Simple method for evaluating cardiac output.

This study compared the accuracy of a formula calculating cardiac output utilizing a patient size modification of a pulse pressure formula of Starr with that measured with a standard thermal dilution technique. During a six-month period 111 patients in the intensive care unit (ICU) on the cardiothoracic and vascular surgical services had comparison of their cardiac output by these two methods. The basic formula of Starr for stroke volume was converted to a stroke volume index by dividing by 1.

A rapid hemodynamic monitor of acute ischemia during cardiac procedures: changes in relaxation via a continuous left ventricular pressure-derivative loop.

Background: Procedures that induce ischemic pre-conditioning during cardiac surgery will require a rapidly visualized hemodynamic monitor of acute ischemia. This study investigated the utility of a continuous loop tracing of left ventricular pressure (LVP) plotted against its derivative (dP/dt) as a visual beat-to-beat monitor of acute changes in myocardial relaxation due to global ischemia.

Materials And Methods: In 11 dogs, LVP, recorded via a micromanometer-tip catheter, was plotted against dP/dt as a continuous loop.

Gamma-guided diagnostic peritoneal lavage for detection of bowel perforation.

Hypothesis: Bowel perforation can be diagnosed by detection of orally administered technetium Tc 99m sulfur colloid ((99m)Tc SC) in diagnostic peritoneal lavage (DPL) fluid using a handheld gamma-detection probe.

Design: A canine intestinal-injury model was used to test the hypothesis. The (99m)Tc SC (55.

Detection and assignment of CYP21 mutations using peptide mass signature genotyping.

Congenital adrenal hyperplasia (CAH) is a common inborn error of steroidogenesis. The clinical spectrum of CAH ranges from the severe classical form, which can be fatal in the newborn, to simple virilizing forms or a milder non-classical form which is often not diagnosed until puberty. Recessive mutations in the autosomal gene encoding 21-hydroxylase (CYP21) are responsible for approximately 95% of CAH cases.

Carbon dioxide field flooding minimizes residual intracardiac air after open heart operations.

Transesophageal echocardiographic studies were used to monitor the presence of air bubbles in the heart after open heart operations. After cardiac valvular procedures all 22 patients managed with careful deairing procedures had persistence of air bubbles for at least 30 minutes and usually for 45 minutes. In 56 patients with CO2 field flooding, all foam disappeared in less than 1 minute in 48 patients and the remaining 8 had complete disappearance in 1 to 24 minutes.

Findlay implantable two-stage centrifugal pump.

The Findlay centrifugal pump is unique in its two-stage pumping mechanisms and in its complementary interrelationship of the stages to each other and to the exit system, and it forms an extremely efficient unit. The first stage is a lift force pump as an inlet. The second and major stage is a shear force pump.

Findlay Implantable Two-Stage Centrifugal Pump.

The Findlay centrifugal pump is unique in its two-stage pumping mechanisms and in its complementary interrelationship of the stages to each other and to the exit system, and it forms an extremely efficient unit. The first stage is a lift force pump as an inlet. The second and major stage is a shear force pump.

Iodized talc pleurodesis for the treatment of pleural effusions.

This prospective study was designed to determine the efficacy of iodized talc pleurodesis in patients with pleural effusions. Thirty-four patients underwent this treatment (three bilaterally) between October 1, 1989, and March 31, 1991. All patients had to have complete or nearly complete lung reexpansion after tube thoracostomy with fluid drainage less than 100 ml in 24 hours.

Superior vena cava syndrome associated with malignant mesothelioma.

A 70-year-old former shipyard worker presented with dyspnea and edema of the upper thorax suggesting the diagnosis of superior vena cava syndrome. Further evaluation revealed mesothelioma with both epithelial and spindled histologic patterns. The extensive mesothelioma had invaded the adventitia of the superior vena cava, the pleura of the lungs bilaterally, the superficial myocardium, and the liver.

Management of airway trauma. II: Combined injuries of the trachea and esophagus.

Twenty-four consecutive patients with combined injuries of the trachea and esophagus were operated on at the Tulane University Hospital and the Charity Hospital of New Orleans between 1967 and 1983. Only 3 of the injuries resulted from blunt trauma, and 1 of these patients had a total transection of both the trachea and esophagus; the remaining injuries were due to penetrating trauma (20 gunshot wounds; 1 stab wound). The combined lesions involved the cervical region in 20 patients and the thoracic esophagus and trachea or bronchus in 4.

Diminished natural killer-cell activity of interstitial pulmonary cell populations from patients with carcinoma of the lung.

