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A MULTIPURPOSE CARDIAC CATHETER
582 found in the
right antrum on exploratory puncture. In right external frontal operation showed extensive involvement of the bony septa between the sinuses were
January, 1959,
a
and infection of the frontal and maxillary bones. After operation the patient was discharged without symptoms, but when he was seen ten months later he was again complaining of swelling round his right eye suggesting the persistence of infection.
I wish to thank Prof. G. W. A. Dick and Mr. Kennedy Hunter for cooperation and help in the preparation of this paper, and Mr. T. Connor for technical assistance. REFERENCES
Bartley, E. O., Hunter, K. (1947) Lancet, i, 908. Bezjak, V., Mimica, M. (1952) Brit. med. J. ii, 757. Hadorn, W. (1938) Schweiz. Med. Wschr. 68, 665. Smith, J. E. (1959) J. comp. Path. 69, 231.
Bacno/ogy In January, 1959,
a second strain (AW/59) of Past. pestis isolated from pus taken at operation. Unfortunately the AW strain isolated in 1945 had not remained viable and it was impossible to make a direct comparison of the two strains. They were, however, similar in morphological, cultural, and biochemical properties apart from a few minor differences: for example, strain AW grew on MacConkey’s medium while AW/59 did not; and the AW strain was sensitive to penicillin while the AW/59 strain was resistant. The AW/59 strain was also resistant to sulphathiazole but sensitive to all other antibiotics against which it was tested. Using the criteria of Smith (1959) it is not possible to assign AW/59 to an animal source. Thus capsules were present, colonies were not mucoid, hyaluronic acid was produced, iridescence was not seen, and acid agglutinability was present at pH 25 and 3-5 but not at pH 4-5 or 5.0. The organism was pathogenic for mice, and it produced fermentation of xylose and mannitol but not sorbitol, maltose, or trehalose. An agglutination test using immune rabbit sera was carried out as previously described (Bartley and Hunter 1947) with the following results:
New Inventions
was
A MULTIPURPOSE CARDIAC CATHETER THE standard cardiac catheter has a lumen through which pressure pulses and blood samples may be obtained, and injections may be made. For recording intracardiac electrocardiograms a catheter is necessary with an electrode near its tip. When inhaled hydrogen is used to detect left-to-right intracardiac shunts a catheter bearing a platinum-black electrode is necessary.1 The investigation of patients with congenital heartdisease has been
simplified by using a catheter capable of serving each of these purposes. The distal portion of a doublelumen catheter is
amputated at XŃX (see figure). A platinum nail, cemented into the cut end, is connected by a lead
It would appear, therefore, that
Type culture strain
no.
1737
are
AW/59 and the National serologically related but not
running
identical. A similar conclusion was reached when the AW strain was compared with 1737 in 1945. Blood taken from the patient in November, 1959, had an agglutination titre of 1 : 40 against the AW/59 strain. In 1945 the patient’s serum had no demonstrable antibody-which is not an unusual finding in Past. septica infections.
Discussion
Human infections with Past. septica are uncommon, and the few reported cases of sinus infection with this organism appear to have run very chronic courses. Hadorn (1938) recorded a case of Past. septica meningitis eight months after a fracture of the skull involving a presumably infected right frontal sinus, and Bezjak and Mimica (1952) described a patient with Past. septica sinus infection who had symptoms and a greenish nasal discharge for six years. It is unfortunately impossible to exclude reinfection in the present case, but it seems equally reasonable to assume a chronic infection over a period of at least twelve years. Apart from the change in penicillin sensitivity, the AW and AW/59 strains appear to be very similar.
Summary A strain of Past. septica was isolated from a patient with frontal sinusitis in 1945 and again in 1959. Direct comparison of the two strains has not been possible, but they appear to be essentially similar except in certain biochemical properties and in penicillin
sensitivity. Assuming that reinfection did not occur, Past. septica sinusitis may apparently be very chronic and last for as long as fifteen years.
(a) Section through the double-lumen cardiac catheter. The distal portion is amputated at x-x, 1 cm. from the proximal orifice. (b) Section showing the platinum nail inserted into the cut end of the catheter, and connected to an amplifier by a lead lying in one lumen of the catheter.
through
the lumen to a suitable amplifier. The platinum nail is "blacked"by electrolysis. The finished catheter thus bears at its tip the orifice of one lumen, and the
platinum-black electrode. The electrode may be used for recording the intracardiac electrocardiogram, or for
detecting inhaled hydrogen. In practice the catheter is inserted into the right side of the heart and pulmonary artery. Pressures are recorded through the lumen. Left-to-right shunts are detected and localised by hydrogen inhalation. Right-to-left shunts are revealed by indicator-dilution curves after dye has been injected through the lumen of the catheter. The intracardiac electrocardiogram is recorded when necessary. The catheter may be obtained from Messrs. Chas. F. Thackray, 10, Park Street, Leeds, 1. We are indebted to Mr. H. Womack, F.LS.T., of the department of physical chemistry in the University of Leeds, for overcoming the problem of providing a cardiac catheter with a platinum-black electrode. H. M. S. was in receipt of a grant from the Nuffield Foundation.
P. G. F. NIXON M.B.
Department of Thoracic Surgery, The General Infirmary at Leeds 1.
Durh.,
M.R.C.P.
