Varicography in the management of primary varicose veins.

Forty-nine legs in 41 patients with primary varicose veins were investigated by varicography, (direct injection of varicose veins with contrast medium). Additional features not found at clinical examination, such as reduplication of the long saphenous vein, unusual terminations of the short saphenous vein and incompetent perforating veins, were found in over 50% of the legs examined. It is suggested that varicography should be carried out in patients with primary varicose veins in whom the clinical assessment is not conclusive.

Contrast agent induced thrombophlebitis following leg phlebography: iopamidol versus meglumine iothalamate.

A comparison was made of the incidence of venous thrombophlebitis resulting from the use of a high-osmolality contrast medium (Conray 60%, meglumine iothalamate), and a low-osmolality contrast medium (Niopam 61%, iopamidol). In 20 patients Conray was injected into one leg and Niopam into the other. The incidence of thrombophlebitis was then determined using the iodine-125 fibrinogen uptake test in a prospective, randomised, double-blind study. There was significantly less thrombophlebitis with Niopam than with Conray and it is concluded that Niopam is a safer contrast medium for phlebography.

Descending phlebography: a comparison of three methods and an assessment of the normal range of deep vein reflux.

Twenty-three legs in 13 patients without evidence of deep vein disease have been examined by descending phlebography using 3 techniques: with the patient semi-erect with no Valsalva manoeuvre with the patient semi-erect with a controlled Valsalva manoeuvre and with the patient supine with a standard Valsalva manoeuvre. It is concluded that the examination performed with the patient supine, using a standard Valsalva manoeuvre, is the most convenient and easiest to interpret of the variation. It is also suggested that deep vein reflux up to Grade 2 is within the normal range.

Varicography in the management of recurrent varicose veins.

Forty lower extremities in 29 patients with recurrent varicose veins have been investigated by varicography. In 29 lower extremities the recurrent varicosities were on the long saphenous venous system and in 11 lower extremities on the short saphenous system. The recurrences consisted of varicose segments or tributaries of the long or short saphenous veins, varicose tributaries at the sites of previous ligations of varicose veins, and varicosities associated with incompetent perforating veins in the midthigh and calf. It is suggested that varicography is a useful method for demonstrating the sites of recurrent varicose veins and for enabling definitive surgery to be performed.

Iohexol and meglumine iothalamate in phlebography of the leg. Comparison of the tolerance.

Fifty patients were examined by ascending phlebography of both legs in a prospective, double blind, within-patient series. Each leg was randomly allocated to the examination using either iohexol 300 mg I/ml or meglumine iothalamate 280 mg I/ml as the contrast medium. Immediate side effects were recorded in all patients, and delayed effects in 45 patients. Statistical analysis using the chi-square test showed that iohexol produced significantly less immediate pain in the leg than meglumine iothalamate. Iohexol produced significantly less nausea, and vomiting during the injection than meglumine iothalamate. No significant difference was found in the incidence of delayed pain and swelling with either medium. The quality of the films produced by iohexol was significantly better than that obtained with meglumine iothalamate.

Fracture of the sella turcica: a report of three cases.

Fractures of the sella turcica are rare. Recognition of fractures in this area is very important as serious immediate and delayed neurological, endocrine and vascular complications may occur. Most of these patients will develop at least one cranial nerve palsy; a significant number will develop hypopituitarism and a few will develop local vascular abnormalities.