Immediate-type hypersensitivity to a bean lectin source with commentary on occupational allergy in allergy-immunology laboratory and research workers.

A case of acute, severe allergic conjunctivitis is reported in a biochemist who had been grinding Bandeiraea simplicifolia, the source of an anti-B lectin. A crude extract of these beans produced immediate-type skin test reactivity, and reaginic antibodies were demonstrated in her serum. Several other examples of occupationally induced allergy in laboratory and research workers in the field of allergy-immunology are briefly cited. Exposure to potential allergens in a dry, powdered form seems particularly hazardous.     

Surgery-proneness: A review and clinical assessment

The authors review the psychiatric literature on patients who undergo repeated, often ill-advised surgery for pain relief, and report on their own clinical study, which shows that many polysurgery patients have similar social and medical histories as well as common aspects of clinical presentation that identify them as a subgroup of chronic pain patients. Identifying surgery-prone patients and redefining their illness as chronic rather than acute can help reduce the incidence of unnecessary surgery.     

Dosage of digoxin in premature infants.

The pharmacokinetics and pharmacodynamics of digoxin in premature infants was studied. During maintenance therapy, after a total digitalizing dose of 30 microgram/kg, the measured digoxin level was related inversely to body weight at birth and to estimated gestational age. The serum digoxin levels found in the immature and smaller infants were two to three times the values usually reported to be toxic in older children. Based on these findings, a second group of premature infants was digitalized with 20 microgram/kg; in this group, the serum digoxin levels were below the toxic range, irrespective of gestational age or birth weight. The cardiac effects of digoxin, i.e., shortened left ventricular pre-ejection period and ejection time as determined by echocardiography, were similar in the two groups. For both groups, the half-life of digoxin in the serum was twice that reported for term infants and children. Since digitalis effect is obtained with lower dose and serum concentration, we recommend that this dose be used in premature infants.     

Unilateral pulmonary vein atresia: Diagnosis and treatment

The clinical, hemodynamic, angiographic and pathologic features of unilateral pulmonary vein atresia in a 16 month old boy are described. The relevant findings were symptoms and signs of influenza, roentgenographic evidence of unilateral diffuse interstitial edema, prominent interlobar fissures and pleural effusion, absence of abnormal cardiac structure and prominent unilateral bronchial circulation. Angiocardiography was necessary for a definitive diagnosis and revealed the lack of a site of entry for venous blood from the right lung into the circulation. The patient was treated successfully by a right pneumonectomy. The histologic hallmark in this case was extensive intimai fibrosis of the pulmonary veins.     

Effect of somatostatin on pancreatic protein secretion induced by cholecystokinin.

Using an in vivo rabbit pancreas preparation, studies were conducted to determine the effect of somatostatin on pancreatic protein secretion induced by the octapeptide of cholecystokinin (OP-CCK) when directly infused intraarterially into the pancreatic parenchyma. Compared to control experiments in which no drugs were given, intraarterial infusion of OP-CCK (30 ng/ml) continuously for 1 hr at a rate of 0.33 ml/min significantly increased (P < 0.005) protein concentration and total protein output in the pancreatic juice without a corresponding change in volume. When given in combination with somatostatin (5 μg/ml) OP-CCK-induced pancreatic protein secretion was markedly inhibited (P < 0.05) without any effect on pancreatic volume output. The observation that volume flow remained unchanged during OP-CCK infusion alone and in combination with somatostatin suggests that the inhibitory effect of somatostatin is mediated through direct inhibition of protein synthesis or release at the level of the pancreatic acinar cell.