Direct closure (DC) of eyelid defects has been retrospectively shown to give excellent outcomes. We present prospective outcome data as further evidence to promote its wider use. A consecutive, unselected, series of patients undergoing eyelid tumour resection was studied prospectively. DC was attempted at the time of biopsy in all of them. If DC proved impossible, delayed reconstruction using other techniques was later performed. Defect size, pre- and post-operative palpebral aperture (PA) measurements and the final visit patients’ and surgeons’ satisfaction scores for function and appearance were recorded. Seventy-three eyelids of 70 patients were studied. Mean resected specimen width was 16.4 mm (4–26 mm) in the DC group, versus 23.9 mm (11–42 mm) for other, non-DC reconstructions. Primary DC was achieved in 74% of this cohort. Mean final post-operative PA measurements in the DC group were 0.7 mm vertically (p = 0.003) and 0.8 mm horizontally (p = 0.009) less than preoperatively, but there was no statistical difference (p = 0.1) in the final horizontal measurements between the operated and un-operated sides in the DC group. DC satisfaction scores were excellent for both eyelid function and appearance. DC of eyelid defects, irrespective of per-operative PA distortion, gives excellent late post-operative outcomes. We recommend that DC, aligning the closure tension parallel to the lid margin, is attempted whenever wound margin approximation is possible in preference to alternative reconstruction techniques, regardless of any temporary PA distortion and globe displacement that this may cause. Eyelid function and appearance recover to near normal within 2 months.

Two patients with sudden onset of acute abdominal pain caused by embolic disease of the superior mesenteric artery (SMA) were evaluated angiographically. In one patient, the study was performed soon after the clinical onset of symptoms, and successful treatment with low-dose topical streptokinase infusion produced total lysis of the clot over a period of 30 h. In the second patient, the angiogram was obtained 6 days following the initial episode of pain. Radiographic and clinical findings indicated advanced gastrointestinal ischemia with bleeding which contraindicated the use of fibrinolytic therapy. Surgical resection of infarcted intestine was required. Early angiographic detection of acute mesenteric thrombus or embolus is crucial for the selection of patients for fibrinolytic therapy. Our cases suggest that with early diagnosis, streptokinase infusion is an alternative to surgical management of selected patients with acute mesenteric ischemia.

A widened mediastinum was found on chest radiography following blunt chest trauma. Aortography alone could not adequately determine the etiology of the radiographic findings; on computed tomography (CT) benign mediastinal widening was confirmed owing to accessory hemiazygous continuation of a left inferior vena cava (IVC), with communication to the left brachiocephalic vein through an enlarged left superior (highest) intercostal vein. This unusual anatomic variant and its radiographic finding are reviewed, as well as the complementary role of CT in the evaluation of the traumatized thoracic aorta and mediastinum.

INTRODUCTION:Sexually transmitted diseases are the most often registered communicable diseases in a great number of countries. The aim of this study was to analyze dynamics and distribution of gonorrhea, syphilis and scabies in Vojvodina region during the last twenty years.MATERIAL AND METHODS:Epidemiological characteristics of gonorrhea, syphilis and scabies were analyzed on the basis of data obtained from the Section of Epidemiology of the Institute of Public Health in Novi Sad. The research included the period between 1980 and 1999, with sex and age distribution of patients. Morbidity rates were given per number of inhabitants of Vojvodina.RESULTS:In the period between 1980-1999 there were 454 registered patients with the diagnosis of syphilis in Vojvodina. The morbidity ratio was highest in 1980 (3.41/100.000), and lowest in 1991 (0.24/100.000). In the twenty-year period there were more patients with gonorrhea, than patients with syphilis. There were 44.621 registered patients with gonorrhea. The maximum morbidity ratio was in 1980 (25.09/100.000), but the minimum was in 1998 (1.68/100.000). Within the examined period scabies was recorded in 56.490 patients. The highest morbidity ratio was in 1984 (232.37/100.000) and the lowest was in 1992 (73.56/100.000).DISCUSSION:The average morbidity ratio of syphilis in USA, between 1992-1994, was 11.8/100.000 and at the same time in Vojvodina it was only 0.42/100.000. In Vojvodina most patients with this disease were 20-39 years old. In the same period in USA the ratio of gonorrhea patients was 309/100.000 and in Vojvodina it was 2/100.000. In this group also, most patients were 20-39 years old. However, scabies mostly appeared at the age of 7-14.CONCLUSION:According to the obtained results, the number of registered patients with these three diseases in Vojvodina stagnates or it decreases. In order to deal with real data, it is necessary to report these diseases regularly.

