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The mechanisms of the heart sounds have been investigated by means of animal experiments and the recording of tracings in normal human subjects. Simultaneous tracings of pressure have been recorded in dogs from the two ventricles, from one ventricle and its respective atrium, and from the aorta and pulmonary artery. The time relationship of the motion of the various valves was revealed by these tracings plus simultaneous external phonocardiograms. Simultaneous intracardiac phonocardiograms confirmed these data. Selective phonocardiograms have been recorded through various filters in man, together with low-frequency tracings of the precordium, carotid and aortic tracings, and jugular tracings. The following conclusions have been reached (Fig. 11): 1. 1. The first sound is made of 3 phases: low-pitched beginning, due to 2. myocardial tension; higher-pitched central phase, due to valvular events; lowpitched final phase, due to vascular phenomena. The central phase contains at least 4 vibrations which correspond to the motion of the 4 valves in the following order: mitral closure, tricuspid closure, pulmonic opening, aortic opening. Whenever one or more large vibrations correspond to the phase of ejection, they are likely to be of a vascular nature. 3. 2. The second sound is made of 3 phases: low-pitched beginning, due to eddies preceding the valvular closure; higher-pitched central phase, due to closure of the semilunar valves; and low-pitched final phase, due to final vibrations plus opening of the A-V valves. The central and final phases correspond, firt, to the closure of the semilunar valves and, then, to the opening of the A-V valves, in this order: aortic closure, pulmonic closure, tricuspid opening, mitral opening. 4. 3. Rapid filling of the ventricles is usually nonsimultaneous, in this order: rapid filling of right ventricle, rapid filling of left ventricle. These data confirm some interpretations of previous workers but exclude others. Time intervals for the various phases are given for large dogs. Measurements taken in phonocardiograms of normal persons, recorded with a technique which is identical to that used in dogs, indicate that similar figures can be used in man.

A new system of absorption bands has been found in the region λλ3020–2400 with an absorbing path of three meters and a pressure of two atmospheres. The gross structure of the system is comparatively simple. Two main progressions of bands with frequency differences 2050 cm—1 and 895 cm—1 have been found. The bands in these progressions can be accurately represented by a general formula: ν=A+ω1′v1′+x11′v1′2+ω2′v2′+x22′v2′2+x12′v1′v2′ with A = 33,293.63, ω1′+x1′ = 895.75, ω2′ = 2065.38, x22′ = — 15.13 and x12′ = — 8.00. The electronic excitation is mainly at the C – N bond. The structure of the molecule in the excited state, its normal frequencies and symmetry properties are also discussed. The frequency difference 2050 cm—1 is considered as due to the totally symmetric longitudinal (C – N) vibration in the excited, state and a tentative assignment is suggested as follows: ν1′ = 895 cm—1, ν2′ = 2050 cm—1, ν3′ = 1770 cm—1, δ2′(u) = 210 cm—1. Other possible assignment has also been briefly discussed.

A case of mucopolysaccharidosis with extensive cardiac valvular involvement is reported. The finding of cytoplasmic inclusions, the Alder anomaly, in the leukocytes in a peripheral blood smear suggested the correct diagnosis, which was confirmed at autopsy.

The present investigation is a part of the program of a series of studies aiming at a satisfactory analysis of the near ultraviolet spectrum of acetylene. The spectrum of C2H2 at room temperature and 300°C was taken with a Bausch and Lomb large quartz spectrograph. The spectrum extends from λ2430A down to the ultraviolet limit of the instrument. More than 1000 bands and lines have been measured. Most of the bands revealed intensification at elevated temperature. Some of them have been partially resolved into rotational lines with alternating intensities. Seven main progressions all with frequency difference ∼1050 cm—1 have been found. Only the bands of three of the progressions showed no intensification at higher temperature. From the differences between these bands, a frequency 580 cm—1 has been observed. Weaker bands on the red side of stronger ones have been proved through temperature variation to be due to transitions from the excited 2v5″(Eg) level in the ground state. Through a tentative assignment,...

