bluuebunny/crossref_metadata_2025 huggingface dataset:
Alterations in intestinal function in acute pancreatitis in an experimental model
Authors: Wang X D , Wang Q , Andersson R , Ihse I
Published: February 2007

Gastrointestinal tract failure may be involved in the development of systemic septic complications in acute pancreatitis. Systemic and intestinal circulation, intestinal permeability and absorptive function were evaluated in the early course of acute pancreatitis induced in rats by retrograde intraductal injection of 0·2 ml of 5 per cent sodium taurodeoxycholate and 0·4 nmol trypsin. A decrease in systemic arterial pressure and intestinal blood flow and an increase in intestinal permeability as measured by the leakage of 125I-labelled human serum albumin from blood to lumen were noted in the distal ileum and colon, reaching statistically significant differences 6 h after induction of pancreatitis. The transport of small molecular markers (sodium fluorescein and 51Cr-labelled ethylenediamine tetra-acetic acid) through the distal ileum and colon in vitro from the mucosal to the serosal site in Ussing chambers significantly increased in the early period (20–60 min) of incubation, while the passage of a macromolecular marker (ovalbumin) demonstrated a definite increase at 60–120 min of incubation. D-Xylose absorption from the gut lumen to the portal vein was significantly less in acute pancreatitis than after sham operation. Intravenous administration of the hydroxyl radical scavenger dimethylsulphoxide prevented the compromised intestinal permeability and gut absorptive capacity induced by acute pancreatitis, but did not affect the reduced arterial pressure and intestinal microcirculation. Cytotoxic oxygen-derived free radicals may contribute to the development of alterations in intestinal permeability and absorptive function found in the early stage of acute pancreatitis in the rat.
Laparoscopic cholecystectomy in a patient receiving continuous ambulatory peritoneal dialysis
Authors: Lale A M , Wheatley T J , Nicholson M L
Published: February 2007

Minimally invasive surgical techniques cause little disruption of the abdominal wall and peritoneum and have clear potential benefits in patients receiving continuous ambulatory peritoneal dialysis (CAPD). The presence of a peritoneal catheter allows the creation of a pneumoperitoneum completely non-invasively.
Audit of general practitioner referrals to a surgical assessment unit: New methods to improve the efficiency of the acute surgical service
Authors: Dookeran K A , Bain I , Moshakis V
Published: February 2007

A total of 653 referrals from general practitioners to an acute surgical service were audited prospectively over a period of 4 months. Middle-grade staff accepting these referrals were able to deal with 182 (27·9 per cent) of these calls without surgical admission. A further 189 (28·9 per cent) referrals were seen on a surgical assessment unit and were not admitted to a surgical ward. The resultant cost saving was approximately 10 000. This confirms that the ready provision of an experienced surgical opinion in combination with early assessment can reduce the number of unnecessary acute surgical admissions referred from general practitioners.
Knee-length versus thigh-length graduated compression stockings in the prevention of deep vein thrombosis
Authors: Williams A M , Davies P R , Sweetnam D I S , Harper G , Pusey R , Lightowler C D R
Published: February 2007

Graduated compression stockings can reduce the incidence of deep vein thrombosis by 60 per cent1, by providing a decreasing compression gradient from the ankle towards the thigh. There is both theoretical and clinical evidence that compression of the thigh as well as the calf does not give extra benefit2,3. Although regarded as safe, improperly used stockings are not without risk. Problems are usually due to areas of localized high pressure, especially under ‘rucked up’ constricting bands of stocking. This is particularly so in the presence of ischaemia; manufacturers state that ischaemia is a contraindication to stocking use. Cases of arterial thrombosis have been reported4, as well as more frequent skin necrosis, when stockings have been used in the presence of reduced arterial blood supply5.
Fast-to-slow muscle conversion by chronic electrostimulation: Effects on mitochondrial respiratory chain function with possible implications for the gracilis neosphincter procedure
Authors: Altomare D F , Boffoli D , Scacco S C , Rinaldi M , Vicente-Prieta R , Martinelli E , Memeo V
Published: February 2007

The effects of chronic, around the clock, low-frequency electrostimulation on the respiratory chain activity and cytochrome content of freshly isolated mitochondria were evaluated in rabbit skeletal muscle before and after 30 days of continuous or cyclical electrostimulation using a totally implantable system and a training programme now used in humans. The respiratory activity measured in state III increased strongly after electrostimulation. The efficiency of the respiratory chain increased significantly after electrostimulation but the activity of complex I (reduced nicotinamide adenine dinucleotide dehydrogenase) did not increase. The amount of cytochromes a and a3, b562, and c and c1 increased clearly after electrostimulation. The respiratory activity rate of mitochondria obtained after continuous electrostimulation was apparently higher than after cyclical electrostimulation. Chronic uninterrupted low-frequency electrostimulation, using a clinical training programme, induces an increase in mitochondrial respiratory chain activity in purified mitochondria of skeletal muscle. These changes are the basis of induced resistance to fatigue in fast-to-slow muscle conversion by chronic electrostimulation.
Pouch-related fistula following restorative proctocolectomy
Authors: Paye F , Penna C , Chiche L , Tiret E , Frileux P , Parc R
Published: February 2007

