bluuebunny/crossref_metadata_2025 huggingface dataset:
ACUTE HÆMORRHAGIC LEUCO‐ENCEPHALITIS
Authors: LANDER H.
Published: September 2017

Twenty‐three cases of acute hæmorrhagic leuco‐encephalitis have been described in the literature under this title. The clinical and pathological features of these cases have been reviewed.

The condition is characterized by the sudden onset of speech disturbances, motor paralyses and urinary incontinence. Rapid progression to coma and death has occurred in all cases.

The illness generally follows a respiratory infection after a short latent interval. It may also arise spontaneously, or follow the administration of certain drugs or chemical agents.

At autopsy, the lesions in the cerebral hemispheres are almost entirely confined to the white matter. Elsewhere in the central nervous system, this predilection is not obvious. The lesions consist of areas of hæmorrhage, perivascular exudate, fibrinoid degeneration of blood vessels, especially of small veins, together with focal and perivascular areas of demyelination and microglial proliferation.

Present evidence suggests that the condition may result from hypersensitivity—a cerebral Arthus phenomenon, and that this state may be induced by different allergens. Auto‐sensitization may be involved.

The relationship of this condition to various types of “hæmorrhagic encephalitis”, and to acute disseminated encephalo‐myelitis is discussed. It would appear that what is known as acute hæmorrhagic leuco‐encephalitis in Australia, the United Kingdom and certain parts of Europe, is called acute necrotizing hæmorrhagic encephalopathy in the United States.

The use of cerebral biopsy in an attempt to obtain a definitive diagnosis during life is advocated.

The early administration of cortisone in the diagnosed case is suggested.
FURTHER OBSERVATIONS ON THE RELATION BETWEEN BODY FLUID VOLUME AND URINE FLOW IN MAN
Authors: LOWE T. E.
Published: September 2017

The factors governing the partition of fluid between the various body compartments are discussed and related to the previously expressed concept of the mechanism of control of body fluid volume.

Further data are presented concerning the relationship between daily urine flow and body weight.

It is concluded that within the limits of the technique used the daily urine flow is linearly related to body fluid volume, but that the relationship may be modified or obscured by changes in the partition of fluid between compartments. Changes in the non‐fluid part of body weight may likewise obscure this relationship when body weight is taken to represent body fluid volume.

This discussion also indicates that control of body fluid volume can be upset in at least three ways : first, a change in the ability to excrete fluid ; secondly, a change in the partition of fluid within the body ; thirdly, a sequestration of fluid outside the influence of the control mechanism.
THE SIGNIFICANCE OF THE PRESENCE IN HUMAN SERUM OF COMPLEMENT‐FIXING ANTIBODIES TO HUMAN TISSUE ANTIGENS
Authors: MACKAY IAN R. , LARKIN LOIS
Published: September 2017

Certain human sera exhibit complement fixation with human tissue antigens, particularly liver and kidney, the reaction being designated auto‐immune complement fixation (AICF) ; the serum factor responsible is considered to be a type of autoantibody.

Positive reactions were frequently associated with an elevated erythrocyte sedimentation rate, a positive response to the cephalin flocculation test and an elevated serum gamma globulin level, but other serological reactions were mostly negative.

About 3% of normal sera reacted in low titre. Positive reactions were obtained in 22 of 28 cases of disseminated lupus erythematosus, in 16 of 99 cases of chronic liver disease, and in Wassermann‐positive cases of syphilis and leprosy. Dermatomyositis, rheumatic disease and nephritis yielded largely negative results. Positive reactions also occurred in cases of fungating carcinoma (in low titre), of aplastic anaemia requiring frequent transfusion, of macroglobulinnmia (two out of 14 cases), and of active Hashimoto's thyroiditis (two cases).

Explanations considered for AICF reactivity of serum were : (a) abnormal antigenic stimulation, as a result of excess tissue autolysis (hepatitis, carcinoma), repeated blood transfusion (aplastic anemia) and liberation of "unfamiliar" antigens such as thryoglobulin (Hashimoto's disease) ; (b) a disease or disorder (possibly a mutation) in the antibody‐forming tissues causing abnormal antibody production (lymphoma, macroglobulinamia.) Consistently elevated AICF titres in disseminated lupus erythematosus suggest that this condition may be basically a disease of the antibody‐producing tissues.
CRYPTOCOCCOSIS (TORULOSIS) : A REPORT OF NINE CASES
Authors: WILSON L. L.
Published: September 2017

Five cases of cryptococcosis occurred in South Australia during 1957. Only four other cases (also described here) were recognized in the previous ten years. In four cases in this series the patient had a preceding respiratory infection followed by pulmonary cryptococcosis, and three of these developed central nervous system involvement. Isolated pulmonary lesions, cerebral granuloma and spinal cord involvement are rare forms of cryptococcosis which also occurred in this series.

No treatment has proved effective; “Amphotericin B” and “Fungizone”, now under trial, were unsuccessful in two cases here. Surgical removal of isolated brain and lung lesions may help, but earlier diagnosis, perhaps by the development of immunological tests, is highly desirable. Because of its varied manifestations, cryptococcal meningitis is difficult to diagnose until late in the course of the disease.

