TREATMENT OF HYPERLIPEMIC DIABETIC PATIENTS—Effects of Dextro-Thyroxine Therapy

Serum low-density lipoproteins of 12 hyperlipemic diabetic patients were lowered, in some cases to normal values, by administration of dextro-thyroxine. Accompanying reductions in serum total cholesterol were largely reflected in the low-density lipoprotein fraction. By contrast, high-density lipoprotein cholesterol concentrations remained relatively unchanged. Diabetic control by insulin or oral hypoglycemic agents was not detectably altered by dextro-thyroxine therapy for periods of 8 to 46 weeks. Therefore, use of the drug for treatment of diabetic hyperlipemia would appear to merit further investigation.     

INTRAVENOUS CHOLANGIOGRAPHY—Some Observations on the Use of Cholografin

Intravenous cholangiography with cholografin is a safe procedure, most useful for the study of patients who have had cholecystectomy and later have symptoms related to the biliary ducts.When jaundice or liver impairment is present, the examination is usually unsuccessful. However, these conditions are not absolute contraindications to the procedure. There may be failure to visualize the biliary ducts even in the presence of a normal liver.Planigraphy is helpful in eliminating confusing superimposed structures and when there is only faint visualization of the common duct.Intravenous cholecystography is only of questionable value as a supplementary examination to oral cholecystography. It may prove useful in certain instances when patients are unable to retain or absorb the oral media or where emergency operation is contemplated.     

DIABETIC PATIENTS WITH MYOCARDIAL INFARCTION—The Diagnostic Accuracy of the Electrocardiogram

In a study involving interpretation of electrocardiograms of two groups of patients who had myocardial infarction—one a group of diabetic patients and the other group made up of nondiabetic—the electrocardiogram was found to be considerably less accurate in the diagnosis of myocardial infarction in the diabetic patient than in the nondiabetic subject. This is due to the fact that the patterns which mask the diagnosis of myocardial infarction in nondiabetic patients occur more frequently in diabetic individuals. It is important to note that in no instance were the electrocardiograms interpreted as normal in the diabetic group.     

CONTROL OF NAUSEA AND VOMITING—Observations on the Use of Chlor-Trimeton? (Chlorprophenpyridamine Maleate) Syrup

Chlor-Trimeton (chlorprophenpyridamine maleate) syrup was effective in preventing and controlling nausea and vomiting in 53 of 57 patients. In doses of one to four teaspoonfuls (2 to 8 mg.), it controlled nausea and vomiting following operative procedures, vomiting due to nonspecific causes, hyperemesis gravidarum, vomiting in altitude and radiation sickness, and vomiting in patients with carcinoma of the colon, acute pancreatitis, and poorly controlled diabetes.No untoward effects from the drug were noted.The syrup was easy to administer, rapidly absorbed, and apparently provided a local anesthetic effect on gastric mucosa.     

SINGLE-DOSE TREATMENT OF ENTEROBIASIS—Use of a New Piperazine-Senna Preparation

A preparation combining piperazine and senna was clinically tested among 31 families in which at least one member was found to be positive for enterobiasis by the customary cellophane-tape anal smear technique. The diagnostic smears were positive for 58 of those tested. Following a single dose of piperazine-senna mixture, all patients were cleared of the infestation as determined by the customary criteria for cure. In six patients in two families, reinfestation occurred in two to three months after the first administration. All were again cleared with one dose of the mixture.Side effects were insignificant and transient. One 4-year-old child vomited, but an hour later ingested a second dose without incident. The preparation was palatable and easily administered.     

