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ABSTRACTS

Circulation 1952;5;941-956
Circulation is published by the American Heart Association. 7272 Greenville Avenue, Dallas, TX
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ISSN: 1524-4539

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ABSTRACTS
Editor: SAMUEL BELLET, M.D.
Abstracters
DAVD I. ABRAMSON, M.D., Chicago ALFRED PICK, M.D., Chicago
LAWRENCE H. BEIZER, M.D., Philadelphia SEYMOUR H. RINZLER, M.D., New York
ARTHuR BERNSTEIN, M.D., Newark FRANCIS F. ROSENBAUM, M.D., Milwaukee
RumH CORTELL. M.D., New York ELLIOT L. SAGALL, M.D., Boston
CHARLms D. ENSELBERG, M.D., New York DAVID SCHERF, M.D., New York
ALFRED FROBESE, M.D., Philadelphia PAUL SCHLESINGER, M.D., Rio de Janeiro, Brazil
BENJAMIN A. GOuLEY, M.D., Philadelphia JOHN B. SCHWEDEL, M.D., New York
RAYMOND HARRIS, M.D., Albany CHARLES R. SHUMAN, M.D., Philadelphia
HERMAN K. HELLERSTEIN, M.D., Cleveland FRANKLIN SIMON, M.D., Newark
J. RODERICK KITCHELL, M.D., Philadelphia Louis A. SOLOFF, M.D., Philadelphia
ALDO A. LUISADA, M.D., Chicago RALPH M. TANDOWSKY, M.D., Hollywood
M. PRICE MARGOLIES, M.D., Philadelphia S. 0. WAIFE, M.D., Philadelphia
S. S. MINTZ, M.D., Philadelphia MARTIN WENDKOS, M.D., Philadelphia
CARL S. NADLER, M.D., New Orleans STANFORD WESSLER, M.D., Boston
MORTON J. OPPENHEIMER, M.D., Philadelphia

BLOOD COAGULATION Circulating Anticoagulant. J. Lab. & Clin. Med


38: 254 (Aug.), 1951.
Stefanini, M.: Autocatalytic Formation of Thrombin A case is reported of a patient with subacute bac-
in Blood Coagulation. Acta med. scandinav. 140: terial endocarditis whose plasma contained an un-
290 (Aug.), 1951. usual anticoagulant. At 25 C., the clotting time of
The process of coagulation of the blood is divided the patient's blood was greatly prolonged, while at
into (1) a slow phase during which enough thrombin 37 C. it was usually within normal limits. Small
is formed to set the autocatalytic mechanisms in amounts of the patient's whole blood delayed the
motion, and (2) an accelerated phase in which clotting time of normal blood at 25 C. but not at
thrombin is formed in increasing amounts and at a 37 C. In the absence of the formed elements of the
progressively more rapid rate so that fibrinogen is blood, the circulating anticoagulant was active at
massively converted to fibrin. The autocatalysis both temperatures. It did not inhibit the action of
which is set in motion by the thrombin is thought thrombin nor did it appear to inactivate either
to be carried out by the aggregation and lysis of fibrinogen or prothrombin.
platelets by thrombin, with ever increasing activa- The fact that the formed elements of the blood
tion of thromboplastin and finally increased forma- were able to counteract the action of the anticoagu-
tion of thrombin, and the formation of a powerful lant at 37 C. was explained on the basis that at this
accelerator found in serum through the action of temperature there was a release of potent thrombo-
thrombin or plasma prothrombin conversion factor plastic material from such cells as the leukocytes
(PPCF) or other plasma precursors. Prothrombin, and platelets.
thromboplastin and calcium react then in the pres- ABRAMSON
ence of serum and platelet accelerator to form
thrombin in increasingly larger amounts. Finally Apul-Haj, S. K., Watson, J., Rinehart, J. F. and
enough thrombin is formed to clot enough fibrinogen Page, E. W.: The Thromboplastic Activity of
to assure the formation of a solid clot. Hyaluronate. Science 114: 237 (Aug. 31), 1951.
The author believes that in order to prevent this Hyaluronate, a mucopolysaccharide, was investi-
chain reaction mechanism from excessive extension gated with regard to a possible thromboplastic ac-
of the thrombus along the vascular tree, there must tivity. It was found that the material had a greater
exist a control mechanism. This is considered to effect on the coagulation time than that produced by
consist primarily of the adsorption of the thrombin an equivalent amount of beef lung thromboplastin.
on the fibrin clot and its gradual neutralization by Similar results were obtained when hyaluronate was
natural antithrombin as the thrombin is slowly re- tested against brain thromboplastin in the one-stage
leased at the time of retraction of the clot. prothrombin method. It was further noted that
ROSENBAUM calcium was essential for hyaluronate activiy and
that the rate of prothrombin conversion was con-
Mueller, J. F., Ratnoff, 0., and Heinle, R. W.: Ob. siderably increased by the presence of the accelerator
servations on the Characteristics of an Unusual factor.
941 Circulation, Volume V, June 1952

