bluuebunny/crossref_metadata_2025 huggingface dataset:
Estimation of Flow Through Bronchial-Pulmonary Vascular Anastomoses with Use of T-1824 Dye
Authors: FRITTS H. W. , HARRIS P. , CHIDSEY C. A. , CLAUSS R. H. , COURNAND A.
Published: June 2012

A dye-dilution method devised to estimate the individual outputs of the ventricles has been used to assess the magnitude of the flow through bronchial-pulmonary anastomoses in patients with chronic lung disease. In 10 normal subjects the output of the left ventricle was, on the average, 0.9 per cent larger than the output of the right. In six patients with advanced pulmonary tuberculosis, the average value was 2.9 per cent, and in 11 patients with bronchiectasis 9.3 per cent. One patient, who had had her left main pulmonary artery ligated, exhibited an anastomotic flow of 20 per cent. In all groups the flow calculated from the Fick equation agreed within 20 per cent with that from the right ventricle. In the normal subjects and the patients with tuberculosis, the same general agreement between the Fick and the left ventricular output was observed. But in the patients with bronchiectasis and the woman with the ligated pulmonary artery, the Fick calculation underestimated the left ventricular output. This underestimation suggests that the blood traversing the bronchial-pulmonary anastomoses had an oxygen content approximating that in the systemic arterial blood.
The Prognosis of Essential Hypertension Treated Conservatively
Authors: SOKOLOW MAURICE , PERLOFF DOROTHEE
Published: June 2012

Four hundred thirty-nine consecutive patients (143 men and 296 women) with essential hypertension were followed on conservative therapy for a minimum of 5 years or until death. The initial blood pressure taken by a standard method and the presence and degree of vascular involvement at the time of registration were recorded on all patients. On the basis of these observations, each patient was classified in one of four classes of over-all hypertensive severity.

At the end of the 5-year follow-up period, 161 patients were dead, 78 men and 83 women. The higher mortality among men was significant and was apparent after the first year of follow-up. A progressive rise in 5-year mortality was observed with increasing degrees of initial blood pressure elevation, fundal involvement, cardiac size by radiogram, and electrocardiographic evidence of left ventricular hypertrophy, as well as with progressively higher classification of over-all hypertensive severity. Patients with mild hypertension and minimal cardiovascular impairment (class I) had an 11 per cent 5-year mortality, while patients with malignant hypertension, renal failure, or congestive heart failure (class IV) had an 84 per cent 5-year mortality. Early deaths in patients with mild hypertension were found to be largely due to atherosclerotic complications or noncardiovascular causes. Possible explanations for long survivals in patients with advanced vascular involvement on initial examination are discussed. The increased mortality of men over women was attributed in part to greater severity of disease on initial registration and in part to a higher incidence of coronary atherosclerosis. The mortality in patients with headache, dizziness, and nervous tension was found to be a factor of the associated vascular complication rather than of the symptoms alone. Patients with clinical obesity were found to have a lower over-all mortality than patients who were not obese. The prognostic value of a standardized initial blood pressure measurement is stressed and is discussed in the light of previous work by Perera, Smirk, and Gilchrist. The prognostic data were presented as a framework against which the long-term treatment of mild and moderate hypertension can be tested.
The Pulmonary Arterial Tree in Ventricular Septal Defect
Authors: WAGENVOORT C. A. , NEUFELD HENRY N. , DUSHANE JAMES W. , EDWARDS JESSE E. , Wagenvoort Noeke
Published: June 2012

A quantitative analysis was made of the pulmonary arterial medial thickness and index of medial surface area (ratio of medial tissue to pulmonary parenchyma) in 50 cases of uncomplicated ventricular septal defect in fetuses, infants, and children. The ages of the subjects ranged from 26 weeks of fetal life to 12 years. The results were compared with those obtained from a control group of the same age.

During the fetal and newborn period, both the thickness and the index of surface area of the media were generally within normal limits, although in an occasional case pulmonary arterial branches were considerably thinner than those in corresponding controls. The subjects between 1 week and 5 weeks of age had a medial thickness and an index of medial surface area that were lower than the average values at the time of birth. In this regard the pulmonary arterial tree in cases of ventricular septal defect corresponded with that in normal newborn infants. Soon after, however, and most clearly from 8 weeks on, the subjects with ventricular septal defect showed a pronounced rise both in medial thickness and in the index of medial surface area, indicating the presence of considerable medial hypertrophy.

Although intimal proliferation was observed in two infants of 11 and 27 days of age, it was uncommon in children less than the age of 1 year. Above that age it was almost invariably present. Plexiform or glomeruluslike structures were found in seven cases. The youngest patient with these lesions was 2½ years of age.
Serum Cholesterol and Atherosclerosis in Man
Authors: MATHUR K. S. , PATNEY N. L. , KUMAR V. , SHARMA R. D.
Published: June 2012

Two hundred cases were selected from medicolegal autopsies for a study of the relationship of serum cholesterol to the amount and severity of atherosclerosis in the aorta and the coronary and cerebral arteries. A preliminary study of cholesterol before and after death in 20 cases showed a close parallel between the two when the sample of blood was taken within 16 hours of death.

The mean serum total cholesterol showed a tendency to rise from 122 mg. per cent ±16 in the first decade to 176 mg. per cent ±28 in the fifth decade. A statistically significant correlation was found between serum total cholesterol levels and age up to the fifth decade.

