bluuebunny/crossref_metadata_2025 huggingface dataset:
Vasomotor Responses to Exercise in the Extremities of Subjects with Vascular Disease
Authors: REDISCH W. , DE CRINIS K. , ANTONIO A. , BOGDANOVITZ A. , STEELE J. M. , Gilbert Gordon , Wheeler Raleigh
Published: June 2012

Response of peripheral blood flow was studied in subjects of various age groups with and without vascular disease. Under constant environmental conditions, the skin-muscle distribution of total flow to the lower extremity showed the following trend. In young healthy adults the muscles get a somewhat higher share; in elderly persons without vascular disease the distribution is about equal; in patients with nongangrenous obliterative arteriosclerosis the skin is favored over the muscle. Exercise increases total flow in all groups, but does not alter the distribution. Sympathectomy does not seem to influence response to exercise.
Arteriovenous Fistula of the Kidney
Authors: SCHEIFLEY CHARLES H. , DAUGHERTY GUY W. , GREENE LAURENCE F. , PRIESTLEY JAMES T.
Published: June 2012

Only 5 reports of cases of renal arteriovenous fistula appeared before or in 1953. Subsequently, 7 isolated reports brought the total to 12, and the 3 that we are reporting make 15.

In reviewing the subject, the classification, incidence, causation, clinical features, diagnostic procedures, and pathophysiologic features were considered. Good evidence supports the thesis that in cases of congenital arteriovenous fistula an eroding renal arterial aneurysm is etiologic.

Outstanding clinical features were hypertension (to group 4) and myocardial insufficiency; these contrast markedly with features of the usual peripheral arteriovenous fistula. Dramatic relief of heart failure and lowered reserve followed corrective operation in every case in which these features were recorded; relief of hypertension followed corrective operation in 11 of 12 cases in which this feature was mentioned. A loud, diffuse, continuous bruit invariably was present.

Preoperative and postoperative catheterization and indicator-dilution studies, angiograms and aortograms are diagnostic measures emphasized in our 3 cases. Arterialization of blood in the vena cava, greatly increased cardiac output, and markedly shortened recirculation times of the dye were found. Excretory urograms were abnormal in 11 of the 12 cases in which they were made.

The mechanism producing hypertension appears related to loss of pressure, decrease in flow, and loss of pulsatile character in the renal artery distal to the fistula, giving a Goldblatt-kidney type of end result. A vicious cycle of increasing hypertension followed by increasing flow through the shunt makes heart failure inevitable.

Since 10 of the 15 cases were reported in the last 4 years, indicating that the lesion is commoner than previously supposed, we advise auscultation over the renal regions in patients with cardiac enlargement or failure of unknown causation, unexplained deformities in urograms, and renal tumors.
Abdominal Aortic Aneurysm: A Study of One Hundred and Two Cases
Authors: ESTES J. EARLE
Published: June 2012

Data were compiled from the records of 101 cases of abdominal aortic aneurysm, almost all of which were due to arteriosclerosis. These records were selected only when there was unequivocal evidence of aneurysm, and cases of true dissecting aneurysm were not included. The data were studied primarily in regard to prognosis of this condition but in addition, all clinical manifestations of abdominal aortic aneurysm were reviewed.
Lodging of an Embolus in a Patent Foramen Ovale
Authors: ROBINSON FABIAN J.
Published: June 2012

A 77 year old man developed severe chest pain and collapsed seven days after prostatectomy and died three days later. Necropsy revealed thrombosis of right femoral vein, complete embolic obstruction of the primary branches of the pulmonary artery, and an embolus, 10 cm. long and 0.5 cm. in diameter, lodged in the foramen ovale. Although no systemic arterial emboli were found, it can be readily seen how such emboli could have developed.
Atypical Secondary or Symptomatic Thrombocytopenic Purpura Developing with the Use of Quinidine Sulfate
Authors: COLLINS DONALD C.
Published: June 2012

Quinidine sulfate, which has a very similar chemical structural formula to that of quinine bisulfate, may on a rare occasion be the etiologic causative agent of an atypical secondary or symptomatic thrombocytopenic purpura of serious degree. Fortunately, the withdrawal of the drug results in a rapid return to normal of the hematologic picture. A case report of such an occurrence is presented. Three additional case reports have been collected from the literature since 1941.
Spatial Vector Electrocardiography
Authors: GRANT ROBERT P.
Published: June 2012

A new method for the interpretation of conventional electrocardiographic leads is presented. It is based upon evidence that all body surface leads tend to record from the same resultant electrical forces. The various leads write different QRS and T contours in a given case, then, simply because the axis for each of the leads has a different direction in the electrical field and therefore registers different components of these electrical forces. The method has many advantages over "pattern" methods of interpretation. To illustrate its use, a study of QRS vectors is presented with special reference to the S
l
S
2
S
3
pattern.
Congenital Aortic Septal Defect with Communication between Aorta and Pulmonary Artery
Authors: SPENCER HERTA , DWORKEN HARVEY J.
Published: June 2012

A case of congenital defect of the aortic septum is reported, together with a summary of thirteen previously described cases. The authors briefly describe their concept of the dynamics of the lesion and suggest a method of possible surgical correction, in instances where the diagnosis is made early.
Aortic Length: Angiocardiographic Measurements
Authors: DOTTER CHARLES T. , ROBERTS DOUGLAS J. , STEINBERG ISRAEL
Published: June 2012

