William B. Bean

The Syndrome of Carcinoid and Acquired Valve Lesions of the Right Side of the Heart

Recent papers by Biörck and Rosenbaum have revived interest in the rare disease characterized pathologically by carcinoid of the small intestine, metastases to the liver, acquired nonrheumatic disease of the tricuspid and pulmonic valve, and angiomas in the skin. Clinically the condition is characterized by dramatic episodes of flushing, mottling of the skin, diarrhea, dyspnea and ultimately by congestive failure. Probably 5-hydroxytryptamine (serotonin) liberated from the carcinoid tumors induces the vascular changes. The suggestion is set forth that an antagonist to this compound might reduce the symptoms and perhaps favorably affect the course of the disease. Two cases are reported.

Dissecting Aneurysm Produced by Diet

Spontaneous dissecting aneurysm of the aorta in man is most commonly a sequel of hypertension but sometimes occurs in association with degenerative liquefaction of the media of the aorta. New light has been thrown upon dissecting aneurysm by its production in growing rats by a diet high in sweet peas. The offending agent has been isolated and a number of simpler related compounds have been synthesized and found effective. The relationship of this syndrome to a spontaneous dissecting aneurysm of the aorta in man is reviewed and some suggestions are made for investigation which may lead to newer methods of therapy.

Pantothenic acid deficiency induced in human subjects.

Summary 1. An abnormal metabolic state has been induced in 4 human volunteers through combined use of a diet deficient in pantothenic acid and a metabolic antagonist, (omega-methyl pantothenic acid). 2. This abnormal state was accompanied by clinical and biochemical abnormalities suggesting adrenal cortical insufficiency, and by a peripheral neuropathy. 3. Administration of pantothenic acid alone did not immediately reverse the abnormal state. A good diet of natural foods and multiple vitamins resulted in rapid complete recovery.

The Arterial Spider and Similar Lesions of the Skin and Mucous Membrane

D R. BEAN: The topic for the conference today will be the arterial spider of the skin and other lesions of skin and mucous membrane which sometimes cause confusion in the minds of physicians. As background for the discussion I will start with a short autobiographic note. This chronicle may help answer a question many students have asked me: How did you get started in clinical research? I do not recall having noticed or having had called to my attention the vascular spider of liver disease when I was an undergraduate student of medicine at the UUniversity of Virginia. When I was an intern on Dr. Longcopes service at the Johns Hopkins Hospital, both Dr. Longcope and Dr. Hamman commented casually upon the spider and remarked on its frequent association with chronic liver disease. Neither one was able to give me any references to medical writings on the subject, nor was their own information very extensive. When I went to the Thorndike Laboratory in Boston I again sought information on the significance of the spider and found that no one at that fountainhead of clinical research could give me any additional help. I inquired of Dr. George Minot, Dr. Soma Weiss, Dr. Chester Keefer, Dr. William Castle and many of their colleagues but was able to get no more information than in Baltimore. Following this, my migration westward began. Arriving in Cincinnati, I found that the spider was well known. Dr. Blankenhorn was