Louis H. Frische

Visualization of the Coronary Circulation by Occlusion Aortography: A Practical Method

Our nations highest death rate gives evidence of the failure of traditional therapeutic methods in arteriosclerotic heart disease. In 1959, the disease will take the lives of over a half-million Americans. The lesion which each year is directly responsible for 400 times as many deaths as poliomyelitis is a localized narrowing confined to the proximal divisions of the left coronary artery. We believe that a direct surgical attack constitutes the most logical approach to this essentially mechanical obstruction to myocardial blood flow. If so, it will be necessary to obtain detailed anatomical information concerning the extent and location of disease in order to select patients for surgery, plan the operative approach, and evaluate the results. This report describes a technic for coronary angiography which has been found to be safe and reliable in the dog. We believe it is ready for application to the study of the diseased coronary arteries of man. In this procedure, a special double-lumen balloon catheter ...

Lumen-Following Safety J-Guide for Catheterization of Tortuous Vessels

Atherosclerotic tortuosity and intimal reconfiguration add to the difficulty and risk of arterial catheterization regardless of how it is performed. The use of small J -shaped catheters as temporary, path-finding substitutes for conventional guides has earned wide acceptance (1). Although effective in principle, this technic requires procedural catheter changes which are time-consuming, inconvenient, and sometimes sanguinary. J-Guide A conventional movable core guide spring is heated and preshaped into a J configuration 6 mm across. This guide is then used in place of a J -catheter. A similar simultaneous development has been reported by others (3). In use, the J-guide is subjected to relatively hazardous stresses produced by repeated manipulation and sharp angulation of an already weakened heat-deformed tip. The chance of breakage is increased: indeed, such a tip was lost in a patient with severe arteriosclerotic peripheral vascular disease. Safety J-Guide2 After development of the safety guide (2), the ...

The “Nonsurgical” Treatment of Iliofemoral Arteriosclerotic Obstruction

Since the original report (1) on transluminal recanalization of arteriosclerotic obstructions, the method has been used a total of 113 times in 74 different patients from January 1964 to September 1965. Treated vessels include the iliac, popliteal, and tibial arteries, as well as the superficial and deep femoral arteries. In this progress report, particular attention will be directed to the problems encountered, the current criteria for case selection, and areas of future promise. Rationale and Method Reduced to fundamentals, the technic of transluminal recanalization entails probe passage followed by radial displacement or molding rather than “reaming” or actual removal of atheromata. This approach tends to eliminate the rough lumen and abrupt changes in caliber which encourage thrombosis after endarterectomy or by-pass grafting, particularly in smaller arteries. Moreover, the fibrosis and vascular distortion resulting from the repair of a surgical incision are avoided in most instances by use of a percu...

Postbulbar duodenal ulcer and ring-stricture. Cause and effect.

Abstract A longitudinal study including repeated hypotonic duodenography examinations was performed on 12 patients with ring-stricture of the descending duodenum. Findings included a common clinical pattern of years of undiagnosed symptoms despite multiple upper gastrointestinal examinations and a characteristic progression of a descending duodenal ulcer to a fixed 2–3 mm stricture diagnosed only by hypotonic duodenography. Surgical proof was obtained only when the duodenum was opened, palpated, and inspected visually from within. Such strictures are not congenital but indicate peptic ulcer disease; they are usually undiagnosed. If suspected, hypotonic duodenography is indicated.

Radiologic Technic for Qualitative and Quantitative Study of Blood Flow

This preliminary report deals with the direct radiographic study of discrete, relatively small spots of artificial radiopacity during their passage through the cardiovascular structures and offers a new and promising technic for studying the motion of blood. As used here, motion refers to movement of and within the blood stream. So defined, it is fundamental to the subject-matter of hemodynamics. Continuing studies are focused upon two major hemodynamic parameters: 1. The velocity, acceleration and deceleration of circulating blood. Through appropriate specialized radiographic technics, it is possible to measure the movement of blood as a function of time. Observations may be completed in 1 msec., repeated in rapid sequence and made simultaneously at many different points within the cardiovascular system. 2. Flow characteristics of circulating blood. The graphic study of flow patterns at multiple points within the blood stream can be carried out simultaneously with blood velocity observations. By analogy, in this technic the blood vessels and chambers of the heart serve as wind tunnels; the blood is the wind, the spots of opacity are smoke tracers and the myocardium is the source of power. The results of extensive experimental studies indicate that the above goals are achievable and warrant the considerable effort and costs involved. It is hoped that this preliminary report will encourage others to explore the possibilities of the method and thereby hasten its perfection.

Intramural barium in ischemic colitis: a new radiographic finding.

Two cases of ischemic colitis are presented, demonstrating a new radiographic finding of intramural dissection of barium. Colonoscopic findings were compatible with that diagnosis. Deep, discrete ulcerations were observed during the healing process. Both patients recovered and prolonged retention of the intramural barium was seen.