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Coarctation of the aorta. Experimental studies regarding its surgical correction
112
:\iVIIERIC.jX HEART .IOTJRN.11,
Prom literature, treatment denw that
a review of this seriw, ant1 ;LS :t result of the perusal quinidinc in adequal e an11 mas~ivr doses, if nwrsrary, is of ventricular tachycartli:a. ‘I’hrre tlors not appt’ar to be its administr:ltion foIlon-iny acutcs coronnr!ncclu~itrns is in
of’ the sparse recent recommended in thf, any unequivocal evi any xray rletrimental. hl-THOlL
Candel, Samuel, and Wheelock, 23:
309,
M. C.:
Acute Non-Specific
Myocarditis.
.411n. Int.
Me(l.
1945.
Eleven cases of acute n1yocnrililis, nc,rlslwcific~ in nature? have been prcsentcd. TllC studies are entirely clinical. The w:~sons for the tliagnoses :ITP prceented. Evidence ip shown that. nlyocarditis occurs more frc~clu~~ntly than lln!: 11ecn supposed. sonlo of the reasons for failure to recognize the condition are indicated. Acute nlyocarditis is dis cussed. The importance of a ljettrr understanding and n nitler appreciation of acute nom specific myocarditis is stressell. Tt is pointed out that failure to appreciate the frequeneof myocarditis may affect adversely some of ihc rurwnt rcsc:~rch. A case of acute niyocnrditiV, following nl>nti: death, is described. -4s far as wve knw, this autopsy of acute nonspecific myocartlitis following in
Grollman, Sodium
A., Harrison, Restriction
T. R., Mason, M. F., Baxter, in the Diet for Hypertension.
ari~~pur:~ti\-~ tonsillitis and is the first rase on record a~utrt t~in~illitis.
J., Crampton,
eventuating (proved
J., and Reichsman,
2. A. X1. PI. 129:
by
AVTTIORS.
F.:
5::fl, i%L5.
Diets rendered IOH. iu solliulr~ content 1,~ dialysis wew found to reduce decidedly tht, That this effect xvas due tcl blood pressure of rats with experiment:tl renal hyl>ertensilJn. the low sodium content of such diets was dcnlonstratrtl. It was also shown that prolonge(l administration of such ‘I low sodium ” diets not only xas not. deleterious but apparently actually prolonged the life of the cxpcrimr~ntal hypertrnsi\-r :tnimnl. In six human hgertensix c llatiruts :j clr;ist ira wcluc:lir)n in the sodium intaBeJ made possible by dialysis of the milk irlcluded in tllc liicl, rcsnlt~cl in no decline in blood pressuru to wwntiall~ normal levels in two, and :4 in one subject, a reduction of tile pwssur~~ moderate reduction in the rem:lining tl~wc~. ~I*IP uf w:lorn, horvever, tlisplayed acute circuhlr*!~ir)riile thcrnp;\-. It. is suggested that tory collapse which reslx~,iidctl l~r~~ml~ll~ III w(lirn~~ such diets be utilizetl for a I~rict’ trial periotl for ll::iitln!s with h>-pertcnsiozi anti employell for a longer period in sull,jrcls \vllo Ilisplay :I f:tvoral~lP rtls]~Onsc. AUTHORS.
Gross, Robert E., and Hufnagel, C. A.: Coarctation of the Aorta. Regarding Its Surgical Correction. New >:11gln.r111.I. I\lcd. 233:
Experimental 37,
Studies
194.5.
