John F. Fairbairn

Aneurysms of the Thoracic Aorta A Clinical Study with Special Reference to Prognosis

The clinical features and follow-up data on107 patients who had a clinical diagnosis of aneurysm of the thoracic aorta made at the Mayo Clinic in the period 1945 through 1955 were reviewed. The ratio of male to female was 2.8 to 1, and the average age at the time of diagnosis was 59.3 years. Fusiform aneurysms were four times as frequent as saccular aneurysms; the most common location of the former was the descending thoracic aorta and of the latter the ascending thoracic aorta. Most of the aneurysms (73 per cent) were probably arteriosclerotic in origin. Symptoms, usually pain, and physical signs were present in a minority of patients and indicated a large aneurysm with a poor prognosis.Diastolic hypertension was present in almost half of the patients at the time of diagnosis and had an adverse effect on the patients survival. Associated arteriosclerotic cardiovascular disease was present in 40 (37 per cent) of the patients at the time of diagnosis; some of these patients had multiple associatedcardiovascular lesions. The presence of associated coronary, cerebral, or other peripheral arterial occlusive or aneurysmal disease had the most deleterious effect on survival. The prognosis for patients with large aneurysms was poorer than for those with small aneurysms.Information as to the cause of death was available in 59 (83 per cent) of the 71 patients known to be dead at the time of follow-up. Approximately a third of the deaths were due to rupture of the thoracic aortic aneurysm, and approximately a half, to associated cardiovascular disease, particularly that due to arteriosclerosis.It is believed that this study of patients with untreated aneurysms of the thoracic aorta may be used as a guide to the selection of patients with aneurysm for surgical treatment and may serve as a basis for evaluating the long-term results of such treatment.

Erythermalgia: Review of 51 Cases

The syndrome of erythermalgia is characterized by a burning distress of the extremities that is accompanied by redness and increased temperature of the skin. These symptoms are initiated or exacerbated by an increase in environmental temperature and diminished by measures that cool the skin. Of 51 patients with this clinical syndrome seen at the Mayo Clinic during the years1951 to 1960 inclusive, 30 were considered as having primary erythermalgia because of the absence of demonstrable associated conditions, and the rest were classified as having secondary erythermalgia because the condition was associated with various diseases. Particularly significant was the relation of erythermalgia to the myeloproliferative disorders as evidenced in 10 cases. In some of these cases, erythermalgia preceded other manifestations of the myeloproliferative disorder by as long as 12 years. The primary type was found to occur in younger individuals and to be more often bilateral, to produce pain of greater intensity, and to involve larger areas of the affected extremities. The pathologic physiology of this syndrome remains unknown.

Abdominal Aortic Aneurysms A Reappraisal

Of 141 patients with abdominal aortic aneurysms diagnosed at the Mayo Clinic from 1950 through 1959 who were not operated on, follow-up information was obtained from 137 patients (97.1 per cent). Of those followed 1 year or more, 87.6 per cent survived 1 year or more; 52.5 per cent survived 3 years, and 36.4 per cent survived 5 years after diagnosis. These results indicate that the prognosis of abdominal aortic aneurysm in this selected group of patients was somewhat better than that previously reported. The prognosis and survival of patients who had a history of associated cardiovascular disease at the time of diagnosis of aneurysm is distinctly less good than those of patients who had no such history. Of those with such a history, 75.0 per cent survived 1 year, 33.3 per cent survived 3 years, and 20.0 per cent survived 5 years. Of those without such a history 95.7 per cent survived 1 year, 63.2 per cent survived 3 years, and 50.0 per cent survived 5 years. Patients with abdominal aortic aneurysms and associated cardiovascular diseases are more likely to die of cardiovascular complications other than ruptured aneurysms. Patients with abdominal aortic aneurysms who have no evidence of associated cardiovascular disease are more likely to die from a ruptured aneurysm than from anything else. It would appear that small asymptomatic abdominal aortic aneurysms in patients with associated cardiovascular disease may be carefully observed until signs of expansion of the aneurysm or symptoms from the aneurysm appear.

Hypertension and renal artery stenosis: Serial observations on 54 patients treated medically

Medical treatment of hypertension was undertaken in 54 selected patients with arteriographically proved stenosis of the renal artery (32 with atheromatous and 22 with fibromuscular lesions). At follow‐up study (average, 20.3 months), 65 per cent of 49 surviving patients were normotensive on a regimen of common antihypertensive drugs in usual doses. There also was improvement in the hypertensive changes noted in the optic fundus. In 13 patients, additional cardiovascular episodes complicated the hypertensive disease and 5 of these patients had died. The frequent long duration of hypertension and frequent bilateral involvement of the renal arteries necessitate caution in recommending surgical treatment when: (1) the situation technically demands nephrectomy; (2) there are renovascular lesions in the absence of significant hypertension; (3) arteriographic and renal function data are discordant; and (4) there is associated severe symptomatic cardiovascular disease, old age, or other infirmities.

Trauma, ischemic limbs and amputation.

A survey was made of 55 patients who underwent amputation of 58 extremities for gangrene. Trauma of some sort preceded 36 of these amputations. Sixty percent of the patients were diabetic. To avoid trauma and its effects, patients with ischemic limbs should not smoke and should care for their feet and avoid injuries of any sort.