LEFT HEART CATHETERIZATION—The Clinical Importance of Findings

Left heart catheterization using the transbronchial route to obtain pressures in the left atrium and left ventricle was used successfully in 29 cases with no mortality or morbidity. It was found to be useful in differentiating between mitral stenosis and mitral insufficiency, as well as determining the amount of aortic stenosis present when there was involvement of the aortic valve. The technique was also helpful in determining which is the predominant lesion when there is a disease of the aortic and mitral valves.In two patients in a series of 29, data obtained by left heart catheterization forestalled operation on the basis of a mistaken diagnosis of mitral stenosis when actually no mitral valvular disease was present. In another eight patients, the predominant lesion was found to be mitral stenosis rather than mitral insufficiency as it was thought to be before catheterization. In two patients, who had only systolic murmurs, catheterization revealed mitral stenosis rather than mitral insufficiency. In four patients who were thought to have mixed valvular disease, left heart catheterization showed only aortic valvular disease.     

The Hypothalamic-Pituitary-Adrenocortical System—Clinical Evaluation by Pharmacologic Techniques

The hypothalamic-pituitary-adrenocortical system is a complex negative feed-back control mechanism. Under non-stress conditions it functions to maintain a circadian rhythm of adrenal steroid production which is secondary to a circadian fluctuation in the sensitivity to suppression of acth by hydrocortisone. Any stressful stimulus causes an augmentation of steroid production which is due in part to a decrease in sensitivity of acth to suppression. Aldosterone production is not primarily controlled by acth.The increased understanding of this system and of its pathologic alterations has led to the development of a number of pharmacologic techniques which have proved most valuable in evaluating its integrity. Hypothalamic-pituitary function can be assessed by the response to the administration of dexamethasone, methopyrapone, bacterial pyrogen and vasopressin. Adrenal cortical function can be assessed by the response to acth, dexamethasone and spironolactone.     

HYPERVENTILATION SYNDROME—A Clinical and Physiological Evaluation

There is a chronic hyperventilation syndrome which is much more common, of greater medical significance and far more difficult to diagnose than the better-known acute hyperventilation attack. This chronic syndrome tends to mimic grave organic disease with which it frequently is associated or superimposed.Studies on 250 patients with chronic hyperventilation patterns revealed the rapidity with which biochemical and physiological changes can occur and the characteristics of the resultant symptoms and signs, with particular reference to the heart and lungs.Once the diagnosis is suspected and appropriately confirmed, it is possible to “cure” over 70 per cent of such patients by means of simple therapeutic measures.     

The Medawar Lecture 1998 is science dangerous?

The idea that science is dangerous is deeply embedded in our culture, particularly in literature, yet science provides the best way of understanding the world. Science is not the same as technology. In contrast to technology, reliable scientific knowledge is value-free and has no moral or ethical value. Scientists are not responsible for the technological applications of science; the very nature of science is that it is not possible to predict what will be discovered or how these discoveries could be applied. The obligation of scientists is to make public both any social implications of their work and its technological applications. A rare case of immoral science was eugenics. The image of Frankenstein has been turned by the media into genetic pornography, but neither cloning nor stem cells or gene therapy raise new ethical issues. There are no areas of research that are so socially sensitive that research into them should be proscribed. We have to rely on the many institutions of a democratic society: parliament, a free and vigorous press, affected groups and the scientists themselves. That is why programmes for the public understanding of science are so important. Alas, we still do not know how best to do this.