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, , 417-420. In the west of Scotland 20 of 40 farmers surveyed had symptoms of farmer's lung. Ten of this group (50%) gave positive precipitin reactions to The fluorescent antibody test was positive in all those with symptoms and also in one who had no clinical evidence of farmer's lung. There was a close relationship between evidence of sensitization to in the serum, demonstrated by the fluorescent antibody test, and the presence of symptoms compatible with farmer's lung. This test may detect the disease in milder form than is possible by conventional precipitin tests and this study confirms the value of this more sensitive technique as a screening procedure. [ABSTRACT FROM PUBLISHER]

A 10-month-old female infant with purpura fulminans is reported. The patient had clotting abnormality compatible with consumption coagulopathy. Histopathological examination revealed the presence of microthrombi. Heparin was effective in correcting the clotting defects. The infant also suffered from microangiopathic haemolytic anaemia. She died 17 days after the onset of the illness from infection in spite of antibiotic therapy. [ABSTRACT FROM PUBLISHER]

No generally accepted clinical classification of acute infective respiratory illness in children exists. In this survey the clinicians accepted in advance an agreed classification using traditional categories based on the part of the respiratory tract most severely affected. The standardized recording of individual symptoms provided a measure of their frequency in each category and made possible a simple quantitative revision of the initial subjective classification. We believe this classification could help family doctors and paediatricians, provide a sharper tool for epidemiological studies in home and hospital, and improve communication between those studying these disorders in different communities. [ABSTRACT FROM PUBLISHER]

Two collaborative studies of acute respiratory disease were organized, one in patients seen in general practice and the other in children admitted to hospital. The main aims were to study the epidemiology and clinical presentation of these diseases and of the viruses associated with them. The field methods used are described and analyses of the consultation rates in general practice and of hospital admissions in children are presented. Both consultations and admissions were most frequent by far in very young children, especially those under the age of 1 year, but the pattern of incidence for the various clinical categories differed with age. Lower respiratory illnesses were relatively much more frequent in infants and in adults over 65 than in intermediate age groups. Seasonal variations were slight for most upper respiratory tract conditions but pronounced for lower respiratory illnesses, especially bronchiolitis of infants which was epidemic each winter, and for influenza. Changes in the initial diagnosis in patients seen in general practice did not greatly influence the total morbidity pattern but the final diagnoses showed a substantial proportional increase in the number of cases of lower respiratory illness. The shortcomings of the field methods and clinical records available for use in the study and the reliability of the results are discussed. [ABSTRACT FROM PUBLISHER]

The effect of a 30 day course of corticotrophin gelatin injections on the natural history of acute unilateral optic neuritis in 27 patients is reported. A further 27 patients received inert injections in a double-blind control. Measurements were made on visual acuity, visual field, macular threshold, and colour vision, and the development of optic atrophy and other neurological episodes was recorded. No significant differences were found between treated and control groups at intervals up to two years from the start of the trial. The criteria for inclusion of patients are given and it is concluded that corticotrophin has no effect on the natural history of the condition as defined. [ABSTRACT FROM AUTHOR]

Presents a study which examined the histologic and enzymatic alterations during the administration of the Norwalk agent of acute infectious nonbacterial gastroenteritis. Subjects and methods; Results; Discussion.

Examines cases of patients with leukemia who developed disseminated, maculonodular rash as a manifestation of systemic candidiasis. Outcome of patient treatment in each case; Information on Candida species; Methods which may help the clinician to distinguish between bacterial and candidal septicemia.

Presents a case study on the treatment of patients with acute non-lymphoblastic leukemia. Medical history of the patients; Treatment modalities for patients; Evaluation and criteria for remission.

Presents a study which described a case of endemic hepatitis associated with Australia antigen in a research laboratory setting. Assessment of individuals for serum glutamic-pyruvic transaminase levels; Representation of acute hepatitis with Australia antigen; Association of the antigen with hepatitis.

Talks about pathophysiology and therapy of the shock of myocardial infarction. Hemodynamics in the animal model; Biochemistry and strength in the animal model; Discussion on the hemodynamic and biochemical changes in man; Methods for increasing myocardial oxygen tension; Conclusions.

Presents a study on interstitial fibrosis after Pneumocystis carinii pneumonia. Method of the study; Results and discussion; Conclusion.

Discusses the diagnosis and management of gastrointestinal bleeding. Clinical appraisal of the patient with acute hemorrhage; Angiography in diagnosis; Details of unusual vascular causes of bleeding.

