bluuebunny/crossref_metadata_2025_split huggingface dataset:
The George E. Brown Memorial Lecture
Authors: ALLEN EDGAR V. 
Published: June 2012

In the course of this presentation I hope it has become evident that the professional life of George Brown could well serve as a model for the activities of the American Heart Association, which has made astonishing and gratifying progress in a few years. The advances in physiology, anatomy, surgery and medicine, as related to cardiovascular diseases, are justifiable reasons for pride. Yet pride in the past can produce no results in the future. Progress in the future must be supported by a tripod, such as has supported it in the past; one leg of the tripod is zeal, another is utilization of skill and knowledge, and another is money. We must furnish all three. The unsolved problems are unsolved not only because they are difficult but because we have not yet achieved a coordinated program of investigation. We must abandon all feelings of futility and avoid tedium. I can find no logical reason to believe that any important cardiovascular disease cannot be largely or wholly vanquished. If the conquest of these diseases continues at the rate which characterized the fifteen years just past, within the lifetime of physicians now living there will be no cardiovascular disease which cannot be prevented or corrected. If we remain imbued with untiring resolution to attack vigorously and with persistent zeal the greatest destroyers of health and life in America, such a program will be continued. We must hold forever before ourselves the truism that scientific research is progress.
Because this is the George Brown Memorial Lecture, I may appropriately quote from another "Brown," although spelled Browne, Sir Thomas, the author of "Religio Medici," who, in 1643, wrote as follows:
"The World which took but six days to make, is like to take six thousand to make out: meanwhile old Truths voted down begin to resume their places, and new ones rise upon us.... Men disparage not Antiquity, who prudently exalt new Enquiries, and make not them the Judges of Truth, who were but fellow Enquirers of it.... Despise not the obliquities of younger ways nor despair of better things whereof there is yet no prospect."
Familial Muscular Subaortic Stenosis
Authors: BRENT LAWRENCE B. , ABURANO AKIO , FISHER DON L. , MORAN THOMAS J. , MYERS JACK D. , TAYLOR W. JAPE 
Published: June 2012

Two families with familial muscular subaortic stenosis have been studied. Hemodynamic data in 2 cases and the operative findings of 1 case are described. Autopsy findings of 3 cases have been presented. Clinical findings indicate at least 3 additional cases in 1 family and 5 in the other.
The pedigrees of both families have been discussed. The incidence of this lesion in each family over 3 generations suggests that the defect is related to Mendelian dominant inheritance. To our knowledge, this is the first report of cases of familial heart disease compatible with transmission by a Mendelian dominant gene.
The importance of differential diagnosis of this disease from other types of aortic or subaortic stenosis prior to surgery has been stressed, since no operation has been devised for this lesion. The distinguishing clinical features include the apical and lower left sternal border location of the systolic murmur, the absence of poststenotic dilatation of the ascending aorta, the absence of calcification of the aortic value, the absence of a murmur of aortic insufficiency, and the strong family history suggesting a familial trait.
The Correction of Hyponatremia in Congestive Heart Failure
Authors: LUCKEY E. HUGH , RUBIN ALBERT L. 
Published: June 2012

Hyponatremia in congestive heart failure occurs principally in the terminal phases of the natural history of heart disease. Fortunately, in some instances it may occur as a transient event in a setting of sudden deterioration in cardiac function. In such instances, it may be reversible.
The most important factor in the occurrence of hyponatremia in these patients is an inordinate retention of water. Thus, the hyponatremia is the result of dilution.
Correction of hyponatremia requires the elimination of water in excess of sodium. The futility and dangers of the use of hypertonic sodium chloride are emphasized.
A method of controlled administration of mercurial diuretics after elevation of the plasma chlorides toward normal with consequent production of acidosis with chloride salts is reviewed. Diuresis following this procedure results in sodium losses in urine that are hypotonic in relation to plasma. The plasma sodium gradually returns to normal, and the patient progressively loses weight.
The Correlation Between the Electrocardiographic Patterns of Ventricular Hypertrophy and the Anatomic Findings
Authors: SCOTT RALPH C. 
Published: June 2012

