Ralph J. Alfidi

Precise Biopsy Localization by Computed Tomography

The ultimate accuracy of percutaneous needle aspiration and core biopsies is directly related to localization of pathology and of the needle tip. Localization methods currently in use include fluoroscopy, ultrasound, and angiography. The authors believe that localization by computed tomography is the single most accurate method for performing biopsies.

Computed tomography of the pancreas.

Computed tomography (CT) has proven useful in diagnosing inflammatory and neoplastic disease of the pancreas. Neoplasms of the pancreas produce enlargement of the gland and loss of surrounding fat planes. Acute pancreatitis also produces enlargement but correct diagnosis can be made with the clinical correlation. The usefulness of CT in chronic pancreatitis depends upon the state of the disease. Distinction between an inflammatory and a neoplastic mass is not possible on the basis of a CT scan alone. CT is also useful for needle guidance for aspiration biopsy of the pancreas.

Computed tomography of the thorax and abdomen; a preliminary report

The utility of computed tomography (CT) in the study of the anatomy, physiology, and pathology of the human body has been the subject of considerable interest since the introduction of CT scanning. The advent of a new prototype scanning device has made it possible to examine a variety of abnormalities in the abdomen and thorax in a manner not previously possible. This development permits a remarkable insight into the study of human disease in vivo.

Definitive role of CT scanning of the pancreas. The second year's experience.

In a group of 188 patients, 192 computed tomographic (CT) scans of the pancreas were done, and the diagnostic accuracy of CT determined relative to other modalities. CT was the most effective method of detecting neoplastic and inflammatory diseases. The full extent of the disease process, including involvement of the retroperitoneum and metastasis to the liver, was visualized with one examination. Calcification and cystic collections associated with pancreatitis were also clearly seen.

Computed Tomography in the Detection of Juxtasellar Lesions

One thousand consecutive computed tomograms were reviewed to determine the accuracy of the procedure in the detection of juxtasellar lesions. The detection rate was compared to those of plain skull films, radionuclide studies, angiography, and pneumoencephalography. Computed tomography was slightly superior to angiography and was surpassed only by pneumoencephalography, both of which are invasive procedures which carry a definite risk. The data indicate that computed tomography is the screening method of choice in the detection of juxtasellar masses.

Angiography in the Diagnosis of Chronic Gastrointestinal Bleeding

Abstract Correlation was positive between angiographic and subsequent pathologic findings in 40 of 53 patients with chronic unexplained gastrointestinal bleeding. It is believed that, in a patient with a history of chronic recurrent bleeding, an anatomic lesion is generally present and can be demonstrated by arteriography even if active bleeding is not in progress at the time of examination. Only 2 of the 53 patients in this study were actively bleeding at the time of examination. The arteriographie details of an intussusception and an ulcerated Meckels diverticulum are also described.

Controversy, Alternatives, and Decisions in Complying with the Legal Doctrine of Informed Consent

The complexities involved in conforming with the legal doctrine of informed consent at present are seemingly limitless. This communication is designed to acquaint the physician attempting to comply with this legal doctrine with an experience gained during the last four years. The major points are aimed at the most frequently asked questions and decisions involved in its implementation. An alternative approach to the question of how and whom to inform is provided, which may make the task easier for those seeking to inform their patients.

Abdominal bruits in renovascular hypertension.

A study of 87 patients surgically treated for renal arterial stenosis revealed that upper abdominal bruits were heard more frequently in patients whose stenosis was due to fibrous disease than to atherosclerosis. A diastolic bruit in a patient with fibrous disease of the renal artery usually indicated a favorable surgical result. Conclusions regarding the prognostic value of diastolic bruits in atherosclerotic renal artery disease must be deferred until a larger number of patients with this finding can be studied. When hypertension of less than 3 years duration was combined with presence of a diastolic bruit, 17 or 18 patients had a favorable surgical outcome. An abdominal bruit should be carefully sought for in all patients evaluated for hypertension; when found, should be characterized acurately, because of the important diagnostic and prognostic information it may provide.

Iatrogenic Arteriovenous Fistulas

A review of 154 cases of iatrogenic arteriovenous fistulas including 5 of the authors own cases indicates that the most common causes are disk surgery, renal biopsy, and vertebral artery puncture. While postrenal biopsy fistulas are apparently of no clinical consequence, those which occur following surgery or vertebral artery puncture represent a very serious and sometimes life-threatening complication. Clinical awareness of arteriovenous fistula formation as a result of surgical and diagnostic procedures indicates the need for meticulous technique in performing even the simplest procedure.

Evaluation of Renal Homotransplantation by Selective Angiography

Management of the patient after renal homotransplantation is often complicated and frequently requires answers to problems not previously encountered. Oliguria is the most common diagnostic question in the early postoperative period. In cadaver renal transplants oliguria may be the result of acute renal failure secondary to ischemia (1), vascular thrombosis, ureteral perforation and slough, or the rejection phenomenon. The ideal management of each of these entities requires early and accurate diagnosis. In an effort to distinguish between these complications, angiography was performed on 20 patients who received renal homotransplantations from living or from cadaver donors at the Cleveland Clinic Hospital, Cleveland, Ohio, since August 1963. Angiograms were obtained primarily to evaluate persistent anuria or oliguria in cadaver transplants, or oliguria after initial diuresis in live donor transplants. Materials and Methods Angiograms were obtained of 20 renal homografts, 15 of which were kidneys from cada...