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Roentgen cardiac kymography: Electrocardiographic correlation
SELECTED
311
ABSTRACTS
The mass was injected at a pressure from 50 to 100 mm. of mercury. The radiopaque mass issued from the renal vein and was collected in a test tube; in every instance, glass beads were recovered from this perfusate. This mixture was injected into sixteen isolated human kidneys with intact capsules. Beads 90 to 440 microns in diameter were recovered from the renal vein in ten of the sixteen kidneys; the maximum diameters were 200 microns or more. Neither age nor disease played a role in determining the size of the beads recovered. The same results were obtained when &capsulated kidneys were used. The authors conclude that these observations indicate the presence of direct arteriovcnous communications which must by-pass the capillary bed in the normal human kidney since these spheres were too large to pass through the capillaries. This experiment was repeated in living rabbits and dogs under ether anesthesia, using a saline suspension of beads and using the lungs as the trap for the beads instead of cannulizing the renal vein. Beads ranging in size from 50 to 180 microns were recovered from the lungs of the rabbits. In seven animals the kidneys were intact and in seven the kidneys were decapsulated. The results indicate the presence of arteriovenous shunts in the kidneys of living rabbits and dogs. The authors finally conclude that if the concept of a functional extraglomerular circulation in the normal kidney is accepted, based upon their experiments, a re-evaluation of the dynamics of renal flow of the blood is in order. BERXSTEIX. Kallner, S. : Thrombosis 81:126 (Feb.), 1948.
as
a Complication
of
Internal
Diseases.
Arch.
Int.
hIed.
The author studied patients with pneumonia in whom fever persisted after the pneumonia The author used heparin and Dicumnrol had been apparently controlled by antibiotic therapy. to treat the thrombosis, which he feels causes the fever to persist and which he thinks is located in the venous system either of the pelvis or of the lower extremities. With this therapy he gives massage to the lower extremities and permits early movement of the lower extremities and trunk. The same technique Therapy is continued until the patient is out of bed and moving about freely. is used for suspected thrombotic complications in the treatment of cases of heart disease, anemia, parturition, and elderly patients who have been confined to bed for a long time for any reason and in any cases in which a manifest thrombosis has been present. He states that though he has used anticoagulants in the treatment of cardiac infarctions, it is too early to make any statements regarding the results. Heparin was also used in a case of TWO hours after the start of heparin therapy the transfusion reaction in which there was anuria. anuria cleared up and long fibrin casts of tubuli were voided. Finally, in fibrinous bronchitis heparin was used to decrease or counteract the deposit of fibrin, and, when combined with ephedrine and epinephrine, is characterized by the author as “life saving.” BERNSTEIN. Thomas, S. F., trocardiographic
Alto,
P., and Garland, L. H.: Roentgen California Med. 68:126 Correlation.
Cardiac (March),
Kymography: 1948.
Elec-
The purpose of this paper is tore-evaluate the roentgen cardiac kymograph and to demonstrate the kymogram sometimes gives information which is not obtainable by any other means, Routinely, exposures of 1.5 to 2 seconds were made in mid-inspiration with the patient as Films in forced inspiration and relaxed as possible in order to avoid a Valsalva or Mullet effect. The criteria expiration were made on occasion to confirm or rule out certain minimal findings. for kymographic diagnosis were the depth (or height), shape, and phase of the waves. The authors found that in most of the patients in this series the waves were usually under 4 mm. in depth. However, in the patients with myocardial disease of any type, the height (or depth) Other findings sometimes of the waves was often 2 mm. and frequently less than 1 millimeter. of the waves where the waves come to an suggestive of disease of the myocardium were “peaking” abrupt point. Splintermg of the waves (both systolic and diastolic) was regarded as important that
312
AMERICAN
HEART
JOURNAL
in the diagnosis of disease, especially when it was accompanied by waves of low amplitude which appeared fuzzy (unsharp). The suppression of waves or absence of movement, or the outright reversal of movement, in any area was considered diagnostic of myocardial damage, and when this occurred in the presence of suitable associated findings, an area of infarction was diagnosed. Localized adhesive pericarditis may produce suppressed and fuzzy waves and mimic an area of localized myocardial damage, but the condition was not encountered in this series. The term myocardial damage is used in this report to include various cardiac abnormalities from myocarditis through myofibrosis to frank infarction. The authors used the electrocardiogram as an Over 350 sets of kymograms were made. accepted test for the diagnosis of major cardiac disease and then matched the kymogram against this method. The two methods correlated in 80.5 per rent of the cases, or 201 patients. Proper11 interpreted, roentgen kymograms have been demonstrated as a reliable source of additional information and in a small percentage of cases can provide information not obtainable clinirally or even by electrocardiogram. Illustrative cases are used to bring out the various points of interest.
