Total central vein obstruction: resolution with angioplasty and fibrinolysis.
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Adult↗
Biomedical subjects
R H Cohan
Publications and source records attributed to R H Cohan.
Selective use of low-osmolar contrast media.
Two thousand thirty-four consecutive patients presented for excretory urography within a 22-month period. Of 57 observed adverse reactions (incidence 2.8%), 54 occurred in 1219 low-risk patients injected with conventional ionic contrast media (HOCM) (incidence 4.4%) while three reactions were noted in the 815 high-risk patients receiving low-osmolar contrast media (LOCM) (incidence 0.4%). Despite strict enforcement of an unchanging list of high-risk criteria by the same pool of radiologists, LOCM use was not constant, increasing in use over time from 26.5% to 55.3% of urograms. In addition, frequency of LOCM selection increased transiently (from 33% to 52%) following a single life-threatening reaction to HOCM. Our results suggest that strict guidelines for use of LOCM are subject to loose individual physician interpretation. Physicians' perceptions of safety made it increasingly difficult to withhold LOCM and progressively more patients were included in high-risk groups.
Adolescent↗
Extravascular toxicity of two magnetic resonance contrast agents. Preliminary experience in the rat.
We compared the relative toxicities of standard concentrations of two magnetic resonance imaging (MRI) contrast agents, ionic gadolinium diethylenetriaminepentacetic acid (DTPA) and low-osmolar gadolinium-1, 4, 7 tris (carboxymethyl)-10-(2'-hydroxypropyl)-1, 4, 7, 10 tetra-azacyclododecane (HP-DO3A) with that of the conventional radiographic contrast medium meglumine diatrizoate, when extravasated into the deep dermal tissues of laboratory rats. Gadolinium-DTPA caused moderate necrosis, hemorrhage, and edema which was not statistically different than meglumine diatrizoate. In contrast, gadolinium HP-DO3A was significantly less toxic than meglumine diatrizoate. Additional experience will be needed in order to determine whether these laboratory results will be clinically relevant in humans.
Animals↗
Renal vein renins: inability to predict response to revascularization in patients with hypertension.
To determine whether the captopril-stimulated renal vein renin ratio (CSRVRR) could enable identification of patients with hemodynamically significant renovascular lesions who would respond to revascularization, the authors measured CSRVRRs in 143 consecutive patients with hypertension who had been selected because of clinical features suggestive of renovascular hypertension. All patients underwent conventional renal arteriography. Renovascular hypertension was the final diagnosis if revascularization resulted in cure or improvement in blood pressure. Complete data were available for 133 patients. Twenty patients had renovascular hypertension; CSRVRR was greater than 1.5 in 13 of these 20 patients (sensitivity, 65%). However, it was also greater than 1.5 in 54 of the 113 patients without renovascular hypertension (false-positive rate, 47.8%). The positive predictive value of CSRVRR was 18.6%; the negative predictive value, 89.3%. It is concluded that CSRVRR is not sufficiently sensitive to enable prediction of which patients will respond to revascularization and is not specific enough to exclude patients who do not have renovascular hypertension.
Adult↗
Iodinated radiographic contrast media: comparison of low-osmolar with conventional ionic agents [corrected].
A large number of reports on radiographic contrast media have appeared over the past year. The majority of these compared various properties of the new, nonionic low-osmolar agents with those of conventional ionic contrast media, including types and rates of adverse reactions, nephrotoxicity, anticoagulant effects, degree of subcutaneous injury resulting from extravasation, and gastrointestinal tolerance. In this review, recent developments in each of these areas are discussed. Although, in general, the newer agents are safer and better tolerated than ionic contrast media, their greatly increased cost prevents them from completely replacing these media. In this time of increasingly cost-conscious health care, even expert opinion concerning indications for nonionic low-osmolar contrast media use (also summarized here) is widely divided.
Contrast Media↗
Extravascular extravasation of radiographic contrast media. Effects of conventional and low-osmolar agents in the rat thigh.
We compared the damage resulting from intradermal injection of four commonly used radiographic contrast media in laboratory rats. Sixty percent meglumine diatrizoate (Reno M 60) and ioxaglate (Hexabrix) produced significantly more ulceration and crusting on gross inspection and more necrosis, edema, and hemorrhage on histologic evaluation than iopamidol 300 (Isovue) or 0.9% (normal) saline. Thirty percent meglumine diatrizoate (Reno M Dip) had an intermediate toxicity, resulting in significantly more visible swelling and more microscopically detected hemorrhage than iopamidol or saline, but less ulceration/crusting and necrosis than Reno M 60 and ioxaglate. Since the three contrast agents of similar osmolality produced different degrees of tissue damage, our results suggest that factors other than high osmolality are partially responsible for determining the severity of injuries from extravasated contrast media.
