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A clinical and pathological study of chronic myocarditis
Selected Levine, Samuel A., Andren, vomiting in Rheumatic
Thekla, Individuals.
Abstracts and
Homans, Katharine A.: Nosebleed and NW F:ngland J. Mr~l. 203: 8X2, 19:KL
The frequency of spells of nausea, vomiting, and epistaxis was ascertained in one hundred individuals suffering from rheumatic fever or one of its allied conditions like chorea or rheumatic heart disease. This was compared with the frequency with similar symptoms in a control group of one hundred nonrheumatic individuals of approximately the same age coming to a surgical clinic.. According to the method used in estimating the occurrence of these symptoms they were found to be three to four times as frequent in the rheumatic as in the nonrheumatic group. The authors believe t,hat attacks of inexplicable nausea and vomiting and spontaneous nosebleed are in some way rrlnted to the rheumatic infection. They occur frequently during a period of the infection that generally is regarded as inactive. Epistaxis particularly may occur for years preceding the first definite attack of rheumatism. These fc:lturcs, together vvith others more commonly emphasized, will enable the physician to identify as rheumatic many conditions which at present go unrecognized or misdiagnosed. Shoemaker, Robert, III, and Eckels, land J. Med. 203: 195, 1930.
John
C.:
Bullet
in
the
Heart.
NW
Eng-
A white woman twenty-three years old wa.s brought into the hospital with two bullet wounds in her chest. One bullet was found localized in the chest wall and under local anesthesia a Z-caliber bullet was removed in the situation indicated by the x-ray report. The other bullet was localized apparently in the wall of the ventricle on the anterior surface probably in the right side. It showed an excursion of 2 cm. during the cardiac cycle. It was decided that since the patient was recovering after emergency shock treatment that no attempt should be made to remove this foreign body. Physical examination otherwise was unimportant. Electrocardiograms made during convalescence shovved a normal cardiac rhythm. The patient recovered, was discharged at fourand eight-week intervals for reexamination. Pitahugh, New
Greene: England
A Clinical J. Med. 203:
and Pathological 201, 1030.
Study
of
Chronic
Myocarditis.
An analysis of the clinical and pathological records of 228 selected fatal cases was undertaken to study the relation bet\veen the clinical syndrome and the necropsy findings in cases of cardiac failure. Cases chosen for study were those in which the heart showed at necropsy hypertrophy and dilatation, fibrosis, or infarction of the myocardium. Hearts with valvular lesions were not included. All of these except 28 showed during life clinical evidences of myocardial insufficiency. Of the 228 cases, 125 died of cardiac failure and form the cardiac group. Fifty-five died of nephritis, 14 of cerebral hemorrhage, and 34 of misceIlaneous causes, making up the noncardiac group. The author then proceeds to analyze the various an430
atomical lesions found at necropsy and also the usual symptoms shown during life in these two groups of patients. Importance of such studies as this cannot he overemphasized in throwing light on the significance of various clinical symptoms.
Hoskin, Jenner: The Effect of Auricular Fibrillation on the Operative Hyperthyroidism. Brit. hi. J. .July 2’6, p. 135, 1930.
Risk in
The present paper is the result of an investigation of 356 consecutive cases of Graves’ disease, exophthalmic and toxic, in which all but 4 had operative treatment; 315 were cases of exophthalmic goiter and 41 of toxic goiter. Thirty cases of auricular fibrillation were found, 22 among the exophthalmic goiter cases and 8 among the toxic, a total of 9.52 per cent. It is probable that a fern cases of transient fibrillation may have been overlooked. There were 12 transient cases, of which 10 occurred after partial thgroidectomy; in the rema.inder, paroxysmal attacks of auriculnr fibrillation were noted electrocardiographically prior to operative treatment. Tn all 12 cases normal rhythm was reestablished within a week of the oprration without quiuidine being administered. Of the 78 cases of permanent fibrillation, there were 4 deaths, 3 following operation. Of the remaining 14 cases 7 bcrame normal within a few days of operation, and in 7 the irregularity persisted. Of these 7, three were not operated upon, 3 had partial thyroidectomy performed, and in 1 case the superior thyroid vessels were tied. One of these cases in which normal rhythm was restored by partial thyroidectomp relapsed into nuricular fibrillation four months later. Out of the 356 cases investigated, the total mortality was 20. The presence of nuriculnr fibrillation must be regarded as n distinctly unfavorable complication during operation. It is associated with cardiac enlargement, rapid pulse rate, and The rf?ect of thr toxic thyroid secretion as shown signs of congestive failure. hy the raised basal metnholie rate is aggrnratrd by an added impairment of cardiac function causeil by the congestive failure. Tt in essential, therefore, that the thyrotoxicosis should be reduced and the ventricular rate controlled before operative procedure is contemplated. Lugol’s solution in combination with digitalis is indicated in preparing these patients for operation.
