A. Stone Freedberg

The presence of spirochetes in human gastric mucosa

1. Spirochetes are rarely found in the mucosa of gastric tissue resected for duodenal ulcer without attendant gastric ulcererations. 2. They are frequently found in those stomachs whose mucosa is diseased by malignant or benign ulcerations. In these instances they are found in or close to the lesion. 3. The silver impregnation method of DaFano will demonstrate spirochetes in the gastric tissue of the dog and human. 4. Incubation and exposure to room temperature for varying periods seemed to exert very little influence on the number of spirochetes in human gastric mucosa.

The Experimental Production of Intercoronary Arterial Anastomoses and their Functional Significance

Animal experiments were done to learn the degree of coronary narrowing required to produce the larger intercoronary collateral channels, their speed of development, and the degree of protection afforded the myocardium. Twelve or more days of 75 per cent narrowing were required to produce sufficiently rich anastomotic communications to protect the myocardium from damage, and to permit survival after superimposed acute complete occlusion. The physiologic and pathologic significance of the intercoronary collateral communications and the clinical implications in coronary artery disease are discussed.

The Potentiating Effect of ACTH and of Cortisone on Pressor Response to Intravenous Infusion of L-Nor-Epinephrine.∗

Summary1. The pressor response to an intravenous infusion of 2.1-13.9 μg per minute of 1-nor-epinephrine was studied, using a constant rate infusion apparatus, in 3 patients before and during the administration of ACTH and cortisone. 2. Striking potentiation of the blood pressure response to nor-epinephrine was noted within 24 hours after administration of 90-180 mg ACTH daily or 150-200 mg cortisone daily. The potentiating effect disappeared within 36 hours after the omission of these agents.Summary 1. The pressor response to an intravenous infusion of 2.1-13.9 μg per minute of 1-nor-epinephrine was studied, using a constant rate infusion apparatus, in 3 patients before and during the administration of ACTH and cortisone. 2. Striking potentiation of the blood pressure response to nor-epinephrine was noted within 24 hours after administration of 90-180 mg ACTH daily or 150-200 mg cortisone daily. The potentiating effect disappeared within 36 hours after the omission of these agents.

Hypothyroidism Produced by Radioactive Iodine (I131) in the Treatment of Euthyroid Patients with Angina Pectoris and Congestive Heart Failure Early Results in Various Types of Cardiovascular Diseases and Associated Pathologic States

Hypothyroidism, induced by I131 to lessen the work of the heart, is proposed as a means of treating certain patients with angina pectoris and congestive failure who are refractory to the standard medical measures. Eighteen such patients have been treated. The period of follow-up averages thirteen months. Eight of the 13 patients with angina pectoris and 3 of 5 patients with congestive failure showed worthwhile improvement. In 6 of the 18 patients, the improvement was striking. Tentative criteria for the selection of patients, their pre- and post-treatment management, and detailed descriptions of the results are presented.

The Thyroid Gland in Pregnancy

THE purpose of this progress report is to review the present status of knowledge of thyroid-gland function in pregnancy; to discuss recent studies utilizing newer investigative technics to refocus ...

The heart in hypothyroidism

Abstract An attempt has been made to review, from the large body of pertinent data, certain aspects of cardiovascular structure and function in hypothyroidism. Although significant alterations have been defined, the preponderance of the data indicates that myocardial decompensation is only rarely, if ever, a consequence of hypothyroidism. Furthermore, the widely assumed causative role of the hypothyroid state per se in the pathogenesis of atherosclerosis is questioned and the need for a critical re-evaluation defined, particularly in the less severe cases and in patients without attendant complicating factors such as age, hypertension, diabetes, etc. The important role of pericardial effusion in the genesis of certain signs and symptoms is underlined. The meagerness of data relating to significant biochemical effects of hypothyroidism at a cellular or subcellular level is noted. The lack of significant effects of hypothyroidism on the related pulmonary and renal functions is delineated. The induction of hypothyroidism for the therapy of severe angina pectoris or congestive heart failure is reviewed ; the need is underscored for further study of (1) the mechanism of action of lowered thyroid function on these cardiac conditions, (2) the abnormalities of thyroid hormone binding, tissue uptake and turnover in certain euthyroid patients with supraventricular tachycardias, and (3) the therapy of this condition by antithyroid measures.

The Lewis A. Conner Memorial Lecture

The physiologic, pathologic, and clinical interrelationships between the thyroid and the cardiovascular system are discussed. The therapeutic effects of hypothyroidism induced by I131 to lessen the work of the heart are described in 39 euthyroid patients with intractable advanced angina pectoris or congestive failure. Only patients were treated who were seriously incapacitated despite all conventional forms of therapy for many months or years. The results of two confirmatory series of cases similarly treated by others are reviewed.

Serum level of protein bound radioactive iodine (I131) in the diagnosis of hyperthyroidism.

Summary 1. The serum protein bound radioactive iodine (I131) level was determined 24 hours after the oral administration of 150 microcuries I131. Twenty subjects were studied; 10 were thyrotoxic and 10 euthyroid. The protein bound I131 was determined by a modification of the method described by Chaikoff et al. 8 2. The serum protein bound I113 in thyrotoxic patients was 38 to 146 × 10−5 microcuries/cc averaging 68. In euthyroid subjects, the serum level ranged from 3 to 28 × 10−5 microcuries/cc, averaging 13. 3. It would appear that this test may be of diagnostic value as a measure of thyroid function.

Hormones, Cholesterol, and Coronary Atherosclerosis

Various hormones have been shown to play an important role in lipid metabolism. Clinical and experimental observations implicate the thyroid, adrenal, gonadal, and pituitary glands in atherogenesis. The evidence is strongest that estrogens play a role in human atherosclerosis. The influence of hypothyroidism requires further study and clarification. Hormones and lipids are obviously not the only factors important in atherogenesis; hypertension, local tissue factors, and altered intravascular coagulation in all probability significantly influence the natural history of the disease.

Objective evidence of the efficacy of medicinal therapy in angina pectoris

Abstract In the treatment of patients with angina pectoris some form of medication is usually prescribed, but in the selection of such drugs the physician must rely either on clinical impressions of their therapeutic value or on the unsupported claims of the manufacturers. Many attempts to prove the value of medication have been made, but there has been little objective evidence of therapeutic action. As a result, the Council of pharmacy and Chemistry of the American Medical Association, in 1937, 1 in reviewing the claims for the therapeutic efficacy of xanthine derivatives, reversed their decision of 1930, 2 and “decided that there is no warrant for claims of efficacy as a dilator of the coronary arteries or of usefulness in overcoming pain in coronary occlusion or angina pectoris.” The purpose of the present investigation is to review the literature and present objective evidence of the pharmacodynamic action of drugs under conditions comparable to those commonly used in the treatment of angina pectoris.