Showing papers in "A.M.A. archives of internal medicine in 1951"
TL;DR: Reports of transitory thrombocytopenia in infants of women with throm bocytopenic purpura are of particular interest, since these cases suggest that an agent producing the throma is transmissible through the placenta.
Abstract: MANY EXPLANATIONS have been advanced for the low thrombocyte (platelet) count in primary or idiopathic thrombocytopenic purpura, but so far all theories lack substantial proof. The disease is somewhat commoner in females and occurs more frequently in the first half of life, although it has been seen in persons of all age groups. A familial history of easy bruising and prolonged bleeding is frequently mentioned in case histories, but few hematological data are offered to support the supposition that thrombocytopenia has occurred in other members of the family. Reports of transitory thrombocytopenia in infants of women with thrombocytopenic purpura are of particular interest, since these cases suggest that an agent producing the thrombocytopenia is transmissible through the placenta.1Both increased destruction and decreased formation of thrombocytes have been advanced as causes of primary thrombocytopenia. Since there is no technic comparable to the reticulocyte count for estimating the rate of
412Â citations
TL;DR: When aureomycin became available and was shown to be effective in therapy of isolated cases of pneumococcic meningitis, it was decided to test its efficacy by treating alternate patients with either penicillin or Aureomycin.
Abstract: PNEUMOCOCCIC meningitis is well known as one of the most serious forms of bacterial meningitis. Before the sulfonamides were used pneumococcic meningitis was almost always fatal. With the advent of penicillin an era of more successful therapy was started. Originally it was established that when small systemic doses of penicillin were given the result could be greatly improved by administering the antibiotic intrathecally. It was later shown1that the administration of large doses of penicillin systemically gave still better results and that intrathecal penicillin therapy was unnecessary when this regimen was employed. In spite of these advances, however, approximately one of three persons with pneumococcic meningitis still died, as shown on analysis of series of unselected cases. Consequently, when aureomycin became available and was shown to be effective in therapy of isolated cases of pneumococcic meningitis, we decided to test its efficacy by treating alternate patients with either penicillin
213Â citations
TL;DR: The present study was undertaken to determine whether there was anything characteristic about the clinical pictures caused by different species of Gram-negative bacilli and to work out a therapeutic approach to patients in whom bacteremia due to these organisms was suspected.
Abstract: SEPSIS due to Escherichia coli was the subject of excellent reports by Jacob 1 in 1909 and Felty and Keefer 2 in 1924. However, the fact that strains and species of Gram-negative bacilli differ in their sensitivity to modern antimicrobial agents has made it desirable to study further not only bacteremias due to E. coli but those due to other non-lactose-fermenting Gram-negative rods. 3 The present study was undertaken to determine whether there was anything characteristic about the clinical pictures caused by different species of Gram-negative bacilli and to work out a therapeutic approach to patients in whom bacteremia due to these organisms was suspected. Presented in this report is a study of 29 cases of bacteremia due to Gram-negative bacilli other than Salmonella. Emphasis has been placed on the incidence of these infections, the clinical and laboratory picture caused by each type of bacilli, the sensitivities of the etiological
182Â citations
TL;DR: The most commonly administered nitrogen mustard is methyl-bis(2-chloroethyl) amine hydrochloride (HN2), and, since 1946, much experience has been gained from its use throughout the world.
Abstract: THE NITROGEN mustards were introduced into medical practice in 1946 for the palliative treatment of the lymphomas, leukemias and other types of neoplastic disease.1The most commonly administered nitrogen mustard is methyl-bis(2-chloroethyl) amine hydrochloride (HN2), and, since 1946, much experience has been gained from its use throughout the world.2This nitrogen mustard has found a useful place as a temporary palliative agent in the management of certain types and stages of neoplastic disease. It must be injected intravenously, and it frequently produces severe nausea and vomiting; consequently, its administration, in most cases, has been regarded as a hospital procedure. Extravasation of the injected solution will produce a prolonged and painful local reaction, and, in patients receiving repeated courses of treatment, venous thromboses and difficulty in finding suitable veins for injection may occur. The dosage must be carefully controlled, since an excessive dose will produce serious, prolonged
162Â citations
TL;DR: The great majority of the patients who received aureomycin intravenously showed no evidence of toxic or side reactions other than those mentioned above, and are now considered to be safe.
