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The filling pressure in the minute vessels of the skin of the foot has been estimated by a method of elevation and reactive hyperemia. A series of 90 observations was made on 78 patients. This test has been found helpful in evaluating the degree of arterial insufficiency, permitting a more accurate selection of patients to be treated by conservative methods, local amputation or more radical procedures.

The blockade effect of the tetraethylammonium ion (TEA) on the autonomic ganglia was studied carefully during the early part of this century, 1 yet it has been only in the past few years that clinical use of this important blockade action has been considered. In this short period, however, it has been used extensively both as a therapeutic and diagnostic agent in diseases relieved by removal of autonomic tone. TEA has been used to evaluate the vasospastic element of arterial insufficiency. Following its administration the rise in temperature produced in the involved extremity is observed. Failure to obtain this rise has suggested the presence of organic occlusive arterial changes. 2,3 The drug has also been used in an attempt to determine the neurogenic component of arterial hypertension as an aid in the selection of candidates for treatment by splanchnic nerve resection. 4 A very wide range of changes in blood flow and blood pressure have been recorded in response to the administration of TEA to patients with these diseases and to normal subjects. 2–6 Little direct information is available regarding the factors responsible for this marked variability. We considered it pertinent therefore to study a group of twenty normal subjects in order to determine the range of the TEA effect unaltered by pathological factors. This study included the determinations of blood pressures at the levels of both the brachial and digital arteries, pulse rate, digital temperature, and electrocardiograms. The results proved informative not only as a basis for the interpretation of responses observed in patients with various diseases, but also yielded information about factors responsible for the wide variability in results observed.

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After recovery from acute occlusion of a major artery to the extremity, even though the circulation is sufficient for tissue nutrition, the patient may develop severe rest pain with paresthesias and numbness of the extremity. This pain has been termed ischemic neuritis. Temporary relief may be obtained by blocking the sympathetic nerves to the leg, but sympathectomy is contraindicated. In a series of ten patients the site of obstruction was visualized by arteriography. Excision of a segment of the thrombosed artery was followed by immediate relief from the pain. There was no significant increase in circulation after this procedure. It is believed that arterectomy is of value in the treatment of this type of pain through the interruption of some nervous reflex which originates from the thrombosed artery.

A few illustrations of unilateral renal disease associated with hypertension that have been observed in man are arteriosclerotic narrowing of the orifice of one main renal artery, caused by arteriosclerosis of the aorta itself or of the first part of the renal artery; arteriosclerotic stenosis in any portion of the main renal artery; and thrombosis of the aorta at the mouth of the renal artery or in the main renal artery. Numerous instances have been reported of hypertension due to renal artery occlusion successfully treated by nephrectomy. In the following report we present the case of a patient with marked hypertension who was treated with thromboendarterectomy for atherosclerotic occlusion of the abdominal aorta and iliac arteries and partial thrombosis of one renal artery. It is the purpose of our paper to discuss the prompt and persistent reduction in the patient's blood pressure that followed this procedure. REPORT OF A CASE

INTRODUCTION THE PRONOUNCED cutaneous hyperemia upon release of a tourniquet has long been familiar to surgeons. This reaction, which is called reactive hyperemia, has been studied in detail by a number of workers, starting with Lister and including many of the outstanding names in vascular physiology. The period of hyperemia bears a definite relationship to the length of the circulatory arrest. Provided occlusion is not prolonged for more than a few minutes, the duration of the hyperemia is usually one-half to threefourths that of the arrest. 1 It has been shown that the hyperemia represents the repayment of a blood flow debt which is built up during the period of arrest in the limb distal to the cuff.* The reaction is dependent upon accumulation of local metabolites during the period of arrest and upon the arterial pressure within the limb. 4 The intense cutaneous hyperemia is the result of dilatation