Don C. Sutton

Needle biopsy of the human ventricular myocardium: Review of 54 consecutive cases☆

Abstract Needle biopsy of certain human organs has become an increasingly important procedure. Specimens of tissue so obtained give opportunity for an accurate morphologic study that is offered by no other means. In the diagnosis of lesions of the myocardium, such methods as electrocardiography, various radiologic procedures, heart catheterization, and bacteriologic or viral studies offer only indirect information from which certain presumptive conclusions can be drawn. Metabolic, inflammatory, fibrotic, and invasive processes of the myocardium can be studied by multiple needle biopsies of the heart. This report presents the findings for the first 54 consecutive patients in whom multiple myocardial biopsies (totaling 150) have been obtained.

Primary hemangioendotheliosarcoma of heart, diagnosed by angiocardiography: review of the literature and report of a case.

Primary malignant tumors of the heart are rare and are seldom recognized before death. This paper reports a case of primary hemangioendotheliosarcoma of the right atrium of the heart, which was diagnosed clinically by angiocardiography. A brief review of the literature is also presented. No reports are to be found in the literature of the antemortem diagnoses of a primary hemangioendotheliosarcoma of the heart by angiocardiography. Autopsy findings are included.

Effect of quinidine on the ventricular complex of the electrocardiogram with special reference to the duration of the Q-T interval

Abstract 1. 1. The electrocardiograms of 121 patients receiving quinidine for treatment of established atrial fibrillation and flutter were analyzed for the effect of quinidine on the ventricular complex, with particular reference to the duration of the Q-T interval. 2. 2. It was found that in 85 per cent of the successfully converted cases, the duration of the Q-T interval, corrected for the heart rate, is not prolonged. The widespread impression that Q-T is prolonged during quinidine administration has resulted from the inclusion of the U wave in the Q-T duration. 3. 3. In 15 per cent of the cases receiving quinidine there was an actual prolongation of the Q-T duration, with or without notching of the T wave. 4. 4. Methods for the differentiation of T-plus-U pattern in which the Q-T interval itself is not prolonged, from a true Q-T prolongation with or without notching of the T wave, are enumerated. 5. 5. Quinidine changed an inverted U wave in two patients to a positive deflection. 6. 6. A brief discussion of the U wave of the electrocardiogram was presented. 7. 7. The typical electrocardiographic pattern in patients receiving quinidine is characterized by a depressed S-T segment and T wave opposite in polarity to a U wave of increased voltage, while the Q-T interval itself, corrected according to the heart rate, is in most cases normal in duration. This electrocardiographic pattern is produced by quinidine alone, although the simultaneous use of digitalis may accentuate the changes in such a pattern. 8. 8. The electrocardiogram is a definite aid in the management of any patient receiving quinidine, particularly when measurement of the blood level of quinidine cannot be obtained. It is the change of the pattern rather than the pattern itself which is important for evaluation of the relative quinidine effect; the electrocardiogram more frequently and more reliably indicates the existence rather than the degree of quinidine effect.

Studies of quinidine plasma levels and rate of decline following cessation of quinidine administration

Abstract 1. 1. Quinidine sulfate was administered in divided dosages for forty-eight hours. Serial plasma quinidine levels were measured 2 hours, 26 hours, and 50 hours after the last dosage. Four groups were studied: normal individuals, and patients with obvious heart, renal, and hepatic disease. 2. 2. Individuals with cardiac disease exhibited a slower decline of quinidine level than the other three groups. 3. 3. The peak levels reached by all the groups were the same. 4. 4. Significant levels of quinidine persisted in the blood of all individuals for 26 hours, in many for 50 hours. 5. 5. The slower loss of quinidine from the blood of cardiac patients is not thought to be a function of delayed excretion by liver or kidneys and does not carry with it the threat of excessive cumulation in the blood of these patients.