Presents a study that observed patients with renal failure associated with progressive glomerulonephritis. Detection of extracapillary cell proliferation with pronounced crescent formation; Evolution of extensive fibrotic changes in the glomerular epithelial crescents; Examination of material with periodicity of fibrin.

It is generally accepted that patients suffering from infections show positive tuberculin skin tests, with certain rare exceptions. Recognized causes of these exceptions include extreme illness, whether due to extensive tuberculosis or to other severe disease, and certain viral infections, notably measles. It is not so generally recognized that a few patients with pulmonary tuberculosis, generally of rather indolent type, who are not acutely ill, persistently fail to react to tuberculin; and that the range of tuberculin sensitivity observed in patients with the more usual forms of tuberculosis is very wide. The effect of cortisone in diminishing the size of tuberculin reactions in patients with pulmonary tuberculosis is directly related to the degree of sensitivity; reactions produced by small doses of tuberculin in patients with high sensitivity are greatly diminished or inhibited, while those produced by 100 T.U. in patients with low sensitivity are not significantly altered. Patients with tuberculosis can be desensitized to tuberculin by increasing injections of tuberculin under chemotherapy cover. In patients who have been so desensitized, the addition of cortisone to tuberculin in an intradermal test produces positive reactions in 70%. Among patients with sarcoidosis giving no reaction to 100 T.U., about half react when cortisone is added. These observations show that in patients with sarcoidosis, a negative tuberculin test cannot be taken to exclude infection. [ABSTRACT FROM PUBLISHER]

During the first 5 years (1963-67) of a new Medical Ophthalmology Unit, 204 of the 1700 admissions had endogenous uveitis. It was anterior in 141 (70%), posterior in thirty-three (16%) and generalized in thirty (14%). Acute uveitis in ninety-seven patients ended in the course of months whereas chronic uveitis in 107 was measured over the years, punctuated by relapses. Sex distribution was equal, and the age at apparent onset of the first incident was evenly spaced in the third to sixth decades, with a mean age of 39 years (range 6-77). Uveitis, observed in twenty children of either sex, was more commonly posterior and chronic. Clinical accompaniments of adult uveitis include rheumatoid arthritis, ankylosing spondylitis, respiratory infections, toxoplasmosis, sarcoidosis and helminth infestations in that order of frequency. No accompanying abnormality could be detected by clinical examination, radiology, haematology or other investigations in ninety-two (45%) patients. It seems that widely cast investigative routines are not worthwhile in view of this poor return, and that instead, a few tests, selected by the clinico-radiological circumstances, might be equally fruitful. For instance, the Kveim-Siltzbach test is helpful in delineating sarcoid uveitis and the toxoplasma dye test in defining one form of posterior uveitis. In this series, the toxoplasma dye test titre was positive significantly more often in posterior than in anterior uveitis, and this was more evident in Negroes rather than Caucasians. Three-quarters of Negroes with choroiditis had toxoplasma dye test titres of 1: 16 and above. [ABSTRACT FROM PUBLISHER]

Forty patients, aged 35-72, who had had an acute myocardial infarct in the preceding 24 hr, and who were seriously ill, were treated in a hyperbaric oxygen bed at 2 atm (atmospheres) absolute for sessions of 2 hr in and 1 hr out for an average period of 4 days. There were thirty-seven survivors after the treatment, giving an immediate mortality of 7·5%, but three of those died later before leaving hospital, giving a total mortality of 15% in seriously ill patients. Pain and dyspnoea were usually improved in the first hyperbaric session, relapsed in air and progressively improved in successive sessions. Arrhythmias, including heart block, showed similar benefit. No case of cardiac arrest occurred while the patients were actually receiving hyperbaric oxygen. There was, in the opinion of the authors, during a period of over 2 years' experience, a consistent pattern of improvement over and above that expected as spontaneous improvement. The hyperbaric oxygen bed is a promising method of treatment for the acute phase of myocardial infarction, and it is simple to use. There will of course always be an irreducible minimum of patients who will die from obstruction of both coronary arteries or other structural lesions such as rupture or emboli. [ABSTRACT FROM PUBLISHER]

Four cases of poisoning by nitrous fumes are reported. Three patients presented with pulmonary oedema, and one of these progressed to the phase of bronchiolitis obliterans; the fourth patient presented with the clinical features of bronchiolitis obliterans. Pulmonary function studies in both phases showed a predominantly restrictive pattern of ventilatory abnormality with a tendency to hypoxaemia, hypocapnia, and reduced transfer factor. Complete recovery followed prompt treatment with corticosteroids. It is emphasized that three of these four accidents were preventable. [ABSTRACT FROM PUBLISHER]

