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Budd-Chiari syndrome, hypertension, and thrombocytopenia developed in a 6-year-old girl as manifestations of primary antiphospholipid antibody syndrome (APS). She improved with systemic corticosteroid and anticoagulation therapy. Anticardiolipin antibodies were found in the patient, her mother and 3 siblings, suggesting the importance of genetic factors. The clinical features of an APS in children is reviewed.

In three of eight patients with the acquired immune deficiency syndrome the Pneumocystis carinii pneumonia treated with intravenous trimethoprim sulfamethoxazole, drug-related reactions occurred 9, 10, and 13 days after therapy. The symptom complex consisted of a maculopapular eruption, fever, eosinophilia, and leukopenia. Oral desensitization with graded doses of trimethoprim sulfamethoxazole was successfully achieved in two of the three patients.

Faced with 1-year daily medication diaries from over 300 patients, each documenting the use of from one to five medications a day, we found it was necessary to devise a system which would reduce this data into a form which would allow a meaningful interpretation of changes of medications in a single patient or group of patients. Since the medications were principally steroids, beta agonists, or xanthines, representative agents were chosen as the standard for each class and the other medications were rated against them. A conversion factor was then determined to allow comparison between classes. Each medication taken by a patient could now be expressed as a single number and the sum of all the medications would be the individual's Asthma Medication Index. The AMI allowed (i) evaluation of a single patient over time, (ii) comparison of different patients at any single point or over a period of time, and (iii) evaluation of entire groups of patients over time as was the case in our evaluation of Zaditen. Application of the system allowed the differentiation of two therapeutic agents versus placebo during a 1-year study, revealing excellent correlation with the physician's global assessment of the patient's improvement. With proper modification of the basic drug groups and intergroup factor relationship, the Index can be adapted to any disease state where a change in concomitant medication is an indicator of therapeutic effect.

Cromolyn sodium is a recently introduced drug used in the prophylactic treatment of severe, perennial, bronchial asthma, particularly in the pediatric age group. In a multicenter trial, 276 chronic asthmatic patients of eight pediatric allergists entered a randomized, double-blind, placebo-controlled, crossover study lasting 12 weeks. Test compounds of cromolyn sodium or placebo were inhaled four times a day, and daily scores were kept of symptom severity as well as frequency of use of other medications. Patients had statistically significant lower average daily symptom scores when treated with cromolyn sodium as compared to treatment with placebo. A strong subjective preference for cromolyn sodium was expressed by 60% of those completing the trial, versus 9% for placebo. The patients' need for other symptomatic medications also dropped significantly during the cromolyn treatment period.

The sera of 20 atopic patients, 10 with hypersensitivity symptoms upon ingestion of milk and 10 without such symptoms, were tested by a radioimmunoassay for the detection of IgE antibodies to whole bovine milk, betalactoglobulin (BL), enzymatic digests of BL and fractions thereof. While only 4/10 patients had IgE antibodies to undigested BL all 10 patients had IgE antibodies to BL digests. All controls gave negative results. These findings suggest that enzymatic digestion of BL may yield antigenic fractions which elicit IgE antibodies and that these antibodies would be missed if the undigested food protein were to be used solely in testing.

Terbutaline tablets and oral solution were tested in 16 subjects between the ages of seven and 15 in a double-blind acute cross-over study. Doses of terbutaline were 2.5, 3.75 or 5.0 mg depending upon the weight of each subject. Both formulations produced significant increases in pulmonary function between 15 minutes and five hours after drug administration as measured by FVC and FEV1. The mean maximal increase in FEV1 was 0.60 liters for the tablet and 0.70 liters for the solution. The mean maximal increase in FVC was 0.53 liters for the tablet and 0.67 for the solution. There were significant increases in heart rate following both tablet and solution. The mean increases were statistically significant between two and five hours after drug administration, ranging from two to nine beats/minute for the tablet and eight to 13 beats/minute for the solution. Terbutaline produced no clinically or statistically significant mean changes in systolic or diastolic blood pressure. The responses to tablet and solution did not differ significantly from each other in any parameter. Terbutaline tablet and oral solution were, therefore, bioequivalent.

Autoantibodies to equine cytochrome c and to porcine malic dehydrogenase are shown in equine and porcine serum, respectively, by immunodiffusion. A confluence of arcs between human plasma and rabbit, horse and pig serum against these antigens suggests the presence of antibodies in human plasma to cytochrome c and malic dehydrogenase. The use of tris buffer containing a low concentration of Dodecyl sodium sulfate for cytochrome c and of glycerol for malic dehydrogenase maintains their solubility and enhances their participation in antibody-antigen immunoprecipitation possibly by unravelling the peptide chains and exposing reactive antigenic determinants hidden within the interstices of the cytochrome c and malic dehydrogenase molecules.

A factor capable of effecting passive transfer in vivo of delayed hypersensitivity to tuberculin to recipients that are tuberculin negative was isolated from the dialyzate of disrupted leukocytes of tuberculin-positive individuals. After this factor was incubated with cultures of peripheral leukocytes from tuberculin-negative individuals, the addition of purified protein derivative of tubercle bacilli resulted in leukocyte stimulation similar to that observed after addition of purified protein derivative to leukocytes from tuberculin-positive individuals.