may be suitable for evaluating new and potentially more effective MRI techniques for improved thrombus visualization.

Animals↗

[The diagnosis of deep venous thromboses of the leg. Color-Doppler sonography versus phlebography].

Angiodynography of the pelvic and deep leg veins was compared with ascending phlebography in a prospective study, comprising 102 examinations. Improved detection of flow following the introduction of the so-called "slow flow technique" permitted direct visualisation of the tibio-fibular veins in the second stage of this study (26 examinations). Demonstration or exclusion of femoro-popliteal thrombosis achieved a sensitivity of 95% and 90% respectively and a specificity of 99% and 97%. During the first part of this study, demonstration of calf vein thrombosis had a low sensitivity of 72%. This was improved by the introduction of a new high-pass filter resulting in the detection of all occlusions (nine). The sonographic signs of acute and chronic occlusions overlap somewhat. Colour demonstration showed eccentric, non-linear channels in two out of three cases and was able to exclude thrombus, although the veins could not be compressed.

Adult↗

Diagnosis of thrombosis by catheter phlebography after prolonged central venous catheterization.

Sixty central venous catheterizations in 53 patients were prospectively studied with respect to phlebographic findings after prolonged parenteral nutrition. Phlebography was performed by a special technique on completion of the intravenous therapy. Under fluoroscopic control, the central venous catheter was slowly removed, while simultaneously contrast medium was continuously injected through it. Two types of thrombosis were demonstrated--sleeve thrombosis, on 25 occasions (42%), and mural veno-occlusive thrombosis, on five occasions (8%). On removal of the catheter the sleeve thrombosis peeled off the catheter and in several cases it was noticed that parts of the sleeve thrombus or the entire sleeve became detached and were carried away with the blood flow. Although the sleeve thrombus seldom gave rise to any symptoms, this type of thrombosis is of great importance in view of the risk of pulmonary embolism, especially in connection with removal of the catheter. With use of the described phlebographic technique thrombi of this type can be visualized.

Adolescent↗

Practical value of phlebography.

Phlebography is a useful examination if a standardized technic is carefully used, and it can be relied upon to diagnose acute thrombophlebitis definitively or to rule it out. The 200 consecutive phlebograms reviewed produced no mortality or pulmonary embolism, and only minimal morbidity. Phlebograms are also useful in mapping before varicose vein surgery and in distinguishing the leg swelling of the postphlebitic state from that of lymphedema.

Diagnosis, Differential↗

Device for lower extremity phlebography.

A simple device is described for lower extremity phlebography. With the patient standing or recumbent, simultaneous injection of contrast material can easily be achieved by one person.

Humans↗

Cervicovertebral phlebography: pathological results.

Cervical phlebography via the femoral vein approach was done in patients with spinal tumors, cervical radiculopathies, and myelopathies. Tumors originating from or extending into the spinal canal readily compress and obstruct the epidural venous plexus. Because of the lateral position of the epidural veins, the foraminal veins are deformed when cervical roots are compressed in the intervertebral foramina by spondylosis of the uncinate processes or lateral disk herniation. In congenitally narrow canals without significant spondylotic bars, the epidural veins were not opacified. Nonfilling of veins was also seen when the canal was narrowed by multiple spondylotic bars. With a few or even a single spondylotic bar, the epidural veins opacified but this was interrupted at the affected levels. When a significant spondylotic bar was associated with a narrow canal higher up, filling of the epidural veins at the level of the bar was completely arrested.

Cervical Vertebrae↗

Leg phlebography: the incidence, nature and modification of undesirable side effects.

A prospective study was performed to elucidate the side effects of contrast medium phlebography for the diagnosis of deep vein thrombophlebitis (DVTP). The phelbograms were obtained with the patient in a semi-erect position, with an average dose of 125 ml of contrast medium infused continuously over 7-12 min. Renografin 60, or the same agent diluted to three-quarter strength, was used. The major side effects were pain during the study and a symptom complex resembling DVTP starting 12-36 hours after the study. Both were more common with the standard contrast medium (pain: 59.0% vs. 30.0%; delayed reaction: 24.0% vs. 7.5%), although the percentage of positive studies was unchanged (about 35.0%). Side effects were more frequent and severe than previously thought, but their incidence can readily be lowered.

Contrast Media↗

New technique for pelvic venography during ascending phlebography.

A technique of pelvic venography making it possible to obtain satisfactory opacification of the iliofemoral segment of the pelvic veins consistently during ascending phlebography is described. The main features are the compression of the inferior vena cava with a compression band and balloon, and the use of a large amount of contrast material.

Humans↗

Plasma prolactin levels in the inferior petrosal sinuses in various pituitary disorders during perihypophyseal phlebography.

The use of intercavernous sinus phlebography for the diagnosis and neurosurgical treatment of pituitary adenomas has enabled the collection of selective venous samplings of the inferior petrosal sinuses (IPSs), where prolactin (PRL) levels can be measured before the hormone becomes excessively diluted in the systemic circulation. In the present study, plasma PRL levels were studied in the right and/or left IPS and, simultaneously, in the peripheral circulation of: (1) normoprolactinemic patients affected with various pituitary disorders which required phlebographic procedures; (2) hyperprolactinemic patients with negative radiological and computed tomographic (CT) signs of pituitary adenomas and (3) adenomatous hyperprolactinemic patients. In the 17 normoprolactinemic patients, the plasma PRL concentration in the IPSs was significantly higher (3.5 times; p less than 0.01) than in the peripheral circulation. In the 11 hyperprolactinemic patients with negative radiological and CT signs of pituitary adenomas, the central gradient for PRL was significantly higher (2.8 times; p less than 0.05) than in the peripheral circulation. No significant difference was detected between PRL concentrations in the left and right IPSs. In the 11 adenomatous hyperprolactinemic patients, there was a significant (p less than 0.01) central gradient for PRL 3.8 times higher than in the peripheral circulation on the ipsilateral side of the tumor. Furthermore, the plasma PRL concentration in the ipsilateral IPS was significantly higher (3.4 times; p less than 0.05) than that in the contralateral sinus. In conclusion, the present study shows that a clear-cut concentration gradient exists between plasma PRL levels in the IPSs and in the peripheral circulation of normoprolactinemic and hyperprolactinemic patients with negative radiological and CT signs of pituitary adenomas.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenoma↗

Reliability of phlebography in the assessment of venous thrombosis in a clinical trial.

In the frame of a multicenter controlled study comparing the efficacy of low-molecular-weight heparin to standard heparin in the prevention of postsurgical thrombosis, 94 phlebograms were centrally evaluated by two independent radiologists. Three months after the first central evaluation, a new reading was performed with the same radiologists, and discrepancies were adjudicated by a senior radiologist. The number of discrepancies between the first and the second evaluation was high: 33 interpretations (35%) had a least one difference, including 14 (14.9%) discrepancies regarding the main issue, i.e. the presence of venous thrombosis. After the adjudication by the senior radiologist, this number decreased but was still large: 22 films (23.4%) with at least one discrepant item in all and 11 related to the presence of venous thrombosis. This report shows that venous thrombosis assessed by phlebography, which is usually considered as a golden standard in clinical trials, deserves a thorough quality control procedure.

Double-Blind Method↗

Orbital phlebography. IV. The carernous sinuses and adjacent venous sinuses of the skull base.

Frontal phlebography has been used to examine the cavernous sinuses and adjacent basal venous sinuses of the skull. The method has proved to be simple and effective. The normal phlebographic anatomy of the basal sinuses and their drainage has been revised in a material of 26 cases. A normal range for the transverse diameter of the pituitary fossa has been established.

Cavernous Sinus↗