Comparison of segmental and global ejection fraction in ischaemic heart disease.

In order to evaluate whether segmental ejection fraction (SEF) is a better index of left ventricular (LV) performance than global ejection fraction (EF), 25 patients with significant coronary stenosis and normal EF were studied. SEF was estimated from the LV cineangiogram after dividing the LV into eight segments by means of a long axis and three equally spaced chords perpendicular to it. The area of a given segment was measured in the end-diastole and the end-systole and SEF was calculated by determining the percent decrease in area for each segment. 12 out of the 25 patients presented hypokinesis, akinesis or dyskinesis of at least two segments; the inferior apical and both diaphragmatic segments were the regions most frequently affected. In 7 patients, these abnormalities were compensated by hyperkinesis of two or three other segments, whereas in the remaining 5 patients contraction abnormalities were not accompanied by hyperkinesis in spite of a normal EF. It is concluded that SEF is a more sensitive index of regional LV function than EF in patients with ischaemic heart disease.

Signos diagnosticos de bloqueos fasciculares izquierdos durante la coronariografia selectiva. / Diagnostic signs of left fascicular blocks during selective coronariography

Se realizo un trabajo prospectivo en el Instituto de Cardiologia y Cirugia Cardiovascular sobre la revaloracion de los signos diagnosticos de los bloqueos fasciculares izquierdos durante la coronariografia selectiva derecha e izquierda.Se efectuaron 100 estudios, 388 inyecciones en el sistema arterial coronario, en pacientes con entidades adquiridas y congenitas, con vasos normales u obstruidos en grado variable. Se estudiaron cinco derivaciones electrocardiograficas, continuas y simultaneas, durante cada inyeccion. Resultaron signos muy utiles: la mayor duracion del complejo QRS, el aumento del indice de White-Bock, la prolongacion de la deflexion intrinsecoide, los criterios espaciales y de morfologia y la desviacion absoluta o relativa del AQRS.Los vectores iniciales del QRS no siempre se modificaron.Fueron frecuentes las variedades incompletas

Aritmias cardiacas durante la coronariografia selectiva. / Cardiac arrhythia during selective coronariography

Se realizo un trabajo prospectivo en el Instituto de Cardiologia y Cirugia Cardiovascular, acerca de las arritmias cardiacas de formacion, de conduccion, o de ambas, durante las coronariografias selectivas derecha e isquierda. Se efectuaron 100 estudios, 388 inyecciones en el sistema arterial coronairo, en pacientes con entidades adquiridas y congenitas, con vasos normales u obstruidos en grado variable.Se estudiaron cinco derivaciones electrocardiograficas, continuas y simultaneas, durante cada inyeccion. La frecuencia cardiaca disminuyo en el 92% de los pacientes la bradicardia y las pausas sinusales fueron hallazgos frecuentes, generalmente seguidas de escapes auriculares y excepcionalmente unionales. El bloqueo fascicular izquierdo se presento en el 86% de los estudios y casi en su totalidad existio fenomeno de Wenckebach en los fasciculos como expresion de bloqueos de grado menor.Otras arritmias cardiacas fueron: extrasistolia ventricular y supraventricular; taquicardia sinusal; sindrome de prexcitacion ventricular; trastornos auriculoventriculares; y otras. La fibrilacion ventricular fue excepcional; no existio actividad repetitiva a pesar de la frecuencia cardiaca enlentecida y del alargamiento del intervalo QT = VM. Se realizaron analisis estadisticos

Aritmias cardiacas durante la coronariografia selectiva. / Cardiac arrhythmia during selective coronariography

Se realizo un trabajo prospectivo en el Instituto de Cardiologia y Cirugia Cardiovascular, acerca de las arritmias cardiacas de formacion, de conduccion, o de ambas, durante las coronariografias selectivas derecha e isquierda. Se efectuaron 100 estudios, 388 inyecciones en el sistema arterial coronairo, en pacientes con entidades adquiridas y congenitas, con vasos normales u obstruidos en grado variable.Se estudiaron cinco derivaciones electrocardiograficas, continuas y simultaneas, durante cada inyeccion. La frecuencia cardiaca disminuyo en el 92% de los pacientes la bradicardia y las pausas sinusales fueron hallazgos frecuentes, generalmente seguidas de escapes auriculares y excepcionalmente unionales. El bloqueo fascicular izquierdo se presento en el 86% de los estudios y casi en su totalidad existio fenomeno de Wenckebach en los fasciculos como expresion de bloqueos de grado menor.Otras arritmias cardiacas fueron: extrasistolia ventricular y supraventricular; taquicardia sinusal; sindrome de prexcitacion ventricular; trastornos auriculoventriculares; y otras. La fibrilacion ventricular fue excepcional; no existio actividad repetitiva a pesar de la frecuencia cardiaca enlentecida y del alargamiento del intervalo QT = VM. Se realizaron analisis estadisticos

