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Evaluation of the urethra in males with spinal cord injury.
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10,000,701
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Of 358 antegrade voiding urethrograms obtained in 200 males with spinal cord injury, the urethra was satisfactorily shown by 154 (77%), permitting evaluation of alterations related to cord damage, surgery, or iatrogenic trauma. In 105 cases the neurogenic urethra was normal, demonstrated only minor distension, or had a patulous appearance, in contrast to urinary tract changes such as a markedly neurogenic bladder, vesicoureteral reflux, and bladder calculi. In 49 patients, abnormalities included (a) changes related to surgical alleviation of sphincter dyssynergia; (b) iatrogenic changes such as diverticula strictures, undermining of the external sphincter ("spiral sign"), and intravasation of contrast material; and (c) pressure necrosis of the urethra. Some changes need no special treatment; others, such as pressure necrosis, require early recognition and prompt therapy.
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] |
10,000,702
|
Neonatal pneumopericardium.
|
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] |
10,000,703
|
The clinical data and radiographs of 50 neonates with pneumopericardium (PPC) were reviewed. Most of these neonates were premature, low-birth-weight infants with hyaline membrane disease who required ventilatory assistance. The presence of other extraventilatory air prior to (or concurrent with) PPC, the use of cardiopulmonary resuscitation with intracardiac drug administration, and improper endotracheal tube placement were contributory factors. However, it was not possible to determine why some infants progressed to PPC and others, with similar disease and predisposing conditions, did not. The primary radiographic sign of PPC is the "halo" sign, which was apparent in 96% of these cases. When this sign was not present, other signs, such as the "pericardial line" sign, were helpful. The overall mortality was 72%. Thirty-three per cent of the fatalities were related to PPC; however, the long-term prognosis is probably more closely related to the severity of underlying lung disease or other complications than to PPC.
|
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] |
10,000,704
|
Aseptic necrosis in familial dysautonomia.
|
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] |
10,000,705
|
Choanal atresia: a case report illustrating the use of computed tomography.
|
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] |
10,000,706
|
High-resolution ultrasound evaluation of experimental brain abscess evolution: comparison with computed tomography and neuropathology.
|
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] |
10,000,707
|
Computed tomographic (CT) and high-resolution ultrasound (HRUS) imaging of experimental brain abscess were correlated with neuropathologic findings in nine mongrel dogs. The HRUS scan was more sensitive to different histologic features than the CT scan but both accurately delineated the evolution of the experimental brain abscess. All stages of abscess evolution were characterized by an appearance of an echogenic rim with a hypoechoic center. In the early stages the echogenicity of the abscess was related primarily to marked cellular infiltration, while in the late stages extensive collagen deposition correlated closely with the echo pattern. The size of the abscess in the cerebritis stages appeared smaller on the HRUS scan than on the CT scan because the latter modality detected the extensive cerebritis around the developing necrotic center whereas the HRUS scan did not. This discrepancy disappeared in the capsule stages. The HRUS scan provided a more accurate depiction of the neuropathologic characteristics of the necrotic than did the CT scan. Healing of the abscess, indicated by a decrease in size of the hypoechoic center, was accurately detected by the HRUS scan.
|
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] |
10,000,708
|
New focus on replacing animals in the lab.
|
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] |
10,000,709
|
Alzheimer's research poses dilemma.
|
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] |
10,000,710
|
A conference on legal and ethical issues in research on senile dementia of the Alzheimer's type was held by the National Institute on Aging on 23-24 November 1981. The presentations, summarized in this article, focused on the controversial problem of doing nontherapeutic, invasive research on patients who are frequently incompetent to give informed consent.
|
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] |
10,000,711
|
Phagocytosis: flow cytometric quantitation with fluorescent microspheres.
|
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10,000,712
|
The phagocytosis of uniform fluorescent latex particles by pulmonary macrophages in the rat was analyzed by flow cytometric methods. The percentage of phagocytic macrophages and the number of particles per cell were determined from cell-size and fluorescence histograms. A comparison of in vivo and in vitro phagocytosis data showed that the percentage of phagocytic lavaged macrophages reflected the availability of instilled particles. With sodium azide used to model phagocytosis inhibition, it was shown that the percentage of phagocytic cells and the number of particles per cell can be determined simultaneously.
|
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] |
10,000,713
|
Serum from monkeys with histories of fetal wastage causes abnormalities in cultured rat embryos.
|
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] |
10,000,714
|
Coupling of histone and DNA synthesis in the somatic cell cycle.
