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Electrocardiography in hypertension: Study of patients subjected to lumbodorsal splanchnicectomy
388
AMERICAN
These results indicate tion which, in the presence fluid into the blood stream. of mercurial diuretics. Manchester, Intensive (Aug.),
HEART
JOURNAL
that a diuresis produced by mercurophylline causes hemoconcentraof peripheral edema, is compensated by a rapid inflow of interstitial This interpretation is consistent with the theory of the renal action
R. C. : Rheumatic Salicylate Therapy 1946.
RELLET.
Fever in Naval Enlisted Personnel: in Cases of Acute Infection.
II. Effectiveness of Arch. Int. Med. 78:170
Studies of salicylate therapy were made in a series of seventy-seven young men with acute rheumatic fever, all of whom exhibited acute polyarticular arthritis as a major manifestation. Fiftyfour patients received intensive salicylate therapy patterned after the regimen outlined by Coburn. Of this group, thirty-five received intravenously 10 Gm. of sodium salicylate in 1 liter of lactate Ringer’s solution or isotonic sodium chloride solution daily for four to ten days; this was followed by oral therapy. The remaining nineteen patients received only oral therapy throughout the course of treatment. The twenty-three patients who comprised the control group received small quantities of salicylate for symptomatic relief of acute symptoms. The results obtained in the intensively treated and the control groups were compared on the basis of temperature, articular manifestations, erythrocyte sedimentation rate, electrocardiographic and clinical findings, and the incidence of relapse and residuae. In the fifty-four patients who received intensive therapy, the average duration of fever was 36 days, and of objective articular manifestations, 2.8 days. In striking contrast, the average duration of fever in the control group was fifteen days and of objective articular manifestations, twenty-six days. The average duration of elevated erythrocyte sedimentation rate was tyenty days in the intensively treated patients and forty-two days in the control group. The cardiac manifestations at the termination of treatment were carefully studied. Of the patients who received intensive therapy, 71 per cent showed no evidence of residual cardiac damage; 15 per cent were classified as having potential rheumatic heart disease on the basis of a slight or moderate mitral systolic murmur. Seven and four-tenths per cent of the intensively treated group had significant carditis \yhen treatment was instituted. This process cleared up completely in all but one patient who was left with a moderate mitral systolic murmur. Significant cardiac residuae were present in 7.4 per cent of the group receiving intensive therapy; only one patient died of heart disease. Significant carditis did not develop in any patient who had not shown evidence of carditis before treatment was begun. In the control group, on the other hand, only 48 per cent of the patients escaped with undamaged hearts, 39 per cent were classified as having potential rheumatic heart disease, and 4.3 per cent had significant carditis which cleared up. In 13 per cent, significant cardiac residua were present. The incidence of chronic infection, as determined by residual arthritis and increased sedimentation rate, was 6 per cent in the intensively treated group and 18 per cent in the control group. The author concludes that the period of active infection is materially shortened and that relapses and residual chronic infection, although not prevented, occur less frequently in patients receiving intensive salicylate therapy than in those who receive symptomatic therapy. Except in occasional severe and refractory infections, salicylate administered orally is as effective as Carditis present prior to treatment was favorably insalicylate administered intravenously. fluenced by intensive salicylate therapy; resulting cardiac manifestations were distinctly less in the intensively treated as compared with the control group. BELLET. Bridges, W. C., Johnson, A. I,., Smithwick. R. H., and White, raph,y in Hypertension: Study of Pati.ents Subjected chnicectomy. J. A. M. A. 131:1476 (Aug. 31), 1946.
