bluuebunny/crossref_metadata_2025_split huggingface dataset:
Syndrome of Short P-R Interval with Abnormal QRS Complexes and Paroxysmal Tachycardia (Wolff-Parkinson-White Syndrome)
Authors: WOLFF LOUIS 
Published: June 2012

The syndrome of short P-R interval with abnormal QRS complexes and paroxysmal tachycardia occurs in otherwise healthy individuals in all age groups. Its interest and importance are related to our knowledge and concepts of the cardiac mechanism, the prevalence and clinical manifestations of paroxysmal tachycardia, the masking of the electrocardiographic signs of heart disease, and the serious consequences involved in making an incorrect diagnosis of heart disease.
A single mechanism is in all probability responsible for the abnormal electrocardiogram and the paroxysmal tachycardia. Premature activation of a small fraction of ventricular musculature shortens the P-R interval and lengthens the QRS interval, thus accounting for the electrocardiographic peculiarities of the syndrome. Whether an anomaly of impulse formation or an anomaly of conduction is responsible for pre-excitation is not known, and the propensity to paroxysmal tachycardia can be explained on either basis. There is no evidence that hitherto unknown phenomena are responsible for the syndrome. The disorder is probably congenital in nature.
A noteworthy feature is the spontaneous or induced shift, back and forth, from the abnormal to the normal type of electrocardiogram. Many drugs and procedures are available for this purpose. This is of immeasurable help in establishing the diagnosis of the Wolff-Parkinson-White syndrome in doubtful cases, and in unmasking the many abnormalities which anomalous excitation conceals.
Diagnostic errors are common, and the reasons for these have been discussed. Myocardial infarction, mitral stenosis, congenital heart disease, right and left ventricular hypertrophy, myocarditis, and bundle-branch block are the mistaken diagnoses most commonly made. Myocardial infarction, right and left ventricular hypertrophy, and right bundle branch block are the conditions most commonly concealed by the anomalous electrocardiogram.
The most important problems still requiring elucidation are those related to etiology, and to the mechanisms responsible for the abnormal electrocardiogram and paroxysmal rapid heart action.
Myocarditis
Authors: DE LA CHAPELLE CLARENCE E. , KOSSMANN CHARLES E. 
Published: June 2012

A review of selected papers on myocarditis published during the past decade and an analysis of some original data together with personal experiences have been presented.
All of these indicate that the clinical diagnosis of myocarditis is made far too infrequently as contrasted with the high incidence of this disease as recognized by pathologists. It is estimated that approximately 10 per cent of all patients coming to necropsy will demonstrate some evidence of myocarditis.
The discrepancy between the clinical and the pathologic incidences can possibly be ascribed to two factors, namely, (a) the relatively innocent nature of the clinical and laboratory findings in many cases, and (b) the apparent reluctance of the clinician to make the diagnosis.
It is likely that a correct diagnosis of myocarditis will be made more often and cardiac catastrophies avoided if the clinician will consider the possibility of the diagnosis, particularly in the course of all types of infectious diseases.
Arterial Malformations which Cause Compression of the Trachea or Esophagus
Authors: GROSS ROBERT E. 
Published: June 2012

In recent years observations have shown that there are certain arterial malformations in the superior mediastinum which bring about significant compression of either the trachea or esophagus, or both of these structures. If the arterial derangements are of such a nature that symptoms are produced by obstruction of the esophagus and particularly by the impairment of the tracheal airway, it is of prime importance to recognize the underlying vascular malformation because surgical approach to the problem has a great deal to offer either by division of an offending vessel or by displacement of an artery in such a manner that more room is provided for the esophagus and trachea.
Roentgenographic examination of the esophagus and trachea with contrast media usually gives a fairly clear impression of the arterial derangement and leads to accurate diagnosis. Visualization of the aortic pathways by angiocardiography or by retrograde aortography is seldom necessary.
At operation, all these anomalies can be exposed through a left anterolateral transpleural approach to the superior mediastinum. Most of the thymus gland can be dissected off and discarded, allowing good visualization of the region.
Emphasis must be placed upon the fact that constrictions of the esophagus or trachea are not caused solely by vessels or ligaments, but that constriction is likewise produced by fibrous bands or sheaths which accompany these vessels and ligaments. Hence, it is important, not only to divide or displace the appropriate vessel or ligament, but also to cut any strands or bands of tissue which accompany these structures and which form a part of a constricting mechanism.
In a series of cases in which surgical therapy has been undertaken for alleviating compression of the esophagus or trachea for the various vascular anomalies under consideration, it has been shown that the risks of surgery can be kept relatively low and that the benefits which accrue from such treatment are real and well worth seeking.
Fluorescent Patterns of Intracutaneous Wheals in Normal and Edematous Extremities
Authors: GIFFORD RAY W. , WINDESHEIM JOHN H. , ESTES J. EARLE , ROTH GRACE M. 
Published: June 2012

