Edward C. Rosenow

Amiodarone pulmonary toxicity

The amount of literature on amiodarone pulmonary toxicity (APT) peaked in 1983-1984 with several hundred cases reported cumulatively, and declined thereafter. Since the mid-1990s, publications have increased, which suggests that APT remains a current problem in clinical practice. Amiodarone remains difficult to diagnose noninvasively, and although the outcome is good in the majority of patients, not all cases of APT can be controlled satisfactorily.

Acid maltase deficiency in adults presenting as respiratory failure.

During the past nine years 10 patients with the adult form of acid maltase deficiency have been observed at the Mayo Clinic. Three of the adults presented with respiratory failure. In all three the respiratory manifestations dominated the clinical picture and the cause of the respiratory failure (muscle weakness) and the underlying myopathy (glycogen storage disease) were initially unsuspected. Careful evaluation of the respiratory function tests, including the maximal static respiratory pressures, electromyographic examination and histochemical and biochemical studies of muscle biopsy specimens eventually led to the correct diagnosis.

Studies on Elective Localization Focal Infection with Special Reference to Oral Sepsis

Introduction............................................................... 205 Description of the experiments and their results................................ 209 Method for the bacteriologic study of dental infections...................... 210 Localization of bacteria from dental foci of infection......................... 213 Localization of bacteria in pus expressed from tonsils and in emulsions of extirpated tonsils directly injected into animals............................... 214 Illustrative cases and experiments........................................ 218 Summary and discussion ..................................................... 233 Experimental findings.................................................... 233 Clinical findings............................. . .................. 242 Therapeutic suggestions........................... 243 Bibliography................................................................. 247

Elective Localization in Determining the Etiology of Chronic Uveitis

In many cases streptococci having elective localizing power have been isolated in uveitis, especially in the acute form. Different foci have been found. The most frequent were teeth, tonsils, prostate, or cervix. Removal of these foci and treatment with autogenous vaccines prepared from the involved eyes of rabbits that had received injections, have been generally efficacious. From the Division of Experimental Bacteriology, The Mayo Foundation. Read in a symposium on chronic uveitis at the second annual meeting of The Association for Research in Ophthalmology, Philadelphia, June 9, 1931. The Mayo Foundation.

Drug-induced bronchopulmonary pleural disease.

More than 75 drugs are known to have adverse effects on the bronchopulmonary pleural system. Many of these drug reactions are fatal unless they are recognized, administration is stopped, and other measures are instituted. No data exist on the number of adverse drug reactions on the lung, because there is no mandatory reporting system in the United States. Probably less than 5% are reported. The clinician should be aware of the drugs that can produce adverse reactions on the lungs and stop the administration as soon as possible. In this article, I have classified the drugs known to produce adverse pulmonary effects as follows: chemotherapeutic, cardiovascular, antibiotic, and anti-inflammatory agents, drugs known to induce systemic lupus erythematosus, inhalants, illicit drugs such as heroin, and miscellaneous drugs. There are no blood tests or other means of diagnosing adverse drug effects on the lung. Chest roentgenographic findings are nonspecific. Pulmonary function abnormalities generally correlate with the degree of dyspnea and chest roentgenographic changes. Therefore, the clinician trying to explain the onset of pulmonary symptoms must be aware of the drugs the patient is taking.

Etiology of muscular spasms during general anesthesia

I N 1880, Humphrey first noted muscuIar activity of a trembIing yet rhythmic type occurring during the administration of ether by inhaIation. During the years of the WorId War this manifestation was reported by several observers.l~3~6~Q*37~‘8,‘Q The condition is known as “ether cIonus” or “ether rigor”; it usuaIIy occurs in the course of induction of anesthesia; the tremor frequently is limited to the Iower Iimbs and ceases as anesthesia deepens. In 1916, Mytinger reported his experiences in anesthetizing IOO patients suffering from idiopathic epiIepsy. Epileptiform convuIsions occurred frequentIy in the stage of induction of anesthesia. In rgzz, Patch reported 2 caSes in which epiIeptiform convuIsions occurred in the course of anesthesia, in onIy one of which was epiIepsy known to be a factor. Both patients recovered. It is in this group of individuals who do not have epiIepsy that we are particuIarIy interested at this time. In 1927 WiIson, anesthetist at Manchester Royai Infirmary, reported 4 cases in which “ether” convuIsions were fataI in 1926. Pinson, on the same date, reported 15 cases in which convulsions occurred in the course of genera1 anesthesia, in nine years experience, incIuding I 1,000 administrations. FoIIowing the appearance of these articles, 12 more cases appeared in the Iiterature in 1927, 13~21~23~24~28~34~38~45~48~53~70~84 g in

