bluuebunny/crossref_metadata_2025 huggingface dataset:
Stokes-Adams Attacks Induced by Rectal Stimulation in a Patient with Complete Heart Block
Authors: SCOTT ROY W. , SANCETTA SALVATORE M.
Published: June 2012

This paper reports a case of complete heart block whose Stokes-Adams attacks were induced by straining at stool and invariably by digital stimulation of the rectum. Electrocardiograms during attacks exhibited high ventricular tachycardia or fibrillation and chaotic heart action.
Correlation of Simultaneously Recorded Electrokymograms and Pressure Pulses of Human Heart and Great Vessels
Authors: SALANS A. H. , SCHACK J. A. , KATZ L. N.
Published: June 2012

In order to define more precisely meaningful points on ventricular and great vessel electrokymograms, intraluminal and intracavitary pressures have been simultaneously recorded. Electrokymograms of the superior vena cava and the pulmonary artery show remarkable constancy of time relationships with simultaneously recorded intraluminal pressure curves. The ventricular electrokymogram is more difficult to define and its limitations are discussed.
Demonstration of Muscle Sphincters as a Capillary Component in the Human Heart
Authors: PROVENZA D. VINCENT , SCHERLIS SIDNEY
Published: June 2012

The capillary network in the ventricular myocardium in man consists of 2 sphincter-type capillaries (the
metarteriole
and the
precapillary
) and a nonmuscular capillary, the classic or
true capillary.
The muscular components of the metarterioles and of the precapillaries are innervated by nerve fibers of which the terminal structure ends as a knotted fibrillar process near the muscle nucleus. The sphincter capillary and its nerve constitute a functional unit. These structures are encountered in the myocardium of man more frequently than elsewhere. In man these functional units conceivably may play a much more prominent role than heretofore realized in the dynamics of cardiac vascularization.
Occlusive Disease of the Carotid Arteries
Authors: SILVERSTEIN ALLEN
Published: June 2012

Within the last 10 years there has been increasing recognition of the frequency of spontaneous occlusions of the carotid arteries as a cause for neurologic deficit, and several reports of successful therapy instituted early in the disease have appeared. Since many patients with symptoms due to carotid occlusion will be seen initially by the general practitioner or internist, increased awareness and knowledge of the condition seem warranted. The clinical and laboratory features of 50 patients with proved carotid occlusions are presented, the varying clinical pictures produced by such occlusions are described, and the potential means of therapy are discussed.
A Cooperative Study of Cerebrovascular Disease
Authors: MCDEVITT ELLEN , GROCH SIGMUND N. , WRIGHT IRVING S.
Published: June 2012

Great interest continues in the treatment of cerebrovascular vascular accidents with anticoagulant agents. This paper presents a preliminary report of a cooperative study of this subject and indicates the methodology and protocol of the study, problems inherent in it, and preliminary findings of the first two years, without drawing definite conclusions.
Cardiac Aneurysm with Ventricular Tachycardia and Subsequent Excision of Aneurysm
Authors: COUCH O. A.
Published: June 2012

A case of ventricular tachycardia in a patient with an anterolateral ventricular aneurysm is reported. The aneurysm was excised and the ventricular tachycardia did not recur, despite discontinuation of quinidine.
Reversible Wenckebach Type Atrioventricular Block Associated with Severe Coronary Artery Disease
Authors: JICK HERSHEL , LINENTHAL ARTHUR J.
Published: June 2012

A patient with severe angina pectoris and congestive heart failure had chronic Wenckebach-type atrioventricular block and episodes of syncope. Atropine abolished the block and prevented the Stokes-Adams attacks. Carotid sinus pressure, digoxin, and exercise increased the block; atropine prevented these effects.
Cardiovascular Responses in Experimentally Induced Alterations of Affect
Authors: BOGDONOFF MORTON D. , COMBS JOSEPH J. , BRYANT GERALD D. N. , WARREN JAMES V.
Published: June 2012

Although alterations in emotional arousal have long been associated with changes in cardiovascular dynamics, the precise quantitative relationship has not been fully detailed. Independent assessment of the emotional change was felt to be a necessary component of a quantitatively oriented study. The variously described responses for "anxiety" and "anger" might better be re-explored in such a manner. The emotional arousal was experimentally produced in the laboratory. Measures of pulse, arterial blood pressure, and cardiac output were conducted both before and during the change in affect evoked by the laboratory stimulus.
Dicumarol, Coumadin, Marcumar and Tromexan
Authors: ESCUDERO JORGE , MCDEVITT ELLEN , WRIGHT IRVING S.
Published: June 2012

There is considerable interest and some difference of opinion about the relative clinical usefulness of many oral anticoagulant agents. In this study the more commonly used agents are evaluated with respect to their action on the clotting process as measured by thrombelastography. This test does not necessarily provide an evaluation of all aspects of the clinical action of an anticoagulant.
Visualization of the Left Branch of the Human Atrioventricular Bundle
Authors: UHLEY HERMAN N. , RIVKIN LAURENCE M.
Published: June 2012

Visualization of the atrioventricular node and bundles of His in the human heart has been very difficult in the past, so much so that the very existence of specialized conducting tissue in man has been questioned. The authors present a simplified technic permitting visualization of the left bundle of His that facilitates studies in this area.
The Earliest Record of Sudden Death Possibly Due to Atherosclerotic Coronary Occlusion
Authors: BRUETSCH WALTER L.
Published: June 2012

