Lars Björk

Anastomoses between the coronary and bronchial arteries.

Enlargement of the bronchial arteries arising from the thoracic aorta or its branches that occurs in pulmonary atresia and severe pulmonary stenoses may provide all or a considerable part of the blood flow to the lungs. Another pathway for the increased bronchial circulation is via collaterals from the coronary arteries to the bronchial arteries, vessels that may be of considerable dimensions (Fig. I) and probably capable of depriving the myocardium of part of its blood supply. It was considered of interest to investigate how often this collateral communication could be observed in cases with decreased pulmonary artery circulation.

Angiographic demonstration of collaterals to the coronary arteries in patients with angina pectoris.

Intercoronary and extracardiac anastomoses to the coronary arteries may be demonstrated by various methods of coronary angiography (SONES et colI. 1959, PAULIN 1964, ARVIDSSON & MOBERG 1966, BJORK 1966, and others). Successful results of operative procedures to increase the vascularization of the myocardium may also be documented by angiography (see accompanying illustration). It must be emphasized however that it is essentially the anatomy of the arteries that is demonstrated by these angiographic methods, and it is well known from vascular studies using peripheral and renal angiography that it is difficult to correlate the anatomical findings at angiography with disturbances of function. It is only to be expected that the same would apply to the myocardium and the anatomy of the coronary arteries as seen at coronary angiography. To investigate these factors, a study was made of 65 patients referred for surgical treatment of angina pectoris. Electrocardiograms with standard and various precordial leads were obtained in all these patients, and the physical work capacity was determined by means of a bicycle ergometer (HALLEN 1964).

Angiographic determination of left atrial and left ventricular volumes in normal children and adults.

Biplane angiocardiography has made it possible to measure the volume of the left atrium and the left ventricle in different phases of the heart cycle. Ordinary biplane angiocardiography has been employed in these measurexad ments by DODGE & TANENBAUM (1956) and ARVIDSSON (1958) and the biplane cineradiographic technique by CHAPMAN, BAKER, REYNOLDS & BONTE (1958). The investigations have mostly been performed in cases of mitral or aortic valvular disease, and attempts have been made at differentiating and classixad fying different types of valvular lesions with the volume variations of the left atrium and left ventricle as guides. Investigations with measurements of the left atrial and left ventricular volumes have been reported in only a few normal adult cases and none in children. The authors therefore feel it worthwhile to report the normal cases they have had the opportunity of studying by means of angiocardiography.

Blood flow in pulmonary and bronchial arteries in acute experimental pneumonia and pulmonary embolism.

Acute lobar pneumonia and pulmonary embolism were induced in rabbits and the blood flow in the pulmonary artery and bronchial arteries was determined using isotopic microspheres. In acute pneumonia the pulmonary artery flow to the involved lung was reduced 8.5 times and the bronchial artery flow was reduced 5.0 times compared to flow in the normal lung. In acute pulmonary embolism, both the pulmonary artery flow (2.3 times) and the bronchial artery flow (2.5 times) were also reduced. For all animals, the reduction in pulmonary artery flow paralleled the reduction in bronchial artery flow (r=0.65).

ANGIOGRAPHIC DIAGNOSIS OF ACUTE PULMONARY EMBOLISM.)

In a case of suspected pulmonary embolism the history may be atypical, the bedside examination negative, and the ECG nondiagnostic. This is espexad cially true in a case of a small or medium-size pulmonary embolus. In such a case, the standard roentgen examination of the chest is usually of limited value. All the classical signs of pulmonary embolism are nonspecific: segmental hypovascularity, dilatation of central pulmonary arteries and the right side of the heart, the contours of pulmonary infarcts and pleural effusion. Pulmonary arteriography seems to be the rational method to provide a more exact diagnosis in suspected cases of pulmonary embolism. However, we have found only two reports of the use of this method in patients. CIECERO and D E L CASTILLO (1956) reported a case of pulmonary infarcts with angiographie demonstration of occlusion of main arteries in the right lung. SCHULZE (1961) reported a case of massive calcified pulmonary artery thrombosis or embolism with angiographie and post-mortem studies. Among the first to use pulmonary arteriography in experimental studies were LOCHHEAD, ROBERTS & DOTTER (1952). They produced massive pul-

Effect on erythrocytes of large doses of contrast medium in clinical angiocardiography.

