bluuebunny/crossref_metadata_2025_split huggingface dataset:
Heart Failure and Lung Disease
Authors: HECHT HANS H. 
Published: June 2012

The confusing and complex interplay of factors leading to "cor pulmonale" may be somewhat clarified if the effects of excessive pulmonary hypertension causing right heart overloading ("pulmonary hypertensive heart disease") are separated from the ventilatory defects that result in arterial desaturation, erythrocytosis, and moderate pulmonary hypertension ("emphysema heart"). In the former group, heart failure dominates the clinical picture; in the latter, it is assumed that heart failure occurs on the basis of a "myocardial factor"—presumably arteriosclerotic heart disease—whose manifestations are colored and modified by the coexisting and contributing respiratory dysfunction. Overlapping of these two distinct forms occurs frequently, and pulmonary hypertension may be severe enough to be the chief precipitating cause of failure in emphysema, particularly in young subjects and in patients with kyphoscoliosis. Respiratory disturbances, fibrosis, and loss of pulmonary elasticity may accompany heart failure secondary to right ventricular overloading which may ultimately lead to significant arterial desaturation at rest and the development of polycythemia, even in this group. It is typical, however, that the disturbances leading to cor pulmonale rarely, if ever, involve the actual pulmonary function of alveolar-capillary gas exchange; they are confined to the abnormalities of the precapillary pulmonary vasculature and to the mechanical apparatus of the chest cage and of the pulmonary parenchyma concerned with breathing mechanisms.
Pulmonary hypertensive heart disease, whatever its cause, has a monotonous symptomatology that is dominated by the signs of heart failure. In cor pulmonale due to emphysema and its allied types, the clinical picture is varied, and oxygen deficiency with arterial desaturation is of central significance. It raises pulmonary artery pressure by a mechanism not fully understood, and it stimulates erythropoiesis. When erythrocytosis has occurred, heart failure from cor pulmonale will soon make its appearance. Unless the arterial oxygen content falls sharply on exercise, resting oxygen saturation values in excess of 80 per cent do not cause this type of polycythemia; nor does polycythemia as such, as in erythremia ("vera"), result in significant arterial desaturation, pulmonary hypertension, or heart failure. However, little is known concerning the hemodynamic load imposed by an increase in blood viscosity.
The management of cor pulmonale must recognize the multiplicity of factors that are concerned and should weigh their relative significance in any given subject. The kaleidoscopic appearance of cor pulmonale requires flexibility of therapy based on a grasp of the individual pathophysiologic interrelations, which may differ from patient to patient.
Conference on Mechanism of Protective Action of Kidney and Relation of Renoprival to Chronic Renal Hypertension
Authors: BRAUN-MENÉNDEZ E. 
Published: June 2012

This conference opened with an elaboration of the concept of the protective action of the normal kidney (Dr. Braun-Menéndez). After initiation of unilateral renal ischemia, the elevated blood pressure is reduced as the intact normal kidney hypertrophies to take over the work of the ischemic kidney. Removal of this intact kidney causes hypertension because the ischemic kidney cannot increase in size or function. As the protective action of the kidney is also lacking following bilateral nephrectomy, renoprival hypertension develops, providing the animals are kept alive long enough.
The cause of renoprival hypertension remains obscure. Gross changes in salt and water metabolism do not have to be present (Dr. Grollman). The normal kidney may produce some material which lowers the blood pressure, or it may destroy or excrete a pressor substance (Dr. Handler). Excretory removal is not so likely as a cause, since the production of simple excretory failure by diverting urine back into the blood stream does not result in hypertension (Dr. Grollman). According to some participants, renoprival and chronic renal hypertension are not identical: Removal of a unilateral ischemic kidney causes the blood pressure to return to normal. This does not fit with the renoprival hypertension theory and is evidence that a pressor agent must be involved (Dr. Goldblatt). A further difference is that whereas antirenin lowers the blood pressure in chronic renal hypertension, it will not lower the blood pressure in renoprival hypertension (Dr. Helmer). Dr. Kolff, however cites reports, such as that of the failure of bilateral nephrectomy to cure renal hypertension, which favor the view that the mechanism of production is the same in both forms of hypertension. Both groups finally agreed that some cases of renal and of renoprival hypertension could not be explained by assuming a single mechanism of action.
Staphylococcal Infections of the Heart
Authors: COHEN SIDNEY 
Published: June 2012

