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The management of hypertension
1006
-4MERICAN
HEART
JOURNAL
Thrombi produce three types of shadows: In incomplete block, the head of the opaque column is usually concave; when the vein is incompletely obliterated a ragged, irregular area extending for a varying length is seen; finally, the opaque material may outline the walls and show a mass within the lumen. Satisfactory venographic information can be obtained in probably 60 to 90 per cent of cases. Discontinuation of the study too soon in pathologic cases or improper timing of the exposures may possibly account for the greater percentage of failure to obtain adequate information. Blocked vessels or other roentgen findings account for additional failures. ZION.
O’Loughlin, genol.
B. J.: Roentgen 58:617 (Nov.), 1947.
Visualization
of the
Inferior
Vena
Cava.
Am.
J. Roent-
No The author outlines a simple and safe procedure for visualizing the inferior vena cava. serious ill effects were encountered in fifty consecutive cases. The patient is prepared in a manner similar to that used in intravenous urography. Sphygmomanometer cuffs are placed about The pressure in the the thighs as proximal as possible, leaving room for femoral venepuncture. cuffs is adjusted to diastolic pressure or slightly higher. Twenty cubic centimeters of a 35 per The rate of cent Diodrast solution are injected through a 18 gauge needle on the side selected. injection is approximately 1.0 C.C. per second. The usual kidney-ureter-bladder exposures are made outlinging the common iliac veins and inferior vena cava. Having the patient hold his breath during the exposure and injection tends to make the blood column move more slowly and smoothly. A Valsalva effort may reverse the flow sufficiently to outline the branches of the iliac veins. The removal of the cuffs releases the dammed-up venous blood from the lower extremities and may wash out or dilute the slightly thrombogenic influence of the Diodrast. ZION.
L’Farinas,
P. :
Abdominal
Venography.
Am.
J. Roentgenol.
58:599
(Nov.),
1947.
The author described a technique of abdominal venography. Under local anesthesia the long saphenous vein is exposed by a small incision at the inner portion of the middle third of the thigh. A tourniquet at the groin permits better visualization of the vein which is then punctured with a small trocar. The tourniquet is released and 40 cc. of Diodrast is rapidly injected into The first was made when the vein. Two 14 by 17 inch film exposures of the abdomen are made. 20 to 2.5 C.C. of the opague material has been injected and the second immediately after the completion of the injection. Normal venography visualizes the femoral, external, common iliac veins, and the inferior vena cava. Compression of the epigastric region with an inflated balloon may permit visualization of the renal, hepatic, and internal iliac veins. Indications for abdominal venography are: (1) obstruction vena cava; (2) abdominal tumors, especially renal neoplasms indicated; (3) liver conditions that lead to portal hypertension vein-vena cava anastomosis in order to determine the’integrity
or thrombosis of the inferior where intravenous urography is with the possibility of a portal of the vena cava. In In thrombophlebitis the site of obstruction of the vessels can easily be demonstrated. tumors that compress and displace the inferior vena cava and common iliac veins, the site of compression and displacement together with the establishment of collateral circulation can be demonstrated. ZION.
White,
P. D.:
The
Management
of Hypertension.
Ann.
Int.
This is a brief reveiw of therapeutic methods which have proved management of hypertension. There is a short summary of the value concerning the true meaning of an elevated blood pressure and of the a regulated mode of living, mental relaxation, physiotherapy, and The importance of restriction of tobacco, coffee, and tea is stressed. diet or the strict rice diet is looked upon favorably. Aside from the
Med.
27:740
(Nov.),
1947.
to be of some value in the of education of the patient effectiveness of vacations, intensive psychotherapy. The use of the low-salt sedation accomplished by
SELECTED
1007
ABSTRACTS
bromides or phenobarbital, drugs seem to occupy a small place in the management of hypertension. It is too early to decide upon the merits of the newer sympatheticolytic drugs, such as tetraethyl ammonium and Priscol. Of the surgical approaches, the extensive lumbodorsal sympathectomy advocated by Smithwick has proved to be worth while in about 75 per cent of the properly selected cases. WENDKOS.
Ray,
C. T., Cava.
and Burch, Arch. Int.
