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Biomedical subjects

J Morganroth

Publications and source records attributed to J Morganroth.

At least 199 records · Page 11Linked to original sources
PubMed1977

The use of the Doppler stethoscope in the evaluation of varicoceles.

Twenty-eight clinically detectable varicoceles of various sizes were examined with a Doppler ultrasonic stethoscope. Retrograde blood flow through the left internal spermatic vein was confirmed in all cases irrespective of size of the vascular abnormality. The Doppler stethoscope also was used to evaluate 13 patients suspected of having varicoceles but with inconclusive physical examinations. Retrograde flow through the internal spermatic vein could likewise be auscultated in 5 of these patients. Finally, the Doppler stethoscope was used to determine the adequacy of internal spermatic vein ligation in 5 postoperative patients whose seminal dysfunction persisted despite what appeared to be a surgically effective correction of aberrant gonadal venous flow.

Epididymis↗
PubMed1977

Prehospital cardiac care: illusion of consensus.

To judge standard practice for managing arrhythmias, what an EMT should be able to do in the field, drugs of choice, the success of EMT training, and the quality of EMT performance, clinical algorithms were developed. Branching logic, forcing yes/no decisions and delineating actions for all contingencies helped formalize and systematize EMT management of urgent and emergency cases. The algorithm set was sent to 19 consultants for review of content, sequence, drug dosage, and drug usage. The results indicated lack of consensus on appropriate prehospital cardiac care, but the approval of the algorithm approach.

Allied Health Personnel↗
PubMed1977

The athlete's heart syndrome: a new perspective.

Although earlier electrocardiographic and roentgenographic studies suggested that the heart of trained athletes differed from that of nonathletes, little was known of the cardiac dimensions of the athlete's heart until the advent of echocardiography. Echocardiographic studies have demonstrated that trained athletes may have increased left ventricular mass and that the structural change accounting for this increase is related to the type of physical conditioning. Athletes participating primarily in isotonic exercise have an increase in left ventricular end-diastolic volume with little or no increase in left ventricular wall thickness whereas those athletes participating primarily in isometric exercise have an increase in left ventricular wall thickness associated with normal left ventricular end-diastolic volume. Comparisons between echocardiographically determined cardiac changes in college and world class athletes were made, and the electrocardiographic and chest roentgenographic changes present in the athlete's heart syndrome were reviewed.

Adaptation, Physiological↗
PubMed1977

New criteria to enhance the predictability of coronary artery disease by exercise testing in asymptomatic subjects.

Thirty-seven subjects (10 asymptomatic and 27 symptomatic) who had undergone maximal treadmill exercise tests and coronary arteriography were selected to determine whether the predictive value of ST-segment depression as a marker of coronary artery disease (CAD) in asymptomatic subjects could be enhanced. All subjects had greater than or equal to 2 mm ST-segment depression during testing. Three of the ten asymptomatic subjects had significant CAD (predictive accuracy 30%) and all had greater than or equal to 2 mm ST depression in the one-minute recovery tracing. ST-segment depression resolved by one minute in all seven subjects without CAD. All 27 symptomatic subjects had CAD (predictive accuracy 100%) and 26 of 27 had greater than or equal to 1 mm (21/24 greater than or equal to 2 mm) ST depression in the one-minute recovery tracing. The age, maximum heart rate and exercise tolerance did not differ significantly between the symptomatic and asymptomatic subjects. Thus the predictive accuracy for CAD in asymptomatic subjects is not enhanced by increasing the degree of ST depression required for a positive exercise test. The predictive value may be enhanced if ST depression persists for greater than or equal to 2 minutes into recovery. These data suggest that by using new criteria accurate identification of asymptomatic patients with CAD by exercise testing may be practical.

Adult↗
PubMed1977

Acute severe aortic regurgitation. Pathophysiology, clinical recognition, and management.

Acute severe aortic regurgitation is a relatively unfamiliar, though life-threatening, disease. We review its diverse causes, anatomic faults, and hemodynamic sequelae and set the stage for an understanding of the clinical manifestations in light of their physiologic mechanisms. Clinical information includes the natural history, physical signs (physical appearance, systemic arterial pulse, jugular venous pulse, precordial palpation, auscultation), electrocardiogram, and chest roentgenogram. Echocardiographic features are especially emphasized and the need for prompt diagnosis and surgical intervention underscored, even in the setting of active infective endocarditis.

