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A system for the routine treatment of the failing heart
1012
AMERICAN
Cooper, F. monium Surgery
W., Jr., Robertson, R. L., Chloride in the Treatment 22:740 Wov.1, 1947.
HEART
and
JOURNAL
Dennis, E. W.: The of Experimental acute
Use of TetraethylamArterial Insufficiency.
The authors carried out resection of the distal aorta including the common iliac arteries and the deep circumflex iliacvessels in thirty dogs. In the control group of ten dogs, nine of the animals died within seven days of the operation. Autopsy showed that death was not due to hemorrhage or peritonitis. All of the animals experienced hindlimb paralysis, coldness, cyanosis, and varying degrees of swelling. In the group of twenty dogs treated with tetraethylammonium chloride, fourteen of the animals survived. These animals regained excellent functional activity within two to six days. Three of the six dogs which died had as their cause of death infection of a posterior extremity. One of the remaining animals died within twelve hours of the operation. The tetraethylammonium chloride was administered intramuscularly, in doses of 25 mg. per kilogram of body weight immediately after excision of the arteries and was continued postoperatively at eight-hour intervals for three days. The authors conclude that sympathetic interruption following an acute arterial injury is a valuable procedure and that tetraethylammonium chloride may be of value either as a substitute for other methods of sympathectic interruption or as a preliminary to them. LORD. Davis, White
H. A.; and King, and Negro Patients.
L.
A Comparative D.: Surg., Gynec. & Obst.
Study 85:597
of Thromboangiitis (Nov.), 1947.
Obliterans
in
The authors reviewed the literature with regard to the presence of thromboangiitis obliterans in the Negro race and pointed out that in only one of the ten reported cases could the patient be considered to be a full-blooded Negro. In their own series of sixty-four cases of thromboangiitis obliterans, nine were Negroes and in four of these pathologic examination verified the clinical diagnosis. However, it was established in at least one of them, a woman, that she was not a fullblooded Negro. With regard to the others, this point was evidently not investigated. The authors found that nonsurgical treatment was conspicuously less successful in Negro than in white patients. ABRAMSON. Gold,
Harry, Kwit, N. T., Modell, W., Hanlon, L. W., Kramer, M., Greenberg, S., Otto, H. L,, Cotlove, E. W., Benton, J. G., Pearlmutter, M., and Zahn, W.: A System for Am. J. Med. 3:665 (Dec.), 1947. the Routine Treatment of the Failing Heart.
The authors propose a standardized regimen for the treatment of cardiac failure. five cardinal factors: the simultaneous use of the mercurial diuretics, salt restriction, water, digitoxin, and the charting of the course by a record of the body weight. The patient is put at rest, given a diet consisting of water intake of two to three quarts. If no digitalis has been given at one time followed by 0.2 mg. daily as a maintenance Mercuhydrin is given daily, beginning with a dose of ‘S daily. This regimen is continued until all signs of failure resistant level, the “dry weight.” ingly. usually
Maintenance The patients allowed but
Each programs,
It involves abundant
four to six glasses of milk daily plus a taken recently, 1.2 mg. of digitoxin are dose. A daily weight record is kept. C.C. and increasing to as high as 2 C.C. disappear and the weight declines to a
is guided by the daily weight, and Mercuhydrin dosage determined accordor their families are taught to administer the latter. A more liberal diet is it is low in salt.
factor of the regimen is discussed and unpleasant symptoms.
in detail,
as well
as guides
to treatment,
maintenance
The authors state that the present study, comparing the results in 502 admissions for congestive failure with results in 140 similar admissions treated by the proposed system, shows that the symptoms and signs of congestive failure subside in about 90 per cent of hospital admissionswhen this system is employed routinely, against about 50 per cent with the current methods in common use; and that the duration of required hospital stay is reduced to about one-third of the time necessary
SELECTED
1013
ABSTRACTS
to bring about similar results by the current methods two types of results are obtained with the proposed complete recoveries.
of treatment. method, namely,
They further state that only a few failures and the rest \vOODS.
Friedman, Upon 1947.
M., and the Action
Bine, R., Jr.: of a Digitalis
Observations Glycoside
Concerning (Lanatoside
C).
the Tnfluence of Potassium ilm. J. hl. SC. 214:633 (Dec.).
Although there is experimental and clinical evidence to support the theory that potassium in physiologic excess tends to inhibit the action of digitalis, there is little known about the physiologic inter-relationships of the two substances. This study, therefore, was concerned with the effects of different concentrations of potassium upon the normal embryonic duck heart. It was found that the absence of potassium led to arrhythmias and early cessation of beating. Excess potassium, conversely, depressed heart action. The absence of potassium was found to enhance the effects of a digitalis glycoside (lanatoside C), whereas an excess of potassium inhibited the actions of the same drug. Only large or toxic amounts of digitalis glycoside were found to cause a probable loss of potassium from the heart. Excess potassium was effective in inhibiting this process. The results of the entire study indicated that excess potassium was able to inhibit the actions of digitalis glycoside (1) by depressing the irritability of the heart, and (2) by serving as a source of potassium to a heart apparently losing it after exposure to toxic amounts of digitalis. DURANT.
