2
126 THE AMERICAN HEART JOURNAL crease in the degree of coronary sclerosis, the left ventricle continues to grow in thickness, while the right ventricle actually appears to lose in thickness until such a time when the sclerosis of the arteries becomes very severe. When this stage is reached, the roles seem to reverse. The left ventricle then thins out somewhat and the right ventricle resumes its progressive hypertrophy. No ex- planation is offered for this phenomenon. AUTHORS. Theis, Prank V., asd Freeland, M. R.: Thromboangiitis Obliterans. Treatment With Sodium Tetrathianate and Sodium Thiosulfate. Arch. Surg. 40: 190, 1940. Intravenous injections of sodium tetrathionate and sodium thiosulfate were usually followed by increased peripheral temperatures, decreased pulse rate, and reduction in blood pressure. These physiologic responses were associated with changes in the oxygen capacity and in the oxygen saturation of the arterial and the venous blood. These effects were opposite to those that occurred with smoking, which is an important etiological factor in thromboangiitis obliterans. The therapeutic value of sodium thiosulfate and sodium tetrathionate is probably due to the changes pro- duced in the blood and the resulting physiologic responses. AUTHORS. Ochsner, Alton, and DeBakey, Michael: Therapy of Phlebothrombosis and Thrombophlebitis. Arch. Surg. 40: 208, 1940. The therapy of thrombophlebitis is reviewed and is cIassified into prophylactic, conservative, and radical measures. The prophylactic measures consist of hydration, mobilization, respiratory stimu- lation, prevention of increased abdominal tension, application of heat, administration of sodium thiosulfate, hirudinization, and heparinization. The conservative measures consist of immobilization and elevation of the involved extremity, application of heat, hirudinization, use of compression bandages, and production of vasodilatation. In the authors’ experience, the best therapeutic measure is procaine hydrochloride block of the regional sympathetic nerves. The rationale of this therapeutic measure is discussed, and the excellent results obtained from its employment in twenty-two cases are described. The technique of t (sympathetic block” as used by the authors is described briefly and illustrated. The radical procedures consist of ligation, excision, incision and drainage, and thrombectomy or emboleetomy. AUWORS. Harrison, Tinsley R.: Some General Principles in the Bedside Diagnosis of Heart Disease. South. M. J. 33: 308, 1940. The necessity for a careful analysis of the subjective manifestations of patients with complainbs referable to the cardiovascular system has been emphasized. In order to illustrate this, certain features of two symptoms have been considered. Recurrent attacks of weakness have been discussed, and four conditions which are frequently overlooked have been mentioned as common causes of the com- plaint. These conditions are: (1) sudden change from the recumbent to the upright position; (2) carotid sinus syncope; (3) spontaneous hypoglycemia; and (4) allergic dizziness. The fact that these conditions are usually incorrectly diagnosed unless a very careful history is taken has been emphasized.

Some general principles in the bedside diagnosis of heart disease: Harrison, Tinsley R.: South. M. J. 33: 308, 1940

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Page 1: Some general principles in the bedside diagnosis of heart disease: Harrison, Tinsley R.: South. M. J. 33: 308, 1940

126 THE AMERICAN HEART JOURNAL

crease in the degree of coronary sclerosis, the left ventricle continues to grow

in thickness, while the right ventricle actually appears to lose in thickness until such a time when the sclerosis of the arteries becomes very severe. When this stage is reached, the roles seem to reverse. The left ventricle then thins out somewhat and the right ventricle resumes its progressive hypertrophy. No ex- planation is offered for this phenomenon.

AUTHORS.

Theis, Prank V., asd Freeland, M. R.: Thromboangiitis Obliterans. Treatment With Sodium Tetrathianate and Sodium Thiosulfate. Arch. Surg. 40: 190, 1940.

Intravenous injections of sodium tetrathionate and sodium thiosulfate were usually followed by increased peripheral temperatures, decreased pulse rate, and reduction in blood pressure. These physiologic responses were associated with changes in the oxygen capacity and in the oxygen saturation of the arterial and the venous blood.

These effects were opposite to those that occurred with smoking, which is an important etiological factor in thromboangiitis obliterans. The therapeutic value of sodium thiosulfate and sodium tetrathionate is probably due to the changes pro- duced in the blood and the resulting physiologic responses.

AUTHORS.

Ochsner, Alton, and DeBakey, Michael: Therapy of Phlebothrombosis and Thrombophlebitis. Arch. Surg. 40: 208, 1940.

