Ray W. Gifford

Essential Hypertension A Twenty-Year Follow-Up Study

THIS follow-up study was undertaken to clarify the natural history of essential hypertension. Information of this type is indispensable to evaluation of therapy for this disease. Keith, Wagener, and Barker in 1939 demonstrated the value of their classification of hypertensive changes in the retina as an aid to prognosis in hypertensive patients. However, the number of patients with milder forms of hypertension in that series was small and the study covered a period of less than 10 years. Consequently, we thought that a more extensive investigation of the prognostic value of ophthalmoscopic findings and other criteria would be desirable.

Effect of Thiazide Diuretics on Plasma Volume, Body Electrolytes, and Excretion of Aldosterone in Hypertension

A study has been made at the Mayo Clinic of the results of treatment in 28 hypertensive patients receiving thiazide diuretics. The use of these agents produced a significant but very temporary reduction in plasma volume in most patients. The plasma volume reverted to or toward normal after the first week of treatment; therefore, hypovolemia could not explain the prolonged hypotensive effect of these drugs. Administration of thiazide diuretics did not deplete the body of its sodium stores, as measured by isotope studies in five patients on an unrestricted diet. Therapy with thiazides did not produce a persistent increase in urinary aldosterone excretion in the nine patients studied for this possibility.

Raynaud's Disease Among Women and Girls

The diagnosis of Raynauds disease was suspected in 756 female patients at the Mayo Clinic from 1920 through 1945. The diagnosis was substantiated from the records of the initial examination or from the follow-up data or examination in 474. The clinical characteristics, including diagnostic criteria, clinical course, complications, and sequelae are discussed.

Prognostic Significance of Raynaud's Phenomenon and Other Clinical Characteristics of Systemic Scleroderma A Study of 271 Cases

Two hundred seventy-one patients with unequivocal systemic scleroderma for whom the diagnosis was first established at the Mayo Clinic between January 1, 1945, and December 31, 1952, have been studied. Follow-up information was obtained 5 to 13 years after the diagnosis at the clinic concerning 236 of these patients, 115 of whom were dead. The cases were analyzed in an effort to determine what factors had a bearing on prognosis. The following seemed to bear little relation to the ultimate prognosis: sex, mode of onset, Raynauds phenomenon, involvement of lungs and periodontal membrane, calcinosis cutis, and trophic changes. The following were considered poor prognostic omens: cardiac or renal involvement, significant elevation of the erythrocyte sedimentation rate, and anemia. The prognosis in systemic scleroderma was found to be worse than previous reports had indicated. This study yielded no basis for the subdivision of systemic scleroderma into acrosclerosis and generalized progressive scleroderma.

Sympathectomy for Raynaud's Phenomenon Follow-Up Study of 70 Women with Raynaud's Disease and 54 Women with Secondary Raynaud's Phenomenon

Follow-up information has been obtained from 70 women with Raynauds disease and 54 women with secondary Raynauds phenomenon who were subjected to surgical sympathetic denervation of one extremity or more. The results of sympathectomy in the upper and lower extremities are described. The effect of operation on the subsequent course, the complications and sequelae are presented and compared with the reports of others.

Raynaud's disease with sclerodactylia. A follow-up study of seventy-one patients.