Signos diagnosticos de bloqueos fasciculares izquierdos durante la coronariografia selectiva. / Diagnostic signs of left fascicular blocks during selective coronariography

Se realizo un trabajo prospectivo en el Instituto de Cardiologia y Cirugia Cardiovascular sobre la revaloracion de los signos diagnosticos de los bloqueos fasciculares izquierdos durante la coronariografia selectiva derecha e izquierda.Se efectuaron 100 estudios, 388 inyecciones en el sistema arterial coronario, en pacientes con entidades adquiridas y congenitas, con vasos normales u obstruidos en grado variable. Se estudiaron cinco derivaciones electrocardiograficas, continuas y simultaneas, durante cada inyeccion. Resultaron signos muy utiles: la mayor duracion del complejo QRS, el aumento del indice de White-Bock, la prolongacion de la deflexion intrinsecoide, los criterios espaciales y de morfologia y la desviacion absoluta o relativa del AQRS.Los vectores iniciales del QRS no siempre se modificaron.Fueron frecuentes las variedades incompletas

Segmental ejection fraction in normal subjects.

Following a modification of the area method described by Gelberg et al., left ventricular regional wall motion was studied in 30 normal subject. The left ventricular cineangiograms were filmed in the right anterior oblique projection at 48 frames/s after injection of 76% sodium-meglumine diatrizoate. The end-diastolic and end-systolic frames were each divided into 8 regions using a grid formed by longitudinal axis, which was traced from the midpoint of the aortic valve to the apex, and three equally spaced perpendiculars to the long axis. Segmental ejection fraction was estimated by determining the percent decrease in each segment area in end-systole with respect to the end-diastolic area. The mean values +/- S. D. obtained for each segment were: anterobasal 58 +/- 14%; anterolateral-proximal 59 +/- 6%; anterolateral-distal 58 +/- 4%; apical-superior 59 +/- 8%; apical-inferior 58 +/- 7%; diaphragmatic-distal 58 +/- 9%; diaphragmatic-proximal 55 +/- 6%; and posterobasal 42 +/- 15%. The values obtained are useful for comparison when evaluating left ventricular performance in patients.

Diagnosis of pancreatic abscess via percutaneous aspiration.

UNLABELLED: The pre-operative diagnosis of a pancreatic abscess was not considered in a comprehensive review in 1972. However, advances in technology (Ultrasound--US, Computed Tomography--CT) has allowed guided percutaneous needle aspiration (PNA) of suspected pancreatic lesions. The purpose of this study was to evaluate the safety and diagnostic ability of PNA to differentiate acute pancreatic inflammatory masses from pancreatic abscess (PA). Thirteen patients underwent PNA after US or CT revealed an acute pancreatic inflammatory mass (12/13 cystic). One patient underwent a second aspiration. Clinical features T degrees--101.3 degrees F mean (13/13), leukocytosis 14,400 cu/mm (11/13). Aspirated material was gram-stained and examined for bacteria and leukocytes and cultured. RESULTS: PNA was accomplished successfully in all patients. Aspirate revealed bacteria in nine and pancreatic abscess was confirmed at surgery (8) or post-mortem exam (1). Four of five patients in whom no bacteria were visualized had medical resolution, the fifth had continued T degree and underwent a second aspiration which diagnosed a PA. PA contained moderate to large number of PML via aspiration. CONCLUSIONS: PNA provides a potentially important and safe diagnosis adjunct to earlier accurate differential diagnosis of pancreatic inflammatory masses from pancreatic abscess.

Therapeutic percutaneous aspiration of pancreatic pseudocysts.

The therapeutic efficacy and safety of percutaneous aspiration of chronic pancreatic pseudocysts was evaluated. Eight patients underwent aspiration a total of ten times. Permanent resolution was obtained in two patients and a third nonsurgical candidate was offered an alternative therapeutic modality. This procedure is simple, rapid, and safe and could become the initial approach to selected patients with a chronic pancreatic pseudocyst.

