bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pulmonic Stenosis, Ventricular Septal Defect, and Right Ventricular Pressure above Systemic Level
Authors: HOFFMAN J. I. E. , RUDOLPH ABRAHAM M. , NADAS ALEXANDER S. , GROSS ROBERT E. 
Published: June 2012

Ten patients with pulmonic stenosis are reported who, despite having right ventricular systolic pressures much above systemic levels, had ventricular septal defects proved at operation in 9 and suggested by indicator-dilution curves in the other.
Because of the high right ventricular systolic pressures these patients had clinical and electrocardiographic evidence of marked right ventricular hypertrophy and were initially thought to have severe pulmonic stenosis with an intact ventricular septum.
One patient had an almost single ventricle with pulmonic and aortic stenosis.
In all the others the right ventricular systolic pressure failed to equilibrate with pressures in the systemic circulation. In 2 patients this was probably due to obstruction of the ventricular septal defect by the septal leaflet of the tricuspid valve. In the others the suggestion that the ventricular septal defect was closed off during systole by muscular contraction was confirmed in 1 patient at operation.
This syndrome has been reported in other series and may occur in as many as 5 to 10 per cent of patients diagnosed as having severe pulmonic stenosis.
It is important to know before operation whether or not there is a ventricular septal defect associated with the pulmonic stenosis, for this influences the decision about doing a right ventriculotomy.
The preoperative diagnosis of this variant of tetralogy of Fallot may be made by phonocardiography and cardiac catheterization.
Heart Block after Repair of Ventricular Septal Defect in Children
Authors: LAUER RONALD M. , ONGLEY PATRICK A. , DUSHANE JAMES W. , KIRKLIN JOHN W. 
Published: June 2012

From March 1955 to April 1959, 174 patients with ventricular septal defect and 124 patients with ventricular septal defect associated with pulmonic stenosis were referred from the Section of Pediatrics of the Mayo Clinic for open intracardiac repair.
Forty-eight of these 298 patients had complete heart block at some time following operation. Eighteen of the patients with heart block died in the immediate postoperative period, 18 had reversion to normal sinus rhythm, and 12 were discharged from the hospital with complete heart block. Three of these 12 patients died subsequently. Two died presumably as a direct result of complete heart block and a third died following a second open cardiac operation. Of the 9 surviving patients, 3 have had serious bradycardia or periods of asystole and 6 have no symptoms from heart block.
One of 3 surgical technics was employed for all the patients in this study with variation in incidence of block with the use of each technic. Other factors that might relate to the incidence of heart block are discussed.
The management of the patient with complete heart block both in the immediate post-operative period and after dismissal from the hospital is described.
Studies of Peripheral Circulation during Sickle-Cell Crisis
Authors: MANFREDI FELICE , SPOTO ANGELO P. , SALTZMAN HERBERT A. , SIEKER HERBERT O. 
Published: June 2012

In 18 Negro patients with sickle-cell anemia or sickle cell-hemoglobin C disease, gradients of oxygen and pH were measured between brachial artery and superficial and deep venous system of the upper extremity. The results obtained during crisis were compared with those obtained from asymptomatic patients.
Arterial oxygen unsaturation, with normal arteriovenous gradients for oxygen and pH was observed in the 11 asymptomatic patients. Unusually low arteriovenous gradients for oxygen and pH, mainly due to abnormal venous values, were found when blood draining from cutaneous areas was compared with arterial samples in the 7 patients studied during acute crisis. The 5 patients restudied after symptoms subsided showed a return toward normal of arteriovenous differences.
The evidence suggests that during crisis arterialization of venous blood is the result of anatomic or functional by passes in the superficial circulation, so that oxygen is not removed by the tissues. It is postulated that a vascular neurogenic mechanism may be the precipitating factor in sickle-cell crisis.
It is also suggested that a low arteriovenous oxygen gradient or arterialization of superficial vein blood may be used as a laboratory aid in establishing the diagnosis of sickle-cell crisis in uncertain cases.
Spontaneous Closure of Ventricular Septal Defects
Authors: EVANS J. R. , ROWE R. D. , KEITH J. D. 
Published: June 2012

