bluuebunny/crossref_metadata_2025_split huggingface dataset:
Mechanisms of Fixed Splitting of the Second Heart Sound
Authors: PERLOFF JOSEPH K. , HARVEY W. PROCTOR 
Published: June 2012

Forty-four patients with wide splitting of the second heart sound and 25 normal controls were studied with fast speed logarithmic phonocardiograms.
In the control group, inspiratory augmentation of right heart filling increased the right ventricular stroke volume, prolonged the right ventricular stroke time and delayed pulmonic valve closure, thus altering the second sound from expiratory synchrony to inspiratory separation of its 2 components.
In the group with atrial septal defects, the second sound normalized postoperatively, reflecting the ability of the right ventricle to undergo its normal inspiratory increase and expiratory decrease in stroke volume when the defect was closed. Before closure, the right ventricular stroke time neither shortened with expiration nor lengthened with inspiration because of the constant diastolic right ventricular hypervolemia. Hence, preoperatively the interval between aortic and pulmonic valve closures remained characteristically wide and fixed. That the preoperative delay in pulmonic valve closure could not have been a reflection of "incomplete right bundle-branch block" was illustrated by the postoperative normalization of the second sound without change in the QRS pattern of the electrocardiogram. Although the split of the second sound was not altered by respiration, it was altered by change in cycle length, widening after longer cycles and narrowing after shorter cycles.
Wide splitting of the second heart sound was found in mitral insufficiency because of early aortic valve closure, in complete right bundle-branch block because of delayed pulmonic valve closure, and in complete left bundle-branch block because of a reversed sequence of aortic-pulmonic valve closure. When right ventricular failure coexisted with these lesions, the decompensated chamber did not convert its inspiratory augmentation of filling into increased stroke volume. The inspiratory increase in right ventricular stroke time and the inspiratory delay in pulmonic valve closure therefore could not occur so the split of the second sound remained fixed throughout the respiratory cycle.
The Aortic Arch Syndrome (Pulseless Disease)
Authors: THURLBECK W. M. , CURRENS J. H. 
Published: June 2012

Ten patients are presented in whom absent arterial pulsations were noted in 1 or both arms. Six patients also had absent carotid arterial pulsations on 1 or both sides.
The blood pressure was determined satisfactorily by a machine devised to record the Korotkov vibrations. This indicates feeble arterial pulsation in spite of inability to palpate them clinically.
Three autopsied cases showed severe atherosclerosis with superimposed thrombosis.
Long-term anticoagulation used in 2 patients for as long as 3 years seemed to result in some clinical improvement.
Clinical Use of the Percutaneous Renal Biopsy
Authors: ARNOLD JOHN D. , SPARGO BENJAMIN 
Published: June 2012

The renal biopsy is undoubtedly a justifiable diagnostic tool though it has not yet reached full maturity in clinical practice.

Risks.
For most patients the risks do not appear to be excessive. An added caution must be exercised in malignant hypertension but even here after careful appraisal of this added risk the biopsy may still be justified. The experience of the operator would appear to modify some of the risk.

Returns.
The biopsy has often added to the confusion surrounding a given case because it may be uninterpretable or because it provides an unfamiliar complex of findings. Thisresult is becoming less common with increasing experience.

Even when the histology of the kidney is not diagnostic, it may suggest something of clinical value about the nature of the disease process, such as the presence of vascular disease, focal nephritis, or tubular disease of unidentified nature. The use of the electron microscope has extended the range of the percutaneous biopsy considerably. It is unfortunate that the cost and complexity of this instrument have confined it to certain centers.
It should be remembered also that a number of technical failures will occur, and the sampling error may be large.
Despite these real problems, the percutaneous renal biopsy is often the only way of establishing a diagnosis and makes its greatest contribution in the appraisal of the asymptomatic patient with proteinuria and an abnormal urinary sediment.
Right Atrial Myxoma
Authors: BELLE MARTIN S. 
Published: June 2012

