bluuebunny/crossref_metadata_2025_split huggingface dataset:
Radioelectrocardiography during Exercise in Patients with Angina Pectoris
Authors: BELLET SAMUEL , ELIAKIM MARCEL , DELIYIANNIS STAVROS , LAVAN DONALD 
Published: June 2012

The electrocardiographic changes during exercise were examined by means of the radio-electrocardiograph and compared with the changes in the postexercise period in 70 patients with coronary artery disease. This method permitted the recording of one-lead tracings during exercise with a stable baseline and minimal interference. In addition, it has the advantage of permitting free exercise because of the absence of wire connections between the patient and the recording machine. Tracings may be taken on patients performing exercise at a distance of up to several hundred feet from the electrocardiograph.
The criteria for abnormality based on double Master two-step tests in 127 normal individuals below the age of 40 years were appearance or increase in ischemic S-T-segment depression of 1 mm. or more, appearance or increase of S-T-segment elevation of 1 mm. or more, inversion of a positive or reversion of a negative T wave, frank inversion of the U wave, widening or narrowing (of a previously widened) QRS complex, and appearance of multiple premature beats.
Thirty-seven of the 70 patients (53 per cent) showed electrocardiographic abnormalities during the period of exercise (single Master two-step test), while only 24 (34 per cent) had similar changes in the postexercise period. Twenty-three of the 70 patients had normal resting electrocardiograms. Of these, 11 (48 per cent) had abnormal alterations during, and six (26 per cent) after exercise. Forty-seven of the 70 patients had abnormal resting electrocardiograms. Twenty-six of these (55 per cent) had abnormal changes during exercise and 18 (38 per cent) after exercise.
The advantage of recording the electrocardiogram during exercise is shown by the fact that in 17 of the 37 patients with abnormal responses, the changes were limited to the actual period of exercise and the immediate postexercise period, and would probably be missed were the postexercise tracing taken alone. Possible improvements in technic aimed at increasing the incidence of positive responses are discussed. It is suggested that the recording of the electrocardiogram both during and after exercise should replace the presently used technic in the Master two-step test.
The Spectrum of Coronary Heart Disease in a Community of 30,000
Authors: SPIEKERMAN RALPH E. , BRANDENBURG JOHN T. , ACHOR RICHARD W. P. , EDWARDS JESSE E. 
Published: June 2012

The high rate of necropsy in deaths among permanent residents of Rochester, Minnesota, provided a unique opportunity to study the prevalence of coronary heart disease and the frequency and mode of death resulting from this disease. In this community of approximately 30,000 population, necropsy was done in 73 per cent of all resident deaths during the years 1947 through 1952. Included in this group were 691 necropsies that represented 67 per cent of the 1,026 deaths of persons 20 years of age or older.
Coronary heart disease caused death in 221 patients (23 per cent of all necropsies and 32 per cent of all necropsies on adults). These 221 coronary deaths in adults represented 41 per cent of the men and 22 per cent of the women. The coronary deaths were attributed to acute coronary failure (sudden death) in 94 patients (43 per cent), acute myocardial infarction in 87 patients (39 per cent), congestive heart failure in 32 patients (14 per cent) and thromboembolism in eight patients (4 per cent). The 87 patients dying during acute myocardial infarction died of congestive heart failure (30 per cent), myocardial rupture (24 per cent), acute coronary failure (23 per cent), and thromboembolism (14 per cent), with the remaining 9 per cent dying of a combination of acute myocardial infarction and additional serious systemic disease.
The greatest number of deaths from coronary heart disease occurred during the seventh decade of life in men and the eighth decade in women. At least one coronary artery exhibited from 25 to 100 per cent obstruction from atherosclerosis in 513 hearts (74 per cent of the adult necropsies).
These necropsies, representing two thirds of all deaths in adults in this community, disclosed that significant coronary-artery disease was present in three of four adults and was the cause of death in four of 10 men and two of 10 women.
Aortic Origin of the Right Pulmonary Artery
Authors: GRIFFITHS SYLVIA P. , LEVINE O. ROBERT , ANDERSEN DOROTHY H. 
Published: June 2012

