Left atrial mass: diagnostic value of transesophageal 2-dimensional echocardiography and indium-111 platelet scintigraphy.
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Biomedical subjects
Publications and source records attributed to L H Harrison.
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A paralytic disease in swine was observed on three farms located in the same geographical area of Georgia. Postmortem examinations revealed the paralysis to be related to spinal poliomalacia. Feed collected from two of the affected farms was used in a feeding study, and the paralytic condition was reproduced. In pigs from both the feeding trial and field cases, the poliomyelomalacia was characterized by focal, symmetrical lesions located in the cervical and lumbar intumescences. Selenium was detected in the feed at levels ranging from 19 to 24 ppm.
In a study comparing indium-111 platelet scintigraphy and two-dimensional echocardiography as methods of identifying left ventricular thrombi, the results obtained with both techniques were verified at surgery or autopsy in 53 patients--34 with left ventricular aneurysms, and 19 with mitral-valve disease. Left ventricular thrombi were found at surgery or autopsy in 14 of the patients with aneurysms and in none of those with mitral-valve disease. Thirteen of 53 echocardiograms (25 per cent) were technically inadequate and excluded from the analysis. In the group with aneurysms, the sensitivity of scintigraphy in detecting thrombi was 71 per cent, and that of echocardiography was 77 per cent. The specificity of scintigraphy was 100 per cent, and that of echocardiography was 93 per cent. We conclude that indium-111 platelet scintigraphy and two-dimensional echocardiography have useful and complementary roles in the detection of left ventricular thrombi. Both these noninvasive techniques can be used to monitor therapy.
Twenty-five low birth weight, premature neonates who were refractory to aggressive medical management underwent ligation of symptomatic patent ductus arteriosus. The mean birth weight was 1,007 g and the mean gestational age 29 weeks. Six patients (24 percent) died before discharge, two from continued cardiorespiratory failure. Echocardiography showed significant improvement in left atrial and left ventricular dimensions after ligation. In the premature neonate with respiratory distress and congestive heart failure refractory to aggressive medical management, surgical ligation may be accomplished with an acceptable hospital mortality in very low birth weight infants.
Analysis of 18 patients who suffered recurrent urolithiasis after anatrophic nephrolithotomy is presented. These patients form a subgroup of 80 patients who underwent 100 consecutive extensive anatrophic nephrolithotomies between 1967 and 1972. Careful documentation of the 18 patients who had recurrent calculi was done in an effort to delineate the causative factors. The recurrence interval varied from less than 6 months to more than 8 years during an over-all followup period of 9.94 years. Marked differences in the characteristics between 14 male and 4 female patients were noted. In the male patients a significant relationship among recurrent staghorn calculi, anomalous urinary drainage and Pseudomonas urinary tract infections was noted. The female patients had recurrent or persistent urinary tract infections or undiagnosed metabolic problems as the primary reason for the recurrent urolithiasis.
Technical advances in cardiac surgery have made accessible previously remote regions within the heart and great vessels; nevertheless, limitations in the ability to locate intramyocardial foreign bodies with precision utilizing conventional radiographic techniques, together with the frequent inability to palpate a foreign body located within the walls of the heart chambers, has dampened early enthusiasm for their removal. Despite this, the recognized complications associated with nonoperative management continue to militate for an aggressive approach. The following case illustrates the use of operative high-frequency ultrasonography in the exact localization of an intramyocardial foreign body. The precision thus afforded minimizes operative time, confines the size of the necessary ventriculotomy, and greatly facilitates successful removal.
A comparison of povidone-iodine to a placebo gel as urinary catheter lubricants focused on the effects of urethral bacterial counts and on patient comfort. The 50 patients were divided into 2 parallel groups in a single blind study. Both lubricants lowered the bacterial counts, with the reduction achieved by povidone-iodine gel significantly greater than the reduction associated with the placebo (p less than 0.02). The numbers of patients experiencing discomfort from the 2 preparations did not differ nor was there any difference in the degree of discomfort, which was minimal for both groups. No other adverse side effects were reported for either lubricant.
