ISSN:0009-7322    

出版商:OVID    

年代:1965

数据来源: OVID

ISSN:0009-7322    

出版商:OVID    

年代:1965

数据来源: OVID

摘要:

Long-term anticoagulant therapy (coumadin) was gradually tapered over a 6-week period in 63 patients, and stopped abruptly in 71. All of these patients had been on coumadin following myocardial infarction. Acareful follow-up showed that there was no difference in the incidence of thrombotic events in the first 6 weeks after discontinuation of therapy, whether this was stopped abruptly or gradually. These results suggest that clinically recognized “rebound” thrombosis does not occur after long-term coumadin therapy is stopped. There appears to be no hazard inherent in stopping long-term coumadin therapy abruptly. A possible exception to this is patients whose therapy must be stopped because of bleeding episodes.

ISSN:0009-7322    

出版商:OVID    

年代:1965

数据来源: OVID

ISSN:0009-7322    

出版商:OVID    

年代:1965

数据来源: OVID

摘要:

Acute salt loading was performed in three groups of patients, a normal group, a group with essential hypertension, and a group with hypertension due to renal arterial stenosis.Patients with hypertension due to renal arterial stenosis were found to excrete an acute salt load in a qualitatively and quantitatively similar manner to normal individuals, in marked contrast to the exaggerated natriuretic response of individuals with essential hypertension.Of measures in which significant differences were found, the test urine volume, per cent of administered sodium excreted, and the ratios of clearance of sodium in the test and baseline periods yielded a clear separation of patients with essential renal hypertension.The results of this study indicate that acute salt loading in hypertensive patients may have diagnostic and prognostic value.The test procedure is simple, rapid, free from morbidity, and requires a minimum of laboratory analyses.

ISSN:0009-7322    

出版商:OVID    

年代:1965

数据来源: OVID

摘要:

The clinical course of nine patients, aged 14 to 49, who either at surgery or autopsy demonstrated myxomatous valvular transformation, has been described. Five females presented with symptomatic mitral insufficiency. Two of them had had endocarditis whereas in the others a heart murmur was detected during childhood. Three of the four men had a recent onset of aortic insufficiency associated in one case with aneurysm of the ascending aorta. The fourth experienced sequential arterial rupture and finally aortic dissection, his asymptomatic valvular lesion becoming manifest only at autopsy.The electrocardiographic, roentgenographic, angiographic, and catheterization findings resembled those seen in rheumatic heart disease, except that neither fibrosis, calcification, nor stenosis was found. The histologic appearance of the valve leaflets was identical to that which has been described, primarily as an incidental lesion, in the Marfan syndrome. Only one of the nine patients, however, demonstrated arachnodactyly. Skeletal mensuration in the remainder revealed a scattering of the many stigmata known to be associated with the Marfan syndrome. Nevertheless, arachnodactyly was diagnosed in at least one member of each of the six families available for investigation, although we did not encounter dislocation of the lens or an example of a complete Marfan syndrome. Erdheim's necrosis of the aortic or arterial media was described in four of the eight cases in which vascular biopsies were obtained. Prosthetic replacement in either the aortic or mitral area was carried out in the eight patients with signs of valvular insufficiency. There was one immediate and one late death. Reoperation was necessary in another case for dehiscence from the mitral annulus and twice in one more patient for the same complication at the aortic area. None demonstrated annular dilatation but isolated aneurysmal enlargement of either the ascending aorta, the membranous septum, or the sinus of Valsalva was encountered.Insufficiency apparently resulted because of valve prolapse from either structural fatigue, ruptured chordae, loss of substance, interference with coaptation, or supervening endocarditis. Myxomatous change may involve not only the chordae and the valve leaflets but also the annulus, since four prosthetic dehiscences occurred either in the early or late postoperative period in three of the eight operated upon. Experience with the one patient who showed aortic insufficiency and aneurysm of the ascending aorta suggests that valvular transformation may be the cause of incompetence in some of these cases rather than extension of the dilatation to the aortic ring.These studies indicate that myxomatous valvular transformation must be considered in the differential diagnosis of valvular insufficiency not only in patients known to have the Marfan syndrome or its various formes frustes, but also as an isolated idiopathic lesion in individuals not distinguishable by external appearance from the normal population. At the present time myxomatous valvular transformation can be suspected to be the cause of isolated valvular insufficiency if evidence for a rheumatic etiology is lacking, musculoskeletal signs of the Marfan syndrome are present, or Erdheim's necrosis is found in the arterial biopsy. There is a characteristic appearance at operation (floppy valve) but the presence of the lesion can only be established by histologic examination of the leaflets.

ISSN:0009-7322    

出版商:OVID    

年代:1965

数据来源: OVID

摘要:

Detailed chemical analyses have been carried out on aorta, and on coronary and aortic atheromata, of men who died during a study of prolonged use of diets rich in unsaturated fat and of control subjects. Concentrations of total aortic lipid and of total aortic calcium were not significantly different for the two groups of subjects. Concentrations of cholesterol and cholesterol esters, triglyceride, and phosphatide showed no difference between the two groups in analyses of aorta, uncomplicated aortic atheromata, complicated aortic atheromata, and coronary atheromata. Coronary atheroma lipid contained substantially more triglyceride than did aortic atheroma lipid, whether derived from complicated or uncomplicated plaques.Atheroma triglyceride in experimental subjects contained more linoleic acid than in control subjects, in all types of plaques. Lesser but significant increases in linoleic acid were seen in cholesterol ester and phosphatide of coronary atheromata and complicated aortic atheromata. In the case of uncomplicated aortic atheroma, changes in linoleic acid of cholesterol ester and phosphatide were smaller and not significant. In both groups of subjects, coronary atheroma contained more cholesteryl oleate and less linoleate than did aortic atheroma.Linoleic acid contents of atheroma lipid fractions were positively correlated with the linoleic acid figures for corresponding fractions of the most recent antemortem serum samples. Ratio of linoleic acid in an atheroma lipid fraction to the linoleic acid content of the corresponding serum fraction was, in most cases, constant after the time of the first sample, obtained after 495 days on experimental diet. It is postulated that this ratio constitutes an estimate of the fraction of atheroma fatty acid derived from plasma. In cholesterol ester and triglyceride, the ratio was about 0.65 in experimental subjects, higher in subjects on the control diet. The ratio for phosphatide was about 0.5 in both groups of subjects.

ISSN:0009-7322    

出版商:OVID    

年代:1965

数据来源: OVID

ISSN:0009-7322    

出版商:OVID    

年代:1965

数据来源: OVID

ISSN:0009-7322    

出版商:OVID    

年代:1965

数据来源: OVID

ISSN:0009-7322    

出版商:OVID    

年代:1965

数据来源: OVID