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10,003,600 | Demyelinating polyradiculitis and multiple sclerosis. | [
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10,003,601 | Ocular dipping. | [
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10,003,602 | Progressive supranuclear palsy and falcotentorial meningioma. | [
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] |
10,003,603 | Acute hypertension with orbital carcinoid tumor. | [
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10,003,604 | Invasive squamous cell carcinoma with intraocular mucoepidermoid features. Conjunctival carcinoma with intraocular invasion and diphasic morphology. | [
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10,003,605 | Cavitation in intraocular malignant melanoma. | [
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] |
10,003,606 | Adjuvant cryotherapy for focal nodular melanoma of the conjunctiva. | [
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10,003,607 | Posterior collagenous layer of the cornea. Ultrastructural classification of abnormal collagenous tissue posterior to Descemet's membrane in 30 cases. | [
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] |
10,003,608 | We studied the transmission electron microscopy of the abnormal collagenous tissue posterior to Descemet's membrane in 30 human corneas that represented 19 different diseases. We named this abnormal tissue the "posterior collagenous layer" of the cornea and classified it into three morphologic types: (1) banded posterior collagenous layer, characterized by 110-nm wide-spacing material, (2) fibrillar posterior collagenous layer, characterized by loose meshwork of collagenous fibrils 20 to 30 nm in diameter, and (3) fibrocellular posterior collagenous layer, characterized by fibroblasts in connective tissue. The published ultrastructural studies of 88 corneas that represented 13 different clinical disorders fit this classification well. The posterior collagenous layers often formed multiple lamellae, but no pattern was invariably associated with a specific clinical disorder. We think these multiple layers represent successive periods of deposition of collagen by a stressed corneal endothelium and provide a lifelong record of senescent and pathologic events. | [
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10,003,609 | Optic nerve damage in human glaucoma. III. Quantitative correlation of nerve fiber loss and visual field defect in glaucoma, ischemic neuropathy, papilledema, and toxic neuropathy. | [
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10,003,610 | The number and distribution of human optic nerve axons were compared with clinical measurements available the same eyes, including visual acuity, disc appearance, and visual field studies. Definite loss of axons occurs prior to reproducible visual field defects in some patients suspected of having glaucoma. In glaucoma, the superior and inferior poles of the nerve lose nerve fibers at a selectively greater rate, leading to an hourglass-shaped atrophy. Cavernous degeneration of the retrobulbar optic nerve is rarely observed in chronic glaucoma. The pattern of atrophy in examples of toxic amblyopia, ischemic optic neuropathy and chronic papilledema differ from that of glaucoma, suggesting different mechanisms of damage in these conditions. | [
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10,003,611 | Effect of sodium hyaluronate on corneal wound healing. | [
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10,003,612 | With the development of the use of sodium hyaluronate for endothelial cell protection during anterior segment surgery, we were interested in the effect of sodium hyaluronate on corneal wound healing. Therefore, the following experiment was performed. Corneal incisions were made in both eyes of 14 albino rabbits. Sodium hyaluronate was used to fill the anterior chamber of the test eye, and balanced salt solution was used in the control eye. The wounds were sutured wih 10-0 nylon. On the seventh postoperative day, and strength was measured. After suture removal, the intraocular pressure was raised until the wound burst. Results showed no statistical difference between these and control eye. | [
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] |
10,003,613 | A new glare tester for clinical testing. Results comparing normal subjects and variously corrected aphakic patients. | [
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10,003,614 | A simple, inexpensive, readily available, easy-to-service clinical glare tester combines an audioviewer able-top projector with a series of specially made slides. Each slide supplies a constant glare source and a variable-contrast, central target. The device was evaluated on 161 normal subjects, 144 patients with cataracts, and 110 aphakic patients whose visual acuity was corrected with spectacles or intraocular lenses. Results showed that aphakic patients, irrespective of the mode of correction, were statistically more glare sensitive than normal phakic patients. Further results confirmed earlier studies that demonstrated that glare sensitivity also increased with age in normal eyes. Broad potential exists for using this method of glare testing in industry, transportation media, and medicolegal and and clinical ophthalmologic studies. | [
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10,003,615 | Anterior segment configuration. | [
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10,003,616 | Orbital metastasis from prostatic carcinoma. | [
