Pseudoobstruction of the anterior tibial artery

Lower extremity arteriography is customarily performed in the anteroposterior projection with the feet in forced plantar flexion. A case is reported showing "pseudoobstruction" of the anterior tibial artery at the ankle in this projection, which was not present with the foot in the neutral position for a lateral view. To confirm the positional nature of this phenomenon in younger patients, pulse tracings of five volunteers were obtained. These showed that pulsatile flow could be repeatedly abolished in the anterior tibial artery by plantar flexion of the foot. The anatomic causes for this phenomenon are discussed.

Percutaneous brush biopsy and internal drainage of biliary tree through endoprosthesis

Percutaneous insertion of a permanent internal prosthesis for biliary tract decompression was successful in 15 patients with obstructive jaundice. Percutaneous brush biopsy of the obstructing lesion that preceded stent placement in six patients was successful in obtaining diagnostic tissue in four. Both techniques are described in detail with illustrative cases.

Current trends on diagnostic work up of pulmonary thromboembolism

This report describes a six month prospective double blind study of 30 consecutive patients who were evaluated at Jackson Memorial Medical Center for pulmonary emboli. In this series, 77 per cent of the patients with lung scans interpreted as high probability for pulmonary emboli had angiographic confirmation of emboli. In 90 per cent of the patients with lung scans interpreted as low probability for pulmonary emboli, angiography confirmed the absence of pulmonary emboli. Five patients had radionuclide scans that were interpreted as nondiagnostic. Although pulmonary arteriography remains the gold standard for the diagnosis of pulmonary emboli we feel it should not be used in the low probability category because of the accuracy of the ventilation perfusion scans. It should be used in the indeterminant group and in the high probability category when anticoagulation therapy is contraindicated; prior to embolectomy or Mobin-Uddin umbrella insertion.

A 23-gauge sheathed needle: an alternative in transhepatic cholangiography

The authors propose the use of the BD 23 gauge sheathed needle as an alternative to the Chiba University needle because it permits both the cannulation of normal biliary radicales and therapeutic drainage of a dilated system, without increased morbidity.

Portosystemic communications studied by transhepatic portography;

The experience of collecting 120 transhepatic portograms, performed in patients with different degrees of portal hypertension, affords the opportunity for discussing the anatomical and hemodynamic features of portosystemic communications. Multiple pathways of decompression were found. The coronary-gastroesophageal collateral formed pathways in 108 cases, other major collaterals in 41, and minor collaterals in 2. This multiplicity of communications suggests that no one vessel is indispensable as a collateral pathway.

Unusual complications of renal cyst puncture

The authors present a case of subcapsular hematoma with compromise of renal function and a case of arteriovenous communication as two infrequent complications of renal cyst puncture.

Some normal variations of knee arthrograms and their anatomical significance

Knees obtained after amputation were fixed with formalin after the joint space was distended with air. The joints were then either dissected or frozen and sectioned vertically with a band saw in planes comparable to those visualized during arthrography. By comparing these anatomical specimens and arthrograms, the anatomical explanations for some normal variations visible or arthrograms could be identified. These variations included the appearance of the popliteus tendon and the posterior part of the lateral meniscus, the air-filled cul-de-sac posterior to the medial meniscus, and the interconnections of the joint space and the gastrocnemius and semimembranosus bursae.

New techniques for interruption of gastroesophageal venous blood flow

Enlarged gastroesophageal veins were successfully obliterated in 41 patients using embolization with modified autogenous clots and/or Gelfoam, balloon occlusion, iatrogenic perivenous hematoma, sclerosing agents (Sotradecol and Keflin), or a combination of these methods. Thirteen patients were actively bleeding when studied, and the site of bleeding was detected in 4. Surgical exploration of 16 patients and autopsy study of 5 showed persistent obliteration ranging between three weeks and seven months. No major complications requiring reparative surgery were encountered. Gelfoam soaked with Sotradecol is the preferred agent because it provides persistent obliteration of the embolized veins. Patients who are acutely bleeding or have done so previously are candidates for selective obliteration of the gastroesophageal veins.

Transhepatic obliteration of gastroesophageal varices: results in acute and nonacute bleeders

Seventy-three patients with hepatic cirrhosis and bleeding gastroesophageal varices underwent transhepatic portal vein catheterization and variceal obliteration. Gastroesophageal varices were successfully obliterated in 32 patients actively bleeding and in 35 patients with stabilized bleeding gastroesophageal varices. The remaining six were technical failures. Follow-up examinations in 10 patients from 1 month to 3 years later showed persistent obliteration of embolized veins. Recurrence of variceal bleeding occurred in nine patients. This method should be considered as a palliative, effective adjuvant to the medical treatment of patients with bleeding gastroesophageal varices.

