bluuebunny/crossref_metadata_2025 huggingface dataset:
The Emphysema Response to Forced Straining (Valsalva's Maneuver)
Authors: MILLS HAROLD , KATTUS ALBERT A.
Published: June 2012

Changes in arterial pressure were recorded during and after forced straining (Valsalva's maneuver) in 29 patients with emphysema. The response in these patients differed greatly from that found in normal subjects and in patients with cardiac disease. Additional physiologic data did not serve to define the mechanisms of this unique response in emphysema to forced straining.
Interrelationship of Drugs Influencing Arterial Pressure in Man
Authors: REDISCH WALTER , TANGCO FRANCISCO F. , LEWIS ARTHUR J. , ANTONIO MARIA AURORA , DECRINIS KURT , STEELE J. MURRAY , Andrews Dorothy , Menkes Stephen
Published: June 2012

Comparison of hemodynamic changes (cardiac output, renal plasma flow, and extremity blood flow) observed during reserpine-induced hypotension with those occurring during pentolinium-induced hypotension suggests better adaptation following reserpine. This difference is believed to be related to the gradation of onset of hypotension. It was found that reserpine-induced hypotension is potentiated by norepinephrine, and pentolinium-induced hypotension by serotonin. Pretreatment with the hypotensive agent increased the pressor response to norepinephrine and serotonin respectively, if the pressor substance was administered before the onset of hypotension.
Long-Term Treatment of Angina Pectoris with Dicumarol
Authors: GABRIELSEN ZETH , MYHRE JON R.
Published: June 2012

By the use of "report cards" the daily amount of anginal pain and the weekly consumption of nitroglycerin tablets were registered in a small series of patients during alternating courses of Dicumarol and a placebo, covering in all more than 2 years. The total number of Dicumarol periods was 24, half of them lasting more than 6 months. The effect of Dicumarol was evaluated.
Biosynthesis of Epinephrine and Norepinephrine by Sympathetic Nerves and Ganglia
Authors: GOODALL MCC. , KIRSHNER NORMAN
Published: June 2012

It is generally believed by the neurophysiologists that the sympathetic neurohormone is norepinephrine and not epinephrine as originally supposed. This concept of norepinephrine as the sympathetic neurohormone has evolved from much impressive circumstantial evidence; however, it has not been demonstrated that the biosynthesis of norepinephrine takes place in the sympathetic nerves and ganglia. This paper shows, through the use of labeled precursors, that the sympathetic nerves and ganglia synthesize norepinephrine in a systematic sequence from tyrosine and that this synthesis apparently terminates with norepinephrine rather than progressing to the formation of epinephrine.
Bronchial Obstruction Due to Pulmonary Artery Anomalies
Authors: CONTRO STEPHEN , MILLER ROBERT A. , WHITE HARVEY , POTTS WILLIS J.
Published: June 2012

A left pulmonary artery, coursing anomalously above the right bronchus and behind the trachea en route to the left lung, can produce disabling respiratory symptoms. Three cases observed by the authors are presented in detail and 5 similar cases, previously reported, are reviewed. The clinical features are those of tracheobronchial obstruction, occurring early in life, associated with endoscopic evidence of extrinsic pressure on the right bronchus and posterior wall of the trachea. The importance of the clinical recognition of this anomaly is stressed, since it appears to be amenable to surgical correction.
Value of an Electrode Catheter in Diagnosis of Ebstein's Disease
Authors: YIM BERNARD J. B. , YU PAUL N.
Published: June 2012

Various features of Ebstein's disease, an unusual congenital malformation of the tricuspid valve, are discussed briefly. Cardiac catheterization with the use of an electrode catheter in such a case is described. The pathophysiologic changes as illustrated by simultaneous intracardiac potentials and pressures are discussed.
Experimental Renal Hypertension
Authors: GOLDBLATT HARRY
Published: June 2012

The evidence is reviewed that the primary cause of essential hypertension in man is intrarenal obliterative vascular disease, from any cause, usually arterial and arteriolar sclerosis, or any other condition which brings about the same disturbance of intrarenal hemodynamics.
Conference on Mechanism of Protective Action of Kidney and Relation of Renoprival to Chronic Renal Hypertension
Authors: BRAUN-MENÉNDEZ E.
Published: June 2012

This conference opened with an elaboration of the concept of the protective action of the normal kidney (Dr. Braun-Menéndez). After initiation of unilateral renal ischemia, the elevated blood pressure is reduced as the intact normal kidney hypertrophies to take over the work of the ischemic kidney. Removal of this intact kidney causes hypertension because the ischemic kidney cannot increase in size or function. As the protective action of the kidney is also lacking following bilateral nephrectomy, renoprival hypertension develops, providing the animals are kept alive long enough.

