Circulation 1952;5;941-956
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However, there was no significant differences be- of the blood. Prophylactic anticoagulant therapy
tween the volumes found in the cyanotic children would seem to be indicated in the dehydration period
and those of the cyanotic adults. The authors believe of selected cases of congestive failure.
that this study suggests that maximal polycythemia HELLERSTEIN
and hypervolemia may be attained in midchildhood
and that no significant alteration in the polycythemia CORONARY ARTERY DISEASE
pattern occurs after this period. MYOCARDIAL INFARCTION
MARGOLIES
Fauteux, M.: Results of Surgical Treatment of
Nuboer, J. F.: Double Aortic Arch. J. Thoracic Coronaritis. Arch. mal. coeur 44: 637 (Aug.),
Surg. 22: 208 (Aug.), 1951. 1951.
The author describes a case of congenital con- The author reports his experience in surgical treat-
striction of the trachea and esophagus, caused by a ment of 78 cases with coronary disease. The oper-
compressing double aortic arch in a male infant. ation consisted in ligation of the great coronary vein
From birth the child suffered from a distinct stridor. and, in most of the cases, denervation of the
Respiration was easier when he was held erect. coronary arteries. The technic of the operation and
Filling the esophagus with barium revealed a con- pre- and postoperative treatment are described.
siderable depression in the posterior wall near the Cases with typical angina, occurring on effort or
third and fourth thoracic vertebrae. The trachea at rest and resisting medical treatment, should be
was also narrowed at this level. The correct diagnosis elected for surgical approach. Hypertension or healed
was then made and the patient was subjected to myocardial infarction is no contraindication, but
surgery. The ductus Botalli was resected and the diabetes, even when treated adequately, is a bad
anterior aortic arch was ligated and divided at the operative risk. The operation is contraindicated in
point of union with the posterior arch. When these the presence of recent myocardial infarction and of
steps were carried out, the esophagus and trachea bundle branch block.
were released from their stricture. The postoperative Of the 78 cases treated by this method, two died
course was uneventful and all symptoms disap- on the operating table and 14 within 20 days follow-
peared except for a slight stridor. ing surgery. The mortality was larger (50 per cent)
ABRAMSON in cases over 60 years. The cause of death was
pulmonary embolism in four cases, coronary throm-
CONGESTIVE HEART FAILURE bosis followed by ventricular fibrillation in two, and
Marvel, R. J., and Shullenberger, W. A.: Thrombo- other complications in the remaining cases. Sixty-
embolic Phenomena Associated with Rapid Diu- two cases survived up to 10 years, and in 45 the
resis In the Treatment of Congestive Heart results are stated as excellent, good or improved.
Failure. Am. Heart J. 42: 194 (Aug.), 1951. PICK
The authors studied 15 cases of congestive heart
failure and two control cases to determine the effects Harman, J. B.: Angina in the Analgesic Limb. Brit.
of rapid dehydration on the blood coagulation M. J. 4730: 521 (Sept. 1), 1951.
system. The treated group consisted of 12 patients The author attempted to test the hypothesis pro-
given digitoxin, sodium restriction, and mercurial posed by Cohen that, in the case of angina pectoris,
diuretics, and three patients on the same regimen there is a continual stream of subliminal pain im-
without digitoxin. Peripheral phlebothrombosis and pulses from the heart and arm, which reaches a
pulmonary embolism occurred in three cases of the functionally related area in the sensorium. When
former group, and in one of the latter group. During integrated with the cortical pattern of the body
rapid diuresis, hemoconcentration was the most con- image, the impulses are localized selectively in that
sistent finding, accompanied by less consistent find- segment. In eight patients with angina, a weak but
ings of increasing prothrombin values, elevated extensive brachial plexus block was performed in
fibrinogen content, rapid coagulation time, and in- order to produce an arm which was analgesic but
creased globulin fractions. These changes preceded which had power and other forms of sensibility only
the thromboembolic episodes, which occurred be- slightly affected. In each instance, the subjects were
tween the sixth and ninth days of therapy. The two then walked over a test course until angina was
control cases without heart disease were given mer- experienced. In seven of the eight patients arm pain
curial diuretics, sodium restricted diets, and digi- occurred after walking a much greater distance than
toxin. They developed no evidence of thromboem- the amount previously sufficient to elicit an attack.