Stepman, Int.
T. Med.
R., and Owyang, E.: 27:914 (Dec.), 1947.
Clinically
Primary
Tuherculous
Pericarditis.
Ann.
Three men, aged 60, 42, and 30 years, respectively, died following a protracted febrile illness during which a pericarditis with effusion was a prominent feature of the disease. In the first two patients, chronic pulmonary tuberculosis was not present and disseminated miliary tuberculosis was the terminal event. In the third patient, there were tuberculous excavative lesions in the lungs and a tuberculous enteritis with ascites. Perirardial paracentesis was perfurmed in each patient during life, but in only one was the tuber&e bacillus recovered from the pericartlial fiuid. At necropsy, a thickened adherent pericardium was noted in each instance. WENDKOS.
LaDue, J. S., and Carter, venting the Recurrence 1947.
S. B.: The Efficacy of Maintenance of Congestive Heart Failure.
.Inn.
Doses Int.
of Digitalis filed. 27:923
in Pre(Dec.),
One hundred four patients with heart disease associated with regular sinus rhythm who had been discharged from the hospital wards after treatment for congestive hearr failure were followed at intervals of from one to four weeks over a period of from six months to two years. At the time the study was begun, most of the patients had been taking 0.1 to 0.3 Gm. of digitalis leaf per day for several weeks or months after discharge from the hospital. .1Ieasurements of \Tenous pressure, circulation time, vital capacity, and weight were madc (luring a one-!o three-month pk,riutI at intervals from one to four weeks; then digitalis WC discontinued ant-l the ~me ~~~c.;L~LIT(.I)~~‘I~)~~ rrpeai~! or’.!! -~~~ii~L , :.>I ~In~pn(~d, ;incl ccic~~ua was recor&I, at the same inter\-air cbf time> Thf> :lqr~ as ~~11 ai: the presence or absence of r.ilel;. the ii;ztB of the iivrr, the rarcliac fi~~iings, and the subjective state of the patient. The data were broken tfown according to the lariafion in the measurements of the ~enm~ pressure, circulation time, vital capacity, tvcight, heart size. and irequenc>of the development of congestive heart failure Lvhile the patients were being studied. In general. it can Iv stated that none of the criteria cm&q-et1 for measurement of the circulation revealed any significant differences during the time digitalis was given to the palicnt and during the period that the drug was withheld. Patients with heart disease lvho were not in failure had on the average, lower \Tital capacity and longer circulation time measurements than did normal individuals of the same age
AMERICAN
Cooper, F. monium Surgery
W., Jr., Robertson, R. L., Chloride in the Treatment 22:740 Wov.1, 1947.
HEART
and
JOURNAL
Dennis, E. W.: The of Experimental acute
Use of TetraethylamArterial Insufficiency.
The authors carried out resection of the distal aorta including the common iliac arteries and the deep circumflex iliacvessels in thirty dogs. In the control group of ten dogs, nine of the animals died within seven days of the operation. Autopsy showed that death was not due to hemorrhage or peritonitis. All of the animals experienced hindlimb paralysis, coldness, cyanosis, and varying degrees of swelling. In the group of twenty dogs treated with tetraethylammonium chloride, fourteen of the animals survived. These animals regained excellent functional activity within two to six days. Three of the six dogs which died had as their cause of death infection of a posterior extremity. One of the remaining animals died within twelve hours of the operation. The tetraethylammonium chloride was administered intramuscularly, in doses of 25 mg. per kilogram of body weight immediately after excision of the arteries and was continued postoperatively at eight-hour intervals for three days. The authors conclude that sympathetic interruption following an acute arterial injury is a valuable procedure and that tetraethylammonium chloride may be of value either as a substitute for other methods of sympathectic interruption or as a preliminary to them. LORD. Davis, White
H. A.; and King, and Negro Patients.
L.
A Comparative D.: Surg., Gynec. & Obst.
Study 85:597
of Thromboangiitis (Nov.), 1947.
Obliterans
in
The authors reviewed the literature with regard to the presence of thromboangiitis obliterans in the Negro race and pointed out that in only one of the ten reported cases could the patient be considered to be a full-blooded Negro. In their own series of sixty-four cases of thromboangiitis obliterans, nine were Negroes and in four of these pathologic examination verified the clinical diagnosis. However, it was established in at least one of them, a woman, that she was not a fullblooded Negro. With regard to the others, this point was evidently not investigated. The authors found that nonsurgical treatment was conspicuously less successful in Negro than in white patients. ABRAMSON. Gold,
Harry, Kwit, N. T., Modell, W., Hanlon, L. W., Kramer, M., Greenberg, S., Otto, H. L,, Cotlove, E. W., Benton, J. G., Pearlmutter, M., and Zahn, W.: A System for Am. J. Med. 3:665 (Dec.), 1947. the Routine Treatment of the Failing Heart.