Cruveilhier-Baumgarten syndrome: Review of the literature and report of a case

Abstract A case of Cruveilhier-Baumgarten syndrome is presented, with a discussion of the important clinical features of this entity, which include a prominent para-umbilical vein, a venous hum and a thrill at the site of the para-umbilical circulation, splenomegaly with or without hepatomegaly, anemia, eosinophilia and persistent leukopenia. The pathogenesis of the disease is also briefly discussed. The diagnosis depends on the physicians awareness of this entity and can usually be made by careful observation and auscultation of the abdomen when any disease resulting in portal hypertension, notably cirrhosis, is present. We believe this is the first case of Cruveilhier Baumgarten syndrome in which definitive confirmation by a glucose tolerance test of the portal anastomotic nature of a dilated abdominal vein was rendered. The case here presented is probably another example—therefore the seventh in the literature —of Cruveilhier-Baumgarten disease (rather than syndrome ) in view of the normal findings at liver biopsy and other criteria. However, since only necropsy affords definitive confirmation, we designate our case as Cruveilhier-Baumgarten syndrome, the eighty-sixth such case described in the literature.

Physiological Effects of Temporary Occlusion of the Coronary Vessels.

Summary 1. Compression of the coronary vessels and immediately adjacent tissue as descrilml caused pain without exception, sometimes salivation, vomiting in one case, a disturbance of respiration, “acute dilatation” of the heart and various changes in the electrocardiogram. Symptoms have not been produced by localized compression and tearing of the myocardium or pericardium. This may be due to a high threshold of problematical pain endings in the normal cardiac muscle and pericardium. 2. Severance of the vagi has not interfered with transmission of pain impulses in 2 dogs. 3. Removal of the left stellate ganglion has prevented the transmission of pain impulses in 2 dogs but salivation occurrecl in one of the 2. 4. A prompt fall of blood pressure occurred in all acute experiments on compression of the coronary vessels as described. Section of the vagi usually prevented this fall in blood pressure. 5. Fall of blood pressure, cardiac dilatation and cardiac irritability are increased by moderate cyanosis (anoxemia).

A clinical evualation of the treatment of hypertension with dihydrogenated ergotoxine alkaloids

Abstract 1. 1. CCK-179 was administered orally to thirty-four symptomatic hypertensive men. 2. 2. A marked drop of blood pressure occurred during the first thirty days of hospitalization plus therapy. This was shown by placebo substitution to be due to hospitalization, not the drug. 3. 3. Parenteral administration produced a definite but transient drop in blood pressure in all cases to whom it was given.

A case of pulsating spleen in mitral and tricuspid disease

Abstract A case of pulsation of the spleen in mitral and tricuspid disease is reported, supplementing the single case thus far reported (by Manges). Eight cases of pulsating spleen occurring in aortic insufficiency have been reported by others.

Interpretation of the velocity measurement ballistocardiogram.

Abstract 1. 1. A portable electromagnetic ballistocardiograph was used to study three groups of individuals: normal persons, patients confined to a hospital and convalescing from noncardiac disease, and patients with obvious cardiac disease. 2. 2. The records were analyzed by four methods: (a) presence of so-called early M or late M pattern, (b) JK:IJ ratio, (c) H-K time interval and its variation, (d) Brown, Hoffman, and de Lalla criteria. 3. 3. Precise determination of the limits of the early and late M patterns could not be made. 4. 4. Observations that the JK:IJ ratio is materially increased by use of the electromagnetic machine are confirmed. 5. 5. The JK:IJ ratio and the H-K interval and its variation failed to distinguish the three groups. Within the cardiac group those with hypertensive and luetic heart disease had a higher JK:IJ ratio, but some of these individuals had normal ratios. 6. 6. Records with some degree of variation (1, 2, 3, or 4) were found in 66 per cent of the individuals with frank cardiac disease, in 55 per cent of the patients convalescing from noncardiac disease, and in 14 per cent of the normal persons. Grade 4 ballistocardiograms were found in 31 per cent, 18 per cent, and 0.9 per cent of these three groups, respectively. These results emphasize that abnormality of the ballistocardiogram was not necessarily associated with cardiac disease. 7. 7. It is emphasized that 34 per cent of the individuals with frank heart disease had normal ballistocardiograms.

Variations in the response of normal persons and cardiac patients to the Nylin heart function test

Abstract 1. 1. The Nylin staircase cardiac function test was performed repeatedly on normal individuals and on a group of cardiac patients. 2. 2. Results and statistical characteristics indicate that the mean figures obtained from a group of persons studied had wide variations, but could be satisfactorily compared. 3. 3. The spontaneous daily variation seen in the response of an individual to the test is of such a magnitude that the test was not satisfactory to follow a single individuals cardiac status.