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Increased blood viscosity has been shown to be an important factor in reducing blood flow in a review and analysis of the history, clinical findings, and haemodynamic, rheological, radiological, and biochemical measurements in 126 patients with intermittent claudication. In some patients increased viscosity seemed to be the determining cause of claudication. A raised plasma fibrinogen was the most common single biochemical abnormality. The results of conventional serum lipid and lipoprotein estimations were abnormal in the series as a whole but did not correlate with clinical findings or flow measurements at individual patient level. There was, however, a significant correlation between some clinical findings and the susceptibility of the red cells to autoxidation.

Seventy-one patients with suspected pulmonary embolism had both pulmonary scans and angiograms. Clinically it was impossible to predict the absence or presence of subsequent angiographic evidence of pulmonary embolism in the individual patient. In 24 patients the scans showed defects that were believed to indicate a high probability of pulmonary embolism-namely, perfusion defects that corresponded to specific anatomical segments of the lung together with normal chest radiographs or radiographs suggestive of pulmonary embolism. Specific angiographic evidence of pulmonary embolism was found in 18 (75%) of these patients. Diffuse, patchy, and non-segmental perfusion defects were seen in 28 patients. Only seven (25%) of this group had angiographic abnormalities specific for embolism. In 12 patients with normal lung scans none showed subsequent evidence of embolism by angiography. It is concluded firstly that lung scanning is a sensitive screening procedure for pulmonary embolism and, secondly, that segmental perfusion defects are highly suggestive of pulmonary embolism.

Selective visceral arteriography was found to be invaluable in the management of two cases of severe gastrointestinal haemorrhage associated with cavernous haemangiomata (a large gastric haemangioma and a small jejunal haemangioma). It is suggested that arteriography may be indicated in cases where a previous laparotomy has not shown the cause of bleeding, when the patient's general condition precludes a prolonged operation, and when superficial haemangiomata are found.

All our patients with a recent thromboembolic occlusion of limb arteries treated with streptokinase have been reviewed retrospectively. Clearing of the main artery, as judged by arteriography or reappearance of arterial pulsations, occurred more often when treatment was started early. If only patients with an iliac, femoral, or popliteal artery occlusion are considered, those who received a lower initial dose had a significantly higher clearing rate and a significantly lower mortality than those who received a high initial dose (500,000 units of streptokinase or more). Therefore an initial standard dose of 1,200,000 units of streptokinase is no longer recommended in these conditions, and even an individually titrated initial dose of more than half a million units could be hazardous. If no neurological abnormalities were present on admission amputation was never necessary, even if clearing of the main artery did not occur. If there was sensory loss of at least part of a limb, amputation was avoided only if the pulsations returned in at least one artery of hand or foot.

The nitroblue tetrazolium (N.B.T.) test was performed on patients in whom a differential diagnosis of pulmonary thromboembolism or lobar pneumonia existed. The mean N.B.T. score in healthy subjects was 6.4% (range 1%-15%). Patients with uncomplicated pulmonary thromboembolism showed a mean N.B.T. value of 7.5% (range 3%-12%). In patients with lobar pneumonia the mean N.B.T. score was 42.4% (range 21%-85%). These results suggest that the N.B.T. test is of value in the differential diagnosis of pulmonary thromboembolism and lobar pneumonia.

Treatment with heparin or streptokinase was allocated randomly to 30 patients with life-threatening pulmonary embolism verified by angiography. Treatment was given for 72 hours and pulmonary angiography was repeated. There was significantly greater (P < 0.001) evidence of thrombolysis in those patients treated with streptokinase compared with those treated with heparin. The reduction of systolic and mean pulmonary arterial pressures was also significantly greater (P < 0.05 and P < 0.02 respectively) in the streptokinase group.Seven patients failed to complete 72 hours of the trial treatment: five successfully underwent pulmonary embolectomy. Six of these "failures" had initial pulmonary angiographic scores of 24 or more and systemic systolic blood pressure recordings of 100 mm Hg or less. Patients with these features should probably be considered for pulmonary embolectomy as the initial treatment.A febrile reaction commonly occurred in the streptokinase group; otherwise side effects were no more common than in the heparin group.

Over a 12-month period four patients developed acute renal failure after undergoing radiological investigations using contrast media. Though the incidence of serious complications is low, the possibility of adverse side effects must be weighed against the usefulness of the information provided by these techniques.

Thirty-one cases of ischaemic cerebral stroke occurring in association with childbirth were fully investigated. The pathological basis of non-haemorrhagic carotid territory strokes in pregnant or puerperal women proved to be similar to that in non-pregnant women of the same age group. Over 70% were due to occlusive cerebral arterial disease or ischaemic lesions unrelated to thrombosis of the intracranial venous system. Comparisons are made with some other reported series in which only a minority of the patients were investigated by angiography, but in which intracranial venous occlusion was assumed to be the primary lesion. It seems likely that many of these patients may also have suffered arterial rather than venous lesions.

