Eight patients with 15 symptomatic nonneoplastic congenital hepatic cysts underwent ultrasound-guided percutaneous aspiration and temporary injection of 99% ethanol into the cyst. All cysts were treated at least twice at the same sitting. The volume of alcohol injected varied from 20 to 100 ml, depending on the size of the cyst. A cure was usually achieved with one alcohol sclerotherapy treatment. Only minor side effects such as transient pain and temperature elevation occurred. No recurrences were found during a follow-up period of 12 to 32 months. The results indicate that aspiration and alcohol sclerotherapy is a feasible alternative to surgical intervention in patients with symptomatic nonneoplastic congenital hepatic cysts. We recommend it as the treatment of choice in cases with high surgical risk or polycystic liver disease.
The value of embolization in surgery for nasopharyngeal angiofibroma is a controversial matter. We analysed retrospectively the results of surgical treatment in ten patients with a nasopharyngeal angiofibroma, the last five of whom underwent pre-operative embolization with Gelfoam®. Embolization reduced the intraoperative blood loss at primary surgery from an average of 1510 ml in the non-embolized patients to 510 ml in the embolized patients and transfusions from an average of 4.4 units to none. Seven reoperations were performed on four non-embolized patients on account of tumour recurrence, while no recurrences were diagnosed among the pre-operatively embolized patients. Blood loss in the reoperations averaged 4065 ml, and transfusions 7.1 units. The results indicate that embolization is effective in reducing intraoperative blood loss and contributes to improved surgical results. We recommend it as a routine pre-operative adjunct to surgery for nasopharyngeal angiofibroma.
A case of infarction of the left testis secondary to transcatheter embolization of a malignant left renal tumor with absolute ethanol is presented. The mechanism producing this complication was due to the anomalous nature of the left testicular artery, originating from the left renal artery distal to the site of the balloon occlusion catheter. The importance of this anomaly is discussed and the literature reviewed.
The carotid body tumor is a rare and often familial glomic tissue tumor that is generally diagnosed angiographically as a high vascular tumor at the carotid bif~rcation.'-~ This tumor can also be seen with computed tomography and static gray-scale ultrasound."6 We present three carotid body tumors in two sisters with a real-time sonographic pattern that we consider to be typical for this lesion.
METHODDuring the ultrasonic examination the patient lay supine with her head hyperextended. A commercially available Toshiba SAL 20 A real-time unit with linear 5-MHz transducer was used, and transverse and longitudinal sonograms were taken.
CASE REPORTS
Case 1A 20-year-old woman who, 4 years earlier, had been operated on for a large right-sided carotid body tumor developed a tender and slowly enlarging mass at the left carotid bifurcation. Realtime sonography revealed an echo-poor, solid, and well-circumscribed mass measuring 13 mm x 22 mm at the left carotid bifurcation. The carotid branches were incorporated into the tumor (Figure 1). Intravenous digital subtraction angiography revealed a densely staining tumor at the left carotid bifurcation. There was widening of the crotch of the carotid bifurcation (Figure 2). At operation, a typical carotid body tumor was excised. The histopathologic diagnosis was paraganglioma. At a check-up 4 months later, there was no palpable mass.
We report a case of a giant renal hemangiopericytoma that was embolized preoperatively with ethanol. Ultrasound and computerized tomography showed multiple smooth-walled cysts within the tumor. The tumor itself was hypervascular and a vascular pattern specific for hemangiopericytoma was noted upon reinterpretation of the angiograms. The diagnostic and therapeutic aspects are discussed, and the literature is reviewed.
The diagnostic significance of excretory urography, renal angiography, ultrasound and computed tomography for predicting the stage of tumours was evaluated by comparing their results with peroperative and histopathological findings. Thirty-nine out of 178 patients operated on for renal cell carcinoma from 1981 to 1988 were subjected to all four diagnostic procedures. The T stage was determined correctly by computed tomography in 80% of the cases, by ultrasound in 74.5%, by renal angiography in 64% and by excretory urography in 56.5%. Excretory urography did not give any significant additional information on the T category compared with the other imaging methods. Angiography is still of value in that it gives preoperative information on the collateral circulation and the number of renal arteries and their location.
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