Abstract: AUREOMYCIN k and has exhibited a minimum of toxic reactions.1The reports of toxicity have been limited almost exclusively to gastrointestinal symptoms after oral medication and chemical thrombophlebitis after intravenous administration. Rarely, chills, malaise, nausea, dizziness, and lower-back pain have been observed in patients during and immediately after rapid intravenous injections.2Local pain has accompanied intramuscular or subcutaneous administration. An occasional allergic-type reaction has also been reported.3 We have administered aureomycin4intravenously to a number of seriously ill patients. Because of the severity of their illnesses, they were given large intravenous doses of aureomycin, occasionally for a long period and, in many cases, oral doses of aureomycin in addition. The great majority of the patients who received aureomycin intravenously showed no evidence of toxic or side reactions other than those mentioned above. A few patients, however, who were given what we now consider to be
128Â citations
TL;DR: The findings indicate that the deep pathways in the pelvis, abdomen and thorax are normally patent and are of greater importance than the anterior parietal ones.
Abstract: THE CURRENT renewed interest in the problems of portal and caval obstruction prompts a reexamination of the anatomy of the communications between the portal and the systemic veins. This report is based on roentgenography and dissection of the communications after their postmortem injection with barium sulfate solution via the femoral veins and inferior caval system in human subjects. The study affords a basis for evaluation of the relative importance of the various possible collaterals. Briefly, the findings indicate that the deep pathways in the pelvis, abdomen and thorax are normally patent and are of greater importance than the anterior parietal ones. The role of porta-systemic communications as collaterals in portal obstruction will be discussed at length. Briefer attention will be paid to the utilization of the portal system as a collateral pathway after obstruction of the venae cavae. HISTORICAL STATEMENT The normal existence of multiple porta-systemic connections has been known
127Â citations
TL;DR: Peritoneal lavage has been possible to maintain bilaterally nephrectomized dogs for periods of 30 to 70 days, which is several times that ever reported previously, with consideration of the inevitable malignant hypertension that develops following.
Abstract: PREVIOUS studies on the use of artificial measures (the artificial kidney, exchange blood transfusions, peritoneal lavage, etc.) to maintain life in the absence of renal function have been carried out chiefly on the human patient. Thus, a total of 101 patients have been treated by continuous peritoneal lavage, 1 but the value of the method remains equivocal because many patients with acute anuria recover spontaneously when treated by more conservative measures. 2 It was deemed necessary, therefore, to carry out studies on the nephrectomized animal in order to establish the potentialities of the method before proceeding to its application to the human patient. The present paper describes procedures for performing peritoneal lavage, by means of which it has been possible to maintain bilaterally nephrectomized dogs for periods of 30 to 70 days, which is several times that ever reported previously. With consideration of the inevitable malignant hypertension that develops following
120Â citations
TL;DR: A spectrum of possible combinations has been shown to exist for various sulfonamides and has been suggested for antibiotics, and it has also been shown that combinations of antibiotics can achieve results unobtainable with any other antibiotics.
Abstract: THE DYNAMICS of antimicrobial action are known to some extent for the "older" antibiotics, particularly penicillin. Data are being accumulated at present on the "newer" antibiotics, aureomycin, chloramphenicol and terramycin. Relatively little information, however, is available on the results of simultaneous action of two or more antibiotics. Such basic information is desirable particularly in view of the increasing trend for multiple antibiotic therapy in medical practice. Two antibiotics acting simultaneously might be additive, synergistic, antagonistic or without any effect on each other. This spectrum of possible combinations has been shown to exist for various sulfonamides 1 and has been suggested for antibiotics. 2 Synergistic effects have been demonstrated for combinations of penicillin and streptomycin in their action against enterococci in vitro 3 and against enterococcic human infections. 4 In some other infections (e. g., brucellosis) it has also been shown that combinations of antibiotics can achieve results unobtainable with any
113Â citations
TL;DR: Experimentalally, both the severity and the duration of the hypoxia of the myocardium occurring with coronary insufficiency would seem to determine whether the changes will be transient and reversible or be characterized by necrosis of theMyocardium.
