Alcohol-induced bronchospasm

A case of alcoholic beverage sensitivity is described which presented as acute bronchospasm. Such reactions in asthmatics are not uncommon, though their severity may be underestimated in the presence of intoxication. Indeed, such patients may be dismissed as suffering only from the effects of intoxication with obvious consequences.

Brain enzyme levels in CSF after cardiac arrest and resuscitation in dogs: markers of damage and predictors of outcome

Levels of brain creatine kinase (CK), aspartate aminotransferase (ASAT), and lactate dehydrogenase (LD) in CSF after cardiac arrest were studied in dog models. Ventricular fibrillation cardiac arrest lasting 10 min or asphyxiation cardiac arrest lasting 0-10 min was followed by cardiopulmonary resuscitation and 96-h intensive care. Outcome was scored as neurologic deficit (0% = normal, 100% = brain death) and overall performance category (1 = normal, 5 = death). Both measures correlated with EEG return time after asphyxiation cardiac arrest, but not after ventricular fibrillation cardiac arrest. Peak activity of enzymes in CSF at 48-72 h post arrest correlated with outcome, and CK was the best predictor. Brain histopathologic damage score at autopsy 96 h post arrest correlated with CK level in CSF (r = 0.79, n = 39) and neurologic deficit (r = 0.70, n = 50). Ischemic neuronal changes occurred after ventricular fibrillation cardiac arrest of 10 min, and neuronal changes plus microinfarcts occurred after asphyxiation cardiac arrest of 1.5-10 min. Brain enzymes were decreased at 6 h post arrest in regions with worst histologic damage (gray matter of neocortex, hippocampus, caudate nucleus, cerebellum). Brain CK decreased further, ASAT remained low, and LD increased at 72 h after arrest. The temporal changes in CK level paralleled the temporal ischemic neuronal changes in the brain, and time to peak activity was unaffected by the severity of the ischemic insult. Peak activity of individual enzymes in CSF was determined predominantly by the brain concentration, but was also influenced by rate of decomposition. This "chemical brain biopsy method" represents a useful adjunctive tool to predict permanent, severe brain damage during comatose states after cardiac arrest and resuscitation.

Cyclosporin A inhibits proteolytic cleavage and degradation of membrane-bound protein kinase C in hepatocytes after stimulation by phorbol ester

Stimulation of hepatocytes by the tumor promoter phorbol 12-myristate 13-acetate (PMA) caused translocation of cytosolic Ca2+/phospholipid-dependent protein kinase C (PK-C). The major part of PK-C activity (greater than 80%) was associated with the membrane fraction after 30 min. During the following 6 h protein kinase C activity decreased to less than 10%. Minor amounts of Ca2+/phospholipid-independent PK-C activity were found in the cytosol fraction at all times; they temporarily increased 2.5-fold with PMA and decreased after 1 h. Cyclosporin A did not affect the translocation of PK-C from the cytoplasm to the membrane fraction, but the decrease of PK-C activity following translocation was blocked. No marked increase of Ca2+/phospholipid-independent PK-C activity was observed in the cytosol in the presence of cyclosporin A. Leupeptin, which is known to inhibit Ca2+-requiring non-lysosomal proteinases (e.g. calpain), showed an effect similar to cyclosporin A. Both agents reduced proteolytic degradation of cellular proteins observed in isolated hepatocytes after PMA treatment. Ca2+-ionophore A23187 in high doses (greater than 10(5) M) partly reversed cyclosporin A and leupeptin action.

Altered Electron Flow in Continuous Cultures of Clostridium acetobutylicum Induced by Viologen Dyes

The physiological response of Clostridium acetobutylicum to methyl and benzyl viologen was investigated. Viologen dyes at low concentrations (at levels of parts per million [micrograms per milliliter]) caused significant metabolic shifts. Altered electron flow appeared to direct carbon flow from acid to alcohol production accompanied by decreased hydrogen evolution. Reducing equivalents normally released as free hydrogen were directed toward formation of NADH which, in turn, resulted in increased alcohol production. In addition, it was shown that solvent production can take place at pH 6.3. Contrary to previous reports, butanol production appears to be independent of high levels of acetate-butyrate and glucose.