bolic phenomena although they did have increases However, in view of the fact that pain could still
in the hematocrit levels, indicating hemoconcentra- be elicited in the analgesic arm, the author concluded
tion. The authors believe that rapid and marked that hypothetical subliminal pain impulses could
diuresis plays an important role in the pathogenesis have played no part in producing the angina, since
of thromboembolic complications encountered in these must have been abolished by the blocking
patients being treated for congestive failure by procedure.
producing hemoconcentration and increased viscosity ABRAMSON
pregnancy must be based onthe usual indications, animals, but in seven animals, normal electrocardio-
and not on the basis of the heart block per se. grams were registered. The authors conclude that
HELLERSTEIN antihistaminic drugs only partly influence the elec-
trocardiographic changes during anaphylactic shock.
Scherlis, L., and Grishman, A.: Spatial Vectorcardi- Therefore, in addition to histamine, other histamine-
ography: Myocardial Infarction. V. Am. Heart J. like substances play a part in this condition.
42: 24 (July), 1951. SCHERF
The authors studied the vectorcardiograms of 67
patients with evidence of myocardial infarction. In Gordon, A., and Goldberg, H.: Correlation of the
41 patients, electrocardiographic evidence revealed Electrocardiographic Pattern of Right Heart Strain
infarction of the inferior aspect of the heart; in 16, and Evidence of Right Ventricular Hypertension
the infarct was in the anteroseptal region; in 15, in in Congenital Heart Disease. Am. Heart J. 42:
the anterolateral area; in nine, in the anterior aspect; 226 (Aug.), 1951.
and in nine, presumptive infarction of the posterior The authors correlated cardiac catheterization
aspect of the heart. Standard, unipolar extremity, data and the electrocardiographic patterns of 21 in-
precordial multiple thoracic leads, and, in 11 pa- fants and children less than 15 years of age with right
tients, esophageal electrocardiograms were recorded, ventricular hypertension and congenital heart dis-
in addition to simultaneously recorded frontal, sagit- ease. Their criteria for right heart strain were based
tal, and horizontal plane vectorcardiograms. The on the abnormal R/S ratio in V 4R and V 1. The
orientation of the QRS sR loops after infarction de- R/S ratio at birth is normally infinity in V4R and
pended upon the localization of the infarcted area. V,; it then decreases gradually and approaches
The loss of the electromotive forces due to destruc- unity at about 3 years of age and is usually less than
tion of tissue with resultant electrically inert areas 1 thereafter. In 12 cases, when the pattern of right
alters both the electrocardiogram and the vector- heart strain was present in the electrocardiogram,
cardiogram. The new resultant electromotive forces the right ventricular systolic pressure was elevated.
in infarction are due to the existence of a new analytic In five cases, right ventricular systolic hypertension
area which augments the electromotive forces of the was present without the electrocardiographic pat-
diametrically opposite area because of the now un- tern of right heart strain. In the remaining cases, the
opposed potential in the uninvolved region. Spatial pattern of right heart strain was masked by patterns
vectorcardiography as recorded by the authors' of left heart strain produced by other lesions, or
technic is considered to be a superior method for the aberrant coronary vessels. There was no specific
analysis of the spatial distribution of the electro- correlation between the degree of hypertension and
motive forces of accession in infarction. the amplitude of the QRS deflection or the R-S ratios
HELLERSTEIN in right heart strain patterns.
HELLERSTEIN
Bunse, W., and Jahn, H.: Changes in the Electro-
cardiogram Caused by Anaphylactic Shock. Aerztl. Dack, S., Corday, E., and Master, A. M.: The Heart
Wchnschr. 6: 755 (Aug.), 1951. In Acute Hemorrhage: A Clinical and Electro-
In a preceding paper, the authors reported that cardiographic Study. Am. Heart J. 42: 161 (Aug.),
electrocardiographic changes during histamine shock 1951.
