bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Effect of Digoxin in the Splanchnic Circulation in Ventricular Failure
Authors: FERRER M. IRENÉ , BRADLEY STANLEY E. , WHEELER HENRY O. , ENSON YALE , PREISIG RUDOLPH , HARVEY RÉJANE M. 
Published: June 2012

Splanchnic hemodynamics were examined in 22 patients with heart disease, 16 of whom had evidence of ventricular insufficiency at the time of study. The response of the splanchnic vasculature to the exhibition of intravenous digoxin was also studied in nine of these subjects.
Ventricular insufficiency was associated with splanchnic vasoconstriction proportional to a generalized increase in peripheral vascular resistance. Splanchnic blood volume was disproportionately increased with respect to total blood volume in patients having visceral congestion with right ventricular failure and combined ventricular failure. A significant relationship between central venous pressure and splanchnic blood volume was demonstrated in these cases. The greater elevation of the former than of the latter suggested the presence of splanchnic venoconstriction.
The vascular readjustment to digoxin resulted in a relative intensification of the already existing vasoconstriction of the splanchnic bed as compared to the diffuse systemic vasodilatation which occurred at the same time as the consequence of the inotropic action of the drug: estimated splanchnic blood flow and splanchnic blood volume diminished at a time when systemic flow rose and peripheral vascular resistance decreased. The ultimate distribution of the volume of blood translocated out of the splanchnic bed during this process remains to be determined.
Anatomic and Physiologic Considerations in Measurements of Myocardial Blood Flow
Authors: ROSS RICHARD S. , FRIESINGER GOTTLIEB C. 
Published: June 2012

Indicators can be used to measure myocardial blood flow if the myocardial circulation can be isolated from other segments of the systemic circulation.
Methods of measuring myocardial blood flow can be divided into groups according to the technic employed to provide "isolation" of the myocardium.
There is no practical method of proved accuracy whereby coronary blood flow can be measured in man in absolute terms of ml./min.
All the so-called clearance methods measure myocardial blood flow in flow/volume units or ml./min./100 Gm.
Myocardial blood flow measurements in these flow/volume units have not proved useful in separation of normal individuals from those with ischemic heart disease at rest, but have been useful in the study of acute intervention such as exercise or the administration of drugs.
The Quantitative Determination of Coronary Flow with a Positron Emitter (Rubidium-84)
Authors: COHEN ALBERTO , GALLAGHER JAMES P. , LUEBS EIDE-DITTMAR , VARGA ZOLTAN , YAMANAKA JIRO , ZALESKI EDWARD J. , BLUEMCHEN GERHARD , BING RICHARD J. 
Published: June 2012

An objective method for the quantitative measurement of the coronary blood flow in ml./min. using a coincidence counting system with rubidium-84, a positron emitter, is described. Accidental coincidence counts arising from independent annihilation of positrons were greatly reduced by simple shielding.
The coronary blood flow was calculated by the extrapolation of the clearance values to zero time. At this time the myocardial extraction ratio of rubidium-84 is unity and clearance is equal to flow. The accuracy of this method was demonstrated on the isolated perfused dog heart.
It was found that the rate of change of the extraction ratio of rubidium-84 in the isolated perfused dog heart and in man was not altered with changes in flow.
The finding that nitroglycerin increases the coronary blood flow in patients without coronary artery disease while decreasing it in patients with coronary artery disease was confirmed.
Kinetocardiographic Changes in Ischemic Heart Disease
Authors: EDDLEMAN E. E. 
Published: June 2012

Patients with myocardial infarctions may show a paradoxic precordial outward systolic movement that can be recorded by the kineto-cardiographic technic and often is felt at the bedside.
Three types of changes occur. The first is an early systolic outward movement, which is abnormally long in duration but not sustained throughout systole. The second is a sustained outward movement during systole called a "bulge," and the third is a late systolic outward movement.

Bulges can be recorded in approximately two thirds of the patients with known infarctions with the largest outward movement most frequently noted in or near the V
3
area.

