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Nature of peripheral resistance in arterial hypertension
SELECTED
253
ABSTRACTS
Patients with rheumatoid arthritis, as a rule, did not show an abnormal antistreptolysin titer. This is in sharp contrast, to the high incidence of raised hemolytic streptococcus agglutinin titers observed in these patients even when the identical strain was used as an antigen to measure both antibodies. Patients with other types of arthritis similarly failed to show an elevated antistreptolysin titer in a significant percentage of eases.. Because three-quarters of the patients mith rheumatic polyarthritis showed a,n abnormally high titer and those with other forms of joint diseases did not, the test was found helpful in diagnosis. Patients with erythema nodosom of hemolytic streptococcal origin and patients with acute pericarditis of rheumatic type had, as a rule, an abnormal titer. When, however, these conditions were of a tuherculous origin, the titer was within normal limits. Here again the serologic determination may be of diagnostic value. Further studies are needed to corroborate this impression since the num her of cases here reported is small. Several patients with lupw erythemntosus disseminatus and periarteritis nodosa had a normal antistreptolysin titer. In no disease have we found a correlation between the antistreptolysin titer and the severity of the illness; hence the titer is of doubtful prognostic significance. Finally, it must he borne in mind that an elevated antistreptolysin titer may be found in a, patient suffering with a disease not related to, but merely preceded by, a hemolytic streptococcus infection. To reason that the elevated titer indicates that the presenting disease is of hemolytic streptocoecal origin may lead to an erroneous diagnosis. AUTHORS. Stead,
J., Jr., and Kunkel, Paul: Nature of Peripheral Hypertension. J. Clin. Investigation 19: 25, 1940,.
Eugene
Arterial
Resistance
in
The increased peripheral resistance present in arterial hypertension cannot be reduced to the normal level in the skin of the hand and the foot, the muscles of the forearm, or in the brain by powerful vasodilating stimuli. The blood flow in the hand and foot at 43” C. and in the muscles of the forearm after exercise shows no significant difference in normal and in hypertensive subjects. In hypertensive subjects cerebral anoxia does not reduce the peripheral resistance in the vessels of the brain to normal levels. Therefore, in postural experiments after the administration of sodium nitrite, subjects with arterial hypertension develop syncope with a much higher arterial pressure than do normal subjects. The finding of a uniform degree of elevation of the peripheral resistance throughout the body is strong evidence against the neurogenic origin of the usual types of clinical hypertension because the nervous vasomotor control is different in each of the tissues investigated. In one subject with arterial hypertension, a marked fall in arterial pressure after malaria produced no change in the blood flow in the foot at 43” C., indicating that no structural changes had taken place in the vessels. In a second subject the blood flow in the foot at 43” C. was decreased when the arterial pressure fell, indicating that permanent vascular damage had occurred. The arterial hypertension in both of these subjects originally result,ed from active vasoconstriction. In one structural changes had later developed. Sensory stimuli, such as pinch, noise, and deep breath, produce vasoconstriction of similar degree in both normal and hypertensive subjects. When the arterial pressure is greatly lowered following malaria, these vasoconstrictor responses remain unchanged.
In arterial hypertension the peripheral resistance is uniformly raised throughout the area of the greater circulation, and it is not increased in the splanchnic area to any greater extent than in other tissues. AUTHORS. Baylin, George J.: Abdominal Aorta.
Collateral Anat. Rec.
Circulation Following 75: 405, 1939.
an
Obstruction
of
the
The collateral circulation is described in a patient, male, aged 34 years, who had a clot with calcification in the abdominal aorta just distal to the orifices of the renal arteries. The most important collateral channel was the colic anastamosis. The superior mesenteric artery and its middle colic branch were almost as large as the aorta, and joined directly with the equally enlarged left colic branch of the inferior mesenteric artery. Other channels of collateral circulation were the somewhat enlarged and tortuous internal mammaries which joined the inferior epigastric arteries on either side. The last three pairs of intercostal arteries were enlarged and tortuous and made numerous connections with other vessels. These connections were important, but ,subordinate to the anastomosis between the two mesenteries. NAIDE.
