bluuebunny/crossref_metadata_2025_split huggingface dataset:
Autopsy Study of Atherosclerosis at Madras, South India
Authors: KULANGARA ABRAHAM C. , SUBRAMANIAM R. 
Published: June 2012

A sample of 263 hearts and 259 aortas, ranging in age from 6 to 94 years, has been examined for atherosclerotic lesions. The atherosclerotic index for the aorta and the coronary, iliac, innominate, and common carotid arteries has been computed and the data have been analyzed according to sex and age groups. The arteries may be arranged in the following descending series, beginning with the one most heavily diseased: the aorta in both sexes; the coronary arteries of men; the iliac, innominate, and common carotid arteries of both sexes; the coronary arteries of women. The aorta is also the most frequently affected blood vessel.
The frequency of atherosclerotic involvement of the coronary arteries is the same in both sexes, but the extent and severity of lesions are much greater (two to four times) in men than in women. Consistently large differences between the sexes have been observed only in the coronary arteries.
The mean atherosclerotic indices of the aorta and coronary arteries in men indicate a much greater severity of the disease at Madras than so far reported from any other place in India, the severity being very similar to that reported from the United States.
Chronic Obstruction of the Superior Vena Cava due to Histoplasmosis
Authors: MARSHALL ROBERT J. , EDMUNDOWICZ ALPHONSE C. , ANDREWS CHARLES E. 
Published: June 2012

Selective angiography and indicator-dilution curves were employed to illustrate the fuctional anatomy of the collateral circulation in two patients with chronic obstruction of the superior vena cava. In both, clinical and laboratory evidence favored an etiologic diagnosis of histoplasmosis.
In case 1, the transit time via the main collateral venous pathway, which comprised the left superior intercostal, accessory hemiazygos and azygos veins, was found to be a little greater than 25 seconds.
In case 2, the superior vena caval obstruction was incomplete, but there was an associated severe narrowing of the right pulmonary artery. Distortion of the indicator-dilution curves provided evidence for an increased bronchopulmonary anastomotic circulation to the right lung.
These observations illustrate how radiographic and hemodynamic technics may usefully be combined to assess the effects of acquired diseases of the major blood vessels.
Atrial Tachysystole with Block
Authors: ROSNER STUART WARREN 
Published: June 2012

Two patients are reported who demonstrated bouts of rapid atrial activity with associated AV block at times unrelated to the administration of digitalis. The criteria of Lown and Levine for the differentiation of PAT with block from atrial flutter are examined. The application of atrial rate in the region of the arbitrary borderline is not a useful criterion. Determination of P-wave direction in leads II and III cannot be made in the presence of an undulating baseline. Identification, when possible, is not sufficient evidence for distinguishing the two arrhythmias. The appearance of the baseline may not warrant the decisive weight commonly given to it. A combination of recording instrument characteristics, the appearance of atrial repolarization at critical rates, as well as subjective factors may explain the undulatory baseline rather than denote a special electrocardiographic entity. Alternation of the P-P cycle length in PAT with block occurs inconstantly and is not an intrinsic property of the arrhythmia. Digitalis, which has a vagal effect, may contribute to the presence of this [see figure in the PDF file] phenomenon. The occurrence of ventricular premature contractions, response to carotid sinus pressure, and the AV ratio are nonspecific findings. The mode of termination of the arrhythmia may also lack specificity. Restoration of sinus rhythm following potassium administration will be, at times, coincidental. Moreover, the successful outcome of such a therapeutic trial is evidence of digitalis intoxication not proof of a specific arrhythmia.
Experimental and clinical evidence has firmly established that digitalis is capable of producing an atrial arrhythmia attended by AV block. This report does not contest the observation. A critical review of the contrasting features of atrial flutter and PAT with block and an analysis of the data in the present cases suggest that the electrocardiogram does not provide a means for the clear-cut separation of atrial tachycardia from flutter in certain cases and questions the existence of such a division. The term atrial tachysystole with block is offered as a designation for such tracings.
Heart Disease Screening in School Children
Authors: NAIMAN RICHARD A. , BARROW J. GORDON 
Published: June 2012

