ISSN:0009-7322    

出版商:OVID    

年代:1962

数据来源: OVID

摘要:

A review was made of the case histories and autopsy reports of 30 patients with systemic lupus erythematosus who had clinical cardiovascular involvement. The presence of an enlarged heart or of gallop rhythmstrongly suggests myocardial involvement, but the electrocardiogram is not specific. Signs and symptoms referable to the heart are unusual as a first manifestation of systemic lupus erythematosus, and in patients receiving suppressive chemotherapy they do not further worsen the prognosis. Systolic murmurs cannot be interpreted as conclusive evidence of Libman-Sacks valvulitis.

ISSN:0009-7322    

出版商:OVID    

年代:1962

数据来源: OVID

摘要:

The relationships between the excretion of sodium and water and adrenal activity in patients with refractory edema have been investigated.Experiments have been performed over a prolonged period with varying doses and combinations of spironolactone, prednisone, hydrochlorothiazide, Su4885, and ACTH. In four patients with Laennec's cirrhosis with ascites the effects of prednisone on the excretion of water and solute were studied during maximum water diuresis.The results indicate that diuretic agents may increase the excretion of sodium without water within certain undefined limits. This effect probably resulted from the delivery to the concentrating segment of an amount of sodium inadequate to dissipate the gradients favoring water reabsorption.Prednisone appeared to have a dual effect: one on the excretion of water, the other on the excretion of sodium. The effects on sodium and water did not appear to be related.The effects of prednisone on the excretion of water support the concept that the glucocorticoids exert an effect on water in the renal tubules rather than on the posterior pituitary.Prednisone enhanced sodium excretion only when given together with another diuretic agent. It is suggested that the failure of prednisone alone to increase sodium excretion resulted from a blockade of ACTH secretion and, thereby, the adrenal synthetic pathway of aldosterone, whereas the renal aldosterone-stimulating pathway continued to function. The potentiating effect of prednisone on the excretion of sodium becomes apparent only when aldosterone activity is overcome in the renal tubules by the natriuretic effects of various diuretics.It is considered possible that renal aldosterone-stimulating hormone acts only under more intense stimuli to edema formation.

ISSN:0009-7322    

出版商:OVID    

年代:1962

数据来源: OVID

摘要:

Eleven patients seriously disabled by mitral regurgitation were re-evaluated 4 to 41 months following mitral annuloplasty (average 19.4 months). Preoperative and postoperative comparative data are presented. One patient was unimproved or worse. The rest were subjectively better.Mean changes were transverse cardiac diameter −17.8 mm. (median 15 mm.) (p< .005); resting stroke index +9 ml./beat/M.2(median 9 ml./beat/M.2,p< .05); resting cardiac index +0.5 L./min./M.2(p= .20); mean pulmonary artery pressure −7.2 mm. Hg, or 29 per cent (median 8 mm. Hg,p< .03); and arteriovenous oxygen difference −12 ml./L. (median 13 ml./L.,p< .005).Abnormally prolonged mixing, as shown by indicator-dilution curves, was decreased in all patients (p< .05). Exercise testing showed varying degrees of improvement in six of the nine so studied.In six patients mitral regurgitation by angiocardiographic measurements postoperatively represented 0, 0, 21, 24, 35, and 46 per cent of the total left ventricular stroke volume. Two patients had increased end-systolic left ventricular volume as evidence for postoperative left ventricular failure. The other four were probably normal.Ten of the 11 patients showed postoperative improvement that was felt to be significant in two or more of the above objective measures. Striking x-ray improvement in heart size occurred in two patients, eight others showed decreases in transverse diameter of up to 17 mm. One developed an increase in heart size.Although probably improved over their preoperative status, two patients had significant mitral stenosis at the time of re-evaluation. Another showed evidences of progressive mitral regurgitation after an initial period of improvement.Mitral annuloplasty is a palliative procedure with considerable potential for effecting a reduction in regurgitant volume and improving the clinical status of carefully selected patients.