Rodriguez, England
R., and Root, J. Med. 238:391
H. F.: (March
Capillary 18), 1948.
Fragility
and
Diabetic
Retinitis.
New
This report is concerned with the results of the Gothlin positive-pressure test for determining The findings reported deal with three groups of the capillary fragility in diabetic patients. patients: nonselected diabetic patients; diabetic patients with varying degrees of retinopathy; and patients with diabetic retinitis or retinitis proliferans and high degrees of capillary fragility, who were treated with rutin. The capillary fragility was found to be increased in forty patients (40 per cent), borderline in four (four per cent), and normal in the remaining fifty-six (56 per cent). Diabetic retinitis and hypertension were the most closely related abnormalities among the forty patients with Twelve of these forty patients with increased petechial counts had increased capillary fragility. retinitis with hypertension and fourteen had retinitis with normal blood pressure. In the group of eight patients with retinitis proliferans the blood pressure was normal in two and above 150/90 in the remaining six. In the entire group, the incidence of poor capillary resistance with hypertension was 27.5 per cent. Among the forty patients with abnormal capillary fragility, normal blood pressure and normal fundi were found in three (7.5 per cent). This group confirms the judgment that increased capillary fragility may be present in young persons with diabetes of long duration as one of the earliest signs of arteriosclerosis, which will subsequently he manifest in nephritis, hypertension, and general arteriosclerosis. .qmong the fifty-six diabetic patients of the nonselected group who had normal capillary fragility, the fundi were normal in fifty-four and retinal damage was present in only two. From the authors’ observations it seems clear that diabetic retinopathy seldom occurs in patients who do not have some degree of increased fragility of the capillary walls. The authors petechial index cent); no patient
studied an additional group was increased in forty-seven was found to be normal.
of fifty-six patients with diabetic (83.9 per cent) and borderline
retinopathy. The in nine (16.1 per
BELLET. Bronstein, Rev.
J. : argent.
The P Wave in Precordial de cardiol. 15:105 (March),
Leads 1948.
in Chronic
Bronchopulmonary
Disease.
No significant abnormalities in the P wave of precordial leads in fifty patients with bronchopulmonary disease of varying severity were noted in a large number of precordial leads taken from the vicinity of the sternum and to the right and left of it. In thirty-five of these subjects a definite P pumonale was present in standard bipolar limb leads.
HECHT.
311
ABSTRACTS
The mass was injected at a pressure from 50 to 100 mm. of mercury. The radiopaque mass issued from the renal vein and was collected in a test tube; in every instance, glass beads were recovered from this perfusate. This mixture was injected into sixteen isolated human kidneys with intact capsules. Beads 90 to 440 microns in diameter were recovered from the renal vein in ten of the sixteen kidneys; the maximum diameters were 200 microns or more. Neither age nor disease played a role in determining the size of the beads recovered. The same results were obtained when &capsulated kidneys were used. The authors conclude that these observations indicate the presence of direct arteriovcnous communications which must by-pass the capillary bed in the normal human kidney since these spheres were too large to pass through the capillaries. This experiment was repeated in living rabbits and dogs under ether anesthesia, using a saline suspension of beads and using the lungs as the trap for the beads instead of cannulizing the renal vein. Beads ranging in size from 50 to 180 microns were recovered from the lungs of the rabbits. In seven animals the kidneys were intact and in seven the kidneys were decapsulated. The results indicate the presence of arteriovenous shunts in the kidneys of living rabbits and dogs. The authors finally conclude that if the concept of a functional extraglomerular circulation in the normal kidney is accepted, based upon their experiments, a re-evaluation of the dynamics of renal flow of the blood is in order. BERXSTEIX. Kallner, S. : Thrombosis 81:126 (Feb.), 1948.
as
a Complication
of
Internal
Diseases.
Arch.
Int.
hIed.
The author studied patients with pneumonia in whom fever persisted after the pneumonia The author used heparin and Dicumnrol had been apparently controlled by antibiotic therapy. to treat the thrombosis, which he feels causes the fever to persist and which he thinks is located in the venous system either of the pelvis or of the lower extremities. With this therapy he gives massage to the lower extremities and permits early movement of the lower extremities and trunk. The same technique Therapy is continued until the patient is out of bed and moving about freely. is used for suspected thrombotic complications in the treatment of cases of heart disease, anemia, parturition, and elderly patients who have been confined to bed for a long time for any reason and in any cases in which a manifest thrombosis has been present. He states that though he has used anticoagulants in the treatment of cardiac infarctions, it is too early to make any statements regarding the results. Heparin was also used in a case of TWO hours after the start of heparin therapy the transfusion reaction in which there was anuria. anuria cleared up and long fibrin casts of tubuli were voided. Finally, in fibrinous bronchitis heparin was used to decrease or counteract the deposit of fibrin, and, when combined with ephedrine and epinephrine, is characterized by the author as “life saving.” BERNSTEIN. Thomas, S. F., trocardiographic
Alto,
P., and Garland, L. H.: Roentgen California Med. 68:126 Correlation.