Autopsy data and electrocardiographic findings in 364 unselected cases were studied; 163 cases were classified as having LVH on the basis of heart weight and ventricular wall thickness; 145 patients were classified into a control group, and 56 patients into an intermediate group. The mean age of the 364 patients was 68.5 years. This study compares the commonly used voltage criteria for LVH and evaluates them on the basis of sensitivity, specificity, and predictive values of a positive or negative finding. Not a single previous voltage or intrinsicoid deflection criterion had a sensitivity greater than 20 per cent of the 163 cases with LVH. The criterion with the greatest sensitivity was that of the authors' where “R” in V6 ⪰ 18 mm. deflection. This criterion had a sensitivity of 24.6 per cent and a specificity of 93.1 per cent. When all the commonly used voltage criteria were combined with the authors' criterion, the diagnosis of LVH could be made in 46.5 per cent of the cases with a specificity of 89.6 per cent, a predictive value of a positive finding of 82 per cent and a predictive value of a negative finding of 62.3 per cent. We feel that RV6 ⪰ 18 mm. should be used with other criteria in order to increase the sensitivity and maintain specificity in making the diagnosis of LVH in the age group studied.

E XTERNAL phonocardiograms in atrial septal defect have been studied by Reinhold and Nadas,l Leatham and Gray,' Effert et al .,' and Souli€ et al .4 A systolic murmur and split 2nd sound over the 2nd left interspace were usually found. A delayed, short early diastolic murmur and a presystolic murmur or 4th sound were often recorded over several areas of the precordium. The presence of a presystolic murmur and a loud 1st sound at the apex may simulate the snapping 1st sound of mitral stenosis . The mechanisms of production of systolic and diastolic murmurs and abnormal heart sounds were tentatively explained . Intracardiac phonocardiograms in atrial septal defect have not been studied systematically, although the method has been introduced by several workers .'-' The site of murmur formation may be precisely located in various cardiac chambers or great vessels (pulmonary artery) by intracardiac phonocardiograms . This comparative study, of external and intracardiac phonocardiography, correlated with intracardiac and vascular pressure tracings, may demonstrate, not only the site of murmur formation, but also the type of transmission of the murmur from the cardiac chambers to the precordium, and also explain the splitting of heart sounds . Intracardiac phonocardiograms in one case of septal defect were presented by Luisada and Testelli10 and other tracings were discussed by Luisada and Lit, in a recent monograph ."

The spectrum of ethylene oxide was investigated from the visible down to about 600A, with high resolution in the vacuum region. No discontinuous absorption was found above 1713A. Two Rydberg series, beginning at 1435 and 1382A were found, which converge to the same ionization potential at about 10.81 ev. Two non‐Rydberg transitions were found, with origins apparently at 1713.4 and 1572.4A. An analysis and discussion is made of the spectrum. It is concluded that the Rydberg transitions arise by excitation from a molecular bonding orbital, very similar to one responsible for Rydberg series in ethylene and related compounds.

THE rapid advances in cardiac surgery during the past ten years have increased the need for accurate diagnosis of lesions of the heart and great vessels. This has resulted in an ever-increasing use of the technic of angiography. The contrast agents employed in angiography contain iodine in amounts varying from 50 to 66 per cent of their weight; they are directly irritating to living tissue,1 , 2 and all are markedly hypertonic —for example, 70 per cent Diodrast (iodopyracet) has nine times, 75 per cent Neo-Iopax (sodium iodomethamate) has ten times, and 70 per cent Urokon (sodium 3 acetylamino-2, 4, 6-triiodobenzoate) has . . .