Statistical analysis of measurement of aortic length made on 250 angiocardiograms indicates that arteriosclerosis, hypertension and syphilitic aortitis produce elongation of the aorta. Aortic length varies widely among normal individuals but is roughly ten times the caliber of the ascending aorta. Syphilitic aortitis produces disproportionate elongation of the ascending portion of the aorta as compared to arteriosclerosis or hypertension.
Postmyocardial Infarction Syndrome
Authors: WEISER NELSON J. , KANTOR MILTON , RUSSELL HOLLIS K.
Published: June 2012

A new syndrome that is likely to follow myocardial infarction has recently been described. The cardinal manifestations of this syndrome may easily be confused with other, more common sequels of myocardial infarction, including cardiac failure, further infarction of the myocardium, and pulmonary embolism. The result of such confusion may be inappropriate therapy. This paper reviews the recent literature and our own experience with this syndrome and discusses the therapeutic implications.
Left Atrial Pressure Pulses in the Presence of Myxoma
Authors: FISH ROBERT G. , TAKARO TIMOTHY , CRYMES THOMAS
Published: June 2012

Findings of transbronchial left heart catheterization in the presence of an atrial myxoma and a normal mitral valve are presented. The genesis and possible significance of unusual differences in contour between high and low left atrial pressure pulses are discussed.
Autopsy Studies in Atherosclerosis
Authors: ROBERTS JAMES C. , WILKINS ROBERT H. , MOSES CAMPBELL
Published: June 2012

The distribution and severity of gross atherosclerosis at autopsy in 153 patients dying
with
morphologic evidence of atherosclerotic catastrophe in the heart, aorta, or brain were compared with that in 347 "noncatastrophic" patients. This study used a grading system for atherosclerosis that included consideration of both the extent and severity of intimal involvement. The study groups contained 78 males and 28 females with catastrophes in the heart, 26 males and 10 females with catastrophes in the aorta, and 20 males and 20 females with catastrophes in the brain. A significantly larger proportion of men had vascular catastrophes than did women. However, there was no sex difference demonstrated in the distribution and severity of atherosclerosis.
Intracardiac Phonocardiogram in Thirty Cases of Atrial Septal Defect
Authors: FERUGLIO GEORGE A. , SREENIVASAN AKKAYA
Published: June 2012

Thirty cases of atrial septal defect proved by cardiac catheterization, surgery, or postmortem examination have been investigated with the technic of intracardiac phonocardiography, which provided precise localization of the source of heart sounds and murmurs. The site and mechanism of origin of the many auscultatory signs in uncomplicated atrial septal defect and in cases of Lutembacher's syndrome, tricuspid atresia, and persistent atrioventricular canal were elucidated by direct intracardiac sound recordings and simultaneous external chest phonocardiograms.
Lipoproteins Quantitated by Paper Electrophoresis as an Index of Atherosclerosis
Authors: WURM MOSES , KOSITCHEK ROBERT , STRAUS REUBEN
Published: June 2012

Data dealing with cholesterol, phospholipid, their ratios, and total lipids in a group of 40 "normal" and 40 individuals with manifest coronary artery disease have been evaluated and have been found to have a low order of significance in determining the atherosclerotic status for both individuals and for groups.

Serum lipoproteins separated by paper electrophoresis and visualized with Fat Red 7B have been shown to occur in 5 fractions. Of these, lipalbumin and beta lipoproteins as well as beta/alpha and beta/lipalbumin ratios reveal a high level of significance for distinguishing normal from abnormal individuals and groups.
Transient Complete Heart Block Occurring during Nasal Irrigation
Authors: MURPHY GERALD M. , WILMER J. G. , CLAIBORNE T. S.
Published: June 2012

Cardiac standstill associated with surgical work about the eyes, nose, and throat occurs but is not frequent.

A case is reported in which the patient collapsed while receiving a treatment with a jet spray in the sphenoid sinus area. There developed heart block and cerebral and myocardial damage. Vagal stimulation with inhibition of the heart beat is suggested as the probable cause.
High Serum Transaminase Activity in Heart Disease
Authors: KILLIP THOMAS , PAYNE MARY ANN
Published: June 2012

A survey of all patients with very high serum glutamic oxalacetic transaminase activity encountered during a 30-month period at The New York Hospital revealed 17 patients with cardiac disease who had 1 or more serum glutamic oxalacetic transaminase (SGOT) determinations exceeding 500 units. None had clinical evidence of primary liver or gallbladder disease. Eleven were admitted with acute myocardial infarction, 6 with severe heart failure. All 17 developed hypotension or shock and all but 1 right heart failure prior to high SGOT activity.

Several patients had abnormalities of liver function when SGOT activity was very high. In 4 there was an excessive increase in prothrombin time following administration of anticoagulants.

In the 8 patients who came to autopsy there was histologic evidence of acute hepatic central necrosis. In 4 there was necrosis of both heart and liver, in 4 necrosis of liver alone.

Clinical and autopsy data from a control series of patients with heart disease selected without regard for the level of SGOT activity corroborate the association between hypotension, central necrosis of the liver, and increased SGOT activity. Increase in venous pressure in the absence of hypotension was not associated with acute central necrosis or elevated SGOT activity.

