Tailored approach for evaluation of peripheral vascular disease: intravenous digital subtraction angiography

A tailored approach for evaluating patients with peripheral vascular disease has been developed using intravenous digital subtraction angiography (IV DSA). This approach includes a history, physical examination, and correlation with Doppler pressure measurements to predict the location of the dominant lesion. In 60 patients, two views of the aortoiliac segment plus three or four views of the femoral and runoff circulation in the most symptomatic leg were obtained. Of the 60 patients, 36% had percutaneous transluminal angioplasty as a primary form of therapy, 32% were treated surgically, and 32% were followed clinically. Only 10% of these patients required further evaluation by conventional angiography. By omitting inpatient arteriography, considerable financial savings and increased patient comfort result.     

Silicone biliary stents for percutaneous management of biliary obstruction

Silicone tubes in 2-F increments from 12 to 20 F were developed for long term external-internal drainage of benign and malignant biliary obstructions. Passed coaxially over Teflon catheters and a guidewire, the silicone stents were softer and had larger sideholes than conventional drainage tubes. Once the acute track had matured (two weeks or longer), a silicone stent, 2 F larger than the preceding one, could be placed at each succeeding tube change. We have placed these tubes in 50 patients, 24 of whom had initially placed percutaneous catheters and 26 of whom had surgically placed stents. These tubes remain patent at least as long as conventional catheters and all patients have reported increased comfort using these catheters compared with standard ones.     

Percutaneous spermatic vein occlusion: evaluation of sclerosing agents in experimental animals

The 5%-20% rate of recurrence of testicular varicoceles after embolotherapy has been a persistent clinical problem. Three sclerosing agents--sodium tetradecyl sulfate 3%, absolute ethanol, and 100 degrees C contrast material--were evaluated in canine spermatic veins for degree and durability of venous occlusion. Pathologic examination for perivenous, pulmonary, and neural changes was performed. Both sodium tetradecyl sulfate and absolute ethanol were effective sclerosants, but sodium tetradecyl sulfate was technically easier to use. The use of a sclerosant in conjunction with balloons or coils is the safest, most effective technique for occluding variococeles and minimizing postembolotherapy recurrences.     

An Analysis of Policies Regulating Medication in the Schools

The administration and storage of prescribed medication in the schools is an area in which parents, physicians and school personnel need a close working relationship. Two hundred local school superintendents, randomly selected from throughout the United States, were requested to identify if their school district had a formal written policy regarding the storage and administration of prescribed drugs and, if so, to send a copy of this policy for analysis. The recommendations derived from the policies received were readily divisible into 12 categories: (1) physician's approval/request for the administration of medication, (2) parental or guardian's request and authorization to give medication, (3) functions of the school nurse, (4) container holding medication, (5) storage of medication, (6) person responsible for administration, (7) supply of medication kept at school, (8) log or written record of medication given, (9) unused medication, (10) delivery of medication to the school, (11) recording of information in student's cumulative folder, and (12) other. The large percentage of school districts responding that they do not have formal written policies to regulate the storage and administration of prescribed drugs in the schools, coupled with the few school districts which sent policies for analysis, provide clear evidence that a greater amount of attention is needed in this area.     

Radiographic diagnosis of tonsillar cyst presenting as dysphagia

Tonsillar retention cysts are common and most often asymptomatic. The radiographic demonstration of a retention cyst in a symptomatic patient is reported. Emphasis should be placed on the oropharynx during barium swallow examinations in appropriately symptomatic patients. Tonsillar retention cysts should be included in the differential diagnosis of mass lesions in this area.     

Superficial femoral artery occlusion: Observations that influence patient selection criteria for angioplasty

The length of an arterial occlusion is one criterion for selection of patients for transluminal angioplasty. A technique is described to fully evaluate the length of a superficial femoral artery occlusion during diagnostic peripheral arteriography.     

Effect of extracellular fluid volume expansion on the interparabronchial septum of the avian lung

Scanning electron microscopy was used to examine the interparabronchial septa of chickens as a potential site of lymphatic drainage in the avian lung. Anaesthetized chickens were subjected to extracellular fluid volume expansion to produce pulmonary oedema as a result of increased capillary fluid flux into the interstitial spaces of the lung. In normal (control) chickens, the adjacent parabronchi were separated by a minimal septal space. In the "volume-loaded" birds, however, the interparabronchial septal spaces were measurably thickened and engorged as a result of hydrostatic pulmonary oedema. These results, which were consistent with reports of the effect of hydrostatic pulmonary oedema in mammals, suggest that the interparabronchial septum is a potential route of lymphatic drainage in the avian lung.     

Digital subtraction spinal cord angiography in patients undergoing thoracic aneurysm surgery

Thoraco-abdominal aortic replacement can be associated with a high incidence of paraplegia. Because the major source of blood supply to the thoraco-abdominal spinal cord is through the anterior spinal artery of Adamkiewicz, reimplantation of intercostal and lumbar arteries could reduce the risk of this operation. We used intraarterial digital subtraction angiography (DSA) for preoperative localization of the anterior spinal artery in 12 patients. This vessel was successfully located in 9 patients, with DSA providing good quality images in all patients. Preoperative knowledge of the origin of this vessel was helpful in the planning of the operation in all patients, but its efficacy as a routine procedure was not established.     

Streamlining operation of an admitting service for interventional radiology

The authors describe how operations of an inpatient admitting service for interventional radiology were improved by developing a clinic and hiring a physician's assistant. The service, begun in 1982, was managed by a senior radiologist and fellows. Because of increasing admissions (from a mean of 52 per year in 1982-1985 to 110 per year in 1985-1987), a 1/2-day, twice-weekly clinic was created in 1985 to evaluate new patients and perform follow-up examinations. In 1986 a physician's assistant was hired to assist in the clinic and during patient admissions. Use of the clinic and physician's assistant streamlined patient flow and management during hospitalization. This resulted in a decrease in mean length of stay for patients undergoing angioplasty (from 3.74 days in 1982-1983 to 2.41 days in 1986-1987). This decrease means cost savings for the hospital under the prospective payment system. Other benefits include improved physician-patient relationships and follow-up, new patients for colleagues (15% of patients had anatomy unsuitable for interventional procedures and were referred to staff surgeons), and increased professional fees.