A comparison of midazolam with trimeprazine as an oral premedicant for children.

The effect of oral premedication was investigated in a double-blind, randomised trial in 85 children undergoing tonsillectomy and/or adenoidectomy. Orally administered midazolam 0.5 mg.kg-1 given 30 min pre-operatively was compared with trimeprazine 2 mg.kg-1 given 90 min pre-operatively and a placebo preparation. Compliance, sedation and ease of induction were assessed as were the duration and quality of recovery. Following premedication with midazolam none of the patients was anxious, crying or distressed on leaving the ward, compared with 2/28 in the trimeprazine group and 5/28 in the placebo group (p = 0.0007). More patients were calm and quiet on arrival in the anaesthetic room following midazolam than following trimeprazine, with both premedicant agents comparing favourably with placebo. There was no significant difference between the three groups in the time to recovery or the sedation score on discharge to the ward. Midazolam is a safe and effective oral premedicant for children.

Case report: massive biliary dilatation mimicking cystic retroperitoneal masses on computed tomography.

An unusual case is presented in which a massively dilated common bile duct produced a confusing CT image of multiple cystic areas within the abdominal cavity. Cholangiography and CT-cholangiography were useful in establishing the correct diagnosis. The differential diagnosis of cystic retroperitoneal masses is discussed.

Hip pain caused by buttock claudication. Relief of symptoms by transluminal angioplasty.

Two patients with severe hip pain proved to have buttock claudication resulting from isolated stenosis of the hypogastric artery. This diagnosis may be elusive if distal pulses are palpable, directing the clinician's suspicion away from vascular pathology. Diagnosis requires angiography. The patients were successfully treated by transluminal angioplasty. Angioplasty is the initial treatment of choice for these patients because the hypogastric artery is usually readily and safely accessible from either the femoral or axillary artery.

Wallstent migration following deployment in right and left bile ducts.

The Wallstent biliary endoprosthesis has recently been approved for treatment of malignant bile duct obstruction. Although minor changes in position have occurred, migration of these stents has been uncommon. The authors report a case in which migration occurred when stents were simultaneously deployed in the right and left bile ducts. Several mechanisms for this complication are postulated.

Dilated periportal lymphatics mimicking an anastomotic bile leak after liver transplantation.

Transhepatic cholangiography is commonly performed during postoperative evaluation of liver transplant patients. The authors describe a potential pitfall in the interpretation of these studies and illustrate that dilated interrupted lymphatics of the donor liver can mimic a periductal leak of contrast material.

Therapeutic implications of phlebographic obstruction in chronic venous stasis.

The purpose of this work was to evaluate the functional characteristics of the venous system of patients with chronic obstruction of their deep veins proved by phlebography. Sixty-eight extremities in 34 normal volunteers and 21 extremities in 17 patients with chronic venous stasis and phlebographically demonstrated obstruction of their deep veins (popliteal-superficial femoral in 33.3%, common femoral in 23.8%, iliac in 33.3% and inferior vena cava in 9.5%) were evaluated using mercury in silastic strain gauges on the feet to measure venous volume changes on elevation and exercise. Regurgitant flow, corrected for arterial foot blood flow, was calculated. In the control group, the apparent regurgitation range was 0 to 2.3 ml %/min (mean +/- 2 SD). Sixty-two percent of extremities with obstructed deep veins had significant functional regurgitation. Regurgitation was detected by phlebography in only 14.3% of cases. From these results we conclude that obstruction of the deep venous system by phlebography may or may not signify functional obstruction and, in itself, therefore, does not indicate that bypass surgery is an appropriate method of treatment. Selection for surgical correction requires quantitative determination of insufficiency since higher grades of regurgitation probably contraindicate venous bypass.

Laser catheter thermal angioplasty: technique and early results in 34 patients.

The laser catheter is a nylon vascular catheter with a metal tip that has an end hole as well as side holes. The metal tip is heated by laser energy delivered through an optical fiber embedded in the catheter wall. The catheter may be advanced over a guidewire for use as an adjunct to balloon angioplasty or for use in smaller vessels as the exclusive method of recanalization. We used the catheter to treat 34 patients with 54 discrete vascular lesions in 35 extremities. Twenty patients were treated for clinically significant claudication and 14 for ischemic changes. Laser catheter-assisted balloon angioplasty was used to treat six iliac artery occlusions, two iliac artery stenoses, 10 superficial femoral artery occlusions, 12 superficial femoral stenoses, four popliteal artery occlusions, and three popliteal stenoses. Initial technical and clinical success in these patients, with follow-up periods of 3-6 months, was equivalent to the results of previous reports of laser probe-assisted balloon angioplasty. In 11 patients, 15 of 17 popliteal or tibial-peroneal lesions were treated with the laser catheter without subsequent balloon angioplasty. The treatment was successful in eight of these patients, with follow-ups for up to 6 months. Our results suggest that the laser catheter is a useful device for the treatment of vascular stenosis or occlusion when used either as an adjunct to balloon angioplasty or in smaller vessels as the exclusive method for angioplasty.

Infrapopliteal and below-knee popliteal lesions: treatment with sole laser thermal angioplasty. Work in progress.

Laser-assisted balloon angioplasty has been successfully performed in peripheral and coronary arteries; however, the ability to perform laser angioplasty alone without the need for subsequent balloon angioplasty has not been reported. In the present series, infrapopliteal and below-knee popliteal sole laser thermal angioplasty was successfully performed on 14 of 16 (88%) lesions in 10 patients. Initial clinical and hemodynamic improvement was observed in seven of 10 (70%) patients, with clinical failure noted in three nonsurgical candidates with poor distal vessel runoff. Short-term clinical follow-up (mean, 6 months) revealed 100% patency at the site of laser thermal angioplasty. Clinical success was maintained in five of seven (71%) patients; symptoms recurred in two patients who had undergone laser thermal angioplasty and adjuvant balloon angioplasty of superficial femoral artery lesions. Treatment of distal peripheral arterial lesions with laser thermal angioplasty alone is feasible; studies comparing it with conventional balloon angioplasty should be considered.