bluuebunny/crossref_metadata_2025_split huggingface dataset:
An Evaluation of Treatment of Hypertension Associated with Occlusive Renal Arterial Disease
Authors: DUSTAN HARRIET P. , PAGE IRVINE H. , POUTASSE EUGENE F. , WILSON LEIGH 
Published: June 2012

Of 131 patients with hypertension and renal arterial stenosis, 99 were treated either by nephrectomy or revascularization operations and 32 were treated medically. Anti-hypertensive effects of surgical treatment were analyzed in 76 patients in whom operations had been performed 1 to 6 years before. Of the remaining 23, 10 died in the immediate postoperative period; in 11, operative treatment was incomplete at the time of review; and, in 2, who did not have sustained diastolic hypertension, operation was performed only to conserve renal function.
Diastolic hypertension remitted in 47 patients (62 per cent); in 12 (16 per cent) arterial pressure was much reduced but not to normal levels, and in 17 (22 per cent) it was unchanged.
The antihypertensive effects of surgical treatment could not be predicted preoperatively. In general, patients less than 21 years of age did not respond with as much blood pressure reduction as did those older, and patients hypertensive for longer than 5 years responded less well than those hypertensive for less than 1 year. Results of function tests of individual kidneys were not helpful in prediction.
Surgical treatment seemed contraindicated in 32 patients because of diffuse atherosclerosis, azotemia from severe nephrosclerosis, unsustained diastolic hypertension or because lesions had not caused disparity in function of the two kidneys. In three of these patients diastolic hypertension remitted spontaneously and in 11 arterial pressure was controlled at near normal levels with antihypertensive drugs. Eighteen patients have persistent diastolic hypertension; 13 of these have been inadequately treated with drugs.
In the group treated surgically, there were 10 immediate postoperative deaths, seven of which were due to atherosclerotic complications. Twelve patients died later, and 11 deaths were due to atherosclerosis. Most of the patients who died had no blood pressure reduction following operation. Ten of the medically treated group have died of atherosclerosis. The mortality was 50 per cent in the patients with ineffective treatment and poor blood pressure control and only 7 per cent in those with good blood pressure control.
The Quantitative Determination of Renin in the Plasma of Patients with Arterial Hypertension
Authors: HELMER OSCAR M. , JUDSON WALTER E. , Sanders R. M. 
Published: June 2012

A method was described for the quantitative determination of renin in small amounts of dialyzed human plasma, utilizing the first order reaction constant.
A wide variation was found in the renin-substrate (angiotensinogen) content of plasma of patients with arterial hypertension. Many of these patients had high concentrations of this factor.
Studies on the Structure of the Pulmonary Trunk
Authors: SALDAÑA MARIO , ARIAS-STELLA JAVIER 
Published: June 2012

A study of the elastic configuration of the pulmonary trunk was undertaken in 443 normal autopsy cases, ranging in ages from the second month of intrauterine life to 96 years.
It has been shown that during the whole of fetal life the elastic configuration of the pulmonary trunk is similar to that observed in the ascending aorta.
The "aortic" configuration of the pulmonary trunk, which is characterized by a great content of long elastic fibers, was observed in the first trimester of life, especially in the 29 days that follow birth.
Two models of the "transitional" configuration have been distinguished. The "transitional-A" model is characterized by a marked fragmentation of the elastic fibers. This elastic pattern has been found between 25 days and 3 years. In the "transitional-B" model most of the fibers are partially disintegrated but not fragmented. Cases with this characteristic were found from 1 month to 9 years.
The "adult" type of pulmonary configuration, which exhibits a poor content in elastic tissue, was already present in the twelfth month of life. Over the ninth year it constituted the totality of cases.
A fourth elastic configuration has been added to the already known "aortic," "transitional," and "adult" types. The designation of "persistent" given to this elastic type alludes to the presence of numerous long elastic fibers that are more characteristic of the "aortic" type, alternating with others that have suffered fragmentation. Cases of the "persistent" type were found from 1 month to 5 years.
A hemodynamic interpretation of the changes observed in the "transitional" models and "persistent" configuration is proposed.
Studies on the Structure of the Pulmonary Trunk
Authors: SALDAÑA MARIO , ARIAS-STELLA JAVIER 
Published: June 2012

