A bipolar radiofrequency catheter fails to occlude a feline uterine horn: A model for fallopian tube occlusion.

We developed a retrograde transvaginal-transcervical-transuterine sterilization technique capable of causing occlusive fibrosis and stricture in the human fallopian tube. The procedure is required to induce a lesion at the intramural-isthmic portion of the tube at sufficient depth to damage epithelium underlying the submucosa and inner muscular layer, without acute damage to the outer muscular layer and serosal surface. Nineteen nulliparous purpose-bred cats were induced and maintained in an anestrus state with testosterone cypionate 5 mg/kg intramuscularly and a 6-18-hour light-dark cycle. After laparotomy, all animals had focal radiofrequency lesioning of uterine horns. Ten of 30 treated uterine horns appeared grossly occluded at the time of sacrifice; however, histologic assessment demonstrated only 6 complete occlusions, and 4 horns showed lack of complete lumen occlusion with or without evidence of recanalization. Although no complications were encountered, bipolar radiofrequency failed to provide a consistent obstructive lesion in a tubular structure similar in size and morphology to the human fallopian tube.

Percutaneous transluminal stent placement to treat subclavian steal syndrome.

PURPOSE: To describe nonsurgical stent placement to treat subclavian steal syndrome after failure of traditional balloon angioplasty. PATIENTS AND METHODS: Seven patients with subclavian steal syndrome underwent diagnostic angiography, which showed four stenoses and three occlusions of the proximal left subclavian artery. Most patients presented with vertigo, left arm claudication, or syncope. Initial balloon angioplasty failed; there was elastic recoil with more than 30% residual stenosis or subintimal dissection. The three occlusions were treated with urokinase pulse-spray thrombolysis. All seven patients then underwent stent placement. RESULTS: Initial technical success was achieved in all seven cases (100%), with an average right versus left arm blood pressure gradient of 0 mm Hg (-11 to 12 mm Hg) at mean follow-up of 12 months (4-24 months) (positive gradient = systolic pressure of right arm > that of left arm; negative gradient = systolic pressure of left arm > that of right arm). Symptoms of arm claudication and syncope resolved, and vertigo improved or resolved after the procedure. There were no deaths, strokes, or emboli in the perioperative or follow-up period. CONCLUSION: Percutaneous transluminal stent placement may be an effective treatment of subclavian steal syndrome in patients with lesions that are refractory to traditional angioplasty.

Hemorrhagic myelolipoma of adrenal gland after blunt trauma.

A case of adrenal myelolipoma is reported in a patient in whom symptoms of hematuria and flank pain developed after the patient had sustained blunt trauma. Adrenal myelolipomas are usually found incidentally at autopsy. However, the symptomatic presentation of this patient was probably caused by traumatic intratumor hemorrhage. The etiology and pathogenesis of these tumors are discussed in relation to their occasional symptomatic presentation and to their differential diagnosis.

Angiographic management of retroperitoneal hemorrhage from renal angiomyolipoma in polycystic kidney disease.

Angiographic management of bilateral angiomyolipomas complicated by hemorrhage in autosomal dominant polycystic kidney disease is presented. The patient had mild stigmata of tuberous sclerosis, and a family history of tuberous sclerosis and autosomal dominant polycystic kidney disease. The radiographic features at diagnosis, and those present during and after embolization are described. Radiological criteria for diagnosis and successful control of bleeding with intra-arterial selective embolization are discussed. Radiographic features before, during and after embolization are exhibited.

MR and CT imaging of perirenal amyloidosis.

The radiographic findings of perirenal amyloidosis have not previously been described. A patient with multiple myeloma and primary amyloidosis (AL) with secondary hydronephrosis as examined on plain film, retrograde ureteropyelography, computed tomography, and magnetic resonance imaging is presented. This case illustrates perirenal amyloidosis and demonstrates the utility of CT and MRI in patient management and surgical treatment.

Retroperitoneal leiomyosarcoma: a rare cause of adrenal pseudotumor on CT and MRI.

Numerous causes of adrenal pseudotumors have been previously described based on computed tomography findings, (CT) with normal anatomical structures being more common causes than extraadrenal neoplasms. This case describes a rare retroperitoneal tumor: a primary vascular leiomyosarcoma arising from the renal hilus, which mimicked an adrenal malignancy on CT and magnetic resonance imaging.

Tracheoesophageal fistula: diagnosis with CT.

A baby with two lower cervical tracheoesophageal fistulas was evaluated with a barium esophagram and computerized tomography (CT). The esophagram identified both fistulas. Axial CT demonstrated the esophageal attachment of the upper fistula and completely displayed the lower fistula. A change in caliber of the esophagus from a collapsed to a distended state marked the site of the fistulas.

Infantile infectious sacroiliitis.

Two infants with pyogenic sacroiliitis are presented. In both babies, the clinical findings were initially attributed to septic arthritis of the ipsilateral hip. The correct diagnosis was not established in either infant until radionuclide scanning showed increased uptake in the ipsilateral sacroiliac joints. Both cases emphasize the importance of proceeding quickly to radionuclide imaging in the baby with clinical and laboratory findings of inflammation in the vicinity of the hip and a negative hip aspiration.