Chronic electrical muscle stimulation is an effective treatment for alleviating intermittent claudication which, by targeted activation of a small muscle mass, does not engender a significant systemic inflammatory response.
Ultrasound guided percutaneous thrombin injection has recently been described for the treatment of iatrogenic femoral pseudoaneurysms. Patient selection and technical aspects of this technique are still evolving and safety data, particularly after coronary intervention, remains limited. The percutaneous thrombin injection of femoral artery pseudoaneurysms in 13 consecutive patients, most of whom were receiving antiplatelet/anticoagulant treatment (aspirin 11, heparin 4, clopidogrel 6), is reported. Thrombin (1000 U/ml) was injected over several seconds until Doppler colour flow within the cavity ceased. The median dose of thrombin injected was 800 U (range 200-1000 U) and the treatment was successful in all cases without complication. In one case, thrombus was visualised within the arterial lumen immediately after thrombin injection, but this dissolved spontaneously within five minutes without evidence of embolisation. In contrast to ultrasound guided compression, percutaneous thrombin injection of femoral pseudoaneurysms is a rapid, well tolerated, and successful technique even in patients receiving antiplatelet/anticoagulant treatment. (Heart 2001;85:e5) Keywords: ultrasound guided percutaneous thrombin injection; iatrogenic femoral artery pseudoaneurysm Iatrogenic femoral artery pseudoaneurysms occur following 0.2-0.5% of diagnostic angiography cases and in up to 8% of coronary interventions.
Three cases of iatrogenic diaphragmatic herniation are reported following thoracic and high abdominal surgery. Each case presented at least 6 months after the original surgery with symptoms of acute upper gastrointestinal obstruction. Diaphragmatic herniation was not considered in the initial differential diagnosis which lead to a delay in their referral. We emphasise the importance of checking the diaphragm following upper abdominal surgery and care when closing a defect.
We suggest that stenting of occluded iliac arteries should be reserved for those patients with limited life expectancy. Patients who are younger and fitter should be offered femorofemoral crossover grafting as a primary procedure until research enables identification of those patients who are most likely to maintain long-term patency after stenting.
C olonic diverticula constitute the most common endoscopic anomaly in the Western world. They are responsible for a spectrum of disease. Most presentations associated with colonic diverticula can safely be managed in primary care. The distinction between those patients who are suitable for primary care management and those who require secondary care referral can be difficult to formulate. This article aims to provide a framework, informed by current guidelines, for the management of diverticular disease in primary care, and the identification of patients likely to benefit from referral to secondary care. An overview of the secondary care management of diverticular disease is also provided. The GP curriculum and diverticular disease Clinical module 3.03: Care of acutely ill people relates to:. Recognition and immediate management of acute diverticulitis Clinical module 3.13: Digestive health relates to:. The assessment of abdominal pain to enable a diagnosis of diverticular disease. Understanding the important dietary factors to consider in diverticular disease and offer appropriate dietary advice. The epidemiology of digestive problems as they present in primary care, and their often complex aetiology. The understanding of secondary care management of diverticular disease
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