Fifty-two children with known heart disease were chosen as index subjects among 1,382 school children.
All 1,382 children were screened by two methods; namely, a clinical screening examination and a heart-sound tape recording with use of three independent cardiologists to read each tape.
Both methods yielded nearly identical results, identifying 16 to 18 of 20 children with congenital heart disease and 10 to 11 of 29 children with rheumatic heart disease.
Using published prevalence figures for congenital and rheumatic heart disease, the authors calculate that these methods will identify only 43 to 58 per cent of heart disease existing in school-age children.
There is no appreciable difference in the sensitivity or specificity of the two methods.
Tape recording of heart sounds with high-quality portable equipment is found to be more cumbersome, expensive, and time consuming, and of no greater sensitivity than clinical screening by available community physicians.
Measurement of Blood Flow in the Femoral Artery in Man at Rest and during Exercise by Local Thermodilution
Authors: GANZ V. , HLAVOVÁ A. , FRONĚK A. , LINHART J. , PŘEROVSKÝ I. 
Published: June 2012

A new method is described for measuring blood flow in the femoral artery in man, based on local thermodilution. The method makes it possible to take 3 or 4 measurements per minute at rest and during muscular exercise of the investigated limb. The average blood flow in eight subjects at rest was 635.9±223.1 ml./min., or 6.0±2.3 ml./100 ml. limb volume/min.
Changes during graded and increased work loads were also measured in 5-minute periods (150, 200, and 250 Kg./min.). The rate of flow rise was faster at the start of a given period than in the latter half of the same period. After the end of the work load, the rate of return of blood flow to the baseline fell off rapidly with time, but by 30 minutes later baseline values had still not been attained.
The Apex Cardiogram in Left Ventricular Outflow Tract Obstruction
Authors: TAFURR EMILIO , COHEN LAWRENCE S. , LEVINE HAROLD D. 
Published: June 2012

The use of the apex cardiogram offers a simple yet valuable aid in the diagnosis of obstruction of the left ventricular outflow tract. Characteristic changes in the ejection component of the apex cardiogram distinguish obstruction due to hypertrophic subaortic stenosis from obstruction due to valvular aortic stenosis. A second systolic wave is inscribed in the mid-ejection period of the apex cardiogram in hypertrophic subaortic stenosis. This wave reflects the development of the obstruction of the outflow tract of the left ventricle by the hypertrophied septum. This obstruction is not apparent in the apex cardiogram at the onset of ejection but becomes manifest as contraction progresses.
Although the apex cardiogram in patients with subaortic stenosis may appear normal at rest, isoproterenol may act as a provocative agent inducing the characteristic changes of this condition.
In valvular stenosis obstruction is reflected in the apex cardiogram from the very onset of ejection and is manifest throughout the total ejection phase as a sustained gradual sloping plateau.
Electrocardiographic Pattern of Massive Myocardial Infarction without Pathologic Confirmation
Authors: MAMLIN JOSEPH J. , WEBER EMIL L. , FISCH CHARLES 
Published: June 2012

A case of a 67-year-old patient with an electrocardiographic pattern of a massive myocardial infarction but with a normal heart at autopsy is described. The cause of death was purulent pneumonia complicated by peripheral vascular collapse.
The findings in our case simply reconfirm the well-established principle that the surface electrocardiogram mirrors the electrical phenomena of the heart, which may or may not parallel histologic changes.
Cardiovascular Manifestations of the Hurler Syndrome
Authors: KROVETZ L. JEROME , LORINCZ ANDREW E. , SCHIEBLER GEROLD L. 
Published: June 2012

