Lionel M. Bernstein

Intravenous procaine amide in the treatment of cardiac arrhythmias.

Abstract 1.1. Thirty-three patients with forty episodes of paroxysmal tachycardia were treated with procaine amide administered intravenously. 2.2. Ten of thirteen episodes of supraventricular tachycardia were converted to sinus rhythm. None of eight episodes of auricular flutter treated were converted. The ectopic focus was suppressed in all of twenty episodes of ventricular tachycardia treated. 3.3. Hypotension and widening of the QRS complexes were noted. Hypotension was controlled by infusions of l-norepinephrine. Convulsions and death in one instance followed procaine amide therapy.

Osmotic Diuretic Treatment of Refractory Edema

Many patients with edema of congestive cardiac failure, nephrosis, and cirrhosis become refractory to all diuretic therapy. Theoretically, the use in adequate dosage of osmotic diuretics whose action is dependent upon physical factors should augment sodium, chloride, and water excretion from whatever level exists prior to their use. In refractory edema, the effect of other diuretics (via alteration of the metabolic, actively resorbing mechanisms of the tubular cells) on tubular rejection of sodium, chloride, and water should be increased by osmotic diuretics. Mannitol was administered intravenously in large doses to test the effectiveness of osmotic diuretics in refractory edema.

Arterenol as an adjunct to the treatment of paroxysmal tachycardia

Abstract The use of l -arterenol is described for maintaining adequate levels of blood pressure during the treatment of paroxysmal tachycardia with intravenous procaine amide. This measure appears to permit the use of larger doses of procaine amide than could otherwise be tolerated and thus facilitates termination of the paroxysm.

Inositol and Mannitol Hexanitrates in Hypertension Management

This clinical study was undertaken because the clinical literature dealing with the use of mannitol and inositol hexanitrate and to a large extent other nitrites and nitrates which have been used in the management of hypertension fails to consider the development of tolerance. It was found that tolerance to the vasodilator action of mannitol and inositol nitrate develops in from 8 to 14 days and is lost completely within 10 days after withdrawal of the drug. The use of these nitrates should be carefully individualized by determining the optimal dose and the period required for the development and loss of tolerance.

Intravenous procaine amide as an aid to differentiate auricular flutter with bundle branch block from paroxysmal ventricular tachycardia.

Abstract In five cases of auricular flutter with bundle branch block simulating paroxysmal ventricular tachycardia the true diagnosis was established by the electrocardiographic changes following intravenously administered procaine amide.

Formal decision supports in medical practice and education

Several formal, quantitative techniques have been developed to help physicians make diagnostic and treatment decisions. Despite the precision of these models, as well as growing documentation of systematic errors in intuitive reasoning, most clinicians choose not to utilize decision supports. This may be due to weaknesses inherent informal models, practical problems implementing them in the clinical environment, or psychological discomfort that arises when physicians try to quantify diagnostic and therapeutic uncertainty or patients’ preferences. An examination of these difficulties, however, does not reveal an adequate basis for rejecting formal decision techniques. Quantitative decision aids can have a positive impact on clinical reasoning and can provide a valuable educational tool for structuring clinical problems. These models can be used to help teach students how to select, structure, and process clinical information. Medical educators now have available models that will enable them to teach severa...

Acetylcholine in differential diagnosis and treatment of paroxysmal tachycardia

Abstract 1. 1. Increasing doses of acetylcholine hydrochloride were given intravenously to 27 patients with paroxysmal tachycardia. Each dose was given in a volume of 1.0 ml. injected rapidly into the tube of an infusion of 5 per cent glucose, providing uniform “bolus effect.” This method also avoided hydrolysis by cholinesterases incident to barbotage. 2. 2. In 8 of 11 patients with paroxysmal supraventricular tachycardia the episodes were promptly terminated and did not recur. Side reactions were mild or absent. 3. 3. Fourteen patients with paroxysmal auricular flutter with rapid ventricular rate were treated. In none were the episodes terminated without recurrence. However, in all cases there were transitory alterations in A-V conduction which sometimes clarified the diagnosis of the mechanism. In 5 patients with flutter and bundle branch block the important possibility of ventricular tachycardia was excluded when the F waves were revealed during the momentary A-V block.