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A multi-disciplinary expert group met to discuss vitamin D deficiency in the UK and strategies for improving population intakes and status. Changes to UK Government advice since the 1st Rank Forum on Vitamin D (2009) were discussed, including rationale for setting a reference nutrient intake (10 µg/d; 400 IU/d) for adults and children (4+ years). Current UK data show inadequate intakes among all age groups and high prevalence of low vitamin D status among specific groups (e.g. pregnant women and adolescent males/females). Evidence of widespread deficiency within some minority ethnic groups, resulting in nutritional rickets (particularly among Black and South Asian infants), raised particular concern. Latest data indicate that UK population vitamin D intakes and status reamain relatively unchanged since Government recommendations changed in 2016. Vitamin D food fortification was discussed as a potential strategy to increase population intakes. Data from dose–response and dietary modelling studies indicate dairy products, bread, hens’ eggs and some meats as potential fortification vehicles. Vitamin D3 appears more effective than vitamin D2 for raising serum 25-hydroxyvitamin D concentration, which has implications for choice of fortificant. Other considerations for successful fortification strategies include: (i) need for ‘real-world’ cost information for use in modelling work; (ii) supportive food legislation; (iii) improved consumer and health professional understanding of vitamin D’s importance; (iv) clinical consequences of inadequate vitamin D status and (v) consistent communication of Government advice across health/social care professions, and via the food industry. These areas urgently require further research to enable universal improvement in vitamin D intakes and status in the UK population.

This review aims to explore trends of early consumption of sugar-sweetened beverages (SSB) in sub-Saharan Africa (SSA), within the context of growing child and adolescent obesity and escalating type-2 diabetes prevalence. We explore efforts to mitigate these, drawing on examples from Africa and elsewhere. SSB, including carbonated drinks and fruit juices, play a contributory role in the development of obesity and associated non-communicable diseases (NCD). SSA is an attractive market for beverage companies owing to its rapid economic growth, growing middle class and youthful populations. SSB already contribute significantly to total sugar and energy consumption in SSA where a plethora of marketing techniques targeted at younger people are utilised to ensure brand recognition and influence purchasing and brand loyalty. Coupled with a general lack of nutrition knowledge or engagement with preventative health, this can lead to frequent consumption of sugary drinks at a young age. Public health efforts in many high income and some middle-income countries address increasing prevalence of obesity and type-2 diabetes by focusing on strategies to encourage reduction in sugar consumption via health policy and public education campaigns. However, similar efforts are not as developed or forthcoming in low-income countries. Health care systems across SSA are ill-prepared to cope with epidemic proportions of NCD, particularly when contextualised with the ongoing battle with infectious diseases. We conclude that greater efforts by governments and the nutrition community to educate the public on the health effects of increased and excessive consumption of SSB are necessary to help address this issue.

Background High sugar consumption contributes to the global obesity epidemic. Sugar-sweetened beverages (SSBs) constitute a significant proportion of sugar consumption and are independently associated with non-communicable diseases. Some equivocal evidence indicates the influence of marketing on sugary food and drink sales and consumption. However, little research has explored this relationship for SSBs, among adult samples, or using diverse marketing exposures. There are no cross-country comparisons of this relationship. Aim We aim to answer: Does SSB consumption vary according to self–reported exposure to sugary drink marketing? Does the relationship between SSB consumption and self–reported exposure to sugary drink marketing vary by country? Methods We analysed data from the 2017 International Food Policy Study (IFPS), a cross-sectional, online survey that sampled adults aged 18 to 64 years in Australia (n=3,767), UK (n=4,047), Mexico (n=4,057), USA (n=4,868), and Canada (n=2,139; aged 31 to 64 years). Surveys covered eating patterns, food environments, purchasing, knowledge of and attitudes to a range of policy measures. This included a seven-day Beverage Frequency Questionnaire. Dependent (SSB consumption) and independent variables (amount of self-reported sugary drinks marketing exposure) were computed, and potential confounders identified. A multinomial logistic regression model examined relative odds of non-, low- or high- weekly SSB consumption by marketing exposure, country, sex, age, and work status. The same model was reconstructed with interaction between marketing exposure and country, and a log likelihood test was used to compare the models. Results SSB consumption varied according to self-reported exposure to sugary drinks marketing. 57% of respondents consumed SSBs, and 72% self-reported exposure to sugary drinks marketing. Compared to those reporting no sugary drinks marketing exposure, those reporting greater exposure were more likely to have low- than no-SSB consumption and more likely to have high- than no-SSB consumption (ps Discussion SSB consumption was positively associated self-reported exposure to sugary drinks marketing in all countries, but this relationship varied by country. These analyses are cross-sectional, but the IFPS panel will be re-contacted annually enabling future longitudinal analyses. Improving understanding of the influence of marketing on SSB consumption could help policymakers to augment current strategies to reduce SSB consumption.

