Herbert M. Sommers

Electrolyte Alterations in Acute Myocardial Ischemic Injury

The electrolyte shifts occurring in myocardial cells irreversibly injured by ischemia were compared in two groups of dogs; one given 40 minutes of transient ischemia followed by 20, 50, 80, and 200 minutes of restored coronary arterial flow and the other 30, 60, 90, 130, and 240 minutes of permanent ischemia. Each interval of restored arterial flow in the transient ischemia group was associated with marked changes in the electrolyte content of the injured myocardium. Sodium, chloride, and water were increased and potassium and phosphorus were decreased. These changes occurred much more quickly in dogs exposed to transient ischemia than in dogs with comparable periods of permanent ischemia. These data indicate that objective chemical evidence of the death of myocardial cells develops slowly in areas of permanent ischemia primarily because of the reduced flow of blood through the ischemic injured tissue.

Hypoplastic left ventricle syndrome: Analysis of thirty autopsy cases in infants with surgical considerations☆

Abstract Physiologic and anatomic data of 30 infants with hypoplastic left ventricular syndrome who underwent autopsy have been reviewed, and a possibly effective surgical palliative measure is proposed. Provision of an unobstructed interatrial communication for free left to right shunting of pulmonary venous blood to the right side of the heart is the first objective. Provision of continuing right to left shunt at the ductus level, sustained by high resistance to pulmonary artery blood flow, is the second. Surgical banding of both pulmonary arteries distal to the ductus is recommended.

Prolonged evaluation of patients with corticosteroid-dependent asthma stage of allergic bronchopulmonary aspergillosis

Eight cases with stage IV allergic bronchopulmonary aspergillosis (ABPA) (corticosteroid-dependent asthma stage) were observed for a total of 82 patient years with individual patients observed for 7 to 19 years (mean 10.2) years. One case is the first case of ABPA diagnosed in the United States in 1967. A second case has been observed through four stages of ABPA. None of these eight cases has demonstrated pulmonary deterioration by clinical, chest roentgenogram, or pulmonary function analysis. After diagnosis, the maintenance dose of prednisone in seven of eight cases was a low to moderate dose alternate-day prednisone. These results suggest that continuous observation and management of episodes of pulmonary consolidation or asthma exacerbations may prevent the progression of ABPA to stage V (fibrotic end stage). The total IgE may remain elevated in these patients, and therapy should not attempt to reduce total serum IgE to normal levels. After prolonged therapy with prednisone for asthma and control of ABPA, the IgE and IgG antibody indices against Aspergillus fumigatus may remain elevated or may be below the levels that are of diagnostic value.

Woodman's disease: Hypersensitivity pneumonitis from cutting live trees

A 28-year-old man developed multiple episodes of fever, cough, shortness of breath, and leukocytosis several hours after cutting live oak and maple trees. Fungal cultures of wood chips from oak and maple trees were positive for Penicillium (three species), Paecilomyces sp., Aspergillus niger, Aspergillus sp., and Rhizopus sp. Gel-immunodiffusion studies demonstrated serum precipitins to extracts of oak chips, Penicillium sp., and Paecilomyces sp., and suggested that Penicillium sp. and Paecilomyces sp. shared cross-reactive antigens that were the significant antigens in the oak chips. ELISA studies demonstrated elevated serum levels of IgG to an oak chip extract, inhibition of that ELISA by preincubation of serum with Penicillium sp., and absence of elevated IgG levels to an extract of freshly cut oak wood that had been stripped of bark to minimize mold contamination. The case analysis indicates that the patient likely had hypersensitivity pneumonitis on exposure to Penicillium sp., when he was cutting trees, and identifies cutting live trees as another occupational exposure that may cause hypersensitivity pneumonitis.

Eikenella corrodens Osteomyelitis

Excerpt To the editor:Eikenella corrodensis a facultatively anaerobic Gram-negative bacillus recently recognized as part of the normal oronasopharyngeal flora, and as an occasional pathogen, in man...