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10,003,617 | Future requirements for and supply of ophthalmologists. What do the forecasts show? | [
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10,003,618 | Forecasts of the requirements for and supply of ophthalmologists in 1990 have produced conflicting results because of varying assumptions about the future utilization of eye care services, incidence and prevalence of ophthalmic disease, physician productivity, and availability of residency training positions. A typical "utilization-based" models, founded on present consumer behavior, predicts a substantial 1990 surplus of ophthalmologists at current rates of residency training. Two "need-based" models, founded on ideal rather than actual use, reach different conclusions because of varying use of a fragile data base and the need to rely heavily on the subjective judgment of experts with regard to norms of care. The 1980 Graduate Medical Educational National Advisory Committee forecasted a surplus, while the 1978 American Academy of Ophthalmology predicted a deficit. Utilization-based models may slightly underestimate future ophthalmologist requirements. However, analysis of the factors that will influence future use suggests that need-based models are likely to overestimate the requirements. It is risky to accept the need-based model projections because of the high cost of a surplus, which include not only the expenses of training unneeded ophthalmologists but also the cost of their decreased exposure to disease and of declining physician morale, acumen, and thresholds for surgical procedures. Because free market mechanisms are ineffective in governing the supply of health providers, it will be necessary for the profession itself to review the current and projected supply and to set limits on the number of persons in training. | [
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10,003,619 | Monitoring ophthalmology graduate education. The Residency Review Committee. | [
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10,003,620 | Formal monitoring of quality control in American graduate medical education is the task of the residency review committees (RRCs). The RRC for ophthalmology consists of nine members appointed by the American Board of Ophthalmology, the American Academy of Ophthalmology, and the American Medical Association. The RRC meets twice each year to determine the accreditation status of residency training programs. As of 1978, the residents ae board eligible only if they have graduated from accredited programs. The review process is based on data collected in standard hospital information forms and a site survey. An RRC member evaluates this information and makes a recommendation that is discussed and voted on by the nine-member RRC body. In response to pressures for greater quality control and regulatory visibility, the review process has been bolstered by improvements in the data-gathering forms and in the surveyors and by a revision of the minimum requirements for accreditation that provides clearer and more stringent guidelines. | [
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10,003,621 | Descemetocele after intraocular lens implantation. | [
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10,003,622 | A persistent central corneal epithelial defect progressing rapidly by stromal ulceration to descemetocele formation was observed in five elderly patients soon after cataract surgery with intraocular lens implantation. The ulceration occurred in the absence of active inflammation or infection in otherwise clear cornea. Topically applied artificial tears, antibiotics, and corticosteroids failed to control the ulceration although bandage soft contact lens therapy and conjunctival flap helped stabilize the cornea in one case each. Spontaneous perforation in two cases necessitated penetrating keratoplasty. | [
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10,003,623 | Hydroxychloroquine. Seven-year experience. | [
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10,003,624 | Ninety-nine patients were treated with hydroxychloroquine sulfate for connective tissue diseases during a seven year period. All patients received the medication for at least one year and most were treated with a daily dosage of 400 mg. Four patients experienced toxic effects, but no patient sustained permanent loss of visual acuity. Toxicity did not seem to represent a cumulative dosage effect. Funduscopic and visual field examinations at six-month intervals are sufficient to detect the occasional adverse reactions and prevent serious retinal toxic effects when a maximum daily dosage of 400 mg is maintained. | [
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10,003,625 | Optic nerve pit during papilledema. | [
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10,003,626 | Introduction to the round table conference on the evaluation of auditory function after surgical procedures. | [
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10,003,627 | Some pitfalls in the evaluation of auditory function after surgical procedures. | [
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10,003,628 | Because clinical bone conduction is composed of at least three different mechanisms, two of which are air conduction, uncritical use of the air-bone gap in connection with surgical procedures may give rise to erroneous conclusions. Genuine bone conduction may be influenced by ear pathology and by surgery due to alterations in the mechanical impedance at the site of application of the bone vibrator and at the round and oval windows. The supplementary use of impedance audiometry and advanced speech audiometry is recommended. | [
