Search

Six patients having mitral stenosis, functional tricuspid regurgitation, and normal sinus rhythm were studied. All patients had a systolic murmur at the lower left sternal border that increased with inspiration. Five patients had right heart catheterization while all six had right atrial pressure-pulses obtained by direct puncture of the right atrium with a 20-gage needle during right thoracotomy. Functional tricuspid regurgitation was proved by subsequent digital exploration of the tricuspid valve. The right atrial pressure pulses obtained were analyzed. The curves taken with the needle-puncture of the right atrium were comparable to those obtained at right heart catheterization. The X descent was well preserved in all six cases. In five patients the X descent was deeper than the Y descent, while in only one patient was the X descent equal to the Y descent. There was no exaggeration of the V wave in any of the curves. The role played by the compliance of the right atrium in preserving the normal contour of the right atrial curve, in spite of tricuspid regurgitation, is discussed. It is concluded that in functional tricuspid regurgitation with normal rhythm the normally preserved X descent followed by a normal V wave may persist in the right atrial curve. The application of this finding to the clinical study of the jugular venous pulse in functional tricuspid regurgitation and normal rhythm is evident.

Summary o 1. The effect of angiotensin has been studied in normal man, as it bears on the resting plasma volume and on changes in the plasma volume during transcapillary refill following experimental hemorrhage. 2. In 1 of 5 normal subjects given the drug there was a severe reaction; for this reason, further experiments were deemed inadvisable. The data on the other 4 were consistent, and for this reason are reported though the numbers are small. 3. Angiotensin caused a reduction in plasma volume averaging 5.3 per cent of the resting value, when given as an infusion 4 hours after the hemorrhage and during the maximum transcapillary refill phase. The net refill over 24 and 48 hours is unchanged by angiotensin and is the same as that observed after norepinephrine. 4. This effect of angiotensin is similar to that exhibited by norepinephrine but is less marked. Norepinephrine reduces the plasma volume 15 to 20 per cent during refill; angiotensin gives a reduction of about 5 per cent. In addition, the effect is reversed during the second 2 hours of angiotensin infusion, with a gradual restoration of the transcapillary refill curve to its normal configuration. 5. Angiotensin further reduces the sodium: potassium ratio in the urine, in some cases below that value produced by hemorrhage alone. In 2 of our cases this alteration was long lasting. 6. Clinical use of angiotensin should be undertaken with these data in mind.

Between 1957 and 1967 a total of 50 patients underwent portal decompression for portal hypertension at the American University Hospital. Thirty-three patients were treated by portacaval anastomosis and 17 were treated by splenorenal anastomosis. The major indications for shunting were hemorrhage (66%); ascites (10%); hypersplenism (6%). The remaining 18% of patients had bleeding as well as either ascites or hypersplenism. In 90% of patients the cause of portal hypertension was intrahepatic obstruction. Patients with altered metabolic function as evidenced by decreased serum albumin, increased serum bilirubin, and elevated sulfobromophthalein retention had the poorest prognosis. The long-term follow-up of cirrhotic patients with variceal hemorrhage whose course has been altered by surgical operation shows that 44% of patients were living and well five years following their initial operation. Overall operative mortality was 18%, with hepatic coma, hemorrhage and shock, sepsis, and electrolyte imbalance making up the list of contributing factors.

Summary Isotope dilution with I 131 iodinated human serum albumin was used to measure the blood volume of 12 ambulatory, normally active, healthy young adults during the course of a day. Volumes increased and hematocrit decreased significantly on the average with changes most marked by evening.

Summary o 1. Equilibrium behavior of erythrocytes tagged with Evans blue dye and radiochromate in the normal and shocked animal was studied. 2. There was no alteration in the disappearance curve of Evans blue dye. 3. There seemed to be a slope of decreasing erythrocyte activity in the shocked animals. This slope was not such as to produce a statistically significant decrement at either 50 or 90 minutes. In Shoemaker's work, steep slopes of strong significance were reported in two thirds of the animals. 4. In no animal did we observe an “inflection point” with a secondary plateau to suggest the clear delineation of a “slowly circulating” red cell volume. 5. The red cell volume measured at the conclusion of the experiment correlated almost perfectly with that observed at the start, as corrected for volume loss by sampling. We therefore did not discover any evidence for a “noncirculating” red cell mass in these animals. 6. On the basis of these data, we cannot confirm the concept that irreversible shock in the dog results in a significant sequestration of erythrocytes from that mass normally exchangeable with infused tagged cells.

Ankylosis of the temporomandibular joint is a serious disability. It is usually the result of arthritis that leads to fibrous or bony ankylosis. Because of the stunted growth of the mandible and atrophy of disuse of the muscles of mastication, it leads to deformities of the face. The treatment of advanced cases is surgical excision of the mandibular condyle. The complications are due to the compact anatomy, and are numerous and serious. The postoperative care consists of simple measures to promote hypertrophy of the muscles of mastication. The operation is recommended even at an early age.