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942 ABSTRACTS
The authors conclude that sulfate-free hyaluron- exceed those found in the systemic circulation. The
ate, as it occurs naturally in the body, perhaps in pressure in the pulmonary artery may be normal in
combination with a protein, is an active thrombo- the trilogy but is always low in the tetralogy. The
plastic agent, this function being related to its intraventricular shunt in the tetralogy is large and
viscosity. Unlike tissue extracts, its activity is predominantly right to left, and is effected mainly
destroyed by hyaluronidase or by any physical pro- through the intraventricular defect and, less fre-
cedure resulting in depolymerization. quently, over the over-riding aorta. Consequently,
ABRAMSON the systemic output is high, while the pulmonary
flow is decreased. In the trilogy, a right to left shunt
Duff, I. F., Linman, J. W., and Birch, R.: The Ad- occurs in the auricles through the communication in
ministration of Heparin. Surg., Gynec. & Obst. the septum and both systemic and pulmonary flow
93: 343 (Sept.) 1951. are usually low. The amount of shunted blood in
The authors review the indications and contra- cyanotic instances of trilogy does not exceed 50 per
indications for the use of heparin and compare the cent of the systemic flow and may decrease on
reactions to this drug with those obtained with exercise in cases without cyanosis.
dicumarol. In a third of cases with tetralogy and in more
Heparin should be used with caution, if at all, in than half of the trilogies, it was not possible to prove
the presence of threatened abortions, potential the communication between the right and left cavi-
hemorrhagic diathesis, increased capillary fragility, ties by cardiac catheterization. On the other hand,
suspected intracranial hemorrhage, and actual or the diagnosis of an over-riding aorta depends en-
potential bleeding from inaccessible ulcerative tirely on the latter procedure, that is, insertion of
lesions, particularly of the gastrointestinal tract. the catheter into the aortic lumen. The angiocardio-
With caution, it may sometimes be employed when graphic signs are not conclusive, since early filling of
dicumarol is contraindicated, as for example, in ad- the vessel may also be seen in the presence of an
vanced age, severe liver disease, congestive heart interatrial septal defect.
failure, severe alkalosis or acidosis, and in the nursing PICK
mother. It should also be used in preference to
dicumarol when adequate laboratory facilities are Joly, Fr., Carlotti, J., and Sicot, J. R.: Intraventricu-
not available for daily prothrombin determinations. lar Communications (Diagnosis by Catheteriza-
Furthermore, in the full evaluation of the relative tion). Clinical and Physiologic Study. Arch. mal.
worth of the two drugs, it must be considered that coeur 44: 602 (July), 1951.
the incidence of bleeding associated with heparin is The authors studied 21 cases with intraventricular
considerably less than with dicumarol. septal defect, all proved by cardiac catheterization
The effect of heparin on the clotting time is and two by autopsy. The subjects were divided into
measured by the simple Lee-White test, and ade- three groups according to clinical, roentgenologic
quate therapeutic effect being prolongation of the and electrocardiographic findings. The first group,
time to twice the pretreatment figure. Mhen the with the typical murmur, a heart of normal size and
drug is given intravenously in full strength the test without axis deviation in the electrocardiogram, was
can be omitted. However, when depository heparin considered to represent the classical Roger's disease.
is used, appropriately spaced clotting time determi- In a second group, the murmur was found some-
nations should be done. times at a higher level than usual or was absent. The
ABRAMSON heart was enlarged with expansive pulsations of the
pulmonary arterial tree and the electrocardiogram
CONGENITAL ANOMALIES showed right axis deviation or right bundle branch
Soull6, P., Joly,
F. Carlotti, J., and Sicot, J.-R.: A block. The authors termed these cases intraventricu-
Comparative Study of the Hemodynamics in Te- lar communications with dilatation of the pulmonary
tralogy and Trilogy of Fallot. (A Study of 43 artery. The third group, roentgenologically similar
Cases). Arch. mal. coeur 44: 577 (July), 1951. to the second, but with the acoustic phenomena
The clinical symptomatology of Fallot's trilogy similar to that of patent ductus arteriosus and with
(pulmonic stenosis with interatrial septal defect) and an electrocardiogram of "combined heart strain,"
the classic tetralogy are similar and their distinction was considered to be complicated by aortic regurgita-
difficult. In order to establish differential diagnostic tion. Angiocardiography revealed delayed opacifica-
criteria, the authors studied 22 cases of tetralogy and tion of the aorta in all three groups. With cardiac
21 cases of trilogy by cardiac catheterization and catheterization, the pulmonary pressure was found
angiocardiography. normal in Roger's type and was elevated in the two
A constant finding in common cases of tetralogy other groups. A large left to right shunt could be
is an equal pressure in the right ventricle and in the demonstrated in most cases, and represented 25 to
aorta. In the trilogy, the principal and almost 50 per cent of the total pulmonary flow. The pe-
pathognomonic sign is marked hypertension within ripheral arterial saturation, as evidence of right to
the right ventricle. with systolic values which may left shunt, was only slightly decreased even in "old"

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ABSTRACTS 943
cases and in cases with signs of marked increase in closing ductus arteriosus. All three died of left ven-
resistance of the pulmonary circulation. tricular failure which was probably secondary to the
The authors emphasize the difficulties in differ- obstructive hypertension. At autopsy it was found
entiating some cases of intraventricular septal defect that the collateral channels were poorly developed.
from other types of congenital malformation with It is pointed out that the development of collateral
similar symptomatology. Laminar flow and incom- channels depends on the relation of the coarctation
plete mixture of the blood, shunted from a left to a to the opening of the ductus arteriosus. The left
right cavity, may obscure the actual localization of ventricular output supplies the great vessels arising
the intracardiac communication. Thus, an intra- from the aortic arch in the normal fetus. The right
ventricular septal defect, associated with an enlarged ventricle, through the ductus arteriosus, supplies the
pulmonary artery, may easily be mistaken for an major portion of the blood in the descending aorta.
intra-atrial septal defect; a patent ductus arteriosus However, when there is a coarctation below the
or for Eisenmenger's complex without cyanosis. aortic mouth of the ductus arteriosus, both the left
PICK and right ventricles supply blood to the aorta proxi-
mal to the coarctation, and blood to the descending
Emery, J. L., and Illingworth, R. S.: Congenital aorta arrives via collateral channels. If this did not
Mitral Stenosis. Arch. Dis. Childhood 26: 304 take place there would be an insufficient blood supply
(Aug.), 1951. to the placenta and the fetus would probably die
Two cases of congenital mitral stenosis in infants prior to term. The authors, therefore, conclude that
3 and 1 2 years of age are presented by the authors. in coarctation distal to the ductus arteriosus, col-
One was treated for four months as a right basal lateral circulation develops during fetal life and in
pleural effusion and had no cardiac murmurs at any such individuals the closure of the ductus after
stage. The clinical diagnosis was then changed to one birth has no effect on the circulation. However,
of congestive heart failure of unknown etiology. The when the coarctation is proximal to the ductus, the
second presented bronchopneumonia superim- same type of blood flow distribution takes place as in
posed on congestive heart failure and the character- the normal fetus, and a collateral circulation does not
istic murmur was found. Death in each case was due develop prior to birth. With the coarctation at the
to congestive heart failure. The lesions in the heart level of the ductus arteriosus the authors believe that
appeared to be congenital in origin and due to ab- the development of collaterals depends on the di-
normal development after the cavities of the heart rection of blood flow on leaving the ductus. With a
had been fully formed. No evidence of fetal endo- flow directed proximal to the coarctation, collaterals
carditis or of a rheumatic process could be found. are believed to develop, but when the flow goes into
BERNSTEIN the descending aorta, an adequate collateral circu-
lation does not develop, as in the three reported
Adams, F. H., and Cunningham, S. C.: Fragility of cases.
Red Blood Cells from Newborn Infants and Chil- MARGOLIES
dren with Cyanotic Congenital Heart Disease.
Pediat. 39: 180 (Aug.), 1951. Scott, H. W., Jr., Elliot, S. R., II, and Clay, R. C.:
Using the spectrophotometric technic, the authors Blood Volume in Congenital Cyanotic Heart Dis-
studied the red blood cell fragility in newborn ease: Simultaneous Measurements with Evans
infants and in children with cyanotic congenital heart Blue and Radioactive Phosphorus. Bull. Johns
disease. The arterial oxygen saturations of the Hopkins Hosp. 89: 121 (Aug.), 1951.
children with congenital heart disease ranged from With the combined use of the Evans blue dye
15 to 75 per cent. The blood from the majority of the method for measuring plasma volume and the radio-
subjects with congenital heart disease had a slightly active phosphorus method for direct measurement of
greater fragility than the normal controls. The red cell volume or whole blood volume, the authors
erythrocytes from the cyanotic patients were oxy- studied 20 patients having congenital cyanotic heart
genated but the fragility of the cells was still greater disease and five noncyanotic convalescent adults.
than the normal controls. Cord blood from the new- The patients with congenital heart disease had
born was tested in a similar manner. An occasional polycythemia and cyanosis due to a right to left
specimen showed a slight increase in fragility. A intracardiac shunt with a diminished effective pulmo-
marked spontaneous hemolysis of oxalated fetal nary blood flow. Studies revealed that these patients
blood was not observed by the authors. had a diminished plasma volume, an increased red
MARGOLIES cell volume and an elevated whole blood volume
when compared with the noncyanotic group. Meas-
Bahn, R. C., Edwards, J. W., and DuShane, J. W.: urements done simultaneously with Evans blue and
Coarctation of the Aorta as a Cause of Death in radiophosphorus in the 20 cyanotic patients showed
Early Infancy. Pediatrics 8: 192 (Aug.), 1951. the plasma volume to be reduced below normal by
The authors report on three cases of coarctation of both the direct and the indirect methods. No studies
the aorta in infancy at the level of the closed or were done on infants with congenital heart disease.

