bluuebunny/crossref_metadata_2025_split huggingface dataset:
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.
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.
Radioelectrocardiographic Changes during Strenuous Exercise in Normal Subjects
Authors: BELLET SAMUEL , ELIAKIM MARCEL , DELIYIANNIS STAVROS , FIGALLO EDUARDO M. 
Published: June 2012

The effect of strenuous exercise (riding a stationary bicycle at 20 to 25 mph for 3 minutes) on the electrocardiogram was studied in 135 normal subjects, aged 17 to 64 years. Radioelectrocardiography was used to record the tracings
during
and
after
the period of exercise.

The following electrocardiographic alterations
during
exercise were interpreted as representing a normal physiologic response; sinus tachycardia (100 per cent of the cases), increased P-wave amplitude (85 per cent), ST-segment depression of the junction type, 1 mm. or more (75 per cent), diminished (68 per cent) or increased (9 per cent) T-wave amplitude. A few ventricular premature beats were observed in only two subjects (1.4 per cent). All these changes were observed, although less frequently, in the period after exercise (1 minute after the cessation of exercise).

According to criteria for abnormality described previously,
23
34 of the 135 subjects (24.8 per cent) exhibited abnormal responses to the bicycle exercise test. Sixteen of the 34 "definitely" and "probably abnormal" responses (47 per cent) occurred only during the period of exercise, 12 were observed both during and after the exercise and six occurred only in the postexercise period.

The incidence of abnormalities in the group of subjects in the age group 40 to 64 years was 37 per cent, while that in subjects in the age group 17 to 40 years was 22.5 per cent.
A comparison between the Master two-step and the bicycle tests suggests that the latter may be more diagnostic for the detection of latent coronary artery disease and the evaluation of the state of physical fitness in subjects below the age of 40 years.
The Present Role of Hypothermia in Cardiac Surgery
Authors: SPENCER F. C. , BAHNSON H. T. 
Published: June 2012

A survey of the current use of hypothermia during cardiac surgery has been presented. Hypothermia remains a simple and safe method to permit the surgical correction of uncomplicated atrial septal defects, although it is gradually being displaced by pump-oxygenators as they become better understood.
In conjunction with extracorporeal circulation moderate and extreme ("deep") hypothermia has been employed. Moderate hypothermia is without any known deleterious effects and may be of benefit by lowering perfusion rates and decreasing intracardiac aspiration of blood. The role of deep hypothermia with circulatory arrest remains uncertain. It is a condition associated with extreme physiologic alterations, many of which are poorly understood, and the safe limits are not yet clearly defined.
Finally, hypothermia remains a beneficial technic for neurologic injury following resuscitation from cardiac arrest. Recent evidence indicates that the mechanism of benefit involves considerably more than simple reduction of cerebral edema.
Negative P Waves in Lead I in Dextroversion: Differential Diagnosis from Mirror-Image Dextrocardia
Authors: MIROWSKI M. , NEILL CATHERINE A. , BAHNSON HENRY T. , TAUSSIG HELEN B. 
Published: June 2012

The electrocardiographic differentiation of dextroversion from mirror-image dextrocardia has frequently been based on the configuration of the P waves in lead I, the assumption being that P waves are upright in dextroversion and inverted in mirror-image dextrocardia.
A patient is presented with inverted P waves in lead I in whom an electrocardiographic diagnosis of dextroversion was made based on the analysis of the unipolar leads. This diagnosis was confirmed at surgery when a ventricular septal defect was successfully repaired.
The Sodi-Pallares method of analysis of the precordial leads is valuable in determining whether the left ventricle lies anteriorly and to the left as in dextroversion or posteriorly and to the right as in mirror-image dextrocardia. Because of the frequency of unusual atrial rhythms in patients with right-lying hearts, the configuration of the P waves is often unreliable. When there is a discrepancy between the result of analysis of atrial activation and that of ventricular activation, the latter should be used in determining whether dextroversion or mirror-image dextrocardia is present.
Hemodynamic Studies of a Monoamine Oxidase Inhibitor, DL-Serine-N
2
-Isopropylhydrazide (RO 4-1038)
Authors: MAXWELL M. H. , GONICK H. C. , SCADUTO L. , PEARCE M. L. , KLEEMAN C. R. 
Published: June 2012