A few patients with angina may have a bulge at rest; however, apparently about 30 per cent develop a bulge on exercise.
The Cardiac Pathology of Chronic Exogenous Obesity
Authors: AMAD KAMEL H. , BRENNAN JAMES C. , ALEXANDER JAMES K. 
Published: June 2012

Appraisal of the gross and microscopic anatomy of the heart was carried out at necropsy in 12 subjects (six men, six women) with marked chronic obesity. In each case the observed heart weight was considerably greater than that predicted at ideal body weight. Nine of the 12 subjects were found to have increase in left ventricular wall thickness, and two increase in right. The increases in heart weight and ventricular wall thickness were due to muscle hypertrophy involving the left ventricle or both left and right ventricles. Neither isolated nor predominant right ventricular hypertrophy was observed.
It has been concluded that myocardial hypertrophy is a more specific and significant anatomic alteration in the hearts of very obese subjects than are the previously reported findings of excess epicardial fat and fatty infiltration of the myocardium. The relationship between chronic augmentation of the work of the heart in these subjects and the development of cardiac hypertrophy has been discussed. The findings in this study have been interpreted as providing further support for the propositions that manifestations of myocardial insufficiency do occur in very obese subjects without evidences of other heart disease, that these manifestations are those of predominant left ventricular or biventricular failure, and that isolated cor pulmonale does not develop in the absence of pulmonary embolization.
Studies on Cardiac Dimensions in Intact Unanesthetized Man
Authors: WILLIAMS JOHN F. , GLICK GERALD , BRAUNWALD EUGENE 
Published: June 2012

The objective of this study was to determine the effects of nitroglycerin on ventricular dimensions. At the time of corrective cardiac operations, silver-tantalum markers were sutured to one or both ventricles of 11 patients without clinical evidence of coronary artery disease. Following recovery, cineradiograms were exposed at 30 frames per second and distances between markers were measured before and after 0.6 mg. of nitroglycerin. In all patients, end-diastolic and end-systolic dimensions decreased within 2 to 6 minutes. Right ventricular end-diastolic and end-systolic lengths decreased by an average of 5.0 per cent and 3.6 per cent of control values, respectively, while left ventricular end-diastolic and end-systolic dimensions declined by an average of 6.2 per cent and 5.9 per cent of control, respectively. The diminutions of end-diastolic ventricular dimensions approximated 30 per cent of the stroke volume. Systolic excursions decreased by an average of 13.3 per cent of control for the right ventricle, while left ventricular excursions decreased in four of the six patients. Systolic, mean, and diastolic arterial pressures decreased in each patient after nitroglycerin. Cardiac output fell from an average of 5.6 to 5.0 L./min., decreasing in each of the six patients in whom it was determined, while stroke volume fell from an average value of 65 ml./beat during the control period to 55 ml./beat after nitroglycerin.
Thus, nitroglycerin reduces both arterial pressure and ventricular dimensions and in view of the relationship between ventricular size, myocardial tension, and oxygen consumption, this action tends to reduce cardiac oxygen requirements and may explain, at least in part, the effectiveness of the drug in angina pectoris.
Idiopathic Enlargement of the Right Atrium
Authors: SUMNER ROBERT G. , PHILLIPS JOHN H. , JACOBY WILLIAM J. , TUCKER DONALD H. 
Published: June 2012

Four patients with idiopathic enlargement of the right atrium are described. All patients were evaluated carefully by clinical means and two were subjected to extensive investigation including cardiac catheterization, angiocardiography, and intracavitary electrocardiography.
The diagnosis of idiopathic enlargement of the right atrium is based primarily on radiographic examination with exclusion of other causes of right atrial enlargement by appropriate clinical and laboratory means. In the patients studied no cause for the right atrial abnormality could be established. Nonetheless, it is concluded that this disease is a distinct clinical entity that deserves further recognition and investigation.
Adaptation to Exercise in Angina Pectoris
Authors: MACALPIN REX N. , KATTUS ALBERT A. 
Published: June 2012

