Eugene B. Ferris

HYPERVENTILATION: ANALYSIS OF CLINICAL SYMPTOMATOLOGY

Excerpt Hyperventilation is a common enough occurrence in clinical practice to justify further study of this phenomenon. Although the symptoms of hyperventilation are well known they are often over...

Life situations, emotions, and the course of patients with arterial hypertension.

THERE is a good deal of evidence to suggest that there is a close relationship between emotional tension and the diffuse arteriolar spasm of hypertension. This evidence has been garnered from several different types of clinical and laboratory research. In laboratory animals Selye has produced evidence which indicates that hypertension may be one of the diseases of adaptation, and suggests that hypertensive disease may be a manifestation of reaction to emotional stress (8). Psychoanalytic studies have revealed evidence of severe and early psychological trauma in patients with hypertension, and the findings strongly suggest that the elevated blood pressure of hypertensive patients may be an expression of suppressed and repressed hostility and rage ( i , 2, 7). Clinical studies of the parallel medical and psychological histories of patients with hypertension have suggested a close relationship in time between specific emotional events and significant occurrences in the natural history of the disease (1, 2, 7, 9). Weiss has reported several interesting and provocative studies of patients in whom the onset of benign hypertension, or the precipitation of the malignant phase, could be correlated with highly significant life events (9). We obtained similar findings in a study

QUANTITATIVE ELECTROENCEPHALOGRAPHIC STUDIES OF ANOXIA IN HUMANS; COMPARISON WITH ACUTE ALCOHOLIC INTOXICATION AND HYPOGLYCEMIA.

That disturbances in consciousness, and consequently in behavior, are produced by anoxia is well known. The clinical picture is essentially that of delirium, a syndrome in which we have pointed out that the primary psychologic symptom is a reduction in the level of consciousness (1). With moderate or severe degree of anoxia the changes are grossly obvious. The evaluation of the harmful effects of mild degrees of anoxia, however, has proven extremely difficult due to the lack of accurate methods of measuring such effects. Such measurements are of obvious importance to aviation medicine and are of interest in studies of the earliest changes in delirium. So far, the most satisfactory methods have concerned changes in visual functions. Various performance and psychological tests have all proven relatively unsatisfactory due to the wide range of individual responses, doubtless influenced by motivation and emotional factors. In such studies statistical analyses of a large number of subjects indicate that significant degrees of impairment of performance begin around 12,000 feet (483.3 mm. Hg). Numerous investigators have reported the effects of anoxia, hypoglycemia, and various drugs on the electroencephalogram, but for the most part, these studies have been concerned with the more marked changes. The demonstration of a close relationship between changes in frequency distribution in the electroencephalogram and levels of consciousness (1) and the development of a quantitative method for analyzing electroencephalographic frequency spectra (2) offer a practical approach to the study of cortical function during mild to moderate degrees of anoxia. The

Psychologic mechanisms in malignant hypertension.

HYPERTENSIVE cardiovascular disease is essentially a nonepisodic condition in which there is no clear-cut relationship between symptoms and structural change. For this reason, it is often quite difficult to establish, with any degree of certainty, the exact date of onset or to reconstruct satisfactorily the previous course. The transition from the benign to the malignant phase, however, represents a relatively well delineated episode and thus provides the clinical investigator with an excellent opportunity for the study of psychosomatic relationships and mechanisms in hypertension. As part of a comprehensive study of this disease, we have investigated 12 patients who were in various stages of the transition from benign to malignant hypertension. In each of these patients, examination of the relationship between the life history and the medical course of the disease revealed that the precipitation of the malignant phase could be chronologically correlated with emotionally significant life situations or events. In 8, where the time of onset of benign hypertension seemed reasonably clear, similar correlations could be made. The primary emphasis of this project was centered upon a simultaneous study of the medical, psychiatric, and physiologic aspects of the transition from the benign to the malignant phase of hypertension in each patient. This report then represents an exploratory effort to arrive at some understanding of the interrelationships involved in this basic phase of the hypertensive problem. This group of patients represented routine hospital admissions and were selected only on the basis of their ability to communicate adequately.

