bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cellular Infiltration of the Human Arterial Adventitia Associated with Atheromatous Plaques
Authors: SCHWARTZ C. J. , MITCHELL J. R. A. 
Published: June 2012

Homogeneous collections of cells resembling small lymphocytes have been found in the adventitia of atheromatous arteries, and the prevalence and degree of cellular infiltration have been shown to correlate closely with the severity of the plaques. The cells are found in the aorta, coronary, iliac, and carotid arteries; but in the carotid arteries the infiltration is less marked. Arterial blocks containing recent thrombus show more cellular infiltration than blocks without thrombus and with recanalizing thrombus.
The location and significance of the adventitial cellular infiltration is unknown, but it may play a part in the etiology or pathogenesis of arterial plaques.
Endocardial Cushion Defect
Authors: SCOTT LEWIS P. , HAUCK ANNA J. , NADAS ALEXANDER S. , GROSS ROBERT E. 
Published: June 2012

Preoperative and postoperative data on 44 patients with endocardial defect, 32 with the incomplete and 12 with the Complete form are presented. Nineteen per cent of the incomplete form died with per cent of the deaths occurring early and 9.5 per cent late. The mortality rate for the complete form was 75 per cent.
Late follow-up results were evaluated in 28 patients 1 to 2½ years following surgery. Catheterization data in nine of 10 and clinical observations in 18 indicated no residual shunt. One patient showed questionable evidence of a left-to-right shunt by cardiac catheterization. Evidence of mitral regurgitation was present in seven (25 per cent) of the survivors. Short chordae attaching the closed cleft margin of the mitral leaflet to the ventricular septum rendered the valve incompetent in nine of 12 autopsied specimens. Surgical exploration of the underside of the cleft margins for such chordae is recommended. No evidence of residual tricuspid regurgitation was found.
Shock: A Semantic Enigma
Authors: RUSHMER ROBERT F. , VAN CITTERS ROBERT L. , FRANKLIN DEAN L. , Baker Donald , Schlegel William , Harding Donald , Watson Nolan , Smith Raymond 
Published: June 2012

The first step in analyzing any clinical problem must be the identification and precise definition of the entity. An adequate definition must be based on accurate and quantitative description in terms of crucial variables. Since many of the essential variables can be measured or estimated on patients, shock can be approached in a series of logical steps for each type:
1. A discrete clinical condition currently classified under the term "shock" could be identified.
2. A specific and unique name and definition of this condition could be derived by direct and quantitative measurements of variables such as those represented in figure 1.
3. The initiating factors would become apparent from these measurements.
4. The compensatory reactions that are inadequate should be distinguished from responses that are inappropriate.
5. With this knowledge at hand, a suitable model of the circulatory disturbance could be evolved and validated by quantitative measurements in experimental analysis.
6. Appropriate therapy of the defined condition could then be based on knowledge of the nature of the basic disturbance. Obviously, treatment that would effectively correct the fundamental defect from extravasation or anaphylaxis might be dangerous if applied to a patient with myocardial infarction.
7. The terminal events in fatal shock-like states can be regarded as a group of potential vicious circles that may have no obvious connection with the original cause of the systemic arterial hypotension. Effective therapy during the final stages of circulatory deterioration requires a great deal more knowledge regarding the various mechanisms of circulatory collapse than we now possess.
Further Electrocardiographic Observations on Direct Epicardial Potentials in Congenital Heart Lesions
Authors: WASSERBURGER R. H. , YOUNG W. P. , SIEBECKER K. , HAWKINS L. K. , BAMFORTH B. , KING J. T. 
Published: June 2012

Epicardial electromotive potentials have been recorded at the time of open thoracotomy on 130 patients, 124 having congenital heart disease.
These data confirm characteristic epicardial potentials with right ventricular preponderance, incomplete right bundle-branch block, and complete right bundle-branch block, as well as with normal rS and rSr' complexes, as identified in the right precordial leads of unipolar electrocardiograms.
The major differential feature between right ventricular preponderance and incomplete right bundle-branch block is a critical difference in onset of depolarization of the free wall of the right ventricle. This measurement, AB of figure 1, is 0.02 second with right ventricular preponderance and 0.03 second or greater with incomplete right bundle-branch block.
Although rR' or rsR' right precordial QRS complexes are identified with both right ventricular preponderance and incomplete right bundle-branch block, the broad left ventricular S wave of the incomplete right bundle-branch block aids in differentiating them on the conventional electrocardiogram.

