David M. Spain

OBSERVATIONS ON ATHEROSCLEROSIS OF THE CORONARY ARTERIES IN MALES UNDER THE AGE OF 46: A NECROPSY STUDY WITH SPECIAL REFERENCE TO SOMATOTYPES

Excerpt Recent studies on establishing criteria for the prediction of the development of coronary artery disease, investigations relating to the development of coronary artery disease in certain so...

Heart block caused by fat infiltration of the interventricular septum (cor adiposum)

Abstract A case of extensive fat infiltration of the right ventricle and interventricular septum of the heart is presented. The clinical manifestations of chronic right-sided heart failure and heart block is attributed to this anatomic change.

Platelet Thrombosis Syndrome

This paper reports the clinical and pathologic manifestations of seven cases of platelet thrombosis syndrome. Evidence is presented to indicate that vascular damage precedes the formation of platelet thrombi. It is suggested that the syndrome may be secondary to a variety of underlying disease entities.

PROBLEMS IN THE STUDY OF CORONARY ATHEROSCLEROSIS IN POPULATION GROUPS

The lesions to be discussed have been defined by two World Health Organization (W.H.O.) Study Groups, Geneva, Switzerland, as follows: “Atherosclerosis is a variable combination of changes of the intima of arteries consisting of focal accumulations of lipids, complex carbohydrates, blood and blood products, fibrous tissue and calcium deposits, and associated with medial changes.”’ “Ischemic heart disease has been defined as the cardiac disability, acute and chronic, arising from reduction or arrest of the blood supply to the myocardium in association with disease processes in the coronary arterial system.”2 More specifically this presentation will deal with the involvement of the coronary arteries by the atherosclerotic lesion. Therefore the two definitions have been joined to form the term “coronary atherosclerotic heart disease.” The walls of the major coronary arteries have a specific morphology, metabolism, enzyme system, and environment, and they are subjected to special kinds of hemodynamic stresses? These facts must be kept constantly in the foreground because, unfortunately, some of the investigations into the pathogenesis of coronary atherosclerotic heart disease have given the impression that the disease process, to quote the late Lyman Duff, is “so independent of the substrate of the vessel wall that it may occur in the absence of blood vessels them~elves.”~ Any information derived from the study of sociocultural factors that are believed to be associated with the development of coronary athersclerotic heart disease must ultimately fit within an acceptable hypothesis that will explain the development of the lesion as defined within the confines of the biological system of the human coronary arteries. Currently there are three widely discussed hypotheses that have been suggested for the pathogenesis of coronary atherosclerosis. The first is that a dietary factor or factors and/or stress (emotional or physical), and/or high blood pressure, alone or in combination, may be associated with the development of lipidemia. This lipidemia is then believed to favor the excessive accumulation of a lipid complex in the coronary arterial wall. It is from this lipid complex that the basic lesion is thought to develop? A second hypothesis states that disturbances of a primary nature in the blood coagulation mechanisms in association with vascular injury results in the deposition of a fibrin coagulum on the intimal surface of the arterial wall. These * This report is based on past and continuing studies at Beth-El Hospital, Brooklyn, N. Y.; the Department of Laboratories and Research of Westchester County, N. Y.; and the Department of Pathology, College of Physicians & Surgeons, Columbia University, New York, N. Y. Some of the autopsy studies have been made in collaboration with V. A. Bradess, Valhalla, N. Y., and some of the population studies were done in collaboration with D. Nathan, Rockville Center, N. Y. The research involved was supported in part by Grant R-745 from the Westchester Heart Association, Purchase, N. Y. and by Grant R-776 from the National Heart Institute, Public Health Service, Bethesda, Md. These studies have been aided by the cooperation of the membership of the Associated Health Foundation, New York, N. Y.

Intercoronary Anastomotic Channels and Sudden Unexpected Death from Advanced Coronary Atherosclerosis

Within the limits of the technic in this study, intercoronary anastomotic channels over 40 µ in diameter were unrelated to age and the degree of coronary atherosclerosis. Intercoronary anastomotic channels over 40 µ in diameter with one exception were found only in the presence of myocardial infarcts. Those persons who died suddenly and unexpectedly with advanced coronary atherosclerosis did not reveal any evidence of intercoronary anastomoses over 40 microns in diameter. This may be a possible factor in the inability of such individuals to survive a severe initial attack of myocardial ischemia.

Failure of Somatotrophic Hormone (STH) to Counteract Cortisone Action on Wounds in Mice.

