SOME RELATIONSHIPS BETWEEN HEART ATTACKS AND PARALYTIC STROKES

When a patient suddenly collapses and loses consciousness, it is reasonable to assume that both the heart and the brain are acutely disordered. In as many as one case in three in which permanent paralysis occurs, cerebral softening rather than hemorrhage is observed at autopsy. Because there is no proof that in the early stages of stroke the changes are irreversible, and because in a significant proportion of cases the heart is simultaneously injured, both stellate ganglion block and anticoagulant therapy seem justified.     

ANOXEMIA AND BRAIN DISEASE

The author advances the concept that anoxemia, either in its general or restricted form, or both, is probably responsible for a considerable portion of “degenerative diseases,” whose etiologic delineation has not yet been traced. It is necessary, he believes, to enlarge greatly the comprehension of the disordered circulatory states to include oxygen want and thereby account for a number of conditions hitherto considered to be of unknown cause. More than this, he finds in oxygen want an explanation of the mechanism of a number of individual lesions or details of lesions otherwise not well understood. The author believes it is very likely that an understanding of cerebral anoxia in its ultimate ramifications will open still wider doors to the understanding of certain clinical syndromes the cause of which remains obscure.     

UNILATERAL RENAL DISEASE AND HYPERTENSION

Cure is obtained in about 20 per cent of patients with unilateral renal disease and hypertension who have nephrectomy primarily for relief of hypertension. Carrying out urologic studies on a larger number of hypertensive patients might result in tracing the condition to renal disease in more cases. Renal angiography more accurately indicates renal origin of hypertension than any other diagnostic study. When it can reasonably be established that hypertension is of renal origin, nephrectomy should be performed unless there is some general contraindication to an operative procedure.