No correlation could be observed between the serum cholesterol level and the amount and severity of atherosclerosis in the arteries. When all the cases were divided into arbitrary groups according to the amount of atherosclerosis, a rise in the levels of mean serum total cholesterol was seen in the first six successive groups of aortic atherosclerosis. But when age was excluded from the correlation between atherosclerosis and serum cholesterol, the interrelationship between the two was found to be statistically insignificant.
Electrocardiographic Changes in Head Injuries
Authors: HERSCH COLIN
Published: June 2012

Electrocardiograms of 164 Bantu patients with head trauma were recorded and studied with reference to two control groups, 100 Bantu patients with trauma to limbs and 164 healthy Bantu subjects.

The electrocardiographic abnormalities that occurred more commonly in the head injury group than in either of the control groups were an increased Q-T
c
interval and an increased voltage of the P wave.

Both traumatic groups differed from the healthy controls in showing a higher incidence of increased QRS voltage and raised S-T segments in precordial leads, inverted T waves in precordial leads V
4
to V
6,
U waves of more than 1 mm. in height, sinus arrhythmia with fixed pacemaker, and sinus arrhythmia with pacemaker wandering in the sinoatrial node.

The number of electrocardiographic abnormalities increased as the level of consciousness deteriorated.
Prediction of Fainting in Blood Donors
Authors: GRAHAM DAVID T.
Published: June 2012

Four hundred and fourteen consecutive blood donors to a hospital blood bank were studied to discover items of value in predicting the occurrence of "reactions." Since it is probable that blood donor "reactions" are almost always vasovagal faints, they are so referred to below.

Several items of predictive value were found: none of the 62 Negroes, but 63 of the 352 white persons fainted; the younger the donor, the more likely a faint; the higher the resting pulse rate before venipuncture, the more likely a faint; admission of "nervousness" was associated with greater chance of fainting than was denial.

Sex, resting blood pressure before venipuncture, and history of previous blood donation did not significantly differentiate fainters from nonfainters.

The data are compatible with the hypothesis that vasovagal fainting in blood donors is the second limb of a diphasic response, and is part of relief from anxiety; the first limb is part of anxiety proper.
Hibernation in Mammals
Authors: Fishman Alfred P. , LYMAN CHARLES P.
Published: June 2012

Hibernation and enforced hypothermia in mammals are widely different physiologic states. Prior to hibernation there are various preparations for the hibernating state, including polyglandular endocrine involution, fattening and/or food storage, and changes in the saturation of depot fat in some animals. The actual causes for the onset of hibernation are unknown, for most hibernators can remain active at low environmental temperatures for long periods. Entrance into hibernation is under precise physiologic control, with heart rate, respiratory rate, and oxygen consumption slowing before a decline in body temperature. A reasonably high blood pressure is maintained during this period and in deep hibernation by an increased peripheral resistance produced in part by vasoconstriction. Homeostasis is continued in hibernation, as evidenced by a normal blood pH, a sensitivity to inspired CO
2
, and a response to ambient temperature below 0 C. by increased metabolic rate. At any time during entrance into hibernation or during hibernation the animal may arouse from this condition. Arousal is a coordinated physiologic event in which the anterior of the body is warmed rapidly by shivering and other heat generating mechanisms, while warmed blood is shunted from the posterior by differential vasoconstriction until the anterior reaches nearly 37 C. The tissues and organs of mammals that hibernate are capable of useful function at lower temperatures than the tissues of mammals that do not hibernate, but a hypothermed mammal that can hibernate will die in hypothermia even though it lives longer and at a lower temperature than a mammal that can not hibernate. Hibernation must involve a resetting of the "physiologic thermostat," which thus permits a controlled cooling of the animal, but the nature of this "resetting" is not known.
Calcium Movements in Muscle
Authors: Brooks Chandler McC. , BIANCHI C. PAUL
Published: June 2012

The movements of calcium in muscle have been followed during contraction and contracture to test the hypothesis that the release of calcium from the surface of the muscle membrane during stimulation initiates the contractile mechanism. Nitrate ion increases the calcium influx during a single twitch and during potassium contracture, and also increases the tension developed. The increased entry of calcium during a potassium contracture is transient and not sustained as is the contracture. Caffeine, which brings about a contracture without depolarization of the membrane and despite the absence of calcium from the medium, causes calcium to be released from the muscle.
The Influence of the Ventriculotomy Site on the Contraction and Function of the Right Ventricle
Authors: MARCH HAROLD W. , ROSS J. KEITH , WEIRICH WILLIAM L. , GERBODE FRANK
Published: June 2012

The effects of right ventricular cardiotomy were investigated in a total of 28 dogs. Half of the group were studied by high-speed cinematography and half by means of ventricular function curves. In both groups long vertical ventriculotomies were done in eight animals and transverse ventriculotomies were performed in six.

Adverse effects on the contraction and function of the right ventricle were observed in the animals undergoing vertical cardiotomy. On the other hand, transverse ventriculotomy did not result in significant abnormalities of right ventricular performance.