The cause of human infection is unknown, but it must be related in some way to the resistance of the host, as well as to variations in virulence or type of the fungus. The significance of contact with pigeons is discussed.
RENAL LESIONS IN SCLERODERMA : CLINICAL AND PATHOLOGICAL FEATURES
Authors: TANGE J. D.
Published: September 2017

The significant renal lesion in scleroderma is a mucoid or loose fibrous swelling of the walls of the intralobular arteries involving the entire wall or the intima alone without inflammatory cell reaction ; the lumen is substantially narrowed or obliterated. Interference with cortical blood flow leads to necrosis and thrombosis of the afferent arterioles and focal infarcts of the cortex. Clinically, these changes are mirrored by rapidly progressive renal failure or by severe hypertension or both. Duration of the illness is short. Lesions in other organs are infrequent and relatively mild. The clinical features and the renal lesions closely resemble those described in malignant or rapidly progressive hypertension. Cortico‐steroids accelerate the progress of the hypertension or may even determine its appearance. Thickening of the basement membranes of the glomerular capillaries is found independently of these arterial lesions. The histories of patients showing this glomerular change suggest that it is probably related clinically to the occurrence of a trace of albumin in the urine, and that the appearance of albuminuria does not necessarily presage the onset of severe hypertension and renal failure.
EARLY NEPHRON CHANGES : A MICRODISSECTION STUDY
Authors: BAXTER THELMA J.
Published: September 2017

A kidney, which appeared to be macroscopically normal, obtained from a patient showing no clinical signs of renal disease, was examined by microdissection and showed considerable morphological change. Differences in glomeruli, particularly of shape, and variations in size of proximal convoluted tubules with small diverticula were found ; these changes were not recognized histologically. There were also a few small cysts.

These are amongst the earliest stages in the development of well‐known phenomena in the granular kidney demonstrable with our present techniques. A familiarity with gross structural changes, of which these are the rudimentary steps, is essential for the appreciation and prospective study of detailed functional alterations in the component units of the organ.
A FATAL CASE OF ACUTE PHOSPHORUS POISONING
Authors: CRANE C. W. , EBELING P. , BENTLEY A. B.
Published: September 2017

A typical, fatal case of phosphorus poisoning is described. Examination of the urine over the final three days showed a progressive fall in the total nitrogen excretion, with grossly elevated values for a‐amino nitrogen. Plasma and urinary aminoacid chromatograms suggest that tubular damage was a factor in the production of the aminoaciduria. The urinary aminoacid patterns differed in several respects from those reported in other conditions causing hepatic coma. Cystine and taurine concentrations were low, while arginine and beta‐aminoisobutyric acid could not be detected. Arginine was detected only after hydrolysis of the urine.
THE CALCIUM INFUSION TEST : A DISCUSSION OF THE PATTERNS FOUND IN VARIOUS DISORDERS
Authors: MCRAE JAMES , CROWE PATRICIA J. , DALE NANCY E.
Published: September 2017

The calcium infusion test was designed to assess calcium and phosphorus homæostasis and to measure bone metabolism. It was introduced as a diagnostic aid in parathyroid disease. The success of the test in these directions is reviewed, and the results of 60 infusions in patients with a wide variety of disorders are outlined and discussed. Most significant are the findings in hyperparathyroidism, in which varying patterns of response occur when impaired renal function and severe bone disease are present. The complete retention of calcium in severe renal disease is confirmed.
THE ROLE OF BODY FLUID VOLUME AND PLASMA “ACTIVE” OSMOTIC PRESSURE IN THE CONTROL OF URINE FLOW AND FLUID INTAKE IN MANS
Authors: LOWE T. E. , SHEATH JUNE
Published: September 2017

Observations of body weight, plasma osmotic pressure, daily urine flow and daily fluid intake in a patient recovering from an œdematous state indicate that changes in both plasma osmotic pressure and body fluid volume have an influence on the volume of urine formed, and possibly on the volume of fluid drunk.

The control system acts in such a way that a rise of plasma osmotic pressure produces a fall in urine flow and a rise in body fluid volume produces an increase in urine flow.

A method is described which enables plasma freezing point to be determined on one millilitre of plasma.
ESSENTIAL CRYOGLOBULINÆMIA AND ACQUIRED HÆMOLYTIC ANÆMIA DUE TO COLD AGGLUTININS
Authors: FIRKIN B. G. , BLACKWELL J. B. , JOHNSTON G. A. W.
Published: September 2017

A case of hæmolytic anæmia associated with a cold agglutinin and essential cryoglobulinæmia is described. The patient did not respond to steroid therapy, but his condition was greatly improved by protection against the cold. Immunological and electrophoretic studies showed that two abnormal proteins were present. One was a cold agglutinin immunologically identical with gamma globulin, and the other was a cryoglobulin which was unrelated immunologically to any normal serum protein.
STUDIES IN FAT ABSORPTION: III. THE RADIOTRIOLEIN AND RADIO‐OLEIC ACID ABSORPTION TESTS
Authors: PLAYOUST M. R. , WYATT V. , BLACKBURN C. R. B.
Published: September 2017