TREATMENT OF INTRAORAL CARCINOMA—Combined Resection of the Jaw and Radical Dissection of the Neck

Intraoral carcinomas first occur as primary growths. From these sites they spread by the lymphatics to the regional nodes. In the past, treatment of these lesions has consisted of radiation therapy for the primary lesion, followed by radical neck dissection. The results of this treatment have not been satisfactory. On the other hand, for carcinoma elsewhere in the body the results of surgical extirpation of the primary lesion, of the intervening lymphatics and of the regional nodes at the same operation has given much better results.In the past few years an attempt has been made to improve the results of treatment of intraoral carcinoma by removal in continuity of the primary lesion, intervening lymphatics and regional nodes. The improvement in anesthesiology, electrolytes and fluid balance, blood replacement, and the development of the antibiotics, in conjunction with the realization that the cosmetic deformity is not as great as might be expected, has led to this development. In those centers where it has been possible to apply this principle of treatment to intraoral carcinoma the results have been very encouraging.     

TREATMENT OF PAIN AND NEUROMUSCULAR TENSION—A Report on Intravenous Use of Tetracaine in 365 Cases

Three hundred and sixty-five patients were given tetracaine intravenously for various types of pain and neuromuscular tension. In the treatment of pain, myositis, muscle spasm, and visceral spasm most patients were relieved. Best results were obtained in syndromes in which pain was associated with muscle spasm, such as in pain in the lower part of the back and scalenus anticus syndromes. The effects of tetracaine intravenously are those of analgesia, vasodilatation, and relaxation of spastic muscle. Sixty-five of the patients were treated for neuromuscular tension, and there was good relaxation and increased comfort. Alcoholics were relieved of some of the tension symptoms and may have been helped to resist the desire to drink. Of 14 patients with premenstrual tension, 13 had complete relief. Eight patients with mixed anxiety and tension states also responded well.Toxic and allergic reactions were negligible, and other side effects were infrequent and of no consequence.     

THE MANAGEMENT OF ALLERGIC PATIENTS—The Role of the Internist

There has been an increasing trend in the United States toward intensive specialization in allergic diseases. Whereas the tendency toward specialization has led to greater knowledge of the scientific aspects of allergic phenomena, it has somewhat diverted the specialists'' attention from the many clinical problems that await solution.Effective treatment of the allergic patient depends in no small measure on the broad viewpoint and clinical experience of the internist. This fact has been reemphasized by the growing awareness of the significance of the secondary or precipitating causes, such as climatic, nutritional, hormonal and psychogenic factors which influence allergic manifestations. Overemphasis on specialization in allergic diseases with their wide ramifications may defeat the main objective—a successful therapeutic result.To meet this challenge, the internist should be trained in allergy and yet retain a broad approach to the more basic problems of internal medicine. This objective may be attained by certain modifications in undergraduate medical instruction in allergy. Postgraduate training sponsored by our national allergy societies affords internists an excellent opportunity to advance their knowledge of clinical allergy.     

Observations on the Etiology and Therapy of “Brittle” Diabetes

Salient aspects of prolonged metabolic studies on seven excessively labile diabetic patients and a review of the literature concerning causation and therapy of brittle diabetes are presented. Brittleness is redefined as “a syndrome of excessive insulin-sensitivity and ketosis-proneness manifested by extreme and unexplainable short-term and long-term fluctuations in the parameters of the disease”. Evidence on the causation of hyperlability points to dysfunction of plasma-protein transport and of hepatic and peripheral tissue metabolism of insulin. No objectively demonstrable complete and lasting stabilization was possible by means of any antidiabetic or adjunctive therapeutic measures. However, achievement of quantitative improvement in the accuracy of regulation of diabetes and moderation in deviations from the acceptable range of parameters were feasible. To this end, therapy recommended for everyday use incorporates the following principles found to be most helpful in following the oscillations of the disease on the research ward: flexibility in the plan of therapy; accuracy, especially in timing of therapeutic events; and employment of an insulin program best suited to the patient''s needs and comfort.     

