A classification is presented of anomalies involving the coronary sinus. These anomalies are classified into four anatomic groups on the basis of (1) enlargement of the coronary sinus, (2) absence of the coronary sinus, (3) atresia of the right atrial coronary sinus ostium, and (4) hypoplasia of the coronary sinus. Anomalies involving the coronary sinus often are associated with other venous anomalies, either of the systemic or the pulmonary circulation. In some there is no basic disturbance of the circulation. Those conditions involving the coronary sinus which are of major functional significance participate in shunts, either left-to-right or right-to-left in nature. Enlargement of the coronary sinus in the absence of a shunt usually indicates that a systemic venous channel joins the coronary sinus anomalously.
Dipicolinic acid constitutes 12% of the dry weight of spores of Bacillus cereus var. terminalis.Following a heat-shock treatment at 65 °C. glucose is oxidized by the ungerminated spores, the amount of oxidation increasing with time of heating from 10 μl. per hour at zero time to 230 μl. per hour after heating for 60 minutes. Also during this treatment there is an increase in the amount of dipicolinic acid released from 2% of the total at zero time to 12.5% of the total after 60 minutes.The possible relationship between this material and the enzymes of resting spores is discussed.
The occurrence of retrograde blood flow in the ipsilateral vertebral artery of patients with proximal occlusion of the subclavian or innominate artery has been amply demonstrated by selective angiography. However, since flow artifacts may be induced by the physical or chemical effects of injections of contrast media, it was thought desirable to employ a different method for physiologic demonstration of the reversed flow.
In the first case, cardio-green dye was injected into the innominate artery and a dilution curve was recorded from the left brachial artery. The early appearance of the dye (6 seconds) proved that a short circuit existed between the arterial injection and sampling sites, and confirmed the authenticity of the reversed vertebral flow shown in previous angiograms.
In the second patient, who had symptoms of cerebral ischemia during exercise of the left (affected) arm, dye injected into the left carotid artery did not appear early in the brachial artery of the resting left arm. When it was injected during a period of intense hyperemia of the left arm, a fraction of the dye did appear early. This confirmed that, when the demand of the arm increased, blood was shunted to it not only from the vertebral-basilar system but also from the carotid system.
The importance of anatomic factors was evident in another case in which absence of the anticipated retrograde flow was explained by the fact that the vertebral artery arose directly rectly from the aorta and did not communicate with the affected subclavian artery.
These observations illustrate how radiographic and hemodynamic technics may usefully be combined to assess the effects of acquired diseases of the major blood vessels.
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