ISSN:0009-7322    

出版商:OVID    

年代:1965

数据来源: OVID

摘要:

The reliability of the radioisotope renogram in detecting functional disparity in the separate kidneys of hypertensive patients with unilateral renal disease was investigated. Renograms recorded in 33 hypertensive patients without unilateral renal disease were employed for establishing control criteria. The physiologic basis for the three types of positive renograms found in the presence of unilateral renal dysfunction has been discussed. The renogram appears to be a valuable method for demonstrating significant disparity in separate kidney function while avoiding the hazards and technical difficulties of bilateral ureteral catheterization.

ISSN:0009-7322    

出版商:OVID    

年代:1965

数据来源: OVID

摘要:

One hundred nine patients with moderately severe hypertension and 12 patients with severe hypertension received the combination of 50 mg. of chlorthalidone plus 0.25 mg. of reserpine combined in a single tablet (Regroton) administered once daily for an average duration of 2 years.The ease of administration (one tablet daily), the effectiveness (78-per cent good response), the lack of development of drug resistance over a 2-year period, and the small incidence of side effects would seem to make the combination of 50 mg. of chlorthalidone plus 0.25 mg. of reserpine the ideal treatment for most patients with hypertension. If a more rapid reduction in arterial pressure is indicated, as in patients with severe hypertension, or if a satisfactory therapeutic response has not been observed in 3 to 4 months in patients with moderately severe hypertension, suboptimal doses of other antihypertensive agents may be added.

ISSN:0009-7322    

出版商:OVID    

年代:1965

数据来源: OVID

摘要:

It should be clearly understood that no evidence was uncovered to indicate an unequivocal etiology for this uncommon disease. One is tempted to qualify “uncommon” in that it no longer connotes the same extreme degree of rarity that would appear from medical literature. Over the same period that these cases were collected an equal number were recognized but unavailable for study for various reasons.Unfortunately, the size of our series precludes statistical analysis. The apparent tendencies to hypercholesteremia, blood-group predilection, and increased incidence of abnormal hemoglobin types are in need of further exploration. One would be remiss not to note at this point that at least one report20related several instances of familial incidence of postpartal heart disease.We are more certain of the significance of malnutrition as a factor in the genesis of this syndrome, although we are unable to assign a precise role. Similarly, the deleterious effects on such patients of hypertension, pyelonephritis, and full-term pregnancy have impressed us, although we can make no judgment as to their frequency of occurrence. Probably, as so often happens, we are most certain of our single pre-investigatory premise that postpartal heart disease is a serious and pernicious syndrome, quite different from that described in most of the literature. That prolonged bed rest is not a panacea is obvious. It is of sufficient merit, however, to warrant use in all such patients, for periods up to 1 year at least.

ISSN:0009-7322    

出版商:OVID    

年代:1965

数据来源: OVID

摘要:

A family in which several members of three separate generations have evidence of congenital familial conduction disturbance has been described. The occurrence of Adams-Stokes seizures with congenital AV block was also noted. From the available information it is clear that the conduction disturbance was congenital in two generations, and the family history suggests that three or four generations were probably involved. The data suggest that in this family the congenital cardiac conduction defects were transmitted as an autosomal dominant trait with incomplete penetrance.

ISSN:0009-7322    

出版商:OVID    

年代:1965

数据来源: OVID

摘要:

Defects in the muscular portion of the interventricular septum are frequently multiple. Although their incidence is significant, scant attention has been paid them as a distinct entity. This report concerns seven patients with multiple muscular ventricular septal defects seen between 1956 and 1962. The patients ranged in age from 4 months to 9 years; five were less than 2 years old. Symptoms and signs of growth retardation, failure to thrive, and marked cardiac decompensation were present in each case. Electrocardiographic evidence of combined ventricular hypertrophy and incomplete right bundle-branch block was noted in each instance. Right heart catheterization demonstrated marked pulmonary hypertension of the high-flow, low-resistance type. These routine studies could not distinguish multiple muscular ventricular septal defects from the more usual membranous septal defect. All patients had cardiac surgery. There was one survivor. In three instances difficulty in identifying all of the multiple fenestrations prevented complete surgical repair. Postmortem examination was done in six patients. The sievelike appearance of the muscular ventricular septum was the most striking gross finding in the majority of the cases. Histologic analysis of the pulmonary vascular structural alterations did not reveal marked changes in any of the cases.In contrast to the widespread belief that most isolated muscular septal defects are innocuous, these seven examples of multiple muscular defects were associated with a picture of severe heart disease. Every effort should be made to diagnose the lesion prior to surgery. Recognition of the multiple nature of the defect is a necessary preliminary to successful therapy. It is hoped that preoperative left heart angiocardiography will successfully demonstrate the multiple lesions.

ISSN:0009-7322    

出版商:OVID    

年代:1965

数据来源: OVID

摘要:

The clinical, radiologic, morbid anatomic, and histologic features of six cases of annular subvalvular left ventricular aneurysms occurring in African subjects are described. The problems of surgical repair are emphasized and the possibilities of antemortem diagnosis discussed.

ISSN:0009-7322    

出版商:OVID    

年代:1965

数据来源: OVID

摘要:

Sixteen patients with diffuse hypertrophic subaortic stenosis have been treated surgically. Thirteen of 14 patients undergoing excision of hypertrophied muscle from the left ventricular outflow tract via left ventriculotomy or aortotomy have survived. Operation has provided excellent symptomatic relief, associated with eradication or significant reduction of the systolic pressure gradient between the left ventricle and the aorta while thepatient is at rest. Operation is recommended for those patients with this disease who are experiencing significant and limiting symptoms related to obstruction of the left ventricular outflow tract.

ISSN:0009-7322    

出版商:OVID    

年代:1965

数据来源: OVID

摘要:

The records of 28 patients receiving digitalis and converted from atrial fibrillation or flutter to sinus rhythm with direct-current countershock were reviewed. Electrocardiographic signs suggesting digitalis intoxication following conversion occurred in 20 of these cases. Two of these patients died as a result of ventricular fibrillation several hours after apparently successful conversion. Six patients on digitalis treated with countershock but not converting and five patients converted withcountershock who were not receiving digitalis or in whom digitalis had been discontinued for several days failed to show these electrocardiographic abnormalities. The results indicate that digitalis intoxication will often appear following conversion to sinus rhythm when no indication of digitalis intoxication was present prior to conversion. It is recommended that digitalis be withheld for several days in subjects for whom a conversion attempt is planned.

ISSN:0009-7322    

出版商:OVID    

年代:1965

数据来源: OVID

摘要:

“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.

ISSN:0009-7322    

出版商:OVID    

年代:1965

数据来源: OVID