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944 ABSTRACTS

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

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ABSTRACTS 945
Agress, C. M., Rosenburg, M. J., Binder, M. J., monic valve. In normal hearts, the tall delayed R as
Schneiderman, A., and Clark, W. G.: Blood seen in right ventricular hypertrophy was not pres-
Volume Changes in Protracted Shock Resulting ent. The authors postulate that the recorded posi-
from Experimental Myocardial Infarction. Am. J. tivity (rsR's') above the pulmonic valve reflects the
Physiol. 166: 603 (Sept.), 1951. predominant potential of the hypertrophied right
Myocardial infarction was produced in open-chest ventricle. In right ventricular hypertrophy, this po-
dogs by embolization of the coronary arteries with tential may be reflected to the left arm, because of
plastic beads in methyl cellulose. Approximately 3 to elevation and displacement of the pulmonary artery
5 mg. per Kg. of beads produced widespread sub- to the left secondary to hypertrophy. The reflection
lethal infarction. Evans blue (T-1824) blood volume of this potential to the left arm (VL) results in left
studies carried out up to five hours showed a reduc- axis deviation. The variability of the electrocardi-
tion in blood volume of 20 per cent over those of a ographic findings in these patients with right ventric-
control group. ular hypertrophy indicates that rotation and cardiac
OPPENHEIMER position are more important than chamber hyper-
trophy alone in the determination of the extremity
Sayj en, J. J., Sheldon, W. F., Horwitz, 0., Kuo, potentials and hence, the axis deviation.
P. T., Peirce, G., Zinsser, H. F., and Mead, J., HELLERSTEIN
Jr.: Studies of Coronary Disease in the Experi-
mental Animal. II. Polarographic Determinations Zatuchni, J.: The Electrocardiogram in Pregnancy
of Local Oxygen Availability in the Dog's Left and the Puerperium. Am. Heart J. 42: 11 (July),
Ventricle during Coronary Occlusion and Pure 1951.
Oxygen Breathing. J. Clin. Investigation 30: 932 The author studied 25 normal patients with un-
(Sept.), 1951. complicated pregnancy, delivery and postpartum
The availability of oxygen in ischemic tissue of the course, with the purpose of defining the position
dog's heart following coronary artery ligation was changes in terms of the mean electrical axis of the
determined by a polarographic technic described by QRS and the electrocardiographic position, and, sec-
the authors. Platinum electrodes are inserted into the ond, to determine whether there was any evidence of
myocardium of the exposed heart. Subsequent de- ventricular hypertrophy. Unipolar electrocardio-
termination of the precise location of the electrodes grams were obtained on an average of 14 days before
shows a differentiation into three zones. (1) A "cen- delivery, 11 hours after delivery, and also two to five
tral" area which shows a rapid decrease in available days later. With advancing pregnancy, the mean
oxygen to less than a quarter of the control period electrical axis shifted to the left until the latter part
values within a few minutes following ligation. The of the third trimester, when it usually shifted toward
administration of pure oxygen by inhalation during the right. The shift to the right continued after de-
coronary occlusion had no significant effect on the livery. The change in the mean electrical axis was
local oxygen availability in this area. (2) A "border" more pronounced than in the electrocardiographic
area which resembles the central area but shows a position as defined by Wilson and associates. The
significant rise in local oxygen availability during major positional change of the heart during preg-
oxygen breathing before termination of the occlu- nancy and the puerperium is rotation around its an-
sion. This supports the indication for inhalation of teroposterior axis. There were no electrocardio-
high oxygen concentrations in human myocardial graphic manifestations of ventricular hypertrophy
infarction. (3) An "outside" area which shows no or "strain."
significant change on occlusion. HELLERSTEIN
W\AIFE
ELECTROCARDIOGRAPHY Evans, E., and Pohiman, L.: Complete Heart Block
in Pregnant Women. Am. Heart J. 42: 18 (July),
Kroop, I. G., Steinberg, M. F., and Grishman, A.: 1951.
The Nature of Left Axis Deviation in Congenital The authors present a case report of a pregnant 18
Cardiac Defects with Right Ventricular Hyper- year old woman with complete heart block, probably
trophy. Am. Heart J. 41: 891 (June), 1951. congenital, and an interventricular septal defect. In
The authors present electrocardiographic findings the year before, the patient had completed her sec-
in three cases of interatrial septal defect with left ond pregnancy uneventfully. In the sixth week of her
axis deviation in the presence of right ventricular third pregnancy, hysterotomy and sterilization were
hypertrophy. Intrapulmonary artery potentials
above the pulmonic valve were recorded by means of performed because of the development of increased
cardiac catheterization in these three patients, in dyspnea on exertion, progressive enlargement of the
two patients with tetralogy of Fallot, and in three heart, and primary T-wave changes in the electro-
patients with pulmonary heart disease. In patients cardiogram. The authors reviewed the literature and
with right ventricular hypertrophy, congenital and found 25 acceptable cases of complete heart block
acquired, a characteristic rsR's' complex was re- pregnancy. These patients survived pregnancy and
corded in the pulmonary artery just above the pul- fetal death was apparently rare. Termination of