H. M. SNOW Technician
Clark, L. C., Jr., Bargeron, L. M., Jr. Surgery, 1959, 46, 797.
right antrum on exploratory puncture. In right external frontal operation showed extensive involvement of the bony septa between the sinuses were
January, 1959,
a
and infection of the frontal and maxillary bones. After operation the patient was discharged without symptoms, but when he was seen ten months later he was again complaining of swelling round his right eye suggesting the persistence of infection.
I wish to thank Prof. G. W. A. Dick and Mr. Kennedy Hunter for cooperation and help in the preparation of this paper, and Mr. T. Connor for technical assistance. REFERENCES
Bartley, E. O., Hunter, K. (1947) Lancet, i, 908. Bezjak, V., Mimica, M. (1952) Brit. med. J. ii, 757. Hadorn, W. (1938) Schweiz. Med. Wschr. 68, 665. Smith, J. E. (1959) J. comp. Path. 69, 231.
Bacno/ogy In January, 1959,
a second strain (AW/59) of Past. pestis isolated from pus taken at operation. Unfortunately the AW strain isolated in 1945 had not remained viable and it was impossible to make a direct comparison of the two strains. They were, however, similar in morphological, cultural, and biochemical properties apart from a few minor differences: for example, strain AW grew on MacConkey’s medium while AW/59 did not; and the AW strain was sensitive to penicillin while the AW/59 strain was resistant. The AW/59 strain was also resistant to sulphathiazole but sensitive to all other antibiotics against which it was tested. Using the criteria of Smith (1959) it is not possible to assign AW/59 to an animal source. Thus capsules were present, colonies were not mucoid, hyaluronic acid was produced, iridescence was not seen, and acid agglutinability was present at pH 25 and 3-5 but not at pH 4-5 or 5.0. The organism was pathogenic for mice, and it produced fermentation of xylose and mannitol but not sorbitol, maltose, or trehalose. An agglutination test using immune rabbit sera was carried out as previously described (Bartley and Hunter 1947) with the following results:
New Inventions
was
A MULTIPURPOSE CARDIAC CATHETER THE standard cardiac catheter has a lumen through which pressure pulses and blood samples may be obtained, and injections may be made. For recording intracardiac electrocardiograms a catheter is necessary with an electrode near its tip. When inhaled hydrogen is used to detect left-to-right intracardiac shunts a catheter bearing a platinum-black electrode is necessary.1 The investigation of patients with congenital heartdisease has been
simplified by using a catheter capable of serving each of these purposes. The distal portion of a doublelumen catheter is
amputated at XŃX (see figure). A platinum nail, cemented into the cut end, is connected by a lead
It would appear, therefore, that
Type culture strain
no.
1737
are
AW/59 and the National serologically related but not
running
identical. A similar conclusion was reached when the AW strain was compared with 1737 in 1945. Blood taken from the patient in November, 1959, had an agglutination titre of 1 : 40 against the AW/59 strain. In 1945 the patient’s serum had no demonstrable antibody-which is not an unusual finding in Past. septica infections.
Discussion
Human infections with Past. septica are uncommon, and the few reported cases of sinus infection with this organism appear to have run very chronic courses. Hadorn (1938) recorded a case of Past. septica meningitis eight months after a fracture of the skull involving a presumably infected right frontal sinus, and Bezjak and Mimica (1952) described a patient with Past. septica sinus infection who had symptoms and a greenish nasal discharge for six years. It is unfortunately impossible to exclude reinfection in the present case, but it seems equally reasonable to assume a chronic infection over a period of at least twelve years. Apart from the change in penicillin sensitivity, the AW and AW/59 strains appear to be very similar.
Summary A strain of Past. septica was isolated from a patient with frontal sinusitis in 1945 and again in 1959. Direct comparison of the two strains has not been possible, but they appear to be essentially similar except in certain biochemical properties and in penicillin
sensitivity. Assuming that reinfection did not occur, Past. septica sinusitis may apparently be very chronic and last for as long as fifteen years.
(a) Section through the double-lumen cardiac catheter. The distal portion is amputated at x-x, 1 cm. from the proximal orifice. (b) Section showing the platinum nail inserted into the cut end of the catheter, and connected to an amplifier by a lead lying in one lumen of the catheter.
through
the lumen to a suitable amplifier. The platinum nail is "blacked"by electrolysis. The finished catheter thus bears at its tip the orifice of one lumen, and the
platinum-black electrode. The electrode may be used for recording the intracardiac electrocardiogram, or for
detecting inhaled hydrogen. In practice the catheter is inserted into the right side of the heart and pulmonary artery. Pressures are recorded through the lumen. Left-to-right shunts are detected and localised by hydrogen inhalation. Right-to-left shunts are revealed by indicator-dilution curves after dye has been injected through the lumen of the catheter. The intracardiac electrocardiogram is recorded when necessary. The catheter may be obtained from Messrs. Chas. F. Thackray, 10, Park Street, Leeds, 1. We are indebted to Mr. H. Womack, F.LS.T., of the department of physical chemistry in the University of Leeds, for overcoming the problem of providing a cardiac catheter with a platinum-black electrode. H. M. S. was in receipt of a grant from the Nuffield Foundation.
P. G. F. NIXON M.B.
Department of Thoracic Surgery, The General Infirmary at Leeds 1.
Durh.,
M.R.C.P.
H. M. SNOW Technician
Clark, L. C., Jr., Bargeron, L. M., Jr. Surgery, 1959, 46, 797.