A group of 37 children is described in whom a systolic murmur heard early in life gradually diminished and eventually disappeared. When the patients were first seen, the clinical findings suggested a small ventricular septal defect but no thrill was present and the systolic murmur had a superficial blowing quality with high-frequency vibrations and tended to stop before the second heart sound. Cardiac catheterization demonstrated a small left-to-right shunt at ventricular level in 4 of the patients while the murmur was present; in 1 this was repeated after the murmur had gone and no abnormality could be demonstrated.
Cardiac catheterization in other patients with typical disappearing systolic murmurs showed a left-to-right shunt in some but in others this was too small to be detected by routine oxygen studies. A rough correlation was established between the length and intensity of the murmur and the size of the shunt. With angiocardiography and intracardiac phonocardiography the exact site of the ventricular septal defect was localized to the muscular portion of the septum in 4 of the patients.
In 1 patient who presented with congestive heart failure, clinical and hemodynamic findings of a large ventricular septal defect diminished over several years and finally disappeared.
Children with the specific type of systolic murmur described may be recognized as having a small defect in the muscular ventricular septum. The defect is thought to be gradually reduced in size and ultimately closed by hypertrophy of septal muscle. Spontaneous closure appears to be not uncommon with small ventricular septal defects and may rarely occur with lesions large enough to present with congestive heart failure.
Comparative Studies of Protoveratrine A and Protoveratrine B Intravenously in Hypertensive Man
Authors: WINER BERTRAM M. 
Published: June 2012

Comparative studies of intravenously administered protoveratrine A and protoveratrine B in hypertensive man indicate that the alkaloids have qualitatively similar hypotensive, bradycrotic, and emetic actions, but quantitatively different hypotensive and emetic potency. The relative hypotensive potencies of the two substances were determined by analyses of logarithmic dose-response curves in the same patients. On a weight basis protoveratrine B was slightly less potent than protoveratrine A.

A favorable dissociation between hypotensive and emetic activity was found. Tolerance ratios were determined in which the largest doses of protoveratrine B given without nausea were compared with the doses of protoveratrine A producing nausea. These ratios were adjusted for the differences in hypotensive potency of the alkaloids. Protoveratrine B was better tolerated than protoveratrine A (
p
<.001). Indeed, protoveratrine B had little emetic activity when given intravenously in doses producing normotension. Protoveratrine B appears to have properties that warrant its preferential selection for parenteral administration. Its effective dosage range has been studied.

The strong hypotensive activity of intravenously administered protoveratrine B, its development of maximal action within minutes, and its pulse-slowing effect favor its use in those hypertensive states in which almost immediate lowering of the blood pressure is indicated.
Fixed hypertension lends itself to the application of biological assay technics. The use of such technics in human pharmacology fosters the perception of clinically significant differences among drugs that are chemically closely related.
Tomographic Evaluation of Hemodynamic Changes in Mitral Stenosis
Authors: DULFANO M. J. , ADLER H. 
Published: June 2012

The hemodynamic findings in 31 patients with mitral valvular disease were correlated with the signs obtained by chest tomography. The normal and pathologic findings are described. The advantages of the tomographic technic for the study of the pulmonary vasculature are pointed out.
The progression of mitral valve narrowing was considered to be best related to the integrated picture of "impaired venous drainage." On this basis, three stages were defined.
The over-all response of the pulmonary circulation to the severity of the disease can be judged by the pattern of blood vessels filling throughout the lung.
It is concluded that for the evaluation of mitral valvular disease routine tomographic technic can indicate many of the essential hemodynamic findings with less hazard than either angiography or cardiac catheterization.
Glycogen-Storage Disease
Authors: MULLER OTTO F. , BELLET SAMUEL , ERTRUGRUL ALI 
Published: June 2012