The sudden death of an Egyptian nobleman is portrayed in the relief of a tomb from the Sixth Dynasty (2625-2475 B.C.). Since there is indisputable evidence from the dissections of Egyptian mummies that atherosclerosis was prevalent in ancient Egypt, it was conjectured that the sudden death might have been due to atheroselerotic occlusion of the coronary arteries.
Work and Heart Disease
Authors: FORD AMASA B. , HELLERSTEIN HERMAN K. , TURELL DAVID J.
Published: June 2012

Knowledge of the cardiovascular requirements of various types of work is essential in making work recommendations for cardiac patients. In a previous study the stresses of work in a light metal manufacturing plant were shown to be small. The present study is an evaluation of the physiologic requirement of a typical day's work in an open-hearth furnace and other areas in a steel mill. The oxygen consumption, pulmonary ventilation, respiratory rate, and other physiologic responses in cardiac patients are compared to those of normal subjects performing the same tasks.
Congenital Insufficiency of the Pulmonary Valve
Authors: SMITH RICHARD D. , DUSHANE JAMES W. , EDWARDS JESSE E.
Published: June 2012

Congenital insufficiency of the pulmonary valve may result if the valvular cusps develop faultily or fail to develop. It is commonly associated with ventricular septal defect, with or without pulmonary stenosis. Under these conditions a continuous precordial murmur may be present. Less commonly, congenital pulmonary valvular insufficiency may appear as an isolated cardiac malformation.
Correlation of Heart Rate During Norepinephrine Infusion with Pulse Pressure Following Amyl Nitrite Inhalation
Authors: FINNERTY FRANK A. , MASSARO GLORIA DECARLO , SIGDA FREDRICK , RYAN MARTIN
Published: June 2012

Conway and Smith have suggested that a decrease in the pulse pressure following inhalation of amyl nitrite might be associated with loss of aortic elasticity. Studies in this laboratory have suggested that a decreased bradycrotic response during infusion of norepinephrine might also be associated with loss of aortic elasticity. It was hoped that further support might be given to such a hypothesis if both procedures gave similar results in the same patients. The present study was designed to compare the effect of inhalation of amyl nitrite on the pulse pressure and infusion of norepinephrine on the heart rate in normal, hypertensive, and arteriosclerotic subjects.
Abscess of the Heart
Authors: ZETTNER ALFRED , IRMIERE VICTOR J.
Published: June 2012

At autopsy we encountered a large abscess of the interatrial septum as a complication of acute vegetative and ulcerative endocarditis, which was probably bacterial. The abscess was connected by a fistula to the aorta and furthermore had ruptured into the left atrium. A search of the literature failed to disclose a similar lesion.
Interarterial Coronary Anastomoses
Authors: PITT BERTRAM
Published: June 2012

It is generally recognized that interarterial coronary anastomoses of functionally significant size occur with great frequency in the presence of occlusive coronary artery disease and in other conditions such as anemia and cardiac hypertrophy in which myocardial anoxia may be present. Disagreement has been expressed by some investigators regarding the incidence of these anastomoses in normal and abnormal hearts. The problem has therefore been reinvestigated by means of a technic of infusion of saline solution and injection of wax spheres of known size. The results of these observations in 75 hearts are presented and their significance is discussed.
Use of Tape-Recorded Heart Sounds in Screening of Children for Heart Disease
Authors: SMITH JACQUES M. , MILLER ROBERT A. , MARIENFELD CARL , HAHNEMAN BETTY , WILLARD JOEL
Published: June 2012

An automated tape-recording unit for use in screening large populations of school children for heart disease has been developed and field tested. A technician can produce good quality apex and base heart sound recordings from 250 children during an average school day. The physician can listen to these recordings at a rate of 140 children per hour, recalling for examination each child considered to have an abnormal recording. Since almost all heart disease in children has some acoustic manifestation, a screening technic based on the heart sounds seems to be a logical one. The studies done with this unit have demonstrated its ability to select children with heart disease from a large number of normal children. Agreement between readers is satisfactory, and the number of "false positives" is considered reasonable.
Postural Effects on the Baselines of Ventricular Performance
Authors: RUSHMER ROBERT F.
Published: June 2012

In both dogs and human subjects, fully relaxed in the horizontal position, the ventricular dimensions and stroke volume are generally at or near maximal levels. During exertion the stroke volume does not progressively increase, indeed it rarely exceeds recumbent control values. On sitting or standing the ventricular size and stroke volume diminish to a new lower control level. When control values are measured during quiet standing, exertion produces a slight but consistent increase in stroke volume approximately to the level found in recumbency. This difference in the baseline for control values must be considered in evaluating the cardiovascular response to exercise.
Gallop Rhythm of the Heart
Authors: GRAYZEL JOSEPH
Published: June 2012

The 2 fundamental types of gallop are ventricular gallop and atrial gallop. Adequate cardiac acceleration modifies these gallops and may produce a summation gallop, an augmented ventricular gallop, or an augmented atrial gallop. The summation and augmented gallops were examined and their relation to the 2 fundamental gallops was quantitated. The cardiac rate at which summation and augmentation occur is unique. A graph and 2 corresponding equations were derived which relate the summation cardiac rate and corresponding cycle length to familiar electrocardiographic and phonocardiographic intervals.
Hypocholesteremic Effect of Benzmalacene
Authors: PAGE IRVINE H. , SCHNECKLOTH ROLAND E.
Published: June 2012

