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1. The primary focus of psychiatric rehabilitation is on improving the competencies of persons with psychiatric disabilities. 2. Both patients and staff must change their ideas about themselves and each other before the work of rehabilitation could move forward. 3. Institutional rigidity works against psychiatric rehabilitation, with its value on individual growth and self-sufficiency.

Modified immune serum globulin, prepared from human immune serum globulin by a nonenzymatic method, is apparently safe for intravenous administration to humans. The efficacy of the preparation was determined in experimental murine infections with seven immunotypes of Pseudomonas aeruginosa. Intravenously administered 0.85% NaCI, 0.3 M glycine, and 10% human albumin did not protect against lethal pseudomonas infection, whereas modified immune serum globulin given by the same route did protect mice. In the mouse protection test, the mean dose of the preparation that saved 50% of mice infected with any of eight strains of P. aeruginosa was 480 mg/kg (range, 12-2,333 mg/kg). For five strains the 50% effective dose was

Immunologic responses to bacteriophage varphiX 174 were studied in 26 patients with immunodeficiency diseases. In eight cases of infantile X-linked agammaglobulinemia, there was prolonged circulation of phage and no detectable antibody response. The remaining 18 patients cleared phage normally and produced antibodies. 10 of these patients made only IgM antibody in spite of repeated immunization; all of these have recurrent respiratory tract infections and require treatment with gamma globulin and antibiotics. Eight patients made both IgM and IgG antibody; they experience either milder or no infections, and only one requires treatment with gamma globulin. Prolonged circulation of bacteriophage varphiX 174 and the absence of a detectable antibody response appear to be distinguishing characteristics of X-linked agammaglobulinemia if severe combined immunodeficiency can be excluded.

The convulsive equivalent syndrome is an entity of paroxysmal cerebral disorder characterized by autonomic disturbances and dysfunction in behavior and communication. This syndrome has been variously referred to by such names as abdominal epilepsy or autonomic epilepsy. Other types of seizures may coexist in certain cases. Although a close correlation between the 14 and 6 per second positive spike electroencephalographic pattern and the convulsive equivalent syndrome has been observed by Gibbs and others, the nature and significance of the 14 and 6 phenomenon remains controversial. In this study 535 cases were divided into 3 groups which have been analyzed and compared. It was found that of 349 children with convulsive equivalent epilepsy, only 55 per cent showed the 14 and 6 pattern, and of 379 children with the 14 and 6 abnormality only 50 per cent had the convulsive equivalent epilepsy.

Physiological concentrations of calcium in serum antagonize the activities of colistin, polymyxin B, and gentamicin against Pseudomonas aeruginosa . Studies were carried out to determine whether tobramycin, a new aminoglycoside antibiotic, is also antagonized by calcium. The activity of tobramycin in vitro was shown to be antagonized by human serum and by physiological concentrations of calcium. The addition of human serum in broth-dilution tests produced a fourfold rise in the minimal inhibitory concentrations of tobramycin for five strains of Pseudomonas . In disc diffusion tests, the addition of calcium to the agar significantly decreased the size of inhibition zones, and the addition of a chelating agent to the agar increased the zone sizes. In a limited comparative study, tobramycin and gentamicin were tested against both light and heavy bacterial inocula of two strains of Pseudomonas . Tobramycin appeared to be antagonized less by serum than was gentamicin at equal antibiotic concentrations.

A prospective study was made of postoperative wound infections at Milwaukee Children's Hospital for 1 year. Essentially all procedures requiring a skin incision were included. The clean surgical wound infection rate was 3.1% (26 infections in 849 cases). There were no significant differences in clean wound infection rates among the individual surgeons or among the four busiest surgical services. The occurrence of postoperative wound infections was associated with administration of prophylactic antibiotics, longer duration of surgical procedures and longer hospital stay before and after surgery. About 50% of patients having a clean surgical procedure were given prophylactic antibiotics. Prophylactic antibiotic were given for 4 days or more in about half the cases.

CONGENITAL pyridoxine deficiency is teratogenic in the rat, producing digital defects, cleft palate, omphalocoele, micrognathia, exencephaly and hypoplasia of the spleen and thymus1. Surviving offspring may develop convulsions2–4, presumably because of a delay in the development of the γ-aminobutyrate shunt in the brain5. Congenital pyridoxine deficiency also causes cleft palate in the mouse6. I have now found that congenital pyridoxine deficiency has an adverse effect on the immunological function of surviving pups.

Human serum inhibits the antibacterial activity of colistin and polymyxin B against Pseudomonas aeruginosa in vitro. By use of a colony-count assay, the inhibitory factor in serum was identified as calcium. The bactericidal activity of colistin was inhibited by either lO"3 m CaCIs, 1596 human serum, or 1596 heparinized plasma. Colistin was not inhibited by plasma containing chelating agents. Colistin may be less active in vivo than predicted on the basis of in-vitro tests of susceptibility to the antibiotic.

