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[Angiographic exploration of endocrine tumours of the pancreas. Arteriography and phlebography (author's transl)].

The authors report their procedure of angiographic localization of endocrine tumors of the pancreas: arteriography and subselective pancreatic phlebography (by transcutaneous transhepatic route) with intrapancreatic venous hormonal assays. This technic is the only one able to localize microscopic secreting tumors (under 2mm diameter in 3 cases on 20 examinations). Interpretation of hormonal data is discussed.

Angiography↗

[Phlebography (author's transl)].

The article discusses the limitations of conclusive information supplied by different phlebographic methods. Particular attention is drawn to the insufficient staining properties, partly of the deep veins of the lower leg, the vena femoralis profunda and gastrocnemius veins. When assessing the course of acute phlebothromboses, conclusive information on the extent of thrombus formation is limited in complete obstruction of deep veins as well as in the reformation of thrombi in vessels which have already undergone post-thrombotic changes. Observation of the valvular function can supply essential information on the extent of fibrinolytic effects. Besides the conventional phlebographic techniques, the article also explains methods for the visualisation of rare angiomatoses with osseous involvement, using transosseous pelvic phlebography.

Angiomatosis↗

[Validity of retrograde peripheral phlebography (author's transl)].

The Authors present and discuss the results obtained in phlebographic exploration by a particular method, namely retrograde peripheral phlebography. After describing the technicalities of this procedure, they evaluated its advantages and disadvantages, and conclude by recommending a more widespread use of this examination.

Female↗

[Sudeck's bone atrophy after leg phlebography - a case study of an unusual complication (author's transl)].

In a 39-year old man, a painful oedema had formed at the back of the foot perimalleolary one day after paravasal contrast medium injection following ascending phlebography. 8 weeks later, the x-ray film showed a maculate Sudeck's bone atrophy in the region of the toes, ankles and the heel. Sudeck's bone atrophy had obviously developed on account of a specific vegetative reactivity, subsequent to the local inflammation.

Adult↗

Thermography in the diagnosis of deep venous thrombosis. A comparison with 99Tcm-plasmin test, clinical diagnosis and phlebography.

Thermography, clinical examination and 99Tcm-plasmin test were performed in 112 patients and compared with phlebography. The study population consists of consecutive outpatients with symptoms compatible with deep venous thrombosis, who presented during regular clinic hours. Scoring systems were constructed for the clinical and thermographic evaluation. Both thermography and clinical diagnosis were insufficiently sensitive and specific for screening purposes. Plasmin test had a high sensitivity, 95%, but a low specificity. It is possible that a combination of thermography and clinical diagnostic criteria can provide an acceptable screening procedure. Combining thermography with a routine examination by the physician on duty yielded less favourable results.

False Negative Reactions↗

[Location of an insulinoma by transhepatic phlebography with staged insulin assays (author's transl)].

Insulinoma was easily diagnosed in a 73-year-old woman who had organic hypoglycaemia associated with hyperinsulinism, but the tumour could not be located by echotomography and computerized tomography. The state of the patient's arteries precluded arteriography. Pancreatic phlebography was carried out by the portal transhepatic route and blood was collected at different levels for plasma insulin assays. A very high gradient at the pancreatic isthmus indicated the site of the tumour, which was found on surgery to be precisely there and could be enucleated. This technique cannot be used systematically to locate insulinomas, but it is unquestionably helpful when the tumour cannot be located by other methods or when these are contra-indicated.

Adenoma, Islet Cell↗

[Severe thromboembolic complications following lumbar spinal phlebography].

From a series of 400 cases of lumbar spine phlebography by selective catheterisation, 4 serious thrombo-embolic episodes were observed, including 2 cases of severe pulmonary embolism which responded favourably to medical treatment. In 3 cases, risk factors were found (prolonged immobilisation in bed past history of phlebitis). One case developed severe phlebitis of the lower limbs despite prophylactic treatment with low dose calcium heparin. In the other cases, no anticoagulant therapy was prescribed before or during the examination.

Adult↗

Iohexol and meglumine iothalamate in phlebography of the leg. Comparison of the tolerance.

Fifty patients were examined by ascending phlebography of both legs in a prospective, double blind, within-patient series. Each leg was randomly allocated to the examination using either iohexol 300 mg I/ml or meglumine iothalamate 280 mg I/ml as the contrast medium. Immediate side effects were recorded in all patients, and delayed effects in 45 patients. Statistical analysis using the chi-square test showed that iohexol produced significantly less immediate pain in the leg than meglumine iothalamate. Iohexol produced significantly less nausea, and vomiting during the injection than meglumine iothalamate. No significant difference was found in the incidence of delayed pain and swelling with either medium. The quality of the films produced by iohexol was significantly better than that obtained with meglumine iothalamate.

Adult↗

Cavernous hemangiomas of the orbit: value of CT, angiography, and phlebography.