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946 ABSTRACTS

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

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ABSTRACTS 947
in patients with antecedent heart disease. The hemo- a fixed arithmetic value. The fact that K is not an
globin level was a good guide to the severity of the arithmetic constant does not prevent it from having
electrocardiographic changes, although there were considerable value. If the value of K and its trend
some exceptions. The electrocardiographic changes is known, they may be of use in determining whether
either preceded or followed the hemodynamic the myocardium is improving or deteriorating. Both
changes, the latter being more common. Clinical rate and duration of systole are determined by a
signs of coronary insufficiency (precordial or sub- common fundamental condition of heart cells. Q-T
sternal pain) occurred in eight cases only. Signs of or K and rate need not always change in a propor-
congestive heart failure were exhibited in five pa- tional manner or in the same direction. Strain raises
tients, three of whom had antecedent severe heart K values above those expected at a given heart rate
disease. Postmortem examination was performed in and increases in strain give still higher K values. In
four cases, and in no instance was there evidence the agonal period, K decreases abruptly. The author
found of recent subendocardial necrosis. is of the opinion that knowledge of K, compared with
The authors believe that the electrocardiographic the expected value at any cycle length, gives more
changes following hemorrhage are due to an intrin- information than the Q-T measurement alone.
sic change in the myocardium as a result of myo- OPPENHEIMER
cardial ischemia and anoxia, mainly of the deep
layers. The authors stress the importance of prompt ENDOCRINE EFFECTS ON
treatment of hemorrhage in patients with coronary CIRCULATION
or hypertensive heart disease.
HELLERSTEIN Blumgart, H. L., Friedberg, A. S., and Kurland, G.
S.: Treatment of Incapacitated Euthyroid Cardiac
Segers, M.: Auriculoventricular Synchronization and Patients by Producing Hypothyroidism with
the Wolff-Parkinson-White Syndrome. Arch. mal. Radioactive Iodine. New England J. Med. 245:
coeur 44: 712 (Aug.), 1951. 83 (July), 1951.
The author presents clinical and experimental ob- The results of radioactive iodine therapy in 37
servations, which in his opinion support the concept euthyroid patients with incapacitating chronic car-
of a hyperexcitable ventricular focus in the explana- diac disease are reported by the authors. In 26 pa-
tion of the Wolff-Parkinson-White syndrome. An tients with angina pectoris, the results were excellent
electrocardiogram is shown with alternation of nor- in seven, worthwhile in four, and not worthwhile in
mal and anomalous conduction, in which ventricular six. The follow-up period had been too brief for final
premature beats had the same contour as the Wolff- clinical evaluation in the remaining nine. Of the 11
Parkinson-White complexes. Corresponding observa- patients with congestive failure, worthwhile im-
tions were made in an experiment, in which a small provement was evident in four, unsatisfactory re-
area of the right ventricle of a rabbit was injected sults in two, and a too brief period for evaluation in
with strychnine. This was followed first by a period five cases. The authors feel that the over-all surgical
during which normal ventricular activation alter- mortality and the parathyroid and laryngeal com-
nated with pre-excitation, and then by an idioven- plications militate against total thyroidectomy. The
tricular rhythm with ventricular complexes of the thiourea drugs are too irregular in action, they must
Wolff-Parkinson-White type. be given for life and dangerous reactions may result
In view of these observations and of previously from their use.
described experiments, in which he demonstrated Although final indications and contraindications
synchronization of rhythm of independent turtle to radioactive iodine treatment have not been formu-
hearts, being only in mechanical contact, the author lated, the authors include as unfavorable factors (a)
believes that an accessory pathway between auricles rapidly progressive cardiovascular disease, including
and ventricles need not be implied to explain the individuals in the terminal phases of their illness,
ventricular pre-excitation in the Wolff-Parkinson- (b) a basal metabolic rate of -15 per cent or lower,
White syndrome. In the presence of a hyperexcit- and (c) some associated conditions including rheu-
able focus in one of the ventricles, pre-excitation of matic fever, bronchiectasis, emotional instability,
the latter by the auricles may occur by mechanical atrophic cirrhosis, recent myocardial infarction and
or electrical stimulation, without any anatomic con- intermittent claudication. Patients who seem likely
nection between the twvo chambers. to benefit are those whose disease has been relatively
PICK stationary for one or more years, or who show evi-
Robb, J. S.: Study of Bazett's K in Animals. Am J. dence of appreciable cardiac reserve such as an
Physiol. 166: 584 (Sept.), 1951. ability to lose the signs of congestive failure, and per-
The author measured Q-T and cycle duration in sons who are tense and hyperactive. Approximately
eight species of animals and showed that Bazett's two-thirds of the patients developed mild to mod-
K(Q-T = K\/cvcle) may not be considered to be erate transient thyroiditis. Management of the in-
"Q-T corrected for heart rate," as K does not have duced myxedema consists of maintaining the lowest

