Noninvasive Imaging and Frequency Analysis for Carotid Artery Diagnosis and Surgical Decisions

An analysis of 212 carotid arteries studied by Doppler imaging, B-mode imaging, and spectral analysis reveals poor correlation though similarity of data base by chi-square and gamma is strong. The differences between arteriogra phy and the noninvasive techniques appear mainly in the categories of normal and \u3e 50% stenosis. Arteriography classifies more patients as normal and non invasives classify more patients as \u3e 50% by a ratio of 2:1. Noninvasive studies can be used to verify the findings using multiple techniques without risk and correlate best with operative findings. Evidence indicates that multimodality noninvasive studies are a reliable way of diagnosing carotid bifurcation disease and may be used in place of arteriography

Abscess of the Lower Leg Anterior Compartment and Osteomyelitis: A Complication of Failed Revascularization: A Case Report

A case of abscess of the lower leg anterior compartment and secondary osteomyelitis of the tibia following an initially successful but later failed revascularization procedure is described. The management of this unusual case is also discussed

Prognostic Nutritional Index: Its Usefulness as a Predictor of Clinical Course

Despite mounting evidence, a question still exists as to the true clinical relevance of varying degrees of malnutrition, the role of currently measured nutritional parameters in identifying malnutrition and predicting clinical risk in individual patients, and the efficacy of nutritional therapy. This study was designed to document the usefulness of the Prognostic Nutritional Index (PNI) as a predictor of clinical course. The nutritional assessments and clinical records of 328 subjects in a Veterans Administration Hospital were reviewed, PNI and complication rates were determined for each of the subjects, and the data statistically analyzed. The PNI was found to be a useful indicator of malnutrition and predictor of clinical course. The PNI appeared to be a more sensitive index of clinical outcome than did comparison of individual nutritional parameters to accepted norms, although it accounted for only 17% of the information needed to predict clinical course perfectly

White Clot Syndrome

Heparin therapy is currently a vital component in the medical management of thromboembolic events. Despite its widespread use, it is associated with relatively few complications, and these are usually minor and quickly reversible. Recently a much more dramatic and serious complication of heparin therapy has been identified. In heparin-induced thrombocytopenia with associated thrombosis or “white clot syndrome,” patients have paradoxic thromboembolic events while receiving heparin. These events are of acute onset and of major consequence, often resulting in limb loss or death. This paper describes our own experience with ten patients in whom the white clot syndrome occurred during heparin therapy for thrombotic or embolic events. Both porcine and bovine heparin preparations were being given through various routes. In the three cases in which platelet aggregation testing was completed, results were positive. Our ten patients ultimately had a 20% major limb amputation rate and an overall 50% mortality