ISSN:0009-7322    

出版商:OVID    

年代:1962

数据来源: OVID

ISSN:0009-7322    

出版商:OVID    

年代:1962

数据来源: OVID

ISSN:0009-7322    

出版商:OVID    

年代:1962

数据来源: OVID

摘要:

A series of observations in 52 hypertensive patients is presented indicating that &agr;-methyl-dopa is an effective antihypertensive agent.The antihypertensive properties of the agent were discovered in the course of biochemical studies with the racemic compound the form used in initial therapeutic trials.Studies on metabolism of DL-&agr;-methyl-dopa indicate incomplete intestinal absorption and rapid excretion in the urine as unchanged drug and as &agr;-methyl-dopamine. The former finding does not seem to be a significant deterrent to its use orally.Comparisons of the D and L isomers of &agr;-methyl-dopa in hypertensive patients showed that all the chemical and pharmacologic effects reside in the L-isomer (Aldomet). Thus, recent studies have been performed with Aldomet exclusively.From observations to date the impression has been gained that Aldomet has several advantages over other antihypertensive agents; these include effectiveness against all degrees of hypertension, frequent lowering of recumbent as well as standing blood pressure, smoothness of effect, and tranquilizing effects. Questions of toxicity and tolerance are not yet completely answered.Sympathetic blockade at a central or peripheral site is the probable basis of the drug's action. This effect may be unrelated to the biochemical property of inhibiting the decarboxylation of aromatic L-amino acids and is possibly due to depletion of tissue stores of norepinephrine by a mechanism not yet fully defined.

ISSN:0009-7322    

出版商:OVID    

年代:1962

数据来源: OVID

摘要:

The coronary arteries of 112 patients with an antemortem diagnosis of coronary arterial disease were studied at necropsy with regard to the feasibility of coronary endarterectomy for direct relief of the luminal narrowing. The patients ranged in age at the time of death from 40 to 87 years. The condition of the coronary arteries in 20 cases (18 per cent) was classed as pattern 1 (theoretically operable), in 58 cases (52 per cent) as pattern 2 (theoretically capable of palliation), and in 34 cases (30 per cent) as pattern 3 (theoretically inoperable). The youngest man who had a pattern 1 condition was 54 years of age, and of 26 men studied who were less than age 60 years, two had pattern 1 conditions, 12, pattern 2, and 12 pattern 3. Of the four women less than 65 years of age, none had pattern 1 conditions, two had pattern 2, and two had pattern 3.An impression gained from this study was that in general the most severe and diffuse lesions observed at necropsy are seen in the younger men who give clinical evidence of coronary arterial disease. Certain clinical features were analyzed in an attempt to find a correlation between these factors and the anatomic state of the coronary arteries. No clearly defined correlation could be discovered in this series.The role of direct surgical attack on the coronary arteries for relief of atherosclerosis does not appear to be an encouraging one from this study of clinical features and the final pathologic anatomy.

ISSN:0009-7322    

出版商:OVID    

年代:1962

数据来源: OVID

ISSN:0009-7322    

出版商:OVID    

年代:1962

数据来源: OVID

ISSN:0009-7322    

出版商:OVID    

年代:1962

数据来源: OVID

摘要:

Ventricular septal defect with low pulmonary vascular resistance and left-to-right shunt is well known to be closely associated with a pansystolic murmur caused by the regurgitant shunt of blood at high velocity across the defect. With very high flows a pulmonary ejection murmur is superimposed on the pansystolic murmur and is occasionally the only systolic murmur if the ventricular septal defect is so large that the velocity of the shunt is small. In two patients thought to have small ventricular septal defects the shunt murmur was confined to early systole, probably because the defect was in the muscular septum and was closed by systolic contraction of the ventricle.The second heart sound is abnormally widely split in the majority of patients, even with small defects. The mechanism is difficult to elucidate but there appears to be slight shortening of the left ventricular isometric time (early A2) and delay in contraction of the right ventricle (late P2). The splitting of the second sound is a useful way of differentiating the large defects with left-to-right shunt from the Eisenmenger group of large defects with equal pulmonary and systemic vascular resistances and a loud single second sound.The auscultatory differential diagnosis of ventricular septal defect is discussed.

ISSN:0009-7322    

出版商:OVID    

年代:1962

数据来源: OVID

摘要:

The characteristics of the second heart sound were analyzed in 350 phonocardiograms recorded from patients in all of whom the diagnosis was proved either at operation or by detailed catheterization studies. A2-P2during expiration averaged 10.6 msec. in normal subjects. Q-A2changed little during inspiration, with an average decrease of only 5.2 msec., while Q-P2increased by an average of 32.6 msec. The average increase of A2-P2during inspiration was therefore 37.8 msec. In patients with ASD, A2-P2during expiration averaged 50.2 msec. and the inspiratory change in Q-P2averaged only 4.6 msec. In 115 of 118 patients with ASD the inspiratory increase of A2-P2ranged from 0 to 10 msec. Following successful surgical closure 29 patients with ASD developed the normal inspiratory augmentation of A2-P2; in the two patients in whom the defect was not completely closed the relatively constant A2-P2noted preoperatively persisted.Release of the Valsalva maneuver exaggerated the inspiratory increase of A2-P2observed in normal subjects but did not modify this interval in patients with ASD. Analysis of the effect of release of the Valsalva maneuver on A2-P2was helpful in separating patients with ASD from normal subjects. Evidence was presented that the relative constancy of the splitting of the second heart sound in patients with ASD is due to reciprocal changes in the magnitude of the left-to-right shunt and the systemic venous inflow into the right ventricle during respiration.In patients with moderate or severe pulmonary stenosis, A2-P2during expiration was longer than in normal subjects and in the same range as in patients with ASD. However, patients with PS showed a normal augmentation of A2-P2during expiration. In patients with congenital AS, and those with PDA, left ventricular ejection tended to be prolonged with reversal of the normal sequence of semilunar valve closure or simultaneous closure of these valves during expiration.

ISSN:0009-7322    

出版商:OVID    

年代:1962

数据来源: OVID

摘要:

Combined aortic and pulmonic stenosis is a rare lesion. The clinical, hemodynamic, and pathologic findings in four patients are presented. The presence of a forceful left as well as right ventricular impulse (in four patients), the difference in the character of the ejection murmur at the second left as opposed to the second right interspace (in two patients), and a diastolic rumble at the apex (in four patients) were characteristic. The electrocardiogram showed right ventricular hypertrophy in all patients; additional and definite left ventricular hypertrophy was found in one. Radiologically, there was evidence of right ventricular enlargement in all and suggestive left ventricular enlargement in three. Simple valvular stenosis of both valves was found in only one patient, and valvular pulmonary and supravalvular aortic stenosis in another. The two remaining patients, those with corrected transposition of the great arteries, had complicated lesions including a single ventricle in one and small ventricular septal defect in the other.Attempts at surgical correction were unsuccessful in all cases.

ISSN:0009-7322    

出版商:OVID    

年代:1962

数据来源: OVID