Radiotriolein absorption and chemical frecal fat determinations have been performed simultaneously on 50 patients, 12 of whom had proved steatorrhœa. A standardized technique was used, in which radiotriolein was incorporated as an emulsion into milk and was given to each subject after a normal breakfast containing 5o grammes of fat. It was found that emulsification of the radiotriolein and the use of a relatively large fat load were both necessary for consistent results. Measurement of the level of unabsorbed radioactivity in the stools (collected for 48 hours after the radio‐fat administration) gave reliable results, which correlated well with the chemically determined faecal fat content, a figure in excess of 3% of the administered radioactivity indicating definite malabsorption. In addition, the radiotriolein test appeared capable of detecting minor degrees of fat malabsorption, the result being abnormal in two post‐gastrectomy subjects and in two with ulcerative colitis, all four of whom had normal chemically determined fæcal fat excretion. Evidence is presented that the blood level of radioactivity five hours after ingestion of the test dose is a reliable test for malabsorption in most cases, a level of less than 5% of the administered dose being abnormal ; however, misleadingly high levels may occur, particularly in post‐gastrectomy subjects, and in these instances measurement of fæcal radioactivity is mandatory. Determination of the maximum, rather than of the five‐hour, level of blood radioactivity was found to be unnecessary, since the former result was no more significant. It was considered that the measurement of the activity of whole blood rather than of a trichloracetic acid precipitate was a justifiable simplification of the procedure. Finally, radio‐oleic acid was of value in the letiological diagnosis of the malabsorption syndrome, since this substance was normally absorbed in subjects with pancreatic disease, but not in subjects with malabsorption of intestinal origin.
ACUTE INTERMITTENT PORPHYRIA
Authors: CURNOW D. H. , MORGAN E. H. , SARFATY G. A.
Published: September 2017

A family in which 11 cases of acute intermittent porphyria were found in three consecutive generations has been studied. Evidence is presented that inheritance was by an autosomal dominant gene.

The usefulness of the Watson and Schwartz test in such a study and in the diagnosis of acute cases is discussed. It is suggested that it be applied to all relatives of known acute porphyrics.

The disease as seen in this family is identical clinically, genetically and biochemically with that found in Sweden, and quite distinct from porphyria cutanea tarda.
ACUTE NECROTIZING GLOMERULITIS
Authors: BIALESTOCK DORA , TANGE J. D.
Published: September 2017

Nine cases of necrotizing glomerulitis have been studied. The lesion was found in association with pulmonary hæmorrhage, or in middle‐aged males with anuria. There were characteristically a low incidence of hypertension and œdema, an insidious onset, a rapid course and a uniformly fatal outcome, usually in urœmia. No causal factors were discovered. The renal lesion consists of necrosis and disintegration of the structure of the glomerular tuft. Cellular proliferation is variable in amount and disorderly. The glomeruli may be replaced by collections of inflammatory and spindle cells or of fibrous tissue. The tubules are spared. The interstitial tissue is œdematous, and may be infiltrated by inflammatory cells. Rarely, renal arteries or arterioles show fibrinoid change without any surrounding inflammatory reaction. Except for pulmonary hœmorrhage in some cases, there are no lesions in other organs. It is concluded that the process shows affinities to both proliferative glomerulonephritis and polyarteritis nodosa, but its exact nature remains to be determined.
OBSERVATIONS ON THE TREATMENT OF SEVERE DIABETIC KETOSIS
Authors: HUDSON BRYAN , BICK MARJORIE , MARTIN F. I. R.
Published: September 2017

A series of 32 patients with severe diabetic ketosis treated by us during 1956–1957 has been compared with a similar group of 67 patients admitted to the Alfred Hospital, Melbourne, between 1952 and 1955.

This comparison has shown that the mortality has decreased during 1956–1957. The reasons for this have been analysed and discussed, and the rationale for the present regime of treatment is presented.

It is concluded that the reduction in mortality has been due to several factors, which include the following: (i) the management of diabetic ketosis by one unit; (ii) the use of alkaline solutions at the commencement of treatment; (iii) the administration of potassium salts early in treatment; (iv) a reduction in the severity of the condition on the patients' admission to hospital.

The need is stressed for educating patients and practitioners in the early recognition of this disorder so that mortality may be further reduced.
SERUM COMPLEMENT LEVELS IN SYSTEMIC LUPUS ERYTHEMATOSUS AND OTHER DISEASES
Authors: ASHERSON G. L.
Published: September 2017

Serum hæmolytic complement has been measured in 166 patients. Low levels of complement occurred in systemic lupus erythematosus, in the nephrotic syndrome, and in parenchymal liver damage. High levels of complement occurred in obstructive jaundice and in conditions characterized by tissue destruction. The low serum complement level in systemic lupus erythematosus was attributed to complement‐fixing antibodies against human tissues found in that condition.
REPORT OF A FAMILY SHOWING “ MIRROR ” MOVEMENTS
Authors: CRAWFORD CHARLES
Published: September 2017

A family is described showing mirror movements in five members of two generations, and a new hypothesis is advanced which may help to throw light on the cause of the condition.
PRIMARY ALDOSTERONISM‐CONN'S SYNDROME
Authors: SIMPSON F. O. , BARNETT A.
Published: September 2017

Electrolyte‐balance studies on a patient with primary aldosteronism are reported.

An aldosterone antagonist, spironolactone (“ SC 9420 ”, “ Aldactone ”, Searle), was effective in promoting sodium excretion and, to some extent, potassium retention.

Spironolactone had some effect also after removal of the tumour.

Vasopressin caused an increase in urine flow in this case.
THYROID‐STIMULATING HORMONE AND TRIIODOTHYRONINE AS AIDS IN THE DIAGNOSIS OF THYROID DISORDERS
Authors: HUDSON BRYAN , WINIKOFF DORA , TAFT H. PINCUS , MARTIN F. I. R.
Published: September 2017

The administration of thyroid‐stimulating hormone (T.S.H.) and 3 : 5 : 3′‐triiodothyronine (T3) has been applied in the assessment of thyroid function in cases of doubtful hypothyroidism, in myxoedema of uncertain origin and in cases of suspected hyperthyroidism. The indices used were plasma protein‐bound iodine (P.B.I.) and I131 uptake by the thyroid.

