bluuebunny/crossref_metadata_2025 huggingface dataset:
Serum Cholesterol and Relative Body Weight of Coronary Patients in Different Populations
Authors: KEYS ANCEL , FIDANZA FLAMINIO
Published: June 2012

Men under 66 years of age suffering from unequivocal coronary heart disease in the Twin Cities of Minnesota and in Naples, Italy, were compared with clinically healthy men matched in place of residence, age, type of occupation, and socioeconomic status.

The Twin Cities patients (
N
= 72) did not differ in relative body weight from their controls (
N
= 338) and the average relative weight of both groups was less than either of the 2 Naples coronary groups and the upper class Naples control subjects. The average relative body weight of the upper class Naples coronary patients (
N
= 54) was insignificantly greater than that of their controls (
N
= 89). The Naples working class coronary patients (
N
= 54) had a significant tendency to be more often overweight than their controls (
N
= 144).

The serum total cholesterol concentration was significantly higher in each of the 3 groups of coronary patients than in their corresponding controls and the 3 groups, control and coronary, formed a sharp progression from high to low cholesterol values in the order: Twin Cities, Naples upper class, Naples working class. In the Naples working class, separation into manual and sedentary workers disclosed no differences in either relative body weight or serum cholesterol.

The differences in serum cholesterol were accounted for by cholesterol in beta-lipoprotein. None of the 3 control groups differed in alpha-lipoprotein cholesterol concentration but in each of the 3 populations the coronary patients tended to have lower alpha values than their controls.

The cholesterol data are compatible with the hypothesis that the 3 populations have different frequency distributions of cholesterol values, the coronary patients in each population tending to be drawn from the upper end of the corresponding population distribution, with no general critical level distinguishing all coronary patients as a total group.

In the past several years coronary patients in the Twin Cities tend to be so frequently on diets or drugs to control cholesterol that it is increasingly difficult to find patients who may properly characterize the natural history of the disease. The patients reported here were free from this complication.
Physiologic Studies in Congenital Absence of the Left Main Pulmonary Artery
Authors: TABAKIN BURTON S. , HANSON JOHN S. , ADHIKARI PRASANT K. , MILLER DONALD B.
Published: June 2012

Physiologic studies in 2 cases of congenital absence of the left pulmonary artery are presented. The significance of carbon dioxide production and oxygen uptake in the affected lung and their relationship to ventilation and perfusion are discussed. All functional and anatomic evidence points to a highly significant bronchial artery circulation substituting in part for the absent pulmonary artery.
Measurements of Enzymes in the Diagnosis of Acute Myocardial Infarction
Authors: HAMOLSKY MILTON W. , KAPLAN NATHAN O.
Published: June 2012

The determination of the levels of activity of various enzymes in the blood or serum of man represents a major advance in the laboratory diagnosis of various disease states. The widespread body distribution of various enzymes at relatively large tissue activity levels in comparison to the small amounts normally in the circulation has, on the one hand, permitted the demonstration of diseased or damaged tissue by the resultant elevation of serum levels of activity. On the other hand, the generally large amounts of the clinically significant enzymes in heart, liver, skeletal muscle, kidney, brain, etc. has precluded the desired specificity of a laboratory test. At the present state of development, increases in circulating levels of various enzymes appear to be more sensitive indicators of tissue damage than previously available ones, such as the erythrocyte sedimentation rate and the C-reactive protein but it must be remembered that they are equally nonspecific. Any cause of tissue breakdown—trauma, infection, infarction, ischemia, neoplasia—may result in elevated serum levels, presumably by the release of enzyme from the damaged tissue. Thus, as with all laboratory tests, considered clinical judgment of the over-all picture remains essential. Despite this limitation, demonstration of elevated serum levels of certain enzymes (the two most useful at this time being SGOT and LDH) serves, in the proper clinical setting, as a highly valuable indicator of myocardial necrosis; failure to observe this on serial testing is an important negative finding. The SGOT activity rises promptly after myocardial infarction, permitting early confirmation. LDH, simpler to measure, affords the advantage of a more persisting abnormality (up to 10 to 14 days after infarction). In most comparative studies, LDH measurements appear to afford a greater over-all positive correlation with the ultimate diagnosis. The rapid development of this area of knowledge has already increased the diagnostic armamentarium of the clinician. Recent promise of methods to increase the specificity of the results augurs well for the future.
Ruptured Mitral Chordae Tendineae
Authors: OSMUNDSON PHILIP J. , CALLAHAN JOHN A. , EDWARDS JESSE E.
Published: June 2012

The present study presents pertinent clinical and pathologic findings in 20 cases of ruptured mitral chordae tendineae encountered at the Mayo Clinic between 1934 and 1958 inclusive. Mitral insufficiency results from the rupture of chordae tendineae, the severity being related to the number of chordae ruptured. The resulting heart disease may be severe and may progress to cardiac decompensation and death. Bacterial endocarditis was the major etiologic factor in rupture of the chordae tendineae in this study.
Relationship between the Electrocardiogram and the Position of the Heart as Determined by Biplane Angiocardiography
Authors: GUNTHEROTH WARREN G. , OVENFORS CARL-OLOF , IKKOS DANAE
Published: June 2012

Anatomic orientation of the heart was determined in 53 patients by selective, biplane angiocardiography, and was compared with the mean electric axis and the location of the transition zone from conventional electrocardiograms. No significant correlation could be demonstrated between (a) the anatomic axis and the electric axis in the frontal plane, or (b) between the electric axis and rotation of the heart about its longitudinal axis, or (c) the location of the interventricular septum and the transition zone of the precordial leads.

