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Excessive hypertension of long duration
1160
AMERICAN
Clinical Orbacb, E. J.: Veins. J. Internat.
Evaluation Coll. Surgeons
HEART
JOURNAL
of a New Technic 11:396 (July-Aug.),
in
the 1948.
Sclerotherapy
of
Varicose
The author describes a new technique for the injection therapy of varicose veins. This consists in the introduction of a small volume of air into the lumen of the vessel preceding the injection of the agent. This procedure prevents the initial dilution of the material by the blood. One cubic centimeter of air is aspirated into the syringe previously filled with the sclerosing agent With the patient standing, the inwhile the syringe is held with the needle pointing upward. jection is made so that first the air and then the solution is injected. With regard to the possible danger of air embolism, the author points out that this never occurs when a small quantity of air is introduced into the saphenous veins or their tributaries. A number of different sclerosing agents were studied, both the conventional and the airblock methods being used. The results indicated that with the air-block procedure a greater incidence of obliteration was obtained than with conventional methods. A new sclerosing agent, Sotradecol (sodium tetradecyl sulfate) was found to be quite effective when used with the new technique. An average dose of 0.4 cc. yielded complete obliteration in 87.7 per cent of the injections. This compared favorably with the 83.8 per cent of successful obliterations obtained with an average dose of 1.7 C.C. of fatty acid solutions, such as sodium morrhuate and monoethanolamine. With the air-block procedure, no cases of slough followed, while with the conventional injection technique fifteen instances of postinjectional slough occurred. Such findings stressed the advantage of the new method in safeguarding against paravenous injections. The importance of minimal thrombosis is pointed out, and methods are discussed in relation to the advantage of production of venous obliteration by intimal concretion rather than by organization of large thrombi. In this regard, it has been shown that a large thrombus is an ideal medium for recanalization. The distension of the veins after the injection of the sclerosing agent and the subsequent formation of large thrombi can be prevented by the application of firm bandages following treatment. ABRAMSON. Mannheimer, Tolerance
E., Carlgren, Test of the
L. E., and Graf, Heart in Children.
W.:
Further J. Pediat.
Experience 258 (July),
With 1948.
the
Hypoxia
The hypoxia tolerance test is performed by having the patient breathe 9 per cent oxygen for ten minutes and noting the effect of the test electrocardiographically and by means of the phonocardiogram. A positive result is based on some of the following changes: depression of the RS-T intervals in Leads I and II of at least 1.0 mm.; development of negative or diphasic Tr or Ts; marked changes in the length of the P-R interval; and the appearance of gallop rhythm. Studies were made in 365 children of whom ninety-one were considered to have normal cardiovascular systems and the remainder were children with rheumatic heart disease, active myocarditis of other etiology, and congenital heart disease (100 cases). With a few exceptions the test was negative in the normal cases. In active rheumatic carditis and active myocarditis of other etiology, about three-fourths of the cases gave positive results. Cases of healed carditis and of gallop rhythm gave a positive result in 25 per cent of the patients. Of fifty-three patients with patent ductus arteriosus, 64.1 per cent gave a positive result, whereas after operation, only 25 per cent reacted positively. Of twenty cases of cyanotic heart disease, only one gave a positive reaction to the hypoxia test. ]omsoa. Burgess, A. M.: Excessive ?59:75 (July 15), 1948.
Hypertension
of
Long
Duration.
New
England
J.
Med.
The author notes the inadequacy of published data bearing upon the prognosis in essential hypertension, especially in the obviously nonprogressive type. The records of private patients with hypertension seen since 1914 were reviewed.Individuals were selected for study in whom systolic pressures of 180 mm. Hg or higher or diastolic pressures of 100 mm. Hg or higher had existed for at least eight years without established cardiac or renal disease or other evidence of progression. In 90 per cent of these patients, the hypertension had existed prior to 1932.
SELECTED
1161
ABSTRACTS
The average survival time was compared with average life expectancy of persons of the same age and sex. The group was then divided into three groups: living, dead, and incapacitated. The!. were also classified into groups according to age, sex, and degree of systolic and diastolic hypertension. Of the original 100 patients, forty-seven are living and fifty-three are dead. The average expectancy of life was exceeded by twenty-eight patients, some of whom are still living. Tht average person of the group lived out almost a normal life span. Of persons over 6.5 years 01 age when hypertension was first noted, all outlived life expectancy. Of the thirty-two persons less than 50 years of age when the hypertension was discovered, the average duration of life was more than fifteen years, but appreciably less than the life expectancy for persons of this age, which is about twenty-six years. Because of the small size of the series, definite conclusions regarding the influence of sex were not drawn. An elevated systolic pressure was not found even when pressures of 250 or over were observed. pressure (120 or more on one or more occasions), the expectancy by a considerably longer period than it group
Since will
forty-seven lengthen;
of the group are hence, the prognosis
still living, is actually
to be especially unfavorable prognostically, Conversely, in patients with a high diastolic actual duration of life fell short of the normal did in the whole group. the average duration more favorable than
of life indicated
for the whole by the data.