The cause of renoprival hypertension remains obscure. Gross changes in salt and water metabolism do not have to be present (Dr. Grollman). The normal kidney may produce some material which lowers the blood pressure, or it may destroy or excrete a pressor substance (Dr. Handler). Excretory removal is not so likely as a cause, since the production of simple excretory failure by diverting urine back into the blood stream does not result in hypertension (Dr. Grollman). According to some participants, renoprival and chronic renal hypertension are not identical: Removal of a unilateral ischemic kidney causes the blood pressure to return to normal. This does not fit with the renoprival hypertension theory and is evidence that a pressor agent must be involved (Dr. Goldblatt). A further difference is that whereas antirenin lowers the blood pressure in chronic renal hypertension, it will not lower the blood pressure in renoprival hypertension (Dr. Helmer). Dr. Kolff, however cites reports, such as that of the failure of bilateral nephrectomy to cure renal hypertension, which favor the view that the mechanism of production is the same in both forms of hypertension. Both groups finally agreed that some cases of renal and of renoprival hypertension could not be explained by assuming a single mechanism of action.
Changes in the Serum Cholesterol and Blood Clotting Time in Men Subjected to Cyclic Variation of Occupational Stress
Authors: FRIEDMAN MEYER , ROSENMAN RAY H. , CARROLL VERNICE , Tat Russell J.
Published: June 2012

Accountants were selectively chosen as a self-controlled group for studying effects of cyclic occupational stress upon serum cholesterol and blood clotting time, since their routine work schedule is interrupted by urgent tax deadlines, associated with severe occupational stress. Forty male accountants (age 28 to 56) were bled biweekly for serum cholesterol and monthly for blood clotting time from January to June 1957. Complete records also were kept of weight, exercise, diet, relative work load, and any exposure to unusual avocational stress. When studied individually, each subject's highest serum cholesterol consistently occurred during severe occupational or other stress, and his lowest at times of minimal stress. The results could not be ascribed to any changes of weight, exercise, or diet. Marked acceleration of blood clotting time consistently occurred at the time of maximum occupational stress, in contrast to normal blood clotting during periods of respite. The possible implications of these results are discussed in relation to the problem of clinical coronary artery disease.
Alimentary Lipemia and the Coagulability of Blood
Authors: SHEEHY THOMAS W. , EICHELBERGER JAMES W.
Published: June 2012

The effect of alimentary lipemia on the coagulation of blood has been studied by means of thrombelastography as a new approach to this problem. Our observations revealed no acceleration of blood coagulation during the phase of alimentary lipemia by this method, which is one of the few technics capable of demonstrating a state of hypercoagulability.
Further Experiences with Blood Coagulation after Fat Meals and Carbohydrate Meals
Authors: BORRERO JAIME , SHEPPARD ERWIN , WRIGHT IRVING S.
Published: June 2012

There have been conflicting reports as to whether the ingestion of fat increases the tendency for the blood to clot, and hence, by implication, the risk of thromboembolic complications in man. In this study the effect of a single meal containing a large amount of fat was compared with that of a practically purely carbohydrate isocaloric meal. Under carefully controlled conditions the clotting time varied widely under fasting conditions, and after both fat and carbohydrate meals the clotting time became longer, shorter, or remain unchanged. The results were unpredictable and although a slight trend toward shortened clotting times was evidenced after the fat meals, the results did not reach accepted statistical standards of probability.
Osmotic Diuretic Treatment of Refractory Edema
Authors: BERNSTEIN LIONEL M. , BLUMBERG BERNARD , ARKIN MURRAY C.
Published: June 2012

Many patients with edema of congestive cardiac failure, nephrosis, and cirrhosis become refractory to all diuretic therapy. Theoretically, the use in adequate dosage of osmotic diuretics whose action is dependent upon physical factors should augment sodium, chloride, and water excretion from whatever level exists prior to their use. In refractory edema, the effect of other diuretics (via alteration of the metabolic, actively resorbing mechanisms of the tubular cells) on tubular rejection of sodium, chloride, and water should be increased by osmotic diuretics. Mannitol was administered intravenously in large doses to test the effectiveness of osmotic diuretics in refractory edema.
A Comparison of the Serum Lipids, Lipoproteins, Glycoproteins, Urinary 17-Ketosteroids, and Gonadotropins in Eunuchs and Control Male Subjects
Authors: FURMAN ROBERT H. , HOWARD R. PALMER , SHETLAR M. R. , KEATY E. CORINNE , IMAGAWA RICHARD
Published: June 2012

The proclivity of men to coronary artery disease has been recognized for almost 2 centuries. The gonadal hormones have understandably come under scrutiny in the search for the explanation of this marked sex difference in susceptibility to disease. Sex hormones are known to alter the physical state of the serum lipids. It has been suggested that eunuchs suffer a less severe form of coronary atherosclerosis than uncastrated subjects. This study compares the serum lipids and lipoproteins, as well as other serum and urinary constituents, in 24 castrated and 20 uncastrated institutionalized men.
The Normal Orthogonal Electrocardiogram and Vectorcardiogram
Authors: PIPBERGER HUBERT V.
Published: June 2012

Preliminary standards for the normal orthogonal electrocardiogram and vectorcardiogram were established as a basis for further studies on pathologic series. Schmitt's corrected lead system (SVEC III) was used. The statistical analysis of electrocardiographic and vectorcardiographic data revealed some intrinsic shortcomings of commonly used analytic criteria. As the orthogonal electrocardiogram and vectorcardiogram are interchangeable, inherent advantages and disadvantages of the 2 methods of display could be evaluated in a quantitative fashion.
Effect of Potassium on Conduction and Ectopic Rhythms in Atrial Fibrillation Treated with Digitalis
Authors: FISCH CHARLES , SHIELDS J. PAUL , RIDOLFO S. ANTHONY , FEIGENBAUM HARVEY
Published: June 2012

Intravenous administration of potassium to patients with atrial fibrillation treated with digitalis resulted in depression of conduction through the A-V node, appearance of complete A-V dissociation and in some abolition of ventricular ectopic beats. The presence or absence of ectopic ventricular beats as well as the degree of depression of A-V node could be controlled at will by varying the rate of infusion. Termination of infusion was paralleled by prompt reappearance of all arrhythmias present before infusion started.
Effects of Racemic Epinephrine Inhalation on Cardiopulmonary Function in Normal Man and in Patients with Chronic Pulmonary Emphysema
Authors: ALEXANDER JAMES K. , MISE JUNICHI , DENNIS EDWARD W. , HERSHBERGER ROBERT L.
Published: June 2012

