DURING THE EXAMINATION of patients for admission to the cerebrovascular disease study at Bellevue Hospital, cervical bruits frequently were heard in patients with and without clinical evidence of cerebrovascular disease. This sign was believed to be useful in the diagnosis of arteriovascular disease, and it was decided to undertake a study to further evaluate it and cover the incidence of bruit in a group of (1 ) patients with clinical evidence of cerebrovascular disease, (2) patients of similar age and sex without evidence of cerebrovascular disease, and (3) healthy young adults. The relationship of cervical bruit with heart murmur was studied, and the transmission of heart sounds to the vessels of the neck was investigated. The influence of factors which might be associated with an increase in the incidence of cerebrovascular disease and bruit was also investigated, and auscultatory, stethographic, and angiographic data obtained from patients with cerebrovascular disease and bruits were correlated.

CA: A Cancer Journal for CliniciansVolume 13, Issue 5 p. 183-186 ArticleFree Access Cancer around the world breaking the cigarette habit BÖRje Ejrup M.D., BÖRje Ejrup M.D. Associate Professor of Medicine, the Karolinska Institute, Stockholm, SwedenSearch for more papers by this author BÖRje Ejrup M.D., BÖRje Ejrup M.D. Associate Professor of Medicine, the Karolinska Institute, Stockholm, SwedenSearch for more papers by this author First published: September/October 1963 https://doi.org/10.3322/canjclin.13.5.183Citations: 1AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Citing Literature Volume13, Issue5September/October 1963Pages 183-186 RelatedInformation

(1961). Vascular Problems in Orthopaedic Surgery. Acta Orthopaedica Scandinavica: Vol. 31, No. 2, pp. 114-129.

Experiences from 12 Swedish hospitals concerning catheterization of the heart and large vessels, with or without contrast injection, have been reviewed with respect to rate of fatal and nonfatal complications, indications and contra-indications, technique, and preventive measures. The rate of certain fatal complications due to right heart catheterization was 55,859; to completed or incomplete angiocardiography 92,451; and to completed or incomplete thoracic aortography 5340.

For a variety of reasons it is difficult to evaluate the influence of therapeutic procedures in essential hypertension, the peculiar feature of which is an elevation of the diastolic blood pressure. Patients present individual problems and do not readily adapt themselves to precise categories and strict comparisons. Furthermore, while hypertension commonly runs a prolonged course over the years and shows of itself spontaneous fluctuations from day to day, yet for reasons unknown the intensity of the disease may abruptly increase and the pace towards a fatal termination quicken with unexpected suddenness. We have no measure of vascular vulnerability with which to compare one patient with another. A feature of the disease, even in the same subject, is its variability. Symptoms pass through phases of activity and seldom correlate with the blood pressure readings. Arteriolar tone is not a fixed quantity. The diastolic pressure is constantly changing, occasionally falling to surprisingly low levels for no obvious reasons. It is remarkable how, after many months of intermittent disablement by headache or giddiness in middle life, a symptom-free stage may ultimately be attained in later years without, however, much significant alteration in the blood pressure. These natural variations and remissions hinder reliable therapeutic deductions in the individual patient. Nervous and emotional factors are difficult to assess and it is well recognized that the hypertensive patient is highly susceptible to suggestion-particularly when it is reinforced by the sympathetic care and understanding of an enthusiastic adviser. Psychological factors may distort the picture and obscure the basic facts. By the study of a group of patients over a sufficiently long period the fallacies attributable to the inconsequential fluctuations of pressure and spontaneous remissions in symptoms are minimized to some extent. All our patients were under the care and supervision of the same observers: accustomed to the same surroundings, the same methods of clinical investigation and familiar with the ways of the examiners, they were thereby exposed to few extraneous factors liable to influence their nervous tension adversely. By the adoption of an attitude of benevolent neutrality, psychological influences were kept as uniform as possible from patient to patient. Each patient reported at intervals and was assessed by the same observers. Many attempts have been made to judge the efficacy of the surgical attack on hypertension (Adson et al., 1934, 1936; Allen and Adson, 1940; Smithwick, 1940, 1944; and Grimson, 1947). Inadequate standards for comparison have proved a stumbling-block. Not infrequently an author has assembled two groups for comparison, one medically and the other surgically treated. To some extent the conclusions are invalidated by a comparison of the author's series of surgically treated patients with a medical group investigated by someone else necessarily employing slightly different standards, techniques, and methods. For example, Wagener and Keith (1939) report on a series of medically treated patients with hypertension and their results have been used by several surgical authors for comparison with their own cases Flaxman (1944) describes a medical series of his own compared with the surgical experiences of Peet et al. (1940); Hammarstrom (1947) compares his surgical cases with a series of non-operated cases described by Bechgaard (1946), and so on. The general consensus of opinion is that sympathectomy is of value particularly in younger patients before the development of serious coronary or renal disease.

Acta Medica ScandinavicaVolume 154, Issue S312 p. 225-227 Total Adrenalectomy in Five Cases of Malignant Hypertension B. EJRUP, B. EJRUP Medical and Surgical Depts., Karolinska Sjukhuset, Stockholm, SwedenSearch for more papers by this authorC. FRANKSSON, C. FRANKSSON Medical and Surgical Depts., Karolinska Sjukhuset, Stockholm, SwedenSearch for more papers by this author B. EJRUP, B. EJRUP Medical and Surgical Depts., Karolinska Sjukhuset, Stockholm, SwedenSearch for more papers by this authorC. FRANKSSON, C. FRANKSSON Medical and Surgical Depts., Karolinska Sjukhuset, Stockholm, SwedenSearch for more papers by this author First published: January/December 1956 https://doi.org/10.1111/j.0954-6820.1956.tb16980.xAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume154, IssueS312January/December 1956Pages 225-227 RelatedInformation