Irving G. Kroop

Level of C-reactive protein as a measure of acute myocardial infarction.

Summary and Conclusions 1. Sera of 7 patients with coronary occlusion and myocardial infarction and of one patient with coronary insufficiency and myocardial necrosis were positive for CRP. 2. Sera of 6 patients with coronary insufficiency but without myocardial necrosis were negative for CRP. 3. These preliminary observations suggest that the CRP test may be a sensitive indicator of myocardial necrosis and inflammation.

Experiences with the Kolff artificial kidney

Abstract The Kolff artificial kidney was used in six cases of acute uremia caused by non-obstructive nephropathies. Clinical histories and laboratory data are presented in detail. The apparatus was shown to be mechanically competent. Its sphere of usefulness is described.

The course of the excitation wave in patients with electrocardiograms showing short P-R intervals and wide QRS complexes (Wolff-Parkinson-White syndrome)

Abstract In seven patients with Wolff-Parkinson-White electrocardiograms, the course of the excitation wave has been explored by means of intracardiac and esophageal leads. The findings strongly suggest that the excitation wave originates in the sinoatrial node and reaches the posterior aspect of the left ventricle and anterior aspect of the right ventricle simultaneously. The atrioventricular conduction is probably effected by means of accessory muscular pathways. The right ventricular myocardium is stimulated from the epicardial surface toward the cavity. The right ventricular segment of the interventricular septum is stimulated either at the end of the right ventricular excitation or, in some cases, it seems to receive its excitation wave predominantly from the direction of the left ventricle. Atrial flutter was the most frequently observed arrhythmia in these patients during paroxysms of tachycardia. The ventricular complexes remained abnormal or had an exaggerated abnormal appearance, resembling those encountered in ventricular tachycardia. In one instance, nodal tachycardia was recorded with normal ventricular complexes. This would suggest that the excitation wave passed down to the ventricles along the bundle of His in a normal fashion.

Congenital tricuspid atresia

Abstract 1. 1. Two cases of congenital tricuspid atresia with autopsies are presented. 2. 2. The cases illustrate two anatomical types of tricuspid atresia: (a) the more common tricuspid atresia without transposition of the great vessels and with pulmonary stenosis (Type IB), and (b) the rarer tricuspid atresia with transposition of the great vessels and without pulmonic or subpulmonic stenosis (Type IIB). 3. 3. In tricuspid atresia the electrocardiogram need not show left axis deviation. 4. 4. The presence or absence of pulmonary vascular markings is not a reliable differential point in the diagnosis of transposition of the great vessels without pulmonary stenosis. 5. 5. On the basis of the anatomical findings it is suggested that an aortopulmonary shunt (Potts) may be indicated in tricuspid atresia with transposition of the great vessels and without pulmonary stenosis. The anastomotic procedure might equalize the blood flow to the lungs and to the periphery.

Presystolic pulsations of the liver in the absence of tricuspid disease.

Abstract Fourteen patients with presystolic liver pulsation in the absence of tricuspid stenosis or organic disease of the tricuspid valve have been described. The underlying hemodynamic mechanism is considered to be resistance to right atrial outflow with reflux to the liver, caused by heart failure, right ventricular hypertension, pericardial effusion, pulmonary hypertension, and interatrial or aorticatrial shunts.

The C-reactive protein determination as a measure of rheumatic activity.

Abstract 1. 1. C-reactive protein determinations were performed on the sera of twenty-four rheumatic fever patients in order to help determine the presence or absence of activity. 2. 2. There was a close correlation between the inactive state and a negative C-reactive protein determination. However, there were two instances of a negative C-reactive protein in the presence of rheumatic activity. 3. 3. A positive test in Sydenhams chorea should suggest the presence of an associated carditis. 4. 4. The C-reactive protein determination was a better guide to activity than the sedimentation rate which showed protracted elevation despite the inactive state.

An evaluation of electrophoresis in rheumatic fever

Abstract 1. 1. An analysis of 40 electrophoretic determinations of the serum proteins in thirty-six patients is the basis of this report. 2. 2. It should be stressed that a beta globulin elevation was encountered in seven out of our thirty patients with rheumatic fever, whereas this fraction is rarely elevated in the postinfectious period of normal individuals (one out of thirty-six patients). 3. 3. Although not specific, an elevated beta globulin fraction should strongly suggest the diagnosis of rheumatic fever. 4. 4. Our data confirm the variability and nonspecificity of the other electrophoretic abnormalities in rheumatic fever. Changes in the alpha-1, alpha-2, and gamma globulins, alone and in combination, were observed. 5. 5. A normal electrophoretic pattern may be obtained in the presence of rheumatic activity. 6. 6. Electrophoretic abnormalities may persist when the disease is inactive clinically and when the C-reactive protein determination is negative. 7. 7. Electrophoresis is of little absolute value in determining rheumatic activity. When used in conjunction with other laboratory tests, such as the sedimentation rate and C-reactive protein, a normal electrophoretic pattern gives the clinician a greater security in deciding the termination of rheumatic activity.

The nature of left axis deviation in congenital cardiac defects with right ventricular hypertrophy.

Abstract 1.1. The electrocardiogram of interatrial septal defect and tetralogy of Fallot without complicating hypertensive or syphilitic heart disease may show, on rare occasion, left axis deviation despite right ventricular hypertrophy. 2.2. Positivity (tall R or R′) in the V L lead greater than the positivity in the V F lead determines the left axis deviation. 3.3. Intracardiac potentials in congenital and acquired right ventricular hypertrophy indicate that the predominant positivity in V L may be derived from the right ventricular surface. 4.4. In some instances, the left ventricular surface potential may determine the positivity in V L . 5.5. The variability of the electrocardiographic findings in our cases of interatrial septal defect indicates that rotation and cardiac position are more important than chamber hypertrophy alone in the determination of the extremity potentials and, hence, the axis deviation.

Boeck's sarcoid with unusual cardiac configuration and electrocardiographic changes

Abstract 1. 1. A case of Boecks sarcoid with unusual cardiac configuration and electrocardiographic changes is presented. 2. 2. A review of the literature indicates that primary cardiac involvement by sarcoid may or may not produce symptoms. Occasionally, however, cardiac symptoms constitute the presenting clinical picture. 3. 3. The most frequent secondary cardiac manifestation of sarcoidosis is cor pulmonale caused by pulmonary fibrosis and hypertension. 4. 4. The anatomic and electrical rotation of the heart in this case is considered a rare secondary manifestation of sarcoid caused by pulmonary fibrosis and emphysema, and mediastino-pleuro-pericardial adhesions.