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Two cases illustrate the clinical manifestations and angiographic findings associated with segmental stenosis of the abdominal aorta. Such lesions represent the chronic occlusive stage of Takayasu's disease, a nonspecific inflammatory arteritis of uncertain etiology. While the disease is considered autoimmune, an infectious process may be involved. Complications typically associated with stenotic lesions of the abdominal aorta are secondary renal hypertension and ischemic symptoms secondary to vascular insufficiency. Surgical correction, the treatment of choice, has achieved excellent results for these well-localized lesions. Secondary renal hypertension was relieved by a spenorenal shunt and the disease has since been controlled with conservative management in the first patient. An aortofemoral bypass graft successfully alleviated the vascular insufficiency in the second patient, although the patient unfortunately expired from a refractory postoperative cardiac complication.

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The use of ultrasonography to diagnose cholelithiasis has recently been recommended to supplement standard reinforced oral cholecystography or as an alternative to reinforced oral studies when a single dose fails to visualize the gallbladder. As yet the use of ultrasonography in the primary diagnosis of cholelithiasis is not generally accepted. To assess the specificity and sensitivity of this mode of diagnosis, fifty patients were reviewed retrospectively. The findings of ultrasonography are compared with standard oral cholecystography and with the pathologic findings. The results of this analysis suggest that diagnosis of cholelithiasis by ultrasonography has a high level of accuracy. Use of this mode of evaluating the gallbladder is suggested as a primary diagnostic test for jaundiced or pregnant patients.

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Use of the Fogarty balloon catheter for hemostasis in vascular trauma and difficult vascular dissections requires constant balloon inflation. A syringe holder to maintain balloon inflation without requiring constant attention of an assistant has been designed. Other applications of the syringe holder are discussed, including use with endotracheal tubes, gastrointestinal tubes, and for Fogarty balloon occlusion of pulmonary segments.

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Liposarcomas are common soft tissue tumors of the mediastinum and the retroperitoneum. Although they are rarely found in the greater omentum, when they occur in that area they can become enormous and be mistaken for pancreatic pseudocysts or ascitic distension. Recently, successful resection of a 10--kg liposarcoma of the omentum was performed at our institution. A description of the clinical presentation, preoperative assessment, and characteristics of this tumor are reported and the literature is surveyed. The use of adjuvant chemotherapy for these tumors is also discussed.

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Twenty-eight patients with total occlusion of the infrarenal aorta have been seen at the UCLA Hospitals in the past 11 years. Claudication was the presenting complaint in all but one patient, with one-third having ischemic rest pain. The average age of these patients was 54 years, and their histories revealed a surprising absence of myocardial infarction, stroke, or diabetes, although 40% had essential hypertension. Heavy tobacco use, however, was characteristic of the entire group. Arteriography proved valuable in identifying and characterizing the vascular abnormalities, but posed problems in technique and interpretation. Significant distal arterial disease was detected radiographically in only 21% of these patients. Operative correction of the aortic occlusion was performed on 26 patients, 18 by aortic bypass grafts and eight by aorto-iliac endarterectomy, with one early postoperative death. Although the thrombus extended to the renal artery origins in 77% of the cases, a well-designed technical approach did not require renal artery occlusion. Using serial creatinine determinations, one case of renal insufficiency was detected which was associated with prolonged postoperative hypotension. Although the extent of distal disease was more severe in those who underwent bypass, symptoms of claudication returned earlier and were more prominent in the endarterectomy group. This recurrence of systems was not favorably altered by sympathectomy performed concomitantly with the initial procedure. Even though this condition seems to pose difficult technical obstacles and has a poor prognosis, infrarenal aortic occlusion can be successfully treated by aortic bypass, with favorable long-term results, if particular attention is paid to elements of the preoperative evaluation and the intraoperative technical requirements peculiar to this relatively uncommon disease entity.

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The Bristow operation with its modifications has become a popular therapeutic modality for recurrent subluxation of the humerus. A patient was recently treated for a false aneurysm of the axillary artery six months after such a procedure. The artery had been lacerated by the dislodged fixation screw. The clinical presentation, intraoperative management and postoperative course were described, and a suggestion for removing the orthopedic screw eight weeks after a Bristow procedure was offered.

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A neonate with idiopathic brachial artery occlusion was recently treated at the San Bernardino County Medical Center. At birth, the right upper extremity was cold, pulseless and cyanotic. Arteriography demonstrated brachial artery occlusion, following which thrombectomy and postoperative heparinization resulted in a viable limb. This represents an unusual case of neonatal arterial occlusion with diagnostic preoperative arteriography and successful Fogarty thrombectomy. Possible etiological factors, treatment alternatives, and long term prognosis are discussed in this report.

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