Animals↗
Extravasation of nonionic radiologic contrast media: efficacy of conservative treatment.
The authors report four large-volume (greater than 20-mL) extravasations in adults and one intermediate-volume (18-mL) extravasation in an infant of iopamidol, a nonionic contrast medium, that occurred during dynamic enhanced computed tomography. The largest volume that extravasated (in two patients) was 150 mL. Although all five patients initially had swelling, erythema, and/or pain after extravasation, all recovered uneventfully. The authors suggest that emergent surgical drainage of all large-volume extravasations, a procedure that was recently recommended, is unnecessary. Large extravascular collections of nonionic contrast media can be well tolerated and are often resorbed without adverse sequelae.
Aged↗
Ovarian vein thrombosis in oncology patients: CT detection and clinical significance.
During a 13-month period, ovarian vein thrombosis (OVT) was detected with CT in six patients with malignant tumors, five of whom were receiving high-dose chemotherapy at the time of diagnosis. None of these patients belonged to previously recognized risk groups. Unlike most patients with postpartum or postoperative OVT, only one of our patients was symptomatic, and none had related CT findings, such as uterine enlargement or other enhancing pelvic masses. Patients with malignant tumors, particularly those undergoing chemotherapy, are at risk for developing OVT. As OVT is often asymptomatic in these patients, and thrombus may resolve without treatment, anticoagulation may not be routinely necessary.
Adult↗
Obliteration of the fat surrounding the celiac axis and superior mesenteric artery is not a specific CT finding of carcinoma of the pancreas.
Partial or complete obliteration of the fat surrounding the celiac axis and superior mesenteric artery on CT is considered so characteristic of pancreatic carcinoma that many consider it diagnostic. However, this finding may be present on CT scans of some treatable tumors. During a 2-year period, we retrospectively collected 10 cases of nonpancreatic tumors that obliterated the fat surrounding the celiac axis and/or superior mesenteric artery. Four patients had metastatic disease, three had lymphoma, two had primary small-bowel adenocarcinoma, and one had a diffuse retroperitoneal endocrine tumor. The scans were analyzed for presence, location, and morphology of the mass and biliary and/or pancreatic ductal dilatation. Of the patients with metastatic disease, three had focal, retropancreatic, periceliac masses without ductal dilatation. One had an infiltrative retroperitoneal process enveloping the pancreas and causing biliary dilatation. Of the patients with lymphoma, two had focal masses in the mesenteric root without ductal dilatation, and one had an infiltrative retroperitoneal process. Of the two patients with primary carcinoma of the small bowel, one had a mesenteric mass without ductal dilatation and the other had an infiltrative retroperitoneal process enveloping the pancreatic head and obstructing the ducts. The patient with the neuroendocrine tumor had an infiltrative retroperitoneal process enveloping the pancreas without ductal dilatation. Obliteration of the fat surrounding the celiac axis and superior mesenteric artery is not a specific CT finding of carcinoma of the pancreas. One cannot rely solely on its presence for the diagnosis of pancreatic carcinoma but should use other important findings such as a focal pancreatic mass and ductal dilatation.
Adenocarcinoma↗
Interventional uroradiology.
Major interventional uroradiologic techniques including percutaneous nephrostomy, vascular augmentation and reduction procedures, percutaneous cyst aspiration, chronic peritoneal dialysis catheter manipulation and urethroplasty are reviewed. A brief history of the development and techniques for performing these procedures are included. The results of clinical series are assessed and their role in patient management is addressed. The development of these procedures has had a significant impact on patient care by providing effective nonoperative therapy.
Angioplasty, Balloon↗
Intravenous digital subtraction renal angiography: use in screening for renovascular hypertension.
Intravenous digital subtraction renal angiography (DSRA) has been compared with conventional angiography only in small, selected series of hypertensive patients. The authors prospectively examined with intravenous DSRA 94 patients at increased risk for renovascular hypertension and compared these studies with conventional angiography. A stenosis of at least one main renal artery was identified with intravenous DSRA in 22 patients and confirmed in 20 patients. No significant stenoses were seen with conventional angiography in any of the 64 patients in whom lesions were not seen with intravenous DSRA. Since inadequate DSRA studies were considered positive for renal artery stenosis, the sensitivity of intravenous DSRA was 100% (25 of 25); specificity, 93% (64 of 69); positive predictive value, 83% (25 of 30); and negative predictive value, 100% (64 of 64). The authors conclude that intravenous DSRA is a sensitive test for identifying stenosis of the main renal arteries and is appropriate to use as a screening test among patients at increased risk for renovascular hypertension.
