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Action of neostigmin in supraventricular tachycardias
American
Federation
Under light sodium amytal narcosis (Gm. 0.3) the patient reacted an episode in which love and hate for his mother were in sharp conflict. An increasingly violent and intense state of rage culminated in an attack of grand ma1 clinically, and electro-encephalographically characteristic. The fit appeared to resolve, in a dynamic sense, the conflict between uncontrollable rage and the restrictions of conscience and society. The role of sodium amytal in the genesis of the reaction is discussed in terms of inactivation of cortical inhibitory influences. ACTION OF NEOSTIGMIN IN SUPRAVENTRICULAR TACHYCARDIAS. Samuel Waldman, M. D. and
Louis Pelner, M.D.,
Brooklyn, New York.
Supraventricular tachycardias of sinus, auricular and nodal origin can be successfully treated by the administration of 1 mg. of neostigmin methylsulfate intramuscularly. Action of this drug is predicated in these instances by its stimulating effect on the vagus nerve. Stimulation of the right vagus is the predominant factor in sinus tachycardia since this nerve ends especially at the sino-auricular node in which the disturbance originates, correction of which restores normal sinus rhythm. That this occurs is borne out by electrocardiographic studies on patients in whom the effect noted is a slowing of the heart by a decrease in rate of impulse formation at the sinoauricular node. An increased T-P interval is produced. In the case of paroxysmal auricular and nodal tachycardias, stimulation of the right vagus would not correct this defect since the defect is not at the sino-auricular node. We could expect left vagal action to be effective since those fibers terminate mainly at the auriculoventricular node. Stimulation here would produce inhibition of conductivity and then induce a heart block of varying degree depending upon the extent of diminished conductivity. That this actually occurs is shown by electrocardiographic studies in those patients in whom heart block occurs varying from first degree block with increased P-R intervals to 2: 1, 3: 1 and 4: 1 incomplete block. No case of complete block was found. After the block normal sinus rhythm was restored.
for Clinical Research DIAGNOSTIC
AND
THERAPEUTIC
USE
OF
TETRAETHYLAMMONIUM AND DIBENAMINE.
A. Dale Console, M.D., New York, New York. (From the Department of Surgery, New
York
Hospital,
Cornell
Medical
College.) The effects of tetraethylammonium and dibenamine have been investigated in ninety-six patients with perivascular disease and hypertension. The beneficial effects of these drugs are dependent entirely upon the temporary vasomotor paralysis which they produce, and unless we assume that they have some additional beneficial action (which, as yet, has not been demonstrated) they can be only as effective as any other measure which produces a similar degree of vasomotor paralysis. The physiologic state produced by sympathectomy differs markedly from that produced by temporary vasomotor paralysis regardless of how the paralysis is achieved. Temporary vasomotor paralysis, therefore, does not uniformly predict the results of sympathectomy in treatment save in some acute occlusions. Since the blockade produced by tetraethylammonium varies in extent and degree, it has been found even less reliable than paravertebral sympathetic block in predicting the results of sympathectomy in perivascular disease. Dibenamine, because it produces a block which may last from twelve to ninety-six hours, may be superior to other diagnostic tests in selecting patients with obliterative disorders for sympathectomy. Neither drug in our experience has proved to be of value in selection of hypertensive patients for sympathectomy. In the treatment of acute vascular occlusions, temporary vasomotor paralysis may be of great value. Tetraethylammonium and dibenamine are both useful, but we prefer dibenamine because of the longer duration of action. In the chronic perivascular disorders the value of temporary vasomotor paralysis must yet be proved. Tetraethylammonium and dibenamine have not proved to be of greater value than other similar methods of treatment. It is doubtful that either drug is appropriate in the treatment of hypertension.
Federation
Under light sodium amytal narcosis (Gm. 0.3) the patient reacted an episode in which love and hate for his mother were in sharp conflict. An increasingly violent and intense state of rage culminated in an attack of grand ma1 clinically, and electro-encephalographically characteristic. The fit appeared to resolve, in a dynamic sense, the conflict between uncontrollable rage and the restrictions of conscience and society. The role of sodium amytal in the genesis of the reaction is discussed in terms of inactivation of cortical inhibitory influences. ACTION OF NEOSTIGMIN IN SUPRAVENTRICULAR TACHYCARDIAS. Samuel Waldman, M. D. and
Louis Pelner, M.D.,
Brooklyn, New York.
Supraventricular tachycardias of sinus, auricular and nodal origin can be successfully treated by the administration of 1 mg. of neostigmin methylsulfate intramuscularly. Action of this drug is predicated in these instances by its stimulating effect on the vagus nerve. Stimulation of the right vagus is the predominant factor in sinus tachycardia since this nerve ends especially at the sino-auricular node in which the disturbance originates, correction of which restores normal sinus rhythm. That this occurs is borne out by electrocardiographic studies on patients in whom the effect noted is a slowing of the heart by a decrease in rate of impulse formation at the sinoauricular node. An increased T-P interval is produced. In the case of paroxysmal auricular and nodal tachycardias, stimulation of the right vagus would not correct this defect since the defect is not at the sino-auricular node. We could expect left vagal action to be effective since those fibers terminate mainly at the auriculoventricular node. Stimulation here would produce inhibition of conductivity and then induce a heart block of varying degree depending upon the extent of diminished conductivity. That this actually occurs is shown by electrocardiographic studies in those patients in whom heart block occurs varying from first degree block with increased P-R intervals to 2: 1, 3: 1 and 4: 1 incomplete block. No case of complete block was found. After the block normal sinus rhythm was restored.
for Clinical Research DIAGNOSTIC
AND
THERAPEUTIC
USE
OF
TETRAETHYLAMMONIUM AND DIBENAMINE.
A. Dale Console, M.D., New York, New York. (From the Department of Surgery, New
York
Hospital,
Cornell
Medical
College.) The effects of tetraethylammonium and dibenamine have been investigated in ninety-six patients with perivascular disease and hypertension. The beneficial effects of these drugs are dependent entirely upon the temporary vasomotor paralysis which they produce, and unless we assume that they have some additional beneficial action (which, as yet, has not been demonstrated) they can be only as effective as any other measure which produces a similar degree of vasomotor paralysis. The physiologic state produced by sympathectomy differs markedly from that produced by temporary vasomotor paralysis regardless of how the paralysis is achieved. Temporary vasomotor paralysis, therefore, does not uniformly predict the results of sympathectomy in treatment save in some acute occlusions. Since the blockade produced by tetraethylammonium varies in extent and degree, it has been found even less reliable than paravertebral sympathetic block in predicting the results of sympathectomy in perivascular disease. Dibenamine, because it produces a block which may last from twelve to ninety-six hours, may be superior to other diagnostic tests in selecting patients with obliterative disorders for sympathectomy. Neither drug in our experience has proved to be of value in selection of hypertensive patients for sympathectomy. In the treatment of acute vascular occlusions, temporary vasomotor paralysis may be of great value. Tetraethylammonium and dibenamine are both useful, but we prefer dibenamine because of the longer duration of action. In the chronic perivascular disorders the value of temporary vasomotor paralysis must yet be proved. Tetraethylammonium and dibenamine have not proved to be of greater value than other similar methods of treatment. It is doubtful that either drug is appropriate in the treatment of hypertension.