Intradermal injection of a fluorescent dye (riboflavin) and ultraviolet light were used to demonstrate cutaneous lymphatic capillaries. The extremities of a control group and the nonedematous extremities of patients with arteriosclerosis obliterans were studied together with edematous extremities of patients with lymphedema, acute thrombophlebitis, chronic venous insufficiency and various other conditions.
The lymphatic capillaries showed up more extensively after a higher percentage of injections into edematous extremities of patients with lymphedema than after injections into the other extremities. On the other edematous extremities except in the cases of nephrotic syndrome and on the normal extremities, either no lymph capillaries or only a few were visible after most of the injections.
Conference on the Role of the Renal Pressor System in Maintenance of Experimental Renal Hypertension
Authors: GOLDBLATT HARRY 
Published: June 2012

The hypothetical presence of increased circulating renin or hypertensin in chronic renal hypertension was debated; eventually it was agreed that methods were too insensitive for accurate assay. Pressor amounts of infused renin could not be detected by some methods of bioassay (Dr. Wakerlin). Hypertensinase activity in blood may destroy the end product before the assay can be performed (Dr. Blaquier). Perhaps rapid tissue removal from circulating blood may account for the inadequacy of the results (Dr. Skeggs). Previous experiments to detect these substances in circulating hypertensive blood have been indecisive (Dr. Braun-Menéndez) or only weakly positive (Drs. Goldblatt and Skeggs) and the clear-cut depressor effects of antirenin might act on a hypothetical nonpressor action of renin (Dr. Wakerlin). Dr. Helmer commented on the sustained pressor substance found in renal vein blood of hypertensive rats. Dr. Grollman believed chronic renal hypertension to be due to interference with an essential function of the kidney which in the normal animal prevents the blood pressure from rising. The failure of the blood pressure to rise when the kidneys from renal hypertensive dogs were perfused in situ by normotensive recipients was again discussed by Drs. Surtshin, Goldblatt and Grollman, and the possible fallacies involved in reasoning from such acute experiments were brought out.
The nature of the stimulus to renin release was discussed again by Dr. Kolff. Non pulsatile flow was probably not a requirement (Dr. Kolff), nor was renal ischemia (Dr. Wakerlin), but some alteration in renal function seemed to be necessary (Dr. Goldblatt). Dr. Wakerlin and Dr. Rodbard advocated, respectively, the view that the primary stimulus might be the volume pulse or the transmural pressure in the renal arterial bed.
An objection to renin as the cause of chronic hypertension based on tachyphylaxis experiments was raised by Dr. Findley. Dr. Goldblatt denied the presence of true tachyphylaxis and was supported by Drs. Helmer and Wakerlin. Dr. McCubbin suggested it might occur only with cruder preparations of renin, and Dr. Braun-Menéndez theorized that receptor sites might be occupied for a time after restoration of normal blood pressure, thus giving rise to a transient tachyphylaxis. Dr. Bumpus supported this explanation by reporting that a pressor response to crude angiotonin can sometimes not be maintained, while the response to pure angiotonin is persistent.
Considerable discussion ensued between Drs. Goldblatt and Grollman concerning the mechanism of blood pressure reduction by removal of a single ischemic kidney. The human renal biopsy and autopsy studies suggesting the primacy of renal arteriolosclerosis in human hypertension were reviewed by Dr. Goldblatt.
Panel Discussion on Genetic and Environmental Factors in Human Hypertension
Authors: KOHLSTAEDT K. G. , MOSER M. , FRANCIS T. , NEEL J. , MOORE F. 
Published: June 2012

