A.M.A. Archives of Internal Medicine

Rall, J. E.

doi: 10.1001/archinte.1957.00260090003001pmid: 13457456

Abstract Some months ago the statement which appears after Dr. J. E. Rail's editorial was received from the United Nations Scientific Committee on the Effects of Atomic Radiation, set up by the General Assembly. It was felt that the statement, while extremely useful, was not as specific as might be desired to be of maximum practical value to our readers. It is therefore published in conjunction with Dr. Rail's informative and disturbing editorial P. S. R. The recent statement by the United Nations Scientific Committee on the Effects of Atomic Radiation, which is reproduced, in part, with this editorial, and the recent action of the National Committee on Radiation Protection, which suggested another decrease in the "permissible" amount of radiation, illustrates the concern of scientists about the hazards of radiation. As indicated by the United Nations Committee statement, physicians, at least in the United States, are responsible for the major portions References 1. The term r (roentgen) will be used throughout, although several other terms might be used. The rad, which more accurately defines the energy absorbed by tissue and which is slightly larger than an r, has recently been introduced. The rem (roentgen equivalent man) is also used in an attempt to correct for the fact that certain types of radiation, namely, neutron and proton radiation, are more effective than x-ray or y-radiation. The rep was used in respect to irradiation from radioisotopes but by and large is not greatly different from the roentgen. 2. Tabulation of Available Data Relative to Radiation Biology, NEPA Project Report 1019-IER-17, Atomic Energy Commission, 1949. 3. Hempelmann, L. H.; Lisco, H., and Hoffman, J. G.: The Acute Radiation Syndrome: A Study of 9 Cases and a Review of the Problem , Ann. Int. Med. 36:279-510 ( (Feb.) ) 1952.Crossref 4. Oughterson, A. W.; LeRoy, G. V.; Liebow, A. A.; Hammond, E. C.; Barnett, H. L.; Rosenbaum, J. D., and Schneider, B. A.: Medical Effects of Atomic Bombs: The Report of the Joint Commission for the Investigation of the Effects of the Atomic Bomb in Japan , Atomic Energy Commission, Office of the Air Surgeon, Army Institute of Pathology, April 19, 1951, Vols. 1-4. 5. Pathologic Effects of Atomic Radiation , Science 124:60-63 ( (July 13) ) 1956.Crossref 6. Blair, H. A.: Data Pertaining to Shortening of Life Span by Ionizing Radiation , University of Rochester, U. R. 442, 1956. Rochester, N. Y., U. of Rochester Atomic Energy Project. 7. Thomson, J. F.; Tourtellotte, W. W.; Carttar, M. S.; Cox, R. S., Jr., and Wilson, J. E.: Studies on the Effects of Continuous Exposure of Animals to Gamma Radiation from Cobalt 60 Plane Sources , Am. J. Roentgenol. 69:830-838 ( (May) ) 1953. 8. Paterson, E.; Gilbert, C. W., and Matthews, J.: Time Intensity Factors and Whole Body Irradiation , Brit. J. Radiol. 25:427-433 ( (Aug.) ) 1952.Crossref 9. Lorenz, E.; Jacobson, L. O.; Heston, W. E.; Shimkin, M.; Eschenbrenner, A. B.; Deringer, M. K.; Doniger, J., and Schweisthal, R.: Effects of Long-Continued Total Body Gamma Irradiation on Mice, Guinea Pigs, and Rabbits: III. Effects on Life Span, Weight, Blood Picture, and Carcinogenesis and the Role of Intensity of Radiation, in National Nuclear Energy Series , Manhattan Project Technical Section, Division 4, Plutonium Project Record, New York, McGraw-Hill Book Company, Inc., 1954, Vol. 22B. 10. Furth, J.: Carcinogenesis by Ionizing Radiation, in Radiation Biology : Vol. 1. High Energy Radiation, edited by A. Hollaender, New York, McGraw-Hill Book Company, Inc., 1954, Pt. 2, Chap. 18 , pp. 1145-1201. 11. Brues, A. M.: Ionizing Radiation and Cancer , Advances Cancer Res. 2:177-195, 1954. 12. March, H. C.: Leukemia in Radiologists in a 20 Year Period , Am. J. M. Sc. 220:282-286 ( (Sept.) ) 1950.Crossref 13. Foley, J. H.; Borges, W., and Yamawaki, T.: Incidence of Leukemia in Survivors of the Atomic Bomb in Hiroshima and Nagasaki, Japan , Am. J. Med. 13:311-321 ( (Sept.) ) 1952.Crossref 14. Simpson, C. L.; Hempelmann, L. H., and Fuller, L. M.: Neoplasia in Children Treated with X-Rays in Infancy for Thymic Enlargement , Radiology 64:840-845 ( (June) ) 1955.Crossref 15. Stewart, A.; Webb, J.; Giles, D., and Hewitt, D.: Malignant Disease in Childhood and Diagnostic Irradiation in Utero , Lancet 2:447 ( (Sept. 12) ) 1956.Crossref 16. Slatis, H. M.: Current Status of Information on the Induction of Mutations by Irradiation , Science 121:817-821 ( (June 10) ) 1955.Crossref 17. Russel, W. L.: Genetic Effects of Radiation in Mammals, in Radiation Biology : Vol. 1. High Energy Radiation, edited by A. Hollaender, New York, McGraw-Hill Book Company, Inc., 1954, Pt. 2, Chap. 12 , pp. 825-859. 18. Slatis, H. M.: A Method of Estimating the Frequency of Abnormal Autosomal Ressive Genes in Man , Am. J. Human Genet. 6:412-418 ( (Dec.) ) 1954. 19. Mutations , Brookhaven National Laboratory, No. 8, Commerce Department, Office of Technical Services, February, 1956. 20. Muller, H. J.: Radiation Damage to the Genetic Material , Am. Scientist 38:33-59 ( (Jan.) ) 1950. 21. Muller, H. J.: Genetic Damage Produced by Radiation , Science 121:837-840 ( (June 17) ) 1955.Crossref 22. Libby, W. F.: Dosages from Natural Radioactivity and Cosmic Rays , Science 122:57-58 ( (July 8) ) 1955.Crossref 23. Handloser, J. S., and Love, R. A.: Radiation Sickness from Diagnostic X-Ray Studies , Radiology 57:252-254 ( (Aug.) ) 1951.Crossref

