Renate L. Soulen

Portal vein blood flow determination in the unanesthetized human by umbilicoportal cannulation

Abstract A direct method for quantitation of portal vein flow in the unanesthetized, unsedated human being is described. In patients with normal livers, portal flow decreases following exercise and increases in the postprandial period. In patients with alcoholic cirrhosis there is a trend toward a decreased response of the portal flow to exercise and to oral stimulus of hypertonic glucose. This method is proposed to provide improved preoperative characterization of portal hemodynamics and allow better selection of patients and procedures for decompression of portal venous hypertension in the patient with esophageal variceal hemorrhage.

Blood Flow in the Human Portal Vein A Cineradiographic Method Using Particulate Contrast Medium

A method of assessing portal blood flow (PVF) is presented, employing Lipiodol droplet injection into the portal system via catheterization of a recanalized umbilical vein at cineradiography. Data are given for the average PVF calculated at rest, after exercise, and at twenty, forty, and sixty minutes after a glucose meal in 6 normal unanesthetized patients. Variations in patients with cirrhosis and portal hypertension are described. This method has diagnostic and therapeutic potential in liver disease and offers an opportunity for study of physiological and pathophysiological conditions.

Thermographic Diagnosis of Deep Venous Thrombosis

Two hundred patients with suspected deep venous thrombosis had thermography performed prior to ascending phlebography. Diagnostic agreement was obtained in 79%. Published diagnostic thermographic criteria were used; it was not possible to diagnose consistently limited or early thrombosis, especially in the calf muscle veins. Venous insufficiency produced the majority of false positives.

Mycosis fungoides: a lymphographic assessment.

Survival of patients with mycosis fungoides involving lymph nodes presently averages two years despite increasingly aggressive local and/or systemic therapy. Encouraged by the improvement in survival of patients with Hodgkins disease following accurate staging, the authors undertook the lymphographic evaluation of a large series of patients with biopsy-proved mycosis fungoides. Results in the first 50 patients suggest: (a) a recognizable lymphographic pattern; (b) a significant role for lymphography in staging; (c) a centripetal progression of disease from the groin; and (d) a need for better definition of the histologic patterns in this disease.

Thermographic Diagnosis of Deep Venous Thrombosis: Anatomically Based Diagnostic Criteria

Deep venous thrombosis is associated with increased heat emission from involved muscle groups and deviation of blood flow from the deep to the superficial venous system. Both of these features can be documented by thermography. An appreciation of the muscular and venous anatomy of the lower limb allows recognition of predictable thermographic images reflecting involvement of various muscle groups in the leg. It is expected that these anatomically based criteria will improve the diagnostic accuracy of thermography and offer a noninvasive, easily repeatable modality of examination for the diagnosis of deep venous thrombosis.

Impact of magnetic resonance on staging of renal carcinoma

Computerized tomography (CT), ultrasound, and angiography have been used for staging renal cell carcinoma. CT has proven to be the most reliable and sensitive of these techniques. Magnetic resonance (MR) has emerged recently as a viable alternative imaging modality. Five patients with renal cell carcinoma and suspected caval involvement were evaluated by CT, ultrasound, and MR. Caval extension and the differentiation of intra-versus retrocaval tumor was seen with greater clarity on MR scans; perinephric extension was seen equally well with both modalities. The primary tumor itself was better defined with CT. In patients with equivocal findings regarding the renal veins or inferior vena cava, MR is a valuable adjunct in preoperative evaluation. In patients at high risk for contrast administration, MR is the staging modality of choice.

Computed tomographic diagnosis of pulmonary varix

A solitary pulmonary nodule was shown by dynamic computed tomography to be vascular, to be enhanced during the pulmonary venous phase, and to be in continuity with the left inferior pulmonary vein. The diagnosis of pulmonary varix was confirmed by pulmonary angiography, an invasive procedure that can be avoided in the future.

Popliteal entrapment syndrome

A case of a type of popliteal entrapment syndrome that does not include an anomalous course of the popliteal artery is presented. In situ thrombosis secondary to entrapment-induced stasis was the presumed cause of ischemic, symptomatology. Thorough knowledge of the possible causes of entrapment and biplane angiography (of the popliteal artery) with provocative maneuvers often are required for diagnosis. As in our patient, surgical release of the entrapment can lead to complete resolution of symptoms.

Angiographic Criteria for Small-Vessel Bypass

Bypass surgery to small vessels below the knee is capable of salvaging, in useful condition, limbs which heretofore would have been amputated. Selection of patients requires angiograms of excellent quality down to and including the foot with sufficiently prolonged filming to answer the following: (a) Is there a patent vessel? (b) Is the angiographic internal diameter at least 1.2 mm? (c) Is there adequate run-off? Ultrasound is a useful adjuvant in programming exposures which must sometimes extend into the 30–50-second range. Cine definition is inadequate. Examples demonstrate these points and postoperative results.

Systemic Coagulation Effects Associated with Intra-Arterial Infusions of Low Doses of Streptokinase for Peripheral Arterial Occlusions

Streptokinase (SK) arterial infusion has become an increasingly used method in the therapy of peripheral arterial occlusive disease. Dosage regimens and durations of therapy are extremely variable. The degree of alteration in the coagulation system has not been adequately addressed. Such alterations might have profound significance regarding patient selection, nature of contraindica tions and degree of toxicity. We have systematically studied the effects of very low doses of SK given intra-arterially in peripheral arterial occlusive disease states. Our detailed studies demonstrate a profound systemic effect on the clot ting mechanism and function in such patients with marked lowering of fibrino gen, depletion of plasminogen and overall hypocoagulability. The effects of these findings on the clinical aspects of this therapeutic technique are discussed.