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The prognosis in syphilitic aortic insufficiency
SELECTED Three children-who had of ltime developed rheumatic gitis.
777
ABSTRACTS
received the additional symptoms following
vitamins an attack
Children on the regular diet without additional vitamins diet with additional vitamins gained weight at approximately the five-month period.
for a, considerable of streptococcus
period pharyn-
and those on the regular the same rate during AUTHOR.
Roth, Irving Acad.
Med.
R.: 16:
Clinical Aspects 514, 1940.
of Rheumatic
Fever in Adults.
Bull.
New
York
IRheumatic fever in adults does not seem to conform to a distinctive pattern, and the polyarthritic picture suggested by hospital records is more apparent than real. At any rate, it does not represent the whole disease. Smoldering forms are not uncommon and it is this form that probably precipitates insidious failures of the circulation. It is probably responsible also for auricular fibrillation in some cases. ‘The anatomic lesions in the younger adults are generally multiple advances, those with combined mitral and aortic lesions are seemingly Chances for survival seem best for those who have mitral lesions alone.
but, as age weeded out.
Aurieular fibrillation, except as a terminal event, is rare in early adulthood. However, as age advances, it soon becomes the dominant arrhythmia and may be, present in from 20 to 25 per cent of patients past 40 years of age. Functional capacity in young adults is generally excellent despite multiple valvular lesions. At middle age or beyond, it is on the decline and heart failure is an ever-present threat. Accompanying diseases are of minor importance in the younger adult with a rheumatic cardiac condition. The greatest hazard is an acute rheumatic episode. At middle age, on the other hand, an accompanying hypertension seems to be the mast embarrassing complication. Emotional factors are present in both groups and color the clinical picture appreciably. Not only symptoms but also physical signs and, in a measure, even prognosis are influenced by them. They must be taken into serious account in any attempt to appraise the clinical aspects of rheumatic heart disease in adult life. AUTrnXL
Kampmeier, R. H., and Combs, Stuart R.: The Prognosis in Syphilitic Insufficiency. Am. J. Syph., Gonor. & Yen. Bis. 24: 578, 1940.
A&tic
An analysis has been made of 163 cases of syphilitic aortic insufficiency studied at Vanderbilt University Hospital. One hundred and twenty, or 73 per cent, of the patients are dead; 54.6 per cent of the deaths occurred within three years after the onset of symptoms. The importance of race and sex in the prognosis of syphilitic aortic insufficiency is clearly indicated by this study. Only one-fourth of the negro males with syphilitic aortie insufficiency survived three or more years after the appearance of symptoms, whereas slightly less than one-half of the white males and negro females, and over one-half of the white females survived three or more years. Occupations involving manual labor are conducive to’ poor prognosis in syphilitic aortic insufficiency. As is to be expected, the chance finding of asymptomatic syphilitic aortic regurgitation at the time of initial examination occ.urred more frequently in patients who are still living.
778
THE
AMERICAN’
HEART
JOUIPINAL
Moreover, the presence of congestive heart failure and evidenee of free aortic regurgitation was noted more frequently in patients who experienced, subsequently, short survival periods. The longer the duration of symptoms of syphilitic aortic insufficiency before the diagnosis becomes established, the poorer the prognosis. This study does not indicate that adequate antisyphilitic treatment influences favorably the prognosis of syphilitic aortic insticiency. AUTRORS.
.Ayman, David, and Goldshine, Archie D.: Blood Pressure Determinations by Patients With Essential Hypertension. I. The Difference Between Clinic and Home Readings Before Treatment. Am. J. M. SC. 200: 465, 1940. Thirty-four patients with various degrees of essential hypertension had their Mood pressure studied over a long period in the clinic and at home. The home readings have been taken very carefully twice daily for weeks or months by the patient or a member of the household. This study shows that the home systolic and diastolic blood pressure readings are lower than the clinic readings in all cases of essential hypertension. In 30 per cent of the cases the systolic home blood pressure readings were 40 mm. or more lower than those in the clinic, and in 24 per cent the diastolic home readings were 20 mm. or more lower than the clinic readings. The method caused no neurosis or harm in any patient. Those patients with only slight difference between home and clinic readings had, in general, comparatively little fluctuation of blood pressure from day to day. The home blood pres’sure method should be of value to teach the patient the nature of his disease, to help the physician observe better the natural course of the disease, to aid in the prognosis of the individual case, and to permit the clear-cut evaluation of
therapy. AUTIXORS.
