Value of laser-assisted angioplasty in the community hospital

The experience with laser-assisted angioplasty at a community hospital was reviewed. One hundred twenty patients required angioplasty during a 7-month period, and in only 17-13 of whom had superficial femoral artery occlusions--was the use of lasers deemed appropriate. The success rate was 65% for laser-assisted angioplasty and 98% for balloon angioplasty. Laser-assisted angioplasty was the initial intervention in eight of the 13 superficial femoral artery occlusions. In two cases, a wire had been first advanced across the lesion, and in three cases, attempts to cross the lesion with a wire had been unsuccessful. The availability of the laser did not significantly increase the number of cases amenable to angioplasty, and at present laser angioplasty, does not seem to be cost-effective for community hospitals.

Evaluation of computed tomography guided percutaneous biopsy of the pancreas

The results of 96 computed tomography guided percutaneous pancreatic aspiration biopsies were reviewed to evaluate the diagnostic sensitivity, specificity and accuracy in pancreatic mass lesions. These were assessed by comparing pathology results to findings at subsequent laparotomy, autopsy or to immediate and long term clinical findings. Effects of varying the size of the biopsy needle and the number of aspirations performed were examined. Of the primary tumors of the pancreas in which adequate material was obtained, 97.3 per cent were correctly diagnosed with one false-negative and no false-positive results. The over-all sensitivity rate for primary tumor so the pancreas was 71.9 per cent using a No. 22 gauge "skinny" needle and 86.7 per cent using a No. 20 gauge needle. Over-all diagnostic accuracy for all types of lesions was 61.8 per cent using a No. 22 gauge needle and 73.3 per cent using a No. 20 gauge needle. A No. 19 gauge needle with a sheath was used on lesions with fluid or necrotic debris when a pseudocyst was a possibility. Over-all diagnostic accuracy using a No. 19 gauge sheathed needle was 81.8 per cent on all types of lesions. There was no benefit in using two passes versus a single aspiration. There were no complications, regardless of the needle size or number of passes. The serum amylase level increased in one instance after biopsy and this returned to normal a few days after biopsy. Computed tomography guided aspirations are safe and effective in evaluation of focal or diffuse enlargements of the pancreas when proper techniques and appropriate precautions are used.

Benign iatrogenic cause of mediastinal gas seen on computed tomography

Following intravenous administration of contrast material, intravenous gas was trapped by a mediastinal mass obstructing the superior vena cava (SVC). The computed tomographic demonstration of gas in the region of a mediastinal mass producing SVC obstruction is presented.