A case report of reversed reciprocating tachycardia sensitive to vagal stimulation which produced interesting patterns of coupling is described. The mechanism of reversed reciprocal rhythm is discussed. This arrhythmia and Wolff-Parkinson-White syndrome can be explained on the basis of anomalous pathway. In the former partial anterograde block through the A-V node is also present.
Clinical data for the first 100 operations utilizing saphenous vein graft are presented. Eighty-seven percent of the patients were between 41 and 60 years of age, the youngest being 26 and the oldest 69. A combined simultaneous single internal mammary artery implantation and saphenous vein graft was done in 41 patients with no increase in the operative risk. The operative mortality rate was 5 percent. There were three late deaths. The most common complications were atrial fibrillation in 12 patients and myocardial infarction in seven. Fifty patients underwent postoperative cardiac catheterization. In 40, the graft was patent and the obstruction was totally relieved. Six patients showed significant narrowing, and in four the graft was closed. The grafts remained in good condition without dilatation over a year postoperatively.
The routine study of regional ventilation of the lungs has been hampered by the lack of safe, simple and accurate methods. Radioisotope techniques have made possible the development of such methods. Two varieties of radioactive scanning have been used: radiolabelled particulate material, and radioactive inert gases. We have performed scans using both inhaled technetium-99m albuminate particles and xenon 133 gas. Normal subjects and patients with pulmonary disease were studied. Particle inhalation in normal controls revealed adequate peripheral filling, although upper airway and gastrointestinal deposition occurred. In patients with pulmonary disease, however, underventilated zones of lung appeared totally unventilated with particle scans, while those with 133Xe gas reflected ventilation disturbances more accurately. Further, a dynamic visualization of ventilation could be obtained using 133Xe, while scans with 99mTc albuminate indicated the cumulative result of several minutes of positive pressure breathing. It is concluded that both methods can offer important information, but each has its own limitations and advantages which should be recognized. Valuable insights into respiratory physiology and pathogenesis of pulmonary diseases can be obtained from these new techniques.
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