Acute Disease↗
PubMed1976

Unsuspected substantial pericardial effusions detected by echocardiography.

In a consecutive series of 1,225 routine echocardiograms, a pericardial effusion (PE) was present in 15% and was considered substantial in 10%. Sixty-one percent (68/111) of the latter were clinically unsuspected. A retrospective analysis of these patients showed that 60% (41/68) had underlying heart disease such as congestive heart failure, left ventricular hypertrophy, or asymmetric septal hypertrophy without other discernible causes for PE. In patients referred specifically for suspected pericardial effusion, 67% (29/43) had diseases recognized as causes of pericardial effusion. Unsuspected substantial PE are commonly detected by echocardiography, especially in patients with underlying heart disease.

Cardiomegaly↗
PubMed1976

Isolated dextroversion of the heart with asymmetric septal hypertrophy.

Dextroversion of the heart is an uncommon congenital anomaly characterized by situs solitus (normal position) of thoracic and abdominal viscera with right cardiac apex. Isolated dextroversion, i.e., without associated congenital heart disease, is rare, but its occurrence permits adult survival, setting the stage for late development of acquired heart disease. The patient herein reported was known since childhood to have a right thoracic heart that represented isolated uncomplicated dextroversion. He presented in the sixth decade with a new murmur that proved to be due to asymmetric septal hypertrophy (ASH) with obstruction. This combination of anomalies is possible only if dextroversion exists without ventricular inversion, since aortic-anterior mitral leaflet continuity is obligatory for obstructive ASH. This paper presented clinical, phonocardiographic, vectorcardiographic, echocardiographic, hemodynamic, angiocardiographic, and intracardiac electrophysiologic information on the unique combination of isolated dextroversion of the heart with obstructive asymmetric septal hypertrophy.

Cardiomegaly↗
PubMed1976

Relation between echocardiographically determined left atrial size and atrial fibrillation.

In an attempt to define quantitatively the relation between left atrial size and atrial fibrillation, echocardiography was used to study 85 patients with isolated mitral valve disease, 50 patients with isolated aortic valve disease, and 130 patients with asymmetric septal hypertrophy. In all three groups of patients, atrial fibrillation was rare when left atrial dimension was below 44 mm (3 of 117 or 3%) but common when this dimension exceeded 40 mm (80 of 148 or 54%). In addition, when left atrial dimension exceeds 45 mm, cardioversion, while initially successful, is unlikely to produce sinus rhythm that can be maintained at least six months. These data suggest that left atrial size is an important factor in the development of atrial fibrillation and in determining the long term result of cardioversion. The pathophysiologic mechansim most consistent with this is that a chronic hemodynamic burden initially produces left atrial enlargement which in turn predisposes to atrial fibrillation. Only prospective studies will determine definitively whether these observations will be useful in decisions concerning prophylactic anticoagulation and elective cardioversion.

Adolescent↗
PubMed1976

Determinants of ventricular septal motion. Influence of relative right and left ventricular size.

To test the hypothesis that the ventricular septum moves during systole toward the center of the ventricular mass (so that the end-diastolic position of the septum within the heart should determine both the direction and the magnitude of septal motion during systole), echocardiograms from patients with several different hemodynamic burdens were analyzed. A linear relation was noted between the end-diastolic intracardiac position of the ventricular septum and the direction and magnitude of systolic septal motion in 1) forty three patients with an atrial septal defect )regression coefficient r = 0.80), 2) fourteen patients with other causes of right ventricular volume overload (r = 0.82), 3) nineteen patients with left ventricular volume overload (r = 0.74), 4) ten patients with right ventricular pressure overload (r = 0.93), 5) ten patients with left ventricular pressure overload (r = 0.80), 6) twenty-eight normal subjects (r = 0.82). We conclude that, in the presence of normal ventricular activation and contraction, the direction and magnitude of sepatal motion during systole is determined by the intracardiac position of the septum at enddiastole.

Adolescent↗
PubMed1976

Cholestyramine: an effective, twice-daily dosage regimen.

Nine patients with familial hypercholesterolemia (type II hyperlipoproteinemia) and two normal volunteers were studied to ascertain the effectiveness of cholestyramine in lowering plasma cholesterol when a twice-a-day dosage regimen was compared with the same total dosage administered four times a day. The study showed that in these subjects the two regimens were equally effective. The ability to administer cholestyramine twice daily in working adults and school children should greatly enhance adherence to this agent.

