CT fluoroscopic guided insertion of inferior vena cava filters

The value and use of inferior vena cava (IVC) filters is well documented and has been growing since the first reported filter placement in 1973 and the first percutaneous insertion in 1982. Access routes now include both jugular veins, both ante-cubital veins and both femoral veins. However, all insertions require some form of imaging, usually fluoroscopy, to identify the location of the filter with respect to the IVC and the renal veins. We describe two cases where the patients' weight was significantly greater than the weight limit of the angiography table, necessitating insertion under CT fluoroscopic guidance.

A safe zone for the passage of screws through the posterior tibial cortex in tibial tubercle transfer

In tibial tubercle transfer, surgery drills and screws can put the popliteal vessels at risk if the posterior cortex is breached. This complication can be devastating. We have looked at arteriograms of 50 knees and identified a safe zone through which an instrument can be passed with more confidence. In our study we found no vessels directly posterior to the supero-medial aspect of the proximal metaphysis in any knee. Whilst care must still be taken, this area will allow surgeons greater confidence to obtain a stronger bicortical hold with any fixation device.

Penile function following intracavernosal injection of vasoactive agents or saline

Few studies on the pharmacological assessment or treatment of impotence have included controls. In a double-blind crossover study, 18 impotent men received either a 2 ml injection of a solution containing 30 mg papaverine and 1 mg phentolamine or a similar volume of normal saline into the corpus cavernosum. The immediate and delayed effects (4 weeks later) were assessed independently and the alternative injection then given. All injections with papaverine and phentolamine were followed by an immediate increase in penile length and rigidity, and 70% of these patients were able to have sexual intercourse for periods of 1 to 4 weeks. No change in penile length or rigidity occurred following the saline injection and only one patient showed some improvement in erection over the next 4 weeks. In the crossover study, no patient developed any increase in length or rigidity of the penis following injection of saline, and improvement in spontaneous erection occurred in only two cases. In contrast, all patients who received papaverine and phentolamine had an increase in penile length and rigidity, and 50% were able to have normal sexual intercourse over the next 4 weeks. This study confirms the value of a combination of vasoactive agents in the management of impotence, irrespective of its aetiology, and suggests that any placebo effect is minimal in this group of patients with considerable psychological overlay.