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November, 1942 VISCERAL TRANSPOSITION—BAUER 585 Fig. 1. (Case III) Note dextrocardia, dextroposition of the barium-filled esophagus, and exchanged position of stomach and liver. tions after muscular exertion, and that he would seek an explanation from friends or from his physician. However, Smith and Horton tell of a 47 year old woman with SIV who attempted suicide, unaware of her abnormality. She aimed “at the place where she thought the heart was situated and where, normally it would have been situated. The bullet entered . . . the fifth interspace about 3 inches ... to the left of the sternum . . . was removed a few days later by a surgeon.” Thus it is possible for the affected individual to reach middle life without an awareness of his anatomical peculiarity. Therefore responsibility for discovery rests with the physician. Physical Examination In a person with SIV the apex impulse will be found on the right. This finding and the observation that the right testicle hangs lower than the left may be noted at a glance, tempting one to venture a snap diagnosis of SIV. Careful percussion of the chest and abdomen will reveal the transposition of the heart, liver, stomach, and spleen. In a thin subject the aortic transposition can be noted by palpating for aortic pulsation, which will Fig. 2. (Case XVI) True dextrocardia, transposition of the abdominal viscera. (Courtesy of Dr. P. A. Yoder) be felt to the right side of the middle of the vertebral column. Whereas normally the right kidney is the lower, in SIV the left kidney is lower. Fluoroscopic examination or the record offered by an x-ray plate (fig. 2), showing dextrocardia, a gas bubble in the stomach, and the exchanged positions of liver and spleen, will provide confirmation of the tentative diagnosis from physical signs. An electrocardiogram showing inversion of lead I and an exchange of position between leads II and III is pathognomonic of the true dextrocardia of complete transposition of the viscera. Observations made at operation and autopsy, particularly if supported by photographic records, cannot be gainsaid. Complicatio7is of SIV The following brief discussion may provide clues as to the type of individual in whom one should suspect the possibility of SIV. Kartagener(1) described a clinical triad since known as the Kartagener syndrome: SIV, sinusitis, and bronchiectasis. Adams 1. Kartagener, M.: Zur Pathogcnese der Bronchiektasien; Bronchiektasien bei Situs viscerum inversus, Beitr. z. Klin. d. Tuberk, 83:489-301, 1933.
Object Description
Rating | |
Fixed Title * | NCHH-17: North Carolina Medical Journal [1940-2001] |
Document Title | North Carolina Medical Journal [1940-2001] |
Subject Topical Other | Public Health -- Periodicals.; Physicians -- North Carolina -- Directory.; Societies, Medical -- North Carolina -- Periodicals. |
Description | Includes Transactions of the Society, -1960; 1961- , Transactions issued separately, bound in.; Includes Transactions of the auxiliary to the Medical Society of the State of North Carolina and Proceedings of the North Carolina Public Health Association. Official organ of the Medical Society of the State of North Carolina, 1940-May 1972; of the North Carolina Medical Society, June 1972-. Vols. for 1940-May 1972 published by the Medical Society of the State of North Carolina; June 1972- by the North Carolina Medical Society. |
Contributor | Medical Society of the State of North Carolina. Transactions.; Medical Society of the State of North Carolina.; North Carolina Medical Society.; North Carolina Medical Society. Transactions.; North Carolina Public Health Association. Proceedings. |
Publisher | [Winston-Salem] : North Carolina Medical Society [etc.], 1940- |
Repository | University of North Carolina at Chapel Hill. Health Sciences Library. |
Host | University of North Carolina at Chapel Hill |
Date | 1942 |
Identifier | NCHH-17-003 |
Form General | Periodicals |
Language | English |
Rights | This item is part of the North Carolina History of Health Digital Collection. Some materials in the Collection are protected by U.S. copyright law. This item is presented by the Health Sciences Library of the University of North Carolina at Chapel Hill for research and educational purposes. It may not be republished or distributed without permission of the Health Sciences Library. |
Digital Collection | North Carolina History of Health Digital Collection |
Sponsor | The North Carolina History of Health Digital Collection is an open access publishing initiative of the Health Sciences Library of the University of North Carolina at Chapel Hill. Financial support for the initiative was provided in part by a multi-year NC ECHO (Exploring Cultural Heritage Online) digitization grant, awarded by the State Library of North Carolina, and funded through the Library Services and Technology Act (LSTA). |
Volume Number | 3 |
Health Discipline | Medicine |
Digital Format | JPEG 2000 |
Print / Download PDF Version | http://archives.hsl.unc.edu/nchh/nchh-17/nchh-17-003.pdf |
Document Sort | all; nchh-17 |
Volume Link | http://dc.lib.unc.edu/cdm/search/collection/nchh/field/identi/searchterm/NCHH-17-003 |
Title Link | http://dc.lib.unc.edu/cdm/search/collection/nchh/field/documa/searchterm/NCHH-17 |
Catalog Record link | http://search.lib.unc.edu/search?R=UNCb1306322 |
Revision History | done |
Description
Fixed Title * | Page 585 (image) |
Document Title | North Carolina Medical Journal [1940-2001] |
