Angiographic diagnosis of leiomyomas of the small intestine

Leiomyomas of the small intestine were demonstrated by visceral angiography in a 54-year old man with recurrent episodes of severe gastrointestinal bleeding over a five-year period. Angiographic features were irregular vessels within the tumor and early opacification of prominent feeding and draining vessels.

Intestinal infarction complicating low cardiac output states

Nonocclusive mesenteric ischemia, leading into intestinal infarction, frequently complicates and causes the fatal outcome in otherwise treatable instances of low cardiac output states. Once intestinal necrosis occurs in these patients, the mortality is almost 100 per cent. A high risk group of patients in whom intestinal infarction occurs because of low cardiac output can be readily identified. A high index of suspicion for the occurrence of intestinal ischemia in these patients should facilitate recognition of the disease during its early stages. The disastrous results experienced by us and others warrant the use of more aggressive methods for the diagnosis and treatment of patients with this condition. A high index of suspicion in a recognizable group of patients observed by selective mesenteric arteriography affords a method for confirmation of the diagnosis of mesenteric vasoconstriction. Once the diagnosis is established, a patient management protocol program should be followed. Sustained infusion of papaverine into the mesenteric artery is useful in reversing mesenteric vasoconstriction. Additionally, the judicious use of celiotomy and intestinal resection, preceded and followed by the sustained infusion of papaverine into the superior mesenteric artery, offers hope for the survival of some of these patients and warrants further use.

Plain film findings in massive gastrointestinal bleeding

The admixture of blood clots and air in the lumen of the stomach or colon produces a bubbly radiolucency on plain films of the abdomen in some patients with massive gastrointestinal bleeding. In 10 patients this radiographic sign served as a clue to the site of bleeding. It is postulated that recognition of this sign on preliminary scout films may facilitate location of the bleeding vessel.

Cardiovascular involvement by invasive thymomas

We have observed 74 cases of thymoma from 1968 to 1974. Six cases of invasive (malignant) thymoma presented in an unusual fashion with signs and symptoms of cardiovascular disease and superior vena caval syndrome. The clinical, pathological, and roentgenographic features of these cases are presented. The literature concerning cardiovascular involvement by thymoma is reviewed and discussed.

Starch granulomatous peritonitis

An unusual case of recurrent starch granulomatous peritonitis that presented as a long-standing paralytic ileus is described and the literature pertaining to this unusual entity is reviewed. The roentgenographic finding of severe prolonged paralytic ileus usually developing late in the post-operative period should suggest the possibility of this disease.

Polyarteritis nodosa causing severe intestinal bleeding

Rupture of an aneurysm of the mesentergic artery caused severe intestinal hemorrhage in a 50-year-old woman with polyarteritis nodosa. Abdominal angiography not only established diagnosis of polyarteritis nodosa by demonstrating multiple visceral aneurysms but also localized the site of bleeding.

Carcinoma of the urachus

Characteristic roentgenographic and anatomical features of a mucinous adenocarcinoma of the urachus were observed in two patients. Both presented with a midline anterior abdominal mass in the supravesicular area. The tumor contained fine stippled calcification in one case. The cystogram demonstrated an irregular filling defect in the bladder dome in the other case. Ultrasonographic examination in one case was helpful in delineating the nature, size, and location of the mass in detail.

Jefferson fracture of the atlas. Report of six cases

Six cases of Jefferson fracture of the atlas are summarized. None had recognizable neurological signs that resulted from the injury when seen in the hospital. With conservative treatment, pain subsided and the fracture stabilized in a short period in all six patients. None of the patients underwent fusion of the cervical spine.

Portal vein thrombosis resulting in portal hypertension in adults

Attempting to elucidate the best way to treat adult patients with extrahepatic portal vein occlusive thrombosis, the experience with six such patients is analyzed. Portal vein thrombosis rarely occurs in adults but when it does, it frequently results in portal hypertension with its concomitant complications. Five patients had bleeding esophageal varices, two had massive refractory ascites. Their conventional liver function tests were not greatly altered. Thrombocytosis and history of thrombophlebitis were encountered in over half of the patients. Splenoportography is the best method to confirm the diagnosis preoperatively. In none of the six patients a decompressive portal systemic shunt could be performed although, it was attempted in five. Three patients survived. It appears that nonoperative management is the treatment of choice in these patients who can remain well for several years, however, when bleeding recurs gastric devascularization or even resective procedures are acceptable therapeutic alternatives.