Hemodynamic studies were performed on 11 patients with severe diastolic hypertension before and after the chronic administration of the monoamine oxidase inhibitor, RO 4-1038.
Although postural hypotension was more marked, the blood pressure decreased significantly in the supine position as well. The hypotensive effect was attributable almost solely to decreased total peripheral resistance and was unrelated to changes in cardiac output, blood volume, or sodium space. Renal plasma flow and glomerular filtration rate were unchanged.
Evidence is presented which suggests that the decrease in blood pressure was not caused by adrenergic blockade.
If RO 4-1038 is a representative monoamine oxidase inhibitor then its hemodynamic action is unique among the clinically useful hypotensive drugs.
Function of the Contralateral Kidney in Renal Hypertension Due to Renal Artery Stenosis
Authors: THAL ALAN P. , GRAGE THEODOR B. , VERNIER ROBERT L. 
Published: June 2012

Severe hypertension of at least 7 years' duration, due to coarctation of the right renal artery, was treated by reconstruction of the abnormal artery and restoration of blood flow to the coarcted kidney. Renal biopsies revealed normal microscopic architecture in the right kidney and advanced hypertensive pathology in the opposite kidney. After 8 months' observation of persistent, moderate hypertension, the left kidney was removed with prompt return of blood pressure to normal levels during the subsequent 2½ years.
These observations demonstrate the precise correlation of hypertension due to renal artery stenosis in the human with the experimental model in rats.
The Relation of Precordial and Orthogonal Leads
Authors: ABILDSKOV J. A. , WILKINSON ROBERT S. 
Published: June 2012

A systematic search was made for the effective axes from an orthogonal lead system that best duplicated the diagnostically significant features of precordial leads.
Only one of 240 precordial leads was not matched with a rotated orthogonal lead having the same features judged to be clinically significant.

The average rotated lead axes corresponding to precordial leads V
1
through V
6
were systematically located from an axis directed upward and to the right corresponding to V
1
to one directed downward and to the left corresponding to V
6
.

The location of these average rotated axes has been presented and the per cent contribution of XYZ leads to each of these axes has been calculated.
These results provide a guide to the orthogonal lead location of diagnostic information now obtained from precordial leads.
Surgical Management of Echinococcal Cysts of the Heart and Pericardium
Authors: HEILBRUNN ALFRED , KITTLE C. FREDERICK , DUNN MARVIN 
Published: June 2012

Surgical treatment of a 27-year-old man with an echinococcal cyst of the heart is reported, illustrating some difficulties and problems manifested by this lesion.
Twenty-seven other patients operated upon for cardiac hydatid disease are reviewed in tabular form.
Symptomatology, diagnosis, and management of this rare cardiac lesion are reviewed.
Experience with 200 Renal Artery Reconstructive Procedures for Hypertension or Renal Failure
Authors: MORRIS GEORGE C. , DEBAKEY MICHAEL E. , COOLEY DENTON A. , CRAWFORD E. STANLEY 
Published: June 2012

Renovascular hypertension is the most common form of reversible hypertension.
An analysis of 200 renal artery reconstructive procedures identified atherosclerosis as the arteriopathic lesion in 83 per cent of cases and fibromuscular hyperplasia in 13 per cent of cases. Bilateral renovascular disease was found in 31 per cent of cases.
Renal arteriography is the most significant factor in the diagnostic evaluation of the hypertensive subject.
Bypass graft and patch-graft angioplasty were the most commonly employed principles of renal artery reconstruction in this series.
The occlusive process in the renal artery produced a pressure gradient exceeding 25 mm. Hg in 76 per cent of cases.
The average period of observation following operation in these 200 patients was 1.6 years, ranging between 3 months and 5 years. Eighty per cent of patients are now normotensive.
The primary goal of operation in 12 patients was reversal of renal failure due to severe bilateral renal artery occlusive disease. Disappearance of azotemia with improved renal function followed revascularization in 11 of 12 patients.
Survival After Mesenteric Arterial Occlusion by Treatment with Low Molecular Weight Dextran
Authors: D'ANGELO GEORGE J. , AMERISO LORENZO M. , TREDWAY JOHN B. 
Published: June 2012

