John L. Juergens

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.

Thrombophlebitis associated with pregnancy

Abstract Of 32,337 pregnant patients observed, 457 had significant superficial or deep thrombophlebitis either during or following termination of pregnancy. Superficial thrombophlebitis was diagnosed in 52 patients during pregnancy and 341 after pregnancy; deep thrombophlebitis occurred in 17 patients during pregnancy and in 47 after it. Although anticoagulant medications were not used for treatment of superficial thrombophlebitis during pregnancy, they commonly were administered for severe superficial thrombophlebitis that followed pregnancy. All patients who had deep thrombophlebitis were treated with anticoagulant drugs. Only 13 of the 32,337 patients developed pulmonary embolism in association with pregnancy. All patients who developed thrombophlebitis or pulmonary embolism recovered after treatment without serious sequelae.

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.

Carpal-tunnel Syndrome Associated with Vasospasm

Twenty-eight patients with concurrent carpal-tunnel syndrome and Raynauds phenomenon or acrocyanosis were studied. Fifteen had a definite diagnosis or presumptive evidence of a systemic disease. Thirteen patients were treated conservatively and fifteen had decompression of the transverse carpal ligament. All patients treated surgically had an excellent result in regard to the carpal-tunnel symptoms, whereas in the group treated conservatively only three showed improvement. Six patients treated surgically had excellent or good results in regard to their vascular symptoms and nine had fair or poor results; in the group conservatively treated, one noted improvement and ten were unchanged or worse. Early surgical treatment of these combined syndromes appears warranted.

Acute superficial venous thrombophlebitis associated with pregnancy

Abstract Among 25,082 pregnant patients observed during a 14 year period (1951 through 1964), 381 had either superficial or deep venous thrombosis during or after pregnancy. Three hundred and thirty-four patients had superficial thrombophlebitis; 37 had the onset during pregnancy and 297 had it after termination of pregnancy. Although anticoagulant drugs were not employed for superficial thrombophlebitis during pregnancy, they were commonly administered for severe superficial thrombophlebitis during the postpartum period. Sixty per cent of the patients required additional hospitalization because of the superficial thrombophlebitis. The one patient who developed postpartum pulmonary embolism recovered uneventfully.

Calcification of vessels in cheek of patient with medial arteriosclerosis

T he demonstration of calcified vessels in the cheeks by means of routine dental roentgenograms is infrequent. It is possible to mistake these calcifications for artifacts or imperfections arising during development of the roentgenogram; nevertheless, oral and roentgenologic examination may be the first opportunity for detection of the signs or symptoms of a systemic vascular disease. The case to be reported illustrates the presence of calcifications in the facial artery.

Rate of Disappearance of Cholesterol-C14 from the Bloodstream of Dogs.

Summary A simplified technic is offered for measuring plasma cholesterol-C14 after intravenous injection of this sterol; it consists of liquid scintillation counting of an alcohol-acetone extract of the plasma. The distribution of cholesterol-4-C14 in 2 normal dogs was calculated from a 60- to 70-day study of plasmatic radioactivity, assuming a 4-compartment mammillary system. Excretory rate constants of 1.5 and 1.6% per day of the retained dose were derived. Preliminary estimates of the “exchangeable cholesterol pool” were made. The size of this pool appeared to increase as serum cholesterol rose, either as the result of a high fat diet or of thyroidectomy.