Citations

Intradermal injection of a fluorescent dye (riboflavin) and ultraviolet light were used to demonstrate cutaneous lymphatic capillaries. The extremities of a control group and the nonedematous extremities of patients with arteriosclerosis obliterans were studied together with edematous extremities of patients with lymphedema, acute thrombophlebitis, chronic venous insufficiency and various other conditions. The lymphatic capillaries showed up more extensively after a higher percentage of injections into edematous extremities of patients with lymphedema than after injections into the other extremities. On the other edematous extremities except in the cases of nephrotic syndrome and on the normal extremities, either no lymph capillaries or only a few were visible after most of the injections.

The response of the intra-arterial pressure to the cold immersion stimulus was studied in 42 healthy young adults, continuous direct (arterial-pressure) recording being used. The average systolic elevation was 22.6 mm. Hg and the average diastolic elevation was 16.3 mm. Hg. The difference between direct and indirect methods of measuring blood pressure was studied in 351 simultaneous determinations in 35 of these young adults. The direct systolic pressure averaged 9.7 mm. Hg higher and the diastolic pressure was 7.3 mm. Hg lower than the indirect measurement.

The cold pressor test was performed three times at 15-minute intervals on 65 normotensive subjects and on 60 patients with essential hypertension both before and during treatment with antihypertensive drugs. The arterial pressure was recorded directly from the radial artery. On the basis of differences in the cold pressor response among individuals in the control group, the criteria for normal reaction and for hyperreaction were modified. The cold pressor response in the patients with essential hypertension was markedly depressed by the ganglionic blocking agents, but was not affected by various combinations of hydralazine, protoveratrine and reserpine.

The effect of hexamethonium on hypertension has been widely studied but its effect on the peripheral blood vessels of patients with severe occlusive vascular disease has been studied on only a few patients although the drug has been used empirically in the treatment of such disease. Observations were made on the effect of hexamethonium ion administered subcutaneously in increasing doses of 10 to 50 mg. on the skin temperature of the fingers and toes, the blood pressure and the pulse rates of a group of patients with severe arteriosclerosis obliterans. On this group of patients hexamethonium had little or no effect.

Fluorescent quantitation of epinephrine and norepinephrine in plasma of patients suspected of having pheochromocytomas is of considerable diagnostic value. The concentrations of these pressor amines in normal subjects, patients with various diseases with and without hypertension, and 13 patients with pheochromocytomas are reported. In all patients with pheochromocytomas and sustained hypertension the concentrations of pressor amines were significantly elevated. However, in patients with paroxysmal hypertension secondary to pheochromocytomas the pressor amine concentrations may be unelevated when the blood pressures are normal. In this latter group provocative tests with intravenous histamine are indicated to induce hypertension prior to quantitating pressor amines.

Abstract Aims This study aimed to evaluate the predictive value of a baseline speckle tracking strain rate imaging-derived discoordination index for response to cardiac resynchronization therapy (CRT). Methods and results Ninety-seven patients with QRS ≥120 ms and left ventricular (LV) ejection fraction ≤35% were prospectively followed after CRT in the Mayo CRT Registry. The LV discoordination index (stretch/shortening or thinning/thickening during ejection) was calculated from three types of deformation, radial, circumferential, and longitudinal, using two-dimensional speckle tracking strain rate imaging. The benefit of CRT was evaluated by reverse remodelling (i.e. reduction of LV end-systolic volume ≥15% at 6-month follow-up) and survival. The optimal cut-off value of the baseline discoordination index in discriminating responders from non-responders was determined by receiver operating characteristic curve analysis. Significant differences in baseline indices between responders and non-responders were noted for radial and circumferential discoordination indices. A mid-ventricular radial discoordination index (RDI-M) >38% best predicted responders, especially in patients with ischaemic cardiomyopathy (area under the curve 0.86 for all patients, sensitivity 80%, and specificity 91%). Death occurred in 28 patients over a median follow-up of 3.2 years. When adjusted for confounding variables, lack of significant discoordination (RDI-M <38%) before CRT was associated with a particularly high mortality (hazard ratio 7.05, 95% confidence interval 2.45–26.0). Conclusion LV discoordination assessed by speckle tracking RDI-M imaging was able to predict reverse remodelling at 6 months and survival of patients who received CRT.

SummaryBackgroundIt remains unclear whether a long‐acting preparation of octreotide (Sandostatin LAR) can be safely used for portal hypertension in patients with compensated cirrhosis.AimTo determine the safety and efficacy of LAR among patients with Child Pugh Class A or B cirrhosis and small oesophageal varices.MethodsA randomised, double‐blind, placebo‐controlled study was conducted in 39 patients with cirrhosis and small oesophageal varices. Safety was based on frequency and severity of adverse events. Efficacy was determined by hepatic vein pressure gradient (HVPG) measured at baseline and day 84 following administration of LAR 10 mg (n = 15), 30 mg (n = 10) or saline (n = 14). Fasting and postprandial portal blood flow (PBF), superior mesenteric artery pulsatility index (SMA‐PI), glucagon and octreotide levels were measured. An intention‐to‐treat analysis was performed.ResultsFour patients in the LAR 30 group (40%) withdrew from the study due to serious adverse events. No patient in the LAR 10 or control group had serious adverse events. There was no statistically significant decrease between HVPG at day 84 and baseline with LAR 30 mg (11.8 ± 2.3 mmHg vs. 14.1 ± 3.2), LAR 10 mg (15.3 ± 4.8 mmHg vs. 15.1 ± 3.8), or saline (13.3 ± 3.8 mmHg vs. 15.1 ± 4.3) (P = 0.26). Neither PBF, SMA‐PI nor plasma glucagon levels were significantly decreased from baseline (P = 0.56).ConclusionsThe absence of significant haemodynamic benefit, as well as the high frequency of severe adverse events associated with use of LAR, do not support the use of this agent in the treatment of portal hypertension.

Assistive equipment has helped lower task demands and back stress for patient-handlers; however, limited research exists on the psychological benefits (i.e., safety and comfort) of self-transfer devices for patients in postoperative care. A study was conducted to determine the efficacy of a bed assistive device in a patient population; the objectives were to compare self-perceived recovery measures and usage of pain medication between patients in the Control ( n = 8; age, 34 ± 6.3years) and Device ( n = 7; 41 ± 12) groups. Fifteen female participants undergoing either abdominal hysterectomy ( n = 6) or Cesareansection ( n = 9) procedures were recruited for the study. Both groups completed a total of twelve questionnaires over a five-week recovery period. The Device Group reported higher levels of energy, less pain interference, lower perceived pain, less reliance on pain medication and returned to activities of daily living faster than the Control Group.