doi: 10.1001/archinte.1957.00260090009002pmid: N/A

This article is only available in the PDF format. Download the PDF to view the article, as well as its associated figures and tables. Abstract The accompanying Preliminary Statement of the National Committee on Radiation Protection and Measurement (NCRP) presents in brief form the essential changes introduced by its new recommendations on permissible radiation exposure. In making the new recommendations, the Committee reviewed its past recommendations in the light of increased knowledge about the long-range effects of radiation exposure on the genetic make-up and life expectancy of man. The NCRP is an advisory group of experts in various phases of the radiation field, and is made up of representatives from the following organizations: American College of Radiology, American Dental Associaton, American Industrial Hygiene Association, American Medical Association, American Radium Society, American Roentgen Ray Society, International Association of Government Labor Officials, National Bureau of Standards, National Electrical Manufacturers Association, Radiological Society of North America, U. S. Air Force, U. S. Army, U. S. Atomic Energy Commission, U. S. Navy, and U. S. Public Health Service. The

doi: 10.1001/archinte.1957.00260090012003pmid: N/A

Abstract I. Introduction. —(1) The United Nations General Assembly, being aware of the problems in public health that are created by the developments of atomic energy, established a Scientific Committee on the Effects of Atomic Radiation. This Committee has considered that one of its most urgent tasks was to collect as much information as possible on the amount of radiation to which man is exposed today, and on the effects of this radiation. Since it has become evident that radiation due to diagnostic radiology and to radiotherapy constitutes a substantial proportion of the total radiation received by the human race, the Committee considers it desirable to draw attention to information that has been obtained on this subject.(2) Modern medicine has contributed to the control of many diseases and has substantially prolonged the span of human life. These results have depended in part on the use of radiation in the detection, References 1. From reports sent by India, Sweden, the United Kingdom, and the United States of America. 2. According to the reports sent by the United Kingdom and the United States of America. 3. See the report of the International Commission on Radiological Protection, published in the British Journal of Radiology—Supplement 6, of December 1954, in the Journal français d'électroradiologie, No. 10, of October 1955, etc. 4. See the report of the International Commission on Radiological Protection, published in the British Journal of Rediology—Supplement 6, of December 1954, in the Journal français d'électroradiologie, No. 10, of October, 1955, etc. 5. United Kingdom. 6. Sweden, United States of America.

WALKER, WILLIAM F;HAMBURGER, MORTON

doi: 10.1001/archinte.1957.00260090015004pmid: 13457457

Abstract Intramuscular injection of procaine penicillin every 6 hours and streptomycin every 12 hours for two weeks has become an accepted plan of therapy for subacute bacterial endocarditis caused by penicillin-sensitive streptococci.1-4 Oral penicillin G has not been employed in this disease because of the relatively unpredictable blood levels associated with its administration. With the use of the recently developed phenoxymethyl penicillin (penicillin V), higher blood levels are maintained because of its greater stability in acid gastric contents.5-7 It has been used successfully in a wide variety of infections where the organisms are sensitive to penicillin. Because of the attendant decrease in discomfort to the patient when oral medication is substituted for intramuscular, it seemed desirable to determine whether oral phenoxymethyl penicillin could be employed in the treatment of bacterial endocarditis. Quinn 8 has reported four cases treated for six weeks with oral phenoxymethyl penicillin, either alone or in References 1. Hunter, T. H.: Endocarditis , in A Textbook of Medicine , edited by R. L. Cecil and R. F. Loeb, Ed. 9, Philadelphia, W. B. Saunders Company, 1955, p. 1312. 2. Geraci, J. E.: Further Experiences with Short-Term (2 Weeks) Combined Penicillin-Streptomycin Therapy for Bacterial Endocarditis Caused by Penicillin-Sensitive Streptococci , Proc. Soc. Staff Meet. Mayo Clin. 30:192, 1955. 3. Hall, B.; Dowling, H. F., and Kellow, W.: Successful Short-Term Therapy of Streptococcal Endocarditis with Penicillin and Streptomycin , Am. J. M. Sc. 230:73, 1955.Crossref 4. Hamburger, M.: The Management of Bacterial Endocarditis , Am. Pract. & Digest Treat. 7:1085, 1956. 5. Linden, H.; Finegold, S. M., and Hewitt, W. L.: Serum Penicillin Concentrations Following Oral Administration of Penicillin V , in Antibiotics Annual 1955-1956 , edited by H. Welch and F. Marti-Ibañez, New York, Medical Encyclopedia, Inc., 1956, pp. 477-482. 6. White, A. C.; Couch, R. A.; Foster, F.; Calloway, J.; Hunter, W., and Knight, V.: Absorption and Antimicrobial Activity of Penicillin V (Phenoxymethyl Penicillin) , in Antibiotics Annual 1955-1956 , edited by H. Welch and F. Marti-Ibañez, New York, Medical Encyclopedia, Inc., 1956, pp. 490-501. 7. Peck, F. B., and Griffith, R. S.: Comparative Clinical Laboratory Studies of Penicillin V and Penicillin G , in Antibiotics Annual 1955-1956 , edited by H. Welch and F. Marti-Ibañez, New York, Medical Encyclopedia, Inc., 1956, pp. 506-509. 8. Quinn, E. L.; Colville, J. M.; Cox, F., Jr., and Truant, J.: Phenoxymethyl Penicillin (Penicillin V) Therapy of Subacute Bacterial Endocarditis , J. A. M. A. 160:931, 1956. 9. Hamburger, M., and Stein, L.: Streptococcus Viridans Subacute Bacterial Endocarditis: Two Week Treatment Schedule with Penicillin , J. A. M. A. 149:542, 1952. 10. Hunter, T. H.: Speculations on the Mechanism of Cure of Bacterial Endocarditis , J. A. M. A. 144:524, 1950.

