Edward Weiss

Evaluation of Stimulation and Suppression Tests in the Etiological Diagnosis of Cushing's Syndrome

Abstract An evaluation of dexamethasone suppression, metyrapone and adrenocorticotrophic hormone (ACTH) stimulation, plasma radioimmunoassayable ACTH, and retrograde adrenal venography in the diffe...

THE EMOTIONAL PROBLEMS OF HIGH BLOOD PRESSURE

Excerpt The organic tradition in medicine has been responsible for a narrow (physical) view of the etiology, pathogenesis and treatment of essential hypertension. The psychosomatic approach does no...

Modern concepts of hypertension and its treatment

Abstract Moderator Hafkenschiel : This seems to be an appropriate time to stop and sum up and emphasize a few of the important points in the day-to-day management of patients with high blood pressure. I have asked Dr. Wolferth to be prepared to do this because of his long experience as a clinician and a teacher. This latter period began in 1920 when he returned from service in France and England in World War I and rejoined the faculty of the University of Pennsylvania as Associate in Medicine. I am happy to say he continues to teach in the University Hospital to the present day, even though he has been emeritus for four years. Dr. Wolferth : I have been rather pleasantly surprised or astonished, if that is the word, this afternoon to find that our areas of disagreement were far less than I had anticipated. I am sure we all are impressed by the importance of the psychogenic aspects of blood pressure and the value of paying attention to such matters in the treatment of our patients. There are other factors concerned in hypertension that must be considered, and these have been very well brought out especially by Dr. Clarks discussion of the role of the kidneys. I think he has brought us up-to-date in that field. How are we going to make further progress? I believe that the neurophysiologists will help us as time goes on. The endocrinologists may help us to attain some breakthroughs that we very urgently need. We need much more information. If we have to place 85 per cent of our patients in the grabbag of essential hypertension, which means hypertension the etiology of which we do not know, then we have not made satisfactory progress in the study of the etiology of this disorder. You have noticed this afternoon that all of us in our discussions of treatment have been groping for etiologic factors, be they psychogenic, neurogenic, or humoral. Recent progress in the finding of disturbances of arterial blood supply to the kidney, for which Goldblatt had prepared us long ago, has taken a few cases out of the grabbag. There is other work going on that has exciting possibilities. What about the roles of norepinephrine, and serotonin in central nervous system tissues? What help are we going to get there? We have made great progress in drug therapy, despite the differences of opinion that have appeared here. The newest of these drugs as of today is chlorothiazide. The future looks bright. I think the problems of hypertensive disease are on the way to solution, but there is still a great deal of work that needs to be done.