Prognostic factors and outcome of pouch-related fistula were analysed from a series of 21 patients, 20 of whom had an ileal J pouch manually anastomosed to the dentate line following mucosectomy. Fistula occurred more often after pouch formation for ulcerative colitis than for familial adenomatous polyposis. In 6 patients the fistula occurred more than 5 months after closure of the diverting loop ileostomy. The origin of the leak was the anastomosis in 14 patients, the vertical staple line in two and the end of the efferent limb in five. Nine forms of treatment were utilized and these were successful in 11 patients and unsuccessful in ten including three pouch excisions. Adverse prognostic factors were late fistula, the presence of an enterocutaneous or a pouch-vaginal fistula track, and diagnosed or suspected Crohn's disease. Resolution of the fistula followed none of six diverting loop ileostomies performed alone, three of 33 attempted drainage procedures, four of ten direct closures, and four of five repeat ileal pouch-anal anastomoses. It is concluded that an aggressive therapeutic approach using repeat ileal pouch-anal anastomosis increases the success rate.
Prognostic significance of lymph node metastasis in advanced carcinoma of the stomach
Authors: Kwon S J , Kim G S
Published: February 2007

This study attempted to clarify the prognostic factors in advanced gastric cancer, with special reference to lymph node metastasis. It was a retrospective study of 401 patients with stage III and IV gastric cancer operated on during the 5 years from 1988 to 1993. A significant relationship was found between the 5-year survival rate and (1) the ratio of the number of metastatic lymph nodes to the total number of dissected lymph nodes (ratios of 1–15, 16–30 and 31 per cent or more were associated with a 5-year survival rate of 81, 23 and 17 per cent respectively), (2) stage N1 or N2 of the Union Internacional Contra la Cancrum tumour node metastasis classification (58 and 27 per cent respectively) and (3) the number of metastatic lymph nodes (1–3, 4–7 and 8 or more were associated with a 5-year survival rate of 67, 49 and 32 per cent respectively). Multivariate survival analysis using Cox's proportional hazard model was applied to these three forms of lymph node status. Among these three variables, the ratio of the number of metastatic lymph nodes to the total number of dissected lymph nodes was the most meaningful prognostic factor.
Experimental oesophagogastric anastomosis: Preliminary report of a new compression device that also fragments
Authors: Rebuffat C , Rosati R , Fumagalli U , Varoli F , Roviaro G , Peracchia A
Published: February 2007

Fifteen Beagle dogs underwent oesophagogastric anastomosis with a new device which enables a ‘sutureless’ compression anastomosis. The device fragmented and was passed in bits anally without causing obstruction. Immediate bursting pressure, tested in five dogs, was between 175 and 190 mmHg. The anastomoses of the remaining dogs were examined macroscopically and microscopically from day 6 to day 30. Healing was excellent with good muscular apposition and minimal residual inflammation.
Annales de chirurgie
Authors: Castaing D
Published: February 2007

For this quarter's digest, Dr Denis Castaing, Editor of Annales de Chirurgie, chooses the best from issues three, four and five of 1996. A reciprocal digest written by our European Editor, Mr Colin Johnson, appears in the French journal.
Laparoscopic fenestration in polycystic liver disease
Authors: Kabbej M , Sauvanet A , Chauveau D , Farges O , Belghiti J
Published: February 2007

Sixteen laparoscopic cyst fenestrations for symptomatic adult polycystic liver disease (APLD) were performed in 13 women, including four patients who had had previous attempts at treatment (percutaneous sclerotherapy in two and fenestration via a laparotomy in two). The median number of cysts deroofed was 32 (range 18–58) during the 13 primary procedures. There was no inhospital death. Postoperative transient ascites occurred in six patients. After operation 11 patients experienced immediate relief of symptoms but during a median follow-up of 26 (range 6–49) months, eight of these patients developed recurrent symptoms. Two patients underwent three repeat laparoscopic fenestrations, at which time perihepatic adhesions were rare and no complication occurred. Because repeat procedures may be performed, laparoscopic fenestration appears to be useful for the treatment of symptomatic APLD. However, it is less effective than fenestration at open surgery or liver resection and should be employed only in patients with predominantly large cysts.
Effect of previous sclerotherapy on the outcome of gastro-oesophageal devascularization and oesophageal transection in bleeding oesophageal varices
Authors: Alam M K , El-Sayed G S M , Abdulmajeed A M , Al-Dohayan A
Published: February 2007

This retrospective analysis studied the effect of sclerotherapy on subsequent oesophageal transection in the management of patients with bleeding oesophageal varices and compared the result with that in those who did not receive sclerotherapy as the primary treatment. Fifty patients were treated by gastro-oesophageal devascularization and oesophageal transection for bleeding oesophageal varices over a 4-year period. Twenty-six patients did not receive sclerotherapy (group 1) and 24 received between one and four sessions of sclerotherapy (group 2) before surgery. Oedema and thickness of the lower end of the oesophagus and some adhesions were noted during surgery in patients who had had previous sclerotherapy; however, stapled oesophageal transection and anastomosis could be performed in all these patients. There was no oesophageal leak in any patient, although there was a higher rate of chest complications (nine versus six patients) in group 2. Six patients (12 per cent) died (three in each group) during the postoperative period; three had Child grade C disease. It is concluded that the decision to operate to control bleeding varices should be made early. One or two sessions of sclerotherapy before surgery does not increase intraoperative difficulty or the postoperative leak rate following oesophageal transection. The outcome of surgery is directly related to the state of liver reserve (Child grade).
Intrahepatic segment III cholangiojejunostomy in advanced carcinoma of the gallbladder
Authors: Kapoor V K , Pradeep R , Haribhakti S P , Singh V , Sikora S S , Saxena R , Kaushik S P
Published: February 2007

