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Deep vein leg thrombosis
Vokme
Number
85
Letters to the Editor
6
2.
Simonyi Toxicol. 3. Simonvi 59:805: 4. Simonyi 5. Simonyi 1969. 6. Simonyi 1971.
et al.: Int. J. Clin. Pharmacol. Ther. 2:129, 246, 1969. et al.: Z. Kreislaufforsch. 58:835. 1969: 1970; 59:815, 1970; 60:579, 1971: et al.: Cor Vasa 12:38, 1969. et al.: Dtsch. Gesundheitsw. 24:2036, et al.:
Cardiol.
Dig.
5:12,
1970;
6:37,
Reply To the Editor: I am grateful to Dr. Simonyi for reprints of his original publications, which are mainly in German and Hungarian. He has done extensive and valuable investigations of the carotid derivative. Of great interest is that his method of application is quite different from ours, i.e., percentage changes in peak dD/dt are used only to express change of state, whereas we “normalized” the peak by expressing it as a per cent of total derivative amplitude. Dr. Simonyi also did not relate the changes to preejection period. On the other hand, he has done much more significant work than we have by relating dD/dt to aortic and ventricular dP/dt and to MSER. This is especially stimulating to me because it more solidly establishes this as a most valuable atraumatic (“unblutige”) method. I am delighted to acknowledge Dr. Simonyi’s excellent contributions. They should be consulted by all serious workers interested in atraumatic methods. David H. Sfiodick, M.D. Director of Cardiology Division Lemuel Shattuck Hospital Tufts University School of Medicine 170 Morton St. Boston, Mass. 02130
Deep
vein
leg thrombosis
To the Editor: I am writing with reference to the editorial by Browse entitled “The problems of deep vein thrombosis,” which appeared in the August, 1972, issue of the JOURNAL (84:149); it attracted my special attention. In the prevention of this condition and of pulmonary embolism that results, everything has been mentioned except the possibility that physical fitness, especially of the legs, achieved by walking or other exercise, may prove to be another important element in prophylaxis. There should be an analysis to see if deep vein leg thrombosis and pulmonary embolism are less common in the people who walk a lot compared with those who do not walk at all or very little. In my own note on the article I said, “Good so far as it goes, but there is no mention of frequent ambulation as a routine way of life, especially in older and heavier individuals who do or do not walk.” Paul
Dudley
White, M.D. 264 Beacon St. Boston. Mass. 02116
843
Reply To the Editor: Dr. White makes an important point concerning the etiology of the deep vein thrombosis which I did not mention in my article because there is no evidence to quote. It would be difficult to undertake a study to detect if activity before admission to hospital had any effect on the incidence of deep vein thrombosis because of the problems of controlling the many other factors, some known and many unknown, which also affect this disease. However, I suspect that he is right and that general physical fitness, and particularly fitness of the legs, may play its part in preventing embolism. One point worth remembering is that a number of studies in England have shown the incidence of thrombosis in small country hospitals to be lower than that in large hospitals in the towns. It is very likely that the patients in country hospitals lead a different life with regard to activity than the town dwellers and so this may be an indication that activity is important. One point no one would deny, frequent ambulation as a routine measure can do nothing but good. Assistant
Ejection
Norman L. Browse, M.D., F.R.C.S. Director and Professor of Surgery St. Thomas’s Hospital London S.E.1, England
fractions
To the Editor: I am writing in regard to the article entitled “Ejection fraction in anomalous origin of the left coronary artery from the pulmonary artery,” by Menke, Shaher, and Wolff, which was published in the JOURNAL in September, 1972 (84:325). In this article, the authors present data on left ventricular ejection fraction in ten patients with anomalous origin of the left coronary artery. Six of these patients with ejection fractions of 0.36 or less have died and four patients with ejection fractions from 0.55 to 0.84 are now alive. Three of the survivors have undergone successful surgery and one has been treated medically. The authors make the statement that those with ejection fractions less than 0.35 have a poor prognosis regardless of the method employed and should be treated by vigorous medical therapy. We have some interesting data on one patient in this regard that may be of interest to the authors. The data on this patient were presented in a review article in the Pediatric Clinics of North America (18:1109, 1971). The patient in question was seen at age 11 months and had an anomalous left coronary artery with myocardial infarction and congestive heart failure. At the time of his initial study, he had a left ventricular end-diastolic volume which was 558 per cent of normal and an ejection fraction of 0.10. He underwent ligation of the anomalous coronary artery with marked clinical improvement. He was restudied at age five years, at which time his end-diastolic volume had decreased markedly to only 170 per cent of normal. The ejection fraction had increased from 0.10 to 0.52. In addition,
Number
85
Letters to the Editor
6
2.