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10,003,629 | Post-operative evaluation of middle ear surgery. | [
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10,003,630 | The authors present a method for the post-operative evaluation of middle ear surgery. They suggest that such a framework should be worked out in greater detail by specialised international societies, so that, as a final result, an international, standardised method for data recording, processing and reporting would be established. | [
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10,003,631 | Evaluation of auditory function after stapedectomy in the absence of the other ossicles. | [
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10,003,632 | Normal function of the middle ear and its measurement. | [
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10,003,633 | Some principles underlying acoustic impedance measurements in the ear canal and their evaluation are reviewed. The following topics are included: some methods of measurement, useful frequency range, the middle-ear system, impedance characteristics of normal and some pathological ears, and the relation between the impedance and tympanometric results. Advantages and disadvantages of measurements with an acoustic bridge and parallel probe tubes are contrasted and the same is done for tympanometry versus static impedance measurements. The relation between tympanograms and static impedance data referred to the tympanic membrane is illustrated by means of a semihypothetical example. The example suggests that a probe frequency around 700 Hz is more informative in tympanometry than a probe frequency of 220 Hz. | [
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] |
10,003,634 | Tympanic membrane perforation descriptors and hearing levels in otitis media. | [
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10,003,635 | The air conduction threshold of hearing was determined at 0.5,1 and 2 kHz by manual audiometry on a consecutive series of young Thai adults with bilateral chronic suppurative otitis media. At the same time, after visual inspection of each tympanic membrane, the perforation was drawn, as faithfully as possible in respect of both shape and relative size, on a 40-mm diagram of a tympanic membrane. A study of the shapes of perforations showed that they could be described as elliptical, reniform or cardioid. For the purposes of calculating the area of a perforation, a reniform perforation was considered to be the result of substracting a smaller ellipse from a larger ellipse, which ellipses were in contact at the point of least curvature. The hearing threshold level was found to be a function of the size of the perforation. A power function best described this relationship. The relationship was such that a total perforation would be associated with a hearing loss of about 60 dB HL over the frequency range 0.5-2 kHz. | [
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10,003,636 | Relationship between the shape of the reconstructed tympanic cavity and the postoperative auditory function. | [
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10,003,637 | The dependence of the postoperative hearing function on the shape of the reconstructed tympanic cavity has been evaluated. After reconstructing a large tympanic cavity, the results were very good; after reconstructing a flat tympanic cavity they were good and after reconstructing a cavum minor they were bad. The main cause of bad long-term hearing ability after type IV tympanoplasty was tympanofibrosis. The global results were better following close tympanoplasty than following open tympanoplasty. | [
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10,003,638 | The round window in acute hearing loss. | [
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] |
10,003,639 | Sensorineural hearing loss has various etiologies. One of them is perilymphatic fistula, which is observed in (1) congenital malformation of the internal ear in children: (2) after operations on the oval window (stapedectomy, interposition); (3) in cases of head trauma, and (4) in acute hearing loss of unknown origin. The authors report 5 of 19 cases of acute hearing loss observed at the ORL Clinic in Kraków and operated on by exploratory tympanotomy. In 4 of them, rupture of the round window membrane (secondary tympanic membrane) was found. A hypothesis for the rupture mechanism is presented. | [
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10,003,640 | A standard determination of paired air- and bone-conduction thresholds under different masking noise conditions. | [
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10,003,641 | Air-(ac) and bone-conduction (bc) thresholds were determined for 96 subjects in the age range 16-30 years. The bc tests were carried out using a B-71 vibrator applied to left and right mastoid under three conditions at the contralateral ear: unoccluded, masked at 25 dB and at 40 dB sensation level; ac audiometry and masking noise used a TDH-39 earphone. By a systematic process of otological classification of the subjects, the bc threshold for 'normal hearing' could be estimated with an uncertainty of less than 1 dB and interpolated for masking noise levels from zero to 40 dB sensation level. Results are expressed as alternating force levels in an artificial mastoid of current commercial design. Variance of the air-bone difference for individual ears is found to be less than the sum of ac and bc threshold variances calculated separately, implying strong air-bone correlation. Comparison is made with other recent studies using B-71 and KH-70-type vibrators, and average results are presented in the context of a proposed international standard for the normal threshold of hearing by bc. | [
