Direct measurement of chlormethiazole extraction by liver, lung and kidney in man.

1 Chlormethiazole was used as a basal sedative for patients undergoing angiographic procedures. 2 Blood samples were drawn opportunistically to examine chlormethiazole extraction across liver, lungs and kidney. 3 Extraction across liver was typically 70-80% and apparently unrelated to input concentrations. Evidence for extraction across lung and kidney was inconclusive but these could each be approximately 20%. 4 Pharmacokinetics of chlormethiazole derived from compartment models were in accord with previous reports and were characterised by a high total body clearance (1-1.5 l/min). 5 Postural changes associated with the radiological procedures caused fluctuating blood concentrations which appear as noise in curve fitting procedures. 6 Pharmacokinetic properties derived from compartment theory cannot cope with these perturbations because of the restriction imposed by time averaging (i.e. mean clearances, half-lives and volumes are produced). Systematic studies of pharmacokinetic properties of perfusion-limited drugs such as chlormethiazole must be developed in such a way as to allow for independent variation of flow and extraction.

Fatal haematemesis from an aorto-oesophageal fistula of obscure aetiology: a case report.

Endoscopy, aortography and laparotomy failed to demonstrate a high aorto-oesophageal fistula of obscure aetiology in a woman presenting with haematemesis. Recognition of Chiari's triad: mid-thoracic pain, sentinel arterial haemorrhage, and final exsanguination after a symptom-free interval, and therapeutic embolization as a mode of therapy, are discussed.

Per catheter control of haemorrhage from the superior and inferior mesenteric arteries.

The relevant findings in 11 cases of per catheter control of haemorrhage from different sites in the large and small bowel are presented together with a description of the techniques and some of the possible complications of vasopressin infusion and gelfoam embolisation. In six of these cases vasopressin infusion was sus achieved by embolisation, three following the failure of vasopressin therapy. In one case embolisation of the ileo-colic artery produced a caecal infarct. Important differences in the vascular supply to the large and small bowel and their practical significance in embolisation are discussed.

Liver tumours and the contraceptive pill: Controversies in aetiology, diagnosis and management.

Six female patients seen at Groote Schuur Hospital between 1973 and 1977, with the types of liver lesion that have been linked aetiologically with the contraceptive pill, are described. Four had focal nodular hyperplasia (1 with spontaneous rupture), and 1 patient had a hepatocellular carcinoma. The sixth patient had spontaneous rupture of the liver but no tumour was demonstrated. Based on this experience and a review of the literature, controversies in aetiology, diagnosis and managment are presented. A defined management policy is proposed for the benign lesions, a less aggressive approach being advocated for focal nodular hyperplasia than for hepatic adenoma.

Angiography in the diagnosis and management of duodenal arteriovenous malformation. A case report.

A case of duodenojejunal arteriovenous malformation with repeated melaena without apparent cause on endoscopy and barium studies is presented. The importance of arteriography in the diagnosis and management is emphasized.

The accelerated diagnosis of jaundice with ultrasonography and narrow-needle cholangiography.

The accuracy of ultrasonography in the diagnosis of jaundice in 70 patients has been compared with that of transhepatic cholangiography and the results of surgery and liver biopsy. A simplified system of grouping the ultrasonic data is presented. The results indicate that ultrasonography is capable of differentiating obstructive from non-obstructive jaundice in 94% of cases and of defining the correct anatomical level in 85% of cases. The accuracy of narrow-needle cholangiography was 100% for obstructive jaundice and 66% normal duct entry rate for non-obstructive jaundice.

Percutaneous embolization for post-traumatic renal haemorrhage.

Treatment of post-traumatic renal haemorrhage by percutaneous embolization in 9 patients is reported. Successful control of haematuria was achieved in 8 patients and 1 patient was referred for surgery. The arteriographic findings and technique are described. One patient developed hypertension but there were no other complications. Super-selective renal arterial embolism can provide definitive therapy in renal trauma, and major surgery may be avoided in most cases.

Percutaneous embolization for the management of hepatic artery aneurysms.

The significant mortality and morbidity of hepatic artery aneurysms indicate the need for new approaches to therapy. Seven cases of intrahepatic aneurysms diagnosed by percutaneous arteriography over a 7-yr period are discussed. Three patients were treated surgically and 4 by percutaneous embolization. The latter method appears to enjoy certain advantages and it may prove to be the treatment of choice for this often fatal condition.

Percutaneous ureteral splinting.

Percutaneous ureteral splinting using a modified catheter technique is described, and experience in treating 5 patients (4 with postoperative fistulas and 1 with stricture) is reported. The method offers an effective alternative to surgery in achieving ureteral splinting and renal drainage.

Control of duodenal haemorrhage with cyanoacrylate.

Three cases of massive duodenal haemorrhage refractory to conventional therapy have been successfully treated by percutaneous selective intra-arterial injection of Isobutyl 2 cyanoacrylate. Case histories, injection technique and review of the literature are presented.

Percutaneous nephrostomy: techniques, indications, and results.

During the past six years at our institution, percutaneous nephrostomy has been utilized for temporary diversion of the upper urinary tract in 33 patients and 42 individual kidneys. Two techniques are described, one of which has been developed recently by one of us (A.R.G.). Indications and results, including complications, are discussed. In our experience this procedure has been found to be safe and highly useful in the management of selected patients who have unilateral or bilateral urinary tract obstruction from a variety of reasons.

Sialography: a simplified technique.

A simplified method of sialography is described. A wedged catheter tip positioned in the duct prevents backward leakage of contrast material into the oral cavity.