Maxwell L. Gelfand

Subacute cor pulmonale: Report of four cases

Abstract Subacute cor pulmonale is a distinct clinical syndrome that is often not too easily diagnosed. Its salient features are (1) development of sudden dyspnea of a progressive nature; (2) absence of an underlying cardiopulmonary disorder to account for the dyspnea, or presence of such disorder in an asymptomatic phase; (3) paucity of physical signs in the chest to explain the dyspnea; (4) signs of failure of the right side of the heart developing later in the course of the disease; (5) lack of therapeutic response to the usual measures for congestive heart failure; (6) roentgenographic evidence of lymphangitic carcinomatosis or pulmonary embolization; (7) electrocardiographic abnormalities suggesting hypertrophy and dilatation of the right ventricle; and (8) a clinical course of only a few weeks or months. Inasmuch as an underlying thrombophlebitis or phlebothrombosis may be responsible for the development of pulmonary embolization, one of the causes of subacute cor pulmonale, it appears reasonable to suggest that anticoagulants be administered as soon as the presence of this condition is suspected. Such early prophylactic therapy may prevent a certain number of otherwise inevitable deaths.

Follow-up electrocardiographic changes in penetrating wounds of the heart treated surgically.

1 From the Department of Surgery, Harlem Hospital, New York, and the Department of Medicine, New York University Postgraduate Medical School, New York. The first reference in the English literature to an electrocardiographic study of a penetrating wound of the heart appeared in 1924 (1). Thereafter, only a few papers trickled in (2-12), and in most instances they discussed single cases or groups of three or four. The interval between the original electrocardiogram taken soon after injury and those observed during a follow-up study consisted of but a few weeks or at most 2 to 3 months. The earlier tracings showed only the conventional limb leads, but with the introduction of precordial leads to the

Sensitivity Tests to Insulin in Patients with Local Skin Lesions from Insulin

Summary 1. Sixteen diabetic patients exhibiting local skin reactions to insulin as nodules with or without erythema or stinging were tested intradermally with various insulin products, beef and pork protein. 2. Sixteen nondiabetics not using insulin were similarly tested with the same substances. 3. Passive transfer tests with the sera of 5 patients manifesting local reactions to insulin were performed. 4. Skin reactions noted in patients exhibiting local reactions to insulin were no different from those obtained in the control group of nondiabetics, non-users of insulin. 5. The Prausnitz-Küstner passive transfer phenomenon was absent in all 5 instances. 6. It is concluded that local nodules with or without stinging or erythema observed in patients receiving insulin therapy are not due to any antigen-antibody mechanism.

Thrombophlebitis; a sign of an unrecognized neoplasm.

* From the Department of Medicine, New York University Post-Graduate Medical School; The Medical Service of University Hospital, and the Fourth Medical Division (N. Y. U.), Bellevue Hospital, New York, N. Y. The association of thrombophlebitis and carcinoma has been noted by many. Almost a century ago, Trousseau’ first commented on this relationship, stating that if the diagnosis of a suspected carcinoma of an internal organ could not be proven, the sudden and spontaneous appearance of thrombophlebitis in a larger vein was corroborative evidence of its existence. In recent years many clinicians have suggested that thrombophletitis of a single vein, or recurrent episodes without obvious explanation, should cause one to suspect the possible existence of an underlying cancerous lesion.2-7 There are some who believe that malignancy detected at this stage is already far advanced and inoperable, whereas others feel that the earlier the thrombotic lesion is detected

Absence of Eosinopenic Response to AGTH Administration by the Aerosol Route in Normal Subjects.

Summary Observations on 6 normal subjects showed that eosinopenia did not occur following aerosol administration of ACTH, indicating that ACTH is not absorbed from the bronchopulmonary tree.

Book Reviews : Mechanisms of Hypertension—with a Consideration of Atherosclerosis. By Henry Alfred Schroeder, M.D.

Straight to the Heart. By George Lawton.

9.00. Pp. 379. Charles C Thomas, Springfield, Ill., 1957

5.00. Pg. 347. International Universities Press, Inc., New York, 1956. This book is unique in that it is a personal account of the thoughts and feelings of a psychoanalyst while undergoing heart surgery. In fact, the fears and anxieties so clearly depicted began soon after the suggestion of cardiac surgery was made to the author by his medical advisers. Although the dread and suspense of a serious operation is not an uncommon experience it is comforting to learn that even the most equanimous of people, the analyst, is also subject to mental upheaval when confronted by a stressful situation particularly one in which life is threatened.

Book Reviews : Straight to the Heart. By George Lawton.

Straight to the Heart. By George Lawton.

5.00. Pg. 347. International Universities Press, Inc., New York, 1956:

5.00. Pg. 347. International Universities Press, Inc., New York, 1956. This book is unique in that it is a personal account of the thoughts and feelings of a psychoanalyst while undergoing heart surgery. In fact, the fears and anxieties so clearly depicted began soon after the suggestion of cardiac surgery was made to the author by his medical advisers. Although the dread and suspense of a serious operation is not an uncommon experience it is comforting to learn that even the most equanimous of people, the analyst, is also subject to mental upheaval when confronted by a stressful situation particularly one in which life is threatened.