Assessment of pulmonary edema based on extravascular thermal volume in dogs

To establish criteria of pulmonary edema by extravascular thermal volume (ETV), ETV and a roentgenogram of the thorax were compared in normal and experimental hydrostatic pulmonary edema dogs. ETV was measured by the double indicator dilution technique using heat as a diffusible indicator and sodium ions as a non-diffusible indicator (thermal-Na method). Mean ETV in 14 dogs under physiologic conditions was 8.20 +/- 1.44 ml/kg. Comparison of ETV with the roentgenogram indicated the density of thoracic the roentgenogram to increase when ETV exceeded 11 ml/kg. Pulmonary edema was recognized clearly in the thoracic roentgenogram at more than 15 ml/kg of ETV. Further increase in ETV did not occur with additional radiographic change. ETV was significantly (P < 0.01) correlated with arterial oxygen tension (PaO2) but not statistically correlated with colloid oncotic pressure (COP), pulmonary arterial wedge pressure (PAWP) or PAWP-COP. Measurement of ETV would thus, appear to be a reliable method for evaluating the severity of pulmonary edema, which has been difficult to diagnose by roentgenography and should facilitate the early diagnosis and management of pulmonary edema.

Left ventricular wall thickness in normal mongrel dogs

To clarify the normal value of ventricular wall thickness we directly measured the ventricular wall thickness of 50 normal mongrel dogs of one year old. Because of a wide range in body weight from 6.0 to 16.0 kg of these 50 dogs, we selected 34 dogs weighing 8 to 12 kg to calculate the mean ventricular wall thickness as normal value of one year old. The results obtained were as follows; (1) The mean and standard deviation of the left ventricular wall thickness was 7.1 +/- 1.2 mm at anterior, 6.3 +/- 1.6 mm at posterior, 7.1 +/- 1.3 mm at lateral, 10.3 +/- 1.8 mm at the interventricular septum, and that of the right ventricular wall thickness was 3.4 +/- 1.0 mm. (2) Although any site of the ventricular wall thickness correlated significantly to heart weight, only the anterior left ventricular wall and interventricular septum barely correlated to body weight. (3) There was no significant correlation between arterial blood pressure and the ventricular wall thickness. Further study should be necessary to clarify influences of aging on the ventricular thickness and to determine the criteria of ventricular hypertrophy.

Role of blood transfusion in organ system failure following major abdominal surgery

Using multivariate probit analysis, the data of 565 patients who underwent major abdominal surgery were retrospectively analyzed, and the etiologic role of blood transfusion in organ system failure (OSF), which includes respiratory failure, gastrointestinal stress bleeding, renal failure, nonobstructive, nonhepatitic jaundice, and coagulopathy, was studied. Apart from the amount of blood transfusion, the following factors were included in the analysis as possible contributors to OSF: age, preoperative hematocrit, organ failure risk (diffuse peritonitis, obstructive cholangitis, liver cirrhosis, terminal cancer, and hemorrhagic shock), operative time, blood loss, and postoperative highest hematocrit. The results showed that, except for preoperative hematocrit, all the factors are statistically significant contributors, blood transfusion being the most significant. There was no statistically significant interaction between blood transfusion and organ failure risk. It is concluded that blood transfusion is an important, independent factor contributing to OSF, and its contribution cannot be attributed to the underlying conditions that require blood transfusion.

Effects of enalapril maleate (MK-421) on renovascular hypertension

The effects of enalapril maleate (MK-421), a new angiotensin converting enzyme inhibitor, were studied on 5 patients with renovascular hypertension (RVH) due to unilateral renal artery stenosis. The therapeutic dosage was increased when the blood pressure (BP) was not controlled for more than 3 days. Blood sampling was performed before, and 5 hr and 24 hr after the first administration, and on the 3rd day with each dosage. The BP was normalized on 5 mg/day in 1 case, 10 mg in 1 case, 20 mg in 2 cases, and 40 mg plus mefruside in 1 case. Plasma renin activity (PRA) was significantly increased after 5 hr and recovered after 24 hr with 2.5 mg of the enalapril maleate, when the BP was not affected. This indicates that the increase in PRA is likely due to the reduced negative feedback of angiotensin II. When the blood pressure was lowered, PRA was increased and plasma aldosterone concentration (PAC) was decreased significantly. This rise of PRA may depend not only on the reduced negative feedback but also on the fall of BP. It is also considered that the PAC was decreased through the decrease in plasma angiotensin II. A fall of the glomerular filtration rate in one case and also a fall of the perfusion of the kidney of the stenotic side in another case were observed by radioisotope renograms. MK-421 administration was a useful treatment for RVH, and clearly normalized the BP of all the patients studied. However, there was a risk of a fall of renal function on the stenotic side due to the decrease in perfusion pressure.

