bluuebunny/crossref_metadata_2025_split huggingface dataset:
Hemodynamics of the Upper Extremities in Subclavian Steal Syndrome
Authors: CONRAD MARGARET C. , TOOLE JAMES F. , JANEWAY RICHARD 
Published: June 2012

Digital flow, digital artery systolic pressure, resistance, pulse volume, pulse contour, and delay between right and left pulses were evaluated in the upper extremities of four patients with the subclavian steal syndrome. Studies were made preoperatively in all patients and following surgical reconstruction of the subclavian in three cases.
Digital artery pressures were consistently lower on the side with the subclavian occlusion.
Flow on the occluded side was equal to or higher than that in the opposite extremity except when a second, more distal occlusion was present.
In each case there was a delay in the foot of the digital pulse on the occluded side and a more marked delay in the pulse peak. Distal to the occlusion the pulse amplitudes were decreased and the contours were abnormal.
The amplitude of the digital pulse was markedly decreased with exercise of the affected extremity.
The pulse delay and the disappearance of pulse in the radial artery during exercise previously described clinically has been confirmed by measurement.
Hemodynamic Studies Following Pericardiectomy for Constrictive Pericarditis
Authors: KLOSTER FRANK E. , CRISLIP RODNEY L. , BRISTOW J. DAVID , HERR RODNEY H. , RITZMANN LEONARD W. , GRISWOLD HERBERT E. 
Published: June 2012

Fourteen patients underwent right heart catheterization 5 to 86 months after pericardiectomy for constrictive pericarditis. Twelve had preoperative catheterizations, all with findings typical of constrictive pericarditis.
All patients showed marked hemodynamic and symptomatic improvement after operation. Three patients had persistent mild elevation of right heart and pulmonary artery pressures; one of these had a low cardiac output. Two other patients developed pulmonary hypertension with exercise, and one man showed an inadequate increase in cardiac output with exercise. Twelve patients were asymptomatic postoperatively and two had exertional dyspnea.
Patients with incomplete pericardiectomy over the ventricles had abnormal hemodynamic results, while decortication of the atria and venae cavae made no difference in the postoperative findings. A left anterolateral thoracotomy incision provided adequate exposure for pericardiectomy, and continues to be the incision of choice at this hospital. Younger patients and those who progressed from recognized acute pericarditis to pericardial constriction more frequently had normal results at cardiac catheterization after operation. Certain preoperative liver-function tests correlated well with the postoperative hemodynamic findings. The role of myocardial disease in producing residual hemodynamic abnormalities remains unresolved.
It is concluded that excellent clinical results and normal hemodynamic findings can be achieved by pericardiectomy in most patients with constrictive pericarditis.
The Electrocardiogram after Mastectomy
Authors: LAMONTE CHARLES S. , FREIMAN ALVIN H. 
Published: June 2012

The electrocardiograms before and after operation have been compared in 20 patients undergoing left mastectomy and in 19 patients undergoing right mastectomy.

There are highly significant increases in the amplitude of the QRS complexes recorded over the precordium after left mastectomy, except in lead V
6
.

There are highly significant increases in the amplitude of the QRS complexes of leads V
3R
and V
1
after both left and right mastectomy.

These data are not completely explained by a diminution of distance between the recording electrode and the myocardium or of electrical resistance following the excision of soft tissue.
The possible relationship is suggested between the precordial voltage changes and the altered thoracic volume conductor.
Ventricular Septal Defect
Authors: RITTER DONALD G. , FELDT ROBERT H. , WEIDMAN WILLIAM H. , DUSHANE JAMES W. 
Published: June 2012