are prevented by antihistaminic drugs. In the pres- The authors studied 28 cases of acute hemorrhage
ent paper, the effect of antihistaminics in anaphylac- in order to determine the factors which predispose
tic shock is discussed. Rabbits were sensitized by individuals to coronary insufficiency, what its earli-
hypodermic injection of 2 cc. of human serum and est clinical and electrocardiographic manifestations
anaphylactic shock was provoked two to three weeks are, and the influence of therapy on this condition.
later by the intravenous injection of the same serum. The average age of the group was 49 years and one-
In order to diminish the degree of the shock, all ani- half were over 50 years of age. An average of 1650 cc.
mals received 0.2 cc. per kilogram of Pernocton just of whole blood transfusion was given. In serial elec-
prior to the second injection. Depression of the RS-T trocardiograms, significant changes occurred in 85
segments and flattening or inversion of the T-waves per cent of the cases dqring the acute stage of hemor-
was observed in leads I and II during the state of rhage. The changes generally involved the RS-T
shock in all control animals. Extrasystoles were rare. segment and T-wave and lasted from three hours to
Prolongation of the auriculoventricular conduction 30 days. During the recovery phase, there was a re-
time and 2:1 block were observed. An intravenous currence of abnormal T-wave alterations in 8 pa-
injection of antihistaminic drugs, administered be- tients. In two patients with massive gastrointestinal
fore the shock was induced, did not prevent these hemorrhage, the pattern of myocardial infarction due
electrocardiographic changes in two out of three to coronary occlusion occurred. The electrocardi-
rabbits. If only 1 cc. instead of 5 cc. of serum wvas ographic changes were more marked. They appeared
used to induce the shock, the electrocardiographic earlier, following lesser degrees of hemorrhage, in the
changes mentioned above remained the same in eight older patients than in the younger, and lasted longer
tirely on salt retention and it is suggested that hyper- Zollinger, H. U.: Hypertension following Experi-
tension in these rats does not result from abnormal mental X-Ray Irradiation of One Kidney in the
metabolism of remaining renal tissue but from failure Rat. Schweiz. Ztschr. Path. u. Bakt. 14: 366 (fasc.
to excrete some "pressor" material. 4), 1951.
OPPENHEIMER In 20 adult rats, one kidney was removed and the
other displaced to the subcutaneous tissue. The rats
Zintel, H. A., Wolferth, C. C., Jeffers, W. A., Haf- were then irradiated with 3000 roentgens per liter.
kenschiel, J. H., and Lukens, F. D. W.: Subtotal Periodic blood pressure measurements taken from
Adrenalectomy in the Treatment of Patients with the tail of the 14 animals who survived the operation
Severe Essential Hypertension. Ann. Surg. 134: for 2 to 16 months, revealed two periods of hyper-
351 (Sept.), 1951. tension. The first phase occurred in the second to
The effect of partial removal of the adrenal gland third week and the second phase in the fifth week
was studied in 26 patients suffering from severe after x-ray treatment. An increase of the heart
hypertension. Nine had simultaneous 95 to 98 per weight and histologic changes in the arterioles found
cent adrenalectomy, subdiaphragmatic sympathec- at autopsy of the animals confirmed the presence of
tomy and splanchnicectomy, while nine others had moderate hypertension. The biphasic course of the
88 to 98 per cent adrenalectomy as their only surgical blood pressure elevation is ascribed by the authors
procedure. Two patients who had evidences of severe to an early and a late effect of x-ray irradiation upon
renal damage were subjected to total removal of both the kidney. The first peak is explained by direct
adrenal glands. A two-stage operation appeared to damage to the tubules of the middle portion of
be more satisfactory than a one-stage procedure. Henle's loop, the second peak is interpreted as the
The authors followed 11 patients for from 4 to 12 result of impaired blood circulation in the secondary
months postoperatively. Two of these had persistent contracted kidney.
normal blood pressure, while a third had periods of PICK
normal pressure, but the level tended to become PATHOLOGIC PHYSIOLOGY
elevated w ith excessive adrenal replacement therapy.
