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With common carotid artery occlusion there is usually no flow in the distal vessels. However, flow to the ipsilateral internal common carotid artery may be maintained by collateral vessels. Nine of 1100 patients referred for carotid duplex sonography were found to have occluded common carotid arteries. Five of these patients had collateral circulation with reconstitution of flow via the external carotid artery. The color Doppler sonograms of three representative patients are presented. There was antegrade flow in the internal carotid artery with retrograde flow in the external carotid artery.

This article describes the CT scans of two patients who, following carotid endarterectomy, developed headache and seizures suggestive of hyperperfusion syndrome. Their CT scans demonstrated ipsilateral mass effect and white matter hypodensity. One patient progressed to hemorrhage and died. Although infarction is described as the commonest neurologic event to occur after carotid endarterectomy, autopsy or cerebral blood flow studies in these patients suggests that the changes were due to hyperperfusion rather that infarction.

The author performed a randomized prospective study of the effects of needle size and of age, sex, myelogram type and operators on the incidence of headache following myelography. In 113 patients randomized to 22 G and 25 G needle groups, data were obtained by questionnaire on the frequency of headache up to five days following the procedure. The influence of needle size was statistically insignificant (63%, 48%, p0.05). Age (p = 0.0002), sex (p = 0.01), myelogram type (p = 0.002) and myelographer (p = 0.03) significantly affected the frequency of headache. The size of the dural perforation appears to be less important than factors relating to age, sex, myelogram type and individual myelographers in the development of headache after myelography.

As the procedure of sentinel lymph node biopsy for breast cancer becomes more widely available, the practicality of it in the hands of general surgeons should be assessed. This is a study of the accuracy and use of this procedure. A prospective study was conducted at two university-affiliated teaching hospitals. Ninety-one patients with invasive breast cancer were enrolled in the study. Twelve patients were excluded from analysis. The remaining 79 patients were injected peritumorally with technetium-99m-labeled sulfur colloid and isosulfan vital blue dye. The sentinel lymph node was located and excised using a gamma probe, and the definitive breast cancer operation was completed, including an axillary dissection. Histology of the sentinel lymph node specimen was compared with that of the axilla. Sentinel lymph nodes were located in 64 (81.0%) of the 79 patients. Sentinel lymph nodes and axillary nodes were benign in 44 (68.8%) of the 64 patients; these patients could potentially have been spared the axillary dissection. Fourteen (21.9%) patients had metastatic cancer to the sentinel nodes only, and five (7.8%) patients had axillary metastasis beyond the sentinel lymph node. Among the 64 patients, there was one false negative. Sensitivity and specificity when a sentinel lymph node was found were 95.0 per cent and 100 per cent, respectively. The sentinel lymph node accurately predicted the axillary contents 98.4 per cent of the time. This study demonstrates that the sentinel lymph node can be identified and is reliable in predicting axillary node status. This study also shows that the procedure has a notable learning curve, but can be used by general surgeons with a commitment to the care of breast cancer patients.

The authors report their initial experience in 52 patients with three different techniques of peripheral artery atherectomy--the Tracwright (Kensey), used in 19 patients, the Simpson AtheroCath, used in 19 patients and the transluminal extraction catheter, used in 14 patients. The indications for atherectomy were claudication in 42 (80%) and limb-threatening ischemia in 10 (19%). There were no deaths. Complications included three arterial perforations, one thrombosis and one groin hematoma requiring operative evacuation. There were no distal embolizations. Atherectomy was initially unsuccessful in 15 (29%) patients. For the successfully completed procedures, the 1-year primary patency rates were as follows: Tracwright (Kensey) catheter 56%, Simpson catheter (63%) and transluminal extraction catheter (0%). Use of subsequent nonoperative procedures on recurrent stenoses produced secondary patency rates of 77% for the Tracwright (Kensey) technique, 80% for the Simpson catheter technique and 78% for the transluminal extraction catheter technique. The authors conclude that their early results justify further evaluation of these three techniques. Use of the transluminal extraction catheter is associated with higher rates of occlusion and restenosis.

Sixty-eight patients with intraventricular hemorrhage (IVH) diagnosed by computed tomography (CT) were reviewed retrospectively to determine the etiology and prognosis, relationship to delayed hydrocephalus, and effect on neurological outcome. The most common causes were a ruptured aneurysm, trauma, and hypertensive hemorrhage. Ruptured aneurysms of the anterior communicating artery can often be predicted from the nonenhanced CT scan. The total mortality rate was 50%; however, 21% of patients returned to normal or had only mild disability. Patients in whom no cause was identified had a better prognosis. Delayed hydrocephalus was related to the effects of subarachnoid hemorrhage rather than obstruction of the ventricular system by blood. IVH per se is seldom a major factor in the neurological outcome.

Acute orbital pseudotumors are inflammatory lesions of unknown etiology that may affect part or, less often, all of the tissue within the orbit. A retrospective computed tomographic (CT) study of 16 patients demonstrated that these lesions occur in one of five specific anatomic patterns: anterior, posterior, diffuse, lacrimal, or myositic. The most common location was lacrimal followed by anterior pseudotumors. Posterior, most common location was lacrimal followed by anterior pseudotumors. Posterior, diffuse, and myositic pseudotumors were equally frequent. Localization on the basis of clinical features correlated with the CT localization. Illustrative cases of each of the five types are included. The role of CT in evaluating the therapeutic response is discussed.

We report the angiographic, computed tomographic, and ultrasonographic findings in two patients with iliac artery aneurysms detected several years after undergoing vascular graft surgery to the aorta. These lesions are often silent until serious complications occur, and they should be treated even when asymptomatic. Radiologists should be familiar with this complication so that it may be more readily diagnosed.