Complications of cardiac catheterisation: a study

Serious complications of radiological examinations are relatively rare but cardiac catheterisation carries an inherent risk factor. The introduction of non-ionic contrast media has reduced the incidence and severity of reactions but the procedure of catheterisation itself is not without problems. A study has been made of patients undergoing routine, non-urgent cardiac angiography and coronary arteriography to assess the incidence of untoward effects related to the procedure and the contrast media. A comparison may be made between a conventional contrast medium and two new, low-osmolar contrast media.     

Complications of central venous catheterization.

The complications of central venous catheterization are discussed in a review of experience and of the literature. The anatomy surrounding the subclavian and internal jugular veins is described. Indications and contraindications of catheterization are reported. Common and unusual complications are discussed and illustrated. Laceration of pleura, subclavian artery puncture, hematoma, catheter malposition, fragment embolization, air embolism, venous thrombosis, and infection are included. The radiologist is responsible for recognizing immediate, as well as delayed, complications of central venous catheterization.     

Principles of cardiac catheterization

Cardiac catheterization, the insertion of catheters into the heart to measure pressures, obtain images and facilitate treatment, is a relatively new procedure and has evolved quickly into a critical diagnostic and therapeutic tool. This article discusses the history of cardiac catheterization, indications and contraindications for its use, catheterization equipment and procedures, patient follow-up and possible complications.     

Effective doses to patients from paediatric cardiac catheterization

The Council Directive of the European Communities 97/43/Euratom requires dose assessment, especially for X-ray examinations of children and if high doses to the patient are involved. Both these aspects apply in cardiac catheterization and angiocardiography of children. Effective doses are a good indicator of radiation risk, particularly for leukaemia. Effective doses have been determined for 2114 infants and children undergoing cardiac catheterization from 1984 to 1996 at the University Hospital in Essen. Conversion factors (effective dose/dose-area product) were calculated based on direct dose-area product measurements for posteroanterior (PA) and lateral (Lat) projections as well as on patient records and examination details. The factors are calculated for eight age groups of children, taking into account the X-ray tube voltage for fluoroscopy and cine-film sequences, with and without zoom mode. Frequency distributions are presented for 2114 patients, for dose-area product, number of angiographic examinations (each combined with one cine-film sequence both PA and Lat) and for calculated effective doses. Highest effective doses are found in newborns (18.0 mSv and 6.5 mSv 90th and 50th percentiles, respectively) compared with adolescents of 15-21 years (8.0 mSv and 3.0 mSv 90th and 50th percentiles, respectively). Effective dose for cardiac catheterization is highest for newborns, in spite of lowest measured dose-area products, because the decreased value of the conversion factors overcompensates for the increase of dose-area product with age. This is especially important because of the higher tumour risk for equal effective dose for young children compared with adults.     

Care of patients after cardiac catheterization.

In an effort to provide more definitive diagnosis for Air Force flyers referred to the USAF School of Aerospace Medicine, cardiac catherization has been performed, as indicated, on over 425 flyers since 1971. Since they are an apparently healthy and asymptomatic population, their recovery after cardiac catheterization is usually uneventful. However, the nurse must be able to recognize and interpret significant potential and/or existing post-catheterization complications. Nursing care of the patient after this procedure is essential to the successful completion of the test. Since any invasive procedure can lead to complications, quick and accurate nursing assessment and action are essential. The possible complications of cardiac catheterization which the nurse may encounter have been divided into possible causes, and a suggested plan of action. Reference tables are provided for each of the two main classifications, in an effort to provide quick guidance for the nurse responsible for care of the patients after catheterization.     

Magnetic resonance imaging in a military setting: a utilization analysis

A prospective study was conducted to evaluate the use of magnetic resonance imaging (MRI) by orthopedic surgeons and residents versus the use of MRI by non-orthopedically trained health care providers in diagnosing knee pathology. Fifty patients initially evaluated by members of one of these groups who underwent subsequent knee MRI evaluation were selected to participate. Two orthopedic examiners individually examined all patients, recording clinical diagnosis and the merit of MRI evaluation in each case. Clinical accuracy, sensitivity, and specificity were compared between groups based on MRI findings. Diagnostic accuracy was similar; however, the orthopedic group displayed greater sensitivity, suggesting better clinical assessment. The study examiners observed both groups using MRI equally inappropriately and found 62% of the imaging studies unjustified. We conclude that knee MRI is used inappropriately in the current military setting. An algorithm is proposed to guide the future use of MRI in the diagnosis and management of knee pathology.     

Should all patients undergo cardiac catheterization after a myocardial infarction?

Between one half and two thirds of patients who survive an acute myocardial infarction (AMI) may be at low risk for future complications and hence can be managed with medical therapy. However, the remaining patients are prone to future complications, which by and large occur within the subsequent 3 months and include cardiac death, recurrent AMI, unstable angina, and congestive heart failure. Current available methods for risk stratification include a good clinical evaluation, rest and stress electrocardiograms (preferentially combined with radionuclide imaging), and possibly two-dimensional stress echocardiography. In patients unable to exercise, pharmacologic perfusion scintigraphy affords a powerful means to identify high-risk patients. Patients deemed to be at high risk should be referred for cardiac catheterization and myocardial revascularization. The practice of performing routine cardiac catheterization after an AMI has led to an over use of resources in the United States. Such a practice is not based on any scientific evidence of enhanced benefit. In fact, in other Western world countries where only selected patients are referred for cardiac catheterization, patient survival appears to be similar to that in the United States. In conclusion, most patients after AMI, whether treated with thrombolytic therapy or not, can be managed conservatively and risk stratified on the basis of noninvasive testing, after which patients deemed to be at high risk should undergo invasive evaluation.     