The majority of patients with advanced carcinoma of the gallbladder have irresectable disease and require palliation for jaundice, pruritus and cholangitis. Intrahepatic segment III cholangiojejunostomy has been described for palliation of high biliary obstruction in these patients. Forty-one patients with stage IV gallbladder cancer underwent intrahepatic segment III cholangiojejunostomy. Subsequent jaundice, pruritus and cholangitis were documented; liver function tests and isotope hepatobiliary scans were performed. All patients had jaundice, 29 had pruritus and 12 had cholangitis. Postoperative complications included anastomotic leak in six patients and wound infection in six. Five patients died within 30 days of operation. Thirty-two patients were available for follow-up. The procedure failed to relieve jaundice, pruritus or cholangitis in four patients; 18 were free of jaundice, pruritus and cholangitis until death or last follow-up, and ten had recurrent jaundice or cholangitis. Isotope scanning was found to be useful to predict success of the procedure. Intrahepatic segment III cholangiojejunostomy provided excellent palliation from jaundice, pruritus and cholangitis with acceptable mortality and morbidity rates in patients with advanced carcinoma of the gallbladder.
Outcome of treatment for distal bile duct cancer
Authors: Fong Y , Blumgart L H , Lin E , Fortner J G , Brennan M F
Published: February 2007

All patients with distal bile duct tumours over a 10-year period (October 1983 to December 1993) were identified by means of a prospective database. The medical records of 104 patients were reviewed. Univariate and multivariate analysis for predictors of outcome was performed. Median age of the patients was 65 (range 30–89) years. Patients presented with a clinical picture indistinguishable from that of pancreatic ductal adenocarcinoma. Twenty patients had no surgical treatment and 23 had a diagnostic laparotomy only. Biliary bypass was performed in 16 patients and radical resection was performed in 45 (pancreaticoduodenectomy, 39; bile duct excision, six). Operative mortality occurred in two of 45 patients having radical resection and complications in 17. Resection provided significant survival benefit. By univariate and multivariate analysis, resectability and negative node status (P < 0-001) were the only predictors of favourable outcome. Sex, age, preoperative stenting, grade of tumour and bilirubin level did not predict outcome. The 5-year survival rate for radically resected, node-negative tumours was 54 per cent. Surgical resection is effective therapy for distal bile duct tumours. These patients have a better outlook than those having resection of pancreatic adenocarcinoma.
Pitfalls in the management of preauricular sinuses
Authors: Currie A R , King W W K , Vlantis A C , Li A K C
Published: February 2007

A total of 159 operations for the excision of a preauricular sinus carried out in 117 patients over an 8-year period were reviewed. Previous excision, the use of a probe to delineate the sinus and operating under local anaesthesia all increased the chance of recurrence. The condition recurred more often in patients who developed postoperative wound sepsis than in those who healed primarily. Means of decreasing the recurrence rate include: (1) meticulous dissection of the sinus by an experienced head and neck surgeon under general anaesthesia; (2) the use of an extended preauricular incision; (3) clearance down to the temporalis fascia to ensure complete removal of all epithelial components; (4) avoidance of sinus rupture; and (5) closure of wound dead space.
Parallel self-expanding covered metal stents in the trachea and oesophagus for the palliation of complex high tracheooesophageal fistula
Authors: Ellul J P M , Morgan R , Gold D , Dussek J , Mason R C , Adam A
Published: February 2007

Palliation of oesophageal carcinoma consists mainly of the treatment of dysphagia. However, 5 per cent of patients with oesophageal cancer also develop a fistula between the oesophagus and trachea. The symptoms of aspiration are devastating and are difficult to treat with low morbidity. Untreated, most patients die from a combination of respiratory infection and starvation1. Recently, covered expanding metal stents have been shown to be an excellent treatment for oesophageal fistula and perforation2,3 and seem to be more effective than conservative treatment, plastic tubes or surgical bypass treatment methods. However, patients who present with a high tracheo-oesophageal complex fistula adjacent to the cricopharyngeal sphincter are particularly difficult to treat. A method is described that enables control of high tracheo-oesophageal fistulas.
Surgical care in octogenarians
Authors: Bufalari A , Ferri M , Cao P , Cirocchi R , Bisacci R , Moggi L
Published: February 2007

The general surgical profile of octogenarians compared with that of younger patients, and risk factors predictive of operative mortality and morbidity, were determined retrospectively using a computer database for all patients admitted between 1989 and 1993. There were 934 admissions of octogenarians and surgery was performed in 447 cases (47.9 per cent). The admission rate of patients over 80 years of age increased during the 5-year period from 4.6 to 9.0 per cent, and was significantly higher than that of geriatric patients aged 65.79 years (P<0.01). Emergency admissions (63.6 per cent) and operations (42.3 per cent) were more frequent in patients aged over 80 years (P<0.01); emergency operations increased during the 5 years from 38 to 59 per cent. Altogether, 83 deaths and 171 complications were recorded. The mortality rate of octogenarians was greater than that of younger patients (P<0.01). Postoperative mortality and morbidity rates were 10.1 and 32.2 per cent respectively. After multiple logistic regression analysis with stepwise backward elimination, an American Society of Anesthesiologists score of II-V (P<0.01), the presence of two associated diseases (P<0.01) and laparotomy procedures (P<0.03) appeared to be independent risk factors for postoperative mortality and morbidity.
Histological identification of fascial structures posterolateral to the rectum
Authors: Kinugasa Y , Murakami G , Suzuki D , Sugihara K
Published: February 2007

Background

A comprehensive understanding of fascial structures around the rectum is important for surgeons. Multilaminar fascial structures have provided different interpretations of reliable surgical planes in rectal surgery.