A tall predominant late R wave in aV
R
, arising from the R' component of the rR' potential of the hypertrophied right ventricular outflow tract, serves to denote an advanced degree of right ventricular hypertrophy, whether the classic pattern of right ventricular preponderance or an incomplete right bundle-branch block associated with right ventricular preponderance presents on the routine electrocardiogram.

The apparent slurred or pure R waves, the Rs and qR right precordial QRS complexes, seen with instances of right ventricular preponderance or incomplete right bundle-branch block, are actually rR' or rsR' complexes. Additional exploratory right anterior chest leads will invariably bring out the initial septal r wave component.
The rR' or rsR' potentials of right ventricular preponderance or right bundle-branch block arise from a relatively selective site of the high medial outflow tract of the right ventricle.
Proteolysis, Fibrinolysis, and Coagulation
Authors: ALEXANDER BENJAMIN , PECHET LIBERTO , KLIMAN ALLAN 
Published: June 2012

The fibrinolytic mechanism, one of the blood protease systems, constitutes a fourth phase of clotting, which contributes to maintenance of coagulation in delicate balance.
"Shwartzman"-induced in vivo coagulation, combined with fibrinolysin, produces profound clotting defects with severe hemostatic failure, in contrast to the relative innocuousness of either alone.
The same defects are obtainable in vitro. The thrombin-fibrinogen interaction is blocked, simulating the in vivo "afiibrinogenemia." These observations are pertinent to thrombolytic therapy invoked for conditions where intravascular clotting may be occurring.
Fibrinogen clottability is also blocked by trypsin. Apparently, fibrinolysin, thrombin, and trypsin are competitive for fibrinogen.
Trypsin, as, well as other proteases, markedly activates factors II, VII, and X, resembling the action of thromboplastin. In contrast, fibrinolysin and thrombin are inert on these clotting factors, whereas on factor V they first activate and then destroy it. This explains why factor V depression is observed in thrombolytic therapy.
The activating effect of trypsin on factors II, VII, and X precludes its use in thrombolytic therapy, and also draws attention to the tryptase-antitryptase equilibrium in normal and certain thrombotic states.
The experimental observations help elucidate some clinical and clinicolaboratory findings in acquired "afibrinogenemia" and therapeutically induced "fibrinolytic" states. The retarded thrombin clotting time of the plasma, and reduction in prothrombic activity attributable to fibrinolytic depression of factor V, may be valuable guides to thrombolytic therapy.
Supravalvular Aortic Stenosis in Association with Mental Retardation and a Certain Facial Appearance
Authors: BEUREN A. J. , APITZ J. , HARMJANZ D. 
Published: June 2012

Four patients with supravalvular aortic stenosis are reported. In three of these patients a certain facial resemblance was striking, and these three patients were also mentally and physically retarded. The cases are very similar to the four cases recently reported in the literature. Supravalvular aortic stenosis in association with mental retardation and a certain facial appearance may constitute a previously unrecognized clinical syndrome.
A systolic thrill and murmur most pronounced in the first right intercostal space and just below the clavicle, with an empty vascular pedicle on the roentgenogram, may be a clue to the clinical diagnosis of supravalvular aortic stenosis.
Supravalvular aortic stenosis is best demonstrated by left ventriculography. A collateral circulation between the coronary arteries and the internal mammary artery has been shown in one patient.
Mitral Regurgitant Flow and Left Ventricular Function in Patients with Mitral Valve Disease
Authors: JOSE ANTHONY D. , BERNSTEIN L. 
Published: June 2012

