Biomedical subjects
Publications and source records attributed to T L McCormick.
Three cases of subclavian steal syndrome are presented, with emphasis on the venous phase following aortic arch injection. Dense opacification of the jugular vein on the involved side was seen, rather than a progressive decrease. In addition, patterns of venous flow in the neck were variable. Venous-phase angiography did not correlate with symptoms.
The renal arteries in three groups of four dogs were occluded to induce renal infarcts using Gelfoam, Gelfoam and steel coil, and barium suspension. Each agent was evaluated for its effect on renal renin output, arteriographic appearance, and the extent of renal infarct produced. Gelfoam embolization produced incomplete infarcts with hypertrophy of remaining viable tissue. Renal infarcts were more extensive with the combination of Gelfoam and coil than with Gelfoam alone. Barium embolization produced the most diffuse and extensive renal infarct. Renal vein plasma renin levels from the embolized kidney were significantly elevated in the Gelfoam-plus-coil dogs, but arterial pressures were significantly higher in only two of four of these dogs 10 weeks after embolization.
Computed tomography and angiography were performed in two patients with ileal carcinoid tumor and in one with retractile mesenteritis. In each instance, a low density right lower quadrant mass with small bowel displacement and thickened mesenteric neurovascular bundles was identified at CT. Superior mesenteric artery (SMA) angiography revealed contraction, kinking and irregularity of mesenteric branches in all cases, but specific histologic diagnosis was not established by angiography alone. Our preliminary experience suggests that SMA angiography may not always be necessary in the diagnosis of either carcinoid tumor or retractile mesenteritis.
A cortical nodule is defined as a focus of more normal renal cortical tissue than usual in an otherwise normal kidney. Such nodules can mimic renal tumors on excretory urography. The urographic features of 29 cases of renal cortical nodules were correlated with arteriographic features to determine if a pattern of different anatomic types could be discerned. The cortical nodules fell into three anatomic groups (similar to Hodson's dissection classification): (1) subcapsular, (2) hilar lip, and (3) septa of Bertin. These anatomic groupings are proposed as a classification scheme for radiologic use. Using this classification, it was found that cortical nodules have urographic features that permit distinction of one type of cortical nodule from another. A better understanding of cortical nodules, based on this classification, should result in more certain urographic diagnosis of cortical nodule. Similarly, mistaking a cortical nodule for renal tumor on urography should be less likely to occur.
The diagnosis of multiple endocrine neoplasia type II (MEN-II) was made in 18 patients from 1966 through 1978 at the University of Michigan Medical Center. Eight patients had adrenal medullary disease. Seven had bilateral adrenal pheocyromocytomas (two with concomitant medullary hyperplasia) and one had a unilateral pheochromocytoma with contralateral medullary hyperplasia. No malignant or extraadrenal pheochromocytomas were found. Pheochromocytomas in patients with MEN-II are multiple and involve both adrenal glands. Adrenal venography is advocated as the primary diagnostic tool for localization of adrenal medullary disease in MEN-II patients.
Three biliary cystadenomas are reported. Two occurred in the left lobe of the liver and the third involved the right lobe and the medial segment of the left lobe. All three patients had gray scale sonography of the liver and two underwent hepatic angiography. The sonographic features were similar to those of cystadenoma of the ovary or pancreas, that is, multilocular cystic lesions with septations and papillary projections. Angiographically the lesions were hypovascular with a faint rim of contrast-material accumulation in the wall and septa of the mass.
The variation in kidney length between the 1-minute radiograph (centered over the kidney) and the 5-minute study (centered over the mid-abdomen) was evaluated on 100 random excretory urograms. When both kidneys were measurable, the change in kidney size was discordant in 40%. Most such changes are due to changes in geometry, differences in centering, or changes in the angle of the kidney with respiration. These alterations are of much greater magnitude than the reported swelling of the kidney due to contrast medium. Since there is practically no relation between the time of injection and changes in renal image size, it makes no difference whether the 1-minute or 5-minute radiograph is selected for measurement.
A case of tracheal compression by a normal aorta deviated to the right with a shift of the heart due to right lung agenesis is presented. The condition was diagnosed by chest fluoroscopy and corrected surgically. The increased mortality associated with right versus left lung agenesis may be due to tracheal compression by a normal aorta in some cases.
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.
The incidence of radiographic changes in the chest following a sternal split for cardiac surgery is examined. These changes include: (a) an indiscinct sternal cortex; (b) elevation of the cardiac silhoutte above the diaphragm; and (c) uneven heights of the medial clavicular ends.