The Suicide Prevention, Depression Awareness, and Clinical Engagement Program for Faculty and Residents at the University of California, Davis Health System.

OBJECTIVE: The authors replicated a program developed by UC San Diego, identified medical staff at risk for depression and suicide using a confidential online survey, and studied aspects of that program for 1 year. METHODS: The authors used a 35-item, online assessment of stress and depression depression developed and licensed by the American Foundation for Suicide Prevention that aims to identify and suicide risk and facilitate access to mental health services. RESULTS: During 2013/2014, all 1864 UC Davis residents/fellows and faculty physicians received an invitation to take the survey and 158 responded (8% response rate). Most respondents were classified at either moderate (86 [59%]) or high risk for depression or suicide (54 [37%]). Seventeen individuals (11%) were referred for further evaluation or mental health treatment. Ten respondents consented to participate in the follow-up portion of the program. Five of the six who completed follow-up surveys reported symptom improvement and indicated the program should continue. CONCLUSIONS: This program has led to continued funding and a plan to repeat the Wellness Survey annually. Medical staff will be regularly reminded of its existence through educational interventions, as the institutional and professional culture gradually changes to promptly recognize and seek help for physicians' psychological distress.

Nanotechnology development and utilization: a primer for diagnostic and interventional radiologists.

The term nanotechnology refers to the design, creation, and manipulation of structures on the nanometer scale. Much of the ongoing research and development of nanotechnology is focused on the development of novel methods of imaging and delivery of therapeutics through minimally invasive means. Multifunctional nanoparticles offer great promise for molecular imaging and directing novel therapeutics to molecular targets, which was never before possible. Nanoparticle-based contrast agents have been developed for all imaging modalities. A rapidly increasing number of companies and government funding initiatives have led to a large number of novel agents in various stages of development, ranging from in vitro and in vivo animal studies to clinical use. However, barriers to the delivery of nanoparticles for tumor imaging and therapy exist. Interventional radiologists may circumvent these barriers by using imaging to guide delivery of nanoparticles.

Acquired peripheral arteriovenous malformations in patients with venous thrombosis: report of two cases.

The etiology of arteriovenous (AV) malformations remains incompletely understood. Two cases of acquired AV malformations wholly located within the thrombosed lumen of the femoral and external iliac veins are presented here. The patients presented with symptoms of high venous pressure: pigmented skin and chronic pain. Such AV malformations have been rarely described in the extracranial circulation. The associated pain was successfully treated with catheter-based embolization of the lesions. The induction of the AV malformations in the peripheral circulatory system raises questions regarding the nature of angiogenesis and its possible triggers.

Congenital single, pelvic iliac artery: a case report.

Congenital vascular anomalies of pelvis and lower limb arteries are rare. During embryologic development, the sciatic artery represents the dominant supplier of blood to the lower limb. The external iliac and femoral arteries appear later in the process and take over as the sciatic artery regresses. Failure of the sciatic artery to regress creates a persistent sciatic artery malformation. Failure of the external iliac artery to properly bud may lead to similar vascular malformations. The authors present a patient with atresia of the left external iliac artery with an associated atresia of the left common iliac vein, duplication of the infrarenal inferior vena cava, and absence of the left S1 bony arch. The left-sided single iliac artery supplies both pelvic structures and the lower limb. The "pelvic" external iliac artery may result from embryologic budding at a lower segmental level than the usual fifth lumbar segmental artery. This combination of anomalies suggests an abnormality of segmentation on left at the first sacral level.

Deep venous reflux associated with a dilated popliteal fossa vein reversed with endovenous laser ablation and sclerotherapy.

Objective. To report an incidence of reflux in the deep venous system reversed by ablation of a popliteal fossa vein (PFV). Method. A 40-year-old man with pain and swelling in the medial upper calf was found to have an incompetent PFV. Results. Reflux in the femoral and popliteal veins was reversed utilizing endovenous laser ablation and foam sclerotherapy, documented on Duplex studies before and after the intervention. There was also resolution of symptoms. Conclusion. A PFV can be associated with deep venous reflux. Correction of this reflux with ablation of the PFV suggests that his type of reflux is secondary to volume effects of the incompetent popliteal vein.

Chronic iliac vein occlusion and painful nonhealing ulcer induced by high venous pressures from an arteriovenous malformation.

