bluuebunny/crossref_metadata_2025 huggingface dataset:
Dynamic Aspects of Cholesterol Metabolism in Different Areas of the Aorta and Other Tissues in Man and Their Relationship to Atherosclerosis
Authors: FIELD HENRY , SWELL LEON , SCHOOLS P. E. , TREADWELL C. R.
Published: June 2012

Tracer doses of cholesterol-4-C
14
were administered to each of 8 patients with limited life expectancies. Chemical determinations of free and esterified cholesterol and determinations of their C
14
-specific activities were made in serially collected sera, in tissues, and in the different layers of the abdominal aorta, the intimas of which were separated where possible, into normal-appearing intima, thickened intima, and free-lying lipid material. The turnover times of the free and esterified cholesterol fractions of the various tissues and the portions of those fractions derived from the plasma and by synthesis were calculated from these data.

The plasma and liver free cholesterol fractions were in equilibrium at the earliest time, 2.5 days. The free cholesterol fractions of other tissues were in equilibrium with the plasma free cholesterol at later dates. The esterified cholesterol fractions of the various tissues, including liver, were in equilibrium with that of the plasma at later dates than were their free fractions.

The findings indicate that a large portion of the cholesterol ester of the plasma is not derived from the liver.

The greater part of both the free and ester cholesterols of other tissues was derived from the plasma, although a significant portion was derived by synthesis, except for both fractions of skeletal muscle. The adrenal glands were the most active in the synthesis of free cholesterol.

The data indicate that a major portion of adrenal cortical hormones is synthesized directly from acetate, without cholesterol as an intermediary product.

A major portion of the cholesterol of the intima was derived from plasma through interchange but a considerable amount of cholesterol was synthesized in the intima. The free-lying lipids in the intima appeared to be inert.

Data concerning the changes of the lipid contents of the intima with the development of atherosclerosis have been presented.

One patient, who died of a second myocardial infarction, differed from the others in having a longer turnover time of the cholesterol of his intima.
Renal Hemodynamic Responses to Stress in Normotensive and Hypertensive Subjects
Authors: BELLO C. T. , SEVY R. W. , OHLER E. A. , PAPACOSTAS C. A. , BUCHER R. M.
Published: June 2012

Renal responses to stress were studied in 28 normotensive and 51 hypertensive patients. Renal clearances of inulin and PAH, filtration fraction, arterial blood pressure, and renal vascular resistance were determined in each patient immediately before, during, and after exercise (sit-ups), or the cold pressor test.

In the control periods immediately before stress the majority of patients with essential hypertension displayed reduced values for inulin clearance (C
in
) and clearance of paraaminohippurate (C
pah
) and increased values for filtration fraction and renal vascular resistance, when compared with normotensive groups. These abnormalities were more severe in malignant hypertension than in benign essential hypertension.

The pattern of response to stress was similar in normotensive and untreated hypertensive patients: reduction in C
in
and C
pah
, and increases in filtration fraction, blood pressure, and renal vascular resistance. These responses were more marked with exercise than with the cold pressor test. These responses to stress were also quantitatively similar in normotensive and untreated hypertensive subjects, except for renal vascular resistance, which was increased more in the hypertensive groups. Hyperreactivity in terms of vascular resistance, however, is not necessarily indicative of vascular smooth muscle hyperreactivity.

The renal responses to exercise or the cold pressor test were reduced or abolished in hypertensive subjects by sympathectomy, and were diminished, in the majority of patients, by therapy with reserpine. Neither sympathectomy nor reserpine affected control (prestress) values for renal clearances or renal vascular resistance, however.

The majority of patients with malignant hypertension, though showing severely reduced values for C
in
and C
pah
, and marked elevations in renal vascular resistance initially, showed minimal renal responses to exercise or the cold pressor test.
Response to Exercise in Congenital Complete Atrioventricular Block
Authors: IKKOS DANAE , HANSON JOHN S.
Published: June 2012

The electrocardiographic and hemodynamic responses to graded exercise in 11 patients with congenital complete atrioventricular block are described. Ventricular rate increases during exercise were unrelated to the resting rate, atrial rate, or heart size. Changes in the ratio of atrial: ventricular rates were observed in all cases during physical work. Physical working capacity was normal or only slightly reduced in all instances. This is accomplished through maintenance of normal minute volumes, which in turn reflects an interplay of several factors: acceleration of ventricular rate, increased heart volume and stroke volume, and a normal or supernormal oxygen-transporting capacity of the blood as reflected in increased amount of total hemoglobin.
Atrial Repolarization—Its Importance in Clinical Electrocardiography
Authors: TRANCHESI JOAO , ADELARDI VICTOR , DE OLIVEIRA JORGE MARTINS
Published: June 2012

A complete study of the electrical effects of the atrial repolarization is made, since it seems that such effects are often inadequately considered in the routine daily interpretation of electrocardiograms.

The alterations of the atrial repolarization are classified as follows: (1) primary, related to ischemia or injury of the atria, and hypersympathetic activity, (2) secondary, when appearing with modifications of the atrial activation, in cases of dilatation, hypertrophy, or intra-atrial block. The electrocardiographic changes produced by hypersympathetic activity are characterized by a P-PR junction (Ja) in the isoelectric line, descending P-R segment, depressed J point, and ascending S-T segment. The P-R and S-T segments have concordant deviations, which means that they behave as "arcs of a same circumference." The record of these electrical events is made in such a manner that the tracing can be morphologically compared to an anchor. An S-T depression has no pathologic significance whenever it is preceded by a concordant and symmetric P-R depression.