|
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] |
10,000,715
|
The coupling of histone and DNA synthesis was examined in the temperature-sensitive hamster fibroblast cell line K12. By monitoring total cellular histone synthesis at various times after quiescent cells were stimulated to proliferate at permissive and nonpermissive temperatures, a direct correlation was found between the rates of DNA and histone synthesis. Furthermore, when DNA synthesis was blocked by the K12 mutation, histone synthesis was reduced to the basal rate.
|
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] |
10,000,716
|
Important distinction.
|
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] |
10,000,717
|
beta, gamma-Peroxy analogs of adenosine and guanosine triphosphate: synthesis and biological activity.
|
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] |
10,000,718
|
Extended analogs of adenosine triphosphate (ATP) and guanosine triphosphate (GTP), in which a peroxide bridge replaces the terminal bridge-oxygen of the triphosphate chain, have been synthesized. The ability of beta, gamma-peroxy-ATP to inhibit or substitute for ATP in representative enzyme systems and that of beta, gamma-peroxy-GTP, for FTP in protein synthesis was tested.
|
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] |
10,000,719
|
Regional differences in the growth of normal and neoplastic cells.
|
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] |
10,000,720
|
This article provides a review of the literature on anteroposterior differences in the growth and functional expression of normal and neoplastic cells. Diverse studies in immunology, wound healing, carcinogenesis, transplantation biology, and developmental biology are brought together to emphasize the practical implications of regional differences for research protocols in all these areas of research. The more fundamental question of mechanisms is approached by consideration of variations in the vascular supply, pattern of nervous system development, expression of temperature differentials, and the establishment of metabolic gradients during development.
|
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] |
10,000,721
|
High-resolution imaging with soft x-rays.
|
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] |
10,000,722
|
The chloride cell: definitive identification as the salt-secretory cell in teleosts.
|
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] |
10,000,723
|
Chloride-secreting isolated opercular membranes from the seawater-adapted teleost Sarotherodon mossambicus contain the several cell types also seen in the branchial epithelium. The vibrating probe technique has been used to localize conductance and chloride current specifically to the so-called chloride cells, thereby establishing these cells definitively as the extrarenal salt-secretory cells.
|
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] |
10,000,724
|
Liposomes as gene carriers: efficient transformation of mouse L cells by thymidine kinase gene.
|
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] |
10,000,725
|
Stable transformation of mouse L cells deficient in thymidine kinase was achieved by liposome-mediated transfer of a recombinant plasmid carrying the thymidine kinase gene. Ten percent of the recipient cells expressed thymidine kinase activity. The transformed phenotype (for example, 200 out of 10(6) cells) was stable under selective and nonselective conditions. The liposome technique is compared with other methods currently used for gene transfer.
|
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] |
10,000,726
|
Tumor metastasis is not due to adaptation of cells to a new organ environment.
|
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] |
10,000,727
|
Murine B16 melanoma cells were adapted for lung survival and growth by allowing them to attach to Bio-Carrier beads and injecting the beads intravenously into normal mice. The beads lodged mechanically in the microcirculation of the lung. When the melanoma cells had grown into visible tumors from the arrested beads, the tumors were removed and the cells were dispersed, cultured to remove normal cells, and reattached to new beads. The process was repeated nine times. Previously another B16 subline was injected intravenously as a suspension of separate tumor cells. Those cells that survived and colonized the lungs were harvested, cultured, and injected again. This selection process was also repeated nine times. Only the subline that was injected in suspension was more metastatic than the parental line, indicating that metastasis involves selection of preexistent metastatic cells and is not an adaptive process by which all cells gradually acquire the ability to grow at particular organ sites.
|
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] |
10,000,728
|
Is the acetylcholine receptor a rabies virus receptor?
|
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] |
10,000,729
|
Rabies virus was found on mouse diaphragms and on cultured chick myotubes in a distribution coinciding with that of the acetylcholine receptor. Treatment of the myotubes with alpha-bungarotoxin and d-tubocurarine before the addition of the virus reduced the number of myotubes that became infected with rabies virus. These findings together suggest that acetylcholine receptors may serve as receptors for rabies virus. The binding of virus to acetylcholine receptors, which are present in high density at the neuromuscular junction, would provide a mechanism whereby the virus could be locally concentrated at sites in proximity to peripheral nerves facilitating subsequent uptake and transfer to the central nervous system.
|
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] |
10,000,730
|
Origin of the cholecystokinin-containing fibers in the rat caudatoputamen.