It is concluded that transverse ventriculotomy is more physiologic and may be the incision of choice, especially in the higherrisk group of patients with pulmonary hypertension.
Some Unusual Features of the Marfan Syndrome
Authors: TUNA NAIP , THAL ALAN P.
Published: June 2012

Four cases of the Marfan syndrome with involvement of the skeletal and cardiovascular systems are reported. In the first two cases with clinical evidence of aortic regurgitation the chest roentgenograms showed relatively normal heart silhouettes while retrograde aortograms revealed large aortic aneurysms in the intrapericardial portion of the aorta involving the sinuses of Valsalva and the aortic ring. Case 1 had, in addition, a carotid body tumor, which was surgically removed. The remaining two cases had dissecting aneurysms of the aorta. Case 3 died and necropsy showed involvement of many systems and several arteries other than the aorta (carotid, subclavian, renal, femoral, splenic, and pulmonary arteries). Case 4 was surgically treated and showed marked improvement. Problems related to etiology, diagnosis, pathology, and treatment are discussed. It is emphasized that the existence of a large aneurysm of the intrapericardiac portion of the aorta may not be detectable without aortography.
Effects of Acetylcholine on Hemodynamics and Blood Oxygen Saturation in Mitral Stenosis
Authors: STANFIELD C. ALPHEUS , FINLAYSON JAMES K. , LURIA MILTON N. , CONSTANTINE HERBERT , FLATLEY F. JOSEPH , Yu PAUL N.
Published: June 2012

Acetylcholine was infused into the main pulmonary artery in a dose of 2 to 12 mg. per minute to 18 patients with mitral stenosis of rheumatic origin. The drug produced significant arterial oxygen desaturation in nine patients. This was associtaed with (a) a decrease in pulmonary resistance and pulmonary arterial pressure, (b) an increase in cardiac index and stroke index, and (c) an increase in "central" blood volume. The changes in the above parameters were minimal or in opposite direction in those patients who showed no significant desaturation.

The data did not lend support to the explanation that arterial desaturation during acetylcholine infusion was due to (a) decreased alveolar ventilaton, (b) focal bronchoconstriction, or (c) opening of pulmonary arteriovenous shunts bypassing the alveoli.

Evidence is presented to show that the most likely mechanism of the decline in arterial oxygen saturation during acetylcholine infusion was an increased pulmonary blood flow in pre-existing poorly ventilated regions of the lungs as a consequence of pulmonary arteriolar dilatation. These changes resulted in a significant lowering of the arterial blood oxygen tension and content, and a considerable widening of the alveolar-arterial oxygen gradient.
The Natural History of Isolated Ventricular Septal Defect
Authors: LUCAS RUSSELL V. , ADAMS PAUL , ANDERSON RAY C. , MEYNE NICOLAAS G. , LILLEHEI C. WALTON , VARCO RICHARD L.
Published: June 2012

Forty patients with isolated ventricular septal defect were studied physiologically two or more times before they underwent surgical treatment. Utilizing baselines obtained by heart catheterizations of normal infants and children, we grouped patients with ventricular septal defect according to the magnitude of the total pulmonary resistance, pulmonary blood flow, and pulmonary arterial pressure, and according to changes in these values over time. The patients with small defects (less than 1 cm. per M.
2
of body surface area) were easily separable on the basis of physiologic findings. Patients with large ventricular septal defects (greater than 1 cm. per M.
2
of body surface area) exhibited one of three possible initial responses to the stress of high pulsatile pulmonary flow and increased pulmonary artery pressure: (1) normal regression of total pulmonary resistance; (2) delayed fall in total pulmonary resistance; (3) failure of the total pulmonary resistance to decrease with age.

These physiologic responses were thought to be related to normal maturation, delayed maturation, or failure of maturation of the pulmonary vascular bed. It was observed that a subsequent increase in total pulmonary resistance could be superimposed on any of the three initial responses at any time. Clinical evidence and catheterization data suggested that the relative size of the ventricular septal defect had decreased in five patients.

The variability of the physiologic courses, the importance of the pulmonary vascular bed in determining these responses, and our lack of understanding of the etiology of the pulmonary vascular changes were noted.

The indications for, and timing of surgical intervention in patients with isolated ventricular septal defects, are discussed in light of the above findings.
Electrocardiographic Patterns in Patients with Cerebrovascular Accidents
Authors: FENTZ VAGN , GORMSEN JOHS.
Published: June 2012

In two Series of 69 patients with acute cerebral infarction and 21 patients with intracranial hemorrhage, 11 and 15 respectively showed electrocardiographic changes that could not be ascribed to the usual cardiac or other extracerebral causes. These changes often simulate myocardial ischemia or even infarction.
Clinical and Chemical Studies with
α
-Methyl-Dopa in Patients with Hypertension
Authors: GILLESPIE LOUIS , OATES JOHN A. , CROUT J. RICHARD , SJOERDSMA ALBERT
Published: June 2012

A series of observations in 52 hypertensive patients is presented indicating that α-methyl-dopa is an effective antihypertensive agent.

The antihypertensive properties of the agent were discovered in the course of biochemical studies with the racemic compound the form used in initial therapeutic trials.

Studies on metabolism of
dl
-α-methyl-dopa indicate incomplete intestinal absorption and rapid excretion in the urine as unchanged drug and as α-methyl-dopamine. The former finding does not seem to be a significant deterrent to its use orally.