Age-related skeletal muscle loss, sarcopenia, cachexia and wider malnutrition (under nutrition) are complex in aetiology with interaction of clinical, social and economic factors. Weight loss and loss of skeletal muscle mass in older people are associated with increased morbidity and mortality with implications for increasing health and social care costs. There is insufficient evidence to identify the ideal treatment options. However, preventing weight loss and loss of skeletal muscle in older age will be keys to reducing morbidity and mortality. This will require all those coming into contact with older people to identify and address weight loss early, including through diet, improving physical activity and increasing social interaction. Public health messages on diet should, in the main, continue to focus on older people achieving current UK dietary recommendations for their age as visually depicted in the eatwell plate together with associated messages regarding dietary supplements where appropriate.

Excerpt CASE REPORT J. G., white male, aged 12 years, was admitted on December 10, 1944 with a chief complaint of generalized swelling. Nine days previously the patient had developed a "cold" which...

Fluorine-19 nuclear magnetic resonance (NMR) studies of cells and perfused organs loaded with fluorinated ion chelators represent a new approach to determining cytosolic free calcium levels in situ. The molecular basis for this approach and the relative advantages and disadvantages of the NMR technique are discussed in this paper. Results obtained on perfused normoxic and ischemic rat hearts are presented, indicating that ischemia is associated with an elevation in the level of cytosolic free calcium before the onset of irreversible cell injury. The results are therefore consistent with this elevation playing a causative role in the mediation of myocardial cell injury resulting from ischemia.

Although multiplication of Mycobacterium leprae in the foot pads of immune-competent mice is limited, and no leprosy-like lesions are produced in these animals, the mouse foot-pad system represents the first truly useful and reproducible animal model of M. leprae infection. Its employment has enabled research into basic questions with respect to the microbiology of M. leprae, and the epidemiology, treatment and control of leprosy. The mouse foot-pad technique is labour-intensive and time-consuming, and is expensive in terms of the costs of animal purchase and maintenance. In addition, the technique appears to be rather imprecise and insensitive, compared with the techniques employed in working with cultivable micro-organisms. For these reasons, and also as a by-product of the success of multi-drug therapy, the technique has been abandoned in many research centres. Nevertheless, until a more simple and sensitive technique for demonstrating the viability of M. leprae is developed, the mouse foot-pad system remains an essential tool for leprosy research. In this review, we discuss the mouse foot-pad technique in detail, analyse its precision, point out its shortcomings, describe its most important applications, and prescribe a method by which to assess the ability of an alternative technique to serve in place of this established technique.