Epinephrine inhalation is now widely used to provide bronchodilator therapy for patients with chronic obstructive pulmonary emphysema. In this study a variety of cardiorespiratory effects following epinephrine inhalation have been examined to compare responses in normal and emphysematous subjects, and to evaluate possible differences between inhalational and parenteral usage of the drug. Since previous studies on the effects of epinephrine in emphysematous patients have been largely concerned with the respiratory apparatus, particular attention here has been directed toward the pulmonary circulation.
Postural Hypotension
Authors: DERN PHILIP L.
Published: June 2012

Clinical experience suggests that there are differences in the extent to which hypertensive patients respond with falls in blood pressure after administration of effective doses of ganglionic-blocking drugs. In this study attempts are made to define the relative magnitudes of the postural and nonpostural falls in blood pressure that are produced by these drugs. Frequent measurements of the blood pressure were made in hypertensive human subjects before and after the administration of ganglion-blocking agents. Drug-induced falls in blood pressure are calculated with reference to the baseline levels of blood pressure established in various ways for the individual patients.
Ventricular Activation in the Pre-Excitation Syndrome (Wolff-Parkinson-White)
Authors: GRANT ROBERT P. , TOMLINSON FRED B. , VAN BUREN JAMES K.
Published: June 2012

Seventy cases of pre-excitation were studied by vector translating methods. Certain properties of the delta event are described that are useful in the recognition of this syndrome electrocardiographically. In about half the cases a ventricular conduction defect without QRS-interval prolongation was demonstrated to have accompanied the pre-excitation. The type of ventricular conduction defect produced depended upon the particular direction of spread of the pre-excitation wave. This and other findings are incompatible with the hypothesis that pre-excitation is due to accelerated atrioventricular conduction and favor the hypothesis that it is due to bridges, whether morphologic or electronic, between atria and ventricles.
The Deep S Wave in Leads V
1
, V
2
, and V
3
in Right Ventricular Hypertrophy
Authors: SHUBIN HERBERT , LEVINSON DAVID C.
Published: June 2012

Six patients with mitral stenosis, 3 with pulmonic stenosis, and 1 with pulmonary hypertension are presented. All had isolated right ventricular hypertrophy and all had deep S waves in V
1
, V
2
, or V
3
. In 3 cases the voltage of R in V
1
was less than 0.5 millivolt. In 3 cases R/S ratios in V
1
of less than 1.0 were present. Vectorcardiograms showed characteristic features and illustrated the reasons for the electrocardiographic findings.
Reverse Wenckebach Block and Complete Atrioventricular Dissociation due to Potassium and Digitalis
Authors: FISCH CHARLES , RIDOLFO ANTHONY S.
Published: June 2012

The relation of digitalis to potassium was studied by administering potassium intravenously before and after digitalization. The disturbances of conduction due to potassium and those occurring after digitalis were observed and are here discussed.
Radioactive Fat Absorption Patterns
Authors: LIKOFF WILLIAM , BERKOWITZ DONALD , WOLDOW ASHER , JACOBS A. GERSON , SKLAROFF DAVID M.
Published: June 2012

Fat tolerance tests with radioactive triolein were performed on a group of patients with coronary atherosclerosis or hypercholesterolemia, and significant differences from normal subjects were observed. The mechanisms and implications of these abnormalities are discussed.
Hereditary Occurrence of the Pre-Excitation (Wolff-Parkinson-White) Syndrome with Re-Entry Mechanism and Concealed Conduction
Authors: HARNISCHFEGER WILLIAM W.
Published: June 2012

The hereditary occurrence of the pre-excitation (Wolff-Parkinson-White) syndrome in 3 generations of 1 family is reported. The syndrome was observed in a grandfather. father, in a set of identical twin girls, and in the male of a second set of fraternal twins. Completed abortive circus movements with re-entry into the normal conduction pathway, as well as concealed forward conduction, in the pre-excitation syndrome are demonstrated. The importance of this observation for the understanding of the mechanism of the Wolff-Parkinson-White syndrome is discussed.
Myocardial Infarction in Rats Fed Diets Containing High Fat, Cholesterol, Thiouracil, and Sodium Cholate
Authors: THOMAS WILBUR A. , HARTROFT W. STANLEY
Published: June 2012

Investigators have produced arteriosclerosis in experimental animals by dietary means for almost half a century. In contrast to the situation in man, however, all previous reports indicate that complicating thrombosis and infarction have been extremely rare in experimental animals. The current report presents dietary regimens by means of which the authors have produced significant numbers of myocardial and renal infarcts in rats (6 of 10 in one group and 4 of 10 in each of 2 others). It is notable that thrombosis occurred before the appearance of severe structural changes in the arterial walls, although abundant fat could often be demonstrated histochemically.
Serum Cholesterol in Man: Diet Fat and Intrinsic Responsiveness
Authors: KEYS ANCEL , ANDERSON JOSEPH T. , GRANDE FRANCISCO
Published: June 2012

Data obtained from a number of dietary experiments in man yield a formula by which the responses in serum cholesterol to changes in diet can be predicted. In this paper the reliability of this formula is tested and the effects of various types of fatty acids on serum cholesterol are investigated.
The Electrocardiogram of the South African Bantu
Authors: WOODS J. D. , LAURIE W.
Published: June 2012