Profound modification of the structure and arrangement of the blood vessels has been shown in tumours after treatment with ICRF 159. X-ray angiography, carbon black (Pelikan ink) labelling, and intravital staining with lissamine green were used to demonstrate the changes. Alteration of the morphology of the blood vessels at the edge of a tumour may affect the escape of malignant cells and the rate of blood flow (and thus the concentration of anticancer drugs) through the tumour.

3 healthy women aged 35 22 and 28 years developed intravascular thrombosis while receiving oral contraceptive therapy (Case 1 took Anovlar for 1 years Case 2 took Conovid for 18 months and Case 3 took Enovid for 1 month). Cases 2 and 3 had chest lesions and were treated as pulmonary embolic disease. Case 1 was fatal and directs attention to the possibility that arterial thrombosis (in this case carotid) may also exist in addition to the more thrombophlebitis of the legs and pulmonary embolism.

Thrombi developing within the origin of the internal carotid artery may be demonstrated by a slow trickle injection of highly concentrated contrast medium, which lingers in pools around the thrombus on the dependent wall of the vessel. With this technique thrombi have been detected which could not be visualized on conventional arteriography because they were obscured by the density of the vascular shadow produced by the forceful injection usually employed in carotid angiography. In addition, trickle arteriography is useful for assessing the position and extent of atheromatous plaques and the contrast stasis associated with them.

To assess restoration of pulmonary perfusion after pulmonary embolism serial lung scans were carried out on 74 patients. Of these, one-third showed almost complete recovery, one-third improved, and the remainder either failed to improve or became worse. Perfusion was most rapidly restored in the first few days after the embolus and more slowly during the next two to three weeks. Untreated patients improved less often and had more new defects in perfusion than patients treated with anticoagulant therapy, no difference occurring in either the amount of improvement or in the rate of recovery of perfusion between patients treated with different anticoagulant regimens. There was evidence of further pulmonary emboli in 35% of treated patients, 82% of these occurring within two weeks of the initial embolus. Patients with defects in perfusion greater than 30% showed considerable improvement but recovered less well than those with smaller defects.

Cooling of the skin over the medial supraorbital region in 80% of patients who have an occlusion or severe stenosis of a carotid artery can be demonstrated by facial thermography. Minor stenotic lesions in the carotid arteries do not produce characteristic thermographic changes, while thermography is of no help in the diagnosis of vertebrobasilar arterial disease. Thermographic changes suggestive of carotid arterial lesions are found occasionally in patients whose angiograms are normal, owing to variations in the size of the frontal sinuses, or factors such as fever or inflammatory lesions. It is suggested that facial thermography is of value in the preliminary investigation of patients with occlusive cerebrovascular disease.

Eighteen patients with major pulmonary embolism were treated with streptokinase infused by a catheter or given intravenously. Fourteen showed clinical improvement and 12 out of 16 patients investigated showed definite angiographic improvement after 24 to 48 hours of treatment with streptokinase. The angiographic improvement following streptokinase contrasted with the lack of this in three patients after 24 hours of heparin treatment.Resolution following streptokinase therapy was most noticeable in patients treated shortly after a single embolic episode, and was least marked in those with recurrent embolism complicated by associated cardiac or pulmonary disease. Of the four patients who failed to improve, two died and two had pulmonary embolectomy and survived.The results suggest that streptokinase therapy is practicable provided that adequate laboratory control is available, and that it hastens early resolution in acute major pulmonary embolism.

Three patients with inoperable malignant hepatomas were treated by intra-arterial infusion of fluorouracil. In each case the treatment gave relief of symptoms: there was striking relief of pain in two cases.Preoperative angiography is essential, but the technical problems are relatively minor.The response of the tumours to chemotherapy is sufficiently encouraging to justify greater efforts for early diagnosis.

In three cases of subdural haematoma which resembled primary subarachnoid haemorrhage the diagnosis was made only by cerebral angiography. Angiography should be done whenever the diagnosis is in doubt.

Forty-seven recipients of renal allografts have been studied at varying intervals of up to five years after transplantation. Renal artery bruit occurred in eight of 16 patients observed over the first two post-transplant months and disappeared spontaneously in four of these. The disappearance of the bruit was associated with poor renal function. Renal bruits were audible in 10 patients examined more than two months after transplantation; nine of these were hypertensive and of six in whom arteriography was performed five were shown to have stenosis of the allograft artery. By contrast only eight of 37 patients without abdominal bruit were hypertensive, and arteriography in 10 normotensive patients without bruit showed no stenosis. It is concluded that while a renal artery bruit during the first two months after transplantation may be a marker of good renal blood flow at the time, its presence suggests a poor long-term prognosis since persistence of the murmur indicates that significant stenosis of the allograft artery is likely, while its disappearance is associated with poor renal function.