The brains of dogs subjected to total cardiac bypass were examined for early signs of ischaemic nerve cell changes. Diffuse nerve cell changes were found immediately following two- and three-hour non-pulsatile perfusions but not following pulsatile perfusions of the same durations. The nerve cell changes found in the brains were acute cell swelling and early ischaemic cell change. Acute cell swelling was found only in the cerebellar Purkinje cells. Ischaemic cell change was found in several regions of the brain but the cerebral cortex and cerebellar Purkinje cells were most frequently affected. Diffuse nerve cell changes are attributed to non-pulsatile blood flow but some complicating factors are recognized. Focal lesions found in three brains may have been due to embolism by blood cell aggregates and/or gas microbubbles. [ABSTRACT FROM PUBLISHER]

Dynamic lung volumes (forced vital capacity, forced expiratory volume in 0·5 second and in 1·0 second), static lung volumes (total lung capacity, functional residual capacity, residual volume), and ventilation-perfusion relationships (alveolar-arterial oxygen tension difference, alveolar dead space ventilation to tidal volume ratio, arterial oxygen and carbon dioxide tension, and the fractional ventilation and perfusion relationship by the three-compartment lung model) were measured in adult asthmatics during the acute, recovery, and stable or asymptomatic phases of an asthmatic attack. Eighteen patients were studied during 20 separate asthmatic attacks. The patients behaved in one of three ways with regard to total lung capacity (TLC): group I had an elevated TLC during the acute asthmatic attack which returned to normal, group II had a normal TLC throughout the attack, and group III had an elevated TLC that did not return to normal on recovery from the asthmatic attack. With the patients separated into the three groups, the other pulmonary function measurements, especially the measurements of ventilation-perfusion abnormality, were compared. There were no statistically significant differences of ventilation-perfusion abnormality between groups I, II, or III. There was a tendency for perfusion abnormality to be less during the acute phase of the asthmatic attack in patients with an elevated TLC (group I). The three-compartment lung model revealed the major abnormality in all groups to be an increased fraction of unventilated but perfused lung. [ABSTRACT FROM PUBLISHER]

Fifty-four opium smokers with chronic obstructive lung disease were studied for two-and-a-half years. Forty-eight patients had a cough for at least two years before the onset of inappropriate exertional dyspnoea. Fine, bubbling adventitious sounds suggesting small airway disease were heard on auscultation over the middle and lower lobes in 38 patients. The prevalence of inflammatory lung disease and chronic respiratory failure in this series is suggested as the main cause for the frequent finding of right ventricular hypertrophy and congestive heart failure. Physiological studies revealed moderate to severe airways obstruction with gross over-inflation and, in 32 patients, an additional restrictive defect probably due to peribronchiolar fibrosis. Radiological evidence of chronic bronchitis and bronchiolitis was observed in 45 patients, `pure' chronic bronchiolitis in six patients, and `widespread' emphysema in 25 patients respectively. Necropsy examinations in nine patients, however, showed destructive emphysema of variable severity in all. Chronic bronchiolitis often associated with striking bronchiolectasis was present in six cases. More severe bronchiolar rather than bronchial inflammation was noted. The heavy opium smokers had characteristic nodular shadows on chest radiography, sometimes associated with a striking reticular pattern not seen in `pure' cigarette smokers. This was due to gross pigmented dust (presumably carbon) deposition in relation to blood vessels, lymphatics, and bronchioles, and also within the alveoli. It is speculated that the initial lesion is an acquired bronchiolitis. Opium smoking induces an irritative bronchopathy favouring repeated attacks of acute bronchiolitis and eventually resulting in obliterative bronchiolitis, peribronchiolar fibrosis, chronic bronchitis, and destructive emphysema. [ABSTRACT FROM PUBLISHER]

Two cases of an acute chest illness occurring in mushroom workers are described. In one patient, who was severely ill, a lung biopsy was obtained which showed a pattern of alveolitis and interstitial fibrosis. The serum of both patients gave a precipitin reaction to an extraction of mushroom compost after spawning, but no reaction occurred to a variety of hay antigens used in the diagnosis of farmer's lung. A provocation test undertaken in one patient demonstrated a reaction to the inhalation of a dilute extract of mushroom compost after spawning. The most severely ill patient made a full clinical and functional recovery without steroid therapy. [ABSTRACT FROM PUBLISHER]

