Perivascular color artifact: pathologic significance and appearance on color Doppler US images

A distinctive type of artifactual extravascular assignment of color was identified in 49 color Doppler ultrasound (US) examinations in 43 patients. This artifact appeared as a random localized mixture of red and blue assigned to perivascular soft tissues; the artifact varied with the cardiac cycle, being most prominent in systole and absent or less prominent in diastole. The artifact was seen in 26 patients (32 examinations) at an anastomotic site or stenotic lesion associated with surgically created arteriovenous fistulas for hemodialysis. It was also observed in ten patients with accidental iatrogenic arteriovenous fistulas (renal transplant [n = 6], femoral artery [n = 3], and iliac artery [n = 1]), five with stenotic arteries not associated with arteriovenous fistulas, and two with arterial aneurysms. The authors believe this artifact reflects perivascular tissue vibration caused by turbulent intravascular blood flow. If properly recognized and accurately interpreted, the artifact can be a valuable color Doppler US sign of underlying vascular abnormality.

Acute orbital pseudotumor with iatrogenic intraorbital air: a diagnostic dilemma

A 13-year-old black female was referred with unilateral granulomatous uveitis and orbital inflammation of sudden onset. Hematologic, serologic, bacteriologic, and ultrasonographic studies along with high resolution CT scans of the orbits were employed to determine the diagnosis and appropriate treatment. Subconjunctival corticosteroid injection containing air prior to referral obfuscated the ultimate diagnosis of pseudotumor. The Pediatric Infectious Disease service delayed definitive treatment with systemic steroids. Differential diagnosis of granulomatous uveitis with orbital inflammation are discussed. CT scan has significantly advanced the diagnosis and management of orbital pseudotumor.

The clinical aspect of retained gastric antrum

Thirty symptomatic patients with retained gastric antrum proved pathologically and/or by isotopic visualization were studied and treated from 1968 to 1983. The latent periods from the antral exclusion to the occurrence of anastomotic ulcers after a subtotal gastrectomy with Billroth's type II reconstruction varied from a few days to 19 years, with an average of 2.8 years. Fasting serum gastrin levels were normal in 14 of 21 patients and were intermittently high in some patients. The basal to maximal acid-output ratio was greater than 0.6 in 69% of the patients; primary cimetidine treatment was effective in three of five patients. Thirty-five operations on 27 patients were divided into six groups; all of these 27 patients eventually underwent resection of retained gastric antrum. We concluded that resection remains the best treatment for anastomotic ulcer related to retained gastric antrum. Additional truncal vagotomy did not provide additional benefit to these patients. Furthermore, cimetidine can be useful to control the symptoms for preoperative preparation or definitive treatment in high-risk patients.

[Self-monitoring of physicians for the detection of iatrogenic diseases]

Iatrogenic diseases are defined as illnesses due to diagnostic or therapeutic procedures. The authors explore the possibility of recording iatrogenic diseases by a physician self-monitoring system. The responsible physician himself records his/her patients' iatrogenic complications on hospital discharge, after which the authors examine retrospectively all charts of the patients involved and a random sample of patients not included. The results show that in one year 208 of 1618 patients were recorded as having an iatrogenic disease which was severe in 88. 7.1% of these cases were not confirmed retrospectively (false positives). On the other hand, about one third of iatrogenic illnesses were not recorded (false negatives), though these were less severe cases only. We calculated that 17% of our patients had iatrogenic diseases, 22% of these were predictable. About a third of the patients had iatrogenic disease before hospital admission, and these patients had more severe, and other, iatrogenic diseases than those who acquired them during hospitalization. Iatrogenic complications affect other organ systems than non-iatrogenic acquired diseases. On average, patients with iatrogenic diseases were 6 years older and hospitalized 10 days longer than other patients. Although not all cases may be recorded, we believe that physician self-monitoring is preferable to other systems for recording iatrogenic diseases, since it may have a direct teaching effect on those who cause the illness.

Diagnostic problems in drug-induced diseases

The evaluation of adverse drug reactions (ADR's) in clinical patients is usually a complex and multifactorial problem. A methodology for this evaluation has been derived from the experience with over 3,000 cases. Illustrative cases are presented to demonstrate in detail a variety of means of linking a drug with an ADR. Emphasis is placed on the frequent diagnostic utility of accurate time-related information, in addition to the use of historical, clinical-laboratory and morphologic findings.

Pattern and quality of recording pre-admission drug treatment in paediatric patients

The pattern and quality of recording drug use before admission was examined in children admitted to a paediatric unit over eight months. The preadmission drug intake (1-7 drugs/patient) was lower than that of adults. Antibiotics were the most frequently prescribed drugs, but mild analgesics and antihistamine preparations were commonly used, often without medical advice. The simultaneous administration of prescribed and non-prescribed drugs appeared to be as common in children as in adults. The number of drugs taken was related to the number of domicilary consultation received and the number of doctors seen as as to confirm that most doctors' visits result in the prescription of medicine. The transfer and recording of drug information was poor, owing principally to lack of communication between doctors and failure to detect self-medication, but the modern practices of self-referral to hospital and use of multiple prescribers have further reduced the information available. The use of a "current treatment card" is required if the full significance of iatrogenic disease in childhood is to be investigated.

Omental arteriovenous fistula following liver biopsy

A case of iatrogenic omental arteriovenous fistula attributable to an earlier unsuccessful liver biopsy is presented. The complications of liver biopsy and the role of arteriography in the diagnosis and management of visceral arteriovenous fistulas are discussed.

Iatrogenic disease: an epidemiologic perspective

Among the most serious problems associated with the increasing number of drugs and procedures used in contemporary medical practice is the identification of therapy-associated diseases. This overview of iatrogenic conditions illustrates some adverse reactions produced by chemical, physical, and infectious agents, with emphasis on reactions that were difficult to detect. The advantages and limitations of several procedures for identifying and quantifying iatrogenic conditions are considered from an epidemiologic perspective.