David State

COMPARISON OF BLOOD FLOW DURING EXTERNAL AND INTERNAL CARDIAC MASSAGE IN MAN.

Cardiorespiratory variables measured during attempts at cardiac resuscitation in 11 patients are presented. These were obtained ten times during closed-chest massage and 15 times during open-chest massage. Three patients were studied during both techniques of resuscitation. Cardiac index and stroke index were significantly better with the internal method, and the mean circulation time was significantly shorter.

An Integrated Procedure for the Rapid Diagnosis of Biliary Obstruction, Portal Hypertension and Liver Disease of Uncertain Etiology

Abstract An integrated procedure consisting of transhepatic cholangiography, liver biopsy and omentoportography, performed under local anesthesia through a 5-cm subxiphoid incision, was used in 100 patients with hepatobiliary disorders that presented major diagnostic or therapeutic problems. Cholangiography was successful in 80 of 91 patients, liver biopsy in all of 54 patients, and omentoportography in 13 of 15 patients. Diagnosis was achieved in all cases. The frequency of two of the three major complications that occurred should be reducible by sulture ligation of puncture sites. There were no deaths attributable to the procedure. Coagulation abnormalities were present in 29 patients. The only recognized contraindication is sensitivity to contrast medium. The integrated procedure is an effective method of resolving puzzling cases of hepatobiliary disease and should save much time and expense. It has also been helpful in the planning and execution of surgery for biliary obstruction and portal hypertension.

COMPARISON OF BLOOD FLOW DURING EXTERNAL AND INTERNAL CARDIAC MASSAGE IN MAN

Cardiorespiratory variables measured during attempts at cardiac resuscitation in 11 patients are presented. These were obtained ten times during closed-chest massage and 15 times during open-chest massage. Three patients were studied during both techniques of resuscitation. Cardiac index and stroke indexwere significantly better with the internal method, and the mean circulation time was significantly shorter.

Observations on the pathway of exogenous C14-histamine in stimulating gastric secretion*

Summary o 1. After injection of C 14 -histamine, radioactivity was determined simultaneously in the gastric, duodenal and rectal mucosa, gastric juice and serum of the dog. 2. The acid secretion was measured simultaneously with the above studies. 3. When gastric secretion had ceased, the level of radioactivity in the gastric mucosa and serum was still moderately high. 4. The level of radioactivity in the gastric duodenal and rectal mucosa correlated well with the known levels of endogenous histamine in these organs. 5. After the C 14 -histamine induced secretion had ceased for one hour, stimulation with the same dose of unlabeled histamine increased the radioactivity of the juice above previous levels.

THE EFFECT OF 2-AMINO-2-HYDROXYMETHYL-1, 3-PROPANEDIOL ON THE ANURIA OF HYPOVOLEMIC STATES*

The anuria accompanying hypovolemic states in general and hemorrhagic shock in particular has been investigated by numerous authors. I t is generally held that anuria is the result of a disproportionate diminution of the renal blood flow and a cessation of glomerular filtration with mean blood pressures below 60 mm. Hg.ln2J Also it has been observed that the lowest renal blood flows are associated with the lowest pH, metabolic acidosis being the constant byproduct of poor perfusion? With the availability for physiological use of an amine buffer 2-amino2 hydroxymethyl 1,3 propanediol or tris(hydroxymethy1)aminomethane (THAM),3-4 which is a reversible hydrogen-ion acceptor forming compounds with carbonic and other acids, the problem of anuria in hypovolemia seems well worth investigating anew.

VALUE OF BIPLANE SPLENOPORTOGRAPHY.

Splenoportography is a useful technic in the evaluation of a variety of diagnostic problems (1, 2). Our procedure differs basically in no significant way from that of Ruzicka and Rousselots group (3). In view of the difficulty experienced in interpreting some of 100 splenoportograms in the anteroposterior views, however, biplane studies were added in the last 20 examinations (4). No attempt is made to analyze the entire series at this time; it is hoped that this preliminary report will show the additional value of the lateral projection with no increased patient risk. We have thus modified splenoportography by use of the biplane Schoonander apparatus. Films are loaded so that alternate exposures are obtained, avoiding any possibility of “fogging” from radiation scatter. The timing sequence based on an analysis of our total experience is as follows: One film alternating in each plane every second for ten seconds, followed by a four-second pause; two films obtained at one-second intervals followed by anoth...

GASTRIN AND THE CONTROL OF ITS RELEASE

Considerable controversy has surrounded gastrin since it was first postulated by Edkins’ in 1906. In the ensuing 55 years, much has been learned about this substance and the factors that regulate its release. There remains, however, a great deal that must still be elucidated. This presentation will attempt to summarize our present knowledge of gastrin and to point out where further information is urgently needed.