LEVITT, MARVIN F.

doi: 10.1001/archinte.1957.00260090020005pmid: 13457458

Abstract During the past decade a serious and often irreversible syndrome has been recognized with increasing frequency in patients with long-standing congestive heart failure. Clinically these patients are characterized by extensive disease of the heart, prolonged histories of recurrent episodes of circulatory failure, and intractable edema. Chemically they present considerable reductions in the serum sodium and chloride concentrations and signs of increasing renal failure. Admission to the hospital is generally prompted by increasing edema and fastness to mercurial diuretics. The precise mechanism whereby prolonged congestive heart failure terminates in this therapeutic paradox remains obscure. The past 10 to 15 years have been noteworthy for the development of several concepts in the management of congestive heart failure. These therapeutic usages have appreciably prolonged the life of the cardiac patient. This very prolongation, however, by exposing tissues to the sequellae of perpetuated ischemia and anoxia, may have rendered these tissues subject to alterations References 1. Schroeder, H. A.: Studies on Congestive Heart Failure: Importance of Restriction of Salt as Compared to Water , Am. Heart J. 22:141 ( (Aug.) ) 1941.Crossref 2. Chasis, H.; Goldring, W.; Breed, E. S.; Schreiner, G. E., and Bolomey, A. A.: Salt and Protein Restriction: Effects on Blood Pressure and Renal Hemodynamics in Hypertensive Patients , J. A. M. A. 142:711 ( (March 11) ) 1950.Crossref 3. Newburgh, L. H.: Renal Tubule Work: Its Significance for the Clinician , Bull. New York Acad. Med. 24:137 ( (March) ) 1948. 4. Berliner, R. W., and Davidson, D. G.: Production of Hypertonic Urine in the Absence of Pituitary Antidiuretic Hormone , J. Clin. Invest. 35:690 ( (June) ) 1956. 5. Mudge, G. H.: Studies on Potassium Accumulation by Rabbit Kidney Slice: Effect of Metabolic Activity , Am. J. Physiol. 165:113 ( (April) ) 1951. 6. Gold, H., et al.: A System for the Routine Management of the Failing Heart , Am. J. Med. 3:665 ( (Dec.) ) 1947.Crossref 7. Schwartz, W. B., and Wallace, W. M.: Electrolyte Equilibrium During Mercurial Diuresis , J. Clin. Invest. 30:1089 ( (Oct.) ) 1951.Crossref 8. Levitt, M. F.: The Interpretation of the Laboratory Data in the Use of the Cation Exchange Resins , Bull. New York Acad. Sc. 57:298, 1953.Crossref 9. Friedberg, C. K.; Halpern, M., and Taymor, J.: The Effect of Intravenously Administered 6063, the Carbonic Anhydrase Inhibitor, 2-Acetylamino-1,3,4,-Thiadiazole-5-Sulfonamide, on Fluid and Electrolytes in Normal Subjects and Patients with Congestive Heart Failure , J. Clin. Invest. 31:1074 ( (Dec.) ) 1952.Crossref 10. Lauson, H. D., and Thompson, D. D.: Effects of Decrease in Glomerular Filtration Rate on Cation Excretion During Loading with Nonreabsorbable Anions , Fed. Proc. 12:83 ( (March) ) 1953. 11. Darrow, D. C.: Changes in Muscle Composition in Alkalosis , J. Clin. Invest. 25:324 ( (May) ) 1946.Crossref 12. Aikawa, J. K.; Felts, J. H., Jr.; Tyor, M. P., and Harrell, G. T.: The Exchangeable Potassium Content in Disease States , J. Clin. Invest. 31:743 ( (July) ) 1952.Crossref 13. Cooke, R. E.; Segar, W. F.; Check, D. B.; Coville, F. E., and Darrow, D. C.: Extrarenal Correction of Alkalosis Associated with Potassium Deficiency , J. Clin. Invest. 31:798 ( (Aug.) ) 1952.Crossref 14. Mudge, G. H., and Hardin, B.: Response to Mercurial Diuretics During Alkalosis: A Comparison of Acute Metabolic and Chronic Hypokalemic Alkalosis in the Dog , J. Clin. Invest. 35: 155 ( (Feb.) ) 1956.Crossref 15. Lown, B.; Weller, J. M.; Wyatt, N.; Hoigne, R., and Merrill, J. P.: Effects of Alterations of Body Potassium on Digitalis Toxicity , J. Clin. Invest. 31:648 ( (June) ) 1952. 16. Relman, A. S., and Schwartz, W. B.: The Nephropathy of Potassium Depletion: A Clinical and Pathological Entity , New England J. Med. 255:195 ( (Aug. 2) ) 1956.Crossref 17. Foye, L. V., Jr., and Feichtmeier, T. V.: Adrenal Cortical Carcinoma Producing Solely Mineralocorticoid Effect , Am. J. Med. 19:966 ( (Dec.) ) 1955.Crossref 18. Levitt, M. F.; Turner, L. B.; Sweet, A. Y., and Pandiri, D.: The Response of Bone, Connective Tissue, and Muscle to Acute Acidosis , J. Clin. Invest. 35:98 ( (Jan.) ) 1956.Crossref

EVANS, ROBERT S.;WEISER, RUSSELL S.

