Percutaneous enterostomy with the Cope suture anchor.

Eighty-two percutaneous enterostomies were performed at three institutions with the Cope suture anchor for stomach or jejunal wall stabilization during alimentation tube placement. The anchors were successfully placed into the stomach or jejunum in 81 cases. Early in the series, two anchors were misplaced, with no sequelae. There were no other complications at the time of placement. In all successful cases, excellent immobilization of the viscus was achieved. Tract dilation and tube placement were easily performed, and there were no guidewire or tube dislodgments.

Transplant renal artery stenosis: evaluation with duplex sonography.

Determination of the cause of hypertension in renal transplant recipients has required invasive studies such as angiography. Consequently there has been recent interest in noninvasive evaluation. Over a 19-month period, duplex sonography was performed on the renal transplant vasculature in 31 allograft recipients who also underwent correlative arteriography. One patient underwent a repeat duplex study and arteriography after surgical repair. On the basis that a frequency shift greater than 7.5 kHz and associated distal turbulence indicate stenosis, 18 duplex sonographic studies were considered positive. Subsequent angiography showed renal artery stenosis in 16 patients and no significant lesion in two. In 14 patients Doppler studies were interpreted as normal; angiography showed no significant arterial abnormality in 13 and significant stenosis in one. These results indicate a sensitivity of 94.1% and specificity of 86.7% for duplex sonography in the diagnosis of transplant renal artery stenosis. Duplex sonography appears to be an excellent noninvasive screening method to evaluate arterial stenosis following renal transplantation.

Double-lumen needle for percutaneous ureteral pressure-flow studies.

Ureteral perfusion studies in patients without preexisting renal access currently must be intermittently interrupted for intrarenal pressure measurement. A double-lumen needle has been successfully placed in four patients (two with native and two with transplanted kidneys). This permits simultaneous perfusion and intrarenal pressure monitoring yet maintains the safety and ease of use of a single skinny needle.

Mechanical clot dissolution: new concept.

The authors present preliminary data on in vitro mechanical clot dissolution by means of a catheter with a tiny high-speed propeller enclosed in a special housing. Preweighed human blood clots were subjected to the catheter in a test tube with saline at various propeller speeds and durations of application. After filtration of the resultant slurry, the clot residue was weighed and examined histologically. Clot dissolution was found to be related to both the duration and speed of propeller rotation. No fibrin residue was seen after dissolution, although potential embolic material, composed of clumps of cellular debris as large as 208 microns in longest dimension, was found. Mechanical clot dissolution could possibly be used in any natural or synthetic blood vessel in which there is acute or subacute thrombosis, with fewer complications and lower cost than obtained with traditional methods.

Mortalities associated with use of a commercial suspension of polyvinyl alcohol.

Two cases of symptomatic neonatal hepatic arteriovenous malformation (AVM) are presented. Both were treated with percutaneous transcatheter embolization and a commercially available polyvinyl alcohol suspension. Both infants died soon after AVM embolization. The results of laboratory examination of particle-size homogeneity of this commercial suspension demonstrate marked inhomogeneity of particle size very probably contributed to the death of these patients. A protocol has been developed to help determine appropriate particle size in individual cases; this may help prevent such catastrophic results during transcatheter embolization.