Antibody activity in sera of patients with humidifier disease: Studies of the water supply as a source of antigens

In 5 patients with respiratory symptoms consistent with humidifier or air conditioner disease, a hypersensitivity pneumonitis, no identifiable organism was cultured from the humidifier water (HW). The water source to the humidifier or air conditioner was investigated for possible antigens which might explain the occurrence of the disease. Three subjects who lived in the same city supplied by Lake Michigan had increased IgG antibody activity against the city water supply when compared with another patient from a different city and a control subject. Both of the latter lived in cities with water supplied from Lake Michigan. Two of the 5 patients showed definite inhibition by concentrated tap water (TW) of IgG antibody against HW. The source of antigens in water was not determined but must be considered in cases of this type of hypersensitivity pneumonitis. A sixth case consistent with humidifier disease had Cephalosporium cultured from her HW. On gel diffusion there was a band of identity with her serum against Cephalosporium extract and her own HW, and by radioimmunoassay (RIA) there was over 50% inhibition of her IgG antibody activity against HW by Cephalosporium. No antibody against her city TW was demonstrated.

Hyperimmunoglobulinemia E in a child with allergic bronchopulmonary aspergillosis and bronchiectasis

A 12-year-old boy was hospitalized for resection of a bronchiectatic lesion. Investigation of an elevated cencentration of serum IgE led to a diagnosis of allergic bronchopulmonary aspergillosis. ABPA has rarely been described in the pediatric age group. This hypersensitivity lung disease is characterized by intermittent wheezing, fever, recurrent pulmonary infiltrates, eosinophilia, hyperimmunoglobulinemia E, and Type I (allergic) skin reactivity to aspergillus extract. Hyphae of aspergillus may also be found in expectorated brown mucus plugs. Type III (Arthus) skin test response and presence of precipitating antibody to this fungus may be demonstrated. Central bronchiectasis or pulmonary fibrosis may result from uncontrolled progression of this disease.

Mitogen-induced Lymphocyte and Cutaneous Reactions in Dogs

The lymphocyte response of dogs to mitogens was determined using separated lymphocyte and whole blood lymphocyte proliferation techniques. Reactivity to optimal doses of the following mitogens was demonstrated in decreasing order of intensity: phytohemagglutinin, Pokeweed mitogen, conconavalin A and sodium periodate. The canine cutaneous reactivity to these mitogens was also determined. Grossly, erythema and induration with all mitogens was maximal at 24 h. Microscopically, lesions using all mitogens consisted of edema, hyperemia and diffuse dermal infiltration with polymorphonuclear leukocytes and mononuclear cells. These mitogen-induced lesions may represent a specific lymphocyte-mediated inflammatory response, although a nonspecific reaction cannot be excluded.

1-N-(S-3-amino-2-hydroxypropionyl) gentamicin B (Sch 21420): A collaborative in vitro susceptibility comparison with amikacin and gentamicin against 12,984 clinical bacterial isolates

Schering Compound Sch 21420 is an aminoglycoside with antibacterial activity similar to amikacin but with a potential for renal toxicity lower than that of gentamicin. The in vitro activity of Sch 21420, amikacin, and gentamicin was compared with 12,984 bacterial isolates from six clinical laboratories. Agar dilution and broth microdilution techniques were both used with comparable results. Against most of the Enterobacteriaceae, Sch 21420 had equal or only slightly greater activity than amikacin.Proteus species were generally more susceptible to amikacin and gentamicin. Gentamicin was more active against most isolates included in this study.Pseudomonas aeruginosa recovered in the different institutions showed marked variations in susceptibility to gentamicin; amikacin and Sch 21420 were effective against most gentamicin-resistant strains that produce inactivating enzymes: but all three drugs were ineffective against permeability mutants. If diminished renal- and ototoxicity are confirmed, Sch 21420 promises to be a welcome addition to the antibiotic armamentarium.

Effect of clavulanic acid on the susceptibility of clinical anaerobic bacteria to ticarcillin: A multicenter study

Over 2,000 recent clinical isolates of anaerobic bacteria were tested at five medical centers for susceptibility to ticarcillin, ticarcillin plus clavulanic acid, clindamycin, and metronidazole. At 64 micrograms/ml, ticarcillin inhibited 92% of all isolates, but 98% were inhibited at this concentration when 2 micrograms/ml of clavulanic acid was added. With different Bacteroides species, clavulanic acid reduced ticarcillin MICs 2- to 32-fold; other anaerobic species were not significantly affected.