A myocardial injury is diagnosed only when the P-R and S-T segments are discordant, that is, when they correspond to "arcs of different circumference." An electrocardiographic exercise test is considered as negative, even in the presence of S-T depression, as long as this segment is inscribed with the same radius as that of the preceding P-R segment.

Other processes that act upon the atrial repolarization, such as atrial infarction, wounds, dilatation, hypertrophy, and pericarditis, are also analyzed, and their influence on the inscription of the ventricular repolarization is stressed.

Exact knowledge of the phenomena of atrial repolarization allows a more accurate interpretation of S-T displacements, and therefore is a safer diagnosis of the pathologic changes acting upon the ventricular repolarization.
Observations on the Occurrence of Right Bundle-Branch Block Following Open Repair of Ventricular Septal Defects
Authors: BRISTOW J. DAVID , KASSEBAUM DONALD G. , STARR ALBERT , GRISWOLD HERBERT E.
Published: June 2012

The occurrence of right bundle-branch block and varying degrees of altered ventricular conduction in a group of cases of ventricular septal defects repaired by direct closure is presented.

The development of abnormal conduction is correlated with the location of the ventricular septal defects and the relationship of the conduction tissue.

The etiologic role of operative trauma to the conduction system is reviewed, and the influence of ventriculotomy alone is discounted.
The Effect of Lipemia upon Tissue Oxygen Tension in Man
Authors: JOYNER CLAUDE R. , HORWITZ ORVILLE , WILLIAMS PHYLLIS G.
Published: June 2012

The effect of varying levels of lipemia upon tissue oxygen tension has been investigated in human subjects with normal and decreased peripheral blood flow. Oxygen tension of the skin was determined during rapid clearing of lipemia to avoid the difficulties inherent in prolonged study over the several hours of increasing lipemia following a fat meal. Regardless of whether peripheral blood flow was normal or decreased, a mean increase of 21.7 per cent in skin oxygen tension occurred during heparin-induced clearing of plasma turbidity. In addition, skin oxygen tension increased during the spontaneous decline of lipemia in 1 subject. Oxygen tension was not increased after a saline placebo injection during lipemia or following heparin injections in subjects with "clear" fasting serum.

The observed increase could not be attributed to changes in blood flow. Skin temperature remained stable during the experiments and the subject's response could not be correlated with skin blood flow as measured by the vasodilatation test. The increase in tissue oxygen tension that occurs during clearing of plasma seems most probably to be due to increased diffusion of oxygen to or from the erythrocytes.
Left Heart Catheterization by the Transseptal Route
Authors: ROSS JOHN , BRAUNWALD EUGENE , MORROW ANDREW G.
Published: June 2012

Experiences with left heart catheterization by the transseptal route in 130 patients are presented. The instruments and technics employed are described in detail and some of the applications in diagnosis and clinical investigation of the method are illustrated. The advantages of transseptal left heart catheterization, which indicate its superiority over other technics, are discussed.
The Vectorcardiogram in the Differential Diagnosis of Atrial Septal Defect in Children
Authors: LIEBMAN JEROME , NADAS ALEXANDER S.
Published: June 2012

Vectorcardiograms have been analyzed in 32 atrial septal defects of the secundum type and 23 endocardial cushion defects, as well as 6 patients in special groups.

All but 1 patient in both major groups showed right ventricular hypertrophy, with clear-cut evidence of additional right bundle-branch block being present in only 3.

The principal difference between ostium secundum and endocardial cushion defects consists in the loop being inferior in the former, superior in the latter. The direction of inscription in the frontal plane tends to be clockwise in the ostium secundum lesions, counterclockwise in the endocardial cushion group.

The 6 patients in special groups could be readily distinguished from the 2 major groups with the use of the vectorcardiogram.

The superior position of the vector loop (left axis deviation in the electrocardiogram) characteristic of endocardial cushion defects, is thought not to be secondary to left ventricular hypertrophy but rather to a congenital anomaly in the conduction system.

A correlation was attempted between the vectorcardiogram and hemodynamic data in 22 patients in each group. The ratio of right to left ventricular work appeared to relate well to the vectorcardiogram. As the ratio increased, more right ventricular hypertrophy appeared.
SYMPOSIUM ON CORONARY HEART DISEASE
Authors: ANDRUS E. COWLES
Published: June 2012

No technic or procedure yet devised surpasses the carefully taken clinical history in the diagnosis of angina pectoris. The electro-cardiogram recorded during an attack, occurring with the patient's ordinary activity or, in the few instances in which it is indicated after standard exercise, is particularly helpful. The ballistocardiogram, though of suggestive value in some instances, has not yet achieved that degree of correlation with clinical findings to be uniformly valuable as a diagnostic tool, in view of the progressive increase in the proportion of abnormal records in the years beyond 40.

