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Intravenous oxygen and pulmonary embolism
!52
AMERICAN
HEART
JOURNAL
live weeks, although cyanosis had been present since birth. Death was preceded by the rapid development of respiratory distress and congestive heart failure. Associated anomalies included a patent ductus arteriosus and a patent foramen ovale. .Z twin brother in whom a loud basal systolic murmur had been heard at the age of 4 weeks, died at the age of 2 months following a sudden attack of dyspnea and cyanosis. Although some form of congenital heart disease was suspected in this twin infant, autopsy was refused and, therefore, the exact diagnosis was never established. WENDKOS. Blakemore, Aorta:
A. H.: The 4 Rational
Clinical Surgical
Behavior Therapy.
of Arteriosclerotic Ann. Surg.
Aneurysm 126:195
(Aug.),
of
the
Abdominal
1947.
Blakemore outlines the characteristic features of abdominal aneurysms and differentiates between thearteriosoleroticandsyphiliticvarieties. The former was encountered twenty-six times, while the latter was observed six time at the Presbyterian Hospital, New York City, in recent years. Arteriosclerotic abdominal aneurysms are fusiform, rarely erode vertebrae (one out of twenty-six cases), originate 3.0 to 4.0 cm. above the orifice of the renal arteries, seldom cause significant symptoms until they leak retroperitoneally, and usually end fatally two to six days after the original rupture. Syphilitic aneurysms of the abdominal aorta, on the other hand, are saccular, usually have their point of origin above the renal arteries, erode vertebral bodies, and therefore, are associated with marked radicular pain. The author then discusses the hemodynamics of fusiform and wide- and narrow-mouthed saccular aneurysms, pointing out that nature’s cure consists in brimful clotting which occurs spontaneously only occasionally in narrow-mouthed saccular aneurysms. The rate of blood flow in the aneurysm is the second important factor in considering a therapeutic approach. By means of his electrothermic method of coagulating aneurysms, Blakemore can determine the rate of blood flow and hence the type of ancursym, and further how much wire is necessary to introduce and heat in order to obtain brimful clotting. In fusiform abdominal aneurysms it is necessary to completely occlude the aorta and the aneurysm in stages from within, thereby permitting the development of an adequate collateral circulation to the legs. The author has dealt successfully with three out of tvvcnty-six cases of fusiform arteriosclerotic aneurysms and two out of six cases of syphilitic fusiform aneurysmof the abdominal aorta. LORD. J. H., and Isoe, I. RI., Intravenous Oxygen and Pulmonary Embolism. Ann. Surg. 126:208 (Aug.), 1947. The authors studied the arterial oxygen saturations in a group of patients who were subjected to an intravenous injection of oxygen. In the first patient 9.3 cc. of oxygen per minute were administered for twenty minutes and the arterial oxygen saturation fell from 91 per cent to 55.5 per cent. Associated with this fall, the patient experienced a sensation of pressure in the lower chest, cough, restlessness, and profuse perspiration. These symptoms cleared in a few minutes after cessation of the oxygen injection. Three other experiments in patients not in shock and two in patients in shock further demonstrated that intravenous oxygen is not of value in elevating the arterial oxygen saturation and, on the contrary, aclually lowers it. The explanation of this phenomenon is that the oxygen gas bubbles occlude the small arteries and arterioles and are not absorbed by the blood stream. One in vitro experiment demonstrated that a small amount of oxygen bubbled through venous blood does not increase the oxygen saturation. The authors conclude that intravenous oxygen is of doubtful therapeutic value in the treatment of shock and may actually be harmful. Sanders,
LORD. Gross,
P.,
and
Benz,
E.
J.:
Pulmonary
Embolism
by
Amniotic
Fluid.
Surg.,
Gynec.
