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Borrelia burgdorferi was isolated from skin biopsy specimens of erythema chronicum migrans lesions on two individuals residing in Menominee County, Michigan, in 1992. To our knowledge, these are the first two cases of culture-confirmed Lyme disease in Michigan. In spite of prompt treatment and resolution of illness, antibodies to B. burgdorferi were detectable for at least 3 months in both patients. Both specimens were obtained at different rural medical practices, thus demonstrating that with adequate laboratory support it is feasible to confirm a diagnosis of acute Lyme disease by culture in rural health care settings.

Pulmonary involvement is known to occur in AM including extensive and prolonged x-ray findings. The physiologic severity and long-term significance of these abnormalities is unknown. We performed serial pulmonary function tests (PFT) in 6 previously healthy children (mean age 11) hospitalized with AM confirmed serologically. Four of 6 had no specific respiratory symptoms, while 1 child presented with acute respiratory failure. Chest x-rays demonstrated infiltrates and nodules, but no effusions. In addition to arterial blood gases, PFT's included spirometry, lung volumes, and diffusing capacity performed 1, 4, 8, and 12 weeks after admission. Mean PaO2on admission was 59 mm Hg (range 42-70). PaO2reverted to normal in 4 children by 2 weeks, and in all 6 by 4 weeks. PFT's initially were severely restricted. Values as % of predicted were: Vital Capacity 55%; Total Lung Capacity 59%; Diffusion Capacity 47%. Decreased exercise tolerance correlated with PFT changes, but x-ray findings did not. PFT's reverted to normal in 3 of 6 by 4 weeks, and in the remaining 3 by 8, 8, and 12 weeks. These studies suggest that the physiologic changes associated with AM are extremely variable. AM may be a cause of life-threatening respiratory insufficiency in previously healthy children. Physiologic changes of the restrictive type may exist despite lack of symptoms. These abnormalities may persist for months, but do not result in permanent damage despite persistence of x-ray abnormalities.

Thirteen-Week Oral Toxicity Study of Methyl Carbamate in Rats and Mice. Quest, J. A., CHAN, P. C, CRAWFORD, D., KANAGALINGAM, K. K., and HALL, W. C. (1987). Fund. Appl. Toxicol. 8, 389–399. The purpose of this study was to identify the toxicologic effects produced by methyl carbamate in F344 rats and B6C3F1 mice. Administration of methyl carbamate by gavage five times a week for 13 weeks to male (50, 100, 200, 400, or 800 mg/kg) and female (62.5,125,250,500, or 1000 mg/kg) rats resulted in dose-related lesions in the liver characterized by proliferative changes in hepatocytes consisting of foci of cellular alteration and frequent mitoses with atypical forms. Toxic alterations consisted of focal hepatocellular necrosis, pigmentation of Kupffer's cells, and the presence of basophilic inclusions resembling nucleoli in the cytoplasm of hepatocytes. Other toxic effects observed in rats were weight loss, testicular hypoplasia, bone marrow hyperplasia, and excessive pigmentation of the spleen. The survival of male and female rats was reduced following administration of the highest dose of methyl carbamate. In contrast to these findings, administration of the chemical to male (93.75, 187.5, 375, 750, or 1500 mg/kg) and female (125, 250, 500, 1000, or 2000 mg/kg) mice five times a week for 13 weeks resulted only in weight loss and inflammatory changes of the liver. The proliferative nature of the hepatic lesions observed in rats suggests that the compound is potentially hepatocarcinogenic.

An outbreak of Salmonella serotype stanley infections occurred in the United States and Finland in 1995. The outbreak was investigated through case-control studies in Arizona, Michigan, and Finland; by isolate subtyping; and by tracing and culturing of the implicated food. Alfalfa sprout consumption was the only exposure associated with S. stanley infections in Arizona (matched odds ratio [MOR] = 11.1; 95% confidence interval [CI], 1.4–513), Michigan (MOR = 5.5; CI, 1.6–23), and Finland (MOR undefined; CI, 4.9-∞). US and Finnish patient isolates were a unique outbreak strain distinct from S. stanley isolates not linked to the outbreak. Alfalfa sprouts eaten by patients in 6 US states and Finland were traced to seed shipped by a Dutch shipper. Thus, it was concluded that alfalfa sprouts grown from contaminated seed caused an international outbreak of 242 S. stanley infections in 17 US states and Finland. This outbreak illustrates a new mechanism through which contamination of fresh produce can cause large, widely dispersed outbreaks.

