摘要:

A number of different materials are used for transcatheter embolization because no single substance is suitable for all situations (Berenstein and Krischeff, 1979). In general, it should be possible to control the depth of vessel penetration and to avoid remote embolization or reflux. The material should have low histo-toxicity and be easy to deliver. In addition, liquid emboli need to have low viscosity to pass easily through fine catheters; to be radio-opaque, produce permanent occlusion, have a short setting time and not adhere to the delivery catheters.Bucrylate (isobutylcyanoacrylate) fulfils, or can be made to fulfil, these conditions. As it is difficult to handle, preliminary laboratory and animal studies are essential. Complications are caused by reflux of emboli or excessive penetration of the capillary bed (Whiteet al., 1977; Greenfieldet al., 1978;Lanceteditorial, 1978). Our animal study shows that circulatory flow control is highly desirable when using liquid emboli (Fig. 1).We used a circulatory model to show that a 1:1 v/v suspension of bucrylate and Pantopaque (iophendlate) is suitable for trans-catheter embolization. This suspension is homogeneous and stable and sufficiently opaque to be visualized on fluoroscopy, and its viscosity is low enough for delivery through fine catheters. Pantopaque facilitates the delivery of bucrylate by retarding its polymerization (Cromwell and Kerber, 1979).

DOI:10.1259/0007-1285-54-644-671

出版商:The British Institute of Radiology    

年代:1981

数据来源: WILEY

摘要:

Single-photon emission tomographic imaging subdivides into two classes of technique: transverse-section computed tomography and longitudinal-section tomography. Longitudinal tomography can be achieved by combining a gamma camera with a spatially or time coded aperture or with a segmented multiple-pinhole collimator (Budinger, 1980). Longitudinal imaging using the latter type of collimator generates spatially distinct camera images. The reconstruction of longitudinal sections from such non-overlapping images does not necessitate decoding of an aperture function. Instead, reconstruction proceeds by iteration and, in principle, provided criteria for depth resolution are met, complete decoupling of reconstructed planes (blur-free imaging) results. For identifying lesions the absence of blurring artefacts is a great advantage over coded aperture imaging in which it is difficult to completely decouple planes (Webbet al., 1978); additionally, multiple-pinhole tomography can quantitatively map out the uptake of a radionuclide in organs and tumours. To date several workers, notably including Vogelet al.(1978, 1979), have concentrated on the development and application of a seven-pinhole aperture for myocardial imaging. Limited by a very small field of view, the seven-pinhole aperture has not found wider application in nuclear medicine. In this note an imaging technique based on the use of an aperture comprising three pinholes arranged in a triangle is proposed which overcomes this limitation and can lead directly to an extension of quantitative, completely decoupled, longitudinal tomography into other important fields of nuclear medicine.

DOI:10.1259/0007-1285-54-644-673

出版商:The British Institute of Radiology    

年代:1981

数据来源: WILEY

摘要:

Duodenoscopic sphincterotomy is now well established as an alternative to surgical intervention for the management of bile duct obstruction. We describe a patient in whom initial failure of sphincterotomy, due to inability to cannulate a stenosed papilla, was overcome by initial dilatation of the papilla with a balloon catheter passed by the transhepatic route.A 79-year-old man underwent emergency cholecystectomy for empyema of the gall bladder. Operative cholangiography showed stones in the common bile duct; the duct was explored and stones were removed.Post-operative T-tube cholangiography showed three stones remaining (Fig. 1). Two attempts at duodenoscopic sphincterotomy failed; the papilla was small and firm, and could not be entered. The patient was discharged with the T-tube in place.

DOI:10.1259/0007-1285-54-644-678

出版商:The British Institute of Radiology    

年代:1981

数据来源: WILEY

摘要:

Biliary sludge is the term applied to the material causing layered ultrasonic echoes in the gall bladder. It may be due to thick or inspissated bile, multiple tiny non-shadowing calculi, pigment granules or cholesterol crystal formation, haemobilia, purulent bile or pus (Conradet al., 1979; Buschiet al., 1979; Fillyet al., 1980). The appearance usually has a medium-to-coarse echo pattern, shows a horizontal fluid/fluid interface, no acoustic shadowing and being gravity-dependent moves when the patient assumes an oblique or lateral decubitus position (Anderson and Harned, 1977; Conradet al., 1979; Fillyet al., 1980; Leopoldet al., 1976). The appearance of biliary sludge may be variable, however; movement under gravity may be very slow (Fillyet al., 1980); in empyema of the gall bladder diffuse echogenic densities may fill the gall bladder and show no gravity dependence or layering effect (Kane, 1980). Inspissation of bile in long-standing biliary obstruction may appear as a uniform solid mass lying in the position of the gall bladder (Weekset al., 1977).In this paper we report four cases of biliary sludge with an unusual appearance. The patients were referred with symptoms of gall-bladder disease or obstructive jaundice and in each case the ultrasonic picture suggested the presence of a sessile tumour arising from the gall-bladder wall.

DOI:10.1259/0007-1285-54-644-679

出版商:The British Institute of Radiology    

年代:1981

数据来源: WILEY

摘要:

Subcutaneous emphysema of gastro-intestinal origin is a rare occurrence, particularly when localized in the lower limb (Foxet al., 1978; Oettinget al., 1955). Until recently 51 cases of subcutaneous emphysema of gastro-intestinal origin have been reported and 23 of these were confined to the lower limb. To our knowledge the aetiology of this patient's soft tissue gas is unique.A 51-year-old male was admitted to our hospital on 3/10/79 complaining of left hip pain of five months' duration which had become more severe over the preceding three weeks. He was unable to weight bear for this period and for two days there had been swelling in the hip region.On examination, temperature was 37.9°C, pulse 88 per minute. Abdominal examination revealed mild tenderness deep in the left iliac fossa but there were no other abdominal signs or symptoms. On rectal examination, there was mild benign prostatic hypertrophy and tenderness and fullness of the left pararectal space. There was pain on movement of the left hip and swelling of the thigh. Hb. was 10.7 mg%, WBC 12600, glucose, urea and electrolytes within normal limits. Past history included asthma, for which the patient took Prednisone 5 mg t.d.s. and Ventolin via inhaler, appendicectomy and tonsillectomy.

