136. Adrenalectomy and sympathectomy for hypertension: Ten year survival

College News Left ventricular recorded in groups left

that included

atria1

pressure,

ventricular (apex

and systemic

in all dogs. Other

to coronary length

ning suture

tension,

(apex

and

after the sensors

for the prongs measuring

left

tendinea

atria1

pressures,

tension,

In

by runhad been

When

changes

the coronary

fibrillation.

“LV

be reversed

by raising

When heart

severe

was restrained

therapeutic

without

maneuver These

conclusions

of

failure

any

restored

while

earlier

of

additional

They

treatment

has

Idiopathic

Versus

with

suggest

in acute heart

Secondary

Diagnosis

ALEXANDER

Based

211

innocent

Cases,

and

BERNARD F.A.c.c.,

M.D.,

Minn.

evidence

of

considered

an

it

in

appears

coarctation following

of the aorta,

myocardial

infarc-

and mitral regurgitation. in patients

with mitral

by intracardiac

in the inflow tract

Left

in the path of

ventriculography

demonstrates

grade 2 (grading

regurgitation

phonocardiography

of the left ventricle

jet.

of the mitral

136.

been

commonly

obstruction,

This murmur

leaflet

has

to

The mur-

lesions such as left ventricular

syndrome,

radiography

in mid-

late systole

without

and

More

tion or pericarditis,

its onset

during

encountered

with specific

tract

has

aortic valve closure.

disease

bulging

valve

during

Phonocardiographic were made

by cine-

of

the

early

1 to 4) regurgitation

septal

systole

confined

and

and

to late

pathophysiologic

in 35 patients

with the late

murmur. Adrenalectomy

Hypertension:

JR., M.D., Rochester,

G. HARRISON,

Murmur,

murmur

finding.

systolic

SCHIRGER, M.D., JOHN A. SPITTELL, JR.,

M.D. and EDGAR

bethey

features

LIKOFF,

in intensity

been

observations

Lymphedema:

Upon

Systolic

systolic

heart

systole.

Differential

and

Ten

Sympathectomy

Year

Survival,

for

ALFRED

M.

SELLERS, M.D., F.A.C.C.,R. H. LOPEZ, M.D., CHARLES

The

differential

(primary) limb

diagnosis

and secondary

is important,

serious

praecox

lymphedema and

8 had

lymphedema

as men, fourth

had

women.

a

with

episode common

was

In several

cases)

and

caused

men

neoplastic

by infection,

lymphangitis

withan in-

the swelling. disease,

Next

prostatic

combined

1953,

JEFFERS, M.D., S. BLAKE-

103 patients

with

Fifty-six

of advanced

mortality

infarction,

33%

tive mortality had

an

surgery;

was 5%.

excellent 12yc failure

cleared

was the first

proved

in 3070.

had myocardial

uremia.

The opera-

response

to improve.

Heart

of renal

THE AMERICANJOURNAL

547.

following

Papilledema

in all patients.

Preservation

Papil-

failure in

the 56 survivors,

hypotensive

failed

cardiac

disease.

39%

and 10% Among

thora(54%)

of the preopera-

and cardiac

was 46yo; stroke

of

by the Smithwick in Smithwick Class

vascular

ledema was noted in 18 patients

or

patients

10 to 13 years. Severity

hypertension was gauged 48 patients were classification;

49. The

forms adrenalec-

subdiaphragmatic

tive

IV indicative

with severe

to all previous

to total or subtotal

sympathectomy.

in

in men and lymphoma lymphedema

as

age 40, seldom

the last circumstance preceded

a

In contrast,

affected

before

when

cases,

were subjected

have survived

by recurrent

predominating

tomy

and

unresponsive

age 40 in most.

started

always

1950

before

lymphangitis.

Under

Between hypertension,

columbar

lymphedema

A.

MORE, M.D., Philadelphia.

