Vol. 60, 1909 - University of North Carolina at Chapel Hill

ABSTRACTS 18,5
pleural pain, and wasting were prominent, of recovery. He believes that in infants
In the most chronic cases only gradual fail- even if the pericardium be opened the relief
ure of strength and health was recorded, afforded will be comparatively slight on
The majority of the symptoms are in no account of the difficulty in draining the
sense localizing. Those which attract tenacious exudation and the presence of
especial attention as unusual and not quite multiple associated lesions. Paracentesis
like those which are expected in severe pulmonary
disease are extreme illness with
lividity, panting respiration and excessive
of the pericardium is, of course, required in
these cases, and if there is sufficient evi-
dence of an effusion it is well to proceed at
dyspnea, curious irregular rises of tempera- once to open the pericardium. As to the
ture accompanied by rapid and feeble action exact site for exploration. West has recently
of the heart, orthopnea, and syncopal at- advocated the left lower margin of the cartacks.
The last two are regarded by the diac dulness—that is, in the region of the
author as the most suggestive, if in addi- impulse.
tion the pulse is stiikingly rapid and ex- In uncomplicated cases this is doubtless
cited. the wise procedure. In accordance with
When the diagnosis has been arrived at the conditions present, however, it may be
with confidence one of two events hasprob- wise to introduce the needle into the fourth
ably occurred—either pericardial friction or fifth intercostal space close to the sternum
has been detected or there has supervened or in the left costoxiphoid angle, pressing
large pericardial effusion. In children it inward and upward behind the lower end
both events are exceptional.
When a case of pneumonia or empyema
of the sternum. Inflammatory changes in
the anterior mediastinum and great thickenfirst
comes under observation, if the exact ing of the pericardium itself make it somecondition
of the heart is recorded it is pos- times difficult to tell when the pericardial
sible in some instances to trace out every cavity has been opened.
stage of the development of the effusion.
Among the most important signs are progressive
muffling of the heart sounds, syn-
The Operation ot Cardiolysis.—Poyn-
ton and Trotter, in The Dul)lin Medical
chronous with enlargement of the cardiac Journal, report such an operation in a boy,
area, together with marked percussion dul- sixteen years of age, which was successful.
ness over the pericardium and sometimes They remark that the operation of cardioposteriorly
in the interscapular region, lysis was first suggested in 1902 by Brauer
Tubular breathing or absent breath sounds and put in practice by Peterson. The name
may also be noted in the interscapular cardiolysis is perhaps a little misleading,
region. as it is at any rate more impressive than
A rapid and extensive increase of the the surgically simple procedure to which it
cardiac dulness upward toward the left is given. It was pointed out by Brauer
clavicle.
that in certain cases of adherent pericardium
The pear-shaped outline of a distended where the heart is embarrassed by fixation
pericardium. to the surrounding parts, a considerable
The abrupt transition from the dulness of amount of this overloading of the heart's
fluid to resonant lung tissue.
A wavy and diffuse pulsation to the left
of the sternum.
When there is much fluid round the heart
the pulse becomes rapid, small, and someaction
could be got rid of by rendering the
prsecordial part of the chest wall more flex-
ible than normal by removing its bony and
cartilaginous framework. No extensive
separation of adhesions was suggested, and
times very irregular and almost running in it is obvious that under the circumstances
character.
'
in which the operation has to be done such
As to the clinical distinction between procedure would be very dangerous. In
rheumatic and pneumococcal pericarditis, the first place the circulatory conditions are
the hitter is at its maximum frequency un- very unfavorable for prolonged general
der four years of age, is almost never com- anaesthesia, while the risk of tearing the
plicated by endocarditis, or dilatation, is as left pleura or even the heart wall would
a rule complicated Ijy empyema, pneu- seem to be very great. The operation was
uionia, and pleurisy, exhibits a marked extremely simple and short and the results
tendency toward pus formation, is only ex- were encouraging. Nevertheless, it seems
' ceptionally complicated by joint involve- to have been very little done. A review of
I inents.
In all these respects the rheumatic the subject published in August, 1908, by
I pericarditis differs. Ernst Venus, gives a total of seventeen
The prognosis of suppurative pericarditis cases, three of them being Brauer's. The
in small children is exceedingly grave, article contains a summary of all the cases
Surgical intervention offers the best chance and seems to be founded on a very comof
success and there are some recorded cases plele study of the literature. There is no