P. D.: Electrocardiogto Lumhodorsal Splan-
The authors describe the changes in the electrocardiogram which are frequently encountered in patients with diastolic hypertension after the reduction of blood pressure by lumbodorsal sympathectomy. A comparison was made between the preoperative and postoperative electrocardiograms taken two weeks and one year or longer after sympathectomy in the cases of 144 patients who were observed for at least one year. Preoperatively, these cases were divided into
SELECTED
38’)
ABSTRACTS
three groups on the basis of pulse pressure in relation to the diastolic level. Type I comprised patients with the narrowest and Type III those with the widest pulse pressures. The following electrocardiographic changes were noted: In the limb leads, 44.5 per cent of the preoperative records were abnormal or borderline. There was a progressive improvement in the abnormal records following operation. Sixty-seven per cent of the total series were normal two weeks postoperatively, and 78.5 per cent were normal at the end of a year. The most favorable group for operation, Type I, had the highest percentage of normal preoperative records. The greatest return to normal occurred in the most unfavorable group, Type III. Following operation, a swing of the electrical axis of more than 10 degrees toward the right took place in 34.1 per cent of the cases by the end of a year. R, decreased in amplitude more than 3 mm. in 41.7 per cent of the cases after one year. The T waves preoperatively were abnormal in 25 per cent of the cases. A year after operation the T waves were practically normal in Lead I in 86.1 per cent of the cases and in Lead II in 90.9 per cent. In the chest leads, 50 per cent were abnormal preoperatively. There was a return to normal by the end of one year in 15 per cent. The T waves of the chest leads when abnormal, tended to improve in each lead postoperatively. From this study, the authors conclude that when hypertensive patients with electrocardiographic evidence of cardiac strain, which is often the first manifestation of impending or actual heart disease, are subjected to bilateral lumbodorsal sympathectomy, they frequently show an improvement in the hypertensive electrocardiographic pattern one year or more postoperatively. This is consistent with the decreased work of the left ventricle. BELLET. Perrin,
P. : Symptoms
Consideration in 50 Year
of Old
the Men.
Pathogenesis
and
Arch.
J. mal.
Treatment
du coeur
39:96
of
Functional
Cardiac
(March-April),
1946.
Symptoms of dyspnoea and tachycardia on effort, often accompanied by chest pain, are frequent in men about 50 years of age who have no objective evidence of heart disease. This type of illness is often very refractory to treatment. The author reports, however, that he obtained striking symptomatic improvement by the injection of vitamin B, 1 mg. every second day, and of testosterone, 25 mg. twice a week. The selection of medication was based on the views of Jayet-Lavergne that vitamin B has a specific effect on cellular polarization in the male. It is emphasized that although the explanation of the mode of action of the treatment is admittedly speculative, the clinical results have been most encouraging in a large group of patients who had received little or no benefit from other forms of therapy. LaPLacE. Lehlanc,
M.
of Mitral
:
Micro-Nodulation. Disease.
a Manifestation
Arch.
J. mal.
du coeur
of Pulmonary
39:69
(March-April),
Stasis
in
the
Presence
1946.
A case of mitral stenosis is reported in which x-ray examination revealed dense mottling throughout both lung fields due to the presence of miliary nodules and what appeared to be small cavities. This condition is easily confused with tuberculosis. Actually it is a rare manifestation of pulmonary stasis due to mitral disease. It is persistent and is not altered by clinical improvement in heart function. It has been ascribed to accumulation of carbon or hemoglobin due to stasis and intra-alveolar edema. LAPLJKE. Lian,
C., and Intercostal
Guinard, Space.
P. : The
Arch.
Practical
J. mal.
Importance
du coeur
39:92
of Auscultation
(March-April),
in
the
First
Right
1946.
The authors believe that the importance of auscultation in the first right intercostal space should be better appreciated. Systolic murmurs which arise from the aorta are almost invariably loudest in this area. There are two circumstances in which this fact may be helpful in diagnosis. When a patient is suspected of having mitral insufficiency and the systolic murmur extends to the base of the heart, if the murmur is best heard in the first right interspace, it is aortic in origin, irrespective of the presence or absence of mitral disease. When a systolic murmur is of equal intensity in the second right and left interspaces, it is aortic and not pulmonic if it is loudest in the first right interspace. Occasionally this area may also be the only site at which an aortic diastolic murmur can be heard. LAPLACE.
