Journal of vascular and interventional radiology : JVIR
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Real-time ultrasonography (US) is frequently used to access the biliary tree, urinary system, and pleural cavity, as well as abscesses and other fluid collections, but is rarely used to access blood vessels. This article describes the clinically indicated circumstances and technical aspects of US-guided access to veins and arteries. The authors' experience suggests that appropriate use of this modality significantly simplifies vascular access difficulties, reduces procedure time and morbidity, and is cost-effective.
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The effect of pH neutralization on the pain experienced during intradermal lidocaine administration was investigated in a prospective blind study of 20 adult volunteers. A plain solution (pH congruent to 6.1) and three different buffered solutions of 1% lidocaine (pH values of 6.8, 7.0, and 7.2) were prepared, and a 0.5-mL intradermal injection of each was administered to the volar aspect of the forearm. ⋯ Solutions with a pH of less than 6.8 (unbuffered lidocaine in this study) predictably produced a burning pain sensation on injection. However, buffering of 1% lidocaine above a pH of 6.8 significantly (P less than .05) reduced the mean quantitative pain estimates compared with the nonbuffered controls.
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J Vasc Interv Radiol · Feb 1992
Case ReportsPaucity of angiographic findings despite extensive organized thrombus in chronic thromboembolic pulmonary hypertension.
The authors describe a patient with chronic thromboembolic pulmonary hypertension. At pulmonary angiography, only severe hypertension with pruning of peripheral vessels was seen; the right pulmonary artery appeared normal. ⋯ At autopsy, a laminated well-organized thrombus that occupied virtually all of the right pulmonary artery and adhered to the vessel wall was seen. Other modalities should be investigated to help establish the diagnosis of chronic thromboembolic pulmonary hypertension.
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J Vasc Interv Radiol · Nov 1991
Multicenter Study Clinical TrialProximity injuries: correlation with results of extremity arteriography.
The results of 170 emergency arteriography procedures in 142 patients who had sustained extremity injuries near major arteries were correlated with the findings from a physical examination conducted prior to arteriography. Radiographically demonstrable significant arterial injuries, which usually required surgical repair, were present at 42 of the 170 injury sites (25%). Major physical findings suggestive of arterial injury were noted at 105 of 170 sites (62%). ⋯ At each of these 65 injury sites, the decision to perform emergency arteriography was based solely on the proximity of the wound to a major artery. In spite of this very low yield in the subgroup of 51 patients without major physical findings, emergency arteriography is still routinely requested for extremity injuries at the authors' institutions. The validity of this policy, a possible reason for its development, and its effect on patient disposition are examined.
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Ultrasound (US)-guided and fluoroscopically guided pericardial catheter placement was performed in 12 patients with known underlying malignancy who had clinical and radiographic evidence of a significant pericardial effusion. US guidance facilitated placement of a 22-gauge needle by means of a subxyphoid or transthoracic approach. The tract was subsequently dilated over a wire under fluoroscopic guidance with placement of either an 8.5- or 10-F catheter. ⋯ Cytologic findings were positive for malignancy in 10 of the 12 patients. Radiologically guided pericardiocentesis allowed safe, rapid stabilization of the condition of patients with symptoms from pericardial effusion. This resulted in excellent palliation in patients with terminal disease and improvement in the clinical status of other patients so that additional therapies, such as sclerosis with tetracycline or surgical placement of a pericardial window, could be performed on an elective basis.