[A new technique of pulmonary arterial angioscopy: capnoangioscopy. An experimental study]. / Nouvelle technique d'angioscopie artérielle pulmonaire: la capnoangioscopie. Etude expérimentale.

From animal experiments (n = 10), the authors describe a new technique of pulmonary arterial angioscopy. A balloon-fitted catheter is introduced into the trunk of one of the pulmonary arteries. A small caliber angioscope with an end capable of being propped up is then pushed within the lumen of the catheter. Intraluminal visualization of the pulmonary artery and its branches cannot begin until after the balloon is inflated to arrest blood flow and the visualization chamber is cleared by sterile carbon dioxide. The quality of the image obtained is similar to that of bronchial endoscopy, making is possible to examine at length the walls of the proximal and distal pulmonary arteries up to a caliber of 2.5 mm, and to detect blood clots. Pulmonary angioscopy is tolerated to the same extent as right heart catheterization. Potential applications of this technique are diagnosis of chronic cor pulmonale and treatment of pulmonary embolism.

[A classical but unknown cause of peritoneal effusion disclosed by echography. Typhoid fever]. / Une cause classique mais peu connue d'épanchement péritonéal de découverte échographique. La fièvre typhoïde.

Two cases of peritoneal effusion discovered by sonography in patients with typhoid fever are reported. These peritoneal effusions have no pejorative value; only clinical findings can differentiate these simple effusions from a perforative thyphoid peritonitis, which is exceptional nowadays. Typhoid fever, among other febrile diseases should be considered when ultrasounds shows an isolated peritoneal effusion.

A study of coronary artery bypass graft patency using MR imaging.

This is a prospective study comparing selective angiography and magnetic resonance (MR) imaging in the evaluation of the patency of coronary artery bypass grafts (CABGs). Twenty-eight patients with 52 grafts were studied (10 internal mammary artery grafts, 19 saphenous vein grafts including 2 sequential grafts, and 15 right coronary artery saphenous vein grafts). The mean interval between MR imaging and the surgical procedure was 13.2 months. Results obtained with angiography were as follows: 39 patent grafts; 4 patent but stenotic (greater than 50%); 9 occluded CABGs. Magnetic resonance imaging was performed with axial imaging, spin echo images, and electrocardiographic gating. Grafts that were normal on angiographic examination appeared without a signal on both the first and the second echoes in 38 of 39 cases. Grafts that were patent but presented significant stenosis as evidenced by angiography presented the same appearance. In one case, there was an aspect corresponding to a decreased blood flow (presence of a signal on the first echo that became stronger on the second echo). The CABG occlusion was determined in seven of nine cases. Occluded grafts twice presented a signal variation corresponding to an old thrombus formation. In two cases, only the origin of the graft was visible without any visualization of its distal portion. In three other cases, neither the proximal nor the distal portions of the graft were identified. Among six CABGs that could not be identified, three were patent. This study demonstrated that MR imaging makes it possible to correctly identify patent CABGs, but this modality has significant limitations because patent but stenotic CABGs may present in the same way as patent CABGs without stenosis. On the other hand, the correct identification of occluded grafts may be accurately performed using MR imaging.

[Subperiosteal metastasis of esophageal adenocarcinoma]. / Métastase sous-périostée d'un adénocarcinome oesophagien.

The authors report an observation of a tibial subperiosteal metastasis of an esophageal cancer. Subperiosteal metastases are rare, appearing on plain radiography as a cortical lysis of a long bone with a "saucer" aspect. They were considered specific of a bronchogenic carcinoma. To the best of our knowledge this is the second observation of subperiosteal metastasis, whose primary tumor is not a broncho-pulmonary cancer.

Selective intraarterial DSA of the parathyroid glands in patients with hyperparathyroidism after parathyroidectomy.

