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The TAS of 211 normo lipemic patients and of 84 hyperlipemic patients has been determined by the tube dilution hemolysis method of Rantz and Randall, the Aso Quantum hemolytic method (I.S.V.T. "Sclavo" S.p.A., Siena) and methods with streptolysin O antigen coated on the surface of biologically inert latex particles. A good correlation has been shown between all the analytical techniques considered and, moreover, the incidence of wrong positives and negatives has been showed in comparison with the hemolytic method by Rantz and Randall, considered test of reference. Finally, the greater influence of cholesterol on the classic hemolytic system, compared with the latex technique in causing an unspecific increase of TAS is proposed; this is evaluated before and after treatment of the hyperlipemic samples with ether.

The authors have analysed data from literature and their own results concerning multiparameter examination of the patients with rheumatoid arthritis. An effort has been made to establish a correlative relationship between changes in the following immunologic values: the level of rheumatoid factor, circulating immune complexes, antibodies to streptolysin-0 and immunoglobulin G; the number of T-lymphocytes and the quantity of natural cells of the killers and the hormone regulatory activity of thymus. Positive interdependence between the presence of rheumatoid factor and that of antibodies to streptolysin-0 as well as an increase in the content of circulating hormone complexes has been determined. In view of absence of one value which is strictly specific and compulsory for rheumatoid arthritis, it is only complex investigation that allows to describe the trends in changes of the immunologic state of the patient with rheumatoid arthritis.

A latex agglutination test was compared with the micro-titration haemolysin inhibition method for the detection of anti-streptolysin O (ASO) antibodies in 428 serum samples. After slight modification of the latex method to produce maximal agglutination good agreement was shown between the results obtained by the two methods. The latex test had a sensitivity of 83.6%, a specificity of 93.3%, a predictive positive value of 86.5% and a predictive negative value of 91.6%. It was convenient, required less labour than the haemolysin test, and permitted economic testing of small numbers of sera.

For the serological diagnostics of the diseases caused by Streptococcus pyogenes (A-streptococci) and secondary diseases (rheumatic fever, acute glomerulonephritis) in the first place the anti-streptolysin reaction is at disposal. In the judgment age is to be taken into consideration and the proportion of the inhibitor in the serum is to be removed by absorption with dextran sulphate. Reliable evidence is to be expected only by the course of the titre. If possible, the antistreptolysin reaction should be supplemented by a second reaction, for which purpose the anti-desoxyribonuclease B-reaction is to be recommended. For supporting the diagnostics of the rheumatoid arthritis at least 2 reactions should be performed, i. e. a haemagglutination test (e. g. after Podliachouk-Harboe) and a particle agglutination test (latex fixation reaction). By means of them the rheumatoid factors (above all antibodies of the IgM-class against gamma-globulin) are proved. The haemagglutinations connect a high specifity with a more insignificant sensitivity, in the particle agglutinations the reverse is the case. Apart from the serological tests mentioned here other proved reactions are mentioned. Besides, data on the valuation of the results and their diagnostic importance are in this paper.

Forty-three children presenting with acute nephritis were studied for evidence of preceeding steptococcal infection. They were compared with a group of control children of similar age. Two-thirds of those with nephritis gave a history of a preceeding respiratory infection (compared with one-third of the controls). A significant rise of antistreptolysin O tire occurred in only 16 children with nephritis and within this minority several did not show a fall of serum C3 level. It is probable that only one-third of the children with acute nephritis had poststreptoccoccal glomerulonephritis. Poststreptococcal glomerulo-nephritis is no longer the main cause of childhood acute nephritis in the Leeds area. There may be many different aetiological factors and this diversity calls for more rigorous investigations and a more guarded prognosis.

A case history is presented of the occurrence of a high binding capacity for native DNA in the serum of a patient on phenylbutazone. This reverted to normal on stopping the drug. The patient also had a reversible neutropenia and leucopenia, and it is suggested that the high anti-DNA binding capacity was a feature of a drug-induced lupus-like phenomenon.