Natural killer-cell activity of fresh interstitial pulmonary cell populations from patients with squamous cell and adenocarcinoma of the lung and carcinoma metastatic to the lung was assessed and compared to that of apparently normal lung. No increase in the percentage of lymphoid cell populations was noted in the interstitium of lung contiguous with tumor, and the cytotoxic capacity of the cells present was depressed as compared to that of normal lung. Natural killer-cell function appears to be down regulated in lung cancer and may be amenable to therapies which activate such cytotoxicity in vivo.

Antiarrhythmic drugs: electrophysiological basis of their clinical usage.

Cardiac arrhythmias arise from abnormalities of impulse initiation or impulse conduction or both. A review of the electrophysiological mechanisms of the genesis of cardiac arrhythmias and of the electrophysiological principles of the treatment of the cardiac arrhythmias leads to: categorization of antiarrhythmic drugs into five classes based on their dominant cardiac electrophysiological actions; a series of categories of their effects on impulse initiation and impulse conduction in different types of cardiac cells; and a systematic approach to pharmacological management of cardiac arrhythmias.

Management of airway trauma. I: Tracheobronchial injuries.

One hundred six consecutive patients with injuries to the tracheobronchial tree who were admitted to the emergency room of the Tulane Medical Center Hospital or the Charity Hospital of Louisiana at New Orleans over a period of almost 20 years were analyzed retrospectively. Penetrating trauma of the neck or chest was reported in 100 of the patients, and only 6 had blunt trauma to the neck or thorax as the cause of injury. There were 18 deaths among the 106 patients (16.

Use of thoracic aortobifemoral artery bypass grafting as an alternative procedure for occlusive aortoiliac disease.

A descending thoracic aortobifemoral artery bypass graft is proposed as an alternative procedure for revascularization of the lower extremities when an intra-abdominal approach is not feasible or is ill-advised. Three patients underwent a thoracobifemoral graft because of severe cardiopulmonary disease combined with multiple prior abdominal surgeries, complications of radiation, and sepsis. Patency of the aortobifemoral grafts was documented by palpable pulses and increased ankle: brachial ratios improving from 0.

Coronary bypass surgery in patients with circulating lupus anticoagulant.

Clinical and laboratory experience with circulating lupus anticoagulant in 3 patients undergoing coronary artery bypass procedures is reported. This circulatory anticoagulant inhibits activation of prothrombin by the prothrombin activator complex (factor Xa, factor V, and phospholipid). The presence of lupus anticoagulant was initially detected because of a prolonged activated partial thromboplastin time and a normal or mildly prolonged prothrombin time.

Subpleural pulmonary hamartoma: demonstration by computed tomography.

A case of a subpleural pulmonary hamartoma demonstrated by computed tomography is presented. The literature on subpleural pulmonary lesions demonstrated by computed tomography is reviewed. Although peripheral pulmonary hamartomas have been well documented, we believe this is the first demonstration of a subpleural location by computed tomography scanning.

Pulmonary microvascular leakage after microembolization and hemodilution.

This study examined the role of colloids versus crystalloids in pulmonary edema associated with the increased pulmonary microvascular permeability secondary to thrombin-induced pulmonary microembolism. Each of 23 healthy dogs received an intravenous injection of thrombin and a fibrinolysis inhibitor, which induced a microembolic state with increased (fivefold) pulmonary lymphatic flow and a lymph/plasma (L/P) protein ratio typical of a permeability change. Seven dogs received no treatment, eight received 15 ml/kg 10% dextran 40 (D40), and eight received 60 ml/kg Ringer's lactate solution (RL).

Relationship between preoperative pulmonary function tests and complications after thoracotomy.

Simple spirometric testing remains useful for the preoperative assessment of patients being evaluated for thoracotomy. To routine spirometric testing, the maximal voluntary ventilation should be added. More specific tests do not seem to add predictive information.

A frequency-time domain signal processing system.

A digital signal processing system for time series analysis with two modes of usage--the first a rapid, hands-on exploratory method, and the second an automatic, printed, labeled graphic output method--is described. The system utilizes a Time Data 1923C system with integral PDP-11 minicomputer, and a console. Major error problems have been contained and a large-volume graphic analysis capability has been developed.

Thoracoscopy: new method of early diagnosis of cardiac herniation.

Cardiac herniation is an uncommon but rapidly fatal complication of radical pneumonectomy. Although operative correction is simple, a successful clinical outcome requires early diagnosis and thoracotomy. A patient is described in whom a left-sided cardiac herniation through a pericardial defect occurred following radical pneumonectomy.