Archives of Internal Medicine

Bean, William B.

doi: 10.1001/archinte.1967.00290190049001pmid: N/A

Abstract It WAS more than 50 years ago that Agnes Arber, a botanist who achieved outstanding distinction and many honors, first brought out this book, her classic study of the outlines of the evolution of the printed herbal in Europe for the 200 years between 1470 and 1670.. Because she felt that she lacked competence in medicine, this aspect was touched on only in a guarded way, and the strictly horticultural aspects were dealt with not at all. On the other hand, from the artistic point of view and from its elegance and general excellence, her book was recognized as a gem. From the beginning it had wide favor and was characterized by Punch as "One of the most beautiful and inspiring picture books it is possible to own." The narrative reflects Professor Arber's growing interest in herbals as it follows the traditional course of a bibliophile and book collector. She

MEYER, JOHN S.;GOTOH, FUMIO;TAKAGI, YASUYUKI

doi: 10.1001/archinte.1967.00290190052002pmid: N/A

Abstract INHALATION of either carbon dioxide gas mixtures or 100% oxygen are widely used therapeutically in cerebrovascular disease and conditions causing cerebral anoxia. There is little or no data in man concerning any improvement of oxygen available to the brain resulting from this treatment, although certain drugs are known to increase oxygen available to ischemic brain.1,2 Techniques for monitoring cerebral blood, Po2, Pco2, and pH now permit recording any changes in the composition of the cerebral venous blood during inhalation of oxygen and carbon dioxide gas mixtures. The present communication describes the effects of inhalation of 100% O2, 5% CO2 plus O2, and 5% CO2 plus air on arterial and jugular venous Po2, Pco2, and pH in a group of volunteer subjects with cerebrovascular disease and other disorders. Material and Methods Case Material. —Twenty-six volunteers with various neurological disorders were studied. The age of the subjects ranged from 13 to 81 References 1. Gotoh, F.; Meyer, J.S.; and Tomita, M.: Carbonic Anhydrase Inhibition and Cerebral Venous Blood Gases and Ions in Man: Demonstration of Increased Oxygen Availability to Ischemic Brain , Arch Intern Med 117:39, 1966.Crossref 2. Meyer, J.S., et al: Improvement in Brain Oxygenation and Clinical Improvement in Patients With Strokes Treated With Papaverine Hydrochloride , JAMA 194:957, 1965.Crossref 3. Gotoh, F.; Meyer, J.S.; and Ebihara, S.: Continuous Recording of Human Cerebral Blood Flow and Metabolism: Methods for Electronic Monitoring of Arterial and Venous Gases and Electrolytes , Med Res Engineering 5:13, 1966. 4. Meyer, J.S., et al: New Techniques for Recording Cerebral Blood Flow and Metabolism in Subjects With Cerebrovascular Disease, in Siekert, R., and Whisnant, J. (eds.): Cerebral Vascular Diseases, 5th Princeton Conference, 1966. 5. Meyer, J.S.; Gotoh, F.; and Tazaki, Y.: Continuous Recording of Arterial PO2, PCO2, JpH and Oxygen Saturation In Vivo , J Appl Physiol 16:896, 1961. 6. Gotoh, F.; Meyer, J.S.; and Takagi, Y.: Cerebral Effects of Hyperventilation in Man , Arch Neurol 12:410, 1965.Crossref 7. Heyman, A., et al: The Cerebral Circulation and Metabolism in Arteriosclerotic and Hypertensive Cerebrovascular Disease , New Eng J Med 249:223, 1953.Crossref 8. Lambertsen, C.J., et al: Oxygen Toxicity: Effects in Man of Oxygen Inhalation at 1 and 3.5 Atmospheres Upon Blood Gas Transport, Cerebral Circulation and Cerebral Metabolism , J Appl Physiol 5:571, 1953. 9. Kety, S.S., and Schmidt, C.F.: The Effects of Altered Arterial Tensions of Carbon Dioxide and Oxygen on Cerebral Blood Flow and Cerebral Oxygen Consumption of Normal Young Men , J Clin Invest 27:484, 1948.Crossref 10. Meyer, J.S., and Gotoh, F.: Interaction of Cerebral Hemodynamics and Metabolism , Neurology 2( (suppl 11) ):46, 1961.Crossref 11. Patterson, J.L., Jr., et al: Threshold of Response of the Cerebral Vessels of Man to Increase in Blood Carbon Dioxide , J Clin Invest 34:1857, 1955.Crossref 12. Fazekas, J.F.; Alman, R.W.; and Bersman, A.N.: Cerebral Physiology of the Aged , Amer J Med Sci 223:249, 1952.Crossref 13. Schieve, J.F., and Wilson, W.P.: The Influence of Age, Anesthesia and Cerebral Arteriosclerosis on Cerebral Vascular Activity to CO2 , Amer J Med 15:171, 1953.Crossref 14. Novack, P., et al: The Effects of Carbon Dioxide Inhalation Upon the Cerebral Blood Flow and Cerebral Oxygen Consumption in Vascular Disease , J Clin Invest 32:696, 1953.Crossref 15. Lassen, N.A.; Munck, O.; and Tottey, E.R.: Mental Function and Cerebral Consumption in Organic Dementia , Arch Neurol Psychiat 77:126, 1957.Crossref 16. Lassen, N.A.: Cerebral Blood Flow and Oxygen Consumption in Man , Physiol Rev 39:183, 1959. 17. Meyer, J.S.; Gotoh, F.; and Ebihara, S.: Influence of Cerebrovascular Disease and State of Consciousness on Cerebral Metabolism , J Amer Geriat Soc 14:205, 1966. 18. Fazekas, J.F., et al: Cerebral Hemodynamics in Cerebral Arteriosclerosis , J Geront 8:137, 1953.Crossref