A case of myxoma of the right atrium with physiologic, surgical, and angiocardiographic findings has been presented together with a review of 6 other published cases.
Several findings have been emphasized that may call attention to the possible diagnosis of right atrial myxoma: right-sided heart failure; intracardiac calcification of the right heart; enlargement of the right ventricle and right atrium; electrocardiographic findings of a prominent P wave and low voltage over right precordium simulating that found in Ebstein's anomaly and marked variation in heart rate not related to any physiologic event or change in rhythm; use of intracavitary electrode catheter to rule out Ebstein's anomaly; and finally, analysis of the right atrial curve may lead one to suspect that other than valvular stenosis is present.
Angiocardiography gives a definitive diagnosis.
Cure may now be obtained with surgical removal of myxomas; therefore, it is important that they be detected during life.
Clinical Evaluation of Chlorothiazide
Authors: KIRKENDALL WALTER M. 
Published: June 2012

In the 2 years chlorothiazide has been available, it has been demonstrated to have many of the characteristics of the ideal diuretic agent. It has become an important drug in the treatment of patients with edema and hypertension. Experience has indicated that the side effects and toxic reactions are not severe nor do they prohibit long-term use of the drug. In the vast majority of patients, clinical effectiveness has persisted for the duration of the study, up to 2 years in some and more than a year in many.
Chlorothiazide is a new type of powerful diuretic agent. Surely other similar compounds will be introduced. For these reasons, it is especially important that we understand its mechanism of action and shortcomings. Interest in the pharmacology of chlorothiazide already has brought us new information about certain fundamental problems of kidney function and systemic arterial hypertension.
The American Heart Association as a National Voluntary Public Health Agency
Authors: SHEPARD W. P. 
Published: June 2012

The role of the voluntary health agencies in this country is well understood. Tuberculosis, blindness, venereal disease, cancer, and other major public health problems have been attacked by them with notable success, some for as long as 50 years. There is a well established pattern of cooperation with official health agencies and with organized medicine.
In its newly added role as a voluntary public health agency, it is important for the American Heart Association to understand these principles and patterns that are discussed here briefly with special emphasis on partnership with nonmedical community leaders, the relationship with the official agencies, including the National Institutes of Health, and on socialized medicine. Good public health work by voluntary organizations is a manifest of the concern of the medical profession with the health of the public and our first bulwark against compulsory government controlled medicine.
Congenital Coronary Arteriovenous Fistula Associated with Large Patent Ductus
Authors: BOSHER LEWIS H. , VASLI SVERRE , MCCUE CAROLYN MOORE , BELTER LESTER F. 
Published: June 2012

An unusual case of congenital coronary arteriovenous fistula is reported, bringing the total number of reported cases to 39.
This is the second case in which the left coronary artery system communicated directly with the right atrium, and also the second case associated with a patent ductus.
Our case is well documented by cardiac catheterization data, retrograde aortography, and postmortem findings.
Although surgical correction of both the patent ductus and coronary arteriovenous fistula was accomplished without great difficulty, the patient died 30 hours postoperatively, presumably from the effects of severe pulmonary hypertension.
Nucleated Red Blood Cells in Congestive Heart Failure
Authors: FRUMIN ABRAHAM M. , MENDELL THEODORE H. , MINTZ SOLOMON S. , NOVACK PAUL , FAULK ARTHUR T. 
Published: June 2012

Five patients with congestive heart failure who had peripheral nucleated red cells are reported and the literature is reviewed.
We believe that bone marrow anoxia is the cause for the premature or abnormal release of nucleated red cells in congestive heart failure.
The presence of nucleated red cells in the peripheral blood of patients with congestive heart failure is suggestive of a poor prognosis.
Autopsy Studies in Atherosclerosis
Authors: WILKINS ROBERT H. , ROBERTS JAMES C. , MOSES CAMPBELL 
Published: June 2012