The correlation of the electrocardiogram with anatomic evidence of ventricular hypertrophy, while laden with numerous pitfalls, still remains the best available means of determining the accuracy of the electrocardiographic diagnosis of ventricular hypertrophy.
In 100 instances of isolated left ventricular hypertrophy (LVH) demonstrated at autopsy, a positive electrocardiographic diagnosis was made in 85 per cent by use of conventional criteria. However, in other studies designed to test the reliability of these criteria, it was found that a false-positive diagnosis was made in 10 to 15 per cent of the cases.
The electrocardiographic diagnosis of right ventricular hypertrophy (RVH) is more difficult. In electrocardiographic studies, confirmed by autopsies, the correlation has ranged from 23 to 100 per cent, while the number of false-positive diagnoses has been as high as 33 per cent. The correct electrocardiographic diagnosis is more frequent in RVH due to congenital heart disease than to acquired heart disease.
The significance of the rSR' pattern in right precordial leads is discussed. Its occurrence in anatomic RVH and the problem of the electrocardiographic diagnosis of RVH in the presence of right bundle-branch block (RBBB) are reviewed.
Combined ventricular hypertrophy (CVH) is frequently missed in the electrocardiogram, the diagnosis having been made in only 8 to 26 per cent of cases proved at autopsy.
The unreliability of the electrocardiographic diagnosis of LVH in the presence of left bundle-branch block (LBBB) is documented.
The precise electrophysiologic phenomena that occur in ventricular hypertrophy are still largely conjectural. The more commonly accepted hypotheses are reviewed.
The lack of close correlation between ventricular wall thickness or respective ventricular muscle mass and the individual electrocardiographic patterns is emphasized. The possible explanations for some of these discrepancies are presented.
Fibrinolysin (Plasmin) Therapy in Acute Deep Thrombophlebitis
Authors: MOSER KENNETH M. , SULAVIK STEPHEN B. , HAJJAR GEORGE C. 
Published: June 2012

Sixty-two patients with deep thrombophlebitis of less than 10 days' duration were studied in controlled fashion. Thirty "control" patients were treated by routine methods including anticoagulant drugs. Thirty-two "treatment" patients received fibrinolysin (plasmin) in addition to control therapy.
The composition of the groups studied and the protocol followed are presented in detail.
Comparison of the 2 groups indicates that the addition of fibrinolysin to the therapeutic regimen leads to more rapid clearing of the acute phlebitic episode and may diminish the short-term incidence of phlebitic recurrence and pulmonary embolization. Postphlebitic residuals were encountered with almost equal frequency in both groups.
Greater short-term differences in therapeutic response exist between control and fibrinolysin patients when analysis is restricted to those treated within 5 days of phlebitic onset.
The available data do not permit firm conclusions regarding the apparently favorable influence of fibrinolysin upon the long-term prognosis of phlebitic subjects, but do indicate that recurrence and embolization can be expected in both groups.
The factors that may influence the results obtained with fibrinolytic therapy are discussed and the importance of considering them in studies of this type is emphasized.
Paroxysmal Atrial Tachycardia with Atrioventricular Block
Authors: GOLDBERG LEONARD M. , BRISTOW J. DAVID , PARKER BRENT M. , RITZMANN LEONARD W. 
Published: June 2012

Paroxysmal atrial tachycardia with block is a cardiac arrhythmia that is usually a manifestation of digitalis toxicity in patients with serious heart disease. The arrhythmia generally ends promptly after potassium administration and withdrawal of digitalis. Since the ventricular rates may be slow and regular, the arrhythmia may be difficult to recognize clinically. Atrial rates as slow as 115 per minute may be seen in cases which are otherwise typical of the condition.
In our series associated pulmonary disease was present in 54 per cent and cor pulmonale in 27 per cent of the cases.
Surgical Relief of Aortic Insufficiency by Direct Operation on the Aortic Valve
Authors: MULLER WILLIAM H. , WARREN W. DEAN , DAMMANN J. FRANCIS , BECKWITH JULIAN R. , WOOD J. EDWIN 
Published: June 2012