|
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] |
10,000,731
|
Large Amounts of cholecystokinin-octapeptide (CCK) are present in the rat caudatoputamen. The peptide occurs in axons and nerve endings but not in perikarya. The origin of CCK in the caudatoputamen was investigated with the use of immunocytochemistry and a radioimmunoassay specific for CCK. Although a small amount of CCK (approximately 30 percent) originates in the amygdaloid complex, the bulk of the peptide (approximately 70 percent) occurs in processes of neurons located ventral to the caudatoputamen, that is, the claustrum or the piriform cortex. The claustrum and piriform cortex receive inputs from various cortical areas and the olfactory system, respectively, and may process information and relay it to the caudatoputamen. Thus CCK may by the transmitter in the final common pathway linking various cortical areas and the olfactory system to the caudatoputamen.
|
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] |
10,000,732
|
Integrating visual information from successive fixations.
|
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10,000,733
|
One of the classic problems in perception is how visual information from successive fixations of a scene is integrated to form a coherent view of the scene. The results of this experiment implicate a process that integrates by summing information from successive fixations after spatially reconciling the information from each glimpse. The output of this process is a memory image that preserves the properly reconciled information from successive fixations.
|
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] |
10,000,734
|
How do we avoid confounding the direction we are looking and the direction we are moving?
|
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10,000,735
|
Contrary to a previous assumption, the center of the expanding pattern of visual flow is not generally useful as an aid in judging the direction of self motion since its direction depends on the direction of gaze. For some visual environments, however, the point of maximum rate of change of magnification in the retinal image coincides with the direction of self motion, independently of the direction of gaze. This visual indicator could be used to judge the direction of self motion.
|
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10,000,736
|
Nonsmokers and cigarette smoke: a modified perception of risk.
|
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] |
10,000,737
|
Human cell hybrids: analysis of transformation and tumorigenicity.
|
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10,000,738
|
Intraspecific human-human cell hybrids provide a stable model system with which to investigate the genetic control of transformed and tumorigenic phenotypes. Using this system it has been shown that these phenotypes are under separate genetic control. Furthermore, the tumorigenic phenotype can be complemented by fusion of different tumorigenic cells, resulting in nontumorigenic hybrids. This system also provides information on the control of differentiated function. Molecular cytogenetic techniques should reveal the nature of the chromosomal control of neoplastic transformation.
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] |
10,000,739
|
Tumors; a mixed bag of cells.
|
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] |
10,000,740
|
Prenatal exposure to the herbicide 2,4-dichlorophenyl-p-nitrophenyl ether destroys the rodent Harderian gland.
|
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] |
10,000,741
|
Exposure of mice to the herbicide 2,4-dichlorophenyl-p-nitrophenyl ether during gestation produces abnormalities that are not readily apparent at birth but become obvious as the pups mature. By 2 weeks after birth there are severe intraorbital defects resulting from destruction of the Harderian glands behind the eyes. This effect is noticeable only postnatally because the Harderian gland does not grow or function until after birth.
|
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] |
10,000,742
|
Muscle fatigue and the role of transverse tubules.
|
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10,000,743
|
Sedimentation field flow fractionation of liposomes.
|
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] |
10,000,744
|
Quantitative analyses of the particle size distribution of liposomes were performed in 30 to 60 minutes by exponential-field sedimentation field flow fractionation. This gentle new separation method exhibits great potential for the high-resolution fractionation and the size or molecular weight analysis of a wide variety of biological macromolecules and colloidal suspensions.
|
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] |
10,000,745
|
Developmental equations for postural tremor.
|
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] |
10,000,746
|
Basilar membrane tuning in the cat cochlea.
|
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] |
10,000,747
|
Ethanol in low doses augments calcium-mediated mechanisms measured intracellularly in hippocampal neurons.
|
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] |
10,000,748
|
The electrophysiological effects of ethanol in low doses (5 to 20 millimoles per liter or 23 to 92 milligrams per 100 milliliters) were examined intracellularly in CA1 cells of rat hippocampus in vitro. Inhibitory and excitatory postsynaptic potentials were increased when ethanol was applied to the respective synaptic terminal regions. Postsynaptically, ethanol caused a moderate hyperpolarization with increased membrane conductance, even when synaptic transmission was blocked. Ethanol augmented the hyperpolarization that followed repetitive firing or that followed the eliciting of calcium spikes in the presence of tetrodotoxin, but not the rapid afterhyperpolarization in calcium-free medium. Ethanol appears to augment calcium-mediated mechanisms both pre- and postsynaptically.
|
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] |
10,000,749
|
Iodine-125-labeled triiodothyronine in rat brain: evidence for localization in discrete neural systems.
|
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] |
10,000,750
|
Autoradiograms prepared from adult rat brains demonstrate that nerve cells and neuropil in different brain regions selectively concentrate and retain intravenously administered triiodothyronine, by mechanisms susceptible to saturation with excess triiodothyronine. A neuroregulatory role for thyroid hormones, strongly supported by the observations, may account for their marked effects on behavior and the activity of the autonomic nervous system.