Bacteriologic Studies in Myasthenia Gravis

Summary A constant hyperglycemic blood sugar level of about 215 mg. % is attained in about 2 weeks after removal of the tail, body, and most of the head portion of the pancreas of month-old rats. Hypophysectomy restores the blood sugar level to about 98 mg. % which is in the normal range (102 mg. %). Hypophysectomy without pancreatectomy results in hypoglycemia unless sugar additional to that used in the diet of normal rats is added.

Acute poliomyelitis studies of streptococci isolated from throats and raw milk in relation to one epidemic

Summary The results of an epidemiologic and experimental study of an epidemic of poliomyelitis, apparently due to raw milk, are reported. The etiologic importance in acute epidemic poliomyelitis of streptococci having characteristic cataphoretic velocity and virulence and specific antigenic properties, that have been described repeatedly previously, is again emphasized by the results of this study.

Streptococci in the Lesions of Experimental Poliomyelitis in Monkeys

Thorough search for bacteria has been made in stained sections of the central nervous system of 60 monkeys in which symptoms and lesions of varying degree, typical of poliomyelitis, had developed following inoculation of virus. Unmistakable Gram-staining cocci and diplococci of varying size, shape and grouping, were found in or adjacent to lesions in 54 of the 60 monkeys. The lesions in the 6 in which diplococci were not demonstrable in the sections available were relatively slight. Three of these 6 died, 12, 18, and 21 days, respectively, after onset of paralysis; the remaining 3 had mild attacks of poliomyelitis and were despatched by anesthesia, respectively on the tenth, eleventh and fourteenth day after the onset of the disease. Of the 54 monkeys in which diplococci were found, 31 were despatched by anesthesia and 23 died from paralysis. A similar search was made for bacteria in sections of the central nervous system of 60 monkeys in which there were no active lesions of poliomyelitis. These 60 animals were used as controls; 32 were despatched by anesthesia and 28 died from various causes other than poliomyelitis. In none of the sections from the 60 monkeys used as controls were diplococci demonstrable.

Serologic Studies with Streptococci Isolated in Cases of Myasthenia Gravis

Green-producing streptococci from the muscles, foci of infection, and nasopharynges of patients with myasthenia gravis were isolated by methods already described. 2 A carbohydrate was extracted from a number of these freshly-isolated strains by the following method: The sedimented growth from 3 liters of dextrose-broth was treated by boiling in physiologic salt-solution for one hour and the bacteria were then removed by centrifuging. The supernatant fluid was cooled and proteins were precipitated by adding glacial acetic acid until a cloud appeared. The proteins were then removed by centrifuging and the carbohydrate was precipitated by adding 2 volumes of 95% alcohol and a small amount of sodium acetate. After a good flocculation appeared the mixture was centrifuged. The carbohydrate sediment was then dissolved in water, reprecipitated with alcohol and sodium acetate, and then redissolved in water, this procedure being carried out 5 or 6 times. The final precipitate was dried in a stream of air and dissolved in 10 cc. of physiologic salt-solution; it was then ready for use as antigen. The activity of the carbohydrate was greatest in freshly-made solutions; it decreased about one-fourth when kept at room temperature for 2 weeks. Precipitation occurred with the carbohydrate from myasthenia gravis strains in 30% of 31 tests made with serums from 15 persons who had myasthenia gravis, in 15% of 20 tests made with serums from 11 persons having disease other than myasthenia gravis, thought to be attributable to green-producing streptococci, and in no instance in 12 tests made with the serums from 7 normal controls. Precipitation occurred with the carbohydrates from strains of green-producing streptococci isolated from persons having disease other than myasthenia gravis in 15% of 32 tests made with the serums from 15 persons who had myasthenia gravis, in 7% of 14 tests made with the serums from 11 persons having disease other than myasthenia gravis, and in no instance in 6 tests made with the serum from 6 normal controls.