The electric variations are greater than can possibly be explained by known rotations of the heart about any anatomic axis.

The degrees of rotation about the heart's longitudinal axis assumed in the concept of "electrical positions" is beyond the range found in normal or hypertrophied hearts.

It is concluded that the electric positions of the heart should be abandoned in favor of direct description in three dimensions of the orientation of the mean electromotive force of the heart. Normal limits should be defined in percentiles or standard deviations.
Origin of Right Pulmonary Artery from Ascending Aorta
Authors: WAGENVOORT C. A. , NEUFELD HENRY N. , BIRGE RICHARD F. , CAFFREY JOHN A. , EDWARDS JESSE E.
Published: June 2012

A case is reported of a 20-day-old infant with origin of the right pulmonary artery from the ascending aorta. Besides its abnormal origin, the artery was stenotic in its proximal half. We believe the malformation results from persistence of the distal (instead of the proximal) part of the primitive sixth aortic arch and of a portion of the right dorsal aorta. The presence of ductal tissue in the wall of the right pulmonary artery supports this concept.

The pulmonary vasculature in the two lungs showed great differences in medial and intimal characteristics. A second case of origin of the right pulmonary artery from the aorta, deseribed elsewhere, provided material for comparative study of the structure of the right main pulmonary arteries and the intrapulmonary branches.
Ballistocardiographic Study in Severe Anemia
Authors: TANDON O. P. , KATIYAR B. C.
Published: June 2012

Ballistocardiographic study in 10 cases of chronic severe anemia, with use of Dock's direct body ballistocardiograph, has been reported. The tracings were studied before and after treatment of anemia.

All cases showed abnormal ballistocardiograms. The abnormalities presented no specific pattern. Prior to treatment, in the majority of cases, the waves were smaller than normal. With few exceptions, the tracings tended to regain their normal size on correction of anemia. No tracings showed fused HJ complexes, tall H waves, notched J waves, M patterns, or high-amplitude curves either before or after treatment.

The present study shows that the state of severe anemia of chronic duration, impairs the mechanical force of cardiac contractions, and, on improvement of anemia, the functional state of the heart improves. Thus, it reflects the usefulness of this new tool in assessing the functional status of the heart in patients with chronically severe anemia.
Biochemical Studies in Full-Blooded Navajo Indians
Authors: KOSITCHEK ROBERT J. , WURM MOSES , STRAUS REUBEN
Published: June 2012

The beta/alpha lipoprotein ratio and other serum lipid components have been studied in a population of full-blooded Navajo Indians. The findings offer a basis for assessing the low degree of atherogenesis and are consistent with evidence for the low incidence of coronary heart disease in this ethnic group.
An Angiocardiographic Sign of Aortic Regurgitation
Authors: ARCILLA RENE A. , AGUSTSSON MAGNUS H. , STEIGER ZWI , GASUL BENJAMIN M.
Published: June 2012

A technic of performing retrograde aortography for the study of aortic insufficiency is presented. The aortograms demonstrate the abnormal expansile movements of the aorta, and the to-and-fro motion of the opacified vascular column in the proximal portion of the aorta with systole and diastole. These phenomena were not observed in patients without aortic insufficiency. A method for calculating the stroke volume and the volume of regurgitation from these aortograms is presented.
Atrial Infarction of the Heart
Authors: LIU CHI KONG , GREENSPAN GILBERT , PICCIRILLO RONALD T.
Published: June 2012

Six cases of atrial infarction associated with ventricular infarction are presented. All cases were diagnosed during life and were confirmed by autopsy.

A clinical diagnosis of atrial infarction should be suspected in patients with ventricular myocardial infarction having any form of atrial arrhythmia. Frequent electrocardiograms should be obtained, especially if sinus rhythm has just been re-established after episodes of supraventricular tachycardia or atrial fibrillation.

The
major
electrocardiographic criteria for the diagnosis of atrial infarction are as follows: elevation of the P-Ta segment of over 0.5 mm. in V
5
; and V
6
with reciprocal depression of the same segment in V
1
and V
2
; elevation of the P-Ta segment of over 0.5 mm. in lead I and its depression in leads II or III; depression of the P-Ta segment of more than 1.5 mm. in precordial leads and 1.2 mm. in leads I, II, and III in the presence of any form of atrial arrhythmia.

The
minor
electrocardiographic criteria in making the diagnosis of atrial infarction are as follows: abnormal P waves: M-shaped, W-shaped, irregular or notched; depression of the P-Ta segment of small amplitude without elevation of this segment in other leads cannot be regarded by itself as positive evidence of atrial infarction.

A diagnosis of atrial infarction can sometimes be made when the presence of ventricular myocardial infarction cannot be definitely established by electrocardiogram.