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10,003,642 | Behaviour of high-frequency hearing in noise. | [
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10,003,644 | The aim of this review is to determine the incidence and aetiology of fatty liver and other liver pathology in aircrew. A review of 525 fatal aircraft accidents resulted in deaths of 776 aircrew. Histology of liver, available in 423 aircrew, was reviewed and 118 found abnormal. There were 66 cases (15.6%) of fatty livers. In 11 of the fatty livers and 8 of the 52 non-fatty livers there was histopathologic evidence compatible with alcohol abuse (4.5%). The histopathologic appearances are discussed. | [
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] |
10,003,645 | Hepato-splenic injury in aircraft accidents. | [
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10,003,646 | Check your oxygen. | [
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10,003,647 | Forensic dentistry. | [
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10,003,648 | Piribedil-induced anti-hypoxic protection in rats. | [
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10,003,649 | The action of the dopaminergic agonist, piribedil, on a conditioned avoidance response was studied in normoxic or hypobaric hypoxic rats. This agonist has no effects in normoxia, but induced an anti-hypoxic protection (improvement of learning in hypoxia), antagonised by low doses of pimozide. The mechanism of the anti-hypoxic property seems to be mediated by the stimulation of the postsynaptic dopaminergic receptors, but does not exclude the role of noradrenergic pathways, as shown by the stabilisation of norepinephrine levels during hypoxia after treatment with piribedil. | [
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10,003,650 | Effect of altitude exposure on induction of streptococcal endocarditis in young and middle-aged rats. | [
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10,003,651 | Young (age 2 months) and middle-aged (age 10 month) rats were injected once with a culture of Streptococcus sanguis and exposed for 24 h to 7620 m altitude. At 6 d 54% of the exposed and 30% of the unexposed middle-aged rats had bacterial endocarditis. Myocarditis developed in 63% of the injected exposed rats of both ages, in 11% of the injected unexposed middle-aged rats, and in none of the unexposed young adults. Interstitial nephritis was found in 46-66% of the injected, unexposed young and middle-aged rats and in 70-86% of the injected, exposed young and middle-aged rats, respectively. About 95% of all injected rats survived 6 d. No evidence of hemoconcentration was found. The increase in cardiac disease induced by altitude was probably due to deleterious effects of hypoxia on the myocardium, and cellular defenses, and to physiological and possible immunological changes associated with aging. | [
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10,003,652 | Television computer games: a 'new look' in performance testing. | [
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10,003,653 | Work at the Naval Biodynamics Laboratory aims at developing a battery of performance evaluation tests for environmental research (PETER). Because repeated-measures designs are virtually universal in environmental studies, the paradigm focuses on stabilisation with practice; thus far, over 50 tasks have been studied. The present report describes how five computerized video games fare as performance tests. The tasks were performed for 3 weeks each, in the same order, by the same subjects. The results show that four out of the five games meet all criteria satisfactorily and one does not, a favorable showing for the video games in comparison with conventional tests of either the paper-and-pencil or apparatus types. In terms of availability, equipment reliability, expense, and other practical considerations, the video games have many advantages. It is concluded that video games have considerable promise for performance testing and other applied contexts. | [
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10,003,654 | Visual scanning behavior and mental workload in aircraft pilots. | [
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] |
10,003,655 | This paper describes an experimental paradigm and a set of preliminary results which demonstrate a relationship between the level of performance on a skilled man-machine control task, the skill of the operator, the level of mental difficulty induced by an additional task imposed on the basic control task, and visual scanning performance. During a constant, simulated piloting task, visual scanning of instruments was found to vary as a function of the level of difficulty of a verbal loading task. The average dwell time of each fixation on the pilot's primary instrument increased as a function of the loading. The scanning behavior was also a function of the estimated skill level of the pilots, with novices being affected by the loading task much more than experts. The results suggest that visual scanning of instruments in a controlled task may be an indicator of both workload and skill. | [
