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On the anaphylactic nature of rheumatic pneumonitis
with seen in .a11 ty?‘es 111 I,atrnt, heart block, espeniallv of the le.srer grades, chronic myocar~lial disease. Even 11crr it seemed rare for it to progress gtaduall~ somet i rues to complete heart block, thougli often it interruptr-l complete or’ _*) ‘1 block, after surprisingly long intervals. Both in thyrotoxicosis ant1 myxe~lema, 1011:: ?“-?i intri.vals were obset,vetl. an{1 tliis relntionsliip to iodine therapy in tliyrotoxicoris neerls more investigation. So
instances of latent block due to trauma were inclmlt=(l in tile series, thoug$ cases have hcen rrportr(l; anI1 one due to blast llils hrfm mentionc~l. Tliere were no cases W?WW latent bloclc r~ml11 wit?) I*ert:tinty ?W attrihutec! to ~liphtheria, but ,such a hisfor! \va~i notetl in s~uue cases as :I pos~ilrle cause tllat could not be excluded. Some curious cases hare been Ilesl.ribt31 in wliiclt P-K intervals, even up to O.:lO azs wmc! second or more, were found without any iltlier evidence of lieart disease. ant1 it i* suggestPI (If there persister?, they tlid not seeul to Ire clue to infection. that exceptional oreractilm of tlie vagus may produ~ unusually long P-R intervals. In some, which have heen dercrihed ratlier fullv. the longest P-R intervals were iri,egular or intermittent.
sucli
Darrow, C. W., and Pathman, J. H.: Relation of Heart Rate to Slow Waves in the Electroencephalogram During Overventilation. Am. .I. Physiol. 140: Xl, 1944. increase of It is dernonstrate~l tlmt, in one-minute periocls of ~,~errentilation, heart rate tends to be antecedent to, or simult,aneous witlt, slowing of the electroencephalogram. The relation of cardiac and cerebral effects during bypocapnia sugIt suggests that, reduction of vaga? cholinergic: gests a possible vagal mechanism. of ac~etylcholine by cholinesterase is vasodilator impulses, a t a time when destruction incrcasrtl by hypocapnia, may be crit,ical. (Lmsequent contractions of the c~rhr:r? blood vessels nray awonnt, for association of cartliac :cc~celeration during ovtsrventilation with slow waves in tltr ~~lrctroen~~e~1~alo~r:~~~~
Rich, A. R., and Gregory, Pneumonitis. Bull. Johns
J. E.:
On the Anaphylactic
Hopkins
Hosp.
73:
465,
Nature
of Rheumatic
1943.
have shown that cardia,. am? arleri:J lesions In preceding papers the authors Iutving the basic characteristics of those of acute rlieuruati~~ fever ran lie produce~l l’lw present comparison hyperronritivity. experimentally as a result of :~ni~phylactic of the peculiar lesion of rlieunmtiv pneunmnitis with that of the Imeurnonitis aausetl by sulfonamide hypersensitivity shows that the two are basically identical, and that ?)ot?i exhibit the primary capillary damage characteristic of focal anaphylactic re-
actiont;. of acute
This provides rheumatic fever
additional evidence may be anaphylactic
in
hupport in origin.
Cardiovascular Carter, J. B., and Traut, E. P.: Anemia. Arch. Int. &led. 72: i.57, 19-U.
of
the
view
Manifestations
that
the
in
lesions
Pernicious
Cdrdiovas(‘ular manifestations were found in 257 of ::(I() c;tse~ of pernic*ious anemia. the presence of severe anemia it is impossible to segregate :r~+~,uratety patients with primary cardiovascular involvement. .Ul of tile usual criteria of (~xrtlio‘I’hese symptoms an11 final\-;lsc*ular dixease may 0Wur solely as the result of anemia. ings are not restricted to anv type of anemia or relate~l to the severity of the anemia. Examination of the blood is essential for dependable cliff’erentiutil~n. Cardiovascular manifestations often oc,zur with hematolo.gi~ (lrcompensation anI1 disappear after treatment or during a remisr;ion. In
R. M.: The Renal Pathology per. Med. 79: 215, 1944.
Calder,
of Nutritional
Hypertension
in Rats.
