Chest radiography and cardiac fluoroscopy in coronary artery disease.

Recent studies suggest a new and important role for the chest film and cardiac fluoroscopy in the assessment of coronary artery disease. The detection of coronary artery calcification and the radiographic appearance of myocardial infarction are just two of the topics thoroughly described in this article.

Lung vascular permeability after reversal of fibronectin deficiency in septic sheep. Correlation with patient studies.

Plasma fibronectin deficiency and opsonic dysfunction exist in critically ill septic surgical, trauma, and burn patients with multiple organ failure. Fibronectin deficiency can be reversed by infusion of fresh plasma cryoprecipitate. The influence of therapy with human cryoprecipitate on lung vascular permeability in septic sheep with plasma fibronectin deficiency following surgery was evaluated.

Pulmonary radiology in the intensive care unit.

The techniques of the standard chest film and the use of specialized views for specific problems are reviewed. The radiographic manifestations of the major presenting causes of acute respiratory failure are described and compared, and the evolution of the radiograph during the progression of these diseases is considered. Radiographic manifestations of commonly encountered complications in the intensive care unit are also presented.

Pulmonary prostacyclin production with increased flow and sympathetic stimulation.

We evaluated the effects of an abrupt increase in flow and of a subsequent sympathetic nerve stimulation on the pulmonary production of prostacyclin (PGI2) and thromboxane A2 (TXA2) in canine isolated left lower lobes perfused in situ with pulsatile flow. When flow was abruptly increased from 50 +/- 3 to 288 +/- 2 ml/min, mean pulmonary arterial pressure (Ppa) increased by 15 +/- 2 Torr and then declined by 2.4 Torr over the next 5 min.

Hepatic perfusion and splanchnic oxygen consumption in patients postinjury.

Hepatic dysfunction following injury is felt to be due to hepatic ischemia. To test this hypothesis we measured hepatic blood flow (HBF) and splanchnic oxygen delivery and consumption in nine multiply injured patients. HBF, measured by indocyanine green clearance, was 0.

Global and regional function in the regionally ischaemic left ventricle related to plasma ionised calcium.

To study the response of function in the regionally ischaemic left ventricle to increased and decreased concentrations of plasma ionised calcium, twenty-two anaesthetised dogs were placed on right heart bypass with constant mean aortic pressure and heart rate. Regional (sonomicrometry) and global left ventricular function were assessed before coronary artery ligation. Then, following ligation, function after 45 min stable ionised hypercalcaemia [( Ca2+] = 1.

Relation of segmental wall motion to global left ventricular function in acute myocardial infarction.

The relation of left ventricular regional wall motion to global ventricular function was evaluated by radionuclide ventriculography in 127 patients within 18 hours of acute myocardial infarction. No patient had evidence of previous myocardial infarction. The following parameters were measured: (1) wall motion index; (2) percent of abnormally contracting segment; (3) ejection fraction (EF); (4) end-diastolic volume (EDV) and end-systolic volume (ESV); and (5) peak systolic cuff pressure/end-systolic volume ratio (PSP/ESV).

Prognostic value of exercise thallium-201 imaging in patients presenting for evaluation of chest pain.

Accurate prognostic information is important in determining optimal management of patients presenting for evaluation of chest pain. In this study, the ability of exercise thallium-201 myocardial imaging to predict future cardiac events (cardiovascular death or nonfatal myocardial infarction) was correlated with clinical, coronary and left ventricular angiographic and exercise electrocardiographic data in 139 consecutive, nonsurgically managed patients followed-up over a 3 to 5 year period (mean follow-up, 3.7 +/- 0.

Effects of ischemic-like insult on myocardial thallium-201 accumulation.

Despite extensive clinical use of thallium-201 (201TI) for myocardial imaging, the effect of ischemia on myocardial accumulation and release of 201TI independent of flow has not been fully defined. Therefore, myocardial accumulation of 201TI in response to ischemic-like myocardial injury was assessed in vitro using the cultured fetal mouse heart preparation. Cultured fetal mouse hearts (n = 311) were subjected to injury simulating ischemia by deprivation of oxygen and oxidizable substrates for periods ranging from 15 minutes to 10 hours.

Effects of reduced coronary flow on thallium-201 accumulation and release in an in vitro rat heart preparation.

