The effect of an 80-mg intravenous dose of furosemide on the urinary excretion of digoxin was determined in three adult men with normal renal function, each of whom was taking 0.25 mg digoxin daily on a chronic basis. On two separate days, serum samples were taken and urine was collected every 2 hours over an 8-hour period for determination of digoxin, creatinine, calcium, and sodium concentrations. On the first day of study, a saline bolus was given intravenously, and on the second day, furosemide was given. In all subjects, urinary digoxin excretion increased after furosemide in direct proportion to the increase in urine volume. No consistent correlation was seen between digoxin excretion and creatinine, calcium, or sodium output. No significant changes in serum digoxin were found in this active study. These results are consistent with the hypothesis that increasing glomerular filtration rate or total urine volume increases the renal excretion of digoxin and may result in increased total urinary output of this glycoside.

Calcium↗

PubMedDate not supplied

Peripheral angioplasty balloon technology.

Changes in balloon and catheter technology have led to the development of smaller, more flexible, and less traumatic balloon dilatation systems. The physical principles that govern balloon angioplasty and the current status of balloon materials and catheter designs will be reviewed. A compilation of various angioplasty catheters is also summarized.

Angioplasty, Balloon↗

PubMedDate not supplied

Circumferential rupture of an angioplasty balloon with detachment from the shaft: case report.

Rapidly evolving angioplasty balloon techniques need continual evaluation for the type or frequency of balloon-related complications. We recently encountered a case where a new narrow shaft polyethylene terephthalate balloon completely separated from the catheter following circumferential rupture. The balloon was successfully retrieved using grasping forceps and a basket. Patterns of balloon rupture and subsequent management are discussed. Problems of this type were more frequent in the early days of balloon angioplasty, but have since become rare. Close surveillance of new low profile balloons is recommended to determine whether this represents an isolated occurrence or a return to the earlier experience.

Angiography↗

PubMedDate not supplied

Pseudoaneurysm formation following directional atherectomy.

Explore the source record for details and available documents.

Aged↗

PubMedDate not supplied

Reducing the discomfort of lidocaine administration through pH buffering.

PURPOSE: A prospective, double-blind study was undertaken to evaluate the effect of using a buffered lidocaine solution on the perception of pain experienced by a patient during its intradermal injection. PATIENTS AND METHODS: One hundred fifty patients undergoing diagnostic angiographic and interventional procedures at the authors' institution were randomly assigned to receive a 1-mL aliquot of one of three lidocaine solutions: plain 1% lidocaine, 1% lidocaine diluted with normal saline in a 10:1 ratio, and 1% lidocaine diluted with 8.4% sodium bicarbonate in a 10:1 ratio. The lidocaine solutions were administered intradermally over 10-15 seconds. A numerical value was placed on the patient's perception of pain, separate from that associated with the 25-gauge needle insertion, with use of a linear visual analog scale. RESULTS: Mean pain scores were as follows: for the 1% lidocaine solution, 2.83 +/- 2.60; for 1% lidocaine plus normal saline solution, 2.89 +/- 2.34; and for 1% lidocaine plus sodium bicarbonate solution, 1.37 +/- 1.73 (P = .0018). CONCLUSION: Buffering lidocaine significantly decreased the discomfort associated with its administration as a local anesthetic.

Adolescent↗

PubMedDate not supplied

Recent development of rigors during infusion of urokinase: is it related to an endotoxin?