.I. b-
Rats sul)sisting on u diet partially deficient in the heat-stable fractions ol The present vitamin B complex are known to experience a rise in blood pressure. study shows that after prolung~d administration of this dietary, abnormal structural tdhanges occur in the kidneys. The surface ol’ this organ l~~ome~ finely granular. The aRerent arterioles show lleqenerative changes, cImGsting of irreuula~, sul Wntlothelial hydline deposits which rncroacdh on the lumen. The intprlohular arterie mtleryo the same change, pluh tlegeneration rlf the media; the lumen of these rc~els is likewise c~ompromised. Resultant, small, streaklike alea+ of irchemic atrophy o(+VW in both c-ortex and medulla, with nevrosis of tlw epithelial lininq of the uriniferous tubules. The glomeruli are reduc,etl in size, tile number of their caornponent loops dec~reasetl, their pattern simplifir4, and the ~~apillary h:~~rment membrane thicltenr~d. In addition to these cahanges, lritlneyr from animals on :t more profoundly tlefil,ient 11iet display numerous arear; ot l~cn~orrl~ayi~~ infiltration in thr cortical and sub scapaular regions. The possible identiQof the:e le;rions \vlth thcsc see:1 iu e~s4~ntial l!yllertension in man is discussell. ALTrron.
Alam, G. M., and Smirk, F. H.: Casual and Basal Blood Pressures. and Egyptian Men. Brit,. Heart .I. 5: 152, 1!)43.
I. In British
Egyptian men resident in Egypt hare much lower blootl l~res~ures tluin British men resident either in Egypt or in F~nglantl. This difYrrent,e tlorr not ~lq~rnil upon tlifferenrrs of temperature, diet, or social status. Half an hour of rest in the ritting posture, togetl!er with ~lelihe~dte 6~rnotion:~l tlr*ensitization to the presemde of the medic*al examiner am1 to thr pro~dure of hlooll pressure measurrmrnt, reduced the systolic2 blood pressure to below 1011 in thirtet,n, am1 to helow HI) in five out of fonrtecbn Egyptian men; to below 10.7 in thirte~~n, ant1 to below 100 in six out of twenty-five British nten. Nu~h lowering of the bloofl pressure \VaS not a~:xo~*i:~tr(l wit11 :any symptoms.
Alam, G. M., and Smirk, F. H.: Casual and Basal Blood Pressures. tial Hypertension. Hrit. Heart d. 5: 158, 1!14:1. In essential pressure (i.e.,
hypertenrion as ordinarily
connitlrrablr mearured,)
II. In Eseen-
(lifYerem~r* c.sist hrtwc~rn t IW casual l~loo~l and tile ba,~l blood I,rerxu:e. In x group
instances of latent block due to trauma were inclmlt=(l in tile series, thoug$ cases have hcen rrportr(l; anI1 one due to blast llils hrfm mentionc~l. Tliere were no cases W?WW latent bloclc r~ml11 wit?) I*ert:tinty ?W attrihutec! to ~liphtheria, but ,such a hisfor! \va~i notetl in s~uue cases as :I pos~ilrle cause tllat could not be excluded. Some curious cases hare been Ilesl.ribt31 in wliiclt P-K intervals, even up to O.:lO azs wmc! second or more, were found without any iltlier evidence of lieart disease. ant1 it i* suggestPI (If there persister?, they tlid not seeul to Ire clue to infection. that exceptional oreractilm of tlie vagus may produ~ unusually long P-R intervals. In some, which have heen dercrihed ratlier fullv. the longest P-R intervals were iri,egular or intermittent.
sucli
Darrow, C. W., and Pathman, J. H.: Relation of Heart Rate to Slow Waves in the Electroencephalogram During Overventilation. Am. .I. Physiol. 140: Xl, 1944. increase of It is dernonstrate~l tlmt, in one-minute periocls of ~,~errentilation, heart rate tends to be antecedent to, or simult,aneous witlt, slowing of the electroencephalogram. The relation of cardiac and cerebral effects during bypocapnia sugIt suggests that, reduction of vaga? cholinergic: gests a possible vagal mechanism. of ac~etylcholine by cholinesterase is vasodilator impulses, a t a time when destruction incrcasrtl by hypocapnia, may be crit,ical. (Lmsequent contractions of the c~rhr:r? blood vessels nray awonnt, for association of cartliac :cc~celeration during ovtsrventilation with slow waves in tltr ~~lrctroen~~e~1~alo~r:~~~~
Rich, A. R., and Gregory, Pneumonitis. Bull. Johns
J. E.:
On the Anaphylactic
Hopkins
Hosp.