To study the relation between myocardial thallium-201 (TI-201) uptake, TI-201 release, and reduced coronary flow, isolated Langendorff rat hearts (n = 8) were perfused for 3 hours at constant flows ranging from physiologic (12 ml/min) to severely ischemic (1.5 ml/min); thallium activity was monitored with a scintillation probe. Each heart was perfused for 1 hour with thallium buffer, followed by 2 hours with thallium-free buffer at the same flow rate.

Classification of mouse VK groups based on the partial amino acid sequence to the first invariant tryptophan: impact of 14 new sequences from IgG myeloma proteins.

Fourteen new VK sequences derived from BALB/c IgG myeloma proteins were determined to the first invariant tryptophan (Trp 35). These partial sequences were compared with 65 other published VK sequences using a computer program. The 79 sequences were organized according to the length of the sequence from the amino terminus to the first invariant tryptophan (Trp 35), into seven groups (33, 34, 35, 36, 39, 40 and 41aa).

Attenuation of hypoxic pulmonary vasoconstriction by pulsatile flow in dog lungs.

We measured pulmonary arterial pressure in isolated lower lobes of dog lungs perfused in situ at several flows during ventilation with 95% O2-5% CO2 and with 3% O2-5% CO2. Pulsatile perfusion was provided by a piston pump, and steady perfusion was provided by a roller pump. The slope of the pressure-flow curve was 16.

Delayed pulmonary dysfunction in head-injured patients.

Intracranial pressure (ICP), cardiopulmonary function, and the degree of neurological dysfunction were measured in 13 patients with serious head injury to determine the relationship of these indices to the development of delayed pulmonary dysfunction. All patients had serious isolated head injury with Glasgow Coma Scale scores of 7 or less 6 hours after injury and elevated ICP at the time of admission to the protocol. Three patients developed arterial pO2 of less than or equal to 80 torr despite the initiation of elevated inspired oxygen fraction (FIO2 greater than or equal to 0.

Computerized tomographic (CT) appearance of the myocardium after reversible and irreversible ischemic injury.

Computerized tomographic abnormalities have been observed within hours after coronary occlusion. It has not been determined whether these CT changes are always indicative of irreversible myocardial damage or whether they can be produced by reversible myocardial injury. Accordingly, in the current study, the circumflex coronary arteries of 16 dogs were occluded for 20 minutes (reversible injury) or 40 minutes (irreversible injury) and then reperfused.

Physiologic--angiographic correlates of coronary arterial stenoses in resting and intensely vasodilated states.

The treatment of ischemic heart disease is dependent upon defining the physiologic significance of coronary arterial stenoses demonstrated on coronary arteriograms. Accordingly, physiologic--angiographic correlates were studied in 12 anesthetized dogs prepared with an electromagnetic flowmeter and micrometer-controlled occluder on the circumflex coronary artery, a pair of sonic crystals in the myocardium within the distribution of the circumflex artery, and a catheter in the thoracic aorta. Measurement of arterial diameters on coronary arteriograms was made to define the minimum percent stenosis that caused: (1) decrease in resting coronary blood flow (CBFr); decline in the peak level of coronary blood flow (CBF) produced by intense vasodilatation induced by intracoronary infusion of ATP (CBFATP); and (3) segmental left ventricular (LV) dysfunction.

Failure of red blood cell transfusion to increase oxygen transport or mixed venous PO2 in injured patients.

Post-trauma patients have an oxygen consumption which is proportional to oxygen delivery, suggesting that tissue oxygen consumption is limited by diffusion. Transfusion of packed red blood cells (RBC), which increases the oxygen-carrying capacity of blood, would be expected to increase mixed venous PO2, thereby improving tissue oxygenation. However, the low P50 of stored blood may increase the affinity of hemoglobin for oxygen and reduce oxygen consumption.

Serial thallium-201 myocardial imaging after dipyridamole infusion: diagnostic utility in detecting coronary stenoses and relationship to regional wall motion.

After a 4-minute i.v. dipyridamole infusion, 0.

Inosine: a protective agent in an organ culture model of myocardial ischemia.

Fetal mouse hearts in organ culture provide a model of ischemic-like injury in which the myocardial protective effect of pharmacological agents can be studied independent of blood flow. To investigate the potential protective effect of a diffusable purine under ischemic-like conditions, we used 4 mM inosine in fetal mouse heart organ cultures deprived of oxygen and oxidizable substrates for 1-10 hours. We studied hearts (n = 258) immediately after simulated ischemia (early) and after a 20-hour recovery period (late), by utilizing three indices of myocardial viability.