Abstract: THE CONCEPT of inadequate coronary blood flow resulting from chronic atherosclerotic narrowing of the coronary arteries as a cause of myocardial infarction without acute occlusion has become rather generally recognized. 1 Among the first pathologic observations of acute myocardial infarction without the presence of an acute coronary occlusion were the studies of Buchner. 2 Blumgart, Schlesinger, and Zoll 3 have stressed the fact that coronary thrombosis or occlusion does not always produce myocardial infarction and, conversely, that acute myocardial infarction may occur in the absence of acute coronary occlusion. They have demonstrated this particularly by the technic of studying the coronary arteries after injection of radiopaque compounds. Experimentally, both the severity and the duration of the hypoxia of the myocardium occurring with coronary insufficiency would seem to determine whether the changes will be transient and reversible or be characterized by necrosis of the myocardium. 4 The primary purpose of this
107Â citations
TL;DR: The high incidence of pyelonephritis in a single kindred offered an extraordinary opportunity to study both the clinical manifestations and the genetic background of the disease found in this group.
Abstract: THIS REPORT deals with a kindred in which many members are affected by a form of renal disease which has led to the death in uremia of several male members of the kindred and which is characterized by most of the manifestations of chronic interstitial pyelonephritis of the type reported by Weiss and Parker. 1 The high incidence of pyelonephritis in a single kindred offered an extraordinary opportunity to study both the clinical manifestations and the genetic background of the disease found in this group. The hereditary occurrence of any form of nephritis is distinctly unusual, and no reports of hereditary pyelonephritis have been found in the literature. Rinkoff and his co-workers, 2 in 1939, reported the occurrence of chronic glomerulonephritis in three brothers. They reviewed the literature as far back as 1875. The disease in their patients was characterized by hypertension, edema, and hematuria. In other reports many instances
99Â citations
TL;DR: The definition of the hypertensive diencephalic syndrome and the demonstration of a pressor substance in the cerebral ventricular fluid of patients with hypertensive disease pointed directly toward central nervous system participation in this disease.
Abstract: CONCEPTS of the pathogenesis of essential hypertension have fluctuated widely during the half-century in which this disease has been recognized. One view is that hypertension is of diverse, probably multiple, causation, dependent on factors broadly classified as neurogenic, cardiovascular, endocrine and renal. 1 Among these, the participation of the nervous system was long ago considered especially significant, although no adequate explanation of the mechanism by which it might have this effect has been offered. Two observations in our experience pointed directly toward central nervous system participation in this disease. There were, first, the definition of the hypertensive diencephalic syndrome 2 and, second, the demonstration of a pressor substance in the cerebral ventricular fluid of patients with hypertensive disease. 3 Further, "neurogenic" hypertension has been defined as a common and early phase of essential hypertension. 4 From the experimental aspect, Koch and Mies 5 described, and others have confirmed, the production
TL;DR: It has been of considerable interest in the past six months to observe in this hospital 11 cases of infection by chromobacteria, one of which had a fatal termination with bacterial endocarditis.
Abstract: INFECTION of human beings by chromobacteria is a relatively rare occurrence. Hence, it has been of considerable interest in the past six months to observe in this hospital 11 cases of infection by these organisms, one of which had a fatal termination with bacterial endocarditis. The chromobacteria have been described as nonsporulating, aerobic bacilli, usually motile and usually Gram-negative, producing yellow, red, or violet pigment which is generally insoluble in water. The bacteria are ordinarily saprophytic and are commonly found in water, soil, and sewage. They grow abundantly and with ease on ordinary mediums, and their most arresting feature is the pigment production, which occurs only in the presence of oxygen, usually only on solid mediums at suitable temperatures, and is most abundant on the primary culture. 1 The chief member of the group producing a violet pigment is Chromobacterium violaceum, that of the group producing pink or red pigment
TL;DR: It is agreed that the presence of the lesion at autopsy may be anticipated during life with a fair degree of certainty if the above clinical syndrome is noted in a patient with long-standing diabetes and in whom there is no previous renal dysfunction.
Abstract: THE RECOGNITION of a possibly specific renal lesion developing in treated diabetics is due to Kimmelstiel and Wilson.1They observed at autopsy a hyalinization of the intercapillary connective tissue of the glomeruli in seven diabetic patients who during life had shown evidence of renal dysfunction. This finding has been fully confirmed by a number of American workers and in this country by Gauld, Stalker and Lyall2and Hall.3 The clinical syndrome associated during life with the specific kidney lesion comprises hypertension, albuminuria and retinopathy; edema is a less constant finding. Death usually occurs either from a cardiovascular accident or from uremia. Most writers on this subject4agree that the presence of the lesion at autopsy may be anticipated during life with a fair degree of certainty if the above clinical syndrome is noted in a patient with long-standing diabetes and in whom there is no previous
TL;DR: The genus Coxiella has been chosen because this organism differs from other members of the rickettsial group in several important respects, e.