Records of 273 cases of ventricular septal defect from five participating institutions were studied. Insignificant hemodynamic disturbance (Roger's) was found in 11 per cent, moderate to large left-to-right shunts in 55 per cent, and severe pulmonary vascular disease ("Eisenmenger's") in 8 per cent. Because of insufficient data, 26 per cent of the cases were not classified hemodynamically. Thus, a spectrum of severity ranging from mild to severe was noted.
There was evidence of congestive heart failure in infancy in 78 cases and a significant mortality occurred in this group, whether treatment was medical (mortality, 27 per cent) or surgical (mortality, 46 per cent). Six patients had hemodynamic evidence of severe progressive pulmonary vascular disease, three when they were less than 8 years old. Correlations of hemodynamic severity with clinical symptoms, roentgenographic findings, and electrocardiographic changes were reasonably good at the extreme ends of the severity spectrum but only fair in the middle range. Over-all mortality was high (28 per cent) for the 163 patients treated surgically, but mortality was also high (18 per cent) for the 110 patients treated medically. Ten of the 20 deaths in the medical group occurred in patients who had had congestive heart failure in infancy. Further study of the natural history of ventricular septal defect is clearly indicated for establishment of improved criteria for selection of cases for operation.
Measurement of Renal Artery Pressures by Catheterization in Patients with and without Renal Artery Stenosis
Authors: CARTER STEFAN A. , RITCHIE GORDON W. 
Published: June 2012

Pressures were successfully measured by catheterization in 13 out of 18 renal arteries with stenosis and in 15 out of 16 vessels without stenosis. The pressures were measured via a small-bore, radiopaque nylon catheter threaded through a curved polyethylene catheter whose tip was placed in the renal vessel. The position of the catheters was confirmed by injections of small volumes of angiographic dye and documented by spot films. Use of the small-bore catheter was necessary to avoid alteration of the measured pressure. Strict attention to technical details is mandatory in order to obtain satisfactory pressure recordings.
In patients without angiographic evidence of stenosis, pressure in the renal arteries did not differ consistently from the aortic pressure. Differences of more than 15 mm Hg in the systolic pressure are probably abnormal.

Abnormal systolic pressure gradients between the aorta and the renal artery were found in some patients with renal artery stenosis, but not in others. In the patients with gradients, good correlation was obtained between the gradient and the dimensions of the stenosis measured on the angiographic films and expressed as L
s
/(D
s
/D
N
),
2
where L
s
is the length of the narrowing, and D
s
and D
N
are respectively the diameters of the lumen of the stenotic and nonstenotic parts of the vessel in a frontal projection.

Our experience suggests that more preoperative pressure measurements by catheterization across renal artery stenosis and correlation relation with angiographic and renal function studies and with the results of operation are warranted.
Open-Heart Surgery on the Elderly
Authors: BOWLES L. THOMPSON , HALLMAN GRADY L. , COOLEY DENTON A. 
Published: June 2012

Data on 54 patients, 60 years of age or more, who had open-heart surgery are reported. This series is comprised of all patients in this age group who were treated surgically from January 1, 1957, to December 31, 1964. Eighty-two per cent were operated on in the past 2 years.
The most common indications for operation were left ventricular aneurysm and aortic valve disease (39 patients). The ages of the patients in this series ranged from 60 to 73 years, with a mean age of 63. Operative mortality was 20% for the entire series and 11% in the last year reported (1964).
It is concluded that advanced age should not be a deterrent to the selection of surgical therapy for elderly patients with heart disease provided that the proper indications exist. Open-heart surgery may be performed in the elderly with mortality that compares favorably with that encountered in younger individuals with similar lesions.
Atherosclerotic Gangrene: Improved Results of Treatment
Authors: PEARCE CHARLES W. , SCHRAMEL ROBERT J. , HEWITT ROBERT L. , SMITH PRENTISS E. , CREECH OSCAR 
Published: June 2012