Saphir, Otto, and Ballinger, Malignant Nephrosclerosis.
Joseph: Arch.
Hypertension Int.
Med.
66:
(Goldblatt) 541,
and Unilateral
1940.
Three cases of severe arterial hypertension secondary to unilateral renal vascular steno,sis, with consequent isehemia of one kidney, are reported. In two of these, autopsy revealed unilateral malignant nephroselerosis (arteriolonecrosis). this unique observation could be exBecause of recent experimental evidence, plained readily. From his experimental studies, primarily concerned with the production of arterial hypertension by clamping the renal arteries in the dog, Goldblatt concluded that both hypertension and renal insufficiency are the minimal prerequisites for the induction of arteriolonecrosis, for in the absence of either of these factors no necrotizing changes are observed. The patients in both these cases had severe arterial hypertension brought about by renal artery changes, with resulting ischemia of one kidney. Both subsequently had renal excretory insufficiency. This was precipitated in one instance by the onset of congestive heart failure and in the other by the development of acute ascending pyelonephritis in the kidney opposite the ischemic one. Because of the presence of the severe arterial hypertension and excretory renal insticiency, the arterioles in the contralateral kidneys (with a patent vascular system) showed necrotic changes, and these kidneys pre,sented the typical picture of malignant nephrosclerosis. The arterioles in the ischemic kidneys revealed no necrotic changes because the stenosis of the renal and intrarenal arteries militated against the presence of Thus, the pathogenesis of the maligsevere hypertension within the arterioles. nant nephrosclero&s in these cases is exactly similar to that of the arteriolo-
777
ABSTRACTS
received the additional symptoms following
vitamins an attack
Children on the regular diet without additional vitamins diet with additional vitamins gained weight at approximately the five-month period.
for a, considerable of streptococcus
period pharyn-
and those on the regular the same rate during AUTHOR.
Roth, Irving Acad.
Med.
R.: 16:
Clinical Aspects 514, 1940.
of Rheumatic
Fever in Adults.
Bull.
New
York
IRheumatic fever in adults does not seem to conform to a distinctive pattern, and the polyarthritic picture suggested by hospital records is more apparent than real. At any rate, it does not represent the whole disease. Smoldering forms are not uncommon and it is this form that probably precipitates insidious failures of the circulation. It is probably responsible also for auricular fibrillation in some cases. ‘The anatomic lesions in the younger adults are generally multiple advances, those with combined mitral and aortic lesions are seemingly Chances for survival seem best for those who have mitral lesions alone.
but, as age weeded out.
Aurieular fibrillation, except as a terminal event, is rare in early adulthood. However, as age advances, it soon becomes the dominant arrhythmia and may be, present in from 20 to 25 per cent of patients past 40 years of age. Functional capacity in young adults is generally excellent despite multiple valvular lesions. At middle age or beyond, it is on the decline and heart failure is an ever-present threat. Accompanying diseases are of minor importance in the younger adult with a rheumatic cardiac condition. The greatest hazard is an acute rheumatic episode. At middle age, on the other hand, an accompanying hypertension seems to be the mast embarrassing complication. Emotional factors are present in both groups and color the clinical picture appreciably. Not only symptoms but also physical signs and, in a measure, even prognosis are influenced by them. They must be taken into serious account in any attempt to appraise the clinical aspects of rheumatic heart disease in adult life. AUTrnXL
Kampmeier, R. H., and Combs, Stuart R.: The Prognosis in Syphilitic Insufficiency. Am. J. Syph., Gonor. & Yen. Bis. 24: 578, 1940.