124 Background: Despite the Institute of Medicine’s recommendation that all cancer survivors be provided with a survivorship care plan (SCP), there is limited information as to whether SCPs improve knowledge. The purpose of this study was to examine the impact of SCPs on patient knowledge regarding tumor stage, cancer treatment and potential risk of long-term side effects, surveillance recommendations, and perceived knowledge of their therapy. Methods: 75 English-speaking women over the age of 18 were enrolled in this prospective study. The participants’ treatment progress was tracked through the electronic medical record and used to create the SCP, which was given to them at the completion of treatment (defined as the time patients had completed radiation and/or chemotherapy treatments and initiated on hormonal therapy, if applicable). Knowledge of stage, treatments, potential side effects, and surveillance recommendations were assessed before receiving the SCP and again two months later. Accuracy of responses was compared using the McNemar test. Results: The median patient age was 56.8 ± 12.5 and 47.1% were stage I, 37.3% were stage II, and 15.7% were stage III. Participants were statistically more accurate in identifying their stage after receiving their SCP than at baseline (72.6% vs. 92.2%, p = 0.0016). While many patients were more accurate in the identification of the cancer treatment they received after SCP, the only significant improvement was in identifying 5-Fluorouracil as chemotherapy received (65.5% vs. 89.7%, p=0.0196). Patients were more accurate in identifying potential side effects but were only statistically more accurate at identifying leukemia as a risk factor (36.0% vs. 46.9%, p=0.0348). At baseline and follow up patients perceived that they had a high level of understanding as it related to their cancer stage (60.4%, and 66.7%), treatment (69.4%, and 71.4%), and surveillance recommendations (61.4%, and 54.6%). Conclusions: SCPs appear to improve patient knowledge in several important areas including basic and specific treatment details, surveillance recommendations, and potential side effects. Delivery of a SCPs is one strategy to improve knowledge of treatments received.

Tyrosinemia type I, the most severe disease of the tyrosine catabolic pathway is caused by a deficiency in fumarylacetoacetate hydrolase (FAH). A patient showing few of the symptoms associated with the disease, was found to be a compound heterozygote for a splice mutation, IVS6-1g->t, and a putative missense mutation, Q279R. Analysis of FAH expression in liver sections obtained after resection for hepatocellular carcinoma revealed a mosaic pattern of expression. No FAH was found in tumor regions while a healthy region contained enzyme-expressing nodules. Analysis of DNA from a FAH expressing region showed that the expression of the protein was due to correction of the Q279R mutation. RT-PCR was used to assess if Q279R RNA was produced in the liver cells and in fibroblasts from the patient. Normal mRNA was found in the liver region where the mutation had reverted while splicing intermediates were found in non-expressing regions suggesting that the Q279R mutation acted as a splicing mutation in vivo. Sequence of transcripts showed skipping of exon 8 alone or together with exon 9. Using minigenes in transfection assays, the Q279R mutation was shown to induce skipping of exon 9 when placed in a constitutive splicing environment. These data suggest that the putative missense mutation Q279R in the FAH gene acts as a splicing mutation in vivo. Moreover FAH expression can be partially restored in certain liver cells as a result of a reversion of the Q279R mutation and expansion of the corrected cells.

In the course of a clinical trial of acedapsone therapy in 17 patients with lepromatous leprosy, the rate of response to therapy was measured by inoculation of mice with Mycobacterium leprae recovered from biopsy specimens of skin lesions obtained before treatment and at intervals of 4, 12, and 24 weeks after institution of treatment. The susceptibility of each isolate of M. leprae to dapsone (4,4′-diaminodiphenylsulfone [DDS]) was measured by passaging organisms that had multiplied in mice to new groups of untreated mice and to mice treated with DDS incorporated in the mouse chow in concentrations of 10 −5 , 3 × 10 −5 , and 10 −4 g/100 ml. The rate of response to acedapsone therapy and the susceptibility of patient strains of M. leprae to DDS varied widely among patients. All isolates were inhibited from multiplication by treatment of mice with 10 −4 g of DDS per 100 ml; all but two isolates were susceptible to 3 × 10 −5 g of DDS per 100 ml; and 17 of 36 isolates, representing nine patient strains, were susceptible to 10 −5 g of DDS per 100 ml. Plasma levels of DDS measured in the mice administered these diets show that the minimal inhibitory concentration of DDS for M. leprae isolated from untreated patients is about 3 ng/ml. No relationship could be demonstrated between DDS susceptibility of pretreatment isolates of M. leprae and the rate at which patients responded to acedapsone therapy. Neither acedapsone treatment of patients nor DDS treatment of mice appeared to select genotypically more resistant M. leprae .