Methods

Pelvic visceral materials for histological assessment were obtained from 12 male cadavers. Large specimens covering wide areas around the mesorectum were embedded in paraffin, followed by preparation of semiserial horizontal sections and sagittal sections for histological examination.

Results

Histological examination demonstrated a prehypogastric nerve fascia and parietal presacral fascia in the retrorectal multilaminar structure. The parietal presacral fascia seemed to divide into several lateral continuations. The prehypogastric nerve fascia appeared to join the most medial continuation of the parietal presacral fascia, which continued ventrally and communicated with Denonvilliers' fascia. Any fascial structure connecting directly between the fascia propria of the rectum and the parietal presacral fascia (that is, the rectosacral fascia) was not found in sagittal sections.

Conclusion

In the retrorectal multilaminar structure, prehypogastric nerve fascia is evident between the fascia propria of the rectum and the parietal presacral fascia. Sharp dissection in front of the prehypogastric nerve fascia according to the histological configuration of the posterolateral fasciae seems reliable.
Inotropic Action of Tolbutamide on Human Myocardium
Authors: Hildner Frank J. , Yeh Billy K. , Javier Roger P. , Fester Arieh , Samet Philip
Published: February 2007

The inotropic action of tolbutamide previously demonstrated in vitro was evaluated in 15 nondiabetic subjects during diagnostic cardiac catheterization. Following bolus injection of 250 mg of tolbutamide intravenously, a rise of serum insulin and a slight fall of serum potassium were observed. Inotropic response was determined from significant fall in PEP/LVET ratio, significant fall of left ventricular end‐diastolic pressure, shift to an augmented function curve in work‐pressure relationships, and prominent rise of dP/dt values at comparable heart rates. The inotropic effect was greatest at 5–15 min with return to near control values at 30 min. An unusually marked inotropic response was observed in one subject. While the measurable net hemodynamic effect of tolbutamide in the human heart is small, its effect on ischemic and normal areas within the heart of a diabetic patient with atherosclerosis may be different. Thus, its ultimate effect on the diseased heart may be significant.
Prolapse of the Tricuspid Leaflets in the Systolic Murmer‐Click Syndrome
Authors: Maranhao Viadir , Gooch Alden S. , Yang Sing S. , Sumathisena D. R. , Goldberg Harry H.
Published: February 2007

Right ventriculography was used to assess the tricuspid valve in 61 patients with systolic murmur‐click syndrome. Systolic murmurs were present in 47 cases, and 32 had clicks. Mitral valve prolapse was present in 52 patients. Late systolic prolapse of the tricuspid valve was demonstrated in 32 patients (52.4%). In 9 cases, prolapse involved the tricuspid valve alone. In the systolic murmur‐click syndrome, prolapse may involve either or both of the atrioventricular valves.
Optimizing Cinefilm
Authors: Kato Warren , Wong Maylene
Published: February 2007

A system for improving the quality of cinefilm and for maintaining quality control is described. Objective criteria for contrast, resolution, and grain structure were established to measure the effects of varying X‐ray dose, f‐stop, development temperature, and selection of film and developer. We found that all variables must be adjusted to maximize the viewing quality and that similar density curves can be achieved, independently of the choice of film and developer.
An Additional Angiographic Sign for Determining Coronary Artery Dominance in Obstructive Coronary Artery Disease
Authors: Cohn Peter F. , Markis John E. , Gorlin Richard
Published: February 2007

An additional angiographic sign for determining coronary artery dominance is proposed. This sign is based on the anatomic pattern of the infraventricular branches in the left anterior oblique view. It is especially helpful in patients in whom the right coronary and/or left circumflex coronary arteries are completely occluded and distal vessels are filled via collaterals.
Measurement of Ejection Fraction in Man by Videodensitometry
Authors: Schuette William H. , Grauer Leonard E. , Whitehouse Willard C. , Itscoitz Samuel B. , Redwood David R.
Published: February 2007

This report describes a new method based on roentgen videodensitometry for the measurement of left ventricular ejection fraction in man. The net forward ejection fraction (NFEF) is calculated directly from the formula NFEF = 1‐exp (−.693/N), where N is the number of cardiac cycles necessary for half of the injected contrast material to be washed out of the left ventricle. The derivation of this formula is presented, and the technique is validated by comparison with washout curves from a Lucite model of the heart and with simultaneous angiographically determined left ventricular ejection fractions in man. The videodensitometry technique offers the following advantages over the conventional volume technique: (1) only a small amount of contrast material is required; (2) ectopic beats are uncommon during the washout phase when measurements are made; (3) the ejection fraction measured is an average of several cardiac cycles; and (4) dependence upon operator interpretation is minimized. Furthermore, given adequate mixing within the chamber, NFEF should be independent of ventricular geometry. Thus, NFEF of the unusually shaped left ventricle can be readily determined.
Percutaneous Cannulation of the Internal Jugular Vein for Temporary Endocardial Pacing
Authors: Widmann Warren D. , Mangiola Stelio , Thomas Lucille , Venezia Janet
Published: February 2007

