- Email: [email protected]
Hyperactive vasodepressor carotid sinus reflex
In seven cases no specific changes in urinary sediment were discovered, but in fourteen cases a singular picture of the sediment was observed. The uniqueness of this picture lies in the presence of red blood cells, red cell zasts, oval fat bodies, fatty casts, broad casts and abnormal quantities of protein in the same specimen of urine. These elements do not occur together in association with glomerulonephritis or with any other renal lesion with which the author is familiar. This unusual sediment is of diagnostic value in doubtful mentioned. The term visceral angiitis is advanced as a convenient these disorders and is not meant to imply a common
cases of the disorders clinical etiologic,
just
designation relation.
for
-kUTIIOR.
Barman,
J. M.,
Moreira.,
Increased Pulmonary tion
M.
I?., and
Ventilation
Consolazio,
During Muscular
P.:
The Elective Exertion.
Stimulus
.T. Clin.
for
Investiga-
22: 53, 1943.
The increase in pulmonary ventilation has been studied in normal r
Sigler, L. H.: 70:
983,
Hyperactive
Vasodepressor
Carotid
Sinus Reflex.
Arch. Int.
Med.
1942.
induced by the carotid This paper covers a study of the vasodepressor effect sinus reflex. Seven hundred patients were tested, most of whom had demonatra.ble cardiovascular disease. Of these, 447 were males and 253 verc females. blood presThe pati%nts were divided into four groups accordin, 71 to the original sure. In Group I were ineluded subjects with normal blood pressure; in Group II, in Group 111, those with moderate hyperpatients with low grade hypertension; tension, and in Group IV those with marked hypertension. It was found that, roughly, about 88 per cent of the males and 82 per cent of If a drop of less than 10 mm. is exc,luded the females showed a drop in pressure. as of insufficient significance, the response is reduced to about 78 per cent for males and 71 per cent for females. The response occurred more frequently and in greater Also, the higher the blood pressure the more frequent degree in the older age groups. A drop was more frequent in the systolic the response and the greater its degree. pressure than in the diastolic. A drop in pressure often occurred in patients with-
ABSTRACTS
AXD
443
REVIEWS
out cardioinhibition but was more frequent in those who also showed cardioinhibitiou. In such patients, the frequency and the degree of vasodepression roughly corresponded to those of cardioinhibition. There was a marked difference in response to stimulation on the two sides in many cases. The amount of stimulation required to produce the maximum response varied from case to case and with the position of the patient. The findings point to the existence of an inherent instability in the vasomotor system in persons who show a marked vasodepression induced by the carotid sinus reflex, which the test helps to demonstrate. The seat of this instability is either in the medullary synapses or in the vasomotor terminals in the vascular tree. Rrteriosclerosis is possibly one of the underlying predisposing causes of such instability, as evidenced by the fact that the reflex is most prevalent under circumstances in which arteriosclerosis is apt to occur, that is, when the patient is a. man is of advanced age, and has a high degree of hypertension. Au~rron.
Starr, I., and Jonas, L.: Supernormal Circulation in Resting Subjects (Ilyperkinemia) With a Study of the Relation of Kinemic Abnormalities to the Basal Metabolic Rate. Arch. Int. Med. 71: 1, 194.1. In a total experience of about 1,400 estimations of cardiac output, one hundred patients were encountered in whom the resting circulation was above normal, a condition we have called hyperkinemia. These patients were usually underweight, and they tended to have resting pulse rates above normal. Hyperkinemia was encountered in almost all patients wi!h thyrotoxicosis without cardiac involvement and in most patients with patent duetus arteriosus. It was found often in patients with emaciation and less frequently in those with pulmonary abnormalities, fever, anemia, hypertension and peripheral arteriovenous communications. In seventeen patients, hpperkinemia was present without any complicating condition having been discovered. These patients with essential hyperkinemia resembled patients with thyrotoxicosis in appearance, but the basal metabolic rate was always normal. The clinical characteristics of this subgroup have been described in detail. The relation between abnormalities of the circulation and the basal metabolic rate has been studied by statistical methods. In uncomplicated hypert,hyroidism and hypothyroidism the relation is almost 1 to 1; i.e., on the average, an abnormal increment or decrement in the basal metabolic rate is accompanied by an equal percentage change in the circulation. In heart disease these twc functions are related, but the relationship is more nearly 1 to 0.5. Under such conditions the circulation is less than normal for any given metabolic rate, and the higher the metabolic rate the greater the circulatory deficit. Other instances of deviation from the normal 1 to 1 relationship between circulation and metabolic rate have been found in cases of emaciation and in some cases of hyperthyroidism after partial thyroidectomy. AUTHORS.
