Neurologic complications of angiography in patients with critical stenosis of the carotid artery.

We retrospectively studied 85 patients with angiographically demonstrable critical carotid stenosis. None suffered either immediate or delayed complications after angiography. In patients with critical stenosis of the carotid artery, the benefits of cerebral angiography clearly outweigh the small potential risk when the procedure is performed with meticulous attention to technical detail.

Neurologic complications of angiography for cerebrovascular disease.

A recent study reported a 12.2% incidence of cerebral complications (5.2% permanent) after cerebral angiography in 147 patients. Because this was markedly different from our experience, we initiated a retrospective study of 301 patients who had undergone cerebral angiography for hemisphere transient ischemia or amaurosis fugax. There was only a 1.3% rate of transient complications (none permanent) in our patients. The benefits of cerebral angiography in patients with suspected cerebrovascular occlusive disease overwhelm the small potential risk of the procedure.

Normal cerebral arteriography in patients with spontaneous subarachnoid hemorrhage.

Previous studies have reported that 18 to 27% of patients with spontaneous subarachnoid hemorrhage have normal cerebral arteriograms. Our series of 220 patients from three hospitals demonstrated normal arteriograms in only 16 (7%). Recent improvements in neuroradiologic techniques, such as femoral catheterization, magnification angiography, oblique and basal projections, and subtraction most probably contribute to the improved yield. Nonvisualization of a cerebral aneurysm probably represents the most common explanation for a normal cerebral arteriogram.

Renal failure after major angiography.

A recently reported 12 per cent incidence of renal failure following angiography prompted our prospective study to substantiate or repudiate this seemingly excessive rate. In 100 consecutive patients, there was no instance of renal failure following angiography. The results of our study indicate that when adequate hydration is maintained angiography does not pose a "significant hazard" of renal failure as previously reported, even in patients with underlying medical problems.

Radiographic diagnosis of meningioma of the lateral ventricle. Review of 22 cases.

Review of 22 cases of meningioma indicates that this lesion occurs slightly more frequently on the left but without predilection for sex or age of the patient. The presenting symptoms were nonspecific. Plain radiographs of the skull sometimes demonstrated calcification in the tumor, but more often did not. Cerebral angiography frequently showed enlargement and displacement of the anterior choroidal artery on the side of the tumor; the lateral posterior choroidal artery on the side of the tumor was also enlarged and displaced in seven of nine patients who underwent vertebral arteriography. Pneumoencephalography accurately demonstrated the site and size of the lesion, as did radionuclide scanning if the lesion was vascular. Computerized tomographic (TC) scanning also determined the location and size of the tumors, as well as their mass effect and vascularity; CT scanning also demonstrated calcification that was not visible on the plain skull radiographs in two of six patients who underwent CT scanning and had calcification.

Stenosis of the deep femoral artery: an evaluation of the accuracy of single-plane, anteroposterior arteriograms.

Pre-operative evaluation of the deep femoral artery is important in determining surgical treatment of aortofemoral disease. We reviewed 16 years' experience in bilateral aorto-femoral by-pass grafting and found that 63.2% of stenoses of the deep femoral arteries seen at surgery had been missed on conventional antero-posterior arteriograms. These findings demonstrate the inadequacy of a single, antero-posterior projection and the need for supplementary views in assessing lesions of the deep femoral artery.

Direct puncture and angiographic evaluation of axillary-to-femoral bypass grafts.

Arteriography of patients with axillary-to-femoral bypass grafts can be performed by direct puncture of the graft and passage of a catheter through the graft. This article reviews some technical considerations as well as some potential complications and how they might be minimized. Three cases are presented.

Cardiovascular radiography.

The differential diagnosis of acute chest pain and shortness of breath is extensive. A plain chest radiograph often is ordered to aid in establishing the precise diagnosis. Frequently, this useful imaging tool is viewed quickly, and thus, many important diagnostic clues can be missed. This article provides an organized approach to interpreting the chest radiograph and reviews some of the important radiographic findings of various diseases.