Cardiac (March),
Kymography: 1948.
Elec-
The purpose of this paper is tore-evaluate the roentgen cardiac kymograph and to demonstrate the kymogram sometimes gives information which is not obtainable by any other means, Routinely, exposures of 1.5 to 2 seconds were made in mid-inspiration with the patient as Films in forced inspiration and relaxed as possible in order to avoid a Valsalva or Mullet effect. The criteria expiration were made on occasion to confirm or rule out certain minimal findings. for kymographic diagnosis were the depth (or height), shape, and phase of the waves. The authors found that in most of the patients in this series the waves were usually under 4 mm. in depth. However, in the patients with myocardial disease of any type, the height (or depth) Other findings sometimes of the waves was often 2 mm. and frequently less than 1 millimeter. of the waves where the waves come to an suggestive of disease of the myocardium were “peaking” abrupt point. Splintermg of the waves (both systolic and diastolic) was regarded as important that
312
AMERICAN
HEART
JOURNAL
in the diagnosis of disease, especially when it was accompanied by waves of low amplitude which appeared fuzzy (unsharp). The suppression of waves or absence of movement, or the outright reversal of movement, in any area was considered diagnostic of myocardial damage, and when this occurred in the presence of suitable associated findings, an area of infarction was diagnosed. Localized adhesive pericarditis may produce suppressed and fuzzy waves and mimic an area of localized myocardial damage, but the condition was not encountered in this series. The term myocardial damage is used in this report to include various cardiac abnormalities from myocarditis through myofibrosis to frank infarction. The authors used the electrocardiogram as an Over 350 sets of kymograms were made. accepted test for the diagnosis of major cardiac disease and then matched the kymogram against this method. The two methods correlated in 80.5 per rent of the cases, or 201 patients. Proper11 interpreted, roentgen kymograms have been demonstrated as a reliable source of additional information and in a small percentage of cases can provide information not obtainable clinirally or even by electrocardiogram. Illustrative cases are used to bring out the various points of interest.
Rodriguez, England
R., and Root, J. Med. 238:391
H. F.: (March
Capillary 18), 1948.
Fragility
and
Diabetic
Retinitis.
New
This report is concerned with the results of the Gothlin positive-pressure test for determining The findings reported deal with three groups of the capillary fragility in diabetic patients. patients: nonselected diabetic patients; diabetic patients with varying degrees of retinopathy; and patients with diabetic retinitis or retinitis proliferans and high degrees of capillary fragility, who were treated with rutin. The capillary fragility was found to be increased in forty patients (40 per cent), borderline in four (four per cent), and normal in the remaining fifty-six (56 per cent). Diabetic retinitis and hypertension were the most closely related abnormalities among the forty patients with Twelve of these forty patients with increased petechial counts had increased capillary fragility. retinitis with hypertension and fourteen had retinitis with normal blood pressure. In the group of eight patients with retinitis proliferans the blood pressure was normal in two and above 150/90 in the remaining six. In the entire group, the incidence of poor capillary resistance with hypertension was 27.5 per cent. Among the forty patients with abnormal capillary fragility, normal blood pressure and normal fundi were found in three (7.5 per cent). This group confirms the judgment that increased capillary fragility may be present in young persons with diabetes of long duration as one of the earliest signs of arteriosclerosis, which will subsequently he manifest in nephritis, hypertension, and general arteriosclerosis. .qmong the fifty-six diabetic patients of the nonselected group who had normal capillary fragility, the fundi were normal in fifty-four and retinal damage was present in only two. From the authors’ observations it seems clear that diabetic retinopathy seldom occurs in patients who do not have some degree of increased fragility of the capillary walls. The authors petechial index cent); no patient
studied an additional group was increased in forty-seven was found to be normal.
of fifty-six patients with diabetic (83.9 per cent) and borderline
retinopathy. The in nine (16.1 per
BELLET. Bronstein, Rev.
J. : argent.
The P Wave in Precordial de cardiol. 15:105 (March),
Leads 1948.
in Chronic
Bronchopulmonary
Disease.
No significant abnormalities in the P wave of precordial leads in fifty patients with bronchopulmonary disease of varying severity were noted in a large number of precordial leads taken from the vicinity of the sternum and to the right and left of it. In thirty-five of these subjects a definite P pumonale was present in standard bipolar limb leads.
HECHT.