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Place of intermittent venous hyperemia in the treatment of obliterative vascular disease
SELECTED
839
ABSTRACTS
arterial pressure (femoral artery), atria1 pressure, and peripheral resistance were established in all cases. The first observed effect was an average fall in venous pressure of 62 mm. H,O which began in five to ten minutes and continued for thirty to sixty minutes. This decrease was not preceded by diuresis and appeared independent of a decrease in the blood volume. The stroke volume improved in twenty patients, but the cardiac rate was variable. There was no constant change in oxygen consumption. The mean arterial pressure usually increased with no consistent change in diastolic pressure. The peripheral resistance fell in eighteen of twenty observations. In eighteen of the twenty-two subjects, the average increase in cardiac output was 1.6 liters per minute. The increase in output resulted primarily from a decrease in arteriovenous oxygen difference and represented an increase in blood flow to the tissues of 2,300 liters per day. Also demonstrated were the facts that patients in congestive failure may have a high cardiac output which can be further increased with digitalis and that lanatoside C increases the cardiac output in the presence of a normal rhythm. The prime action of the digitalis appears to be on the ventricular muscle which enables the ventricles to increase their output. There is a fall in atria1 pressure which is primarily due to changes in venous tone. The further fall in venous pressure which may occur later appears to be related to the decrease in blood volume caused by the diuresis. BEKNSTEIS. Evoy,
M. II., Treatment
and de Takats, of Obliterative
G.: Place Vascular
of Intermittent Disease. Arch.
Venous
Hyperemia
in
the
Int. Med. 1:292 (March), 1948. After preliminary tests of the peripheral circulation, the patients were instructed to rent or buy an automatic rhythmic venous constrictor apparatus, to use it at home for two to three hours daily, and to report every three months for the first year, twice a year for the second year, and once in the third year. Improvement was measured by objective methods, the most sensitive of which were found to be venous filling time and walking ability. Subjective improvement was noted in a higher percentage than objective improvement, but subjective improvement without objective evidence of improvement was disregarded. Of 100 patients studied, sixtyseven derived some benefit, whereas thirty-three either showed no improvement or had a progression of the disease. The authors conclude that intermittent venous hyperemia is contraindicated in acute venous thrombosis, lymphangitis, severe arteriolar obstruction, and frank gangrene. Sympathectomy is still the treatment of choice in those cases with definite spasm, but venous hyperemia appears to offer additional benefit after vasoconstrictor tone is abolished. Diabetic patients with peripheral nerve involvement, patients with pronounced vascular spasm, and those with arteriolar and capillary stasis are not suitable subjects. Patients with vascular sclerosis in whom preliminary tests show poor response to sympathectomy or those who have already undergone sympathectomy, but still have considerable claudication, constitute the group for whom this form of treatment is indicated. It is an ambuiatory treatment to be used at home. “If the rhythmic constrictor did nothing else but supply the patient with a harmless placebo, it would fulfill a need in geriatric practice.” BERNSTEIN. Mervin G.: Mixed Infection in Subacute Bacterial Endocarditis. Arch. Int. Med. 81:334 (March), 1948. Mixed infection in two cases of subacute bacterial endocarditis which responded favorably In one case Corynebacterium $vewSodiphthericum and to antibiotic therapy are reported. Streptococcus tiridans were present; in the second case Streptococcus tirridans and Hemophillts @arainflztensaae were present. The recognition of mixed infection is important in view of the In one case it was obvious that both streptomycin and penicillin present choice of antibiotics. were essential. Adequate selection of suitable antibiotics may require identification of all the organisms involved in a given infection. It is suggested that mixed infection in subacute bacterial endocarditis may be more frequent than is reported. BERNSTEIN.
Olinger,
839
ABSTRACTS
arterial pressure (femoral artery), atria1 pressure, and peripheral resistance were established in all cases. The first observed effect was an average fall in venous pressure of 62 mm. H,O which began in five to ten minutes and continued for thirty to sixty minutes. This decrease was not preceded by diuresis and appeared independent of a decrease in the blood volume. The stroke volume improved in twenty patients, but the cardiac rate was variable. There was no constant change in oxygen consumption. The mean arterial pressure usually increased with no consistent change in diastolic pressure. The peripheral resistance fell in eighteen of twenty observations. In eighteen of the twenty-two subjects, the average increase in cardiac output was 1.6 liters per minute. The increase in output resulted primarily from a decrease in arteriovenous oxygen difference and represented an increase in blood flow to the tissues of 2,300 liters per day. Also demonstrated were the facts that patients in congestive failure may have a high cardiac output which can be further increased with digitalis and that lanatoside C increases the cardiac output in the presence of a normal rhythm. The prime action of the digitalis appears to be on the ventricular muscle which enables the ventricles to increase their output. There is a fall in atria1 pressure which is primarily due to changes in venous tone. The further fall in venous pressure which may occur later appears to be related to the decrease in blood volume caused by the diuresis. BEKNSTEIS. Evoy,
M. II., Treatment
and de Takats, of Obliterative
G.: Place Vascular
of Intermittent Disease. Arch.
Venous
Hyperemia
in
the
Int. Med. 1:292 (March), 1948. After preliminary tests of the peripheral circulation, the patients were instructed to rent or buy an automatic rhythmic venous constrictor apparatus, to use it at home for two to three hours daily, and to report every three months for the first year, twice a year for the second year, and once in the third year. Improvement was measured by objective methods, the most sensitive of which were found to be venous filling time and walking ability. Subjective improvement was noted in a higher percentage than objective improvement, but subjective improvement without objective evidence of improvement was disregarded. Of 100 patients studied, sixtyseven derived some benefit, whereas thirty-three either showed no improvement or had a progression of the disease. The authors conclude that intermittent venous hyperemia is contraindicated in acute venous thrombosis, lymphangitis, severe arteriolar obstruction, and frank gangrene. Sympathectomy is still the treatment of choice in those cases with definite spasm, but venous hyperemia appears to offer additional benefit after vasoconstrictor tone is abolished. Diabetic patients with peripheral nerve involvement, patients with pronounced vascular spasm, and those with arteriolar and capillary stasis are not suitable subjects. Patients with vascular sclerosis in whom preliminary tests show poor response to sympathectomy or those who have already undergone sympathectomy, but still have considerable claudication, constitute the group for whom this form of treatment is indicated. It is an ambuiatory treatment to be used at home. “If the rhythmic constrictor did nothing else but supply the patient with a harmless placebo, it would fulfill a need in geriatric practice.” BERNSTEIN. Mervin G.: Mixed Infection in Subacute Bacterial Endocarditis. Arch. Int. Med. 81:334 (March), 1948. Mixed infection in two cases of subacute bacterial endocarditis which responded favorably In one case Corynebacterium $vewSodiphthericum and to antibiotic therapy are reported. Streptococcus tiridans were present; in the second case Streptococcus tirridans and Hemophillts @arainflztensaae were present. The recognition of mixed infection is important in view of the In one case it was obvious that both streptomycin and penicillin present choice of antibiotics. were essential. Adequate selection of suitable antibiotics may require identification of all the organisms involved in a given infection. It is suggested that mixed infection in subacute bacterial endocarditis may be more frequent than is reported. BERNSTEIN.
Olinger,