Considerable attention has been directed to the "suggested" low incidence of atheroselerosis in the Bantu and its relation to diet and blood lipids. Electrocardiographic abnormalities found in the Bantu have been regarded as unreliable evidence either of the presence or the nature of heart disease in these subjects and hence not inconsistent with the alleged freedom of heart disease in these people. In the present study the authors challenge the validity of such an interpretation of electrocardiographic changes.
Serum Parameters as Discriminators between Normal and Coronary Groups
Authors: SCHLESSINGER BERNARD S. , WILSON FREDRICK H. , MILCH LAWRENCE J.
Published: June 2012

Evaluation was undertaken of several measurements in discriminating between a group of clinically normal persons and a group of persons with definite atherosclerosis manifested by clinical myocardial infaretions. Various S
f
lipoprotein classes, the serum cholesterol, the beta lipoprotein cholesterol, the lipid phosphorus, and the "atherogenic index" were included in the study. The results are presented and their significance is discussed.
The Growth of the Normal Aorta and of the Anastomotic Site in Infants Following Surgical Resection of Coarctation of the Aorta
Authors: MOSS ARTHUR J. , ADAMS FORREST H. , O'LOUGHLIN BERNARD J. , DIXON WILFRID J.
Published: June 2012

Observations were made on the growth of the anastomotic site 2 to 4 years after surgical resection of coaretation of the aorta in 5 infants who were less than 2 years of age at the time of surgery. Aortic measurements were made from biplane angiocardiograms. The physiologic adequacy of the anastomotic site was demonstrated by absence of a gradient in direct pressure measurements between the upper and lower extremities. Additional observations on the normal growth of the descending thoracic aorta were made from studies in 154 subjects with other forms of heart disease. They ranged in age from 2 days to 74 years.
Rupture of Aneurysm of Aortic Sinus of Valsalva Associated with Acute Bacterial Endocarditis
Authors: JICK HERSHEL , KASARJIAN P. JACK , BARSKY MORLEY
Published: June 2012

A case of ruptured aortic sinus of Valsalva aneurysm secondary to acute bacterial endocarditis is presented. In diagnosis of this entity emphasis is placed on the character, location, and radiation of the murmur. Importance of correct diagnosis is mentioned, since in some cases surgical correction may be carried out.
Dietary Fat, Serum Cholesterol Levels and Incidence of Atherosclerosis in Delhi
Authors: PADMAVATI S. , GUPTA S. , PANTULU G. V. A.
Published: June 2012

Very little information is available about the incidence of coronary heart disease in India, or of factors considered responsible for it. In a previous paper, the incidence of atherosclerosis as judged by electrocardiogram, the fat intake, and serum cholesterol levels in 2 low-income groups (industrial and rural) in Delhi were investigated. These data in high-income groups in Delhi have now been studied and the results compared. There were considerable differences in the findings in the 2 groups.
The Interrelationships of Serum Cholesterol, Cholesterol Esters and Phospholipids in Health and in Coronary Artery Disease
Authors: GERTLER MENARD M. , GARN STANLEY MARION , LERMAN JACOB
Published: June 2012

Serum cholesterol (free, esters and total) and serum phospholipids were determined in 97 men who had experienced coronary heart disease prior to the age of 40, 146 healthy nonhospitalized men of comparable age and a group of 97 men who were "matched" to the coronary disease group. The mean values for serum cholesterol (total) were 286 mg. per 100 cc., 224 mg. per 100 cc., and 247 mg. per 100 cc. for the coronary disease group, control group and matched control group, respectively. The serum phospholipids were highest in the coronary disease group. It is demonstrated that the interrelationships of the lipids in coronary heart disease are more important than any one of the constituents taken by itself. The theoretic implications of the total cholesterol: phospholipids ratio are considered.
Liver Function Tests in Chronic Congestive Heart Failure
Authors: FELDER LEONARD , MUND ALVIN , PARKER JULIUS G.
Published: June 2012

It has been difficult for the clinician to evaluate quantitatively and qualitatively the degree of damage to the liver in the presence of congestive heart failure. This paper gives a statistical analysis of the results of various liver function tests on a group of patients with congestive heart failure. The analysis includes comparisons based on etiology, type of rhythm, duration of heart failure, and nutrition.
Effect of Strophanthus on Coronary Blood Flow and Cardiac Oxygen Consumption of Normal and Failing Human Hearts
Authors: BING R. J. , MARAIST F. M. , DAMMANN J. F. , DRAPER A. , HEIMBECKER R. , DALEY R. , GERARD R. , CALAZEL P.
Published: June 2012

The action of strophanthus preparations on the coronary blood flow and the oxidative metabolism of the normal and failing human heart has been studied by coronary sinus catheterization. It has been found that strophanthus preparations have no effect on the coronary flow or oxidative metabolism of either the normal or failing heart. This agrees with the concept that the oxidative metabolism (energy production) of the failing heart in vivo is not abnormal. The results indicate that this drug is responsible for causing more effective conversion of oxidative energy into work.
Production of Experimental Cholesterol-Induced Atherosclerosis in Chicks with Minimal Hypercholesterolemia and Organ Lipidosis
Authors: STAMLER J. , KATZ L. N. , Bolene C.
Published: June 2012