Comparisons of the
d
and
l
isomers of α-methyl-dopa in hypertensive patients showed that all the chemical and pharmacologic effects reside in the
l
-isomer (Aldomet). Thus, recent studies have been performed with Aldomet exclusively.

From observations to date the impression has been gained that Aldomet has several advantages over other antihypertensive agents; these include effectiveness against all degrees of hypertension, frequent lowering of recumbent as well as standing blood pressure, smoothness of effect, and tranquilizing effects. Questions of toxicity and tolerance are not yet completely answered.

Sympathetic blockade at a central or peripheral site is the probable basis of the drug's action. This effect may be unrelated to the biochemical property of inhibiting the decarboxylation of aromatic
l
-amino acids and is possibly due to depletion of tissue stores of norepinephrine by a mechanism not yet fully defined.
Ischemic Heart Disease and Accelerated Cardiovascular Aging
Authors: MOSS ARTHUR J.
Published: June 2012

Twenty-one men less than 54 years of age with a previous history of myocardial infarction were studied with the ultra-low frequency acceleration ballistocardiograph. The analysis of each ballistocardiogram is presented. Eighty-one per cent (17/21) of these cardiac patients had an abnormal ballistocardiogram indicative of accelerated cardiovascular aging. This figure of 81 per cent is significantly greater (
p
< .01) than the percentage of abnormal ballistocardiograms in an age-matched, overtly healthy male population. It appears that there is a definite association between ischemic heart disease and an abnormal ballistocardiogram indicative of accelerated cardiovascular aging.
Restoration of Normal Intracardiac Pressures after Extensive Pericardiectomy for Constrictive Pericarditis
Authors: FITZPATRICK D. P. , WYSO E. M. , BOSHER L. H. , RICHARDSON D. W.
Published: June 2012

In each of seven patients studied by cardiac catheterization more than 2 weeks after extensive pericardiectomy, performed because of constrictive pericarditis, normal right heart pressure-pulse contours were demonstrated.

The extensiveness of pericardial removal seems the most likely explanation for the normal catheterization findings, which contrast with demonstration by other workers of persistence for periods up to 2 years of the "W"-shaped atrial pressures and high end-diastolic ventricular pressures characteristic of pericardial constriction.

Clinical findings, abnormal right heart pressures, and surgical considerations are presented for a total of 11 patients with constrictive pericarditis who were subjected to pericardiectomy between 1955 and 1960.
Direct Repair of Dissecting Aneurysms of the Aorta
Authors: HUFNAGEL CHARLES A. , CONRAD PETER W.
Published: June 2012

The concept of direct repair of dissecting aneurysm of the aorta has been proposed.

The complete repair of the dissection and concomitant repair of aortic insufficiency have been discussed.
Endocardial Cushion Defect with Pulmonic Stenosis
Authors: SCOTT LEWIS P. , HAUCK ANNA J. , NADAS ALEXANDER S.
Published: June 2012

Five patients with endocardial cushion defect, pulmonic stenosis, and right-to-left shunt have been presented. Valvular pulmonic stenosis was present in all, with additional infundibular stenosis in two. Four patients had complete atrioventricular canal defects. In two children both great arteries arose from the right ventricle.

In the clinical differentiation of this entity from the common forms of cyanotic congenital heart disease, the electrocardiogram, characterized by left axis deviation and a counterclockwise inscription of the plane vector loop, is the most helpful tool.

The surgical problems presented may be formidable and even impossible to solve, if both great arteries emerge from the right ventricle.
Bleeding from Occult Tumors during Anticoagulant Therapy
Authors: MICHAELS MILTON M.
Published: June 2012

Five patients treated with anticoagulants for a variety of reasons developed gastrointestinal bleeding. Further diagnostic studies in each case uncovered a previously unsuspected tumor.
Atrial Septal Defect
Authors: LEE YU-CHEN , SCHERLIS LEONARD
Published: June 2012

The results of the electrocardiographic, vectorcardiographic, and hemodynamic studies of 70 patients with atrial septal defects are analyzed. Serial electrocardiograms and vectorcardiograms were obtained in 16 patients following surgery.

The incidence of the rSR' and rSr' patterns in the right precordial leads was 60 per cent.

To a limited extent, the configuration of the electrocardiogram is related to right ventricular pressure and PBF/SBF. However, no quantitative assessment could be made by determining the magnitude of R or R' in lead V
1
.

The vectorcardiogram is an important adjunct to the electrocardiogram in detecting right ventricular hypertrophy. As the right ventricular pressure increases, the QRS sÊ loop tends to shift more to the right and anteriorly.

Although it can be generally stated that the rSR' configuration in atrial septal defects is usually due to right ventricular hypertrophy, this configuration is also due to terminal conduction delay or terminal conduction delay associated with right ventricular hypertrophy in a significant number of instances.

The vectorcardiogram is useful in detecting terminal conduction delay in patients with rSR' in the right precordial leads. It was also of value in determining the presence of right ventricular hypertrophy in combination with terminal conduction delay.

The evidence of terminal conduction delay may disappear after successful repair of atrial septal defects.