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948 ABSTRACTS
metabolic rate consistent with the patient's comfort HYPERTENSION
by administration of small doses of thyroid. Davis, L., Tarkington, J., and Anderson, R. K.:
ROSENBAUM Physiologic Principles Underlying the Treatment
of High Diastolic Hypertension by the Thiocy-
Govier, W. M., and Feenstra, E. S.: The Effect of anates and Sympathectomy. Ann. Surg. 133: 867
Certain Hormones and Miscellaneous Compounds (June), 1951.
on Serum Disease In the Rabbit. Am. Heart J. The effect of thiocyanate therapy was studied by
42: 266 (Aug.), 1951. the authors in a series of dogs made hypertensive
Vascular disease was produced by the injection of with the Goldblatt clamp. A depletion of lipid gran-
horse serum in 229 rabbits and the effects of nitrogen ules was noted in the three layers of the adrenal
mustard, various hormones and miscellaneous sub- cortex, most marked in the zona glomerulosa. On
stances, believed to be concerned in allergic phe- withdrawal of the medication, there was a reappear-
nomena and cell-wall integrity, were studied by the ance of these granules. Bilateral thoracolumbar sym-
authors. Nitrogen mustard was not effective. pathectomy seemed to increase the effect produced
Adrenal cortical extract, ACTH and 17-OH-corti- by thiocyanate therapy.
costerone were most effective in the prevention of It was concluded that a combination of a reduc-
lesions. Testosterone, thiamine triphosphate, and tion in adrenal cortical function by sympathetic de-
penicillin G (the latter in high dosage) were mod- nervation of the adrenal medulla and depletion of
erately effective. Tripelennamine, atropine, procaine, the lipids of the adrenal cortex by thiocyanates would
and sodium allyl mercaptoacetate (the precursor of result in a more effective lowering of blood pressure
penicillin 0) did not prevent lesions. than could be accomplished by either procedure
HELLERSTEIN alone.
ABRAMSON
Teilum, G., Engbaek, H. C., Harboe, N., and Simon-
sen, M.: Effects of Cortisone on Experimental Holley, H. L., Elliott, H. C., Jr., and Holland, C. M.,
Glomerulonephritis. J. Clin. Path. 4: 301 (Aug.), Jr.: Serum Sodium Values in Essential Hyper-
1951. tension. Proc. Soc. Exper. Biol. and Med. 77: 561
White rabbits of the same strain were immunized (July), 1951.
with a formaldehyde-killed Pfeiffer bacillus culture A series of serum sodium determinations were
administered in intravenous injections three times made on 75 hypertensive patients and on 400 normo-
weekly. The eight animals immunized for 7 to 16 tensive individuals. The results obtained revealed a
months showed severe albuminuria. On biopsy of the statistically significant rise in the serum sodium of
renal tissue from the left upper pole of the kidney at the hypertensive patients. The authors avoided any
laparotomy, five of these animals showed marked conclusions of their results. One might be tempted to
glomerular changes comparable with the natural dis- conclude that these findings support the concept of
ease (Ellis's type 1 and type 2 nephritis). Type 1 adrenal participation in the production of the hyper-
nephritis was characterized by proliferation of endo- tensive syndrome and this might offer a basis for the
thelial and epithelial cells of the tufts and also pro- restriction of sodium in the treatment of hyperten-
liferation of extracapsular mesenchymal cells. The sion. The authors believe that until the significance
proliferating cells display pronounced pyroninophilia of these findings is more clearly understood, it may
(with Unna-Pappenheim's methyl green-pyronine perhaps be better to avoid any definite conclusions
stain). In type 2 nephritis, the glomeruli are ex- as to their therapeutic or etiologic concepts.
tremely poor in cells, with large deposits of a homo- MINTZ
geneous substance in massive lumps.
The aforementioned five rabbits were administered Perera, G. A.: Altered Metabolic Response Prior to
cortisone hypodermically in daily doses of 20 mg. It the Development of Hypertensive Vascular Dis-
was begun five days after the first operation and was ease. Am. Heart H. 42: 308 (Aug.), 1951.
given in series of six days' duration interrupted by The author presents a case report of a 27 year old
one day on which another biopsy of the kidney was woman with a normal blood pressure who exhibited
made. This was continued until the animal died. In a pressor response to desoxycorticosterone and failed
rabbits showing type 1 glomerulonephritis, cortisone to lose weight during rigid salt restriction for 24
caused a marked regression of pyroninophilic cells in- hours. Such responses were observed before by the
side and outside the glomeruli, and promoted a tran- author, only in hypertensive patients. Three months
sition to homogeneous precipitates in the tufts and later, the patient developed hypertension. Since the
approached the picture of type 2 nephritis. In the increase in arterial tension following desoxycorti-
case comparable to type 2 nephritis, further masses costerone and failure to lose weight under the stimu-
of homogeneous precipitates were accumulated in lus of rigid salt restriction occurred prior to the ap-
the tufts, whereas the cellular areas decreased. The pearance of elevation of the blood pressure, the
histologic picture suggested amyloid nephrosis. author suggests that perhaps an altered metabolic
RINZLER response may exist before the development of hy-

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ABSTRACTS 949
pertension. Further search is warranted for a met- McDowell, F. H., and Plum, F.: Arterial Hyperten-
abolic factor long in advance of the first signs of sion Associated with Acute Anterior Poliomyelitis.
overt disease. New England J. Med. 245: 241 (Aug. 16), 1951.
HELLERSTEIN The authors observed 95 patients with acute or
subacute poliomyelitis. Hypertension was considered
Hetzel, B. S.: Some Aspects of the Natural History present if the diastolic blood pressure seas over 90
of Hypertensive Vascular Disease. M. J. Aus- mm. Hg for more than 12 hours. Arterial hyperten-
tralia 2: 22 (Aug.), 1951. sion developed in 45 patients. It was observed twice
The clinical features of a series of 203 patients as frequently in males as in females. The hyperten-
with hypertension are reviewed by the authors. The sion was of greater degree and longer duration in pa-
known causes of hypertension accounted for only 11 tients needing artificial respiration. The possibility
per cent of the cases. "Essential" hypertension com- of the deleterious effect of body or tank-type respira-
prised 89 per cent of the cases in the series. In men, tors was considered by the authors, but hypertension
obsessional compulsive personality traits were found was also observed in one patient treated with a rapid-
in 50 per cent. There was little evidence of obesity or rocking bed. The greatest incidence of hypertension
endocrine disturbance. Family history was positive was in those patients suffering bulbospinal paralysis
in only 19 per cent. In women, a history of toxemia or paralysis of all four extremities. Ten of the hyper-
of pregnancy occurred in 53 per cent of those who tensive respiratory patients still had hypertension 3
were parous, and in 83 per cent of these cases the to 12 months after the onset of their acute illness.
hypertension dated from pregnancy. Evidence of The hypertension is considered to be the result of
compulsive personality traits was present in 50 per invasion of the brain-stem autonomic structures or a
cent. A "positive" family history was present in 43 manifestation of a generalized alarm reaction. Anox-
per cent. emia, hypercapnia or artificial respiration seemed to
The course of a case of hypertension is determined intensify or prolong the otherwise transient hyper-
by the development of hypertensive vascular dis- tensive state.
ease, which is characterized by diffuse arteriolar dis- ROSENBAUM
ease. "Primary" hypertension which is clinically sig-
nificant appears by the age of 50 years, the blood Handler, P., and Bernheim, F.: Effects of Caloric
pressure reading being at least 180 mm. Hg (systolic) Restriction, Salt Restriction, and Role of Pituitary
and 120 mm. (diastolic). and Adrenal Glands in Experimental Renal Hy-
In "primary" hypertension, the course is more pertension. Am. J. Physiol. 166: 528 (Sept.), 1951.
rapid in men than in women. In women, the course A low protein diet may impair synthesis or secre-
is more rapid in those who have had an episode of tion of ACTH. Rats with subtotal nephrectomies
toxemia of pregnancy. have their blood pressure returned to normal by a
The condition termed malignant hypertension is low protein diet and small amounts of ACTH will
the most advanced stage of hypertensive vascular elevate it again. These authors investigated the in-
disease. It is indicated clinically by diffuse retinal fluence of salt and water restriction and the role of
edema called "papilledema", which is not produced pituitary and adrenal function in the hypertension
by increased intracranial pressure but by vascular of subtotal nephrectomy. Wlhen using circulating
damage. This complication is especially frequent in eosinophils as an index of ACTH secretion, the re-
renal hypertension and is responsible for its bad striction of protein, salt, calories, or choline all gave
prognosis. indication of decreased pituitary elaboration or se-
BERNSTEIN cretion. Since exposure to cold was still able to
restore the hypertension after hypophysectomy or a
Hellerstein, H. K., Orbison, J. L., Rodbard, S., Wil- low protein regime in partially nephrectomized rats,
burne, M., and Katz, L. N.: The Effect of Rutin the authors suggest that neurogenic factors may be
in Experimental Malignant Hypertension. Am. operative. Since eosinopenia was observed at the
Heart J. 42: 271 (Aug.), 1951. same time, the adrenal cortex is probably controlled
The authors produced fulminating hypertension by factors other than ACTH under these circum-
in 16 dogs by bilateral renal artery constriction. stances. Hyperthyroidism and dinitrophenol both
Rutin (220 mg.) prevented the characteristic hemor- elevate blood pressure in partially nephrectomized
rhagic phenomena when administered subcutane- rats maintained on a low protein diet. In similar
ously 10 days before renal artery ligation and during animals, cortisone effects were more marked than
the postoperative period. Both control and treated DCA effects. ACTH (1 mg. on two successive days,
dogs developed equally severe uremia and the sur- subcutaneously) produced an immediate rise in blood
vival time was not altered. The protective action of pressure in bilaterally nephrectomized rats to levels
rutin is thought to be due to its stabilizing effect on like those in subtotally nephrectomized rats on a.
the ground substance of arterioles and of the peri- normal protein intake. From these results, it is con-
capillary sheath. cluded that the effects of cortisone and ACTH on
HELLERSTEIN subtotally nephrectomized rats do not depend en-

