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The coagulation defects of the blood of 30 patients after six months of dicumarol therapy have been studied. A preparation of brain or soybean phospholipids corrected the abnormal coagulation time and the thrombin generation test of patients on long-term dicumarol therapy. The deficiency in thromboplastin generation of these patients was not corrected.

1. 1. Only 16 cases of rheumatic fever or chorea occurred among 16,200 medical cases in Miami during a period of eight years. 2. 2. Among 413 patients with organic heart disease seen by the author during the past two years in hospital, clinic, or private practice, 103, or practically 25 per cent were of rheumatic etiology. However, in only 6 instances did the rheumatic disease orginate in southern Florida. 3. 3. Rheumatic heart disease is found with only one-third the frequency among elementary school children born in Miami that it is found in children born in the North who have taken up residence in Miami. 4. 4. There is evidence that patients with active rheumatic heart disease improve at a more rapid rate if moved to southern Florida from northern climates during the cold months.

Seventy-eight patients were given long-term dicumarol therapy after one or more attacks of myocardial infarction to see whether recurrent attacks could be warded off. Encouraging results ensued over periods up to five years. Protocols of 12 fatal cases are given, only 4 of whom had recurrent acute coronary thrombosis. Hemorrhagic complications met with are analyzed. Ambulatory treatment is shown to be feasible if patients are painstakingly followed.

The use of insulin, in association with glucose, is not empiric treatment in heart disease, but is based upon physiological evidence that this procedure improves the nutrition of the myocaridum. A review of the numerous published clinical reports indicates that insulin-glucose therapy has a beneficial effect on various types of heart disease, in spite of the obvious difficulty of assessing the value of any specified treatment in cardiac patients. In a group of 20 patients with heart disease, 50% improved with the use of insulin in association with a high carbohydrate diet and extra feedings of glucose. Patients with the anginal syndrome or coronary thrombosis, with or without left ventricular failure, are in particular likely to derive benefit from such therapy. It is not proposed to use insulin-glucose therapy in place of other routine measures, but more as an adjunct to other methods of treatment. Electrocardiographic studies indicate that no untoward effects are obtained following the use of insulin-glucose in the non-diabetic subject with heart disease, and evidence of improvement in the nutritional state of the myocardium is obtained in some cases. The benefit derived in cardiac patients is due not only to improved nutrition of the myocardium, but may be due in part to improved digestive functions and elevation of the general spirit of the patient.

Instances of infection of the aorta by the gonococcus are quite rare, only nine cases being found in a recent search of the literature by Aschner.1 The present case is reported because of the unique combination of a multilocular aneurysm of the aorta with acute vegetative gonococcus aortitis and congenitally bicuspid aortic valve with acute vegetative gonococcus endocarditis.

We have presented a pooled clinical investigation in 1,091 patients with coronary atheroslcerosis treated with long-term anticoagulants for 3 to 100 months, for a total of 24,454 months. The average duration of therapy was 22.4 months. Four and four-tenths per cent developed non-fatal thromboembolism, and 131 patients, or 12.0 per cent, died on the regimen, mostly from cardiac disease. Three hundred nineteen patients, or 29.2 per cent, abandoned the regimen; an average 18.4 months' follow-up of these showed that 28.2 per cent died within 4 years, chiefly with cardiac disease. These 319 patients serve as “controls”. Six hundred sixty-nine patients, or 61.3 per cent, continued the regimen an average of 27.6 months of therapy. Four hundred seventeen patients not given anticoagulants were used as additional “controls” and were followed by 5 of the authors for 3 to 120 months, averaging 38.1 months. Of these, 37.4 per cent died, the majority from cardiovascular disease.

Excerpt The clinical features of the pericarditis found during the course of some cases of acute coronary artery thrombosis have been recently reviewed by Blumer1who rejuvenated the termpericarditi...

Excerpt The clinical pattern of coronary atherosclerosis is remarkably variable in different subjects, but observation over a period of years reveals that patients fall into groups delineated by th...

Excerpt Syphilitic aortic aneurysms appear with sufficient frequency to be easily recognizable. There is a multitude of complications occurring in combination with this entity, however, which prese...