The clinical course and pathologic findings in three cases of anomalous origin of the right pulmonary artery from the ascending aorta are described. The malformation is characterized by (1) absent right branch of the pulmonary artery, (2) a single large vessel arising from the ascending aorta, entering the hilus of the lung and constituting its sole arterial blood supply, and (3) normal size and structure of the right lung. A review of the literature indicates the rarity of this lesion as an isolated anomaly; patent ductus arteriosus is the most frequently described additional defect.
Histologic examination of the right and left lungs reveals bilateral and symmetrical pulmonary vascular changes, despite the difference in their arterial supply. Some pathophysiologic observations based on the necropsy findings in these cases are discussed.
Early diagnosis and surgical correction are imperative, since this malformation may lead to irreversible congestive heart failure and death in infancy. Surgical repair may be accomplished by transplanting the anomalous right pulmonary artery from the aorta to the main pulmonary trunk.
A Clinicopathologic Study on the Feasibility of Direct Surgical Treatment of Occlusive Coronary Arterial Disease
Authors: SWEDLUND HARRY A. , ACHOR RICHARD W. P. , EDWARDS JESSE E. 
Published: June 2012

The coronary arteries of 112 patients with an antemortem diagnosis of coronary arterial disease were studied at necropsy with regard to the feasibility of coronary endarterectomy for direct relief of the luminal narrowing. The patients ranged in age at the time of death from 40 to 87 years. The condition of the coronary arteries in 20 cases (18 per cent) was classed as pattern 1 (theoretically operable), in 58 cases (52 per cent) as pattern 2 (theoretically capable of palliation), and in 34 cases (30 per cent) as pattern 3 (theoretically inoperable). The youngest man who had a pattern 1 condition was 54 years of age, and of 26 men studied who were less than age 60 years, two had pattern 1 conditions, 12, pattern 2, and 12 pattern 3. Of the four women less than 65 years of age, none had pattern 1 conditions, two had pattern 2, and two had pattern 3.
An impression gained from this study was that in general the most severe and diffuse lesions observed at necropsy are seen in the younger men who give clinical evidence of coronary arterial disease. Certain clinical features were analyzed in an attempt to find a correlation between these factors and the anatomic state of the coronary arteries. No clearly defined correlation could be discovered in this series.
The role of direct surgical attack on the coronary arteries for relief of atherosclerosis does not appear to be an encouraging one from this study of clinical features and the final pathologic anatomy.
Multiple Small Pulmonary Arteriovenous Fistulas
Authors: SANDERS J. S. , MARTT J. M. 
Published: June 2012

The condition of multiple small pulmonary arteriovenous fistulas is discussed with regard to diagnosis, complications, and possible etiology. The lesions are believed to be either congenital in origin or secondary to cirrhosis of the liver with portal hypertension. Surgical therapy has not been attempted in this condition because of the diffuse nature of the lesions.
A case is discussed wherein the diagnosis of diffuse small pulmonary arteriovenous fistulas was made by cardiac catheterization. The catheter was passed through an atrial septal defect into a pulmonary vein. Difference in oxygen saturation between the pulmonary vein and pulmonary capillaries (pulmonary vein wedge) revealed conclusive evidence of a right-to-left shunt in this area. Etiologic and therapeutic considerations are discussed in view of recent literature on this subject.
Atrial Tachycardia with Block Treated with Digitalis
Authors: MORGAN WILLIAM L. , BRENEMAN GERALD M. 
Published: June 2012

Fifteen cases of atrial tachycardia with block were seen at the Henry Ford Hospital in 1 year. In nine cases the arrhythmia was not a result of digitalis excess. One of these nine patients has had the arrhythmia for 5 years, and two others had not received prior digitalis. In four cases, stopping digitalis and adding potassium did not affect the arrhythmia. Two patients experienced a brief episode of the arrhythmia while continuing digitalis. The addition of digitalis or a continued maintenance dose was necessary to control congestive heart failure or a rapid ventricular rate in all nine patients. The six remaining patients with atrial tachycardia with block had digitalis intoxication.
When one first encounters this arrhythmia, the possibility of digitalis intoxication should immediately be considered. Digitalis and diuretics should be stopped and potassium added. If the arrhythmia persists despite this therapy, digitalis intoxication becomes less likely and the administration of the drug may be indicated.
Hourly Changes in Serum Cholesterol Concentration
Authors: PETERSON JOHN E. , KEITH ROBERT A. , WILCOX ALAN A. 
Published: June 2012