PURPOSE: This study was undertaken to determine the prevalence of rigors associated with the use of urokinase (UK) and to assay for the presence of an endotoxin in the UK solution. PATIENTS AND METHODS: Records of 75 patients who underwent 86 UK infusions between January 1988 and July 1992 were reviewed to evaluate for the development of UK-associated rigors. A modified chromogenic limulus amebocyte lysate (LAL) test was performed to determine the presence of endotoxin in four samples of UK from lots associated with rigors, one sample of UK not associated with rigors, sterile water, nonionic contrast medium, and ionic contrast medium. RESULTS: Between January 1, 1988, and July 10, 1990, 43 patients underwent 46 UK treatments (group 1) with no documented rigors (0% prevalence). In 45 of these 46 treatments, a standard, non-pulse-spray bolus of 75,000-500,000 IU of UK (mean dose, 182,222 IU) was used. Between July 11, 1990, and July 6, 1992, 38 patients underwent 40 UK treatments (group 2). In 33 of these 40 treatments, a standard bolus was given. Five patients received a pulse-spray bolus. The mean bolus was 213,768 IU (range, 100,000-500,000 IU). Eleven group 2 patients developed rigors (28% prevalence; P = .0005 vs group 1). The chromogenic LAL tests demonstrated no endotoxin in sterile water, nonionic contrast media, or ionic contrast media. Endotoxin was detected in small concentrations in the four samples of UK associated with rigors and in the UK sample not associated with rigors. CONCLUSION: The increase in the prevalence of rigors associated with the use of UK does not appear to be related to an endotoxin in UK, since the concentration of endotoxin detected is well below the threshold pyrogenic dose in humans.

Contrast Media↗

PubMedDate not supplied

Percutaneous transluminal angioplasty of visceral arterial stenoses: results and long-term clinical follow-up.

PURPOSE: To determine the efficacy and safety of percutaneous transluminal angioplasty (PTA) of the visceral arteries. PATIENTS AND METHODS: We retrospectively evaluated the results of PTA performed in 20 visceral arteries in 19 patients (10 men, nine women; mean age, 63 years). Eleven patients had symptoms characteristic of mesenteric ischemia, four had atypical abdominal pain, and four were undergoing prophylactic dilation before undergoing another procedure involving the abdominal aorta. Clinical follow-up was possible in all patients. RESULTS: PTA was technically successful in 15 of 19 patients (79%); among these 15 patients, 12 (80%) did well clinically. Of the seven PTA procedures that were immediate failures, five failed secondary to an occult malignancy or to extrinsic arterial compression by the median arcuate ligament. Ten (83%) of the 12 patients in whom the procedures were immediate clinical successes are still clinically improved at 4-73 months follow-up (mean, 25 months). PTA was successful in only one of the four patients who had symptoms atypical of mesenteric ischemia, but it was successful in 11 of the 15 patients who had symptoms of mesenteric ischemia or who underwent prophylactic dilation. Major complications occurred in three (16%) of the 19 patients. CONCLUSION: PTA of visceral artery stenoses is effective in patients with symptoms of mesenteric ischemia. It is also effective as prophylaxis in patients undergoing additional procedures in the abdominal aorta.

Abdominal Pain↗

PubMedDate not supplied

Effect of screw length on bioabsorbable interference screw fixation in a tibial bone tunnel.

Initial tibial fixation strength is the weak link after anterior cruciate ligament reconstruction with a quadrupled hamstring tendon graft fixed with bioabsorbable interference screws. The purpose of this study was to determine the biomechanical differences between 28-mm and tapered 35-mm interference screws for tibial fixation of a soft tissue graft in 16 young cadaveric tibias. Failure mode, displacement before failure, and ultimate failure load were tested with a testing machine aligned with the tibial tunnel to simulate a worst-case scenario. The mode of failure was graft slippage past the screw in all but one of the specimens. The mean maximum load at failure of the 28-mm screw was 594.9 +/- 141.0 N, with mean displacement at failure of 10.97 +/- 2.20 mm. The mean maximum load at failure of the 35-mm screw was 824.9 +/- 124.3 N, with a mean displacement to failure of 14.38 +/- 2.15 mm. The 38% difference in mean maximal load at failure was significant. Important variables in hamstring tendon graft fixation within a bone tunnel include bone mineral density, dilatation, gap size, screw placement, and screw width and length. Attention to these variables will help to provide secure graft fixation during biologic incorporation throughout the rehabilitation period.

Absorbable Implants↗