Twelve patients with angina pectoris manifested an ability to adapt to exercise during treadmill stress testing with electrocardiographic monitoring. Three patterns of adaptation were seen. Nine subjects had the ability to continue walking after the onset of angina with eventual disappearance or lessening of anginal pain and the associated ischemic ST-segment depression; anginal pain and ST depression began to diminish during a steady state of blood pressure and heart rate in those cases in which these factors were measured. Four subjects were able to continue walking for long periods of time during a state of angina and ischemic ST depression. Three subjects demonstrated an increase in exercise capacity after being warmed up by a preceding bout of exercise-induced angina; blood pressures and heart rates during the initial, "warming-up" effort tended to be higher than those during the early stages of the second effort. In three subjects more than one of these patterns of adaptation were demonstrated. Five of the subjects showed striking subjective and objective improvement in exercise tolerance while on a program of regular walking exercise.
Selective coronary cineangiography was performed in eight of these patients and two patterns of coronary disease were seen: (1) occlusion of a major coronary vessel with good collateral channels circumventing the obstruction; (2) strategically placed, proximal, stenotic lesions in major coronary vessels without frank occlusion and without discernible collateral development.
Some diagnostic and therapeutic implications of these findings are discussed.
Transposition of the Great Vessels
Authors: FERENCZ CHARLOTTE 
Published: June 2012

A microscopic study of the lungs of 106 patients with transposition of the great vessels has revealed early and severe hypertensive alterations in the pulmonary arteries. These striking changes, associated in almost all instances with normal pulmonary veins, indicate a state of high resistance of the arterial bed.
Pulmonary arterial damage was, in general, most advanced in the patients with a large ventricular septal defect, but in spite of this these were the patients who lived longest. It seemed obvious, therefore, that their relatively favorable course was due to a greater beneficial than damaging effect of the ventricular septal defect.
Consideration of these findings in the light of known physiologic data has led to a clarification of the physiologic variations of the transposition circulation. Using the recognized physiologic definitions of flows and shunts the transposition circulation is characterized by a diminished effective flow and a bidirectional but predominantly left-to-right shunt. The effect of a large intracardiac communication is to increase the effective flow and to lessen the shunts. With increasing size of the intracardiac communication the spectrum is completed when the circulatory characteristics of a single ventricle are reached in which the anatomic position of the great vessels becomes physiologically insignificant.
The effect of a common systolic ejectile force in patients with a large ventricular septal defect will be similar in the transposition circulation and in the normal circulation. Three physiologic states are possible which depend upon the relative magnitude of the systemic and pulmonary resistances.
The early appearance and malignant nature of the hypertensive alterations in the pulmonary arteries of patients with transposition of the great vessels suggest that the impact upon the lungs of high blood flow and pressure is aggravated by arterial vasoconstriction. This may be initiated by anoxia and a lowered blood pH. Elevation of pulmonary venous pressure and the increased viscosity of the blood due to polycythemia may add to the damage.
Prominence of the bronchial arteries noted in the lung sections suggests that an expanded bronchial circulation augments the effective flow in these patients. If the bronchial venous drainage leads to systemic veins, the bronchial circulation could act as an accessory pulmonary circulation and could improve the effective flow without having to cross the already overloaded intracardiac communications.
The anatomic findings and physiologic considerations reported in this study reveal several aspects of the early and severely damaging cardiopulmonary effect of transposition of the great vessels and indicate an urgent necessity of surgical therapy in early life.
Pulmonary Pressure, Cardiac Output, and Arterial Oxygen Saturation during Exercise at High Altitude and at Sea Level
Authors: BANCHERO NATALIO , SIME FRANCISCO , PEÑALOZA DANTE , CRUZ JULIO , GAMBOA RAÚL , MARTICORENA EMILIO 
Published: June 2012

The response elicited by exercise on pulmonary pressure, cardiac output, and arterial oxygen saturation in 35 lifetime residents of high altitude has been studied at high altitude (14,900 feet above sea level), and 22 residents of low altitude have been studied at sea level. A procedure combining cardiac catheterization, arterial cannulation, and spirometry was carried out. The exercise was moderate and was performed in supine position using a bicycle ergometer, the work load being 300 kg-m/min/m,
2
and the average increase of the oxygen uptake being 4.7 times at sea level and 4.8 times at high altitude.

