Franklin Simon

Cholesterol reduction in patients with arteriosclerosis.

* Attending in Medicine, Newark Beth Israel Hospital, Newark, New Jersey; Director and Attending Physician, Heart Institute, United Hospitals of Newark. t Assistant in Medicine, Newark Beth Israel Hospital, Newark, New Jersey. ‡ Sodium dextrothyroxine for this study was made available as Choloxin by Thomas A. Garrett, M.D., Medical Director, Flint, Eaton and Company, Division of Baxter Laboratories, Inc., Morton Grove, Illinois. INTRODUCTION

Primary thrombocytosis and anginal syndrome.

Abstract Two cases of angina pectoris complicated by primary thrombocytosis in which reduction of the platelet count with radioactive phosphorus relieved the angina are reported. Hematologic studies including platelet counts should be performed on young patients with symptoms and signs of coronary artery disease.

The treatment of cardiovascular symptoms of vasomotor origin.

With the advent of the tranquilizers, there has been added a new most valuable group of preparations for the treatment of the anxious patient. However, it became obvious to us, as we began to use these new drugs, that they did not often help in the control of the vasomotor symptomatology of many of our patients-particularly those who complained of headache, sweating, palpitation, and flushing such as are typically seen in the menopausal or anxious patient. For some years, we have used a combination of three active neurotropic drugs rather than the commonly used brainstem sedative phenobarbital alone in our patients with the psychomotor symptoms mentioned above. This use was based

The effect of sodium dextrothyroxine on serum cholesterol and mortality rates in cardiac patients.

atherosclerotic disease process, but it was not until the Framingham prospective studyl, 2, 3 indicated a positive correlation between elevated cholesterol and the risk of developing coronary artery disease that the incentive for decreasing serum cholesterol levels became clear. Not until Paul Leren’s impressive study4 was there evidence that lowering serum cholesterol could be of therapeutic value. Now, elevated cholesterol is recognized as an important risk factor associated with death from coronary artery disease, and is included in the statement on risk by the American Heart Association.5 In our hands, diet therapy for elevated cholesterol is unsuccessful since it is totally dependent upon strong patient motivation. Even obese and diabetic

THE TREATMENT OF SHOCK ACCOMPANYING MYOCARDIAL INFARCTION.

In patients with myocardial infarction, from 5 to 17 per cent will develop shock which has a mortality rate of from 80 to 90 per cent when untreated.’ In these patients, there is a reduced stroke volume accompanied by tachycardia and peripheral vasoconstriction.2 It has been postulated by some that it is the failure of adequate vasoconstriction to compensate for the degree of fall in cardiac output that is the essential problem in shock accompanying myocardial infaretion.3 , 4 However, it was also once thought that the drop in blood pressure after infarction was beneficial. But, Corday and his associates 5 in 1949 showed that, in dogs, there was a loss of contractility and

The Treatment of Obesity in Patients with Cardiovascular Disease

optimal health and he is, in fact, threatened with a lessened life expectancy because of his increased susceptibility to the so called &dquo;degenerative disorders,&dquo; as well as to other diseases. The high incidence of obesity presents an actual problem in public health, the magnitude of which is presented in insurance statistics which clearly define the increased mortality rates for overweight patients, especially those over the age of 45.2 It appears that a decrease in life expectancy may be correlated with the degree of obesity within certain limits.3, 4 Overweight of 25 per cent or more raises the mortality by 74 per cent above that of persons of normal weight.5 The threat to survival effects young adults as well as the more aged. Human experience in this respect is borne out by experimental studies with animals in which it

ORAL MERCURIAL DIURESIS

The constant search of the pharmacologist and clinician for a safe, acceptable and effective oral diuretic points up the continued need for such a product and its extreme usefulness in medical practice. Certainly, an oral preparation has obvious advantages: 1. Diuresis at a slow and regular rate with the avoidance of acute, often uncomfortable, diuresis (1) which frequently results in marked alterations of fluid and electrolyte balance. Rapid, intense diuresis has been known to induce attacks of gout (2), tetany (3), cerebral thrombosis (4), and digitalis intoxication. 2. Ease of administration, which means not only greater acceptability by the patient at less expense than professionally administered medication, but also the absence or reduced frequency of painful injections when the oral preparation is effective. The use of a potent parenteral product obtained from a multiple-dose vial and given subcutaneously as one would give insulin (5) was a great step forward in diuretic therapy. An oral preparation with the required features, used in conjunction with such a product, would make a valuable combination. Acceptability by the patient determines in very great part the usefulness of a diuretic, and thus the medical control of the congestive picture.