Grace M. Roth

The Changes in the Intra-Arterial Pressure during Immersion of the Hand in Ice-Cold Water

The response of the intra-arterial pressure to the cold immersion stimulus was studied in 42 healthy young adults, continuous direct (arterial-pressure) recording being used. The average systolic elevation was 22.6 mm. Hg and the average diastolic elevation was 16.3 mm. Hg. The difference between direct and indirect methods of measuring blood pressure was studied in 351 simultaneous determinations in 35 of these young adults. The direct systolic pressure averaged 9.7 mm. Hg higher and the diastolic pressure was 7.3 mm. Hg lower than the indirect measurement.

Pharmacologic and Chemical Tests as an Aid in the Diagnosis of Pheochromocytoma

Today pharmacologic and chemical tests are helpful in screening a relatively large number of patients for pheochromocytoma and are a definite aid to a correct diagnosis. No one test is infallible, and knowledge concerning the drugs used or the manner in which the blood and urine are collected, or both, is necessary to avoid a false-positive or false-negative result from the tests.

The cardiovascular effects of smoking with special reference to hypertension.

Tobacco long has been suspected of being an etiologic factor in cardiovascular disease, and different types of investigations have been carried out to prove or disprove the relationship. We have been particularly interested in this problem because of our close association with the problems of smoking in peripheral vascular disease and hypertension. Because the man in good health may feel that smoking is bad only for one who is ill, it is important to determine the effect of smoking on normal individuals. One would expect little difficulty in determining the effect of smoking tobacco on the circulation of normal individuals. However, all methods of measuring peripheral blood flow in man are indirect, and each has its own inherent error. Some of the confusion in the results of smoking tests has arisen because too little attention has been paid to certain factors concerning the status of the individual. The most important of these factors are (1) the environmental temperature, (2) the position of the subject, particularly the extremities, (3) the taking of food and (4) the basal metabolic rate.2 All must be considered whenever measurements of peripheral blood flow are made. Our standard smoking test, which used the skin temperatures as a measurement of blood flow, took into consideration the four factors just listed and also required simultaneous observations of blood pressure and pulse rates.

Relation of Basal Metabolic Rate to Vasodilatation and Vasoconstriction of the Extremities of Normal Subjects as Measured by Skin Temperatures

Various indirect methods of measuring blood flow in the peripheral blood vessels of man are available. Irrespective of the method used for measuring blood flow, certain fundamental factors concerned with the status of the subject or patient influence the measurement of blood flow. These factors are environmental temperature, position of the extremities and food. The present investigation indicates that a consideration of the basal metabolic rate or basal heat production is another important factor.

Direct Arterial Study of the Blood Pressure Response to Cold of Normotensive Subjects and Patients with Essential Hypertension before and during Treatment with Various Antihypertensive Drugs

The cold pressor test was performed three times at 15-minute intervals on 65 normotensive subjects and on 60 patients with essential hypertension both before and during treatment with antihypertensive drugs. The arterial pressure was recorded directly from the radial artery. On the basis of differences in the cold pressor response among individuals in the control group, the criteria for normal reaction and for hyperreaction were modified. The cold pressor response in the patients with essential hypertension was markedly depressed by the ganglionic blocking agents, but was not affected by various combinations of hydralazine, protoveratrine and reserpine.

Effects of Alcohol and Nitroglycerin On Vascular Responses in Man

* Chief, Section of Cardiovascular Physiology, Department of Clinical Physiology, Scott and White Clinic, Temple, Texas. † Section of Internal Medicine, Lovelace Clinic, Albuquerque, New Mexico. ‡ Director, Vascular Laboratory, Lovelace Clinic, Albuquerque, New Mexico. § Ellab, Type 28, Electrolaboratoriet, Copenhagen. ¶ Beckman Instrument Co., Fullerton, California. ∥ Honeywell Visicorder—1508. The treatment of peripheral vascular disease is often influenced by subjective information concerning the response of patients receiving a variety of vasodilatory drugs. Little convincing evidence has been presented to establish whether

