Letters to the Editor
First and second heart sounds
A complication
To the Editor: I read with interest the excellent paper entitled “Changing views on the mechanism of the first and second heart sounds,” by Dr. A. A. Luisada and colleagues, which appeared in THE JOURNAL (Vol. 86: 503-514, 1974). I just would like to bring to your attention that although the material was excellent, however, some errors have occurred: 1. There are 62 references at the end of the paper, whereas I could find only 69 references in the test. 2. A serious error has occurred on page 512, second column, “An article published during the preparation of this manuscripts, . . . ” in which Dr. Luisada tries to disprove his own claims, because the flmt author of reference 59 is Dr. Luisada himself. Jami G. Shakibi, M.D., F.AA,P., F.A.C.C. Director, Section Z Pediatric Cardiology Queen Pahlavi Foundation Cardiovascular Medical Centre Shahanshahi Park Pahlavi Road Tehran, Iran
To the Editor: We read with considerable interest the letter of Drs. Atcheaon and Pred on complications of cardiac resuscitation (AM. HEART J. 69:263,1976.) We should like to draw attention to another possible complication, compression fracture of the spine. It is surprising that little reference is made of this linding in the literature and it is very possible that it is being overlooked. Okel’ reported a single case of vertebral fracture which he felt was related to numerous (35) high energy countershocks administered during a successful resuscitation effort. The possible cause in this instance was felt to be the generalized muscle contractions produced by the countershock. A compression fracture has also been reported following convulsions in the carotid sinus syndrome.’ These two reports would suggest a mechanism similar to that observed in psychiatric patients undergoing elective countershock. Perhaps this problem is being overlooked and suggests the need for thoracic and lumbar spine films in all patients who have been successfully resuscitated. It is strange indeed that this finding is so infrequently observed when one considers the incidence of osteoporosis as well as the frequently vigorous closed-cheat massage and repeated countershocks that are a daily occurrence in our general hospitals. Yune-Gill Jeong, M.D. Leonard P. Caccamo, M.D., FA.C.P. Department of Internal Medicine S. Elizabeth Hospital and the Northeastern Ohio Universities College of Medicine Youngstown, Ohio 44505
Reply To the Editor: I wish to thank Dr. Shakibi for calling attention to two errors in the references, which were caused by the several revisions of the manuscript. The reference cited on page 512 should have been 61 instead of 59. Reference 62 should have been added to reference 56 on page 510. A. A. Luisada, M.D. Department of Cardiology Oak Forest Hospital 15900 South Cicero Ave. Oak Forest, Ill. 60452
680
of cardiac resuscitation
REFERENCES
1. Okel, B. B.: Vertebral fracture from cardioversion shock, J.A.M.A. 203369, 1966. 2. Fishberg, A. M., and Lippmann, R. K.: Compression fracture of spine in carotid sinus syndrome, Mt. Sinai J. Med. N. Y. 12: 296, 1945.
November,
1975, Vol. 90, No. 5
First and second heart sounds
A complication
To the Editor: I read with interest the excellent paper entitled “Changing views on the mechanism of the first and second heart sounds,” by Dr. A. A. Luisada and colleagues, which appeared in THE JOURNAL (Vol. 86: 503-514, 1974). I just would like to bring to your attention that although the material was excellent, however, some errors have occurred: 1. There are 62 references at the end of the paper, whereas I could find only 69 references in the test. 2. A serious error has occurred on page 512, second column, “An article published during the preparation of this manuscripts, . . . ” in which Dr. Luisada tries to disprove his own claims, because the flmt author of reference 59 is Dr. Luisada himself. Jami G. Shakibi, M.D., F.AA,P., F.A.C.C. Director, Section Z Pediatric Cardiology Queen Pahlavi Foundation Cardiovascular Medical Centre Shahanshahi Park Pahlavi Road Tehran, Iran
To the Editor: We read with considerable interest the letter of Drs. Atcheaon and Pred on complications of cardiac resuscitation (AM. HEART J. 69:263,1976.) We should like to draw attention to another possible complication, compression fracture of the spine. It is surprising that little reference is made of this linding in the literature and it is very possible that it is being overlooked. Okel’ reported a single case of vertebral fracture which he felt was related to numerous (35) high energy countershocks administered during a successful resuscitation effort. The possible cause in this instance was felt to be the generalized muscle contractions produced by the countershock. A compression fracture has also been reported following convulsions in the carotid sinus syndrome.’ These two reports would suggest a mechanism similar to that observed in psychiatric patients undergoing elective countershock. Perhaps this problem is being overlooked and suggests the need for thoracic and lumbar spine films in all patients who have been successfully resuscitated. It is strange indeed that this finding is so infrequently observed when one considers the incidence of osteoporosis as well as the frequently vigorous closed-cheat massage and repeated countershocks that are a daily occurrence in our general hospitals. Yune-Gill Jeong, M.D. Leonard P. Caccamo, M.D., FA.C.P. Department of Internal Medicine S. Elizabeth Hospital and the Northeastern Ohio Universities College of Medicine Youngstown, Ohio 44505
Reply To the Editor: I wish to thank Dr. Shakibi for calling attention to two errors in the references, which were caused by the several revisions of the manuscript. The reference cited on page 512 should have been 61 instead of 59. Reference 62 should have been added to reference 56 on page 510. A. A. Luisada, M.D. Department of Cardiology Oak Forest Hospital 15900 South Cicero Ave. Oak Forest, Ill. 60452
680
of cardiac resuscitation
REFERENCES
1. Okel, B. B.: Vertebral fracture from cardioversion shock, J.A.M.A. 203369, 1966. 2. Fishberg, A. M., and Lippmann, R. K.: Compression fracture of spine in carotid sinus syndrome, Mt. Sinai J. Med. N. Y. 12: 296, 1945.
November,
1975, Vol. 90, No. 5
