W. Jape Taylor

The late apical systolic murmur: Clinical, hemodynamic and angiographic observations

Abstract These studies have confirmed the presence of late mitral regurgitation associated with a peculiar deformity of the mitral valve in patients with a late apical systolic murmur. This lesion is not always innocuous, however, as 4 of 8 of our patients have a severe degree of mitral regurgitation, 2 of them also having a significant amount of left ventricular and left atrial enlargement. In addition, in 1 patient with similar clinical findings bacterial endocarditis has developed. Evidence for a congenital origin of this lesion in some of these patients is also presented.

HEMOGLOBIN POLYMORPHISM: ITS RELATION TO SICKLING OF ERYTHROCYTES IN WHITE-TAILED DEER.

Hemoglobins with different electrophoretic mobilities are associated with bizarre shapes seen during ordinary light microscopy of erythrocytes from the white-tailed deer, Odocoileus virginianus; nonsickling is contingent upon a specific hemoglobin. Sickling in vitro, which isproduced to a maximum degree in the presence of oxygen and elevated pH, is not associated with hematological abnormalities or disease despite marked differences in physical characteristics of sickled and nonsickled cells.

Effect of polyamines on the electrokinetic properties of red blood cells

Abstract At the physiological pH 7.4, the zeta potential of the normal red blood cell in 1.5% glycine buffer was found to be −52 mv, whereas that of sickling erythrocytes is −45 mv. Addition of spermidine to normal red blood cells reduced the zeta potential by approximately 20 mv. In sickling red blood cells, where the polyamine content is determined to be 5 to 6 times greater than in the normal erythrocyte, addition of spermidine reduced the zeta potential by only 5 mv, indicating that little more polyamine binding occurs. The polyamine content of whole blood taken from 24 patients having sickle cell anemia was found to be more than ten times that of whole blood from normal donors. Binding of polyamines to the normal red blood cell was analyzed from the surface charge potential variation as a function of polyamine concentration and the apparent binding constant determined to be 130 d1/g. The difference in the electrokinetic properties of normal and sickling red blood cells in this system may be attributed, in part, to a variation in the polyamine content of the two types of erythrocytes.

The Mechanism of the Generation of the Third and Fourth Heart Sounds

A simple unitarian concept of the mechanism of third and fourth sounds is presented. This study demonstrates that the third sound occurs during early rapid diastolic ventricular filling at a time when atrial pressure exceeds ventricular pressure. It is recorded within the ventricle and on the ventricular wall. It coincides with ventricular muscle vibrations. The fourth sound is demonstrated to consist of two components, both occurring when atrial pressure exceeds ventricular. The first component coincides with the peak of atrial contraction, is recorded within the atria, and is inaudible. The second component, which is audible (25 to 70 cycles per second) and follows the first by 0.01 to 0.02 second, is recordable within the ventricle coinciding with the impact of blood from atrial systole against the ventricular wall. These observations demonstrate that the audible third and fourth heart sounds have a common origin in the ventricles and have the same temporal and hemodynamic relationships regardless of etiology.

Combined ventricular hypertrophy in infancy

Abstract The vectorcardiograms and electrocardiograms in 10 infants with congenital malformations of the heart have been described. Each malformation would presumably result in combined ventricular hypertrophy. The results in 7 patients were compared with the previously established vectorcardiographic criteria for combined ventricular hypertrophy, and it was demonstrated that these criteria may be applicable to infants as young as 7 days. Three infants demonstrated vectorcardiographic patterns different from the previously described patients. One patient, Case 8, revealed a pattern which may indicate an additional criterion of biventricular hypertrophy in the newborn. One common denominator in each of the 10 patients was large diphasic QRS complexes observed in the mid-precordial leads of the electrocardiogram. The corresponding vectorcardiograms in each instance, regardless of the direction of inscription, revealed a QRS loop in the horizontal plane oriented in space so that it manifested itself electrically at the midprecordial leads as large diphasic QRS complexes over 50 mm. These tall mid-precordial QRS complexes have been called the Katz-Wachtel phenomenon and presumably reflect combined ventricular hypertrophy. The derivation of this term was traced.

The production of congenital heart defects with the use of antisera to rat kidney, placenta, heart, and lung homogenates

Abstract Pregnant Long-Evans rats received antisera to adult rat kidney, lung, and heart, rat placenta, and purified glomerular basement membrane on the ninth to eleventh days of gestation in doses ranging from 1 to 3 ml. per 100 Gm. The teratogenic antisera produced increased resorption rates, reductions in fetal weight, and significant malformations—with the exception of heart antiserum, which was not teratogenic in this experiment. Kidney and placenta antisera had a malformation rate of 76 and 80 per cent, with nearly three fourths of these being cardiovascular defects. Glomerular basement membrane and lung antisera were also teratogenic but less so. The cardiovascular malformations included situs inversus associated with truncus (4), as well as single ventricle (2), truncus arteriosus (8), various transpositions (7), interventricular septal defects (6), and several aortic outflow tract or proximal aorta abnormalities. These abnormalities were compared to those produced by trypan blue, which produces mostly transposition complexes, as well as to those produced by other teratogenic agents. The results suggest that antiserum produces its own unique spectrum of malformations, somewhat different from those produced by trypan blue, and therefore that the two agents may have different modes of action.

