- Email: [email protected]
The blood pressure in the years following recovery from coronary thrombosis
SELECTED In a total of 55 families active esposure; in 53 per
with rheumatic parents, in 47 per cent, cent, activity followed inactive exposure.
In 57 families with nonrheumatic familial exposure (cnsua.1 cont,art.) lmsurr (int,imate contact). The imerval between active one year in 20 per cent; two :i 1 per cent. The 227 rheumatic 01’ these years, 159,
U!l
ABS’I’RICTS
parent s, in 5i per cent, ; in 43 per cent, nct.ivity
or inactive t.0 five years
activity
followed
activity followed extrafollowed familid c4.
cxpoxure and the onset of rheumatism was in 49 per cent: and six to eleven years in
siblings experirnced or 27 per cent, were
588 calendar simultaneous
years years
of rheumatic of rheumatic
activity. activity.
The interval between the related manifestations was: One month, 29 per cent: one to t,wo months, 24 per cent; two to eleven months, 47 per cent. Three-fourths 01’ the related manifestations of rheumatic activity were between joint. pains aud other rheumatic manifestations. One-fourth of the rrlated manifestations was between polyarthritis, carditis, and chorea. Tn 66 per rent the interval hc&wn I hese major manifestat,ions was two t,o eleven mont.hs. Tn 51 families, 59 parents (mother or father) were rheumatic?; 41 per cent cxln’rienced rheumatic activity during the lifetime of the siblings. In no instance The incidence of rheumat,ic siblings wap did a negative parent acquire the disease. comparable in families with a rheumatic mother or father. In only Of 1IL’ rheumatic families, 49 per cent had parent,al rheumatism. 28 per cent of sides apparent,ly
t,he families negative.
were
parents
and
peiligfve
Of a total of 468 siblings over the age of three 46 per cent males and 54 per cent females.
on maternal
years;,
48 per cent
All identical twins cited (4 pairs) were alike in having IL! pairs of fraternal twins, 5 pairs had similar incidence, negat,ivr, and 7 pairs had dissimilar incidence. A genetic analysis observed and expected For children expected value For children value 86.
of the data values.
of 58 pairs 88. of
corrected
of negative
for
rheumatic i.e.? both
size of family
parents,
the
gave
and were
paternal
rheumatic;
fever. positive
agreement
Of the or both between
nhserved
incidence
was 90, the expected
37 positive
mothers,
the
observed
incidence
For children of 29 positive respectively 29 and 27.9.
fathers,
the
observed
and
expected
The hereditary mechanism involved was a single autosomal Dominance, involving one or more genes, and recessives involving genes, as well as sex linkage were all excluded.
was
incidences recessive two or
94. the
were gene. more
AUTHOR. Palmer, J. H.: The Blood Pressure in the Years Goronary Thrombosis. Lancet 1: 741, 1937.
Following
Recovery
From
An analysis was made of the blood pressure findings in 212 patients who survived The incidence of hyperan attack of coronary thrombosis by at least three months. tension (160 mm. systolic and/or 100 mm. diastolic) as determined by readings made More than half before or at any time after the attack, was found to be 73 per cent. the cases showed hypertension during the first year. The hypertensive group included 37 per cent of those aged under fifty, and 78 to 84 per cent of those in the next three decades of life at the time of the attack. All except one of the 20 female patients were hypertensives.
630
THE
AMERICAN
HEART
JOTJR~AL
The average course of the blood pressure during ten years after coronary thrombosis (not including the first, month following the attack) has been plotted. The systolic pressure showed a slight rise during this period while the diastolic showed a slight fall. Evidence before the levels were exceeded.
is adduced to show that the average blood pressure for the series attack was probably about 170/100. Although on the average the prior not regained during the ten-year period, they mere in a few cases actually AUTHOR.
Kalbfleisch, Path.
49:
H. :
Phrenico-Pleural
Collateral
Circula$ion.
Frankfurt.
Ztschr.
f.
10, 1936.
