Citations

Albuminuria may be an integral part of the picture of congestive heart failure. Of 161 patients in whom the histologic renal findings were considered to be either normal or to be of such a nature as not to be responsible in themselves for albuminuria, and in whom clinically obvious causes for albuminuria had been eliminated, 141, or 88 per cent, had albuminuria. The incidence of albuminuria was about equal among the various types of heart disease when heart failure existed. A trend existed for the grade of albuminuria to parallel the grade of heart failure. Based on a study of 21 patients, there seemed to be a correlation between the grade of albuminuria and the group of hypertension, according to funduscopic examination. No correlation was found between the grade of albuminuria on one hand and the systolic or diastolic values for blood pressure, the known duration of elevated blood pressure, the grades of hematuria or the values for blood urea on the other hand. Among the 161 patients with heart failure in our group 1 (kidneys either normal or containing lesions not judged to be causes for albuminuria), there was no predominant renal lesion associated with any one cardiac lesion.

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.

Patients who have pulmonary stenosis and ventricular septal defect usually have a right-to-left intracardiac shunt. This paper presents hemodynamic and clinical data on 11 patients who have pulmonary stenosis, ventricular septal defect and left-to-right shunts. Four of these patients also have defects in the atrial septum, and three have demonstrable bidirectional shunts. The level and direction of shunts were determined by blood oxygen-saturation data and indicator-dilution studies. Choice of the form of treatment to be used in patients such as these should be based largely on hemodynamic considerations. Many resemble patients with tetralogy of Fallot who have had a successful pulmonary valvotomy.

The response of the intra-arterial pressure to the cold immersion stimulus was studied in 42 healthy young adults, continuous direct (arterial-pressure) recording being used. The average systolic elevation was 22.6 mm. Hg and the average diastolic elevation was 16.3 mm. Hg. The difference between direct and indirect methods of measuring blood pressure was studied in 351 simultaneous determinations in 35 of these young adults. The direct systolic pressure averaged 9.7 mm. Hg higher and the diastolic pressure was 7.3 mm. Hg lower than the indirect measurement.

On the thoracic roentgenograms of patients with mitral stenosis, costophrenic septal lines are frequently seen. These lines are a sign of pulmonary venous hypertension. They were not seen in a representative group of patients with pulmonary arterial hypertension but without pulmonary venous hypertension.

The cold pressor test was performed three times at 15-minute intervals on 65 normotensive subjects and on 60 patients with essential hypertension both before and during treatment with antihypertensive drugs. The arterial pressure was recorded directly from the radial artery. On the basis of differences in the cold pressor response among individuals in the control group, the criteria for normal reaction and for hyperreaction were modified. The cold pressor response in the patients with essential hypertension was markedly depressed by the ganglionic blocking agents, but was not affected by various combinations of hydralazine, protoveratrine and reserpine.

Administration of a moderately large or large dose of cortisone to dogs having acute myocardial infarctions inhibited slightly the rate of removal of necrotic muscle fibers in these animals as compared with untreated animals. Delay was appreciable at four and six days after production of the infarct in animals receiving 2.5 mg. of cortisone per kilogram of body weight and at 4, 6, 12 and 21 days in animals receiving 10 mg. per kilogram. At all other periods up to essentially complete healing of the infarcts as defined at 60 days, no appreciable differences existed between treated and untreated animals.

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.