A case of glycogen-storage disease (Coritype II), with accumulation of glycogen in the myocardium, skeletal muscle, smooth muscle, liver, kidney, central nervous system, and autonomic ganglia is presented.
Glycogen storage in the autonomic ganglia of the intestinal tract (Plexus-myentericus-Auerbach), which gave rise clinically to Hirschsprung's disease, could explain the feeding problems and constipation often observed in these cases.
The classification into four different types of Cori and Andersen appears to be the most satisfactory one at the present time. These types are different disease entities with the same expression of abnormality, the deposition of glycogen; but the pathogenesis and the clinical and pathologic findings are strikingly different.
Glycogen storage of the heart is probably more common than the review of the literature indicates. Many of these cases are missed, mainly types III and IV, because the possibility is not considered and the patient is inadequately studied in life and during necropsy.
Primary Myocardial Disease
Authors: FOWLER NOBLE O. , GUERON MOSCHE , ROWLANDS DAVID T. 
Published: June 2012

This study describes 18 patients from the University of Cincinnati Hospitals who died of congestive heart failure without clinical or pathologic evidence of a primary cause.
Clinical features. Their ages were from 18 months to 68 years at death. Fourteen were male and four female; 11 were white and seven were Negro. Seven patients had heart failure for 5 years or more; three had heart failure for over 10 years. Seven patients were alcoholic and three had nutritional cirrhosis. Transient mitral or tricuspid systolic murmurs and apical protodiastolic gallop rhythms were common. Atrial fibrillation was present in six patients. The electrocardiograms revealed abnormal left axis deviation in three and left bundle-branch block in two.
Right heart catheterization was performed in four of these patients and showed low cardiac output, increased arteriovenous oxygen difference, and elevation of pulmonary arterial, pulmonary wedge, right ventricular diastolic, and right atrial pressures.
Pathologic features. Heart weights were over 500 Gm. in 13 patients; all 18 had left ventricular hypertrophy. Mural thrombi were present in 10; six had pulmonary emboli and three had systemic arterial emboli. One patient had gross myocardial scarring; only two had small accumulations of inflammatory cells in the myocardium. Ten had focal increase of elastic tissue.
Primary myocardial disease may simulate coronary artery disease because of the abnormal electrocardiogram; it may simulate hypertensive heart disease because of elevation of diastolic blood pressure during heart failure in some patients; it may simulate pericardial effusion because of the poor cardiac pulsations, narrow pulse pressure, and paradoxical pulse. It may simulate rheumatic heart disease because of the apical systolic and diastolic murmurs, left atrial enlargement, and presence of Kerley lines. The cause is unknown. Only one patient in this group had a familial history of similar heart disease.
The Mechanical Consequences of Anomalous Atrioventricular Excitation (WPW Syndrome)
Authors: MARCH HAROLD W. , SELZER ARTHUR , HULTGREN HERBERT N. 
Published: June 2012

The mechanical consequences of anomalous atrioventricular excitation were studied in 12 patients by means of phonocardiograms, carotid pulse tracings, and in one instance, by data from cardiac catheterization. Three of these patients were also observed during normal conditions so that they supplied their own control data.
In five instances mechanical anomalies were detectable as a consequence of the electrocardiographic abnormality. These anomalies were complex and consisted in one case of early onset and completion of ejection on both sides, and in another case of early completion on the left side. In three instances there was late activation on the contralateral side and possibly on the homolateral side as well.
The remaining cases exhibited no such abnormalities by the methods studied, and in one subject this is illustrated with records made during both anomalous and normal conduction.
The literature pertaining to this problem is critically reviewed, and an attempt is made to interpret both the previous and the present observations. The divergent nature of the observations suggests that the effect of anomalous excitation on the mechanics of the heart is the resultant of a number of variables, including the transmission time through the atrioventricular node and the site of entry of the anomalous focus.
It is possible that the atrioventricular node does not function in some cases in which Wolff-Parkinson-White conduction is always present and it is not possible to induce normal beats with drugs, exercise, or respiratory maneuvers.
Effects of Erythrol Tetranitrate and Amotriphene on Exercise Tolerance Tests in Angina Pectoris
Authors: RUSKIN ARTHUR 
Published: June 2012