Hemodynamic observations in 15 cases of the Hunter-Hurler syndrome are reported. Required premedication was two to three times that usually needed. No major complications or deaths occurred. As a group, these individuals tend to have slight elevations of pulmonary artery pressures and more definite elevations of systemic arterial pressures. They generally have normal cardiac outputs and, thus, elevations of total systemic, total pulmonary, and pulmonary arteriolar resistances. In only one case was there clinical and angiocardiographic evidence of valvular involvement, that case having aortic insufficiency. In another case there was only angiocardiographic evidence of mitral insufficiency. Only one child was in congestive heart failure at the time of the study. There was no evidence of coronary artery disease. The ascending limb right ventricular pressure curve was frequently notched and the pressure rise time of the left ventricle (dp/dt) was low. No case had a congenital malformation of the heart.
Those individuals who have normal vascular bed resistances appear to live longer than those who have elevated resistances early in life. The prognosis is also better for the male Hurler of the sex-linked variety than for those cases due to autosomal recessive inheritance.
Discrete Subaortic Stenosis Complicated by Aortic Valvular Regurgitation
Authors: MORROW ANDREW G. , FORT LYNN , ROBERTS WILLIAM C. , BRAUNWALD EUGENE 
Published: June 2012

Four patients are described in whom combined aortic stenosis and regurgitation was evident on examination. In each of them obstruction to left ventricular outflow was shown to be due to congenital subaortic stenosis, and aortic regurgitation resulted from the sequelae of bacterial endocarditis. The presence of this unusual combination of congenital and acquired malformations was suggested by certain clinical findings, and results of the preoperative hemodynamic and angiographic studies that established the diagnosis are presented.
In three patients the subaortic membrane was resected, and aortic regurgitation was corrected by reconstruction or replacement of the aortic valve. All of the patients evidenced striking clinical improvement after operation, confirmed by the results of postoperative hemodynamic assessments. A fourth patient died before operation; the pathologic findings are presented in detail.
Results of Open-Heart Surgery in Patients with Pulmonic Stenosis and Intact Ventricular Septum
Authors: TANDON RAJENDRA , NADAS ALEXANDER S. , GROSS ROBERT E. 
Published: June 2012

A group of 108 consecutive patients with moderate-to-severe pulmonic stenosis and intact ventricular septum, operated upon by means of a pump oxygenator between the years of 1957 and 1961, has been presented.
The total mortality of the series was 2.77 per cent, and an additional 1.8 per cent were left with residual neurologic complications.
Fifty per cent of the patients showed an excellent result as indicated by normal electrocardiograms or right ventricular pressure below 65 mm. Hg by cardiac catheterization. An additional 26 per cent had good results as indicated by the absence of symptoms, normal x-rays, mild electrocardiographic changes, and in three instances, slight right ventricular hypertension.
Ten per cent had unsatisfactory results based on significant residual abnormalities in the electrocardiograms, x-rays, or postoperative catheterization data.
Dynamics of the Collateral Circulation in Patients with Subclavian Steal
Authors: MARSHALL ROBERT J. , MANTINI EMIL L. 
Published: June 2012

The occurrence of retrograde blood flow in the ipsilateral vertebral artery of patients with proximal occlusion of the subclavian or innominate artery has been amply demonstrated by selective angiography. However, since flow artifacts may be induced by the physical or chemical effects of injections of contrast media, it was thought desirable to employ a different method for physiologic demonstration of the reversed flow.
In the first case, cardio-green dye was injected into the innominate artery and a dilution curve was recorded from the left brachial artery. The early appearance of the dye (6 seconds) proved that a short circuit existed between the arterial injection and sampling sites, and confirmed the authenticity of the reversed vertebral flow shown in previous angiograms.
In the second patient, who had symptoms of cerebral ischemia during exercise of the left (affected) arm, dye injected into the left carotid artery did not appear early in the brachial artery of the resting left arm. When it was injected during a period of intense hyperemia of the left arm, a fraction of the dye did appear early. This confirmed that, when the demand of the arm increased, blood was shunted to it not only from the vertebral-basilar system but also from the carotid system.
The importance of anatomic factors was evident in another case in which absence of the anticipated retrograde flow was explained by the fact that the vertebral artery arose directly rectly from the aorta and did not communicate with the affected subclavian artery.
These observations illustrate how radiographic and hemodynamic technics may usefully be combined to assess the effects of acquired diseases of the major blood vessels.
Clinical Features of Fluid Retention Complicating Treatment with Guanethidine
Authors: SMITH A. J. 
Published: June 2012