|
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] |
10,000,751
|
Changes in serum cholesterol and triglyceride levels after jejunoileal and gastric bypasses in morbidly obese patients.
|
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] |
10,000,752
|
Ischemic proctitis.
|
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10,000,753
|
The rectum is rarely involved in ischemic colitis because of its abundant collateral blood supply. Thus, other forms of inflammatory intestinal disease, such as antibiotic associated or infectious colitis, are considered to be more likely if the rectum is inflamed. Yet, collateral flow develops slowly. Therefore, ischemic proctitis does occur in instances of sudden occlusion of the major blood supply to the rectum, such as after an aortic operation. The histopathology of this condition does not differ from that of infectious colitides, and the diagnosis of ischemic colitis can only be confirmed after careful culturing and assessment of the stool for clostridial toxins. Penile Doppler pressure measurements, as demonstrated in the patient presented herein, may be a simple, noninvasive method of inferring rectal blood flow and, therefore, aid in the diagnosis of ischemic proctitis.
|
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] |
10,000,754
|
Transtracheal mediastinal lymphography for visualization of metastatic lymph nodes in carcinoma of the esophagus.
|
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] |
10,000,755
|
Mediastinal lymphography was carried out preoperatively upon 15 patients with carcinoma of the thoracic part of the esophagus. The tracheal bifurcation was punctured, and contrast medium was slowly injected. Mediastinal lymphograms were taken within 24 hours and, again, three and seven days after this injection. The paratracheal lymph nodes were demonstrated in almost all of the patients, and a filling defect was observed in three patients, leading to possible metastatic involvement. In seven patients, the right pulmonary hilar lymph nodes were demonstrated, and no node was considered to be metastatic. In three, paraesophageal lymph nodes were preoperatively diagnosed as metastatic. All seven lymph nodes in which metastasis was suspected were confirmed to be metastatic at pathologic examination. The smallest node correctly assessed as metastatic was 6 by 6 millimeters.
|
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] |
10,000,756
|
Treatment of finger ischemia with Bier block reserpine.
|
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] |
10,000,757
|
Fourteen patients with severe Raynaud symptoms, including four patients with ulceration of the fingers, were treated by regional medical sympathectomy achieved by the tourniquet controlled intravenous injection of reserpine. Nine of the patients had significant objective clinical improvement which, in each patient, correlated with the demonstration of vasospasm on pretreatment studies. The five patients without improvement had advanced organic obstructive arterial disease without vasospasm.
|
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] |
10,000,758
|
Percutaneous abscess drainage.
|
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] |
10,000,759
|
Forty-two abscess collections in the abdomen, pelvis and mediastinum were drained in 40 patients. Thirty-two were drained completely and required no operative treatment. The high success rate combined with the low morbidity rate and low mortality suggest that, if possible, percutaneous drainage of abscesses is preferable to operative drainage.
|
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] |
10,000,760
|
Technique of venous impedance plethysmography for quantification of venous reflux.
|
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] |
10,000,761
|
A study was conducted applying a technique of venous impedance plethysmography for the quantitation of venous reflux to a group of 20 normal persons and five patients with postphlebitic limbs. Results demonstrate a significantly higher reflux refilling rate for those patients with postphlebitic limbs compared with the refilling rate for those in the normal group. It is believed that this technique is a valuable diagnostic tool for detecting venous reflux caused by valve incompetence and that it provides an indication of progression of venous insufficiency in the patient.
|
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] |
10,000,762
|
Level of amputation after failure of limb salvage procedures.
|
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] |
10,000,763
|
It has been claimed that the level of amputation is rendered higher by unsuccessful limb salvage bypass procedures. To evaluate this premise, we analyzed 242 major amputations performed for atherosclerotic vascular disease. One hundred and sixty-one amputations were performed as primary operations--50 per cent being below knee and 50 per cent, above knee amputations. Eighty-one amputations followed failure of an arterial revascularization. Twenty-three amputations, 13 below knee and ten above knee, followed late closure of such bypass procedures. Early failure of the bypass in 58 patients resulted in 46 below knee and 12 above knee amputations. After failure of 45 bypasses to arteries distal to the popliteal, 14 of the patients required above knee amputation. Following 28 unsuccessful femoropopliteal bypasses, only two patients needed above knee amputation. Thus, the risk of jeopardizing the knee joint should not be considered a major contraindication to limb salvage procedures, especially if a femoropopliteal bypass is contemplated.
|
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] |
10,000,764
|
Laser conization versus cold knife conization.
