1
Letter to the Editor Thermadiiutian flowmeter In the article entitled “Pulsatile aspects of coro- nary sinus blood flow in closed-chest dags” by Stein and aqsociatea (AMER. HEART J. 78:331, 1969), referenm is made to the thermodilution flowmeter described by me in the JourneE of A@lded PhysioEogy (21:1883, 1966). It needs to be pointed out that this is not a thermistor welo& probe as mentioned by Doctor Stein. It is rather a catheter flowmeter which measures mean v&me flow in the coronary sinus, based on the principle that heat produced by an electrical coil is uniformly distributed in the blood stream through the mechanical action of a stirrer and that the temperature change obtained, which is measured downstream, is inversely proportional to flow* In thi regard, I find Dr. Stein’s statement, “a thermistor transducer was also utilized by Hfonso for the measurement of coronary sinus velocity,” to be incorrect and misleading. Needless to say, measurements of flow and phasic variations in Aow with a velocity flow probe, without simultaneous measurements of the vessel diameter, do not permit meaningful interpretation, Skoda Afonso, M.D., Ph.D. Cardiovascular Research Laboratory Ubtivc~si~y of Wsconsin Medtial Schod Madison, Ws. Thank you for forwarding Dr. Afunso’s letter to me. Klr. Afonso is certainly correct regarding the capabilities of his thermodilution catheter-tip flow- meter. i do not completely agree with Dr. Afonso’s comments regarding the in~rpre~tion of coronary sinus velocity. In an articIe now in press in the Amiuct*l HEAET Jouzar~~, we showed a linear relationship between increments of coronary sinus velocity and increments of left anterior descending corona& flow in dogs after several interventions. Therefore. it mav, in fact. be Dossibie to obtain some < , . meaningful interpretation from the measurement of coronary sinus velocity without simultaneous measurement of the vessel diameter. Of course, more precise information would be obtained from total flow measurements. Paul D. Stein, M.D. Associate Puafessor of Medicine and Director, Curd& CatLQrisa~ion Laborafwy University of ORlahuma Medicd Cester OkMwma City, OkEa. Medical research has become incredibly produc- tive in recent years, and for rhe plethora of articles, lectures, and seminars on these new discoveries ail of us can be truly grateful. Unfortunately, much of the so-called information explosion has a different and less lofty origin. The publish-or-perish philoso- phy of our universities and research institutes has caused to be published a vast array of trivia and poorly performed studies. About this, much has been said but little accomplished. At least, though, the problem is recognized as such. However, there is yet another source of surfeit which, apparently, is held so sacrosanct that it has not even been recognized as an excess, and yet it is about this that we should most raise our voices in anger. Year after year, some of the best known figures in Medicine regularly inundate the scientific journals with a monotonous repetition of the same hackneyed ideas, while others seem to be bent on au endless cycle of travels to medical meetings where they re- re-re-represent their effete theses ad nauseum. For example, ii I read one more article on the tu-o-step electrocardiogram by You-Know-Who, or hear one more Iecture on anticoagulant therapy by you- Know-Who-Also-I think I shall scream! Surely repetition carried out to such extremes cannot be justified on the basis of education. Rather, the objec- tive clearly seems to be that of keeping the authors’ names constantly before the medical community in order to maintain their high positions in the uni- versities, hospitals, and scientific societies. Un- doubtedly, they believe, as do the soap and tooth- paste manufacturers, that constant repetition of a iie will transform it into a truth. - Who is to blame for such self-serving advertisinE? (And there is no better way to desc&e this rep& hensihie behavior than that.] Certainly the indldi- viduals involved must assume their share of the guilt, but, in my opinion, the journal editors and conference chairmen are the main culprits. It is their privilege and duty to select fresh, worthwhile topics for presentation to their audiences, and their ahdi- cation of this responsibility when confronted by a request for time or space from a patrician provides the forum for these self-seeking advertisers to tout their sales pitches. The result is that valuabIe journal space or conference time is wasted, that the audience is carrsed to groan “Oh no, not again!“, and that sincere young men become prematurely cynical about the behavior of those whom they would like to emulate. 1, far one, have had my fill. Henceforth, I expect to hold every editor or conference chairman strictly accountable for his censorship responsibility. Abuses will be publicly challenged. Mymn R. Schoenfdd, M.D., F.A.C.P.* 11 Brotlx River Rd. YonkeYs, N* Y. It%704

