Gary B. Davis

Angiographic embolization of intractable puerperal hematomas

Puerperal hematomas may not respond to conventional therapy, including vaginal packing, drainage, and hypogastric artery ligation. Two cases are presented in which selective angiographic arterial embolization was used to manage this potentially lethal complication.

Therapeutic Embolization for Intractable Chronic Bleeding

Intractable, chronic vaginal and/or vesicle bleeding complicating pelvic cancers in five women was treated by transcatheter embolization of the hypogastric artery or its branches. Bleeding was presumed to be from hypervascular granulation tissue formed in response to irradiation in two patients and from tumor tissue in three. The embolic materials were Gelfoam and Oxycel reinforced autologous clots. Bleeding was stopped or reduced in volume by at least 90% in each patient. This form of therapy was useful even though bleeding site was not demonstrated angiographically.

Sodium nitroprusside in the treatment of ergotism.

Severe peripheral vasoconstriction of the legs due to hypersensitivity to small doses of ergotamine tartrate developed in a patient with migraine headaches. The vasospasm was successfully treated with continuous intra-arterial and intravenous infusion of sodium nitroprusside. The contribution of angiography in the diagnosis and treatment of ergotism is stressed.

The Relative Effects of Selective Intra-arterial and Intravenous Vasopressin Infusion

The relative effects of selective intra-arterial and intravenous infusions of vasopressin were evaluated in 16 normotesive dogs. One group was infused via the left gastric artery, one was infused via a peripheral vein, and a control group was not infused. Flow to the stomach and bowel was reduced by an average of 73% and 45%, respectively. There was no significant difference between selective intra-arterial and intravenous infusions with regard to their effects on visceral flow or their systemic parameters. Control animals demonstrated only minor variations from base-line flow.

99mtechnetium penicillamine: a renal cortical scanning agent.

99mTechnetium penicillamine, a renal cortical imaging agent, can be used to provide a rapid, safe and non-invasive assessment of renal morphology and the renal vascular supply. Since this agent is not excreted significantly during the imaging procedure cortical scans of high quality can be obtained without image deterioration owing to a superimposed collecting system. These scans, which are clearly superior in anatomical detail to earlier scans using 131I hippuran, can be obtained along with the 131I hippuran renogram when the patient comes to the nuclear medicine department. Herein we demonstrate the anatomical detail it is now possible to achieve by presenting the cortical renal scans and accompanying radiograms from 5 patients with different renal pathology.

Oriental cholangiohepatitis: Preoperative radiographic and ultrasonographic diagnosis

The recent influx of immigrants from Southeast Asia into the United States has increased the likelihood of encountering unusual diseases heretofore rarely seen in this country. Among these disorders is Oriental cholangiohepatitis, a potentially life-threatening process whose early diagnosis is facilitated by roentgenographic findings. Ultrasonography can also provide useful information, although potential pitfalls in diagnosis should be recognized.

Diagnosis of colonic varices by air-contrast barium enema examination: Report of a case

A case of colonic varices presenting as serpiginous and tubular submucosal lesions in the sigmoid on air-contrast enema examination is reported. The associated angiographic and colonoscopic findings are illustrated, and the pertinent literature is reviewed.

Campylobacter Colitis: a Common Infectious Form of Acute Colitis

A case of acute ulcerating colitis due toCampylobacter fetus is presented. The radiographic and endoscopic findings are indistinguishable from those of idiopathic acute ulcerative colitis. The clinical and bacteriological data relating to Campylobacter are discussed.

99mTechnetium penicillamine scans: an index of differential renal function.

The relative renal accumulation of 99mtechnetium penicillamine was evaluated as an index of differential renal function. Regions of interest were assigned over each kidney with a computer and the renal uptake of 99mtechnetium penicillamine was determined. A simple background correction was made by subtracting the renal activity at 10 minutes from that at 25 minutes. The percentage of 99mtechnetium penicillamine accumulation in the left kidney was correlated with the percentage of the total effective renal plasma flow to the left kidney. Effective renal plasma flow was determined after the intravenous injection of 131 I hippuran using a highly sophisticated computerized technique that has been validated in patients by comparison with traditional split renal function studies. The correlation coefficient between the 2 measurements was 0.97. In addition to its use as an index of differential effective renal plasma flow 99mtechnetium penicillamine is an excellent cortical imaging agent and the relative distribution of 99mtechnetium penicillamine between the 2 kidneys and within a single kidney can be assessed qualitatively by visual inspection of the scan.

