- Email: [email protected]
Phentolamine and IHSS
Letters
to the Editor
Central retinal vein thrombosis in a patient with primary pulmonary hypertension To the Editor: The etiology of primary pulmonary hypertension (P.P.H.) is still controversial.’ In the past it was believed that abnormal fibrinolysis,2 disturbed coagulation,3 or local factors” took part in the pathogenesis of this entity. Lately, we followed a 30-year-old woman with P.P.H. and increased turnover of fibrinogen who developed central retinal vein thrombosis. This complication may support the assumption that P.P.H. seems to be more than a localized disorder of the pulmonary vasculature. Our patient presented two years ago with dyspnea and hemoptysis, and following cardiac cathetherization and investigation which excIuded all known reasons for secondary pulmonary hypertension, she was diagnosed as suffering from P.P.H. At that time her plasma fibrinogen concentration was 383 mg./dl. (normal 150 to 400 mg./dl.) with a T’/z of 2.4 days, and its turnover was 1.11 mg./ml./day (normal 0.57 k 0.05 mg./ml./day). The patient’s condition remained stable for two years, when she was presently readmitted because of a sudden decrease in the vision of the left eye. Fundoscopy and fluorescein angiography revealed a thrombosis of the central retinal vein. In this patient the turnover of the fibrinogen was found to be significantly increased, a finding which may be related to the occurrence of venous thrombosis.” It is possible that our patient had a tendency for thrombosis, etiologically related to the P.P.H. Moreover, the appearance of central retinal vein thrombosis may indicate that at least in some patients the etiology of P.P.H. is not limited to the pulmonary vasculature.6 S. Berliner, M.D. H. Dean, M.D. Y. Shoenfeld, M.D. R. Avissar, M.D. J. Pinkhas, M.D. Department of Medicine “D” Be&son Medical Center Petah Tikva, Israel
REFERENCES 1. 2.
3.
4. 5. 6.
134
Edwards, W. D., and Edward, J. E.: Clinical primary pulmonary hypertension, Circulation 56:884, 1977. Ingelesby, T. V., Singer, J. W., and Gordon, D. S.: Abnormal fibrinolysis in familial pulmonary hypertension, Am. J. Med. 55:5, 1973. Singh, I., and Chohan, I. J.: Blood coagulation changes at high altitude predisposing to pulmonary hypertension, Br. Heart J. 34:611, 1972. Editorial: Pulmonary veno-occlusive disease, Br. Med. J. 3:369, 1972. Deykin, D.: Antithrombotic therapy, Postgrad. Med. 65:135, 1979. Walcott, G., Burchel, H., and Brown, A. L.: Primary pulmonary hypertension, Am. J. Med. 49~70, 1970.
Phentolamine
and
IHSS
To the Editor: We have read with great interest the article by Kerin and associates entitled “Evaluation of phentolamine as a provocative test for idiopathic hypertrophic subaortic stenosis” (AM. HEART J. 97: 204,1979) and agree entirely with their findings. However, we could find no reference to our previous work on the subject,‘. 2 despite the fact that one was an Annotation that appeared in this JOURNAL. Eduardo Moreyra, M.D. Luis E. Alday, M.D., F.A.C.C. School of Medicine National University of Cordoba Avda. Chacabuco 23 5000 Cordoba, Argentina REFERENCES 1.
2.
Moreyra, E., Buteler, B., Madoery, R. and Alday, L.: Drugs and maneuvers in the diagnosis of muscular subaortic stenosis, AM. HEART J. 83:431, 1972. Moreyra, E., Alday, L., Madoery, R., Buteler, B., and Amuchastegui, L.M.: Use of phentolamine as compared to other tests in the clinical diagnosis of muscular subaortic stenosis, Cardiology 58:99, 1973.
Reply To the Editor: We are pleased to learn that Drs. Eduardo Moreyra and Luis Alday share our enthusiasm for the potential usefulness of phentolamine as a provocative test for idiopathic hypertrophic subaortic stenosis (IHSS). We acknowledge that another paper on the same subject was published by Drs. Moreyra and Alday in Cardiology (58:99, 1973) and also an Annotation by them appeared in this JOURNAL (83:431, 1972). These papers were not known to us at the time of our publication. Nicholas Z. Kerin Director, Noninvasive Laboratory Section of Cardiovascular Diseases Assistant Professor Wayne State University Detroit, Mich. 48235
Prophylaxis
of venous
thromboembolism
To the Editor: Dr. Blaisdell, in his Editorial on low-dose heparin prophylaxis of deep vein thrombosis,’ has reached some conclusions which are open to question. He suggests that asymptomatic venous thrombi are not, in terms of morbidity, important. However in a survey of the clinical features of pulmonary embolism, Bell and colleaguesz found that leas than a,quarter of their patients with angiographically proven emboli had
July,
1980,
Vol.