The clinical and pathological findings in a fatal case of farmer's lung in a 17-year-old youth are described. His lungs were uncomplicated by chronic disease, and his first exposure to mouldy hay probably occurred only weeks before his death. As this was an acute attack, whose duration could be measured in days, the changes seen are probably the earliest to be recorded, and the probable nature of the sensitivity reaction can be deduced. The pathological process is seen to be an acute centrilobular bronchopneumonia of a special type and is associated with an obstructive bronchiolitis. There is a focal interstitial pneumonia with much proliferation of alveolar epithelium, and there is a necrotic exudate in which neutrophils and eosinophils are seen along with mononuclears, some lymphocytes, and plasma cells. The alveolar spaces are in many cases obscured, but others contain a haemorrhagic fluid. Alveolar capillaries show an acute vasculitis, with platelet and fibrin deposition, and with acute neutrophil infiltration. Serological and mycological data are included. Precipitins to mouldy hay and to were found in the serum. In dusts collected from his habitat was found. We think the bronchiolitis explains the severe dyspnoea, and the vasculitis accounts for the malaise, fever, and haemoptysis. The histological findings are compared with accounts of experimentally produced Arthus reactions and tuberculin reactions, and we give our reasons for believing the fundamental lesion to be an Arthus reaction. [ABSTRACT FROM PUBLISHER]

The pathology of five patients who had a biopsy in the acute stage is described; interstitial pneumonia, sarcoid-like granulomata, bronchiolitis, and vasculitis were found. Three of these patients progressed to the chronic stage, when the one with the most extensive bronchiolar involvement had lung function findings of airway obstruction. One progressed to the chronic stage with lung function findings of a transfer defect, and another had radiographic evidence of pulmonary fibrosis with normal lung function tests at rest. The pathology of the chronic stage is described in six patients, with necropsy findings in five. Interstitial pulmonary fibrosis, cystic change, and pulmonary hypertensive changes were the principal findings. [ABSTRACT FROM PUBLISHER]

In assessing patients suffering from farmer's lung, the acute stage must be distinguished from the chronic stage of the disease. The conspicuous radiographic signs in the acute farmer's lung episode and the often dramatic clearing make an important contribution to the diagnosis. The radiographic changes in chronic farmer's lung are not specific and cover a wide range of appearances. Even minor nodular changes are significant. Farmer's lung, acute and chronic, is not a disease predominantly characterized by a defect in gas exchange. During the acute illness the reduction in diffusing capacity is often accompanied by a decrease in lung volumes; the pulmonary function profile of the chronic stage is variable. In only a relatively small proportion of chronic farmer's lung patients does a defect in gas exchange predominate, and in some it may be manifest only during exercise. Airway obstruction is a feature of chronic farmer's lung. In chronic farmer's lung patients discrepancies between the severity of complaints and results of pulmonary function tests are not infrequent. In some patients with considerable disability conventional pulmonary function studies may demonstrate little or no impairment of the functions measured. In patients suffering from an acute farmer's lung episode, serological tests should be positive, possibly in high titre. In the chronic stage of the disease the chance of finding positive serology in a patient diminishes with the length of time elapsed since the last acute episode. The period of serological transition appears to be the third year. [ABSTRACT FROM PUBLISHER]

Two cases of acute Wegener's granulomatosis are described. The first ended fatally after an illness of only two weeks. In the second a remission of three years has been obtained with heavy doses of steroid. At present there is evidence of impaired pulmonary gas transfer and also chronic glomerulonephritis, but the patient is asymptomatic. When the disease presents with pulmonary cavitation it may be confused with pulmonary neoplasm, tuberculosis, or lung abscess, and the diagnosis is made by biopsy. The Rose-Waaler was strongly positive in the case tested. [ABSTRACT FROM PUBLISHER]

The article presents a study on the creatine phosphokinase (CPK) activity in newly admitted psychiatric patients. Raised serum CPK activity has been shown to occur in physical disorders and in acute psychosis. The study found that about half of newly-admitted psychotic patients have raised CPK activity. The presence of psychotic or physical illness is indicated by raised CPK. The increase in serum CPK was associated with the psychotic illness itself rather than environmental or any other factors associated with admission to hospital.

The article presents a study which investigates the effect of lithium on the schizophrenic process by comparing lithium and chlorpromazine in newly hospitalized acute schizophrenics, irrespective of diagnostic sub-type or affective coloring. It was designed to avoid toxicity in those patients receiving lithium, so that any potential neuroleptic effect of this ion would not be masked. The results indicate that chlorpromazine is clearly more effective than lithium, either in reducing symptom severity or in bringing about remission in schizophrenic patients.