A case of embolie-thrombotic closure of the left lower pulmonary artery fifty-two-year-old cardiac patient is described in which the blood supply from collaterals from the diaphragm to which the lung had become adherent. left bronchial artery was also found to be dilated.
in a came The
A second case of Laennec cirrhosis of the liver, liver carcinoma, congestion of the systemic and pulmonary circuits in a fifty-five-year-old man is reported in which venous collaterals had been established between the portal vein, veins in the abdominal wall, and veins in the right side of t,he diaphragm. In addition venous collaterals were present betwen the diaphragm and the pulmonary veins of the adherent lung. L. N.
Linton,
Robert
England
II.:
J. Med.
Acute Peripheral 216:
Arterial
Occlusion and Its Treatment.
K.
New
871, 1937.
In general, there are four types of treatment of embolism: (1) Embolectomy, (2) the use of intermittent negative and positive pressure, (3) the use of vasodilators, and (4) symptomatic or “watchful waiting.“’ Embolectomy was successful in 4 out of 9 cases. Careful localization was made preoperatively, by means of palpation and the use of an aneroid sphygmomanometer. Negative-positive and negative pressure treatment was successful in 9 out of 13 cases. This is especially encouraging in that these eases were not suitable for embolectomy because of the poor condition of the patients. The average length of treatment necessary to establish an adequate One of the patients treated successfully circulation was four and one-half days. by means of negative-positive pressure had a large embolus occluding the bifurcation of the aorta and the arteries below the bifurcation. The author believes that early application of intermittent negative-positive pressures prevented formation The author has no of secondary thrombi in the arteries distal to the occlusion. data on the use of vasodilators, since he did not wish to complicate the results of the other methods of treatment. In only one of 13 cases receiving no treatment was the limb saved. Of 5 cases of embolus in the arm, 4 recovered with no treatment but these cases were not included because of the frequency of spontaneous development of collateral circulation in this extremity. The best results from a single method of treatment of embolus was suction and pressure therapy. The writer believes the ideal method of treatment for suitable cases is a combination of treatments, namely, embolectomy followed by use of the suction-pressure treatment and also the production of peripheral vasodilatation. In cases properly treated, a still higher percentage of extremities should be saved.
H. M.
with rheumatic parents, in 47 per cent, cent, activity followed inactive exposure.
In 57 families with nonrheumatic familial exposure (cnsua.1 cont,art.) lmsurr (int,imate contact). The imerval between active one year in 20 per cent; two :i 1 per cent. The 227 rheumatic 01’ these years, 159,
U!l
ABS’I’RICTS
parent s, in 5i per cent, ; in 43 per cent, nct.ivity
or inactive t.0 five years
activity
followed
activity followed extrafollowed familid c4.
cxpoxure and the onset of rheumatism was in 49 per cent: and six to eleven years in
siblings experirnced or 27 per cent, were
588 calendar simultaneous
years years
of rheumatic of rheumatic
activity. activity.
The interval between the related manifestations was: One month, 29 per cent: one to t,wo months, 24 per cent; two to eleven months, 47 per cent. Three-fourths 01’ the related manifestations of rheumatic activity were between joint. pains aud other rheumatic manifestations. One-fourth of the rrlated manifestations was between polyarthritis, carditis, and chorea. Tn 66 per rent the interval hc&wn I hese major manifestat,ions was two t,o eleven mont.hs. Tn 51 families, 59 parents (mother or father) were rheumatic?; 41 per cent cxln’rienced rheumatic activity during the lifetime of the siblings. In no instance The incidence of rheumat,ic siblings wap did a negative parent acquire the disease. comparable in families with a rheumatic mother or father. In only Of 1IL’ rheumatic families, 49 per cent had parent,al rheumatism. 28 per cent of sides apparent,ly
t,he families negative.
were
parents
and
peiligfve
Of a total of 468 siblings over the age of three 46 per cent males and 54 per cent females.
on maternal
years;,
48 per cent
All identical twins cited (4 pairs) were alike in having IL! pairs of fraternal twins, 5 pairs had similar incidence, negat,ivr, and 7 pairs had dissimilar incidence. A genetic analysis observed and expected For children expected value For children value 86.