Left axis deviation, superior displacement, and counterclockwise direction of inscription of the QRS sÊ loop in the frontal plane are valuable signs for differentiating ostium primum defects from ostium secundum defects. Each of the eight proved instances of ostium primum defects had these typical features.
Measurement of Arterial Aging in Relation to Diabetes Mellitus
Authors: HUSTON JOHN H. , ABBOUD FRANCOIS M.
Published: June 2012

The purpose of this study was to investigate the incidence of premature arterial aging in diabetes mellitus and to re-examine the relationship between this type of degenerative vascular change and the other features of the diabetic state. A sensitive method was used to measure changes in the elastic properties of large arteries. Twenty-nine of 50 diabetic patients had premature arterial aging. Sixty-two per cent of the patients, with abnormally high rigidity indices had retinopathy and 21 per cent had Kimmelstiel-Wilson's syndrome. The findings suggest that in diabetic patients premature arteriosclerosis is not necessarily secondary to peripheral occlusive angiopathy. The importance of the duration of diabetes in the development of premature arterial aging was demonstrated. An accelerated arteriosclerotic process may occur with late onset of diabetes. The relation between the metabolic and the vascular defects, was not clear cut. The possibility that the vascular anomalies of the diabetic trait might be inherited without the metabolic counterpart was suggested by the discovery of premature arterial aging in 11 of 50 nondiabetic subjects with a family history of diabetes.
Electrocardiographic Findings in 122,043 Individuals
Authors: HISS ROLAND G. , LAMB LAWRENCE E.
Published: June 2012

Electrocardiograms on 122,043 apparently healthy male subjects aged 16 years to over 50 years have been studied. Of this group 5,773 subjects (4.72 per cent) had electrocardiographic abnormalities. The more common abnormalities were expressed in terms of rate per thousand subjects for each 5-year age group. This provides a means of relating incidence to age. Each abnormality and its clinical significance is discussed.

In 54,668 subjects incidental findings such as notched P waves, amplitude, and wave forms were tabulated.
Observations on Serum Cholesterol Levels in the Twin Population of Evans County, Georgia
Authors: MCDONOUGH JOHN R. , HAMES CURTIS G. , GREENBERG B. G. , GRIFFIN LOUIS H. , EDWARDS ANDREW J.
Published: June 2012

Important factors affecting the variation in cholesterol were found to be the genotype of the individual, age, and type of residence. The effect of genotype is clearly shown in comparing MZ twins with their matched pairs. The difference between MZ twins and their matched pairs was large and statistically significant, while for DZ and UD twins the difference was so small it could easily have been due to chance. In interpreting the significance of the effect of type of residence, we are also comparing two age groups that are almost nonoverlapping, so that adjustment for age by covariance might be questionable, since it involves extrapolating beyond the limits of the data.

Thus, it seems that two important sources of variation of cholesterol have been isolated: type of residence or age which is confounded or entangled, and genotype.
Closed-Chest Resuscitation in a Cardiac Catheterization Laboratory
Authors: DAWSON BRIAN , MOFFITT EMERSON A. , GLOVER WILLIAM J. , SWAN H. J. C.
Published: June 2012

Closed-chest massage and defibrillation were used successfully in the management of six acute cardiac emergencies occurring in a cardiac catheterization laboratory. A modification of the Kouwenhoven method of closed-chest massage was used in infants and small children. It is concluded that open-chest resuscitation is usually unnecessary during cardiac catheterization.
Thrombotic Occlusion of Abdominal Aortic Aneurysm Following Distal Embolization
Authors: SEIDENBERG BERNARD , STERN JACOB , HURWITT ELLIOTT S.
Published: June 2012

The second successfully treated case of sudden complete occlusion of an abdominal aortic aneurysm is presented. The thrombosis was caused by impaired run-off following an embolic occlusion of the right iliac artery. This complication is extremely rare in abdominal aortic aneurysms.
Complete Interruption of the Aortic Arch
Authors: ROBERTS WILLIAM C. , MORROW ANDREW G. , BRAUNWALD EUGENE
Published: June 2012

The clinical, hemodynamic, angiographic, and pathologic findings in three patients with complete interruption of the aortic arch are presented. In addition, data derived from published reports of 52 previous patients are summarized. This malformation is never an isolated one, since a patent ductus arteriosus is always present and a ventricular septal defect is almost invariably found as well. The diagnosis of absence of the aortic arch is difficult, since differential cyanosis is uncommon, relative systolic hypertension of the arms is rare, and the heart murmur, when present, is of a nonspecific nature. At catheterization the pressure in the pulmonary artery, patent ductus arteriosus, and descending aorta is usually similar to that in the ascending aorta and in its branches. Selective angiocardiography has been shown to be the only means of establishing the presence of the malformation prior to operation or autopsy. Since the majority of patients with absence of the aortic arch die within the month following birth, early recognition of the lesion is imperative if surgical correction is to be of benefit.
Acyanotic Levocardia
Authors: ROSENBAUM HAROLD D. , PELLEGRINO EDMUND D. , TRECIOKAS LEO J.
Published: June 2012

Three cases of acyanotic levocardia are reported. One case was associated with congenitally corrected transposition and arterial AV valve insufficiency. The precise nature of the heart disease in the second case has not been determined, and the last case was without known cardiac disease.

Attention is drawn to a serious lack of an accepted terminology in describing cases with spatial derangements of the heart or its chambers as well as incomplete data in published reports concerning the relative positions and internal anatomy of the chambers of the heart, its peripheral connections, and the disposition of the abdominal viscera.