Eighteen patients with recurrent hyperparathyroidism after parathyroidectomy were prospectively examined with selective intraarterial digital subtraction angiography (DSA) of the brachiocephalic arteries. The results were compared with findings at reoperation. Seventeen of the 21 remaining abnormal parathyroid glands were correctly detected by selective DSA (sensitivity = 81%). In the neck and mediastinum, sensitivities were 73% (8/11) and 90% (9/10), respectively. All patients with histopathologic confirmation of primary hyperparathyroidism (17/18) became normocalcemic postoperatively. We conclude that selective intraarterial DSA is indicated in patients with recurrent hypercalcemia after parathyroidectomy when the results of noninvasive imaging techniques are uncertain.

Study of isotonic contrast media in intravenous digital subtraction angiography.

Arterial enhancement obtained with isotonic contrast media in intravenous digital subtraction angiography was studied. Ten dogs were injected with ioxaglate, iopamidol, and ioxitalamate at equal iodine concentration and at concentrations corresponding to plasma osmolality. Three variables were studied: osmolality, injection rate, and iodine dose. Provided their iodine concentration is sufficient, isotonic contrast media appear as efficient as the corresponding hypertonic formulation, at equal iodine dose. Moreover, the use of isotonic ioxaglate allows a lower dose of iodine to be administered without significant reduction in peak arterial value.

Intravenous digital subtraction angiography in Takayasu's disease. A report of 32 cases.

IVDSA appears to be a reliable method and should therefore be considered as a first step examination when Takayasu's disease is suspected. The simplicity and safety of the method provide a rationale for the use of this technique in Takayasu's disease. Therapeutic decisions can usually be obtained without further radiological investigation, and conventional arteriography has to be performed only when data obtained with IVDSA are insufficient. In these rare cases, conventional arteriography aims at the investigation of a particular area. The site of arterial puncture can be precisely guided by IVDSA.

[Takayasu's disease. Value of digital intravenous angiography. 44 cases]. / Maladie de Takayasu. Intérêt de l'angiographie numérique intraveineuse. 44 observations.

Forty-four patients with Takayasu's arteritis were explored by digital intravenous angiography either for diagnostic purposes and pre-therapeutic assessment (n = 29) or immediately after surgery (n = 15). There were 36 women, 6 men and 2 children; mean age was 31 years. The contrast medium (mean volume 140 ml) was injected into central (74%) or peripheral (26%) veins. No other angiographic exploration was contemplated in 24 patients selected for medical treatment. Among 15 patients destined to surgery or percutaneous angioplasty, 13 were operated upon without further angiography and 2 underwent arteriography since the distal vascular bed beyond the major lesions could not be evaluated adequately. Data obtained from post-operative evaluation (n = 15) were satisfactory, with 1 failure in this group. Digital intravenous angiography seems to be reliable enough to be used as first examination in patients with suspected Takayasu's arteritis. The procedure is well tolerated and can be repeated for optimum determination of the operation date. Arteriography can now be reserved to those rare cases where digital angiography has failed; it can then be limited to the study of a specific territory, the site of puncture being located by digital angiography.

[Digitized intravenous angiography in Takayasu's disease. Apropos of 44 cases]. / Place de l'angiographie numérisée intraveineuse dans la maladie de Takayasu. A propos de 44 cas.

Forty-four patients with Takayasu's disease were investigated by digitised intravenous angiography (DIVA) during a diagnostic and pretherapeutic work up (N = 29) or at surgery (N = 15); the aim of this retrospective study was to assess the role of DIVA in the investigation of this condition. The patients were 36 women, 6 men and 2 children; the average age was 31 years. The intravenous injections were performed in a central vein in 74% and in a peripheral vein in 26% of patients; the average amount of contrast medium injected was 140 ml per investigation (32 g of iodine %). Depending on the site of the lesions, the distribution of the 43 successfully investigated patients was as follows: Type I: 13 (20%), Type II: 6 (14%), Type III: 12 (28%), Type IV: 12 (28%). In the group of patients managed medically (N = 14) no other angiographic investigations were considered. In the group with an indication for surgery or percutaneous angioplasty (N = 15), the procedure was carried out without further angiography in 13 cases; in 2 patients the imaging of the distral vessels was inadequate and complementary angiography was required. All postoperative controls (N = 15) but one were satisfactory. These results show that DIVA is sufficiently reliable for it to be considered as an investigation of first intent in patients with suspected Takayasu's disease. The investigation is well tolerated and can be repeated when necessary to determine the optimal time for surgery. Arterial angiography should seem only to be indicated when the venous approach has failed, which was rare in this series.

