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Cutaneous precordial anaesthesia in angina pectoris and coronary occlusion (an experimental study)
916
AMERICAN
HEART
JOURNAI
0.27 per cent had congenital heart lesions, or 1.8 per cent of those who had heart disease. Threefourths of these patients had not been cyanased or seriously hampered by their congenital heart lesion& The salient findings in eighty-four cases examined by the author are tabulated and the significance of various clinical symptoms discussed.
Nylin, Ductus
G., and Biorck, G. : Circulatory Arteriosus Before and After
Corpuscle and Blood Volume in a Case of Patent Ligation. Acta med. Scandinav. 127:434 (No. V), 1947.
Study of the circulating blood volume by the radiophosphorus method for “tagging” red blood corpuscles (de Hevesy) confirmed previous observations by other workers, using the blue aao-dye technique, that there was a decrease after ligation of a patent ductus arteriosus. The red cell count decreased 8 per cent; the circulating blood volume, 12 per cent; and the roentgenographic heart volume, 19 per cent. The authors feel that their study supports the view that the blood volume is increased in shunts of the ductus arteriosus type. SAYEN.
Espersen, T., and Jorgensen, tension Due to Chromaffin 1947.
J.:
Electrocardiographic Adrenal Tumor.
Acta
Changes in Paroxysmal med. Scandinav. 127:494
Hyper(No. 1’1,
The electrocardiographic findings in a case of paroxysmal hypertension due to pheochromocytoma of the adrenal and associated with thyroid hyperplasia are presented and discussed. Between attacks, tracings were normal or showed sinus tachycardia, auricular fibrillation, flutter, or sinoauricular block. Three tracings recorded during attacks of hypertension, headache, and palpitation showed auricular fibrillation with many deformed ventricular complexes in two instances, while on the third occasion atrioventricular dissociation was observed. Postoperatively, one tracing showed auricular fibrillation and subsequent recordings were normal. The Q-T segment and T-wave changes reported by other writers were not seen. The authors concur with the view of others that the alterations in rhythm are produced by increased epinephrine content of the blood through “combined accelerans and vagus effect, the latter via the pressosensitive zones.“ They believe that the peculiarly characteristic electrocardiographic abnormality associated with pheochromocytoma is heterotopic stimulus formation, and that T-wave alternation, described by others, is probably associated with hypertension rather hyperepinephrinemia. SAYEN.
Djin-Yuan 28:25
Guo: (No. I),
Dissecting 1947.
Aneurysm
of the
Aorta
Related
to Trauma.
:-\cta
radiol.
After citing instances of posttraumatic dissecting aneurysm from the medical literature, including three asymptomatic cases, the author reports the case of a 39-year-old farmer who fell off a horse in 1935, struck his chest on a stump, and fractured his sternum and some ribs. He recovered after “bilateral pneumonia.” X-rays taken then (193.5) showed a “double” am-tic knob which was of similar appearance in 1944, save for calcification in part of the wall. In the oblique projection the calcified transverse and descending aorta could be seen to form a “camel’s hump,” a double angulation with a downward-bowed connecting link replacing the smooth curve of the aortic arch. The patient himself felt well and continued an athletic existence. The rare but occasional occurrence of painless dissecting aneurysm of the aorta after trauma is emphasized as a possibility not often enough investigated by roentgenography in cases with clinical diagnoses of cardiac concussion. SAYEN.
Lindgren, A. : Cutaneous Preeordial Occlusion (an Experimental Study). Sixteen patients with the angina1 10 per cent oxygen, 90 per cent nitrogen
Anaesthesia Cardiolo&a
syndrome mixture)
in Angina Pectoris 11:207, 1947.
and
Coronary
were subjected to hypoxemia (breathing of a until angina occurred, The time of appearance
SELECTED
917
ABSTRACTS
Electrocardiograms were of pain was noted and the area of pain was mapped out on the skin. The capillary oxygen saturation taken at frequent intervals before, during, and after the test. was also determined. The mapped out skin area was anesthetized by subcutaneous injection of 1 per cent novocaine without epinephrine. Most patients tolerated the hypoxemia longer after the anesthesia and the pain was less severe. In some patients the pain “migrated” outside the In fourteen patients the electrocardiogram improved after anesthesia. anesthetized area. After anseEleven patients were made to exercise by bicycle until the appearance of pain. thesia, with the same amount of work, seven patients remained free from pain and two were much improved. Nine showed significant improvement of the electrocardiogram. Two patients had Two patients were anesthetized during relief of pain without change in the electrocardiogram. Following the inspontaneous attacks of angina, after the recording of an electrocardiogram. filtration of the skin, the electrocardiographic changes and the pain disappeared. The authors speculate whether their results signify improved coronary circulation, and Two patients subjected to whether cervicothoracic sympathectomy achieves the same results. the hypoxemia test before and after the operation experienced greatly reduced discomfort and milder electrocardiographic changes. Five patients with acute myocardial infarction were anesthetized with LL30 (effective for five to six hours). The severe pain disappeared, leaving a sensation of dull substernal oppression. The pain reappeared but was less severe after the anesthesia wore off. The electrocardiographic changes were not affected. LENEL.