Chronic femoral vein compression (May-Thurner Syndrome) is a known rare cause of deep venous thrombosis. Subsequent angiogenesis and the development of arteriovenous malformation (AVM) in the setting of chronic venous thrombosis is by itself a rare and poorly understood phenomenon. We report a case in which elevated venous pressures resulting from such compression appear to have resulted in the development of a pelvic arteriovenous malformation, which was further complicated by chronic, nonhealing painful lower extremity ulcers, and the development of extensive subcutaneous venous collaterals. Following successful embolization of the pelvic AVM and ablation of veins under the ulcers with laser and sclerotherapy, the patient's ulcers healed and she became pain-free.

Massive hematochezia: a complication of methamphetamine-induced vasculitis treated by transcatheter hemostasis.

A long-term, heavy methamphetamine user with life-threatening rectal hemorrhage was treated with transcatheter occlusion of the bleeding arteries. The bleeding blood vessels were vulnerable submucosal arteries, part of the collateral supply to the distal colon. Visceral arteriography demonstrates severe arterial stenotic lesions of the celiac axis, superior mesenteric artery and the inferior mesenteric artery. Collateral vessels were seen with corkscrew morphology similar to that seen with thromboangiitis obliterans.

Snare technique for the placement of a peripherally inserted central catheter in the neonatal and pediatric patient.

PURPOSE: The placement of a peripherally inserted central catheter (PICC) for neonatal or pediatric patients may at times be technically challenging. We describe an alternate method of placing a PICC in neonatal and pediatric patients with difficult venous access. METHODS: An Amplatz gooseneck snare is advanced from the femoral vein to the basilic vein, as a target for puncture and guidewire positioning, allowing PICC placement. Between 1999 and 2006, 44 PICCs were placed in the manner described. The medical records were reviewed allowing for up to 7 yrs of patient follow-up. RESULTS: Ninety-five percent of PICCs were successfully placed using the snare technique. Two placements were aborted and two procedural complications occurred. The review revealed no evidence of osteomyelitis, nerve injury, deep venous thrombosis or leg length discrepancy. CONCLUSION: This technique offers an alternate method for PICC placement in neonatal and pediatric patients when conventional methods are unsuccessful. The technique avoids the need for intermediate to long-term jugular, subclavian or femoral vein access.

Use of T-Stat to predict colonic ischemia during and after endovascular aneurysm repair: a case report.

As surgeons become more aggressive in treating aneurysms with endovascular techniques, traditional surgical principles of preserving internal iliac arteries and the inferior mesenteric artery have been challenged. A case is presented where the T-Stat device (Spectros Corp, Portola Valley, Calif), an optical real-time sensor approved by United States Food and Drug Administration for measuring colon ischemia, was used as an adjunctive measure to assist in the successful endovascular aneurysm repair in a patient at high risk for colon ischemia.

Evaluation of short-term and long-term complications after emergent internal iliac artery embolization in patients with pelvic trauma.

PURPOSE: To assess the incidence of long- and short-term complications following internal iliac artery (IIA) embolization after blunt pelvic trauma. MATERIALS AND METHODS: One hundred trauma patients with pelvic fractures underwent pelvic angiography from 1994 through 2006. Sixty-seven patients underwent IIA embolization. These patients were retrospectively identified for medical record review. Short- and long-term complications were defined as those occurring at less than or greater than 30 days, respectively. Complications and outcomes were assessed through chart review and, when possible, a standardized questionnaire. Patients who underwent IIA embolization were compared with matched control patients with blunt pelvic trauma who did not undergo pelvic arteriography. Individuals were matched by age, sex, year of admission, and injury scores. RESULTS: There were no significant differences in skin necrosis, sloughing, pelvic perineal infection, or nerve injury between embolized and nonembolized patients within 30 days. There was no significant difference in claudication, skin ulceration, or regional pain at a mean of 18.4 months follow-up. In the long term, buttock, thigh, and perineal paresthesia occur at a significantly higher rate in embolized patients. Skin sloughing in the embolized patient group is an important but rare complication. CONCLUSIONS: IIA embolization is an important means of controlling pelvic arterial hemorrhage. There is no significant increase in the risk of most evaluated long- and short-term complications in trauma patients who underwent IIA embolization versus those who did not. However, IIA embolization is associated with a marginally significantly increased rate of buttock, thigh, or perineal paresthesia.