Samuel Losner

Diagnostic aids in acute myocardial infarction: clinical and experimental.

Abstract A battery of tests consisting of serial determinations of plasma fibrinogen, SGO-transaminase, serum aldolase, the C-reactive protein (CRP), and the erythrocyte sedimentation rate (ESR) was applied to patients with acute myocardial infarction, subendocardial necrosis, and coronary insufficiency, as well as to a group of dogs with ligation of the left anterior coronary artery at various levels. In the patients with acute myocardial infarction the enzymes reached their maximum concentration within 1 to 2 days after onset of the symptoms, and oeturned to normal 3 to 4 days later. The peak of fibrinogen concentration appeared on the second or third day following coronary occlusion, and returned to normal levels at the end of the second or during the third week. The maximum level of all 3 blood constituents reflected the gravity of the disease. During the stage of convalescence, recurrent elevations of both the enzymes as well as the fibrinogen concentration mirrored an extension of the myocardial infarction. The fibrinogen level, moreover, reflected a protracted clinical course and indicated such complications as intercurrent pericarditis, heart failure with pulmonary edema or pulmonary embolization. On the other hand, in patients with coronary insufficiency or subendocardial necrosis, all 3 blood constituents remained within normal levels or occasionally showed very moderate elevations. It is concluded that neither the enzymes nor the fibrinogen concentration alone adequately reflect the totality of the myocardial injury, but when applied conjointly and serially, they are useful tools to supplement the electrocardiographic findings. The ESR and the CRP usually attain abnormal values in acute coronary occlusion. Morever, they neither reflect the severity nor the duration of the disease. Moreover, the ESR frequently is considerably accelerated in patients with coronary insufficiency. In dogs with experimentally produced myocardial infarction the enzymes reached their peak levels within 24 hours, and the fibrinogen within 2 days after operation. A semiquantitative relationship between the extent of myocardial infarction and the maximum concentration of these blood constituents exists.

Diagnosis of lipoid pneumonia

Abstract 1. 1. Lipoid pneumonia occurs not only in chronically debilitated adults or in physically handicapped children, but also has been observed in apparently healthy individuals. Mineral oil is the most common cause of this condition since it is widely used as a mild laxative as well as a vehicle for oily nose drops, thorat lubricants or various oil-containing medications. 2. 2. The differential diagnosis of lipoid pneumonia frequently causes considerable difficulty since this condition may be confused with other pulmonary diseases such as low grade infections, tuberculosis, fungus disease, sarcoidosis or benign and malignant neoplasms. 3. 3. The recognition of lipoid pneumonia is of particular importance in those patients in whom a diagnosis of bronchogenic carcinoma is entertained because needless surgical intervention may be avoided. 4. 4. The clinical findings are not characteristic, and include productive cough, dyspnea, febrile exacerbations and chest findings associated with pulmonary consolidation. In many instances the patients are asymptomatic. 5. 5. The diagnosis of lipoid pneumonia can be established clinically with a considerable degree of accuracy by correlating the roentgenographic findings with cytologic studies of the sputum as well as of material aspirated transthoracically from the lung. 6. 6. The positive sputum contains lipophages and abundant amounts of free sudanophilic material, while the material aspirated from the lung is considered positive when the characteristic lipophages, single or arranged in clusters and frequently transformed into giant cells, are found. 7. 7. The roentgenographic features indicative of lipoid pneumonia are discussed. 8. 8. The mechanism of the progressive nature of the disease after discontinuance of the inciting liquid petrolatum is suggested as being due to reaspiration of disintegrated lipophages. 9. 9. Early clinical recognition of lipoid pneumonia may prevent extensive spread of the pulmonary involvement by discontinuing the intake of mineral oil or other oil-containing medications.

Fibrinogen preservation in serum after heparin.

Summary 1. Very little or no fibrinogen remains after coagulation of normal blood in glass test tubes. 2. Small amounts of fibrinogen are detectable in siliconized tubes as late as 20 minutes after gross coagulation. 3. Considerable quantities of fibrinogen can be demonstrated in citrated serum from individuals having received 50 or 75 mg of heparin intravenously during a 3 hour observation period after gross coagulation has occurred. 4. Similarly, fibrinogen is detectable in citrated serum in considerable quantities after gross coagulation of normal blood when added to small amounts of heparin in vitro 5. The preservation of fibrinogen in serum after heparin seems to be attributable to a direct inhibition of its polymerization reaction to fibrin.

Plasma Fibrinogen and Serum Aldolase in Acute Myocardial Infarction

maximum fibrinogen concentration, which usually is reached during the first few days of illness, seems to correlate closely with the severity of the clinical picture. Our study was facilitated by the use of a rapid and simple procedure of fibrinogen determination which has been developed in our laboratory in recent years. This test, termed the clot density method, is based on the increasing optical density of coagulating plasma and yields results within a few minutes after withdrawal of venous blood. The normal values range from 5 to 15, which corresponds to a fibrinogen concentration of 210 to 390 mg percent. The sedimentation rate is still commonly employed as a laboratory guide for the clinical evaluation of patients with acute coronary occlusion. Since the results obtained by this method are in many instances erratic and misleading, we attempted to compare the data obtained by the clot density method with those of the sedimentation rate in serial studies carried out on 75 patients with acute myocardial infarction. Although there is frequently a parallelism between the corrected sedimentation rate and the fibrinogen concentration as expressed in clot density terms, there

Clot Density Determination of Fibrinogen in Experimental Myocardial Infarction

Summary 1. In vitro experiments indicate that the clot density determination of fibrinogen may be applicable to either human as well as canine plasma. 2. Fifty dogs were subjected to a) sham-operation, b) high coronary artery ligation, c) low coronary artery ligation. 3. Significant differences in the mean fibrinogen levels were found in the three groups corresponding to the various degrees of myocardial necrosis. 4. These results seem to bear out a previously reached clinical impression that the maximum fibrinogen concentration parallels the extent of the myocardial infarct.

Delayed Blood Coagulation in Rabbits with Localized Shwartzman Reaction

Summary 1. A localized Shwartzman reaction was produced in 20 rabbits. 2. The Lee-White clotting time determined with blood obtained through cardiac puncture was found considerably prolonged when the reaction appeared and gradually returned to normal during the ensuing 6 days.

The Ballistoscope An Instrument for the Study of the Cardiac Impulse.

Summary An instrument called ballisto-scope is described, which registers any motion of the underlying surface in a two-dimensional plane. Placed upon the sternum it reveals ballistic patterns which are constant and characteristic in normal individuals as well as in patients with various types of heart disease.

Prolongation of Serum Prothrombin Time After Heparin

Summary 1. The one-stage prothrombin time of freshly coagulated and centrifuged blood is considerably prolonged after the intravenous administration of heparin. 2. The interaction time of calcium, serum, and plasma is similarly prolonged after intravenous injection of heparin. 3. The prolongation of the serum prothrombin time after administration of heparin is assumed to be due to both the antithromboplastic as well as antithrombic actions of the latter.

Comparison of citrated and oxalated plasma in the photoelectric determination of prothrombin time.

Summary (1) In a series of 600 photoelectric determinations of the prothrombin time of 100 normal individuals, the mean value for citrated plasma was 12.6 seconds as compared to 13.8 seconds for oxalated plasma. (2) The standard deviation was 0.15 second for citrated as compared to 0.19 second for oxalated plasma. (3) The onset of clotting is more easily determined photoelectrically with citrated than with oxalated plasma. This is evidenced by a more distinct swing of the galvanometer lightbeam because no precipitate but a soluble complex of calcium citrate is formed upon addition of calcium chloride.