Embolization of extensive peripheral angiodysplasias. The alternative to radical surgery

We describe two patients with extensive pelvic and lower limb angiodysplasias, in whom hemodynamic complications subsequently developed. These have been treated by selective angiography and multiple percutaneous transcatheter embolizations with satisfactory results (1 1/2 to four years of follow-up). One patient had had three previous operations with no improvement; amputation was the only surgical alternative. In the other patient, hip disarticulation and hemipelvectomy was seriously considered because of cardiac failure not responding to medical therapy. We review the literature and use our cases to illustrate points of technique and reemphasize the essential role of therapeutic embolization in the management of extensive angiodysplasia.

CT in localization of impalpable cryptorchid testes

Computed tomography was used for preoperative localization in 12 patients with undescended testes. Because three patients had bilateral involvement, 15 absent or undescended testes were studied. Surgical confirmation of the CT findings was obtained in 12 instances. Confirmation was not obtained in one patient who refused operation and it was considered incomplete in another due to limited surgical exploration. There was one incorrect localization. The procedure is quick, simple, noninvasive, and can be performed at all ages. The testicular radiation exposure was considered acceptable on the basis of phantom measurement. The lowest possible exposure factors were used on all patients. CT findings assisted planning of operative procedures and in some cases enabled more limited and shorter operations.

Sex-influenced expression of Madelung's deformity in a family of dyschondrosteosis

Dyschondrosteosis is a mesomelic form of short stature which occurs in conjunction with a characteristic wrist deformity. Madelung's deformity. A family with dyschondrosteosis had an affected father and two daughters. The affected females had dyschondrosteosis and Madelung's deformity, while the affected males had dyschondrosteosis, but no Madelung's deformity. All affected members had arthralgias. The occurrence of male to male transmission confirms an autosomal dominant inheritance pattern for this disorder.

Ungual tufts in the follow-up of patients on maintenance hemodialysis

A recent publication showed the earliest signs of renal osteodystrophy in patients on maintenance hemodialysis (MHD) to occur in the tufts [1]. We present three patients on MHD, in two of whom the earliest unequivocal radiographic improvement was seen in the tufts. The third patient had been on MHD and, following subtotal parathyroidectomy, showed significant osseous improvement in the hands with relatively equal improvement in the hands with relatively equal improvement in the tufts and middle phalanges. It appears that, with the use of routine primary or secondary magnification, the tufts are radiographically a highly sensitive site for both the early occurrence and improvement of osteodystrophy in patients on MHD. We are not aware of any previous publication pointing out exclusive improvement in the tufts in patients on MHD with virtually no change in the mid-phalanges. Two of these three cases illustrate that renal osteodystrophy is reversible by maintenance hemodialysis alone.

CT as a primary diagnostic method in evaluating intraabdominal abscess

In 19 cases, a correct diagnosis of intraabdominal abscess was made by CT body scanning. There was one false-positive diagnosis and initially one false-negative diagnosis. CT proved to be an efficient imaging method for diagnosis, for planning of therapeutic procedures, and in monitoring response to operative or conservative treatment. It has advantages over ultrasound and gallium scanning especially in severely ill, postoperative, and obese subjects. In addition, needle aspiration under CT control is readily performed and can be undertaken at the same examination. Confirmation of the diagnosis and therapeutic aspiration with or without introduction of a drainage catheter can then be undertaken.

Terminal phalangeal tufts: earliest site of renal osteodystrophy findings in hemodialysis patients

Direct magnificaiton of the hands of 44 patients on maintenance hemodialysis showed that the earliest unequivocal changes of renal osteodystrophy occur in the tufts. Some workers made a similar observation, but no previous objective study confirmed or refuted the sensitivity of the tufts in the diagnosis of renal osteodystrophy. The macroradiograph is consistently reproducible and serves as an excellent visual record of subtle changes.

Intestinal bypass: a modification

Six hundred sixty-four patients who have had metabolic intestinal surgery for the treatment of morbid obesity are reviewed. Particular attention is directed to difference in weight loss, morbidity and mortality in end-to-side and end-to-end shunts, the former performed in 300 patients and the latter in 262 patients. Unsatisfactory weight loss was observed in 20% of patients with end-to-side shunts, while only 8% of patients with end-to-end shunts failed to lose a sufficient amount of weight. Morbidity and mortality were significantly increased in this latter group. This led to adoption of a modification of the end-to-side operation by developing a plication ?REVENT REFLUX. Our preliminary observation indicates that in 102 patients who have had this operation, similar weight loss is attained to that of end-to-end shunts with no greater morbidity or mortality than the end-to-side type.

Angiographic demonstration of non-occlusive hepatic infarction with scintigraphic and microscopic correlation

The angiographic appearances of histologically proven hepatic infarction without vascular occlusion has not, to our knowledge, been previously described. A case of non-occlusive hepatic infarction in a diabetic patient is presented and correlated with scintigraphic and microscopic findings. It would appear to be the first recorded case of hepatic infarction associated with diabetic ketoacidosis. A follow-up angiogram showed resolution. The literature is briefly reviewed.

Primary hyperparathyroidism presenting as spinal cord compression: report of a case

A report of a case of primary hyperparathyroidism presenting as spinal cord compression due to a brown tumour of the vertebra is presented. Coexisting chrondrocalcinosis illustrates one of the several radiological features seen in hyperparathyroidism.

Uncommon sphenoidal fractures and their sequelae

Eight cases with fractures of the sphenoid bone are discussed. In four the sella turcica was involved. One showed bilateral fractures of the medial pterygoid plates resulting in an open-bite deformity. Another patient exhibited bilateral carotid-cavernous fistulae. This brings the total of documented, angiographically demonstrated, post-traumatic, bilateral, carotid-cavernous fistulae to seven. Fractures of the planum sphenoidale, the floor of the sphenoid sinus, and bilateral fractures of the lesser wings are also shown. The anatomy of the sphenoid bone and clinical sequelae are briefly discussed.

Paraganglionomas in the neck

Three paraganglionomas in the neck investigated by angiography are presented. The value of angiography in these tumours is stressed, and one case showed distinctive radiological features hitherto undescribed which probably constitute a basis for the definitive preoperative diagnosis of malignant lesions.

Paravertebral ossification in psoriasis and Reiter's disease

In a retrospective study of psoriatic arthropathy and Reiter's disease, it is shown that paravertebral ossification (PVO), of the type described by Bywaters and Dixon (1965) and other types of non-marginal syndesmophytes (McEwan et al., 1971) may be the sole or major radiological abnormality. This sign is of particular value where the appearances of the sacro-iliac or other joints are normal or equivocal and is at least as significant as the peripheral I.P. joint involvement in the hands, where these conditions are suspected. This radiological sign may precede the typical psoriatic rash.