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April, 1951 SOUTHERN MEDICINE & SURGERY 159 the patient is transported to a hospital. In case of any question of bone injury, x-rays should be made of the injured extremity. C. Riordan, N. O. Med. & Sx^rg. Jl, Mar. THERAPEUTICS J. F. Nash, M.D., Editor, St. Pauls, N. C. Curable Hypertension When a patient comes complaining that he is getting deaf, examine his ears for wax. Removing the wax may relieve your patient and make you a great reputation. If the deafness is not due to wax it is unlikely that much improvement of the hearing can be effected. This line of reasoning and procedure is applicable to high blood pressure, as considered by Beck-er.^ Despite rice and other low salt diets, sympathectomy and psychotherapy, the cure of hypertensive disease is impossible except for certain cases of unilateral kidney disease, coarctation of the aorta, and functioning tumors of the chromaffin system — pheochromocytoma. "Curable" — herein lies the importance of pheochromocytoma. The diagnosis is simple, and eradication of the disease is possible- These chromaffin tumors produce high b. p. by the secretion of epinephrine and/or a substance closely related. They most commonly arise from the medullary tissue of the adrenals but may occur anywhere in the chromaffin system—in the thoracic paraganglia, the abdominal paraganglia, or the organ of Zuckerkandl. They are called chromaffin tumors because the cells have affinity for chromic acid. Smithwyck, in a recent series of 1,000 patients undergoing sympathectomy for high b. p., discovered five pheochromocytomas on routine examination of the adrenal glands during the operative procedure. |0f course only a small percentage of the total of persons with high b. p. apply for sympathectomy.] Cases of intermittent high b. p. with tremor, sweating and and headaches are apt to be misdiagnosed as psychoneurosis. In cases with convulsions, [jheochromocytoma may simulate brain tumor, epilepsy, or eclampsia. Three of our cases and nine others known to us became manifest during pregnancy. The diagnosis is based upon 1) a high index or suspicion, 2) depression of the elevated b. p. by pharmacologic means, 3) provocation of an attack, and 4) attempt at localization. Every patient with hypertension should be suspected of having a pheochromocytoma until this possibility is ruled out- 1. M. C. Becker, Newark, in The Merck Report. April. In the presence of a secreting pheochromocytoma, a brief but definite drop in b. p. resulted from the injection of a test dose of benzodioxau, provides an effective, simple, harmless means of detecting a functioning pheochromocytoma in the routine study of all sustained hypertensives and during the hypertensive stage of intermittent hypertension. The rapid injection of histamine base in the majority of cases reproduced attacks identical to the spontaneous attack of which these patients complained. The test must be reserved for cases of paroxysmal hypertension and during the stage when the pressure is normal. Fifty per cent of these patients have x-ray evidence of a tumor mass in the adrenal area, either by intravenous pyelography (32%) or perirenal insufflation (18%). Surgical exploration always is indicated whether the tumor is localized or not. The Rice Diet in Ambulatory Patients With Essential Hypertension: A Two-Year Study of 105 Patients (d. G. Loofbourow et al., Boston, in New Eng. Jour. Med., April 19th) In two years' time two (12.5%) of the strict group had maintained improvement in b. p.; three (19%) had died; in 9 (56%) the disease had progressed; and in 4 (25%) the disease had remained stationary. In a random group treated on a conservative medical program, we could easily match these results, unless the group were weighted with cases of malignant hypertension. The factors in favor of the use of the rice diet are that it is definite therapy for those patients who have extreme blood-pressure anxiety, that it teaches self-discipline to patients who can accept it, and that it is easy to teach and simple to follow. The factors against its use are several. The diet is by no means innocuous; it is lethal if the patient is not carefully watched. The increased time needed for observation puts a heavy load on the doctor and increases the cost to the patient, because of weekly visits. The diet is so monotonous that in some patients it has seemed responsible for recurrent depressions and in others for overt hostiUty such that we have been unable to persuade patients to return. We are planning a program for the next several years, using a diet that has a normal protein, a very low fat, a low salt content and c.-h. higher than normal (unless it is desirable for the patient to lose weight). We expect this diet to be acceptable to the patient; it has definite advantages from a nutritional point of view. It is our opinion at this point that the rice diet is unpleasant and expensive for the patient, very demanding on the doctor and potentially dangerous. In ambulatory patients it produces no better results than more conservative medical therapy. Smallpox (108 Cases) in Wuhu (Alfred Y. S. Tan. M.D., Wuhu G(meral Hospital. Wuhu. in Chinese Medical Journal, Jan.-Feb., 1951) As hich as 95 per cent of all persons were estimated to have suffered from this disease before the development of vaccination. In China, during the period of 1920-1930, few persons had been vaccinated. Today too many infants and ?dults are not vaccinated until the appearance of an epidemic when compulsory vaccination is enforced by the local health authorities. Our earliest admitted cases were soldiers and family members of the military staffs. After
