Quantitative Hemagglutination Studies in the Rh Blood Group System. II. A Study of the D (Rho) Agglutinogen

The reactivity of Rh positive red cells with saline anti-D sera has beeninvestigated by means of quantitative hemagglutination methods. The inhibitory effect of C on the D antigen has been confirmed and the possibility ofinhibition by this antigen in the cis position suggested. It is also suggested thatthe e antigen has suppressive effect on D. The presence of companion antigensresults in a -D-> R₂ > R_o > R₁ progression of decreasing agglutinability.Within families differences in the agglutination behavior between homozygousand heterozygous D positive cells were found. The heterogeneity of thisantigen was confirmed.

Accepted on November 20, 1960     

Relation Between Severity of Anemia and Erythropoietin Titer in Human Beings

Patients with severe hematologic disorders may have elevated erythropoietintiters in plasma or urine at higher hemoglobin concentrations than those associated with elevated titers in experimental animals or patients anemic as aresult of simple blood loss. Patients with "primary" hematologic disease mayhave a measurable titer of erythropoietin in the plasma and urine at hemoglobinconcentrations up to 8 Gm./100 ml., but patients with iron-deficiency anemiashow elevated titers in the urine only with hemoglobin concentrations at orbelow 4 Gm./100 ml. and in the plasma below 5 Gm./100 ml. The abruptnesswith which the titer rises and the severity of the anemia required beforemeasurable titers appear are similar in man and in rabbits, sheep and dogs.The fact that no measurable erythropoietin titer can be demonstrated whenthe hemoglobin concentration is well below that required for intense stimulation of erythropoiesis and the abruptness of the rise at hemoglobin concentration of 4 Gm./100 ml. or less suggest that erythropoietin may not bean important factor in the control of erythropoiesis except in extreme circumstances. On the other hand, these facts may be explained more simply by theinsensitivity of the assay methods used.

Submitted on March 13, 1961 Accepted on May 6, 1961     

Automatic Implantable Cardioverter Defibrillator/Permanent Pacemaker Interaction: Loss of Pacemaker Capture Following AICD Discharge

A 78-year-old man treated with amiodarone for recurrent ventricular tachycardia, had sequential placement of a bipolar VVI pacemaker and an automatic implantable cardioverter defibrillator (AICD). During defibrillation threshold testing, there was failure to capture of the pacer in the post-shock period. The time of failure to capture appeared energy-related: the greater the energy delivered, the longer the failure to capture. Careful attention will be necessary in constructing combined AICD/pacemaker units.     

Cerebellar Stimulation for Spastic Cerebral Palsy; Preliminary Report; On-going Double Blind Study

To date, June 1, 1986, 33 spastic cerebral palsy (CP) patients have taken part in a double blind study testing the safety and efficacy of chronic cerebellar stimulation (CCS) for reduction of spasticity and improvement in function. Seven U.S. surgical centers involving ten neurosurgeons have implanted the Neurolith 601 cerebellar stimulator supplied by Pacesetter Systems Inc. (Sylmar, CA). A pilot study was run with three patients at Stanford University (Stanford, CA) using taped-on real (strong) and dummy (weak) magnets to control the ON-OFF status. Following the pilot study, a magnetically controllable switch was placed in line between the Neurolith stimulator and the cerebellar lead to allow more reliable switching sequences for the study. The test battery included joint angle measurements (passive and active), motor performance testing, reaction time, hand dynamometry, grooved peg board placement, hand/foot tapping, and rotary pursuit testing. Testing only was done at presurgery. Testing and ON-OFF switching was performed following recovery from surgery and at one, two, and four months. After four months, the switch was left turned ON. Of the 30 patients using the implanted switch, 11 were dropped from the study and seven are still in progress. Of the 11 dropped from the study, four were due to switch problems and three were due to double blind protocol violations, i.e., the participants discovered the stimulus status. The remaining four were removed because of a broken lead, infection, or unrelated medical problems, or refusal to participate after implant. A preliminary analysis indicated that three-quarters of the patients have a demonstrable quantitative improvement during the time the stimulation was "ON." Three patients showed no significant change.     