The incidences of obesity, hypertension, nephrosclerosis, and rheumatic carditis in 500 adult patients were noted at autopsy, and were correlated with the distribution and severity of concomitant atherosclerosis.
In men, obesity uncomplicated by hypertension was associated with a significant increase in the severity of coronary atherosclerosis and the occurrence of cardiac catastrophes. Uncomplicated obesity in women appeared to have no effect upon concomitant atherosclerosis.
Hypertension in men was associated with significantly increased coronary and cerebral atherosclerosis, and with a greater occurrence of myocardial infarction. Hypertensive women had significantly more severe atherosclerosis than normotensive women in most of the arteries studied, and also had significantly more myocardial infarcts.
The atherosclerosis of patients who had nephrosclerosis was similar in distribution and severity to that of patients who had hypertension.
The presence of rheumatic carditis appeared not to influence the extent or severity of concomitant atherosclerosis.
Aberrant Left Coronary Artery
Authors: COHEN HARVEY , SIEW SHIRLEY 
Published: June 2012

A case is reported of the anomalous origin of the left coronary artery from the pulmonary artery in a Bantu male infant aged 9 months. The clinical, radiologic, and electrocardiographic findings, and the cardiac pathology are presented.
The 45 cases previously reported in the literature are reviewed and the clinical syndrome and pathologic physiology of the aberrant left coronary artery are discussed.
Arteriosclerosis Obliterans: Review of 520 Cases with Special Reference to Pathogenic and Prognostic Factors
Authors: JUERGENS JOHN L. , BARKER NELSON W. , HINES EDGAR A. 
Published: June 2012

The clinical and follow-up data on 520 non-diabetic patients less than 60 years of age who had a clinical diagnosis of arteriosclerosis obliterans of the lower extremities made at the Mayo Clinic in the period 1939 through 1948 were reviewed from the standpoint of pathogenesis, prognosis, and clinical course of the disease. The ratio of males to females was 11 to 1, and the mean concentration of plasma cholesterol in the male patients with arteriosclerosis obliterans was approximately 50 mg. per 100 ml. greater than that of either of 2 control groups of men without clinical evidence of atherosclerosis. The incidence of smoking among the men with this disease was higher than in a comparable group of men without it. Obesity was not commonly associated with arteriosclerosis obliterans, while hypertension was associated with the disease about 3 times as often as in a control group without the disease.
The survival rate for patients with arteriosclerosis obliterans was less favorable than that of a normal population of a similar age and sex distribution, and the survival rate for patients with atherosclerotic aorto-iliac occlusion was significantly less favorable than that of patients with atherosclerotic occlusion of the femoral artery. In approximately three fourths of the patients who died, the cause of death was thought to be disease of the coronary arteries. The presence of atherosclerosis elsewhere than in the arteries supplying the extremities, as manifested by clinical coronary artery or cerebrovascular disease at the time of diagnosis, had an adverse effect on survival.
Four per cent of the patients required amputation of a leg shortly after the diagnosis of arteriosclerosis obliterans was made at the clinic, and an additional 4.9 per cent subsequently required amputation during the 5-year period following the initial examination. Only 3.0 per cent of patients with intermittent claudication as the only symptom of their disease required an amputation during this period. Eleven and three-tenths per cent of patients who continued to smoke, but none who abstained from smoking, had amputations within 5 years.
Since all patients of the series were treated before the advent of direct arterial surgery for segmental arterial occlusion, it is believed that the subsequent course of the disease in these patients may be used as a basis for comparative evaluation of results in patients subjected to direct arterial surgical procedures.
Serum Lipoproteins in Patients with Intermittent Claudication and Myocardial Infarction
Authors: NESTEL P. J. 
Published: June 2012

The serum beta/alpha lipid ratios were estimated by electrophoresis in 4 groups of people. These comprised 44 male patients with intermittent claudication; 61 men who were matched for age with the previous group and who were clinically free of cardiovascular disease; 30 male patients who had recently had a myocardial infarction; and a further group of 30 male controls whose physical activity was limited by factors other than disease.
The highest mean serum beta/alpha lipid ratio was found among the patients with intermittent claudication and was very significantly higher than the ratios found among the other 3 groups. The difference in the ratios between the patients with myocardial infarction and the 2 control groups was not significant.
These differences and in particular the difference in the ratios between the patients with myocardial infarction and intermittent claudication are discussed.
Myocardial Infarction in Patients Treated with Sippy and Other High-Milk Diets
Authors: BRIGGS R. D. , RUBENBERG M. L. , O'NEAL R. M. , THOMAS W. A. , HARTROFT W. S. 
Published: June 2012