AMERICAN
These results indicate tion which, in the presence fluid into the blood stream. of mercurial diuretics. Manchester, Intensive (Aug.),
HEART
JOURNAL
that a diuresis produced by mercurophylline causes hemoconcentraof peripheral edema, is compensated by a rapid inflow of interstitial This interpretation is consistent with the theory of the renal action
R. C. : Rheumatic Salicylate Therapy 1946.
RELLET.
Fever in Naval Enlisted Personnel: in Cases of Acute Infection.
II. Effectiveness of Arch. Int. Med. 78:170
Studies of salicylate therapy were made in a series of seventy-seven young men with acute rheumatic fever, all of whom exhibited acute polyarticular arthritis as a major manifestation. Fiftyfour patients received intensive salicylate therapy patterned after the regimen outlined by Coburn. Of this group, thirty-five received intravenously 10 Gm. of sodium salicylate in 1 liter of lactate Ringer’s solution or isotonic sodium chloride solution daily for four to ten days; this was followed by oral therapy. The remaining nineteen patients received only oral therapy throughout the course of treatment. The twenty-three patients who comprised the control group received small quantities of salicylate for symptomatic relief of acute symptoms. The results obtained in the intensively treated and the control groups were compared on the basis of temperature, articular manifestations, erythrocyte sedimentation rate, electrocardiographic and clinical findings, and the incidence of relapse and residuae. In the fifty-four patients who received intensive therapy, the average duration of fever was 36 days, and of objective articular manifestations, 2.8 days. In striking contrast, the average duration of fever in the control group was fifteen days and of objective articular manifestations, twenty-six days. The average duration of elevated erythrocyte sedimentation rate was tyenty days in the intensively treated patients and forty-two days in the control group. The cardiac manifestations at the termination of treatment were carefully studied. Of the patients who received intensive therapy, 71 per cent showed no evidence of residual cardiac damage; 15 per cent were classified as having potential rheumatic heart disease on the basis of a slight or moderate mitral systolic murmur. Seven and four-tenths per cent of the intensively treated group had significant carditis \yhen treatment was instituted. This process cleared up completely in all but one patient who was left with a moderate mitral systolic murmur. Significant cardiac residuae were present in 7.4 per cent of the group receiving intensive therapy; only one patient died of heart disease. Significant carditis did not develop in any patient who had not shown evidence of carditis before treatment was begun. In the control group, on the other hand, only 48 per cent of the patients escaped with undamaged hearts, 39 per cent were classified as having potential rheumatic heart disease, and 4.3 per cent had significant carditis which cleared up. In 13 per cent, significant cardiac residua were present. The incidence of chronic infection, as determined by residual arthritis and increased sedimentation rate, was 6 per cent in the intensively treated group and 18 per cent in the control group. The author concludes that the period of active infection is materially shortened and that relapses and residual chronic infection, although not prevented, occur less frequently in patients receiving intensive salicylate therapy than in those who receive symptomatic therapy. Except in occasional severe and refractory infections, salicylate administered orally is as effective as Carditis present prior to treatment was favorably insalicylate administered intravenously. fluenced by intensive salicylate therapy; resulting cardiac manifestations were distinctly less in the intensively treated as compared with the control group. BELLET. Bridges, W. C., Johnson, A. I,., Smithwick. R. H., and White, raph,y in Hypertension: Study of Pati.ents Subjected chnicectomy. J. A. M. A. 131:1476 (Aug. 31), 1946.