Increased electrotonic coupling in aged rat hippocampus: a possible mechanism for cellular excitability changes

The effects of aging on the intercellular transfer of the low molecular weight fluorescent dye 5,6-carboxyfluorescein was studied in subfields fascia dentata, CA1, and CA3 of rat hippocampal slices maintained in vitro. All three areas exhibited a statistically significant increase in dye coupling with age. The increased dye coupling was accompanied by an apparent increase in postsynaptic excitability as assessed by the ratio of the population spike to EPSP components of the extracellulary recorded field potential. The possibility that artifactual dye coupling due to cell fusion contributed significantly to these results was ruled out by the demonstrations that a high molecular weight, dextran-coupled fluorescein compound did not produce multiple fills and that dye coupling with carboxyfluorescein could be prevented by prior intracellular loading with Ca++, a procedure that decouples gap junctions in other tissue. The increase in extent of electrical coupling suggested by these data may largely account for the apparent increase in cellular excitability of this tissue with age and may reflect the mechanism by which the senescent hippocampus compensates for the loss of afferent input during the course of normal aging. The additional possibility is raised that increased electrical coupling may reflect a mechanism for permanent associative storage of information in this system.

Thalamic and subcortical gliosis with dementia

We describe two cases of patients with "primary dementia" in whom autopsy showed marked astrocytosis in several subcortical nuclei, but chiefly in those of the thalamus. One patient had the onset of symptoms at 31 years of age and a subacute course. The second patient was an elderly man with a strong familial history of dementia. These cases offer further evidence that subcortical lesions, especially in the thalamus, may produce a dementia that is not always clinically distinguishable from Alzheimer's disease and other "cortical" dementias.

Occlusion of hippocampal electrical junctions by intracellular calcium injection

Low-molecular weight dyes such as Lucifer yellow or carboxyfluorescein have been used to investigate the electrical connectivity of neurons via gap junctions. The interpretation that such dye passage is mediated through intercellular channels has been controversial and difficult to corroborate with direct techniques in mammalian brain. We report here that elevated intracellular free Ca2+, a treatment shown to cause gap junction occlusion in other tissues, significantly blocks dye transfer between hippocampal cells. Furthermore, intracellular injection of FITC-dextran (which is too large to cross gap junctions) never resulted in multiple hippocampal cell fills. These data lend strong support to the argument that the extent of dye-coupling provides a good estimate of the number of intercellular communication channels, and raises the possibility that these channels may be physiologically modulated.

Thirteen-week toxicity study of d-alpha-tocopheryl acetate (vitamin E) in Fischer 344 rats

A 13-wk study was conducted by administering d-alpha-tocopheryl acetate (vitamin E) in corn oil by gavage to groups of ten male and ten female Fischer 344 rats at doses of 0, 125, 500 or 2000 mg/kg body weight daily for 13 wk. The dose of corn oil given was 3.5 ml/kg. Additional groups of ten males and ten females were included and served as untreated controls. Deaths occurred only in males at 2000 mg/kg. Vitamin E dosing had no effect on body weight or food consumption. The liver-to-body weight ratio of females at 2000 mg/kg was significantly increased. In males, high levels of vitamin E (2000 mg/kg) caused prolongation of both prothrombin and activated partial thromboplastin (APTT) times, reticulocytosis and a decrease in haematocrit values and haemoglobin concentrations. APTT was also lengthened in females at this dose level. High levels (2000 mg/kg) caused haemorrhagic diathesis in both males and females and increased medullary erythropoiesis in the spleen of one male. Vitamin E at all doses tested caused interstitial inflammation and adenomatous hyperplasia of the lung. The above findings indicate that vitamin E administration in excessive amounts is potentially toxic.