SICKLING PHENOMENA OF DEER

In an apparently random survey of the blood from several species of zoo animals, in 1840, Gulliver noted on microscopic examination that the erythrocytes of various deer would assume a number of bizarre shapes. Sharp angulations and spicules projecting in various directions were the principle features of these cells. It is likely that the observations was entirely fortuitious, based as it was on a propensity for the cells containing oxyhemoglobin to sickle so readily that it is difficult to observe them in room air without their becoming sickled. Complete deoxygenation of blood samples abolished sickling, but at an elevated pH sickling occurs at relatively low oxygen tensions. This relationship is clearly demonstrated in FIGURE 1, in which is depicted the relationship of oxygen saturation to sickling in an environment where pH was fixed at 7.8 by an isotonic sodium phosphate buffer containing potassium at a physiological concentration. At this pH a PO, of only 25-35 mm Hg is required to produce the degree of oxygen saturation at which sickling becomes pronounced. Intermittent observations on the sickle cells of a limited number of various wild-killed or zoo deer were reported over the years. Most notable of these were the studies of Undritz * who reported that the sickling of deer erythrocytes is reversible and related to changes in pH. However, information regarding the sickling phenomena of deer erythrocytes remained scanty. In 1960, with the assistance of the Florida Game and Fresh Water Fish Commission, we established an experimental herd of White-tailed deer (Odocoileus virginianus), which has been under continuous investigation at the University of Florida since that time. The objective was to study various physiological parameters, genetic transmission of the hemoglobin chains, structural characteristics of the hemoglobins, the determinants of the morphological changes of the erythrocytes and possible methods for modification of these alteration^.^^ No pathological effects from the sickling have been noted in the deer, but many other features of the deer hemoglobins have turned out to be as unusual as are their erythrocyte morphologies. These include the presence of duplicate a-chain genes, multiple @-chain variants, marked structural differerences between allelic @ chains rather than single point mutations, and the association of specific @chain types with distinct morphological aberrations and patterns of hemoglobin polymerization. This presentation will review the structural and genetic features that produce the remarkable hemoglobin heterogeneity of the White-tailed deer, and will report new information on the structural differences between the @-chain types, particularly those that are associated with the characteristic morphological changes.

Bacterial Endocarditis in a Patient with Idiopathic Hypertrophic Subaortic Stenosis

A rare case of subacute bacterial endocarditis, due to a streptococcus viridans organism, is reported in a patient with idiopathic hypertrophic subaortic stenosis (IHSS). Subacute bacterial endocarditis prophylaxis is recommended for patients with IHSS.

Fractionation of coral snake venom: Preliminary studies on the separation and characterization of the protein fractions

Abstract Lyophilized coral snake ( Micrurus f.fulvius ) venom was fractionated into six homogeneous and one heterogeneous fractions (labelled F-FVII in order of their elution) using CM-cellulose columns eluted with phosphate buffers (pH 6·0–9·0). Identification of each fraction on starch gel electrophoresis revealed that fractions I through VI migrated as homogeneous proteins. FVII was composed of four separate migrating units. All of the migrating units present in the crude venom were accounted for in the seven fractions. FIII, VI and VII each accounting for approximately 25 per cent of the recovery weight, were equally toxic, and were as toxic as the crude venom. All three possessed a strong anticoagulant activity. FIV and V present in moderate amounts, were toxic at concentrations 10 times that of the crude venom and possessed a weak anticoagulant activity. FII was toxic at concentrations 20 times that of the crude venom while FI was not toxic. All seven fractions exhibited a strong phospholipase A activity and hemolyzed red cells. None of the fractions nor the crude venom hemolyzed red cells without ovolecithin. None of the fractions or crude venom were proteolytic.

Multiple hemoglobin α-chains in the sika deer (Cervus nippon)

Investigation of the hemoglobin α-chains of an Asiatic deer, the sika (Cervus nippon), was prompted by the heterogenity of α-chain gene loci in the Virginia white-tailed deer (Odocoileus virginianus). Although electrophoresis of hemoglobin chains from 10 sika revealed only a single α-chain band, peptide mapping demonstrated variations in the α-TPIII∗ and α-TPIV peptides. Substitutions at positions 15, 20, and 22 produce a minimum of five α-chains; two possible additional chains could not be proven because of inseparability of the whole α-chains. The most common chain contains Asp-15, Lys-20 and Pro-22 but in other chains glycine is present at position 15, Asx at position 20, and either serine or Asx at position 22. The probable explanation for the large number of α-chains is gene duplication which may have been produced by breedings between subspecies from different geographical areas. Comparison with the α-chain structure of the white-tailed deer suggests that the sika may have evolved from the lineage which produced the white-tailed deer after the α-chain genes of the latter species had duplicated. In addition, these data provide further examples of the unusual variability of this portion of the α-chain.