A new substance, Benzmalacene, was tested to determine whether it had hypocholesteremic effect in normotensive, hypertensive and hypercholesteremic patients. It proved effective. But after 4 months' treatment liver function began to deteriorate. It is strongly urged that drugs which interfere with cholesterol synthesis in the body be studied most carefully for long periods before widespread clinical trials to prevent atherosclerosis are attempted.
Correlation of Clinical and Hemodynamic Findings in Patients with Systemic Arteriovenous Fistulas
Authors: MUENSTER JOSEPH J. , GRAETTINGER JOHN S. , CAMPBELL JAMES A.
Published: June 2012

Although studies of the pathologic physiology of arteriovenous fistula have been reported, the circulatory responses to exercise and the nature of the syndrome resembling congestive heart failure have not been elucidated.
Abnormalities of the Arterial Pulse Wave in Young Diabetic Subjects
Authors: LAX HENRY , FEINBERG ARTHUR W. , Urban William
Published: June 2012

Abnormalities have been noted in the arterial pulse wave of human subjects with peripheral arteriosclerosis and with hypertension. The major change, diminution to disappearance of the dicrotic wave, has also been found in young diabetic subjects. The present study reports on the differences in the configuration of the arterial pulse wave of 162 diabetic subjects between the ages of 11 and 29 years and a comparable group of 275 nondiabetic controls. The findings seem to support the concept that the vascular abnormalities seen in diabetes mellitus are an integral part and not a complication of the disease.
Intracardiac Phonocardiography in Ventricular Septal Defect
Authors: FERUGLIO GEORGE A. , GUNTON RAMSAY W.
Published: June 2012

It has been demonstrated that intracardiac phonocardiography provides precise localization of the source of cardiovascular sounds. Can this technic be of practical help in the diagnosis of small or complicated ventricular septal defects? Is a ventricular septal defect ever silent? What mechanisms are responsible for the diastolic murmurs in ventricular septal defect? In an attempt to answer these problems, intracardiac phonocardiograms have been studied in 47 cases.
The Vectorcardiogram and Electrocardiogram in Persistent Common Atrioventricular Canal
Authors: BEREGOVICH JONAS , BLEIFER SELVYN , DONOSO EPHRAIM , GRISHMAN ARTHUR
Published: June 2012

The electrocardiogram and vectorcardiogram are of great aid in differentiating atrial septal defect of the secundum type from the ostium-primum type. In the latter condition there is left axis deviation in the scalar electrocardiogram and superior orientation of the QRS vector in the sagittal and frontal planes. There are relatively few congenital lesions that lead to the same degree of axis deviation and superior orientation of the QRS vector.
Familial Muscular Subaortic Stenosis
Authors: BRENT LAWRENCE B. , ABURANO AKIO , FISHER DON L. , MORAN THOMAS J. , MYERS JACK D. , TAYLOR W. JAPE
Published: June 2012

Two families with familial muscular subaortic stenosis have been studied. Hemodynamic data in 2 cases and the operative findings of 1 case are described. Autopsy findings of 3 cases have been presented. Clinical findings indicate at least 3 additional cases in 1 family and 5 in the other.

The pedigrees of both families have been discussed. The incidence of this lesion in each family over 3 generations suggests that the defect is related to Mendelian dominant inheritance. To our knowledge, this is the first report of cases of familial heart disease compatible with transmission by a Mendelian dominant gene.

The importance of differential diagnosis of this disease from other types of aortic or subaortic stenosis prior to surgery has been stressed, since no operation has been devised for this lesion. The distinguishing clinical features include the apical and lower left sternal border location of the systolic murmur, the absence of poststenotic dilatation of the ascending aorta, the absence of calcification of the aortic value, the absence of a murmur of aortic insufficiency, and the strong family history suggesting a familial trait.
The Correction of Hyponatremia in Congestive Heart Failure
Authors: LUCKEY E. HUGH , RUBIN ALBERT L.
Published: June 2012

Hyponatremia in congestive heart failure occurs principally in the terminal phases of the natural history of heart disease. Fortunately, in some instances it may occur as a transient event in a setting of sudden deterioration in cardiac function. In such instances, it may be reversible.

The most important factor in the occurrence of hyponatremia in these patients is an inordinate retention of water. Thus, the hyponatremia is the result of dilution.

Correction of hyponatremia requires the elimination of water in excess of sodium. The futility and dangers of the use of hypertonic sodium chloride are emphasized.

A method of controlled administration of mercurial diuretics after elevation of the plasma chlorides toward normal with consequent production of acidosis with chloride salts is reviewed. Diuresis following this procedure results in sodium losses in urine that are hypotonic in relation to plasma. The plasma sodium gradually returns to normal, and the patient progressively loses weight.
The Correlation Between the Electrocardiographic Patterns of Ventricular Hypertrophy and the Anatomic Findings
Authors: SCOTT RALPH C.
Published: June 2012

The correlation of the electrocardiogram with anatomic evidence of ventricular hypertrophy, while laden with numerous pitfalls, still remains the best available means of determining the accuracy of the electrocardiographic diagnosis of ventricular hypertrophy.