It is concluded that the individual with nonprogressive hypertension of at least eight years’ duration lives to within three or four years of his normal life expectancy. Although individuals less than 50 years of age are less likely to live out a normal life span than older individuals, the average length of life for this age group is fifteen years after the discovery of hypertension. This study has obvious significance in its bearing management. A more extensive investigation, with cians, is suggested.
upon the selection of candidates for surgical the collaboration of a large number of physi-
KAY. Major, Med.
The S.: 48:1489
Electrocardiogram (July), 1948.
in
Catatonic
Schizophrenia.
New
York
State
J.
This paper is concerned with the study of fifty-two schizophrenics, thirty-six of the catatonic, and sixteen of the hebephrenic type with catatonic episodes. The age was limited to 35 years to eliminate from the study any cases of latent coronary artery disease. In all cases, there was no evidence of cardiac disease. The electrocardiographic findings departed from the normal in the following ways: extreme shortening of the P-R intervals; frequency of abnormal P and T waves in the chest leads; and the Mixed electrocardiographic changes occurred frequent occurrence of S-T segment depressions. many times in the cases described by the author. All of the patients in this study presented one or more signs of autonomic imbalance. It is probable that the electrocardiographic abnormalities under discussion are due to imbalanced autonomic activity causing alterations in the myocardial innervation and in the coronary blood supply.
BELLET. Willius, Proc.
F. A.: An Staff Meet.,
Unusually Mayo Clin.
Early 23:316
Description (July 7),
of 1948.
the
So-called
Tetralogy
of
Fallot.
The author had previously credited the eminent Dutch physician, Eduard Sandifort, with the first description, in 1777, of the combination of congenital cardiovascular defects which is still He now produces documentary evidence to show that the known as the “tetralogy of Fallot.” Dane, Niels Stensen, or Nicholas Steno, described this derangement in observations dated 16711672, his report antedating that of Sandifort by 105 years.
ARKLESS.
AMERICAN
Clinical Orbacb, E. J.: Veins. J. Internat.
Evaluation Coll. Surgeons
HEART
JOURNAL
of a New Technic 11:396 (July-Aug.),
in
the 1948.
Sclerotherapy
of
Varicose
The author describes a new technique for the injection therapy of varicose veins. This consists in the introduction of a small volume of air into the lumen of the vessel preceding the injection of the agent. This procedure prevents the initial dilution of the material by the blood. One cubic centimeter of air is aspirated into the syringe previously filled with the sclerosing agent With the patient standing, the inwhile the syringe is held with the needle pointing upward. jection is made so that first the air and then the solution is injected. With regard to the possible danger of air embolism, the author points out that this never occurs when a small quantity of air is introduced into the saphenous veins or their tributaries. A number of different sclerosing agents were studied, both the conventional and the airblock methods being used. The results indicated that with the air-block procedure a greater incidence of obliteration was obtained than with conventional methods. A new sclerosing agent, Sotradecol (sodium tetradecyl sulfate) was found to be quite effective when used with the new technique. An average dose of 0.4 cc. yielded complete obliteration in 87.7 per cent of the injections. This compared favorably with the 83.8 per cent of successful obliterations obtained with an average dose of 1.7 C.C. of fatty acid solutions, such as sodium morrhuate and monoethanolamine. With the air-block procedure, no cases of slough followed, while with the conventional injection technique fifteen instances of postinjectional slough occurred. Such findings stressed the advantage of the new method in safeguarding against paravenous injections. The importance of minimal thrombosis is pointed out, and methods are discussed in relation to the advantage of production of venous obliteration by intimal concretion rather than by organization of large thrombi. In this regard, it has been shown that a large thrombus is an ideal medium for recanalization. The distension of the veins after the injection of the sclerosing agent and the subsequent formation of large thrombi can be prevented by the application of firm bandages following treatment. ABRAMSON. Mannheimer, Tolerance
E., Carlgren, Test of the
L. E., and Graf, Heart in Children.
W.:
Further J. Pediat.