In 22 lepromatous Filipino patients receiving their first injection of 225 mg acedapsone (DADDS), dapsone (DDS), and monoacetyl DDS (MADDS) were present in plasma in approximately equal quantities. Peak levels of parent drug, DDS, and MADDS occurred between 22 and 35 days. The half-times of disappearance (T1/2) from plasma were 43 days for DDS and MADDS and 46 days for DADDS. Acetylator phenotyping with sulfamethazine (SMZ) and DDS showed that 17 patients were rapid and 5 patients were slow acetylators. Correlations between acetylation of SMZ and DDS after DDS and of acetylation of DDS after DDS and DADDS were highly significant. However, acetylation of DDS after DADDS did not differentiate the patients into acetylator phenotypes. The T1/2 of DDS after DDS in the patients was directly related to the minimum levels of DDS at 77 days after DADDS treatment. These minimum levels were 8-fold higher than the minimum inhibitory concentration (MIC) of DDS for Mycobacterium leprae in mice and rats, but not all patients responded satisfactorily. No relationship could be demonstrated between the bacteriologic response and any of the pharmacologic parameters examined in these Filipino patients. In a companion study, minimum levels of DADDS, MADDS, and DDS were determined in 447 leprosy patients of all disease types from the Karimui District of Papua New Guinea who had been receiving 225 mg DADDS every 70 to 80 days for the past 5 years. All patients exhibited DDS levels above the MIC of DDS for M. leprae, no significant differences in plasma sulfone levels were found among disease types, no relationship between rate of healing in paucibacillary patients and sulfone levels were found, and type of response in multibacillary patients and sulfone levels were unrelated. No substantial accumulation of the sulfones in the Karimui patients receiving continuous therapy with DADDS for 5 years was indicated from a comparison with the levels in the Filipino patients following a single injection of DADDS.

A pharmacologic study of clofazimine (B663) was carried out in mice and human subjects to provide information needed for interpretation of data from studies of drug action in the two species. The quantities of B663 in mouse carcasses were measured to determine the half-time of disappearance (t ½) of the drug and the absorption of the drug after oral administration. The antimicrobial activity of orally-administered B663 was studied in mice infected with Mycobacterium leprae and correlated with the quantity of B663 in the carcass. Published studies of the effect of the drug in murine infections with M. leprae and M. tuberculosis were reinterpreted. The t ½ of B663 is about 1 week in male BALB/c mice. The antimicrobial effect of the drug appears to require a concentration in the mouse carcass smaller than 1 mg/kg for M. leprae and greater than 5 to 10 mg/kg for M. tuberculosis. The concentration of B663 was also measured in the plasma, urine and feces of volunteers and leprosy patients. The t ½ of the drug is at least 70 days in man. The disposition of the drug thus differs greatly between the two species, making difficult the transfer of information from laboratory to clinic.

Dapsone (4,4′-diaminodiphenylsulfone), incorporated into the mouse chow in a concentration of 0.1 g/100 g of diet, was administered for 1 week to mice in which Mycobacterium leprae had multiplied to the level of 10 6 organisms/footpad. M. leprae were harvested from these and also from control mice, diluted serially, and inoculated into additional mice. The organisms recovered from untreated mice multiplied in passage with a mean doubling time of 12.2 days, and 35% or more of the inoculated organisms were viable, i.e., capable of infecting mice. Growth curves of M. leprae recovered from dapsone-treated animals lagged behind those of organisms from control animals by an average of 78 days, equivalent to 98.8% killing. Foot-by-foot harvests showed that only 0.2% of the M. leprae recovered from treated mice were viable, suggesting that treatment of mice with dapsone had been accompanied by killing of 99.4% of the viable M. leprae .

The Field effect is the decreased biological response to a second challenge in the graft versus host reaction (GvHR). Treatment of recipeint rats or mice during the initial GvHR by methotrexate or cyclophosphamide effected the secondary unresponsivienss. Methotrexate and cyclophosphamide demonstrated different temporal responses indicating different mechanisms of their immunosuppresdive activities.

