CEREBRAL VASCULAR DISEASES—Certain Clinical and Electroencephalographic Aspects

In a preliminary study of 52 patients with cerebral vascular disease, clinical and electroencephalographic evaluations were compared. Most of the patients were in the sixth and seventh decade of life and had had symptoms of cerebral vascular disease for over a year. Seventeen of the patients had clinical evidence of intermittent cerebral ischemia. When routine electroencephalographic techniques were used, 47 per cent of the records were within normal limits. Twenty patients with cerebral vascular disease, eight of whom had clinical cerebral vascular insufficiency, were studied during posturally induced hypotension. No activation was detected in any of these 20 patients. It would appear that other methods of activation, including tilt-table studies, and serial recordings should be further explored and evaluated in these disorders if more clinically useful information is to be gained.     

EXOPHTHALMOS—From the Standpoint of the Ophthalmologist

There are many causes of abnormal protrusion of one or both eyes, the most common of which is imbalance of the glands of internal secretion. Among other causes are a variety of tumors that originate behind the eye or that extend to that location from other parts in the body. Infections can extend to the orbit behind the eye from the neighboring structures such as the paranasal sinuses. Infection may also extend to the orbit from distant areas by way of the blood and cause exophthalmos.     

EXOPHTHALMOS—From the Standpoint of the Otolaryngologist

Exophthalmos may be due to an inflammatory process or to tumor formation. Inflammatory processes are most likely to occur in children and young adults. Tumors are the most common cause of exophthalmos in adults.Since the advent of chemotherapy and the antibiotics, rarely does orbital cellulitis develop from sinal infection.Tumors causing exophthalmos are likely to be benign if they arise from the frontal sinus and malignant if they arise from the maxillary and ethmoid sinuses.     

HYPOPARATHYROIDISM—Medical and Surgical Aspects

Hypoparathyroidism is almost invariably a complication of operation on the thyroid gland, and the diagnosis usually presents no problem. Fairly good control of the symptoms is possible by medical management, but, since substitution therapy is not available, the treatment of hypoparathyroidism is not completely satisfactory. Parathyroid homografting has been attempted; at present, however, grafting procedures must be considered experimental.     

HEARING CONSERVATION—Industrial Aspects in California

Impaired hearing is a serious problem. The number of persons with a significant hearing loss has been estimated to be approximately 10 per cent of the population.Hearing loss owing to exposure to noise is becoming an increasingly important disease. Although it has been recognized for more than a century, little if anything was done to prevent it until a few years ago.The initiation of hearing conservation for employees has been undertaken by many of the large companies, particularly in California.Hearing conservation includes preemployment and follow-up hearing tests, control of noise at the source and personal protection (ear plugs, ear muffs).Noise-induced hearing loss is directly related to noise-exposure. Noise must be measured in terms of volume, wave length and length of exposure. Exposure must be analyzed for daily distribution and total time.Although the noise-exposure problem is a serious one, cooperation of employee, employer and the legal and medical professions to initiate preventive programs can reduce it to a minimum.     

Mechanical Complications of Myocardial Infarction—Radiologic Aspects

Left ventricular aneurysm, interventricular septal defect and acute mitral valve incompetence due to papillary muscle damage are three mechanical complications which cause intractable heart failure following myocardial infarction. In each case surgical intervention can result in dramatic improvement of congestive heart failure.A hemodynamically significant left ventricular aneurysm enlarges the cardiac silhouette and frequently causes a localized protrusion as seen radiographically. Cardiac fluoroscopy will disclose an abnormal pulsation of the left ventricular border. The left ventricular angiogram establishes the diagnosis, reveals the extent of the aneurysm and may disclose a filling defect in the aneurysmal sac due to the presence of mural thrombus. Coronary arteriography shows occlusion of a major vessel, most commonly the anterior descending branch of the left coronary artery.Ischemic perforation of the interventricular septum and acute mitral incompetence due to severe papillary muscle damage both cause severe heart failure shortly after myocardial infarction. A similar pansystolic murmur accompanies both conditions, and differentiation between the two is rarely possible on the basis of the electrocardiogram or x-ray film of the chest. Ventricular cardiac catheterization and left ventricular angiocardiography are required for a correct diagnosis.     

ACUTE MYOCARDIAL INFARCTION—A Discussion of Certain Controversial Issues

As a general rule, it is not believed possible to classify patients with acute myocardial infarction as to the future severity of their illness at the time of the initial examination. However, classifications are possible from complete clinical data of the first few days with regard to the predicted mortality rates. Whether to manage the patient in the hospital or at home depends on the community facilities. The patient should be in bed for a period of two to three weeks if unquestioned infarction has occurred.The main avenue of investigation as to lowering of mortality needs to be directed toward the prevention of heart failure or sudden unexpected death probably related to arrhythmia. If the patient is hospitalized and laboratory facilities are available, anticoagulant therapy can be safely and effectively carried out without undue risk or prohibitive increase in the cost of management. The experience of the author and his colleagues has led to the belief that anticoagulants given routinely to patients with myocardial infarction are effective in decreasing the incidence of thromboembolic complications.