chronic congestive heart failure was studied in dogs with surgically-produced tricuspid insufficiency and pulmonic stenosis. Ascites formed in association with an elevation in mean right atrial pressure. The volume of ascitic fluid and the rate of urinary sodium excretion varied greatly in individual dogs during the course of congestive failure and among the different animals. Sodium retention was most common but periods of sodium balance and natriuresis occurred. Comparative data on the right and left ventricles were obtained from determinations of intracardiac pressures, measurements of ventricular muscle mass at the time of sacrifice and studies of the lungs for evidence of chronic passive congestion. There was significant right ventricular hypertrophy but no evidence of left ventricular hypertrophy or failure.
The incidence of pulmonary toxicity associated with mitomycin is unpredictable, but more likely to occur at higher dosages. Treatment with corticosteroids is encouraged to improve pulmonary response.
1. The dosage of protamine necessary for the postoperative neutralization of heparin, used as anticoagulant during extracorporeal circulation, was studied in 25 patients by means of both the protamine titration test and the plasma thrombin time.
2. The plasma thrombin time was found to be far more sensitive in the detection of small quantities of residual heparin than was the protamine titration test, which failed to demonstrate significant quantities of circulating heparin.
3. Adequate neutralization of circulating heparin was achieved when an initial postoperative protamine dose of 1.5 times the calculated residual heparin was given and followed by additional protamine when indicated by the result of the plasma thrombin time.
4. No toxic effects of protamine were noted on such a dosage schedule.
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