Extraperitoneal, perivesical pelvic effusions may be hemorrhagic or uriniferous, the latter resulting from extraperitoneal rupture of the bladder or disruption of the posterior urethra. The effusions may be recognized on anteroposterior radiographs of the pelvis by (a) displacement of the bladder (small effusion); (b) obliteration of the normal soft-tissue anatomy within the pelvis (moderate effusion); and (c) upward displacement of the pelvic ileal loops and extension of the effusion into the flank stripes (large effusion). Perivesical effusions most frequently accompany anterior pelvic arch injuries, i.e., double vertical and Malgaigne fractures and fractures involving, or separation of, the pubic symphysis.
Insertion of a hooked stylet into the region of a mammographic abnormality is a simple method of localization prior to biopsy. The hook on the stylet does not permit movement of the localization device away from the lesion during the interval between placement and surgical excision. A xeroradiograph of the biopsy specimen determines whether the suspected region was obtained surgically.
The occurrence of cardiac failure during pregnancy is most often secondary to valvular heart disease. The additional cardiovascular strain resulting from the pregnancy is often sufficient to deconpensate the paLienL's already compromised cardiac status. Intensive medical therapy is often necessary to achieve completion of a successful pregnancy. On other occasions, a therapeutic abortion may be indicated. Future pregnancies are often contraindicated.The following case of cardiac failure became manifest during pregnancy. The cause of the cardiac failure was easily diagnosed and surgically correctable.High output cardiac failure developed during the pregnancy of a young female who was stabbed in the abdomen five years earlier. The patient remained asymptomatic for five years following the trauma.During the second trimester of four fourth post-trauma pregnancy, she developed symptoms of cardiac failure. An aortagram and a selective superior mesenteric arteriogram were done without difficulty. An angiographic diagnosis of a fistula between the superior mesenteric artery and vein was made. After surgical repair of the fistula, symptoms disappeared and she concluded her pregnancy with no further difficulty. CASE REPORT W. ''V. Gravida 7, Para 6 was admitted in her 18th week of gestation with complaints of easy fatigability and increasing dyspnea on exertion. Approximately five years previous to admission, the patient had received stab wounds in her abdomen. No exploratory laparotomy was performed. Following the abdominal trauma, the patient had three successful pregnancies. Physical examination revealed a scar in the left upper quadrant.An aortagram was performed via the right femoral artery using the Seldinger technique. This was followed by selective catheterization of the superior mesenteric artery. Because of the patient's pregnancy, only a limited number of exposures were made. Examination of the selective study revealed an arteriovenous fistula involving the first branch of the superior mesenteric artery with rapid filling of tortuous dilated veins. There was extremely rapid opacification of the portal vein following injection of the contrast medium into the superior mesenteric artery. It was interesting to note that there was a second phase of filling of the portal vein with contrast medium resulting from the normal arteriovenous circuit.
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