Hilmert A. Ranges

Catheterization of the Right Auricle in Man

Forssmann 1 first used catheterization of the right heart on himself, after exposure of a vein of the arm by a surgeon. Numerous other investigators since have used right heart catheterization for visualization of the right chamber of the heart and pulmonary vascular trees by means of contrast substance. 2 3 4 5 6 7 The introduction of the Robb and Steinberg method, 8 however, renders this method unnecessary for the latter purpose. Collection of right heart blood by catheterization of the right auricle for determining cardiac output in man 9 is mentioned by Grollman, 10 who discredits it because of the possible dangers and numerous misleading factors associated with it. In animal experimentation it is widely used and its innocuity established. Because it is apparently the soundest method for obtaining mixed venous blood for respiratory gas determinations, and because of the numerous problems of hemodynamics it might help solve, a method of right heart catheterization was developed which attempts to overcome objections to former methods. The principal objections included the possibility of venous thrombi and thrombophlebitis that might be associated with introduction of a foreign body in the blood stream, the formation of thrombi within the catheter, and the psychic effects accompanying the procedure with possible alterations in the cardiac output. The following equipment was used in our method: a specially made 10 gauge Lindeman type of needle; a 3-way stopcock with a Luer lock, tightly fitting adapter; a No. 8 French flexible radiopaque ureteral catheter with 2 holes, one at the rounded tip and another about 1 cm from the tip. The catheter is silk with a smooth varnish finish. A saline reservoir with rubber tubing and clamp for controlling the rate of flow was also used. Under the strictest asepsis a nick is made in the skin over the median basilic vein of either the right or left arm after a preliminary infiltration with 2% novocain.

GLOMERULAR DYNAMICS IN THE NORMAL HUMAN KIDNEY

One of the most interesting facts about the renal circulation is that during marked changes in renal blood flow (adrenalin ischemia and pyrogenic hyperemia) the rate of glomerular filtration typically remains unchanged. This fact has been attributed to the circumstance that the changes in renal blood flow are mediated primarily by changes in the tonus of the efferent arterioles; consequently, any increase or decrease in blood flow is accompanied by a reciprocal change in glomerular filtration pressure, with the result that the filtration rate remains unchanged (3). Beyond the fact that this emphasis upon the efferent arteriole is to some extent contrary to the importance which has hitherto, chiefly for anatomical reasons, been attached to the afferent vessel, this description of the glomerular circulation presents several interesting implications. It assumes that the rate of glomerular filtration is determined solely by glomerular pressure factors, exclusive of any limitation imposed by the permeability of the glomerular membranes. There logically issues from this assumption the question whether or not filtration pressure equilibrium is normally reached in the glomerulus. The answer to this question is of practical importance in two respects. If filtration equilibrium is reached in the glomerular circulation, then this fact must set the upper limit to the hydrostatic pressure available to propel blood through the efferent arterioles and the postglomerular circulation. And in the face of a demonstration of filtration equilibrium in the normal kidney, a decrease in filtration rate in renal disease cannot logically be attributed to reduced permeability of the glomerular capillaries, in contradistinction to a decrease in filtration pressure or in total filtering

SYSTEMIC AND RENAL CIRCULATORY CHANGES FOLLOWING THE ADMINISTRATION OF ADRENIN, EPHEDRINE, AND PAREDRINOL TO NORMAL MAN

This report concerns the systemic and renal circulatory changes in normal man during the action of adrenin, ephedrine, and paredrinol. Special attention has been paid to the interrelationship and integration of the many factors involved in the production of the over-all response. Although these three substances are similar chemically and have long been known (1) as vasopressor drugs, their sites and modes of action appear to vary. The observations presented here throw light upon the circulatory mechanisms involved in the pressor response. The subjects were male convalescent patients on the Third (New York University) Medical Division of Bellevue Hospital, who were examined, for the most part, under basal conditions. Adrenin was administered subcutaneously and intramuscularly in 0.5 to 1.5 mgm. doses, ephedrine was given intramuscularly in 50 to 75 mgm. doses, and paredrinol was injected intramuscularly in 20 to 30 mgm. doses, after control values had been obtained. Cardiac output was determined by a modification of Starrs ballistocardiograph (2), using the wave area formula advocated by Starr (3). The instrument was calibrated after each study by the method recommended by Starr (4). All figures for stroke volume and cardiac output have been increased by 18.5 per cent because Cournand et al. (2) have shown the ballistocardiographic output to average 18.5 per cent lower than the value obtained by the direct Fick method in man. Arterial pressure was measured directly in the femoral artery with a Hamilton optical manometer (5) and mean pressure was obtained by planimetric measurement of the area under the pressure pulse curve. The total peripheral vascular resistance was calculated in absolute units by

Suitability of Inulin for Intravenous Administration to Man

Attention has been called to the fact that, while some samples of inulin are physiologically innocuous, others, apparently of the highest chemical purity, may induce febrile reactions, accompanied in the more severe forms by chills, nausea and lumbar pain. 1 According to Co Tui, et al., 2 , 3 , 4 the pyrogenic activity can be removed by passing the solution through a Seitz serum filter or EK filter, a fact which we have confirmed for the EK filter. Treatment with filter material (asbestos) in bulk is ineffective. Originally we removed the pyrogenic activity as follows: 750 gm. of dry inulin (8% water) are dissolved in 1500 cc. of hot distilled water and boiled for 5 minutes with 50 gm. of Norit A; the solution is filtered hot with the aid of suction, mixed with an equal volume of 95% alcohol, and chilled in the icebox. The inulin is filtered out by suction and well drained by hand pressure. If further purification is desired the moist inulin is dissolved in 1200 cc. of distilled water and the above process repeated; otherwise it is dried at 50° for 15 to 24 hours. This method was used by the Pfanstiehl Chemical Company to purify inulin on a large scale, the resulting preparations being non-reactive in man in doses of 100 gm., administered intravenously as a 20% solution in 1.0% NaCl, injected at a rate of 6 to 10 cc. per minute. But more recently Norit extraction has failed to work, both in our hands and in the Pfanstiehl laboratory, and until the method is corrected we are removing the reactivity by filtering the 5 or 10% solution through a Seitz EK serum filter.