Intracellular fluorescent staining with carboxyfluorescein: a rapid and reliable method for quantifying dye-coupling in mammalian central nervous system

Previous studies investigating electrotonic coupling in mammalian central nervous system have used the fluorescent marker Lucifer Yellow as an indicator of the presence of intercellular junctions between neurons. The fluorescent dye 5,6-carboxyfluorescein is known to have approximately 5 times the fluorescent yield of Lucifer Yellow. We have investigated the use of this dye as a potential alternative fluorescent marker on two types of neurons in the rat hippocampus in vitro. Unfixed hippocampal slices were mounted in a mixture of n-propyl gallate in glycerol and viewed with epifluorescence optics. Injections of small, brief hyperpolarizing currents through carboxyfluorescein-filled glass pipettes reliably produced neuronal fills of good quality. Both dendritic spines and axonal arborizations (including the thin mossy fibers of the dentate gyrus) were frequently observable. In addition to single cell fills, clusters consisting of 2-6 neurons were observed. No correlation was found between the number of cells per cluster and the ejection time. In addition, even cells exhibiting poor electrophysiological characteristics, or cells impaled only briefly, frequently exhibited good quality dye filling. This method will be particularly useful when large sample sizes are necessary to compare regional variations in the extent of electrotonic coupling in the mammalian brain.

Long-term enhancement of hippocampal synaptic transmission and the acquisition of spatial information

The hypothesis that memories are stored as a specific distribution of strengths in a population of modifiable synapses was examined by the bilateral induction of long-term enhancement in synapses of the main afferent fiber system to the hippocampal formation in rats. Brief, high-frequency activation of the perforant pathway in chronically prepared animals resulted in a persistent increase in the field EPSP and population spike, measured extracellularly in fascia dentata. This treatment resulted in a profound and persistent deficit in the acquisition of new spatial information in a task requiring spatial "reference" memory, and disruption of recently acquired spatial information. Well-established spatial memory was completely unaffected, however, as was the acquisition of spatial information into short-term "working" memory. These results support the hypothesis that, during the formation of "cognitive maps," spatial information must be temporarily stored at modifiable synapses at the input stage to the hippocampal formation, but that this information is not needed once the representation of the environment is well established. Spatial working memory, in a familiar environment, appears not to depend on the distribution of synaptic strengths in this system at all.

What is the optimum A-V interval in D.D.D. pacing?

One of the programmable parameters in recent pacemakers is atrio-ventricular interval. To find out the optimum A-V interval studies were done in 14 patients. Multigated radionuclide scans were used to measure the left ventricular function, at a resting heart rate of 70/minute. Seven patients had poor left ventricles (ejection fraction less than 50%). Left ventricular ejection fraction, relative cardiac output and end diastolic counts were highest at 250 M. Sec. interval compared to 150. Ejection rates and end systolic counts were not related to A-V interval. Relative cardiac output was 27% higher in poor ventricles at 250 delay than 150. This observation was not significant in normal hearts. Optimum P-R interval is 250 M. Sec. for maximum left ventricular function.

Amelioration of brain damage by lidoflazine after prolonged ventricular fibrillation cardiac arrest in dogs