Forty-four (32.8 per cent) of 134 patients [see figure in the PDF file] treated continuously with guanethidine for a period of at least 12 months developed recognizable fluid retention.
Previous edema may be a predisposing factor and fluid retention occurred more commonly in women. Neither of these factors offers a complete explanation of this side effect.
No evidence has been found to suggest that fluid retention occurs preferentially in patients with renal or cardiac insufficiency. The findings are compatible with a universal fluidretaining influence of guanethidine presenting as a graded phenomenon.
Late Results of Operation for Acquired Aortic Valvular Disease
Authors: MCGOON DWIGHT C. , ELLIS F. HENRY , KIRKLIN JOHN W. 
Published: June 2012

Of the 614 open-heart operations performed at the Mayo Clinic for acquired aortic valvular disease, 130 were performed on patients who also required repair of other valves. Review of the remaining 484 operations resulted in the following observations.
Operation for acquired aortic valvular disease may now be accomplished with a hospital mortality rate of 4%. The incidence of late death and failure of patients to improve has averaged 44% for previously employed techniques of valvular repair. Failure of the valve or prosthesis to function properly was the most common cause of late failure after operations in which these earlier methods were used. In the 138 more recent cases, in which operations employing the aortic ball valve (Starr-Edwards prosthesis) were used, the incidence of late failure has been reduced to 14%, and failure of the prosthesis to function properly has not yet occurred in the absence of infection. Late bacterial endocarditis and thromboembolism were the most serious problems associated with use of the ball-valve prosthesis. In contrast with the late results of the former techniques, use of the ball valve has resulted in improvement for 79% of the patients; in the great majority of these there has been a dramatic return to normal living.
Despite the highly satisfactory results of current methods, the fact that 14% of patients have already died after an initially successful operative result, and that another 12% have suffered complications causing their late result to be less than totally satisfactory, indicates that the policy of recommending for operation only those patients who have significant and progressive cardiac disability should be continued.
Plasma Renin Activity in Acute Tubular Necrosis and Other Renal Diseases Associated with Hypertension
Authors: TU W. H. , Dawson Margaret 
Published: June 2012

By in vitro and in vivo bioassay methods, activity of plasma renin was studied in patients with acute tubular necrosis, polyarteritis, systemic lupus erythematosus, or the terminal stage of chronic renal disease.
Plasma renin activity was increased during the oliguric phase of acute tubular necrosis, polyarteritis, or systemic lupus erythematosus; it was not increased during the diuretic phase of acute tubular necrosis and in the terminal stage of chronic renal disease.
Acute reversible hypertension, observed in some patients during the oliguric phase of acute tubular necrosis, vas associated with a marked increase in plasma renin. A similar association was observed in hypertensive patients with polyarteritis or systemic lupus erythematosus, but not in hypertensive patients with the terminal stage of chronic renal disease. These data suggest that the renin mechanism may participate in the acute hypertension of acute tubular necrosis, polyarteritis, and systemic lupus erythematosus, but not in chronic hypertension in the present study.
Persistent Common Atrioventricular Canal
Authors: FRATER R. W. M. 
Published: June 2012

The mitral valve anatomy of endocardial cushion defects is reviewed and compared with the anatomic requirements for normal mitral valve function. It is shown that very often mitral valve anatomy is such that function should be not at all or only minimally affected. Evidence is quoted that this is indeed so.
The potential harm that may result from indiscriminate suturing of mitral valve clefts and careless repair of the septal defects is described. Principles for the repair of the mitral valve in these cases are enunciated. A small series of cases that have had preoperative and 1-year postoperative assessments of mitral valve function is presented to illustrate some of these points.
Relationship between Polycythemia and Surgical Mortality in Patients Undergoing Total Correction for Tetralogy of Fallot
Authors: LEACHMAN ROBERT D. , HALLMAN GRADY L. , COOLEY DENTON A. 
Published: June 2012

