Nathan Rosenthal

Generalized giant lymph follicle hyperplasia of lymph nodes and spleen: A hitherto undescribed type

T HE clinical picture of a general adenopathy associated with enlargement of the spleen is encountered in a variety of disease conditions. The chronic diseases in adult life in which this association of symptoms is dominant are the leukemias, the infectious granulomas (under which are included Hodgkin’s disease, syphilis and tuberculosis) and lymphosarcomatosis. However, in the last ten years we have accumulated three instances of a general adenopathy with splenomegaly which do not represent any of the groups just mentioned, and furnish examples of a condition which we believe has escaped recognition or at least, if seen, has not been reported or recorded as a disease entity. We base this statement on the fact that a diligent and conscientious search of the literature has failed to reveal more than one instance identical with, or even similar to, the group that is presented here. This case was reported by Becker’ in 1901. A lymph node was removed during life, three years after onset of the disease, and considered as hyperplastic by the pathologist. The adenopathy and splenomegaly subsided somewhat after arsenic medication. We have assumed the responsibility of naming this condition splenomegalia lymphatica hyperplastica. Localized hyperplasia of lymph nodes of long standing (so-called lymphomas) has been re-

Intradermal Venom Reaction. A New Method of Determining Capillary Fragility

Summary A new capillary fragility test based on intraderimal injections of titrated moccasin snake venom is described. This test was found helpful in the niaiiagement of thrombocytopenic purpura heniorrhagica. Its applicability as a guide to local, general and toxic capillary changes is discussed.

Nature of Peripheral Resistance in Arterial Hypertension

The arteriolar hypertonus responsible for hypertension is to be explained by one of the following mechanisms: 1. Increase in sympathetic vasoconstrictor impulses. 2. Circulating pressor substances. 3. A local disturbance in the vessels themselves. The first factor has been ruled out since anesthetization of vasomotor nerves does not release the vascular hypertonicity. 1 That there is no increase in circulating pressor substances in the blood of patients with hypertension is indicated by the following experiments. Direct cross transfusions were performed between patients with malignant hypertension and subjects with normal cardiovascular systems (these subjects had inoperable carcinomata). Two Unger sets were employed simultaneously so that at no time was there an appreciable change in blood volume in either patient. Four such procedures were carried out, the amounts of blood interchanged being 500, 700, 1460 and 2000 cc. respectively. Congo red was injected into one subject before the transfusion. Forty-two percent of the dye was found in the blood of the other subject at the completion of the experiment. If hypertension is due to a circulating pressor substance, a rise in blood pressure should be expected in the normal subjects with large amounts of hypertensive blood and a fall in pressure in the hypertensive patients with equivalent amounts of normal blood. No such changes were observed in either group. Experimental hypertension was produced in dogs by the Goldblatt technique. 2 The tails of such dogs were then perfused alternately with their own heparinized or citrated arterial blood and with blood from normal dogs. A constant volume pump was used and the pressures required to force the blood through the tissues compared. In 4 instances the blood from the hypertensive dogs had a depressor effect and in one case a pressor effect as compared with blood from normal dogs.

ROLE OF MERCAPTOPURINE IN THE TREATMENT OF LEUKEMIA AND RELATED DISEASES

The initial dosage of 6-MP was 2.5 mgm./kg./day. This dosage was usually maintained for at least four weeks, depending upon the patients response. If the leukocytes were depressed or if marked improvement occurred, the dosage was reduced to a quantity as low as 0.5 mgm./kg./day. In general, no untoward effect was noted following administration, except in two patients not included in this series, who discontinued the drug because of nausea. In general, other drugs were stopped during the use of 6-MP except in patients having acute leukemia and thrombocytopenia. These patients were given moderate doses of oral cortisone ranging from 25 to 75 mgm. daily in conjunction with the

The effect of pancreatic rennet on blood coagulation

At the last meeting of this society, one of us 1 presented certain observations on pancreatic rennet. Particular stress was laid on the state in which the rennet probably exists in pancreatic extract, and its intimate chemical association with trypsin. In speaking therefore of the pancreatic rennet we wish it understood that it is the rennet-trypsin unit and not the rennet alone that we are dealing with. Mention was also made of the absolute dependence of the milk coagulating function of rennet on the calcium ion. The theoretical considerations which have prompted the present investigation will be discussed fully at another time and place. Suffice it to say for the moment that rennet (as a class) appears to be widely distributed in nature, in the animal as well as in the vegetable kingdom. In the latter, its native function often seems to be that of a coagulant of the sap of the plant in which it exists, a process comparable, in some respects, to that of blood coagulation. Our first attempt to discover the effect of pancreatic rennet upon the coagulation of the blood consisted in the following simple experiment. A small quantity of the purified pancreatic rennet was added to a portion of blood freshly drawn from the cubital vein of an hemophilic individual, and the coagulation time noted. We found that whereas the blood in the control tube required I hour and 20 minutes for coagulation, the specimen to which the rennet was added clotted in 90 seconds. The result was so striking that we determined to make a careful investigation of the phenomenon. In a study of the effect of various tissue extracts on blood coagulation, Mills 2 found that a saline extract of pancreas has very slight coagulating power for blood.