A direct indicator-dilution principle for measurement of regurgitant flow has been applied in the study of 39 patients with mitral valve disease.
Certain technical modifications in the procedure appear to have abolished the grossly anomalous results encountered previously, enabling a degree of reliance to be placed on the quantitative measurement.
With use of the measurement obtained, together with other hemodynamic data, the functional status of patients with mitral incompetence has been analyzed. The findings confirm that left ventricular failure, not mitral incompetence itself, underlies many of the criteria presently used to determine the severity of the disease, i.e., the presence of symptoms, the clinical and radiologic signs, and abnormalities in arterial dye dilution curves. These criteria are therefore probably not optimal ones on which to base selection of patients for surgical treatment, or to follow its results.
Congenital Mitral Stenosis
Authors: DAOUD GEORGES , KAPLAN SAMUEL , PERRIN EUGENE V. , DORST JOHN P. , EDWARDS F. KATHRYN 
Published: June 2012

Seven patients with isolated congenital mitral stenosis are described. In one instance there was an associated coarctation of the aorta. Repeated pulmonic infections, pulmonary edema, and congestive heart failure occurred frequently. The clinical diagnosis is suspected in the presence of an apical diastolic rumbling murmur and left atrial enlargement. Presystolic accentuation of this diastolic murmur, a sharp first heart sound, and an opening snap strengthen the diagnosis. Cardiomegaly and the electrocardiographic finding of right ventricular hypertrophy are common. Pulmonary hypertension and congestive heart failure may obscure the clinical picture of isolated congenital mitral stenosis. In infancy, the presence of tight mitral stenosis is usually associated with a poor prognosis.
The mitral leaflets showed variable degrees of fusion and thickening. The chordae tendineae were shortened and the papillary muscles hypertrophic. Endocardial fibroelastosis was common in the left heart, especially in the atrium.
In infancy and early childhood, the results of the medical and surgical treatment were generally poor. In older children, a better result was obtained and the surgical indications in these instances are not unlike those of rheumatic mitral stenosis.
Ventricular Septal Defect with Aortic Insufficiency
Authors: KECK ERNST W. O. , ONGLEY PATRICK A. , KINCAID OWINGS W. , SWAN H. J. C. 
Published: June 2012

Eighteen patients with the combination of ventricular septal defect and aortic insufficiency were studied. Nine also had infundibular pulmonary stenosis. Seventeen were treated by open-heart operations.
The physical findings were those of a typical ventricular defect murmur and thrill together with an aortic insufficiency blow and a wide pulse pressure. A systolic murmur at the upper left sternal border with thrill is strongly suggestive of the additional lesion of infundibular pulmonary stenosis, but the presence or absence of infundibular pulmonary stenosis was indicated most accurately at cardiac catheterization and on inspection at operation. It was not of sufficient severity for signs of additional right ventricular hypertrophy to appear on the electrocardiogram.
Retrograde aortography serves to demonstrate the severity of the aortic regurgitation.
The problem of the surgical correction of these lesions will be the subject of a separate communication.
Studies in Serum Lipids
Authors: CROMIE J. B. , THOMSON K. J. , CULLIMORE O. S. , BEACH E. F. 
Published: June 2012

Repeated measurements of the fasting and 2-hour postprandial serum lipids (cholesterol, phospholipid, and triglyceride) of "normal" [see table in the PDF file] subjects and subjects with atherosclerotic heart disease when consuming diets of high-, low-, or "normal"-fat content have been made.
Triglyceride levels correlated better with the clinical diagnosis of heart disease than did cholesterol or phospholipid levels. The wide fluctuations in triglyceride levels in the same [see table in the PDF file] subject (normal or atherosclerotic) when on a "normal self-selected" diet and the unexpected findings when a short-term (3-day) period of dietary fat manipulation render the value of random triglyceride levels as an indictator of the presence or likely development of atherosclerotic heart disease of little or no value in the individual subject.
Studies on Digitalis
Authors: KAHLER RICHARD L. , THOMPSON RONALD H. , BUSKIRK ELSWORTH R. , FRYE ROBERT L. , BRAUNWALD EUGENE 
Published: June 2012

