Ultrasound as an aid in the diagnosis and management of ovarian carcinoma: preliminary report

Ultrasonic scanning was used to assist in the diagnosis and management of ovarian tumors. Tumor response to therapy was evaluated with sequential ultrasound examinations in conjunction with clinical observations. Contact B-mode scanning and physical examination were complementary in demonstrating a change in tumor size, delineating small amounts of ascites, and identifying early omental implants. The information was used to guide the patient's management by chemotherapy.

Experimental use of prostaglandin E1 in nonocclusive mesenteric ischemia

Nonocclusive mesenteric ischemia was produced in dogs by intraarterial infusion of digoxin and by hemorrhage of 1/3 of total blood volume. Both methods produced a substantial drop in the superior mesenteric arterial blood flow rate. In each case, a superior mesenteric arterial infusion of 0.1 mug./kg. per minute of prostaglandin E1 allowed the blood flow rate to increase to above the control level without significantly altering heart rate or systemic arterial pressure. The improved arterial blood flow rates were accompanied by a reversal of the diffuse mesenteric vasoconstriction that was seen in the ischemic state. These findings were demonstrated by superior mesenteric arteriography performed prior to and following the production of mesenteric ischemia and again following the infusion of prostaglandin E1.

A feasibility study for percutaneous retroperitoneal lymph node biopsy

A percutaneous technique for the biopsy of retroperitoneal lymph nodes was studied in animals and cadavers. Access to the retroperitoneal space from the groin to the diaphragm has been achieved, and satisfactory biopsies of iliac and lumbar lymph nodes opacified by pedal lymphangiography have been obtained. Further investigations, however, are needed to improve the technique and to minimize the potential hazards associated with this procedure.

Percutaneous transfemoral renal artery occlusion in patients with renal carcinoma. Preliminary report

Twenty-four patients have undergone percutaneous transfemoral selective renal artery occlusion as part of their management for renal carcinoma. Preoperative infarction was performed in 7 cases. This facilitated surgery by eliminating the major blood supply to the tumor and resulted in collapse of the large collateral veins and created edema within the perirenal tissue. In 17 patients with visceral metastases, tumor infarction was performed in lieu of nephrectomy for control of the primary lesion and in hopes of stimulating an autoimmune response. The current status of this procedure s discussed in light of its indications, complications, and preliminary results.

Transcatheter arterial embolization in the management of bleeding in the cancer patient

Selective transcatheter arterial embolization was performed in 7 cancer patients with gastrointestinal or uterine bleeding. Most were bleeding from neoplastic tissue and were refractory to conservative management. Complete and permanent cessation of bleeding was obtained in 5 patients, including 3 with gastric bleeding, 1 with colonic bleeding, and in 1 with uterine bleeding. Successful arterial embolization allowed further treatment of the underlying disease which was particularly critical as these patients were poor surgical candidates. No significant or prolonged side effects were noted.

The use of prostaglandin E1 to enhance the angiographic visualization of the splanchnic circulation

Superior mesenteric angiograms were obtained in a series of dogs before and again after the injection of a 1-ml bolus of prostaglandin E1 (0.1-1.0 mug/kg) through the angiographic catheter. The prostaglandin E1 produced, on the average, a 100% increase in the superior mesenteric arterial blood flow with only minimal changes in the heart rate, systemic arterial pressure, and portal venous pressure. Opacification of the portal venous system was consistently enhanced after the prostaglandin E1. The arterial phase was preserved by increasing the rate of contrast administration.

Arteriographic demonstration of intravenous tumor extension

The arteriographic demonstration of a linear, striated arterial pattern in the anatomic course of the draining vein is reliable evidence of venous extension by a tumor and represents the supply to the intravenous component of the neoplasm. In addition to its previously described occurrence with hypernephromas, this report documents the characteristic angiographic appearance with hepatocellular tumors and a retroperitoneal osteosarcoma as reliable evidence of tumor extension into the inferior vena cava. It is possible that in some cases, the parallel arteries represent markedly enlarged vasa vasorum of the involved venous structure. The frequent invasion of the inferior vena cava by hepatomas and the importance of inferior vena cavography in their angiographic evaluation is also emphasized.

Lymphangiography in ovarian cancer

Lymphangiography can be of assistance in pre-treatment staging and thereby influence management of patients with ovarian cancer. The distribution of lymph node metastases was related to the histologic type of ovarian neoplasm. Tumors of germ cell origin more frequently spread to para-aortic lymph nodes, while epithelial neoplasms of the ovary metastasized to the pelvic and para-aortic lymph nodes, apparently in continuity. In this series, lymph node metastasis from ovarian cancer was seldom associated with ascites.

Urographic manifestations of metastatic melanoma

Urinary tract involvement with metastatic malignant melanoma occurs much more commonly than generally thought. It is usually part of a disseminated process with a poor life expectancy. The renal parenchyma is the most common site affected, although this is infrequently detected roentgenographically. Urothelial involvement of the renal pelves, ureters, and bladder manifests as single or multiple filling defects at pyelography. This appearance of metastatic melanoma of the urinary tract has not been previously described in the roentgenologic literature. Recognition is important to prevent unnecessary intervention and to guide palliative treatment.

Problems in selection of topical anti-inflammatory corticosteroids

Desonide, a non-fluorinated topical corticosteroid (16-alpha-hydroxyprednisolone acetonide), is compared with its fluorinated analogue, triamcinolone acetonide, as to vasoconstriction ability and epidermal penetration rate. Clinical effectiveness of desonide is further assessed by means of a double-blind paired comparison with an accepted potent fluorinated steroid, betamethasone 17-valerate. It is demonstrated that fluorination of the steroid molecule is not necessary to achieve potent topical anti-inflammatory effect. Vasoconstriction and epidermal penetration are not enhanced by fluorination in the drugs studied.