Pyogenic arthritis of the sacro-iliac joint. Long-term follow-up

Nine cases of sacro-iliac pyarthrosis are presented. The difficulty in localizing the infection is attributable mostly to failure to appreciate the posteriorly situated physical findings. This, and the difficulty with early roentgenographic demonstration of the lesion, may lead to unnecessary abdominal exploration (as in two of our patients) or to prolonged delay in diagnosis and hence spread of the infection. Awareness of the usual physical findings and prompt use of radioisotope scanning to localize the infection led to earlier diagnosis and avoidance of surgery in three patients seen recently. Antibiotic therapy, with or without surgery, led to cure in all patients, with minimum sequelae.     

Cryosurgery of the ureter in dogs

The effect of cryosurgery on the ureter has been studied in dogs. A single 1- or 2-min cryosurgical exposure produced stricture in two of eight animals. A tumoricidal cryosrugical dose consisting of three, 2-min exposures caused stricture in six of eight dogs. Histopathologic examination of the ureter after repetitive cryosurgery showed progressive, persistent loss of smooth muscle, fibrosis of the lamina propria, and early loss with subsequent regeneration of the transitional epithelium. Although there was no loss of ureteral integrity, the possibility of permanent ureteral damage should be considered with the use of cryosurgery.     

Current management of digitalis intoxication

Of the commonly used drugs, digitalis has one of the highest therapeutic-toxic ratios. Mortality is significantly increased in the 20% to 30% of patients on digitalis who are in a toxic state when admitted to the hospital. Successful use of digitalis depends on avoidance of its use in situations likely to result in toxicity; recognition of the signs, symptoms, and electrocardiographic findings of digitalis intoxication; and stopping digitalis completely as the initial treatment of digitalis intoxication.     

Human thyroid adenyl cyclase-stimulating activity in immunoglobulin G of patients with Graves' disease

We have studied the characteristics of the stimulation of adenyl cyclase (AC) activity in human thyroid plasma membranes by thyroid-stimulating hormone (TSH) and by immunoglobulin G (IgG) from the sera of patients with Graves' disease. AC activity was measured as adenosine 3',5'-cyclic monophosphate (cAMP) generated by membranes in a 10 minute incubation. IgG from two patients with Graves' disease possessed particularly potent human thyroid AC-stimulating activity; the dose-response curves with these IgGs were essentially parallel to those obtained with TSH. As little as 30 mug of the IgG of one patient with Graves' disease or 8 muU of TSH caused significant AC stimulation. A Lineweaver-Burk plot of the data suggested similarity in the site of action of both TSH and human thyroid adenyl cyclase stimulator (HTACS) in Graves' IgG. Submaximal doses of HTACS and TSH had additive effects on AC stimulation, but a large dose of a Graves' IgG with potent AC stimulating activity did not enhance AC stimulation by a maximal dose of TSH. The effect of HTACS on AC was slower in onset and longer in duration than an equipotent dose of TSH. HTACS was detectable in IgGs of 9 of 15 untreated hyperthyroid Graves' disease patients; its concentration, however, did not correlate significantly with tests of thyroid function, nor with long-acting thyroid stimulator (LATS) activity. In another 11 treated patients with Graves' disease, selected for the presence of LATS, HTACS and LATS were significantly correlated. We observed no inhibition of LATS activity in a Graves' IgG chosen for such testing because of its high titer of HTACS and no detectable LATS. However, an inhibitor of HTACS was detected in 2 of 4 IgGs; one of these two IgGs also inhibited AC stimulation by TSH. Conclusions: 1) Some Graves' disease IgGs contain a human thyroid AC stimulator (HTACS), probably different from LATS. 2) HTACS may act via a common pathway with TSH; it differs from TSH, however, in having a slower onset and a greater effect during more prolonged incubation with plasma membranes. 3) There is also an inhibitor of HTACS activity in some Graves' disease IgGs.     

Intra-arterial sympathetic blockade in the treatment of clinical frostbite

Regional medical sympathectomy achieved by the intra-arterial injection of reserpine appeared to be of benefit in the treatment of five patients with acute or chronic frostbite injuries. Clinical improvement was associated with a significant increase in arteriographically determined regional perfusion.