Citations

Congenital insufficiency of the pulmonary valve may result if the valvular cusps develop faultily or fail to develop. It is commonly associated with ventricular septal defect, with or without pulmonary stenosis. Under these conditions a continuous precordial murmur may be present. Less commonly, congenital pulmonary valvular insufficiency may appear as an isolated cardiac malformation.

Necropsy studies in cases of pulmonary hypertension of unknown cause show structural changes in the pulmonary vessels that are called irreversible. Acetylcholine chloride was infused at a rate of 2 mg. per minute into the outflow tract of the right ventricle of a 48-year-old woman who had pulmonary hypertension. The mean pulmonary artery pressure decreased from 56 to 25 mm. Hg and the pulmonary flow increased slightly. These findings are consistent with the theory that so-called idiopathic pulmonary hypertension may at some stage be maintained by vasoconstriction.

Survival following surgical correction of congenital cardiovascular defects is unlikely if pulmonary hypertension cannot be decreased significantly. Infusions of acetylcholine decreased pulmonary vascular resistance in 6 of 11 patients having pulmonary hypertension associated with atrial or ventricular septal defects. When the acetylcholine was combined with the breathing of oxygen, resistance decreased further. These findings are consistent with the theory that, at some stage, the pulmonary hypertension in cases of congenital heart disease is maintained at least in part by vasoconstriction and therefore is potentially reversible.

When 24 normal subjects under basal conditions smoked two thirds of 2 cigarettes, there was no appreciable rise in the levels of the fasting blood sugar and the epinephrine-like substances of the systemic venous blood. However, the smoking of two thirds of 2 cigarettes significantly raised the blood pressure and pulse rate, and decreased the skin temperature of fingers and toes.

The present studies are concerned with the effect of high oxygen inhalation on patients with atrial septal defects. The problem of the amount of pulmonary vascular resistance and the relative contribution of irreversible structural changes and vascular tone may be of important prognostic significance in evaluation of such patients for cardiac surgery.

Cerebral infarction is attended by extravasation of blood in varying degrees. The present study was undertaken to learn whether anticoagulant therapy increases the extravasation and thereby diminishes or negates possibly favorable therapeutic effects. A series of experiments on dogs is described and the clinical implications are discussed.

The arterioles in the kidneys and pancreas in 50 consecutive necropsy cases of cardiac hypertrophy of undetermined cause and in 50 control cases were measured and studied histopathologically in an effort to determine the cause of the cardiac hypertrophy. The weight of the heart, the ventricle affected by hypertrophy and the age of the patient also were recorded in each case and correlated with the changes in the ratio of the wall to lumen in the arterioles. This study revealed that in about 40 per cent of cases the cardiac hypertrophy was probably due to antecedent hypertension.

Experienced clinicians have known for some time that bleeding owing to the use of dicumarol is not entirely a measure of the degree of prothrombin deficiency. This presentation emphasizes that bleeding may occur when prothrombin deficiency is not great and that bleeding may fail to occur when prothrombin deficiency is marked. Nonetheless great prothrombin deficiency causes bleeding more frequently than lesser degrees of prothrombin deficiency. Time is an important factor, for patients are much more apt to bleed when prothrombin deficiency has endured for several days than when it has been present only a day or so.

Data were compiled from the records of 101 cases of abdominal aortic aneurysm, almost all of which were due to arteriosclerosis. These records were selected only when there was unequivocal evidence of aneurysm, and cases of true dissecting aneurysm were not included. The data were studied primarily in regard to prognosis of this condition but in addition, all clinical manifestations of abdominal aortic aneurysm were reviewed.

This study concerns an evaluation of the anatomicopathologic changes found in blood vessels of the skin in areas of venous insufficiency in the lower legs. These changes have been compared with the vascular structure in comparable areas of skin in normal persons. Apparently evidence of arteriolar damage is more a concomitant finding in the clinical picture of chronic venous insufficiency than are venular changes. This is demonstrated in a study of 30 patients. The vascular changes show no correlation with the condition of the skin at the site from which the biopsy material was taken.