Calcium entry blockers can ameliorate postischemic cerebral hypoperfusion, protect the myocardium against ischemia, and may protect against early postischemic neurologic deficit. This study documents that a calcium entry blocker, given after cardiac arrest, can ameliorate late postischemic neurologic deficit (ND). Thirty-four dogs received 10 min of ventricular fibrillation, restoration of spontaneous circulation by external cardiopulmonary resuscitation, and standard postarrest intensive care. Eleven of these dogs were given lidoflazine, 1 mg/kg body weight, within 10 min postarrest and again at 8 h and 16 h. Pupillary light reflexes, EEG activity, arterial-cerebrovenous oxygen gradients (O2 demand/supply ratios) and intracranial pressure were the same in both groups. After weaning from controlled ventilation at 24 h, ND scores improved consistently through the 96-h observation period in the lidoflazine-treated dogs. In the control group, ND scores were significantly higher than in the lidoflazine-treated dogs. In the lidoflazine-treated group, 5/11 dogs achieved normal overall performance and none remained comatose, whereas all control dogs had some deficit and 4/11 remained comatose. Delayed neurologic deterioration occurred in 6/11 control and 0/11 lidoflazine-treated dogs. Total mean cerebral histopathologic damage (HD) scores at 96 h were not significantly different between the two groups; however, individual HD scores and maximum cerebro-spinal fluid (brain-specific) creatine-phosphokinase activity--which increases after brain insults--correlated well with 96-h ND scores. In the lidoflazine group, life-threatening dysrhythmias were less frequent and the norepinephrine requirement for blood pressure maintenance was the same as in the control group. Cardiac output remained at prearrest levels in the lidoflazine-treated dogs, but decreased in the control group, particularly during the first 4 h postarrest.

Multifaceted therapy after global brain ischemia in monkeys

The pathophysiology of postischemic encephalopathy is complex, and includes tissue acidosis, edema, hypoperfusion, membrane dysfunction, impaired energy production, and possibly hypermetabolism. We tested the hypothesis that this multifactorial clinical problem must be approached with multifaceted therapy, with specific treatment aimed at each of the above postischemic changes. Eighteen minutes of complete global brain ischemia was produced with a higher pressure neck cuff in pigtailed monkeys. Control treatment postischemia (n = 9): 1) Normotension (MAP greater than or equal to 80 mmHg) restored within 2 min postischemia, 2) controlled ventilation for 24 hours with PaCO2 = 25 mmHg, 3) normothermia, and 4) phenytoin seizure prophylaxis from 20 hours postischemia. Experimental treatment (n = 10): Control treatment plus the following modifications: 1) Hemodilution to hematocrit 25% at 1-4 min postischemia, 2) brief hypertension (MAP 130 mmHg for 5 min) after accomplished hemodilution, 3) hypothermia for 6 hours, 4) pentobarbital 30 mg/kg i.v., 5) dexamethasone 4 mg/kg i.v. Outcome was evaluated at 96 hours postischemia by overall performance categories (OPC) (OPC I = normal, OPC V = brain death), neurologic deficit (ND) scores (100% ND = brain death, 0% ND = normal), and histologic damage scores of the brains.

RESULTS

Brain death developed in 1/9 control and 0/10 treated animals. The number of awake monkeys (OPC I and II) at 96 hours postischemia was significantly higher in the treated group (7/10) than in the control group (2/9) (p = 0.05). The median ND scores for the two groups were 16 and 35% respectively (p greater than 0.05). The results strongly suggest that postischemic treatment may be beneficial and that a multifaceted therapeutic approach is worth pursuing.

Prolonged immobilization and controlled ventilation do not improve outcome after global brain ischemia in monkeys

This study is a therapeutic evaluation of prolonged immobilization and controlled intermittent positive-pressure ventilation (IPPV) after global brain ischemia (GBI) in pigtailed monkeys. Sixteen min of GBI was produced with a high-pressure neck cuff, while the lungs were being continuously ventilated. Normotension was restored within 2 min postischemia (PI). The control group of 13 monkeys was weaned from IPPV 4 to 6 h PI. The treatment group of 18 animals was paralyzed and ventilated with a 50:50 nitrous oxide-oxygen mixture for 48 h PI. Intensive care was maintained for 96 h PI. In the control group, 8 of 10 animals were awake at 96 h PI compared to 7 of 11 in the treatment group. Neurologic deficit scores for the survivors in the 2 groups were also not significantly different. Histologic examination supported this conclusion. Paralysis/IPPV for 48 h post-GBI with 50% N2O facilitates control of blood gases and blood pressure, but does not improve the neurologic outcome over that achieved with only 4 to 6 h controlled ventilation.