VOLUNTARY BREATHHOLDING. II. THE RELATION OF THE MAXIMUM TIME OF BREATHHOLDING TO THE OXYGEN TENSION OF THE INSPIRED AIR

The striking effect of 100 per cent oxygen in lengthening the period of voluntary breathholding became apparent to us during experiments concerned with underwater weighing, in which it was desirable for the subjects to remain immersed as long as possible. Although a few observers (1, 2) have noted this effect of oxygen previously, it has received very little attention in the literature since World War I; and some, notably Schneider (3), concluded that oxygen had a relatively insignificant influence upon the breathholding time. The studies reported herewith were originally presented (4) as a method for demonstrating objective physiological effects of relatively small changes in altitude (PO2, oxygen tension). This seemed important, because most functional tests of anoxemia do not reveal changes until altitudes of 12,000 to 16,000 feet are reached. These studies show conclusively that a close relation does exist between variations in maximum voluntary breathholding time and those of the PO2 of inspired air. This relationship is of interest, because it offers a simple quantitative functional test which is sensitive to relatively slight changes in pO2 of inspired air, and also because it throws considerable light on the interrelation of oxygen and CO2 as stimulants which force the subject to start breathing after a period of breathholding.

THE EFFECTS OF INTRAVENOUSLY ADMINISTERED VERATRUM VIRIDE IN HYPERTENSIVE AND NORMOTENSIVE SUBJECTS

Excerpt INTRODUCTION Recent studies by Freis and his co-workers have demonstrated that veratrum viride produces a fall in blood pressure not associated with a change in cardiac output or a signific...

Role of Pressor Substances in Etiology of Arterial Hypertension

The theory that circulating substances play an etiological role in arterial hypertension has been revived recently by a series of studies carried on by Bohn and his associates. 1 ,2,3 These investigators of the Volhard clinic have reported the finding of increased amounts of pressor substances in the urine and in the blood of patients with “pale hypertension” (Volhard). In view of the important implications of Bonns conclusions, we have reinvestigated this problem. Because of the fact that several hormones and chemical substances are present in greater concentration in the urine than in the blood, and because large amounts of urine are readily obtainable for maximum chemical concentration, we have studied particularly extracts of urine. Blood and chest, abdominal and cerebrospinal fluids were also tested, both before and after extraction. In order to ascertain the efficacy of the alcohol-acetone fractionation of pressor and depressor substances, we have tested biologically not only the alcohol but also the acetone fraction, whereas Bohn utilized only the former. Twenty-one subjects were studied, 8 of whom were normal, 7 had malignant hypertension, 2 benign hypertension, and 4 chronic glomerulonephritis with hypertension. Extraction of a number of 24-hour urine specimens on each subject was performed. A total of 120 extracts were repeatedly tested on 55 cats. Dial and amytal given intraperitoneally were used as anesthetics, but comparative observations were also made of the effect of identical extracts on animals anesthetized with ether, chloral hydrate and urethane. Care was taken to test the same extracts in different animals, as well as to test different extracts obtained from the same subject in the same animal.

ARTERIALIZATION OF INTERNAL JUGULAR BLOOD DURING HYPERVENTILATION AS AN AID IN THE DIAGNOSIS OF INTRACRANIAL VASCULAR TUMORS

Excerpt The diagnosis of intracranial vascular tumors is important because treatment is, as a rule, nonsurgical; often roentgenological treatment is the procedure of choice. In the diagnosis of vas...

OBSERVATIONS ON THE USE OF THE RESPIRATOR IN REFRACTORY STATUS ASTHMATICUS

Excerpt Introduction Recent advances in our knowledge of the nature and management of bronchial asthma have contributed greatly to the intelligent handling and well being of patients afflicted with...