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Purpose: To determine whether intraarterial digital subtraction angiography (DSA) is as accurate as cut-film (film hard-copy) angiography (CFA) in the evaluation of suspected pulmonary embolus., Materials and Methods: Under a protocol approved by the institutional review board, CFA and DSA images were obtained in identical posteroanterior and oblique projections in one lung of each patient undergoing pulmonary angiography (n = 80). Diagnoses based on results of blinded review of each study (CFA vs DSA) by three separate reviewers (80 patients x three reviewers = 240 diagnoses for each modality) were compared with the diagnoses made by the physician who performed the procedure on the basis of CFA, DSA, and clinical data and with the consensus diagnoses obtained by means of group review of both studies together if necessary. The reviewers' confidence in their diagnoses was graded from 1 (certain) to 10 (uncertain)., Results: Pulmonary emboli were present in 13 (16%) of 80 patients. Two hundred thirty-six (98.3%) of 240 DSA diagnoses and 231 (96.3%) of 240 CFA diagnoses were correct. The sensitivity (correct identification of emboli by all three reviewers) of DSA was 92% and of CFA was 69% (P = .083). The specificities of the modalities were not statistically significantly different. The reviewers' confidence was significantly better in their DSA diagnoses than in their CFA diagnoses (P < .004)., Conclusion: DSA allows more confident detection of pulmonary embolus than does CFA, with no loss in diagnostic accuracy.

Intestinal angina may be caused by compression of the celiac artery by the median arcuate ligament of the diaphragm. Aortography can suggest the diagnosis, but the diaphragm cannot be visualized by this examination. We report a symptomatic woman in whom spiral computed tomography-guided angiography demonstrated stenosis of the celiac artery, superior mesenteric artery, and both renal arteries due to diaphragmatic compression. Surgery was beneficial.

Background: Extracapsular extension of nodal metastases from cancer of the breast is a frequent histologic finding, but its significance for prognosis and treatment is unclear., Methods: One hundred forty-three patients with breast cancer who had metastases to axillary lymph nodes were identified and divided into two groups: those with entirely intracapsular metastases (ICM), and those with extracapsular metastases (ECM)., Results: ECM was found in 58.7% of patients. A direct correlation was found between ECM and both the number of metastases and their size. Overall survival was significantly lower in patients with ECM, but an influence on survival independent of node count could be demonstrated only in patients with one to three involved nodes. ECM did not influence the pattern (i.e., locoregional versus distant) of recurrence and was not associated with increased recurrence in the axilla. Radiation therapy reduced locoregional failures in both ICM and ECM groups, but it did not improve survival., Conclusions: It is concluded that ECM has limited influence on prognosis independent of the number of positive nodes and is not an indication for radiation therapy of the axilla after a complete axillary dissection.

We report a girl with shortness of stature and minor anomalies representing a mild form of the Ullrich-Turner syndrome. Cytogenetic studies showed 3 distinct anomalies: 1) a familial pericentric inversion, inv(3) (p25q21)pat, in all cells examined; 2) monosomy X (45,X) in 70% of cells; 3) isochromosome X (46,X,i(Xq)) in 30% of cells. The karyotype designation is: 45,X,inv(3) (p25q21)pat/46,X,i(Xq), inv(3) (p25q21)pat. The pedigree, which was originally interpreted as representing the segregation of a 2;3 translocation, is corrected and updated. Reproductive risks in families with pericentric inversions are discussed.

Learning problems in patients with neurofibromatosis (NF) are probably the most frequent characteristics after those that define the disorder. They are not secondary to the physical problems. A recent survey that compared children who have NF with their siblings revealed a 37% greater incidence of learning disabilities in the children with NF. Intelligence quotient (IQ) data from several studies indicate that almost all patients with NF have a normal IQ, but there is a progression from low normal to normal as these patients reach adulthood. The most common psychoeducational problems include visual-perceptual-motor delay, spelling and arithmetic disabilities, and a cluster of weaknesses related to cortical organization, similar to those seen in children with attention-deficit disorders. A type of learning disability unique to patients with NF has not been identified, and the diagnosis and treatment of the learning problems are generally the same as for children without NF.