Measurements of the thickness of the media of the pulmonary trunk and ascending aorta were made in 200 normal autopsy cases ranging in ages from birth to 80 years. One hundred cases were persons who were born and lived permanently in places between 11,300 to 14,900 feet above sea level. One hundred persons of comparable ages, born at sea level, served as control.
It is shown that at high altitudes the pulmonary trunk exhibits a thicker media than at sea level, in the course of the whole of life. This fact is explained by the occurrence, at high altitudes, of a mild degree of pulmonary arterial hypertension from birth.
The media of the ascending aorta of high altitude natives was found to be thinner than that of sea level inhabitants, after 30 years. This characteristic appears to be related to the existence of a lower systolic pressure at high altitudes than at sea level.
Epinephrine in the Treatment of Cardiac Failure due to Shunts
Authors: RUDOLPH ABRAHAM M. , MESEL EMMANUEL , LEVY JAY M. 
Published: June 2012

A technic for establishing a controlled aorto-pulmonary shunt in closed-chest, spontaneously breathing dogs has been developed. Wide opening of the shunt is well tolerated in some animals, but others develop acute left ventricular failure. Administration of sympathetic blocking agents may induce a failure response on opening the shunt, in an animal that previously tolerated it well.
Epinephrine infusion during the control period consistently prevented cardiac failure when the shunt was widely opened. Epinephrine was also capable of reversing the failure, if rapidly infused before left ventricular systolic pressure had dropped to extremely low levels. It was also effective in countering the adverse effects of sympathetic blocking agents. The optimal rate of infusion was found to be 0.5 to 1.5 µg./Kg./min. of epinephrine hydrochloride.
A constant infusion of epinephrine hydrochloride was administered to three infants with large left-to-right shunts who had failed to respond to intensive decongestive measures, and who manifested severe cardiac failure with severe pulmonary edema. Marked clinical improvement resulted, and anesthesia and surgery were well tolerated while the infusion was continued.
Epinephrine should be administered with a constant infusion apparatus to avoid induction of ventricular ectopic beats due to overdosage. Its use is reserved, at present, for the management of the desperately sick infant with acute left ventricular failure due to systemic-pulmonary shunts.
Physiologic Studies Early after Repair of Tetralogy of Fallot
Authors: THEYE RICHARD A. , KIRKLIN JOHN W. 
Published: June 2012

Physiologic studies have been carried out during the first 3 days after intracardiac repair of tetralogy of Fallot. All patients survived. The ratio between systolic pressure in right ventricle and a systemic artery was 0.7 or less in all cases and did not vary significantly during the period of study. Residual left-to-right shunts of moderate degree were demonstrated in three patients (repaired with Teflon prostheses). In one of these three, no definite evidence of shunt could be found 2 weeks after operation. Additional abnormal circulatory pathways exist in these patients. Clear evidence was obtained of left-to-right shunting through aorticopulmonary collateral connections in one case. Systemic index was usually below normal or in the low normal range. It was usually lower on the second and third postoperative days than on the first postoperative day. Left atrial pressure was sometimes strikingly higher than right atrial pressure 30 minutes after repair, but not thereafter. Pulmonary vascular resistance was normal or slightly elevated. Gas exchange and management were adequate to maintain normal or near normal oxygen and carbon dioxide levels in arterial blood. Mild metabolic acidosis existed on the first 2 days, but had generally cleared by the third day.
The implications of these data are discussed relative to ventricular function and performance, adequacy and technic of surgical repair, administration of blood after operation, and the state of preparedness in the lung and left ventricle in patients with tetralogy of Fallot.
Chronic Pericardial Effusion Complicating Endomyocardial Fibrosis
Authors: ABRAHAMS D. GORDON , PARRY E. H. O. 
Published: June 2012