Fitz,
Reginald, Parks, Arch. Int. Med. 64:
Harry, and 1133, 1939.
Branch,
Charles
F.:
Periarteritis
Nodosa.
A case of periarteritis is reported in a patient, female, aged 37 years, who had symptoms of the disease for eleven years before death. The patient was studied during twenty months of almost continuous hospitalization so that a fairly comComplete plete account of the evolution of the disease in this case was developed. necropsy findings are reported. NAIDE.
McLaughlin, clavian
Intermittent C. W., Jr., and Pompa, A. M.: Vein. J. A. M. A. 113: 1960, 1939.
Obstruction
of the
Sub-
The report concerns intermittent occlusion of the subclavian vein in a 24-yearold farmer. Swelling and cyanosis of the entire right upper extremity followed Cervical pain acexertion and subsided with rest over a period of two years. companied these symptoms. Eight years prior to present illness, he sustained a fracture of both bones of the right forearm which healed without deformity. No sensory disturbance or loss of strength was noted. taken after collodial thorium dioxide was injected into and into the axillary vein showed clearly an obstruction as it crossed the first rib. At operation was sectioned,
the narrowing allowing the rib
Ten days following and both arms were in size and position.
the
was to slip
confirmed downward,
operation, exercise same diameter.
X-ray photographs to be the median cubital vein or narrowing of the vein
and the scalenus anticus and relieving the obstruction.
failed Venagran
to
produce edema showed the vein
mu,scle
or cyanosis; to be normal MCGOVERN.
Stewart, Harold Investigation
J., and Watson, 19: 35, 1940.
Robert
Measurements volume output,
of the arteriovenous stroke volume, vital
F.:
The
Circulation
oxygen difference, capacity, cardiac
oxygen size,
in Athletes.
J. Clin.
consumption, minute circulation time and
253
ABSTRACTS
Patients with rheumatoid arthritis, as a rule, did not show an abnormal antistreptolysin titer. This is in sharp contrast, to the high incidence of raised hemolytic streptococcus agglutinin titers observed in these patients even when the identical strain was used as an antigen to measure both antibodies. Patients with other types of arthritis similarly failed to show an elevated antistreptolysin titer in a significant percentage of eases.. Because three-quarters of the patients mith rheumatic polyarthritis showed a,n abnormally high titer and those with other forms of joint diseases did not, the test was found helpful in diagnosis. Patients with erythema nodosom of hemolytic streptococcal origin and patients with acute pericarditis of rheumatic type had, as a rule, an abnormal titer. When, however, these conditions were of a tuherculous origin, the titer was within normal limits. Here again the serologic determination may be of diagnostic value. Further studies are needed to corroborate this impression since the num her of cases here reported is small. Several patients with lupw erythemntosus disseminatus and periarteritis nodosa had a normal antistreptolysin titer. In no disease have we found a correlation between the antistreptolysin titer and the severity of the illness; hence the titer is of doubtful prognostic significance. Finally, it must he borne in mind that an elevated antistreptolysin titer may be found in a, patient suffering with a disease not related to, but merely preceded by, a hemolytic streptococcus infection. To reason that the elevated titer indicates that the presenting disease is of hemolytic streptocoecal origin may lead to an erroneous diagnosis. AUTHORS. Stead,
J., Jr., and Kunkel, Paul: Nature of Peripheral Hypertension. J. Clin. Investigation 19: 25, 1940,.