The treatment of atrial infarction is similar to that of ventricular infarction. Attention should be directed to the control of atrial arrhythmias and to the prevention of mural thrombi.
Myocardial Response to Cigarette Smoking in Normal Subjects and Patients with Coronary Disease
Authors: REGAN T. J. , FRANK M. J. , MCGINTY J. F. , ZOBL E. , HELLEMS H. K. , BING R. J.
Published: June 2012

The myocardial and peripheral hemodynamic effects of cigarette smoking have been assessed during a steady state situation in a group of normal subjects, and compared with a group of patients with coronary artery disease.

During smoking, in both groups there was augmentation of heart rate, systemic arterial pressure, and left ventricular work, this response being somewhat greater in the coronary patients. Despite these hemodynamic alterations, neither group had a significant change in coronary blood flow, so that myocardial oxygen usage remained virtually identical with the value before smoking. There was no evidence of myocardial ischemia in the coronary subjects during smoking. The various factors, potentially responsible for the lack of myocardial blood flow increment are considered.
"Nonspecific" ST and T-Wave Changes
Authors: FRIEDBERG CHARLES K. , ZAGER ALBERT
Published: June 2012

A study was made of 1,000 consecutive adult in-patient electrocardiograms to determine the possibility of making a more precise diagnosis than "nonspecific ST and T-wave changes." More than 50 per cent (209) of the 410 abnormal electrocardiograms (exclusive of arrhythmias) were characterized by nonspecific depression of ST segment or T wave inversion, or both.

These 209 cases comprised four groups: (1) 46 patients (22 per cent) had received digitalis, which could account for the ST-T changes; (2) 57 patients (27 per cent) had had an acute episode of cardiac pain within 5 days prior to the electrocardiogram; (3) 57 patients (27 per cent) had had no recent cardiac pain but suffered from some disease that could be regarded as a possible cause for the ST-T changes; and (4) 49 patients (24 per cent) had no apparent cause for the electrocardiographic changes. In the last group, in contrast with the others, the ST-segment depression was less than 0.5 mm. and the T-wave inversion less than 1 mm.

In patients with recent cardiac pain, as contrasted with those without such pain, the electrocardiograms were characterized by a combination of ST depression and T-wave inversion, with a depth of more than ½ mm. of the ST depression and more than 1 mm. inversion of the T wave, by isolated T-wave inversion of more than 2 mm. and especially by more than 5 mm. in the midprecordial leads, and by an ischemic contour of the ST segment that is depressed more than ½ mm.

There was no definite difference in the electrocardiographic findings in the patients with recent cardiac pain of less than ½ hour and those with recent cardiac pain of more than ½ hour when the cases with transmural infarction (Q-wave changes) were excluded. This is compatible with the concept that the electrocardiogram usually does not distinguish between subendoeardial ischemia and subendocardial necrosis. The latter differentiation would depend on multiple clinical and laboratory findings.
Isolated Ventricular Septal Defect of the Persistent Common Atrioventricular Canal Type
Authors: NEUFELD HENRY N. , TITUS JACK L. , DUSHANE JAMES W. , BURCHELL HOWARD B. , EDWARDS JESSE E.
Published: June 2012

Among 60 necropsy specimens of isolated ventricular septal defects and more than 300 cases of ventricular septal defect observed at operation, 15 cases demonstrating unusual anatomic positions of the defect were found. The ventricular defect differed from the ordinary ventricular septal defect in that it usually occupied the position of the ventricular component of the defect in persistent common atrioventricular canal. For this reason it was named
ventricular septal defect of the persistent common atrioventricular canal type.

Deformities of one or both atrioventricular valves were common (nine of 15 cases). No atrial septal defects of the ostium primum type were present. Anatomic studies of the conduction tissue revealed that this tissue skirted the posterior and inferior aspects of the ventricular septal defect and that, as in persistent common atrioventricular canal, the course taken by the conduction tissue was unusually long, as a result of the peculiar posteroinferior position of the lower edge of the defect.

The electrocardiographic features were striking. In all cases the mean electrical axis of the QRS lay above the isoelectric point; the vector loop obtained in the frontal plane from the scalar electrocardiogram was directed counterclockwise, and its main mass was above the zero line. In addition, in all cases there were signs of right ventricular overload, and in some cases of left ventricular overload as well.

Electrocardiographic findings of this pattern have been thought by some authors to be diagnostic of persistent common atrioventricular canal, but we observed that they also occurred in each of the cases of isolated ventricular septal defect of the variety described herein. We recognize that in the usual variety of ventricular septal defect this electrocardiographic pattern occurs, but it does so uncommonly. We have not studied its exact incidence. The anatomy, hemodynamics, and surgical considerations are different in cases with this defect from those with persistent common atrioventricular canal. The surgical risk in these cases has been higher than that in the usual type of ventricular septal defect.