Complications of percutaneous transaxillary catheterization for arteriography and selective chemotherapy.

This report enumerates and analyzes the complications of percutaneous transaxillary catheterization encountered in 200 consecutive patients undergoing diagnostic arteriography, and 20 consecutive patients who had catheter placement for selective chemotherapy. Diagnostic arteriography led to minor complications in eleven percent and major complications in two percent. Risk correlated with the type of procedure, number of catheter exchanges and particularly, the presence of arteriographic risk factors, such as hypertension, bleeding tendencies, and advanced atherosclerosis. Therapeutic catheter placements had a 15 percent incidence of minor and a 20 percent incidence of major complications. Here, also, complications were more likely in the presence of the arteriographic risk factors. Suggested means for decreasing the hazards of the transaxillary catheterization include: exclusion of high risk patients, use of a proper puncture site, careful catheter manipulation, the fewest possible catheter exchanges, correct manual hemostatis following catheter withdrawal, and close observation of the patient after the procedure. Early surgical intervention is indicated in the presence of a progressively developing neural defect.     

Outpatient arteriography and cardiac catheterization: effective alternatives to inpatient procedures

Traditionally, arteriography and cardiac catheterization have been inpatient procedures. Growing public and medical interest in cost containment prompted consideration of performing them as outpatient procedures. Ninety-five outpatient cerebral, peripheral, or visceral arteriograms and 89 outpatient cardiac catheterizations done in a 36-month period were reviewed. Findings indicate that outpatient cardiovascular examinations can be performed safely, with no additional risk to the patient, and provide an efficient, convenient alternative to hospitalization.     

基于分形理论的军事医学解析

分形是由数量巨大的分形元胞，依据简单构造规则，自组织与他组织相结合，形成复杂系统的模式。自相似性、构造规则的简单性和分形元胞是分形理论的3个要点。军事医学系统具备分形元胞，在编制体系、作用地位、学科体系等方面存在分形现象，具备分形特征。分形是解析、认识军事医学系统的有力工具。     

Complications of cerebral angiography: a prospective analysis of 2,924 consecutive procedures

Introduction Cerebral angiography is an invasive procedure associated with a small, but definite risk of neurological morbidity. In this study we sought to establish the nature and rate of complications at our institution among a large prospective cohort of consecutive patients. Also, the data were analysed in an attempt to identify risk factors for complications associated with catheter angiography. Methods Data were prospectively collected for a consecutive cohort of patients undergoing diagnostic cerebral angiography between January 2001 and May 2006. A total of 2,924 diagnostic cerebral angiography procedures were performed during this period. The following data were recorded for each procedure: date of procedure, patient age and sex, clinical indication, referring specialty, referral status (routine/emergency), operator, angiographic findings, and the nature of any clinical complication or asymptomatic adverse event (arterial dissection). Results Clinical complications occurred in 23 (0.79%) of the angiographic procedures: 12 (0.41%) significant puncture-site haematomas, 10 (0.34%) transient neurological events, and 1 nonfatal reaction to contrast agent. There were no permanent neurological complications. Asymptomatic technical complications occurred in 13 (0.44%) of the angiographic procedures: 3 groin dissections and 10 dissections of the cervical vessels. No patient with a neck dissection suffered an immediate or delayed stroke. Emergency procedures (P = 0.0004) and angiography procedures performed for intracerebral haemorrhage (P = 0.02) and subarachnoid haemorrhage (P = 0.04) were associated with an increased risk of complications. Conclusion Neurological complications following cerebral angiography are rare (0.34%), but must be minimized by careful case selection and the prudent use of alternative noninvasive angiographic techniques, particularly in the acute setting. The low complication rate in this series was largely due to the favourable case mix.     

2010-2015年飞行不合格飞行人员疾病谱分析

目的 分析近5年飞行不合格飞行人员疾病谱特点和规律,为新时期进一步做好航卫保障工作提供参考资料.方法 收集我院2010年1月-2015年4月190例飞行不合格飞行人员病历资料,按疾病种类、涉及专业科室及年龄分布进行分类统计.结果 排在前20位的病症为头痛、高血压、腰椎间盘突出症、颈椎病、高脂血症、抑郁症、屈光不正、晕厥、神经性耳聋、心境不良等.前10位专业科室是神经内科、骨科、心血管内科、精神科、眼科、消化科、内分泌科、耳鼻喉科、全军临床航空医学中心及泌尿外科.31～40岁年龄段构成比最高,占51.05％.结论 飞行人员医学停飞疾病谱较广,涉及各专业科室,其中内科、骨科、眼科和耳鼻喉科疾病依然是医学停飞的常见原因,而精神性和代谢性疾病呈上升趋势,值得关注和重视.     

Percutaneous extraluminal (subintimal) recanalization of a brachial artery occlusion following cardiac catheterization

A 47-year-old woman presented with disabling right arm claudication 10 weeks after Sones cardiac catheterization via a brachial artery cut-down. A technique of extraluminal recanalization of the brachial artery occlusion, used to treat this patient, is described. Received: 0/00/000 Accepted: 0/00/00