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

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