The high incidence of hypertension in the Negro in the West Indies and United States and the infrequency of the disease in the African Negro were the focal point of Dr. Moser's presentation. The coincidence of a high salt intake in the Bahama population which he studied was emphasized as a possible "lead" for further study.
Dr. Francis emphasized the value of a longitudinal and complete epidemiologic study in uncovering etiologic factors in hypertension. A definition of hypertension should not be based on any arbitrary blood pressure, but frequency distribution curves for an entire population should be studied together with selective group characteristics which might lead to a definition of susceptibles. Then a follow-up program might be devised which would identify the factors involved in the appearance or progression of hypertensive disease in the susceptible individual or the mild case. From this standpoint the situation in the Bahamas, where the life history of the disease was telescoped into a shorter time span, seemed ideal.
Dr. Neel emphasized the almost certain heterogeneity of the hypertensive trait, as proposed by Professor Pickering, and other difficulties in making genetic studies in this field: variations in blood pressure readings, effects of acquired diseases, and environmental influences such as the acculturation process at work in certain African populations.
Prof. Moore reviewed the current surveys of the incidence of hypertension in certain populations. These support the concept of a continuous distribution of the blood pressure, of varying sex incidence depending on the age of the sample, and of a tendency to find an increase in the proportion of hypertensive subjects in older age groups. The failure of diastolic blood pressure to follow these patterns was an interesting and unexplained phenomenon. The value of longitudinal studies as in the Framingham survey, was demonstrated by the evidence of the reduced life expectancy which even mild degrees of hypertension imposed on the individual.
In subsequent discussion, further information about blood pressure in East African populations was contributed by Drs. Perry and Grollman, and on blood pressure and dietary habits and diseases of Japanese, Eskimo, Central American, and Formosan populations were discussed by Drs. Kirkendall, Rodbard, Grollman, Stamler and Moser.
Multiple and Infraductal Coarctations of the Aorta
Authors: ZAROFF LAWRENCE I. , KREEL ISADORE , SOBEL HAROLD J. , BARONOFSKY IVAN D. 
Published: June 2012

Reports of multiple and infraductal coarctations are appearing more frequently in the literature as interest in the treatment of cardiovascular disease grows.
A case with 4 distinct coarctations is presented.
A Study of Renal Function in Orthostatic Hypotension
Authors: BRODWALL ERLING KRUGE 
Published: June 2012

Renal function studies have been carried out in both the recumbent and in the oblique position in 2 cases of orthostatic hypotension. In both cases a definite fall in plasma flow and glomerular filtration rate took place, but this occurred only after registration of a considerable fall in blood pressure.
The filtration fraction remains unchanged after the fall in blood pressure. The extraction ratio remains unchanged after a considerable fall in blood pressure.
The data may indicate that the renal function becomes normal if blood pressure is kept on a low level over a fairly long period. However, further observations are required before any definite conclusion may be drawn.
Differentiation of Interatrial Communications by Clinical Methods
Authors: DUSHANE JAMES W. , WEIDMAN WILLIAM H. , BRANDENBURG ROBERT O. , KIRKLIN JOHN W. 
Published: June 2012

Of 128 children with anatomically confirmed interatrial communications 74 had ostium secundum, 37 had ostium primum defects, 5 had common atrium, and 12 had total anomalous pulmonary venous connection.
Analysis of the medical history, physical examination, roentgenogram, and electrocardiogram resulted in accurate diagnosis in most instances. In 6 of the 128 patients the proper diagnosis was not made: 3 infants with total anomalous pulmonary venous connection died within a few hours after admission to the hospital and did not have proper diagnostic evaluation; the condition of 3 other patients with ostium secundum defects was misdiagnosed as ostium primum defect before surgical treatment.
In patients with ostium secundum and ostium primum defects the symptoms, signs, roentgenologic data, and findings at cardiac catheterization are similar, but differences in respect to the electrocardiograms are striking when the latter are subjected to vectorial analysis. The QRS loop is clockwise in the presence of ostium secundum defect and counterclockwise when ostium primum defect is at hand.
Clinical and roentgenologic manifestations also are noted among patients with common atrium and total anomalous pulmonary venous connection, and the findings at cardiac catheterization likewise may be similar, but the electrocardiographic differences are significant. The QRS loop is counterclockwise in patients with common atrium and clockwise in patients with total anomalous pulmonary venous connection.
Open Operation in the Treatment of Calcific Aortic Stenosis
Authors: KIRKLIN JOHN W. , MANKIN HAROLD T. 
Published: June 2012