It is probable many more individuals with levocardia without heart disease, or with acyanotic heart disease, exist than is suggested by the current medical literature.
Hemodynamic-Phonocardiographic Correlations of the Fourth Heart Sound in Aortic Stenosis
Authors: GOLDBLATT ALLAN , AYGEN MAURICE M. , BRAUNWALD EUGENE
Published: June 2012

The hemodynamic findings obtained at left heart catheterization in 46 patients with aortic stenosis of varying severity were correlated with the presence of a fourth heart sound determined phonocardiographically. From this correlation it may be concluded that, when a fourth heart sound is detectable in an adult patient with aortic stenosis, it usually indicates that the obstruction is severe (gradient exceeding 70 mm. Hg, left ventricular systolic pressure above 160 mm. Hg), that the left ventricular end-diastolic pressure is elevated (12 mm. Hg or above), and that the "a" wave in the left atrial pressure pulse is tall (14 mm. Hg or higher). The sound probably results from a forceful atrial contraction that forces a large volume of blood into a ventricle, the walls of which have been rendered less compliant than normal by the presence of left ventricular hypertrophy. The presence of this sound is easily detectable at the bedside by auscultation, and its presence may be confirmed by phonocardiography. The potential clinical usefulness of this physical finding, the presence of which is capable of separating patients with moderate or severe obstruction from those with mild obstruction, is self-evident.
Abdominal Aortic Aneurysms
Authors: SCHATZ IRWIN J. , FAIRBAIRN JOHN F. , JUERGENS JOHN L.
Published: June 2012

Of 141 patients with abdominal aortic aneurysms diagnosed at the Mayo Clinic from 1950 through 1959 who were not operated on, follow-up information was obtained from 137 patients (97.1 per cent). Of those followed 1 year or more, 87.6 per cent survived 1 year or more; 52.5 per cent survived 3 years, and 36.4 per cent survived 5 years after diagnosis. These results indicate that the prognosis of abdominal aortic aneurysm in this selected group of patients was somewhat better than that previously reported.

The prognosis and survival of patients who had a history of associated cardiovascular disease at the time of diagnosis of aneurysm is distinctly less good than those of patients who had no such history. Of those with such a history, 75.0 per cent survived 1 year, 33.3 per cent survived 3 years, and 20.0 per cent survived 5 years. Of those without such a history 95.7 per cent survived 1 year, 63.2 per cent survived 3 years, and 50.0 per cent survived 5 years.

Patients with abdominal aortic aneurysms and associated cardiovascular diseases are more likely to die of cardiovascular complications other than ruptured aneurysms. Patients with abdominal aortic aneurysms who have no evidence of associated cardiovascular disease are more likely to die from a ruptured aneurysm than from anything else.

It would appear that small asymptomatic abdominal aortic aneurysms in patients with associated cardiovascular disease may be carefully observed until signs of expansion of the aneurysm or symptoms from the aneurysm appear.
Idiopathic Ventricular Septal Hypertrophy Causing Muscular Subaortic Stenosis
Authors: WIGLE E. DOUGLAS , HEIMBECKER RAYMOND O. , GUNTON RAMSAY W.
Published: June 2012

The clinical, hemodynamic, angiographic and, where available, surgical and postmortem findings of 10 cases of muscular subaortic stenosis have been reviewed and, from the evidence at hand, it would appear that the majority of these cases had as the basis for the stenosis, idiopathic ventricular septal hypertrophy (asymmetrical hypertrophy of the heart).
3
This septal muscle mass leads to obstruction of the right as well as the left ventricular outflow tract, in addition to impeding diastolic ventricular filling as a result of low ventricular compliance. These features give rise to a unique clinical, hemodynamic, and angiographic picture.
Effects of Chlorothiazide on Systemic Hemodynamics in Essential Hypertension
Authors: VILLARREAL HERMAN , EXAIRE JOSÉ EMILIO , REVOLLO ANDRÉS , SONÍ JORGE
Published: June 2012

Nineteen observations were made in 12 patients with early essential hypertension. The comparative effects upon mean arterial blood pressure, cardiac index, and total peripheral resistance of the acute and long-term administration of chlorothiazide were studied.

With acute administration of the drug, a 10 per cent drop in mean arterial blood pressure, a decrease of 18 per cent in cardiac index, and an increase of 7 per cent in peripheral resistance were observed.

With long-term administration, a decrease of 21 per cent in mean arterial blood pressure, an increase of 4 per cent in cardiac index, and a drop of 26 per cent in peripheral resistance were found.

