Biomedical subjects
Publications and source records attributed to H M Hoogewoud.
In a lethal case of peripheral embolization of the leg and the inferior mesenteric artery after ethanol embolization of the left kidney, we thought that contrast media might have been part of the cause of the peripheral complications as a result of flocculation of the contrast media and secondary dislocation of friable thrombotic material. The interactions of ethanol with different contrast media were tested.
Fifty-two patients with postoperative sepsis were studied by abdominal and pelvic computerized tomography (CT) for the presence and location of septic foci. CT mapping of infected fluid collections had direct therapeutic consequences as it allowed the selection of patients for percutaneous drainage, local operative drainage or relaparotomy. As soon as sepsis is suspected, an abdominal and pelvic CT study should be performed so that therapeutic procedures may be carried out at a stage at which no organ is yet failing, that is, in a period of lowest mortality.
The value of computer tomography in the investigation of carcinomas of the renal pelvis was analysed in 22 patients. In 88% of cases it was possible to differentiate tumours confined to stages I and II from tumours in the advanced stages III and IV. Computer tomographic signs of stages III and IV were demonstration of infiltration into the surrounding tissues and into the renal parenchyma as well as the presence of regional lymph node metastases. Computer tomography should follow urography wherever there is a suspicion of a pelvic carcinoma in order to define the tumour more precisely.
The venous and lymphogenic tumor extension (Robson, Stage III) was assessed in two patient collectives with renal neoplasms: in the first (n = 47), only cavography, in the second (n = 45), only computerized tomography was performed. For both groups there were no false negative diagnoses. False positive readings can occur with CT. Thus, ambiguous findings in CT should be clarified by cavography. CT was superior to cavography regarding the detection of pathologic lymph nodes. However, lymph node enlargement was caused in 10% of these cases by inflammatory hyperplastic reaction without evidence of metastatic tumor spread.
A comparative diagnostic study was carried out on 40 patients with pathologically proven renal malignancies which were staged both by angiography and CT. CT is more accurate than angiography for the detection of both perirenal and pararenal extension of the primary tumour (T-staging), and angiography is only slightly superior to CT in the evaluation of intravascular extension of the malignancy. The diagnostic performance of CT is clearly superior to angiography in detecting malignant lymphatic spread (L-staging) and distant metastases (M-staging). CT is, therefore, becoming the primary diagnostic approach for the staging of renal malignant tumours.
PURPOSE: The Günther basket inferior vena cava filter (GBF) has been withdrawn from the market because of its mechanical instability, but a number of patients still live with the device. METHODS: In a two-center study, we evaluated the long-term follow-up of the GBF, based on clinical data in 78 patients, and on imaging studies including plain radiographs, Doppler ultrasound, angiography, or computed tomography (CT) in 50 patients. RESULTS: In a mean period of 3 years, pulmonary embolism was diagnosed in five patients (6.4%), with an overall rate of 0.02 embolic episodes per patient per year. None of these patients required hospitalization, and there were no deaths due to pulmonary embolism. Inferior vena cava thrombosis was documented in three patients (3.9%), and occlusive venous thrombosis at the access site in seven patients (9%). Spontaneous migration was documented in 43% of the examined filters and spontaneous disruption in 77%. Dislocated filter fragments were localized by CT in the adjacent retroperitoneum in 11%, in the aortic lumen in 2%, and in a peripheral pulmonary artery in 7%. None of the patients had symptoms attributable to filter migration or disruption. CONCLUSION: Our results indicate that the rate of clinically relevant complications with the GBF is no higher than with other vena cava filters. Because mechanical instability of the GBF had no clinical consequences, we conclude that patients who live with this device may be observed and treated in a manner similar to patients with other vena cava filters.
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