Marcy L. Sussman

The roentgenkymogram in myocardial infarction

Abstract Characteristic abnormalities in left ventricular pulsation as recorded roentgenkymographically in 200 cases of myocardial infarction were as follows: 1. (1) Localized diminution or absence of pulsation. 2. (2) Complete systolic expansion or paradoxical pulsation. 3. (3) Partial systolic expansion, indicated by expansion early in systole or a delay in the completion of systole. 4. (4) Marked diastolic splintering. These changes are found in cases of either recent or old infarction. In cases of recent infarction, even slight irregularities and diminution of pulsation may be of significance. These changes were found in 75 per cent of our cases of myocardial infarction, and are likely to be permanent, although progression and regression have been noted often. A persistently normal kymogram does not exclude the possibility of myocardial infarction. In most cases abnormalities appear within three weeks of the attack, if they appear at all, but occasionally characteristic changes do not appear for several months. Characteristic roentgenkymographic findings usually permit one to make the diagnosis of myocardial infarction secondary to coronary artery occlusion.

Radiographie Estimation of Pulmonary Artery Pressure in Mitral Valvular Disease

It is becoming increasingly evident that the surgical relief of mitral stenosis should not be attempted unless associated pulmonary hypertension can be demonstrated (3, 4, 7, 10). In the absence of pulmonary hypertension, symptoms of cardiac failure are usually due to active rheumatic carditis or myocardial insufficiency, and in these cases mitral commissurotomy may be expected to produce a poor result or even lead to the death of the patient. The clinical diagnosis of pulmonary hypertension is difficult inasmuch as it produces no completely reliable physical or electrocardiographic findings. Its radiographic determination, however, offers considerable promise, since it has been shown that the appearance of the pulmonary vessels is a reflection of pulmonary hemodynamics (1, 5, 11, 13, 15, 18, 19). The present study was undertaken to determine whether a clinically useful correlation could be established between the size of the pulmonary artery and its major branches and the pulmonary artery pressure. Since...

A Comparison of Electrokymography and Roentgenkymography in the Study of Myocardial Infarction

The authors present two cases of myocardial infarction to demonstrate that electrokymography is superior to roentgenkymography as a method for detecting localized areas of myocardial damage. This superiority is based principally on greater ease of exploration of the ventricular pulsations, clearer delineation of the kymographic curve as a result of greater magnification, and more accurate analysis of the phases of the cardiac cycle by simultaneous recording and integration with other graphic tracings.

Some clinical applications of electrokymography; the findings in myocardial infarction and heart block.

The study of cardiac pulsations by fluoroscopy and roentgenkymography has contributed interesting data regarding the physiology of cardiac contraction both in the normal and in such abnormal states as valvular heart disease, myocardial disease, and pericarditis. Analysis of the movements of the aorta, pulmonary artery, and other great vessels also is of some value in the differential diagnosis of aortic aneurysm and mediastinal tumor. The usefulness of roentgenkymography is limited, however, by several inherent technical difficulties which detract from its clinical application and popularity. For example, since the amplitude of movement of the heart borders is not magnified, the recorded movement is often small and difficult to analyze. If a larger or spread-out tracing is desired, the time of exposure during which the cardiac movement is recorded must necessarily be short, ranging from 1 to 1.5 seconds. This limits the study of cardiac movement in bradycardia and the arrhythmias. With the development and...

Contrast roentgen visualization of coarctation of the aorta

Abstract 1. 1. Contrast visualization of the aorta offers an excellent diagnostic aid in clinically obscure or atypical cases of coarctation of the aorta. 2. 2. The fluorographic multiple exposure technique is especially advantageous, since many photographs with fluoroscopic observation of the required phase of the cardiac cycle are obtained. 3. 3. There has been no undue reaction to the necessary procedures, whether in children or in adults.

Visualization of the coronary circulation during angiocardiography.

Abstract The coronary arteries and the coronary sinus may occasionally be identified in the films taken during routine angiocardiography in man. The arteries are seen mainly in children, in whom the aorta and its branches are usually more clearly outlined. In adults, the coronary sinus is sometimes filled in retrograde fashion from the right auricle.