|
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] |
10,000,765
|
This prospective, randomized study compares, for the first time, measured blood loss at conization and within 24 hours after using either the cold knife technique or the carbon dioxide laser scalpel. One hundred and ten consecutive patients were evaluated. The median blood loss in the laser group of 55 patients was 4.6 milliliters at, and within, 24 hours after operation compared with 30.1 milliliters in the cold knife group of 55 patients. More important, however, is that the corresponding figures for the range of bleeding were 0.4 to 155.4 milliliters and 5.6 to 1,570.9 milliliters, respectively. The incidence rate for bleeding complications requiring surgical intervention was 1.8 per cet for the laser group and 14.6 per cent for the cold knife group. This difference was statistically significant, p less than 0.015--Fischer's exact test. Conization for treatment of premalignant changes of the cervix uteri will probably remain the treatment of choice for some time to come. It is our opinion that, in the future, laser conization will replace cold knife conization.
|
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] |
10,000,766
|
Toxic shock syndrome in the postoperative patient.
|
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] |
10,000,767
|
Toxic shock syndrome occurred in two patients within seven days of operation in women in whom Staphylococcus aureus was isolated from the wound incisions. Both patients had negative vaginal cultures. One patient was menstruating at the time of onset of the disease and the other was seven days' postpartum. Although toxic shock syndrome mainly occurs in menstruating women who use tampons and have positive vaginal cultures for Staphylococcus aureus, wound infection may also be a source for toxin production and adsorption.
|
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] |
10,000,768
|
Thrombectomy and arteriovenous fistula for iliofemoral venous thrombosis in fertile women.
|
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] |
10,000,769
|
Thirteen women of fertile age with left-sided iliofemoral venous thrombosis were treated with thrombectomy and a temporary arteriovenous fistula in the groin. In nine patients, the appearance of thrombosis could be related to pregnancy; in three of these, obstetric complications occurred. Diagnosis was obtained by antegrade and retrograde phlebography. After three months, the arteriovenous fistula was closed. Anticoagulant treatment was given from the time of diagnosis and for a total of six months. Patency of the iliac vein was determined by phlebography or venous occlusion plethysmography, or both. Based upon these findings, a short term patency rate of 85 per cent was achieved. Analysis of the material indicates a multifactorial pathogenic mechanism in the development of iliofemoral venous thrombosis. Important factors are pregnancy, obstetric complications, mechanical factors causing flow resistance in the iliac vein, hormonal factors and defective fibrinolysis.
|
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] |
10,000,770
|
Hemodynamics, oxygen consumption and serum catecholamine changes in progressive, lethal peritonitis in the dog.
|
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] |
10,000,771
|
A progressive, lethal canine peritonitis model was developed using the intraperitoneal injection of previously processed, frozen human stool. Of 15 dogs with fecal contamination, seven died within 24 hours and eight died over two to nine days, with a mean of five days. The model was associated with an initial hyperdynamic state which became quite variable as sepsis progressed. The cardiac index in the septic dogs correlated directly with the arteriovenous oxygen content difference. Evidence of multiple system organ failure and a significant increase in norepinephrine levels was noted in the septic dogs. The serum catecholamine levels were inversely correlated with the systemic blood pressure but did not correlate with the systemic vascular resistance or the cardiac index. This implies a lack of responsiveness of resistance vessels or the heart to catecholamines in this severely septic dog model.
|
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] |
10,000,772
|
Let the preserver of spleens beware.
|
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] |
10,000,773
|
Surgical correction of ectropion of the anal mucosa.
|
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] |
10,000,774
|
A method to correct an ectropion of the anal mucosa, using the triangular flap technique, has been described. The operation is simple and physiologically sound, with special attention being paid to skin tension lines. The results are excellent, and the patient is relieved of discomfort, bleeding tenesmus and pruritus which accompany ectropion of the anal mucosa.
|
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] |
10,000,775
|
Effects of nonsurgical coronary reperfusion on the left ventricle in human subjects compared with conventional treatment. Study of 18 patients with acute myocardial infarction treated with intracoronary infusion of streptokinase.
