Biomedical subjects
Publications and source records attributed to A P Hemingway.
Therapeutic embolization of the hepatic artery was performed in two patients actively bleeding from aneurysms resulting from previous surgical damage to the artery at cholecystectomy. The advantages of embolization over surgical ligation of the hepatic artery are discussed.
A family is described which has exhibited in four generations a bizarre form of arthritis mutilans and osteolysis, the features of which seem to fit most closely with a diagnosis of hereditary multicentric osteolysis, a subgroup of idiopathic multicentric osteolysis. The differential diagnosis of arthritis mutilans associated with osteolysis is discussed; this includes a wide variety of disorders ranging from rheumatoid arthritis to rare conditions such as the Winchester syndrome.
160 selective visceral angiograms were performed in 145 patients with gastrointestinal bleeding. In 52 studies done as emergency procedures (group A) 87% were positive, and in 108 elective procedures (group B) 74% were positive. The commonest lesion demonstrated in group B was angiodysplasia (43 patients) and most of these cases had previously undergone various investigations which had proved to be negative. Angiodysplasia is clearly an important cause of obscure gastrointestinal bleeding that may go unrecognised for many years. In addition to its diagnostic value angiography also proved extremely successful as a therapeutic measure in appropriate cases. Embolisation was performed in 36% of group A patients with positive angiograms, and in 10% of corresponding group B patients.
Five patients under the age of 21 years are described in whom a Meckel's diverticulum was found in association with angiodysplasia of the caecum or ascending colon. Angiodysplasia has only been observed previously in patients over the age of 35 years and its demonstration in 5 young patients with Meckel's diverticulum points not only to an association between the two disorders, but suggests that angiodysplasia may have a congenital aetiology.
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A total of 160 percutaneous needle biopsies of pulmonary lesions were performed in 149 patients. Cytological and bacteriological examination of the biopsy material yielded clinically useful information in 87% of these patients. False-negative diagnoses were made in 6%, but there were no false-positive diagnoses. In most patients the biopsy obviated the need for a diagnostic thoracotomy. The principal complication of the procedure was pneumothorax, which occurred in 24% of patients; the pneumothorax, however, was usually very small and only two of these patients required treatment with a pleural drain. There were no deaths in the series. It is concluded that percutaneous needle biopsy is an effective and relatively safe method of obtaining diagnostic material from a pulmonary lesion.
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Few previous studies of the accuracy of duplex Doppler in the assessment of carotid artery stenosis have looked at the accuracy in excluding disease in populations with a significant number of normal arteries. In addition, few studies have compared different criteria for stenosis. Duplex Doppler was used to evaluate the carotid arteries in 80 patients. Two well-described methods for analysing Doppler traces were used and the results were compared with those obtained from non-selective digital subtraction angiography. On the basis of these findings, the Doppler criteria used for carotid stenosis were redefined in terms of changes in peak velocity rather than Doppler frequency shift. Using these criteria, the sensitivity of Doppler in identifying carotid stenosis was 97% (98% sensitivity for greater than 50% stenosis) and specificity was increased from 84% to 93%.
Substantial developments in interventional radiology over the last two decades have resulted in the introduction of new methods of treatment for patients with advanced malignancy. These new minimally invasive techniques avoid the need for prolonged hospital inpatient care.