BAUM, STANLEY;NUSBAUM, MOREYE;CLEARFIELD, HARRIS R.;KURODA, KOSON;TUMEN, HENRY J.

doi: 10.1001/archinte.1967.00290190064003pmid: N/A

Abstract THE DIAGNOSTIC challenge of gastrointestinal bleeding is one that confronts physicians constantly. Even the most astute clinician aided by skillfully used radiographic and endoscopic procedures may be defeated in his search for the location and cause of a hemorrhage. The frequency with which the cause of gastrointestinal bleeding remains undiagnosed has been emphasized many times. In some series of carefully studied patients, failure to find the source of a hemorrhage has ranged from 15% to 40%.1-3 When bleeding has been characterized by melena without hematemesis inability to find the cause has been even more striking, as high as 52% in one series.4 Even surgical exploration frequently fails to disclose the cause of melena. Retzlaff et al5 reported that the source of the bleeding was discovered at operation in only 30% of a group of patients with melena. Because of the need for greater accuracy in locating these References 1. Birke, G., and Engsted, T.L.: Melena and Hematemesis: a Follow-Up Investigation, With Special Reference to Bleeding of Unknown Origin , Gastroenterologia 85:97, 1956.Crossref 2. Jones, P.A.; Read, A.E.; and Stubbe, J.L.: Alimentary Bleeding of Obscure Origin: A Follow-Up Study and Commentary , Brit Med J 1:1138, 1959.Crossref 3. Berkowitz, D.: Fatal Gastrointestinal Hemorrhage: Diagnostic Implications From a Study of 200 Cases , Amer J Gastroent 40:372, 1963. 4. Rives, J.D., and Emmett, R.O.: Melena: A Survey of 206 Cases , Amer J Surg 20:458, 1954. 5. Retzlaff, J.A.; Hagedorn, A.B.; and Bartholomew, L.G.: Abdominal Exploration for Gastrointestinal Bleeding of Obscure Origin , JAMA 177:104, 1961.Crossref 6. Green, H.L.: A New Suction Tube for Diagnosis of Obscure Gastrointestinal Bleeding , Gastroenterology 46:128, 1964. 7. Pittman, F.E.: The Fluorescein String Test: An Analysis of Its Use and Relationship to Barium Studies of the Upper Gastrointestinal Tract in 122 Cases of Gastrointestinal Tract Hemorrhage , Ann Intern Med 60:418, 1964.Crossref 8. McKibbin, B., and Watson, B.W.: Localization of Intestinal Bleeding Using a Miniature Geiger Counter , Gut 4:82, 1963.Crossref 9. Nusbaum, S., and Baum, S.: Radiographic Demonstration of Unknown Sites of Gastrointestinal Bleeding , Surg Forum 14:374, 1963. 10. Nusbaum, M., et al; Demonstration of Intraabdominal Bleeding by Selective Arteriography , JAMA 191:389, 1965.Crossref 11. Baum, S., et al: Demonstration of Intra-Abdominal Bleeding by Percutaneous Selective Celiac and Superior Mesenteric Arteriography , Surgery 58:797-805 ( (Nov) ) 1965. 12. Margulis, A.R.; Heinbecker, P.; and Bernard, H.R.: Operative Mesenteric Arteriography in the Search for the Site of Bleeding in Unexplained Gastrointestinal Hemorrhage , Surgery 48:534, 1960. 13. Odman, P.: Percutaneous Selective Angiography of the Main Branches of the Aorta (Preliminary Report) , Acta Radiol 45:1, 1956.Crossref 14. Odman, P.: Percutaneous Selective Angiography of the Coeliac Artery , Acta Radiol , (suppl 159) , 1958. 15. Seldinger, S.L.: Catheter Replacement of the Needle in Percutaneous Angiography , Acta Radiol 46:641, 1953. 16. Baum, S.; Martin, R.; and Roy, R.: Respiratory Stereoscopic Abdominal Arteriography: A Simple and Inexpensive Method , Radiology 83:1013, 1964.Crossref 17. Conn, H.C.; Smith, H.W.; and Brodoff, M.: Observer Variation in the Endoscopic Diagnosis of Esophageal Varices: A Prospective Investigation of the Diagnostic Validity of Esophagoscopy , New Eng J Med 272:830, 1965.Crossref 18. Liebowitz, H.R.: Gastrointestinal Hemorrhage After Portacaval Shunt: Recurrence in Patients With Cirrhosis of the Liver After Portacaval Shunt , Arch Intern Med 115:273, 1965.Crossref

