Noninvasive measurement of femoral artery pressure for evaluating aortoiliac occlusive disease

Femoral systolic pressures measured by a compression technique (FSCP), were compared with proximal thigh systolic pressures (PTSP), for evaluation of aortoiliac occlusive disease. In phase I FSCP were measured by compressing the artery with a pressure cuff rolled into a cylinder and using disappearance of the profunda femoris Doppler signal (FSCP-D), or flattening of thigh plethysmographic waveforms (FSCP-P), as sensors. In normal extremities the compression techniques yielded false high values. The mean ratio of FSCP-D to brachial systolic pressure, FSCP-D/BSP, was 1.25 +/- 0.06 and the mean FSCP-P/BSP was 1.37 +/- 0.15, a value approximately equal to the mean PTSP/BSP, 1.38 +/- 0.20. In patients with aortoiliac occlusive disease linear regression analysis revealed a good correlation between FSCP-D/BSP and direct intraoperative measurements of femoral/aortic systolic pressure, FSP/ASP, (R = 0.79 and R2 = 0.63), a fair correlation between FSCP-P/BSP and FSP/ASP (R = 0.49, R2 = 0.24) but a poor correlation between PTSP/BSP and FSP/ASP (R = 0.35, R2 = 0.12). In phase II studies a soft bladder was used for arterial compression. In normal extremities the mean FSCP-D/BSP was 1.07 +/- 0.06, close to the predicted normal value of 1.00. In a second group of patients with occlusive disease a better correlation was observed between values of FSCP-D/BSP and FSP/ASP (R = 0.91, R2 = 0.82), than any of the correlations of noninvasive measurements with direct intraoperative values of FSP/ASP obtained in the first phase of the study.     

Bronchoprovocation: effect on priming and desensitization phenomenon in the lung.

Priming, or increased sensitivity to antigen, has not been demonstrated in the lung and could play a role in asthmatic symptomatology during seasonal pollen exposure. It is also an important consideration in the design of any experimental protocol requiring serial bronchoprovocations with antigen. Thirteen patients with a history of asthma symptoms during the pollen season and a positive skin test to ragweed extract were selected. Patients were given bronchial challenge out of season on 4 successive days with stepwise inhalations of antigen, and airways conductance was monitored in the body plethysmograph. Antigen dose-response curves were drawn, and the cumulative dose required for a 35% reduction in specific airway conductance was calculated and designated Provocation Dose (PD35). No regular trend toward either priming or desensitization was noted. The daily changes in antigen sensitivity did not correlate with daily variation of baseline pulmonary function. To determine if there was any priming due to natural exposure to pollen, 9 patients were brought back and rechallenged during the pollen season with no significant increase in bronchial sensitivity to ragweed extract. The PD35 method provides figures useful for comparing dose-response curves and shows a one-log variation from day to day. Any evaluation by bronchial challenge of antigen sensitivity or drug efficacy must take into account such variation.     

Specific questionnaires in medical practice. Review of a 12-year experience

Specifically targeted questionnaires are relatively easy to design, both for a specific disease and for a specific physician's practice. Patients generally enjoy using them, and their use can provide a better history and medical record, help avoid legal problems, and save physician time.     

Glenn Shunt: Long-Term Results and Current Role in Congenital Heart Operations

Fifty cyanotic patients (aged 2 days to 22 years) underwent Glenn shunts for tricuspid atresia and other cyanotic heart defects. Thirteen of 15 operative deaths occurred in infants less than 4 months old, and only 1 death has occurred in the last 9 years. Results were poor in patients with Ebstein's anomaly, truncus arteriosus, transposition of the great vessels, and complex defects other than tricuspid atresia and univentricular heart.Of the 35 patients followed from 0.9 to 14.8 years, 12 were followed for more than 10 years. None of the 11 late deaths could be attributed to complications of the shunt. Minimal evidence of intrapulmonary shunting was found by angiography, pulmonary venous oximetry, or radioisotopic studies. Late deterioration due to venous collaterals and decreased flow to the opposite lung necessitated Blalock-Taussig shunts in 6 and Fontan procedures in 10. All survived the Fontan procedures with minimal morbidity.These data support the concept that Glenn shunts do not necessarily result in pulmonary abnormalities and may be indicated as a staged procedure in a few selected patients prior to a Fontan procedure.     

