- Email: [email protected]
Answers to some objections to extensive sympathectomy for essential hypertension
760
THE
AMERICAN
HEART
JOURmNAL
The facts here presented, while not conclusive, clearly indicate the need for a more thorough study of (1) the epidemiology of this disease, especially with regard to the sequence between cases in the same family, and (2) the inherited predisposition, including a search for stable somatic characteristics which might be associated with susceptibility to rheumatic infection. AUTHOR.
Allen, E. V., and Aclson, A. W.: Answers pathectomy for Essential Hypertension. 426,
to Some Objections Proc.
Staff
to Extensive
Meet.,
Mayo
Clinic
Sym13:
1938.
An extraordinary interest in the treatment of essential hypertension by sympathectomy has developed. Concurrently with this interest, certain objections to the treatment of essential hypertension by sympathectomy have been broached. The objections most frequently stated are considered and answered for the purpose of clarification of the issues. Most of the theoretical objections have been shown not to be valid as far as humans are concerned by the results obtained following sympathectomy. HINES.
Zinck,
K. H.:
Wchnschr.
Changes in Blood 17:
278,
Vessels and Organs Following
Burns.
Klin.
1938.
Microscopic studies of the tissues of eight youthful subjects who died of third Some of these changes are, as the degree burns showed many interesting changes. author admits, well known. The author notes especially localized swellings of the larger arteries around the vasa vasorum, which appear within twenty-four hours and progress through atrophy of both the elastic and muscular coats to fragmentation within three weeks. The muscular coats of the venous walls also participate in the process, and even in the aorta is affected to a milder degree. The lesions recall those reported to follow extreme use of adrenalin in man. The heart also is involved partly by a similar affection of the coronary vessels and partly in an apparently independent process consisting of edema and fatty degeneration of the fibers, often with considerable destruction of the contractile substance. All of the organs and tissues show pathologic changes; swelling and rupture of the striated muscle fibers; replacement of the normal white cells of the blood by youthful cells of the myeloid series and shrinking of the red blood cells; in the kidney, inflation, collapse and lysis of the glomeruli; hemorrhage into the capsular spaces, cloudy swelling and hyalinization of the tubules, occasionally severe Somewhat similar changes, mostly panarteritis but always widespread edema. involving edema are found in all the organs. Of especial interest is the disappearance of lipoid from the adrenal glands and the disappearance of the basophilic substance and pepton cells of the pituitary gland. The author wonders whether these changes might not be of importance in the lack of regulation of blood pressure. In concluding, he states that many of the pathologic changes are similar to those of acute infections, notably diphtheria, and decries the use of cortical extract in treatment when it is obvious that the adrenal gland is only one of the many organs involved. STEELE.
MBsz~ros, Scandinav.
Oscillometric
K. : 95:
Studies of the Arteries
in Scleroderma.
Acta med.
522, 1938.
Ten patients, suffering with oscillometric index and in the
scleroderma, more advanced
uniformly cases,
the
showed curve
decrease in the was exceedingly
THE
AMERICAN
HEART
JOURmNAL
The facts here presented, while not conclusive, clearly indicate the need for a more thorough study of (1) the epidemiology of this disease, especially with regard to the sequence between cases in the same family, and (2) the inherited predisposition, including a search for stable somatic characteristics which might be associated with susceptibility to rheumatic infection. AUTHOR.
Allen, E. V., and Aclson, A. W.: Answers pathectomy for Essential Hypertension. 426,
to Some Objections Proc.
Staff
to Extensive
Meet.,
Mayo
Clinic
Sym13:
1938.
An extraordinary interest in the treatment of essential hypertension by sympathectomy has developed. Concurrently with this interest, certain objections to the treatment of essential hypertension by sympathectomy have been broached. The objections most frequently stated are considered and answered for the purpose of clarification of the issues. Most of the theoretical objections have been shown not to be valid as far as humans are concerned by the results obtained following sympathectomy. HINES.
Zinck,
K. H.:
Wchnschr.
Changes in Blood 17:
278,
Vessels and Organs Following
Burns.
Klin.
1938.
Microscopic studies of the tissues of eight youthful subjects who died of third Some of these changes are, as the degree burns showed many interesting changes. author admits, well known. The author notes especially localized swellings of the larger arteries around the vasa vasorum, which appear within twenty-four hours and progress through atrophy of both the elastic and muscular coats to fragmentation within three weeks. The muscular coats of the venous walls also participate in the process, and even in the aorta is affected to a milder degree. The lesions recall those reported to follow extreme use of adrenalin in man. The heart also is involved partly by a similar affection of the coronary vessels and partly in an apparently independent process consisting of edema and fatty degeneration of the fibers, often with considerable destruction of the contractile substance. All of the organs and tissues show pathologic changes; swelling and rupture of the striated muscle fibers; replacement of the normal white cells of the blood by youthful cells of the myeloid series and shrinking of the red blood cells; in the kidney, inflation, collapse and lysis of the glomeruli; hemorrhage into the capsular spaces, cloudy swelling and hyalinization of the tubules, occasionally severe Somewhat similar changes, mostly panarteritis but always widespread edema. involving edema are found in all the organs. Of especial interest is the disappearance of lipoid from the adrenal glands and the disappearance of the basophilic substance and pepton cells of the pituitary gland. The author wonders whether these changes might not be of importance in the lack of regulation of blood pressure. In concluding, he states that many of the pathologic changes are similar to those of acute infections, notably diphtheria, and decries the use of cortical extract in treatment when it is obvious that the adrenal gland is only one of the many organs involved. STEELE.
MBsz~ros, Scandinav.
Oscillometric
K. : 95:
Studies of the Arteries
in Scleroderma.
Acta med.
522, 1938.
Ten patients, suffering with oscillometric index and in the
scleroderma, more advanced
uniformly cases,
the
showed curve
decrease in the was exceedingly