A NEW VASOCONSTRICTOR—A Preliminary Report

Otrivin,® a compound of the hydrochloride salt of phenyl-aminomethylimidazoline, was administered to 74 patients for varying periods as a nasal vasoconstrictor. Seventy-three had relief of nasal congestion for from five to six hours—longer periods than had been obtained with other vasoconstrictors they had used. No pressor effect was noted.     

CALIFORNIA'S ALCOHOLIC REHABILITATION PROGRAM—A Preliminary Report

Confronted by the most serious alcoholism problem in the United States, California has begun an extensive rehabilitation program in three categories: Treatment and rehabilitation services; study and investigation; education, information and training. Treatment clinics operate in seven cities and it is proposed to help finance further facilities in communities interested in their local alcoholic problem. Grants to medical schools for improved personnel training are also proposed. Basic and clinical research and epidemiologic, sociologic and follow-up studies are in progress. Public education to the problems of alcoholism, stressing that it is an illness requiring treatment, is under way. This multi-faceted approach is expected to supply answers to many of the questions surrounding alcoholism.     

DELAYED FILMS IN BRONCHOGRAPHY—A Preliminary Report

In bronchography, the oil often does not fill all bronchial branches. Films taken 30 to 60 minutes later frequently complete the opacification of bronchi in lingula, middle lobe and lower lobes. Such delayed films may demonstrate bronchiectasis not shown initially, or may exclude bronchiectasis suspected on the first films.     

MANAGEMENT OF ATOPIC DERMATITIS—A Preliminary Report

A treatment regimen for atopic dermatitis (disseminated neurodermatitis) which attempts to cope with the factors of dry skin and retention of sweat was successful in a series of 22 consecutive patients, all of whom remain under observation. Objectives of the treatment are: Preservation of the natural lipid surface film, avoidance of controllable stimuli to sweating, avoidance of greases and oils topically applied, control of bacterial infection in the skin, resolution of active dermatitis with topical corticosteroids in vehicles low in lipids or free of them, and correction of existing keratoderma. This program does not purport to alter atopic constitutional factors.Among the 22 patients were seven with severe dermatitis requiring prolonged, continuous or intermittent, systemic corticosteroid therapy who were treated and had no exacerbation for periods up to ten months at the time of last report. The total daily dose of topical corticosteroid is small. Systemic corticosteroid therapy was withdrawn at the initiation of this treatment and has not been reinstituted. No untoward reactions have been observed.Results to date warrant treatment and long term observation of additional patients to determine the ultimate value of this method.     

TREATMENT OF ITCHING—A Preliminary Report on Results with a New Oral Antipruritic

A new antipruritic, trimeprazine, was used in the treatment of itching associated with a variety of dermatologic disorders in 215 patients.Good to excellent relief of itching was experienced by 71 per cent of the patients, fair relief by 15 per cent and poor relief by 14 per cent.Side effects included mild and transient drowsiness or dizziness that cleared spontaneously; six cases of drowsiness that necessitated discontinuance of the drug; three cases of drowsiness that was controlled by reduction of the dosage; and one case of generalized eruption that cleared upon discontinuance of the drug.     

PARKINSON'S SYNDROME,DEPRESSION AND IMIPRAMINE—A Preliminary Report

Patients with Parkinson''s syndrome whose major symptoms are akinesis, rigidity, inertia, depression, irritability and failure of adaptation rather than tremor appear to benefit in a global way from therapy with imipramine. Patients without much over-all functional impairment do not show this improvement. The hypothesis is offered that motivation to move and ability to move are perhaps neurologically as well as psychologically related functions.     

CARDIAC CATHETERIZATION IN ADULT CONGENITAL HEART DISEASE—A Preliminary Report

The diagnosis of uncomplicated ventricular septal defect and uncomplicated patent ductus arteriosus presents few hazards. Differential diagnosis of atrial septal defect and of transposed pulmonary veins is technically more difficult. The complex nature of most types of cyanotic congenital heart disease requires the combined use of catheterization, determination of circulation times, ventilation studies, and possibly angiocardiography.Reports of eight cases in which cardiac catheterization was carried out illustrate the common forms of acyanotic and cyanotic heart disease and the factors in diagnosis.     

X-Ray Survey Results and Costs—A Health Officer's Viewpoint,A Preliminary Report

The obvious results of a mass chest x-ray survey from a health officer''s viewpoint are:1. The early discovery of unknown cases of pathologic conditions of the chest—tuberculosis, neoplasms, heart abnormalities.2. Increase in the community''s awareness of its tuberculosis problem.3. Opportunity to work closely with the medical society and the individual private physicians.4. Stimulation of all agencies in a community, health and non-health, to work together on a health project for the good of all of the people.5. Increased cooperation between the local department of public health and other health agencies in a community.6. Opportunity to underline to a staff of a local department of public health the importance of thinking in terms of the department as a whole, rather than in terms of respective divisions or bureaus.7. Opportunity to focus the awareness of the community on its public health services.In relation to costs, there are three aspects from a health officer''s viewpoint:1. The planning, together with other agencies, of an adequate budget with full recognition of community resources.2. The planning for estimated expansion of tuberculosis control services both in terms of increased expense for maintenance and operation, and of assignment of personnel to survey staff with resulting curtailment or postponement of other programs.3. The planning for completion of the follow-up program of the x-ray survey and of future continued extension of the total tuberculosis control program as the result of increased community awareness of the tuberculosis problem.     