The fact remains that the incidence of severe coronary atherosclerosis is so high, particularly among men 45 years of age and older, as to demand continual effort to differentiate angina pectoris from other types of chest discomfort, to detect its earliest manifestations, or even to search out some refinement of diagnostic technic that may predict the consequences of coronary artery disease before coronary insufficiency has supervened.
Raynaud's Disease and Primary Pulmonary Hypertension
Authors: CELORIA GUILLERMO C. , FRIEDELL GILBERT H. , SOMMERS SHELDON C.
Published: June 2012

A case of Raynaud's disease with autopsy is reported in which the clinical picture was dominated by pulmonary hypertension apparently unassociated with any significant pulmonary parenchymal disease. Microscopically cellular intimal proliferation of small pulmonary muscular arteries and arterioles was the most characteristic lesion. In several proximal medium-sized muscular arteries there was necrotizing arteritis with thrombus formation. Similar vascular lesions were not found in other organs, although generalized arteriosclerosis and arteriolosclerosis were present. The pulmonary vascular changes are thought to represent a local exacerbation of generalized vascular disease, but a specific etiology was not apparent.
The Mammary Souffle of Pregnancy and Lactation
Authors: TABATZNIK BERNARD , RANDALL THOMAS W. , HERSCH COLIN
Published: June 2012

Two hundred and fifty-seven consecutive South African Bantu women were examined during pregnancy and the puerperium in order to determine the incidence of the mammary souffle. It was found in 15.3 per cent of women examined in the postpartum period, 13.3 per cent in the third trimester of pregnancy, 17.9 per cent in the second trimester, and in none before the twelfth week of pregnancy.

The phonocardiographic features of the murmur are illustrated and evidence is presented to indicate that the murmur is arterial in origin.

It is suggested that the murmur may arise at the site of anastomosis between branches of the aortic intercostal arteries and branches of the internal mammary artery.
An Index for the Evaluation of Arteriosclerotic Lesions in the Abdominal Aorta
Authors: HOLMAN RUSSELL L. , BROWN B. W. , GORE IRA , MCMILLAN GARDNER C. , PATERSON JAMES C. , POLLAK O. J. , ROBERTS JAMES C. , WISSLER ROBERT W.
Published: June 2012

An index for the evaluation of arteriosclerotic lesions based on visual observation of selected and unselected specimens of the abdominal aorta was derived from a statistical analysis of simple grading and ranking studies.

This index, I = 1/2P
T
+ 1/4P
F
+ 1/2P
C
, takes cognizance of most of the grossly visible quantitative and qualitative features of human arteriosclerotic lesions. In it P
T
, P
F
, and P
C
are the quantitative estimates of the per cent of total area diseased (T) and the per cent lesion area with fibrous plaques (F) and complicated lesions (C), respectively. The index is subjective but relatively reproducible by the same or different observers. It does not carry any implications of etiology or pathogenesis. The work of the Committee is continuing, and it is hoped that indices based on such methods may prove useful when applied to other parts of the arterial system or in studying several parts simultaneously, thus facilitating basic studies on arteriosclerosis both in man and in animals.
Myocardial Blood Flow and Oxygen Consumption during Postprandial Lipemia and Heparin-Induced Lipolysis
Authors: REGAN TIMOTHY J. , BINAK KENAN , GORDON SEYMOUR , DEFAZIO VALENTINO , HELLEMS HARPER K.
Published: June 2012

The role of the physical state of plasma as a determinant of oxygen availability to the myocardium has been investigated during the course of alimentary lipemia. After the development of substantial plasma lactescence, the coronary blood flow (nitrous oxide method) and myocardial oxygen consumption were assessed in 7 normal human subjects and repeated after heparin-induced lipolysis. The lipemic state was further contrasted with a control fasting group, comparable in age and sex.

The mean coronary blood flow for 15 fasting controls was 83 ml. per 100 Gm. of left ventricle per minute with a myocardial oxygen extraction of 11.04 volumes per cent, and a myocardial oxygen consumption of 9.0 ml. per 100 Gm. of left ventricle per minute. By contrast, the mean coronary blood flow during maximal lipemia in the 7 subjects fed cream was 20 per cent below normal, with a value of 67 ml. per 100 Gm. per minute (
p
=< 0.01). As the extraction of oxygen was not significantly affected, the calculated myocardial oxygen consumption was proportionately reduced to 7.02 ml. per 100 Gm. per minute (
p
=< 0.01). A failure of the anticipated oxygen extraction increment in the face of coronary blood flow reduction suggests an impediment of blood-tissue oxygen transport during lipemia.

After the administration of 60 mg. of heparin to the 7 lipemic subjects, a 65 per cent decline in plasma lactescence was observed by 45 minutes, when the coronary blood flow and myocardial oxygen consumption were elevated to 87 ml. per 100 Gm. per minute (
p
=< 0.05) respectively. Thus, the reduced coronary flow and myocardial oxygen consumption were restored in each instance to normal levels during the process of plasma clearing. There were no associated systemic hemodynamic changes to account for such increments. These heparin effects appear dependent on the lipemia-clearing property, for no alteration in coronary dynamics was found in 6 additional patients in whom this activity was not manifest after the same heparin dosage.

The residual lactescence after post-heparin lipolysis was associated with no significant deviation of coronary dynamics from the normal. That a concentration-dependent phenomenon is operative, was confirmed in a separate group of patients in whom low lactescence values developed in the course of alimentary lipemia without affecting myocardial oxygen consumption.