10 times as often

(80

legs except

Idio-

M.D., WILLIAM

D. ITSKOVITZ, M.D. and WILLIAM

therapy,

lymphedema

lymphedema).

bilateral

rarely

out trichophytosis. most

represent patients

WOLFERTH,

HAROLD

women

began

had

complicating

both

carcinoma

of the lower

may 211 had

congenital

and was often caused fectious

Of (123

lymphedema

often as women, affected

latter

affected

and swelling

the patients

secondary

the

disease.

C.

idiopathic

of the lower limb seen in 7 years, 131 had

idiopathic pathic

between

lymphedema

for

underlying

lymphedema

Half

late

the regurgitant

states.

134.

diagnosis

lymphedema,

by historical

WILLIAM

increasing

is demonstrated as

are at variance

investigators.

as a possible

M.D. and

the Marfan

of the measurements

observations

The

outflow

the

competence,

Late

*135.

association

opening

other

full

to normal

50

pressure.

supervened

in a

findings alone.

organic

but not always,

perfusion

and secondary

SEGAL,

mur

to ventricular

by the pericardium,

from return

listed above.

was below

could often, failure

sac

pericardiotomy

tension,

neoplasm

of one leg. Although

aids in differential

idiopathic

end with and envelope

dimensions.

pressure

the coronary

heart

pericardial

evident

tendinea

often progressed

failure”

lymphangiography

systole

chorda

of cardiac

perfusion

mm. Hg, “LV failure”

with swelling

presenting

of this may per-

malignant

Philadelphia.

LV segment

diastolic

low systolic chorda

characteristic

patient

physical

by high LVDP.

high

awareness

of occult

The

was characterized

of neoplasm;

mit early diagnosis

often can be distinguished

LV

prongs.

was closed

manifestation

tween

left ventricular

to base),

with transmural

or coaptation

left

length

which moved in an open slot).

high

the

internally),

length

Acute LV failure

and

they included

ventricular

the pericardium

(except

length,

ostium

were

were made

tendinea left

measured

all experiments applied

chorda

segment

pressures

6 to 12 dogs;

circumference,

epicardial segment

arterial

measurements

and

size im-

function

has

OF CARDIOLOGY

College News bec.n

excellent.

Adrenal

management.

The

antihypcrtensivc much

less

presented

advent

agents

necessary.

following pares

rcplacemcnt

and Florins.”

cortisone

of newer,

so favorably

other

patients

in

effective

collateral

channels

These areas

of medical

and

its consideration

whose vascular

in the face of difficult

of factors

survival comin

disease

medical

is

manage-

collaterals

Fortunately,

Postsurgical

Complete

Heart

Block,

ROBERT

D. SELLERS, M.D., ANATOLIO B. CRUZ, M.D., ROBERT S. EI.IOT,

C. WALTON LILLEHEI,

M.D., F.A.C.C.

channels

containing vein

Postsurgical plications

heart

over-all

mortality

complete

from

mostsignificantly

open

cardiac

block has been enountered

cent of the patients at the University

undergoing

August

1955 expired.

was used January were

heart

with Isuprel

with

electrode

postsurgical

heart

70 per cent survived

Sixty per cent of the surviving

The

sinus rhythm

chronic

been divided surgical

block

electrode

period.

postsurgical

of cases.

the acute

Of treated

and pace-

postoperative group

while 40 per cent remained heart

clusion

block

into those with chronic

33,

and

is believed

future.

Of the 26 living

entirely

The

cases

have

complete

post-

heart block and those with intermittent

com-

heart block. The late mortality

mammary

arteriograms

rate

The

Ingestion

chronic

block and many of those

type have been managed

with

each

group

surgical

of lesions

cussed.

for

obtained

in

etiology

of post-

to complete-

of septal defects will be considered

important The

The

block and its relationship

ness of closure factors

in avoiding

management

heart

and

block will be dis-

of postsurgical

in both the acute and chronic

measurements reduced

The

Pedicle

Operation

heart

block

stage will be presented. for Angina

WILLIAM H. SEWELL, M.D., Oteen, JANUARY 1964

N. C.

mammary

been

obtained.

except

blood

for the I

Pectoris,

and

Shock

of Barbiturates

SHZJBIN,

or

M.D., F.A.c.c.,

V.4s.4~r

N.