doi: 10.1001/archinte.1957.00260090027006pmid: 13457459

Abstract Introduction During the past 10 years new and improved serological techniques have permitted the demonstration and characterization of the antibodies of acquired hemolytic anemia even though little is known about their genesis. The antibodies of this disease syndrome resemble the isoantibodies evoked by incompatible transfusions and maternal-fetal incompatibility in many characteristics of serological behavior except for their unique property of autoactivity. Prior to the last decade serological demonstration of antibodies in acquired hemolytic anemia was possible only in unusual instances in which hemolysis occurred in vitro, since agglutination of red cells in saline media by these abnormal proteins is rarely if ever observed. When cold agglutinins were present in association with acquired hemolytic anemia, agglutination of the patients' red cells was frequently noted. However there was little evidence that these antibodies were the cause of the persistent abnormal destruction, since they were frequently present without causing hemolytic anemia and appeared References 1. The fractions of human plasma proteins were supplied by the Cutter Laboratories, Berkeley, Calif. 2. Dameshek, W., and Schwartz, S. O.: The Presence of Hemolysins in Acquired Hemolytic Anemia , New England J. Med. 218:75, 1938.Crossref 3. Dacie, J. V., and Mollison, P. L.: Survival of Normal Erythrocytes After Transfusion to Patients with Familial Haemolytic Anemia (Acholuric Jaundice) , Lancet 1:550, 1943.Crossref 4. Diamond, L. K., and Denton, R. L.: Rh Agglutination in Various Media with Particular Reference to Value of Albumin , J. Lab. & Clin. Med. 30:821, 1945. 5. Morton, J. A., and Pickles, M. M.: Use of Trypsin in the Detection of Incomplete Anti-Rh Antibodies , Nature, London 159:779, 1947. 6. Coombs, R. R. A.; Mourant, A. E., and Race, R. R.: A New Test for the Detection of Weak and "Incomplete" Rh Agglutinins , Brit. J. Exper. Path. 26:255, 1945. 7. Wasastjerna, C.: Leukocyte-Agglutinins in a Case of Chronic Granulocytopenia and Hemolytic Anemia , Acta med. scandinav. 149:355, 1954. 8. Dacie, J. V., and de Gruchy, G. C.: Auto-Antibodies in Acquired Haemolytic Anaemia , J. Clin. Path. 4:253, 1951. 9. Payne, R.; Spaet, T. H., and Aggeler, P. M.: An Unusual Antibody Pattern in a Case of Idiopathic Acquired Hemolytic Anemia , J. Lab. & Clin. Med. 46:245, 1955. 10. Matoth, Y.; Elian, E.; Nelken, D., and Nevo, A. C.: Specificity of Lytic Factors for Erythrocytes, Leukocytes and Platelets in a Case of Pancytopenia , Blood 11:735, 1956. 11. Hare, R. L.; Heck, F. J., and Mathieson, D. R.: The Antiglobulin (Coombs) Test as an Aid in the Diagnosis of Hemolytic Syndromes , J. Lab & Clin. Med. 43:867, 1954. 12. Evans, R. S., and Duane, R. T.: Acquired Hemolytic Anemia: I. The Relation of Erythrocyte Antibody Production to Activity of the Disease; II. The Significance of Thrombocytopenia and Leukopenia , Blood 4:1196, 1949. 13. Evans, R. S.: Autoantibodies in Hematologic Disorders , Stanford M. Bull. 13:152, 1955. 14. Dacie, J. V.: Acquired Hemolytic Anemia with Special Reference to the Antiglobulin (Coombs') Reaction , Blood 8:813, 1953. 15. Cutbush, M.; Crawford, H., and Mollison, P. L.: Observations on Anti-Human Globulin Sera , Brit. J. Haemat. 1:410, 1955. 16. Kidd, P.: Elution of Incomplete Type of Antibody from the Erythrocytes in Acquired Haemolytic Anaemia , J. Clin. Path. 2:103, 1949. 17. Komninos, Z. D., and Rosenthal, M. C.: Studies on Antibodies Eluted from the Red Cells in Autoimmune Hemolytic Anemia , J. Lab. & Clin. Med. 41:887, 1953. 18. Evans, R. S.; Takahashi, K.; Duane, R. T.; Payne, R., and Liu, C. K.: Primary Thrombocytopenic Purpura and Acquired Hemolytic Anemia: Evidence for a Common Etiology , A. M. A. Arch. Int. Med. 87:48, 1951. 19. Weiner, W.; Battey, D. A.; Cleghorn, T. E.; Marson, F. G. W., and Meynell, M. J.: Serological Findings in a Case of Haemolytic Anaemia with Some General Observations on the Pathogenesis of This Syndrome , Brit. M. J. 2:125, 1953. 