The relation between bundle branch block and cardiac enlargement

The size of the heart was ascertained at necropsy or by roentgenologic examination in 100 consecutive cases of typical bundle branch block.The clinical diagnoses were: arteriosclerotic heart disease, 58 per cent; coronary artery occlusion, 25 per cent; chronic rheumatic valvular disease, 9 per cent; and miscellaneous conditions, 8 per cent.The heart was enlarged in all cases in which it was examined post mortem; the average cardiac weight was 586 Gm., the lowest, 375 Gm.Of the cases in which there was only a roentgenographic examination, the heart was increased in size in 91 per cent. In three of the six cases in which there was no enlargement, the diagnosis was Graves' disease.Left bundle branch block was present in 90 per cent of the cases. In 71 per cent of these the left ventricle was larger than the right, and in none was the right ventricle preponderant. Hypertensive heart disease was almost invariably associated with left bundle branch block.Of the ten cases of right bundle branch block, the right ventricle was predominant in four, and the left ventricle in one. Both ventricles were enlarged in five cases of coronary artery occlusion.Diffuse myocardial involvement was found in all cases in which a necropsy was performed.It is concluded that, in most instances, chronic bundle branch block is the result of an increase in the size of the heart, and of myocardial damage, with diffuse involvement of the bundle branch system. The type of bundle branch block depends on which ventricle is predominantly enlarged.     

Einzelreferate und Buchbesprechungen

Ohne Zusammenfassung     

Einzelreferate und Buchbesprechungen

Ohne Zusammenfassung     

Digital mucinous pseudocysts

Thirty-one patients with 46 digital mucinous pseudocysts are reviewed. The pseudocysts are usually soft, fluctuant, dome-shaped, dimpled, smooth lesions located near and often associated with a linear defect of the fingernail. Transillumination confirms the diagnosis. Treatment is conservative, usually consisting of intralesional injections. If surgery is necessary, distal interphalangeal joint injection of methylene blue aids in complete removal by identifying the mesothelial-lined pedicle leading from the distal joint to the pseudocyst.     

Refractory Angina

The regimen for treating refractory angina is similar to that for impending infarction. Specific approaches to treatment include drugs and other medical methods. Operative intervention is reserved for those patients who do not respond to medical measures.     

Pediatric Power Wheelchairs: Evaluation of Function in the Home and School Environments

The purpose of this study was to compare the performance of four power wheelchairs when used by children to perform a variety of indoor activities. Eight boys and eight girls performed a series of 11 functional tasks when positioned in each of four different power wheelchairs reflecting different design classes. There were no significant differences for many of the dependent variables. However, the Everaid Turbo was significantly better for functional positioning at a standard kitchen table and at school desks and for accessing objects at different heights. By contrast the Invacare Jaguar was better for straight-line driving speed. Other findings include children's subjective impressions of the four power wheelchairs.