Abstracts Papers presented at the Eleventh Annual Session of the Society of Gastrointestinal Radiologists, October 1, 1981, Boca Raton, Florida

Papers Presented at the Eleventh Annual Session of the Society of Gastrointestinal Radiologists, October 1, 1981, Boca Raton, Florida ESOPHAGEAL NODULARITY A NORMAL VARIANT OF THE ESOPHAGEAL MUCOSA Seth N. Glick, M.D. Steven K. Teplick, M.D. Department of Diagnostic Radiology Hahnemann Medical College and Hospital 230 North Broad Street Philadelphia, PA. 19102 Small superficial round nodules (2-4 mm) are frequently observed on routine double contrast esophagrams. They may be focal or diffuse, and appear as fine granularity or sharply defined filling defects. Endoscopic~lly, they are seen as white excrescences on a normal mucosal background. However, they may not be appreciated, unless specifically sought, becaUse of inadequate lumenal distension. Biopsy reveals normal or slightly hyperplastic squamous epithelium and vacuolated epithelial cells containing abundant glycogen. This has been termed glycogenic acanthosis. Esophageal symptoms are usually absent or cannot be correlated with this morphology. We evaluated 300 consecutive esophagrams considered to demonstrate adequate mucosal detail. Nodularity was found in 30%. These were usually confirmed endoscopically when sought. In addition to true nodules, pseudo-nodules may be caused by several types of artifacts such as transverse esophageal folds. Several pathologicconditions may resemble the normal esophageal nodules, however, radiologic and clinical criteria can usually make the distinction. The Esophageal Survey in Upper Gastrointestinal Radiography Dean D. T. Maglinte, M.D., Katharine L. Krol, M.D., Lloyd D. Caudill, M.D., David L. Brown, M.D., and William Michael McCune, M.D. Gastrointestinal Radiology Section Methodist Hospital and Graduate Medical Center, 1604 North Capitol Ave., Indianapolis, IN 46206 When an upper gastrointestinal study is requested on a patient with non-specific abdominal complaints, there are no guidelines as to what should be the minimum esophageal survey. Of 200 patients referred for upper gastrointestinal series, 40 (20%) had radiographic evidence of esophageal disease. Reflux esophagitis, frequently considered difficult to diagnose radiographically, was demonstrated in 31 (16%). A non-invasive carcinoma, varices and a leiomyoma were found. It is suggested that a thorough evaluation of the esophagus consisting of double contrast, single contrast distention radiograph, fluoroscopic motility assessment and mucosal relief study be included in every upper gastrointestinal series. This minimum multiphasic routine evaluation offers the potential for improvement in diagnostic accuracy with little additional examination time. Barium Swallow After Total Laryngectomy Koehler RE, Balfe DM, Setzen M, Weyman P J, Baron RL, Ogura J Department of Radiology and Divls]on of Otolaryngology, Washington University School of Medicine, St. Louis, Mo Dysphagia is a frequent problem in patients who have undergone total laryngectomy and the barium swallow is often useful for evaluaHng the cause for the symptoms. The examination may be di f f icul t to interpret, however, because a variety of anatomic changes may be produced by radiation, infection, fistula, recurrent tumor or the operation itself. We analyzed radiographs and clinical information on 43 patients with total laryngectomy with followup periods ranging from g months to 17 years. Recurrent tumor was found in IS patients and was evident radiographically as a mass deviating the neopharynx in 14. Benign strictures in nine patients apeared either as a long symmetrical r~arrowing or as a very short, weblike narrowing. Fistulas were demonstrated in 12 patients and presaged the development of recurrent tumor in five. Cricopharyngeal muscular-dysfunctlon accounted for the dysphagia in five cases. An understanding of these patterns leads to more accurate interpretation of the postoperative barium swallow and the radiographic findings often indicate the correct diagnosis with a high degree of confidence. 0364-2356/82/0007-0087