Serial lung scintigraphy: utility in diagnosis of pulmonary embolism

Pairs of sequential perfusion lung scans and pulmonary angiograms obtained in 45 patients were reviewed to investigate the utility of short-term, sequential scintigraphy in the diagnosis of pulmonary embolism (PE). Forty-six sequential scan pairs were reviewed; 13 were ventilation-perfusion (V-P) pairs. Angiograms were obtained within 48 hours of either the first (65%) or second (35%) perfusion scan in each pair. Sequential scintigraphic patterns were classified as showing change (i.e., improvement in defects, new defects), no change, or as being indeterminate. A changing perfusion pattern was associated with a high (20/23) likelihood of PE, but seven of 16 patients with stable perfusion patterns also had PE. The sensitivity of a changing perfusion pattern for PE was 0.74 (20/27) and its specificity was 0.75 (9/12). In two of six patients who had serial V-P studies that showed changing perfusion defects, there were matched changes in regional ventilation and angiograms were negative. The findings suggest that short-term serial perfusion lung scanning may aid the scintigraphic diagnosis of PE in certain circumstances. Serial V-P imaging is needed, however, to maximize diagnostic specificity.     

Recombinant alpha-2-interferon for hairy cell leukemia

Twenty-two patients with hairy cell leukemia were treated with biosynthetic (recombinant) alpha-2-interferon in an open-label, single- arm efficacy study. Patients received 2 X 10(6) U/m2 recombinant alpha- 2-interferon three times weekly. Therapy was well tolerated subjectively with minimal short-term hematologic toxicity. Two patients had bacterial infections during the period of study, and one patient experienced a short-lived readily reversible rejection of a corneal transplant. Statistical comparison of the mean hematologic indices at study entry and after three to six months of therapy with recombinant alpha-2-interferon indicates a significant improvement in hemoglobin, granulocyte, and platelet counts. Bone marrow biopsies in six of 14 patients after six months of therapy showed a greater than 50% decrease in the infiltration of leukemia cells. We conclude that recombinant alpha-2-interferon is highly effective therapy for hairy cell leukemia.     

Variable breakpoints on the Philadelphia chromosome in chronic myelogenous leukemia

The abl oncogene is translocated from chromosome 9 to 22 in the creation of the Philadelphia (Ph1) chromosome. This article describes new translocation breakpoints identified in two patients with chronic myelogenous leukemia using Southern blotting and cloned human DNA probes from chromosome 9. The translocation breakpoints on chromosome 9 in both of these patients lie closer to the human cellular abl (c-abl) gene, and the chromosome 22 breakpoints are distributed more widely than previously reported. These data help to define more clearly the chromosomal span of the breakpoints and indicate that some translocations include very little chromosome 9 sequence located 5' to the c-abl gene.     

A new pyeloureteral drainage catheter

We describe a new pyeloureteral drainage catheter that can be used for both genitourinary tract stenting and drainage, as well as tamponade of bleeding from the renal parenchyma or subcutaneous tissue. Primary indications for the use of this catheter and recommendations on insertion techniques are presented. With the exception of one case of minor kinking of the catheter, we have had no complications or failures with this catheter. While insertion through an unprotected tissue track is somewhat difficult, we have had good success introducing the catheter through a 24-F or larger Teflon working sheath. The catheter has excellent patient retention properties. It can be converted from external to internal drainage or vice versa simply and quickly on the ward.     

An audit of paediatric epilepsy care

Basic standards for the process of paediatric epilepsy care were identified and applied in a clinical audit; findings were presented and the audit repeated. Standards agreed related to quality of correspondence, prescribing practice, appropriateness of drug monitoring, use of neuroimaging, and quality of requests for electroencephalography (EEG). Parent satisfaction with staff courtesy, doctor communication, and clinic visits were also assessed. In the second audit prescribing practice and appropriateness of drug monitoring had improved, but quality of patient correspondence and requests for EEG were unchanged. In both periods of care many parents were dissatisfied with the quality and amount of information provided about epilepsy. Standards of care for the medical management of children with epilepsy can be agreed and used to identify achievable improvements in that care.     

New heavy-duty exchange guide wire

A major drawback of currently used exchange guide wires is insufficient stiffness, causing them to buckle or dislodge when used during catheter exchanges. A new heavy-duty exchange guide wire is described that facilitates catheter exchanges around sharp corners, such as those encountered during various cardiac interventional procedures. The wire was successfully used in experimental valvuloplasty and experimental dilation of the ductus arteriosus.     

Percutaneous techniques in the management of urological complications in renal transplant patients

Obstruction of urine flow and urine leaks are potentially life-threatening complications in renal transplant patients. The diagnosis is difficult, and definite treatment may therefore be delayed. This paper reviews the clinical course of ten renal transplant patients with urologic complications, discusses the limitations of the standard tests used to investigate such problems, and describes the role of percutaneous antegrade pyelography and nephrostomy drainage catheter placement as safe and accurate diagnostic and therapeutic procedures.