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950 ABSTRACTS

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

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ABSTRACTS 951
of the cardiac output, oxygen consumption, blood the pulmonary arteries. It will be seen that the de-
oxygen levels, femoral artery pressure and the right gree of anoxemia and the height of the pulmonary
ventricular pressure. All five patients had marked arterial pressure varied considerably in different in-
elevation in the pulmonary artery pressure and pul- dividuals. One finding bore no real relationship to
monary resistance was markedly increased. The the other. The results, the authors believe, suggest
pulmonary diastolic pressures ranged from 100 to that there is no constant relationship between pul-
500 per cent above normal. These findings are the monary pressure, anoxemia and the ratio of the
same as those found in cor pulmonale from other residual air to the total capacity of the lungs.
causes. BERNSTEIN
It is not known why patients with thoracoplasty
may develop cor pulmonale. This can occur even Kjellberg, S. R., and Rudhe, U.: Electrokymography
though the contralateral lung is free of disease. of the Pulmonary Artery in Cases of Pulmonary
FROBESE Stenosis. Acta radiol. 36: 133 (Aug.), 1951.
The authors stress the similarity between the
Wilson, Vernon H.: Serial Femoral Arterial and electrokymographic tracings in the post-stenotic por-
Venous Blood Oxygen Studies in Anoxaemic Pa- tions of the aorta in coarctation and the pulmonary
tients with Widespread Respiratory Disease artery in pulmonic stenosis. The pattern, in eight
Whilst Breathing Atmospheric Air and During cases of pulmonic stenosis, shows a slowly rising up-
Oxygen Administration. South African J. M. Sc., ward deflection in systole which is, at times, asso-
16: 15 (July), 1951. ciated with an anacrotic notch and a partial reduc-
The author demonstrated, by serial blood oxygen tion or even the complete absence of the incisura on
studies, that femoral arterial and venous blood oxy- the descending limb at the time of closure of the
gen saturations were raised during oxygen admin- pulmonic valve or shortly thereafter. Of the three
istration in patients with widespread respiratory case reports furnished, simultaneous ventricular pres-
disease and central cyanosis. The method of oxygen sure and electrokymographic curves were obtained
administration used was by nasal catheters at slow in one.
rates of oxygen flow. Twenty patients were studied. SCIIWEDEL
The subjects for study were chosen from patients
with central cyanosis due to widespread respiratory Greenfield, A. D. M., Shepherd, J. T., and Whelan,
disease in the medical and surgical wards. R. F.: The Part Played by the Nervous System in
Oxygen administered by nasal catheters (Tudor the Response to Cold of the Circulation through
Edwards Spectacles 1938), at slow rates of oxygen the Finger Tip. Clin. Sc. 10: 347 (Aug.), 1951.
flow, elevated the femoral arterial and venous blood Studies of the response to cold were made on nor-
oxygen saturation in the patients with widespread mal subjects and on patients with sympathectomy
respiratory disease and central cyanosis, and cor- and with peripheral nerve section. A calorimetric
rected anoxemia in the majority of cases. The three method was used for estimation of heat loss from the
patients, whose femoral arterial oxygen saturation finger tip. In normal subjects the index fingers of
failed to rise above eighty per cent after oxygen ad- both hands responded during the early period of ex-
ministration, differed from the other patients in hav- posure to cold with symmetrical vasodilatation. Af-
ing gross lobar absorption collapse, in addition to ter blocking the ulnar nerve, cold vasodilatation was
widespread bronchopneumonia in the rest of the unimpaired. Cold vasodilatation occurred in the
lungs. Oxygen administration had a variable effect sympathectomized patients, and in the early days,
on the femoral arteriovenous blood oxygen difference. after traumatic nerve section. In the cases of periph-
Only one of the 20 patients showed clinical evidence eral nerve section, tested after a sufficient time
of oxygen want while breathing atmospheric air. for nerve fiber degeneration to occur, only a small
BERNSTEIN response was found. However the response could be
increased in every case by preliminary warming.
Gilroy, J. C., and Wilson, Vernon H.: On the Rela- The authors agree with previously reported work
tionship of Pulmonary Hypertension to Anoxaemia that cold vasodilatation does not depend upon the
in Cases of Respiratory Disease with Cor Pul- integrity of the sympathetic nervous system. They
monale. South African J. M. Sc. 16: 1 (July), reconcile conflicting views of the dependence of the
1951.
The authors chose the subjects for study from pa- response to cold upon the integrity of somatic sen-
tients admitted to the medical wards with wide- sory nerves by emphasizing that although cold vaso-
spread respiratory disease, central cyanosis and sys- dilatation is greatly reduced in the denervated
temic venous engorgement of varying severity. At finger, it is nevertheless present. While the response
the time of the investigation, three of the patients can take place in the absence of a local axon reflex
were convalescent and, therefore, serve as a com- pathway, it is much greater when the nerves are
parison to the remaining 13 patients who were still intact.
suffering from their disease during catheterization of ENSELBERG