Feeding chicks a mash enriched with 0.25 per cent cholesterol plus 5 per cent cottonseed oil induces a minimal sustained hypercholesterolemia. After 35 weeks of this regimen, birds exhibited a high incidence of gross cholesterol-induced atherosclerosis, particularly prominent in the thoracic aorta. The presence of atherosclerosis in these chicks with minimal diet-induced hypercholesterolemia lends further experimental support to the concept of the relationship of cholesterol in general, and exogenous cholesterol in particular, to the pathogenesis of human atherosclerosis.
Effect of Choline and Inositol on Plasma and Tissue Lipids and Atherosclerosis in the Cholesterol-Fed Chick
Authors: STAMLER J. , BOLENE C. , HARRIS R. , KATZ L. N.
Published: June 2012

The lipotropic factors choline and inositol fail to exert a prophylactic effect against hypercholesterolemia, organ lipidosis and atherogenesis in the cholesterol-fed chick.
Electrical Impedance Plethysmography
Authors: NYBOER JAN , Kreider Marian M. , Hannapel Leonard
Published: June 2012

The quantity of blood measured by electrical impedance plethysmography is defined by its resistive effect in parallel to the resistance of other tissue of the segment. By substitution of this parallel resistive value, together with data relative to the resistivity of blood and the length of the segment in the formula for the volume of an electrical conductor, we are able to derive the volume of the pulse in cubic centimeters. It follows that the volume displaced from the venous reservoir and the rate of refilling of the venous reservoir of an extremity may also be determined quantitatively.
Effects of Intravenous Administration of Fibrinolysin (Plasmin) in Man
Authors: MOSER KENNETH M.
Published: June 2012

The potentiality of dissolving clots has aroused great interest in fibrinolysin (plasmin) as a therapeutic agent in thromboembolism. In this paper the effects of intravenous administration of purified fibrinolysin in man are reported, with special emphasis upon systemic toxicity and alterations in clotting factors and fibrinolytic activity. This information is necessary for the evaluation of this agent for clinical purposes.
Effect of Oxygen on Pulmonary Vascular Resistance in Patients with Pulmonary Hypertension Associated with Atrial Septal Defect
Authors: SWAN H. J. C. , BURCHELL HOWARD B. , WOOD EARL H.
Published: June 2012

The present studies are concerned with the effect of high oxygen inhalation on patients with atrial septal defects. The problem of the amount of pulmonary vascular resistance and the relative contribution of irreversible structural changes and vascular tone may be of important prognostic significance in evaluation of such patients for cardiac surgery.
Staphylococcal Infections of the Heart
Authors: COHEN SIDNEY
Published: June 2012

The basic problems of staphylococcal infections do not seem near to solution. Possibly an effective and safe antibiotic will be found to which resistant, pathogenic staphylococcal mutants will not appeal. This may, not be an overly sanguine hope. Had it not been for the ability of the staphylococcus to synthesize penicillinase, this goal would have been achieved already, for staphylococcal mutants pathogenic to man and intrinsically resistant to penicillin (i.e., without the production of penicillinase) have not been reported. Even with better antibiotics grave problems would remain, however, for the staphylococcus often inflicts severe or even irremediable damage, especially in the heart, before the disease can be diagnosed.

Prevention is the crucial problem. Refinements in isolation technics and hospital sanitation may improve the protection of the patient in the operating room and the newborn infant in the nursery. Nevertheless, the hard core of infections in debilitated or otherwise susceptible medical patients will probably remain. To help them it will be necessary to learn to restore the mechanisms of normal host resistance that have been depleted by disease.
Circulatory Changes in Acute Glomerulonephritis
Authors: DEFAZIO VALENTINO , CHRISTENSEN RAYMOND C. , REGAN TIMOTHY J. , BAER LESEM J. , MORITA YOSHIKAZU , HELLEMS HARPER K.
Published: June 2012

Conflicting opinions have been expressed as to the mechanism of pulmonary and peripheral congestion frequently observed in the oliguric stage of acute glomerulonephritis. Hemodynamic studies in 7 patients studied during the oliguric edematous phase of the disease demonstrated that these patients have high ventricular filling pressures associated with an increase in cardiac output and are, therefore, examples of a high output congestive state.
Role of the Kidney in the Pathogenesis of Congestive Heart Failure
Authors: BARGER A. CLIFFORD , MULDOWNEY FRANCIS P. , LIEBOWITZ MARTIN R.
Published: June 2012

The pathogenesis of sodium retention in congestive heart failure has been a difficult problem to elucidate. The production in dogs of cardiac valvular lesions of increasing severity has enabled investigators to study the sequential alterations in salt and water balance in the same animal from the normal state through the progressive stages of cardiac impairment until frank failure is present. The findings in dogs suggest that: 1. Abnormalities in sodium metabolism are detectable in mild heart disease long before overt failure is present. 2. Total exchangeable sodium may be increased in animals with mild valvular damage. These animals have normal exercise tolerance and normal basal glomerular filtration rates. 3. Increased sympatho-adrenal (adrenergie) activity is responsible, in large measure, for the decreased sodium and water excretion in dogs with cardiac impairment. 4. Preliminary experiments suggest that the carotid sinus may be the receptor organ initiating the reflex increase in sympatho-adrenal tone, and may be the elusive "volume receptor" for which investigators have been searching. 5. Evidence is also available that the carotid sinus may play a major role in the regulation of the zona glomerulosa of the adrenal cortex, the site of aldosterone production.
Successful Repair of Sinus of Valsalva-Left Atrial Fistula
Authors: KAY JEROME HAROLD , ANDERSON ROBERT M. , LEWIS REUBEN R. , REINBERG MARTIN
Published: June 2012

An unusual dissecting sinus of Valsalvaleft atrial fistula with successful repair is reported. This lesion was repaired by open heart surgery with the utilization of a heart-lung machine.
Digitalis Delirium
Authors: CHURCH GERARD , MARRIOTT HENRY J. L.
Published: June 2012

The use and suitability of the term digitalis delirium are briefly discussed. Attention is drawn to the paucity of detailed reports on this important manifestation of digitalis poisoning.