GREGORY, DANIEL H.;MESSNER, RONALD;ZINNEMAN, HORACE H.

doi: 10.1001/archinte.1967.00290190073004pmid: N/A

Abstract IN SPITE of the advent of antibiotics, the incidence of brain abscess has not changed over the past three decades.1-3 Its mortality and morbidity remain formidable. In previously reported series, its mortality ranged from 35% to 60% with a morbidity of 50% to 80% among the survivors.1-7 These depressing figures are due in part to the difficulty in establishing an early diagnosis. The present study was undertaken with the hope of gaining information which might be helpful in arriving at an earlier diagnosis. Clinical Material The case records of all patients with the diagnosis of brain abscess seen in the Minneapolis Veterans Administration Hospital over the ten-year period from 1955 to 1965 were reviewed. Twenty-one cases in which the abscess was the direct result of trauma were excluded. The diagnosis in the remaining 29 cases was established at surgery or autopsy. These cases were selected for study.The References 1. Ballantine, H.T., Jr., and White, J.C.: Brain Abscess , New Eng J Med 248:14, 1953.Crossref 2. Liske, E., and Weikers, N.J.: Changing Aspects of Brain Abscess , Neurology 14:294, 1964.Crossref 3. Gates, E.M.; Kernohan, J.W.; and Craig, W.M.: Metastatic Brain Abscess , Medicine 29:71, 1950.Crossref 4. Heineman, H.S., and Braude, A.I.: Anaerobic Infections of the Brain , Amer J Med 35:682, 1963.Crossref 5. McFarlan, A.M.: The Bacteriology of Brain Abscess , Brit Med J 2:643, 1943.Crossref 6. Kerr, F.W.L., and King, R.B.: Brain Abscess: A Study of Forty-Seven Consecutive Cases , JAMA 168:868, 1958.Crossref 7. Loeser, E., and Scheinberg, L.: Brain Abscesses , Neurology 7:601, 1957.Crossref

ALTEMUS, L. REED;LEE, ROBERT E.

doi: 10.1001/archinte.1967.00290190080005pmid: N/A

Abstract PULMONARY hypertension is a rare complication of lung carcinomatosis. Bristowe described the first case in 1868.1 Until 1961, only 17 cases appeared in the literature.2 Primarily, the discussions pertained to the unique clinical and pathological aspects, with little, if any, attention focused upon the associated roentgenographic findings. Since the onset of symptoms and clinical course differed from either acute or chronic cor pulmonale, the term "subacute" cor pulmonale was advocated by Brill and Robertson in 1937.3 This terminology was used specifically for malignant tumor embolization of the lung. However, subsequent reports emphasized that nonmalignant emboli originating from veins or uterine trophoblastic elements may initiate the identical clinical picture.4-6 Furthermore, pure lymphangitic carcinomatosis may provoke sufficient changes within the pulmonary vascular bed to induce pulmonary hypertension and, in turn, the same characteristic clinical picture.7-9 A review of the literature and three cases encountered at Presbyterian-University Hospital disclosed a radiologie spectrum which

LONDON, SEYMOUR B.;LONDON, ROSE E.