Previously recommc~nderl pr~~wduw~ for 1 iic hurgi~~al lelitxf of coarctation of the aorta have included anastomosiny a sul~~lnvian artcry into the aorta distal to its ohstruetion, reportion of the aorta either 1)~ a vein 01 moving the constriction, and replaein g the rcmoretl l,y a portion of aorta previowly secured nt nc~~l0p.q. After considering theye rurgical aplir~:wl~t~s~ Clross aud lldnagel felt that it was theo retically possible to remove the constriction and directly rwnite lhe upper and lower portions This n-as iried experimen!:ally on (logs and gave encourag of the divided aorta end to end. ing results. The three chief difficulties that ~~erc ~n(.ounlered were : thrombus formation at the site of suture of the aorta, fatal dilatation of the heart at the time of the rcmo~al of the clamps from the aorta, and hind-leg paralysis secondary to ischemia of the spinal cord. After finding methods of combating these complildntiorw, the surgical prowdure was applied to two humans. The first patiwt, was a ti-year-old tloy who stood the opera&n satisfactorily until the clamps were removed from the aorta.. At this point the heart became enormously dilated and the child died. The second patient was a 12.gear-old girl. The clamps in this instance were very gra~lually releawl, n full ten minutes being taken to accomplish
113
ANNOUSCEMEST
complete opening. There was 315 before operation be obtained@ the legs. tions of the Yfemornl artery Gross,
Robert England
E.: Surgical J. Med. 233:
were no delrterious effects. The systolic blood prepsure in the arms and 140 after operation. Preoperatively no hystolic readings could After operation the systolic pressure in the legs was 14.5 and pulsawere readily felt. Relief for 586, 3%;.
Tracheal
Obstruction
Prom
a Vascular
Ring.
New
A child of 4 months m-ho had ha11 I\-heczing. Ilifficult respiration since birth and who periodically developed attacks of tracheobronchitis with an increase of dyspnea, cough, and fever was studied by Gross. Both from the literature and from ntcropsy experience he was aware that occasionally the trachea TY:IS obstructed by vascular elements. The obstruction conies about in two ways. A patent ductus arteriosus or a ligamenturn arteriosum may make traction on the pulmonary %r$ery, which is? of course, iu front of the trachea, and thus compress the trachea sufficiently -to produce symlltoms. The other form of vascular obstruction of the trachek occurs when the Lrch of the’nortn splits, witlt one portion going in front nf the trachea and the other portion brhiFI1 the esophagus. In the Case described by Gross, obstructibti of the tra.chea was strongly suspected. and intlecll diagnosed, in life. The diagnosis was based principally on tile fact that lipiodol rho~cd the tmchra to be compressed in front, and ltirium showed the esophagus to be compressed posteriorly. Roth forms of obstruction were present. Separation of the li~amentum arteriosum partially relieved the pressure of the Becnulie the postrrior branch of the aorta was the largc~r. pulmonary. artery on the trachea. the anterior branch was sq~aratcd at a point between the lrft common carotid artery and thr left subclavinn artery. The results were very satisfactory. So far as ihe author is awarp this is the first time this opnntion lras bcrn pwformrd.
High,
R. H., and Aegerter, E. E.: Rheumatic Heart DiseaseAssociated Encephalitis. J. Pediat. 27: 343, 19-15.
With
Meningo
A Negro boy, age4 13 years, who had first had rheumatic fever at the age of 5, had evidepces of severe meningeal irritation. At necropsy there was unmistakable evidenc.e of an active rheumatic carditis. The meninges, brain, and spinal cord showed a marked and rather unusual inflammatory reaction consisting of an abundant lymphocytic infiltration about most of the small vessels. In some areas, mingled with the lymphocytes, were large cells resembling those seen in an Aschoff body. The morphology and pattern were hardly The identical with that of an Bsehoff nodule, but the cellular elements were the same. implication is that the changes in the nervous system and the heart were the result of the BELLE-r. same etiological factor.
Announcement The Alnerican College of Physickins will resume its Annual Meetings in 1946. The meeting will be held in Philadelphia, May 13 to 17, inclusive, under the presidency of Dr. Ernest E. Irons, Chicago, and the general chairmanship of Dr. Morris Piersol, Philadelphia, The headquarters will be at the Philadelphia Municipal Auditorium, 34th Street below Spruce Street.
