Joseph F. Walter

Transcatheter Hemostasis of Gastrointestinal Bleeding Using Modified Autogenous Clot

Clinical and laboratory experience with clot additives and with the use of modified autogenous clot as an agent for transcatheter hemostasis is described. Oxycel (oxidized cellulose) produces a highly occlusive, relatively stable, firm clot and is eventually absorbed. It offers a firm matrix for clot formation, promotes coagulation despite a variety of deficient clotting factors, increases clot durability, and delays clot lysis. All nine patients in the clinical study showed immediate cessation of gastrointestinal bleeding. Two instances of transient duodenal infarction, attributable to the use of clots, indicate that the method is not without some risk.

Angiography of Massive Hemorrhage Secondary to Pancreatic Disease

Twenty patients with massive abdominal hemorrhage related to chronic pancreatitis, pancreatic neoplasms and arteriovenous malformations were studied angiographically. Abdominal hemorrhage drained most frequently into the gastrointestinal tract, but also flowed through cutaneous drain sites and fistulas, intraperitoneally, into pseudocysts and once into a large pancreatic tumor. The most common angiographic observation in pancreatitis was pseudoaneurysm formation. Both patients with arteriovenous malformation had dilated, racemose feeding arteries and early dense filling of the draining veins. Three patients had pancreatic carcinoma and documented bleeding from gastroesophageal varices related to portal or splenic vein occlusion by the tumor. Five patients were treated by vasopressin infusion, balloon tamponade, or therapeutic embolization.

Transcatheter embolization for lower gastrointestinal bleeding.

Transcatheter embolization was performed in 7 patients with lower gastrointestinal bleeding. Hemorrhage was controlled in each of the 5 actively and massively bleeding patients but recurred after several months in 2 patients who had bled intermittently from vascular dysplasias. The authors recommend preoperative angiographic localization of the bleeding site in almost all cases of major lower gastrointestinal bleeding. When the cause and bleeding site have been identified, it seems reasonable to exploit the therapeutic potential of the angiographic catheter already in place: indeed, surgery may be obviated. If embolism fails or ischemic sequelae develop, partial colectomy can still be performed. Further long-term follow-up will be necessary before the role of transcatheter embolization can be definitively assessed.

Acute Axial Neuroarthropathy

While neuroarthropathy has long been recognized, major stress has been placed upon advanced changes in peripheral joints, particularly in tabetic patients. Recent experience with 14 cases of vertebral neuroarthropathy documents its acute or rapidly progressive development in the spine (an infrequently stressed site) and illustrates etiologies other than luetic disease, including syringomyelia and diabetes. The combination of diabetes and Charcots disease has rarely been documented in the American literature. Because of the problems that exist in the pathological, serologic, and clinical diagnosis of neuropathic disease, the pivotal role of the roentgenologist in suggesting or confirming the diagnosis is emphasized.

Histological-venographic correlates in portal hypertension.

Magnification hepatic wedge venography and manometry were evaluated in 40 patients with portal hypertension and in 6 normal individuals. Venography (alone or in combination with manometry) generally facilitated prediction of histology in cirrhosis, hepato-venular occlusive disease, periportal fibrosis, congenital hepatic fibrosis, and portal vein obstruction. The magnification wedge venograms demonstrated a number of histological features of cirrhosis that have not previously been described in vivo, including porto-hepatic vein shunts, micro- and macronodular regeneration, and obstructive changes which were more severe in hepatic than in portal veins.

Newer Angiographic Observations in Cholangiocarcinoma

Three new angiographic features of cholangiocarcinoma are bile duct dilatation, venous obstruction and arterio-arterial collaterals. Differentiation of the lucencies of dilated bile ducts (cylindrical in shape) from those due to metastases (spherical) is discussed. Because of its high reliability and the difficulties of operative diagnosis, angiography can play an important diagnostic role in patients with suspected cholangiocarcinoma.

Angiographic and pathologic features of probable primary carcinoid-like hepatic tumors.

The angiographic and pathologic features of two cases of primary carcinoid-like hepatic tumors are described. Neither patient had the carcinoid syndrome.

Arterlographic Diagnosis of a Gunshot Injury to the Ureter

A gunshot wound to the ureter was diagnosed angiographically. Such injuries are not common; however, they are frequent enough and the consequences of delayed diagnosis and secondary repair are serious enough that ureteric injury should be considered in all cases of abdominal trauma.

Lymphangiographic Findings in Histoplasmosis

The lymphangiographic findings of histoplasmosis in an 11-year-old girl are presented and correlated with the histopathology of a mediastinal lymph node. Nonconfluent lymphadenographic defects with discrete margins measuring 2-4 mm in diameter were seen, corresponding to the microscopic demonstration of nodal granulomas of the same size. This is quite different from the lymphadenographic pattern usually present in lymphoma but might be seen in certain stages of other granulomatosis diseases.