Advanced atherosclerosis of the lower limb often necessitates major amputation unless arterial flow can be restored. To improve results of treatment on the Tulane Surgical Unit at Charity Hospital, we decided in 1964 to extend indications for restoration of arterial flow to all patients who faced possible loss of a lower limb and who had a patent distal segment of artery to which anastomosis could be made. The general condition of the patient was not held to be a deterrent if operation could be done with use of a local anesthetic.
From July 1, 1957 to July 1, 1964, an average of 21 operations was performed each year for restoration of arterial flow to the lower limb: two-thirds for femoropopliteal occlusive disease and one-third for aortoiliac occlusive disease. In contrast, 108 operations were performed from July 1, 1964 to July 1, 1965: three-fourths for femoropopliteal occlusive disease and one-fourth for aortoiliac occlusive disease. The fatality rate for operative restoration of arterial flow to the lower limb was 4.1% for the first seven years and 5.5% for the eighth year.
An average of 79 major amputations of the lower limb was done for atherosclerosis each year from 1957 to 1964, whereas only 53 amputations were done during the 1964-1965 period. The annual number of major amputations was thus reduced by 33%. The increased number of digital and transmetatarsal amputations from an average of 22 each year during the period 1957-1964 to 42 during 1964-1965 reflects our increased effort to avoid major amputation. Our recent experience suggests that the criteria for restorative operations in patients faced with loss of limbs may safely be extended and that a positive attitude toward operation for advanced atherosclerosis will result in preservation of more limbs.
Adjunctive Use of a Surface-Active Agent in Extracorporeal Circulation
Authors: MIYAUCHI YOSHIMASA , INOUE TAKAYUKI , PATON BRUCE C. 
Published: June 2012

1. A nonionic surfactant, Pluronic F68, was used in prolonged experimental and clinical extracorporeal circulation, and data are presented which support the efficacy of the use of this agent.
2. Hemolysis and fat embolism resulting from prolonged cardiopulmonary bypass with a bubble oxygenator were greatly reduced by use of the surfactant.
3. The surfactant markedly prevented and improved the intravascular "sludging." 4. The surfactant also reduced the fibrin deposition on the filter of the oxygenator.
5. The function of the pump oxygenator was not affected.
6. No adverse physiological effects resulting from the Pluronic were discovered. It may, therefore, have widespread application in extracorporeal circulation.
Anomalous Left Coronary Artery Arising from the Pulmonary Artery in an Adult
Authors: LIKAR IVAN , CRILEY J. MICHAEL , LEWIS KENNETH B. 
Published: June 2012

The 29-year-old woman with anomalous left coronary artery arising from the pulmonary trunk whose case is presented is at the time of writing, the oldest patient on record in whom this condition has been diagnosed during life. The diagnosis was made by aortic cineangiography and confirmed by selective injection of contrast material into the right coronary artery. The collateral pathways between the right and the anomalous left coronary artery were thus defined. Vectorcardiographic and electrocardiographic patterns of anterolateral myocardial infarction with periinfarction block have not been observed in any of the previously reported adults with this type of rare congenital anomaly.
The 27 cases of ligation of the aberrant left coronary artery arising from the pulmonary artery reported in the literature have been reviewed and the results of this operation discussed.
Diagnosis of the anomalous left coronary artery in adult life is possible if it is considered in patients presenting with a continuous murmur at the base and electrocardiographic evidence of myocardial infarction.
Clinical Evaluation of Blood Flow to the Hand
Authors: EJRUP BORJE , FISCHER BOGUSLAV , WRIGHT IRVING S. 
Published: June 2012

One hundred fifty individuals of different ages without evidence of peripheral vascular impairment (100 normal persons and 50 patients with history of cerebral vascular disease) were examined with the Allen test; the radial and ulnar arteries were examined in both hands. A false-positive test could easily be obtained spontaneously or be provoked by intentional hyperextension of the hand more than 20° beyond the straight position. In the straight position of the hand, the time for appearance of rubor after opening of the hand exceeded 5 seconds in 34% of the normal persons. When a relaxed slight flexion at the wrist joint was used, the flush after opening the hand appeared at an average of 3 seconds for the ulnar artery and 2.75 for the radial artery. In 50 normal individuals examined with optimal technique described, no individual artery required more than 6 seconds for the flush to appear after opening of the hand.
The authors recommend that the Allen test be performed with the patient's hand slightly flexed and relaxed.
The Use of Hyperbaric Oxygenation in the Treatment of Cerebral Ischemia and Infarction
Authors: HEYMAN ALBERT , SALTZMAN HERBERT A. , WHALEN ROBERT E. 
Published: June 2012