In 148 cases the right internal jugular vein was used as the initial approach for percutaneous insertion of temporary endocardial pacemaker electrodes. Complications were few and none were serious. The technique of percutaneous cannulation of this vein for temporary endocardial pacing is described in detail.
Radiation Exposure to Angiographer During Coronary Arteriography Using the U arm Image Amplifier
Authors: Begg Frank R. , Hans Lawrence F.
Published: February 2007

Radiation exposure to the angiographer was measured using thermoluminescent dosimeters (TLD), commercial film badges, and appropriate ionization survey meters.

Data were collected during 47 coronary artery examinations with the lead overleaf. During a single coronary examination, the angiographer receives 0.9 mR to the lens and 2.8 mR to the hand. The calculated yearly exposure to the angiographer performing 10 examinations per week is 450 mR to the lens, 9% of the maximum permissible dose (MPD), and 1400 mR to the hand, 2% of the MPD.

Exposure rates for the left anterior oblique (LAO) and right anterior oblique (RAO) projections during cine and fluoroscopy were taken at the position occupied by the angiographer. Scatter radiation is 5‐10 times greater in the LAO projection.

The second trial was monitored during 18 coronary artery examinations minus the lead overleaf. A significant decrease in radiation exposure was accomplished through the use of the lead overleaf.
Coronary Arteriography: Prevention of Thromboembolic Complications Using a Pressure‐Drip Flushing Technique
Authors: Rashid Ahmad , Hildner Frank J. , Fester Arieh , Javier Roger P. , Narula Onkar S. , Samet Philip
Published: February 2007

All selective coronary arteriographic examinations (1,833) performed in the authors' laboratory during a five‐year period (1/1/70 to 12/31/74) were analyzed for mortality and total morbidity according to method used. During the first two years, the control period, the classic brachial artery cutdown (Sones) and percutaneous femoral artery puncture (Judkins) techniques were utilized. Mortality rate for the total 589 patients was 1.01%. This included a mortality of 0.26% (1/386) for the brachial arteriotomy method, and 2.5% (5/203) for the percutaneous femoral puncture approach.

After introduction of the pressure‐drip flushing technique, the subsequent three‐year mortality rate for a total of 1,244 patients was 0.16%. This included an incidence of 0.17% (1/585) for brachial arteriotomy and 0.15% (1/659) for modified percutaneous puncture techniques.

The morbidity incidence during the initial two‐year period was 3.0% (18/589). This included an incidence of 2.0% for brachial arteriotomy and 5.0% for percutaneous puncture techniques. After institution of the new pressure‐drip flushing technique the total incidence fell to 1.2% equally divided between arteriotomy and percutaneous techniques.

Modification of the classic percutaneous femoral artery puncture technique has resulted in major reduction of mortality and morbidity complications which are chiefly thromboembolic in nature. It has not significantly influenced local thrombotic complications of arteriotomy.
Catheter Drainage of the Pericardial Space
Authors: Glancy D. Luke , Richter Mary Ann
Published: February 2007

A technique is described for catheterizing and draining the pericardial space in patients with large effusions that are likely to recur.
Tricuspid Whoop
Authors: Edelstein Josef , Kerin Nicholas Z. , Louridas George
Published: February 2007

The present report describes a patient with a whooping murmur secondary to tricuspid insufficiency. The main features of this tricuspid whoop were as follows: variable in time, moving from mid to late systole; unpredictably associated with normal respiratory phases; after deep inspiratory apnea was almost constantly present.
Quantitative Evaluation of Coronary Perfusion in Man
Authors: Klocke Francis J.
Published: February 2007

The usefulness and limitations of currently available techniques for quantitating coronary flow in ischemic heart disease are summarized. There are appreciable difficulties in assessing coronary flow solely from an arteriographic evaluation of the epicardial arteries. There is a considerable reserve mechanism for vasodilation at the arteriolar level, and a proximal occlusive lesion produces a reduction in flow only after this distal reserve has been exhausted. In addition, small increments in the severity of established lesions sometimes cause profound reductions in flow. The development of clinically useful flow measurements has been impeded by methodological problems related to nonuniformity of flow within the left ventricle in coronary artery disease. Validation of specific techniques for abnormal situations is difficult but possible and should probably be a prerequisite to the clinical application of any technique. When a methodologically appropriate technique is employed, average left ventricular flow per unit weight is found to be reduced systematically at rest in patients with double‐ and triple‐vessel disease. This reduction is a group difference, however, and is not always evident in individual patients. Accordingly, more recent measurements have concentrated on the assessment of regional perfusion, and two general approaches, selective venous sampling and selective precordial sampling are illustrated. While only preliminary measurements of regional flow are available, it is clear that these measurements offer a more sensitive tool for detecting abnormalities of flow in individual patients and thereby for contributing to the management of specific clinical problems. Measurements of regional flow need to be performed during stress as well as at rest. For the future, there is also need for techniques which can assess transmural variations of flow in man and relate measurements of regional flow to regional oxygen demand. Because of the complexity of current techniques which are methodologically adequate, measurements of coronary flow will, for the immediate future, probably remain confined to clinical centers which have a special interest in them. The effort in these centers will hopefully include significant emphasis on the refinement of existing techniques so that they are more widely applicable.
Treadmill Exercise Testing in the Presence of Digitalis Therapy or Nonspecific ST‐T Changes: Correlation with Coronary Angiography
Authors: Nasrallah Antoine T. , Garcia Efrain , Benrey Jaime , Hall Robert J.
Published: February 2007