The roentgenkymogram in myocardial infarction: II. Clinical and electrocardiographic correlation

Abstract 1. 1. A correlation is presented of the roentgenkymographic observations, electrocardiographic changes, and clinical course in 200 cases of acute and old myocardial infarction secondary to coronary artery occlusion. 2. 2. A close correlation was found between the incidence and degree of kymographic abnormalities and the clinical course, as judged by the severity of the attack and degree of recovery. The kymogram is usually normal when the attack is mild and the recovery good. Regression or complete disappearance of kymographic abnormalities is a good prognostic sign. The kymographic abnormalities are usually marked when the attack is severe and the recovery incomplete. 3. 3. The roentgenkymogram not infrequently presents abnormalities characteristic of myocardial infarction when the electrocardiogram is normal or atypical. On the other hand, the roentgenkymogram may remain normal or return to normal, while typical electrocardiographic abnormalities persist. These two methods of examination therefore supplement each other. 4. 4. The roentgenkymogram should prove to be of most diagnostic value during the acute stage, when the clinical course and electrocardiogram are not typical of coronary artery occlusion, and following recovery, when the characteristic signs of previous infarction have disappeared. 5. 5. Posterior infarction produced abnormalities in the posteroanterior kymogram as often as did anterior infarction. In only a minority of cases of either anterior or posterior infarction were abnormalities visualized better in the left oblique kymogram than in the posteroanterior kymogram. A possible reason for this is discussed. When multiple infarcts were present, or one involving both surfaces of the left ventricle, the frequency and degree of kymographic abnormalities increased. 6. 6. At post-mortem examination, systolic expansion in four cases could be correlated with a large area of infarction or thinning of the left ventricle. Diminution of pulsation occurred in one case in which there was a small posterior infarct, and in another in which there was diffuse myofibrosis.

Enhancement of Penetration of Penicillin into Inflamed and Normal Mucous Membrane by Hyaluronidase.

Summary The instillation of 200,000 units of crystalline penicillin G into We diseased and normal paranasal antrum is well tolerated and except for the development of an allergic reaction in one patient, was without any adverse effect. In 24 out of 26 patients with chronic suppurative disease of the sinuses and in all 5 normal subjects, a significant penicillin level in the blood was found after the intra-antral instillation. In both groups, the addition of hyaluronidase to the instilled penicillin resulted in even higher blood levels than those found without its use, with one exception. In two patients in whom no blood level could be demonstrated, the addition of hyaluronidase resulted in a significant concentration of penicillin in the blood. It is postulated that the increased blood penicillin level following hyaluronidase is due to greater diffusion and penetration of the penicillin as a result of the spreading action of hyaluronidase.

A method for producing sustained high penicillin levels in the blood.

Summary A method for obtaining high sustained blood levels of penicillin is described. This consists in repeated large intravenous doses of crystalline penicillin, injected rapidly, in patients receiving caronamide. Clinical applications are suggested. We wish to thank Miss Beatrice Toharsky for capable technical assistance.

Pupillary Reactions During Ether and Chloroform Anesthesia After Morphine.

In the course of anesthesia by ether and chloroform in the dog, the pupil dilates at 2 stages, in the period of excitement and in the period of deep narcosis. If there is violent excitement the intermediary constriction is not observed. It is commonly held that the primary dilatation is a reflex phenomenon (inhibition of the oculomotor or stimulation of the sympathetic or both). There is no clear statement, however, whether the dilatation of the pupil in the stage of deep narcosis is the result of asphyxia or the direct effect of the anesthetic. While studying the response of the vagus nerve to morphine during ether and chloroform anesthesia, it was observed that in deep ether narcosis, the pupils of the dog under the influence of morphine were widely dilated, while in deep chloroform narcosis under the same conditions, the pupils were constricted. These observations seemed of interest in their bearing upon the mechanism of the pupillary changes produced by ether and chloroform. Twelve experiments were then performed to check and extend these observations and the results are the subject of the present report. Ether and chloroform were administered by inhalation with the open cone method. The pupils were measured under constant conditions of light for any given experiment. Both eyes were examined; the pupils were found equal in all except one instance. Electrocardiographic records of the heart rate were taken at frequent intervals, making it possible in this way to correlate simultaneous effects upon the vagus and oculomotor nerves. The condensed protocols of the experiments with 2 dogs serve to illustrate the general results. The size of the pupils is expressed in percentage of the diameter of the iris. The stage of anesthesia is designated as “light” when voluntary movements as well as corneal conjunctival reflexes are present; as “deep” when these have disappeared; as “partial recovery” when the eye reflexes have reappeared; as “recovery” when voluntary movements begin.