Philip Rosenblatt

Myocardial infarction in the newborn infant

Summary Two cases of myocardial infarction occurring in the neonatal period are presented. This condition has not been previously described in newborn infants. It is possible that such a lesion may be present and yet be unnoticed at autopsy examination.

The role of the sympathetic nervous system in acutepoliomyelitis

Summary We have presented clinical evidence showing that sympathetic nervous system involvement in acute poliomyelitis may manifest itself in the cervical region by Horners Syndrome, in the thoracic region by spasm of the pulmonary blood vessels with dilatation and irregularity of the right side of the heart, in the gastric region by pylorospasm, in the intestinal region by constipation or diarrhea, in the rectal region by intestinal obstruction, in the bladder region by retention or incontinence of urine and in the skin by angioparesis or spasm. Presumptive evidence has been presented to show that the blood vessels in the chronic poliomyelitic extremity behave and respond similar to the angiospasm of Raynauds disease or the cramplike pain in intermittent peripheral arterial claudication. Conclusive evidence that the blood vessels were in spasm was found inthe twelve patients tested with the oscillometer. The actual excursions were far below the normal. We have also shown that angiospasm was present in the encephalitic, paralytic, and in the nonparalytic extremity of acute poliomyelitis. Pathologic evidence to substantiate the clinical findings was presented by showing involvement of the lateral horn as well as of the sympathetic ganglia. We have demonstrated that short wave diathermy with the rhythmic constrictor dilated the blood vessels and increased the blood supply to the extremity. The muscles relaxed and the pain diminished or subsided only to return when the blood vessels contracted. However, we feel that neither short wave diathermy nor hot packs are the solution for the relief of the muscle spasm and pain in acute poliomyelitis, since these methods do not produce sustained vasodilatation. The method of choice would be a drug that could be administered by mouth, subcutaneously, or by the intravenous route. We fully understand that the subject matter in this paper is debatable.We hope, however, that it will provoke others to investigate further the role of the sympathetic nervous system in acute poliomyelitis, and that it will eventually lead to a better understanding of the clinical picture of the disease and hence to a more scientific therapeutic approach.

A New Method of Administering Heparin.

In the course of studies on experimental subacute bacterial ednocarditis, attempts were made to produce the disease in heparinized rabbits. The methods for heparinizing humans, namely, by continuous venoclysis or by repeated intravenous injections, were virtually impossible of adaptation for the rabbit. However, rabbits will develop and maintain a prolonged coagulation time over a protracted period with repeated subcutaneous injections of heparin, the average daily requirement being about 45 mg of commercial heparin† administered in fractional doses. 1 In order to eliminate the disturbing abrupt rises, sharp peaks and unpredictable drops in coagulation time as well as the technical difficulties incidental to fractional daily dosage, a simpler means had to be devised for continuous heparinization by the subcutaneous route. In view of the success obtained with pellet and capsule implantation of hormones, 2 similar experiments were pursued with heparin. Pellets containing 50 mg and glass capsules tightly packed with 100 mg of heparin were implanted under sterile precautions subcutaneously or subfascially through a small skin incision. While rabbits could be heparinized in this fashion, this approach had to be abandoned for the following reasons: The results with glass capsules were erratic. On some occasions a spectacular but shortlived effect was obtained: at other times, the results were negative and when the capsule was removed subsequently it was discovered that practically none of the heparin had been acted upon. Additional shortcomings were: The necessity for instrumental procedure; the rapid absorption of pellets with resultant inordinately delayed coagulation time and subsequent precipitate drop; the presence at times of local hemorrhage and the obvious impracticability of sustaining heparin effects over prolonged periods.