Abstract: Q FEVER was originally described by Derrick 1 in Queensland, Australia, where it was first observed as an acute febrile illness among abattoir workers. Since 1945, the disease has been reported from many parts of the world 2 and from a number of widely separated localities of the United States. 3 At present the disease appears to be established endemically in California, where in the past three years more than 700 cases have been recognized and confirmed in the laboratory. In certain parts of the state this disease has become an important addition to the differential diagnosis of acute febrile illnesses. The disease is caused by a Rickettsia, previously known as Rickettsia burneti or Rickettsia diaporica, but now designated as Coxiella burnetii (Derrick). The genus Coxiella has been chosen because this organism differs from other members of the rickettsial group in several important respects, e. g., the organism is filtrable,
TL;DR: The Eisenmenger complex is usually presented as a cyanotic form of congenital heart disease consisting of a high defect of the ventricular septum, the aorta overriding the defect and dilatation of the pulmonary vessels, with an unobstructed pulmonary orifice.
Abstract: VICTOR Eisenmenger 1 in 1897 reported the case of a cyanotic adult who at autopsy was observed to have a large ventricular septal defect. Twenty-five years later, Maude Abbott 2 brought into focus the fact that in Eisenmenger's case the aorta was overriding the defect of the septum. She separated this malformation from the simple ventricular septal defect on one hand and the tetralogy of Fallot on the other and named it "the Eisenmenger complex." In the last few years this syndrome has attracted much attention, as the diagnosis of the Eisenmenger complex was considered to be a contraindication for the performance of surgical procedures devised for the relief of cyanosis. The Eisenmenger complex is usually presented as a cyanotic form of congenital heart disease consisting of a high defect of the ventricular septum, the aorta overriding the defect and dilatation of the pulmonary vessels, with an unobstructed pulmonary orifice.
TL;DR: The concept that glomerulonephritis, as seen clinically, is a manifestation of an antigen-antibody reaction was first made by Schick 1 in 1907 and additional support was given when Masugi 3 succeeded in producing, experimentally, a clinical and morphologic picture identical with human glomeral tissue by injecting heterologous nephrotoxic serum.
Abstract: THE SUGGESTION that glomerulonephritis, as seen clinically, is a manifestation of an antigen-antibody reaction was first made by Schick 1 in 1907. This concept found some acceptance, although it was based at that time mostly on circumstantial evidence. Volhard 2 also emphasized and endeavored to prove this theory. Additional support was given the concept when Masugi 3 succeeded in producing, experimentally, a clinical and morphologic picture identical with human glomerulonephritis by injecting heterologous nephrotoxic serum. Masugi believed that the glomerulonephritis thus produced in animals was caused directly by the union of the injected antibody with the glomerular tissue, which acted as a fixed antigen. Kay, 4 however, has suggested that a more complicated system is involved in the pathogenesis of nephrotoxic nephritis, since the signs of nephritis do not appear immediately upon injection of the nephrotoxic serum but only after an interval of several days. The experiments of Masugi and
TL;DR: Improvement after corticotrophin therapy has been seen in a number of cases of acute leukemia, with "complete" temporary remissions in some.
Abstract: SINCE the discovery that corticotrophin (ACTH) and cortisone exert beneficial effects on a wide variety of disease processes which had not been considered previously to be primarily hormonal in nature, a number of patients with disorders of the blood have been treated with these agents. This report describes our own studies in 40 cases. A preliminary report of the observations on 24 of these cases has been published. 1 It is now well known that lymphopenia and neutrophilia develop in experimental animals 2 and in man 3 after administration of corticotrophin. The reduction in circulating eosinophils which follows administration of corticotrophin has been used as a test for adrenal-cortical insufficiency. 4 Alterations have also been produced by corticotrophin and cortisone in various disease processes involving the leucocytes. Thus, improvement after corticotrophin therapy has been seen in a number of cases of acute leukemia, with "complete" temporary remissions in some. Improvement
TL;DR: In the many reviews published during the last 15 years the diagnostic features mentioned above have always been emphasized, together with the often dramatic results following splenectomy, and the natural course of the disease has been discussed in relatively few publications.