Treadmill exercise test results were studied in 93 patients with chest pain who had received digitalis therapy or had nonspecific ST‐T changes in the resting electrocardiogram. Results of the treadmill test were correlated with the findings of coronary angiography. A positive treadmill result was defined as horizontal or down‐sloping ST segment depression greater than or equal to 1.0 mm. Of the 40 patients with no or insignificant coronary artery disease, 15 had taken digitalls; 4 of the 15 demonstrated a positive response on the treadmill test. Of the 53 patients with coronary artery disease, 21 had taken digitalis; 15 of the 21 displayed a positive response. Among the remaining 32 not on digitalis, 20 had a positive response. The specificity of the treadmill exercise test was 96% in patients with coronary artery disease not on digitalis and whose resting electrocardiogram showed nonspecific ST changes. The specificity of the treadmill test in patients who had received digitalis was 73%. Sensitivity was 63% and 71%, respectively. By utilizing more stringent criteria in the interpretation of the treadmill exercise test (greater than or equal to 1.5 mm ST depression), among the patients on digitalis only 6.7% (1/15) with normal coronary arteries and 48% (10/21) with coronary artery disease had a positive response. With the use of the latter criterion the test was specific in 93% (14/15) of the patients and is usually indicative of coronary artery disease.
Left Ventricular Pressure Responses in Post‐Angiographic Angina
Authors: Boudoulas Harisios , Leighton Richard F.
Published: February 2007

Alterations in left ventricular end‐diastolic pressure and in dp/dt observed in ten patients with coronary heart disease who developed angina pectoris following left ventricular cineangiography were compared with those of six other patients who developed angina spontaneously and with patients who underwent left ventricular cineangiography without experiencing angina. In the patients with post‐angiographic angina there was a greater increase in end‐diastolic pressure than that seen in the other patients, but there was no significant change in dp/dt. Changes in left ventricular pressure associated with post‐angiographic angina would appear to reflect the combined effects of increased preload provided by the contrast material and of ventricular dysfunction including diminished compliance associated with angina. A rise in end‐diastolic pressure greater than 20 mmHg following left ventricular cineangiography should alert the physician that the patient may be having myocardial ischemia.
Post Infarction Left Ventricular Pseudoaneurysm Properly Diagnosed Clinically and Angiographically and Successfully Treated Surgically
Authors: Scanlon Patrick J. , Moran John M. , Nemickas Vidas , Johnson Sarah A. , Pfister Charles , Gunnar Rolf M.
Published: February 2007

A case of pseudoaneurysm of the left ventricle following acute myocardial infarction is reported. The condition was accurately diagnosed by left ventricular angiography and successfully treated by surgical resection of a massive false aneurysm.
Serial Coronary Arteriography with 105mm Photofluorography: 24‐Month Experience, 2,200 Patients
Authors: Schoonmaker Fred W. , Vijay N. K. , Rich Jerry
Published: February 2007

A 105 mm camera has been used for over 24 mo in evaluation of the coronary circulation for the most part and occasionally the proximal peripheral arteries in 2,200 patients. This photofluorographic technique provides sufficient diagnostic image detail with improved operating convenience and reduced radiation exposure compared to the large film changer.

105 mm serialography is a good adjunct to cine arteriography as a complementary film recording system, and in many cases may supplement large film serialography.
The external field intravascular electromagnetic flowmeter system as applied to standard arteriographic catheters and conscious humans
Authors: Macalpin Rex N. , Kolin Alexander , Stein Justin J.
Published: February 2007

New methodology, utilizing electromagnetic principles, has been developed for the measurement of regional vascular blood flow in intact animals and man. The flow sensor consists of a fine, insulated wire loop which has a small electrode on each side of the loop. This loop‐probe, which is inserted like a guidewire through standard cardiac or angiographic catheters, springs open upon emerging from the catheter, and the electrodes are automatically applied to diametrically opposite sides of the inner vascular wall. This miniaturization of the flow sensor has been achieved by imposing the magnetic field which pervades the artery from a coil located outside the body. As blood flows through the vessel across the magnetic field, the induced voltage across the blood column detected between the electrodes is proportional to the volume rate of blood flow. The loop‐probe can be used simultaneously as an arterial diameter gauge. Means are described for achievement of a reliable, nonocclusive zero‐flow baseline and flow calibration.
Treadmill exercise testing in mass screening for coronary risk factors
Authors: Allen William H. , Aronow Wilbert S. , De Cristofaro Dominic
Published: February 2007