20. Dacie, J. V., and Cutbush, M.: Specificity of Auto-Antibodies in Acquired Haemolytic Anaemia , J. Clin. Path. 7:18, 1954. 21. Hollander, L.: Specificity of Antibodies in Acquired Haemolytic Anaemia , Sep. exper. 12:468, 1953. 22. van Loghem, J. J., and van der Hart, M.: Varieties of Specific Auto-Antibodies in Acquired Haemolytic Anaemia , Vox sanguinis 4e:2, 1954. 23. Crowley, L. V., and Bouroncle, B. A.: Studies on the Specificity of Autoantibodies in Acquired Hemolytic Anemia , Blood 11:700, 1956. 24. Freund, J.: The Effect of Paraffin Oil and Mycobacteria on Antibody Formation and Sensitization: A Review , Am. J. Clin. Path. 21:645, 1951. 25. Donohue, D. M.; Motulsky, A. G.; Giblett, E. R.; Pirzio-Biroli, G.; Viranuvatti, V., and Finch, C. A.: The Use of Chromium as a Red-Cell Tag , Brit. J. Haemat. 249, 1955. 26. Ashby, W.: Determination of Length of Life of Transfused Blood Corpuscles in Man , J. Exper. Med. 29:267, 1918.Crossref 27. van Loghem, J. J.; Kresner, M.; Coombs, R. R. A., and Roberts, G. F.: Observations on a Prozone Phenomenon Encountered in Using the Anti-Globulin Sensitisation Test , Lancet 2:729, 1950.Crossref 28. Mollison, P. L., and Cutbush, M.: Use of Isotope-Labelled Red Cells to Demonstrate Incompatibility in Vivo , Lancet 1:1290, 1955.Crossref 29. Thurm, R. H., and Bassen, F.: Infectious Mononucleosis and Acute Hemolytic Anemia: Report of 2 Cases and Review of the Literature , Blood 10:841, 1955. 30. Sawitsky, A.; Papps, J. P., and Wiener, L. M.: The Demonstration of Antibody in Acute Hemolytic Anemia Complicating Infectious Mononucleosis , Am. J. Med. 8:260, 1950.Crossref 31. Huntington, P. W., Jr.: Hemolytic Anemia in Infectious Mononucleosis: Case Report , Delaware M. J. 23:165, 1951. 32. Hall, B. D., and Archer, F. C.: Acute Hemolytic Anemia Associated with Infectious Mononucleosis , New England J. Med. 249:973, 1953.Crossref 33. Dacie, J. V.: Occurrences in Normal Human Sera of "Incomplete" Forms of "Cold" Auto-Antibodies , Nature, London 166:36, 1950.Crossref 34. Selwyn, J. G., and Hackett, W. E. R.: Acquired Haemolytic Anaemia: Survival of Transfused Erythrocytes in Patients and Normal Recipients , J. Clin. Path. 2:114, 1949.Crossref 35. Bouroncle, B. A.; Dodd, M. C., and Wright, C. S.: A Study of Cold Hemagglutinins for Normal and Trypsinized Red Blood Cells in the Serum of Normal Individuals and of Hemolytic Anemias , J. Immunol. 67:265, 1951. 36. Dacie, J. V.: The Presence of Cold Hæmolysins in Sera Containing Cold Hæmagglutinins , J. Path. & Bact. 62:241, 1950. 37. Dacie, J. V.: Hemolysins in Acquired Hemolytic Anemia: Effect of pH on the Activity in Vitro of a Serum Hemolysin , Blood 4:928, 1949. 38. Mayer, M. M.; Osier, A. G.; Bier, O. Y., and Heidelburger, M.: Activating Effect of Magnesium and Other Cations on the Hemolytic Function of Complement , J. Exper. Med. 84:535, 1946. 39. Hinz, C. F., Jr.; Jordan, W. S., Jr., and Pillemer, L.: The Properdin System and Immunity: IV. The Hemolysis of Erythrocytes from Patients with Paroxysmal Nocturnal Hemoglobinuria , J. Clin. Invest. 35:453, 1956. 40. Jakobowicz, R., and Bryce, L. M.: Some Observations on Anti-O Agglutinins , M. J. Australia 2:373, 1949. 41. Parish, H. J., and Macfarlane, R. G.: The Effect of Calcium in a Case of Autohæmagglutination , Lancet 2:477, 1941. 42. Komninos, Z. D., and Désy, L.: Thermal Range of Activity of Antibodies Eluted from the Red Cells in Autoimmune Hemolytic Anemia , J. Lab. & Clin. Med. 46:74, 1955. 43. Carter, B. B.: Effect of pH on Rh Antibody Titrations , Am. J. Clin. Path. 23:705, 1953. 44. Gardner, F. H.: Transfer to Normal Red Cells of an Agglutinin Demonstrable in the Acidified Sera of Patients with Acquired Hemolytic Jaundice , J. Clin. Invest. 28:783, 1949. 45. Mackay, I. R.; Eriksen, N.; Motulsky, A. G., and Volwiler, W.: Cryo- and Macroglobulinemia: Electrophoretic, Ultracentrifugal and Clinical Studies , Am. J. Med. 20:564, 1956.Crossref 46. Pisciotta, A. V.: Cold Hemagglutination in Acute and Chronic Hemolytic Syndromes , Blood 10:295, 1955.

