[Feasibility of tetrapolar impedance plethysmography to determine regional pulmonary ventilation].
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Biomedical subjects
Publications and source records attributed to I Daskalov.
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The authors have studied 86 patients with staghorn calculi who underwent preoperative quantitative renal scintigraphy. 50 of them (63 kidneys) had one or two follow-up scans between 1 and 9 years after the operation. These scintigraphic data were compared with those of I.V.U. These 50 patients had undergone surgery on 60 kidneys (12 pyelotomies only, 26 pyelotomies associated with limited nephrotomies, 18 extended nephrotomies and finally 4 bi-value nephrotomies). In 46 of these patients, the urine became definitively sterile and there was no recurrence of lithiasis in any of them. These quite exceptional conditions were such that it is possible to bear in mind only the operative technique in assessing the possible harmful consequences of each type of operation. The authors clearly show that the threat to function of the kidney which has been operated upon is more threatened when there has been a nephrotomy and when such a nephrotomy has been more extensive. A limited nephrotomy is associated with a mean loss of (% of renal function. Extended nephrotomies or more than 3 cm result in a loss of function of approximately 22%. Large bi-value nephrotomies result in a 36% loss of function. Simultaneous study of scintigraphic scans and I.V.U. revealed that a loss of 1 cm in height of the renal parenchyma corresponds to a functional loss of 10% as determined by scintigraphy. Of basic importance is the fact that the impairment caused by nephrotomies remains stable and does not worsen with the passage of time.
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The authors determined the minute heart volume, according to Fick method with right cardiac catheterization of 20 healthy youths. With the comparison of the results obtained, the differences were within the limits of +/- 10, and in almost half of the examined-- +/- 5%. The relatively small discrepancies in the values obtained, suggest that the impedence-method proves to be a reliable method for bloodless determination of minute heart volume.
The authors realized synchronous records of impedance--cardiogram with PCG, ECG and the curves of the pressure within the separate cardio-vascular segments. That enables them to make a phase characteristic of the separate parts of impedance-cardiographic curve, thus establishing that the latter is synchronized with the mechanics of the left ventricle.
The authors draw the attention to certain technical details in recording the impedance cardiography and the reading of the records, being of essential importance for the method accuracy. A new method is proposed for the measuring of (dZ/dt) min and T. Seventy healthy subjects were examined. The reliability of impedance cardiography in the determination of stroke volume (gammacardiographic controls) and the significance of the method for the dynamic follow up of cardiac and pulmonary state are discussed.
Ureteral ruptures in children are more frequent because of the inadequate support provided by the retroperitoneal tissue and consequent mobility of the kidney. The authors have noted a new observation concerning trauma of the subpyelar segment of the ureter in a 9 year old boy. The diagnosis was established three days following the injury with the aid of intravenous urography. The defect was repaired with surgery in which a termino-terminal anastomosis was performed. Renal angiography is of little help in discovering ureteral lesions. Whereas retrograde pylorography can be helpful in such a case. The early diagnosis and reparation immediately following the injury gives the best results, whereas late reparation of such a lesion can lead to a halt in renal function. The authors believe that intravenous urography is one method which can help in making an early diagnosis and should always be used in trauma cases presenting macro and microhematuria.
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After a brief discussion on the basis of the dilution method for determination of telediastolic volume (TDV) of the ventricles, the authors described the results from their own experimental studies on 8 nonbred dogs, on whom 186 curves of indicator "washing" (of the dye "Cardiogreen" were recorded, presented on 2 tables. The results showed that the measurements should be made by means of the later steps of the curves. TDV and accordingly the relative stroke volume of both ventricles differed slightly. The smaller values, according to the authors, of TDV of the left ventricle in comparison with the right ventricle revealed that the size of the relative stroke voluem depended both on the mechanism of Starling and on the contractility of the ventricles.
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