Pain in thrombo-angiitis obliterans

Pain in thrombo-angiitis obliterans

cause, psralieling oompiled from that hospital of the United records are States Registration not reliable. &~a. Uorbi~iitg statis~rt;ti A4n ana...

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cause, psralieling oompiled from

that hospital

of the United records are

States Registration not reliable.

&~a.

Uorbi~iitg

statis~rt;ti

A4n analysis of the records of 556 private patients suffering from organie heiiit disease was made to determine the relative incidence of the various etiological ita-tars, as well as their associated abnormalities. From this study hypertension (49.4 per cent), arteriosclerosis (20.3 per cent), and rheumatic fever (20 per cent) were found to represent the etiological faetors in 90 per cent of the eases. Other less frequent factors were syphilis, thyrotoxicosia, and eongenital maldevelopmeuts. d&e rheumatic fever was rare, and syphilis was not a common cause of heart disease, findings which correspond to similar groups of private patients. BubRciite bacterial endocarclitis occurred in 2 per cent of the patients. atz, Louis N., Mayne, ence of Pain Fibers Arcah. Int. Med. 55:

Walter, and in the Nerve 760, 193.5.

Weinstein, Plexus

William: Surrounding

Gardiac Pain: Freathe Coronasy Vessels,

The observation of earlier workers is confirmed that occlusion of the coronary vessels and the surrounding tissue in the unanesthetized dog gives rise to an eEective response resembling an angina1 at,tack. The response from this procedure is similar to that obtained on compressing a superficial somatic sensory nerve, save for the inability of the animal to locate the site of irritation. The results show that artery, but to stimulation the vessels. The evidence

this response is due not of afferent fibers located for this is:

to the oeelusion of in the nerve plexus

the

corona:)

surr~~xidin~

I. Occlusion of a carefully isolated strip of the coronary artery caused n5 response, but a definite response was obtained when the undissected coronary vosaels above and below this point were compressed. 2. Destruction of the nerve plexus with phenol and alcohol abolished the response to compression, but the response was still positive when a region above the phenoliced area was stimulated. 3. Complete preliminary occlusion of the carefully isolated ecrormry artery did not prevent a positive response to compression above or below this point. 4. Pericardial caused syneope

but

tamponade following bleeding no I (anginal’ ’ response.

from

5. Positive affective responses occur only when vessels is compressed. The rest of the myocardium stimulation by pressure. It is concluded that ischemia of the myocardium nisms operating on the nerve endings and nerve angina1 attacks. Goldsmith, Grace A., Brown, George Am. J. M. Se. 189: 819, 1935.

Pain

the and

coronary

region about the eorouary epicardium is insensitive to

is at most one of many fibers which may give

in

artery

mecharise to

T~~o~~o-An~~~~~s

are seven distinct recognizable types of pain in thromboangiitis CJbliterans. major factors involved in the production of pain are ischemia and i&ammation. The types of pain observed in arteriosclerosis obbterans are similar to t,hose in thromboangiitis obliterans, with the exception that pain resulting from phlebitis and arteritis is absent. Intermittent claudication was the initial symptom in more than 90 per cent of the cases in this series. The recognition of the arterial basis of this symptom is of crucial importance, as avoidance of ulcers and gangrene and preservation of limbs Jepend largely on early appreciation of the circulatory impairment. The preseme The

There two

E.:

a ruptured

848

THE

AMERICAN

HEART

JOUR,NAL

or absence of pulsations in the peripheral arteries should be determined case in which pain in the extremities is a prominent feature. All types of pain present in this disease are amenable to treatment exception of that attributable to severe degrees of ischemie neuritis. The decrease in the incidence of amputation in cases of thromboangiitis has followed, to a large degree, the effective treatment of pain.

in

any

with

the

obliterans

Brams, William A., Golden, J. S.: The Early Response of Venesiection With Observations on So-Called Bloodless! Velnesection. Am. J. M. SC. 189: 813, 1935. So-called ‘ (bloodless venesection ” failed to reduce venous pressure or to modify pulse rate or arterial pressure in patients with cardiac failure. These results are in contrast to the changes observed in the same patients after bloodletting. The effects of ordinary venesection were studied in fifteen patients with cardiac failure. Observations mere made every five minutes for a period of one hour after venesection was completed. It was exceptional for either the systolic or diastolic arterial pressure to show an appreciable fall after venesection or during the period of observation. The same results were observed in patients with arterial hypertension as in those with normal pressure. The pulse rate remained unchanged in all experiments. Venous pressure fell consistently after bloodletting, the maximum drop occurring immediately after completion of venesection. The fall began early in the course of veneseetion, becoming apparent after removal of the first 100 OX. of blood and continuing to drop as more blood was withdrawn. A partial return toward the control level within a few minutes was observed in the majority of instances, but the level of venous pressure after an hour was usually lower than the control level. The fall in venous pressure was especially marked in cases in which venous hypertension existed, and the actual drop also depended greatly on the quantity of blood removed. The greatest drop usually occurred in cases of venous hypertension in which from 600 to 800 cc. of blood were removed, though it so happened that a level nearer to normal was reached in the cases with a smaller blood removal. The practical significance of the fall in venous pressure after venesection, in relation to cardiac failure, is briefly discussed.

Morlock, Carl G., Horton, Bayard T.: Variations Tuberculosis. Am. J. M. SC. 189: 803, 1935.

in Blood

Pressure

in

Renal

As a result of the analysis of the systolic blood pressures of 346 patients who had proved renal tuberculosis, we cannot concur in the opinion generally expressed that an active tuberculous lesion, regardless of its situation, has an accompanying arterial tension lower than normal. In the series of cases analyzed it was found that the vast majority of patients (approximately 76 per cent) had normal hlood pressures, 22 per cent had hypertension-that is, a systolic pressur-e of 140 mm. of mercury or more-and approximately 2 per cent had hypotension-that is, a systolic The number of patients in this series blood pressure less than 100 mm. of mercury. with hypertension or hypotension was not any greater than was found in a larger control series of normal individuals in the same age groups.