100,
No.
1
to the Editor
Central retinal vein thrombosis in a patient with primary pulmonary hypertension To the Editor: The etiology of primary pulmonary hypertension (P.P.H.) is still controversial.’ In the past it was believed that abnormal fibrinolysis,2 disturbed coagulation,3 or local factors” took part in the pathogenesis of this entity. Lately, we followed a 30-year-old woman with P.P.H. and increased turnover of fibrinogen who developed central retinal vein thrombosis. This complication may support the assumption that P.P.H. seems to be more than a localized disorder of the pulmonary vasculature. Our patient presented two years ago with dyspnea and hemoptysis, and following cardiac cathetherization and investigation which excIuded all known reasons for secondary pulmonary hypertension, she was diagnosed as suffering from P.P.H. At that time her plasma fibrinogen concentration was 383 mg./dl. (normal 150 to 400 mg./dl.) with a T’/z of 2.4 days, and its turnover was 1.11 mg./ml./day (normal 0.57 k 0.05 mg./ml./day). The patient’s condition remained stable for two years, when she was presently readmitted because of a sudden decrease in the vision of the left eye. Fundoscopy and fluorescein angiography revealed a thrombosis of the central retinal vein. In this patient the turnover of the fibrinogen was found to be significantly increased, a finding which may be related to the occurrence of venous thrombosis.” It is possible that our patient had a tendency for thrombosis, etiologically related to the P.P.H. Moreover, the appearance of central retinal vein thrombosis may indicate that at least in some patients the etiology of P.P.H. is not limited to the pulmonary vasculature.6 S. Berliner, M.D. H. Dean, M.D. Y. Shoenfeld, M.D. R. Avissar, M.D. J. Pinkhas, M.D. Department of Medicine “D” Be&son Medical Center Petah Tikva, Israel
REFERENCES 1. 2.
3.
4. 5. 6.
134
Edwards, W. D., and Edward, J. E.: Clinical primary pulmonary hypertension, Circulation 56:884, 1977. Ingelesby, T. V., Singer, J. W., and Gordon, D. S.: Abnormal fibrinolysis in familial pulmonary hypertension, Am. J. Med. 55:5, 1973. Singh, I., and Chohan, I. J.: Blood coagulation changes at high altitude predisposing to pulmonary hypertension, Br. Heart J. 34:611, 1972. Editorial: Pulmonary veno-occlusive disease, Br. Med. J. 3:369, 1972. Deykin, D.: Antithrombotic therapy, Postgrad. Med. 65:135, 1979. Walcott, G., Burchel, H., and Brown, A. L.: Primary pulmonary hypertension, Am. J. Med. 49~70, 1970.
Phentolamine
and
IHSS
To the Editor: We have read with great interest the article by Kerin and associates entitled “Evaluation of phentolamine as a provocative test for idiopathic hypertrophic subaortic stenosis” (AM. HEART J. 97: 204,1979) and agree entirely with their findings. However, we could find no reference to our previous work on the subject,‘. 2 despite the fact that one was an Annotation that appeared in this JOURNAL. Eduardo Moreyra, M.D. Luis E. Alday, M.D., F.A.C.C. School of Medicine National University of Cordoba Avda. Chacabuco 23 5000 Cordoba, Argentina REFERENCES 1.
2.
Moreyra, E., Buteler, B., Madoery, R. and Alday, L.: Drugs and maneuvers in the diagnosis of muscular subaortic stenosis, AM. HEART J. 83:431, 1972. Moreyra, E., Alday, L., Madoery, R., Buteler, B., and Amuchastegui, L.M.: Use of phentolamine as compared to other tests in the clinical diagnosis of muscular subaortic stenosis, Cardiology 58:99, 1973.
Reply To the Editor: We are pleased to learn that Drs. Eduardo Moreyra and Luis Alday share our enthusiasm for the potential usefulness of phentolamine as a provocative test for idiopathic hypertrophic subaortic stenosis (IHSS). We acknowledge that another paper on the same subject was published by Drs. Moreyra and Alday in Cardiology (58:99, 1973) and also an Annotation by them appeared in this JOURNAL (83:431, 1972). These papers were not known to us at the time of our publication. Nicholas Z. Kerin Director, Noninvasive Laboratory Section of Cardiovascular Diseases Assistant Professor Wayne State University Detroit, Mich. 48235
Prophylaxis
of venous
thromboembolism
To the Editor: Dr. Blaisdell, in his Editorial on low-dose heparin prophylaxis of deep vein thrombosis,’ has reached some conclusions which are open to question. He suggests that asymptomatic venous thrombi are not, in terms of morbidity, important. However in a survey of the clinical features of pulmonary embolism, Bell and colleaguesz found that leas than a,quarter of their patients with angiographically proven emboli had
July,
1980,
Vol.
100,
No.
1