In 100 instances of isolated left ventricular hypertrophy (LVH) demonstrated at autopsy, a positive electrocardiographic diagnosis was made in 85 per cent by use of conventional criteria. However, in other studies designed to test the reliability of these criteria, it was found that a false-positive diagnosis was made in 10 to 15 per cent of the cases.

The electrocardiographic diagnosis of right ventricular hypertrophy (RVH) is more difficult. In electrocardiographic studies, confirmed by autopsies, the correlation has ranged from 23 to 100 per cent, while the number of false-positive diagnoses has been as high as 33 per cent. The correct electrocardiographic diagnosis is more frequent in RVH due to congenital heart disease than to acquired heart disease.

The significance of the rSR' pattern in right precordial leads is discussed. Its occurrence in anatomic RVH and the problem of the electrocardiographic diagnosis of RVH in the presence of right bundle-branch block (RBBB) are reviewed.

Combined ventricular hypertrophy (CVH) is frequently missed in the electrocardiogram, the diagnosis having been made in only 8 to 26 per cent of cases proved at autopsy.

The unreliability of the electrocardiographic diagnosis of LVH in the presence of left bundle-branch block (LBBB) is documented.

The precise electrophysiologic phenomena that occur in ventricular hypertrophy are still largely conjectural. The more commonly accepted hypotheses are reviewed.

The lack of close correlation between ventricular wall thickness or respective ventricular muscle mass and the individual electrocardiographic patterns is emphasized. The possible explanations for some of these discrepancies are presented.
Fibrinolysin (Plasmin) Therapy in Acute Deep Thrombophlebitis
Authors: MOSER KENNETH M. , SULAVIK STEPHEN B. , HAJJAR GEORGE C.
Published: June 2012

Sixty-two patients with deep thrombophlebitis of less than 10 days' duration were studied in controlled fashion. Thirty "control" patients were treated by routine methods including anticoagulant drugs. Thirty-two "treatment" patients received fibrinolysin (plasmin) in addition to control therapy.

The composition of the groups studied and the protocol followed are presented in detail.

Comparison of the 2 groups indicates that the addition of fibrinolysin to the therapeutic regimen leads to more rapid clearing of the acute phlebitic episode and may diminish the short-term incidence of phlebitic recurrence and pulmonary embolization. Postphlebitic residuals were encountered with almost equal frequency in both groups.

Greater short-term differences in therapeutic response exist between control and fibrinolysin patients when analysis is restricted to those treated within 5 days of phlebitic onset.

The available data do not permit firm conclusions regarding the apparently favorable influence of fibrinolysin upon the long-term prognosis of phlebitic subjects, but do indicate that recurrence and embolization can be expected in both groups.

The factors that may influence the results obtained with fibrinolytic therapy are discussed and the importance of considering them in studies of this type is emphasized.
Paroxysmal Atrial Tachycardia with Atrioventricular Block
Authors: GOLDBERG LEONARD M. , BRISTOW J. DAVID , PARKER BRENT M. , RITZMANN LEONARD W.
Published: June 2012

Paroxysmal atrial tachycardia with block is a cardiac arrhythmia that is usually a manifestation of digitalis toxicity in patients with serious heart disease. The arrhythmia generally ends promptly after potassium administration and withdrawal of digitalis. Since the ventricular rates may be slow and regular, the arrhythmia may be difficult to recognize clinically. Atrial rates as slow as 115 per minute may be seen in cases which are otherwise typical of the condition.

In our series associated pulmonary disease was present in 54 per cent and cor pulmonale in 27 per cent of the cases.
Serum Potassium and the Electrocardiogram in Hypokalemia
Authors: WEAVER WALT F. , BURCHELL HOWARD B.
Published: June 2012

A definite correlation can be established between the electrocardiogram and the serum potassium level at hypokalemic levels. A study was made at the Mayo Clinic of 130 hypokalemic patients with relatively stable clinical states. Variations in Q-T intervals, P-R intervals, atrial rhythm, P waves, T/R values, and T-wave and U-wave contour in hypokalemia were noted as were the relationships between the T-U complex, electrical repolarization phenomena and potassium metabolism. Since modifying factors such as drugs, certain electrolyte disturbances, variations in cardiac rate, conduction defects, and myocardial ischemia were eliminated by careful selection of patients, only the influence of acid-base imbalance, sodium-potassium ratio, and hypertension on the electrocardiogram was studied. Acid-base imbalance and hypertension often simulated or obscured electrocardiographic evidence of hypokalemia.