Six cases of atrial infarction associated with ventricular infarction are presented. All cases were diagnosed during life and were confirmed by autopsy. A clinical diagnosis of atrial infarction should be suspected in patients with ventricular myocardial infarction having any form of atrial arrhythmia. Frequent electrocardiograms should be obtained, especially if sinus rhythm has just been re-established after episodes of supraventricular tachycardia or atrial fibrillation. The major electrocardiographic criteria for the diagnosis of atrial infarction are as follows: elevation of the P-Ta segment of over 0.5 mm. in V 5 ; and V 6 with reciprocal depression of the same segment in V 1 and V 2 ; elevation of the P-Ta segment of over 0.5 mm. in lead I and its depression in leads II or III; depression of the P-Ta segment of more than 1.5 mm. in precordial leads and 1.2 mm. in leads I, II, and III in the presence of any form of atrial arrhythmia. The minor electrocardiographic criteria in making the diagnosis of atrial infarction are as follows: abnormal P waves: M-shaped, W-shaped, irregular or notched; depression of the P-Ta segment of small amplitude without elevation of this segment in other leads cannot be regarded by itself as positive evidence of atrial infarction. A diagnosis of atrial infarction can sometimes be made when the presence of ventricular myocardial infarction cannot be definitely established by electrocardiogram. The treatment of atrial infarction is similar to that of ventricular infarction. Attention should be directed to the control of atrial arrhythmias and to the prevention of mural thrombi.

Intracardiac phonocardiograms were studied during left heart catheterization in two normal subjects and 15 patients with mitral or aortic valve lesions. Data pertaining to normal intracardiac, left atrial and left ventricular sounds are discussed. Data obtained in mitral stenosis, mitral insufficiency, aortic stenosis and aortic insufficiency are reported. The murmurs were best recorded in those chambers which received the blood flow (normal or pathologic) during the production of each murmur. Observations dealing with the third or fourth heart sound and with the mitral opening snap are reported.

Problems dealing with the registration of either apical or basal diastolic murmurs of poor magnitude are discussed. Current methods of phonocardiography are reviewed. Eight normal subjects and thirty abnormal cases were studied by means of a variable band-pass filter with additional amplification. The various frequencies of the cardiac murmurs were analyzed. A band between 60 and 110 vibrations per second was found adequate for magnifying and recording murmurs caused by mitral stenosis. A band between 150 and 200 was found adequate for magnifying and recording murmurs caused by aortic defects or mitral insufficiency. A routine method of study of cardiac murmurs, called ``selective phonocardiography'' is outlined. It is based on the use of the two above bands, in addition to ``stethoscopic'' phonocardiograms. Incorporation of filters in the case of the phonocardiograph is recommended. A new method of study of the frequency of extra sounds is described. Preliminary observations are reported. A new technique of intracardiac(ic) phonocardiography during routine catheterization is described. Preliminary studies in animals are reported.

The absorption spectra of gaseous isocyanic acid, methyl, ethyl and phenyl isocyanates have been observed in the ultraviolet. The long wavelength limits of the continuous absorption found were as follows: HNCO, λ2240; CH3NCO, λ2550; C2H5NCO, λ2480; C6H5NCO, λ2420A. In the case of isocyanic acid, diffuse bands were also found in the region λλ2570–2250A. Characteristic absorption bands due to an excitation in the benzene ring were found in phenyl isocyanate. The structures are probably represented by the formulae H–N=C=O, CH3–N=C=O, C2H5–N=C=O, C6H5–N=C=O. The products and energies of dissociation have been described. The absence of the characteristic absorption due to =C=0 has also been discussed.

Two new techniques are presented for use in routine cardiac catheterization or in special studies on the heart. 1. 1. Intracardiac electrocardiography is done by using a column of 5 per cent saline solution with 10 per cent heparin within the catheter as an “exploring” electrode. The “chest” wire is connected with a metal outlet of the strain gauge. 2. 2. Intracardiac phonocardiography is done by using the column of normal saline or glucose solution within the catheter as the carrier of sound waves. The electric output of the strain gauge is differentiated, amplified, and filtered, and is recorded by a phonocardiograph. Application of these methods is simple and can be used routinely in animal or human catheterization, both in the right and left heart.

