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.     

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.     

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.     

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.     

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.     

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.     

RADIATION THERAPY IN BREAST CANCER—A Preliminary Report on the Application of a Technique of the McWhirter Type

A modification of the radiation technique advocated by McWhirter was used in the treatment of 12 patients with carcinoma of the breast. On the basis of observations it is believed that the method has definite merit. It is believed that for patients who have had radical mastectomy, radiotherapy should be protracted over a period of more than three weeks.     

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.     

WESTERN EQUINE ENCEPHALITIS IN INFANTS—A Report on Three Cases with Sequelae

Approximately one-third of the laboratory-confirmed cases of Western equine encephalitis occur in children under the age of 10. The present paper describes three instances of Western equine encephalomyelitis virus infection in infants under one year of age, together with the resultant sequelae. The difficulties associated with diagnosis of central nervous system disturbances in very young children are discussed, and it is pointed out that in view of the frequent occurrence of clinical infections with the arthropod-borne encephalitis viruses these agents should be given serious consideration as a cause of acute central nervous system infection in childhood and as the possible etiology for obscure, severe neurological disturbances in the pediatric age groups.     

TRIFLUOROETHYLVINYL ETHER (FLUOROMAR?)—A Preliminary Report on Clinical Experience and Animal Experiment

In observations of 80 cases in which Fluoromar was used for inhalation anesthesia it was noted that induction was rapid; maintenance although labile, was usually smooth; and recovery of reflexes was rapid. Anesthetic complications were minimal, and postanesthetic complications were limited to nausea and vomiting in no greater incidence than that expected to follow the use of most inhalation anesthetic agents.Fluoromar produces rapid, and not particularly unpleasant, loss of consciousness, and will produce complete anesthesia without supplement. However, the muscular relaxation afforded by Fluoromar is not complete, and delayed recovery from anesthesia may follow attempts to produce relaxation by deepening too greatly the level of anesthesia.The inflammability of Fluoromar is less than that of other inhalation agents.     

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.     

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.     

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.     

THE REMOVAL OF STONES FROM LOW IN THE URETER—A Report on an Improved Method

Extraction of stones from the lower part of the ureter can be facilitated by use of a long filiform which permits the attachment and introduction of dilating Phillips catheters of increasing caliber and of various stone extractors. The filiform must be left in place, with the tip superior to the stone, until the ureter has been successfully dilated, the stone extracted and a drainage catheter inserted. The filiform serves to guide the instruments up the ureter.Smooth muscle relaxation, or “tone paralysis,” is achieved by leaving each dilating catheter in the ureter for at least ten minutes.A combination of spinal and local anesthesia is used, and this contributes further to the desired ureteral relaxation. This simple method was used successfully in 34 of 35 consecutive cases to remove a stone in the lower part of the ureter.     

Upper Lobe Lobectomy and Concomitant Thoracoplasty in Pulmonary Tuberculosis—A Preliminary Report

In this, a preliminary report, the advantages and disadvantages of upper lobe lobectomy and concomitant thoracoplasty in tuberculosis have been summarized. There has been no undue increase in the operative hazard, there have been no complications, and the immediate results have been entirely satisfactory.Twenty-six patients were subjected to a combined operation (17 upper lobectomy-thoracoplasty and nine pneumonectomy-thoracoplasty) with one postoperative death.Indications for primary lobectomy have been discussed.The technique of resection and concomitant thoracoplasty has been briefly described.     

LOCAL ANESTHESIA FOR HERNIOPLASTY—Immediate Ambulation and Return to Work—A Preliminary Report

In 50 cases in which hernioplasty was carried out with atraumatic technique under local anesthesia, the patients walked away from the operating table, then through the corridors, without assistance. They usually drove home the next day and returned to their regular occupations immediately. Few had pain necessitating more than mild analgesia.In a period of follow-up ranging from six months to three years at the time of this report, two patients had recurrence.