It is concluded that very high SGOT activity (>500 units) in patients with heart disease is at least in part caused by acute hepatic central necrosis secondary to a drop in cardiac output and reduced hepatic blood flow. Caution is urged in the interpretation of increased blood activity of intracellular enzyme systems as evidence for myocardial necrosis. Acute circulatory changes may result in hepatic necrosis and increased blood enzyme activity without myocardial infarction.
Pericardial Effusion, a Manifestation of Systemic Lupus Erythematosus
Authors: BERGEN STANLEY S.
Published: June 2012

Four cases of systemic lupus erythematosus with pericardial effusion as a prominent manifestation are reported. Lack of awareness of this finding as a not infrequent part of the disease entity led to misdiagnosis in 2 instances and incorrect treatment in 1. The literature on the subject is reviewed and suggestions are offered for diagnosis.
Occupational Physical Activity and the Degree of Coronary Atherosclerosis in "Normal" Men
Authors: SPAIN DAVID M. , BRADESS VICTORIA A.
Published: June 2012

In autopsies on "normal" white men between the ages of 30 and 60, who died suddenly from accident, homicide, or suicide, there were no significant differences in the degree of coronary atherosclerosis in those engaged in sedentary occupations and those engaged in physically active occupations.
Ventricular Septal Defect with Patent Ductus Arteriosus
Authors: SASAHARA ARTHUR A. , NADAS ALEXANDER S. , RUDOLPH ABRAHAM M. , WITTENBORG MARTIN H. , GROSS ROBERT E.
Published: June 2012

Twenty-two patients with the combined lesions of ventricular septal defect and patent ductus arteriosus, proved at cardiac catheterization, are reviewed in detail in regard to their clinical profile, hemodynamic data, and indications for, and results of, surgical repair.

The incidence of this combination of lesions is not so uncommon as would be anticipated by the paucity of the reports in the medical literature. The diagnosis of both lesions is important for management and surgical technic.

The striking findings by physical examination are the gross undernourishment and the wide pulse pressure in the great majority. Almost all have harsh systolic murmurs along the mid left sternal border and only 2 had continuous Gibson murmurs. Consequently, auscultation is of little help in delineating the presence of an associated patent ductus arteriosus.

The electrocardiogram is of minor importance in the diagnosis of this combination of lesions. Roentgenograms in the majority show features common to either lesion alone although the frequency with which left atrial enlargement is found appears to be greater in this combination of lesions.

Careful hemodynamic studies are crucial in the diagnosis of these 2 lesions. At the ductal level passage of the catheter establishes the diagnosis, or an increase in oxygen saturation greater than 5 per cent in comparison to the right ventricular blood strongly suggests the presence of a patent ductus arteriosus. The great majority of the ventricular septal defects were diagnosed by an increase in the oxygen saturation of 10 per cent or greater at the ventricular level. Almost all had pulmonary artery hypertension.

Thirteen patients had surgical intervention; 9 had only closure of the patent ductus arteriosus alone and 4 had complete repair of the lesions. In the former group there were 2 deaths and 2 improved significantly. In the latter group there were 2 surgical deaths and 2 were markedly improved. The 2 surgical deaths appear to be directly related to the massive hemorrhage through the unsuspected patent ductus arteriosus while on cardiac bypass and the subsequent technical difficulty of closing both defects from an anterior thoracotomy.

The relationship of calculated pulmonary vascular resistance to surgical closure of the defects is discussed.

It is suggested that if the patent ductus arteriosus is diagnosed on the basis of a typical machinery murmur, correction of this lesion is indicated, irrespective of the associated ventricular defect. If, on the other hand, the clinical picture is suggestive of a ventricular defect alone and the presence of the combination of lesions is discovered only at catheterization, then simultaneous correction of the 2 lesions is recommended. In small infants in whom the combined operation is particularly difficult at the present time, a preliminary trial of medical management is recommended; only if this fails to accomplish the expected result should division of the ductus be undertaken.
Physiologic Differentiation of Pulmonic Stenosis with and without an Intact Ventricular Septum
Authors: HOFFMAN J. I. E. , RUDOLPH ABRAHAM M. , NADAS ALEXANDER S. , PAUL MILTON H.
Published: June 2012

Since May 1957 cardiac catheterization has been carried out in 46 patients with pulmonic stenosis and an intact ventricular septum (pulmonic stenosis) and 42 patients with pulmonic stenosis and a right-to-left shunt through a septal defect (tetralogy of Fallot).

Right atrial pressures were usually higher in pulmonic stenosis. Average pulmonary arterial and left atrial mean pressures were similar in the 2 groups, as were the pulmonary blood flows.

Although significant differences between right ventricular and systemic arterial systolic pressures may be demonstrated in tetralogy of Fallot, simultaneous right ventricular and left ventricular or aortic systolic pressures were always within a few mm. Hg of each other.

The postectopic right ventricular systolic pressure was always at least 10 mm. Hg above its previous level in pulmonic stenosis, whereas in tetralogy of Fallot it almost never exceeded its previous level by more than 10 mm. Hg.