The article presents a study concerning the levels of free fatty acids (FFA) before and after insulin injection to men with acute schizophrenia. The blood glucose and plasma-FFA of twenty-eight patients in mental hospitals are studied whose medications are off for three days. Findings reveal that schizophrenics have a higher level of FFA than non-psychotics. Schizophrenic patients have no reaction to heart rate and blood glucose in relation to insulin while non-psychotics showed a positive reaction. It concludes that the of increase activity in the autonomic nervous system is one basis for the increase of FFA-levels in schizophrenics.

The article presents a study that examines the differential effect of the schizophrenic mother's stages of illness on her children. In this study, data were collected on all schizophrenic women who were pregnant during their admission in mental hospital in 1955 to 1964. Their 175 children were divided into three groups according to the time of birth in relation to the mother's illness. Findings suggest that children born by schizophrenic mothers during the acute stage of their illness are more vulnerable to childhood behavior disorders than their siblings born at earlier or later periods.

Five patients with multiple sclerosis and four normal subjects have been followed for over two years. Plasma phospholipid levels and phospholipid fatty acid composition have been assayed periodically. The increased amount of plasma lysolecithin already described by us has been confirmed in this longitudinal study. A significant increase in saturated fatty acids of lysolecithin has also been demonstrated. In contrast, the lecithin concentration and fatty acid composition do not show any significant variations. The lysolecithin saturated/unsaturated fatty acid ratio was different in the same patients at different times, but no correlation was established between these variations and the clinical symptoms measured using the Kurtzke scale. The possible significance of saturated fatty acid increase in lysolecithin in the pathogenetic mechanisms of multiple sclerosis is discussed. [ABSTRACT FROM AUTHOR]

Arterial and venous pressures have been measured in the cortical circulation of baboons. Arterial perfusion pressure was found to be relatively lower in hypercapnia than in normocapnia, while venous pressure was higher in hypercapnia than normocapnia. In hypercapnia, during middle cerebral occlusion, the arteriovenous pressure differences virtually disappeared and evidence of collateral inflow to the ischaemic zone was absent. Reactive hyperaemia after middle cerebral occlusion was reduced or abolished in hypercapnia. The significance of these findings in relation to treatment of ischaemic vascular disease with CO(2) is discussed. [ABSTRACT FROM AUTHOR]

Two men developed acute intravascular haemolysis after exposure to arsine gas in a metal smelting works. Both survived; one developed acute renal failure and required peritoneal dialysis. His renal function returned to near normal within 3 months. The probable mode of exposure has been investigated and is discussed. The toxic effects of arsine are briefly reviewed. The preventive action taken is detailed. [ABSTRACT FROM PUBLISHER]

Intravenous injections of 20-25 mg. -propranolol did not change the heart rate or systemic pressure in 13 patients with cardiac infarction. Cardiac output was depressed in 10, but there was no clinical deterioration. -Propranolol was better tolerated than -propranolol under these conditions and justifies further investigation as an anti-dysrhythmic agent. The major depressant effects of -propranolol following cardiac infarction appear to be due to beta-adrenergic blockade and not to a direct depressant action on cardiac muscle. [ABSTRACT FROM PUBLISHER]

The article discusses the comparative study concerning the performance of manic patients and thought-process-disordered schizophrenics on the Grid Test for schizophrenic thought disorder. The test was administered by twelve patients and twenty-four schizophrenics with thought-process disorder. The difference on a group of manic patients from both acute and chronic thought-disordered schizophrenics has been successfully determined by the use of Grid Test. The intensity score for all patients were differentiated by the groups, however, the consistency did not so.

The article presents a study that determines if the type of neurotic symptom shown by schizophrenics is related to the frequency with which they use psychological as opposed to objective constructs. In this study, 40 patients admitted to hospital had an undisputed diagnosis of schizophrenia and showed active psychotic signs or symptoms at time of testing. Results showed that among acute schizophrenics, there was a significant tendency for those patients who used psychological as opposed to objective, constructs when differentiating among people in photographs to admit to psychological, rather than somatic neurotic symptoms.

The article presents a study that evaluates the effectiveness of a new adrenal steroid in the treatment of acute mental disorders . The results offer virtually no support for the view that neurosterone is superior to a placebo, and they clearly indicate that it is inferior to chlorpromazine. There is a very tenous suggestion that neurosterone may have certain activating properties. This stems from the finding that it was almost significantly more effective than both chlorpromazine and placebo in increasing sociability. The only other target symptom which reflected a trend in favor of neurosterone, although one which did not approach statistical significance was interest.