Angiography of liver transplantation patients

Over 45 months, 119 angiographic examinations were performed in 95 patients prior to liver transplantation, and 53 examinations in 44 patients after transplantation. Transplantation feasibility was influenced by patency of the portal vein and inferior vena cava. Selective arterial portography, wedged hepatic venography, and transhepatic portography were used to assess the portal vein if sonography or computed tomography was inconclusive. Major indications for angiography after transplantation included early liver failure, sepsis, unexplained elevation of liver enzyme levels, and delayed bile leakage, all of which may be due to hepatic artery thrombosis. Other indications included gastrointestinal tract bleeding, hemobilia, and evaluation of portal vein patency in patients with chronic rejection who were being considered for retransplantation. Normal radiographic features of hepatic artery and portal vein reconstruction are demonstrated. Complications diagnosed using results of angiography included hepatic artery or portal vein stenoses and thromboses and pancreaticoduodenal aneurysms. Intrahepatic arterial narrowing, attenuation, slow flow, and poor filling were seen in five patients with rejection.     

Femoral artery pseudoaneurysm: diagnosis with conventional duplex and color Doppler US

Three patients with clinically suspected pseudoaneurysm as a complication of femoral puncture were referred for ultrasound (US) evaluation with both conventional duplex Doppler US and color Doppler imaging. Pseudoaneurysm (n = 2) and simple hematoma (n = 2) were depicted with both Doppler systems, and a separate pseudoaneurysm and a hematoma were found in one patient. These diagnoses were confirmed surgically. Distinctive Doppler spectral waveforms and color Doppler findings enabled confident diagnoses. Color Doppler imaging allowed faster detection of intraaneurysmal flow, and the track between the injured artery and the pseudoaneurysm was identified only with color Doppler imaging. Duplex Doppler US with color Doppler imaging allows for the rapid, unequivocal diagnosis of pseudoaneurysm, thus enabling prompt treatment without the need for invasive diagnostic modalities.     

Esophageal stenosis: treatment with balloon catheters

We have performed 84 balloon dilatations in 40 patients who had esophageal strictures. Of these patients, 31 who had benign diseases improved, and the procedure proved to be safe, reliable, and easy to perform; in 77% of these patients, only one or two dilatations were necessary. In 10 patients who had previously undergone treatment with bougienage, the symptom-free interval of 9.3 months following balloon dilatation is four times longer than that experienced following bougienage. In patients who have malignant disease, though the symptom-free intervals are short, the procedure can be repeated easily and is accepted well by patients so that palliation can be achieved. Since only readily controlled transverse forces act in the balloon therapy, rupture is virtually eliminated, while the use of a flexible angiographic guidewire to traverse the strictures practically excludes perforation. Balloon dilatation offers distinct advantages compared with bougienage for the treatment of esophageal strictures.     

Medication errors in community pharmacy: an investigation into the types and potential causes

Objectives To establish the nature of medication errors occurring within community pharmacy and analyse common error patterns. To identify factors which influence the occurrence of medication errors and near misses, with the intention of designing systems or strategies to reduce the occurrence of these events. Setting Fifteen community pharmacies situated within Brighton and Hove City Primary Care Trust, East Sussex, between January and March 2004. Method A self‐reporting form was designed, piloted and administered to pharmacists, which gathered information on the detection of an error or near miss in the dispensing process. Key findings One‐hundred and thirteen near misses and thirty‐two medication errors were reported. The majority of near misses were detected by the pharmacist at the final check, and the majority of medication errors were detected by the patient or patient's representative. Selection errors were most common, with similar drug names and packaging cited as the main contributory factors. ‘Business’ was frequently cited as the circumstance surrounding the error. Conclusion This study demonstrates that pharmacists do have an important part to play and the positive impact of community pharmacists in preventing, detecting and correcting errors and thus preventing harm to patients in the primary care setting. However, medication errors do occur, and therefore a multifactorial approach by manufacturers, marketing and packaging personnel, in addition to input from pharmacists, may be an effective permanent solution in reducing the errors made.