Parametric survival analysis of gastric cancer patients

A total of 1026 patients with gastric cancer was followed up for five years after surgery and classified into different groups according to surgeons' assessment of nodal involvement, serosal invasion, peritoneal spread, and hepatic metastasis. The survival of each group was studied by parametric analysis, using the log normal model and three parameters estimated: proportion of patients cured (c), mean (m), and SD of log survival times of patients not cured. With these parameters, compared with the conventional five-year survival or the median time, the survival pattern of each group was delineated in detail, and prognostic inferences beyond the follow-up period were made feasible. Groups with more localized lesions were characterized by higher values of c and m. This implied that although patients in these groups have a better chance of cure, they are exposed to a relatively higher risk of late death due to recurrence. This method proved also useful to compare the prognostic values of different classification and to develop better staging systems.

A factor analytic assessment of prognosis in ischemic heart disease using thallium-201 myocardial scintigraphy, radiocardiograhy and orthogonal electrocardiography

One hundred and three subjects with ischemic heart disease (IHD) were followed-up in an attempt to assess the most important factors affecting morbidity and mortality. At the time of initial examination 23 patients had congestive heart failure. During the one year follow-up after the examination 11 patients died. Various parameters including perfusion defects (SCORE) on 201 Tl-myocardial scintigrams, radiocardiographic hemodynamic data and orthogonal electrocardiographic parameters were analysed at the onset of the study, according to the method of "factor analysis". The factor analytic technique enabled a summary of the data obtained from these non-invasive approaches into five major interpretable components termed factors 1 to 5; factor 1 as "the extent of myocardial ischemia", factor 2 "heart size", factor 3 "cardiac pump function", factor 4 "peripheral blood volume" and factor 5 "QRS forces". The relationship between these five factors with a one-year mortality rate was then investigated. Of these factors, factor 1 which included SCORE, spatial G/QRS, T/QRS and QRS-T angle proved to be the most important as related to morbidity and mortality in IHD. Factors 2 and 3 were also shown to be useful prognostic indicators of subsequent mortality. Thus, a combination of these non-invasive parameters is useful not only to diagnose IHD but also serves as one form of evaluation of the prognosis in patients with IHD.

Parametric survival analysis of gastric cancer patients

A total of 1026 patients with gastric cancer was followed up for five years after surgery and classified into different groups according to surgeons' assessment of nodal involvement, serosal invasion, peritoneal spread, and hepatic metastasis. The survival of each group was studied by parametric analysis, using the log normal model and three parameters estimated: proportion of patients cured (c), mean (m), and SD of log survival times of patients not cured. With these parameters, compared with the conventional five-year survival or the median time, the survival pattern of each group was delineated in detail, and prognostic inferences beyond the follow-up period were made feasible. Groups with more localized lesions were characterized by higher values of c and m. This implied that although patients in these groups have a better chance of cure, they are exposed to a relatively higher risk of late death due to recurrence. This method proved also useful to compare the prognostic values of different classification and to develop better staging systems.

Decreased early diastolic dV/dt in ischemic heart disease observed by ECG-gated radiocardiography

(1) ECG-gated RCG were performed in 127 cases, among them 30 were normal controls, 35 were hypertensives, 16 were ischemic heart diseases, 8 were cardiomyopathies and the rest of 38 cases were of miscellaneous cardiac diseases. (2) ECG-gated RCG were performed consecutively after the preceding RCG. Parameters calculated from RCG and ECG-gated RCG were evaluated together in terms of the sensitivity to discriminate the ischemic heart diseases from the control subjects. Among the parameters evaluated, peak diastolic dV/dt was the most sensitive index to discriminate the ischemic heart group from the control group. PDdV/dt of 20 ml/100 msec/m2 was considered to be a borderline between two groups. (3) Principal component analysis of 12 variables in 127 cases demonstrated that the peak diastolic dV/dt was closely correlated with the cardiac pump function, but was also well related to the ischemic heart factor. (4) ECG-gated RCG following the preceding RCG is a sensitive method to discriminate the ischemic heart disease from the control group.