56G THE TOCOPHEROLS 



patients, record no recognizable benefit resulting from this therapeutic 

 procedure. Many varial^les, some controllable and others not, enter into 

 such clinical studies and markedly influence the final conclusions, which 

 often fall far short of a critical evaluation of patient response in terms of 

 what the result might have been in the absence of tocopherol therapy. Until 

 many of these variables are resolved and more reliable criteria of responses 

 established, the ciuestion of the merits of tocopherol therapy in heart dis- 

 eases must be considered an unsettled one. 



2. Peripheral Vascular Disease 



Rather remarkable effects of high dosage of a-tocopherol in the manage- 

 ment of vascular disorders such as indolent ulcers, early grangrene of the 

 extremities, thromboangiitis obliterans, thrombophlebitis, phleobothrom- 

 bosis and cerebral thrombosis, and also burns, have been reported by Shute 

 et al.f' "^^-^^ these effects are attributed to antithrombic, thrombocytolj^ic, 

 and capillary- vasodilative functions of tocopherol. Others report beneficial 

 effects in cases of thromboangiitis obliterans,^^' ^^ leg ulcers,"'^^ and phlebi- 

 tis,'^" but contrary views are also expressed. ■^^"^^ Increased peroxide content 

 of subcutaneous tissues in cases of vascular disease of the extremities, sug- 

 gestive of a local deficiency of vitamin E,'*^ and the reported effects of to- 

 copherol on experimentally induced femoral thrombi^^ and in prevention 

 of arterial lesions^^ in dogs, are of interest in this connection. 



26 M. E. Eisen and H. Gross, N. Y. State J. Med. 49, 2422 (1949). 



27 H. Berger, A^. Y. State J. Med. 50, 441 (1950). 



28 E. V. Shute, A. B. Vogelsang, F. R. Skelton, and W. E. Shute, Surg. Gynecol. 

 Obstet. 86, 1 (1948); Seminar 1, 3 (1949). 



23 A. B. Vogelsang, E. V. Shute, and W. E. Shute, Med. Record 161, 83 (1948). 

 30 E. V. Shute, Ann. N. Y. Acad. Set. 52, 358 (1949). 

 " W. E. Shute and E. V. Shute, Seminar 1, 47 (1949). 



32 E. V. Shute, /. Ohstet. Gynaecol. Brit. Empire 58, 843 (1951). 



33 E. V. Shute and W. E. Shute, Am. J. Surg. 84, 187 (1952). 



34 W. R. Cameron, Seminar 3, 9 (1951). 



35 A. H. Ratcliffe, Lancet 257, 1128 (1949). 



3" A. M. Boyd, A. H. Ratcliffe, R. P. Jepson, and G. W. H. James, ./. Bone and Joint 

 Surg. 31B, 325 (1949). 



37 C. Stritzler, Ann. N. Y. Acad. Sci. 52, 368 (1949). 



38 H. Siedenstopf and A. Kruger, Med. Klin. 44, 1060 (1949). 



39 A. Bijdendijk and F. J. Noordhoek, Nederl. Tijdschr. Geneesk. 95, 1039 (1951). 

 "*" R. Castagna and G. Impallomeni, Bol. Soc. Piemont Chir. 18, 155 (1948). 



" L. L. Pennock, Ann. N. Y. Acad. Sci. 52, 413 (1949). 



42 L. L. Pennock and A. M. Minno, Angiology 1, 337 (1950). 



43 A. Wegner, Dermatol. Wochschr. 123, 385 (1951). 



44 H. I. Lippmann, in discussion of paper by E. V. Shute, ref. 30. 



45 K. E. Jessen, J. Glavind, S. Hartmann, and H. Dam, Acta. Pathol. Microbiol. 

 Scand. 29, 73 (1951). 



«G. Enria and R. Ferrero, Arch. Sci. Med. 91, 23 (1951). 

 « R. L. Holman, Southern Med. J. 42, 108 (1949). 