Effect of thyroidectomy and thyroxine on 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) induced toxicity

Chemical thyroidectomy effectively protected athyroid rats from mortality during 45 days after dosing with 100 micrograms 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD)/kg, whereas 70 to 80% of nonthyroidectomized-euthyroid and thyroidectomized-T4 (thyroxine)-maintained-euthyroid rats died within the same period of time. There was a significant decrease in body weight of all TCDD-treated groups compared to vehicle controls. However, body weight loss was much slower in thyroidectomized-athyroid (congruent to 1 g/day) than in nonthyroidectomized-euthyroid or in thyroidectomized-T4-euthyroid (congruent to 8 g/day) rats. TCDD significantly reduced feed intake in nonthyroidectomized-euthyroid and thyroidectomized-T4-euthyroid rats, but no altered feed consumption was observable in thyroidectomized-athyroid animals. These data indicate that thyroid hormone(s) play(s) an important role in mediating the toxicity of TCDD.     

The effect of allopurinol on the degree of early myocardial ischemia

The effect of allopurinol on the size of ischemic injury was evaluated following ligation of the left anterior descending coronary artery (LAD) in 37 open-chest dogs. Heart rate, aortic blood pressure, left ventricular pressure, cardiac ouptut, and total peripheral resistance were continuously monitored. Arterial blood was obtained and analyzed for electrolytes, enzymes, uric acid, total inorganic phosphates, lactate, and pyruvate before and after two hours of LAD ligation. At two hours, the hearts were perfused with fluorescein dye to delineate the flow/no flow areas of the excised cross-section myocardium. Planimetry and section thickness were used to calculate the volume of ischemic myocardium.Heart rate and cardiac output were higher and peripheral resistance was lower at baseline and two hours after ligation in the allopurinol intravenously pretreated dogs than in controls. Uric acid was significantly lower at baseline and two hours after LAD ligation and lower levels of total inorganic phosphate, calcium, and magnesium were present at two hours after ligation. The stained cross-sectioned hearts showed that the control and postligation allopurinol treated animals had respective ischemic areas of 19.42% and 21.56% of the total myocardium below the section of the LAD ligation obtained perpendicular to the long axis of the heart. In contrast, animals pretreated with allopurinol, whether orally or intravenously, showed 14.19% and 12.28% ischemic areas, respectively. The latter represented 36.74% less (p < .005) than in the control group. Postmortem angiographic studies performed on hearts from each group demonstrated collateral connections to the distal LAD in the allopurinol intravenously pretreated group and an absence of open collaterals in the control group.The study suggests that allopurinol pretreatment has a protective effect on the ischemic myocardium. This is probably due to opening of coronary collaterals either by direct vasodilatory action or by maintaining locally high levels of adenosine by enzyme inhibition which in turn acts as a vasodilator.     

The dexamethasone suppression and thyrotropin-releasing hormone tests in depressed borderline patients

Borderline patients can be both a diagnostic and a therapeutic enigma. We investigated a group of 24 depressed women with borderline personality disorder or strong borderline features by DSM III criteria for the presence of either an abnormal dexamethasone suppression test (DST) or a blunted TSH response to TRH, abnormalities which have been reported in major depression. Thirteen of the 24 borderlines failed to suppress on the DST, compared with one of 14 normal women (p < 0.01). Nine of the 24 borderlines had a blunted TSH response to TRH, compared with one of 11 normal women. Neuroendocrine abnormalities were found in a total of 75% of the borderline women, independent of whether or not they met DSM III criteria for major depressive disorder. The results of this study support the notion that many borderline patients with depression have a genuine affective component to their illness, perhaps biologically similar to major depression in non-borderlines.