Neutralizing polyclonal antibody to respiratory syncytial virus (RSV) has been shown to be an effective prophylactic agent when administered intravenously in high-risk infants. This study describes the generation of a humanized monoclonal antibody, MEDI-493, that recognizes a conserved neutralizing epitope on the F glycoprotein of RSV. The affinity of MEDI-493 was found to be equal to or slightly better than an isotype-matched chimeric derivative of the parent antibody. In plaque reduction, microneutralization, and fusion-inhibition assays, MEDI-493 was significantly more potent than the polyclonal preparation. Broad neutralization of a panel of 57 clinical isolates of the RSV A and B subtypes was demonstrated. Pretreatment of cotton rats with MEDI-493 resulted in 99% reduction of lung RSV titers at a dose of 2.5 mg/kg, corresponding to a serum concentration of 25–30 µg/mL. Further, MEDI-493 did not induce increased RSV infection or pathology in either a primary or a secondary challenge.

TO THE EDITOR. —Even after the comprehensive report of George et al in the November 1985 issue of the Archives1 on Aeromonas-related diarrhea in adults, and the earlier report of Agger et al in another journal,2 the literature on Aeromonas-related diarrhea in adults is still anemic. One suspects that a reason for this is the reluctance of microbiology laboratories to report what appears to be minor growth of the organism.3 This reluctance is stronger, we suspect, when the laboratory's technique is to place a subculture onto an agar dish that contains the initial fecal culture grown from broth. Our laboratory, which serves a general hospital with a mean census of approximately 250 patients, used such a technique with alkaline peptone broth, and found Aeromonas in feces of 17 patients, all of whom had diarrhea during a 24-month period. This frequency was exceeded by Campylobacter species

Human T cell leukemia virus (HTLV) type II is endemic in certain American Indians, and high rates of infection occur in intravenous drug users (IVDUs). North American IVDUs are infected with two distinct variants, HTLV-IIa and -IIb. IfIVDUs became infected as a result ofinteraction with members of an American Indian population, both viral forms should be demonstrable in such populations. Nucleotide sequence analysis of 630 bases of the env gene encoding the gp21 protein was done on DNA from 12 New Mexico Indians (8 Pueblo, 4 Navajo). All samples were typical subtype a or b viruses. Seven of the 8 Pueblo and 2 of 4 Navajo had subtype b; the rest had subtype a. The results are compatible with an indigenous New World origin for both subtypes of HTLV-II.

The effect of small-particle aerosol therapy with amantadine was assessed in a randomized, double-blind study of 20 patients with naturally acquired influenza A virus infection. Aerosol treatments of 20 min with either distilled water or with amantadine hydrochloride (1.0 g/100 ml of distilled water) were given three times a day for four days. The amantadine-treated patients experienced a significantly more rapid resolution of clinical signs and symptoms when compared with placebo-treated patients. The resolution of fever was similar for both groups. Aerosol delivery of amantadine did not affect the frequency of viral isolation from upper respiratory tract secretions but was associated with a trend toward reduced quantity of viral shedding. Serial pulmonary function tests found no important differences between the groups. Amantadine-treated patients experienced a greater frequency of mild local side effects (rhinorrhea, nasal irritation) during aerosol exposures, but aerosol treatments did not cause any apparent decline in pulmonary function.

