Jorge Martins de Oliveira

Intravenous injection of hyaluronidase in acute myocardial infarction: Preliminary report of clinical and experimental observations

Abstract A preliminary communication is presented on the intravenous injection of hyaluronidase in acute myocardial infarction. Six cases are reported and electrocardiographic changes are shown after the administration of the drug. The results of studies in seven dogs are reported. Apparently, hyaluronidase acts by reducing intramyocardial edema during the acute phase following coronary occlusion. The physiopathology of this intramyocardial edema is discussed, as well as the possible mechanisms of action of this enzyme. The authors stress the necessity of further investigations before hyaluronidase can be accepted as an efficient drug in the management of acute myocardial infarction.

Auricular overloadings: Electrocardiographic analysis of 193 cases

The authors studied the auriculograms of 193 patients presenting mitral lesions (41 cases), congenital cardiac malformations (100 cases), and pulmonary disease (52 cases). In the great majority of the cases hemodynamic correlations were established and in 20 patients the vectorcardiogram was analyzed. The chief characteristics of the P wave and the P vector in left, right, and combined atrial overloading are stressed. The following conclusions are drawn: 1. (1) The most important findings for left atrial overloading are a marked backward orientation of the P vector, appearance of notching and increase in the duration of the P waves in the limb and left precordial leads. 2. (2) There seems to exist a correlation between the duration of the P waves and the degree of left atrial dilatation. 3. (3) P waves with normal duration may exist in the presence of hypcrtrophied but not significantly dilated left auricles. 4. (4) A tendency of the AP to deviate to the right in patients with mitral lesions was found whenever the right auricular pressures were elevated. 5. (5) In all cases of significant right auricular systolic overloading (systolic pressure above 10 mm Hg) in our series of congenital heart diseases, the amplitude of the P waves was above 2 mm either in the limb or precordial leads. 6. (6) Arterial oxygen desaturation tends to increase the amplitude of the P waves. Patients with both elevated right atrial pressures and arterial desaturation presented the highest P waves in this study. 7. (7) Slight degrees of right atrial overloading, particularly in patients with interatrial septal defect, were detected in many cases by the presence of peaked P waves of normal amplitude, mostly in V1 and V2. 8. (8) The interpretation of the ventricular complex adds important data in the diagnosis of right atrial overloading. 9. (9) Pulmonary emphysema and arterial desaturation as a consequence of disturbance in the mechanism of hematosis, in patients with chronic disease of the lungs, produce marked changes in the P waves and the P vector. The P waves become tall and peaked and the AP is deviated rightward and downward. 10. (10) In the presence of pulmonary emphysema with arterial desaturation, it is very difficult to decide by the auriculogram whether there also exists right auricular overloading. 11. (11) The existence of combined auricular overloading may be suspected from the ECG for two reasons: (a) the presence of morphologic signs compatible with overloading of both atria; (b) the existence of morphologic signs of left atrial overloading associated with a tendency of the AP to deviate to the right. 12. (12) Vectorcardiogram: P loops with leftward and backward orientation, increased in width, and sometimes showing eight-shaped figures are very suggestive of left atrial overloading. P loops with normal width, increased magnitude and a forward orientation are diagnostic of right atrial overloading.

Regional Distribution of Myocardial Blood Flow in the Dog as Determined by Rb86

The distribution of Rb86Cl in the canine myocardium was determined at 20 seconds, 10 minutes, and 19 hours after administration of isotope. The uptake of Rb86 20 seconds after injection is related to blood flow, and the myocardial distribution of isotope probably closely reflects the apportionment of coronary blood flow. The isotope was uniformly divided between the various regions of the left ventricle and averaged 6.4 per cent of the injected dose per 100 Gm. of tissue. This value exceeded the fractional uptake of 4.3 per cent for the right ventricle and 3.7 per cent for the atria. After 19 hours, the Rb86 content serves virtually as a tracer for potassium. After this interval, the myocardial distribution of Rb86 closely followed previously published reports of the relative potassium contents of the various myocardial regions.

Effect of hyaluronidase upon the water content of ischemic myocardium

Abstract In a series of dogs submitted to ligation of the circumflex branch of the left coronary artery, changes in the water content of the ischemic myocardium were determined. A progressive increase in the amount of water in the tissue was observed after ligation. Hyaluronidase injected intravenously proved to significantly reduce the water content of the damaged areas. Five hours after ligation in the untreated series, the mean water content of the ischemic area was found to be higher than that of the intact region by 3.71 per cent. In the group receiving hyaluronidase, the mean water content of the ischemic area was higher than that of the normal area by only 1.09 per cent. The importance of further investigation is stressed in order that any possible advantages in reducing edema in an ischemic myocardium may be demonstrated.

Surgical treatment of mitral insufficiency; direct vision correction with use of mechanical pump oxygenator and extracorporeal perfusion.

Abstract We have described our experiences during the past year with the direct vision surgical correction of mitral regurgitation in 30 patients operated on by the extracorporeal circulation technic with the heart beating. It is felt that with the use of a mechanical pump oxygenator, direct vision correction of mitral regurgitation will now be a realization in the majority of such patients. The valves in a few patients are so destroyed that nothing short of valve replacement will suffice. The operative mortality and morbidity during the developmental phase has been low. Some of the technical factors contributing to this mortality and morbidity are correctable. Others, such as extensively destroyed valves, pulmonary vascular changes, and poor myocardial reserve, may be largely avoided by earlier surgical intervention.

Wolff-Parkinson-White syndrome and tetralogy of fallot∗: Report of a case

Abstract A case of tetralogy of Fallot proven at operation and autopsy presented the classic electrocardiographic findings of Wolff-Parkinson-White syndrome. An additional anatomic finding of interest was the presence of marked endocardial sclerosis involving the upper part of the interventricular septum. It is postulated that abnormal activation of this zone could have been responsible for the abnormal interventricular conduction.

Changes in the levels of serum cholesterol and beta lipoprotein according to age, sex, and the existence of coronary heart disease

Abstract In 292 normal individuals and in 156 patients with coronary heart disease, the levels of serum beta lipoprotein and alpha and beta lipoprotein cholesterol were determined. The method applied was that of beta lipoprotein flocculation and precipitation with polyvinylpyrrolidone (P.V.P.). It was shown that serum alpha cholesterol decreases with age, whereas beta cholesterol and beta lipoprotein increase. It was found that men have higher levels of serum beta cholesterol and beta lipoprotein than women, and lower levels of alpha cholesterol than women. In patients with coronary heart disease, serum beta lipoprotein and its cholesterol content are elevated, whereas levels of serum alpha cholesterol are diminished. The possible role played by beta lipoprotein in atherogenesis is discussed.

Effects of hyaluronidase upon the distribution of plasma albumin and red blood cells in normal and ischemic myocardium

Abstract The effects of hyaluronidase have been determined upon the whole blood, red cell, intravascular and extravascular plasma equivalents, and water content of normal and ischemic myocardium of the dog. Neither ischemia nor hyaluronidase, alone or combined, affects the myocardial content of red cells or intravascular plasma. Ischemia produces a marked increase in the water content and extravascular plasma equivalent, presumably as a result of increased capillary permeability. Hyaluronidase also increases the extravascular plasma equivalent, but not the water content, of the normal myocardium. In a region rendered ischemic as the result of coronary artery ligation, the increase in water content is largely prevented by the hourly intravenous injection of hyaluronidase. It is concluded that this enzyme reduces localized edema after coronary ligation by virtue of its actions as a spreading factor and as a lymphagogue.