The conclusion is drawn that reduction of mean arterial blood pressure with acute administration of chlorothiazide is due to decrease in cardiac output, whereas with long-term use it is due to reduction in total peripheral resistance.
Cell-Membrane Ultrastructure
Authors: FERNÁNDEZ-MORÁN H.
Published: June 2012

The combined electron-microscope and biochemical evidence regarding mitochondria and mitochondrial fractions, although still preliminary in character, indicates that all the functional enzymatic components of the electron-transport chain are compactly arranged in the "elementary particle," which may therefore be regarded as the ultimate unit of mitochondrial function. New data have also been obtained on the hydrated lipoprotein matrix, the recently isolated structural protein, solubilized pure lipid fractions, cytochromes, and other constituent elements of the respiratory-enzyme assemblies.
Physiological Effects of High Pressures of Nitrogen and Oxygen
Authors: FENN WALLACE O.
Published: June 2012

A brief survey is given of the effects of different pressures on living organisms. High-oxygen partial pressures inhibit oxidative metabolism and, according to Gerschman, have effects which summate at some point with the effects of radiation. In a study of the mechanism of the narcotic effect of inert gases, it was found that high pressures of nitrogen and argon, but not helium, act like other anestheties in favoring water-in-oil rather than oil-in-water emulsion of dilute NaOH solutions and olive oil. The effect is small but appears to be real. This suggests that inert gases may make the lipoidal surface layer of cells relatively more continuous and therefore less permeable.
Movement of Inorganic Ions across the Membrane of Striated Muscle
Authors: ADRIAN R. H.
Published: June 2012

The unidirectional fluxes of sodium, chloride, and potassium across the membrane of striated muscle cells are described under a number of experimental conditions. The results are compared with the predicted behavior of simple membranes. With the possible exception of chloride, it is concluded that the movements of these ions cannot be described without postulating variable permeabilities or a variable number of `carriers' or `sites' in the membrane.
Physiologic Studies Following Surgical Correction of Atrial Septal Defect and Similar Lesions
Authors: REHDER KAI , KIRKLIN JOHN W. , THEYE RICHARD A.
Published: June 2012

Physiologic observations were made on eight patients following repair of atrial septal defect or total anomalous pulmonary venous connection. A pattern of changes in cardiac output and atrial pressures during the first 3 postoperative days was noted. Cardiac output was abnormally low in some patients with obstructive pulmonary vascular disease or low atrial pressures. Transfusion of whole blood was effective in elevating cardiac output in the operating room and after operation. Left atrial pressure was higher than right atrial pressure in the operating room. Postoperatively left and right atrial pressures tended to become equal in some patients, and the levels were slightly elevated. Heart rate did not seem to be directly related to cardiac output. Ventilation was adequate with regard to elimination of carbon dioxide. Arterial oxygen saturation was maintained at 93 per cent or more by the use of oxygen-enriched mixtures. The difference in arteriovenous oxygen content was inversely related to cardiac output. Acidemia was present 2 to 4 hours after operation, but in general the pH of arterial blood had returned to normal by day 2. Some mechanisms possibly related to the observations are discussed.
Inadvertent Myocardial Biopsy
Authors: BLANKENHORN DAVID H. , JELLIFFE ROGER W. , AMSDEN NEAL F. , JOHNSON JOHN L.
Published: June 2012

The hazard during left ventricular puncture is described of inadvertent myocardial biopsy and possible embolization from it.
Ventricular Aneurysm
Authors: ABRAMS DAVID L. , EDELIST ARYEH , LURIA MYRON H. , MILLER ALBERT J.
Published: June 2012

Sixty-five consecutive autopsied cases of ventricular aneurysm are reviewed. The incidence of aneurysm following myocardial infarction is similar to that reported in other series. Myocardial infarction preceded the formation of an aneurysm of the ventricle in the vast majority of patients, and a new myocardial infarction was the cause of death of about 50 per cent of them. The survival rate of patients with ventricular aneurysm is not significantly different from the long-term survival of all patients with myocardial infarction found in the same institution. Complications of ventricular aneurysm such as chronic congestive heart failure and rupture of the aneurysm were infrequent causes of death, and systemic embolic phenomena were not observed as a cause of death. In only four patients was the diagnosis made ante mortem. The lack of characteristic clinical, radiologic, and electrocardiographic findings is discussed. It is suggested that the hemodynamic significance of ventricular aneurysms is not ordinarily great, in view of the unaffected statistical prognosis in its presence. The recommended indications for surgery of ventricular aneurysms, based on this retrospective study, are presented.
Spontaneous Calcific Embolization Associated with Calcific Aortic Stenosis
Authors: HOLLEY KEITH E. , BAHN ROBERT C. , MCGOON DWIGHT C. , MANKIN HAROLD T.
Published: June 2012

The problem of spontaneous calcific embolization was investigated at necropsy in 165 patients with calcific aortic stenosis. Minor coronary arteries contained calcific emboli in 18 patients (11 per cent), and major coronary arteries contained calcific emboli in 10 (6 per cent). Examination of the brain, kidney, and eye also disclosed spontaneous calcific emboli. In three instances of major coronary artery embolization, there was evidence of old silent infarction but no associated clinical disorder. Calcific embolization is apparently not rare in cases of calcific aortic stenosis, but this phenomenon does not appear to lead very often to extensive infarction or to clinically obvious disorders.
Hemodynamic Consequences of Oxygen Breathing in Left Ventricular Failure
Authors: DALY WALTER J. , BEHNKE ROY H.
Published: June 2012

As in normal men, oxygen breathing in patients with left ventricular failure is associated with a further reduction of cardiac index, partially the result of decreased stroke index and partially the result of decreased heart rate. The decrease in heart rate and cardiac index is associated with a decrease in left ventricular work index without impairing the delivery of oxygen to the tissues or the over-all tissue pO
2
. In this group of patients, oxygen breathing did not result in a decreased pulmonary vascular resistance.
Dextrorotation of the Heart
Authors: AYRES STEPHEN M. , STEINBERG ISRAEL
Published: June 2012