DOI:10.1259/0007-1285-54-644-682

出版商:The British Institute of Radiology    

年代:1981

数据来源: WILEY

摘要:

Acquired giant diverticulum is an uncommon but well-recognized finding in patients with diverticular disease of the colon. Fifty-one cases have been reported so far in the English language literature (Kricunet al., 1980). In forty-eight cases the diverticulum arose from the sigmoid colon; in two from descending colon (Ferguson and Boinis, 1966; Kricunet al., 1980); but in only one case from the transverse colon (Sagar, 1973).A further case of a solitary giant diverticulum arising from the transverse colon of a patient with extensive diverticulosis is reported. Because of its situation high in the abdomen on plain radiographs the diverticulum was initially mistaken for a lesion arising from the upper gastrointestinal tract. Barium follow-through examination provided the correct diagnosis.A previously well 66-year-old male presented with a fourday history of constipation, upper abdominal pain and slight abdominal distension.

DOI:10.1259/0007-1285-54-644-683

出版商:The British Institute of Radiology    

年代:1981

数据来源: WILEY

摘要:

Large bowel pseudo tumours caused by adhesions and bands are rare but cause a diagnostic problem as they can mimic more serious disease. The lesions characteristically occur in the transverse and the sigmoid colon, the most important underlying cause being previous surgery. Pre-operatively the diagnosis cannot be made with certainty and if a pseudo tumour is considered, colonoscopy is recommended and may help avoid laparotomy. If the diagnosis is suspected because of negative findings at laparotomy, peroperative colonoscopy can avoid resection.A 60-year-old housewife had a recent onset of paraumbilical pain, constipation and rectal bleeding. She had undergone appendicectomy and Caesarian section 40 and 30 years ago respectively. Physical examination suggested a mass in the left iliac fossa, rectal examination being normal. Sigmoidoscopy revealed traces of blood in the upper rectum and carcinoma or diverticular disease of the colon were considered in the differential diagnosis. Barium enema showed one segment of deformity with mucosal irregularity in the distal transverse colon, and another segment of narrowing in the sigmoid colon (Figs. 1 and 2). The sigmoid lesion showed thumb-printing of the lateral wall suggestive of local ischaemia (Fig. 3). Such areas did not alter with 0.5 mg glucagon IV and the appearance of the transverse colonic lesion suggested a carcinoma.

DOI:10.1259/0007-1285-54-644-685

出版商:The British Institute of Radiology    

年代:1981

数据来源: WILEY

摘要:

The finding of cystic abnormalities in the fetal abdomen is being increasingly reported. Double cystic structures in the fetal abdomen are typically seen in duodenal atresia (Gee and Abdullah, 1978). A similar appearance may be produced by bilateral hydronephrosis (Hately and Nicholls, 1979). Similar appearances have also been reported in a case of a choledochal cyst (Dewburyet al., 1980).We report a case where multiple small cysts, which later proved to be lymphangiectasia in the mesentery of the small bowel, were seen filling the fetal abdomen. This is an extremely rare condition, and, to our knowledge, no similar case has been previously reported in the literature of either surgical pathology or diagnostic radiology.A 23-year-old primigravida at 33 weeks' gestation was referred for ultrasound examination with a history of slight vaginal bleeding. The examination showed a single live fetus consistent in size with dates. A right antero-lateral placenta was shown in the upper segment. In addition, it was noted that the fetal abdomen was filled with small cystic spaces (Fig. 1). The vaginal bleeding subsided with conservative management, and the pregnancy proceeded normally.

DOI:10.1259/0007-1285-54-644-687

出版商:The British Institute of Radiology    

年代:1981

数据来源: WILEY

摘要:

Factors implicated in the aetiology of acute pancreatitis include biliary tract disease, alcohol abuse and abdominal trauma (Imrie and Whyte, 1975).Reported is a case of hyperparathyroidism due to a solitary parathyroid adenoma, diagnosed by computerized tomography (CT) but which presented as acute pancreatitis.A previously healthy 20-year-old male was admitted with a 24-hour history of severe constant central abdominal pain and vomiting. There was no history of biliary disease, alcohol abuse or abdominal trauma. On examination he was flushed and toxic with a tachycardia of 114 per minute. He was extremely tender with guarding in the epigastrium and right hypochondrium; bowel sounds were normal.Plain radiographs of the abdomen were normal, haemoglobin was 16.2 g% and total WBC was 17700. Serum amylase was grossly elevated (4500 i.u./l), albumin was low (34 g/l), calcium markedly raised at 3.45 m.mol/l (corrected to 3.65 m.mol/1 for albumin), and phosphate correspondingly reduced at 0.69 m.mol/1. A diagnosis of acute pancreatitis associated with hypercalcaemia was made and he was treated conservatively.

DOI:10.1259/0007-1285-54-644-689

出版商:The British Institute of Radiology    

年代:1981

数据来源: WILEY

摘要:

Since 1911, when Shenton described the radiological alterations in the hip in cases of tuberculosis (Shenton, 1911), all radiologists have used Shenton's line when diagnosing pathological conditions of the hip (Fig. 1).

DOI:10.1259/0007-1285-54-644-691-b

出版商:The British Institute of Radiology    

年代:1981

数据来源: WILEY