of the data values.
of 58 pairs 88. of
corrected
of negative
for
rheumatic i.e.? both
size of family
parents,
the
gave
and were
paternal
rheumatic;
fever. positive
agreement
Of the or both between
nhserved
incidence
was 90, the expected
37 positive
mothers,
the
observed
incidence
For children of 29 positive respectively 29 and 27.9.
fathers,
the
observed
and
expected
The hereditary mechanism involved was a single autosomal Dominance, involving one or more genes, and recessives involving genes, as well as sex linkage were all excluded.
was
incidences recessive two or
94. the
were gene. more
AUTHOR. Palmer, J. H.: The Blood Pressure in the Years Goronary Thrombosis. Lancet 1: 741, 1937.
Following
Recovery
From
An analysis was made of the blood pressure findings in 212 patients who survived The incidence of hyperan attack of coronary thrombosis by at least three months. tension (160 mm. systolic and/or 100 mm. diastolic) as determined by readings made More than half before or at any time after the attack, was found to be 73 per cent. the cases showed hypertension during the first year. The hypertensive group included 37 per cent of those aged under fifty, and 78 to 84 per cent of those in the next three decades of life at the time of the attack. All except one of the 20 female patients were hypertensives.
630
THE
AMERICAN
HEART
JOTJR~AL
The average course of the blood pressure during ten years after coronary thrombosis (not including the first, month following the attack) has been plotted. The systolic pressure showed a slight rise during this period while the diastolic showed a slight fall. Evidence before the levels were exceeded.
is adduced to show that the average blood pressure for the series attack was probably about 170/100. Although on the average the prior not regained during the ten-year period, they mere in a few cases actually AUTHOR.
Kalbfleisch, Path.
49:
H. :
Phrenico-Pleural
Collateral
Circula$ion.
Frankfurt.
Ztschr.
f.
10, 1936.
A case of embolie-thrombotic closure of the left lower pulmonary artery fifty-two-year-old cardiac patient is described in which the blood supply from collaterals from the diaphragm to which the lung had become adherent. left bronchial artery was also found to be dilated.
in a came The
A second case of Laennec cirrhosis of the liver, liver carcinoma, congestion of the systemic and pulmonary circuits in a fifty-five-year-old man is reported in which venous collaterals had been established between the portal vein, veins in the abdominal wall, and veins in the right side of t,he diaphragm. In addition venous collaterals were present betwen the diaphragm and the pulmonary veins of the adherent lung. L. N.
Linton,
Robert
England
II.:
J. Med.
Acute Peripheral 216:
Arterial
Occlusion and Its Treatment.
K.
New
871, 1937.
In general, there are four types of treatment of embolism: (1) Embolectomy, (2) the use of intermittent negative and positive pressure, (3) the use of vasodilators, and (4) symptomatic or “watchful waiting.“’ Embolectomy was successful in 4 out of 9 cases. Careful localization was made preoperatively, by means of palpation and the use of an aneroid sphygmomanometer. Negative-positive and negative pressure treatment was successful in 9 out of 13 cases. This is especially encouraging in that these eases were not suitable for embolectomy because of the poor condition of the patients. The average length of treatment necessary to establish an adequate One of the patients treated successfully circulation was four and one-half days. by means of negative-positive pressure had a large embolus occluding the bifurcation of the aorta and the arteries below the bifurcation. The author believes that early application of intermittent negative-positive pressures prevented formation The author has no of secondary thrombi in the arteries distal to the occlusion. data on the use of vasodilators, since he did not wish to complicate the results of the other methods of treatment. In only one of 13 cases receiving no treatment was the limb saved. Of 5 cases of embolus in the arm, 4 recovered with no treatment but these cases were not included because of the frequency of spontaneous development of collateral circulation in this extremity. The best results from a single method of treatment of embolus was suction and pressure therapy. The writer believes the ideal method of treatment for suitable cases is a combination of treatments, namely, embolectomy followed by use of the suction-pressure treatment and also the production of peripheral vasodilatation. In cases properly treated, a still higher percentage of extremities should be saved.
H. M.