Electrocardiographic criteria of hypokalemia include various combinations of the following signs: (1) T/U value of 1 or less in lead II or V
3
, (2) U-wave amplitudes of greater than 0.5 mm. in lead II or greater than 1 mm. in V
3
, and (3) S-T depression of 0.5 mm. or more in lead II or leads V
1
, V
2
, and V
3
. It must be remembered that a normal electrocardiogram does not exclude hypokalemia and that an electrocardiogram which fulfills the established criteria does not necessarily indicate hypokalemia unless the factors discussed have been eliminated or minimized.
Correction of Mitral Insufficiency under Direct Vision
Authors: KAY EARLE B. , NOGUEIRA CID , ZIMMERMAN H. A.
Published: June 2012

The incompetent valves in the majority of patients with mitral regurgitation can be surgically corrected by the technics described above. The ease and effectiveness of the correction are largely dependent upon the severity of the pathologic process. The roles of chronic myocarditis, myocardial failure, pulmonary vascular sclerosis, and the presence of other valvular defects are important factors in the eventual result. Fortunately, the abnormality in the majority of valves can be corrected, and the myocardial reserve is usually sufficient to provide satisfactory function. With continued progress in this field, earlier surgical intervention, and probably less severe disease from improved treatment, better results can be anticipated in the future.
Surgical Relief of Aortic Insufficiency by Direct Operation on the Aortic Valve
Authors: MULLER WILLIAM H. , WARREN W. DEAN , DAMMANN J. FRANCIS , BECKWITH JULIAN R. , WOOD J. EDWIN
Published: June 2012

The natural history of patients with aortic insufficiency and the previous experimental and clinical operations devised for its relief are reviewed.

Methods that have been used at the University of Virginia Hospital for treatment of aortic insufficiency are reported. These procedures include the release of the fixed valve leaflet and removal of calcium from it, aortic valve leaflet extension with suture of a small piece of compressed polyvinyl sponge or Teflon fabric to the edge of one of the leaflets, excision and replacement of a portion of the valve with a synthetic leaflet, and complete subcoronary replacement of the valve with a prosthesis. To relieve isolated rheumatic aortic insufficiency, an annulus has been constricted or a bicuspid aortic valve has been created. Insufficiency resulting from perforation of one or more valve leaflets by subacute bacterial endocarditis has been treated by closure of the perforations.

Nineteen patients underwent 21 operations for the correction of aortic insufficiency. All had been in, or were in, heart failure, and several had significant coronary artery disease or multivalvular disease. Eleven of the 19 patients are well or markedly improved. Eight died during or after the operative procedure.

It is concluded that a direct attack upon the insufficient aortic valve is the procedure of choice at the present time.
Antidiuretic Hormones
Authors: SAWYER WILBUR H. , MUNSICK ROBERT A. , VAN DYKE H. B.
Published: June 2012

There are at least 3 antidiuretic hormones. Arginine vasopressin is the antidiuretic hormone of most mammals, including man. This function is served by lysine vasopressin in the pig, and by arginine vasotocin in birds, reptiles and amphibians. All 3 hormones are closely related chemically and act on the kidney in a similar manner. Arginine vasotocin also exists in fish, in which the antidiuretic response is not known to occur. This antidiuretic hormone appeared, therefore, in vertebrate phylogeny before it acquired antidiuretic function. Anatomic considerations suggest that the fish neurohypophysis serves to regulate adenohypophysial secretion. There is evidence that such a primitive type of neurohypophysial function has persisted throughout subsequent vertebrate evolution.
Pathogenesis and Management of Chronic Ulcerations of the Extremities
Authors: SHEPS SHELDON G.
Published: June 2012

It can be seen that the variety of chronic ulcerations of the skin of the extremities is legion. Attention to the underlying disease process is of paramount importance because of the difference in definitive treatment and prognosis. Appropriate simple medical measures as outlined above often suffice in the local treatment of these ulcerations. Regional sympathetic denervation has a definite but relatively minor role in the management of these disorders. The widespread, indiscriminate use of a host of salves, ointments, and other potions is to be condemned.
Permutation Trial of Diuretics
Authors: KIIL FREDRIK
Published: June 2012

In order to increase the amount of information per day of observation the permutation trial is introduced in the study of acute effects of diuretic agents.

Chlorothiazide and hydroflumethiazide in optimal doses (2 Gm. and 200 mg. daily) and placebo tablets were given, 1 drug on each of the 3 days of the study, in all permutations to 12 patients treated by current methods for right heart failure.

The error variance of sodium, potassium, chloride, and water excretion was reduced by taking into account the variation due to permutations and days.

Chlorothiazide showed a stronger diuretic action than hydroflumethiazide, whereas the natriuretic effects were not significantly different as judged by analysis of variance. Hydroflumethiazide was less kaliuretic.

Magnesium excretion was independent of diuresis. Neither of the diuretics showed any effect on magnesium and calcium excretion. The ratio of sodium and chloride excretion was significantly lower during hydroflumethiazide than during chlorothiazide action.

The calculated sodium concentration in the additionally excreted urine during hydroflumethiazide administration was far above serum levels (the mean of 12 observations was 353 mEq. per liter), and significantly higher than during chlorothiazide action. This effect was also demonstrated in 6 control patients during water loading, suggesting that hydroflumethiazide increases free water reabsorption also when antidiuretic hormone is absent.