Background Pancreatitis after biliary stenting is a rare complication. To reduce this risk, some endoscopists routinely perform biliary sphincterotomy before stenting, but the value of this practice is not established.Methods: The incidence of pancreatitis was reviewed in patients undergoing biliary stenting with and without a biliary sphincterotomy.Results: Postprocedure pancreatitis occurred in 4 of 83 (4.8%) patients treated with transpapillary biliary stents. Patients with proximal biliary strictures were at significantly increased risk for postprocedure pancreatitis (4 of 24) versus those with distal or no strictures (0 of 59) (p = 0.006). The four patients with pancreatitis after stenting had not undergone sphincterotomy. Of those treated conservatively, two cases were graded severe (one fatal), and one was mild. The other patient was markedly symptomatic from pancreatitis, but improved dramatically after treatment with a needle-knife sphincterotomy done within 24 hours of the original ERCP.Conclusion: The risk of pancreatitis following transpapillary biliary stenting is increased in patients with proximal biliary strictures. Such lesions (malignant or benign) may serve as a fulcrum, leading to medial deflection of the stent and compression of the pancreatic orifice. The hypothesis that sphincterotomy may decrease the risk of biliary stent-induced obstructive pancreatitis should be tested in patients with proximal biliary strictures.

PURPOSE: To report the preliminary results in a trial comparing the Amplatz mechanical thrombectomy (MT) device with surgical thrombectomy (ST) to declot occluded dialysis access grafts.PATIENTS AND METHODS: Thirty-seven patients were randomly assigned by computer to either ST (n = 18) or MT (n = 19), Diagnostic fistulograms were obtained at the end of the procedure, and Doppler ultrasound was performed at 1-month follow-up, Plasma free hemoglobin levels were measured before, immediately after, and 24 hours after the procedure in the MT group, Success was defined as initial success with restoration of flow through the graft, primary patency at 30 days, and secondary patency at 30 days.RESULTS: Technical success with MT was 89%. Primary patency in the MT series was 47% and secondary 30-day patency was 68%, Technical success with ST was 83%. Primary patency in the ST series was 77% and secondary patency at 30 days was 77%, Angioplasty (n = 18) and stent placement (n = 6) were performed in the MT cases, Angioplasty was impossible in one patient, Immediately after MT, plasma free hemoglobin levels above normal were noted in 63% of the cases, but these levels were within normal levels after 24 hours in 88% of the cases.CONCLUSION: Initial success of MT in patients with occluded dialysis access grafts is comparable to that of ST, No statistically significant differences in primary or secondary patencies were seen

Bullet emboli to the heart are rare and are typically treated by operative extraction through a median sternotomy and cardiotomy. This report details the case of an 18-year-old male who sustained two gunshot wounds, one of which lodged in his left renal vein. At laparotomy, the bullet embolized to the right atrium via the inferior vena cava. Under fluoroscopic guidance the bullet was retrieved with a snare introduced percutaneously through the right internal jugular vein. Sternotomy and possible cardiopulmonary bypass were avoided.

PURPOSE: To determine the feasibility of using the Amplatz thrombectomy device (ATD) to treat massive pulmonary embolism (PE).PATIENTS AND METHODS: Five patients (four men, one woman; mean age, 45.2 years) with massive PE underwent mechanical thrombectomy with the ATD, which creates a vortex that pulverizes and recirculates the clots within the pulmonary circulation. The patients were followed up for 7-18 months after thrombectomy.RESULTS: Marked improvement in pulmonary perfusion was observed in one patient and moderate improvement was observed in three patients at angiography and ventilation-perfusion scanning. No changes could be assessed in one patient who died shortly after the procedure. One patient developed hemoptysis during the procedure, most likely because of a reperfusion syndrome. A reduction in pulmonary artery pressure was observed in only one patient; the remaining patients had increased pressure. The four surviving patients were discharged within 8 days.CONCLUSION: Mechanical thrombectomy with the ATD provides rapid debulking of thrombus in some patients with massive PE and has the potential to improve treatment and outcomes of the most sick patients.

To describe the spectrum of radiologic findings in crutch-induced axillary artery injury and the effects of its unique pathophysiology on diagnostic evaluation and treatment.

A retrospective review of 20 adult patients with splanchnic venous obstruction secondary to chronic pancreatitis was performed to identify factors important in the preoperative diagnosis and operative management of this disorder. Fifteen patients with isolated splenic vein obstruction, four with portal occlusion and one with isolated inferior mesenteric vein occlusion were studied. Chronic alcoholism was the etiology of the pancreatitis in 18 patients; two patients had a Type IV hyperlipidemia. Four patients with massive hemorrhage from gastric varices were treated with splenectomy. Most patients presented with complaints of chronic pancreatitis, requiring pancreaticojejunostomy to treat the underlying pancreatic disorder. Splenic artery inflow control was obtained preoperatively in six patients and offers a technique that is beneficial in decreasing operative blood loss. The dynamic computerized tomography (CT) scan was a valuable diagnostic tool in identifying splanchnic venous obstruction although selective angiography is required for confirmation of the diagnosis.

