Thrombosis at venous insertion sites after inferior vena caval filter placement

Color Doppler flow imaging or compression ultrasound (US) was used to prospectively determine frequency of thrombosis at 54 venous insertion sites (47 in common femoral veins, seven in right internal jugular veins) after percutaneous placement of Greenfield filters for interruption of the inferior vena cava. Fifty-one filters were successfully placed in 51 patients with a dilator set or a balloon angioplasty catheter. Nine focal thrombi were detected in the common femoral vein (19%) and one in the right internal jugular vein (14%). Use of dilators induced eight thrombi (24%), compared with two (10%) from balloon catheters. The left common femoral vein had a high frequency of thrombosis, regardless of dilation technique (five of nine). Of nine patients with acute common femoral vein thrombosis, four became symptomatic within 10 days after the procedure. Patients may remain asymptomatic or have delayed symptoms; thus, US is valuable for determining patients at risk of thrombosis of the common femoral vein.     

Diagnostic morphologic and urodynamic antegrade pyelography

Diagnostic antegrade pyelography, with a thin needle, is basically a simple procedure that can be performed relatively rapidly under local anesthesia with few complications of significance. Its role, however, is frequently crucial to subsequent patient management. During morphologic antegrade examination, aspirated urine can be analyzed for tumor cells (cytologic examination), infection (smear, culture), or other biochemical alterations. The use of antegrade pyelography in the demonstration of internal diversion, ureteral fistula, and the site and cause of obstruction is well established. Dynamic antegrade study is crucial in the assessment of many pyeloureteral units in which the issue of current obstruction is equivocal or uncertain. Absolute renal and bladder pressures are obtained simultaneously; these and the calculated differential pressure provide objective data relative to ureteral resistance to urine flow and renal nephron preservation.     

Venous Thromboembolic Events in the Rehabilitation Setting

Venous thromboembolism (VTE) is a disease entity that encompasses both deep venous thrombosis and pulmonary embolism. During the past decade there have been significant advances in the understanding of prophylaxis and treatment of VTE. There is an extensive research base from which conclusions can be drawn, but the heterogeneity within the rehabilitation patient population makes the development of rigid VTE protocols challenging and overwhelming for the busy clinician. Given the prevalence of this condition and its associated morbidity and mortality, we review the evidence for the prevention, identification, and optimal treatment of VTE in the rehabilitation population. Our goal is to highlight studies that have the most clinical applicability for the care of VTE patients from a physiatrist's perspective. At times, information about acute care protocols is included in our discussion because these situations are encountered during the consultation process that identifies patients for rehabilitation needs.     

Flavone acetic acid: a novel agent with preclinical antitumor activity against colon adenocarcinoma 38 in mice

Flavone acetic acid, given on Days 2 and 9 at a dose of 267 mg/kg, inhibited tumor growth completely in 60%-80% of mice with early-stage Colon Adenocarcinoma 38. The therapeutic efficacy of the flavone against this tumor was retained when the sites of tumor implantation and drug administration were separated. Flavone acetic acid also caused regression of advanced (500-mg) Colon 38 tumors, with greatest efficacy observed following administration of high individual dose rather than high total dose. Unlike many previous potential anticancer agents, only modest activity was observed for this compound against either P388 or L1210 leukemia.     

Mathematical inference of blood gas data

Direct measurement of serum pH and the partial pressures of blood oxygen and carbon dioxide may be performed economically and accurately using specific electrode devices, and these measured values may easily be corrected for patient temperature. Oxyhemoglobin saturation, serum bicarbonate concentration, oxygen and carbon dioxide content, and arteriovenous differences may then be calculated if hemoglobin and hematocrit are known. Although the computational techniques have been available for some time, they have not been combined into a single, efficient procedure which is readily usable in clinical practice.

A suitable computer program was written and extensively validated. Calculated oxyhemoglobin saturations are virtually indistinguishable from those of the standard oxyhemoglobin dissociation curve. The calculated P₅₀ (7.4) is 26.4. Calculated values of carbon dioxide content compare favorably with those published in the literature, and oxygen content determinations correspond well to measurements by the standard Van Slyke technique (r = 0.978).

Input and output requirements of the computation procedure are minimal and entirely discrete in nature. Programmable desk top calculators, or utility time shared computer systems with inexpensive keyboard-printer terminals could therefore provide this service.     

A retrospective review of the course of patients with pancreatitis discharged on jejunal feedings.

INTRODUCTION: Although parenteral nutrition (PN) has been the standard nutrition therapy in patients with pancreatitis requiring nutrition support, it is associated with a higher rate of catheter-related sepsis and gut atrophy. Research suggests enteral nutrition (EN) is possible in patients with pancreatitis without exacerbating symptoms when infused jejunally. The purpose of this study was to review the course of patients with resolving pancreatitis discharged to home on EN. METHODS: The medical records of 33 patients with a percutaneous endoscopic gastrostomy tube with jejunal extension (PEG-J) or nasojejunal tube (NJ) who received home EN were reviewed. The data collected included duration of EN, formula used, goal and maximum tolerated flow rates, anthropometric measures, and gastrointestinal complications. RESULTS: Ninety-seven percent of patients received a standard polymeric formula providing an average of 1845 +/- 421 kcal/d. Forty-two percent of patients took pancreatic enzyme supplements. Complications occurring in patients included nausea and vomiting (42%), feeding rate intolerance (18%), diarrhea (12%), and PEG site infection (27%). Seventy-seven percent of patients achieved nutritional goals. CONCLUSION: Standard polymeric EN seems to be safe and efficacious in the home setting for patients with resolving pancreatitis.