Showing papers by "Howard Hughes Medical Institute published in 1968"

Uremic Pericarditis Clinical Features and Management

Abstract: Uremic pericarditis occurred in 41% of 83 patients admitted to the chronic dialysis program at the Peter Bent Brigham Hospital. In the vast majority of these patients the pericarditis was present before dialysis and cleared clinically after beginning therapy. Instances of pericarditis that developed during regular dialysis were associated with metabolic stress such as surgery or infection or inadequate dialysis. When the pericarditis failed to resolve the patients usually died with sepsis or had severe tamponade which necessitated early pericardiectomy. The two cases reported illustrate resorption of massive pericardial effusions with dialysis. The utility of percutaneous pericardial catheterization as a treatment for uremic pericardial tamponade is demonstrated.

The Apexcardiogram in Myocardial Asynergy

Abstract: The apexcardiogram was analyzed in 41 patients with an altered pattern of left ventricular contraction. Four types were distinguished: type I, an early sustained systolic bulge which occurred in 12 patients, all of whom had large aneurysms and large enddiastolic volumes; type II, a bulge confined to midsystole which occurred in 13 patients, 11 of whom had some form of ventricular asynergy; type III, a late or end-systolic bulge which occurred in 12 patients, seven of whom had ventricular asynergy; type IV, a prominent spike during diastolic filling which occurred in four patients who had large zones of ventricular asynergy.

Control of Postcardiac Surgical Tachycardias with Propranolol

Abstract: Twenty-two patients manifesting arrhythmias refractory to conventional therapy have been treated with propranolol 1 to 19 days after cardiac surgery. Rapid control of ventricular response to supraventricular arrhythmias, abolition of ventricular irritability caused by digitalis excess, and frequent conversion of acute atrial fibrillation or flutter were attained. Control of the arrhythmia was achieved in all but one instance. No significant side effects were encountered, although the potential risks of propranolol are stressed. Propranolol appears to fill specific needs unsatisfied by standard therapy for arrhythmias developing after cardiac surgery.

Influence of a Defoaming Agent upon the Hematological Complications of Pump Oxygenators

Abstract: Measurements of plasma hemoglobin values were made at many different sites of a Cross-Kay disk pump oxygenator during extracorporeal bypass in patients undergoing reparative valve surgery. Hemoglobin values were always higher in the line of the aspirator and defoaming chamber than in any other part of the system. Sampling immediately proximal and distal to the defoaming chamber revealed significant increases in plasma hemoglobin values as a result of the defoaming process. Studies of the hematological effects of the defoaming agent, polymethylsiloxane, which coats the disposable stainless steel sponge in the defoaming chamber, showed it greatly reduced the resistance of red cells to lysis by mechanical trauma. Similar studies of plasma showed the hemolytic effects of the defoaming agent are to some extent mediated by the plasma. It is concluded that the widely used defoaming agent, polymethylsiloxane, contributes to the hemolytic action of the bubbling, suctioning, and defoaming processes during open heart surgery. The addition of a water soluble surfactant material, that stabilizes emulsions (Pluronic F68), blocked or prevented the hemolytic process without interfering with the action of the antifoam material.