Tom W. Staple

Radiology of Angiodysplasien of the Limb1

Clinical and radiological management of 18 patients with angiodysplasias of the leg is reviewed. The lesions were divided into (a) localized arteriovenous malformations, (b) diffuse arteriovenous malformations, (c) small-vessel malformations, and (d) venous malformations, a classification which has proved to be useful in planning the angiographic procedure. The plain-film and clinical findings are reviewed. Surgical results are best in small localized lesions which do not involve structures demonstrated angiographically as being functionally vital.

Trephine Bone Biopsy by Radiologists

Trephine bone biopsies were performed in 67 patients. Routine radiography, laminagraphy, and radioisotopic techniques were employed to determine areas of involvement and exact sites for biopsy. Sites were selected on the basis of accessibility, possible complications, and chances of recovering diagnostic material. The biopsy material was informative in 81% of patients. One controllable hemorrhage, one temporary sinus tract, a small pneumothorax requiring no therapy, and two benign vasovagal responses were the only complications. Widespread malignant disease and osteomyelitis, particularly disk-space infection, are the most suitable lesions for trephine biopsy.

Osseous Metastases from Cerebellar Medulloblastoma

Abstract Two cases of osteoblastic metastases from previously treated medulloblastoma are presented. Because medulloblastoma does not metastasize to the lungs, a skeletal survey and/or bone scan are of greater value than a chest radiograph. The typical history is usually sufficient for a correct diagnosis of this rare cause of sclerotic bone in children.

Venous Angiography of Hemodialysis Fistulas: Experience with 52 Studies

The authors describe a simple outpatient venous angiographic method of delineating arteriovenous fistulas constructed for chronic hemodialysis, and variations of the basic technique are offered to solve the problems of overlapping vessels and obscured anastomoses. A normal fistula produces enlargement of the involved artery only, but there may be enlargement of multiple veins in the extremity in which the fistula is constructed. Stenoses, occlusions, surgical variations, aneurysms, functional abnormalities in the direction and quantity of flow, and inadequate positioning of the dialysis needles are discussed.

Coarctation of the aorta in infancy. Hemodynamic studies

Seventeen severely symptomatic infants with coarctation of the aorta were studied by right heart catheterization and selective angiocardiography prior to operation or death. In four patients the coarctation of the aorta was the only significant lesion. Thirteen had significant associated cardiac malformation (s). It is often difficult to ascertain which malformation is the major contributor to congestive failure or whether it is the compound effect of the combination of defects. Operative correction was attempted in 15, with 10 survivors; it is felt that these infants have a better chance of survival if treated operatively.

Ilio-iliac arteriovenous fistula following intervertebral disc surgery

Summary The clinical and roentgenographic findings of an ilio-iliac arteriovenous fistula nine years following intravertebral disc surgery are described. The mode of injury is discussed, and the vascular injuries following disc surgery are reviewed.

Idiopathic Nonfamilial Aero-osteolysis with Cortical Defects and Mandibular Ramus Osteolysis

A case is presented of progressive acro-osteolysis of the hands combined with progressive mandibular ramus osteolysis and multiple cortical defects. The features of acro-osteolysis are reviewed and classified.

Arthrography of total hip replacement using subtraction technique.

To determine whether separation or infection is occurring about a total hip replacement prosthesis, the authors use a subtraction technique employing a multiple film changer. After contrast agent is injected, comparison stress views may demonstrate a wider distribution of the agent than unstressed anteroposterior views. Recent experiments by the authors indicate that contrast agents commonly used in arthrography do not inhibit bacterial growth. Three fluid specimens are withdrawn at arthrography for culturing.

Accidental migration of an intravenous infusion catheter from the arm to the lung.

The use of intravenous catheters for the administration of fluids has rapidly grown in acceptance. They are not without hazard, however, as illustrated in the following case report, in which a catheter progressed from an injection site in the right antecubital vein to the lung. Case Report A 55-year-old Negro male was seen in the emergency room of Barnes Hospital, St. Louis, Mo., on March 23, 1965, because of intermittent convulsive episodes becoming progressively more severe over a period of three hours prior to admission. In the emergency room the patient had several convulsive seizures and was irritable and combative. Sedation was given intravenously and intramuscularly. An Intracath tubing 2 was threaded into the right antecubital vein, and an infusion of fluids was begun. On the way to the ward a physician noted hemorrhage at the site of insertion of the intravenous tubing. Upon investigation, the distal (intravascular) portion of the polyvinyl tubing was missing. A tourniquet was placed about the ri...

Central chondrosarcoma of the appendicular skeleton.

The characteristic radiographic and pathologic appearance of central chondrosarcoma of the long bones is presented. The proximal femoral shaft is the most frequent site of involvement followed by the humeral head and the proximal shaft. This lesion is frequently misdiagnosed, and in this series of 14 patients was frequently thought to be enchondroma. Due to the invasive nature of the lesion, local measures such as curettage are not adequate and disarticulation is frequently warranted.