From Peripheral to Coronary Dynamic Angioplasty: Analysis of Resulting Particles

The factors that could reduce the size of particles generated by peripheral (8 Fr) and coronary (5 Fr) Kensey catheters (KC) in calcified and noncalcified atheroma were investigated. Fresh endarterectomy specimens (72 calcified, 72 noncalcified) were inserted in a flow circuit and randomized to undergo simulated dynamic angioplasty using 5 Fr or 8 Fr KC at a range of predetermined cam speeds (20,000–80,000 rpm) and flow rates (18–60 mL/min). Atherectomy as measured by weight loss from the specimen was greater in noncalcified lesions, 21.4 ± 4.5 mg and 14.9 ± 3.8 mg, respectively (P < 0.001). In calcified atheroma, the atherectomy was asymmetrical in 38 out of 72 specimens but in only 12 of 72 noncalcified lesions (P < 0.01). Overall, 65%± 3.9% of collected particles were smaller than 5 μm and 86.8%± 9.1% were smaller than 35 μm. In the remaining 13.2%± 8.9% of particles larger than 35 μm, significant differences were detected between the maximum particle size in each group. Larger particles were generated from calcified atheroma. In noncalcified lesions, increasing cam speed reduced maximum particle size from 890 to 170 μm (P < 0.001). Although a higher flow rate and the use of 5 Fr catheter have also significantly reduced the particle size, their effect was less than that exerted by cam speed. In calcified atheroma, cam speed was the only factor observed to influence the maximal particle size, reducing it from 1,260 to 381 μm (P < 0.001). In conclusion, although the majority of particles resulting from the use of KC were small, a proportion of large particles was also detected. Their size could be significantly reduced by careful adjustment of the operating parameters. These results are important for future application of KC in coronary dynamic angioplasty. However, the impact of reducing particle size on the risk of embolism in vivo requires further study.     

PAPULAR MUCINOSIS

Most patients previously reported to have papular mucinosis had the generalized lichenoid papular form (scleromyxedema) with abnormal gamma globulin. Microscopic examination of affected skin showed increased acid mucopolysaccharides in the dermis and proliferation of fibroblasts. Our patient had the discrete form of papular mucinosis without abnormal serum gamma globulin but with increased amounts of acid mucopolysaccharides in the dermis and no proliferation of fibroblasts.     

MULTIPLE MYELOMA WITH SYNOVIAL AMYLOID DEPOSITION

A 56-year-old man developed multiple myeloma with severe jointstiffness and arthralgia without definite joint swelling. Atpost-mortem examination large amounts of amyloid were foundby light and electron microscopy in the synovial fluid and onthe surface of the synovial membrane. Smaller amounts of amyloidwere identified beneath the lining cells and in vessel walls.No inflammatory reaction was found in the synovial membraneor fluid. Synovial amyloid may occasionally be responsible forjoint stiffness and arthralgia, as well as for more marked jointchanges mimicking rheumatoid arthritis. The diagnosis can beestablished by synovial biopsy. ^*Supported in part by funds from the Veterans Administration,and grants from the Arthritis Foundation, Eastern PennsylvaniaChapter, and Smith, Kline and French Laboratories.     

Cholecystokinin Cholecystography in the Diagnosis of Acalculous Extrahepatic Biliary Tract Disorders

Cholecystokinin cholecystography represents a study designed to identify patients with acalculous e.xtrahepatic biliary tract disorders. In this study, a positive cholecystokinin cliolecystognini (CCK-GB) was defined as both reproduction of the patient's biliary tract-type pain phis one or more of various roentgen abnormalities. Using these criteria, 20 patients luid a positive CCK-GB. After failure of medical management, 19 of these patients came to surgery. Seventeen of 18 available for follow-up were cured of their biliary tract pain by surgery. FoIIow-up of this group of patients has ranged from one montli to 60 months. In view of our findings plus those in other reported series, we conclude that CCK-CB provides a reliable study for the diagnosis of acalculous extrahepatic biliary tract disorders.     

The evaluation of cardiovascular drugs in the anaesthetized,unrestrained rat

A method is reported which allows continuous long-term drug administration and simultaneous blood pressure measurement in the unanaesthetized unrestrained rat. The external jugular vein and abdominal aorta were cannulated and the opposite ends of the cannulae were passed subcutaneously and exteriorized at the back of the head. They were then passed through a spring attached at the lower end to the skull and, at the upper end, to a counter-weighted cantilever. In rats so prepared, infusion of angiotensin amide 200 ng kg^?1 min^?1 caused a rise of blood pressure which lasted the 48 h infusion period. Heart rate decreased initially but recovered within 6 h. Angiotensin amide 30 ng kg^?1 min^?1, infused up to seven days, was without effect on blood pressure or heart rate, and both doses of angiotensin amide failed to alter cardiac catecholamine turnover. Hydralazine, mecamylamine and clonidine reduced blood pressure to 63, 62 and 84% of control respectively while clonidine induced a transient increase before its depressor effect. Heart rate was increased by hydralazine to 138%, and decreased by clonidine to 74% of control, and was unaffected by mecamylamine. The magnitude of pressor response to noradrenaline, tyramine and angiotensin was reduced by hydralazine and increased by mecamylamine. Clonidine increased the pressor response to angiotensin but had no effect on that to noradrenaline or tyramine.     

FIVE YEARS‘ EXPERIENCE WITH PROXIMAL GASTRIC (HIGHLY SELECTIVE) VAGOTOMY

In the five-year period 1972 to 1976 the authors' preferred treatment for patients with chronic duodenal or prepyloric peptic ulcer requiring surgery was proximal gastric vagotomy. In spite of this preference, only two-thirds of such patients were so treated. Most patients with bleeding and stenosis were treated by bilateral truncal vagotomy and drainage, and a few by Polya gastrectomy. Proximal gastric vagotomy proved to be a safe elective operation without mortality and with a proven ulcer recurrence rate so far of 6%. Compared with those who had bilateral truncal vagotomy and drainage, the proximal gastric vagotomy patients complained less often of diarrhoea but more often of weight loss and reflux. Two patients have had persistent postprandial non-peptic pain, thought possibly due to upper gastric ischaemia.