doi: 10.1001/archinte.1967.00290190087006pmid: N/A

Abstract KOROTKOFF1 proposed the auscultatory method of indirect blood pressure measurement in 1905. His "first" sound has been accepted as the index of systolic pressure. He also pointed out that "at the disappearance of sounds, the manometric figure... corresponds to the minimal pressure." This observation has provoked heated debate, continuing to the present. Staunch adherents of the "last sound" school are vigorously opposed by antagonists supporting "muffling" as the correct index of indirect diastolic end point. The clinical observation of the sudden change in sounds has been proposed by early investigators 2-7 in the field of indirect blood pressure measurement and defended more recently by Roberts,8 Van Bergen,9 Moss,10 and others. Korotkoff's original observations on the other hand have been upheld by a large number of investigators.11-20 Their opinion probably represents a majority view. In 1951, the committee of the American Heart Association under the chairmanship of Dr. Carl J. Wiggers21 References 1. Korotkoff, N.S.: A Contribution to the Problem of Methods for the Determination of the Blood Pressure , Rep Imper Milit Med Acad 11:365, 1905 2. Ruskin, A.: Classics in Medical Hypertension , Springfield, Ill: Charles C Thomas, Publishers, 1956, pp 126-133. 3. Fischer, J.: Die auskultatorische Blutdruckmessung im Vergleich mit der Oszillatorischen von Heinrich von Recklinghausen und ihre durch die Phasenbestimmung bedingte Werthe , Ztschr Diaetet Physik Therap 12:389, 1909. 4. Warfield, L.: Studies in Auscultatory Blood Pressure Phenomena , Arch Intern Med 10:258, 1912.Crossref 5. Taussig, A.E., and Cook, J.E.: The Determination of the Diastolic Pressure in Aortic Regurgitation , Arch Intern Med 11:542, 1913.Crossref 6. Erlanger, J.: Studies in Blood Pressure Estimation by Indirect Methods: II. Mechanism of the Compression Sounds , Amer J Physiol 40:82, 1916. 7. Bramwell, C.: Blood Pressure and Its Estimation , Lancet 1:138-140, 184-188, 1940.Crossref 8. Rappaport, M.B., and Luisada, A.A.: Indirect Syphygmomanometry; Physical and Physiologic Analysis and New Procedures for Estimation of Blood Pressure , J Lab Clin Med 29:638-656, 1943. 9. Roberts, L.N.; Smiley, J.R.; and Manning, G.W.: A Comparison of Direct and Indirect Blood Pressure Determinations , Circulation 8:232-242, 1953.Crossref 10. Van Bergen, F.H., et al: Comparison of Indirect and Direct Methods of Measuring Arterial Blood Pressure , Circulation 10:481,1954.Crossref 11. Moss, A.J., and Adams, F.H.: Index of Indirect Estimation of Diastolic Blood Pressure , Amer J Dis Child 106:364,1963.Crossref 12. Ettinger, W.: Auskultatorische Methode der Blutdruckbestimmung und ihr praktischer Wert , Wein Klin Wschr 20:992-996, 1907. 13. Gittings, J.C.: Auscultatory Blood Pressure Determination , Arch Intern Med 6:196, 1910.Crossref 14. Hooker, D.R., and Southworth, J.D.: Interpretation of the Blood Pressure Sounds , Arch Intern Med 13:384, 1914.Crossref 15. Hamilton, W.F.; Woodbury, R.A.; and Harper, H.T., Jr.: Physiological Relationships Between In- trathoracic, Intraspinal, and Arterial Pressures , JAMA 107:853, 1936.Crossref 16. Ragan, C., and Bordley, J., III: Accuracy of Clinical Measurements of Arterial Blood Pressure With a Note on the Auscultatory Gap , Bull Hopkins Hosp 69:504, 1941. 17. Steele, J.M.: Comparison of Simultaneous Indirect (Auscultatory) and Direct (Intra-arterial) Measurements of Arterial Pressure in Man , J Mount Sinai Hosp NY 8:1042, 1942. 18. Master, A.M.; Garfield, C.D.; and Walters, M.B.: Normal Blood Pressure and Hypertension New Definition , Philadelphia: Lea & Febiger, 1952, pp 30-32. 19. Wood, P.: Diseases of the Heart and Circulation , ed 2, London: Eyre & Spotteswoode Publishers Ltd., 1957, pp 39, 40. 20. Harrison, E.G., Jr.; Roth, G.M.; and Hines, E.A., Jr.: Bilateral Indirect and Direct Arterial Pressure , Circulation 22:419, 1960.Crossref 21. Burch, G.E., and DePasquale, N.P.: Primer of Clinical Measurements of Blood Pressure , St. Louis: C. V. Mosby Company, Medical Publishers, 1962, p 65. 22. Bordley, J., et al: Recommendations for Human Blood Pressure Determinations by Sphygmomanometer , Circulation 4:503, 1951.Crossref 23. Committee to Revise Standardization of High Blood Pressure Readings: Recommendations for Human Blood Pressure Determinations by Sphygmomanometers , Amer Heart Assoc, NY, 1951. 24. Burton, A.C.: Peripheral Circulation, Measurement of Arterial Pressure , Ann Rev Physiol 15: 213, 1953.Crossref 25. Rushmer, R.F.: Cardiovascular Dynamics , ed 2, Philadelphia: W. B. Saunders Co., 1961, pp 135-136. 26. London, S.B., and London, R.E.: Time Relationship of Korotkow Sounds to the Intra-arterial Pressure Curve , Circulation (suppl 3-116) , pp 19, 20, 1964. 27. London, S.B., and London, R.E.: Comparison of Indirect Pressure Measurements (Korotkow) With Simultaneous Direct Brachial Artery Pressure Distal to the Cuff , in Snapper, I. (ed): Advances in Internal Medicine vol 13, Chicago: Year Book Medical Publishers, Inc., to be published. 28. Erlanger, J.: A New Instrument for Determining the Minimum and Maximum Blood Pressures in Man , Hopkins Hosp Rep 12:53, 1904. 29. Erlanger, J., and Hooker, D.R.: An Experimental Study of Blood Pressure and of Pulse Pressures in Man , Hopkins Hosp Rep 12:145, 1904.

