Helen C. Redman

Splanchnic Artery Stenosis and Occlusion

The observations and information available on stenosis and occlusion of the splanchnic arteries are primarily derived from surgical (1–4) and autopsy (5–7) studies. The clinical problem of splanchnic artery obstruction, however, extends beyond those patients who are either severely symptomatic or those with a fatal course. Undetermined from these studies is the incidence of asymptomatic or atypically symptomatic patients with splanchnic vessel lesions, since these vessels are not routinely palpated during exploratory laparotomy nor routinely described in autopsy reports (8). Knowledge of this incidence is necessary in evaluating the significance of the type and number of splanchnic vessel obstructions and the influence of collateral vessels in relation to the symptoms of intestinal angina. Abdominal arteriography, in contrast to autopsy and surgical studies, offers a unique opportunity to investigate these lesions in an in vivo population and thus to study their potential natural incidence and history. It...

Computed Tomography as an Adjunct in the Staging of Hodgkin's Disease and Non-Hodgkin's Lymphomas

Computed tomography (CT) of the abdomen has been evaluated as an adjunct in the staging of 25 patients with Hodgkins disease and non-Hodgkins lymphomas. Enlarged para-aortic nodes were consistently identified as were splenomegaly and larger splenic nodules. While lymphography and other staging procedures remain necessary in the evaluation of such patients, CT provides additional information useful to the surgeon. The cross-sectional display aids in the planning of appropriate therapy ports since the adenopathy is often found to be more extensive than was demonstrated at lymphography.

Arterial Collaterals in the Liver Hilus

Abstract Arterial collaterals in the hilus of the liver may develop in a variety of clinical situations including neoplasm, atherosclerosis, operative ligation and other vascular stenoses, and cirrhosis. They are normally present but are not demonstrated angiographically unless they are functioning as collaterals. Hilar collaterals are an important factor in maintaining liver viability following accidental or purposeful hepatic arterial ligation. The authors base their discussion on personal experience with 16 cases.

The Spectrum of Angiographic Findings in Hepatoma

The angiographic findings are presented in 5 patients with hepatoma. Three cases had the usual hypervascular angiographic appearance, but two were quite hypovascular. Such poorly vascularized hepatomas can probably not be differentiated from metastases or locally invasive carcinomas, such as cholangiocarcinoma and carcinoma of the pancreas.

Differential Problems in the Angiographie of Carcinoma the Pancreas1

Abstract Angiographic findings in patients with abnormal changes similar to those in carcinoma of the pancreas disclosed the following diseases: carcinoma of the ampulla of Vater, bile duct, or stomach, metastases to peripancreatic lymph nodes, pancreatitis, atherosclerosis, posterior penetrating benign antral gastric ulcer, postoperative changes, and arteritis. Some of these can be diagnosed by careful gastrointestinal examination before angiography; others may be misdiagnosed as carcinoma because of the similarity in the angiographic changes. False-positive diagnoses should occur only occasionally.

Effect of epinephrine on celiac and superior mesenteric angiography.

The effect of epinephrine on celiac and superior mesenteric angiography has been studied in 65 patients. Evaluation has been made of changes in arterial detail, transit time of contrast material, capillary accumulation, venous opacification and of the diagnostic usefulness of the drug in the various lesions encountered. Epinephrine caused the most marked constriction and increase in transit time in the splenic artery. An actual decrease in transit time of the contrast material was seen in the bowel arteries. The pancreatic vessels were not constricted, except in the presence of chronic pancreatitis. The duodenal arteries also showed increased filling following the drug. In general, capillary accumulation was diminished except in the duodenum, and veins were not seen as well except in the superior mesenteric distribution. In general, primary and secondary tumors were demonstrated better after epinephrine if they were vascular and if the contrast material reached the vascular bed of the tumor. Carcinomas of the stomach were not seen as well because of marked constriction of the gastric vessels. Inflammatory lesions showed increased constriction following the drug, with the exception of lesions of the duodenum. Collateral vessels were not affected by the drug. The usefulness of this technique for physiologic investigations is discussed.

Hemobilia and pancreatitis as complications of a percutaneous transhepatic cholangiogram

SummaryPercutaneous transhepatic cholangiography (PTC) was performed on a 23-year-old male because of an atypical progression of hepatitis B antigen-negative hepatitis. No bile duct was entered and the procedure was uneventful. However, celiac angiography the day following PTC revealed abnormal liver vessels in the target area and the patient developed hemobilia and clinical pancreatitis, causing common duct obstruction. Symptomatology persisted until celiotomy 32 days after PTC. Clots were found obstructing the common bile duct.This case is presented both because of the unusual complications of PTC and the unusual angiographic abnormalities. It is suggested that PTC be reserved for the evaluation of patients when there is a specific indication for the procedure either to differentiate cholestatic jaundice from extrahepatic jaundice or to localize a site of obstruction before surgical intervention.

CATHETERIZATION OF ARTERIES IN THE RABBIT.

Selective catheterization of blood vessels aided by fluoroscopy has been a common procedure in man for the last ten years. Special catheterization technics have also been developed for some animals, especially the dog and cat (2, 4, 6). In 1933, Rousthoi (7) performed his classical experiments with arterial catheterization in the rabbit. Introducing a cannula or a catheter into the common carotid artery and gently passing it down into the aorta, he was the first to visualize the coronary arteries in a living animal by an injection of contrast material nonselectively into the ascending aorta. The present report describes a technic for selective arterial catheterization in the rabbit. Method and Material The technic employed is as follows: An ear vein of the rabbit is cannulated with a pediatric scalp vein needle and Diabutal or urethane anesthesia is administered. Physiologic saline with heparin (1,000 I.U. per 500 ml) is used for rinsing the catheter. The catheter employed is made of a small radiopaque vi...

Spillover Flowmeter: A Preliminary Report

Principle. A catheter is introduced into the aorta, with the tip in the branch where flow is to be measured. Contrast medium is injected through the catheter and the flow is followed fluoroscopically and with cineradiography. At sufficient injection rate, the medium starts leaking back into the aorta during diastole. Further increase in injection rate causes back-leak during systole. The injection rate is registered and, therefore, the systolic and diastolic blood flow can be calculated. The blood pressure is also recorded, so that the duration of the systolic and diastolic flow can be determined and the mean flow calculated.

Angiography in carcinoma of the biliary tract.

Abstract The angiographic findings have been presented in 20 patients with carcinoma of the biliary tract. The primary angiographic abnormality in these patients was serrated arterial encasement. The larger tumours also had a moderate number of tumour vessels and accumulation of contrast media, but in the smaller tumours these latter characteristics were not as well defined. Angiography was very useful in establishing a diagnosis in these patients and should be a central part of the radiological evaluation of patients with obstructive jaundice.