A STUDY OF INFLATION OF THE LUNGS OF THE NEWBORN—A Preliminary Report

There seems to be no reasonable doubt that the lungs in a newborn expand progressively during the first few days of life. Some degree of atelectasis seems to be perfectly normal. This is indicated by a number of roentgenographic studies (including those here reported); by the reported findings of pathologists; by the fact that in experimental animals the lungs inflated very unevenly; and by the fact that aeration of only a portion of the lung is needed for complete oxygenation of the blood. The relation of atelectasis to neonatal death is not entirely clear and is probably not always the same. The infant may die from other causes before the lungs are fully expanded. Atelectasis may develop secondarily to other debilitating conditions. The frequent coincidence of prematurity and extensive atelectasis is impressive. It may be that the lungs are so incompletely formed that they cannot expand. On the other hand, atelectasis and massive collapse in the adult is a serious condition and there seems to be no good reason to suppose that this cannot also occur in infants and be serious per se.The air pressures found necessary to expand the lungs in rabbit fetuses were found to be about ten times what adult humans use in quiet respiration and were of about the same magnitude as the pressures found necessary to expand the lungs of stillborn humans. An attempt to produce atelectasis in newborn rabbits by chilling was most inconclusive. Atelectasis did develop in three of 15 animals used in the experiment, but the relation to chilling was not at all clear.     

Treatment of Chronic Insomnia with Yoga: A Preliminary Study with Sleep–Wake Diaries

There is good evidence for cognitive and physiological arousal in chronic insomnia. Accordingly, clinical trial studies of insomnia treatments aimed at reducing arousal, including relaxation and meditation, have reported positive results. Yoga is a multicomponent practice that is also known to be effective in reducing arousal, although it has not been well evaluated as a treatment for insomnia. In this preliminary study, a simple daily yoga treatment was evaluated in a chronic insomnia population consisting of sleep-onset and/or sleep-maintenance insomnia and primary or secondary insomnia. Participants maintained sleep–wake diaries during a pretreatment 2-week baseline and a subsequent 8-week intervention, in which they practiced the treatment on their own following a single in-person training session with subsequent brief in-person and telephone follow-ups. Sleep efficiency (SE), total sleep time (TST), total wake time (TWT), sleep onset latency (SOL), wake time after sleep onset (WASO), number of awakenings, and sleep quality measures were derived from sleep–wake diary entries and were averaged in 2-week intervals. For 20 participants completing the protocol, statistically significant improvements were observed in SE, TST, TWT, SOL, and WASO at end-treatment as compared with pretreatment values.     

USE OF TRANQUILIZERS IN DISEASES OF THE SKIN—A Preliminary Report

Tranquilizing agents such as chlorpromazine and reserpine were used in various diseases of the skin in which the psychogenic factors were considered important etiologic agents. While a tranquilizing effect was obtained in the majority of instances, the side reactions and variation in response were so great as to render these agents unsatisfactory for routine use as tranquilizers. Meprobamate (marketed under the trade names Miltown and Equanil) was then used on a group of dermatologic patients with more consistent tranquilizing effect and comparatively little unpleasant side reactions. It is felt that further study of the use of meprobamate as a tranquilizing agent in dermatology is worth while.     

EXPERIMENTAL INVESTIGATIONS ON ACTION OF ANTIHISTAMINIC NASAL SOLUTION—A Preliminary Report

The effect of antihistaminic drugs in the form of solutions for nasal instillation on the mucous membranes of rabbits was investigated. So far as histologic observations would indicate, Antistine®-Privine® was the most harmful and caused almost complete necrosis throughout the entire nasal area. Pyribenzamine® was the least harmful. Allergan® caused more damage than did Pyribenzamine in the nasal mucosa of rabbits, but considerably less than Antistine-Privine.Clinically, the author has observed Antistine-Privine to be extremely irritating when employed as a topical application for symptomatic relief of nasal allergic disease. Pyribenzamine has caused considerable pain and discomfort in patients and has been least effective for relief of nasal congestion since it does not contain a vasoconstrictive agent. Allergan has not been observed by the author to be irritating to any degree in patients with nasal allergic disease unaccompanied by acute infection, and it has been noted to be the least irritating of these three antihistaminic solutions in nasal allergic disease complicated by infection.     

HYPOTHYROIDISM IN MEN IN INDUSTRY—A Preliminary Report on Chemical Evidence

Of 2,807 specimens from blood donors and men in industry, 340 or 12 per cent had serum protein-bound iodine values of 4.0 micrograms or less per 100 cc.In a selected group of 610 “white collar” workers, 52 or 8.5 per cent had similar low values.Careful reexamination of a sample of the latter group indicated that at least 75 per cent of them had hypothyroidism needing treatment.Further analysis of the factors producing hypothyroidism and the validation of the incidence found is warranted. If the incidence observed in this study is confirmed, these findings indicate that 6 per cent to 9 per cent, or more than a million middle aged American men have hypothyroidism.