P. D.: Electrocardiogto Lumhodorsal Splan-
The authors describe the changes in the electrocardiogram which are frequently encountered in patients with diastolic hypertension after the reduction of blood pressure by lumbodorsal sympathectomy. A comparison was made between the preoperative and postoperative electrocardiograms taken two weeks and one year or longer after sympathectomy in the cases of 144 patients who were observed for at least one year. Preoperatively, these cases were divided into
SELECTED
38’)
ABSTRACTS
three groups on the basis of pulse pressure in relation to the diastolic level. Type I comprised patients with the narrowest and Type III those with the widest pulse pressures. The following electrocardiographic changes were noted: In the limb leads, 44.5 per cent of the preoperative records were abnormal or borderline. There was a progressive improvement in the abnormal records following operation. Sixty-seven per cent of the total series were normal two weeks postoperatively, and 78.5 per cent were normal at the end of a year. The most favorable group for operation, Type I, had the highest percentage of normal preoperative records. The greatest return to normal occurred in the most unfavorable group, Type III. Following operation, a swing of the electrical axis of more than 10 degrees toward the right took place in 34.1 per cent of the cases by the end of a year. R, decreased in amplitude more than 3 mm. in 41.7 per cent of the cases after one year. The T waves preoperatively were abnormal in 25 per cent of the cases. A year after operation the T waves were practically normal in Lead I in 86.1 per cent of the cases and in Lead II in 90.9 per cent. In the chest leads, 50 per cent were abnormal preoperatively. There was a return to normal by the end of one year in 15 per cent. The T waves of the chest leads when abnormal, tended to improve in each lead postoperatively. From this study, the authors conclude that when hypertensive patients with electrocardiographic evidence of cardiac strain, which is often the first manifestation of impending or actual heart disease, are subjected to bilateral lumbodorsal sympathectomy, they frequently show an improvement in the hypertensive electrocardiographic pattern one year or more postoperatively. This is consistent with the decreased work of the left ventricle. BELLET. Perrin,
P. : Symptoms
Consideration in 50 Year
of Old
the Men.
Pathogenesis
and
Arch.
J. mal.
Treatment
du coeur
39:96
of
Functional
Cardiac
(March-April),
1946.
Symptoms of dyspnoea and tachycardia on effort, often accompanied by chest pain, are frequent in men about 50 years of age who have no objective evidence of heart disease. This type of illness is often very refractory to treatment. The author reports, however, that he obtained striking symptomatic improvement by the injection of vitamin B, 1 mg. every second day, and of testosterone, 25 mg. twice a week. The selection of medication was based on the views of Jayet-Lavergne that vitamin B has a specific effect on cellular polarization in the male. It is emphasized that although the explanation of the mode of action of the treatment is admittedly speculative, the clinical results have been most encouraging in a large group of patients who had received little or no benefit from other forms of therapy. LaPLacE. Lehlanc,
M.
of Mitral
:
Micro-Nodulation. Disease.
a Manifestation
Arch.
J. mal.
du coeur
of Pulmonary
39:69
(March-April),
Stasis
in
the
Presence
1946.
A case of mitral stenosis is reported in which x-ray examination revealed dense mottling throughout both lung fields due to the presence of miliary nodules and what appeared to be small cavities. This condition is easily confused with tuberculosis. Actually it is a rare manifestation of pulmonary stasis due to mitral disease. It is persistent and is not altered by clinical improvement in heart function. It has been ascribed to accumulation of carbon or hemoglobin due to stasis and intra-alveolar edema. LAPLJKE. Lian,
C., and Intercostal
Guinard, Space.
P. : The
Arch.
Practical
J. mal.
Importance
du coeur
39:92
of Auscultation
(March-April),
in
the
First
Right
1946.
The authors believe that the importance of auscultation in the first right intercostal space should be better appreciated. Systolic murmurs which arise from the aorta are almost invariably loudest in this area. There are two circumstances in which this fact may be helpful in diagnosis. When a patient is suspected of having mitral insufficiency and the systolic murmur extends to the base of the heart, if the murmur is best heard in the first right interspace, it is aortic in origin, irrespective of the presence or absence of mitral disease. When a systolic murmur is of equal intensity in the second right and left interspaces, it is aortic and not pulmonic if it is loudest in the first right interspace. Occasionally this area may also be the only site at which an aortic diastolic murmur can be heard. LAPLACE.