Three of the patients died. All eight patients who Seifter, S.: The Effects of Dietary Deprivation of
lived showed improvement of one or more of their Potassium on Heart Glycogen and on Blood
symptoms and were able to return to part or full Glycolysis. J. Lab. & Clin. Med. 38: 78 (July),
time activity, whereas before adrenalectomy they 1951.
had been incapacitated. Two of the patients con- Rats deprived of dietary potassium for periods of
tinued to require adrenal replacement therapy. time varying from 7 to 77 days showed a compara-
The authors concluded that subtotal adrenalec- tively rapid absolute increase in the glycogen con-
tomy will produce some beneficial effects on the tents of their hearts as compared with suitable con-
signs and symptoms, as well as a variable reduction trols. The cardiac glycogen level of such potassium
in the blood pressure, of hypertensive patients. starved rats increased to about twice the normal
Longer follow-up studies are necessary for the full value, and could rapidly be restored to the control
evaluation of this procedure. level by realimentation with potassium for several
ABRAMSON days.
Analysis of the red blood cells of the potassium
starved rats for their potassium content revealed no
Brust, A. A., Reiser, M. F., and Ferris, E. B., Jr.: significant deviation from the control value even
Evaluation of Neurogenic Control of Blood Pres- after 35 days of dietary deficiency.
sure in Hypertension with Tetraethylammonium The rats maintained on a potassium deficient diet
Chloride and Spinal Anesthesia. J. Clin. Investi- for 49 and 77 days respectively exhibited no signifi-
gation 39: 925 (Sept.), 1951. cant difference from control rats in the capacity of
The authors report on comparative study of the their blood to metabolize glucose to lactic acid, and
hypotensive effects of tetraethylammonium chloride no qualitative or quantitative differences in blood
(TEAC) and spinal anesthesia (to a level of T3 or glycolysis.
T6). In all subjects (11 with malignant and 13 with MINTZ
benign hypertension) both TEAC and spinal anes-
thesia significantly reduced the blood pressure. The Zimmerman, H. A.: Hemodynamics: Studies on a
degree of fall in blood pressure due to TEAC paral- Group of Patients Who Developed Cor Pulmonale
leled the effect of anesthesia. Lower blood pressure Following Thoracoplasty. Thoracic Surg. 22: 93
readings were obtained with TEAC, and this sub- (July) , 1951.
stance further reduced the blood pressure when ad- Studies were made by the author on five patients
ministered during high spinal anesthesia. It would who developed cor pulmonale 8 to 15 years after
seem that the autonomic blockade of TEAC was thoracoplasty. These patients were encountered in
more complete than that of high spinal anesthesia. the course of 650 cardiac catheterizations done under
WAIFE the guidance of the author. Measurements w-ere made
Kopelman, H., and Lee, G. de J.: The Intrathoracic served in the esophageal tracings of normal dogs.
Blood Volume in Mitral Stenosis and Left Ven- Following the production of mitral insufficiency,
tricular Failure. Clin. Sc. 10: 383 (Aug.), 1951. characteristic alterations of the esophageal pulse
The authors made studies before and after con- wave contour were observed, which closely resem-
gestive heart failure in 11 patients with mitral steno- bled the pressure tracings obtained simultaneously
sis and 16 with left ventricular failure. In addition, within the left atrium itself.
observations were made on 10 persons without heart It was possible to detect a fall of the regurgitation
disease. Both the direct Fick method and the dye pressure which resulted from hemorrhage or a rise
method were used to determine cardiac output in which was produced by aortic compression. A ratio
many cases. Intrathoracic blood volume was deter- of approximately 3 to 1 was observed between the
mined by the dye method, and in some cases where simultaneously recorded atrial and esophageal pulse
the dye was injected into the pulmonary artery by pressures in the dogs with mitral insufficiency.
a cardiac catheter, the pulmonary blood volume was The authors suggest that the contour, of the pulse
calculated. Good correlation without any systematic waves of the esophagus at the level of the left atrium,
error was found in the cardiac output determina- recorded with this technic, closely reflects that of the
tions with the Fick method and the Hamilton dye pressure pulses of the left atrium and that, within
method. The mean intrathoracic blood volume in limits, a pressure relationship of a quantitative na-
normal subjects was 1.8 L. i 0.28 L. (standard de- ture exists.