Thiopental treatment after global brain ischemia in pigtailed monkeys

The authors investigated the value of high-dose thiopental (TH) therapy after 16-min complete global brain ischemia (GBI) in three groups of pigtailed monkeys, using a neck cuff model of GBI with 96 h intensive care postischemia (PI). Control group (n18): Normotension was restored within 2 min PI; paralysis/controlled ventilation was maintained for 48 h PI with 50% N2O/O2. Thiopental loading group (n13): Control treatment plus TH-loading with 90 mg/kg iv given from 5 to 65 min PI (mean peak TH plasma level 130 micrograms/ml). Thiopental anesthesia group (n14): Control treatment plus TH anesthesia with 90 mg/kg iv given over 12 h PI (sustained TH plasma levels of 25-35 micrograms/ml and EEG burst suppression). Norepinephrine requirement for blood pressure control PI was greater in the TH groups than in the control group (P less than 0.05). Lidocaine was needed for control of arrhythmias in the TH loading group. There was no significant difference in mortality or neurologic outcome between the groups. At 96 h PI seven of 11 animals were awake in the control group, compared with seven of 12 and six of 12 in the two TH groups. Neurologic deficit scores (NDS) for the survivors at 96 h PI were 23 +/- 6% (mean +/- SD) (n10) in the control group, compared with 25 +/- 9% (n11) and 26 +/- 12% (n10) in the two TH groups (NDS 100% = brain death, 0% = normal). Seizures PI (in 1-2 of each group) were associated with worse neurologic deficits.(ABSTRACT TRUNCATED AT 250 WORDS)

Frequency of anaphylactoid reactions during intravenous urography with radiographic contrast media at two different temperatures

One hundred randomly selected patients undergoing routine excretory urography were assigned in double-blind fashion by alternate entry pairs to receive radiographic contrast media at 37 degrees C (Group I) or room temperature (Group II). There were three anaphylactoid reactions and five nonanaphylactoid reactions in Group I, and five anaphylactoid and eight nonanaphylactoid reactions in Group II, differences that were not statistically significant. No differences were detected between reactors and nonreactors. Thus, in this study, infusion temperature had no effect on the frequency of adverse reactions to radiographic contrast media during excretory urography.

Xenon- and iodine-enhanced CT of diffuse cerebral circulatory arrest

The role of contrast-enhanced computed tomography (CT) was evaluated in three nonhuman primates with a severe cerebrovascular insult and resulting elevated intracranial pressure and diffuse circulatory arrest. In all three animals the brain vasculature did not opacify after the bolus intravenous injection of iodinated contrast media. In addition, the brain substance did not enhance although the arterial blood enhanced normally after inhalation of a high concentration of xenon. Xenon-enhanced CT scanning, like 133Xe radionuclide scanning, may be used to define the absence of generalized cerebral perfusion.

Neuropathologic correlation of computerized tomography in Huntington's disease

CT has proved a useful adjunct to the clinical examination in the differential diagnosis of chorea in adults. The CT abnormalities in cases of Huntington's disease are compared with those of a pathologically verified case of Huntington's disease cut in the CT scan plane of tomography. Relative measurements of caudate atrophy on CT agree well with atrophic processes noted neuropathologically.

Long-term experience with the Mobin-Uddin umbrella

Umbrella filters have been inserted in 56 patients over the last seven years. Indications varied from shock to a huge clot in the major veins. Most of the patients were in Greenfield's Class IV. All were treated with heparin before and after caval filter insertion. There were no deaths, but there were a few complications. the cava were patent during the follow-up period in patients who were on Coumadin therapy. Minimal residual venous stasis was noticed in the legs. The Mobin-Uddin umbrella in a simple and effective means of prevention of pulmonary emboli.

Splenic infarction and spontaneous rupture of the spleen after therapeutic embolization

Patients with major hematologic disorders who have hypersplenism and alterations in their immune mechanism are subject to a higher incidence of bacteremia after embolization procedures. In certain instances, these infectious complications can be fatal. Medical splenectomy for hematologic disorders is sometimes complicated by massive splenic infarction and spontaneous rupture; spontaneous rupture appears to be a function of both infarct size and underlying infectious complications. Prophylactic measures can be employed to avoid these complications after interventional splenic embolization.