The prevalence of an abnormal maximal treadmill stress test (MTST) was correlated with coronary risk factors in 1,077 asymptomatic adults (709 men and 368 women) in Long Beach, California. Of 1,077 adults, 113 (10.5%) had a positive MTST. A positive MTST was correlated with sex (p < 0.001), age (p < 0.001), a serum cholesterol ≥ 200 mg% (p < 0.02), hypertriglyceridemia (p < 0.05), cigarette smoking (p < 0.025), and with the number of coronary risk factors (p < 0.005) but not with hypertension, cigar or pipe smoking, obesity, or blood sugar.
Effects of intravenous glucose during pacing‐induced angina pectoris in patients with coronary artery disease
Authors: Zir Leonard M. , Nocero Michael M. , Rose Malcolm , Weisinger Barbara , Krauss Kenneth , Glassman Ephraim
Published: February 2007

The effects of hypertonic glucose infusion on the anginal threshold determined by atrial pacing was studied in 14 patients with significant coronary artery disease. After glucose, angina occurred at a significantly lower heart rate and double product (systolic arterial pressure × heart rate), suggesting a decreased tolerance to ischemic stress. No stoichiometric relationship was noted between glucose uptake and lactate production, and there was no evidence that hypertonic glucose infusion resulted in enhanced anaerobic glycolysis in the ischemic myocardium. Acute elevation of plasma glucose levels may not be beneficial to patients with coronary artery disease.
Prolapsing mitral valve leaflet syndrome. A spectrum that includes cleft posterior mitral valve
Authors: Kerin Nicholas Z. , Edelstein Josef , Louridas George
Published: February 2007

Two patients with a prolapse and cleft posterior mitral leaflet were studied. The first case had an associated ostium secundum type atrial septal defect. In both cases, the pansystolic regurgitation of contrast material during angiography corresponded to the pansystolic configuration of the murmur. In each instance, the systolic murmurs displayed a late systolic accentuation during the maximal prolapse of the mitral valve. The echocardiographic studies demonstrated only a late systolic prolapse which in both patients corresponded angiocardiographically to the maximum buckling of the pansystolic prolapse. Echocardiographic and angiocardiographic features of cleft posterior mitral valve leaflet are discussed.
Aneurysm of the subclavian artery: A complication of retrograde brachial artery catheterization
Authors: Chiavacci Wayne E. , Bucciarelli Richard L. , Victorica Benjamin E.
Published: February 2007

A case of an aneurysm of an anomalous right subclavian artery following retrograde catheterization of the right brachial artery is described. This complication was not recognized until the patient presented with symptoms related to a superior mediastinal mass. After appropriate studies were performed operative intervention was successful in establishing a patent subclavian artery.
The wolff‐Parkinson‐White syndrome: The value of the HIS bundle electrogram
Authors: Haft Jacob I. , Gomes Joseph Anthony C.
Published: February 2007

The HIS bundle electrogram has led to the aquisition of additional information on the physiology of the WPW syndrome and has become a useful technique for its diagnosis. The findings on the HBE and their interpretation in WPW are reviewed.
Cine angiographic diagnosis of patent foramen ovale in paradoxical embolism
Authors: Tracy Gerald P. , Smulyan Harold , Potts James L. , Eich Robert H. , Johnson Lewis W.
Published: February 2007

A case of paradoxical embolism is presented in which the antemortem diagnosis was facilitated by a new simple angiographic technique that demonstrated a patent foramen ovale. An additional 14 patients were studied by this technique, and one had a patent foramen ovale. The mechanism of reversal of the normal intraatrial pressure gradient and subsequent right to left shunt through a patent foramen ovale is discussed. This angiographic technique may be readily applied in any diagnostic catheterization laboratory and complements existing methods for detecting patency of the foramen ovale in patients with suspected paradoxical embolism.
The evaluation of routine selective arteriography in the investigation of renovascular hypertension
Authors: Staab Edward V. , Smith Clyde W. , Burko Henry
Published: February 2007

A comparison of lesions discovered by selective renal arteriograms with abnormalities observed on abdominal aortograms was made in 100 consecutive hypertensive patients. Twenty‐one lesions not seen on aortograms were found by selection. Eight patients with a normal aortogram had lesions. An abnormality was discovered in at least one study in 58 patients. The increased rate of lesion detection by selective studies outweighs the slight risk of complications.
Potential artifact in measurement of left ventricular filling pressure with flow‐directed catheters
Authors: Meister Steven G. , Engel Toby R. , Fischer Herbert A. , Frankl William S.
Published: February 2007

Artifactual pulmonary wedge pressure measurements were encountered during bedside use of Swan‐Ganz catheters. These values were higher than pulmonary artery end diastolic pressure and devoid of typical phasic contours. Utilizing fluoroscopy these artifacts were reproduced by advancing the catheter tip 2–4 cm beyond the site of initial wedging and reinflating the balloon. Spurious increases of pulmonary wedge pressure of up to 15 mm Hg were thus obtained.

In vitro catheter testing demonstrated overlapping of the catheter tip by the deformed balloon when it was fully inflated in a channel too small to accomodate it.