In the discussion of the electrophysiologic theories that seek to explain the unusual electrocardiographic patterns in this group of cases, a new theory is offered, based on studies of the conduction system. In our opinion, the different orientation of the advancing fronts of depolarization is the result of congenital displacement of the bundle of His in its relation to the ventricular septal defect.
Auscultatory Findings in Patients with a Small Ventricular Septal Defect
Authors: VAN DER HAUWAERT LUKE , NADAS ALEXANDER S.
Published: June 2012

The auscultatory and phonocardiographic findings were analyzed in 21 cases of small ventricular septal defect. Eleven patients had identical right ventricular and pulmonary artery systolic pressures, whereas in nine a minimal systolic gradient across the infundibulum of the right ventricle was demonstrated. One half of the patients, with or without an infundibular gradient, had a pansystolic plateau-shaped murmur. Several patients, mostly those with an infundibular gradient, had a distinct diamond-shaped murmur. A few children showed an early systolic decrescendo murmur. Appreciable, even wide splitting of the second sound with inspiratory widening, was demonstrated. It is proposed that a sharp differentation between "ejection" and "regurgitant" systolic murmurs may be difficult under certain circumstances. Furthermore, it is suggested that the definition of an "innocent" or "functional" murmur may depend on the sensitivity of the diagnostic methods used.
Serum Sodium and Potassium in Essential Hypertension
Authors: LEVINE BERNARD E. , WELLER JOHN M. , REMINGTON RICHARD D.
Published: June 2012

This study was undertaken to determine if an association exists between blood pressure level and serum sodium or potassium concentration. All methods and measurements were standardized, and variables possibly influencing these factors were analyzed. Since increased salt intake has been postulated as an etiologic factor in essential hypertension, each patient was questioned in this regard.

Fifty normotensive and 43 hypertensive patients were studied. No significant associations were found between the height of the blood pressure, the serum sodium or potassium level, and the stated salt intake.
A Histopathologic Study of the Atrioventricular Communications in Two Hearts with the Wolff-Parkinson-White Syndrome
Authors: LEV MAURICE , KENNAMER REXFORD , PRINZMETAL MYRON , DE MESQUITA QUINTILIANO H.
Published: June 2012

The atrioventricular communications and the AV node, bundle, and bundle branches of two cases with the WPW syndrome were studied histologically. One case was that of chronic Chagas' myocarditis and the other possible chronic Chagas' myocarditis.

Accessory muscular communications in the right atrioventricular junction were found in one heart, and no communications outside the conduction system in the other.

Inflammatory changes were found in the conduction system of both hearts.

The literature of the anatomic changes in hearts with the WPW syndrome, and that with the presence of accessory atrioventricular muscular communications without the WPW syndrome are reviewed.

From the study of the literature and of our two cases, it appears that some cases of the WPW syndrome are associated with accessory communications and others are not, and accessory communications may be present without this syndrome. Of the four cases with this syndrome, however, in which a thorough study has been made of all possible conduction pathways, three showed accessory communications. On the other hand, inflamatory changes in the pre-atrioventricular nodal area, AV node, bundle and bundle branches have been found in many cases of the WPW syndrome.

It is thus clear that an anatomic base has as yet not been established for the WPW syndrome. It is possible that a different mechanism may be responsible in different cases. The high incidence of inflammation of the conduction system in the studied cases makes accelerated conduction an attractive hypothesis, where no accessory bundles have been found. More correlative histologic and clinical work needs to be performed in this field.
Treatment of Complete Transposition of the Great Vessels with the Blalock-Hanlon Operation
Authors: OCHSNER JOHN L. , COOLEY DENTON A. , HARRIS LEONARD C. , MCNAMARA DAN G.
Published: June 2012

Transposition of the great vessels is the most frequent cause of death from congenital heart disease in childhood. The high incidence and poor prognosis of this condition have stimulated the development of many palliative and corrective surgical procedures, but in general their results have been discouraging.

During the past 6 years at the Texas Children's Hospital 45 patients with transposition of the great vessels have undergone palliative operation by the creation of an atrial septal defect, using the Blalock-Hanlon technic. The prime criterion for the selection of a patient for surgical treatment was severe anoxemia with or without associated congestive heart failure. The majority of cases were under 1 year of age and 49 per cent less than 3 months of age at the time of surgery.

Among 28 patients operated upon during the past 2 years 23, or 82 per cent, survived operation with general improvement. Use of this palliative operation is recommended for the small infant or critically ill patient, and totally corrective procedures should be reserved until conditions are more favorable for survival.
Atherosclerosis in India
Authors: MATHUR K. S. , PATNEY N. L. , KUMAR V.
Published: June 2012

Striking differences in the extent and severity of atherosclerosis were observed when our results were compared with those reported from the United States, Japan, and Jamaica, and South India by Gore et al.
4
Up to the age of 30 years the mean atherosclerotic indices of aorta from these sources were not significantly different. Subsequently, however, the mean atherosclerotic index in our cases was almost equal to that reported from South India but it was much less than that recorded in the U.S.A. and significantly less than that reported from Japan and Jamaica. It is thus seen that the factors that initiate atherogenesis are different from those that are effective in the formation of the later grades of lesions, since the same amount of streaking does not lead to an equal amount of fibrous plaque formation. It also shows that there are important geographic differences in the prevalence of these latter factors. Similarly, the coronary atherosclerosis was almost equal in our and the South Indian series but in both these places it was less advanced than that obtained in the U.S.A., Japan, and Jamaica.
Blood Pressure during Supine Exercise in Idiopathic Orthostatic Hypotension
Authors: MARSHALL ROBERT J. , SCHIRGER ALEXANDER , SHEPHERD JOHN T.
Published: June 2012

The arterial blood pressure was measured during exercise in six patients with idiopathic orthostatic hypotension. In five there was a pronounced fall of arterial pressure while the subjects exercised in the supine position on a horizontal table. The systolic and diastolic pressures fell by an average of 50 and 32 mm. of mercury, respectively. During comparable exercise with the table tilted 15 degrees head downward, the pressures fell to a similar degree. Thus, an abnormal response of blood pressure occurred under conditions in which venous pooling was unlikely to be present.