|
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] |
10,000,776
|
Left ventricular function was assessed sequentially with biplane cineventriculography in 18 patients with acute myocardial infarction, in whom nonsurgical reperfusion was achieved within 8.2 +/- 6.9 hours (mean +/- standard deviation) after the onset of chest pain with intracoronary infusion of streptokinase (2,000 units/min for 66 +/- 16 minutes). Ejection fraction increased from 51.4 +/- 9.8 percent before reperfusion to 55.9 +/- 9.0 percent immediately after completion of streptokinase infusion (n = 13, p less than 0.01); the length of the akinetic myocardial segment decreased from 10.2 +/- 6.1 to 7.1 +/- 4.9 cm (p less than 0.025). Left ventricular function data before reperfusion and in the chronic stage of infarction (before surgery) were compared with data obtained in two medically treated groups that were matched retrospectively: control group I, nine patients with permanent obstruction of the infarcted vessel; control group II, nine patients with spontaneous recanalization of the initially obstructed vessel. In the acute stage of infarction, ejection fraction and akinetic segment length were comparable in the three groups. In the chronic stage ejection fraction was higher in the study group (57.4 +/- 12.7 percent) than in control group I (43.4 +/- 7.6 percent, probability [p] less than 0.05); the akinetic segment was shorter in the study group (4.5 +/- 6 versus 9.4 +/- 5.5 cm, p less than 0.025). Preservation of R waves was more extensive in the study group. Intraoperative inspection in 10 study group patients and transmural biopsy performed in 3 of these patients revealed the bulk of reperfused myocardium to be viable. It is concluded that jeopardized myocardium was preserved by nonsurgical reperfusion during the acute stage of coronary occlusion.
|
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] |
10,000,777
|
Two dimensional Doppler echocardiographic/M mode echocardiographic and phonocardiographic method for study of extracardiac heterograft valved conduits in the right ventricular outflow tract position.
|
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] |
10,000,778
|
Significant concern exists over the long-term results of right ventricular outflow tract repair using heterograft valved conduits. Because these conduits and valves are difficult to image using ultrasound, a serially applicable two dimensional Doppler echocardiographic, M mode echocardiographic and phonocardiographic method for noninvasive investigation was developed and applied in 15 children. The method provides two dimensional echocardiographic imaging of valve contour and motion, as well as M mode and phonocardiographic analysis and quantitative range-gated Doppler information about the timing of flow through the conduit. Conduit diameter in two dimensional echocardiographic images correlated well with known conduit size (r = +0.96). A thickened and stenosed heterograft valve was predicted in two patients before hemodynamic investigation. This new method provides serially obtainable information to aid in the management of children and infants with a valved conduit placed for repair of congenital heart malformations and aids in planning the timing of hemodynamic follow-up studies.
|
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] |
10,000,779
|
Distal aortopulmonary septal defect, aortic origin of the right pulmonary artery, intact ventricular septum, patent ductus arteriosus and hypoplasia of the aortic isthmus: a newly recognized syndrome.
|
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10,000,780
|
The association of distal aortopulmonary septal defect, aortic origin of the right pulmonary artery, intact ventricular septum and interruption or coarctation of the aortic isthmus has not previously been reported as a syndrome. This combination of anomalies was encountered in five new patients and was previously reported in three. Two patients have undergone surgery with successful results. In contrast to the sagittally oriented conventional proximal aortopulmonary septal defect, the patients in this series had a more distal type of defect, possibly representing a partial persistence of the common arterial trunk. The pulmonary arterial bifurcation may malattach to this undivided truncal segment and, as a result, the right pulmonary artery may be partially or completely shifted into the aorta. This abnormal right pulmonary arterial origin may lead to "steal" from the aortic flow during embryogenesis and to hypoplasia of the aortic arch. This concept is supported by the angiographic observation that the greater the rightward displacement of the right pulmonary artery, the greater the hypoplasia of the arch. The diagnostic angiographic sign is a strikingly high origin of the right pulmonary artery together with aortic arch hypoplasia or atresia. Closure of the aortopulmonary septal defect with implantation of the right pulmonary artery in the pulmonary trunk and repair of the aortic arch anomaly is the recommended surgical treatment.
|
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] |
10,000,781
|
Comparison of the electrophysiologic effects of intravenous and oral verapamil in patients with paroxysmal supraventricular tachycardia.
|
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] |
10,000,782
|
The electrophysiologic effects of intravenous verapamil (a bolus dose of 0.15 mg/kg body weight followed by infusion of 0.005 mg/kg per min) were compared with those of oral verapamil (80 mg every 6 hours for 48 hours) in eight patients who had paroxysmal supraventricular tachycardia. The mechanism of tachycardia was atrioventricular (A-V) nodal reentry in four patients and A-V reentry utilizing an accessory pathway for retrograde conduction in the remaining four. The electrophysiologic effects of oral and intravenous verapamil were similar. Both preparations significantly prolonged anterograde effective and functional refractory periods of the A-V node (p less than 0.001). Both significantly increased the shortest pacing cycle length maintaining 1:1 anterograde conduction over the A-V node (p less than 0.001). Retrograde conduction over the A-V node was greatly prolonged with verapamil in one patient but was unaffected in the others. There was no significant effect on sinoatrial conduction time, sinus nodal recovery time or atrial or ventricular refractoriness. Both preparations prevented induction of tachycardia in six patients none of whom had recurrence of sustained tachycardia while receiving long-term oral therapy (5 to 10 months). Neither preparation had a significant effect in two patients and this predicted failure of long-term oral therapy in one of these patients. The results of acute drug testing with intravenous verapamil can be extrapolated to predict the electrophysiologic results and response to long-term therapy with oral verapamil.
