Volumetric rendering techniques: applications for three-dimensional imaging of the hip

Volumetric rendering is a new approach to three-dimensional (3D) imaging that overcomes many of the drawbacks of currently available surface-rendering systems. Its application on the Pixar Imaging System in two cases of acetabular fracture was assessed to illustrate the features of the technique. The fast-computing architecture and large memory of this system allow rapid generation of a series of high-quality 3D images in each plane of rotation (x or spinal axis, z or somersaulting axis) that can be viewed as independent static images or as an animated real-time video loop. Editing to remove the normal contralateral hemipelvis enhances appreciation of acetabular abnormalities. Every pixel of computed tomographic data is preserved, allowing representation of both soft tissue and bone as translucent overlap. The presentation of data also allows detection of subtle abnormalities and features and minimizes the artifact generation common in surface-rendered images.     

Radiologically guided balloon dilation of gastrointestinal strictures. Part I. Technique and factors influencing procedural success

Radiologically guided balloon catheters were used to dilate 94 gastrointestinal strictures in 92 patients over a 6-year period. Fifty strictures were esophageal and 44 nonesophageal (22 gastroenterostomies, 11 antral-pyloric strictures, four colorectal strictures, four enteroenterostomies, and three miscellaneous strictures). Factors influencing the success of stricture intubation included patient age, stricture location (esophageal vs. nonesophageal and proximal vs. distal esophageal), and association with a surgical anastomosis. Malignancy was associated with greater postdilation irregularity and a smaller increase in stricture diameter, as measured radiographically. Procedural failures occurred in 8% of cases (2% of esophageal and 30% of nonesophageal lesions). Two small, asymptomatic mucosal tears were seen after dilation (one esophageal and one colonic); no other procedural complications occurred. Following successful dilation, 16 patients (17%; six with esophageal and ten with non-esophageal strictures) had recurrence of symptoms during short-term (30-day) follow-up.     

Utilization of screening mammography: comparison of different physician specialties

Data obtained on 426 consecutive patients referred to a breast center by 122 physicians, including family practitioners, general surgeons, and other specialists, showed that the obstetricians-gynecologists referred the greatest average number of patients per physician, with more than 50% of these referrals for screening mammography. Internists referred fewer patients by nearly a factor of ten, with only one-third of these patients referred for screening mammography. Internists may be the weakest link in the utilization of screening mammography.     

Radioimmunoscintigraphy of squamous carcinomas of the head and neck

A pilot study was carried out to assess the value of a radiolabeled antibody against epidermal growth factor receptor (EGFR1) in localizing tumors in patients with squamous carcinomas of the head and neck. Positive images of large tumours (greater than 3 cm diameter) were obtained in 8 of 11 patients after intravenous administration of 111indium-labeled EGFR1. Two patients gave equivocal results, while negative scans were obtained from the patient with the smallest tumor (1 cm diameter). There were no false-positive images. The success of this study in localizing relatively large squamous carcinomas indicates that the antibody should be evaluated in patients with smaller tumors to establish the limits of detection of the technique.     

Septic complications after cardiac catheterization and percutaneous transluminal coronary angioplasty

Septic complications after cardiac catheterization and percutaneous transluminal coronary artery angioplasty are distinctly uncommon. However, we have recently treated nine patients with sepsis and life-threatening complications after cardiac catheterization alone or after catheterization and subsequent percutaneous transluminal coronary angioplasty. The common denominator in all patients was either repeat puncturing of the ipsilateral femoral artery or leaving the femoral artery sheath in for 1 to 5 days after the procedure. Two patients died as a direct result of their septic complications. One death occurred in a patient in whom bacterial endocarditis with congestive heart failure developed, and the other patient had a large retroperitoneal hematoma that became secondarily infected. Infected aneurysms that were successfully treated developed in three patients. Our study suggests that colonization of the needle tract by skin flora predisposes to septic complications if repeat arterial punctures are required or if a femoral artery sheath is left in place for more than 24 hours. Patients in whom sepsis develops after these procedures should be initially treated with antibiotics effective against gram-positive organisms. CT scanning or angiography should be considered for patients with persistent sepsis, septic emboli, and abdominal or flank pain. Infected aneurysms require resection or ligation because of the propensity of these aneurysms to rupture.     

Jamesian pragmatism: a framework for working towards unified diversity in nursing knowledge development

Nursing is frequently described as practical or pragmatic and there are many parallels between nursing and pragmatism, the school of thought. Pragmatism is often glancingly referenced by nursing authors, but few have conducted in‐depth discussions about its applicability to nursing; and few have identified it as a significant theoretical basis for nursing research. William James's pragmatism has not been discussed substantially in the nursing context, despite obvious complementarities. James's theme of pluralism fits with nursing's diversity and plurality; his emphasis on social conscience in our actions matches nursing's fundamental purpose of improving the lives of others; his continuous testing of pluralistic truths in critically reflective practice pairs well with nursing's focus on developing best‐available, holistic evidence; and his conceptualization of truth as being born in practice and becoming an instrument in practice is entirely compatible with nursing's theory–practice identity. The oft‐discussed theory–practice gap is seen to hinder the development of nursing knowledge. If nursing is to find its identity in knowledge development and potentiate the knowledge developed, it is imperative to identify and address that which is impeding progress. By way of the pragmatic tenets of William James, I will argue that a significant part of the theory–practice gap lies in how nursing knowledge development is operationalized, creating a false dichotomy between practice and research. I will also argue that the research–practice schism has been widened by continued philosophical and methodological infighting in the research community. I will describe how Jamesian pragmatism can be ‘what works’ for rebuilding relationships and supporting an engaged plurality within nursing research and bring research and practice together into a collaborative and iterative process of developing nursing knowledge.