Comparison of the acute effects of diuretic agents is through the permutation trial made possible in the ordinarily equipped hospital without serious interference with current treatment.
The Structure of Water and Electrolyte Solutions
Authors: PODOLSKY RICHARD J.
Published: June 2012

Intermolecular forces tend to organize water molecules into a tetrahedral lattice, conferring "crystalline" properties on the liquid. The simple ions, such as Na
+
, K
+
, and Cl
-
, have dimensions which are of the same order as the water molecule. Therefore, in aqueous solution, ions can substitute for water molecules in the water lattice. However, because the force between ion and water molecule differs from the force between 2 water molecules, the properties of the lattice are perturbed by an ion. Transport processes in electrolyte solutions are analyzed in terms of the specific lattice perturbation produced by each ion. This approach is contrasted with the classical hydrodynamic model in which ions in solution are treated as spheres in a continuous fluid. The relevance of ionic transport in aqueous solution to the transport across biologic membranes is briefly discussed.
Function of the Collecting Ducts
Authors: ULLRICH KARL J.
Published: June 2012

Urine was sampled from microcatheters situated at different levels of the collecting ducts of golden hamsters. Appropriate analyses provided data concerning the function of the collecting ducts with respect to concentrating and acidifying the urine. The conclusion is reached that the collecting ducts serve 2 functions: a
passive
one, i.e., the back-diffusion of water and urea and an
active
one, i.e., the exchange of sodium for hydrogen ions and the formation of ammonia.
Stop-Flow Studies on Ion and Water Reabsorption in the Dog
Authors: MALVIN RICHARD L. , WILDE WALTER S.
Published: June 2012

The stop-flow method has been used to study various aspects of renal tubular transport mechanisms. According to this method, aldosterone promotes the tubular reabsorption of sodium in the distal tubule. The method also indicates that the secretion of potassium, hydrogen and ammonium occurs in a very distal portion of the nephron. The substitution of anions such as ferrocyanide, sulfate and phosphate for chloride apparently increases the area of the nephron involved in the secretion of hydrogen and potassium. The stop-flow experiments support other evidence that the rate of flow of urine through the loops of Henle affects the countercurrent multiplier system which, in turn, determines the ability of the kidneys to elaborate a concentrated urine.
Cardiovascular Manifestations in Argemone Mexicana Poisoning (Epidemic Dropsy)
Authors: SANGHVI L. M. , MISRA S. N. , BOSE T. K.
Published: June 2012

Cardiovascular manifestations have been studied in 11 patients with argemone oil poisoning.

Tachycardia, alterations in the heart sounds, cardiac enlargement, or electrocardiographic and ballistocardiographic changes indicated myocardial involvement in every case. The latter was suggestive of a nonspecific type of myocarditis and was considered to be of a minor nature. The prominent manifestations included dyspnea, edema, hepatic enlargement, and pulmonary congestion. The last 3 were probably due to capillary dilatation, whereas the cause of dyspnea was uncertain.

These manifestations suggested the presence of cardiac failure, which, however, was considered unlikely except in 1 case.
Stenosis of the Right Main Pulmonary Artery
Authors: LUAN LAWRENCE L. , D'SILVA JOSEPH LLOYD , GASUL BENJAMIN M. , DILLON ROBERT F.
Published: June 2012

Ten cases of isolated stenosis of the right main pulmonary artery are presented, 7 with associated anomalies. Although right heart catheterization and angiocardiography are usually necessary to demonstrate this malformation, a knowledge of the existence of this anomaly correlated with auscultatory and roentgenologic findings may often lead to a correct clinical diagnosis.
Some Circulatory Effects of 5-Hydroxytryptamine in Man
Authors: HARRIS P. , FRITTS H. W. , COURNAND A.
Published: June 2012

Continuous infusions of small quantities of 5-hydroxytryptamine (5-HT) were made into the pulmonary artery in 7 human subjects. In only 1 instance was there an unequivocal rise in pressure in the pulmonary artery and this was accompanied by a rise in brachial arterial pressure. The most consistent effect of the drug was to raise the heart rate. There was no effect on the cardiac output.

Single rapid injections of 5-HT were made into the right atrium in 3 other subjects. In 1 of these subjects the injection of 4 µg. per Kg. caused transient ventricular arrest and systemic hypotension followed by a sustained rise in pressure in the pulmonary and brachial arteries. The results of this study were thought to indicate the presence of a Bezold-like reflex. The rapid injection of 5-HT was therefore thought to be dangerous and the investigation was discontinued.
A New Method of Left Ventricular Catheterization
Authors: LITTMANN DAVID , STAROBIN OSCAR E. , HALL JACK H. , MATTHEWS ROBERT J. , WILLIAMS JOHN A.
Published: June 2012

A description is presented of a rapid and relatively uncomplicated method of left heart catheterization. It is possible in this manner to obtain many types of left ventricular studies and ventriculograms of diagnostic quality. A special loop-end catheter is employed, which is percutaneously introduced into the aorta and which regularly enters the left ventricle through the aortic valve except when this valve is stenosed or deformed. This entry is accomplished without apparent injury to the heart.
Obstruction of Left Ventricular Outlet in Association with Ventricular Septal Defect
Authors: LAUER RONALD M. , DUSHANE JAMES W. , EDWARDS JESSE E.
Published: June 2012

In a pathologic collection of 722 congenital heart lesions we have observed 10 cases in which a ventricular septal defect was associated with obstruction to normal left ventricular outflow. These cases are presented in the framework of a classification relating hemodynamics to the position of the obstructing lesion and the size of the ventricular septal defect. One additional case observed clinically and at operation is also reported to make more nearly complete the classification of the anatomic arrangements in which the common denominators are ventricular septal defect and obstruction to normal ventricular outflow.
Aortic and Coronary Atherosclerosis in the Three Racial Groups in Cape Town
Authors: SACKS M. I.
Published: June 2012

An autopsy survey of aortic and coronary atherosclerosis in patients dying in a general hospital in Cape Town has shown marked differences between the whites and the Bantu. These differences were clearly demonstrated by a direct comparison of Bantu and White men between the ages of 40 and 59. They probably also existed among older subjects and women although relatively few Bantu over the age of 60, and fewer women than men were unfortunately available for study.