Subject Topical Other | Public Health -- Periodicals.; Physicians -- North Carolina -- Directory.; Societies, Medical -- North Carolina -- Periodicals. |
Description | Includes Transactions of the Society, -1960; 1961- , Transactions issued separately, bound in.; Includes Transactions of the auxiliary to the Medical Society of the State of North Carolina and Proceedings of the North Carolina Public Health Association. Official organ of the Medical Society of the State of North Carolina, 1940-May 1972; of the North Carolina Medical Society, June 1972-. Vols. for 1940-May 1972 published by the Medical Society of the State of North Carolina; June 1972- by the North Carolina Medical Society. |
Contributor | Medical Society of the State of North Carolina. Transactions.; Medical Society of the State of North Carolina.; North Carolina Medical Society.; North Carolina Medical Society. Transactions.; North Carolina Public Health Association. Proceedings. |
Publisher | [Winston-Salem] : North Carolina Medical Society [etc.], 1940- |
Repository | University of North Carolina at Chapel Hill. Health Sciences Library. |
Host | University of North Carolina at Chapel Hill |
Date | 1942 |
Identifier | NCHH-17-003-0595 |
Form General | Periodicals |
Page Type | all; all images; x-ray; article |
Language | English |
Rights | This item is part of the North Carolina History of Health Digital Collection. Some materials in the Collection are protected by U.S. copyright law. This item is presented by the Health Sciences Library of the University of North Carolina at Chapel Hill for research and educational purposes. It may not be republished or distributed without permission of the Health Sciences Library. |
Filename | northcarolinamed31942medi_0595.jp2 |
Digital Collection | North Carolina History of Health Digital Collection |
Sponsor | The North Carolina History of Health Digital Collection is an open access publishing initiative of the Health Sciences Library of the University of North Carolina at Chapel Hill. Financial support for the initiative was provided in part by a multi-year NC ECHO (Exploring Cultural Heritage Online) digitization grant, awarded by the State Library of North Carolina, and funded through the Library Services and Technology Act (LSTA). |
Volume Number | 3 |
Issue Number | 11 |
Page Number | 585 |
Health Discipline | Medicine |
Full Text | November, 1942 VISCERAL TRANSPOSITION—BAUER 585 Fig. 1. (Case III) Note dextrocardia, dextroposition of the barium-filled esophagus, and exchanged position of stomach and liver. tions after muscular exertion, and that he would seek an explanation from friends or from his physician. However, Smith and Horton tell of a 47 year old woman with SIV who attempted suicide, unaware of her abnormality. She aimed “at the place where she thought the heart was situated and where, normally it would have been situated. The bullet entered . . . the fifth interspace about 3 inches ... to the left of the sternum . . . was removed a few days later by a surgeon.” Thus it is possible for the affected individual to reach middle life without an awareness of his anatomical peculiarity. Therefore responsibility for discovery rests with the physician. Physical Examination In a person with SIV the apex impulse will be found on the right. This finding and the observation that the right testicle hangs lower than the left may be noted at a glance, tempting one to venture a snap diagnosis of SIV. Careful percussion of the chest and abdomen will reveal the transposition of the heart, liver, stomach, and spleen. In a thin subject the aortic transposition can be noted by palpating for aortic pulsation, which will Fig. 2. (Case XVI) True dextrocardia, transposition of the abdominal viscera. (Courtesy of Dr. P. A. Yoder) be felt to the right side of the middle of the vertebral column. Whereas normally the right kidney is the lower, in SIV the left kidney is lower. Fluoroscopic examination or the record offered by an x-ray plate (fig. 2), showing dextrocardia, a gas bubble in the stomach, and the exchanged positions of liver and spleen, will provide confirmation of the tentative diagnosis from physical signs. An electrocardiogram showing inversion of lead I and an exchange of position between leads II and III is pathognomonic of the true dextrocardia of complete transposition of the viscera. Observations made at operation and autopsy, particularly if supported by photographic records, cannot be gainsaid. Complicatio7is of SIV The following brief discussion may provide clues as to the type of individual in whom one should suspect the possibility of SIV. Kartagener(1) described a clinical triad since known as the Kartagener syndrome: SIV, sinusitis, and bronchiectasis. Adams 1. Kartagener, M.: Zur Pathogcnese der Bronchiektasien; Bronchiektasien bei Situs viscerum inversus, Beitr. z. Klin. d. Tuberk, 83:489-301, 1933. |
Digital Format | JPEG 2000 |
Print / Download PDF Version | http://hsl.lib.unc.edu/specialcollections/nchealthhistory/nchh-17-pdf |
Document Sort | all; nchh-17 |
Article Title | The Recognition Of Visceral Transposition |
Article Author | D Def Bauer |
Volume Link | http://dc.lib.unc.edu/cdm/search/collection/nchh/field/identi/searchterm/NCHH-17-003 |
Title Link | http://dc.lib.unc.edu/cdm/search/collection/nchh/field/documa/searchterm/NCHH-17 |
Catalog Record link | http://search.lib.unc.edu/search?R=UNCb1306322 |
Revision History | done |
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