viation), with a mean index of 1.14 L./sq.m. ± MINTZ
0.18 L./sq.m.
A marked increase in intrathoracic blood volume Westcott, R. N., Fowler, N. 0., Scott, R. C., Hauen-
was found in the cases with left ventricular failure, stein, V. D., and McGuire, J.: Anoxia and Human
the mean being 2.7 L. i 0.5, the mean index being Pulmonary Vascular Resistance. J. Clin. Investi-
1.68 L./sq.m. i 0.35. After clinical improvement gation 30: 957 (Sept.), 1951.
the volume was only slightly decreased, being still The effect of anoxia (breathing 13 per cent oxygen
significantly higher than normal. In mitral stenosis in nitrogen) on the pulmonary vascular system was
during failure, only a slight increase in intrathoracic determined bv the authors in a group of 32 patients,
blood volume was found, being 2.1 L. ± 0.42 with 21 of whom had normal cardiovascular-pulmonary
an index of 1.33 L./sq.m. i 0.26. After clinical im- systems. The others had various cardiac and pul-
provement the volume was very slightly above the monary disorders. Anoxia led to an average rise of
normal values. The increase in intrathoracic blood 24.6 per cent in mean pulmonary artery pressure,
volume could not be accounted for by changes in but there was no change in pulmonary "capillary"
heart size studied roentgenologically. pressure. There was no significant alteration in car-
The authors conclude that the main increase in diac output as determined by the direct Fick method.
intrathoracic blood volume in left ventricular failure In 10 subjects, simultaneous measurements of pul-
occurs in the pulmonary vasculature, and that the monary artery and pulmonary "capillary" pressures
persistence of increased volume after clinical im- and cardiac output revealed that the pulmonary
provement may be due to residual increase in pul- arteriolar resistance increased significantly (48.5 per
monary blood volume. In mitral stenosis, on the cent) on breathing 13 per cent oxygen.
other hand, there was only a slight increase of circu- Minor changes were noted in brachial artery pres-
lating blood volume in the lungs during failure. Since sure and in total peripheral vascular resistance while
in both groups, reduction in cardiac output was the ballistocardiogram invariably became markedly
similar, the difference is best explained by changes abnormal during periods of anoxia.
in the pulmonary vasculature in mitral stenosis such The authors believe that the results indicate that
as the higher pulmonary arterial pressure, anatomic anoxia leads to an increase in pulmonary vascular
changes in the pulmonary arteries and branches, ac- resistance through vasoconstriction, although it is
tive pulmonary arteriolar constriction and, in some not known whether this constriction is mediated
cases, pulmonary embolic sequelae. through the autonomic nervous system or depends
ENSELBERG on a direct local effect.
WAIFE
Lasser, R. P., and Loewe, L.: Characteristic Pres- VASCULAR DISEASE
sure Pulses Recorded with an Esophageal Balloon
in Experimental Mitral Insufficiency in Dogs. Plaut, A.: Asymptomatic Focal Arteritis of the Ap-
Proc. Soc. Exper. Biol. & Med. 77: 798 (Aug.), pendix. Am. J. Path. 27: 247 (Mar.-Apr.), 1951.
1951. The writer has collected a series of 88 cases of
Pulsations in the esophagus at the level of the left necrotizing exudative arteritis of the appendix. The
atrium were simultaneously recorded by the authors small arteries and arterioles in the various coats are
in normal dogs and in the same animals following equally involved but the tip of the appendix shows
the production of mitral insufficiency. the greatest concentration of these lesions, which
An identifiable and consistent pattern was ob- are barely visible to the naked eye. Microscopically,
sive weakening in an inherited congenital malforma- at the periphery of the film and are more readily
tion of the aortic media. found in these films of platelet masses than in
BERNSTEIN buffy coat films.