The relevance of the lipemic state, per se, to the pathophysiology of myocardial ischemia appears to depend upon the establishment of an oxygen gradient within the myocardium, presumably through altered pressure-flow relationships produced by lipemic blood within a pathologic vessel.
Reoperation for Mitral Stenosis
Authors: HARKEN DWIGHT E. , BLACK HARRISON , TAYLOR WARREN J. , THROWER WENDELL B. , ELLIS LAURENCE B.
Published: June 2012

A series of 80 reoperations for mitral stenosis in 79 patients is reported and analyzed.

The most important causes of deterioration after valvuloplasty for mitral stenosis are inadequate initial operation, restenosis, and mitral insufficiency. Generally more than one of these factors pertain.

An adequate mitral valvuloplasty requires the complete opening of both the anterior and posteromedial commissures and the mobilization of the chordae tendineae from each other and from the wall of the ventricle.

The advantages and limitations of closed reoperation, open reoperation, the right-sided approach, and the use of the transventricular valvulotome are reviewed.

More complete correction of stenosis with mobilization of posteromedial, anterior, and subvalvular chordae is emphasized. This is attained by operating from both the ventral and dorsal aspects of the patient through a left posterolateral thoracotomy incision.

An Ivalon operating tunnel sutured to the left atrial wall at reoperation makes it possible to carry out the more extensive valvuloplasty at reoperations.

A lower operative mortality, better longterm results, and fewer instances of deterioration are anticipated when this concept of improved valvuloplasty is effected initially.
Total Anomalous Pulmonary Venous Drainage at Cardiac Level
Authors: ROWE R. D. , GLASS I. H. , KEITH J. D.
Published: June 2012

In 6 patients with total anomalous pulmonary venous drainage at cardiac level, differentiation between pulmonary veins entering the right atrium and those entering the coronary sinus was possible after selective angiocardiography into the pulmonary artery.

The principal feature of the angiocardiogram of the coronary sinus variety is an egg-shaped opacification over the spine within the right atrial contour. In the direct connection of pulmonary veins to the right atrium, the latter chamber may fill promptly after pulmonary venous return, sometimes starting as a circular shadow with the right atrium but never having the ovoid appearance of the coronary sinus variety.
Acute Constrictive Epicarditis Following Infectious Mononucleosis
Authors: WILSON D. R. , LENKEI S. C. , PATERSON J. F.
Published: June 2012

The case history of a 24-year-old man is reviewed, who had pericarditis, cardiac tamponade, and many other manifestations of infectious mononucleosis. Cardiac-output estimations during the course of the illness showed a marked drop in his cardiac index. This, together with other findings, was interpreted as being due to the development of constrictive epicarditis. At operation the epicardium was densely adherent to the underlying myocardium. After extensive resection of both layers of the pericardium the patient made an uneventful recovery.
A Simplified Technic for the Detection of Patent Ductus Arteriosus and of Other Left-to-Right Shunts Originating from the Aorta
Authors: BRAUNWALD EUGENE , CORNELL WILLIAM P.
Published: June 2012

A simplified technic for the detection of left-to-right shunts originating from the aorta is described. A thin, radiopaque catheter is introduced into the aortic arch through a Cournand needle placed in the femoral artery, and injections of a solution of Kr
85
are made. In the presence of a shunt the injected Kr
85
is rapidly detected in the expired air but in the absence of a shunt the appearance time of Kr
85
in the expired air is delayed. When an aortic shunt is present it may be localized by means of injections of cardiogreen dye at various points in the aorta by sampling the blood from the right brachial artery. The value of these technics is illustrated by descriptions of their application in five patients with various forms of congenital or acquired heart disease.
Premature Ventricular Depolarization
Authors: CACERES CESAR A.
Published: June 2012

Surface "fusion beats", beats with initial and terminal QRS abnormalities, and accompanying secondary ST-T-wave changes appear following intracavitary evidence of premature depolarization. In instances of premature activation of a portion of myocardium, the intracavitary deflection of premature ventricular depolarization may not be apparent in surface leads and, if present, may be reflected in surface leads only by subtle changes in wave configuration that include (1) shortening of the P-R interval, (2) prolongation or amplitude changes or both in the QRS, (3) changes in contour of initial and terminal portion of the QRS, sometimes resembling those of infarction, and (4) secondary ST-T-wave changes. Evidence of electrical asynchronism in a single ventricle and between ventricles is presented.
Ballistocardiographic Evaluation of the Cardiovascular Aging Process
Authors: MOSS ARTHUR J.
Published: June 2012

A clinically adaptable, ultra-low frequency acceleration ballistocardiograph that met all theoretic considerations of biophysical design was used to evaluate the cardiovascular aging process in 307 overtly healthy men aged 18 to 54.

A new practical method for quantitative ballistocardiographic analysis is described, and the changing ballistocardiographic pattern with advancing age is elucidated.

Criteria for ballistocardiographic abnormality are established in terms of accelerated cardiovascular aging, and the degree of abnormality is graded (I-III).

The initial appearance of accelerated cardiovascular aging (grade-I abnormality) was present on the ballistocardiogram in 16 per cent of the population by age 35. A more severe degree of aging (grade II) was evident in 16.5 per cent of the individuals by age 50. There was a rather constant attack rate for the initial development of an abnormal ballistocardiogram (grade I) during the 20 to 39 age period, and an accelerated attack rate after age 40. The rate of conversion to a more severe grade of ballistocardiographic abnormality increased significantly in the fifth decade.