Three cases of digitalis delirium resulting from toxicity with 3 different preparations—gitalin, digoxin, and digitoxin—are presented. The first case demonstrates how the signs of early intoxication in a single patient may vary with different preparations and indeed with the same glycoside on separate occasions. The second case provides an alarming example of delirium which, although provoked by a short-acting glycoside, nevertheless lasted longer than 2 weeks. The third illustrates how easily the diagnosis of digitalis intoxication can go unrecognized when superimposed on a complex clinical picture.

The clinical features of these cases are discussed in the light of previous reports.
The Electrocardiographic Pentalogy of Pulmonary Emphysema
Authors: WASSERBURGER R. H. , KELLY J. R. , RASMUSSEN H. K. , JUHL JOHN H. , Lloyd C. J. , Bauers H.
Published: June 2012

The clinical applicability of the routine electrocardiogram and the chest roentgenogram in assessing advanced pulmonary emphysema is shown by a correlative study on 150 adults with moderately severe and severe pulmonary emphysema determined by pulmonary function studies. From these data a rather uniform electrocardiographic pattern has emerged entitled "the electrocardiographic pentalogy of pulmonary emphysema" which by itself suggests the presence of an advanced emphysematous state.
Effect of Heart Irregularity on Left Ventricular and Arterial Peak Systolic Pressures in Aortic Stenosis
Authors: BREALL W. S. , SHAFFER A. B.
Published: June 2012

In aortic stenosis, systemic arterial peak systolic pressure may remain relatively steady in the face of marked, arrhythmia-induced, variations in left ventricular peak systolic pressure. A possible basis for this phenomenon is presented. It is suggested that beat-to-beat variations in the systolic pressure gradient across the aortic valve region may not always reflect variations in stroke volume.
An Aortic-Right Ventricular Fistula of More than Eighteen Months' Duration
Authors: BRONK THEODORE T. , MCDERMID WILLIAM J. , RODBARD SIMON
Published: June 2012

A 79-year-old man who developed evidence suggesting an intracardiac shunt survived at least 18 months after its onset. Intracardiac mechanisms that may protect the pulmonary circulation from excessive flows are suggested, based on anatomic findings at necropsy.
Hemodynamic and Hypotensive Effects of Long-term Therapy with Chlorothiazide
Authors: CONWAY JAMES , LAUWERS PHILIP
Published: June 2012

Long-term treatment of hypertension with chlorothiazide alone produces mioderate reduction in blood pressure in 66 per cent of patients with hypertension. This fall in pressure is due to a reduction in total peripheral resistance rather than a fall in cardiac output.
Discordant Pulsus Alternans
Authors: MCINTOSH HENRY D.
Published: June 2012

A patient with simultaneously recorded discordant pulsus alternans is presented. No similar example of this phenomenon has been found in the English literature.

The implications of this observation in elucidating the mechanism of pulsus alternans are discussed.
SYMPOSIUM ON CONGESTIVE HEART FAILURE
Authors: NADAS ALEXANDER S. , HAUCK ANNA J.
Published: June 2012

Congestive failure in infancy and childhood may occur in a number of diseases. Congenital heart disease. however, is probably the most common cause of failure, with rheumatic fever second. Although the basic physiology of cardiac decompensation is similar in adults and children, the presenting clinical picture may be somewhat different in the 2 groups.

We believe that infants and children with congestive failure should be treated vigorously, for we have the distinct impression that the mortality rate of these youngsters with severe heart disease has decreased appreciably since a more optimistic attitude prevails among parents and doctors about these problems. Vigorous use of anticongestive measures and antibiotics is worthwhile and results in many instances in the survival of an infant to an age when successful surgical repair is feasible. Certainly not all babies with congestive failure due to congenital, rheumatic, or other kind of heart disease can be salvaged. But surely the experience of the last few years has given us a much more optimistic outlook on this entire field. There are enough children attending school and enjoying life today who seemed at "death's door" in infancy to make us hesitate to give an unqualifiedly poor prognosis to almost any child in congestive failure. Similarly, we are more and more reluctant to suggest cardiac surgery as a dramatic emergency measure except in a few well-chosen cases. Intelligent medical management can salvage a large number of these children and allow them to survive to an age when relatively low surgical mortality may be offered.
Heart Disease and Filtrable Viruses
Authors: PEARCE JOHN M.
Published: June 2012

A number of filtrable viruses can infect the heart and there produce myocarditis, enadocarditis, and pericarditis. However, this action depends on a coexisting deprivation of oxygen to the heart.
Surgical Correction of Coarctation of the Main Pulmonary Artery
Authors: THROWER WENDELL B. , ABELMANN WALTER H. , HARKEN DWIGHT E.
Published: June 2012

Two cases of pure congenital coarctation of the main pulmonary artery are reported.

One case may be unique in that it represents the first report of an anatomically proved constriction located in the middle third of the main trunk. In this patient, successful open correction under hypothermia was carried out with cinematographic documentation. The results of preoperative and postoperative cardiac catheterization are described.