Six patients are described in whom right ventricular endomyocardial fibrosis was accompanied by a large pericardial effusion. This effusion did not appear to modify either the course of the disease or the physical signs, which included gross elevation of the venous pressure, tricuspid incompetence, and massive ascites with complete absence of dependent edema. Atrial fibrillation was a very common finding.
Cardiac catheterization confirmed the presence of tricuspid incompetence and showed a "dip-and-plateau" contour in the right ventricular tracing. In addition the mean pressures recorded from the pulmonary artery and all parts of the right heart were virtually the same.
Two patients died and were examined postmortem. The findings included gross enlargement of the right atrium, complete disorganization of the tricuspid valve, and progressive obliteration of the right ventricular cavity. It is suggested that death may be due to gradual occlusion of the right atrium by antemortem thrombosis.
The condition must be distinguished from tuberculous pericarditis. Important factors in the differential diagnosis are the presence of tricuspid incompetence with systolic expansion of the neck veins, atrial fibrillation, and the demonstration of cardiac enlargement, due to aneurysmal dilatation of the right atrium.
Premature Mitral Valve Closure
Authors: MEADOWS W. R. , VAN PRAAGH STELLA , INDREIKA MEILUTE , SHARP J. T. 
Published: June 2012

The phenomenon of premature mitral valve closure is described in three patients with severe aortic insufficiency and related to absence of the first heart sound.
The occurrence of premature mitral closure is favored by severe aortic regurgitation probably with increased impedance to left ventricular filling.
Available evidence suggests that this phenomenon usually occurs in the more rapidly developing forms of aortic incompetence (bacterial endocarditis, post surgical, and traumatic rupture of the valve), that it is uncommon, and that it often implies a grave prognosis.
It should be suspected when the apical first heart sound is absent in aortic incompetence.
Effects of Surface-Active Aerosols and Pulmonary Congestion on Lung Compliance and Resistance
Authors: OBENOUR RICHARD A. , SALTZMAN HERBERT A. , SIEKER HERBERT O. , GREEN JAMES L. 
Published: June 2012

Pulmonary compliance and resistance were studied in normal subjects after quiet respiration, deep breathing, and the nebulization of surface-active agents. Deep breathing resulted in a significant rise in pulmonary compliance and decrease in airway and tissue resistance. Alcohol nebulizations increased compliance and decreased resistance in normal subjects. Siliconized superinone and water nebulizations had an opposite effect.
Simulated pulmonary congestion in normal subjects and congestive heart failure with pulmonary edema inhibited the anticipated response to alcohol aerosols. Responsiveness returned in part to patients with congestive heart failure after restoration of cardiac compensation. These observations suggest that pulmonary vascular congestion is a major cause of altered respiratory mechanics in heart failure. In the presence of pulmonary congestion, surface-active aerosols do not demonstrably affect compliance.
Long-Term (10 to 13 Years) Follow-Up Study after Transventricular Pulmonary Valvulotomy for Pulmonary Stenosis with Intact Ventricular Septum
Authors: MIROWSKI M. , SHAH KISHOR D. , NEILL CATHERINE A. , TAUSSIG HELEN B. 
Published: June 2012

A long-term follow-up study on 46 patients with pulmonary stenosis and intact ventricular septum who survived transventricular pulmonary valvulotomy performed at the Johns Hopkins Hospital between 1949 and 1951 was carried out; the mean follow-up period was 11.2 years. Preoperatively these patients were severely incapacitated, 76 per cent were cyanotic, 80 per cent had cardiomegaly, and 52 per cent were in congestive cardiac failure.
All 46 survivors of the pulmonary valvulotomy were alive at the time of the present evaluation. In almost half of these patients the long-term results were excellent and the pulmonary stenosis appeared to be virtually relieved. The results were good in 26 per cent of the patients; these patients also had remarkable subjective and objective improvement but still presented signs of residual right ventricular hypertrophy on the electrocardiogram. In 26 per cent of patients the long-term results were poor; seven of these patients have been reoperated upon. Twenty-nine per cent of the patients developed pulmonary insufficiency after surgery; there was no evidence, however, that this complication affected the long-term results.
The long-term studies indicate that for patients with mild to moderate pulmonary valvular stenosis a transventricular pulmonary valvulotomy gives extremely satisfactory results. For patients with congestive cardiac failure, cyanosis, or severe incapacity, the long-term results frequently are less satisfactory.
Cardiac Performance after Open Intracardiac Surgery
Authors: KIRKLIN JOHN W. , THEYE RICHARD A. 
Published: June 2012