After T.S.H., the rise in P.B.I. levels was greatest in euthyroid patients (regardless of previous thyroid administration), least in primary thyroid failure and intermediate in pituitary myxoedema. The rise in I131 uptake after T.S.H., on the other hand, distinguished only the euthyroid group from patients with primary myxcedema, being significantly higher in the former group.

After T3 administration, suppression of I131 uptake, regardless of the initial value, was observed in the euthyroid group, whilst in thyrotoxicosis no such suppression occurred. Changes in P.B.I. levels were of no diagnostic significance in these cases.
DIVIDENDS FROM MITRAL VALVOTOMY : A TWO TO SEVEN YEARS' FOLLOW‐UP
Authors: LEAROYD B. M. , BLACKET R. B. , SINCLAIR-SMITH B. C. , MILLS F. H. , HALLIDAY J. H. , MADDOX J. K.
Published: September 2017

Studies have been made of 87 patients treated by finger‐fracture valvotomy for mitral stenosis five or more years ago, and of 224 patients followed for only two years. At the time of operation the mean age of the patients was 38 years, and 34% had atrial fibrillation.

The functional classification of the patients and the results of the operation in each group are presented. The operative mortality was 5%, but ranged from 2.5 % in Class II patients to 25% in Class IV patients. When the total number operated on is used as the base line, 61% of patients had a good result (improvement by at least one functional class) at two years. At five years this figure had fallen to 51%. The best results were obtained in the less severe cases.

Age in itself did not materially affect the outcome, but atrial fibrillation, whose incidence increased with age, lessened the prospects of success. Considerable cardiac enlargement was also an adverse factor.

Mitral incompetence present before operation or produced by surgery had an unfavourable effect on the outcome, and severe incompetence proved lethal. When moderate incompetence was present after operation, roughly two‐thirds of the patients had a good result at two years, but this figure fell to one‐third by five years.

The most significant factor in continued post‐operative improvement was the completeness of separation of the adherent valve cusps. Division of one commissure gave temporary benefit to many patients, but by five years only one in four maintained their improvement. Deterioration was due to restenosis, which may also occur even when both commissures are adequately split.

We conclude that mitral valvotomy as originally practised leaves much to be desired. The pathology of advanced mitral stenosis does not readily lend itself to correction. We advise surgical treatment early in the disease, when disability is first noticeable and atrial fibrillation, embolism and valvular distortion have not occurred.

The results of more recent surgical techniques, although initially encouraging, remain to be evaluated.
EXPERIMENTAL CHOLANGITIS FOLLOWING BILIARY OBSTRUCTION
Authors: RONAI P. M. , MAGAREY F. R.
Published: September 2017

Experiments have been performed on rats in which biliary obstruction has been created and followed by an intravenous injection of a suspension of Bacterium coli. Rats with obstruction only and with injection of B. coli only have been used as controls.

The experiments show not only that biliary obstruction predisposes to infection of the liver and bile ducts, but also that the infection is accentuated and accelerated.

The results also clearly indicate that the invading microorganisms reach the liver and bile ducts by the hæmatogenous route.
PLASMA TRANSAMINASE IN LIVER DISEASE
Authors: O'BRIEN E. N. , PATERSON BETTY , RALSTON MARY , MACKAY IAN R.
Published: September 2017

The plasma glutamic oxalacetic transaminase level (G‐O.T.) was estimated in 206 cases of liver disease. Levels over 500 units favoured a diagnosis of acute viral hepatitis ; but levels of this order and higher occurred in active chronic hepatitis and lupoid hepatitis during an exacerbation. Levels between normal and 200 units were found in all forms of liver disease.

Serial G‐O.T. estimations proved of considerably greater diagnostic and prognostic aid than single readings, and were of value in studying the progress of liver disease, the assessment of therapeutic response and the detection of sensitivity to hepatotoxic drugs.

The value of G‐O.T. estimation in obstructive jaundice was limited, since the results overlapped those found in parenchymal liver disease

The histological finding of hepatocellular necrosis was never associated with normal G‐O.T. levels ; but no close association could be shown between the degree of liver cell necrosis and the G‐O.T. level.
A CASE OF PROTEIN‐LOSING ENTEROPATHY
Authors: FREEMAN ZELMAN
Published: September 2017

The case described is of a woman, aged 61 years, presenting with diarrhoea, fever and œdema associated with hypoproteinæmia. Biopsy of the intestine showed acute non‐specific ileitis, and biopsy of the liver showed severe fatty degeneration. Laparotomy revealed some vascular engorgement of the subserosal vessels in the lower ileal area. After the commencement of prednisone therapy, there was considerable improvement in the clinical features, the hypoproteinæmia and the histological appearances in the liver. In the state of remission, studies with radioactive labelled albumin showed a degradation rate of 0.46 gramme per day per kilogram, and studies with radio‐iodinated polyvinylpyrrolidone showed a fMcal loss of 2.9% in 96 hours. Both figures are twice to three times normal.
RENAL BIOPSY
Authors: MACKAY IAN R. , TAFT L. I.
Published: September 2017

In this study diagnostically adequate tissue was obtained by aspiration biopsy of the kidney in 200 (78%) of the 257 patients investigated. Diabetic nephropathy most often complicated long‐standing diabetes ; but diabetic renal lesions did not depend on the duration and severity of the diabetes or on the degree of diabetic control with insulin. Twenty‐five patients with lupus nephritis were treated with cortisone ; “ mild ” and “ moderate ” glomerular lesions showed histological arrest ; but improvement was exceptional. Histological study of 38 cases of subacute glomerulo‐nephritis supported the validity of Allen's (1955) classification. In a limited analysis, the long‐term prognosis of patients treated with cortisone was not significantly better than that of untreated cases.

