Search

Fifty-one patients required the implantation of a Cordis Omnis-Stanicor permanent pacemaker. His bundle electrograms studies, which included right atrial pacing and sinoatrial (SA) node postsuppression recovery times, were performed prior to the implantations. Pacing and sensing thresholds were obtained in all patients. Syncope or episodes of dizziness were the presenting symptoms in virtually every patient. Twenty-eight of the 51 patients had the sick sinus syndrome. Only nine patients were in complete heart block, and an additional nine were in second-degree heart block. The His bundle electrogram technique was not particularly helpful in selecting the potential pacemaker candidate. The symptomatic patient with second- or third-degree heart block requires a pacemaker. In the sick sinus syndrome, the His bundle electrogram was a disappointing tool in detecting abnormalities. In chronic bundle branch block, the His bundle electrogram appears to play a major role. A prolonged H-V interval in a symptomatic patient, in whom a specific noncardiac cause cannot be identified, signifies that a pacemaker is required.

Extra-anatomic bypass is an extremely useful procedure under certain clinical situations. However, it has been suggested that it may steal blood from the peripheral distribution of the donor artery. The hemodynamics of extra-anatomic bypass under basal and maximal flow, hypotensive state and inadequate inflow and outflow of donor artery were studied in twelve mongrel dogs. A right external iliac artery to left external iliac artery bypass with ligation of left external iliac artery proximal to the anastomosis was used as an experimental model. The hemodynamic situation of axillo-femoral bypass where the flow through the graft is several times the normal flow in the donor artery was simulated by increasing the graft flow by creating an A-V fistula on the recipient side. Following bypass, the increased demand of flow was met by a proportional increase of inflow into the donor artery and in supra-renal aortic flow. The "steal" of blood from the peripheral distribution of the donor artery was observed only when inflow into the donor artery was restricted beyond a critical point (60% in basal flow and 40% in a maximal flow). Restriction of outflow in the donor artery had no adverse effect on the hemodynamics of the bypass grafts. Neither steal nor redistribution of blood was observed in the hypotensive state. The result of this study suggests that the fear of "stealing" blood from other areas following an extra-anatomic bypass is ill-founded in the presence of normal inflow.

Sesame oil has been reported to contain sesamolin, sesamin and sesamol as contact allergens. A female patient had cheilitis due to sesame oil in a lipstick. She reacted to sesamolin and sesamin, but not to sesamol. We carried out analysis of the sesame oil by high performance liquid chromatography. We detected sesamolin and sesamin but not sesamol in sesame oil.

A patient with a saccular aneurysm arising from the left superior polar renal artery is presented together with a review of two further reports from the literature. The importance of selective arteriography and the interpretation of the "naked calyx" sign in the diagnosis of supernumerary renal arteries has been emphasized. We feel that this is the only report of an aneurysm of a polar artery successfully treated by excision and end-to-end arterial anastomosis.

Following massive resection of the small intestine, including the ileocecal valve in seven adult mongrel dogs, the remaining 20 centimeters of the proximal part of the jejunum was anastomised to the midtransverse portion of the colon. All dogs were given parenteral nutrition for four weeks. Six weeks after resection, the dogs underwent reexploration, and gross and microscopic examinations of the remaining part of the jejunum were carried out. Grossly, there was a 29.5 per cent increase in the length and a 31 per cent increase in the circumference of the intestine. Microscopically, there was a 23 per cent increase in the depth of the crypts, a 21 per cent increase in the number of villi and a 22 per cent increase in the width of the villi. No change was observed in the height of the villi.

Histologic changes in canine autogenous femoral veins were studied after interposition into the femoral artery. After a 50 per cent reduction of distal blood flow, marked fibrosis of the intima, causing narrowing of the intima and focal destruction of the internal elastic membrane and media, were found in the vein graft and the adjacent arterial segment. These changes are probably due to abnormal intraluminal pressure of femoral artery and interposed vein graft following constriction.

Intestinal adsorption of triolein, Risa and d-xylose was determined before and after reduction of blood flow in the superior mesenteric artery. Absorption of d-xylose did not change, but absorption of triolein and Risa appeared to be slightly improved after arterial constriction, even if the artery was completely thrombosed. Enhancement in absorption of Risa and triolein was probably the result of extensive collateral formation around the constricted superior mesenteric artery.

In 12 mongrel dogs, the comparative effectiveness of systemic versus regional heparinization was studied after injecting 100 units per kilogram of heparin into a systemic vein or regionally into an artery. Activated plasma thromboplastin time was used to monitor the heparin activity, and the coagulability of blood in the general circulation was compared with the coagulability of blood in the excluded circulation distal to the vascular clamps. Both methods of heparinization were found to be equally effective. Heparin injected regionally rapidly achieves a uniform distribution in the excluded, as well as the general, circulation and, as such, cannot be called regional. There was no difference in coagulability of blood in the general circulation compared with the blood in the excluded circulation. Results of this study suggest that regional heparinization is, in fact, systemic heparinization.

The hemodynamics of extra-anatomic bypass were studied with the use of right to left iliac artery bypass grafts. An arteriovenous fistula on the recipient side was used to increase the flow through the graft. Flow measurements in this model under normotensive conditions showed proportionate increases in the suprarenal aortic blood flow and in the blood flow through the segment of donor artery proximal to the bypass graft anastomosis. Stealing of blood was not observed even when the graft flow was increased to approximately 11 times the normal flow in the donor artery. Arfonad was used for producing hypotension through vasodilatation. In the presence of peripheral vasodilatation, adequate blood flow can be expected after such bypass grafts at blood pressures as low as 80 millimeters of mercury and hypotension per se does not produce vascular steal.