George C. Griffith

Anomalies of the Coronary Arteries and their Clinical Significance

Fifty-four cases with anomalies involving the coronary artery circulation were found among 18,950 autopsies during a 10-year period at the Los Angeles County Hospital. The purpose of this survey is to present the different types of coronary artery anomalies and to elucidate their practical clinical significance.

Dissecting Aneurysm of the Aorta: Its Clinical, Electrocardiographic and Laboratory Features: A Report of Fifty-eight Autopsied Cases

The literature has been reviewed, and 58 autopsied cases of dissecting aneurysm of the aorta observed at the Los Angeles County Hospital over a ten year period have been carefully studied. Clinical-pathologic correlation has been attempted whenever possible, with emphasis on diagnostic features. The increasing incidence of accurate diagnosis of dissecting aneurysm has been noted, and it is hoped that this review will help solidify the clinical syndrome or syndromes of the condition and thus facilitate diagnosis in dubious instances.

A study of the beneficial effects of anticoagulant therapy in congestive heart failure.

Excerpt Thromboemboli are a frequent cause of death in patients with congestive heart failure. In 565 patients with rheumatic heart disease and congestive heart failure, autopsied at the Los Angele...

The Treatment of Shock Associated with Myocardial Infarction

As a background to the problem of shock associated with acute myocardial infarction, a review of 816 recent consecutive and proved cases has been made. One hundred and sixty-one cases met the arbitrary criteria for the definition of shock. Therefore, shock was found to have occurred in 20 per cent of the patients with myocardial infarction. The mortality was 81 per cent (128 patients died). In the present study, 134 patients with acute myocardial infarction in shock were treated. All of these patients were first treated by strictly routine measures, including digitalis when indicated. Sixty of the 134 patients were relieved by prompt routine therapy given within a three-hour period of time. The remaining 74 patients were treated by (1) retrograde arterial infusion, (2) the newer sympathomimetic drugs such as methoxamine, isopropylnorepinephrine and norepinephrine and (3) other agents such as cholinesterase and cortisone. An evaluation of these methods was made and the over-all mortality of shock as associated with myocardial infarction was reduced from 81 per cent to 48 per cent.

Acute and subacute disseminated lupus erythematosus; a correlation of clinical and postmortem findings in eighteen cases.

Eighteen cases of disseminated lupus erythematosus were verified by postmortem study in a series of 19,242 autopsies. Shortness of breath was the most common complaint and occurred in 16. Fourteen of this number had definite cardiac pathology. All 16 had definite pulmonary pathology. Fourteen cases had abnormal urinalysis. Of these cases, 7 had elevated blood nonprotein nitrogen values of over 40 mg., and only 4 had hypertension. However, 14 cases had abnormal pathologic renal findings. Fifteen of the 18 cases had a skin lesion; 11 of the 15 were definitely of the lupus type. Hypochromic anemia was present in 17, leukopenia in 14, elevated sedimentation rate in all cases recorded and an elevated serum globulin in 9. The diagnosis is made by summation of the clinical findings; namely, shortness of breath, joint pains, skin rash, fever, pulmonary, cardiac, and renal abnormalities, and by the laboratory findings of hypochromic anemia, albuminuria, increased sedimentation rate, elevated serum albumin, presence of lupus erythematosus cells, and by a positive skin biopsy.

Effect of Heparin and Treburon in Postprandial Hyperlipemia

Conclusions 1. Heparin or Treburon given intramuscularly were equally effective in producing a sharp fall in alimentary lipomicronemia within 30 to 60 minutes. 2. The alterations noted in serum fat emulsions were not related to changes in cholesterol, its fractions, or lipid phosphorus. These chemical determinations were not significantly influenced by either heparin or Treburon. 3. Treburon given intravenously produced a sharp drop in the lipid particle count within 5 to 15 minutes and this was maximal within one hour of injection. 4. Treburon given sublingually was ineffective.

