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“Temporal arteritis”. Some aspects of subacute arteritis in later life
146
AMERICAN
HEART
JOURNAL
Observation of a patient with hypertension serves two purposes: it enables the physician to know the duration of the process and to detect the slightest evidence of progression. If progression is observed the operation cannot be delayed too long. There is no clinical test to determine operability; each case must be settled on its individual merits. WAGNER.
Jennings, Life.
G. H.: Brit. M.
“Temporal J. 1:443
Arteritis.” (March 6), 1948.
Some
Aspects
of Subacute
Arteritis
in
Later
The authors report their clinical experience in four cases of temporal arteritis. They stress that this condition most often occurs in elderly women and causes severe protracted headaches in association with an acute inflammatory arteritis of the temporal and other vessels. The course is usually prolonged over months and possibly years, but generally responds favorably. Coal tar analgesics are helpful but narcotics are often required at night for sleep. Arterectomy was performed in two cases with questionable benefit. Comparison and differentiation from a clinical pathologic point of view is made between this entity, thromboangiitis obliterans, and periarteritis nodosa. WAGNER.
Freidlich, A. J., Jr., ethylammonium
Chapman, Chloride.
W. P., and Stanbury, J. B.: A Severe New England J. Med. 288:629 (April
Reaction 29), 1948.
to Tetra-
During a study of gastrointestinal motility, tetraethylammonium chloride was given to a small, emotionally unstable, normotensive, 37-year-old woman with evidence suggestive of the menopause and hypothyroidism. The patient experienced a reaction of such severity as to cause grave concern. Marked hyperventilation developed during the administration of 230 mg. at a rate of 100 mg. per minute. At the conclusion of the injection, the blood pressure had fallen from 120/80 to 75/S. Within thirty seconds she exhibited alarming respiratory distress. During the next thirty minutes she received repeated small injections of epinephrine, and oxygen was administered. She complained of inability to move her legs, and signs of tetany appeared. The pulse rate, which had remained below 100 during the early period of the reaction, rose to 140 and then to 190 per minute, at which time paroxysmal auricular tachycardia was diagnosed electrocardiographically. Glucose solution, plasma, and whole blood’ were administered during the following several hours. The heart rate reverted to normal after eighteen hours despite which hypotension persisted and was still present on the ninth day. By this time her genera1 condition was sufficiently improved to permit her discharge from the hospital. The mechanisms involved in this unusual reaction to the drug were not clearly apparent. KAY.
Dubow, E., and Solomon, N. H.: trics 32:495 (April), 1948.
Salicylate
Tolerance
and
Toxicity
in Children.
Pedia-
This study was undertaken because of the difference of opinion regarding the incidence of toxicity and the dosage at which toxicity to salicylates manifests itself. A group of nineteen children between the ages of 8 months and 11 W years were treated with varying dosage of sodium salicylate or acetylsalicylic acid, without alkali. Eleven had active rheumatic fever, and all but one were acutely ill. In addition to clinical observation, plasma salicylate levels, serum carbon dioxide content, and pH values were studied on alternate days. Coburn’s dosage of 0.15 Gm. per kilogram of body weight was given to six children. Three received two separate courses, one of sodium salicylate and one of acetylsalicylic acid, two were given sodium salicylate alone, and one was given acetylsalicylic acid alone. Five of the six children developed toxic manifestations consisting of hyperpnea, apathy, and lassitude; three manifested anorexia; two had tinnitus. The plasma salicylate level ranged between 32 and 41 mg. per 100 C.C. of blood. Because of the toxic manifestations, a dosage schedule of 0.10 Gm. per kilogram was tried in three patients, but the plasma level reached only 19 to 21 mg. per 100 C.C. of blood. An intermediate dose of 0.125 Gm. per kilogram was administered to seven children and salicylate levels
AMERICAN
HEART
JOURNAL
Observation of a patient with hypertension serves two purposes: it enables the physician to know the duration of the process and to detect the slightest evidence of progression. If progression is observed the operation cannot be delayed too long. There is no clinical test to determine operability; each case must be settled on its individual merits. WAGNER.
Jennings, Life.
G. H.: Brit. M.
“Temporal J. 1:443
Arteritis.” (March 6), 1948.
Some
Aspects
of Subacute
Arteritis
in
Later
The authors report their clinical experience in four cases of temporal arteritis. They stress that this condition most often occurs in elderly women and causes severe protracted headaches in association with an acute inflammatory arteritis of the temporal and other vessels. The course is usually prolonged over months and possibly years, but generally responds favorably. Coal tar analgesics are helpful but narcotics are often required at night for sleep. Arterectomy was performed in two cases with questionable benefit. Comparison and differentiation from a clinical pathologic point of view is made between this entity, thromboangiitis obliterans, and periarteritis nodosa. WAGNER.
Freidlich, A. J., Jr., ethylammonium
Chapman, Chloride.
W. P., and Stanbury, J. B.: A Severe New England J. Med. 288:629 (April
Reaction 29), 1948.
to Tetra-
During a study of gastrointestinal motility, tetraethylammonium chloride was given to a small, emotionally unstable, normotensive, 37-year-old woman with evidence suggestive of the menopause and hypothyroidism. The patient experienced a reaction of such severity as to cause grave concern. Marked hyperventilation developed during the administration of 230 mg. at a rate of 100 mg. per minute. At the conclusion of the injection, the blood pressure had fallen from 120/80 to 75/S. Within thirty seconds she exhibited alarming respiratory distress. During the next thirty minutes she received repeated small injections of epinephrine, and oxygen was administered. She complained of inability to move her legs, and signs of tetany appeared. The pulse rate, which had remained below 100 during the early period of the reaction, rose to 140 and then to 190 per minute, at which time paroxysmal auricular tachycardia was diagnosed electrocardiographically. Glucose solution, plasma, and whole blood’ were administered during the following several hours. The heart rate reverted to normal after eighteen hours despite which hypotension persisted and was still present on the ninth day. By this time her genera1 condition was sufficiently improved to permit her discharge from the hospital. The mechanisms involved in this unusual reaction to the drug were not clearly apparent. KAY.
Dubow, E., and Solomon, N. H.: trics 32:495 (April), 1948.
Salicylate
Tolerance
and
Toxicity
in Children.
Pedia-
This study was undertaken because of the difference of opinion regarding the incidence of toxicity and the dosage at which toxicity to salicylates manifests itself. A group of nineteen children between the ages of 8 months and 11 W years were treated with varying dosage of sodium salicylate or acetylsalicylic acid, without alkali. Eleven had active rheumatic fever, and all but one were acutely ill. In addition to clinical observation, plasma salicylate levels, serum carbon dioxide content, and pH values were studied on alternate days. Coburn’s dosage of 0.15 Gm. per kilogram of body weight was given to six children. Three received two separate courses, one of sodium salicylate and one of acetylsalicylic acid, two were given sodium salicylate alone, and one was given acetylsalicylic acid alone. Five of the six children developed toxic manifestations consisting of hyperpnea, apathy, and lassitude; three manifested anorexia; two had tinnitus. The plasma salicylate level ranged between 32 and 41 mg. per 100 C.C. of blood. Because of the toxic manifestations, a dosage schedule of 0.10 Gm. per kilogram was tried in three patients, but the plasma level reached only 19 to 21 mg. per 100 C.C. of blood. An intermediate dose of 0.125 Gm. per kilogram was administered to seven children and salicylate levels