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Effect of lanatoside C on the circulation of patients with congestive failure
838
AMERICAN
HEART
JOURNAL
As there is a loss of vitamin C in acute rheumatic fever, there should be a supplementary administration of this vitamin to avoid depletion of ascorbic acid reserves. The giving of vitamin A in addition seems to be useful. The authors conclude that an appropriate scheme of salicylate therapy in children with rheumatic fever should include the oral use of freshly prepared solutions of sodium salicylate in flavored water with sodium bicarbonate added in the proportion 1:l when given every four hours, or 1:2 when given every two hours. The last dose in the evening and the first in the morning may be doubled to permit a longer undisturbed interval during the night. The administration by enema seems to be indicated in patients with severe vomiting. Aspirin or calcium aspirin in tablets can also be used. The quantity of sodium salicylate which in children raises the level to 25 or 35 mg. per 100 ml. is in the range of 0.12 to 0.18 grain per kilogram of body weight. The estimation of salicylate plasma level’ seems advisable to control the accuracy of the administration and to avoid overdosage. BELLET. Cohen, M. Neurosis
E.,
White,
P. D.,
and
Johnson,
R. E.:-
Neurocirculatory
Asthenia,
Anxiety
Arch. Int. Med. 81:260 (March), 1948. the Effort Syndrome. An attempt is made to summarize certain major positive findings (physical, physiological, subjective, and objective) which the authors have observed in a five-year study of neurocirculatory asthenia. The confused terminology regarding this condition is discussed and the various synonyms described. The exact limits of the terms so used are not clearly defined, but they all refer to a type of disorder in which several of the following features are striking: nervousness, easy fatigue, shortness of breath, palpitation, spells of faintness, giddiness, apprehension, poor muscular work performance, and emotional stress. However, all or any of these symptoms are not associated with any diagnosable disease of the heart, lungs, nervous system, or thyroid gland. The authors studied 144 patients with an average age of 26.9 years. Abnormal findings were few and such positive findings that were present occurred in a high percentage of cases. These findings included a high resting pulse rate, increased respiratory rate, flushed face, hyperactive knee jerks and ankle jerks, and tremors of the fingers. In contrast to these findings was the multiple nature and high incidence of subjective symptoms. Studies of muscular work demonstrated a defect in aerobic metabolism in all grades of work. Pulmonary ventilation was abnormal as was awareness of dyspnea. The pulse rate for all grades of exercise was abnormally high. Heart size, electrocardiograms, resting circulatory measurements, and cardiac output were all normal. Quantitative studies of pain revealed an abnormal reaction to painful stimuli. All patients diagnosed as having neurocirculatory asthenia were placed in the “neurosis” category on psychological testing. Statistics revealed a definite familial incidence with an almost “Mendelian” hereditary pattern, and the authors do not believe that environment and experiences have been demonstrated to be the major factors in causing the disorder. From a prognostic viewpoint, a convenient distinction is made, on the basis of history alone, between acute and chronic neurocirculatory asthenia. Those diagnosed as having an acute disturbance demonstrated more nearly normal observations than did patients with chronic disease. Strong emphasis is placed on the determined fact that basal measurements made with the patients resting may not show abnormalities, while measurements made with the subject under stress may show marked differences; the stronger the stress, the greater the deviation from normal. No specific effective curative measures are proposed. BERNSTEIN. Stead,
or
E. A., Jr., Warren, culation of Patients
J. V., and Brannon, E. S.: Effect With Congestive Failure. Arch.
of Lanatoside
C on the
Cir-
Int. Med. 81:282 (March), 1948. Twenty-two patients in congestive heart failure were observed after they had received a single intravenous injection of 1.6 mg. of lanatoside C. Control observations were made on admission in all cases and repeated after the total digitalization. Cardiac output (direct Fick),
SELECTED
839
ABSTRACTS
arterial pressure (femoral artery), atria1 pressure, and peripheral resistance were established in all cases. The first observed effect was an average fall in venous pressure of 62 mm. H,O which began in five to ten minutes and continued for thirty to sixty minutes. This decrease was not preceded by diuresis and appeared independent of a decrease in the blood volume. The stroke volume improved in twenty patients, but the cardiac rate was variable. There was no constant change in oxygen consumption. The mean arterial pressure usually increased with no consistent change in diastolic pressure. The peripheral resistance fell in eighteen of twenty observations. In eighteen of the twenty-two subjects, the average increase in cardiac output was 1.6 liters per minute. The increase in output resulted primarily from a decrease in arteriovenous oxygen difference and represented an increase in blood flow to the tissues of 2,300 liters per day. Also demonstrated were the facts that patients in congestive failure may have a high cardiac output which can be further increased with digitalis and that lanatoside C increases the cardiac output in the presence of a normal rhythm. The prime action of the digitalis appears to be on the ventricular muscle which enables the ventricles to increase their output. There is a fall in atria1 pressure which is primarily due to changes in venous tone. The further fall in venous pressure which may occur later appears to be related to the decrease in blood volume caused by the diuresis. BEKNSTEIS. Evoy,
M. II., Treatment
and de Takats, of Obliterative
G.: Place Vascular
of Intermittent Disease. Arch.