BEIZER
Beresford, 0. D.: The Clinical Diagnosis of Dis-
secting Aneurysm of the Aorta. Brit. M. J. 4728: Lenegre, J., and Chevalier, H.: Preliminary Tech-
397 (Aug.), 1951. nical Note Concerning the Histologic Study of
Dissecting aneurysm is said to be found once in the Septum of the Heart. Arch. mal. coeur 44:
every 400 to 500 necropsies, but the true incidence 512 (June), 1951.
may be higher, as this does not include cases in The authors describe a new technic for micros-
which the process has healed. One in 10 cases re- copy of the conduction system. The whole intra-
covers and dies from other causes. About 80 per ventricular septum is prepared in a single block.
cent of cases occur in subjects over the age of 50. In contrast to previously used methods, it is ex-
In young subjects, the condition is associated with amined in longitudinal cuts proceeding anteriorally
pregnancy er with a congenital narrowing of the from its posterior part. The Tawara node and the
aorta. Sixty-five per cent of cases occur in males. His bundle and branches can be identified without
Hypertension is often present, but opinions differ difficulty by staining every twentieth, or even
about the exact frequency. In this series 5 of the fortieth, section out of 2000 to 3000, and the whole
11 cases had evidence of hypertension. It is con- conduction system can be studied in as few as 100
sidered that a radial pulse is absent in only 2.8 per to 200 microscopic slides.
cent of cases and a femoral pulse in only 7 per cent, PICK
but it seems probable that peripheral vascular dis-
turbances would be found much more often if all Lian, C., and Coblentz, B.: Venous Catheterization
accessible pulses were examined at frequent in- in the Course of Compression of the Superior
tervals. Vena Cava. Arch. mal. coeur 44: 634 (July),
It is important to stress that often a combination 1951.
of two or more syndromes will arouse suspicion of The authors present six examaples which demon-
the true diagnosis. Thus, in a case presenting as strate the diagnostic value of cardiac catheteriza-
coronary occlusion, the finding of diminished or tion in the compression syndrome of the superior
absent pulsation in a peripheral vessel should call vena cava. In three cases; normal pressures were
for a reconsideration of the diagnosis, as should obtained in the right auricle and in the lower part of
the finding of peripheral sensory loss in a case of the vessel, a sudden pressure elevation occurred
"perforated ulcer." Laboratory investigations are when the catheter was retracted to the level of the
not of much assistance in diagnosis, though electro- right clavicle, thus indicating a venous stenosis in
cardiography may exclude alternative cardiac diag- this region. In one case, in whom occlusion of the
noses. Nor is any active treatment likely to be of superior vena cava was suspected on clinical grounds,
use, and adequate sedation seems the most reason- the diagnosis had to be corrected to that of con-
able course. The average time of survival from the gestive right heart failure since pressure elevation
onset of symptoms is four to seven days. The oc- was also found in the right auricle and ventricle.
currence of a quiesent stage after a dramatic onset In two other subjects, failure to advance the cathe-
should not dissuade the physician from giving a ter beyond the right clavicle revealed the presence
guarded prognosis. of a venous occlusion in this region.
BERNSTEIN PICK
OTHER SUBJECTS Anderson, R.: Diodrast Studies of the Vertebral
Mathis, Hazel B.: A Simple Office Procedure for and Cranial Venous Systems to Show Their
Demonstrating Lupus Erythematosus Cells In Probable Role in Cerebral Metastases. J. Neuro-
Peripheral Blood. Blood 6: 470 (May), 1951. surg. 8: 411 (July), 1951.
A simple technic for the demonstration of lupus In a series of 1076 verified intracranial tumors,
erythematosus cells in venous blood is described. the author found the incidence of metastatic tumors
About 5 cc. of venous blood is placed in a sterile was 8.4 per cent. Since the brain is devoid of lym-
centrifuge tube containing 3 drops of liquid heparin. phatics, it is assumed that cerebral metastatic lesions
When sedimentation has occurred at room tempera- are blood-borne. In such lesions as carcinoma of the
ture, the supernatant plasma and the extreme upper- lung, the route of spread to the cerebrum is along
most level of the underlying cells are transferred the arterial tree. However, the spread of lesions
to a second sterile centrifuge tube and held for 45 from the caval system or portal system to the
minutes at 37.5 C. or two hours at room tempera- brain is not easily explained. In the absence of con-
ture. The incubated plasma is then centrifuged. genital cardiac lesions this blood-borne material
The sediment is smeared and stained with a Ro- could not bypass the pulmonary filter. Batson postu-
manowsky stain. L.E. cells are more readily found lated that the spread of carcinoma could occur by