Differential diagnosis of pulmonic stenosis by means of intracardiac phonocardiography

The purpose of the present paper is to describe the origin of the systolic murmur in pulmonic stenosis and to discuss the diagnostic possibilities of intracardiac phonocardiography. Right heart catheterization was carried out with the aid of a double-lumen A.E.L. phonocatheter on 48 pulmonic stenosis patients with or without associated heart lesions. The diagnosis was confirmed by heart catheterization and angiocardiography in all cases and in 38 of them, by surgical intervention. Simultaneous phonocardiograms were recorded with intracardiac pressure tracings. In valvular pulmonic stenosis, the maximum ejection systolic murmur was localized in the pulmonary artery above the pulmonic valve and well transmitted to both right and left pulmonary arteries, the superior vena cava, and right and left atria. The maximal intensity of the ejection systolic murmur in infundibular stenosis was found in the outflow tract of right ventricle. The contractility of the infundibulum greatly contributes to the formation of the ejection systolic murmur in the outflow tract of right ventricle. In tetralogy of Fallot, the major systolic murmur is caused by the pulmonic stenosis, whereas the high ventricular septal defect is not responsible for it. In pulmonary branch stenosis, the systolic murmur was recorded distally to the site of stenosis. Intracardiac phonocardiography has proved useful for the differential diagnosis of various types of pulmonic stenosis.

Real-time observation of cardiac movement and structures in congenital and acquired heart diseases employing high-speed ultrasonocardiotomography

Echocardiography has proved useful for cardiac diagnosis during the past several years; however, the conventional one-dimensional ultrasound pulse echo method cannot easily visualize the anatomical relationships of the various cardiac structures. To overcome the limitation, the authors attempted a real-time observation of cardiac structures and introduced high-speed ultrasonocardiotomography with a Sonolayergraph Model SSL-51H (Toshiba) having a logarithmic amplifier. Thirty sector images are produced per second by a mechanically operated, single flat or 75 mm. focus transducer measuring 10 mm. in diameter. The angle of a sector image composed of about 120 scanning lines is arbitrarily changeable from null to 65 degrees. The fast succession of images produced enables clear observation of the movement of cardiac structures in real time. Study of 230 patients by means of the proposed system suggests that it is advantageous as a quick method to provide two-dimensional echocardiograms for cardiac diagnosis and assessment, especially in noninvasive diagnosis.

Mobilization of folate from liver into blood stream following histidine injection in rats

A marked reticulocyte response following intraperitoneal injections of histidine monohydrochloride was observed in rats which were fed on a folate-free diet immediately after weaning for a period of 20 days or more. This finding was taken as an evidence for mobilization of folate stored in the liver into blood stream following histidine injection.

Real-time observation of ruptured right sinus of Valsalva aneurysm by high speed ultrasono-cardiotomography. Report of a case

A two-dimensional echocardiographic manifestation of a ruptured right sinus of Valsalva aneurysm is described in this case report. The ultrasono-cardiotomograms demonstrated the aneurysm cut longitudinally and protruding into the outflow tract of the right ventricle. The configuration of the aneurysm was consistent with the contrast medium-filled sinus demonstrated by angiocardiography. In systole, the aneurysmal sinus moved anteroinferiorly together with the aortic wall. The echocardiogram revealed an abnormal two-layered horizontal echo in the right ventricle which showed the aneurysm when the ultrasonic beam passed through the interventricular septum near the aortic root and mitral leaflets. During the operation, the protruding sinus and a small interventricular septal defect in the membranous septum under it were observed through the opened right ventricle. After the closure of the aneurysm, the two-dimensional echocardiogram no longer showed an abnormal configuration.

Zinc deficiency in two infants during total parenteral alimentation for diarrhea

Zinc deficiency was observed in two infants receiving total parenteral alimentation for chronic diarrhea. An acrodermatitis enteropathica-like rash occurred in both of the infants. Staphylococcus aureus was cultured from the rash. Treatment with zinc resulted in rapid cure of the rash and a subsidence of other signs consistent with zinc deficiency.

Clinical study on the flow murmurs at the defect area of atrial septal defect by means of intracardiac phonocardiography

In order to study flow murmurs through atrial septal defects, right heart catheterization was performed on 48 patients of secundum type, four of primum type, and five of probe-patent foramen ovale, with the double-lumen phonocatheter of Lewis, at the tip of which barium titanate was mounted. The flow murmurs at the defect area were classified into three patterns: v murmur, atriosystolic murmur, and mid-diastolic murmur. V murmur was continuous, extending from late systole to diastole, of low to medium pitch, closely related to atrial v wave and augmenting with expiration. It had no significant correlation to the ratio of left-to-right shunt. It was recorded in 32 out of 48 cases of secundum type and one of primum type, but not observed in probe-patent foramen ovale. Atriosystolic murmur was noted in 17 of 48 cases of secundum type and one of primum type. It was connected with atrial a wave. Mid-diastolic murmur was found at the defect area in four subjects of secundum type. It was thought to be an independent entity from v murmur and to be another one due to shunt flow through the septal defect, since it had no relation to v wave but it was localized between v and a waves in the pressure curve of the right atrium. It is different in localization from mid-diastolic murmur due to relative tricuspid stenosis at the inflow tract of right ventricle.

Globoid cell leukodystrophy: the first case with antemortem diagnosis in Japan

A Japanese boy was diagnosed as globoid cell leukodystrophy on the basis of a marked decrease in the galactocerebroside beta-galactosidase activity in the leukocytes and the serum when one year and two months old. At autopsy when 1 year and 10 months, microscopic findings were characteristic for those of globoid cell leukodystrophy. Galactocerebroside beta-galactosidase activities of leukocytes and sera of his father and mother were found to be half those of control subjects, thus it suggested the parents being heterozygotes of the disease.