The basic problems of staphylococcal infections do not seem near to solution. Possibly an effective and safe antibiotic will be found to which resistant, pathogenic staphylococcal mutants will not appeal. This may, not be an overly sanguine hope. Had it not been for the ability of the staphylococcus to synthesize penicillinase, this goal would have been achieved already, for staphylococcal mutants pathogenic to man and intrinsically resistant to penicillin (i.e., without the production of penicillinase) have not been reported. Even with better antibiotics grave problems would remain, however, for the staphylococcus often inflicts severe or even irremediable damage, especially in the heart, before the disease can be diagnosed.
Prevention is the crucial problem. Refinements in isolation technics and hospital sanitation may improve the protection of the patient in the operating room and the newborn infant in the nursery. Nevertheless, the hard core of infections in debilitated or otherwise susceptible medical patients will probably remain. To help them it will be necessary to learn to restore the mechanisms of normal host resistance that have been depleted by disease.
Digitalis Delirium
Authors: CHURCH GERARD , MARRIOTT HENRY J. L. 
Published: June 2012

The use and suitability of the term digitalis delirium are briefly discussed. Attention is drawn to the paucity of detailed reports on this important manifestation of digitalis poisoning.
Three cases of digitalis delirium resulting from toxicity with 3 different preparations—gitalin, digoxin, and digitoxin—are presented. The first case demonstrates how the signs of early intoxication in a single patient may vary with different preparations and indeed with the same glycoside on separate occasions. The second case provides an alarming example of delirium which, although provoked by a short-acting glycoside, nevertheless lasted longer than 2 weeks. The third illustrates how easily the diagnosis of digitalis intoxication can go unrecognized when superimposed on a complex clinical picture.
The clinical features of these cases are discussed in the light of previous reports.
SYMPOSIUM ON CONGESTIVE HEART FAILURE
Authors: NADAS ALEXANDER S. , HAUCK ANNA J. 
Published: June 2012

Congestive failure in infancy and childhood may occur in a number of diseases. Congenital heart disease. however, is probably the most common cause of failure, with rheumatic fever second. Although the basic physiology of cardiac decompensation is similar in adults and children, the presenting clinical picture may be somewhat different in the 2 groups.
We believe that infants and children with congestive failure should be treated vigorously, for we have the distinct impression that the mortality rate of these youngsters with severe heart disease has decreased appreciably since a more optimistic attitude prevails among parents and doctors about these problems. Vigorous use of anticongestive measures and antibiotics is worthwhile and results in many instances in the survival of an infant to an age when successful surgical repair is feasible. Certainly not all babies with congestive failure due to congenital, rheumatic, or other kind of heart disease can be salvaged. But surely the experience of the last few years has given us a much more optimistic outlook on this entire field. There are enough children attending school and enjoying life today who seemed at "death's door" in infancy to make us hesitate to give an unqualifiedly poor prognosis to almost any child in congestive failure. Similarly, we are more and more reluctant to suggest cardiac surgery as a dramatic emergency measure except in a few well-chosen cases. Intelligent medical management can salvage a large number of these children and allow them to survive to an age when relatively low surgical mortality may be offered.
Surgical Correction of Coarctation of the Main Pulmonary Artery
Authors: THROWER WENDELL B. , ABELMANN WALTER H. , HARKEN DWIGHT E. 
Published: June 2012