It is suggested that the fall in blood pressure during exercise in the supine position was the result of failure of compensatory constriction of other vascular beds and not of failure of the cardiac output to increase. Thus, the net peripheral resistance in such patients is less than that in normal persons performing comparable exercise.
A Method of Photographing Fluorescence in Circulating Blood in the Human Retina
Authors: NOVOTNY HAROLD R. , ALVIS DAVID L.
Published: June 2012

A simple method, with use of intravenous fluorescein, was used for producing and photographing fluorescence in circulating blood of the human retina.

Separate arteriolar and venous filling phases, arteriolovenous shunt, sluggish choroidal circulation, stratified flow of fluorescein, and rapid central retinal circulation times were observed in normal retinas.

Similar findings were seen in hypertensive and diabetic patients, and, in addition, neovascularization was clearly defined, and some cotton-wool patches, but not hemorrhages, were found to fluoresce.

Limitations and applications of the method are discussed.
Plasma Lipoprotein Lipase after Subcutaneous Heparin
Authors: CONNOR WILLIAM E. , ARMSTRONG MARK L.
Published: June 2012

Plasma lipoprotein lipase was measured at intervals after the subcutaneous injection of heparin in 34 men. This enzyme was significantly increased in plasma for as long as 24 hours after a 50-mg. dose. While the initial response was greater after a 200-mg. dose, the 24-hour lipoprotein lipase was similar for both 50 mg. and 200 mg.

Plasma lipoprotein lipase produced after intravenous heparin was dissipated after 6 hours.

The lipoprotein-lipase response at 16 and 24 hours after the subcutaneous injection of heparin was similar in men with coronary and cerebral atherosclerosis and in healthy men. Age did not affect plasma lipoprotein-lipase response.

Patients who had received 50 mg. of heparin subcutaneously each day for an average time of 12 months did not have exhaustion of the lipoprotein-lipase response to a test dose of heparin.

It is suggested that the daily administration of heparin is necessary to produce a continuous concentration of plasma lipoprotein lipase. A dose of 50 mg. (5,000 units) given subcutaneously produced a prolonged lipoprotein-lipase response and only a mild anticoagulant effect, unlikely to induce the complication of bleeding.
The Genesis of Hyponatremia Associated with Marked Overhydration and Water Intoxication
Authors: STORMONT JAMES M. , WATERHOUSE CHRISTINE
Published: June 2012

Prolonged overhydration and hyponatremia have been produced in 10 patients with use of Pitressin Tannate in Oil. Balance studies have shown that in patients who developed moderate hyponatremia, the drop in serum sodium could be explained by water retention. In patients who developed severe water intoxication, the very low levels of serum sodium (100-114 mEq./L.) could not be entirely accounted for by changes in salt and water balance.

Certain patients failed to develop severe water intoxication although an equivalent degree of overhydration was achieved. In these subjects, further overhydration was limited by intermittent episodes of low solute diuresis. This diuretic escape from Pitressin effect has been evaluated by measurement of U/P osmolar ratio on 24-hour urine specimens as well as T
c
H
2
O during hypertonic mannitol infusion. Defects in both aspects of renal concentration were observed, although they were not necessarily coexistent.
Reactivity of Cardiac Vessels and Reparative Processes Following Cardiac Infarction
Authors: ANDREEV SERGEY V.
Published: June 2012

It was stated that the human heart possesses a high vasomotor activity: in 1 to 3 minutes the coronary vessels may pass into a state of spasm or dilatation in such a manner that the volume flow may change up to 2 to 7 times. Apparently, this phenomenon discloses one of the mechanisms leading to prolonged spasm of the coronary arteries.

Vasomotor activity of the heart is characterized by three types of rhythmic oscillations of vessels, which differ from one another in amplitude, form, and frequency. In some intoxications (dysentery, diphtheria, pneumococcal infection) and diseases, vasomotor activity tends to decrease, whereas in the subacute stage of cardiac infarction in man and in dog, in angina pectoris, in atherosclerosis of the coronary vessels, and in hypertensive disease, it seems to be compensatorily augmented.

Two-phased or distorted reaction of heart vessels is determined not only by the atherosclerotic process but by neurohumoral influences of necrotic focus upon the metabolism in the heart and in the vascular wall.

The most constant spasmolytic effect upon the vessels of the human heart was obtained by the administration of euphyllin and strophathin in low concentrations.

It was demonstrated that, in addition to vitamins, hormones, aminoacids, and mineral salts, many other factors participate in the regulation of vascular tone.

