Gifford, Ray W.

Eight hundred fifty-seven determinations of the pH of venous blood with simultaneous blood pressure observations were carried out on 590 patients. The pH of venous blood of the patients who had been under medication for a long period before the tests did not vary significantly from that of patients who had had no medication. The most consistent result was the rise in the pH of venous blood 30 minutes after a dose of phentolamine hydrochloride (Regitine). The oral administration of 40 grains of sodium bicarbonate did not increase the response of the blood pressure during the histamine test, irrespective of the type of previous medication, even though the pH of the venous blood was low initially and rose to normal levels after the administration of the sodium bicarbonate. This may be due to the fact that none of the patients had pheochromocytomas with excessive release of pressor amines.

A study has been made at the Mayo Clinic of the results of treatment in 28 hypertensive patients receiving thiazide diuretics. The use of these agents produced a significant but very temporary reduction in plasma volume in most patients. The plasma volume reverted to or toward normal after the first week of treatment; therefore, hypovolemia could not explain the prolonged hypotensive effect of these drugs. Administration of thiazide diuretics did not deplete the body of its sodium stores, as measured by isotope studies in five patients on an unrestricted diet. Therapy with thiazides did not produce a persistent increase in urinary aldosterone excretion in the nine patients studied for this possibility.

Two hundred seventy-one patients with unequivocal systemic scleroderma for whom the diagnosis was first established at the Mayo Clinic between January 1, 1945, and December 31, 1952, have been studied. Follow-up information was obtained 5 to 13 years after the diagnosis at the clinic concerning 236 of these patients, 115 of whom were dead. The cases were analyzed in an effort to determine what factors had a bearing on prognosis. The following seemed to bear little relation to the ultimate prognosis: sex, mode of onset, Raynaud's phenomenon, involvement of lungs and periodontal membrane, calcinosis cutis, and trophic changes. The following were considered poor prognostic omens: cardiac or renal involvement, significant elevation of the erythrocyte sedimentation rate, and anemia. The prognosis in systemic scleroderma was found to be worse than previous reports had indicated. This study yielded no basis for the subdivision of systemic scleroderma into acrosclerosis and generalized progressive scleroderma.

Follow-up information has been obtained from 70 women with Raynaud's disease and 54 women with secondary Raynaud's phenomenon who were subjected to surgical sympathetic denervation of one extremity or more. The results of sympathectomy in the upper and lower extremities are described. The effect of operation on the subsequent course, the complications and sequelae are presented and compared with the reports of others.

The diagnosis of Raynaud's disease was suspected in 756 female patients at the Mayo Clinic from 1920 through 1945. The diagnosis was substantiated from the records of the initial examination or from the follow-up data or examination in 474. The clinical characteristics, including diagnostic criteria, clinical course, complications, and sequelae are discussed.

This case of atherosclerotic aneurysm of the popliteal artery is of interest because the patient was a man 35 years old and because the condition was discovered only because palpation of the peripheral arteries was included as a part of routine examination. Only after the aneurysm had been found was a history of intermittent claudication elicited. The indications for the surgical treatment of popliteal aneurysms are discussed.

Intradermal injection of a fluorescent dye (riboflavin) and ultraviolet light were used to demonstrate cutaneous lymphatic capillaries. The extremities of a control group and the nonedematous extremities of patients with arteriosclerosis obliterans were studied together with edematous extremities of patients with lymphedema, acute thrombophlebitis, chronic venous insufficiency and various other conditions. The lymphatic capillaries showed up more extensively after a higher percentage of injections into edematous extremities of patients with lymphedema than after injections into the other extremities. On the other edematous extremities except in the cases of nephrotic syndrome and on the normal extremities, either no lymph capillaries or only a few were visible after most of the injections.

The effect of hexamethonium on hypertension has been widely studied but its effect on the peripheral blood vessels of patients with severe occlusive vascular disease has been studied on only a few patients although the drug has been used empirically in the treatment of such disease. Observations were made on the effect of hexamethonium ion administered subcutaneously in increasing doses of 10 to 50 mg. on the skin temperature of the fingers and toes, the blood pressure and the pulse rates of a group of patients with severe arteriosclerosis obliterans. On this group of patients hexamethonium had little or no effect.