Leiter, L., Eichelberger, L., and Roma, M.: Studies on Renin: The Duration of the Pressor Effect of Large Doses in Conscious Normal and Renally Abnormal Dogs. Observations on Anesthetized and Uremic Dogs, and the Anaphylactic and Pathological Effects of Pig Renin. J. Clin. Investigation 22: 11, 1943. Trained, conscious dogs, injected \yith renin intravenously, in single moderate or large doses, sufficient to elevate the mean femoral blood pressure 50 to 100 mm. Hg, gave similar pressor responses whether their kidneys were normal or experimentally abnormal as the result of partial constriction of arteries or ureters, with or without nephrectomy.
cases of the disorders clinical etiologic,
just
designation relation.
for
-kUTIIOR.
Barman,
J. M.,
Moreira.,
Increased Pulmonary tion
M.
I?., and
Ventilation
Consolazio,
During Muscular
P.:
The Elective Exertion.
Stimulus
.T. Clin.
for
Investiga-
22: 53, 1943.
The increase in pulmonary ventilation has been studied in normal r
Sigler, L. H.: 70:
983,
Hyperactive
Vasodepressor
Carotid
Sinus Reflex.
Arch. Int.
Med.
1942.
induced by the carotid This paper covers a study of the vasodepressor effect sinus reflex. Seven hundred patients were tested, most of whom had demonatra.ble cardiovascular disease. Of these, 447 were males and 253 verc females. blood presThe pati%nts were divided into four groups accordin, 71 to the original sure. In Group I were ineluded subjects with normal blood pressure; in Group II, in Group 111, those with moderate hyperpatients with low grade hypertension; tension, and in Group IV those with marked hypertension. It was found that, roughly, about 88 per cent of the males and 82 per cent of If a drop of less than 10 mm. is exc,luded the females showed a drop in pressure. as of insufficient significance, the response is reduced to about 78 per cent for males and 71 per cent for females. The response occurred more frequently and in greater Also, the higher the blood pressure the more frequent degree in the older age groups. A drop was more frequent in the systolic the response and the greater its degree. pressure than in the diastolic. A drop in pressure often occurred in patients with-
ABSTRACTS
AXD
443
REVIEWS
out cardioinhibition but was more frequent in those who also showed cardioinhibitiou. In such patients, the frequency and the degree of vasodepression roughly corresponded to those of cardioinhibition. There was a marked difference in response to stimulation on the two sides in many cases. The amount of stimulation required to produce the maximum response varied from case to case and with the position of the patient. The findings point to the existence of an inherent instability in the vasomotor system in persons who show a marked vasodepression induced by the carotid sinus reflex, which the test helps to demonstrate. The seat of this instability is either in the medullary synapses or in the vasomotor terminals in the vascular tree. Rrteriosclerosis is possibly one of the underlying predisposing causes of such instability, as evidenced by the fact that the reflex is most prevalent under circumstances in which arteriosclerosis is apt to occur, that is, when the patient is a. man is of advanced age, and has a high degree of hypertension. Au~rron.
Starr, I., and Jonas, L.: Supernormal Circulation in Resting Subjects (Ilyperkinemia) With a Study of the Relation of Kinemic Abnormalities to the Basal Metabolic Rate. Arch. Int. Med. 71: 1, 194.1. In a total experience of about 1,400 estimations of cardiac output, one hundred patients were encountered in whom the resting circulation was above normal, a condition we have called hyperkinemia. These patients were usually underweight, and they tended to have resting pulse rates above normal. Hyperkinemia was encountered in almost all patients wi!h thyrotoxicosis without cardiac involvement and in most patients with patent duetus arteriosus. It was found often in patients with emaciation and less frequently in those with pulmonary abnormalities, fever, anemia, hypertension and peripheral arteriovenous communications. In seventeen patients, hpperkinemia was present without any complicating condition having been discovered. These patients with essential hyperkinemia resembled patients with thyrotoxicosis in appearance, but the basal metabolic rate was always normal. The clinical characteristics of this subgroup have been described in detail. The relation between abnormalities of the circulation and the basal metabolic rate has been studied by statistical methods. In uncomplicated hypert,hyroidism and hypothyroidism the relation is almost 1 to 1; i.e., on the average, an abnormal increment or decrement in the basal metabolic rate is accompanied by an equal percentage change in the circulation. In heart disease these twc functions are related, but the relationship is more nearly 1 to 0.5. Under such conditions the circulation is less than normal for any given metabolic rate, and the higher the metabolic rate the greater the circulatory deficit. Other instances of deviation from the normal 1 to 1 relationship between circulation and metabolic rate have been found in cases of emaciation and in some cases of hyperthyroidism after partial thyroidectomy. AUTHORS.
Leiter, L., Eichelberger, L., and Roma, M.: Studies on Renin: The Duration of the Pressor Effect of Large Doses in Conscious Normal and Renally Abnormal Dogs. Observations on Anesthetized and Uremic Dogs, and the Anaphylactic and Pathological Effects of Pig Renin. J. Clin. Investigation 22: 11, 1943. Trained, conscious dogs, injected \yith renin intravenously, in single moderate or large doses, sufficient to elevate the mean femoral blood pressure 50 to 100 mm. Hg, gave similar pressor responses whether their kidneys were normal or experimentally abnormal as the result of partial constriction of arteries or ureters, with or without nephrectomy.