M. Lea Thomas

Pulmonary Complications following Lymphography—With a Note on Technique

A series of patients undergoing lymphography was studied in order to assess the incidence and nature of pulmonary complications. None of our patients developed pulmonary symptoms, but the majority showed radiographic evidence of pulmonary oil embolism which was considered to be of no clinical significance.

Contrast agent induced thrombophlebitis following leg phlebography: iopamidol versus meglumine iothalamate

A comparison was made of the incidence of venous thrombophlebitis resulting from the use of a high-osmolality contrast medium (Conray 60%, meglumine iothalamate), and a low-osmolality contrast medium (Niopam 61%, iopamidol). In 20 patients Conray was injected into one leg and Niopam into the other. The incidence of thrombophlebitis was then determined using the iodine-125 fibrinogen uptake test in a prospective, randomised, double-blind study. There was significantly less thrombophlebitis with Niopam than with Conray and it is concluded that Niopam is a safer contrast medium for phlebography.

Gangrene following peripheral phlebography of the legs

Abstract Two patients are described in whom leg phlebography was followed by gangrene of toes. In these patients there was evidence of a malformation or thrombosis of the deep venous system which prevented contrast medium from escaping readily from the site of injection. It is therefore suggested that if deep venous filling does not occur using the authors standard technique the examination should be abandoned.

Visualization of the plantar arch by aortography: technique and value

Arteriograms of the feet in 100 consecutive, routine aortograms in patients with leg ischaemia were analysed to assess the frequency with which the plantar arch was visualized. The technique used involved a long injection time, a large volume of contrast medium and slow filming. The plantar arch was demonstrated in 75% of feet, shown to be occluded in 12% and not demonstrated for technical reasons in 13%. The importance of the integrity or otherwise of the plantar arch is emphasized in assessing patients for distal bypass grafts. It is recommended that an attempt be made to demonstrate the plantar arch in all patients undergoing aortography for ischaemia of the legs.

An improved intraosseous phlebography cannula

There has recently been renewed interest in the investigation by phlebography of obstruction of the pelvic veins, both in the chronic case (Cockett and Lea Thomas, 1965; Cockett, Lea Thomas and Negus, 1967) and in patients presenting with pulmonary emboli (Browse, Lea Thomas and Solan, 1967).

Limb muscle compression: an alternative technique for intravenous digital subtraction angiography

A simple, muscle-compression technique to introduce a bolus of contrast medium from hand or foot injections for intravenous digital subtraction angiography (DSA) is described. Fifty millilitres of the non-ionic contrast medium iopamidol 300 was used for each projection. In 18 out of the 20 examinations an acceptably diagnostic arteriogram was obtained. It is suggested that the compression technique is a useful alternative for intravenous DSA when conventional venous access is impossible.

Varicography in the management of primary varicose veins

Forty-nine legs in 41 patients with primary varicose veins were investigated by varicography, (direct injection of varicose veins with contrast medium). Additional features not found at clinical examination, such as reduplication of the long saphenous vein, unusual terminations of the short saphenous vein and incompetent perforating veins, were found in over 50% of the legs examined. It is suggested that varicography should be carried out in patients with primary varicose veins in whom the clinical assessment is not conclusive.

Malakoplakia of the bladder demonstrated by double contrast cystography

Malakoplakia is an uncommon disease characterised by the presence of soft raised yellow or grey-brown plaques in the bladder or, less often, in the ureter or renal pelvis. They may be single or multiple and tend to be centrally umbilicated. The histological findings are also characteristic with the presence of large cells with eosinophilic cytoplasm and with bodies containing iron and calcium in and between the cells. These bodies are named Michaelis-Gutmann bodies (or calcospherites) after the two workers who first described the condition in 1902.