A study has been made of the incidence of myocardial infarcts among 3 groups of autopsied patients who were matched for age, sex, race, and place and period of death: (1) patients with peptic ulcers who had been treated with a Sippy diet or milk products, (2) patients with peptic ulcers who were not known to have been so treated, (3) a group consisting of non-ulcer patients matched with the other 2 groups.
In the U.S.A. the incidence of myocardial infarcts was more than twice as high in the ulcer patients treated with Sippy diet than it was in either of the other 2 groups. The differences in each case were statistically highly significant. There was no significant difference in the incidence of myocardial infarcts between the ulcer patients not treated with the Sippy diet and the non-ulcer controls.
Differences and similarities of the same degree were noted among corresponding groups from Great Britain. It is tempting to think that the high incidence of myocardial infarcts among the Sippy-treated patients was a result of the butter-fat content of their diets. Mere association, however, does not constitute proof and further study is needed before definitive conclusions are drawn.
Epidemiology of Group-A β-Hemolytic Streptococci as Related to Acute Rheumatic Fever in Miami, Florida
Authors: SASLAW MILTON S. , JABLON JAMES M. , Saul Madelyn , Jenks Sallie Anne 
Published: June 2012

Rheumatic fever and rheumatic heart disease are infrequent in Dade County, Florida.
Conversely, β-hemolytic streptococci are recovered frequently, particularly from the throats of children 6 to 9 years old.
The relationship between group-A β-hemolytic streptococci, clinical illness, and rheumatic illness may be different in South Florida from elsewhere in the United States.
Pulmonary Vascular Volume, Resistance, and Compliance in Man
Authors: MILNOR WILLIAM R. , JOSE ANTHONY D. , MCGAFF CHARLES J. 
Published: June 2012

Pulmonary blood volume was measured in 19 patients, with use of a dye-dilution method and simultaneous bilateral cardiac catheterization. Pulmonary mean transit time was measured by subtracting left atrial-to-peripheral artery mean transit time from pulmonary artery-to-peripheral artery mean transit time.

Average pulmonary blood volume was 365 ml. per M.
2
(range 126 to 598 ml. per M.
2
). This value is significantly smaller than previous estimates by less direct methods.

The ratio of pulmonary blood volume to mean intravascular pressure was used as an indication of pulmonary vascular compliance. Patients with high pulmonary vascular resistance had relatively low pulmonary vascular compliance.
A significant correlation between pulmonary blood volume and stroke volume was found, lending support to the hypothesis that the volume and elasticity of the pulmonary vascular bed contribute to the regulation of cardiac output.
Successful External Electrical Defibrillation in Acute Myocardial Infarction
Authors: NAST PHILIP R. , PENNYPACKER CHARLES S. , WAGNER JOSEPH A. 
Published: June 2012

A patient with an acute myocardial infarction was observed who gave all the appearances of being dead; the electrocardiogram attached at the time showed ventricular fibrillation, which persisted for at least 6 minutes.
Regular sinus rhythm was restored within 2 minutes after external defibrillation with the Zoll-Electrodyne External Defibrillator with use of 60-cycle alternating current at 350 volts every 10 seconds for 3 shocks.
No other similar case that survived has been found in the literature.
The necessity of immediate recognition of ventricular fibrillation in acute myocardial infarction is pointed out in cases of "sudden death."
The preference of external electrical defibrillation over direct heart defibrillation is discussed.
Interarterial Coronary Anastomoses and Coronary Arterial Pattern
Authors: PEPLER W. J. , MEYER B. J. 
Published: June 2012

The coronary arterial pattern and coronary anastomoses have been investigated in 90 European and 98 Bantu hearts.
A significantly better coronary anastomotic blood supply has been demonstrated in Bantu hearts. This was found to be present from a very early age onward and not related to hypertrophy, atherosclerosis of the coronary arteries, or to gross anatomic differences of the arterial tree, such as a third primary division of the left coronary artery. The latter was found to be more common (74 per cent) in Bantu than in European hearts (38 per cent).
It is suggested that the reason for the better anastomoses might be the high incidence of megaloblastic and iron-deficiency anemia in Bantu children.
The low incidence of the severe degrees of coronary atherosclerosis and its complications has been reaffirmed in the Bantu hearts.
Auscultatory and Phonocardiographic Assessment of Fallot's Tetralogy
Authors: VOGELPOEL LOUIS , SCHRIRE VELVA 
Published: June 2012

