S. Heenan

Evaluation of dynamic lymphoscintigraphy and sentinel lymph-node biopsy for detecting occult metastases in patients with penile squamous cell carcinoma.

To evaluate the introduction of dynamic lymphoscintigraphy and sentinel lymph‐node (SLN) biopsy (used to detect occult lymph node metastases in patients with penile cancer and clinically impalpable inguinal lymph nodes at presentation) at a UK tertiary referral centre for penile cancer.

Transbrachial Arteriography: Indications and Complications

PURPOSE to retrospectively evaluate brachial artery puncture at the antecubital fossa with regard to the indications for and complications arising from the procedure. PATIENTS AND METHODS Sixty-two cumulative brachial artery punctures in fifty-three patients over a 5-year-period were retrospectively studies. RESULTS In the majority of cases the brachial approach was utilised in order to avoid groin puncture in patients with absent femoral pulses or recent graft surgery. Occasionally it was performed as a more direct method of assessing upper limb arterial anatomy. Catheter sizes ranged from 3F to 8F. Fifty-one (82%) of the procedures were diagnostic and 11 (18%) were interventional. Glyceryl trinitrate was routinely administered. The overall incidence of complications was low (8%) and included haematoma and arterial spasm. None required surgical intervention and all resolved without permanent sequelae. CONCLUSION Brachial artery puncture at the antecubital fossa is a suitable site of access for both diagnostic and interventional procedures. Potential limitations are the long distance from puncture site to that of intervention and damage to the brachial artery can result in upper limb ischaemia. Percutaneous brachial artery puncture at the antecubital fossa is, however, a low-risk alternative to either intravenous digital subtraction angiography or axillary artery puncture in patients in whom the femoral approach is contraindicated.

MRI appearances of the asymptomatic patellar tendon on gradient echo imaging

Thickening of the patellar tendon and foci of increased signal intensity have been described as characteristic features of “jumpers knee” (chronic patellar tendinitis) on magnetic resonance imaging (MRI). It was our impression that such appearances may be seen in the patellar tendons of patients without symptoms referable to the anterior part of the knee when using gradient echo images. The appearances of the asymptomatic patellar tendon on three-dimensional gradient echo sequences were studied by retrospectively reviewing the images of 60 patients, none of whom had symptoms related to the anterior part of the knee. The anteroposterior width of the patellar tendon was measured at three levels (superior, middle and inferior) on the central sagittal image of a gradient echo sequence. The relative signal intensities at the same levels were recorded. In 97% of subjects the superior part of the tendon was wider than the midpoint, and in 97% the inferior part was wider than the midpoint. The range of widths was wide, and there was no significant difference between sexes. Focal increased signal intensity in the superior part was shown in 75%, and in the inferior part in 43%. The asymptomatic patellar tendon shows uniform thickness throughout most of its length, but there are focal expansions at the proximal and distal ends. It usually demonstrates low signal on MRI, but may contain foci of increased signal intensity at either or both ends when imaged on gradient-echo sequences.Thickening of the patellar tendon and foci of increased signal intensity have been described as characteristic features of “jumpers knee” (chronic patellar tendinitis) on magnetic resonance imaging (MRI). It was our impression that such appearances may be seen in the patellar tendons of patients without symptoms referable to the anterior part of the knee when using gradient echo images. The appearances of the asymptomatic patellar tendon on three-dimensional gradient echo sequences were studied by retrospectively reviewing the images of 60 patients, none of whom had symptoms related to the anterior part of the knee. The anteroposterior width of the patellar tendon was measured at three levels (superior, middle and inferior) on the central sagittal image of a gradient echo sequence. The relative signal intensities at the same levels were recorded. In 97% of subjects the superior part of the tendon was wider than the midpoint, and in 97% the inferior part was wider than the midpoint. The range of widths was wide, and there was no significant difference between sexes. Focal increased signal intensity in the superior part was shown in 75%, and in the inferior part in 43%. The asymptomatic patellar tendon shows uniform thickness throughout most of its length, but there are focal expansions at the proximal and distal ends. It usually demonstrates low signal on MRI, but may contain foci of increased signal intensity at either or both ends when imaged on gradient-echo sequences.

Percutaneous transluminal angioplasty by a retrograde subintimal transpopliteal approach

We report three cases of femoropopliteal occlusive disease which were successfully recanalized subintimally and retrogradely via the popliteal artery. The merits and limitations of this approach are discussed.

Directional atherectomy in the treatment of anastomotic neointimal hyperplasia associated with prosthetic arterial grafts: Technique and preliminary results

The development of anastomotic neointimal hyperplasia is a common cause of late prosthetic arterial bypass graft failure. The cost and morbidity of graft failure are high, hence the widespread use of graft surveillance programmes in order to detect graft-related stenoses before they progress to occlusion. However, the optimal treatment of stenoses secondary to neointimal hyperplasia is not clear, with a number of authors reporting poor results with both balloon angioplasty and surgical revision. We report our early experience with the Simpson atherectomy catheter in the treatment of anastomotic neointimal hyperplasia associated with prosthetic arterial grafts at eight sites in seven patients. A high technical success rate may be expected and further long-term studies of this mode of treatment are indicated.

Current status of dynamic lymphoscintigraphy and sentinel lymph‐node biopsy in urological malignancies

The lymphatics were mapped using lymphangiograms taken via the dorsal penile lymphatics. The SLN was located initially using an anterior-posterior radiograph. The junction of the femoral head and the ascending ramus of the pubis were found most often to contain the SLN centre. This corresponded anatomically to the lymph nodes adjacent to the superficial epigastric vein, which were located medial and superior to the epigastric-saphenous junction.

Evaluation of the Pullback Atherectomy Catheter in the treatment of lower limb vascular disease

Purpose:To evaluate prospectively the Pullback Atherectomy Catheter (PAC) in terms of its technical success and 1-year patency in the treatment of lower limb vascular disease.Methods:Thirty-nine PAC procedures were performed in 34 patients to treat atherosclerotic disease (occlusive in 51%) of the femoropopliteal arteries, including four cases of graft neointimal hyperplasia and three dissection flaps. Follow-up was by ankle-brachial indices at 24hr and 1 month, and arteriography at 6 and 12 months.Results:Technical success was achieved in 38 of 39 procedures (97.4%). There was a reduction in mean stenosis from 89.4% to 12.1%, but 69.2% of procedures required additional balloon dilatation to achieve an adequate arterial lumen. Complications followed 15.4% of procedures, a third of which required surgery.Conclusion:The PAC is an easy and relatively safe catheter to use, but does not provide a satisfactory arterial lumen without additional percutaneous transluminal angioplasty (PTA). It proved to be effective, however, in the treatment of graft neointimal hyperplasia and in the resection of obstructive intimal flaps following PTA.