Venous
Hyperemia
in
the
Int. Med. 1:292 (March), 1948. After preliminary tests of the peripheral circulation, the patients were instructed to rent or buy an automatic rhythmic venous constrictor apparatus, to use it at home for two to three hours daily, and to report every three months for the first year, twice a year for the second year, and once in the third year. Improvement was measured by objective methods, the most sensitive of which were found to be venous filling time and walking ability. Subjective improvement was noted in a higher percentage than objective improvement, but subjective improvement without objective evidence of improvement was disregarded. Of 100 patients studied, sixtyseven derived some benefit, whereas thirty-three either showed no improvement or had a progression of the disease. The authors conclude that intermittent venous hyperemia is contraindicated in acute venous thrombosis, lymphangitis, severe arteriolar obstruction, and frank gangrene. Sympathectomy is still the treatment of choice in those cases with definite spasm, but venous hyperemia appears to offer additional benefit after vasoconstrictor tone is abolished. Diabetic patients with peripheral nerve involvement, patients with pronounced vascular spasm, and those with arteriolar and capillary stasis are not suitable subjects. Patients with vascular sclerosis in whom preliminary tests show poor response to sympathectomy or those who have already undergone sympathectomy, but still have considerable claudication, constitute the group for whom this form of treatment is indicated. It is an ambuiatory treatment to be used at home. “If the rhythmic constrictor did nothing else but supply the patient with a harmless placebo, it would fulfill a need in geriatric practice.” BERNSTEIN. Mervin G.: Mixed Infection in Subacute Bacterial Endocarditis. Arch. Int. Med. 81:334 (March), 1948. Mixed infection in two cases of subacute bacterial endocarditis which responded favorably In one case Corynebacterium $vewSodiphthericum and to antibiotic therapy are reported. Streptococcus tiridans were present; in the second case Streptococcus tirridans and Hemophillts @arainflztensaae were present. The recognition of mixed infection is important in view of the In one case it was obvious that both streptomycin and penicillin present choice of antibiotics. were essential. Adequate selection of suitable antibiotics may require identification of all the organisms involved in a given infection. It is suggested that mixed infection in subacute bacterial endocarditis may be more frequent than is reported. BERNSTEIN.
Olinger,
AMERICAN
HEART
JOURNAL
As there is a loss of vitamin C in acute rheumatic fever, there should be a supplementary administration of this vitamin to avoid depletion of ascorbic acid reserves. The giving of vitamin A in addition seems to be useful. The authors conclude that an appropriate scheme of salicylate therapy in children with rheumatic fever should include the oral use of freshly prepared solutions of sodium salicylate in flavored water with sodium bicarbonate added in the proportion 1:l when given every four hours, or 1:2 when given every two hours. The last dose in the evening and the first in the morning may be doubled to permit a longer undisturbed interval during the night. The administration by enema seems to be indicated in patients with severe vomiting. Aspirin or calcium aspirin in tablets can also be used. The quantity of sodium salicylate which in children raises the level to 25 or 35 mg. per 100 ml. is in the range of 0.12 to 0.18 grain per kilogram of body weight. The estimation of salicylate plasma level’ seems advisable to control the accuracy of the administration and to avoid overdosage. BELLET. Cohen, M. Neurosis
E.,
White,
P. D.,
and
Johnson,
R. E.:-
Neurocirculatory
Asthenia,
Anxiety
Arch. Int. Med. 81:260 (March), 1948. the Effort Syndrome. An attempt is made to summarize certain major positive findings (physical, physiological, subjective, and objective) which the authors have observed in a five-year study of neurocirculatory asthenia. The confused terminology regarding this condition is discussed and the various synonyms described. The exact limits of the terms so used are not clearly defined, but they all refer to a type of disorder in which several of the following features are striking: nervousness, easy fatigue, shortness of breath, palpitation, spells of faintness, giddiness, apprehension, poor muscular work performance, and emotional stress. However, all or any of these symptoms are not associated with any diagnosable disease of the heart, lungs, nervous system, or thyroid gland. The authors studied 144 patients with an average age of 26.9 years. Abnormal findings were few and such positive findings that were present occurred in a high percentage of cases. These findings included a high resting pulse rate, increased respiratory rate, flushed face, hyperactive knee jerks and ankle jerks, and tremors of the fingers. In contrast to these findings was the multiple nature and high incidence of subjective symptoms. Studies of muscular work demonstrated a defect in aerobic metabolism in all grades of work. Pulmonary ventilation was abnormal as was awareness of dyspnea. The pulse rate for all grades of exercise was abnormally high. Heart size, electrocardiograms, resting circulatory measurements, and cardiac output were all normal. Quantitative studies of pain revealed an abnormal reaction to painful stimuli. All patients diagnosed as having neurocirculatory asthenia were placed in the “neurosis” category on psychological testing. Statistics revealed a definite familial incidence with an almost “Mendelian” hereditary pattern, and the authors do not believe that environment and experiences have been demonstrated to be the major factors in causing the disorder. From a prognostic viewpoint, a convenient distinction is made, on the basis of history alone, between acute and chronic neurocirculatory asthenia. Those diagnosed as having an acute disturbance demonstrated more nearly normal observations than did patients with chronic disease. Strong emphasis is placed on the determined fact that basal measurements made with the patients resting may not show abnormalities, while measurements made with the subject under stress may show marked differences; the stronger the stress, the greater the deviation from normal. No specific effective curative measures are proposed. BERNSTEIN. Stead,