Sublingual erythrol tetranitrate is a potent drug in counteracting coronary insufficiency, as evidenced by reversal of positive electrocardiographic exercise tolerance tests in 72 per cent of 36 cases and reduction of anginal attacks in them by more than 50 per cent.
Comparative studies with amotriphene indicate some subjective alleviation of angina, but objective reversals of the electrocardiographic effects of exercise in only 16 per cent of the cases.
Side effects of erythrol tetranitrate, particularly headache, are seen in a minority of cases and are often circumvented by starting with a small dose and gradually increasing it as necessary.
Alleviation of ectopic beats on exercise occurred equally in a minority of cases on the two drugs.
The Pulmonary Arterial Tree in Atrial Septal Defect
Authors: WAGENVOORT C. A. , NEUFELD HENRY N. , DUSHANE JAMES W. , EDWARDS JESSE E. , Wagenvoort Noeke 
Published: June 2012

The pulmonary vascular tree was studied in 12 cases of uncomplicated atrial septal defect in fetuses, infants, and children. The ages of these subjects ranged from 24 weeks of fetal life to 11 years. A quantitative analysis was made of the medial thickness and of the index of medial surface area (ratio of medial tissue to pulmonary parenchyma) of the pulmonary arterial branches. In contrast to subjects with ventricular septal defect in corresponding age groups, the three fetuses in this series had medial hypertrophy, as indicated by a high index of medial surface area. In the postnatal group, both the medial thickness and the index of medial surface area were also usually greater than in the controls of corresponding ages, notably in two patients, who, at the ages of 7 weeks and 4 months, died of cardiac failure. No satisfactory explanation for these unexpected findings can be offered.
Slight to moderate intimal proliferation was observed in some muscular and elastic pulmonary arteries, in bronchial arteries, and in pulmonary veins in several subjects. Thickening of the intima in elastic arteries was observed in a fetus of 26 weeks' gestation. Pronounced obliterative intimal changes were found in only one subject, an 11-year-old girl with severe pulmonary hypertension.
A Guide to Anticoagulant Therapy
Authors: ALEXANDER BENJAMIN , WESSLER STANFORD 
Published: June 2012

The physician who undertakes anticoagulant therapy tampers with one of the most important homeostatic functions of the body. In so doing, he subjects the patient to the calculated hazard of possible hemorrhage balanced against the risks of the thrombosis or embolism that he seeks to prevent or treat. Agents currently employed are heparin and coumarin-type compounds. These two categories of anticoagulants act at different sites of the coagulation mechanism, are administered differently, are metabolized differently, are reversed by different antidotes, and their effects are measured by different tests.
Certain facts about which the physician should be adequately informed have been presented regarding the hemostatic mechanism; the physiology and pharmacology of the anticoagulants, especially as they may explain the wide variation in individual response; certain aspects of methodology; and the various practical problems involved in therapeutic management. Emphasis has been placed on the importance of individualization of treatment, careful clinical observation, and frequent reliable laboratory tests as guides to proper therapy.
The Pulmonary Vessels in Incipient Left Ventricular Decompensation
Authors: SIMON MORRIS 
Published: June 2012

Dilatation of the pulmonary vessels of the upper zones and constriction of the vessels of the lower zones characterizes left ventricular decompensation.
These changes may precede the onset of clinical symptoms providing a useful warning sign of impending danger.
A hypothesis is suggested to account for the non-uniform vessel pattern.
An exception is noted in patients with severe emphysema or bronchitis in whom generalized dilatation may occur.
Aneurysm of the Distal Popliteal Artery and Its Relationship to the Arcuate Popliteal Ligament
Authors: GEDGE STAFFORD W. , SPITTEL JOHN A. , IVINS JOHN C. 
Published: June 2012

Two cases presenting complications of popliteal aneurysm requiring amputation have been presented. Dissection of these limbs showed proximal popliteal aneurysms located immediately beyond the adductor magnus tendinous hiatus and, in addition, distal popliteal aneurysms immediately below the arcuate popliteal ligament.
Another case is described in which bilateral popliteal aneurysms were located in the distal popliteal artery—that is, immediately below the arcuate popliteal ligament. These findings support the concept that post-stenotic dilation may be one of the causal factors in the pathogenesis not only of proximal but also of distal popliteal aneurysms.
Surgical Treatment of Dissecting Aneurysm of the Aorta Analysis of Seventy-Two Cases
Authors: DE BAKEY MICHAEL E. , HENLY WALTER S. , COOLEY DENTON A. , CRAWFORD E. STANLEY , MORRIS GEORGE C. 
Published: June 2012