Two cases of pure congenital coarctation of the main pulmonary artery are reported.
One case may be unique in that it represents the first report of an anatomically proved constriction located in the middle third of the main trunk. In this patient, successful open correction under hypothermia was carried out with cinematographic documentation. The results of preoperative and postoperative cardiac catheterization are described.
A plea is made for the routine use of open operation for correction of "pure pulmonic valvular stenosis." This allows better correction when the diagnosis is confirmed and flexibility for treatment if the unusual coarctation or constriction of the pulmonary artery is encountered.
Effect of Age on Pulse Wave Velocity and "Aortic Ejection Time" in Healthy Men and in Men with Coronary Artery Disease
Authors: SIMONSON ERNST , NAKAGAWA K. 
Published: June 2012

Impedance plethysmograms were taken in 51 healthy men and 42 normotensive men with coronary heart disease from the aorta near the place of auscultation of the aortic valve and from the femoral artery in the femoral triangle recorded simultaneously with the 3 electrocardiographic standard leads.
The aortic pulse wave velocity was determined from the time interval between the foot points of the aortic and femoral volume pulse, and the anatomic distance between the electrodes. It increases with age in normal subjects as well as in patients, but the values are significantly higher in the patients. These results are suggestive of accelerated degenerative changes in the aorta, probably due to atherosclerosis.
The interval from the earliest detectable QRS deflection to the foot point of the aortic volume pulse ("aortic ejection time") becomes longer with age in the normal group. In patients with coronary artery disease, the prolongation is significantly larger for each of 3 age subgroups. The results suggest that ventricular ischemia affects ventricular isometric contraction.
Hourly Variation in Total Serum Cholesterol
Authors: PETERSON JOHN E. , WILCOX ALAN A. , HALEY MELVIN I. , KEITH ROBERT A. 
Published: June 2012

Evidence is presented to indicate that the level of serum cholesterol in certain individuals may vary widely within a matter of hours.
The data suggest also that a rapid fluctuation of the serum cholesterol level may be induced in some persons by modifying certain aspects of their environment.
Varying lability of the level of serum cholesterol and the differing response of individuals to certain environmental factors require that careful attention be given to the sampling methods used in research.
Essential Hypertension and Aldosterone
Authors: VENNING ELEANOR H. , DYRENFURTH INGE , DOSSETOR JOHN B. , BECK JOHN C. 
Published: June 2012

Serial determinations of the urinary excretion of aldosterone have been made in hypertensive patients. Although the majority of patients with benign essential hypertension excrete amounts of aldosterone within the normal range, the mean excretion of 26 patients was significantly higher than that observed in normotensive individuals. When renal complications were present, the mean excretion was still further increased and in patients with malignant hypertension all the values were above the normal range.
The mean excretion of the tetrahydro metabolite of aldosterone was also found to be higher in patients with essential hypertension.
These patients have a normal response to adrenocorticotrophic hormone stimulation, urinary and plasma corticosteroids, as well as urinary aldosterone, showing comparable increases.
The aldosterone content of adrenal glands obtained post mortem from two patients with malignant hypertension was within the range observed by other investigators in primary aldosteronism.
The Electrocardiogram in Ventricular Septal Defect
Authors: VINCE DENNIS J. , KEITH JOHN D. 
Published: June 2012

One hundred and nineteen cases of ventricular septal defect in infancy and childhood have been reviewed, with special reference to the electrocardiogram. The changes in the electrocardiogram were related to the hemodynamics found at cardiac catheterization, and particularly the pulmonary to systemic blood flow ratios, pulmonary artery pressures, and oximetry. They were also studied in relation to the groups of cases that obviously had a low pulmonary vascular resistance with or without diastolic loading of the left ventricle. Survival of a patient following closure of the defect with a drop in pulmonary artery pressure was also taken as a sign that the pulmonary vascular resistance was not excessive. The patients with clinical and hemodynamic evidence of a high pulmonary vascular resistance were also evaluated in relation to the electrocardiogram.

