William J. Oetgen

Pulmonary vascular response during raynaud's phenomenon in progressive systemic sclerosis

Progressive systemic sclerosis and Raynauds phenomenon are associated with a distinctly vascular form of pulmonary involvement and pulmonary hypertension. To investigate a possible underlying vasospastic predisposition in these patients, the pulmonary vascular response to Raynauds phenomenon induced by cold-water hand immersion was examined in nine patients. Four patients had pulmonary fibrosis and four patients had the CREST syndrome; no patient had pre-existing pulmonary hypertension. During Raynauds phenomenon, there was no significant rise in mean pulmonary artery pressure (15 +/- 3 versus 15 +/- 2 mm Hg, p = NS) or pulmonary vascular resistance (112 +/- 38 versus 118 +/- 50 dynes X second X cm-5, p = NS) over baseline, despite a significant rise in mean aortic pressure (104 +/- 14 versus 92 +/- 11 mm Hg, p less than 0.01) and systemic vascular resistance (1,700 +/- 450 versus 1,500 +/- 470 dynes X second X cm-5, p less than 0.01). It is concluded that pulmonary vasospasm with transient pulmonary hypertension does not occur in patients with progressive systemic sclerosis and Raynauds phenomenon during episodes of Raynauds phenomenon. Abnormal pulmonary vasospasm in these patients in response to other stimuli, however, is not excluded.

Hypnotic Intervention in Cardiac Arrhythmias: Advantages, Disadvantages, Precautions, and Theoretical Considerations

Abstract A patient with ventricular tachycardia, which could not be controlled by various drug regimens, was treated using an hypnotic strategy. Among the positive results were a lessening of ectopic beats, an increase in exercise tolerance, a possible break in the arrhythmic pattern, and an increase in the patients sense of participation in his treatment. Of the disadvantages noted, the most notable was a blocking of the patients awareness that an arrhythmia was present, which deviated from his previous pattern and may have been facilitated by the dissociative strategy used. Additional well-designed, prospective studies in this area are needed to determine the overall usefulness of hypnosis in cardiac patients.