Biomedical subjects
Publications and source records attributed to K J Cho.
The splenic artery frequently produces a contour defect on the posteromedial aspect of the stomach, particularly in elderly individuals. When the artery is tortuous or aneurysmal, the impression is prominent and may simulate a neoplasm. Similarly, the aorta can produce a gastric impression. Recognition of these impressions on the stomach wall avoids erroneous diagnosis and unnecessary exploratory surgery.
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Each of the three patients with a type of unilateral, localized cystic disease of the kidney that did not fit into a specific category of existing classifications had numerous cysts involving a part of one kidney. Selective angiography showed stretching of arteries around cysts that remained radiolucent in the nephrographic phase, and microscopic examination demonstrated that septa among the cysts contained compressed renal elements. The condition appeared to be neither progressive nor familial. All three had hypertension. Two patients who had nephrectomy for the cystic lesion became normotensive postnephrectomy. Despite some morphologic resemblances, this condition is believed to be different from adult type polycystic kidney disease in its clinical and genetic aspects.
The importance of the occasional anomalous origin of the left gastric artery (LGA) from the aorta in the arteriographic evaluation of gastrointestinal haemorrhage is illustrated by two cases. The incidence of the anomaly is between 2.5 and 5.4% and should be considered when the LGA is not opacified on a coeliac arteriogram.
Radiologic findings and medical records of 27 patients with angiographic documentation of splenic vein occlusion were reviewed. The most common causes were pancreatic carcinoma, pancreatitis, and malignant lymphoma. Radiographic findings which suggest splenic vein occlusion are gastric varices without esophageal varices and collateral veins in the left upper abdomen during the vascular phase of rapid sequence pyelography. Additional features may be associated with the underlying disease, such as pancreatic calcification and upper abdominal mass lesions. The diagnosis is usually confirmed by high dose celiac or splenic angiography. Examination of the stomach with barium for the detection of gastric varices is more sensitive than has been previusly recognized; features which suggest them are described. Isolated gastric varices may be a clue to isolated splenic vein occlusion and its underlying causes.
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Twenty patients with massive abdominal hemorrhage related to chronic pancreatitis, pancreatic neoplasms and arteriovenous malformations were studied angiographically. Abdominal hemorrhage drained most frequently into the gastrointestinal tract, but also flowed through cutaneous drain sites and fistulas, intraperitoneally, into pseudocysts and once into a large pancreatic tumor. The most common angiographic observation in pancreatitis was pseudoaneurysm formation. Both patients with arteriovenous malformation had dilated, racemose feeding arteries and early dense filling of the draining veins. Three patients had pancreatic carcinoma and documented bleeding from gastroesophageal varices related to portal or splenic vein occlusion by the tumor. Five patients were treated by vasopressin infusion, balloon tamponade, or therapeutic embolization.
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The renal angiographic and venographic findings in five patients with renal amyloidosis are described. The findings include (1) normal or slightly decreased main renal artery; (2) pruning, tortuosity, and irregularity of the distal interlobar arteries, associated with smooth cortical margin and relatively homogeneous nephrogram; (3) nonvisualization of interlobular arteries; (4) asymmetric and uneven involvement of the kidneys; (5) prominent extrarenal arteries; and (6) renal vein thrombosis, frequently involving segmental and interlobar veins. Angiographic differential points between renal amyloidosis and other chronic renal parenchymal diseases are discussed with emphasis on the clinical history.
Three cases of pancreatic arteriovenous malformation are presented. This entity is known to be a part of Osler-Weber-Rendu disease. However, asymptomatic pancreatic arteriovenous malformation also occurs. The angiographic features are specific and consistent of dilated and tortuous feeding arteries, racemose intrapancreatic vascular network, and early filling veins. Massive gastrointestinal hemorrhage is a frequent complication. The importance of preoperative localization of the lesion and postoperative confirmation of complete resection by angiography is stressed.
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Renovascular hypertension was controlled in a 15-year-old boy by total infarction of the renal parenchyma behind a segmental renal artery stenosis. Two separate embolizations were required to occlude the branches distal to the stenosis. Blood pressure did not return to normal until after the second procedure. This approach may be useful in patients with intrarenal arterial stenoses who would be difficult to approach operatively without sacrificing a significant portion of the kidney.
The spleen of each of 20 mongrel dogs was traumatized by creating a wedge laceration, and selective arterial infusion was then performed with vasopressin in four dogs, pituitrin in eight, and epinephrine in eight. Infusion therapy with vasoconstrictors controlled the splenic hemorrhage in 19 of 20 dogs. The 15 dogs surviving the experimental period of four to eight weeks showed well-healed scars at the sites of lacerations. Three dogs had small contracted spleens as a result of massive infarction. The results of this experiment indicate that splenic hemorrhage in the experimental dogs can be controlled by selective infusion of pituitrin or vasopressin, but is more effectively controlled with epinephrine.
A primary mesenteric branch of the superior mesenteric artery was embolized with Amicar-mixed clots in seven dogs and with gelatin sponges in five dogs. All of the dogs embolized with Amicar-mixed clots survived the experimental period and no mesenteric damage was found with postmortem studies. Three of the five dogs embolized with gelatin sponges showed a local stricture within the embolized segment of intestine. Collateral blood supply to the strictured segment of bowel in these three dogs developed via arterial arcades, mural branches of the vasa recta and omental arteries.