A microhaemagglutination test in disposable U plates has been devised for rapid, quantitative evaluation in antistreptococcal antibodies in human sera. Fresh or freeze-dried glutaraldehyde-treated sheep erythrocytes sensitized with over fifteen extracellular proteins released by group A Streptococcus pyogenes including streptolysin O, deoxyribonucleases, hyaluronatelyase, streptokinase and nicotinamide dinucleotide glycohydrolase were used. Haemagglutination and anti-streptolysin O (ASLO) titers were determined in parallel on 434 serum specimens from 123 healthy subjects ("controls") and 311 patients with a history of supposed or evident streptococcal infection. The titration of the four above-mentioned anti-enzyme antibodies has also been made on about 100 sera from both groups. Haemagglutination titre (HT) was less than 800 in control sera. By contrast it was greater than 800 up to 12 800 in patients specimens. Very good correlation was found between HT on the one hand and ASLO or anti-SK, anti-HA and anti-NADase antibodies on the other hand. HT and anti-DNase B antibodies were less correlated. Haemagglutination titres appear to rise earlier than serological titres of conventional streptococcal antibodies. The haemagglutination test described may be particularly helpful as a rapid serologic indicator of streptococcal infections and more reliable than the titration of ASLO alone, or of any one of anti-enzyme antibodies.

This prospective study showed that thalassaemic patients, though susceptible to streptococcal infection, as evident from their elevated A.S.O. titres, are not, as has been suggested, more likely to develop acute glomerulonephritis than the rest of the population. The incidence of thalassaemic trait found among typical cases of acute glomerulonephritis does not exceed that of the general Thai population. There were 5 out of 56 cases of thalassaemic patients having transient microscopic haematuria.

The effect of hypoxic hypoxia on the specific factors of immunity of 16 test subjects was studied during their 30-day exposure to an altitude of 2100-4200 m above the sea level in the area of the Elbrus mountain. In order to differentiate the effect of hypoxia per se from that of other factors typical of highlands, five runs of altitude chamber experiments were carried out. In each run the test subjects were 10 times lifted to altitudes of 3200 m, 4200 m and 5200 m. The chamber experiments were performed on 28 test subjects, aged 26-46. During an exposure to an altitude the test subjects did two or three times exercises of 450-900 kgm/min on a bicycle ergometer. The experimental findings show that hypoxic hypoxia brings about consistent changes in the immunobiological status of man that are directly correlated with the level of hypoxia. These changes include a decline in the acquired antiviral and antitoxic immunity activation of the autoimmune process and an increase in the phagocytic activity of neutrophils. Our results suggest optimal profiles of the hypoxic effect to which test subjects should be exposed during mountain training for a specific occupational activity.

The level of non-specific immune response was evaluated in 409 operable breast cancer patients by a battery of classical tests performed at least before and after treatment. We propose a synthetic classification of the various tests into 5 categories (from I 1 to I 5) of growing pejorative weight for a rapid and better understanding between the laboratory and the clinicians and also for overall comparison in time. With this type of evaluation the percentage of patients exhibiting depressed immune response was 14 per cent initially and rose to 39 per cent at the end of irradiation. Six months later, however, only 3 per cent of the patients had an immune assessment lower than the initial level. The pronounced immune depression observed by other authors concerned mainly patients having undergone post-operative irradiation after removal of the breast. The curative treatments used here in the hope of avoiding radical breast surgery was performed under much different ballistic, biological and psychological conditions which should be taken into account before condemning the dangers of this method.

Sera from normal controls from patients with streptococcal diseases, and from other patients whose serum was sent for anti-streptolysin 0 determinations were tested for antistreptolysin 0 (ASO) and anti-DNase B (ADB) antibodies. The Streptozyme test was performed on the same sera. The upper limits of normal in the control population were established as 160 units for ASO and as 240 units for ADB, respectively. The usefulness of the ADB test in addition to the ASO test was confirmed: when both tests were performed elevated titers could be demonstrated in a higher percentage of various streptococcal diseases. With respect to streptococcal infections of the skin the anti-DNase B-test was superior to the ASO test. In this study of the Streptozyme test showed an elevated antibody titer in a lower proportion than the other two tests.

It was shown that L-forms of streptococci were constantly isolated by means of the method used by the authors from patients with rheumatism, irrespective of the activity and the course of the disease. The data obtained pointed to the presence of septicemia caused by the L-forms of streptococci in patients with rheumatism both at the active and inactive phase. In this connection it should be noted that modern clinical criteria of the activity of rheumatic process are unreliable.

Figures on normal values of Anti-Streptolysin-O-Titres are not available for most parts of Africa. This is certainly so for Zambia. The purpose of this paper is to produce reference figures for the normal adult. The results indicate that the curve is skewed towards the lower values and that 75% of values are 1:100 or below. If the sera of all subjects showing titres of 1:200 are considered however 93% of all cases studied are included. It is therefore concluded that this is the upper limit of normal and that figures above 1:200 must be regarded as abnormal.