Willner, Otto: Some Observations on Mitral mals Among Chinese. Am. J. M. SC. 180:
Stenosis and Measurements
of Nor-
300, 1930. Among 24,000 patients admitted to the Peiping Union Medical College Hospital during seven and one-half years, 95 men and 63 women were found to have mitral stenosis as a single or combined valrulnr lesion. It would seem that there is a low incidence of typical rheumatic fever among these people. In this group of patients it was found that the asthenie habitus was prevalent. For comparison an examination was made of 150 healthy young Chinese adults in order to determine whether there was a correlation between the 3 predominating characteristics found in the group of individuals with mitral stenosis, namely, asthenic build, mitral configuration of thr heart, nnd a large angle of the electrical axis. It ~-as not clear that such a correlation existed.
Parsonnet, Aaron E., and Hymaq Albert Syndrome of Complete Heart-Block: J. M.
SC., 180:
356,
S.: Barium Chlorid in the Stokes-Adams Negative Results in Eight Cases. Am.
1930.
The authors have been interested in the use of barium in a series of of complete heart-block complicated by the Stokes-Adams syndrome. these cases were they able to obtain any semblance of pharmacological Special attention wa.s focused upon ological action either good or bad. and the source of barium employed. Amounts varying from 0.04 to
eight cases In none of or physithe quality as much as
Thekla, Individuals.
Abstracts and
Homans, Katharine A.: Nosebleed and NW F:ngland J. Mr~l. 203: 8X2, 19:KL
The frequency of spells of nausea, vomiting, and epistaxis was ascertained in one hundred individuals suffering from rheumatic fever or one of its allied conditions like chorea or rheumatic heart disease. This was compared with the frequency with similar symptoms in a control group of one hundred nonrheumatic individuals of approximately the same age coming to a surgical clinic.. According to the method used in estimating the occurrence of these symptoms they were found to be three to four times as frequent in the rheumatic as in the nonrheumatic group. The authors believe t,hat attacks of inexplicable nausea and vomiting and spontaneous nosebleed are in some way rrlnted to the rheumatic infection. They occur frequently during a period of the infection that generally is regarded as inactive. Epistaxis particularly may occur for years preceding the first definite attack of rheumatism. These fc:lturcs, together vvith others more commonly emphasized, will enable the physician to identify as rheumatic many conditions which at present go unrecognized or misdiagnosed. Shoemaker, Robert, III, and Eckels, land J. Med. 203: 195, 1930.
John
C.:
Bullet
in
the
Heart.
NW
Eng-
A white woman twenty-three years old wa.s brought into the hospital with two bullet wounds in her chest. One bullet was found localized in the chest wall and under local anesthesia a Z-caliber bullet was removed in the situation indicated by the x-ray report. The other bullet was localized apparently in the wall of the ventricle on the anterior surface probably in the right side. It showed an excursion of 2 cm. during the cardiac cycle. It was decided that since the patient was recovering after emergency shock treatment that no attempt should be made to remove this foreign body. Physical examination otherwise was unimportant. Electrocardiograms made during convalescence shovved a normal cardiac rhythm. The patient recovered, was discharged at fourand eight-week intervals for reexamination. Pitahugh, New
Greene: England
A Clinical J. Med. 203:
and Pathological 201, 1030.
Study
of
Chronic
Myocarditis.
