Biomedical subjects
Publications and source records attributed to S F Millward.
We report three patients in whom the performance of a rectal biopsy produced an ulcer that was found during a subsequent examination (two at double-contrast barium enema examinations and one at colonoscopy). In each case, the iatrogenic ulcers presented an unusual appearance and resulted in the performance of inappropriate follow-up studies.
Radiographs taken on the day of admission on 52 patients with acute pancreatitis have been compared with similar radiographs of 30 patients with acute cholecystitis and 22 patients with perforated duodenal ulcer. Two radiologists, who were unaware of the clinical features, looked specifically for the presence of 30 radiological signs. The only abdominal signs seen more frequently in acute pancreatitis were fluid levels in the stomach and duodenum, usually associated with dilatation. Duodenal abnormalities were seen in 42% of patients with acute pancreatitis and 21% of the controls (P less than 0.05) while gastric dilatation with a fluid level was seen in 29% of cases of acute pancreatitis compared with 12% of controls (P less than 0.05). Seventy per cent of the patients with severe acute pancreatitis had an abnormal chest radiograph on admission compared with 18% of those with mild disease. Left pleural effusion was the most common abnormality in severe pancreatitis (43%) and was seen significantly more often than in mild pancreatitis (P less than 0.01) and the control group (P less than 0.05). Therefore, consideration of the admission chest radiograph may help at an early stage to distinguish patients with severe pancreatitis from those with mild disease.
The films of 37 consecutive post-exploratory operative cholangiograms were reviewed. Approximately half of the cases showed obstruction to contrast flow into the duodenum, but there was no relationship between obstruction and retained calculi. The obstruction probably occurs proximal to the ampulla at the choledochal sphincter. In only one case was a stone found that would otherwise have been missed by the omission of a post-exploratory film from the operative cholangiogram. In the six cases in which stones were missed, the post-exploratory operative cholangiogram was misleading. It is suggested that the post-exploratory operative cholangiogram is not a reliable way of checking common bile duct clearance prior to closure of the abdominal wound.
Explore the source record for details and available documents.
A study was undertaken to determine whether reducing needle size would reduce the complication rate of outpatient angiography with 4F catheters. One hundred fifty-two patients were randomized. An 18-gauge needle was used in 51, a 20-gauge in 50, and a 21-gauge in 51. Patients were observed for 2 h. No patients deteriorated after discharge. None of the 18-gauge patients developed a hematoma. Four percent of the 20-gauge and 2% of the 21-gauge patients had mild hematomas. This suggests that outpatient angiography using 4F catheters and 2 h of observation is safe. Increased safety with 20 or 21-gauge needles was not confirmed.
PURPOSE: The authors report a simple technique in which palpation of anatomic landmarks is used to localize the pulseless common femoral artery. MATERIALS AND METHODS: A finger is placed immediately lateral to the pubic tubercle and inferior to the inguinal ligament to palpate the point allowing the most posterior depression. Anatomically, this depression lies between the iliopsoas muscle laterally and the pectineus muscle medially. The femoral vein lies in the floor of this depression, and 1.5 cm lateral to the depression lies the femoral artery. RESULTS: This anatomic relationship and its usefulness for locating the common femoral artery were verified by puncture and dissection of nine cadaveric groins and successful puncture of 19 pulseless arteries of 17 patients. CONCLUSION: The described technique was found to be quick, simple, and reliable and is now the authors' method of choice for puncturing the pulseless femoral artery.
PURPOSE: The authors describe their experience with LG-Medical (LGM [Vena Tech]) filter placement and follow-up. PATIENTS AND METHODS: LGM vena cava filters were placed in 63 patients. Follow-up was obtained by means of duplex sonography of the introduction vein and inferior vena cava (IVC) and abdominal radiography in 50 patients, and by means of autopsy in an additional four patients. In eight, only clinical follow-up was obtained and one patient was lost to follow-up. RESULTS: Major complications of placement occurred in three patients, all when the right internal jugular vein was used for introduction: In one patient a filter was inadvertently placed in the right renal vein and in two the filter failed to open fully. No serious complications of placement occurred when either the right or left common femoral veins were used. Pulmonary embolism (PE) recurred in four patients (6%) and was fatal in one. Septicemia from an infected filter was the probable cause of death in another patient. Introduction vein thrombosis occurred in five patients (8%) and was symptomatic in two (3%). Occlusion of the IVC occurred in 15 patients (24% of the total patient group, but 28% of those with objective follow-up) and was symptomatic in 12 (19%). Two patients with IVC occlusion had recurrent PE. CONCLUSION: These data suggest that the rate of IVC occlusion is higher than most previous reports have suggested and that IVC occlusion may be a potentially serious complication.
PURPOSE: The authors describe their preliminary clinical experience with the Gunther temporary inferior vena cava (IVC) filter. PATIENTS AND METHODS: Seven women and 10 men, mean age 52 years (range, 19-85 years), were treated with the temporary IVC filter. Indications for filter placement were pulmonary embolism (PE) in four patients and iliofemoral deep venous thrombosis in six. In these patients anticoagulation was contraindicated because of planned major surgery. Filters were placed in four patients following massive PE and in three for prophylaxis following cranial trauma. Four patients had underlying malignant disease. Filters were introduced through the right common femoral vein in 14 patients, the left common femoral vein in two, and the left internal jugular vein in one. RESULTS: No patient developed recurrent PE with the filter in place. All filters were removed without complication 3-14 days (mean, 7 days) after placement. Two of the patients with underlying malignant disease required placement of a permanent filter. Two patients developed IVC thrombosis with the filter in place, and both developed recurrent PE after filter removal. Two patients developed insertion vein thrombosis. One patient developed a bleeding disorder that caused a massive hematoma at the insertion vein site, which may have contributed to her death. CONCLUSION: The Gunther temporary filter can be used in selected patients; however, patients with underlying malignant disease may be more appropriately treated with a permanent filter. The temporary filter does not appear to reduce the rate of insertion vein and IVC thrombosis.
PURPOSE: An in vitro comparison of clot-trapping abilities of permanent and temporary inferior vena cava (IVC) filters. MATERIALS AND METHODS: A flow model was used to simulate the IVC. Two permanent IVC filters, the titanium Greenfield and LG-Medical (LGM), were compared with two temporary filters, the Filcard International and Gunther. Clot sizes used were 2.5 x 2.5 mm, 2.5 x 5 mm, 5 x 5 mm, 5 x 10 mm, and 5 x 20 mm. Individual clots were presented to the filters with the simulated IVC in a horizontal or vertical orientation. Clot-trapping dynamics and pressure gradient changes during the injection of multiple, sequential clots were also examined. RESULTS: As clot size diminished, all filters trapped fewer clots; however, the temporary filters trapped more small clots than the permanent filters. Very little difference was observed in clot-trapping abilities among the filters for clots of 5 x 10 mm or greater. In the horizontal orientation, the permanent filters trapped 38% of all clots delivered, while the temporary filters trapped 73%, chi 2 = 24.8 (P < .001). In the vertical orientation, the overall clot-trapping abilities of the filters improved, with the permanent filters trapping 73% of all clots delivered, while the temporary filters trapped 95%, chi 2 = 18 (P < .001). During trapping of multiple clots, the temporary filters allowed fewer clots to pass. CONCLUSION: The temporary filters performed better than the permanent filters in both individual clot-trapping orientations. During multiple clot-trapping experiments, fewer clots were allowed to pass by the temporary filters. The temporary filters demonstrated the ability to capture clots both inside and outside the wire struts.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.