Radiology
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Use of a power injector to deliver contrast material intravenously for computed tomography is a safe alternative to a bolus or drip infusion technique. The authors performed 5,280 injections at rates of 0.5-5.0 mL/sec. Six extravasations occurred, and none resulted in long-term sequelae. This complication rate is 0.1%.
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A case of mediastinal angiolipoma in a 63-year-old man is described. A computed tomographic scan of the thorax demonstrated a large encapsulated mass with fatty and soft-tissue components near the esophagus. ⋯ However, at surgery a benign noninfiltrating angiolipoma was found and removed. To the authors' knowledge, angiolipomas have not previously been reported to occur within the mediastinum.
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Acute upper-extremity arterial occlusion may be due to embolic phenomena or de novo thrombosis. If the occlusion is left untreated, claudication or ischemia necessitating amputation can occur. Operative Fogarty-balloon embolectomy has been the treatment of choice for this entity. ⋯ A single significant groin hematoma was seen. Neither stroke nor death occurred in any case, and no amputations were necessary. Local transcatheter intraarterial administration of urokinase can be considered a first-line treatment for brachial artery embolus and other causes of acute upper-extremity arterial occlusion.
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Celiac plexus block with alcohol was performed to relieve pain in 124 patients with abdominal malignancies. A transaortic technique was employed in which a single needle was advanced from a left posterior paramedian approach through the aorta to deposit anesthetic agent directly onto the celiac plexus. ⋯ No major hemorrhagic or neurologic complications were encountered. The transaortic method of celiac block is as effective as, easier to perform, and may be safer than the classic two-needle technique.
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A retrospective review of the transvaginal sonograms of 50 women with laparoscopically confirmed ectopic pregnancy was performed to determine whether certain sonographic findings can be detected to confirm the diagnosis. Forty-seven of the 50 pregnancies were tubal. ⋯ In each case in the series, at least one abnormal uterine, adnexal, or peritoneal finding was detected at transvaginal sonography. Because of its improved resolution of uterine and adnexal structures, transvaginal sonography is recommended as a means for detailed evaluation of patients suspected of having an ectopic pregnancy.