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In 350 consecutive ascending phlebographies thrombosis was demonstrated in 60, 6 of which were limited to the foot. The veins of the foot is an overlooked place for the origin of thrombosis and emboli.
Orbital phlebography has gained increasing importance in the evaluation of otologic and intracranial pathology. The practical use of this method in vascular and neoplastic lesions in the middle cranial fossa, as well as its probable value in cerebello-pontine angle tumours is reported.
The degree of pain produced by Amipaque 260 and Isopaque 260 at intraosseous phlebography in patients with varicose ulcerations in the ankle region was compared. Amipaque produced less pain than Isopaque. No complications or side-effects occurred during the observation period of about one year.
The incidence of postoperative thrombosis of the leg at phlebography, and the prophylactic effect of low-dose heparin, was assessed in a double-blind investigation comprising 50 patients. Thrombosis occurred in 17 per cent in the heparin group and in 23 per cent in the placebo group. This difference is not significant. No prophylactic effect of low-dose heparin was demonstrated.
The side-effects at phlebography of the lower limb were evaluated using an ionic contrast medium, meglumine-metrizoate, and a non-ionic contrast medium, metrizamide. A post-phlebographic accumulation of 125I-fibrinogen was found in 6 patients examined with meglumine-metrizoate indicating a post-phlebographic thrombosis. Ten patients were examined with metrizamide with no post-phlebographic increase in 125I-fibrinogen uptake. Though the groups are small the difference is statistically significant at the 0.2 per cent level.
Fifty patients with testicular tumor were subjected to computer tomography, lymphography, cavography, and retrograde phlebography of the left renal and testicular veins followed by urography. The yield of computer tomography in detecting metastases of the iliac, lumbar and thoracolumbar regions was compared with that of the other examinations, and was particularly high in the upper part of the retroperitoneal space.
Pancreatic phlebography was performed in 67 patients with proven inflammatory or tumour disease in the region of the pancreas. The findings are described and the diagnostic value of the method is discussed.
In 22 patients with deep venous insufficiency thermography performed at rest and immediately after exercise was compared with conventional ascending phlebography. Thermography was found to have a high sensitivity in detecting incompetent perforating veins, while the specificity was low. The non-invasive thermography is an attractive technique for preoperative detection of perforating veins.
A comparison was made of the incidence of venous thrombophlebitis resulting from the use of a high-osmolality contrast medium (Conray 60%, meglumine iothalamate), and a low-osmolality contrast medium (Niopam 61%, iopamidol). In 20 patients Conray was injected into one leg and Niopam into the other. The incidence of thrombophlebitis was then determined using the iodine-125 fibrinogen uptake test in a prospective, randomised, double-blind study. There was significantly less thrombophlebitis with Niopam than with Conray and it is concluded that Niopam is a safer contrast medium for phlebography.
A prospective, randomised study on 60 legs in 45 patients examined by ascending lower-limb phlebography was conducted to compare Hexabrix 320 (May and Baker Ltd), iohexol 300 and iohexol 240. The quality of opacification of the veins, side-effects, cost and amount of contrast agent used were compared. All three agents produced adequate examinations. Iohexol 300 was preferred for its denser opacification. Iohexol 240 was associated with the lowest incidence of side-effects and Hexabrix 320 cost the least per examination.
Descending phlebography was performed in 24 legs with groin recurrence following previous long saphenous vein surgery. Recurrence was demonstrated in 20 legs (83%) and the value of this technique in patient assessment is discussed.
The present study aimed at evaluating the anterior pituitary hormone levels in the inferior petrosal sinuses and in the peripheral blood of 55 patients affected by various pituitary disorders and undergoing perihypophysial phlebography on neurosurgical indication or for diagnostic purposes. The results indicated that in 6 patients with Cushing's disease and in 4 with hyperprolactinemia the secreting adenoma could be localized by inferior petrosal sinus sampling. Furthermore, the concentrations of all the pituitary hormones were found to be higher in the right and/or in the left inferior petrosal sinus than in peripheral blood, showing a clear gradient between central and peripheral samples. Moreover, the evaluation of hormone central/peripheral concentration ratios revealed noteworthy differences, namely, that central/peripheral concentration ratios of GH, ACTH, and PRL were significantly higher than those of TSH, FSH, and LH (p less than 0.01). On the contrary, no significant differences were found when the concentration ratios of GH, ACTH and PRL or TSH, FSH and LH were compared among themselves. This finding may be attributed to at least two factors: the increased pulsatility and the relatively short biological halftime of polypeptic hormones (GH, ACTH, and PRL) compared with glycoprotein hormones (TSH, FSH, and LH).