All patients with tetralogy of Fallot had flat-topped right ventricular pressure curves, whereas 31 of 46 patients with pulmonic stenosis had triangular right ventricular pressure curves.

The phonocardiogram was found to be among the most useful tools in differentiating the 2 groups. Auscultatory phenomena of severe pulmonic stenosis with a widely split second heart sound, late crescendic diamond-shaped systolic murmur, and persistence of this murmur beyond the sound of aortic closure differed strongly from tetralogy of Fallot of equal severity.

At cardiac catheterization proof of the presence of a ventricular septal defect may be gained by passing the catheter through it. If this is not done, the presence of a ventricular septal defect may be strongly inferred if the right ventricular pressure curve has almost parallel sides and a flat or rounded top, if the right ventricular systolic pressure is near that in the systemic circulation, and if it does not rise after ectopic beats more than 10 mm. Hg above its previous level. For greater certainty in diagnosis indicator-dilution curves or angiocardiography should be done.

The accurate preoperative diagnosis of the presence or absence of a ventricular septal defect is extremely important, for at open-heart operation it is essential not to miss the ventricular septal defect after completely relieving the obstruction to right ventricular outflow; it is just as important not to do unnecessary right ventriculotomies.
Adult Endocardial Fibroelastosis Associated with Dextrocardia and Situs Inversus
Authors: HOFFMAN FRANKLIN G.
Published: June 2012

The clinical and pathologic features of the first case of endocardial fibroelastosis in an adult, associated with dextrocardia and situs inversus, is reported. Difficulties in diagnosis are, evident. It is considered that the occurrence of this lesion in this patient is not, evidence of a congenital origin. Other intracardiac defects are rarely found associated with dextrocardia and situs inversus. The incidence of acquired heart disease in this group probably is no different from that in the general population.

Endocardial fibroelastosis and its closely related entities in the adult may pose a difficult problem in differential diagnosis. The implications involved are realistic, since exploratory thoracotomy may be considered if constrictive pericarditis cannot be ruled out. This entity should be suspected in patients, particularly young adults, with progressive congestive failure where the etiology is obscure. Patients over 60 years of age with Stokes-Adams disease, in the absence of unequivocal evidence of arteriosclerotic heart disease or aortic stenosis, should also be suspected of having this entity.
33, 37
The frequent occurrence of thromboembolic episodes is more often associated with endocardial fibroelastosis than with other entities. Efforts to arrive at a definite diagnosis should be made, and exploration advised when constrictive pericarditis cannot be ruled out. Unfortunately, cases of endocardial fibrosis, myocardial fibrosis, and probably similar entities comprising the constrictive syndrome, on occasion will be found at operation.
59
This difficulty may arise if constrictive pericarditis is associated with cardiomegaly.
SYMPOSIUM ON CORONARY HEART DISEASE
Authors: BUTTERWORTH J. SCOTT , REPPERT EDMUND H.
Published: June 2012

The auscultatory findings in acute myocardial infarction and arteriosclerotic heart disease have been briefly reviewed. It has been pointed out that there are no auscultatory findings that can equal the efficiency of the electrocardiogram in the diagnosis of acute myocardial infarction. The signs that do occur are probably the result of variable factors such as diastolic filling and ventricular ejection time and are not necessarily peculiar to myocardial infarction. On the other hand, certain complications that may occur as the result of myocardial infarction and certain conditions that may simulate myocardial infarction may produce auscultatory findings that are of definite diagnostic and prognostic significance.
I
131
-Diodrast Studies in Unilateral Renal Disease
Authors: BLOCK JEROME B. , HINE GERALD J. , BURROWS BELTON A. , Bikerman Valentine
Published: June 2012

A procedure utilizing I
131
-Diodrast with carrier Diodrast and a ratiometer has been evaluated for the early diagnosis of unilateral renal disease.

Relative differences in function between kidneys demonstrated by this procedure correlated well with findings at surgical exploration or autopsy.

In 3 patients with unilateral renal arterial stenosis who had normal intravenous pyelograms, I
131
-Diodrast results were abnormal.

Although normal I
131
-Diodrast results may rule out unilateral renal disease, an abnormal result with I
131
-Diodrast may be seen with any lesion resulting in urine flow differences between kidneys.
Separated Renal Functions in Patients with Renal Arterial Disease, Pyelonephritis, and Essential Hypertension
Authors: DUSTAN HARRIET P. , POUTASSE EUGENE F. , CORCORAN A. C. , PAGE IRVINE H.
Published: June 2012

Function tests of the individual kidneys have been performed during mannitol diuresis and vasopressin infusion in hypertensive patients with essential hypertension, pyelonephritis, and occlusive lesions of one or both main renal arteries or their primary branches.

In patients with essential hypertension, glomerular filtration rate and renal plasma flow on the two sides, though depressed, were practically equal, as were urine flow, water, solute, and sodium excretions.

Pyelonephritis and branch arterial lesions alike depressed urine flow, glomerular filtration rate, and renal plasma flow in the affected or more-affected kidneys; water, total solute, and sodium excretions were in proportion to glomerular filtration rate. These findings indicate a decrease in numbers of functioning nephrons without a qualitative change in function of those remaining.