or
E. A., Jr., Warren, culation of Patients
J. V., and Brannon, E. S.: Effect With Congestive Failure. Arch.
of Lanatoside
C on the
Cir-
Int. Med. 81:282 (March), 1948. Twenty-two patients in congestive heart failure were observed after they had received a single intravenous injection of 1.6 mg. of lanatoside C. Control observations were made on admission in all cases and repeated after the total digitalization. Cardiac output (direct Fick),
SELECTED
839
ABSTRACTS
arterial pressure (femoral artery), atria1 pressure, and peripheral resistance were established in all cases. The first observed effect was an average fall in venous pressure of 62 mm. H,O which began in five to ten minutes and continued for thirty to sixty minutes. This decrease was not preceded by diuresis and appeared independent of a decrease in the blood volume. The stroke volume improved in twenty patients, but the cardiac rate was variable. There was no constant change in oxygen consumption. The mean arterial pressure usually increased with no consistent change in diastolic pressure. The peripheral resistance fell in eighteen of twenty observations. In eighteen of the twenty-two subjects, the average increase in cardiac output was 1.6 liters per minute. The increase in output resulted primarily from a decrease in arteriovenous oxygen difference and represented an increase in blood flow to the tissues of 2,300 liters per day. Also demonstrated were the facts that patients in congestive failure may have a high cardiac output which can be further increased with digitalis and that lanatoside C increases the cardiac output in the presence of a normal rhythm. The prime action of the digitalis appears to be on the ventricular muscle which enables the ventricles to increase their output. There is a fall in atria1 pressure which is primarily due to changes in venous tone. The further fall in venous pressure which may occur later appears to be related to the decrease in blood volume caused by the diuresis. BEKNSTEIS. Evoy,
M. II., Treatment
and de Takats, of Obliterative
G.: Place Vascular
of Intermittent Disease. Arch.
Venous
Hyperemia
in
the
Int. Med. 1:292 (March), 1948. After preliminary tests of the peripheral circulation, the patients were instructed to rent or buy an automatic rhythmic venous constrictor apparatus, to use it at home for two to three hours daily, and to report every three months for the first year, twice a year for the second year, and once in the third year. Improvement was measured by objective methods, the most sensitive of which were found to be venous filling time and walking ability. Subjective improvement was noted in a higher percentage than objective improvement, but subjective improvement without objective evidence of improvement was disregarded. Of 100 patients studied, sixtyseven derived some benefit, whereas thirty-three either showed no improvement or had a progression of the disease. The authors conclude that intermittent venous hyperemia is contraindicated in acute venous thrombosis, lymphangitis, severe arteriolar obstruction, and frank gangrene. Sympathectomy is still the treatment of choice in those cases with definite spasm, but venous hyperemia appears to offer additional benefit after vasoconstrictor tone is abolished. Diabetic patients with peripheral nerve involvement, patients with pronounced vascular spasm, and those with arteriolar and capillary stasis are not suitable subjects. Patients with vascular sclerosis in whom preliminary tests show poor response to sympathectomy or those who have already undergone sympathectomy, but still have considerable claudication, constitute the group for whom this form of treatment is indicated. It is an ambuiatory treatment to be used at home. “If the rhythmic constrictor did nothing else but supply the patient with a harmless placebo, it would fulfill a need in geriatric practice.” BERNSTEIN. Mervin G.: Mixed Infection in Subacute Bacterial Endocarditis. Arch. Int. Med. 81:334 (March), 1948. Mixed infection in two cases of subacute bacterial endocarditis which responded favorably In one case Corynebacterium $vewSodiphthericum and to antibiotic therapy are reported. Streptococcus tiridans were present; in the second case Streptococcus tirridans and Hemophillts @arainflztensaae were present. The recognition of mixed infection is important in view of the In one case it was obvious that both streptomycin and penicillin present choice of antibiotics. were essential. Adequate selection of suitable antibiotics may require identification of all the organisms involved in a given infection. It is suggested that mixed infection in subacute bacterial endocarditis may be more frequent than is reported. BERNSTEIN.
Olinger,