Jesus Zornoza

Percutaneous fine needle aspiration biopsy of pancreatic and other abdominal masses.

Percutaneous fine needle aspiration biopsy of 18 patients with pancreatic masses, and 19 with other intra-abdominal tumors, showed it to be a safe, accurate procedure. A diagnostic biopsy yield was obtained in over 85% of the cases without clinical complications. Indications for fine needle biopsy are: (a) to avoid surgery by obtaining a histologic diagnosis; (b) to determine the staging of a neoplastic disease process; and (c) to facilitate treatment planning. The technique of skinny needle biopsy is discussed.

Arterial occlusion in the management of pain from metastatic renal carcinoma.

Arterial embolization was performed in nine patients with metastases from renal carcinoma who had severe pain resistant to conventional therapy. Patients with metastases in the ilium (four), the lumbosacral spine (one), and the base of the skull (one) experienced pain relief lasting from one to six months. The other three patients, who had metastases in the proximal femur, underwent preoperative embolization to facilitate tumor curettage and internal hip fixation. No significant complications were seen with this therapeutic approach.

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.

Fine Needle Aspiration Biopsy of Retroperitoneal Lymph Nodes and Abdominal Masses: An Updated Report

Percutaneous fine needle aspiration biopsy of retroperitoneal lymph nodes and abdominal masses was performed in 109 patients. Eighty-five per cent of the aspiration biopsies yielded sufficient cytologic material for a correct diagnosis. Indications include confirmation of lymphangiographic findings and the establishment of a histologic diagnosis in lieu of surgery. No significant complications were encountered.

Pulmonary alveolar proteinosis: its association with hematologic malignancy and lymphoma.

Pulmonary alveolar proteinosis (PAP) developed in 5 patients with hematologic malignancy or lymphoma. Possible pathogenetic mechanisms which might predispose the patient to this association include the unavailability of competent alveolar phagocytes secondary to profound leukopenia, or inhibition of alveolar phagocytosis by elevated globulins. The spectrum of pulmonary abnormalities produced by PAP includes classical butterfly perihilar alveolar consolidation, lobar consolidation, parenchymal nodules, and hilar adenopathy. Four of the 5 cases had complicating infections, making the exact radiological correlation with PAP difficult.

Transcatheter arterial occlusion in the management of rectosigmoidal bleeding.

Transcatheter arterial occlusion was performed in five patients with recurrent rectosigmoidal bleeding. Four had malignant neoplasms, and the fifth, an arteriovenous malformation. The superior hemorrhoidal artery was embolized in two patients, the inferior mesenteric artery in two, and the left internal iliac artery in one patient. In four patients, immediate and complete control of rectal bleeding was achieved, and gradual control was accomplished in the fifth patient. Left lower quadrant pain and fever developed in three patients. The possibility of rectosigmoidal bleeding from the internal iliac artery is stressed.

Aspiration biopsy of discrete pulmonary lesions using a new thin needle. Results in the first 100 cases.

The authors describe their initial experience with a new thin spinal-type needle for aspiration biopsy of the lung. One hundred patients with discrete pulmonary lesions were studied. Diagnosis was possible in 87% of cases, and no significant complications were encountered.

Lung cancer in chronic leukemia and lymphoma.

Review of the number of lung cancers subsequently developing in patients with chronic leukemia or lymphoma revealed a statistically significant (p less than .001) increase in the incidence of lung cancer in these patients. Of 684 patients with chronic leukemia seen between 1961 and 1972 (followed through 1976), 19 developed lung cancer versus 3 expected cases. Of 2708 patients with lymphoma seen in the same period, 23 developed lung cancer versus 7 expected cases. These data indicate that lung cancer be given serious consideration when a new pulmonary lesion is noted in these patients, and biopsy may be warranted.

The Use of Prostaglandin E1 for Enhanced Visualization of the Splanchnic Circulation

A single bolus injection of prostaglandin E1 (5-7.5 microgram) into the superior mesenteric, hepatic or pancreatico-duodenal arteries was employed as a pharmacoangiographic aid in 22 patients. Good quality arterial phase and greatly enhanced portal venograms were obtained. No significant complications were observed. The authors found the technique useful in diagnosis of primary and metastatic lesions in the liver and pancreas.

The therapy of osteosarcoma by intraarterial cis-platinum and limb preservation

Intraarterial infusion of cis-platinum was evaluated in 14 patients with primary osteosarcoma because the method delivers a higher dose to the neoplasm without increasing systemic toxicity. The tumor response was evaluated by clinical examination, conventional radiography, angiography, and histopathologic examination. Eight (57%) of the 14 patients responded. Among the eight responders, four patients with medullary osteosarcoma of the extremities were treated by limb salvage operation followed by insertion of an endoprosthesis to preserve limb function. The responders are all alive with a median follow-up period of 17.5 months; six of them have no evaluable disease. The six failures died of disease after median survival of 6.5 months. Intraarterial cis-platinum infusion proved to be an effective approach in treating osteosarcoma and created the opportunity for limb salvage.