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Abstract
The surgical treatment of hypertension, which consists of subdiaphragmatic resection
of the major, minor, and lesser splanchnic nerves, celiac ganglion, and lumbar sympathetic
ganglions, is associated with a small risk and is followed by satisfactory alleviation
of symptoms in selected cases.
Assuming that all hypertension can be divided into four groups, depending upon the
severity, Group 1 does not require surgical treatment and Group 4 is too severe and
too far advanced to warrant the expectation of adequate results. Groups 2 and 3 then
should be considered for operative treatment. More important than the group are the
preoperative tests which indicate the potential physiologic changes that will follow
sympathetic denervation of the vascular area below the diaphragm.
The so-called cold test indicates the upper limits of the blood pressure resulting
from emotion or cold. The four other tests indicate the lower limits of the blood
pressure readings associated with prolonged vasodilatation, and, therefore, denote
the probable values for the blood pressure following extensive sympathectomy. They
are as follows: (1) Twenty-four consecutive hourly determinations of the blood pressure
are made while the patient is in bed, to establish the maximal blood pressure, the
minimal blood pressure, and the mean or average blood pressure. (2) Slow and intermittent
intravenous injection of a 5 per cent solution of pentothal sodium is made until there
is no further drop in blood pressure. (3) One-half grain (0.032 gm.) of sodium nitrite
is administered at intervals of thirty minutes until six doses have been given. (4)
Hourly determinations of blood pressure are made during rest and sleep for a minimum
of twenty-four hours.
If the blood pressure drops to nearly normal and if the patient is less than 50 years
of age, the operation should be considered.
The results in a large series of cases have been quite satisfactory. The effect of
the operation is physiologic in character, and, if so considered, the results justify
the procedure.
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Article info
Publication history
Received:
May 2,
1938
Footnotes
☆Read as part of the Louis A. Greensfelder Memorial Lectureship, Michael Reese Hospital, Chicago, Ill., Dec. 23, 1937.
Identification
Copyright
© 1938 Published by Elsevier Inc.