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10,003,656 | Recent life change measurement in Canadian Forces pilots. | [
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10,003,657 | This study is the first in a series of steps aimed at developing a management tool that will provide a technique for screening accident-prone aviators. Because "life change" is found to be a contributing factor to stress and development of illness in both civilian and military populations, the study of life change events in aviators is a reasonable point from which to begin. The Holmes and Rahe Recent Life Change Questionnaire was administered to an experimental group of 158 aviators and two control groups: one group of 127 ground crew who were matched for age and location, and a group of 46 who were matched for rank. Significant differences were found between some of the subgroups but there were no significant differences between the experimental group and either of the control groups. Nonetheless, this aviator population is functioning at a level of life change-induced stress which would normally predict health changes in 50% of the general population. Therefore, it is concluded, the effect of excessive life change as a contributing factor to personal stress and illness or accident merits further study. | [
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10,003,658 | Measurement of systolic time intervals by electrical plethysmography: validation with invasive and noninvasive methods. | [
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10,003,659 | An experiment was conducted to validate the use of electrical impedance plethysmography for measuring systolic time intervals. This method is of interest in aerospace medicine since it is a noninvasive technique and very easy to use without causing discomfort to the subject. The equipment, with electrodes placed in front of the heart, gave both the first derivative of the electrical impedance variation and the E.C.G. The tracings were compared to simultaneous recordings of either the carotid pulse or blood pressures obtained by right and left catheterization. The results did not permit us to determine the right side systolic times. However, demarcated points of the plethysmogram permitted us to determine accurately the beginning of left mechanical systole and aortic opening and closure. Consequently, this method can determine the left ejection time (LPEP), the left isovolumetric contraction time (LIVCT), and the ventricular ejection time (LVET) with good accuracy. | [
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] |
10,003,660 | Surgical treatment of recurrent frontal sinus barotrauma: a case report. | [
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10,003,661 | Surgical treatment of recurrent frontal sinus barotrauma. | [
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10,003,662 | The future of Soviet space exploration. | [
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10,003,663 | Dimethyl sulfoxide (DMSO)--a unique therapeutic entity. | [
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10,003,664 | Family intervention for inner-city populations. | [
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10,003,665 | Sexual behavior in female rats born in all-female litters. | [
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10,003,666 | Females born in all-female litters and females stemming from predominantly male litters were compared for masculine (mounting) and feminine sexual behavior (lordosis) under various dosages of estradiol followed by progesterone and under testosterone stimulation. Estradiol did not affect mounting levels in these groups. A critical dose level was established at 0.25 mg/animal of estradiol for both groups with respect to receptive behavior. Testosterone treatment reliably stimulated mounting in these females, but no differences were determined with respect to the litter composition in utero. The results are considered as a critical and negative finding with regard to the possibility that testosterone stemming from male littermates in utero affects the female's sexual development. | [
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10,003,667 | The effects of external stimuli on the emotional-aversive response evoked by intrahypothalamic carbachol injections. | [
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10,003,668 | The aim of this investigation was to examine the effects of threatening (the sight and barking of the dog) or "Neutral" (flash and tone) stimuli on the emotional-aversive response evoked by direct intracerebral application of carbachol in cats. Unilateral microinjections of carbachol in 10 microgram doses and 2 mu1 volume into anterior hypothalamic/preoptic area caused a full-blown emotional response with marked vocalization. All stimuli which might be threatening for cats caused a significant increase of vocalization. "Neutral" stimuli of comparable intensity were without effect. To investigate the effects of stimulation intensity two clocks: low and loud (difference of 27 dB), were used. The loud click significantly increased vocalization level while the low click of the same intensity as a dog's barking had no significant influence on the carbachol-induced response. Cholinergic stimulation of the anterior hypothalamic/preoptic area seems to be specifically responsible for the obtained change of perception towards increased sensitivity to any potentially threatening alteration of the environment. | [
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10,003,669 | Different reaction patterns in individually and socially reared rats during exposures to novel environments. | [