Acceleration of reparative processes in experimentally produced focal lesions of the heart was encountered after application of a complex treatment on animals with vitamins and aminoacids (B
12
, adenosinetriphosphate, methionine, and desoxyribonucleic acid).
The Contractile Structure of Cardiac and Skeletal Muscle
Authors: Kossmann Charles E. , HUXLEY H. E.
Published: June 2012

Previous findings that have led to the `sliding-filament' model for striated muscle are reviewed, together with some recent observations on isolated filaments produced by a new procedure. The basic structure of the contractile apparatus in skeletal and in cardiac muscle appears to be identical. The relation between certain special features of cardiac muscle and its structure is discussed.
The Structure of the Specialized Impulse-Conducting System of the Steer Heart
Authors: Kossmann Charles E. , RHODIN JOHANNES A .G. , DEL MISSIER PETER , REID L. CORSAN
Published: June 2012

The specialized impulse-originating and -conducting system of the steer heart has been analyzed with the light, phase contrast, and electron microscopes after careful dissection of its gross anatomic parts. The specific tissue is composed of cells with distinct cell boundaries. No syncytium exists. The cells of the sino-atrial (S-A) and atrioventricular (A-V) nodes closely resemble those of the common myocardium. They connect end to end via intercalated disks, most of which represent the starting point and termination of numerous myofibrils. The cells of the bundle of His and its distal branches are large and spindleshaped and joined in a staggered fashion. They display a fair number of myofibrils. The cell contact is established by numerous desmosomes that only rarely connect with myofibrils. It is believed that the multiple desmosome type of connection, present in most parts of the specific tissue of the steer heart, indicates that this tissue has maintained its embryologic appearance, to a large extent. The role of the desmosomes in facilitating the propagation of the impulse throughout the specific tissue is discussed.
Membrane Excitation in Cardiac Muscle
Authors: Brooks Chandler McC. , WEIDMANN SILVIO
Published: June 2012

The contributions made during the past 10 years are reviewed. Intracellular recording has made it possible to state absolute values for the cardiac resting potential (90 mv., inside negative to outside) and the "overshoot" during activity (30 mv., inside positive to outside). The surface membrane of a resting fiber is considered to be predominately permeable to K ions. During activity, Na conductance increases and K conductance decreases. The latter process is thought to be essential for explaining the high membrane resistance that is measured during the long-lasting "plateau" found with cardiac muscle. A hypothesis is presented that would account for the termination of the plateau and the beginning of repolarization.
Physiology of Atrioventricular Transmission
Authors: Brooks Chandler McC. , HOFFMAN BRIAN F.
Published: June 2012

This paper describes records of the transmembrane action potential of fibers from different parts of the specialized conducting system and electrograms recorded directly from these fibers in situ. On the basis of these records it is possible to describe certain physiologic mechanisms for conduction delay, block, and supernormal conduction. In general, impaired conduction is associated with a reduced level of membrane potential. This may be caused by incomplete repolarization or partial depolarization. In the normal conducting system, local differences in, action-potential duration and local pacemaker activity most frequently are the cause of a low membrane potential. In disease states, on the other hand, many other factors may be operative. At the atrial margin of the atrioventricular (A-V) node, local anatomic and electrophysiologic properties of the fibers normally cause a very low conduction velocity. The safety factors for conduction here appear to be quite low, and delayed transmission or block often does not result from refractoriness or partial depolarization of nodal fibers. Supernormal conduction, at least in Purkinje fibers, seems to result from the high level of membrane potential reached at the end of repolarization. Whether other factors are responsible for supernormality within the A-V node remains to be seen.
A Comparison of the Pulmonary Blood Flow between Left and Right Lungs in Normal Subjects and Patients with Congenital Heart Disease
Authors: DOLLERY C. T. , WEST J. B. , WILCKEN D. E. L. , HUGH-JONES P.
Published: June 2012

Carbon dioxide labeled with oxygen-15 has been used to study the regional blood flow in the lungs of patients with pulmonary stenosis. The upper and lower zone flows were normal in patients with isolated pulmonary stenosis, but both were low in patients with the tetralogy of Fallot. A comparison of the two upper zones showed a significantly higher blood flow through the left upper zone in patients with both isolated pulmonary stenosis and the tetralogy of Fallot.

A significantly higher flow was also found through the left upper zone than the right of normal subjects. By contrast, patients with atrial septal defect had a higher flow through the right upper zone than the left. Neither difference was as large as in the patients with right ventricular outflow tract obstruction.

Patients with ventricular septal defect and those with patent ductus arteriosus had almost identical flow through the two upper zones.
The Persistence of High Body Sodium in Previously Edematous Patients with Heart Disease
Authors: CARROLL HUGH J. , FARBER SAUL J.
Published: June 2012

Measurements of total body water and total exchangeable sodium were made in patients with heart disease rendered free of edema following congestive heart failure.

The total exchangeable sodium in most of the patients was higher than would have been predicted on the basis of their body weight and total body water. Serial measurements showed that some patients gradually lose their excess sodium over a period of months without a loss of body water; others maintain an elevated ratio of body sodium to body weight and body sodium to body water for periods of at least several months.