A clinical and phonocardiographic study has been made on 62 cases of Fallot's tetralogy in order to determine the value of auscultation and phonocardiography in assessing the severity of the stenosis.
The severity of the tetralogy, as determined by clinical methods, was correlated with the length and loudness of the murmur and other auscultatory signs.
Increasingly severe stenosis was shown to be associated with a shorter, earlier, and softer systolic murmur. In extreme tetralogy, the murmur was invariably soft and very short, being confined to early systole and ending in midsystole. An aortic ejection sound was usually audible and the second sound invariably loud and single. In severe tetralogy, the murmur was usually loud and short, with its crescendo before midsystole and termination before the aortic second sound. A pulmonary component was never audible. In moderate cases, the murmur was loud and longer, with its crescendo at midsystole and termination before or at the aortic second sound, which was never obscured by the murmur. A very soft pulmonary component was only rarely recorded. In mild cases, the murmur was loud and more prolonged with the crescendo in the latter half of systole and extension into, but rarely much beyond, the aortic component. Although at times loud at the aortic component, the murmur totally obscured this sound in only 1 case. A pulmonary component was frequently recorded and often heard; it was extremely soft and localized, but occasionally relatively loud. Splitting was always wide (average 0.09 second). The loud, long murmur reflected good pulmonary flow; the audible or recordable pulmonary component, a relatively normal pulmonary arterial pressure.
Since the length and loudness of the systolic murmur reflect the volume rate of blood ejected through the stenosis, auscultation is believed to be a most valuable method of assessing both the severity of stenosis and fluctuations in blood flow, which may result from changes in systemic resistance and tonus of the infundibulum of the right ventricle. The change in murmur during cyanotic or syncopal attacks has thrown considerable light on the mechanism of such attacks.
Dissecting Aneurysm of the Aorta The Clinical Features of Thirty Autopsied Cases
Authors: ERB BLAIR D. , TULLIS I. FRANK 
Published: June 2012

The clinical diagnosis of dissecting aneurysm of the aorta depends on awareness of the entity, keen clinical suspicion, and an understanding of the varied manifestations. Clinical suspicion is sharpened by association of certain preexisting conditions found to be related to an increased incidence of aortic dissection. Recognition of the Marfan's syndrome, pregnancy, or preexisting hypertension in a patient presenting as an acute catastrophe may lead to the diagnosis. A family history of aortic dissection is similarly helpful.
The variable manifestations call for careful reasoning. Multiple system involvement in many cases is the initial lead in establishing the diagnosis. The many systems frequently involved in the symptomatology of aortic dissection have in common the origin of the blood supply. When the aorta is damaged, branches to various organs may be affected so that the symptoms depend on the branches involved. Because any portion of the aorta may be involved in the dissecting process, no single clinical picture suffices for its recognition. Aortic valvular findings often are seen with involvement of the ascending aorta, central neurologic findings may result from occlusion of the carotid arteries, spinal cord manifestations may result from occlusion of the intercostal arteries, renal manifestations may be seen with renal artery involvement, and so on down the aorta. However, the pattern of a catastrophic episode—whether cardiovascular, neurologic, or abdominal—calls for consideration of aortic dissection. All of the finesse of the most careful physical examination may be required to make the diagnosis but the coexistence of chest pain, aortic murmurs, and peripheral artery occlusion is practically diagnostic. Laboratory adjuncts including roentgenographic evidence of mediastinal widening, evidence of hematuria, and the absence of electrocardiographic evidence of myocardial infarction may be helpful. Electrocardiographic evidence suggestive of myocardial infarction does not, however, exclude aortic dissection.
Dissecting aneurysm of the aorta now is a surgical emergency that requires early accurate diagnosis and early surgical treatment, if the natural survival rate of 10 per cent is to be improved.