Impairment of Red Cell Viability by Exposure to "Excess" Acid--Citrate Dextrose

Collection of blood in "excess" ACD leads to a loss of red cell viability whenthe blood is transfused back into the donor, even without any appreciablestorage period. The mechanism of this loss of viability is not clear. The loss isaccentuated by incubation at 37 C.; it is not affected by varying the dextroseconcentration of the ACD; it cannot entirely be attributed to change in pH ofthe final suspension medium; and it is not related to the degree of swelling ofthe red cells. The loss of viability can completely be corrected by the additionof small amounts of chloride to the ACD.

This effect is presumably the same as the "lesion of collection" described byGibson et al. in relation to viability studies after 28 days of storage.⁴

Submitted on September 27, 1965 Accepted on February 6, 1966     

EPIDEMIOLOGY OF ALCOHOLIC CIRRHOSIS

Seventy-seven alcoholic patients, 54 men and 23 women, had cirrhosis of the liver when they first attended the Alcoholism Clinic at St Vincent's Hospital, Melbourne, between July, 1964, and June, 1968. During this period 800 chronic alcoholics, 663 men and 137 women, attended the clinic. Cirrhosis was thus diagnosed twice as often in women as in men. The case histories of the 77 cirrhotic patients were reviewed, and information was collected about socio-economic status and drinking habits. This information was compared with that obtained from a sample of 220 patients--all those who attended the Alcoholism Clinic between July, 1966, and June, 1967. Most of the cirrhotic patients were beer drinkers, as are the majority of Australian alcoholics. Relatively more cirrhotics were habitual excessive drinkers. The cirrhotic patients did not drink more heavily, but they had drunk excessively for longer when their cirrhosis was diagnosed. Cirrhotic women, however, had drunk excessively for a significantly shorter time than cirrhotic men. No difference was found in the incidence of either social isolation or clinical peripheral neuropathy between cirrhotic and alcoholic patients, or between male and female cirrhotics. Cirrhosis was not commoner among the lower socio-economic groups. These findings were interpreted as suggesting that nutrition did not play an important part in the causation of the liver disease. Women appear to be more susceptible than men to cirrhosis of the alcoholic, and unremitting habitual excess more damaging than intermittent alcohol abuse. Some undetermined predisposition must also exist, since the disease is still sporadic even when these factors operate.     

Using the 12-Lead ECG to Localize the Origin of Atrial and Ventricular Tachycardias: Part 2—Ventricular Tachycardia

Monomorphic ventricular tachycardia (VT) can arise from multiple different ventricular locations in the context of several different underlying myocardial substrates. Despite this variability, the surface 12-lead electrocardiograph (ECG) has proven to be a robust and reproducible initial mapping tool that can provide useful information in localizing the origin of both focal and reentrant forms of VT. The second part of this review series will look at the use of the ECG in mapping the various forms of VT encountered in clinical practice.     

Early white-matter abnormalities of the ventral frontostriatal pathway in fragile X syndrome

Aim  Fragile X syndrome is associated with cognitive deficits in inhibitory control and with abnormal neuronal morphology and development.
Method  In this study, we used a diffusion tensor imaging (DTI) tractography approach to reconstruct white-matter fibers in the ventral frontostriatal pathway in young males with fragile X syndrome ( n =17; mean age 2y 9mo, SD 7mo, range 1y 7mo–3y 10mo), and two age-matched comparison groups: (1) typically developing ( n =13; mean age 2y 3mo, SD 7mo, range 1y 7mo–3y 6mo) and (2) developmentally delayed ( n =8; mean age 3y, SD 4mo, range 2y 9mo–3y 8mo).
Results  We observed that young males with fragile X syndrome exhibited increased density of DTI reconstructed fibers than those in the typically developing ( p =0.001) and developmentally delayed ( p =0.001) groups. Aberrant white-matter structure was localized in the left ventral frontostriatal pathway. Greater relative fiber density was found to be associated with lower IQ (Mullen composite scores) in the typically developing group ( p =0.008).
Interpretation  These data suggest that diminished or absent fragile X mental retardation 1 protein expression can selectively alter white-matter anatomy during early brain development and, in particular, neural pathways. The results also point to an early neurobiological marker for an important component of cognitive dysfunction associated with fragile X syndrome.