Black and Stephenson (1962) reported the results of betaadrenergic-receptor blockade in animals, using pronethalol. They found that the drug induced bradycardia and they indicated the possibility of using it in certain arrhythmias. Stock and Dale (1963) reported its use on patients with various arrhythmias. They found it useful in controlling the ventricular rate in atrial fibrillation and in the treatment of digitalisinduced arrhythmias, and they studied its effect in supraventricular tachycardias and upon various types of ectopic beat. After the production of evidence that the drug is carcinogenic to mice (Paget, 1963) the makers advised that its use should be restricted to those conditions that directly threaten life or to those patients whose life-expectation is short. The development of propranolol (Inderal), which is free from carcinogenic activity in mice (Black, Crowther, Shanks, Smith, and Dornhorst, 1964) and has a therapeutic ratio ten to twenty times greater than pronethalol, has renewed interest in the clinical application of beta-receptor blockade. The present paper reports experiences using propranolol in selected cases of atrial fibrillation, in atrial flutter and tachycardia, and in ventricular arrhythmias. Atrial FibrillationEleven patients were studied. Of these, five had rheumatic heart disease, four had thyrotoxicosis, one had mitral stenosis and thyrotoxicosis, and one had no underlying cardiac disorder. The patients with rheumatic heart disease were selected because of failure to control the ventricular rate at rest or on exercise with maximum tolerated doses of digitalis. The patient with idiopathic atrial fibrillation was studied both before and after digitalization. Those patients with thyrotoxicosis had been given digitalis to the maximum tolerated dose.Seven patients were studied before and during steady-state exercise on the cycle ergometer in the supine position. The patients were exercised for four minutes and the heart rate was measured during the last half-minute of exercise. The work load was kept constant for each individual patient. The propranolol was given intravenously in a standard dose of 10 mg. The resting rate after the drug was given was taken as the mean of readings at five-minute intervals between 15 and 25 minutes after the injection.
Compared with pedicled harvesting, skeletonized harvesting of the internal thoracic artery provides a short-term reduction in the extent and incidence of chest wall dysesthesia after coronary bypass, consistent with reduced intercostal nerve injury and therefore the reduced potential for neuropathic chest pain.
The natural history of isolated pulmonary stenosis is largely unknown. Knowledge of this subject has been gained mostly from studying groups of patients of different ages, or from necropsy records, procedures clearly less satisfactory than following up individual cases. Only two authors have reported follow-up studies; Barritt (1954) observed 33 cases (8 have been catheterized) over periods of 5 to 21 years, and Fabricius (1959) followed up 47 of 75 fully-documented cases for periods of between 2 and 10 years, but in both series the patients were mainly children. The advent of successful surgical treatment has made such studies more difficult to pursue.In this paper we present the findings in 75 cases of isolated pulmonary stenosis with special reference to 59 who have been observed for periods ranging from 2 to 23 years. SUBJECTS AND METHODSThe records were examined of all patients who have attended the University Department of Cardiology, Manchester Royal Infirmary, during the past 23 years, in whom a diagnosis of isolated pulmonary stenosis was made. We were able to trace all patients in whom this diagnosis seemed likely from a study of the case notes; many had been attending at regular intervals and 24 had undergone surgical treatment. One patient diagnosed clinically died in 1952 and some died as a result of operation; all the remainder who had not been seen in the last 2 years were recalled and re-examined.Cardiac catheterization was performed in 59 of the 75 patients; those not investigated by catheterization were only included in the series if a confident clinical diagnosis could be made. In all except one, who probably had associated aortic stenosis, pulmonary stenosis was the only lesion present. None were clinicially cyanosed. The stenosis was valvular in all except 4 patients where it was due to a localized subvalvular obstruction. Repeat catheterization after an interval of six to eight years was carried out in 3 patients.Patients were classified into mild, moderate, and severe cases according to Wood's criteria (1956). Those subjected to cardiac catheterization were graded according to the height of the right ventricular pressure, mild cases having pressures of 30-50 mm. Hg, moderate between 50 and 100 mm. Hg, and severe over 100 mm. Hg. Those not catheterized were graded on a combination of clinical, radiological, and electrocardiographic data as suggested by Wood, and which correlate closely with the hamodynamic changes.The clinical, electrocardiographic, and radiological findings at the first and subsequent attendances were noted and compared. For the purposes of this study, the period of follow-up of surgical cases ended at the time of operation. Effort tolerance was graded according to the nomenclature adopted by the New York Heart Association (1953).The electrocardiograms were classified as follows: Grade I: normal.Grade II: (i) mean frontal axis of +90°to + 1100 and/or(ii) R/S or R'S ratio in lead Vl greater than 1-0 with R or R' less than 0 5 millivolts. 151 1i on 10 May 2018 by guest. Prot...
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.