Further evidence has been obtained to indicate that the concentration of serum cholesterol can vary widely during the course of a few hours in certain individuals.
The data are consistent with a hypothesis that changes in the concentration of serum cholesterol may relate to the anticipation of an event as well as to the event itself.
Similarity in the hourly variation in serum cholesterol concentration occurring among eight carefully selected subjects, during control as well as during test periods, is note-worthy.
Conduction Disturbances in Patent Ductus Arteriosus
Authors: MIROWSKI M. , AREVALO F. , MEDRANO G. A. , CISNEROS F. A. 
Published: June 2012

A study of conduction disturbances in 200 patients with patent ductus arteriosus was carried out.
The atrioventricular (AV) conduction was found generally disturbed as compared with normal cases. A significant delay in AV conduction was demonstrated by the high incidence (10.5 per cent) of first-degree AV block, by the elevated percentage of high values of the P-R index and by a high mean P-R index in the whole series (0.85 versus 0.75 in normal subjects).
After surgery a significant improvement in AV conduction was noted. First-degree AV block disappeared in 79 per cent of the cases, and in some instances the block decreased in intensity. In cases without diagnosis of AV block the improvement, as manifested by the diminution of the P-R index, was observed in 62 per cent of the cases. The improvement in AV conduction was greater in those groups with higher preoperative P-R index. The impression was that a large number of cases with high values of the P-R index, although still below the upper limit of normal (1.00), actually have first-degree AV block, undiagnosed by the usual criteria. The mean P-R index after surgery for the whole group was 0.79.
It was suggested that the AV conduction disturbances in patent ductus arteriosus are related, in some way, to the hemodynamic conditions of this entity and particularly to the left-to-right shunt between aorta and pulmonary artery.
Six cases (3 per cent) of incomplete right bundle-branch block and five (2.5 per cent) of incomplete left bundle-branch block were found. These disturbances did not change after surgery.
Studies on Starling's Law of the Heart
Authors: GLEASON WILLIAM L. , BRAUNWALD EUGENE 
Published: June 2012

The applicability of Starling's law of the heart to the circulation of intact human subjects was studied by means of serial biplane angiocardiography utilizing injections into the left ventricle in nine patients, four of whom were unanesthetized. The end-diastolic and end-systolic volumes of the left ventricle were determined from the angiocardiograms by the method described by Dodge, and stroke volumes were calculated by subtracting the end-systolic from the end-diastolic volumes. In four patients large beat-to-beat variations in left ventricular end-diastolic volume occurred. These were accompanied by changes in stroke volume which varied directly with the preceding left ventricular end-diastolic volume. In four patients the left ventricular end-diastolic volume remained about constant, and in these patients the stroke volume showed little or no change. From these observations it was concluded that the ventricular stroke volume is a function of the end-diastolic volume and that therefore Starling's law of the heart is applicable to man.
In the ninth patient pulsus alternans occurred; this was accompanied by concordant alternation of the left ventricular end-diastolic volume; i.e., the larger end-diastolic volumes resulted in larger stroke volumes and higher systolic pressures than did the smaller end-diastolic volumes. These observations are compatible with the concept that alternation of ventricular contraction can be explained by alternation of end-diastolic volume.
Ruptured Papillary Muscle Following Myocardial Infarction with Long Survival
Authors: BRENEMAN GERALD M. , DRAKE ELLET H. 
Published: June 2012

Two cases of rupture of a papillary muscle of the left ventricle are presented. We believe that these are the two longest recorded survivals of this complication of acute myocardial infarction.
A presumptive clinical diagnosis is possible from the characteristic history of sudden deterioration together with the development of a loud apical systolic murmur. The differential diagnosis and the possibility of corrective surgery in a patient who survives the acute event are discussed.
Renal and Adrenal Relationships in Refractory Edema
Authors: KESSLER EDWARD , HILTON JAMES G. , LEVY M. ROBERT 
Published: June 2012