Calcareous disease of the aortic valve, diagnosed by fairly uniform signs and measurements, has been treated in 14 cases at the Mayo Clinic by an open surgical technic with utilization of extracorporeal circulation. One patient died during the operation and another died after leaving the hospital. Among 7 cases followed 6 to 9 months after operation, definite symptomatic improvement has been shown in 6.
This disease is very dangerous, but a small improvement in the size of the valvular orifice can bring important benefits. The open operation is advantageous in avoidance of creating or aggravating insufficiency while relieving stenosis.
Presently this operation is advised for patients whose disability is significant or progressing. Severe coexisting coronary artery disease is a contraindication; but associated aortic valvular insufficiency, advanced degrees of disability, and left ventricular failure are not.
Clinical and Cardiodynamic Effects of Adrenocortical
Authors: GREENE MURRAY A. , GORDON ARTHUR , BOLTAX ADOLPH J. 
Published: June 2012

This study is concerned with the effects of adrenocortical steroids in patients with congestive heart failure.
Nine adults with heart failure were studied during a steady clinical state (5 to 7 days), during administration for 13 to 16 days of prednisome (6 patients) or triamcinolone (3 patients) and in some subjects following steroid withdrawal. Daily determinations of fluid balances were made. Standard right heart catheterizations and measurements of blood volumes were performed prior to and at the termination of therapy.
Three types of responses to steroids occurred. In 5 patients increases in subjective and objective manifestations of heart failure and increased fluid retention occurred. Four of them developed precarious clinical conditions during steroid therapy, requiring mercurial diuretics, but with poor results. In general, cardiodynamic status at the termination of steroid therapy correlated well with clinical status. In 3 patients the clinical status did not change. Some depression in urinary sodium and chloride excretions were noted during therapy. Cardiodynamics were unaltered, except for an unexplained decrease in right ventricular end-diastolic pressure in 1 patient. In 1 patient clinical and cardiodynamic state improved, despite positive fluid balance. This was the only subject with primary lung disease (emphysema) and cor pulmonale.
These studies suggest that corticosteroids are generally detrimental in uncomplicated congestive heart failure. Greater deterioration appeared in subjects having the more severe degrees of decompensation, suggesting that exogenous fluid-retaining influences were added to endogenous fluid-retaining forces, resulting in further accumulation of fluid in a circulatory system already burdened by hypervolemia.
Changes in the Character and Location of Arterial Lesions in Mammals and Birds in the Philadelphia Zoological Garden
Authors: RATCLIFFE H. L. , YERASIMIDES T. G. , ELLIOTT G. A. 
Published: June 2012

Improved nutrition for mammals and birds at the Philadelphia Zoological Garden has been followed by continued increases in the frequency of arteriosclerosis and by changes in the character and location of the lesions. During the first decade after diets were improved the large atheromata of the proximal aorta and brachiocephalic arteries of birds were replaced by smaller, more compact lesions, usually of the abdominal aorta. At the same time many species of mammals developed atheromata of the aorta, whereas earlier these lesions had been found chiefly in baboons and monkeys (Cercopithecidae).
During the second decade of adequate nutrition, and especially since 1950, arteriosclerosis of the coronary arteries has become relatively common in both mammals and birds. Usually this lesion has developed in the distal, intramural segments of the coronary arteries, as intimal thickening and occlusion. Most frequently it has been associated with myocardial fibrosis, but it also has led to myocardial infarction and sudden death in both mammals and birds. Present evidence suggests that this lesion reflects a response of adequately nourished animals to population densities.
Differential Diagnosis of the Taussig-Bing Heart from Complete Transposition of the Great Vessels with a Posteriorly Overriding Pulmonary Artery
Authors: BEUREN ALOIS 
Published: June 2012