The immunologic status of 28 patients with angiogenic sepsis was studied. Characteristic impairments and the prognostic value of certain indices (T- and B-lymphocytes, isohemagglutinin, circulating immune complexes, general clinical analyses of blood with the counting of the leukocyte intoxication index) were established. Recommendations for the assessment of the immune protection of the patients and a program of the immune-correcting therapy are given.

In order to identify the possibility of prenatal or perinatal bacterial contact with immunization of the cellular immunity system as underlying cause of the "idiopathic" newborn icterus (without blood group incompatibility) the lymphocyte transformation test with addition of streptolysin O or E. coli antigen was carried out in 68 newborns with a birth weight ranging between 1260 and 4200 g. The sensitization rate identified among the newborns with hyperbilirubinaemia did not differ significantly from those of the control group. Thus an ensured connection between a prenatal streptococcus or E. coli contact and the appearance of an idiopathic newborn hyperbilirubinaemia could not be established.

Thirty-one patients who presented with acute glomerulonephritis have been reviewed with respect to the involvement of the streptococcus in their disease. The high incidence of the condition and the fact that 76 percent of the patients had evidence of streptococcal infection, as indicated by a raised anti-streptolysin O-titre is discussed.

A.S.O. titers were determined in 93 children with various kidney diseases. In addition, 52 children without renal disorders were investigated as controls. In the children with renal disease, 38 suffered from the "idiopathic", "primary" nephrotic syndrome of childhood. Thirteen had acute, post-infectious glomerulonephritis, 16 had "primary" chronic glomerulonephritis, 3 had pyelonephritis, and 1 had disseminated lupus nephritis. In acute glomerulonephritis, with or without N.S., the titers were higher than in the controls, which is known and consistent with the frequency of preceding streptococcal infections. Children with chronic glomerulonephritis, with and without associated N.S., did not show a similar tendency to increased values. All patients but one with "primary", , "idiopathic" N.S. of childhood had titers of less than 100. They were between 50 and 12 Todd units. These titers were observed early during the course of the disease and persisted for years in spite of remissions. They were not related to concomitant antimicrobial therapy, nor to corticosteroid administration. In "idiopathic" nephrotic syndrome of childhood a titer of less than 100 does not, in itself, lead to the diagnosis of a N.S. of childhood. However, a greater than 100 titer speaks against it and may well serve as a valid indication for a renal biopsy, in order to differentiate this disease from acute glomerulonephritis, and also from R.P.G.N. whenever they are associated with a N.S. The low titers are only of value in differentiating the "primary" form of the N.S. from the "secondary" forms which are preceded by chronic renal disease or which are due to another underlying, systemic disease. In nephrotic children less than 6 years of age, the less than 100 A.S.O. titers may also be due to their age.

The distribution of serum antistreptococcal esterase titers in healthy school children, aged 10 to 12, and in healthy adults was determined by the method used by Hayano and Tanaka. The upper limit of its normal titer value was 600 ASE units in the children and 500 ASE units in the adults, and its diagnostic levels were over 600 ASE units in children and over 500 ASE units in adults. There was no close correlation between ASE and ASO or ADN-B.

We are conducting prospective studies of patients in Santiago, Chile, who have had an attack of rheumatic fever and are receiving continuous secondary prophylaxis with monthly injections of benzathine penicillin G. Throat cultures are obtained just prior to injection each month, and serum antistreptococcal antibody titers (antistreptolysin O and antideoxyribonuclease B) are performed at least every 3 months. During the course of these studies we have observed 17 recurrences of "pure" chorea in 10 patients (six girls). In four recurrences the timing of serologic studies and onset of chorea appeared to exclude the occurrence of an immunologically significant group A streptococcal infection within the preceding 6 to 9 months. In one case the period of serologic follow-up was too brief to allow a definite determination. In the remaining 12 recurrences serologic evidence was suggestive or confirmatory of recent streptococcal infection; however, in several instances the titer elevations were quite modest. Our data suggest that in certain chorea-prone patients, Sydenham chorea may recur after streptococcal infections too weak and transient to be readily detectable or, alternatively, after stimuli other than streptococcal infection.

This is a case-report of a gangrene involving muscle and fascia of the left femur due to group A of beta-hemolytic streptococci without visible injury of the skin. The diagnosis was derived from germ-evidence and by course of anti-desoxyribonuclease-B titer.