Severe aortic and coronary atherosclerosis did on occasions occur in the Bantu but were much less common than in the whites. Severe luminal narrowing of the coronary arteries was particularly rare in the Bantu, and this is in keeping with the rarity with which they develop myocardial infarction. The aorta and coronary arteries of the Bantu often showed complete freedom from atherosclerosis in age groups in which it was rare to find such freedom in the whites.

The differences between the whites and Cape Coloured were much less pronounced than those between the whites and Bantu, were rather more apparent in men than women, and tended to disappear in the presence of aggravating factors such as hypertension. Even in groups in which severe coronary atherosclerosis was as commonly encountered in the Cape Coloured as in the whites, the Cape Coloured appeared to show a lower frequency of severe luminal narrowing. Attention has been drawn to the possibility that the differences between the total white and Cape Coloured populatios of Cape Town are greater than those revealed by this study, as only the lesser economically privileged of the whites were eligible for admission to the hospital that provided the material for the study.
Circulatory Effects of Guanethidine
Authors: RICHARDSON D. W. , WYSO E. M. , MAGEE J. H. , CAVELL G. C.
Published: June 2012

Guanethidine, a new synthetic hypotensive drug that probably interferes with release of norepinephrine from sympathetic nerve endings and that does not inhibit parasympathetic activity, has proved an effective agent in reducing blood pressure in 25 hypertensive patients studied for periods up to 6 months. Untoward effects have been limited to orthostatic hypotension and mild diarrhea.

The drug apparently lowers blood pressure by reduction in cardiac output rather than by relaxation of the arterioles. Reduction in renal blood flow and glomerular filtration rate accompanied administration of the drug, but in no case did progressive azotemia or oliguria occur.

This agent is an extremely potent hypotensive drug with a remarkably prolonged duration of action and with none of the parasympatholytic side effects produced by ganglionic-blocking agents.
Effects of Acute Hypoxia and Exercise on the Pulmonary Circulation
Authors: FISHMAN ALFRED P. , FRITTS HARRY W. , COURNAND ANDRÉ
Published: June 2012

The effects of acute hypoxia, of graded exercise, or both, on the pulmonary circulation were studied in 17 normal subjects. In 3 of these subjects, and in 3 patients with restricted vascular beds, the effects of these stimuli were compared during successive test periods.

In 7 normal subjects, moderate exercise, associated with an increase in cardiac output of approximately 25 per cent, resulted in an average rise in pulmonary arterial mean pressure of 3 mm.Hg. More strenuous exercise in the same subjects, associated with a further increase in cardiac output of approximately 25 per cent, did not elicit further increment in pulmonary arterial mean pressure.

In contrast, 10 subjects with normal pulmonary circulations, who responded to acute hypoxia with an average reduction of arterial oxygen saturation of 17 per cent, manifested an average increase in cardiac output of 5 per cent and an average rise in mean pulmonary arterial pressure of 4 mm.Hg. The critical level of arterial blood oxygen saturation for a significant rise in pulmonary arterial pressure was 85 per cent: in 6 subjects, with arterial blood O
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saturation reduced below this level, the average pulmonary artery pressure rise was 7 mm. Hg.

In the 3 subjects with normal pulmonary circulations who performed exercise and were exposed to acute hypoxia, the contrasting effects of these stimuli on the pulmonary circulation were striking. In the 3 patients with restricted vascular beds exposed successively to both stimuli, the rise in pulmonary arterial mean pressure appeared to be linearly related to the increase in pulmonary blood flow.

In 1 subject, the surgical resection of the preganglionic fibers and ganglia which supply sympathetic efferent nerves to the pulmonary vascular tree was without effect on the responses of the pulmonary circulation to acute hypoxia and to exercise.

The present study failed to identify the mechanism and the site of action of acute hypoxia on the pulmonary circulation.
Effects of Acute Hypoxia on the Volume of Blood in the Thorax
Authors: FRITTS H. W. , ODELL J. E. , HARRIS P. , BRAUNWALD E. W. , FISHMAN A. P.
Published: June 2012

Two different methods were used to study the effect of acute hypoxia on the volume of blood in the thorax. The first method entailed estimating the central blood volume by the Stewart-Hamilton dye-dilution technic; the second involved the use of a teeter-board. The 2 methods gave comparable results. Both indicated that the volume of blood in the thorax is not appreciably altered by hypoxia.
Retinal Vascular Reactivity in Patients with Diabetes Mellitus and with Atherosclerosis
Authors: HICKAM J. B. , SIEKER H. O.
Published: June 2012

By means of fundus photography, a comparative study has been made of the constrictor response of retinal vessels to the inhalation of oxygen in 47 control subjects, 50 diabetic patients, and 15 persons with atherosclerosis unassociated with hypertension or diabetes.

The diabetic group showed decreased reactivity of both arteries and veins, as indicated by a decreased constrictor response to oxygen. Retinal arterial reactivity was significantly reduced in diabetic subjects, even in the absence of retinopathy or hypertension. With the appearance of retinopathy, arterial reactivity was still further reduced.