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952 ABSTRACTS

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,

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ABSTRACTS 953
these vessels show focal necrosis in their walls, de- stressed, as was the value of radiography as an aid
struction of the elastic lamellas, fibrinoid degenera- to diagnosis.
tion of the media, infiltration of monocytes, poly- Three cases which appeared to be gastrointestinal
morphonuclear leukocytes and eosinophils. While hemorrhage were described, as well as one case in
necrotic material fills the lumens of many of the which the aneurysm eroded into the spine, transect-
involved vessels, there is no thrombosis, no aneurysm ing the cord.
formation, and no infarction. BERNSTEIN
The author stresses the fact that focal arteritis
of the appendix is not related to periarteritis nodosa Firstbrook, J. B.: The Newer Knowledge of Athero.
and that microscopic discovery of such a lesion sclerosis. Brit. M. J. 4724: 133 (July), 1951.
should cause no fear of the possibility of the latter On the basis of present evidence, it would seem
condition. It is unique in that it occurs only in the that the initiating cause of experimental athero-
appendix. It probably plays little or no role in the -sclerosis is the administration of cholesterol. How-
development of appendicitis. ever, because of the operation of modifying factors,
GOULEY not all animals receiving the same amount of cho-
lesterol for the same length of time develop the
Duomarco, J., Rimini, R., Sapriza, J. P., and Sur- same degree of lesions. In the first place, there is a
raco, G. H.: The Collapse of the Large Thoracic wide variation in the degree of hypercholesteremia
Veins. Cuore e circ. 35: 156 (June), 1951. which develops. This variation depends probably
Angiocardiographic studies in man show a col- on varying thyroid activity and possibly on other
lapse of the large veins of the chest in certain posi- factors. In the second place, not all animals with
tions of the body. The large veins were visualized the same degree of hypercholesteremia develop
through injection of a radiopaque medium and evi- lesions at the same rate. In general, the greater the
dence of collapse was given by the observation of degree of hypercholesteremia the more rapid is
dimmer and less regular shadows. Collapse was ob- the development of atherosclerosis. However, var-
served in the following conditions: (a) intrathoracic iations in the degree of obesity, or some factor
collapse of the subclavian and probably also of the associated with obesity, can greatly modify the re-
jugular vein, in the upright position; (b) complete sponse. Finally, the rate of development of lesions
collapse of the superior vena cava, in the erect posi- is influenced by the arterial blood pressure and by
tion; (c) the contrast medium did not flow from the pre-existing damage to the arterial wall.
right atrium into the inferior cava; this fact is ex- So far as dietary cholesterol is concerned, al-
plained with an intrathoracic collapse of the latter. though the circumstantial evidence is considerable,
The above-described venous collapses did not there is no direct evidence for the hypothesis that
occur in patients with congestive failure. In such dietary cholesterol is involved in human athero-
cases, the superior cava was found d'stended in the sclerosis. There is strong evidence from clinical,
upright position, and the length of the distended pathologic, and experimental studies that an emi-
segment increased with the rise of venous pressure. nently desirable measure in the prevention of ath-
The contrast medium flowed from the right atrium erosclerosis is the prevention or correction of obesity.
through the inferior vena cava into the hepatic The virtues of a low-fat diet in this connection are
veins. The intrathoracic collapse of the subclavian well known. A diet particularly low in animal fat
and jugular veins in the upright position was also has what may prove to be an additional virtue-a
found to be absent in congestive failure. low-cholesterol content.
LuISADA BERNSTEIN
Hirschowitz, B. I., and Bagg, L.: Aneurysm of the
Abdominal Aorta with a Report of Four Unusual Moses, M. F.: Aortic Aneurysm Associated with
Cases. Gastroenterol. 18: 375 (July), 1951. Arachnodactyly. Brit. M. J. 4723: 81 (July),
In 16 cases of aneurysm of the abdominal aorta 1951.
presented by the authors, aneurysm of the abdominal Two cases of arachnodactyly with aneurysmal
portion of the aorta occurred in 22 per cent. dilatation of the ascending aorta and multiple aortic
In a group of patients with thoracic aortic aneu- tears, without dissecting aneurysm or rupture, are
rysms, syphilis was incriminated in 31 out of 37 reported. In cases of arachnodactyly with cardio-
cases (84 per cent); but it was present in only four vascular abnormality it is suggested that the aortic
out of 16 (25 per cent) of the aneurysms of the ab- defects occur as often as the better-known con-
dominal portion, whereas arteriosclerosis caused 11 genital heart lesions, such as patent foramen ovale.
(69 per cent) and infected emboli 1 (6 per cent). In the adult, aortic incompetence due to dilatation
Pain was present in the majority of the cases (66 of the aortic ring and ascending aorta constitute
per cent), tenderness in 75 per cent, and a mass in the usually associated cardiovascular anomaly. These
63 per cent of cases. Of these masses, 80 per cent aortic lesions, though resembling the results of ac-
pulsated. The difficulties of accurate diagnosis were quired disease, are probably the results of progres-