Three patients with acquired valvular heart disease and cardiac enlargement who were able to perform normal everyday activity without difficulty in the absence of digitalis therapy were exercised while receiving a placebo and again while receiving digoxin. Digoxin administration did not produce a significant change in body weight or in the subjective condition of the individuals. Varying degrees of exercise were performed on a treadmill in a Metabolic Chamber and oxygen consumption was measured cotinuously before, during, and after the period of exercise, utilizing a continuous gas flow paramagnetic oxygen analyzer. The oxygen debt that developed during digoxin administration was compared to that observed during placebo administration.
In all patients the oxygen debt was smaller during the period of digoxin administration, although the external work performed was identical. In the first patient, following a 7-minute walk, the oxygen debt was 53 per cent more and following a 10-minute walk it averaged 40 per cent more while not receiving digoxin than when receiving this drug. In the second subject the oxygen debt following a 7-minute walk was 34 per cent more and following 10-minute walk it averaged 74 per cent more when he was not receiving digoxin than when receiving this drug. In the third subject the oxygen debts were 46 per cent and 41 per cent greater following 10- and 15- minute walks respectively, when she was not receiving digoxin.
The accumulation of a smaller oxygen debt following exercise while these subjects were receiving digoxin indicates that the functional status of their circulatory system was improved by the drug. It would appear that digitalis administration is beneficial to at least some patients who have cardiac disease and enlarged hearts and some decrease in cardiac reserve without signs or symptoms of heart failure.
Effects of Inhalation of 100 Per Cent Oxygen on the Pulmonary Blood Volume in Patients with Organic Heart Disease
Authors: GLICK GERALD , SCHREINER BERNARD F. , MURPHY GERALD W. , YU PAUL N. 
Published: June 2012

The effect of breathing 100 per cent oxygen on the pulmonary blood volume, pulmonary arterial pressure, left atrial pressure, and pulmonary vascular distending pressure was studied during cardiac catheterization in eight patients with organic heart disease. In half of the patients, a significant decrease in pulmonary blood volume was observed. This decline in pulmonary blood volume in the face of a decrease or no change in the pulmonary distending pressure is interpreted as evidence for a passive mechanism of action for 100 per cent oxygen.
The effects of hyperoxia are compared to those of acetylcholine, which works by actively dilating the pulmonary vascular bed.
A Surgical Approach to Ebstein's Disease
Authors: SCOTT III L. P. , DEMPSEY J. J. , TIMMIS H. H. , MCCLENATHAN J. E. 
Published: June 2012

Ebstein's disease in a severely cyanotic 7-year-old boy was successfully treated by anastomosing the superior vena cava to the right pulmonary artery.
A discussion of impaired right heart function in Ebstein's disease is presented emphasizing the inefficiency of right atrial contraction as a consequence of the "atrialization" of the right ventricle.
It is our belief that right heart bypass with a superior vena cava to right pulmonary artery anastomosis is the surgical procedure of choice in patients severely ill from Ebstein's disease.
A Method for the Control of Severe Alterations in Acid-Base Equilibrium
Authors: MOORE DOUGLAS , BERNHARD WILLIAM F. 
Published: June 2012

Tris buffer was utilized in the prevention or treatment of profound metabolic acidosis which developed during, and immediately after, extended periods of extracorporeal circulation. In 16 patients (group I), buffer was added to the 24-hour-old heparinized priming blood prior to initiation of bypass, to counteract a low pH and high lactic acid concentration. The success of this therapy was manifested by the stability of all acid-base parameters during and following operation.
In the second group of 11 patients (group II), severe metabolic acidosis developed despite preliminary buffering of the priming blood. Here, the administration of additional buffer successfully restored acid-base equilibrium prior to the termination of perfusion.
The buffer also proved effective in the treatment of two patients who developed severe respiratory acidosis in the immediate postperfusion period, and was instrumental in the resuscitation of a final patient following a prolonged period of cardiac arrest.
It is suggested that tris buffer is a safe, potent agent for use in the prevention and treatment of acidosis from whatever cause.
Aortic Replacement
Authors: STARR ALBERT , EDWARDS M. LOWELL , MCCORD COLIN W. , GRISWOLD HERBERT E. 
Published: June 2012