Inhibition of human neutrophil oxidative metabolism and degranulation in vitro by nitroblue tetrazolium and vitamin E

The effect of a mixture of nitroblue tetrazolium (NBT) and vitamin E on the metabolism and ultrastructure of polymorphonuclear leukocytes (PMN) from normal subjects or patients with chronic granulomatous disease (CGD) was determined in vitro. Increasing concentrations of NBT and vitamin E progressively decreased rates of oxygen consumption and 1-14C-glucose oxidation by normal PMN stimulated with particulates to a degree that exceeded either agent alone. NBT-vitamin-E also inhibited vacuole formation and the cytochemical release of myeloperoxidase-positive granules. The depressed oxidative metabolism and degranulation of NBT-vitamin-E-treated control PMN closely approximated the blunted responses of CGD PMN which were similar alone or in the presence of NBT-vitamin-E. In contrast to these effects, the highest concentration of NBT-vitamin-E used in the study did not damage, decrease rates of unstimulated oxidative metabolism of, or impair ingestion of particulates by control or CGD PMN. NBT and vitamin E impose a state on normal PMN which is remarkably similar to that observed in PMN from patients with CGD.

Superior vena cava syndrome: a complication of transvenous pacemaker implantation

Superior vena cava syndrome developed in 4 of 1,000 patients in whom a transvenous pacemaker had been implanted. In all cases, endocardial leads were inserted through the cephalic vein and positioned at the apex of the right ventricle. The classical signs and symptoms of superior vena cava hypertension were observed from two weeks to one year after implantation, and the diagnosis was confirmed by cavography. Symptoms resolved following heparin therapy and long-term anticoagulation.

Xeromammographic automatic exposure termination

A method of automatic exposure termination (AET) for xeromammography has been devised, significantly reducing the rate of repeat exposures due to poor choice of manual exposure factors. AET images are of good quality and are reliably produced. The concept of AET is based on the existence of an optimal transmitted exposure to the selenium plate, which is easily determined experimentally. In routine clinical xeromammography, a repeat rate of 20% was eliminated by the use of AET.

Atrial septal defect due to blunt thoracic trauma

The case report of an atrial septal defect with right-to-left shunting in an adult following blunt chest trauma is presented. To our knowledge a successfully repaired traumatic atrial septal defect has not been previously reported in the English-language literature.

The effects of methylprednisolone on the complications of coronary artery surgery

Complications of coronary artery surgery were analyzed in a prospective controlled study of 150 patients, one group receiving methylprednisolone before temporary cardiopulmonary bypass. The patient population was comparable in both the groups. The number of deaths were the same in both the groups, myocardial infarction and cardiac arrhythmias were definitely lower in the Solu-Medrol group. Cerebral vascular accidents were higher in the control group and there were none in the drug treated group. Incidences of pulmonary embolism was reduced by the drug. Oxygen consumption by the tissues was higher in the Solu-Medrol treated group. There were no known complications of the drug, such as stress ulcer and infection. One patient did receive prophylactic antibiotics. Solu-Medrol was deliberately given in patients who were known to have uncomplicated duodenal ulcer. Post-operative bleeding in patients with duodenal ulcer was not noted. This could be explained due to the short acting nature of Solu-Medrol. We feel that Solu-Medrol does minimize serious sequelae of heart-lung machine in coronary artery surgery.

Should the pericardium be closed after an open-heart operation?

A controlled clinical study was carried out to decide whether the pericardium should be left open or closed after open-heart operations. One hundred patients had the pericardium closed with interrupted silk, another 100 had the pericardium left open. Complications were alike except for the more frequent occurrence of a pericardial rub in the closed group (14 vs 3 patients), though the incidence of post-pericardiotomy syndrome was equal. There was no late tamponade. Two early reexplorations for bleeding were done in the open group, none in the closed. There were no postoperative deaths. In the patients who consented to postoperative angiography following revascularization procedures, the incidence of graft failure was equal in both groups. The pericardium should be closed after an open-heart operation. Morbidity and mortality are unchanged, and repeat cardiac exploration is safer.

