Thomas J. Dry

THE RÔLE OF DIABETES IN THE DEVELOPMENT OF DEGENERATIVE VASCULAR DISEASE: WITH SPECIAL REFERENCE TO THE INCIDENCE OF RETINITIS AND PERIPHERAL NEURITIS

Excerpt The advent of arteriosclerosis is one of the inevitable consequences of aging. The existence of arteriosclerosis in one or another part of the vascular tree after the age of 30 is to be exp...

Coarctation of the aorta at an unusual site, associated with a congenitally bicuspid aortic valve

Abstract We have reported a case of coarctation of the aorta in which the site of stenosis was between the left common carotid and the left subclavian arteries. The condition was diagnosed during life and proved by postmortem examination. The case reported is of further interest because of the presence of a congenitally bicuspid aortic valve which was the seat of subacute vegetative endocarditis.

Continuous observations of the arterial oxygen saturation at rest and during exercise in congenital heart disease.

Abstract Continuous observations, made with the Millikan compensated circuit oximeter, of the arterial oxygen saturation of nineteen normal subjects and of twenty patients with cyanotic and noncyanotic types of congenital cardiac defects are presented. When normal individuals were given pure oxygen to breathe, their arterial oxygen saturation increased, on the averag,, 2.7 percentage points (to reach 100 per cent saturation) in 1.3 minutes. In fifteen patients with a cyanotic type of congenital cardiac defect, breathing pure oxygen produced an average increase in oximeter saturation reading of 6.2 percentage points attained in an average period of 3.0 minutes. Normal subjects showed practically no change in their arterial oxygen saturation when they changed from the supine to the erect position or when they walked on a treadmill for five minutes at 1.7 miles per hour. Patients with a cyanotic type of congenital cardiac defect showed an average decrease in oximeter saturation reading of 2.4 percentage points when they stood up and 10.9 percentage points when they exercised on the treadmill. It is suggested that the compensated circuit oximeter is of considerable value in studying patients with congenital cardiac defects for two reasons: (1) Its use in conjunction with Van Slyke analyses of arterial blood makes possible a more accurate estimation of the resting arterial oxygen saturation of such patients. (2) Measurements of the arterial oxygen saturation can be made continuously during the performance of various cardiovascular and respiratory function tests, thus greatly facilitating an objective interpretation of the results obtained. Such tests serve as a valuable adjunct in the judging of the efficacy of corrective surgical procedures in these patients.

INTERPRETATION OF THE ELECTROCARDIOGRAPHIC FINDINGS IN CALCAREOUS STENOSIS OF THE AORTIC VALVE

Excerpt In the last few years distinct progress has been made in the clinical recognition of calcareous stenosis of the aortic valve. This is clearly exemplified by the fact that, as late as 1931, ...

Results from trichlorethylene inhalations in the anginal syndrome of coronary sclerosis

Abstract The results of inhalations of trichlorethylene in this series of cases of the anginal syndrome of coronary sclerosis do not permit this method of treatment to be accepted with enthusiasm. In eighteen cases (45 per cent) varying degrees of improvement occurred. However, when these cases are critically analyzed it is found that onlyone patient obtained complete relief while the others had fewer attacks of less severity. In five cases (12.5 per cent), temporary improvement was noted but a return of the previous symptoms occurred while the treatment was still in progress. It is possible that these patients became imbued with a new hope in undertaking this treatment and that their primary response was influenced by this attitude. We, however, were very careful not to create any false hopes among the patients treated. They were frankly advised that the procedure was entirely experimental. In thirteen cases (32.5 per cent) no improvement whatsoever was noted. The patients in these cases received treatment from one to seven months. Four patients (10 per cent) died during the course of treatment. All deaths occurred suddenly. Two of the patient who died were temporarily improved. We have already mentioned the difficulties encountered in the evaluation of the results of therapy in the anginal syndrome of coronary sclerosis. This evaluation is based largely on the interpretation of variations in subjective phenomena. We cannot overlook the natural history of the disease or the fact that similar data have been furnished by many individual observers who have used other drugs in the treatment of this disease. While the results obtained with this method of treatment have been disappointing, it is however a procedure that warrants a trial when the usual therapeutic agents have failed to give relief. In our experience, and according to the method described, the drug is well tolerated and its administration appears to be perfectly safe.

Arationale for the treatment of peptic ulcer

1. There are undoubtedly several interesting factors which are responsible for the genesis, reactivation and chronicity of peptic ulcer. 2. The most important of these factors are traumatization of local tissue, erosion made possible by any means which reduces the defensive reaction of tissue and certain systemic factors of which neurogenic influences are the most important. 3. Anyrationale for treatment of peptic ulcer must recognize the importance of all potential causes and direct therapeutic considerations toward all of them. Treatment must be sufficiently flexible so that consideration is given not only to the three factors mentioned before, in a general way, but also toward that factor which can frequently be shown to be the predominant one in a particular case. 4. Individual exacerbations are merely breakdowns in the cycle of peptic ulcer. The program of treatment must, therefore, be a prophylatic one, directing special attention toward prevention of disturbances in tissues, in gastric chemism, and in the nervous system of the patient, even during asymptomatic periods.