The therapy of thrombophlebitis is reviewed and is cIassified into prophylactic, conservative, and radical measures.

The prophylactic measures consist of hydration, mobilization, respiratory stimu- lation, prevention of increased abdominal tension, application of heat, administration of sodium thiosulfate, hirudinization, and heparinization.

The conservative measures consist of immobilization and elevation of the involved extremity, application of heat, hirudinization, use of compression bandages, and production of vasodilatation.

In the authors’ experience, the best therapeutic measure is procaine hydrochloride block of the regional sympathetic nerves. The rationale of this therapeutic measure

is discussed, and the excellent results obtained from its employment in twenty-two cases are described. The technique of t (sympathetic block” as used by the authors is described briefly and illustrated.

The radical procedures consist of ligation, excision, incision and drainage, and

thrombectomy or emboleetomy. AUWORS.

Harrison, Tinsley R.: Some General Principles in the Bedside Diagnosis of Heart Disease. South. M. J. 33: 308, 1940.

The necessity for a careful analysis of the subjective manifestations of patients with complainbs referable to the cardiovascular system has been emphasized. In order to illustrate this, certain features of two symptoms have been considered. Recurrent attacks of weakness have been discussed, and four conditions which are frequently overlooked have been mentioned as common causes of the com- plaint. These conditions are: (1) sudden change from the recumbent to the upright position; (2) carotid sinus syncope; (3) spontaneous hypoglycemia; and (4) allergic dizziness. The fact that these conditions are usually incorrectly diagnosed unless a very careful history is taken has been emphasized.

Page 2: Some general principles in the bedside diagnosis of heart disease: Harrison, Tinsley R.: South. M. J. 33: 308, 1940

SELECTED ABSTRACTS 127

Certain aspects of another important symptom, pain in the chest, have also been discussed. It has been pointed out that the diagnosis of angina pectoris is almost entirely dependent upon an accurate history. Certain conditions such as

paroxysmal tachycardia, paroxysmal auricular fibrillation, and spontaneous hypo- glycemia, which may induce the attacks of angina pectoris in the absence of mental or physical exertion, have been considered. The relation of angina pectoris

to chronic pain in the shoulder region has been discussed. The similarity of the pain produced by herniation of the stomach through the esophageal hiatus of the diaphragm to the pain of angina pectoris has been mentioned. Emphasis has been placed on the general principle that a careful and detailed history is usually the most important means of arriving at the correct diagnosis in a patient with a pain in the chest.

Wood, Paul: The Action of Digitalis in Heart Failure With Normal Rhythm. 3rit. Heart J. 2: 132, 1940.

Digitalis effected demonstrable improvement in eighteen out of twenty cases of congestive heart failure with normal rhythm. This was judged by serial measurements of the venous blood pressure in those with systemic congestion, and of the arm-to-tongue circulation time in those with pulmonary congestion.

Since it has been stated that rheumatic heart disease responds better to digitalis than other etiological types, it is of interest that only one of the present series was rheumatic.

0bservation.s showed that the fall in venous blood pressure following intra- venous digoxin was not due to slowing of the heart.

A single olbservation refuted the view that the beneficial action of digitalis is due to its constricting effect upon the hepatic vein.

AVCEOR.

WeichseI, H. S.: Studies in PeripheraI Vascular Diseases. I. Intravenous Cal- cium in Occlusive Vascular Disease. Ann. Int. Med. 13: 1150, 1940.

Weichsel reports good resul& in treating peripheral vascular disease with calcium. The number of patients so treated is not specified. The solution used at first was a 10 per cent calcium gluconate in 10 to 20 C.C. of saline, later 2 grams of calcium chloride in saline. The injections were given intravenously once a week for twelve weeks. The observations are based on thirty recordings of the Tyeos recording oscillometer before and after treatment and in addition relief of pain, drop in blood pressure, slowing of pulse, increase in eIaudication distance, reduction in amount of rest, pain and night cranaps, healing of ulcers, and promotion of collateral circulation.

MCGOVERN.

Baker, T. W.: Histaminase in the Treatment of Cold Allergy. J. A. M. A. 114: 1059, 1940.

This is the report of two cases of cold sensitivity successfully treated with histaminase and gradual desensitization to cold. In each instance the condition had been precipitated by the use of cold water, milk, or handling ice. The use of histaminase for other alIergic conditions is suggested.

MCGOVERN.