Libbrecht, dynamic
L.,
A Special Reactions.
Form Acta
of Essential Hypertension din. belg. 2:106 (Jan.-Feb.),
With 1947.
Paradoxical
Pharmaco-
A syndrome of essential hypertension is described in which the subcutaneous injection of 1.0 mg. of adrenalin is followed by paradoxical hypotension with bradycardia and paradoxical leucopenia with lymphopenia. Subcutaneous injection of atropine produces paradoxical stimulation of the gastric secretion. Reversal of the paradoxical reaction to adrenalin is produced by a preventive injection of atropine. The probable mechanism and etiology of the paradoxical reactions are discussed.. The author believes that a state of hypoparasympathicotonia is the basis of the syndrome for which he proposes the name “neurotonic hypertension.” LAPLACE.
Gobat, the
P. Y.: Striated
Variations Muscle
of the Amount of Cytochrome-C in Human Pathology. Helvet med.
in the Myocardium and acta 14:45 (Feb.), 1947.
in
The following is a report of a study of the cytochrome-C levels in skeletal and heart muscle normal and various pathologic states. The cytochrome-C level of muscle is subject to individual variations. The myocardium, however, always contains more respiratory pigments than skeletal muscle. This difference is accentuated with age, and can be recognized very distinctly by an increase of the relation between cardiac and muscular cytochrome or C/M. This increased from 2.93 mg. per cent, between the ages of 20-30 years, to 3.77 mg. per cent, between 80-90 years, with its minimum between SO-60 years. This increase of the C/M results:especially from a pronounced diminution of muscular cytochrome. i,n old persons. HoweGer,’ cardiac ‘muscle has a more or less constant requirement of catalysts for its cellu!ar respiratiou “. ‘Hypertension causes an increase of heart respiratory pigments in relation to the muscular’ hypkrtrophy. Children have only a small amount of cytochrome. Rut later in life the muscle fiber is ra$idIy ‘enriched in cytochrome-C ‘and contains the greatest amount between 20 to 30 years. Beybnd this’ age; a tendency. of progressive decrease can be observed in spite of the fact that a slight increase tin be seen in-peasons.from.50 to’60 years .df age. . I%seases’involving the tihoh body have a similar influence upon both cardiac’and muscular cytochrome and the relation C/M firesents an increase according to age both in sick and in healthy p;crsons. .‘Acute infections and even acute febrile infectious diseases possess hardly any influence under
AMERICAN
HEART
JOURNAI
0.27 per cent had congenital heart lesions, or 1.8 per cent of those who had heart disease. Threefourths of these patients had not been cyanased or seriously hampered by their congenital heart lesion& The salient findings in eighty-four cases examined by the author are tabulated and the significance of various clinical symptoms discussed.
Nylin, Ductus
G., and Biorck, G. : Circulatory Arteriosus Before and After
Corpuscle and Blood Volume in a Case of Patent Ligation. Acta med. Scandinav. 127:434 (No. V), 1947.
Study of the circulating blood volume by the radiophosphorus method for “tagging” red blood corpuscles (de Hevesy) confirmed previous observations by other workers, using the blue aao-dye technique, that there was a decrease after ligation of a patent ductus arteriosus. The red cell count decreased 8 per cent; the circulating blood volume, 12 per cent; and the roentgenographic heart volume, 19 per cent. The authors feel that their study supports the view that the blood volume is increased in shunts of the ductus arteriosus type. SAYEN.
Espersen, T., and Jorgensen, tension Due to Chromaffin 1947.
J.:
Electrocardiographic Adrenal Tumor.
Acta
Changes in Paroxysmal med. Scandinav. 127:494
Hyper(No. 1’1,
The electrocardiographic findings in a case of paroxysmal hypertension due to pheochromocytoma of the adrenal and associated with thyroid hyperplasia are presented and discussed. Between attacks, tracings were normal or showed sinus tachycardia, auricular fibrillation, flutter, or sinoauricular block. Three tracings recorded during attacks of hypertension, headache, and palpitation showed auricular fibrillation with many deformed ventricular complexes in two instances, while on the third occasion atrioventricular dissociation was observed. Postoperatively, one tracing showed auricular fibrillation and subsequent recordings were normal. The Q-T segment and T-wave changes reported by other writers were not seen. The authors concur with the view of others that the alterations in rhythm are produced by increased epinephrine content of the blood through “combined accelerans and vagus effect, the latter via the pressosensitive zones.“ They believe that the peculiarly characteristic electrocardiographic abnormality associated with pheochromocytoma is heterotopic stimulus formation, and that T-wave alternation, described by others, is probably associated with hypertension rather hyperepinephrinemia. SAYEN.
Djin-Yuan 28:25
Guo: (No. I),
Dissecting 1947.
Aneurysm
of the
Aorta
Related
to Trauma.
:-\cta
radiol.