An analysis of the clinical and pathological records of 228 selected fatal cases was undertaken to study the relation bet\veen the clinical syndrome and the necropsy findings in cases of cardiac failure. Cases chosen for study were those in which the heart showed at necropsy hypertrophy and dilatation, fibrosis, or infarction of the myocardium. Hearts with valvular lesions were not included. All of these except 28 showed during life clinical evidences of myocardial insufficiency. Of the 228 cases, 125 died of cardiac failure and form the cardiac group. Fifty-five died of nephritis, 14 of cerebral hemorrhage, and 34 of misceIlaneous causes, making up the noncardiac group. The author then proceeds to analyze the various an430
atomical lesions found at necropsy and also the usual symptoms shown during life in these two groups of patients. Importance of such studies as this cannot he overemphasized in throwing light on the significance of various clinical symptoms.
Hoskin, Jenner: The Effect of Auricular Fibrillation on the Operative Hyperthyroidism. Brit. hi. J. .July 2’6, p. 135, 1930.
Risk in
The present paper is the result of an investigation of 356 consecutive cases of Graves’ disease, exophthalmic and toxic, in which all but 4 had operative treatment; 315 were cases of exophthalmic goiter and 41 of toxic goiter. Thirty cases of auricular fibrillation were found, 22 among the exophthalmic goiter cases and 8 among the toxic, a total of 9.52 per cent. It is probable that a fern cases of transient fibrillation may have been overlooked. There were 12 transient cases, of which 10 occurred after partial thgroidectomy; in the rema.inder, paroxysmal attacks of auriculnr fibrillation were noted electrocardiographically prior to operative treatment. Tn all 12 cases normal rhythm was reestablished within a week of the oprration without quiuidine being administered. Of the 78 cases of permanent fibrillation, there were 4 deaths, 3 following operation. Of the remaining 14 cases 7 bcrame normal within a few days of operation, and in 7 the irregularity persisted. Of these 7, three were not operated upon, 3 had partial thyroidectomy performed, and in 1 case the superior thyroid vessels were tied. One of these cases in which normal rhythm was restored by partial thyroidectomp relapsed into nuricular fibrillation four months later. Out of the 356 cases investigated, the total mortality was 20. The presence of nuriculnr fibrillation must be regarded as n distinctly unfavorable complication during operation. It is associated with cardiac enlargement, rapid pulse rate, and The rf?ect of thr toxic thyroid secretion as shown signs of congestive failure. hy the raised basal metnholie rate is aggrnratrd by an added impairment of cardiac function causeil by the congestive failure. Tt in essential, therefore, that the thyrotoxicosis should be reduced and the ventricular rate controlled before operative procedure is contemplated. Lugol’s solution in combination with digitalis is indicated in preparing these patients for operation.
Willner, Otto: Some Observations on Mitral mals Among Chinese. Am. J. M. SC. 180:
Stenosis and Measurements
of Nor-
300, 1930. Among 24,000 patients admitted to the Peiping Union Medical College Hospital during seven and one-half years, 95 men and 63 women were found to have mitral stenosis as a single or combined valrulnr lesion. It would seem that there is a low incidence of typical rheumatic fever among these people. In this group of patients it was found that the asthenie habitus was prevalent. For comparison an examination was made of 150 healthy young Chinese adults in order to determine whether there was a correlation between the 3 predominating characteristics found in the group of individuals with mitral stenosis, namely, asthenic build, mitral configuration of thr heart, nnd a large angle of the electrical axis. It ~-as not clear that such a correlation existed.
Parsonnet, Aaron E., and Hymaq Albert Syndrome of Complete Heart-Block: J. M.
SC., 180:
356,
S.: Barium Chlorid in the Stokes-Adams Negative Results in Eight Cases. Am.
1930.
The authors have been interested in the use of barium in a series of of complete heart-block complicated by the Stokes-Adams syndrome. these cases were they able to obtain any semblance of pharmacological Special attention wa.s focused upon ological action either good or bad. and the source of barium employed. Amounts varying from 0.04 to
eight cases In none of or physithe quality as much as