The authors propose a standardized regimen for the treatment of cardiac failure. five cardinal factors: the simultaneous use of the mercurial diuretics, salt restriction, water, digitoxin, and the charting of the course by a record of the body weight. The patient is put at rest, given a diet consisting of water intake of two to three quarts. If no digitalis has been given at one time followed by 0.2 mg. daily as a maintenance Mercuhydrin is given daily, beginning with a dose of ‘S daily. This regimen is continued until all signs of failure resistant level, the “dry weight.” ingly. usually
Maintenance The patients allowed but
Each programs,
It involves abundant
four to six glasses of milk daily plus a taken recently, 1.2 mg. of digitoxin are dose. A daily weight record is kept. C.C. and increasing to as high as 2 C.C. disappear and the weight declines to a
is guided by the daily weight, and Mercuhydrin dosage determined accordor their families are taught to administer the latter. A more liberal diet is it is low in salt.
factor of the regimen is discussed and unpleasant symptoms.
in detail,
as well
as guides
to treatment,
maintenance
The authors state that the present study, comparing the results in 502 admissions for congestive failure with results in 140 similar admissions treated by the proposed system, shows that the symptoms and signs of congestive failure subside in about 90 per cent of hospital admissionswhen this system is employed routinely, against about 50 per cent with the current methods in common use; and that the duration of required hospital stay is reduced to about one-third of the time necessary
SELECTED
1013
ABSTRACTS
to bring about similar results by the current methods two types of results are obtained with the proposed complete recoveries.
of treatment. method, namely,
They further state that only a few failures and the rest \vOODS.
Friedman, Upon 1947.
M., and the Action
Bine, R., Jr.: of a Digitalis
Observations Glycoside
Concerning (Lanatoside
C).
the Tnfluence of Potassium ilm. J. hl. SC. 214:633 (Dec.).
Although there is experimental and clinical evidence to support the theory that potassium in physiologic excess tends to inhibit the action of digitalis, there is little known about the physiologic inter-relationships of the two substances. This study, therefore, was concerned with the effects of different concentrations of potassium upon the normal embryonic duck heart. It was found that the absence of potassium led to arrhythmias and early cessation of beating. Excess potassium, conversely, depressed heart action. The absence of potassium was found to enhance the effects of a digitalis glycoside (lanatoside C), whereas an excess of potassium inhibited the actions of the same drug. Only large or toxic amounts of digitalis glycoside were found to cause a probable loss of potassium from the heart. Excess potassium was effective in inhibiting this process. The results of the entire study indicated that excess potassium was able to inhibit the actions of digitalis glycoside (1) by depressing the irritability of the heart, and (2) by serving as a source of potassium to a heart apparently losing it after exposure to toxic amounts of digitalis. DURANT.
Stepman, Int.
T. Med.
R., and Owyang, E.: 27:914 (Dec.), 1947.
Clinically
Primary
Tuherculous
Pericarditis.
Ann.
Three men, aged 60, 42, and 30 years, respectively, died following a protracted febrile illness during which a pericarditis with effusion was a prominent feature of the disease. In the first two patients, chronic pulmonary tuberculosis was not present and disseminated miliary tuberculosis was the terminal event. In the third patient, there were tuberculous excavative lesions in the lungs and a tuberculous enteritis with ascites. Perirardial paracentesis was perfurmed in each patient during life, but in only one was the tuber&e bacillus recovered from the pericartlial fiuid. At necropsy, a thickened adherent pericardium was noted in each instance. WENDKOS.
LaDue, J. S., and Carter, venting the Recurrence 1947.
S. B.: The Efficacy of Maintenance of Congestive Heart Failure.
.Inn.
Doses Int.
of Digitalis filed. 27:923
in Pre(Dec.),
One hundred four patients with heart disease associated with regular sinus rhythm who had been discharged from the hospital wards after treatment for congestive hearr failure were followed at intervals of from one to four weeks over a period of from six months to two years. At the time the study was begun, most of the patients had been taking 0.1 to 0.3 Gm. of digitalis leaf per day for several weeks or months after discharge from the hospital. .1Ieasurements of \Tenous pressure, circulation time, vital capacity, and weight were madc (luring a one-!o three-month pk,riutI at intervals from one to four weeks; then digitalis WC discontinued ant-l the ~me ~~~c.;L~LIT(.I)~~‘I~)~~ rrpeai~! or’.!! -~~~ii~L , :.>I ~In~pn(~d, ;incl ccic~~ua was recor&I, at the same inter\-air cbf time> Thf> :lqr~ as ~~11 ai: the presence or absence of r.ilel;. the ii;ztB of the iivrr, the rarcliac fi~~iings, and the subjective state of the patient. The data were broken tfown according to the lariafion in the measurements of the ~enm~ pressure, circulation time, vital capacity, tvcight, heart size. and irequenc>of the development of congestive heart failure Lvhile the patients were being studied. In general. it can Iv stated that none of the criteria cm&q-et1 for measurement of the circulation revealed any significant differences during the time digitalis was given to the palicnt and during the period that the drug was withheld. Patients with heart disease lvho were not in failure had on the average, lower \Tital capacity and longer circulation time measurements than did normal individuals of the same age