Andrew B. Crummy

Computerized Fluoroscopy in Real Time for Noninvasive Visualization of the Cardiovascular System

A computerized fluoroscopic system with dedicated real-time hard-wired algorithms can be used for cardiovascular imaging with or without injection of iodine. Initial differentiated and integrated time subtraction displays are presented. Contrast studies appear adequate for visualization of cardiovascular dynamics. Cardiac images without contrast material suggest expected blood flow patterns but are difficult to interpret.

A New Approach to the Treatment of Priapism

A 26-year-old man with post-traumatic priapism was treated successfully by occlusion of the left internal pudendal artery with an autologous clot. The recovery was marked by the return of entirely normal sexual function. This excellent result suggests that autologous clot injection of the internal pudental artery should be considered as an appropriate form of therapy for the treatment of selected patients with priapism.

Digital K-edge subtraction radiography.

K-edge subtraction images have been produced using a digital video image processor. Images formed by three filtered x-ray beams are detected by an image intensifier-Plumbicon system, digitilized, and combined in real time to produce bone- and tissue-free K-edge subtraction images of iodinated structures. Preliminary studies of rhesus monkey cranial, spinal, and abdominal structures are compared with those of conventional radiography.

The Bird's Nest Inferior Vena Caval Filter: Review of a Single-Center Experience

PURPOSE To examine a large single-center experience with Birds Nest vena caval filters for indications, clinically evident recurrent thromboembolic disease, and other filter-related complications. MATERIALS AND METHODS During a 6-year period, 308 patients underwent percutaneous placement of an inferior vena caval filter. The 267 patients who received a Birds Nest filter are the subject of this retrospective review. The series included 162 men and 105 women who ranged in age from 16 to 88 years (mean, 57.1 +/- 17.0 standard deviation). RESULTS Indications for filter placement included contraindication to anticoagulation (n = 141), complication of anticoagulation (n = 23), failure of anticoagulation (n = 30), failure of previously placed filter (n = 1), and prophylaxis (n = 82). Ten patients had more than one indication. Acute lower extremity deep venous thrombosis was confirmed in 133 patients, pulmonary embolism (PE) was found in 44 patients, and both were positively diagnosed in 37 other patients. Fifty-three patients had no documented acute thromboembolic disease at the time of insertion. Mean follow-up was 13 months. Thirty-day mortality was 9.7%, including one death from recurrent PE and one major puncture-site bleeding episode that may have contributed to death. Recurrent PE was found at radionuclide scanning or autopsy in three patients (1.1%), whereas another eight patients (3.0%) had suspected recurrent PE without confirmatory studies. Eight patients (3.0%) developed early venous access site thrombosis, including two who progressed to phlegmasia cerulea dolens with fatal complications. Significant nonthromboembolic problems were encountered in 1.9% of patients. CONCLUSIONS The Birds Nest filter is a safe and effective device for patients with complicated venous thromboembolic disease.

Traumatic aneurysm of perforating peroneal artery. Arterial bleeding--cause of severe pain following inversion, plantar flexion, ankle sprains.

1. Anomalous arterial circulation at the ankle is present in 3 per cent of the population, and predisposes to arterial injury by severe inversion, plantar flexion of the ankle. 2. Arterial bleeding should be considered in the differential diagnosis of severe pain following inversion, plantar flexion, ankle sprains. 3. A case is presented with a post-traumatic false aneurysm of the perforating peroneal artery. This was associated with rupture of the anterior fibulotalar ligament, the anterior portion of the talocalcaneal ligament, and anterolateral ankle joint capsule. The patient had a satisfactory functional result following resection of the aneurysm and repair of the artery and damaged ligaments.

Renal Hypertension Secondary to Unilateral Radiation Damage Relieved by Nephrectomy

The possibility of renal damage resulting from therapeutic irradiation was pointed out early in the history of radiation therapy (1, 2, 7, 9). The danger was largely disregarded, however, until reports of a large number of cases from Manchester emphasized the frequency of grave renal complications when the kidney received irradiation in the therapeutic dosage range (4, 6, 8). A latent period of thirteen years between irradiation and the appearance of hypertension has been recorded (5). In that instance, nephrectomy restored the blood pressure to normal. The present report describes a case of hypertension secondary to radiation-induced renal damage, detected eighteen years after x-ray treatment in which both kidneys were included in the field. Only one kidney demonstrated significant abnormality, and its removal twenty-four years after the irradiation returned the blood pressure to normal. Case Report J. B., a 64-year-old white male, was referred for treatment of an aortic aneurysm in 1963. His blood press...

A new guidewire with kink-resistant core and low-friction coating

A new guidewire constructed from kinkresistant titanium-nickel alloy, polyurethane, and hydrophilic polymer is described. We have used this wire in 119 angiographic and 49 interventional procedures without complications. In numerous applications, it offers significant advantages over other guidewires. It is particularly helpful for angiography and interventional procedures requiring catheterization through markedly tortuos vessels, tight stenoses, or occlusions.

Absorption edge fluoroscopy using quasi-monoenergetic x-ray beams.

A new technique has been developed for imaging small concentrations of elements having K absorption edges in the diagnostic x-ray energy range. Highly sensitive video image subtraction apparatus is used to take the difference between images formed by x-ray spectra peaked above and below the absorption edge. All portions of the image field are detected simultaneously using a conventional image intensifier, eliminating the need for scanning the x-ray defector. Quasi-monoenergetic x-rays are obtained by filtering conventional fluoroscopic x-ray beams. Compared with other methods the technique could lead to a low cost system offering a large reduction in imaging time, with resolution comparable to conventional image intensified fluoroscopy. The results of tests involving periodic images generated electrically or by periodic insertion of x-ray absorbers are presented to illustrate the properties of the imaging electronics. The feasibility of the technique is demonstrated by images of phantoms containing small concentrations of iodine and xenon.

Nonpenetrating Injuries to the Thoracic Aorta

THIS YEAR over 50,000 persons in the United States will die as a result of automobile accidents. Autopsy examination shows that 1 in 6 sustain fracture of the thoracic aorta (4). Immediate exsanguination occurs in most, but 10 to 20 per cent of the injured will survive long enough for reparative surgery provided the diagnosis is established (8, 12, 16). Correlation of radiologic with clinical evidence allows the diagnosis to be made with confidence. I t is our purpose to review the findings in 12 cases of aortic fracture, 10 of which were seen in the acute phase. Pathogenesis Nonpenetrating injuries of the thoracic aorta may be produced by direct forces such as compression or blast or by indirect forces such as deceleration, or by a combination of these. The forces generated by rapid deceleration in either the vertical or horizontal plane are the most common causes of aortic fracture (8, 12, 16). Haas (5) studied patients who died in airplane accidents and showed that vertical forces of deceleration produ...

Multilocular renal cyst. Angiographic, ultrasonic, and cyst-puncture findings.

Abstract Multilocular renal cysts are rare lesions which can be diagnosed preoperatively by correlating seemingly discordant angiographic and ultrasonic findings. Cyst puncture and injection are confirmatory. Preoperative diagnosis permits cyst removal rather than nephrectomy.