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Since the respiratory airways branch to all parts of the lungs and
ready access is provided through the nose or mouth, exploration of
these passages for direct visualization or tissue sampling has long
been a clinical challenge. This would be particularly helpful in
diagnosing those pulmonary diseases that involve the bronchial tree
or affect the surrounding lung parenchyma which prove difficult to
diagnose or define by indirect methods. The pioneering efforts of
Chevalier Jackson in 1918, using bismuth insufflation for
radiologic visualization of the bronchial tree, and of Sicard and
Forestier, who introduced poppy seed oil (lipiodol) in 1922,
rapidly established bronchography as a practical radiologic
diagnostic procedure. The initial enthusiasm was soon tempered by
recognition of practical problems, and over the years the
popularity of bronchography has waxed and waned as techniques were
refined and new equipment, instrumentation and contrast agents
evaluated. At the same time, alternative methods of diagnosis were
being developed, notably sputum cytology, percutaneous needle
aspira tion and biopsy, and bronchial brushing. In recent years, a
number of medical and technologic developments have revived
interest in transbronchial techniques and have made such a
diagnostic approach more attractive. Improvements in topical airway
anesthesia effectiveness have simplified passage of a variety of
catheters, brushes, biopsy devices, fiberoptic or other
bronchoscopic instruments along the bronchial passageways. Methods
of guiding the catheter or other trans bronchial instrument toward
the target site in the lung have also been refined.
2 Diagnostic Use of Radiographic Methods in Coronary Disease. . . .
. . . . . . . . . . . . . . . . . . . . . . 56 3 Material. . . . .
. . . . . . . . . . . . . . . . . . . . 58 4 Mode of Operation . .
. . . . . . . . . . . 62 5 Radiological Projections. . . . . . . .
. . . . . . . . . 63 6 Monitoring of Cardiac Parameters . . . . . .
. . . . . . 64 7 Pharmacological Tests . . . . . . . . . . . . . .
. . 66 7. 1 Coronary Arteries . . . . . . . . . . . . . . . . . . .
. . 66 7. 2 Left Ventricle. . . . . . . . . . . . . . . . . . . . .
. . . 67 8 Accidents and Risks of Coronary Arteriography . . . . .
67 References . . . . . . . . . . . . . . . . . . . . . . . . . 68
III Angiographic Explorations: Normal Results . . . 71 1 Left
Ventricle and Left Ventricular Function 71 1. 1 Radiological
Anatomy. . . . . . . . . . . . 71 1. 2 Normal Kinetics. . . . . . .
. . . . . . . . 77 1. 3 Analysis of Wall Contraction . . . . . . 78
1. 4 Volumes and Function Indexes. . . . . . . 81 2 Coronary
Arteries and Veins . . . . . . . . 84 2. 1 Origin, Calibre and
Preponderance of the Coronary Arteries . . . . . . . . . . . . . .
. . . . . . . . . . 84 2. 2 Nomenclature and Segmentation of the
Coronary Arteries . . . . . . . . . . . . . . . . . . . . . . 87 2.
3 A Reminder About the Physiology of Coronary Circulation . . . . .
. . . . . . 93 2. 4 Angiographic Anatomy . . . . . . . . . . 94 2.
4. 1 Left Coronary Artery . . . . . . . . . . . 94 2. 4. 2 Right
Coronary Artery. . . . . . . . . . . . . 95 2. 4. 3 Vascularization
of Nodes and the Conduction System . . 96 2. 4. 4 Interconnecting
Anastomoses . . . . . . . . . . . . . . . 97 2. 5 Coronary Veins .
. . . . . . . . . . . . . . . . . . 97 References . . . . . . . . .
. . . . . . . . . . . . . . . . 98 IV Angiographic Explorations:
Congenital Anomalies of the Coronary Arteries. . . . . . . . . . .
. . . . . . . . . . . . . 100 1 Anomalies of the Origin, Course and
Distribution of Coronary Arteries Arising from the Aorta . . . . .
. . . 100 2 Abnormal Origin of a Coronary Artery from the Pulmonary
Artery . . . . . . . . . . . . . . . . . . . . . 101 3 Anomalies in
the Diameter of Coronary Arteries . . . . . 104 4 Coronary Fistulae
. . . . . . . . . . . 109 References . . . . . . . . . . . . . . .
. . . . . . . . . . 113 VII V Angiographic Explorations: Coronary
Atheroma. . . . . . . . 114 1 Left Ventricle . . . . . . . . . . .
. . . . . . . . . . . . . 114 1. 1 Morphological Anomalies: Bulging
and Lacuna-Like Aspects . . . . . . . . . . . . . . . . . . . . . .
. . . . .
Journalists, always very direct and in search of sensation,
essentially asked me two questions on the occasion of this
workshop: What were the goals of the meeting? With the improvement
of diagnosis through the development of image techniques, didn't
the contrast media already have their future behind them? Many
answers were provided during the course of the workshop, and in
order to best answer the journalists I proposed the following
synopsis. 1. Since the 1979 Colorado Springs workshop organized by
E. Lasser, progress has been so rapid and the newly available works
so numerous that another meeting on an international level for the
purpose of pre senting and discussing these advances appeared
indispensable. Why not then in Europe and why not in Lyon? To
expand on this progress, by 1981 the new contrast media with
less-hyperosmolar molecules, still in the trial stage in 1979, were
al most all available commercially for angiography, albeit at
prohibitive prices. The advantages of these various media are
becoming better known; moreover, in the wake of Lasser's work, our
understanding of the pathophysiology of their noxious effects is
also advancing rapidly owing to the use of models (for the target
organs: heart, vessel wall, nervous system, kidney; and for the
more general reactions: blood cells, coagulation, complement
system, circulating enzymatic systems). In addition, further new
molecules are currently being studied in re search laboratories.
2."
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