The relationships between the excretion of sodium and water and adrenal activity in patients with refractory edema have been investigated.
Experiments have been performed over a prolonged period with varying doses and combinations of spironolactone, prednisone, hydrochlorothiazide, Su4885, and ACTH. In four patients with Laennec's cirrhosis with ascites the effects of prednisone on the excretion of water and solute were studied during maximum water diuresis.
The results indicate that diuretic agents may increase the excretion of sodium without water within certain undefined limits. This effect probably resulted from the delivery to the concentrating segment of an amount of sodium inadequate to dissipate the gradients favoring water reabsorption.
Prednisone appeared to have a dual effect: one on the excretion of water, the other on the excretion of sodium. The effects on sodium and water did not appear to be related.
The effects of prednisone on the excretion of water support the concept that the glucocorticoids exert an effect on water in the renal tubules rather than on the posterior pituitary.
Prednisone enhanced sodium excretion only when given together with another diuretic agent. It is suggested that the failure of prednisone alone to increase sodium excretion resulted from a blockade of ACTH secretion and, thereby, the adrenal synthetic pathway of aldosterone, whereas the renal aldosterone-stimulating pathway continued to function. The potentiating effect of prednisone on the excretion of sodium becomes apparent only when aldosterone activity is overcome in the renal tubules by the natriuretic effects of various diuretics.
It is considered possible that renal aldosterone-stimulating hormone acts only under more intense stimuli to edema formation.
Evaluation of Mitral Annuloplasty for Mitral Regurgitation
Authors: ANDERSON ARTHUR M. , COBB LEONARD A. , BRUCE ROBERT A. , MERENDINO K. ALVIN 
Published: June 2012

Eleven patients seriously disabled by mitral regurgitation were re-evaluated 4 to 41 months following mitral annuloplasty (average 19.4 months). Preoperative and postoperative comparative data are presented. One patient was unimproved or worse. The rest were subjectively better.

Mean changes were transverse cardiac diameter -17.8 mm. (median 15 mm.) (
p
< .005); resting stroke index +9 ml./beat/M.
2
(median 9 ml./beat/M.
2
,
p
< .05); resting cardiac index +0.5 L./min./M.
2
(
p
= .20); mean pulmonary artery pressure -7.2 mm. Hg, or 29 per cent (median 8 mm. Hg,
p
< .03); and arteriovenous oxygen difference -12 ml./L. (median 13 ml./L.,
p
< .005). Abnormally prolonged mixing, as shown by indicator-dilution curves, was decreased in all patients (
p
< .05). Exercise testing showed varying degrees of improvement in six of the nine so studied.

In six patients mitral regurgitation by angiocardiographic measurements postoperatively represented 0, 0, 21, 24, 35, and 46 per cent of the total left ventricular stroke volume. Two patients had increased end-systolic left ventricular volume as evidence for postoperative left ventricular failure. The other four were probably normal.
Ten of the 11 patients showed postoperative improvement that was felt to be significant in two or more of the above objective measures. Striking x-ray improvement in heart size occurred in two patients, eight others showed decreases in transverse diameter of up to 17 mm. One developed an increase in heart size.
Although probably improved over their preoperative status, two patients had significant mitral stenosis at the time of re-evaluation. Another showed evidences of progressive mitral regurgitation after an initial period of improvement.
Mitral annuloplasty is a palliative procedure with considerable potential for effecting a reduction in regurgitant volume and improving the clinical status of carefully selected patients.
Secondary Malignant Tumors of the Pericardium
Authors: THURBER DELORAN L. , EDWARDS JESSE E. , ACHOR RICHARD W. P. 
Published: June 2012