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954 ABSTRACTS

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

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ABSTRACTS 955
way of' the vertebral venous system. He showed the demonstrable response in experimental animals.
that contrast media injected into the dorsal vein Sympathetic denervation in animals renders smooth
of the penis could pass easily along the vertebral muscle supersensitive to chemical stimulation. The
venous system, its close association with the veins chief controversy is whether or not there is a real
of the body wall, pelvic and shoulder girdles and difference between the sensitizing effects of pre-
lastly the venous sinuses in the cranium. This ganglionic and postganglionic sympathectomies.
system is free of valves and the blood flow in it can FROBESE
be altered by postural changes and variations in
intrathoracic or intra-abdominal pressures. Steele, G. D. F.: Persistent Anxiety and Tachy-
The authors repeated Batson's studies on 12 cardia Successfully Treated by Prefrontal Leu-
cadavers and obtained the same results. Then he cotomy. Brit. M. J. 4723: 84 (July), 1951.
applied similar procedures in 22 living patients A case is described in which persistent anxiety,
with normal circulations. Here he used 20 cc. of tachycardia and raised basal metabolic rate un-
52.5 per cent Diodrast solution injected into the responsive to other methods of treatment were
femoral or cephalic veins. By external abdominal successfully treated by bilateral prefrontal leucot-
compression, he was able to force the contrast media omy. A year has passed without relapse. The
into the ascending lumbar veins and the vertebral general change in personality has been compatible
venous system rather than its normal course up with excellent social rehabilitation. The case demon-
the vena cava. When the intrathoracic pressure strates some problems in diagnosis and treatment.
was increased the contrast media injected into the BERNSTEIN
cephalic vein did not go past the subclavian vein
but backed up into all of the transverse cervical, Fitzgerald, J. E., Webster, A., Zummo, B. P., and
scapular, deep cervical, internal jugular, external Williams, P. C.: Evaluation of Adequate An-
jugular and vertebral veins. When the media backed tepartum Care for the Cardiac Patient. J.A.M.A.
up into the cranium, the internal cerebral veins as 146: 910 (July 7), 1951.
well as the external venous sinuses were filled. During an 11 year period, 704 mothers delivered
It is felt that these studies support the thesis that of viable infants in the Cook County Hospital were
cerebral metastases from distant primary foci can diagnosed as having organic heart disease; 24 ma-
occur via the vertebral venous system. ternal deaths were attributed to cardiac disease
FROBESE and complications. This compared with 21 deaths
reported from a group of only 244 women with
Simeone, F. A., and Felder, D. A.: The Super- organic heart disease who were not seen in the
sensitivity of Denervated Digital Blood Vessels clinic. Of the 21 clinic patients who died, 15 had
in Man. Surgery 30: 218 (July), 1951. no antepartum attention whatsoever and six had
Data on the occurrence of postdenervation super- inadequate care. In the entire series of 704 patients
sensitivity of digital blood vessels in humans was with organic heart disease, pregnancy was inter-
collected. These extremities were either chronically rupted in only eight instances, of which three died.
denervated by operation or were acutely denervated The authors state that management of the preg-
by procaine block of the peripheral nerves. No nant woman should date back to the day of her
attempt was made to demonstrate a difference be- initial illness. Marriage and pregnancy call for re-
tween the effects of preganglionic and postganglionic evaluation of her cardiac status. During pregnancy
denervation. a study should be made of the patient's functional
Observations were made of the color changes in capacity. Functional class 1 patients usually are
the skin after the injection of single doses of ad- not hospitalized until the onset of labor. Class 2
renaline intravenously. It was impossible to produce patients are admitted at the time of diagnosis and
the circumscribed pallor or the cyanosis of Ray- are hospitalized until they become class 1, then
naud's phenomenon unless there had been a recur- followed closely. Class 3 and class 4 patients are
rence of vasomotor activity. In the patients who admitted for study and treatment and are hos-
had developed a recurrence of vasomotor activity, pitalized for the remainder of the gestational and
it was not necessary to inject adrenaline to produce puerperal periods or until compensated. The au-
pallor and cyanosis as they developed it when thors feel the patient with cardiac disease may be
merely exposed to cold. safely delivered from below if there is no obstetric
The authors studied five patients before and contraindication. During labor the cardiac patient
after sympathectomy with plethysmographic studies requires constant vigilance, and care does not end
of the fifth finger. In all patients there was an in- with delivery but must go through the postpartum
creased responsiveness after sympathectomy as period. The fact that only 3 of the 24 cases that
manifested by a greater shrinkage of the parts and died had adequate care suggests that obstetric
a prolongation of the response subsequent to the mortality could be considerably reduced in cardiac
intravenous injection of adrenaline cases by proper management.
The authors point out that this would conform to KITCHELL

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956 ABSTRACTS
Howard, P., Leathart, G. L., Dornhorst, A. C., and occasions the patient has had transient hyper-
Sharpey-Schafer, E. P.: The "Mess Trick" and thermia with temperature elevations of 109 to 112
the "Fainting Lark." Brit. M. J. 4728: 382 (Aug.), F., checked by rectum, mouth, and axilla. This,
1951. plus the bizarre behavior of the diaphragm, remains
The "mess trick" consists of suddenly compressing unexplained in his case.
the chest after hyperventilation for about one min- KITCHELL
ute. Hyperventilation leads to dilatation of muscle
and constriction of brain blood vessels. Compres- Gilley, E. W., McCord, M. C., and Taguchi, J. T.:
sion of the chest causes the victim to perform an Acute Nonspecific Pericarditis. Am. J. M. Sc.
involuntary Valsalva maneuver, which in the pres- 222: 249 (Sept.), 1951.
ence of peripheral dilatation is sufficient to reduce The importance of differentiating acute benign
effective blood pressure and consequently cerebral pericarditis from myocardial infarction is empha-
blood flow to levels which cause unconsciousness. sized in this clinical study of nine patients in whom
The "fainting lark" consists in a subject's squat- the diagnosis of pericarditis was established. Among
ting on his haunches and hyperventilating for 20 the clinical features discussed as being helpful in
breaths, rising rapidly to the erect posture, and the differential diagnosis of these two conditions are
immediately performing the Valsalva maneuver. the following items: (1) an antecedent respiratory
Consciousness is lost within a few seconds. The infection is frequently observed in pericarditis; (2)
mechanism is the same as in the "mess trick," with chest pain in pericarditis resembles that of myo-
the added factor of the fall in blood pressure pro- cardial infarction except that it is often distinctly
duced by rising from the squatting posture. accentuated by respiration; (3) the pericardial fric-
BERNSTEIN tion rub of pericarditis occurs early, is of greater
intensity and more widespread than that of infarc-
tion; (4) fever, leukocytosis and increased sedimenta-
Craddock, W. L.: Diaphragmatic Flutter with Symp- tion rate occur earlier in pericarditis than in myo-
toms Resembling Angina Pectoris. J.A.M.A. 146: cardial infarction; (5) chest x-rays may show cardiac
1315 (Aug. 4), 1951. enlargement with rapid changes noted in heart size
The case of a transient elderly male prevaricator, in pericarditis, and pulmonary abnormalities are
whose story has been reported and published in those of pleuritis or pneumonitis; in myocardial
medical journals at least six times since 1935, is infarction, the heart size does not show rapid changes
again reviewed. In all reported hospitalizations there and the pulmonary abnormalities noted are usually
have been evidences of psychopathy, malingering, those of congestion; (6) the electrocardiogram in
belligerency, and procacity. Aliases are numerous. pericarditis shows serial changes of S-T segment
The individual usually applies for hospital admis- elevations without reciprocal T-wave inversion until
sion pounding the left side of the chest with his fist later when the S-T segment is isoelectric; QRS
and complaining bitterly of "pain in my heart." patterns are not abnormal in pericarditis.
Despite irregular breathing with periods of apnea, In 2 patients paroxymal supraventricular tachy-
there has been no evidence of circulatory impair- cardia was observed during their illness. One patient,
ment or cyanosis. A loud "tick-tock" sound of treated with heparin and dicoumarin for supposed
unequal intensity is heard throughout the chest myocardial infarction, died on the twelfth day of
with the ratio of this sound to the heart beat of therapy as a result of cardiac tamponade produced
3:1 or 4 :1. In almost every instance the cardiac by hemorrhage into the pericardial sac.
mechanism has been reported normal. On several SHUMAN

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