Occlusive lesion of one main renal artery decreased glomerular filtration rate and renal plasma flow on the affected side; urine flow was relatively more depressed than filtration rate, urinary osmolality was higher, and urinary sodium concentration was sharply decreased, as was the excreted fraction of the filtered sodium load.

Bilateral occlusive main arterial lesions sometimes had effects similar to those of unilateral lesions in the sense of greater functional deficits on the more-affected sides. However their functional patterns were not consistent.

The enhanced renal sodium reabsorption observed in patients with unilateral and bilateral main renal artery diseases could not be explained solely by decreases in filtered sodium load; this suggests that decreases in intrarenal arterial pressure also affect sodium excretion.

Changes in renal functions caused by arterial disease depend on the site of the lesion and not on the pressor mechanism it may evoke.
Atrial Flutter with Irregular Ventricular Response as a Contraindication to Digitalis
Authors: LONDON SEYMOUR B. , LONDON ROSE E.
Published: June 2012

Digitalis may have an additive effect on impaired atrioventricular conduction, so that atrial flutter with variable ventricular response may progress to complete heart block with ventricular asystole.

Two cases are presented of atrial flutter with. variable ventricular response in whom ventricular standstill occurred during digitalis therapy.

External electric stimulation of the heart can maintain the circulation in digitalis-induced ventricular standstill.
Blood Capillaries of the Heart and Other Organs
Authors: Kossmann Charles E. , PALADE GEORGE E.
Published: June 2012

The article is a review of work recently carried out on blood capillaries by the author in collaboration with Drs. M. G. Farquhar, G. Majno, and S. L. Wissig.

It reviews the morphology of these vessels at the electron-microscope level and confirms the existence of at least 3 distinct types of blood capillaries in small laboratory mammals. It shows that the capillary wall consists of 3 concentric layers (endothelium, basement membrane, and adventitia), and indicates that the basement membrane forms a continuous layer in all capillaries so far studied.

Experiments in which colloidal gold particles were used as a tracer have shown that, in capillaries with a continuous endothelium (muscle capillaries), the particles are transported across it by "pinocytic" vesicles. At the end of this step they must still transverse the basement membrane.

Experiments on glomerular capillaries, which typically have a discontinuous s endothelium, were carried out on normal and nephrotic rats using ferritin as a tracer. By its accumulation on the luminal side of the basement membrane, the ferritin has identified this layer as the main filtration barrier.

A similar function of the basement membrane was demonstrated in muscle venules and venous capillaries by experiments in which the endothelium was rendered discontinuous by local treatment with histamine and serotonin.
Myocardial Infarction and Atrial Arrhythmias
Authors: JAMES THOMAS N.
Published: June 2012

In each of 11 necropsied patients with myocardial infarction and atrial arrhythmias, a coronary occlusion was found proximal to the origin of the sinus node artery and there was infarction of the sinus node.

The multiple factors influencing the onset of atrial arrhythmias during acute myocardial infarction are discussed. Infarction of the sinus node is only one of these factors. Other important ones are ischemia of the AV node, vagal and vagomimetic reflexes, atrial distention, and circulating chronotropic substances.

By combination of a knowledge of the anatomy and pathology of the human coronary arteries with the observation of atrial arrhythmias during acute myocardial infarction, an accurate diagnosis of the point of coronary occlusion can often be made.
A Clinical Appraisal of the Vectorcardiogram in Myocardial Infarction
Authors: HUGENHOLTZ PAUL G. , FORKNER CLAUDE E. , LEVINE HAROLD D.
Published: June 2012

Two-hundred six patients with myocardial infarction were studied with the Frank vectorcardiographic lead system and the standard 12-lead electrocardiogram in common use. Distinctive and statistically significant measurements separated these individuals from normal controls, similarly studied.

Of 125 patients with convincing evidence of past myocardial infarction all showed abnormal vectorcardiograms. Only 76 of these presented electrocardiograms, diagnostic of infarction at the time of the diagnostic vectorcardiogram. Eleven (9.6 per cent) showed no evidence of infarction in their electrocardiographic tracings.

The theory is held by some that modern vectorcardiography should be superior to conventional electrocardiography. The present observations in suspected myocardial infarction suggest that this method may yield confirmatory evidence in most cases, additional and complementary data in some, and decisive information not otherwise available, in a few.
Role of the Kidney and the Renin-Angiotensin System in the Response of Aldosterone Secretion to Hemorrhage
Authors: MULROW PATRICK J. , GANONG WILLIAM F.
Published: June 2012

In summary, these data show that in hypophysectomized dogs:

1. Hemorrhage stimulates mainly aldosterone secretion.

2. Nephrectomy prevents stimulation of aldosterone secretion by hemorrhage.

3. Nephrectomy lowers basal secretion of aldosterone.

4. Crude saline extracts of dog kidneys, semipurified renin extracts of dog kidneys, and synthetic angiotensin can stimulate aldosterone secretion.

These findings suggest that in hypophysectomized dogs, the kidney, via the renin-angiotensin system, is an important mechanism by which hemorrhage stimulates aldosterone secretion.
Anomalous Muscle Bundle of the Right Ventricle
Authors: LUCAS RUSSELL V. , VARCO RICHARD L. , LILLEHEI C. WALTON , ADAMS PAUL , ANDERSON RAY C. , EDWARDS JESSE E.
Published: June 2012

Seven examples of anomalous muscle bundles of the right ventricle have been presented. In one patient having an associated ventricular septal defect, spaces between the anomalous muscle were confused surgically with the ventricular septal defect.