The relationship between an abnormal ballistocardiogram, accelerated cardiovascular aging and coronary artery disease is discussed.
Recent Trends in Therapy of Cerebral Vascular Disease
Authors: GROCH SIGMUND N. , WRIGHT IRVING S.
Published: June 2012

The various measures available for the therapy of a patient with a stroke have been discussed. The value of vigorous conservative therapy has been emphasized. The role of anticoagulant drugs has been detailed. This mode of therapy seems most efficacious in treatment of recurrent transient ischemic attacks and the slowly progressive stroke. The value of anticoagulants in the acute phase of cerebral thrombosis and in long-term postinfarction therapy is not clear as yet. The role of anticoagulant drugs in treatment of cerebral embolism seems well established. It may be wise to delay institution of these drugs for 24 to 36 hours after the acute stroke. Surgical procedures give promise of value in certain well-defined syndromes. The patient with cerebral hemorrhage remains a formidable therapeutic problem.
Aortic Stenosis
Authors: BJÖRK VIKING OLOV , CULLHED INGEMAR , LODIN HERMAN
Published: June 2012

In 36 cases of valvular heart disease with a clinical diagnosis of isolated or significant aortic stenosis we have performed percutaneous intercostal puncture of the left ventricle for pressure measurements and, in all but one case, left ventricular angiocardiography. The possible correlations between the pressure gradient and the angiocardiographic findings are discussed.

With the exception of the unsatisfactory angiocardiograms due to oblique projection of the valvular planes, valuable information was obtained regarding the degree of aortic stenosis. This was especially the case if the aortic stenosis was combined with mitral valve disease, resulting in a small or no systolic pressure gradient.
Long-Term Results of Aortic-Pulmonary Anastomosis for Tetralogy of Fallot
Authors: PAUL MILTON H. , MILLER ROBERT A. , POTTS WILLIS J.
Published: June 2012

The first 100 consecutive patients with a diagnosis of tetralogy of Fallot upon whom an aortic-pulmonary anastomosis could be performed were subjected to a clinical and physiologic evaluation 11 to 13 years after operation.

At this long-term follow-up 92 patients were traced. Nine patients died at the time of surgery and, in the period from 1946 to 1959, 10 patients died, most often from congestive heart failure. To our knowledge only three patients have required a second shunt operation to relieve recurrent cyanosis. The clinical results were considered good or excellent in 68 per cent of the survivors, fair in 30 per cent, and poor in 2 per cent.

The long-term poor results and mortality were usually associated with too large an initial anastomosis leading to either left ventricular overwork and congestive heart failure or severe pulmonary hypertension and progressive pulmonary vascular obstruction.

Right heart catheterization studies indicated that in a group of 18 patients in whom the pulmonary vascular bed could be evaluated, 15 patients had a normal pulmonary vascular resistance after 11 to 13 years of a clinically adequate aortic-pulmonary shunt.

The role of the shunt procedures as a valuable salvage operation at the present time for a select segment of patients with tetralogy of Fallot and certain other complex cyanotic lesions is reemphasized.
The Frequency of Aschoff Bodies in Atrial Appendages of Patients with Mitral Stenosis
Authors: RUEBNER B. H. , BOITNOTT J. K.
Published: June 2012

Three hundred and sixteen biopsies of atrial appendages obtained at mitral valvotomy were studied histologically. They were divided into those with Aschoff bodies (41 per cent), those with nonspecific granulomas (23 per cent), and those without either lesion. These findings were compared with those of previous investigators.

A study of 24 hearts with mitral stenosis and survey of the literature showed that Aschoff bodies in the left atrial appendage are usually accompanied by similar lesions in the rest of the heart.

The average age of patients with Aschoff bodies in their atrial biopsy was 4 years less than that of those with "nonspecific granulomas" and more than 7 years less than that of patients without inflammatory foci in the endocardium. The etiology of "nonspecific granulomas" is discussed.

Aschoff bodies were rare in patients with organized atrial thrombi, most of whom were fibrillating. Statistical analysis showed that thrombosis rather than fibrillation was the principal factor associated with a lowered incidence of Aschoff bodies. It was concluded that mechanical factors may determine the localization of rheumatic lesions in the heart.

Elevated sedimentation rates were recorded as often in patients with negative biopsies as in those with Aschoff bodies.

The percentage of positive biopsies fell from 66 per cent in patients aged 15 to 20 years to 14 per cent in patients aged over 55 years. The age incidence of Aschoff bodies has been compared with that of acute rheumatic fever, which is rare after the age of 15 years. It is concluded that in patients with mitral stenosis, histologic activity may continue for 20 years or more in the absence of clinical signs and symptoms.

The proportion of positive biopsies was lowest in June and maximal in September. This seasonal change suggests that the histologic process is only intermittently active. The seasonal variation in the percentage of Aschoff bodies is discussed in relation to the seasonal incidence of acute rheumatic fever.

Our results appear to establish the concept of a "subclinical" rheumatic process which has been postulated by many previous investigators.
Sodium from Drinking Water as an Unsuspected Cause of Cardiac Decompensation
Authors: ELLIOTT GEORGE B. , ALEXANDER ELIZABETH A.
Published: June 2012

A survey of 300 samples of drinking water from Southern Alberta analyzed for sodium content showed that a considerable proportion of well waters contain very high sodium levels, ranging up to 420 mg. per cent (4,200 ppm.).