Abstract: THE CONDITION first recorded by Werlhof1and now known as "idiopathic," "essential," or "primary" thrombocytopenic purpura is usually described as a disease of unknown causation characterized by such hemorrhagic manifestations as purpura, bleeding from the mucous membranes, thrombocytopenia, a prolonged bleeding time, and failure of the clot to retract, in the absence of an underlying disease known to lead to thrombocytopenia. In the many reviews published during the last 15 years the diagnostic features mentioned above have always been emphasized, together with the often dramatic results following splenectomy.2On the other hand, the natural course of the disease has been discussed in relatively few publications,3in spite of the fact that the tendency to remissions and relapses is well recognized. Although chronic mild hemorrhagic symptoms are mentioned, one usually gains the impression that while one attack of thrombocytopenic purpura leaves the patient subject to further attacks the
TL;DR: A group of 15 patients with hemochromatosis was taken to study and assess case records and pathological material available on a further eight patients and found that little need be added, on the clinical side, to his description of the disease.
Abstract: IN THE study of a rare disease it is unusual for one group of investigators to be able to see personally a large series of cases. The occasion of the visit of one of us (T. L. A.) to Melbourne, Australia, was taken to study a group of 15 patients with hemochromatosis (13 men and 2 women) and to assess case records and pathological material available on a further eight patients (7 men and 1 woman). All the patients had been seen at the Clinical Research Unit of the Walter and Eliza Hall Institute and the Royal Melbourne Hospital in the last three and one-half years. As a basis for this study we took the excellent monograph on hemochromatosis by Sheldon 1 and found that little need be added, on the clinical side, to his description of the disease. But in the last few years advances have taken place in
TL;DR: During the past 20 years Foshay has studied "a score or more" of patients, but his attempts at elucidating the etiology were unrewarding, and he has not reported his work.
Abstract: INCIDENT to his studies on tularemia in 1932, Dr. Lee Foshay1in Cincinnati first recognized a disease entity occurring in persons who had been scratched by or had had contact with cats. This illness was characterized by the appearance of an initial cutaneous lesion at the site of a scratch, followed by the development of regional lymphadenitis which frequently proceeded to suppuration. The aspirated pus was sterile, and serologic studies gave negative reaction for tularemia. During the past 20 years Foshay has studied "a score or more" of these patients, but his attempts at elucidating the etiology were unrewarding. He has not reported his work. In 1945, Dr. F. M. Hanger1in New York had a paronychia after gardening. There was a cat in the household, but Hanger had no history of scratch. Sterile suppurative regional adenitis associated with fever and constitutional symptoms ensued. An antigen prepared from
TL;DR: The absence of correlation between increased pulmonary arterial pressures and clinical evidence of pulmonary congestion in patients having mitral stenosis led Borden and associates to conclude that, in addition to the reflected high pressures in the left atrium, an anatomic obstructive factor existed in the pulmonary vascular tree.
Abstract: IN THE presence of structural obstruction to the free flow of blood from the lungs to the left ventricle, such as in classic mitral stenosis, proliferative thickening of the walls of the small arteries and arterioles occurs.1It has been conjectural whether such changes are coincidental findings related to high pressures in the left atrium and pulmonary artery or whether, in some unique way, they cause pulmonary hypertension in excess of the obstruction to venous outflow and at times protect the pulmonary capillaries against excessive pressures. The absence of correlation between increased pulmonary arterial pressures and clinical evidence of pulmonary congestion in patients having mitral stenosis led Borden and associates2to conclude that, in addition to the reflected high pressures in the left atrium, an anatomic obstructive factor existed in the pulmonary vascular tree. The absence of increased volume of pulmonary blood among patients with mitral stenosis, as
TL;DR: Aureomycin has attained great clinical significance because of its therapeutic activity against a wide bacterial spectrum, which includes a number of Gram-positive and Gram-negative organisms, and it appears to be highly specific against many members of the rickettsial group and some virus-like agents.