Object Description
Rating | |
Fixed Title * | NCHH-22: Southern Medicine and Surgery [1921-1953] |
Document Title | Southern Medicine and Surgery [1921-1953] |
Subject Topical Other | Medicine -- North Carolina -- Periodicals. |
Publisher | Charlotte, N.C. : Charlotte Medical Press, 1921-1953. |
Repository | University of North Carolina at Chapel Hill. Health Sciences Library. |
Host | University of North Carolina at Chapel Hill |
Date | 1951 |
Identifier | NCHH-22-113 |
Form General | Periodicals |
Language | English |
Rights | This item is part of the North Carolina History of Health Digital Collection. Some materials in the Collection are protected by U.S. copyright law. This item is presented by the Health Sciences Library of the University of North Carolina at Chapel Hill for research and educational purposes. It may not be republished or distributed without permission of the Health Sciences Library. |
Digital Collection | North Carolina History of Health Digital Collection |
Sponsor | The North Carolina History of Health Digital Collection is an open access publishing initiative of the Health Sciences Library of the University of North Carolina at Chapel Hill. Financial support for the initiative was provided in part by a multi-year NC ECHO (Exploring Cultural Heritage Online) digitization grant, awarded by the State Library of North Carolina, and funded through the Library Services and Technology Act (LSTA). |
Volume Number | 113 |
Health Discipline | Medicine |
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Print / Download PDF Version | http://archives.hsl.unc.edu/nchh/nchh-22/nchh-22-113.pdf |
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Volume Link | http://dc.lib.unc.edu/cdm/search/collection/nchh/field/identi/searchterm/NCHH-22-113 |
Title Link | http://dc.lib.unc.edu/cdm/search/collection/nchh/field/documa/searchterm/NCHH-22 |
Catalog Record link | http://search.lib.unc.edu/search?R=UNCb2542543 |
Revision History | keep |
Description
Fixed Title * | Page 159 |
Document Title | Southern Medicine and Surgery [1921-1953] |
Subject Topical Other | Medicine -- North Carolina -- Periodicals. |
Publisher | Charlotte, N.C. : Charlotte Medical Press, 1921-1953. |
Repository | University of North Carolina at Chapel Hill. Health Sciences Library. |
Host | University of North Carolina at Chapel Hill |
Date | 1951 |
Identifier | NCHH-22-113-0157 |
Form General | Periodicals |
Page Type | all; report/review |
Language | English |
Rights | This item is part of the North Carolina History of Health Digital Collection. Some materials in the Collection are protected by U.S. copyright law. This item is presented by the Health Sciences Library of the University of North Carolina at Chapel Hill for research and educational purposes. It may not be republished or distributed without permission of the Health Sciences Library. |
Filename | southernmed1131951char_0157.jp2 |
Digital Collection | North Carolina History of Health Digital Collection |
Sponsor | The North Carolina History of Health Digital Collection is an open access publishing initiative of the Health Sciences Library of the University of North Carolina at Chapel Hill. Financial support for the initiative was provided in part by a multi-year NC ECHO (Exploring Cultural Heritage Online) digitization grant, awarded by the State Library of North Carolina, and funded through the Library Services and Technology Act (LSTA). |
Volume Number | 113 |
Issue Number | 5 |
Page Number | 159 |
Health Discipline | Medicine |
Full Text | April, 1951 SOUTHERN MEDICINE & SURGERY 159 the patient is transported to a hospital. In case of any question of bone injury, x-rays should be made of the injured extremity. C. Riordan, N. O. Med. & Sx^rg. Jl, Mar. THERAPEUTICS J. F. Nash, M.D., Editor, St. Pauls, N. C. Curable Hypertension When a patient comes complaining that he is getting deaf, examine his ears for wax. Removing the wax may relieve your patient and make you a great reputation. If the deafness is not due to wax it is unlikely that much improvement of the hearing can be effected. This line of reasoning and procedure is applicable to high blood pressure, as considered by Beck-er.