ABSTRACT
PURPOSE: This report describes intermediate findings from an ongoing prospective randomized trial comparing the results of percutaneous transluminal angioplasty (PTA) with results of endovascular stent placement in patients undergoing hemodialysis. PATIENTS AND METHODS: Among 87 consecutive patients with venous stenoses or occlusions, 47 (54%) were treated with PTA alone and 40 (46%) were treated with PTA and stent placement. RESULTS: For peripheral sites, the primary patency rates for PTA at 60, 180, and 360 days were 55%, 31%, and 10%, respectively, and for stents were 36%, 27%, and 11%, respectively (P = .6528). The secondary patency rates for PTA at 60, 180, and 360 days were 94%, 80%, and 71%, respectively, and for stents were 73%, 64%, and 64%, respectively (P = .1677). For central sites, the primary patency rates for PTA at 60, 180, and 360 days were 81%, 23%, and 12%, respectively, and for stents were 67%, 11%, and 11%, respectively (P = .4595). The secondary patency rates for PTA were 100% at each interval, and for stents were 100%, 89%, and 78%, respectively (P = .5408). CONCLUSION: Intermediate results suggest that, overall, there is no difference in the patency rates for peripheral venous stenoses in dialysis patients treated with PTA or PTA and endovascular stent placement. At this time, the numbers of patients are too small to conclude if certain sites such as larger central veins will respond better to one treatment or the other.
Subject(s)
Angioplasty, Balloon , Catheters, Indwelling , Renal Dialysis , Stents , Adult , Aged , Aged, 80 and over , Arm/blood supply , Arteriovenous Shunt, Surgical/adverse effects , Axillary Vein/pathology , Brachiocephalic Veins/pathology , Catheters, Indwelling/adverse effects , Constriction, Pathologic/therapy , Equipment Failure , Female , Humans , Iliac Vein/pathology , Male , Middle Aged , Polytetrafluoroethylene , Prospective Studies , Recurrence , Saphenous Vein/pathology , Subclavian Vein/pathology , Survival Analysis , Vascular Diseases/therapy , Vascular Patency , Veins/pathologyABSTRACT
We compared the heart weights and the incidence of atherosclerotic lesions in trauma fatalities testing positive for cocaine with the hearts of cocaine negative trauma fatalities, with the hearts of decedents dying from cocaine overdose, and with historic controls derived from the literature. There were 116 trauma victims, 83 men and 33 women, aged 20-50 years, and 26 men with cause of death listed as cocaine toxicity. The 32 cocaine (+) male trauma fatalities had a mean age 34 +/- 10 years and a mean heart weight of 375 +/- 82 grams. The 51 cocaine free males had a mean age 31 +/- 9 years, and mean heart weight 337 +/- 54 grams (P = .01). Heart weights in the cocaine using group were also significantly greater than historical controls from World War I, Korea, and Vietnam. The incidence of atherosclerotic changes was similar in both groups, but cocaine (+) men had more frequent coronary artery lesions involving multiple vessels (P = .01). Comparisons between 16 cocaine (+) females and 17 cocaine (-) female controls disclosed no significant differences in heart weight or the frequency of atherosclerotic lesions. The 26 men dying of cocaine overdose also had larger hearts than the controls (379 +/- 64 g, P = .004), and more severe CAD (30% had involvement of 2 or more vessels, P = .02). The degree of myocardial hypertrophy documented in this study was highly significant, but because the increase is modest (around 10%), it is likely to go unrecognized at autopsy.(ABSTRACT TRUNCATED AT 250 WORDS)
Subject(s)
Cardiomegaly/pathology , Cocaine , Coronary Disease/pathology , Substance-Related Disorders/pathology , Adult , Cardiomegaly/etiology , Coronary Disease/etiology , Female , Humans , Male , Middle Aged , Organ SizeABSTRACT
The effects of iodinated contrast agents upon renal function were determined in 11 patients undergoing arteriography. Serial radionuclide renograms were performed to calculate the glomerular filtration rate, effective renal plasma flow and filtration fraction before and after arteriography. The effective renal plasma flow was the parameter most adversely affected. The magnitude of renal dysfunction depended upon the amount of contrast medium administered, as well as probably pre-existing renal disease and site of injection.
Subject(s)
Angiography/adverse effects , Contrast Media/adverse effects , Kidney/drug effects , Adult , Aged , Contrast Media/administration & dosage , Creatinine/blood , Female , Glomerular Filtration Rate/drug effects , Humans , Kidney/diagnostic imaging , Male , Middle Aged , Radionuclide Imaging , Renal Circulation/drug effects , Sex FactorsABSTRACT
This report relates the findings in a death by use of an air gun. It is believed to be the second reported homicidal air gun death in the United States. The fatal wound was unusual in that two pellets were loaded in "piggyback" fashion into the single shot .20 caliber Sheridan air gun. The lethal pellet penetrated the brain. Current literature on air gun deaths and injuries is reviewed.
Subject(s)
Forensic Medicine , Homicide , Autopsy , Humans , Male , Middle AgedABSTRACT
The authors have attempted to place fluoroscopically approximately 400 nasointestinal tubes in 7 years. The tube was guided into the jejunum in 39% of patients, into the third portion of the duodenum in 57%, and into the second portion in 76%.
