The effect of ceruletide on the small bowel transit time of barium sulfate suspension was studied in 165 patients. The control group consisted of 115 cases. An intramuscular injection of 500--750 ng/kg body weight ceruletide was given in 106 cases (group A), 20 ng/kg ceruletide was intravenously injected in 35 patients (group B), and 40 ng/kg was intravenously injected in 24 cases (group C). The mean transit time in group A was 62 +/- 41 min (mean +/- SD), and 126 +/- 62 min in the corresponding control group of 83 cases. (P less than 0.001). The mean transit time in group B was 65 +/- 50 min, and 69 +/- 56 min in group C, whereas in the corresponding control group of 32 cases the mean transit time was 137 +/- 79 min (P less than 0.01). A normal radiographic pattern was found in 75%, and slightly increased segmental contractions in 21%. Overtonicity and pronounced segmental contractions were seen in 4%. The recommended standardized small bowel study using ceruletide reduces the examination time by roughly one-half and produces simultaneous and uniform opacification of the jejunum and ileum.
The results of pharmacoangiography using angiotensin were compared with the findings in 101 patients during selective angiography of the kidneys (48 cases), the pancreas and liver (46 cases) and of peripheral soft tissue lesions (7 cases). Angiotensin in a dose of 0.5--l mug (renal artery), 1--5 mug (coeliac artery) and 5--10 mug (peripheral vessels) was found to be a constant and potent vaso-constrictor in 99% of cases. Intraarterial injection of angiotensin improved evaluation in 18 out of 27 cases (66%) with a final diagnosis of a tumor, in 18 out of 22 patients (77%) with cysts and in 16 out of 24 (66%) with an inflammatory process. In three out of 27 cases (11%) an angiographic diagnosis was possible only after using pharmacoangiography. The use of angiotensin represents a valuable possibility of clarifying otherwise uncertain angiographic diagnoses. This is particularly the case where superselective catheterisation is impossible.
Techniques of hepatic vein catheterization, hepatic venous pressure measurement, and occlusion phlebography using a balloon catheter are described. Hepatic venous pressure measurements (n=95) and hepatic occlusion phlebography were combined in 32 cases. In patients with liver cirrhosis (n=63) a significant elevation of hepatic venous pressure gradients was found. A decrease of the pressure gradient was seen after portacaval and splenorenal shunt operations. Hepatic occlusion phlebography showed alterations of hepatic veins only in patients with cirrhosis. A rough correlation between pressure gradients and the extent of changes in the liver veins was found. Hepatic occlusion phlebography, in patients who had undergone shunt procedure, demonstrated various collaterals. Combined hepatic vein pressure measurements and hepatic occlusion phlebography using a balloon catheter are proposed as a very suitable method for the evaluation of chronic liver disease and portal hypertension.
Occlusion arteriography using flow-directed Swan-Ganz balloon catheters is a safe and simple method, which opens up new technical, diagnostic, and therapeutic possibilities. Since 1976, occlusion arteriography with double-lumen Swan-Ganz balloon catheters and a percutaneous introducer system has been performed in 315 patients. The following advantages were found: (1) simplification of selective and subselective catheterization due to the flow-directed positioning of the balloon-tipped catheter; (2) high contrast of the arterial phase of the angiogram and demonstration of the smallest arteries as a result of a brief, complete occlusion of the main vessels ("standstill arteriogram"); (3) early and optimal demonstration of the corresponding venous system, especially optimization of the indirect splenoportogram and mesentericoportogram; (4) reduction of the volume of contrast agent usually needed for diagnostic reasons; (5) reliable and complete blockade of the tumor-feeding artery during transcatheter embolization with particulate substances; (6) reliable and complete blockade of the feeding artery as a preoperative protective measure in tumor nephrectomy and splenectomy.
Using new puls sequences MRI is superior to CT in the differential diagnosis of renal tumours. MRI is superior to CT in the differentiation between complicated cysts and cystic or hypovascular renal cell carcinomas.
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