Myocardial macroaggregate uptake on successive lung perfusion scans

In a patient with an Eisenmenger syndrome and multiple intraventricular communications, myocardial uptake of macroaggregated albumin appeared during a perfusion lung scan. This pattern can be explained by an increase of arterial pulmonary hypertension heightening the proportion of the right-to-left shunt.     

Thrombosed synthetic hemodialysis access fistulas: failure of fibrinolytic therapy

Seven episodes of acute thrombosis occurring in five patients with polytetrafluoroethylene dialysis fistulas were treated with local infusions of low-dose streptokinase. Bleeding from previous dialysis puncture sites necessitated stopping the infusion in six out of seven patients, although in one of these six, the graft reopened. The seventh patient had never been dialyzed through the graft and thrombolysis was achieved without incident. Surgery was avoided in only one patient. The authors contend that in these patients the risks of fibrinolytic therapy outweigh the benefits. Surgical thrombectomy, coupled with intraoperative angiography and possible angioplasty, is the preferred method of treating these patients. Venography prior to the creation of the fistula helps the surgeon avoid diseased vessels and may avert early failure of the fistula.     

Classification and pathomorphology of lumbar stenosis.

A classification system based on pathologic anatomy distinguishing between three types of lumbar stenosis is reported: stenosis of the spinal canal, isolated stenosis of the nerve root canal, and stenosis of the intervertebral foramen. Each type of stenosis is classified as primary, secondary, combined or mixed. Pathomorphological pictures which may represent the vertebral bodies, the neural arch and the discoligamentous structures in the various forms of stenosis, among which degenerative spondylolisthesis, are examined. Finally, the authors describe the pathologic modifications occurring in the nervous structures as the possible consequence of a lumbar stenosis.