1. A segment of small bowel, approximately 30 cm., was acutely deprived of its arterial supply in 16 dogs.
2. Six dogs served as controls, receiving 15 ml./Kg. of 0.9 per cent saline or 1 ml./Kg. heparin. In all of these animals, the segment of bowel became necrotic.
3. Ten animals received 15 ml./Kg. of low molecular weight dextran after five hours of arterial occlusion, with survival of the involved bowel in all 10 dogs for a period of 48 hours to 3 weeks.
4. After five hours, the serum amylase in all animals decreased. In the control animals, the amylase value continued to decrease, whereas in the animals receiving the low molecular weight dextran it began to rise toward normal value.
Application to Coronary Arteries of the Basic Principles Governing the Development of Collateral Arterial Channels
Authors: SEWELL WILLIAM H. 
Published: June 2012

The experiments performed on 350 dogs showed that when certain technical points were observed, a pedicle containing the mammary artery, mammary vein, and surrounding soft tissue consistently contributed large collateral channels which were capable of carrying the entire arterial blood supply to a large portion of the left ventricle of the heart of a dog with experimental chronic coronary arterial hypotension. Original plastic devices were used to produce controlled, gradual, coronary constrictions and occlusions.
Direction and velocity of movement and size of the donor arteries, the collateral channels, and the recipient coronary arteries were determined from frame-by-frame analysis of cinearteriograms.
Newer Techniques of Transseptal Left-Heart Catheterization
Authors: COPE CONSTANTIN 
Published: June 2012

1. Teflon tubing is ideally suited for transseptal catheterization because of its low coefficient of friction.
2. Catheterization of the left ventricle can be easily performed with a maneuverable spring guide.
3. A Teflon-tipped cannula and a tough, flexible, Teflon guide are used for percutaneous catheter insertions.
4. Safety measures used in transseptal puncture are described.
5. Simultaneous percutaneous insertion of a retrograde Teflon aortic catheter and the transseptal catheter permit transvalvular gradients to be obtained even when a diseased mitral or aortic valve cannot be crossed.
Correlation of the Extent and Severity of Atherosclerosis in the Coronary and Cerebral Arteries
Authors: MATHUR K. S. , KASHYAP S. K. , KUMAR V. 
Published: June 2012

A study of correlation of the extent and severity of atherosclerosis in the coronary and cerebral arteries and between their individual branches has been undertaken in 200 consecutive medicolegal autopsies.
The coronary atherosclerosis developing first in the second decade appears about 20 years earlier than the cerebral atherosclerosis. There is, however, a significant correlation between the coronary and cerebral arterial beds.
There is a significant interbranch relationship within the coronary system. The atherosclerotic process starts earliest in the left anterior descending branch of the coronary arteries. The extent of correlation is more marked between the two branches of the left coronary artery than that of either of them with the right coronary artery. The interbranch relationship in the cerebral arterial bed also shows a significant correlation. Basilar artery shows the maximum atherosclerosis, next in order being middle cerebral artery; the postcerebral artery shows much less affliction to the atheroma and the anterior cerebral artery exhibits a high degree of freedom.
Complete Transposition of the Great Vessels
Authors: ELLIOTT LARRY P. , NEUFELD HENRY N. , ANDERSON RAY C. , ADAMS PAUL , EDWARDS JESSE E. 
Published: June 2012

