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Current chemotherapeutic regimens often require long-term central venous access for their administration. Obtaining a durable form of vascular access in patients with recurrent cancer can be a challenge due to direct tumor involvement and prior surgical, chemotherapeutic or radiation therapy. We describe a case of a peripherally inserted access port in a patient with recurrent head and neck cancer, in whom radiation therapy planned for metastatic mediastinal disease prevented placement of a chest port. At the time of port implantation, venography revealed central venous occlusion. Using mediastinal venography, a collateral pathway to the superior vena cava was identified between the left and right internal mammary veins. By employing this technique, an arm port system was successfully navigated through the collateral pathway percutaneously with the tip of the port tubing placed at the cavoatrial junction. This case illustrates technical nuances and emphasizes the importance of thorough venography when attempting to achieve difficult vascular access.

Adinazolam (ADI) is a new benzodiazepine with anxiolytic and antidepressant properties. To assess its effects on the acute stress response, rats were given a single intraperitoneal injection of 2.5 or 5.0 mg/kg of ADI and stressed for 1 hr by restraint. Neither dose of ADI had any effect on heart rate, blood pressure or norepinephrine (NE) and epinephrine (EP) in plasma in the resting rats. In the stressed animal, 2.5 and 5.0 mg/kg of ADI did not affect stress-induced increases in heart rate or blood pressure but both significantly reduced the stress-induced increases in plasma NE and EP. During certain stressful experiences in patients with abnormally-increased sympathetic drive, ADI may be therapeutically useful in reducing high levels of catecholamines.