:\iVIIERIC.jX HEART .IOTJRN.11,
Prom literature, treatment denw that
a review of this seriw, ant1 ;LS :t result of the perusal quinidinc in adequal e an11 mas~ivr doses, if nwrsrary, is of ventricular tachycartli:a. ‘I’hrre tlors not appt’ar to be its administr:ltion foIlon-iny acutcs coronnr!ncclu~itrns is in
of’ the sparse recent recommended in thf, any unequivocal evi any xray rletrimental. hl-THOlL
Candel, Samuel, and Wheelock, 23:
309,
M. C.:
Acute Non-Specific
Myocarditis.
.411n. Int.
Me(l.
1945.
Eleven cases of acute n1yocnrililis, nc,rlslwcific~ in nature? have been prcsentcd. TllC studies are entirely clinical. The w:~sons for the tliagnoses :ITP prceented. Evidence ip shown that. nlyocarditis occurs more frc~clu~~ntly than lln!: 11ecn supposed. sonlo of the reasons for failure to recognize the condition are indicated. Acute nlyocarditis is dis cussed. The importance of a ljettrr understanding and n nitler appreciation of acute nom specific myocarditis is stressell. Tt is pointed out that failure to appreciate the frequeneof myocarditis may affect adversely some of ihc rurwnt rcsc:~rch. A case of acute niyocnrditiV, following nl>nti: death, is described. -4s far as wve knw, this autopsy of acute nonspecific myocartlitis following in
Grollman, Sodium
A., Harrison, Restriction
T. R., Mason, M. F., Baxter, in the Diet for Hypertension.
ari~~pur:~ti\-~ tonsillitis and is the first rase on record a~utrt t~in~illitis.
J., Crampton,
eventuating (proved
J., and Reichsman,
2. A. X1. PI. 129:
by
AVTTIORS.
F.:
5::fl, i%L5.
Diets rendered IOH. iu solliulr~ content 1,~ dialysis wew found to reduce decidedly tht, That this effect xvas due tcl blood pressure of rats with experiment:tl renal hyl>ertensilJn. the low sodium content of such diets was dcnlonstratrtl. It was also shown that prolonge(l administration of such ‘I low sodium ” diets not only xas not. deleterious but apparently actually prolonged the life of the cxpcrimr~ntal hypertrnsi\-r :tnimnl. In six human hgertensix c llatiruts :j clr;ist ira wcluc:lir)n in the sodium intaBeJ made possible by dialysis of the milk irlcluded in tllc liicl, rcsnlt~cl in no decline in blood pressuru to wwntiall~ normal levels in two, and :4 in one subject, a reduction of tile pwssur~~ moderate reduction in the rem:lining tl~wc~. ~I*IP uf w:lorn, horvever, tlisplayed acute circuhlr*!~ir)riile thcrnp;\-. It. is suggested that tory collapse which reslx~,iidctl l~r~~ml~ll~ III w(lirn~~ such diets be utilizetl for a I~rict’ trial periotl for ll::iitln!s with h>-pertcnsiozi anti employell for a longer period in sull,jrcls \vllo Ilisplay :I f:tvoral~lP rtls]~Onsc. AUTHORS.
Gross, Robert E., and Hufnagel, C. A.: Coarctation of the Aorta. Regarding Its Surgical Correction. New >:11gln.r111.I. I\lcd. 233:
Experimental 37,
Studies
194.5.