The Taussig-Bing transposition bears the name of the authors who described for the first time the clinical, physiologic, and anatomic findings. It has been recognized that the malformation is physiologically not so distinct as it is anatomically and that a transposition with the same physiologic pattern but different anatomy has been observed. Several case reports have appeared in the literature in which no clear differentiation was made in regard to the second type of transposition with overriding pulmonary artery. In the latter instance there is a complete transposition of both great vessels with a posteriorly placed overriding pulmonary artery in contrast to the original Taussig-Bing heart in which the 2 vessels are side by side, the pulmonary artery being in its normal place.
Following the original case report, 14 cases were seen in this clinic in which the diagnosis was established either by catheterization, angiocardiography, or autopsy. In 4 other cases, the diagnosis of a transposition with a posterior overriding pulmonary artery was made. Criteria for the differential diagnosis of these 2 lesions are pointed out. The differentiation of these 2 transpositions is of particular importance for possible surgical correction.
Prognostic Significance of Raynaud's Phenomenon and Other Clinical Characteristics of Systemic Scleroderma
Authors: FARMER RICHARD G. , GIFFORD RAY W. , HINES EDGAR A. 
Published: June 2012

Two hundred seventy-one patients with unequivocal systemic scleroderma for whom the diagnosis was first established at the Mayo Clinic between January 1, 1945, and December 31, 1952, have been studied. Follow-up information was obtained 5 to 13 years after the diagnosis at the clinic concerning 236 of these patients, 115 of whom were dead. The cases were analyzed in an effort to determine what factors had a bearing on prognosis. The following seemed to bear little relation to the ultimate prognosis: sex, mode of onset, Raynaud's phenomenon, involvement of lungs and periodontal membrane, calcinosis cutis, and trophic changes. The following were considered poor prognostic omens: cardiac or renal involvement, significant elevation of the erythrocyte sedimentation rate, and anemia.
The prognosis in systemic scleroderma was found to be worse than previous reports had indicated. This study yielded no basis for the subdivision of systemic scleroderma into acrosclerosis and generalized progressive scleroderma.
Electrocardiogram in Asthmatic Children
Authors: MIYAMOTO TERUMASA , KASS IRVING , HOFFMAN MURRAY S. 
Published: June 2012

Electrocardiograms of 137 asthmatic children, 5 to 16 years in age, were compared with findings in normal children.
The following deviations from normal were found: lower voltage and longer duration of P waves in all leads; lower voltage of R waves in all precordial leads and almost all limb and unipolar leads; deeper S waves over left precordial leads; slight delay of intrinsicoid deflection in right precordial leads, but no difference in left precordial leads; somewhat increased duration of QRS complexes; increased heart rate in the older age groups, but no differences in P-R and Q-T intervals; predominantly vertical electrocardiographic position of the heart.
These observations provide further electro-cardiographic evidence that asthmatic children, compared with normal children of the same age range, show a tendency toward right ventricular hypertrophy and hyperinflated lungs.
Tricuspid Stenosis with Pulmonary Atresia
Authors: PAUL MILTON H. , LEV MAURICE 
Published: June 2012

An opportunity was presented during cardiac catheterization to study the hemodynamic function of the obstructed right ventricular chamber in a heart with tricuspid stenosis, pulmonary atresia, and an intact ventricular septum.
Cineangiocardiograms demonstrated that the anatomically stenotic tricuspid orifice was also a regurgitant orifice and it is postulated that the bidirectional flow of blood associated with the tricuspid regurgitation prevents the obstructed ventricle from becoming obliterated by stasis-thrombosis.
Intermittent Disappearance of the Murmur of Patent Ductus Arteriosus
Authors: SHAPIRO WILLIAM , SAID SAMI I. , NOVA PHILLIP L. 
Published: June 2012

Transient spontaneous disappearance of the machinery murmur in an otherwise typical case of patent ductus arteriosus unassociated with pulmonary hypertension is described.
Observations of blood pressure changes, physiologic dead space variations in the upright and horizontal postures, and the anatomy of the ductus arteriosus suggested that shunt flow was absent or markedly reduced during the periods in which the murmur was inaudible.