Abdominal Aortic Aneurysm Diameters: A Study on the Discrepancy between Inner to Inner and Outer to Outer Measurements.

INTRODUCTION: The NHS Abdominal Aortic Aneurysm Screening Programme (NAAASP) uses the maximal anterior to posterior (AP) inner-to-inner (ITI) wall diameter in sizing aortic dimensions when screening with ultrasound. It is recognised that ITI measurements are smaller than outer-to-outer (OTO) measurements, and the primary aim was to calculate the absolute difference in AP ITI and OTO measurements across varying aortic diameters. The secondary aim was to estimate the potential number of patients lost from the screening programme. METHODS: Since April 2012, patients outside the screening programme that undergo ultrasound of abdominal aortas have their ITI and OTO measurements recorded. These measurements were compared retrospectively and analysed for variability at threshold sizes of AAAs. RESULTS: From May 2012 to October 2013, 452 abdominal aortic ultransound scans recorded both ITI and OTO measurements. The majority (81%) were performed on men with the mean age of 78 years. The mean difference between ITI and OTO measurements was 4.21 mm (p < .001). There was no difference between the genders. Thresholds were created for analysis between different ITI and OTO aortic diameters; these were <3 cm, 3.1-4 cm, 4.1-5 cm, and >5 cm. There was no significant difference between the means at each threshold size for ITI diameter (p = .758). In the first 2 years from April 2012, 15,447 men underwent screening.Of these, 177 (1.14%) had sub-threshold ITI aortic diameters between 2.6 cm and 2.9 cm. This would upscale to 5,316 men nationally. CONCLUSION: We have demonstrated a consistent and significant 4mm difference between ITI and OTO diameters in live scanning. Lowering the threshold for entry into a surveillance AAAs to an ITI diameter of 26mm rather than the current 30 mm is advocated. An alternative cost-effective way is to rescreen this small sub-group at 5 or 7 years.

Imaging and management of complications of central venous catheters.

Central venous catheters (CVCs) provide valuable vascular access. Complications associated with the insertion and maintenance of CVCs includes pneumothorax, arterial puncture, arrhythmias, line fracture, malposition, migration, infection, thrombosis, and fibrin sheath formation. Image-guided CVC placement is now standard practice and reduces the risk of complications compared to the blind landmark insertion technique. This review demonstrates the imaging of a range of complications associated with CVCs and discusses their management with catheter salvage techniques.

Imaging and management of complications of open surgical repair of abdominal aortic aneurysms.

Open repair is still considered the reference standard for long-term repair of abdominal aortic aneurysms (AAA). In contrast to endovascular aneurysm repair (EVAR), patients with open surgical repair of AAA are not routinely followed up with imaging. Although complications following EVAR are widely recognized and routinely identified on follow-up imaging, complications also do occur following open surgical repair. With frequent use of multi-slice computed tomography (CT) angiography (CTA) in vascular patients, there is now improved recognition of the potential complications following open surgical repair. Many of these complications are increasingly being managed using endovascular techniques. The aim of this review is to illustrate a variety of potential complications that may occur following open surgical repair and to demonstrate their management using both surgical and endovascular techniques.

Paget-Schroetter syndrome treated with cutting-balloon angioplasty.

Here, a case of Paget-Schroetter Syndrome in a 25-year-old guitar player is reported. After thrombolysis, conventional angioplasty failed to dilate the underlying subclavian stenosis both before and after first-rib excision with scalenus anterior and medius division. For the third attempt at angioplasty, a cutting balloon was used, which immediately produced a good result. Venography at 4-year follow-up showed no restenosis and no functional deficit. This case report demonstrates that cutting-balloon angioplasty may be considered when conventional balloon fails and may have greater durability than conventional balloon angioplasty in the treatment of Paget-Schroetter syndrome.

Dental arch relationships on three-dimensional digital study models and conventional plaster study models for patients with unilateral cleft lip and palate.

