Colour-coded duplex ultrasonography in selection of patients for transluminal angioplasty

Transluminal angioplasty can be used to relieve symptomatic lower extremity arterial disease with minimal morbidity. This prospective study compares the accuracy of colour-coded duplex ultrasonography with intra-arterial digital subtraction angiography in selection of femoro-popliteal lesions for angioplasty. Isolated, short (<6cm) and haemodynamically significant stenosis (>50% reduction in diameter) were considered for angioplasty. Colour-duplex selection and exclusion was in agreement with angiography in 68 out of 86 lower limbs (79%). The sensitivity, specificity, positive and negative predictive value of colour duplex compared with angiography yielded values of 60.9, 87.5, 60.9 and 85.7%, respectively. The discrepancy between colour duplex and digital subtraction angiography can be partly explained by the tendency of duplex to underestimate the severity and length of disease. It is concluded that colour-coded duplex can be used as a screening tool for lower extremity arterial disease to select appropriate lesions for endovascular procedures. The accuracy of duplex in the present study was not perfect and the decision for further intervention should be based on clinical grounds.     

Rubella vaccination: The effect of health education andadministrative systems on vaccination rates in two health authorities

In 1983, the contribution of a standardised health education package on the schoolrubella vaccination programme was assessed in two adjoining health authorities. A controlled trial in schools showed that there was no statistically significant association between the use of the health education package and a high vaccination rate. Before 1983, inaccurate denominators based on consent forms sent out were used in calculating uptake rates. In addition, the numerator used in determining the numbers of children protected by the end of any one year did not take account of children previously immunised or those wishing to attend their family doctor. The study introduced an accurate denominator based on named class lists and an accurate numerator based on school vaccinations and general practitioner vaccinations as well as the number of children previously immunised, all of which had a marked enhancing effect on the percentage of children protected by the end of an academic year.     

Antireflux biliary stents: Are they the solution to stent occlusions?

Endoscopic insertion of plastic or metal stents is a wellestablished treatment for malignant biliary obstruction. The major limitation of this technique is stent occlusion. Duodenobiliary reflux has been considered a key contributor to stent occlusion. The presence of plant fibers in 35% to 60% of occluded stents on confocal laser microscopy has further confirmed the presence of reflux when the stent is placed across the papilla. Antireflux stents address this problem by allowing normal antegrade flow but preventing reflux. Recent studies comparing these antireflux stents with the standard Tannenbaum stents have shown significantly prolonged patency. Although initial results are encouraging, larger randomized trials are required to establish efficacy.     

Mortality following surgery for fractures of the neck of femur

The mortality following surgery for hip fractures during 1982 is reviewed. 91 procedures were performed on 89 patients. The mortality rate at 4 weeks following general anaesthesia was 2.7%. This is much lower than previously reported. Possible reasons for the variation in mortality between this series and others, are discussed.