Bernard Goluboff

Studies of the Cerebral Circulation and Metabolism in Congestive Heart Failure

In a study of the cerebral circulation and metabolism in congestive heart failure, using Ketys nitrous oxide technic, it was found that no significant alterations of the cerebral circulation were present when the quantities measured were compared with values determined for a control group. A decrease in cerebral blood flow and oxygen consumption below values established for normal young individuals was demonstrated to be secondary to the presence of arteriosclerosis and not to cardiac decompensation as had previously been concluded. It was also found that in the series studied the increased venous and cerebrospinal fluid pressures were not of sufficient magnitude to affect the cerebral circulation. The factor of a decreased arterial carbon dioxide tension as a cause for diminished cerebral blood flow in cardiac decompensation was similarly considered and dismissed.

Studies on Water Excretion Following Intravenous Hydration and the Administration of Pitressin or Nicotine in Congestive Heart Failure

The diuretic response to intravenous infusions of 5 per cent glucose in water and the antidiuretic response to intravenous injections of nicotine salicylate and aqueous Pitressin, during maximal water diuresis, were studied in normal subjects and patients in congestive failure of varying severity. Patients in moderately severe congestive failure exhibited normal diuretic responses during the periods of intravenous hydration and normal antidiuretic responses following nicotine or Pitressin injections. Patients in more severe congestive failure failed to achieve comparable diuretic responses, following intravenous hydration; in the course of this, signs of increasing congestive failure developed, which were associated with further decrease in urine flows, at times, without any further decrease in renal hemodynamics. These studies confirm the impression that patients in moderate congestive failure have neither increased sensitivity to, nor reduced ability to, inactivate endogenous or exogenous antidiuretic hormone. In addition, the observation, that patients in more severe failure do not achieve adequate water diuresis during intravenous hydration, suggests that sustained production of antidiuretic production, independent of normal osmoreceptor control, may be contributing to their fluid retention.

Sarcomatous degeneration of osteitis deformans causing compression of the cauda equina.

A 84-year-old white female was admitted to the Albert Einstein Medical Center on June 7, 1958 with a four-year history of low back pain with radiation of pain into both lower extremities of four weeks’ duration. With the onset of pain radiating down her legs, the patient noted stiffness and weakness of the lower extremities upon arising in the morning, which improved as the day pro essed. The atient herself had noted no change, r u t she had teen told by friends and family that she appeared markedly shorter in recent years. Examination revealed marked tenderness to pressure over the lumbar spine; the lumbar curvature was greatly increased. Complete roentgen survey revealed advanced changes of Paget’s disease involving the left femur, right ilium, ri ht humerus,

control of intracranial pressure at operation

N IMPORTANT addition to neurosurgical A technic in recent decades has been the control of intracranial pressure at the operating table. The brain is enclosed in a rigid container and an opening through the skull not only provides access to the inside of this container but also permits the pressure from within to force the contents out. The latter will be more likely to occur when the intracranial pressure is known to be increased preoperstively, as with some brain tumors.