Spectral phonoangiography, a noninvasive method for measurement of the residual-lumen diameter of carotid stenosis by bruit analysis, was compared with x-ray angiography and direct measurement of the pathological specimen at carotid endarterectomy in 39 bifurcations from 36 patients. In six studies, the bruit was too faint to analyze. In 31 of the other 33 studies, the phonoangiogram predicted the residual-lumen diameter to within 0.5 mm of the measured value. Of the 39 contrast angiograms, 35 showed residual lumens within 0.5 mm of the value measured in the specimen, two showed lumens between 0.5 and 1 mm, and the sizes of two could not be estimated because of vessel overlap in all planes. Spectral phonoangiography and contrast angiography are both accurate methods for evaluation of carotid stenosis. Since phonoangiography is noninvasive, it may be of particular value in determining the natural history in patients with carotid bruits.

SUMMARY Turbulent flow distal to arterial stenoses produces bruits with a characteristic sound spectrum, analysis of which has permitted accurate non-invasive assessment of the residual lumen diameter of the stenosis in the case of the human carotid artery. In contrast, investigators working with In vitro elastic models of arteries or with excised vessels have reported finding mainly resonant spectra of bruits recorded distal to stenoses. We have studied tbe effects of turbulent flow on tbe sound spectrum produced at the arterial wall and the influence of surrounding tissue on this spectrum. Aortic, carotid, and femoral stenoses were produced in dogs by external banding of the arteries with 5mm wide Teflon bands. Recordings of bruits made directly on the vessel wall had a sound spectrum made up of 2 components, one due to turbulent flow, and the second to a superimposed resonant spectrum from arterial wall vibration. This was true of 3 kinds of vessels studied. The effects of surrounding tissue on tbe sound spectrum of arterial bruits was sbown by comparing the spectra of bruits recorded directly on the vessel wall, on tbe freshly closed wound and on tbe healed wound. The sound properties of the artery in situ are very different from those of exposed or excised vessels or elastic tubes. Although intravascular turbulence may be accurately appreciated at the skin surface, arterial wall resonance in the intact animal is extensively damped by tbe normal coupling of the artery to its surrounding tissue. Stroke, Vol 11, No 4, 1980ALTHOUGH AUSCULTATION of arterial bruits has been taught since the time of Laennec, only recently has quantitative information been derived concerning the extent of arterial disease. Lees and Dewey 1 in 1970 showed that flow through a significant arterial stenosis resulted in a spectrum of pressure fluctuations at the surface of the skin remarkably similar to wall pressure fluctuations in fully turbulent pipe flow at a high Reynolds number, and that quantitative information about the size of the residual lumen at the stenosis could be obtained by spectral analysis of the bruit recorded at the skin surface overlying the artery. In later studies, Lees and collaborators showed that accurate clinical diagnosis of the extent of carotid stenosis could be made non-invasively by quantitative analysis of bruit spectra. '" 4 The analytical method depends upon the recognition of a single frequency peak beyond which sound intensity drops sharply with increasing frequency.By contrast, Boughner and Roach showed that isolated arteries studied ex vivo resonate when excited by a sound stimulus at certain characteristic frequencies.0 Kim and Corcoran* showed that turbulent flow in latex tubes produced 2 spectra superimposed on one another -a turbulent spectrum caused by disturbed fluid flow and a resonant spectrum resulting from the natural frequency of the tube itself, which was set in vibratory motion by the turbulent flow.The present study was designed to investigate whether turbulent blood flow in art...

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Antegrade phlebography of a testicular vein in connection with orchidectomy was performed in 29 patients and funicular lymphography was successful in 26 of these. Eleven patients had retroperitoneal metastases and 18 were normal. The phlebographic and lymphographic findings in both groups are described and discussed as well as the collateral pathways in cases with stenosis of the testicular vein. Antegrade phlebography is recommended but funicular lymphography does not merit a place in the routine examinations of patients with testicular tumor.