Four of five patients with asymptomatic small or moderate-size pulmonary arteriovenous malformation (PAVM) presented with a paradoxical embolus and stroke. In these patients chest radiographic findings were subtle and arterial hypoxemia provided the real clue to diagnosis. Computed tomography (CT) and cerebral arteriography confirmed embolic occlusion in four of five patients. Careful family screening including posteroanterior (PA) and lateral chest radiographs and arterial oxygen determinations in sitting or standing positions are recommended for early detection of asymptomatic patients with PAVM. Early therapeutic intervention (with balloon embolotherapy) is recommended to avoid paradoxical embolization.
Analysis of 193 femoropopliteal angioplasties demonstrated patency rates in the stenotic group of 75.5% at 6 months and 54.4% at 54 months. The patency rates for the occlusive group were 93.7% at 6 months and 72.9% at 54 months; these rates were significantly better than those in patients with stenoses. A group of 14 patients with long-segment (greater than 7 cm) stenosis had the highest risk of early failure, with a 6-month patency of 23.1%. After removal of the long-segment stenosis group from the results, there were no significant differences between the long-term patencies for stenotic and occlusive lesions. If angioplasty of long stenoses is attempted, a high initial success rate but early failure should be anticipated.
The diagnostic value of the microscopic examination of bone core specimen versus osseous blood, obtained by 110 percutaneous biopsies performed on 100 patients, was evaluated. A diagnosis of malignancy was made by biopsy in 54 cases. In 52 cases in which osseous blood (clot and smears) was available for examination, a positive diagnosis for malignancy was made microscopically in 49 (94%). In 46 cases in which bone cores were studied separately, a microscopic diagnosis of malignancy was made from the bone core in 39 (85%). If osseous blood had not been available for examination only 39 (72%) of the 54 biopsies would have been positive for malignancy; the other 14 biopsies would have been classified as either negative or insufficient for diagnosis. In those biopsies where both bone cores and osseous blood were available, the osseous blood showed better malignant tissue morphology and was considered better diagnostic material in 19 cases, whereas bone cores were considered better diagnostic material in only three cases. Osseous blood, which is usually easily available in bone biopsies, is valuable diagnostic material; it should be treated as a tissue specimen and not discarded.
As an alternative to performing interventional radiology on inpatients under the care of internists and surgeons, the authors have established a cardiovascular radiology admitting service for well-screened, elective patients. The patients are admitted under the care of a cardiovascular radiology fellow and a staff physician. From April 1982 to December 1983, 133 patients were admitted to the service. Patients are cared for in a surgical ward or in an intermediate unit, as determined by the clinical situation. Advantages of this approach include a broader patient referral base, improved rapport with clinical colleagues and patients, improved follow-up data, and rapid evaluation and treatment, resulting in short hospital stays. The major disadvantages involve the commitment of time and staff necessary to provide quality care. The concept of the interventional radiologist in the role of admitting physician has important implications in terms of negotiations for additional financial compensation, commensurate with the skill and time required for performing these procedures and caring for the patient.
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