TREATMENT OF ENDOTOXIC SHOCK—The Dilemma of Vasopressor and Vasodilator Therapy

Hemodynamic studies have demonstrated that the fall of blood pressure in shock caused by endotoxin in dogs does not result primarily from dilatation or “vasomotor collapse.” Indeed, vasoconstriction is increased and may be excessive. Progression of shock has recently been blamed on such excessive vasoconstriction. For this reason the use of sympathomimetic drugs as vasopressor agents has been challenged and sympatholytic or adrenolytic agents have been recommended.In the present study, vasopressor and vasodilator drugs were used for the treatment of shock in dogs caused by endotoxin. Vasodilator drugs, when used after the onset of shock, hastened a fatal outcome but vasopressor agents were not detrimental when used in moderate doses.The effectiveness of the vasopressor agent is not necessarily due to a primary vasoconstrictor action on arteries and arterioles, as previously assumed.     

TREATMENT OF SUPERFICIAL FUNGOUS INFECTIONS—Value and Limitations of Systemic Administration of Griseofulvin

Comprehensive studies and numerous clinical reports have shown that griseofulvin orally in a dose of 1 gm. daily is an effective treatment for superficial fungous infections of the skin, hair and nails. The drug is not effective against yeast infections (moniliasis), bacterial infections or most of the deep fungous infections.Duration of treatment varies with the site of infection, glabrous skin, crotch and scalp responding within four to five weeks. Infections of palms, soles and nails require a considerably longer time, palms healing more quickly than soles and fingernails more quickly than toenails, which may require up to a year of continuous treatment.Auxiliary measures such as clipping hair, removing infected nail tissue and topical fungicides shorten the duration of treatment.No serious side effects have been reported. Minor discomforts such as headaches and mild rashes occur in some cases.Observations of a series of 49 patients with superficial fungous infections, especially hand, foot and nail infections due to Trichophyton rubrum, confirmed these reports taken from the literature. Attempts to use a reduced dosage schedule did not prove satisfactory.     

Some Observations on the Morphology and Division of Balantidium coli and Balantidium caviae (?)

SYNOPSIS. Studies of the body ciliature of Balantidium coli and B. caviae (?) after Breslau's opal-blue and Klein's silver nitrate techniques revealed a preoral-dorsal suture area where some of the ciliary rows fail to reach the peristomial margin. The incomplete kineties ranged up to a dozen in number and were variable in arrangement. In a count of 100 specimens of B. caviae (?) the incomplete kineties were at the right of the suture in 39, at the left in 24 and on both sides of the suture line in 37. At the posterior end not many kineties reach the pole but no sutural pattern was seen in that region. Scattered irregularities in the ciliary rows were sometimes seen.
Studies of the oral region tend to confirm the view of Fauré-Fremiet that the peristomial ciliature consists of short rows of cilia which are continuations of the anterior body kineties. Membranelles were not found. Thus, some species of Balantidium , at least, show affinities with the Holotricha in agreement with Nie and Fauré-Fremiet.
Fission commonly produces two equal-sized daughters but many cases of unequal division were observed. In both these species conjugants are much smaller than vegetative animals and two preconjugant divisions are indicated, the first of which may be unequal.
During the early stages of fission, the anterior ends of the kineties of the posterior daughter change direction, becoming oblique in the fission zone. In this region the kinetosomes multiply; possibly some of the kineties also divide but evidence for this is incomplete. No evidence of reorganization at the anterior end of the anterior daughter was seen.
Attempts to infect hamsters with B. coli and B. caviae (?) failed. No parasites were found in two collared peccaries repeatedly examined.     

INTRACRANIAL ANGIOGRAPHY IN THE TREATMENT OF CEREBRAL VASCULAR ACCIDENTS—Reports of Cases and a Review of the Literature

Five cases of intracerebral hematoma, including one case of calcified intracerebral hematoma, are presented and treatment is discussed.The role of carotid arteriography, stellate ganglion blocks, vasodilator drugs and operation in the treatment of cerebral vascular accidents is discussed and typical cases of the various vascular anomalies of the cerebral vascular system are presented.