A&tic
An analysis has been made of 163 cases of syphilitic aortic insufficiency studied at Vanderbilt University Hospital. One hundred and twenty, or 73 per cent, of the patients are dead; 54.6 per cent of the deaths occurred within three years after the onset of symptoms. The importance of race and sex in the prognosis of syphilitic aortic insufficiency is clearly indicated by this study. Only one-fourth of the negro males with syphilitic aortie insufficiency survived three or more years after the appearance of symptoms, whereas slightly less than one-half of the white males and negro females, and over one-half of the white females survived three or more years. Occupations involving manual labor are conducive to’ poor prognosis in syphilitic aortic insufficiency. As is to be expected, the chance finding of asymptomatic syphilitic aortic regurgitation at the time of initial examination occ.urred more frequently in patients who are still living.
778
THE
AMERICAN’
HEART
JOUIPINAL
Moreover, the presence of congestive heart failure and evidenee of free aortic regurgitation was noted more frequently in patients who experienced, subsequently, short survival periods. The longer the duration of symptoms of syphilitic aortic insufficiency before the diagnosis becomes established, the poorer the prognosis. This study does not indicate that adequate antisyphilitic treatment influences favorably the prognosis of syphilitic aortic insticiency. AUTRORS.
.Ayman, David, and Goldshine, Archie D.: Blood Pressure Determinations by Patients With Essential Hypertension. I. The Difference Between Clinic and Home Readings Before Treatment. Am. J. M. SC. 200: 465, 1940. Thirty-four patients with various degrees of essential hypertension had their Mood pressure studied over a long period in the clinic and at home. The home readings have been taken very carefully twice daily for weeks or months by the patient or a member of the household. This study shows that the home systolic and diastolic blood pressure readings are lower than the clinic readings in all cases of essential hypertension. In 30 per cent of the cases the systolic home blood pressure readings were 40 mm. or more lower than those in the clinic, and in 24 per cent the diastolic home readings were 20 mm. or more lower than the clinic readings. The method caused no neurosis or harm in any patient. Those patients with only slight difference between home and clinic readings had, in general, comparatively little fluctuation of blood pressure from day to day. The home blood pres’sure method should be of value to teach the patient the nature of his disease, to help the physician observe better the natural course of the disease, to aid in the prognosis of the individual case, and to permit the clear-cut evaluation of
therapy. AUTIXORS.
Saphir, Otto, and Ballinger, Malignant Nephrosclerosis.
Joseph: Arch.
Hypertension Int.
Med.
66:
(Goldblatt) 541,
and Unilateral
1940.
Three cases of severe arterial hypertension secondary to unilateral renal vascular steno,sis, with consequent isehemia of one kidney, are reported. In two of these, autopsy revealed unilateral malignant nephroselerosis (arteriolonecrosis). this unique observation could be exBecause of recent experimental evidence, plained readily. From his experimental studies, primarily concerned with the production of arterial hypertension by clamping the renal arteries in the dog, Goldblatt concluded that both hypertension and renal insufficiency are the minimal prerequisites for the induction of arteriolonecrosis, for in the absence of either of these factors no necrotizing changes are observed. The patients in both these cases had severe arterial hypertension brought about by renal artery changes, with resulting ischemia of one kidney. Both subsequently had renal excretory insufficiency. This was precipitated in one instance by the onset of congestive heart failure and in the other by the development of acute ascending pyelonephritis in the kidney opposite the ischemic one. Because of the presence of the severe arterial hypertension and excretory renal insticiency, the arterioles in the contralateral kidneys (with a patent vascular system) showed necrotic changes, and these kidneys pre,sented the typical picture of malignant nephrosclerosis. The arterioles in the ischemic kidneys revealed no necrotic changes because the stenosis of the renal and intrarenal arteries militated against the presence of Thus, the pathogenesis of the maligsevere hypertension within the arterioles. nant nephrosclero&s in these cases is exactly similar to that of the arteriolo-