The data imply the possibility of significant quantities of osmotically inactive sodium in patients with heart disease.
A Nomogram for Long-Term Anticoagulant Therapy
Authors: TENCH WILIIAM R. , ROSS HUGH C.
Published: June 2012

It appears that the nomogram, because of its predictability, has been useful, not only in patients who tend to vary their requirements, but as a tool to find the proper weekly schedule for each patient. Moreover, prothrombin times have tended to lose their peaks and valleys; adjustments have become less frequent and of much smaller degree.
Isolated Anomalous Connection of a Great Vein to the Left Atrium
Authors: MEADOWS W. R. , BERGSTRAND INGEMAR , SHARP J. T.
Published: June 2012

A case is reported of isolated anomalous drainage of the inferior vena cava into the left atrium, the second in the literature and the first with catheterization data and dyedilution curves. The anomaly is reflected by a well-defined clinical syndrome, is compatible with full cardiac competence at least until middle life, and should be relatively simple to correct surgically.
Radioisotope Scanning of the Precordial Distribution of Iodide in Patients with Myocardial Infarction
Authors: MASON DEAN T. , FRYE ROBERT L. , WAGNER HENRY N.
Published: June 2012

Precordial scanning of the distribution of radioiodine (I
131
-labeled iodide) in patients with myocardial infarction has been suggested by others as a means of delineating the infarcted area.

Attempts to localize radioiodine in 14 precordial scans of 12 patients with myocardial infarction resulted in the demonstration of localized areas of radioactivity in seven scans. This collection of radioactivity was found to be within the stomach, resulting from the normal concentration of radioiodine that occurs in gastric secretions.
Isolated Right Ventricular Hypoplasia with Atrial Septal Defect or Patent Foramen Ovale
Authors: SACKNER MARVIN A. , ROBINSON MORTON J. , JAMISON WILLIAM L. , LEWIS DAVID H.
Published: June 2012

With the rare exception of connective-tissue replacement of the right ventricular myocardium ("parchment heart"), underdevelopment of the right ventricle, as a clinical entity, has been related to tricuspid atresia or stenosis, pulmonary atresia and certain cases of transposition of the great vessels. This report is concerned with four cases, aged 2 months to 39 years, in which a diminutive right ventricle was not dependent on these factors. Three cases occurred in the same family and, in association with atrial septal defect, produced distinctive clinical and hemodynamic features. Right-sided heart failure predominated, dyspnea was mild to moderate, and cyanosis was present in association with clinical, electrocardiographic, and roentgenographic evidence of left ventricular enlargement. Cardiac catheterization and venous angiocardiography showed a bidirectional interatrial shunt, normal pulmonary arterial pressure, no pressure gradient across the pulmonic and tricuspid valves, and a diminutive right ventricle. Anastomosis of the superior vena cava to the right pulmonary artery and closure of the atrial septal defect may ameliorate the hemodynamic disturbance.
Clinical Observations with an Orthogonal Lead System
Authors: WILKINSON ROBERT S. , RABINOWITZ ROBERT , MELTZER STANLEY , ABILDSKOV J. A.
Published: June 2012

Orthogonal electrocardiographic leads of 85 normal and 104 abnormal subjects obtained with a new lead system were examined for the counterparts of clinically significant findings in conventional 12-lead electrocardiograms. Most of the findings judged significant in conventional leads had easily recognizable counterparts in orthogonal leads. Excluding findings suggestive of ventricular enlargement, the conventional tracings of 40 subjects showed QRS abnormalities, and counterparts of these were identified in the orthogonal leads of all but one subject. Counterparts of findings suggesting ventricular enlargement could not be evaluated, since the range of normal variation of orthogonal leads obtained with the system used has not been established in quantitative terms. Conventional records of 99 subjects showed abnormalities of the S-T segments or T waves or both, and recognizable abnormalities of these portions of the curves were present in the orthogonal leads of 97 of the subjects.
Cardiac Aspects of Friedreich's Ataxia
Authors: BOYER SAMUEL H. , CHISHOLM ARTHUR W. , MCKUSICK VICTOR A.
Published: June 2012

Twenty-seven kindreds with Friedreich's ataxia were seen at the Johns Hopkins Hospital from 1935 to 1957. In three kindreds the disease exhibited an apparently dominant mode of inheritance. Affected individuals in each of the remaining 24 kindreds were confined to single sibships and in 18 of these limited to a single patient.

Thirty-three patients from these kindreds were studied in considerable detail. Follow-up information was obtained on all individuals and electrocardiograms together with chest x-rays were obtained on most of them. Eighteen or 55 per cent exhibited major cardiac abnormalities including cardiac enlargement in four and possible enlargement in an additional two, prominent systolic murmurs in six, a diastolic murmur and other signs suggesting mitral stenosis in one, probable pericardial effusion in another, and major electrocardiographic abnormalities in 16. Two developed atrial fibrillation and one atrial flutter. Heart disease contributed to death definitely in four and possibly in two others of eight patients who have died. Autopsy was performed in two patients; diffuse myocardial fibrosis was found in one of these. An unusual feature of the cardiac disturbance in five patients was the tendency of remission toward normalcy. This finding, together with the supposition that some patients were seen before developing evidence of heart disease, indicates that the frequency of cardiac abnormality probably exceeds the minimum estimate of 55 per cent.

