Edward B. Krumbhaar

A frequent obstructive anomaly of the mouth of the left common iliac vein

Abstract This study of the opening of the left common iliac vein into the inferior vena cava is based on the examination of 412 bodies: 97 stillborn babies and infants up to 10 months old, 28 children from 1 to 9 years of age, 23 adolescents from 10 to 19 years of age, and 264 adults up to 90 years of age. The width of the opening first increased rapidly with increasing age, and later more slowly. The curve reached its peak during the seventh decade. A valve was found to be normally present in the newborn at the lower pole of the opening, but it appeared to be worn off in an ever greater percentage as age progressed, and more so in obstructed than in normal openings. This observation seems to be significant with regard to the cause of varices of the lower extremities, which have often been explained as a result of venous valvular insufficiency. Obstruction of the orifice in the 399 cases analyzed was observed in 95 instances (23.8 per cent), with a possibility of 16 more instances in the stillborn and infants. It was less common in children and babies (4.7 per cent), although, if the 16 doubtful cases are included, the percentage rises to 17.3 per cent. In those over 10 years of age, it was found 89 times (33.8 per cent). It occurred with equal frequency in males and females, and in whites and Negroes. According to location and other criteria, the obstructions could be divided into five groups (Figs. 3 and 4). The most common site of obstruction was the upper pole of the orifice, where two-thirds of all obstructions were found. Concerning the pathogenesis of the obstructions, few, if any, were thought to be caused by faulty development, per se. They appeared to be acquired during the growth period, rarely before birth, and rarely after adolescence. As to the mechanism involved, it was observed that the obstructions occurred at a point where the right iliac artery crosses and exerts pressure on the vein. This pressure conceivably interferes with the proper development of the opening into the vena cava or causes an injury resulting in organization and fibrosis. In a small number of cases the obstructions could be shown to be organized thrombi. The clinical significance of the obstructions is apparent from the greater frequency of thrombosis in the left than in the right leg. This preponderance could be confirmed in our material, as well as in an analysis of 1,000 consecutive autopsies from one of our hospitals.

AN ARTICLE CONTRIBUTED TO AN ANNIVERSARY VOLUME IN HONOR OF DOCTOR JOSEPH HERSEY PRATT: THE EFFECTS OF LARGE DOSES OF BENZEDRINE SULPHATE ON THE ALBINO RAT: FUNCTIONAL AND TISSUE CHANGES

Excerpt Of the synthetic preparations of the epinephrine group, benzedrine (phenylisopropylamine) is in some respects more efficient than epinephrine and ephedrine, and also has additional therapeu...

TRANSIENT AURICULAR FIBRILLATION: AN ELECTROCARDIOGRAPHIC STUDY

In this communication are presented the results of a detailed study, by means of the electrocardiograph, of six individuals exhibiting the change from a normal heart rhythm to that of auricular fibrillation. Although the disturbance of cardiac mechanism that causes this type of cardiac irregularity—incoordinate contraction or fibrillation of the auricular musculature—has been understood only during the past few years, its clinical prototype, the pulsus irregularis perpetuus of Hering, or the totally irregular pulse, has for years been recognized as one of the commonest as well as one of the gravest forms of cardiac arrhythmia. Perhaps from the widespread use of Herings terminology, however, the erroneous impression has been prevalent that this condition once present is practically always permanent. Already a sufficient number of cases have been published to combat this view, so that we must now consider that auricular fibrillation, like the other disturbances of the

A historical sketch of the School of Medicine of the University of Pennsylvania.

An advertisement in the 1765 Pennsylvania Gazette described the course as follows: “Dr. Shippens course of Anatomical Lectures will begin on Thursday, the 14th of November, 1765. It will consist of sixty lectures, in which the situation, figure and structure of all parts of the Human Body will be demonstrated on the fresh subject; their respective uses explained, and their Diseases, with the Indications and Methods of Cure, briefly treated of; all the necessary Operations in Surgery will be performed, a course of Bandages given, and the whole will conclude with a few plain and general directions in the Practice of Midwifery. Each person to pay six Pistoles.”