"Complete" surgical correction of Fallot's tetralogy carries a much higher risk in patients with a hemoglobin concentration greater than 18 Gm. per cent (31 per cent mortality) than in those whose hemoglobin concentration is less than 18 Gm. per cent (10 per cent mortality).
The successful reduction of hemoglobin concentration from greater than 18 Gm. per cent to less than 18 Gm. per cent through systemic-pulmonary anastomosis greatly reduces the surgical risk associated with "complete correction." The mechanism by which this reduces surgical mortality is not known but may be related to (1) decreasing the hemorrhagic tendency associated with polycythemia and (2) conditioning of the pulmonary vascular bed and "left heart" in preparation for their new role when definitive repair has been accomplished.
The hemoglobin concentration can be used to grade the severity of Fallot's tetralogy. Such grading would provide a basis for valid appraisal of surgical mortality rates among otherwise comparable series of cases.
Hemorrhagic Necrosis of the Gastrointestinal Tract and Its Relation to Cardiovascular Status
Authors: MING SI-CHUN 
Published: June 2012

Seventy-five cases of hemorrhagic necrosis of the gastrointestinal tract were analyzed and compared with the entire autopsy population as control. The disease occurred most frequently in association with shock, which was present in 80 per cent of the cases with the gastrointestinal lesions.
The incidence of heart disease was higher in the cases of hemorrhagic necrosis than in the control group. The role of cardiac dysfunction in the etiology of hemorrhagic necrosis is emphasized as are the roles played by the bacterial toxins and shock. All three conditions have been shown to result in marked reduction of the intestinal blood flow and venous stasis.
Hemorrhagic necrosis of the gastrointestinal tract probably represents a conglomeration of microinfarcts of the mucosa secondary to markedly decreased local blood flow. Vasopressor agents have produced no beneficial effect; the effect of vasodilators remains to be determined.
Studies of Contractile Force in Man
Authors: AUSTEN W. GERALD 
Published: June 2012

Forty-five patients undergoing open-heart surgery for acquired aortic valve disease were studied with measurements of left ventricular contractile force. The data presented clearly indicate that coronary perfusion afforded, on the average, better protection to left ventricular contractility as recorded by a strain-gage arch than did hypothermia. This was particularly true in the usual case, which required an hour or longer of aortic occlusion.
Patients who required 40 minutes or less of aortic occlusion demonstrated approximately identical decreases in contractile force with hypothermia or coronary perfusion.
Bilateral coronary perfusion did not usually afford much additional left ventricular protection as compared to unilateral left coronary perfusion. In a small number of patients with significant coronary arterial occlusion, bilateral coronary perfusion appeared to give better left ventricular protection.
A Nomogram for Estimation of the Cardiac Valve Areas
Authors: WONG PETER C. Y. , SANDERS CHARLES A. 
Published: June 2012

A nomogram for the estimation of cardiac valve areas by the Gorlin formula has been described. The advantages of the nomographic approach are four-fold: (1) it results in considerable time saving in doing mathematical calculations; (2) it lessens the chance of mathematical error; (3) it provides a rapid means of checking the accuracy of a valve area calculated in the conventional manner; (4) it facilitates the understanding of the relationships between the various factors employed in the valve area formula.
As a result, the nomogram will be a useful adjunct in the operation of the cardiac catheterization laboratory and in the education of its physician personnel.
The Effect of Stethoscope-Applied Pressure in Auscultation
Authors: HOWELL WILLIAM L. , ALDRIDGE C. FOSTER 
Published: June 2012

The effect of pressure against the chest wall in the use of the stethoscope for both the bell and the diaphragm chest piece is discussed.
A modified diaphragm chest piece in a single head designed to increase the auscultatory discrimination is discussed.
Comparison of the modified and conventional diaphragm chest pieces on an artificial precordium and with the employment of accepted engineering principles in the study of sound revealed the superiority of the modified diaphragm.