Dextrorotation of the heart is a morphologic entity characterized by rotation to the right in both frontal and transverse planes of the body; the relative location of the cardiac chambers is normal. In contrast to mirror-image dextrocardia, which results from a defect in lateralization of the entire embryo occurring in the first 10 days of fetal life, dextrorotation results from a teratogenic agent acting in the sixth fetal week. More than 75 per cent of the patients with dextrorotation in this series had associated congenital cardiac anomalies. Corrected transposition of the great vessels was present in eight of 41 patients. A normal electrocardiogram provided a clear differentiation from mirror-image dextrocardia; angiocardiography permitted precise analysis of the in-vivo morphology.
Radioisotopic Renography
Authors: BURBANK MAHLON K. , HUNT JAMES C. , TAUXE W. NEWLON , MAHER FRANK T.
Published: June 2012

Sodium ortho-iodohippurate (Hippuran) I
131
renography has been performed by a standardized technic in patients with renal artery stenosis, pyelonephritis, primary aldosteronism, pheochromocytoma, and renal tubular acidosis with nephrocalcinosis, as well as in patients in whom the hypertension was apparently not secondary. Fifty of 94 patients studied were found to have abnormal renograms.

In patients with renal artery stenosis, all of 37 patients studied had values on the renogram that were outside the range for normal subjects. Although the renographic findings were not considered diagnostic of renal artery stenosis, certain abnormalities of the renogram were commonly observed in the presence of such lesions. When a unilateral delay in the appearance of maximal radioactivity was associated with delayed disappearance ot the medium, renal artery stenosis was frequently observed. Less pronounced differences in the function of the two kidneys were observed in patients with bilateral renal artery stenosis. A state of antidiuresis was often found helpful in the detection of less severe differences in renal function.

In patients with predominantly unilateral pyelonephritis, the renographic abnormalities were qualitatively consistent with the degree of impairment of renal function. Bilateral abnormalities were observed in two patients who had bilateral parenchymal disease. The abnormalities on the renogram did not permit distinction between renovascular and renal parenchynal disease. Pyelonephritis associated with obstructive uropathy revealed findings highly suggestive of renal artery stenosis. Distinction from renovascular lesions could be determined with the aid of urographic studies.

Only three of 44 patients with essential hypertension had abnormal renograms. The renograms, normal and abnormal, revealed essentially equal function of the two kidneys. The patients with abnormal renograms were not found by other technics to have evidence of secondary hypertension.

The patients who were found to have pheochromocytoma and primary aldosteronism had normal isotope renograms. The patient with renal tubular acidosis and nephrocalcinosis had a bilaterally abnormal renogram and severe impairment of total renal function.

The presence of a normal isotope renogram, as performed in our laboratory, is considered strong evidence against the existence of a renal or renovascular cause for secondary hypertension.
Capillary Pattern in Familial Schizophrenics
Authors: MARICQ HILDEGARD RAND
Published: June 2012

The nailfold capillary pattern was studied in 152 subjects: 60 normal, 50 familial, and 42 nonfamilial schizophrenic patients.

Significant correlation exists between family history and visibility of the subpapillary plexus in the nailfold.

The duration of illness is greater and there are more older patients in the familial group.

High plexus rating is not related to chronological age, sex, or duration of illness.

The incidence of above normal blood pressure is essentially the same in high plexus-low plexus groups.

It is concluded that there is a familial group of schizophrenic patients constitutionally different from the other schizophrenics; the combination of family history and plexus rating as criteria make it possible to select a homogeneous group of patients for further study in schizophrenia.
Aorto-Inferior Vena Caval Fistula of Neoplastic Origin Hemodynamic and Coronary Blood Flow Studies
Authors: CRAWFORD E. STANLEY , TURELL DAVID J. , ALEXANDER JAMES K.
Published: June 2012

A case report of a 51-year-old man is presented, who spontaneously developed an aorto-vena caval fistula in the region of a mesenchymal tumor involving both the abdominal aorta and vena cava. The disease was manifested clinically by rapidly progressive and massive leg swelling, prominent abdominal and leg veins, a machinery murmur over the abdomen and in the flanks, and a pulsatile abdominal mass, with signs of cardiac enlargement and a high output state. The fistula was demonstrated preoperatively by translunmbar aortography and closed surgically by resection of the tumor en masse, with a part of the vena caval wall and the distal aorta and proximal common iliac arteries. Vascular continuity was restored by lateral suture of the vena cava and by insertion of a bifurcation graft bridging the defect in the aorta and iliac arteries. The patient has been relieved of all clinical manifestations of the fistula to date, 1 year after operation.

Preoperative hemodynamic studies revealed certain alterations characteristic of systemic arteriovenous fistula, including increased pulse pressure, high cardiac output and stroke volume, reduced systemic vascular resistance and arteriovenons oxygen difference, and increased plasnma and circulating blood volumes. Some degree of cardiac failure appeared to be present. Coronary arteriovenous oxygen difference was normal, indicating that the observed increase in coronary blood flow closely paralleled the augmented energy requirement of the heart as reflected by the ventricular oxygen uptake. Reversion to normal of the observed changes in systemic hemodynamics, coronary blood flow, and myocardial metabolism was demonstrated 2 weeks postoperatively.