PubMed · 513419
The source did not provide an abstract. Follow the original record for more information.
Explore connections, maps & timelines
W Darmody, J E Tintinalli. 1979. Head injuries.. https://doi.org/10.1016/s0361-1124(79)80156-2
Cite the original work for its findings. Save a collection to share your selection of sources.
KEEP EXPLORING
Although cineangiography has been in use for 35 years, it has important limitations. Films are expensive to produce, cannot be readily copied or transmitted electronically, are bulky, and require a large storage space. Digital angiography will soon replace film for archiving cardiac catheterization images, ultimately offering powerful new capabilities at a reduced cost. The transition toward the filmless angiogram is characterized by both great promise and important risks. Current nonfilm archiving systems (such as super-VHS videotape or analog optical disks) have not met the needs of the cardiovascular community, owing to poor image quality and resolution inferior to that of cine films. Analog storage media can result in a standard error in lesion measurements exceeding 1 mm and have a suboptimal signal-to-noise ratio. While digital media record adequate image detail, proprietary formats preclude the universal compatibility supplied by cine film. As a consequence of incompatibility, referred patients must undergo repeat catheterization prior to surgery or intervention. To resolve the compatibility problem, a committee established by the American College of Cardiology in conjunction with manufacturers (DICOM) has developed a standardized digital recording format using CD-ROM to transfer images between medical centers. The availability of this standardized interchange medium will have a positive impact on research as well as on patient care by eliminating barriers to image exchange throughout the cardiovascular community. Support for the DICOM approach by practitioners is vital to the transition to digital future.
Explore the source record for details and available documents.
HISTORY AND CLINICAL FINDINGS: A 55-year-old woman developed increasing shortness of breath and breath-independent pain in the left lower chest. 20 years previously she had had an episode of pulmonary embolism and 10 years previously a central venous thrombosis in the left eye. No cause of the increased thrombogenesis had been found. On admission she had resting dyspnoea but a stable circulation. On auscultation the breath sounds were diminished over the left base and there was a diastolic murmur over the pulmonary area with an accentuated second sound. There was also marked tenderness below the left costal margin. Recurrent pulmonary embolism or left-sided pleuropneumonia was suspected. INVESTIGATION: Arterial blood gases (without additional oxygen) showed severe hypoxaemia (pO2 42.3 mm Hg, pCO2 27.8 mm Hg, pH 7.455, oxygen saturation 80.5%). Transthoracic and transoesophageal echocardiography showed normal left ventricular dimensions, right atrial and ventricular dilatation, and an atrial septal aneurysm with a right to left interatrial shunt. Right heart catheterisation demonstrated severe pulmonary hypertension. Sonography, computed tomography and scintigraphy revealed multiple splenic infarcts. TREATMENT AND COURSE: Heparinisation was instituted (partial thromboplastin time 70-90 s) and overlapping oral anticoagulation to a Quick value of 20%. Subsequently the calcium antagonist felodipine (15 mg daily) was given. The mean pulmonary artery pressure was 61 mm Hg before and 57 mm Hg after treatment. CONCLUSION: Splenic infarction resulting from paradoxical embolisation is rare, but should be routinely considered in the presence of thromboembolic phenomena.