Citations

Experienced clinicians have known for some time that bleeding owing to the use of dicumarol is not entirely a measure of the degree of prothrombin deficiency. This presentation emphasizes that bleeding may occur when prothrombin deficiency is not great and that bleeding may fail to occur when prothrombin deficiency is marked. Nonetheless great prothrombin deficiency causes bleeding more frequently than lesser degrees of prothrombin deficiency. Time is an important factor, for patients are much more apt to bleed when prothrombin deficiency has endured for several days than when it has been present only a day or so.

This study concerns an evaluation of the anatomicopathologic changes found in blood vessels of the skin in areas of venous insufficiency in the lower legs. These changes have been compared with the vascular structure in comparable areas of skin in normal persons. Apparently evidence of arteriolar damage is more a concomitant finding in the clinical picture of chronic venous insufficiency than are venular changes. This is demonstrated in a study of 30 patients. The vascular changes show no correlation with the condition of the skin at the site from which the biopsy material was taken.

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.

The case history of a patient with apparent spontaneous rupture of the posterior tibial artery is presented, with a brief review of the previously reported cases.

Clinical experience has not confirmed previous observations that intravenous injection of vitamin C and intramuscular injection of histidine monohydrochloride are useful in the treatment of peripheral ischemia observed in arteriosclerosis obliterans. Clinical experience with intravenous injection of ether has failed to indicate that this method of treatment is of value in improving the peripheral arterial circulation in thrombo-angiitis obliterans and arteriosclerosis obliterans.

This study was undertaken to ascertain whether coarctation of the aorta produces permanent hemodynamic abnormalities that may persist despite resection and end-to-end anastomosis. The results of studies in 10 patients 4 to 7 years after operation are compared to those obtained before and immediately after operation. The most significant finding was continued decrease in residual coarctation, in addition to dramatic immediate postoperative improvement in the degree of circulatory impairment.

Idiopathic livedo reticularis may be associated with ulcerations of the lower extremities beginning primarily during the warmer or summer months, as well as the more usual occurrence of winter ulcerations. Summer ulceration apparently is a new and rare entity which has many clinical and histopathologic features similar to winter ulcerations. Hypertension, Raynaud's phenomena, acrocyanosis and thrombosis of digital arteries were noted only in patients with winter ulcerations, while edema of the legs and feet was a more prominent feature in patients with summer ulcerations. Medical treatment, including rest in bed, elastic supportive bandages and a trial of hexamethonium (bistrium bromide) injections, seemed to be the treatment of choice. Lumbar sympathectomy did not seem to be of great permanent value.