A plea is made for the routine use of open operation for correction of "pure pulmonic valvular stenosis." This allows better correction when the diagnosis is confirmed and flexibility for treatment if the unusual coarctation or constriction of the pulmonary artery is encountered.
Protein Molecules in Solution
Authors: KLOTZ IRVING M.
Published: June 2012

A protein molecule in solution may undergo a host of interactions: with solvent, with small molecules and ions, with itself, with other macromolecules. In a physiologic milieu, all of these possibilities are present. A variety of interactions will occur. On the basis of the behavior of these substances in simple systems, reasonable guesses can often be made as to which interactions will predominate in a biologic environment.
Measurements of Electrical Potentials and Ion Fluxes on Single Renal Tubules
Authors: GIEBISCH GERHARD
Published: June 2012

Experimental technics are described which permit the measurements of stable electrical potential differences across the cell membrane of single renal tubule cells and across single tubules. The inside of the tubule lumen is normally found to be electrically negative to the outside, while the cell interior is found to be negative to both the peritubular fluid and the tubule lumen. Such electrical measurements, in conjunction with known concentration gradients and flux measurements of various ions across single renal tubules, permit some deductions to be made on the driving forces involved in the movement of various ion species across the luminal and peritubular cell membrane of renal tubule cells.
Ion Movement in the Eye
Authors: KINSEY V. EVERETT
Published: June 2012

The optical integrity and the metabolism of the eye depend on the exchange of substances between the blood vessels of the eye and the ocular chambers. The present paper considers the exchange of 3 ions in particular, i.e., sodium, chloride and bicarbonate, in the eye, with particular reference to the role of diffusion and active transport in determining the ionic composition of the various ocular fluids.
Effect of Age on Pulse Wave Velocity and "Aortic Ejection Time" in Healthy Men and in Men with Coronary Artery Disease
Authors: SIMONSON ERNST , NAKAGAWA K.
Published: June 2012

Impedance plethysmograms were taken in 51 healthy men and 42 normotensive men with coronary heart disease from the aorta near the place of auscultation of the aortic valve and from the femoral artery in the femoral triangle recorded simultaneously with the 3 electrocardiographic standard leads.

The aortic pulse wave velocity was determined from the time interval between the foot points of the aortic and femoral volume pulse, and the anatomic distance between the electrodes. It increases with age in normal subjects as well as in patients, but the values are significantly higher in the patients. These results are suggestive of accelerated degenerative changes in the aorta, probably due to atherosclerosis.

The interval from the earliest detectable QRS deflection to the foot point of the aortic volume pulse ("aortic ejection time") becomes longer with age in the normal group. In patients with coronary artery disease, the prolongation is significantly larger for each of 3 age subgroups. The results suggest that ventricular ischemia affects ventricular isometric contraction.
Hourly Variation in Total Serum Cholesterol
Authors: PETERSON JOHN E. , WILCOX ALAN A. , HALEY MELVIN I. , KEITH ROBERT A.
Published: June 2012

Evidence is presented to indicate that the level of serum cholesterol in certain individuals may vary widely within a matter of hours.

The data suggest also that a rapid fluctuation of the serum cholesterol level may be induced in some persons by modifying certain aspects of their environment.

Varying lability of the level of serum cholesterol and the differing response of individuals to certain environmental factors require that careful attention be given to the sampling methods used in research.
Vasoconstriction and Medial Hypertrophy in Pulmonary Hypertension
Authors: WAGENVOORT C. A.
Published: June 2012

To determine whether thickening of the media of pulmonary muscular arteries in cases of pulmonary hypertension is the result of vasoconstriction or of hypertrophy or of both, a method for calculating the amount of arterial muscular tissue per unit of pulmonary tissue was devised. Comparison of the mean medial thickness, expressed as a percentage of the diameters of the arteries, with the amount of arterial muscular tissue per unit of lung, will give an impression as to whether vasoconstriction or hypertrophy prevails in a certain case. This method was applied to sections of pulmonary tissue from 10 normal controls and 17 patients with congenital cardiac disease with pulmonary hypertension. Medial hypertrophy was present in all cases of congenital heart disease studied as compared with controls, and was more pronounced in severe than in moderate pulmonary hypertension. In some cases also vasoconstriction appeared to play an important or even a dominant role in the thickening of the medial layer. In 2 cases of atrial septal defect with large pulmonary flow, hypertrophy was masked by dilatation of the vessels resulting in a relatively thin media.
Sex Differences in the Electrocardiogram
Authors: SIMONSON ERNST , BLACKBURN HENRY , PUCHNER THOMAS C. , EISENBERG PAULINE , RIBEIRO FERNANDA , MEJA MANUEL
Published: June 2012

In 424 men and 142 women, clinically "healthy," ages 40 through 59 years, significant sex differences in electrocardiographic characteristics were found. The differences were minor in the limb-lead amplitudes (P, Q, R, S, T), but QRS and P-R duration was significantly shorter in women. Precordiallead amplitudes (R, S, T) were significantly smaller in women. Present normal standards derived from groups of men are not valid for women.
Treatment of Shock and Prevention of Ischemic Necrosis with Levarterenol-Phentolamine Mixtures
Authors: ZUCKER GARY , EISINGER ROBERT P. , FLOCH MARTIN H. , SINGER MARK M.
Published: June 2012