Two instances of recurrent episodes of heart failure at home, which ceased after substitution of a low- for unsuspected high-sodium water supplies, are described.

The sodium is present in soils derived from underlying marine deposits of seas that covered the whole of the North American plains in ancient times. It is not readily recognizable by taste, especially as sulfate, and may cause darkening of soil so that its presence remains quite unsuspected.

Tasteless sodium in water forms a source of perplexing decompensation in otherwise well-controlled heart disease. The features of the terrain that lead to high sodium content in water supplies are described to alert physicians to similar possibilities in their own regions.
Aortic Pressures during Closed-Chest Cardiac Massage
Authors: GUREWICH VICTOR , SASAHARA ARTHUR A. , QUINN JAMES S. , PEFFER CATHERINE J. , LITTMANN DAVID
Published: June 2012

A case of ventricular fibrillation is presented which occurred during retrograde left heart catheterization and preparation for aortography. Direct arterial pressures were recorded from a catheter in the abdominal aorta during closed-chest cardiac massage. These indicated that substantial blood pressures can be readily produced by this simple and practical method.
Isolated Incompetence of the Pulmonic Valve
Authors: PRICE BEN O.
Published: June 2012

Two cases of isolated incompetence of the pulmonic valve diagnosed during life are reported and a review of the literature is presented.

The diagnosis should be suspected in patients with a basal diastolic murmur and right ventricular enlargement who have no evidence of other cardiac valvular disease.

The characteristic murmur associated with isolated incompetence of the pulmonic valve appears to be related to filling of the dilated right ventricle.

The diagnosis can be confirmed clinically by right heart catheterization.

The lesion is not benign in the human being, and right ventricular failure may be precipitated when complicating diseases are present.
Aortic Valve Perforation in Bacterial Endocarditis
Authors: TOMPSETT RALPH , LUBASH GLENN D.
Published: June 2012

This report describes 10 patients with bacterial endocarditis who during observation developed signs of dynamic aortic insufficiency or experienced marked worsening of the manifestations of pre-existing aortic insufficiency. The autopsy findings in these patients provide evidence that the clinical signs were associated with perforation or rupture of the aortic valve cusps. It is suggested that this sequence of events in the course of bacterial endocarditis is common and that its occurrence must be regarded as an ominous prognostic sign.
Vascular Malformation Overlying the Pulmonary Artery Simulating a Patent Ductus Arteriosus
Authors: ERNST CALVIN B. , KLASSEN KARL P. , RYAN JOSEPH M.
Published: June 2012

An arteriovenous fistula with aneurysmal dilatation involving branches of both coronary vessels and the pulmonary artery is discussed.

The malformation was limited to the main pulmonary artery and presented a small left-to-right shunt without symptoms.

Ligation of the supplying vessels resulted in the disappearance of a murmur typical of a patent ductus arteriosus.
Prognosis of Men Returning to Work after First Myocardial Infarction
Authors: DIMOND GEORGE E.
Published: June 2012

The 5-year prognosis of 202 railway operating employees returning to full-time work after their initial myocardial infarction and the 10-year survival rates of 97 of these men have been described. The 5-year survival rate was 83 per cent and the 10-year survival rate was 57 per cent.

Twenty-five per cent of these men died or were totally disabled at the end of 5 years and 50 per cent at the end of 10 years. The cause of death or disability following the initial infarction was largely due to recurrent myocardial infarction.

The prognosis for men returning to fulltime activity after the first myocardial infarction is better than that reported for those surviving without consideration for their functional recovery. This better prognosis is not due to freedom from second infarctions but to a decreased incidence of myocardial failure and the ability better to survive and tolerate a second infarction.
Relationship between Arterial Pressure and Exertional Angina Pectoris in Hypertensive Patients
Authors: GEORGOPOULOS A. J. , SONES F. M. , PAGE IRVINE H.
Published: June 2012

Seven hypertensive patients, five with coronary arterial disease and two with normal coronary arteries, with exertional angina pectoris and left ventricular hypertrophy were subjected to exercise in the sitting and supine position.

The five patients with coronary arterial disease developed, during exercise in both positions, striking arterial pressure elevation followed by angina pectoris and electrocardiographic changes. When the pressor response to exercise was eliminated by intravenous sodium nitroprusside, these were prevented.

In the two patients with normal coronary arteries who had orthostatic and exertional hypotension secondary to antihypertensive treatment, exercise in the sitting position caused intense hypotension followed by angina pectoris and electrocardiographic changes. In contrast, exercise in the supine position, which caused only minimal pressure changes, was not followed by angina pectoris.