Progressive enlargement of an hepatic cell adenoma.

Over a 5-mo period, an hepatic cell adenoma was noted to increase considerably in size, despite discontinuation of oral contraceptives. Progressive tumor enlargement was documented by hepatic angiography, computed tomographic scan (CT scan) of the liver and 99mTc liver scan. The repeat hepatic angiogram also revealed that the tumor had become more vascular. Multiple adenomas were in fact seen by all three techniques mentioned above. At surgery, seven hepatic cell adenomas were demonstrated, of which four were resected.

Double-ended pigtail ureteral stent: useful modification to single end ureteral stent.

A newly created ureteral stenting catheter of double-ended pigtail design is introduced. The pigtail design at both ends maintains the catheter in place by serving as a solid anchoring device, both intravesically and within the renal pelvis; upward or downward migration of the stent is thus prevented. It is designed also to minimize trigonal irritation. The catheter can be introduced easily either cystoendoscopically or through a percutaneous antegrade route, or by a combination of both methods. It offers the additional advantage of being readily available from an inexpensive stock source; it may be quickly and easily custom made and shaped for any ureter by the physician immediately prior to its insertion. It thus avoids having to have premanufactured, more expensive ureteral stents of different lengths. Open surgery for upper urinary tract decompression can thus be avoided.

Relief of malignant obstructive jaundice by percutaneous insertion of a permanent prosthesis in the biliary tree.

Twelve patients with malignant obstruction of the biliary tree were treated by dilating the lesion percutaneously and inserting an internal large-bore teflon prosthesis in place bridging the the stricture. All 12 patients had unresectable neoplasms. The procedure was devised because existing modes of palliation using surgical techniques are associated with significant mortality or mobidity. There are also many problems with nonsurgical catheter drainage. Decompression was achieved in all 12 patients as shown radiographically by passage of contrast into the duodenum. Disappearance of pruitus was achieved in seven of seven patients, and in 10 of 12 disappearance of jaundice (bilirubin, before prosthesis, 18.4 +/- 4.5 mg/dl [mean +/- 1 SD], bilirubin 1 month after prosthesis, 1.8 +/- 0.6 mg/dl [mean +/- 1 SD], P less than 0.001) with improvement of general clinical status was achieved. Percutaneous placement of a permanent biliary tract prosthesis is safe and effective for the palliative decompression of malignant biliary tract obstruction.

Jaundice, choledocholithiasis, and a nondilated common duct.

In two cases of jaundice due to choledocholithiasis, the biliary tree was not dilated on skinny-needle transhepatic cholangiography. Visualization of the biliary tree before arriving at a diagnosis in certain cases of jaundice is needed.

Fluoroscopically guided thin needle aspiration biopsy of the abdomen and retroperitoneum.

The results of 49 transabdominal and translumbar thin needle percutaneous aspiration biopsies in patients suspected of having malignant disease are reported. A correct diagnosis was obtained in 40 cases. Placement of the Chiba needle was accomplished by fluoroscopically controlled biplane radiography during constrast examinations. No complications were encountered. The technique allows cytologic diagnosis of malignancy without high risk exploratory surgery, prolonged hospitalization, or delay of treatment. Use of fluoroscopic needle guidance and biplane radiography for confirmation of position using various contrast examinations as markers is felt to be superior to either CT or ultrasound. The technique is readily available in all radiology departments.

Rapid diagnosis of obstructive jaundice due to pancreatic abscess with pancreaticobiliary fistula.

A case of pancreatic abscess with pancreaticobiliary fistula manifesting as obstructive jaundice of occult etiology is presented. Diagnosis was made preoperatively by skinny needle percutaneous transhepatic cholangiography. In addition, a communication between the biliary tree and the pancreatic abscess cavity was demonstrated in the absence of previous biliary surgery or primary biliary tract disease. We feel this is the procedure of choice for emergency visualization of the biliary tree in a jaundiced patient where a surgically approachable lesion is suspected.

A new technique for transhepatic liver tract dilatation. An aid in transhepatic portography.

Transhepatic portography is frequently difficult or unsuccessful in cirrhotic patients because of catheter friction by the fibrotic liver and the presence of ascites. The authors describe a technique of liver tract dilatation which circumvents these difficulties.