A fluorescent antibody reagent was applied to a portion of the renal biopsy specimen in 71 cases, in order to determine the possible part played by antibodies in the production of nephritis. Positive reactions, suggesting localization of human globulin in the glomerulus, were obtained chiefly in lupus nephritis and in diffuse membranous glomerulo‐nephritis.

Renal biopsy proved of most value in early diffuse renal disease wherein diagnosis, prognosis and probable response to treatment are best assessed on morphological grounds ; it was of less value in advanced renal disease with sclerosis.
STRONTIUM “ RICKETS ” : BONE, CALCIUM AND STRONTIUM CHANGES
Authors: STOREY E.
Published: September 2017

When rats were fed increasing levels of strontium in the diet, inhibition of calcification was shown by increased width of epiphyseal cartilage, presence of uncalcified bone matrix and decreased ash weight of bone. When ash weight was used as an indicator of mineralization, inhibition of calcification became greater as the dietary strontium level increased. This inhibition became most obvious when the calcium‐strontium ratio in serum, expressed on a molar basis, became less than 10 : 1.

In contrast to ash weight, the percentage ash in bone was a less sensitive indicator of rhachitic change, because both mineral and organic weight decreased proportionately, and consequently the percentage ash remained unchanged until high dietary levels of strontium were reached.

The incorporation of strontium into bone varied, not with dietary strontium levels, but with the ratio of calcium to strontium. The two ions were treated similarly, for the decrease in calcium‐strontium ratio in the bone was almost directly proportional to that in diet for both young and old rats. In growing animals, addition of new bone crystals was probably the most important mechanism whereby strontium became incorporated into ash, while in slowly‐growing rats ion exchange assumed a more important role.

At low dietary levels of strontium, bone matrix formation decreased roughly proportionately to inhibition of calcification, but at higher levels uncalcified bone matrix became prominent. These results may be of significance to the problem of osteoporosis, for they demonstrate that disorder of calcification can be associated with decreased growth of bone matrix. This suggests that “ osteomalacic ” and “ anti‐anabolic ” mechanisms are not mutually exclusive, but may be interrelated factors in the pathogenesis of osteoporosis.
THE EFFECT OF NIALAMIDE ON ENDOGENOUSLY AND EXOGENOUSLY ELEVATED BLOOD AMMONIA LEVELS IN PATIENTS WITH LIVER DISEASE
Authors: BEAL R. W. , BLACKBURN C. R. B.
Published: September 2017

Nialamide (1‐[2‐benzylcarbamyl)ethyl]‐2‐isonicotinoyl‐hydrazine), an analogue of iproniazid, has been shown to lower the blood ammonia levels of patients with liver disease. Twelve studies were carried out on nine patients with elevated blood ammonia levels due to liver disease (eight cases) or to uræmia (one case). In each study the intravenous injection of 100 mg. of nialamide significantly reduced the blood ammonia level, the reductions ranging from 18% to 75% of the initial levels. It was also effective in lowering arterial blood ammonia levels artificially raised by the continuous intravenous infusion of ammonium chloride in eight patients with liver disease. Clinical benefit in patients with hepatic coma or pre‐coma did not parallel the improvement in arterial or venous blood ammonia levels.
THE d‐XYLOSE ABSORPTION TEST
Authors: JOSKE R. A. , CURNOW D. H.
Published: September 2017

The metabolism of d‐xylose in man is reviewed and the physiological and chemical basis of the d‐xylose absorption test outlined.

Study of 50 normal Australian subjects showed the normal result of the test to be 6·6 ± 1·4 grammes, and the lower limit of normal was taken as 3·8 grammes. The urinary volume was 414±164 ml., and the two‐hour blood level 37·0±7·2 mg. per 100 ml. These results agree with others in the literature. Two hundred xylose absorption tests were performed on 186 patients. It was found that impaired xylose absorption was almost always accompanied by other evidence of malabsorption, although steatorrhoea could be gross with normal xylose absorption. Xylose absorption was usually depressed in sprue, adult coeliac disease, severe infective enteritis and other primary small bowel diseases, as well as in elderly patients with extensive vascular disease. The test gave variable results after gastrectomy and in liver disease, the reticuloses and rheumatoid arthritis. The result was usually normal in pernicious anaemia, pancreatic disease and diabetes mellitus. Impaired xylose absorption was significantly related to hypo‐albuminæmia, but not to folic acid, vitamin B12 or fat absorption, or to serum calcium or potassium levels.
TREATMENT OF THYROID OPHTHALMOPATHY WITH CORTICOID ANALOGUES
Authors: HALES IAN B. , THOMAS IAN DAVIES
Published: September 2017