In the remaining six cases, the anomalous muscle bundle caused obstruction within the right ventricular cavity. Five of these patients had associated ventricular septal defect, with a clinical picture resembling that of the cyanotic or acyanotic tetralogy of Fallot. The cases served to demonstrate that the surgeon who exposes the right ventricle to relieve an obstructive lesion in the right ventricular infundibulum or in the pulmonary valve, may find no such lesions in these locations but instead may be dealing with an obstruction more proximal than these areas. Relief of the obstruction within the right ventricle may be attained by resecting the anomalous muscle mass.

In one patient having intact ventricular septum and pulmonary valvular stenosis, an anomalous muscle bundle within the right ventricle which lay proximal to the infundibulum was responsible for persistent right ventricular obstruction after pulmonary valvotomy.

Anomalous muscle bundles in the right ventricle may be suspected when, in the angiocardiogram, they cause filling defects within the right ventricle.
Cardiac Myxomas with Systemic Embolization
Authors: SILVERMAN JAY , OLWIN JOHN S. , GRAETTINGER JOHN S.
Published: June 2012

A case of left atrial myxohemangioendothelioma, diagnosed ante mortem by removing a tumor embolus to the bifurcation of the aorta, is reported. The patient had been misdiagnosed as having had rheumatic heart disease with paroxysmal atrial fibrillation and embolization to the right middle cerebral artery. In retrospect, because of the characteristics of the second heart sound and absence of an opening snap, a rheumatic etiology should have been questioned.

The literature regarding embolization of atrial myxomas has been reviewed.
Quantitative Radiocardiography
Authors: LEWIS M. L. , GIUNTINI C. , DONATO L. , HARVEY R. M. , COURNAND A.
Published: June 2012

The method of quantitative radiocardiography has been applied to the study of cardiac output, right ventricular and pulmonary blood volume in cardiovascular normals, emphysematous subjects, and patients with various types of heart disease.

The values of blood flow obtained by means of this technic have been compared with those measured simultaneously by the direct Fick method. A linear correlation has been demonstrated between Q
RIHSA
and Q
Fick
, with a regression coefficient of 1.0395 ± 0.0566, when appropriate correction has been made for the contribution of activity in the paracardiac tissues.

The principle of the measurement of right ventricular rate of emptying from the fractional decay rate of the precordial counting during the passage of the indicator through the right heart has been validated. The right ventricle behaves essentially as a mixing chamber; a constant fraction of its volume is ejected with each systole. The variability of the emptying rate does not exceed the limits expected on the grounds of statistics of radioactive measurements in normal and in cardiac patients. The significance of the variability observed in emphysematous patients has been discussed.

The measured ventricular rates of emptying are reproducible in repeated curves recorded after injection of RIHSA or dissolved Kr
85
; are little affected by change of the position of the tip of the injecting catheter; or by small changes in the position of the collimator.

The right ventricular end-diastolic and residual volumes have been found to average 221 ± 50 ml. and 128 ± 34 ml. respectively, in 18 normal subjects.

The calculated pulmonary blood volume in 18 normal subjects averages 313 ± 58 ml./M.
2
The significance of this value and the possible extreme range of error resulting from the method have been assessed.
Resection of Myocardial Aneurysms after Infarction during Temporary Cardiopulmonary Bypass
Authors: LILLEHEI C. WALTON , LEVY MORRIS J. , DEWALL RICHARD A. , WARDEN HERBERT E.
Published: June 2012

The report consists of five patients with chronic postinfarct left ventricular aneurysms. The age distribution was between 47 and 63 years. The time lapse between the initial infarct and the appearance of the left ventricular aneurysm was 2 weeks to 2 years. The time interval between the initial infarct and surgery was 5 months to 6 years. Less than adequate bedrest following the infarct, multiple infarcts, and systemic hypertension were other factors present in this group. Right heart catheterization was performed in two patients and showed reduced cardiac output and elevated pulmonary pressures in one. The electrocardiograms were consistent with extensive old myocardial infarction and ventricular aneurysm. The diagnosis was suggested by electrocardiograms and roentgenography, supported by kymography, and confirmed by angiography.

The world literature on surgically treated patients with ventricular aneurysms is briefly reviewed with emphasis on the varied surgical approaches to the problem in the past. The method of complete excision with ventriculoplasty during cardiopulmonary bypass was used in all our patients during the past 4 years. The anatomic distribution of the ventricular aneurysm as well as the histopathology of the resected specimen is described.

All patients survived the operation, and were observed from 6 months to 40 months after operation. There have been no late deaths to date, and all patients have been rehabilitated. Postoperative catheterization studies have confirmed the clinical improvements observed.

More attention should be given to this relatively common complication after infarct because excision under temporary heart-lung bypass is a safe and feasible approach.
A Longitudinal Study of Blood Pressure
Authors: HARLAN WILLIAM R. , OSBORNE ROBERT K. , GRAYBIEL ASHTON
Published: June 2012

A longitudinal study of blood pressure in a homogeneous group of young men followed over an 18-year period has been presented. Seven hundred and eighty-five (96 per cent) of the surviving members have been re-evaluated, and the mean age at the time of re-examination was 42 years.

