Walter H. Sheldon

Abscesses of the Valve Rings of the Heart, a Frequent but Not Well Recognized Complication of Acute Bacterial Endocarditis

Abscesses of the valve rings of the heart were encountered at autopsy in 86 per cent of patients with acute bacterial endocarditis who had received antibiotic therapy. The abscesses, which appeared to arise from mycotic aneurysms in the valve rings, represented in most instances the only persistent focus of acute inflammation. They may account in part for the unsatisfactory results in the treatment of acute bacterial endocarditis, and their frequent occurrence suggests a relationship to antibiotic therapy.

Cushing's syndrome produced by a pituitary basophil carcinoma with hepatic metastases

Abstract A basophil cell carcinoma of the anterior pituitary, with multiple liver metastases, was found at autopsy in a young Negress with classic Cushings syndrome. These findings indicate that in rare instances the adenohypophysis may be the site of the initiating lesion of this disorder.

Pituitary Basophile Hyperplasia and Crooke's Hyaline Changes in Man After ACTH Therapy

Summary The administration of ACTH appears to have produced morphologic changes in the anterior pituitary of two patients. These changes consisted of an increase in the total number of basophiles, Crookes hyaline cytoplasmic changes in these cells and basophilic stippling of many of the chromophobes. It is possible that these changes reflect the storage of endogenous ACTH following stimulation of the adrenal cortex by the therapeutic administration of this hormone.

Leptospiral Antigen demonstrated by the Fluorescent Antibody Technic in Human Muscle Lesions of Leptospirosis icterohemorrhagiae.

Summary Leptospiral antigen was demonstrated with the fluorescent antibody technic in the muscle lesions of a patient with L. icterohemorrhagiae infection. This observation indicates that the muscle lesions in Weils disease are produced by the leptospirae. It has also been shown that the nonspecific staining of human polymorphonuclear leucocytes can be eliminated by absorption of the conjugate with rabbit bone marrow powder.

Pathogenesis of the Jarisch-Herxheimer Reaction: A REVIEW OF CLINICAL AND EXPERIMENTAL OBSERVATIONS*

During the past few years we have been engaged in a clinical and experimental study of the pathogenesis of the Jarisch-Herxheimer reaction in syphilis. The results of this investigation have been published in a series of papers (Sheldon and Heyman, 1949; Sheldon, Heyman, and Evans, 1951a, b, 1952). The present report summarizes our observations and presents our concepts of the pathogenesis of the Herxheimer reaction in syphilis, as well as in other infections. We shall use this opportunity to speculate upon the significance of the reaction as a manifestation of a hypersensitivity phenomenon. The Herxheimer reaction has long been known to be a common occurrence in the treatment of syphilis, but its pathogenesis has evoked little interest. The reaction is generally attributed to the release of endotoxins or spirochaetal breakdown substances following the initial administration of spirochaeticidal agents. These substances are thought to produce systemic manifestations, such as fever, chills, and malaise, as well as an exacerbation of syphilitic lesions. The results of our studies seem to indicate that the Herxheimer reaction is a hypersensitivity phenomenon of the delayed type similar to the focal hypersensitivity type of tuberculin reaction.

Failure of ACTH or Cortisone to suppress Tuberculin Skin Reactions in Tuberculous Guinea Pigs.

Summary Guinea pigs with active progressive tuberculosis were given ACTH or cortisone for 6 days. A definite tuberculin skin reaction was obtained in all animals during the period of hormone administration. The reaction appeared less marked in the treated animals than in the controls. It is suggested that ACTH or cortisone do not interfere primarily with the immune mechanism of the tuberculin skin reaction but decrease the associated acute inflammatory process.

Pulmonary embolism caused by penicillin-oil-beeswax: An experimental investigation, with report of a near-fatal case

T HE dangers of the accidental intravenous injection of drugs in oil bases are well known. Although penicillin in an oil-beeswax vehicle has been in clinical use for more than a year, up to the present no report of such a mishap with a penicillin-oil-beeswax preparation has been published. No studies have appeared of the effects of the intravenous injection of the mixture in experimental animals. This communication therefore outlines the consequences of an accidental intravenous injection of a penicillin in oil-beeswax preparation, and summarizes animal experiments in which rabbits were injected intravenously with the same material. seconds the syringe, which contained previously warmed penicillin-oil-beeswax preparation, was attached. As an additional precaution, the needle was aspirated and only then was the mixture injected.

Histochemical Demonstration of Liver Glycogen in Human Diabetic Acidosis by Liver Biopsy

Summary Liver biopsy specimens obtained during diabetic acidosis and its treatment were examined by the Gomori technic for glycogen. Severe glycogen depletion was found before treatment. Restoration of glycogen content occurred after a few hours of therapy.