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126 Abstracts of Papers
salvaged by embolectomy as had survived operation
in the previous half century.
Our experience with pulmonary embolectomy
using temporary cardiopulmonary bypass for other-
wise fatal acute massive pulmonary embolism now
includes 8 patients, 4 of whom are long term sur-
vivors. Pulmonary arteriograms following operation
have demonstrated excellent clearing of the pul-
monary arterial tree by the technic of massaging the
lungs to express emboli in peripheral branches and
by time allowed for complete embolectomy using
cardiopulmonary bypass. Experimental investiga-
tions and clinical experience have demonstrated
advantages of partial cardiopulmonary bypass for
resuscitating these patients prior to definitive em-
bolectomy, and current improvements in pump
oxygenators now allow immediate availability of
bypass for such procedures.
Current status of pulmonary embolectomy will
be presented, and recent improvements in surgical
technics will be discussed.
7. Interrelationship of Lipids and Estrogens
in 100 Normal Patients and 100 Patients with
Coronary Artery Disease, S. R. BENDER, M.D.,
H. S. KROMAN,M.D., and A. N. BREST,M.D., F.A.c.c.,
Philadelphia, Pa.
The relation between blood lipids and blood estro-
gens has long been suspected and documented.
By utilizing newer biochemical technics developed
in our laboratory, a study was made to show the
relation of specific blood lipids to specific estrogenic
substances. One hundred normal men and women
(pre- and postmenopausal) were compared with 100
men and women (pre- and postmenopausal) having
coronary artery disease (documented myocardial
infarctions) with associated states of hyperlipemia.
The estrogens (estrone: 17B-estradiol, estriol)
were chemically extracted and separated by gas
chromatography as described by Kroman and Bender
et al. Total cholesterol, triglyceride and lipoprotein
per cent composition were determined by con-
ventional technic.
Results indicate that of 100 normal subjects
(age range, 20 to 58 yr), 9G per cent showed a higher
concentration of 17B-estradiol than estrone. In the
100 male and female patients with hyperlipemia and
coronary artery disease (age range, 30 to 70 yr.)
92 per cent exhibited a higher concentration of
estrone than 17B-estradiol. No significant relation
was noted between the lipids and estriol concen-
tration. A significant decrease (p < 0.01) in the
concentration of 17B-estradiol was observed in men
with coronary artery disease and hyperlipemia when
compared to normal male patients. A similar relation
was observed upon comparing women with coronary
artery disease and hyperlipemia to a similar group
of normal women.
These results suggest the implication of the female
sex hormones in the genesis of hyperlipemia.
*8. Exertion and Acute Coronary Artery Injury,
ASHER BLACK, M.D., MARTIN M. BLACK, M.D., GOP-
FREDO G. GENSINI, M.D., F.A.c.c., and SALVATORE
DI GIORGI, M.D., Syracuse, N.Y.
The relation between exertion and acute coronary
injury is investigated as to the pathophysiologic
sequence of events. Five cases of acute myocardial
infarction following very strenuous exertion are
presented. Two patients came to autopsy; the
pathology of the coronary artery lesions is reviewed.
The nature, evolution and location of coronary
artery plaques and their relation to the hemodynamics
and motion of coronary arteries were investigated.
Within the life cycle of coronary artery plaques,
changes can take place during which they may be
more susceptible to internal hemorrhage and frac-
ture. The relation of acute coronary artery injury
to internal hemorrhage into the plaque or fracture is
correlated with coronary artery motion as seen on
coronary cinearteriography during the resting state
and following the administration of isoproterenol.
Coronary artery motion consisting of pulsations,
stretching along the long axis (accordion action),
and spiral twisting is seen. There is also a whip-
like action of the coronary arteries with the fulcrum
of the whip being localized in the area where the
usual occluding coronary plaques appear. The
concept that this unique motion of coronary arteries
in the patient with vulnerable plaques may, under
the influence of strenuous exertion, result in acute
coronary artery injury and coronary artery spasm or
occlusion is developed.
A short run of cinearteriography demonstrating var-
ious motions of coronary arteries will be presented.
9. The Fallacy of Applying the Poise&e Equa-
tion to Segmental Arterial Stenosis, DAVID BYAR,
M.D., RICHARD V. FIDDIAN, M.B., MARCIA QUEREAU,
A.B., JOHN T. HOBBS,M.B. and EDWARD A. EDWARDS,
M.D., Boston, Mass.
Poiseuille derived his formula on the basis of the
steady laminar flow of water through “capillary”
glass tubes of even diameter. While the variables
which appear in his equation are also significant in
the turbulent flow through stenoses, their quantita-
tive relationships are altered.
Because viscosity and peripheral resistance cannot
be adequately controlled in vivo, we have studied
THE AMERICANJOURNAL OF CARDIOLOGY