TURCK, MARVIN;BELCHER, DONALD W.;RONALD, ALLAN;SMITH, RONALD H.;WALLACE, JAMES F.

doi: 10.1001/archinte.1967.00290190098007pmid: N/A

Abstract CEPHALORIDINE, one of the new semisynthetic derivatives of cephalosporin C, is active against a wide variety of pathogenic microorganisms.1-7 Although cephaloridine is chemically related to sodium cephalothin (Keflin), the cephalosporin antibiotic currently in use in the United States, the modification in structure appears to offer some advantages. Results of preliminary studies indicated that cephaloridine possessed greater in vitro activity against some gram-positive strains than sodium cephalothin, consistently demonstrated higher and more sustained antibacterial levels in the blood, and was better tolerated following intramuscular administration 8-11 (and according to written communication from R. S. Griffith, July 1965). This report deals with use of cephaloridine in 86 hospitalized patients treated for a variety of severe infections, and describes its in vitro effects against common bacterial pathogens. Materials and Methods Laboratory Studies. —Minimal inhibitory concentrations (MIC) and minimal bactericidal concentrations (MBC) of cephaloridine and sodium cephalothin were determined with 50 strains each References 1. Murdoch, J.McC., et al: Clinical Trial of Cephaloridine: A New Broad-Spectrum Antibiotic Derived from Cephalosporin C , Brit Med J 2:1238-1240, 1964.Crossref 2. Barber, M., and Waterworth, P.M.: Penicillinase-Resistant Penicillins and Cephalosporins , Brit Med J 2:344-349, 1964.Crossref 3. Muggleton, P.W.; O'Callaghan, C.H.; and Stevens, W.K.: Laboratory Evaluation of a New Antibiotic—Cephaloridine , Brit Med J 2:1234-1237, 1964.Crossref 4. Cephaloridine, editorial , Brit Med J 2:1211-1212, 1964.Crossref 5. Apicella, M.A.; Perkins, R.L.; and Saslaw, S.: Cephaloridine Treatment of Bacterial Infections , Amer J Med Sci 251:266-276, 1966.Crossref 6. Kislak, J.W.; Steinhauer, B.W.; and Finland, M.: Cephaloridine—Activity in Vitro and Absorption and Excretion in Normal Young Men , Amer J Med Sci 251:433-448, 1966.Crossref 7. Stewart, G.R., and Holt, R.J.: Laboratory and Clinical Results With Cephaloridine , Lancet 2:1305-1309, 1964.Crossref 8. Cohen, P.G.; Romansky, M.J.; and Johnson, A.C.: Cephaloridine—Laboratory and Clinical Evaluation in 78 Patients, abstracted, Fifth Interscience Conference on Antimicrobial Agents and Chemotherapy, pp 894-900, 1966. 9. Holloway, W.J., and Scott, E.G.: Clinical Experience With Cephaloridine, abstracted, Fifth Interscience Conference on Antimicrobial Agents and Chemotherapy, pp 916-921, 1966. 10. Flux, G.; Nunnery, A.W.; and Riley, H.D., Jr.: Evaluation of Cephaloridine in Infants and Children, abstracted, Fifth Interscience Conference on Antimicrobial Agents and Chemotherapy, pp 933-936, 1966. 11. Benner, E.J.; Brodie, J.L.; and Kirby, W.M.M.: Laboratory and Clinical Comparison of Cephaloridine and Cephalothin, abstracted, Fifth Interscience Conference on Antimicrobial Agents and Chemotherapy, pp 888-893, 1966. 12. Turck, M., et al: Laboratory and Clinical Evaluation of a New Antibiotic—Cephalothin , Ann Intern Med 63:199-211, 1965.Crossref 13. Turck, M.; Lindemeyer, R.J.; and Petersdorf, R.G.: Comparison of Single-Disk and Tube-Dilution Techniques in Determining Antibiotic Sensitivities of Gram-Negative Pathogens , Ann Intern Med 58: 56-65, 1963.Crossref 14. Benner, E.J., et al: Inactivation of Cephalothin and Cephaloridine by Staphylococcus aureus , J Bact 90:1599-1604, 1965. 15. Lucas, J.B., et al: Treatment of Gonorrhea in Males With Cephaloridine , JAMA 195:919-921, 1966.Crossref 16. Anderson, K.N., and Petersdorf, R. G.: Cephalosporin C and Cephalothin in Gram-Negative Infections , in Antimicrobial Agents and Chemotherapy , Ann Arbor: Braun-Brumfield, 1962, p 724. 17. Benner, E.J., et al: Natural and Acquired Resistance of Klebsiella-Aerobacter to Cephalothin and Cephaloridine , Proc Soc Exp Biol Med 119:536-541, 1965.Crossref 18. Louria, D.B., and Brayton, R.G.: The Efficacy of Penicillin Regimens: With Observations on the Frequency of Superinfection , JAMA 186:987-990, 1963.Crossref 19. Kabins, S.A., Eisenstein, B.; and Cohen, S.: Anaphylactoid Reaction to an Initial Dose of Sodium Cephalothin , JAMA 193:165-166, 1965.Crossref 20. Perkins, R.L., and Saslaw, S.: Experiences With Cephalothin , Ann Intern Med 64:13-24, 1966.Crossref 21. Merrill, S.L., et al: Cephalothin in Serious Bacterial Infection , Ann Intern Med 64:1-12, 1966.Crossref 22. Abraham, E.P.: In Biochemistry of Some Peptide and Steroid Antibiotics , New York: John Wiley & Sons, Inc, 1957, p 34. 23. Kabins, S.A., and Cohen, S.: Cephaloridine Therapy as Related to Renal Function, abstracted, Fifth Interscience Conference on Antimicrobial Agents and Chemotherapy, Washington, DC, Oct 17-21, 1965, to be published. 24. Kunin, C.M., and Atuk, N.: Excretion of Cephaloridine and Cephalothin in Patients With Renal Impairment , New Eng J Med 274:654-655, 1966.Crossref

