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Mechanisms underlying pulmonary and cardiac complications of electrically induced convulsions
788
AMERICAN
Spuhler,
V.
Helvet.
O.,
Wiesingcr,
med.
acta
IL
lS:95
and
(Jan.),
HEART
Meili,
E.:
JOIJRNAI
Diuretic
and
Circulating
Plasma
Volume.
1948.
1. Geigy-blue 536 is suitable for the determination of circulating blood plasma. 2. Our normal values for the circulating plasma volume of 1,800 to 3,800 CC. correspond to those of the literature. 3. After the administration of Salyrgan the amount of circulating plasma was reduced in every case and the hematocrit was increased in five of six cases. These results may be due 10 a concentration of blood; this explanation coincides with the assumption that mercurial diuretics have their exclusive site of action in the kidneys and draw water from the blood. 4. Xanthine derivatives have their special site of action in the circulatory system. 5. In some cases of anasarca and diabetes, we observed that the dye disappeared more rapidly than usual from the blood, probably because of a greater capillary permeability. The dye is found regularly in artificial whrals produced by histamine. .‘\VTHOHS.
D. H., Olcesky, S., and S~onc, R. B.: Vitamin E in Angina Pectoris. Lancet 1:102 (Jan. 17), 1948. It has been suggesied that vitamin E relieves the pain and improves the exercise tolerance of patients with angina pcctoris by its possihlr action as a coronary vnsodilator or by virtue of a beneficial influence on myocardial metabolism. srries included twentyIWO patients (scvc‘n~ecr~ men and five women), The authors’ 44 to 66 years of age, who were having frequent attacks of angina. The patients received the following drugs succcssivcly: 50 mg. of vitamin E three times daily, phenobarbital, grain W three times daily, aminophylline, grains 1 5.2 three times daily, and calcium lactate, grains 5 three times daily (as a control). Aftw each drug had been received for three weeks, the effects were evaluated. The results of this study sug-gest that vitamin E is no more beneficial than phenobarbital or aminophyllinc; the authors conclude that vitamin E is not of any therapeutic value in the routine treatment of angina pcctol-is. Makinson,
WAGNER.
Godfrey,
J. :
86 (Jan.
‘I‘horacic
15),
Tenderness
in
Pulmonary
New
Infarclion.
England
J. Med.
238:
1948.
Marked, localized intercostal tenderness was observed as an early sign in five monary infarction. None of the cases showed the entire combination of symptoms that generally are considered typical of this condition. It is suggested that chest connection with a pleuritic type of pain, in the absence of trauma, be considered pulmonary infarction, even in the absence of supporting symptoms, signs, or x-ray
cases of puland signs tenderness in suggestive of changes. KAY
Altschule,
M.
Complications
D.,
and
Tillotson, of
Electrically
(Jan. 22), 1948. Maximal forced expiration an electrically induced convulsive
Ii.
J.: Induced
Mechanisms Convulsions.
with extreme diaphragmatic Profuse salivation seizure.
Underlying
Pulmonary New
England
and
J. Med.
elevation is maintained and excessive bronchial
Cardiac
238:ll.j
throughout secretion are
In I he \.igorolls inspiration tha~ trrmina~cs the seizul-c, aspiration 01 ;cccornpatl>ing fealures. this material may result in patchy at&c+&. Jf this persists and be~rnes infected, I11ng abscess may develop. By a similar mechanism, latent tuherrulosis may be disseminated. Rise of peripheral venous pressure was consistently observed. This is attributed LO increased intrathoracic pressure. As a result of the rush of impounded blood into the heart in the postconvulsive phase, and because an accumulated oxygen deficit must be overcome, heart work is increased. The myocardial infarctions reported in relation to electric shock therapy probably occur shortly after, rather than during, the convulsion. The authors agree with others that the arrhythmias of the postconvulsive period are probably consequent to vagal reflexes activated by sudden distention of the auricles and great thoracic veins. Attention is D-turbocurarine is recommended to reduce the postconvulsive cardiac strain. directed to the potentially dangerous vagal stimulating effects of certain other preparations of curare. KAY.
Crutcher, R. R., and cal and Autopsy
Daniel, Studies.
R. A., Jr.: Surgery
Pulmonary 23:47 (Jan.),
Embolism, 1948.