Among 13,314 necropsies following death from neoplastic and nonneoplastic diseases performed at the Mayo Clinic from 1942 through 1958, 189 cases of secondary malignant lesions of the pericardium were demonstrated, an incidence of 1.42 per cent. Carcinoma of the lung and breast, the lymphomas, and leukemia constituted the large majority of the primary malignant lesions that caused the pericardial metastasis. Fifty-five of the 189 patients were adjudged to have had some impairment of cardiac function as a consequence of the pericardial metastasis and the following conclusions concern this group.
1. In 47 patients (86 per cent), the lesions were either the immediate or a contributory cause of death.
2. The most common mechanism whereby metastatic lesions in the pericardium interfered with cardiac function was by the development of pericardial effusion. Next in frequency was effusion combined with myocardial invasion and then cardiac constriction by tumor. Combinations of these processes with malignant encroachment on the great vessels and with invasion of coronary veins were the other mechanisms noted. Involvement of coronary arteries and the cardiac nerve supply was not noted.
3. Pericardial fluid was significant in causing tamponade in 31 cases. The fluid was frankly hemorrhagic in a small minority of these cases although fibrinous pericarditis was present in 45 (82 per cent) of the group. Pleural effusion was present in 48 (92 per cent) of 52 cases and was usually bilateral. Ascites was present in 22 (50 per cent) of 44 cases; the quantity was usually rather small.
4. Only one patient had metastasis to the pericardium without metastasis to other thoracic structures; exclusive of patients with leukemia, 43 (92 per cent) of 47 patients had extrathoracic metastatic lesions.
5. Dyspnea, cough, pleural effusion, hepatomegaly, and thoracic pain were the most commonly recorded signs and symptoms that might be related to the pericardial lesions. However, more specific signs and symptoms directing attention to pericardial or cardiac involvement were not commonly recorded.
6. The diagnosis of pericardial metastatic disease was suspected or established in only 16 (29 per cent) of the 55 patients, although 34 (62 per cent) either received treatment for congestive heart failure or were given roentgen therapy to mediastinal structures.
7. Of the 27 patients whose electrocardiograms were available, 25 had T-wave abnormalities, 22 had low QRS voltage, and 15 showed sinus tachycardia.
8. Thoracic roentgenograms, made on 53 patients, supplied clues to the diagnosis of pericardial malignancy in 28.
Congenital Absence of the Pulmonary Valve
Authors: MILLER ROBERT A. , LEV MAURICE , PAUL MILTON H. 
Published: June 2012

A group of cases of tetralogy of Fallot with congenital absence of the pulmonary valve are presented, and it is indicated that this abnormality presents a characteristic clinical, physiologic, and pathologic syndrome.
It is postulated that the aneurysmal dilatation of the pulmonary artery may result either from a congenital weakness at the base of the pulmonary artery or from the hemodynamic effects of a ventricular septal defect and infundibular stenosis in the presence of pulmonary regurgitation.
The absence of the pulmonary valve has not been a deterrent to successful corrective surgery aimed at the basic pathology of tetralogy of Fallot in three cases.
On the Plasma Membrane of Some Bacteria and Fungi
Authors: ROBINOW CARL F. , Marak John 
Published: June 2012

The contents of bacterial cells can be reversibly pulled away. (plasmolyzed) from the wall by strong salt solutions. Bacterial "protoplasts"—living cells divested of their wall—shrink or swell with changing concentrations of solutes in their environment and burst when this concentration falls below a critical level. These observations have long suggested that the cytoplasm of bacteria is covered by a selectively permeable plasma membrane.
In recent years electron microscopy has revealed the existence of a narrow profile at the surface of the cytoplasm of bacteria. In some bacteria, these profiles have the dimensions of sections of the "unit membrane" found in the interior and at the surface of plant and ainimal cells.
In the place of a unit membrane, single tracks of densely stained granules are found in many bacteria. New electron micrographs confirm the observation of Young and Fitz-James (1959) that the first spore membrane is derived fromn an infolding of the plasma membrane of the mother bacterium.

Illustrations are provided of the plasmna membrane of
B. mycoides
and of the yeast
Lipomyces lipofer
.
Ventricular Fusion Beats
Authors: MARRIOTT HENRY J. L. , SCHWARTZ NEIL L. , BIX HAROLD H. 
Published: June 2012

Relatively precise criteria are proposed for the recognition of ventricular fusion beats. Apart from the obvious and widely accepted criteria involving contour, duration, and time of appearance, other less obvious characteristics have been adduced: (1) the P-S time of the fusion beat must always be considerably longer than the P-R interval of the component sinoatrial beat; (2) the P-R interval of the fusion beat is generally not more than 0.06 second shorter than the sinoatrial P-R; (3) the terminal vector of the fusion beat is always different from that of the sinoatrial beat, while the initial vector may or may not differ. Exceptions to these criteria are seen in the presence of bundle-branch block, during periods of inconstant atrioveutricular conduction times, and presumably in the presence of diffuse intraventricular conduction delays.
The shortcomings of conventional diagrams for depicting the mechanisms of arrhythmias are noted, and a plea is made for the use of more accurate symbols in their construction.
Fusion beats are not an indispensable criterion for the diagnosis of ventricular parasystole.