ISSN:0098-6569    

DOI:10.1002/ccd.1810010302

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1975

数据来源: WILEY

摘要:

AbstractEighty of 654 patients studied because of chest pain were found to have normal coronary arteriography. Fifty of these completed submaximal treadmill exercise studies. The purpose of this study was to determine whether treadmill electrocardiography could obviate the need for coronary arteriography in the evalution of patients with undiagnosed chest pain. Of patients studied, 22% had typical angina pectoris, while 78% had atypical chest pain. The resting electrocardiogram was normal in 58% of patients, while 42% showed repolarization abnormalities. Submaximal treadmill testing was normal in 64%, incomplete in 12%, and demonstrated classic ischemic S‐T depression in 24%. Our findings of 24% positive studies in patients with normal vessels and 12% incomplete tests suggest that stress electrocardiography may be of limited value in predicting the morphologic state of the coronary arteries in patients with undiagnosed chest pai

ISSN:0098-6569    

DOI:10.1002/ccd.1810010303

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1975

数据来源: WILEY

摘要:

AbstractRadiation exposure to the angiographer was measured using thermoluminescent dosimeters (TLD), commercial film badges, and appropriate ionization survey meters.Data were collected during 47 coronary artery examinations with the lead overleaf. During a single coronary examination, the angiographer receives 0.9 mR to the lens and 2.8 mR to the hand. The calculated yearly exposure to the angiographer performing 10 examinations per week is 450 mR to the lens, 9% of the maximum permissible dose (MPD), and 1400 mR to the hand, 2% of the MPD.Exposure rates for the left anterior oblique (LAO) and right anterior oblique (RAO) projections during cine and fluoroscopy were taken at the position occupied by the angiographer. Scatter radiation is 5‐10 times greater in the LAO projection.The second trial was monitored during 18 coronary artery examinations minus the lead overleaf. A significant decrease in radiation exposure was accomplished through the use of the lead overlea

ISSN:0098-6569    

DOI:10.1002/ccd.1810010304

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1975

数据来源: WILEY

摘要:

AbstractWith the increased utilization of portable image intensifiers for pacemaker insertions, an investigation of the radiation hazards to operative personnel was undertaken. The personnel were tested first utilizing a Rando phantom and later during actual pacemaker insertions. Studies of medical personnel show the critical organs to be the thyroid (approximately 15mR per procedure) and the lens of the eye (approximately 13mR per procedure). While the MPD/week was not exceeded, the radiation dosage was substantial and could increase under operating conditions other than those measured. Recommendations to insure safer operation of this equipment are presented.

ISSN:0098-6569    

DOI:10.1002/ccd.1810010305

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1975

数据来源: WILEY

摘要:

AbstractExperience with 648 consecutive percutaneous transfemoral coronary arteriograms and left ventriculograms performed in a teaching laboratory without the use of systemic anticoagulation during the procedure was reviewed. Only 1 death was felt to be related to a procedure, and this occurred 3 weeks after a myocardial infarction. There were 10 myocardial infarctions or emboli, 8 cerebral vascular accidents, and 7 femoral artery complications. Only 1 patient experienced a residual neurologic change following a procedure‐related cerebral vascular accident, and this was a mild visual field defect. Clotting of the catheter without sequelae but necessitating procedural changes occurred in 10 instances. The transient nature of the neurologic deficits and the low mortality suggest that the emboli which occurred in these patients were small, possibly platelet‐fibrin accumulations. It is postulated that with the use of careful technic larger emboli capable of producing myocardial infarction with shock or disabling cerebral vascular accidents can be prevented, even in a training situation. However, smaller embolic phenomena probably cannot be completely avoided by the use of careful technic, and it is for prevention of small emboli that systemic anticoagulation with heparin may be of va

ISSN:0098-6569    

DOI:10.1002/ccd.1810010306

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1975

数据来源: WILEY

摘要:

AbstractAll selective coronary arteriographic examinations (1,833) performed in the authors' laboratory during a five‐year period (1/1/70 to 12/31/74) were analyzed for mortality and total morbidity according to method used. During the first two years, the control period, the classic brachial artery cutdown (Sones) and percutaneous femoral artery puncture (Judkins) techniques were utilized. Mortality rate for the total 589 patients was 1.01%. This included a mortality of 0.26% (1/386) for the brachial arteriotomy method, and 2.5% (5/203) for the percutaneous femoral puncture approach.After introduction of the pressure‐drip flushing technique, the subsequent three‐year mortality rate for a total of 1,244 patients was 0.16%. This included an incidence of 0.17% (1/585) for brachial arteriotomy and 0.15% (1/659) for modified percutaneous puncture techniques.The morbidity incidence during the initial two‐year period was 3.0% (18/589). This included an incidence of 2.0% for brachial arteriotomy and 5.0% for percutaneous puncture techniques. After institution of the new pressure‐drip flushing technique the total incidence fell to 1.2% equally divided between arteriotomy and percutaneous techniques.Modification of the classic percutaneous femoral artery puncture technique has resulted in major reduction of mortality and morbidity complications which are chiefly thromboembolic in nature. It has not significantly influenced local thrombotic complications of ar

ISSN:0098-6569    

DOI:10.1002/ccd.1810010307

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1975

数据来源: WILEY

摘要:

AbstractA special high viscosity preparation of water soluble radiopaque contrast media was explored in animals for its suitability in selective coronary angiography. The high viscosity required power injection to accomplish adequate filling during selective coronary arteriography. The anticipated angiographic advantages, such as prolonged visualization and coating of the vascular walls, were marginal. Comparison with conventional preparations of the same contrast agent suggests that the high viscosity itself exerts some protective effect with regard to the immediate side effects on the electrocardiogram and mechanical function of the myocardium. However, the high viscosity preparation induced electrocardiographic signs compatible with myocardial ischemia not usually seen to follow the injection of conventional contrast agents. These were followed by mechanical heart failure or ventricular fibrillation resulting in death of 6 of the 10 experimental animals. It was concluded that high viscosity contrast media preparations are unsuitable for use in clinical selective coronary arteriography as presently practiced.

ISSN:0098-6569    

DOI:10.1002/ccd.1810010308

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1975

数据来源: WILEY

摘要:

AbstractExperience with a simplified technique for selective coronary angiography by the brachial cutdown approach using preformed coronary catheters in over 500 cases is described. This technique has facilitated selective catheterization of the coronary arteries in patients where use of the Sones catheter has proven difficult or impossible. Particularly, coronary arteries in patients with a dilated aortic root, high‐rising left coronary artery or tortuous subclavian artery are easily catheterized with the preformed catheters described in this report. Shortened procedure time, an acceptable morbidity (1.4%) and mortality (0.2%), and improved coronary opacification by virtue of the ease in selectively entering the coronary ostia make these preformed catheters a useful modification to coronary angiography by the transbrachial approac

ISSN:0098-6569    

DOI:10.1002/ccd.1810010309

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1975

数据来源: WILEY

摘要:

AbstractA technique is described for catheterizing and draining the pericardial space in patients with large effusions that are likely to recur.

ISSN:0098-6569    

DOI:10.1002/ccd.1810010310

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1975

数据来源: WILEY

摘要:

AbstractPericardiocentesis is a lifesaving procedure in cardiac tamponade but is associated with significant and often life threatening complications. A patient is described in whom a catheter was inserted into the pericardium. This provided for prolonged pericardial drainage of purulent fluid and has the potential for decreasing the risk of this procedure.

ISSN:0098-6569    

DOI:10.1002/ccd.1810010311

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1975

数据来源: WILEY