|
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] |
10,000,783
|
Combined therapy with verapamil and propranolol in chronic stable angina.
|
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] |
10,000,784
|
The comparative efficacy of verapamil (360 mg daily) and propranolol (240 mg daily) was evaluated with computerized treadmill exercise in 22 patients with chronic stable angina in a placebo-controlled double-blind crossover study with 4 weeks on each active phase. Fourteen of these patients still had angina despite active drug therapy and they were further treated with a combination of verapamil (360 mg) and propranolol (120 mg) for 4 weeks. The mean exercise time for these patients taking placebo was 4.8 +/- 0.22 minutes (mean +/- standard error of the mean) and this increased to 6.8 +/- 0.64 minutes with propranolol and 8.0 +/- 0.5 minutes with verapamil. A further increase to 10.1 +/- 0.88 minutes was observed with the combination of both drugs and seven patients became symptom-free. S-T segment criteria improved with both drugs, and combination therapy produced a further reduction in peak S-T depression. Electrocardiographic ambulatory monitoring showed no evidence of conduction defects and mean hourly heart rates were similar to those seen with propranolol alone. Left ventricular function indexes were not significantly different from those obtained with propranolol. Combination therapy with verapamil and propranolol appears to be efficacious in the treatment of selected patients with severe chronic stable angina. The patients need to be carefully monitored for adverse effects.
|
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10,000,785
|
Rate of rise of the carotid pulse. An investigation of observer error in a common clinical measurement.
|
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] |
10,000,786
|
Bedside estimation of the rate of rise of the carotid pulse is a standard clinical observation whose reliability has not been determined. To ascertain interobserver agreement (primary objective) and compare the velocity of rise of the carotid displacement (not pressure) pulse (supplementary objective), three blinded observers evaluated, ranked and palpated the velocity of rise of carotid pulse as "unremarkable," "slow" or "rapid" in 20 consecutive patients. The relative rate of rise of the recorded carotid pulse was represented by the angle between baseline and the initial carotid peak at a standard paper speed of 100 mm/s. Chi-square analyses yielded no significant interobserver agreements (probability [p] 0.22 to 0.51). There was also no correlation of observers' ranking of rise of carotid pulse with the ranking from independent measurement of the recorded pulse rise velocity (p = 0.10 to 0.99). Observer agreement was unanimous only four times and even in these instances was consistent with the recorded carotid pulse rise velocity only once. The results suggest that unbiased observers cannot reliably discriminate slow from "normal" velocity of rise of carotid pulse.
|
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] |
10,000,787
|
Seminar on surgical therapy for ventricular arrhythmias--part I. Introduction and perspective.
|
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] |
10,000,788
|
Role of implantable pacemakers in control of recurrent ventricular tachycardia.
|
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] |
10,000,789
|
Implanted pacemakers can provide a viable alternative to pharmacologic therapy or surgical management of patients with recurrent ventricular tachycardia. An increasing variety of pacemaker techniques are proving useful for preventing, controlling the effective rate of or terminating ventricular tachycardia. To assess the role of permanent pacing in the treatment of ventricular tachycardia, a consecutive series of 160 patients undergoing electrophysiologic testing for recurrent ventricular tachycardia were analyzed. Thirty-nine patients received implantable pacemakers, of which 13 were intended for bursts of rapid ventricular pacing. No adverse responses were attributed to these burst pacemakers, but concern for possible acceleration of tachycardia and appropriate identification of the arrhythmia were among factors limiting more widespread use of antitachycardia pacing. Some of these limitations may be resolved with further advances in electrophysiologic understanding of arrhythmias combined with strides in medical electronics, which will permit the development of new generations of highly sophisticated antitachycardia pacemakers.
|
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10,000,790
|
Role of catheter mapping in the preoperative evaluation of ventricular tachycardia.