Eugene
Arterial
Resistance
in
The increased peripheral resistance present in arterial hypertension cannot be reduced to the normal level in the skin of the hand and the foot, the muscles of the forearm, or in the brain by powerful vasodilating stimuli. The blood flow in the hand and foot at 43” C. and in the muscles of the forearm after exercise shows no significant difference in normal and in hypertensive subjects. In hypertensive subjects cerebral anoxia does not reduce the peripheral resistance in the vessels of the brain to normal levels. Therefore, in postural experiments after the administration of sodium nitrite, subjects with arterial hypertension develop syncope with a much higher arterial pressure than do normal subjects. The finding of a uniform degree of elevation of the peripheral resistance throughout the body is strong evidence against the neurogenic origin of the usual types of clinical hypertension because the nervous vasomotor control is different in each of the tissues investigated. In one subject with arterial hypertension, a marked fall in arterial pressure after malaria produced no change in the blood flow in the foot at 43” C., indicating that no structural changes had taken place in the vessels. In a second subject the blood flow in the foot at 43” C. was decreased when the arterial pressure fell, indicating that permanent vascular damage had occurred. The arterial hypertension in both of these subjects originally result,ed from active vasoconstriction. In one structural changes had later developed. Sensory stimuli, such as pinch, noise, and deep breath, produce vasoconstriction of similar degree in both normal and hypertensive subjects. When the arterial pressure is greatly lowered following malaria, these vasoconstrictor responses remain unchanged.
In arterial hypertension the peripheral resistance is uniformly raised throughout the area of the greater circulation, and it is not increased in the splanchnic area to any greater extent than in other tissues. AUTHORS. Baylin, George J.: Abdominal Aorta.
Collateral Anat. Rec.
Circulation Following 75: 405, 1939.
an
Obstruction
of
the
The collateral circulation is described in a patient, male, aged 34 years, who had a clot with calcification in the abdominal aorta just distal to the orifices of the renal arteries. The most important collateral channel was the colic anastamosis. The superior mesenteric artery and its middle colic branch were almost as large as the aorta, and joined directly with the equally enlarged left colic branch of the inferior mesenteric artery. Other channels of collateral circulation were the somewhat enlarged and tortuous internal mammaries which joined the inferior epigastric arteries on either side. The last three pairs of intercostal arteries were enlarged and tortuous and made numerous connections with other vessels. These connections were important, but ,subordinate to the anastomosis between the two mesenteries. NAIDE.
Fitz,
Reginald, Parks, Arch. Int. Med. 64:
Harry, and 1133, 1939.
Branch,
Charles
F.:
Periarteritis
Nodosa.
A case of periarteritis is reported in a patient, female, aged 37 years, who had symptoms of the disease for eleven years before death. The patient was studied during twenty months of almost continuous hospitalization so that a fairly comComplete plete account of the evolution of the disease in this case was developed. necropsy findings are reported. NAIDE.
McLaughlin, clavian
Intermittent C. W., Jr., and Pompa, A. M.: Vein. J. A. M. A. 113: 1960, 1939.
Obstruction
of the
Sub-
The report concerns intermittent occlusion of the subclavian vein in a 24-yearold farmer. Swelling and cyanosis of the entire right upper extremity followed Cervical pain acexertion and subsided with rest over a period of two years. companied these symptoms. Eight years prior to present illness, he sustained a fracture of both bones of the right forearm which healed without deformity. No sensory disturbance or loss of strength was noted. taken after collodial thorium dioxide was injected into and into the axillary vein showed clearly an obstruction as it crossed the first rib. At operation was sectioned,
the narrowing allowing the rib
Ten days following and both arms were in size and position.
the
was to slip
confirmed downward,
operation, exercise same diameter.
X-ray photographs to be the median cubital vein or narrowing of the vein
and the scalenus anticus and relieving the obstruction.
failed Venagran
to
produce edema showed the vein
mu,scle
or cyanosis; to be normal MCGOVERN.
Stewart, Harold Investigation
J., and Watson, 19: 35, 1940.
Robert
Measurements volume output,
of the arteriovenous stroke volume, vital
F.:
The
Circulation
oxygen difference, capacity, cardiac
oxygen size,
in Athletes.
J. Clin.
consumption, minute circulation time and