G. : Vascular Responses Med. 80587 (NOV.), 1947.
in Man
to Ligation
of the
Inferior
Vena
The authors investigated the circulatory adjustments in twelve patients following ligation of the inferior vena cava in the treatment of pelvic thrombophlebitis. In all instances but one, there was an elevation in venous pressure in the lower extremities and a gradual decline toward normal in the subsequent years of observation. A tendency for the plasma protein content to increase was also noted after ligation. With regard to clinical observations, no diminution in functional capacity was observed, nor was any intermittent claudication experienced. The severity of the edema varied from mild to extreme, disappearing within two months after operation in all cases but three. For the most part, the large veins of the legs and feet were not dilated, and no demonstrable varicosities were noted. Some small varicosities were present in the cutaneous veins. The superficial veins of the abdominal wall and gluteal region and also the long thoracic veins were dilated, forming an unusually prominent network. The authors concluded that remarkable readjustments occur in the lower extremities after ligation of the inferior vena cava. The fact that the edema disappeared at a time when the venous pressure in the lower extremities was still considerably elevated appeared to support the view that hydrostatic intravascular pressure, per se, plays a relatively unimportant role in edema formation, and that as long as only the hydrostatic pressure is increased, compensatory mechanisms develop to a high degree. ABRAMS~N.
Magner, D., and 44:485 (Nov.),
McKenzie, 1947.
H.
F.:
Cystic
Medionecrosis
of
the
Aorta.
Arch.
Path.
The authors report a case of large, fusiform aneurysm of the ascending arch of the aorta in a 23-year-old man in whom death occurred as a result of perforation into the pericardial sac with resulting tamponade of the heart. The patient, first seen two years previously because routine x-ray examination revealed a large mediastinal mass, had had no relevant past medical history, except that at the age of 18 years, after playing hockey, he had had severe retrosternal pain for three days. There was no traumatic incident. Repeated x-ray examinations showed a gradual increase in the size of the mediastinal mass, which was seen to pulsate in the fluoroscopic examination. Serologic tests were negative and the patient worked in good health for three years following the initial discovery of the aneurysm. A few days after a bronchoscopy which showed pulsation in the trachea, the patient collapsed :nri !!ied ivith 3 perCo,ra?it>n flf thr ane:!ry~m intn i-he peric:*rdir:m r’nfor:!rnntcly, no bl!xTd prc5 Laboratory data revealed nothing of note. sure record was obtained. At necropsy the heart was found to be of normal weight and showed no abnormality. The aortic valve leaflets were described 5s normal. despite the close proximity of the aneurysm, which involved the ascending and transverse portion of the arch. Detailed histologic examination revealed characteristic changes of cystic medionecrosis and excluded syphilis as an etiological factor. ‘The authors comment on the complete lack of knowledge of the origin of this lesion. GOULEY.
-4MERICAN
HEART
JOURNAL
Thrombi produce three types of shadows: In incomplete block, the head of the opaque column is usually concave; when the vein is incompletely obliterated a ragged, irregular area extending for a varying length is seen; finally, the opaque material may outline the walls and show a mass within the lumen. Satisfactory venographic information can be obtained in probably 60 to 90 per cent of cases. Discontinuation of the study too soon in pathologic cases or improper timing of the exposures may possibly account for the greater percentage of failure to obtain adequate information. Blocked vessels or other roentgen findings account for additional failures. ZION.
O’Loughlin, genol.
B. J.: Roentgen 58:617 (Nov.), 1947.
Visualization
of the
Inferior
Vena
Cava.
Am.
J. Roent-
No The author outlines a simple and safe procedure for visualizing the inferior vena cava. serious ill effects were encountered in fifty consecutive cases. The patient is prepared in a manner similar to that used in intravenous urography. Sphygmomanometer cuffs are placed about The pressure in the the thighs as proximal as possible, leaving room for femoral venepuncture. cuffs is adjusted to diastolic pressure or slightly higher. Twenty cubic centimeters of a 35 per The rate of cent Diodrast solution are injected through a 18 gauge needle on the side selected. injection is approximately 1.0 C.C. per second. The usual kidney-ureter-bladder exposures are made outlinging the common iliac veins and inferior vena cava. Having the patient hold his breath during the exposure and injection tends to make the blood column move more slowly and smoothly. A Valsalva effort may reverse the flow sufficiently to outline the branches of the iliac veins. The removal of the cuffs releases the dammed-up venous blood from the lower extremities and may wash out or dilute the slightly thrombogenic influence of the Diodrast. ZION.
L’Farinas,
P. :
Abdominal
Venography.
Am.
J. Roentgenol.
58:599
(Nov.),
1947.
