CT fluoroscopic guided insertion of inferior vena cava filters.

The value and use of inferior vena cava (IVC) filters is well documented and has been growing since the first reported filter placement in 1973 and the first percutaneous insertion in 1982. Access routes now include both jugular veins, both ante-cubital veins and both femoral veins. However, all insertions require some form of imaging, usually fluoroscopy, to identify the location of the filter with respect to the IVC and the renal veins. We describe two cases where the patients' weight was significantly greater than the weight limit of the angiography table, necessitating insertion under CT fluoroscopic guidance.

A safe zone for the passage of screws through the posterior tibial cortex in tibial tubercle transfer.

In tibial tubercle transfer, surgery drills and screws can put the popliteal vessels at risk if the posterior cortex is breached. This complication can be devastating. We have looked at arteriograms of 50 knees and identified a safe zone through which an instrument can be passed with more confidence. In our study we found no vessels directly posterior to the supero-medial aspect of the proximal metaphysis in any knee. Whilst care must still be taken, this area will allow surgeons greater confidence to obtain a stronger bicortical hold with any fixation device.

Inferior vena caval filters: an overview of current use.

Inferior vena cava filters trap dislodged clot and decrease recurrent pulmonary embolism. The main indications are pulmonary embolism or extensive deep vein thrombosis when anticoagulants are contraindicated, and recurrent pulmonary embolism despite adequate anticoagulation. Newer filters trap clinically significant emboli while maintaining patency, making them safe and effective.

Staphylococcus aureus meningitis--a rare complication of iliacus muscle abscess.

Staphylococcus aureus meningitis is a rare but well recognized condition which had a high mortality and incidence of neurological sequelae. It is usually associated with chronic underlying conditions. A case is reported of S. aureus meningitis in a previously healthy young man. The epidemiology, microbiological findings and treatment of this condition are discussed.

Sonography of the thymus in healthy children: frequency of visualization, size, and appearance.

OBJECTIVE: The purpose of this study was to determine the frequency of visualization, the size, and the sonographic appearance of the normal thymus on sonograms of children 2-8 years old. SUBJECTS AND METHODS: Fifty children without symptoms referable to the thymus were scanned through the suprasternal notch and parasternal windows with a Diasonics DRF 100 scanner and a 7.5-MHz probe. The anteroposterior and longitudinal dimensions of the thymus were measured and the echogenicity of the thymus was subjectively assessed and compared with the liver and thyroid gland. No change was made in the time-gain compensation or overall gain settings. RESULTS: The thymus was completely visualized and measured in 47 (94%) of the 50 patients. The mean anteroposterior and longitudinal measurements were 1.4 and 2.5 cm, respectively, for the right lobe and 1.4 and 2.9 cm, respectively, for the left lobe. On longitudinal sonograms, the right lobe tended to have an inverted teardrop shape whereas the left lobe was either triangular or sickle shaped. The mean absolute dimensions of the thymus changed little with age, although the number of children in each age group was small. The internal echogenicity of the thymus most closely resembled that of the liver. CONCLUSION: The thymus is clearly and easily visualized on sonograms in the majority of children 2-8 years old, a much later age than reported previously.

Echo enhancement behind solid intra-hepatic metastases: a potential pitfall in diagnosis.

Posterior echo enhancement is rightly considered a reliable sign of a cystic lesion. Three examples are given of solid metastatic deposits present within fatty livers which showed posterior echo enhancement. The reason for this finding is discussed and the importance of distinguishing such lesions from abscesses is emphasized.

Penile function following intracavernosal injection of vasoactive agents or saline.

Few studies on the pharmacological assessment or treatment of impotence have included controls. In a double-blind crossover study, 18 impotent men received either a 2 ml injection of a solution containing 30 mg papaverine and 1 mg phentolamine or a similar volume of normal saline into the corpus cavernosum. The immediate and delayed effects (4 weeks later) were assessed independently and the alternative injection then given. All injections with papaverine and phentolamine were followed by an immediate increase in penile length and rigidity, and 70% of these patients were able to have sexual intercourse for periods of 1 to 4 weeks. No change in penile length or rigidity occurred following the saline injection and only one patient showed some improvement in erection over the next 4 weeks. In the crossover study, no patient developed any increase in length or rigidity of the penis following injection of saline, and improvement in spontaneous erection occurred in only two cases. In contrast, all patients who received papaverine and phentolamine had an increase in penile length and rigidity, and 50% were able to have normal sexual intercourse over the next 4 weeks. This study confirms the value of a combination of vasoactive agents in the management of impotence, irrespective of its aetiology, and suggests that any placebo effect is minimal in this group of patients with considerable psychological overlay.