Julian R. Beckwith

THE MANAGEMENT OF MYOCARDIAL INFARCTION WITH PARTICULAR REFERENCE TO THE CHAIR TREATMENT

Excerpt The time-honored treatment of acute myocardial infarction at complete bed-rest has been challenged recently and evidence presented that many patients do at least as well if allowed to sit i...

Surgical Relief of Aortic Insufficiency by Direct Operation on the Aortic Valve

The natural history of patients with aortic insufficiency and the previous experimental and clinical operations devised for its relief are reviewed. Methods that have been used at the University of Virginia Hospital for treatment of aortic insufficiency are reported. These procedures include the release of the fixed valve leaflet and removal of calcium from it, aortic valve leaflet extension with suture of a small piece of compressed polyvinyl sponge or Teflon fabric to the edge of one of the leaflets, excision and replacement of a portion of the valve with a synthetic leaflet, and complete subcoronary replacement of the valve with a prosthesis. To relieve isolated rheumatic aortic insufficiency, an annulus has been constricted or a bicuspid aortic valve has been created. Insufficiency resulting from perforation of one or more valve leaflets by subacute bacterial endocarditis has been treated by closure of the perforations. Nineteen patients underwent 21 operations for the correction of aortic insufficiency. All had been in, or were in, heart failure, and several had significant coronary artery disease or multivalvular disease. Eleven of the 19 patients are well or markedly improved. Eight died during or after the operative procedure. It is concluded that a direct attack upon the insufficient aortic valve is the procedure of choice at the present time.

THE RELATIONSHIP BETWEEN HEART DISEASE AND GALL-BLADDER DISEASE

Excerpt INTRODUCTION The purpose of this report is to survey the relationship between heart disease and gall-bladder disease. A review of the American literature will be presented and the physiolog...

Blood Volumes in Hypertensive Partially Nephrectomized Rats.

Summary Plasma and total blood volumes were determined in 33 normal male and 20 normal female rats. In the hypertensive partially nephrectomized rat, the plasma volume was increased, the red cell volume decreased and the total blood volume remained unchanged. It is concluded that hypertension is not associated with increased blood volumes in these experiments.

Relation of therapeutic response to nifedipine to coronary anatomy and motion of S-T segment during unstable angina pectoris

Of 77 patients hospitalized for unstable angina pectoris and failure of oral, dermal, or intravenous nitrates and/or beta blockade, 81 percent with negligible or single-vessel disease and 55 percent with two- or three-vessel disease showed response (p less than 0.05) to nifedipine therapy. Patients with either S-T elevation or no change during pain responded better (31 of 45) than those with any S-T depression (16 of 32; p less than 0.05). Patients with negligible or single-vessel disease had a higher prevalence of S-T elevation (13 of 16) than patients with two- or three-vessel disease (15 of 31; p = 0.004). S-T motion did not predict response in patients with two- or three-vessel disease, but did predict response in patients with negligible or single-vessel disease. On follow-up study at 9 +/- 8 (range one to 33) months, 39 of 42 who had shown response were free from pain. Three died from infarction without unstable angina. (range one to 33) months, 39 of 42 who had shown response were free from pain. Three died from infarction without unstable angina. Five who showed response had elective bypass surgery. The addition of nifedipine abolished or reduced pain episodes by more than 50 percent in 61 percent of patients with refractory unstable angina pectoris. Patients with negligible or single-vessel disease with S-T elevation benefit most. In patients with two- or three-vessel disease, the type of S-T motion did not predict response. Follow-up of all those with response indicated sustained amelioration by nifedipine therapy. Failure of nifedipine therapy should not be accepted until a dose of 120 mg per day has been achieved, or until intolerable side effects appear.