The natural history of patients with aortic insufficiency and the previous experimental and clinical operations devised for its relief are reviewed.
Methods that have been used at the University of Virginia Hospital for treatment of aortic insufficiency are reported. These procedures include the release of the fixed valve leaflet and removal of calcium from it, aortic valve leaflet extension with suture of a small piece of compressed polyvinyl sponge or Teflon fabric to the edge of one of the leaflets, excision and replacement of a portion of the valve with a synthetic leaflet, and complete subcoronary replacement of the valve with a prosthesis. To relieve isolated rheumatic aortic insufficiency, an annulus has been constricted or a bicuspid aortic valve has been created. Insufficiency resulting from perforation of one or more valve leaflets by subacute bacterial endocarditis has been treated by closure of the perforations.
Nineteen patients underwent 21 operations for the correction of aortic insufficiency. All had been in, or were in, heart failure, and several had significant coronary artery disease or multivalvular disease. Eleven of the 19 patients are well or markedly improved. Eight died during or after the operative procedure.
It is concluded that a direct attack upon the insufficient aortic valve is the procedure of choice at the present time.
Permutation Trial of Diuretics
Authors: KIIL FREDRIK 
Published: June 2012

In order to increase the amount of information per day of observation the permutation trial is introduced in the study of acute effects of diuretic agents.
Chlorothiazide and hydroflumethiazide in optimal doses (2 Gm. and 200 mg. daily) and placebo tablets were given, 1 drug on each of the 3 days of the study, in all permutations to 12 patients treated by current methods for right heart failure.
The error variance of sodium, potassium, chloride, and water excretion was reduced by taking into account the variation due to permutations and days.
Chlorothiazide showed a stronger diuretic action than hydroflumethiazide, whereas the natriuretic effects were not significantly different as judged by analysis of variance. Hydroflumethiazide was less kaliuretic.
Magnesium excretion was independent of diuresis. Neither of the diuretics showed any effect on magnesium and calcium excretion. The ratio of sodium and chloride excretion was significantly lower during hydroflumethiazide than during chlorothiazide action.
The calculated sodium concentration in the additionally excreted urine during hydroflumethiazide administration was far above serum levels (the mean of 12 observations was 353 mEq. per liter), and significantly higher than during chlorothiazide action. This effect was also demonstrated in 6 control patients during water loading, suggesting that hydroflumethiazide increases free water reabsorption also when antidiuretic hormone is absent.
Comparison of the acute effects of diuretic agents is through the permutation trial made possible in the ordinarily equipped hospital without serious interference with current treatment.
Cardiovascular Manifestations in Argemone Mexicana Poisoning (Epidemic Dropsy)
Authors: SANGHVI L. M. , MISRA S. N. , BOSE T. K. 
Published: June 2012

Cardiovascular manifestations have been studied in 11 patients with argemone oil poisoning.
Tachycardia, alterations in the heart sounds, cardiac enlargement, or electrocardiographic and ballistocardiographic changes indicated myocardial involvement in every case. The latter was suggestive of a nonspecific type of myocarditis and was considered to be of a minor nature. The prominent manifestations included dyspnea, edema, hepatic enlargement, and pulmonary congestion. The last 3 were probably due to capillary dilatation, whereas the cause of dyspnea was uncertain.
These manifestations suggested the presence of cardiac failure, which, however, was considered unlikely except in 1 case.
Some Circulatory Effects of 5-Hydroxytryptamine in Man
Authors: HARRIS P. , FRITTS H. W. , COURNAND A. 
Published: June 2012