It is concluded that in hypertensive patients with coronary arterial disease, further elevation of arterial pressure during exercise is an important factor in precipitating angina pectoris by increasing cardiac work. In hypertensive patients with normal coronary arteries and exertional hypotension secondary to antihypertensive treatment, marked lowering of arterial pressure during exercise is a factor of importance in producing angina pectoris, probably by reduction of perfusion pressure and coronary flow relative to the hypertrophied left ventricle.
Control of Ventricular Tachycardia by Direct Cardiac Electric Shock
Authors: CLAREBROUGH J. K. , HOIPKINS I.
Published: June 2012

A case is presented of ventricular tachycardia occurring following myocardial infarction. When medical measures failed to convert the rhythm to normal, direct cardiac electric shock was employed, with return to normal of the cardiac rhythm and recovery of the patient.
Intracardiac Myxomas with Report of Two Unusual Cases and Successful Removal
Authors: DIFFERDING JOHN T. , GARDNER RICHARD E. , ROE BENSON B.
Published: June 2012

A comprehensive review of the various aspects of intracardiac myxomas is presented. Two unusual cases are illustrative of many of the problems encountered. Of particular interest are the successful surgical removals of the myxomas in both cases.
The Surgical Treatment of Ventricular Septal Defect in Infancy
Authors: MORROW ANDREW G. , BRAUNWALD NINA S.
Published: June 2012

Thirteen infants with ventricular septal defect, pulmonary hypertension, and severe congestive heart failure were treated by pulmonary artery constriction. The 12 children who survived operation have been followed from 1 to 4 years and have evidenced striking improvement in growth, weight gain, and exercise tolerance. None has had pneumonia or heart failure after operation. Considerations in the selection of patients for pulmonary artery constriction, the surgical method employed, and its hemodynamic control are described.
A New Technic for Complete Correction of Transposition of the Great Vessels
Authors: IDRISS F. S. , GOLDSTEIN I. R. , GRANA L. , FRENCH D. , POTTS W. J.
Published: June 2012

A procedure for complete anatomic correction of transposition of the great vessels is described. The technic is based on the concept of isolating an aortic segment containing both coronary ostia and turning the segment over to fit the outflow stump of the left ventricle. Experimental work and two clinical trials are presented and discussed.

We believe that this operation provides an anatomic and physiologic correction of the great vessels and coronary arteries in transposition. In spite of two clinical failures, we think this operation is worthy of further trials.
Comparative Effects of Thyroxin Analogues as Hypocholesteremic Agents
Authors: BEST MAURICE M. , DUNCAN CHARLES H.
Published: June 2012

L-thyroxin and four thyroxin analogues were administered to a group of hypercholesteremic euthyroid patients, the majority with arteriosclerotic heart disease, and the effects on serum total cholesterol compared. L-thyroxin and each of the analogues studied, tetraiodothyroformic acid, dimethyldiiodothyroformic acid, D-thyroxin and D-triiodothyronine, were given to four to nine patients for periods up to 10 months.

At the doses employed each of the analogues resulted in a reduction in the mean level of serum cholesterol without obvious evidence of hypermetabolism or aggravation of angina pectoris or congestive heart failure. The reduced level of serum cholesterol was sustained throughout the period of hormone administration, and upon the substitution of a placebo returned to the pretreatment range.

L-thyroxin, at the dose employed, also effected a modest sustained reduction in serum cholesterol but both patients with angina included in this group experienced an increase in severity of symptoms.

Except for four patients who developed acneiform dermatitis, salivary gland swelling, or gastrointestinal symptoms during the administration of the formic acid analogues, no toxic or undesirable effects were observed from any of the analogues.

To evaluate better the general metabolic effects of the analogues each was administered to three or more of a group of seven myxedematous patients for periods of 6 to 12 months. Given in sufficient amount all were observed to increase basal metabolic rate and to maintain a clinically euthyroid state.

From these observations, it is concluded that the D-isomers of thyroxin and triiodothyronine, while not without general metabolic effects, are tolerated by the majority of euthyroid patients with coronary atherosclerosis in amounts sufficient to maintain a reduced serum cholesterol level.
The Electrocardiogram, Vectorcardiogram, and Ventricular Gradient in the Tetralogy of Fallot
Authors: DEPASQUALE N. P. , BURCH G. E.
Published: June 2012

The electrocardiogram, ventricular gradient, and spatial vectorcardiogram were studied in 140 patients with proved tetralogy of Fallot. The patients were separated into three groups according to hemodynamic data.

The salient features of the electrocardiogram in patients of group I consisted of diminutive R waves in leads I and V
6
, a deep Q wave and high R wave in lead III, a prominent R wave in lead V
1
, which was not wide, and the absence of Q waves in leads I, V
1
, and V
6
.

The electrocardiogram in patients of group II was similar to that of the patients of group I except for the appearance of more signs of left ventricular electric activity and less clock-wise rotation of the heart.

The electrocardiogram of the patients of group III was similar to that previously described for ventricular septal defect.

Â
QRS
, Â
T
, Ĝ, and sVCG reflected the same general trend as the electrocardiograms.

The electrophysiologic data presented support clinical observations indicating that the tetralogy of Fallot includes patients with a wide range of hemodynamic differences.
Study of the Mechanism of Hyperlipemia
Authors: KUO PETER T. , WHEREAT ARTHUR F. , BASSETT DAVID R. , STAPLE EZRA
Published: June 2012

The fatty acid patterns of the serum chylomicrons of 10 normal and 10 hyperlipemic subjects were determined by gas-liquid chromatography, before and after feedings of cream, corn oil, and coconut oil. Their depot fat composition was analyzed. Changes in the composition of the fasting serum chylomicrons of these hyperlipemic patients after they were stabilized on low fat, and rice and fruit diets were also studied.

