Subarachnoid Spinal Adhesions: An Attempt Experimentally to Produce and Prevent Their Recurrence.

Abstract

897seem to be proof positive that the disturbance was not of an organic nature, at any rate not totally so. It is quite conceivable that pathological changes may be present in the region of the bundle and primary branches which would require very little additional change for the precipitation of block. Under such conditions, however, one should expect to find slight transition periods and increasing block. A mechanical factor could quite conceivably add the necessary additional sudden and temporary factor. That there is a mechanical factor playing a part is substantiated by the fact that the periods of normal conduction in these patients were induced by respiratory maneuvers. The Miiller's or Valsalva experiments, either of which were accompanied by the sudden conspicuous changes in intraventricular conduction, were apparently concurrent with the cardiac dilatation.The clinical value of the observations lies in the realization of the fact that the serious prognostic significance of permanently organically produced bundle branch block is not to be applied until the possibility of a temporary disturbance is ruled out. Furthermore, as generally recognized, patients with bundle branch block are known to die suddenly at the slightest provocation, especially during a minor therapeutic or surgical procedure. Any blood pressure may be enough to press the already over exerting heart to a point of causing ventricular fibrillation and exitus. During the periods of normal conduction these patients are relatively good surgical risks. In one of our patients the discovery of the transient nature of the condition led us to follow her carefully electrocardiographically and to subject her to 2 successful surgical operations, a Cesarean and a later sterilization, during periods in which she was not blocking, without precipitating any evidence of undue cardiac embarrassment.