JAGER, B. V.

doi: 10.1001/archinte.1967.00290190108008pmid: N/A

Abstract Persons injected intravenously with human γ-globulin may develop symptoms which include anxiety, flushing of the face, a constricting feeling in the chest, muscle pain in the trunk or thighs, nausea and vomiting, fever, and rarely collapse.1-3 In one study seven of 54 subjects receiving 110 ml of 1.5% γ-globulin solution intravenously experienced a reaction.1 However, readministration, if within 72 hours, was well tolerated even by those who previously had reacted unfavorably. Individual susceptibility as well as rate of infusion, total amount given and perhaps the specific γ-globulin preparation may be determinants in the frequency and severity of symptoms. Peculiarly, the incidence of systemic reactions was extremely high in those with antibody deficiency syndromes such as primary agammaglobulinemia.1,4 By contrast, pepsin treated preparations of γ-globulin elicited few or no symptoms when given to people with a variety of diseases including agammaglobulinemia.5-7 The present report describes symptoms and laboratory findings observed during References 1. Barandun, S., et al: Intravenous Administration of Human γ-Globulin , Vox Sang 7:157-174, 1962.Crossref 2. Moore, G.E.; Sandberg, A.; and Amos, D.B.: Experimental and Clinical Adventures With Large Doses of Gamma and Other Globulins as Anticancer Agents , Surgery 41:972-983, 1957. 3. Coon, W.W., et al: Experiences With Large Infusions of γ-Globulin , Amer J Surg 102:548-553, 1961.Crossref 4. Hitzig, W.H., and Willi, H.: Hereditäre lymphoplasmocytäre Dysgenesie ("Alymphocytose mit Agammaglobulinämie") , Schweiz Med Wschr 91: 1625-1633, 1961. 5. Schultze, H.E., and Schwick, G.: Über neue Möglichkeiten intravenöser γ-globulin-Applikation , Deutsch Med Wschr 87:1643-1650, 1962.Crossref 6. Lang, W.: Die intravenöse γ-Globulin-Therapie , Deutsch Med Wschr 89:2374-2379, 1964.Crossref 7. Koch, F.: Erste Erfahrungen mit Gamma-VeninR, einem intravenös injizierbaren Gamma-globulin-Präparat, in der Kinderheilkunde , Deutsch Med Wschr 88:282-285, 1963.Crossref 8. Cohen, S.: Nomenclature of Human Immunoglobulins, editorial , Immunology 8:1-5, 1965. 9. Glaser, J., and Wyss-Souffront, W.A.: Alleged Anaphylactic Reactions to Human γ-Globulin , Pediatrics 28:367-376, 1961. 10. Squire, J.R.: Immunoglobulins , Proc Roy Soc Med 57:749-752, 1964. 11. Richerson, H.B., and Seebohm, P.M.: Anaphylactoid Reaction to Human γGlobulin , Arch Intern Med 117:568-572, 1966.Crossref 12. Richter, M., et al: Effects of Physicochemical Agents on the Electrophoretic Properties of Serum Proteins in Starch Gel Medium , Canad J Biochem 40:35-39, 1962.Crossref 13. Christian, C.L.: Studies on Aggregated γ-Globulin: I. Sedimentation, Electrophoretic, and Anticomplementary Properties , J Immun 84:112-116, 1960. 14. Christian, C.L.: Studies on Aggregated γ-Globulin: II. Effect in Vivo , J Immun 84:117-121, 1960. 15. Ishizaka, K.; Ishizaka, T.; and Sugahara, T.: Biologic Activity of Aggregated γGlobulin: III. Production of Arthus-like Reactions , J Immun 86: 220-227, 1961. 16. Benacerraf, B.; Sebestyen, M.; and Cooper, N.S.: The Clearance of Antigen Antibody Complexes from the Blood by the Reticulo-endothelial System , J Immun 82:131-137, 1959. 17. Barandun, S.; Kaiser, M.; and Dostal, V.: Zur Frage der intravenösen γGlobulin-Applikation , Helv Med Acta 28:551-555, 1961. 18. Tomasi, T.B., Jr.: Human γGlobulin Analytical Review , Blood 25:382-403, 1965. 19. Terry, W.D.; Fahey, J.L.; and Steinberg, A.G.: GM and INV Factors in Subclasses of Human IgG , J Exp Med 122:1087-1102, 1965.Crossref 20. Stiehm, E.R., and Fudenberg, H.H.: Antibodies to γ-Globulin in Infants and Children Exposed to Isologous γGlobulin , Pediatrics 35:229-235, 1965. 21. Utsumi, S., and Karush, F.: Peptic Fragmentation of Rabbit γG-Immunoglobulin , Biochemistry 4:1776-1779, 1965.Crossref 22. Ishizaka, K., and Ishizaka, T.: Molecular Basis of Passive Sensitization: II. The Role of Fragment III of γGlobulin and Its Disulfide Bond in Passive Sensitization and Complement Fixation , J Immun 93:59-68, 1964. 23. Amiraian, K., and Leikhim, E.J.: Properties of Fragments of Human Wassermann Antibodies , Immunology 10:349-353, 1966.