An outbreak of influenza B occurred in an elderly population residing in a Minnesota nursing home between April 24 and May 21, 1979 and involved 129(35.9%) of the 359 residents. Throat swabs from 11 of 19 acutely ill residents yielded influenza B virus similar to the B/Singapore179 strain. Fourfold or greater increases in titer of complement-fixing or hemagglutination-inhibiting antibodies were detected in paired sera from 18 of the 19personsaffected and from three of 16unaffected residents. Three hundred thirty-three (93%) of the 359 residents had received trivalent influenza virus vaccine in November 1978. The attack rate wasage-specific and increased withage (z = 2.69; P = 0.007). Increasing susceptibility to influenzaB with age in the elderly has not been previously demonstrated in this infrequentlystudied population. Increasedrisk for becoming ill was also found to be statistically associated with decreasing levels of care required and residence in closed wards and temporally associated with taking meals in the facility's dining areas.

The influence of bacille Calmette-Guerin (BCG) on the pathogenesis of experimental airborne tuberculosis was studied. In a model that approximates the conditions under which man is vaccinated and infected, BCG-vaccinated and unvaccinated guinea pigs were infected by the respiratory route with an inoculum that resulted in the inhalation and retention (by each animal) of approximately three virulent tubercle bacilli (Mycobacterium tuberculosis strain H37Rv). Hematogenous seeding of the lungs occurred in unvaccinated animals about three weeks after aerosol infection but did not occur in BCG-vaccinated animals. Furthermore, the lungs of BCG-vaccinated animals failed to kill H37Rv that was introduced intravenously; however, evidence of mycobacteriostatic activity was found throughout the lungs. In view of the importance of hematogenous dissemination to the apex of the lungs in the establishment of pulmonary tuberculosis in man, the foregoing observations suggest a means by which vaccination with BeG may confer acquired resistance to tuberculosis.

The degree and duration of hypoxemia in babies with RSV has not been studied. We used an ear oximeter to measure dally the arterial satuation(% Sat)on 32 infants consecutively admitted with RSV bronchiolitis and pneumonia; median age 2 months. Oximetry readings compared to simultaneous arterial gases gave a correlation coefficient of 0.95, and 0.7 compared to capillary gases. On admission these infants' mean % Sat was 86%(pO2=53 mm Hg), range 75-95%(pO241-75). The lowest mean value was not until day 3 and was 85%(pO251) with a range of 53-96%(pO228-87). The severity of hypoxemia fluctuated in any given day and was prolonged. At discharge the mean % Sat=90%(pO260) range 83-98% (pO247-113); only 3 infants had values >93%(or >pO266). Mean % Sat of 9 infants 3-7 weeks after discharge was 96%(pO287), range 93-98%(pO266-113). Clinical detection of hypoxemia was difficult. Marked hypoxemia existed without cyanosis. However, severity of hypoxemia correlated with cyanosis, respiratory rate, younger age and % bands. No correlation existed with total WBC, PMNs, nor clinical severity judged by retraction and lethargy. Thus, RSV hypoxemia may be severe, prolonged, and clinically occult. Ear oximetry is a valuable and non-invasive technic in the management of infants with RSV lower respiratory tract disease.

Blood donors have been screened for antibodies to human T cell lymphotropic virus (HTLV) type I since December 1988. Screening for HTLV-II has been simultaneously done because of cross-reactivity between antibodies to the two viruses. Currently, <1 in 10,000 US blood donors is positive for HTLV-I or -II. Lookback studies led to the identification of6 HTLV-II-infected patients. Three received transfusions before introduction of HTLV-I screening tests, while the other 3 received blood components that tested negative for HTLV-I. The HTLV-II subtypes of each of 4 donor/recipient pairs, as determined by DNA amplification using polymerase chain reaction, were identical, supporting the view that transfusions were the source of infection. In conclusion, currently licensed blood donor screening tests for HTLV-I lack sensitivity for HTLV-II, and transfusion of blood from HTLV-II-infected donors that test negative on HTLVI screening tests may result in infection.