Continuous infusions of small quantities of 5-hydroxytryptamine (5-HT) were made into the pulmonary artery in 7 human subjects. In only 1 instance was there an unequivocal rise in pressure in the pulmonary artery and this was accompanied by a rise in brachial arterial pressure. The most consistent effect of the drug was to raise the heart rate. There was no effect on the cardiac output.
Single rapid injections of 5-HT were made into the right atrium in 3 other subjects. In 1 of these subjects the injection of 4 µg. per Kg. caused transient ventricular arrest and systemic hypotension followed by a sustained rise in pressure in the pulmonary and brachial arteries. The results of this study were thought to indicate the presence of a Bezold-like reflex. The rapid injection of 5-HT was therefore thought to be dangerous and the investigation was discontinued.
Aortic and Coronary Atherosclerosis in the Three Racial Groups in Cape Town
Authors: SACKS M. I. 
Published: June 2012

An autopsy survey of aortic and coronary atherosclerosis in patients dying in a general hospital in Cape Town has shown marked differences between the whites and the Bantu. These differences were clearly demonstrated by a direct comparison of Bantu and White men between the ages of 40 and 59. They probably also existed among older subjects and women although relatively few Bantu over the age of 60, and fewer women than men were unfortunately available for study.
Severe aortic and coronary atherosclerosis did on occasions occur in the Bantu but were much less common than in the whites. Severe luminal narrowing of the coronary arteries was particularly rare in the Bantu, and this is in keeping with the rarity with which they develop myocardial infarction. The aorta and coronary arteries of the Bantu often showed complete freedom from atherosclerosis in age groups in which it was rare to find such freedom in the whites.
The differences between the whites and Cape Coloured were much less pronounced than those between the whites and Bantu, were rather more apparent in men than women, and tended to disappear in the presence of aggravating factors such as hypertension. Even in groups in which severe coronary atherosclerosis was as commonly encountered in the Cape Coloured as in the whites, the Cape Coloured appeared to show a lower frequency of severe luminal narrowing. Attention has been drawn to the possibility that the differences between the total white and Cape Coloured populatios of Cape Town are greater than those revealed by this study, as only the lesser economically privileged of the whites were eligible for admission to the hospital that provided the material for the study.
Circulatory Effects of Guanethidine
Authors: RICHARDSON D. W. , WYSO E. M. , MAGEE J. H. , CAVELL G. C. 
Published: June 2012

Guanethidine, a new synthetic hypotensive drug that probably interferes with release of norepinephrine from sympathetic nerve endings and that does not inhibit parasympathetic activity, has proved an effective agent in reducing blood pressure in 25 hypertensive patients studied for periods up to 6 months. Untoward effects have been limited to orthostatic hypotension and mild diarrhea.
The drug apparently lowers blood pressure by reduction in cardiac output rather than by relaxation of the arterioles. Reduction in renal blood flow and glomerular filtration rate accompanied administration of the drug, but in no case did progressive azotemia or oliguria occur.
This agent is an extremely potent hypotensive drug with a remarkably prolonged duration of action and with none of the parasympatholytic side effects produced by ganglionic-blocking agents.
Effects of Acute Hypoxia and Exercise on the Pulmonary Circulation
Authors: FISHMAN ALFRED P. , FRITTS HARRY W. , COURNAND ANDRÉ 
Published: June 2012

The effects of acute hypoxia, of graded exercise, or both, on the pulmonary circulation were studied in 17 normal subjects. In 3 of these subjects, and in 3 patients with restricted vascular beds, the effects of these stimuli were compared during successive test periods.
In 7 normal subjects, moderate exercise, associated with an increase in cardiac output of approximately 25 per cent, resulted in an average rise in pulmonary arterial mean pressure of 3 mm.Hg. More strenuous exercise in the same subjects, associated with a further increase in cardiac output of approximately 25 per cent, did not elicit further increment in pulmonary arterial mean pressure.