The role of corticoid analogues in thyroid ophthalmopathy has been reevaluated. Eight consecutive patients with progressive ophthalmopathy have been given corticoids. In all cases progression was prevented and a varying degree of regression of symptoms and signs occurred. Ophthalmoplegia responded completely only in those patients treated less than eight weeks after its appearance. The possible mechanisms by which corticoids act are discussed.
EXPERIENCE WITH THE FOREIGN GAS METHOD FOR THE DETECTION OF LEFT‐TO‐RIGHT INTRACARDIAC SHUNTS
Authors: BERNSTEIN L. , JOSE A. D.
Published: September 2017

We have reported and discussed our results of using the nitrous oxide test for studying intracradiac left‐to‐right shunts in too patients. The significant advantages of this test over serial oxygen content measurements have been confirmed. The use of gas chromatography for nitrous oxide analysis has made the test quicker, more accurate and easier to apply during cardiac catheterization.
ASTHMA IN QUEENSLAND PUBLIC HOSPITALS IN 1957
Authors: DERRICK E. H. , THATCHER R. H.
Published: September 2017

Asthma was responsible for 2673, or 1·62%, of all admissions to Queensland public hospitals in 1957. Males predominated in childhood and after the age of 55 years. Females predominated in the intervening years. A striking fall in the male incidence in the second decennium suggests a favourable prognosis for most asthmatic boys. The apparent incidence of asthma varied considerably from place to place throughout the State. The geographical variation could not be explained simply in terms of latitude, altitude, temperature, rainfall or distance from the coast. The seasonal distribution changed significantly at about the Tropic of Capricorn. To the south, the main incidence was in autumn; to the north, no seasonal pattern had a wide prevalence.

An ætiological study of asthma must take into account the variation in the complex of causes with sex, age, season and locality.
HYPOCHROMIC ANÆMIAS NOT CAUSED BY IRON DEFICIENCY
Authors: MOORE CARL V.
Published: September 2017

The causes of hypochromic anæmia not due to iron deficiency have been reviewed. Because of their frequency the various thalassæmic syndromes are clinically of most importance, but the other forms are of great theoretical interest. Information about the biochemical defects or lesions responsible for the non‐iron‐deficient hypochromias is not complete enough to pinpoint the abnormalities. In‐vitro study of hæm synthesis has provided many interesting data, but final answers must wait until techniques are also available to study globin formation within nucleated red blood cells, and until the union of pigment and protein portion of the hæmoglobin molecule can be followed.
THE EFFECT OF THYROTROPHIC HORMONE ON THE PLASMA THYROID HORMONES IN MAN
Authors: WELLBY MAURICE L. , HETZEL BASIL S. , ISAACHSEN MARGARET L.
Published: September 2017

The effect of thyrotrophic hormone administration on the plasma pattern of the iodine‐containing amino acids has been studied in 11 normal and 12 thyrotoxic subjects. The method employed a paper chromatographic separation of the individual iodinated compounds in plasma extracts prepared with an anion exchange resin. The iodine‐containing amino acids were then located by chemical staining by means of the ceric sulphate‐arsenious acid reaction. Parallel chemical and radioactive studies were carried out in eight of the thyrotoxic subjects after I131 therapy.

In the normal subjects, the intramuscular administration of thyrotrophic hormone (TSH ; hog origin), 30 U.S.P. units, was followed by the appearance of diiodotyrosine (DIT) and increased amounts of the iodothyronines, particularly triiodothyronine (T3) in the plasma. In hyperthyroid subjects TSH administration was followed by increases in the iodothyronine fraction. In most cases DIT was present before TSH administration, and the increases in DIT after TSH administration were smaller than those seen in normal subjects. Similar results were obtained in the parallel radioactive studies.

The pattern of iodine‐containing amino acids previously described in hyperthyroidism has been reproduced in normal subjects by the administration of TSH. The association of the presence of DIT with increased amounts of T3 under conditions of thyroid over‐activity suggests that these two phenomena may be related. It is suggested that the release of DIT from the gland under these conditions may indicate a biosynthetic mechanism for the production of greater amounts of the more rapidly acting T3.
EXPERIMENTAL FIBRINOLYSIS
Authors: FANTL P.
Published: September 2017

The commercial preparation “Thrombolysin” intended for intravenous infusion in the treatment of thrombosis has properties which can be imitated by a mixture prepared from streptokinase as the major and plasmin as a minor component. Such mixtures have fibrinolytic activity which increases with concentration. This is in contrast to streptokinase, which shows inhibitory properties at higher concentrations.

Intravenous infusions of “Thrombolysin” were well tolerated. According to the amount injected, a corresponding decrease in blood plasminogen level occurred. In the dosage recommended for injection, no influence on prothrombin, fibrinogen or other plasma proteins was detected.

Plasma taken several minutes after infusion of “Thrombolysin” no longer showed proteolytic activity.

Adequate amounts of streptokinase added during clot formation in vitro produced short lysis time of fibrin, but streptokinase added after clot formation showed considerably less activity.
RADIOACTIVE ARSENIC IN THE DIAGNOSIS OF INTRACRANIAL TUMOURS
Authors: FARRER P. A. , MCRAE J.
Published: September 2017

In 92 patients studied by automatic scintillation scanning of the head following intravenous injection of positron‐emitting arsenic‐74, accurate detection and localization resulted in 30 of 36 cases of proven space‐occupying cerebral lesions (83%). The lesions were not detected in the other six cases (17%), whilst false positive localization occurred in two of the group of 50 patients (4%) whom subsequent investigations placed in the normal category.