Cardiac output and related variables were measured in patients after open intracardiac surgery. Factors affecting cardiac performance during this period were the original anatomic lesions, the details of the operative procedure, ventricular-outflow resistance, transfusion of blood, the stage of convalescence, and digitalis. In postoperative patients, metabolic rate, level of hemoglobin, and level of oxygen in arterial blood varied more widely and acutely than in nonsurgical patients, resulting in a less predictable relation between cardiac output and oxygen saturation of mixed venous blood.
Therapeutic applications of these observations were discussed.
Aneurysms of the Thoracic Aorta
Authors: JOYCE JOHN W. , FAIRBAIRN JOHN F. , KINCAID OWINGS W. , JUERGENS JOHN L. 
Published: June 2012

The clinical features and follow-up data on 107 patients who had a clinical diagnosis of aneurysm of the thoracic aorta made at the Mayo Clinic in the period 1945 through 1955 were reviewed. The ratio of male to female was 2.8 to 1, and the average age at the time of diagnosis was 59.3 years. Fusiform aneurysms were four times as frequent as saccular aneurysms; the most common location of the former was the descending thoracic aorta and of the latter the ascending thoracic aorta. Most of the aneurysms (73 per cent) were probably arteriosclerotic in origin. Symptoms, usually pain, and physical signs were present in a minority of patients and indicated a large aneurysm with a poor prognosis.
Diastolic hypertension was present in almost half of the patients at the time of diagnosis and had an adverse effect on the patient's survival. Associated arteriosclerotic cardiovascular disease was present in 40 (37 per cent) of the patients at the time of diagnosis; some of these patients had multiple associated cardiovascular lesions. The presence of associated coronary, cerebral, or other peripheral arterial occlusive or aneurysmal disease had the most deleterious effect on survival. The prognosis for patients with large aneurysms was poorer than for those with small aneurysms.
Information as to the cause of death was available in 59 (83 per cent) of the 71 patients known to be dead at the time of follow-up. Approximately a third of the deaths were due to rupture of the thoracic aortic aneurysm, and approximately a half, to associated cardiovascular disease, particularly that due to arteriosclerosis.
It is believed that this study of patients with untreated aneurysms of the thoracic aorta may be used as a guide to the selection of patients with aneurysm for surgical treatment and may serve as a basis for evaluating the long-term results of such treatment.
Initial Ventricular Impulse
Authors: RUSHMER ROBERT F. , Harding Donald , Baker Donald , Watson Nolan 
Published: June 2012

During the early stages of ventricular systole, myocardial tension develops very rapidly, ventricular pressure rises steeply to exceed arterial pressure, and momentum is then rapidly imparted to the blood flowing out of the ventricles. The acceleration of blood out of the ventricles is an expression of the force being applied by the contracting myocardium, and the peak flow velocity can be regarded as the product of the net force applied over the time from the onset of ejection to the peak. The product of force and time is designated by a well-established physical term: impulse (I=Ft). Thus, "initial ventricular impulse" appears to be an appropriately descriptive term for the dynamic properties of ventricular ejection. Direct and continuous records of acceleration, the outflow rate of blood, and the rates of change of ventricular and arterial pressure demonstrate that ejection of blood from both ventricles (particularly the left) is more like striking a piston with a mallet than like squeezing blood out of a chamber. These dynamic characteristics of ventricular ejection are greatly altered by autonomic control and by simulated disease conditions.
Initial ventricular impulse is greatly augmented during exercise, by stimulation of sympathetic nerves to the heart, and following long diastolic intervals. On the contrary, initial ventricular impulse is markedly depressed during premature ventricular contractions, acute coronary occlusion, exsanguination hypotension, general anesthesia, etc. Thus, signs of changing ventricular impulse may have significant value in assessing the performance capability of the heart. For this purpose, certain clinical tests of cardiac performance (e.g., arterial pressure pulses, electrokymograms, precordial displacements, ballistocardiograms) may have unsuspected importance. Experiments on animals have considerable value in suggesting measurements that might be appropriately employed on human subjects and patients, but because of species differences, the validation of initial ventricular impulse as clinical test of value must ultimately be accomplished by appropriate measurements conducted on human subjects. For this reason, a specific experimental design is suggested for the evaluation of certain indirect indicators that may have potential value in routine assessment of the cardiac status. By means of modern high-speed computers, cross correlations, and factor analysis could bring to light the aspects of peripheral arterial pulse waves, kinetocardiograms, electrokymograms, and ballistocardiograms of reliable predictive value in assessing initial ventricular impulse in man.
Electrode Catheters and the Diagnostic Application of Intracardiac Electrography in Small Children
Authors: WATSON HAMISH 
Published: June 2012