In 60 pediatric patients, 75 central venous catheters representing 1866 patient days were placed to provide parenteral nutrition. During the 21-month study period, surgical residents were responsible for dressing changes during the first 16 months and a specially trained nurse was responsible during the final 5 months. Twenty percent of the lines became infected. The infection rate was significantly higher in the lines cared for by residents, 28.8% compared to 3.3% in the lines cared for by the nurse. This occurred in spite of the lines being in place significantly longer in the nurse group (31.7 us 20.3 patient days/line).These data indicate that a specially trained person using aseptic techniques can reduce infection rates in patients receiving central venous parenteral nutrition. (Journal of Parenteral and Enteral Nutrition 10:220-222, 1986)

• Antibiotic therapy of experimental Pseudomonas keratitis was evaluated quantitatively by determining numbers of viable bacteria in the cornea of guinea pigs. Topically applied carbenicillin disodium, gentamicin sulfate, and tobramycin sulfate were often significantly more effective than topically applied polymyxin B sulfate. Intramuscular therapy with tobramycin was as effective as topical therapy, and the results exhibited less variability. Topical tobramycin every 30 minutes was significantly more effective than topical therapy every 60 minutes. No combination of antibiotics was significantly better than a single effective drug. The concentration of tobramycin in the aqueous correlated more closely to therapeutic efficacy than did the concentration in the cornea. Although all antibiotics reduced numbers of bacteria in the cornea by more than 99% in the first 24 hours of therapy, none was able to sterilize the cornea in four additional days of continuous therapy. Persistence of organisms despite apparently adequate topical therapy may explain some reported cases of relapse in humans. ( Arch Ophthalmol 95:1638-1643, 1977)

A generalized erythematous scaly rash, alopecia, lymphadenopathy, and hepatosplenomegaly developed in an infant girl during the first 6 weeks of life. Repeated bacterial and fungal infections, persistent diarrhea, and generalized wasting complicated the course of her illness, and death occurred at 5 1/2 months of age. Lymph node architecture was completely obliterated by histiocytes and eosinophils; no plasma cells or germinal centers were present. Both humoral and cellular immune systems were severely but not completely impaired. Familial reticuloendotheliosis with eosinophilia is, in some cases, associated with combined immune deficiency.

Acute infections with Mycoplasma pneumoniae were observed in four patients with immunodeficiency syndromes. The illnesses were unusual in that symptoms were more severe, cough persisted longer, and there were minimal or no changes on chest roentgenograph. Treatment with tetracycline and erythromycin resulted in rapid improvement. Two patients suffered repeated episodes of mild pruritic rashes associated with joint pain during convalescence. The lack of radiologic chest findings suggests that pulmonary infiltrates in immunologically normal persons with M. pneumoniae infection may be a result of an immunologic reaction. That our patients did recover and stop excreting the organisms indicates that part of resistance to M. pneumoniae infection may be due to cell-mediated

"Amongst all my acquaintance, I see no people so soon sick, and so long before they are well, as those who take so much physic; their very health is altered and corrupted by their frequent prescriptions." Montaigne COLDS are common. The US National Health Survey for July 1961 to June 1962, reported 231,000,000 episodes of acute respiratory disease. 1 Of these, 112,000,000 were colds, and 81,000,000 influenza. In that twelve-month period acute illnesses occurred at the rate of 222 per 100 persons. Acute viral respiratory diseases caused 60% of all acute illnesses; the Cleveland Family Study reported similar findings. 2 The common cold is everyone's disease and has caused a profusion of all kinds of nostrums. The great losses from morbidity and great cost of remedies, home and prescribed, necessitate critical evaluation of optimum therapy. Since recovery almost always occurs, evaluation of therapy is difficult. Prophylactic antibiotics have often been

Because calcium was found to be antagonistic in vitro to the activity of colistin and polymyxin B on Pseudomonas aeruginosa , the effects of calcium and serum on gentamicin and carbenicillin were also examined. Serum was antagonistic to gentamicin in antibiotic tube dilution tests on five strains of P. aeruginosa . Serum was not antagonistic to carbenicillin in tube dilution tests. Physiologic concentrations of calcium antagonized the activity of gentamicin but not carbenicillin. The antagonism observed with gentamicin was less than that previously seen with colistin. The antagonistic effect of calcium and serum was removed by a chelating agent. Gentamicin and carbenicillin may be more active in vivo against P. aeruginosa than colistin or polymyxin B.

