A diagnosis of paradoxical cerebral embolus (PCE) was made in five patients aged 31 to 62 years who sustained eight cerebral ischemic events. No patient had evidence of primary carotid system or left heart disease. A probe-patent foramen ovale was the presumed mechanism in four patients, and an unsuspected congenital atrial septal defect was found in the fifth patient. Clinically apparent pulmonary emboli or venous thrombosis preceded the cerebral event in only one instance. Review of the literature reveals a high mortality with PCE. However, careful clinical search for this lesion may be rewarding: four of our five patients survived. One should consider PCE in any patient with cerebral embolus in whom there is no demonstrable left-sided circulatory source. This principle applies particularly if there is concomitant venous thrombosis, pulmonary embolism, or enhanced potential for venous thrombosis due to, for example, morbid obesity, use of hormonal birth control pills, prolonged bed rest (especially postoperatively), or systemic carcinoma.

Primary thrombosis of the subclavian-axillary vein is a condition of uncertain origin resulting in proximal arm swelling, discomfort on use, and prominence of engorged collateral veins in the upper arm and chest. The literature is reviewed and the authors' own experience with 23 patients, evaluated from 1950 through 1966, is detailed. This disorder is a clinically distinct venous complication of the neurovascular compression syndrome of the upper extremity. Contrary to the findings recorded by others, spontaneous improvement following conservative management, while initially good, ceases after the first few months. After a mean follow-up period of 8 years, nine patients have major, and 12 have minor, residual symptoms when using the affected arm. Venous collateral patterns persist in all patients. Early venography and thrombectomy are proposed.

A total of 97 patients underwent 107 renal revascularization procedures for restoration and preservation of renal function. Of the 4 groups of high risk surgical patients that emerged an overall successful outcome was achieved in 83%, with a 6% mortality rate and an 11% morbidity rate. Renal revascularization for restoration and preservation of renal function can be performed safely with good results. The preoperative serum creatinine level was not predictive of the surgical outcome. Alternative bypass procedures are preferred.

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