HALL, WILLIAM J.;McCABE, WILLIAM R.

doi: 10.1001/archinte.1967.00290190113009pmid: N/A

Abstract RECENT investigations have indicated that both the incidence and severity of trichinosis is waning in the United States. Studies during the 1930's demonstrated trichinous infestation in approximately 15% to 25% of autopsies,1-3 but more recently Most reported that the incidence had decreased to 5% in autopsies performed in the 1960's.4 Fatality rates approaching 50% in patients with neurologic or cardiac involvement also were common in the past, yet Gray calculated that, at present, the fatality rate in such patients was approximately 8%.5 Much of the decrease in the incidence and morbidity from trichinosis is attributable to improved feeding practices by pork raisers and greater care in the preparation of pork products. Despite this improvement, outbreaks of trichinosis still occur and result in significant morbidity. A circumscribed outbreak of trichinosis originating from a single food source was observed in Boston during September 1965. This report is presented to References 1. Most, H., and Helpern, M.: Incidence of Trichinosis in New York City , Amer J Med Sci 202:251-257, 1941.Crossref 2. Pote, T.B.: The Present Incidence of Trichinella spiralis in Man as Determined by a Study of 1,060 Unselected Autopsies in St. Louis Hospitals , Amer J Med Sci 197:47-52, 1939.Crossref 3. Wright, W.H.; Kerr, K.B.; and Jacobs, L.: Studies on Trichinosis: XV. Summary of the Findings of Trichinella spiralis in a Random Sampling and Other Samplings of the Population of the United States , Public Health Rep 58:1293-1313, 1943.Crossref 4. Most, H.: Trichinellosis in the United States: Changing Epidemiology During the Past 25 Years , JAMA 193:871-73, 1965.Crossref 5. Gray, D.F.; Morse, B.S.; and Philips, W.F.: Trichinosis With Neurologic and Cardiac Involvement , Ann Intern Med 57:230-44, 1962.Crossref 6. Mackie, T.T.; Hunter, G.W., III; and Worth, C.B.: A Manual of Tropical Medicine , Philadelphia: W. B. Saunders Company, 1945. 7. Spink, W.W.: Trichinella Antigen: Further Observation on Its Use in the Diagnosis of Trichinosis , New Eng J Med 216:5-8, 1937.Crossref 8. Gould, S.E.: Trichinosis , Springfield, Ill: Charles C Thomas, Publishers, 1945, p 153. 9. Kagan, I.G.: Trichinosis: A Review of Biologic, Serologic and Immunologic Aspects , J Infect Dis 107:65-93, 1960.Crossref 10. Maynard, J.E., and Kagan, I.G.: Intradermal Test in the Detection of Trichinosis , New Eng J Med 270:1-6, 1964.Crossref 11. Thiabendazole (Preclinical Evaluation) , Merck, Sharp and Dohme Research Laboratory, Rahway, NJ: Merck & Co., Inc., 1964. 12. Campbell, W.C., and Cuckler, A.C.: Effect of Thiabendazole Upon Experimental Trichinosis in Swine , Proc Soc Exp Biol Med 110:124-8, 1962.Crossref 13. Chowdhury, A.B.; Banyopadhyay, A.K.; and Banerjee, M.: Preliminary Observations on the Clinical Trial of Thiabendazole Against Human Helminthiasis , Bull Calcutta Sch Trop Med 12:124-5, 1964. 14. Stone, O.J.; Stone, C.T., Jr.; and Mullins, J.F.: Thiabendazole—Probable Cure for Trichinosis , JAMA 187:536-38, 1964.Crossref 15. Spaeth, G.L.; Adams, R.E.; and Soffe, A.M.: Treatment of Trichinosis , Arch Ophth 71:359-63, 1964.Crossref 16. Kean, B.H., and Hoskins, D.W.: Treatment of Trichinosis With Thiabendazole: A Preliminary Report , JAMA 190:852-53, 1964.Crossref 17. Medical Communications Department, Merck, Sharp and Dohme Research Laboratories: Mintezol Annotated Bibliography , West Point, Pa: Merck & Co., Inc., 1964, pp 1-20. 18. Maynard, J.E., and Kagan, I.G.: Trichinosis , Practitioner 191:622-629, 1963.