HOLLADAY, W. E.;WITHAM, A. C.

doi: 10.1001/archinte.1957.00260090056007pmid: 13457460

Abstract In the 69 years since the classical description of the tetralogy of Fallot,1 a "characteristic" clinical picture has evolved. The wide variability of this syndrome, however, is not generally known, but is dependent upon the severity of the anatomical defects and fluctuating functional reactions of each patient. The purpose of this report is to discuss some "unusual" clinical manifestations of this complex, illustrated by short case histories. The material is drawn from only 32 cases, emphasizing that such findings are not rare. The diagnosis was verified in all but two by at least two of the following methods: (1) cardiac catheterization, (2) angiocardiography, (3) operation, (4) autopsy. Patients were selected partially by the adequacy of the clinical data. History, physical examination, x-rays, fluoroscopy, electrocardiograms, and routine laboratory work were available in all. Twenty-five were examined by at least one of us. Phonocardiograms, cardiac catheterization, and operative findings were available References 1. Fallot, A.: Contribution à l'anatomie pathologique de la maladie bleue (cyanose cardiaque) , Marseille-méd. 25:77, 1888. 2. Kjellberg, S. R.; Mannheimer, E.; Rudhe, U., and Jonsson, B.: Diagnosis of Congenital Heart Disease , Chicago, The Year Book Publishers, Inc., 1955. 3. Rowe, R. D.; Vlad, P., and Keith, J. D.: Experiences with 180 Cases of Tetralogy of Fallot in Infants and Children , Canad. M. A. J. 73:23, 1955. 4. Wood, P.; Magidson, O., and Wilson, P. A. O.: Ventricular Septal Defect, with a Note on Acyanotic Fallot's Tetralogy , Brit. Heart J. 16: 387, 1954.Crossref 5. Van Slyke, D. D., and Lundsgaard, C.: Cyanosis , Medicine 2:1, 1923. 6. Taussig, H. B.: Tetralogy of Fallot: Especially the Care of the Cyanotic Infant and Child , Pediatrics 1:307, 1948. 7. Cassels, D. E., and Morse, M.: Blood Volume in Congenital Heart Disease , J. Pediat. 31:485, 1947.Crossref 8. Shephard, R. J.: The Influence of Age on the Hæmoglobin Level in Congenital Heart Disease , Brit. Heart J. 18:49, 1956.Crossref 9. Hamilton, W. F.; Winslow, J. A., and Hamilton, W. F., Jr.: Notes on a Case of Congenital Heart Disease with Cyanotic Episodes , J. Clin. Invest. 29:20, 1950.Crossref 10. Brock, R.: Control Mechanisms in the Outflow Tract of the Right Ventricle in Health and Disease , Guy's Hosp. Rep. 104:356, 1955. 11. Fainting, Editorial , Am. J. Med. 13:387, 1952.Crossref 12. Perkins, G. B.; Hammond, M. M.; Dwan, P. F., and Shapiro, M. J.: Tetralogy of Fallot: Analysis of 41 Cases of Patients Treated Surgically at University of Minnesota Hospitals , J. Pediat. 35:401, 1949.Crossref 13. Abbott, M. E.: Atlas of Congenital Heart Disease , New York, American Heart Association, 1936. 14. Brock, R. C.: Congenital Pulmonary Stenosis , Am. J. Med. 12:706, 1952.Crossref 15. Marquis, R. M.: Longevity and the Early History of the Tetralogy of Fallot , Brit. M. J. 1:819, 1956.Crossref 16. Brinton, W. D., and Campbell, M.: Necropsies in Some Congenital Diseases of the Heart, Mainly Fallot's Tetralogy , Brit. Heart J. 15:335, 1953.Crossref 17. Wood, P.: Congenital Heart Disease: Review of Its Clinical Aspects in Light of Experience Gained by Means of Modern Techniques , Brit. M. J. 2:693, 1950.Crossref 18. McCord, M. C.; Komesu, S., and Blount, S. G., Jr.: The Characteristics of the Right Atrial Pressure Wave Associated with Right Ventricular Hypertrophy , Am. Heart J. 45:706, 1953.Crossref 19. Baker, C.; Brock, R. C.; Campbell, M., and Suzman, S.: Morbus Cœruleus: A Study of 50 Cases After Blalock-Taussig Operation , Brit. Heart J. 11:170, 1949.Crossref 20. Rowe, R. D.; Vlad, P., and Keith, J. D.: Atypical Tetralogy of Fallot: A Noncyanotic Form with Increased Lung Vascularity; Report of 4 Cases , Circulation 12:230, 1955.Crossref 21. Brown, J. W.: Congenital Heart Disease , Ed. 2, New York, Staples Press, Inc., 1950. 22. Gelfman, R., and Levine, S. A.: The Incidence of Acute and Subacute Bacterial Endocarditis in Congenital Heart Disease , Am. J. M. Sc. 204:324, 1942.Crossref 23. Wittenborg, M. H., and Neuhauser, E. B. D.: Diagnostic Roentgenology in Congenital Heart Disease , Circulation 11:462, 1955.Crossref 24. Mitchell-Nelson Textbook of Pediatrics , edited by Waldo E. Nelson, Ed. 6, Philadelphia, W. B. Saunders Company, 1954. 25. Sussman, M. L., and Jacobson, G.: A Critical Evaluation of the Roentgen Criteria of Right Ventricular Enlargement , Circulation 11:391, 1955.Crossref 26. Campbell, M., and Gardner, F. E.: Radiological Features of Enlarged Bronchial Arteries , Brit. Heart J. 12:183, 1950.Crossref 27. Nadas, A. S.; Rosenbaum, H. D.; Wittenborg, M. H., and Rudolph, A. M.: Tetralogy of Fallot with Unilateral Pulmonary Atresia: Clinically Diagnosable and Surgically Significant Variant , Circulation 8:328, 1953.Crossref 28. Woods, A.: The Electrocardiogram in the Tetralogy of Fallot , Brit. Heart J. 14:193, 1952.Crossref 29. Sodi-Pallares, D.: New Bases of Electrocardiography , translated by R. M. Calder, St. Louis, C. V. Mosby Company, 1956. 30. Goodwin, J. F.; Steiner, R. E.; Mounsey, J. P. D.; MacGregor, A. G., and Wayne, E. J.: A Critical Analysis of the Clinical Value of Angiocardiography in Congenital Heart Disease , Brit. J. Radiol. 26:161, 1953.Crossref 31. Grishman, A.; Steinberg, M. F., and Sussman, M. L.: Tetralogy of Fallot: Contrast Visualization of Heart and Great Vessels , Radiology 37:178, 1941.Crossref 32. Lowe, J. B.: The Angiocardiogram in Fallot's Tetralogy , Brit. Heart J. 15:319, 1953.Crossref 33. Bing, R. J.; Vandam, L. D., and Gray, F. D., Jr.: Physiological Studies in Congenital Heart Disease: Results of Preoperative Studies in Pa- tients with Tetralogy of Fallot , Bull. Johns Hopkins Hosp. 80:121, 1947. 34. Hales, M. R., and Liebow, A. A.: Collateral Circulation to the Lungs in Congenital Pulmonic Stenosis , Bull. Internat. A. M. Museums 28:1, 1948. 35. Connolly, D. C.; Lev, R.; Kirklin, J. W., and Wood, E. H.: Symposium on Cardiac Catheterization: The Problem of Isolated Valvular Versus Infundibular Pulmonic Stenosis with Particular Reference to Cardiac Catheterization Data and Records Obtained at Time of Operation , Proc. Staff Meet. Mayo Clin. 28:65, 1953. 36. Lillehei, C. W.; DeWall, R. A.; Read, R. C.; Warden, H. E., and Varco, R. L.: Direct Vision Intracardiac Surgery in Man Using a Simple, Disposable Artificial Oxygenator , Dis. Chest 29:1, 1956.Crossref

