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Orientaciones en el tratamiento del sindrome cardiaco de la tuberculosis
April, 1934]
CARDIO-VASCULAR DISEASE AND TUBERCULOSIS
later becoming very severe, with a hmmatogenous spread to the pericardium and lungs: The chronic nature of the pericarditis was shown by the absence of symptoms of pressure, the large amount of fluid and the thickness of the sac, while the lung involvement w~s confirmed by the positive Sputum and the radiograms. J u d g i n g from the literature, tuberculous pericarditi s is not a particularly rare disease, and probably many cases .were overlooked before the present improvement in radiological technique. Apar~ from the size of the swelling, the specially interesting features of the case were that the boy should have found himself capable of strenuous exercise before the operation; t h e ability to stand removal of a large volume of fluid ( t w o litres) without shock, and the thickness and rigidity of the parietal pericardium, with the peculiar .torsion of the heart itself. GIANNOTTI, G. Contribute ella cones. cenza della pericardite net tubercolitici. Pathologica, 1933, 25, 439. Among five cases of acute pericarditis with effusion which he encountered among 496 cases of pulmonary tuber. culosis, the writer found that four were of undoubtedly tuberculous origin, while in one the action of tubercle bacilli could be excluded. Not only is the presence of tubercle bacilli rare in tuberculous pericarditls, but the discovery of giant cells is rarer still, as the author could find only one or at most two in all the sections examined in his cases. In the presence therefore of acute perieardial lesions suspected to be tuberculous a n examination should be made of several sections from differout parts of the pericardium so as to avoid regarding tuberculous pericarditis as a pericarditis due to other causes or vice versa. ARROM, D. Orientaciones en el tratamiento del stndrome cardiaco de la tuberculosis. ~ev. dc ttig. e de T~tber. culosis, 1933, 287 85. The treatment of the different forms of cardiac disease of tuberculous origin
323
must vary according to the case. I n pleurisy with effusion the fluid must be evacuated in time, otherwise there is a risk of cardiac compression by bands or o,~ dextrocardia w h e n t h e e f f u s i o n is on the lef~ side. Tuberculous pericarditis should receive early freatment to prev e n t the occurrence of pericardial adhesions which may considerably interfere with cardiac function. In the investigation of the etiology of asthma the possibility of tuberculosis being the cause of the disease should always be borne in mind. Radiology and kymography are a valuable g u i d e to the diagnosis and treatmentof lesions of the mediastinum. Cardiotonic and diuretic treatment associated w i t h causal therapy yield remarkable results in e x tensive old-standing fibrosis of the lung. Any suspicion of tuberculosis in a subject of heart disease enables the practitioner to abandon any unsuitable treatment.
TUBERCULOSIS
OF
THE
EYE.
IVOODS, A. C. Tuberculosis of the Eye. International Clln{cs, 1933, 43rd Serie% i,96.
The diagnosis of tuberculosis of the conjunctive and ocular adnexa offers no great difficulty, the infection here being exogenous or by direct extension from a neighbouringosteomyelitis. In doubtful eases biopsy or animal inoculation makes the diagnosis clear. In intraocular inflammations the infection is endogenous ; biopsy and inoculation are impracticable unless the vision is so completely destroyed that enucleation of the eye is justified on account of pain, and there are no secretions or fluids which can beexamined for bacilli. The diagnosis must be made on the suggestive clinical appearance, the exclusion of syphilis, the demonstration that focal infection is absent or unrelated to the ocular inflammation, and the presence of an undue degree of tuberculin hypersensitivity. I t is only from pathological material, rarely available, that the tuberculous nature of the chronic non-specific inflammation can be proved. Tuberculous keratitis is usually see-
CARDIO-VASCULAR DISEASE AND TUBERCULOSIS
later becoming very severe, with a hmmatogenous spread to the pericardium and lungs: The chronic nature of the pericarditis was shown by the absence of symptoms of pressure, the large amount of fluid and the thickness of the sac, while the lung involvement w~s confirmed by the positive Sputum and the radiograms. J u d g i n g from the literature, tuberculous pericarditi s is not a particularly rare disease, and probably many cases .were overlooked before the present improvement in radiological technique. Apar~ from the size of the swelling, the specially interesting features of the case were that the boy should have found himself capable of strenuous exercise before the operation; t h e ability to stand removal of a large volume of fluid ( t w o litres) without shock, and the thickness and rigidity of the parietal pericardium, with the peculiar .torsion of the heart itself. GIANNOTTI, G. Contribute ella cones. cenza della pericardite net tubercolitici. Pathologica, 1933, 25, 439. Among five cases of acute pericarditis with effusion which he encountered among 496 cases of pulmonary tuber. culosis, the writer found that four were of undoubtedly tuberculous origin, while in one the action of tubercle bacilli could be excluded. Not only is the presence of tubercle bacilli rare in tuberculous pericarditls, but the discovery of giant cells is rarer still, as the author could find only one or at most two in all the sections examined in his cases. In the presence therefore of acute perieardial lesions suspected to be tuberculous a n examination should be made of several sections from differout parts of the pericardium so as to avoid regarding tuberculous pericarditis as a pericarditis due to other causes or vice versa. ARROM, D. Orientaciones en el tratamiento del stndrome cardiaco de la tuberculosis. ~ev. dc ttig. e de T~tber. culosis, 1933, 287 85. The treatment of the different forms of cardiac disease of tuberculous origin
323
must vary according to the case. I n pleurisy with effusion the fluid must be evacuated in time, otherwise there is a risk of cardiac compression by bands or o,~ dextrocardia w h e n t h e e f f u s i o n is on the lef~ side. Tuberculous pericarditis should receive early freatment to prev e n t the occurrence of pericardial adhesions which may considerably interfere with cardiac function. In the investigation of the etiology of asthma the possibility of tuberculosis being the cause of the disease should always be borne in mind. Radiology and kymography are a valuable g u i d e to the diagnosis and treatmentof lesions of the mediastinum. Cardiotonic and diuretic treatment associated w i t h causal therapy yield remarkable results in e x tensive old-standing fibrosis of the lung. Any suspicion of tuberculosis in a subject of heart disease enables the practitioner to abandon any unsuitable treatment.
TUBERCULOSIS
OF
THE
EYE.
IVOODS, A. C. Tuberculosis of the Eye. International Clln{cs, 1933, 43rd Serie% i,96.
The diagnosis of tuberculosis of the conjunctive and ocular adnexa offers no great difficulty, the infection here being exogenous or by direct extension from a neighbouringosteomyelitis. In doubtful eases biopsy or animal inoculation makes the diagnosis clear. In intraocular inflammations the infection is endogenous ; biopsy and inoculation are impracticable unless the vision is so completely destroyed that enucleation of the eye is justified on account of pain, and there are no secretions or fluids which can beexamined for bacilli. The diagnosis must be made on the suggestive clinical appearance, the exclusion of syphilis, the demonstration that focal infection is absent or unrelated to the ocular inflammation, and the presence of an undue degree of tuberculin hypersensitivity. I t is only from pathological material, rarely available, that the tuberculous nature of the chronic non-specific inflammation can be proved. Tuberculous keratitis is usually see-