73:
465,
Nature
of Rheumatic
1943.
have shown that cardia,. am? arleri:J lesions In preceding papers the authors Iutving the basic characteristics of those of acute rlieuruati~~ fever ran lie produce~l l’lw present comparison hyperronritivity. experimentally as a result of :~ni~phylactic of the peculiar lesion of rlieunmtiv pneunmnitis with that of the Imeurnonitis aausetl by sulfonamide hypersensitivity shows that the two are basically identical, and that ?)ot?i exhibit the primary capillary damage characteristic of focal anaphylactic re-
actiont;. of acute
This provides rheumatic fever
additional evidence may be anaphylactic
in
hupport in origin.
Cardiovascular Carter, J. B., and Traut, E. P.: Anemia. Arch. Int. &led. 72: i.57, 19-U.
of
the
view
Manifestations
that
the
in
lesions
Pernicious
Cdrdiovas(‘ular manifestations were found in 257 of ::(I() c;tse~ of pernic*ious anemia. the presence of severe anemia it is impossible to segregate :r~+~,uratety patients with primary cardiovascular involvement. .Ul of tile usual criteria of (~xrtlio‘I’hese symptoms an11 final\-;lsc*ular dixease may 0Wur solely as the result of anemia. ings are not restricted to anv type of anemia or relate~l to the severity of the anemia. Examination of the blood is essential for dependable cliff’erentiutil~n. Cardiovascular manifestations often oc,zur with hematolo.gi~ (lrcompensation anI1 disappear after treatment or during a remisr;ion. In
R. M.: The Renal Pathology per. Med. 79: 215, 1944.
Calder,
of Nutritional
Hypertension
in Rats.
.I. b-
Rats sul)sisting on u diet partially deficient in the heat-stable fractions ol The present vitamin B complex are known to experience a rise in blood pressure. study shows that after prolung~d administration of this dietary, abnormal structural tdhanges occur in the kidneys. The surface ol’ this organ l~~ome~ finely granular. The aRerent arterioles show lleqenerative changes, cImGsting of irreuula~, sul Wntlothelial hydline deposits which rncroacdh on the lumen. The intprlohular arterie mtleryo the same change, pluh tlegeneration rlf the media; the lumen of these rc~els is likewise c~ompromised. Resultant, small, streaklike alea+ of irchemic atrophy o(+VW in both c-ortex and medulla, with nevrosis of tlw epithelial lininq of the uriniferous tubules. The glomeruli are reduc,etl in size, tile number of their caornponent loops dec~reasetl, their pattern simplifir4, and the ~~apillary h:~~rment membrane thicltenr~d. In addition to these cahanges, lritlneyr from animals on :t more profoundly tlefil,ient 11iet display numerous arear; ot l~cn~orrl~ayi~~ infiltration in thr cortical and sub scapaular regions. The possible identiQof the:e le;rions \vlth thcsc see:1 iu e~s4~ntial l!yllertension in man is discussell. ALTrron.
Alam, G. M., and Smirk, F. H.: Casual and Basal Blood Pressures. and Egyptian Men. Brit,. Heart .I. 5: 152, 1!)43.
I. In British
Egyptian men resident in Egypt hare much lower blootl l~res~ures tluin British men resident either in Egypt or in F~nglantl. This difYrrent,e tlorr not ~lq~rnil upon tlifferenrrs of temperature, diet, or social status. Half an hour of rest in the ritting posture, togetl!er with ~lelihe~dte 6~rnotion:~l tlr*ensitization to the presemde of the medic*al examiner am1 to thr pro~dure of hlooll pressure measurrmrnt, reduced the systolic2 blood pressure to below 1011 in thirtet,n, am1 to helow HI) in five out of fonrtecbn Egyptian men; to below 10.7 in thirte~~n, ant1 to below 100 in six out of twenty-five British nten. Nu~h lowering of the bloofl pressure \VaS not a~:xo~*i:~tr(l wit11 :any symptoms.
Alam, G. M., and Smirk, F. H.: Casual and Basal Blood Pressures. tial Hypertension. Hrit. Heart d. 5: 158, 1!14:1. In essential pressure (i.e.,
hypertenrion as ordinarily
connitlrrablr mearured,)
II. In Eseen-
(lifYerem~r* c.sist hrtwc~rn t IW casual l~loo~l and tile ba,~l blood I,rerxu:e. In x group