Rifampin was rapidly bactericidal for Mycobacterium leprae. Leprosy responds very slowly to current therapy, so there is a special need for more rapidly effective drugs. In mice rifampin exerted a bactericidal-type effect with single administration by gavage; the effect increased with dosage in the range 10 to 40 mg/kg of body weight. Five patients with lepromatous disease were treated with 600 mg rifampin daily, and the viability of the bacilli in their skin lesions was tested by inoculation of mice. Infectivity for mice had completely disappeared in the 1st specimen collected after the start of therapy—at 7 days in 4 patients and 14 days in 1. In 4 control patients treated with dapsone, infectivity for mice was lost much more slowly and in 1 was still present, though decreased, 112 days after the start of treatment. The slower loss of infectivity with dapsone is in accord with our previous experience in which the same methods were used.

Perforation of the interventricular septum due to subacute bacterial endocarditis is a rare condition. 1,2 Wilson 3 reported three cases of mycotic aneurysm with perforation of the interventricular septum complicating subacute bacterial endocarditis. The purpose of this paper is to present a case of subacute bacterial endocarditis complicated by perforation of the interventricular septum diagnosed during life and confirmed at post-mortem examination.

Percutaneous insertion of myocardial electrodes and electrical pacing were employed in the treatment of ten patients with A-V block complicating myocardial infarcts. The technique of wire insertion is given and representatives cases are described. Prognosis in such cases is dependent primarily on the extent of cardiac damage produced by the infarction, but electrical pacing will complement the usual therapeutic regimen.

A comparison of 47 patients having proven myocardial infarction with a group of 50 patients having no evidence of coronary disease failed to show a difference in serum Mg levels between the two groups. Further analysis showed no correlation between the levels of serum magnesium and serum cholesterol or triglyceride. The literature is reviewed and apparent conflicts in results are considered. There is some basis for believing that a relationship exists between Mg and atherogenesis, but it would appear that approaches to the question to date have not been sufficiently thorough. The advent of atomic-absorption spectrophotometry should make possible more-accurate and -dependable Mg determinations in the future.

1.1. Spirometric studies were performed on ten patients with moderately acute attacks of asthma prior to and for one hour following the administration of 2 mg. of butanefrine. 2.2. There was a uniform response characterized by a combination of increase in vital capacity, reserve air, complemental air, expiratory differential, and an initial increase in the volume of minute ventilation with a tendency to return toward the initial volume one hour after the administration of butane-frine. 3.3. There was an increase in the heart rate, a lowering of the diastolic blood pressure, and an absence of side-effects following the injection of butanefrine. 4.4. Eight patients obtained complete symptomatic and objective relief. Two patients required additional medication.

Summario in Interlingua Per medio del methodo del analyse del via del unda de accession, disveloppate in 1943 per Gardberg e Ashman, le autores ha analysate le alterationes electrocardiographic del complexo QRS post infarcimento myocardial in areas posterior, lateral, septal, anterior, e combinatemente ventricular. Le effectos del varie positiones electrocardiographic del corde super le resultante alterationes del complexo QRS post infarcimento myocardial es presentate graphicamente. Electrocardiogrammas illustrative es includite. Omne le patientes del presente serie esseva electrocardiographate ante le infarcimento myocardial. Assi un comparation de electiocardiogrammas pre- e post-infarcimental es possibile. Le remanente parte del reporto consiste de remarcas in re (1) methodos de registration electrocardiographic (includente varie systemas empleate in vectocardiographia spatial), (2) le importantia de prender in consideration le effectos de eccentricitate, (3) le potential del terminal commun, e (4) le inadequatia del uso de representation dipolic in certe situationes. Nos conclude que al tempore presente il non existe un methodo satisfacente pro le correction de errores de eccentricitate.

Patients with previously untreated lepromatous leprosy were treated by injections of acedapsone (DADDS), a repository sulfone given at 77-day intervals. The response to therapy was evaluated primarily by the results of inoculation of mice with Mycobacterium leprae from serially obtained skin punch biopsy specimens. In 3 of 10 patients, infectivity for mice was lost in less than 100 days; in the others the infectivity was lost more slowly, and in the slowest more than 300 days were required. The results were compared with those in 14 patients treated with dapsone (DDS) in dosages of 50 mg daily; in 12 of these, infectivity of the bacilli was not demonstrable after 100 days. Tests of the M. leprae isolates for DDS-sensitivity in mice showed that drug-resistance, in the usual sense, was not involved in the slower loss of infectivity. The implications of this slower response for the long-term therapeutic response to acedapsone are not yet clear.