In eight patients Friedreich's ataxia with cardiac involvement was mistaken for rheumatic or congenital heart disease. The appearance of leg pains early in the disease increased the mimicry of rheumatic fever in a number of patients.

Both cardiac and neurologic manifestations of Friedreich's ataxia are regarded as having a common genetic origin and serve as another example of pleiotropy.
Simulation of Electrocardiogram of Apicolateral Myocardial Infarction by Myocardial Destructive Lesions of Obscure Etiology (Myocardiopathy)
Authors: PRUITT R. D. , CURD G. W. , LEACHMAN ROBERT
Published: June 2012

A myocardial destructive process unrelated to occlusive coronary arterial disease has been documented at necropsy in two patients aged 37 years and 23 years at the time of death.

In the third patient, 25 years of age, electrocardiographic findings of a transmural lesion of the apicolateral wall of the left ventricle existed in the absence of evidence of impaired myocardial reserve.

The nature of myocardial destruction encountered in cases 1 and 2 is compared with that in the case of parchment heart described initially by Osler.

The theoretic implications of total loss of R waves in semidirect leads overlying a region of epicardial destruction are noted.
The Antihypertensive Effects of Chlorthalidone
Authors: BRYANT J. MARION , SCHVARTZ NATALIO , TOROSDAG SETA , FLETCHER LUCIAN , FERTIG HARRISON , SCHWARTZ M. STEPHEN , QUAN RICHARD B. F. , MCDERMOTT JOHN J. , SPENCER THOMAS B.
Published: June 2012

Chlorthalidone administered in a single daily dose (200 mg. per day) produced a significantly greater hypotensive effect than chlorothiazide (250 mg. t.i.d.) and a greater, but not significantly different, response than hydrochlorothiazide (25 mg. t.i.d.).

Reserpine (0.1 to 0.5 mg. per day) significantly augmented the hypotensive effect of chlorthalidone, but chlorthalidone given alone produced an effect equal to the combination of a benzothiazide with reserpine.

Side effects characteristic of sulfonamide diuretics of minimal degree, including hyperuricemia, accompany chlorthalidone administration.

Presently, chlorthalidone, when individualization of dosage is observed, approaches an ideal sulfonamyl for the control of hypertension in relation to that of other members of this chemical series.
The Extractability of Serum Lipids in Normal Subjects, Coronary Disease, Hyperlipemia, and Hypercholesteremia
Authors: AMATUZIO D. S. , GRANDE FRANCISCO , WADA SHOHACHI
Published: June 2012

The lipid extraction of fasting serum samples was studied with various alcohol-ether solutions. The release of cholesterol and esterified fatty acids from the serum lipoproteins was found to be significantly different in the various disease states studied as compared to the normal subject. The fraction of lipid release from fasting serum was not related to the total level of the cholesterol or esterified fatty acids in normal subjects, coronary artery disease, and hypercholesteremia.
Ten to Thirteen Year Follow-up on Patients after a Blalock-Taussig Operation
Authors: TAUSSIG HELEN B. , CRAWFORD HILARY , PELARGONIO SALVATORE , ZACHARIOUDAKIS STELLA
Published: June 2012

Analysis of 224 patients who were living 5 years after operation showed that at the end of 10 to 13 years, 40 per cent were still doing well, 46 per cent had failed to maintain improvement, 2 per cent had developed cardiac failure, and 12 per cent had died. The majority of patients who had failed to maintain improvement suffered from increasing cyanosis and dyspnea associated with a small heart and clear lung fields; hence these patients can be helped by a second operation:— either a second anastomosis or total correction. The results of a second anastomosis have, however, not been as satisfactory as the first anastomosis. Clearly total correction is the ideal.

The age at which total correction is indicated depends not only on the skill of the surgeon but on the severity of the abnormality. The long-time results of total correction are unknown. Inasmuch as abnormal tissue does not grow as fast as normal tissue, the possibility exists that the area in which tissue has been excised and a patch inserted may fail to grow or even contract and cause the right ventricle to become abnormally small.

Analysis of the results at the end of 5, 10, and 13 years showed that only 10 patients (less than 5 per cent) had required a second operation at the end of a years and only 20 per cent had required a second operation in the ensuing 5 years. Older patients, i.e., those between 8 and 12 years, had done far better than younger children. Only two of a group of 38 children operated upon between 8 and 12 years of age had required a second operation within 10 years. Thus a Blalock-Taussig operation offers the child an excellent chance to attain the major part of his growth before total correction is undertaken.

A further advantage of an early anastomotic procedure is that it restores the pulmonary vascular bed to normal and thereby renders it easier for the lungs to adjust to the full circulatory load placed on them at the time of the total correction.

The conclusion is reached, therefore, that for infants and small children a Blalock-Taussig operation is preferable. For children who have attained or nearly attained full growth, total correction is the ideal.

For many patients, especially those between 8 and 12 years of age for whom total correction is not possible, a simple Blalock-Taussig operation offers an extremely good prognosis.