MEDICAL LITERATURE has been deluged during the past few years with books and papers on penicillin; but a book which has been produced under the general editorship of Sir Alexander Fleming himself represents a complete and authoritative summary of penicillin therapy as it stands today.' The book contains a series of independent contributions by \"experienced and eminent men who have worked with penicillin in Great Britain\". Their opinions and practical methods differ slightly, and there is some overlapping; but these are not disadvantageous, comparison and contrast lending interest to the reading. In the first or general section of the book Fleming contributes two chapters, one on the history and development of penicillin, introducing some interesting sidelights in the romance of discovery, the other on the bacteriological control of penicillin therapy. In both chapters the information is set out in meticulous detail and with a clarity and simplicity which can be enjoyed by all readers. Fleming also gives the right perspective to the place of penicillin amongst the antibiotics and lays down the principles of treatment. Both chapters are well illustrated and are the most outstanding in the book. Included in this first section also are chapters on the chemistry and manufacture of penicillin and its pharmacy, pharmacology and methods of administration. The second section of the book is entirely clinical, giving each author's view on the use of penicillin therapy in a disease or an infection of some particular region of the body. The entire range of peniCillin-sensitive conditions is considered in twenty authoritative and clearly written chapters; these contain many references and illustrations. Dental and veterinary diseases are also given fairly full consideration. The final section is a condensed resume of much of the preceding chapters and is written for. the general practttioner. This chapter is superttuous: it does not contain enough detall to be of much practical value. The book as a Whole, however, will undoubtedly be considered a classical contribution to medical literature and is strongly recommended, not only because of the general interest of its topic, but as a reference book on penicillin therapy of hitherto unequalled excellence. The typography, although conforming to war economy standards, is clear and the paper is good. There is an excellent list of references and the index is satisfactory.

Gray's Anatomy

Editor's Choice - Vascular Access: 2018 Clinical Practice Guidelines of the European Society for Vascular Surgery (ESVS).

Methods and apparatus are provided for non-continuous circumferential treatment of a body lumen. Apparatus may be positioned within a body lumen of a patient and may deliver energy at a first lengthwise and angular position to create a less-than-full circumferential treatment zone at the first position. The apparatus also may deliver energy at one or more additional lengthwise and angular positions within the body lumen to create less-than-full circumferential treatment zone(s) at the one or more additional positions that are offset lengthwise and angularly from the first treatment zone. Superimposition of the first treatment zone and the one or more additional treatment zones defines a non-continuous circumferential treatment zone without formation of a continuous circumferential lesion. Various embodiments of methods and apparatus for achieving such non-continuous circumferential treatment are provided.

Methods and apparatus for performing a non-continuous circumferential treatment to a body lumen

https://www.jvascsurg.org/article/S0741-5214(11)01857-X/pdf

Factors affecting the patency of arteriovenous fistulas for dialysis access

Pulmonary vasculitis in behcet disease: a cumulative analysis.

Purpose
The aim of this study was to assess the effect of the color Doppler system on the artifact known as the “twinkling sign.”

Methods
Sixty-five patients with at least 1 urinary tract calculus seen on sonography were examined with color Doppler sonography. Two color Doppler systems of 2 different generations were used. Examinations included gray-scale, color Doppler, power Doppler, and spectral evaluations of the calculus with various settings of Doppler gain, velocity range, color filter, focal depth, and acoustic power.

Results
A color artifact was present within and/or distal to 29 (39%) of 75 urinary tract calculi when the old generation system was used. Use of the new generation system produced this color artifact within and/or distal to 72 (96%) of the urinary tract calculi. The intensity of the artifact was affected by the acoustic output of the equipment.

Conclusions
The twinkling sign is an artifact that can not only lead to misdiagnosis of vascular flow within a structure but also help differentiate a very small stone from other small echogenic structures when later generation “all-digital” systems are used. The color sensitivity of the system and acoustic power used are important technical factors that affect the production of this artifact. © 1999 John Wiley & Sons, Inc. J Clin Ultrasound 27:433–439, 1999.