Of 25 dapsone derivatives and analogs screened for activity against Mycobacterium leprae in the mouse footpad system, only 7 were active. All seven were metabolized to or contaminated with dapsone.

There is strong evidence that chronic ingestion of cadmium results in tubulointerstitial nephritis with a Fanconi-type syndrome in both humans and animals (2,4). There are fewer reports of glomerulonephritis associated with cadmium exposure (1–4) . Those reports that mention glomerular damage usually attribute it to autoantibody production against tissue damaged by cadmium (1,2,4). Our laboratory has accumulated evidence that chronic cadmium ingestion can inhibit clearance of immune complexes by the mononuclear phagocytic system of mice. Such abnormalities may allow the persistence of soluble antigen antibody complexes in the circulation which in turn might lead to greater deposition of the complexes in the glomeruli of the kidney and possibly other sites potentially injurious to organ function.

SummaryA new broad-spectrum antimicrobial, 2-amino-5-(l-methyl-5-nitro-2-imi-dazolyl)-1,3,4-thiadiazole, reported inactive against Mycobacterium tuberculosis, inhibited multiplication of M. leprae in the mouse foot pad when administered orally to the mice. The dose-response curve was very steep: 0.2 g% of the drug exhibited considerable activity, whereas 0.05 g% was only modestly active in one experiment and inactive in another. This drug appears to be one of the few that is bactericidal for M. leprae.This work was partially supported by the U. S. Leprosy Panel of the U. S.-Japan Cooperative Medical Science Program administered by the Geographic Medicine Branch, National Institute of Allergy and Infectious Diseases (Grant R 22 AI 07801). Supplies of 2-amino-5-(l-methyl-5-nitro-2-imidazolyl)-1,3,4-thiadi-azole were generously furnished by Lederle Laboratories, Pearl River, New York.

Methotrexate administered to rats undergoing a local graft-versus-host reaction (GvHR) had two quite distinct effects on the lymphoid hypertrophy, that characterizes the GvHR, depending upon the timing of the drug administration

Mice exhibiting a spontaneous SLE-like lethal autoimmunity (female NZB/W hybrids) were given monthly doses of cyclophosphamide (CPA) 240 mg/kg p.o. starting at four months of age. Antibodies to DNA and sheep red blood cells (SRBC) were measured as well as general well being of the mice. The CPA-treated group demonstrated a marked increased in survival compared to the untreated controls with reduction of anti-DNA antibody levels but only a slight inhibition of the anamnestic response to SRBC immunization.

The effect of rifampin therapy in leprosy was studied in two clinical short-term trials in which skin punch biopsy specimens were taken at regular intervals for the inoculation of mice in order to monitor the decrease in proportion of viable Mycobacterium leprae in the patients' lesions. In a trial of rifampin in a dosage of 600 mg daily, the bacterial viability fell to undetectable levels in the first specimen taken after the start of therapy (at 3–4 days in 4 patients, 7–8 days in 9, and 14 days in 2). Dapsone-treated controls required 20 to more than 112 days for the same change. In a trial of a single dose of 1,500 mg rifampin, the viability fell to undetectable levels in the first specimen taken after the start of therapy also (at 3–5 days in all 14 patients).

To define the minimal inhibitory concentration (MIC) of dapsone (DDS) for Mycobacterium leprae in rats, we determined the relationship between dietary and plasma levels of DDS in uninfected male and female Lewis rats. This knowledge was applied to the design of experiments using rats inoculated in the footpads with M. leprae . The MIC for DDS in male and female rats, respectively, was 1.5 to 4.0 ng and 1.8 to 3.0 ng of DDS/ml of plasma, even though the sexes exhibited markedly different concentrations of DDS when receiving the same dietary level of DDS. These values for the MIC of DDS for M. leprae in rats are nearly identical to the previously determined MIC of DDS for M. leprae in mice.