The information obtained from the electrocardiogram may be graded according to degree of severity: (a) normal electrocardiogram, (b) left ventricular loading, (c) combined loading, (d) isolated right ventricular loading. These groups may be further graded depending on the diminishing number of signs listed below.
1-7
A detailed review of these four groups in relation to the following criteria may allow one to identify a low or only moderately raised pulmonary vascular resistance, or one that is sufficiently moderate to permit successful corrective surgery in the pediatric age group: 1. An R in V
6
over 20 mm. 2. A Q in V
6
of 4 mm. or over. 3. An S in V
1
over 25 mm. 4. A Q in V
6
of 2 mm. or more when associated with evidence of right ventricular loading. 5. An axis of less than 90°. 6. Counterclockwise vector. 7. Broad notched P waves in standard leads I or II, with late inversion in V
1
.

As a rule, several of these criteria occur together, but even if only one of them is present, one may conclude that the pulmonary vascular resistance is not excessive. Further support to this conclusion is evident if any of the above 7 items are accompanied by one or more of the following: (x) a pulmonary blood flow that is twice systemic, (y) an absence of reversal of flow through the defect either at rest or with exercise, (z) an age under 7 years.
Among the 119 infants and children with ventricular septal defect, over 90 per cent appeared to have a sufficiently low pulmonary vascular resistance to be operable provided the surgical technic is adequate and provided complete heart block does not occur.
Age appears to be an important factor in assessing the likelihood of success at surgery. Only an exceptional case shows hemodynamic findings indicating inoperability before the age of 7 years.
During the first year of life many cases of ventricular septal defect have signs of left ventricular loading appear or increase, suggesting a favorable trend in the pulmonary vascular resistance. Until surgical technic makes operation more readily feasible in infancy, the optimum age of correction would appear to be between 2 and 7 years.
The Prognosis of Essential Hypertension Treated Conservatively
Authors: SOKOLOW MAURICE , PERLOFF DOROTHEE 
Published: June 2012

Four hundred thirty-nine consecutive patients (143 men and 296 women) with essential hypertension were followed on conservative therapy for a minimum of 5 years or until death. The initial blood pressure taken by a standard method and the presence and degree of vascular involvement at the time of registration were recorded on all patients. On the basis of these observations, each patient was classified in one of four classes of over-all hypertensive severity.
At the end of the 5-year follow-up period, 161 patients were dead, 78 men and 83 women. The higher mortality among men was significant and was apparent after the first year of follow-up. A progressive rise in 5-year mortality was observed with increasing degrees of initial blood pressure elevation, fundal involvement, cardiac size by radiogram, and electrocardiographic evidence of left ventricular hypertrophy, as well as with progressively higher classification of over-all hypertensive severity. Patients with mild hypertension and minimal cardiovascular impairment (class I) had an 11 per cent 5-year mortality, while patients with malignant hypertension, renal failure, or congestive heart failure (class IV) had an 84 per cent 5-year mortality. Early deaths in patients with mild hypertension were found to be largely due to atherosclerotic complications or noncardiovascular causes. Possible explanations for long survivals in patients with advanced vascular involvement on initial examination are discussed. The increased mortality of men over women was attributed in part to greater severity of disease on initial registration and in part to a higher incidence of coronary atherosclerosis. The mortality in patients with headache, dizziness, and nervous tension was found to be a factor of the associated vascular complication rather than of the symptoms alone. Patients with clinical obesity were found to have a lower over-all mortality than patients who were not obese. The prognostic value of a standardized initial blood pressure measurement is stressed and is discussed in the light of previous work by Perera, Smirk, and Gilchrist. The prognostic data were presented as a framework against which the long-term treatment of mild and moderate hypertension can be tested.
The Pulmonary Arterial Tree in Ventricular Septal Defect
Authors: WAGENVOORT C. A. , NEUFELD HENRY N. , DUSHANE JAMES W. , EDWARDS JESSE E. , Wagenvoort Noeke 
Published: June 2012