Adult↗
PubMed1975

Electrocardiographic evidence of left ventricular hypertrophy in otherwise normal children. Clarification by echocardiography.

Eleven apparently normal children whose electrocardiograms demonstrated greatly increased precordial QRS voltages suggestive of left ventricular hypertrophy were studied by echocardiography to determine whether this finding represented an early manifestation of cardiac disease. Echocardiographic measurements of the thickness of the ventricular septum and of the left ventricular posterobasal wall were normal in all 11 subjects when compared with normal values for age. Also within normal limits were left ventricular, left atrial and aortic root internal diameters, left ventricular mass and the motion and structure of the anterior and posterior mitral valve leaflets. We conclude: (1) These children probably have normal hearts; (2) increased precordial QRS voltage in children and adolescents, in the absence of other abnormalities, is an unreliable indicator of left ventricular hypertrophy; and (3) echocardiography is a powerful diagnostic test in determining the significance of abnormal electrocardiograms suggestive of left venticular hypertrophy.

Adolescent↗
PubMed1975

Type III hyperlipoproteinemia: an analysis of two contemporary definitions.

Two current definitions of type III hyperlipoproteinemia, "floating beta" lipoproteins and an estimate of the relative content of cholesterol and triglyceride in lipoproteins of density less than 1,006 (very low-density [VLD] lipoproteins), have been compared. Over 3100 complete lipoprotein analyses of 182 adults with primary familial hyperglyceridemia, covering a wide range of plasma lipid concentrations, formed the data base for this retrospective analysis: The ratio of VLD lipoprotein cholesterol to the plasma triglyceride concentration (VLDL/TG=r) proved capable of segregating an apparently unique subpopulation with persistently abnormal very low-density lipoprotein composition. Although floating beta lipoproteins were present in nearly all patients with a high r value, they also appeared inconsistently in many other patients. It is concluded that the chemical index to VLD lipoprotein composition is the better, albeit, temporary definition for this disorder. When the plasma triglyceride concentration is between 150 and 1000 mg/100 ml, an r not less than 0.25 should be considered as suggestive and a value not less than 0.30 as diagnosttc of type III hyperlipoproteinemia.

Adult↗
PubMed1975

The biochemical, clinical, and genetic features of type III hyperlipoproteinemia.

The clinical and biochemical features of type III hyperlipoproteinemia are described in 49 patients from 23 to 70 years of age. An increase in very low-density lipoproteins (VLDL) of abnormal chemical composition was the basis for diagnosis. The untreated patients all had hypercholesterolemia and hyperglyceridemia, and, on the average, decreased concentrations of both low- and high-density lipoproteins. Seventy-four percent had xanthomas, and classic "xanthoma striata palmaris" was found in more than half. Twenty-seven percent had ischemic heart disease, detected earlier in men than in women. Twenty-seven percent had peripheral vascular disease (compared to 4% of subjects with type II hyperlipoproteinemia). Twenty-five of 35 subjects achieved normal lipid levels with dietary therapy alone. Analysis of 29 kindred showed hyperlipidemia in half of adult blood relatives; half of these had type III, the remainder usually had sample endogenous hyperglyceridemia (type IV). Only 2 of 55 children less than 20 years of age were affected, both with type IV.

Adult↗
PubMed1975

Comparative left ventricular dimensions in trained athletes.

Little is known about the structure of athletes' hearts of anatomic variations associated with training. Echocardiograms of 56 active athletes were obtained. Mean left ventricular end-diastolic volume and mass were increased in athletes involved in isotonic exercise, such as swimming (181 ml, 308 g) and running (160 ml, 302 g), compared with controls (101 ml, 211 g); wall thickness was normal (less than or equal to 12 mm). Athletes involved in isometric exercise, such as werstling and shot putting, had normal mean left ventricular end-diastolic volumes (110 ml, 122 ml), but increased wall thickness (13 to 14 mm) and mass (330 g, 348 g). Thus, athletes participating in isotonic exercise had increased left ventricular mass with cardiac changes similar to those in chronic volume overloads. Athletes participating in isometric exercise had increased left ventricular mass with cardiac changes similar to those in chronic pressure loads, recognizing greater left ventricular mass and volume in well-trained athletes aids in interpreting values deviating from "normal" limits.

Adolescent↗