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• Basic principles of fluid dynamics and material properties underlie many facets of the diagnosis, treatment, and natural history of vascular disease. I review the concepts of total fluid energy and both viscous and inertial energy losses with reference to arterial occlusive disease. I contrast the vascular wall properties of arteries and veins and discuss the relevance of mechanical principles to arterial aneurysm. I review the pathophysiologic features of small and large arteriovenous fistula. Finally, I discuss the altered dynamics associated with venous obstruction and valvular insufficiency in light of recent noninvasive diagnostic techniques that provide simple rapid assessment of venous pathophysiologic features. ( Arch Surg 115:216-223, 1980)

From 1969 to 1973, we undertook a direct surgical therapeutic approach with 62 patients who had intracranial aneurysms. The surgical mortality for patients in the first three clinical grades was 5%. Sixty-eight percent of the entire group of patients had improved conditions at follow-up. When these results are compared to the expected outcome of the natural course of the disease under conservative management, the superiority of the direct approach is seen. With the aid of modern instrumentation, anesthesia, steroid therapy, and magnification, neurosurgical centers handling a reasonable volume of these cases should achieve comparable results. ( JAMA 237:1845-1847, 1977)

In a study designed to assess the potential value of radionuclide aortography in diagnosis of aortic and anastomotic aneurysms, 43 patients were examined. Radionuclide studies correctly identified 26 of 28 aortic aneurysms while physical examination identified 26 of 28, and lateral plain film roentgenograms showed 23 of 28. Three of five anastomotic aneurysms were demonstrated by the radionuclide technique. The radionuclide study was helpful in finding three previously unsuspected aneurysms and in excluding four abdominal and three thoracic masses from consideration as aneurysms. Clearly, this noninvasive technique has utility in lending objectivity to evaluation of patients with arterial aneurysm disease.

The syndrome of subarachnoid hemorrhage from ruptured intracranial aneurysm is well known. The symptoms vary; in some the symptoms are severe and progressive, in others the course may fluctuate. This fluctuation may be very conspicuous, so that after several days of relative improvement with lucidity there appears an increasing drowsiness or stupor. In these instances, one may conclude that there has been a recurrence of the intracranial bleeding, as confirmed by the reappearance or increase in the amount of blood in the cerebrospinal fluid. The downhill course, however, may be due to aneurysmal bleeding into the substance of the brain or into the subdural space. According to Logue9and Clarke and Walton,3hemorrhage from a ruptured aneurysm frequently extends into the subdural space. These extensions are small, form a very thin layer over the brain, and are usually found at autopsy. There are cases in which the subdural

We wish to report a case of suprasellar aneurysm exposed and incised at operation. A large muscle graft was packed into the aneurysmal sac. This is the sixth instance that we have found of a patient's surviving the opening of a suprasellar aneurysm. Since we have been able to find but few cases of this type in the literature, we wish to emphasize certain aspects of the problem of suprasellar aneurysm both from the diagnostic and from the therapeutic standpoint. The association of paralysis of the third, fourth, fifth and sixth cranial nerves with aneurysms of the infraclinoid portion of the internal carotid artery has become well known. Dandy 1 has reported several such cases of pure arterial aneurysm diagnosed by clinical means and cured by operation. A second type of aneurysm has been but little mentioned in the literature. To distinguish this type from the infraclinoid group, it is