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10,003,670 | Individually and group-reared male rats were behaviourally compared after various periods of different housing, (i) during a first exposure to the new environment, and (ii) after habituation (two repetition trials) to the situation, during a fourth exposure in a slightly modified test-box. Compared to group-housed controls an elevated locomotor activity upon the first exposure and a reduced reaction in response to the slight modifications were found in individually housed rats. | [
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10,003,671 | Hippocampal cellular plasticity during extinction of classically conditioned nictitating membrane behavior. | [
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10,003,672 | Hippocampal unit responses were recorded during extinction of classically conditioned nictitating membrane (NM) behavior in the rabbit. Prior studies have shown that during the acquisition phase of nictitating membrane conditioning, the frequency of hippocampal cell firing increases at a faster rate (across trials) than learned behavior. Results reported here show that, during the early phases of extinction, conditioned hippocampal unit responses decrement at a faster rate than learned NM behavior. Furthermore, only certain components of the conditioned hippocampal unit response display robust spontaneous recovery across successive days of extinction training. In all, results show that changes in the activity of hippocampal neurons predict changes in learned behavior over trials of conditioning and extinction, and demonstrate that hippocampal cellular activity is particularly sensitive to stimulus configurations or environmental contingencies that produce changes in behavior. | [
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10,003,673 | Analysis of facial displays and verbal report to assess subjective state in the non-invasive detection of limbic system activation by procaine hydrochloride. | [
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10,003,674 | The problem of scalp EEG as a measure of cortical or subcortical activity is particularly relevant to complex partial seizures as the abnormal discharging is frequently limbic in origin [14, 30]. Livingston [38] has suggested that administration of intravenous procaine as a limbic activator and cortical suppressor would be of utility in diagnosing limbic involvement in complex partial seizures. While there is considerable evidence derived from experimental animal models that procaine hydrochloride is a limbic system activator that acts preferentially on subcortical epileptic foci at lower doses than on less active epileptic foci or non-epileptic tissue [2, 4], it was necessary to demonstrate that procaine activates the human limbic system. The non-invasive approach taken in the present study was to compare the published effects of direct electrical stimulation of the human limbic system [31] to the behavioural and subjects effects of intravenous procaine administration. The areas in which we obtained the most robust procaine effects (hallucinations, emotions and alimentary sensations) were also Halgren et al.'s [31] most repeatable effects. The correspondence between electrical stimulation effects and procaine administration effects was striking - with verbal report by patients matching exactly in many instances. Furthermore, analysis of facial displays proved useful in providing access to subjects state fluctuations which would otherwise have gone undetected. The data provide strong evidence that procaine hydrochloride can be used as a human limbic system activator. Future research will investigate the clinical and diagnostic significance of differential response to procaine. | [
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10,003,675 | Electrodermal response patterns in neurological patients with disturbed vigilance. | [
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10,003,676 | In 18 neurological patients with severely disturbed vigilance and 18 healthy subjects, electrodermal responses to acoustic stimuli were elicited. There were substantial differences between both groups in the temporal patterning of electrodermal responses. Patients reacted significantly less on initial trials than healthy subjects and exhibited their maximal responses on later trials. This response pattern is interpreted as reflecting changes in activation. | [
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10,003,677 | Penicillin-sensitive Moraxella prosthetic endocarditis. Near disaster caused by failure to treat with penicillin. | [
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10,003,678 | A patient with late prosthetic endocarditis resulting from Moraxella non-liquefaciens is reported. Correct laboratory indentification is of therapeutic importance as Moraxella is often highly sensitive to penicillin. Because of suspected penicillin sensitivity, antibiotics other than penicillin were used, but failed to control the endocarditis. Prompt response occurred when penicillin was given. Penicillin remains by far the most effective antibiotic for the treatment of endocarditis, particularly when affecting prosthetic valves, and caused by organisms sensitive to penicillin. | [
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10,003,679 | Invasive electrophysiological study in the Jervell and Lange-Nielsen syndrome. | [
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10,003,680 | Assessment of heart neurons in dilated (congestive) cardiomyopathy. | [