Dissecting aneurysm of the aorta is an extremely serious condition that pursues a rapidly fatal course in more than 75 per cent of cases. Follow-up data on 72 patients surgically treated indicate that effective surgical treatment significantly alters the course of the disease and in the majority of instances removes the threat of death by rupture. The operative mortality rate in these 72 patients was 26 per cent. For lesions occurring distal to the left subclavian artery, resection of the descending thoracic aorta with replacement by aortic graft utilizing hypothermia or the bypass pump was successful in 80 per cent of cases.
Most patients surviving operation have been able to resume previous activities with minimal risk of sudden death from rupture of the aneurysm or failure of the aortic graft.
The importance of recognizing the characteristic clinical manifestations, of making precise roentgenographic diagnosis, and of instituting effective surgical treatment in the management of dissecting aortic aneurysm has been stressed.
A Method of Treatment for Pericardial Pain
Authors: WEISSBEIN ARTHUR S. , HELLER FLOYD N. 
Published: June 2012

Two patients are presented, in whom dramatic, complete, and prolonged relief from the pain of acute pericarditis was afforded by left stellate ganglion block. In one, this method was successful after the patient had been virtually incapacitated by pain for 75 days. As far as we have been able to ascertain, this mode of therapy has not been previously employed. The distribution of the pain seemed to implicate the phrenic nerve; however, the relief secured by stellate ganglion block appears contrary to this traditional theory.
It is concluded that the mechanism of pericardial pain is not completely understood but that the current, generally accepted explanations are quite likely inaccurate. The inferior cervical and first thoracic sympathetic ganglia may play a large, if not complete role in the transmission of these pain impulses.
There are several practical aspects to our observations. Stellate ganglion block might be logically employed during the acute phase of pericarditis if the pain is severe, and also when the patient is incapacitated by recurrences. There remains also a virtually unexplored field, the relief of the pain of acute myocardial infarction by this procedure.
The Clinical Significance of the Pulmonary Collateral Circulation
Authors: FISHMAN ALFRED P. 
Published: June 2012

The clinical significance of the normal and the expanded pulmonary collateral circulation is considered from the point of view of its nutrient, hemodynamic, and respiratory functions.
In the normal lung, the collateral arterial circulation is too diminutive to serve other than a nutrient function. Its roles in preventing pulmonary infarction after embolization, in producing "ischemic lung disease," and in the direct treatment of pulmonary carcinomas are considered.
The expanded collateral arterial circulation associated with localized pulmonary lesions or which occurs after ligation of a pulmonary artery seems to be without appreciable hemodynamic effect on either the pulmonary circulation, the left heart, or the systemic circulation. Only in patients with generalized suppurative disease of the lung has it been shown to affect the pulmonary circulation by diverting mixed venous blood away from diseased areas. The possibility exists that the increment in pulmonary blood flow contributed by the collateral arterial circulation may aggravate pulmonary hypertension in patients with diffuse restriction of the pulmonary vascular bed.
The venous portion of the expanded collateral circulation may conceivably contribute to pulmonary hypertension by aggravating systemic arterial hypoxemia in patients with right heart failure from hypoxemic cor pulmonale.
The expanded collateral arterial circulation may assume a major respiratory function in subjects with systemic hypoxemia and curtailed pulmonary blood flow. In such cases, the "effective" pulmonary collateral blood flow has been shown to equal normal values for pulmonary arterial blood flow.
Different portions of the pulmonary collateral circulation may be responsible for hemoptysis in different diseases: in pulmonary disease, the arterial portion; in mitral stenosis, the venous portion; in pulmonary infarction, an imbalance between the two.
The relationship between the pulmonary collateral circulation and clubbing of the digits remains uncertain.
The pulmonary collateral circulation is considered, finally, with respet to (1) limitations of present methodoloy, (2) principles involved in the development of collateral circulations in general, and (3) therapeutic implications.