Sidney Leibowitz

Infectious mononucleosis: The value of differential absorption tests in its serologic diagnosis

Abstract 1.1. The sheep cell agglutination test is preeminent in the diagnosis of infectious mononucleosis. 2.2. Absorptions with guinea pig kidney and beef cell antigen suspensions, greatly enhance the specificity of the sheep cell agglutination test in the diagnosis of infectious mononucleosis. 3.3. The use of the absorption tests as part of the examination of serum for heterophile antibodies is routinely indicated whenever the antibody titer is 1:896 or lower. This indication rests on the reported identification of normal Forssman antibodies in diseases other than infectious mononucleosis at titers up to this level. 4.4. In the absence of suspicion of serum sickness a titer of 1:1792 or higher may, for practical purposes, be presumed to be diagnostic of infectious mononucleosis. Absorption of the antibodies at any titer is necessary to differentiate serum sickness antibodies from those of infectious mononucleosis. 5.5. Under certain special circumstances absorption tests should be employed even in cases which reveal titers of 1:1792 or higher.

The effect of intravenous aminophylline on the capacity for effort without pain in patients with angina of effort.

Abstract 1. 1. An intravenous injection of 0.24 Gm. aminophylline increases the capacity for effort without pain in patients with angina of effort. There are fairly marked individual variations in this response. 2. 2. The increased capacity for effort without pain lasts longer than one hour.

Infectious mononucleosis: Report of case with first appearance of significant numbers of heterophil antibodies and abnormal lymphocytes (“virocytes”) in seventh week of illness

Abstract 1.1. A case is presented of a twenty-one year old female with infectious mononucleosis in whom the diagnosis could not be established until the seventh week of her illness when diagnostically significant numbers of abnormal lymphocytes and heterophil antibodies were first detected in the peripheral blood. 2.2. This delayed appearance of significant numbers of abnormal lymphocytes and heterophil antibodies is unusual in infectious mononucleosis. 3.3. The case serves to emphasize that in diagnostic problems in which infectious mononucleosis enters into the differential diagnosis it is important to persist with these hematologic and serologic examinations at least into the third month of illness.

An evaluation of the meulengracht regime in the treatment of bleeding peptic ulcer

1. The results obtained in a series of 21 cases of bleeding peptic ulcer treated with the Meulengracht regime are presented. These are compared with a control group of 72 cases treated with the older “star-vation-Sippy” method. 2. Mortality statistics of all cases treated with the Meulengracht regime, thus far reported in the literature, are presented. These are compared with similar statistics for the older methods of treatment. 3. The mortality rate in the Meulengracht series was 4.76 per cent. This is a decided improvement over the 11.1 per cent mortality in the control group. 4. The patients receiving early liberal feedings manifested a well-being not noted in those under the older method of treatment. 5. The average period of hospitalization was not decreased under the Meulengracht regime. 6. Two of our 21 cases (9.5 per cent) were further complicated by the occurrence of perforation, whereas this occurred in only one patient in our control series (1.4 per cent). The possible role played by the increased feedings is considered.

Weil's disease: Report of five cases

Abstract 1.1. Five cases of Wells disease are presented, with postmortem findings in the one fatal case. 2.2. Diagnosis was accomplished by serum agglutination tests in four of the patients and by postmortem microscopic examination of lung scrapings in the fifth. 3.3. Unusual clinical features noted in one or more of the patients include maculopapular skin eruption, pyelonephritis, persistent impairment of urinary concentrating ability and severe alopecia. Optic neuritis complicated one case. 4.4. In two of the patients a clearcut contact with rats was indicated. 5.5. Penicillin treatment was employed in one patient.

Pericardial effusion due to hemolytic streptococcus following an acute upper respiratory infection: Associated pleural effusions

Abstract 1. 1. A case is presented of a 52-year-old man with pericardial and pleural effusion which followed an acute upper respiratory infection. Culture of the pericardial fluid yielded a hemolytic streptococcus. Treatment with penicillin was successful. 2. 2. The literature is reviewed, and the rarity of isolation of the hemolytic streptococcus from the pericardial effusion in such cases is stressed.

COMPLICATIONS FROM CHLORPROMAZINE-Reply

To the Editor:— The comment by Dr. Trimble is of interest. The observation of fasting hyperglycemia early in the course of our patient with chlorpromazine-induced jaundice led to the performance of a glucose tolerance test on the 10th day of her illness. This was typical of diabetes mellitus. It was duplicated when the test was repeated on the 42nd day after the onset of illness when all evidences of liver dysfunction had disappeared and she had long abstained from the drug. Available follow-up information failed to clarify whether this hyperglycemia and abnormal glucose tolerance were transient or persistent. No similar data have been obtained thus far since her discharge. At no time did random urine samples reveal glycosuria, either during the illness or in the follow-up period. There was no diabetic history prior to the illness and no family history of diabetes. In preparing our paper we were at first

An advisor (preceptor) program for interns at a general hospital.

• A program was worked out whereby a staff member, designated as the monitor, assigned each of 16 interns to a staff advisor or preceptor. Each preceptor was expected to function as a mature, experienced advisor in personal contact with the neophyte in medicine, to discover dissatisfactions, and to submit reports on the progress of the intern and of the program. After a year of operation, the program was enthusiastically endorsed by interns, preceptors, administrative officers, and monitor. Maladjustments were recognized and corrected early, and the interns fulfilled their assignments well, derived much benefit from their first year, and stimulated their teachers and preceptors to greater efforts.