The serotypes of hepatitis B surface antigen present in patients at the Lynchburg Training School and Hospital were determined by counterelectrophoresis. Hepatitis B surface antigen was detected by counterelectrophoresis in 72 of 82 samples that were positive by complement fixation or passive hemagglutination techniques. Of the isolates that were serotyped, 51 (71%) were ad, and 21 (29%) were ay; thus the ad:ay ratio was about 2.4:1. The incidence of the ay serotype was significantly higher in females and in patients with Down's syndrome. The ay serotype was not randomly distributed in the institution but was clustered in two of seven female wards and four of 11 male wards, all of which contained younger patients who had been institutionalized at an early age.

Presents readers' letters in response to an October 5, 1998 article, `The Fury of Georges,' and the November 16, 1998 article `The Fury of Mitch,' in `Newsweek' magazine. The banana industries, such as Dole, laying off workers; The emergency preparations called for by the St. Eustatius government.

Asserts that the order of birth affects the character of chief executives. Aggressiveness and vindictiveness of first-born executives; Openness of late-born executives to social change and innovation; Famous chief executives and their order of birth.

My world is the science of medicine. Among my test tubes, serums, lights and microscope, I find happiness: a guardian at a crossroads, a guide along the misted road to health. Yet in my daily rounds there sometimes comes an hour when I feel an emptiness. The sense of sacred missions that fire the priest and preacher, the teacher and the nurse seems strangely lacking, for mine is not the laying on of hands. Then it is that I must go to other courts—where children laugh, unconscious of the horror of their twisted bodies; where fevers burn and wasting illness stalks from cot to cot. There it is I see him, between the beds, in whitened gown, so kindly, calm and smiling—the baby's doctor. His gentler hands will hold some poor wee human mite, whose whispered breath scarce dares return to tortured lips. With defter eye and touch he reads

Boston, July 16, 1906. TO THE EDITOR: —The title page of "Pathology and Treatment of Glaucoma" by Priestley Smith, published by Churchill, London, 1891, states that the volume is a revised publication, with additions, of the Erasmus Wilson lectures, delivered at the Royal College of Surgeons of England, in March, 1889. This is interesting in view of the claims for priority as regards the gelatin method of preserving specimens in Prof. Watters' letter in The Journal, A. M. A., July 14, 1906. Smith's method may be briefly described somewhat as follows: Fixation by the bichromate method, freezing, bisecting and embedding in a glycerin or gelatin jelly, the latter being prepared by soaking gelatin in water (⅛), melting, and after adding the white of an egg, boiling and filtering. Glycerin, 8 parts, and 60 drops of 10 per cent. carbolic acid is then added. At page 183 of this monograph it

TO THE EDITOR. —The article by Heimbach and Crout in the Archives (129:430, 1972) found that the atropine-induced increase of heart rate was diminished in hyperthyroid subjects as compared to normals. They then approached the conclusion that tonic vagal inhibition is reduced in hyperthyroidism.This conclusion would be more nearly valid if they had ruled out, through appropriate controls, the initial value effect described by Wilder1: when an initial value is high (pulse for example), a drug or other influence which raises the value has a smaller than usual effect; conversely, when an initial value is low, an agent which decreases the value has a smaller than usual effect. This law seems intuitively obvious. However, it does not apply to all systems2 and does restrict certain conclusions and inferences from autonomic studies such as those of Heimbach and Crout.References

This book is the published proceedings of the 17th Annual Conference on the Kidney sponsored by the National Kidney Foundation and held on Oct 7 to 9, 1965. It is a patchwork quilt of new and old material concerning many aspects of glomerulonephritis prepared by multiple authors.Clinicians will most appreciate "Physiologic Aspects of Acute Glomerulonephritis" and "Therapy of Acute Glomerulonephritis." The difficulties of attempting to correlate abnormalities of renal function and histology in glomerulonephritis are well presented, and the point "that glomerulonephritis is really a total nephron disease" is underscored. This conclusion is not surprising in the light of the "intact nephron hypothesis" as proposed by Bricker in recent years. While this concept is alluded to in discussion, more extensive interpretation of reported observation in terms of this hypothesis would have been interesting.Both the extent and limits of present knowledge of physiologic abnormalities in acute glomerulonephritis are well