John S. Train

Hip pain caused by buttock claudication : relief of symptoms by transluminal angioplasty

Two patients with severe hip pain proved to have buttock claudication resulting from isolated stenosis of the hypogastric artery. This diagnosis may be elusive if distal pulses are palpable, directing the clinicians suspicion away from vascular pathology. Diagnosis requires angiography. The patients were successfully treated by transluminal angioplasty. Angioplasty is the initial treatment of choice for these patients because the hypogastric artery is usually readily and safely accessible from either the femoral or axillary artery.

Role of computed tomography in the diagnosis of infectious spondylitis.

Nineteen patients with infectious spondylitis were evaluated by computed tomography (CT) and the results were compared with conventional radiography. In each case the diagnosis was established by biopsy. The use of CT in evaluation of the extent of bone and soft tissue involvement as well as its role in differentiating inflammatory from noninflammatory destructive processes is discussed.

Wallstent Migration Following Deployment in Right and Left Bile Ducts

The Wallstent biliary endoprosthesis has recently been approved for treatment of malignant bile duct obstruction. Although minor changes in position have occurred, migration of these stents has been uncommon. The authors report a case in which migration occurred when stents were simultaneously deployed in the right and left bile ducts. Several mechanisms for this complication are postulated.

Dilated periportal lymphatics mimicking an anastomotic bile leak after liver transplantation

Transhepatic cholangiography is commonly performed during postoperative evaluation of liver transplant patients. The authors describe a potential pitfall in the interpretation of these studies and illustrate that dilated interrupted lymphatics of the donor liver can mimic a periductal leak of contrast material.

Ureteroscopic management of ureteral cholesteatoma

Cholesteatoma of the upper urinary tract is a rare nonmalignant condition histologically characterized by keratinized desquamative squamous metaplasia. Most cases have been managed by extensive ablative surgery. We describe a new approach in the diagnosis and management of a patient with ureteral cholesteatoma using transurethral ureteroscopy and evacuation.

Separation of the left gastric artery from the gastric air shadow: a diagnostic sign of lesser curvature wall lesion

Separation of the left gastric artery from the gastric air shadow is a diagnostic sign of lesser curvature gastric lesions. This finding is especially helpful in patients with large exophytic wall lesions in whom barium examination, CT and ultrasound are not diagnostic. This was demonstrated in two patients with large leiomyomas of the stomach.

Lipohemarthrosis: its occurrence with occult cortical fracture of the knee.

Three patients with fat fluid levels in the knee following trauma were shown to have small cortical fractures. None of the fractures was visible in routine roentgenograms. Because of the finding of the lipohemoarthrosis in each case, additional roentgenograms were taken until small cortical fractures could be visualized.