ISSN:0009-7322    

出版商:OVID    

年代:1961

数据来源: OVID

摘要:

Historically, the awareness of renal artery narrowing as a curable cause of hypertension has evolved gradually, highlighted especially by Goldblatt and Poutasse. The increasing use of renal arteriography over the past 8 years in this hospital has yielded a total of 70 patients with renal artery abnormalities out of 110 hypertensive patients examined.In order to select the hypertensive patients most likely to have demonstrable arterial lesions, certain indications for arteriography were used. Most useful among these were the presence of an epigastric bruit, malignant hypertension, atheroselerosis of the abdominal aorta, and recent onset of hypertension. However, no one indication was always present in patients with lesions or always absent in those without abnormalities.Of the 70 patients with renal artery abnormalities, 54 were considered to represent sufficient renal artery stenosis to be potential candidates for surgical correction, while 16 had minor renal artery abnormalities. Atherosclerotic lesions occurred in 63 per cent of the patients with significant lesions, fibromuscular hyperplasia in 28 per cent, unilateral renal artery hypoplasia or atrophy in 7 per cent, and one case had embolic renal artery occlusion. Fifty-four per cent of all patients with significant lesions had bilateral disease. The patients with atherosclerotic lesions and those with fibromuscular hyperplasia differed markedly in sex distribution, age, and severity of hypertension. It is suggested that the retrograde transfemoral catheterization technic may be associated with fewer complications in patients without extensive occlusive atherosclerotic disease of the aorta, and iliac and femoral arteries.At operation the radiologic findings were confirmed in all but one patient. Corrective surgical procedures were performed in 38 patients, including nephrectomy, endarterectomy, segmental resection with reanastomosis, and splenorenal arterial shunt. Of the 31 patients who survived, 25 (81 per cent) had a postoperative fall in blood pressure, 14 to normal, in addition to improvement in clinical status. The follow-up period, however, is not yet sufficiently long to permit definite conclusions. Seven patients died; most of these had bilateral renal artery disease and extensive atherosclerosis of the cerebral and coronary arteries.Divided renal function studies were of limited diagnostic value because of the high incidence of bilateral lesions. In all patients with significant differences in renal sodium and water excretion, a postoperative fall in blood pressure occurred, but the same number of patients with equal bilateral excretion also had a fall in blood pressure.The importance of suspecting renal artery lesions in hypertensive patients regardless of age, severity of hypertension, or renal function is stressed. The question is discussed whether all patients with sustained hypertension should undergo arteriography. Although further studies to determine the true prevalence of occlusive renal artery lesions in the hypertensive population are in order, the fact that 50 per cent of our 110 patients had occlusive lesions and 60 per cent of the operated cases had a fall in blood pressure attests not only to the prevalence of the lesion but also to its potential curability.

ISSN:0009-7322    

出版商:OVID    

年代:1961

数据来源: OVID

ISSN:0009-7322    

出版商:OVID    

年代:1961

数据来源: OVID

摘要:

Facial resemblance to a patient in whom supravalvular aortic stenosis was discovered and successfully relieved at operation has led to the correct diagnosis of supravalvular stenosis in three other patients. All four patients are mentally subnormal. The presence of supravalvular aortic stenosis in mentally retarded patients with the unusual facial features here detailed may constitute a syndrome that has not previously been described.

ISSN:0009-7322    

出版商:OVID    

年代:1961

数据来源: OVID

ISSN:0009-7322    

出版商:OVID    

年代:1961

数据来源: OVID

ISSN:0009-7322    

出版商:OVID    

年代:1961

数据来源: OVID

摘要:

Precordial scanning of the distribution of radioiodine (I131-labeled iodide) in patients with myocardial infarction has been suggested by others as a means of delineating the infarcted area.Attempts to localize radioiodine in 14 precordial scans of 12 patients with myocardial infarction resulted in the demonstration of localized areas of radioactivity in seven scans. This collection of radioactivity was found to be within the stomach, resulting from the normal concentration of radioiodine that occurs in gastric secretions.

ISSN:0009-7322    

出版商:OVID    

年代:1961

数据来源: OVID

摘要:

Fifty patients with tetralogy of Fallot have had surgical correction of their complex defects made possible by the open technic during the past 5 years. The overall 5-year operative mortality was 18 per cent. This was reduced to 15 per cent during the past 2 years in 20 patients. Forty-one of the patients are alive, asymptomatic, and have normal physical activity. Ffteen patients have had cardiac evaluation studies including cardiac catheterization from 1½ to 3 years postoperatively. Thirteen patients had normal cardiac hemodynamics. In only two patients was there evidence of incomplete hemodynamic improvement even though marked clinical improvement was gained.

ISSN:0009-7322    

出版商:OVID    

年代:1961

数据来源: OVID

摘要:

Myocardial metabolism was studied in 11 patients with progressive muscular dystrophy. Coronary blood flow was measured in four, the cardiac output in six patients. The blood concentrations of oxygen, glucose, inorganic phosphate, pyruvate, and lactate, and the serum activities of malic dehydrogenase and aldolase were determined in simultaneously drawn coronary sinus and arterial blood samples.The cardiac outputs were elevated in all patients. Myocardial extractions of pyruvate and lactate were negative in two patients. Inorganic phosphate concentrations in blood were elevated. Malic dehydrogenase and aldolase were released by the heart in several patients. Differences in oxidation-reduction potential between arterial and coronary venous blood were positive, suggesting glycolysis in the heart muscle. This was accompanied by increased myocardial extraction of glucose. Apparently aerobic glycolysis occurred, since sufficient oxygen was present to account for all glucose extracted.Stimulation of glycolysis by inorganic phosphate was suggested by the relationship between the elevated inorganic phosphate concentration in blood and the myocardial glucose extraction. This suggests the possibility of uncoupling of oxidative phosphorlyation in the myocardium.

ISSN:0009-7322    

出版商:OVID    

年代:1961

数据来源: OVID

ISSN:0009-7322    

出版商:OVID    

年代:1961

数据来源: OVID