Biomedical subjects
Publications and source records attributed to J P Archie.
The results of 47 operations for parotid tumor in a community hospital are reviewed. The morbidity and recurrence rates are comparable to those of large published series and support the hypothesis that subtotal parotidectomy can be done safely in a general surgical group practice in which no single surgeon has a large experience.
An analysis of 110 consecutive patients undergoing bilateral selective carotid arteriograms and phonoangiography, periorbital Doppler examination and air-filled pressure oculoplethysmography demonstrates that combined testing gives a 98 per cent accuracy rate in diagnosing the presence or absence of carotid artery stenosis in 83 of 100 patients with carotid artery stenosis and in 84 of 120 normal patients. The remaining patients had only one abnormal test result, either an abnormal phonoangiogram, 40 per cent probability of carotid artery stenosis, or an abnormal periorbital Doppler study, 12.5 per cent probability.
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The physiologic and functional improvement after aortofemoral bypass was quantitatively assessed by preoperative and postoperative noninvasive vascular testing in two groups of patients operated upon for claudication alone, those with significant occlusive disease of the lower extremity limited to the aortoiliac segments and those with combined disease of both the aortoiliac and superficial femoral arteries. While there is a statistically significant increase in segmental pressures and exercise times after aortofemoral bypass in the group with combined disease, these objective hemodynamic parameters are far from normal and are statistically significantly lower than values obtained in the group of patients with open superficial femoral arteries. Accordingly, we question the advisability of proximal arterial reconstruction in patients with combined hemodynamically significant aortoiliac and occlusive disease of the superficial femoral artery and claudication as the only indication for operation.
A patient with a symptomatic duodenal polyp was found at operation to have a 4 cm diameter adenomatous polyp of the ampulla of Vater, with both the common bile duct and pancreatic duct passing through the stalk and emptying from the polyp. The polyp was excised at the base of the stalk, and the two ducts reconstructed by a double spincteroplasty technique. The postoperative course and 2 1/2 year follow-up have been uneventful.
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The left ventricular transmural distribution of steady diastolic blood flow was measured with microspheres at three constant coronary perfusion pressures and two constant diastolic transmural pressures. The pressure-flow ratio in each layer was near linear allowing calculation of an apparent downstream pressure at zero diastolic transmural pressure (or intrinsic myocardial pressure) of 2.0 to 2.4 kPa (15 to 18 mmHg). When the transmural pressure was 2.67 kPa (20 mmHg), the increment of pressure in the outer 4/5 of the ventricular wall was 0.80 kPa (6 mmHg) (interpreted as transmitted intramyocardial pressure). Thus, intrinsic intramyocardial pressure is large and is a major determinant of diastolic coronary blood flow, and transmitted intramyocardial pressure has its major effect in the subendocardium.
The two components of myocardial oxygen delivery, coronary blood flow to capillaries and diffusion from capillaries to mitochondria, were studied in six dogs, (1) prior to shock, (2) after three hours of hemorrhage shock at a mean systemic arterial pressure of 40 torr, (3) after reinfusion of shed blood, and (4) during the irreversible late posttransfusion stage. There was a maldistribution of left ventricular coronary flow during late shock consistent with subendocardial ischemia. Cardiac performance was significantly impaired after resuscitation and all dogs became irreversible. Total and regional left ventricular coronary blood flow and myocardial oxygen delivery to capillaries were significantly greater than preshock values in (3) but not different from preshock values in (4). However, the myocardial oxygen diffusion area to distance ratio was significantly lower than preshock values in (3), and slightly lower in (4). These data suggest that myocardial oxygen diffusion may be impaired in the early post transfusion period, (3). Accordingly, the probable etiology of left ventricular dysfunction and possibly irreversibility after resuscitation from hemorrhagic shock is subendocardial ischemia during shock with either post-resuscitation impairment of myocardial oxygen diffusion, or in cellular oxygen utilization, or both.
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Shunting of radionuclide labeled 9 micron diameter microspheres by the systemic circulation, and 6 body regions was measured in two dog shock models: endotoxic shock (1 mg/kg E. Coli endotoxin intravenously) and sepsis and septic shock (5 days after cecal ligation). Mean systemic arterial blood pressure was significantly lower than control in both the endotoxic and septic shock groups. Mean systemic shunting was 7.7% in the control group and 7.3% and 4.3% respectively in the endotoxic and septic shock groups. Regional shunting of the head, heart, and skeletal muscle were not significantly different in the three groups. However, mean shunting in the splanchnic circulation was 36.5% in the septic shock group as compared to 18.6% in the control group (p less than 0.05). Mean kidney shunting in the endotoxic group was 15.1% compared to 4% in the control group (p less than 0.05). During resuscitation with crystalloid, mannitol, blood, and cortiocosteroids mean aterial blood pressure and cardiac index increased but systemic arterial-venous shunting was 3.8 and 4.3% in endotoxic and septic shock respectively. These data show that systemic anatomic arterial-venous shunting is small and not different from control in both dog shock models, and regional arterial-venous shunting is increased only in the splanchnic circulation in the septic model and in the kidney in the endotoxin model.
Right ventricular function curves as measured by right ventricular stroke work were normal in all control lambs, whereas three of five lambs with banded pulmonary arteries had relatively flat curves. Left ventricular function was similarly normal in the control group as compared to a near zero slope function curve in the banded group. Regional myocardial blood flow to the septum and right and left ventricles was similar in control and banded lambs. At rest right ventricular coronary vascular resistance was lower in the banded than in the control group and decreased in both groups during both isoproterenol and dextran stress states. In general, both groups had a similar ratio of right to left ventricular oxygen supply to demand ratio. These results show first that there is minimal, if any, biventricular functional reserve in lambs with persistent right ventricular hypertension, and second, that there is substantial coronary vascular reserve in both normal and banded groups.
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