Clinical significance of inferior phrenic angiography; special reference to diaphragmatic or paradiaphragmatic lesions.
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Biomedical subjects
Publications and source records attributed to Y Numaguchi.
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A case of intracranial hypoglossal neurinoma is reported. The diagnostic importance of an enlarged hypoglossal canal with isolated hypoglossal nerve palsy is emphasized. The computed tomography and angiographic findings are described.
Forty-two acoustic neurinomas and seven meningiomas in the cerebellopontine angle were reviewed, and the radiological differential diagnosis of these tumors is discussed. Though enlarged internal auditory meati and characteristic CT findings were reasonably reliable indicators for the diagnosis of acoustic neurinomas, it was angiography which substantiated their correct diagnosis. An arcuate vein was frequently demonstrated with acoustic neurinomas, but never with meningiomas. Visualization of tangled veins seems to favor a diagnosis of acoustic neurinomas. Contrary to earlier reports, tumor stains were most frequently visualized using selective external carotid arteriography. The degree of tumor stains did not aid in differentiating acoustic neurinomas from meningiomas. The importance of using angiotomography, especially in the anteroposterior projection, and external carotid angiography during prolonged injections of large amounts of contrast media, is emphasized.
Eighteen cases of intracranial meningioma that received preoperative or postoperative irradiation with 60Cobalt or Linac have been reviewed. Eight patients received preoperative irradiation because their tumours were very large, hypervascular, and surgically not readily accessible. Two angioblastic meningiomas of the haemangiopericytoma type responded well to irradiation and were easily extirpated. One of these developed a local recurrence and metastases to the lungs and liver nine years after surgery. The recurrent intracranial tumour and nodules in the lungs responded well to irradiation. The other six cases of meningiomas of meningothelial, transitional, or haemangioblastoma types, did not improve clinically or radiologically after irradiation. Ten cases received postoperative irradiation because their tumours were only partially removed or were histologically malignant. In all cases irradiation was most effective for recurrent tumours of the haemangiopericytoma type. This study indicates that irradiation is useful in tumours of the haemangiopericytoma type as an adjunct to surgery or for palliation in advanced stages. Irradiation may been effective in supressing recurrences in two cases of other types of meningioma, although the number of cases is too small to allow any definite conclusion.
A case of afferent loop syndrome demonstrated by computed tomography (CT) is described. To our knowledge, no CT findings of this syndrome have been illustrated in the literature. This syndrome can be definitely diagnosed by CT when a U-shaped cystic mass continuous with the biliary system is demonstrated behind the superior mesenteric artery.
Prolonged injection angiography (PIA), in which large amounts of contrast material are administered for three or four seconds, was used to visualize the vasculature of 70 intracranial neoplasms. Tumor stains were demonstrated better with or solely by PIA in all pituitary adenomas with suprasellar extension and in most meningiomas. PIA was less effective in tumors with marked arteriovenous shunts or in low-grade gliomas. PIA is especially indicated when avascular or hypovascular masses are encountered on conventional angiography or when contrast enhancement is encountered on computed tomography (CT). PIA is also indicated to demonstrate neoplasms which are not enhanced with contrast media on CT since PIA demonstrates the venous anatomy surrounding the tumors especially well.
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A case of solitary plasmacytoma of the skull base growing into the cerebellopontine angle is reported. Myeloma protein of the lambda type light chain was identified in the patient's cerebrospinal fluid. The difficulty in differentiating solitary plasmacytomas of the skull base from other tumors in this location, such as chordoma and meningioma, is discussed.
Among the lymphograms of 25 F.U.O. patients whose diagnoses were unknown after several weeks of detailed examinations, abnormalities were noted in 4. Of the 4 abnormal cases, 2 were finally diagnosed by superficial lymph nodes biopsies as having malignant lymphomas. The other 2 had no final diagnoses; though biopsies of enlarged superficial lymph nodes were performed, they showed only reactive hyperplasia. No exploratory laporatomy was performed among the 25 cases. We conclude that lymphography is not absolutely indicated in the evaluation of F.U.O.
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The circulatory anatomy of the iliofemoral region was elucidated by doing detailed angiography in 50 cases, and we classified the vessels into 4 types. In most cases, the s.c.i.a. predominated over the s.i.e.a. Therefore, it is probably better to plan free flaps supplied by this artery. This vessel usually arises approximately two or three fingerbreadths inferior to the intersection of the femoral artery and the inguinal ligament, and the skin flap should be designed in the area inferior and parallel to the inguinal ligament.
A case of intracranial cavernous hemangioma displaying feeding arteries, tumor stains, and venous pools is presented. Tumors of this type may simulate avascular masses on angiography; however, when surgically excised, they bleed profusely. A correct preoperative diagnosis can help avoid unnecessary incisions. Prolonged injection angiography clearly depicts the tumors and their venous pools, which may be pathognomonic of cavernous hemangiomas.
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