The therapeutic usefulness of hyperbaric oxygenation in cerebral vascular disease was evaluated in 22 persons with recent neurologic deficits caused by cerebral embolism, thrombosis, hemorrhage, or arteriographic complications. Hyperoxygenation produced a significant elevation in content and tension of oxygen in blood and increased the reservoir of oxygen available for utilization by neurons. Remarkable and dramatic improvement in neurologic function occurred in four patients. The improvement persisted in two patients. In two others the neurologic deficit recurred a few hours after removal from the hyperbaric chamber; repeated exposure to high oxygen pressures was associated with only temporary improvement. In six other patients there was some evidence of clinical recovery immediately after onset of hyperoxygenation, but the neurologic deficit returned during decompression. The remaining 12 patients did not improve during hyperbaric oxygenation.
These observations indicate that in some patients neuronal structures remain viable for some hours after loss of function in acute cerebral ischemia. In such instances an increase in oxygen delivery may reverse cellular ischemia and prevent death of cerebral tissues. Hyperbaric oxygenation may provide supportive therapy in some patients with acute cerebral ischemia, thereby permitting the removal of the occlusive lesion by surgery or other methods.
The Junction Between the Left Atrium and the Pulmonary Veins
Authors: NATHAN H. , Eliakim M. 
Published: June 2012

Some anatomic features of the posterior wall of the left atrium, the atrial-pulmonary venous junctions, and the myocardial sleeves extending over the pulmonary veins, as observed in 16 human hearts, are described.
Different patterns of direction of the myocardial fibers of the atrial wall were found in the different specimens. The atrial wall between the upper pulmonary veins was consistently thicker than that between the lower ones. Similarly, the sphincter-like structures of the atrial-pulmonary venous junctions were generally more conspicuous, and the myocardial venous sleeves better developed in the superior than in the inferior pulmonary veins. The physiological and pathological implications of these findings are discussed.
Evaluation of the Left Ventricle in Patients with Mitral Stenosis
Authors: FEIGENBAUM HARVEY , CAMPBELL RICHARD W. , WUNSCH CHARLES M. , STEINMETZ EDWARD F. 
Published: June 2012

In an attempt to objectively evaluate the status of the left ventricle in 32 patients with mitral stenosis, a modified form of supine leg exercise was done during simultaneous left and right heart catheterization. Besides measuring the usual hemodynamic parameters, a ratio of mitral valve flow (MVF) or diastolic left ventricular volume change (Δv/Δt) and the slope of the rise of left ventricular diastolic pressure (Δp/Δt) was calculated at rest and during exercise (Δv/Δp). The results of these measurements were compared with those obtained on nine patients with either innocent functional heart murmurs or hemodynamically insignificant stenotic valvular lesions.
None of the nine control patients had left ventricular end-diastolic pressures (LVEDP) greater than 12 mm Hg either at rest or with exercise. Exercise also did not appreciably alter the Δv/Δp ratio. Among the patients with mitral stenosis eight patients had distinctly elevated (greater than 14 mm Hg) LVEDP with exercise and 19 patients, including the eight with abnormal LVEDP, decreased the Δv/Δp ratio with exercise.
The difficulties and limitations associated with this type of study are discussed. However, there is a distinct possibility that these results are indicative of an abnormal left ventricle in some patients with mitral stenosis. It is further suggested that this abnormality may be related in some way to decreased left ventricular compliance. In addition, a close statistical correlation between Δv/Δp and cardiac output implicates this left ventricular abnormality as a possible etiological factor in the reduced cardiac output seen in many patients with mitral stenosis.
Furosemide
Authors: STASON WILLIAM B. , CANNON PAUL J. , HEINEMANN HENRY O. , LARAGH JOHN H. 
Published: June 2012

The physiological effects of furosemide, a new diuretic agent chemically related to thiazide diuretics, have been evaluated in seven normal subjects and in 39 patients with edema of varied origin.
The compound exhibited an unusually broad dose-response curve so that increasing diuresis could be induced with oral doses of from 40 mg once daily to 600 mg three times daily. At the higher dosages furosemide was significantly more effective than conventional thiazide diuretics and exhibited an order of potency which can be achieved with ethacrynic acid.
In many of its diuretic properties furosemide resembled thiazide agents. The natriuresis and diuresis which it produced was associated with a disproportionate loss of chloride and potassium and the consequent production of degrees of hypokalemic alkalosis.

