Experimental and Clinical Observations on Poldine in Treatment of Duodenal Ulcer

Prognosis.-Ourfirst patient is of interest because of the long survival period.A significant feature of septal perforation is that death does not occur immediately: Edmondson and Hoxie (1942) found an average period of survival of 7.4 days.In the series of Sanders et al. (1956) 13% (12 patients) lived from two months to several years.Treatment.-Thegeneral principles of treatment are based on the knowledge that the efficiency of the heart in which septal perforation has occurred has already been impaired by coronary atherosclerosis followed by myocardial infarction.The left-to-right shunt, with increased blood-flow and raised pressure in the pulmonary circulation, throws an extra strain on the ventricles, and leads to heart failure.In our first two cases the administration of digitalis was of benefit, and diuretics were of considerable help.In Case 1, after a few weeks, there was a loss of response to mercurial diuretics: chlorothiazide with potassium supplements had an immediate beneficial effect.Summary Three cases of ventricular septal perforation are described.The diagnosis should be considered when a patient with an acute myocardial infarction suddenly deteriorates and develops a loud blowing pansystolic murmur between the left sternal edge and apex in the fourth and fifth left intercostal spaces.Dye-dilution curves in two cases showed the presence of a left-to-right shunt.We thank Professor J. McMichael for his advice and encouragement, Dr.