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10,003,681 | Pathological studies in seven hearts from patients with dilated cardiomyopathy have shown that the number of neurons is significantly reduced in these compared with five hearts from normal subjects. The number of ganglion cells was counted in a strip of right atrial wall between the venae cavae and sectioned serially. The mechanism responsible for the neuronal depopulation in this type of cardiomyopathy could not be determined. Previous viral infection may be causally related. Three hearts of patients suffering from chronic Chagas's heart disease were also studied. Depopulation of neurons was most severe in the hearts with Chagas's disease and less severe in those with dilated cardiomyopathy, though neurons were still significantly reduced in number in the latter compared with normal controls. Despite the lack of a specific, definite cause for the depopulation of neurons, physiological evidence of parasympathetic impairment in patients with dilated cardiomyopathy is in agreement with the pathological findings. It is suggested that on the basis of our findings neuronal depopulation in some patients with dilated cardiomyopathy may be of aetiological significance. | [
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10,003,682 | Interrelation of heart rate and autonomic activity in asymptomatic men with unobstructed coronary arteries. Studies with atrial pacing, adrenaline infusion, and autonomic blockade. | [
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10,003,683 | Open aortic valvotomy for congenital aortic stenosis. Late results. | [
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10,003,684 | Forty-nine consecutive patients, aged 2 to 28 years, were followed after open aortic valvotomy. Three late deaths occurred in relation to reoperation. Seventeen reoperations were performed 2 to 14 years after valvotomy for severe stenosis in 12 patients, aortic regurgitation in three patients, and aortic stenosis and regurgitation in two patients. Among the 12 patients who required reoperation for severe obstruction, five aged over 19 years had calcified valves with normal aortic roots and valve replacement was simple. Seven had tunnel obstruction with a hypoplastic aortic root, constituting a difficult surgical problem, and necessitating total aortic root replacement in four. The postoperative course after simple aortic valvotomy is determined by several factors; the basic pathological form of the obstruction is the most important. Those who present in the first decade with lumpy valves and small aortic roots tend to form a diffuse tunnel obstruction when residual stenosis remains after valvotomy; older patients with pliable domed valves slowly develop calcified cusps and present less problems as the aortic root is usually a good size. Although aortic valvotomy offers good early results with a low mortality, it should be regarded as palliative as all patients will ultimately require reoperation. Younger patients with lumpy valves and a small aortic root have more problems and may require different initial management. | [
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10,003,685 | Atresia of left atrioventricular connection. Surgical considerations. | [
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10,003,686 | Balloon atrial septostomy under two dimensional echocardiographic control. | [
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10,003,687 | Two dimensional echocardiography has been used to guide balloon atrial septostomy in five cases of transposition of the great arteries. A single lumen balloon catheter was used. The catheter can be accurately located within the left atrium before inflation of the balloon, thus avoiding some of the traumatic accidents possible during septostomy. The balloon can be observed creating the atrial defect and the approximate size of the resulting defect noted. It can also be seen if the foramen ovale is only being stretched and not torn. The use of the two dimensional echocardiogram during septostomy should significantly contribute to the speed, efficiency, and safety of the procedure. | [
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10,003,688 | Myocardial infarct size and cardiac performance at exercise soon after myocardial infarction. | [
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10,003,689 | Infarct size was estimated from serial serum CK MB measurements in a series of 101 patients admitted less than 15 hours after the first acute myocardial infarction. A maximal symptom limited exercise test comprising impedance measurements for the estimation of stroke volume at rest and at different levels of exercise was performed early after admission by 26 patients. There was a slight, though not significant, negative correlation between infarct size and physical capability as measured by the duration of work. The rise in systolic blood pressure during exercise showed a significantly negative and the increase in heart a significantly positive correlation to infarct size. This suggests that the rise in blood pressure, which is less in patients with the larger infarcts, is compensated by an increase in heart rate, so that the same maximum of cardiac performance and myocardial oxygen consumption is reached. The increase in cardiac stroke volume during exercise was negatively correlated with infarct size. Stroke volume only increased during lower levels of exercise; the increase in cardiac output at higher levels of exercise was achieved entirely by an increase in heart rate. The magnitude of ST segment elevation during exercise showed a significantly positive correlation with infarct size, whereas the occurrence of arrhythmias during exercise was independent of it. | [