DURING the course of previous studies of Raynauds disease in women and girls, and of patients with systemic scleroderma,2 we encountered the records of 71 patients with Raynauds disease and secondary selero-dermatous changes confined to the digits (sclerodactylia). These patients all had Ray-nauds disease as defined by the criteria of Allen and Brown,3 namely: (1) episodes of Raynauds phenomenon precipitated by cold or emotion, (2) bilaterality of the phenomenon , (3) absence of gangrene or the presence of only minimal degrees of cutaneous gangrene of the digits, (4) absence of any systemic disease that might account for the occurrence of Raynauds phenomenon, and (5) duration of symptoms of 2 years or longer. In addition to the Raynauds disease, all 71 patients had sclerodermatous changes in one or more digits when first examined at the Mayo Clinic, but none had any evidence of cutaneous sclerosis in other sites or of systemic seleroderma. Because of the confusion that has resulted from the various classifications of scleroder-ma, and in light of OLeary and Waismans contention4 that patients with Raynauds disease and sclerodactylia should be considered to have systemic scleroderma of a type that they called acrosclerosis, it was thought worth while to conduct a follow-up study of these patients. Follow-up information was obtained from all of the patients at re-examination at the clinic or by correspondence or both. Preliminary Observations The 71 verified cases of Raynauds disease were divided into a medical group (40 patients) and a surgical group (31 patients), depending on whether or not a cervicothoracic sympathectomy had been performed for the relief of symptoms. The ages of the medically treated patients ranged from 22 to 68 years (average 39.3) at the time of the original diagnosis at the clinic. The ages of the patients treated surgically ranged from 18 to 56 years (average 35.5). The average age for the entire group was 37.6 years (table 1). Only 5 patients (7 per cent) were men; however, many of the cases were selected from a group that had included only women. At the time of the original diagnosis, trophic changes of the digits (ulcerations, fissuring, chronic paronychiae) had been observed in 26 of the 71 patients (36.6 per cent) ; 15 of the 26 were subsequently treated by means of cervicothoracic sympathectomy. Amputations of digits had been performed for 3 patients (4 per cent), involving amputation of single digits in …

Clinical evaluation of hypertensive patients

Abstract Four cases of hypertension secondary to lesions of the renal arteries are presented with comments on the history, results of physical and laboratory examinations and surgical findings. Points emphasized are as follows: 1. 1. Hypertension of renal or renal arterial origin should be suspected in the presence of: (A) acute hypertension in young patients with angiospastic ocular changes; (B) rapidly progressive symptomatic hypertension of recent onset; (C) abrupt acceleration of chronic essential hypertension; (D) a history suggestive of a recent renal vascular accident; (E) a continuous bruit over the superolateral area of the abdomen and (F) a disparity in the size and function of the kidneys on excretory urography. 2. 2. In our experience the isotope renogram has served as an excellent screening procedure for the evaluation of renal function in hypertensive patients. 3. 3. Renal arteriography is a highly desirable procedure which aids in the more complete evaluation of hypertensive patients in whom abnormalities suggestive of renal arterial disease are found on physical or urographic examination or in the isotope renograms. This is especially true when surgical intervention is planned. The vagaries of translumbar aorticorenal arteriography are legion. Retrograde aortographic technics for renal arteriography are technically more satisfactory in our experience. 4. 4. Evaluation of function of each kidney alone may on occasions prove not only of diagnostic help, but more importantly, it may provide evidence of the adequacy of function of the individual kidneys, and thus may prove decisive regarding the feasibility of surgical intervention.

The Use of Hexamethonium in Treatment of Arteriosclerosis Obliterans

The effect of hexamethonium on hypertension has been widely studied but its effect on the peripheral blood vessels of patients with severe occlusive vascular disease has been studied on only a few patients although the drug has been used empirically in the treatment of such disease. Observations were made on the effect of hexamethonium ion administered subcutaneously in increasing doses of 10 to 50 mg. on the skin temperature of the fingers and toes, the blood pressure and the pulse rates of a group of patients with severe arteriosclerosis obliterans. On this group of patients hexamethonium had little or no effect.

Atherosclerotic Popliteal Aneurysm in a Man Thirty-five Years Old Report of a Case

This case of atherosclerotic aneurysm of the popliteal artery is of interest because the patient was a man 35 years old and because the condition was discovered only because palpation of the peripheral arteries was included as a part of routine examination. Only after the aneurysm had been found was a history of intermittent claudication elicited. The indications for the surgical treatment of popliteal aneurysms are discussed.

Fluorescent patterns of intracutaneous wheals in normal and edematous extremities.

Intradermal injection of a fluorescent dye (riboflavin) and ultraviolet light were used to demonstrate cutaneous lymphatic capillaries. The extremities of a control group and the nonedematous extremities of patients with arteriosclerosis obliterans were studied together with edematous extremities of patients with lymphedema, acute thrombophlebitis, chronic venous insufficiency and various other conditions. The lymphatic capillaries showed up more extensively after a higher percentage of injections into edematous extremities of patients with lymphedema than after injections into the other extremities. On the other edematous extremities except in the cases of nephrotic syndrome and on the normal extremities, either no lymph capillaries or only a few were visible after most of the injections.