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A superior vena cava-right pulmonary artery (SVC-RPA) anastomosis was constructed in a 2-year-old boy with tetralogy of Fallot. Ten years later and 5 years after "corrective" surgery without removal of the shunt, cyanosis and heart failure developed. Stereocineangiography and lung scanning revealed arteriovenous fistulas and dilated vessels in the right lung. The SVC-RPA anastomosis was taken down, the SVC being reimplanted in the right atrium and the RPA end being closed with a few stitches. Neither lobectomy nor pneumonectomy was performed. Immediately after the operation and during a follow-up period of almost 2 years, the boy has remained asymptomatic. Whenever a correction is planned in a patient with SVC-RPA anastomosis, the vessels of the right lung should be examined by scanning and angiography. If important arteriovenous fistulas do exist, the affected lung should be excluded from the pulmonary artery circulation.

The results of CT scan are discussed with special reference to the value of density measurements in several cases of mediastinal cyst lesions. Although in some cysts with watery content, the CT attenuation values can be indicative, in most other lesions with heterogeneous structure and viscid fluid content, attenuation values in CT scan cannot be considered conclusive for diagnosis.

The complications related to the use of subclavian catheters for hemodialysis were prospectively studied in 257 consecutive acute and chronic renal failure patients. Using 394 catheters, 3006 single needle dialyses were performed. Indications for starting catheter dialysis were mainly the absence or disappearance of an adequate vascular access. Most hazardous complications were sepsis (9), malposition (6), hemothorax (3), bleeding (2), vena cava thrombosis (2) and pneumothorax (2). A number of mechanical problems occurred, where the obstructed catheter could easily be replaced by a modified Seldinger technique. No mortal complications occurred. Patient tolerance was excellent. It is concluded that single needle subclavian hemodialysis is a valuable alternative vascular access method in acute situations. It enables the continuation of hemodialysis on an ambulatory basis.

The accuracy of scrotal thermography as a diagnostic method to confirm or detect spermatic venous reflux in patients with palpable and subclinical varicocele, respectively, was evaluated. In all, 118 scrotal thermograms were performed in 110 patients, and the results were compared with the findings by selective retrograde venography of the internal spermatic vein whenever required. Normal thermograms were recorded in 23 oligospermic men without varicocele. Of 39 patients with palpable varicocele, 37 had abnormal thermograms; normal recordings occurred in 2 patients with associated unilateral testicular atrophy. Among 36 men suspected of having subclinical varicocele, 19 had abnormal thermograms and 16 presented reflux on the venogram. Venography was performed in 5 of the remaining 17 men with normal thermograms; only 1 had reflux. Screening for varicocele by means of scrotal thermography thus revealed reflux in 16 of 36 patients with unexplained infertility. Postoperative thermograms were disturbed in 6 of 20 cases, 5 of which presented reflux. Only 1 of 14 postoperative patients with normal thermograms underwent venography, and no reflux was demonstrable. Both the difference in temperature between the affected and contralateral hemiscrotum and the area of hyperthermia were significantly greater in patients with grades II and III varicocele, compared with those with subclinical and grade I varicocele. It is concluded that scrotal thermography is a valuable screening method for the detection of spermatic venous reflux. The technique allows selection of patients to be subjected to retrograde venography.

Retrospective analysis of 100 patients treated for varicocele-associated infertility by means of transcatheter embolization with 2-isobutyl-cyano acrylate (Bucrylate, Ethicon Inc., Somerville, NJ) reveals that the age of the man and the duration of infertility do not influence the probability of pregnancy after treatment. Patients treated for subclinical varicoceles had the same probability of success as patients with larger varicoceles. The following factors were found to have predictive power as far as the posttreatment success rate is concerned: the coincidence of other disease interfering with the fertility of the man or woman, serum follicle-stimulating hormone concentration, total testicular volume, and pretreatment semen quality. Depending on the latter factors, the probability of conception varies between 8% and 80%. It seems possible to define certain subgroups of varicocele patients with poor, moderate, or good fertility prognosis.

The study concerns 127 consecutive patients, presenting congenital heart disease, with an age distribution from neonatal to 15 years (mean 5 years). With non-ionic Amipaque, 164 injections were performed, with ionic Isopaque Coronar 81. Isopaque Coronar caused in 51% of the cases a clear discomfort for the patient; with Amipaque the side-effects were reduced to 9% (p less than 0.001). The mean body temperature rise with Amipaque was only 0.09 degrees C, against 0.28 degrees C with Isopaque Coronar (p less than 0.001). The changes in the heart rate reached 8.35% with Amipaque and 15.2% with Isopaque Coronar (p less than 0.001). Amipaque caused a mean of 1.8 extrasystoles per injection; Isopaque Coronar 2.2 (p less than 0.05). The quality of the angiogram with Amipaque was quite better than with Isopaque Coronar (p less than 0.0025). The non-ionic Amipaque is a much safer and better tolerated compound that the ionic Isopaque Coronar for paediatric angiocardiography.

Selective retrograde catheterisation of the left internal spermatic vein at its orifice in the renal vein was carried out in 25 patients suspected of varicocele. When contrast medium is injected, the patients with varicocele, standing in the erect position, present a retrograde filling of the varicose spermatic vein, in contrast to the absence of such reflux in normal men. The venography is indicated for diagnostic and therapeutic purposes and it is the only available, non-surgical technique to prove the existence of a disturbed venous flow in the testicular region.

The radiological anatomy of the internal spermatic vein(s) was studied in 200 retrograde venograms performed as part of presurgical evaluation in patients with variocele. A large range of anatomical variations was found at the left side. Bilateral reflux occurs in one out of four patients with unilateral varicocele at palpation. Bilateral treatment is therefore necessary in as much as one fourth of cases with "unilateral' left side varicocele. In right side varicocele the spermatic vein generally enters the right renal vein. Varicocele ligation should be performed near the internal inguinal ring in order to interrupt reflux most securely. Non-surgical treatment of varicocele by means of sclerosis or embolization of the internal spermatic vein, will remain restricted to those cases in which reflux passes through only one spermatic vein. Insufficient knowledge of the anatomy of the internal spermatic vein(s), and the resulting incomplete interruption of reflux in this (or these) vessel(s) may be the cause of poor treatment results reported by some authors.