To facilitate catheter entrance into the stomach during percutaneous gastrostomy, we sutured a balloon to a nasogastric tube and inflated the balloon in the stomach. The balloon provides support and firmness for the compliant stomach, and prevents the gastric wall from being pushed away by incoming needles and catheters. The balloon frequently becomes palpable in the left upper quadrant and offers a good target fluoroscopically or sonographically. Trocar catheters were easier to insert when the target balloon technique was used, and trocar puncture shortened procedure time. The technique initially was developed in the laboratory and then tested in cadavers. Presently it is used with patients. To date, no specific complications have occurred with this procedure.
Benign hepatic tumors and peliosis hepatis developed in a patient who had received androgen therapy for three years. The tumors were identified by arteriography. Peliosis hepatis was diagnosed by wedged hepatic venography: to our knowledge, this method has not been previously used to diagnose this condition. Wedged venography, performed four months after withdrawal of androgen therapy and after liver function had nearly returned to normal, demonstrated morphologic improvement as well. On the basis of this case and other histologic descriptions of peliosis hepatis, we believe that wedged hepatic venography is a simple, sensitive, and specific diagnostic modality.
99m Tc-sestamibi myocardial perfusion imaging is frequently performed in conjunction with exercise or pharmacologic stress testing for evaluation of coronary heart disease. Interpretation of these studies includes systematic review of unprocessed rotating projectional images for evaluation of cardiac size as well as the presence of motion or attenuation artifacts. Occasionally, incidental noncardiac findings are detected on review of the projectional images. We report a case of a patient with a history of autosomal dominant polycystic kidney disease who was found to have a large abdominal photopenic area on the projectional images. The photopenic area corresponded to the location of large intraabdominal cysts on abdominal CT and was consistent with hepatic cysts associated with the patient's known polycystic kidney disease. We review the differential diagnosis of large abdominal photopenic regions identified on myocardial projectional images and the importance of routinely analyzing these images for incidental noncardiac findings. Inci dental noncardiac findings occasionally are detected on review of projectional 99m Tc-sestamibi myocardial perfusion images (1). Here, we report a case in which a large abdominal photopenic area was found on myocardial perfusion imaging in a patient with a history of autosomal dominant polycystic kidney disease. CASE REPORTA 69-y-old man was seen in our cardiology specialty office for evaluation of symptoms of shortness of breath with exertion and abnormalities found on a standard exercise test. He had experienced occasional symptoms of dyspnea with exertion during the past 3 mo. He denied symptoms of exertional or rest chest pain. His cardiac risk factors included a history of borderline hypertension and a family history of cardiac disease. The past medical history was significant for known autosomal dominant polycystic kidney disease. He had been found to have large renal and hepatic cysts on an earlier CT scan and was undergoing nephrology evaluation for moderate renal insufficiency.On physical examination the blood pressure was 121/82 mm Hg, the heart rate 72 beats per minute, and the respiratory rate 16 breaths per minute. The lungs were clear to auscultation. On cardiac examination, there was a regular rhythm with a soft systolic murmur at the left sternal border. On abdominal examination, there was mild diffuse distention without tenderness to palpation.The electrocardiogram showed sinus rhythm and nonspecific ST-T changes. A recent standard exercise treadmill stress test had demonstrated abnormal electrocardiographic changes at peak exercise in the inferior and lateral precordial leads.In light of the patient's symptoms and electrocardiographic abnormalities observed on standard stress testing, repeated treadmill stress testing was performed in conjunction with same-day stress-rest 99m Tc-sestamibi myocardial perfusion imaging. The patient reached an exertional level of 10 metabolic equivalents and 100% of maximum predicted heart rate without symptoms of chest pain. Abnorm...
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