1.1. Spirometric studies were performed on sixteen patients, thirty minutes and one hour following the administration of 100 mg. of benadryl orally. 2.2. When compared with the initial spirometric tracings, no consistent changes were noted in the vital capacity, tidal air, minute ventilation, expiratory differential, respiratory rate, or degree of emphysema following benadryl. 3.3. Following the administration of epinephrine and aminophylline to five of these sixteen patients, there was a uniform increase in the vital capacity, tidal air, minute ventilation, expiratory differential, and no increase in the respiratory rate. 4.4. Six of the patients derived subjective benefit with decrease in dyspnea following the use of benadryl. In three of these, spirometric data were directly opposed to the subjective report. In one case the same response was obtained as found after the administration of epinephrine and aminophylline.

A new pharmacological method for screening potential immunosuppressive drugs, the local graft-versus-host reaction in rats, has been used to evaluate the efficacy of cyclophosphamide applied at varous times in the development of this reaction.

With the increased utilization of angiocardiography as a diagnostic procedure, many new routes of administration of iodopyracet concentrated solution1have been introduced to obtain more satisfactory pictures. The purpose of this report is to demonstrate a simple route of injection when the superior vena cava is obstructed. In this situation visualization of the cardiac chambers and great vessels cannot be obtained by injecting iodopyracet into the usual site, i. e., veins in the antecubital region. A. L., a 54-year-old Negro, was admitted on Oct. 3, 1949, because of a superior mediastinal obstruction that produced paralysis of the vocal cords, partial obstruction of the trachea and esophagus, right periocular edema, and cervical lymphadenopathy. Kolmer's test was positive; microscopic study of a cervical node showed tuberculous lymphadenitis; acid-fast stains were positive. Venous pressure was 240 mm. of water in the left arm and 195 mm. of water in the right arm.

During the last two decades, the literature on atherosclerosis has become overwhelming. Not only have there been many original scientific contributions, but the subject has been discussed extensively in review articles and books. The pathology observed in human coronary atherosclerosis appears to be unique but does bear some resemblance to certain phases of both induced and spontaneous atherosclerosis in animals. Factors that appear to contribute to both human and animal vascular derangement embrace a wide diversity of stimuli. Dietary components such as lipids have been, and still are, fashionable as pathogenic agents [1]. There is a strong school of thought that believes the early formation of thrombi is of paramount importance in the human disease [2]. The rheologists believe that the turbulence and flow through vessels of certain sizes contribute profoundly to the pathogenesis of atherosclerosis [3]. Other investigators believe that prospective coronary artery disease patients can be found using personality test interviews [4]. Correlations have been found relating coronary heart disease with hypertension, obesity, cigarette smoking, circulating catecholamines, and heredity [5]. It is obvious from the numerous studies by reputable investigators that the formation of the ultimate vascular change called “atheroma” is probably a common result of a variety of stimuli. Not only do these multiple etiologic factors have a similar pathologic manifestation, but also there must be a receptive vessel in an appropriately receptive individual for the formation of an atheromatous lesion.

Summary Lepromatous-leprosy patients entering treatment with DDS were followed by repeated biopsies of skin lesions. The bacilli in the specimens were counted, scored for solid staining, and their infectiousness tested by inoculation of mice. Some of the patients were also followed by nasal washings. The infectiousness for mice decreased in the first 30 days, and was only barely detectable at 30 to 90 days, after which it was not detectable. In the range where it could be determined accurately the proportion of solidly staining bacilli decreased in parallel with the infectiousness. The number of bacilli in the skin specimens decreased much more slowly during the period of observation (the first 300 to 400 days of treatment). The rate of loss was estimated to average 0.93 log10 units (8.5-fold) per year. As observed previously, the number of bacilli in the nasal washings decreased more rapidly than the number of bacilli in the skin. The infectiousness of the nasal bacilli fell at about the same rate as that of the skin bacilli.

