- Email: [email protected]
Cardiac enlargement in fever therapy induced by intravenous injection of typhoid vaccine
SELECTED
ABSTRACTS
271
It is emphasized that the intraresulted in recovery and restoration of normal rhythm. venous injection of procaine or other local anesthetic agents is to be scrupulously avoided in the conscious patient, in whom it may produce cardiovascu1a.r collapse or stimulation However, the of the central nervous system to the point of generalized convulsions. tolerance to procaine in the anesthetized subject is different from that of unanesthetized individuals. In experimental work on dogs anesthetized with ayclopropane, 150 mg. of procaine was injected intravenously without any evidence of untoward effects. In the series of patients reported by the author, the single dose of procaine used in the anesthetized patient ranged from 30 to 70 milligrams. No deleterious effects were observed; on the contrary, cardioeirculatory improvement was often effected. The author related his experience with single-dose injections intravenously into fourteen anesthetized patients with acute arrhythmias during intrathoraeie operations. The arrhythmias always improved dramatically. The use of procaine during anesthesia to diminish eardia.c irritability was based upon a number of findings. Investigators have shown that procaine applied locally to It has also been established that the heart reduced the irritability of the myocardium. during chloroform anesthesia the injection of procaine protects against the development Cardiac arrhythmias produced by of ventricular fibrillation produced by epinephrine. epinephrine during cyclopropane anesthesia in dogs can be abolished by procaine after such arrhythmias have been established. Pre\-ious studies have also shown that-when the ventricular fibrillation sets in during cyelopropone anesthesia, the intracardiac injection of procaine is usually followed by a return of sinus rhythm. In discussing the efficacy of the use of procaine, it is stated that general anesthesia probably affords specific protection against the stimulating action of procaine on thr central nervous system. Further studies are needed, however, to determine the optimal dose. BELLET. Noble,
R. P., Gregersen, M. I., Porter, P. M., and Buckman, A.: Blood Volume in Clinical Shock. II. The Extent and Cause of Blood Volume Reduction in Traumatic Hemorrhagic and Burn Shock. J. Clin. Tnvestigation 25: 172 (Ivfay) 1946.
The mechanism of traumatic shock is similar to that of hemorrhagic shock iu that the plasma proteins and the erythrocytes alike are lost from the circulating blood in proportional amounts, and hemodilution occurs to compensate for the reduction in circulating blood volume. The inference is that severe skeletal trauma is accompanied by loss of whole blood into the injured tissues and that a generalized increase in capillary permeability does not occur in these conditions. On the contrary, burn shock and peritonitis are accompanied by hemoconcentration due to loss of plasma at the site of injury. FRIEDLAND.
Weens, H. S., and Heyman, A.: Cardiac Enlargement in Fever Therapy Induced by Intravenous Injection of Typhoid Vaccine. Arch. Int. Med. 77: 307 (Harrh) 1946. The effects of febrile illnesses upon the heart, particularly in the precipitation of heart failure, are discussed by the authors. During the treatment of patients with neurosyphilis with fever induced by intravenous administration of typhoid vaccine, these authors observed roentgenographic evidence of cardiac enlargement in a significant number of eases. Cardiac enlargement was present in eight of fifteen patients during the period of fever therapy. Increases in the transverse diameter varying from 1 to 2.3 cm. were observed. In two patients there was associated pulmonary congestion. The increase in the heart size was usually recognized by the end of the flrst week, but was more pronounced after the second or third week of therapy. Regression of the increased heart size usually occurred during the month following fever. BELLET.
ABSTRACTS
271
It is emphasized that the intraresulted in recovery and restoration of normal rhythm. venous injection of procaine or other local anesthetic agents is to be scrupulously avoided in the conscious patient, in whom it may produce cardiovascu1a.r collapse or stimulation However, the of the central nervous system to the point of generalized convulsions. tolerance to procaine in the anesthetized subject is different from that of unanesthetized individuals. In experimental work on dogs anesthetized with ayclopropane, 150 mg. of procaine was injected intravenously without any evidence of untoward effects. In the series of patients reported by the author, the single dose of procaine used in the anesthetized patient ranged from 30 to 70 milligrams. No deleterious effects were observed; on the contrary, cardioeirculatory improvement was often effected. The author related his experience with single-dose injections intravenously into fourteen anesthetized patients with acute arrhythmias during intrathoraeie operations. The arrhythmias always improved dramatically. The use of procaine during anesthesia to diminish eardia.c irritability was based upon a number of findings. Investigators have shown that procaine applied locally to It has also been established that the heart reduced the irritability of the myocardium. during chloroform anesthesia the injection of procaine protects against the development Cardiac arrhythmias produced by of ventricular fibrillation produced by epinephrine. epinephrine during cyclopropane anesthesia in dogs can be abolished by procaine after such arrhythmias have been established. Pre\-ious studies have also shown that-when the ventricular fibrillation sets in during cyelopropone anesthesia, the intracardiac injection of procaine is usually followed by a return of sinus rhythm. In discussing the efficacy of the use of procaine, it is stated that general anesthesia probably affords specific protection against the stimulating action of procaine on thr central nervous system. Further studies are needed, however, to determine the optimal dose. BELLET. Noble,
R. P., Gregersen, M. I., Porter, P. M., and Buckman, A.: Blood Volume in Clinical Shock. II. The Extent and Cause of Blood Volume Reduction in Traumatic Hemorrhagic and Burn Shock. J. Clin. Tnvestigation 25: 172 (Ivfay) 1946.
The mechanism of traumatic shock is similar to that of hemorrhagic shock iu that the plasma proteins and the erythrocytes alike are lost from the circulating blood in proportional amounts, and hemodilution occurs to compensate for the reduction in circulating blood volume. The inference is that severe skeletal trauma is accompanied by loss of whole blood into the injured tissues and that a generalized increase in capillary permeability does not occur in these conditions. On the contrary, burn shock and peritonitis are accompanied by hemoconcentration due to loss of plasma at the site of injury. FRIEDLAND.
Weens, H. S., and Heyman, A.: Cardiac Enlargement in Fever Therapy Induced by Intravenous Injection of Typhoid Vaccine. Arch. Int. Med. 77: 307 (Harrh) 1946. The effects of febrile illnesses upon the heart, particularly in the precipitation of heart failure, are discussed by the authors. During the treatment of patients with neurosyphilis with fever induced by intravenous administration of typhoid vaccine, these authors observed roentgenographic evidence of cardiac enlargement in a significant number of eases. Cardiac enlargement was present in eight of fifteen patients during the period of fever therapy. Increases in the transverse diameter varying from 1 to 2.3 cm. were observed. In two patients there was associated pulmonary congestion. The increase in the heart size was usually recognized by the end of the flrst week, but was more pronounced after the second or third week of therapy. Regression of the increased heart size usually occurred during the month following fever. BELLET.