These measurement artifacts are thus attributed to distal migration of the catheter tip into relatively small pulmonary artery branches and to subsequent occlusion of the catheter lumen by the balloon when it is reinflated. This can readily be avoided by routinely inflating the balloon with the minimum volume of air sufficient to yield a pulmonary wedge pressure tracing.
A new wedge to facilitate obtaining half‐Axial views during coronary arteriography
Authors: Grollman J. H. , Barack Bruce M. , Macalpin Rex N.
Published: February 2007

A wedge has been designed and constructed to facilitate obtaining posteroanterior and oblique half‐axial projections routinely during coronary arteriographic examinations in a conventionally equipped catheterization laboratory.
Caliber and distribution of normal coronary arterial anatomya
Authors: Vieweg Cdr. W. V. R. , Alpert L. Cdr. J. S. , Hagan Capt. A. D.
Published: February 2007

Selective coronary arteriograms of 125 patients with normal coronary arteries were reviewed to establish the caliber and distribution of normal coronary arterial anatomy. Measurements established the following normal values for coronary arterial caliber in right (R), mixed (M), and left (L) inferior emphasis systems expressed in mm (± SEM):

R M L Main left coronary artery 4.7 ± 0.1 5.2 ± 0.2 5.0 ± 0.2 Proximal left anterior descending artery 3.9 ± 0.1 4.1 ± 0.2 3.8 ± 0.2 Mid‐left anterior descending artery 2.3 ± 0.1 2.4 ± 0.1 2.5 ± 0.1 Left circumflex artery 3.2 ± 0.1 3.8 ± 0.2 4.0 ± 0.2 Proximal right coronary artery 4.1 ± 0.1 3.7 ± 0.1 2.7 ± 0.1 Mid‐right coronary artery 3.4 ± 0.1 2.7 ± 0.1 1.9 ± 0.1 S gnificant differences in the caliber of right coronary arterial systems and left circumflex coronary arterial systems validate the separation of coronary arterial anatomy into right, mixed, and left inferior emphasis systems, depending upon the blood supply to the inferior wall of the left ventricle. Classification of the anatomical pattern into right, mixed, and left inferior emphasis systems is useful in the cardiac catheterization laboratory at the time of selective coronary arteriography. If the expected distribution of the coronary vessels is not found, then missing vessels must be sought out. A knowledge of the range of normal size for the coronary arterial tree should be of value in defining the severity of coronary arterial narrowing.
Treatment of angiographically produced cord seizures by intra‐Arterial diazepam
Authors: Gordon David H. , Levin David C.
Published: February 2007

10 mg of Diazepam administered into the lumbar artery supplying the artery of Adamkiewicz abolished cord seizures produced by accidental flooding of the cord with a high concentration of contrast material. Selective intra‐arterial Diazepam is a safe and effective method of controlling cord seizures.
A comparison of formulas used to estimate mixed venous saturations
Authors: Iskandrian Abdulmassih , Kimbiris Demetrios , Bemis Charles E. , Mintz Gary
Published: February 2007

True mixing of venous blood in the absence of shunt occurs in the pulmonary artery. In the presence of left to right shunt at a level proximal to the pulmonary artery, mixed venous blood for oxygen saturation (MVO2) is estimated by using an average of blood samples taken from the chamber proximal to the shunt. In atrial septal defect, the determination of MVO2 is calculated by using blood samples from the superior vena cava (SVC) and the inferior vena cava (IVC). Several formulas have been proposed, utilizing varying combinations of blood samples taken from the SVC and IVC. In the present investigation, 100 patients without evidence of shunt were studied during routine cardiac catheterization. Duplicate blood samples were taken from the pulmonary artery (PA), the SVC, and the IVC, and were analyzed for oxygen‐saturation. If one assumes that the PA blood sample represents true venous blood mixing (TMVO2), the following formulas were used for comparison: (1) PA = SVC; (2) PA = IVC; (3) PA = (SVC + IVC)/2; (4) PA = (2SVC + IVC)/3; (5) PA = (3SVC + IVC)/4; and (6) PA = (2IVC + SVC)/3.

When one uses the standard two variable regression equations, this study shows that the 90% confidence limits are wide. The correlation, however, is somewhat better if one uses the formulas (3‐6). Therefore, the error that may be introduced in calculating the TMVO2 may be substantial and can critically alter the estimation of the shunted blood volume.
Effects of adalat (nifedipine) on left ventricular hemodynamics in angina pectoris: Comparative study with propranolol
Authors: Kurita Akira , Ogawa Takeshi , Kanazawa Masakuni , Hamamato Hiromu , Mabuchi Genichi
Published: February 2007

The hemodynamic effects of nifedipine and propranolol administered intravenously were studied in 17 patients with angina pectoris. Nine patients received nifedipine and eight received propranolol. The hemodynamic parameters were compared at rest and during supine bicycle exercise at work loads known to produce angina. Exercise‐induced angina improved in four out of nine patients following nifedipine and in one out of eight patients following propranolol. Nifedipine significantly reduced the increment of left ventricular end‐diastolic pressure and Vmax during exercise. Intravenous propranolol significantly suppressed the increment of heart rate, max dp/dt, tension time index, and Vmax during exercise. Although the exact mode of action of nifedipine remains uncertain, it is suggested that it decreases myocardial oxygen requirements primarily through a reduction of left ventricular volume, whereas propranolol suppresses the positive chronotropic and inotropic responses of the heart muscle to exercise.
Cavernous hemangioma of the right atrium: Presumptive diagnosis by coronary angiography
Authors: Raabe Daniel S. , Fischer John C. , Brandt Ralph L.
Published: February 2007

The angiographic findings in a patient with an interesting vascular tumor of the right atrium are described. The tumor was supplied by vessels from both the right and left coronary arteries and consisted of dilated blood spaces in which contrast material persisted for a prolonged period of time.

Since this picture is identical to that described in cavernous hemangioma of other organs, this report presumably represents the first description of the angiographic findings in a cavernous hemangioma of the heart.