Both at sea level and at high altitude the cardiac output augmented during exercise proportionally to the increase in oxygen uptake, and thus followed the pattern of response described by other authors. The cardiac output as well as the oxygen intake, for the magnitude of exertion performed in this study, was almost the same at sea level and at high altitude. The cardiac output rose during exercise almost exclusively as a result of an increase in the heart rate, with the stroke volume remaining practically constant.
Despite similar increase in cardiac output, the response of pulmonary pressure was smaller for sea-level subjects than for the high-altitude subjects. Increments of mean pulmonary pressure of nearly 50% and 100% were observed on exercise at sea level and at high altitude, respectively.

During exercise the arterial oxygen saturation did not change in the sea-level studies, but decreased significantly in the high-altitude studies. The decrement observed in high-altitude residents is related to a fall in arterial pO
2
which at resting conditions is placed on the steep part of the oxygen dissociation curve.
Analysis of Experience in Workmen's Compensation for Heart Cases
Authors: BERGY GORDON G. , SPARKMAN DONAL R. 
Published: June 2012

In this study of industrial insurance experience in cardiac cases in the State of Washington, particular attention was given to the consistency of medical opinion regarding causal relation of effort to heart attack and to the role of physicians in arriving at decisions as to such causal relationship. Four hundred thirty-one cardiac claims (53% of the total claims) submitted to the Washington State Department of Labor and Industries between 1950 and 1958 were reviewed. Twenty-one and three-tenths per cent of the claimants had documented prior heart disease. Only 6.6% had previous accepted claims for heart disease. At least 78% of all claimants whose records were studied had coronary heart disease and of the deaths, 97.8% were due to manifestations of atherosclerosis. Cardiac trauma was a rarity, occurring in 0.6% of the total and was nonfatal in all cases.
In the opinion of the authors causal relationship to the work being performed was present in 71% of the "death" cases in which compensation was allowed; conversely, it was demonstrable in only 31% of the cases of living claimants in which compensation was granted.
After the introduction of criteria for causal relationship by the Washington State Heart Association and internist panels, the following changes occurred: (1) The consistency of the assessment of causal relationship to accepted medical opinion improved, for (a) rejection of claims, where causal relationship to work existed, were fewer, and (b) the acceptance of claims where causal relationship was lacking, decreased. (2) The incidence of appeals decreased. Thus, criteria for guidance of physicians in the determination of causal relationship appear to be valuable, and determination of causal relationship and rating of disability may be better performed by a person other than the patient's attending physician.
Complete Heart Block Following Replacement of the Aortic Valve
Authors: GANNON PAUL G. , SELLERS ROBERT D. , KANJUH VLADIMIR I. , EDWARDS JESSE E. , LILLEHEI C. WALTON 
Published: June 2012

The incidence of postoperative complete heart block in a series of 124 cases of replacement of the aortic valve by a ball valve prosthesis was 12.9% (16 of 124). In all but one case, complete heart block was treated by pacing the heart with an artificial pacemaker.
The complete heart block was temporary in seven cases and persistent in nine. Six of the patients with acute persistent complete heart block died within ten days of operation, and one patient died on the forty-ninth postoperative day. Two patients are alive, both with implanted pacemakers. Five of the seven patients who resumed their preoperative rhythm survived.
Among the 16 patients with some form of complete heart block postoperatively, nine died (56.2%).
The basis for surgical induction of complete heart block when placing a ball valve prosthesis in the aortic orifice lies in the proximity of the bundle of His and its left branch to the aortic valve. In particular, the inferior aspect of the noncoronary cusp is closely related to major conduction tissue. Under the conditions of this operation, the conduction tissue may be strangulated or injured by sutures, or it may be injured when calcific material of the diseased aortic valve is removed.
It is of interest that the incidence of postoperative complete heart block in this series was approximately the same with the Starr-Edwards sutured prosthesis (that is, 13%; 11 of 84 cases) as it was with the Magovern sutureless prosthesis (12.5%; 5 of 40 cases).
Hemodynamics of Complete Transposition of the Great Vessels Before and After the Creation of an Atrial Septal Defect
Authors: SHAHER REDA M. , KIDD LANGFORD 
Published: June 2012