The procedure is harmless, painless and simple to perform. It requires no general anæsthesia and may be performed on poor‐risk patients. It is of special value in patients who pose difficulty in the performance of angiography on anatomical grounds. Scanning has been found to outline the site and extent of the tumour bed in infiltrative and posterior hemisphere neoplasms, in the detection of which neuroradiological studies are frequently not helpful.

The present study confirms that positron scanning is a reliable screening test for supratentorial tumours of the brain. It may be repeated safely at appropriate intervals without radiation or pharmacological hazard.
ORAL I131‐TRIOLEIN TOLERANCE CURVES IN NORMAL, ATHEROSCLEROTIC AND HYPERLIPÆMIC SUBJECTS
Authors: PRIOR I. A. M. , ARMSTRONG W. E. , CARR A. H.
Published: September 2017

The levels of whole blood and trichloracetic precipitable radioactivity have been studied after the oral administration of I131‐labelled triolein in 30 atherosclerotic, seven hyperlipæmic and 20 apparently normal subjects. A very abnormal pattern with high peak levels and persistently high levels at 24, 48 and 72 hours has been found in the hyperlipæmic subjects. The mean levels were significantly higher in the atherosclerotic as compared with the normal subjects, but considerable overlap was present between the groups, and the test clearly lacks sensitivity in detecting all subjects with manifest atherosclerosis.

Estimation of the lipæmia clearance rate showed no significant difference in the atherosclerotic as compared with the control group, but the figure was significantly slower in the hyperlipæmic group in the first 24 hours. The effect of anticoagulants given by mouth was observed in eight subjects, and repeat observations made while they were on and off anticoagulants failed to confirm any significant effect from the anticoagulants on mean levels or on rate of clearing.

The limitations and future value of the oral I131 triolein test are discussed.
OBSERVATIONS ON TRIAMTERENE—A NEW DIURETIC
Authors: BARNETT A. J. , BAUMGARTEN A. , BRANDSTATER M.
Published: September 2017

In subjects without cedema, triamterene given orally caused increased urinary excretion of sodium and chloride, but not of potassium, in the 12 hours following administration, but continued administration produced no effect on the 24‐hour electrolyte excretion.

In a short‐term trial, in which patients were treated for four‐day periods with triamterene, chlorothiazide and combined therapy, triamterene and chlorothiazide had similar effects on weight loss and sodium excretion, but there was less loss of potassium with triamterene. Combination of the two drugs resulted in increased excretion of sodium, but not in weight loss or larger urine volume.

In the long‐term treatment of refractory cedema, triamterene alone was unavailing, but when combined with chlorothiazide or with chlorothiazide plus spironolactone, it was of distinct value. The dose required (450 mg. per day) was higher than that used by other workers (100 to 300 mg. per day). No side effects were observed which could be attributed to the drug.
CHRONIC LEAD NEPHROPATHY
Authors: EMMERSON B. T.
Published: September 2017

In view of the evidence for the existence of a form of chronic renal disease due to renal damage by lead in childhood, the requirements for a clinical diagnosis of chronic lead nephropathy were considered. The chief difficulty in confirming such a diagnosis during life was that of finding evidence of excessive past lead absorption. To this end, the effect of a standardized infusion of calcium EDTA upon the excretion of lead in the urine in various groups of patients was investigated.

In 19 control subjects with normal renal function, the increase in the urinary excretion of lead due to the calcium EDTA (the EDTA lead excretion) varied up to about 0·6 mg. In 22 subjects with renal insufficiency of varying degrees attributable to childhood lead poisoning, the EDTA lead excretion was always above this figure, as it was also found to be in patients with significant industrial lead exposure. In 19 out of 23 patients with renal disease attributable to causes other than lead, the EDTA lead excretion was comparable with that of the control group with normal renal function. The results in the other four patients in this group were considered in detail, and it was suggested that they had suffered excessive past lead absorption which was ætiologically unrelated to their renal disease. In patients with chronic lead nephropathy, a significant correlation was also demonstrated between the EDTA lead excretion and both the plasma creatinine level and the plasma carbon dioxide content. The results in individual patients also suggested that the amount of lead excreted after the infusion of calcium EDTA increased with increasing renal failure, probably owing in part to the associated disorder of bone metabolism.

A group of patients with renal disease in whom the nature of the renal disease was not readily apparent were investigated by this calcium EDTA technique. It was shown that, of those whose EDTA lead excretion exceeded 0·6 mg., evidence of excessive past lead absorption likely to be ætiologically related to the renal disease could be demonstrated in 12 out of 16 patients. In the other four patients, the lead content of bone was at the upper limit of normal, but, even at autopsy, the role of lead in the ætiology of the renal disease in these patients could not be determined with any certainty. The chief toxic effect of the calcium EDTA to be noted was the development of postural hypotension in patients with severe renal disease, especially in those already receiving hypotensive agents.

Gout was found to occur in half the patients with chronic lead nephropathy, but to occur infrequently in patients with chronic renal disease not due to lead or to primary gout. Therefore, a patient with chronic renal disease who develops an acute attack of gouty arthritis should be investigated to determine whether the underlying renal disease is chronic lead nephropathy.
THE NEPHROTIC SYNDROME IN PREGNANCY
Authors: JOHNSTON C. I. , JOHNSON J. R. , READER R.
Published: September 2017

The clinical course of 10 patients with the idiopathic nephrotic syndrome who underwent 29 pregnancies is reported, together with the result of these pregnancies. Twenty of the pregnancies resulted in the birth of living infants.