Pitfalls in transhepatic portography

Difficulties commonly encountered in transhepatic catheterization of the portal vein and interpretation of portograms are discussed. A long-sleeved trocar is recommended. Curved guide wires and deflector assemblies may assist in superselective catheterization of the tributaries of the portal vein. The judicious use of embolic material (small volumes, slowly injected) should guarantee the success and safety of this technique. Transhepatic obliteration of the gastroesophageal veins is a relatively simple and usually successful form of palliative treatment for actively bleeding and stable gastroesophageal varices. Thoroughness of the embolization procedure and of interruption of blood flow in the gastroesophageal veins is necessary to prevent early recurrence of bleeding.

An angiographic approach to hepatobiliary diseases

Abdominal aortography and celiacomesenteric angiography preceded or followed by cholangiography and portography provide the most comprehensive approach and thorough angiographic evaluation of hepatobiliary-pancreatic diseases. Transhepatic catheterization and subsequent embolization of gastroesophageal veins are of great value in actively bleeding, as well as in stable, varices. Exit embolization of the needle tract minimizes the possibility of the leakage of blood or of bile.

Why every renal mass is not always a surgical lesion, the need for an orderly, logical, diagnostic approach

The fact that approximately 95 per cent of asymptomatic renal masses are benign is a compelling reason for the streamlined diagnostic approach which is described herein. Within the confines of these guidelines for the study of renal masses, when proceeding from simple to complex methods of evaluation, one should always consider the age of the patient, the status of the cardiovascular system, the radiologic appearance of the mass on drip infusion nephrotomography and the results of renal echography as qualifying determinants and then propose the logical sequence of individualized studies under the best possible circumstances.

Arteriographic bleeding: a new sign

A new sign of arteriographic bleeding, diastolic clearance of angiographic contrast medium selectively from the bleeding vessel, is described. The use of this sign must be confined to rapidly bleeding end-vessel distributions or when nonopacified collateral circulation is not a consideration. It should not be confused with the normal washout of contrast substance in areas of multiple parent vessel collateral circulation where intermittent opacification is a normal feature.

Selective catheterization of the portal vein and its tributaries. Preliminary report

The portal vein and its tributaries were selectively catheterized in 90 patients. Only one complication required surgery. This technique not only provides information about the status of the portal circulation and liver parenchyma but can also be used in the treatment of bleeding esophageal varices by selective embolization of autologous clots or inert material.

Properties of noninfectious and transforming viruses released by Murine sarcoma virus-induced hamster tumor cells

The cell culture lines HTG2 and HTG3 were established from a transplantable hamster tumor induced by a murine sarcoma virus (strain Gz-MSV) after 17 and 60 in vivo passages, respectively. The viruses released by these two cell lines markedly differ in morphology, antigenic composition, infectivity, transforming ability, and enzymatic activity. HTG2 virions contained the sarcoma genome but were noninfectious for mouse and hamster cells (S+H-virus). HTG3 virions transformed hamster but not mouse cells. Whereas HTG2 cells and its virus contained murine type C virus gs-1 antigen, all HTG3 clonal lines expressed both murine and hamster type C virus gs-1 antigens. The RNA-dependent DNA polymerase activity of HTG2 virus was very low, whereas that of HTG3 virus was relatively high. HTG2 virions contained electron-lucent centers only. HTG3 virus consisted of the expected mixture of virions with electron-dense and electron-lucent centers. Many broken or incomplete virions were present in both viruses. HTG2 virus is a noninfectious "defective" sarcoma virus without detectable helper virus. Data obtained in these experiments suggest that HTG3 virus is a hamster type C virus pseudotype of Gz-MSV (Gz-MSV [HaLV]). The genome of Gz-MSV is capable of antigenic expression in heterologous cells and in the presence of heterologous viruses. Attempts to chemically activate hamster type C virus (HaLV) from HTG2 cells were unsuccessful. The HTG1 cell culture line, established from another Gz-MSV-induced hamster tumor, initially released a virus indistinguishable from the HTG2 virus. After in vitro passage, spontaneous activation of HaLV occurred in HTG1 cells, and the resultant Gz-MSV (HaLV) had properties similar to those of the HTG3 virus.

Tumour regression and relapse in mice inoculated with murine sarcoma virus (Moloney)

The oncogenic effect of the virus was tested in mice of different strains and ages. Local sarcomas were induced in all mice, although strain, age or dose dependent variations were found. 4 forms of development occurred: progressive lethal; lethal but long persistent; complete tumour regression; tumour recurrence after regression. Virus activity was highest in the progressively-growing and in the recurrent tumours, while in the long-persistent tumours or in tissue at the site of regressed tumours, little or no virus could be detected.