Harvey M. Goldstein

Transcatheter occlusion of abdominal tumors.

Radiological and clinical experience with transcatheter intravascular occlusion of abdominal and pelvic tumors in 55 patients is presented. Major indications include control of hemorrhage, palliation of local tumor symptoms, and preoperative management of facilitate surgery. Methods of occlusion included embolization (clot, subcutaneous tissue, and Gelfoam), introduction of a stainless steel coil into larger vessels, and balloon catheters. Hemorrhage was controlled in 8 of 12 patients with bleeding gastrointestinal and pelvic tumors. Experience in 36 patients with hypernephroma is discussed. Initial observations are presented, including occlusion of the hepatic artery for dearterialization of primary and secondary neoplasms and of the splenic artery for hypersplenism.

Gray Scale Ultrasound Evaluation of Hepatic Neoplasms: Patterns and Correlations

Ninety malignant hepatic neoplasms were studied by gray scale ultrasound. Four different ultrasonic patterns were observed: (a) discrete, relatively echo-free masses; (b) discrete, relatively echogenic masses; (c) totally echo-free masses; and (d) a diffuse alteration of echo architecture without discrete masses. There has been no apparent association of ultrasonic pattern with either the histologic type of neoplasm or the angiographic vascularity. Corresponding isotopic data is discussed.

Transcatheter Arterial Embolization in the Management of Bleeding in the Cancer Patient

Selective transcatheter arterial embolization was performed in 7 cancer patients with gastrointestinal or uterine bleeding. Most were bleeding from neoplastic tissue and were refractory to conservative management. Complete and permanent cessation of bleeding was obtained in 5 patients, including 3 with gastric bleeding, 1 with colonic bleeding, and in 1 with uterine bleeding. Successful arterial embolization allowed further treatment of the underlying disease which was particularly critical as these patients were poor surgical candidates. No significant or prolonged side effects were noted.

TRANSCATHETER EMBOLIZATION OF RENAL CELL CARCINOMA

Experiences with transcatheter embolic occlusion of 12 hypernephromas are presented.Tumor occlusions were performed preoperatively in 6 of the patients to aid surgical management. In the 6 inoperable cases, embolizations were performed for palliation of specific symptoms and to reduce tumor size, usually in conjunction with chemotherapy.Results of the preoperative embolizations are encouraging as surgical resections have been facilitated with decrease in operative times and blood loss. Follow-up data are presently accumulating in the inoperable cases.Pertinent technical considerations of tumor infarction and side effects of the procedure are discussed.

Radiological Manifestations of Radiation-Induced Injury to the Normal Upper Gastrointestinal Tract

Radiation-induced injury to the normal esophagus, stomach, and duodenum in patients with advanced cervical carcinoma who received high para-aortic lymph-node irradiation to an average tumor dose of 5,000 rads is discussed. Radiation esophagitis is usually the result of mediastinal irradiation for bronchogenic carcinoma. The most consistent radiological finding is abnormal motility, with esophageal stricture and/or ulceration occurrring less frequently. Radiation gastritis usually presents as pyloric ulceration or irregular contractions of the antrum, simulating gastric carcinoma. Postbulbar duodenal mucosal thickening, ulceration, and strictures may occur. Pertinent clinical features, pathogenesis, and pathological correlations are discussed.

Computed Tomography in the Evaluation of Musculoskeletal Neoplasms

In a study of 62 musculoskeletal neoplasms, computed tomography contributed little to establishing tissue diagnosis. Its primary value lay in the assessment of intraosseous and/or extraosseous extent of disease. CT also established the presence or absence of disease in a small number of cases with clinically questionable findings. In most cases, conventional radiographic methods were superior in diagnosing musculoskeletal neoplasms.

Transperitoneal percutaneous retroperitoneal lymph node aspiration biopsy.

Percutaneous aspiration biopsies of opacified retroperitoneal lymph nodes, and retroperitoneal, intraperitoneal and paraspinal masses were successfully accomplished in 14 of 17 patients. A 23-guage needle was utilized for the procedure which is performed under fluoroscopic guidance. Metastatic carcinoma, sarcoma and melanoma were readily identified by aspiration biopsy while the diagnosis of lymphoma, especially as to type, was more difficult. No significant complications have resulted from the passage of the needle through the peritoneal cavity.

Ultrasonography of necrotic hepatic metastases.

Twelve patients with sonolucent hepatic metastases studied with gray scale ultrasonography are presented. Extensive necrosis presumably accounts for the sonolucent appearance of the hepatic lesions. The spectrum of ultrasonographic features and correlations, particularly with computed tomography, are presented. The similarity between anechoic hepatic metastases and benign conditions of the liver is emphasized.

Angiographic evaluation of pancreatic disease. A further appraisal.

Reappraisal of pancreatic angiography among 76 proved cases involving normal studies and those demonstrating pancreatic neoplasms and pancreatitis reaffirms conclusions drawn from a prior series from this institution. Differentiation of the normal and abnormal pancreas was accomplished in 92% of cases. Angiographic abnormality was present in 97% of pancreatic carcinomas and confident differentiation of carcinoma from pancreatic inflammatory disease was possible in 85% of cases. Subselective angiography, magnification techniques, and pharmacoangiography significantly improved diagnostic confidence and accuracy, particularly in patients with small tumors or pancreatitis. In addition to its diagnostic value, a major benefit of pancreatic angiography lies in its ability to predict tumor resectability in the majority of patients.

Angiographic Evaluation of Carcinoid Tumors of the Small Intestine: The Value of Epinephrine

The angiographic features in 5 cases of carcinoid tumors of the small intestine are discussed. Findings included irregularity and narrowing of the distal mesenteric and intestinal arcade arterial branches, minimal parenchymal stain, and obstructed venous return. A stellate arterial configuration was not noted. In 2 cases in which epinephrine was employed, tumor staining of the primary lesions and their hepatic metastases was markedly enhanced. Possible mechanisms of action for the pharmacoangiographic effect of epinephrine are discussed.