IDIOPATHIC thrombocytopenic purpura is one of the few disorders of obscure origin in which the effect of cortisone and corticotrophin (ACTH) therapy has not been extensively reported. 1 Results of administration of the hormones will be difficult to evaluate since spontaneous remissions are common. In some patients, however, the disease runs a chronic, unremitting course, so that the effect of agents of possible therapeutic value is of greater significance. During the past four years we have had the opportunity of observing the disease in a most severe and persistent form in a woman, and we wish to report the dramatic effect of corticotrophin administration. REPORT OF CASE The patient (A. M.) was a 41-year-old married school teacher who was well until 1945, when she noted the appearance of spontaneous bruising and small hemorrhages in the skin, along with bleeding of the gums and frequent nosebleeds. These symptoms continued without remission

Right heart catheterization is the only practical mean to verify the clinical diagnosis of primary pulmonary hypertension during life. The differential diagnosis of this syndrome is briefly discussed. Studies of right heart catheterization in patients with chronic obstructive emphysema have demonstrated the following data: 1.Cardiac output is increased at rest in a certain number of cases, but this finding is not the rule, especially in late stages. 2.Pulmonary resistance may be increased at rest and shows a further increase during exercise. 3.Right ventricular work is markedly increased during physical exercise. 4.Different findings of pulmonary arterial pressure, arterial O2 saturation, and cardiac output in different patients may reflect a different extent or type of vascular changes, possibly because the patients were in different stages of an evolutionary process.

Patients with organic heart disease constitute about 5 per cent of all hospital admissions in China. The relative incidence is as follows: rheumatic heart disease, 35 to 50 per cent; hypertensive heart disease, 11 to 40 per cent; atherosclerotic heart disease, 7 to 16 per cent; chronic pulmonary disease, 6 to 10 per cent; syphilitic heart disease, 2 to 6 per cent; and congenital heart disease, 4 to 7 per cent. Other conditions involving the heart have been reported. These include pulmonary edema of high altitude, cardiac arrhythmias following antimony treatment for schistosomiasis and Kershan disease. The last is a disease caused either by fungi poisoning or a rodent-born virus which produces acute or chronic myocardial necrosis. Progress and development in research and cardiovascular surgery are discussed.

Summary(1) Three of 12 rabbits receiving intraperitoneal injections of blood immediately after removal from the heart developed a transiently positive antiglobulin serum test (Coombs test) with a reagent made by injecting rabbit serum into guinea pigs. None of the 3 developed evidence of a hemolytic anemia. (2) Rabbits receiving injections of rabbit red cell stroma which had been incubated with bacterial filtrate or emulsions of rabbit liver or kidney failed to develop positive agglutination tests with the same reagent.

The spectrum of sulfur hexafluoride has been investigated down to wavelengths about 600A. The maximum of the first electronic transition is found at about 1050A. Three other transitions occur between this wavelength and 802A, where strong continuous absorption begins, and nothing further can be resolved at shorter wavelengths. Qualitative suggestions are offered about the dissociation of SF6 and the value of its ionization potential.

Excerpt Digitalization has been used prophylactically in surgical patients with cardiovascular disease. However, we have encountered several incidences of fatal digitalis toxicity in patients recei...

MANY EXPLANATIONS have been advanced for the low thrombocyte (platelet) count in primary or idiopathic thrombocytopenic purpura, but so far all theories lack substantial proof. The disease is somewhat commoner in females and occurs more frequently in the first half of life, although it has been seen in persons of all age groups. A familial history of easy bruising and prolonged bleeding is frequently mentioned in case histories, but few hematological data are offered to support the supposition that thrombocytopenia has occurred in other members of the family. Reports of transitory thrombocytopenia in infants of women with thrombocytopenic purpura are of particular interest, since these cases suggest that an agent producing the thrombocytopenia is transmissible through the placenta.1Both increased destruction and decreased formation of thrombocytes have been advanced as causes of primary thrombocytopenia. Since there is no technic comparable to the reticulocyte count for estimating the rate of

Excerpt The detection of unilateral renal artery stenosis, a potentially curable lesion, is of utmost importance. The use of excretory urography, radiorenography, split renal function tests, and ao...