OBJECTIVE: To determine if three-dimensional (3D) digital study models could replace plaster study models for the evaluation of dental arch relationships for patients with unilateral cleft lip and palate. DESIGN: Observational study involving plaster study models from a records archive. SETTING: U.K. National Health Service. PATIENTS, PARTICIPANTS: Thirty sets of study models of 5-year-old patients with unilateral cleft lip and palate were identified and scanned to produce 3D digital study models by ESM Digital Solutions Ltd. (Swords, Co. Dublin, Ireland) using an R250 Orthodontic Study Model Scanner (3Shape A/S, Copenhagen, Denmark). INTERVENTIONS: None. MAIN OUTCOME MEASURE(S): The plaster and 3D digital study models were scored using the 5-year-olds' and modified Huddart Bodenham indices and analyzed using the Friedman test (p < .05) and two-way ANOVA, respectively. Intra-observer and interobserver reproducibility were calculated from the 5-year-olds' index data using the weighted kappa statistic for both the plaster and 3D digital models. RESULTS: Intra-observer and interobserver reproducibility were good (0.62 to 0.83 and 0.64 to 0.78, respectively). There were no statistically significant differences between the scores for the 3D digital study models when compared to the plaster study models for either the 5-year-olds' index (p  =  .12) or for the modified Huddart Bodenham index (p  =  .506). CONCLUSIONS: Three-dimensional digital models are a valid alternative to traditional plaster study models for the evaluation of dental arch relationships in patients with unilateral cleft lip and palate.

A stuck hemodialysis central venous catheter.

BACKGROUND: A growing number of hemodialysis patients are dependent upon central venous catheters (CVCs) for long-term vascular access. Although many complications of CVCs have been documented, the phenomenon of the stuck catheter is described relatively infrequently. CASE REPORT: We describe a case where attempts to remove the line by exploration of the jugular insertion site in theater were unsuccessful and the line was internalized. DISCUSSION: The case is then discussed with all available cases in the literature to suggest principles of managing and preventing the stuck catheter phenomenon.

Outpatient angioplasty and stenting facilitated by percutaneous arterial suture closure devices.

AIM: To review our practice of outpatient percutaneous vascular interventions facilitated by an arterial suture device. MATERIALS AND METHODS: A retrospective review of all patients attending this tertiary centre for iliac or femoral intervention was undertaken between February 2001 and December 2004. All patients who underwent angioplasty or stenting had their puncture sites closed using a Perclose suture. Patients were kept flat for 15min and allowed to fully mobilize at 60min. Puncture sites were scored for visible bruising, haematoma and pain at discharge and on outpatient follow-up. Patient preference for future outpatient treatment was assessed. RESULTS: Fifty-seven outpatients underwent 81 punctures. Forty-eight (84%) patients underwent iliac angioplasty; of those 42% underwent stent placement. Six patients (10%) required inpatient admission, five secondary to failed suture deployment. One patient had a non-closer-related puncture site intimal flap occlusion successfully repaired at surgery. Fifty-one (90%) patients discharged with a mean time of 157min (60-280min). Forty-six (92%) patients had no visible bruising or palpable haematoma on discharge. No patient had a haematoma greater than 2.5cm. No discharged patient required readmission. Thirty percent reported a moderate to severe groin pain score (2-5/5) at discharge, increasing to 40% at follow-up. Forty-seven (98%) of the 48 patients, who expressed a preference, would be happy to undergo outpatient treatment again. CONCLUSION: Outpatient treatment is feasible, well tolerated and preferable to patients, but 10% will require inpatient admission. A planned post-procedure analgesia regimen or advice should be considered.

A cross-site vascular radiology on-call service: the Manchester experience.

AIM: A cross-site vascular radiology on-call service was established 5 years ago to cover two vascular centres in Manchester. We aimed to review the service. MATERIALS AND METHODS: A prospective audit of out-of hours referrals and procedures over a three month period (March-May 2003) was undertaken. RESULTS: There were 52 incidents in 49 patients (mean 4 calls per week). Nine involved telephone advice only, the remainder (82%) required a procedure. Angiography was performed on 88% of patients and therapeutic radiological intervention on 50%. 71% of calls occurred at a weekend. 50% of the calls were from vascular surgery and 50% from other sources. The consultant vascular radiologist was present for 93% of procedures. CONCLUSIONS: The workload suggests that a vascular radiology on call service is justified in Manchester. There have been no major problems with its implementation and operation. This is a consultant led service, with very few cases being devolved to a specialist registrar (SpR).

