This study compared hand-held arterial compression with compression by a mechanical clamp to achieve hemostasis following transfemoral catheterization in 3,255 patients from six different hospitals. The time spent in manual compression of the artery averaged 33.5 minutes compared with 19.9 minutes using the clamp. The incidence of hematoma formation using the manual method was 6%; it was 2% using the mechanical device. No ischemic symptoms or complications resulted from the use of the holding device. The results suggest that the mechanical method is an effective and time-saving alternative to manual compression for control of bleeding after transfemoral catheterization.
Changes in pulmonary vascular (arteriolar) resistance were estimated in 58 patients with mitral stenosis following mitral valvotoimny and during exercise. Evidence is presented that changes in "resistance" reflect active changes in the caliber of the vessels due to alteration in their smooth muscle tone, valvotonmy being followed by a decrease in tone and exercise by an increase.I T IS well known that patients with mitral stenosis have medial hypertrophy of the pulmonary arteries, that a muscular media develops in the arterioles,1-4 and that these histologic changes often are accompanied by an increased resistance to blood flow through the vessels of the lungs.5 Many attempts have been made to define the mechanism of this increased resistance with the use of adrenergic and ganglionic blocking agents.6-9 The conflicting nature of the conclusions emphasizes the difficulty in interpreting the results. This is mainly due to the fact that the potent action of these drugs on the systemic circulation makes it difficult to decide whether the changes in the pulmonary circulation are actively or passively induced. The recent use of acetylcholine injected into the pulmonary artery in such a concentration that it is inactivated before reaching the left side of the heart has demonstrated that the high pulmonary vascular resistance in mitral stenosis is at least partly functional;10 that is, tone is present in the smooth muscle of the pulmonary vessels and this contributes to the pulmonary hypertension.In the present paper, some of the factors are examined that may be concerned in the maintenance of this tone. METHODSThe hemodynamic data on 58 adult patients were analyzed. All clinical and laboratory findings, and this was confirmed in the majority of eases at the time of mitral valvotoiny. There were 42 women and 16 men, aged 18 to 53 years, with an average age of 34 years for the women and 38 years for the men. Any patient having a systemic blood pressure higher than 140 mm. Hg systolic and 90 mm. diastolic was not included in this report. Intravascular pressures were recorded by straingage manometers, the zero reference point being midehest at the level of the third interspace on the sternum with the patient supine. The cardiac output was determined by the Fick principle. The rate of consumption of oxygen was measured by collecting expired air for 5 minutes and analyzing it immediately by the Haldane method; blood samples from the pulmonary and radial arteries withdrawn midway during the collection of expired air were analyzed for their oxygen content in duplicate by the method of Van Slyke and Neill.1"The oxygen capacity of hemoglobin was measured by the method of Sendroy,12 with the modification of Roughton, Darling, and Root.13 Midway during the collection of the blood samples, a record of pulmonary and radial artery pressures was obtained that was considered to represent the resting state. The catheter tip was then advanced into the "wedge" position of either peripheral lung field and the pressure was measured.For th...
Six hundred and seventy-six healthy subjects between 5 and 77 years of age have been studied by radioelectrocardiography. These subjects were studied before exercise, during a Master's two-step test, and after exercise. Orthostatic ST-T changes occurred in 32 of 200 subjects (16 per cent). The results indicate that the positioning of the bipolar chest leads is crucial in eliminating "abnormal" ST-T changes caused by changes in posture and position. Criteria for orthostatic ST-T changes have been presented. It is concluded that more rigid criteria for "definitely abnormal" ST-T changes during radioelectrocardiography should be developed, so that coronary artery disease will not be overdiagnosed, nor will significant ST-T changes be regarded as "normal variants" occurring with activity.
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