Patients with the uncomplicated type of the nephrotic syndrome underwent pregnancy with no change in the status of their disease. Although during five pregnancies in patients with the complicated type of the nephrotic syndrome there was progression of their disease, in all these patients after pregnancy there was a return to the pre‐pregnant status as judged on clinical and biochemical criteria. It is suggested that pregnancy associated with the idiopathic nephrotic syndrome has a good prognosis, and that pregnancy appears to have little immediate harmful effect on the course of the nephrotic syndrome.
BRONCHO‐PULMONARY ASPERGILLOSIS
Authors: BLACKWELL J. B.
Published: September 2017

This is a survey of 14 cases of broncho‐pulmonary aspergillosis diagnosed during the six‐year period ended March, 1963. Dissemination of the fungus was found in only one case, this being also the only instance in which death could be attributed in large measure to the Aspergillus infection. Two of the patients who had a solitary aspergilloma were considered to be suffering from a primary form of the disease, whilst in the remaining 12 it was classified as secondary. It was found that, in common with experience elsewhere in the world, the secondary forms were associated with the prior administration of antibiotic drugs or corticosteroids, and that they occurred in persons with debilitating fatal diseases.
THE EFFECT OF ARGININE GLUTAMATE ON ELEVATED BLOOD AMMONIA LEVELS IN CHRONIC LIVER DISEASE
Authors: DAVEY M. G.
Published: September 2017

Arginine glutamate infusions were given to two patients with advanced liver disease. This treatment reduced venous blood ammonia levels in both, and brought about temporary clinical improvement in one. Urea synthesis appears to have been stimulated. No other significant changes in blood chemistry, and only slight clinical side‐effects, were recorded.
RESPIRATORY SYMPTOMS AND VENTILATORY CAPACITY IN MEN EXPOSED TO ISOCYANATE VAPOUR
Authors: GANDEVIA BRYAN
Published: September 2017

Twenty employees in a factory using isocyanate were studied in an attempt to relate clinical features to significant decreases observed in ventilatory capacity during the course of a working day (reported in detail elsewhere). The clinical picture of the “isocyanate respiratory syndrome” is described by reference to cases occurring in current and former employees, and the morbidity is shown to be a significant factor in the labour turnover. Evidence is presented to suggest that greater decreases in ventilatory capacity on exposure to isocyanate vapour are found in those who smoke and who give a history of cough and sputum prior to employment, and those who have a productive cough or wheeze on examination. A past or family history of chest disease or a history of chronic or recurrent nasal symptoms does not, in the present series, appear to influence the ventilatory reaction to isocyanate. The evidence for the development of tolerance in some subjects is described.
DIGITAL CLUBBING IN CHRONIC OBSTRUCTIVE LUNG DISEASE
Authors: PAIN M. C. F.
Published: September 2017

Finger clubbing was detected in 24% of 50 patients with chronic obstructive lung disease. The patients with clubbing had a lower mean arterial oxygen saturation than those without clubbing, and no patient with clubbing had a normal arterial oxygen saturation. All patients with clubbing had abnormally large veno‐arterial shunts, and this may be of some ætiological significance.
CYTOPLASMIC BUDDING OF HUMAN LYMPHOCYTES DUE TO IONIZING RADIATION
Authors: SHIELS D. O.
Published: September 2017

Ionizing radiation causes statistically significant increases in the percentage of lymphocytes, both large and small, which exhibit cytoplasmic budding in Leishman‐stained air‐dried blood films of humans exposed to low doses. In subjects exposed to not more than 10r, over 50% of small lymphocytes exhibited this phenomenon.
Mitigation of acidified salmon rivers – effects of liming on young brown troutSalmo trutta
Authors: Hesthagen T. , Larsen B. M. , Bolstad G. , Fiske P. , Jonsson B.
Published: September 2017

In southern Norway, 22 acidified rivers supporting anadromous salmonids were mitigated with lime to improve water quality and restore fish populations. In 13 of these rivers, effects onSalmo truttaandSalmo salardensities were monitored over 10–12 years, grouped into age 0 and age ≥ 1 year fish. These rivers had a mean annual discharge of between 4·9 and 85·5 m3 s−1, and six of them were regulated for hydro‐power production.Salmo salarwere lost in six of these rivers prior to liming, and highly reduced in the remaining seven rivers. Post‐liming,S. salarbecame re‐established in all six rivers with lost populations, and recovered in the seven other rivers.Salmo truttaoccurred in all 13 study rivers prior to liming. Despite the improved water quality, both age 0 and age ≥ 1 yearS. truttadensities decreased asS. salardensity increased, with an average reduction of >50% after 10 years of liming. For age 0 yearS. truttathis effect was less strong in rivers whereS. salarwere present prior to liming. In contrast, densities ofS. truttaincreased in unlimed streams above the anadromous stretches in two of the rivers following improved water quality due to natural recovery. Density increases of both age 0 and age ≥ 1 yearS. salarshowed a positive effect of river discharge. The results suggest that the decline inS. truttadensity after liming is related to interspecific resource competition due to the recovery ofS. salar. Thus, improved water quality through liming may not only sustain susceptible species, but can have a negative effect on species that are more tolerant prior to the treatment, such asS. trutta.