The history of intracardiac electrography has been reviewed with particular reference to its practical application.
The increasing versatility of electrode catheters is stressed and a new multipurpose diagnostic catheter with a platinum electrode is described.
Electrograms chosen from 500 consecutive cases have been presented to demonstrate the use of an intracardiac lead during routine cardiac catheterization, and the special value of this technic in the investigation of congenital heart disease in babies and small children is emphasized.
Acute Infusion of Synthetic Angiotensin II in Patients with Essential Hypertension
Authors: VAGNUCCI ANTONIO I. , LAULER DAVID P. , HICKLER ROGER B. , THORN GEORGE W. 
Published: June 2012

Angiotensin II (1-
l
-asparaginyl-5-
l
-valyl angiotensin octapeptide) infused intravenously in subjects with idiopathic hypertension caused depression of the renal hemodynamics in all of them. In agreement with the findings of other investigators, more than one third of the patients showed a decrease in the rate of the sodium excretion; in the remaining subjects, the pressor infusion increased the excretion of sodium.

In all the hypertensive patients, angiotensin II favored renal reabsorption of water.
From the available evidence, it appears that angiotensin II acts upon the renal tubules. The reason for the opposite effect on sodium excretion in hypertensive patients remains unexplained.
Clinical Experience with Fluorescence Retinal Cinematography
Authors: LINHART JOSEPH W. , MCINTOSH HENRY D. , HEYMAN ALBERT , HART LEONARD M. 
Published: June 2012

Clinical experience with fluorescence retinal cinematography in 70 patients is presented.
The sequence of normal retinal vascular filling is described. Of particular interest is the demonstration that the retinal circulation consists of a number of vascular segments, each of which may have different flow characteristics.
The pathologic alterations in patients with diabetic and hypertensive retinopathy, papilledema, and other disease states are discussed.
The dynamic portrayal of the retinal circulation, enabling moment-to-moment evaluation, and the efficiency of the cinematographic technic are distinct advantages over the singlefilm method.
Innocent Cardiovascular Murmurs in the Adult
Authors: WEAVER WALT F. , WALKER COLIN H. M. 
Published: June 2012

One hundred young adults who were known to have had innocent murmurs as children were re-examined 16 or more years after the murmur was detected. In all individuals a murmur was again heard. Whether or not this was the same murmur could not be determined. While most (85 per cent) had the vibratory quality similar to the childhood vibratory innocent murmur, 87 per cent were audible at or above the third left intercostal space, a higher proportion than is usually found in children. The murmurs could be divided into three main groups: those maximum at the lower left sternal border (58 per cent), the pulmonary area (31 per cent), and the aortic area and neck (10 per cent). Only one was maximum at the apex. No true cardiorespiratory murmurs were heard.
In this study the cardiac sounds and murmurs were faithfully reproduced by the taperecording equipment employed, thus supporting the view that this technic could be used in heart-screening programs but offers no advantage over simple auscultation.
The Effect of Digitalis on Ventricular Ejection in Normal Human Subjects
Authors: WEISSLER ARNOLD M. , GAMEL WILLIAM G. , GRODE HARVEY E. , COHEN SIDNEY , SCHOENFELD CLYDE D. 
Published: June 2012

The administration of deslanoside to normal subjects was associated with an abbreviation in the duration of all phases of mechanical systole in the absence of a change in cardiac output. The decrease in the ejection time index following deslanoside is an expression of the [see figure in the PDF file] diminution in the duration of ventricular ejection relative to heart rate and reflects the enhanced mean rate of left ventricular ejection following the drug. These observations lend additional evidence for the positive inotropic effect of digitalis in the normal heart.
Serial determinations of the left ventricular ejection time index following deslanoside afforded observations on the temporal course of the effect of the drug. The decrease in the left ventricular ejection time index proved to be dose dependent, lending evidence for a direct relationship between the positive inotropic effect and the decreased duration of left ventricular ejection.