Sten Winblad

Studies in mitral stenosis: VI. Pulmonary vessels in mitral stenosis

Abstract 1. 1. The first fifty consecutive patients operated upon for mitral stenosis by the same surgeon were analyzed as to the state of the lungs preoperatively, pulmonary complications at the time of operation, and present results of the surgical intervention. 2. 2. Pulmonary complications were regarded as the predominant cause of postoperative disturbances and deaths. The reasons for this are discussed. 3. 3. In the majority of patients a biopsy of the lingula was obtained for histologic study at the time of operation. The findings at preoperative examinations of the lungs were correlated with the histologic findings. The value of the various examinations was analyzed and evaluated on the basis of structural changes of the lung. 4. 4. All fatal cases and the majority of patients with severe pulmonary complications showed pulmonary changes histologically. In our material, morphologically abnormal lungs have proved to be particularly vulnerable in connection with operation. If the pulmonary complications are overcome, however, the prospect of a satisfactory response is as good in this group as in the other. 5. 5. Angiopulmography was carried out in most patients and yields more pathologic findings than do the lingula biopsies. There is a good agreement between the findings of these two examinations in spite of the fact that they cover different parts of the pulmonary structure. The reason for this correlation is discussed and the value of angiopulmography for the evaluation of changes in the pulmonary vessels is emphasized. Pathologic angiopulmograms seem to occur more often and earlier than the structural changes in the lungs. Chest radiograms yield less information and are difficult to evaluate. As pulmonary complications were more frequent in the biopsied group and the lingula biopsies in general gave little additional information, this procedure is now abandoned. 6. 6. Among other clinical examinations carried out in order to evaluate the state of the lungs, the arterial oxygen saturation level was found most informative. A decreased oxygen saturation occurred only with concomitant morphologic changes. Data as P.V.R. and cardiac index, as well as duration of symptoms, age, and functional group of the patients were of moderate value, whereas mean pulmonary arterial pressure and the remaining data referred to in this paper were noninformative. 7. 7. The further development of preoperative functional pulmonary tests is emphasized.

Studies in mitral stenosis. II. Observations on incidence of active rheumatic carditis in left auricular appendages resected at operation for mitral stenosis

Abstract The possibilities of clinical and laboratory diagnosis of active rheumatic processes in the heart of each patient to be operated upon for mitral stenosis are discussed on the basis of biopsies from left auricular appendages, resected at operations for mitral stenosis. Rheumatic activity was found to be present in spite of negative clinical and laboratory findings. Pathologic sedimentation rate or antistreptolysin titers alone should not be regarded as positive evidence of such activity. Long-term follow-ups are necessary to evaluate the importance of active rheumatic endocarditis for the prognosis in operated cases of mitral stenosis.

Listeriosis during pregnancy and neonatal period in Sweden 1958--1974.

Abstract. In 1958–1974 altogether 46 cases of bacteriologically verified infection of Listeria monocytogenes were diagnosed during pregnancy and the neonatal period. Eight pregnancies resulted in abortion and three in stillbirth. Thirty‐seven children were born alive, 17 of whom died, all but one within a few days. These children were divided into three groups according to their age at the onset of illness: 22 cases with “Early disease” (≤2 days), four cases with “Intermediate disease” (3–5 days) and eight cases with “Late disease” (≤6 days). Three children were apparently healthy. Septicemia or “Granulomatosis infantiseptica” dominated in “Early disease” and claimed as many as 13 deaths. In “Late disease” all the children had meningo‐encephalitis, and only one of them died. The symptoms were typical of purulent meningitis. The group of “Intermediate disease” consisted of overlapping cases of the other two groups. Ampicillin alone or combined with gentamicin seemed to be the drug of choice in the therapy of neonatal listeriosis. Of the surviving children, two were seriously damaged and two had moderate injuries. Fifteen children are apparently healthy. In cases where pregnancy terminated in abortions, stillborns or children with “Early disease”, the mothers often showed signs of infection. The mothers of the children with “Late disease” were apparently healthy. These children were infected from other sources, some of them nosocomially. If listeriosis is diagnosed during pregnancy, the women should be treated with ampicillin.

A simple routine method for detecting hidden rheumatoid factors

A new and simple routine method is described for detecting hidden rheumatoid factors in human serum. EDTA glycine and NaCl were used to liberate hidden rheumatoid factors and to inactivate complement before rheumatoid-factor activity was determined in a glycine--NaCl solution. Forty-nine out of 97 sera from individuals with seronegative rheumatoid arthritis gave positive reactions by this method. Rheumatoid sera with low titres by standard tests gave higher titres with the new method. The new method detects both IgM and IgG rheumatoid factors and is simple and suitable for use in routine medical laboratories. Used in parallel with the classical tests, it facilitates detection of hidden rheumatoid factors.

A Suspension of Kaolin Particles Used as a Medium to Detect the Rheumatoid Factor in Blood Serum

SummaryKaolin suspensions have previously been successfully employed to demonstrate antibodies against the phosphatide antigen of the tubercle bacillus. They can be similarly used to demonstrate the reaction between pooled gamma globulin and the serum of patients with rheumatoid arthritis, provided that complement is inactivated with EDTA and a suitable buffer is employed. The theoretical basis of particle agglutinations is discussed.

Chapter IV Yersinia enterocolitica (Synonyms: “Pasteurella X”, Bacterium enterocoliticum for Serotype 0–8)

Publisher Summary This chapter discusses the biochemical properties of Yersinia enterocolitica , which is a gram-negative rod, morphologically similar to Pasteurella . It grows on agar, blood agar, and on media such as endoagar, Salmonella–Shigella (SS)-agar, and desoxycholate agar. Y. enterocolitica is urease positive and phenylalanine negative, oxidase negative, catalase positive, usually sucrose positive, cellobiose positive and Voges–Proskauer positive only at 22 ° C. Y. enterocolitica is routinely isolated from stools or from extirpated appendices. A few cases have been described in which Y. enterocolitica was isolated from blood or urine. Routine cultivation may be carried out using ordinary media suitable for pathogenic enterobacteria. SS-agar seems to be suitable and better than endoagar. Cultivation demands incubation for 48 hours and is best at room temperature. A good selective method includes primary cultivation of the material in ordinary peptone broth at 4 ° C for 3–5 days. Y. enterocolitica grows well at this temperature.

THE REACTION OF RHEUMATOID FACTOR WITH IMMUNOGLOBULIN G FROM VARIOUS ANIMAL SPECIES

Publisher Summary This chapter presents a study analyzing the reaction of rheumatoid factor with immunoglobulin G from various animal species. The starting material of GG for the production of IgG consisted of serum pools. The pools consisted of 200 human sera, 200 rabbit sera, 200 rat sera, and 200 hen sera, 10 pig sera, 17 horse sera, and 20 sera from oxen respectively. Crude-gammaglobulins were produced by fractionated salting out with ammonium sulfate (20–50%), followed by dialysis. A latex fixation test was performed with latex from Difco in powder form to which was added IgG, and the result of the test was read with the slide technique against undiluted serum. The reaction was performed without heating of IgG and after heating of IgG for 20 min at 63°C. The Waaler–Rose reaction was performed according to Winblad with serum, whose normal agglutinin against sheep blood cells had been absorbed. A titre of = 1/64 was regarded as positive. Of the blood donor sera, 3% gave a positive latex fixation test, which agrees well with that found in earlier large normal series. In no case was the Waaler–Rose reaction positive.