The author described a technique of abdominal venography. Under local anesthesia the long saphenous vein is exposed by a small incision at the inner portion of the middle third of the thigh. A tourniquet at the groin permits better visualization of the vein which is then punctured with a small trocar. The tourniquet is released and 40 cc. of Diodrast is rapidly injected into The first was made when the vein. Two 14 by 17 inch film exposures of the abdomen are made. 20 to 2.5 C.C. of the opague material has been injected and the second immediately after the completion of the injection. Normal venography visualizes the femoral, external, common iliac veins, and the inferior vena cava. Compression of the epigastric region with an inflated balloon may permit visualization of the renal, hepatic, and internal iliac veins. Indications for abdominal venography are: (1) obstruction vena cava; (2) abdominal tumors, especially renal neoplasms indicated; (3) liver conditions that lead to portal hypertension vein-vena cava anastomosis in order to determine the’integrity
or thrombosis of the inferior where intravenous urography is with the possibility of a portal of the vena cava. In In thrombophlebitis the site of obstruction of the vessels can easily be demonstrated. tumors that compress and displace the inferior vena cava and common iliac veins, the site of compression and displacement together with the establishment of collateral circulation can be demonstrated. ZION.
White,
P. D.:
The
Management
of Hypertension.
Ann.
Int.
This is a brief reveiw of therapeutic methods which have proved management of hypertension. There is a short summary of the value concerning the true meaning of an elevated blood pressure and of the a regulated mode of living, mental relaxation, physiotherapy, and The importance of restriction of tobacco, coffee, and tea is stressed. diet or the strict rice diet is looked upon favorably. Aside from the
Med.
27:740
(Nov.),
1947.
to be of some value in the of education of the patient effectiveness of vacations, intensive psychotherapy. The use of the low-salt sedation accomplished by
SELECTED
1007
ABSTRACTS
bromides or phenobarbital, drugs seem to occupy a small place in the management of hypertension. It is too early to decide upon the merits of the newer sympatheticolytic drugs, such as tetraethyl ammonium and Priscol. Of the surgical approaches, the extensive lumbodorsal sympathectomy advocated by Smithwick has proved to be worth while in about 75 per cent of the properly selected cases. WENDKOS.
Ray,
C. T., Cava.
and Burch, Arch. Int.
G. : Vascular Responses Med. 80587 (NOV.), 1947.
in Man
to Ligation
of the
Inferior
Vena
The authors investigated the circulatory adjustments in twelve patients following ligation of the inferior vena cava in the treatment of pelvic thrombophlebitis. In all instances but one, there was an elevation in venous pressure in the lower extremities and a gradual decline toward normal in the subsequent years of observation. A tendency for the plasma protein content to increase was also noted after ligation. With regard to clinical observations, no diminution in functional capacity was observed, nor was any intermittent claudication experienced. The severity of the edema varied from mild to extreme, disappearing within two months after operation in all cases but three. For the most part, the large veins of the legs and feet were not dilated, and no demonstrable varicosities were noted. Some small varicosities were present in the cutaneous veins. The superficial veins of the abdominal wall and gluteal region and also the long thoracic veins were dilated, forming an unusually prominent network. The authors concluded that remarkable readjustments occur in the lower extremities after ligation of the inferior vena cava. The fact that the edema disappeared at a time when the venous pressure in the lower extremities was still considerably elevated appeared to support the view that hydrostatic intravascular pressure, per se, plays a relatively unimportant role in edema formation, and that as long as only the hydrostatic pressure is increased, compensatory mechanisms develop to a high degree. ABRAMS~N.
Magner, D., and 44:485 (Nov.),
McKenzie, 1947.
H.
F.:
Cystic
Medionecrosis
of
the
Aorta.
Arch.
Path.
The authors report a case of large, fusiform aneurysm of the ascending arch of the aorta in a 23-year-old man in whom death occurred as a result of perforation into the pericardial sac with resulting tamponade of the heart. The patient, first seen two years previously because routine x-ray examination revealed a large mediastinal mass, had had no relevant past medical history, except that at the age of 18 years, after playing hockey, he had had severe retrosternal pain for three days. There was no traumatic incident. Repeated x-ray examinations showed a gradual increase in the size of the mediastinal mass, which was seen to pulsate in the fluoroscopic examination. Serologic tests were negative and the patient worked in good health for three years following the initial discovery of the aneurysm. A few days after a bronchoscopy which showed pulsation in the trachea, the patient collapsed :nri !!ied ivith 3 perCo,ra?it>n flf thr ane:!ry~m intn i-he peric:*rdir:m r’nfor:!rnntcly, no bl!xTd prc5 Laboratory data revealed nothing of note. sure record was obtained. At necropsy the heart was found to be of normal weight and showed no abnormality. The aortic valve leaflets were described 5s normal. despite the close proximity of the aneurysm, which involved the ascending and transverse portion of the arch. Detailed histologic examination revealed characteristic changes of cystic medionecrosis and excluded syphilis as an etiological factor. ‘The authors comment on the complete lack of knowledge of the origin of this lesion. GOULEY.