Comparative induction of gene mutations and chromosome damage by 1-methoxy-1,3,5-cycloheptatriene (MCHT), 1. Results from a battery of standard tests.

The ability of 1-methoxy-1,3,5-cycloheptatriene (MCHT) to induce gene mutations and chromosome breaks has been examined in a battery of standard assays. MCHT was not mutagenic to 5 strains of Salmonella, with or without S9 fraction. In L5178Y TK+/- mouse lymphoma cells, MCHT induced TK-/- mutants in the presence but not in the absence of S9 fraction. In V79 Chinese hamster cells, MCHT induced azaguanine-resistant mutants in the presence and absence of S9 but the effect was considerably reduced in the absence of S9. MCHT resulted in no increases in chromosome aberrations in cultured human lymphocytes, with or without S9 fraction, neither was there any increase in micro-nucleated polychromatic erythrocytes in treated mice. MCHT thus appears on the basis of these results, to be possibly a specific gene mutagen (rather than clastogen) for mammalian cells. This uncommon mutagenicity profile has been investigated further in an accompanying paper (Cole et al., 1990) and has proved to be an oversimplification.

Nordic (cross-country) skiing injuries in Australia.

A retrospective study of 88 nordic skiing injuries from the 1984 and 1985 skiing seasons in Australia is presented. To our knowledge, this is the largest study to date of such injuries. These injuries are compared with alpine skiing injuries from the same medical clinic for the 1985 skiing season. There was a much lower incidence of injury from nordic skiing; however, when injuries did occur, they tended to be more serious than those of alpine skiing and frequently required immediate evacuation to hospital for treatment. As the nordic skier is relatively isolated from medical services, these findings need to be considered in the future planning of rescue services for such skiers.

Actinomycosis of the jaws. 2 case reports.

The diagnosis of actinomycosis is not always straightforward. It has been described as a masquerader, and 2 cases are presented which exemplify this. Their mode of presentation and natural history are contrasted.

An investigation of the genetic toxicology of irradiated foodstuffs using short-term test systems. III--In vivo tests in small rodents and in Drosophila melanogaster.

Six in vivo genetic toxicity tests were carried out on irradiated or unirradiated cooked chicken, dried dates and cooked fish. The tests were as follows: sex-linked recessive lethal mutations in Drosophila melanogaster (dried dates only), chromosome aberrations in bone marrow of Chinese hamsters, micronucleus test in rats, mice and Chinese hamsters, sister-chromatid exchange in bone marrow of mice and Chinese hamsters and in spermatogonia of mice, and DNA metabolism in spleen cells of Chinese hamsters. None of the tests provided any evidence of genetic toxicity induced by irradiation. However, dried dates, whether irradiated or not, showed evidence of some genetic toxicity in their effect on DNA metabolism in spleen cells and SCE induction in bone marrow. Feeding irradiated fish affected DNA metabolism in the spleen cells of Chinese hamsters. This effect could be interpreted as an induction of an immunoactive compound, although it could also be explained by the persistence of an immunoactive compound due to the removal by irradiation of spoilage organisms that would normally degrade it.

The effect of dose fractionation on gamma-radiation induced mutations in mammalian cells.

The lethal and mutagenic effects of single and fractionated doses of gamma-radiation were studied in V79-4 Chinese hamster cells, as dose fractionation is of interest in radiation protection studies. The results show that the induction of 8-azaguanine resistant (Agr) mutants has a non-linear dose response curve following single doses of radiation. The lethal and mutagenic effects of fractionated doses were always less than if the radiation was given in a single dose. Any change in treatment which led to an increase in survival also led to a decrease in induced mutation frequency. There was a relationship between mutation and survival which was independent of the number of fractions in which the radiation was given. This could be of consequence in radiological protection.