Abstract: AUREOMYCIN, isolated by Duggar in 1948,1is an antibiotic biosynthesized by the actinomycete, Streptomyces aureofaciens It has attained great clinical significance because of its therapeutic activity against a wide bacterial spectrum, which includes a number of Gram-positive and Gram-negative organisms, and it appears to be highly specific against many members of the rickettsial group and some virus-like agents The antibiotic is a yellow powder said to be soluble in distilled water and in 5% dextrose solution in distilled water Solutions in isotonic sodium chloride solution precipitate when a level of more than 1% of the drug is attained The aqueous solutions are acid and when neutralized or made alkaline deterioration of activity is rapid at room temperature After oral administration of a single dose of 05 gm, aureomycin appears in the urine in 1 hour and is detectable up to 16 hours, the peak concentration occurring between 2 and
TL;DR: It is claimed that any patient with epilepsy and rheumatoid arthritis may have systemic lupus erythematosus, and electroencephalographic evidence of this phenomenon is needed to support this contention.
Abstract: THE DISCOVERY of the L. E. (lupus erythematosus) phenomenon 1 in vivo 2 and in vitro 3 has provided accurate diagnostic procedures for acute disseminated lupus erythematosus. These tests have given consistently positive reactions in typical cases of lupus. Moreover, they have indicated that the disease may exist for varying lengths of time in previously unrecognized forms before entering into the final, familiar clinical picture. The present study was prompted by the observation of protracted grand mal epileptic attacks in six of 23 lupus patients with positive L. E. test reactions. In brief, it is our contention that any patient with epilepsy and rheumatoid arthritis may have systemic 4 lupus erythematosus. The association of convulsive seizures with lupus erythematosus has been noted in many case reports, though no specific reference devoted to a correlation of the two entities has been found in the literature. To our knowledge electroencephalographic evidence of
TL;DR: It was felt worth while to review the accumulated electrocardiographic records of the Equitable Life Assurance Society of the United States for bundle branch block to indicate that survival in the presence of this abnormality is considerably longer than was originally believed.
Abstract: BUNDLE branch block has long been regarded as an ominous electrocardiographic sign. Numerous instances have been reported of prolonged survival of subjects with bundle branch block, and several studies have indicated that survival in the presence of this abnormality is considerably longer than was originally believed. These studies, however, have varied widely in the number of subjects followed, the time interval over which they were followed and the statistical methods employed in calculating the results obtained.1They have in common the fact that they were derived from patient records from hospitals, outpatient departments and private practices. In view of the fact that no mortality study has as yet been published on a group of persons not under medical care at the time of discovery of the lesion, it was felt worth while to review the accumulated electrocardiographic records of the Equitable Life Assurance Society of the United States for
TL;DR: This study examined the adrenal glands of patients who had received pituitary adrenocorticotropic hormone and cortisone prior to death for the possibility of finding structural changes which might be interpreted as a morphologic expression of functional stimulation or depression of the Adrenal cortex.
Abstract: THE INCREASING availability of pituitary adrenocorticotropic hormone (ACTH) and cortisone for clinical use has afforded us the opportunity to examine the adrenal glands of patients who had received these preparations prior to death. The possibility of finding structural changes which might be interpreted as a morphologic expression of functional stimulation or depression of the adrenal cortex made this study of interest. In addition, information might be obtained through which alterations in the adrenal glands of man could be compared with the known morphologic patterns in the adrenal cortices of animals under varying experimental conditions. To appreciate the morphologic changes in the adrenal glands of patients studied in this series, it is necessary to review briefly the normal histologic pattern of lipid deposition in the human adrenal cortex. The greatest concentration of sudanophilic material is usually seen in the outer portion of the zona fasciculata, with a smaller amount in the
TL;DR: The granulomatous nature of brucellosis has been well known since the description of such lesions in the experimentally infected guinea pig by Fabyan (1912) and later Jaffe ( 1922) and other workers, and later von Albertini and Lieberherr (1937) presented in detail the changes occurring in the liver and spleen.