Effect of color Doppler system on the twinkling sign associated with urinary tract calculi

Objective. To evaluate whether the diameter of the main renal artery is an indicator of the presence of an accessory renal artery in sonographic examination. Methods. Of cases undergoing renal intraarterial digital subtraction angiography for any reason, those with no renal arterial disease detected on digital subtraction angiography were included in the investigation. Accessory renal arteries were disclosed by digital subtraction angiographic examinations. The dimensions of the kidney were measured sonographically. The lowest, highest, and mean values of diameters of main renal arteries were determined by sonography and angiography in both the group with accessory renal arteries and the group without accessory renal arteries. Results. Of kidneys with sonographically normal dimensions, angiographic evaluation was made in 107, and sonographic evaluation was made in 97, the renal arteries of which could be visualized optimally. Both radiologic methods showed that diameters of main renal arteries were significantly smaller in the presence of the accessory renal artery (P <.001, Student t test, Mann-Whitney U test, and receiver operating characteristic curve). Condusions. In sonographic examination, the presence of the main renal artery with a diameter smaller than usual in a kidney with normal dimensions is indicative of the presence of an accessory renal artery. Taking this into account, we can obtain higher rates of detection of accessory renal arteries in sonographic examinations.

https://onlinelibrary.wiley.com/doi/pdf/10.7863/jum.2003.22.5.433

Correlation between the diameter of the main renal artery and the presence of an accessory renal artery: sonographic and angiographic evaluation.

OBJECTIVE In the Marmara earthquake, which occurred on August 17, 1999, 639 people had renal complications, and 477 needed hemodialysis treatment because of acute renal failure due to crush injury. Our objective was to use Doppler ultrasonography as a noninvasive procedure to provide renal hemodynamic information. METHODS We evaluated 9 patients with severe crush injury by using Doppler ultrasonography to measure renal resistive indexes within 16 to 32 hours after the earthquake and 6 weeks later. All patients had acute renal failure and underwent hemodialysis. RESULTS All measured initial resistive indexes were high (mean +/- SD, 0.83 +/- 0.08), and they were correlated with the number of hemodialysis sessions (r = 0.703; P = .034), the duration of hemodialysis treatment (r = 0.819; P = .007), and oligoanuria (r = 0.937; P < .0001). All patients recovered from the acute renal failure, and repeated Doppler ultrasonography showed significant decreases in resistive indexes (0.59 +/- 0.07; P < .01) and renal lengths (P < .05). CONCLUSIONS In crush injury, measurement of renal resistive indexes can be useful for the prognosis of recovery from acute renal failure.

Renal Doppler ultrasonographic findings in earthquake victims with crush injury.

Color Doppler ultrasonographic findings in intratesticular varicocele.

Objectives
The purpose of this study was to assess the effect of carotid artery stenting on ophthalmic artery blood flow using transorbital color and spectral Doppler sonography and review the changes in relation to cerebral hemodynamics.

Methods
Twenty-eight consecutive patients with severe internal carotid artery stenosis (≥70%) who were scheduled for carotid stenting were included. Ophthalmic artery Doppler sonography was performed bilaterally before and after stenting. The flow direction, peak systolic velocity (PSV), end-diastolic velocity (EDV), pulsatility index (PI), and resistive index in the ophthalmic artery were recorded.

Results
Twenty male and 8 female patients with 10 right-sided and 18 left-sided stenoses were studied. The mean overall carotid stenosis ratio ± SD was 87.3% ± 9.9%. After stenting in the ophthalmic artery ipsilateral to the stenosis, significant increases in the PSV (−3.87 ± 48.81 to 46.70 ± 25.33 cm/s; P < .001), and EDV (−3.02 ± 16.31 to 11.24 ± 7.37 cm/s; P < .001) were detected, and the increase in the PI approached significance (1.40 ± 0.59 to 1.62 ± 0.52; P = .055). A change in the flow direction from retrograde to antegrade was noted in 11 patients (39%) after stenting, and in 1 patient with no detectable flow, reconstitution of flow was observed. Increases in the PSV and EDV (P= .03 for ΔEDV) were more pronounced in symptomatic patients than asymptomatic patients after stenting.

Conclusions
Substantially decreased ophthalmic artery velocity and retrograde flow are suggestive of high-grade carotid artery stenosis (≳90%). Stenting improves ophthalmic artery perfusion and positively changes cerebral hemodynamics in high-grade carotid artery stenosis, especially in symptomatic patients, which can be monitored with ophthalmic artery Doppler sonography.

https://onlinelibrary.wiley.com/doi/pdf/10.7863/ultra.33.4.629

Hasan Özcan

Papers

Effect of color Doppler system on the twinkling sign associated with urinary tract calculi

Correlation between the diameter of the main renal artery and the presence of an accessory renal artery: sonographic and angiographic evaluation.

Renal Doppler ultrasonographic findings in earthquake victims with crush injury.

Color Doppler ultrasonographic findings in intratesticular varicocele.

Effect of carotid artery stenting on ophthalmic artery flow patterns.