A Correlation
of Clini-
There have been 83,984 admissions to the Vanderbilt University Hospital between 1930 and 1944, inclusive. Four thousand one hundred eighty-two patients (excluding still births) died in the hospital and 2,580 (63 per cent) came to autopsy. There were 35,540 operations (including ear, eye, nose, and throat) carried out during this fifteen-year period. Fifty-five patients had fatal pulmonary emboli, confirmed by autopsy, twenty-five occurring postoperatively. On the basis of 100 per cent autopsies there would have been an expected incidence of thirty-nine cases. Hence, the incidence of fatal pulmonary emboli occurring postoperativeIy is 0.109 per cent or one in 911 operations. The authors point out that the incidence of fatal pulmonary emboli is greater in serious]), ill patients than in patients who are relatively good risks and whose surgical condition carries a In twenty-three of fifty-five autopsy records, thrombi were found in the veins favorable prognosis. of the pelvis and upper abdomen. There were three cases in which the origin of the emboli was the right side of the heart. It is pointed out that restriction of activityor fixation of patients in bed is more important There were 2,107 admissions than early ambulation as a means of preventing pulmonary emboli. for pulmonary tuberculosis during this period and although the majority of these patients were confined to bed they were permitted to move about in bed without restriction. There was no instance of fatal pulmonary embolism in this group. LORD.
Singleton, A. O., and Singleton, A Common Carotid-Internal 1948.
A. O., Jugular
Jr.:
Cerebral Arteriovenous
Hemorrhage Fistula.
Following Surgery
Repair of 23:75 (Jan.),
The authors discuss fifty cases in the litqrature of common carotid-internal jugular fistulas, pointing out that seventeen of the patients had restoration of arterial flow while the remaining thirty-three had interruption of the flow by ligation of the common carotid artery. It is of significance that in the group of seventeen patients in whom arterial flow was restored there was only one death, and this was the result of bronchopneumonia. In the group of thirty-three who had arterial interruption, there were three deaths and three recurrences, two deaths having been due to cerebral anemia and one, to coronary occlusion. In addition, one patient had a hemiplegia following ligation of the carotid artery. The authors report an instance of an arteriovenous fistula between the common carotid artery and internal jugular vein treated by maintainance of arterial continuity and followed by cerebral hemorrhage and death. The patient, a 49-year-old farmer, had been struck in the neck by a rock at the age of 12 years and shortly thereafter had noticed a whirling sound in the head. Three years before his admission, a swelling had appeared in the left side of the neck and for three months the patient had experienced exerlional dyspnea and palpatation. Physical examination
AMERICAN
Spuhler,
V.
Helvet.
O.,
Wiesingcr,
med.
acta
IL
lS:95
and
(Jan.),
HEART
Meili,
E.:
JOIJRNAI
Diuretic
and
Circulating
Plasma
Volume.
1948.
1. Geigy-blue 536 is suitable for the determination of circulating blood plasma. 2. Our normal values for the circulating plasma volume of 1,800 to 3,800 CC. correspond to those of the literature. 3. After the administration of Salyrgan the amount of circulating plasma was reduced in every case and the hematocrit was increased in five of six cases. These results may be due 10 a concentration of blood; this explanation coincides with the assumption that mercurial diuretics have their exclusive site of action in the kidneys and draw water from the blood. 4. Xanthine derivatives have their special site of action in the circulatory system. 5. In some cases of anasarca and diabetes, we observed that the dye disappeared more rapidly than usual from the blood, probably because of a greater capillary permeability. The dye is found regularly in artificial whrals produced by histamine. .‘\VTHOHS.
D. H., Olcesky, S., and S~onc, R. B.: Vitamin E in Angina Pectoris. Lancet 1:102 (Jan. 17), 1948. It has been suggesied that vitamin E relieves the pain and improves the exercise tolerance of patients with angina pcctoris by its possihlr action as a coronary vnsodilator or by virtue of a beneficial influence on myocardial metabolism. srries included twentyIWO patients (scvc‘n~ecr~ men and five women), The authors’ 44 to 66 years of age, who were having frequent attacks of angina. The patients received the following drugs succcssivcly: 50 mg. of vitamin E three times daily, phenobarbital, grain W three times daily, aminophylline, grains 1 5.2 three times daily, and calcium lactate, grains 5 three times daily (as a control). Aftw each drug had been received for three weeks, the effects were evaluated. The results of this study sug-gest that vitamin E is no more beneficial than phenobarbital or aminophyllinc; the authors conclude that vitamin E is not of any therapeutic value in the routine treatment of angina pcctol-is. Makinson,
WAGNER.
Godfrey,
J. :
86 (Jan.
‘I‘horacic
15),
Tenderness
in
Pulmonary
New
Infarclion.
England
J. Med.
238:
1948.