Frequency distribution curves of blood pressure yielded a unimodal distribution and indicated that blood pressure is a graded continuous variable. There was no evidence of natural bimodal distribution to suggest emergence of a qualitatively different population. Each individual tended to maintain his relative position within the distribution curve over the period of study, but this was modified by genetic and environmental factors.

Significant correlations were found between the variables of weight and somatotype. A significantly greater increase in blood pressure was noted in association with increasing weight. Subjects with a predominance of ectomorphic characteristics had a smaller increment of blood pressure over the period of study. Endomorphic subjects had a greater increment of blood pressure. The changes in blood pressure related to somatotype were modified by weight, but not dependent upon an increase in weight.

A family history of vascular disease was associated with a significantly greater increase in blood pressure. The greater increment in blood pressure associated with a positive family history was not dependent upon weight gain for its influence. There was no evidence that a positive family history separated a portion of the population ranked according to blood pressure.

Analysis of the upper and lower segments of the distribution curves, revealed significant differences between the characteristics of each group. These differences followed the same pattern as the entire group but were quantitatively different.

These results are discussed with regard to the concept that hypertension represents a quantitative difference in blood pressure resulting from a multiplicity of factors, both genetic and environmental.
Successful Excision of a Left Ventricular Hamartoma
Authors: PARKS FLOYD R. , ADAMS FORREST , LONGMIRE WILLIAM P.
Published: June 2012

A case of a 2-year-old child with a large hamartoma of the left ventricular wall is presented. The excision of the tumor is described, and a 2-year follow-up is given. Primary cardiac tumors should be suspected in patients with unexplained cardiac failure, unexplained cardiac arrhythmias, intracardiac calcifications, irregular shadows on x-ray, or symptoms and murmurs that change with position. Angiocardiography is suggested for diagnosis. Technical problems at operation involve the maintenance of satisfactory cardiac function and valve competence.
Alternation of the Heart
Authors: LITTMANN DAVID
Published: June 2012

Alteration of the heart occurs whenever any of its tissues, contractile or conductive, fail to function during alternate beats. This results in a diversity of 2:1 conduction blocks with electrical alternation and myocardial blocks that produce alternation of the pulse. In a general way, the more distal blocks, involving bundle branches, arborization, and myocardium are the more ominous, implying serious underlying heart disease. They can occur normally, however, at rapid heart rates.

Another type of alternation involving atrial as well as ventricular waves is sometimes seen in serious pericardial disease with effusion. It is believed to be due to an unusual rotary oscillation of the heart released from its normal inhibitory mediastinal restraints by the surrounding effusion. This is an anatomic rather than a cellular form of alternation and can exhibit other mechanical disorders such as alternating friction sounds.
Intracardiac Rupture of Hydatid Cysts of the Heart
Authors: DI BELLO RAÚL , MENÉNDEZ HÉCTOR.
Published: June 2012

Intracardiac rupture of hydatid cysts of the heart is very frequent (38.66 per cent) and often causes sudden death (29 per cent). Cysts of the right ventricle rupture into the heart cavities far more often than do those of the left ventricle. Frequently, the cyst undergoes multiple intracardiac or pericardio-intracardiac ruptures.

The consequences of the intracardiac rupture depend above all upon the contents of the cyst. If it contains liquid and microscopic elements, no mechanical disorders occur, but it may give rise to metastatic visceral echinococcosis. If it contains vesicles, or is degenerated, it may give rise to large emboli.
Assisted Circulation
Authors: SOROFF HARRY S. , LEVINE HERBERT J. , SACHS BARRY F. , BIRTWELL WILLIAM C. , DETERLING RALPH A. , Collins Judith A. , Kasuba Jean
Published: June 2012

The effect of counterpulsation upon hemodynamics and myocardial oxygen consumption was studied in 14 dogs. With properly synchronized counterpulsation, a reduction in mean systolic pressure, tension-time index, left ventricular work, and myocardial oxygen consumption was observed, with no change in effective cardiac output. The reduction in myocardial qO
2
, however, did not parallel the fall in tension-time index. Mechanical efficiency fell and the oxygen cost of pressure generation by the left ventricle rose. Premature triggering of the pump systole resulted in an actual increase in myocardial qO
2
, despite a fall in tension-time index. The influence of counterpulsation upon the energy requirements of the left ventricle is briefly discussed.
Relationship of Hypoxia to Arrhythmia and Cardiac Conduction Hemorrhage
Authors: CLARK RICHARD E. , CHRISTLIEB IGNACIO , SANMARCO MIGUEL , DIAZ-PEREZ RODRIGO , DAMMANN J. FRANCIS , Zipser Martin E.
Published: June 2012

The relationship between hypoxia, arrhythmia, and hemorrhage of the conducting system was studied in the experimental laboratory by rendering several different groups of rats and dogs hypoxic, and by the histological examination of the area of the atrioventricular node and bundle of His in sections obtained from the hearts of these animals. Sixty-one per cent of rats aged two weeks or older developed arrhythmias and had hemorrhage. None of 10 baby rats presented changes when submitted to the same type of experiment. Hemorrhage was present in only 40 per cent of asphyxiated dogs and in 40 per cent of the dogs that were made hypoxic during cardiopulmonary bypass; 75 per cent of dogs which underwent total mitral valvular replacement and expired in acute pulmonary edema 3 to 10 days postoperatively presented a similar type of lesion. In most cases, the administration of oxygen sufficed to reverse the electrocardiographic changes back to normal.