ONE OF THE therapeutically reversible acute complications of recent myocardial infarction is the development of complete heart block. When the heart rate falls below 25 to 30 beats per minute, syncopal or convulsive seizures develop accompanied by the clinical picture of shock. This emergency requires immediate therapy not only for survival, but to prevent cerebral, cardiac, and renal complications resulting from repeated episodes of inadequate circulation. In the above situation we have employed a procedure similar to that described by Dr. C. W. Lillehei 1 for therapy of heart block complicating surgical repair of ventricular septal defects. The procedure consists of inserting a No. 18 spinal needle into the right ventricular cavity by puncturing the chest wall just medial to the point of maximal impulse and directing the needle superiorly and medially toward the second right costochondral junction. Then a No. 26 stainless steel wire is passed through the needle

Twelve cases are presented with electrocardiograms showing a prominent R wave and decrease in amplitude of the S wave in Lead V 1 due to myocardial infarction disturbing the normal opposing electromotive forces which cause a deep S wave in Lead V 1 .

IN TYROSINEMIA or tyrosinosis1the main clinical features are multiple renal tubular defects as in the typical de ToniDebre Fanconi syndrome and nodular cirrhosis of the liver.1,2,3Thrombocytopenia and increased pigmentation of the skin may be other characteristics. Slight mental retardation has been found in some of the patients.1There are no particular neurologic abnormalities. Abdominal distension, rickets resistant to ordinary doses of vitamin D, or both have been the presenting symptoms at ages ranging between a few months and 4 years. The prognosis is variable. The disorder may cause death in early infancy, but some patients have also reached adult age. The causes of death have been liver failure or an acute water and electrolyte crisis due to the renal tubular defects. Biochemically, the condition which probably is inherited as an autosomal recessive gene is characterized by hypertyrosinemia and the urinary excretion of large amounts of

1. 1. A case of pulmonary valvular stenosis with patency of the foramen ovale is reported. 2. 2. Prolonged retention of the contrast medium in the right ventricle on angiocardiography and marked disparity between the right ventricular and systemic arterial systolic pressures were observed. These signs in a subject with a right-to-left shunt and pulmonic stenosis are presumably pathognomonic of an intact ventricular septum and patent atrial septum. 3. 3. A fall in blood oxygen content, detected when the catheter was passed into the pulmonary artery, is believed to represent an increase in the right-to-left shunt consequent to obturation of the stenosed pulmonary valve by the catheter. From the magnitude of the change in blood oxygen content, the probable flow of blood through the atrial defect, through the pulmonary valve, and through extracardiac precapillary collaterals to the lungs has been calculated.

Excerpt This work was undertaken to evaluate venous pressure measurements in diagnosis of cirrhosis of the liver. Only patients with classical clinical manifestations of cirrhosis were included in ...

Recently hexamethonium compounds have been widely utilized in this country for the therapy of hypertension. Hexamethonium compounds are anticholinergic drugs that block sympathetic and parasympathetic ganglions of the autonomic nervous system. Side-effects from these compounds are a result of parasympatholytic effects resulting in obstipation, ileus, blurred vision, dryness of the mouth, and urinary retention, and sympatholytic effects resulting in severe hypotension with possible exacerbation or precipitation of cerebral, cardiac, or renal damage. The purpose of this report is to present three cases that will emphasize the prolonged hypotensive reaction that may result from the oral administration of hexamethonium compounds. REPORT OF CASES Case 1.— A 48-year-old Negro woman was first seen at Charity Hospital outpatient department in April, 1952. A few days before, she had been seen in another department, with a chief complaint of weakness, visual blurring of three weeks' duration, and a history of hypertension for six years.

The morphologic appearance of Mycobacterium leprae in acid-fast stained sections of skin biopsy specimens from patients with lepromatous leprosy has been found to correlate well with the infectivity of the specimen for the mouse. Viable M leprae were demonstrated in 15 of the 16 patients with previously untreated lepromatous leprosy. Ten of 38 specimens obtained early in the course of dapsone therapy of previously untreated patients were found to contain viable M leprae ; and the viability of the organisms was found to be much reduced in five of these ten specimens. By contrast, of 15 specimens obtained during dapsone therapy from five patients prove to harbor dapsone-resistant M leprae ; 14 were demonstrated unequivocally to contain viable organisms.

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