Color flow duplex scanning was used to "map" the iliofemoral and femora/popliteal segments in 61 patients (84 extremities) undergoing evaluation for excimer laser an#oplasty. Eight locations, iliac, common femora/, profunda femoris, proximal and distal superficial femoral artery, proximal and distal popliteal, and tibioperoncal trtmk were scored as normal versus abnormal, >50% stenosis, or occluded, and occlusions were measured in centimeters. Specificity, sensitivity, and accuracy were calculated with the arteriogram as the gold standard (83% and 96%, respectively, for normal vs abnormal, 87% and 99% for 50% stenosis, and 81% and 99% for occlusions). Color flow accurately identified the presence and extent of occlusions in 48 of 51 extremities (94%) when compared to arteriography plus operative findings, since arteriography alone tended to overestimate occlusion length. It is concluded that color flow Doppler alone may be used to screen patients with peripheral vascular disease to assess candidacy for endovascular procedures without antecedent arteriography, and that arteriography alone would exclude some patients from consideration by falsely overestimating occlusion lengths.
Color flow duplex scanning was used to "map" the iliofemoral and femoral popliteal segments in 61 patients (84 extremities) undergoing evaluation for excimer laser angioplasty. Eight locations, iliac, common femoral, profunda femoris, proximal and distal superficial femoral artery, proximal and distal popliteal, and tibioperoneal trunk were scored as normal versus abnormal, greater than 50% stenosis, or occluded, and occlusions were measured in centimeters. Specificity, sensitivity, and accuracy were calculated with the arteriogram as the gold standard (83% and 96%, respectively, for normal vs abnormal, 87% and 99% for 50% stenosis, and 81% and 99% for occlusions). Color flow accurately identified the presence and extent of occlusions in 48 of 51 extremities (94%) when compared to arteriography plus operative findings, since arteriography alone tended to overestimate occlusion length. It is concluded that color flow Doppler alone may be used to screen patients with peripheral vascular disease to assess candidacy for endovascular procedures without antecedent arteriography, and that arteriography alone would exclude some patients from consideration by falsely overestimating occlusion lengths.
After ten years of court decisions that have gradually broadened the scope of the psychotherapist’s duty to protect potential victims from violence, California has recently passed legislation that limits liability only to those cases where a patient has made a specific threat to an identifiable victim. Although this legislation has articulated the appropriate clinical response in such situations, it may have created a false sense of security for therapists treating patients who are perpetrators or victims of family violence. Though some perpetrators of violence do make a specific verbal threat, therapists are likely to encounter many more who do not verbalize a threat, but nevertheless pose a serious danger to their family members. This article briefly discusses the recent history of the duty-to-protect issue and the violence prediction literature as they relate to domestic violence. Specific interventions are suggested for clinicians in cases where the violence potential is great but no specific threat is made by the client.
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