The purpose of this study was to determine the accuracy of CT angiography using a multidetector scanner in the evaluation of patients with peripheral vascular disease.Eighteen patients with peripheral vascular disease who were referred for elective digital subtraction angiography (DSA) also underwent CT angiography. We scanned patients from the level of the superior mesenteric artery to the pedal arteries in a single helical scan. CT angiograms were produced using maximum-intensity-projection reconstructions. Findings were graded according to six categories: 1, normal (0% stenosis); 2, mild (1-49% stenosis); 3, moderate (50-74% stenosis); 4, severe (75-99% stenosis); 5, occluded; and 6, nondiagnostic. CT angiography findings were compared with DSA findings for each arterial segment.We found agreement for the degree of stenosis in 77.7% of the arteries and discrepancy for 22.3% of the arteries when all categories were considered. Grouping the six categories according to the threshold for treatment (categories 1 and 2 as one group and categories 3, 4, and 5 as the second group) resulted in an agreement of 91.95%. Compared with DSA, CT angiography yielded a sensitivity of 90.9% and a specificity of 92.4%.Multidetector CT angiography is an accurate, noninvasive technique for the imaging of peripheral vascular disease.
The application of electrical methods to the study of cerebral function is still in an experimental stage. In 1923 Grant,1using a simple Wheatstone bridge arrangement, reported marked diminution in the electrical resistance of tumor tissue as compared with that of normal brain. Berger2amplified electric potentials set up in the brain and ascribed changes in potential to nervous activity. Foerster and Altenburger3succeeded in recording characteristic changes in potential in several cases of tumor of the brain. Subsequently, electroencephalographic methods have resulted in the accumulation of a considerable amount of data, especially with respect to the epileptic syndromes.4Recently, important contributions to the possibility of localization of tumors by electroencephalography5have been made. However, in only a few instances (notably, those of Foerster and Altenburger,3in Germany, and Walter, in England) have direct records from the cortex been demonstrated. We believed that studies
Lateral rupture of the cervical intervertebral disks should be considered in the differential diagnosis in a patient with a history of pain or stiffness of the neck, with radiation of pain to the shoulder, arm or hand. In some cases the superficial impression may be that of angina pectoris. Differential diagnosis between cervical rib and scalenus anticus syndrome and cervical disk can usually be made on the basis of the point of reference of pain or numbness. In cases of cervical disk rupture, symptoms and signs are usually referable to the sixth and seventh cervical dermatomes, whereas the other conditions usually involve the eighth dermatome. Roentgenograms of the cervical spine frequently show reversal of the normal curve and narrowing of the suspected interspace.Cervical disks which rupture closer to the midline may produce signs and symptoms of degenerative cord disease, such as amyotrophic lateral sclerosis, or may even cause complete paralysis simulating spinal cord tumor.Because of the great risk of cord compression, manipulative treatment is hazardous. Conservative therapy, using halter traction and a Thomas collar, is advisable before proceeding with myelography and surgery. The results of surgery are excellent.
Arterial involvement in Behçet's syndrome is rare. Aneurysms are common among the arterial lesions, affecting various arteries but mostly the abdominal aorta. Surgical interposition graft insertion is the treatment of choice for large aneurysms. However, vasculitis in these patients is the reason for the notorious surgical complications that result in up to 50% false aneurysms in anastomotic sites. Recently, endovascular repair for abdominal aortic aneurysms has been established.To learn more about vascular Behçet's and, specifically, to compare the results of surgical treatment and endovascular repair of AAA in patients with Behçet's syndrome.We retrieved the medical records of all 53 patients with Behçet's disease admitted to Rambam Medical Center during the years 1985 and 2001, and analysed the results and follow-up of open surgery versus endovascular repair of AAA in patients with known Behçet's syndrome.Of the 53 patients with Behçet's disease 18 had vascular manifestations (34%). AAAs were encountered in 8 patients (15%) and 5 were treated. Open surgery (group 1), under general anesthesia, lasted less than 3 hours with an average aortic damping time of 34 minutes (range 26-41 min) after which the patients were transferred to the intensive care unit for 24-48 hours. Endovascular treatment (group 2), although lasting about the same time without the need for intensive care, necessitated contrast media and fluoroscopy. The length of hospital stay was considerably shorter for patients after endovascular repair compared to open surgery (3 days vs. 6 days). Combined mortality and morbidity was higher in patients who underwent open surgery compared to endovascular repair (one death, one major amputation and three anastomotic pseudoaneurysms compared to one temporary contrast-induced nephropathy).Vasculo-Behçet's patients with AAA are better candidates for endovascular treatment than atherosclerotic patients. Combined morbidity (especially anastomotic pseudoaneurysms) and mortality of Behçet's patients after endovascular repair is considerably lower than after open surgery.