In contrast, 10 subjects with normal pulmonary circulations, who responded to acute hypoxia with an average reduction of arterial oxygen saturation of 17 per cent, manifested an average increase in cardiac output of 5 per cent and an average rise in mean pulmonary arterial pressure of 4 mm.Hg. The critical level of arterial blood oxygen saturation for a significant rise in pulmonary arterial pressure was 85 per cent: in 6 subjects, with arterial blood O
2
saturation reduced below this level, the average pulmonary artery pressure rise was 7 mm. Hg.

In the 3 subjects with normal pulmonary circulations who performed exercise and were exposed to acute hypoxia, the contrasting effects of these stimuli on the pulmonary circulation were striking. In the 3 patients with restricted vascular beds exposed successively to both stimuli, the rise in pulmonary arterial mean pressure appeared to be linearly related to the increase in pulmonary blood flow.
In 1 subject, the surgical resection of the preganglionic fibers and ganglia which supply sympathetic efferent nerves to the pulmonary vascular tree was without effect on the responses of the pulmonary circulation to acute hypoxia and to exercise.
The present study failed to identify the mechanism and the site of action of acute hypoxia on the pulmonary circulation.
Retinal Vascular Reactivity in Patients with Diabetes Mellitus and with Atherosclerosis
Authors: HICKAM J. B. , SIEKER H. O. 
Published: June 2012

By means of fundus photography, a comparative study has been made of the constrictor response of retinal vessels to the inhalation of oxygen in 47 control subjects, 50 diabetic patients, and 15 persons with atherosclerosis unassociated with hypertension or diabetes.
The diabetic group showed decreased reactivity of both arteries and veins, as indicated by a decreased constrictor response to oxygen. Retinal arterial reactivity was significantly reduced in diabetic subjects, even in the absence of retinopathy or hypertension. With the appearance of retinopathy, arterial reactivity was still further reduced.
The patients with uncomplicated atherosclerosis did not show significant changes in retinal vascular reactivity.
Catecholamines in the Localization of Pheochromocytoma
Authors: CROUT J. RICHARD , SJOERDSMA ALBERT 
Published: June 2012

Data on urinary catecholamines in a collected series of 75 cases of pheochromocytoma, including 18 of our own cases, indicate that the differential assay of urinary norepinephrine and epinephrine may be of value in predicting the location of the tumor preoperatively. If there is a significant elevation of urinary epinephrine (42 per cent of all cases), the tumor may be expected to lie in or adjacent to one of the adrenal glands in about 95 per cent of cases. Other tumors of this type have been found only in the organs of Zuckerkandl. If the urine contains norepinephrine alone (58 per cent of all cases), the tumor will be found in one of the adrenal areas in about two thirds of the cases and in an extra-adrenal location in the remainder. In a few patients (6 per cent) of this type, the tumor may be extra-abdominal.
In some unusual cases more precise information on the location of the tumor must be obtained preoperatively. The demonstration of a marked step-up in plasma catecholamine concentration at the level of the tumor, the sampling being done by venous catheterization, is a useful and safe means of localizing the tumor. Five cases are presented illustrating the use of this procedure.
Tetralogy of Fallot with Anomalous Tricuspid Valve Simulating Pulmonary Stenosis with Intact Septum
Authors: NEUFELD HENRY N. , MCGOON DWIGHT C. , DUSHANE JAMES W. , EDWARDS JESSE E. 
Published: June 2012

An anatomicopathologic entity of the tetralogy of Fallot with an additional finding of an accessory flap of tricuspid valvular tissue is described. In the 3 cases reported in this paper, the outstanding hemodynamic finding was a right ventricular systolic pressure that was significantly greater than the systemic systolic pressure.
The hemodynamic findings were explained by the fact that the accessory tricuspid flap partially closed the large ventricular septal defect.
The clinical picture was similar to that of either severe pulmonary stenosis with an intact ventricular septum or severe pulmonary stenosis with a small ventricular septal defect and a right-to-left shunt at the ventricular level.