Editorial Some Aspects of Pheochromocytoma

THE diagnosis and management of pheochromocytoma still impose problems, although ordinarily the diagnosis is not too difficult. Many of the 66 patients in our series who were later proved to have pheochromocytomas at operation or at necropsy were referred to our associates or us with the diagnosis already made or strongly suspected. On the other hand, we could not verify the previous diagnosis of pheochromocytoma in many cases. Because of the type of operation and the operative risk, the correct preoperative diagnosis is most important. Pheochromocytomas, tumors of the medullary portion of the adrenal gland, cause paroxysmal or persistent hypertension. In general, patients whose tumors are secreting epinephrine and norepinephrine intermittently have paroxysmal hypertension, and those whose tumors are secreting pressor substances continuously have persistent hypertension. All patients with paroxysmal hypertension ctomplain of spells or attacks. Excruciating headaches, usually of only 1 to 15 minutes duration, are the commonest symptom, but frequently they are accompanied by drenching sweats and palpitation. Occasionally paroxysmal sweating and palpitation may occur in a patient without headache but with an unusually high basal metabolic rate. Also present can be tachveardia, nervousness, tremor, dyspnea, great anxiety, pallor or flushing of the face, nausea and vomiting, varying

EFFECTS OF SMOKING OF TOBACCO ON THE CARDIOVASCULAR SYSTEM OF NORMAL PERSONS AND PATIENTS WITH HYPERTENSION

Although considerable evidence is available that the smoking of tobacco produces constriction of the blood vessels and changes in the electrocardiogram, some lack of agreement among investigators still remains. With more refined methods and better controls perhaps further agreement can be obtained. All methods of measuring blood flow in man are indirect. However, irrespective of the methods, fundamental factors concerned with the status of the subjects, which bear directly on the measurement of blood flow in the extremities must be considered. These appeared to be 1) the environmental temperature; 2) the position of the subject, particularly of his extremities; 3) the taking of food; and 4) the basal metabolic rate.

Simultaneous Determination of Temperatures of Skin and Muscle before and after Lumbar Sympathectomy

A group of 26 patients who had peripheral occlusive arterial disease of the lower extremity were studied before and after chemical or surgical unilateral lumbar sympathectomy. The temperatures of the gastrocnemius muscle and of the skin of the sural area were determined simultaneously preoperatively and postoperatively. Only patients who had undergone successful unilateral lumbar sympathetic denervation based on the postoperative area of anhidrosis were included. The data were obtained under basal conditions among the 26 patients, and the persons studied were divided into two groups. Group 1 was composed of 17 patients (65 per cent) who had a definite parallel increase of 1.2 C. in the temperature of the gastrocnemius muscle and the skin after unilateral sympathectomy. In group 2 (nine patients or 35 per cent) the temperature of the gastrocnemius muscle and the skin of the sural area was unchanged after unilateral sympathectomy. Since none of these patients were suitable for surgical bypass arterial-grafting procedures and all were in the older age group, not too much could be expected from the standpoint of an increase in temperature. However, when the temperature of the skin after operation increased, the temperature of the gastrocnemius muscle also increased.

Effect of Nylidrin Hydrochloride On the Skin and Muscle Temperatures of Patients With Occlusive Arterial Disease of the Lower Extremities

new drug of this type is accompanied by considerable enthusiasm, which soon is followed by disappointment when the lack of permanent and objective results becomes apparent. Many drugs, promising at first, later fall into oblivion. On the other hand, encouraging results have been reported with different vasodilators in several clinical studies. Because of the difficulty in distinguishing between purely symptomatic improvement and a true increase in arterial blood flow, it is important to obtain objective evidence of increased blood flow through the affected tissues. The present study was undertaken to determine the effects of a new vasodilator substance, nylidrin hydrochloride,§ § on the skin and muscle temperatures of patients with occlusive arterial disease of the lower