Previously recommc~nderl pr~~wduw~ for 1 iic hurgi~~al lelitxf of coarctation of the aorta have included anastomosiny a sul~~lnvian artcry into the aorta distal to its ohstruetion, reportion of the aorta either 1)~ a vein 01 moving the constriction, and replaein g the rcmoretl l,y a portion of aorta previowly secured nt nc~~l0p.q. After considering theye rurgical aplir~:wl~t~s~ Clross aud lldnagel felt that it was theo retically possible to remove the constriction and directly rwnite lhe upper and lower portions This n-as iried experimen!:ally on (logs and gave encourag of the divided aorta end to end. ing results. The three chief difficulties that ~~erc ~n(.ounlered were : thrombus formation at the site of suture of the aorta, fatal dilatation of the heart at the time of the rcmo~al of the clamps from the aorta, and hind-leg paralysis secondary to ischemia of the spinal cord. After finding methods of combating these complildntiorw, the surgical prowdure was applied to two humans. The first patiwt, was a ti-year-old tloy who stood the opera&n satisfactorily until the clamps were removed from the aorta.. At this point the heart became enormously dilated and the child died. The second patient was a 12.gear-old girl. The clamps in this instance were very gra~lually releawl, n full ten minutes being taken to accomplish
113
ANNOUSCEMEST
complete opening. There was 315 before operation be obtained@ the legs. tions of the Yfemornl artery Gross,
Robert England
E.: Surgical J. Med. 233:
were no delrterious effects. The systolic blood prepsure in the arms and 140 after operation. Preoperatively no hystolic readings could After operation the systolic pressure in the legs was 14.5 and pulsawere readily felt. Relief for 586, 3%;.
Tracheal
Obstruction
Prom
a Vascular
Ring.
New
A child of 4 months m-ho had ha11 I\-heczing. Ilifficult respiration since birth and who periodically developed attacks of tracheobronchitis with an increase of dyspnea, cough, and fever was studied by Gross. Both from the literature and from ntcropsy experience he was aware that occasionally the trachea TY:IS obstructed by vascular elements. The obstruction conies about in two ways. A patent ductus arteriosus or a ligamenturn arteriosum may make traction on the pulmonary %r$ery, which is? of course, iu front of the trachea, and thus compress the trachea sufficiently -to produce symlltoms. The other form of vascular obstruction of the trachek occurs when the Lrch of the’nortn splits, witlt one portion going in front nf the trachea and the other portion brhiFI1 the esophagus. In the Case described by Gross, obstructibti of the tra.chea was strongly suspected. and intlecll diagnosed, in life. The diagnosis was based principally on tile fact that lipiodol rho~cd the tmchra to be compressed in front, and ltirium showed the esophagus to be compressed posteriorly. Roth forms of obstruction were present. Separation of the li~amentum arteriosum partially relieved the pressure of the Becnulie the postrrior branch of the aorta was the largc~r. pulmonary. artery on the trachea. the anterior branch was sq~aratcd at a point between the lrft common carotid artery and thr left subclavinn artery. The results were very satisfactory. So far as ihe author is awarp this is the first time this opnntion lras bcrn pwformrd.
High,
R. H., and Aegerter, E. E.: Rheumatic Heart DiseaseAssociated Encephalitis. J. Pediat. 27: 343, 19-15.
With
Meningo
A Negro boy, age4 13 years, who had first had rheumatic fever at the age of 5, had evidepces of severe meningeal irritation. At necropsy there was unmistakable evidenc.e of an active rheumatic carditis. The meninges, brain, and spinal cord showed a marked and rather unusual inflammatory reaction consisting of an abundant lymphocytic infiltration about most of the small vessels. In some areas, mingled with the lymphocytes, were large cells resembling those seen in an Aschoff body. The morphology and pattern were hardly The identical with that of an Bsehoff nodule, but the cellular elements were the same. implication is that the changes in the nervous system and the heart were the result of the BELLE-r. same etiological factor.
Announcement The Alnerican College of Physickins will resume its Annual Meetings in 1946. The meeting will be held in Philadelphia, May 13 to 17, inclusive, under the presidency of Dr. Ernest E. Irons, Chicago, and the general chairmanship of Dr. Morris Piersol, Philadelphia, The headquarters will be at the Philadelphia Municipal Auditorium, 34th Street below Spruce Street.