ISSN:0009-7322    

出版商:OVID    

年代:1962

数据来源: OVID

摘要:

The clinical, hemodynamic, angiographic, and pathologic findings in three patients with complete interruption of the aortic arch are presented. In addition, data derived from published reports of 52 previous patients are summarized. This malformation is never an isolated one, since a patent ductus arteriosus is always present and a ventricular septal defect is almost invariably found as well. The diagnosis of absence of the aortic arch is difficult, since differential cyanosis is uncommon, relative systolic hypertension of the arms is rare, and the heart murmur, when present, is of a nonspecific nature. At catheterization the pressure in the pulmonary artery, patent ductus arteriosus, and descending aorta is usually similar to that in the ascending aorta and in its branches. Selective angiocardiography has been shown to be the only means of establishing the presence of the malformation prior to operation or autopsy. Since the majority of patients with absence of the aortic arch die within the month following birth, early recognition of the lesion is imperative if surgical correction is to be of benefit.

ISSN:0009-7322    

出版商:OVID    

年代:1962

数据来源: OVID

摘要:

Three cases of acyanotic levocardia are reported. One case was associated with congenitally corrected transposition and arterial AV valve insufficiency. The precise nature of the heart disease in the second case has not been determined, and the last case was without known cardiac disease.Attention is drawn to a serious lack of anaccepted terminology in describing cases with spatial derangements of the heart or its chambers as well as incomplete data in published reports concerning the relative positions and internal anatomy of the chambers of the heart, its peripheral connections, and the disposition of the abdominal viscera.It is probable many more individuals with levocardia without heart disease, or with acyanotic heart disease, exist than is suggested by the current medical literature.

ISSN:0009-7322    

出版商:OVID    

年代:1962

数据来源: OVID

摘要:

Homogeneous collections of cells resembling small lymphocytes have been found in the adventitia of atheromatous arteries, and the prevalence and degree of cellular infiltration have been shown to correlate closely with the severity of the plaques. The cells are found in the aorta, coronary, iliac, and carotid arteries; but in the carotid arteries the infiltration is less marked. Arterial blocks containing recent thrombus show more cellular infiltration than blocks without thrombus and with recanalizing thrombus.The location and significance of the adventitial cellular infiltration is unknown, but it may play a part in the etiology or pathogenesis of arterial plaques.

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:

The hemodynamic findings obtained at left heart catheterization in 46 patients with aortic stenosis of varying severity were correlated with the presence of a fourth heart sound determined phonocardiographically. From this correlation it may be concluded that, when a fourth heart sound is detectable in an adult patient with aortic stenosis, it usually indicates that the obstruction is severe (gradient exceeding 70 mm. Hg, left ventricular systolic pressure above 160 mm. Hg), that the left ventricular end-diastolic pressure is elevated (12 mm. Hg or above), and that the “a” wave in the left atrial pressure pulse is tall (14 mm. Hg or higher). The sound probably results from a forceful atrial contraction that forces a large volume of blood into a ventricle, the walls of which have been rendered less compliant than normal by the presence of left ventricular hypertrophy. The presence of this sound is easily detectable at the bedside by auscultation, and its presence may be confirmed by phonocardiography. The potential clinical usefulness of this physical finding, the presence of which is capable of separating patients with moderate or severe obstruction from those with mild obstruction, is self-evident.

ISSN:0009-7322    

出版商:OVID    

年代:1962

数据来源: OVID

摘要:

A case of left atrial myxohemangioendothelioma, diagnosed ante mortem by removing a tumor embolus to the bifurcation of the aorta, is reported. The patient had been misdiagnosed as having had rheumatic heart disease with paroxysmal atrial fibrillation and embolization to the right middle cerebral artery. In retrospect, because of the characteristics of the second heart sound and absence of an opening snap, a rheumatic etiology should have been questioned.The literature regarding embolization of atrial myxomas has been reviewed.

ISSN:0009-7322    

出版商:OVID    

年代:1962

数据来源: OVID