Neuroradiologic studies performed in 18 cases of surgically verified intraorbital cavernous hemangioma are reported. Skull films usually showed enlargement of the orbit and evidence of soft-tissue mass. Phlebography rarely demonstrated filling of the cavernous hemangioma or enlarged draining veins. On angiography, in addition to displacement of vessels, pooling of contrast medium in the cavities of the hemangioma was observed in more than half the cases. Computed tomography (CT) demonstrated a rounded, hyperdense, enhancing lesion usually in the superior segment of the intraconal space. Although CT may be sufficient for planning the surgical approach, in most cases a combination of CT and angiography will give better, more specific preoperative diagnosis.

Adolescent↗

Computed orbital phlebography of the cavernous sinuses.

Computed orbital phlebography (COP), described as computed tomography with concomitant injection of contrast medium into a frontal vein, was used to evaluate the cavernous sinuses in 19 patients with intrasellar or parasellar lesions and in two normal controls. Bilateral opacification occurred in 12 subjects, eight of whom had pituitary tumors. Unilateral partial obliteration was encountered in four subjects, all of whom had pituitary tumors with marked parasellar extension. In three subjects with parasellar tumors, ipsilateral total obliteration of the cavernous sinus was seen. In one subject with no sign of parasellar tumor, there was no opacification of the cavernous sinuses, a failure attributed to technical factors. In one other subject, the frontal vein puncture was unsuccessful and COP could not be performed.

Cavernous Sinus↗

[Phlebography in recent injuries of the lower limbs. Its role in operative decisions].

67 patients were transferred to a traumatology centre within a mean period of 8 days following an accident in order to envisage treatment of their fractures. Routine pre-operative phlebography was undertaken in 37 patients. It detected the presence of thromboses in 46% of cases. Anticoagulant treatment was started immediately and the date of orthopaedic surgery delayed because of the risk of pulmonary embolism.

Adolescent↗

[Systemic and local reactions in leg phlebography with special reference to iodine-containing contrast media. Randomized, prospective, intraindividual double-blind study using iodine-containing contrast media of different osmolarity and iodine concentration. I].

Iopamidol, a non-ionic, tri-iodinated radiographic contrast medium, was superior to the ionic substances ioxaglate, ioglicinate and ioxitalamate in the ascending phlebography. In 180 examinations on 90 patients (report I), which were carried out intraindividually by double blind technique, distinct differences were recorded in particular at pain registration. Since iopamidol was well tolerated in nearly all cases, pain was registered in 10% in ioxaglate, in 22% in ioglicinate and in 37% in ioxitalamate. Anaphylactoid reactions had been observed in one case (1.1%) with iopamidol, in 7% with ioglicinate, in 10% with ioxitalamate and in 17% with ioxaglate. The low incidence of clinically manifest postphlebographic thrombophlebitis and deep venous thrombosis was surprising. In no case was deep venous thrombosis seen after the application of low-osmolar substances, whereas transitory superficial vein irritations could be observed more frequently (10% in iopamidol and 21% in ioxaglate). In ioglicinate as well as in ioxitalamate one deep vein thrombosis and in 10% resp. 30% superficial thrombophlebitis were recorded.

Contrast Media↗

[Serious thromboembolitic incidents during lumbar spine phlebography].

From a series of 400 cases of lumbar spine phlebography by selective catheterisation, 4 serious thrombo-embolic episodes were observed, including 2 cases of severe pulmonary embolism which responded favourably to medical treatment. In 3 cases, risk factors were found (prolonged immobilisation in bed, past history of phlebitis). One case developed severe phlebitis of the lower limbs despite prophylactic treatment with low dose calcium heparin. In the other cases, no anti-coagulant therapy was prescribed before or during the examination.

Adult↗

Varicose veins. Do not do phlebography unnecessarily; preserve the great saphenous vein!

Phlebography should be performed only on special indications, chiefly for the diagnosis of thrombosis. A non-invasive method such as venous plethysmography is valuable in assessing deep venous insufficiency. Local exstirpation of varices and perforants and percutaneous paired sutures round superficial varices are recommended instead of stripping, as the saphenous vein may be needed for arterial reconstruction in risk groups, e.g. all male smokers. Peripheral arterial pulsations should always be checked to ascertain that the symptoms are not due to arteriosclerotic occlusion.

Humans↗

Phlebography of the internal spermatic vein (and the ovarian vein).

Phlebography of the internal spermatic vein was performed on 87 patients. In only two cases were slight complications (fever and chill) recorded after the examinations. The patients felt only a little discomfort during the examination. They did not have to be hospitalized before or after the examinations. In a few cases we saw sufficient values distally, at the level of L4-5. We have interpreted these cases as being normal.

Adolescent↗

[Isotope phlebography. Value and limitations. Reliability in recent deep venous thrombosis of the lower limbs (author's transl)].

Isotope phlebography is a reliable examination in the diagnosis of deep venous thrombosis. Too complicated and expensive to be suggested for the purpose of routine detection, it nevertheless is of definite interest in three circumstances: --Suspicion of pulmonary embolism, with visualisation of any possible reservoir of peripheral clot and proof of the embolism. --Postoperatively, for repeated follow up to evaluate permeability after surgical procedures. --Finally, dynamic information by calculation of transit time of the radioactive embolus. Combined with Doppler measurement of peripheral venous pressures, it reflects the emptying capacities of a limb affected by post-phlebitis syndrome and hence plays a role in the decision to stop oral anticoagulants.

Humans↗