Experience 258 (July),
With 1948.
the
Hypoxia
The hypoxia tolerance test is performed by having the patient breathe 9 per cent oxygen for ten minutes and noting the effect of the test electrocardiographically and by means of the phonocardiogram. A positive result is based on some of the following changes: depression of the RS-T intervals in Leads I and II of at least 1.0 mm.; development of negative or diphasic Tr or Ts; marked changes in the length of the P-R interval; and the appearance of gallop rhythm. Studies were made in 365 children of whom ninety-one were considered to have normal cardiovascular systems and the remainder were children with rheumatic heart disease, active myocarditis of other etiology, and congenital heart disease (100 cases). With a few exceptions the test was negative in the normal cases. In active rheumatic carditis and active myocarditis of other etiology, about three-fourths of the cases gave positive results. Cases of healed carditis and of gallop rhythm gave a positive result in 25 per cent of the patients. Of fifty-three patients with patent ductus arteriosus, 64.1 per cent gave a positive result, whereas after operation, only 25 per cent reacted positively. Of twenty cases of cyanotic heart disease, only one gave a positive reaction to the hypoxia test. ]omsoa. Burgess, A. M.: Excessive ?59:75 (July 15), 1948.
Hypertension
of
Long
Duration.
New
England
J.
Med.
The author notes the inadequacy of published data bearing upon the prognosis in essential hypertension, especially in the obviously nonprogressive type. The records of private patients with hypertension seen since 1914 were reviewed.Individuals were selected for study in whom systolic pressures of 180 mm. Hg or higher or diastolic pressures of 100 mm. Hg or higher had existed for at least eight years without established cardiac or renal disease or other evidence of progression. In 90 per cent of these patients, the hypertension had existed prior to 1932.
SELECTED
1161
ABSTRACTS
The average survival time was compared with average life expectancy of persons of the same age and sex. The group was then divided into three groups: living, dead, and incapacitated. The!. were also classified into groups according to age, sex, and degree of systolic and diastolic hypertension. Of the original 100 patients, forty-seven are living and fifty-three are dead. The average expectancy of life was exceeded by twenty-eight patients, some of whom are still living. Tht average person of the group lived out almost a normal life span. Of persons over 6.5 years 01 age when hypertension was first noted, all outlived life expectancy. Of the thirty-two persons less than 50 years of age when the hypertension was discovered, the average duration of life was more than fifteen years, but appreciably less than the life expectancy for persons of this age, which is about twenty-six years. Because of the small size of the series, definite conclusions regarding the influence of sex were not drawn. An elevated systolic pressure was not found even when pressures of 250 or over were observed. pressure (120 or more on one or more occasions), the expectancy by a considerably longer period than it group
Since will
forty-seven lengthen;
of the group are hence, the prognosis
still living, is actually
to be especially unfavorable prognostically, Conversely, in patients with a high diastolic actual duration of life fell short of the normal did in the whole group. the average duration more favorable than
of life indicated
for the whole by the data.
It is concluded that the individual with nonprogressive hypertension of at least eight years’ duration lives to within three or four years of his normal life expectancy. Although individuals less than 50 years of age are less likely to live out a normal life span than older individuals, the average length of life for this age group is fifteen years after the discovery of hypertension. This study has obvious significance in its bearing management. A more extensive investigation, with cians, is suggested.
upon the selection of candidates for surgical the collaboration of a large number of physi-
KAY. Major, Med.
The S.: 48:1489
Electrocardiogram (July), 1948.
in
Catatonic
Schizophrenia.
New
York
State
J.
This paper is concerned with the study of fifty-two schizophrenics, thirty-six of the catatonic, and sixteen of the hebephrenic type with catatonic episodes. The age was limited to 35 years to eliminate from the study any cases of latent coronary artery disease. In all cases, there was no evidence of cardiac disease. The electrocardiographic findings departed from the normal in the following ways: extreme shortening of the P-R intervals; frequency of abnormal P and T waves in the chest leads; and the Mixed electrocardiographic changes occurred frequent occurrence of S-T segment depressions. many times in the cases described by the author. All of the patients in this study presented one or more signs of autonomic imbalance. It is probable that the electrocardiographic abnormalities under discussion are due to imbalanced autonomic activity causing alterations in the myocardial innervation and in the coronary blood supply.
BELLET. Willius, Proc.
F. A.: An Staff Meet.,
Unusually Mayo Clin.
Early 23:316
Description (July 7),
of 1948.
the
So-called
Tetralogy
of
Fallot.
The author had previously credited the eminent Dutch physician, Eduard Sandifort, with the first description, in 1777, of the combination of congenital cardiovascular defects which is still He now produces documentary evidence to show that the known as the “tetralogy of Fallot.” Dane, Niels Stensen, or Nicholas Steno, described this derangement in observations dated 16711672, his report antedating that of Sandifort by 105 years.
ARKLESS.