Imaging techniques in patients with biliary obstruction

The most frequent causes of cholestasis include choledocholithiasis and neoplasms (pancreatic head carcinoma, ampullary carcinoma, cholangiocarcinoma). The authors discussed imaging modalities currently applied in the diagnostics of patients with suspected obstruction biliary tract obstruction. Special attention was paid to the efficacy of these techniques in detecting the obstruction and determining its level and nature. In general, US or CT are first performed in patients with cholestasis. The use of percutaneous cholangiography and retrograde cholangiopancreatography is often limited to therapeutic interventions. Magnetic resonance offers images similar to both conventional cholangiography and computed tomography. This technique offers complex evaluation of bile ducts and other abdominal organs.

[Efficacy of spiral computed tomography in evaluation of renal arteries in patients with renovascular hypertension]

The aim of this study is an estimation of efficacy of spiral computed tomography (SCT) in evaluation renal arteries in patients with renovascular hypertension. SCT was performed in 54 patients (32 females and 22 males) by means of Picker PQ 2000. The thickness 4 mm, index 4 mm, pitch 1.0. Contrast agents-Uropolinum 75% or Ultravist 350 were applied automatically 3-4 mm/sec. with delay 20-22 sec. Secondary reconstruction with 2 mm leyers was performed by Maximum Intensity Projection (MIP). In all patients the abdominal arteriography was performed as a reference method. The coincidence of both methods in evaluation of renal arteries occlusion or stenosis was estimated by Cohen kappa coefficient. In addition, sensitivity and specificity of SCT were estimated.

RESULTS

Consistence of SCT and arteriography for right, left and additional renal artery were as follows: 0.914, 0.92, 0.85. Sensitivity and specificity SCT for rigt, left and additional renal artery were as follows: 95.5% and 95.8%, 96.5% and 95.8%, 50% and 100%. The highest efficacy of SCT was noted in ostium, the most difficult place in evaluation of renal artery during arteriography examination.

[Intrahepatic portocaval shunt as a new method for treating and prevention of bleeding from esophageal varices in portal hypertension]

The aim of this study was the presentation of percutaneous transjugular intrahepatic porto-systemic shunt (TIPS) and its place among the other methods of the treatment of esophageal variceal bleedings. In the period from June 1992 to December 1997, 31 cirrhotic patients with portal hypertension and recurrent variceal bleedings were submitted for TIPS. This group consisted of 14 female and 17 male patients, their age ranging from 17 to 68 years (average 52). According to Child-Pugh classification 4 patients represented group A, 11--group B and 16--group C. Each of these patient was admitted to our Department after recurrent bleeding, resistant to typical treatment: terlipressein infusion, balloon tamponade and endoscopic sclerotherapy. In 24 patients (78%) TIPS was performed successfully. In 7 cases TIPS was performed in candidates for orthotopic liver transplantation.

CONCLUSIONS

TIPS is quite new, nearly 10 years old method for portal decompression. It is an effective and less invasive method than surgical procedures in the treatment of portal hypertension, especially in Child-Pugh group B and C patients if the sclerotherapy is not effective. It protects cirrhotic patients waiting for liver transplantation against the esophageal bleedings.

[The use of iodinated contrast agents in neuroradiology]

The authors describe iodinated contrast materials, which are commonly used in neuroradiological applications. The adverse reactions after their, administration are discussed. The indications for safer, non-ionic contrast media are presented. The protocol of prophylactic treatment of high risk patients is also formulated. We present the contrast material protocol used at our institution for neuroradiology.

Problems of the Polish radiology in light of anticipated changes in the system of financing and organisation of the health care

The present condition of radiology in Poland is evaluated. The main issues are the organisation, equipment and system of undergraduate and postgraduate training in radiology. The positive phenomena such as integration of all imaging techniques, good training of radiologists in the area of conventional radiology, establishing a number of modern imaging centres and lively international contacts, are presented. In light of anticipated changes in the organisation and financing of the health care as well as the possibility of increasing the integration of the Polish radiology with the European system of health care, the following seems advisable: reducing the exposure of the population to X-rays, prompt replacement of X-ray units which have been in use for over 15 years, improved effectiveness and modernization of postgraduate training in radiology and improved organisation of work, especially proper utilisation of the equipment.

[Embolization of the branches of the external carotid artery]

Authors present their own experience with the embolization of the external carotid artery branches. The main indications to embolization included well vascularized and hemorrhagic brain tumors in facial part of the skull, mainly meningiomas, juvenile angiofibromas, and angioneuromyomas. Embolization of external carotid artery was performed in 15 patients. Complete impatience of blood vessel supplying the tumor was achieved in 12 cases, but it was incomplete in 3 cases. Single serious complication in the form of hemiplegia was noted. There were also mild complications in 5 patients, which did not require any intervention.

[Recanalization of occlusion of the peripheral segment of the femoral artery by the Kensey method]

The aim of the presented study was to analyse the surgical technique and results of recanalization of the peripheral segment of iliac artery with Kensey's technique. Altogether 16 patients were operated. Arterial patency was observed in 14 patients immediately after surgery. This number decreased to 11 after a 3-month follow-up. Complications in the form of perforation of the arterial wall, hemorrhage at the site of puncture and thrombotic lesions in the reconstructed arterial channel were seen in 4 cases. Authors' own experience suggests that Kensey's technique together with laser surgery are the treatment of choice in case of iliac arterial occlusion in patients, in whom classic surgery is contraindicated.

[Value of localizing examinations used in the diagnosis of primary hyperaldosteronism]

Localizing examinations were performed in 115 patients with the clinical and biochemical signs of the primary hyperaldosteronism between 1975 and 1978. Adenoma of the adrenal cortex was diagnosed in 52 examined patients out of whom 42 underwent surgery, and 12 were classified for the operation. The remaining patients, in whom a cause of hyperaldosteronism was not found, are treated conservatively and followed-up. It was shown that CT-scanning and scintigraphy of the suprarenal cortex are the most convenient techniques in the localization of tumours in patients with the primary hyperaldosteronism. Ultrasound is less valuable diagnostically but may help in tumour localization in about 50% of patients.