MAY, ROBERT P.;LEHMANN, JAMES D.;SANFORD, JAY P.

doi: 10.1001/archinte.1967.00290190117010pmid: N/A

Abstract LIVER abscess, despite refinement in diagnostic and therapeutic aids, remains a serious illness with a high morbidity and mortality. Due to the pitfalls in differentiating amebic from pyogenic abscess and the marked difference in the mortality, we have reviewed the cases of liver abscess at Parkland Memorial Hospital since 1943 in an effort to establish clinical and laboratory features which might be used to differentiate the two. At the same time, a reasonable approach to therapy of hepatic abscesses might be established. Methods Cases were obtained by review of the infectious disease service and record room files and autopsy protocols at Parkland Memorial Hospital from 1943 to 1966. Only patients with macroscopic abscesses were selected for this review.Based on the following features, the cases were divided into amebic and pyogenic groups. Patients were classified as having amebic abscesses if they manifested one of the following: (1) demonstration of amebae References 1. Ogden, W.W.; Hunter, P.; and Rines, J.D.: Pyogenic Liver Abscess , J Louisiana Med Soc 114: 139, 1962. 2. Sherman, J.D., and Robbins, S.L.: Changing Trends in the Casuistics of Hepatic Abscess , Amer J Med 28:943, 1960.Crossref 3. Ochsner, A., and DeBakey, M.: Amebic Hepatitis and Hepatic Abscess , Surgery 13:460, 1943. 4. Craig, C.F.: The Etiology, Diagnosis and Treatment of Amebiosis , Baltimore: Williams & Wilkins Company, 1944. 5. Cronin, K.: Pyogenic Abscess of the Liver , Gut 2:53, 1961.Crossref 6. Ochsner, A., and DeBakey, M.: Pyogenic Abscess of Liver , Amer J Surg 40:292, 1938.Crossref 7. Schiff, L.: Diseases of the Liver , Philadelphia: J. B. Lippincott Company, 1956. 8. Gollin, F.F.; Sims, J.L.; and Cameron, J.R.: Liver Scanning and Liver Function Tests: Comparative Study , JAMA 187:111, 1964.Crossref 9. Schwan, B.M.; Block, M.A.; and Eyler, W.R.: Liver Abscess: Rose Bengal I131 Hepatic Photoscan in Diagnosis and Management , JAMA 187:708, 1964. 10. Ibrahim, M.S., and Abdel-Wahal, M.F.: Detection of Amebic Liver Abscess by Isotope Scanning , Brit Med J 1:1325, 1963.Crossref 11. Wilmot, A.J.; Powell, S.J.; and Adams, E.B.: Chloroquine Compared With Chloroquine and Emetine Combined in Amebic Liver Abscess , Amer J Trop Med 8:623, 1959.