A ball-valve prosthesis for aortic replacement has been described which, while it is similar to the mitral ball valve in terms of materials and construction, is quite different in sewing margin and internal geometry. Implantation is greatly facilitated by the flexibility of the prosthesis in terms of external diameter, and by the availability of a full set of varying sizes for obtaining a proper fit. Widening of the aortic root by patch grafting has not been necessary. Long-term survival has been achieved in the dog, and early clinical results are most promising.
While the selection of the ideal aortic valvular replacement must await further experience with all types of prostheses, continued evaluation of the ball valve in the aortic position, in carefully chosen patients, is indicated.
Ventricular Septal Defect with Aortic Valvular Incompetence
Authors: ELLIS F. HENRY , ONGLEY PATRICK A. , KIRKLIN JOHN W. 
Published: June 2012

Nineteen patients with ventricular septal defect and severe aortic valvular incompetence have been operated on at the Mayo Clinic. There were two early deaths and two late deaths. The ventricular septal defect was located high and anteriorly in the septum and was often small. Aortic valvular incompetence was due, in most cases, to a deformed, prolapsing right coronary cusp. Mild to moderate degrees of infundibular pulmonary stenosis coexisted in nine patients.
Repair of the ventricular septal defect was readily accomplished in most cases by direct suture, and relief of obstruction to right ventricular outflow was effected, when required, by resection of the crista supraventricularis. Repair of the aortic incompetence was attempted by a variety of means, but the incidence of persistent significant regurgitation was high, except when prosthetic cusp replacement was used.
It is currently our policy to defer operation in children unless there are significant symptoms. When the patient is past the age of about 12 to 14 years, operation is advised under proper circumstances, and it consists generally of suturing of the ventricular septal defect and replacement of the right coronary cusp of the aortic valve.
Effects of Right Ventriculotomy upon Activation of the Epicardial Surface of the Canine Right Ventricle
Authors: GENENDER LAWRENCE J. , STUCKEY JACKSON H. , JOMAIN SERGE L. , HOFFMAN BRIAN F. 
Published: June 2012

The sequence of activation of the epicardial surface of the right ventricle has been studied before and after right ventriculotomy. Normally, the area of the right ventricle adjacent to the anterior interventricular groove is activated first, the midportion of the wall second, and the area adjacent to the posterior interventricular groove and the anterior basal area are activated last. Activation of the entire epicardial surface of the right ventricle requires 25 to 40 msec.
Right ventriculotomy does not alter the sequence of activation or the time of activation of the right ventricular epicardium if the incision passes medial to the free-running Purkinje fibers or through their arborization on the right, ventricular wall. When the ventriculotomy is made lateral to the arborization of these fibers, activation of that portion of the wall lateral to the incision is delayed, and activation of the entire ventricular surface requires 42 to 52 msec.
There is no electrocardiographic evidence of bundle-branch block, complete or partial, following right ventriculotomy, regardless of the location of the incision.
Aortico-Left Ventricular Tunnel
Authors: LEVY MORRIS J. , LILLEHEI C. WALTON , ANDERSON RAY C. , AMPLATZ KURT , EDWARDS JESSE E. 
Published: June 2012

To be distinguished from aneurysm of an aortic sinus (Valsalva) is the rare condition in which an abnormal channel begins in the ascending aorta (above the right coronary artery), bypasses the aortic valve, and leads through the ventricular septum into the left ventricular cavity. This entity, which has not previously been diagnosed during life, to our knowledge, is herein named aortico-left ventricular tunnel.
The cases of three patients (aged 3, 5, and 10 years) with this rare condition are described. The clinical, electrocardiographic, and radiological features were similar in each case and resembled those in aortic valvular insufficiency.
The diagnosis may be established clinically through selective aortography. This reveals that the origin of the abnormal communication lies in the anterior wall of the ascending aorta above the levels of the coronary arterial origins. The abnormal communication leads to the left ventricle. The condition is distinguished from aortic sinus aneurysm by its origin above the level of the aortic sinuses.
Identical anatomical findings and the presence of abnormal physical findings since infancy in each of the three patients suggest that this peculiar condition is a congenital malformation.