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This report defines the incidence of variations in the renal vascular pedicle in a group of patients with normal renal function as determined by standard laboratory criteria. The study group consisted of 166 patients undergoing renal arteriography as potential renal allograft donors. Ninety-seven patients were male and 69 were female. Ages ranged from 18-54 years, median age being 37 years. All patients underwent preliminary screening tests including blood chemistries, creatinine clearance, urinalysis, culture and excretory urography. If these studies were normal, renal arteriography was performed utilizing flush aortogram and, in 20% of cases, selective renal arteriography. The most common anomaly was the presence of multiple renal arteries supplying the same kidney, occurring in 32% of cases. Prehilar segmental branching was the second most common variation, occurring in 17% of patients. Other variations included fetal lobulation (4%), significant stenosis at origin of the renal artery (2%), fibromuscular dysplasia (2%), microaneurysms (0.5%), true aneurysms (1%) and dromedary hump (0.5%). Less than one-half of the patients demonstrated the simplest vascular pedicle, namely, single artery and vein bilaterally. The incidence of anatomical variations in the renal vascular pedicle is greater than attributed to normal subjects in previous reports. Anomalies determine the choice of kidney in renal allografting and may disqualify a potential donor, even in the face of ostensibly normal renal function. Routine arteriography should be considered a standard prerequisite in the evaluation of potential living related renal donors.
A randomized prospective study was carried out comparing the recommended dose of amikacin sulfate (Amikin) (15 mg./Kg.) with a lower dose (7.5 mg./Kg.) in the treatment of complicated urinary tract infections. A total of 50 patients were entered in the study over a period of sixteen months. Bacteriologic results were comparable in both groups. Laboratory values remained normal with the exception of 1 patient in the high-dose group who had renal insufficiency. No evidence of ototoxicity was recorded. Our data indicate that low dosage amikacin sulfate is satisfactory in the treatment of complicated urinary tract infections.
A randomized prospective study was done, comparing massive penicillin dosage (60 million units) to the recommended dose of ticarcillin (200 mg. per kg.) in the treatment of complicated urinary tract infections. A total of 50 patients with staghorn or multiple calculi who underwent anatrophic nephrolithotomy was entered into the study during a period of 14 months. Bacteriologic results were comparable. No significant toxicity from either massive penicillin or ticarcillin was observed.
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During the past 75 years much progress has occurred in the field of vascular surgery. During this period, contributions from clinical surgeons have stimulated new scientific discoveries which have led to further clinical applications in a mutually perpetuating cycle of surgical advancement. One of the major achievements has been the use of the venous autograft employed as an arterial substitute. First used by Goyanes in 1906 to replace a popliteal aneurysm, a venous autograft was first successfully employed in the United States by Bernheim in 1915. The stepwise development of this aspect of modern vascular surgery is presented, and the role of other related contributions in making its use feasible is reviewed.
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Despite numerous clinical reports of coronary artery fistulas, there have been no laboratory models. A circumflex coronary-pulmonary artery fistula was constructed with a vein graft in 11 adult foxhounds. A temporary intravascular shunt obviated the need for cardiopulmonary bypass. Measurements of aortic flow, arterial pressure, left ventricular pressure and its derivative, heart rate, and flow in the proximal coronary, distal coronary, and fistula were made with the fistula open and closed in 9 animals. Mean fistula flow was 89 c.c. per minute, representing a 1.1:1 left-to-right shunt. Mean proximal coronary flow increased 211 per cent, and there was a relative steal of 26 per cent of distal coronary flow with the fistula functioning. Phasic flow patterns showed continuous systolic and diastolic flow in the proximal coronary artery and fistula. Despite the striking changes in coronary flow patterns, there was no significant effect on measured left ventricular function. Futher uses for this model and variations of it aresuggested.
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