Good pressor responses were obtained in 51 of 68 cases of shock treated with levarterenol-phentolamine mixtures. No necrosis developed in 33 extravasations of mixtures. One slough resulted from an extravasation of 8 mg./L. of levarterenol alone. Our present practice is to add 5 mg. of phentolamine to each liter of levarterenol solution.
Intermittent Atrial Parasystole
Authors: FISCH CHARLES , CHEVALIER ROBERT B.
Published: June 2012

A case of atrial parasystole is reported. The parasystolic rhythm was intermittent in character and began each time with an atrial premature beat exhibiting a constant relation to the preceding sinus beat.
Cor Triloculare Biatriatum
Authors: CHAMBERS WILLIAM N. , CRISCITIELLO MODESTINO G. , GOODALE FAIRFIELD
Published: June 2012

The case of a 41-year-old woman with congenital pulmonary stenosis and single ventricle is reported. This is the fifteenth instance recorded of survival to adult life of a patient with cor triloculare biatriatum. Increased pulmonary resistance may be a reason for her comparative longevity, and the significance of prominent bronchopulmonary anastomoses has been discussed. This patient's course demonstrates the hazards of phlebotomy in congenital heart disease and secondary polycythemia. The mechanism for this adverse effect is not understood and warrants further study. Although others have discussed the problem informally, this appears to be the first documented report of the precipitation of multiple cerebral thromboses following phlebotomies.
Essential Hypertension and Aldosterone
Authors: VENNING ELEANOR H. , DYRENFURTH INGE , DOSSETOR JOHN B. , BECK JOHN C.
Published: June 2012

Serial determinations of the urinary excretion of aldosterone have been made in hypertensive patients. Although the majority of patients with benign essential hypertension excrete amounts of aldosterone within the normal range, the mean excretion of 26 patients was significantly higher than that observed in normotensive individuals. When renal complications were present, the mean excretion was still further increased and in patients with malignant hypertension all the values were above the normal range.

The mean excretion of the tetrahydro metabolite of aldosterone was also found to be higher in patients with essential hypertension.

These patients have a normal response to adrenocorticotrophic hormone stimulation, urinary and plasma corticosteroids, as well as urinary aldosterone, showing comparable increases.

The aldosterone content of adrenal glands obtained post mortem from two patients with malignant hypertension was within the range observed by other investigators in primary aldosteronism.
The Electrocardiogram in Ventricular Septal Defect
Authors: VINCE DENNIS J. , KEITH JOHN D.
Published: June 2012

One hundred and nineteen cases of ventricular septal defect in infancy and childhood have been reviewed, with special reference to the electrocardiogram. The changes in the electrocardiogram were related to the hemodynamics found at cardiac catheterization, and particularly the pulmonary to systemic blood flow ratios, pulmonary artery pressures, and oximetry. They were also studied in relation to the groups of cases that obviously had a low pulmonary vascular resistance with or without diastolic loading of the left ventricle. Survival of a patient following closure of the defect with a drop in pulmonary artery pressure was also taken as a sign that the pulmonary vascular resistance was not excessive. The patients with clinical and hemodynamic evidence of a high pulmonary vascular resistance were also evaluated in relation to the electrocardiogram.

The information obtained from the electrocardiogram may be graded according to degree of severity: (a) normal electrocardiogram, (b) left ventricular loading, (c) combined loading, (d) isolated right ventricular loading. These groups may be further graded depending on the diminishing number of signs listed below.
1-7
A detailed review of these four groups in relation to the following criteria may allow one to identify a low or only moderately raised pulmonary vascular resistance, or one that is sufficiently moderate to permit successful corrective surgery in the pediatric age group: 1. An R in V
6
over 20 mm. 2. A Q in V
6
of 4 mm. or over. 3. An S in V
1
over 25 mm. 4. A Q in V
6
of 2 mm. or more when associated with evidence of right ventricular loading. 5. An axis of less than 90°. 6. Counterclockwise vector. 7. Broad notched P waves in standard leads I or II, with late inversion in V
1
.

As a rule, several of these criteria occur together, but even if only one of them is present, one may conclude that the pulmonary vascular resistance is not excessive. Further support to this conclusion is evident if any of the above 7 items are accompanied by one or more of the following: (x) a pulmonary blood flow that is twice systemic, (y) an absence of reversal of flow through the defect either at rest or with exercise, (z) an age under 7 years.

Among the 119 infants and children with ventricular septal defect, over 90 per cent appeared to have a sufficiently low pulmonary vascular resistance to be operable provided the surgical technic is adequate and provided complete heart block does not occur.

Age appears to be an important factor in assessing the likelihood of success at surgery. Only an exceptional case shows hemodynamic findings indicating inoperability before the age of 7 years.

During the first year of life many cases of ventricular septal defect have signs of left ventricular loading appear or increase, suggesting a favorable trend in the pulmonary vascular resistance. Until surgical technic makes operation more readily feasible in infancy, the optimum age of correction would appear to be between 2 and 7 years.
The Synthesis of Phospholipids in Human Atheromatous Lesions
Authors: ZILVERSMIT D. B. , MCCANDLESS ESTHER L. , JORDAN PAUL H. , HENLY WALTER S. , ACKERMAN R. F. , Boals Anne
Published: June 2012

Femoral arteries, abdominal aortas, one renal artery, and one coronary artery removed from patients injected with P
32
phosphate showed in most instances an active incorporation of the label into the phospholipids of intima and adventitia. A comparison of the specific activities of arterial plaque and plasma phospholipids suggests that the excess arterial phospholipids are originally derived from synthesis by the arterial wall, or at least undergo continuous renewal in situ.