We describe a new method for relieving biliary obstruction due to malignant solid tumors. The method consists of placement of radium needles in a Ring biliary drainage catheter for three days. After removing the radium needles, the catheter is left in place to allow for repair of irradiated tissues, then it is removed. The object is to leave the patient with a patent biliary tree without a biliary drainage prosthesis. The clinical course of six patients treated by this method is described, and the autopsy findings in three cases are outlined. Three patients died with a serum total bilirubin ranging from 1-4.5 mg/100 ml, two to three months after removing the drainage catheter. Two patients died before the bile drainage catheter could be removed. One patient is alive with a bile drainage catheter in place. Possible modifications in technique and catheters are being considered.
One hundred thirty patients underwent low-dose, catheter-directed fibrinolytic therapy for arterial and graft occlusions present for various periods of time. In 65 consecutive patients the therapeutic parameters were identical, and a careful hematologic evaluation was performed. In the subsequent 65 patients, varying doses of fibrinolytic agents were employed. Fibrinolytic therapy was found to be beneficial in a diverse group of clinical situations and in patients whose occlusions had occurred at varying lengths of time. Early study demonstrated that effective fibrinolysis can be achieved at approximately onetwentieth of the systemic level and that systemic effects could be avoided in all patients during 24-hour infusions and in many patients infused up to 96 hours. Bleeding complications occurred only in patients in whom concomitant heparinization was employed, and this was thought to be the causative factor. Therapeutic success and avoiding complications are strongly dependent on close monitoring of patients and joint decision making by the vascular surgeon and radiologist.
Nitrous oxide is an ideal agent for use not only in the interventional radiology suite, but throughout the radiology department for pain relief and anxiety reduction. It is safe, easy to use, and effective in a multitude of clinical settings. During a one year period nitrous oxide analgesia was used in 300 patients with adequate analgesia and/or anxiety reduction in over 95 percent.
Double-lumen subclavian catheters have recently been released for use as a temporary blood access for extracorporeal circulation. Initial reports indicate that once properly inserted, these catheters are safe. However, massive mediastinal hematoma that occurred 3 days after insertion and uneventful initial dialysis with a double-lumen subclavian catheter has been documented. The patient experienced excruciating pain immediately after the onset of the subsequent dialysis and was found to have developed a massive mediastinal hematoma. It appears that at some point after the completion of the initial dialysis, the catheter tip eroded the vein and entered the mediastinum. As a result, the proximal (arterial) perforations were inside the vein, allowing blood to freely enter the circuit and be forcefully pumped into the mediastinum through the distal (venous) perforations near the tip. Prompt recognition of the problem and immediate discontinuation of dialysis prevented a potential fatal outcome in this case.
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