Evidence has gathered through the years that a large part of the side effects of modern contrast media is directly correlated to the hyperosmolarity of these products. As the red blood cells are exposed to the highest concentration of the contrast medium on rapid intracardiac or aortic injection, these are obviously the cells that may be expected to incur damage, particularly on repeat examinations. It has been indicated that such damage occurs, by in vitro studies (BERNSTEIN et colI. 1964, McINTOSH et colI. 1967) and in animal experiments (BERNSTEIN et coIL). The aim of the present study has been to determine whether changes in the red blood cells may be demonstrated with standard laboratory methods, in patients in whom large quantities of highly concentrated contrast media had been injected at angiocardiography.

Effect of angiocardiography on erythrocyte aggregation in the conjunctival vessels.

Increased intravascular aggregation in the conjunctival vessels has been observed in patients after injection of various contrast media (SOBIN et coll. 1959, LINDGREN, LÖFSTRÖM & SALTZMAN 1964, inter alios). No studies have been performed on the erythrocyte aggregation after injection of large doses of contrast media, however, as in angiocardiography. The present investigation was undertaken to demonstrate the frequency and severity of changes in the aggregation of red blood cells after angiocardiography with the two contrast media most currently in use, Isopaque 60 % and Urografin 76 %. Material and Methods. Forty-two unselected patients were studied: 26 men and 16 women, in whom angiocardiography had been performed as part of a routine preoperative evaluation of cardiac disease; the ages varied from 18 to 60 years. Urografin 76 % (sodium and methylglucamine diatrizoate) was used in half the number of patients and Isopaque 60 % (sodium metrizoate) in the other half. There were no méthodologie differences between the two groups as to

Radiographic Determination of the Bone Mineral Content in Osteoporosis

The determination of the bone mineral content in osteoporosis or osteomalacia is difficult, as evidenced by the many different methods described. Direct biopsy of the bone, with chemical determination of its mineral content, is of course the most accurate method, the specimen usually being taken from an iliac crest. The limitations of this method are mainly due to the problem of locating the biopsy to compact or spongious bone and the surgical procedure necessary for obtaining the biopsy specimen. Most methods for determination of the bone mineral content are based on a radiologie technique. It is recognized that the simple subjective estimation of bone mineral content from ordinary films of different bones is an unreliable method of detecting and measuring déminéralisation. The mineral content must be doubled or diminished to half its original value from one examination to another before the difference is detectable. A method of demonstrating more objectively the presence of osteoporosis has been used by e. g. BARNETT & NORDIN (1960). They obtained an index

Semi-Automatic Construction and Computer Analysis of Volume Curves and Pressure-Volume Curves in Left Ventricular Cineangiography

Different methods have been described for calculating the volumes of the cardiac chambers, especially the left ventricle, with the aid of angiocardiography. The construction of volume curves from the left ventricle by full size angiocardiography with an exposure frequency of 6 per second has also been attempted by using data from several cardiac cycles (DODGE et colI. 1956, 1966 and ARVIDSSON 1958, 1961, inter alios). Cineangiocardiography with exposure frequencies of 100 per second or more are however more suitable for building such curves (RUSHMER & THAL 1951, CHAPMAN et coll. 1958, 1966, GRIBBE et coll. 1959, BRUN et coll. 1966, inter alios). The routine use of left ventricular volume curves produced with the aid of angiocardiography and pressure-volume curves, and their further analysis, should mean considerable diagnostic and probably also prognostic gains in the assessment of patients with cardiac disease (DODGE et coll., BRUN et coll, inter alios). Increased information on the state of the myocardium, better

Radiographic determination of the bone mineral content in amputation stmps.

Increasing attention is paid nowadays to the rehabilitation of patients with leg amputations. One problem is the considerable déminéralisation of the bones that sometimes occurs in amputation stumps. A simple and reliable technique for its mensuration would therefore be useful. Various methods have been used to determine the bone mineral content in patients. BJÖRK (1965) found a modification of the method of KEANE, SPIEGLER & DAVIS (1959) useful in osteoporosis, and the present authors have modified this method further to make it suitable for the determination of the bone mineral content of the tibia.