In Canada, about 100 sporadically occurring cases of brucellosis are reported yearly. Three patients were admitted to one Montreal hospital in the first seven months of 1963; all were employed in or around a packing plant. One had pain and electrocardiographic changes suggestive of Brucella myocarditis; he recovered promptly. Symptoms of neurasthenia and anxiety are common and were observed in two of these three cases. Two had positive blood cultures; the third showed conclusive agglutination to Br. abortus (1:10,240). In some patients with frequent previous exposures to infection the agglutination response may be equivocal and difficult to interpret. All three patients responded well to tetracycline; streptomycin and corticosteroids also have a role in the therapy of some cases. There may also be some place for combined antibiotic and vaccine therapy. The program of control of the disease in cattle in Canada is aimed at eradication by 1967.

Most gram-negative bacteria are at least partially susceptible to the bactericidal activity of antibody and complement (AbC) in human serum. Traub and Sherris recently found that polymyxin B acted synergistically with human serum on Escherichia coli [1]. The synergism was attributed to the concerted action of AbC and polymyxin B on the cytoplasmic membrane of the bacteria [2-5]. Ampicillin and kanamycin were not synergistic with serum.

Summary Since May 1, 1946, 24 cases of mycobacterial cervical adenitis in children under the age of 12 years were reported to the Muscogee County Tuberculosis Study. It is believed that these represent practically all the known cases in the community. On the basis of bacteriologic findings and skin sensitivity to PPD-S and other mycobacterial antigens, the cases were separated into 2 groups: one in which Myco. tuberculosis was a likely etiological agent, and the other in which the disease was probably caused by some other mycobacterium. In this series, it appeared that mostcervical adenitis, clinically compatible with a diagnosis of tuberculosis, was caused by mycobacteria other than Myco. tuberculosis. A history of exposure to tuberculosis, an insidious onset in a male Negro child, and the presence of lesions elsewhere in the body favored the diagnosis of tuberculosis. Dual skin testing, with the use of PPD-S and a PPD prepared from an atypical acid-fast bacillus causing cervical adenitis, appeared to be helpful in differentiating tuberculosis from other mycobacterial cervical adenitis. Bacteriologic examinations afforded the best opportunity to obtain an etiological diagnosis. The treatment of choice appeared to be excision of the affected node, accompanied by antituberculosis chemotherapy. Excision not only gave good therapeutic results in this series, but also yielded the best specimen for bacteriologic examination.

SPHEROPLASTS are bacteria that are deficient in cell wall and can be prepared by a variety of methods from Gram-negative bacteria. One way to examine the degree of cell wall removal is to study the infection of Spheroplasts with bacteriophage, which attaches to receptors on the cell wall. Bacteriophage adsorption and multiplication in spheroplasts have been reported by a number of authors1–7. The ability of spheroplasts prepared by treatment with serum to multiply phage has not yet been investigated.

GASTROINTESTINAL disease is common among patients with variable immunodeficiency syndromes (IDS),1 2 3 4 but is rarely seen in patients with infantile X-linked agammaglobulinemia.2 , 5 In a recent study, Giardia lamblia was found to be the cause of gastrointestinal symptoms in seven of eight cases of variable IDS.6 G. lamblia caused a malabsorption syndrome in the patient with infantile X-linked agammaglobulinemia described below. Case Report A 12-year-old boy with infantile X-linked agammaglobulinemia was admitted to the University Hospital, Seattle, in June, 1971, for a prospective study of the structure and function of the gastrointestinal tract in IDS. Results of studies of his immune system . . .

To examine the influence of partial antibiotic therapy on laboratory findings in Haemophilus influenzae meningitis, 272 untreated cases and 202 partially treated, culture-positive cases from 1953 through 1971 were reviewed. There was no significant difference between the two groups with respect to several cerebrospinal fluid (CSF) values. Both the untreated and partially treated groups had a similar proportion of cases with negative Gram stain and CSF glucose level over 40 mg/100 ml or a predominance of CSF mononuclear cells. Eight patients had received ampicillin sodium, chloramphenicol, or tetracycline for two days or more. The CSF findings of these patients resembled those of the untreated group. The data support the conclusion that antibiotics In the usual outpatient dosages seldom interfere with the diagnosis of H influenzae meningitis.

THE FIRST type of agammaglobulinemia reported was an X-linked recessive disease characterized by recurrent bacterial infections, very low serum immunoglobulins,* and absence of antibody responses. 1 Many other types have since been recognized 2-5 and a short classification of the agammaglobulinemias is listed in Table 1. Each type appears to be distinct, and each is probably the result of a different defect in the maturation and function of immunologic mechanisms. The purpose of this report is to present studies of seven patients with agammaglobulinemia. These studies indicate that cases currently called congential sporadic agammaglobulinemia may be a heterogeneous group with different defects of immunity. Agammaglobulinemia is used here in the generic sense to mean a group of related diseases which are characterized by low serum immunoglobulins, impaired antibody response, and abnormal lymphoid morphology. The use of agammaglobulinemia in this sense is comparable to the use of anemia to indicate diseases