UDH~JI,

were

performed.

increase

amounts

in blood

doxically When

in peripheral

was disproportionately

oxygen pCOZ

saturation was

produced

and blood

blood fell.

to high

agents was of special

to elevate

output

With

assisted at

near

was in was

normal fluids. interest. an in-

flow, and para-

arterial

resistance.

were

to normal

was reduced

maintained

There

of intravenous

doses of metaraminol pressure

output

volume.

index

resistance

serial

predominantly

of metaraminol

pressure

a decrease

larger

plasma

in cardiac

of of

in whom

Cardiac

administration

ingestion

administration

in one half of the patients,

Moderate crease

following or

in 12 patients

The effect of vasopressor

diac 138.

was studied

values following

surgery

Doses

with coma

block following

will be presented.

heart

patients

tranquilizers

those who had decreased

and the results

to be open in all

casts have

HERBERT

associated

prompt

types

for

of Hypotension

with much more encourag-

ing results. various

ex-

postoperative

MAX H. WEIL, M.D., F..4.c.c.,

postsurgical

of heart

The

to be known

M.B. and LEONARD ROSOFF, M.D., Los Angeles.

complete

The incidence

was found

of Suicidal

Tranquilizers,

narcotics

pacemaker

22 are

was found to be carrying

Mechanism

in 1962,

an implantable

artery

of all of these

139.

Beginning

heart

in the

patients,

improved.

is believed

on whom artery

After

Shock

the intermittent

avoidable

that died two weeks postoperatively.

barbiturates,

with

or greatly

or corrosion

The mammary

per cent while that in the latter group was 12 per cent. with

in

performed

who are the same, or only a little better.

of the 5 patients

to the heart

was found

has been

postpedicle

for the failure

in the former group seen up to the end of 1961 was 74 all of the patients

for collateral

to be potentially

free of angina

the 4 patients

on 61

cause of 2 of the 4 postoperative

deaths

planation

was performed

operation

The

oc-

to be a prob-

of having angina pectoris.

“demand”

on 30 of them.

wall.

implant.

clinically

the pedicle

mammary It was im-

found

cinearteriography

A physiologic

artery, tissue.

the postoperative

artery

lem with the Vineberg suspected

The best

from a pedicle

in the left ventricular avoided

of the mammary

Coronary

in dogs

reverted

heart block.

postsurgical

plete postsurgical

In

and pacemaker

armamentarium.

and/or a myocardial

to a normal

All

block seen before

maker,

in chronic

10 per surgery

at that time, Isuprel@

to the therapeutic

the 200 cases

and

Center.

of this group

1957 a myocardial

added

in about

Medical

Beginning

in the therapy

surgery,

intracardiac

of Minnesota

of the cases with postsurgical

to the

mammary

of pedicle

blood.

be recognized

connective

in an incision

type

only to

cinearteriography.

the internal

of

system.

for arterial

in dogs developed

and surrounding

patients

block has been one of the com-

that has contributed

can

arterial to develop

“demand”

areas

an under-

the development

can be expected

with coronary

collateral

and

MORRIS .I. LEVY, M.D., Minneapolis.

control

to the coronary

such

or patients

This 137.

over 650 dogs gave

that

with physiologic

planted

ment.

using

standing

treatment

term

forms

Experiments

with

sympathectomy

as to revive

those hypertensive progressing

long

and

with

treatment

more

has made surgical However,

adrenalcctomy

surgical

therapy few problems

used so as

range,

peripheral

increased

and car-

ventilation,

arterial

in only one patient, normal

levels,

and