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• W654697144 abstract "The title is an understatement of the content of this thin book for it goes beyond complications to provide a useful bonus of prevention and treatment. is a presentation of physical hazards to the patient and of legal hazards to the physician. If the gauntlet of complications does not deter the physician performing the examination, it will mobilize him to the cautious preparation that has become known as defensive medicine. The multi-authored text makes for uneven presentation without editorial control; it would have been most helpful if the many possible complications could have been succinctly and uniformly tabulated. Nevertheless, it comprises fascinating reading in both solid statistics and unabashed opinions. The chapter on contrast media confirms that their growing use and concomitant concern serve only to dismantle the hypotheses of mechanisms of production, prevention, and treatment of reactions. Dr. Lalli's hypothesis is that these are psychogenic and that if a general anesthetic is not a practical preventive, he suggests atropine and a strong sedative. Percutaneous Femoral Angiography and Axillary Arteriotomy Procedures are presented, but brachial arteriography is included in chapters on surgical management of angiographic complications, along with a surgeon's view of complications of femoral arteriography. The text notes contradiction in two of the tables that show that experience is and is not a factor in the incidence of thrombosis in femoral angiography, without comment as to how this could occur or of what value the tables are to the reader. The introduction to the chapter on Neuroradiologic Special Procedures is an admonition favoring transfer of patients to medical facilities with a concentration of skills and equipment, as opposed to the small hospital. This subject should be pursued to more closely defined criteria of competency and adequacy, else there is no need for this book; the center described will write rather than read the story, and the community becomes a disinterested observer. This chapter has useful information for a hospital practice with limited volume, but little to add to the experience in a neurologic center. Surgical treatment of angiographic complications are dealt with rather modestly, considering the catastrophic complications that timely surgical intervention may avert. The chapter on Cardiac and Coronary Artery Catheterization in adults provides the raison d'etre of the book. For it is an in depth survey of specific hazards of technical radiologic complexities. It would seem imprudent to permit enthusiasm for a new procedure to mask potential hazards ... or to close our eyes and memories to complications that do occur. The chapters on Lymphangiography and Bronchography are excellent, as are the discussions on Roentgen-guided Aspiration Biopsies of Thoracic, Renal, and Skeletal Lesions, a much neglected area for the radiologist's participation. Electric microshock hazards are briefly outlined and should alert the clinician to possible iatrogenic electrocution inherent in his equipment. This may be a situation totally foreign to his clinical expertise. The legal implications are particularly strong. As the scope and demand for angiography grow, involving the radiologist in more high risk activities, the need for broadened training and practice becomes apparent. If there is new opportunity and new satisfaction in the development and exercise of such skills, there are also new risks of injury to the patient and risks of liability for the radiologist. The chapter on bronchography is an excellent review of a senior radiologic procedure with information on material, techniques, and complications to recommend the book to the radiologist who may not be actively involved in angiography. Under Legal Implications, Dr. Wasmuth concisely outlines the evolution of malpractice and points out that this is more of a social problem than a medical or legal one. is likely that there will be a multitude of answers, but no solution. Dr. Alfidi's brief chapter on Informed Consent deals with the development of such forms at the Cleveland Clinic. Thoughtfully prepared consent forms and patient questionnaires indicate that a majority of patients can accept a frank presentation of possible danger. A more recent development gives the patient an opportunity to accept or reject detailed information, a procedure the courts have approved. The chapters by attorneys are educational, but disappointing. Mr. Nurenberg's vehemence concerning the conspiracy of silence illustrates only the plaintiff's attorney's attitude when there is no witness to support his client's case. He fails to see this as an occupational hazard of plaintiff's attorneys, compatible to malpractice suits as an occupational hazard of physicians. Mr. Morris presents the defense attorney's case in a rambling account of defense to malpractice in general. The basic material is here, interesting in general and fascinating in particular, as it pertains to an involved radiologist. In a summary of good advice, Mr. Morris offers as a rule, There should be complete cooperation on the part of the medical profession ... who, if they do not hang together, most assuredly will hang separately insofar as medical legal information is concerned. The disparate attitudes of defense and plaintiff attorneys illustrate the adversary nature of a law suit and perhaps why physicians find it difficult to think like a lawyer. VINCENT P. COLLINS, M.D." @default.
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• W654697144 title "Complications and legal implications of radiologic special procedures" @default.
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