Search

CONCERN about human immunodeficiency virus (HIV) and other bloodborne pathogens is rising throughout society as infection becomes more prevalent. Many members of the Society of Interventional Radiology (SIR) have expressed the need for an official statement from the Society that addresses practice issues unique to interventional radiology. As a result, the SIR Subcommittee on HIV and Bloodborne Pathogens was formed to review current knowledge about risk of bloodborne pathogen transmission during interventional radiology procedures, to summarize exposure control regulations and recommendations as they pertain to the practice of interventional radiology and review ways that risk can be reduced, and to formulate a policy for the Society to assist its members in dealing with this complicated subject. LEVEL OF RISK IN INTERVENTIONAL RADIOLOGY

I have tried to give a little history, discuss some current topics: PACS, inappropriate image utilization, CT screening, Night Hawk, molecular imaging, sonoscope, CAD, and LBBH. I hope these issues are more familiar to you now. The articles that follow from the faculty of the University of Missouri-Kansas City School of Medicine and Saint Luke's Hospital will bring you up to date regarding the current status of CT, MRI, ultrasound, nuclear medicine, mammography, and interventional radiology.

Screening mammography is the primary method used for the detection of breast cancer. Computer assisted detection (CAD) systems, magnetic resonance imaging of the breast, and breast lymphoscintigraphy with sentinel lymph node biopsy are three new imaging techniques developed to assist in the detection and evaluation of breast cancer and will be described and discussed.

This paper reviews the scientific literature on four procedures: Coronary Calcium Scoring (CCS), Lung Cancer Screening (LCS), Computed Tomographic Colonography (CTC), and Whole Body Computed Tomography (WBCT). No published studies demonstrate that these procedures reduce morbidity or mortality when used to screen healthy, asymptomatic patients.

Advertising directly to asymptomatic patients and encouraging self-referral to CT centers for computed tomographic screening is a new phenomenon in radiology. This is not analogous to drug advertising that is directed to symptomatic patients and promotes medication that is FDA approved based on published medical research. CT should ideally be done for specific clinical indications after a thorough history, physical exam, and appropriate laboratory studies. CT screening--at this time--should only be done as part of an IRB-approved study protocol.

A case of asymptomatic, adherent, nonobstructing, barium fecalith (barolith) of the cecum, present for 2 years after previous barium studies, in a 63 year old woman is reported. Although obstruction by retained barium has been described, this is the first report of this type of complication of barium studies. Surgical removal of such fecaliths is recommended because of their adherence and resistance to purging as well as the possibilities of intussusception, obstruction, ulceration, or perforation of the colon.

Melioidosis is a disease caused by a motile, pleomorphic, Gram-negative bacillus, Pseudomonas pseudomallei. The clinical manifestations were first described in 1912 by Whitmore and Krishnaswami (17). Clinically as well as bacteriologically related to glanders, melioidosis is characterized by a fulminating septicemia with extreme prostration and a high mortality rate. Over 300 cases of this disease have been reported, 2 in persons who had never been outside the United States (2, 11). The 7 pathologically proved cases in this series were in United States servicemen in South Vietnam. The clinical manifestations, pathologic findings, and radiologic correlation will be considered in an attempt to establish an approach for early diagnosis. All the 7 cases in our experience occurred in individuals who were in excellent health prior to their illness. They had been engaged in widely varied activities; therefore, from an initial epidemiologic search, the only common factor is general location. Six of the 7 patients...

A case of nonsurgical treatment of renal arterial rupture secondary to balloon angioplasty is reported.

Postoperative stenosis of a benign ureteroileal anastomotic stenosis was dilated using Gruntzig balloon catheters. Technique and eleven-month follow-up are reported. Initial results are favorable.

Radiographs of the kidneys were obtained during inspiration with a 10 degrees cephalad angulation of the central ray. With this technique, costocartilaginous calcifications were not projected over the renal areas in 94% of cases.

THIS technic for the removal of fishhooks was developed out of frustration in trying to push large hooks through thick skin and small hooks through any skin. The procedure is as follows: the entran...

To the Editor.— The editorial in the July 12th issue by Dr King 1 left me a bit perplexed. His opening statement, "How should a physician address his patients?" was answered in his final paragraph by "if you are a mature patient and your doctor calls you by your first name, then in return address him by his first name." The question posed seems addressed to his physician audience; however, the reply seems addressed to the physician's patients. In considering the question of how to address patients, a recent column by "Miss Manners" is notable ( Minne apolis Star and Tribune , April 24, 1985, p 15DX). In it, columnist Judith Martin attacks the "unauthorized use of first names in impersonal situations as, for example, by doctors and nurses who have the mistaken notion that this makes patients feel better." The following day, the Minneapolis Star and Tribune commented on this position

To the Editor. — The article entitled "Apnea After Intravenous Diazepam Therapy" by Hall and Ovassapian (238:1052, 1977) emphasizes an important complication. They report using a 10-mg bolus intravenously for treatment of the patient's anxiety. A bolus injection to me generally means rapid intravenous injection. The product information sheet accompanying Valium emphasizes the importance of slow intravenous injection (5 mg/min). I use this drug frequently during angiography for the same indication. I believe it is important to use slow intravenous administration since frequently a patient will become very sedated with obvious slowing of the respirations with less than 10 mg. By using slow intravenous administration, the patient's condition can be monitored, and overdosage with the resultant complications can be avoided.