This paper is based on a study of specimens of the heart that were obtained in 60 cases of complete transposition of the great vessels.
The external relationship of the aorta and pulmonary trunk usually differed from the classic description of the aorta lying directly anterior to the pulmonary trunk (type III). This relationship was present in only two of the 60 cases. In 39 cases, the relationship of the great vessels was oblique (type I). In 19 of the 60 cases, the relationship of the great vessels was side-to-side (type II).
There were two main patterns of origin of the coronary arteries. One had a tendency to be associated with the oblique (type I) relationship of the great vessels, which was most common; the other had a tendency to be associated with the side-to-side (type II) relationship of the great vessels, which was the second most common type.
A ventricular septal defect was present in 22 (37 per cent) of the 60 cases. The anatomic characteristics of these defects were the same as occur in cases of an isolated defect in the ventricular septum. It was of particular interest that a left ventricular-right atrial communication was observed in three cases.
Miscellaneous conditions observed include congenital obstruction of the aortic arch (eight cases), a right aortic arch in association with a ventricular septal defect and pulmonary stenosis (two cases), and juxtaposition of the atrial appendages (two cases).
The atrioventricular valves resembled the homolateral valves of normal hearts. An Ebstein-like malformation of the mitral valve was present in one case.
Atrial Activity and Systemic Blood Pressure during Anesthesia in Man
Authors: LAVER MYRON B. , TURNDORF HERMAN 
Published: June 2012

Atrial contribution to ventricular performance was evaluated during halothane anesthesia in man by a method whereby atrioventricular dissociation is readily induced. Three conditions are outlined that facilitate production of this arrhythmia in man: general anesthesia with a halothane-oxygen mixture by use of an average inspired halothane concentration of 0.5 per cent; controlled ventilation following muscle paralysis with d-tubocurare; and an exogenous stimulus, most easily provided by the onset of surgery. The last factor is probably mediated via direct sympathetic stimuli to the heart.
The change from sinoatrial to atrioventricular nodal rhythm was associated with a fall in arterial pressure and a rise in central venous pressure; the heart rate remained unaltered. The changes in the systemic and central venous pressures were attributed to failure of atrial systole to contribute to ventricular filling during diastole.
It is suggested that tricuspid regurgitation may occur during nodal rhythm, since synchronous atrioventricular contraction is required for adequate closure of the atrioventricular valve. Further studies of this problem in anesthetized man with this particular pharmacologic tool are indicated.
Hemodynamic Effects of Chronic Severe Anemia
Authors: ROY SUJOY B. , BHATIA MADAN L. , MATHUR VIRENDER S. , VIRMANI SHYAMA 
Published: June 2012

Data on the cardiac output and circulatory dynamics obtained by cardiac catheter studies in 51 subjects with chronic severe anemia are presented. Patients are divided into two groups: group A consists of 26 subjects with an average hemoglobin value of 3.0 Gm. per 100 ml. (range 1.5 to 3.8 Gm.); group B, 25 patients with a hemoglobin level of 4.0 to 6.5 Gm., average 4.5 Gm.
Group A subjects have a somewhat faster heart rate (99 against 92 a minute), higher cardiac index (8.0 versus 6.3 liters per minute per square meter), and stroke index (88 and 68 ml. per beat per square meter) than group B patients.
The oxygen consumption values in both groups are normal (average 158 and 160 ml. per minute per square meter), while more oxygen is extracted by the tissue in group A subjects (61 and 53 per cent) whereas less oxygen is transported to the tissue (261 and 321 ml. per minute per square meter).
The stroke volume seems to bear a closer relationship to the high cardiac output than such other parameters as heart rate, right heart filling pressure, and velocity of blood flow. Apparently the presence of slow heart rate does not negate high cardiac output.
Data also suggest that systemic vascular resistance may play an important role in the high cardiac output as the two are inversely related, and by increasing the peripheral arterial pressure the output can be significantly reduced.
Restudy data after the treatment of the anemia (hemoglobin 10.0 to 12.5 Gm. per 100 ml.) show appreciable reduction in the cardiac output and in the right heart filling pressure, increase in the peripheral vascular resistance and oxygen transport values, and widening of the arteriovenous oxygen differences with concomitant decrease in the oxygen extraction by the tissue.