Citations

Nicotinic acid was administered orally to 33 patients with hypercholesterolemia in doses varying from 1.5 to 6.0 Gm. per day for periods of 3 months to 1½ years. Significant, sustained, and reproducible decreases in the concentration of cholesterol and total lipids in the plasma and of serum beta-lipoprotein cholesterol were observed in a majority of patients. This form of therapy appears to be effective, practical, and probably free from serious harmful effects.

In normal subjects smoking or the injection of nicotine produces transient vascular effects on the heart and blood vessels. Apparently tobacco angina or tobacco heart is a clinical entity. Abnormal vascular responses after smoking in normal subjects may be due to hypersensitivity to nicotine, such as occurs in tobacco heart, or to the effect of nicotine on a vascular system demonstrated to be hyperreactive by the cold pressor test. Tobacco is one of the most prominent contributing factors in thromboangiitis obliterans, as thromboangiitis is rarely found in nonsmokers. The question as to whether the effects of smoking are due to sudden increased work of the heart or constriction of the coronary artery has stimulated a great amount of research. There is evidence to support both theories. The findings of abnormal ballistocardiograms before and after smoking in the offspring of hypertensive parents and after smoking in the offspring of parents with coronary heart disease are highly important. Statistically coronary artery disease seems to occur more frequently and at an earlier age in the person who smokes much than in the nonsmoker. Likewise, the mortality rate is higher among younger persons with coronary disease who are smokers than among those who are nonsmokers.

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.

Daily water metabolism of 21 patients was studied for 3 days after intracardiac surgery and whole-body perfusion. The average obligatory water losses of these patients were approximately 500, 750, and 750 ml. per M. 2 of body surface per day on the first, second, and third postoperative day, respectively. A simple system, which combines knowledge of the estimated postoperative water requirement with the known daily change in body weight, was devised to manage accurately water metabolism after intracardiac surgery.

The medical problems in the selection of patients for direct-vision reconstructive operations utilizing the pump-oxygenator of the Gibbon type are discussed. The evaluation of the pulmonary vascular changes is one of the most important medical tasks in many cases. The operative risk for such lesions as ventricular septal defect with high pulmonary flow, tetralogy of Fallot, pulmonary stenosis with intact ventricular septum, and atrial septal defect of the partial atrioventricular canal type is constantly decreasing and is 15 per cent or less at the present time. Heart block and cardiac arrhythmias are still, on occasion, serious postoperative complications. During 1 period of 3 months, subacute bacterial endocarditis ( Pseudomonas ) occurred in 4 patients but it has not recurred since.

Arteriovenous fistula involving the portal vein or its tributaries is a rare condition that in some cases can be treated successfully by surgery if it is recognized. The clinical manifestations and diagnostic criteria are presented.

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.

Each of 21 patients was noted to have a low concentration of water in the serum immediately after whole-body perfusion. This indicated a loss of water either by the patient or the pump-oxygenator. Investigation suggested that the patient, and not the pump-oxygenator, was the source of water loss. Two of the 21 patients had a profuse, short-lived solute diuresis in the immediate postperfusion period. These phenomena are apparently benign and they require no specific treatment.