Bronchial artery embolization for massive hemoptysis

Improved angiographic techniques have proved that therapeutic embolization is effective in controlling massive hemorrhage in selected sites of the gastrointestinal tract and central nervous system. We have controlled massive hemoptysis in five cases with use of our improved techniques and bronchial artery embolization. Because mortality due to massive hemoptysis in both benign and malignant disease is high, therapeutic bronchial artery embolization is the preferable approach in some cases.

Keratomalacia in the cachectic hospitalized patient

Keratomalacia occurred in two cachectic hospitalized patients, each with severe vitamin A-protein deficiency secondary to a lethal disease. Prompt therapy with parenteral and topical vitamin A, protein supplementation, and a soft contact lens restored corneal integrity and prevented visual loss in one patient. Keratinization of the conjunctiva did not occur in either patient. Patients with severe protein deficiency may develop keratomalacia in the absence of a severely decreased serum level of vitamin A.

Concomitant prophylactic inferior vena caval clipping

Fatal pulmonary embolism is a common complication of any major surgery, especially in high risk patients. Experimental work in animals showed definite impairment of myocardial function after inferior vena caval ligation, but no changes after clipping. During the last four years, we have used concomitant vena caval clipping as a prophylactic measure in major abdominal vascular procedures. No added mortality or morbidity has occurred because of clipping per se and no deaths were due to pulmonary embolism. We recommend concomitant prophylactic clipping as an adjunctive procedure for all laparotomy patients who are prone to pulmonary embolism.

Pattern of occlusive peripheral vascular disease in India. (clinicopathological study of 79 cases)

The pattern of peripheral vascular disease in India was studied in 89 patients undergoing amputation for vascular insufficiency. A control group of 26 limbs was studied for aging changes. Clinically, cases were classified into TAO (25), ASO (54) and thrombo-embolic disease (10). Angiographic, macroscopic and microscopic study of dissected vascular tree was done in view of clinical diagnosis. No significant difference was noted in the frequency and extent of involvement of limb arteries in TAO and ASO. Histologically angiitis was noted in 4 cases of TAO and one of ASO but these did not form a distinct clinical group. Primary thrombotic occlusion was seen in 21 cases of TAO and 23 cases of ASO. Atheroma with and without thrombosis was found in 26 cases. In 4 cases the arterial tree was normal. Atheromatous lesions were not seen in control group. In the groups under study they were thought to represent old thrombi rather than degenerative lesions predisposing to thrombosis. In view of these findings it was felt that Buerger's disease was primarily a thrombotic disorder. Angiitis was rare and was probably secondary. The two clinical groups TAO and ASO are not pathologically distinct as very high percentage of the latter showed primary thrombosis. The genesis of thrombosis in two groups however may be different.

Aorto-coronary graft for dissected coronary artery

A 46-year-old woman while undergoing selective coronary cine angiogram dissected her coronary artery. She was managed by heparin therapy followed by urgent aorto-coronary artery saphenous vein graft with no consequences.

T-BINDER FOR EXPOSING THE CIRCUMFLEX CORONARY ARTERY

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Incidence and prevention of pulmonary embolism after coronary artery surgery

Pulmonary embolism is one of the common complications of aortocoronary artery graft surgery. During one year period, 22 patients had documented evidence of pulmonary embolism out of 231 patients who were operated. There were four deaths and all confirmed by autopsy. Clinical signs of phlebitis were absent in many cases of pulmonary embolism. Elastic stockings were not effective to prevent phlebitis. Heparin did not prevent deaths in all four patients. Heparin therapy and aggressive caval interruption by Modin-Uddin umbrella has eliminated deaths in the last 450 cases.