Marked, localized intercostal tenderness was observed as an early sign in five monary infarction. None of the cases showed the entire combination of symptoms that generally are considered typical of this condition. It is suggested that chest connection with a pleuritic type of pain, in the absence of trauma, be considered pulmonary infarction, even in the absence of supporting symptoms, signs, or x-ray
cases of puland signs tenderness in suggestive of changes. KAY
Altschule,
M.
Complications
D.,
and
Tillotson, of
Electrically
(Jan. 22), 1948. Maximal forced expiration an electrically induced convulsive
Ii.
J.: Induced
Mechanisms Convulsions.
with extreme diaphragmatic Profuse salivation seizure.
Underlying
Pulmonary New
England
and
J. Med.
elevation is maintained and excessive bronchial
Cardiac
238:ll.j
throughout secretion are
In I he \.igorolls inspiration tha~ trrmina~cs the seizul-c, aspiration 01 ;cccornpatl>ing fealures. this material may result in patchy at&c+&. Jf this persists and be~rnes infected, I11ng abscess may develop. By a similar mechanism, latent tuherrulosis may be disseminated. Rise of peripheral venous pressure was consistently observed. This is attributed LO increased intrathoracic pressure. As a result of the rush of impounded blood into the heart in the postconvulsive phase, and because an accumulated oxygen deficit must be overcome, heart work is increased. The myocardial infarctions reported in relation to electric shock therapy probably occur shortly after, rather than during, the convulsion. The authors agree with others that the arrhythmias of the postconvulsive period are probably consequent to vagal reflexes activated by sudden distention of the auricles and great thoracic veins. Attention is D-turbocurarine is recommended to reduce the postconvulsive cardiac strain. directed to the potentially dangerous vagal stimulating effects of certain other preparations of curare. KAY.
Crutcher, R. R., and cal and Autopsy
Daniel, Studies.
R. A., Jr.: Surgery
Pulmonary 23:47 (Jan.),
Embolism, 1948.
A Correlation
of Clini-
There have been 83,984 admissions to the Vanderbilt University Hospital between 1930 and 1944, inclusive. Four thousand one hundred eighty-two patients (excluding still births) died in the hospital and 2,580 (63 per cent) came to autopsy. There were 35,540 operations (including ear, eye, nose, and throat) carried out during this fifteen-year period. Fifty-five patients had fatal pulmonary emboli, confirmed by autopsy, twenty-five occurring postoperatively. On the basis of 100 per cent autopsies there would have been an expected incidence of thirty-nine cases. Hence, the incidence of fatal pulmonary emboli occurring postoperativeIy is 0.109 per cent or one in 911 operations. The authors point out that the incidence of fatal pulmonary emboli is greater in serious]), ill patients than in patients who are relatively good risks and whose surgical condition carries a In twenty-three of fifty-five autopsy records, thrombi were found in the veins favorable prognosis. of the pelvis and upper abdomen. There were three cases in which the origin of the emboli was the right side of the heart. It is pointed out that restriction of activityor fixation of patients in bed is more important There were 2,107 admissions than early ambulation as a means of preventing pulmonary emboli. for pulmonary tuberculosis during this period and although the majority of these patients were confined to bed they were permitted to move about in bed without restriction. There was no instance of fatal pulmonary embolism in this group. LORD.
Singleton, A. O., and Singleton, A Common Carotid-Internal 1948.
A. O., Jugular
Jr.:
Cerebral Arteriovenous
Hemorrhage Fistula.
Following Surgery
Repair of 23:75 (Jan.),
The authors discuss fifty cases in the litqrature of common carotid-internal jugular fistulas, pointing out that seventeen of the patients had restoration of arterial flow while the remaining thirty-three had interruption of the flow by ligation of the common carotid artery. It is of significance that in the group of seventeen patients in whom arterial flow was restored there was only one death, and this was the result of bronchopneumonia. In the group of thirty-three who had arterial interruption, there were three deaths and three recurrences, two deaths having been due to cerebral anemia and one, to coronary occlusion. In addition, one patient had a hemiplegia following ligation of the carotid artery. The authors report an instance of an arteriovenous fistula between the common carotid artery and internal jugular vein treated by maintainance of arterial continuity and followed by cerebral hemorrhage and death. The patient, a 49-year-old farmer, had been struck in the neck by a rock at the age of 12 years and shortly thereafter had noticed a whirling sound in the head. Three years before his admission, a swelling had appeared in the left side of the neck and for three months the patient had experienced exerlional dyspnea and palpatation. Physical examination