JOHNSON, PHILIP C.;HUGHES, WILLIAM L.;BIRD, ROBERT M.;PATRICK, DANIEL R.

doi: 10.1001/archinte.1957.00260090071008pmid: 13457461

Abstract The technique of using hexavalent chromium for labeling red blood cells in vitro was introduced by Gray and Sterling, in 1950.1 In 1953, Ebaugh et al.2 showed that this method was a convenient way to approximate the survival of erythrocytes in vivo. Weinstein and LeRoy 3 were the first to publish data on Cr51-labeled red cells from nine patients with various hematological disorders. Several other authors 4-6 have presented similar data from patients with known hemolytic disease. It remains necessary, however, to review critically the usefulness of this test in clinical practice as a measure of increased erythrocyte destruction. It has been shown in the normal subject that the disappearance of the radioactivity from the blood results from at least two variables, the linear loss of the red cells from the circulation due to senescence and an exponential elution of chromium from the tagged cells.2,7 References 1. Gray, S. J., and Sterling, K.: Determination of Circulating Red Cell Volume by Radioactive Chromium , Science 112:179, 1950.Crossref 2. Ebaugh, F. G., Jr.; Emerson, C. P., and Ross, J. F.: The Use of Radioactive Chromium 51 as Erythrocyte Tagging Agent for Determination of Red Cell Survival in Vivo , J. Clin. Invest. 32:1260, 1953.Crossref 3. Weinstein, I. M., and LeRoy, G. V.: Radioactive Sodium Chromate for Study of Survival of Red Blood Cells: II. The Rate of Hemolysis in Certain Hematologic Disorders , J. Lab. & Clin. Med. 42:368, 1953. 4. Read, R. C.; Wilson, G. W., and Gardner, F. H.: The Use of Radioactive Sodium Chromate to Evaluate the Life Span of the Red Blood Cell in Health and Certain Hematologic Disorders , Am. J. M. Sc. 288:40, 1954. 5. Donohue, D. M.; Motulsky, A. G.; Giblett, E. R.; Pirzio-Biroli, G.; Viranuvatti, V., and Finch, C. A.: The Use of Chromium as a Red-Cell Tag , Brit. J. Haemat. 1:249, 1955. 6. Weinstein, I. M.; Spurling, C. L., Klein, H., and Necheles, T. F.: Radioactive Sodium Chromate for the Study of Survival of Red Blood Cells: III. The Abnormal Hemoglobin Syndromes , Blood 9:1155, 1954. 7. Necheles, T. F.; Weinstein, I. M., and LeRoy, G. V.: Radioactive Sodium Chromate for Study of Survival of Red Blood Cells: I. The Effect of Radioactive Sodium Chromate on Red Cells , J. Lab. & Clin. Med. 42:358, 1953. 8. Mollison, P. L., and Veall, N.: The Use of the Isotope 51Cr as a Label for Red Cells , Brit. J. Haemat. 1:62, 1955. 9. Strumia, M. M.; Taylor, L.; Sample, A. B.; Colwell, L. S., and Dugan, A.: Uses and Limitations of Survival Studies of Erythrocytes Tagged with Cr51 , Blood 10:429, 1955. 10. Sutherland, D. A.; McCall, M. S.; Groves, M. T., and Muirhead, E. E.: The Survival of Human Erythrocytes Estimated by Means of Cells Tagged with Radioactive Chromium: A Study of the Normal State , J. Lab. & Clin. Med. 43:717, 1954. 11. Lawrence, J. H.: Polycythemia, Physiology, Diagnosis and Treatment Based on 303 Cases , New York, Grune & Stratton, Inc., 1955. 12. Hammarsten, J. F.; Whitcomb, W.; Lowell, J. R., and Johnson, P. C.: Red Cell Lifespan and Iron Turnover in Patients with Hypoxia Due to Pulmonary Emphysema , J. Lab. & Clin. Med. 48:814, 1956.

KAIPAINEN, W. J.;SEPPALA, KARI

doi: 10.1001/archinte.1957.00260090075009pmid: 13457462

Abstract The literature on the treatment of endocarditis lenta recommends massive antibiotic therapy. Experience has proved that this is inevitable. However, the clinician has found it difficult to understand why the treatment of endocarditis lenta in particular calls for considerably higher penicillin doses than other diseases to destroy the microorganisms found sensitive to penicillin in vitro. According to Moore (1946) the center of the vegetation is necrotic and relatively poor in cells; it is surrounded by bacterial colonies covered by fibrin and platelet masses. Studying the penetration of the fibrin clot by penicillin, Weinstein et al. (1951) found that it took two hours for the penicillin concentration inside the clot to equal that in the fluid outside. In addition, it was found that a viridans Streptococcus is capable of living in the fibrin clot in a penicillin concentration in which in other in vitro conditions it is easily destroyed. Hence it References 1. The director of the First Medical Clinic of Helsinki University, Prof. William Kerppola, M.D.; the head of the Medical Department of Maria Hospital, Prof. Guido Tötterman, M.D., and the head of the Medical Department of Kivelä Hospital, Prof. Pauli Soisalo, M.D., made their material available to us. 2. Cates, J. E., and Christie, R. V.: Subacute Bacterial Endocarditis: A Review of 442 Patients Treated in 14 Centres Appointed by the Penicillin Trials Committee of the Medical Research Council , Quart. J. Med. 20:93, 1951. 3. Finland, M.: Treatment of Bacterial Endocarditis: Dosage of Penicillin, Use of Other Antibiotics and Treatment of Patients with Negative Blood Cultures , Circulation 9:292, 1954.Crossref 4. Friedberg, C. K.: Subacute Bacterial Endocarditis: Revision of Diagnostic Criteria and Therapy , J. A. M. A. 144:527, 1950.Crossref 5. The Diagnosis and Treatment of Subacute Bacterial Endocarditis , Am. Pract. & Digest Treat. 4:444, 1953 6. The Year Book of Medicine (1954-1955 Year Book Series) , edited by P. B. Beeson et al., Chicago, The Year Book Publishers, Inc., 1954, p. 43. 7. Herrell, W. E.: Antibiotic and Chemotherapeutic Agents in Infections of the Blood Stream and Heart , J. A. M. A. 150:1450, 1952. 8. Kaipainen, W. J., and Seppälä, K.: Endocarditis Lenta: A Review of 118 Patients Treated During the 10-Year Period 1945 to 1954 , Acta med. scandinav. 155:71, 1956. 9. Keefer, C. S.: Present Day Treatment of Subacute Bacterial Endocarditis: Minot Lecture , J. A. M. A. 152:1397, 1953. 10. Merzweiler, A.; Walter, A. M., and Heilmeyer, L.: Bericht zur Endocarditis lenta nach 1945 in Deutschland: Eine kritische Übersicht über ein grösseres Patientengut unter Verwendung mathematisch-statistischer Methoden , Deutsche med. Wchnschr. 78:560, 639, and 665, 1953. 11. Moore, R. A.: The Cellular Mechanism of Recovery After Treatment with Penicillin: I. Subacute Bacterial Endocarditis , Tr. & Stud. Coll. Physicians Philadelphia 14:55, 1946. 12. Weinstein, L.; Daikos, G., and Perrin, T. S.: Studies on the Relationship of Tissue Fluid and Blood Levels of Penicillin , J. Lab. & Clin. Med. 38:712, 1951.

