Kazi Mobin-Uddin

Transvenous Caval Interruption with Umbrella Filter

Abstract For prevention of pulmonary embolism, transvenous interruption of the inferior vena cava by the umbrella filter was performed in 100 patients between July, 1968, and June, 1970. Filter dis...

Comparison of ice water with iced saline solution for gastric lavage in gastroduodenal hemorrhage

Abstract Ice water is simpler to use than iced saline solution for gastric cooling in patients with upper gastrointestinal bleeding. Gastric lavage in dogs with either saline solution or water results in a decrease in serum potassium and osmolality. The lack of differences in systemic effects suggests that ice water may be used as readily as iced saline solution when complemented with intravenous electrolyte solutions and the monitoring of serum potassium.

Intravenous Caval Interruption for Pulmonary Embolism in Cardiac Disease

Surgical ligation or plication of the inferior vena cava in acutely ill patients with significant cardiopulmonary disease carries a high mortality. Intravenous interruption of the inferior vena cava by an intracaval umbrella-like device placed under local anesthesia has been performed in 15 patients with significant cardiac disease: 12 with chronic congestive heart failure and 3 with intractable heart failure and shock. There was one early death from heart failure and shock three days after caval interruption and three late deaths from congestive heart failure and one from ruptured sigmoid diverticulitis. The remaining ten patients are alive and well 2 months to 11½ months after caval interruption. There has been no further recurrence of pulmonary embolism.

The physiological response of the heart to segmental myocardial resection

Abstract In 28 dogs the right and left ventricular stroke work, dp/dt and ventricular function curves (VFC) were obtained before and after resection of a segment of the anterior wall of the left ventricle. In 9 experiments, acute ischemia of the segment was produced by ligating the anterior descending branch of the left coronary artery. In all dogs cervical vagotomy was done before or after ischemia or resection. In normal hearts, after resection, marked depression in VFC were noted. After vagotomy the VFC showed a shift to the left. After ischemia, there was a significant decrease in stroke work but with a nonsignificant shift to the left of the VFC after vagotomy. In the majority of dogs, upon increasing the ventricular end-diastolic pressure, heart rate deceleration and peripheral vasodilation occurred. After ischemia, the magnitude of this response showed a greater decline with an occasional change in the pattern of these parameters which was not altered by vagotomy. After resection of the ischemic area in two thirds of the dogs the VFC showed improvement with a shift to the left. These experiments indicate that in spite of the operative trauma the immediate performance of the post-ischemic heart in the absence of the ischemic segment is somewhat improved. The results also suggest that the cardiac and extra-cardiac reactions, due to the stimulation of induced ventricular ischemia receptors, are not totally mediated via the vagus nerve and they remain active after removal of the ischemic segment.

Misdiagnosis of pneumonia in patients needing mechanical respiration

During a prospective study of tracheostomy and mechanical ventilation, it was found that the primary physicians made a clinical diagnosis of pneumonia in 60 of 111 patients. The primary indications for assisted ventilation included multiple trauma and ventilatory failure after major operations. Only 18 patients had supportive evidence for a diagnosis of pneumonia. Evaluation of the pulmonary processes indicated

Infusion of blood into the myocardium: Effect and flow studies☆

Abstract An experimental model, analogous to the internal mammary artery implantation operation, immediately after its insertion is presented for study. Adult mongrel dogs were anesthetized and an occlusive catheter was placed in the coronary sinus through the azygos vein. Coronary sinus blood flow averaged 0.39 ml. per gram of cardiac muscle per minute. Coronary sinus blood flow uniformly rose to an average of 43% above normal when the animal was placed on total cardiopulmonary bypass. Occlusion of the coronary arteries reduced coronary sinus blood flow to an average of 9% of normal. Infusion of blood into the left ventricular myocardium with a needle at 50 ml. per minute resulted in the recovery of 81% of this blood from the coronary sinus. From observations it was deduced that the blood not recovered was lost into the ventricular lumen, the myocardial lymphatics, and extravasated into the myocardium. Some ST shift of the electrocardiogram was observed.