Cerebral complications in pertussis

Summary 1. Over a period of fifteen years, 6,002 cases of pertussis were seen at the Kingston Avenue Hospital. Forty-seven of these were complicated by clinical cerebral manifestations. 2. (a) During the years 1932 to 1938 inclusive, 2,758 patients were admitted and 261 died, a general mortality rate of 9.4 per cent. Twenty-four cases were associated with cerebral complications. Six patients died, a mortality rate of 25 per cent. (b) From 1939 to 1946 inclusive, 3,244 patients were admitted and 109 died, a general mortality rate of 3.3 per cent. Twenty-three cases were complicated by cerebral manifestations and thirteen patients died, a mortality rate of 56.5 per cent. 3. Of the forty-seven patients with cerebral complications, 28 survived and nineteen died, an average mortality rate of 40.4 per cent. 4. The onset of cerebral complications was almost always accompanied by convulsions and a sudden rise in temperature. 5. Fifty per cent of the patients who developed cerebral complications were under one year of age, and 60 per cent were under 2 years of age. 6. In 72.5 per cent of the patients, the onset of the cerebral complications occurred during the third and fourth weeks of the disease. 7. Spinal fluid studies were made in thirty-eight of the forty-seven patients. The findings were normal in all but eight cases. There was no correlation between the prognosis for life or sequelae and the spinal fluid findings. 8. The prognosis in patients with cerebral complications in whooping cough epends upon the age of the patient, the severity of the paroxysm, the nutritional state of the patient, the length of the convulsive seizure, the duration of the coma, and upon the presence of an associated complication. 9. In round figures, one-third of the patients with cerebral complications die, one-third recover to develop sequelae, one-third recover completely. 10. Twelve of the twenty-eight surviving patients in our series were followed over periods ranging from two months to eight years. Five (43 per cent) of them showed a tendency to further central nervous system manifestations. 11. The pathologic changes in the brains of thirty-four autopsied patients with cerebral complications were edema and congestion of the brain, petechial hemorrhages, subarachnoid hemorrhages, and thrombosis of cerebral veins and sinuses. 12. No changes of an inflammatory nature were observed. 13. The pathologic changes may be considered due to vascular disturbances or degenerative changes incident to anoxemia rather than inflammatory in origin. 14. The term “encephalopathy” appropriately covers these pathologic changes. 15. Treatment is entirely symptomatic. There is no effective specific therapy. 16. Present trends in age distribution of pertussis indicate a greater incidence in infants under one year of age.

The Prolonging Action of Penicillin by Para-Aminohippuric Acid.

Conclusions 1. When the plasma para-aminohippuric acid concentration was maintained at or above 10 mg/100 ml a 3 to 6 fold elevation in penicillin plasma concentration was obtained except in two instances. 2. When the para-aminohippuric acid plasma levels were allowed to fall below 10 mg/100 ml there was no effect of that compound on the plasma concentration of penicillin. 3. The para-aminohippuric acid was non-toxic in the dosage given even when administered over a period of 8 days.

Acute poliomyelitis; a clinical and statistical study of 263 cases.

Summary Poliomyelitis knows no limitation of age, sex, or race. The term “infantile paralysis” should be discarded in the light of present knowledge. Increased physician awareness of the disease and more frequent recourse to lumbar puncture in suspected cases have contributed to the apparent increase in incidence of the disease as well as to its shift toward older age groups. We have reported on our experiencesin the 1950 epidemic and have reviewed 263 cases studied at the height of the epidemic. More than 25 per cent of our cases were nonparalytic, 22.7 per cent were of the bulbar type, and 50.4 per cent were spinal in type. The over-all mortality rate was 8 per cent. Symptomatology, age and sex ratios, and mortality figures were in general agreement with those reported in other epidemics. Study of the spinal fluid findings offered no prognostic guide to the extent of paralytic involvement. It assumed only a diagnostic confirmatory role in most instances. About 5 per cent of patients showed no pleocytosis or increased spinal fluid protein values on hospital admission. Similarly the length or severity of prodromal symptoms had no bearing on the ultimate outcome of the disease. The virulence of the disease variedfrom month to month and was emphasized. A general plan of treatment of the major types of the disease was given. The cause of death in poliomyelitiswas generally the result of bulbar involvement. The exact mechanism is controversial. We have emphasized the importance of pulmonary angiospasm and have offered this as an explanation for the underlying cause of death. Tracheotomy is of value only when there is tracheobronchial obstruction. This is generally not present in bulbar poliomyelitis. In addition the use of vasodilator drugs, notably Priscoline, has been cited in the treatment of vasospastic phenomena in poliomyelitis.

Malignant mesonephroma of the ovary

Argyria of the uterus and tube is of relatively little clinical importance in itself. However, in the connective tissue of the cutis only a definite amount of silver can be stored, otherwise general argyria may a.ppear. By any former application of silver the deposits mav be close to this threshhold. Then the additional absorption of a relat&ly small amount of silver may lead to discoloration of the skin. In cases of otherwise unaccountable argyria in women, t,he possibility of absorption from a silver pessary should be kept, in mind.

Type F hemophilus influenzae meningitis

Summary 1. A case of type f H. influenzae meningitis in an infant 10 months of age was presented. 2. Clinical recovery was enhanced after the addition of penicillin to the therapeutic regime of sulfadiazine and streptomycin. 3. A review of the literature was presented with particular reference to the in vitro sensitivity of the type f H. influenzae to antibiotics. 4. Within recent years there has been a relative and absolute increase in meningitis due to H. inflenzae of all types.

Venospasm an Early and Late Manifestation of Poliomyelitis

Edema and cyanosis of paralyzed portions, or of whole extremities in poliomyelitis have been recognized for a long time. These findings have been considered a result of venous congestion secondary to muscular paralysis. It is common knowledge that most poliomyelitis patients bedridden as a result of paralysis do not develop cyanosis and edema of the extremities. Some do, however, and the edematous extremities are not infrequently diagnosed as, and treated for, thrombophlebitis. ’