Abstract: HEPATIC involvement in brucellosis has been recognized since the original description of undulant fever as a distinct disease entity by Marston in 1859. 1 It was noted by Hughes (1897). 2 Cantaloube (1911) 3 stressed the frequency of liver involvement, reporting hepatomegaly in 10% of his cases. Centrolobular necrosis (Hardy and others, 1931 ) 4 of the liver in human brucellosis and even extensive destruction of liver parenchyma (Wohlwill, 1932) 5 have been described. The granulomatous nature of brucellosis has been well known since the description of such lesions in the experimentally infected guinea pig by Fabyan (1912) 6 and later Jaffe ( 1922) 7 and other workers. Loffler and von Albertini (1930) 8 described such lesions in human material, and later von Albertini and Lieberherr (1937) 9 reviewed the pathology of human brucellosis and presented in detail the changes occurring in the liver and spleen. Although but few English references have appeared, in the
TL;DR: The sensitivity of any given strain of organism to an antimicrobial agent is generally defined in terms of the concentration of the agent which inhibits the growth of the organism either partially or completely, or which kills the organisms within the time limit of the test.
Abstract: THE DETERMINATION of the sensitivity of bacteria to antibiotics in vitro has become a common laboratory procedure, the results of which are widely used in defining the range and relative efficacy of antibiotics against different microorganisms. The results of tests for sensitivity are also generally used in the management of the specific therapy of patients with bacterial infections. The sensitivity of any given strain of organism to an antimicrobial agent is generally defined in terms of the concentration of the agent which inhibits the growth of the organism either partially or completely, or which kills the organisms within the time limit of the test.1Several methods of determining this value are in common use, and the results obtained with any given strain by the different methods may show wide discrepancies, depending on the details of the method and the choice of the end point. This difficulty is well known
TL;DR: There has been some disagreement on the effect of high altitude on cardiac output, but apparently the changes are not as severe as previously thought.
Abstract: FOR MANY years there has been an intense interest in the adaptation of human beings to residence at high altitude. Numerous studies have been made of permanent residents of a mining district in Peru, where the altitude is 10,000 to 15,000 ft. (3,048 to 4,572 meters) above sea level. Residents of high altitude usually exhibit an increase in the hemoglobin content of the blood. 1 Moreover, with increasing altitude, and hence increasing anoxia, the elevation of the hemoglobin content of the blood becomes more marked. Anoxia also causes an increase in ventilation, with a resultant decline of the carbon dioxide tension in the alveoli and arterial blood. 2 The lowered carbon dioxide tension in the blood is compensated for by a decrease in bicarbonate, so that the blood pH remains normal. 3 There has been some disagreement on the effect of high altitude on cardiac output, but apparently the changes
TL;DR: Investigation of the possible toxic effects of aureomycin on the livers of mice and dogs suggested that mice tolerate aUREomycin well, and all the patients who displayed jaundice had received very large doses of a Aureomycin.
Abstract: DURING the course of clinical trials to determine the value of intravenous aureomycin therapy in various infections, we encountered several patients who exhibited jaundice, which, in some cases, was accompanied with pathologic changes in the liver. Our suspicions were aroused that the hepatic changes might be related to the administration of aureomycin because they did not appear to be the result of the disease for which the patient was being treated. Furthermore, all the patients who displayed jaundice had received very large doses of aureomycin. The details of these cases are reported in the preceding article in this issue. 1 As a result of those observations, we decided to investigate the possible toxic effects of aureomycin on the livers of mice and dogs. Several reports in the literature suggested that mice tolerate aureomycin well. Up to 200 mg. per kilogram of body weight per day given orally for eight weeks
TL;DR: This study examines the interrelations between the degree of stenosis, the presence of organic pulmonary vascular lesions, the occurrence of emboli, and rheumatic activity, and the manner in which cardiovascular breakdown and death occur in patients with mitral stenosis between January, 1945, and June, 1949.
Abstract: WITH THE development of surgical technics for the relief of mitral stenosis which promise to be both effective and not unreasonably hazardous, it has become important to reassess this syndrome in regard to various pathologic factors that may affect the clinical course of the disease and have a bearing on the selection of patients for operation. Among such factors, the interrelations between the degree of stenosis, the presence of organic pulmonary vascular lesions, the occurrence of emboli, and rheumatic activity, and the manner in which cardiovascular breakdown and death occur are important. This study was undertaken with these points in view. MATERIALS AND METHODS Cases studied were from the post-mortem files of the Mallory Institute of Pathology, of the Boston City Hospital, between January, 1945, and June, 1949, and include the autopsy and clinical records of all patients whose conditions was diagnosed at post-mortem examination during this period as rheumatic