THOMAS, WILBUR A.;BLACHE, J. OWEN;LEE, KYU TAIK

doi: 10.1001/archinte.1957.00260090079010pmid: 13457463

Abstract In a recent study 1-2 of the incidence of acute myocardial infarction in white patients among the cases which came to autopsy at Washington University for the period 1910-1954, several striking facts were apparent. The incidence of acute myocardial infarction had increased markedly over the years, especially among elderly women. The relative incidence had changed from two males to one female in the period 1910-1939 to one to one in the period 1940-1954. Because of these findings, we believe a review of many of the established concepts regarding the incidence of the disease entity is indicated. One feature that requires further investigation is the incidence among Negroes. Previous reports 3-8 from the United States (including a study by one of us) 8 and Africa9-10 documented a much lower occurrence of coronary arteriosclerotic disease and its complications among Negroes. However, some recent reports 11-12 have suggested a marked increase of References 1. Lee, K. T., and Thomas, W. A.: Myocardial Infarction: Changing Sex Ratio and Other Factors; An Epidemiological Study of Acute Myocardial Infarction Based on the Experiences of Barnes Hospital for 45 Years , A. M. A. Arch. Int. Med. 97:421-430 ( (April) ) 1956.Crossref 2. Lee, K. T., and Thomas, W. A.: Factors Associated with Changing Sex Ratio of Myocardial Infarction: Study with Special Reference to the Disproportionate Rise in Incidence of the Disease Among Older Women , A. M. A. Arch. Int. Med. 98:80-83 ( (July) ) 1956.Crossref 3. Burch, G. W., and Voorhies, N. W.: Study of Incidence of Coronary Occlusion and Angina Pectoris in White and Negro Races , Am. J. M. Sc. 198:685-690 ( (Nov.) ) 1939.Crossref 4. Thomas, J.: Analysis of 317 Cases of Heart Disease in Negroes , J. Nat. M. A. 38:202-205 ( (Nov.) ) 1946. 5. Vital Statistics, Special Reports , Federal Security Agency, National Office of Vital Statistics, Feb. 5-March 2, 1948, Vol. 27, p. 295. 6. Vital Statistics of the United States, Part I , Federal Security Agency, Public Health Service, 1937-1949. 7. Vital Statistics of United States , Health, Education and Welfare Department, Public Health Service, National Office of Vital Statistics, 1954, Vol. 2, p. 72. 8. Blache, J. O., and Handler, F. P.: Coronary Artery Disease: Comparison of the Rates and Patterns of Development of Coronary Arteriosclerosis in the Negro and White Races with Its Relation to Clinical Coronary Artery Disease , Arch. Path. 50:189-198 ( (Aug.) ) 1950. 9. Higginson, J., and Pepler, W. J.: Fat Intake, Serum Cholesterol Concentration, and Atherosclerosis in the South African Bantu: II. Atherosclerosis and Coronary Artery Disease , J. Clin. Invest. 33:1366-1371 ( (Oct.) ) 1954.Crossref 10. Walker, A. R. P.; Anderson, N., and Bersohm, I.: Sex Factor in Coronary Artery Disease, Correspondence , Brit. M. J. 1:1234-1235 ( (May 26) ) 1956.Crossref 11. Keil, P. G., and McVay, L. V.: A Comparative Study of Myocardial Infarction in the White and Negro Races , Circulation 13:712-718 ( (May) ) 1956.Crossref 12. Keys, A.: Sex Factor in Coronary Artery Disease, Correspondence , Brit. M. J. 2:98-99 ( (July 14) ) 1956.Crossref 13. Schwab, E. H., and Schulze, V. E.: Heart Disease in American Negro of the South , Am. Heart J. 7:710-717 ( (Aug.) ) 1932.Crossref 14. Thomas, W. A.; Lee, K. T., and Rabin, E. R.: Fatal Acute Myocardial Infarction in Diabetic Patients: A Comparative Study of 94 Autopsied Diabetics with Acute Myocardial Infarction and 406 Autopsied Nondiabetics with Acute Myocardial Infarction, with Special Reference to Age and Sex Distribution , A. M. A. Arch. Int. Med. 98: 489-494 ( (Oct.) ) 1956.Crossref 15. Hunter, W. S.: Coronary Occlusion in Negroes , J. A. M. A. 131:12-14 ( (May 4) ) 1946.Crossref