Upon a full American diet, after 12 hours of fasting, the fatty acid pattern of the very light serum chylomicrons of the hyperlipemic patients was found to reflect that of the ingested fats, consisting chiefly of a mixture of saturated animal fats. The effect of food fats was less evident in the heavier serum chylomicrons and very low density lipoprotein fraction of these patients, where the pattern of endogenously synthesized fat predominated.

A low-fat diet in eight of these patients caused a significant lowering of the serum chylomicron (triglyceride) concentration and a shift of chromatographic pattern of the very light serum chylomicrons toward that of the non-hyperlipemic subjects. It is apparent that the clearing of the exogenous fats from the serum permits the endogenous lipids to dominate the picture.

A low caloric rice and fruit diet appeared to arouse a temporary acceleration in the mobilization of fat from the body depot in two patients. In these patients, the fatty acid composition of serum chylomicrons, the very low density lipoproteins, and the depot fat were found to be similar to one another.

Dietary fat contributed directly to alimentary lipemia of the normal and diseased subjects. At or near the peak of alimentary lipemia, the composition of the very light serum chylomicrons of all subjects was found to be practically identical with the ingested fat. Alimentary lipemia of hyperlipemic patients was intensified and prolonged.

A relative increase in oleic acid, together with an elevated oleic/stearic ratio has been reported in the serum chylomicrons of patients with coronary artery disease. The same findings occurred in our patients, when there was an increase (relative or absolute) in the very light serum chylomicrons, due either to excessive dietary fat intake or to increased mobilization of fat from the depot.
The Reopened Ventricular Septal Defect
Authors: MARCH HAROLD W. , GERBODE FRANK , HULTGREN HERBERT N.
Published: June 2012

The persistence of a left-to-right shunt due to the unsuccessful repair of a ventricular septal defect associated with infundibular stenosis has been described.

A characteristic clinical picture has been reported. The main features include congestive heart failure, tricuspid insufficiency, and increased pulmonary blood flow.

The severity of the symptoms appears to be due to the persistence of a left-to-right shunt at a time when the myocardium has been affected adversely by such operative insults as potassium arrest and ventriculotomy.

The particular difficulties attending the repair of a ventricular septal defect with infundibular stenosis include the proximity of the defect to the hypertrophied muscle mass, the soft muscular margin of such a defect, and the tension on the suture line. Ivalon and Teflon prostheses have been disappointing in their failure to maintain the integrity of the repair.

All of the patients were reoperated upon. Five survived and their defects are now closed. The second repairs were abetted by the development of a fibrous scar around the margin of the defect. The five survivors are in good health and there is no evidence of a remaining shunt.

As a consequence of these experiences, surgical technics were modified. The defects are now closed by direct suture with interrupted silk, followed by the application of a crimped Dacron patch over the repair. The results have been encouraging and since the new technic has been adopted, there have been virtually no recurrences.
Left Atrial and Left Ventricular Pressures in Subjects without Cardiovascular Disease
Authors: BRAUNWALD EUGENE , BROCKENBROUGH EDWIN C. , FRAHM CHARLES J. , ROSS JOHN
Published: June 2012

Transseptal left heart catheterizations were carried out in 18 patients without apparent evidence of organic cardiovascular disease. These studies have permitted delineation of the pressures that exist in the left side of the heart in normal subjects studied in a basal physiologic state.
The Sarcoplasmic Reticulum of Skeletal and Cardiac Muscle
Authors: Kossmann Charles E. , FAWCETT DON W.
Published: June 2012

This paper traces the development of our present concept of the structural organization of the sarcoplasmic reticulum in striated muscle and reviews the physiologic evidence for its participation in intracellular impulse conduction. Comparative observations are presented showing that this system of membrane-limited tubules is particularly well developed in exceptionally fast-acting skeletal muscles. These findings are interpreted as evidence supporting the hypothesis that the reticulum is involved in the coupling of excitation to contraction, but it is considered likely that it also has other important functions in muscle metabolism. The sarcoplasmic reticulum of cardiac muscle is found to be much less extensive and less precisely arranged in relation to the cross-banded pattern of the myofibrils, than it is in skeletal muscle. It is believed, nevertheless, that it may prove to have a significant role in the physiology of the myocardium.
The Regulation of Metabolism and Energy Release in Contracting Muscle
Authors: Taggart John V. , MOMMAERTS WILFRIED F. H. M.
Published: June 2012

A brief review has been given of our present knowledge of the nature of the chemical events coupled with muscular contraction. Although there are experiments that fail to demonstrate a breakdown of ATP in the contraction of living muscle, these may yet yield to special explanations, leaving the conclusion that a breakdown of ATP is the reaction most closely related to the mechanical activity of the contractile structure. Owing to a rapid rephosphorylation reaction, this event appears in the form of a breakdown of phosphocreatine. The amount of energy liberated in contraction may be written as the sum of 3 quantities (a) activation energy, (b) shortening energy, and (c) work. It appears that, chemically, these correspond to 3 distinct quantities of phosphocreatine breakdown. The matter is complicated by the fact that the activation energy is not constant but may diminish as the muscle shortens. This may be little noticeable in frog sartorius muscle (dependent on the treatment) but appears to be pronounced in the heart, where it leads to the classical observation that work against a high pressure is performed less efficiently than work raised by ejections of an increased volume.