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Letter to the Editor

Thermadiiutian flowmeter

In the article entitled “Pulsatile aspects of coro- nary sinus blood flow in closed-chest dags” by Stein and aqsociatea (AMER. HEART J. 78:331, 1969), referenm is made to the thermodilution flowmeter described by me in the JourneE of A@lded PhysioEogy (21:1883, 1966). It needs to be pointed out that this is not a thermistor welo& probe as mentioned by Doctor Stein. It is rather a catheter flowmeter which measures mean v&me flow in the coronary sinus, based on the principle that heat produced by an electrical coil is uniformly distributed in the blood stream through the mechanical action of a stirrer and that the temperature change obtained, which is measured downstream, is inversely proportional to flow* In thi regard, I find Dr. Stein’s statement, “a thermistor transducer was also utilized by Hfonso for the measurement of coronary sinus velocity,” to be incorrect and misleading.

Needless to say, measurements of flow and phasic variations in Aow with a velocity flow probe, without simultaneous measurements of the vessel diameter, do not permit meaningful interpretation,

Skoda Afonso, M.D., Ph.D. Cardiovascular Research Laboratory

Ubtivc~si~y of Wsconsin Medtial Schod Madison, Ws.

Thank you for forwarding Dr. Afunso’s letter to me. Klr. Afonso is certainly correct regarding the capabilities of his thermodilution catheter-tip flow- meter.

i do not completely agree with Dr. Afonso’s comments regarding the in~rpre~tion of coronary sinus velocity. In an articIe now in press in the Amiuct*l HEAET Jouzar~~, we showed a linear relationship between increments of coronary sinus velocity and increments of left anterior descending corona& flow in dogs after several interventions. Therefore. it mav, in fact. be Dossibie to obtain some

< , .

meaningful interpretation from the measurement of coronary sinus velocity without simultaneous measurement of the vessel diameter. Of course, more precise information would be obtained from total flow measurements.

Paul D. Stein, M.D. Associate Puafessor of Medicine and

Director, Curd& CatLQrisa~ion Laborafwy University of ORlahuma Medicd Cester

OkMwma City, OkEa.

Medical research has become incredibly produc- tive in recent years, and for rhe plethora of articles,

lectures, and seminars on these new discoveries ail of us can be truly grateful. Unfortunately, much of the so-called information explosion has a different and less lofty origin. The publish-or-perish philoso- phy of our universities and research institutes has caused to be published a vast array of trivia and poorly performed studies. About this, much has been said but little accomplished. At least, though, the problem is recognized as such. However, there is yet another source of surfeit which, apparently, is held so sacrosanct that it has not even been recognized as an excess, and yet it is about this that we should most raise our voices in anger.

Year after year, some of the best known figures in Medicine regularly inundate the scientific journals with a monotonous repetition of the same hackneyed ideas, while others seem to be bent on au endless cycle of travels to medical meetings where they re- re-re-represent their effete theses ad nauseum. For example, ii I read one more article on the tu-o-step electrocardiogram by You-Know-Who, or hear one more Iecture on anticoagulant therapy by you- Know-Who-Also-I think I shall scream! Surely repetition carried out to such extremes cannot be justified on the basis of education. Rather, the objec- tive clearly seems to be that of keeping the authors’ names constantly before the medical community in order to maintain their high positions in the uni- versities, hospitals, and scientific societies. Un- doubtedly, they believe, as do the soap and tooth- paste manufacturers, that constant repetition of a iie will transform it into a truth. -

Who is to blame for such self-serving advertisinE? (And there is no better way to desc&e this rep& hensihie behavior than that.] Certainly the indldi- viduals involved must assume their share of the guilt, but, in my opinion, the journal editors and conference chairmen are the main culprits. It is their privilege and duty to select fresh, worthwhile topics for presentation to their audiences, and their ahdi- cation of this responsibility when confronted by a request for time or space from a patrician provides the forum for these self-seeking advertisers to tout their sales pitches. The result is that valuabIe journal space or conference time is wasted, that the audience is carrsed to groan “Oh no, not again!“, and that sincere young men become prematurely cynical about the behavior of those whom they would like to emulate.

1, far one, have had my fill. Henceforth, I expect to hold every editor or conference chairman strictly accountable for his censorship responsibility. Abuses will be publicly challenged.

Mymn R. Schoenfdd, M.D., F.A.C.P.* 11 Brotlx River Rd.

YonkeYs, N* Y. It%704