Adult↗
Radiology of penile prostheses.
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Erectile Dysfunction↗
Flunisolide aerosol in the treatment of perennial allergic rhinitis.
A double-blind, crossover study was performed with a new topical aerosol steroid, flunisolide, administered every 12 hours over a period of eight weeks to 36 adult patients with perennial allergic rhinitis. During the treatment period the majority of patients had significant relief of symptoms as compared with the placebo period. Most prominent improvement occurred with the symptoms of nasal stuffiness, sneezing, rhinorrhea and the number of times patients had to blow their noses. Best results were obtained in patients with higher degrees of atopy. Side effects were minimal and limited to nasal irritation in some patients. Criteria for optimal patient selection are discussed and an explanation for the lack of systemic effects of aerosolized use of the newer corticosteroids is given.
Adolescent↗
Treatment of perennial allergic rhinitis with cromolyn sodium. Double-blind study on 34 adult patients.
A double-blind crossover study was performed on 34 adult patients with perennial allergic rhinitis, using an aqueous solution of 4% cromolyn sodium or a placebo substance six times daily over a 4-wk period with daily documentation of both symptoms and use of symptomatic medications. All patients had markedly positive skin test reactions to at least one antigen. Chemistry screens and IgE serum levels were determined. Significant reductions occurred in the symptom-scores for runny nose, stuffy nose, sneezing, and nose blowing while patients were on cromolyn treatment (p less than 0.005). Likewise, while on treatment, there was a significant reduction in the consumption of antihistamines. In an attempt to differentiate between good and poor cromolyn responders by clinical and laboratory parameters, we found that (1) patients with high IgE levels responded better than those with low IgE levels, (2) patients with markedly positive skin test reactions to epidermoids and to foods responded better than those with pollen allergy, and (3) females appeared to have a significantly better drug response than males. Age did not play a role in drug response, nor did drug sequence (placebo-active or active-placebo).
Adolescent↗
Minocycline therapy in acne vulgaris.
A double-blind, random distribution study showed that a lower than recommended dose of minocycline--50 mg twice daily--was as effective as a dose of 250 mg twice daily of tetracycline for treatment of acne vulgaris in comparable patient groups, and that minocycline produced no vestibular side effects at the lower dosage. Like tetracycline, minocycline did not produce the phototoxicity associated with demeclocycline or the life-threatening colitis associated with clindamycin. Patients in this study did not develop a resistance either to minocycline or to tetracycline. Studies of the use of minocycline in patients who have developed tetracycline resistance and long-range studies of patients on the new lower dose of minocycline are now underway.
Acne Vulgaris↗
Computed tomography of renal lymphoma.
The CT studies of 29 patients with renal or perirenal lymphoma were retrospectively reviewed. Four patterns of disease were identified. Seventeen of 29 patients (59%) had bilateral renal masses. Only seven of these patients had associated enlarged retroperitoneal lymph nodes. Eight patients (28%) had single renal or perirenal lesions adjacent to or contiguous with bulky retroperitoneal lymphadenopathy. Three patients had infiltration of the perirenal space without significant renal parenchymal involvement, and one patient had a solitary renal mass. No patients in this series had diffuse involvement of the kidney without a focal mass. Renal involvement with lymphoma should be considered in any patient who develops multiple homogeneous solid renal or perirenal masses, even in the absence of other retroperitoneal disease.
Female↗
CT of fundoplication.
To determine the CT findings postfundoplication, we retrospectively compared CT in 22 postfundoplication patients with CT in 22 patients with unrepaired hiatal hernias and gastroesophageal (GE) junction abnormalities and 24 patients with gastric or esophageal carcinoma involving the GE junction. Seventeen of the 22 postfundoplication patients had undergone a Nissen procedure. Of the 22 patients, 11 had esophageal dilatation, 14 had GE junction masses, 4 had esophageal wall thickening, 7 had surgical clips, and none had hepatic metastases or upper abdominal lymphadenopathy. Statistically, on CT, postfundoplication patients are more likely to have a GE junction mass (p = 0.023) and least likely to have wall thickening (p = 0.021). Nonetheless, because the findings occur frequently in each group, they are not diagnostic in the individual patient. However, 11 of 12 post-Nissen masses had the unique finding of an oval or linear central fat density within the mass. This finding was absent in the other postfundoplication masses and in those patients with repaired hiatal hernia or tumor. We conclude that pseudomasses occur on CT postfundoplication and can be indistinguishable from hiatal hernias and GE junction neoplasms unless a central fat density is present.
Adult↗