Douglas W. Voth

Toxic Shock Syndrome in Menstruating Women

Eight adult women became severely ill with an acute, toxic erythroderma during menses. The syndrome was characterized by fever, generalized erythema, profound shock, multiple organ dysfunction, and desquamation occurring several days after the rash had faded. Gastrointestinal and cardiovascular abnormalities were present in all patients; three patients required ventilatory support; dialysis was performed on two; and one patient died. Mild relapse occurred in two patients during subsequent menses; the other patients have recovered without sequelae during follow-up of 6 to 42 months. Cervical colonization or local infection with Staphylococcus aureus is associated with this syndrome.

Extreme hypertrophy of the left atrial appendage: The case of the giant dog ear∗☆

Abstract 1. 1. We have described the case of a fortyseven year old male patient with a huge left atrial appendage herniated through a pericardial defect. This mass was 11 cm. long and was, very probably, the site of an electrical signal. Electrocardiographic evidence of this was best demonstrated by P wave and P-R interval alterations in leads III, aVL and aVF. 2. 2. Following surgical excision, the peculiarities seen in the preoperative electrocardiogram disappeared. 3. 3. This is the first reported instance of such an abnormality which was visualized by angiocardiography and corrected by resection.

EFFECT OF COMBINED MYCOPLASMA PNEUMONIAE AND PNEUMOCOCCAL INFECTIONS IN HAMSTERS

The role of Mycoplasma pneumoniae as an etiologic agent for primary atypical pneumonia in humans is well established. The most common bacterial agent in acute lobar pneumonia is pneumococcus, and the same organism is also frequently recovered from purulent sputums in patients with chronic bronchitis. Intranasal (IN) inoculation of M . pneumoniae in cotton rats or hamsters results in multiplication of the microorganism in respiratory tissues. Some of the inoculated animals may show pneumonic consolidation but no clinical illness.2.9 In our laboratory, when hamsters were inoculated intranasally with 200 M . pneumoniae (F.H. strain) organisms, mycoplasmal multiplication was demonstrable in the nasal turbinates, trachea and lungs on the fourth day after inoculation with an average infectivity titers between 4-6 logs per gram of tissue. (FIGURE 1 ) Larger inoculums may show mycoplasmal colonization in hamster respiratory tissues as early as the first day after inoculation. A strain of type 1 pneumococcus (Pn-1), which was made virulent after serial passages in mice by intraperitoneal inoculations, was used for these experiments. This Pn-1 regularly produced a fatal disease in mice in about 12-14 hours after intraperitoneal inoculation. When 20 organisms of Pn-1 were inoculated intranasally in hamsters, active multiplication of pneumococci was demonstrable in the upper respiratory tract (nasal turbinates and trachea) one day after inoculation and in the lungs from the second day on. (FIGURE 2). These inoculated hamsters did not appear sick clinically, although varying degrees of pneumonic consolidations were seen during autopsy. To investigate the effect of combined mycoplasmal and pneumococcal infection in hamsters, five groups of animals were inoculated as follows: Group A: Pneumococci in a dosage of 2 organisms per hamsters were given intranasally . GroupB: Same as Group A, but 20 pneumococci per hamster were given intranasally , Group C: M. pneumoniae in a dosage of 200,000 organisms per hamster were given intranasally. Group D: M . pneumoniae given intranasally, as in Group C, followed on the fourth day by 2 pneumococci per hamster intranasally. Group E: Same as in Group D, but 20 pneumococci per hamster were given. At one or two-day intervals, two hamsters from each group were killed by intraperitoneal injection of 10 mg pentobarbital sodium. The axillary artery was severed and blood was collected aseptically for pneumococcal bacteremia titrations. An aliquot of blood was also inoculated in PPLO broth for M. pneumoniae growth. The lungs were examined closely for pneumonia and a 10% suspension was made and titrated in sheep blood agar plates or PPLO broths,4 for quantitative determinations of pneumococci and mycoplasma, respectively. Results on pneumococcal bacteremia in this experiment are summarized in