Hypoxia is suggested as the primary cause for these changes, on the basis of previous clinical and experimental work and the information collected from these experiments. The importance of a possible species difference was suggested when attempts were made to correlate the results in rats, dogs, and humans.
Hypotensive and Renal Effects of Diazoxide, a Sodium-Retaining Benzothiadiazine Compound
Authors: BARTORELLI C. , GARGANO N. , LEONETTI G. , ZANCHETTI A.
Published: June 2012

Diazoxide, a new compound of the benzo-thiadiazine group, has been shown to decrease both systolic and diastolic arterial pressure in mild or moderate hypertensive patients, even though it lacks the saluretic properties characteristic of the other known compounds of the group.

Instead of promoting sodium excretion, diazoxide appears to be a powerful sodium- and chloride-retaining agent, its prolonged use leading to important increases in plasma volume and body weight, and probably to some redistribution between extracellular and intracellular fluid. Glomerular filtration rate and renal plasma flow are often increased during treatment with the drug.

Although diazoxide was in several respects a useful hypotensive agent, at least in hypertensive patients without heart failure, it may share with other benzothiadiazine compounds some pancreatic toxicity, a side effect that should be carefully considered during benzothiadiazine treatment.
Results of Surgical Treatment of Incipient Stroke
Authors: WHISNANT JACK P. , SIEKERT ROBERT G. , BERNATZ PHILIP E. , ELLIS F. HENRY
Published: June 2012

Recently we have studied the role of surgical treatment of patients having occlusive cerebrovascular disease, particularly incipient stroke (or focal intermittent cerebrovascular insufficiency). This report concerns 35 pa-patients with incipient stroke in whom circulation was restored to normal by operation on an artery in an attempt to prevent transient ischemic episodes and cerebral infarction.

Since all of the patients were neurologically normal at the time of the surgical procedure, we were concerned primarily with the risk of [see tablein the PDF file] the procedure, particularly in terms of cerebral infarction. The operative mortality rate was 8.5 per cent (three patients). Six patients (17 per cent) sustained cerebral infarcts. Four of these had mild neurologic deficits, usually consisting of clumsiness and mildly reduced discriminatory sensation in one hand; one had a severe neurologic deficit, and one died. Evidence shows that at least some of these infarcts resulted from emboli arising from the operative site at the time of or shortly after the operation.

The results of long-term follow-up revealed that 66 per cent of the surgically treated patients were normal compared to 25 per cent of a contrast group; and 17 per cent of the treated patients had suffered cerebral infarcts compared to 40 per cent of the contrast group. The long-term results are thus similar to the immediate postoperative results. These findings simply indicate that an operated patient's prognosis was good over the long term if the cerebral ischemic episodes were relieved and if he sustained no complications from the surgical procedure.
Subclavian Steal
Authors: WILLIAMS CARL L. , SCOTT STEWART M. , TAKARO TIMOTHY
Published: June 2012

Five patients with subclavian artery stenosis, reversed vertebral artery blood flow, and basilar arterial insufficiency have been described. Four patients were successfully treated by arterial reconstruction.

Serial angiography demonstrated in each case a stenosis of the subclavian artery proximal to the origin of the vertebral artery, with delayed retrograde flow through this vertebral artery to the subclavian artery distally.
Coronary Radiography and Endarterectomy
Authors: NILES NELSON R. , DOTTER CHARLES T.
Published: June 2012

Postmortem angiography, kerosene perfusion, latex mass-injection radiographic studies and the conventional methods of anatomic pathology have been used in a study of coronary artery disease in 189 hearts, 88 of which had myocardial infarction associated with coronary arteriosclerosis. Analysis was directed to ascertain whether sclerotic lesions appeared to be amenable to surgical removal and whether such removal is likely to result in an increased flow of blood to the myocardium. Affirmative conclusions to these questions were reinforced by 42 postmortem coronary resections done in 31 cases. Fluidtight closures permitted follow-up perfusion studies in 25 successful resections done for the relief of coronary luminal narrowing, and in 16 of these significant increase in the perfusion rate resulted. Twelve of these 25 were endarterectomies, and increased perfusion rates were achieved in 10 of them. From the logical standpoint, direct relief such as appears mechanically feasible through surgical endarterectomy offers an attractive therapeutic approach to myocardial ischemia from coronary arteriosclerosis. The presence of multiple main-vessel lesions and of distal small-branch disease does not preclude significant improvement; these are not contraindications to such surgery.

In view of the frequency and mortality of coronary arteriosclerosis and because of the inadequacies of other methods of therapy in use today, the clinical trial of a direct attack upon the occluding lesion appears to be warranted. Current clinical failures provide opportunities while external artificial circulation and other methods for left ventricular assistance or bypass pumping provide means for gaining surgical experience and offering at least a slim chance to patients whose lives would otherwise be lost. Radiographic studies of the coronary system will be essential to any surgical attack likely to succeed.