|
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] |
10,000,791
|
Although surgery is an accepted mode of therapy for refractory ventricular tachycardia, routine aneurysmectomy has yielded unpredictable results. This is believed to have occurred because there was no documentation that the arrhythmia actually arose from resected aneurysmal tissue. Catheter endocardial mapping has been used to localize preoperatively the area of origin of the arrhythmia. This technique has established that the arrhythmias arise near the endocardium at the borders of the aneurysm or infarction, or both. These regions, particularly when they occur in the interventricular septum, are not resected by standard aneurysmectomy. Intraoperative endocardial and epicardial mapping have validated the accuracy of this technique. We believe that catheter mapping should be performed before surgery for the following reasons: (1) In some patients ventricular tachycardia is not inducible in the operating room (for example, automatic ventricular tachycardia can be mapped in the catheterization laboratory); (2) in some patients not all morphologic forms of tachycardia can be induced or mapped intraoperatively because of failure of inducibility, time constraints or degeneration of the arrhythmia to ventricular fibrillation; and (3) intraoperative endocardial mapping occasionally cannot be performed because of lack of technical skills, physical factors such as mural thrombosis, or the inability to induce ventricular tachycardia after aneurysmectomy. Other methods currently being evaluated to localize the origin of ventricular tachycardia that do not require induction of arrhythmia are analysis of ventricular electrograms during sinus rhythm and pacemapping.
|
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] |
10,000,792
|
Usefulness of the ajmaline test in patients with latent bundle branch block.
|
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] |
10,000,793
|
Twelve patients were studied with intermittent bundle branch block whose conduction disturbance disappeared completely and could no longer be recorded even after provoked changes in heart rate. Premature atrial stimulation and atrial pacing at rapid rates were performed in nine patients; in none of these nine were these procedures able to evoke the complete bundle branch block pattern that all patients exhibited before the spontaneous normalization of conduction. In marked contrast, the administration of ajmaline (1 mg/kg body weight, intravenously in 90 seconds) caused the bundle branch block pattern to reappear in 10 (83.3 percent) of the 12 patients 30 to 120 seconds after the end of the injection, and in 11 patients (91.6 percent) when additional atrial stimulation was performed in 1 of the 2 "failures." This pharmacologic test was much more rapid and simple than electrophysiologic testing and it was noninvasive. Results of this study suggest that some form of subclinical fascicular injury was present (or had persisted) at a time when intraventricular conduction was persistently normal even though no significant physiologic alteration could be demonstrated by the atrial stimulation techniques. The ajmaline test may become a valuable tool for uncovering cases of latent bundle branch block and furthering our knowledge of the early natural history of intraventricular block.
|
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] |
10,000,794
|
Cardiac catheterization for patients with pure mitral stenosis--I.
|
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] |
10,000,795
|
Cardiac catheterization for patients with pure mitral stenosis--II.
|
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] |
10,000,796
|
Left atrial volume overload in mitral regurgitation: a two dimensional echocardiographic study.
|
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] |
10,000,797
|
Left atrial volume in patients with mitral valve disease was studied with two dimensional echocardiography. The left atrial dimension was derived by planimetry of the left atrial area and, assuming spherical geometry, left atrial volume was calculated. Patients with severe mitral regurgitation had marked systolic expansion of the left atrium with large phasic changes in left atrial cubic dimension. Conversely, patients with severe mitral stenosis had small changes in the cubic dimension in comparison with the large left atrial size. Left atrial volumetric changes were similar among patients with atrial fibrillation and normal sinus rhythm. Therefore, left atrial volume overload is an additional two dimensional echocardiographic diagnostic feature of severe mitral regurgitation.
|
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10,000,798
|
Comparison of noninvasive techniques in evaluation of the nontissue cardiac valve prosthesis.
|
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] |
10,000,799
|
The ability of bedside auscultation, echophonocardiography and cinefluoroscopy to detect prosthetic valve malfunction was compared in 81 patients with a Bjork-Shiley aortic or mitral valve prosthesis or a Beall mitral valve prosthesis. In 32 patients with an abnormal mitral valve prosthesis proved by cardiac catheterization, the sensitivities of auscultation, echophonocardiography and cinefluoroscopy were 94, 78 and 88 percent, respectively. In 25 patients with a normal mitral valve prosthesis, the specificities were 96, 64 and 89 percent, respectively. Twelve patients had an abnormal aortic valve prosthesis; the sensitivities of auscultation, echophonocardiography and cinefluoroscopy were 92, 58 and 33 percent, respectively. In 12 patients with a normal aortic valve prosthesis, the specificities were 100, 75 and 92 percent, respectively. Auscultation can detect almost all cases of malfunction of nontissue prosthetic valves. Echophonocardiography and cinefluoroscopy can detect most cases of malfunction of mitral valve prostheses, but false positive studies are common; both procedures are less useful in detecting malfunction of aortic valve prostheses.
|
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] |
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