Norman A. Christensen

Problems Associated with Long-Term Anticoagulant Therapy Observations in 139 Cases

LONG-TERM anticoagulant therapy is being used frequently in the management of certain vascular and thromboembolic diseases. Results predominantly favorable in respect to prolonged survival and decreased morbidity have been reported from use of coumarin anticoagulants in these diseases.1-4 However, there has not been adequate evaluation of the ease or difficulty with which a satisfactory and practical program of prolonged anticoagulant therapy can be carried out. The purpose of this paper is to evaluate this aspect of anticoagulant therapy in ambulatory patients with vascular and thromboembolic diseases who have been observed during the past 1011⁄22 years. The following specific problems were considered: (1) the adequacy of control of prothrombin activity, (2) the hemorrhagic complicatious occurring during treatment, (3) the vascular and thromboembolic complications occurring during treatment, (4) the reasons for discontinuing treatment, (5) the vascular and thromboembolic complications that occurred immediately following cessation of treatment, and (6) the problems occasioned by surgery in patients on treatment.

Pathology of the intrapulmonary arteries and arterioles in coarctation of the aorta associated with patent ductus arteriosus.

Abstract This is a report of four cases wherein coarctation of the aorta and patent ductus arteriosus were associated. In two cases, in which the ages were 15 and 22 years, respectively, the coarctation was distal to the aortic mouth of the patent ductus arteriosus. In the other two cases, in which the ages were 23 months and 7 years, respectively, the aortic coarctation lay proximal to the aortic mouth of the ductus arteriosus. Changes of significant proportions involved the intrapulmonary arteries and arterioles in each case. In the first two cases the changes were most striking in the intrapulmonary arteries. These consisted of medial hypertrophy, fragmentation of the elastic laminae, adventitial fibrosis, and fibrous proliferation of the intima. The changes were associated with significant degrees of narrowing of the arterial lumina. Thrombi in various stages of organization were encountered in both cases. In one case there was hyalinization of the intimal and medial tissue. The arterioles showed scattered changes of severe degree. In general, the arteriolar walls were thickened, a change associated with relatively narrow lumina. In one of the first two cases there was evidence that the right ventricle had exerted sufficient pressure to force blood into the aorta, thus assuming the function of a systemic ventricle. In the second group of two cases the arteries of the lungs showed medial hypertrophy and adventitial fibrosis, changes associated with luminal narrowing. The arteriolar changes in these two cases were more striking than those in the first two cases. These changes likewise consisted of medial hypertrophy and adventitial fibrosis. In one case, in addition, intimal fibrous thickening of the arterioles was diffuse. In both of these cases the evidence suggested strongly that the descending aorta was supplied with blood by the right ventricle.

Acute Severe Facial Injuries: Treatment, Including Current Concepts of Tetanus Prophylaxis

Acute severe trauma of the face usually brings three problems in emergency form: hemorrhage, inadequacy of the airway, and tetanus prophylaxis. Ordinarily, most of the immediate efforts are directed toward soft-tissue injuries. Allowing more time before treating extensive facial bone injuries permits the patient to recover from the original trauma and the surgeon to formulate his plan after thorough study of the situation. With few exceptions, acute severe facial injuries are tetanus-prone and must be treated accordingly.

Tetanus Neonatorum—a Curiosity?

Excerpt Though tetanus neonatorum is so rare in most highly developed countries as to be for them a medical curiosity, this is not so for most of the world. Representatives at the recent Internatio...