Further observation on the unusual manifestations of rheumatic disease with report of some cases

On careful analysis of the clinical history of Case IV, we find that the patient from childhood has been having frequent fevers and joints pains and that during the present illness which has lasted for one year previous to admission, aside from the symptoms of cardiac failure and those referable to the lungs due to pulmonary tuberculosis, he had pain and swelling of the joints and also fever. Such clinical history is certainly very suggestive of rheumatic infection. Blood Wassermann was negative, and the autopsy findings including the histological examination of the viscera showed no evidence of syphilitic infection. The absence of Aschoff bodies is not against rheumatic infection inasmuch as they are not always found in the organs affected by rheumatic infeciton and they are especially absent in the chronic stage of the disease. The role played by rheumatic infection in the production of lesion in the aorta and in other arteries is very well recognizedAccording to M.A. Clerc and Noel Daschamps certain infections such as malaria, scarlet fever, typhoid, pneumonia, la grippe, and above all, acute articular rheumatism especially in children are mentioned as causative factors of aneurysm of the arch of the aortaV.P. Sydenstricker speaks of arteritis as one of the complications of rheumatic infection, although he says that arteritis is seldom recognized clinically but it may be suspected when there is tenderness on pressure over superficial arteritis. Aortic lesion due to rheumatic arteritis has been observedMalcolm Goodridge, discussing the diagnosis of syphilitic aortitis, in the Textbook of Medicine by Cecil, 4th edition, 1937, p. 1146, says: the age incidence of syphilitic diseases of the aorta is somewhat helpful in differentiating it from artheroma of the aorta, which is prone to occur in the declining years of life and from rheumatic aortitis which occurs in adolescence or early adult life. (Conclusion)

The diagnostic value of examination of sternal marrow (continued from Vol. II, No. 2)

The first study on bone marrow in the Philippines is presentedThe total cell count and the differential bone marrow picture are discussed. The bone marrow cell count is about 100,000 per cm. for the normal Filipino adult. The total cell count includes nucleated red cells and all white cells. The relation between erythroblasts and white cells in adults is 10-20:100: in children it is higher, in the first year of life 30-40:10, then it slowly decreases with advance in ageThe bone marrow biopsy is indispensable for the diagnosis of all blood diseases. In pernicious anemia the diagnosis is based on the presence of megaloblasts in the bone marrow. The effect of liver therapy can be observed by the disappearance of the megaloblasts. All regenerative anemias are characterized by a severe erythropoetic activity of the bone marrow, and so the ratio of erythroblasts to white cells must be high. Post-infectious anemias are characterized by a shift to the left do not suggest splenectomy. The third possibility, the megakaryopenic purpura, is a clear contraindication for splenectomyIn infectious diseases such as septico-pyemias, pneumonias, etc. there are remarkable changes in the bone marrow. However,these changes are only of pathologic interest and we would not suggest sternal punctures in these cases because they do not help in the diagnosis. Similarly in Hogdkins disease there are no characteristic changes in the bone marrowBone marrow changes in malign new-growth are studied. There is sometimes a eosinophilia, but this is not constant. Both erythropoetic and hypoplastic responses of the bone marrow are observed. In old age the cell count and erythropoetic activity seem to be decreased. X-ray treatment of new-growth has a very important effect in the bone marrow, producing low cell counts and poor erythropoetic activity. (Summary)

The relationship of serum proteins, protein-bound iodine and Tri-lodothyronine binding capacity in Filipino children with the nephrotic syndrome

These data indicate that patients with nephrotic syndrome have diminished thyroid hormone binding proteins as shown by the result that 14 of the 22 nephrotic patients have low residual or reserve binding proteins as reflected by a low T3-I13 binding capacity. Of these 14 patients with low or reduced thyroid hormone binding proteins, only 5 have actually low PBI values while the rest have normal PBI except for 2 patients with unexplained high PBI levelsWhen correlated with their serum albumin all 14 patients with diminished T3-I13 binding capacity have severe hypoalbuminemia. This confirms the observation of Musa et al that in patients with nephrotid syndrome, the serum protein binding of thyroid hormone is more closely related to the serum albumin.(Conclusion)

Hysterogram in hydatidiform mole

1. Diagnosis of H. mole is difficult because of pitfalls2. A definitive diagnosis must be established before attempting evacuation3. Hysterogram with "moth eaten" appearance or "honeycombed" pattern gives a positive diagnosis of mole4. The vest radiograph is after one minute of injection5. Two scout films and one film after one minute injection are sufficient for economy6. No complications7. Hysterography is very simple and economical and does not need any special equipment and training8. In conclusion, we strongly endorse the widespread use of hysterography by specialists and general practitioners for its accuracy, simplicity, safety and economy. (Summary and conclusions)

Clinical trial on the efficacy and safety of added glycine and glucyl glycine to oral rehydration solution

This study was undertaken to determine the efficacy and safety of using an ORS with added glycine and glycyl-glycine. This was a double blind, controlled clinical trial. Randomization was done using permuted blocks of variables lenghts. The code was entrusted to personnel not connected with the research and obtained only after submission of observations. The patients were allocated to receive either the standard WHO-ORS formulation or the ORS-glycine and glycyl-glycine formulation. Addition of glycine and glycyl-glycine did not offer beneficial effects in terms of reduction of stool volume and duration of diarrhea. The absorption-promoting quality of the glycine and glycyl-glycine added to the ORS was observed by the higher weight gain after rehydration, 24 hours and, on discharge, despite a higher stool output. This property was offset by the consequent osmotic penalty