Factors in myocardial rupture: An analysis of two hundred and four cases at Los Angeles County Hospital between 1924 and 1959∗

Abstract The total analysis of 204 cases of myocardial rupture which occurred in the Los Angeles County Hospital was reported. Myocardial rupture rarely occurs under the age of 50 years. Although the incidence of myocardial infarction invariably is reported to be higher among men than women our material indicates that cardiac rupture is somewhat more likely to develop in women [110 women (53.9 per cent), ninety-four men (46.1 per cent)]. Myocardial rupture is relatively rare in Negro patients. In our material reasonably good correlation was obtained between electrocardiographic indication of acute myocardial infarction and necropsy incidence of myocardial necrosis. As was anticipated, myocardial rupture occurred at or immediately adjacent to the site of necrosis. Ordinarily, myocardial ruptures occur in the left ventricle. In our series the most frequent site of rupture was in the anterior wall, especially at the junction of the anterior wall and the septum. Average survival time for twenty-one patients admitted to the hospital within 6 hours of the clinical onset of myocardial infarction was 9 days, whereas average survival time for twentyone patients hospitalized 7 hours or longer after the myocardial infarction was only 2.6 days. The longer survival time for patients hospitalized within the first 6 hours may be due to greater restriction of their activity in the immediate postinfarction period. Death usually is immediate in ventricular rupture, whereas in the interventricular septal rupture most of the patients survive a few days. In the final 8 years and 3 months of our survey, the incidence of rupture following myocardial infarction has undergone a sharp decrease at the Los Angeles County Hospital. This decrease is presumably due to better management of the acute episode of myocardial infarction and more particularly to the use of vasopressor drugs and anticoagulants. Anticoagulants did not increase the incidence of the rupture but cardiac tamponade is relatively frequent in patients with myocardial rupture maintained on anticoagulants. The physician must be alert for signs of tamponade (i.e., pulsating neck veins, increase in cardiac dullness) because tamponade can be managed surgically. Except for the reduced incidence of myocardial rupture in the period of survey, the findings are in agreement with earlier reports from the same hospital.

THE CLINICAL USAGE OF HEPARIN.

Abstract Heparin, an endogenous biochemical polysaccharide, is a direct antithrombin. It acts as a clearing factor, a lipase enzyme activator, an antiinflammatory agent and an antihistamine substance. The greatest therapeutic effect of heparin is in the treatment of venous thromboembolic disease, coronary artery diseases, polycythemia, embolic phenomena associated with valvular or other intracardiac defects, and in surgery of the circulatory system. Heparin is administered by the intravenous or subcutaneous routes—never intramuscularly. When used as an anticoagulant, the dosage is sufficient to maintain the coagulation time at two times the normal just prior to the administration of the next dosage. In acute myocardial infarction, and in long term therapy, the mortality and the thromboembolic phenomena are markedly reduced. The occurrence of significant hemorrhage is minimal. The side effects are few. The contraindications are serious liver and kidney disease, gastrointestinal bleeding, blood dyscrasias and neurocerebral injury.

Polyarteritis Nodosa A Correlation of Clinical and Postmortem Findings in Seventeen Cases

The correlation of the clinical and postmortem findings shows that there is no close relationship between the syndrome of polyarteritis nodosa and the allergic states, that pain is the most common symptom, that congestive heart failure is the common cause of death. There is no consistent relationship of the symptomatology referable to the gastrointestinal, central nervous, and pulmonary systems to the pathologic lesions found. Above all, it is to be noted that although hypertension is one of the most frequent signs of polyarteritis, it may develop very late. Therefore, the rejection of this diagnosis because of the absence of hypertension will lead to error, as may the absence of eosinophilia and subcutaneous nodules.

Assay of Anti-Anginal Agents I. A Curve Analysis with Multiple Control Periods

The measure of an anti-anginal agent is its ability to decrease chest pain. Because of the subjective character of pain, extreme care is necessary in choosing patients upon whom anti-anginal medication is to be tested. We have used the double-blind technic and an initial control period to neutralize the many extraneous mental and physical factors, such as bias or the patient-physician relationship itself, that might interfere with an accurate appraisal. This study shows, in addition, that proper evaluation of an anti-anginal agent requires that its effect be measured against multiple control periods without medication throughout the various phases of angina pectoris.