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A technic for testing hypertensive patients preoperatively
624
AMERICAN
HEART
JOURNAL
The diagnostic problem in exceptional cases may be very of the heart is necessary to establish an accurate and definitive this way will some cases avoid harmful surgery.
difficult. In these, catheterization preoperative diagnosis. Only
in
DURANT. Smith,
B. C., Peripheral
and Quimhy, E. H.: The Use of Radioactive Vascular Disease. Ann. Surg. 125:360 (March),
Sodium 1947.
in
the
Study
of
By means of an intravenous injection of 3 to 7 cc. of a sterile solution of radioactive sodium and counting the arrival of the radioactive atoms at the sole of the foot by a Geiger-Mtiller counter, the authors have developed a method of studying the circulation to an extremity. The radioactive sodium leaves the capillaries, enters the extravascular fluid, and builds up to an equilibrium, and curves can be plotted which have a definite normal range. Various pathologic states, such as occlusive vascular disease on an arteriosclerotic and also on a thromobangiitic basis, have been studied. The test enabled the authors to determine the advisability of conservative therapy, and if amputation became necessary, the lowest possible level in which it was safe. The test also may be of value in the preoperative selection of hypertensive patients for thoracolumbar sympathectomy.. Patients whose curves were very low, that is, with a considerable spasmotic element, usually benefitted greatly, whereas those with normal curves either experienced a severe vascular complication or died following operaticn. LORD. Saccomanno, G., Utgterhack, the Surgical Treatment
R. A., and Klemme, of Angina Pectoris.
R. Ann.
M.: Surg.
Anatomic Data Regarding 125:49 (Jan.), 1947.
Employing dogs as their experimental animal, the authors isolated the spinal cord between the eighth cervical and the seventh thoracic segments. The spinal nerves were also isolated and The effect of stimulation of each spinal nerve on the pulse cut between a ligature and the cord. rate and blood pressure was studied. They observed that cardiac acceleraticn was greatest when the second and third thoracic nerves were stimulated; acceleration was present but less in degree when the fourth and fifth nerves were stimulated. There was no change in rate on stimulation of the eighth cervical and first thoracic nerves. The authors also observed that elevation of the bleed pressure followed stimulation of the second through the seventh thoracic nerves, in a relatively constant manner. As a result of their experimental data and that of others, they concluded that surgical removal or alcohol injection of the second, third, and fourth thoracic sympathectic ganglia on the left side (usually the affected side) will result in relief of angina1 pain and bring about diminution of coronary spasm. LORD. Southworth, J. Preoperatively.
L.
and Russek, Ann. Surg.
H. I.: 125:119
A Technic (Jan.), 1947.
for
Testing
Hypertensive
Patients
The authors first point out that sympathectomy in the treatment of hypertensive patients is a worthwhile procedure. The mechanism by which operation brings relief is obscure but seems to be most valuable in those patients who demonstrate a significant degree of vasospasm. The most difficult task has been the proper selection of cases preoperatively, and they believe that continuous caudal analgesia and lumbar peridural anesthesia have real value in determining which patient will have effective blood pressure reduction following sympathectcmy. The technic of continuous caudal analgesia is simpler than lumbar peridural anesthesia, but the latter more nearly reproduces the denervation achieved by thoracolumbar sympathectomy. Approximately one third of the paper is devoted to a description No results are offered as these have been presented in an earlier report.
of
the
two
technics. LORI?.
AMERICAN
HEART
JOURNAL
The diagnostic problem in exceptional cases may be very of the heart is necessary to establish an accurate and definitive this way will some cases avoid harmful surgery.
difficult. In these, catheterization preoperative diagnosis. Only
in
DURANT. Smith,
B. C., Peripheral
and Quimhy, E. H.: The Use of Radioactive Vascular Disease. Ann. Surg. 125:360 (March),
Sodium 1947.
in
the
Study
of
By means of an intravenous injection of 3 to 7 cc. of a sterile solution of radioactive sodium and counting the arrival of the radioactive atoms at the sole of the foot by a Geiger-Mtiller counter, the authors have developed a method of studying the circulation to an extremity. The radioactive sodium leaves the capillaries, enters the extravascular fluid, and builds up to an equilibrium, and curves can be plotted which have a definite normal range. Various pathologic states, such as occlusive vascular disease on an arteriosclerotic and also on a thromobangiitic basis, have been studied. The test enabled the authors to determine the advisability of conservative therapy, and if amputation became necessary, the lowest possible level in which it was safe. The test also may be of value in the preoperative selection of hypertensive patients for thoracolumbar sympathectomy.. Patients whose curves were very low, that is, with a considerable spasmotic element, usually benefitted greatly, whereas those with normal curves either experienced a severe vascular complication or died following operaticn. LORD. Saccomanno, G., Utgterhack, the Surgical Treatment
R. A., and Klemme, of Angina Pectoris.
R. Ann.
M.: Surg.
Anatomic Data Regarding 125:49 (Jan.), 1947.
Employing dogs as their experimental animal, the authors isolated the spinal cord between the eighth cervical and the seventh thoracic segments. The spinal nerves were also isolated and The effect of stimulation of each spinal nerve on the pulse cut between a ligature and the cord. rate and blood pressure was studied. They observed that cardiac acceleraticn was greatest when the second and third thoracic nerves were stimulated; acceleration was present but less in degree when the fourth and fifth nerves were stimulated. There was no change in rate on stimulation of the eighth cervical and first thoracic nerves. The authors also observed that elevation of the bleed pressure followed stimulation of the second through the seventh thoracic nerves, in a relatively constant manner. As a result of their experimental data and that of others, they concluded that surgical removal or alcohol injection of the second, third, and fourth thoracic sympathectic ganglia on the left side (usually the affected side) will result in relief of angina1 pain and bring about diminution of coronary spasm. LORD. Southworth, J. Preoperatively.
L.
and Russek, Ann. Surg.
H. I.: 125:119
A Technic (Jan.), 1947.
for
Testing
Hypertensive
Patients
The authors first point out that sympathectomy in the treatment of hypertensive patients is a worthwhile procedure. The mechanism by which operation brings relief is obscure but seems to be most valuable in those patients who demonstrate a significant degree of vasospasm. The most difficult task has been the proper selection of cases preoperatively, and they believe that continuous caudal analgesia and lumbar peridural anesthesia have real value in determining which patient will have effective blood pressure reduction following sympathectcmy. The technic of continuous caudal analgesia is simpler than lumbar peridural anesthesia, but the latter more nearly reproduces the denervation achieved by thoracolumbar sympathectomy. Approximately one third of the paper is devoted to a description No results are offered as these have been presented in an earlier report.
of
the
two
technics. LORI?.