Pressures, hemoglobin, and oxygen saturations were measured and shunts and flows calculated before and after the surgical creation of an atrial septal defect in 20 patients with complete transposition of the great vessels. Eleven patients had intact ventricular septa and nine had ventricular septal defects. Of the group with intact septa, the shunt increased in nine and diminished in one; arterial oxygen saturation increased in nine and diminished in one; hemoglobin content decreased in eight and increased in two; systemic blood flow increased in six, diminished in two, and was unchanged in one; and pulmonary blood flow diminished in two. Of those with a ventricular septal defect, the shunt increased in all but one; arterial oxygen saturation increased in four, remained the same in two, and diminished in three; hemoglobin content increased in five and diminished in four; systemic blood flows increased in five and diminished in three; and pulmonary blood flows diminished in four.
It was concluded that the procedure does not improve arterial oxygen saturation in any patient in whom the arterial oxygen saturation is 65% or more initially, and that this operation is primarily of benefit when there is an intact ventricular septum.
Respiratory Mechanics Following Open-Heart Surgery for Acquired Valvular Disease
Authors: GARZON ANTONIO A. , SELTZER BERNARD , KARLSON KARL E. 
Published: June 2012

1. Pulmonary mechanics were determined preoperatively and postoperatively in 20 patients following open-heart surgery for acquired valvular disease.
2. The surviving patients had minimal increase of the work of breathing, associated with an increase in nonelastic resistance during the early postoperative period. These changes in pulmonary mechanics are insufficient to explain the respiratory difficulties experienced by these patients.
3. In the fatal cases compliance decreased to half the preoperative level, and respiratory work increased to five times the preoperative value. In these individuals excessive work of breathing produces a significant demand on physiological resources, and controlled mechanical ventilation is indicated.
Focal Lipid Lesions in Blood Vessels due to Erythrocytes and Platelets
Authors: BARNARD P. J. , THOMPSON D. H. 
Published: June 2012

Experiments on goats and rabbits living on a normal diet demonstrated that the lipid associated with organizing thrombi became concentrated in fibrosed focal lesions of blood vessels. The lipid that appeared during organization of lysed erythrocytes underwent changes similar to those of lipid in thrombi. From this it was concluded that what red cells there were in the thrombi contributed to the total lipid present.
These observations are pertinent to the pathogenesis of atherosclerosis, because they help to explain the thrombosis characteristically associated with this disease, and how lipid can be delivered to restricted regions of the arterial intima.
Correlation of the Pressor Activity of the Renal Venous Effluent with Excretory Function and Other Tests in Focal, Parenchymal, and Vascular Renal Disease
Authors: MCPHAUL JOHN J. , MCINTOSH DUNCAN A. , WILLIAMS LESTER F. , GRITTI EMIL J. , GROLLMAN ARTHUR 
Published: June 2012

A series of 170 hypertensive patients suspected of suffering from renovascular disease have been subjected to various tests designed to identify the presence of a surgically remediable lesion.
The presence of a pressor agent in the renal venous effluent, as determined by bioassay on the rat, has proven to be an accurate method for detecting the presence of renovascular hypertension responsive to surgical treatment. Split-function excretory tests, aortography, and other tests used for this purpose could not be relied on as the sole criterion as to whether surgical intervention is indicated in a given patient.