Radionuclide brain scans in hospitalized psychiatric patients.

Radionuclide brain scans were obtained routinely on 100 consecutive patients admitted to the inpatient psychiatric service. Ninety-nine of these scans were unequivocally normal. One showed unilateral decreased flow in the carotid distribution, but this was not confirmed arteriographically nor did this result in any change in therapy. The authors conclude that there is no justification for the use of the radionuclide brain scan as a screening procedure for patients presenting with psychiatric symptoms.

Positron emission tomography and its role in the evaluation of brain tumors.

Positron emission tomography (PET) is a newly evolving, biological method for quantitative imaging of regional function and metabolism within various organs of the living human body. Whereas existing conventional tomographic imaging modalities--CT and MRI--provide only anatomical information, positron emission tomography provides quantifiable information about organ metabolism and function. Brain tumors are the disease entities for which positron emission tomography is most widely applied. PET has the great potential for providing clinically important information about disease processes. PET has not only had a major impact on the diagnostic role of radiology in brain tumors, but also has potential role for therapeutic application to brain brachytherapy.

Microvascular reconstruction of the mouth, face and jaws. Oromandibular reconstruction - free fibula flap.

Dental surgeons may encounter in their clinical practice patients who present with aggressive pathologies that require early diagnosis and prompt treatment. This action may limit the extent of tissue damage and, where relevant, improve survival outcome. Clinicians should therefore be aware of the range of resective, reconstructive and rehabilitative options that are available in the management of these patients. We present our experience with the free fibula flap used for oromandibular reconstruction; this was undertaken in 21 patients following resective surgery for malignant pathology, cytologically benign but biologically aggressive odontogenic pathology and radiation induced osteonecrosis. We also review the history, surgical anatomy, surgical assessment and potential complications that are relevant to the free fibula flap.

TRISS methodology in penetrating trauma: 198 patients at Baragwanath Hospital.

TRISS methodology is a statistical technique by which the probability of survival in injury can be estimated. It combines an anatomical index of injury severity (the injury severity score, ISS), a physiological index (the revised trauma score, RTS), age and the mechanism of injury. In this study TRISS was used to assess 198 patients with penetrating injury at Baragwanath Hospital. One hundred and sixty-two patients had stab wounds, 26 gunshot wounds, and 10 received other injuries. Fifty patients were seriously injured (ISS > 15). Four patients (2%) died. The respective probabilities of survival for these four patients, as derived by TRISS, were 0%, 0%, 6% and 46%. TRISS demonstrated that the outcome of the patients as a group was comparable to other centres. TRISS is a useful method for monitoring the effectiveness of a trauma unit and objectively identifying cases for peer review.

Gastrointestinal radiology from the time of Walter B. Cannon to the 21st century.

From its very inception, gastrointestinal radiology was at the forefront of radiology, combining physiologic and anatomic information. From evaluation of esophageal motility to the first depiction of gastric ulcers and carcinomas of the alimentary tube, gastrointestinal radiology became indispensable to physicians and surgeons. Improvements in fluoroscopic and radiographic equipment, the tilting table, the image intensifier with the television train, the introduction of selective visceral angiography with safer contrast media and, more recently, digital subtraction angiography, digital ultrasound (US), color Doppler US, computed tomography, and magnetic resonance (MR) imaging--all of these advances have made imaging diagnosis more precise and specific. A new modality--localized tissue MR spectroscopy--should offer an insight into metabolism and suggest optimal modes of treatment and follow-up. The gastrointestinal radiologist of the future will have to be multimodality trained. A new generation of alimentary tract interventional radiologists will further the trend toward less invasive surgical therapy. No end of advances is in sight.

Sonographic findings in gastric leiomyosarcoma.

Ultrasonography in two cases of gastric leiomyosarcoma demonstrated predominantly solid masses with multiple echo-free cystic areas. Metastases to the liver showed similar sonographic findings. In both cases, ultrasonography was of value in assessing the extragastric extent of the lesion.