A quantitative analysis was made of the pulmonary arterial medial thickness and index of medial surface area (ratio of medial tissue to pulmonary parenchyma) in 50 cases of uncomplicated ventricular septal defect in fetuses, infants, and children. The ages of the subjects ranged from 26 weeks of fetal life to 12 years. The results were compared with those obtained from a control group of the same age.
During the fetal and newborn period, both the thickness and the index of surface area of the media were generally within normal limits, although in an occasional case pulmonary arterial branches were considerably thinner than those in corresponding controls. The subjects between 1 week and 5 weeks of age had a medial thickness and an index of medial surface area that were lower than the average values at the time of birth. In this regard the pulmonary arterial tree in cases of ventricular septal defect corresponded with that in normal newborn infants. Soon after, however, and most clearly from 8 weeks on, the subjects with ventricular septal defect showed a pronounced rise both in medial thickness and in the index of medial surface area, indicating the presence of considerable medial hypertrophy.
Although intimal proliferation was observed in two infants of 11 and 27 days of age, it was uncommon in children less than the age of 1 year. Above that age it was almost invariably present. Plexiform or glomeruluslike structures were found in seven cases. The youngest patient with these lesions was 2½ years of age.
Serum Cholesterol and Atherosclerosis in Man
Authors: MATHUR K. S. , PATNEY N. L. , KUMAR V. , SHARMA R. D. 
Published: June 2012

Two hundred cases were selected from medicolegal autopsies for a study of the relationship of serum cholesterol to the amount and severity of atherosclerosis in the aorta and the coronary and cerebral arteries. A preliminary study of cholesterol before and after death in 20 cases showed a close parallel between the two when the sample of blood was taken within 16 hours of death.
The mean serum total cholesterol showed a tendency to rise from 122 mg. per cent ±16 in the first decade to 176 mg. per cent ±28 in the fifth decade. A statistically significant correlation was found between serum total cholesterol levels and age up to the fifth decade.
No correlation could be observed between the serum cholesterol level and the amount and severity of atherosclerosis in the arteries. When all the cases were divided into arbitrary groups according to the amount of atherosclerosis, a rise in the levels of mean serum total cholesterol was seen in the first six successive groups of aortic atherosclerosis. But when age was excluded from the correlation between atherosclerosis and serum cholesterol, the interrelationship between the two was found to be statistically insignificant.
Prediction of Fainting in Blood Donors
Authors: GRAHAM DAVID T. 
Published: June 2012

Four hundred and fourteen consecutive blood donors to a hospital blood bank were studied to discover items of value in predicting the occurrence of "reactions." Since it is probable that blood donor "reactions" are almost always vasovagal faints, they are so referred to below.
Several items of predictive value were found: none of the 62 Negroes, but 63 of the 352 white persons fainted; the younger the donor, the more likely a faint; the higher the resting pulse rate before venipuncture, the more likely a faint; admission of "nervousness" was associated with greater chance of fainting than was denial.
Sex, resting blood pressure before venipuncture, and history of previous blood donation did not significantly differentiate fainters from nonfainters.
The data are compatible with the hypothesis that vasovagal fainting in blood donors is the second limb of a diphasic response, and is part of relief from anxiety; the first limb is part of anxiety proper.
The Influence of the Ventriculotomy Site on the Contraction and Function of the Right Ventricle
Authors: MARCH HAROLD W. , ROSS J. KEITH , WEIRICH WILLIAM L. , GERBODE FRANK 
Published: June 2012

The effects of right ventricular cardiotomy were investigated in a total of 28 dogs. Half of the group were studied by high-speed cinematography and half by means of ventricular function curves. In both groups long vertical ventriculotomies were done in eight animals and transverse ventriculotomies were performed in six.
Adverse effects on the contraction and function of the right ventricle were observed in the animals undergoing vertical cardiotomy. On the other hand, transverse ventriculotomy did not result in significant abnormalities of right ventricular performance.
It is concluded that transverse ventriculotomy is more physiologic and may be the incision of choice, especially in the higherrisk group of patients with pulmonary hypertension.