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10,003,690 | Myocardial injury after phenylpropanolamine ingestion. | [
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10,003,691 | Three patients developed clinical evidence of myocardial injury after acute ingestion of phenylpropanolamine, a sympathomimetic amine found in a large number of decongestant and appetite suppressant formulations. Increases in the serum creatine kinase and MB isoenzyme levels, ventricular arrhythmias, and electrocardiographic repolarisation abnormalities were seen. Excessive catecholamine stimulation has been shown to produce acute myocardial necrosis experimentally, and a similar mechanism may be present in these patients. | [
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10,003,692 | Missing coronary artery. Review of technical problems in coronary arteriography resulting from anatomical variants. | [
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10,003,693 | Isolated disease of left anterior descending coronary artery. Angiocardiographic and clinical study of 218 patients. | [
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] |
10,003,694 | The angiocardiographic and clinical findings in 218 patients with significant obstruction confined to the left anterior descending coronary artery were reviewed to study the influence of the site of obstruction and of the collateral circulation on clinical presentation and prognosis. One hundred and fifty-six patients had been managed medically, 51 had had aortocoronary bypass operations, and 11 had had left ventricular aneurysms excised. The artery was divided into three segments: left anterior descending 1 (LAD1) from its origin to the first septal branch, left anterior descending 2 (LAD2) from the first septal to the first diagonal branch, and left anterior descending 3 (LAD3) the remaining distal vessel. Cardiogenic shock occurred only in patients with LAD1 lesions, but apart from this the clinical presentation bore no consistent relation to the site of disease. Patients with proximal lesions were more likely to have a "positive" exercise test, had more severely impaired left ventricular function, and had a worse prognosis than those with more distal disease. Non-visualisation of collateral vessels in patients with left anterior descending occlusion was associated with extensive infarction, and patients who presented with infarction had more severely impaired ventricular function than those who presented with angina and subsequently had an infarction. Left ventricular function was poor at the time of angiography in 11 of 12 of those who subsequently died; it is therefore unlikely that the prognosis of patients with isolated left anterior descending obstruction could be improved by expanding the indication for aortocoronary bypass from that of severe angina. | [
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10,003,695 | Strong family history and cigarette smoking as risk factors of coronary artery disease in young adults. | [
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10,003,696 | This study is based on 435 consecutive patients age 50 or less who had coronary arteriography. There were 335 patients with coronary artery disease and 100 with normal coronary arteries. Risk factors reviewed were "packet-years" of cigarette smoking, family history of coronary disease in first-degree relatives 50 years of age or less, age- and sex-corrected serum cholesterol and triglycerides, hypertension, and diabetes. By univariate analysis, each risk factor except hypertension and diabetes was significantly more frequent in patients with coronary disease than in those without. By multivariate analysis of all risk factors in patients with and without coronary disease, the male or female patient with coronary disease could best be identified by the strong family history, cigarette smoking history, and age- and sex-corrected serum cholesterol. The percentage of patients with coronary disease when the three risk factors were present was 95%, two factors present 88%, one factor present 67%, none of the three 25%, strong family history alone 90%, smoking alone 66%, and serum cholesterol greater than 80th centile alone 52%. | [
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10,003,697 | Malignant neurilemmoma of left atrium. | [
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10,003,698 | A 31-year-old woman, whose chief complaint was back pain, was found to have an echocardiographic abnormality suggestive of a left atrial myxoma. Angiography clearly showed a large radiolucent mass protruding from the left atrium into the left ventricle during diastole. X-rays of the sacrum disclosed the presence of a malignant tumour. Biopsy specimens taken from the tumour in the sacral plexus showed a malignant neurilemmoma. Despite extensive chemotherapy, widespread metastases developed and the patient died four months after admission. Necropsy disclosed three discrete tumours in the left atrium, which were found to be malignant neurilemmoma, shown on histology to be metastases from the primary in the sacral plexus. | [
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10,003,699 | Pacemaker-masked hypertension in a patient with mitral stenosis. | [
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