The patients with uncomplicated atherosclerosis did not show significant changes in retinal vascular reactivity.
Electrocardiographic Sequelae of Right Ventriculotomy in Patients with Ventricular Septal Defects
Authors: FISHER JUNE M. , THEILEN ERNEST O. , JANUARY LEWIS E. , EHRENHAFT JOHANN L.
Published: June 2012

Right bundle-branch block appeared frequently after closure of ventricular septal defects, particularly in those patients who also had infundibular stenosis and in whom some of the infundibular muscle was resected. The magnitude of the postoperative changes of right bundle-branch block indicates that a conduction disturbance was produced, probably as a result of interruption of pathways in the septum. These alterations are in contrast to the postoperative disappearance or regression of secondary R waves in rSR' complexes in other patients whose preoperative interpretation included incomplete right bundle-branch block. Regression of these abnormalities supports the view that right ventricular hypertrophy rather than delayed conduction through the septum was at fault in the beginning.

Extensive T-wave changes in precordial [see figure in the PDF file] leads after right ventriculotomy and closure of ventricular septal defects indicate a significant alteration ventricular repolarization. The extent and duration of these abnormalities cannot be explained by pericarditis, myocardial infarction, or the occasional development of left ventricular hypertrophy secondary to aortic insufficiency from an unsupported aortic cusp. T-wave abnormalities were more common than in a smaller group of patients in whom bubble oxygenators were used for other operations, which did not include right ventriculotomy. Possible mechanisms for the production of the T-wave changes include injury to septal muscle from sutures, coronary air embolism, and muscle damage from the ventriculotomy itself.
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Induced cardiac arrest, whether anoxic or drug-induced, does not have a direct relationship to these changes. The clinical course of these patients thus far indicates that these electrocardiographic changes have no prognostic significance.
Catecholamines in the Localization of Pheochromocytoma
Authors: CROUT J. RICHARD , SJOERDSMA ALBERT
Published: June 2012

Data on urinary catecholamines in a collected series of 75 cases of pheochromocytoma, including 18 of our own cases, indicate that the differential assay of urinary norepinephrine and epinephrine may be of value in predicting the location of the tumor preoperatively. If there is a significant elevation of urinary epinephrine (42 per cent of all cases), the tumor may be expected to lie in or adjacent to one of the adrenal glands in about 95 per cent of cases. Other tumors of this type have been found only in the organs of Zuckerkandl. If the urine contains norepinephrine alone (58 per cent of all cases), the tumor will be found in one of the adrenal areas in about two thirds of the cases and in an extra-adrenal location in the remainder. In a few patients (6 per cent) of this type, the tumor may be extra-abdominal.

In some unusual cases more precise information on the location of the tumor must be obtained preoperatively. The demonstration of a marked step-up in plasma catecholamine concentration at the level of the tumor, the sampling being done by venous catheterization, is a useful and safe means of localizing the tumor. Five cases are presented illustrating the use of this procedure.
Direct-Reflection Oximetry in Routine Cardiac Catherization
Authors: BOSSINA K. K. , MOOK G. A. , ZIJLSTRA W. G.
Published: June 2012

A reflection cuvette oximeter providing instantaneous values has been used in a series of 195 cardiac catheterizations in infants and children. The introduction of this method had considerable influence on the entire catheterization procedure, since the direct availability of fluoroscopic, pressure, and oxygen saturation data allows development of an accurate and complete diagnosis during the catheterization. Six cases, selected because of the important part direct oximetry played in their elucidation, are discussed.
Detection of Right-to-Left Shunts with an Arterial Potentiometric Electrode
Authors: CLARK LELAND C. , BARGERON L. M. , LYONS CHAMP , BRADLEY MERRILL N. , McARTHUR KATRINA T.
Published: June 2012

Saline solution saturated with hydrogen is completely cleared of hydrogen in passing through the normal lung. The presence of dissolved hydrogen, which can be detected with a platinum electrode, in the aorta following the injection of hydrogen saturated solutions into the right heart is therefore diagnostic of a right-to-left shunt. Localization of the shunt is made by a series of injections into the various chambers of the heart. Since the electrode also responds to increased concentrations of sodium ascorbate, this substance can be used as an indicator in itself and as a test to establish the functional ability of the aortic electrode. The sensitivity and speed of the response of the electrode, together with the relative simplicity and inexpensiveness of the procedure, makes the technic readily adaptable to routine diagnostic catheterizations in infants.
Tetralogy of Fallot with Anomalous Tricuspid Valve Simulating Pulmonary Stenosis with Intact Septum
Authors: NEUFELD HENRY N. , MCGOON DWIGHT C. , DUSHANE JAMES W. , EDWARDS JESSE E.
Published: June 2012

An anatomicopathologic entity of the tetralogy of Fallot with an additional finding of an accessory flap of tricuspid valvular tissue is described. In the 3 cases reported in this paper, the outstanding hemodynamic finding was a right ventricular systolic pressure that was significantly greater than the systemic systolic pressure.

The hemodynamic findings were explained by the fact that the accessory tricuspid flap partially closed the large ventricular septal defect.

The clinical picture was similar to that of either severe pulmonary stenosis with an intact ventricular septum or severe pulmonary stenosis with a small ventricular septal defect and a right-to-left shunt at the ventricular level.