A ssistanit Surgeon, Westminster Hospital [WITH PHOTOGRAVURE PLATE] The treatment of hypertension by resectnon of the dorsolumbar sympathetic nervous system has been practised for many years in the United States, where there is already an extensive literature on the subject. This literature has been reviewed elsewhere (Blodgett and Cutler, 1947;Bassett, 1948 Diagnosis In five cases there seemed to be a cause for the hypertension: three patients had chronic nephritis, one patient had calculi in both kidneys, and the fifth, a married woman aged 47, had suffered from eclampsia 28 years previously. One patient with renal hypertension, a man aged 53 who had a clear history of acute nephritis at the age of 23, stated that his father and brother had both died from a " stroke." In this case the chronic nephritis had entered a malignant phase, and the familial tendency to high blood pressure had probably accentuated the disease. In the other 19 cases, in spite of careful interrogation and investigation, the origin of the hypertension was obscure, except that nine had a family history of hypertensive cardiovascular disease, suggesting that they might be cases of essential hypertension. However, when the records of these 19 patients were viewed as a whole an impression was gained that many were cases of chronic renal disease rather than essential hypertension.Malignant Hypertension.-There were six cases of malignant hypertension in this series-four primary and two secondary. The following criteria were used in making the diagnosis: (1) The presence of papilloedema with or without oedema of the surrounding retina-all six cases; (2) necrosis of the glomeruli or afferent arterioles on renal biopsy or at necropsy-five cases; (3) gross impairment of renal function-three cases; and (4)
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