Bedside carbon dioxide cavagrams for inferior vena cava filters: preliminary results.

OBJECTIVE: The objective of this study was to evaluate the feasibility of using carbon dioxide (CO(2)) as a contrast agent in performing bedside inferior vena cavagrams before the insertion of vena cava filters. There was a consecutive series of patients undergoing bedside preinsertion cavagrams with inferior vena cava filter insertion. The setting was an 825-bed tertiary care hospital. The subjects were trauma patients undergoing inferior vena cava filter insertion. METHODS: The intervention used was vena cavagrams with CO(2) as the contrast agent. The main outcomes we measured were image quality, adverse reactions, cardiorespiratory changes, and renal failure. RESULTS: Ten patients underwent CO(2) cavography. All cavagrams were successful, demonstrating opacification of the inferior vena cava with identification of the renal veins and iliac bifurcation. There were no adverse reactions of renal failure. CONCLUSIONS: Carbon dioxide-contrasted vena cavagrams can be safely performed at the bedside, and they give good opacification of the inferior vena cava.

Preliminary experience with the Hutson-Russell loop cutaneous choledochojejunostomy.

In 1984, the use of a choledochojejunocutaneous fistula was described to allow balloon dilation of benign biliary strictures. Later, the use of the technique to obtain repeated access to the biliary tree in a larger series of patients was reported. The experience provided a foundation for the application of the technique in nine patients at Wilford Hall United States Air Force Medical Center. Represented were a variety of benign and malignant disorders. Six patient reports are offered from this preliminary experience to demonstrate the range of problems lending themselves to the use of the Hutson-Russell loop. Suggestions for present and future applications of the versatile choledochojejunocutaneous loop are included.

The middle mesenteric artery: an unusual source for colonic hemorrhage.

To the authors' knowledge, colonic hemorrhage from anomalous ventral aortic mesenteric arteries has not been described previously. They report a case in which a middle mesenteric artery with unusual vascular distribution supplied a splenic flexure hemorrhage in a 62-year-old man. Although this is a rare anomaly, a thorough understanding of the middle mesenteric artery may have important diagnostic and therapeutic implications.

Comparison of balloon angioplasty and laser thermal angioplasty in the treatment of femoropopliteal atherosclerotic disease: initial results of a prospective randomized trial. Work in progress.

The authors recently initiated a prospective randomized trial in which results of standard balloon angioplasty were compared with those of laser thermal angioplasty in the treatment of patients with symptoms of femoropopliteal occlusive disease. The data regarding their initial technical success are reported herein. Twenty-five patients with moderate to severe claudication have thus far undergone 27 procedures. The type of lesions treated varied from short focal stenoses to occlusions up to 10 cm in length; 12 stenoses and 15 occlusions were treated. Fourteen procedures were randomized to laser therapy and 13 to standard balloon angioplasty. If the primary randomized treatment failed, the alternative procedure was then attempted. Of the 14 laser procedures, five were initial failures; three of these failures were subsequently treated successfully with the balloon technique. Three of 13 balloon procedures were failures; none were subsequently successful with use of the laser. While these data are limited, initial experience indicates that technical success is directly related to the ability to pass an angiographic wire through the lesion and the length and type of lesions. It does not appear to depend on whether the laser or the balloon is used.

Computed tomography of intralobar bronchopulmonary sequestration supplied from the renal artery.

Intralobar bronchopulmonary sequestration typically receives systemic arterial supply from the descending thoracic or upper abdominal aorta. Isolated reports have documented supply from branch vessels of the abdominal aorta, including the celiac axis and inferior phrenic artery. We report a case of the anomalous arterial supply arising from the right renal artery.