Tolosa-Hunt syndrome (THS), or painful ophthalmoplegia is associated to a non-specific granulomatosis of unknown etiology, that involves the superior orbital fissure and its nervous and vascular structures. The clinical picture that responds to steroid therapy, is variable and is always associated with pain. Inflammatory conditions, tumors and aneurysms can produce similar symptoms. Computed tomography, cerebral angiography and orbital phlebography are the imaging methods of choice for making the diagnosis. We revised the results of these radiological examinations of eight patients seen at the Hospital São Paulo from 1989 to 1991, with the diagnosis of THS according to Hunt and Hannerz criteria. The analysis of orbital phlebographic changes based upon Hannerz et al. systematization showed non-specific features, but those were able to help the diagnosis.
One hundred patients were examined by ascending phlebography of both legs in a prospective, double-blind, within-patient study. Each leg was randomly allocated to the examination using either lopamidol 61% as the contrast medium. Immediate side effects were recorded in all patients, and delayed effects in 46 patients. Statistical analysis using the chi-square test showed that lopamidol produced significantly less immediate and delayed pain in the foot and the leg than Conray. Iopamidol produced significantly less nausea and vomiting during the injection than Conray. There was no significant difference in the quality of the phlebograms with either of contrast medium.
Transverse axial computed tomography (CT) has been combined with CT digital phlebography to study nine patients with superior vena cava syndrome. Six were due to malignancy, two were secondary to benign disease, and one was a paraneoplastic manifestation. This combined CT approach successfully identified the abnormal morphology of the superior vena cava, demonstrating external compression, encasement, or intraluminal thrombus in all patients and the collateral venous channels in eight. The efficacy and advantages of this technique are discussed. This technique is a rapid, informative, and cost-effective method for the workup of superior vena cava syndrome. The CT digital phlebogram, however, is not successful in regularly and optimally opacifying the normal superior vena cava because of the limited amount of contrast material, dilution effect of the nonopacified incoming flow from the jugular and azygos veins, and the lack of image enhancement from the CT digital scanograms.
Venous thrombosis after hip arthroplasty was studied using the 125I-fibrinogen test and phlebography. Eight out of ten dextran-treated and six out of ten control patients developed thrombosis. The thrombi were small and most frequently dorsal and dorso-lateral veins were involved. There were no thigh thrombi without concurrent calf thrombi. Half of the thrombi were found within the first postoperative week whereas the remainder occurred later. Preoperative venous pathology predisposed to postoperative thrombosis.
Twenty-five patients with pain in the knee or hip were examined by means of bilateral intraosseous phlebography, intraosseous pressure measurements and 99mTechnetium polyphosphate scintigraphy. All patients with typical rest pain--either due to osteoarthritis or to the intraosseous engorgement-pain syndrome--showed venous stasis and increased pressure in the bone marrow near the painful joint and abnormally high uptake of the radiotracer. In patients with other types of pain this correlation was absent. The results indicate that 99mTechnetium polyphosphate scintigraphy can be used as a screening method in the diagnosis of the intraosseous engorgement-pain syndrome in patients with a typical history. However, increased isotope uptake in a joint region may be due to a variety of other causes. The identical findings with all three methods of investigation in patients with the intraosseous engorgement-pain syndrome and osteoarthritis suggest a common pathomechanism.
According to digital subtraction angiography in 5 cases of idiopathic ischemic necrosis of the head of the femur, the arterial and venous circulation was normal. However, pertrochanteric phlebography showed stasis of contrast indicating venous obstruction. We suggest that this could be due to arteriovenous-venous shunting, possibly resulting from sympathetic dysfunction, as in the diabetic foot.