Biomedical subjects
Publications and source records attributed to B E Rubin.
A patient with recurrent transitional cell carcinoma involving an ileal conduit is reported. This case is unusual for the following reasons: the malignancy was located in an area where there was no transitional epithelium; a "napkin ring" deformity was present; there was a 6-year interval between the initial cystectomy and the recurrence of the malignancy.
The striated nephrogram following renal trauma is reported for the first time. Previously, the striated parenchymal pattern has been oted in obstruction and in a small number of cases of hypotension. Tamm-Horsfall proteinuria, and renal vein thrombosis.
The diagnostically useful computed tomography (CT) findings in five new cases of inferior vena cava thrombosis are reported. These findings include: (a) inhomogeneous density of the inferior vena cava, usually best demonstrated after contrast medium injection; (b) caval density less than aortic density; (c) rim enhancement which may be seen with both caval thrombosis and tumor invasion; and (d) enlargement of the vena cava if accompanied by at least one or more of the above findings. A bolus injection of contrast medium followed immediately by CT helps to make some of the above described findings more prominent. In selected patients, this injection should be made into the femoral vein.
We describe a patient in whom superior vena cava syndrome developed after central venous catheterization and infusion of caustic medications. The diagnosis was proven by venography. Because anticoagulant therapy was contraindicated, the patient was clinically observed and the syndrome improved spontaneously. Follow-up venographic examination was normal.
Four patients with blunt abdominal trauma underwent computed tomography (CT) as part of their diagnostic evaluation. In each case CT accurately demonstrated the pathology and the extent of injury. The results suggest that routine use of CT scanning may be an effective screening modality in the traumatized patient. It is perhaps more specific than radioisotope scanning and may eventually reduce the need for invasive techniques such as angiography.
Four patients with blunt abdominal trauma did not have surgical treatment for intrahepatic hemorrhage and hematoma. Two patients were diagnosed 24 hours after injury as having significant active hemorrhage, although their clinical status was stable. They were successfully treated by superselective transcatheter occlusion of the hepatic artery and they recovered without incident. Two patients were diagnosed one week after injury as having quiescent intrahepatic hematoma and they too recovered without complication. Although more patients will have to be evaluated, it is our belief that nonoperative management of selected patients with an intrahepatic hematoma is reasonable and safe. Patients should be observed periodically with radioisotope scans, ultrasound or computerized tomography until the hematoma resolves.
Four patients with renal lymphoma were evaluated by computed tomography and presented the following different manifestations: (a) multiple large and small nodules infiltrating each kidney; (b) a single large renal mass extending into the perirenal space; (c) diffuse infiltration of both kidneys; and (d) lesion of the renal hilus encasing the renal pelvis and proximal ureter of one kidney. Computed tomography is a sensitive, noninvasive imaging modality that should be performed early in the course of disease in patients with known or suspected lymphoma.
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Sixty-seven hip-arthroplasty and fifty-two hip-fracture patients participated in a placebo-controlled randomized double-blind study on the effects of low-dose heparin prophylaxis in the prevention of venous thromboembolism. In this study, a positive thromboembolic event meant a positive test by: (1) daily 125I-fibrinogen scanning, (2) contrast venography on the tenth postoperative day, or (3) radionuclide perfusion lung scan in confirmation of suspected clinical pulmonary emboli. Nineteen (59.4 per cent) of thirty-two placebo-treated arthroplasty patients showed evidence of a thromboembolic event in contrast with eight (22.9 per cent) of thirty-five heparin-treated patients (p less than 0.003). Heparin-treated arthroplasty patients required mean blood transfusions of 4.7 units, contrasted with a mean 3.2-unit transfusion requirement for placebo-treated patients (p less than 0.05). The incidence of observed bleeding complications was higher among the heparin-treated patients. Of the twenty-three placebo-treated patients with fracturs, 39.1 per cent had a thromboembolic event, while 41.4 per cent of the twenty-nine who received heparin showed evidence of thromboembolism, demonstrating that low-dose heparin afforded no protection, nor did it affect the incidence of bleeding complications or transfusion requirements in fracture patients.
Two patients who sustained liver trauma with intrahepatic and intraperitoneal hemorrhage are reported. Selective and subselective arteriography identified the hemorrhagic artery in each case. Transcatheter therapeutic embolization successfully stopped the hemorrhage acutely in one patient and produced almost complete cessation of hemorrhage in the other patient. No further blood replacement was required after the emoblization procedures. Liver function tests were abnormal prior to embolization and gradually improved afterward. Neither patient required surgery, and both were discharged from the hospital. Each patient has remained free of symptoms for 5 and 4 months, respectively. Arteriography offers accurate diagnostic information and therapeutic potential in patients who experience hemorrhage following trauma. In addition, therapeutic embolization may offer decreased morbidity and reduced hospital stay. Successful results of therapeutic embolization depend on awareness of its usefulness and upon rapid mobilization of angiographic and support personnel.
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