Two new cases of popliteal venous aneurysm, confirmed with findings from venography, are added to seven previously reported cases revealed in the authors' search of the English-language literature. This rare anomaly usually shows as recurrent pulmonary emboli in patients with no underlying predisposition to deep venous thrombosis. Physical examination is usually not helpful in the diagnosis. Results of combined real-time and Doppler ultrasound should indicate the diagnosis, but venography is necessary for confirmation and further anatomic detail. Surgical treatment has been fraught with complications. Eight patients, including these two new cases, have undergone surgery, and none have had a recurrence of pulmonary embolism following surgery.

This is a prospective analysis of 351 patients in two distinct groups undergoing ascending phlebography, impedance plethysmography (IPG), and/or phleborheography (PRG) within the same 24-hour period. One hundred twenty patients also had a 125I-fibrinogen uptake test (RFUT). The two patient groups consisted of the following: those patients evaluated because of suspicion of deep vein thrombosis (DVT) (diagnostic) and those patients at high risk for postoperative DVT (total joint replacement) who had routine noninvasive testing and ascending phlebography (surveillance). The overall sensitivities for IPG and PRG were significantly better in the diagnosis group (71% [69 of 97 patients] and 78% [82 of 105], respectively) compared with the surveillance group (20% [14 of 71] and 27% [17 of 63], respectively) (p < 0.0001). The sensitivities for IPG and PRG detecting proximal (A/K) thrombi was 83% (68 of 82 patients) and 92% (79 of 86) in the diagnosis group compared with 32% (11 of 34) and 33% (9 of 27) in the surveillance group (p < 0.0001). Although there was no difference in overall incidence of DVT between the diagnosis group (56%, 118 of 212 patients) and the surveillance group (55%, 76 of 139), the results can be explained by the difference in A/K thrombi (84% [99 of 118] and 47% [36 of 76]) (p < 0.001) and occlusive A/K thrombi (84% [58 of 69] and 23% [7 of 31]) (p < 0.0001), respectively. Of the patients with A/K thrombi, 97% (67 of 69) in the diagnosis group had hemodynamically detectable thrombi compared with only 48% (12 of 25) in the surveillance group (p < 0.001). Combining the RFUT with the noninvasive studies for surveillance significantly improved the sensitivity for both A/K and distal thrombi. Patient selection also appears to have a significant influence on the results of the combination of IPG and RFUT when the current surveillance group is compared with similarly performed studies in a previously reported diagnosis group. The location and magnitude of thrombi in any patient population can be skewed depending on indications and timing of testing, thereby significantly affecting the sensitivity of noninvasive tests. IPG and PRG are reliable for evaluating patients with suspected DVT. However, patients with postoperative DVT have a high incidence of nonocclusive thrombi. Because noninvasive hemodynamic tests cannot identify accurately postoperative DVT, they cannot be used to generate epidemiologic data or as end points for studies evaluating efficacy of prophylaxis in patients undergoing total joint replacement, and anatomic studies of the deep venous system continue to be required. (J VASC SURG 1988;7:40-9.)

Mediastinal widening on a chest X-ray associated with chest trauma is a sign of possible traumatic aortic rupture. This paper presents a case of left-sided vena cava which mimicked an aortic rupture on chest roentgenogram. Contrast CT scan demonstrated the anomaly as the cause of the abnormal plain film.

HomeRadiologyVol. 164, No. 3 PreviousNext LettersTranscatheter embolization in the management of pulmonary hemorrhage.I VujicI VujicI VujicPublished Online:Sep 1 1987https://doi.org/10.1148/radiology.164.3.3615896MoreSectionsPDF ToolsAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookXLinked In Article HistoryPublished in print: 1987 FiguresReferencesRelatedDetailsRecommended Articles RSNA Education Exhibits RSNA Case Collection Vol. 164, No. 3 Metrics Altmetric Score PDF download

Successful percutaneous replacement of the venous limb of a LeVeen peritoneovenous shunt with the use of angioplastic technique is reported. This method may be a first line of treatment in patients with intractable ascites and a failing shunt caused by chronic occlusion of the superior vena cava.

An unusual case of unintentional release of a spring coil into the superior mesenteric artery is reported. The coil migrated distally into the ileocolic artery, and the situation was successfully resolved by retrieval of the coil with grasping forceps.

Failure to visualise the intra-abdominal portion of the inferior vena cava (IVC) using contrast-enhanced computed tomography (CT) is unusual. A review of 1272 contrast-enhanced abdominal CT examinations revealed that the IVC was not visible at one or more levels in only 132 (10.4%). In 57 (43%), non-visualisation was due to pathological processes, most frequently metastatic carcinoma, causing compression or thrombosis of the IVC. In the remainder, technical factors or artefacts could explain the non-visualisation. Techniques and procedures to improve visualisation of the IVC are discussed. Failure to visualise the IVC on CT at any level unexplained by artefacts is abnormal.