Transcatheter embolization of multiple pulmonary artery aneurysms in Behçet's syndrome. Report of a case.

Transcatheter embolization of a pulmonary artery aneurysm in Behçet's disease has rarely been attempted. A report is presented of a case with four pulmonary aneurysms and massive hemoptysis. Transcatheter embolization was successfully performed in three of these aneurysms, with clinical improvement during a follow-up period of 11 months. Technical problems, hazards, and indications for embolization in these patients are discussed.

[Digital angiography. 1st evaluation of 1000 tests]. / Angiographie numérique. Premier bilan de 1 000 examens.

The authors report their experience of 1 000 examinations using digital subtraction angiography. The technique is particularly well suited to the study of the thoraco-abdominal aorta and its main branches. It is about 80% reliable for the exploration of cervico-encephalic vessels and somewhat less reliable for the vertebro-basilar territory. It is usually convenient for the study of the renal arteries: investigations for reno-vascular hypertension can now be carried out in one session beginning with angiography and ending with urography. Digital subtraction angiography is also very useful in the assessment of vascular surgery, whatever the area involved or the type of operation, and for the study of pulmonary vessels, notably when looking for pulmonary emboli. Digital subtraction arteriography is undoubtedly superior to conventional arteriography. Its impact remains to be determined, but is avoids the drawbacks of the venous route. Its present limitations are of a technical nature: the intensifying screen is too small so that the examination must proceed by segments, hence the need for repeated doses of contrast medium the dangers of which must be borne in mind when digital subtraction angiography is contemplated. On the other hand, this technique has obvious economical advantages: examinations can be performed in out-patients and substantial savings can be made on the number of films.

[Evaluation of vascular surgery with digital subtraction angiography. A study of 127 patients]. / Evaluation de la chirurgie vasculaire par angiographie numérisée. Etude de 127 patients.

We have performed digital subtraction angiography (DSA) on 127 patients treated by vascular surgery. This technique was easily and safely performed in outpatients, without any complication. Our experience indicates that DSA is accurate for post operative evaluation in 96% of cases. In digestive arterial surgery, some examinations (3.3%) are insufficient. Distal run off is usually well seen, everywhere, except in kidneys. There is a good correlation between angiographic results and clinical status. However, significant abnormalities were discovered in 5% of cases without any clinical signs. Digital intravenous angiography is a safe and mildly invasive procedure for postoperative evaluation of vascular surgery.

[Current applications of numeric angiography in the study of cervico-cerebral vessels, the aorta, pulmonary vessels and following vascular surgery]. / De l'angiographie numérique pour l'étude des vaisseaux cervico-encéphaliques, de l'aorte, des vaisseaux pulmonaires, et après chirurgie vasculaire.

Numeric angiography is an examination of choice for studying the thoraco-abdominal aorta, whatever the underlying pathological condition, and is often the only angiographic investigation useful and necessary for deciding on therapy in cases of aneurysm. In contrast, results are unsuccessful in approximately 15% of cases when neck vessels are studied. Significant lesions nearly always produce sufficient information for the decision as to therapy to be made. Vascular surgery follow up is an excellent indication for numeric angiography, whatever the surgical technique used or the anatomic site involved. Reliable data can be obtained from pulmonary vessels by the use of this method in patients with pulmonary embolism, arteriovenous malformations, and abnormal venous return.

[Advantages and current limitations of numeric angiography]. / Avantages et limites actuelles de l'angiographie numérique.

Numeric angiography possesses the definite advantages of diminished risks when compared with conventional arteriography, and marked reliability when used for valid indications. It is also economically interesting since hospitalization is avoided. Limitations of the method are currently related to technical and data-processing problems. Insufficient size of the brilliance amplifiers means that several injections of contrast medium are necessary, with increased risks in some patients. Image resolution is insufficient with currently available matrices to study small vessels. The rate of image production, originally insufficient, now with modern equipment enables mobile structures such as the heart to be studied.