^ Despite rice and other low salt diets, sympathectomy and psychotherapy, the cure of hypertensive disease is impossible except for certain cases of unilateral kidney disease, coarctation of the aorta, and functioning tumors of the chromaffin system — pheochromocytoma. "Curable" — herein lies the importance of pheochromocytoma. The diagnosis is simple, and eradication of the disease is possible- These chromaffin tumors produce high b. p. by the secretion of epinephrine and/or a substance closely related. They most commonly arise from the medullary tissue of the adrenals but may occur anywhere in the chromaffin system—in the thoracic paraganglia, the abdominal paraganglia, or the organ of Zuckerkandl. They are called chromaffin tumors because the cells have affinity for chromic acid. Smithwyck, in a recent series of 1,000 patients undergoing sympathectomy for high b. p., discovered five pheochromocytomas on routine examination of the adrenal glands during the operative procedure. |0f course only a small percentage of the total of persons with high b. p. apply for sympathectomy.] Cases of intermittent high b. p. with tremor, sweating and and headaches are apt to be misdiagnosed as psychoneurosis. In cases with convulsions, [jheochromocytoma may simulate brain tumor, epilepsy, or eclampsia. Three of our cases and nine others known to us became manifest during pregnancy. The diagnosis is based upon 1) a high index or suspicion, 2) depression of the elevated b. p. by pharmacologic means, 3) provocation of an attack, and 4) attempt at localization. Every patient with hypertension should be suspected of having a pheochromocytoma until this possibility is ruled out- 1. M. C. Becker, Newark, in The Merck Report. April. In the presence of a secreting pheochromocytoma, a brief but definite drop in b. p. resulted from the injection of a test dose of benzodioxau, provides an effective, simple, harmless means of detecting a functioning pheochromocytoma in the routine study of all sustained hypertensives and during the hypertensive stage of intermittent hypertension. The rapid injection of histamine base in the majority of cases reproduced attacks identical to the spontaneous attack of which these patients complained. The test must be reserved for cases of paroxysmal hypertension and during the stage when the pressure is normal. Fifty per cent of these patients have x-ray evidence of a tumor mass in the adrenal area, either by intravenous pyelography (32%) or perirenal insufflation (18%). Surgical exploration always is indicated whether the tumor is localized or not. The Rice Diet in Ambulatory Patients With Essential Hypertension: A Two-Year Study of 105 Patients (d. G. Loofbourow et al., Boston, in New Eng. Jour. Med., April 19th) In two years' time two (12.5%) of the strict group had maintained improvement in b. p.; three (19%) had died; in 9 (56%) the disease had progressed; and in 4 (25%) the disease had remained stationary. In a random group treated on a conservative medical program, we could easily match these results, unless the group were weighted with cases of malignant hypertension. The factors in favor of the use of the rice diet are that it is definite therapy for those patients who have extreme blood-pressure anxiety, that it teaches self-discipline to patients who can accept it, and that it is easy to teach and simple to follow. The factors against its use are several. The diet is by no means innocuous; it is lethal if the patient is not carefully watched. The increased time needed for observation puts a heavy load on the doctor and increases the cost to the patient, because of weekly visits. The diet is so monotonous that in some patients it has seemed responsible for recurrent depressions and in others for overt hostiUty such that we have been unable to persuade patients to return. We are planning a program for the next several years, using a diet that has a normal protein, a very low fat, a low salt content and c.-h. higher than normal (unless it is desirable for the patient to lose weight). We expect this diet to be acceptable to the patient; it has definite advantages from a nutritional point of view. It is our opinion at this point that the rice diet is unpleasant and expensive for the patient, very demanding on the doctor and potentially dangerous. In ambulatory patients it produces no better results than more conservative medical therapy. Smallpox (108 Cases) in Wuhu (Alfred Y. S. Tan. M.D., Wuhu G(meral Hospital. Wuhu. in Chinese Medical Journal, Jan.-Feb., 1951) As hich as 95 per cent of all persons were estimated to have suffered from this disease before the development of vaccination. In China, during the period of 1920-1930, few persons had been vaccinated. Today too many infants and ?dults are not vaccinated until the appearance of an epidemic when compulsory vaccination is enforced by the local health authorities. Our earliest admitted cases were soldiers and family members of the military staffs. After |
Digital Format | JPEG 2000 |
Print / Download PDF Version | http://archives.hsl.unc.edu/nchh/nchh-22/nchh-22-113.pdf |
Document Sort | all; group-e; nchh-22 |
Volume Link | http://dc.lib.unc.edu/cdm/search/collection/nchh/field/identi/searchterm/NCHH-22-113 |
Title Link | http://dc.lib.unc.edu/cdm/search/collection/nchh/field/documa/searchterm/NCHH-22 |
Catalog Record link | http://search.lib.unc.edu/search?R=UNCb2542543 |
Revision History | keep |
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