Biomedical subjects
Publications and source records attributed to M N Coel.
A simplified plain film examination for erosive otitis media was evaluated in 202 ears. In most of the operated cases (86.5%), a perorbital anteroposterior and an oblique lateral were sufficiency for diagnosis. Considerable attention should be paid to the configuration of the attic-antrum area, and in particular the presence or absence of Körner's septum (the petrosquamous suture).
Giving an intravenous diuretic during urography (furosemide-augmented urography, vasodilated urography) causes renal swelling which is easily measured. Several investigators have used this observation as the basis of a screening test for renovascular hypertension. They found that normal kidneys enlarge in area by more than 10%, while kidneys with renal artery stenosis show a blunted size response, usually less than 5%. We used the technique in 46 patients with proven essential hypertension in order to further examine its potential usefulness in the hypertensive population. The 92 kidneys showed an average area increase of only 7.0% +/- 3.6% SD, and only 15% of the kidneys enlarged by more than 10%. Based on these observations we doubt that vasodilated urography will be valuable as a screening test for renovascular hypertension because of the high incidence of false positive and indeterminate results in patients without renal artery stenosis.
The incidence of complications following supine phlebography was studied in 109 patients (142 legs) retrospectively and 89 patients (106 legs) prospectively. Virtually all patients had some discomfort during the procedure, while three patients had delayed pain for up to 4 days following examination. Three patients developed hives, one of whom also had bronchospasm. There were two cases with subcutaneous extravasation. The shorter endothelial contact time of supine phlebography compared to the semiupright technique might explain the reduced incidence of pain.
In an attempt to explain the greater morbidity from essential hypertension in the black as compared with the white race, we evaluated the intrarenal vasculature of 27 patients with hypertension (19 white and 8 black). All patients had mild-to-moderate hypertension (mean arterial pressure, 110 to 125 mm Hg), normal renal function, and minimal target-organ damage. All patients had selective renal angiograms, which were evaluated for arterial nephrosclerosis. Additionally, renal blood flow was estimated by the clearance of para-aminohippurate. Patient age, blood pressure, and plasma renin activity did not differ between the two races. Black hypertensives had significantly (P less 0.01) more severe nephrosclerosis than the white patients. Renal blood flow was lower (P less than 0.05) in black patients (390 +/- 35 ml/min - m2 body surface area) than white patients (473 +/- 19 ml/min - m2 body surface area). These findings may help to explain racial differences in morbidity and mortality from essential hypertension.
A solitary extramedullary plasmacytoma of the kidney associated with contralateral myeloma kidney is reported. The tumor demonstrated extensive palisading tumor vessels, heretofore thought to be characteristic of renal lymphoma. Plasmacytoma as the etiology of a renal mass should be considered when there is nonfunction of a normal-appearing contralateral kidney.
Recent laboratory data have suggested equivalent therapeutic value of selective intraarterial or peripheral intravenous infusions of vasopressin in the control of gastrointestinal bleeding. However, recent experience in two clinical cases continues to support a therapeutic advantage of the selective intraarterial route and casts doubt on the applicability of the laboratory results to man. Until further data is accumulated, it is premature to discard the presumed therapeutic advantage of the selective intraarterial infusion of vasopressin.
For fifty-five patients with acute low-back pain or radicular pain, ascending lumbar venography was as accurate as myelography (86 per cent) in localized herniation of a lumbar disc in surgically proved cases. Myelography and lumbar venography are complementary diagnostic studies which should be used together in doubtful cases. Lumbar venography is easily performed is well-tolerated, and is relatively painless. It is not associated with arachnoiditis and has a negligible complication rate.
Explore the source record for details and available documents.
The authors report a case of subacute spinal subdural hematoma in a patient with ankylosing spondylitis. Only 18 such cases have been reported in the nonradiological literature. Early diagnosis is imperative in order to minimize neurological sequelae.
Explore the source record for details and available documents.
Aneurysms of the smaller splanchnic arteries, though rare, are of great significance because of the high mortality rate associated with rupture of these vessels. Such aneurysms often occur in patients with pancreatitis or pancreatic pseudocysts. Four cases are presented to demonstrate the preoperative diagnosis of this entity by selective arteriography.
Explore the source record for details and available documents.
Inability to advance double-curved catheters beyond the origin of tortuous arch vessels in a common problem in femorocerebral angiography in the aged or hypertensive patient. The authors describe a simple technique involving the use of an exchange guide wire and straight catheter which has proved to be safe and successful in such circumstances.
Despite recognized limitations, the renal vein renin ratio (RVRR) remains the most commonly used index of surgical curability in hypertensive patients with renal artery stenosis. It is generally held that a ratio exceeding 1.5 forecasts a favorable response to surgery. Measurement of this ratio in 40 patients with essential hypertension (no arteriographically demonstrated stenosis) showed 8 (20%) with RVRR over 1.5, confirming an overlap of this ratio between patients with essential and renovascular hypertension. Intra-arterial injection of contrast material influenced renal vein renin activity (RVRA) in some individuals, but we were unable to demonstrate significant alterations in the group as a whole. Since the influence of intra-arterial contrast material on RVRA is variable and unpredictable, it appears unwise to collect renal venous blood for renin measurements soon after angiography.
Percutaneous fine-needle aspiration biopsy was performed on pigs with no complications. Pancreatic cells were retrieved in 73% of the biopsies. Thus, percutaneous biopsy with cytologic examination for pancreatic carcinoma can be performed in order to plan for appropriate therapy.