Simonyi Toxicol. 3. Simonvi 59:805: 4. Simonyi 5. Simonyi 1969. 6. Simonyi 1971.
et al.: Int. J. Clin. Pharmacol. Ther. 2:129, 246, 1969. et al.: Z. Kreislaufforsch. 58:835. 1969: 1970; 59:815, 1970; 60:579, 1971: et al.: Cor Vasa 12:38, 1969. et al.: Dtsch. Gesundheitsw. 24:2036, et al.:
Cardiol.
Dig.
5:12,
1970;
6:37,
Reply To the Editor: I am grateful to Dr. Simonyi for reprints of his original publications, which are mainly in German and Hungarian. He has done extensive and valuable investigations of the carotid derivative. Of great interest is that his method of application is quite different from ours, i.e., percentage changes in peak dD/dt are used only to express change of state, whereas we “normalized” the peak by expressing it as a per cent of total derivative amplitude. Dr. Simonyi also did not relate the changes to preejection period. On the other hand, he has done much more significant work than we have by relating dD/dt to aortic and ventricular dP/dt and to MSER. This is especially stimulating to me because it more solidly establishes this as a most valuable atraumatic (“unblutige”) method. I am delighted to acknowledge Dr. Simonyi’s excellent contributions. They should be consulted by all serious workers interested in atraumatic methods. David H. Sfiodick, M.D. Director of Cardiology Division Lemuel Shattuck Hospital Tufts University School of Medicine 170 Morton St. Boston, Mass. 02130
Deep
vein
leg thrombosis
To the Editor: I am writing with reference to the editorial by Browse entitled “The problems of deep vein thrombosis,” which appeared in the August, 1972, issue of the JOURNAL (84:149); it attracted my special attention. In the prevention of this condition and of pulmonary embolism that results, everything has been mentioned except the possibility that physical fitness, especially of the legs, achieved by walking or other exercise, may prove to be another important element in prophylaxis. There should be an analysis to see if deep vein leg thrombosis and pulmonary embolism are less common in the people who walk a lot compared with those who do not walk at all or very little. In my own note on the article I said, “Good so far as it goes, but there is no mention of frequent ambulation as a routine way of life, especially in older and heavier individuals who do or do not walk.” Paul
Dudley
White, M.D. 264 Beacon St. Boston. Mass. 02116
843
Reply To the Editor: Dr. White makes an important point concerning the etiology of the deep vein thrombosis which I did not mention in my article because there is no evidence to quote. It would be difficult to undertake a study to detect if activity before admission to hospital had any effect on the incidence of deep vein thrombosis because of the problems of controlling the many other factors, some known and many unknown, which also affect this disease. However, I suspect that he is right and that general physical fitness, and particularly fitness of the legs, may play its part in preventing embolism. One point worth remembering is that a number of studies in England have shown the incidence of thrombosis in small country hospitals to be lower than that in large hospitals in the towns. It is very likely that the patients in country hospitals lead a different life with regard to activity than the town dwellers and so this may be an indication that activity is important. One point no one would deny, frequent ambulation as a routine measure can do nothing but good. Assistant
Ejection
Norman L. Browse, M.D., F.R.C.S. Director and Professor of Surgery St. Thomas’s Hospital London S.E.1, England
fractions
To the Editor: I am writing in regard to the article entitled “Ejection fraction in anomalous origin of the left coronary artery from the pulmonary artery,” by Menke, Shaher, and Wolff, which was published in the JOURNAL in September, 1972 (84:325). In this article, the authors present data on left ventricular ejection fraction in ten patients with anomalous origin of the left coronary artery. Six of these patients with ejection fractions of 0.36 or less have died and four patients with ejection fractions from 0.55 to 0.84 are now alive. Three of the survivors have undergone successful surgery and one has been treated medically. The authors make the statement that those with ejection fractions less than 0.35 have a poor prognosis regardless of the method employed and should be treated by vigorous medical therapy. We have some interesting data on one patient in this regard that may be of interest to the authors. The data on this patient were presented in a review article in the Pediatric Clinics of North America (18:1109, 1971). The patient in question was seen at age 11 months and had an anomalous left coronary artery with myocardial infarction and congestive heart failure. At the time of his initial study, he had a left ventricular end-diastolic volume which was 558 per cent of normal and an ejection fraction of 0.10. He underwent ligation of the anomalous coronary artery with marked clinical improvement. He was restudied at age five years, at which time his end-diastolic volume had decreased markedly to only 170 per cent of normal. The ejection fraction had increased from 0.10 to 0.52. In addition,