After citing instances of posttraumatic dissecting aneurysm from the medical literature, including three asymptomatic cases, the author reports the case of a 39-year-old farmer who fell off a horse in 1935, struck his chest on a stump, and fractured his sternum and some ribs. He recovered after “bilateral pneumonia.” X-rays taken then (193.5) showed a “double” am-tic knob which was of similar appearance in 1944, save for calcification in part of the wall. In the oblique projection the calcified transverse and descending aorta could be seen to form a “camel’s hump,” a double angulation with a downward-bowed connecting link replacing the smooth curve of the aortic arch. The patient himself felt well and continued an athletic existence. The rare but occasional occurrence of painless dissecting aneurysm of the aorta after trauma is emphasized as a possibility not often enough investigated by roentgenography in cases with clinical diagnoses of cardiac concussion. SAYEN.
Lindgren, A. : Cutaneous Preeordial Occlusion (an Experimental Study). Sixteen patients with the angina1 10 per cent oxygen, 90 per cent nitrogen
Anaesthesia Cardiolo&a
syndrome mixture)
in Angina Pectoris 11:207, 1947.
and
Coronary
were subjected to hypoxemia (breathing of a until angina occurred, The time of appearance
SELECTED
917
ABSTRACTS
Electrocardiograms were of pain was noted and the area of pain was mapped out on the skin. The capillary oxygen saturation taken at frequent intervals before, during, and after the test. was also determined. The mapped out skin area was anesthetized by subcutaneous injection of 1 per cent novocaine without epinephrine. Most patients tolerated the hypoxemia longer after the anesthesia and the pain was less severe. In some patients the pain “migrated” outside the In fourteen patients the electrocardiogram improved after anesthesia. anesthetized area. After anseEleven patients were made to exercise by bicycle until the appearance of pain. thesia, with the same amount of work, seven patients remained free from pain and two were much improved. Nine showed significant improvement of the electrocardiogram. Two patients had Two patients were anesthetized during relief of pain without change in the electrocardiogram. Following the inspontaneous attacks of angina, after the recording of an electrocardiogram. filtration of the skin, the electrocardiographic changes and the pain disappeared. The authors speculate whether their results signify improved coronary circulation, and Two patients subjected to whether cervicothoracic sympathectomy achieves the same results. the hypoxemia test before and after the operation experienced greatly reduced discomfort and milder electrocardiographic changes. Five patients with acute myocardial infarction were anesthetized with LL30 (effective for five to six hours). The severe pain disappeared, leaving a sensation of dull substernal oppression. The pain reappeared but was less severe after the anesthesia wore off. The electrocardiographic changes were not affected. LENEL.
Libbrecht, dynamic
L.,
A Special Reactions.
Form Acta
of Essential Hypertension din. belg. 2:106 (Jan.-Feb.),
With 1947.
Paradoxical
Pharmaco-
A syndrome of essential hypertension is described in which the subcutaneous injection of 1.0 mg. of adrenalin is followed by paradoxical hypotension with bradycardia and paradoxical leucopenia with lymphopenia. Subcutaneous injection of atropine produces paradoxical stimulation of the gastric secretion. Reversal of the paradoxical reaction to adrenalin is produced by a preventive injection of atropine. The probable mechanism and etiology of the paradoxical reactions are discussed.. The author believes that a state of hypoparasympathicotonia is the basis of the syndrome for which he proposes the name “neurotonic hypertension.” LAPLACE.
Gobat, the
P. Y.: Striated
Variations Muscle
of the Amount of Cytochrome-C in Human Pathology. Helvet med.
in the Myocardium and acta 14:45 (Feb.), 1947.
in
The following is a report of a study of the cytochrome-C levels in skeletal and heart muscle normal and various pathologic states. The cytochrome-C level of muscle is subject to individual variations. The myocardium, however, always contains more respiratory pigments than skeletal muscle. This difference is accentuated with age, and can be recognized very distinctly by an increase of the relation between cardiac and muscular cytochrome or C/M. This increased from 2.93 mg. per cent, between the ages of 20-30 years, to 3.77 mg. per cent, between 80-90 years, with its minimum between SO-60 years. This increase of the C/M results:especially from a pronounced diminution of muscular cytochrome. i,n old persons. HoweGer,’ cardiac ‘muscle has a more or less constant requirement of catalysts for its cellu!ar respiratiou “. ‘Hypertension causes an increase of heart respiratory pigments in relation to the muscular’ hypkrtrophy. Children have only a small amount of cytochrome. Rut later in life the muscle fiber is ra$idIy ‘enriched in cytochrome-C ‘and contains the greatest amount between 20 to 30 years. Beybnd this’ age; a tendency. of progressive decrease can be observed in spite of the fact that a slight increase tin be seen in-peasons.from.50 to’60 years .df age. . I%seases’involving the tihoh body have a similar influence upon both cardiac’and muscular cytochrome and the relation C/M firesents an increase according to age both in sick and in healthy p;crsons. .‘Acute infections and even acute febrile infectious diseases possess hardly any influence under