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Although air embolism is relatively rare, more frequent recognition of the condition has followed understanding of better established physiologic concepts. Fundamentally, the two types of air embolism are pulmonary (venous) and arterial. Arterial embolism results from the entrance of air into the left side of the heart from the pulmonary veins or through septal defects, usually patent foramen ovale. The air bubbles escape into the systemic arteries, and the clinical manifestations depend on the site of arterial occlusion. Since this type of embolism does not apply to the case reported herein, it will not be considered further. In pulmonary (venous) embolism air enters a systemic vein and is carried to the right side of the heart. Here the churning action of the heart on the blood and air forms "blood foam." This foam may either remain in the heart or pass into the pulmonary arteries. The amount of obstruction in

• Peripheral arterial disease in 52 patients was treated with azapetine, given either orally or intravenously. The oral dosage was 75 or 100 mg. per day; the intravenous dosage was 1 mg. of azapetine per kilogram of body weight in 250 cc. of saline solution injected slowly over a 30-minute period. Improvement of circulation in the extremities was manifested not only in the alleviation of symptoms but also in the results of oscillometric readings, skin temperature recordings, and reflex skin temperature changes after warming and cooling the extremities. The evidence showed that azapetine is a potent arterial vasodilator in vasospastic disease of the extremities. Intravenous injection gave immediate vasodilation in 7 of 10 patients so tested and is believed to afford a test whereby the patient's ability to benefit by oral administration of azapetine or by sympathectomy can be predicted.

• Approximately 500,000 cases of pulmonary embolism appear each year in the United States, with most having clots that originated in the deep veins of the lower extremities. Since the clinical diagnosis of deep venous thrombosis (DVT) is accurate only half the time, a safe method that affords immediate and definitive diagnosis of DVT is urgently needed. One diagnostic technique now available is phleborheography (PRG). We examined 1,076 patients (2,152 limbs) during the period of 1976 to 1979. By performing PRG before hospital admission, 392 patients who had negative study results were not hospitalized, resulting in an estimated savings of $960,400 and avoiding both the hazardous treatment and the stigma associated with a diagnosis of DVT. After one to three years of follow-up in 593 patients (1,186 limbs) who had had negative results from PRG, only three (0.5%) have shown evidence of postphlebitic swelling and one (0.2%) has had pulmonary embolus. ( Arch Surg 1981;116:795-797)

THE PURPOSE of this presentation is to review the clinical picture of the seemingly expansile supraclavicular or superior mediastinal pulsating mass. While to physical examination or chest fluoroscopy, pulsating masses may seem to be aneurysmal, aneurysms in the innominate-carotid-subclavian vessels are rare.1,2In this area aneurysmectomy carries a high morbidity and mortality. Occasionally all doubt of diagnosis is removed by visible or palpable aneurysmal bone erosion in the area of the clavicle or upper sternum. More often, careful palpation reveals a tortuous course of one of the large arteries of the area which accounts for the swelling and establishes a diagnosis (Fig 1). In the group between these extremes definite diagnosis by physical examination is impossible because of the heavy skeleto-muscular structures shielding the area. Angiography to confirm aneurysm becomes mandatory. By clinical or fluoroscopic examination, each of the following patients was thought to have an innominate aneurysm. Each