Summary 1. 1 mg daily of somatotrophic hormone does not counteract the effect of 1 mg daily of cortisone on wound healing in mice. 2. 1 mg of somatotrophic hormone daily does not effect wound healing in mice as compared with untreated controls.

The Local Tissue Reaction in Rabbits to Gelfoam Implants Containing Desmosterol or Cholesterol.

Summary and Conclusions It would appear from this limited study in rabbits that desmosterol lying free in extra-cellular sites is not innocuous, in that it excites an intense inflammatory reaction in the subcutaneous site of implantation. The fate of desmosterol and its distribution in the body tissues is not yet known. Whether or not desmosterol may appear freely in the extra-cellular tissues of blood vessel walls as is the case with cholesterol is also not known. Because of the fact that desmosterol does incite an intense inflammatory reaction, its fate and distribution in the body should be determined before MER-29 can be considered to be a relatively safe serum cholesterol lowering agent.

DISCUSSION: SOCIOCULTURAL FACTORS IN CHRONIC ORGANIC DISEASE

The emergence of chronic organic diseases as a dominant feature of the illness pattern in the populations of the more highly industrialized areas has necessitated new approaches for the investigation of the causation of disease. The features of chronicity, multiple causation, long subclinical latent periods, and the interrelationship of genetic and environmental factors require complex approaches aimed a t their solution. Among the present problems in the study of sociocultural factors and chronic organic disease are: (1) the necessity for the development of new criteria for the determination of proof of causation in chronic disease states; (2) the availability of suitable population groups for long-term epidemiological studies; and (3) appropriate techniques to alter the cultural habits of people to alleviate or prevent disease.

GAMMA GLOBULIN DEFICIENCY IN INFANCY

Interest in gamma globulin levels in infants was stimulated by the problem of the large number of sudden unexpected deaths in infants that came to the attention of the Westchester Medical Examiner’s office, Valhalla, N. Y. These infants, in apparently good health and without any significant history, symptoms, or signs of illness, are usually found dead in a crib or carriage within hours after last being seen or fed. Years ago these deaths were considered the result of strangulation or suffocation, thought to have been brought about by smothering with bed clothes or pillows or by aspiration into the lungs of the contents of the previous feeding. As many of these infants found dead in their cribs have been found lying face up, however, as have been found lying face down. Significant numbers have been found dead during the summer season when no bed clothes are used. Careful post-mortem examinations have usually revealed no evidence of aspiration into the tracheobronchial tree. For these reasons the concept of suffocation has been abandoned. Considerations such as compression of the heart or trachea by an enlarged thymus gland, as well as numerous other theories, have likewise been discarded as untenable. Analysis of the circumstances surrounding these cases points toward infection, particularly in the respiratory tract, as being the most likely precipitating factor in the deaths of most of these infants. The extensive studies in sudden death in infancy by Werne‘ support this view. In many of these cases, however, the anatomic evidence of infection is either absent or entirely insufficient to account for the rapid course of events, especially in the absence of any previous clinical manifestations. Eighty-one of these sudden natural deaths in infants under the age of six months were studied by us during the period from 1950 to 1954. These cases were completely autopsied, and post-mortem bacteriological studies were made. No opportunity for virus studies presented itself. The usual post-mortem findings consisted of congestion of the lungs with varying degrees of edema, subpleural petechial hemorrhages, and subepicardial and pericardial petechial hemorrhages. These findings were considered merely terminal and nonspecific events. Post-mortem cultures of nasopharynx, lungs, and spleen revealed a variety of organisms, some of which were pathogens and others not. Careful search for foci of infection or inflammation revealed that of the 81 cases, 26 had significant respiratory infections; 21 had only minimal evidence of focal inflammation, most frequently found in either the upper and/or lower respiratory tracts; and 34 had no significant anatomic findings whatsoever. None of these cases presented any anatomic evidence of intestinal infection. This was to have been expected because cases with a previous history of diarrhea would

Post-Mortem Procedures: An Illustrated Textbook

In this country, in recent years, there has been a steady decline in the number of postmortem examinations. Part of this failure to obtain autopsy consents is based on a lack of public education concerning their value. But equally contributory are the unfortunate attitudes of too many clinicians, derived from their lack of appreciation of the many purposes served by the postmortem examination. A properly performed autopsy is invaluable, if not essential, to forensic medicine and in the primary education of medical students and the continuing education of physicians. The autopsy permits the determination of the definitive cause of death in difficult and puzzling cases and the development of ongoing data bases for medical research and epidemiologic studies. We evaluate the quantitative and qualitative accuracy of laboratory tests and other techniques by the type and character of the pathological alterations in the various tissues of the body, as revealed at