20 seconds) that it would appear they could hardly be speeded up much in their 'action by chewing. We, too, have noted the acceleration of the pulse rate during steady-state walking, but it would be difficult to pinpoint a time of onset for this side effect in an already accelerated heart rate. Since we were primarily interested in the effect on anginal pain, we were particularly alert to changes in this symptom. We did make note of the effect on the electrocardiogram and the blood pressure and found that the pressure was the primary determinant of the so-called double product (heart rate X systolic blood pressure) . Albert A. Kattus, M.D. Division of Cardiology, Department of Medicine University of California, Los Angeles

'Statement from ACCP Committee on Pulmonary Rehabilitation To the Editor: The following statement has been approved by the Committee on Pulmonary Rehabilitation of the American Conege of Chest Physicians: Home oxygen is a safe form of therapy. This has been proven by its use in chronic obstructive pulmonary disease patients with proper instruction in standard safety measures.

Thomas L. Petty, M.D., F.C.C.P. Chairman, Committee on Pulmonary Rehabilitation Denver

T c under the effect of this drug. This observation may explain the beneficial effect of propranolol therapy in· . patients who have a congenitally prolonged Q- T interval. It would be interesting to investigate the effect of this drug on the Q- T interval in a large series of such patients, a study not yet performed, to the best of my knowledge. Shlomo Stem, M.D. Associate Professor of Medicine Hebrew University-Hadassah Medical School Jerusalem, Israel

1 Crawford MH, Karliner JS~ O'Rourke RA, et al: Prolonged Q-T interval syndrome: Successful treatment with combined ventricular pacing and propranolol. Chest 68: 369371, 1975 2 Phillips J, Ichinose H: Clinical and pathologic studies in the hereditary syndrome of a long Q-T interval, syncopal spells and sudden death. Chest 58:236-243, 1970 3 Garza LA, Viele RL, Nora JJ, et al: Heritable Q-T prolongation without deafness. Circulation 41:39-48, 1970 4 Ratshin RA, Hunt D, Russell RO Jr, et al: Q-T interval prolongation, paroxysmal ventricular arrhythmias, and convulsive syncope. Ann Intern Med 75:919-924, 1971 5 Vincent MG, Abildskov JA, Burgess MJ: Q-T interval syndromes. Prog Cardiovasc Dis 16:523-530, 1974 6 Stem S, Eisenberg S: The effect of propranolol (Indew) on the electrocardiogram of normal subjects. Am Heart J 77: 192-195, 1969

Bone Resorption in Progressive Systemic Sclerosis

Propranolol Therapy and the

Q- T

Interval To the Editor: Crawford and co-workers 1 have reported in Chest on the successful treatment with combined ventricular pacing and propranolol of a patient with the syndrome of a prolonged Q-T interval. These investigators stressed that propranolol usually acts favorably in such patients, as also reported by previous investigators,2-5 while drugs such as quinidine and procaine amide should not be employed, because they prolong the Q-T interval. Crawford and co-workers accept that propranolol is considered to be the most effective drug for preventing the ventricular arrhythmias in this syndrome, but they believe that the effect of this drug on the Q-T interval is "inconsistent" and conclude that the precise mechanism of the beneficial effect of this drug in the syndrome of prolonged Q-T interval is unclear. May I draw your attention to a previous investigation published in 1969, 6 describing the effect of intravenously administered propranolol hydrochloride on the electrocardiograms of 21 normal subjects? In an but one examinee, this study demonstrated a shortening of the QCHES~ 7~

1,

JUL~

1976

To the Editor: In the December 1975 issue (Chest 68:838-840, 1975), -an article entitled "Bone Resorption of the Ribs and Pulmonary Function in Progressive Systemic Sclerosis" by Steigerwald et al was published. It stated that "Heretofore, however, there have not been, to our .knowledge, any reports of bone resorption of the ribs in PSS" (progressive systemic sclerosis). The authors have completely misstated the facts! Reference is made to an article entitled "Superior Marginal Rib Defects" by E. Nicholas Sargent, M.D., Franklin Turner, M.D., and George Jacobson, M.D., which was published in the July 1969 issue of the American lourool of Roentgenology (106:491-505, 1969). In this article, examples of progressive systemic sclerosis including photographs of rib destruction are presented, and an additional reference by Keats is quoted. It is obvious that the authors have made a very poor search of the literature, and their case presentation certainly is not the first in the literature! E. Nicholas Sargent, M.D. Department of Health Services Los Angeles County-University of Southem California Medical Center, Los Angeles

COMMUNICATIONS TO THE EDITOR 107

Letter: Propranolol therapy and the Q-T interval.

20 seconds) that it would appear they could hardly be speeded up much in their 'action by chewing. We, too, have noted the acceleration of the pulse r...
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