Early failure of aortoiliac kissing stents: histopathologic correlation.
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Angiography↗
Biomedical subjects
R Vogelzang
Publications and source records attributed to R Vogelzang.
Peliosis hepatis with intrahepatic hemorrhage: successful embolization of the hepatic artery.
Peliosis hepatis is defined as the appearance of blood filled lakes in the hepatic parenchyma. It has been associated with various pharmacological agents and infections. Treatment has been primarily symptomatic and includes discontinuation of offending medications, partial hepatectomy or occasionally liver transplantation. We report a 58 year old white female on hormone replacement therapy who developed symptomatic peliosis hepatis and underwent successful superselective hepatic artery embolization with control of bleeding.
Embolization, Therapeutic↗
Treatment of peripancreatic fluid collections in patients with complicated acute pancreatitis.
We reviewed an experience with treatment of peripancreatic fluid collections in patients with complicated acute pancreatitis to identify clinical and computed tomography (CT) parameters that are helpful in the selection of patients for treatment and to assess treatment outcome. The extent of CT abnormalities determined a CT severity score (mild = 1, severe = 4). From 1985 to 1990, 650 patients were hospitalized with acute pancreatitis; a peripancreatic fluid collection was found in 36 patients (5.5 percent). Ten of 11 patients with successful outcome after no invasive treatment (group 1) had a low CT severity score of 1 or 2; mean serum albumin was 4.0 gram percent. Of 25 patients who had some form of drainage, 12 had a high CT severity score of 3 or 4 (p < 0.05) and a mean serum albumin of 3.4 grams percent (p < 0.05). Nine patients had only operative drainage (group 2) and 16 had CT-directed percutaneous catheter drainage (group 3). In group 3, percutaneous catheter drainage successfully drained the fluid collection in six patients, while ten patients needed an operation, in addition to percutaneous drainage, to effectively débride and drain the necrotizing pancreatic problem. As a result of the current review, we propose an algorithm for treatment of these patients.
Acute Disease↗
Selective preoperative evaluation for possible N2 disease in carcinoma of the lung.
The efficacy of computed tomography and surgical mediastinal exploration in determining tumor resectability were retrospectively evaluated in 92 consecutive patients with non-small cell lung carcinoma. Status of mediastinal nodes was ultimately determined by surgical mediastinal exploration or thoracotomy. Patients were divided into three groups on the basis of chest roentgenography: Group I comprised 30 patients with peripheral T1 or T2 lesions with normal hilar and mediastinal shadows. Only one patient was found to have an involved node. Chest roentgenography had an accuracy rate of 96% and computed tomography, 93%. Thoracotomy is recommended without either computed tomography or surgical mediastinal exploration in this group. Group II comprised 47 patients with T1 or T2 lesions with an abnormal hilus, an abnormal mediastinal shadow, or either the hilus or mediastinum obscured by overlying parenchymal disease. Computed tomography revealed mediastinal nodes 1 cm or greater in size (abnormal node group) in 21 patients (45%) and smaller than 1 cm (normal node group) in 26 patients (55%). Surgical mediastinal exploration was performed in the abnormal node group and involved nodes were found in 17 of 21 patients (81%). In the normal node group, thoracotomy only was performed and no involved nodes were found. Computed tomography is recommended in all patients in Group II. Patients in the normal node group may be subjected to thoracotomy only and those in the abnormal node group should undergo surgical mediastinal exploration as the next diagnostic step before thoracotomy. Group III comprised 15 patients with grossly abnormal mediastinal shadows. Findings from computed tomography were abnormal in all 10 patients in whom it was done. Surgical mediastinal exploration was done in all 15 and yielded abnormal results in 14. It is recommended in this group that computed tomography is unnecessary and surgical mediastinal exploration should be the only diagnostic procedure. Thus, in potentially resectable non-small cell lung carcinoma, the use of computed tomography and surgical mediastinal exploration should be selective and should be determined by appropriate initial interpretation of the chest roentgenogram.
Carcinoma, Non-Small-Cell Lung↗
An algorithmic approach to evaluate pulmonary masses.
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Humans↗
Ultrasonographic features of prostatic carcinoma.
Over an 18-mo period, 93 prostate examinations were performed by a suprapubic transabdominal approach. By applying ultrasonographic tissue textural analysis, we were able to identify 16 out of 19 carcinomas. Most of these analyses showed ill-defined focal abnormalities located either in the posterior or the posterior-lateral portion of the gland. Ten of the analyses demonstrated increase echogenicity, while six demonstrated decreased echogenicity. Irregularity of the capsule was an unreliable sign in determining capsular invasion. The degree of extension appears to be better evaluated by computed tomography (CT). In conclusion, transabdominal ultrasound holds promise in the detection of prostatic carcinoma, while staging should be done by CT.
Carcinoma↗
Preoperative CT and MR imaging of ischiopagus twins.
Each case of conjoint twins is unique. Preoperative imaging is helpful to determine the feasibility of separation. Shared and separate organs can be delineated; and operative technique and problems anticipated. We performed ultrasonography, CT, magnetic resonance imaging, and arteriography preoperatively on ischiopagus conjoint twins. The single most helpful study was CT performed during a bolus intravenous contrast medium injection into one twin. Arteriography was also very helpful. The other studies were complementary but added little additional structural details. Sedation of conjoint twins is complicated yet crucial for optimal imaging studies. A combination of oral and intramuscular sedation was used and worked well for all of the studies.
Angiography↗