However, physiological studies indicate that furosemide is qualitatively and quantitatively more similar to ethacrynic acid than to thiazide agents. Thus, furosemide, like ethacrynic acid and unlike thiazide diuretics acted to interfere with both urinary concentration (T
c

H
H2
O

) during antidiuresis and to block urinary dilution (C

H
H2
O

) during water diuresis. It also caused a negative urinary hydrogen balance during diuresis.

The data suggest that furosemide acts to block sodium chloride reabsorption in the ascending limb of Henle's loop and in more cortical distal diluting segments. The magnitude of its effects suggests that it also may interfere with proximal sodium chloride reabsorption. Ion exchange sodium reabsorptive mechanisms appear unaffected and become overactive during drug administration thereby accounting for the observed increases in potassium and hydrogen ion excretions.

Because of its properties furosemide was especially useful intravenously as an adjunct in the treatment of acute pulmonary edema and for oral maintenance therapy in the treatment of difficult or refractory edematous patients, many of whom exhibit associated electrolyte derangements or azotemias. In these difficult situations, for maximum diuresis and to avoid problems associated with K
+
, H
+
and Cl
-
depletion, intermittent therapy added to a maintenance schedule which utilizes aldosterone antagonists or chloride and potassium supplements appears advisable.

Furosemide, also like ethacrynic acid, was capable of adding to the natriuretic action of all other types of diuretic agents. This observation provides additional evidence for the existence of a number of different tubular transport processes located at different sites in the nephron which can participate in sodium conservation.
Left Atrial Volume and Its Changes in Heart Disease
Authors: HAWLEY RICHARD R. , DODGE HAROLD T. , GRAHAM THOMAS P. 
Published: June 2012

Left atrial volume and volume change during the heart cycle were determined and compared with left ventricular stroke volume and forward, or effective, stroke volume in 57 patients who were grouped as follows: normal, primary cardiomyopathy, aortic valve disease, predominant mitral insufficiency, predominant mitral stenosis, and combined aortic and mitral valve disease.
In this study left atrial cyclic volume change averaged 41% of the left ventricular stroke volume and was in no case more than 72% of the left ventricular stroke volume, regardless of the type of heart disease. Some patients with aortic valve disease or primary cardiomyopathy have left atrial maximum volumes as large as those seen in many patients with mitral stenosis. Three features of left atrial volume and volume change per heart beat were observed in patients with mitral insufficiency: (1) a large left atrial volume (all patients with a left atrial volume greater than 365 ml had mitral insufficiency), (2) a large left atrial cyclic volume change, and (3) a left atrial volume change per beat equal to or greater than the forward, or effective, left ventricular stroke volume. It was also demonstrated that the left atrial cyclic volume change in patients with atrial fibrillation may be large and in this study showed no significant difference from values observed in patients with normal rhythm.
Circulation Time End Points
Authors: PIERSON RICHARD N. , GRIECO MICHAEL , SWINTON NEIL , DUBIN MICHAEL 
Published: June 2012

Ideal measurements are both simple and precise. The subjective circulation time has provided more simplicity than precision to three generations of physicians attempting to analyze cardiac function. Other more complex and less available measurements have displaced the circulation time from its prior vogue, probably because of the wide ranges of normal circulation time values. Yet, no other bedside measurement of cardiac function reflects both cardiac output and central blood volume with a single result.
The peripheral arrival characteristics of radioisotope-labeled albumin are described in 15 normal subjects and in 13 patients with heart failure. These circulation-times are compared with the taste end point of the saccharin indicator simultaneously injected.
Taste threshold, a variable not dependent on cardiac status, determines a significant proportion of the circulation time in both normal and failing circulations.
The wide availability of instruments which measure radioactivity, dye density, or thermal change as a function of time could reinvest the circulation time with a new precision, in return for a modest loss of simplicity. Bypass of the noncardiac variable taste threshold may be added to the other well-described advantages of an objective circulation-time measurement by use of the time of half-peak concentration as the end point in recording the circulation time.