Obst. 85:315 (Sept.), 1947. In addition to the well-known causes of embolism to the lungs, such as thrombi from venous sources in the legs and fat emboli from fracture sites, Gross and Benz report three cases of pulmon-
&
AMERICAN
HEART
JOURNAL
live weeks, although cyanosis had been present since birth. Death was preceded by the rapid development of respiratory distress and congestive heart failure. Associated anomalies included a patent ductus arteriosus and a patent foramen ovale. .Z twin brother in whom a loud basal systolic murmur had been heard at the age of 4 weeks, died at the age of 2 months following a sudden attack of dyspnea and cyanosis. Although some form of congenital heart disease was suspected in this twin infant, autopsy was refused and, therefore, the exact diagnosis was never established. WENDKOS. Blakemore, Aorta:
A. H.: The 4 Rational
Clinical Surgical
Behavior Therapy.
of Arteriosclerotic Ann. Surg.
Aneurysm 126:195
(Aug.),
of
the
Abdominal
1947.
Blakemore outlines the characteristic features of abdominal aneurysms and differentiates between thearteriosoleroticandsyphiliticvarieties. The former was encountered twenty-six times, while the latter was observed six time at the Presbyterian Hospital, New York City, in recent years. Arteriosclerotic abdominal aneurysms are fusiform, rarely erode vertebrae (one out of twenty-six cases), originate 3.0 to 4.0 cm. above the orifice of the renal arteries, seldom cause significant symptoms until they leak retroperitoneally, and usually end fatally two to six days after the original rupture. Syphilitic aneurysms of the abdominal aorta, on the other hand, are saccular, usually have their point of origin above the renal arteries, erode vertebral bodies, and therefore, are associated with marked radicular pain. The author then discusses the hemodynamics of fusiform and wide- and narrow-mouthed saccular aneurysms, pointing out that nature’s cure consists in brimful clotting which occurs spontaneously only occasionally in narrow-mouthed saccular aneurysms. The rate of blood flow in the aneurysm is the second important factor in considering a therapeutic approach. By means of his electrothermic method of coagulating aneurysms, Blakemore can determine the rate of blood flow and hence the type of ancursym, and further how much wire is necessary to introduce and heat in order to obtain brimful clotting. In fusiform abdominal aneurysms it is necessary to completely occlude the aorta and the aneurysm in stages from within, thereby permitting the development of an adequate collateral circulation to the legs. The author has dealt successfully with three out of tvvcnty-six cases of fusiform arteriosclerotic aneurysms and two out of six cases of syphilitic fusiform aneurysmof the abdominal aorta. LORD. J. H., and Isoe, I. RI., Intravenous Oxygen and Pulmonary Embolism. Ann. Surg. 126:208 (Aug.), 1947. The authors studied the arterial oxygen saturations in a group of patients who were subjected to an intravenous injection of oxygen. In the first patient 9.3 cc. of oxygen per minute were administered for twenty minutes and the arterial oxygen saturation fell from 91 per cent to 55.5 per cent. Associated with this fall, the patient experienced a sensation of pressure in the lower chest, cough, restlessness, and profuse perspiration. These symptoms cleared in a few minutes after cessation of the oxygen injection. Three other experiments in patients not in shock and two in patients in shock further demonstrated that intravenous oxygen is not of value in elevating the arterial oxygen saturation and, on the contrary, aclually lowers it. The explanation of this phenomenon is that the oxygen gas bubbles occlude the small arteries and arterioles and are not absorbed by the blood stream. One in vitro experiment demonstrated that a small amount of oxygen bubbled through venous blood does not increase the oxygen saturation. The authors conclude that intravenous oxygen is of doubtful therapeutic value in the treatment of shock and may actually be harmful. Sanders,
LORD. Gross,
P.,
and
Benz,
E.
J.:
Pulmonary
Embolism
by
Amniotic
Fluid.
Surg.,
Gynec.
Obst. 85:315 (Sept.), 1947. In addition to the well-known causes of embolism to the lungs, such as thrombi from venous sources in the legs and fat emboli from fracture sites, Gross and Benz report three cases of pulmon-
&